JACC. Clinical electrophysiology最新文献

{"title":"Computed Tomography–Defined Ridges and Functional Mapping in Ablation of Postinfarction Ventricular Tachycardia","authors":"Laurens Verhaeghe MD, Geoffroy Ditac MD, Hubert Cochet MD, PhD, Michael Ghannam MD, Mélèze Hocini MD, Pierre Jaïs MD, Frédéric Sacher MD, PhD, Frank Bogun MD, PhD","doi":"10.1016/j.jacep.2026.07.011","DOIUrl":"10.1016/j.jacep.2026.07.011","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2597-2599"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793150","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":"From QRS Duration to Correctable Dyssynchrony","authors":"Ugur Canpolat MD","doi":"10.1016/j.jacep.2026.07.033","DOIUrl":"10.1016/j.jacep.2026.07.033","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2605-2607"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257664","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":"Proteomic Signatures Associated With Life-Threatening Arrhythmic Events in Brugada Syndrome","authors":"Motoki Furutani MD, PhD, Mika Nakashima BS, Shogo Miyamoto MD, PhD, Shunsuke Miyauchi MD, PhD, Sho Okamura MD, PhD, Yousaku Okubo MD, PhD, Takehito Tokuyama MD, PhD, Noboru Oda MD, PhD, Daichi Shigemizu PhD, Yukiko Nakano MD, PhD","doi":"10.1016/j.jacep.2026.06.027","DOIUrl":"10.1016/j.jacep.2026.06.027","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2590-2592"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257929","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":"CA in AF With LVSD With and Without LV Fibrosis","authors":"Louise Segan MBBS, MPH, PhD,&nbsp;Peter M. Kistler MBBS, PhD,&nbsp;Kenneth Cho MBBS,&nbsp;Shane Nanayakkara MBBS, PhD,&nbsp;David M. Kaye MBBS, PhD,&nbsp;Benedict Costello MBBS, PhD,&nbsp;Hitesh Patel MBBS, PhD,&nbsp;Hariharan Sugumar MBBS, PhD,&nbsp;Aleksandr Voskoboinik MBBS, PhD,&nbsp;Liang-Han Ling MBBS, PhD,&nbsp;Richard Schilling MBBS, MRCP, MD,&nbsp;Manuja Premaratne MBBS, PhD,&nbsp;Joseph B. Morton MBBS, PhD,&nbsp;Jonathan M. Kalman MBBS, PhD,&nbsp;Sandeep Prabhu MBBS, PhD","doi":"10.1016/j.jacep.2026.04.028","DOIUrl":"10.1016/j.jacep.2026.04.028","url":null,"abstract":"<div><h3>Background</h3><div>Catheter ablation (CA) improves outcomes in atrial fibrillation (AF) with left ventricular systolic dysfunction (LVSD), but the influence of LV fibrosis remains unclear.</div></div><div><h3>Objectives</h3><div>This study sought to compare outcomes of CA in patients with AF and LVSD stratified by the presence or absence of LV late gadolinium enhancement (LGE) on cardiac magnetic resonance.</div></div><div><h3>Methods</h3><div>Patients from the CAMERA-MRI II (Catheter Ablation Versus Medical Rate Control of the Atrial Fibrillation With Systolic Heart Failure and Myocardial Fibrosis—an MRI Guided Multi-Centre Randomised Controlled Clinical Trial) randomized study were classified as LGE positive (LV LGE burden ≥5%) or LGE negative (&lt;5%) and all underwent CA. Outcomes at 12 months included change in left ventricular ejection fraction (LVEF), LVEF normalization, AF burden, functional capacity, and heart failure hospitalization.</div></div><div><h3>Results</h3><div>Eighty patients underwent CA (40 LGE positive and 40 LGE negative). Both groups demonstrated substantial improvement in LVEF (LGE positive: ΔLVEF +20.3 ± 11.0%; LGE negative: +21.7 ± 11.8%; <em>P</em> = 0.578 for between-group difference in change). Unadjusted 12-month LVEF was lower in LGE-positive patients (49.1 ± 11.3% vs 54.5 ± 9.0%; <em>P</em> = 0.019); however, after adjustment for baseline cardiac magnetic resonance and markers of baseline disease severity, LGE status was not independently associated with 12-month LVEF (<em>P</em> = 0.849). Fewer LGE-positive patients achieved LVEF normalization (LVEF ≥50% in 52% vs 82% in LGE negative; <em>P</em> = 0.004), whereas arrhythmia-free survival and AF burden reduction were comparable. Improvements in biomarkers, functional status, and quality of life occurred in both groups. Higher LGE burden (&gt;20%) was associated with attenuated LVEF recovery.</div></div><div><h3>Conclusions</h3><div>In AF with LVSD, CA is associated with substantial improvement in LV systolic function and clinical status regardless of LGE status. Absolute 12-month LVEF and normalization rates are lower in LGE-positive patients, consistent with greater baseline disease severity, whereas higher scar burden appears to modulate the magnitude of recovery and may inform expectations regarding outcomes.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2477-2488"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163012","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":"Not All Lesions Are Created Equal","authors":"Jeanne du Fay de Lavallaz MD, PhD,&nbsp;Jackson J. Liang DO","doi":"10.1016/j.jacep.2026.05.029","DOIUrl":"10.1016/j.jacep.2026.05.029","url":null,"abstract":"<div><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (219KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span></figure></span></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2474-2476"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360436","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":"Catheter Ablation for Atrial Fibrillation in Patients With Left Ventricular Dysfunction","authors":"Saman Nazarian MD, PhD","doi":"10.1016/j.jacep.2026.07.016","DOIUrl":"10.1016/j.jacep.2026.07.016","url":null,"abstract":"<div><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (147KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span></figure></span></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2489-2492"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840239","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 Predictive Value of Impedance for Defibrillation Success After S-ICD Implantation","authors":"Jolien A. de Veld MD,&nbsp;Mikhael F. El-Chami MD,&nbsp;Christelle Marquie MD,&nbsp;Pier D. Lambiase BCH, BM, MBChB, PhD,&nbsp;Lucas V.A. Boersma MD, PhD,&nbsp;Martin C. Burke DO,&nbsp;Anouk de Weger MSc,&nbsp;Leonard A. Dijkshoorn MD,&nbsp;Mashhour Hosny MD,&nbsp;Timothy R. Betts MD,&nbsp;Marc A. Miller MD,&nbsp;Jürgen Kuschyk MD,&nbsp;Hendrik Bonnemeier MD, PhD,&nbsp;Louise R.A. Olde Nordkamp MD, PhD,&nbsp;Serge Boveda MD, PhD,&nbsp;Arthur A.M. Wilde MD, PhD,&nbsp;Lonneke Smeding PhD,&nbsp;Reinoud E. Knops MD, PhD","doi":"10.1016/j.jacep.2026.05.004","DOIUrl":"10.1016/j.jacep.2026.05.004","url":null,"abstract":"<div><h3>Background</h3><div>The subcutaneous implantable cardioverter-defibrillator is a completely extrathoracic device, making implantation position crucial. This can be evaluated using the PRAETORIAN score, but defibrillation testing (DFT) is currently recommended. There is a trend in replacing DFT with impedance. However, there are situations in which impedance can give a false sense of security.</div></div><div><h3>Objectives</h3><div>This study sought to compare predictive values of impedance and the PRAETORIAN score for DFT success.</div></div><div><h3>Methods</h3><div>The multicenter PRAETORIAN-DFT (A Randomised Trial of S-ICD Implantation With and Without Defibrillation Testing) Trial randomized 965 patients between DFT and PRAETORIAN score calculation after subcutaneous implantable cardioverter-defibrillator implantation. DFT was successful if the ventricular arrhythmia converted to sinus rhythm or atrial fibrillation within 5 seconds from 65J shock delivery within 2 inductions. Predictive values of impedance and PRAETORIAN score were calculated, using a cutoff of 90 for both values.</div></div><div><h3>Results</h3><div>Overall, 457 patients underwent DFT according to protocol. DFT was successful in 445 patients and unsuccessful in 12. The failed DFT group had significantly higher impedance (median: 87 [Q1-Q3: 63-108] vs 68 [Q1-Q3: 57-78]; <em>P</em> = 0.014). Impedance &lt;90 ohms had a negative predictive value (NPV) of 98% for successful DFT, but only one-half of failed DFTs had an impedance ≥90 ohms (sensitivity 50%). A PRAETORIAN score &lt;90 had a NPV of 99% with a sensitivity of 70%. In addition, the PRAETORIAN score had a higher positive likelihood ratio and a lower negative likelihood ratio compared with impedance.</div></div><div><h3>Conclusions</h3><div>Impedance &lt;90 ohms predicts DFT success with a NPV of 98% but misses 50% of DFT failures and is therefore an insufficient surrogate for DFT. Impedance might serve as an intraoperative tool to estimate correct implant position, but this should always be confirmed with imaging to ensure effective shock delivery. (A Randomised Trial of S-ICD Implantation With and Without Defibrillation Testing [PRAETORIAN-DFT]; <span><span>NCT03495297</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2558-2568"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225381","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":"Nanosecond Pulsed-Field Ablation Reduces Neuromuscular Stimulation and Widens the Safety Window","authors":"Rongrong Liu BE,&nbsp;Yuyi Guo PhD,&nbsp;Jinlin Gong BE,&nbsp;Qun Wang PhD,&nbsp;Qiancheng Zhao PhD,&nbsp;Fukun Shi PhD,&nbsp;Jinsong Guo PhD,&nbsp;Junfeng Rao PhD,&nbsp;Jian Zhou MD,&nbsp;Guomin Wang PhD,&nbsp;Jie Zhuang PhD","doi":"10.1016/j.jacep.2026.04.023","DOIUrl":"10.1016/j.jacep.2026.04.023","url":null,"abstract":"<div><h3>Background</h3><div>Microsecond pulsed field ablation (PFA) is limited by severe neuromuscular stimulation (NMS). Nanosecond PFA (nsPFA) is a promising alternative, but quantitative comparisons of NMS under matched energy conditions are lacking.</div></div><div><h3>Objectives</h3><div>This study sought to quantitatively compare NMS intensity between energy-matched microsecond PFA (μsPFA) and nsPFA, and to evaluate the dose-response of NMS for both modalities.</div></div><div><h3>Methods</h3><div>A total of 6 dogs underwent randomized pulmonary vein isolation (PVI) and atrial ablation with μsPFA or nsPFA at matched high (358.2 J) and low (108.9 J) energy. NMS was precisely quantified using inertial measurement units to measure acceleration, angular velocity, and contraction energy. Ablation effectiveness was assessed via acute PVI and 14-day histology.</div></div><div><h3>Results</h3><div>All high-dose protocols for both modalities achieved 100% acute PVI and transmural lesions. NMS, however, differed profoundly. μsPFA induced contractions in 100% of applications, whereas nsPFA induced 0% at low doses and 61.5% at high doses. At high doses, μsPFA produced 1.89-fold greater peak acceleration (<em>P</em> &lt; 0.001) than nsPFA. μsPFA also produced approximately twice as many contraction events as nsPFA (<em>P</em> = 0.006). Although peak NMS metrics increased with dose for both modalities, the absolute NMS intensity of high-dose nsPFA remained lower than even low-dose μsPFA. Notably, nsPFA contraction energy did not reach statistical significance despite higher energy delivery (<em>P</em> = 0.145), whereas μsPFA showed a significant surge (<em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>nsPFA effectively achieves acute PVI and transmural lesions while markedly reducing NMS compared with μsPFA. Its attenuated dose-response and lower absolute stimulation magnitude provide a wider safety window, potentially allowing for higher-energy delivery to optimize therapeutic effectiveness without compromising patient tolerance.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2453-2464"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163086","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 Lazarus Protocol: Rescue Catheter Ablation of Incessant Ventricular Fibrillation by Purkinje Substrate Denetworking in Critically Ill Patients With Ischemic Cardiomyopathy.","authors":"Choudhary Anwar Ahmed Chahal, Kristian Galanti, Mohamad AlKhayat, Nishi Patel, Meghan Christie, Danielle Notarangelo, Pasquale Santangeli, Frank Bogun, Mélèze Hocini, Edmond Obeng-Gyimah","doi":"10.1016/j.jacep.2026.08.006","DOIUrl":"10.1016/j.jacep.2026.08.006","url":null,"abstract":"<p><p>We report a case series of 3 critically ill patients with refractory incessant ventricular fibrillation (VF) who underwent catheter ablation using high-density mapping of the Purkinje system during ongoing VF, combined with targeted Purkinje denetworking and myocardial substrate modification. All patients were supported with advanced mechanical circulatory support, including venoarterial extracorporeal membrane oxygenation or venoarterial extracorporeal membrane oxygenation with Impella support, and procedures were guided by electroanatomic mapping with multimodality imaging integration. Purkinje potentials and abnormal electrograms within infarcted and border-zone myocardium were targeted, resulting in restoration and maintenance of sinus rhythm with no inducible ventricular arrhythmias after ablation. These findings suggest that, in carefully selected patients, combined Purkinje-targeted ablation and substrate modification may provide a life-saving rescue strategy for otherwise refractory incessant VF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109812","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":"High-Voltage Nanosecond Pulse Field Ablation Using a Compliant Circular Catheter to Treat Atrial Fibrillation","authors":"Vivek Y. Reddy MD,&nbsp;Jan Petru MD,&nbsp;Johan Vijgen MD,&nbsp;Mohit Turagam MD,&nbsp;Jacob S. Koruth MD,&nbsp;Moritoshi Funasako MD,&nbsp;Pavel Hala MD,&nbsp;Pieter Koopman MD,&nbsp;Jan Skoda MD,&nbsp;Giuseppe Stifano MD,&nbsp;Mirco Vincenzo La Fazia MD,&nbsp;David Kenigsberg MD,&nbsp;Andrea Natale MD,&nbsp;Petr Neuzil MD, PhD","doi":"10.1016/j.jacep.2026.04.012","DOIUrl":"10.1016/j.jacep.2026.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Most pulsed field ablation (PFA) technologies for atrial fibrillation use microsecond-scale pulses. Nanosecond pulses, by virtue of their short duration, enable larger pulse amplitudes to project lesion depth, without near-field thermal effects.</div></div><div><h3>Objectives</h3><div>The goal of this study was to determine the outcomes of treating paroxysmal atrial fibrillation using a novel circular nanosecond PFA (nsPFA) catheter.</div></div><div><h3>Methods</h3><div>In a first-in-human study of patients with symptomatic paroxysmal atrial fibrillation, the nsPFA catheter was used to deliver 2.5-second or 5-second applications. Invasive remapping assessed lesion durability at 2 to 3 months, with additional nsPFA for incomplete lesions. Follow-up included transtelephonic monitoring and Holter monitoring at 6 and 12 months.</div></div><div><h3>Results</h3><div>At 3 centers, 177 patients (mean age 61 ± 10 years; 36% female; left atrial diameter 41 ± 5 mm) underwent pulmonary vein isolation (PVI) using 2.5-second (n = 36 patients) or 5-second (n = 141) applications. Additional ablation was at the posterior wall (n = 87), cavotricuspid isthmus (n = 11), or mitral isthmus (n = 29). All (100%) lesions were acutely successful, with transpired PVI time of 12 ± 5 minutes, and total left atrial dwell time for the nsPFA catheter of 19 ± 13 minutes. Total procedure and fluoroscopy times were 61 ± 27 minutes and 9 ± 6 minutes, respectively. Three (of 177 [1.7%]) primary serious adverse events occurred: inflammatory pericardial effusion, hemolysis with acute kidney injury, and stroke. Post procedure brain magnetic resonance imaging (35 patients) revealed 11.4% silent cerebral events (DWI+ / ADC-reduced) and 11.4% silent cerebral lesions (SCE plus FLAIR+). PVI durability with the 5-second applications was 91%. The 1-year estimate for freedom from atrial arrhythmia was 89.7% (95% CI: 80.5%-94.6%).</div></div><div><h3>Conclusions</h3><div>nsPFA demonstrated reasonable safety, good lesion durability, and favorable 1-year clinical effectiveness. (Evaluation of the CellFX® Nano-Pulsed Field Ablation [PFA] 360 Catheter Endocardial Ablation System for the Treatment of Atrial Fibrillation; <span><span>NCT06696170</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2370-2384"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005386","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}