Heart rhythm最新文献

{"title":"Updated evidence on peri-operative neutrophil-to-lymphocyte ratio in cardiac surgery: A dual analysis of prognostic and diagnostic value for post-operative atrial fibrillation.","authors":"Mohamed K A Awad, Ahmed E Ali, Muhammad S Mazroua, Karim Ali, Radwa K Awad, Toqa R Mohamed, Mohamed Abdelmaksoud, Mahmoud A Hashim, Redi Nikollari, Panos N Vardas, Hussein Abu-Daya","doi":"10.1016/j.hrthm.2025.09.036","DOIUrl":"10.1016/j.hrthm.2025.09.036","url":null,"abstract":"<p><strong>Background: </strong>Post-operative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, increasing morbidity. The neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammation, has been studied as a predictor.</p><p><strong>Objective: </strong>We aimed to assess the association between NLR and new-onset POAF.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Web of Science, and Embase through June 2025 for studies reporting pre-operative or post-operative NLR and incidence of POAF in adult cardiac surgery patients. Diagnostic test accuracy (DTA) was assessed to evaluate the predictive performance of pre-operative NLR for POAF, using pooled sensitivity, specificity, and likelihood ratios. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.</p><p><strong>Results: </strong>32 studies (20,056 patients) were included. In 27 studies excluding pre-operative atrial fibrillation (13,630 patients), POAF was associated with significantly higher pre-operative NLR (standardized mean difference [SMD] = 0.51; 95% confidence interval [CI]: 0.34-0.67; P < .001; I² = 94.0%). Post-operative NLR was also elevated in POAF patients (SMD = 0.30; 95% CI: 0.13-0.47; P < .001; I² = 70.7%). Among 4 studies including patients with prior atrial fibrillation (6364 patients), no significant association was observed (SMD = 0.04; P = .21). DTA analysis of 12 studies showed pooled sensitivity of 0.52, specificity of 0.71, and diagnostic odds ratio of 3.74 (area under the curve [AUC] = 0.713), indicating moderate diagnostic accuracy.</p><p><strong>Conclusion: </strong>Elevated NLR is associated with increased risk of POAF. Distinguishing new-onset POAF and accounting for surgical type are essential when evaluating NLR as a predictive biomarker.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212495","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":"Patient-reported outcomes of deep sedation during pulsed field ablation for atrial fibrillation with a novel variable-loop catheter.","authors":"Vanessa Sciacca, Philipp Lucas, Thomas Fink, Angeliki Darma, Denise Guckel, Maxim Didenko, Maximilian Mörsdorf, Martin Braun, Moneeb Khalaph, Yuri Bocchini, Nadica Trajkovska, Karen Harutyunyan, Philipp Sommer, Christian Sohns","doi":"10.1016/j.hrthm.2025.09.033","DOIUrl":"10.1016/j.hrthm.2025.09.033","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190942","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":"Premature ventricular contractions on healthy and diseased hearts: Differential acute effect of coupling interval and location.","authors":"Marc Soriano-Amores, Zoraida Moreno-Weidmann, Esther Jorge-Martín, Andreu Ferrero-Gregori, Bieito Campos-Garcia, Sergi Casabella-Ramon, Concepción Alonso-Martín, Enrique Rodríguez-Font, Chi-Hion Li, Xavier Viñolas-Prat, Vicenta Llorente-Cortés, Sònia Mirabet-Pérez, Gerard Amorós-Figueras, Jose M Guerra","doi":"10.1016/j.hrthm.2025.09.035","DOIUrl":"10.1016/j.hrthm.2025.09.035","url":null,"abstract":"<p><strong>Background: </strong>The precise pathophysiological mechanisms underlying premature ventricular contraction (PVC)-induced cardiomyopathy remain unclear.</p><p><strong>Objective: </strong>This study aimed to compare the acute physiological effects of PVCs delivered at different coupling intervals (CIs) and anatomic sites in healthy hearts and in hearts with an established dilated cardiomyopathy.</p><p><strong>Methods: </strong>10 swine were studied: 5 served as controls, and 5 underwent pacemaker implantation with 180 beats/min pacing for 4 weeks to induce nonischemic dilated cardiomyopathy (NIDCM). PVCs were delivered from 14 left ventricular (LV) and 6 right ventricular sites at 4 CIs in both groups. QRS duration and hemodynamic parameters (aortic flow, maximal rate of pressure rise, and maximal rate of pressure fall) were assessed.</p><p><strong>Results: </strong>PVC QRS duration increased as CI shortened in both groups (control 85 ± 7 ms at 500 ms vs 93 ± 7 ms at 350 ms, P < .01; NIDCM 103 ± 6 ms vs 119 ± 6 ms, P < .01). Hemodynamic deterioration paralleled QRS prolongation and was more pronounced in the NIDCM group. PVCs from the LV had a greater hemodynamic impact.</p><p><strong>Conclusion: </strong>Shorter PVC CIs prolong QRS duration and worsen hemodynamics, with these effects more pronounced in the dilated cardiomyopathic hearts. This could correlate with a greater long-term decline in the LV ejection fraction, thereby increasing the risk of developing PVC-induced cardiomyopathy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185475","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":"Expanding the indications for flecainide: Good idea or CAST reprise?","authors":"Peter R Kowey, Farah Olleik","doi":"10.1016/j.hrthm.2025.09.030","DOIUrl":"10.1016/j.hrthm.2025.09.030","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174859","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":"Impact of alternative efficacy end point definitions on reported outcomes after ablation of paroxysmal atrial fibrillation - Insights from the COMPARE-CRYO study using continuous rhythm monitoring.","authors":"Salik Ur Rehman Iqbal, Thomas Kueffer, Sven Knecht, Patrick Badertscher, Jens Maurhofer, Philipp Krisai, Corinne Jufer, Gregor Thalmann, Dik Heg, Helge Servatius, Hildegard Tanner, Michael Kühne, Laurent Roten, Christian Sticherling, Tobias Reichlin","doi":"10.1016/j.hrthm.2025.09.026","DOIUrl":"10.1016/j.hrthm.2025.09.026","url":null,"abstract":"<p><strong>Background: </strong>Recurrence after atrial fibrillation (AF) ablation is commonly defined as any atrial arrhythmia lasting ≥30 seconds. It is unclear how alternative efficacy end point definitions would change the observed success rates and how they would relate to patients' disease burden or health care utilization metrics.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of alternative end point definitions after AF ablation based on AF-burden, duration or number of episodes using implantable cardiac monitors (ICM).</p><p><strong>Methods: </strong>This is a prespecified substudy of the COMPARE-CRYO (COMPARison of the PolarX and the Arctic Front CRYOballoon for pulmonary vein isolation) study, which enrolled patients with paroxysmal AF undergoing cryoballoon ablation. All patients underwent ICM implantation, and the blanking period was 90 days. Details were collected on timing, duration, and number of episodes, and AF-burden between 91-365 days. Outcome measures were redo ablations and AF-related hospitalizations.</p><p><strong>Results: </strong>The primary end point of any recurrence lasting ≥30 seconds occurred in 89 of 201 patients (44%). One-year success rates increased with increasing arrhythmia duration thresholds from 56% (≥30 sec) to 97% (≥24 hrs), with number of episode thresholds from 56% (≥1 episode) to 98% (≥100 episodes) and with AF-burden thresholds from 56% (AF-burden >0%) to 93% (AF-burden >2%). Rates of redo ablations and AF-related hospitalizations increased for AF-episode durations >1 hour, >6 AF-episodes, and an AF-burden >0.1%, and were highest for AF-episode durations >24 hours, >33 AF-episodes, and an AF-burden >1%.</p><p><strong>Conclusion: </strong>Alternative efficacy end point definitions have a significant impact on reported outcomes and health care utilization metrics after AF ablation. These findings are important when considering end point definitions other than the traditional 30 seconds in the design of future AF-ablation trials.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112979","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 tachycardia substrate mapping with cardiac computed tomography and cardiac magnetic resonance imaging: Head-to-head comparison of two clinically available postprocessing platforms.","authors":"Damian Laan, Luuk H G A Hopman, Rosa M Figueras I Ventura, Bruno Soré, Cornelis P Allaart, Michiel J B Kemme, Marco Götte, Pieter G Postema, Pranav Bhagirath","doi":"10.1016/j.hrthm.2025.09.028","DOIUrl":"10.1016/j.hrthm.2025.09.028","url":null,"abstract":"<p><strong>Background: </strong>Advanced postprocessing of late gadolinium enhancement cardiac magnetic resonance (CMR) and computed tomography (CCT) imaging increasingly guides ventricular tachycardia ablation. However, a direct comparison between 2 widely adopted platforms, ADAS 3D LV (Adas3D Medical) and inHEART (IHU Liryc/Inria), is lacking.</p><p><strong>Objective: </strong>This study aimed to compare CMR- and CCT-derived ventricular substrate models generated by ADAS 3D and inHEART in patients with ischemic and nonischemic cardiomyopathy undergoing ventricular tachycardia ablation.</p><p><strong>Methods: </strong>Patients who underwent both CCT and late gadolinium enhancement CMR before ablation were retrospectively included. ADAS 3D models were generated on-site, whereas inHEART models were processed remotely. Substrate models were evaluated using a custom scoring system incorporating quantitative (scar mass, transmurality) and qualitative parameters (wall thickness, scar delineation, and conduction corridors). Electroanatomic maps (EAMs) assessed correspondence between low-voltage and ablation regions, with imaging-defined corridors.</p><p><strong>Results: </strong>16 patients (n = 8 ischemic, n = 8 nonischemic) were analyzed; 12 had detailed EAM data. Scar core and border zone measurements were comparable between platforms in both subgroups (all P > .05). ADAS 3D showed slightly higher visualization scores, particularly in nonischemic cardiomyopathy, although differences were not statistically significant. Spatial concordance between imaging-derived scar and EAM-defined ablation areas was good to excellent in 10 of 12 cases.</p><p><strong>Conclusion: </strong>ADAS 3D and inHEART demonstrated high concordance in scar quantification and substrate characterization, with comparable performance across cardiomyopathy types. Given their complementary strengths, platform choice should be guided by procedural goals, imaging availability, operator experience, and institutional context, as each system offers distinct advantages. Prospective studies are needed to evaluate the impact on procedural success and long-term outcomes.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112940","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":"Learning curve and procedural efficiency of zero-fluoroscopy pulsed-field ablation for atrial fibrillation.","authors":"Juliana Pérez-Pinzón, Daniel Villarreal, Mengyu Ma, John-Ross Clarke, Enrico G Ferro, Ronuk Modi, Omeralfaroug Adam, Nicolas Isaza, Gabriel Odozynski, Gursharan Samra, Margot Yopes, Eduardo B Saad, Peter Zimetbaum, Charles I Haffajee, Shu Yang, Timothy Maher, Kapil Kumar, Alexei Shvilkin, Andre d'Avila, Gregory F Michaud, Patricia Tung, Jonathan W Waks, Andrew H Locke","doi":"10.1016/j.hrthm.2025.09.024","DOIUrl":"10.1016/j.hrthm.2025.09.024","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA) has demonstrated safety and noninferiority compared with radiofrequency ablation (RFA) for atrial fibrillation. However, real-world data comparing RFA and PFA using a zero-fluoroscopy workflow, particularly regarding acute procedural efficiency and outcomes, remain limited.</p><p><strong>Objective: </strong>This study aimed to compare procedural characteristics of zero-fluoroscopy RFA and PFA pulmonary vein isolation (PVI) at a high-volume academic institution.</p><p><strong>Methods: </strong>We analyzed 827 consecutive zero-fluoroscopy first-time ablations performed between January 2022 and March 2025. Only patients with PVI or PVI with posterior wall isolation (PWI) lesion sets were included. Procedure time was defined as venous access to sheath removal time. Mixed-effects regression models were used for statistical analysis.</p><p><strong>Results: </strong>The mean age was 65 ± 10 years, 68% of patients were male, and 54% had paroxysmal atrial fibrillation. Zero-fluoroscopy RFA and PFA procedures were 25 and 14 minutes shorter, respectively, than fluoroscopy-guided procedures (P < .001). Zero-fluoroscopy procedure time was significantly reduced with PFA compared with RFA (-25 minutes), particularly during PVI + PWI (PVI -16 minutes; PVI + PWI -28 minutes) (P < .001). The learning curve for zero-fluoroscopy PFA did not vary by physician or years of experience and plateaued after 114 total PFA cases. Based on the mixed-effects model analysis, each additional PFA case performed reduced procedure time by 0.5 minutes (P < .001). Severe complications were rare (0.48%), with no significant difference between energy types.</p><p><strong>Conclusion: </strong>Zero-fluoroscopy PFA is safe and effective, with comparable acute procedural outcomes and safety profile with zero-fluoroscopy RFA. The zero-fluoroscopy PFA learning curve is independent of career stage or physician.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102720","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":"Challenges in longitudinal atrial late gadolinium enhancement quantification in patients undergoing pulmonary vein isolation.","authors":"Luuk H G A Hopman, Nikki van Pouderoijen, Michiel J B Kemme, Cornelis P Allaart, Marco J W Götte","doi":"10.1016/j.hrthm.2025.09.021","DOIUrl":"10.1016/j.hrthm.2025.09.021","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086028","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":"Innovative curled-tip guidewire kit for percutaneous epicardial access: Assessment in a canine model.","authors":"Zihan Jiang, Hongda Zhang, Lei Ding, Min Tang","doi":"10.1016/j.hrthm.2025.09.016","DOIUrl":"10.1016/j.hrthm.2025.09.016","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080499","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":"Response to the letter to the editor entitled \"High-risk transvenous lead extraction can be safely performed in the electrophysiology laboratory\".","authors":"Robert D Schaller, Balaram Krishna Hanumanthu, Francis E Marchlinski, Marisa Cevasco, Michael Acker, Joshua M Cooper, Mouhannad M Sadek","doi":"10.1016/j.hrthm.2025.09.011","DOIUrl":"10.1016/j.hrthm.2025.09.011","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064592","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}