Pub Date : 2024-10-08DOI: 10.1016/j.jacep.2024.09.006
Masaaki Yokoyama, Roberto Mené, Cinzia Monaco, Kinan Kneizeh, Konstantinos Vlachos, Karim Benali, Nicolas Derval, Pierre Jaïs, Thomas Pambrun
{"title":"Mitral Line Epicardial Reconduction via the Coronary Sinus Free Wall Just After Endocardial PFA.","authors":"Masaaki Yokoyama, Roberto Mené, Cinzia Monaco, Kinan Kneizeh, Konstantinos Vlachos, Karim Benali, Nicolas Derval, Pierre Jaïs, Thomas Pambrun","doi":"10.1016/j.jacep.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620679","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 : 2024-10-08DOI: 10.1016/j.jacep.2024.08.016
Aashish Katapadi, Jalaj Garg, Aditya Mansabdar, Nikhila Chelikam, Fnu Ehteshamuddin, Minar Rane, Devi Nair, James Marcum, Theodore Pope, Peter Park, Christopher Ellis, Rajesh Kabra, Monica Lo, Donita Atkins, Jacqueline Saw, Atman Shah, Dhanunjaya Lakkireddy
Background: Left atrial appendage closure (LAAC) is frequent alternative for stroke prophylaxis in patients for whom oral anticoagulation is contraindicated. Pulmonary artery injury (PAI) is a feared yet rare complication of endocardial LAAC, but its surrounding literature is scarce.
Objectives: The aim of the current study was to review prior PAI published reports and the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to understand evidence and mechanisms of PAI after LAAC.
Methods: A systematic review was conducted of the literature and MAUDE database for previously reported cases of PAI, and cases were reviewed for patient characteristics and outcomes. In addition, we identify risks and review our strategies to avoid this injury.
Results: Thirty-six cases (16 case reports and 20 MAUDE reports) of PAI were found. These patients had a mean age of 73.6 ± 8.2 years with a median CHA2DS2VASC score of 5 (quartile 1-quartile 3: 3-6). Most commonly, LAAC associated with PAI involved a dual-seal (75%) followed by lobular occlusive devices (19.4%); the device was unspecified in 2.8% of cases. PAI commonly presented postprocedurally, either within the first 24 hours (50%) or beyond (38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%). Overall, 52.8% required surgery with or without antecedent pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI was associated with a high mortality rate (ie, 33.3%). Unfortunately, no specific cardiac imaging or procedural details to predict PAI were noted in the reports.
Conclusions: Presentation of PAI after LAAC can occur immediately following the procedure or be delayed. Thus, the threshold for suspicion, especially with rapid and hemodynamically significant pericardial effusion, after LAAC should be low.
背景:左心房阑尾关闭术(LAAC)是口服抗凝禁忌症患者预防中风的常用替代方法。肺动脉损伤(PAI)是心内膜 LAAC 令人担忧但却罕见的并发症,但相关文献却很少:本研究旨在回顾之前发表的 PAI 报告和美国食品药品管理局制造商和用户设施设备经验(MAUDE)数据库,以了解 LAAC 后 PAI 的证据和机制:方法:我们对文献和 MAUDE 数据库中之前报道的 PAI 病例进行了系统性回顾,并对病例的患者特征和结果进行了回顾。此外,我们还确定了风险并回顾了避免这种损伤的策略:结果:共发现 36 例 PAI(16 例病例报告和 20 例 MAUDE 报告)。这些患者的平均年龄为 73.6 ± 8.2 岁,中位 CHA2DS2VASC 评分为 5(1-3 分位:3-6)。与 PAI 相关的 LAAC 最常见的是双密封(75%),其次是小叶闭塞器(19.4%);2.8% 的病例未指定闭塞器。PAI 通常在手术后 24 小时内(50%)或 24 小时后(38.9%)出现,伴有心脏填塞(61.1%)或心脏骤停(19.4%)。总体而言,52.8%的患者需要在进行或不进行心包穿刺的情况下进行手术,16.7%的患者在进行心包穿刺后得到了控制。PAI 与高死亡率有关(即 33.3%)。遗憾的是,报告中没有提到预测 PAI 的具体心脏成像或手术细节:结论:LAAC 术后 PAI 可在术后立即出现,也可延迟出现。结论:LAAC 术后 PAI 可在术后立即出现,也可延迟出现。因此,LAAC 术后的怀疑阈值应较低,尤其是快速且血流动力学显著的心包积液。
{"title":"Pulmonary Artery Injury Following Endocardial Left Atrial Appendage Occlusion: The Known and Unknown.","authors":"Aashish Katapadi, Jalaj Garg, Aditya Mansabdar, Nikhila Chelikam, Fnu Ehteshamuddin, Minar Rane, Devi Nair, James Marcum, Theodore Pope, Peter Park, Christopher Ellis, Rajesh Kabra, Monica Lo, Donita Atkins, Jacqueline Saw, Atman Shah, Dhanunjaya Lakkireddy","doi":"10.1016/j.jacep.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.08.016","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage closure (LAAC) is frequent alternative for stroke prophylaxis in patients for whom oral anticoagulation is contraindicated. Pulmonary artery injury (PAI) is a feared yet rare complication of endocardial LAAC, but its surrounding literature is scarce.</p><p><strong>Objectives: </strong>The aim of the current study was to review prior PAI published reports and the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to understand evidence and mechanisms of PAI after LAAC.</p><p><strong>Methods: </strong>A systematic review was conducted of the literature and MAUDE database for previously reported cases of PAI, and cases were reviewed for patient characteristics and outcomes. In addition, we identify risks and review our strategies to avoid this injury.</p><p><strong>Results: </strong>Thirty-six cases (16 case reports and 20 MAUDE reports) of PAI were found. These patients had a mean age of 73.6 ± 8.2 years with a median CHA<sub>2</sub>DS<sub>2</sub>VASC score of 5 (quartile 1-quartile 3: 3-6). Most commonly, LAAC associated with PAI involved a dual-seal (75%) followed by lobular occlusive devices (19.4%); the device was unspecified in 2.8% of cases. PAI commonly presented postprocedurally, either within the first 24 hours (50%) or beyond (38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%). Overall, 52.8% required surgery with or without antecedent pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI was associated with a high mortality rate (ie, 33.3%). Unfortunately, no specific cardiac imaging or procedural details to predict PAI were noted in the reports.</p><p><strong>Conclusions: </strong>Presentation of PAI after LAAC can occur immediately following the procedure or be delayed. Thus, the threshold for suspicion, especially with rapid and hemodynamically significant pericardial effusion, after LAAC should be low.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500590","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 : 2024-10-08DOI: 10.1016/j.jacep.2024.09.007
Elizabeth S Kaufman
{"title":"The Importance of Following Treatment Guidelines in Long QT Syndrome Regardless of Genotype Status.","authors":"Elizabeth S Kaufman","doi":"10.1016/j.jacep.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620710","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 : 2024-10-08DOI: 10.1016/j.jacep.2024.07.028
Adam S C Dennis, Michele Orini, Eva Melis Hesselkilde, Arnela Saljic, Benedikt M Linz, Stefan M Sattler, James Williams, Jacob Tfelt-Hansen, Thomas Jespersen, Anthony W C Chow, Pier D Lambiase
Background: In ventricular tachycardia (VT), optimal substrate mapping strategies identifying arrhythmogenic sites are not established.
Objectives: This study sought to evaluate multidirectional pacing on the distribution of specific conduction and repolarization metrics to localize re-entrant VT sites in a porcine infarct model.
Methods: Substrate maps were created in 13 pigs with chronic myocardial infarction using the Advisor HD Grid (Abbott) during right ventricular (RV), left ventricular, biventricular pacing (BIV), and sinus rhythm (SR). Critical VT sites of early-, mid-, and late-diastolic signals were delineated. Vulnerable sites to re-entry were defined as sites of latest activation timing within and post-QRS complex, largest activation and activation-recovery interval gradients. Distances between the 20 most vulnerable sites and diastolic VT points were measured, and identification of VT points was assessed using the area under the receiver-operating characteristic curve.
Results: A total of 34 VTs were mapped, and 48 sinus and pacing maps were obtained (10 BIV, 13 left ventricular, 13 RV, 12 SR). Late potential mapping in SR was taken as the established clinical standard for comparison. Latest activation time with BIV pacing provided the closest localization for VT isthmus (median 5.5 mm; IQR: 7.15 mm; P < 0.005). The gradient of activation-recovery interval using RV pacing had closest localization for VT exit and entrance (median 10.6 mm; IQR: 5.0 mm; P < 0.005 and 9.4 mm; IQR: 8.0 mm; P < 0.05). Global sensitivity and specificity analysis showed that gradient of activation-recovery interval in SR achieved the highest area under the receiver-operating characteristic curve, with similar results from the gradient of activation timing.
Conclusions: Multidirectional pacing in combination with conduction and repolarization parameters enables better localization of VT diastolic critical sites vs SR late potentials.
{"title":"Impact of Multidirectional Pacing on Activation and Repolarization Parameters to Localize Ischemic Ventricular Tachycardia Circuits.","authors":"Adam S C Dennis, Michele Orini, Eva Melis Hesselkilde, Arnela Saljic, Benedikt M Linz, Stefan M Sattler, James Williams, Jacob Tfelt-Hansen, Thomas Jespersen, Anthony W C Chow, Pier D Lambiase","doi":"10.1016/j.jacep.2024.07.028","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.07.028","url":null,"abstract":"<p><strong>Background: </strong>In ventricular tachycardia (VT), optimal substrate mapping strategies identifying arrhythmogenic sites are not established.</p><p><strong>Objectives: </strong>This study sought to evaluate multidirectional pacing on the distribution of specific conduction and repolarization metrics to localize re-entrant VT sites in a porcine infarct model.</p><p><strong>Methods: </strong>Substrate maps were created in 13 pigs with chronic myocardial infarction using the Advisor HD Grid (Abbott) during right ventricular (RV), left ventricular, biventricular pacing (BIV), and sinus rhythm (SR). Critical VT sites of early-, mid-, and late-diastolic signals were delineated. Vulnerable sites to re-entry were defined as sites of latest activation timing within and post-QRS complex, largest activation and activation-recovery interval gradients. Distances between the 20 most vulnerable sites and diastolic VT points were measured, and identification of VT points was assessed using the area under the receiver-operating characteristic curve.</p><p><strong>Results: </strong>A total of 34 VTs were mapped, and 48 sinus and pacing maps were obtained (10 BIV, 13 left ventricular, 13 RV, 12 SR). Late potential mapping in SR was taken as the established clinical standard for comparison. Latest activation time with BIV pacing provided the closest localization for VT isthmus (median 5.5 mm; IQR: 7.15 mm; P < 0.005). The gradient of activation-recovery interval using RV pacing had closest localization for VT exit and entrance (median 10.6 mm; IQR: 5.0 mm; P < 0.005 and 9.4 mm; IQR: 8.0 mm; P < 0.05). Global sensitivity and specificity analysis showed that gradient of activation-recovery interval in SR achieved the highest area under the receiver-operating characteristic curve, with similar results from the gradient of activation timing.</p><p><strong>Conclusions: </strong>Multidirectional pacing in combination with conduction and repolarization parameters enables better localization of VT diastolic critical sites vs SR late potentials.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500587","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 : 2024-10-08DOI: 10.1016/j.jacep.2024.09.015
Hawkins C Gay, Rod S Passman
{"title":"AI and Personal Digital Health Tools: Pioneering the Future of Precision Health Care.","authors":"Hawkins C Gay, Rod S Passman","doi":"10.1016/j.jacep.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.015","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620669","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 : 2024-10-08DOI: 10.1016/j.jacep.2024.09.002
Shohei Kataoka, Haran Yogasundaram, Tomer Mann, Byron Lee, Ramanan Kumareswaran, Gregory E Supple, Henry H Hsia, David J Callans, Melvin M Scheinman
{"title":"A Tale of 2 Troubling Tachycardias.","authors":"Shohei Kataoka, Haran Yogasundaram, Tomer Mann, Byron Lee, Ramanan Kumareswaran, Gregory E Supple, Henry H Hsia, David J Callans, Melvin M Scheinman","doi":"10.1016/j.jacep.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.09.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545468","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 : 2024-10-03DOI: 10.1016/j.jacep.2024.08.017
Shunsuke Uetake, Kanae Hasegawa, Masaaki Kurata, Giovanni Ernest Davogustto, Tiffany Ying Hu, Kara K Siergrist, Zachary Yoneda, Travis D Richardson, Arvindh N Kanagasundram, William G Stevenson, Harikrishna Tandri
Background: Patients with ventricular tachycardia (VT) frequently present in unstable VT and are subject to urgent/high-risk ablation procedures. Clinical predictors of prolonged hospitalization and mortality are needed for optimal management of these patients.
Objectives: This study seeks to identify factors associated with prolonged hospitalization and mortality in emergent unplanned VT ablation procedures.
Methods: Fifty consecutive patients hospitalized emergently for VT with structural heart disease who underwent catheter ablation were prospectively followed up for outcomes and complications.
Results: Of the 50 patients (mean ± SD age 67.6 ± 12.8 years), 86.0% were male, 62.0% had ischemic cardiomyopathy, and their median left ventricular ejection fraction was 28.5%. Hospital stay <7 days (median 3 days) occurred in 28 (56.0%) patients (Group 1) and >7 days (median 10 days) or death <7 days occurred in 22 (44.0%) patients (Group 2). PAINESD score and left ventricular ejection fraction were similar between the groups. Compared with Group 1, Group 2 had significantly worse NYHA functional class III or higher (25.0% vs 63.6%; P = 0.006), electrical storm (46.4% vs 77.3%; P = 0.027), and prior failed VT ablation (35.7% vs 68.2%; P = 0.023). Multivariable analysis showed that NYHA functional class III or higher and prior failed VT ablation were predictive of prolonged hospital stay. After ablation, compared with Group 1, Group 2 had worse heart failure (10.7% vs 54.5%; P = 0.001), VT recurrences (3.6% vs 68.2%; P < 0.001), and 7 deaths within 30 days.
Conclusions: Patients undergoing emergent VT ablation are at high risk for prolonged hospital stay, which is predicted by NYHA functional class III or higher and a prior failed ablation. Early VT recurrences and worsening heart failure contribute to prolonged hospitalization and a high 30-day mortality.
{"title":"Emergent Ablation for Ventricular Tachycardia: Predictors of Prolonged Hospitalization and Mortality.","authors":"Shunsuke Uetake, Kanae Hasegawa, Masaaki Kurata, Giovanni Ernest Davogustto, Tiffany Ying Hu, Kara K Siergrist, Zachary Yoneda, Travis D Richardson, Arvindh N Kanagasundram, William G Stevenson, Harikrishna Tandri","doi":"10.1016/j.jacep.2024.08.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.08.017","url":null,"abstract":"<p><strong>Background: </strong>Patients with ventricular tachycardia (VT) frequently present in unstable VT and are subject to urgent/high-risk ablation procedures. Clinical predictors of prolonged hospitalization and mortality are needed for optimal management of these patients.</p><p><strong>Objectives: </strong>This study seeks to identify factors associated with prolonged hospitalization and mortality in emergent unplanned VT ablation procedures.</p><p><strong>Methods: </strong>Fifty consecutive patients hospitalized emergently for VT with structural heart disease who underwent catheter ablation were prospectively followed up for outcomes and complications.</p><p><strong>Results: </strong>Of the 50 patients (mean ± SD age 67.6 ± 12.8 years), 86.0% were male, 62.0% had ischemic cardiomyopathy, and their median left ventricular ejection fraction was 28.5%. Hospital stay <7 days (median 3 days) occurred in 28 (56.0%) patients (Group 1) and >7 days (median 10 days) or death <7 days occurred in 22 (44.0%) patients (Group 2). PAINESD score and left ventricular ejection fraction were similar between the groups. Compared with Group 1, Group 2 had significantly worse NYHA functional class III or higher (25.0% vs 63.6%; P = 0.006), electrical storm (46.4% vs 77.3%; P = 0.027), and prior failed VT ablation (35.7% vs 68.2%; P = 0.023). Multivariable analysis showed that NYHA functional class III or higher and prior failed VT ablation were predictive of prolonged hospital stay. After ablation, compared with Group 1, Group 2 had worse heart failure (10.7% vs 54.5%; P = 0.001), VT recurrences (3.6% vs 68.2%; P < 0.001), and 7 deaths within 30 days.</p><p><strong>Conclusions: </strong>Patients undergoing emergent VT ablation are at high risk for prolonged hospital stay, which is predicted by NYHA functional class III or higher and a prior failed ablation. Early VT recurrences and worsening heart failure contribute to prolonged hospitalization and a high 30-day mortality.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545469","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 : 2024-10-01DOI: 10.1016/j.jacep.2024.06.008
Elizabeth S. Kaufman MD
{"title":"Genetic Testing in Younger Adults With Pacemakers","authors":"Elizabeth S. Kaufman MD","doi":"10.1016/j.jacep.2024.06.008","DOIUrl":"10.1016/j.jacep.2024.06.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 10","pages":"Pages 2261-2262"},"PeriodicalIF":8.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788057","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}