Heart rhythm最新文献

{"title":"Is transition from nonselective left bundle branch pacing to selective left bundle branch pacing superior to left ventricular septal pacing transition at lead implantation?","authors":"Yoji Iida, Tomoaki Izawa, Nobuyuki Makishima","doi":"10.1016/j.hrthm.2025.10.039","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.039","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354675","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":"Pulsed Field Ablation of Focal Atrial Tachycardia Adjacent to the Phrenic Nerve: A First Case Report Using a Novel Dual-Energy Catheter.","authors":"Toshinori Chiba, Gerhard Hindricks, Ulf Landmesser, Philipp Attanasio, Verena Tscholl","doi":"10.1016/j.hrthm.2025.10.038","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.038","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354718","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":"New-Onset Atrial Fibrillation as a Predictor of Cancer: Insights from a Real-World Dataset.","authors":"Ashraf Alzahrani, Kaushik Gokul, Aswathi Paleri, Edward M Powers, Steven Bailin, Eric H Yang, Michael Fradley, Peter Farjo, Paari Dominic","doi":"10.1016/j.hrthm.2025.10.040","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.040","url":null,"abstract":"<p><strong>Background: </strong>A bidirectional relationship between atrial fibrillation (AF) and cancer has been suggested, but the mechanisms and directionality remain poorly understood.</p><p><strong>Objectives: </strong>To examine the relationship between new-onset AF and incident cancer across different age groups.</p><p><strong>Methods: </strong>This retrospective study utilized the TriNetX research network. Patients with hypertension, type II diabetes, or coronary artery disease were included and stratified by the presence of AF. Individuals with prior malignancy were excluded. Patients were categorized into three age groups: 30-50, 50-70, and 70-85 years and matched 1:1 using propensity scores. The primary outcome was all-cause cancer incidence, with secondary analyses of site-specific malignancies. Risk ratios, Kaplan-Meier survival analysis, and multivariable Cox regression models were used. Follow-up was up to 15 years after AF diagnosis.</p><p><strong>Results: </strong>Matched cohort sizes were: 30-50 (n=67,156 per group), 50-70 (n=510,308), and 70-85 (n=882,729). AF was associated with increased cancer risk: RR 2.99, 1.79, and 1.49 across increasing age groups (all p<0.001). Kaplan-Meier analyses showed decreased cancer-free survival: HR 2.96, 1.84, and 1.53 across increasing age groups (all p<0.001). Sensitivity analyses excluding cancers diagnosed within the first 3 months and after the first year of AF onset, comparing AF subtypes, and using multivariable Cox models confirmed consistent associations.</p><p><strong>Conclusion: </strong>AF is associated with an increased risk of incident cancer, particularly in younger individuals.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354631","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":"Disease Penetrance and Phenotypic Spectrum of Desmoplakin Variant Carriers in the Population.","authors":"Manasa Gurumoorthi, Ghaith Sharaf Dabbagh, Rachel Wolfe, Kerrick Hesse, Ravi Shah, Leonie Kurzlechner, Kanishk Yadav, Brittany Balint, Babken Asatryan, Farah Sheikh, C Anwar A Chahal, Andrew P Landstrom","doi":"10.1016/j.hrthm.2025.10.043","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.043","url":null,"abstract":"<p><strong>Background: </strong>Desmoplakin (DSP) variants cause arrhythmogenic cardiomyopathy (ACM), a disorder characterized by myocardial fibrosis, arrhythmias, and sudden cardiac death. DSP-mediated ACM often involves left ventricular (LV) dysfunction and myocardial inflammation, yet existing diagnostic criteria may underdetect disease, underscoring the need for population-based penetrance estimates.</p><p><strong>Objective: </strong>To assess the prevalence and phenotypic penetrance of DSP variants in a genotyped population.</p><p><strong>Methods: </strong>Among 200,580 UK Biobank participants with exome sequencing, DSP variants were classified as predicted-deleterious (pDel), predicted loss-of-function (pLOF), or ClinVar 2-star pathogenic/likely pathogenic (P/LP). A subset of pDel carriers underwent ECG and CMR testing, matched to genotype-negative controls. Phenotypic penetrance was assessed using ICD-10 diagnoses, ECG, and CMR. Variant clustering within functional DSP domains was also evaluated.</p><p><strong>Results: </strong>Of 200,580 participants, 1407 (0.7%) carried a pDel, 168 (0.08%) a pLOF, and 44 (0.02%) a ClinVar 2* P/LP DSP variant. Myocarditis occurred in 0.28% of pDel, 1.8% of pLOF, and 4.5% of ClinVar P/LP carriers versus 0.07% of controls (p<0.05). Cardiomyopathy prevalence increased from 1.4% (pDel) to 5.4% (pLOF) and 6.8% (P/LP) versus 0.6% in controls (p<0.01). DSP carriers had more frequent lateral T-wave inversions and abnormal LV strain. Missense variants clustered within two functional DSP domains.</p><p><strong>Conclusions: </strong>DSP pDel variants are common but show low penetrance for myocarditis and cardiomyopathy, with risk increasing with more stringent classification. Electrocardiographic and strain abnormalities may aid early detection, supporting genotype-first approaches for DSP interpretation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354695","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":"Beyond the Sodium Channel: Proteomic Clues to the Brugada Syndrome Substrate.","authors":"Luigi Anastasia, Giuseppe Ciconte, Carlo Pappone","doi":"10.1016/j.hrthm.2025.10.042","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.042","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336667","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":"Safety and performance of a novel defibrillation lead for left bundle branch area placement: primary results of the LEADR LBBAP clinical trial.","authors":"Pugazhendhi Vijayaraman, Xingbin Liu, Russell Denman, Edward J Schloss, Zachary I Whinnett, Jordana Kron, Marek Jastrzębski, John S Zakaib, Walter P Abhayaratna, François Philippon, Muhammad R Afzal, Parash Pokharel, James Burrell, Jocelyn Tanner, Tessa Geelen, Megan L Platner, Kiah Butler, Pamela K Mason, George H Crossley","doi":"10.1016/j.hrthm.2025.10.028","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.028","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular placement of the OmniaSecure defibrillation lead has demonstrated high defibrillation success and low occurrence of lead-related major complications. With the advent of left bundle branch area pacing (LBBAP) as a physiological pacing option, use of the OmniaSecure lead may be a viable alternative for LBBAP in the ICD population.</p><p><strong>Objective: </strong>To understand the defibrillation efficacy at implant and safety of the OmniaSecure lead for LBBAP.</p><p><strong>Methods: </strong>The global LEADR LBBAP trial enrolled patients indicated for de novo implantation of a primary or secondary prevention ICD or CRT-D. Per study protocol, LBBAP includes ECG characterization of LBBP and deep septal pacing. The primary efficacy objective was defibrillation efficacy at implant exceeding a pre-specified threshold of 88% in ≥160 patients. The primary safety endpoint was to demonstrate the OmniaSecure lead-related major complication rate at 3 months post-implant.</p><p><strong>Results: </strong>A total of 307 patients underwent an LBBAP implant attempt (age: 64.9±12.2 years; 28.7% female; BMI: 28.4±6.1kg/m²). A total of 293 patients were successfully implanted per protocol (95.4%). The primary efficacy objective was met with 100% of patients defibrillated to protocol. The observed freedom from OmniaSecure lead-related major complications at 3 months was 97.9% (CI: 95.8-100%). There were zero study lead fractures, no oversensing adverse events and stable electrical parameters through 2.6±2.5 months follow-up.</p><p><strong>Conclusions: </strong>These results demonstrate implantation of OmniaSecure lead when intended for LBBAP results in high defibrillation success at implant, stable short-term electrical parameters, and a low rate of OmniaSecure lead-related major complications at 3 months.</p><p><strong>Clinical trial registration number: </strong>NCT04863664.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329062","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 technique to optimize extravascular ICD implantation with the use of a video-assisted thoracoscopic epicardial access tool.","authors":"Ashkan Ehdaie, Jessica Mao, Archana Ramireddy, Eric Braunstein, Eugenio Cingolani, Michael Shehata, Xunzhang Wang, Raymond Schaerf","doi":"10.1016/j.hrthm.2025.10.026","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.026","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329057","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":"Optimization of Pacing for Patients Receiving Ineffective Cardiac Resynchronization Therapy.","authors":"Nobuhiko Ueda, Satoshi Oka, Kohei Ishibashi, Tsukasa Oshima, Toshihiro Nakamura, Yuichiro Miyazaki, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Takeshi Aiba, Hideaki Kanzaki, Chisato Izumi, Teruo Noguchi, Kengo Kusano","doi":"10.1016/j.hrthm.2025.10.030","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.030","url":null,"abstract":"<p><strong>Background: </strong>Effective pacing is essential for maximizing response to cardiac resynchronization therapy (CRT). High ineffective CRT pacing (%i-CRT) has been linked to poor prognosis, but characteristics of high %i-CRT and optimal follow-up settings remain unclear.</p><p><strong>Objectives: </strong>To investigate the characteristics and efficacy of pacing optimization for patients with high-percentage ineffective cardiac resynchronization therapy (%i-CRT).</p><p><strong>Methods: </strong>We assessed 225 consecutive patients (2018 - 2024) using EffectivCRT (Medtronic Inc., Minneapolis, MN, USA). The %i-CRT was measured throughout the follow-up period. CRT response was defined as an improved left ventricular (LV) ejection fraction ≥10% and/or reduced LV end-systolic volume ≥15%. High %i-CRT was defined as >2.0%.</p><p><strong>Results: </strong>Thirty-six patients (16%) had high %i-CRT. They exhibited significantly lower CRT response rates than others (14 patients [48%] vs. 129 patients [76%]; p=0.003). The predominant causes were pseudo-fusion or latency (13 patients [36%]). Among patients with high %i-CRT, the time from CRT initiation to the maximum i-CRT was shorter (p=0.012) and the maximum i-CRT was higher (p<0.001) among those patients with pseudo-fusion or latency. Atrioventricular (AV) or interventricular (VV) delay optimization was performed for 10 patients, resulting in %i-CRT improvement from 64.6% (interquartile range [IQR], 39.3%-87.5%) to 6.4% (IQR, 1.8%-32.0%) (p=0.005) and shortening of the QRS duration from 165±31 ms to 138±21 ms (p=0.003). Three of seven initial non-responders converted to CRT responders after optimization.</p><p><strong>Conclusions: </strong>I-CRT occurred early, and the maximum i-CRT was high among patients with latency or pseudo-fusion. Optimization of AV or VV delay improved i-CRT and shortened the QRS duration.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329111","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":"Low Acute Complication Rates with a Variable Loop Pulsed Field Ablation Catheter: Early Real-World Experience from the REAL-AF Registry.","authors":"Christopher Porterfield, Kousik Krishnan, Moeem Saleem, Matthew Ebinger, Amulya Gampa, Joshua Greenberg, Paari Dominic, Sergio Conti, Gustavo Morales, E Matthew Quin, Arfaat Khan, David Steckman, Anil Rajendra, Alexandru Costea, Mohammad Ali Jazayeri, Joshua Silverstein, Allyson Varley, Jose Osorio, Paul Zei","doi":"10.1016/j.hrthm.2025.10.027","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.027","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329086","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 Predictive Power of Left Atrial Reservoir Strain for Long-Term Atrial Fibrillation in The Atherosclerosis Risk in Communities (ARIC) Study.","authors":"Daokun Sun, Lap Sum Chan, Faye L Norby, Riccardo M Inciardi, Elsayed Z Soliman, Alvaro Alonso, Scott D Solomon, Amil M Shah, Wei Pan, Lin Yee Chen","doi":"10.1016/j.hrthm.2025.10.029","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.029","url":null,"abstract":"<p><strong>Background: </strong>Left atrial (LA) function measures from the two-dimensional echocardiograms are linked to atrial fibrillation (AF) development, but their standalone predictive value remains unclear.</p><p><strong>Objective: </strong>This study assessed the standalone predictive power of LA function measures for long-term AF prediction (5 and 10 years).</p><p><strong>Methods: </strong>We analyzed 5,442 older adults (median age 74) from the Atherosclerosis Risk in Communities (ARIC) study without prior AF. Participants were split into training and testing sets (7:3 ratio). We evaluated the standalone predictive performance of LA strain measures (reservoir, conduit, and contraction strain) with and without age for long-term AF. The performance was compared to that of the CHARGE-AF score and a machine learning-based predictive model that incorporates the most important routinely measured echocardiographic parameters with LA strain measures.</p><p><strong>Results: </strong>LA reservoir strain alone achieved a Harrell's C-index of 0.664 and 0.646 for 5- and 10-year AF prediction, improving to 0.677 and 0.663 when combined with age, which outperformed the CHARGE-AF score (0.667 and 0.655) and other LA strain measures. A better predictive performance was achieved by the machine learning-based predictive model, including LA reservoir strain, age, race, and 9 echocardiographic parameter; the C-indexes were 0.732 (0.686-0.777) for 5-year and 0.725 (0.693-0.757) for 10-year prediction.</p><p><strong>Conclusion: </strong>The standalone predictive performance of LA reservoir strain for long-term AF risk is comparable to CHARGE-AF score (11 variables) and slightly lower than that of a machine learning-based model with 12 variables, highlighting the importance of LA reservoir in AF risk prediction.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329124","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}