JACC. Clinical electrophysiology最新文献

{"title":"Automated Diagnosis of Pediatric ECG through AI-ECG: As good (and bad) as the experts.","authors":"Dustin Nash, Anthony G Pompa, Jennifer N Avari Silva","doi":"10.1016/j.jacep.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656825","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":"Impact of Anterior Right Ventricular Outflow Tract Conduction Block on QRS Morphology in Repaired Tetralogy of Fallot.","authors":"Jeremy P Moore, Katja Zeppenfeld","doi":"10.1016/j.jacep.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719333","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":"Acute Coronary Occlusion Following Radiofrequency Ablation for Premature Ventricular Complexes in the Distal Great Cardiac Vein.","authors":"Jeanne du Fay de Lavallaz, Ashwini Kerkar, Brett Wanamaker, Frank Bogun","doi":"10.1016/j.jacep.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719328","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":"Nanosecond vs Microsecond Pulsed Field Ablation: Lesion Durability and Muscle Contraction in a Canine Model.","authors":"Lei Ding, Aikai Zhang, Yang Sun, Yuandong Liu, Yingjie Qi, Zihan Jiang, Lijie Mi, Fengyuan Yu, Hongda Zhang, Min Tang","doi":"10.1016/j.jacep.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>A nanosecond pulsed field generator and a circular multielectrode catheter have been introduced.</p><p><strong>Objectives: </strong>The aim of this study was to compare the durability, safety, and muscle contraction of ablation via microsecond or nanosecond pulsed field ablation (PFA) in canines.</p><p><strong>Methods: </strong>Under general anesthesia without muscle relaxants, 24 canines were subjected to isolation of the superior vena cava (SVC) and pulmonary veins (PVs) using nanosecond or microsecond PFA. Repeat mapping was performed and the animals were sacrificed acutely (7 days, n = 9), subacutely (30 days, n = 9), or chronically (3 months, n = 6).</p><p><strong>Results: </strong>All SVCs were isolated with durable isolation. A total of 161 sections from the SVC revealed transmural lesions in all sections, with a mean depth of 1.3 ± 0.7 mm. Similarly, all the PVs were isolated. Durable isolation was achieved in 23 (95.8%) of 24 PVs in nanosecond PFA and 22 (91.7%) of 24 PVs in microsecond PFA. Nanosecond PFA resulted in transmural lesions in 148 (97.4%) of 152 sections and a median lesion depth of 2.7 ± 1.2 mm. Microsecond PFA created transmural lesions in 155 (96.9%) of 160 sections with a median depth of 2.6 ± 1.0 mm. There were no significant differences in depth or transmurality between groups. Nanosecond PFA caused no, slight, and severe muscle contraction in 70.8%, 12.5%, and 16.7% PVs, respectively, and microsecond PFA resulted in no and severe muscle contraction in 29.2% and 70.8% PVs, respectively. Nanosecond PFA demonstrated a significantly lower incidence of severe muscle contraction (P < 0.001).</p><p><strong>Conclusions: </strong>Nanosecond PFA yields comparable lesion durability, safety, and significantly reduced muscle contractions to microsecond PFA, which may help enable PV isolation without general anesthesia.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673858","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":"TEMPORARY REMOVAL: JACC: Clinical Electrophysiology 2024 Young Author Achievement Award Winner.","authors":"Kalyanam Shivkumar","doi":"10.1016/j.jacep.2025.02.002","DOIUrl":"10.1016/j.jacep.2025.02.002","url":null,"abstract":"<p><p>The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567131","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":"Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III).","authors":"Willem Gerrits, Philippe C Wouters, Cheyenne S L Chiu, Marco Guglielmo, Maarten J Cramer, Pim van der Harst, Kevin Vernooy, Antonius M W van Stipdonk, Vokko P van Halm, Vincent F van Dijk, Abdul Ghani, Alexander H Maass, Sing-Cien Yap, Frebus J van Slochteren, Mathias Meine","doi":"10.1016/j.jacep.2025.01.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.022","url":null,"abstract":"<p><strong>Background: </strong>To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.</p><p><strong>Objectives: </strong>The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.</p><p><strong>Methods: </strong>A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.</p><p><strong>Results: </strong>The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).</p><p><strong>Conclusions: </strong>Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673860","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":"Transmural Activation Mapping of Ventricular Arrhythmias With High-Frame Rate Echocardiography and Validation Against Contact Mapping.","authors":"Johanna B Tonko, Melina Tourni, Aikaterini Afentouli, Anthony Chow, Joseph Hansen-Shearer, Biao Huang, Ross J Hunter, Richard Schilling, Mengxing Tang, Elisa Konofagou, Pier D Lambiase","doi":"10.1016/j.jacep.2024.11.019","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.019","url":null,"abstract":"<p><strong>Background: </strong>The restriction of activation mapping to the ventricular surface of contemporary mapping systems often leads to failure to correctly identify the true sites of origin (SoOs) of intramural and/or subepicardial ventricular arrhythmias (VAs), reducing procedural success.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate if noninvasive electromechanical wave imaging (EWI) can locate the SoOs of VAs along the endo-epicardial axis in patients with and without structural heart disease.</p><p><strong>Methods: </strong>Patients with VAs requiring ablation underwent preprocedural transthoracic EWI to identify the SoOs and validate using contact mapping. Local electromechanical activation was defined as time point of the downward zero crossing on the incremental axial strain curve. The site of earliest activation on contact mapping and/or successful ablation was employed as ground truth for VA SoO.</p><p><strong>Results: </strong>Twenty-eight patients underwent EWI, and 25 proceeded to contact mapping (56% men, mean age 53 ± 16 years, mean left ventricular ejection fraction 47% ± 28%, 52% with late gadolinium enhancement (LGE) on magnetic resonance imaging). Five patients were excluded (insufficient or different ventricular tachycardia or ventricular ectopic activity at the time of EWI vs contact mapping). EWI mapping correctly localized the VA SoOs in 17 of 20 (85%) of the cases and mapped them to the adjacent segments in the remaining ones. In the presence of scar, EWI localized 81.8% of the VA SoOs (n = 9 of 11) correctly compared with 88.9% (n = 8 of 9) in patients without (P = NS). The transmural SoOs (endocardial, midmyocardial, or epicardial) were successfully identified in 18 of 20 cases (90%; P = NS for LGE-positive vs LGE-negative patients).</p><p><strong>Conclusions: </strong>EWI correctly identified the transmural SoOs of focal VAs, including in the presence of scar, in the majority of cases using contact mapping as the gold standard and thus could support preprocedural planning, including requirement for epicardial access and/or ablation techniques. The absence of a true gold standard for clinical transmural mapping remains an important challenge for the validation of novel mapping technologies.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719283","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":"Expert-Level Automated Diagnosis of the Pediatric ECG Using a Deep Neural Network.","authors":"Joshua Mayourian, William G La Cava, Sarah D de Ferranti, Douglas Mah, Mark Alexander, Edward Walsh, John K Triedman","doi":"10.1016/j.jacep.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.003","url":null,"abstract":"<p><strong>Background: </strong>Disparate access to expert pediatric cardiologist care and interpretation of electrocardiograms (ECGs) persists worldwide. Artificial intelligence-enhanced ECG (AI-ECG) has shown promise for automated diagnosis of ECGs in adults but has yet to be explored in the pediatric setting.</p><p><strong>Objectives: </strong>This study sought to determine whether an AI-ECG model can accurately perform automated diagnosis of pediatric ECGs.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included all patients with an ECG at Boston Children's Hospital read by an experienced pediatric cardiologist (≥5,000 reads) between 2000 and 2022. A convolutional neural network was trained (75% of patients) and internally tested (25% of patients) on ECGs to predict ECG diagnoses. The primary outcome was a composite of any ECG abnormality (ie, detecting normal vs abnormal ECG). Secondary outcomes include Wolff-Parkinson-White syndrome (WPW) and prolonged QTc. Model performance was assessed with area under the receiver-operating (AUROC) and precision recall (AUPRC) curves.</p><p><strong>Results: </strong>The main cohort consisted of 201,620 patients (49% male; 11% with known congenital heart disease) and 583,134 ECGs (median age 11.7 years [Q1-Q3: 3.1-16.9 years]; 56% any ECG abnormality, 1.0% WPW, and 5.3% with prolonged QTc). The AI-ECG model outperformed the commercial software interpretations for detecting any abnormality (AUROC 0.94; AUPRC 0.96), WPW (AUROC 0.99; AUPRC 0.88), and prolonged QTc (AUROC 0.96; AUPRC 0.63). During readjudication of ECGs with AI-ECG/original cardiologist read discordance, blinded expert readers were more likely to agree with AI-ECG classification than the original reader to detect any abnormality (P = 0.001), WPW (P = 0.01), and prolonged QTc (P = 0.07).</p><p><strong>Conclusions: </strong>Our model provides expert-level automated diagnosis of the pediatric 12-lead ECG, which may improve access to care.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656829","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":"Whole-Heart Histological and CMR Validation of Electroanatomic Mapping by Multielectrode Catheters in an Ovine Model","authors":"Timothy Campbell BSc, PhD ,&nbsp;Richard G. Bennett BSc, MBChB, PhD ,&nbsp;Robert D. Anderson MBBS, PhD ,&nbsp;Chris Davey BSc, PhD ,&nbsp;Alexandra K. O’Donohue BMedSc(Hons), PhD ,&nbsp;Aaron Schindeler BSc(Hons), PhD ,&nbsp;Kasun De Silva MBBS, PhD ,&nbsp;Ashwin Bhaskaran MBBS ,&nbsp;Samual Turnbull BSc ,&nbsp;Dinesh Selvakumar MBBS, PhD ,&nbsp;Yasuhito Kotake MD, PhD ,&nbsp;Chi-jen Hsu MBBS, PhD ,&nbsp;James J.H. Chong MBBS, PhD ,&nbsp;Eddy Kizana MBBS, PhD ,&nbsp;Saurabh Kumar BSc(Med)/MBBS, PhD","doi":"10.1016/j.jacep.2024.11.011","DOIUrl":"10.1016/j.jacep.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Accurate electroanatomic mapping is critical for identifying scar and the long-term success of ventricular tachycardia ablation.</div></div><div><h3>Objectives</h3><div>This study sought to determine the accuracy of multielectrode mapping (MEM) catheters to identify scar on cardiac magnetic resonance (CMR) and histopathology.</div></div><div><h3>Methods</h3><div>In an ovine model of myocardial infarction, we examined the effect of electrode size, spacing, and mapping rhythm on scar identification compared to CMR and histopathology using 5 multielectrode mapping catheters. We co-registered electroanatomic mapping, CMR, and histopathology for comparison. Catheter-specific voltage thresholds were identified based on underlying amounts of normal myocardium on transmural histology biopsies.</div></div><div><h3>Results</h3><div>Ten animals were included: 6 with anteroseptal myocardial infarction and 4 control animals. A total of 419,597 points were manually reviewed across the catheters, with 315,487 points used in the analysis. There were minimal differences in bipolar and unipolar voltages, scar areas, and abnormal electrograms between catheters and between rhythms. Catheter-specific bipolar and unipolar voltage thresholds for normal myocardium were High-Density Grid &gt;2.78 mV and &gt;6.19 mV, DuoDecapolar &gt;2.22 mV and &gt;6.05 mV, PentaRay &gt;1.66 mV and &gt;5.35 mV, Decanav &gt;1.36 mV and &gt;4.75 mV, Orion &gt;1.21 mV and &gt;6.05 mV, respectively. Catheter-specific bipolar thresholds improved the accuracy for detecting endo-mid myocardial scar on CMR by 1.8%-15.6% and catheter-specific unipolar thresholds improved the accuracy in the mid-epicardial layers by 25.3%-81.1%.</div></div><div><h3>Conclusions</h3><div>Minimal differences were observed in scar detection and electrogram markers between commercially available multielectrode mapping catheters and differing wave fronts. Compared to traditional voltage criteria for bipolar and unipolar scar, catheter-specific thresholds markedly improved accuracy for delineating scar on CMR.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 521-535"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023345","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":"State of the Art in Left Atrial Appendage Occlusion","authors":"Jalaj Garg MD ,&nbsp;Rajesh Kabra MD ,&nbsp;Rakesh Gopinathannair MD ,&nbsp;Luigi Di Biase MD, PhD ,&nbsp;Dee Dee Wang MD ,&nbsp;Jacqueline Saw MD ,&nbsp;Rebecca Hahn MD ,&nbsp;James V. Freeman MD ,&nbsp;Christopher R. Ellis MD ,&nbsp;Dhanunjaya Lakkireddy MD","doi":"10.1016/j.jacep.2024.10.024","DOIUrl":"10.1016/j.jacep.2024.10.024","url":null,"abstract":"<div><div>Left atrial appendage occlusion (LAAO) has become an important therapeutic target for stroke prevention in patients with nonvalvular atrial fibrillation. Over the past 2 decades, several advancements in LAAO devices (percutaneous and surgical) have been made for stroke prevention and arrhythmia therapy. However, there are several unanswered questions regarding optimal patient selection, the preferred LAAO approach and device, the management of periprocedural and postprocedural complications, including pericardial effusion, device-related thrombus, and device leaks. This review focuses on fundamental foundational concepts in various aspects of the left atrial appendage and management strategies as they relate to current clinical needs.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 602-641"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}