Heart rhythm最新文献

{"title":"Distinct mechanistic features of atrial fibrillation in hypertrophic cardiomyopathy.","authors":"Michael Liu, Sarah Huang, Masataka Kawana, Matthew T Wheeler, Victoria Parikh, Marco V Perez","doi":"10.1016/j.hrthm.2026.03.1958","DOIUrl":"10.1016/j.hrthm.2026.03.1958","url":null,"abstract":"<p><p>Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is increasingly recognized as a distinct clinical entity, characterized by early onset, high prevalence, and uniquely poor outcomes compared with AF in the general population. This review synthesized emerging evidence on the genetic, molecular, and hemodynamic mechanisms underlying AF-HCM. Patients with AF-HCM face a dramatically increased risk of stroke and heart failure, independent of conventional risk stratification tools, necessitating universal anticoagulation and aggressive rhythm control. Current therapies including cardiac ablation and antiarrhythmic drugs demonstrate limited efficacy and/or safety in this population. Recent clinical trials and real-world studies reveal persistent AF incidence despite advances in HCM management, underscoring the need for novel, disease-specific therapeutic strategies. AF-HCM exemplifies the importance of genotype-driven precision medicine in cardiology and highlights ongoing gaps in the treatment of complex inherited arrhythmias.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current of Injury Mapping and Right Atrial Lead Performance With Selective Use of Stylet Railing.","authors":"Mohamed Gad, Robert D Schaller","doi":"10.1016/j.hrthm.2026.04.054","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.054","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower socioeconomic status is associated with lower quality of care of atrial fibrillation despite comprehensive no-cost access to medical care in Australia.","authors":"Joseph Hogarty, Malanka Lankaputhra, Emily Mahony, Aleksandr Voskoboinik, Emily Nehme, Dion Stub, Luke P Dawson, Mark Horrigan, Peter Kistler, Jonathan M Kalman, David M Kaye, Ziad Nehme, Jocasta Ball","doi":"10.1016/j.hrthm.2026.04.052","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.052","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES) is an established risk factor for poor cardiovascular outcomes, with atrial fibrillation (AF) a major contributor to cardiovascular morbidity and mortality.</p><p><strong>Objective: </strong>To examine associations between SES, clinical outcomes and access to guideline-directed therapies in patients attended by emergency medical services (EMS) with a prehospital AF diagnosis within a universal healthcare setting METHODS: We conducted a population-based cohort study of consecutive adults attended by EMS for AF across Victoria, Australia (January-2015-June-2019). Patients were stratified into SES quintiles using census-based postcode indices.</p><p><strong>Results: </strong>Primary analysis included 14,987 patients, median age 76 (Q1-Q3:67-84), 43% male. Time-to-event-analysis demonstrated a gradient of lower rates of outpatient cardioversion and ablation and increased EMS re-presentations and mortality amongst lower SES groups. On multivariable analysis compared with the highest SES quintile, the lowest SES group was associated with reduced cardioversions (aHR 0.73(0.61-0.86), p<0.001) and ablations (aHR 0.48(0.39-0.60), p<0.001) and higher risk of EMS re-presentation for AF within 30 days (aOR 1.61(1.19-2.17), p=0.002) and over median 2.1-year follow-up (aHR 1.18(1.03-1.36), p=0.019). Mortality was also higher at 30 days (aOR 1.68(1.31-2.15), p<0.001) and over median 2.1-year follow-up (aHR=1.42(1.28-1.58),p<0.001) compared to the highest SES group. In a competing-risk model treating death as a competing event, re-presentation effect estimates remained directionally similar but attenuated and no longer statistically significant.</p><p><strong>Conclusion: </strong>The lowest SES groups compared to the highest were associated with reduced access to cardioversion and ablation following index attendance, along with more frequent EMS re-presentations for AF and higher mortality within 30 days and long-term follow-up.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development and progression of left atrial myopathy in patients undergoing recurrent left atrial ablation procedures.","authors":"Karan Saraf, Michael Malaty, David Ferreira, Kerissa Govender, Lloyd Butel-Simoes, Amandeep Kaur, Aaron Sverdlov, Andreu Porta Sanchez, Andrew C T Ha, Vijay Chauhan, Paolo D'Ambrosio, Gwilym M Morris, Nicholas Jackson","doi":"10.1016/j.hrthm.2026.04.056","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.056","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation remains central to atrial fibrillation (AF) ablation, yet recurrence can occur despite durable isolation, and is associated with low voltage areas (LVAs), a surrogate for atrial fibrosis.</p><p><strong>Objectives: </strong>This study characterised longitudinal LVA changes in repeat ablation patients and identified predictors of substrate progression.</p><p><strong>Methods: </strong>Consecutive adults undergoing de novo left atrial ablation for AF were enrolled, with repeat ablation cases analysed. LVAs were quantified, with progression defined as >10% LVA increase. Conduction velocity and electrogram complexity were measured, with regression analysis assessing predictors and association with AF recurrence.</p><p><strong>Results: </strong>In 90 patients, total LVA rose from 9.5±16.8% to 19.0±24.7% (p<0.001); 33% of patients had >10% progression, mainly in septal (42%), anterior (37%), and posterior (34%) segments. Patients with progression had higher CHA₂DS₂-VASc (2.75 vs. 2.05, p=0.021), larger LA volumes (152 vs. 122ml, p=0.008), and slower baseline CV (0.86 vs. 1.02 m/s, p=0.013). Multivariable analysis confirmed baseline LA volume (p=0.002) and conduction velocity (p=0.043) as predictors of progression (R²=0.206). LVA burden predicted 12-month AF recurrence (OR 3.65 per 1%, p=0.049 baseline; OR 2.54, p=0.012 at second procedure).</p><p><strong>Conclusion: </strong>LA myopathy advances in one-third of repeat AF ablation patients without chamber enlargement, exhibiting heterogeneous progression favouring septal, anterior, and posterior segments while sparing the lateral wall. Baseline conduction velocity and LA volume robustly predict LVA progression, indicating functional electrical remodelling precedes structural fibrosis, highlighting the importance of integrating functional markers when characterizing atrial substrate progression.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Irregularity Factor: Mechanistic Insights into Beat-to-beat Irregularities in Atrial Fibrillation Cycle Length.","authors":"Natasja M S de Groot, Lianne N van Staveren, Eva A H Lanters, Vehpi Yildirim, Richard Hendriks, Rudolf A de Boer, Hemanth Rammanah, Mathijs S van Schie","doi":"10.1016/j.hrthm.2026.04.059","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.059","url":null,"abstract":"<p><strong>Background: </strong>Measures derived from atrial fibrillation cycle length (AFCL) are used to identify regions crucial for AF maintenance or predict (ablation) treatment outcomes. However, mechanisms underlying beat-to-beat irregularities in AFCL is unknown.</p><p><strong>Objectives: </strong>We aimed to 1) investigate beat-to-beat changes in AFCL (Δ-AFCL) by relating temporal variation in AFCL with quantified beat-to-beat changes in activation patterns and conduction times (Δ-CT) 2) test whether the Irregularity Factor (IF) (SD of the Δ-AFCL histogram), is indicative of activation patterns complexity.</p><p><strong>Methods: </strong>Mapping was performed in 24 patients with longstanding persistent AF (LSPAF) and a reference group (N=25, induced (acute) AF). At the mapping area center, Δ-AFCL was calculated by subtracting each AFCL from preceding AFCL and related to causes of beat-to-beat changes in CT (CT_(N) - CT _(N-1)) of fibrillation waves from electrode array border towards mapping area center.</p><p><strong>Results: </strong>The IF was larger during LSPAF (52±17 vs 25±10;P<0.001) compared to acute AF. Δ-CTs were also larger (25±8ms vs 19±7ms;P=0.005) and caused by changes in conduction velocity (Δ-CVs:36±6cm/s versus 29±6cm/s;P=0.001) and -direction (Δ-direction:94±13° versus 64±22°;P<0.001);Δ-pathlenghts (Δ-PL:13±4mm versus 14±3mm;P=0.333) were comparable. IF correlated with conduction block (ρ=0.887), lines of conduction block lengths (ρ=0.900), number of fibrillation waves (ρ=0.889) and focal waves (ρ=0.609), (all P<0.001).</p><p><strong>Conclusion: </strong>The IF indicates the underlying complexity of activation patterns, is higher during LSPAF compared to acute AF and is comparable throughout the atria during LSPAF. It is an easy-to-calculate, objective electrical biomarker which independently from the AF mechanisms can be used for e.g. guiding patient tailored treatment.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Resynchronization in Left Bundle Branch Block Achieved by Conduction System Pacing: A Strain-Based Analysis.","authors":"Thomas Van Overmeiren, Pedro G Diogo, Emine Özpak, Simon Calle, Gábor Vörös, Maarten A J De Smet, Jean-Benoît le Polain de Waroux, Frank Timmermans, Jan De Pooter","doi":"10.1016/j.hrthm.2026.04.055","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.055","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) improves synchronous left ventricular (LV) contraction and therefore emerged as an alternative to biventricular pacing for cardiac resynchronization therapy (CRT). However, the extent of mechanical resynchronization with LBBAP remains incompletely characterized.</p><p><strong>Objective: </strong>To assess resynchronization following LBBAP in patients with baseline left bundle branch block (LBBB) or right ventricular pacing (RVP)-induced dyssynchrony, across the full range of left ventricular ejection fraction (LVEF).</p><p><strong>Methods: </strong>This multicenter study included patients undergoing LBBAP with LBBB or need for upgrade from RVP. Mechanical dyssynchrony and resynchronization were evaluated using septal strain imaging at baseline, early post-implantation, and late post-implantation. Global longitudinal strain (GLS), and mid-septal strain curves were analyzed.</p><p><strong>Results: </strong>Left bundle branch pacing (LBBP) during follow-up was confirmed in 71% of the patients, left ventricular septal pacing (LVSP) in 14%, and deep septal pacing (DSP) in 15%. Septal strain patterns improved immediately and progressively after implantation (P=0.01), with GLS increasing from -12 ± 6% at baseline to -15 ± 6% at follow-up (P<0.001). Resynchronization was not significantly different between LBBP and LVSP, but was inferior in DSP, with lower Δ mid-septal PSS (P=0.004) and ΔLVEF (P=0.03) at one year. In regression analysis, both LBBB-stages and type of LBBAP-capture were associated with reverse remodeling following LBBAP.</p><p><strong>Conclusion: </strong>LBBAP provides substantial mechanical resynchronization with immediate and progressive improvements in septal mechanics. Resynchronization was not significantly different between LBBP and LVSP, but was attenuated in DSP, where residual dyssynchrony was associated with lower LVEF one year after implantation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Ventricular Arrhythmia and Tissue Effects of Radiofrequency Delivery Through a Pacing Lead in a Beating Swine Septum.","authors":"Binbin Luo, Longfu Jiang, Kecheng Dai, Xianfeng Du, Di Lu, Lu Zhang, Ding Yuan, Wenqiang Ruan","doi":"10.1016/j.hrthm.2026.04.053","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.053","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new mapping and ablation strategy for premature ventricular complexes originating from the proximal left anterior fascicle under the guidance of electrocardiographic characteristics.","authors":"Xiaofeng Lu, Shi Peng, Wenhua Li, Cheng Tang, Bo Yang, Wei Song, Juan Xu, Xintao Li, Yan Liu, Tong Wei, Lin Liang, Liping Li, Weijie Zhu, Jun Li, Shaowen Liu, Jackson J Liang, Songwen Chen","doi":"10.1016/j.hrthm.2026.04.058","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.058","url":null,"abstract":"<p><strong>Background: </strong>Premature ventricular complexes (PVCs) originating from the proximal left anterior fascicle (LAF) can be eliminated safely from the right coronary cusp (RCC).</p><p><strong>Objective: </strong>This study was performed to evaluate a new mapping and ablation strategy for proximal LAF-PVCs under the guidance of electrocardiographic characteristics.</p><p><strong>Methods: </strong>Proximal LAF-PVCs were defined as PVC-QRS with prominent inferior frontal plane QRS axis, right bundle branch block pattern, and with QRS duration difference (between PVC and sinus rhythm) <15ms. The study group consisted of consecutive patients with proximal LAF-PVCs, which were prospectively mapped and ablated from only the RCC. The control group consisted of patients with proximal LAF-PVCs, which were mapped from the left ventricle and RCC before ablation from within the RCC was successful.</p><p><strong>Results: </strong>There were 24 and 8 patients in the study and control groups, respectively. For the study group, after mapping from only the RCC, proximal LAF-PVCs were eliminated with ablation from the RCC alone (2.5±0.7 lesions). Mapping time (9.3±5.8min vs. 27.9±6.8min, P<0.001), and procedure time (43.8±7.5min vs. 61.0±6.9min, P<0.001) of the study group were shorter than that of the control group. Long-term success rates and electrocardiographic characteristics were similar between groups.</p><p><strong>Conclusion: </strong>Under the guidance of electrocardiographic characteristics, this new mapping and ablation strategy (from the RCC alone) is a simple, safe, and effective method for elimination of proximal LAF-PVCs.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SMARTBrugada study: Smartwatch Marginosternal Application for Recording Type I Brugada Pattern.","authors":"Angelo Melpignano, Ludovica R Vocale, Francesco Vitali, Luca Canovi, Federico Gibiino, Chiara Bianchi, Michele Malagù, Cristina Balla, Matteo Bertini","doi":"10.1016/j.hrthm.2026.04.060","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.060","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using monophasic potential mapping to visualize the Brugada substrate.","authors":"Mark G Hoogendijk, Sing-Chien Yap, Bastiaan J Boukens","doi":"10.1016/j.hrthm.2026.03.1969","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.03.1969","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}