Heart rhythm最新文献

{"title":"Extrastimuli-assisted Functional Mapping Improves Ventricular Tachycardia Ablation Outcomes: A Systematic Review, Meta-analysis, and Meta-regression.","authors":"Bruno Wilnes, Beatriz Castello-Branco, Eduardo Maia Martins Pereira, Luiza Marinho Lopes, Vivian Barroso Santos, Ana Clara Bicalho, Lucas Melo, Sara Regina Silva Cupertino, Anna Terra França, Marcos Roberto Queiroz França, Gustavo de Araújo Silva, Marina Pereira Mayrink, Isabella Moreira Gonzalez Fonseca, Reynaldo Castro de Miranda, José Luiz Padilha da Silva, Maria Carmo Pereira Nunes, Andre Assis Lopes do Carmo","doi":"10.1016/j.hrthm.2025.03.2000","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2000","url":null,"abstract":"<p><strong>Background: </strong>In the context of VT ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. Additionally, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.</p><p><strong>Objectives: </strong>To assess the efficacy and safety of functional mapping-assisted ventricular tachycardia (VT) ablation and compare procedural outcomes between dynamic and static mapping approaches.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were searched using MeSH terms \"Ventricular Tachycardia Ablation\", \"Functional Mapping\", \"Recurrence\", \"Complications\", and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random-effects models and p<0.05. Subgroup analysis and meta-regression were performed.</p><p><strong>Results: </strong>We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ±29.7 months. Ischemic etiology comprised 490 (72.7%) patients, left ventricular ejection fraction (LVEF) varied from 25 ±10% to 41.5 ±13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) employed static techniques, and 1 (6.3%) used a mixed approach. Procedure duration (p=0.520) or complication incidence (p=0.110) were similar between dynamic and static mapping modalities. Dynamic mapping subgroup exhibited significantly lower VT recurrence rate when compared to the static mapping population (p<0.010). This result persisted on a meta-regression model adjusted for ischemic etiology and LVEF, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (p=0.005).</p><p><strong>Conclusion: </strong>Functional mapping demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced post-ablation recurrence rates without significantly increasing procedure duration.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794707","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":"One year clinical and safety outcome of obese patients undergoing pulmonary vein isolation for atrial fibrillation with pulsed field ablation or cryoballoon ablation - a propensity matched analysis.","authors":"Sebastian Feickert, Smilla Wagner, Kristof Biernath, Hüseyin Ince, Jasmin Ortak, Andreas A Boehmer, Giuseppe D'Ancona, Niels Christian Ewertsen","doi":"10.1016/j.hrthm.2025.03.1999","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1999","url":null,"abstract":"<p><strong>Background: </strong>Thermal-based ablation techniques, such as cryoballoon ablation (CBA), are widely used for pulmonary vein isolation (PVI) but show notable recurrence rates, particularly in obese patients. One possible reason is the reduced efficacy of thermal energy in tissues with significant epicardial fat, which can impede effective lesion formation and insulation of targeted areas.</p><p><strong>Objective: </strong>Pulsed field ablation (PFA) has shown promising results for atrial fibrillation (AF) treatment, providing effective isolation with a favorable safety profile. This study investigates the clinical and safety outcomes of PFA compared to CBA in obese patients with AF.</p><p><strong>Methods: </strong>This retrospective propensity-matched study included symptomatic paroxysmal and persistent AF patients with a body mass index (BMI) >30 kg/m² who underwent PFA or CBA at a single institution. Matching criteria included age, left atrial diameter, left ventricular ejection fraction, and AF type (paroxysmal vs. persistent), as well as pre-existing conditions such as diabetes, coronary artery disease, and hyperlipoproteinemia. Procedural workflows were standardized, focusing on PV isolation. Outcomes assessed were procedural efficiency, recurrence rates, and complications.</p><p><strong>Results: </strong>Post-matching revealed lower recurrence rates in the PFA group (25%) compared to the CBA group (42.9%, p=0.02). PFA was associated with significantly shorter left atrial (LA) time (33.8 min. vs. 49.7 min., p<0.01) and procedural time (46.8 min. vs. 69.3 min., p<0.01) than CBA, although fluoroscopy time showed no significant difference. Safety outcomes were similar across both groups.</p><p><strong>Conclusion: </strong>PFA offers an alternative to CBA in obese patients, with superior recurrence outcomes and shorter procedural durations post-matching in this single-center cohort. PFA may be a preferred approach for AF management in this high-risk population. Future randomized trials are warranted to validate these findings and optimize treatment protocols for obese AF patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794788","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":"Rethinking Anticoagulation After Bariatric Surgery: Direct Oral Anticoagulants vs. Warfarin in Atrial Fibrillation.","authors":"Emmanuel Otabor, Justin Lam, Laith Alomari, Abiodun Idowu, Festus Ibe, Yaman Jarrar, Jana Alomari","doi":"10.1016/j.hrthm.2025.03.1998","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1998","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794724","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":"","authors":"","doi":"10.1016/j.hrthm.2025.03.1882","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1882","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795336","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 modernized classification of cardiac anti-arrhythmic drugs: its application to clinical practice.","authors":"Ming Lei, Lin Wu, Derek A Terrar, Christopher L-H Huang","doi":"10.1016/j.hrthm.2025.03.1997","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1997","url":null,"abstract":"<p><p>Cardiac arrhythmias pose a major public health problem and pharmacological intervention remains key to their therapy. The landmark Vaughan Williams (VW, 1970) classification utilizing known actions of then available anti-arrhythmic drugs (AADs) became and remains central to management, but requires revision in response to extensive subsequent advances. Our modernized antiarrhythmic drug (AAD) classification reflected and sought to facilitate such fundamental physiological and clinical development. We here respond to requests for an adaptation of our scheme specifically focussed at clinical practice. This adaptation: (1) improves accessibility of our original scheme to clinical practice, focussing on key AADs in clinical use rather than investigational new drugs (INDs) whilst still conserving and encompassing the classic VW scheme. We nevertheless (2) preserve a rational conceptual framework based on current understanding of the relevant electrophysiological events, their underlying cellular or molecular cardiomyocyte targets and the functional mechanisms they mediate. Additionally, (3) the adopted subclasses within each AAD class parallel clinical practice in including only subclasses containing established AADs, or approved potential off-label drugs, as opposed to those only including INDs. Finally, (4) the simplified scheme remains flexible, permitting drugs to be placed in multiple classes where required, and the future addition of classes and subclasses in the light of future investigations and clinical approvals. We thus derive from our comprehensive modernized AAD classification a more focussed and simpler scheme, for clinical use. This both modernizes but preserves the classic Vaughan Williams classification, and remains flexible accommodating for future developments.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788172","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":"Transseptal Puncture for Catheter Ablation of Atrial Fibrillation in Patients with Septal Occluder Devices.","authors":"Moneeb Khalaph, Philipp Lucas, Niklas Schenker, Andreas Rillig, Christian-Hendrik Heeger, Mustapha El Hamriti, Maxim Didenko, Sebastian Beyer, Denise Guckel, Thomas Fink, Vanessa Sciacca, Max Mörsdorf, Martin Braun, Maria Ivannikova, Werner Scholtz, Volker Rudolph, Guram Imnadze, Christian Sohns, Andreas Metzner, Philipp Sommer","doi":"10.1016/j.hrthm.2025.03.1996","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1996","url":null,"abstract":"<p><strong>Background: </strong>Transseptal puncture (TSP) is critical for atrial fibrillation (AF) ablation. However, patients with atrial septal occluders (ASO) for atrial septal defects (ASD) or persistent foramen ovale (PFO) pose unique challenges.</p><p><strong>Objective: </strong>This study aimed to evaluate the peri- and post-procedural safety, AF recurrence, and incidence of newly developed ASD/PFO up to 12 months post-procedure.</p><p><strong>Methods: </strong>This multicenter, prospective observational study included 59 patients (mean age 61.2±12.1 years, 56% male) with drug-refractory AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. Of these, 38 had ASDs and 21 had PFOs, with ASOs in situ. All punctures (Single TSP) were performed under fluoroscopic guidance.</p><p><strong>Results: </strong>The majority of TSP-position in IAS related to the ASO was inferior-posterior to the ASO (66.1%) or inferior-anterior (23.7%). In the case of failure of the inferior part, puncture was performed in superior-posterior puncture (8.5%) or puncture through the occluder (1.7%). The mean ablation time was 14.9±8.4 minutes, including radiofrequency (83.0%), cryoballoon (11.9%), and pulsed-field ablation (5.1%). No major complications were observed, except for one transient phrenic nerve palsy during cryoballoon ablation, which recovered intra-procedurally. Voltage mapping revealed no additional substrate related to the occluder. During a 12-month follow-up, 7 patients (11.9%) experienced AF recurrence.</p><p><strong>Conclusion: </strong>TSP and PVI are safe and can be safely performed in patients with an ASO. No additional substrate related to the occluder was seen. While no direct comparison was made, outcomes align with existing literature. Further studies are needed.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788259","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":"High density mapping of upper-loop macro-reentry surrounding the superior vena cava: substrate evolved ablation strategy.","authors":"Nan Wu, Wenjie Liu, Jinlin Zhang, Li Luo, Hongwu Chen, Liangrong Zheng, Gang Yang, Xia Sheng, Yunfan Wang, Liang Zhao, Weizhu Ju, Mingfang Li, Kai Gu, Zidun Wang, Xiaohong Jiang, Hailei Liu, Minglong Chen","doi":"10.1016/j.hrthm.2025.03.1995","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1995","url":null,"abstract":"<p><strong>Background: </strong>The circuit of scar-related upper-loop macro-reentry surrounding the superior vena cava (SVC-AFL) has been described by prior case reports. However, the correlation between the circuit and arrhythmogenic substrates, and the corresponding optimized ablation strategy need to be further investigated.</p><p><strong>Objective: </strong>We aimed to identify the electrophysiological substrate and corresponding ablation strategies of SVC-AFL using high-resolution mapping.</p><p><strong>Methods: </strong>From June 1, 2017 to May 1, 2023, consecutive patients with macro-reentrant atrial tachycardias (ATs) from 7 institutions were retrospectively evaluated. Patients with SVC-AFL were enrolled and analyzed.</p><p><strong>Results: </strong>Among 1282 patients with macro-reentrant ATs, 16 patients (1.2%, median age 60.9 years, 8 male) had SVC-AFL (mean cycle length, 281.0±55.1 ms), all identified during high-resolution activation mapping. All patients had prior cardiac surgery (14, 87.5%) or catheter ablation (8, 50.0%). A longitudinal surgical-incision/scar extending from the SVC to the right atrium (RA) was observed in all patients, enabling macro-reentry. SVC-AFLs with shorter circuits (<180 mm) had more slow conduction areas than those with longer circuits (>180 mm) [3.0 (2.0, 4.0) vs. 1.0 (1.0, 1.5), P=0.023]. All ATs were terminated by ablating the channel between the surgical-incision/scar and anatomical barriers. Cavotricuspid isthmus (CTI) block was achieved in all patients. During a 21-month follow-up, all patients were free of atrial arrhythmias except for 4 patients experiencing short-lived paroxysmal ATs that did not require further ablation.</p><p><strong>Conclusion: </strong>A surgical-incision/scar extending from the SVC to RA promotes the development of SVC-AFL. Substrate-based linear lesions, along with prophylactic CTI ablation, afford favorable clinical outcomes.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788154","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":"Significant Tricuspid Regurgitation After Cardiovascular Implantable Electronic Device Implantation and the Impact on Long-term Prognosis.","authors":"Dan-Ying Lee, Tze-Fan Chao, Ta-Chuan Tuan, Chih-Min Liu, Jo-Nan Liao, Shih-Ann Chen","doi":"10.1016/j.hrthm.2025.03.1994","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1994","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788160","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":"AB-499634-001 CAN CRYOABLATION PRE-TREATMENT MITIGATE CORONARY ARTERY SPASM AND INJURY AFTER PULSED FIELD ABLATION?","authors":"Thomas A. Dewland,&nbsp;Ramkumar Venkateswaran,&nbsp;Satoshi Higuchi,&nbsp;Chanhee Lee,&nbsp;Edward P. Gerstenfeld","doi":"10.1016/j.hrthm.2025.03.009","DOIUrl":"10.1016/j.hrthm.2025.03.009","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 4","pages":"Page S4"},"PeriodicalIF":5.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867993","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":"CE-499648-002 STAR VT RANDOMIZED TRIAL COMPARING STEREOTACTIC ABLATIVE RADIOSURGERY FOR RECURRENT VT WITH REPEATED RADIOFREQUENCY ABLATION IN PATIENTS WITH STRUCTURAL HEART DISEASE","authors":"Jana Haskova,&nbsp;Dan Wichterle,&nbsp;Petr Peichl,&nbsp;Lukas Knybel,&nbsp;Radek Neuwirth,&nbsp;Otakar Jiravsky,&nbsp;Marek Sramko,&nbsp;Jakub Cvek,&nbsp;Josef Kautzner","doi":"10.1016/j.hrthm.2025.03.078","DOIUrl":"10.1016/j.hrthm.2025.03.078","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 4","pages":"Pages S37-S38"},"PeriodicalIF":5.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867826","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}