Journal of Cardiovascular Electrophysiology最新文献

{"title":"Response to the Letter to the Editor \"How to Manage Ventricular Arrhythmia Following Durable Left Ventricular Assist Device Implantation\".","authors":"Elena Efimova, Arash Arya","doi":"10.1111/jce.16590","DOIUrl":"https://doi.org/10.1111/jce.16590","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter Ablation Improves Ventilatory Efficiency in Atrial Fibrillation-Mediated Cardiomyopathy.","authors":"Nikhil Ahluwalia, David Bruce, Ashley Ashdown, Fabrizio Focacci, Hakam Abbass, Shohreh Honarbakhsh, Anthony Chow, Mehul Dhinoja, Ross J Hunter, Steffen Petersen, Guy Lloyd, Richard J Schilling","doi":"10.1111/jce.16606","DOIUrl":"https://doi.org/10.1111/jce.16606","url":null,"abstract":"<p><strong>Background: </strong>Exercise Oscillatory Ventilation (EOV) and a steep ventilatory efficiency (VE/VCO2) slope are features of ventilatory inefficiency on cardiopulmonary exercise testing (CPET), both associated with poor prognosis in patients with heart failure (HF). The prevalence in patients with co-existent atrial fibrillation (AF) and the impact of catheter ablation (CA) is unknown.</p><p><strong>Objectives: </strong>To characterize ventilatory inefficiency in patients with persistent AF and Left Ventricular Systolic Dysfunction (LVSD) and assess the impact of CA.</p><p><strong>Methods: </strong>Patients with persistent AF and Left Ventricular Ejection Fraction (LVEF) < 50% undergoing first-time CA were prospectively enrolled. Echocardiography and CPET were performed at baseline and 6 months post-CA. EOV was defined using the Kremser-Corrà criteria, and VE/VCO2 slope gradient > 30 was considered abnormal.</p><p><strong>Results: </strong>A total of 53 participants were enrolled (mean LVEF of 34 ± 9%). A total of 10 (19.2%) exhibited EOV at baseline. These patients had larger indexed left atrial (41.6 ± 13.1 mL/m² vs. 33.3 ± 9.3 mL/m², p = 0.03) and ventricular volumes [65.7 mL/m² (57.1, 89.0) vs. 46.7 mL/m² (39.8, 61.4), p = 0.03]. The partial pressure of end-tidal carbon dioxide (P_ETCO₂) at peak exercise increased (33.7 ± 6.1 mmHg to 41.2 ± 5.8 mmHg, p < 0.001) and correlated with improvement in HF symptoms (p = -0.003) and objective HF markers. A total of 25 (48.1%) had an abnormal VE/VCO2 gradient. The EOV pattern resolved in eight (80%) participants due to a reduction in EOV burden (71.1 ± 11.9% vs. 48.8 ± 14.8%, p = 0.006) and the component amplitude of minute ventilation cycles (2.6 L/min (2.5,3.2) vs 2.2 L/min (1.8,2.6), p = 0.028). Fewer patients had an abnormal VE/VCO2 gradient after CA [25 (48.1%) vs. 16 (34.0%), p = 0.004].</p><p><strong>Conclusions: </strong>Ventilatory inefficiency is common in patients with AF and LVSD. CA improves both EOV and VE/VCO2 in AF-induced cardiomyopathy. Improvement in P_ETCO₂ is also seen and correlates with HF symptom burden.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of Ineffective Cardiac Resynchronization Therapy Pacing Provides Insights Into Hidden Causes and Therapeutic Targets of Nonresponder.","authors":"Satoshi Oka, Nobuhiko Ueda, Mitsuru Wada, Kohei Ishibashi, Toshihiro Nakamura, Yuichiro Miyazaki, Akinori Wakamiya, Hideaki Kanzaki, Chisato Izumi, Kengo Kusano","doi":"10.1111/jce.16605","DOIUrl":"https://doi.org/10.1111/jce.16605","url":null,"abstract":"<p><strong>Introduction: </strong>An effective cardiac resynchronization therapy (CRT) algorithm classifies each left ventricular (LV) pace as effective or ineffective based on electrogram morphology. Loss of capture, latency, pseudo-fusion during sinus rhythm, and rapid ventricular responses due to atrial fibrillation (AF) and premature ventricular conductions (PVCs) are potential causes of ineffective CRT pacing. However, little is known about the relationship between percentage of ineffective CRT pacing (%i-CRT) and CRT response.</p><p><strong>Methods and results: </strong>Among 136 consecutive CRT recipients, we evaluated 44 patients with an effective CRT algorithm. The primary outcome was the prevalence of CRT responders, defined as a reduction in the LV end-systolic volume by ≥ 10% 6 months after implantation. The median values of percent ventricular pacing and %i-CRT were 97.5% (interquartile range [IQR]: 96.4%-98.3%) and 0.3% (IQR: 0.1%-1.0%), respectively. Patients in the highest quartile of %i-CRT (%i-CRT ≥ 1%) showed a significantly lower prevalence of CRT responders (4 [36.4%] vs. 28 [84.8%], p = 0.004) than the remaining quartiles. The univariate analysis showed that %i-CRT ≥ 1% was negatively associated with the CRT response (odds ratio: 0.10, 95% confidence interval: 0.02-0.48). The most frequent cause of ineffective pacing was rapid ventricular responses due to AF and/or PVCs, whereas the cause of the highest %i-CRT in this cohort was latency. A total of three nonresponders with a high %i-CRT showed favorable responses after therapeutic interventions for their hidden causes.</p><p><strong>Conclusion: </strong>High %i-CRT could be associated with an unfavorable CRT response and provide insights into hidden causes and therapeutic targets.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor Concerning the Article \"Ablation of Premature Ventricular Contractions with Prepotentials Mapped Inside Coronary Cusps: When to Go Infra-Valvular?\"","authors":"Yajun Wang, Youmei Shen, Hailei Liu","doi":"10.1111/jce.16611","DOIUrl":"https://doi.org/10.1111/jce.16611","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemolysis Biomarkers After Pulmonary Vein Isolation via a Balloon-In-Basket PFA Catheter.","authors":"Lorenzo Marcon, Domenico G Della Rocca, Giampaolo Vetta, Kazutaka Nakasone, Antonio Sorgente, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1111/jce.16608","DOIUrl":"https://doi.org/10.1111/jce.16608","url":null,"abstract":"<p><strong>Introduction: </strong>The extensive use of pulsed field ablation (PFA) in clinical settings has unveiled new evidence suggesting potential involvement in red blood cell structural impairment resulting in hemolysis and potential acute kidney injury (AKI).</p><p><strong>Methods: </strong>In this study, blood samples were collected from 16 patients before and 24 h after pulmonary vein isolation (PVI) via a novel investigational PFA-based technology. Biochemical analyses were performed to assess hemolysis and AKI, including total and indirect bilirubin, lactate dehydrogenase (LDH), haptoglobin, plasma free hemoglobin, urea, creatinine, and estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>Based on the periprocedural changes in hemolysis biomarkers, none of the patients displayed evidence of clinically relevant hemolysis following PVI with the PFA catheter.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Tricuspid Regurgitation on Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.","authors":"Sebastian Weyand, Viola Adam, Paloma Biehler, Patricia Hägele, Simon Hanger, Stephanie Löbig, Andrei Pinchuk, Felix Ausbuettel, Christian Waechter, Peter Seizer","doi":"10.1111/jce.16615","DOIUrl":"https://doi.org/10.1111/jce.16615","url":null,"abstract":"<p><strong>Background: </strong>The impact of tricuspid regurgitation (TR) on the outcomes of pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unclear. While the effects of mitral regurgitation (MR) on PVI outcomes are well-documented, there are limited data on how moderate or greater TR influences PVI efficacy and recurrence rates.</p><p><strong>Objectives: </strong>The aim of this study was to assess the impact of moderate or greater TR on the outcomes of PVI, particularly focusing on AF recurrence rates within the first year post-PVI.</p><p><strong>Methods: </strong>We conducted an observational cohort study involving 421 patients undergoing their first PVI. 96 patients with moderate or greater TR were propensity score-matched with 96 controls based on age, sex, body mass index, and MR severity. Procedural parameters, complication rates, and AF recurrence within 1-year post-PVI were analyzed.</p><p><strong>Results: </strong>Despite comparable procedural parameters and low overall complication rates between the groups, patients with moderate or greater TR experienced significantly higher AF recurrence rates within the first year after PVI. Right atrium (RA) area was notably larger in these patients, suggesting a potential link between RA remodeling and increased AF recurrence.</p><p><strong>Conclusions: </strong>Our findings indicate that moderate or greater TR is associated with higher recurrence rates of AF after PVI, potentially due to RA enlargement and remodeling. This highlights the need for tailored ablation strategies that consider the RA substrate and/or TR treatment in patients with significant TR and AF. Further multicenter, prospective studies are required to validate these results and explore long-term outcomes.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Neuromodulation and Neurocardiology.","authors":"Robert Lemery","doi":"10.1111/jce.16593","DOIUrl":"https://doi.org/10.1111/jce.16593","url":null,"abstract":"<p><p>Neurocardiology has mostly been a specialty of medicine led by anatomists and physiologists. The characterization of the cardiac autonomic nervous system has resulted in a new understanding and appreciation of neurocardiology, leading to potential novel neuromodulation therapies in clinical cardiology and cardiac electrophysiology. Sympathectomy or spinal cord stimulation for the treatment of angina pectoris, as well as cardiac sympathetic denervation for the treatment of long QT syndrome associated with malignant ventricular arrhythmias, have been available and performed for more than half a century. However, a new neuromodulation has emerged, based on contemporary research findings, assisted by state-of-the art imaging and ablation techniques. Patients with structural heart disease and malignant ventricular arrhythmias, as well as symptomatic ventricular ectopy, can potentially benefit from techniques to reduce autonomic tone, such as stellate ganglionic block, epidural anesthesia and cardiac sympathetic denervation. Renal sympathetic denervation not only has been shown to ameliorate the treatment of patients with hypertension, but may also reduce atrial and ventricular arrhythmias. Patients with heart failure may be improved clinically by potentiating parasympathetic tone. Cardiac mapping of ganglia and nerves can be performed to delineate regions of ablation that can suppress atrial fibrillation, and potentially treat symptomatic bradyarrhythmias and cardio-inhibitory syncope.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Style Over Substance? Stylet-Driven Pacing Leads for the Purposes of Left Bundle Branch Area Pacing.","authors":"Sami Ibrahim, Pamela K Mason","doi":"10.1111/jce.16610","DOIUrl":"https://doi.org/10.1111/jce.16610","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Contact Force in Robotic Magnetic Navigation Ablation.","authors":"Michal Orczykowski, Maciej Bak, Krzysztof Kaczmarek, Piotr Urbanek, Bodalski Robert, Krzysztof Dubowski, Grzegorz Warminski, Pawel Derejko, Pawel Ptaszynski, Maciej Sterlinski, Maria Bilinska, Lukasz Szumowski","doi":"10.1111/jce.16597","DOIUrl":"https://doi.org/10.1111/jce.16597","url":null,"abstract":"<p><strong>Introduction: </strong>Stability of catheter-tissue contact in the robotic magnetic navigation (RMN) system is one of the key features that distinguishes this system from manually guided catheters. Numerous studies have shown that contact force (CF) in manually controlled catheters is as crucial for forming an optimal lesion as the duration of application or power. Catheters used in the RMN system lack a quantitative method for intraoperative monitoring of this parameter. Our study aims to partially address this gap in scientific knowledge.</p><p><strong>Methods: </strong>We conducted a total of 1200 CF measurements using the RMN system (Stereotaxis, St. Louis, MO, USA), a magnetic-guided 8 Fr RF ablation catheter (THERMOCOOL RMT Catheter, Biosense Webster, Irvine, CA, USA) inserted through a long sheath (SR0, Abbott Cardiovascular, Nathan Lane North, Plymouth, MN, USA), and a precision jewelry scale (IKEME, Guangdong, CN). We analyzed the impact on the obtained CF values of four different magnetic field vectors (transverse, sagittal, caudal, and cranial), two field strengths (0.1T and 0.08T), and three catheter extension configurations from the long sheath (with Position 1 being the least extended and Position 3 the most extended).</p><p><strong>Results: </strong>The contact force values varied significantly across the different magnetic field vectors, field strengths, and catheter extensions from the vascular sheath. The greatest differences in achieved values were observed across the different magnetic field vectors in the Position 1, ranging from 3.52 ± 0.1 g (caudal plane) to 15.15 ± 0.05 g (cranial plane) at 0.08 Tesla (T) field strength (p < 0.001), and from 4.10 ± 0.06 g (caudal) to 15.01 ± 0.07 g (cranial) at 0.1 T, p < 0.001. Differences in other vectors reached approximately 20%. The highest CF values were obtained in Position 1, intermediate values in Position 2, and the lowest in Position 3. An exception was the transverse vector, where, particularly with a magnetic field of 0.1 T, more similar values were observed across Positions 1-3, with respective values of 8.61 ± 0.14 g, 9.36 ± 0.06 g, and 8.31 ± 0.05 g. A stronger magnetic field (0.1 T compared to 0.08 T) resulted in higher CF values, especially during measurements in the transverse vector. This effect was most pronounced in the most extended catheter from the sheath - Position 3 (with respective values of 4.54 ± 0.09 g vs. 8.31 ± 0.05 g, p < 0.001). In the sagittal, cranial, and caudal vectors, the differences were less noticeable.</p><p><strong>Conclusion: </strong>Different magnetic field vectors, catheter extensions from the sheath, and magnetic field strengths result in varying contact force values. For effective radiofrequency ablation lesions, these factors should be considered alongside power, duration, and other established parameters.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Ablation Within the Coronary Venous Sinus in Pediatric Patients.","authors":"Shankar Baskar, Martin J LaPage, Nicholas J Ollberding, David S Spar, Brynn E Dechert, Audrey Dionne, Luis Ochoa, Ian Law, Peter P Karpawich, Diana Torpoco-Rivera, Christopher W Follansbee, Jason Garnreiter, Richard J Czosek","doi":"10.1111/jce.16607","DOIUrl":"https://doi.org/10.1111/jce.16607","url":null,"abstract":"<p><strong>Background: </strong>Catheter-based ablation in the coronary venous sinus (CS) can be associated with inadvertent coronary artery (CA) injury. However, a significant gap remains in the literature with regard to safety of such ablation in pediatrics.</p><p><strong>Objectives: </strong>The primary aim of this study was to describe the safety of catheter-based ablation within the CS. Secondary aim was to describe the practice pattern of ablation energy source within the CS among pediatric centers.</p><p><strong>Methods: </strong>This was a multi-center, retrospective study over a period of 20 years (1999-2019) involving seven centers. Pediatric patients (≤ 21 years of age) undergoing ablation within the CS were included.</p><p><strong>Results: </strong>A total of 211 patients were included (median age: 14 [IQR: 10.5, 16.0]). Accessory pathways were the target in almost 90% of the patients with cryoablation in 55%, nonirrigated RF in 40% and irrigated RF in 6%. Only 16% had coronary arteriogram done before RF. There was a single patient who had CA injury, in the form of a transient spasm of the left circumflex CA following RF in the proximal CS. There was transient high-grade AV block in six patients (2.8%) who either had RF or cryoablation. There was no permanent AV block.</p><p><strong>Conclusion: </strong>The use coronary arteriogram before RF in the CS is infrequent, although acute CA injury appears to be rare following such ablation. Transient heart block is not uncommon, and the operators need to be vigilant in monitoring AV nodal conduction.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}