JACC. Clinical electrophysiology最新文献

{"title":"Image Integration of 3-Dimensional Computed Tomography Papillary Muscle Model to Support Ablation of Papillary Muscle Arrhythmias","authors":"Johanna B. Tonko MD , Anthony Chow MD , Martin Lowe PhD , Mehul B. Dhinoja MD , Pier D. Lambiase PhD","doi":"10.1016/j.jacep.2024.09.039","DOIUrl":"10.1016/j.jacep.2024.09.039","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 436-440"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785442","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}

{"title":"Quantifying DNA Lesions and Circulating Free DNA","authors":"Lisa Pool MSc ,&nbsp;Stan W. van Wijk MSc ,&nbsp;Mathijs S. van Schie PhD ,&nbsp;Yannick J.H.J. Taverne MD, PhD ,&nbsp;Natasja M.S. de Groot MD, PhD ,&nbsp;Bianca J.J.M. Brundel PhD","doi":"10.1016/j.jacep.2024.10.008","DOIUrl":"10.1016/j.jacep.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) persistence is associated with molecular remodeling that fuels electrical conduction abnormalities in atrial tissue. Previous research revealed DNA damage as a molecular driver of AF.</div></div><div><h3>Objectives</h3><div>This study sought to explore the diagnostic value of DNA damage in atrial tissue and blood samples as an indicator of the prevalence of electrical conduction abnormalities and stage of AF.</div></div><div><h3>Methods</h3><div>High-sensitivity long-run real-time PCR was performed on mitochondrial (ND1) and nuclear (P53) DNA from atrial tissue samples from paroxysmal (PAF), persistent (PeAF), and longstanding persistent (LS-PeAF) AF, and sinus rhythm (SR) patients (n = 83). PicoGreen assay and quantitative polymerase chain reaction were used on circulating free DNA (cfDNA) markers (total cfDNA, β-globin, ND1, and P53) in blood samples of 70 patients with AF or SR. High-resolution epicardial mapping of the atria (n = 48) was conducted to quantify electrical conduction abnormalities.</div></div><div><h3>Results</h3><div>The number of DNA lesions gradually and significantly increased in PAF and PeAF and in patients with &lt;3 years of AF compared with SR. In SR, the quantity of nuclear DNA damage significantly correlated with the proportion of fractionated potentials. Mitochondrial DNA lesions correlated with slower conduction velocity and lower potential amplitudes in AF samples. Also, mitochondrial cfDNA levels decreased in patients with &gt;3 years of AF compared with &lt;3 years of AF (<em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>The quantity of DNA lesions in atrial tissue samples is associated with atrial conduction abnormalities and stage of AF. Serum DNA damage markers discriminate short- from long-term AF. Therefore, the quantity of DNA damage may have diagnostic value in clinical AF management.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 321-332"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965107","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}

{"title":"Dual- Vs Single-Chamber Ventricular Pacing in Isolated Congenital Complete Atrioventricular Block in Infancy.","authors":"Reina Bianca Tan, Kristyn A Pierce, James Nielsen, Shubhayan Sanatani, Michael D Fridman, Elizabeth A Stephenson, Sowmith Rangu, Carolina Escudero, Douglas Mah, Allison Hill, Austin M Kane, A Sami Chaouki, Luis Ochoa Nunez, Sit-Yee Kwok, Sabrina Tsao, Dania Kallas, S Yukiko Asaki, Shashank Behere, Anne Dubin, Christopher Ratnasamy, Jeffrey A Robinson, Christopher M Janson, Frank Cecchin, Maully J Shah","doi":"10.1016/j.jacep.2024.12.025","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.025","url":null,"abstract":"<p><strong>Background: </strong>The optimal pacemaker programming strategy for infants with isolated congenital complete atrioventricular block (CCAVB) remains unresolved. Dual-chamber pacing maintains atrioventricular synchrony and physiological heart rate variability but increases the burden of ventricular pacing on a myocardium that may be inherently prone to left ventricular (LV) dysfunction.</p><p><strong>Objectives: </strong>This study sought to compare clinical outcomes of dual (DDD)- vs single (VVI)- chamber pacing in infants with CCAVB (DAVINCHI).</p><p><strong>Methods: </strong>A multicenter retrospective study (2006-2023) identified infants with CCAVB and pacemaker implant at <1 year, with single-site ventricular pacing and no significant congenital heart disease. Outcome measured were clinically significant LV dysfunction, mortality, and complications.</p><p><strong>Results: </strong>A total of 109 infants (64% autoimmune CCAVB) were identified, 60.6% had VVI pacing. Over a median follow-up of 5 years, 60 complications occurred in 47 subjects (43.1%). Smaller infants had more complications. Clinically significant LV dysfunction developed in 11 (10.1%) and was more frequent in DDD (21% vs 3%; P = 0.006). LV dysfunction resulted in mortality in 1 patient and 10 patients required a change in pacing mode. Independent risk factors for LV dysfunction were DDD pacing and neonatal implant. Right ventricular pacing lead placement had a higher HR (HR: 2.67) for LV dysfunction but was not statistically significant (P = 0.2).</p><p><strong>Conclusion: </strong>DDD pacing increases LV dysfunction risk compared with VVI in infants with CCAVB. Single-chamber LV apical pacing should be considered in infants with isolated CCAVB who require pacing. There is a high risk of pacing-related complications, particularly with an increased risk of ventricular lead complications in low-weight neonates.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523498","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":"Fixed Knotting of Looped Pulsed Field Ablation Catheter due to Tip Inversion Without Guidewire Retraction.","authors":"Suguru Nishiuchi, Yuji Matsuo, Shingo Yoshimura, Akiko Kodama, Taiki Masuyama, Kenichi Kaseno, Takehito Sasaki, Kohki Nakamura, Shigeto Naito","doi":"10.1016/j.jacep.2024.11.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364700","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":"Comparison of the Latest ESC, ACC/AHA/ACCP/HRS, and CCS Guidelines on the Management of Atrial Fibrillation.","authors":"Julian Wolfes, Christian Ellermann, Gerrit Frommeyer, Lars Eckardt","doi":"10.1016/j.jacep.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.018","url":null,"abstract":"<p><p>The introduction of evidence-based and structured guidelines has undoubtedly improved the care of cardiologic patients and in many cases simplified decision-making for the treatment team. The European Society of Cardiology in collaboration with the European Association for Cardio-Thoracic Surgery, the American College of Cardiology, the American Heart Association, the American College of Clinical Pharmacy, and the Heart Rhythm Society, and the Canadian Cardiovascular Society/Canadian Heart Rhythm Society have developed guidelines for the management of patients with atrial fibrillation. Because all 3 guidelines refer to almost the same scientific data, their recommendations are undoubtedly largely in agreement. Nevertheless, there are some interesting differences based on different interpretations of the same study, different publication dates, or differences in local conditions and health care resources. The following article aims at lining out these similarities and differences.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476144","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":"Conduction Tissue Inflammation is Associated With Electrical Instability in Human Myocarditis.","authors":"Andrea Frustaci, Michele Magnocavallo, Pietro Rossi, Stefano Bianchi, Stefano Guarracini, Michele Di Mauro, Romina Verardo","doi":"10.1016/j.jacep.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.011","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407832","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":"Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF Study).","authors":"Sanjeev Saksena, Jennifer Ken-Opurum, David S McKindley, Ron Preblick, Jason Rashkin, Omar M Aldaas, Sesha Sai Srinivas Sistla, Jonathan C Hsu","doi":"10.1016/j.jacep.2024.11.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.11.020","url":null,"abstract":"<p><strong>Background: </strong>Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.</p><p><strong>Objectives: </strong>The aim of this study was to characterize rhythm-control strategies after index ablation.</p><p><strong>Methods: </strong>A total of 2,429,863 patients in Optum's deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined.</p><p><strong>Results: </strong>In total, 23,323 patients underwent index ablation (median follow-up duration 1,165 days); 3,862 (16.6%) underwent ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeat ablations, incident individual AF or atrial flutter patient events (n = 7,907) averaged 2.0 per patient, while other coded arrhythmias (n = 2,298) averaged 0.6 per patient. AAD use after index ablation was common (46.9% overall), ranging from 62.8% to 92.3% among patients with ≥1 repeat ablation. Repeat ablation was associated with AF phenotype (long-standing persistent vs paroxysmal; incidence rate ratio [IRR]: 2.26; 95% CI: 1.27-3.68), AAD use (vs no use; IRR: 1.42; 95% CI: 1.30-1.56), obstructive sleep apnea (vs no obstructive sleep apnea; IRR: 1.26; 95% CI: 1.20-1.33), valvular heart disease (vs no valvular heart disease; IRR: 1.12; 95% CI: 1.07-1.18), coronary artery disease (vs no coronary artery disease; IRR: 1.13; 95% CI: 1.07-1.19), and body mass index 30 to 35 kg/m² (vs <30 kg/m²; IRR: 1.10; 95% CI: 1.02-1.20).</p><p><strong>Conclusions: </strong>In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407812","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 Left Ventricular Summit: Pulsed Field Ablation for Refractory Premature Ventricular Complexes.","authors":"Karim Benali, Masaaki Yokoyama, Konstantinos Vlachos, Kinan Kneizeh, Cinzia Monaco, Ruxandra Sava, Josselin Duchateau, Sylvain Ploux, Antoine Da Costa, Frederic Sacher, Michel Haissaguerre, Pierre Jais, Mélèze Hocini","doi":"10.1016/j.jacep.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.022","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476490","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":"Pilot Study of Early Catheter Ablation and Neurological Outcomes in Atrial Fibrillation-Related Stroke: RESCUE-STROKE.","authors":"Aashish Katapadi, Jalaj Garg, Nikhila Chelikam, Sudha Bommana, Luigi DiBiase, Donita Atkins, Rajesh Kabra, Douglas Darden, Peter Park, Naga Venkata K Pothineni, Rawan Albadareen, Syed Kazi, Rakesh Gopinathannair, Andrea Natale, Dhanunjaya Lakkireddy","doi":"10.1016/j.jacep.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>Inadequate management of atrial fibrillation (AF) after stroke is associated with a worse prognosis, and the impact of early rhythm control with catheter ablation (CA) on neurological outcomes in these patients is poorly understood.</p><p><strong>Objectives: </strong>This study sought to evaluate the impact of early rhythm control with CA in patients with new-onset AF at the time of stroke.</p><p><strong>Methods: </strong>We performed a retrospective, observational study of patients hospitalized with stroke and new-onset AF from 2021 to 2023. Patients underwent routine care (n = 36) with rate control or antiarrhythmic drugs or rhythm control with CA (n = 36) after discharge. Functional neurological outcomes at admission, discharge, and 6 and 12 months were measured using the modified Rankin score-a scoring system from 0 to 6, describing patient activity levels. AF-related outcomes are also measured.</p><p><strong>Results: </strong>Though the modified Rankin score was similar at admission (4.5 ± 1.0 vs 4.4 ± 1.0; P = 0.717) and discharge (4.23 ± 0.7 vs 4.2 ± 0.8; P = 0.656), it was lower at 6 months (2.0 ± 0.7 vs 3.5 ± 0.8; P < 0.001) and 12 months (1.1 ± 0.8 vs 3.0 ± 1.0; P < 0.001) for those that underwent CA. They also had a faster time to rhythm control (54.5 ± 15.6 days vs 73.1 ± 26.3 days; P < 0.001) and continued AF freedom at 12 months (100% vs 13.9%; P < 0.001), with fewer repeat strokes (0% vs 13.9%; P = 0.091), major bleeding (11.1% vs 25%; P = 0.126), number of hospitalizations (0.4 ± 0.8 vs 1.8 ± 1.5; P < 0.001), and mortality (0% vs 11.1%; P < 0.001).</p><p><strong>Conclusions: </strong>Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in the study populations, it is uncertain whether these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449055","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":"Causal Machine Learning for Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation.","authors":"Che Ngufor, Nan Zhang, Holly K Van Houten, David R Holmes, Jonathan Graff-Radford, Mohamad Alkhouli, Paul A Friedman, Peter A Noseworthy, Xiaoxi Yao","doi":"10.1016/j.jacep.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.12.013","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter left atrial appendage occlusion (LAAO) is an alternative to lifelong anticoagulation, but optimal patient selection remains challenging.</p><p><strong>Objectives: </strong>This study sought to apply a novel causal machine learning framework to identify patients who would benefit from LAAO vs a direct oral anticoagulant (DOAC).</p><p><strong>Methods: </strong>We identified 744,190 adult patients with atrial fibrillation treated with either LAAO or DOAC between March 13, 2015, and December 31, 2019, using data from OptumLabs Data Warehouse. One-to-one propensity score matching was used to create a cohort where patients were similar in 107 baseline characteristics. A causal forest model was used to estimate the heterogeneous treatment effect for a composite outcome of ischemic stroke, systemic embolism, major bleeding, and all-cause mortality.</p><p><strong>Results: </strong>In the matched cohort of 28,930 patients, the mean age was 76.8 ± 6.3 years; 5,818 patients (40%) were female, and the mean CHA₂DS₂-VASc score was 5.8. LAAO was associated with no difference with the primary composite outcome in comparison to NOAC early on (average treatment effect of -0.68% [-1.4%, 0.06%] at 1 year), but a lower risk at the end of 2 years (average treatment effect of -2.9% [-3.7%, -2.0%]). At the end of 2 years, 30.1% of the overall cohort were classified as potentially benefiting from LAAO, 69.7% were classified as neutral, and 1.4% were potentially harmed by LAAO.</p><p><strong>Conclusions: </strong>Novel machine learning algorithms were developed to identify patients who are more likely to benefit from LAAO vs DOACs. This information can support clinical decision-making to determine which patients should be referred to subspecialists for further examination and discussion of LAAO.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407830","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}