Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Pulsed Field Ablation of Small Vessel-Related Arrhythmias: A New Catheter and Methods.","authors":"Fengqi Xuan, Yunhao Li, Jie Zhang, Long Lin, Daoyang Zhang, Qi Zhang, Ping Zhang, Yujie Zhang, Wei Ma, Yaling Han, Zulu Wang, Ming Liang","doi":"10.1161/CIRCEP.124.013606","DOIUrl":"10.1161/CIRCEP.124.013606","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013606"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662538","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":"The PARADIGM Study: Procedural Augmented Reality Assessment in a 3-Dimensional Image-Guided Modality.","authors":"Alan Hanley, Andrew Locke, Jagmeet Singh, Patricia Tung, William J Hucker, Robert D'Angelo, Jennifer N Avari Silva, Jonathan R Silva, Andre d'Avila, Gregory F Michaud","doi":"10.1161/CIRCEP.124.013222","DOIUrl":"10.1161/CIRCEP.124.013222","url":null,"abstract":"<p><strong>Background: </strong>The CommandEP system v2 (Sentiar, St. Louis, MO) utilizes an augmented reality headset (Magic Leap, Plantation, FL) to display a real-time 3-dimensional electroanatomic map, catheter locations, and ablation catheter contact force data to the electrophysiologist using a hands-free interface. In the intra-PARADIGM study (Procedural Augmented Reality Assessment in a 3-Dimensional Image Guided Modality), the impact of the CommandEP system on the electrophysiologist's ability to navigate accurately, intraprocedural communications, and system usability were studied.</p><p><strong>Methods: </strong>CommandEP was used prospectively in patients undergoing electrophysiologist studies at 2 sites with 8 users. The electrophysiologist's ability to navigate accurately was calculated as catheter tip displacement from the target using CommandEP versus the electroanatomic mapping system. Physician-mapper interactions were quantified and classified as high- versus low-quality communications (high quality directly impacted navigation, medical decision-making, or patient care). Usability was assessed via survey.</p><p><strong>Results: </strong>A total of 102 patients completed the study with the following diagnoses: atrial fibrillation (n=78/102, 76%), atrial flutter (8/102, 8%), atrial tachycardia/supraventricular tachycardia (n=9/102, 9%), premature ventricular contraction (n=6/102, 6%), and cardiac neuroablation (1/102, 1%). The physician's ability to navigate was more accurate when using the CommandEP system with an average distance of 2.98±2 mm versus electroanatomic mapping system 3.27±2 mm (<i>P</i>=0.02); 21% of points navigated using CommandEP versus 28% of points navigated using electroanatomic mapping system were >4 mm from the target (<i>P</i>=0.03). In all, 393 communications during study tasks were counted with 30 events when using CommandEP versus 363 events when using electroanatomic mapping system. Subanalysis showed no difference in accuracy pre- versus postcontact force (p=ns) and a slight reduction in both low- and high-quality communications (p=ns). Notably, 94% agreed/strongly agreed that they felt comfortable using the system, and 72% agreed/strongly agreed they would be comfortable using the CommandEP system in most/all EPS.</p><p><strong>Conclusions: </strong>The CommandEP system improved physicians' ability to navigate accuracy, reduced the number of communications, increased the quality of communications, and had high usability.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013222"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771238","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":"Progression of Atrial Cardiomyopathy Predicts Subsequent Stroke: An Analysis of Left Atrial Low-Voltage Areas in Patients With Atrial Fibrillation Ablation.","authors":"Yasuhiro Matsuda, Satoshi Kudo, Masaharu Masuda, Hiroyuki Uematsu, Ayako Sugino, Hirotaka Ooka, Subaru Fujii, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takuya Tsujimura, Yosuke Hata, Sho Nakao, Masaya Kusuda, Wataru Ariyasu, Toshiaki Mano","doi":"10.1161/CIRCEP.124.013550","DOIUrl":"10.1161/CIRCEP.124.013550","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013550"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656489","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":"One-Year Safety and Performance of a Dual-Chamber Leadless Pacemaker.","authors":"Reinoud E Knops, James E Ip, Rahul Doshi, Derek V Exner, Pascal Defaye, Robert Canby, Maria Grazia Bongiorni, Morio Shoda, Gerhard Hindricks, Petr Neužil, Mayer Rashtian, Karel T N Breeman, Jordan R Nevo, Leonard Ganz, Chris Hubbard, Anu Bulusu, Vivek Y Reddy","doi":"10.1161/CIRCEP.124.013619","DOIUrl":"10.1161/CIRCEP.124.013619","url":null,"abstract":"<p><strong>Background: </strong>A dual-chamber leadless pacemaker can provide bradycardia therapy to most patients with pacemaker indications without the complications associated with a lead or pulse generator. We sought to confirm whether previously reported 3-month safety and performance outcomes were sustained through 12 months by determining whether 12-month complication-free and performance success rates exceeded their prespecified performance goals.</p><p><strong>Methods: </strong>Patients were enrolled in the prospective, single-group Aveir DR i2i Study if they had a standard indication for dual-chamber pacing. Enrolled patients were implanted with an Aveir DR dual-chamber leadless pacemaker system, which comprised 2 communicating leadless pacemakers (1 in the right atrium and 1 in the right ventricle). The primary safety outcome evaluated whether freedom from serious device- or procedure-related events through 365 days exceeded the predetermined performance goal of 76.5%. The primary performance outcome determined whether the composite of atrial capture threshold (≤3.0 V at 0.4 ms) and sensing amplitude (P-wave ≥1.0 mV) at the 12-month visit exceeded the predetermined performance goal of 80.0%.</p><p><strong>Results: </strong>Sites attempted implantation in 300 subjects, where 63.3% had sinus-node dysfunction and 33.3% had atrioventricular block as their primary pacing indication. The primary safety end point was achieved, with a Kaplan-Meier 12-month complication-free rate of 88.6% (95% CI, 84.5-91.8; <i>P</i><0.001). The primary performance end point was achieved in 92.8% of patients (95% CI, 89.7-95.8; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Both primary safety and performance end points were met after 1 year, demonstrating consistency with previously reported 3-month outcomes of a dual-chamber leadless pacemaker.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05252702.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013619"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718104","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":"Physical Activity Reduction in Patients Following ICD Therapy.","authors":"Michael Christof, Alex Page, Spencer Z Rosero, Valentina Kutyifa","doi":"10.1161/CIRCEP.124.013196","DOIUrl":"10.1161/CIRCEP.124.013196","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013196"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669438","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":"Blanking Period After Catheter Ablation of Paroxysmal Atrial Fibrillation: Insights From Continuous Cardiac Monitoring.","authors":"Martin Aguilar, Laurent Macle, Sewanou H Honfo, Paul Khairy, Julia Cadrin-Tourigny, Aamiya Sidhu, Marc W Deyell, Nathaniel M Hawkins, Richard G Bennett, Jason G Andrade","doi":"10.1161/CIRCEP.124.013232","DOIUrl":"10.1161/CIRCEP.124.013232","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013232"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440059","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":"Oxidative Stress Causes Mitochondrial and Electrophysiologic Dysfunction to Promote Atrial Fibrillation in <i>Pitx2^+/-</i> Mice.","authors":"Tuerdi Subati, Kyungsoo Kim, Zhenjiang Yang, Matthew B Murphy, Joseph C Van Amburg, Isis L Christopher, Owen P Dougherty, Kaylen K Woodall, Charles D Smart, Joyce E Johnson, Agnes B Fogo, Venkataraman Amarnath, Vineet Agrawal, Joey V Barnett, Jeffrey E Saffitz, Katherine T Murray","doi":"10.1161/CIRCEP.124.013199","DOIUrl":"10.1161/CIRCEP.124.013199","url":null,"abstract":"<p><strong>Background: </strong>The strongest genetic risk factors for atrial fibrillation (AF) are DNA variants on chromosome 4q25 near the transcription factor gene <i>PITX2</i> (Pitx2:Paired-like homeodomain transcription factor 2). Mice deficient in <i>Pitx2</i> (<i>Pitx2</i>^<i>+/-</i>) have increased AF susceptibility, although the molecular mechanism(s) remains controversial. <i>Pitx2</i> encodes a transcription factor that activates an antioxidant response to promote cardiac repair. Increased reactive oxygen species causing oxidation of polyunsaturated fatty acids generates reactive lipid dicarbonyl moieties that adduct to proteins and other macromolecules to promote cellular injury. We tested the hypothesis that oxidative stress, and specifically isolevuglandins, the most reactive lipid dicarbonyls identified, are increased in the setting of <i>Pitx2</i> deficiency to promote proarrhythmic remodeling and AF.</p><p><strong>Methods: </strong><i>Pitx2</i>^<i>+/-</i> and <i>Pitx2</i>^<i>+/+</i> wild-type littermate control mice were treated orally with vehicle, the lipid dicarbonyl scavenger 2-hydroxybenzylamine, or an inactive control compound at weaning, until study at age 16 to 18 weeks.</p><p><strong>Results: </strong><i>Pitx2</i>^<i>+/-</i> mice demonstrated increased P wave duration indicative of slowed atrial conduction, as well as increased inducible AF burden and sustained AF, compared with wild type, and these abnormalities were prevented by 2-hydroxybenzylamine. Both reactive oxygen species and isolevuglandin protein adducts were elevated in <i>Pitx2</i>^<i>+/-</i> atria with reduced expression of reactive oxygen species-protective genes. High-resolution respirometry demonstrated impaired mitochondrial function in <i>Pitx2</i>^<i>+/-</i> atria, with disruption of mitochondrial integrity and cell-cell junctions with connexin lateralization, as well as decreased mitochondrial biogenesis gene expression. Proarrhythmic ionic current remodeling in <i>Pitx2</i>^<i>+/-</i> atrial myocytes included elevated resting membrane potential, abbreviated action potential duration, and reduced maximum phase 0 upstroke velocity compared with wild type. Most of these abnormalities were ameliorated or prevented by 2-hydroxybenzylamine.</p><p><strong>Conclusions: </strong>These results demonstrate a critical role for lipid dicarbonyl mediators of oxidative stress in the proarrhythmic remodeling and AF susceptibility that occurs with <i>Pitx2</i> deficiency, implying the possibility of genotype-specific therapy to prevent AF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013199"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482249","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":"Sane Approach to Optimizing the Workload in Remote Monitoring of Cardiovascular Implantable Electronic Devices.","authors":"Markus Sane, Toni Jäntti, Annukka Marjamaa, Elina Pennanen, Charlotte Aura, Eeva Torvinen, Leena Karjalainen, Pekka Raatikainen, Jarkko Karvonen","doi":"10.1161/CIRCEP.124.013078","DOIUrl":"10.1161/CIRCEP.124.013078","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring offers an effective and safe method for monitoring patients with cardiovascular implantable electronic devices. The downside of remote monitoring is the overflow of the data. Since many of the remote monitoring transmissions are nonactionable, optimizing alert transmissions could partly overcome this problem.</p><p><strong>Methods: </strong>We collected data on the number and the causes of all alert-, scheduled-, and patient-initiated transmissions as well as actions initiated by these transmissions in 2023. According to our strategy, all clinically nonrelevant alerts were turned off. The trend of alert transmissions and the proportion of actionable scheduled transmissions are presented. The patient safety was monitored by analyzing the premortem alerts and changes to alert settings in deceased patients, as well as the rate of actionable scheduled or patient-initiated transmissions during follow-up.</p><p><strong>Results: </strong>During the study period 8182 transmissions were generated from 3732 cardiovascular implantable electronic devices. Of these, 2306 (28%) were alert transmissions, of which 57% (n=1290) were considered clinically nonrelevant. The rate of alerts decreased by 44% from January to December (0.07 versus 0.04 per device per month, <i>P</i>=0.001). Of the 3335 scheduled transmissions, 11% (364) were actionable, and the proportion of actionable scheduled transmissions remained unchanged during the follow-up period (<i>P</i>=0.08). Notably, none of the deaths were linked to the adjustment of alert settings.</p><p><strong>Conclusions: </strong>Our data indicated that active evaluation of the clinical relevance of all alert transmissions and deactivation of clinically nonrelevant alerts reduce the remote monitoring workload. However, long-term follow-up is needed to ensure that patient safety is not compromised.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013078"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457087","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":"In Vivo Endocardial and Epicardial Mapping of Human Sinus Node: From Electrical Landmarks to Anatomical Landmarks.","authors":"Ivan Eltsov, Luigi Pannone, Dhanunjaya Lakkireddy, Andrea Sarkozy, Gian Battista Chierchia, Mark La Meir, Carlo de Asmundis","doi":"10.1161/CIRCEP.124.013533","DOIUrl":"10.1161/CIRCEP.124.013533","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013533"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440064","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":"Subcutaneous Implantable Defibrillators in Young Patients: Arrhythmias, Complications, and Physical Activity.","authors":"Pietro Francia, Matteo Ziacchi, Federico Migliore, Paolo De Filippo, Antonio Dello Russo, Stefano Viani, Antonio Rapacciuolo, Giulio Falasconi, Carmen Adduci, Giovanni Bisignani, Luca Checchi, Giuseppe Busacca, Luca Santini, Carlo Lavalle, Valeria Ilia Calvi, Antonio Curcio, Massimo Silvetti, Antonio Pangallo, Marco Carbonaro, Davide Giorgi, Raimondo Pittorru, Mariolina Lovecchio, Sergio Valsecchi, Mauro Biffi, Antonio D'Onofrio, Antonio Pelliccia","doi":"10.1161/CIRCEP.124.013365","DOIUrl":"10.1161/CIRCEP.124.013365","url":null,"abstract":"<p><strong>Background: </strong>The safety of subcutaneous implantable cardioverter defibrillator (S-ICD) recipients who lead active lifestyles and engage in recreational sports is unknown. We aimed to evaluate the association between lifestyle and recreational sports and the occurrence of arrhythmia- and device-related complications, appropriate and inappropriate shocks in S-ICD recipients.</p><p><strong>Methods: </strong>We assessed a cohort of young-adult (15-65 years) S-ICD patients, evaluated their physical activity with IPAQ (International Physical Activity Questionnaire), and assessed the association between lifestyle and recreational sports on S-ICD safety and shocks.</p><p><strong>Results: </strong>We enrolled 602 S-ICD recipients (77% men; age, 46±14 years). According to the IPAQ, patients were categorized as inactive subjects (26.4%), moderately active subjects (45.2%), or highly active subjects (28.4%). Among moderately/highly active subjects, 163 (27.1%) were recreational athletes. During follow-up (47.3 [interquartile range, 27.0-67.6] months), 23 patients (3.8%) reached the safety end point of arrhythmia- or device-related complications, with moderately and highly active subjects showing in multivariate analysis similar incidence compared with inactive subjects (<i>P</i>=0.59 and <i>P</i>=0.83, respectively). Forty-four patients had 87 appropriate shocks. In multivariate analysis, moderately and highly active subjects showed a nonsignificantly lower incidence of appropriate shocks compared with inactive subjects (<i>P</i>=0.12 and <i>P</i>=0.11, respectively). Consistently, there was a nonsignificant lower incidence of appropriate shocks in athletes versus nonathletes (<i>P</i>=0.06). Thirty-nine patients had 46 inappropriate shocks. Moderately and highly active subjects had similar incidence of inappropriate shocks compared with inactive subjects (<i>P</i>=0.92 and <i>P</i>=0.88, respectively).</p><p><strong>Conclusions: </strong>Young S-ICD patients often lead active lifestyles and participate in sports. Higher activity levels were not associated with increased implantable cardioverter defibrillator-related complications or increased risk of implantable cardioverter defibrillator shocks.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013365"},"PeriodicalIF":9.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482252","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}