JACC. Clinical electrophysiology最新文献

{"title":"Outcomes of Patients With Reduced Left Ventricular Function Undergoing Left Atrial Appendage Occlusion","authors":"Angela Y. Higgins MD,&nbsp;Chien-Yu Huang PhD,&nbsp;Sarah Zimmerman MS,&nbsp;Daniel J. Friedman MD,&nbsp;Maxwell E. Afari MD,&nbsp;Jordan Leyton-Mange MD,&nbsp;Dhanunjaya R. Lakkireddy MD,&nbsp;Moussa Mansour MD,&nbsp;Richa Sharma MD, MPH,&nbsp;Amit N. Vora MD, MPH,&nbsp;Kamil F. Faridi MD, MSc,&nbsp;James V. Freeman MD, MPH, MS","doi":"10.1016/j.jacep.2026.04.004","DOIUrl":"10.1016/j.jacep.2026.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter left atrial appendage occlusion (LAAO) is an alternative treatment to prevent stroke in patients with atrial fibrillation. Patients with reduced left ventricular ejection fraction (LVEF) represent a particularly high-risk population for stroke, but data on LAAO for these patients are limited.</div></div><div><h3>Objectives</h3><div>The objective of this study was to evaluate outcomes after LAAO stratified according to LVEF (&lt;30%, 30%-39%, 40%-49%, and ≥50%).</div></div><div><h3>Methods</h3><div>The National Cardiovascular Data Registry LAAO Registry was used to identify patients ≥18 years of age with a documented LVEF who underwent LAAO from December 2015 to December 2023. Outcomes through 1 year stratified according to LVEF were evaluated by using adjusted logistic regression and Cox proportional hazards regression (reference group: LVEF ≥50%).</div></div><div><h3>Results</h3><div>The study included 186,085 patients (5,192 [2.8%] with an LVEF &lt;30%). There was no difference in procedural success (98.0% for LVEF &lt;30% vs 98.1% for LVEF ≥50%; <em>P</em> = 0.12) or in-hospital mortality for LVEF &lt;30% (adjusted OR: 1.39; 95% CI: 0.76-2.55). At 1 year, there was no difference in any stroke (adjusted HR: 1.10; 95% CI: 0.88-1.37) or ischemic stroke/arterial thromboembolism (adjusted HR: 1.26; 95% CI: 0.94-1.68) for patients with LVEF &lt;30% compared with LVEF ≥50%. All-cause mortality was significantly increased for every 10% reduction in LVEF at 1 year, with the highest risk in those with an LVEF &lt;30% (adjusted HR: 1.93; 95% CI: 1.75-2.12).</div></div><div><h3>Conclusions</h3><div>For patients with a reduced LVEF, there was no significant difference in procedural success or major in-hospital complications. There was also no significant difference in stroke through 1 year of follow-up. Patients with a reduced LVEF had higher 1-year mortality, consistent with the known prognosis of patients with heart failure with reduced LVEF. These findings suggest that LAAO is reasonably safe and effective for selected patients with low LVEF, although the net clinical benefit may be attenuated due to the high risk of mortality.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2503-2515"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054400","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":"Left Ventricular Pseudoaneurysm Following Mitral Annular Radiofrequency Ablation","authors":"Charles Audiat MD,&nbsp;Giampaolo Vetta MD,&nbsp;Jan Remes MD,&nbsp;Silvia Solari MD,&nbsp;Sibille Lejeune MD, PhD,&nbsp;Domenico Giovanni Della Rocca MD, PhD,&nbsp;Alexandre Almorad MD, PhD","doi":"10.1016/j.jacep.2026.06.031","DOIUrl":"10.1016/j.jacep.2026.06.031","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2629-2632"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630508","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":"Successful Ablation of a Posteroseptal Accessory Pathway in a Right Ventricular Diverticulum","authors":"Yingchuan Yan MSc,&nbsp;Dongyang Long PhD (Candidate),&nbsp;Fan Zhang MSc,&nbsp;Fengqi Xuan MD,&nbsp;Shaobo Fan MSc,&nbsp;Jie Zhang MSc,&nbsp;Jun Ding MSc,&nbsp;Wei Ma MD, PhD","doi":"10.1016/j.jacep.2026.06.042","DOIUrl":"10.1016/j.jacep.2026.06.042","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2637-2641"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673882","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":"CMR Detected Atrial Structural and Functional Remodeling in AF HFrEF","authors":"Kenneth K. Cho MBBS, MPhil,&nbsp;Louise Segan MBBS, PhD,&nbsp;Peter M. Kistler MBBS, PhD,&nbsp;Chris Anthony MBBS, PhD,&nbsp;Sarah Gutman MBBS, PhD,&nbsp;Ben Costello MBBS, PhD,&nbsp;James Hare MBBS, PhD,&nbsp;Jeremy B. William MBBS,&nbsp;Rose F. Crowley MD,&nbsp;David Chieng MBBS, PhD,&nbsp;Nicholas D'Elia MBBS,&nbsp;Hariharan Sugumar MBBS, PhD,&nbsp;Liang-Han Ling MBBS, PhD,&nbsp;Aleksandr Voskoboinik MBBS, PhD,&nbsp;Joseph B. Morton MBBS, PhD,&nbsp;Geoffrey Lee MBBS, PhD,&nbsp;Alex J. McLellan MBBS, PhD,&nbsp;Sonia Azzopardi RN,&nbsp;Annie Curtin RN,&nbsp;Kevin Cheung MD,&nbsp;Sandeep Prabhu MBBS, PhD","doi":"10.1016/j.jacep.2026.04.034","DOIUrl":"10.1016/j.jacep.2026.04.034","url":null,"abstract":"<div><h3>Background</h3><div>Atrial remodeling is pathological in heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The impact of catheter ablation (CA) compared with medical rate control (MRC) for contractile atrial function in AF HFrEF patients, and its effect on exercise capacity has not been explored.</div></div><div><h3>Objectives</h3><div>This study aimed to assess cardiac magnetic resonance changes in biatrial parameters and exercise capacity in AF HFrEF patients from the CAMERA-MRI (Catheter Ablation Versus Medical Rate Control of Atrial Fibrillation) and CAMERA-MRI II (Catheter Ablation Versus Medical Rate Control of Atrial Fibrillation with Systolic Heart Failure and Myocardial Fibrosis) multicenter studies, comparing CA to MRC.</div></div><div><h3>Methods</h3><div>Biatrial parameters (atrial ejection fraction [EF], indexed volumes) were assessed by serial cardiac magnetic resonance (baseline and ≥6 months). Exercise capacity was assessed by serial 6-minute walk test (6MWT).</div></div><div><h3>Results</h3><div>In total, 123 patients (age 60.7 ± 11.1 years, 17 women, 82 CA, 41 MRC) were included. Baseline atrial measurements and 6MWT distance were similar between groups. CA patients had reverse remodeling of all structural and functional biatrial parameters (<em>P &lt;</em> 0.001), with no change in any parameters for MRC. On multivariable analysis, Δ left atrial emptying fraction (LAEF) (95% CI: 0.23-0.54; <em>P</em> &lt; 0.001) and AF burden (95% CI: −0.16 to −0.01; <em>P =</em> 0.020) remained independently associated with Δ left ventricular (LV) EF, whereas sinus rhythm at follow-up was no longer significant <em>(P =</em> 0.865). 6MWT improved in 20 (48.8%) MRC vs 63 (76.8%) CA patients <em>(P =</em> 0.002). Univariable predictors of Δ6MWT included ΔLAEF (R = 0.27; 95% CI: 0.52-2.47; <em>P</em> = 0.003), ΔLVEF (R = 0.23; 95% CI: 0.33-2.52; <em>P</em> = 0.011), and AF burden (R = 0.27; 95% CI: −1.15 to −0.19; <em>P</em> = 0.007), but none remained significant on multivariable analysis.</div></div><div><h3>Conclusions</h3><div>Sinus rhythm restoration with CA, along with reduction in biatrial size, led to increases in biatrial EF compared with MRC. AF burden, over the binary endpoint of rhythm at follow-up, better predicted changes in LAEF, functional status, and LVEF. LAEF predicts improvements in LVEF over the endpoint of sinus rhythm at follow-up, suggesting that restoration of atrial contractile function is a key feature of recovery in HFrEF.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2493-2502"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277504","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":"PVI Durability After PFA or RFA in Persistent-AF","authors":"Oskar M. Galuszka MD,&nbsp;Thomas Kueffer PhD,&nbsp;Samuel H. Baldinger MD,&nbsp;Helge Servatius MD,&nbsp;Claudia Herrera Siklódy MD,&nbsp;Nikola Kozhuharov MD,&nbsp;Gregor Thalmann MD, PhD,&nbsp;Antonio Madaffari MD,&nbsp;Andreas Haeberlin MD, PhD,&nbsp;Fabian Noti MD,&nbsp;Hildegard Tanner MD,&nbsp;Tobias Reichlin MD,&nbsp;Laurent Roten MD","doi":"10.1016/j.jacep.2026.04.027","DOIUrl":"10.1016/j.jacep.2026.04.027","url":null,"abstract":"<div><h3>Background</h3><div>Durable pulmonary vein isolation (PVI) is the primary objective of atrial fibrillation (AF) ablation, yet reconnections are common and non-PV mechanisms may drive recurrence in persistent AF.</div></div><div><h3>Objectives</h3><div>This study sought to compare PVI durability and arrhythmia recurrence between pulsed field ablation (PFA) and radiofrequency ablation (RFA) in persistent AF patients.</div></div><div><h3>Methods</h3><div>Persistent AF patients undergoing PVI were prospectively enrolled, with a mandatory remapping procedure performed after 6 months regardless of recurrence. RFA was used in phase 1 (n = 30) and PFA was used in phase 2 (n = 30). Patients were followed with 7-day Holter electrocardiograms after 3, 6, and 12 months. Primary and secondary endpoints were PVI durability and arrhythmia recurrence.</div></div><div><h3>Results</h3><div>Of 60 enrolled patients, 51 underwent the mandated remapping procedure after a median of 7.2 months (mean age 68 years; 82% male). PVI was durable in 78 of 102 PVs (76%) with RFA and in 82 of 104 PVs (79%) with PFA (adjusted OR: 1.20; 95% CI: 0.37-3.88; <em>P</em> = 0.77), with lowest durability in the right superior PV (PFA 72%; RFA 69%). All PVs were durably isolated in 26 patients (51%). Of 26 patients (51%) with durably isolated PVs, 9 (35%) experienced AF recurrence prior to the remapping procedure. Of 25 patients (49%) with reconnected PVs, 7 (28%) experienced AF recurrence. At 1-year follow-up, freedom from recurrence after mandated redo procedure was 70% with no difference between the 2 ablation technologies (adjusted HR: 0.80; 95% CI: 0.24-2.64; <em>P</em> = 0.71).</div></div><div><h3>Conclusions</h3><div>In patients with persistent AF, PFA demonstrated PVI durability comparable to RFA. Arrhythmia recurrence occurred in a substantial proportion of patients with durable PVI, suggesting a role for non-PV mechanisms.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2439-2449"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338548","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":"V-V-A Response in Fast-Slow AVNRT With a Bystander Concealed Nodoventricular Pathway","authors":"Hironori Nakamura MD, PhD,&nbsp;Hidehira Fukaya MD, PhD,&nbsp;Megumi Toraiwa MD,&nbsp;Wataru Shinkai MD,&nbsp;Shuhei Kobayashi MD, PhD,&nbsp;Yuki Arakawa MD, PhD,&nbsp;Naruya Ishizue MD, PhD,&nbsp;Jun Kishihara MD, PhD,&nbsp;Jun Oikawa MD, PhD,&nbsp;Junya Ako MD, PhD","doi":"10.1016/j.jacep.2026.06.032","DOIUrl":"10.1016/j.jacep.2026.06.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2633-2636"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673963","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":"Ablation of Typical Right Atrial Flutter Through the Arm","authors":"Aneesh Tolat MD,&nbsp;Gregory Panza PhD,&nbsp;Craig Moskowitz MD,&nbsp;Meir Friedman MD,&nbsp;Steven Zweibel MD","doi":"10.1016/j.jacep.2026.07.024","DOIUrl":"10.1016/j.jacep.2026.07.024","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages 2600-2602"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891361","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":"Full Issue PDF","authors":"","doi":"10.1016/S2405-500X(26)00924-2","DOIUrl":"10.1016/S2405-500X(26)00924-2","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 10","pages":"Pages I-CCXC"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149252001","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":"Beyond the Surface","authors":"John Silberbauer MA MD(Res),&nbsp;Tarvinder Dhanjal PhD","doi":"10.1016/j.jacep.2026.06.007","DOIUrl":"10.1016/j.jacep.2026.06.007","url":null,"abstract":"<div><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (166KB)</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 2528-2530"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421007","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":"Running to a Type 1 - Exercise-Provoked Brugada.","authors":"Andrew D Krahn, Benjamin M Moore","doi":"10.1016/j.jacep.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.09.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227787","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}