Europace最新文献

{"title":"Translational approach to ventricular innervation: the posterior descending ganglionated plexus.","authors":"Ann-Kathrin Kahle, Niklas Klatt, Katharina Scherschel, Christiane Jungen, Pawel Kuklik, Fares-Alexander Alken, Nikolaj Klöcker, Stephan Willems, Elvira Weber, Udo Boeken, Artur Lichtenberg, Alexander Bernhardt, Samer Hakmi, Dainius H Pauza, Christian Meyer","doi":"10.1093/europace/euaf099","DOIUrl":"https://doi.org/10.1093/europace/euaf099","url":null,"abstract":"<p><strong>Aims: </strong>Modulation of cardiac neural control is increasingly explored to treat cardiac arrhythmias. While the atrially located ganglionated plexus (GPs) have been studied intensively, characterization of ventricular GPs is sparse. This proof-of-principle study aimed to assess the role of the posterior descending GP (PDGP) for neural control of cardiac electrophysiology, while offering a translational roadmap into clinical practice.</p><p><strong>Methods and results: </strong>Since an initial systematic literature review revealed the PDGP as a small, consolidated GP on the posterior left ventricle in dogs, swine and humans, we subsequently conducted morphological C57BL/6 murine studies (n=43) indicating ventricular GPs in only 10% of hearts. Based on our initial findings, in a proof-of-principle study analyzing 4,300 local unipolar electrograms from a multi-electrode sock, the impact of functional PDGP modulation was studied in an ex-vivo retrograde-perfused porcine model. Wave propagation characteristics determined by epicardial activation mapping demonstrated increased dispersion of conduction velocity during high-frequency (8.52±2.24 radian vs. 2.79±0.89 radian; P=0.018) and nicotine stimulation (19.79±6.49 radian vs. 2.79±0.89 radian; P=0.044) compared to paced rhythm. High-frequency stimulation prolonged activation recovery intervals in the posterior (257.8±6.7 ms vs. 244.8±1.9 ms; P=0.044) and basal (258.1±4.2 ms vs. 244.8±1.9 ms; P=0.039) right ventricle compared to the posterior left ventricle. Analysis of explanted human hearts confirmed the presence of the PDGP within epicardial adipose tissue near its eponymous coronary artery and the posteromedial left atrial GP. Three-dimensionally reconstructed human hearts suggested the PDGP localization characterized by interpatient anatomical variability.</p><p><strong>Conclusion: </strong>The present translational approach to ventricular innervation demonstrates first evidence of the functional relevance of the PDGP, with morphological findings indicating species-related differences. Novel imaging modalities might pave the way for future functional and therapeutic interventions.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987493","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":"Phenotypic expression of rare progressive cardiac conduction disease variants in the general population.","authors":"Ravi A Shah, Julia Ramírez, Claire Kirkby, Charlotte Ives, Martin Lowe, Patricia B Munroe, Pier D Lambiase, William J Young","doi":"10.1093/europace/euaf103","DOIUrl":"https://doi.org/10.1093/europace/euaf103","url":null,"abstract":"<p><strong>Background and aims: </strong>Familial progressive cardiac conduction disease (PCCD) is a heritable condition leading to conduction defects that may require pacemaker implantation. The penetrance of rare PCCD variants in general populations and relationship with electrocardiogram (ECG) trait polygenic risk scores (PRS) is unknown. We investigated the prevalence and phenotypic expression of rare variants linked with PCCD in a population cohort and to establish whether ECG-trait PRSs improve risk prediction.</p><p><strong>Methods: </strong>Carriers of known rare pathogenic/likely pathogenic (P/LP) PCCD variants, and variants of uncertain significance (VUS) were identified in 469,511 UK Biobank participants. Primary (any conduction disease) and secondary (high-grade AV block and pacemaker implantation) outcomes were evaluated in lifetime-risk Cox proportional hazard models including rare variant status, sex, and age. Additional models including PR and QRS PRSs were tested.</p><p><strong>Results: </strong>There were 25 P/LP carriers (5 genes) and 3,174 VUS carriers (4 genes). Conduction disease was more prevalent in P/LP individuals compared to non-carriers (28% vs 5.3%, p<0.001) with a hazard ratio (HR) of 6.60 (95% CI=3.14-13.8) over 6.5 million person-years of follow-up and C-index 0.602 (0.599-0.605). This was driven by AV block (HR 23.2 [8.7-61.8]) and pacemaker implantation (HR 13.4 [6.01-29.8]). All individuals were aged >50 at diagnosis. Combined with P/LP status, PR-PRS and QRS-PRS improved model performance (C-index 0.618 [0.615-0.622]).</p><p><strong>Conclusions: </strong>In a population-based cohort, PCCD P/LP variant carriers were at greater risk of conduction disease. Including PRSs for the PR and QRS improved risk prediction, supporting the combination of rare and common variants in risk assessment.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992451","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":"From moderate to strenuous training: unraveling mechanistic contributors and biomarkers for atrial fibrillation in exercise.","authors":"Anna Alcarraz, Aline Meza-Ramos, Cira Rubies, Maria Sanz-de la Garza, Carlos Eduardo Bolaños-Gomez, Marta Sitges, Lluis Mont, Montserrat Batlle, Eduard Guasch","doi":"10.1093/europace/euaf098","DOIUrl":"https://doi.org/10.1093/europace/euaf098","url":null,"abstract":"<p><strong>Background: </strong>The impact of the transition from moderate to strenuous exercise on atrial fibrillation (AF) risk and its underlying mechanisms remain poorly understood. We aimed to analyze biatrial remodeling after moderate and strenuous exercise, compare it with pathological atrial damage, and noninvasively identify strenuous exercise insults.</p><p><strong>Methods: </strong>Young male Wistar rats were trained at a moderate (MOD) or high-intensity (INT) load; sedentary (SED) rats served as controls. After 16 weeks, electrophysiological and echocardiographic studies were obtained, and atrial samples were used for fibrosis quantification. Plasmatic biomarkers (at rest and after exercise) and atrial gene expression (mRNA array) were assessed. Results were compared with a transverse aortic constriction (TAC) model.</p><p><strong>Results: </strong>AF inducibility progressively increased with exercise load. Both trained groups presented bradycardia, an enhanced parasympathetic tone and biatrial dilatation. INT rats exhibited prolonged P-waves and greater fibrosis in the left (LA) and right atria (RA). The proarrhythmogenic remodeling substantially differed in both atria. Compared with MOD, inflammatory pathways were enriched in the RA of INT, similar to the TAC model. Only minor changes were observed after exercise in the LA. Plasma biomarkers showed unremarkable changes between groups at rest, but intensive exercise led to a transient increase in proinflammatory markers.</p><p><strong>Conclusions: </strong>Exercise-induced AF pathology is load-dependent: parasympathetic tone augmentation and atrial dilatation drive AF risk in moderately trained rats, whereas a further increase is associated with atrial fibrosis. Transient inflammation, identifiable through plasma biomarkers, could underpin AF susceptibility and fibrosis in the RA of INT rats, and serve as biomarkers.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978546","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":"Reply to the use of tissue characterization using cardiac magnetic resonance imaging and response to cardiac resynchronization therapy.","authors":"Alphonsus Liew, Sandra Howell, Christopher Aldo Rinaldi","doi":"10.1093/europace/euaf101","DOIUrl":"https://doi.org/10.1093/europace/euaf101","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993122","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":"HIgh Power short duration radiofrequency ablation or cryoballoon ablation for paroxysmal Atrial Fibrillation (HIPAF trial).","authors":"Arian Sultan, Sven Kreutzer, Jonas Wörmann, Jakob Lüker, Jana Ackmann, Jan-Hendrik Schipper, Jan van den Bruck, Karlo Filipovic, Cornelia Scheurlen, Kerstin Rosenberger, Daniel Steven","doi":"10.1093/europace/euaf066","DOIUrl":"10.1093/europace/euaf066","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary vein isolation (PVI) is a first-line treatment option for paroxysmal atrial fibrillation (PAF). Radiofrequency ablation (RFA) or cryoballoon ablation (CBA) are commonly used modalities. Recent studies demonstrated the superiority and potential benefits of very high-power short-duration (vHPSD) RFA using 70 W compared to conventional RFA (<50 W). Prospective randomized data comparing vHPSD RFA with 70 W with the frequently used CBA in the setting of PAF are lacking.</p><p><strong>Methods and results: </strong>We conducted a randomized non-inferiority trial involving 170 patients undergoing de novo PVI for PAF. Patients were randomly assigned in a 1:1 ratio to undergo vHPSD RFA or to receive CBA. The composite primary endpoint consisted of (i) any atrial arrhythmia, (ii) new antiarrhythmic drug (AAD) onset, and (iii) re-ablation during 1 year after index procedure. The non-inferiority margin was predefined as a 10% lower 1-year event-free survival rate in vHPSD compared to CBA (delta = -0.1). A total of 170 patients with symptomatic PAF were enrolled and assigned to undergo de novo PVI, with 84 receiving vHPSD and 86 undergoing CBA. The overall study population had a mean age of 65 ± 11 years and included 50.6% women. For vHPSD PVI a 70 W/7 s anterior and 70 W/5 s posterior protocol including 3D mapping was used. Cryoballoon ablation was performed as usual. Successful PVI was achieved in all patients. Overall procedure time for vHPSD was significantly longer (81.1 ± 20.0 vs. 67.7 ± 17.2 min; P < 0.001). However, the mere ablation time was comparable (39.3 ± 15.5 vs. 36.7 ± 14.5 min; P = 0.285). Fluoroscopy time and amount of contrast medium were significantly lower for vHPSD PVI (9.2 ± 3.6 vs. 10.5 ± 4.3 min; P = 0.031; 15.5 ± 5.8 vs. 43.1 ± 30.0 mL; P < 0.001). Complication rates were comparable between groups. One pulmonary vein stenosis occurred after vHPSD. Three pericardial effusions and two transient ischaemic attack were reported after CBA. After a median follow-up of 367 days, 73.8% [n = 62, 95% confidence interval (CI): 63.1-82.8%] of patients in the vHPSD PVI group and 81.4% (n = 70, 95% CI: 71.6-89.0%) in the CBA group remained free of any event. Non-inferiority of vHPSD PVI compared to CBA PVI could not be demonstrated, with a difference of -0.076 [95% CI: (-0.201 to 0.049)] in event-free survival rates off AADs, as the 95% CI includes the delta of -0.1.</p><p><strong>Conclusion: </strong>In this randomized non-inferiority trial comparing vHPSD RFA to CBA for PVI in patients with PAF, non-inferiority of vHPSD RFA could not be shown. Both methods showed comparable safety outcome with a shorter procedure time for CBA.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751823","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 and prognosis of electrical storm during acute myocardial infarction.","authors":"Alexandre Salaun, Raphael Martins, Sandro Ninni, Rayan Mohammed, Ruxandra Sava, Donovan Decaudin, Pierre Groussin, Dominique Pavin, François Brigadeau, Amine Tazibet, Soundous M'Rabet, Gabriel Laurent, Didier Klug, Antoine Da Costa, Karim Benali, Charles Guenancia","doi":"10.1093/europace/euaf077","DOIUrl":"10.1093/europace/euaf077","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771630","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":"Comparisons between sinus rhythm and paced maps using the 'one acquisition-two maps' technique.","authors":"Deborah Foltran, Maxime Beneyto, Jean Timnou Bekouti, Quentin Voglimacci-Stephanopoli, Hubert Delasnerie, Maud Tabuteau, Philippe Maury","doi":"10.1093/europace/euaf052","DOIUrl":"10.1093/europace/euaf052","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 5","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998555","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":"Aetiology and haemodynamic patterns of orthostatic hypotension in a tertiary syncope unit.","authors":"Madeleine Johansson, Boriana S Gagaouzova, Ineke A van Rossum, Roland D Thijs, Viktor Hamrefors, J Gert van Dijk, Artur Fedorowski","doi":"10.1093/europace/euaf017","DOIUrl":"10.1093/europace/euaf017","url":null,"abstract":"<p><strong>Aims: </strong>Orthostatic hypotension (OH) is an important differential diagnosis in unexplained syncope. Neurogenic OH (nOH) has been postulated to differ from non-neurogenic OH (non-nOH), yet pathophysiological differences are largely unexplored. We aimed to investigate aetiology and tilt table test (TTT)-induced haemodynamic responses in symptomatic OH patients.</p><p><strong>Methods and results: </strong>We performed a retrospective study analysing patients referred for unexplained syncope or highly symptomatic orthostatic intolerance with TTT-verified classical OH (cOH). Medical records were analysed for the presumptive aetiology of cOH. Fifty-two patients (mean age 73 ± 9 years, 46% women) with good quality TTT recordings were divided into three groups on clinical grounds: nOH, non-nOH, and mixed OH. The log-ratio (LR) method was applied to compare the decrease in mean arterial pressure (MAPLR) and corresponding contributions of heart rate (HRLR), stroke volume (SVLR), and total peripheral resistance (TPRLR) during the upright phase of TTT. The prevalence of cOH was 12 (23%) nOH, 14 (27%) non-nOH, and 26 (50%) mixed OH. No difference in MAPLR was observed among the three groups during the 4th upright minute of TTT (nOH: -0.10 ± 0.04 vs. non-nOH: -0.07 ± 0.05 and vs. mixed OH: -0.06 ± 0.05, P = 0.10). The contributions of HRLR, SVLR, and TPRLR to the drop in MAPLR did not differ between groups (all P > 0.05).</p><p><strong>Conclusion: </strong>One-half of highly symptomatic OH patients had mixed OH, whereas one-quarter had either pure neurogenic or non-neurogenic OH, respectively. Different forms of OH were indifferentiable based on haemodynamic responses during TTT, questioning the clinical utility of such classification. Larger studies are needed to confirm these findings.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002514","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":"Post-pacing interval after failed anti-tachycardia pacing for scar-related ventricular tachycardia: implications for the location of the critical substrate.","authors":"Masafumi Sugawara, Jakub Sroubek, Justin Lee, Shady Nakhla, Oussama Wazni, Pasquale Santangeli, Koji Higuchi","doi":"10.1093/europace/euaf069","DOIUrl":"10.1093/europace/euaf069","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 5","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977583","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":"Management of patients with transvalvular right ventricular leads undergoing transcatheter tricuspid valve interventions: a scientific statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC endorsed by the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society and the Canadian Heart Rhythm Society.","authors":"Jean-Claude Deharo, Julien Dreyfus, Maria-Grazia Bongiorni, Haran Burri, Pascal Defaye, Michael Glikson, Nigel Lever, Antonio Mangieri, Blandine Mondésert, Jens Cosedis Nielsen, Maully Shah, Christoph Thomas Starck, Archana Rao, Christophe Leclercq, Fabien Praz, Sergio Richter, Nicolas Amabile, Alexander Breitenstein, Óscar Cano, Karol Čurila, Jamie Manlucu, Robert D Schaller, Hung-Fat Tse, Christian Veltmann, Zachary Whinnett","doi":"10.1093/europace/euaf061","DOIUrl":"10.1093/europace/euaf061","url":null,"abstract":"<p><p>Up to one-third of patients referred for transcatheter tricuspid valve intervention (TTVI) have a transvalvular pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead in place. Both the electrophysiology and interventional cardiology communities have been alerted to the complexity of decision-making in this situation due to potential interactions between the leads and the TTVI material, including the risk of jailing or damage to the leads. This document, commissioned by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, reviews the scientific evidence to inform Heart Team discussions on the management of patients with a PPM or ICD who are scheduled for or have undergone TTVI.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751824","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}