JACC. Clinical electrophysiology最新文献

{"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}

{"title":"The Relevance of the Type of Ventricular Arrhythmia in Titin-Related Dilated Cardiomyopathy: A Multicenter Study.","authors":"Micaela Ebert, Marta de Riva, Adrianus P Wijnmaalen, Daniela Q C M Barge-Schaapveld, Marianne Bootsma, Jarieke Hoogendoorn, Daniela Husser, J Peter van Tintelen, Jan D H Jongbloed, Sergio Richter, Antonio Berruezo, Gerhard Hindricks, William G Stevenson, Katja Zeppenfeld","doi":"10.1016/j.jacep.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.010","url":null,"abstract":"<p><strong>Background: </strong>Truncating titin variants (TTNtvs) are the most prevalent cause of inherited dilated cardiomyopathy. Occurrence of different ventricular arrhythmia (VA) subtypes, including premature ventricular complexes (PVCs), nonsustained ventricular tachycardia (NSVT), and sustained monomorphic VT (SMVT), has been reported.</p><p><strong>Objectives: </strong>The aim of this study was to analyze the prognostic relevance of distinct VA subtypes among TTNtv carriers and their underlying arrhythmogenic substrates.</p><p><strong>Methods: </strong>Twenty-two TTNtv carriers referred for ablation of SMVT (n = 14) or frequent PVCs (n = 8) from 5 centers were included (mean age 56 ± 11 years; left ventricular ejection fraction 38% ± 13%; 77% male). Detailed phenotyping was performed, including Holter monitoring, cardiac imaging, and electroanatomical mapping. Patients were followed up for a median of 44 months.</p><p><strong>Results: </strong>Demographic characteristics, including age, comorbidities, and left ventricular ejection fraction, were similar. NSVTs were frequent in both groups but faster in patients with SMVT (cycle length: 350 milliseconds [Q1-Q3: 315-403 milliseconds] vs 427 milliseconds [Q1-Q3: 395-469 milliseconds]). Although substrates for SMVT extended in a basal ring-like fashion with septal predominance, PVC sites of origin were limited to the basal anterior left ventricular segment. In the SMVT group, acute complete procedural success was achieved for 36%; during follow-up, 86% had recurrent VT, and 50% died of progressive heart failure. In the PVC group, complete abolition of PVCs was achieved in only 13%; at 3 months, median PVC burden was 1%, and there were no deaths or sustained VT during follow-up. VA subtype and NSVT cycle length were associated with mortality and poor VT-free survival.</p><p><strong>Conclusions: </strong>In TTNtv carriers, SMVTs but not frequent PVCs are associated with high mortality due to heart failure. Occurrence of SMVT may identify a subgroup at risk for rapid, progressive adverse remodeling. The prognostic significance of different VA subtypes needs to be confirmed in a larger cohort.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634016","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 Efficacy of Left Atrial vs Biatrial Cardioneuroablation in Patients With Vasovagal Syncope: A Randomized Clinical Trial.","authors":"Bin Tu, Aiyue Chen, Simin Cai, Zhuxin Zhang, Likun Zhou, Zihao Lai, Pakezhati Maimaitijiang, Zhicheng Hu, LingMin Wu, Ligang Ding, Lihui Zheng, Yan Yao","doi":"10.1016/j.jacep.2025.01.019","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.019","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation has been proposed to be effective in patients with vasovagal syncope, whereas the preferred ablation strategy is undetermined.</p><p><strong>Objectives: </strong>This study aimed to determine the preferred ablation strategy of cardioneuroablation between the left atrial (LA) and the bilateral atrial (BiA) approach.</p><p><strong>Methods: </strong>This study was a prospective randomized clinical trial to compare the efficacy of 2 ablation strategies for patients with vasovagal syncope. The participants were randomly assigned to either the LA or BiA ganglion plexus ablation group in a 1:1 ratio.</p><p><strong>Results: </strong>Eighty participants (37 men [46.2%]; age 38 ±16 years) were enrolled, with 40 participants in each group. The efficacy was 87.5% in the LA group (95% CI: 76.8 to 98.2%) and 90% (95% CI: 80.7 to 99.7%) in the BiA group (P = 0.723; P for noninferiority = 0.001). Compared to the BiA group, LA group reduced the average procedure time by 13 minutes (95% CI: 6-20 minutes), the average x-ray dosage by 5.7 mGy (95% CI: 2.1-9.3 mGy), the average ablation lesions by 4 (95% CI: 2-6), and ablation time by 125 seconds (95% CI: 60-190 seconds). No significant difference was observed in presyncope recurrence rate (15% vs 10%; P = 0.498), quality of life (78.7 ± 13.6 vs 80.9 ± 10.6; P = 0.417), mean heart rate (79 ± 11 vs 77 ± 9; P = 0.391), and response to head-up tilt test (57.1% vs 62.2%; P = 0.664) between groups at 12 months.</p><p><strong>Conclusions: </strong>The LA approach's efficacy was noninferior to the BiA approach, whereas the LA approach showed the added benefit of reduced procedure time, a smaller ablation lesion, and smaller x-ray dosage. (Different Catheter Ablation Strategy in Vasovagal Syncope; NCT05573178).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673866","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 Peculiar Pattern of Preexcitation.","authors":"Shohei Kataoka, Jakrin Kewcharoen, Henry H Hsia, Eduardo Back Sternick, Edward P Gerstenfeld, Melvin M Scheinman","doi":"10.1016/j.jacep.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.004","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633953","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":"Age-Associated Perinexal Narrowing Masks Consequences of Sodium Channel Gain of Function in Guinea Pig Hearts.","authors":"Xiaobo Wu, David Ryan King, Gregory S Hoeker, Xiaoping Wan, Isabelle Deschenes, Scott R Johnstone, Robert G Gourdie, Seth H Weinberg, Steven Poelzing","doi":"10.1016/j.jacep.2024.12.027","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.027","url":null,"abstract":"<p><strong>Background: </strong>Voltage-gated sodium channel gain of function (Na_vGOF) is associated with an elevated risk for cardiac arrhythmia. Recent studies have demonstrated that Na_vGOF can be exacerbated by widening the sodium channel-rich perinexus next to gap junction plaques. Clinically, the incidence of Na_vGOF-related cardiac events increases with advancing age. However, the impact of aging on perinexal changes and contribution to age-related risk for arrhythmias in Na_vGOF remains unclear.</p><p><strong>Objectives: </strong>The aim of this study was to test the hypothesis that age-related increase in arrhythmogenic risk is associated with perinexal remodeling in a model of Na_vGOF.</p><p><strong>Methods: </strong>Na_vGOF was pharmacologically induced in isolated adult (3 months, n = 17) and aged (15 months, n = 19) guinea pig hearts. Epicardial action potentials were optically mapped, and age-associated perinexal remodeling was measured with transmission electron microscopy.</p><p><strong>Results: </strong>Na_vGOF electrical phenotypes were comparable between adult and aged hearts despite their exacerbation after perinexal widening. The similarity in these phenotypes may be masked by the narrower perinexus with aging. Furthermore, perinexal widening led to a high incidence of arrhythmias in aged Na_vGOF hearts, whereas no arrhythmias were induced in adult Na_vGOF hearts. This increased incidence of arrhythmias in aged Na_vGOF hearts following perinexal widening may be associated with the increased dispersions of epicardial action potential duration and transmural repolarization.</p><p><strong>Conclusions: </strong>Perinexal widening exacerbates arrhythmogenic propensity with age, primarily by heterogeneously increasing action potential duration, whereas perinexal narrowing appears to be adaptive and cardio protective in the context of Na_vGOF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567124","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 Death Without Known Cardiovascular Disease: A Call to Action.","authors":"Neal A Chatterjee","doi":"10.1016/j.jacep.2025.01.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.021","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673863","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":"Junctions Speak in Volumes: The Role of the Intercellular Space in Cardiac Cell-Cell Propagation.","authors":"Mario Delmar, Xianming Lin","doi":"10.1016/j.jacep.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567132","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":"Pulsed-Field vs Thermal Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.","authors":"Samy Gribissa, Thomas Kueffer, Sven Knecht, Xavier Waintraub, Nicolas Badenco, Philippe Charron, Pauline Pinon, Raphael King, Estelle Gandjbakhch, Guillaume Duthoit, Christian Sticherling, Tobias Reichlin, Mikael Laredo","doi":"10.1016/j.jacep.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.009","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).</p><p><strong>Objectives: </strong>The goal of this study was to compare the safety and efficacy of PFA and thermal ablation in patients with HCM and AF.</p><p><strong>Methods: </strong>From 2016 to 2024, patients with HCM undergoing a first AF ablation using PFA or thermal ablation (cryoballoon or radiofrequency) were retrospectively included from 3 French and Swiss centers. Freedom from atrial arrhythmia (AA) recurrence at the 12-month follow-up was assessed.</p><p><strong>Results: </strong>Overall, 109 patients (median age 60 years; 68% male; 43% paroxysmal AF) with HCM underwent PFA (n = 58) or thermal ablation (n = 51) of AF. In addition to pulmonary vein (PV) isolation, extra-PV ablation was performed in 62% of PFA cases and in 18% of thermal cases. PFA was associated with shorter median procedure times than thermal ablation (81 minutes [Q1-Q3: 60-110 minutes] vs 132 minutes [Q1-Q3: 75-190 minutes]; P < 0.0001) and with less postprocedural heart failure (n = 0 vs n = 4; P = 0.03). Freedom from AA recurrence was 57% (95% CI: 46%-67%) after 12 months. PFA was associated with less AA recurrence than thermal ablation (adjusted HR: 0.46; 95% CI: 0.23-0.91; P = 0.03). Extra-PV ablation was associated with more sustained AA recurrence with thermal ablation (HR: 3.07; 95% CI: 1.21-7.82; P = 0.02) but not with PFA (HR: 1.07; 95% CI: 0.35-3.27; P = 0.91).</p><p><strong>Conclusions: </strong>In patients with HCM and AF, PFA seems to be associated with better safety and efficacy outcomes than thermal ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633955","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}