Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Atrial Topology for a Unified Understanding of Typical and Atypical Flutter.","authors":"Mattias Duytschaever, Robin Van den Abeele, Niels Carlier, Arthur Santos Bezerra, Bjorn Verstraeten, Sebastiaan Lootens, Karel Desplenter, Arstanbek Okenov, Timur Nezlobinsky, Dipen Shah, Annika Haas, Armin Luik, Jordi Martens, Milad El Haddad, Maarten De Smet, Benjamin De Becker, Clara Francois, Jean-Benoit Le Polain de Waroux, Rene Tavernier, Sebastien Knecht, Sander Hendrickx, Nele Vandersickel","doi":"10.1161/CIRCEP.124.013102","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.013102","url":null,"abstract":"<p><strong>Background: </strong>Macroreentry stands as the predominant mechanism of typical and atypical flutter. Despite advances in mapping, many aspects of macroreentrant atrial tachycardia remain unsolved. In this translational study, we applied principles of topology to understand the activation patterns, entrainment characteristics, and ablation responses in a large clinical macroreentrant atrial tachycardia database.</p><p><strong>Methods: </strong>Because the atrium can be topologically seen as a closed sphere with holes, we used a computational fixed spherical mesh model with a finite number of holes to induce and analyze macroreentrant atrial tachycardia. The ensuing insights were used to interpret high-density activation maps, postpacing interval-tachycardia cycle length values (difference between postpacing interval and tachycardia cycle length), and ablation response in 131 cases of typical and atypical flutter (n=106 left atrium, n=25 right atrium).</p><p><strong>Results: </strong>Modeling of macroreentrant atrial tachycardia revealed that reentry on closed surfaces consistently manifests itself as paired rotation and that an odd number of critical boundaries is mathematically impossible. Together with mathematical confirmation by the index theorem, this led to a unifying construct that could explain the number of loops, difference between postpacing interval and tachycardia cycle length values, and ablation outcomes (termination, no change, or prolongation in tachycardia cycle length) in all 131 cases.</p><p><strong>Conclusions: </strong>Combining topology with the index theorem offers a novel and cohesive framework for understanding and managing typical and atypical flutter.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575499","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}

{"title":"Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.","authors":"Jonathan P Piccini, Evan J Stanelle, Cody C Johnson, Elaine M Hylek, Rahul Kanwar, Dhanunjaya R Lakkireddy, Suneet Mittal, James Peacock, Andrea M Russo, Dana Soderlund, Mellanie True Hills, Rod S Passman","doi":"10.1161/CIRCEP.123.012394","DOIUrl":"https://doi.org/10.1161/CIRCEP.123.012394","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with an increased risk of stroke, yet the limitations of conventional monitoring have restricted our understanding of AF burden risk thresholds. Predictive algorithms incorporating continuous AF burden measures may be useful for predicting stroke. This study evaluated the performance of temporal AF burden trends as predictors of stroke from a large cohort with insertable cardiac monitors.</p><p><strong>Methods: </strong>Using deidentified data from Optum Clinformatics Data Mart (2007-2019) linked with the Medtronic CareLink insertable cardiac monitor database, we identified patients with an insertable cardiac monitor for AF management (n=1197), suspected AF (n=1611), and cryptogenic stroke (n=2205). Daily AF burden was transformed into simple moving averages, and temporal AF burden trends were defined as the comparison of unique simple moving average pairs. Classification trees were used to predict ischemic stroke, and AF burden significance was quantified using bootstrapped mean variable importance.</p><p><strong>Results: </strong>Of 5013 patients (age, 69.2±11.7 years; 50% male; CHA₂DS₂-VASc, 3.7±1.9) who met inclusion criteria, 869 had an ischemic stroke over 2 409 437 days total follow-up. Prior stroke or transient ischemic attack (variable importance, 13.13) was the number 1 predictor of future stroke followed by no prior diagnosis of AF (7.35) and AF burden trends in follow-up (2.59). Temporal proximity of AF and risk of stroke differed by device indication (simple moving averages: AF management, <8 days and suspected AF and cryptogenic stroke, 8-21 days). Together, baseline characteristics and AF burden trends performed optimally for the area under the receiver operating characteristic curve (0.73), specificity (0.70), and relative risk (5.00).</p><p><strong>Conclusions: </strong>AF burden trends may provide incremental prognostic value as leading indicators of stroke risk compared with conventional schemes.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496198","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}

{"title":"Using Atrial Fibrillation Burden Trends and Machine Learning to Predict Near-Term Risk of Cardiovascular Hospitalization.","authors":"James Peacock, Evan J Stanelle, Lawrence C Johnson, Elaine M Hylek, Rahul Kanwar, Dhanunjaya R Lakkireddy, Suneet Mittal, Rod S Passman, Andrea M Russo, Dana Soderlund, Mellanie True Hills, Jonathan P Piccini","doi":"10.1161/CIRCEP.124.012991","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.012991","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation is associated with an increased risk of cardiovascular hospitalization (CVH), which may be triggered by changes in daily burden. Machine learning of dynamic trends in atrial fibrillation burden, as measured by insertable cardiac monitors (ICMs), may be useful in predicting near-term CVH.</p><p><strong>Methods: </strong>Using Optum's deidentified Clinformatics Data Mart Database (2007-2019), linked with the Medtronic CareLink ICM database, we identified patients with >1 days of ICM-detected atrial fibrillation. ICM-detected diagnostic parameters were transformed into simple moving averages over different periods for daily follow-up. A diagnostic trend was defined as the comparison of 2 simple moving averages of different periods for each diagnostic parameter. CVH was defined as any hospital, emergency department, or ambulatory surgical center encounter with a cardiovascular diagnosis-related group or diagnosis code. Machine learning was used to determine which diagnostic trends could best predict patient risk 5 days before CVH.</p><p><strong>Results: </strong>A total of 2616 patients with ICMs met the inclusion criteria (71±11 years; 55% male). Among them, 1998 (76%) had a planned or unplanned CVH over 605 363 days. Machine learning revealed distinct groups: (A) sinus rhythm (reference), (B) below-average burden, (C) above-average burden, and (D) above-average burden with decreasing patient activity. The relative risk was increased in all groups versus the reference (B, 4.49 [95% CI, 3.74-5.40]; C, 8.41 [95% CI, 7.00-10.11]; D, 11.15 [95% CI, 9.10-13.65]), including a 21% increase in CVH detection over prespecified burden thresholds of duration (≥1 hour) and quantity (≥5%). The area under the receiver operating characteristic curve increased from 0.55 when using hourly burden amounts to 0.66 when using burden trends and decreasing patient activity (<i>P</i><0.001), a 20% increase in predictive power.</p><p><strong>Conclusions: </strong>Trends in atrial fibrillation were strongly associated with near-term CVH, especially above-average burden coupled with low patient activity. This approach could provide actionable information to guide treatment and reduce CVH.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496199","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}

{"title":"Impact of Being Underweight on the Safety and Efficacy of Atrial Fibrillation Ablation: An Analysis From the Japanese Catheter Ablation Registry.","authors":"Takashi Nakashima, Reina Tonegawa-Kuji, Kohki Nakamura, Koshiro Kanaoka, Michikazu Nakai, Masaru Nagase, Makoto Yamaura, Takahisa Ido, Shigekiyo Takahashi, Takuma Aoyama, Koichi Nagashima, Masaharu Masuda, Seigo Yamashita, Koji Miyamoto, Yu-Ki Iwasaki, Kazuhiro Satomi, Seiji Takatsuki, Koichi Inoue, Kengo Kusano, Teiichi Yamane, Wataru Shimizu","doi":"10.1161/CIRCEP.124.013026","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.013026","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496196","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}

{"title":"Multicenter Hemodynamic Assessment of the LOT-CRT Strategy: When Does Combining Left Bundle Branch Pacing and Coronary Venous Pacing Enhance Resynchronization?: Primary Results of the CSPOT Study.","authors":"Marek Jastrzębski, Paul Foley, Badrinathan Chandrasekaran, Zachary Whinnett, Pugazhendhi Vijayaraman, Gaurav A Upadhyay, Robert D Schaller, Rafał Gardas, Travis Richardson, D'Anne Kudlik, Robert W Stadler, Patrick Zimmerman, James Burrell, Robert Waxman, Richard N Cornelussen, Jonathan Lyne, Bengt Herweg","doi":"10.1161/CIRCEP.124.013059","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.013059","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) may be an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). We sought to compare the acute hemodynamic and ECG effects of LBBAP, BVP, and left bundle-optimized therapy CRT (LOT-CRT) in CRT candidates with advanced conduction disease.</p><p><strong>Methods: </strong>In this multicenter study, 48 patients with either nonspecific interventricular conduction delay (n=29) or left bundle branch block (n=19) underwent acute hemodynamic testing to determine the change in left ventricular pressure maximal first derivative (LV d<i>P</i>/d<i>t</i>_max) from baseline atrial pacing to BVP, LBBAP, or LOT-CRT.</p><p><strong>Results: </strong>Atrioventricular-optimized increases in LV d<i>P</i>/d<i>t</i>_max for LOT-CRT (mean, 25.8% [95% CI, 20.9%-30.7%]) and BVP (26.4% [95% CI, 20.2%-32.6%]) were greater than unipolar LBBAP (19.3% [95% CI, 15.0%-23.7%]) or bipolar LBBAP (16.4% [95% CI, 12.7%-20.0%]; <i>P</i>≤0.005). QRS shortening was greater in LOT-CRT (29.5 [95% CI, 23.4-35.6] ms) than unipolar LBBAP (11.9 [95% CI, 6.1-17.7] ms), bipolar LBBAP (11.7 ms [95% CI, 6.4-17.0]), or BVP (18.5 [95% CI, 11.0-25.9] ms), all <i>P</i>≤0.005. Compared with patients with left bundle branch block, patients with interventricular conduction delay experienced less QRS reduction (<i>P</i>=0.026) but similar improvements in LV d<i>P</i>/d<i>t</i>_max (<i>P</i>=0.29). Bipolar LBBAP caused anodal capture in 54% of patients and resulted in less LV d<i>P</i>/d<i>t</i>_max improvement than unipolar LBBAP (18.6% versus 23.7%; <i>P</i><0.001). Subclassification of LBBAP capture (EHRA criteria) indicated LBBAP or LV septal pacing in 27 patients (56%) and deep septal pacing in 21 patients (44%). The hemodynamic benefit of adding left ventricular coronary vein pacing to LBBAP depended on baseline QRS duration (<i>P</i>=0.031) and success of LBBAP (<i>P</i><0.004): LOT-CRT provided 14.5% (5.0%-24.1%) greater LV d<i>P</i>/d<i>t</i>_max improvement and 20.8 (12.8-28.8) ms greater QRS shortening than LBBAP in subjects with QRS ≥171 ms and deep septal pacing capture type.</p><p><strong>Conclusions: </strong>In a CRT cohort with advanced conduction disease, LOT-CRT and BVP provided greater acute hemodynamic benefit than LBBAP. Subjects with wider QRS or deep septal pacing are more likely to benefit from the addition of a left ventricular coronary vein lead to implement LOT-CRT.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04905290.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496197","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}

{"title":"Exercise Training Improves Cognitive Function and Neurovascular Control in Patients With Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Secondary Analysis of the Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial.","authors":"Guilherme Veiga Guimarães, Paulo Roberto Chizzola, Veridiana Moraes D'Avila, Paulo Roberto Santo Silva, Leandro Silva Alves, Edimar Alcides Bocchi","doi":"10.1161/CIRCEP.124.013193","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.013193","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459450","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}

{"title":"Resuscitated Sudden Cardiac Arrest as the Initial Presentation of Hypertrophic Cardiomyopathy.","authors":"William H Swain, Daniel R Burczak, Shahid Karim, Andredi M Pumarejo Medina, Khaled Ismail, Mateo Alzate-Aguirre, J Martijn Bos, Peter A Noseworthy, Darrell B Newman, John R Giudicessi, Jeffrey B Geske, Steve R Ommen, Michael J Ackerman, Adelaide M Arruda-Olson, Konstantinos C Siontis","doi":"10.1161/CIRCEP.124.012970","DOIUrl":"https://doi.org/10.1161/CIRCEP.124.012970","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459451","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}

{"title":"Electrocardiogram-Based Artificial Intelligence to Discriminate Cardioembolic Stroke and Stratify Risk of Atrial Fibrillation After Stroke.","authors":"Shaan Khurshid, Samuel F Friedman, Shinwan Kany, Rahul Mahajan, Ashby C Turner, Steven A Lubitz, Mahnaz Maddah, Patrick T Ellinor, Christopher D Anderson","doi":"10.1161/CIRCEP.124.012959","DOIUrl":"10.1161/CIRCEP.124.012959","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079418","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}

{"title":"Coronary Vasospasm During Isthmus Pulsed Field Ablation With Wide Area Focal Catheter.","authors":"Alvise Del Monte, Domenico Giovanni Della Rocca, Luigi Pannone, Giampaolo Vetta, Ioannis Doundoulakis, María Cespón Fernández, Lorenzo Marcon, Cinzia Monaco, Antonio Sorgente, Gezim Bala, Erwin Ströker, Juan Sieira, Alexandre Almorad, Andrea Sarkozy, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1161/CIRCEP.124.012923","DOIUrl":"10.1161/CIRCEP.124.012923","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079417","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}

{"title":"Incidental Premature Ventricular Contractions in Young Athletes: Shape and Size (of Premature Ventricular Contractions burden) Matter.","authors":"Marius I Chukwurah, Eugene H Chung","doi":"10.1161/CIRCEP.124.013345","DOIUrl":"10.1161/CIRCEP.124.013345","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281271","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}