JACC. Clinical electrophysiology最新文献

{"title":"Effects of Dual-Energy Lattice-Tip Catheter Ablation of Ventricular Arrhythmias on Cardiac Implantable Electronic Device Performance.","authors":"Ehsan Mahmoodi, Arwa Younis, Koji Higuchi, Jakub Sroubek, Justin Z Lee, Roy Chung, Osama Dasa, Shady Nakhla, Brittany Paulin-Mosho, Nolan Hight, Niraj Varma, Ayman A Hussein, Tyler Taigen, Mohamed Kanj, Mandeep Bhargava, Walid I Saliba, Oussama M Wazni, Pasquale Santangeli","doi":"10.1016/j.jacep.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.028","url":null,"abstract":"<p><strong>Background: </strong>The Sphere-9 lattice-tip catheter (Affera, Medtronic) enables delivery of both radiofrequency ablation (RFA) and pulsed field ablation (PFA) for ventricular arrhythmia (VA) ablation. Data on its impact on cardiac implantable electronic devices (CIEDs) are limited.</p><p><strong>Objectives: </strong>This study sought to evaluate changes in CIED function following VA ablation using the Sphere-9 catheter.</p><p><strong>Methods: </strong>We reviewed 65 consecutive patients (median age 71 years, 94% male, 63% ischemic cardiomyopathy, median left ventricular ejection fraction 31%) with pre-existing CIEDs who underwent VA ablation (62 ventricular tachycardia [95%], 3 premature ventricular contraction [5%]) using the Sphere-9 catheter (combined RFA/PFA (53 [82%]), RFA alone (6 [9%]), PFA alone (6 [9%])). Device interrogation was performed within 30 days preprocedure, within 7 days postprocedure, and at 3-month (+/- 30 days) follow-up.</p><p><strong>Results: </strong>At 3-months, right ventricular leads demonstrated reduced sensing amplitude (11.7-10.0 mV, P = 0.04), pacing impedance (441-422 Ω, P < 0.001), shock impedance (64-59 Ω, P = 0.01), and increased capture threshold (0.9-1.0 V at 0.4-0.5 milliseconds, P = 0.03). Left ventricular (LV) leads demonstrated reduced pacing impedance (544-475 Ω, P = 0.04), whereas LV capture threshold remained elevated (1.0-1.4 V, P = 0.08). Right atrial lead parameters remained stable. No patient required CIED revision. One patient experienced cardiac resynchronization therapy-D pulse generator failure during PFA delivery 7.5 mm from an LV lead tip electrode, requiring generator replacement.</p><p><strong>Conclusions: </strong>Ventricular arrhythmia ablation using the Sphere-9 dual-energy lattice-tip catheter was associated with small but persistent changes in right and left ventricular lead parameters. Serious CIED interactions were uncommon, and further studies are needed to better understand the underlying mechanisms.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136669","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":"Electrophysiological Manifestations of Suspected Bachmann's Bundle Infarction Due to Occlusion of the Right Sinus Node Artery.","authors":"Tetsuma Kawaji, Shumpei Mori, Yuichiro Miyazaki, Misaki Naka, Saki Yamano, Bingyuan Bao, Tomoya Kimura, Shun Hojo, Shintaro Matsuda, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1016/j.jacep.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193875","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":"Four Distinct Morphologies of Bundle Branch Reentrant Ventricular Tachycardia Eliminated by Right Bundle Branch Ablation.","authors":"Miki Amemiya, Atsushi Suzuki, Seiji Fukamizu, Yasuteru Yamauchi","doi":"10.1016/j.jacep.2026.08.029","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.029","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136708","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":"Acute Regional Atrial Metabolic Inflexibility in Atrial Fibrillation: Evidence From Human Vein of Marshall Arteriovenous Samplings.","authors":"Lee Bockus, Ahmad Kassar, Romanos Haykal, Nadia Chamoun, Yaacoub Chahine, Dennis Wang, Daniel Raftery, Rong Tian, Zoltan Arany, Nazem Akoum","doi":"10.1016/j.jacep.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.030","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136697","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":"Adjunctive Low-Voltage Area Ablation Reduces Atrial Fibrillation Recurrence in Persistent Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.","authors":"Sohaib A Virk, Vincenzo Somma, Peter M Kistler, Jonathan M Kalman","doi":"10.1016/j.jacep.2026.08.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.023","url":null,"abstract":"<p><strong>Background: </strong>Adjunctive low-voltage area ablation (LVAA) has been proposed as a substrate modification strategy to improve outcomes of catheter ablation in persistent atrial fibrillation (AF); however, randomized controlled trials (RCTs) evaluating LVAA have yielded inconsistent findings.</p><p><strong>Objectives: </strong>This meta-analysis sought to evaluate the efficacy of LVAA in addition to pulmonary vein isolation (PVI) compared with PVI alone in patients with persistent AF.</p><p><strong>Methods: </strong>Electronic databases were searched from inception to September 2026 for eligible RCTs. The primary endpoint was recurrent AF/atrial tachyarrhythmia ≥12 months after index ablation. Secondary endpoints included major periprocedural complications and procedural durations. Meta-analyses were performed using random-effects models. Trial sequential analysis was performed to assess the robustness of cumulative evidence.</p><p><strong>Results: </strong>Seven RCTs comprising 1,487 participants (weighted mean age 68 years, 60% male) were included. Compared with PVI alone, PVI + LVAA was associated with significantly lower recurrence of AF/atrial tachyarrhythmia (HR: 0.67; 95% CI: 0.50-0.88; I² = 55%; P = 0.004). Trial sequential analysis demonstrated that the cumulative Z-curve crossed the monitoring boundary for benefit, supporting the robustness of the observed treatment effect. Adjunctive LVAA increased total procedure duration (mean difference: 30.5 minutes; 95% CI: 5.8-55.2; P = 0.02) and radiofrequency ablation duration (mean difference: 12.3 minutes; 95% CI: 5.4-19.1; P < 0.001) without increasing fluoroscopy time or major periprocedural complications (relative risk: 1.12; 95% CI: 0.60-2.10; P = 0.7).</p><p><strong>Conclusions: </strong>Among patients with persistent AF, adjunctive LVAA in addition to PVI significantly reduces recurrent atrial tachyarrhythmia compared with PVI alone. These findings support electroanatomically guided substrate modification as a promising individualized ablation strategy in persistent AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136724","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":"Retrograde Right Bundle Branch Block in Tachycardia Uncovering AVRT Using a Right-Sided Accessory Pathway.","authors":"Waddah Malas, Fatima M Ezzeddine","doi":"10.1016/j.jacep.2026.08.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109769","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":"Radiofrequency-Facilitated Left Bundle Branch Area Pacing as a Bailout Strategy in Patients With Septal Resistance.","authors":"Oriana Bastidas, Julian M Aristizabal, Luis Miguel Ruiz, Jorge E Marín, Cesar D Niño, Wilmer Borja, David Ocampo, Maria Camila Diaz-Ayala, Andres Díaz, Juan C Diaz","doi":"10.1016/j.jacep.2026.08.025","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.025","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136680","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":"Increased Heart Failure Risk After Low-Voltage-Area Ablation in Patients With Paroxysmal Atrial Fibrillation.","authors":"Mizuki Ochi, Akihiro Sunaga, Hiroyuki Uematsu, Shota Kato, Hirotaka Ooka, Satoshi Kudo, Shin Okamoto, Kiyonori Nanto, Yosuke Hata, Masaya Kusuda, Wataru Ariyasu, Subaru Fujii, Masaharu Masuda","doi":"10.1016/j.jacep.2026.08.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.022","url":null,"abstract":"<p><strong>Background: </strong>Extensive atrial ablation may impair atrial function; however, its impact on long-term heart failure (HF) risk remains unclear.</p><p><strong>Objectives: </strong>This study sought to evaluate the association between low-voltage area (LVA) ablation and HF outcomes after catheter ablation for paroxysmal atrial fibrillation (AF).</p><p><strong>Methods: </strong>This was a long-term follow-up analysis of the Volatile Coronary Lesion and Obstructive Nodal Atrial Fibrillation trial. A total of 398 patients were followed for up to 7 years and classified into 3 groups: no LVAs (group A), LVAs with LVA ablation (group B), and LVAs without LVA ablation (group C). The primary outcome was HF hospitalization.</p><p><strong>Results: </strong>During a median follow-up of 1,660 (735-2,555) days, HF hospitalization occurred in 21 patients. Sinus rhythm was maintained in 96% of patients, with no differences among groups (P = 0.26). Patients with LVAs had a higher incidence of HF hospitalization than those without (18% vs 3%; P < 0.001). Among patients with LVAs, HF hospitalization occurred more frequently in those undergoing LVA ablation (30% vs 6%; P = 0.01). In a competing-risk analysis accounting for all-cause death, the cumulative incidence of HF hospitalization remained significantly higher in patients undergoing LVA ablation (Gray's test, P = 0.042). Among patients who experienced HF hospitalization, most events occurred during documented sinus rhythm.</p><p><strong>Conclusions: </strong>Among patients with paroxysmal AF and LVAs, LVA ablation was associated with a higher incidence of HF hospitalization despite a high rate of sinus rhythm maintenance. Given the limited sample size and number of events, these findings should be considered exploratory and hypothesis-generating, and warrant confirmation in larger prospective studies.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136654","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":"Impact of Interelectrode Spacing on Ventricular Tachycardia Substrate Mapping: Insights Into 3-Dimensional Characteristics of the Arrhythmogenic Substrate.","authors":"Yuto Iioka, Yuki Komatsu, Yasutoshi Shinoda, Yuichi Hanaki, Yuka Oda, Yusuke Hayashi, Yoshihiro Harano, Yuki Matsuoka, Kojiro Ogawa, Akira Kimata, Hiro Yamasaki, Miyako Igarashi, Tomoko Ishizu, Akihiko Nogami","doi":"10.1016/j.jacep.2026.08.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.021","url":null,"abstract":"<p><strong>Background: </strong>Re-entrant ventricular tachycardia (VT) circuits often involve 3-dimensional activation across the endocardium, epicardium, and mid-myocardium, highlighting the importance of comprehensive substrate assessment. Wider interelectrode spacing may incorporate broader-field electrical components that are less apparent on conventional closely spaced recordings.</p><p><strong>Objectives: </strong>This study sought to investigate the electrophysiological impact of interelectrode spacing on substrate mapping and its potential implications for 3-dimensional features of VT substrate.</p><p><strong>Methods: </strong>Sixty-eight high-density substrate maps from 35 patients undergoing catheter ablation for scar-related VT were retrospectively analyzed. Closely spaced (2-mm) and widely spaced (8-mm) bipolar electrograms were simultaneously acquired using a decapolar catheter and used to generate closely and widely spaced bipolar electrode maps (CEM and WEM).</p><p><strong>Results: </strong>Compared with CEM, WEM, which incorporates a greater contribution of far-field components, demonstrated higher bipolar amplitudes, a greater prevalence of multicomponent electrograms, and a lower prevalence of split potentials (all P < 0.01). Lines of block delineated by split potentials on CEM were frequently attenuated or no longer apparent on WEM because the corresponding electrograms appeared fragmented and lacked a distinct split configuration. In an exploratory analysis of 6 VTs with evaluable activation maps, activation gaps were larger with closely than widely spaced bipolar mapping (32.5% vs 20.0%; P = 0.03). In 4 VTs, widely spaced recordings identified diastolic or presystolic far-field potentials not evident with closely spaced recordings.</p><p><strong>Conclusions: </strong>Widely spaced bipolar electrograms may provide complementary functional information beyond that obtained with conventional near-field recordings by incorporating broader-field electrical components, thereby offering additional insight into the potential 3-dimensional characteristics of the arrhythmogenic substrate.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109792","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":"Abrupt Wall Thickness Transitions Amid Ischemic Re-Entrant Ventricular Tachycardia.","authors":"Edward J Ciaccio, Nicholas S Peters, Angelo B Biviano","doi":"10.1016/j.jacep.2026.07.032","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.07.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024808","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}