Heart rhythm最新文献

{"title":"Prediction of ischemic stroke by the CHA2DS2 -VA score in an Asian population: A report from the prospective nationwide COOL-AF registry.","authors":"Rungroj Krittayaphong, Sirin Apiyasawat, Komsing Methavigul, Chulaluk Komoltri, Gregory Y H Lip","doi":"10.1016/j.hrthm.2025.04.062","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.04.062","url":null,"abstract":"<p><strong>Background: </strong>The CHA₂DS₂-VA score, derived by the removal of female sex from the CHA₂DS₂-VASc score, has recently been recommended for the prediction of ischemic stroke/systemic embolism (SSE) in patients with atrial fibrillation (AF).</p><p><strong>Objective: </strong>Given the limited data in non-Western cohorts, the objective was to compare the performance of CHA₂DS₂-VASc and CHA₂DS₂-VA score for the prediction of SSE in an Asian population.</p><p><strong>Methods: </strong>AF patients from the prospective multicentre COOL-AF registry were studied. Patients were followed-up every 6 months for 3 years. The primary outcome was SSE. C-statistics were used to compare the performance of CHA₂DS₂-VASc and CHA₂DS₂-VA scores for SSE risk prediction. The pattern of OAC use is according to the practicing physicians.</p><p><strong>Results: </strong>A total of 3405 patients were studied (mean age 67.8±11.3 years, 41.8% female). The incidence rate of SSE was 1.51 (1.26-1.78) per 100 person-years. The risk ratio for SSE for females was higher than males at CHA₂DS₂-VA scores ≥2 [1.72 (1.19-2.50), p = 0.004], similar for patients with and without OAC use. The C-statistics for SSE was not statistically significantly different between CHA₂DS₂-VASc and CHA₂DS₂-VA scores [0.655 (0.639-0.671) and 0.647 (0.631-0.663), p=0.258]. Females had a greater risk of SSE compared to males at age above 70 years (p-value_interaction 0.007).</p><p><strong>Conclusion: </strong>Female patients with AF have an increased SSE risk compared to male patients with a higher CHA₂DS₂-VA scores and at age above 70 years. The CHA₂DS₂-VA scores had a numerical but non-statistically significant difference to CHA₂DS₂-VASc score for SSE risk prediction.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011760","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":"Win ratio analysis of the REVERSE cardiac resynchronization trial.","authors":"Michael R Gold, William T Abraham, Javed Butler, Michael R Zile, Rami Kahwash, Bart Gerritse, Cecilia Linde","doi":"10.1016/j.hrthm.2025.04.059","DOIUrl":"10.1016/j.hrthm.2025.04.059","url":null,"abstract":"<p><strong>Background: </strong>The novel win ratio (WR) statistic has emerged as a promising alternative end point for the comparison of 2 treatment groups on multiple end points simultaneously, but it has not been used for cardiac resynchronization therapy (CRT) trials. The REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE; ClinicalTrials.gov identifier: NCT00271154) was the first multicenter, randomized CRT trial in mild heart failure (HF). The primary result was a non-significant reduction in the proportion of CRT patients with worsened clinical composite score compared with control. However, CRT did improve reverse remodeling measures and delayed time to first HF hospitalizations.</p><p><strong>Objective: </strong>To demonstrate the value of the WR for the evaluation of CRT using data from REVERSE.</p><p><strong>Methods: </strong>Individual patient data were analyzed using the WR on a hierarchical end point at 12 months that included the following clinical composite score components: all-cause death, HF hospitalization, crossover or exit because of HF, change in New York Heart Association class from baseline, and the Patient Global Assessment. All pairs of a CRT and a control patient were compared. The WR is the number of CRT wins divided by the number of losses. Reverse remodeling and quality of life were assessed as alternative end points.</p><p><strong>Results: </strong>REVERSE included 610 patients randomized between treatment (CRT-ON, n = 419) and control (CRT-OFF, n = 191). Comparison of all 80,029 treatment/control pairs resulted in 53.5% wins, 36.9% losses, and 9.5% ties. The WR was 1.45 (95% confidence interval, 1.17-1.80), showing CRT superiority (P = .0009).</p><p><strong>Conclusion: </strong>WR analysis confirms the benefits of CRT beyond a single primary end point and holds promise for analysis of combined end points in CRT and other arrhythmia studies.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983357","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":"Skipping the scope: Risk-based transesophageal echo omission in pulmonary vein isolation.","authors":"Moritz Rothe, Andreas A Boehmer, Pascal Spork, Katia Schneider, Lilli Wiedenmann, Elena Nussbaum, Christoph Keim, Peter Weiß, Bianca C Dobre, Bernhard M Kaess, Joachim R Ehrlich","doi":"10.1016/j.hrthm.2025.04.056","DOIUrl":"10.1016/j.hrthm.2025.04.056","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005575","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":"The Bachmann Bundle Pacing Target: Retrograde Mapping and Microstructural Correlation.","authors":"Daniel L Lustgarten, Nicole Habel, Margaret Infeld, Daniel Correa de Sa, Robert Lobel, Peter Spector, Nathaniel Thompson, Joseph Winget, Neal Duong, Bo Ye, Paul A Iaizzo, Markus Meyer","doi":"10.1016/j.hrthm.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.04.012","url":null,"abstract":"<p><p>Electroanatomic mapping of the right atrial breakout site during retrograde Bachmann bundle pacing in 15 patients in sinus rhythm undergoing pulmonary vein isolation provided the anatomic localization of the putative lead insertion target for Bachmann bundle pacing. In all patients the target area could be mapped to the inferoseptal superior vena cava, with some variation in the earliest breakout site in the anteroposterior plane. Microstructural correlation reveals that the Bachmann bundle functions as an atrial conduction pathway supported by anatomic features to provide interatrial synchrony.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997701","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":"Watchful waiting for frequent minimally symptomatic premature ventricular complexes.","authors":"Mohammed Naji, Christopher Scoma, Troy LaBounty, Michael Ghannam, Jackson Liang, Amrish Deshmukh, Kelly Arps, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank Bogun","doi":"10.1016/j.hrthm.2025.04.054","DOIUrl":"10.1016/j.hrthm.2025.04.054","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976527","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":"Radiofrequency-aided venous ethanol vs optimized radiofrequency for primary and repeat ablation of left ventricular summit arrhythmias: A propensity score-matched comparison.","authors":"Maarten A J De Smet, Milad El Haddad, Benjamin De Becker, Clara François, Reshma Amin, Rene Tavernier, Sébastien Knecht, Mattias Duytschaever, Jean-Benoît le Polain de Waroux","doi":"10.1016/j.hrthm.2025.04.053","DOIUrl":"10.1016/j.hrthm.2025.04.053","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency (RF) ablation of left ventricular summit arrhythmias (LVSAs) is challenging and may fail due to the anatomical inaccessibility of the substrate. Coronary venous ethanol ablation (CVEA) has been suggested as an alternative ablation strategy for drug- and RF-refractory LVSA.</p><p><strong>Objective: </strong>This study compared venous ethanol with or without adjunctive RF (CVEA ± RF) vs optimized RF (ORF) for primary or repeat ablation of LVSA.</p><p><strong>Methods: </strong>After propensity score matching, 41 of 43 patients treated with CVEA ± RF were compared to 41 of 93 patients who underwent ORF ablation.</p><p><strong>Results: </strong>Patient characteristics were similar for both groups (77% male, median age 65 [56-71] years, median 2 [1-2] previous ablation procedures). The mean pace-match was 97.1 ± 1.7% for venous vs 94.7 ± 3% for conventional mapping (P < .0001). The earliest presystolic signal was -41 ± 11 ms for venous vs -28 ± 10 ms conventional mapping (P < .0001). Acute procedural success was 95% vs 83% for CVEA ± RF and ORF respectively (P = .077). Ventricular premature beat burden decreased by 58% after ORF and by 91% following CVEA ± RF (P = .041). In patients with ventricular tachycardia, ventricular tachycardia burden decreased by 96% after CVEA ± RF (P < .0001), while a 70% reduction was not significant for ORF. After a median follow-up of 24 (12-58) months, 20% of CVEA ± RF patients recurred as compared to 54% following ORF (P = .002). Following ORF ablation, 1 patient developed pericarditis, 1 patient tamponade, and 1 patient atrioventricular block. In the CVEA ± RF group, one patient suffered a vascular access complication. No patients died.</p><p><strong>Conclusion: </strong>When venous mapping supports intramural origin, RF-aided venous ethanol ablation is an effective strategy for the treatment of LVSA also when compared to ORF ablation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976425","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 ischemic stroke in sinus node dysfunction with and without atrial fibrillation: Evidence for the presence of a left atrial myopathy in patients with isolated sinus node dysfunction-an analysis of the UK Biobank.","authors":"Sohaib A Virk, William W H Ho, Fumihiko Takeuchi, Gwilym M Morris, Peter M Kistler, Jonathan Kalman","doi":"10.1016/j.hrthm.2025.04.055","DOIUrl":"10.1016/j.hrthm.2025.04.055","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence indicates sinus node dysfunction (SND) may be an important marker of a biatrial myopathy. However, the relative risk of ischemic stroke in isolated SND has not been clearly delineated in comparative prospective studies.</p><p><strong>Objective: </strong>This study examined the association between SND (with and without concomitant atrial fibrillation [AF]) and ischemic stroke (IS) in the UK Biobank.</p><p><strong>Methods: </strong>The UK Biobank is a prospective, population-based cohort of >500,000 individuals aged 40-69 years recruited across the United Kingdom between 2006 and 2010, with follow-up extending beyond 10 years. Incident health events were longitudinally tracked through electronic health record linkages with hospital admissions, primary care records, and death registration data using International Classification of Diseases, Tenth Revision coding. Individuals with SND, AF, or both were identified. Patients with prosthetic heart valves, rheumatic mitral valve diseases, mitral stenosis, and prior IS were excluded. The primary end point was time to IS.</p><p><strong>Results: </strong>Of the 451,493 participants (median age 57 years, 44.2% male) included in this study: 593 had isolated SND, 955 had combined SND and AF, 37,065 had isolated AF, and 412,880 comprised controls with neither SND nor AF. During a median follow-up of 13.2 years, yearly IS incidence was 0.37%, 0.60%, 0.59%, and 0.10% in these groups, respectively. In multivariable competing-risk regression modeling accounting for death, isolated SND conferred a significantly increased risk of IS compared to controls (subdistribution hazard ratio 2.28; 95% confidence interval, 1.57-3.31; P < .001). Participants with AF and SND had a similar risk of IS, compared to those with isolated AF (subdistribution hazard ratio 1.07; 95% confidence interval, 0.84-1.37; P = .58).</p><p><strong>Conclusion: </strong>SND is an independent risk marker for the development of IS in individuals without AF. This provides further evidence of SND being an electrical marker of a biatrial myopathy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017103","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":"Simplified 3-ganglionated plexus ablation for the treatment of recurrent vasovagal syncope and functional bradyarrhythmia.","authors":"Carlos Minguito-Carazo, Jesús Daniel Martínez-Alday, Javier García Seara, Jose Luis Martínez Sande, Xesus Alberte Fernández López, Federico García-Rodeja Arias, Olekshander Shangutov, Juliana Elices Teja, Beatriz González Chana, Teba González Ferrero, Carlos Tilves Bellas, José Ramón González Juanatey, Moisés Rodríguez-Mañero","doi":"10.1016/j.hrthm.2025.04.052","DOIUrl":"10.1016/j.hrthm.2025.04.052","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is an emerging treatment for recurrent vasovagal syncope (VVS), extrinsically mediated atrioventricular block (AVB), and sinus node dysfunction (SND). However, there is ongoing debate regarding the number of ganglionated plexuses (GPs) to ablate.</p><p><strong>Objective: </strong>To evaluate differences in the degree of autonomic denervation and clinical outcomes between a simplified 3-GP ablation strategy and an extensive ablation approach.</p><p><strong>Methods: </strong>This is a prospective, observational study of patients with recurrent VVS, extrinsic AVB, or SND. Patients were categorized into group A (3-GP ablation: right superior, left superior, and left posteromedial GP) and group B (additional GP ablation). Primary outcomes included relative heart rate (HR) increase after the atropine test at baseline and 6 months and syncope or pacemaker-free survival in the follow-up.</p><p><strong>Results: </strong>Overall, 58 patients were included. There were no significant differences in the relative HR increase after the atropine test following CNA (A: 9.9% [4.1-19.0] vs B: 5.6% [2.8-8.4], P = .069) or at 6 months (A: 24.8% [15.0-37.2] vs B: 19.9% [16.8-25.4], P = .277). Similarly, after 19.1 (9.2-26.8) months there were no significant differences in syncope or pacemaker-free survival between groups (A: 15.2% vs B: 32.0%; log-rank P = .467). No significant differences were observed in most HR variability parameters or autonomic functional tests. Both groups showed a significant improvement in the SF-36 quality-of-life score (physical function p<.001, health change P < .001). Procedural time (P = .036) and fluoroscopy time (P = .015) were significantly shorter in the only 3-GP group.</p><p><strong>Conclusion: </strong>A simplified 3-GP ablation strategy resulted in similar autonomic denervation and clinical outcomes compared with an extended ablation approach.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997466","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":"Top 5 stories in sports electrophysiology: Sudden cardiac death","authors":"Eugene H. Chung MD, MPH, FHRS ,&nbsp;Douglas Darden MD ,&nbsp;Rachel Lampert MD, FHRS","doi":"10.1016/j.hrthm.2025.02.043","DOIUrl":"10.1016/j.hrthm.2025.02.043","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 5","pages":"Pages 1367-1368"},"PeriodicalIF":5.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882324","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":"An iconic figure from CARE-HF: The Cardiac Resynchronization - Heart Failure trial","authors":"John G.F. Cleland MD, PhD","doi":"10.1016/j.hrthm.2025.03.1960","DOIUrl":"10.1016/j.hrthm.2025.03.1960","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 5","pages":"Pages 1131-1133"},"PeriodicalIF":5.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882398","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}