JACC. Clinical electrophysiology最新文献

{"title":"State of the Art in Left Atrial Appendage Occlusion","authors":"Jalaj Garg MD ,&nbsp;Rajesh Kabra MD ,&nbsp;Rakesh Gopinathannair MD ,&nbsp;Luigi Di Biase MD, PhD ,&nbsp;Dee Dee Wang MD ,&nbsp;Jacqueline Saw MD ,&nbsp;Rebecca Hahn MD ,&nbsp;James V. Freeman MD ,&nbsp;Christopher R. Ellis MD ,&nbsp;Dhanunjaya Lakkireddy MD","doi":"10.1016/j.jacep.2024.10.024","DOIUrl":"10.1016/j.jacep.2024.10.024","url":null,"abstract":"<div><div>Left atrial appendage occlusion (LAAO) has become an important therapeutic target for stroke prevention in patients with nonvalvular atrial fibrillation. Over the past 2 decades, several advancements in LAAO devices (percutaneous and surgical) have been made for stroke prevention and arrhythmia therapy. However, there are several unanswered questions regarding optimal patient selection, the preferred LAAO approach and device, the management of periprocedural and postprocedural complications, including pericardial effusion, device-related thrombus, and device leaks. This review focuses on fundamental foundational concepts in various aspects of the left atrial appendage and management strategies as they relate to current clinical needs.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 602-641"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965108","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":"Exploring Selective Neuromodulation for Atrial Fibrillation","authors":"Ivan Nenadic MD, PhD ,&nbsp;Christian Meyer MD ,&nbsp;Marat Fudim MD, MHS","doi":"10.1016/j.jacep.2024.12.017","DOIUrl":"10.1016/j.jacep.2024.12.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 579-582"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476484","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":"Defining Voltage Mapping Thresholds for Multielectrode Catheters","authors":"Haris M. Haqqani MBBS(Hons), PhD","doi":"10.1016/j.jacep.2025.01.007","DOIUrl":"10.1016/j.jacep.2025.01.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 536-539"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679243","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 Beat-to-Beat Measurement of R-Wave Peak Time for Left Bundle Branch Area Pacing","authors":"Alberto Spadotto MD ,&nbsp;Rune Paamand MSc ,&nbsp;Estel Clua i Sánchez BSc ,&nbsp;Valérian Valiton MD ,&nbsp;Olivier Leonard MSc ,&nbsp;Karl Firth MSc ,&nbsp;Haran Burri MD","doi":"10.1016/j.jacep.2024.10.035","DOIUrl":"10.1016/j.jacep.2024.10.035","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 596-598"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023121","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":"Pseudo Peridevice Leak After LAA Closure Device Implantation Unmasking a Persistent Left Superior Vena Cava","authors":"Fatima M. Ezzeddine MD ,&nbsp;Ammar M. Killu MBBS ,&nbsp;Rachel C. Haagensen PA-C, MS ,&nbsp;Xiaoke Liu MD, PhD","doi":"10.1016/j.jacep.2024.10.021","DOIUrl":"10.1016/j.jacep.2024.10.021","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 648-649"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813037","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":"Heritable Burden of Community Sudden Death by Autopsy and Molecular Phenotyping for Precision Genotype Correlation","authors":"Zian H. Tseng MD, MAS ,&nbsp;James W. Salazar MD, MAS ,&nbsp;Julianne Wojciak MS ,&nbsp;W. Patrick Devine MD, PhD ,&nbsp;Brielle A. Kinkead BS ,&nbsp;Matthew Yee BA ,&nbsp;David Eik BA ,&nbsp;Jean Feng PhD ,&nbsp;Andrew J. Connolly MD, PhD ,&nbsp;Ellen Moffatt MD","doi":"10.1016/j.jacep.2024.10.027","DOIUrl":"10.1016/j.jacep.2024.10.027","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac death (SCD) genetic studies neglect the majority occurring in older decedents with cardiovascular pathology.</div></div><div><h3>Objectives</h3><div>This study sought to determine the burden of genetic disease in unselected adult sudden deaths by precision genotype–postmortem phenotype correlation.</div></div><div><h3>Methods</h3><div>The authors used autopsy, histology, and toxicology to adjudicate cause and identify high-suspicion phenotypes (eg, hypertrophic cardiomyopathy) among presumed SCDs aged 18 to 90 years referred to the county medical examiner from February 2011 to January 2018. They tested 231 genes associated with sudden death and correlated genotype with postmortem phenotypes, including myocardial analysis. Family history in high-suspicion phenotype cases was obtained.</div></div><div><h3>Results</h3><div>Of 856 autopsied presumed SCDs, families of 359 consented and 306 cases (66% cardiac cause) ultimately underwent genetic testing (mean age 62 years, 74% male). Seventy-five cases met high-suspicion phenotype criteria (8.8%), of which 36 underwent testing; 18 families met with a genetic counselor. We found 14 cases with autosomal dominant or X-linked pathogenic/likely pathogenic (P/LP) variants (apparent yield 4.6%); 6 had concordant cause (corrected yield 2%). Yields restricted to autopsy-confirmed cardiac causes (2.5%) and high-suspicion phenotypes (2.7%) were similar. Myocardial genotyping in 14 high-suspicion decedents matched negative blood genotyping, thus did not support somatic mosaicism. Myocardial RNA in a P/LP <em>PKP2</em> carrier without phenotype demonstrated nonsense-mediated escape as potential mechanism for incomplete penetrance. One-half of high-suspicion cases had a family history of a related condition or sudden death.</div></div><div><h3>Conclusions</h3><div>In this 7-year countywide study, 2% of total sudden deaths and 2.5% of confirmed SCDs had identifiable genetic cause, corrected for genotype–phenotype concordance. These results do not support routine genetic testing for community sudden deaths, particularly without autopsy.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 471-481"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871843","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":"Pulsed Field Ablation for Atrial Fibrillation With Persistent Left Superior Vena Cava and Heterotaxy Syndrome","authors":"Jorge E. Romero MD ,&nbsp;Andres F. Miranda-Arboleda MD ,&nbsp;Mohamed Gabr MD ,&nbsp;Kyleigh K. Oliveira BSc ,&nbsp;William H. Sauer MD ,&nbsp;Usha B. Tedrow MD, MS","doi":"10.1016/j.jacep.2024.10.032","DOIUrl":"10.1016/j.jacep.2024.10.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 650-654"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005188","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":"Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation","authors":"Konsta Teppo MD, PhD ,&nbsp;K.E. Juhani Airaksinen MD, PhD ,&nbsp;Olli Halminen PhD ,&nbsp;Jussi Jaakkola MD, PhD ,&nbsp;Jari Haukka PhD ,&nbsp;Elis Kouki MD ,&nbsp;Alex Luojus MD ,&nbsp;Jukka Putaala MD, PhD ,&nbsp;Birgitta Salmela MD, PhD ,&nbsp;Miika Linna PhD ,&nbsp;Aapo L. Aro MD, PhD ,&nbsp;Pirjo Mustonen MD, PhD ,&nbsp;Juha Hartikainen MD, PhD ,&nbsp;Gregory Y.H. Lip MD ,&nbsp;Mika Lehto MD, PhD","doi":"10.1016/j.jacep.2024.10.029","DOIUrl":"10.1016/j.jacep.2024.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.</div></div><div><h3>Objectives</h3><div>This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy.</div></div><div><h3>Methods</h3><div>The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA₂DS₂-VASc (ie, CHA₂DS₂-VA) score values.</div></div><div><h3>Results</h3><div>In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients’ mean CHA₂DS₂-VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA₂DS₂-VA scores. The IS rate in patients with a CHA₂DS₂-VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period.</div></div><div><h3>Conclusions</h3><div>The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 583-592"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871998","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":"Subclavian Ansae Stimulation on Cardiac Hemodynamics and Electrophysiology in Atrial Fibrillation","authors":"Vijayabharathy Kanthasamy MBBS, CCDS, CEPS-A ,&nbsp;Richard Ang PhD ,&nbsp;Arun Sridhar PhD ,&nbsp;Sandip Vyas BSc, CCDS, CEPS-A ,&nbsp;Sarah Whittaker-Axon BSc, CCDS ,&nbsp;Richard Schilling MD ,&nbsp;Shohreh Honarbakhsh PhD ,&nbsp;Nikolaos Papageorgiou MD, PhD ,&nbsp;Antonio Creta MBBS, PhD ,&nbsp;Nikhil Ahluwalia PhD ,&nbsp;Ross Hunter PhD ,&nbsp;Malcolm Finlay PhD","doi":"10.1016/j.jacep.2024.10.023","DOIUrl":"10.1016/j.jacep.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>The sympathetic autonomic nervous system plays a major role in arrhythmia development and maintenance. Historical preclinical studies describe preferential increases in cardiac sympathetic tone upon selective stimulation of the subclavian ansae (SA), a nerve cord encircling the subclavian artery.</div></div><div><h3>Objectives</h3><div>This study sought to define, for the first time, the functional anatomy and physiology of the SA in humans using a percutaneous approach.</div></div><div><h3>Methods</h3><div>The authors prospectively recruited patients undergoing catheter ablation for paroxysmal atrial fibrillation (AF) under general anesthesia. SA stimulation (SAS) was performed on the left and/or the right (L/SAS and/or R/SAS, respectively) within the subclavian artery using an ablation catheter introduced via a femoral arterial sheath. Stimulation involved up to 70 V, 10 Hz, and a 2- to 4-millisecond pulse width for 15 to 30 seconds. Invasive blood pressure (BP), heart rate, and electrophysiological parameters were recorded. A positive response was a ≥10% increase in BP or heart rate from baseline.</div></div><div><h3>Results</h3><div>Seventeen patients (median age 60 years [Q1-Q3: 58-67 years];11 male subjects; paroxysmal AF duration 24 months [Q1-Q3: 10-60 months) underwent the stimulation protocol before their clinical AF ablation procedure. A positive hemodynamic response was observed in 11 patients; of these, arrhythmia was inducible in 5 patients. The median sinus cycle length decreased after stimulation, and there was a larger decrease with R/SAS (L/SAS 1,008 milliseconds to 926 milliseconds [<em>P</em> = 0.037] vs R/SAS 1,029.5 milliseconds to 917 milliseconds [<em>P</em> = 0.005]). Both L/SAS and R/SAS led to a notable increase in median systolic BP (L/SAS 81 to 128 mm Hg [<em>P</em> = 0.005] vs R/SAS 85 to 104 mm Hg [<em>P</em> = 0.007]) and a similar trend in diastolic BP. In addition, there was a demonstrable decrease in interatrial conduction time and increase in P-wave dispersion.</div></div><div><h3>Conclusions</h3><div>This study represents the first successful application of selective SAS in humans. The SA is a potentially important site for targeted autonomic neuromodulation therapy.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 563-578"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965109","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":"Artificial Intelligence–Enabled Electrocardiogram Predicts Sudden Cardiac Death in Repaired Tetralogy of Fallot","authors":"Joshua Mayourian MD, PhD ,&nbsp;Edward T. O’Leary MD ,&nbsp;John K. Triedman MD ,&nbsp;Rachel M. Wald MD ,&nbsp;Anne Marie Valente MD ,&nbsp;Tal Geva MD","doi":"10.1016/j.jacep.2024.10.031","DOIUrl":"10.1016/j.jacep.2024.10.031","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 3","pages":"Pages 593-595"},"PeriodicalIF":8.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978430","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}