JACC. Clinical electrophysiology最新文献

{"title":"International Multicenter Cohort Study on Beta-Blocker–Free Treatment Strategies for Catecholaminergic Polymorphic Ventricular Tachycardia Patients","authors":"Raquel Neves MD ,&nbsp;Sahej Bains BS ,&nbsp;J. Martijn Bos MD, PhD ,&nbsp;Christian van der Werf MD, PhD ,&nbsp;Auke T. Bergeman MD ,&nbsp;Puck Peltenburg MD ,&nbsp;Nico A. Blom MD, PhD ,&nbsp;Shubhayan Sanatani MD ,&nbsp;Heikki Swan MD ,&nbsp;Vincent Probst MD ,&nbsp;Prince J. Kannankeril MD, MSCI ,&nbsp;Jonathan R. Skinner MD ,&nbsp;Ramon Brugada MD ,&nbsp;Tomas Robyns MD ,&nbsp;Martin Borggrefe MD ,&nbsp;Wataru Shimizu MD, PhD ,&nbsp;Janneke A.E. Kammeraad MD, PhD ,&nbsp;Andrew D. Krahn MD ,&nbsp;Arthur A.M. Wilde MD, PhD ,&nbsp;Michael J. Ackerman MD, PhD","doi":"10.1016/j.jacep.2024.10.005","DOIUrl":"10.1016/j.jacep.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare, potentially life-threatening genetic heart disease. Nonselective beta-blockers (BBs) are highly effective in reducing CPVT-triggered arrhythmic events. However, some patients suffer from unacceptable BB side effects and might require strategies without a BB.</div></div><div><h3>Objectives</h3><div>This study sought to review the spectrum of and outcomes associated with BB-free treatment configurations in patients with CPVT enrolled in the International CPVT Registry.</div></div><div><h3>Methods</h3><div>From the Registry, patients with <em>RYR2</em> variant-positive CPVT treated with a BB-free strategy for ≥6 months were included. Two treatment groups were defined: patients classified as very low risk and treated with intentional nontherapy (INT) and patients who needed to be treated but did not tolerate BBs and were treated with 3 different strategies.</div></div><div><h3>Results</h3><div>Overall, 100 of 1,017 patients (10%) were on a BB-free treatment strategy. There were 73 patients (33 females [42%]) in the INT group. In patients 66 (90%), INT was pursued after low-risk assessment in asymptomatic patients and absent or negligible stress test phenotype. Twenty-seven patients (22 females, 81%) were treated using 3 different BB-free treatment strategies (flecainide monotherapy, n = 21; left cardiac sympathetic denervation monotherapy, n = 2; flecainide + left cardiac sympathetic denervation, n = 4). In total, 25 patients (93%) were previously treated with BBs. During a median follow-up of 6 years (IQR: 3-9 years), 2 patients (2%) had a CPVT-associated event.</div></div><div><h3>Conclusions</h3><div>Although nonselective BBs remain the cornerstone treatment for CPVT, 10% of patients with CPVT required a BB-free treatment strategy. After careful risk assessment, safe and effective BB-free treatment strategies can be configured.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 270-278"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871799","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":"DNA Damage in Atrial Fibrillation","authors":"Christian Meyer MD, MA ,&nbsp;Tanja Zeller PhD","doi":"10.1016/j.jacep.2024.11.017","DOIUrl":"10.1016/j.jacep.2024.11.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 333-336"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479442","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":"Clinical and Electrophysiological Characteristics of Marshall Bundle–Related Atrial Tachycardia","authors":"Yasuaki Tanaka MD ,&nbsp;Atsushi Takahashi MD ,&nbsp;Hirotaka Yano MD ,&nbsp;Naohiko Kawaguchi MD ,&nbsp;Emiko Nakashima MD ,&nbsp;Kenji Okubo MD ,&nbsp;Hiroyuki Hikita MD ,&nbsp;Tetsuo Sasano MD","doi":"10.1016/j.jacep.2024.10.019","DOIUrl":"10.1016/j.jacep.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)–related atrial tachycardia (AT).</div></div><div><h3>Objectives</h3><div>This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.</div></div><div><h3>Methods</h3><div>Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study. A 1.6-F hexapolar electrode catheter was inserted into the vein of Marshall (VOM) if endocardial left atrial mapping showed centrifugal propagation and post-pacing intervals after entrainment pacing suggested a macro-re-entrant mechanism. MB-related AT was diagnosed only when activation along the VOM was consistent with the propagation of the AT circuit, and post pacing interval within the VOM approximated the tachycardia cycle length.</div></div><div><h3>Results</h3><div>Among 48 patients, 20 were diagnosed with MB-related AT. The activation direction along the VOM was predominantly descending (n = 13), rather than ascending (n = 7). There were diverse breakthrough sites to the endocardium along the course of the VOM. Two patients experienced persistent AT despite a conduction block in the VOM. Thirteen patients underwent chemical ablation with ethanol injection, and the remaining 7 underwent radiofrequency ablation at the earliest endocardial activation sites or mitral isthmus areas. Acute termination of AT was observed in 20 patients. No recurrence was observed in the group that underwent chemical ablation; however, 4 patients in the radiofrequency group experienced recurrence (n = 0 of 13 vs n = 4 of 7).</div></div><div><h3>Conclusions</h3><div>Understanding the distinct clinical and electrophysiological characteristics of MB-related AT can facilitate the diagnosis and treatment of this AT type.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 362-372"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871215","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 Pericardial Access Technique Facilitated by Direct Visualization and Vacuum Suction","authors":"Hina Amin MBBS ,&nbsp;Arman Arghami MD ,&nbsp;Alan M. Sugrue MBBCh ,&nbsp;Ammar M. Killu MBBS","doi":"10.1016/j.jacep.2024.10.002","DOIUrl":"10.1016/j.jacep.2024.10.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 448-453"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785435","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":"Novel Size Adjustable Cryoballoon Ablation Catheter for Atrial Fibrillation","authors":"Yosuke Hayashi MD ,&nbsp;Shinsuke Miyazaki MD ,&nbsp;Junichi Nitta MD ,&nbsp;Osamu Inaba MD ,&nbsp;Yuichiro Sagawa MD ,&nbsp;Shinsuke Iwai MD ,&nbsp;Yukio Sekiguchi MD ,&nbsp;Yukihiro Inamura MD ,&nbsp;Yasuteru Yamauchi MD ,&nbsp;Tetsuo Sasano MD","doi":"10.1016/j.jacep.2024.10.018","DOIUrl":"10.1016/j.jacep.2024.10.018","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 414-417"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813033","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 Restitution Threshold Index Characterizes the Association Between Atrial Fibrillation Ventricular Rate and Ejection Fraction","authors":"Nikhil Ahluwalia MBBS, MSc,&nbsp;Shohreh Honarbakhsh MBBS, PhD,&nbsp;Abhishek Joshi MB, ChB, PhD,&nbsp;Hakam Abbass,&nbsp;Anthony W. Chow MBBS, MD,&nbsp;Mehul Dhinoja MBBS,&nbsp;Steffen E. Petersen MD, DPhil,&nbsp;Guy Lloyd MD,&nbsp;Ross J. Hunter MBBS, PhD,&nbsp;Richard J. Schilling MBBS, MD","doi":"10.1016/j.jacep.2024.10.020","DOIUrl":"10.1016/j.jacep.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Patients with reduced left ventricular ejection fraction (LVEF) and rate-controlled atrial fibrillation (AF) may improve after restoring sinus rhythm. This may be due to the elimination of the short R-R intervals during AF even when mean heart rate is acceptable.</div></div><div><h3>Objectives</h3><div>This work aims to evaluate a novel parameter representing the burden of short R-R intervals during AF and its association with reduced LVEF and LVEF recovery after catheter ablation (CA).</div></div><div><h3>Methods</h3><div>Patients with persistent AF were prospectively enrolled pre-CA and grouped as having reduced (LVEF ≤50%) or preserved LVEF. Sequential R-R intervals on resting Holter monitoring were measured. We sought to define a threshold R-R interval at which the difference in the percentage of short R-R intervals is greatest when comparing patients with reduced and preserved ejection fraction. We termed this threshold the restitution threshold (RT) in the belief that this may be possible to apply as a threshold to identify patients with AF-mediated cardiomyopathy. This percentage burden of intervals shorter than the RT was defined as the restitution threshold index (RTI). The association with reduced LVEF in AF and predicting improvement in LVEF after CA was then evaluated.</div></div><div><h3>Results</h3><div>A total of 104 patients were enrolled; 53 (51%) had a reduced LVEF. There was no difference in mean heart rate; however, at an RT of 660 ms, the RTI was higher in the reduced LVEF arm (56.1% ± 23.1% vs 39.5% ± 26.0%; <em>P</em> &lt; 0.001). It was an independent predictor of left ventricular systolic dysfunction. The RTI in the reduced LVEF arm had an area under the receiver operating characteristic of 0.74 (95% CI: 0.47-0.95) and positive predictive value of 0.97 for LVEF improvement after CA, which was observed in 39 of 47 (83.0%) participants in sinus rhythm.</div></div><div><h3>Conclusions</h3><div>The RTI in persistent AF was associated with a reduced LVEF, whereas mean heart rate was not. The RTI could be used to predict LVEF improvement after CA.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 282-294"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813046","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":"Uncommon Conduction Disturbances After Transcatheter Aortic Valve Replacement","authors":"Bernard Belhassen MD ,&nbsp;Oholi Tovia-Brodie MD ,&nbsp;Marcelo Elizari MD ,&nbsp;Yoav Michowitz MD","doi":"10.1016/j.jacep.2024.10.022","DOIUrl":"10.1016/j.jacep.2024.10.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 458-469"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813051","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":"Atrial Fibrillation in Patients Receiving Mavacamten for Obstructive Hypertrophic Cardiomyopathy","authors":"Thomas A. Boyle MD ,&nbsp;Nosheen Reza MD ,&nbsp;Matthew Hyman MD, PhD,&nbsp;Gregory Supple MD,&nbsp;Vincent Y. See MD, MS,&nbsp;Amy Marzolf CRNP,&nbsp;Nicole Hornsby CRNP,&nbsp;Alejandro de Feria MD,&nbsp;Teresa Wang MD,&nbsp;Kenneth B. Margulies MD,&nbsp;Anjali Tiku Owens MD ,&nbsp;David S. Frankel MD","doi":"10.1016/j.jacep.2024.10.014","DOIUrl":"10.1016/j.jacep.2024.10.014","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 411-413"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785437","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":"Development of a Multivariable Prediction Model to Estimate Probability of Sleep-Disordered-Breathing in Patients With AF","authors":"Kadhim Kadhim MBChB, PhD ,&nbsp;Adrian D. Elliott PhD ,&nbsp;Melissa E. Middeldorp PhD, MPH ,&nbsp;Chrishan J. Nalliah MBBS, PhD ,&nbsp;R. Doug McEvoy MD ,&nbsp;Nicholas A. Antic MBBS, PhD ,&nbsp;Rajeev K. Pathak MBBS, PhD ,&nbsp;Mehrdad Emami MD ,&nbsp;Dennis H. Lau MBBS, PhD ,&nbsp;Jonathan M. Kalman MBBS, PhD ,&nbsp;Dominik Linz MD, PhD ,&nbsp;Prashanthan Sanders MBBS, PhD","doi":"10.1016/j.jacep.2024.10.013","DOIUrl":"10.1016/j.jacep.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (AF) and negatively impacts treatment outcomes. Optimal tools for AF patient selection for SDB testing are lacking.</div></div><div><h3>Objectives</h3><div>This study sought to develop and validate a prediction tool to detect patients who have AF with moderate-to-severe SDB.</div></div><div><h3>Methods</h3><div>Prospectively collected data on 442 consecutive ambulatory patients with AF who were undergoing polysomnography were used as the derivation sample. Performance was externally validated on a test cohort of 409 patients. Significant SDB was defined as an apnea-hypopnea-index ≥15/h. Multivariable logistic regression was used to construct a prediction model and calculate individual SDB probabilities.</div></div><div><h3>Results</h3><div>Significant SDB was present in 34% and 54% of patients in the derivation and validation cohorts, respectively. The prediction model comprised age, sex, body mass index (BMI), diabetes, and previous stroke or transient ischemic attack. Following calibration, the model had a good discrimination ability for significant SDB on external validation (C-statistic: 0.75; 95% CI: 0.71-0.80). A simplified composite score (MOODS, range 0-8) comprised male sex (1 point), overweight (BMI: 25-29.9 kg/m², 1 point) or obesity (BMI: ≥30 kg/m², 3 points), diabetes (2 points), and stroke/transient ischemic attack (2 points) had good discrimination on external validation (C-statistic: 0.73; 95% CI: 0.68-0.77). As a rule-out or a rule-in test, a MOODS score of ≤1 had a 100% sensitivity and score of ≥5 had a 96% specificity for detecting significant SDB, respectively.</div></div><div><h3>Conclusions</h3><div>The MOODS score provides an individualized and accurate probability of significant SDB in patients with AF. MOODS has the potential to aid clinical decision making and allow efficient resource allocation.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 309-317"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785440","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-Power Short-Duration Radiofrequency Application for Faster and Safer Pulmonary Vein Isolation","authors":"Sergio Castrejón-Castrejón MD, PhD ,&nbsp;Marcel Martínez Cossiani MD ,&nbsp;Nuria Basterra Sola MD, PhD ,&nbsp;Javier David Romero Roldán MD ,&nbsp;José Luis Ibáñez Criado MD, PhD ,&nbsp;Joaquín Osca MD, PhD ,&nbsp;Ivo Roca-Luque MD, PhD ,&nbsp;Angel Moya PhD ,&nbsp;Aurelio Quesada PhD ,&nbsp;Víctor Manuel Hidalgo Olivares MD ,&nbsp;Nicasio Pérez Castellano MD, PhD ,&nbsp;Juan Manuel Fernández-Gómez MD ,&nbsp;Rosa Macías-Ruiz MD, PhD ,&nbsp;Bruno Bochard Villanueva MD ,&nbsp;Nerea Gonzalo Bada MD ,&nbsp;Consuelo Froilán Torres MD ,&nbsp;Beatriz Sanz Verdejo BS ,&nbsp;Paula Sánchez Somonte MD ,&nbsp;Carlos Escobar Cervantes MD, PhD ,&nbsp;Raúl Moreno MD, PhD ,&nbsp;José Luis Merino MD, PhD","doi":"10.1016/j.jacep.2024.10.009","DOIUrl":"10.1016/j.jacep.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>The optimal radiofrequency application (RFa) parameters for safe and durable pulmonary vein isolation (PVI) are debated. High-power short-duration (HPSD) has been used as an alternative to conventional power delivery (CPD).</div></div><div><h3>Objectives</h3><div>This study sought to compare HPSD 70 W/9-10 s (HPSD-70) with CPD 25-40 W in patients undergoing PVI.</div></div><div><h3>Methods</h3><div>Patients were randomized to HPSD-70 or CPD (25-40). The primary outcomes were freedom from atrial arrhythmia recurrences and the incidence of esophageal thermal lesions (EDELs) after ablation.</div></div><div><h3>Results</h3><div>Among 304 patients randomized, 301 remained in the study (median age: 61 years; Q1-Q3: 53-69 years; 72% men): 294 patients (97.7%) underwent ablation, 285 (94.7%) underwent endoscopy, and 290 (98.6%) completed the follow-up. At 12 months, 100 patients (73.5%) in the CPD (25-40) group and 87 patients (67%) in the HPSD-70 group were free from recurrences off antiarrhythmic drugs (HR: 1.28; 95% CI: 0.82-1.99; <em>P</em> = 0.28). The incidences of EDELs were 2.7% in the CPD (25-40) group and 3.6% in the HPSD-70 group (<em>P</em> = 0.94). Median left atrial dwell (153 vs 137 min; <em>P</em> = 0.03) and total RF times for definitive PVI (31 vs 11.2 min; <em>P</em> &lt; 0.001) were shorter with HPSD-70 ablation. Four symptomatic embolic events (2 strokes, 1 transient ischemic attack, and 1 splenic infarct) occurred with HPSD-70 and none with CPD (25-40) RFa (<em>P</em> = 0.056).</div></div><div><h3>Conclusions</h3><div>HPSD-70 RFa was noninferior to prevent arrhythmia recurrences, and the incidence of EDELs was similar compared with CPD (25-40) RFa. The embolic events were numerically higher in the HPSD-70 group. (High Radiofrequency Power for Faster and Safer Pulmonary Vein Ablation Trial [POWER FAST III]; <span><span>NCT04153747</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 350-361"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871786","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}