JACC. Clinical electrophysiology最新文献

{"title":"Can You Hit the Bull's Eye?: MRI Image-Based Targeting of Coronary Sinus Lead Placement.","authors":"Karoly Kaszala","doi":"10.1016/j.jacep.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019168","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":"Intentional Right Atrial Appendage Perforation to Facilitate Epicardial Access: Leveraging Cardiac Anatomy.","authors":"Justin Hayase, Jason S Bradfield","doi":"10.1016/j.jacep.2025.02.044","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.044","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967474","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":"Left Bundle Branch Pacing: Histology, the Key to Understand Different Responses.","authors":"José-Ángel Cabrera, David González-Casal, Karol Curila, Tomás Datino, Francisco Garmendia, Adolfo Fontenla, Damián Sánchez-Quintana","doi":"10.1016/j.jacep.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965158","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":"Effect of Pulsed-Field Ablation on Human Coronary Arteries: A Longitudinal Study With Intracoronary Imaging.","authors":"Mark T K Tam, Joseph Y S Chan, Chin Pang Chan, Eugene B Wu, Angel Lai, Alex C K Au, Wai Kin Chi, GuangMing Tan, Bryan P Yan","doi":"10.1016/j.jacep.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.014","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA) is known to cause acute coronary spasm. Whether this translates into long-term coronary artery stenosis is unknown.</p><p><strong>Objectives: </strong>This study sought to evaluate changes in coronary artery after PFA for atrial flutter.</p><p><strong>Methods: </strong>After pulmonary vein isolation with PFA (Farapulse; Boston Scientific), patients undergoing ablation of the mitral isthmus (MI) or cavotricuspid isthmus (CTI) were included. They underwent coronary angiography and optical coherence tomography (OCT) before and immediately after ablation. Bolus intracoronary nitroglycerine was given before and throughout ablation. Three months after ablation, patients underwent repeated OCT.</p><p><strong>Results: </strong>A total of 21 patients were included. 1 patient did not undergo PFA owing to the incidental finding of a critical coronary lesion in close proximity to the area to be ablated. Another patient defaulted postprocedure imaging follow-up. 19 patients had paired imaging data, in 20 coronary vessels (18 right coronary and 2 left circumflex arteries). At the ablation site, at 3 months, vascular wall area increased by a median of 0.40 mm² (Q1-Q3: 0.13-0.71 mm²; P < 0.01), or 17.1% (Q1-Q3: 8.6%-31.0%). The median reduction in the luminal area was 0.70 mm² (Q1-Q3: 0.18-1.30 mm²; P < 0.01), or 10.1% (Q1-Q3: 4.7%-16.2%). These changes were not observed in a predetermined reference site remote from the ablation target.</p><p><strong>Conclusions: </strong>PFA of the CTI and MI is associated with acute spasm, and mild narrowing of the coronary arteries at 3 months. Although intracoronary vasodilator therapy may prevent or treat acute spasm, the risk of arterial stenosis remains, calling for heightened vigilance and long-term follow-up.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966816","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":"Intercalated Disc Abnormalities Are Linked to Arrhythmias in Inflammatory Cardiomyopathy.","authors":"Giovanni Peretto, Stefania Rizzo, Andrea Menegon, Andrea Villatore, Rengasayee Veeraraghavan, Davide Vignale, Valerio Castoldi, Laura Perani, Tamara Canu, Maria Carla Panzeri, Stefania Del Rosso, Rossana Norata, Martina Rocchi, Mila Della Barbera, Elena Rossi, Marco Cursi, Andrea Bergamaschi, Corrado Campochiaro, Giacomo De Luca, Marco Rasponi, Chiara Di Resta, Anna Palmisano, Paola Carrera, Luca Muzio, Alessandra Laura Giulia Pedrocchi, Letizia Leocani, Davide Lazzeroni, Francesca Sanvito, Simone Sala, Lorenzo Dagna, Paolo Guido Camici, Gianvito Martino, DeLisa Fairweather, Alida Linda Patrizia Caforio, Cristina Basso, Antonio Esposito, Leslie T Cooper, Paolo Della Bella","doi":"10.1016/j.jacep.2025.02.025","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.025","url":null,"abstract":"<p><strong>Background: </strong>The relationship between intercalated disc abnormalities (IDAs) and arrhythmias in inflammatory cardiomyopathy (ICM) remains incompletely understood.</p><p><strong>Objectives: </strong>This study presents a pilot research that aimed to: 1) investigate the link between IDAs and arrhythmias in humans with ICM; and 2) compare findings in humans and mice with experimental autoimmune myocarditis (EAM).</p><p><strong>Methods: </strong>Humans with ICM (N = 316) investigated for either genetic or autoimmune IDAs were identified at a referral center. Ultrastructural analysis on biobanked tissue was performed to determine the average intercellular cleft width (ICW) between cardiac myocytes. IDA+ cases were compared with IDA- control subjects matched 1:1 by age, sex, and race/ethnicity. The primary endpoint was the occurrence of clinically demanding supraventricular or ventricular arrhythmias, recorded either by Holter electrocardiography or implanted devices during a 24-month prospective follow-up. The relationships between ICW and arrhythmias were compared in humans and male mice with EAM (n = 12).</p><p><strong>Results: </strong>Of 316 humans with ICM (mean age 45 ± 15 years, 63% male), 70 (22%) were IDA+ and 107 (34%) had arrhythmias on admission. IDA+ patients had greater ICW than control subjects (44 ± 8 nm vs 28 ± 4 nm; P < 0.001) and higher incidence of clinically demanding arrhythmias both at presentation (31 of 70 vs 9 of 70; P < 0.001) and during follow-up (44 of 70 vs 10 of 70; P < 0.001). In a multivariable model, IDAs predicted the occurrence of major ventricular arrhythmias by 24 months (HR: 3.0; 95% CI: 1.4-6.4; P = 0.004). In mice, arrhythmias were documented in 7 of 12 EAM cases and 0 of 6 control animals (P = 0.038). Increased ICW was found in close relationship with arrhythmias in both species (humans: 32 of 44 with vs 4 of 52 without arrhythmias; P < 0.001; mice: 7 of 8 with vs 0 of 4 without arrhythmias; P = 0.010), as well as with abnormal ventricular electrograms on viable murine myocardial tissue (5 of 6 vs 0 of 6; P = 0.015).</p><p><strong>Conclusions: </strong>As a shared trait between genetic and autoimmune ICM, IDAs are linked to arrhythmias in humans and find promising applications in the EAM mouse model.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001243","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":"Transventricular VT Ablation Guided by LBBAP Lead in a Patient With Mechanical Double Valve Replacement.","authors":"Serkan Topaloglu, Ahmet Korkmaz, Ozcan Ozeke, Nisa Koroglu, Sona Huseynova, Meryem Kara, Elif Hande Ozcan Cetin, Serkan Cay, Firat Ozcan","doi":"10.1016/j.jacep.2025.02.036","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.036","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019173","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":"Premature Ventricular Complexes and Nonsustained Ventricular Tachycardia in Cardiac Sarcoidosis.","authors":"Jose F de Melo, Julia Debertin, Matteo Castrichini, Andrew N Rosenbaum, John P Bois, John R Giudicessi, Tahir S Kafil, Abhishek J Deshmukh, Suraj Kapa, Alan M Sugrue, Ammar M Killu, Freddy Del-Carpio Munoz, Christopher V DeSimone, Gurukripa Kowlgi, Nicholas Y Tan, Fatima M Ezzeddine, Samuel J Asirvatham, Omar F Abou Ezzeddine, Konstantinos C Siontis","doi":"10.1016/j.jacep.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>The prevalence and prognostic significance of frequent premature ventricular complexes (PVCs) and nonsustained ventricular tachycardia (NSVT) in cardiac sarcoidosis (CS), especially in patients with normal or mildly decreased left ventricular function, have not been studied.</p><p><strong>Objectives: </strong>This study sought to investigate the prognostic value of PVCs and NSVT in patients with CS and normal or mildly decreased left ventricular ejection fraction.</p><p><strong>Methods: </strong>We included 192 patients with definite or probable CS with left ventricular ejection fraction >35% and no previous history of ventricular tachycardia (VT)/ventricular fibrillation (VF) or sudden cardiac death, who underwent up to 48 hours of clinically indicated Holter monitoring. Baseline PVC burden and presence of NSVT were correlated with presence of fluorodeoxyglucose (FDG) uptake on positron emission tomography and late gadolinium enhancement (LGE) on magnetic resonance imaging. We performed multivariable analysis for the associations of PVC burden and NSVT with the composite endpoint of sustained VT/VF, advanced heart failure therapy, and all-cause mortality.</p><p><strong>Results: </strong>The median PVC burden was 0.3% (Q1-Q3: 0.02%-2.5%), and 36 (18.8%) patients had PVC burden ≥5%. Sixty-two patients (32.3%) had NSVT detected during Holter monitoring. PVC burden and NSVT had an association with LGE presence but not with FDG uptake. A total of 33 patients (17.2%) experienced the composite endpoint during a median follow-up of a 3 years. In multivariable analysis, PVC burden ≥5% vs <5% (HR: 2.84; 95% CI: 1.26-6.40; P < 0.01) and presence of NSVT (HR: 4.74; 95% CI: 2.15-10.46; P < 0.01) were associated with the composite endpoint.</p><p><strong>Conclusions: </strong>Our results suggest that an elevated PVC burden and the presence of NSVT are prognostically relevant and may have a role in the risk stratification of patients with CS.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077896","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":"Dronedarone vs Sotalol Among Patients With Atrial Fibrillation: A Meta-Analysis of Retrospective Observational Databases.","authors":"Jagmeet P Singh, Mattias Wieloch, Shannon L Reynolds, Carina Blomström-Lundqvist, Alex T Sandhu, A John Camm, Shaum Kabadi, Krishna Pundi, Mintu P Turakhia, Rania Boiron, Natasha Din, Jun Fan, Caroline G Heller, Reno C Leeming, David S McKindley, Renee M Sajedian, Peter R Kowey","doi":"10.1016/j.jacep.2025.02.029","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.029","url":null,"abstract":"<p><strong>Background: </strong>Dronedarone and sotalol are antiarrhythmic drugs (AADs) recommended in similar populations per atrial fibrillation (AF) guidelines; however, comparative safety data are limited.</p><p><strong>Objectives: </strong>The goal of this study was to assess the safety of dronedarone vs sotalol for treatment of AF in AAD-naive patients.</p><p><strong>Methods: </strong>This was a prespecified noninterventional meta-analysis of 4 retrospective observational cohort studies from 4 databases (Optum Clinformatics Data Mart, Merative MarketScan, Veterans Health Administration Electronic Health Record, and the Swedish National Patient Register) conducted by using one master protocol. Each analysis emulated the target trial using an active comparator (dronedarone vs sotalol), new user design with an as-treated approach. Primary outcomes were tested hierarchically for dronedarone vs sotalol: first for statistical significance of cardiovascular (CV) hospitalization, and then for statistical significance of ventricular arrhythmias. Propensity score matching (PSM) was used for confounding control, and negative control outcomes were used to assess residual confounding. Outcomes were evaluated by using Cox proportional hazards regression; meta-analysis was performed by using fixed effects models.</p><p><strong>Results: </strong>The dronedarone and sotalol cohorts were well balanced within databases before and after PSM (after PSM mean age range: 62.5-70.9 years; mean CHA₂DS₂-VASc score range: 1.81-3.15). Negative control outcomes exhibited little-to-no evidence of residual confounding. Meta-analysis found significantly lower rates of CV hospitalization (pooled HR: 0.91; 95% CI: 0.85-0.97) and ventricular arrhythmias (pooled HR: 0.77; 95% CI: 0.69-0.85) with dronedarone vs sotalol.</p><p><strong>Conclusions: </strong>In this retrospective meta-analysis, dronedarone exhibited significantly lower rates of CV hospitalization and ventricular arrhythmias compared with sotalol. These findings provide real-world evidence to support selection of the most appropriate first-line AAD for rhythm control in patients with AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990804","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":"Calcium Homeostatic Feedback Control Predicts Atrial Fibrillation Initiation, Remodeling, and Progression.","authors":"Nicolae Moise, Seth H Weinberg","doi":"10.1016/j.jacep.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a progressive disorder, with arrhythmia episodes becoming increasingly longer and ultimately permanent. The chaotic electrical activity by itself is well known to drive progression, a process classically summarized as \"AF begets AF.\" However, the mechanisms underlying this progression are not yet well defined.</p><p><strong>Objectives: </strong>We hypothesize that calcium homeostatic feedback regulating ion channel expression is a critical mechanistic component of this pathological process.</p><p><strong>Methods: </strong>We propose a modeling framework that tracks both short-term beat-to-beat electrical and calcium activity and long-term tissue substrate remodeling as a single coupled dynamical system. Importantly, the full AF progression from healthy to pathological remodeled tissue is reproduced, in contrast with prior studies that consider \"snapshots\" of various AF stages.</p><p><strong>Results: </strong>Simulations predict that single cells respond to fast pacing by maintaining intracellular calcium concentrations through dynamic ion channel expression and electrical phenotype changes. In 2-dimensional homogeneous tissue, spontaneous spiral waves stabilize into permanent re-entry. In 2-dimensional heterogeneous tissue, we observe the initiation of re-entrant activity in response to fast pacing, followed by increasingly longer intermittent, and then permanent, arrhythmic activity. Simulations predict critical properties of re-entrant wave locations, leading to a novel hypothesis: spiral wave activity itself drives underlying substrate remodeling and the emergence of remodeled tissue \"niches\" that support the stabilization of fast re-entrant activity.</p><p><strong>Conclusions: </strong>Thus, the model joins multiple lines of inquiry (ie, long-term calcium regulation, ion channel coexpression and remodeling, and tissue-scale arrhythmia spatiotemporal organization) into a single coherent framework, and for the first time, captures the dynamics of the long-term natural history of AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005044","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":"The Sternal Foramen: A Notable Issue for Subcutaneous Implantable Defibrillator Implantation.","authors":"Faisal Matto, John D Hummel","doi":"10.1016/j.jacep.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077907","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}