Pub Date : 2025-12-01DOI: 10.1016/j.jacep.2025.08.010
Samir Saba MD, Sandeep Jain MD, N.A. Mark Estes III MD, Madhurmeet Singh DO, Alaa Shalaby MD
{"title":"Survival of Older Patients Who Receive Cardiac Resynchronization Therapy Devices With or Without Defibrillation Capability","authors":"Samir Saba MD, Sandeep Jain MD, N.A. Mark Estes III MD, Madhurmeet Singh DO, Alaa Shalaby MD","doi":"10.1016/j.jacep.2025.08.010","DOIUrl":"10.1016/j.jacep.2025.08.010","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 12","pages":"Pages 2760-2762"},"PeriodicalIF":7.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137654","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}
Left atrial appendage closure (LAAC) is an established therapeutic strategy to prevent ischemic stroke in selected patients with atrial fibrillation. However, residual peridevice leaks (PDLs) post-LAAC remain a critical concern.
Objectives
This study sought to assess the clinical impact of Watchman FLX device overcompression.
Methods
Data on consecutive patients undergoing a transesophageal echocardiography (TEE)-guided LAAC between 2020 and 2023 in 2 high-LAAC volume centers were collected and patients with a device compression higher (overcompression group) or lower (normal compression group) than 30% as evaluated by procedural TEE were compared in terms of procedural complications, composite of cardiovascular death, ischemic stroke, or systemic embolism, and PDL at TEE follow-up.
Results
This study included 61 overcompression and 175 normal compression patients. Baseline and procedural characteristics did not differ between the 2 groups. Both composite of procedural complications (1.6% vs 1.7%; P = 0.968) and of cardiovascular death, ischemic stroke, or systemic embolism during follow-up (9.8% vs 12%; P = 0.971) did not significantly differ between the 2 groups. At 2-month TEE follow-up, the rate of residual PDL was significantly lower in the overcompression group (8.2% vs 32.6%; P < 0.001). At the multivariate analysis, the device compression rate was the only variable independently associated to risk of PDL at TEE follow-up (adjusted OR: 0.935; 95% CI: 0.927-0.948; P = 0.003).
Conclusions
In this dual-center cohort of TEE-guided LAAC, the overcompression group was independently associated to a higher rate of LAA occlusion at TEE follow-up.
背景：左心房附件关闭术（LAAC）是一种针对房颤患者预防缺血性卒中的治疗策略。然而，laac后残留的外围设备泄漏（pdl）仍然是一个关键问题。目的：本研究旨在评估Watchman FLX装置过度压迫的临床影响。方法：收集2020年至2023年在2个高LAAC容量中心连续接受经食管超声心动图（TEE）引导的LAAC患者的数据，并比较手术TEE评估的器械压缩高于（过度压缩组）或低于（正常压缩组）30%的患者的手术并发症、心血管死亡、缺血性卒中或全体性栓塞的综合情况以及TEE随访时的PDL。结果：本研究包括61例过度压迫患者和175例正常压迫患者。两组患者的基线和手术特征无差异。术后并发症（1.6% vs 1.7%, P = 0.968）和随访期间心血管死亡、缺血性卒中或全身性栓塞（9.8% vs 12%, P = 0.971）两组间无显著差异。在2个月的TEE随访中，过度压迫组的残余PDL率显著降低（8.2% vs 32.6%; P < 0.001）。在多因素分析中，器械压缩率是TEE随访时PDL风险唯一独立相关的变量（校正OR: 0.935; 95% CI: 0.927-0.948; P = 0.003）。结论：在TEE引导LAAC的双中心队列中，TEE随访时，过度压迫组与LAA闭塞率较高独立相关。
{"title":"Impact of Device Compression on Peridevice Leak After Left Atrial Appendage Closure","authors":"Vincenzo Mirco La Fazia MD , Roberto Galea MD , Domenico Giovanni Della Rocca MD , Carola Gianni MD , Antanas Gasys MD , Sanghamitra Mohanty MD , Raouf Madhkour MD , Nicola Pierucci MD , Prem Geeta Torlapati MD , Konstantina Chalkou PhD , Gaetano Chiricolo MD , Caroline Chong-Nguyen MD , Rodney Horton MD , Amin Al-Ahmad MD , Luigi Di Biase MD , Lorenz Räber MD, PhD , Andrea Natale MD","doi":"10.1016/j.jacep.2025.08.014","DOIUrl":"10.1016/j.jacep.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage closure (LAAC) is an established therapeutic strategy to prevent ischemic stroke in selected patients with atrial fibrillation. However, residual peridevice leaks (PDLs) post-LAAC remain a critical concern.</div></div><div><h3>Objectives</h3><div>This study sought to assess the clinical impact of Watchman FLX device overcompression.</div></div><div><h3>Methods</h3><div>Data on consecutive patients undergoing a transesophageal echocardiography (TEE)-guided LAAC between 2020 and 2023 in 2 high-LAAC volume centers were collected and patients with a device compression higher (overcompression group) or lower (normal compression group) than 30% as evaluated by procedural TEE were compared in terms of procedural complications, composite of cardiovascular death, ischemic stroke, or systemic embolism, and PDL at TEE follow-up.</div></div><div><h3>Results</h3><div>This study included 61 overcompression and 175 normal compression patients. Baseline and procedural characteristics did not differ between the 2 groups. Both composite of procedural complications (1.6% vs 1.7%; <em>P</em> = 0.968) and of cardiovascular death, ischemic stroke, or systemic embolism during follow-up (9.8% vs 12%; <em>P</em> = 0.971) did not significantly differ between the 2 groups. At 2-month TEE follow-up, the rate of residual PDL was significantly lower in the overcompression group (8.2% vs 32.6%; <em>P</em> < 0.001). At the multivariate analysis, the device compression rate was the only variable independently associated to risk of PDL at TEE follow-up (adjusted OR: 0.935; 95% CI: 0.927-0.948; <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>In this dual-center cohort of TEE-guided LAAC, the overcompression group was independently associated to a higher rate of LAA occlusion at TEE follow-up.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 12","pages":"Pages 2742-2753"},"PeriodicalIF":7.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212679","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 : 2025-12-01DOI: 10.1016/j.jacep.2025.08.004
Peter J. Schwartz MD , Lia Crotti MD, PhD
Calmodulinopathies are very rare genetic disorders associated with a high risk for sudden cardiac death. Disease-causing variants in 1 of the 3 identical CALM genes cause severe forms of long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, or idiopathic ventricular fibrillation, and there are many unanswered questions concerning management and underlying mechanisms. What is currently known depends largely on the initial publications from the ICamR (International Calmodulinopathy Registry). However, progress is delayed because the accrual of patients in ICamR is slow. As we did long ago for long QT syndrome, this is a call for action, requesting doctors all over the world to enroll even their isolated cases in the Registry. This is the only way to obtain, for an adequate number of patients, the data necessary to define the spectrum of clinical manifestations and the genotype-phenotype correlation essential for an improved risk stratification and best therapeutic management. If you are willing to contribute, please contact us.
{"title":"Calmodulinopathies","authors":"Peter J. Schwartz MD , Lia Crotti MD, PhD","doi":"10.1016/j.jacep.2025.08.004","DOIUrl":"10.1016/j.jacep.2025.08.004","url":null,"abstract":"<div><div>Calmodulinopathies are very rare genetic disorders associated with a high risk for sudden cardiac death. Disease-causing variants in 1 of the 3 identical <em>CALM</em> genes cause severe forms of long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, or idiopathic ventricular fibrillation, and there are many unanswered questions concerning management and underlying mechanisms. What is currently known depends largely on the initial publications from the ICamR (International Calmodulinopathy Registry). However, progress is delayed because the accrual of patients in ICamR is slow. As we did long ago for long QT syndrome, this is a call for action, requesting doctors all over the world to enroll even their isolated cases in the Registry. This is the only way to obtain, for an adequate number of patients, the data necessary to define the spectrum of clinical manifestations and the genotype-phenotype correlation essential for an improved risk stratification and best therapeutic management. If you are willing to contribute, please contact us.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 12","pages":"Pages 2791-2794"},"PeriodicalIF":7.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954375","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 : 2025-12-01DOI: 10.1016/j.jacep.2025.10.026
Demosthenes G. Katritsis MD, PhD , Damian Sanchez-Quintana MD, PhD , Eduardo Back Sternick MD, PhD , Robert H. Anderson MD, PhD
{"title":"Is There an Intramyocardial \"Purkinje\" System in the Heart?","authors":"Demosthenes G. Katritsis MD, PhD , Damian Sanchez-Quintana MD, PhD , Eduardo Back Sternick MD, PhD , Robert H. Anderson MD, PhD","doi":"10.1016/j.jacep.2025.10.026","DOIUrl":"10.1016/j.jacep.2025.10.026","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 12","pages":"Page 2769"},"PeriodicalIF":7.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801880","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 : 2025-12-01DOI: 10.1016/j.jacep.2025.08.006
Takumi Yamada MD , G. Neal Kay MD
{"title":"Acceleration of Left Ventricular Summit Arrhythmias Induced by Unsuccessful Radiofrequency Applications as a Guide to Origin","authors":"Takumi Yamada MD , G. Neal Kay MD","doi":"10.1016/j.jacep.2025.08.006","DOIUrl":"10.1016/j.jacep.2025.08.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 12","pages":"Pages 2824-2830"},"PeriodicalIF":7.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137507","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}
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