JACC. Clinical electrophysiology最新文献

{"title":"Site-Specific Ventricular Tachycardia Inducibility","authors":"Asad A. Aboud MD ,&nbsp;Robert L. Abraham MD ,&nbsp;Oluwaseun Adeola MD ,&nbsp;Ikutaro Nakajima MD, PhD ,&nbsp;Ryohsuke Narui MD, PhD ,&nbsp;Tomofumi Nakamura MD ,&nbsp;Arvindh N. Kanagasundram MD ,&nbsp;Travis Richardson MD ,&nbsp;William G. Stevenson MD","doi":"10.1016/j.jacep.2024.10.034","DOIUrl":"10.1016/j.jacep.2024.10.034","url":null,"abstract":"<div><h3>Background</h3><div>Programmed electrical stimulation (PES) is an essential part of ventricular tachycardia (VT) ablation procedures, but VT is not always inducible, usually for reasons that are not clear.</div></div><div><h3>Objectives</h3><div>This study sought to review pacing site-specific failure of PES to induce scar-related VT and to provide a potential mechanistic explanation of the phenomena using a computer simulation.</div></div><div><h3>Methods</h3><div>Six patients in whom aggressive PES from traditional RV pacing sites failed to induce VT, but VT was easily inducible from a nontraditional site, were reviewed. In computer simulations, initiation of re-entry by PES at sites distributed around the re-entry circuit was studied.</div></div><div><h3>Results</h3><div>We identified 6 patients who had no inducible sustained VT from the RV apex/outflow tract with at least 3 extrastimuli, but for whom VT was relatively easily induced from a site in the LV, basal RV, or epicardium. In 5 of the 6 patients, the site that induced VT was closer to the likely re-entry circuit region. In computer simulations, the spatial relation of the pacing site to the entrance and exits of a circuit isthmus influenced initiation of re-entry by an extrastimulus by determining the time available for recovery of excitability at the initial region of block.</div></div><div><h3>Conclusions</h3><div>The PES site can have a marked effect on inducibility of VT in some patients such that PES from the RV apex and outflow regions fails to induce clinically relevant VTs. The frequency with which this occurs is not certain. Stimulation from alternative sites is a reasonable consideration in selected patients.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 509-517"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005212","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":"Sudden Cardiac Arrhythmic Arrest","authors":"Kurt S. Hoffmayer MD ,&nbsp;Melvin M. Scheinman MD","doi":"10.1016/j.jacep.2024.11.008","DOIUrl":"10.1016/j.jacep.2024.11.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 496-497"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079347","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 Tachyarrhythmias With Ultra-Rapid Ventricular Response and Sudden Death in Patients Without Structural Heart Disease","authors":"Maarten A.J. De Smet MD, PhD ,&nbsp;Benjamin De Becker MD, PhD ,&nbsp;Clara François MD ,&nbsp;Jean-Benoit le Polain de Waroux MD, PhD ,&nbsp;Sebastien Knecht MD, PhD ,&nbsp;Mattias Duytschaever MD, PhD ,&nbsp;Rene Tavernier MD, PhD","doi":"10.1016/j.jacep.2024.10.025","DOIUrl":"10.1016/j.jacep.2024.10.025","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac death (SCD) is generally associated with life-threatening ventricular arrhythmias. Supraventricular arrhythmias are an accepted cause of SCD in Wolff-Parkinson-White syndrome and complex congenital heart disease. However, the role of atrial tachyarrhythmias (ATAs) in SCD in patients with structurally normal hearts is unclear.</div></div><div><h3>Objectives</h3><div>The goal of this study was to present data on resuscitated patients without structural heart disease (SHD), experiencing recurrent implantable cardioverter-defibrillator (ICD) shocks, who share common clinical and electrical features suggesting that ATAs can cause SCD.</div></div><div><h3>Methods</h3><div>We describe the clinical characteristics and ICD analysis of syncopal events terminated with shock delivery in 5 young SCD survivors without SHD. Details on the follow-up after ablation of the arrhythmia causing the syncopal episode are also reported.</div></div><div><h3>Results</h3><div>In all patients (4 male, 1 female; median age 23 years; age range 15-47 years), a surface electrocardiogram recording in the resuscitation setting suggested ventricular fibrillation. After the index event, all patients exhibited recurrent arrhythmic syncopal episodes in a setting of elevated adrenergic tone, treated with ICD shocks. ICD interrogation suggested ATAs (atrial fibrillation in 4 patients, atrial tachycardia in 1 patient), conducting to the ventricles at rates approaching 300 beats/min, as the underlying arrhythmia leading to the syncopal events. ATA ablation abolished episodes of arrhythmic syncope and shock delivery in all patients after a median follow-up of 34 months. No patient died suddenly during follow-up.</div></div><div><h3>Conclusions</h3><div>Common clinical and electrical features define a distinct entity of SCD caused by ATAs with ultra-rapid ventricular response in otherwise healthy patients. Catheter ablation of the ATA is an effective treatment in these patients.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 482-495"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142870839","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}

{"title":"Percutaneous VT Ablation Via RA-to-LV Access in Patients With Double Mechanical Valves","authors":"Konstantinos C. Siontis MD ,&nbsp;Jeffrey R. Winterfield MD ,&nbsp;Matthew M. Zipse MD ,&nbsp;Timothy R. Maher MD ,&nbsp;Siva K. Mulpuru MD ,&nbsp;Muhammet C. Celik MD ,&nbsp;Teyyar Gökdeniz MD ,&nbsp;Arvindh N. Kanagasundram MD ,&nbsp;Chin-Yu Lin MD ,&nbsp;Yenn-Jiang Lin MD, PhD ,&nbsp;Fa-Po Chung MD, PhD ,&nbsp;Naga Venkata K. Pothineni MD ,&nbsp;Matthew C. Hyman MD ,&nbsp;Robert D. Schaller MD ,&nbsp;Yi-Wen Liao MD ,&nbsp;Wendy S. Tzou MD ,&nbsp;Andre D’Avila MD ,&nbsp;Francis E. Marchlinski MD ,&nbsp;William G. Stevenson MD ,&nbsp;Pasquale Santangeli MD","doi":"10.1016/j.jacep.2024.10.030","DOIUrl":"10.1016/j.jacep.2024.10.030","url":null,"abstract":"<div><h3>Background</h3><div>In patients with mechanical aortic and mitral valves requiring catheter ablation of ventricular tachycardia (VT), a technique for access from the right atrium (RA) to the left ventricle (LV) via puncture of the inferoseptal process of the LV was previously described in a single-center series.</div></div><div><h3>Objectives</h3><div>This study sought to report the multicenter experience of VT ablation using this novel LV access approach.</div></div><div><h3>Methods</h3><div>We assembled a multicenter registry of patients with double mechanical valves who underwent VT ablation with RA-to-LV access.</div></div><div><h3>Results</h3><div>Eighteen patients from 10 VT ablation centers were included (15 men; age: 63.9 ± 10 years, LV ejection fraction: 32% ± 10%). In 14 patients, the procedure was performed on uninterrupted anticoagulation, and 4 patients underwent bridging with heparin. A mean of 2.5 VTs were inducible at procedure onset. LV access was successful in all cases with intracardiac echocardiography–guided puncture with a radiofrequency wire (n = 16) or standard transseptal needle (n = 2), followed by balloon dilation. Postablation, complete noninducibility of VT was achieved in 17 (94%) patients. One intramural perimitral annular hematoma was noted after LV access that was managed conservatively without sequelae. No other procedure-related complications were noted, such as new AV block. LV-RA shunt was present by echocardiogram within 24 to 72 hours in 10 (56%) patients. A small residual shunt was noted in 1 of them more than 3 months postablation. During the median follow-up of 10.4 months, 3 (17%) patients experienced VT recurrence.</div></div><div><h3>Conclusions</h3><div>In this multicenter registry of patients with double mechanical valves, VT ablation with RA-to-LV access was feasible, safe, and effective.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 540-550"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005243","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":"Intrapericardial Corticosteroids and Colchicine Prevent Pericarditis and Atrial Fibrillation After Epicardial Ablation of Ventricular Arrhythmias","authors":"Jorge E. Romero MD ,&nbsp;Carlos D. Matos MD ,&nbsp;Fermin Garcia MD ,&nbsp;Andres Enriquez MD ,&nbsp;Luis Carlos Saenz MD ,&nbsp;Carolina Hoyos MD ,&nbsp;Isabella Alviz MD ,&nbsp;Mohamed Gabr MD ,&nbsp;Fernando Moreno BS ,&nbsp;Carli Peters MD ,&nbsp;Rafael H. Isaac MD ,&nbsp;Carlos Tapias MD ,&nbsp;Eric D. Braunstein MD ,&nbsp;Alejandro Velasco MD ,&nbsp;Matthew Hanson MD ,&nbsp;Nathaniel Steiger MD ,&nbsp;Bruce Koplan MD ,&nbsp;Nestor Lopez-Cabanillas MD ,&nbsp;Paul Zei MD ,&nbsp;William H. Sauer MD ,&nbsp;Usha B. Tedrow MD, MS","doi":"10.1016/j.jacep.2024.10.033","DOIUrl":"10.1016/j.jacep.2024.10.033","url":null,"abstract":"<div><h3>Background</h3><div>Postprocedural pericarditis (PP) can occur in up to 29.4% of patients undergoing epicardial catheter ablation of ventricular tachycardia (VT). Despite several proposed strategies to mitigate this adverse outcome, rates of PP and pericarditic pain remain high.</div></div><div><h3>Objectives</h3><div>This study sought to assess the impact of intrapericardial steroids instillation (ISI) combined with periprocedural colchicine on PP after epicardial VT ablation.</div></div><div><h3>Methods</h3><div>This prospective multicenter study included patients undergoing epicardial VT ablation between June 2021 and December 2023. The primary outcome was the occurrence of pericarditis, defined as the presence of pericarditic chest pain and pericarditic electrocardiographic (ECG) changes. Secondary outcomes included the pericarditic pain score at 6, 12, 24, and 48 hours after the procedure, pericardial effusion, postprocedural new-onset atrial fibrillation (AF), constrictive pericarditis, admission due to pericarditis, and gastrointestinal side effects. A systematic literature search was performed to identify historical control groups to compare with our cohort.</div></div><div><h3>Results</h3><div>A total of 129 patients underwent epicardial VT ablation with subsequent ISI and colchicine therapy. The combination of ISI and colchicine resulted in a nonsignificant trend of lower rates of pericarditis when compared with all historical control groups (3.1% [4 of 129] vs 7.0% [12 of 172]; <em>P</em> = 0.109) and a significant difference when compared to intrapericardial steroids (3.1% vs 13.2%; <em>P</em> = 0.030). The rates of pericarditic pain (10.9% [14 of 129] vs 30.9% [21 of 68]; <em>P</em> = 0.001), pericarditic ECG changes (5.4% [7 of 129] vs 33.8% [23 of 68]; <em>P</em> &lt; 0.001) and new-onset atrial fibrillation (0.8% vs 19.5%; <em>P</em> = &lt;0.001) were significantly lower in our study than in historical control groups.</div></div><div><h3>Conclusions</h3><div>The instillation of intrapericardial steroids along with periprocedural colchicine after epicardial VT ablation led to a decreased incidence of adverse effects associated with pericardial inflammation when compared with historical control groups. Further research with contemporary control groups is needed to confirm the suggested impact of the strategy described here.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 498-508"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023313","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":"Full Issue PDF","authors":"","doi":"10.1016/S2405-500X(25)00112-4","DOIUrl":"10.1016/S2405-500X(25)00112-4","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages I-CLXXXIX"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678399","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}

{"title":"The Association of Electrical Delay on Hemodynamic Response With Cardiac Resynchronization Therapy.","authors":"Angelo Auricchio, Kris Siejko, Nicholas Wold, Yinghong Yu, Michael R Gold","doi":"10.1016/j.jacep.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.011","url":null,"abstract":"<p><strong>Background: </strong>The effect of electrical delay at the left ventricular (LV) pacing site on acute hemodynamic response with cardiac resynchronization therapy (CRT) has been investigated only in small observational studies.</p><p><strong>Objectives: </strong>This study evaluates the impact of electrical delay, as assessed by interventricular (right ventricular-LV]) interval, on the acute hemodynamic response to CRT in a large, diverse multicenter cohort.</p><p><strong>Methods: </strong>A total of 144 patients in 3 prospective studies, the PATH-CHF (Pacing Therapies in Congestive Heart Failure) I and II and the CRTAVO (CRT Optimization Algorithm Validation Study), were pooled and analyzed. At the time of CRT implantation, all pacing leads, pressure catheters placed in the right ventricle and left ventricle, and the surface electrocardiogram were connected to an external pacing computer. A standardized, randomized stimulation protocol was used to assess response.</p><p><strong>Results: </strong>The RV-LV interval was associated with an increase in the rate of LV pressure rise response. In the full cohort, LV effective contractility monotonically increased with a prolongation of the RV-LV time. Other significant predictors of the increase in rate of LV pressure rise were QRS duration and, to a lesser extent, female sex and ischemic etiology.</p><p><strong>Conclusions: </strong>RV-LV and QRS durations are strong predictors of the acute hemodynamic response with CRT. These findings may help in patient selection, lead placement, and pacing benefit expectation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633956","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":"Chemical Ablation of Atrial Fibrillation and the Fine Balancing Act of Neuromodulation in Cardiology.","authors":"Robert Lemery","doi":"10.1016/j.jacep.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567129","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 Reappraisal of Neuropeptide Y as Biomarker and Therapeutic Target in Arrhythmic Disorders.","authors":"Tania Zaglia, Olujimi A Ajijola","doi":"10.1016/j.jacep.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.012","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633957","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 Novel Radiofrequency-Assisted Trans-RAA Perforation Technique for Pericardial CO₂ Insufflation to Facilitate Epicardial Access.","authors":"Pasquale Santangeli, Nolan Hight, Arwa Younis, Ioan Liuba, Justin Lee, Koji Higuchi, Jakub Sroubek, Shady Nakhla, Roy Chung, Walid Saliba, Mandeep Bhargava, Ayman Hussein, Mohamed Kanj, Paul Schoenhagen, Paresh Vasandani, Oussama Wazni, Samir Kapadia","doi":"10.1016/j.jacep.2025.01.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.020","url":null,"abstract":"<p><strong>Background: </strong>Perforation of a coronary venous branch for pericardial insufflation of carbon dioxide (CO₂) enhances safety of epicardial access. The multiple procedural steps and length of the procedure remain a major limitation of this approach impacting its routine clinical adoption.</p><p><strong>Objectives: </strong>This study describes a novel and streamlined technique for pericardial CO₂ insufflation via radiofrequency (RF)-assisted right atrial appendage (RAA) perforation.</p><p><strong>Methods: </strong>Between 2023 and 2024, 18 patients (age: 55 ± 11 years; left ventricular ejection fraction: 44 ± 13%) underwent epicardial access for mapping and ablation of ventricular arrhythmias facilitated by pericardial CO₂ insufflation via a microperforation of the RAA with a custom-made telescopic crossing assembly consisting of a stiff 0.014-inch guidewire within 1.8-Fr microcatheter delivered inside a 4-Fr support catheter. The proximal end of the guidewire was connected to a unipolar RF generator (20-30 W in \"cut mode\", <1 s burst) to obtain a controlled RAA wall microperforation and facilitate advancement of the 1.8-Fr microcatheter in the pericardial space for CO₂ insufflation.</p><p><strong>Results: </strong>Successful RAA exit with the RF guidewire-microcatheter assembly was achieved in all patients, and epicardial access was completed in 17 (94%) patients. In 1 patient, significant pericardial adhesions were detected after RAA exit, and epicardial access was deferred. The median time from femoral venous insertion of the catheter assembly to CO₂ insufflation was 4 min (range: 3-7 min). Significant bleeding (>80 mL) occurred in 1 patient (patient #3; 150 mL), which led to a modification of the technique (shortening of the RF burst to <1 s with 1-2 mm guidewire exposure past the microcatheter and minimal advancement during RF). After technique modification (15 patients), pericardial bleeding ranged from 5 mL-30 mL (median: 10 mL; IQR: 5-20 mL). No patient had inadvertent right ventricle puncture or damage to a coronary artery. Three patients had pericardial pain after the procedure requiring 1 week of therapy with nonsteroidal anti-inflammatory drugs and colchicine.</p><p><strong>Conclusions: </strong>Intentional RAA perforation for pericardial CO₂ insufflation with a custom RF guidewire-microcatheter assembly can be safely and efficiently performed to facilitate epicardial access for ventricular arrhythmias ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633952","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}