Europace最新文献

{"title":"Impact of myocardial phenotype on optimal atrioventricular delay settings during biventricular and left bundle branch pacing at rest and during exercise: insights from a virtual patient study.","authors":"Claudia A Manetti, Nick van Osta, Ahmed S Beela, Lieven Herbots, Frits W Prinzen, Tammo Delhaas, Joost Lumens","doi":"10.1093/europace/euaf082","DOIUrl":"10.1093/europace/euaf082","url":null,"abstract":"<p><strong>Aims: </strong>Previous studies have not examined the role of non-electrical myocardial disease substrates in determining the optimal atrio-ventricular delay (AVD) settings. We conducted virtual patient simulations to evaluate whether myocardial disease substrates influence the acute response to AVD optimization at rest and during exercise.</p><p><strong>Methods and results: </strong>The CircAdapt cardiovascular model was used to simulate various left ventricular (LV) remodelling found in cardiac resynchronization therapy candidates. We simulated electrical dyssynchrony, LV dilatation with preserved and reduced contractility, and increased LV passive stiffness. We simulated cardiac resynchronization following biventricular (BiVP) and non-selective LBB pacing (nsLBBP). The paced-AVD ranged from 220 to 40 ms. Cardiac output and heart rate were increased to simulate different levels of exercise. The optimal AVD was the one leading to the highest stroke volume (SV) and the lowest mean left atrial pressure (mLAP). At rest, in simulations with healthy myocardium the gain in SV by AVD optimization was larger compared to those with reduced contractility and stiff myocardium. However, mLAP was comparably decreased by AVD optimization in both healthy and diseased myocardium. During exercise, the optimal AVD shifted to shorter values, and mLAP was more sensitive to AVD, particularly in the presence of hypo-contractile and stiff myocardium.</p><p><strong>Conclusion: </strong>Simulations show that hypocontractility and stiffness reduce the effect of AVD optimization on SV but enhance its benefit in lowering mLAP. Notably, virtual patients with stiff ventricles experience greater benefits from AVD optimization during exercise compared to resting conditions. Furthermore, nsLBBP provides more favourable improvements in mLAP than BiVP.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802858","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":"Baseline and 10-year change in the number of ideal cardiovascular health metrics and sudden cardiac death in the community.","authors":"Jean-Philippe Empana, Marie-Cecile Perier, Peder Emile Warming, Eloi Marijon, Irene van Valkengoed, Frederik N Ågesen, Eva Prescott, Rezza Jabbari, Rachel E Climie, Petra Elders, Marieke T Blom, Peter J Schwartz, Hanno L Tan, J Tfelt-Hansen, Xavier Jouven","doi":"10.1093/europace/euaf046","DOIUrl":"10.1093/europace/euaf046","url":null,"abstract":"<p><strong>Aims: </strong>Adherence to an ideal cardiovascular health (CVH) might contribute to lower the burden of sudden cardiac death (SCD) in the community. We aimed to examine the association between the number of ideal CVH metrics at baseline and of its change over 10 years with the risk of SCD.</p><p><strong>Methods and results: </strong>The Copenhagen City Heart Study is a community-based prospective cohort study. The number of ideal CVH metrics (range 0-6; non-smoking and ideal level of body mass index, physical activity, untreated glucose, untreated systolic blood pressure, and untreated total cholesterol levels) at baseline in 1991-94 and its 10-year change thereof between 1981-83 and 1991-94 were evaluated. Definite SCD was defined as a death occurring within 1 h (eye-witnessed case) or within 24 h (non-eye-witnessed) of symptoms onset, with the presence of confirmed ventricular tachycardia and the exclusion of non-cardiac cause at autopsy. Fine and Gray sub-distribution HRs (sHRs) were calculated to account for competing risk. The study population includes 8837 participants (57% women; mean age 57 years, ±15 years) in 1991-94. After a median follow-up of 22.6 years from 1 January 1993 up to 31 December 2016, 56 definite SCD occurred. The risk of definite SCD decreased gradually with the number of ideal metrics in 1991-94 [sHR = 0.58; 95% confidence interval (CI): 0.44-0.75 per additional ideal metric] and with the change (i.e. improvement) in the number of ideal metrics between 1981-83 and 1991-94 (sHR = 0.68; 0.50-0.93 per change in the number of ideal metrics). Effect size was lower for coronary death, all-cause mortality, and coronary heart disease events.</p><p><strong>Conclusion: </strong>Adherence to a higher number of ideal cardiovascular health was related to a substantial lower risk of definite SCD.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630261","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":"Late arrhythmic burden in patients with left bundle branch block after TAVR with the Evolut valve.","authors":"Silvia Mas-Peiro, Thibault Lhermusier, Marina Urena, Luis Nombela-Franco, Victoria Vilalta, Antonio Muñoz-Garcia, Ignacio Amat-Santos, Felipe Atienza, Neal Kleiman, Chekrallah Chamandi, Vicenç Serra, Marc W Deyell, Francisco Campelo-Parada, Pierre Mondoly, Gaspard Suc, Victoria Canadas-Godoy, Eduard Fernandez-Nofrerias, Javier Castrodeza, Jaime Elizaga, Pierre Baudinaud, Jaume Francisco Pascual, John G Webb, Emilie Pelletier-Beaumont, François Philippon, Josep Rodés-Cabau","doi":"10.1093/europace/euaf057","DOIUrl":"10.1093/europace/euaf057","url":null,"abstract":"<p><strong>Aims: </strong>Arrhythmic burden after discharge in patients with new-onset persistent left bundle branch block (NOP-LBBB) following transcatheter aortic valve replacement (TAVR) with Evolut devices remains largely unknown. The aim of this study is to assess the incidence and type of arrhythmias at 2-year follow-up in patients with NOP-LBBB post-TAVR.</p><p><strong>Methods and results: </strong>This is a prospective multicentre study including 88 patients with LBBB persisting for ≥3 days post-implantation. Before discharge, an implantable loop recorder (REVEAL XT/LINQ) was implanted; patients had continuous monitoring for 2 years. Arrhythmic events were adjudicated in a central core lab. Of the arrhythmic events, 411 were detected in 58 patients [65.9%; 2 (1-4) events per patient]. Symptoms were reported in 12/58 (20.7%), and therapy was changed in 25/58 (43.1%). There were 101 bradyarrhythmic events in 33 patients [35 high-grade atrioventricular block (HAVB) and 66 severe bradycardia]. The HAVB incidence was higher in the early (4-week) phase and remained stable over time, whereas severe bradycardia increased after 1 year. Permanent pacemaker was required in 11 (12.5%) patients (6.8% and 5.7% in the first and second year, respectively). There were 310 tachyarrhythmic events in 29 patients (120 AF/AFL, 111 AT, 72 SVT, 6 NSVT, and 1 VT); its incidence decreased throughout the 2 years. New AF/AFL episodes occurred in 20/69 patients [29%; symptomatic in 2/20 (10%)].</p><p><strong>Conclusion: </strong>Patients with NOP-LBBB post-TAVR with Evolut devices exhibited a high burden of late arrhythmias, with events occurring in two-thirds of patients and leading to treatment changes in about half of them. These data should inform future studies on cardiac monitoring devices for follow-up and treatment optimization in this challenging population.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656574","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":"Flecainide acetate inhalation solution for cardioversion of recent-onset, symptomatic atrial fibrillation: results of the phase 3 RESTORE-1 trial.","authors":"Michiel Rienstra, Anderson C Woite-Silva, Aaf Kuijper, Sabine Eijsbouts, Karin Kraaier, Tomas Janota, Clara Van Ofwegen, Ype Tuininga, Erik Badings, Jose Luis Merino, Jeremy N Ruskin, A John Camm, Peter R Kowey, Christopher Dufton, Jean Maupas, Dawn Parsell, Luiz Belardinelli","doi":"10.1093/europace/euaf064","DOIUrl":"10.1093/europace/euaf064","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. New treatments are needed to cardiovert recent-onset paroxysmal AF quickly and safely. RESTORE-1 was a multicentre, randomized, double-blind, placebo-controlled trial of a 120 mg orally inhaled solution of flecainide acetate (FlecIH-103) for cardioversion of symptomatic, recent-onset (≤48 h) paroxysmal AF. The study aim was to evaluate the efficacy and safety of FlecIH-103 administered via oral inhalation.</p><p><strong>Methods and results: </strong>Patients experiencing a recent-onset paroxysmal AF episode were randomized to receive a single dose of FlecIH-103 or placebo delivered over two 3.5 min inhalation periods, while patients were monitored using 12-lead electrocardiograms and Holter. The trial was stopped prematurely after treating 55 patients, due to lower-than-expected conversion rates and plasma levels. Mean age was 59.6 years, 31.5% of patients were female, and 59.2% were having their first AF episode. Conversion rate was 30.8% (95% confidence interval: 14.7-43.8) for the active group (n = 39) and 0.0% for the placebo group (n = 12) (P = 0.04). Median time to conversion was 12.8 min (IQR: 17.2). In the active group, the mean flecainide plasma level was 198 ng/mL (SD: 156), which is ∼50% lower than in the previous studies. The most common adverse events (AEs) were dysgeusia, dyspnoea, and cough. All AEs were short-lasting and of mild or moderate intensity.</p><p><strong>Conclusion: </strong>Despite early termination of the trial, FlecIH-103 was significantly more effective than placebo in cardioverting AF. Safety data did not show any serious AEs. Further studies of FlecIH-103 are needed to optimize the combination of drug formulation and inhalation delivery platform.</p><p><strong>Clinical trial registration: </strong>URL: https://clinicaltrials.gov, unique identifier: NCT05039359.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709189","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":"Towards personalized therapy for atrial fibrillation: the rhythmic climbing of dronedarone.","authors":"Maria Carelli, Emanuel Raschi, Igor Diemberger","doi":"10.1093/europace/euaf079","DOIUrl":"https://doi.org/10.1093/europace/euaf079","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 4","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004226","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":"A new basket player on the court: pulsed field ablation with a balloon-in-basket system for atrial fibrillation.","authors":"Marco Schiavone, Luigi Di Biase","doi":"10.1093/europace/euaf065","DOIUrl":"10.1093/europace/euaf065","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751809","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":"Mitochondrial damage mediates STING activation driving obesity-mediated atrial fibrillation.","authors":"Zhen Cao, Yuntao Fu, Yuanjia Ke, Yajia Li, Kexin Guo, Xiaojian Long, Yixuan Luo, Qingyan Zhao","doi":"10.1093/europace/euaf081","DOIUrl":"10.1093/europace/euaf081","url":null,"abstract":"<p><strong>Aims: </strong>Obesity is a significant risk factor for atrial fibrillation (AF), but the mechanisms by which obesity contributes to AF are not fully understood. Recent studies have indicated that the Stimulator of Interferon Genes (STING) signalling, mediated by mitochondrial damage, plays a crucial role in cardiac remodelling in various metabolic and cardiovascular diseases. This study aims to explore the role of STING in obesity-mediated AF and its potential mechanisms.</p><p><strong>Methods and results: </strong>In this study, rats were divided into four groups: two groups received tail vein injections of AAV9-cTnT-STING siRNA and were fed either a normal diet or a high-fat diet (HFD) for 12 weeks; the other two groups received injections of AAV9-cTnT-NC siRNA and were similarly fed either a normal diet or a HFD. The atrial STING signalling, AF vulnerability, electrical remodelling, and substrate remodelling were assessed in all groups. Results showed that the induction of AF was increased in obese rats, accompanied by severe mitochondrial damage and upregulation of the STING inflammatory signalling cascade. STING activation was associated with atrial fibrosis, cardiomyocyte apoptosis, and substrate remodelling, including alterations in the gap junction protein CX40 and ion channels. Additionally, STING was linked to excessive calcium transfer from the endoplasmic reticulum to the mitochondria. Knockdown of STING prevented AF vulnerability and both electrical and substrate remodelling in obese rats.</p><p><strong>Conclusion: </strong>Mitochondrial damage-mediated activation of the STING signalling pathway promotes obesity-induced atrial remodelling and the occurrence of AF.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788119","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":"Acute ischaemic stroke during high-power short-duration ablation for atrial fibrillation patients: a case series study.","authors":"Xiaofeng Lu, Xintao Li, Yong Lu, Juan Xu, Shi Peng, Yutong Ye, Yan Liu, Xiaoyu Zhang, Tong Wei, Lin Liang, Liping Li, Yong Wei, Jun Li, Shuai Guo, Shaowen Liu, Songwen Chen","doi":"10.1093/europace/euaf068","DOIUrl":"10.1093/europace/euaf068","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729502","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":"Sex differences in the risk of readmission for ventricular arrhythmia following myocardial infarction in patients without implantable cardioverter defibrillator: a nationwide cohort study.","authors":"Charles Guenancia, Jean-Marc Sellal, Nefissa Hammache, Mathieu Echivard, Antoine Da Costa, Christian de Chillou, Karim Benali","doi":"10.1093/europace/euaf059","DOIUrl":"10.1093/europace/euaf059","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691592","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":"PULSE survey: Population Survey on Knowledge, Gaps and Perception of Heart Rhythm disorders-an initiative of the Scientific Initiatives Committee of the European Heart Rhythm Association.","authors":"Melanie A Gunawardene, Helmut Pürerfellner, Jose L Merino, Dominik Linz, Arian Sultan, Daniel Scherr, Jean Claude Deharo, Peter Wohlmuth, Johannes Feldhege, Francisco Moscoso Costa, Silvia Ribeiro, Emmanouil Charitakis, Axel Verstrael, Matteo Anselmino, Gabor Szeplaki, Stefan Simovic, Tomasz Jadczyk, Raquel Adelino, Ioannis Katsoularis, Max Liebregts, Roland Richard Tilz, Kyoung-Ryul Julian Chun","doi":"10.1093/europace/euaf032","DOIUrl":"10.1093/europace/euaf032","url":null,"abstract":"<p><strong>Aims: </strong>Despite increasing prevalence, the general population lacks knowledge regarding diagnosis, implications, and management of cardiac arrhythmias (CA). This study aims to assess public perception of CA and identify knowledge gaps.</p><p><strong>Methods and results: </strong>The 36-item PULSE survey was disseminated via social media to the general population and conducted under the auspices of the European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) with EHRA patient committee support. Among 3924 participants (2177 healthy, 1747 with previously diagnosed CA; 59% female, 90% European), 81% reported fear of CA. Females were more likely to be 'very' or 'moderately afraid' than males [odds ratio (OR) 1.159 (1.005, 1.337), P = 0.046]. While most recognized complications of CA-heart failure (82%), stroke (80%), and death (75%)-43% were unaware that CA can be asymptomatic. Those with cardiopulmonary resuscitation (CPR) training in the past 5 years were 2.6 times and 4.7 times more confident identifying sudden cardiac death and initiating CPR (P < 0.001). Confidence was lower in retired participants [OR 0.574 (0.499, 0.660), P < 0.001] and Southern Europeans [OR 0.703 (0.600, 0.824), P < 0.001]. Without CPR training, only 15% felt confident initiating CPR. Among CA participants, 28% reported severe to disabling daily symptoms. Males were more often asymptomatic (20% vs. 9%, P < 0.001). Treatment rates were comparable between sex categories (81% vs. 79%, P = 0.413). Interdisciplinary shared decision-making processes were reported by 4%. Notably, 1 in 10 CA cases was self-diagnosed using a wearable device, and 30% of CA participants used smartwatches for self-monitoring.</p><p><strong>Conclusion: </strong>Significant knowledge gaps regarding CA exist in the general population. Targeted educational initiatives could be a viable tool to enhance public knowledge, confidence in detecting and managing arrhythmias, particularly for women, who experience greater fear and symptom severity despite similar treatment rates.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 4","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751742","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}