Spontaneous echo contrast (SEC) with atrial fibrillation (AF) is known to increase stroke risk. However, the effect of SEC grades on outcomes after left atrial appendage closure (LAAC) remains unclear.
Objectives
This study aimed to evaluate the impact of SEC grades on clinical outcomes after LAAC.
Methods
A total of 1,276 consecutive patients undergoing LAAC were analyzed. They were classified into SEC 0+, SEC 1/2+, and SEC 3/4+ groups based on preprocedural transesophageal echocardiography. Clinical outcomes were compared among the groups.
Results
There were 595 (46.6%), 509 (39.9%), and 172 (13.5%) patients in the SEC 0+, SEC 1/2+, and SEC 3/4+ groups, respectively. The SEC 3/4+ group (11.5%) had a higher ischemic stroke/transient ischemic attack/systemic embolism incidence than the SEC 0+ (4.4%; P = 0.009) and SEC 1/2+ (5.4%; P = 0.047) groups; SEC grade, however, was not a significant predictor in multivariate analysis. Compared with the SEC 0+ group (2.8%), both the SEC 1/2+ (8.4%; P < 0.001) and SEC 3/4+ (12.4%; P < 0.001) groups were associated with a higher risk of device-related thrombus (DRT). When SEC grade and AF type were combined for assessment, SEC 3/4+ with nonparoxysmal AF was associated with both thromboembolic events (adjusted HR: 2.52; 95% CI: 1.22-5.20; P = 0.013) and DRT (adjusted HR: 2.89; 95% CI: 1.50-5.60; P = 0.003).
Conclusions
Patients with greater SEC grade displayed a higher incidence of thromboembolic events and DRT, and combined SEC grade and AF type independently predicted these events. Further research is needed regarding optimal treatment strategy in patients with severe SEC.
{"title":"Impact of Spontaneous Echo Contrast on Clinical Outcomes After Left Atrial Appendage Closure","authors":"Sachiyo Ono MD , Shunsuke Kubo MD , Naoki Nishiura MD , Kazunori Mushiake MD , Ryuki Chatani MD , Takeshi Maruo MD , Kazushige Kadota MD, PhD , Mitsuru Sago MD , Shuhei Tanaka MD , Masahiko Asami MD , Daisuke Hachinohe MD , Toru Naganuma MD, PhD , Yohei Ohno MD, PhD , Tomoyuki Tani MD , Hideharu Okamatsu MD , Gaku Nakazawa MD, PhD , Yusuke Watanabe MD, PhD , Masaki Izumo MD, PhD , Mike Saji MD, PhD , Shingo Mizuno MD , Kentaro Hayashida MD, PhD","doi":"10.1016/j.jacep.2025.09.028","DOIUrl":"10.1016/j.jacep.2025.09.028","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous echo contrast (SEC) with atrial fibrillation (AF) is known to increase stroke risk. However, the effect of SEC grades on outcomes after left atrial appendage closure (LAAC) remains unclear.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the impact of SEC grades on clinical outcomes after LAAC.</div></div><div><h3>Methods</h3><div>A total of 1,276 consecutive patients undergoing LAAC were analyzed. They were classified into SEC 0+, SEC 1/2+, and SEC 3/4+ groups based on preprocedural transesophageal echocardiography. Clinical outcomes were compared among the groups.</div></div><div><h3>Results</h3><div>There were 595 (46.6%), 509 (39.9%), and 172 (13.5%) patients in the SEC 0+, SEC 1/2+, and SEC 3/4+ groups, respectively. The SEC 3/4+ group (11.5%) had a higher ischemic stroke/transient ischemic attack/systemic embolism incidence than the SEC 0+ (4.4%; <em>P</em> = 0.009) and SEC 1/2+ (5.4%; <em>P</em> = 0.047) groups; SEC grade, however, was not a significant predictor in multivariate analysis. Compared with the SEC 0+ group (2.8%), both the SEC 1/2+ (8.4%; <em>P</em> < 0.001) and SEC 3/4+ (12.4%; <em>P</em> < 0.001) groups were associated with a higher risk of device-related thrombus (DRT). When SEC grade and AF type were combined for assessment, SEC 3/4+ with nonparoxysmal AF was associated with both thromboembolic events (adjusted HR: 2.52; 95% CI: 1.22-5.20; <em>P</em> = 0.013) and DRT (adjusted HR: 2.89; 95% CI: 1.50-5.60; <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>Patients with greater SEC grade displayed a higher incidence of thromboembolic events and DRT, and combined SEC grade and AF type independently predicted these events. Further research is needed regarding optimal treatment strategy in patients with severe SEC.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 277-290"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504210","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 : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.jacep.2025.10.003
Giuseppe Ciliberti MD, PhD , Joseph Westaby PhD , Gherardo Finocchiaro MD, PhD , Michael Papadakis MRCP, MD , Elijah R. Behr MA, MBBS , Sanjay Sharma BSc, MRCP, MD , Mary N. Sheppard MD
Background
Cardiac amyloidosis is an increasingly recognized condition in clinical practice. Its role in sudden cardiac death (SCD), particularly as a first manifestation, remains poorly characterized.
Objectives
The goal of this study was to assess the clinical and pathologic characteristics of SCD decedents with histologically confirmed cardiac amyloidosis in a large autopsy-based registry.
Methods
This study reviewed 8,107 SCD cases referred to a specialist cardiac pathology center between 1994 and 2023. SCD was defined as cardiovascular death within 12 hours of apparent well-being. Histologic confirmation of cardiac amyloidosis was based on Congo red positivity and apple-green birefringence under polarized light. Clinical history and autopsy findings were analyzed.
Results
Cardiac amyloidosis was identified in 33 cases (0.4%), with 26 (79%) responsible for SCD. Most decedents were male (64%) with a mean age of 67 ± 18 years; 18% were aged <50 years. Coronary amyloid infiltration was significantly more frequent among decedents whose SCD was attributed to cardiac amyloidosis compared with those in whom cardiac amyloidosis was identified as an incidental finding (69% vs 14%; P = 0.026). Despite antemortem cardiac symptoms being present in 39%, only 1 patient (3%) had a known cardiac amyloidosis diagnosis before death.
Conclusions
Cardiac amyloidosis can be associated with SCD and is often undiagnosed during life. Coronary infiltration may contribute to SCD risk.
{"title":"Antemortem Underdiagnosis of Cardiac Amyloidosis in Sudden Cardiac Death Victims","authors":"Giuseppe Ciliberti MD, PhD , Joseph Westaby PhD , Gherardo Finocchiaro MD, PhD , Michael Papadakis MRCP, MD , Elijah R. Behr MA, MBBS , Sanjay Sharma BSc, MRCP, MD , Mary N. Sheppard MD","doi":"10.1016/j.jacep.2025.10.003","DOIUrl":"10.1016/j.jacep.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac amyloidosis is an increasingly recognized condition in clinical practice. Its role in sudden cardiac death (SCD), particularly as a first manifestation, remains poorly characterized.</div></div><div><h3>Objectives</h3><div>The goal of this study was to assess the clinical and pathologic characteristics of SCD decedents with histologically confirmed cardiac amyloidosis in a large autopsy-based registry.</div></div><div><h3>Methods</h3><div>This study reviewed 8,107 SCD cases referred to a specialist cardiac pathology center between 1994 and 2023. SCD was defined as cardiovascular death within 12 hours of apparent well-being. Histologic confirmation of cardiac amyloidosis was based on Congo red positivity and apple-green birefringence under polarized light. Clinical history and autopsy findings were analyzed.</div></div><div><h3>Results</h3><div>Cardiac amyloidosis was identified in 33 cases (0.4%), with 26 (79%) responsible for SCD. Most decedents were male (64%) with a mean age of 67 ± 18 years; 18% were aged <50 years. Coronary amyloid infiltration was significantly more frequent among decedents whose SCD was attributed to cardiac amyloidosis compared with those in whom cardiac amyloidosis was identified as an incidental finding (69% vs 14%; <em>P</em> = 0.026). Despite antemortem cardiac symptoms being present in 39%, only 1 patient (3%) had a known cardiac amyloidosis diagnosis before death.</div></div><div><h3>Conclusions</h3><div>Cardiac amyloidosis can be associated with SCD and is often undiagnosed during life. Coronary infiltration may contribute to SCD risk.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 343-349"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564049","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 : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.jacep.2025.09.043
Tammy Ryan MD, PhD , Carlos A. Morillo MD , José Jalife MD, PhD
Aging is one of the most significant risk factors for the development of atrial fibrillation, and given our aging population, this is likely to present a major public health challenge in the coming years. Although the specific mechanisms underlying this association remain poorly understood, several biological processes including fibrosis, DNA damage, chromatin remodeling, amyloid deposition, mitochondrial dysfunction, and inflammation have been implicated in the structural and functional deterioration that leads to the development of atrial fibrillation. Herein, we review work from the last several years that has contributed to our understanding of the link between aging and atrial fibrillation with a focus on the basic pathophysiological mechanisms. We also outline areas for future research aimed at better characterizing this complex relationship.
{"title":"The Complex Interplay Between Aging, Cardiac Remodeling, and Atrial Fibrillation","authors":"Tammy Ryan MD, PhD , Carlos A. Morillo MD , José Jalife MD, PhD","doi":"10.1016/j.jacep.2025.09.043","DOIUrl":"10.1016/j.jacep.2025.09.043","url":null,"abstract":"<div><div>Aging is one of the most significant risk factors for the development of atrial fibrillation, and given our aging population, this is likely to present a major public health challenge in the coming years. Although the specific mechanisms underlying this association remain poorly understood, several biological processes including fibrosis, DNA damage, chromatin remodeling, amyloid deposition, mitochondrial dysfunction, and inflammation have been implicated in the structural and functional deterioration that leads to the development of atrial fibrillation. Herein, we review work from the last several years that has contributed to our understanding of the link between aging and atrial fibrillation with a focus on the basic pathophysiological mechanisms. We also outline areas for future research aimed at better characterizing this complex relationship.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 403-413"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564085","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}
Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited.
Objectives
This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF.
Methods
This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management.
Results
The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro–B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro–B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini–Mental State Examination and frailty scores. These benefits remained significant after adjustment.
Conclusions
The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies. (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly [REHEALTH AF]; UMIN000047023)
背景：关于导管消融治疗≥80岁非瓣膜性心房颤动（AF）的益处的证据仍然有限。目的：本研究旨在评估导管消融与保守治疗老年非瓣膜性房颤患者（≥80岁）的临床疗效。方法：这项前瞻性、基于登记的多中心观察性研究纳入了703例年龄≥80岁的非瓣膜性房颤患者，这些患者来自日本47家医院（2022年6月至2023年12月）。其中249例行导管消融治疗，454例行非消融治疗。结果：非消融术组年龄稍大，合并症较多，基线特征略差；然而，大多数是潜在的消融候选者，差异很小。在中位随访504天（Q1-Q3: 375-667天）期间，未匹配组（HR: 0.78; P = 0.30）和匹配组（HR: 0.65; P = 0.21）的主要结局（卒中、短暂性脑缺血发作、全身栓塞、心血管事件、出血或全因死亡的综合结果）之间没有差异。然而，在匹配的队列中，对数n端前b型利钠肽和白蛋白水平的多变量调整显示消融有显著的益处（调整后的HR: 0.44; P = 0.029）。1年时，消融改善了症状、生活质量、n端前b型利钠肽水平和左房内径，并更好地保存了迷你精神状态检查和虚弱评分。这些好处在调整后仍然显著。结论：REHEALTH房颤研究（评估高龄房颤导管消融后的健康预期寿命和长期结果登记）研究首次对≥80岁房颤患者进行了消融与非消融的前瞻性比较。尽管消融改善了房颤的功能和结构结果，但在没有调整的情况下，其预后获益有限，但在多变量校正后才出现。在精心挑选的老年患者中，消融术可能提供有意义的优势，支持个体化治疗策略。评估高龄房颤导管消融后的健康预期寿命和长期结果登记[REHEALTH AF]； UMIN000047023)。
{"title":"Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients","authors":"Shu Hirata MD , Yasuo Okumura MD , Koichi Nagashima MD , Ryuta Watanabe MD , Katsuaki Yokoyama MD , Naoya Matsumoto MD , Takeshi Kato MD , Hidehira Fukaya MD , Hidemori Hayashi MD , Shiro Nakahara MD , Wataru Shimizu MD , Yu-ki Iwasaki MD , Yuhi Fujimoto MD , Yasushi Mukai MD , Koichiro Ejima MD , Takayuki Otsuka MD , Shinya Suzuki MD , Masato Murakami MD , Masaomi Kimura MD , Masahide Harada MD , Kenta Murotani PhD","doi":"10.1016/j.jacep.2025.10.007","DOIUrl":"10.1016/j.jacep.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF.</div></div><div><h3>Methods</h3><div>This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management.</div></div><div><h3>Results</h3><div>The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; <em>P</em> = 0.30) or matched (HR: 0.65; <em>P</em> = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro–B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; <em>P</em> = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro–B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini–Mental State Examination and frailty scores. These benefits remained significant after adjustment.</div></div><div><h3>Conclusions</h3><div>The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies. (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly [REHEALTH AF]; <span><span>UMIN000047023</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 307-321"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603518","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 : 2026-02-01Epub Date: 2025-11-12DOI: 10.1016/j.jacep.2025.09.034
Jiahao Zheng MSc , Mathijs S. van Schie PhD , Lixia Dai MD , Paul Knops BSc , Jolanda Kluin MD, PhD , Yannick J.H.J. Taverne MD, PhD , Vadim V. Fedorov PhD , Natasja M.S. de Groot MD, PhD
Background
Electrical activity from the sino-atrial node (SAN) spreads via specific pathways into surrounding atrial tissue. Inferior sino-atrial node exit sites (SANi) have been observed in patients with structural heart disease and atrial fibrillation. However, determinants of preferential sino-atrial conduction pathways and the associated electrical properties of the SANi region remain poorly understood.
Objectives
This study sought to examine differences in unipolar potential morphology and the degree of remodeling at the right atrium (RA) between patients with superior sino-atrial node exit sites (SANs) and SANi.
Methods
High-resolution epicardial mapping was performed in 27 patients with structural heart disease undergoing elective open-heart surgery. Electrodes within an 8-mm radius of the SAN exit site were classified as the SAN area. Electrophysiological properties, including potential voltage, conduction block, and R/S ratios, were computed.
Results
SANi, identified in 7 patients, exhibited lower potential voltages (median: 1.3 [Q1-Q3: 1.2-1.7] vs 2.6 [Q1-Q3: 2.2-3.6] mV; P = 0.014) and unipolar rS-wave morphologies, whereas SANs had full S-wave morphologies. The total activation times of RA were prolonged in SANi patients (median: 89 [Q1-Q3: 79-98] vs 78 [Q1-Q3: 66-85] milliseconds; P = 0.046). Heart rates were comparable between groups and remained consistent during both the preoperative and intraoperative periods.
Conclusions
SANi identified by high-resolution epicardial mapping were associated with extensive RA remodeling and are most likely due to altered sino-atrial conduction pathways.
背景：窦房结（SAN）的电活动通过特定途径向周围心房组织扩散。下窦房结出口部位（SANi）在结构性心脏病和房颤患者中被观察到。然而，首选心房传导通路的决定因素和SANi区域的相关电特性仍然知之甚少。目的：本研究旨在探讨右心房单极电位形态和重构程度在有上窦房结出口部位（SANs）和有上窦房结出口部位（SANi）的患者之间的差异。方法：对27例接受择期心内直视手术的结构性心脏病患者进行高分辨率心外膜标测。在SAN出口位置的8mm半径内的电极被归类为SAN区域。计算电生理特性，包括电位电压、传导阻滞和R/S比。结果：7例SANi患者表现出较低的电位（中位数：1.3 [Q1-Q3: 1.2-1.7] vs 2.6 [Q1-Q3: 2.2-3.6] mV; P = 0.014）和单极rs波形态，而SANs则表现出完整的s波形态。SANi患者RA的总激活时间延长（中位数：89 [Q1-Q3: 79-98] vs 78 [Q1-Q3: 66-85]毫秒；P = 0.046）。两组之间的心率具有可比性，并且在术前和术中期间保持一致。结论：高分辨率心外膜测绘发现的SANi与广泛的RA重塑有关，并且很可能是由于窦房传导通路的改变。
{"title":"Inferior Sino-Atrial Node Exit Sites Are Associated With Electrical Remodeling","authors":"Jiahao Zheng MSc , Mathijs S. van Schie PhD , Lixia Dai MD , Paul Knops BSc , Jolanda Kluin MD, PhD , Yannick J.H.J. Taverne MD, PhD , Vadim V. Fedorov PhD , Natasja M.S. de Groot MD, PhD","doi":"10.1016/j.jacep.2025.09.034","DOIUrl":"10.1016/j.jacep.2025.09.034","url":null,"abstract":"<div><h3>Background</h3><div>Electrical activity from the sino-atrial node (SAN) spreads via specific pathways into surrounding atrial tissue. Inferior sino-atrial node exit sites (SAN<sub>i</sub>) have been observed in patients with structural heart disease and atrial fibrillation. However, determinants of preferential sino-atrial conduction pathways and the associated electrical properties of the SAN<sub>i</sub> region remain poorly understood.</div></div><div><h3>Objectives</h3><div>This study sought to examine differences in unipolar potential morphology and the degree of remodeling at the right atrium (RA) between patients with superior sino-atrial node exit sites (SAN<sub>s</sub>) and SAN<sub>i</sub>.</div></div><div><h3>Methods</h3><div>High-resolution epicardial mapping was performed in 27 patients with structural heart disease undergoing elective open-heart surgery. Electrodes within an 8-mm radius of the SAN exit site were classified as the SAN area. Electrophysiological properties, including potential voltage, conduction block, and R/S ratios, were computed.</div></div><div><h3>Results</h3><div>SAN<sub>i</sub>, identified in 7 patients, exhibited lower potential voltages (median: 1.3 [Q1-Q3: 1.2-1.7] vs 2.6 [Q1-Q3: 2.2-3.6] mV; <em>P</em> = 0.014) and unipolar rS-wave morphologies, whereas SAN<sub>s</sub> had full S-wave morphologies. The total activation times of RA were prolonged in SAN<sub>i</sub> patients (median: 89 [Q1-Q3: 79-98] vs 78 [Q1-Q3: 66-85] milliseconds; <em>P</em> = 0.046). Heart rates were comparable between groups and remained consistent during both the preoperative and intraoperative periods.</div></div><div><h3>Conclusions</h3><div>SAN<sub>i</sub> identified by high-resolution epicardial mapping were associated with extensive RA remodeling and are most likely due to altered sino-atrial conduction pathways.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 251-260"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504226","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 : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.jacep.2025.11.019
Arthur A.M. Wilde MD, PhD , Alexander J.A. Groffen PhD
{"title":"Phenotype-Enhanced Classification of Genetic Variants in Long QT Syndrome, Type 2","authors":"Arthur A.M. Wilde MD, PhD , Alexander J.A. Groffen PhD","doi":"10.1016/j.jacep.2025.11.019","DOIUrl":"10.1016/j.jacep.2025.11.019","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 360-362"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911486","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 : 2026-02-01Epub Date: 2026-02-23DOI: 10.1016/j.jacep.2025.11.028
Alexander H. Maass MD, PhD
{"title":"The Real Risk-Benefit Ratio of Contemporary Implantable Cardioverter-Defibrillator Therapy Remains Unknown","authors":"Alexander H. Maass MD, PhD","doi":"10.1016/j.jacep.2025.11.028","DOIUrl":"10.1016/j.jacep.2025.11.028","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 2","pages":"Pages 400-401"},"PeriodicalIF":7.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283627","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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