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JACC. Clinical electrophysiology最新文献

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Mitral Line Epicardial Reconduction via the Coronary Sinus Free Wall Just After Endocardial PFA. 心内膜 PFA 术后通过冠状窦游离壁的二尖瓣口线心外膜重构
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 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
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引用次数: 0
Pulmonary Artery Injury Following Endocardial Left Atrial Appendage Occlusion: The Known and Unknown. 心内膜左房阑尾闭塞后的肺动脉损伤:已知与未知。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 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。
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引用次数: 0
The Importance of Following Treatment Guidelines in Long QT Syndrome Regardless of Genotype Status. 无论基因型状况如何,遵循长 QT 综合征治疗指南的重要性。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 10.1016/j.jacep.2024.09.007
Elizabeth S Kaufman
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引用次数: 0
Impact of Multidirectional Pacing on Activation and Repolarization Parameters to Localize Ischemic Ventricular Tachycardia Circuits. 多向起搏对激活和复极化参数的影响以定位缺血性室性心动过速回路
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 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.

背景:在室性心动过速(VT)中,确定心律失常发生部位的最佳底物映射策略尚未确立:本研究旨在评估多向起搏对特定传导和复极化指标分布的影响,以便在猪心梗模型中定位再入性室速部位:使用Advisor HD Grid(雅培)在右心室(RV)、左心室、双心室起搏(BIV)和窦性心律(SR)时绘制13头慢性心肌梗死猪的基底图。划定了舒张早期、中期和晚期信号的VT关键部位。再入的易损部位被定义为 QRS 波群内和 QRS 波群后激活时间最晚、激活和激活-恢复间期梯度最大的部位。测量了 20 个最易发生 VT 的部位与舒张期 VT 点之间的距离,并使用接收器工作特征曲线下的面积评估了 VT 点的识别:结果:共绘制了 34 个 VT,48 个窦房和起搏图(10 个 BIV、13 个左心室、13 个 RV、12 个 SR)。SR 的晚期电位图被作为既定的临床标准进行比较。BIV 起搏的最新激活时间为 VT 峡部提供了最接近的定位(中位数:5.5 毫米;IQR:7.15 毫米;P < 0.005)。使用 RV 起搏的激活-恢复间期梯度最接近 VT 出口和入口的定位(中位数:10.6 毫米;IQR:5.0 毫米;P < 0.005 和 9.4 毫米;IQR:8.0 毫米;P < 0.05)。全局灵敏度和特异性分析表明,SR 中的激活梯度-恢复间隔的接收者操作特征曲线下的面积最大,激活梯度定时的结果与之相似:多向起搏结合传导和复极化参数能更好地定位 VT 舒张临界点和 SR 迟电位。
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引用次数: 0
AI and Personal Digital Health Tools: Pioneering the Future of Precision Health Care. 人工智能和个人数字健康工具:开创精准医疗的未来。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 10.1016/j.jacep.2024.09.015
Hawkins C Gay, Rod S Passman
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引用次数: 0
A Tale of 2 Troubling Tachycardias. 两个令人不安的心动过速的故事
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-08 DOI: 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
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引用次数: 0
Emergent Ablation for Ventricular Tachycardia: Predictors of Prolonged Hospitalization and Mortality. 室性心动过速的紧急消融术:延长住院时间和死亡率的预测因素。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 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.

背景:室性心动过速(VT)患者经常出现不稳定 VT,需要进行紧急/高风险消融手术。为了对这些患者进行最佳管理,需要对延长住院时间和死亡率进行临床预测:本研究旨在确定与计划外紧急 VT 消融术中住院时间延长和死亡率相关的因素:方法:连续对 50 例因 VT 急诊住院并伴有结构性心脏病、接受导管消融术的患者进行前瞻性随访,以了解结果和并发症:50 名患者(平均 ± SD 年龄为 67.6 ± 12.8 岁)中,86.0% 为男性,62.0% 患有缺血性心肌病,中位左室射血分数为 28.5%。住院时间为 7 天(中位数为 10 天)或死亡结论:接受急诊 VT 消融术的患者住院时间延长的风险很高,NYHA 功能分级 III 级或以上和之前消融失败的患者都可能出现这种情况。VT早期复发和心衰恶化导致住院时间延长和30天死亡率升高。
{"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}
引用次数: 0
Genetic Testing in Younger Adults With Pacemakers 对使用心脏起搏器的年轻成年人进行基因检测。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 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}
引用次数: 0
Coronary Vasospasm During Pulse-Field Focal Ablation of the Cavotricuspid Isthmus Observed With Intravascular Ultrasound 通过血管内超声观察脉冲场聚焦消融腔静脉峡过程中的冠状动脉血管痉挛
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.032
Cinzia Monaco MD , Roberto Menè MD , Masaaki Yokoyama MD, PhD , Kinan Kneizeh MD , Thomas Pambrun MD , Pierre Coste MD, PhD , Mélèze Hocini MD , Pierre Jaïs MD, PhD , Nicolas Derval MD
{"title":"Coronary Vasospasm During Pulse-Field Focal Ablation of the Cavotricuspid Isthmus Observed With Intravascular Ultrasound","authors":"Cinzia Monaco MD ,&nbsp;Roberto Menè MD ,&nbsp;Masaaki Yokoyama MD, PhD ,&nbsp;Kinan Kneizeh MD ,&nbsp;Thomas Pambrun MD ,&nbsp;Pierre Coste MD, PhD ,&nbsp;Mélèze Hocini MD ,&nbsp;Pierre Jaïs MD, PhD ,&nbsp;Nicolas Derval MD","doi":"10.1016/j.jacep.2024.06.032","DOIUrl":"10.1016/j.jacep.2024.06.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 10","pages":"Pages 2293-2296"},"PeriodicalIF":8.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107443","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
Outcomes of Pacemaker Implantation During Pregnancy 妊娠期植入起搏器的结果
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.033
Vardhmaan Jain MD , Abdul Mannan Khan Minhas MD , Birju Rao MD, MSCR , Stacy Westerman MD , Neal K. Bhatia MD , Mikhael F. El-Chami MD , Kamala P. Tamirisa MD , Faisal M. Merchant MD
{"title":"Outcomes of Pacemaker Implantation During Pregnancy","authors":"Vardhmaan Jain MD ,&nbsp;Abdul Mannan Khan Minhas MD ,&nbsp;Birju Rao MD, MSCR ,&nbsp;Stacy Westerman MD ,&nbsp;Neal K. Bhatia MD ,&nbsp;Mikhael F. El-Chami MD ,&nbsp;Kamala P. Tamirisa MD ,&nbsp;Faisal M. Merchant MD","doi":"10.1016/j.jacep.2024.06.033","DOIUrl":"10.1016/j.jacep.2024.06.033","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 10","pages":"Pages 2271-2273"},"PeriodicalIF":8.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145657","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
JACC. Clinical electrophysiology
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