JACC. Clinical electrophysiology最新文献

{"title":"Effects of Implantable Cardioverter-Defibrillator Leads on the Tricuspid Valve and Right Ventricle","authors":"Darryl P. Leong MBBS, MPH, MBiostat, PhD ,&nbsp;Hisham Dokainish MD ,&nbsp;Blandine Mondésert MD ,&nbsp;Germano Cavalli MD ,&nbsp;Aditya Khetan MD ,&nbsp;Filipe Cirne MD ,&nbsp;Rocio Baro Vila MD ,&nbsp;Harry Klimis MBBS, BMedSci, PhD ,&nbsp;Tais Araujo De Jesus MD ,&nbsp;Naif Saad AlGhasab MD ,&nbsp;Vahid Akbari MD ,&nbsp;Asem Suliman MD ,&nbsp;Osama Eltebi MD ,&nbsp;Ali Almhri MD ,&nbsp;Tahsin Ferdous MSc ,&nbsp;Angie Djuric ,&nbsp;Jamil Bashir MD ,&nbsp;Andrew D. Krahn MD ,&nbsp;Derek V. Exner MD, MPH ,&nbsp;François Philippon MD ,&nbsp;Jeff S. Healey MD, MSc","doi":"10.1016/j.jacep.2024.04.034","DOIUrl":"10.1016/j.jacep.2024.04.034","url":null,"abstract":"<div><h3>Background</h3><div>There are no randomized data to inform the extent to which transvenous cardiac leads cause tricuspid regurgitation (TR).</div></div><div><h3>Objectives</h3><div>This study sought to determine the effect of a transvenous implantable cardioverter-defibrillator (TV-ICD) on TR severity, and secondarily, on right ventricular (RV) size and function.</div></div><div><h3>Methods</h3><div>We evaluated TR severity before and 6 months after implantable cardioverter-defibrillator insertion in a post hoc analysis of adults randomized to receive a transvenous (n = 252) or subcutaneous implantable cardioverter-defibrillator (S-ICD) (n = 251) device. TR and RV size and systolic function were assessed by echocardiographic images analyzed in a core laboratory.</div></div><div><h3>Results</h3><div>At baseline, at least mild TR was present in 30% of individuals. At 6 months, the proportion of participants with any TR in the TV-ICD group was 42% vs 19% in the S-ICD group (<em>P</em> &lt; 0.001). The proportion with moderate or severe TR was 7% in the TV-ICD group vs 2% in the S-ICD group (<em>P</em> = 0.021). At 6 months, the OR of at least 1 grade worsening of TR in the TV-ICD group as compared with the S-ICD group was 7.2 (95% CI: 3.3-15.8; <em>P</em> &lt; 0.001). There were no differences between groups with respect to RV size or systolic function.</div></div><div><h3>Conclusions</h3><div>Six months following TV-ICD insertion, there was a 7-fold increase in the risk of at least 1 grade worsening of TR, with 7% of individuals having TR that was moderate or severe. There was no detectable difference in RV size or function; however, longer follow-up is needed.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24003694/pdfft?md5=59aa8c6d5a656d1ef377e6ab669c56af&pid=1-s2.0-S2405500X24003694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603645","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":"Identification of Critical Slowing of Conduction Using Unipolar Atrial Voltage and Fractionation Mapping","authors":"Ziliang Ye MD ,&nbsp;Nawin L. Ramdat Misier BSc ,&nbsp;Mathijs S. van Schie PhD ,&nbsp;Hongxian Xiang MD ,&nbsp;Paul Knops BSc ,&nbsp;Jolanda Kluin MD, PhD ,&nbsp;Yannick J.H.J. Taverne MD, PhD ,&nbsp;Natasja M.S. de Groot MD, PhD","doi":"10.1016/j.jacep.2024.04.036","DOIUrl":"10.1016/j.jacep.2024.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Ablation strategies targeting fractionated or low-voltage potentials have been widely used in patients with persistent types of atrial fibrillation (AF). However, recent studies have questioned their role in effectively representing sites of conduction slowing, and thus arrhythmogenic substrates.</div></div><div><h3>Objectives</h3><div>The authors studied the relationship between local conduction velocity (CV) and the occurrence of fractionated and/or low-voltage potentials in order to identify areas with critically slowing of conduction.</div></div><div><h3>Methods</h3><div>Intraoperative epicardial mapping was performed during sinus rhythm. Unipolar potentials with an amplitude &lt;1.0 mV were initially classified as low-voltage and potentials with ≥3 deflections as fractionation. A range of thresholds were also explored. Local CV was computed using discrete velocity vectors.</div></div><div><h3>Results</h3><div>A total of 319 patients were included. Fractionated, low-voltage potentials were rare, accounting for only 0.36% (Q1-Q3: 0.15%-0.78%) of all atrial sites. Local CV at sites with fractionated, low-voltage potentials (46.0 cm/s [Q1-Q3: 22.6-72.7 cm/s]) was lowest compared with sites with either low-voltage, nonfractionated potentials (64.5 cm/s [Q1-Q3: 34.8-99.4 cm/s]) or fractionated, high-voltage potentials (65.9 cm/s [Q1-Q3: 41.7-92.8 cm/s]; <em>P</em> &lt; 0.001). Slow conduction areas (CV &lt;50 cm/s) could be most accurately identified by using a low voltage threshold (&lt;1 mV) and a minimum of 3 deflections (positive predictive value: 54.2%-70.7%), although the overall sensitivity remained low (0.1%-1.9%).</div></div><div><h3>Conclusions</h3><div>Sites with fractionated, low-voltage potentials have substantially slower local CV compared with sites with either low-voltage, nonfractionated potentials or fractionated, high-voltage potentials. However, the strong inverse relationship between the positive predictive value and sensitivity of a combined voltage and fractionation threshold for slowed conduction is likely to complicate the use of these signal-based ablation approaches in AF patients.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24004559/pdfft?md5=77d0e2337ee8929e43fe5a1383a7f4d0&pid=1-s2.0-S2405500X24004559-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633484","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":"Atrial Fibrillation Burden on a 14-Day ECG Monitor: Findings From the GUARD-AF Trial Screening Arm","authors":"Daniel E. Singer MD, Steven J. Atlas MD MPH, Alan S. Go MD, Steven A. Lubitz MD MPH, David D. McManus MD MSc, Rowena J. Dolor MD MHS, Ranee Chatterjee MD MPH, Michael B. Rothberg MD MPH, David R. Rushlow MD, Lori A. Crosson PhD MS, Ronald S. Aronson MD, Donna Mills RN, Michael Patlakh BS, Dianne Gallup MS, Emily C. O’Brien PhD, Renato D. Lopes MD PhD MHS","doi":"10.1016/j.jacep.2024.08.010","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.08.010","url":null,"abstract":"The “burden” of atrial fibrillation (AF) detected by screening likely influences stroke risk, but the distribution of burden is not well described. This study aims to determine the frequency of AF and the distribution of AF burden found when screening individuals ≥70 years of age with a 14-day electrocardiograph monitor. This is a cohort study of the screening arm of a randomized AF screening trial among those ≥70 years of age without a prior AF diagnosis (between 2019 and 2021). Screening was performed with a 14-day continuous electrocardiogram patch monitor. Analyzable patches were returned by 5,684 (95%) of screening arm participants; the median age was 75 years (Q1-Q3: 72-78 years), 57% were female, and the median CHADS-VASc score was 3 (Q1-Q3: 2-4). AF was detected in 252 participants (4.4%); 29 (0.5%) patients had continuous AF and 223 (3.9%) had paroxysmal AF. Among those with paroxysmal AF, the average indices of AF burden were of low magnitude with right-skewed distributions. The median percent time in AF was 0.46% (Q1-Q3: 0.02%-2.48%), or 75 (Q1-Q3: 3-454) minutes, and the median longest episode was 38 (Q1-Q3: 2-245) minutes. The upper quartile threshold of 2.48% time in AF corresponded to 7.6 hours. Age greater than 80 years was associated with screen-detected AF in our multivariable model (OR: 1.46; 95% CI: 1.06-2.02). Most AF detected in these older patients was very low burden. However, one-quarter of those with AF had multiple hours of AF, raising concern about stroke risk. These findings have implications for targeting populations for AF screening trials and for responding to heart rhythm alerts from mobile devices (Guard AF [A Study to Determine if Identification of Undiagnosed Atrial Fibrillation in People at least 70 Years of Age Reduces the Risk of Stroke]; )","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180648","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":"Sharpening the Spear","authors":"Andreas S. Barth MD, PhD","doi":"10.1016/j.jacep.2024.05.039","DOIUrl":"10.1016/j.jacep.2024.05.039","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901742","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":"Termination Without Global Propagation in Re-Entrant Ventricular Tachycardia: Electrophysiologic Characteristics and 3D-Electroanatomical Mapping Analysis.","authors":"Yumi Katsume, Kanae Hasegawa, Sarawuth Limprasert, Akiko Ueda, Arvindh N Kanagasundram, Travis D Richardson, William G Stevenson, Kyoko Soejima","doi":"10.1016/j.jacep.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.08.004","url":null,"abstract":"<p><strong>Background: </strong>Termination of ventricular tachycardia (VT) by a pacing stimulus that does not generate a QRS complex (termination without global propagation [TWGP]) can be a marker for a critical re-entry circuit isthmus. However, the electrophysiologic and anatomic features of these sites and their relation to VT substrate defined by 3-dimensional electroanatomical maps (3D-EAM) remain unknown.</p><p><strong>Objectives: </strong>This retrospective study aimed to characterize TWGP sites and their relation to VT substrate identified by 3D-EAM.</p><p><strong>Methods: </strong>A total of 632 consecutive cases of catheter ablation for scar-related VT at 2 University medical centers were reviewed to identify TWGP.</p><p><strong>Results: </strong>TWGP was observed 12 times at 11 different sites in 10 patients (5 ischemic cardiomyopathy). The TWGP stimulus fell immediately before or synchronous with the QRS in all cases, and evidence of local capture despite absence of a QRS complex was observed 6 times. In 5 sites, pacing after VT termination produced a QRS different than the VT. Four sites were in dense scar areas (<0.1 mV), and 6 in abnormal low voltage zone (0.1-1.5 mV). Additional mapping or ablation that abolished VT were consistent with the TWGP site being in a VT isthmus. A substrate marker for VT of late potentials, evoked delayed potentials, or slow conduction was present at 6 of 11 TWGP sites.</p><p><strong>Conclusions: </strong>TWGP may be a marker for detecting a re-entry circuit isthmus that has escaped detection based on electrogram or pace mapping-based substrate mapping.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287387","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":"Improvement of Erectile Dysfunction After Atrial Fibrillation Ablation: A Medication Dependency Analysis.","authors":"Vincenzo Mirco La Fazia,Gianluca Massaro,Sanghamitra Mohanty,Carola Gianni,Domenico Giovanni Della Rocca,Prem Geeta Torlapati,Rodney Horton,Amin Al-Ahmad,Luigi Di Biase,Andrea Natale","doi":"10.1016/j.jacep.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.08.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262301","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":"New-Onset Left Ventricular Dysfunction After Left Bundle Branch Pacing.","authors":"Shunmuga Sundaram Ponnusamy, Vithiya Ganesan, Sudharshana Nagalingam, Vadivelu Ramalingam, Selvaganesh Mariappan, Habibullah Moghal, Senthil Murugan, Mahesh Kumar, Riya Joseph, Pugazhendhi Vijayaraman","doi":"10.1016/j.jacep.2024.07.019","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.019","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch pacing (LBBP) provides stable pacing parameters and has been suggested as an alternative for right ventricular pacing and cardiac resynchronization therapy.</p><p><strong>Objectives: </strong>The aim of the study was to assess the incidence and etiology of new-onset left ventricular dysfunction (NOLVD) following LBBP in patients with baseline normal left ventricular (LV) function and cardiomyopathy patients with normalized LV function.</p><p><strong>Methods: </strong>Patients undergoing successful LBBP for symptomatic bradyarrhythmia or as an alternative to cardiac resynchronization therapy were included. Normalization of LV function was defined as improvement in LV ejection fraction to ≥50%. Patients with baseline normal LV function and those with recovered LV function after LBBP constituted the study group. Loss of conduction system capture (LOCSC) was defined as complete or partial loss of right bundle branch delay pattern along with inability to demonstrate capture transition during threshold assessment.</p><p><strong>Results: </strong>A total of 426 patients were included; 59% (n = 250) had baseline normal LV function (group I) and 41% (n = 176) had recovered LV function after LBBP (group II). Mean follow-up duration of 28.3 ± 16.7 months. NOLVD was noted in 3.75% (n = 16; group I = 5 and group II = 11) of patients. The etiologies for NOLVD were LOCSC in 62.5% (n = 10), suboptimal atrioventricular (AV) delay in 18.7% (n = 3), atrial fibrillation in 6.3% (n = 1), and idiopathic in 12.5% (n = 2). LOCSC occurred at a mean interval of 9.2 ± 6.4 months after the initial implantation. Reinterventions (n = 6) including lead repositioning, AV delay optimization, and AV junction ablation resulted in renormalization of LV function in all 6 patients.</p><p><strong>Conclusions: </strong>Periodic assessment in device clinic is required because NOLVD from reversible causes can occur during follow-up in patients after LBBP.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346826","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":"Ambulatory Rhythm Monitoring in People Living With HIV: A Cross-Sectional Analysis From a Comparative Cohort.","authors":"Cody Cichowitz, Godfrey A Kisigo, Salama P Fadhil, Grace Ruselu, Nikola Fajkis-Zajączkowska, Eva Mujuni, Megan A Willkens, Priscilla Hsue, Robert N Peck","doi":"10.1016/j.jacep.2024.07.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287383","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":"Ablation for Atrial Fibrillation in Patients With Rare Pathogenic Variants in Cardiomyopathy and Arrhythmia Genes.","authors":"Majd A El-Harasis, Zachary T Yoneda, Katherine C Anderson, Fei Ye, Joseph A Quintana, J Roberto Martinez-Parachini, Gregory G Jackson, Bibin T Varghese, Diane M Crawford, Lili Sun, Hollie L Williams, Matthew J O'Neill, Giovanni E Davogustto, James L Laws, Brittany S Murphy, Kelsey Tomasek, Yan Ru Su, Emily McQuillen, Emma Metz, Carly Smith, Doug Stubbs, Dakota D Grauherr, Quinn S Wells, Gregory F Michaud, Pablo Saavedra, Juan Carlos Estrada, Travis D Richardson, Sharon T Shen, Arvindh N Kanagasundram, Jay A Montgomery, Harikrishna Tandri, Christopher R Ellis, George H Crossley, Prince J Kannankeril, Lynne W Stevenson, William G Stevenson, Steven A Lubitz, Patrick T Ellinor, Dan M Roden, M Benjamin Shoemaker","doi":"10.1016/j.jacep.2024.06.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.06.035","url":null,"abstract":"<p><strong>Background: </strong>Patients with rare, pathogenic cardiomyopathy (CM) and arrhythmia variants can present with atrial fibrillation (AF). The efficacy of AF ablation in these patients is unknown.</p><p><strong>Objective: </strong>This study tested the hypotheses that: 1) patients with a pathogenic variant in any CM or arrhythmia gene have increased recurrence following AF ablation; and 2) patients with a pathogenic variant associated with a specific gene group (arrhythmogenic left ventricular CM [ALVC], arrhythmogenic right ventricular CM, dilated CM, hypertrophic CM, or a channelopathy) have increased recurrence.</p><p><strong>Methods: </strong>We performed a prospective, observational, cohort study of patients who underwent AF catheter ablation and whole exome sequencing. The primary outcome measure was ≥30 seconds of any atrial tachyarrhythmia that occurred after a 90-day blanking period.</p><p><strong>Results: </strong>Among 1,366 participants, 109 (8.0%) had a pathogenic or likely pathogenic (P/LP) variant in a CM or arrhythmia gene. In multivariable analysis, the presence of a P/LP variant in any gene was not significantly associated with recurrence (HR 1.15; 95% CI 0.84-1.60; P = 0.53). P/LP variants in the ALVC gene group, predominantly LMNA, were associated with increased recurrence (n = 10; HR 3.75; 95% CI 1.84-7.63; P < 0.001), compared with those in the arrhythmogenic right ventricular CM, dilated CM, hypertrophic CM, and channelopathy gene groups. Participants with P/LP TTN variants (n = 46) had no difference in recurrence compared with genotype-negative-controls (HR 0.93; 95% CI 0.54-1.59; P = 0.78).</p><p><strong>Conclusions: </strong>Our results support the use of AF ablation for most patients with rare pathogenic CM or arrhythmia variants, including TTN. However, patients with ALVC variants, such as LMNA, may be at a significantly higher risk for arrhythmia recurrence.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145655","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":"Mechanisms of Mitral Isthmus Reconnection After Ablation With and Without Vein of Marshall Ethanol Infusion.","authors":"Paul Schurmann,Akanibo Da-Wariboko,Armen Kocharian,Adi Lador,Apoor Patel,Nilesh Mathuria,Amish S Dave,Miguel Valderrábano","doi":"10.1016/j.jacep.2024.07.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.009","url":null,"abstract":"BACKGROUNDReconnection of the mitral isthmus (MI) is common after radiofrequency ablation (RFA). Vein of Marshall ethanol infusion (VOMEI) expedites MI ablation, but long-term results are unclear.OBJECTIVESThis study sought to determine anatomic substrates of failed MI ablation, with and without VOMEI.METHODSConsecutive VOMEI procedures were included (n = 231; of which 140 were de novo ablations and 91 were prior RFA failures (rescue VOMEI). MI conduction mechanisms were studied with vein of Marshall (VOM) electrograms obtained with a 2-F octapolar catheter, mapping, and differential pacing.RESULTSIn rescue VOMEI, intact VOM electrograms showed epicardial connections, epi-endocardial dissociation, and VOM conduction in pseudo-MI block. After VOMEI, after a follow-up of 725 ± 455 days, 78 patients (33.7%) experienced recurrence. Of those, 36 (46%) had evidence of MI reconnection and 42 had other mechanisms. Of the 36 patients with MI reconnection, endocardial radiofrequency (RF) at the annular MI restored block in 16 (45%), and coronary sinus (CS) RF was required in 20 (55%). Post-VOMEI recurrence mechanisms included CS connection-dependent arrhythmias: CS-mediated perimitral flutter, CS-to-left atrium (LA) and CS ostial re-entry, and CS focal activity. Intraprocedural factors associated with MI reconnection included volume of ethanol delivered ≥4 mL (OR: 0.74; P = NS), CS ablation at VOMEI (OR: 4.05; P = 0.003), and age (OR: 1.06; P = 0.011).CONCLUSIONSMI reconnections after RFA are due to epicardial connections from VOM. Recurrences after VOMEI are due to incomplete annular MI RFA and CS arrhythmogenesis including CS-mediated perimitral flutter, CS-to-LA re-entry and CS focal activity. Adding complete CS disconnection to VOMEI may prevent recurrences.","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262486","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}