Author + information
- David J. Wilber, MD, FACC, Editor-in-Chief, JACC: Clinical Electrophysiology∗ ()
- ↵∗Address correspondence to:
Dr. David J. Wilber, Editor-in-Chief, JACC: Clinical Electrophysiology, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
The editorial leadership of JACC: Clinical Electrophysiology believes that one important role for this journal is to provide a forum for evolving concepts and to encourage the exploration of incompletely characterized domains in our understanding of the mechanisms and optimal clinical management of cardiac arrhythmias. To that end, we take this opportunity to introduce a new feature of our journal, the Mini-Focus issue, which will be published 2 to 3 times annually. This feature will be incorporated into the regularly scheduled issues of the journal, and it will consist of 3 or more original research papers and invited commentary on topics of interest and importance to the field. The focus areas for the upcoming year are “Ventricular Arrhythmias in Patients with LVADs” and “Global AF Mapping for Identifying Sustaining Mechanisms and Ablation Targets.”
Left ventricular assist devices (LVADs) have become an increasingly viable and available option for treatment of patients with end-stage heart failure, both as a bridge-to-transplant or recovery, and as destination therapy. The frequency of sustained ventricular arrhythmias and their influence on outcomes was recognized early in the first and second INTERMACS (Interagency Registry for Mechanical Circulatory Support) reports in 2008 and 2010. Since that time, additional data regarding optimal management strategies, including the role of implantable defibrillators and catheter ablation, have become available. Limited information has been published regarding the genesis and origin of these arrhythmias and the potential role of the LVAD in aggravating or ameliorating their occurrence and effect. However, much remains incompletely explored, including the effectiveness of antiarrhythmic interventions in this population and the timing and coordination of these procedures with LVAD implantation.
Our understanding of the sustaining mechanisms for atrial fibrillation, and the best approaches for ablation of this arrhythmia as the clinical manifestations of this disease unfold, continues to evolve. On the mechanistic side, the early view of atrial fibrillation (AF) as a critical number of random self-perpetuating re-entrant wavelets propagating through heterogeneous atrial tissue has been challenged by recent experimental and clinical observations that AF can be maintained by a small number of repetitive focal sources (rotors or focal impulses) that produce disorganized global activation when rapid impulses cannot be uniformly propagated. Of importance, these sources may be localized to relatively discrete anatomic areas that differ between patients but remain stable or repeat in the same areas for each individual. There is also growing evidence that many widely used ablation strategies beyond pulmonary vein isolation (linear lesions, electrogram-based ablation) have limited efficacy in improving long-term outcomes. Strategies for global mapping of AF to identify focal sustaining sources, both from body surface mapping and endocardially based multielectrode baskets, have been recently introduced into clinical practice. The feasibility of targeting these sources for ablation has been demonstrated. However, there is a wealth of unanswered questions regarding the underlying causes for site-specific localization of AF drivers, and there is controversy regarding the long-term efficacy of ablation guided by these concepts.
We invite the readership of JACC: Clinical Electrophysiology and members of the electrophysiology community to take up the challenge by addressing some of these knowledge gaps, contributing to our understanding of underlying pathophysiology, and paving the way to better outcomes and quality of life for our patients afflicted with these disorders.
Specific inquiries or concerns regarding the Mini-Focus issues can be directed to the Editorial Board or journal staff at.”
- American College of Cardiology Foundation