Europace最新文献

{"title":"Persistent atrial fibrillation with left atrial low-voltage area: who benefit from additional modification?","authors":"Hengzhi Zhang, Ning Chen, Qiuheng Bian, Mingchuan Yuan, Gang Yang, Youmei Shen, Hongwu Chen, Weizhu Ju, Mingfang Li, Kai Gu, Nan Wu, Hailei Liu, Minglong Chen","doi":"10.1093/europace/euaf095","DOIUrl":"10.1093/europace/euaf095","url":null,"abstract":"<p><strong>Aims: </strong>The presence of low-voltage areas (LVAs) is associated with increased recurrence rate following ablation of persistent atrial fibrillation (PeAF). However, the benefit of additional LVA modification remains controversial. This substudy of the STABLE-SR-II trial aims to explore the factors that influence the benefit of additional LVA ablation for PeAF patients with LVAs.</p><p><strong>Methods and results: </strong>In the STABLE-SR-II trial, PeAF patients with de novo ablation were randomized to receive either circumferential pulmonary vein isolation (CPVI, CPVI-alone group) or CPVI plus LVA ablation (CPVI-plus group). Patients with LVAs were included and analyzed in this substudy. The primary outcome was freedom from atrial arrhythmias 18 months after a single ablation procedure. LVAs were detected in 133 out of 276 PeAF patients (48%). Age and LVA burden were potential factors influencing the relative success of additional LVA ablation compared with CPVI alone in the univariable analysis. In multi-adjusted models, significant benefit from additional LVA ablation was found in patients aged ≥65 years [n = 50, hazard ratio (HR) 0.14, 95% confidence interval (CI) 0.02-0.83] or with LVA burden ≥ 15% (n = 18, HR 0.01, 95% CI: 0-0.44). LVA burden ≥15% was observed in 10 of 50 patients aged ≥65 years (20%) and in 8 of 83 patients aged <65 years (10%). Combined subgroup analysis demonstrated that LVA ablation was particularly beneficial for patients aged ≥65 years, regardless of LVA burden.</p><p><strong>Conclusion: </strong>LVA ablation following CPVI may provide additional benefits for older PeAF patients (≥65 years) in the first procedure.</p><p><strong>Clinical trial registration: </strong>NCT03448562 [CPVI Alone Versus CPVI Plus Electrophysiological Substrate Ablation in the LA During SR for the Treatment of Non-PAF (STABLE-SR_II)].</p>","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/PMC12076150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993125","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":"High Mortality After NSTEMI and Implications for ICD Trials Design.","authors":"Laurent Fauchier, Alexandre Bodin, Bertrand Pierre","doi":"10.1093/europace/euaf096","DOIUrl":"https://doi.org/10.1093/europace/euaf096","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985267","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":"Exploring the Effects of Glucagon-like Peptide-1 Receptor Agonists on Ventricular Arrhythmias: A Propensity Score-Matched Analysis.","authors":"Min Choon Tan, Aravinthan Vignarajah, Yong Hao Yeo, Justin Z Lee, Andrea M Russo, Luis R Scott, Dan Sorajja","doi":"10.1093/europace/euaf090","DOIUrl":"https://doi.org/10.1093/europace/euaf090","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984413","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":"Multiparametric models for predicting major arrhythmic events in Brugada syndrome: a systematic review and critical appraisal.","authors":"Daniel A Gomes, Pier D Lambiase, Richard J Schilling, Riccardo Cappato, Pedro Adragão, Rui Providência","doi":"10.1093/europace/euaf091","DOIUrl":"https://doi.org/10.1093/europace/euaf091","url":null,"abstract":"<p><strong>Background: </strong>Despite several risk models to predict major arrhythmic events (MAE) in Brugada syndrome (BrS) having been developed, reproducibility and methodology remain a concern. Our aim was to assess the quality of model development and validation, and determine the discriminative performance of available models.</p><p><strong>Methods: </strong>Electronic databases (Medline, Embase and Central) were searched through September/2024 for studies developing or validating multivariable prediction models for MAE in BrS. Methodological quality and risk of bias (RoB) were assessed using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and the Prediction Model Risk of Bias Assessment (PROBAST) Tool. Pooled random-effects c-statistics were obtained for each model.</p><p><strong>Results: </strong>A total of 16 studies, including 11 unique multivariable scores, were included. All models had domains classified as high RoB. Common sources of bias were inappropriate inclusion/exclusion criteria, predictor selection, low number of events and underreporting of performance measures. Pooled c-statistics among patients without previous MAE showed good performance for Brugada-Risk (AUC 0.81, 95%CI 0.71-0.91; I2 64%; 3 studies), fair for PAT (AUC 0.79, 95%CI 0.45-1.12; I2 95%; 2 studies), Delise (AUC 0.77, 95%CI 0.72-0.81, I2 39%, 3 studies), and Sieira (AUC 0.73, 95%CI 0.64-0.82; I2 64%; 5 studies), and moderate for Shanghai (AUC 0.69, 95%CI 0.61-0,76; I2 13%; 3 studies).</p><p><strong>Conclusions: </strong>Currently available multiparametric models for prediction of MAE in BrS have important shortcomings in model development and inadequate evaluation. Further validation of current models in external cohorts is required before safe transition to clinical practice.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004342","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":"A heart job - predicting sudden cardiac arrest.","authors":"Pieter G Postema","doi":"10.1093/europace/euaf092","DOIUrl":"https://doi.org/10.1093/europace/euaf092","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990437","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":"Re-recognized the Maintenance Mechanism of Persistent Atrial Fibrillation via Electrogram Analysis in Termination Regions.","authors":"Mu Qin, Le-Tian Wang, Shi-Yi Wang, Yu Zhang, Wei-Feng Jiang, Shao-Hui Wu, Kai Xu, Yang Liu, Xu-Min Hou, Xu Liu","doi":"10.1093/europace/euaf087","DOIUrl":"https://doi.org/10.1093/europace/euaf087","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987340","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":"Countywide burden, pathology, and genetics of lethal hypertrophic cardiomyopathy: from the POST SCD study.","authors":"Leila Haghighat, Andrew Connolly, Francesca N Delling, Theodore P Abraham, Ellen Moffatt, Zian H Tseng","doi":"10.1093/europace/euaf088","DOIUrl":"https://doi.org/10.1093/europace/euaf088","url":null,"abstract":"<p><strong>Background: </strong>Incidence of sudden cardiac death (SCD) is 1%/year in cohorts with hypertrophic cardiomyopathy (HCM), but this estimate presumes arrhythmic cause and misses occult cases dying before diagnosis.</p><p><strong>Methods: </strong>POST SCD (POstmortem Systematic InvesTigation of Sudden Cardiac Death) is a prospective cohort study using autopsy, clinical records, and toxicology to adjudicate arrhythmic or non-arrhythmic causes among presumed SCDs (pSCDs) meeting WHO criteria aged 0-90 years in San Francisco County. We included all incident cases 2/1/2011-3/1/2014 (n=525) and approximately every third day 3/1/2014-9/1/2022 (n=497) based on medical examiner call schedule. We identified HCM victims via 3 approaches: 1) pathology; 2) echocardiogram (TTE); 3) genetic criteria. Incidence calculations used county data and estimated HCM prevalence of 1:500 from studies of persons aged 23-35 years old.</p><p><strong>Results: </strong>Of 1,022 pSCDs (558 [54.6%] arrhythmic deaths) during the study period, 13 had HCM: 10 met pathology criteria; 2 via review of 203 TTEs (missed on initial report); 1 via genetic testing. Of these, 11 were arrhythmic deaths, yielding 1.3% burden of sudden death (pSCD) and 2% of arrhythmic death. Only 2 of 13 (15%) pSCDs with HCM had premortem diagnosis. Incidence for persons with HCM 18-35 years old was 0.2% pSCDs/year and 0.1% SADs/year. pSCDs with HCM had a higher proportion of arrhythmic cause (11/13 [85%] vs. 547/1009 [54%], p=0.03) than those without. pSCD burden due to HCM decreased with age (p=0.003), highest among victims <35 years old, for whom HCM accounted for 7.1% of pSCD and 9.4% of arrhythmic death. Genetic testing of 317 consented pSCDs yielded pathogenic or likely pathogenic variants in 40% (2/5), and identified 1 additional case without clinical phenotype.</p><p><strong>Conclusions: </strong>In this 11-year countywide postmortem study, HCM meeting pathologic, clinical, or genetic criteria was associated with autopsy-confirmed arrhythmic cause of sudden death, accounting for 2% of SADs up to age 90, highest in cases <35 years old. Since 85% of cases were undiagnosed before pSCD, the true burden of HCM-related sudden death may be substantially underestimated.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993241","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":"GSTP1 inhibits angiotensin II-induced atrial fibrillation by regulating ferroptosis.","authors":"Han Li, Zhenyu Feng, Benke Li, Jie Bai, Qiu-Yue Lin, Xiaohong Yu, Ningning Zhang, Yunpeng Xie, Xiaolei Yang","doi":"10.1093/europace/euaf083","DOIUrl":"https://doi.org/10.1093/europace/euaf083","url":null,"abstract":"<p><p>Atrial fibrillation is the most common arrhythmia in clinical practice and increases the potential risk of stroke, thromboembolism, and death. glutathione-S-transferases pi 1 (GSTP1), a key factor of ferroptosis, can participate in stress signal and cell damage pathway through its non-catalytic activity, and has the role of regulating and protecting cells from carcinogens and electrophilic compounds. However, the role and mechanism of GSTP1 in angiotensin II-induced atrial fibrillation have not been studied. We constructed a mouse model of atrial fibrillation using Ang II and identified key factors by proteome and ferroptosis PCR array. We investigated the role of GSTP1 in atrial remodeling and NRAMs by the ferroptosis inhibitor Ferrostatin-1 (Fer-1), AAV9-cTNT-GSTP1 and GSTP1 inhibitor Ezatiostat. The results showed that the ferroptosis pathway was significantly altered in atrial fibrillation by proteomics. The ferroptosis inhibitor Fer-1 demonstrated that inhibiting ferroptosis can intervene in Ang II-induced atrial fibrillation. The ferroptosis PCR array showed that the expression of GSTP1 was significantly decreased in atrial fibrillation, and it was verified in cells and human atrial tissues. In mice infected with AAV9-cTNT-GSTP1, it was found that overexpression of GSTP1 inhibited Ang II-induced atrial fibrillation. Overexpression of GSTP1 inhibited Ang II-induced myocardial injury, oxidative stress, and ferroptosis in vitro. Therefore, these results preliminarily demonstrate that GSTP1-mediated ferroptosis plays a crucial role in the Ang II-induced atrial fibrillation model and can be considered a potential therapeutic target for atrial fibrillation.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788193","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":"State of the Art of Artificial Intelligence in Clinical Electrophysiology in 2025. A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), and the ESC Working Group in e-Cardiology.","authors":"E Svennberg, J K Han, E G Caiani, S Engelhardt, S Ernst, P Friedman, R Garcia, H Ghanbari, G Hindricks, S H Man, J Millet, S M Narayan, G A Ng, P A Noseworthy, F V Y Tjong, J Ramírez, J P Singh, N Trayanova, D Duncker","doi":"10.1093/europace/euaf071","DOIUrl":"https://doi.org/10.1093/europace/euaf071","url":null,"abstract":"<p><strong>Aim: </strong>Artificial Intelligence (AI) has the potential to transform cardiac electrophysiology (EP), particularly in arrhythmia detection, procedural optimization, and patient outcome prediction. However, a standardized approach to reporting and understanding AI-related research in EP is lacking. This scientific statement aims to develop and apply a checklist for AI-related research reporting in EP to enhance transparency, reproducibility and understandability in the field.</p><p><strong>Methods: </strong>An AI checklist specific to EP was developed with expert input from the writing group and voted on using a modified Delphi process, leading to the development of a 29-item checklist. The checklist was subsequently applied to assess reporting practices to identify areas where improvements could be made and provide an overview of the state of the art in AI-related EP research in three domains from May 2021 until May 2024: atrial fibrillation management, sudden cardiac death (SCD), and EP lab applications.</p><p><strong>Results: </strong>The EHRA AI checklist was applied to 31 studies in atrial fibrillation management, 18 studies in SCD, and 6 studies in EP lab applications. Results differed between the different domains, but in no domain reporting of a specific item exceeded 55 % of included papers. Key areas such as trial registration, participant details, data handling, and training performance were underreported (<20%). The checklist application highlighted areas where reporting practices could be improved to promote clearer, more comprehensive AI research in EP.</p><p><strong>Conclusion: </strong>The EHRA AI checklist provides a structured framework for reporting AI research in EP. Its use can improve understanding but also enhance the reproducibility and transparency of AI studies, fostering more robust and reliable integration of AI into clinical EP practice.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751739","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":"Multipoint pacing is associated with reduction of heart failure hospitalizations or death in patients who do not respond to cardiac resynchronization therapy. Results of the MORE-CRT MPP randomized trial.","authors":"Christophe Leclercq, Haran Burri, Leonardo Calò, Christopher Aldo Rinaldi, Johannes Sperzel, Bernard Thibault, Tim Betts, Pascal Defaye, Andreas Hain, Olivier Piot, Kwangdeok Lee, Wenjiao Lin, Annalisa Pollastrelli, Andrea Grammatico, Giuseppe Boriani","doi":"10.1093/europace/euaf070","DOIUrl":"https://doi.org/10.1093/europace/euaf070","url":null,"abstract":"<p><strong>Background and aims: </strong>Cardiac resynchronization therapy (CRT) via biventricular pacing (BIVP) is an effective treatment, but non-responders are at higher risk of death and heart failure (HF) hospitalizations compared with CRT responders. The MORE-CRT MPP trial aimed to evaluate whether CRT with multipoint pacing (MPP) is associated with improved clinical outcomes in CRT non-responders.</p><p><strong>Methods: </strong>CRT patients were treated with conventional BIVP for 6 months and then assessed for CRT response (left ventricular end-systolic volume relative reduction >15% vs. baseline). CRT non-responders were 1:1 randomized to BIVP or MPP and followed for 6 months. The main endpoint of this secondary analysis was HF hospitalizations or all-cause mortality.</p><p><strong>Results: </strong>Out of 3724 CRT patients (67±11 years, 1050 female) 1677 were non-responders and randomized to MPP or BIVP, of whom 1421 (722 MPP and 699 BIVP) had complete data. In a mean follow-up of 5±1 months after randomization, MPP was associated with a lower incidence of HF hospitalizations or all-cause mortality (48/722 (6.64%)) compared with BIVP (73/699 (10.44%), RRR=36% (95% CI=±4%), p=0.0107). At multivariable analysis, MPP was associated with a lower occurrence of the main endpoint (odds ratio=0.60, p=0.0124). At logistic regression analysis HF hospitalizations or all-cause death were lower with MPP vs. BIVP in the whole population and in many patients subgroups, e.g. ischemic patients and patients with long (>105 ms) interventricular electrical delay.</p><p><strong>Conclusion: </strong>In MORE-CRT MPP randomized trial, multipoint pacing was associated with a significant reduction of all-cause mortality and HF hospitalizations in prior non-responders to conventional biventricular pacing.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751736","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}