Heart rhythm最新文献

{"title":"Arrhythmogenic atrial remodeling during pregnancy in mice.","authors":"Valérie Long, Beatrice Motok, Élisabeth Leblanc, Georges Tannous, W Glen Pyle, Céline Fiset","doi":"10.1016/j.hrthm.2024.10.064","DOIUrl":"10.1016/j.hrthm.2024.10.064","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy is associated with greater vulnerability to supraventricular tachyarrhythmias.</p><p><strong>Objective: </strong>As the underlying mechanisms remain to be elucidated, we investigated whether pregnancy induces atrial remodeling that might contribute to this.</p><p><strong>Methods: </strong>Atrial electrophysiological and contractile properties were examined in nonpregnant and pregnant (P) mice. Cell shortening and Ca²⁺ imaging were measured on atrial myocytes. Atrial action potential and ionic currents were recorded using the patch-clamp technique. Atrial messenger RNA and protein expression were analyzed using quantitative polymerase chain reaction and Western blot.</p><p><strong>Results: </strong>The P-wave area on the electrocardiogram increased by 50% during pregnancy, suggesting atrial enlargement, confirmed by echocardiography. The atrial myocytes were longer in P mice, adding further evidence to the physiological hypertrophy associated with pregnancy. Echocardiography showed a 50% increase in atrial fractional area change during pregnancy, indicating much stronger contraction. A similar increase in cell shortening was observed in P mice and was associated with a decrease in sarcomere length and changes in myofilament protein phosphorylation. However, pregnancy did not affect L-type Ca²⁺ current, Ca²⁺ transients, and SR Ca²⁺ load. Myocytes from P mice showed twice as many spontaneous contractions and spontaneous diastolic Ca²⁺ releases. Moreover, pregnancy was associated with a 50% increase in action potential duration, linked to a reduction in the density of the Ca²⁺-independent transient outward K⁺ current and the underlying K_V4.3 channel.</p><p><strong>Conclusion: </strong>During pregnancy, atrial tissues undergo substantial remodeling, potentially contributing to the development of supraventricular tachyarrhythmias.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618780","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":"Electrophysiological characteristics of lead position-dependent electrogram uninterrupted transition during left bundle branch pacing.","authors":"Jiabo Shen, Longfu Jiang, Hao Wu, Lu Zhang, Hengdong Li, Lifang Pan","doi":"10.1016/j.hrthm.2024.10.062","DOIUrl":"10.1016/j.hrthm.2024.10.062","url":null,"abstract":"<p><strong>Background: </strong>The interrupted technique of left bundle branch pacing (LBBP) limits the continuous monitoring of paced electrocardiogram and intracardiac electrogram (EGM) transitions, which may result in overlooked or misinterpreted subtle transitions.</p><p><strong>Objectives: </strong>This study aimed to explore the electrophysiological characteristics of lead position-dependent EGM continuous transitions to evaluate lead depth and to investigate the clinical significance of transseptal pacing modalities.</p><p><strong>Methods: </strong>A continuous pacing and recording technique enabled by a rotatable connector was used to allow the real-time monitoring of progressive changes in paced EGM and electrocardiographic morphology. Careful observations were conducted to evaluate whether there were significant changes in the amplitude and morphology of the ventricular current of injury (COI), R-wave peak times in leads V₁ and V₆, QRS duration, and impedance at different interventricular septal depths.</p><p><strong>Results: </strong>The study included 105 patients. Nonselective LBBP was achieved in 94 patients (89.5%), of whom 88 (83.8%) achieved selective LBBP (SLBBP). Left ventricular septal pacing was confirmed in 11 patients (11.5%). The amplitude of ventricular EGM predictably changed with radial septum depth and peaked in the interventricular septum (26.3±11.3 mV). As the lead was inserted into the left ventricular subendocardium, the ventricular COI declined to a level approximating that of the right septum (11.7 ± 6.3 mV for SLBBP vs 10.4 ± 5.8 mV for right ventricular septal pacing). When selective left bundle branch capture occurred, significant morphological transitions in the ventricular COI were observed in the unfiltered EGM.</p><p><strong>Conclusion: </strong>The continuous recording technique provides a more detailed understanding of pacing lead radial depth throughout implantation. COI amplitude and morphology variations can identify different pacing modalities, particularly in recognizing SLBBP.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618797","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 race and ethnicity on the rhythm control of newly diagnosed atrial fibrillation: Insights from the Get With the Guidelines Atrial Fibrillation Registry.","authors":"Connor P Oates, Larry R Jackson, Rebecca Young, Karen Chiswell, Anne B Curtis, Jonathan P Piccini, Vivek Y Reddy, William Whang","doi":"10.1016/j.hrthm.2024.11.003","DOIUrl":"10.1016/j.hrthm.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>An early rhythm control strategy is the preferred management for patients newly diagnosed with atrial fibrillation (AF). A rhythm control strategy, however, has been historically underused for patients from underrepresented racial and ethnic groups (UREGs).</p><p><strong>Objective: </strong>We aimed to determine whether disparities in rhythm control are present at the initial diagnosis with AF.</p><p><strong>Methods: </strong>We used the Get With the Guidelines (GWTG)-Atrial Fibrillation registry to compare the use of a rhythm control strategy among patients with different racial and ethnic backgrounds hospitalized with a new diagnosis of AF from January 2013 through December 2023.</p><p><strong>Results: </strong>Among 21,567 patients hospitalized for newly detected AF across 249 hospitals, 17,659 patients (81.9%) identified as non-Hispanic White (NHW), 1,860 patients (8.6%) identified as Black, 1,232 patients (5.7%) identified as Hispanic, and 255 patients (1.2%) identified as Asian. After adjusting for age, sex, and year of presentation, NHW patients were more likely to receive rhythm control (odds ratio [OR], 1.19 [1.07, 1.33], P = .0013) compared with non-White patients at the time of initial diagnosis with AF. Black patients were less likely to receive rhythm control compared with all other racial and ethnic groups (OR, 0.80 [0.71, 0.91], P = .0005). These differences persisted after fully adjusting for demographic characteristics, clinical variables, hospital characteristics, and socioeconomic factors.</p><p><strong>Conclusions: </strong>Differences in rhythm management exist amongst patients from different racial and ethnic groups. Efforts to mitigate disparities in AF management should include an emphasis on rhythm control at the time of initial diagnosis.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618800","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":"Pain management after cardiac implantable electronic device procedures in a single center out of the United States: Emphasis on opioid prescription.","authors":"Ido Avivi, Shafik Khoury, Netanel Golan, Yishay Szekely","doi":"10.1016/j.hrthm.2024.10.076","DOIUrl":"10.1016/j.hrthm.2024.10.076","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618806","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":"Ablation of premature ventricular complexes originating from papillary muscle using pulsed field energy: the first in USA experience.","authors":"Padmapriya Muthu, Poojan Prajapati, Hema Vemulapalli, Juan F Rodriguez-Riascos, Aria Raman, Komandoor Srivathsan","doi":"10.1016/j.hrthm.2024.10.067","DOIUrl":"10.1016/j.hrthm.2024.10.067","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618777","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 prognosis of patients with an SCN5A loss-of-function variant and progressive cardiac conduction disorder or Brugada syndrome.","authors":"Fenna Tuijnenburg, Virginnio M Proost, Aurélie Thollet, Julien Barc, Alexander J A Groffen, Christiaan C Veerman, Saskia N van der Crabben, Vincent R van der Pas, Florence Kyndt, Sean J Jurgens, Michael W T Tanck, Pieter G Postema, J Peter van Tintelen, Connie R Bezzina, Vincent Probst, Arthur A M Wilde, Jean-Baptiste Gourraud, Ahmad S Amin","doi":"10.1016/j.hrthm.2024.10.057","DOIUrl":"10.1016/j.hrthm.2024.10.057","url":null,"abstract":"<p><strong>Background: </strong>The long-term prognosis of patients with a loss-of-function variant in the cardiac sodium channel gene SCN5A is unknown.</p><p><strong>Objective: </strong>This study aimed to evaluate the long-term arrhythmic risk in patients with an SCN5A loss-of-function variant to identify predictors of arrhythmic events.</p><p><strong>Methods: </strong>Probands and family members with (likely) pathogenic SCN5A loss-of-function variants were retrospectively included. Clinical and electrocardiographic data at baseline and last follow-up were collected. Patients with a history of cardiac arrest, sustained ventricular tachycardia, symptomatic or documented atrial tachy- or bradyarrhythmia, or arrhythmogenic syncope were categorized as symptomatic. Arrhythmic events at follow-up were defined as sudden death, aborted cardiac arrest, documented ventricular fibrillation, and/or sustained ventricular tachycardia.</p><p><strong>Results: </strong>We included 615 patients (349 men, 242 probands, 157 with a spontaneous type 1 Brugada electrocardiogram, and 111 symptomatic at baseline). During a median follow-up of 9.5 (Q1,Q3 5.0-14.3) years, arrhythmic events occurred in 41 patients (6.7%), equating an overall event rate of 0.7%/y: 2.0%/y in symptomatic and 0.3%/y in asymptomatic patients. In the overall study population, symptoms at baseline, male sex, and QRS prolongation were identified as independent predictors of arrhythmic events. In asymptomatic patients, male sex and QRS prolongation were also identified as predictors. Asymptomatic women with QRS interval < 100 ms did not experience arrhythmic events at follow-up.</p><p><strong>Conclusion: </strong>Key predictors of arrhythmic risk in patients with an SCN5A loss-of-function variant, regardless of a Brugada syndrome diagnosis, are symptoms at baseline, male sex, and prolonged QRS interval. Our findings may enable more tailored management strategies in patients with an SCN5A loss-of-function variant based on their individual risk profiles.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567886","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":"Feasibility and safety of pulsed field ablation at the ventricular outflow tract using focal point catheter.","authors":"Lihui Zheng, Pakezhati Maimaitijiang, Aiyue Chen, Zihao Lai, Yan Yao","doi":"10.1016/j.hrthm.2024.10.059","DOIUrl":"10.1016/j.hrthm.2024.10.059","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmias commonly originate from the ventricular outflow tract. It remains unexplored whether pulsed field ablation (PFA) can create durable lesions safely at the ventricular outflow tract.</p><p><strong>Objective: </strong>This study aimed to evaluate the feasibility and safety of a novel PFA catheter to deliver focal ablation to the ventricular outflow tract, especially pulmonary and aortic sinus cusps (PSCs and ASCs).</p><p><strong>Methods: </strong>Twelve swine were divided into 3 groups: 24-hour, 2-week, and 4-week post-ablation. PFA was delivered to predefined sites of PSCs and ASCs with a focal point catheter, positioned by a mapping system, fluoroscopy, and intracardiac echocardiography. Electrophysiologic assessment, coronary angiography, transesophageal echocardiography, and gross and histologic examination were performed to evaluate the impact of PFA delivery on cardiac structure and function.</p><p><strong>Results: </strong>All subjects survived, and no adverse events were observed. There was a significant decrease in voltage amplitude and increase in pacing thresholds at PSCs and ASCs. There were no significant differences in AH or HV intervals between pre-ablation and post-ablation (AH, P = .70; HV, P = .90). After PFA delivery to ASCs, coronary arteries were fully perfused in each heart, without ST-segment elevation observed. No severe valvular dysfunction was observed on intracardiac echocardiography and transesophageal echocardiography. Gross and histologic examination confirmed the creation of well-demarcated lesions at the targeted sites without damage to adjacent structures.</p><p><strong>Conclusion: </strong>PFA delivered by the focal point catheter could create durable lesions at PSCs and ASCs without damage to coronary arteries, atrioventricular block, or valvular dysfunction, indicative of the feasibility and safety of this novel PFA catheter at the ventricular outflow tract.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567879","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 and winding road to electrocardiographic imaging (ECGI)","authors":"Yoram Rudy PhD, FHRS,","doi":"10.1016/j.hrthm.2024.08.060","DOIUrl":"10.1016/j.hrthm.2024.08.060","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"21 11","pages":"Pages 2081-2082"},"PeriodicalIF":5.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top Stories: Syncope","authors":"Benjamin M. Moore MBBS, PhD,&nbsp;Andrew D. Krahn MD, FHRS","doi":"10.1016/j.hrthm.2024.08.057","DOIUrl":"10.1016/j.hrthm.2024.08.057","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"21 11","pages":"Pages 2364-2365"},"PeriodicalIF":5.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ivabradine use in children","authors":"Christopher M. Janson MD","doi":"10.1016/j.hrthm.2024.09.025","DOIUrl":"10.1016/j.hrthm.2024.09.025","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"21 11","pages":"Pages 2366-2367"},"PeriodicalIF":5.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540288","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}