JACC. Clinical electrophysiology最新文献

Background: Supraventricular tachycardia (SVT) is a common type of arrythmia leading to patient distress and substantial health care utilization. Although the mechanistic underpinnings of SVT are well elucidated, the etiologies remain unknown.

Objectives: This study aimed to determine to what extent SVT may be heritable using a classical biometrical twin study design.

Methods: Monozygotic and same-sex dizygotic twin pairs born in Denmark, in which one or both members were diagnosed with SVT between 1977 and 2024, were identified through the Danish Twin Registry and the Danish National Patient Registry. The risk in the co-twin following the index-twin's diagnosis was estimated by using Cox proportional hazards models. Heritability of SVT was assessed by using probandwise concordance rates and biometrical models.

Results: Of 32,324 twin pairs (12,006 monozygotic and 20,318 dizygotic pairs), at least one SVT diagnosis was identified in 663 twin pairs. After an SVT diagnosis in the index-twin, the risk of SVT was significantly higher in monozygotic co-twins compared with dizygotic co-twins (HR: 3.61; 95% CI: 1.35-9.63; P = 0.01), which remained significant after adjusting for age and sex (HR: 3.3; 95% CI: 1.24-8.89; P = 0.01). The probandwise concordance rate was significantly higher in monozygotic twins compared with dizygotic twins (9% vs 3%; P < 0.001). Biometrical models indicated that 35% of SVT risk could be attributed to genetics and 65% to unique environmental components.

Conclusions: Based on a large nationwide population of monozygotic and same-sex dizygotic twins, this is the first study to quantify the genetic and environmental contributions to SVT.

Atrial fibrillation ablation trials have significantly evolved over the past 3 decades, especially recently with the introduction of pulsed field ablation. Efficacy endpoint definitions are inconsistent among clinical trials, leaving the readers (ie, physicians, patients, payers, and regulators) to determine which values are most meaningful and how to compare results across various technologies. This review highlights differences in study design, atrial arrhythmia monitoring methods, and endpoint definitions of key pulsed field ablation trials and discusses the challenges of making cross-trial comparisons. Ultimately, a coordinated effort by physician-researchers, in collaboration with industry partners and regulatory agencies, could establish consensus-driven benchmarks for clinical success, recurrence thresholds, and quality-of-life measures. Such harmonization would enhance the reliability of cross-trial comparisons and support faster, better informed decision-making in both clinical and policy settings.

The treatment of atrial fibrillation (AF) is compounded by its common coexistence with depression. Autonomic dysfunction has been described in both conditions, which may represent a shared target for treatment. A narrative review was conducted to synthesize the literature surrounding depression, AF, autonomic dysfunction characterized using heart rate variability, and antidepressant medication. Invasive autonomic modulation in AF has been studied as part of catheter ablation for AF. Changes in autonomic indices after catheter ablation have been associated with improved quality of life and reduced anxiety scores in the short term. Treating depression in AF using clinically available selective serotonin reuptake inhibitor antidepressants may reduce excessive changes in heart rate variability and possibly autonomic dysfunction seen in AF. These agents may also improve compliance with lifestyle changes that are critical in the management of AF. These agents have a good safety track record in the coronary artery disease and heart failure populations but have not been systemically studied in arrhythmia likely secondary to concurrent administration of class III antiarrhythmic medications. However, effects on QT interval vary within this drug class and are not as large as those exerted by tricyclic antidepressants. Additionally, behavioral treatment of depression in AF has been shown to reduce symptom perception and health care utilization despite stable AF burden. In conclusion, effective treatment of depression may have direct benefits on AF treatment via autonomic modulation and indirect benefits via enhanced risk factor management and reduced symptom perception.

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.