JACC. Clinical electrophysiology最新文献

{"title":"Percutaneous Stellate Ganglion Ablation as a Novel Bail-Out Strategy for Refractory Ventricular Arrhythmias: A Clinical Case Series.","authors":"Filippo Angelini, Paolo Cotogni, Marco Minniti, Benedetta De Guidi, Arianna Morena, Simone Frea, Antonio Toscano, Maurizio Berardino, Gaetano Maria De Ferrari, Veronica Dusi","doi":"10.1016/j.jacep.2026.02.045","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.02.045","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837889","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":"Adjunctive Purkinje Denetworking During Ventricular Tachycardia Ablation in Patients With Prior Ventricular Fibrillation.","authors":"Robert N Kerley, Henry D Huang, Esseim Sharma, Elisabeth Wong, Mohamed Gabr, Nikolas Nozica, Usha B Tedrow, William H Sauer","doi":"10.1016/j.jacep.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.04.001","url":null,"abstract":"<p><strong>Background: </strong>Recurrence after ventricular tachycardia (VT) ablation remains common in patients with monomorphic VT and spontaneous polymorphic ventricular tachycardia (PMVT) or ventricular fibrillation (VF), suggesting mechanisms beyond myocardial scar alone. The Purkinje system plays a central role in both triggering and sustaining malignant ventricular arrhythmias. Whether adjunctive Purkinje de-networking (PDN) improves outcomes in this high-risk population is unknown.</p><p><strong>Objectives: </strong>This study sought to determine whether adjunctive PDN during VT ablation is associated with improved arrhythmia outcomes in patients with prior spontaneous PMVT/VF.</p><p><strong>Methods: </strong>Multicenter retrospective cohort study of patients undergoing monomorphic VT ablation (2023-2025) with prior spontaneous PMVT or VF. Patients underwent VT ablation with adjunctive PDN (n = 27) or VT ablation alone (n = 28). The primary endpoint was 12-month VT/VF-free survival. Secondary endpoints included ICD therapies, repeated ablation, and procedural safety.</p><p><strong>Results: </strong>At 12 months, VT/VF-free survival was higher with adjunctive PDN (80.8% vs 49.2%; absolute difference: 31.6%). Adjunctive PDN was associated with lower VT/VF recurrence (HR: 0.29; 95% CI: 0.11-0.72; P = 0.017). When limited to PMVT/VF events, recurrence rates were lower in both absolute (7.4% vs 39.3%) and relative (HR: 0.20; 95% CI: 0.07-0.59; P = 0.018) terms. Implantable cardioverter-defibrillator therapies declined significantly after ablation in both groups (P < 0.001). Iatrogenic left bundle branch block occurred more frequently with PDN (14.8% vs 3.6%; P = 0.19), although no patients required permanent pacing or device upgrade.</p><p><strong>Conclusions: </strong>In this high risk cohort, adjunctive PDN during VT ablation was associated with a substantial reduction in recurrent ventricular arrhythmias, with a modest increase in risk of left bundle branch block. These findings support prospective evaluation of PDN in patients with prior VF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771436","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":"Incidence of Worsening Aortic Regurgitation After Mapping and Ablation in the Aortic Cusps.","authors":"Dakota De Cecco, Jeanne du Fay de Lavallaz, Amrish Deshmukh, Kelly Arps, Frank Bogun, Michael Ghannam, Thomas Crawford, Rakesh Latchamsetty, Boldizsar Kovacs, Jennifer Beney, Tobias Reichlin, Patrick Badertscher, Fabian Jordan, Christian Sticherling, Raktham Mekritthikrai, Mark Prasad, Henry D Huang, Jackson J Liang","doi":"10.1016/j.jacep.2026.03.039","DOIUrl":"10.1016/j.jacep.2026.03.039","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmias from the aortic cusps (ACs) represent a subset of left ventricular outflow tract arrhythmias. Although ablation in this region can be highly effective, concerns persist regarding aortic valve injury and iatrogenic aortic regurgitation (AR). Contemporary data on AR incidence after AC mapping/ablation remain limited.</p><p><strong>Objectives: </strong>This study sought to determine the incidence, severity, and clinical significance of AR in a multicenter cohort after mapping and/or radiofrequency ablation in the ACs or commissures.</p><p><strong>Methods: </strong>We retrospectively analyzed patients at 4 high-volume centers (2015-2024) who underwent AC/commissural mapping and/or ablation for ventricular arrhythmia and had paired preprocedural and postprocedural transthoracic echocardiograms (TTEs). AR was graded by using standardized criteria; procedure-related AR was defined as ≥2-grade worsening or new ≥moderate AR.</p><p><strong>Results: </strong>Among 290 patients, 208 (218 procedures) had complete paired TTEs. Baseline AR was absent in 81% and mild in 18%. Retrograde aortic access was used in 94%, and 77% underwent radiofrequency ablation within the cusps. Clinically significant AR (≥2-grade worsening or new moderate AR) occurred in 2 procedures (0.9%), both representing progression from preexisting mild-to-moderate AR, with one of the patients having a bicuspid valve. New mild AR (1-grade increase from none to mild) occurred in 26 procedures (11.9%). Among 14 with additional follow-up imaging (median 320 days after first postprocedural TTE), AR resolved in 8 (57%) and remained mild in 6 (43%). No patient required valve intervention.</p><p><strong>Conclusions: </strong>Significant AR occurred in approximately 1% after AC mapping/ablation. New mild AR developed in 12.5% and improved in more than one-half during follow-up. No valve interventions were required, supporting the safety of cusp and commissural ablation at experienced centers.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771487","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":"Visually-Guided Pulsed Field Ablation for Durable Pulmonary Vein Isolation: Chronic Remapping & One-Year Outcomes in the First-in-Human VISION AF Study.","authors":"Vivek Y Reddy, Jan Petrů, Moritoshi Funasako, Jacob S Koruth, Petr Neužil","doi":"10.1016/j.jacep.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.04.009","url":null,"abstract":"<p><strong>Background: </strong>Tissue contact optimizes pulsed field ablation (PFA), but existing methods - based on impedance, thermal response or contact force - remain indirect. An endoscope-enabled PFA balloon catheter allows direct, real-time visualization of the electrode-tissue interface.</p><p><strong>Objectives: </strong>To evaluate the safety, lesion durability and clinical outcomes of the novel, ultra-compliant PFA balloon catheter with direct tissue visualization.</p><p><strong>Methods: </strong>VISION AF was a single-arm study of paroxysmal AF patients undergoing pulmonary vein isolation (PVI) using a morphable PFA balloon catheter with integrated endoscope, and 12 longitudinal electrodes for circumferential energy delivery using either 4 applications with a single rotation (Phase A) or 4 applications without rotation (Phase B). Invasive remapping assessed lesion durability. Clinical recurrence was assessed with 7-day Holters at 3-/6-months, and weekly trans-telephonic monitoring after a 2-month blanking period.</p><p><strong>Results: </strong>Four operators treated 50 patients: age 61±9 years; 68% male, LVEF 63±5%, CHA₂DS₂-VASc 2.0±1.4, 86% deep sedation/14% anesthesia (Phases A/B = 33/17). There were no serious device-related complications. Brain MRI in 36 patients revealed 5.6% DWI+/FLAIR- and 0% DWI+/FLAIR+ lesions. Using 4.3±1.0 applications/vein, PVI was achieved in 100% of patients. Transpired PVI times were 26±10 min (Phase A) or 18±4 min (Phase B). Fluoroscopy time was 4±3 min (range 0-12). Remaps at 81±28 days revealed durable PVI in 99.4% of PVs (175 of 176), translating to 97.8% of patients (44 of 45). The 6-month freedom from atrial arrhythmias was 91.5% (95%CI 79.3-96.8%).</p><p><strong>Conclusions: </strong>Direct visualization of electrode-tissue contact was associated with efficient, safe and durable PVI with promising rhythm outcomes.</p><p><strong>Clinical trial registration: </strong>NCT06828939.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771593","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":"Atrial Effective Refractory Periods in Patients With Frequent Premature Atrial Complexes: Implications for Atrial Fibrillation.","authors":"Satoshi Higuchi, Gaku Hatayama, Satoshi Miyazawa, Yuko Matsui, Kunihiro Kani, Kensuke Kikuchi, Shonosuke Watanabe, Shun Hasegawa, Shohei Kataoka, Kyoichiro Yazaki, Daigo Yagishita, Masahiro Yagi, Edward P Gerstenfeld, Morio Shoda, Junichi Yamaguchi","doi":"10.1016/j.jacep.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.04.003","url":null,"abstract":"<p><strong>Background: </strong>Recent animal models show that frequent premature atrial complexes (PACs) induce atrial remodeling through conduction slowing without altering the atrial effective refractory period (AERP), suggesting a mechanism distinct from atrial fibrillation (AF)-induced remodeling. However, the impact of frequent PACs on human AERP remains unclear.</p><p><strong>Objectives: </strong>The purpose of this study was to compare AERP characteristics in patients with isolated frequent PACs and those with AF.</p><p><strong>Methods: </strong>This prospective study included patients undergoing ablation for isolated frequent PACs, paroxysmal atrial fibrillation (PAF), or persistent AF. After a 6-beat 600-ms drive train (S1), the S2 interval was increased in 10-ms steps until atrial capture occurred; the longest noncapturing S2 was defined as AERP. AERPs were measured at 9 sites, including 4 pulmonary veins (PVs), and 5 extra-PV regions. Interatrial conduction time was measured from P-wave onset to latest activation on the coronary sinus catheter.</p><p><strong>Results: </strong>A total of 143 patients were included (PAC: n = 21, burden 36 ± 17%; PAF: n = 65; persistent AF: n = 57). In the PVs, AERP was longest in PAC, intermediate in PAF, and shortest in persistent AF (PAC: 254.9 ± 22.4 vs PAF: 229.5 ± 38.6 vs persistent AF: 205.4 ± 29.1 ms; P < 0.001). In extra-PV regions, AERPs were similar between PAC and PAF, whereas persistent AF showed significantly shorter values (256.0 ± 21.7 vs 260.9 ± 28.2 vs 225.7 ± 24.2ms; P < 0.001). Interatrial conduction time was comparable between PAC and PAF but prolonged in persistent AF (122 ± 12 vs 118 ± 20 vs 131 ± 23 ms; P = 0.004). Multivariable regression demonstrated arrhythmia type as an independent determinant of both PV and extra-PV AERP (standardized β = -0.54 and -0.62, respectively; P < 0.001). Within PAC patients, AERPs did not differ by PAC origin.</p><p><strong>Conclusions: </strong>Isolated frequent PACs were characterized by preserved AERP in both PV and extra-PV regions. Shorter AERPs in the PVs in PAF and more widespread AERP shortening in persistent AF may reflect the transition from PACs to PAF and then progression to persistent AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771410","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":"Prevalence and Event-Free Follow-Up of the Athlete Early Repolarization Pattern in Professional Athletes.","authors":"P Nelson Hsieh, Timothy W Churchill, Bradley J Petek, Marius I Chukwurah, Sarah Urbut, Jonathan H Kim, Aaron L Baggish, James M Whalen, Eugene H Chung, James Sawalla Guseh","doi":"10.1016/j.jacep.2026.03.018","DOIUrl":"10.1016/j.jacep.2026.03.018","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771525","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":"A Pulsed Field Ablation-Based Endocardial Strategy for Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy.","authors":"Robert N Kerley, Elisabeth Wong, Ian Laxina, Jeffrey Winterfield, William Sauer, Usha B Tedrow","doi":"10.1016/j.jacep.2026.02.009","DOIUrl":"10.1016/j.jacep.2026.02.009","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771398","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":"Trigger- vs Substrate-Based Purkinje De-Networking for Ventricular Fibrillation: Insights From a Multicenter Study.","authors":"Robert N Kerley, Henry D Huang, Uyanga Batnyam, Babak Nazer, Esseim Sharma, Jason S Bradfield, Justin H Hayase, Chau Vo, Bishnu P Dhakal, Jeffrey Winterfield, Usha B Tedrow, William H Sauer","doi":"10.1016/j.jacep.2026.03.024","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.03.024","url":null,"abstract":"<p><strong>Background: </strong>Purkinje-mediated ventricular fibrillation (VF) may arise from discrete fascicular triggers or diffuse abnormal Purkinje substrate. The relative performance of trigger-based vs substrate-based de-networking remains uncertain.</p><p><strong>Objectives: </strong>The goal of this study was to compare outcomes of trigger-focused and substrate-based Purkinje de-networking for VF.</p><p><strong>Methods: </strong>In this retrospective multicenter cohort, 43 patients underwent Purkinje-targeted VF ablation using high-power, short-duration radiofrequency energy (90 W for 4 seconds or 50 W for 10 seconds). Patients were grouped according to ablation strategy: 1) trigger group (n = 19), ablation of the culprit premature ventricular complex-triggering fascicle; or 2) substrate group (n = 24), elimination of all abnormal Purkinje-like potentials. The primary endpoint was recurrence of polymorphic ventricular tachycardia/VF; secondary endpoints included conduction system complications. Median follow-up was 12.2 months (Q1-Q3: 8.8-18.8 months).</p><p><strong>Results: </strong>Baseline characteristics were similar between groups. Freedom from polymorphic ventricular tachycardia/VF was higher with substrate modification (22 of 24 [91.7%]; 95% CI: 73.0%-98.9%) than with trigger-based ablation (12 of 19 [63.2%]; 95% CI: 38.4%-83.7%; HR: 0.20 [95% CI: 0.05-0.76]; log-rank test; P = 0.026). Both approaches significantly reduced arrhythmic burden (trigger group: 3.9 ± 0.8 episodes to 0.4 ± 0.2 episodes [P < 0.001]; substrate group: 4.8 ± 1.2 episodes to 0.1 ± 0.1 episodes [P < 0.001]). Conduction complications differed: new left bundle branch block occurred in 5 of 24 substrate patients (20.8%), whereas one posterior fascicular block occurred in the trigger group (1 of 19 [5.3%]; P < 0.001).</p><p><strong>Conclusions: </strong>Substrate-based de-networking was associated with greater freedom from ventricular tachycardia/VF but a higher rate of conduction system injury. Trigger-focused ablation may serve as an initial strategy in patients with identifiable premature ventricular complex triggers, with substrate modification reserved for refractory or nontriggered VF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771596","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":"Cardioneuroablation for Ictal Asystole: A Multicenter Case Series.","authors":"John H Bertot, Tolga Aksu, Henry Huang, Victor Neira, Matthew Hanson, Matthew Hyman, Dan Wichterle, Bor Antolič, Mauricio Scanavacca, Carina Hardy, Sergio Conti, Juan Carlos Zerpa, Raktham Mekritthikrai, Timothy Markman, Kathryn A Davis, Andres Enriquez","doi":"10.1016/j.jacep.2026.04.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.04.002","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is an emerging therapy for vagally mediated bradyarrhythmias. Its role in ictal asystole, a rare but severe manifestation of epilepsy, remains poorly defined.</p><p><strong>Objectives: </strong>This study sought to summarize procedural characteristics and clinical outcomes of CNA performed for ictal asystole.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study across 6 international centers, identifying adult patients who underwent CNA for ictal asystole (≥4 s) from 2017 to 2025.</p><p><strong>Results: </strong>A total of 12 patients (aged 39 ± 9 years, 50% female) were included; 9/12 had focal impaired-awareness seizures. All patients exhibited sinus arrest during the events, with a mean asystole of 16 ± 8 s, and a median number of 7 syncopal events. Biatrial CNA (75% under conscious sedation) was facilitated by 3-dimensional electroanatomic mapping. Ganglionated plexi (GPs) were identified using anatomical landmarks and fractionated electrograms. Right superior (12 of 12), right inferior (10 of 12), and left inferior (9 of 12) GPs were most frequently ablated. After CNA, the sinus rate increased by ≥25% in 10 of 12 patients, and 9 of 12 demonstrated a blunted atropine response. No procedural complications occurred. Over a median follow-up of 20.5 months, 8 of 12 patients remained free from ictal asystole. Four patients experienced recurrent syncope at 2 to 15 months and underwent repeated CNA, with one of them achieving durable freedom from syncope. Two patients ultimately required a pacemaker implant.</p><p><strong>Conclusions: </strong>In patients with ictal asystole, biatrial CNA appears to be safe and may substantially reduce syncope burden, although repeated ablation or permanent pacing may be required. Prospective studies are needed to better define efficacy and long-term outcomes.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771439","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":"Left Bundle Branch Area Pacing: Does Lead Position Matter?","authors":"Haran Burri, Marek Jastrzębski","doi":"10.1016/j.jacep.2026.02.037","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.02.037","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771476","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}