JACC. Clinical electrophysiology最新文献

英文中文

Adrenergic Hypersensitivity Drives Ventricular Arrhythmias Following Loss of Plexin-Mediated Cardiac Innervation 神经丛介导的心脏神经支配丧失后，肾上腺素能过敏引起室性心律失常。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.08.016

Ching Zhu MD, PhD , Takako Makita PhD , Emilio Y. Lucero MD, PhD , Arun Jyothidasan PhD , Rhea Patel PhD , Jessica J. Wang MD, PhD , Yang Cao PhD , Howard A. Rockman MD , Kalyanam Shivkumar MD, PhD, FACC

Background

Ventricular arrhythmias (VAs) are a leading cause of death and arise from a combination of cardiac muscle injury and dysfunction of the intramyocardial sympathetic nerves that control cardiac electrophysiology. The adrenergic mechanisms by which intramyocardial nerves contribute to arrhythmogenesis are poorly understood. Semaphorin-plexin signaling pathways are responsible for developmental guidance of sympathetic nerves onto the heart and have previously been associated with VAs in humans.

Objectives

This study sought to investigate adrenergic control of arrhythmogenesis, and explored the cardiac electrophysiology of a Plexin-A3/-A4 double knockout mouse model with loss of cardiac adrenergic nerves.

Methods

Cardiac structure and function were studied by using tissue clearing, immunohistochemistry, and echocardiography. Electrocardiogram and optical mapping of action potentials were used to evaluate electrophysiological responses to pharmacologic β-adrenergic stimulation and blockade. Circulating catecholamines were measured and β-adrenergic receptor density quantified in cardiac membranes. Finally, a phenome-wide association study was performed by using data from the UK Biobank to search for associations between PLXNA4 and human arrhythmias.

Results

Mice with loss of plexin-dependent cardiac innervation had structurally normal hearts but displayed spontaneous VAs driven by adrenergic hypersensitivity, as well as increased cardiac β-adrenergic receptor density. Several human PLXNA4 variants were associated with arrhythmia phenotypes.

Conclusions

These data establish a model of VAs driven by enhanced adrenergic receptor signaling, in the absence of structural heart disease. This model can be used to investigate adrenergic mechanisms of arrhythmogenesis and to identify novel antiarrhythmic targets.

背景：室性心律失常（室性心律失常）是导致死亡的主要原因之一，由心肌损伤和控制心脏电生理的心内交感神经功能障碍共同引起。心肌内神经参与心律失常的肾上腺素能机制尚不清楚。信号传导素-丛蛋白信号通路负责交感神经到心脏的发育指导，并且先前与人类VAs有关。目的：探讨肾上腺素能对心律失常的控制作用，探讨神经丛素- a3 /-A4双敲除小鼠心脏肾上腺素能神经缺失模型的心脏电生理。方法：采用组织清除、免疫组化、超声心动图等方法研究心脏结构和功能。用心电图和动作电位光学作图评价β-肾上腺素能药物刺激和阻断的电生理反应。测定循环儿茶酚胺含量，测定心膜β-肾上腺素能受体密度。最后，利用英国生物银行（UK Biobank）的数据进行全现象关联研究，以寻找PLXNA4与人类心律失常之间的关联。结果：失去神经丛依赖性心脏神经支配的小鼠心脏结构正常，但在肾上腺素能超敏反应的驱动下出现自发性VAs，心脏β-肾上腺素能受体密度增加。几种人类PLXNA4变异与心律失常表型相关。结论：这些数据建立了在没有结构性心脏病的情况下，肾上腺素能受体信号增强驱动的VAs模型。该模型可用于研究心律失常发生的肾上腺素能机制，并确定新的抗心律失常靶点。

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A Case of LBBB-Dependent AVRT Via a Decrementally Conducting Kent Bundle lbbb依赖性AVRT经递减导通Kent束1例。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.09.021

Masahiro Ishikura MD, Tetsuro Takase MD, Akifumi Mitsushima MD, Akira Shinoda MD, Yoshio Furukawa MD

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Renal Denervation During Atrial Fibrillation Ablation 房颤消融过程中的肾去神经支配

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.12.003

Krittapoom Akrawinthawong MD, MSc , Jonathan S. Steinberg MD

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Acute and Long-Term Outcomes of Contralateral Transvenous Leads for Cardiac Implantable Electrical Devices 心脏植入式电装置对侧经静脉导联的急性和长期疗效。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.09.004

Paishiun Nelson Hsieh MD, PhD , Dingxin Qin MD, MSc , Theofanie Mela MD , Gregory F. Michaud MD

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Is Speaking Silver and Silence Gold? 说话是银，沉默是金？左心耳隔离对围装置泄漏的意义。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.09.032

Thomas Fink MD, Vanessa Sciacca MD, Philipp Sommer MD

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From Rescue to Routine 从救援到日常

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.12.004

Timothy Maher MD, Andre d’Avila MD, PhD

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Defining Success of Atrial Fibrillation Ablation 心房颤动消融成功的定义

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.12.017

Nassir Marrouche MD , Taya V. Glotzer MD

引用次数: 0

Risk Stratification in Left Bundle Branch Block After Transcatheter Aortic Valve Implantation 经导管主动脉瓣植入术后左束支传导阻滞的风险分层：多中心ECG算法研究。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.09.010

Patrick Badertscher MD , Teodor Serban MD , Gregoire Massoullie MD, PhD , Romain Eschalier MD, PhD , Lena Rivard MD, MSc , Delphine Portelance MD , Ron Waksman MD , Valerie Pavlicek MD , Patrizio Pascale MD , Mattia Pagnoni MD , Thomas Lambert MD , Christian Reiter MD, PhD , Clemens Steinwender MD , Sven Knecht PhD, MSc , Felix Mahfoud MD , Christian Sticherling MD , Michael Kühne MD

Background

Managing left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) remains challenging.

Objectives

The aim of this study was to develop a novel, simplified electrocardiogram (ECG) algorithm for predicting infranodal conduction delay in LBBB (both new onset as well as preexisting) patients after TAVI and to compare its performance vs current European Society of Cardiology (ESC) ECG criteria.

Methods

A multicenter analysis of prospectively enrolled patients undergoing electrophysiology testing for preexisting or new-onset LBBB after TAVI was conducted. The novel algorithm was developed by analyzing various combinations of the PR interval, QRS duration pre-TAVI and post-TAVI, and changes in these parameters to identify patients with infranodal conduction delay (defined as a His-ventricular interval ≥70 milliseconds).

Results

A total of 769 patients with LBBB (12% preexisting) after TAVI underwent risk stratification using electrophysiology testing at 7 institutions (mean age 81 ± 7 years; 57% female; 21% His-ventricular ≥70 milliseconds). A novel algorithm using solely a PR interval of 190 milliseconds and a QRS interval of 160 milliseconds revealed a sensitivity of 88% and an negative predictive value of 92% for the rule-out of infranodal conduction delay (PR interval post-TAVI <190 milliseconds AND QRS duration post-TAVI <160 milliseconds) and a specificity and positive predictive value of 85% and 41%, respectively, for the rule-in of infranodal conduction delay (PR interval post-TAVI ≥190 milliseconds AND QRS duration post-TAVI ≥160 milliseconds). By comparison, the ESC ECG criteria showed a sensitivity of 72%, a negative predictive value of 88%, specificity of 53%, and a positive predictive value of 28%.

Conclusions

The novel, simplified ECG algorithm showed a superior performance for the rule-out and rule-in of infranodal conduction delay compared with current ESC ECG criteria.

背景：处理经导管主动脉瓣植入术（TAVI）后左束支阻滞（LBBB）仍然具有挑战性。目的：本研究的目的是开发一种新的、简化的心电图（ECG）算法，用于预测TAVI后LBBB（包括新发和已存在的）患者的管内传导延迟，并将其性能与当前欧洲心脏病学会（ESC）心电图标准进行比较。方法：对前瞻性入组患者进行电生理检查，检查TAVI术后已存在或新发的LBBB，进行多中心分析。该算法通过分析tavi前后PR间期、QRS持续时间的各种组合，以及这些参数的变化来识别管内传导延迟（定义为His-ventricular interval≥70 ms）患者。结果：共有769例TAVI后LBBB患者（12%既往存在）在7家机构通过电生理测试进行了风险分层（平均年龄81±7岁，57%为女性，21%心室≥70毫秒）。一种仅使用190毫秒PR间隔和160毫秒QRS间隔的新算法对tavi后肠内传导延迟（PR间隔）的排除敏感性为88%，阴性预测值为92%。结论：与目前的ESC ECG标准相比，新的简化ECG算法在排除和纳入肠内传导延迟方面表现出更优越的性能。

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From Electrical to Thermal Insight 从电到热的洞察：心室射频消融的实时能量分析。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.10.022

Felix Bourier MD

引用次数: 0

PVC Location and Heart Failure 聚氯乙烯定位和心力衰竭

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2026-01-01 DOI: 10.1016/j.jacep.2025.10.035

Hassan Adam Alhassan MBChB, MPH

引用次数: 0

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