Heart rhythm最新文献

{"title":"Localized abnormal Q waves are not associated with echocardiographic regional wall motion abnormalities","authors":"Yoav Granot MD , Tal Ben Shaul MD , Shir Frydman MD , Michal Laufer Perl MD , Shmuel Banai MD , Yan Topilsky MD , Ofer Havakuk MD","doi":"10.1016/j.hrthm.2025.05.056","DOIUrl":"10.1016/j.hrthm.2025.05.056","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1030-e1031"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191740","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":"SCAI/HRS technical review on transcatheter left atrial appendage occlusion","authors":"Edmond M. Cronin MB BCh BAO, FHRS ,&nbsp;Steven Filby MD, FSCAI ,&nbsp;Michael E. Field MD, FHRS ,&nbsp;Chetan Huded MD, FSCAI ,&nbsp;Julia H. Indik MD, PhD, FHRS ,&nbsp;Abhishek Sharma MD, FSCAI ,&nbsp;Chelsea Armah MPH ,&nbsp;Scott Firestone MS ,&nbsp;Angela M. Fix MPH, MCW ,&nbsp;Emily Senerth MS, MPH ,&nbsp;Rebecca L. Morgan PhD, MPH ,&nbsp;Yngve Falck-Ytter MD","doi":"10.1016/j.hrthm.2025.05.049","DOIUrl":"10.1016/j.hrthm.2025.05.049","url":null,"abstract":"<div><h3>Background</h3><div>Nonvalvular atrial fibrillation (NVAF) is associated with an increased risk of stroke due to thrombus formation in the left atrial appendage, where over 90% of thrombi originate. While oral anticoagulation (OAC) is the standard therapy for stroke prevention, many patients cannot tolerate long-term OAC due to bleeding risks. Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative strategy. Despite its rapid adoption, substantial variability exists in clinical practice regarding patient selection, imaging techniques, procedural guidance, and postprocedural management. This systematic review aims to collect and synthesize evidence to inform the development of new Society for Cardiovascular Angiography &amp; Interventions and the Heart Rhythm Society guidelines on LAAO.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane Library from inception through January 5, 2024, for studies of the percutaneous LAAO procedure. Eligible studies were conducted in adults with NVAF undergoing LAAO, or with peridevice leak or device-related thrombus after an occlusion procedure. Studies of surgical LAAO, double device or combined procedures, and devices that are not currently marketed in the United States were excluded. Data were extracted from studies in duplicate and summarized using meta-analysis and narrative synthesis. Risk of bias (RoB) was assessed using the RoB in nonrandomized studies of interventions tool, and version 2 of the Cochrane RoB tool for randomized trials (RoB 2.0). Overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.</div></div><div><h3>Results</h3><div>Our search identified 3769 titles and abstracts, of which 27 studies met eligibility criteria and contributed data to the analysis. Data were abstracted to address outcomes of LAAO for stroke prevention in patients with NVAF, in comparison to OAC, no therapy, and across various approaches including preprocedure imaging, intraprocedure guidance, and postprocedure antithrombotic regimens.</div></div><div><h3>Conclusions</h3><div>Left atrial appendage occlusion is an effective alternative to OAC for stroke prevention in NVAF patients with bleeding risks, but uncertainties remain regarding imaging strategies and postprocedural management.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1064-e1074"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775300","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":"Tissue characteristics underlying endocardial local impedance subtypes in chronic myocardial infarction","authors":"Júlia Aranyó MD ,&nbsp;Daina Martínez-Falguera MSc ,&nbsp;Albert Teis MD, PhD ,&nbsp;Edgar Fadeuilhe MD ,&nbsp;Oriol Rodríguez-Leor MD, PhD ,&nbsp;Víctor Bazan MD, PhD ,&nbsp;Axel Sarrias MD ,&nbsp;Cristian Tebe MPH, PhD ,&nbsp;Roger Villuendas MD, PhD ,&nbsp;Victoria Delgado MD, PhD ,&nbsp;Antoni Bayés-Genís MD, PhD ,&nbsp;Carolina Gálvez-Montón DVM, PhD ,&nbsp;Felipe Bisbal MD, PhD","doi":"10.1016/j.hrthm.2025.05.017","DOIUrl":"10.1016/j.hrthm.2025.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Local impedance (LI) mapping is feasible and provides additional tissue characterization<span> of the ventricular tachycardia substrate. Data on tissue composition underlying the LI spectrum are lacking.</span></div></div><div><h3>Objective</h3><div><span>To describe the tissue composition underlying different LI subtypes in a chronic myocardial infarction (MI) </span>swine model.</div></div><div><h3>Methods</h3><div><span><span>One month after non-reperfused anterior MI, 18 </span>Landrace<span> Large White pigs underwent delayed-enhancement </span></span>cardiac magnetic resonance<span><span> (DE-CMR) and endocardial left ventricular (LV) LI mapping. DE-CMR images were post-processed off-line to obtain </span>LV wall thickness, scar subtypes, and border zone (BZ) corridors, and were co-registered with LI maps. Tissue samples were obtained from abnormal LI sites.</span></div></div><div><h3>Results</h3><div>Low LI zones exhibited more pronounced wall thinning compared to intermediate LI tissue (2.8 ± 0.7 vs 3.8 ± 0.9 mm; <em>P &lt;</em><span> .001) and correlated with DE-CMR dense endocardial scarring (91.4%) and with epicardial scarring (75% dense and 24% BZ tissue). Intermediate LI tissue exhibited predominantly subendocardial scarring, with more heterogeneous distribution (45% dense, 47% BZ, and 8% healthy tissue) and less epicardial involvement (73% healthy tissue). Most DE-CMR BZ corridors (75.6%) colocalized with intermediate LI tissue. Histologically, tissue from intermediate LI zones displayed less collagen I (</span><em>P</em> = .008), collagen III (<em>P</em> = .053), and collagen volume fraction (<em>P</em> = .021), and greater vascular density (<em>P</em> = .075), compared to low LI zones.</div></div><div><h3>Conclusions</h3><div>Areas of low LI had a higher proportion of dense, transmural scar and wall thinning compared to intermediate LI areas. DE-CMR BZ corridors colocalized with intermediate LI in most cases. LI subtypes showed distinctive histological composition.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e968-e977"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093444","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 effectiveness of a novel balloon-in-basket pulsed-field ablation catheter for the treatment of paroxysmal and persistent AF: Volt-AF IDE trial acute results","authors":"Monica Lo MD ,&nbsp;Alok Gambhir MD, PhD, FHRS ,&nbsp;Sri Sundaram MD ,&nbsp;Prashanthan Sanders MBBS, PhD, FHRS ,&nbsp;David DeLurgio MD ,&nbsp;Amar Trivedi MD ,&nbsp;Stavros Mountantonakis MD, MBA ,&nbsp;Chris Woods MD, PhD, FHRS ,&nbsp;Petr Neuzil MD ,&nbsp;Atul Verma MD ,&nbsp;Joaquin Osca MD ,&nbsp;Peter Loh MD, PhD ,&nbsp;Hugh Calkins MD ,&nbsp;David Strouse MD ,&nbsp;Gian-Battista Chierchia MD ,&nbsp;Brett Atwater MD ,&nbsp;Emily Wenzel MD ,&nbsp;Wenjiao Lin MS ,&nbsp;Amber Miller PhD ,&nbsp;Dhanunjaya Lakkireddy MD, FHRS","doi":"10.1016/j.hrthm.2025.04.037","DOIUrl":"10.1016/j.hrthm.2025.04.037","url":null,"abstract":"<div><h3>Background</h3><div>Increasing use of Pulsed Field Ablation (PFA) to treat atrial fibrillation (AF) has led to concerns related to tissue contact, hemolysis, and electroanatomic mapping integration. A novel balloon-in-basket PFA catheter offers form and function to address these concerns.</div></div><div><h3>Objective</h3><div>The VOLT-AF Investigational Device Exemption (IDE) study is a prospective, single-arm global IDE study designed to demonstrate the Volt PFA system (Abbott Laboratories, Chicago, Illinois) is safe and effective for the treatment of paroxysmal AF (PAF) and persistent AF (PersAF).</div></div><div><h3>Methods</h3><div>Symptomatic, drug-refractory PAF and PersAF subjects were enrolled for de novo ablation. Ablation strategy was pulmonary vein isolation-only using the Volt PFA catheter with EnSite X EP System integration for visualization and dynamic contact display. End points were the rate of the device- or procedure-related SAE within 7 days and acute procedural success.</div></div><div><h3>Results</h3><div>A total of 392 subjects (57 roll-in, 335 primary analysis, 51.8% PAF, 64.7% men, age 65.0 ± 11.0 years) were enrolled at 38 sites from April to September 2024. Acute isolation was observed in 99.4% of veins (666/670) in 98.2% of patients with PAF (162/165), and in 99.8% of veins (633/634) in 99.4% of patients with PersAF (154/155), with 18.5 ± 3.6 applications/patient. Primary safety endpoint events occurred in 1.9% of subjects. Procedural efficiency and acute outcomes did not differ with fluoroscopy use. Conscious or deep sedation was associated with increased procedural efficiency, with no difference in acute success compared with general anesthesia. No clinically relevant hemolysis or kidney injury was reported.</div></div><div><h3>Conclusion</h3><div>These results demonstrate the acute safety and effectiveness of a novel balloon-in-basket PFA catheter to treat paroxysmal and persistent AF. Long-term outcome follow-up is ongoing.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2524-2533"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999336","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 a current of injury compared with left bundle branch area pacing","authors":"Pietro Palmisano MD ,&nbsp;Maurizio Collantoni MD ,&nbsp;Salvatore Bonanno MD ,&nbsp;Marco Giuranna MD ,&nbsp;Amato Santoro MD ,&nbsp;Giuseppe Dattilo MD, PhD ,&nbsp;Pasquale Crea MD, PhD ,&nbsp;Erberto Carluccio MD ,&nbsp;Michele Accogli MD ,&nbsp;Giovanni Coluccia MD","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":"22 10","pages":"Pages e1032-e1033"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","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}

{"title":"Non-early catheter ablation vs drug therapy in atrial fibrillation: Results from the CABANA trial","authors":"Zhen Wang MD ,&nbsp;Mingxiao Li MD ,&nbsp;Chao Jiang MD ,&nbsp;Manlin Zhao MD ,&nbsp;Hang Guo MD ,&nbsp;Yiwei Lai MD ,&nbsp;Yufeng Wang MD ,&nbsp;Mingyang Gao MD ,&nbsp;Shijun Xia MD ,&nbsp;Liu He PhD ,&nbsp;Xueyuan Guo MD ,&nbsp;Songnan Li MD ,&nbsp;Nian Liu MD ,&nbsp;Chenxi Jiang MD ,&nbsp;Ribo Tang MD ,&nbsp;Ning Zhou MD ,&nbsp;Caihua Sang MD ,&nbsp;Deyong Long MD ,&nbsp;Xin Du MD ,&nbsp;Jianzeng Dong MD ,&nbsp;Changsheng Ma MD","doi":"10.1016/j.hrthm.2024.11.010","DOIUrl":"10.1016/j.hrthm.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Early rhythm control reduces the risk of cardiovascular events in patients with atrial fibrillation<span><span> (AF). Despite the superiority of catheter ablation in maintaining </span>sinus rhythm, the knowledge gaps regarding the prognostic benefits of non-early (onset of AF ≥1 year) ablation remain.</span></div></div><div><h3>Objective</h3><div>The study aimed to describe outcomes of non-early AF in the CABANA trial.</div></div><div><h3>Methods</h3><div><span>CABANA randomized AF participants to catheter ablation or drug therapy. The primary end point was a composite of death, disabling stroke, serious </span>bleeding, or cardiac arrest. Secondary end points included all-cause mortality and all-cause mortality or cardiovascular hospitalization.</div></div><div><h3>Results</h3><div>A total of 2178 patients (median age, 67 years; 810 [37.2%] female) were included, 1122 (51.5%) with non-early AF. For the primary outcome, the adjusted hazard ratio (aHR) of ablation vs drug therapy was 0.83 (95% confidence interval [CI], 0.53–1.30; <em>P</em> = .413) in non-early AF patients and 0.78 (95% CI, 0.52–1.16; <em>P</em> = .220) in early AF patients (interaction <em>P</em> value = .787). Non-early ablation resulted in a relative reduction of 26% and 23% in all-cause mortality (aHR, 0.74; 95% CI, 0.42–1.33; <em>P</em> = .314) and all-cause mortality or cardiovascular hospitalization (aHR, 0.77; 95% CI, 0.65–0.91; <em>P</em> = .002), respectively. After exclusion of patients with prior heart failure, non-early AF patients receiving ablation still had a significantly lower risk of all-cause mortality or cardiovascular hospitalization (aHR, 0.78; 95% CI, 0.65–0.93; <em>P</em> = .005).</div></div><div><h3>Conclusion</h3><div>Non-early AF patients may benefit from catheter ablation similar to early AF patients. Catheter ablation may be an effective treatment strategy to reduce the composite risk of all-cause mortality or cardiovascular hospitalization in non-early AF patients.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2534-2542"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618804","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":"Electrical substrate of the right ventricle in valvular pulmonary stenosis: Early observations from electrophysiology studies before pulmonary valve replacement","authors":"Jeff Hong MD ,&nbsp;Amr El-Bokl MD ,&nbsp;Nicola Maschietto MD, PhD ,&nbsp;Edward T. O’Leary MD","doi":"10.1016/j.hrthm.2024.10.075","DOIUrl":"10.1016/j.hrthm.2024.10.075","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2686-2688"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618808","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":"Slowly conducting anatomic isthmuses of tetralogy of Fallot: An opportunity for “prophylactic” ventricular tachycardia ablation","authors":"Bryce V. Johnson MD ,&nbsp;Mark Sonderman MD ,&nbsp;Matthew J. Magoon BS ,&nbsp;Andrew Pistner MD ,&nbsp;Bishoy Hanna MD ,&nbsp;Graham H. Bevan MD ,&nbsp;Rosemary McDonagh BS ,&nbsp;Patrick M. Boyle PhD, FHRS ,&nbsp;Melissa R. Robinson MD, FHRS ,&nbsp;Nazem Akoum MD, FHRS ,&nbsp;Neal A. Chatterjee MD, MSc ,&nbsp;Eric V. Krieger MD ,&nbsp;Babak Nazer MD","doi":"10.1016/j.hrthm.2024.10.073","DOIUrl":"10.1016/j.hrthm.2024.10.073","url":null,"abstract":"<div><h3>Background</h3><div><span>Patients with repaired tetralogy of Fallot<span><span> are at risk of ventricular tachycardia (VT) and </span>sudden cardiac death<span>. Most VTs arise from 5 slowly conducting anatomic isthmuses (SCAIs; conduction velocity ≤0.5 m/s) bound by the right ventriculotomy, ventricular septal defect patch, and tricuspid and pulmonic valves. Historically, </span></span></span>risk stratification electrophysiologic studies involved programmed ventricular stimulation with VT induction guiding implantable cardioverter-defibrillator (ICD) implantation or VT ablation.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate a “prophylactic” strategy of ablating SCAIs even in the absence of inducible VT to reduce ICD implantation and arrhythmic events and to compare this with the “historical” strategy.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective cohort study<span>. The historical cohort underwent programmed ventricular stimulation to guide ICD implantation or VT ablation. The prophylactic cohort underwent right ventricular electroanatomic mapping and ablation of SCAIs. A composite end point of arrhythmic death, cardiac arrest, sustained VT, and ICD complication was compared between the cohorts.</span></div></div><div><h3>Results</h3><div><span>Ninety-two patients with repaired tetralogy of Fallot had risk stratification electrophysiologic studies. Of 57 prophylactic patients, SCAIs were identified or ablated in 33 (58%), 16 (28%) had inducible VT before ablation, and 1 received ICD. Of 35 historical patients, 15 (43%) had inducible VT; 3 had cryoablation during pulmonic valve replacement and 11 received ICDs. No prophylactic patients met the composite end point during a median 21 months (interquartile range, 8–35 months) vs 10 (29%) historical patients during a median 125 months (interquartile range, 90–142 months; </span><em>P</em> = .017). There were no ablation-related complications.</div></div><div><h3>Conclusion</h3><div>Prophylactic SCAI ablation is associated with fewer ICD implantations and a reduction in incident arrhythmic events without ablation-related complications.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2669-2677"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675352","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":"Bloodstream infection in patients with cardiac implantable electronic devices and prosthetic heart valves: The role of PET-CT","authors":"Tardu Özkartal MD ,&nbsp;Marco Bergonti PhD, MD ,&nbsp;Maria Luce Caputo PhD, MD ,&nbsp;Luca Ceriani MD ,&nbsp;Giulio Conte PhD, MD","doi":"10.1016/j.hrthm.2024.11.024","DOIUrl":"10.1016/j.hrthm.2024.11.024","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2726-2728"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686901","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":"Risk of recurrent ventricular tachyarrhythmia following the occurrence of a first ventricular arrhythmic event in patients with a primary prevention implantable cardioverter-defibrillator","authors":"Matthew Wang BS,&nbsp;Ilan Goldenberg MD,&nbsp;Arwa Younis MD,&nbsp;Ido Goldenberg MD,&nbsp;Michael Christof,&nbsp;David T. Huang MD, FHRS,&nbsp;Scott McNitt MS,&nbsp;Bronislava Polonsky MS,&nbsp;Valentina Kutyifa MD, PhD,&nbsp;Wojciech Zareba MD, PhD,&nbsp;Amole Ojo MD,&nbsp;Mehmet K. Aktaş MD, MBA, FHRS","doi":"10.1016/j.hrthm.2024.11.033","DOIUrl":"10.1016/j.hrthm.2024.11.033","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data on clinical and arrhythmic outcomes after a first ventricular tachyarrhythmia (VTA) in heart failure (HF) patients who receive a primary prevention implantable cardioverter-defibrillator (ICD).</div></div><div><h3>Objective</h3><div>This study was designed to quantify the burden of and to identify risk factors for recurrent VTA in this population and to evaluate the risk of all-cause mortality associated with recurrent VTA.</div></div><div><h3>Methods</h3><div>The study comprised 789 patients who experienced VTA following primary prevention ICD implantation in 5 ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). Landmark analysis was used to quantify the burden and to identify predictors of recurrent VTA. Time-dependent analysis was used to evaluate the association of VTA recurrence with subsequent mortality.</div></div><div><h3>Results</h3><div>The mean age of the study patients was 63 years, and 17% were women. The cumulative probability of experiencing at least 1 recurrent VTA episode at 3 years after a first VTA episode was 60%; the recurrent VTA burden after a first event during 3 years was 2.8 episodes per patient. The risk of recurrent VTA remained ≥56% at 3 years regardless of baseline clinical and echocardiographic risk factors. VTA recurrence was associated with a significant 2-fold increased risk of subsequent all-cause mortality.</div></div><div><h3>Conclusion</h3><div>Patients with a primary prevention ICD who experience an episode of VTA are at high risk of recurrent VTA, regardless of baseline risk factors. Recurrent VTA is associated with a pronounced increase in the risk of death. These findings suggest a need for early intervention after a first VTA in patients who receive a primary prevention ICD.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2651-2660"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709855","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}