Heart rhythm最新文献

{"title":"Early Versus Delayed Catheter Ablation in Atrial Fibrillation and Heart Failure: A Systematic Review and Meta-Analysis.","authors":"Mustafa Eray Kilic, Mehmet Emin Arayici, Yigit Resit Yilancioglu, Oguzhan Ekrem Turan, Emin Evren Ozcan, Mehmet Birhan Yilmaz","doi":"10.1016/j.hrthm.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.012","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and heart failure (HF) frequently coexist, worsening outcomes. Catheter ablation (CA) is an established therapy, but the optimal timing remains unclear.</p><p><strong>Objective: </strong>To evaluate the impact of early versus delayed CA on clinical outcomes in patients with AF and HF.</p><p><strong>Methods: </strong>This PROSPERO-registered systematic review (CRD42025643686) adhered to PRISMA guidelines. Comparative studies enrolling adults with AF and HF were included. Early CA was defined as ablation performed within varying timeframes (often ≤12 months) after AF diagnosis or HF decompensation versus delayed CA beyond that period. Primary outcomes were AF recurrence, all-cause mortality, and HF hospitalizations. Random-effects meta-analyses were performed.</p><p><strong>Results: </strong>Ten studies (n=15,822) contributed to the meta-analyses. Early CA was associated with significantly reduced AF recurrence (k=8; HR 0.63, 95% CI: 0.52-0.78, p<0.0001) and HF hospitalization (k=5; HR 0.63, 95% CI: 0.51-0.77, p<0.0001). A non-significant trend towards reduced all-cause mortality was observed (k=4; HR 0.71, 95% CI: 0.41-1.24, p=0.23). Statistical heterogeneity was absent for HF hospitalization (I²=0%), moderate for AF recurrence (I²=67.6%), and high for mortality (I²=75.3%). Narrative synthesis included two additional RCTs comparing treatment strategies.</p><p><strong>Conclusion: </strong>Evidence from pooled observational studies suggests early CA is associated with reduced AF recurrence and HF hospitalization in patients with AF and HF; a mortality benefit was not statistically confirmed. Interpretation warrants caution due to reliance on observational data and methodological heterogeneity across studies.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484083","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":"Targeted epicardial pulsed field ablation of atrial ganglionated plexi: Electrophysiological and histological analysis in pigs.","authors":"Julie Norup Hertel, Sarah Dalgas Nissen, Lucas Alexander Lindberg, Mélodie Schneider, Alisha Niskala, Jonas L Isaksen, Kezia Jerltorp, Charles Ye, Ben J M Hermans, Luca Aerts, Bart Maesen, Sevasti-Maria Chaldoupi, Kenneth Coffey, John Reilly, Barry O'Brien, Thomas Jespersen, Arnela Saljic, Dominik Linz","doi":"10.1016/j.hrthm.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.016","url":null,"abstract":"<p><strong>Background: </strong>Modulation of autonomic nervous system activation by ganglionated plexi (GP) ablation is considered a key component of atrial fibrillation (AF) treatment. Endocardial pulsed field ablation (PFA) has limited impact on epicardially located GPs due to their significant distance from the endocardium, whereas epicardial PFA delivery directly to GP sites may display antiarrhythmic effects by effective ablation of GPs with minimal collateral myocardial damage.</p><p><strong>Objectives: </strong>To determine antiarrhythmic and structural effects of epicardial PFA-delivery to atrial GP sites.</p><p><strong>Methods: </strong>In an open-chest pig model, five epicardial GP sites were carefully identified (anatomical landmarks and response to high-frequency stimulation (HFS)) and targeted by saline-irrigated bipolar PFA (PFA-Group, n=6, and sham-operated pigs (n=2)). Atrial epicardial electrogram (EGM)-amplitude, atrial effective refractory period (aERP), AF-inducibility, and AF-duration were investigated. Immunohistochemical staining was performed on treatment-adjacent structures.</p><p><strong>Results: </strong>In the PFA-Group, PFA was successfully delivered to each GP-site. Local epicardial EGM-amplitudes did not change after PFA-delivery. After PFA-treatment the aERP at the higher and lower lateral right atrium increased by 49±42ms (p=0.036) and 99±42ms (p=0.006), respectively. AF-inducibility decreased from 100% to 33% (p=0.046) and AF-duration decreased from 4.4±0.6min to 1.3±2.1min (p=0.007). PFA-treatment resulted in lower S100-protein intensity within GP-cytoplasm (-44.8%, p=0.003) and GP-membrane (-34.9% p=0.004), indicating acute GP damage. The surrounding atrial structures including the neuronal sympathetic network and arteries were spared.</p><p><strong>Conclusion: </strong>Targeted anatomically and HFS-guided epicardial PFA-delivery to GP sites induces acute GP damage, prolongs aERP, and reduces AF-inducibility and AF-duration while preserving surrounding neuronal, myocardial, and vascular structures.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484084","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 Mitral Valve Complex: A Complex Trap to Be Avoided by Cardiac Electrophysiologists - A Systematic Review.","authors":"Hussam Ali, Ahmad Abdelrady Abdelsalam Farghaly, Robert H Anderson, Pierpaolo Lupo, Sara Foresti, Guido De Ambroggi, Riccardo Bessi, Silvia Magnani, Riccardo Cappato","doi":"10.1016/j.hrthm.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.013","url":null,"abstract":"<p><p>Catheter entrapment within the mitral valve complex (MVC) is a rare but serious complication during left-heart catheterization. A systematic review, the first on this topic, was conducted through PubMed and Embase databases following the PRISMA guidelines to identify cases of catheter entrapment within the MVC during electrophysiological procedures. Forty-six patients were included predominantly undergoing catheter ablation of atrial tachyarrhythmias (71.7%). The circular mapping catheters were the most frequently entrapped materials (50%), followed by ablation and multispline catheters. Ablation catheters were entrapped mostly when advanced retrogradely, while multispline catheter entrapment was exclusively observed in patients with mechanical valves. Percutaneous management was successful in 47.8% of patients, of whom one-third required retrieval of embolized catheter segments. Surgery was necessary in 52.2% of patients, including valve surgery in 30.4%. Awareness of this potential complication and applying preventive strategies are essential when mapping or ablating adjacent to the MVC.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309874","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":"COMMENTARY: SUDDEN DEATH IN COMPETITIVE STUDENT- ATHLETES WITH HYPERTROPHIC CARDIOMYOPATHY AT A CROSSROADS: CRITICAL VIEWS ON LIBERALIZING RETURN-TO-PLAY ELIGIBILITY.","authors":"Barry J Maron, Ethan J Rowin, Jiri Bonaventura, Cristina Basso, Domenico Corrado, Gaetano Thiene, Andre L Churchwell, Fred Basilico, Paul D Thompson, Rick A Nishimura, N A Mark Estes","doi":"10.1016/j.hrthm.2025.06.014","DOIUrl":"10.1016/j.hrthm.2025.06.014","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340045","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":"Counterpoint: Sudden Cardiac Death in Competitive Student-Athletes with Hypertrophic Cardiomyopathy: From one-size-fits-all to personalization.","authors":"Harald T Jorstad, Maarten A van Diepen, Michael J Ackerman, Arthur A M Wilde","doi":"10.1016/j.hrthm.2025.06.015","DOIUrl":"10.1016/j.hrthm.2025.06.015","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340046","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":"Ventricular arrhythmia detection with a wearable ring-type PPG sensor: a feasibility study.","authors":"Nicole J van Steijn, Shari Pepplinkhuizen, Pieter G Postema, Reinoud E Knops, Michiel M Winter","doi":"10.1016/j.hrthm.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.008","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmias (VA) are most frequently the onset of sudden cardiac death and early detection is key for survival. Limited studies suggest wrist worn photoplethysmography (PPG) sensors can detect VA. Ring-type wearable PPG sensors may be more accurate, however they have not yet been investigated.</p><p><strong>Objective: </strong>We aim to show the sensitivity of a ring-type wearable PPG sensor to detect induced VA.</p><p><strong>Methods: </strong>Patients undergoing a procedure involving VA induction were included. The CART-I was positioned on the finger during the procedure and PPG and reference ECG data were collected. A loss of cardiac output (CO) was defined as a flatline, or a decrease in amplitude ≥50%. Sensitivity was calculated using a contingency table. Bland-Altman analysis and intraclass correlation coefficients (ICC) were used to assess the agreement between PPG- and ECG-derived arrhythmia durations.</p><p><strong>Results: </strong>Thirty-seven patients were enrolled, of whom 25 were included: defibrillation threshold testing (n=16), ventricular tachycardia (VT) ablation (n=8) and electrophysiological study (n=1). A total of 67 VA, of which 27 ventricular fibrillation (VF) and 40 VT episodes, were recorded. A loss of CO was observed on the tachograms of all VF episodes and in 36 (90%) VT episodes. The sensitivity was 94% (100% for VF, 90% for VT). Mean difference in VA duration was 0.1 (95% Limits of Agreement -1.4 - 1.7) seconds, with an ICC of 0.998 (95% CI: 0.997 - 0.999), indicating excellent agreement.</p><p><strong>Conclusion: </strong>This study suggests that a ring-type wearable device can detect, with high sensitivity, changes in arterial pulse flow during induced VA.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301921","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":"Kerfed Tip Enhances Catheter Stability During Accessory Pathways Ablation in Children.","authors":"Dustin Nash, Kathryn Collins, David Martin Runciman, Johannes von Alvensleben","doi":"10.1016/j.hrthm.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.007","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301920","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":"Prognosis for loss-of-function versus hot-spot variants in RBM20-related cardiomyopathy.","authors":"Alexis Hermida, Flavie Ader, Guillaume Jedraszak, Louis Vogel, Gilles Millat, Christophe Beyls, Nicolas Martin, Agathe Vernier, Philippe Charron, Estelle Gandjbakhch","doi":"10.1016/j.hrthm.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.009","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293654","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 Senescent Heart and Atrial Fibrillation.","authors":"Amitabh C Pandey, Ghassan Bidaoui, Hadi Younes, Eli Tsakiris, Nassir F Marrouche","doi":"10.1016/j.hrthm.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.005","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is increasing in prevalence and burden globally as the population greys. Aging, a multi-faceted universal biological process, is a primary driver of AF development and persistence. However, the mechanistic connection between aging and atrial myopathy, the main substrate for the development and sustenance of AF remains poorly elucidated. Cellular senescence is a foundational aging component characterized by cell cycle arrest, an anti-apoptotic phenotype, and a unique secretome linking it to many chronic and aging-related diseases, including atherosclerosis, arrhythmia, and myocardial diseases. In this review, we discuss the literature on the molecular basis of cardiac senescence and the associated secretory phenotype. Then, we discuss its relationship to atrial myopathy and remodeling through the activation of the renin-angiotensi¹n-aldosterone system, mitochondrial alterations, and epigenetic changes. We then offer insights into pre-clinical studies on senolytic and senomorphic agents specifically in cardiology and finally discuss the challenges and future directions.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293657","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":"Heart failure hospitalisation from recurrent AF is uncommon following catheter ablation in patients with HFrEF.","authors":"Kenneth Cho, Sandeep Prabhu, Louise Segan, Jeremy William, Rose Crowley, Nicholas D'Elia, David Chieng, Hariharan Sugumar, Liang-Han Ling, Aleksandr Voskoboinik, Joseph B Morton, Geoffrey Lee, Alex J McLellan, Justin Lineham, Matthew Morton, Sonia Azzopard, Annie Curtin, Michael W Lim, Youlin Koh, Michael Wong, Jonathan M Kalman, Peter M Kistler","doi":"10.1016/j.hrthm.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence following catheter ablation (CA) on HF is not well understood.</p><p><strong>Objective: </strong>We sought to examine the clinical outcomes and hospitalisation patterns in AF HFrEF patients following CA.</p><p><strong>Methods: </strong>This multicentre study reports the re-admission outcomes for patients with AF and HFrEF (LVEF≤40%) following CA.</p><p><strong>Results: </strong>231 patients (60.5±11.1years, 37 females, mean LVEF 30.7±7.1%, persistent AF 87.9%) with AF and HFrEF underwent CA. At 3.0 years follow-up, recurrent AF occurred in 120 (51.9%) and complete LV systolic recovery (LVEF≥50%) in 125 (54%) patients. There were 366 hospitalisations amongst 123 patients: 240 cardiac and 126 non-cardiac. Arrhythmia related hospitalisations occurred in 179: 151 recurrent atrial arrhythmia without HF, 4 AF with HF, 3 supraventricular tachycardia and 21 ventricular arrhythmia. Other cardiac hospitalisations (61) included: HF without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3) and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery post ablation (OR=1.32, 95% CI=1.11-12.55 P=0.03), persistent AF versus paroxysmal AF recurrence (OR=1.76, 95% CI=1.21-27.72 P=0.03), ischemic cardiomyopathy (OR=3.62, 95% CI=1.16-11.30 P=0.02), and furosemide use (OR=4.96, 95% CI=1.55-15.91 P<0.01) were associated with future HF hospitalisation.</p><p><strong>Conclusion: </strong>After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF and HF, but more commonly present with HF without AF, or AF without HF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293653","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}