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Women Trainees in Electrophysiology and the Effect of Role Models. 电生理学女学员和榜样的影响。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-28 DOI: 10.1161/CIRCEP.123.012577
Tina Baykaner, Shana Greif, Ramya S Vajapey, Christine M Albert, Zaid Aziz, Nitish Badhwar, T Jared Bunch, Jim W Cheung, Jonathan Chrispin, Mina K Chung, Paul Clopton, Daniel H Cooper, Joshua M Cooper, Alexandru Costea, Henry D Huang, Jodie L Hurwitz, Lior Jankelson, Ridhima Kapoor, Anne Kroman, Rakesh Latchamsetty, Jackson J Liang, Moussa Mansour, Nassir F Marrouche, Faisal M Merchant, John M Miller, Stavros Mountantonakis, Jonathan P Piccini, Andrea M Russo, Benjamin A Steinberg, Usha Tedrow, Wendy S Tzou, Elaine Y Wan, Paul J Wang, Janet K Han
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引用次数: 0
Chronobiologic Analysis of Electrical Storm at a Single Tertiary Care Center. 一家三级医疗中心的电风暴时间生物学分析
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-22 DOI: 10.1161/CIRCEP.124.012869
Cameron Incognito, Becky Yi-Wen Liao, Jeffrey Hedley, Joshua Parker, Kristine T Posadas, Oussama Wazni, Kenneth Mayuga, Venu Menon, John Rickard, W H Tang, Zoran B Popović
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引用次数: 0
Can Intracardiac Echocardiography Reduce Steam Pops During Half-Normal Saline Irrigated Radiofrequency Ablation? 心内超声心动图能否减少半正常生理盐水灌注射频消融过程中的蒸汽爆裂?
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-28 DOI: 10.1161/CIRCEP.123.012635
Kanae Hasegawa, Zachary T Yoneda, Jose R Martines-Parachini, Edward M Powers, Giovanni E Davogustto, Tiffany Y Hu, Kenichi Tokutake, Masaaki Kurata, Travis D Richardson, Jay A Montgomery, Sharon Shen, Juan C Estrada, Pablo J Saavedra, Amy Emerson, Marilyn L Walker, Harikrishna Tandri, Gregory F Michaud, Arvindh N Kanagasundram, William G Stevenson

Background: Irrigated radiofrequency ablation with half-normal saline can potentially increase lesion size but may increase the risk of steam pops with the risk of emboli or perforation. We hypothesized that pops would be preceded by intracardiac echocardiography (ICE) findings as well as a large impedance fall.

Methods: In 100 consecutive patients undergoing endocardial ventricular arrhythmia radiofrequency ablation with half-normal saline, we attempted to observe the ablation site with ICE. Radiofrequency ablation power was titrated to a 15 to 20 Ohm impedance fall and could be adjusted for tissue whitening and increasing bubble formation on ICE. Steam pops were defined as audible or a sudden explosion of microbubbles on ICE.

Results: Of 2190 ablation applications in 100 patients (82% cardiomyopathy, 50% sustained ventricular tachycardia), pops occurred during 43 (2.0%) applications. Sites with pops had greater impedance decreases of 18 [14, 21]% versus 13 [10, 17]% (P<0.001). ICE visualized 1308 (59.7%) radiofrequency sites, and fewer pops occurred when ICE visualized the radiofrequency ablation site (1.4%) compared with without ICE visualization (2.8%; P=0.016). Of the 18 ICE-visible pops, 7 (39%) were silent but recognized as an explosion of bubbles on ICE. With ICE, 89% of pops were preceded by either tissue whitening or a sudden increase in bubbles. In a multivariable model, tissue whitening and a sudden increase in bubbles were associated with steam pops (odds ratio, 7.186; P=0.004, and odds ratio, 29.93; P<0.001, respectively), independent of impedance fall and power. There were no pericardial effusions or embolic events with steam pops.

Conclusions: Steam pops occurred in 2% of half-normal saline radiofrequency applications titrated to an impedance fall and are likely under-recognized without ICE. On ICE, steam pops are usually preceded by tissue whitening or a sudden increase in bubble formation, which can potentially be used to adjust radiofrequency application to help reduce pops.

背景:使用半生理盐水冲洗射频消融术有可能增大病灶面积,但可能会增加蒸汽爆裂的风险以及栓塞或穿孔的风险。我们假设,爆裂之前会有心内超声心动图(ICE)检查结果以及阻抗大幅下降:方法:在 100 例连续接受心内膜室性心律失常射频消融术的患者中,我们尝试用 ICE 观察消融部位。射频消融功率被调节到 15 到 20 欧姆的阻抗值,并可根据组织变白和 ICE 上气泡形成增加的情况进行调整。蒸汽爆裂是指在 ICE 上可听到或突然爆发的微气泡:在 100 名患者(82% 患有心肌病,50% 患有持续性室性心动过速)的 2190 次消融治疗中,有 43 次(2.0%)发生了爆裂。出现爆裂的部位阻抗下降幅度更大,分别为 18 [14, 21]% 和 13 [10, 17]% (PP=0.016)。在 18 个 ICE 可见的爆裂声中,有 7 个(39%)是无声的,但在 ICE 上可识别为气泡爆炸。在使用 ICE 时,89% 的爆裂前会出现组织变白或气泡突然增加。在多变量模型中,组织变白和气泡突然增加与蒸汽爆裂有关(几率比为 7.186;P=0.004,几率比为 29.93;PC 结论):在阻抗下降的半正常生理盐水射频应用中,有 2% 出现了蒸汽爆裂,如果没有 ICE,这种情况很可能没有被充分认识到。在使用 ICE 时,蒸汽爆裂之前通常会出现组织变白或气泡形成突然增加的现象,这有可能用来调整射频应用以帮助减少爆裂。
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引用次数: 0
Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall. 脉冲场消融 "困难 "心室靶点的临床前研究:腔内移动结构、室间隔和左室游离壁。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-16 DOI: 10.1161/CIRCEP.124.012734
Moritz Nies, Keita Watanabe, Iwanari Kawamura, Carlos G Santos-Gallego, Vivek Y Reddy, Jacob S Koruth

Background: Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue.

Methods: A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall.

Results: (1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions.

Conclusions: This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.

背景:- 基于心内膜导管的心室心肌脉冲场消融术(PFA)前景广阔。然而,人们对 PFA 针对腔内结构、心外膜的能力以及在厚心室组织中实现跨膜病变的方法知之甚少。方法:- 在全身麻醉、电解剖图、透视和心内超声心动图(ICE)引导下,使用格状尖端导管将双相单极 PFA 输送到猪心室。我们进行了实验,以评估重复应用单极 PFA 消融以下目标的可行性和安全性:i)腔内乳头肌和节律带;ii)心外膜目标;iii)用于室间隔和左心室游离壁的心肌中层目标的双极 PFA。结果如下- i) 成功消融了乳头肌(n=13),然后在 2、7 和 21 天进行了评估。九个接触稳定的病灶在 2 天时的长度为 18.3≥2.4毫米,宽度为 15.3≥1.5毫米,深度为 5.8≥1.0毫米。慢性病损显示腱膜保留,无二尖瓣反流。ii) 经心房生理盐水/二氧化碳辅助心外膜入路成功,心外膜单极病变的平均长度、宽度和深度分别为 30.4≥4.2 毫米、23.5≥4.1 毫米和 9.1≥1.9 毫米。12 个完成的双极病变的平均长度、宽度和深度分别为 29.6≥5.5毫米、21.0≥7.3 毫米和 14.3≥4.7毫米。长期来看,这些病变显示出均匀的纤维化变化,但没有组织破坏。双极病变明显深于单极心外膜病变。结论- 这项活体评估表明,PFA 能成功消融腔内结构,形成深心外膜病变和跨壁左心室病变。
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引用次数: 0
Left Ventricular Summit Arrhythmias: Have We Reached the Peak of Ablation Success or Just a Higher Plateau? 左室峰值性心律失常:我们是否已达到消融成功的顶峰,抑或只是一个更高的台阶?
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-01 Epub Date: 2024-05-08 DOI: 10.1161/CIRCEP.124.012969
Carli J Peters, Francis E Marchlinski
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引用次数: 0
Harnessing Data Insights for Improved Patient Care in LAAO: A Novel Approach to Personalized Risk Assessment at the Bedside. 利用数据洞察力改善 LAAO 患者护理:床旁个性化风险评估的新方法。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-28 DOI: 10.1161/CIRCEP.124.012845
Jaya Chandrasekhar, Jacqueline Saw
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引用次数: 0
Differential Pacing Maneuver From the Vein of Marshall. 来自马歇尔静脉的差分起搏手法。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI: 10.1161/CIRCEP.123.012420
Naohiko Kawaguchi, Yasuaki Tanaka, Kenji Okubo, Shinichi Tachibana, Emiko Nakashima, Katsumasa Takagi, Hiroyuki Hikita, Tetsuo Sasano, Atsushi Takahashi

Background: Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections.

Methods: Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent.

Results: Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; P<0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement.

Conclusions: Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.

背景:双向二尖瓣峡部(MI)阻滞传统上是通过冠状窦(CS)的不同起搏及其序列变化来验证的。本研究旨在评估从马歇尔静脉(VOM)进行差分起搏检测心外膜 MI 连接的能力:方法:将 VOM 电极导管插入消融线的室间隔侧,进行射频和 VOM 乙醇 MI 消融。使用常规 CS 起搏验证 MI 阻滞。为了进行差异 VOM 起搏分析,首先从靠近阻滞线的远端 VOM 双极进行起搏,然后再从近端 VOM 双极进行起搏。比较从不同 VOM 起搏部位的起搏刺激到通过阻滞线另一侧的 CS 导管记录到的电图的时间间隔。如果远端 VOM 起搏时的间隔长于近端 VOM 起搏时的间隔,则表明 VOM 连接阻滞;但如果前者的间隔较短,则认为通过 VOM 的连接持续存在:共对 50 名患者进行了评估。根据 CS,9 名患者的起搏 MI 消融不完全,分析表明这些患者的 VOM 连接持续存在。在 41 例经 CS 结果证实的完全 MI 阻滞患者中,有 30 例(73%)患者的远端 VOM 起搏间期比近端 VOM 起搏间期长 11±5 毫秒。然而,在 11 名患者(27%)中,前者的间期比后者短 16±8 毫秒,这表明 VOM 连接残留。11 名患者的跨线传导时间明显短于其他 30 名患者(166±21 对 197±36 毫秒;PC 结论:差异 VOM 起搏操作反映了 VOM 的传导状态。该操作可发现 CS 起搏时缺失的残余心外膜连接。
{"title":"Differential Pacing Maneuver From the Vein of Marshall.","authors":"Naohiko Kawaguchi, Yasuaki Tanaka, Kenji Okubo, Shinichi Tachibana, Emiko Nakashima, Katsumasa Takagi, Hiroyuki Hikita, Tetsuo Sasano, Atsushi Takahashi","doi":"10.1161/CIRCEP.123.012420","DOIUrl":"10.1161/CIRCEP.123.012420","url":null,"abstract":"<p><strong>Background: </strong>Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections.</p><p><strong>Methods: </strong>Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent.</p><p><strong>Results: </strong>Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; <i>P</i><0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement.</p><p><strong>Conclusions: </strong>Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012420"},"PeriodicalIF":8.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930337","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}
引用次数: 0
Genetic Testing in Brugada Syndrome: A 30-Year Experience. Brugada 综合征的基因检测:30 年的经验
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-01 DOI: 10.1161/CIRCEP.123.012374
Luigi Pannone, Antonio Bisignani, Randy Osei, Anaïs Gauthey, Antonio Sorgente, Cinzia Monaco, Domenico Giovanni Della Rocca, Alvise Del Monte, Antanas Strazdas, Joerelle Mojica, Maysam Al Housari, Vincenzo Miraglia, Sahar Mouram, Giampaolo Vetta, Gaetano Paparella, Robbert Ramak, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Gudrun Pappaert, Juan Sieira, Thomy de Ravel, Mark La Meir, Andrea Sarkozy, Pedro Brugada, Gian Battista Chierchia, Sonia Van Dooren, Carlo de Asmundis

Background: A pathogenic/likely pathogenic variant can be found in 20% to 25% of patients with Brugada syndrome (BrS) and a pathogenic/likely pathogenic variant in SCN5A is associated with a worse prognosis. The aim of this study is to define the diagnostic yield of a large gene panel with American College of Medical Genetics and Genomics variant classification and to assess prognosis of SCN5A and non-SCN5A variants.

Methods: All patients with BrS, were prospectively enrolled in the Universitair Ziekenhuis Brussel registry between 1992 and 2022. Inclusion criteria for the study were (1) BrS diagnosis; (2) genetic analysis performed with a large gene panel; (3) classification of variants following American College of Medical Genetics and Genomics guidelines. Patients with a pathogenic/likely pathogenic variant in SCN5A were defined as SCN5A+. Patients with a reported variant in a non-SCN5A gene or with no reported variants were defined as patients with SCN5A-. All variants were classified as missense or predicted loss of function.

Results: A total of 500 BrS patients were analyzed. A total of 104 patients (20.8%) were SCN5A+ and 396 patients (79.2%) were SCN5A-. A non-SCN5A gene variant was found in 75 patients (15.0%), of whom, 58 patients (77.3%) had a missense variant and 17 patients (22.7%) had a predicted loss of function variant. At a follow-up of 84.0 months, 48 patients (9.6%) experienced a ventricular arrhythmia (VA). Patients without any variant had higher VA-free survival, compared with carriers of a predicted loss of function variant in SCN5A+ or non-SCN5A genes. There was no difference in VA-free survival between patients without any variant and missense variant carriers in SCN5A+ or non-SCN5A genes. At Cox analysis, SCN5A+ or non-SCN5A predicted loss of function variant was an independent predictor of VA.

Conclusions: In a large BrS cohort, the yield for SCN5A+ is 20.8%. A predicted loss of function variant carrier is an independent predictor of VA.

背景:20%至25%的布鲁格达综合征(BrS)患者可能存在致病性/可能致病性变异,而SCN5A的致病性/可能致病性变异与较差的预后有关。本研究的目的是根据 ACMG 变异分类确定大型基因面板的诊断率,并评估 SCN5A 和非 SCN5A 变异的预后:方法:1992 年至 2022 年间,所有 BrS 患者均在 UZB 登记处进行了前瞻性登记。研究的纳入标准为:(1)确诊为 BrS;(2)使用大型基因面板进行遗传分析;(3)根据 ACMG 指南对变异进行分类。SCN5A中存在致病/可能致病变异的患者被定义为SCN5A+。非 SCN5A 基因变异或无变异报告的患者被定义为 SCN5A- 患者。所有变异均被归类为错义或预测功能缺失:共分析了 500 名 BrS 患者。共有 104 名患者(20.8%)为 SCN5A+,396 名患者(79.2%)为 SCN5A-。在 75 名患者(15.0%)中发现了非 SCN5A 基因变异,其中 58 名患者(77.3%)为错义变异,17 名患者(22.7%)为预测功能缺失变异。在84.0个月的随访中,48名患者(9.6%)出现了室性心律失常(VA)。与SCN5A+或非SCN5A基因的预测功能缺失变异携带者相比,没有任何变异的患者无VA生存率更高。没有任何变异的患者与SCN5A+或非SCN5A基因的错义变异携带者之间的无VA生存率没有差异。在Cox分析中,SCN5A+或非SCN5A预测功能缺失变异是VA的独立预测因子:结论:在一个大型 BrS 队列中,SCN5A+ 的发病率为 20.8%。预测的功能缺失变异携带者是VA的独立预测因子。
{"title":"Genetic Testing in Brugada Syndrome: A 30-Year Experience.","authors":"Luigi Pannone, Antonio Bisignani, Randy Osei, Anaïs Gauthey, Antonio Sorgente, Cinzia Monaco, Domenico Giovanni Della Rocca, Alvise Del Monte, Antanas Strazdas, Joerelle Mojica, Maysam Al Housari, Vincenzo Miraglia, Sahar Mouram, Giampaolo Vetta, Gaetano Paparella, Robbert Ramak, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Gudrun Pappaert, Juan Sieira, Thomy de Ravel, Mark La Meir, Andrea Sarkozy, Pedro Brugada, Gian Battista Chierchia, Sonia Van Dooren, Carlo de Asmundis","doi":"10.1161/CIRCEP.123.012374","DOIUrl":"10.1161/CIRCEP.123.012374","url":null,"abstract":"<p><strong>Background: </strong>A pathogenic/likely pathogenic variant can be found in 20% to 25% of patients with Brugada syndrome (BrS) and a pathogenic/likely pathogenic variant in SCN5A is associated with a worse prognosis. The aim of this study is to define the diagnostic yield of a large gene panel with American College of Medical Genetics and Genomics variant classification and to assess prognosis of SCN5A and non-SCN5A variants.</p><p><strong>Methods: </strong>All patients with BrS, were prospectively enrolled in the Universitair Ziekenhuis Brussel registry between 1992 and 2022. Inclusion criteria for the study were (1) BrS diagnosis; (2) genetic analysis performed with a large gene panel; (3) classification of variants following American College of Medical Genetics and Genomics guidelines. Patients with a pathogenic/likely pathogenic variant in SCN5A were defined as SCN5A<sup>+</sup>. Patients with a reported variant in a <i>non-SCN5A</i> gene or with no reported variants were defined as patients with SCN5A<sup>-</sup>. All variants were classified as missense or predicted loss of function.</p><p><strong>Results: </strong>A total of 500 BrS patients were analyzed. A total of 104 patients (20.8%) were SCN5A<sup>+</sup> and 396 patients (79.2%) were SCN5A<sup>-</sup>. A <i>non-SCN5A</i> gene variant was found in 75 patients (15.0%), of whom, 58 patients (77.3%) had a missense variant and 17 patients (22.7%) had a predicted loss of function variant. At a follow-up of 84.0 months, 48 patients (9.6%) experienced a ventricular arrhythmia (VA). Patients without any variant had higher VA-free survival, compared with carriers of a predicted loss of function variant in <i>SCN5A<sup>+</sup></i> or <i>non-SCN5A</i> genes. There was no difference in VA-free survival between patients without any variant and missense variant carriers in <i>SCN5A<sup>+</sup></i> or <i>non-SCN5A</i> genes. At Cox analysis, SCN5A<sup>+</sup> or non-SCN5A predicted loss of function variant was an independent predictor of VA.</p><p><strong>Conclusions: </strong>In a large BrS cohort, the yield for SCN5A<sup>+</sup> is 20.8%. A predicted loss of function variant carrier is an independent predictor of VA.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012374"},"PeriodicalIF":8.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995780","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}
引用次数: 0
Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis. 制定 NOCSAE 标准以降低脐带损伤风险。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI: 10.1161/CIRCEP.123.011966
Nathan Dau, Cynthia Bir, Elizabeth McCalley, David Halstead, Mark S Link

Background: Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs.

Methods: To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years.

Results: Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021.

Conclusions: An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.

背景:心源性猝死(Commotio cordis),即胸部受到相对无害的撞击而导致的心脏性猝死(SCD),是导致运动中心源性猝死的主要原因之一。商业胸部保护器尚未被证明能降低这些 SCD 的风险:为了制定评估胸部保护器的标准,我们进行了四个阶段的研究。首先,利用生理学脐带损伤模型来评估预测 SCD 的变量。接下来,根据生理模型的数据开发了一个替代模型,并对风险的衰减进行了评估。在第三阶段,对该模型进行了校准和验证。最后,国家运动装备标准操作委员会通过了该标准,并对该标准进行了为期 3 年的公开审查和修订:结果:在所有变量中,冲击力对 SCD 的预测最为准确。据预测,能将冲击力降至阈值以下的胸壁保护器可降低 SCD 风险。实验模型与机械替代物之间的相关性从每小时 30 英里的长曲棍球的 0.783 到每小时 50 英里的棒球的 0.898 不等。该标准已授权给国家运动装备标准操作委员会,该委员会于 2018 年 1 月初步通过了该标准,并于 2021 年 7 月最终确定了该标准:基于一个成熟的脊髓损伤模型的生理数据,一个有效的机械替代物可以预测使用胸部保护器后 SCD 的减少情况。更大的力量减少可在很大程度上防止脊髓损伤。国家运动装备标准操作委员会关于护胸的新标准应能显著降低运动场上发生脊髓损伤的风险。
{"title":"Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.","authors":"Nathan Dau, Cynthia Bir, Elizabeth McCalley, David Halstead, Mark S Link","doi":"10.1161/CIRCEP.123.011966","DOIUrl":"10.1161/CIRCEP.123.011966","url":null,"abstract":"<p><strong>Background: </strong>Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs.</p><p><strong>Methods: </strong>To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years.</p><p><strong>Results: </strong>Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021.</p><p><strong>Conclusions: </strong>An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e011966"},"PeriodicalIF":8.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930336","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}
引用次数: 0
Comparative Evaluation of Activity Sensing Rate Responses of a Leadless Pacemaker Using Intracardiac Accelerometer Versus Traditional Activity Sensing Pacemaker. 使用心内加速计的无引线起搏器与传统活动感应起搏器的活动感应速率响应比较评估。
IF 8.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-18 DOI: 10.1161/CIRCEP.123.012616
Jo Jo Hai, Chu-Pak Lau, Hung-Fat Tse
{"title":"Comparative Evaluation of Activity Sensing Rate Responses of a Leadless Pacemaker Using Intracardiac Accelerometer Versus Traditional Activity Sensing Pacemaker.","authors":"Jo Jo Hai, Chu-Pak Lau, Hung-Fat Tse","doi":"10.1161/CIRCEP.123.012616","DOIUrl":"10.1161/CIRCEP.123.012616","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012616"},"PeriodicalIF":8.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142900","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}
引用次数: 0
期刊
Circulation. Arrhythmia and electrophysiology
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