Pub Date : 2025-11-03DOI: 10.1016/j.jacep.2025.09.042
Michael W Lim, Geoffrey R Wong, Troy W Watts, Souvik K Das, Youlin Koh, Sohaib A Virk, Danlu Liang, Paul B Sparks, Joseph B Morton, Geoffrey Lee, Peter M Kistler, Jonathan M Kalman
Background: Atrial substrate is characterized by regions of reduced bipolar voltage (BV), conduction velocity slowing, and complex potentials. It is thought to reflect the myocardial tissue loss and interstitial fibrosis that typifies atrial remodeling. Whether this remodeling results in regional changes in left atrial wall thickness (LAWT) is unclear.
Objectives: This study sought to determine whether computed tomography (CT)-derived LAWT is associated with regional atrial substrate in atrial fibrillation (AF) patients.
Methods: High-density electroanatomic maps of the left atrium (LA) were created in a cohort of adult patients undergoing index AF ablation. LAWT derived from the preprocedure CT utilizing automated postprocessing software was correlated with electrical markers of atrial substrate in the overall LA and at 6 predefined atrial regions.
Results: The study included 77 patients. In multiple linear regression analyses incorporating mean LAWT, age, body mass index, AF type, and LA volume, mean LAWT was an independent predictor of mean BV (β = 1.34; P < 0.001) and conduction velocity (β = 25.63; P = 0.005) as well as an independent predictor of the percentage of low voltage (β = -30.80; P < 0.001) and conduction slowing/block (β = -31.69; P = 0.013) points. Regional mean LAWT was an independent predictor of regional mean BV across all 6 predefined LA segments (anterior/posterior/roof/inferior/septal/lateral). Regional mean LAWT of the anterior (β = -5.42; P = 0.033) and roof (β = -3.17; P = 0.021) segments were also independent predictors of the percentage of complex potentials in the corresponding segments.
Conclusions: CT-derived LAWT is a promising noninvasive marker of LA substrate.
背景：心房底物的特征是双极电压（BV）降低、传导速度减慢和复杂电位。它被认为反映了心房重构的心肌组织损失和间质纤维化。这种重构是否会导致左房壁厚度（LAWT）的局部改变尚不清楚。目的：本研究旨在确定计算机断层扫描（CT）衍生的LAWT是否与房颤（AF）患者的区域性心房底物相关。方法：在一组接受指数心房颤动消融的成年患者中建立左心房高密度电解剖图。利用自动后处理软件从术前CT获得的LAWT与整个LA和6个预定义心房区域的心房底物电标记相关。结果：共纳入77例患者。在纳入平均LAWT、年龄、体重指数、AF类型和LA容积的多元线性回归分析中，平均LAWT是平均BV （β = 1.34, P < 0.001）和传导速度（β = 25.63, P = 0.005）的独立预测因子，也是低电压百分比（β = -30.80, P < 0.001）和传导减慢/阻滞（β = -31.69, P = 0.013）点的独立预测因子。区域平均LAWT是所有6个预定义LA节段（前/后/顶/下/中隔/外侧）区域平均BV的独立预测因子。前节段（β = -5.42; P = 0.033）和顶节段（β = -3.17; P = 0.021）的区域平均LAWT也是相应节段复杂电位百分比的独立预测因子。结论：ct衍生的LAWT是一种很有前途的无创LA底物标志物。
{"title":"Left Atrial Wall Thickness as a Marker of Atrial Substrate in Patients With Atrial Fibrillation.","authors":"Michael W Lim, Geoffrey R Wong, Troy W Watts, Souvik K Das, Youlin Koh, Sohaib A Virk, Danlu Liang, Paul B Sparks, Joseph B Morton, Geoffrey Lee, Peter M Kistler, Jonathan M Kalman","doi":"10.1016/j.jacep.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.09.042","url":null,"abstract":"<p><strong>Background: </strong>Atrial substrate is characterized by regions of reduced bipolar voltage (BV), conduction velocity slowing, and complex potentials. It is thought to reflect the myocardial tissue loss and interstitial fibrosis that typifies atrial remodeling. Whether this remodeling results in regional changes in left atrial wall thickness (LAWT) is unclear.</p><p><strong>Objectives: </strong>This study sought to determine whether computed tomography (CT)-derived LAWT is associated with regional atrial substrate in atrial fibrillation (AF) patients.</p><p><strong>Methods: </strong>High-density electroanatomic maps of the left atrium (LA) were created in a cohort of adult patients undergoing index AF ablation. LAWT derived from the preprocedure CT utilizing automated postprocessing software was correlated with electrical markers of atrial substrate in the overall LA and at 6 predefined atrial regions.</p><p><strong>Results: </strong>The study included 77 patients. In multiple linear regression analyses incorporating mean LAWT, age, body mass index, AF type, and LA volume, mean LAWT was an independent predictor of mean BV (β = 1.34; P < 0.001) and conduction velocity (β = 25.63; P = 0.005) as well as an independent predictor of the percentage of low voltage (β = -30.80; P < 0.001) and conduction slowing/block (β = -31.69; P = 0.013) points. Regional mean LAWT was an independent predictor of regional mean BV across all 6 predefined LA segments (anterior/posterior/roof/inferior/septal/lateral). Regional mean LAWT of the anterior (β = -5.42; P = 0.033) and roof (β = -3.17; P = 0.021) segments were also independent predictors of the percentage of complex potentials in the corresponding segments.</p><p><strong>Conclusions: </strong>CT-derived LAWT is a promising noninvasive marker of LA substrate.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564069","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}
Pub Date : 2025-11-03DOI: 10.1016/j.jacep.2025.10.002
Reid P Schlesinger, Matteo Castrichini, Ramin Garmany, Taylor Witter, Michael J Ackerman, John R Giudicessi
{"title":"RBM20 Truncating Variants Predict Major Ventricular Arrhythmia Risk Independent of Structural Remodeling.","authors":"Reid P Schlesinger, Matteo Castrichini, Ramin Garmany, Taylor Witter, Michael J Ackerman, John R Giudicessi","doi":"10.1016/j.jacep.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.10.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458303","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}
Pub Date : 2025-11-02DOI: 10.1016/j.jacep.2025.09.025
Enrico G Ferro, Lorenzo V Arvanitis, Siling Li, Yang Song, Roger J Laham, Daniel B Kramer, Robert W Yeh, Peter J Zimetbaum, Eric A Secemsky
Background: Given recent approval of percutaneous tricuspid valve devices, clinical evidence is needed to guide lead management (extraction vs "jailing" [ie, entrapping]) for patients with preexisting cardiac implantable electronic devices (CIEDs).
Objectives: The goal of this study was to describe nationwide trends in both surgical and percutaneous tricuspid interventions and resulting clinical outcomes, particularly for patients with CIEDs.
Methods: Tricuspid interventions were identified among Medicare beneficiaries with and without CIEDs. In-hospital and 30-day procedural complications were compared with propensity score models. Predictors of CIED extraction were identified with Cox regression.
Results: From 2016 to 2023, a total of 25,910 patients underwent tricuspid interventions, 2,355 (9.2%) of whom had CIEDs. The volume of percutaneous tricuspid interventions increased from <1% in 2016 to 28% in 2023, and patients with CIEDs underwent significantly more percutaneous interventions than patients without CIEDs (17.2% vs 7.9%). Among patients with CIEDs, tricuspid intervention plus extraction was performed in 18.9% of cases. CIED infection was the most common predictor of extraction (35.8%). Overall, patients undergoing tricuspid interventions (with or without CIEDs) had high rates of death (1.1%), shock (14.1%), and bleeding requiring transfusion (8.7%). For patients with CIEDs, concomitant extraction was not associated with more complications compared with no extraction, except for more in-hospital acute kidney injury (adjusted OR: 1.61; 95% CI: 1.31-1.98).
Conclusions: The nationwide volume of percutaneous tricuspid interventions is increasing, driven primarily by patients with CIEDs, who represent approximately 10% of the tricuspid procedural volume. Concomitant lead extraction was frequently used when clinically indicated and was not associated with higher complications. The high complication rate for all tricuspid interventions suggests that extraction procedures should be deployed cautiously in this population.
{"title":"Practice Patterns and Outcomes for Tricuspid Interventions Among Medicare Patients With Cardiac Implantable Electronic Devices.","authors":"Enrico G Ferro, Lorenzo V Arvanitis, Siling Li, Yang Song, Roger J Laham, Daniel B Kramer, Robert W Yeh, Peter J Zimetbaum, Eric A Secemsky","doi":"10.1016/j.jacep.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.09.025","url":null,"abstract":"<p><strong>Background: </strong>Given recent approval of percutaneous tricuspid valve devices, clinical evidence is needed to guide lead management (extraction vs \"jailing\" [ie, entrapping]) for patients with preexisting cardiac implantable electronic devices (CIEDs).</p><p><strong>Objectives: </strong>The goal of this study was to describe nationwide trends in both surgical and percutaneous tricuspid interventions and resulting clinical outcomes, particularly for patients with CIEDs.</p><p><strong>Methods: </strong>Tricuspid interventions were identified among Medicare beneficiaries with and without CIEDs. In-hospital and 30-day procedural complications were compared with propensity score models. Predictors of CIED extraction were identified with Cox regression.</p><p><strong>Results: </strong>From 2016 to 2023, a total of 25,910 patients underwent tricuspid interventions, 2,355 (9.2%) of whom had CIEDs. The volume of percutaneous tricuspid interventions increased from <1% in 2016 to 28% in 2023, and patients with CIEDs underwent significantly more percutaneous interventions than patients without CIEDs (17.2% vs 7.9%). Among patients with CIEDs, tricuspid intervention plus extraction was performed in 18.9% of cases. CIED infection was the most common predictor of extraction (35.8%). Overall, patients undergoing tricuspid interventions (with or without CIEDs) had high rates of death (1.1%), shock (14.1%), and bleeding requiring transfusion (8.7%). For patients with CIEDs, concomitant extraction was not associated with more complications compared with no extraction, except for more in-hospital acute kidney injury (adjusted OR: 1.61; 95% CI: 1.31-1.98).</p><p><strong>Conclusions: </strong>The nationwide volume of percutaneous tricuspid interventions is increasing, driven primarily by patients with CIEDs, who represent approximately 10% of the tricuspid procedural volume. Concomitant lead extraction was frequently used when clinically indicated and was not associated with higher complications. The high complication rate for all tricuspid interventions suggests that extraction procedures should be deployed cautiously in this population.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458264","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}
Pub Date : 2025-11-02DOI: 10.1016/j.jacep.2025.09.035
Reshma Amin, Francis Murgatroyd, Josh Wilcox, Aaraby Ragavan, Donah Zachariah, Claire A Martin, Rachel Bastiaenen, Mark O'Neill, Matthew Wright, John Whitaker
{"title":"Catheter Ablation of Atrial Tachycardia Inducing Tachycardia Cardiomyopathy in the Maternal Population: High Risk, High Reward.","authors":"Reshma Amin, Francis Murgatroyd, Josh Wilcox, Aaraby Ragavan, Donah Zachariah, Claire A Martin, Rachel Bastiaenen, Mark O'Neill, Matthew Wright, John Whitaker","doi":"10.1016/j.jacep.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.09.035","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458099","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jacep.2025.09.033
Christopher C. Cheung MD, MPH , Jonathan M. Kalman MBBS, PhD
{"title":"Social Determinants of Health in Atrial Fibrillation Care","authors":"Christopher C. Cheung MD, MPH , Jonathan M. Kalman MBBS, PhD","doi":"10.1016/j.jacep.2025.09.033","DOIUrl":"10.1016/j.jacep.2025.09.033","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 11","pages":"Pages 2445-2447"},"PeriodicalIF":7.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584260","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jacep.2025.06.031
Marco Bergonti MD, PhD , Frederic Sacher MD , Bernard Belhassen MD , Georgia Sarquella-Brugada MD , Elena Arbelo MD, PhD , Avi Sabbag MD , Lia Crotti MD , Jacob Tfelt-Hansen MD , Daniele Faccenda MD , Michela Casella MD, PhD , Konstantinos P. Letsas MD , Andrea Rossi MD , Peter J. Schwartz MD , Cinzia Monaco MD , Esther Scheirlynck MD , Luigi Pannone MD, PhD , Vincenzo Russo MD , Leonardo Calò MD , Maria Luce Caputo MD, PhD , Paola Berne MD , Giulio Conte MD, PhD
Background
Atrial fibrillation (AF) occurs in up to 20% of patients with Brugada syndrome (BrS), yet its risk factors and prognostic implications remain uncertain.
Objectives
This study sought to identify risk factors for AF in patients with non–high-risk BrS and to evaluate the impact of AF on ventricular arrhythmias (VAs), sick sinus syndrome (SSS), and stroke in non–high-risk BrS.
Methods
This was a multicenter, retrospective study conducted across 20 international centers. Non–high-risk BrS patients were stratified based on the presence or absence of AF. The primary endpoint was the occurrence of VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, or arrhythmic sudden cardiac death.
Results
A total of 686 BrS patients were analyzed (39.3 years of age, 33.1% female, 31.8% spontaneous type 1 electrocardiogram, 36.0% pathogenic/likely pathogenic SCN5A variant), including 280 with AF (40.8%). Proband status and older age were associated with AF at Cox regression analysis. Over a median follow-up of 48.8 months, the incidence of VAs was 0.26% per year, with no significant difference between patients with and without AF (HR: 0.67; P = 0.58). Early-onset AF (<20 years) was associated with significantly higher risk of VAs (P < 0.001). SSS was twice as prevalent in BrS patients with AF (10.0% vs 6.2%; P = 0.047), and stroke occurred exclusively in the AF group (2.5%), despite low CHA2DS2-VA (mean 0.5).
Conclusions
The presence of AF in non–high-risk BrS does not identify patients with higher risk of VAs. However, early-onset AF (<20 years) defines a distinct subgroup with elevated risk. Patients with AF and BrS have a significantly higher risk of SSS and stroke.
背景：高达20%的Brugada综合征（BrS）患者发生心房颤动（AF），但其危险因素和预后影响仍不确定。目的：本研究旨在确定非高危BrS患者房颤的危险因素，并评估房颤对非高危BrS患者室性心律失常（VAs）、病态窦性综合征（SSS）和卒中的影响。方法：这是一项在20个国际中心进行的多中心回顾性研究。非高危BrS患者根据是否存在房颤进行分层。主要终点是VAs的发生，定义为持续性室性心动过速、室性颤动或心律失常性心源性猝死。结果：共分析686例BrS患者（年龄39.3岁，女性33.1%，自发性1型心电图31.8%，致病性/可能致病性SCN5A变异36.0%），其中280例合并AF（40.8%）。Cox回归分析显示，先证者身份和年龄与房颤相关。在48.8个月的中位随访中，VAs的发生率为每年0.26%，有和没有房颤的患者之间无显著差异（HR: 0.67; P = 0.58）。早发性房颤（2DS2-VA，平均0.5）。结论：非高危BrS中房颤的存在并不能识别VAs风险较高的患者。然而，早发性房颤(
{"title":"The Clinical Significance of Atrial Fibrillation in Non–High-Risk Brugada Syndrome","authors":"Marco Bergonti MD, PhD , Frederic Sacher MD , Bernard Belhassen MD , Georgia Sarquella-Brugada MD , Elena Arbelo MD, PhD , Avi Sabbag MD , Lia Crotti MD , Jacob Tfelt-Hansen MD , Daniele Faccenda MD , Michela Casella MD, PhD , Konstantinos P. Letsas MD , Andrea Rossi MD , Peter J. Schwartz MD , Cinzia Monaco MD , Esther Scheirlynck MD , Luigi Pannone MD, PhD , Vincenzo Russo MD , Leonardo Calò MD , Maria Luce Caputo MD, PhD , Paola Berne MD , Giulio Conte MD, PhD","doi":"10.1016/j.jacep.2025.06.031","DOIUrl":"10.1016/j.jacep.2025.06.031","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) occurs in up to 20% of patients with Brugada syndrome (BrS), yet its risk factors and prognostic implications remain uncertain.</div></div><div><h3>Objectives</h3><div>This study sought to identify risk factors for AF in patients with non–high-risk BrS and to evaluate the impact of AF on ventricular arrhythmias (VAs), sick sinus syndrome (SSS), and stroke in non–high-risk BrS.</div></div><div><h3>Methods</h3><div>This was a multicenter, retrospective study conducted across 20 international centers. Non–high-risk BrS patients were stratified based on the presence or absence of AF. The primary endpoint was the occurrence of VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, or arrhythmic sudden cardiac death.</div></div><div><h3>Results</h3><div>A total of 686 BrS patients were analyzed (39.3 years of age, 33.1% female, 31.8% spontaneous type 1 electrocardiogram, 36.0% pathogenic/likely pathogenic <em>SCN5A</em> variant), including 280 with AF (40.8%). Proband status and older age were associated with AF at Cox regression analysis. Over a median follow-up of 48.8 months, the incidence of VAs was 0.26% per year, with no significant difference between patients with and without AF (HR: 0.67; <em>P</em> = 0.58). Early-onset AF (<20 years) was associated with significantly higher risk of VAs (<em>P</em> < 0.001). SSS was twice as prevalent in BrS patients with AF (10.0% vs 6.2%; <em>P</em> = 0.047), and stroke occurred exclusively in the AF group (2.5%), despite low CHA<sub>2</sub>DS<sub>2</sub>-VA (mean 0.5).</div></div><div><h3>Conclusions</h3><div>The presence of AF in non–high-risk BrS does not identify patients with higher risk of VAs. However, early-onset AF (<20 years) defines a distinct subgroup with elevated risk. Patients with AF and BrS have a significantly higher risk of SSS and stroke.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 11","pages":"Pages 2471-2480"},"PeriodicalIF":7.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954531","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jacep.2025.06.012
Naohiko Sahara MD , Yasutoshi Shinoda MD, PhD , Beeletsega Yeneneh MD , Philip Gideon MD , Michael F. Morris MD , Praneeth Katrapati MD , Nathaniel Shatz BA , Rong Bai MD , Jake Martinez DO , Yu Liao MD , Dalise Yi Shatz BA , Michael S. Zawaneh MD , Wilber Su MD , J. Peter Weiss MD , Roderick Tung MD
Background
There is no established imaging technique to detect and diagnose periaortic scar, an increasingly prevalent and challenging substrate referred for ventricular tachycardia (VT) ablation. We hypothesized that wall thinning detected with intracardiac echocardiography (ICE) can identify periaortic arrhythmogenic substrate (PAS) in patients with structural heart disease.
Objectives
This study sought to validate a new method of identifying PAS using ICE in comparison with electro-anatomic mapping and cardiac magnetic resonance (CMR).
Methods
A total of 84 VT ablation patients were analyzed (87% male, median age 72 years [Q1-Q3: 63-75 years], 61% with nonischemic cardiomyopathy) and categorized into 2 groups: PAS+ (n = 29) and PAS− (n = 55) based on voltage-defined scar and deceleration zones. Wall thickness of the basal anterior septum was measured by ICE and CMR at a standardized distance from the left ventricular ostium in diastole by an independent core lab. In 43 patients with CMR, correlation with late gadolinium enhancement (LGE) in the basal anterior septum was also assessed.
Results
A significant difference in wall thickness measured at 1 cm from the left ventricular ostium with ICE was observed between PAS+ and PAS− patients (0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm]; P < 0.001). Wall thickness by ICE had higher diagnostic performance than CMR, with only 50% of PAS+ patients exhibiting LGE. At a cutoff of <0.60 cm, the sensitivity and specificity of ICE predicting PAS+ were 58% and 87% (positive predictive value 71%, negative predictive value 80%) in comparison with 50% and 84% (positive predictive value 69%, negative predictive value 70%) with CMR-LGE, respectively.
Conclusions
ICE-detected wall thinning may be a novel imaging technique to identify arrhythmogenic periaortic VT substrate in this challenging anatomic region, which often eludes diagnosis with CMR. The absence of LGE on CMR does not rule out the presence of periaortic substrate in patients presenting with outflow tract VT.
背景：腹主动脉周围瘢痕是室性心动过速（VT）消融的一种日益普遍和具有挑战性的基底，目前尚无成熟的成像技术来检测和诊断腹主动脉周围瘢痕。我们假设心内超声心动图（ICE）检测到的壁变薄可以识别结构性心脏病患者的主动脉周围致心律失常底物（PAS）。目的：本研究旨在验证一种使用ICE识别PAS的新方法，并与电解剖测绘和心脏磁共振（CMR）进行比较。方法：对84例VT消融患者进行分析（87%为男性，中位年龄72岁[Q1-Q3: 63-75岁]，61%为非缺血性心肌病），并根据电压定义的疤痕和减速区分为PAS+ (n = 29)和PAS- (n = 55)两组。基底前隔壁厚度由独立的核心实验室在离左室舒张期口的标准距离上通过ICE和CMR测量。在43例CMR患者中，还评估了基底前隔晚期钆增强（LGE）的相关性。结果：PAS+和PAS-患者在距左室口1cm处的ICE壁厚有显著差异（0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm], P < 0.001）。ICE的壁厚比CMR有更高的诊断效能，只有50%的PAS+患者表现出LGE。结论：ice检测壁变薄可能是一种新的成像技术，可以在这一具有挑战性的解剖区域识别致心律失常的主动脉周围VT底物，这通常无法通过CMR诊断。CMR上没有LGE并不排除有流出道VT的患者存在主动脉周围底物。
{"title":"Intracardiac Echocardiography for the Detection of Arrhythmogenic Periaortic Ventricular Tachycardia Substrate","authors":"Naohiko Sahara MD , Yasutoshi Shinoda MD, PhD , Beeletsega Yeneneh MD , Philip Gideon MD , Michael F. Morris MD , Praneeth Katrapati MD , Nathaniel Shatz BA , Rong Bai MD , Jake Martinez DO , Yu Liao MD , Dalise Yi Shatz BA , Michael S. Zawaneh MD , Wilber Su MD , J. Peter Weiss MD , Roderick Tung MD","doi":"10.1016/j.jacep.2025.06.012","DOIUrl":"10.1016/j.jacep.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>There is no established imaging technique to detect and diagnose periaortic scar, an increasingly prevalent and challenging substrate referred for ventricular tachycardia (VT) ablation. We hypothesized that wall thinning detected with intracardiac echocardiography (ICE) can identify periaortic arrhythmogenic substrate (PAS) in patients with structural heart disease.</div></div><div><h3>Objectives</h3><div>This study sought to validate a new method of identifying PAS using ICE in comparison with electro-anatomic mapping and cardiac magnetic resonance (CMR).</div></div><div><h3>Methods</h3><div>A total of 84 VT ablation patients were analyzed (87% male, median age 72 years [Q1-Q3: 63-75 years], 61% with nonischemic cardiomyopathy) and categorized into 2 groups: PAS+ (n = 29) and PAS− (n = 55) based on voltage-defined scar and deceleration zones. Wall thickness of the basal anterior septum was measured by ICE and CMR at a standardized distance from the left ventricular ostium in diastole by an independent core lab. In 43 patients with CMR, correlation with late gadolinium enhancement (LGE) in the basal anterior septum was also assessed.</div></div><div><h3>Results</h3><div>A significant difference in wall thickness measured at 1 cm from the left ventricular ostium with ICE was observed between PAS+ and PAS− patients (0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm]; <em>P <</em> 0.001). Wall thickness by ICE had higher diagnostic performance than CMR, with only 50% of PAS+ patients exhibiting LGE. At a cutoff of <0.60 cm, the sensitivity and specificity of ICE predicting PAS+ were 58% and 87% (positive predictive value 71%, negative predictive value 80%) in comparison with 50% and 84% (positive predictive value 69%, negative predictive value 70%) with CMR-LGE, respectively.</div></div><div><h3>Conclusions</h3><div>ICE-detected wall thinning may be a novel imaging technique to identify arrhythmogenic periaortic VT substrate in this challenging anatomic region, which often eludes diagnosis with CMR. The absence of LGE on CMR does not rule out the presence of periaortic substrate in patients presenting with outflow tract VT.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 11","pages":"Pages 2352-2364"},"PeriodicalIF":7.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080641","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}
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