Journal of Cardiovascular Electrophysiology最新文献

{"title":"Trends in Mortality Related to Atrial Fibrillation and Dementia in Older Adults in the United States: A 2000-2020 Analysis.","authors":"Muhammad U Sohail, Ruqiat M Batool, Muhammad Saad, Saad A Waqas, Muhammed A Noushad, Muhammad O Sohail, Matthew Bates, Raheel Ahmed, David Ripley","doi":"10.1111/jce.16644","DOIUrl":"https://doi.org/10.1111/jce.16644","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and dementia are increasingly prevalent in aging US populations. Their association raises public health concerns, emphasizing the need to understand mortality trends in older adults. This study examines AF and dementia-related mortality trends from 2000 to 2020.</p><p><strong>Methods: </strong>Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates for individuals aged 65 and older, reporting age-adjusted mortality rates (AAMRs) per 100 000 persons. Trends were assessed through annual percent change (APC) analysis via Joinpoint regression, with stratifications by sex, race/ethnicity, urbanization, and Census regions.</p><p><strong>Results: </strong>A total of 400 103 AF and dementia-related deaths were recorded between 2000 and 2020. The AAMR increased markedly from 25.4 in 2000 to 70.4 in 2020. The overall AAMR showed a steady increase from 2000 to 2018 (APC: +4.2%; 95% CI: 2.5-5.5), with a sharper rise from 2018 to 2020 (APC: +9.5%; 95% CI: 4.5-12.2; p < 0.001). Mortality rates were comparable between men (AAMR: 44.4) and women (AAMR: 43.9). NH White individuals exhibited the highest AAMR (47.0), followed by NH Black (26.6), Hispanic (23.1), and NH Asian/Pacific Islander (18.0) populations. Nonmetropolitan areas had higher AAMRs (48.1) compared to metropolitan areas (43.5). Regionally, the Western US recorded the highest AAMR at 48.2, while state-level disparities showed a nearly threefold difference between the top 90th and bottom 10th percentiles.</p><p><strong>Conclusion: </strong>Rising AF and dementia-related mortality rates among older adults highlight a need for targeted screening and intervention, particularly for high-risk demographics and underserved regions.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692212","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":"Static Versus Dynamic Risk of Sudden Cardiac Death: Implications for Improvement of Prediction and Prevention.","authors":"Marita Knudsen Pope, Sumeet S Chugh","doi":"10.1111/jce.16654","DOIUrl":"https://doi.org/10.1111/jce.16654","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) is a major public health challenge, resulting in significant loss of life each year. Effective prevention relies on identifying individuals at elevated risk; however, accurate prediction of SCD has proven difficult. The current clinical strategy relies on a static risk assessment, primarily using left ventricular ejection fraction (LVEF) < 35% as a key criterion. This approach, however, often falls short. Emerging evidence highlights the potential of dynamic risk assessment to improve SCD risk stratification when changes in vulnerable clinical substrate are monitored over time. These dynamic changes, observed months to years before an event or during the time-period immediately preceding it, have shown promise in enhancing risk prediction. Thus far, relatively few studies have investigated this dynamic risk concept, underscoring the need for further research including validation in larger, prospective studies and clinical trials. Such studies could pave the way for long-term and near-term dynamic risk assessment tools that are independent of, and additive to, static risk stratification, ultimately leading to more accurate and timely identification of patients at risk of SCD.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700448","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":"Clinical Features of Brugada Syndrome Patients With SCN5A Variants.","authors":"Sho Okamura, Hidenori Ochi, Mika Nakashima, Rie Akiyama, Takehito Tokuyama, Yousaku Okubo, Shunsuke Miyauchi, Shogo Miyamoto, Naoto Oguri, Yukimi Uotani, Takumi Sakai, Motoki Furutani, Yasuki Kihara, Yukiko Nakano","doi":"10.1111/jce.16643","DOIUrl":"https://doi.org/10.1111/jce.16643","url":null,"abstract":"<p><strong>Background: </strong>SCN5A is the most common susceptibility gene in patients with Brugada syndrome (BrS); however, the interpretation and management of benign or variants of unknown clinical significance (VUS) in SCN5A remains a challenge despite the availability of genetic testing.</p><p><strong>Objective: </strong>This study aimed to investigate the relationship between the SCN5A variants and clinical symptoms of BrS patients.</p><p><strong>Methods: </strong>We resequenced the SCN5A gene in 239 patients diagnosed with BrS at Hiroshima University Hospital and analyzed the association between the SCN5A variants and clinical features, 12-lead electrocardiography (ECG) parameters, and signal-averaged ECG.</p><p><strong>Results: </strong>Overall, 84 SCN5A variants were identified: 55 benign, 7 pathogenic, and 22 VUS. No significant difference in the incidence of previous cardiac events was observed between patients with and without SCA5A benign variants. The female proportion was higher in BrS patients with SCN5A VUS or pathogenic variants. Moreover, the symptomatic proportion was higher in BrS patients with SCN5A VUS or pathogenic variants than in those without SCN5A variants. Multivariate analyses revealed that the presence of SCN5A pathogenic variants, longer r-J intervals in lead V1, and the presence of fragmented QRS were independently associated with cardiac events in BrS patients, and that positive late potentials, longer LAS40, and lower RMS40 were significantly associated with symptomatic BrS in patients carrying SCN5A VUS.</p><p><strong>Conclusions: </strong>SCN5A pathogenic variants were found to be independent risk factors for cardiac events in BrS patients. Although SCN5A VUS was not an independent risk factor for cardiac events, proportion of symptomatic patients was higher in BrS patients with SCN5A VUS than in those without SCN5A variants. In BrS patients with SCN5A VUS, the signal-averaged ECG was the key to the risk stratification for cardiac events.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692058","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":"Abstracts from the 30th Annual Atrial Fibrillation Symposium, January 16-18, 2025.","authors":"","doi":"10.1111/jce.16619","DOIUrl":"https://doi.org/10.1111/jce.16619","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691904","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":"First-Line Marshall Plan Approach in Persistent Atrial Fibrillation: A Prospective Single-Center Cohort Study.","authors":"Antoine Carmaux, Cedric Yvorel, Karim Benali, Cécile Romeyer, Rayan Mohammed, Jean Michel Vovor, Antoine Da Costa","doi":"10.1111/jce.16650","DOIUrl":"https://doi.org/10.1111/jce.16650","url":null,"abstract":"<p><strong>Background: </strong>Different ablation strategies have been developed for persistent atrial fibrillation (PeAF), but early management is still controversial. In the clinical setting of PeAF, the safety and efficacy of early Marshall plan have not yet been fully studied.</p><p><strong>Objectives: </strong>Our prospective cohort study sought to: (1) assess the safety and feasibility of the thermal Marshall plan (MPA) approach as a first-line therapy in PeAF patients; (2) evaluate its long-term sinus rhythm maintenance efficacy; (3) identify the long-term predictive factors of AF recurrence in PeAF patients after MPA approach.</p><p><strong>Methods and results: </strong>Between January 2020 and December 2023, 118 PeAF patients were selected for first intent Marshall plan ablation (MPA). Marshall vein failure occurred in 9/118 patients (7.6%). Accordingly, 109 patients who underwent MPA as first-line therapy were included. After the blanking period of 3 months, 62/109 patients were in sinus rhythm (SR) (57%), 33/109 were in AF (30.2%), 8/109 were in left atrial flutter (AFL) (7.3%), and six were in right AFL (5.5%). Re-ablation was performed in 4/33 patients (12.1%) and cardioversion in 29/33 (87.9%) for patients in AF at 3 months after healing. All patients in AFL at 3 months were re-ablated and all recovered SR. At 12 months postablation, two patients were lost to follow-up (1.8%), 94/107 (87.8%) were in SR and 13/107 had AF recurrence (12.2%). At 21 ± 11 months postablation, 81/107 (75.7%) were in SR at the last control, and 26/107 (24.3%) had AF recurrence. The ablation procedure ratio was 1.17 (109 primo ablation, 18 re-ablation). The only predictive factors of late AF recurrence after first-line PeAF MPA were both left atrial dilatation and low left ventricular ejection fraction (LVEF).</p><p><strong>Conclusions: </strong>This real-life prospective cohort study showed that de novo MPA in PeAF is feasible, relatively safe, and associated with a high rate of freedom from arrhythmia recurrence during long-term follow-up. The percentage of patients remaining in SR during long-term follow-up was close to 76%. The only predictive MPA failure factors were both left atrial dilatation and low LVEF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692208","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":"Differences Between the Unipolar Versus Bipolar Potential-Based Activation Maps of Ventricular Premature Contractions Arising From Ventricular Outflow Tracts.","authors":"Yoshimori J An, Masafumi Sugawara, Jakub Sroubek, Katsuhide Hayashi, John O Lopez, Justin Lee, Shady Nakhla, Pasquale Santangeli, Oussama M Wazni, Koji Higuchi","doi":"10.1111/jce.16647","DOIUrl":"https://doi.org/10.1111/jce.16647","url":null,"abstract":"<p><strong>Background: </strong>The use of an automated annotation algorithm based on the maximal negative derivative of the unipolar potential (-dV/dTmax) for local activation timing in the ablation of outflow tract (OT) ventricular premature contractions (VPCs) remains controversial.</p><p><strong>Objective: </strong>To investigate the spatial differences in the earliest activation sites (EASs) of OT-VPCs identified by an automated annotation based on unipolar -dV/dTmax versus manual annotation using local bipolar potentials.</p><p><strong>Methods: </strong>Seventy-nine patients with frequent OT-VPCs who underwent successful ablation were included. VPCs originated from the right ventricular OT (RVOT) free wall (n = 10), RVOT septum (n = 25), aortomitral continuity (AMC) (n = 19), and aortic sinus cusps (ASCs) (n = 25). The spatial distance between EASs identified by the two annotation methods was analyzed.</p><p><strong>Results: </strong>The spatial distance between EASs was significantly larger in ASC-origin VPCs compared to non-ASC-origin VPCs (median: 11.9 mm [IQR: 7.9-14.9] vs. 1.2 mm [IQR: 0.0-3.3], p < 0.001). Among non-ASC-origin VPCs, the spatial difference was smallest in VPCs from the RVOT free wall (median: 0 mm) and larger in those from the RVOT septum (median: 1.6 mm) and AMC (median: 2.2 mm).</p><p><strong>Conclusion: </strong>The spatial discordance of EAS between unipolar and bipolar mapping varies by the VPC origin site. The discrepancy is particularly pronounced in ASC-origin VPCs, emphasizing the need for careful interpretation of automated annotation algorithms to ensure accurate localization and effective ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692107","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":"An Unpredictable Atrioventricular Accessory Pathway: Low-Risk or High-Risk?","authors":"Tommaso Sciarretta, Davide Genovese, Giacomo Prete, Paolo Antonio Maria Squasi, Francesco Basso, Luca De Mattia, Vittorio Calzolari, Carlo Cernetti","doi":"10.1111/jce.16640","DOIUrl":"https://doi.org/10.1111/jce.16640","url":null,"abstract":"<p><p>A 66-year-old man with known asymptomatic preexcitation was admitted to our department for symptomatic complete infranodal atrioventricular block and scarce intermittent anterograde conduction through the atrioventricular accessory pathway. The accessory pathway was not further stratified due to evidence of intermittent conduction with a sinus node heart rate of 60 bpm, and a bicameral pacemaker was implanted. Surprisingly, after 4 months, the patient developed preexcited, rapidly conducted atrial fibrillation and ultimately underwent successful accessory pathway catheter ablation. Even when intermittent ventricular preexcitation is documented at low heart rates, it does not exclude the presence of an accessory pathway with high-risk conduction properties during follow-up.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692057","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":"“Measure Twice Cut Once” to Avoid Conduction System Injury and Eliminate Parahisian PVCs","authors":"Francis E. Marchlinski,&nbsp;Balaram Krishna J. Hanumanthu,&nbsp;Andres Enriquez","doi":"10.1111/jce.16628","DOIUrl":"10.1111/jce.16628","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 4","pages":"739-740"},"PeriodicalIF":2.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691903","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":"Where Did the Party Go? The Significance of Limited Pulmonary Vein Connections in Persistent Atrial Fibrillation Ablation - An Editorial.","authors":"Joey Junarta, Anthony Aizer","doi":"10.1111/jce.16649","DOIUrl":"https://doi.org/10.1111/jce.16649","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663435","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":"Elective Generator Replacement of the Subcutaneous Implantable Defibrillator-Always a Simple Pit Stop?","authors":"Fabian Fastenrath, Sara Wuerfel, Volker Liebe, Ibrahim Akin, Daniel Duerschmied, Martin Borggrefe, Juergen Kuschyk, Boris Rudic","doi":"10.1111/jce.16638","DOIUrl":"https://doi.org/10.1111/jce.16638","url":null,"abstract":"<p><strong>Background and aims: </strong>The safety and efficacy of the subcutaneous implantable cardioverter-defibrillator (S-ICD) has been proven in various clinical trials. Data on device replacement strategies is scarce. This study aims to evaluate long-term shock efficacy, trends in shock impedance, and the effects of a replacement strategy at elective device replacement.</p><p><strong>Methods: </strong>Between January 2018 and November 2022, a total of 99 consecutive patients underwent S-ICD device replacement. Shock impedance was determined at initial implantation, before and after device replacement. In case of high shock impedance, additional optimization of lead and generator position was performed if applicable, as well as the removal of fibrous encapsulation (\"capsulectomy\") of the S-ICD pocket.</p><p><strong>Results: </strong>Defibrillation testing with the first 65 J shock was successful in 87% of patients after initial device implantation versus 85% with the same device immediately before device replacement (p = 0.88). Eight patients preoperatively failed defibrillation testing with 65 J and 80 J. After a mean dwell time of 65 ± 21 months, shock impedance increased significantly from 82 ± 23 Ω at initial implantation to 98 ± 37 Ω at replacement (p = 0.004). Capsulectomy and optimized repositioning of the S-ICD lead and generator resulted in a significant decrease of shock impedance to 81 ± 25 Ω as compared to 98 ± 37 Ω before the replacement (p = 0.004). 65 J shock efficacy improved to 95%. Postoperative defibrillation testing was successful in all patients. No acute complications were observed.</p><p><strong>Conclusion: </strong>High conversion rates at device replacement are achievable through optimized replacement strategy. In addition to improving the lead and generator position, capsulectomy appears to be a safe and effective way to reduce shock impedance and might contribute to overall system performance.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663432","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}