Heart rhythm最新文献

{"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":"https://doi.org/10.1016/j.hrthm.2025.09.024","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA) has demonstrated safety and non-inferiority compared to radiofrequency ablation (RFA) for atrial fibrillation (AF). However, real-world data comparing RFA and PFA using a zero-fluoroscopy workflow, particularly regarding acute procedural efficiency and outcomes, remains limited.</p><p><strong>Objective: </strong>To compare procedural characteristics of zero-fluoroscopy RFA and PFA 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>Mean age was 65±10 years, 68% of patients were male, and 54% had paroxysmal AF. Zero-fluoroscopy RFA and PFA procedures were 25 and 14 minutes shorter, respectively, than fluoroscopy-guided procedures (p<0.001). Zero-fluoroscopy procedure time was significantly reduced with PFA compared to RFA (-25 minutes), particularly during PVI+PWI (PVI: -16 minutes; PVI+PWI: -28 minutes) (p<0.001). 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<0.001). Severe complications were rare (0.48%), with no significant difference between energy types.</p><p><strong>Conclusions: </strong>Zero-fluoroscopy PFA is safe and effective, with comparable acute procedural outcomes and safety profile compared to zero-fluoroscopy RFA. 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":"Impact of Empagliflozin and Dapagliflozin on Sudden Cardiac Death: A Systematic Review and Meta-Analysis of Adjudicated Randomized Evidence.","authors":"Andrea Matteucci, Claudio Pandozi, Michela Bonanni, Marco Valerio Mariani, Luca Sgarra, Lorenzo Nesti, Nicola Pierucci, Vincenzo Mirco La Fazia, Carlo Lavalle, Federico Nardi, Furio Colivicchi","doi":"10.1016/j.hrthm.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.023","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce cardiovascular outcomes in the spectrum of cardio-renal-metabolic syndrome. Albeit basic and translational evidence support a putative anti-arrhythmic role, at the clinical level, a lack of consensus has emerged across different studies, and the true impact on sudden cardiac death (SCD) risk remains unclear.</p><p><strong>Objective: </strong>To assess the effect of empagliflozin and dapagliflozin on SCD in patients with type 2 diabetes, heart failure, or chronic kidney disease.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted on randomized controlled trials. A total of 58,569 participants from 8 trials were included, with 30,565 patients treated with SGLT2 inhibitors and 28,104 controls assigned to placebo. The median follow-up period was 29 months. We performed pooled analysis, meta-regression, and subgroup analyses to explore the impact on SCD risk across different populations and treatment regimens.</p><p><strong>Results: </strong>The pooled analysis showed a reduced risk of SCD with SGLT2 inhibitors (OR: 0.82; 95% CI: 0.72-0.94; p = 0.0104), with negligible heterogeneity (τ² = 0.0000; I² = 0.0%; Q = 3.17, p = 0.8687). Subgroup-specific estimates (age, follow-up duration, population, and SGLT2 inhibitor type) did not reach statistical significance. Meta-regression showed no significant moderation by mean age, study duration, or gender. No evidence of publication bias was detected.</p><p><strong>Conclusion: </strong>Empagliflozin and dapagliflozin may reduce the relative risk of sudden cardiac death. These data expand the spectrum of cardiovascular benefits attributed to SGLT2 inhibition. Further trials specifically designed to address pre-adjudicated arrhythmic endpoints are warranted.</p>","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":"145091481","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":"Cardioneural Ablation: Toward Achieving Uniformity in Nomenclature, Procedural Approaches and Outcome Measures.","authors":"Wei-Hsin Chung, Duc Do, Muhammed Ibrahim Erbay, Olujimi A Ajijola","doi":"10.1016/j.hrthm.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.022","url":null,"abstract":"<p><p>The cardiac autonomic nervous system plays a pivotal role in regulating heart function through a complex network of extrinsic and intrinsic components, including ganglionated plexi (GPs). Cardioneuroablation (CNA), a novel therapeutic approach targeting GPs, has emerged as a treatment for cardioinhibitory vasovagal syncope and select atrioventricular block cases. However, heterogeneity in anatomical nomenclature, GPs identification techniques, ablation strategies, and procedural endpoints limits standardization. While methods such as high-frequency stimulation, electroanatomic mapping, and anatomical guidance are used to localize GPs, each has limitations. CNA has demonstrated favorable short-term outcomes, yet concerns regarding long-term efficacy, reinnervation, and safety, particularly related to ventricular arrhythmia risk, remain. This review critically reviews the studies from the basic science of the cardiac autonomic nervous system to the latest clinical outcomes, highlighting the need for unified terminology, patient selection criteria, procedural techniques, and the necessity for long-term, multicenter studies to optimize CNA's safety and effectiveness.</p>","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":"145091505","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":"PPG-based smartphone application vs usual care for atrial fibrillation screening: A European multicenter randomized trial.","authors":"Jakob Johannes Reichl, Khaled Abdel Hamid, Thilo Burkard, Annina Salome Vischer, Caroline Guzman, Dariusz Dudek, Artur Pawlik, Bela Merkely, Janos Marcell László, Athanasios J Manolis, Manolis S Kallistratos, Dominik Linz, Markus Dörr, Christine Bahr, Branko Belesin, Thomas Hübner, Nicole König, Diana Piper, Jens Eckstein","doi":"10.1016/j.hrthm.2025.07.060","DOIUrl":"10.1016/j.hrthm.2025.07.060","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most frequent arrhythmia worldwide and a major cause of ischemic stroke. Screening tools are becoming increasingly popular to detect AF for stroke prevention, yet data from randomized trials are lacking.</p><p><strong>Objective: </strong>The purpose of this study was to analyze AF detection rates using a smartphone application with early intervention (intervention group) compared with no intervention (sham group).</p><p><strong>Methods: </strong>This is an international, multicenter, prospective, randomized, sham-controlled, double-blinded trial conducted between October 2019 and May 2024. Patients with no prior AF were randomized 1:1 to an intervention group or a sham group. The study application used the smartphone camera to generate photoplethysmography signals. If an arrhythmia was detected, patients in the intervention group received a notification and a 7-day patch electrocardiogram to confirm AF.</p><p><strong>Results: </strong>A total of 1021 patients from 8 centers were randomized. The mean CHA₂DS₂-VASc score was 3.4 ± 0.92 in the intervention group and 3.5 ± 1.02 in the sham group. Arrhythmia was detected in 32 (3.1%) cases: 20 (3.9%) in the intervention group and 12 (2.4%) in the sham group. AF was diagnosed in 13 (1.3%) patients. AF detection rates were numerically higher in the intervention group (10 [1.9%] vs 3 [0.5%]; P = .094), especially in cases of asymptomatic AF (4 [0.8%] vs 0 [0%]; P = .13). There was no difference in the rate of stroke, transient ischemic attack, or systemic embolism after 6 months.</p><p><strong>Conclusion: </strong>In this multicenter trial, application usage in combination with early intervention did not significantly increase overall AF detection rates. However, asymptomatic AF detection was numerically higher in the intervention group, aligning with current guidelines that recommend photoplethysmography-based devices for AF screening.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794219","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":"https://doi.org/10.1016/j.hrthm.2025.09.021","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-16","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 Curved 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":"https://doi.org/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":"Shifting Sites of Care in Electrophysiology: Trends and Cost Differences in Device Implantation Procedures Across Ambulatory and Hospital Settings in the Medicare Population.","authors":"Pranav Puri, Rahul Aggarwal, Ashraf Alzahrani, Peter Farjo, Paari Dominic","doi":"10.1016/j.hrthm.2025.09.020","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.020","url":null,"abstract":"<p><strong>Background: </strong>Cardiac electrophysiology (EP) procedures, such as pacemaker and implantable cardioverter-defibrillator (ICD) implantations, are increasingly shifting from inpatient hospitals to outpatient settings. Ambulatory surgery centers (ASCs) may offer cost advantages over hospital outpatient departments (HOPDs), but national trends and payment differences in the Medicare population remain under characterized.</p><p><strong>Objective: </strong>To evaluate trends in site-of-service utilization and Medicare payment differences for EP device implantation procedures between 2016 and 2023.</p><p><strong>Methods: </strong>This cross-sectional study analyzed 100% Medicare fee-for-service claims data from 2016-2023 using the Physician/Supplier Procedure Summary files and 2023 payment data from the Medicare Procedure Price Lookup Tool. Pacemaker and ICD implantations were identified via CPT codes and categorized by site of service: inpatient, HOPD, or ASC. Annual procedure volumes were normalized per 10,000 Medicare Part B beneficiaries. Linear regression was used to assess volume trends and ASC uptake. Payment comparisons between ASC and HOPD settings were performed for five representative procedures.</p><p><strong>Results: </strong>From 2016 to 2023, pacemaker volumes declined from 47.2 to 44.2 per 10,000 beneficiaries, and ICD volumes declined from 22.8 to 16.6 per 10,000. Concurrently, ASC utilization rose from 1.5% to 7.2% for pacemakers and from 1.4% to 6.9% for ICDs (p < 0.001 for both trends). In 2023, Medicare reimbursed 15-26% less for device implantations performed in ASCs compared to HOPDs. For example, dual-chamber pacemaker implantation (CPT 33208) cost $8,131 in ASCs versus $10,673 in HOPDs. Aggregate Medicare savings from shifting five EP procedures to ASCs totaled $59.3 million in 2023.</p><p><strong>Conclusion: </strong>The use of ASCs for EP device implantation is increasing and is associated with substantially lower Medicare payments without affecting physician reimbursement. These findings highlight opportunities for cost savings and support the case for expanded ASC utilization and site-neutral payment reform.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069395","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":"High-risk transvenous lead extraction can be safely performed in the electrophysiology laboratory.","authors":"Alphonsus Liew, Sandra Howell, Christopher Aldo Rinaldi","doi":"10.1016/j.hrthm.2025.08.047","DOIUrl":"10.1016/j.hrthm.2025.08.047","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":"145064747","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}

{"title":"Balloon occlusion for left atrial perforation: Tamponade to treat tamponade.","authors":"Jonathan Na, Andrea Giulio Quarti, Ross Michael Reul, Miguel Valderrábano","doi":"10.1016/j.hrthm.2025.08.044","DOIUrl":"10.1016/j.hrthm.2025.08.044","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":"145058206","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}