Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Characteristics of Patients With the Arrhythmogenic Mitral Valve Prolapse Syndrome and Sudden Cardiac Arrest and Sustained Ventricular Arrhythmias.","authors":"Apurba Chakrabarti, John R Giudicessi, Fatima M Ezzeddine, Francesca N Delling, Shalini Dixit, Yoo Jin Lee, Daniele Muser, Silvia Magnani, Aniek Van Wijngaarden, Nina Ajmone Marsan, Marc A Miller, Jonathan Gandhi, Maria G Trivieri, Jonaz Font, Raphael Martins, James A McCaffrey, Pasquale Santangeli, Francis E Marchlinski, Himal Chapagain, Don Mathew, Krishna Kancharla, Faisal F Syed, Ahad Abid, Lukasz Cerbin, Wendy S Tzou, Lohit Garg, Domenico G Della Rocca, Andrea Natale, Sanghamitra Mohanty, Seth H Sheldon, Ling Kuo, Kristina H Haugaa, Eivind W Aabel, Andres Enriquez, Shingo Maeda, Amrish Deshmukh, Michael Ghannam, Frank Bogun, Michael J Ackerman, Jackson J Liang","doi":"10.1161/CIRCEP.124.013099","DOIUrl":"10.1161/CIRCEP.124.013099","url":null,"abstract":"<p><strong>Background: </strong>Patients with arrhythmogenic mitral valve prolapse syndrome are at increased risk for life-threatening ventricular arrhythmias, but studies have been limited by small sample sizes. We sought to assemble an international arrhythmogenic mitral valve prolapse syndrome registry to delineate the clinical, imaging, and treatment characteristics of patients with arrhythmogenic mitral valve prolapse syndrome who survived sudden cardiac arrest (SCA) or had sustained ventricular tachycardia (VT) or ventricular fibrillation.</p><p><strong>Methods: </strong>In this descriptive registry, we characterized patients with arrhythmogenic mitral valve prolapse syndrome who survived SCA, sustained VT, or ventricular fibrillation. Deidentified data were abstracted locally and combined centrally.</p><p><strong>Results: </strong>We included 148 patients who had SCA or VT/ventricular fibrillation. Patients had a mean age of 43.7±15.4 years; 68% were women, 73% had bileaflet prolapse, 65% had mitral annular disjunction, 67% had nonsustained VT, and 59% had inferolateral T-wave inversions. Syncope (n=54, 48%) and anterolateral T-wave inversion (n=26, 22%) were relatively common. Catheter ablation was performed in 50 (35%) patients for premature ventricular complexes and in 18 (17.7%) patients for VT. Sites of origin for arrhythmias were commonly in the papillary muscles, fascicles, mitral annulus, and inferior/inferolateral left ventricle.</p><p><strong>Conclusions: </strong>In this international descriptive registry of patients with arrhythmogenic mitral valve prolapse syndrome and SCA, patients were young, women, and had bileaflet mitral valve prolapse, mitral annular disjunction, inferolateral T-wave inversions, and nonsustained VT. A history of syncope and anterolateral T-wave inversions was relatively common in patients who survived SCA or sustained VT/ventricular fibrillation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013099"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457076","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":"Predicted Risk of Ventricular Arrhythmias in a Genome-First Population With Genetic Risk for Arrhythmogenic Right Ventricular Cardiomyopathy.","authors":"Eric D Carruth, Brittney Murray, Crystal Tichnell, Katelyn Young, Hugh Calkins, Cynthia A James, Christopher M Haggerty","doi":"10.1161/CIRCEP.124.013231","DOIUrl":"10.1161/CIRCEP.124.013231","url":null,"abstract":"<p><strong>Background: </strong>Population genomic screening for desmosome variants associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) may facilitate early disease detection and protective intervention. The validated ARVC risk calculator offers a novel means to risk stratify individuals with diagnosed ARVC, but predicted risk in the context of genomic screening identification has not been explored.</p><p><strong>Methods: </strong>Individuals harboring a pathogenic/likely pathogenic variant in a desmosome gene (<i>PKP2</i>, <i>DSP</i>, <i>DSG2</i>, or <i>DSC2</i>) were identified through the Geisinger MyCode Genomic Screening and Counseling program. The ARVC risk calculator was applied to patients with a subsequent evaluation of right ventricular function. This predicted risk was compared with outcomes in the first 5 years (range, 0.3-5.0 years) after genetic result return.</p><p><strong>Results: </strong>Of 254 individuals with a clinically confirmed pathogenic/likely pathogenic desmosome variant, 113 (median age, 56 [interquartile range, 42-66]; 71% female) had cardiac imaging in follow-up and no prior sustained ventricular arrhythmia (VA). Eighty-two (73%) had no ARVC task force criteria (TFC) besides the variant (possible diagnosis), 22 (19%) had a single additional minor criterion (borderline diagnosis), and 9 (8%) met criteria for definite diagnosis. The median 5-year predicted VA risk was 3.9% (2.3%-6.6%), notably lower than that of the calculator derivation cohort (20.6%). The risk of fast VA was 1.6% (1.0%-2.9%). The predicted VA risk was higher in individuals with any nongenetic ARVC task force criteria (6.3% [2.5-13.2%]) versus those without (3.7% [2.2-5.6%]; <i>P</i>=0.01), and in individuals with <i>DSP</i> variants (6.1% [3.9-7.8%] versus <i>PKP2</i> 3.4% [2.2-5.3%]; <i>P</i>=0.01). Over a median 3.0 years of follow-up (≤5 years only), no sustained VA events were observed in this cohort.</p><p><strong>Conclusions: </strong>The predicted 5-year risk of VA in individuals ascertained via population genomic screening for desmosome variants is low (3.9%; 1.6% for fast VA) but may vary by affected gene and ARVC task force criteria burden.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013231"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482250","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 Results of a Novel Pediatric Pacemaker in Neonates and Infants.","authors":"Charles I Berul, Lindsey Haack, Elizabeth D Sherwin, Robert D Whitehill, Dustin Nash, Soham Dasgupta, Christopher Johnsrude, Stephanie F Chandler, Marc D LeGras, Bradley C Clark, Erick Jimenez, Heather M Giacone, Scott Ceresnak, Garbiñe Goya, Lanier B Jackson, Tam Dan Pham, Santiago O Valdes, Edward Rhee, Rachel Brucker, Sonja Olson, Teri Whitman","doi":"10.1161/CIRCEP.124.013436","DOIUrl":"10.1161/CIRCEP.124.013436","url":null,"abstract":"<p><strong>Background: </strong>To address the unmet need for a smaller pacemaker for babies, a specially modified implantable pulse generator was developed containing a Medtronic Micra subassembly in a polymer header connecting to a bipolar epicardial lead. The aim of this study was to report midterm follow-up data and outcomes of patients who underwent implantation of this device.</p><p><strong>Methods: </strong>Deidentified data were collected from 12 of 15 sites in the United States implanting the pediatric implantable pulse generator between March 2022 and February 2024. All 29 patients at these 12 sites within this timeframe were included in the analysis.</p><p><strong>Results: </strong>The median age at implant was 15 days (range, 0 days to 3 years, including 1 outlier). The median weight was 2.3 kg (range, 1.3-11.4 kg). Gestational age was 28.5 weeks to term, with 23 (79%) patients born prematurely. Of those with anatomic information, 25% had congenital heart disease. The average duration of implant was 325 days (73-808 days). The most recent lead impedance mean was 612 ohms (450-840 ohms), ventricular capture threshold mean was 1 V @ 0.4 ms (range, 0.38-2.75 V), and R-wave sensing mean was 12.5 mV (3.6-20 mV). There were 7 generator explants (24%), removed at 6.5 to 31 months of age.</p><p><strong>Conclusions: </strong>The pediatric implantable pulse generator can be safely implanted in neonates and infants. This multicenter report demonstrates that the devices remain stable, with effective pacing, normal electrical parameters, and battery longevity aligned with projections. This novel pediatric pacemaker provides a viable alternative to standard-size generators and addresses a vital unmet need for these small patients.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013436"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491012","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":"Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy.","authors":"Omar M Abdelfattah, Ahmed Sayed, Ahmed Al-Jwaid, Ahmed Hassan, Deaa Abu Jazar, Arun Narayanan, Mark S Link, Matthew W Martinez","doi":"10.1161/CIRCEP.124.013479","DOIUrl":"10.1161/CIRCEP.124.013479","url":null,"abstract":"<p><strong>Background: </strong>Over the past decades, hypertrophic cardiomyopathy has become a contemporary treatable disease. However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.</p><p><strong>Methods: </strong>Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate/inappropriate shocks, and ICD-related complications.</p><p><strong>Results: </strong>In total, 234 studies (N=92 500, 514 748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12 139 patients (16.43%) received an ICD over 429 766 person-years of follow-up, with an ICD implantation rate of 2.79%/y ([95% CI, 2.35%-3.32%] I²=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%; <i>P</i>=0.002), with noticeable geographic variation (<i>P</i>=0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%/y ([95% CI, 3.08%-3.84%] I²=88.40%) and 1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%/y ([95% CI, 3.08%-4.16%] I²=88.03%), and declined significantly over time (<i>P</i>=0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%/y) to 2020 (0.31%/y).</p><p><strong>Conclusions: </strong>Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023407126.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013479"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078611","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":"Complete Left Bundle Branch Block With <i>V5/V6: RS/Rs/rS</i> Pattern and Long-Term Outcomes.","authors":"Su Hu, Ting Wang, Lan Mi, Jing Feng, Xiaoyun Sun, Jie Liu, Na Zhao, Junkui Wang","doi":"10.1161/CIRCEP.124.013036","DOIUrl":"10.1161/CIRCEP.124.013036","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013036"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000725","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":"Comparing Phenotypes for Acute and Long-Term Response to Atrial Fibrillation Ablation Using Machine Learning.","authors":"Prasanth Ganesan, Maxime Pedron, Ruibin Feng, Albert J Rogers, Brototo Deb, Hui Ju Chang, Samuel Ruiperez-Campillo, Viren Srivastava, Kelly A Brennan, Wayne R Giles, Tina Baykaner, Paul Clopton, Paul J Wang, Ulrich Schotten, David E Krummen, Sanjiv M Narayan","doi":"10.1161/CIRCEP.124.012860","DOIUrl":"10.1161/CIRCEP.124.012860","url":null,"abstract":"<p><strong>Background: </strong>It is difficult to identify patients with atrial fibrillation (AF) most likely to respond to ablation. While any arrhythmia patient may recur after acutely successful ablation, AF is unusual in that patients may have long-term arrhythmia freedom despite a lack of acute success. We hypothesized that acute and chronic AF ablation outcomes may reflect distinct physiology and used machine learning of multimodal data to identify their phenotypes.</p><p><strong>Methods: </strong>We studied 561 consecutive patients in the Stanford AF ablation registry (66±10 years, 28% women, 67% nonparoxysmal), from whom we extracted 72 data features of electrograms, electrocardiogram, cardiac structure, lifestyle, and clinical variables. We compared 6 machine learning models to predict acute and long-term end points after ablation and used Shapley explainability analysis to contrast phenotypes. We validated our results in an independent external population of n=77 patients with AF.</p><p><strong>Results: </strong>The 1-year success rate was 69.5%, and the acute termination rate was 49.6%, which correlated poorly on a patient-by-patient basis (φ coefficient=0.08). The best model for acute termination (area under the curve=0.86, Random Forest) was more predictive than for long-term outcomes (area under the curve=0.67, logistic regression; <i>P</i><0.001). Phenotypes for long-term success reflected clinical and lifestyle features, while phenotypes for AF termination reflected electrical features. The need for AF induction predicted both phenotypes. The external validation cohort showed similar results (area under the curve=0.81 and 0.64, respectively) with similar phenotypes.</p><p><strong>Conclusions: </strong>Long-term and acute responses to AF ablation reflect distinct clinical and electrical physiology, respectively. This de-linking of phenotypes raises the question of whether long-term success operates through factors such as attenuated AF progression. There remains an urgent need to develop procedural predictors of long-term AF ablation success.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012860"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381736","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":"Sudden Cardiac Death in Childhood: Peaks in Teenagers.","authors":"Joseph D Westaby, Mary N Sheppard","doi":"10.1161/CIRCEP.124.013355","DOIUrl":"10.1161/CIRCEP.124.013355","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013355"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381737","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":"Characteristics of In Vivo Lesion Formation With a Temperature-Controlled Diamond-Tip Radiofrequency Ablation Catheter in the Ventricle: A Preclinical Model.","authors":"Tatsuhiko Hirao, Maryam E Rettmann, Megan M Schmidt, Omar Z Yasin, Gurukripa N Kowlgi, Naoto Otsuka, Taro Koya, Laura K Newman, Douglas L Packer, Konstantinos C Siontis","doi":"10.1161/CIRCEP.124.013120","DOIUrl":"10.1161/CIRCEP.124.013120","url":null,"abstract":"<p><strong>Background: </strong>Power-controlled radiofrequency ablation with irrigated-tip catheters has been the norm for ventricular ablation for almost 2 decades. New catheter technology has recently integrated more accurate tissue temperature sensing enabling temperature-controlled irrigated ablation. We aimed to investigate the in vivo ablation parameters and lesion formation characteristics in ventricular myocardium using a novel temperature-controlled radiofrequency catheter.</p><p><strong>Methods: </strong>Twenty canines were divided into 3 groups: 4 noninfarcted, acute (phase I); 8 noninfarcted, chronic (phase II); and 8 infarcted, chronic (phase III). Lesions were delivered with a temperature-controlled radiofrequency system utilizing a chemical vapor deposit diamond for efficient thermal diffusivity. In phase I, 17 ablation settings were tested (temperature set points, 50/60/70 °C; ablation duration, 15/30/60/90/120 s; and power limit, 30/50 W). Four and one of these sets of parameters were further tested in phases II and III, respectively. Lesions were assessed by ex vivo contrast-enhanced magnetic resonance imaging and gross pathology 5 weeks after ablation in phases II/III.</p><p><strong>Results: </strong>Across all phases, 111 ablation lesions were delivered. Ablation with the power limit of 50 W, the temperature set point of 60 °C, and the duration of 60 s produced significantly larger and deeper lesions (mean, 569.2 mm³; mean maximal depth, 9.8 mm) compared with 50 W/60 °C/30 s (mean, 340.4 mm³; mean maximal depth, 8.3 mm) and 50 W/50 °C/60 s (mean, 227 mm³; mean maximal depth, 6.9 mm), with <i>P</i><0.05 for all pairwise comparisons. Ablation of infarcted myocardium in phase III (50 W/60 °C/30 s) resulted in smaller impedance and bipolar electrogram amplitude changes and lesion size compared with ablation in normal myocardium with the same settings. No steam pop, myocardial perforation, or char formation was observed in any of the 111 ablations across all phases.</p><p><strong>Conclusions: </strong>In vivo radiofrequency ablation in a canine model with a diamond-tip temperature-controlled catheter using a temperature set point of 60 °C and a power limit of 50 W created large lesions without steam pop risk in both normal and infarcted ventricular myocardia.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013120"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028071","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 Diagnosis to Ablation Time on Recurrence of Atrial Fibrillation and Clinical Outcomes After Catheter Ablation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.","authors":"Ahmed Mazen Amin, Hossam Elbenawi, Ubaid Khan, Omar Almaadawy, Mustafa Turkmani, Wael Abdelmottaleb, Mohammed Essa, Mohamed Abuelazm, Basel Abdelazeem, Zain Ul Abideen Asad, Abhishek Deshmukh, Mark S Link, Christopher V DeSimone","doi":"10.1161/CIRCEP.124.013261","DOIUrl":"10.1161/CIRCEP.124.013261","url":null,"abstract":"<p><strong>Background: </strong>Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing of atrial fibrillation (AF) ablation relative to the diagnosis time. We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on clinical outcomes after AF ablation.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials through August 2024. Pairwise, prognostic, and reconstructed time-to-event data meta-analyses were conducted using R V. 4.3.1. Our primary end point was time to first AF recurrence, with secondary end points of all-cause mortality, tamponade, stroke, and heart failure.</p><p><strong>Results: </strong>Our cohort included 23 studies with 43 711 patients. Shorter DAT was significantly associated with reduced AF recurrence across both paroxysmal and persistent AF subgroups (<i>P</i><0.01). There was a significant decrease in benefit for paroxysmal AF over time and a slight decrease in benefit for persistent AF over time. However, the benefit remained significant in both over time. DAT per year was significantly associated with a 10% increased risk of AF recurrence. Reconstructed Kaplan-Meier analysis showed that DAT >1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF. DAT ≤1 year was significantly associated with decreased all-cause mortality (<i>P</i><0.01) and showed a trend toward an association with a lower incidence of stroke (<i>P</i>=0.08). However, there was no significant difference in heart failure between DAT ≤1 year and DAT >1 year.</p><p><strong>Conclusions: </strong>Early ablation is more beneficial in paroxysmal AF, with a notable decrease in benefit over time, while in persistent AF, the benefit remains significant but slightly decreases over time. Shorter DAT was significantly associated with decreased all-cause mortality and showed a trend toward an association with a lower incidence of stroke.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/prospero/display_record.php?; Unique identifier: CRD42024525542.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013261"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078612","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":"Validation of a Demography-Based Adaptive QT Correction Formula Using Pediatric and Adult Datasets Acquired From Humans and Guinea Pigs.","authors":"Kazi T Haq, Kate M McLean, Grace C Anderson-Barker, Charles I Berul, Michael J Shattock, Nikki Gillum Posnack","doi":"10.1161/CIRCEP.124.013237","DOIUrl":"10.1161/CIRCEP.124.013237","url":null,"abstract":"<p><strong>Background: </strong>QT correction (QTc) formulae are widely used in clinical and research settings but often underperform, possibly due to demographic influences on the QT-heart rate (HR) relationship. To address this limitation, we developed an adaptive QTc (QTcAd) formula, which adjusts for demographic factors like age, and compared its efficacy to other standard formulae.</p><p><strong>Methods: </strong>The QTcAd formula was tested across diverse age groups with different HR in both humans and guinea pigs. Using retrospective ECG data from 1819 pediatric patients at Children's National Hospital and 2400 subjects from the Pediatric Heart Network database, alongside in vivo (N=55) and ex vivo (N=66) guinea pig ECG recordings, we evaluated the formula's effectiveness. Linear regression fit parameters of QTc-HR (slope and <i>R</i>²) were utilized for performance assessment. To evaluate the accuracy of the predicted QTc, we acquired epicardial electrical and optical voltage data from Langendorff-perfused guinea pig hearts.</p><p><strong>Results: </strong>In both human subjects and guinea pigs, the QTcAd formula (QTcAd=QT+(|<i>m</i>|×(HR-HR_mean)) consistently outperformed other formulae across all age groups. For instance, in a 20-year-old human group, the QTcAd formula successfully nullified the inverse QT-HR relationship (<i>R</i>²=5.1×10^-10, slope=-3.5×10^-5), whereas the Bazett formula failed to achieve comparable effectiveness (<i>R</i>²=0.21, slope=0.91). Moreover, the QTcAd formula exhibited better accuracy than the age-specific Benatar QTc formula, which overcorrected QTc (1-week human QT: 263.8±14.8 ms, QTcAd: 263.8±7.3 ms, <i>P</i>=0.62; Benatar QTc: 422.5±7.3 ms, <i>P</i><0.0001). The optically measured pseudo-QT interval (143±22.5 ms, n=44) was better approximated by QTcAd (180.6±17.0 ms) compared with all other formulae. Furthermore, we demonstrated that the QTcAd formula was not inferior to individual-specific QTc formulae.</p><p><strong>Conclusions: </strong>The demography-based QTcAd formula showed superior performance across human and guinea pig age groups, which may enhance the efficacy of rate-corrected K.M.M. for cardiovascular disease diagnosis, risk stratification, and drug safety testing in children and adults.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013237"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078613","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}