JACC. Clinical electrophysiology最新文献

{"title":"Electrocardiogram-Based Deep Learning to Predict Mortality in Repaired Tetralogy of Fallot.","authors":"Joshua Mayourian, Juul P A van Boxtel, Lynn A Sleeper, Vedang Diwanji, Alon Geva, Edward T O'Leary, John K Triedman, Sunil J Ghelani, Rachel M Wald, Anne Marie Valente, Tal Geva","doi":"10.1016/j.jacep.2024.07.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.015","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence-enhanced electrocardiogram (AI-ECG) analysis shows promise to predict mortality in adults with acquired cardiovascular diseases. However, its application to the growing repaired tetralogy of Fallot (rTOF) population remains unexplored.</p><p><strong>Objectives: </strong>This study aimed to develop and externally validate an AI-ECG model to predict 5-year mortality in rTOF.</p><p><strong>Methods: </strong>A convolutional neural network was trained on electrocardiograms (ECGs) obtained at Boston Children's Hospital and tested on Boston (internal testing) and Toronto (external validation) INDICATOR (International Multicenter TOF Registry) cohorts to predict 5-year mortality. Model performance was evaluated on single ECGs per patient using area under the receiver operating (AUROC) and precision recall (AUPRC) curves.</p><p><strong>Results: </strong>The internal testing and external validation cohorts comprised of 1,054 patients (13,077 ECGs at median age 17.8 [Q1-Q3: 7.9-30.5] years; 54% male; 6.1% mortality) and 335 patients (5,014 ECGs at median age 38.3 [Q1-Q3: 29.1-48.7] years; 57% male; 8.4% mortality), respectively. Model performance was similar during internal testing (AUROC 0.83, AUPRC 0.18) and external validation (AUROC 0.81, AUPRC 0.21). AI-ECG performed similarly to the biventricular global function index (an imaging biomarker) and outperformed QRS duration. AI-ECG 5-year mortality prediction, but not QRS duration, was a significant independent predictor when added into a Cox regression model with biventricular global function index to predict shorter time-to-death on internal and external cohorts. Saliency mapping identified QRS fragmentation, wide and low amplitude QRS complexes, and flattened T waves as high-risk features.</p><p><strong>Conclusions: </strong>This externally validated AI-ECG model may complement imaging biomarkers to improve risk stratification in patients with rTOF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287384","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":"Modeling Idiopathic Ventricular Fibrillation Using iPSC Cardiomyocytes and Computational Approaches: A Proof-of-Concept Study.","authors":"Louise Reilly, Mitchell Josvai, Manasa Kalluri, Corey L Anderson, Haibo Ni, Kate M Orland, Di Lang, Alexey V Glukhov, Eleonora Grandi, Lee L Eckhardt","doi":"10.1016/j.jacep.2024.07.014","DOIUrl":"10.1016/j.jacep.2024.07.014","url":null,"abstract":"<p><p>Idiopathic ventricular fibrillation (IVF) is an unrefined diagnosis representing a heterogeneous patient group without a structural or genetic definition. IVF treatment is not mechanistic-based due to the lack of experimental patient-models. We sought to create a methodology to assess cellular arrhythmia mechanisms for IVF as a proof-of-concept study. Using IVF patient-specific induced pluripotent stem cell-derived cardiomyocytes, we integrate electrophysiological optical mapping with computational modeling to characterize the cellular phenotype. This approach flips the traditional paradigm using a biophysically detailed computational model to solve the problem inversely. Insight into the cellular mechanisms of this patient's IVF phenotype could also serve as a therapeutic testbed.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287385","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":"Ventricular Tachycardia Substrates in Children and Young Adults With Repaired Tetralogy of Fallot.","authors":"Justin Wallet, Yoshitaka Kimura, Nico A Blom, Monique R M Jongbloed, Robin A Bertels, Mark G Hazekamp, Katja Zeppenfeld","doi":"10.1016/j.jacep.2024.07.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.016","url":null,"abstract":"<p><strong>Background: </strong>Patients with repaired tetralogy of Fallot (rTOF) have a time-dependent increased risk of ventricular tachycardia (VT). Slow conducting anatomical isthmuses (SCAIs) are the dominant VT substrates in adults with rTOF. It is unknown if they are present at younger age.</p><p><strong>Objectives: </strong>This study aimed to characterize VT substrates in patients with rTOF <30 years of age.</p><p><strong>Methods: </strong>Data of consecutive patients with rTOF aged <30 years who underwent electroanatomical mapping and programmed electrical stimulation between 2005 and 2022 were analyzed.</p><p><strong>Results: </strong>Fifty-five patients were included (median age: 15.8 years, IQR: 13.8-21.8 years; 15 repaired via ventriculotomy; 13 complex TOF variants). Twelve patients had right ventricle-to-pulmonary artery conduits inserted during initial repair or had early pulmonary valve replacement (PVR) (<1 year after repair). Indications for electroanatomical mapping and programmed electrical stimulation were spontaneous VT, before PVR, and risk stratification in 5, 40, and 10 patients, respectively. In 16 patients (29%), SCAI 3 was identified; no other SCAI was present. Monomorphic VT was inducible in 8 and related to SCAI 3 in 7 patients. Identified VT substrates were targeted by ablation. Right ventricle-to-pulmonary artery conduit/early PVR, ventriculotomy, and complex TOF were associated with SCAI 3 in univariable analysis. During a median follow-up of 5.3 years, VT recurred in 2 patients. No patients died.</p><p><strong>Conclusions: </strong>In young patients with rTOF, SCAI 3 is the dominant substrate for VT. Complex TOF and interrelated type and timing of (re-)operation may contribute to the development of SCAI 3 already at a young age.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346840","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":"Biatrial Resynchronization With Electrogram-Guided Bachmann Bundle Pacing","authors":"","doi":"10.1016/j.jacep.2024.04.030","DOIUrl":"10.1016/j.jacep.2024.04.030","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2103-2107"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431957","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":"Cardiac MRI Oversampling in Heart Digital Twins Improves Preprocedure Ventricular Tachycardia Identification in Postinfarction Patients","authors":"","doi":"10.1016/j.jacep.2024.04.032","DOIUrl":"10.1016/j.jacep.2024.04.032","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Ventricular tachycardia (VT), which can lead to </span>sudden cardiac death<span>, occurs frequently in patients after myocardial infarction. Radiofrequency catheter ablation (RFA) is a modestly effective treatment of VT, but it has limitations and risks. </span></span>Cardiac magnetic resonance<span> (CMR)–based heart digital twins have emerged as a useful tool for identifying VT circuits for RFA treatment planning. However, the CMR resolution used to reconstruct these digital twins may impact VT circuit predictions, leading to incorrect RFA treatment planning.</span></div></div><div><h3>Objectives</h3><div>This study sought to predict RFA targets in the arrhythmogenic substrate using heart digital twins reconstructed from both clinical and high-resolution 2-dimensional CMR datasets and compare the predictions.</div></div><div><h3>Methods</h3><div>High-resolution (1.35 × 1.35 × 3 mm), or oversampled resolution (Ov-Res), short-axis late gadolinium–enhanced CMR was acquired by combining 2 subsequent clinical resolution (Clin-Res) (1.35 × 1.35 × 6 mm) short-axis late gadolinium–enhanced CMR scans from 6 post–myocardial infarction patients undergoing VT ablation and used to reconstruct a total of 3 digital twins (1 Ov-Res, 2 Clin-Res) for each patient. Rapid pacing was used to assess VT circuits and identify the optimal ablation targets in each digital twin. VT circuits predicted by the digital twins were compared with intraprocedural electroanatomic mapping data and used to identify emergent VT.</div></div><div><h3>Results</h3><div>The Ov-Res digital twins reduced partial volume effects and better predicted unique VT circuits compared with the Clin-Res digital twins (66.6% vs 54.5%; <em>P</em> &lt; 0.01). Only the Ov-Res digital twin successfully identified emergent VT after a failed initial ablation.</div></div><div><h3>Conclusions</h3><div>Digital twin infarct geometry and VT circuit predictions depend on the magnetic resonance resolution. Ov-Res digital twins better predict VT circuits and emergent VT, which may improve RFA outcomes.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2035-2048"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456950","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 Changes in Atrial Arrhythmia Burden After Renal Denervation Combined With Pulmonary Vein Isolation","authors":"","doi":"10.1016/j.jacep.2024.04.035","DOIUrl":"10.1016/j.jacep.2024.04.035","url":null,"abstract":"<div><h3>Background</h3><div>The autonomic nervous system plays an important role in atrial fibrillation<span> (AF) and hypertension. Renal denervation (RDN) lowers blood pressure (BP), but its role in AF is poorly understood.</span></div></div><div><h3>Objectives</h3><div>The purpose of this study was to investigate whether RDN reduces AF recurrence after pulmonary vein isolation (PVI).</div></div><div><h3>Methods</h3><div>This study randomized patients from 8 centers (United States, Germany) with drug-refractory AF for treatment with PVI+RDN vs PVI alone. A multielectrode radiofrequency Spyral catheter system was used for RDN. Insertable cardiac monitors were used for continuous rhythm monitoring. The primary efficacy endpoint was ≥2 minutes of AF recurrence or repeat ablation during all follow-up. The secondary endpoints included atrial arrhythmia<span> (AA) burden, discontinuation of class I/III antiarrhythmic drugs, and BP changes from baseline.</span></div></div><div><h3>Results</h3><div>A total of 70 patients with AF (52 paroxysmal, 18 persistent) and uncontrolled hypertension were randomized (RDN+PVI, n = 34; PVI, n = 36). At 3.5 years, 26.2% and 21.4% of patients in RDN+PVI and PVI groups, respectively, were free from the primary efficacy endpoint (log rank <em>P =</em> 0.73). Patients with mean ≥1 h/d AA had less daily AA burden after RDN+PVI vs PVI (4.1 hours vs 9.2 hours; <em>P =</em><span> 0.016). More patients discontinued class I/III antiarrhythmic drugs after RDN+PVI vs PVI (45% vs 14%; </span><em>P =</em><span> 0.040). At 1 year, systolic BP changed by −17.8 ± 12.8 mm Hg and −13.7 ± 18.8 mm Hg after RDN+PVI and PVI, respectively </span><em>(P =</em> 0.43). The composite safety endpoint was not significantly different between groups.</div></div><div><h3>Conclusions</h3><div>In patients with AF and uncontrolled BP, RDN+PVI did not prevent AF recurrence more than PVI alone. However, RDN+PVI may reduce AF burden and antiarrhythmic drug usage, but this needs further prospective validation.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2062-2073"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456953","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":"Obstructive Sleep Apnea and Atrial Fibrillation","authors":"Abhishek J. Deshmukh MBBS,&nbsp;Virend K. Somers MD, PhD","doi":"10.1016/j.jacep.2024.06.022","DOIUrl":"10.1016/j.jacep.2024.06.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2085-2087"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995738","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":"Novel Sleep Phenotypic Profiles Associated With Incident Atrial Fibrillation in a Large Clinical Cohort","authors":"Catherine M. Heinzinger DO, MS ,&nbsp;Brittany Lapin PhD, MPH ,&nbsp;Nicolas R. Thompson MS ,&nbsp;Yadi Li MEd ,&nbsp;Alex Milinovich BA ,&nbsp;Anna M. May MD, MS ,&nbsp;Cinthya Pena Orbea MD ,&nbsp;Michael Faulx MD ,&nbsp;David R. Van Wagoner PhD ,&nbsp;Mina K. Chung MD ,&nbsp;Nancy Foldvary-Schaefer DO, MS ,&nbsp;Reena Mehra MD, MS","doi":"10.1016/j.jacep.2024.05.027","DOIUrl":"10.1016/j.jacep.2024.05.027","url":null,"abstract":"<div><h3>Background</h3><div>While sleep disorders are implicated in atrial fibrillation (AF), the interplay of physiologic alterations and symptoms remains unclear. Sleep-based phenotypes can account for this complexity and translate to actionable approaches to identify at-risk patients and therapeutic interventions.</div></div><div><h3>Objectives</h3><div>This study hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.</div></div><div><h3>Methods</h3><div>Data from the STARLIT (sleep Signals, Testing, And Reports LInked to patient Traits) registry on Cleveland Clinic patients (≥18 years of age) who underwent PSG from November 27, 2004, to December 30,2015, were retrospectively examined. Phenotypes were identified using latent class analysis<span> of symptoms and PSG-based measures of sleep-disordered breathing and sleep architecture. Phenotypes were included as the primary predictor in a multivariable-adjusted Cox proportional hazard models for incident AF.</span></div></div><div><h3>Results</h3><div>In our cohort (N = 43,433, age 51.8 ± 14.5 years, 51.9% male, 74.9% White), 7.3% (n = 3,166) had baseline AF. Over a 7.6- ± 3.4-year follow-up period, 8.9% (n = 3,595) developed incident AF. Five phenotypes were identified. The hypoxia<span> subtype (n = 3,245) had 48% increased incident AF (HR: 1.48; 95% CI: 1.34-1.64), the apneas + arousals subtype (n = 4,592) had 22% increased incident AF (HR: 1.22; 95% CI: 1.10-1.35), and the short sleep + nonrapid eye movement<span> subtype (n = 6,126) had 11% increased incident AF (HR: 1.11; 95% CI: 1.01-1.22) compared with long sleep + rapid eye movement (n = 26,809), the reference group. The hypopneas subtype (n = 2,661) did not differ from reference (HR: 0.89; 95% CI: 0.77-1.03).</span></span></div></div><div><h3>Conclusions</h3><div><span>Consistent with prior evidence supporting hypoxia as an AF driver and cardiac risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates vulnerability for AF development, providing potential value in enhancing our understanding of integrated sleep-specific symptoms and physiologic risk of atrial </span>arrhythmogenesis.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2074-2084"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633498","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":"Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator","authors":"","doi":"10.1016/j.jacep.2024.04.028","DOIUrl":"10.1016/j.jacep.2024.04.028","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts.</div></div><div><h3>Objectives</h3><div><span>This study sought to evaluate the characteristics of recurrent VF<span> recorded on implantable defibrillator </span></span>electrograms, associated with these substrates.</div></div><div><h3>Methods</h3><div><span><span><span>This was a multicenter collaboration study. At 32 centers, we selected patients with an initial diagnosis of IVF and recurrent arrhythmia at follow-up without </span>antiarrhythmic drugs, in whom mapping demonstrated Purk or MiCM substrate. We analyzed variables related to previous ectopy, sinus rate preceding VF, trigger, and initial VF cycle lengths. </span>Logistic regression with cross validation was used to evaluate the performance of criteria to discriminate Purk or MiCM substrates</span><strong>.</strong></div></div><div><h3>Results</h3><div><span>Among 95 patients (35 women, age 35 ± 11 years) meeting the inclusion criteria, IVF was associated with MiCM in 41 and Purk in 54 patients. A total of 117 arrhythmia recurrences including 91% VF were recorded on defibrillator. Three variables were mostly discriminant. Sinus tachycardia (≤570 ms) was more frequent in MiCM (35.9% vs 13.4%, </span><em>P</em> = 0.014) whereas short-coupled (&lt;350 ms) triggers were most frequent in Purk-related VF (95.5% vs 23.1%, <em>P</em> = 0.001), which also had shorter VFCLs (182 ± 15 ms vs 215 ± 24 ms, <em>P</em> &lt; 0.001).The multivariable combination provided the highest prediction (accuracy = 0.93 ± 0.05, range 0.833-1.000), discriminating 81% of IVF substrates with a high probability (&gt;80%). Ectopy were inconsistently present before VF.</div></div><div><h3>Conclusions</h3><div>Characteristics of arrhythmia recurrences on implantable cardioverter- defibrillator provide phenotypic markers of the distinct and hidden substrates underlying IVF. These findings have significant clinical and genetic implications.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 1982-1994"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544829","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":"Full Issue PDF","authors":"","doi":"10.1016/S2405-500X(24)00745-X","DOIUrl":"10.1016/S2405-500X(24)00745-X","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages I-CL"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X2400745X/pdfft?md5=39f06226c99d18b06259d3b598a8f939&pid=1-s2.0-S2405500X2400745X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}