JACC. Clinical electrophysiology最新文献

{"title":"Ablation of Established Cardiac Arrhythmia Targets With New Energy Sources: Pulse Field Ablation for Typical and Atypical Atrial Flutters.","authors":"Gregory K Feld","doi":"10.1016/j.jacep.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.027","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanism of Stroke Related to a Small Peridevice Leak Coupled with \"Reverse\" Device-Related Thrombus.","authors":"Marshall Winner, Gaurang Gandhi, Dilesh Patel, Hemal Shah, Muhammad Athar, Ann Canterbury, Emile G Daoud","doi":"10.1016/j.jacep.2025.07.026","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.026","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and Prognostic Significance of Exercise Stress Testing in Desmosomal Arrhythmogenic Cardiomyopathy.","authors":"Matteo Castrichini, Raquel Neves, Ramin Garmany, Thomas Allison, Michael J Ackerman, John R Giudicessi","doi":"10.1016/j.jacep.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.014","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic cardiomyopathy (ACM) is characterized by fibrofatty myocardial replacement and increased arrhythmic risk. Although exercise exacerbates desmosomal ACM, the prognostic significance of arrhythmias during exercise stress tests (ESTs) remains unclear.</p><p><strong>Objectives: </strong>The goal of this study was to determine the impact of ventricular arrhythmia observed during peak exercise and/or recovery EST phases on the risk of major ventricular arrhythmia (MVA) events in patients with desmosomal ACM.</p><p><strong>Methods: </strong>A retrospective review of 904 patients with ACM was used to identify those with a pathogenic/likely pathogenic variant in DSC2, DSG2, DSP, JUP, and PKP2. After exclusion of patients with no EST data, demographic and electrocardiographic data were extracted from the medical record. The arrhythmic burden (premature ventricular complexes [PVCs], couplet, bigeminy, nonsustained VT, sustained VT, ventricular fibrillation, and PVCs per minute) during each EST phase (baseline, peak, and early and late recovery) were reviewed and correlated with MVA outcomes (sudden cardiac arrest, sustained VT, and appropriate implantable cardioverter-defibrillator therapies).</p><p><strong>Results: </strong>A total of 326 ESTs from 147 patients (89 PKP2 [60%], 45 DSP [31%], 10 DSG2 [7%], and 3 DSC2 [2%]) were included. PKP2-ACM patients exhibited increased PVCs per minute (P < 0.001), bigeminy (P < 0.001), couplets (P < 0.001), and nonsustained VT (P < 0.001) during recovery. Recovery phase arrhythmias in PKP2-ACM patients were associated with a higher risk of MVA events (HR: 10.580; P = 0.003), a pattern absent in other genotypes (HR: 1.037; P = 0.973). This association remained significant in multivariable analysis (adjusted HR: 3.851; P = 0.040).</p><p><strong>Conclusions: </strong>PKP2-ACM patients display a distinct recovery phase arrhythmic profile predictive of MVA events, emphasizing the importance of EST in risk stratification and management. Future studies are needed to validate these findings and ascertain the additive value of EST beyond established risk factors.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrioventricular Interval Modulation: Looking Beyond Blood Pressure Needed?","authors":"Frits W Prinzen, Joost Lumens","doi":"10.1016/j.jacep.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Additional ECG Indicators for Prognosis Prediction in Patients With Cardiac Sarcoidosis.","authors":"Junichi Kamoshida, Kohei Ishibashi, Takanori Kawabata, Kei Enokizono, Satoshi Oka, Yuichiro Miyazaki, Keiko Shimamoto, Akinori Wakamiya, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Kengo Kusano","doi":"10.1016/j.jacep.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.008","url":null,"abstract":"<p><strong>Background: </strong>Cardiac sarcoidosis (CS) is characterized by variability in ventricular repolarization and depolarization due to sarcoid granulomas. The T-wave peak to end (Tp-e)/QT ratio and fragmented QRS complex (fQRS), which are markers of repolarization dispersion and depolarization abnormality, respectively, predict arrhythmic risk in cardiac conditions. However, their prognostic value in CS remains uncertain.</p><p><strong>Objectives: </strong>This study aimed to assess the association between the Tp-e/QT ratio and fQRS presence with prognosis and arrhythmic risk in CS patients through a Japanese nationwide survey.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study used data from a nationwide survey on CS conducted from 2014 to 2016 in Japan. The authors categorized CS patients based on Tp-e/QT ratios and fQRS presence. They assessed a composite of all-cause mortality and ventricular arrhythmia events as primary outcomes, and a composite of cardiac-related deaths (heart failure and sudden death) and ventricular arrhythmia events as secondary outcomes.</p><p><strong>Results: </strong>Among 227 CS patients (151 women, median follow-up: 1,286 days), grouped by Tp-e/QT ratios (cutoff value: 0.232) and fQRS presence, higher Tp-e/QT ratios and fQRS indicated poorer prognosis. Multivariable analysis revealed high Tp-e/QT (HR: 3.01; P = 0.002), fQRS (HR: 2.48; P = 0.012), past ventricular tachycardia, and left ventricular ejection fraction (LVEF) ≤35% as independent adverse outcome predictors. These electrocardiograph indicators were also significant in CS patients with LVEF >35% (Tp-e/QT > 0.232: HR: 3.62; P = 0.011; fQRS: HR: 3.38; P = 0.022).</p><p><strong>Conclusions: </strong>High Tp-e/QT ratios and fQRS presence in CS patients suggest worse prognosis, particularly with LVEF >35%, highlighting their importance in early-stage arrhythmic risk. (Investigation of Fixation Behavior During Perimetry Test; UMIN000018393).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conduction Block Complicating Transcutaneous Aortic Valve Replacement: Many Unanswered Questions.","authors":"Alfred E Buxton, Peter Zimetbaum","doi":"10.1016/j.jacep.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.012","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Hormone Profiles in Patients With Torsades de Pointes Ventricular Tachycardia: A Clinical-Electrophysiological Translational Study.","authors":"Pietro Enea Lazzerini, Vamsi Krishna Murthy Ginjupalli, Jean-Baptiste Reisqs, Iacopo Bertolozzi, Silvia Cantara, Maria Grazia Castagna, Riccardo Accioli, Antonio D'Errico, Alessandra Cartocci, Anna Cantore, Viola Salvini, Decoroso Verrengia, Fabio Salvadori, Tommaso Marzotti, Matteo Capecchi, Stefania Bisogno, Michele Voglino, Sciaila Bernardini, Yongxia Sarah Qu, Franco Laghi-Pasini, Maurizio Acampa, Antonio Abbate, Pier Leopoldo Capecchi, Mohamed Boutjdir","doi":"10.1016/j.jacep.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.009","url":null,"abstract":"<p><strong>Background: </strong>Female sex is a well-recognized risk factor for long QT syndrome and torsades de pointes (TdP), likely reflecting the influence of sex hormones on ventricular repolarization. Overall, estradiol prolongs, whereas progesterone and testosterone shorten, heart rate-corrected QT interval. However, no studies have comprehensively evaluated sex hormone levels in male and female long QT syndrome patients developing TdP, nor their implications in terms of clinical outcomes and electrophysiological changes.</p><p><strong>Objectives: </strong>This study was aimed at determining the sex hormones profiles in male and female TdP patients, and defining their role in this clinical setting.</p><p><strong>Methods: </strong>The authors investigated: 1) the levels of sex hormones in a prospective cohort of male and female patients who developed TdP; 2) the relationship between sex hormones and arrhythmia outcome in TdP men and women; 3) the in vitro impact of sex-specific TdP hormone profiles on guinea pig ventricular myocyte and human-induced pluripotent stem cell-derived cardiomyocyte action potential duration, and their modulation by sex-specific hormonal interventions.</p><p><strong>Results: </strong>Over 13 years, 68 TdP patients (42 female) were consecutively enrolled. Compared to control subjects, a differential sex hormone profile was observed in TdP men and women, primarily reduced testosterone in male patients and increased 17β-estradiol in female patients. Within the TdP cohort, lower testosterone in men and higher 17β-estradiol in women were associated with a worse short-term arrhythmia outcome. In vitro reproduction of sex-specific TdP hormone profiles prolonged action potential duration in sex-matched cardiomyocytes, an effect reversed by the addition of testosterone in male patients and progesterone in female patients, respectively.</p><p><strong>Conclusions: </strong>Different sex hormone profiles, primarily low testosterone in male patients and high 17β-estradiol in female patients, are associated with TdP occurrence and outcome in men and women. These endocrine milieus act, at least in part, via direct and reversible effects on cardiac electrophysiology, thereby supporting the antiarrhythmic potential of sex-specific hormonal-modulating therapies.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of extended cryoballoon ablation, standard cryoballoon ablation, and radiofrequency catheter ablation in patients with persistent atrial fibrillation.","authors":"Min Soo Cho, Ji Hyun Lee, Il-Young Oh, Jung-Bok Lee, Minsoo Kim, Kee-Joon Choi, Youngjin Cho, Gi-Byoung Nam","doi":"10.1016/j.jacep.2025.08.003","DOIUrl":"10.1016/j.jacep.2025.08.003","url":null,"abstract":"<p><strong>Background: </strong>The performance of cryoballoon (CB) ablation compared with radiofrequency (RF) ablation has been demonstrated in patients with paroxysmal atrial fibrillation (AF). However, the role of CB ablation in patients with persistent AF has not been well established. Furthermore, the efficacy of additional posterior wall isolation following CB pulmonary vein (PV) isolation remains controversial.</p><p><strong>Methods: </strong>We conducted a multicenter, randomized, adjudicator-blinded trial comparing three approaches in patients with persistent AF: RF, standard CB (PV isolation only), and extended CB ablation (PV plus posterior wall isolation). The primary outcome was recurrence of atrial arrhythmia (AA) including AF or atrial tachycardia (AT) after a predefined blanking period (three months), in the absence of antiarrhythmic drugs.</p><p><strong>Results: </strong>A total of 288 patients were enrolled from two sites in South Korea. The mean age was 59.0 years; 12.8% were women; the mean left atrial diameter was 44.2 mm; and 37.2% had long-standing persistent AF. At 12 months, the primary outcome-freedom from AA recurrence-was similar across the three groups (50.4% for RF ablation vs. 47.3% for standard CB vs. 44.8% for extended CB; P = 0.787). This trend remained consistent regardless of antiarrhythmic drug use (51.5% vs. 50.0% vs. 49.1%, respectively; P = 0.924) and whether patients underwent one or two procedures (57.9 vs. 52.9% vs. 52.2%, respectively; P = 0.945). No significant differences were observed in the rates of direct current cardioversion (9.6% vs. 10.2% vs. 4.2%; P = 0.236) or cardiovascular hospitalization (3.2% vs. 0% vs. 2.1%; P = 0.170). The incidence of major adverse events was also comparable among the groups (1.0% in all groups; P > 0.99).</p><p><strong>Conclusions: </strong>In patients with persistent AF, CB ablation was found to be as effective as RF ablation. The addition of posterior wall isolation using CB ablation did not improve the rhythm outcomes compared with standard CB ablation. These findings do not support the routine use of posterior wall isolation with CB in patients with persistent AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmogenic Cardiomyopathy Is a New Phenotype Associated With the CACNA1C p.Arg518Cys (R518C) Variant.","authors":"Clément Boiteux, Samuel Chauveau, Kevin Gardey, Laurent Sebbag, Geoffroy Ditac, Cécile Cazeneuve, Nathan Mewton, Alexandre Janin, Philippe Chevalier, Antoine Delinière","doi":"10.1016/j.jacep.2025.06.039","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.039","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Misleading QRS Morphology of Scar-Related Ventricular Tachycardia.","authors":"Yumi Katsume, Daisuke Togashi, Shunsuke Uetake, Salah H Alahwany, Zachary T Yoneda, Travis D Richardson, Jay A Montgomery, Sharon T Shen, Juan C Estrada, Arvindh N Kanagasundram, Harikrishna Tandri, William G Stevenson","doi":"10.1016/j.jacep.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.004","url":null,"abstract":"<p><strong>Background: </strong>The QRS morphology of ventricular tachycardia (VT) reflects the re-entry circuit exit location and helps guide mapping for radiofrequency ablation (RFA). It can be misleading, however, particularly in structural heart disease.</p><p><strong>Objective: </strong>The aim of this study was to assess the relation of the site where RFA terminated VT to the location of the exit predicted by the VT QRS morphology.</p><p><strong>Methods: </strong>This study included 64 scar-related re-entrant left ventricular VTs (57.9% ischemic cardiomyopathy) with an identified region where RFA terminated the VT; a previously reported electrocardiogram algorithm that uses the QRS vector to predict the VT exit region on the American Heart Association 17-segment left ventricular model was applied. QRS discordant VTs were defined as having the RFA termination site outside of the predicted exit region. Entrainment and pace mapping (PM) data were also analyzed to assess possible reasons for discrepancies.</p><p><strong>Results: </strong>The QRS morphology was discordant with the termination region in 57 (89%) VTs. Two types of discordance were seen. In 22 (34.4%), the termination region was remote from the circuit exit. In 32 (50%), the termination site was in the VT re-entry circuit exit, but the QRS suggested a different exit region. Analysis of voltage maps and PM suggested that the QRS vector was often altered by scar.</p><p><strong>Conclusions: </strong>For scar-related VTs, the exit predicted from a vector-based QRS algorithm often differs from the location where ablation terminates the VT. This is an important consideration for use of the QRS to guide VT ablation strategies. PM can potentially assist in recognizing this discrepancy and warrants study.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}