Journal of Cardiovascular Electrophysiology最新文献_第8页

Expanding the Biophysical Insights Into Esophageal Heating During Radiofrequency Ablation. 在射频消融过程中扩大食道加热的生物物理见解。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-12-02 DOI: 10.1111/jce.70213

Naoya Kataoka, Teruhiko Imamura

引用次数: 0

Correction to “The Single-Delayed-Phase Contrast Computed Tomography Before Ablation to Reduce Radiation Exposure Without Compromising Diagnostic Pulmonary Vein Accuracy” “消融前单次延迟相位对比计算机断层扫描减少辐射暴露而不影响肺静脉诊断准确性”的更正。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-12-02 DOI: 10.1111/jce.70206

In the main body, under the Result section (page 2344, paragraph 3.3), a value was reported with incorrect significant figures.

① Incorrect: “ …, with values of 0.63 ± 1.36 mm and 0.50 ± 1.2 mm for the coronal and axial planes, respectively.”

Correct: “…, with values of 0.63 ± 1.36 mm and 0.50 ± 1.18 mm for the coronal and axial planes, respectively.”

In connection with this, the relevant portion of Table 3 will also be corrected from 1.2 mm to 1.18 mm.

② Incorrect: “The mean differences for these veins were 0.88 ± 1.52 mm (LSPV), 0.65 ± 1.22 mm (LIPV), 0.68 ± 1.4 mm (RSPV), and 0.32 ± 1.2 mm (RIPV).”

Correct: “The mean differences for these veins were 0.88 ± 1.52 mm (LSPV), 0.65 ± 1.22 mm (LIPV), 0.68 ± 1.41 mm (RSPV), and 0.32 ± 1.20 mm (RIPV).”

③ Incorrect: “The corresponding mean differences were 0.32 ± 1.10 mm (LSPV),0.71 ± 1.22 mm (LIPV), 0.60 ± 1.1 mm (RSPV), and 0.38 ± 1.2 mm (RIPV).”

Correct: “The corresponding mean differences were 0.32 ± 1.10 mm (LSPV),0.71 ± 1.22 mm (LIPV), 0.60 ± 1.15 mm (RSPV), and 0.38 ± 1.17 mm (RIPV).”

④ Table 4 A contained errors in significant figures, and the relevant values have been corrected.

These corrections are for clarification and do not alter the main findings or conclusions of the study.

We apologize for these errors.

在正文中，在结果部分（第2344页，第3.3段）下，报告了一个有效数字不正确的值。①错误：“…，冠状面和轴向面分别为0.63±1.36 mm和0.50±1.2 mm。”正确：“…，冠状面和轴向面分别为0.63±1.36 mm和0.50±1.18 mm。”与此相关，表3的相关部分也将从1.2毫米修正为1.18毫米。②错误：“这些静脉的平均差异为0.88±1.52 mm (LSPV), 0.65±1.22 mm (LIPV), 0.68±1.4 mm （RSPV）和0.32±1.2 mm （RIPV）。”正确：这些静脉的平均差异为0.88±1.52 mm (LSPV), 0.65±1.22 mm (LIPV), 0.68±1.41 mm （RSPV）和0.32±1.20 mm （RIPV）。③错误：“相应的平均差值分别为0.32±1.10 mm （LSPV）、0.71±1.22 mm （LIPV）、0.60±1.1 mm （RSPV）、0.38±1.2 mm （RIPV）。”正确：相应的平均差异为0.32±1.10 mm (LSPV),0.71±1.22 mm (LIPV), 0.60±1.15 mm （RSPV）和0.38±1.17 mm （RIPV）。④表4a中有显著数字错误，相关数值已进行了修正。这些更正是为了澄清，不会改变研究的主要发现或结论。我们为这些错误道歉。

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引用次数: 0

Safety and Clinical Outcome of Subcutaneous Implantable Cardioverter-Defibrillators in an Asian Population: A Prospective Study 亚洲人群皮下植入式心律转复除颤器的安全性和临床结果：一项前瞻性研究。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-12-02 DOI: 10.1111/jce.70199

Karen Ka Ying Li, Chi Keong Ching, Azlan Hussin, Tachapong Ngarmukos, Joseph Y. S. Chan, Bo-Young Joung, Morio Shoda, Wei Hua, Abe Ho Ting Ngan, Hung-Fat Tse

Background

There is limited data on long-term safety and efficacy of subcutaneous implantable cardioverter defibrillator (S-ICD) in Asian patients with a lower body mass index (BMI) due to smaller body build.

Methods

We performed a 2 year prospective study in 5 Asian cities from May 2017 to May 2018 to investigate the safety and feasibility of S-ICD for primary or secondary prevention of sudden cardiac death in an Asian population.

Results

We enrolled 75 S-ICD recipients (77% males; age 49.6 ± 16.8 years) with a mean BMI of 24.6 ± 5.0 (range 15.9–40.9) with 67% (50/75) with BMI ≤ 23. The indications of S-ICD were primary and secondary prevention in 26 (35%) and 49 (65%) patients, respectively. Among them, 51 patients suffer from ischemic (30, 59%) or nonischemic (21, 41%) cardiomyopathy, and 25 patients have channelopathies. Their mean left ventricular ejection fraction was 44.4 ± 15.1%. All patients had successful S-ICD implantation with a mean procedural duration of 75.5 ± 28.1 min using conscious sedation in majority of patients (65/75, 87%); and defibrillation testing was performed in 62 patients (83%). After 2 years of follow-up, 8 patients developed serious adverse events, including 4 deaths (2 asystole, 1 sepsis, 1 myocardial infarction), 2 ventricular tachycardia storm, 1 pocket infection, and 1 lead failure requiring replacement. Both patients with ventricular tachycardia storm received appropriate shocks, and no patient developed inappropriate shocks.

Conclusions

S-ICD implantation for both primary and secondary prevention of sudden cardiac death was found to be safe in an Asian population, including those with a low BMI, and was associated with a low rate of device-related complications.

背景：由于体型较小，亚洲患者的体重指数（BMI）较低，关于皮下植入式心律转复除颤器（S-ICD）长期安全性和有效性的数据有限。方法：我们于2017年5月至2018年5月在5个亚洲城市进行了一项为期2年的前瞻性研究，以调查S-ICD在亚洲人群中用于一级或二级预防心源性猝死的安全性和可行性。结果：我们纳入75例S-ICD受者（77%为男性，年龄49.6±16.8岁），平均BMI为24.6±5.0（范围15.9-40.9），67% (50/75)BMI≤23。S-ICD的适应症为一级预防26例（35%），二级预防49例（65%）。其中缺血性（30.59%）或非缺血性（21.41%）心肌病51例，通道病变25例。平均左室射血分数为44.4±15.1%。所有患者均成功植入S-ICD，大多数患者使用清醒镇静，平均手术时间为75.5±28.1 min (65/ 75,87%)；62例（83%）患者行除颤试验。随访2年后，8例患者出现严重不良事件，包括4例死亡（2例心脏骤停，1例败血症，1例心肌梗死），2例室性心动过速风暴，1例袋感染，1例导联衰竭需要更换。两例室性心动过速风暴患者均接受了适当的电击，无患者发生不适当的电击。结论：S-ICD植入用于心脏性猝死的一级和二级预防在亚洲人群中是安全的，包括那些低BMI的人群，并且与器械相关并发症的发生率低相关。

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引用次数: 0

Deep Learning-Based Prediction Model for Cardiac Resynchronization Therapy Responders Using Electrocardiogram Data 基于心电图数据的心脏再同步化治疗应答者的深度学习预测模型。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-12-02 DOI: 10.1111/jce.70212

Hitoshi Mori, Yuya Fujisaki, Syunta Higuchi, Masataka Narita, Daisuke Kawano, Kazuhisa Matsumoto, Wataru Sasaki, Tsukasa Naganuma, Naomichi Tanaka, Kazuhiko Kuinose, Haruka Yamazaki, Hiroki Yamazaki, Wataru Yoshino, Toshiki Takeda, Yoshifumi Ikeda, Ritsushi Kato

Background

Cardiac resynchronization therapy (CRT) is an established treatment for advanced heart failure, but approximately 30% of patients fail to respond. This study aimed to develop and evaluate deep learning models using preimplantation electrocardiogram (ECG) data to predict CRT response.

Methods

We conducted a retrospective analysis of 285 patients who underwent CRT implantations and completed a 6-month follow-up. Responders were defined as those exhibiting ≥ 15% left ventricular end-systolic volume reduction. Three models were developed: ResNet-18 model trained on ECG images, self-supervised learning (SSL) enhanced ResNet-18 model, and LightGBM model trained on time-series ECG data. Model performance was evaluated using accuracy, positive predictive value (PPV), and negative predictive value (NPV), averaged across 10 random seeds. Model interpretability using Gradient-weighted Class Activation Mapping (Grad-CAM) was performed on 36 responder cases.

Results

The SSL + ResNet-18 model demonstrated the most stable performance (accuracy 78.5% ± 5.5%) and PPV of 81.3%. The ResNet-18 model achieved the highest PPV of 84.2% but had lower accuracy (74.1%) and larger variability. The LightGBM model exhibited the highest accuracy (79.4%) but the lowest PPV at 72.8%. Grad-CAM showed that precordial leads were highlighted in 13 cases (36.1%), limb leads in 16 (44.4%), and both regions in 7 (19.4%), indicating heterogeneity in the model's focus and potential diversity in the electrical features contributing to CRT response prediction.

Conclusion

AI models using preimplantation ECG data, particularly those based on image inputs, can effectively predict CRT responders. This approach may enhance patient selection and support personalized therapy strategies in CRT management.

背景：心脏再同步化治疗（CRT）是晚期心力衰竭的既定治疗方法，但大约30%的患者没有反应。本研究旨在开发和评估使用植入前心电图（ECG）数据来预测CRT反应的深度学习模型。方法：我们对285例接受CRT植入的患者进行了回顾性分析，并完成了6个月的随访。应答者被定义为左心室收缩末期容积减少≥15%的患者。开发了三种模型：基于心电图像训练的ResNet-18模型、基于时间序列心电数据训练的自监督学习（SSL）增强ResNet-18模型和LightGBM模型。通过10个随机种子的平均准确率、正预测值（PPV）和负预测值（NPV）来评估模型的性能。使用梯度加权类激活映射（Grad-CAM）对36例应答者进行模型可解释性分析。结果：SSL + ResNet-18模型最稳定，准确率为78.5%±5.5%，PPV为81.3%。ResNet-18模型的PPV最高，为84.2%，但准确率较低（74.1%），变异性较大。LightGBM模型的准确率最高（79.4%），但PPV最低（72.8%）。grada - cam显示，心前导联突出13例（36.1%），肢体导联突出16例（44.4%），两个区域突出7例（19.4%），表明模型焦点的异质性和电特征的潜在多样性有助于CRT反应预测。结论：基于植入前心电数据的人工智能模型，特别是基于图像输入的人工智能模型，可以有效预测CRT应答者。这种方法可以增强患者的选择，并支持CRT管理中的个性化治疗策略。

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引用次数: 0

Outcomes of Ventricular Tachycardia Ablation in Cardiac Laminopathy: An Updated Systematic Review and Single-Arm Meta-Analysis 心脏层压病室性心动过速消融的结果：最新的系统评价和单组荟萃分析。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-12-02 DOI: 10.1111/jce.70193

Matteo Castrichini, Iuri Ferreira Felix, Vanessa Karlinski Vizentin, Ramin Garmany, Trung Huynh, Ikram U. Haq, Will H. Swain, Konstantinos C. Siontis, Ammar M. Killu, Abhishek J. Deshmukh, Michael J. Ackerman, John R. Giudicessi

Background

Ventricular tachycardia (VT) is a life-threatening arrhythmia frequently observed in structural heart diseases, including LMNA-related cardiomyopathy, a genetic disorder associated with high risk of sudden cardiac death and progressive systolic dysfunction. While catheter ablation is an established therapeutic option for VT, its efficacy in cardiac laminopathy remains poorly defined.

Objectives

To synthesize available evidence on the role and outcomes of VT ablation in patients with cardiac laminopathy.

Methods

A systematic review and single-arm meta-analysis was performed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for studies reporting VT ablation outcomes in LMNA-related cardiomyopathy. An inverse variance random-effects model was applied for meta-analysis of proportions.

Results

Seven studies (six cohorts, one abstract) comprising 62 patients (mean age 53.2 ± 9.7 years; 85% male; 88% with implantable cardioverter-defibrillator) were included. An endocardial/endo-epicardial approach was used in 93% of cases. Acute procedural success was achieved in 37% (95% CI: 14%–63%; I² = 27.4%), and 28% required multiple procedures. Over a median follow-up of 26 (9–35) months, VT recurrence occurred in 91% (95% CI: 76%–100%; I² = 37.2%). All-cause mortality was 54% (95% CI: 39%–70%; I² = 28%), predominantly from cardiac causes (51%, 95% CI: 25%–76%; I² = 53%), and 14% (95% CI: 1%–34%; I² = 42%) underwent heart transplantation.

Conclusions

In LMNA-related cardiomyopathy, catheter ablation is associated with high VT recurrence, limited long-term success, and substantial cardiovascular mortality and transplantation rates, underscoring the importance of ICD implantation and the need for alternative strategies, including variant-specific and molecularly targeted therapies.

背景：室性心动过速（VT）是一种常见于结构性心脏病的危及生命的心律失常，包括lmna相关性心肌病，一种与心源性猝死和进行性收缩功能障碍高风险相关的遗传性疾病。虽然导管消融是VT的一种确定的治疗选择，但其对心脏板层病的疗效仍不明确。目的：综合现有的关于室速消融在心脏板层病患者中的作用和结果的证据。方法：根据PRISMA指南进行系统评价和单臂荟萃分析。检索PubMed、Embase和Cochrane数据库，寻找报道lmna相关心肌病的室速消融结果的研究。采用逆方差随机效应模型对比例进行meta分析。结果：纳入7项研究（6个队列，1个摘要），包括62例患者（平均年龄53.2±9.7岁，85%为男性，88%为植入式心律转复除颤器）。93%的病例采用心内膜/心外膜内入路。急性手术成功率为37% (95% CI: 14%-63%; I²= 27.4%)，28%需要多次手术。在26（9-35）个月的中位随访中，91%的VT复发率（95% CI: 76%-100%; I²= 37.2%）。全因死亡率为54% (95% CI: 39%-70%; I²= 28%)，主要来自心脏原因（51%,95% CI: 25%-76%; I²= 53%）和14% （95% CI: 1%-34%; I²= 42%）的心脏移植。结论：在lmna相关性心肌病中，导管消融与高VT复发率、有限的长期成功、大量心血管死亡率和移植率相关，强调了ICD植入的重要性和替代策略的必要性，包括变异特异性和分子靶向治疗。

{"title":"Outcomes of Ventricular Tachycardia Ablation in Cardiac Laminopathy: An Updated Systematic Review and Single-Arm Meta-Analysis","authors":"Matteo Castrichini, Iuri Ferreira Felix, Vanessa Karlinski Vizentin, Ramin Garmany, Trung Huynh, Ikram U. Haq, Will H. Swain, Konstantinos C. Siontis, Ammar M. Killu, Abhishek J. Deshmukh, Michael J. Ackerman, John R. Giudicessi","doi":"10.1111/jce.70193","DOIUrl":"10.1111/jce.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular tachycardia (VT) is a life-threatening arrhythmia frequently observed in structural heart diseases, including LMNA-related cardiomyopathy, a genetic disorder associated with high risk of sudden cardiac death and progressive systolic dysfunction. While catheter ablation is an established therapeutic option for VT, its efficacy in cardiac laminopathy remains poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To synthesize available evidence on the role and outcomes of VT ablation in patients with cardiac laminopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and single-arm meta-analysis was performed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for studies reporting VT ablation outcomes in LMNA-related cardiomyopathy. An inverse variance random-effects model was applied for meta-analysis of proportions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies (six cohorts, one abstract) comprising 62 patients (mean age 53.2 ± 9.7 years; 85% male; 88% with implantable cardioverter-defibrillator) were included. An endocardial/endo-epicardial approach was used in 93% of cases. Acute procedural success was achieved in 37% (95% CI: 14%–63%; I² = 27.4%), and 28% required multiple procedures. Over a median follow-up of 26 (9–35) months, VT recurrence occurred in 91% (95% CI: 76%–100%; I² = 37.2%). All-cause mortality was 54% (95% CI: 39%–70%; I² = 28%), predominantly from cardiac causes (51%, 95% CI: 25%–76%; I² = 53%), and 14% (95% CI: 1%–34%; I² = 42%) underwent heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In LMNA-related cardiomyopathy, catheter ablation is associated with high VT recurrence, limited long-term success, and substantial cardiovascular mortality and transplantation rates, underscoring the importance of ICD implantation and the need for alternative strategies, including variant-specific and molecularly targeted therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 2","pages":"268-274"},"PeriodicalIF":2.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Utility Analysis of Left Bundle Branch Area Versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Multicenter, Prospective, Quasi-Experimental Study 心脏再同步化治疗中左束分支面积与双室起搏的成本-效用分析：一项多中心、前瞻性、准实验研究。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-11-30 DOI: 10.1111/jce.70202

José M. Sánchez-Moreno, Leticia García-Mochón, Manuel Molina-Lerma, Guillermo Gutiérrez-Ballesteros, Manuel Frutos-López, Ricardo Pavón-Jiménez, M. C. Olvera-Porcel, Juan Jiménez-Jáimez, Miguel Álvarez

Introduction

Cardiac resynchronization therapy (CRT) is a well-established treatment for patients with heart failure (HF). Recently, left bundle branch area pacing (LBBAP) has emerged as a more physiological alternative to biventricular pacing (BVP) for CRT. This study aimed to evaluate the cost-utility of LBBAP CRT compared with BVP CRT.

Methods

A cost-utility, non-randomized, prospective, multicenter, quasi-experimental study was performed in four referral centers. Patients eligible for CRT were treated with LBBAP or BVP, depending on the participating center. The primary health outcome was quality-adjusted life years (QALYs) measured using the EQ-5D-5L questionnaire, and the analysis considered the cost of the implant and all procedure-related events over the 12-month follow-up. Clinical outcomes were also evaluated.

Results

Sixty-two consecutive patients were included (42 LBBAP CRT and 20 BVP CRT). Clinical outcomes were similar in both groups. The incremental cost-utility analysis showed that LBBAP CRT generated an average cost saving of €2391.02 per patient compared with BVP (95% CI −330.28 to 5112.69), while providing an incremental gain of 0.07 QALYs (95% CI −0.03 to 0.16).

Conclusions

LBBAP CRT could be an efficient alternative to BVP CRT for cardiac resynchronization with similar clinical and QALY outcomes but potentially significant average cost savings per patient.

心脏再同步化治疗（CRT）是治疗心力衰竭（HF）的一种行之有效的方法。近年来，左束支区起搏（LBBAP）已成为CRT中比双室起搏（BVP）更具有生理性的替代方法。本研究旨在比较LBBAP CRT与BVP CRT的成本-效用。方法：在四个转诊中心进行了一项成本-效用、非随机、前瞻性、多中心、准实验研究。根据参与中心的不同，符合CRT条件的患者接受LBBAP或BVP治疗。主要健康结局是使用EQ-5D-5L问卷测量质量调整生命年（QALYs），分析考虑了植入物的成本和12个月随访期间的所有手术相关事件。临床结果也进行了评估。结果：连续纳入62例患者（LBBAP CRT 42例，BVP CRT 20例）。两组临床结果相似。增量成本-效用分析显示，与BVP相比，LBBAP CRT平均为每位患者节省了2391.02欧元的成本（95% CI -330.28至5112.69），同时提供了0.07个qaly的增量收益（95% CI -0.03至0.16）。结论：LBBAP CRT可能是心脏再同步化的有效替代BVP CRT，具有相似的临床和QALY结果，但可能显着节省每位患者的平均成本。

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引用次数: 0

Outcomes of Focused Double Extrastimuli Mapping and Ablation in Ventricular Tachycardia 聚焦双刺激标测和消融治疗室性心动过速的结果。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-11-26 DOI: 10.1111/jce.70196

Surachat Jaroonpipatkul, Andrea N. Keithler, Thipsukhon Sathapanasiri, Harikrishna Tandri, T. Jared Bunch, Ravi Ranjan, Klitos Konstantinidis

Background

Conventional substrate mapping for scar-related ventricular tachycardia (VT) often fails to fully delineate critical arrhythmogenic components. Functional mapping strategies using extrastimuli have shown promise but are limited by procedural complexity.

Methods

In total, 57 patients undergoing VT ablation between March 2023 and October 2024 were included in the study. Patients were grouped based on whether targeted double extrastimuli mapping (focused DEMAP) was used to guide mapping and ablation. Mapping was performed using EnSite X with omnipolar technology. Clinical and procedural outcomes were compared between focused DEMAP and non-DEMAP groups with outcomes follow-up at 12 months.

Results

Focused DEMAP revealed a significantly higher correlation between DZs and VT critical isthmuses compared to sinus rhythm mapping (75.9% vs. 37.1%, p = 0.01). VT-free survival at 12 months was higher in the DEMAP group (88.03%) than in the non-DEMAP group (58.10%, p = 0.04). Trends also favored DEMAP in reducing cardiovascular hospitalization (10.55% vs. 24.70%) and mortality, though not statistically significant. Overall procedure time was similar mainly driven by less time during ablation and a lower mean ablated area in the focused DEMAP group compared to the non-DEMAP group.

Conclusion

The focused DEMAP, a focused double extrastimulus mapping strategy, enhances VT substrate identification and is associated with improved VT-free survival without prolonging procedure time. This approach may refine substrate-based ablation and optimize lesion targeting without increasing procedural burden.

背景：疤痕相关室性心动过速（VT）的传统底物映射通常不能完全描述关键的致心律失常成分。使用外刺激的功能映射策略已经显示出前景，但受到程序复杂性的限制。方法：共纳入2023年3月至2024年10月期间接受VT消融的57例患者。根据是否使用靶向双刺激外标测（聚焦DEMAP）来指导标测和消融，对患者进行分组。使用EnSite X全极技术进行制图。比较重点DEMAP组和非DEMAP组的临床和手术结果，随访12个月。结果：与窦性心律测图相比，聚焦DEMAP显示DZs与VT临界峡部的相关性显著更高（75.9% vs. 37.1%, p = 0.01）。DEMAP组12个月无vt生存率（88.03%）高于非DEMAP组（58.10%,p = 0.04）。趋势也有利于DEMAP降低心血管住院率（10.55%对24.70%）和死亡率，尽管没有统计学意义。总体手术时间相似，主要是由于与非DEMAP组相比，DEMAP组的消融时间更短，平均消融面积更小。结论：聚焦DEMAP是一种聚焦的双外刺激定位策略，可以增强VT底物识别，并在不延长手术时间的情况下改善无VT生存。这种方法可以在不增加手术负担的情况下改进基底消融和优化病灶定位。

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引用次数: 0

Induction Test-Guided Ablation Improves Clinical Outcomes in Recurrent Atrial Fibrillation and Durable Pulmonary Vein Isolation 诱导试验引导消融改善复发性心房颤动和持久肺静脉隔离的临床结果。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-11-25 DOI: 10.1111/jce.70205

Yasuyuki Egami, Taichi Mukai, Mikako Kise, Noriyuki Kobayashi, Ayako Sugino, Masaru Abe, Hiroaki Nohara, Shodai Kawanami, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masamichi Yano, Masami Nishino

Background

In patients with recurrent atrial fibrillation (AF) despite durable pulmonary vein isolation (PVI), the optimal catheter ablation (CA) strategy remains unclear. Non-pulmonary vein (non-PV) foci contribute to AF recurrence, whereas the benefit of empirical posterior wall isolation (PWI) is inconsistent.

Objective

To compare an induction test-guided ablation strategy with empirical PWI in patients with recurrent AF and durable PVI.

Methods

We retrospectively analyzed 99 patients undergoing repeat CA with durable PVI, allocated to an induction test-guided ablation group (IT, n = 59) and an empirical PWI group (emp-PWI, n = 40). In the IT group, non-PV foci were identified and ablated. If ablation failed or no foci were induced, PWI was performed (IT-PWI subgroup); successful elimination of non-PV foci defined the IT-SE subgroup. The primary outcome was freedom from AF recurrence at 12 months. To minimize selection bias, we performed propensity score matching (PSM) using logistic regression and 1:1 nearest-neighbor matching with a caliper of 0.2.

Results

In unmatched cohort, AF-free survival was higher with IT versus emp-PWI (75% vs. 56%; HR 2.3, 95% CI 1.13–4.52; p = 0.021). This advantage persisted after PSM (log-rank p = 0.016; HR 3.0, 95% CI 1.17–7.68; p = 0.022). Among the IT group, outcomes were similar between the IT-SE and IT-PWI subgroups (78% vs. 72%, p = 0.613). In the IT-PWI subgroup, residual non-PV foci were associated with higher recurrence (p = 0.023).

Conclusions

In recurrent AF despite durable PVI, an induction test-guided ablation strategy was associated with greater freedom from AF recurrence compared to empirical PWI and this association remained after PSM.

背景：在持续肺静脉隔离（PVI）的复发性心房颤动（AF）患者中，最佳导管消融（CA）策略尚不清楚。非肺静脉（non-PV）病灶导致房颤复发，而经验性后壁隔离（PWI）的益处并不一致。目的：比较诱导试验引导消融策略与经验PWI治疗复发性房颤和持续性PVI患者的疗效。方法：回顾性分析99例伴有持续性PVI的重复CA患者，分为诱导试验引导消融组（IT, n = 59）和经验PWI组（emp-PWI, n = 40）。在IT组中，非pv病灶被识别并消融。若消融失败或未诱导病灶，则行PWI检查（IT-PWI亚组）；成功消除非pv焦点定义了IT-SE子组。主要终点为12个月无房颤复发。为了最大限度地减少选择偏差，我们使用逻辑回归和1:1最近邻匹配进行倾向得分匹配（PSM），卡尺为0.2。结果：在未匹配的队列中，与emp-PWI相比，IT患者无af生存率更高（75% vs. 56%; HR 2.3, 95% CI 1.13-4.52; p = 0.021）。这种优势在PSM后持续存在（log-rank p = 0.016; HR 3.0, 95% CI 1.17-7.68; p = 0.022）。在IT组中，IT- se和IT- pwi亚组之间的结果相似（78%对72%，p = 0.613）。在IT-PWI亚组中，残留的非pv灶与较高的复发率相关（p = 0.023）。结论：在持续PVI的复发性房颤中，与经验PWI相比，诱导试验引导的消融策略与房颤复发的自由度更大相关，并且这种相关性在PSM后仍然存在。

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引用次数: 0

Propensity-Matched Five-Year Cardiac Resynchronization Therapy Outcomes in Sarcoidosis With Heart Failure 结节病合并心力衰竭患者5年心脏再同步化治疗结果的倾向匹配

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-11-24 DOI: 10.1111/jce.70204

Yong Hao Yeo, Tze Ern Ong, Aravinthan Vignarajah, Min Choon Tan, Nishanthi Vigneswaramoorthy, Luis Scott, Hicham El-Masry, Dan Sorajja, Abhishek Deshmukh, Christopher V. DeSimone, Justin Z. Lee

Introduction

Cardiac resynchronization therapy (CRT) improves clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, data on its efficacy in patients with sarcoidosis and HFrEF are limited.

Methods

Using the TriNetX network, we identified patients with sarcoidosis, heart failure with a left ventricular ejection fraction (LVEF) below 35%, and either left bundle branch block (LBBB) or prolonged QRS duration ( > 150 ms) between 2014 and 2019. Patients were categorized into two cohorts: (1) those who received CRT and (2) those who received an ICD-only implant. Five-year outcomes included all-cause mortality, all-cause hospitalization, heart failure exacerbation, and the proportion of patients with improvement in LVEF to greater than 40% and greater than 50%.

Results

Out of 245 eligible patients, we identified a cohort of 87 patients (mean age 62.6 ± 9.5 years) who received CRT and 87 patients (mean age 62.1 ± 11.1 years) who received ICD-only implant, with similar propensity scores, and included them in a comparative analysis. At 5-year follow-up, the CRT group demonstrated outcomes comparable to the ICD-only implant group for all-cause mortality (14.9% vs. 20.7%; HR 0.63; 95% CI 0.31–1.28; p = 0.19), all-cause hospitalization (83.9% vs. 77.0%; HR 1.24; 95% CI 0.89–1.73; p = 0.19), and heart failure exacerbation (28.7% vs. 28.7%; HR 0.90; 95% CI 0.52–1.57; p = 0.72). The proportion of patients with improvement in LVEF to greater than 40% and greater than 50% was also similar in both groups (LVEF > 40%, 43.7% vs. 33.3%; HR 1.30; 95% CI 0.80–2.10; p = 0.29; LVEF > 50%, 31.0% vs. 17.2%; HR 1.72; 95% CI 0.92–3.24; p = 0.09).

Conclusion

CRT implantation had similar long-term outcomes compared to ICD-only implantation in patients with sarcoidosis and HFrEF, particularly all-cause mortality, all-cause hospitalization, heart failure exacerbation, and the proportion of patients with improvement in LVEF to greater than 40% and greater than 50%.

心脏再同步化治疗（CRT）改善了心力衰竭伴射血分数降低（HFrEF）患者的临床结果。然而，关于其对结节病和HFrEF患者疗效的数据有限。方法：使用TriNetX网络，我们确定了2014年至2019年期间结节病，左心室射血分数（LVEF）低于35%的心力衰竭，左束支传导阻滞（LBBB）或QRS持续时间延长（> 150 ms）的患者。患者被分为两组：(1)接受CRT的患者和(2)只接受icd植入的患者。5年结局包括全因死亡率、全因住院、心力衰竭加重、LVEF改善患者比例分别大于40%和大于50%。结果：在245例符合条件的患者中，我们确定了87例接受CRT的患者（平均年龄62.6±9.5岁）和87例接受仅icd植入的患者（平均年龄62.1±11.1岁），倾向评分相似，并将他们纳入比较分析。在5年随访中，CRT组在全因死亡率（14.9% vs. 20.7%; HR 0.63; 95% CI 0.31-1.28; p = 0.19）、全因住院（83.9% vs. 77.0%; HR 1.24; 95% CI 0.89-1.73; p = 0.19）和心力衰竭加重（28.7% vs. 28.7%; HR 0.90; 95% CI 0.52-1.57; p = 0.72）方面的结果与仅icd植入组相当。两组患者LVEF改善至40%以上和50%以上的比例也相似（LVEF > 40%， 43.7%比33.3%;HR 1.30; 95% CI 0.80-2.10; p = 0.29; LVEF > 50%， 31.0%比17.2%;HR 1.72; 95% CI 0.92-3.24; p = 0.09）。结论：在结节病和HFrEF患者中，CRT植入术与单纯icd植入术的远期预后相似，尤其是全因死亡率、全因住院率、心力衰竭加重率，LVEF改善患者比例分别大于40%和大于50%。

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引用次数: 0

Treatment Options, Regulatory Pathways and Global Patterns of Use for Cardiac Implantable Devices in Patients With Titanium Allergy 钛过敏患者心脏植入装置的治疗选择、调节途径和全球使用模式

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology

Pub Date : 2025-11-24 DOI: 10.1111/jce.70195

Rahul Devathu, Kushal Chatterjee, Erick Godinez, Samhith Kambampati, Daniel Joseph Gonzalez, Michael H. Kim, Jiaqi Li, Ishan Paranjpe, Muhammad Fazal, Rachel Brucker, Tina Baykaner

Background

Titanium hypersensitivity is an uncommon but important challenge in patients requiring cardiac implantable electronic devices (CIEDs). Reactions are difficult to predict, often mimic infection, and complicate timely diagnosis.

Methods

We reviewed diagnostic considerations, therapeutic strategies, regulatory pathways, and global distribution of coated devices. Data sources included prior case reports, regulatory guidelines, and industry distribution records.

Results

Management options range from conservative observation to prophylactic implantation of hypoallergenic devices. Gold-coated and polymer-coated alternatives are effective but constrained by production costs, lack of reimbursement, and limited availability. In the United States, access is possible through custom device and compassionate use pathways, both requiring extensive regulatory approvals. Globally, most requests originate from the U.S. and Europe, with fewer from other regions due to economic and cultural barriers.

Conclusions

Improved awareness, streamlined regulatory frameworks, and multidisciplinary collaboration are essential to expand access and optimize outcomes for patients with titanium hypersensitivity.

背景：钛过敏是一种罕见但重要的挑战，患者需要心脏植入式电子装置（cied）。这些反应很难预测，常常模仿感染，并使及时诊断复杂化。方法：我们回顾了涂层装置的诊断考虑、治疗策略、调节途径和全球分布。数据来源包括以前的病例报告、监管指南和行业分布记录。结果：治疗选择从保守观察到预防性植入低过敏性装置。金涂层和聚合物涂层替代品是有效的，但受到生产成本、缺乏偿还和有限可用性的限制。在美国，可以通过定制设备和同情使用途径获得，这两种途径都需要广泛的监管批准。在全球范围内，大多数请求来自美国和欧洲，由于经济和文化障碍，来自其他地区的请求较少。结论：提高认识、简化监管框架和多学科合作对于扩大钛过敏患者的可及性和优化结果至关重要。

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引用次数: 0