JACC. Clinical electrophysiology最新文献

{"title":"Procedure-Related Complications Associated With Catheter Ablation for Idiopathic Premature Ventricular Complexes: A Systematic Review and Meta-Analysis.","authors":"Sean DeAngelo, Maryam Haghshomar, Badri Aryal, Muhammed Khawar Sana, Robert D Schaller","doi":"10.1016/j.jacep.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.038","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008708","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":"In Vivo Assessment of Cardiac Radiofrequency Ablation in a Large-Animal Model Using Photoacoustic-Ultrasound Imaging.","authors":"Nilesh Mathuria, Krithik Vishwanath, Blake C Fallon, Antonio Martino, Giorgio Brero, Richard C Willson, Miguel Valderrabano, Carly S Filgueira, Richard R Bouchard","doi":"10.1016/j.jacep.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.031","url":null,"abstract":"<p><p>Despite advancements in catheter technology, intraoperative assessment of radiofrequency ablation (RFA) lesions remains elusive. Prior ex vivo data suggest photoacoustic imaging (PAI) can provide RFA lesion characteristics, but in vivo data are lacking. PAI involves delivering near-infrared light to tissue, leading to transient acoustic waves that can be detected by clinically available ultrasound transducers, providing optically based tissue characterization at depth. Three epicardial RFA lesions were delivered in an open-chest porcine model. In vivo PAI-based measurements of RFA lesion dimensions matched (<0.7-mm error) gross pathologic assessment, yielding in vivo feasibility data of PAI to provide intraoperative RFA lesion dimensions.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966817","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":"Luminal Esophageal Temperature Rises With Pulsed Field Ablation.","authors":"Armen A Kocharian, Monisha Krishna Murthy, Apoor Patel, Rajesh Venkataraman, Nilesh S Mathuria, Adi Lador, Joe Fahed, Miguel Valderrábano","doi":"10.1016/j.jacep.2025.02.037","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.037","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971656","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 Hospital VT Ablation Volume on Post-Procedural Complications: Argument for Selective Referral to High-Volume Centers.","authors":"Agam Bansal, Anirudh Nandan, Jakub Sroubek, Justin Lee, Koji Higuchi, Ayman Hussein, Shady Nakhla, Mina Chung, Niraj Varma, Walid Saliba, Mandeep Bhargava, Tyler Taigen, Mohamed Kanj, Oussama Wazni, Pasquale Santangeli","doi":"10.1016/j.jacep.2025.02.041","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.041","url":null,"abstract":"<p><strong>Background: </strong>Existing studies have shown a relationship between hospital case volume and outcomes of various cardiovascular procedures. The impact of hospital procedure volume on complications of catheter ablation of ventricular tachycardia (VT) and the potential benefit of selective referral to high-volume centers have not been previously evaluated.</p><p><strong>Objectives: </strong>This study sought to assess the associations between hospital procedure volume of VT catheter ablation and postprocedural morbidity and mortality.</p><p><strong>Methods: </strong>The NIS (National Inpatient Sample) database was queried for hospital admissions for VT ablation in the United States during the year 2019. Hospitals were divided into tertiles of VT ablation volume (high-volume hospitals [HVH] ≥50 ablations per year, medium-volume hospitals performed 16-49 ablations, and low-volume hospitals [LVH] ≤ 15 ablations). Data on adverse events including in-hospital mortality and postprocedural complications were collected.</p><p><strong>Results: </strong>Patients in HVH were more likely to have comorbidities including heart failure (74.3% vs 64.7%; P = 0.02) and kidney disease (25.3% vs 21.7%; P = 0.044) than LVH. After controlling for baseline confounders and with LVH as reference, HVH had lower in-hospital mortality (adjusted OR [aOR] = 0.80; 95% CI: 0.71-0.91; P = 0.04), cardiac tamponade (aOR = 0.58; 95% CI: 0.32-0.78; P = 0.01), and need for blood transfusion (aOR = 0.41; 95% CI: 0.21-0.68; P = 0.008). It can be estimated that for every 17 patients shifted from LVH to HVH, 1 death, cardiac tamponade, or major bleeding event could be prevented.</p><p><strong>Conclusions: </strong>Patients undergoing VT ablation at HVH were sicker on average, yet had lower in-hospital mortality and procedure-related morbidity compared to LVH. Selective VT patient referral to HVH has the potential to substantially reduce in-hospital complications following VT ablation nationally.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003536","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":"Music of the Heart: Arrhythmias.","authors":"Jiun-Ruey Hu","doi":"10.1016/j.jacep.2025.02.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006308","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 and Clinical Outcomes of High-Risk Device-Related Thrombus in the Amulet IDE Trial.","authors":"Jens Erik Nielsen-Kudsk, Boris Schmidt, Stephan Windecker, Neeraj Shah, William Gray, Christopher R Ellis, Konstantinos Koulogiannis, Jordan A Anderson, Ryan Gage, Dhanunjaya Lakkireddy","doi":"10.1016/j.jacep.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Characteristics of device-related thrombus (DRT) may differ between types of left atrial appendage occlusion devices, and the association of different DRT characteristics to clinical outcomes is largely unknown.</p><p><strong>Objectives: </strong>The incidence, characteristics, and clinical outcomes through 5 years of high- and low-risk DRTs were assessed in the Amulet IDE trial (AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational Device Exemption [IDE] Trial).</p><p><strong>Methods: </strong>An independent core laboratory analyzed all available images at the required 45-day and 12-month visits, and clinical events were reported through 5 years' post-left atrial appendage occlusion.</p><p><strong>Results: </strong>Of the 1,788 patients with a successful device implant, DRT was observed in 3.3% (30 of 903) and 4.5% (40 of 885) of Amulet and Watchman 2.5 device patients throughout 12 months, respectively (P = 0.192). DRTs were successfully classified as high risk if pedunculated, mobile, >3 mm in thickness, or without continuation onto the left atrial wall. A significantly higher incidence of high-risk DRTs was observed on the Watchman 2.5 device (4.0% [35 of 885]) compared with the Amulet occluder (2.2% [20 of 903]) (P = 0.030). Most low-risk DRTs resolved (12 of 15), whereas high-risk DRTs remained mostly unresolved (34 of 55). Through 5 years, all clinical outcome rates were numerically higher in the high-risk DRT group compared with the low-risk DRT or no-DRT group; significance was observed in the composite of stroke, systemic embolism, or cardiovascular death (30.4% vs 19.9%; HR: 1.74; 95% CI: 1.03-2.92; P = 0.037) and cardiovascular death (26.4% vs 14.5%, HR: 2.09; 95% CI: 1.20-3.66; P = 0.009).</p><p><strong>Conclusions: </strong>High-risk DRTs were observed in a higher number of Watchman 2.5 device patients compared with Amulet occluder patients. The composite of stroke, systemic embolism, or cardiovascular death occurred more often in patients with high-risk DRTs compared with those with low-risk DRTs or no DRTs. (AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational Device Exemption [Amulet IDE Trial]; NCT02879448).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982733","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":"Partial Perforation: A Tolerated Reality of Left Bundle Branch Area Pacing?","authors":"Bengt Herweg","doi":"10.1016/j.jacep.2025.02.033","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.033","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004536","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 Impact of High-Intensity Targeted Ablation of Identifiable Critical Zones in Scar-Related Ventricular Tachycardia.","authors":"Yuka Oda, Yuki Komatsu, Yasutoshi Shinoda, Yuichi Hanaki, Masayuki Hattori, Naoaki Hashimoto, Takashi Kanda, Fumiharu Miura, Naoya Hironobe, Yuto Iioka, Yoshihiro Harano, Yuki Matsuoka, Takanori Arimoto, Hitoshi Minamiguchi, Nobuhiko Makino, Kentaro Yoshida, Hiro Yamasaki, Miyako Igarashi, Tomoko Ishizu, Akihiko Nogami","doi":"10.1016/j.jacep.2025.02.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.021","url":null,"abstract":"<p><strong>Background: </strong>Ventricular tachycardia (VT) isthmus boundaries correlate with a localized line of conduction block (LOB) identified by substrate mapping during baseline rhythm. In particular, a rotational activation pattern (RAP), which is characterized as a wavefront propagation pivoting around the edge of the fixed LOB accompanied by conduction slowing, may have a high proclivity toward re-entry.</p><p><strong>Objectives: </strong>This study aimed to assess outcomes of ablation targeting the RAP around the LOB identifiable during substrate mapping.</p><p><strong>Methods: </strong>We studied 81 patients (median age 68 years; 85% male; 25% ischemic cardiomyopathy) who underwent ablation primarily targeting the regions exhibiting a RAP around the LOB associated with clinical VT.</p><p><strong>Results: </strong>High-resolution substrate mapping identified a RAP in 41 patients (51%). Of these, 30 patients (Group A) underwent ablation of an area with a radius >1 cm, including the targeted RAP regions. In 11 patients (Group B), RAPs were unable to be ablated because of the proximity of the RAP site to the conduction system, coronary arteries, or phrenic nerves, or based on the operator's discretion to avoid hemodynamic decompensation. The remaining 40 patients (Group C) had no identifiable RAP, and none of them had no mid-diastolic activities during VT due to intramural or contra-surface arrhythmogenic substrate. During 1-year follow-up, 83% freedom from VT recurrence was achieved in Group A, compared with 41% and 39% in Groups B and C, respectively (P = 0.003).</p><p><strong>Conclusions: </strong>The identification of critical zones of the VT re-entrant circuit, which may be co-localized with regions hosting RAP around the LOB, as well as high-intensity ablation targeting these regions, appear to be important for successful ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003479","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":"Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter Registry.","authors":"Federico Migliore, Luca Ottaviano, Alberto Arestia, Gerardo Nigro, Antonio Dello Russo, Stefano Viani, Valter Bianchi, Antonio Bisignani, Paolo Pieragnoli, Gennaro Vitulano, Roberto Rordorf, Pietro Francia, Erika Taravelli, Ennio Pisanò, Carlo Lavalle, Roberta Brambilla, Matteo Ziacchi, Antonio Rapacciuolo, Miguel Viscusi, Paolo De Filippo, Carmelo La Greca, Patrizia Pepi, Pasquale Notarstefano, Antonio Curcio, Raimondo Pittorru, Nicolò Martini, Alessandro Seganti, Carlo Napolitano, Mariolina Lovecchio, Sergio Valsecchi, Gianluca Botto, Silvia G Priori","doi":"10.1016/j.jacep.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD. Nevertheless, long-term data from large cohorts of BrS patients with S-ICDs are lacking.</p><p><strong>Objectives: </strong>This multicenter study aimed to assess the long-term outcomes of S-ICD therapy in patients with BrS.</p><p><strong>Methods: </strong>The study included 450 consecutive BrS patients (mean age 43 ± 12; 86% male) who underwent S-ICD implantation between 2014 and 2024.</p><p><strong>Results: </strong>During a median follow-up of 52 months (25th-75th percentile: 29-72), appropriate shocks were delivered in 3% of patients (1.2%; 95% CI: 0.2-2.2, at 12 months), with a first-shock success rate of 90% (100% with 2 shocks). Inappropriate shocks occurred in 7% of patients (1.4%; 95% CI: 0.3-2.5, at 12 months). Shock zone programmed at 250 beats/min (HR: 0.40; 95% CI: 0.18-0.89; P = 0.025) and more than 1 suitable vector on screening (HR: 0.39; 95% CI: 0.17-0.87; P = 0.023) were independent protective factors against inappropriate shock. Device-related complications were reported in 4% of patients (2.5%; 95% CI: 1.0-3.9 at 12 months). The need for antibradycardia pacing was reported in 3 patients (0.7%). No device explantation because of the need for antitachycardia pacing was noted.</p><p><strong>Conclusions: </strong>Our findings support the S-ICD as a viable alternative to the transvenous ICD for preventing sudden cardiac death in BrS patients without pacing indication (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742934","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":"Transient Complete Atrioventricular Block Following Slow Pathway Ablation Near the Atrioventricular Nodal Artery.","authors":"Yuka Oda, Akihiko Nogami, Ryuichi Usui, Kikuya Uno","doi":"10.1016/j.jacep.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.001","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002983","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}