JACC. Clinical electrophysiology最新文献

{"title":"Comparison of the Latest ESC, ACC/AHA/ACCP/HRS, and CCS Guidelines on the Management of Atrial Fibrillation","authors":"Julian Wolfes MD,&nbsp;Christian Ellermann MD,&nbsp;Gerrit Frommeyer MD,&nbsp;Lars Eckardt MD","doi":"10.1016/j.jacep.2024.12.018","DOIUrl":"10.1016/j.jacep.2024.12.018","url":null,"abstract":"<div><div>The introduction of evidence-based and structured guidelines has undoubtedly improved the care of cardiologic patients and in many cases simplified decision-making for the treatment team. The European Society of Cardiology in collaboration with the European Association for Cardio-Thoracic Surgery, the American College of Cardiology, the American Heart Association, the American College of Clinical Pharmacy, and the Heart Rhythm Society, and the Canadian Cardiovascular Society/Canadian Heart Rhythm Society have developed guidelines for the management of patients with atrial fibrillation. Because all 3 guidelines refer to almost the same scientific data, their recommendations are undoubtedly largely in agreement. Nevertheless, there are some interesting differences based on different interpretations of the same study, different publication dates, or differences in local conditions and health care resources. The following article aims at lining out these similarities and differences.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 836-849"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476144","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":"Transmural Activation Mapping of Ventricular Arrhythmias With High–Frame Rate Echocardiography and Validation Against Contact Mapping","authors":"Johanna B. Tonko MD ,&nbsp;Melina Tourni MEng ,&nbsp;Aikaterini Afentouli BSc ,&nbsp;Anthony Chow MD, PhD ,&nbsp;Joseph Hansen-Shearer PhD ,&nbsp;Biao Huang MEng ,&nbsp;Ross J. Hunter MD, PhD ,&nbsp;Richard Schilling MD, PhD ,&nbsp;Mengxing Tang PhD ,&nbsp;Elisa Konofagou PhD ,&nbsp;Pier D. Lambiase MD, PhD","doi":"10.1016/j.jacep.2024.11.019","DOIUrl":"10.1016/j.jacep.2024.11.019","url":null,"abstract":"<div><h3>Background</h3><div>The restriction of activation mapping to the ventricular surface of contemporary mapping systems often leads to failure to correctly identify the true sites of origin (SoOs) of intramural and/or subepicardial ventricular arrhythmias (VAs), reducing procedural success.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate if noninvasive electromechanical wave imaging (EWI) can locate the SoOs of VAs along the endo-epicardial axis in patients with and without structural heart disease.</div></div><div><h3>Methods</h3><div>Patients with VAs requiring ablation underwent preprocedural transthoracic EWI to identify the SoOs and validate using contact mapping. Local electromechanical activation was defined as time point of the downward zero crossing on the incremental axial strain curve. The site of earliest activation on contact mapping and/or successful ablation was employed as ground truth for VA SoO.</div></div><div><h3>Results</h3><div>Twenty-eight patients underwent EWI, and 25 proceeded to contact mapping (56% men, mean age 53 ± 16 years, mean left ventricular ejection fraction 47% ± 28%, 52% with late gadolinium enhancement (LGE) on magnetic resonance imaging). Five patients were excluded (insufficient or different ventricular tachycardia or ventricular ectopic activity at the time of EWI vs contact mapping). EWI mapping correctly localized the VA SoOs in 17 of 20 (85%) of the cases and mapped them to the adjacent segments in the remaining ones. In the presence of scar, EWI localized 81.8% of the VA SoOs (n = 9 of 11) correctly compared with 88.9% (n = 8 of 9) in patients without (<em>P</em> = NS). The transmural SoOs (endocardial, midmyocardial, or epicardial) were successfully identified in 18 of 20 cases (90%; <em>P</em> = NS for LGE-positive vs LGE-negative patients).</div></div><div><h3>Conclusions</h3><div>EWI correctly identified the transmural SoOs of focal VAs, including in the presence of scar, in the majority of cases using contact mapping as the gold standard and thus could support preprocedural planning, including requirement for epicardial access and/or ablation techniques. The absence of a true gold standard for clinical transmural mapping remains an important challenge for the validation of novel mapping technologies.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 667-681"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719283","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":"Articulating the JACC Journals’ Direction in Times of Global Change","authors":"Harlan M. Krumholz MD, SM (Editor-in-Chief, JACC),&nbsp;Biykem Bozkurt MD, PhD (Editor-in-Chief, JACC: Heart Failure),&nbsp;Y. Chandrashekhar MD (Editor-in-Chief, JACC: Cardiovascular Imaging),&nbsp;Bonnie Ky MD, MSCE (Editor-in-Chief, JACC: CardioOncology),&nbsp;Douglas L. Mann MD (Editor-in-Chief, JACC: Basic to Translational Science),&nbsp;David J. Moliterno MD (Editor-in-Chief, JACC: Cardiovascular Interventions),&nbsp;Kalyanam Shivkumar MD, PhD (Editor-in-Chief, JACC: Clinical Electrophysiology),&nbsp;Candice K. Silversides MD (Editor-in-Chief, JACC: Advances),&nbsp;Gilbert H.L. Tang MD, MSc, MBA (Editor-in-Chief, JACC: Case Reports),&nbsp;Jian’an Wang MD, PhD (Editor-in-Chief, JACC: Asia)","doi":"10.1016/j.jacep.2025.02.001","DOIUrl":"10.1016/j.jacep.2025.02.001","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 878-879"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882723","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":"Association of Left Ventricular Summit Arrhythmias With Pathogenic Genetic Variants","authors":"Nitin Kondamudi MD ,&nbsp;Elliot J. Stein MD, MS ,&nbsp;Graham H. Bevan MD ,&nbsp;Andrew B. Stergachis MD, PhD ,&nbsp;Fuki Hisama MD ,&nbsp;Babak Nazer MD ,&nbsp;Neal A. Chatterjee MD, MSc","doi":"10.1016/j.jacep.2024.12.008","DOIUrl":"10.1016/j.jacep.2024.12.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 830-832"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079995","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":"Inflammatory Ventricular Arrhythmias With Histologic Confirmation of Parasitic Disease in Chronic Chagas Cardiomyopathy","authors":"Radhika Gulhar MD ,&nbsp;Justin Hayase MD ,&nbsp;Gregory A. Fishbein MD ,&nbsp;Sheba Meymandi MD ,&nbsp;Jason S. Bradfield MD","doi":"10.1016/j.jacep.2024.11.003","DOIUrl":"10.1016/j.jacep.2024.11.003","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 850-853"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364772","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":"Implantable Loop Recorder and Arrhythmia Detection in Hypertrophic Cardiomyopathy.","authors":"Omar M Abdelfattah, Deaa Abu Jazar, Arun Narayanan, Martin Maron, Ethan Rowin, Matthew W Martinez","doi":"10.1016/j.jacep.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003481","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":"Outcomes of Lead Extraction Based on Lead Dwell Time: Implications for Management of Redundant Leads.","authors":"Wissam Mekary, Mikhael F El-Chami, Neal K Bhatia, Michael S Lloyd, Stacy Westerman, Miguel A Leal, David DeLurgio, Anshul M Patel, Christine Tompkins, Faisal M Merchant","doi":"10.1016/j.jacep.2025.02.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.035","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990807","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":"Microvolt Activation Alternans Identifies Conduction Velocity Heterogeneity and the Entrance Site of Ischemic Ventricular Tachycardia.","authors":"Nathan C Denham, Adrian M Suszko, Masimba Nemaire, Abhishek Bhaskaran, Stéphane Massé, Kumaraswamy Nanthakumar, Michel Haïssaguerre, Eugene Downar, Edward Vigmond, Vijay S Chauhan","doi":"10.1016/j.jacep.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.014","url":null,"abstract":"<p><strong>Background: </strong>Body surface microvolt QRS alternans has been shown to predict ventricular tachyarrhythmias in patients with cardiomyopathy; however, the mechanism is unclear.</p><p><strong>Objectives: </strong>Our aim was to determine the spatiotemporal relationship of beat-to-beat bipolar electrogram (EGM) activation alternans (AA) to the ventricular tachycardia (VT) circuit and to surface QRS alternans.</p><p><strong>Methods: </strong>Intraoperative mapping during ventricular pacing and induced VT was performed in 9 patients with ischemic cardiomyopathy using a 112-bipole endocardial array. AA was quantified at EGM sites during pacing, timed to the surface QRS complex (intra vs post), correlated to local conduction velocity (CV), the location of the VT circuit, and surface QRS alternans. In silico modeling was performed to investigate the relationship between conduction disturbances and AA.</p><p><strong>Results: </strong>Intra-QRS and post-QRS AA was present in 8 of 9 patients with similar frequency (4.6% [Q1-Q3: 2.8%-8.3%] vs 3.5% [Q1-Q3: 1.0%-4.7%]; P = 0.77) and magnitude (192 μV [Q1-Q3: 72-246 μV] vs 470 μV [Q1-Q3: 270-601 μV]; P = 0.158). The presence of intra-QRS AA strongly correlated with the entrance of the VT circuit compared with remote regions (OR: 6.8; 95% CI: 3.7-12.5; P < 0.001). CV heterogeneity was the primary determinant of intra-QRS AA magnitude, in which each 0.1 increase in heterogeneity correlated with a 31-μV (95% CI: 3-59 μV) magnitude increase (P = 0.032). Intra-QRS AA magnitude strongly correlated with surface QRS alternans magnitude (r = 0.92, P = 0.001). Computer modeling supported AA sites representing <1-mm channels with 2:1 conduction block.</p><p><strong>Conclusions: </strong>Microvolt intra-QRS AA in the bipolar EGM is a marker of CV heterogeneity that associates with the VT entrance and may guide VT ablation. Surface QRS alternans is a manifestation of intra-QRS AA and may inform risk stratification.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970018","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":"Characterization of the Thermal Properties of Healthy vs Infarcted Ventricular Tissue: Implications for Radiofrequency Ablation.","authors":"Maite Izquierdo, Juan J Pérez, Omérim Gaona, Josep Navarro, Javier Navarrete, Luis Martinez-Dolz, Luis Almenar, Oscar Cano, Nuria Mancheño, Ana González-Suárez, Joaquín Osca, Enrique Berjano","doi":"10.1016/j.jacep.2025.02.032","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency (RF) ablation is the technique of choice for treating ventricular tachycardias in ischemic cardiomyopathy. However, recent experimental studies have found it to be ineffective. Poor heat transmission in collagen-rich scar tissue was 1 of the explanations given, even though the thermal properties of infarcted tissue have never been studied.</p><p><strong>Objectives: </strong>The purpose of the present study was to measure the thermal properties of chronically infarcted myocardium.</p><p><strong>Methods: </strong>A total of 5 freshly explanted human hearts from patients undergoing heart transplantation with previous chronic myocardial infarction were studied in the operating room. A 2-needle thermal sensor model SH-3 Tempos (Meter Group) was introduced into different infarcted and healthy areas in the left ventricle to measure the thermal conductivity, volumetric heat capacity, and thermal diffusivity. All the measured areas were excised for histological analysis. An in silico model of radiofrequency catheter ablation was then built to evaluate the impact of the thermal parameters obtained. Stiffness, electrical properties, and vascularization were also included to simulate realistic healthy and infarcted myocardium according to previously published data.</p><p><strong>Results: </strong>More than one-half of the area of the infarcted samples was composed of collagen. No significant differences were found between the thermal properties of infarcted and healthy tissue. The RF lesion depths obtained from the computational model did not have any clinically relevant differences (<0.4 mm in depth) between the infarcted and healthy tissue.</p><p><strong>Conclusions: </strong>Thermal properties of infarcted tissue are not sufficiently different from healthy tissue to justify different RF lesion sizes, according to our computational model.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005659","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":"Long-Term Follow-Up Data on Flecainide Use as an Antiarrhythmic in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multicenter Study.","authors":"Sean Gaine, Thomas Rolland, Babken Asatryan, Mikael Laredo, James Sampognaro, Richard T Carrick, Giovanni Peretto, Steven Muller, Andrea Villatore, Brittney Murray, Crystal Tichnell, Anneline S J M Te Riele, Peter Loh, Paolo Compagnucci, Michela Casella, Marika Martini, Marco Schiavone, Claudio Tondo, Chiara Cappelletto, Gianfranco Sinagra, Marco Merlo, Lior Jankelson, Mario Delmar, Mattia Targetti, Maurizio Pieroni, Iacopo Olivotto, Leonardo Calò, Maddalena Graziosi, Elena Biagini, Harikrishna Tandri, Barbara Bauce, Cynthia James, Marina Cerrone, Hugh Calkins, Estelle Gandjbakhch, Alessio Gasperetti","doi":"10.1016/j.jacep.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.023","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Several animal models have been used to postulate a therapeutic role of the inhibition of the ryanodine 2 receptor via the use of flecainide for this disease. Clinical data describing its use are scarce, however, especially in patients without implantable cardioverter-defibrillators or with left ventricular (LV) involvement.</p><p><strong>Objectives: </strong>This study sought to report safety and effectiveness long-term, multicenter data on the impact of flecainide therapy on arrhythmic outcomes in patients with a definite diagnosis of ARVC.</p><p><strong>Methods: </strong>Patients with definite ARVC receiving flecainide at 12 academic institutions were enrolled in the study. Baseline was defined as the time of flecainide initiation. Premature ventricular complex burdens, nonsustained ventricular tachycardia (NSVT) rates, and sustained VA yearly/rates were collected and compared while on and off flecainide. Side effects and flecainide discontinuation were tracked. Analyses were performed in the overall cohort as well as stratifying for genotype (gene positive vs negative; plakohpillin-2 [PKP-2] vs non PKP-2) and for LV involvement.</p><p><strong>Results: </strong>A total of 191 patients (37.9 ± 13.7 years; 69.0% male; 89.0% probands; 59.2% having implantable cardioverter-defibrillators; 33.0% with prior VA; 43.5% PKP-2⁺; LV ejection fraction 55.9 ± 7.3%; right ventricular ejection fraction 44.5 ± 10.5% at baseline) were enrolled, with 66 patients (34.6%) showing LV involvement. The median dose of flecainide was 200 mg/d [150-200 mg/d], with 166 patients (86.9%) also taking a beta-blocker. The median follow-up time on flecainide was 4.2 years [1.9-6.3 years]. Flecainide was well tolerated, with a low (7.9%) discontinuation rate. After flecainide initiation, a significant reduction in the 24-hour premature ventricular complex burden and in the rate of nonsustained ventricular tachycardia was observed (2,190 vs 418; P < 0.001; 35.1% vs 21.5%; P = 0.003). For patients with prior VA events, a significant reduction in the amount of VA episodes/y (1.1 [0.4-1.6] episodes/y vs 0 [0-0.3] episodes/y; P < 0.001) was observed. These safety and effectiveness findings were consistent across genotype subgroups, as well as in patients with and without LV involvement.</p><p><strong>Conclusions: </strong>Flecainide use had a favorable safety profile and was associated with an observed to a significant reduction in arrhythmic burden in patients with ARVC, irrespective of the underlying genotype or LV involvement.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003482","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}