JACC. Clinical electrophysiology最新文献

{"title":"Reduction of AF Burden After Cryoballoon Ablation in Patients With Early Persistent AF: The COOL-PER Trial.","authors":"So-Ryoung Lee, Eue-Keun Choi, Kyung-Yeon Lee, JungMin Choi, Hyo-Jeong Ahn, Soonil Kwon, Young-Keun On, Ji Hyun Lee, Youngjin Cho, Il-Young Oh, Hong-Euy Lim, Min-Soo Cho, Gi-Byoung Nam, Gregory Y H Lip, Seil Oh","doi":"10.1016/j.jacep.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF.</p><p><strong>Objectives: </strong>This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF.</p><p><strong>Methods: </strong>This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed.</p><p><strong>Results: </strong>A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires.</p><p><strong>Conclusions: </strong>In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719280","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 Interelectrode Distance for Accurate Mapping of Postinfarct Scars: Insights on Electrogram Characteristics.","authors":"Michael Barkagan, Ofir Brem, Arwa Younis, Zachary P Bubar, Jonathan Yarnitsky, Anat Milman, Maxime Zabern, Vladimir Vasilenko, Dor Yadin, Elad Anter","doi":"10.1016/j.jacep.2025.01.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.018","url":null,"abstract":"<p><strong>Background: </strong>There is an ongoing effort to develop catheters with closer interelectrode spacing to improve mapping resolution. However, the optimal distance for mapping postinfarct scar has yet to be established.</p><p><strong>Objectives: </strong>This study sought to assess the effect of interelectrode distance on ventricular scar electrograms.</p><p><strong>Methods: </strong>In 8 swine with healed myocardial infarction, the left ventricle was mapped using an experimental 48-electrode array with a 1.2 mm center-to-center distance. Additional maps with 2.4, 3.6, and 4.8 mm distances were created using nonadjacent electrodes. The impact of interelectrode distance on voltage amplitude and near-field (NF) and far-field (FF) activity relationships was analyzed.</p><p><strong>Results: </strong>At a 1.2 mm interelectrode distance, voltage amplitudes <1.5 mV accurately correlated with the endocardial infarct surface area, while increasing the distance to 4.8 mm progressively overestimated the infarct area (P < 0.001). However, adjusting voltage cutoffs for each interelectrode distance restored the correlation to the actual infarct size. The primary distinction between distances was the ability to differentiate NF from FF potentials. At 4.8 mm and 3.6 mm, FF potential amplitude often exceeded NF amplitude (NF/FF ratios of 0.8 ± 0.3 and 0.9 ± 0.2, respectively). Reducing the distance to 2.4 mm attenuated FF potentials, yielding an NF/FF ratio of 1.2 ± 0.4. Further reduction to 1.2 mm showed no significant additional effect (NF/FF ratio 1.3 ± 0.3; P = 0.09).</p><p><strong>Conclusions: </strong>Bipoles with a 2 mm interelectrode distance most effectively match endocardial scar tissue and attenuate NF potentials. These benefits plateau at 2 mm, suggesting that it may represent the optimal distance for delineating postinfarction substrates.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719276","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 Personal and Therapeutic Choices We Make Really Matter When It Comes to Atrial Fibrillation Ablation.","authors":"T Jared Bunch","doi":"10.1016/j.jacep.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.015","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":"143673876","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":"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":"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":"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}