JACC. Clinical electrophysiology最新文献

英文中文

Associations Between Biomarkers of Myocardial Injury and Systemic Inflammation and Risk of Incident Ventricular Arrhythmia 心肌损伤和全身炎症生物标志物与室性心律失常发病风险之间的关系

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.04.017

Background

Cardiac troponins (cTns) and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VAs) is unclear.

Objectives

This study sought to assess whether cTnT, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA.

Methods

In a prospective, observational study of patients treated with implantable cardioverter-defibrillator, cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4 ± 0.5 years and were associated with implantable cardioverter-defibrillator–detected incident VA, HF hospitalizations, and mortality.

Results

This study included 489 patients aged 66 ± 12 years and 83% were men. Median concentrations of cTnT were 15 (Q1-Q3: 9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease, and HF. During 3.1 ± 0.7 years of follow-up, 137 patients (28%) had ≥1 VA. cTnT concentrations were associated with an increased VA risk (per log-unit, HR: 1.63; 95% CI: 1.31-2.01; P < 0.001), also after adjustment for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction (P < 0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4 years were not associated with subsequent VA.

Conclusions

Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predict incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.

背景：心肌肌钙蛋白（cTns）和炎症生物标志物在心力衰竭（HF）时升高，可预测心血管风险。这些生物标志物是否与室性心律失常（VAs）的风险相关尚不清楚：本研究旨在评估 cTnT、生长分化因子 15 (GDF-15)、白细胞介素 6 (IL-6) 和 C 反应蛋白 (CRP) 的浓度是否与室性心律失常的发生有关：在一项针对接受植入式心律转复除颤器治疗的患者的前瞻性观察研究中，在基线和 1.4 ± 0.5 年后测量了 cTnT、GDF-15、IL-6 和 CRP，它们与植入式心律转复除颤器检测到的 VA 事件、高频住院和死亡率相关：该研究共纳入 489 名患者，年龄为 66 ± 12 岁，83% 为男性。纳入时 cTnT 的中位浓度为 15（Q1-Q3：9-25）纳克/升，浓度较高与年龄、男性、糖尿病、冠状动脉疾病和心房颤动有关。在 3.1 ± 0.7 年的随访期间，137 名患者（28%）≥1 次 VA。cTnT 浓度与 VA 风险增加有关（每对数单位，HR：1.63；95% CI：1.31-2.01；P <0.001），同样在调整年龄、性别、体重指数、冠状动脉疾病、HF、肾功能和左心室射血分数（P 结论）后也是如此：较高浓度的 cTnT、GDF-15、IL-6 和 CRP 与心房颤动住院和死亡有关，但只有 cTnT 可预测 VA 事件。这些发现表明，心肌损伤而非炎症可能在 VA 和心脏性猝死中起着病理生理作用。

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引用次数: 0

Epicardial Pulsed Field Ablation for the Treatment of Paroxysmal Atrial Fibrillation During Cardiac Surgery 治疗心脏手术中阵发性心房颤动的心外膜脉冲场消融术

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.06.012

引用次数: 0

Cardiac Imaging, Histopathologic, and Electrical Correlation of Ventricular Tachycardia Isthmus Substrate in Desmoplakin Cardiomyopathy 去甲斑蝥素心肌病室性心动过速峡部基质的心脏成像、组织病理学和电学相关性

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.06.021

引用次数: 0

Full Issue PDF 全期 PDF

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/S2405-500X(24)00745-X

引用次数: 0

Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation 接受室性心动过速消融术的耐用左室辅助装置受术者的死亡率。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.04.037

Background

Left ventricular assist device (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established.

Objectives

This single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival.

Methods

This retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke’s Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models.

Results

Post-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]).

Conclusions

VT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.

背景：左心室辅助装置（LVAD）受术者室性心动过速（VT）的发病率较高。然而，VT消融术在这一人群中的作用尚未得到充分证实：这项单中心回顾性队列研究旨在探讨 LVAD 植入术后 VT 消融对存活率的影响：这项回顾性研究调查了2011年1月至2021年1月期间在贝勒圣路加医疗中心和德克萨斯心脏研究所接受LVAD植入术的患者队列。根据 VT 发生率、VT 发病时间以及 VT 消融的发生和时间，利用 Kaplan-Meier 生存分析和 Cox 比例危险模型比较了 LVAD 接受者的全因估计死亡率：结果：在 575 名 LVAD 受者中，53% 的患者在植入后出现 VT。植入后一年内出现 VT 的患者死亡率较高（HR：1.62 [95% CI：1.15-2.27]）。在这组患者中，与 VT 发生后 45 个月内只接受药物治疗的患者相比，接受导管消融治疗的患者存活率更高（HR：0.48 [95% CI：0.26-0.89]）。此外，在这一人群中实施消融术后，死亡率与未发生植入后 VT 的患者一致（HR：1.18 [95% CI：0.71-1.98]）：结论：植入 LVAD 后 1 年内发生 VT 与存活率降低有关。结论：植入 LVAD 1 年内发生 VT 与存活率降低有关，但与单纯药物治疗相比，在这一人群中进行 VT 消融可改善存活率。在难治性 VT 患者中，导管消融术与其他无植入后 VT 的 LVAD 患者相比，生存率更高。导管消融 VT 与 LVAD 受者存活率的提高有关，但还需要进一步的前瞻性随机研究来比较 LVAD 受者的 VT 消融与医疗管理。

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引用次数: 0

Idiopathic Ventricular Fibrillation 特发性室颤：真正的特发性还是我们遗漏了隐匿性病理？

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.06.014

引用次数: 0

Ablation as Salvation…Via Transplantation? 消融是救赎......通过移植？

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.06.011

引用次数: 0

Association of Left Atrial Late Gadolinium Enhancement With Electrogram Abnormalities, Impedance, and Aortic Proximity 左心房晚期钆增强与电图异常、阻抗和主动脉邻近性的关系

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.06.031

引用次数: 0

Comparative Efficacy and Safety of Pulsed Field Ablation Versus Radiofrequency Ablation of Idiopathic LV Arrhythmias 脉冲场消融与射频消融治疗特发性左心室心律失常的疗效和安全性比较

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.04.025

Background

Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.

Objectives

This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.

Methods

Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach. Ablations were delivered using an investigational dual-energy (RFA/PFA) contact force (CF) and local impedance-sensing catheter. After 1-week survival, animals were euthanized for lesion assessment.

Results

A total of 55 PFA (4 applications/site of 2.0 KV, target CF ≥10 g) and 36 RFA (CF ≥10 g, 25–50 W targeting ≥50 Ω local impedance drop, 60-second duration) were performed. LV interventricular septum: average PFA depth 7.8 mm vs RFA 7.9 mm (P = 0.78) and no adverse events. Papillary muscle: average PFA depth 8.1 mm vs RFA 4.5 mm (P < 0.01). Left ventricular summit: average PFA depth 5.6 mm vs RFA 2.7 mm (P < 0.01). Steam-pop and/or ventricular fibrillation in 4 of 12 RFA vs 0 of 12 PFA (P < 0.01), no ST-segment changes observed. Epicardium: average PFA depth 6.4 mm vs RFA 3.3 mm (P < 0.01). Transient ST-segment elevations/depressions occurred in 4 of 5 swine in the PFA arm vs 0 of 5 in the RFA arm (P < 0.01). Angiography acutely and at 7 days showed normal coronaries in all cases.

Conclusions

In this swine study, compared with RFA, PFA of common idiopathic LV-VAs locations produced deeper lesions with fewer steam pops. However, PFA was associated with higher rates of transient ST-segment elevations and depressions with direct epicardium ablation.

背景：目前尚缺乏射频消融（RFA）与脉冲场消融（PFA）对常见特发性左室心律失常（LV-VAs）部位的疗效和安全性的比较数据：本研究试图比较 RFA 与 PFA 对常见特发性左心室-VAs 位置的治疗效果：方法：10 头猪被随机分为 PFA 和 RFA 两种，PFA 用于 LV 室间隔、乳头肌、经远端冠状动脉窦的 LV 峰部，RFA 用于剑突下途径的 LV 心外膜。消融使用的是一种研究性双能量（RFA/PFA）接触力（CF）和局部阻抗感应导管。动物存活 1 周后，安乐死以评估病变：共进行了 55 次 PFA（4 次/部位，2.0 KV，目标 CF ≥10 g）和 36 次 RFA（CF ≥10 g，25-50 W，目标≥50 Ω局部阻抗下降，持续时间 60 秒）。左心室室间隔：PFA 平均深度为 7.8 毫米，RFA 为 7.9 毫米（P = 0.78），无不良反应。乳头肌：PFA 平均深度为 8.1 毫米，RFA 为 4.5 毫米（P < 0.01）。左心室顶点：平均 PFA 深度 5.6 毫米 vs RFA 2.7 毫米（P < 0.01）。12 例 RFA 中的 4 例与 12 例 PFA 中的 0 例相比（P < 0.01），未观察到 ST 段变化。心外膜：PFA 平均深度为 6.4 毫米，RFA 为 3.3 毫米（P < 0.01）。PFA 组 5 头猪中有 4 头出现短暂的 ST 段抬高/压低，而 RFA 组 5 头猪中只有 0 头出现这种情况（P < 0.01）。所有病例在急性期和 7 天后的血管造影均显示冠状动脉正常：结论：在这项猪研究中，与 RFA 相比，PFA 对常见的特发性左心室-VA 病变部位产生的病变更深，蒸汽爆裂更少。然而，与直接心外膜消融相比，PFA 与较高的一过性 ST 段抬高和压低相关。

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引用次数: 0

Identification of Critical Slowing of Conduction Using Unipolar Atrial Voltage and Fractionation Mapping 利用单极心房电压和分频绘图确定传导的临界减慢。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-09-01 DOI: 10.1016/j.jacep.2024.04.036

Background

Ablation strategies targeting fractionated or low-voltage potentials have been widely used in patients with persistent types of atrial fibrillation (AF). However, recent studies have questioned their role in effectively representing sites of conduction slowing, and thus arrhythmogenic substrates.

Objectives

The authors studied the relationship between local conduction velocity (CV) and the occurrence of fractionated and/or low-voltage potentials in order to identify areas with critically slowing of conduction.

Methods

Intraoperative epicardial mapping was performed during sinus rhythm. Unipolar potentials with an amplitude <1.0 mV were initially classified as low-voltage and potentials with ≥3 deflections as fractionation. A range of thresholds were also explored. Local CV was computed using discrete velocity vectors.

Results

A total of 319 patients were included. Fractionated, low-voltage potentials were rare, accounting for only 0.36% (Q1-Q3: 0.15%-0.78%) of all atrial sites. Local CV at sites with fractionated, low-voltage potentials (46.0 cm/s [Q1-Q3: 22.6-72.7 cm/s]) was lowest compared with sites with either low-voltage, nonfractionated potentials (64.5 cm/s [Q1-Q3: 34.8-99.4 cm/s]) or fractionated, high-voltage potentials (65.9 cm/s [Q1-Q3: 41.7-92.8 cm/s]; P < 0.001). Slow conduction areas (CV <50 cm/s) could be most accurately identified by using a low voltage threshold (<1 mV) and a minimum of 3 deflections (positive predictive value: 54.2%-70.7%), although the overall sensitivity remained low (0.1%-1.9%).

Conclusions

Sites with fractionated, low-voltage potentials have substantially slower local CV compared with sites with either low-voltage, nonfractionated potentials or fractionated, high-voltage potentials. However, the strong inverse relationship between the positive predictive value and sensitivity of a combined voltage and fractionation threshold for slowed conduction is likely to complicate the use of these signal-based ablation approaches in AF patients.

背景：针对分馏电位或低电压电位的消融策略已广泛应用于持续性房颤（AF）患者。然而，最近的研究对其在有效代表传导减慢部位，从而代表致心律失常基质方面的作用提出了质疑：作者研究了局部传导速度（CV）与分化电位和/或低电压电位发生之间的关系，以确定传导严重减慢的区域：方法：在窦性心律时进行术中心外膜测图。结果：共纳入 319 名患者：共纳入 319 名患者。分馏低电压电位很少见，仅占所有心房部位的 0.36%（Q1-Q3：0.15%-0.78%）。与低电压、非分馏电位（64.5 cm/s [Q1-Q3：34.8-99.4 cm/s]）或分馏、高电压电位（65.9 cm/s [Q1-Q3：41.7-92.8 cm/s]；P <0.001）的部位相比，分馏、低电压电位部位的局部 CV 最低（46.0 cm/s [Q1-Q3：22.6-72.7 cm/s]）。慢速传导区（CV 结论：与低电压、非分馏电位或分馏、高电压电位的部位相比，分馏、低电压电位的部位的局部 CV 明显较慢。然而，电压和分馏阈值对传导减慢的阳性预测值和敏感性之间的强烈反比关系可能会使这些基于信号的消融方法在房颤患者中的应用复杂化。

{"title":"Identification of Critical Slowing of Conduction Using Unipolar Atrial Voltage and Fractionation Mapping","authors":"","doi":"10.1016/j.jacep.2024.04.036","DOIUrl":"10.1016/j.jacep.2024.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Ablation strategies targeting fractionated or low-voltage potentials have been widely used in patients with persistent types of atrial fibrillation (AF). However, recent studies have questioned their role in effectively representing sites of conduction slowing, and thus arrhythmogenic substrates.</div></div><div><h3>Objectives</h3><div>The authors studied the relationship between local conduction velocity (CV) and the occurrence of fractionated and/or low-voltage potentials in order to identify areas with critically slowing of conduction.</div></div><div><h3>Methods</h3><div>Intraoperative epicardial mapping was performed during sinus rhythm. Unipolar potentials with an amplitude <1.0 mV were initially classified as low-voltage and potentials with ≥3 deflections as fractionation. A range of thresholds were also explored. Local CV was computed using discrete velocity vectors.</div></div><div><h3>Results</h3><div>A total of 319 patients were included. Fractionated, low-voltage potentials were rare, accounting for only 0.36% (Q1-Q3: 0.15%-0.78%) of all atrial sites. Local CV at sites with fractionated, low-voltage potentials (46.0 cm/s [Q1-Q3: 22.6-72.7 cm/s]) was lowest compared with sites with either low-voltage, nonfractionated potentials (64.5 cm/s [Q1-Q3: 34.8-99.4 cm/s]) or fractionated, high-voltage potentials (65.9 cm/s [Q1-Q3: 41.7-92.8 cm/s]; <em>P</em> < 0.001). Slow conduction areas (CV <50 cm/s) could be most accurately identified by using a low voltage threshold (<1 mV) and a minimum of 3 deflections (positive predictive value: 54.2%-70.7%), although the overall sensitivity remained low (0.1%-1.9%).</div></div><div><h3>Conclusions</h3><div>Sites with fractionated, low-voltage potentials have substantially slower local CV compared with sites with either low-voltage, nonfractionated potentials or fractionated, high-voltage potentials. However, the strong inverse relationship between the positive predictive value and sensitivity of a combined voltage and fractionation threshold for slowed conduction is likely to complicate the use of these signal-based ablation approaches in AF patients.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24004559/pdfft?md5=77d0e2337ee8929e43fe5a1383a7f4d0&pid=1-s2.0-S2405500X24004559-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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