JACC. Clinical electrophysiology最新文献

{"title":"Expanding the Scope of Permissible Exercise in Arrhythmogenic Cardiomyopathy.","authors":"Bruce B Lerman, Jim W Cheung","doi":"10.1016/j.jacep.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038551","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":"When Less Can Be More in Cardioneuroablation.","authors":"Piotr Futyma","doi":"10.1016/j.jacep.2026.08.004","DOIUrl":"10.1016/j.jacep.2026.08.004","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990009","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":"Evolution in Functional Mapping for Ventricular Tachycardia: Can We Focus Better on the Target?","authors":"Henry H Hsia","doi":"10.1016/j.jacep.2026.07.036","DOIUrl":"10.1016/j.jacep.2026.07.036","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989973","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":"Adjuvant Ablation for PeRsistent AtrIal FibrillAtion Using Dual ENergy LatticE Tip Catheter: ARIADNE-Randomized Clinical Trial Acute Results.","authors":"Stavros E Mountantonakis, James K Gabriels, Haisam Ismail, Kostantinos P Letsas, Michalis Efremidis, Ourania Kariki, Subbaro Choudry, Nicholas Skipitaris, Andrew Krumerman, Kristie M Coleman","doi":"10.1016/j.jacep.2026.08.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.016","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038200","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":"When the VT Lies Between the Struts: Left Coronary Cusp Tachycardia After TAVR.","authors":"Jesús Diz-Díaz, Teba González-Ferrero, Carlos Álvarez-Ortega, Rafael Peinado","doi":"10.1016/j.jacep.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990024","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":"Acute Modulation of Arrhythmogenic Ventricular Substrate Following Cardiac Stereotactic Body Radiation Therapy.","authors":"Negar Raissi-Dehkordi, Nastaran Raissi-Dehkordi, Jonathan A Salas, Weihow Hsue, Julia Wilson, Myles S Miller, Spencer Moavenzadeh, Michele M Kim, Sarah Hagan, Jeffrey Arkles, David J Callans, Timothy M Markman, Francis E Marchlinski, Keith A Cengel, Cory M Tschabrunn","doi":"10.1016/j.jacep.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.009","url":null,"abstract":"<p><strong>Background: </strong>Cardiac stereotactic body radiation therapy (cSBRT) is a noninvasive, investigational treatment for refractory ventricular tachycardia (VT). The antiarrhythmic effects and time course of action of cSBRT on abnormal ventricular substrate remain poorly understood.</p><p><strong>Objectives: </strong>This study aimed to investigate the electrophysiological, molecular, and structural changes following cSBRT in a porcine infarct model.</p><p><strong>Methods: </strong>Anterior myocardial infarction was created in a porcine model of infarct-related re-entrant VT (n = 8). Swine were randomized to cSBRT (n = 4) or control infarct (n = 4) groups. Baseline electrophysiology study and high-resolution electroanatomic maps were performed 8 to 10 weeks postinfarction. The cSBRT group received 25 Gy single-fraction photon radiation guided by initial left ventricular substrate maps. Cardiac magnetic resonance imaging followed by repeat electrophysiology study and mapping studies were performed 6 weeks later.</p><p><strong>Results: </strong>cSBRT resulted in significant prolongation of the effective refractory period in remote, nontargeted myocardium (cSBRT: 216 ± 21-252 ± 11 ms, Δ +17% vs control: 234 ± 7-249 ± 1 ms, Δ +6.5%) and targeted scar tissue (cSBRT: 258 ± 10-291 ± 18 ms, Δ +13% vs control: 274 ± 13-284 ± 8 ms, Δ +3.7%; group × timepoint interaction P = 0.048). Sustained VT was inducible in all 8 subjects at the terminal timepoint. There was a trend toward more prolonged VT cycle length (cSBRT: 195 ± 19-295 ± 55 ms, Δ +53% vs control: 212 ± 15-261 ± 14 ms, Δ +23%; P = 0.22). Connexin-43 immunoreactive area density in the infarct region was lower in the cSBRT group (1.4% vs 2.7%, respectively; P < 0.01). There was no difference detected in late gadolinium enhancement volume (cSBRT: 29.3% ± 7.8% vs control: 27.2% ± 11.3%; P = 0.8) or histologic fibrosis (cSBRT: 54.9% ± 13.4% vs control: 54.6% ± 20.6%; P = 0.95).</p><p><strong>Conclusions: </strong>Delivery of 25 Gy cSBRT produced early electrical remodeling with increased effective refractory period and decreased connexin-43 area density, without evidence of increased fibrosis.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038151","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":"Multimodality Imaging and Pace-Mapping Patterns in Patients With Cardiac Sarcoidosis and Ongoing Inflammation Undergoing Ventricular Tachycardia Ablation.","authors":"Boldizsar Kovacs, Chaitanya Madamanchi, Venkatesh L Murthy, Michael Ghannam, Jackson J Liang, Kelly Arps, Amrish Deshmukh, Hubert Cochet, Frederic Sacher, Pierre Jais, Mélèze Hocini, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank Bogun","doi":"10.1016/j.jacep.2026.07.020","DOIUrl":"10.1016/j.jacep.2026.07.020","url":null,"abstract":"<p><strong>Background: </strong>The arrhythmogenesis in cardiac sarcoidosis (CS) is poorly understood. The recent ability to register fluorodeoxyglucose (FDG)-avid (FDG+) areas from positron emission tomography studies enables us to correlate the location of areas containing late gadolinium enhancement (LGE+) on cardiac magnetic resonance imaging with FDG-avid areas.</p><p><strong>Objectives: </strong>This study sought to characterize ventricular tachycardia (VT) target sites with respect to FDG uptake and to correlate with VT recurrence post-VT ablation.</p><p><strong>Methods: </strong>In 14 patients (4 women; age 55 ± 11 years; ejection fraction 43% ± 14%) with definite CS and active inflammation referred for VT ablation, positron emission tomography and cardiac magnetic resonance findings were registered to electroanatomic maps. VT target areas were identified with pace- and entrainment-mapping, and conduction patterns were assessed based on different stimulus-QRS intervals of VA target sites.</p><p><strong>Results: </strong>A total of 43 distinct VTs with 59 VT target sites were identified. A total of 88% of the identified VT target sites were in LGE+ areas, whereas 71% were in FDG+ areas. The LGE+ and FDG+ sites colocalized at 59% of all VT target sites. VT exit sites were identified for 42 of 59 VT target sites and nonexit sites for 17 of 59 VT target sites. VT exit sites were associated with FDG+ areas. During a follow-up time of 32 ± 33 months, 6 patients in whom only VT exit sites were identified had a higher VT recurrence rate than patients (n = 8) in whom both nonexit sites and exit sites for individual VTs were identified (100% vs 25%; P = 0.01), indicating that ablation at both exit and nonexit sites yielded superior results.</p><p><strong>Conclusions: </strong>In patients with CS and active inflammation, most VT target sites were confined to LGE+ and FDG+ areas. VT exit sites were associated with FDG+ areas. Patients in whom only VT exit sites were identified had higher VT recurrences.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944937","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":"Stereotactic Body Radiation Therapy for VT in Chagas Cardiomyopathy: A Prospective Phase I/II Pilot Study.","authors":"Bernardo Salvajoli, Cristiano F Pisani, Rodrigo M Kulchetscki, Jason Cook, Léa Maria Macruz Ferreira Demarchi, Victor Augusto Bertotti Ribeiro, João Victor Salvajoli, William G Stevenson, Mauricio Ibrahim Scanavacca","doi":"10.1016/j.jacep.2026.06.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.06.023","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic body radiation therapy (SBRT) is a novel noninvasive therapy for ventricular tachycardia (VT), but its role in Chagas cardiomyopathy remains unexplored.</p><p><strong>Objectives: </strong>This study aimed to evaluate the safety and preliminary efficacy of SBRT for refractory VT in patients with chronic Chagas cardiomyopathy.</p><p><strong>Methods: </strong>We prospectively enrolled patients with Chagas cardiomyopathy and refractory VT who had failed or were ineligible for catheter ablation. A single 25-Gy fraction of SBRT was delivered to an arrhythmogenic substrate identified by multimodality imaging. The primary outcomes were a reduction in VT burden and treatment-related adverse events.</p><p><strong>Results: </strong>Eleven patients (age: 64.9 ± 6.7 years; LVEF: 31.6 ± 9.8%) with implantable cardioverter-defibrillators, 9 of whom had prior failed ablations, underwent SBRT. The median internal target volume was 27.3 cm³, and the planning target volume was 91.1 cm³. During a median follow-up of 160 days, VT recurred in 10 patients. The median time to recurrence after a 6-week blanking period was 79 days (IQR: 51.5-167). The patient without recurrence died of noncardiac causes 22 days after SBRT. Comparing the 12 months after SBRT with the 6 months before SBRT, there was a statistically significant reduction in the burden of VT episodes (P = 0.040), antitachycardia pacing therapies (P = 0.012), and combined antitachycardia pacing/shocks (P = 0.022), although isolated implantable cardioverter-defibrillator shocks were not statistically significantly reduced. The 12-month overall survival was 45.5%, and no severe treatment-related adverse events were reported.</p><p><strong>Conclusions: </strong>SBRT is a feasible approach for refractory VT in Chagas cardiomyopathy. Despite a high rate of VT recurrence, SBRT statistically significantly reduced the burden of ventricular arrhythmia, warranting further investigation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109720","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":"Targeting the Cardiac Neuroaxis for Prevention of Postoperative Atrial Fibrillation: Are We Ready for Prime Time?","authors":"Sunny S Po, Praloy Chakraborty","doi":"10.1016/j.jacep.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990016","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":"Prevalence and Prognostic Significance of Exercise-Accentuated J-Point Elevation in Brugada Syndrome.","authors":"Mayank Sardana, Christopher N Kanaan, Amal Youssef, J Martijn Bos, Thomas G Allison, Michael J Ackerman, John R Giudicessi","doi":"10.1016/j.jacep.2026.07.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.07.018","url":null,"abstract":"<p><strong>Background: </strong>The clinical significance of accentuation of precordial J-point elevation during exercise in Brugada syndrome (BrS) remains unclear.</p><p><strong>Objectives: </strong>This study sought to determine the prevalence and prognostic significance of accentuation of J-point elevation during exercise in a large single-center BrS cohort.</p><p><strong>Methods: </strong>In this retrospective study, 141 consecutive patients referred for BrS evaluation (95 with type 1 BrS pattern-BrS1 cohort, 46 without type 1 pattern but with loss-of-function sodium voltage-gated channel alpha subunit 5 variants-SCN5A cohort) who underwent exercise stress testing (EST) from January 1, 2000, through October 31, 2025 were included. Two blinded cardiologists reviewed all tracings. An exercise-accentuated BrS phenotype was defined as J-point elevation increase ≥1 mm in V1/V2 during exercise. Cardiac events included arrhythmic syncope, cardiac arrest, and appropriate implantable cardioverter-defibrillator shocks. Firth penalized logistic regression was used for unadjusted and adjusted analyses.</p><p><strong>Results: </strong>Overall, 41 patients (29%) demonstrated an exercise-accentuated BrS phenotype, emerging near peak exercise (median 90% age-predicted maximum heart rate). The phenotype was highly reproducible on serial testing (88% of follow-up ESTs). Exercise-accentuated phenotype was not associated with overall cardiac events (unadjusted OR: 1.83 [0.84-3.99]; P = 0.13; adjusted OR: 1.22 [0.47-3.21]; P = 0.69). However, it was strongly associated with exertion-triggered cardiac events (unadjusted OR: 10.50 [2.94-37.50]; P < 0.001; adjusted OR: 10.04 [2.76-36.53]; P < 0.001), independent of sex, exercise workload, and baseline type 1 pattern. Consistent results were noted in SCN5A variant-positive patients.</p><p><strong>Conclusions: </strong>Exercise-induced accentuation of J-point elevation reproducibly identifies a subset of BrS patients at risk for exertional cardiac events. These findings support the inclusion of EST in the evaluation of patients with a clinical diagnosis or genetic susceptibility to BrS and may inform exercise-related risk counseling.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944860","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}