Heart rhythm最新文献

{"title":"Exploring SCN5A variants associated with atrial fibrillation in atrial cardiomyocytes derived from human induced pluripotent stem cells: A characterization study","authors":"Marion Pierre MSc ,&nbsp;Mohammed Djemai MSc ,&nbsp;Valérie Pouliot MSc ,&nbsp;Hugo Poulin MSc ,&nbsp;Michael H. Gollob MD ,&nbsp;Mohamed Chahine PhD","doi":"10.1016/j.hrthm.2024.09.013","DOIUrl":"10.1016/j.hrthm.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) poses a major risk for heart failure, myocardial infarction, and stroke. Several studies have linked <em>SCN5A</em> variants to AF, but their precise mechanistic contribution remains unclear. Human induced pluripotent stem cells (hiPSCs) provide a promising platform for modeling AF-linked <em>SCN5A</em> variants and their functional alterations.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the electrophysiological impact of 3 AF-linked <em>SCN5A</em> variants (K1493R, M1875T, N1986K) identified in 3 unrelated individuals.</div></div><div><h3>Methods</h3><div>CRISPR-Cas9 was used to generate a new hiPSC line in which Na_V1.5 was knocked out. Following differentiation into specific atrial cardiomyocyte by using retinoic acid, the adult wild-type (WT) and 3 AF variants were introduced into the Na_V1.5 knockout (KO) line through transfection. Subsequent analysis including molecular biology, optical mapping, and electrophysiology were performed.</div></div><div><h3>Results</h3><div>The absence of Na_V1.5 channels altered the expression of key cardiac genes. Na_V1.5 KO atrial-like cardiomyocytes derived from human induced pluripotent stem cells displayed slower conduction velocities, altered action potential (AP) parameters, and impaired calcium transient propagation. The transfection of the WT channel restored sodium current density, AP characteristics and the expression of several cardiac genes. Among the AF variants, 1 induced a loss of function (N1986K) while the other 2 induced a gain of function in Na_V1.5 channel activity. Cellular excitability alterations and early afterdepolarizations were observed in AF variants.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that distinct alterations in Na_V1.5 channel properties may trigger altered atrial excitability and arrhythmogenic activity in AF. Our KO model offers an innovative approach for investigating <em>SCN5A</em> variants in an adult human cardiac environment.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1574-1587"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284503","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":"Cardiac magnetic resonance feature tracking reveals abnormalities in patients with idiopathic ventricular fibrillation","authors":"Lisa M. Verheul MD ,&nbsp;Marco Guglielmo MD ,&nbsp;Alexander Hirsch MD, PhD ,&nbsp;Stefano Figliozzi MD ,&nbsp;Pim van der Harst MD, PhD ,&nbsp;Mimount Bourfiss MD, PhD ,&nbsp;Niek H.J. Prakken MD, PhD ,&nbsp;Birgitta K. Velthuis MD, PhD ,&nbsp;Sing C. Yap MD, PhD ,&nbsp;Rutger J. Hassink MD, PhD","doi":"10.1016/j.hrthm.2024.11.040","DOIUrl":"10.1016/j.hrthm.2024.11.040","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1617-1619"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754923","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":"Novel risk predictor of arrhythmias for patients with potassium channel–related congenital long QT syndrome","authors":"Christian Krijger Juárez MD ,&nbsp;Virginnio M. Proost MD ,&nbsp;Michael W. Tanck PhD ,&nbsp;Sven Dittmann PhD ,&nbsp;J. Martijn Bos MD ,&nbsp;Lia Crotti MD, PhD ,&nbsp;Julien Barc PhD ,&nbsp;Maarten P. van den Berg MD, PhD ,&nbsp;Jasmin Mujkanovic BSc ,&nbsp;Corinna Rickert BSc ,&nbsp;Raquel Almeida Lopes Neves MD ,&nbsp;Giulia Musu BSc ,&nbsp;Federica Dagradi MD ,&nbsp;Fulvio L.F. Giovenzana MD ,&nbsp;Aurélien Clédel MD ,&nbsp;Aurélie Thollet PhD ,&nbsp;John R. Giudicessi MD, PhD ,&nbsp;Jacob Tfelt-Hansen MD ,&nbsp;Vincent Probst MD, PhD ,&nbsp;Peter J. Schwartz MD, PhD ,&nbsp;Arthur A.M. Wilde MD, PhD","doi":"10.1016/j.hrthm.2024.12.015","DOIUrl":"10.1016/j.hrthm.2024.12.015","url":null,"abstract":"<div><h3>Background</h3><div>Congenital long QT syndrome (LQTS) is characterized by delayed ventricular repolarization, predisposing to potentially lethal ventricular arrhythmias. The variability in disease severity among patients remains largely unexplored, underscoring the limitations of current risk stratification methods.</div></div><div><h3>Objective</h3><div>We aimed to evaluate the potential utility of electrocardiographic markers from the exercise stress test (EST) in identifying patients with high-risk LQTS.</div></div><div><h3>Methods</h3><div>The study, which considered patients with LQTS type 1 and LQTS type 2, comprised a discovery cohort of 695 and a validation cohort of 635 patients.</div></div><div><h3>Results</h3><div>The change in corrected QT (QTc) interval between rest and recovery (between rest and 3–4 minutes into the recovery period, called recovery-rest ΔQTc) was consistently greater in symptomatic patients. Sensitivity analyses performed on EST data obtained on and off β-blockers as well as upon distinguishing between patients with a baseline QTc interval below and those above 470 ms demonstrated consistent findings. The association of recovery-rest ΔQTc with cardiac events remained significant in a subanalysis focusing on future events (ie, occurring after the EST). An optimal recovery-rest ΔQTc cutoff was determined for LQTS type 1 (35 ms) and LQTS type 2 (16 ms) separately and was shown to be significantly associated with cardiac events.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that in patients with LQTS, dynamic QT interval measures obtained during the EST are associated with lifetime arrhythmic events and events after the EST. Such measures can be helpful in identifying a higher-risk subset of patients with LQTS in order to optimize their management. Further research may confirm these findings in larger cohorts and explore the potential benefit of combining genetic and EST data for more precise risk stratification.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1562-1571"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828253","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":"Complications of catheter ablation for atrial fibrillation: Important differences in patients with systolic heart failure","authors":"Rose Crowley BMed, MD ,&nbsp;Jeff Ma ,&nbsp;Matthew B. Morton MBBS ,&nbsp;Swetha Vasudevan MBBS ,&nbsp;Louise Segan MBBS ,&nbsp;Jeremy William MBBS, PhD ,&nbsp;David Chieng MBBS, PhD ,&nbsp;Hariharan Sugumar MBBS, PhD ,&nbsp;Aleksandr Voskoboinik MBBS, PhD ,&nbsp;Sandeep Prabhu MBBS, PhD ,&nbsp;Liang-Han Ling MBBS, PhD ,&nbsp;Jonathan M. Kalman MBBS, PhD, FHRS ,&nbsp;Peter M. Kistler MBBS, PhD, FHRS","doi":"10.1016/j.hrthm.2024.09.028","DOIUrl":"10.1016/j.hrthm.2024.09.028","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1437-1439"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345219","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":"Table Of Content","authors":"","doi":"10.1016/S1547-5271(25)02351-3","DOIUrl":"10.1016/S1547-5271(25)02351-3","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages A5, A6, A8, A9, A10"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178675","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":"All-cause mortality due to conduction abnormalities in the United States: Sex, racial, and geographic variations from 1999 to 2022","authors":"Alireza Ghajar MD ,&nbsp;Kyaw M. Khant MD, MHA ,&nbsp;Maeve M. Sargeant BS ,&nbsp;Tharun Bandarupalli MD ,&nbsp;Binu Philips MD ,&nbsp;Fabrizio R. Assis MD ,&nbsp;John N. Catanzaro MD, MBA, FHRS ,&nbsp;Rajasekhar Nekkanti MD ,&nbsp;Samuel F. Sears PhD ,&nbsp;Ghanshyam Shantha MD, MPH","doi":"10.1016/j.hrthm.2024.09.010","DOIUrl":"10.1016/j.hrthm.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Mortality related to conduction abnormalities in the United States (US) population is not well documented. Population-based stratification approaches can improve public health policies and targeted strategies.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate all-cause mortality related to conduction abnormalities in the US population</div></div><div><h3>Methods</h3><div>The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to calculate the age-adjusted mortality rate (AAMR) per 100,000 individuals older than 35 years related to conduction abnormalities between 1999 and 2022.</div></div><div><h3>Results</h3><div>A total of 207,861 deaths were attributed to conduction abnormalities throughout the study period ,with 56,186 of these deaths occurring between 2020 and 2022. All-cause mortality related to conduction abnormalities has increased during the past decade with an exponential growth in 2020–2021 (coronavirus disease 2019 era; annual percent change of 16.6% per year). Although the mortality rates decreased in 2022, they remained elevated compared to 2019–2020. Throughout the past 2 decades, males consistently exhibited higher mortality rates than females, with the rate in 2022 being 1.5 times higher (AAMR 11.4 vs 7.0 per 100,000). Non-Hispanic Black patients experienced a significantly higher mortality rate compared to non-Hispanic White individuals in the study period (AAMR 13.7 vs 8.6 per 100,000 in 2022). In the past 2 decades, mortality has been persistently higher in rural and small- to medium-sized metropolitan areas than in large metropolitan urban areas.</div></div><div><h3>Conclusion</h3><div>Mortality rates related to conduction abnormalities have increased over the past decade, and persistent disparities have been observed. These data suggest that continued innovative outreach approaches and engagement with underrepresented populations remain essential.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1498-1503"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284468","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":"Rates and predictors for sustained ventricular tachycardia in patients with cardiac sarcoidosis and AV block as first cardiac presentation: Implications for device implantation","authors":"Borislav Dinov MD ,&nbsp;Carsten Henfling ,&nbsp;Hans Ebbinghaus MD ,&nbsp;Konrad Latuscynski MD ,&nbsp;Ingo Paetsch MD ,&nbsp;Cosima Jahnke MD ,&nbsp;Samuel Sossalla MD ,&nbsp;Ulrich Laufs MD ,&nbsp;Laura Ueberham MD","doi":"10.1016/j.hrthm.2024.09.020","DOIUrl":"10.1016/j.hrthm.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Atrioventricular block (AVB) is a frequent initial presentation of cardiac sarcoidosis (CS), but dangerous ventricular arrhythmias (VA) can occur. Despite the scarcity of data, guidelines recommend implantable cardioverter-defibrillator (ICD) rather than a pacemaker implantation whenever a device is needed.</div></div><div><h3>Objective</h3><div>In this study, we aimed to establish predictors for sustained VA in patients with CS presenting with pacing indication because of an AVB.</div></div><div><h3>Methods</h3><div>We prospectively enrolled 112 patients with CS. Excluding those with VA, 82 patients remained and were divided into 2 groups: 34 individuals with AVB as initial presentation and 48 with other symptoms as first presentation (OSF). Both groups were compared for clinical characteristics, rates of VA, left ventricular assist device (LVAD) implantation, heart transplantation, and mortality.</div></div><div><h3>Results</h3><div>During follow-up, VA was detected in 50% in the AVB and 10.4% in the OSF group (<em>P</em> = .001). Death, LVAD implantation, and heart transplantation occurred in 11.8% in AVB group vs 10.4% in the OSF group (<em>P</em> = .847). Late gadolinium enhancement (LGE) was equally observed in both groups: 70% vs 70.5% (<em>P</em> = .966), whereas more patients in the AVB group exhibited abnormal positron emission tomography (PET) uptake: 86.2% vs 54.3% (<em>P</em> = .007). In multivariate analysis, AVB (hazard ratio [HR], 25.15), right ventricular (RV) LGE in cardiovascular magnetic resonance (CMR) (HR, 7.39) were predictors for VA occurrence, whereas the use of immunosuppressive therapy was associated with less VA (HR, 0.26).</div></div><div><h3>Conclusions</h3><div>Patients with CS presenting with AVB have a high risk of sustained VA. Although immunosuppressive drugs may reduce the occurrence of VA, ICD implantation is reasonable, especially in case of RV LGE.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1598-1605"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284513","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":"Specific locations of myocardial inflammation and fibrosis are associated with higher risk of events in cardiac sarcoidosis","authors":"Ana Devesa MD, PhD ,&nbsp;Philip M. Robson PhD ,&nbsp;Busra Cangut MD, MS ,&nbsp;Ravi Vazirani MD ,&nbsp;Vittoria Vergani MD ,&nbsp;Gina LaRocca MD ,&nbsp;Angelica M. Romero-Daza MD ,&nbsp;Steve Liao MD ,&nbsp;Lévi-Dan Azoulay MD ,&nbsp;Renata Pyzik MS, MA ,&nbsp;Rima A. Fayad MPH ,&nbsp;Adam Jacobi MD ,&nbsp;Ronan Abgral MD, PhD ,&nbsp;Adam S. Morgenthau MD ,&nbsp;Marc A. Miller MD ,&nbsp;Zahi A. Fayad PhD ,&nbsp;Maria Giovanna Trivieri MD, PhD","doi":"10.1016/j.hrthm.2024.09.011","DOIUrl":"10.1016/j.hrthm.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate whether the involvement of certain myocardial segments is associated with higher risk compared to others.</div></div><div><h3>Methods</h3><div>One hundred twenty-four patients with suspected clinical sarcoidosis underwent ¹⁸F-FDG-PET/MR. Late gadolinium enhancement (LGE) and focal ¹⁸F-FDG uptake were evaluated globally and in the 16 myocardial segments. Presence of LGE was defined when the percentage of LGE exceeded 5.7% globally (relative to myocardial volume) and in each myocardial segment. Patients were followed up for 5.5 years. Events were defined as ventricular arrhythmia (VA) (including sustained ventricular tachycardia, ventricular fibrillation, and appropriate implantable cardioverter-defibrillator discharge), heart failure hospitalization, or all-cause death.</div></div><div><h3>Results</h3><div>Mean age was 57.1 ± 8.9 years, and 39.5% were female. Twenty-two patients (17.6%) had an event during follow-up, and 9 (7.2%) presented with VA. LGE and ¹⁸F-FDG uptake were more frequent in patients with than without events (36.4% vs 7.8%, <em>P</em> = .001). Presence of LGE and ¹⁸F-FDG in the basal anterior segment were independent predictors for events after adjustment for left ventricular ejection fraction and relative enhanced volume (LGE: odds ratio [1.2–92.4], <em>P</em> = .034;¹⁸F-FDG: odds ratio 5.5 [1.1–27.5], <em>P</em> = .038). LGE presence in basal to mid-anterior, mid-anteroseptal, and basal to mid-inferoseptal segments was an independent predictor of VA. Presence of ¹⁸F-FDG in basal to mid-anterior, mid-inferoseptal and mid-inferior segments was an independent predictor of VA.</div></div><div><h3>Conclusion</h3><div>Involvement of specific myocardial segments, particularly basal to mid-anterior and mid-septal segments, is associated with higher rates of events in patients with suspected cardiac sarcoidosis.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1606-1614"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284515","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":"What lies beneath: Provoking the QT to identify risk in long QT syndrome","authors":"Andrew D. Krahn MD, FHRS,&nbsp;Benjamin M. Moore MBBS, PhD","doi":"10.1016/j.hrthm.2025.01.040","DOIUrl":"10.1016/j.hrthm.2025.01.040","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1572-1573"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255597","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 functional substrate in patients with atrial fibrillation is predictive of recurrences after catheter ablation","authors":"Antonio Frontera MD, PhD ,&nbsp;Francesco Villella MD ,&nbsp;Ernesto Cristiano MD ,&nbsp;Francesca Comi ENG ,&nbsp;Alessia Latini MD ,&nbsp;Carlo Ceriotti MD ,&nbsp;Paola Galimberti MD ,&nbsp;Donah Zachariah MD ,&nbsp;Gabriele Pinna MD ,&nbsp;Antonio Taormina MD ,&nbsp;Kostantinos Vlachos MD ,&nbsp;Mikaël Laredo MD ,&nbsp;Pablo J. Sánchez-Millán MD ,&nbsp;Diego Penela PhD ,&nbsp;Andrea Bernardini MD ,&nbsp;Fabrizio Bologna MD ,&nbsp;Andrea Giomi MD ,&nbsp;Giuseppe Augello MD ,&nbsp;Gianluca Botto MD ,&nbsp;Stylianos Tzeis MD ,&nbsp;Patrizio Mazzone MD","doi":"10.1016/j.hrthm.2024.09.017","DOIUrl":"10.1016/j.hrthm.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced characterization of the atrial electrical substrate may lead to better comprehension of atrial fibrillation (AF) pathophysiology.</div></div><div><h3>Objective</h3><div>With the use of high-density substrate mapping, we sought to investigate the occurrence of functional electrophysiological phenomena in the left atrium and to assess potential association with arrhythmia recurrences after catheter ablation.</div></div><div><h3>Methods</h3><div>Sixty-three consecutive patients with AF referred for ablation were enrolled. Analysis of conduction abnormalities relied on two acquired left atrial electroanatomic maps (sinus and atrial paced rhythm). We classified conduction abnormalities as fixed (if these were present in both rhythms) or functional rhythm dependent (if unmasked in one of the two rhythms). Esophagus and aorta locations were recorded to check the correspondence with abnormal conduction sites.</div></div><div><h3>Results</h3><div>There were 234 conduction abnormalities detected, of which 125 (53.4%) were functional rhythm dependent. The most frequent anatomic site of functional phenomena was the anterior wall, followed by the posterior wall, in sinus rhythm and the pulmonary venous antra in paced rhythm. Sites of functional phenomena in 82.6% of cases corresponded with extracardiac structures, such as sinus of Valsalva of ascending aorta anteriorly and the esophagus posteriorly. Most (88%) areas with functional phenomena had normal bipolar voltage. After pulmonary vein ablation, the number of residual functional phenomena is an independent predictor of AF recurrence (hazard ratio, 2.539 [1.458–4.420]; <em>P</em> = .001) with a risk of recurrences at multivariable Cox analysis.</div></div><div><h3>Conclusion</h3><div>Dual high-density mapping (during sinus and paced rhythms) is able to unmask functional, rhythm-dependent phenomena that are predictive of AF recurrences during follow-up.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1401-1410"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284526","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}