Heart rhythm最新文献

{"title":"Use of Guideline-directed Medical Heart Failure Therapy in Patients with Suspected Arrhythmia-Induced Cardiomyopathy.","authors":"Rebecca Arnet, Corinne Isenegger, Sven Knecht, Jonas Brügger, Philipp Krisai, Christian Müller, Otmar Pfister, Felix Mahfoud, Christian Sticherling, Michael Kühne, Patrick Badertscher","doi":"10.1016/j.hrthm.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.029","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511742","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":"\"Right-variant\" atypical atrioventricular nodal reentrant tachycardia with a bystander, concealed nodofascicular/nodoventricular bypass tract.","authors":"Taihei Itoh, Shogo Hamaura, Yuichi Toyama, Yuji Ishida, Masaomi Kimura, Hirofumi Tomita","doi":"10.1016/j.hrthm.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.028","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511740","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":"Narrowed sinus rhythm electrograms in the zone of uniform slow conduction are helpful to identify VT isthmus location, shape, and orientation.","authors":"Edward J Ciaccio, James Coromilas, Henry H Hsia, Elaine Y Wan, Hirad Yarmohammadi, Deepak S Saluja, Angelo B Biviano, Nicholas S Peters","doi":"10.1016/j.hrthm.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.032","url":null,"abstract":"<p><strong>Background: </strong>Although the sinus rhythm uniform slow conduction zone is an indicator of the reentrant ventricular tachycardia (VT) sources, it cannot alone be used for delineation.</p><p><strong>Objective: </strong>Utilize substrate mapping to determine VT isthmus characteristics.</p><p><strong>Methods: </strong>In 31 canine postinfarction experiments, an infarct and border zone formed in the anterior left ventricle following LAD coronary artery ligation. In each experiment, 3-5 days postinfarction, sustained monomorphic reentrant VT was reproducibly inducible via premature electrical stimulation. Epicardial bipolar electrograms were acquired using multielectrode grids. The isthmus location, shape, and orientation was determined from VT activation mapping. Sinus rhythm electrograms were marked for activation time and duration, and mapped. The VT isthmus was prognosticated from the sinus rhythm maps via the following paradigm: 1. Locate the late activation region. 2. Determine and outline the border of the largest area of narrowed electrograms (≲40msec) nearest the late activation region. 3. Ascertain the direction of uniform slow conduction in the narrowed electrogram region. 4. Draw lateral isthmus boundaries symmetric to the uniform slow conduction direction there.</p><p><strong>Results: </strong>At the VT isthmus versus periphery, sinus rhythm electrograms are narrower (p<0.02) and activation time differences trend greater with less variability (p∼0.1). Overlap of predicted versus actual VT isthmus location was 57.9±23.6%, with a centroids difference of 7.60±6.29mm, and a divergence in exit angle of 18.0±9. 5°.</p><p><strong>Conclusion: </strong>Narrowed electrogram duration near sinus rhythm late activation sites, along with uniform slow conduction, are indicative of VT isthmus location, and activation wavefront exit direction can be discerned from activation maps.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511741","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":"Very Slow Atrioventricular Node Reentry Masquerading as Junctional Rhythm: Diagnostic Challenges and Mechanistic Insights.","authors":"Benzy J Padanilam, Justin Arunthamakun, Neal Joshi, Michelle Nsahlai, Jerin George, Sapan Bhuta, Parin J Patel, Jeff A Olson, Brad A Clark, Leonard A Steinberg, Jasen L Gilge, Eric N Prystowsky","doi":"10.1016/j.hrthm.2025.06.027","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.027","url":null,"abstract":"<p><strong>Background: </strong>Very slow atrioventricular node reentrant tachycardia (AVNRT) can mimic non-reentrant accelerated junctional rhythm (AJR) or junctional tachycardia (JT) OBJECTIVE: Describe the clinical features and mechanism of slow AVNRT masquerading as AJR or JT (collectively called junctional rhythms, JR).</p><p><strong>Methods: </strong>We reviewed all AVNRT and JT ablations performed at Ascension St. Vincent Hospital, Indianapolis, from July 2016 to June 2024. Patients with a tachycardia cycle length (TCL) ≥500 ms were analyzed, focusing on clinical characteristics and electrophysiological findings.</p><p><strong>Results: </strong>Among 556 AVNRT ablations, 22 patients had TCL ≥500 ms. Nine were clinically diagnosed with JR based on one or more of the following: initiation with junctional beats (4), an apparent accelerating junctional rhythm merging into sinus rhythm (3), slow tachycardia rates in the 70-110 bpm (8), incessant slow tachycardia with simultaneous atrial and ventricular activation identified on implantable cardioverter-defibrillator interrogation (1). Five of these 9 patients with JR diagnosis also had a supraventricular tachycardia (SVT) diagnosis. During EP study, HrPAC perturbed the next His in all 22 cases, confirming AVNRT. The mean TCL was 578ms (range, 500-670ms). Two patients each had initiation with junctional beats and isorhythmic dissociation with sinus rhythm at onset of AVNRT. Radiofrequency ablation successfully modified the slow pathway and eliminated AVNRT in 21 of 22 patients.</p><p><strong>Conclusions: </strong>Clinically apparent JR are often very slow AVNRT in patients referred for ablation. The mechanism of AVNRT initiation with isorhythmic dissociation with sinus rhythm may be concurrent JR and AVNRT or 2-for-1 AV nodal conduction and AVNRT competing with sinus rhythm.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495888","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":"Characteristics of patients with Brugada Syndrome and monomorphic ventricular tachycardia.","authors":"Cinzia Monaco, Karim Benali, Maria Cespon-Fernandez, Xavier Bouteiller, Alvise Del Monte, Luigi Pannone, Elodie Surget, Giuseppe Mascia, Pasquale Notarstefano, Roberto Menè, Kinan Kneizeh, Masaaki Yokoyama, Marine Arnaud, Konstantinos Vlachos, Kazutaka Nakasone, Laurens Verhaeghe, John L Fitzgerald, Allan Plant, Domenico Della Rocca, Aude Cathala, Sophie Samson, Juan Sieira, Romain Tixier, Josselin Duchateau, Thomas Pambrun, Giulio Conte, Gian Battista Chierchia, Meleze Hocini, Italo Porto, Nicolas Derval, Patrizio Mazzone, Frederic Sacher, Pierre Jaïs, Pedro Brugada, Carlo de Asmundis, Michel Haïssaguerre","doi":"10.1016/j.hrthm.2025.06.025","DOIUrl":"10.1016/j.hrthm.2025.06.025","url":null,"abstract":"<p><strong>Background: </strong>Brugada Syndrome (BrS) is an arrhythmogenic disorder associated with sudden cardiac death primarily due to ventricular fibrillation (VF). Monomorphic ventricular tachycardias (MVT) are rarely reported, and little is known about their characteristics.</p><p><strong>Objective: </strong>To evaluate the characteristics of BrS patients presenting with MVT compared to those with VF.</p><p><strong>Methods: </strong>We performed a retrospective multicentre study of BrS patients who received an implanted defibrillator (ICD). Inclusion criteria were: 1) initiation of ventricular arrhythmia on ICD recordings, 2) absence of anti-arrhythmic drugs or prior ventricular ablation. Arrhythmic events were classified as MVT or polymorphic VT/VF (both referred VF) according to the guidelines. We analysed clinical data, characteristics related to arrhythmia initiation and electroanatomical substrate.</p><p><strong>Results: </strong>Among 793 BrS patients with ICDs (44.2±17.7 years, 37.1% women), 54 met the inclusion criteria. ICD recordings showed a total of 47 VF episodes and 27 MVT episodes, overlapping in only one patient. MVT patients were older at first event (47.7±13.4 vs. 40.7±12.6 years, p=0.06), had higher QRS duration, more prevalence of syncope, and later recurrences after ICD implantation (median 51 vs. 20 months, p=0.018). Rapid rhythms (>100 bpm) were more frequent before MVT than VF (48.1% vs. 8.5%, p<0.001) with a lower incidence of ectopy (22.2% vs 61.7, p=0.001). Abnormal epicardial substrate was broader in MVT patients in baseline conditions (11.3 ± 5.5 cm² vs. 6.8 ± 3.2 cm², p=0.006).</p><p><strong>Conclusion: </strong>VF/PVT and MVT in patients with Brugada Syndrome have distinct clinical presentations. MVT shows a later onset compared to VF/PVT, and is associated with broader substrate area.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368805","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":"Effect of oral anticoagulant therapy on adverse outcomes in atrial fibrillation patients after intracranial haemorrhage.","authors":"Wulamiding Kaisaier, Chaokun Guan, Min Ye, Siyu Guo, Yili Chen, Yugang Dong, Gregory Y H Lip, Chen Liu, Wengen Zhu","doi":"10.1016/j.hrthm.2025.06.023","DOIUrl":"10.1016/j.hrthm.2025.06.023","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) patients following intracerebral hemorrhage (ICH) remains uncertain. Although recent randomized controlled trials (RCTs) have investigated this clinical dilemma, findings have been inconclusive.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of restarting OACs in in AF patients after ICH, we conducted a meta-analysis of RCTs.</p><p><strong>Methods: </strong>We conducted literature search in PubMed, Embase, and the Cochrane Library (CENTRAL), identifying eligible RCTs from inception to March 2025. The primary outcomes were recurrent ICH and stroke or systemic embolism (SSE). Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model.</p><p><strong>Results: </strong>Three RCTs (APACHE-AF, SoSTART, and PRESTIGE-AF), comprising a total of 623 patients with a median follow-up of 1.2 to 1.9 years, were included. Most patients received direct oral anticoagulants. Compared with non-OAC therapy, OAC resumption was associated with a significantly increased risk of recurrent ICH (RR, 3.32; 95% CI, 1.28-8.61) and major bleeding (RR, 3.33; 95% CI, 1.54-7.22), without a significant reduction in SSE (RR, 0.68; 95% CI, 0.38-1.23). No significant differences were observed in ischemic stroke, major vascular events, all-cause mortality, or cardiovascular mortality.</p><p><strong>Conclusion: </strong>In AF patients with prior ICH, restarting OAC therapy is associated with increased risks of recurrent ICH and major bleeding, without a corresponding reduction in thromboembolic events or all-cause mortality.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368806","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":"Feasibility Study: Characterizing Acute Lesion Dimensions in Patients With and Without Devices Using Non-Contrast (Native T₁-weighted) MRI After VT/PVC Radiofrequency Ablation.","authors":"Terenz Escartin, Maria Terricabras, Calder Sheagren, Philippa Krahn, Idan Roifman, Graham Wright, Christopher C Cheung","doi":"10.1016/j.hrthm.2025.06.024","DOIUrl":"10.1016/j.hrthm.2025.06.024","url":null,"abstract":"<p><strong>Background: </strong>Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) has been shown to reliably locate RFA lesions with microvascular obstruction (MVO) as a broadly accepted signature. However, MVO volume depends on the time elapsed after gadolinium contrast injection. Native T₁w MRI has recently been shown to accurately characterize RFA lesions in preclinical models.</p><p><strong>Objective: </strong>To demonstrate the feasibility of wideband native T₁w MRI in characterizing lesion dimensions in patients within 7-days of ventricular tachycardia (VT) radiofrequency ablation (RFA).</p><p><strong>Methods: </strong>Post-ablation wideband native T₁w and 3D LGE MRI was performed within 7-days of RFA. RFA lesion surface area (mm²), volume (mm³), and native T₁w maximum lesion depth were calculated. Average catheter contact force (g), ablation duration (s) and impedance drop (Ω) were calculated. Patients with and without implantable cardioverter defibrillators (ICDs) were included.</p><p><strong>Results: </strong>10 patients (median age 64.5 years, 60% ischemic) underwent VT RFA (80% endocardial, 20% epicardial RFA), and post-ablation cardiac MRI within 7-days of RFA (median 4.5 days). There was a significantly greater mean MVO surface area and volume compared to mean native T₁w lesion surface area and volume (p=0.0108, p=0.0376; p<0.05), respectively. There were strong positive correlations between average surface area and average volume measured by MVO and native T₁w (r=0.71, p=0.0237; r=0.70, p=0.0265; p<0.05), respectively. Average maximum native T₁w lesion depth correlated with average ablation duration and average impedance drop (r=0.73, p=0.02; r=0.68, p=0.04, p<0.05), respectively.</p><p><strong>Conclusion: </strong>Native T₁w MRI can effectively characterize lesion dimensions in patients with and without ICDs within 7 days post-ablation. This emerging biomarker may facilitate early prediction of RFA efficacy and ablation success particularly in patients demonstrating contraindications to gadolinium contrast agents.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368807","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":"Determining the Optimal Age Cutoff to Investigate for Cardiac Sarcoidosis in Patients with Complete Heart Block.","authors":"Bharath R Biyyala, Anil K Gehi, Anthony J Mazzella","doi":"10.1016/j.hrthm.2025.06.020","DOIUrl":"10.1016/j.hrthm.2025.06.020","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340047","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":"Ventricular Fibrillation in Early-Stage Cardiomyopathy: The Loop of Undetectable Substrate of Sudden Cardiac Death.","authors":"Andrea Villatore, Francesco Fioravanti, Alberto Barengo, Simone Sala, Paolo Della Bella, Giovanni Peretto","doi":"10.1016/j.hrthm.2025.06.022","DOIUrl":"10.1016/j.hrthm.2025.06.022","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340048","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":"Long-term outcome of His bundle pacing with current of injury compared to left bundle branch area pacing.","authors":"Pietro Palmisano, Maurizio Collantoni, Salvatore Bonanno, Marco Giuranna, Amato Santoro, Giuseppe Dattilo, Pasquale Crea, Erberto Carluccio, Michele Accogli, Giovanni Coluccia","doi":"10.1016/j.hrthm.2025.06.019","DOIUrl":"10.1016/j.hrthm.2025.06.019","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336461","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}