JACC. Clinical electrophysiology最新文献

{"title":"The Misleading QRS Morphology of Scar-Related Ventricular Tachycardia.","authors":"Yumi Katsume, Daisuke Togashi, Shunsuke Uetake, Salah H Alahwany, Zachary T Yoneda, Travis D Richardson, Jay A Montgomery, Sharon T Shen, Juan C Estrada, Arvindh N Kanagasundram, Harikrishna Tandri, William G Stevenson","doi":"10.1016/j.jacep.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.004","url":null,"abstract":"<p><strong>Background: </strong>The QRS morphology of ventricular tachycardia (VT) reflects the re-entry circuit exit location and helps guide mapping for radiofrequency ablation (RFA). It can be misleading, however, particularly in structural heart disease.</p><p><strong>Objective: </strong>The aim of this study was to assess the relation of the site where RFA terminated VT to the location of the exit predicted by the VT QRS morphology.</p><p><strong>Methods: </strong>This study included 64 scar-related re-entrant left ventricular VTs (57.9% ischemic cardiomyopathy) with an identified region where RFA terminated the VT; a previously reported electrocardiogram algorithm that uses the QRS vector to predict the VT exit region on the American Heart Association 17-segment left ventricular model was applied. QRS discordant VTs were defined as having the RFA termination site outside of the predicted exit region. Entrainment and pace mapping (PM) data were also analyzed to assess possible reasons for discrepancies.</p><p><strong>Results: </strong>The QRS morphology was discordant with the termination region in 57 (89%) VTs. Two types of discordance were seen. In 22 (34.4%), the termination region was remote from the circuit exit. In 32 (50%), the termination site was in the VT re-entry circuit exit, but the QRS suggested a different exit region. Analysis of voltage maps and PM suggested that the QRS vector was often altered by scar.</p><p><strong>Conclusions: </strong>For scar-related VTs, the exit predicted from a vector-based QRS algorithm often differs from the location where ablation terminates the VT. This is an important consideration for use of the QRS to guide VT ablation strategies. PM can potentially assist in recognizing this discrepancy and warrants study.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954575","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":"Social Determinants of Health and Disparities in Diagnosis-to-Ablation Time for Atrial Fibrillation.","authors":"Danish Iltaf Satti, Jeffrey Shi Kai Chan, Robert Weinstein, Julia De Conti Pelanda, Hassan Mirbolouk, Linh Tran, Jenna Milstein, Keva Garg, Elham Hatef, Nino Isakadze, Konstantinos N Aronis, Joseph E Marine, Ronald Berger, Hugh Calkins, David Spragg","doi":"10.1016/j.jacep.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.006","url":null,"abstract":"<p><strong>Background: </strong>Social determinants of health (SDOH) significantly influence health care access and outcomes, but their impact on atrial fibrillation (AF) diagnosis-to-ablation time (DAT) and anticoagulation prescription rates is unknown.</p><p><strong>Objective: </strong>The goal of this study was to assess the associations between SDOH, measured by using the Area Deprivation Index (ADI), and DAT and anticoagulation prescription rates in patients undergoing AF ablation.</p><p><strong>Methods: </strong>Data from the Hopkins AF Ablation Registry (2014-2023) were analyzed retrospectively. The relationship between ADI and DAT was evaluated by using log-gamma regression analysis, adjusting for age, sex, race, and comorbidities. Restricted cubic spline analysis was used to qualitatively assess the linearity of the associations. For anticoagulation prescription rates, only patients who qualified for therapy were included, and logistic regression was used to assess the association between ADI and anticoagulant prescription at discharge, adjusting for the same covariates.</p><p><strong>Results: </strong>After excluding patients with missing data, 1,025 patients undergoing first AF ablation were included. Higher ADI scores, indicating greater SDOH burden, were significantly associated with longer DAT. Each 10-unit increase in ADI percentile corresponded to a 6.96% increase in DAT (95% CI: 1.02-1.12; P = 0.003), equating to a delay of 3.83 months (95% CI: 1.27-6.39). Restricted cubic spline revealed a linear relationship between ADI and DAT. Subgroup analyses did not show any significant interactions by age group, sex, or race. No significant association was found between ADI percentile and anticoagulant prescription at discharge (P = 0.097).</p><p><strong>Conclusions: </strong>Greater SDOH burden is associated with significant delays in accessing AF ablation. Addressing socioeconomic barriers is essential to ensure equitable and timely AF care.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954515","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":"Avoiding a Pitfall in the Entrainment Response of Bundle-Branch Re-entrant Tachycardia: Accounting for Fascicular Delay.","authors":"Alfredo Chauca-Tapia, Anthony Li, Magdi Saba","doi":"10.1016/j.jacep.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954354","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 Arrhythmia Burden (SMURDEN) After Ablation of AF Is Associated With Improvement in Quality of Life.","authors":"Ghassan Bidaoui, Han Feng, Chanho Lim, Nour Chouman, Ala Assaf, Mayana Bsoul, Hadi Younes, Christian Massad, Yishi Jia, Yingshou Liu, Mario Mekhael, Charbel Noujaim, Eoin Donnellan, Omar Kreidieh, Amitabh C Pandey, Swati Rao, Nassir F Marrouche","doi":"10.1016/j.jacep.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.011","url":null,"abstract":"<p><strong>Background: </strong>Among patients with persistent atrial fibrillation (AF), magnetic resonance imaging (MRI)-guided fibrosis ablation did not reduce arrhythmia recurrence compared with pulmonary vein isolation (PVI) alone.</p><p><strong>Objectives: </strong>The aim of this study was to assess the determinants of symptom and quality of life (QoL) change after PVI with or without MRI-guided ablation.</p><p><strong>Methods: </strong>This prespecified DECAAF II (Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation) trial analysis included patients with persistent AF who had symptom severity scores before and after ablation. Patients were provided with a smartphone-based electrocardiography device for single-lead AF burden (SMURDEN) assessment. Participants completed the Atrial Fibrillation Symptom Severity (AFSS) and Short-Form 36 (SF-36) surveys at baseline, 3 months, and 12 months postablation. Symptom and QoL improvement determinants were explored through univariable and multivariable linear models.</p><p><strong>Results: </strong>Surveys from 750 patients were analyzed, revealing balanced baseline AFSS and SF-36 scores between the treatment arms (AFSS symptom score: mean ± SD = 12.3 ± 8.2 for PVI and 12.0 ± 8.0 for MRI-guided fibrosis ablation; P = 0.670). Symptoms improved in both arms (AFSS symptom score: 6.8 ± 0.5 for PVI and 7.3 ± 0.5 for MRI-guided fibrosis ablation; P = 0.114). Patients without AF recurrence exhibited greater improvement in most of the SF-36 subcategories and AFSS subcategories (P < 0.05). SMURDEN showed a correlation with QoL improvement and was the only predictor of no improvement or symptom worsening (R = 0.31; P < 0.001).</p><p><strong>Conclusions: </strong>Patients who experienced AF recurrence reported diminished symptom and QoL improvements. SMURDEN emerged as the most significant predictor of symptom improvement and was the only independent factor associated with a lack of improvement or worsening of symptoms.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954292","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":"Large Genomic Rearrangements in Long QT Syndrome Patients: Implications for Clinical Management.","authors":"Alessandro Trancuccio, Deni Kukavica, Patrick Gambelli, Andrea Mazzanti, Carlo Napolitano, Mirella Memmi, Silvia G Priori","doi":"10.1016/j.jacep.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954431","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":"Rethinking Risk in Mitral Valve Prolapse: The Promise of Machine Learning and Multimodal Phenotyping.","authors":"Jean-Claude Deharo, Benjamin Essayagh, Avi Sabbag","doi":"10.1016/j.jacep.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.003","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954497","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":"Electrical Storm in Patients With Hypertrophic Cardiomyopathy.","authors":"Pierre Groussin, Melvyn Dezecot, Donovan Decaudin, Dominique Pavin, Sandro Ninni, Cédric Klein, Pierre Ollitrault, Laure Champ Rigot, Jonaz Font, Antoine Da Costa, Jean-Marc Sellal, Néfissa Hammache, Alexandre Salaun, Charles Guenancia, Philippe Mabo, Karim Benali, Raphaël Martins","doi":"10.1016/j.jacep.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.035","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic strategies for electrical storm (ES) in patients with hypertrophic cardiomyopathy (HCM) are not well defined, yet this population is at risk for ventricular arrhythmias (VAs).</p><p><strong>Objective: </strong>The aim of this study was to analyze acute management, in-hospital mortality, and long-term outcomes of patients with HCM experiencing ES.</p><p><strong>Methods: </strong>This multicenter study retrospectively enrolled patients with ES complicating HCM between 2017 and 2023 in 6 tertiary centers.</p><p><strong>Results: </strong>Twenty-three patients were included (mean age 61.5 ± 15.2 years, 73.9% male, left ventricular ejection fraction 50% ± 14%). Five patients (22%) had an apical aneurysm. Ten (43.4%) patients had a history of VA, including 3 with previous ES. The majority of VAs were monomorphic ventricular tachycardias (18 patients [78%]). Most patients received amiodarone (n = 20 [87%]) and beta-blockers (n = 16 [70%]). For 10 patients (44%), a radiofrequency catheter ablation was performed (including 2 endo-epicardial ablations), resulting in negative programmed ventricular stimulation in 4 patients. During their hospital management, 8 patients experienced recurrences of VA (2 [25%] previously ablated and 6 [75%] nonablated). Two (9%) patients died during the index hospitalization and 4 other patients died following discharge (median follow-up 18 months). Seven patients (30%) experienced recurrences of arrhythmias, including 4 who had undergone ablation. Radiofrequency ablation was not associated with better outcomes (recurrence rate or overall survival) in this study.</p><p><strong>Conclusions: </strong>ES in HCM frequently resolves using antiarrhythmic drugs. Many patients will present with VA recurrences. Long-term outcomes were poor, and one-fourth of the patients ended up dying at 18 months. Further studies are warranted to better analyze radiofrequency outcomes in this specific population.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954442","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":"Conduction Block in a Fasciculoventricular Pathway.","authors":"Fatima M Ezzeddine","doi":"10.1016/j.jacep.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.07.001","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954388","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":"Peak Frequency for Characterizing and Predicting Critical Isthmus and Termination Sites in Macro-Re-Entrant Atrial Tachycardia.","authors":"Adrian M Petzl, Corentin Chaumont, Neel A Patel, Brian Otto, Lily Englander, Ramanan Kumareswaran, Timothy M Markman, David J Callans, Michael P Riley, Andres Enriquez, Matthew C Hyman, Francis E Marchlinski, David Lin","doi":"10.1016/j.jacep.2025.06.037","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.037","url":null,"abstract":"<p><strong>Background: </strong>Identifying critical isthmuses in macro-re-entrant atrial tachycardia (MRAT) is challenging. Omnipolar Technology Near Field mapping with the Peak Frequency (PF) tool holds promise for identifying critical regions sustaining re-entry, though PF signal characteristics and the algorithm's clinical value need further exploration.</p><p><strong>Objectives: </strong>This study sought to analyze properties of PF in MRAT critical isthmuses and evaluate the value of Omnipolar Technology Near Field PF mapping in guiding ablation.</p><p><strong>Methods: </strong>Consecutive patients undergoing MRAT ablation procedures with fully mapped circuits (using EnSite-X and HD-Grid) and termination during ablation were included. PF values were analyzed globally across the atrium and compared to the ablation termination site (within 5-mm diameter). The absolute maximum PF at and the number of ablation lesions required for termination were recorded.</p><p><strong>Results: </strong>The study involved 21 MRATs (12 left, 9 right atrial) from 17 patients (age 63.9 ± 18.3 years). Termination typically required a median of 1 (Q1-Q3: 1-7) ablation lesion, with 48% terminating after the initial lesion. Maximum PF values at termination sites were significantly higher (615.2 ± 85.7 Hz) than global PF values (317.6 ± 45.4 Hz; P < 0.01) and PF within the 5-mm termination diameter (499.6 ± 115.4 Hz; P < 0.01). Voltage at termination sites (0.39 ± 0.56) was significantly lower than the global average (0.73 ± 0.57; P < 0.01). PF values above 363 Hz differentiated isthmus regions from global atrial PF, with values >530 Hz indicating maximum PF at termination sites.</p><p><strong>Conclusions: </strong>Peak frequencies at MRAT termination sites are substantially higher than global atrial PFs, supporting the potential of PF mapping as an effective tool for identifying critical isthmuses in MRAT ablation procedures.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954386","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":"Mapping and Ablation of Paraseptal Focal Atrial Tachycardias.","authors":"Ivaylo R Tonchev, Arie L Schwartz, Ashley M Nisbet, David Chieng, Troy M Watts, Paul Sparks, Joseph B Morton, Geoffrey Lee, Peter M Kistler, Jonathan M Kalman","doi":"10.1016/j.jacep.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.022","url":null,"abstract":"<p><strong>Background: </strong>Focal atrial tachycardia (AT) may arise from a range of closely related anatomical sites in the paraseptal region.</p><p><strong>Objectives: </strong>This study sought to define the anatomical distribution and examine the electrocardiographic and electrophysiological features of paraseptal focal AT, suggest a mapping approach, and report ablation outcomes.</p><p><strong>Methods: </strong>This retrospective single-center study defined paraseptal ATs as originating from the following anatomical sites: right perinodal region, septal tricuspid annulus, right septum, coronary sinus (CS) ostium, left septum, septal mitral annulus, aorto-mitral continuity, and non-coronary cusp (NCC) adjacent. Early septal activation was defined when the earliest right atrial activation occurred at the His bundle region or CS ostium ≥10 milliseconds before P-wave onset.</p><p><strong>Results: </strong>Among 227 patients (mean age 54.8 ± 15.8 years; 61.7% female), foci were diverse and included: right perinodal, n = 61 (26.9%); septal tricuspid annulus, n = 23 (10.1%); right septum, n = 28 (12.3%); CS ostium, n = 43 (18.9%); left septum, n = 28 (12.3%); septal mitral annulus, n = 16 (7.1%); aorto-mitral continuity, n = 19 (8.4%); and NCC adjacent, n = 9 (4%). Ablation was attempted in 213 (93.8%) of 227 patients and was successful in 189 (88.7%) of 213 patients; there were no instances of persistent atrioventricular block. The NCC was not a common ablation site. P-wave morphology was characteristic (V₁ was predominantly negative/positive, isoelectric/positive, or isoelectric, 91%) but did not distinguish between these anatomical sites. Sequential and systematic mapping was required to localize earliest activation.</p><p><strong>Conclusions: </strong>Paraseptal focal ATs arise from diverse but closely related anatomical locations. There is no single site from which ablation is consistently successful. Although some are indeed perinodal and accessible from the NCC, others arise from adjacent structures. Nevertheless, detailed, sequential mapping facilitates safe and effective ablation in most cases.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835096","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}