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JACC. Clinical electrophysiology最新文献

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Sex-Specific Computational Models of Atrial Electrophysiology: Mechanistic Insights and Implications for Atrial Fibrillation Therapy. 心房电生理学的性别特异性计算模型:心房颤动治疗的机理认识和意义》。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-16 DOI: 10.1016/j.jacep.2024.08.019
Benjamin Buck, Thomas J Hund
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引用次数: 0
Transseptal Transition Patterns During Left Bundle Branch Area Lead Implantation. 左束支区导联植入过程中的跨节转换模式
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-16 DOI: 10.1016/j.jacep.2024.07.025
Marek Jastrzębski, Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Marek Rajzer, Haran Burri, Karol Curila, Pugazhendhi Vijayaraman

Background: Continuous deep septal pacing and signal recording during implantation of left bundle branch pacing (LBBP) lead enables to monitor beat-to-beat changes of electrocardiogram (ECG) and myocardial current of injury (COI) as the lead crosses the septum.

Objectives: This study aimed to characterize patterns of continuous QRS, ST-T, and COI change for monitoring of the lead depth and instantaneous determination of the obtained capture type (LBBP vs left ventricular septal pacing [LVSP]).

Methods: The ECG and COI during lead implantation were scrutinized for sudden changes of V6 R-wave peak time, V1 initial and terminal R-wave amplitude, V3-V6 R-wave amplitude, repolarization pattern and S-wave amplitude in I, V5-V6, and COI drop. The sudden and gradual transition patterns were diagnosed depending on the presence or absence of the above beat-to-beat ECG phenomena, respectively.

Results: A total of 212 pacemaker recipients were analyzed; LBBP and LVSP were obtained in 77.4% and 22.6%, respectively. There were 4.7 ± 2.1 and 0.2 ± 0.6 beat-to-beat phenomena in LBBP and LVSP patients, respectively. The sudden transition pattern, recognized in 80.7%, had sensitivity and specificity for LBBP diagnosis of 98.8% and 81.2%, respectively. A sudden drop of COI (29.4 ± 8.5 mV to 12.8 ± 4.9 mV) was observed in 53.9% patients (LBBP was simultaneously obtained in 92.7%).

Conclusions: Capture of left bundle branch during lead penetration is a beat-to-beat phenomenon. Two transseptal transition patterns were identified: 1) sudden, which is typical for obtaining LBBP; and 2) gradual, which is typical for obtaining LVSP. A sudden COI drop, a very observable phenomenon, also identified reaching the left subendocardial area.

背景:在植入左束支起搏(LBBP)导联过程中进行连续的室间隔深部起搏和信号记录,可监测导联穿过室间隔时心电图(ECG)和心肌损伤电流(COI)的逐搏变化:本研究旨在描述连续 QRS、ST-T 和 COI 变化的模式,以监测导联深度并即时确定所获得的捕获类型(LBBP 与左室间隔起搏 [LVSP]):方法:仔细观察导联植入过程中的心电图和 COI,观察 V6 R 波峰值时间、V1 R 波初始和终末振幅、V3-V6 R 波振幅、I、V5-V6 的复极化模式和 S 波振幅以及 COI 下降的突然变化。根据有无上述逐次搏动的心电图现象,分别诊断为骤变和渐变模式:结果:共分析了 212 名起搏器接受者,其中 77.4% 和 22.6% 分别获得了 LBBP 和 LVSP。在 LBBP 和 LVSP 患者中分别出现了 4.7 ± 2.1 和 0.2 ± 0.6 次跳动现象。80.7%的患者能识别突然转换模式,其对 LBBP 诊断的敏感性和特异性分别为 98.8% 和 81.2%。53.9%的患者观察到COI突然下降(29.4 ± 8.5 mV至12.8 ± 4.9 mV)(92.7%的患者同时获得LBBP):结论:左束支在导联穿刺过程中被捕获是一种逐搏现象。结论:导联穿刺时捕获左束支是一种逐搏现象:1)突然,这是获得 LBBP 的典型模式;2)渐进,这是获得 LVSP 的典型模式。还发现了到达左心内膜下区域的 COI 骤降,这是一种非常容易观察到的现象。
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引用次数: 0
Persistent ST-Segment Elevation Before and After Left Bundle Branch Pacing. 左束支起搏前后的持续 ST 段抬高
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-15 DOI: 10.1016/j.jacep.2024.07.026
Michael Byers, Faiz Subzposh, Pugazhendhi Vijayaraman
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引用次数: 0
Magnetic Resonance-Guided Stereotactic Radioablation for Septal Ventricular Tachycardias. 磁共振引导下的室间隔室速立体定向射频消融术
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.jacep.2024.08.008
Stefano Bianchi, Domenico Marchesano, Michele Magnocavallo, Marco Polselli, Paolo di Renzi, Gianmarco Grimaldi, Filippo Maria Cauti, Cristian Borrazzo, Randa El Gawhary, Antonio Bisignani, Massimiliano Campoli, Alessandra Castelluccia, Daniele Porcelli, Pietro Rossi, PierCarlo Gentile

Background: Stereotactic arrhythmia radioablation (STAR) was introduced to treat ventricular tachycardia (VT) refractory to catheter ablation. No data are now available in the septal VT substrate setting, representing a challenge when using conventional techniques.

Objectives: This study sought to evaluate the arrhythmic burden in patients with septal VT treated with magnetic resonance-guided STAR (MRgSTAR).

Methods: We enrolled consecutive patients with septal VT substrate. The therapy target was achieved by combining anatomic/functional and electrophysiologic information. Patients were treated with a single fraction of 25 Gy adopting MRgSTAR. All patients were clinically followed up, and all implantable cardiac devices were remotely monitored. The efficacy outcome included recurrences of any sustained VT beyond the 6-week blanking period after MRgSTAR. The safety outcome was the incidence of adverse events and atrioventricular block.

Results: We included 11 patients with septal substrate VT (median age: 68 years; Q1-Q3: 64.5-78 years; 100% male). Clinical presentation was an electrical storm in 81.8% of patients. No complications occurred after MRgSTAR, and 6 (54.5%) patients were discharged on the same day of treatment. During a mean follow-up of 12 ± 6 months, the efficacy outcome occurred in 3 (27.3%) cases. A significative reduction of implantable cardioverter-defibrillator (ICD) therapy (23.6 before MRgSTAR vs 1.7 after MRgSTAR; P < 0.001) was observed. Left ventricular ejection fraction increased significantly after treatment (38% [Q1-Q3: 33.5%-42.0%] before MRgSTAR vs 43.8% [Q1-Q3: 35%-47%] after MRgSTAR; P = 0.04). No adverse effects were observed in the implantable cardioverter-defibrillator and lead system; in the 7 patients with preserved atrioventricular conduction, no atrioventricular block was reported.

Conclusions: MRgSTAR represents a safe and effective strategy for treating septal VT.

背景:立体定向心律失常射频消融术(STAR)用于治疗导管消融术难治的室性心动过速(VT)。目前还没有关于室间隔 VT 底物的数据,这对使用传统技术来说是一个挑战:本研究旨在评估使用磁共振引导 STAR(MRgSTAR)治疗室间隔 VT 患者的心律失常负荷:我们招募了连续的室间隔 VT 基底患者。结合解剖学/功能学和电生理学信息确定治疗目标。采用MRgSTAR对患者进行单次25 Gy治疗。对所有患者进行临床随访,并对所有植入式心脏设备进行远程监控。疗效结果包括 MRgSTAR 治疗后 6 周空白期后任何持续性 VT 的复发。安全性结果是不良事件和房室传导阻滞的发生率:我们共纳入了 11 名室间隔基质 VT 患者(中位年龄:68 岁;Q1-Q3:64.5-78 岁;100% 男性)。81.8%的患者临床表现为电风暴。MRgSTAR 治疗后未出现并发症,6 名患者(54.5%)在治疗当天出院。在平均 12 ± 6 个月的随访期间,3 例(27.3%)患者获得了疗效。观察到植入式心律转复除颤器(ICD)治疗显著减少(MRgSTAR治疗前为23.6例,MRgSTAR治疗后为1.7例;P < 0.001)。治疗后左室射血分数显著增加(MRgSTAR 前为 38% [Q1-Q3: 33.5%-42.0%] vs MRgSTAR 后为 43.8% [Q1-Q3: 35%-47%]; P = 0.04)。在植入式心律转复除颤器和导联系统中未观察到不良反应;在7名房室传导保留的患者中,未报告房室传导阻滞:结论:MRgSTAR 是治疗室间隔 VT 的一种安全有效的策略。
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引用次数: 0
Mechanisms of Chemical Atrial Defibrillation by Flecainide and Ibutilide. 氟卡尼和伊布利特的化学性心房除颤机制
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.jacep.2024.08.009
Pei-Chi Yang, Luiz Belardinelli, Colleen E Clancy

Background: Effective and safe pharmacological approaches for atrial defibrillation offer several potential advantages over techniques like ablation. Pharmacological therapy is noninvasive, involving no risk associated with the procedure or resulting complications. Moreover, acute drug intervention with existing drugs is likely to be low cost and broadly accessible, thereby addressing a central tenet of health equity.

Objectives: This study aims to investigate ibutilide-mediated action potential prolongation to promote use-dependent effects of flecainide on Na+ channels by reducing the diastolic interval and, consequently, drug unbinding to reduce action potential excitability in atrial tissue and terminate re-entrant arrhythmia.

Methods: Here we utilize a modeling and simulation approach to predict the specific combinations of sodium- and potassium-channel blocking drugs to chemically terminate atrial re-entry.

Results: Computational modeling and simulation show that acute application of flecainide and ibutilide is a promising example of drug repurposing that may constitute a promising combination for chemical atrial defibrillation.

Conclusions: We predict the drug concentrations that promote efficacy of flecainide and ibutilide used in combination for atrial chemical defibrillation. We also predict the potential safety pharmacology impact of this drug combination on ventricular electrophysiology.

背景:与消融等技术相比,有效、安全的心房除颤药物疗法具有多项潜在优势。药理疗法是非侵入性的,不会带来手术风险或并发症。此外,使用现有药物进行急性药物干预的成本可能很低,而且可以广泛使用,从而解决了健康公平的核心问题:本研究旨在研究伊布利特介导的动作电位延长,通过缩短舒张间期促进非加尼对 Na+ 通道的依赖性作用,从而使药物解除结合,降低心房组织中的动作电位兴奋性,终止再入性心律失常:计算建模和模拟显示,急性应用氟卡尼和伊布利特是药物再利用的一个很有希望的例子,可能构成化学性心房除颤的一种很有希望的组合:我们预测了氟卡尼和布替利联合用于心房化学除颤时促进疗效的药物浓度。我们还预测了这种药物组合对心室电生理学的潜在安全药理学影响。
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引用次数: 0
Percutaneous Retrieval of an Embolized Amulet Device From the Aorta Using a Novel Retrieval System. 使用新型检索系统从主动脉经皮检索栓塞的 Amulet 装置。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-12 DOI: 10.1016/j.jacep.2024.08.007
Yashasvi Chugh, Praveen Ranganath, Haojie Wang, Purav Mody, George Heberton, Praveen Rao
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引用次数: 0
Overcoming Lead Penetration Failure in Left Bundle Branch Area Pacing. 克服左束支区起搏中的导联穿透失败
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-09 DOI: 10.1016/j.jacep.2024.07.021
Aymeric Menet, Inès Belkahia, Outteryck François, Guillaume Toubeau, Noémie Selin, Jeremy Layec, Marie Decroocq, Yves Guyomar, Sylvestre Maréchaux, Guillaume Viart

Left bundle branch area pacing is an innovative technique employed to maintain left ventricular synchrony. However, the operator can face challenges in penetrating the lead into the septum during screwing. Two pitfalls-helix-only penetration and shallow penetration-hinder lead penetration. The research, conducted in 2 phases on patients and swine hearts, tested 2 techniques to overcome these issues. The results highlight the impact of endocardial involvement and suggest that the optimal technique involves intentionally creating an endocardial breach rather than simply unscrewing and rescrewing. This solution could facilitate the procedure by minimizing the number of attempts to reach the pacing site and thus reducing the risk of complications.

左束支区起搏是一种用于保持左心室同步性的创新技术。然而,操作员在拧螺丝时将导联穿入室间隔可能面临挑战。两个陷阱--仅螺旋穿透和浅穿透--阻碍了导联穿透。这项研究分两个阶段在病人和猪的心脏上进行,测试了克服这些问题的两种技术。研究结果强调了心内膜参与的影响,并建议最佳技术是有意制造心内膜破口,而不是简单地拧下再拧上。这种解决方案可以最大限度地减少到达起搏部位的尝试次数,从而降低并发症的风险,为手术提供便利。
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引用次数: 0
Enhanced Ca2+-Driven Arrhythmogenic Events in Female Patients With Atrial Fibrillation: Insights From Computational Modeling. 女性心房颤动患者 Ca2+ 驱动的致心律失常事件增强:计算建模的启示
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-09 DOI: 10.1016/j.jacep.2024.07.020
Xianwei Zhang, Yixuan Wu, Charlotte E R Smith, William E Louch, Stefano Morotti, Dobromir Dobrev, Eleonora Grandi, Haibo Ni

Background: Substantial sex-based differences have been reported in atrial fibrillation (AF), but the underlying mechanisms are poorly understood.

Objectives: This study sought to gain a mechanistic understanding of Ca2+-handling disturbances and Ca2+-driven arrhythmogenic events in male vs female atrial cardiomyocytes and establish their responses to Ca2+-targeted interventions.

Methods: We integrated reported sex differences and AF-associated changes (ie, expression and phosphorylation of Ca2+-handling proteins, cardiomyocyte ultrastructural characteristics, and dimensions) into our human atrial cardiomyocyte model that couples electrophysiology with spatially detailed Ca2+-handling processes. Sex-specific responses of atrial cardiomyocytes to arrhythmia-provoking protocols and Ca2+-targeted interventions were evaluated.

Results: Simulated quiescent cardiomyocytes showed increased incidence of Ca2+ sparks in female vs male myocytes in AF, in agreement with previous experimental reports. Additionally, our female model exhibited elevated propensity to develop pacing-induced spontaneous Ca2+ releases (SCRs) and augmented beat-to-beat variability in action potential (AP)-elicited Ca2+ transients compared with the male model. Sensitivity analysis uncovered distinct arrhythmogenic contributions of each component involved in sex and/or AF alterations. Specifically, increased ryanodine receptor phosphorylation emerged as the major SCR contributor in female AF cardiomyocytes, whereas reduced L-type Ca2+ current was protective against SCRs for male AF cardiomyocytes. Furthermore, simulated Ca2+-targeted interventions identified potential strategies (eg, t-tubule restoration, and inhibition of ryanodine receptor and sarcoplasmic/endoplasmic reticulum Ca2⁺-ATPase) to attenuate Ca2+-driven arrhythmogenic events in women, and revealed enhanced efficacy when applied in combination.

Conclusions: Sex-specific modeling uncovers increased Ca2+-driven arrhythmogenic events in female vs male atria in AF, and suggests combined Ca2+-targeted interventions are promising therapeutic approaches in women.

背景:据报道,心房颤动(AF)存在很大的性别差异,但对其潜在机制却知之甚少:本研究旨在从机制上了解男性与女性心房心肌细胞的 Ca2+ 处理紊乱和 Ca2+ 驱动的致心律失常事件,并确定它们对 Ca2+ 靶向干预的反应:我们将已报道的性别差异和房颤相关变化(即 Ca2+ 处理蛋白的表达和磷酸化、心肌细胞超微结构特征和尺寸)整合到我们的人类心房心肌细胞模型中,该模型将电生理学与详细的空间 Ca2+ 处理过程结合在一起。评估了心房心肌细胞对心律失常诱发方案和Ca2+靶向干预的性别特异性反应:结果:模拟静息心肌细胞显示,房颤时女性心肌细胞与男性心肌细胞相比,Ca2+火花发生率增加,这与之前的实验报告一致。此外,与男性模型相比,我们的女性模型表现出更高的起搏诱导的自发 Ca2+ 释放(SCR)倾向,以及动作电位(AP)诱导的 Ca2+ 瞬时的节拍间变异性增加。敏感性分析揭示了性别和/或房颤改变所涉及的每个成分的不同致心律失常作用。具体来说,在女性房颤心肌细胞中,里约丁受体磷酸化的增加是导致 SCR 的主要因素,而 L 型 Ca2+ 电流的减少则对男性房颤心肌细胞的 SCR 起保护作用。此外,模拟的Ca2+靶向干预发现了潜在的策略(如t-微管恢复、抑制雷诺丁受体和肌浆/内质网Ca2⁺-ATP酶),可减轻女性Ca2+驱动的致心律失常事件,当联合应用时,效果更佳:结论:性别特异性模型揭示了房颤中女性与男性心房中Ca2+驱动的致心律失常事件的增加,并表明针对女性的Ca2+联合干预是很有前景的治疗方法。
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引用次数: 0
QT Prolongation and Acquired Long QT Syndrome in Climbers on Mount Everest. 珠穆朗玛峰登山者的 QT 延长和获得性长 QT 综合征。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-06 DOI: 10.1016/j.jacep.2024.07.012
Thomas Pilgrim, Christoph Ryffel, Pasang Phurba Sherpa, Tendi Sherpa, Ojaswee Sherchand, Oskar Galuszka, Katja E Odening, Martina Rothenbühler, Tobias Reichlin, Kunjang Sherpa
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引用次数: 0
Ventricular Tachycardia Substrate in Cardiomyopathy With Excessive Trabeculation Evaluated by Magnetic Resonance and Functional Mapping. 通过磁共振和功能图谱评估伴有过度小梁的心肌病的室性心动过速基质
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-06 DOI: 10.1016/j.jacep.2024.08.001
Akihiko Nogami, Yuki Komatsu, Yuka Oda, Ryuichi Usui, Kikuya Uno
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引用次数: 0
期刊
JACC. Clinical electrophysiology
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