Journal of Cardiovascular Electrophysiology最新文献

{"title":"Thromboembolic Complications From Atrial Fibrillation and Atrial Flutter in Pediatrics and Young Adults: A Multicenter Study.","authors":"Robert Whitehill","doi":"10.1111/jce.16692","DOIUrl":"https://doi.org/10.1111/jce.16692","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007935","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":"Superwide Left Atrial Circumferential Ablation for Persistent Atrial Fibrillation: A Randomized Controlled Trial.","authors":"Yue Cao, Wei Du, Yalan Fei, Hao Yang, Meng Wang, Qingshan Dong, Xianjin Li, Shijie Li, Bing Han","doi":"10.1111/jce.16700","DOIUrl":"https://doi.org/10.1111/jce.16700","url":null,"abstract":"<p><strong>Background: </strong>It remains to be answered whether further enlargement of the isolation area in the left atrium (LA) could produce better effectiveness than pulmonary vein antrum isolation (PVAI) for treatment of atrial fibrillation (AF).</p><p><strong>Aims: </strong>To assess the effectiveness of superwide left atrial circumferential ablation (SWLACA) for treatment of persistent AF (PeAF) through a randomized controlled study.</p><p><strong>Methods: </strong>A total of 248 patients (male 63.7%, median age 65 years) with PeAF were randomly divided into the SWLACA group and PVAI group. The circumferential lines were located 2-3 cm from the PV ostia in the SWLACA group and approximately 1 cm in the PVAI group, respectively. The primary endpoint was the recurrence of atrial tachyarrhythmia after a single procedure.</p><p><strong>Results: </strong>Conduction block between LA and pulmonary veins (PVs) were achieved in all patients. The isolation areas were obviously larger in the SWLACA group (p < 0.001). Compared with the PVAI group, the SWLACA group was associated with a longer procedure duration (p = 0.013) and fluoroscopic time (p = 0.038). During the 12-month follow-up, the overall recurrence rate of atrial tachyarrhythmia after a single procedure was not significantly different between the two groups (21.0% vs 26.6%; p = 0.297). However, the SWLACA group had significantly fewer AF recurrences (12.9% vs. 25.0%; p = 0.015), and more atrial tachycardia recurrences (8.1% vs. 1.6%; p = 0.018). After multiple procedures, the SWLACA group had a significantly higher total arrhythmia recurrence-free rate (p = 0.030).</p><p><strong>Conclusions: </strong>Compared with PVAI, although SWLACA did not significantly decrease the overall arrhythmia recurrence rate for PeAF, it was associated with a notable reduction in the recurrence of AF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025948","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":"Correction to \"Physiological Pacing: Historical Review With an Eye to the Future\".","authors":"Richard Sutton, Atul Prakash, Robert Anderson, Damien Sanchez-Quintana","doi":"10.1111/jce.16705","DOIUrl":"https://doi.org/10.1111/jce.16705","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018256","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":"Effect of Superior Vena Cava Isolation Added to Pulmonary Vein Isolation on the Postprocedural Heart Rates of Patients With Paroxysmal Atrial Fibrillation.","authors":"Kodai Negishi, Ken Okumura, Hideharu Okamatsu, Takuo Tsurugi, Yasuaki Tanaka, Koichi Nakao, Tomohiro Sakamoto, Junjiro Koyama, Hirofumi Tomita","doi":"10.1111/jce.16699","DOIUrl":"https://doi.org/10.1111/jce.16699","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) is often associated with an increased resting heart rate (rHR) due to neuromodulation of the cardiac autonomic plexus. Changes in the rHR by adding superior vena cava (SVC) isolation (SVCI) to PVI have not been fully elucidated.</p><p><strong>Methods: </strong>We retrospectively analyzed 257 consecutive patients with paroxysmal AF undergoing ablation index-guided AF ablation from January 2021 to June 2022. In patients with SVC myocardial sleeve ≥ 20 mm above the sinus node, circumferential SVCI was added. Consequently, PVI only was done in 110 patients and PVI plus SVCI was in 147 patients. We analyzed rHRs obtained at baseline and 1, 3, 6, and 12 months after the ablation procedure using a linear mixed-effects model. Predictors of increases in rHRs > 20% from baseline values were also examined.</p><p><strong>Results: </strong>The characteristics of the patients with PVI only versus PVI + SVCI were as follows: mean age, 70.2 ± 10.6 versus 65.3 ± 10.3 years, respectively (p < 0.001); percentage of females, 44.5% versus 28.6%, respectively (p = 0.009); and baseline rHR, 62.5 ± 11.4 versus 61.0 ± 9.2 beats/minute, respectively (p = 0.239). At 1 month after the procedure, PVI + SVCI patients had a significantly higher rHR by 9.04 beats/minute (95% confidence interval [CI, 6.57-11.51], p < 0.01) compared to PVI-only and maintained significantly increased rHRs throughout the 12-month period. Multivariate logistic regression analysis revealed that SVCI added to PVI had a positive impact on rHRs increase > 20% (odds ratio [OR], 3.59 [95% CI 2.09-6.18], p < 0.001), while beta-blockers showed a negative impact (OR, 0.51 [95% CI 0.30-0.87], p = 0.01).</p><p><strong>Conclusion: </strong>The addition of SVCI to PVI led to increases in rHRs, presumably because of additional modulation of the cardiac autonomic plexus.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010958","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 Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed?","authors":"Dimitrios Sfairopoulos, George Bazoukis, Skevos Sideris, Nikolaos Fragakis, Konstantinos Letsas, Konstantinos Zekios, Tong Liu, Panagiotis Korantzopoulos","doi":"10.1111/jce.16697","DOIUrl":"https://doi.org/10.1111/jce.16697","url":null,"abstract":"<p><p>The development of advanced atrioventricular block (AVB) in patients on bradycardic and/or antiarrhythmic therapy (drug-related AVB) represents a clinical challenge, raising the question of whether the AVB is directly caused by these agents (drug-induced AVB) or if the offending drugs exacerbate an underlying conduction system disease. Traditionally, β-blockers, non-dihydropyridine calcium channel blockers, class Ic/III antiarrhythmics, and digoxin have been considered reversible causes of advanced AVB. However, recent evidence shows a weak cause-and-effect relationship between these drugs and AVB in the elderly, along with high recurrence rates of AVB despite initial resolution after drug discontinuation. This may also apply to patients on high doses of these medications, drug combinations, or with additional reversible factors such as hyperkalemia. Despite these considerations, the European Guidelines do not suggest permanent pacing for AVB due to transient causes that are correctable, including bradycardic/antiarrhythmic drug therapy. On the other hand, the American Guidelines recommend permanent pacing for selected patients with symptomatic second- or third-degree AVB who are on stable, necessary antiarrhythmic or β-blocker treatment, without waiting for drug washout or reversibility. Notably, an accumulating body of evidence indicates that true drug-induced AVB is rare, while recurrence rates are high. Therefore, early permanent pacing should be recommended, especially for frail elderly patients. Moreover, in patients with drug-related AVB and atrial tachyarrhythmias, adopting an early permanent pacing approach seems prudent when bradycardic and/or antiarrhythmic treatment is necessary. Finally, delays in permanent pacing are not justified when temporary pacing is needed, given the increased associated risks in such cases.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009068","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":"Premature Atrial Contractions as a Marker of Atrial Cardiopathy: A Revised Analysis of the ARCADIA Randomized Trial.","authors":"Adi Elias, Justin T Teraoka, Elsayed Z Soliman, Mitchell S V Elkind, Hooman Kamel, Richard A Kronmal, W T Longstreth, David L Tirschwell, Marco R Di Tullio, Gregory M Marcus","doi":"10.1111/jce.16629","DOIUrl":"https://doi.org/10.1111/jce.16629","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial cardiopathy may be associated with an increased risk of stroke independent of atrial fibrillation (AF). In the ARCADIA trial, apixaban was not superior to aspirin in preventing recurrent stroke among patients with a cryptogenic stroke and atrial cardiopathy. We aimed to determine whether the presence of at least one premature atrial complex (PAC), a known harbinger of AF and stroke, would enhance the ability to identify individuals most likely to benefit from apixaban.</p><p><strong>Methods: </strong>In ARCADIA, atrial cardiopathy was defined by NT-proBNP > 250 pg/mL, a P-wave terminal force greater than 5000 μV × ms in lead V1, or a left atrial diameter index ≥ 3 cm/m² on echocardiogram. For the current analysis, the presence of any PAC on the baseline 12-lead ECG was substituted for the less atrial-specific NT-proBNP criterion. The presence of any PAC was also assessed as a sole atrial cardiopathy criterion.</p><p><strong>Results: </strong>Of the 1015 patients randomized in ARCADIA, 85 had at least one PAC. The revised atrial cardiopathy criteria were met by 593 patients; 301 were randomized to apixaban and 292 to aspirin. The annualized recurrent stroke rates were 3.1% for apixaban versus 4.4% for aspirin (HR 0.71, 95% CI: 0.38-1.34, p = 0.29). No differences in risk of recurrent stroke among participants with PACs, compared to those without PACs, were observed.</p><p><strong>Conclusion: </strong>In patients enrolled in the ARCARDIA trial, utilizing the presence of PACs as a potential marker of atrial cardiopathy did not reveal definitive evidence of benefit of apixaban compared to aspirin.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT03192215.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020543","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":"Automatic Threshold Function With Left Bundle Branch Area Versus Traditional Right Ventricular Lead Placement.","authors":"Daniel J Friedman, Jessica Burr, Paul W Jones, Nicholas Wold","doi":"10.1111/jce.16696","DOIUrl":"https://doi.org/10.1111/jce.16696","url":null,"abstract":"<p><strong>Introduction: </strong>Left bundle branch area pacing (LBBAP) leverages the strengths of His bundle pacing (HBP) and traditional myocardial pacing. While automatic threshold (AT) algorithms are often not suitable for HBP leads, their function in LBBAP remains uncertain.</p><p><strong>Methods: </strong>Data from the LATITUDE remote monitoring system were evaluated retrospectively comparing LBBAP leads to a sample of right ventricular (RV) placed leads. AT accuracy was assessed comparing the nearest in-office (IO) pacing capture threshold (PCT) ± 7 days at 1 and/or 3 months at 0.4 ms pulse width. Methodology from a previous trial (CAPTIVATE, NCT02097290) used for regulatory approval of an AT algorithm for standard RV apical leads was employed, comparing percent of accurate tests, with an accurate test defined as: |AT - IO | ≤ 0.6 V (or ≤ 1 V if IO > 3.5 V). Secondary analysis assessed the percentage of devices with AT turned off during 6 mo follow-up. Statistical comparisons were made using Chi-square tests.</p><p><strong>Results: </strong>Data from 1288 devices (798 LBBAP, 490 RV) were evaluated, limited by the in-office visit requirement for comparison. Among LBBAP patients, 677 had an INGEVITY+ lead, 121 FINELINE II. Generators were 668 PM, 128 CRT-D/P, 2 ICD; 694 in RV port, 96 LV, 8 RA. Compared to IO PCT, the AT algorithm accuracy was 96.9% in LBBAP leads and 97.6% in RV leads, (LBBAP vs. RV p = 0.47, Figure 1), both exceeding the 90% target. The median (IQR) difference between AT and IO PCTs for LBBAP leads was 0.1 V (0.0, 0.2 V); 59%, 81% and 91% of AT values were within 0.1, 0.2 and 0.3 V of IO, respectively (Figure 2). The AT feature was turned off at similar rates for LBBAP and RV leads in first 6 mo (LBBA 1.8%, RV 0.9%; p = 0.18; Figure 3).</p><p><strong>Conclusion: </strong>AT algorithms' accuracy was high and similar for RV and LBBAP leads in this analysis. Future research is needed to determine if current algorithms are sufficient for achieving conduction system capture when the conduction system threshold is greater than the myocardial threshold.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020580","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":"Genome-Wide Association Study of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation in a Japanese Population.","authors":"Takumi Sakai, Motoki Furutani, Mika Nakashima, Naoki Ishibashi, Junji Maeda, Naoto Oguri, Shogo Miyamoto, Shunsuke Miyauchi, Sho Okamura, Yousaku Okubo, Takehito Tokuyama, Noboru Oda, Risa Mitsumori, Shumpei Niida, Kouichi Ozaki, Daichi Shigemizu, Yukiko Nakano","doi":"10.1111/jce.16674","DOIUrl":"https://doi.org/10.1111/jce.16674","url":null,"abstract":"<p><strong>Introduction: </strong>Catheter ablation of atrial fibrillation (AF) is an established treatment; however, recurrence remains a major issue.</p><p><strong>Methods: </strong>This study included 606 patients with AF who underwent catheter ablation in Hiroshima University Hospital, including 143 and 463 patients with and without AF recurrence within 3 years after ablation, respectively. A logistic regression analysis and genome-wide association study (GWAS) were conducted to identify the clinical and genetic factors, respectively, associated with the AF recurrence risk.</p><p><strong>Results: </strong>A logistic regression analysis revealed persistent AF, nonpulmonary vein AF triggers, the N-terminal pro-brain natriuretic peptide level, and the left atrial volume before catheter ablation were significant factors for recurrence (false discovery rate < 0.05). Additionally, six variants (rs2106865, rs12577119, rs12574466, rs4902609, rs8027532, and rs2032303) were associated with the AF recurrence risk, based on the GWAS results' suggestive significance (p < 5 × 10^-6). An expression quantitative trait locus analysis revealed a significant association between rs2106865 and ATP-binding cassette subfamily C member 8 (ABCC8) expression in heart tissues (atrial appendage and left ventricle). A linear regression analysis demonstrated a significant association between the ABCC8 variant rs2106865 and left atrium volume before ablation. Finally, the Cox proportional hazard model showed a significant association between the ABCC8 variant and AF recurrence (p = 1.30 × 10^-5 by log-rank test; hazard ratio 1.74, 95% confidence interval 1.38-2.20).</p><p><strong>Conclusions: </strong>Our findings, which highlight both the clinical and genetic factors associated with AF recurrence in Japanese patients, may contribute to future efforts to improve treatment strategies for AF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972454","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":"Outcomes of Micra Leadless Pacemaker Implants in Centers With and Without Cardiac Surgery.","authors":"Gianluca Manzo, Gabriele Giannola, Gerardo Nigro, Giulio Zucchelli, Antonino Nicosia, Pietro Palmisano, Luca Bontempi, Miguel Viscusi, Mattia Liccardo, Marcello Piacenti, Giuseppe Coppola, Mario Volpicelli, Giovanni Morani, Sem Briongos, Saverio Iacopino","doi":"10.1111/jce.16701","DOIUrl":"https://doi.org/10.1111/jce.16701","url":null,"abstract":"<p><strong>Background: </strong>Micra leadless pacemaker offers an alternative to traditional transvenous pacemakers by eliminating the risks associated with leads and device pockets. Due to the technical demands of a leadless transcatheter pacemaker, concerns initially limited the procedure to centers with on-site cardiac surgery (CS) capabilities. However, growing evidence supports its safe implementation in noncardiac surgical centers, though data comparing outcomes in these settings remain limited.</p><p><strong>Aims: </strong>This analysis aims to evaluate the safety and feasibility of Micra leadless pacemaker implantation in centers with and without CS, assessing acute complications, device performance, and patient follow-up.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1899 patients who received a Micra pacemaker from May 2015 to September 2024 at 23 centers. Patients were divided into two groups: those implanted in centers with CS (CS, n = 1025) and those without (No-CS, n = 874). The primary endpoint was acute complications within 15 days postimplant, while secondary endpoints included device performance and clinical follow-up at 12 months.</p><p><strong>Results: </strong>The overall acute complication rate was low at 0.6%, with no significant difference between the CS (0.5%) and No-CS groups (0.8%; p = 0.391). Procedural times were slightly shorter in No-CS centers (41.2 ± 19.8 vs. 46.1 ± 19.3 min; p < 0.001), and both groups showed comparable device performance and patient outcomes over the follow-up period.</p><p><strong>Conclusion: </strong>The Micra leadless pacemaker can be safely and effectively implanted in centers without CS capabilities, broadening access to this technology across diverse clinical settings.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965661","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":"Revisiting First-Line VoM Ablation in PeAF: Evidence Based Medicine Also Matters.","authors":"Antoine Da Costa, Antoine Carmaux, Karim Benali","doi":"10.1111/jce.16698","DOIUrl":"https://doi.org/10.1111/jce.16698","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019364","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}