JACC. Clinical electrophysiology最新文献

{"title":"Clinical and Electrophysiological Characteristics of Inducible Polymorphic Ventricular Tachycardia in Repaired Tetralogy of Fallot.","authors":"Jeremy P Moore, Eihab Ghantous, Victor Waldmann, Francis Bessière, Nawel Babouri, Mitchell I Cohen, Edward T O'Leary, Nimesh S Patel, Babak Nazer, Weiyi Tan, Frank A Fish, Aarti S Dalal, Elisabetta Mariucci, Reina B Tan, Michael S Lloyd, Christopher J McLeod, Charles C Anderson, Ronald J Kanter, Bryce V Johnson, Bo Wang, Philip M Chang, Paul Khairy","doi":"10.1016/j.jacep.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.016","url":null,"abstract":"<p><strong>Background: </strong>Although sustained monomorphic ventricular tachycardia (MVT) in repaired tetralogy of Fallot (TOF) is linked to abnormally conducting anatomical isthmuses, the clinical importance of inducible polymorphic ventricular tachycardia (PVT) is unclear.</p><p><strong>Objectives: </strong>The aim of this study was to determine the clinical and electrophysiological characteristics of inducible PVT in TOF.</p><p><strong>Methods: </strong>Patients from the ongoing CATAPULT-TOF (Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot) registry with inducible sustained PVT at index electrophysiology study were included. Abnormal anatomical isthmus was defined as conduction velocity <0.5 m/s. Centrally adjudicated episodes with ≥3 consecutive beats of similar morphology (10 of 12 leads) were labeled transiently organized PVT (TO-PVT). TO-PVT was analyzed in relation to three-dimensional substrate characteristics and postablation inducibility.</p><p><strong>Results: </strong>Of 186 patients (mean age 40 years; 55% male), sustained PVT was induced at 27 procedures (15%). Patients with PVT vs MVT were more likely to undergo operation in the current era (P = 0.008), not require palliative shunt (P = 0.01), exhibit a lower right ventricular end-diastolic volume/left ventricular end-diastolic volume ratio (P = 0.02), and harbor faster anatomical isthmus conduction velocity (P = 0.03). Of those with available electrocardiography data, greater number of TO beats was associated with ≥1 anatomical isthmus (median 3 vs 0 beats; P = 0.001). The proportion with TO-PVT decreased with catheter ablation, with 14 of 24 identified at baseline (58%; median 3.5 beats; cycle length 181 milliseconds), 3 (23%) of 13 postablation, and 1 (8%) of 13 at follow-up electrophysiology study (P_trend = 0.001).</p><p><strong>Conclusions: </strong>Patients with inducible PVT display a lower clinical risk profile and healthier myocardial substrate than those with MVT. Organized beats at episode onset appear to be associated with anatomical isthmuses that can be targeted by catheter ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001197","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":"S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads-the HONEST Cohort.","authors":"Vasileios Sousonis, Peggy Jacon, Fawzi Kerkouri, Rodrigue Garcia, Christelle Marquié, Walid Amara, Fréderic Anselme, Nicolas Badenco, Nathalie Behar, Mohamed Belhameche, Abdeslam Bouzeman, Samir Fareh, Benoît Guy-Moyat, Alexis Hermida, Jérome Hourdain, Laurence Jesel, Pierre Khattar, Ziad Khoueiry, Gabriel Laurent, Vladimir Manenti, Alexis Mechulan, Aymeric Menet, Antoine Milhem, Pierre Mondoly, Pierre Ollitrault, David Perrot, Michael Peyrol, Bertrand Pierre, Nicolas Sadoul, Didier Scarlatti, Jerome Taieb, Claire Vanesson, Pierre Winum, Vincent Probst, Eloi Marijon, Pascal Defaye, Serge Boveda","doi":"10.1016/j.jacep.2025.04.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.020","url":null,"abstract":"<p><strong>Background: </strong>Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can be a viable option for patients with transvenous ICDs experiencing complications (rescue S-ICD).</p><p><strong>Objectives: </strong>This study sought to evaluate the outcomes of rescue S-ICD implantation using data from the HONEST French nationwide S-ICD cohort.</p><p><strong>Methods: </strong>All rescue S-ICD patients were identified. Outcomes (complications, reinterventions, and mortality) were compared between rescue and de novo S-ICD patients. Subgroup analyses were performed based on the implantation indication (infective vs noninfective) and the presence of abandoned leads.</p><p><strong>Results: </strong>Among 4,924 patients in the HONEST cohort, 651 underwent rescue S-ICD implantation (295 with infective indications, 244 with abandoned leads). Over a follow-up of 4.2 ± 2.2 years, complications and reinterventions were similar in rescue and de novo S-ICD patients (22.6% vs 21.0%; P = 0.35 and 8.7% vs 7.2%; P = 0.17, respectively), in infective and noninfective rescue S-ICD patients (21.6% vs 23.5%; P = 0.55 and 8.9% vs 8.6%; P = 0.90, respectively) and in patients with abandoned and extracted leads (24.3% vs 21.7%; P = 0.46 and 8.3% vs 9.0%; P = 0.77, respectively). Mortality was higher in rescue compared to de novo S-ICD patients (16.9% vs 10.2%; P < 0.001) and in rescue S-ICD patients with infective indications (29.2% vs 6.7%; P < 0.001) and extracted leads (21.9% vs 8.6%; P < 0.001), mainly due to a higher burden of comorbidities, as none of these parameters was independently associated with mortality in multivariate analyses. No S-ICD-related deaths were observed.</p><p><strong>Conclusions: </strong>Rescue S-ICD implantation is an acceptable option for patients with device-related complications. Lead abandonment in the setting of a noninfective indication appears to be safe. (S-ICD French Cohort Study [HONEST]; NCT05302115).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002343","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":"Patient Centered mobile Health TECHnology Enabled Atrial Fibrillation Management (mTECH Afib): A Pilot Randomized Controlled Trial.","authors":"Nino Isakadze, Natalie A Horstman, Jie Ding, Courtney Eddy, Stephney Blair, Chang H Kim, Luu V Pham, Francoise A Marvel, Erin M Spaulding, Mansi Nimbalkar, Erin D Michos, Jeffrey Sham, Patrick Dunn, Joseph E Marine, Hugh Calkins, Seth S Martin, David Spragg","doi":"10.1016/j.jacep.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF).</p><p><strong>Objectives: </strong>This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification.</p><p><strong>Methods: </strong>Patients with AF were enrolled from outpatient clinics. Patients were randomized in a 1:1 ratio to either usual care only or the virtual program. The study objectives were to assess feasibility, with the goal of achieving at least 60% participant retention at 12 weeks, intervention engagement, and participant satisfaction.</p><p><strong>Results: </strong>Among 61 patients enrolled (76% of those approached), the mean age was 65 ± 8 years, and 36% were women. A total of 89% of all participants were retained by 12-week follow-up. In the intervention group, at 12-weeks, 88% continued using the smartphone application, 73% continued participation in virtual coaching calls, and 80% reported being satisfied with the program.</p><p><strong>Conclusions: </strong>The mTECH Afib (Patient Centered mobile health TECHnology Enabled Atrial Fibrillation Management) trial demonstrates feasibility of conducting a randomized controlled trial using an innovative digital health technology-enabled intervention with broad patient engagement and acceptance of the program components. Large-scale clinical trials powered for health outcomes will be necessary to establish intervention efficacy.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017736","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":"CARIDONEURAL ABLATION-A NEW HOPE.","authors":"Olujimi Ajijola, Kalyanam Shivkumar","doi":"10.1016/j.jacep.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.019","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110642","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":"NEMESIS-PFA: Investigating Collateral Tissue Injury Associated with Pulsed Field Ablation.","authors":"Dhanunjaya Lakkireddy, Aashish Katapadi, Jalaj Garg, Eli Herink, Michael Klotz, Jagruth Ghanta, Aanya Kabra, Rajesh Kabra, Naga Venkata Pothineni, Douglas Darden, Rangarao Tummala, Scott Koerber, Rakesh Gopinathannair, Sudharani Bommana, Donita Atkins, Rahul Chaudhary, Mackenzie Mbai, Venkat Tholakanahalli, Sanghamitra Mohanty, Luigi DiBiase, Andrea Natale","doi":"10.1016/j.jacep.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.017","url":null,"abstract":"<p><strong>Background: </strong>Early evidence showed reduced complications with pulsed field ablation (PFA), but non-target tissue collateral damage created by electroporation effects is poorly understood and may significantly differ between systems.</p><p><strong>Objective: </strong>In this study, we evaluate the collateral effects of PFA.</p><p><strong>Methods: </strong>NEMESIS-PFA is a multicenter, observational registry of patients who underwent AF ablation from March 2024 onwards with any approved PFA systems - either a circular multielectrode array, spherical, pentaspline, or variable loop catheter - or radiofrequency ablation (RFA). We assessed procedural characteristics, biomarkers for myocardial injury, hemolytic anemia, and renal function, and left atrial (LA) function in select patients.</p><p><strong>Results: </strong>A total of 871 patients, aged 68.9±10.9 years and male (70.8%), with paroxysmal (59.4%) atrial fibrillation, and CHA₂DS₂VASC of 3.3±1.3 were included. Of these, 87.1% (n=773) underwent PFA with a pentaspline (70.9%), circular multielectrode (14.1%), spherical (12.4%), and variable loop (2.3%) catheter. Significant post-procedural change in certain biomarkers such as troponin (13551.0 vs., 127.5 p<0.001), LDH (107.5 IU/L vs. 26.5, p<0.001), and haptoglobin (-102.0 mg/dL vs. -33.5, p<0.001) were detected following the PFA procedures compared to RFA, and the change was dose dependent. There were also significant differences in biomarkers across PFA systems. Lastly, there was a significant change in LA ejection fraction (-5.0% vs. -20.0%, p<0.001) in PFA versus RFA.</p><p><strong>Conclusions: </strong>Current PFA technologies are associated with higher troponin leak, hemolysis, renal dysfunction than RFA. As PFA becomes mainstream, future studies appraising these effects and understanding the short term and long-term implications are needed. NEMESIS-PFA is a multicenter observational study of patients undergoing pulsed-field (PFA) or radiofrequency (RFA) ablation for atrial fibrillation. 871 patients underwent PFA (87.7%) with pentaspline (70.9%), circular multielectrode (14.1%), spherical (12.4%), or variable loop (2.3%) catheters, or RFA (11.2%). Changes in troponin (127.5 vs. 13551.0 ng/dL, p<0.001), lactate dehydrogenase (26.5 vs. 107.5 IU/L, p=0.007), and haptoglobin (-33.5 vs. -102.0 mg/dL, p<0.001) were significantly higher in PFA than RFA; they were also dose-dependent and varied across systems. Left atrial ejection fraction (-5.0% vs. -20.0%, p<0.001) also differed. This suggests that collateral effects of PFA are worse than RFA and requires additional study.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110650","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":"Health Care Cost Burden of Atrial Fibrillation Presentations to Emergency Departments.","authors":"Luke P Dawson, Jocasta Ball, Andrew Wilson, Lance Emerson, Aleksandr Voskoboinik, Ziad Nehme, Mark Horrigan, David Kaye, Jonathan M Kalman, Peter M Kistler, Dion Stub","doi":"10.1016/j.jacep.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.023","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077842","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":"Flecainide for the Treatment of Andersen-Tawil Syndrome.","authors":"Tomer D Mann, Ayhan Yoruk, Raquel A Neves, Auke T Bergman, Martijn J Bos, Christian van der Werf, Michael H Gollob, Jason D Roberts, Habib Khan, Shubhayan Sanatani, Vasanth Vedantham, Byron K Lee, Anastasiea Yesaulov, Andrew D Krahn, Rafik Tadros, Arthur A Wilde, Michael J Ackerman, Melvin M Scheinman","doi":"10.1016/j.jacep.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.020","url":null,"abstract":"<p><strong>Background: </strong>Andersen-Tawil syndrome type 1 (ATS1) is a rare arrhythmogenic disorder resulting from loss-of-function mutations in KCNJ2. Although the use of flecainide has been proposed to treat and prevent life-threatening arrhythmic events in ATS1, it has only been tested in small case series with limited follow-up. We performed a multicenter cohort study to determine the impact of flecainide on ATS.</p><p><strong>Objectives: </strong>This study aimed to assess the efficacy and safety of flecainide in reducing ventricular arrhythmia and related symptoms in patients with ATS1.</p><p><strong>Methods: </strong>Clinical and genetic data from consecutive ATS1 patients from 9 centers were collected and entered into a database at UCSF Medical Center, San Francisco, California, USA, and pooled for analysis.</p><p><strong>Results: </strong>The study included 31 ATS1 patients with a median age of 27 years (Q1-Q3: 24-38 years). The median follow-up time was 4.2 years (Q1-Q3: 1.6-9.7 years), and the median daily dose of flecainide was 150 mg (Q1-Q3: 100-200 mg). A positive exercise treadmill test was defined as any ventricular arrhythmia other than occasional single premature ventricular contractions, and was seen in 16 of 18 patients before treatment. This decreased to 5 of 18 patients with flecainide (OR: 0.13; P = 0.035). One episode of nonsustained ventricular tachycardia was observed on exercise treadmill test during flecainide treatment, compared with 6 observed during pretreatment. The ventricular arrhythmia score, defined as the most severe arrhythmia on Holter monitoring, improved in 66% of patients (mean improvement 0.62 ± 1.6 U; P = 0.005). Premature ventricular contraction burden decreased by 84.8% (71.5%-100%), from 22.3% at baseline to 3.8% with flecainide (P < 0.001). While on flecainide, symptomatic patients had a 77.7% chance of becoming symptom-free (95% CI: 56.2%-100%). Most patients (21/25, 84%) reported no side effects. One patient experienced a VT storm while treated with flecainide but tolerated a lower dose with a good response.</p><p><strong>Conclusions: </strong>These data demonstrate that flecainide treatment may be effective and well-tolerated in ATS1 patients. The occurrence of an arrhythmic storm in 1 patient underscores the potential for toxicity and mandates careful dose titration monitored by rest and exercise electrocardiogram for QRS widening.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077838","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 Mitral Regurgitation on Outcomes of Catheter Ablation for AF With Left Ventricular Systolic Dysfunction.","authors":"Louise Segan, Sandeep Prabhu, Shane Nanayakkara, Andrew Taylor, James Hare, Rose Crowley, Jeremy William, Kenneth Cho, Michael Lim, Youlin Koh, Souvik Das, David Chieng, Hariharan Sugumar, Aleksandr Voskoboinik, Liang-Han Ling, Benedict Costello, David M Kaye, Alex McLellan, Geoffrey Lee, Joseph B Morton, Jonathan M Kalman, Peter M Kistler","doi":"10.1016/j.jacep.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and left ventricular (LV) systolic dysfunction (LVSD) may be associated with function mitral and tricuspid regurgitation (FMR/FTR). Prior studies have largely assessed impact of MR on AF ablation outcomes in the presence of preserved LV ejection fraction.</p><p><strong>Objectives: </strong>This study sought to determine the impact of FMR on the outcomes of catheter ablation (CA) in patients with AF and LVSD.</p><p><strong>Methods: </strong>We examined baseline clinical characteristics, CA outcomes, and change in echocardiographic parameters (FMR and FTR severity, LV and left atrial [LA] dimensions, LVEF) at baseline and 12 months in individuals with AF and LVSD with at least mild FMR undergoing CA. Patients with primary mitral valve disease were excluded.</p><p><strong>Results: </strong>235 patients (age 62.8 years,16.2% female, NYHA functional class III (Q1-Q3: II-III)) underwent CA and were categorized by FMR severity at baseline (mild n = 117; moderate/severe n = 118). Baseline characteristics were comparable irrespective of degree of FMR, other than lower LVEF (LVEF 29% [Q1-Q3: 22.8%-35.0%] vs 35% [Q1-Q3: 30.0%-41.0%]; P < 0.001) and increased tricuspid regurgitation in moderate/severe MR (22%) vs mild MR (8%, P < 0.001). LA size did not differ significantly across FMR groups (P = 0.233). At 12 months following CA, recurrent atrial arrhythmia occurred in 101 of 235 (43.0%) including 42.7% in mild vs 43.2% in moderate-to-severe MR (P = 0.940). The severity of FMR did not influence arrhythmia recurrence (OR: 1.15; 95% CI: 0.54-1.86; P = 0.601) nor LV recovery (OR: 1.07; 95% CI: 0.67-1.25; P = 0.153). After CA, 89% of those with significant FMR and 85% with significant FTR exhibited ≥1 grade reduction at 12 months. Change in LV dimensions was associated with MR responders (OR: 0.93; 95% CI: 0.87-0.99; P = 0.022) with a greater reduction in LV size at 12 months in MR improvement (-5.0 (Q1-Q3: -9.3 to -1.0) vs non-improvement -1.0 (Q1-Q3: -5.0 to 2.5), P = 0.004) whereas change in LA size was not (OR: 0.98; 95% CI: 0.97-1.03; P = 0.984).</p><p><strong>Conclusions: </strong>In patients with AF and LVSD, the degree of FMR did not impact the success of ablation. There was a significant reduction in FMR and FTR at 12 months following CA. Patients with AF and LVSD should be strongly considered for AF ablation irrespective of the degree of mitral regurgitation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015774","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":"Outcomes and Burdens to Return-to-Play for Phenotype Negative Athletes With a Genetic Heart Disease.","authors":"Katherine A Martinez, J Martijn Bos, Kathryn E Tobert, John R Giudicessi, Michael J Ackerman","doi":"10.1016/j.jacep.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.013","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, the care of athletes with a genetic heart disease (GHD) has shifted. Guidelines surrounding return-to-play (RTP) for athletes who are genotype positive but phenotype negative (G+/P-) remain variable and their management challenging. Recommendations depend on diagnosis, ranging from RTP with monitoring [hypertrophic cardiomyopathy (HCM), and long QT syndrome (LQTS)] to automatic disqualification [catecholaminergic polymorphic ventricular tachycardia (CPVT), and arrhythmogenic cardiomyopathy (ACM)].</p><p><strong>Objectives: </strong>This study sought to examine the prevalence, management, and outcomes of athletes with G+/P- GHD using a retrospective cohort of all self-identified athletes considered G+/P- treated in Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic between July 2000 and November 2023.</p><p><strong>Methods: </strong>There were 274 G+/P- athletes [119 females (43%); mean age at diagnosis 15 ± 12 years; median follow up 32 months] participating in sports at all levels. Diagnoses included LQTS (231; 84%), CPVT (19; 7%), ACM (15; 6%), or HCM (9; 3%). Treatments initiated after our first evaluation, but required for RTP approval, included pharmacologic therapy (187; 68%), left cardiac sympathetic denervation (11; 4%), or an implantable cardioverter defibrillator (6; 2%).</p><p><strong>Results: </strong>For 76 athletes (27%), an intentional non-therapy strategy was implemented. One in five athletes (53; 19%) specifically sought RTP approval following disqualification elsewhere.</p><p><strong>Conclusions: </strong>Despite possessing a GHD-associated variant, a GHD-associated cardiac event or death has not occurred in over 1,300 combined years of follow-up. RTP for most G+/P- athletes is safe. Restricting such athletes based solely on a positive genetic test result should be viewed as genetic discrimination.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077919","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":"HRS/ACC Scientific Statement: Guiding Principles on Same-Day Discharge for Intracardiac Catheter Ablation Procedures.","authors":"Amit J Shanker, Samuel O Jones, James C Blankenship, Jim W Cheung, Ijeoma A Ekeruo, Jodie L Hurwitz, Christopher F Liu, Faisal M Merchant, Wilber W Su, Paul D Varosy","doi":"10.1016/j.jacep.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.019","url":null,"abstract":"<p><p>Percutaneous catheter ablation in interventional cardiac electrophysiology has evolved over the past several decades. Technologic advances and evolving procedural strategies have improved procedural efficiencies, increased success rates, and lowered complication rates. These advances have increased the ability to treat more patients successfully; however, limitations to access have grown. Access challenges (exacerbated during the COVID-19 public health emergency) and economic pressures have driven a shift in practice trends to reduce hospitalization duration and optimize resource utilization. A same-day discharge (SDD) strategy has increasingly been used to address these challenges. Incorporating a SDD strategy has recently been supported by global clinical studies (demonstrating proof of concept) and real-world evidence/United States Centers for Medicare & Medicaid Services claims data (characterizing a low incidence of complications and need for readmission/emergency department visits). This document analyzes available global clinical data and real-world evidence examining the impact of a cardiac ablation SDD strategy on patient safety, patient access, operational efficiencies, and health care expenditures. Recommended best practices will also be characterized built on the foundation of a shared decision-making strategy that optimizes patient safety, comfort, and procedural outcomes. As clinical flow paradigms evolve with alternate sites of care (ie, ambulatory surgery centers), real-world registries to track outcomes should inform future decision-making.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003480","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}