Heart rhythm最新文献

{"title":"Does a novel regulator of ion channel trafficking relate to sudden cardiac death? Your help is needed.","authors":"Marina Cerrone, Arthur A M Wilde","doi":"10.1016/j.hrthm.2025.05.032","DOIUrl":"10.1016/j.hrthm.2025.05.032","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180661","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 leadless left ventricular endocardial and left bundle branch area pacing on biventricular repolarization metrics.","authors":"Nadeev Wijesuriya, Marina Strocchi, Mark Elliott, Vishal Mehta, Felicity De Vere, Sandra Howell, Alphonsus Liew, Jane Kwan, Paolo Bosco, Steven A Niederer, Christopher A Rinaldi","doi":"10.1016/j.hrthm.2025.05.047","DOIUrl":"10.1016/j.hrthm.2025.05.047","url":null,"abstract":"<p><strong>Background: </strong>Cardiac resynchronization therapy (CRT) delivered with left ventricular (LV) epicardial pacing may increase arrhythmic risk through detrimental effects on ventricular repolarization. Leadless LV endocardial CRT including leadless left bundle branch area pacing (LBBAP) may mitigate this by preserving a more physiological transmural activation pattern.</p><p><strong>Objective: </strong>This study aimed to evaluate the effect of leadless LV endocardial and leadless LBBAP on repolarization metrics derived from electrocardiographic imaging (ECGi).</p><p><strong>Methods: </strong>Ten patients with leadless endocardial CRT systems underwent a temporary pacing plus ECGi study, testing right ventricular, LV, and biventricular pacing (BiVP) settings, as well as atrioventricular-optimized LV pacing. Epicardial electrograms were used to derive metrics of repolarization and activation-recovery interval dispersion. The primary outcome measurements were acute improvement (ie, reduction) from baseline (right ventricular pacing or underlying rhythm) of these repolarization metrics.</p><p><strong>Results: </strong>Ten patients were studied; 5 had received LV lateral wall endocardial pacing, and 5 had received LBBAP with leadless septal wall pacing. The optimal leadless pacing setting significantly improved biventricular dispersion of repolarization by 23.7% ± 14% (P < .01), and this effect was more pronounced with LBBAP (29.3% ± 15%, P = .01) vs lateral wall pacing (18% ± 12%, P = .03). Similar results were observed for activation-recovery interval dispersion and biventricular repolarization gradients. The most pronounced improvements were observed where LV-only pacing as opposed to BiVP was used, either through LBBAP or atrioventricular-optimized LV pacing from any endocardial location.</p><p><strong>Conclusion: </strong>Optimized leadless LV endocardial lateral wall pacing and LBBAP improve ECGi-derived ventricular repolarization metrics. LV-only pacing seemed superior to endocardial BiVP, potentially reflecting repolarization heterogeneity caused by a collision of 2 paced wavefronts.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173487","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":"External validation of atrial fibrillation risk prediction tools in a racially diverse cohort of patients with hypertrophic cardiomyopathy.","authors":"Henry Pronovost, Ali Asghar Kassamali, Jeff Ehmsen, Bryana Rivers, Alessio Gasperetti, Katherine C Wu, Ethan Rowin, Jose A Madrazo, Richard T Carrick","doi":"10.1016/j.hrthm.2025.05.046","DOIUrl":"10.1016/j.hrthm.2025.05.046","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM). The 2024 American Heart Association/American College of Cardiology guidelines recommend validated clinical tools such as the HCM-AF score for individualized assessment of AF risk. To date, these tools have been validated only in predominantly white HCM patient populations.</p><p><strong>Objective: </strong>This study aimed to compare the performances of published AF risk prediction tools in a racially diverse cohort of patients with HCM.</p><p><strong>Methods: </strong>This was a retrospective study of patients with HCM without previous AF evaluated at the Johns Hopkins HCM Center. Assessments of AF risk were generated using the HCM-AF score and other non-HCM-specific risk scores (C2HEST, HARMS2-AF, CHA₂DS₂-VASc, and CHARGE-AF). Patients were followed longitudinally for the development of new-onset, clinically significant AF. Discrimination was assessed using concordance-based c-statistics.</p><p><strong>Results: </strong>A total of 631 patients with HCM were included, with a mean age of 55.9 ± 15.3 years; 49.7% were women, 64.7% were white, 24.1% were black, and 11.2% identified with other nonwhite race. During a median follow-up of 3.1 years, new AF was diagnosed in 18.9% of patients. The HCM-AF score demonstrated better risk discrimination (c-statistic 0.72) than other non-HCM-specific risk scores (c-statistics 0.56-0.67) and effectively stratified patients into low-risk (0.9% AF/year), medium-risk (3.4% AF/year), and high-risk groups (7.4% AF/year). Discrimination of AF risk by the HCM-AF score was similar for white (c-statistic 0.71) and nonwhite patients (c-statistic 0.74).</p><p><strong>Conclusion: </strong>The HCM-AF score demonstrated good AF risk discrimination in a diverse cohort of patients with HCM, outperforming alternative non-HCM-specific AF risk scores and validating its use in nonwhite HCM populations.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142418","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":"Ensuring catheter-tissue contact with intracardiac echocardiography during pulsed-field ablation improves procedure outcome in patients with atrial fibrillation.","authors":"Sanghamitra Mohanty, Michela Casella, Brandon Doty, Marco Schiavone, Kirollos Gabrah, Yari Valeri, Prem Geeta Torlapati, Vincenzo Mirco La Fazia, Carola Gianni, Amin Al-Ahmad, John D Burkhardt, G J Gallinghouse, Rodney Horton, John Allison, Weeranun Bode, Rashi Sharma, Antonio Dello Russo, Claudio Tondo, Devi G Nair, Andrea Natale","doi":"10.1016/j.hrthm.2025.05.045","DOIUrl":"10.1016/j.hrthm.2025.05.045","url":null,"abstract":"<p><strong>Background: </strong>Catheter-tissue contact is critical in creating durable lesions during pulsed-field ablation (PFA) of atrial fibrillation (AF).</p><p><strong>Objective: </strong>This study aimed to compare the reconnection rate of previously ablated targets using PFA with vs without intracardiac echocardiography (ICE) guidance for confirmation of tissue contact.</p><p><strong>Methods: </strong>This multicenter prospective study included consecutive patients with paroxysmal and persistent AF undergoing their first procedure using the PFA system. Patients were classified as the ICE group if ICE was used for the assessment of catheter-tissue contact (n = 310) or the fluoro group if fluoroscopy-guided ablation was used (n = 286). All patients received isolation of pulmonary veins; left atrial posterior wall isolation was performed in most patients at the index procedure. Further ablations were performed only in the presence of spontaneous triggers or documentation that those triggers were responsible for arrhythmia either spontaneously or after isoproterenol challenge.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the groups. At the end of the follow-up, arrhythmia recurrence was noted in 39 (12.6%) and 64 patients (22.3%) in the ICE and fluoro groups, respectively (P = .002). All 39 patients in the ICE group and 54 patients (84%) in the fluoro group received repeat ablation. At the redo procedure, reconnection of previously ablated structures was detected in 4 of 39 (10.3%) and 32 of 54 patients (59.2%) in the ICE and fluoro groups, respectively (P < .001). \"Fluoroscopy-guided\" ablation was found to be an independent predictor of reconnection (odds ratio 8.548; 95% confidence interval 3.224-22.667; P < .001) and recurrence (odds ratio 1.221; 95% confidence interval 1.001-1.971; P = .021).</p><p><strong>Conclusion: </strong>ICE-guided PFA with confirmed catheter-tissue contact was associated with a better success rate and a significantly lower reconnection rate in patients with AF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142355","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":"Epicardial placement of implantable cardioverter-defibrillators in adults: Technical considerations, system performance, and clinical outcomes.","authors":"Poojita Shivamurthy, Marisa Cevasco, Gregory E Supple, Balaram Krishna Hanumanthu, Timothy M Markman, Gustavo Guandalini, Matthew C Hyman, Andres Enriquez, Ramanan Kumareswaran, Michael G Fradley, Rajat Deo, Vincent Y See, Michael Riley, Fermin Garcia, Saman Nazarian, David Lin, David S Frankel, Sanjay Dixit, Andrew E Epstein, David J Callans, Francis E Marchlinski, Robert D Schaller","doi":"10.1016/j.hrthm.2025.05.034","DOIUrl":"10.1016/j.hrthm.2025.05.034","url":null,"abstract":"<p><strong>Background: </strong>Surgical implantation of epicardial implantable cardioverter-defibrillator (ICD) is considered when transvenous ICD placement is not feasible because of congenital anomalies, venous obstruction, or prior infections. Epicardial pacemakers are well-studied but less is known about contemporary epicardial ICD systems in adults.</p><p><strong>Objectives: </strong>This case series details the indications, techniques, safety, and long-term performance of surgically implanted epicardial high voltage (HV) coils and leads in adults.</p><p><strong>Methods: </strong>We included all patients who received epicardial HV coils or leads at the Hospital of the University of Pennsylvania between 2014 and 2025.</p><p><strong>Results: </strong>Nineteen patients (14 men, median age 64 years) were identified. Indications included ICD replacement after lead extraction for endocarditis (7), placement during concomitant surgery, including for tricuspid regurgitation (6), left ventricular assist device (3), and lack of venous access (3). HV coils were used in 58%, and 42% received epicardial leads. All patients received epicardial pace-sense leads; 68% received cardiac resynchronization therapy. HV coils or leads were sewn to the epicardium: 48% on the posterior left ventricle, 16% on the anterior right ventricle, 26% on both ventricles, and 11% in the transverse sinus. Two patients had impedances > 200 Ω because of a loose set screw and a damaged connector pin, respectively. Two had impedances < 20 Ω without clinical impact. One coil fractured 1.5 years post-implant. No failed shocks or lead migrations occurred. During a median follow-up of 468 days, 26% died, largely from advanced heart failure, none were attributable to surgery.</p><p><strong>Conclusion: </strong>Surgical implantation of epicardial ICD systems with HV coils/leads is safe and feasible. Multidisciplinary planning and long-term monitoring are essential.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142358","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":"Atrial fibrillation is not associated with altered left atrial microRNA expression profile in patients with advanced heart failure.","authors":"Tímea Bálint, Mihály Ruppert, Bence Ágg, Dávid Nagy, Krisztina Pálóczi, Kálmán Szenthe, Ferenc Bánáti, Alex Ali Sayour, Attila Oláh, Bálint András Barta, Javier Barallobre-Barreiro, Péter Ferdinandy, Béla Merkely, Tamás Radovits","doi":"10.1016/j.hrthm.2025.05.041","DOIUrl":"10.1016/j.hrthm.2025.05.041","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is common in patients with chronic heart failure (HF). Nevertheless, some patients with HF remain in sinus rhythm (SR) even with marked left atrial (LA) dilatation and fibrosis. The underlying mechanisms for the differences in atrial arrhythmogenicity are poorly uncovered. Recent findings indicate that distinct microRNAs (miRNA) might induce left atrial (LA) structural and molecular alterations. However, the impact of miRNA dysregulation on AF development in the context of HF has not been studied independently of LA remodeling.</p><p><strong>Objective: </strong>This study aimed to evaluate the differences in LA miRNA expressions in patients with HF with AF or SR.</p><p><strong>Methods: </strong>LA myocardial samples were obtained from patients with advanced HF with AF (n = 12; paroxysmal n = 4, chronic as persistent/permanent n = 8) or SR (n = 12) undergoing heart transplantation. The extent of LA interstitial fibrosis was evaluated using picrosirius red staining. The LA load was estimated by measuring LA mRNA expression of the NPPA gene encoding atrial natriuretic peptide with quantitative real-time polymerase chain reaction and circulating N-terminal pro-atrial natriuretic peptide (NT-proANP) by enzyme-linked immunosorbent assay. The LA miRNA screening was performed using the NanoString technology.</p><p><strong>Results: </strong>LA dilatation, fibrosis, NPPA gene expression, as well as circulating NT-proANP levels were similar between the AF and SR groups, suggesting a comparable extent of atrial remodeling and load among the study groups. The miRNA analysis revealed no differences in atrial miRNA expression between the groups, even after AF subgroup analysis.</p><p><strong>Conclusions: </strong>The LA miRNA expression profile shows no distinction between AF and SR in patients with advanced HF with similar levels of pathological atrial remodeling.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142387","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":"Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial.","authors":"Karol Curila, Jan Mizner, Jan Morava, Radovan Smisek, Jana Vesela, Ondrej Sussenbek, Petr Stros, Jindrich Kupec, Petr Waldauf, Pavel Leinveber, Lukas Poviser, Laszlo Nagy, Jan Cerny, Barbora Bitmanova, Pavel Jurak, Rostislav Polasek","doi":"10.1016/j.hrthm.2025.05.036","DOIUrl":"10.1016/j.hrthm.2025.05.036","url":null,"abstract":"<p><strong>Background: </strong>Conduction system pacing (CSP) replaces right ventricular pacing (RVP) in bradycardia patients.</p><p><strong>Objective: </strong>To compare CSP vs RVP in patients with pacemaker indication due to atrioventricular conduction disease.</p><p><strong>Methods: </strong>This study randomized patients to CSP or RVP in 1:1 ratio and followed them for 12 months. CSP received either His bundle pacing or left bundle branch area pacing; The primary end point was a change in the left ventricular ejection fraction (LVEF). The combined composite clinical end point consisted of cardiovascular death, cardiac resynchronization therapy upgrade, or hospitalization for heart failure.</p><p><strong>Results: </strong>Of 249 patients, 125 were randomized to RVP and 124 to CSP; there were no differences between clinical parameters. In CSP, 10 patients received His bundle pacing, 96 left bundle branch area pacing, 15 deep septal pacing, and 3 RVP. Procedural and fluoroscopy times were longer in CSP vs RVP (63 vs 40 and 7 vs 3 minutes; P < .001). In the intention-to-treat analysis, the LVEF decline in CSP was smaller than RVP (-2% vs -4%, P = .03), and a LVEF decrease ≥ 10% occurred more often in RVP 19 (16%) than CSP 6 (5%), P = .01. There was no difference in the composite clinical outcome between RVP and CSP (9 vs 4, P = .15). There was also no difference in procedural complications (9 in RVP vs 2 in CSP, P = .09).</p><p><strong>Conclusion: </strong>In patients with severe conduction disease, CSP led to a smaller LVEF decline than RVP after 1 year of pacing. Both pacing methods had similar rates of clinical end points and procedural complications.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141856","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":"East Asian immigration and direct oral anticoagulant dosing for atrial fibrillation: A population-based cohort study.","authors":"Erika Nakajima, Andrew C T Ha, Feng Qiu, Peter C Austin, Cynthia A Jackevicius, Dennis T Ko, Paul Dorian, Douglas S Lee, Husam Abdel-Qadir","doi":"10.1016/j.hrthm.2025.05.040","DOIUrl":"10.1016/j.hrthm.2025.05.040","url":null,"abstract":"<p><strong>Background: </strong>Some East Asian (EA) guidelines recommend lower doses of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) than in North America and Europe.</p><p><strong>Objective: </strong>The study aimed to investigate the association of immigration from EA with DOAC dosing and outcomes in AF.</p><p><strong>Methods: </strong>This was a population-based cohort study using administrative databases of Ontario immigrants with AF aged ≥ 66 years who were dispensed DOAC prescriptions from 2012 to 2019. Birth country was classified as EA or not. We used multivariable logistic regression to assess the association of EA birth with DOAC dose and cause-specific hazards regression for the association of EA birth and DOAC dose with stroke or bleeding or death. The interaction between EA birth and DOAC dosing was studied for each outcome.</p><p><strong>Results: </strong>Among 14,421 immigrants, 3958 (27.4%) were born in EA. EA immigrants had lower odds of receiving full-dose DOACs vs non-EA immigrants (odds ratio 0.64, 95% confidence interval [CI] 0.58-0.69, P < .001). EA birth was not associated with a composite of hospitalization for stroke or bleeding (hazard ratio [HR] 0.97, 95% CI 0.84-1.12, P = .67) or hospitalization for stroke (HR 0.86, 95% CI 0.71-1.04, P = .13), but was associated with higher bleeding hazard (HR 1.15, 95% CI 1.02-1.30, P = .02) and lower mortality (HR 0.91, 95% CI 0.84-0.99, P = .04). There was no significant interaction between EA birth and DOAC dosing for stroke (P = .41), bleeding (P = .27), or death (P = .33).</p><p><strong>Conclusions: </strong>EA immigrants were less likely to receive full-dose DOACs and had a higher bleeding hazard, similar stroke hazard, and lower mortality risk than non-EA immigrants. There was no evidence that DOAC dosing had a differential treatment effect in EA immigrants.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142394","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":"Diaphragmatic hernia with a nonischemic electrocardiographic presentation of the spiked helmet sign.","authors":"Chang Dai, Zi-En Chen, Shu-Lin Wu, Yu-Mei Xue, Fang-Zhou Liu","doi":"10.1016/j.hrthm.2025.05.033","DOIUrl":"10.1016/j.hrthm.2025.05.033","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142390","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":"Effectiveness of upgrading to left bundle branch area pacing compared with biventricular pacing in patients with right ventricular pacing-induced cardiomyopathy.","authors":"Chen He, Shun Xu, Chuangshi Wang, Xiaofei Li, Haojie Zhu, Jiaxin Zeng, Enrui Zhang, Jiangang Zou, Xiaohan Fan","doi":"10.1016/j.hrthm.2025.05.042","DOIUrl":"10.1016/j.hrthm.2025.05.042","url":null,"abstract":"<p><strong>Background: </strong>Pacing-induced cardiomyopathy (PICM) occurs in some patients requiring a high burden of right ventricular pacing (RVP). Whether left bundle branch area pacing (LBBAP) might be superior to biventricular pacing delivering cardiac resynchronization therapy remains unclear.</p><p><strong>Objective: </strong>The present study aimed to evaluate the effectiveness of LBBAP compared with BiVP in patients with PICM.</p><p><strong>Methods: </strong>This prospective, 2-center observational study enrolled consecutive patients with PICM who underwent upgrading to either LBBAP or BiVP. LBBAP was further classified into left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP). The primary end point was the change in left ventricular ejection fraction (LVEF) from baseline to 6-month follow-up. Other echocardiographic parameters, N-terminal pro-B-type natriuretic peptide levels, New York Heart Association functional class, and clinical events (all-cause mortality, heart failure hospitalization, and malignant ventricular arrhythmias) were evaluated during follow-up.</p><p><strong>Results: </strong>In total, 78 patients were included in the final analysis (33% patients with LVEF < 35%), including 40 patients with LBBAP (30 with LBBP and 10 with LVSP) and 38 patients with BiVP. At the 6-month follow-up, LVEF improvement was significantly greater in patients with LBBAP than those with BiVP (9.59 ± 7.48% vs 4.91 ± 7.73%; P = .008), and higher in LBBP than LVSP (10.62 ± 7.28% vs 6.47 ± 7.57). During a mean follow-up duration of 20.5 ± 12.5 months, clinical outcomes did not differ between BiVP and LBBAP groups (26.3% vs 17.5%; adjusted hazard ratio = 1.57 [0.55-4.48], P = .395) after adjustment for confounders.</p><p><strong>Conclusions: </strong>PICM upgrading to LBBAP or BiVP demonstrated similar clinical outcomes, but upgrading to LBBAP was associated with greater improvement in LVEF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142351","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}