JACC. Clinical electrophysiology最新文献

Background: Superior vena cava syndrome (SVC) is an uncommon complication of transvenous leads (TVL). Management often involves removal of the TVL, venoplasty, and stenting in certain situations.

Objectives: This study sought to define the management of lead-related SVC syndrome.

Methods: We identified patients with lead related SVC between 2014 and 2025 at Mayo Clinic sites. Demographic data, information regarding cardiac implantable electronic device, extraction procedure, and venoplasty procedure data were abstracted from the charts for analysis.

Results: A total of 28 leads were present in 14 patients causing SVC syndrome. Median age of the study cohort was 61.0 (Q1-Q3: 45.8-66.8) years, and 50% were female. Median number of leads implanted per patient was 2.0 (Q1-Q3: 1-2) leads, and median age of the leads was 48.0 (Q1-Q3: 31.8-74.0) months. A total of 11 patients (78.6%) underwent extraction procedure, and all of them had complete procedural success without complications. Of the total cohort, 7 underwent venoplasty and 7 underwent stenting. During a median follow-up of 22.1 (Q1-Q3: 9.5-66.3) months, 5 patients (35.7%) had recurrent symptomatic stenosis (2 with index balloon venoplasty and 3 index transvenous lead extraction and venoplasty). Of the 11 patients who underwent extraction, 6 required reimplantation of the device: 2 transvenous, 2 epicardial, 1 subcutaneous, and 1 leadless device implantation.

Conclusions: Effective management of TVL-associated SVC syndrome involves venoplasty with or without transvenous lead extraction, showing good medium-term outcomes. Reimplantation of the device with TVL requires careful consideration, and efforts should be made to consider a leadless device when feasible.

Background: Pulsed field energy is an increasingly adopted technology for ablation of atrial fibrillation (AF). Although clinical data on pulsed field ablation (PFA) is positive, data on ischemic cerebral lesions (ICLs) after PFA is limited. Because the individual PFA systems differ substantially in pulse characteristics, cerebral safety should be studied separately for each system.

Objectives: This study sought to assess the incidence of ICLs after PFA for AF using a variable-loop circular catheter.

Methods: The study was designed as a prospective, observational, cohort, single-center study. In patients with nonparoxysmal AF, pulmonary vein and left atrial posterior wall isolation were performed. National Institutes of Health Stroke Scale scores were assessed within 24 hours post ablation. Brain magnetic resonance imaging (1.5T, diffusion-weighted imaging included) was conducted 1 day before and 24 hours after the procedure to detect acute ICL. The study initially aimed to enroll 40 patients but was terminated early because of safety concerns.

Results: Twenty-one patients were enrolled (age 66.1 ± 9.0 years, 38% women, all with nonparoxysmal AF). ICLs occurred in 14 (66.7%) patients, with a median of 2 (IQR: 0, 3) lesions per patient, and a median cumulative lesion burden of 10.5 mm (6.3, 19.3). Most ICLs (28; 55.8%) were localized in the posterior territory. One patient experienced a transient ischemic attack, and 1 patient suffered a major peri-procedural stroke (National Institutes of Health Stroke Scale = 6; modified Rankin scale = 3 at the day 30 clinical follow-up).

Conclusions: PFA using a variable-loop circular catheter was associated with a high rate of ICLs. More than half of the lesions were in the posterior cerebrovascular territory. (Cerebral Safety After Pulsed-Field Ablation of Atrial Fibrillation; NCT06786988).

Background: Isolated nonischemic left ventricular scar (NILVS), identified by cardiac magnetic resonance, is an increasing finding in athletes and may be the substrate for life-threatening arrhythmias. Clinical significance in asymptomatic athletes is yet to be investigated.

Objectives: This study sought to describe the clinico-genetic profile and follow-up of asymptomatic athletes diagnosed with NILVS through preparticipation screening.

Methods: We evaluated 40 athletes (90% males, 44 [range:33-52] years) including 9 elites, with isolated NILVS involving at least 2 segments, no previous major arrhythmic events, with available genetic testing and >1 year of follow-up. Data regarding electrocardiography, echocardiography, 24-hour Holter, exercise testing, and genetic analysis were collected. Follow-up assessed therapy, sport participation, and outcome.

Results: Electrocardiogram abnormalities were present in 48%, and all showed premature ventricular beats at exercise testing, mostly with right bundle branch/superior axis morphology. Left ventricular ejection fraction was normal or mildly reduced. Genetic testing or family screening was positive in 9 (23%). Athletes without familial/genetic background were older and declared higher cumulative years of sports activity. Over a median follow-up time of 23 months, 84% continued noncompetitive sport, mostly (73%) on beta-blocker therapy. Two major arrhythmic events occurred (resuscitated cardiac arrest and sustained ventricular tachycardia), both in athletes with a positive family history for NILVS, but negative genetic testing, and both during noncompetitive exercise.

Conclusions: NILVS in asymptomatic athletes may carry arrhythmic risk even in the absence of previous symptoms or left ventricular dysfunction. Athletes with NILVS and no gene mutations/family history are older and with a higher past exercise volume.