Journal of Cardiovascular Electrophysiology最新文献

{"title":"Removal of EVICD Leads Are Specialized Tools Required?","authors":"Russell Denman","doi":"10.1111/jce.16562","DOIUrl":"10.1111/jce.16562","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"301-302"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907112","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":"Frequency and Genotype-Dependence of intrinsic chronotropic insufficiency among patients with congenital long QT syndrome.","authors":"Veda K Kulkarni, Alexa M Pinsky, J Martijn Bos, Raquel Neves, Sahej Bains, John R Giudicessi, Thomas G Allison, Michael J Ackerman","doi":"10.1111/jce.16471","DOIUrl":"10.1111/jce.16471","url":null,"abstract":"<p><strong>Introduction: </strong>Long QT syndrome (LQTS) is a cardiac channelopathy characterized by QT prolongation and a potential for arrhythmic syncope, sudden cardiac arrest or deaths (SCA/SCD). It has been speculated that patients with LQTS might have a primary sinoatrial node (SAN) phenotype of chronotropic insufficiency (CI). This has not been demonstrated convincingly before because of the potentially confounding effects of beta blocker (BB) therapy. Herein, we set out to determine whether untreated patients with LQTS demonstrate intrinsic CI.</p><p><strong>Methods and results: </strong>A retrospective review of all treadmill exercise stress tests (TEST) was performed on patients with one of the three most common LQTS genotypes: LQT1, LQT2, and LQT3. For each patient, the first TEST completed while off BB was analyzed. Patients with prior left cardiac sympathetic denervation (LCSD) therapy were excluded. CI was defined as having an age- and gender-predicted peak heart rate (HR) < 85% and/or a predicted HR reserve (HRR) < 80%. Overall, 463 LQTS patients (245 LQT1, 125 LQT2, and 93 LQT3) were included (267 female [58%]; mean age at time of TEST [29 ± 17 years]). Mean % predicted peak HR for all LQTS patients was 87.6% (range 42.9% - 119.1%) and mean % predicted HRR was 80% (range 19.1% - 153%). Overall, half of all LQTS patients (n = 234; 51%) displayed CI; 64% of patients with LQT1 (n = 157), 37% with LQT2 (n = 46), and 33% with LQT3 (n = 31). Patients with LQT1 were most likely to exhibit CI compared to patients with LQT2 (p < .0001) and LQT3 (p < .0001). CI was significantly more common in LQT1 compared to controls (p < .0001), while there was no difference between LQT2 (p = .5) or LQT3 and controls (p > .9). Presence of CI was not a predictor of LQTS-associated symptoms, BB side effects or likelihood of future breakthrough cardiac events (BCE).</p><p><strong>Conclusions: </strong>Patients with LQTS, particularly LQT1, demonstrate a SAN phenotype of CI. If assessing BB therapy effect by impact on peak HR, the patient's pretreatment peak HR, rather than an age- and gender-predicted maximum HR, should be used.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"17-23"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466300","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":"Techniques and outcomes of atrial fibrillation ablation in patients with persistent left superior vena cava.","authors":"Ting-Wei Ernie Liao, Lingyu Xu, Mirmilad P Khoshknab, Carli J Peters, David J Callans, Francis E Marchlinski, Robert D Schaller, David S Frankel, Jeffrey J Luebbert, Gustavo S Guandalini, Saman Nazarian","doi":"10.1111/jce.16414","DOIUrl":"10.1111/jce.16414","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate tailored approaches, techniques, and outcomes of catheter ablation in patients with persistent left superior vena cava (PLSVC) undergoing atrial fibrillation (AF) ablation.</p><p><strong>Background: </strong>PLSVC presents unique challenges for AF ablation due to its potential as an arrhythmogenic source and the complex anatomical variations it introduces.</p><p><strong>Methods: </strong>The retrospective cohort included 16 patients with PLSVC that underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania. Procedures involved pre-ablation imaging, 3D electroanatomical mapping, pulmonary vein isolation, and targeted ablation strategies focusing on the PLSVC-related ablation. The primary endpoints were procedural safety and AF recurrence postablation.</p><p><strong>Results: </strong>The cohort's mean age was 51.9 ± 17.9 years, 31.2% of whom were female. Triggers from the PLSVC were identified in 66.7% of procedures. Tailored ablation strategies were employed to isolate PLSVC-left atrium/coronary sinus connections or directly target the induced triggers, with a success rate of 85% in achieving isolation or targeted ablation once triggers were induced. The recurrence rate of arrhythmia postablation was 46.7% in the patient-based analysis and 65% in the procedure-based analysis. No major complications occurred.</p><p><strong>Conclusion: </strong>This study highlights the significance of recognizing PLSVC as a potential source of AF triggers. The single procedure success rate is low compared to patients without PLSVC. Further studies are warranted to enhance outcomes in this challenging AF population.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"179-187"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621124","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":"Risk Prediction in Non-Ischemic Cardiomyoapthy.","authors":"Jay A Montgomery, Gregory G Jackson","doi":"10.1111/jce.16499","DOIUrl":"10.1111/jce.16499","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"198-200"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668062","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":"Oldest-in-Human Successful Extraction Experience of a Novel Substernal Extravascular Defibrillator.","authors":"Karanjeet Chauhan, Alistair Royse, Ian Goh, Ian Crozier, Gareth Wynn","doi":"10.1111/jce.16511","DOIUrl":"10.1111/jce.16511","url":null,"abstract":"<p><strong>Introduction: </strong>Substernal extravascular defibrillators (EV ICDs) have been shown to be effective and safe for patients at risk of sudden cardiac death, however, there is little evidence around the safety of extracting chronic devices.</p><p><strong>Methods and results: </strong>We present a 50-year-old patient in whom a Medtronic EV ICD system was successfully removed without specialist extraction tools, 186 weeks after implantation, by an operator experienced in transvenous lead extraction but without formal training in EVICD implantation.</p><p><strong>Conclusion: </strong>The successful extraction of an EV ICD system is possible without specialised tools at least 3.6 years post-implant.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"295-297"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687086","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":"Unipolar Voltage for Better Characterizing Left Atrium Substrates: Comparing the Predictive Efficacy for Recurrence Post Atrial Fibrillation Ablation in a Post Hoc Analysis of STABLE-SR-III Trial.","authors":"Xiuyu Qi, Hongwu Chen, Gang Yang, Hailei Liu, Zidun Wang, Xiaohong Jiang, Chang Cui, Cheng Cai, Weizhu Ju, Minglong Chen","doi":"10.1111/jce.16490","DOIUrl":"10.1111/jce.16490","url":null,"abstract":"<p><strong>Background: </strong>While bipolar voltage (BV) is acknowledged as an indicator of viable cardiomyocyte activation, unipolar recording has emerged as an alternative technique due to its advantage of providing a wider field of view. This study aims to compare the efficacy of unipolar voltage (UV) versus BV in predicting ablation recurrence in atrial fibrillation patients.</p><p><strong>Methods: </strong>In Substrate Ablation in the Left Atrium during Sinus Rhythm Trial III, 375 patients completed the follow-up with preserved mapping data were included in the analysis. For each patient, the mean UV and BV was obtained from the electrograms sampled in left atrium (LA).</p><p><strong>Results: </strong>Totally 301 patients experience the primary endpoint within 23.0 ± 9.2 months. While both low UV and BV had significant associations with long-term recurrence of atrial tachyarrhythmia (ATa), only mean UV was independently associated with the outcome. The model by UV with ablation feature had higher discriminatory power to predict ATa recurrence compared with BV model (area under the curve [AUC]: 0.858 vs. 0.757, p < 0.001). In subgroup analysis, UV reveals more powerful predictive efficacy compared with BV, with the AUC 0.843 versus 0.751 (p < 0.001) in circumferential pulmonary vein isolation (CPVI) alone cohort and 0.882 versus 0.750 (p < 0.001) in CPVI plus cohort, respectively.</p><p><strong>Conclusion: </strong>UV exhibits higher efficacy for predicting long-term ATa recurrence after ablation compared with BV in elderly patients with atrial fibrillation regardless of whether the patient accepts substrate modification. The outcome suggests that unipolar recording may better characterize LA fibrosis by capturing more comprehensive transmural features than bipolar signals.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov. Unique Identifier: NCT03462628.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"149-156"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604745","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":"Limitation of Unipolar Electrograms in Guiding Successful RFCA of Idiopathic Ventricular Arrhythmias Associated With Discrete Pre-Potential.","authors":"Chengye Di, Qun Wang, Yanxi Wu, Longyu Li, Yan Zhang, Wenhua Lin","doi":"10.1111/jce.16503","DOIUrl":"10.1111/jce.16503","url":null,"abstract":"<p><strong>Objectives: </strong>Activation mapping for idiopathic ventricular arrhythmias (IVAs) typically relies on identifying the earliest bipolar electrograms and unipolar electrograms characterized by an initial QS morphology preceding the intrinsic deflection. However, the utility of unipolar electrogram morphology, particularly when associated with discrete pre-potentials, in guiding IVA mapping is not well understood.</p><p><strong>Methods: </strong>We retrospectively analyzed 537 patients who underwent successful radiofrequency catheter ablation (RFCA) for IVAs between March 2016 and August 2023. Among them, 23 patients (4.3%) exhibited discrete bipolar pre-potentials with an isoelectric line between the end of the discrete pre-potential and the onset of the QRS complex during IVAs at the successful RFCA site. These cases were included in this study.</p><p><strong>Results: </strong>The time interval from the onset of the discrete pre-potential to the onset of the QRS complex was 66.4 ± 18.3 ms. The duration of the isoelectric line between the end of the discrete pre-potential and the onset of the QRS complex was 36.9 ± 13.6 ms. Unipolar electrograms associated with discrete pre-potentials exhibited an initial negative morphology in only 13 out of 23 patients (56.5%). In contrast, initial positive and isoelectric configurations in unipolar electrograms were observed in two patients (8.7%) and eight patients (34.8%), respectively. Perfect pace mapping was obtained in 21 patients (91.3%). RFCA was successful at the earliest site of the pre-potential within 3.5 ± 1.5 s in all 23 patients. During the 2.4 ± 1.2 years follow-up period, only one patient (4.3%) experienced a recurrence of clinical IVAs, with no complications reported during RFCA or follow-up.</p><p><strong>Conclusions: </strong>Unipolar electrograms show limited reliability in guiding the identification of IVAs origins compared to bipolar electrograms associated with discrete pre-potentials.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"235-245"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668044","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":"Age and Clinically Actionable Events in Patients With Implantable Loop Recorders: Analysis of Multicenter Loop Recorder Registry.","authors":"Joo Hee Jeong, So-Ryoung Lee, Il-Young Oh, Myung-Jin Cha, Hong Euy Lim, Hyoung-Seob Park, Pil-Sung Yang, Sung Ho Lee, Junbeom Park, Ki-Hun Kim, Jun-Hyung Kim, Jae-Sun Uhm, Jin Hee Ahn, Jumsuk Ko, Ju Youn Kim, Jaemin Shim","doi":"10.1111/jce.16509","DOIUrl":"10.1111/jce.16509","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about age and clinical intervention after implantable loop recorder (ILR) insertion. This study investigated the association between age and clinical intervention after ILR implantation.</p><p><strong>Methods and results: </strong>Data were obtained from a multicenter registry of ILR in Korea (2017-2020, n = 795). ILRs were inserted with indications of unexplained syncope, recurrent palpitation, or cryptogenic stroke. The primary outcome was clinically actionable event that was a composite of the newly detected atrial fibrillation (AF), pacemaker or implantable cardioverter defibrillator (ICD) implantation, catheter ablation, and anticoagulation initiation. The mean age was 64.3 years, and the mean follow-up duration was 20.6 months. Clinically actionable events were observed in 322 (40.5%) patients. Compared to younger age (< 50 years), older age (≥ 50 years) showed higher prevalence of newly detected AF (3.7% vs. 15.8%; p = 0.001), pacemaker implantation (11.2% vs. 21.2%; p = 0.022), and initiation of anticoagulation (3.7% vs. 18.6%; p < 0.001). No significant differences were found in ICD implantation (1.9% vs. 1.3%; p = 0.996) or catheter ablation (3.8% vs. 6.0%; p = 0.512). The older age group more frequently experienced clinically actionable events compared to the younger age group (hazard ratio 2.52, 95% confidence interval: 1.86-3.41; p < 0.001). A significant association was found in the increase of age (per 1-year) and the risk of clinically actionable events (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.04; p < 0.001).</p><p><strong>Conclusion: </strong>Advanced age is a significant risk factor for clinical intervention after ILR insertion. ILR should be considered more actively in older patients requiring prolonged rhythm monitoring.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"266-275"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728925","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":"Assessment of palpitations in patients with frequent premature ventricular contractions.","authors":"Yue Gao, Rui Jiang, Yan Liu, Zi-Xuan Li, Xin-He Xu, Shi-Jie Li, Xian-Jin Li, Bing Han","doi":"10.1111/jce.16476","DOIUrl":"10.1111/jce.16476","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with frequent premature ventricular contractions (PVCs), palpitations may not always be directly caused by PVCs, and therefore, it is essential to establish symptom-rhythm correlations to determine the appropriate treatment. This study aims to analyze the palpitations and related factors in patients with frequent PVCs.</p><p><strong>Methods: </strong>The study enrolled patients with frequent PVCs who were not combined with other arrhythmias or structural heart disease. Through face-to-face consultation, patients were divided into symptomatic and asymptomatic groups. For symptomatic patients, the correlation between palpitations and PVC was further evaluated based on the temporal consistency of symptom onset and PVC occurrence. The demographic, clinical, and electrocardiogram features of the patients in each group were compared.</p><p><strong>Results: </strong>Of the 214 patients enrolled, 124(57.9%) experienced palpitations. Compared to the asymptomatic group, the symptomatic group had a higher proportion of females (63.7% vs. 47.8%; p = .020) and a higher proportion of subjects with anxiety (44.4% vs.14.4%; p = .000). Within the symptomatic patients, 72 (33.60%) who had palpitations that were clearly correlated with PVCs were classified as the PVC-relevant group. In this group, the PVC CI ratios were significantly lower (55% [52% -60%] vs. 62% [55% -67%]; p = .001) and the Post-PVC CI were longer (1170 [1027-1270] vs. 1083 [960-1180] ms; p = .018) than in the PVC-irrelevant group.</p><p><strong>Conclusion: </strong>A direct relationship between palpitations and PVCs could be established only in a minority of patients with frequent PVCs. PVCs with a relatively short PVC CI and a long post-PVC CI were more likely to cause palpitations, whereas palpitations lasting only a few seconds were more likely to be directly relevant to PVCs.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"32-41"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocardial ablation of ganglionated plexus for the treatment of carotid sinus syndrome.","authors":"Carlos Minguito-Carazo, Jesús Daniel Martínez-Alday, Javier García Seara, José Luis Martínez-Sande, Teba González-Ferrero, Oleksandr Shangutov, Juliana Elices-Teja, X Alberte Fernández López, José Ramón González-Juanatey, Moisés Rodríguez-Mañero","doi":"10.1111/jce.16469","DOIUrl":"10.1111/jce.16469","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker implantation. This study investigates cardioneuroablation (CNA) as an alternative strategy for CSS.</p><p><strong>Methods: </strong>Prospective study of consecutive patients referred for CNA due to CSS. All patients underwent CSM, atropine test and 24-h Holter monitoring before the procedure and at 6 months. The primary objective was the absence of any cardioinhibitory response to CSM following CNA. Secondary objectives included the combined endpoint of syncope and presyncope-free survival, pacemaker-free survival, differences in heart rate variation (HRV), as well as differences in the pre- and postprocedure atropine tests and in the SF-36 quality-of-life questionnaire.</p><p><strong>Results: </strong>A total of 13 consecutive patients (84.6% male, mean age 63.8 ± 12.3 years) were included. CSM revealed a symptomatic asystolic pause in all patients before CNA (7.3 [5.6-10.5] s). After the procedure, all the patients had a negative CSM, and only one patient (7.7%) had a positive CSM at 6 months. After a median follow-up of 11.2 (10.6-16.3) months, syncope or presyncope-free survival was 84.6%, and none required pacemaker implantation. There was an improvement in the energy and health change items in the SF-36 questionnaire. There was a reduction in HR increase in the atropine test at 6 months (pre-CNA: 66% [52-84] vs. post-CNA 26.0% (19.8-29.3]; p = .008) and in HRV parameters.</p><p><strong>Conclusions: </strong>In this proof-of-efficacy study, performed in patients affected by asystolic CSS, CNA was effective in reducing the rate of cardioinhibitory responses, suggesting a potential efficacy in also reducing syncopal recurrences. Controlled trials are warranted to corroborate clinical findings.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"7-16"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466299","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}