Heart rhythm最新文献

{"title":"Latent class analysis-derived patterns of comorbidities in patients with atrial fibrillation, adherence to integrated care and impact on long-term outcomes: an analysis from a prospective cohort.","authors":"Marta Mantovani, Marco Vitolo, Davide A Mei, Niccolò Bonini, Paola Trapanese, Enrico Tartaglia, Matteo Paolini, Manuela Orlandi, Jacopo F Imberti, Giuseppe Boriani","doi":"10.1016/j.hrthm.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) commonly coexists with multiple cardiovascular (CV) and non-CV comorbidities, which may cluster in distinct clinical phenotypes with different outcome implications.</p><p><strong>Objective: </strong>We aim to identify comorbidity-based phenotypes in AF using latent class analysis (LCA), characterize their clinical course and assess the association of integrated care adherence with outcomes across phenotypes.</p><p><strong>Methods: </strong>A LCA based on 11 conditions (CV and non-CV) was performed. The primary outcome was a composite of all-cause death, thromboembolic (TE) events, and acute coronary syndrome (ACS). Secondary outcomes were all-cause death and ACS/TE events.</p><p><strong>Results: </strong>We included 1233 AF patients (median age 75 [66-82] years, females 37.5%). Four clinical LCA-derived phenotypes were identified: \"Low comorbidity\" (31.5%); \"Cardio-metabolic\" (33.9%); \"Elderly comorbid\" (22.9%); and \"Atherosclerotic-HF\" (11.8%). During a median follow-up of 542 days, 234 patients (22.7%) experienced the primary outcome. Compared to \"Low comorbidity\", \"Cardio-metabolic\" (aHR 1.64, 95% CI 1.13-2.39), \"Elderly comorbid\" (aHR 1.62, 95% CI 1.09-2.42) and \"Atherosclerotic-HF\" (aHR 2.81, 95%CI 1.83-4.34) phenotypes were independently associated with a higher risk of the primary outcome. Adherence to integrated care varied across phenotypes and was associated with a lower risk of adverse events, with no evidence of significant heterogeneity across phenotypes (p int=0.157).</p><p><strong>Conclusions: </strong>Latent class analysis identified distinct AF clinical phenotypes characterized by specific patterns of comorbidities and associated with different risk of adverse outcomes. The absence of significant heterogeneity in the association between integrated care and outcomes across phenotypes supports its potential value across different levels of clinical complexity in AF patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206790","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":"Stroke Risk-Based Anticoagulation After Atrial Fibrillation Ablation: ALONE-AF Post-Hoc Analysis.","authors":"Young Shin Lee, Jae-Sun Uhm, Junbeom Park, Daehoon Kim, Pil-Sung Yang, Hee Tae Yu, Tae-Hoon Kim, Jaemin Shim, Eue-Keun Choi, Il-Young Oh, Jun Kim, Jum-Suk Ko, Kyoung-Min Park, Jung-Hoon Sung, Hyung Wook Park, Hyoung-Seob Park, Jong-Youn Kim, Ki-Woon Kang, Dongmin Kim, Jin-Kyu Park, Dae-Hyeok Kim, Jin-Bae Kim, Hui-Nam Pak, Young Soo Lee, Boyoung Joung","doi":"10.1016/j.hrthm.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Discontinuation of oral anticoagulant (OAC) in patients without recurrent atrial arrhythmia after ablation for atrial fibrillation (AF) has been demonstrated to reduce composite outcomes of stroke, systemic embolism, and major bleeding compared with continued OAC.</p><p><strong>Objective: </strong>This study aimed to evaluate the optimal OAC strategy according to baseline stroke risk and AF recurrence.</p><p><strong>Methods: </strong>In this post-hoc analysis of the Long-Term Anticoagulation Discontinuation after Catheter Ablation for Atrial Fibrillation (ALONE-AF) trial, patients were stratified according to CHA₂DS₂-VASc score ≤2 and ≥3. Within each stratum, outcomes were compared between the OAC discontinuation and continuation subgroups. The cumulative incidence of stroke, systemic embolism, and major bleeding at 2 years was estimated using the Kaplan-Meier method, with competing risk analysis accounting for AF recurrence.</p><p><strong>Results: </strong>Among 840 patients, 584 and 256 had a CHA₂DS₂-VASc score ≤2 (mean age 62.0±7.5 years, 15.9% female) and ≥3 (mean age 68.9±7.3 years, 45.3% female), respectively. In the CHA₂DS₂-VASc ≤2 stratum, the primary outcome occurred in one patient (0.4%) in discontinuation subgroup vs. six (2.4%) in continuation subgroup (absolute difference -1.9 percentage points, P=0.066). In the CHA₂DS₂-VASc ≥3 stratum, two events (1.8%) occurred in the continuation subgroup only (absolute difference -1.8 percentage points, P=0.172). All major bleeding events (n=5) occurred in the continuation subgroups. Competing risk analysis yielded consistent results.</p><p><strong>Conclusions: </strong>In this exploratory post-hoc analysis, no statistically significant differences in outcomes were observed between OAC strategies when stratified by CHA₂DS₂-VASc score, though event numbers were limited. Larger prospective trials are needed to confirm these observations.</p><p><strong>Trial registrations: </strong>ClinicalTrials.gov Identifier: NCT04432220.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206803","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":"Myocardial Fibrosis as an Arrhythmogenic Substrate: Integrating Genetics, Imaging and Invasive Electrophysiology for Sudden Death Risk Stratification.","authors":"Raimondo Pittorru, Deni Kukavica, Nicola Pierucci, Joan Llevadot-Sesmilo, Pranav Bhagirath, Alessandro Trancuccio, Domenico Corrado, Andreu Porta-Sanchez, Ivo Roca-Luque","doi":"10.1016/j.hrthm.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.010","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206786","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":"Can a Wrist-Worn Stimulator Improve the Results of an AF Ablation?","authors":"Brian Olshansky, Mohammed Mhanna","doi":"10.1016/j.hrthm.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.015","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192631","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":"First use of empagliflozin to treat a patient with congenital long QT syndrome type III.","authors":"Ehud Chorin, Roei Merin, Moshe Giladi, Louise Henriques, Ariel Banai, Raphael Rosso, Sami Viskin","doi":"10.1016/j.hrthm.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.007","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192706","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":"Conduction System Recovery After Pulsed Field Ablation of a Para-Hisian PVC.","authors":"Fatimah A Alkhunaizi, Francis E Marchlinski, Matthew C Hyman","doi":"10.1016/j.hrthm.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.004","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149442","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":"Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations.","authors":"Yaacoub Chahine, Heather Wood, Åshild Telle, Savannah F Bifulco, Carter A Anderson, Nadia Chamoun, Ahmad Kassar, Romanos Haykal, Zorica Ristić, Christoph M Augustin, Nazem Akoum, Patrick M Boyle","doi":"10.1016/j.hrthm.2026.09.057","DOIUrl":"10.1016/j.hrthm.2026.09.057","url":null,"abstract":"<p><strong>Background: </strong>Computational models of atrial fibrillation (AF) help clarify arrhythmia mechanisms, but the contribution of left atrial (LA) epicardial adipose tissue (EAT) is rarely included.</p><p><strong>Objective: </strong>To assess whether incorporating EAT-associated effects into fibrosis-based atrial models alters reentrant arrhythmia inducibility, and to characterize the pro-arrhythmic properties of EAT-affected tissue.</p><p><strong>Methods: </strong>LA fibrosis and EAT were quantified by LGE and Dixon MRI in 19 patients with persistent AF. For each patient, three anatomically identical image-personalized models were built (fibrosis only; fibrosis plus half-epicardial EAT effects, 0.5 mm; fibrosis plus full-epicardial EAT effects, 1.0 mm), yielding 855 simulations. In EAT regions, inward rectifier K⁺ current was reduced by 35%, intracellular K⁺ by 50%, and conduction velocity by 25%.</p><p><strong>Results: </strong>Sustained reentry occurred in 370 simulations (43.3%), of which 306 had a functional (rotor-driven) component. Functional reentry inducibility rose from 22.8% (fibrosis only) to 41.4% (half-EAT) and 43.2% (full-EAT). At least one functional reentry was inducible in 12/19 fibrosis-only models, 18/19 half-EAT models, and 19/19 full-EAT models. Median inducible simulations per patient increased from 4 to 6 (p=0.004) and 7 (p=0.003), without significant difference between half- and full-EAT (p=0.895). Fibrosis/EAT overlap regions comprised only 2.1% of the LA wall but were the most arrhythmogenic, with a median 65.5% of their volume harboring reentry versus 8.8% (non-substrate), 37.3% (fibrosis), and 42.8% (EAT) (all p<0.001). In an exploratory analysis of PVI-only ablation patients (n=13), fibrosis-EAT overlap outside the PVI region was associated with 1-year recurrence (log-rank p=0.007).</p><p><strong>Conclusion: </strong>Adding EAT effects to fibrosis-based models increased sustained functional reentry, with transmural depth contributing only modestly. Reentry anchored preferentially where fibrosis and EAT effects coexisted.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148106","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":"Nuclear magnetic resonance-derived lipoprotein profile and risk of atrial tachyarrhythmia recurrence after catheter ablation: a case-cohort design within the PREDIMAR trial.","authors":"Authors' Names Lucía Belzunce, Leticia Goni, M Teresa Barrio-López, Pablo Ramos, Luis Tercedor, Jose Luis Ibáñez Criado, Núria Amigó, Pol Torné, Cristina Razquin, Víctor de la O, Alicia Ibáñez-Criado, Rosa Macías-Ruiz, Miguel Ángel Martínez-González, Ignacio García-Bolao, Jesús Almendral, Miguel Ruiz-Canela","doi":"10.1016/j.hrthm.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.002","url":null,"abstract":"<p><strong>Background: </strong>Lipoproteins could be potential biomarkers of atrial tachyarrhythmia recurrence (TAR) after catheter ablation; however, their association remains inconclusive and based exclusively on routine lipid measurements. Nuclear magnetic resonance (NMR) enables detailed lipoprotein characterization beyond conventional assays.</p><p><strong>Objective: </strong>To identify a baseline NMR-derived lipoprotein profile associated with the risk of TAR after catheter ablation.</p><p><strong>Methods: </strong>We conducted a case-cohort study (212 cases and 238 participants in a random sub-cohort, with 93 overlapping cases) nested in the PREDIMAR (PRevención con DIeta Mediterránea de Arritmias Recurrentes) trial. Conventional lipoprotein profiles were measured using the Pentra C-200 and advanced lipoprotein profiles were assessed by NMR. Lipoprotein values were normalized and scaled to one standard deviation using Blom's inverse normal transformation. Cox models were used to assess the associations between baseline lipoproteins and TAR. Additionally, a cholesteryl ester transfer (CETP)-mediated lipoprotein exchange score was constructed and evaluated.</p><p><strong>Results: </strong>After 18-month follow-up, higher baseline remnant cholesterol (hazard ratio = 1.26, 95% confidence interval= 1.06-1.51, per SD), higher cholesterol and triglyceride content in very-low-density lipoproteins (VLDL) (hazard ratio_perSD = 1.22, 95% confidence interval= 1.03-1.46) or in intermediate-density lipoproteins (IDL) (hazard ratio_perSD = 1.29, 95% confidence interval= 1.09-1.52), showed increased risks of TAR. Higher triglyceride-to-HDL cholesterol ratio was directly associated, and higher triglyceride-to-VLDL cholesterol and triglyceride-to-IDL cholesterol ratios were inversely associated with recurrence. A CETP-mediated lipoprotein exchange score was directly associated with recurrence.</p><p><strong>Conclusion: </strong>An atherogenic lipoprotein profile characterized by elevated remnant cholesterol is associated with a higher risk of TAR after catheter ablation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147034","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":"A Rounding Error Dressed as Reform: The Implications of a Large Private Health Insurance Company's Prior Authorization Concession for the Electrophysiology Patient.","authors":"Dhanunjaya Lakkireddy, Jalaj Garg, Chris X Yang, Rajesh Kabra, Sandeep Gautam, Sana M Al-Khatib, Jagmeet Singh, Suneet Mittal, Amit Shanker, Molly Sachdev, Scott Greenberg, Kenneth Ellenbogen, Rakesh Gopinathannair, Andrea Natale, Mina Chung","doi":"10.1016/j.hrthm.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.006","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148413","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":"Differences in Tricuspid Valve Insufficiency, Mechanical Synchrony, and Cardiac Remodeling Between Left Bundle Branch Area Pacing and Right Ventricular Pacing.","authors":"Qing Jin, Zhan Li, Xingbiao Ren, Junjie Li, Min He, Yaoqian Zhang, Haiyan Wang","doi":"10.1016/j.hrthm.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Cardiac implantable electronic device-induced tricuspid regurgitation (CIED-induced TR) involves primary (lead-induced) and functional etiologies. The impact of left bundle branch area pacing (LBBAP) versus right ventricular pacing (RVP) on these mechanisms remains unclear.</p><p><strong>Objective: </strong>To compare the incidence and mechanisms of TR among pacing modalities, and evaluate the prognostic significance of these mechanisms.</p><p><strong>Methods: </strong>We analyzed 225 patients with first-time RV apical pacing (RVAP, n=97) or RV septal pacing (RVSP, n=78) using stylet-driven leads, and LBBAP (n=50) using lumenless leads. Echocardiography and electrocardiography were performed at baseline and 2 years post-implantation. Three-dimensional echocardiography assessed lead interference. Kaplan-Meier analysis compared event-free survival between lead-induced (LITR) and functional TR (FTR) groups. Cox regression identified predictors for adverse outcomes.</p><p><strong>Results: </strong>Despite a higher baseline heart failure burden than RVP (P< .001), LBBAP showed the lowest TR progression rate (20.0% vs RVAP 43.3% vs RVSP 35.9%, P=.020) over 25.8 months. Mechanistically, LBBAP shortened QRS duration (vs RVP widening, P< .001) and demonstrated less lead interference than RVAP (28.0% vs 50.5%, P= .009). Furthermore, LBBAP showed greater left-heart reverse remodeling and improvement in mitral regurgitation, while preserving right-heart structure and function better than RVP. Over 37.4 months, LITR showed worse outcomes than FTR (P= .03). LITR, pulmonary hypertension, reduced left ventricular ejection fraction, and elevated creatinine were independent predictors for adverse outcomes.</p><p><strong>Conclusion: </strong>LBBAP was associated with less CIED-induced TR than RVP, likely through reduced mechanical interference, superior electrical synchrony, and favorable cardiac remodeling. Furthermore, LITR was associated with a worse prognosis than FTR.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147688","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}