JACC. Clinical electrophysiology最新文献

{"title":"Epicardial Mapping and Ablation of Focal Atrial Tachycardia from the Crista Terminalis During Cardiac Surgery.","authors":"Steven Liskov, Jenna A Milstein, Andreas S Barth, Ari Cedars, Bret A Mettler, Danielle Gottlieb Sen, Konstantinos N Aronis","doi":"10.1016/j.jacep.2024.12.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.021","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476482","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":"Whole-Heart Histological and CMR Validation of Electroanatomic Mapping by Multielectrode Catheters in an Ovine Model.","authors":"Timothy Campbell, Richard G Bennett, Robert D Anderson, Chris Davey, Alexandra K O'Donohue, Aaron Schindeler, Kasun De Silva, Ashwin Bhaskaran, Samual Turnbull, Dinesh Selvakumar, Yasuhito Kotake, Chi-Jen Hsu, James J H Chong, Eddy Kizana, Saurabh Kumar","doi":"10.1016/j.jacep.2024.11.011","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.011","url":null,"abstract":"<p><strong>Background: </strong>Accurate electroanatomic mapping is critical for identifying scar and the long-term success of ventricular tachycardia ablation.</p><p><strong>Objectives: </strong>This study sought to determine the accuracy of multielectrode mapping (MEM) catheters to identify scar on cardiac magnetic resonance (CMR) and histopathology.</p><p><strong>Methods: </strong>In an ovine model of myocardial infarction, we examined the effect of electrode size, spacing, and mapping rhythm on scar identification compared to CMR and histopathology using 5 multielectrode mapping catheters. We co-registered electroanatomic mapping, CMR, and histopathology for comparison. Catheter-specific voltage thresholds were identified based on underlying amounts of normal myocardium on transmural histology biopsies.</p><p><strong>Results: </strong>Ten animals were included: 6 with anteroseptal myocardial infarction and 4 control animals. A total of 419,597 points were manually reviewed across the catheters, with 315,487 points used in the analysis. There were minimal differences in bipolar and unipolar voltages, scar areas, and abnormal electrograms between catheters and between rhythms. Catheter-specific bipolar and unipolar voltage thresholds for normal myocardium were High-Density Grid >2.78 mV and >6.19 mV, DuoDecapolar >2.22 mV and >6.05 mV, PentaRay >1.66 mV and >5.35 mV, Decanav >1.36 mV and >4.75 mV, Orion >1.21 mV and >6.05 mV, respectively. Catheter-specific bipolar thresholds improved the accuracy for detecting endo-mid myocardial scar on CMR by 1.8%-15.6% and catheter-specific unipolar thresholds improved the accuracy in the mid-epicardial layers by 25.3%-81.1%.</p><p><strong>Conclusions: </strong>Minimal differences were observed in scar detection and electrogram markers between commercially available multielectrode mapping catheters and differing wave fronts. Compared to traditional voltage criteria for bipolar and unipolar scar, catheter-specific thresholds markedly improved accuracy for delineating scar on CMR.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023345","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":"Automated Beat-to-Beat Measurement of R-Wave Peak Time for Left Bundle Branch Area Pacing.","authors":"Alberto Spadotto, Rune Paamand, Estel Clua I Sánchez, Valérian Valiton, Olivier Leonard, Karl Firth, Haran Burri","doi":"10.1016/j.jacep.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.10.035","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023121","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":"Incidence and Clinical Management of Supraventricular Arrhythmias in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia.","authors":"Brett C Austin, Gurukripa N Kowlgi, Raquel Almeida Lopes Neves, Konstantinos C Siontis, J Martijn Bos, John R Giudicessi, Michael J Ackerman","doi":"10.1016/j.jacep.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.018","url":null,"abstract":"<p><strong>Background: </strong>Smaller studies suggest supraventricular arrhythmias (SVAs) are common in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT).</p><p><strong>Objectives: </strong>This study aimed to determine the incidence, type, and clinical management of SVAs observed within a large, single-center cohort of CPVT cases.</p><p><strong>Methods: </strong>The electronic medical records of 206 patients (51% female; average age at diagnosis 21 ± 17 years) diagnosed clinically with CPVT between January 2000 and September 2023 were reviewed for electrocardiographic evidence of SVAs, including atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), and supraventricular tachycardia. SVAs were considered clinically significant when sustained for >30 seconds, with or without symptoms, ultimately necessitating clinical evaluation. SVA type, symptoms, and therapeutic efficacy were assessed.</p><p><strong>Results: </strong>Overall, 17 (8.3%) of 206 patients had evidence of an SVA (AF/AFL in 8, AT in 9, and supraventricular tachycardia in 1 [1 patient experienced both AT and AF/AFL]). The median age at SVA diagnosis was 28 years (Q1-Q3: 16-34 years). A total of 11 (65%) of 17 patients were symptomatic, 3 (27%) of whom experienced inappropriate shocks. All patients were trialed on antiarrhythmics. Owing to drug failure, intolerance, or patient/provider preference; 5 (29%) of 17 patients with SVAs underwent radiofrequency ablation. Notably, over a median follow-up duration of 11 months (Q1-Q3: 5-45 months), 1 SVA recurrence was observed in a patient treated medically.</p><p><strong>Conclusions: </strong>In comparison with prior studies, the incidence of SVAs in this large, single-center CPVT cohort was substantially lower (8.3% vs 26%-35%). Although a larger multicenter study is needed to confirm, this study suggests that radiofrequency ablation durably treats CPVT-associated SVAs.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364769","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 and Flutter in a Contemporary Cohort of Patients With Myotonic Muscular Dystrophy.","authors":"Melissa A Austin, Gregory E Supple, Samuel Carrell, Colin Quinn, Lauren Elman, Saman Nazarian","doi":"10.1016/j.jacep.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.007","url":null,"abstract":"<p><strong>Background: </strong>Literature on the prevalence and management of atrial arrhythmias in patients with myotonic muscular dystrophy type 1 (MMD1) or myotonic muscular dystrophy type 2 (MMD2) is limited.</p><p><strong>Objectives: </strong>This study sought to describe incidence, prevalence, and predictors of atrial fibrillation (AF) and atrial flutter (AFL) in a contemporary cohort of patients with myotonic muscular dystrophy (MMD).</p><p><strong>Methods: </strong>Associations between patient factors and incident AF/AFL were analyzed in patients with MMD referred for routine electrophysiology evaluation between January 2013 and September 2023.</p><p><strong>Results: </strong>We identified 120 patients (96 MMD1, 24 MMD2) seen for new electrophysiology clinic visits for MMD cardiac evaluation. Median age at MMD diagnosis was 34.6 years (Q1-Q3: 21.8-51.0 years), with a younger age at diagnosis for MMD1 patients (P < 0.001). AF or AFL was diagnosed in 31% of patients (31 of 96 MMD1 patients vs 6 of 24 MMD2 patients; P = 0.656) during the study period. AF occurred in 34 (28%) patients, AFL in 9 (8%), and 6 of 37 had both AF and AFL. Anticoagulation (AC) was prescribed at initial AF/AFL diagnosis in 41% (n = 15 of 37) of patients. The CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score was higher in patients who received AC (P < 0.001). Twelve (32%) patients underwent catheter ablation. One stroke occurred in the AF/AFL group (no AC, CHA₂DS₂-VASc score 0). Female MMD1 patients were less likely to develop AF/AFL (HR: 0.08). Diagnosis of MMD1 at a younger age (HR: 0.95 per year) and greater CTG nucleotide repeats (HR: 1.09 per 50 repeats) were associated with incident AF/AFL.</p><p><strong>Conclusions: </strong>There was a high prevalence of AF/AFL in this single-institution MMD cohort. The CHA₂DS₂-VASc score may not be an effective tool in this population.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023120","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":"Postablation Arrhythmogenic Channels Predict Atrial Fibrillation Recurrence: Iatrogenic Substrate Revisited.","authors":"Mariona Regany-Closa, Josep Pomes, Elena Arbelo, Jean-Baptiste Guichard, Andreu Porta-Sanchez, Eduard Guasch, Josep Brugada, Ivo Roca-Luque, Lluís Mont, Till F Althoff","doi":"10.1016/j.jacep.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023330","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":"Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation.","authors":"Nicola Pierucci, Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Marco Schiavone, Brandon Doty, Kirollos Gabrah, Domenico G Della Rocca, J David Burkhardt, Amin Al-Ahmad, Luigi Di Biase, Michela Casella, Antonio Dello Russo, Devi Nair, Moussa Mansour, Claudio Tondo, Andrea Natale","doi":"10.1016/j.jacep.2024.11.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.009","url":null,"abstract":"<p><strong>Background: </strong>Earlier studies have documented the risk for sinoatrial node injury and phrenic nerve paralysis as complications following radiofrequency catheter ablation for electrical isolation of the superior vena cava (SVCI).</p><p><strong>Objectives: </strong>The aim of this study was to assess the safety and feasibility of SVCI in patients with atrial fibrillation undergoing pulsed field ablation (PFA) METHODS: Six hundred sixteen consecutive patients undergoing PFA for pulmonary vein isolation plus SVCI were included in this multicenter analysis. Superior vena cava (SVC) ablation was performed under the continuous guidance of intracardiac echocardiography. The PFA catheter was placed at the junction between the SVC and the right atrium at the level of the lower border of the pulmonary artery. A total of 4 applications were given to achieve complete electrical isolation of the SVC. Sinus node injury and phrenic nerve stunning were checked during the procedure, before discharge, and at 2-month follow-up.</p><p><strong>Results: </strong>A total of 616 patients receiving SVCI were included in the analysis. Acute SVCI was achieved in all 616 patients (100%). In the flower configuration used in the first 10 patients, 2 transient sinus node injuries and 2 episodes of phrenic nerve stunning were observed, which resolved spontaneously during the procedure. In the remaining patients, the basket configuration was used; only 1 episode of phrenic nerve stunning was registered, which regressed before the end of the procedure. No permanent damages were registered at discharge and at 2-month follow-up.</p><p><strong>Conclusions: </strong>Intracardiac echocardiography-guided PFA can effectively isolate the SVC with a good safety profile.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023337","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":"Mirror-Image Artifact Due to Insulation Breach on Adjacent Leads.","authors":"Fatima M Ezzeddine, Paul A Friedman, Siva K Mulpuru, Alan Sugrue, Charles D Swerdlow, Ammar M Killu","doi":"10.1016/j.jacep.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.020","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476486","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, Justin Hayase, Gregory A Fishbein, Sheba Meymandi, Jason S Bradfield","doi":"10.1016/j.jacep.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.003","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-13","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":"Neuropeptide Y as a Prognostic Biomarker in Electrical Storm.","authors":"Jianjun Tang, Chengfeng Liu, Zhuo Wang, Tongjian Zhu, Min Zhong, Yasai Li, Mingxian Chen","doi":"10.1016/j.jacep.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.021","url":null,"abstract":"<p><strong>Background: </strong>Electrical storm (ES), characterized by recurrent ventricular arrhythmias, presents a major clinical challenge, so the identification of dependable biomarkers of mortality is essential for risk stratification and targeted intervention.</p><p><strong>Objectives: </strong>The aim of this study was to investigate the potential utility of neuropeptide Y (NPY) levels in association with mortality in patients experiencing drug-refractory ES.</p><p><strong>Methods: </strong>A prospective cohort study was conducted, enrolling 95 patients diagnosed with ES. They were divided into 2 groups: a control group (n = 62) and a refractory group (n = 33). Demographic and clinical data were collected at enrollment. Plasma NPY levels were measured in hospitalization. A receiver-operating characteristic curve was used to define an NPY threshold, with Youden's index applied to identify the optimal cutoff point for heightened mortality risk in patients with ES. According to NPY threshold, patients were divided into a low NPY group and a high NPY group. The log-rank test was used for Kaplan-Meier survival curve comparison between 2 groups. Cox proportional hazards modeling was used to assess the association between NPY level and mortality.</p><p><strong>Results: </strong>Patients in the refractory group exhibited significantly higher venous NPY levels compared with those in the control group. Receiver-operating characteristic analysis identified an NPY threshold of 44.4 pg/mL with sensitivity of 0.91 and specificity of 0.90. Elevated baseline NPY levels were significantly associated with an increased risk for mortality in patients with ES (95% CI: 0.89-0.99). The survival curves depicted a clear divergence between patients with high and low NPY levels, highlighting the association of elevated NPY level with increased mortality.</p><p><strong>Conclusions: </strong>NPY emerges as a potential biomarker for risk stratification in patients experiencing ES.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364780","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}