Heart rhythm最新文献

{"title":"Epicardial placement of implantable cardioverter-defibrillators in adults: Technical considerations, system performance, and clinical outcomes","authors":"Poojita Shivamurthy MD ,&nbsp;Marisa Cevasco MD, MPH ,&nbsp;Gregory E. Supple MD ,&nbsp;Balaram Krishna Hanumanthu MD ,&nbsp;Timothy M. Markman MD ,&nbsp;Gustavo Guandalini MD ,&nbsp;Matthew C. Hyman MD ,&nbsp;Andres Enriquez MD ,&nbsp;Ramanan Kumareswaran MD ,&nbsp;Michael G. Fradley MD ,&nbsp;Rajat Deo MD ,&nbsp;Vincent Y. See MD ,&nbsp;Michael Riley MD ,&nbsp;Fermin Garcia MD ,&nbsp;Saman Nazarian MD ,&nbsp;David Lin MD ,&nbsp;David S. Frankel MD ,&nbsp;Sanjay Dixit MD ,&nbsp;Andrew E. Epstein MD ,&nbsp;David J. Callans MD ,&nbsp;Robert D. Schaller DO","doi":"10.1016/j.hrthm.2025.05.034","DOIUrl":"10.1016/j.hrthm.2025.05.034","url":null,"abstract":"<div><h3>Background</h3><div>Surgical implantation of epicardial implantable cardioverter-defibrillator (ICD) is considered when transvenous ICD placement is not feasible because of congenital anomalies, venous obstruction, or prior infections. Epicardial pacemakers are well-studied but less is known about contemporary epicardial ICD systems in adults.</div></div><div><h3>Objectives</h3><div>This case series details the indications, techniques, safety, and long-term performance of surgically implanted epicardial high voltage (HV) coils and leads in adults.</div></div><div><h3>Methods</h3><div>We included all patients who received epicardial HV coils or leads at the Hospital of the University of Pennsylvania between 2014 and 2025.</div></div><div><h3>Results</h3><div>Nineteen patients (14 men, median age 64 years) were identified. Indications included ICD replacement after lead extraction for endocarditis (7), placement during concomitant surgery, including for tricuspid regurgitation (6), left ventricular assist device (3), and lack of venous access (3). HV coils were used in 58%, and 42% received epicardial leads. All patients received epicardial pace-sense leads; 68% received cardiac resynchronization therapy. HV coils or leads were sewn to the epicardium: 48% on the posterior left ventricle, 16% on the anterior right ventricle, 26% on both ventricles, and 11% in the transverse sinus. Two patients had impedances &gt; 200 Ω because of a loose set screw and a damaged connector pin, respectively. Two had impedances &lt; 20 Ω without clinical impact. One coil fractured 1.5 years post-implant. No failed shocks or lead migrations occurred. During a median follow-up of 468 days, 26% died, largely from advanced heart failure, none were attributable to surgery.</div></div><div><h3>Conclusion</h3><div>Surgical implantation of epicardial ICD systems with HV coils/leads is safe and feasible. Multidisciplinary planning and long-term monitoring are essential.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e908-e918"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142358","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":"East Asian immigration and direct oral anticoagulant dosing for atrial fibrillation: A population-based cohort study","authors":"Erika Nakajima BSc ,&nbsp;Andrew C.T. Ha MD ,&nbsp;Feng Qiu MSc ,&nbsp;Peter C. Austin PhD ,&nbsp;Cynthia A. Jackevicius BScPhm, PharmD, MSc ,&nbsp;Dennis T. Ko MD, MSc ,&nbsp;Paul Dorian MD, MSc ,&nbsp;Douglas S. Lee MD, PhD ,&nbsp;Husam Abdel-Qadir MD, PhD","doi":"10.1016/j.hrthm.2025.05.040","DOIUrl":"10.1016/j.hrthm.2025.05.040","url":null,"abstract":"<div><h3>Background</h3><div>Some East Asian (EA) guidelines recommend lower doses of direct oral anticoagulants<span> (DOACs) for atrial fibrillation (AF) than in North America and Europe.</span></div></div><div><h3>Objective</h3><div>The study aimed to investigate the association of immigration from EA with DOAC dosing and outcomes in AF.</div></div><div><h3>Methods</h3><div><span>This was a population-based cohort study using administrative databases of Ontario immigrants with AF aged ≥ 66 years who were dispensed DOAC prescriptions from 2012 to 2019. Birth country was classified as EA or not. We used multivariable </span>logistic regression<span> to assess the association of EA birth with DOAC dose and cause-specific hazards regression for the association of EA birth and DOAC dose with stroke or bleeding or death. The interaction between EA birth and DOAC dosing was studied for each outcome.</span></div></div><div><h3>Results</h3><div>Among 14,421 immigrants, 3958 (27.4%) were born in EA. EA immigrants had lower odds of receiving full-dose DOACs vs non-EA immigrants (odds ratio 0.64, 95% confidence interval [CI] 0.58–0.69, <em>P &lt;</em> .001). EA birth was not associated with a composite of hospitalization for stroke or bleeding (hazard ratio [HR] 0.97, 95% CI 0.84–1.12, <em>P =</em> .67) or hospitalization for stroke (HR 0.86, 95% CI 0.71–1.04, <em>P =</em> .13), but was associated with higher bleeding hazard (HR 1.15, 95% CI 1.02–1.30, <em>P =</em> .02) and lower mortality (HR 0.91, 95% CI 0.84–0.99, <em>P =</em> .04). There was no significant interaction between EA birth and DOAC dosing for stroke (<em>P =</em> .41), bleeding (<em>P =</em> .27), or death (<em>P =</em> .33).</div></div><div><h3>Conclusions</h3><div>EA immigrants were less likely to receive full-dose DOACs and had a higher bleeding hazard, similar stroke hazard, and lower mortality risk than non-EA immigrants. There was no evidence that DOAC dosing had a differential treatment effect in EA immigrants.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e849-e857"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142394","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":"Defining success in atrial fibrillation ablation trials: A response on antiarrhythmic drug use and diagnosis-to-ablation timing","authors":"Sandeep Prabhu MBBS, PhD, FHRS ,&nbsp;Louise Segan MBBS, MPH ,&nbsp;Peter Kistler MBBS, PhD, FHRS","doi":"10.1016/j.hrthm.2025.06.043","DOIUrl":"10.1016/j.hrthm.2025.06.043","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1044-e1045"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527638","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":"Erratum to “Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy,” Volume 21, Issue 8, P1342-1353, August 2024","authors":"","doi":"10.1016/j.hrthm.2025.06.018","DOIUrl":"10.1016/j.hrthm.2025.06.018","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Page e1075"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540040","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":"Author’s reply—Transatrial epicardial access: Advancing from experimental models to human feasibility","authors":"Pasquale Santangeli MD, PhD","doi":"10.1016/j.hrthm.2025.06.053","DOIUrl":"10.1016/j.hrthm.2025.06.053","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Page e1047"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649353","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":"Osimertinib induces prolongation of action potential duration via downregulation of KCNN1 expression: Exploring the potential mechanisms of arrhythmia","authors":"Xin Li MD ,&nbsp;Song Lin MD ,&nbsp;Jiayi Huang MD ,&nbsp;Yongping Lin PhD ,&nbsp;Zhongbao Ruan MD, FACC","doi":"10.1016/j.hrthm.2025.07.011","DOIUrl":"10.1016/j.hrthm.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Compared with earlier generations of epidermal growth factor receptor–tyrosine kinase inhibitors, the third-generation agent osimertinib demonstrates superior efficacy in patients with non–small cell lung cancer and has become the first-line treatment, but is associated with more pronounced cardiotoxicity, especially arrhythmia.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the underlying mechanisms of the potential proarrhythmic effects of osimertinib.</div></div><div><h3>Methods</h3><div>We investigated osimertinib’s effects on cell viability, structure, and electrophysiological properties of human induced pluripotent stem cell–derived cardiomyocytes using cell viability assays, immunofluorescence staining, transmission electron microscopy, and optical mapping. A zebrafish in vivo model was used to validate cardiotoxicity. Western blotting (WB) assessed relative protein expression on cardiomyocyte membranes, whereas RNA sequencing and quantitative reverse transcription polymerase chain reaction identified significantly altered signaling pathways and target genes. Rescue experiments were conducted to confirm the pathogenic mechanism.</div></div><div><h3>Results</h3><div>The cell viability assay indicated that osimertinib reduced human induced pluripotent stem cell–derived cardiomyocyte viability (half-maximal inhibitory concentration = 3.492 μM). At this osimertinib concentration, immunofluorescence revealed disorganized myofilament sarcomeres, and transmission electron microscopy showed increased mitochondrial damage, whereas optical mapping demonstrated prolonged action potential duration and elevated incidence of early afterdepolarizations even at a near-physiological concentration. In vivo studies demonstrated that osimertinib-exposed zebrafish exhibited bradycardia, pericardial edema, and prolonged QT interval. WB revealed no significant changes in the expression of epidermal growth factor receptor. RNA sequencing revealed significant downregulation of potassium ion channel genes, with quantitative reverse transcription polymerase chain reaction and WB analysis demonstrating the most pronounced decrease in potassium calcium-activated channel subfamily N member 1 (KCNN1) expression. Modulating KCNN1 expression can reverse the electrophysiological alterations.</div></div><div><h3>Conclusion</h3><div>Osimertinib prolongs action potential duration and promotes arrhythmias through off-target inhibition of <em>KCNN1</em> expression.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e990-e999"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626050","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":"Efficacy of percutaneous stellate ganglion block according to ventricular arrhythmia cycle length: A post hoc subanalysis of the STAR study","authors":"Enrico Baldi MD, PhD ,&nbsp;Roberto Rordorf MD ,&nbsp;Sara Compagnoni MD ,&nbsp;Veronica Dusi MD, PhD ,&nbsp;Antonio Sanzo MD ,&nbsp;Francesca Romana Gentile MD ,&nbsp;Simone Frea MD ,&nbsp;Carol Gravinese MD ,&nbsp;Filippo Maria Cauti MD, PhD ,&nbsp;Gianmarco Iannopollo MD ,&nbsp;Francesco De Sensi MD ,&nbsp;Edoardo Gandolfi MD ,&nbsp;Laura Frigerio MD ,&nbsp;Pasquale Crea MD, PhD ,&nbsp;Domenico Zagari MD ,&nbsp;Matteo Casula MD ,&nbsp;Giuseppe Sangiorgi MD ,&nbsp;Simone Persampieri MD ,&nbsp;Gabriele Dell’Era MD ,&nbsp;Giuseppe Patti MD ,&nbsp;Enrico Chieffo","doi":"10.1016/j.hrthm.2024.11.015","DOIUrl":"10.1016/j.hrthm.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Data on the predictors of percutaneous stellate ganglion block (PSGB) efficacy in electrical storm are scanty.</div></div><div><h3>Objective</h3><div>We aimed to assess whether PSGB efficacy is influenced by the arrhythmia type and cycle length before the procedure.</div></div><div><h3>Methods</h3><div><span><span>This is a subanalysis of the multicenter STAR study. The population was stratified into 3 groups according to the median cycle length of the latest ventricular arrhythmia before PSGB: </span>ventricular fibrillation (VF), fast </span>ventricular tachycardia<span> (VT), and slow VT. The primary outcome was the number of treated arrhythmic episodes (with antitachycardia pacing or direct current shocks) in the hour immediately after PSGB compared with the hour before.</span></div></div><div><h3>Results</h3><div>We considered 139 PSGBs from 112 patients divided into VF (51 procedures), fast VT (44 procedures, VT cycle &lt;375 ms), and slow VT (44 procedures, VT cycle ≥375 ms). The number of treated arrhythmic episodes in the hour after every PSGB was significantly lower compared with the hour before in all groups (VF: 0 [0–1] vs 5 [2–8], <em>P</em> &lt; .001; fast VT: 0 [0–0] vs 1 [0–6.5], <em>P</em> &lt; .001; slow VT: 0 [0–0] vs 1 [0–4.5], <em>P</em><span> = .001). In analyzing the reduction of the number of antitachycardia pacing sequences or direct current shocks from the hour before to the hour after PSGB, a significant trend was observed across the groups (Jonckheere-Terpstra trend </span><em>P</em> &lt; .001), and a significant difference was observed in comparing slow VT vs VF and fast VT vs VF but not in comparing slow VT vs fast VT. VF was independently associated with the probability of reduction of treated events after PSGB.</div></div><div><h3>Conclusion</h3><div>PSGB is an effective treatment of electrical storm in patients with all types of ventricular arrhythmias. However, its effectiveness was more pronounced in patients with VF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2477-2485"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647563","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":"Transvenous extraction for the management of very old cardiac implantable electronic device leads: Should we abandon the concept of lead abandonment?","authors":"Mark H. Schoenfeld MD","doi":"10.1016/j.hrthm.2024.11.048","DOIUrl":"10.1016/j.hrthm.2024.11.048","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e906-e907"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750619","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":"Uniform slow conduction during sinus rhythm and low voltage/low voltage gradient ΔV/V characterize the VT isthmus location","authors":"Edward J. Ciaccio PhD ,&nbsp;Henry H. Hsia MD, FHRS ,&nbsp;David Robinson ,&nbsp;Nicolas Cedilnik PhD ,&nbsp;Lawrence Zeldin MD ,&nbsp;Elaine Y. Wan MD, FHRS ,&nbsp;Angelo B. Biviano MD, FHRS ,&nbsp;Hirad Yarmohammadi MD, MPH, FHRS ,&nbsp;Deepak S. Saluja MD, FHRS","doi":"10.1016/j.hrthm.2024.11.051","DOIUrl":"10.1016/j.hrthm.2024.11.051","url":null,"abstract":"<div><h3>Background</h3><div>Reentrant ventricular tachycardia (VT) properties require further elucidation.</div></div><div><h3>Objective</h3><div>To understand circuit mechanisms and improve ablation targeting.</div></div><div><h3>Methods</h3><div><span><span>In postinfarction VT patients undergoing electrophysiology study<span> and catheter ablation, high-density </span></span>endocardial </span>electrogram<span><span><span> contact mapping data was acquired during sinus rhythm (n = 6) and during VT (n = 12) and annotated by the system. Bipolar </span>endocardial VT voltage was used to compute the voltage gradient, ΔV/V, at isthmus midline and at the lateral boundaries. Voltage was additionally represented as a depth as well as a color change, to better visualize level. </span>Linear regression analysis<span> was implemented to quantitate the sinus rhythm activation gradient along the isthmus long-axis midline, and along 3 other spokes originating from a last activation point.</span></span></div></div><div><h3>Results</h3><div>The mean voltage along the isthmus long-axis was 0.234 ± 0.137 mV, vs 0.383 ± 0.290 mV aside boundaries (<em>P</em> &lt; .001). The gradient ΔV/V along the isthmus long-axis was 0.425 ± 0.324, vs 0.823 ± 0.550 at boundaries (<em>P</em> &lt; .001). Sinus rhythm activation was uniform (mean r² = 0.93 ± 0.05) and slow (∇ = 0.16 ± 0.03 mm/msec) along the spoke coinciding with isthmus long-axis midline, vs less uniform (mean r² = 0.32 ± 0.25) and rapid (∇ = 0.73 ± 0.62 mm/msec) along the other spokes (<em>P</em> &lt; .001 and <em>P</em> = .003, respectively). Plotting <em>r</em>^<em>2</em> vs ∇, parameters of isthmus vs nonisthmus spokes were clearly separable.</div></div><div><h3>Conclusion</h3><div>A low-voltage trench coincides with the VT isthmus, vs abrupt voltage increase at the lateral boundaries, which may contravene prior definitions of conducting channels. Sinus rhythm uniform slow conduction occurs at the VT isthmus location, preventing circuit disruption while enabling the formation of an excitable gap to perpetuate reentry.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2486-2496"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768335","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":"Balancing act: The intricate web of medical device recall decisions","authors":"Kenneth Stein MD, FHRS,&nbsp;Maria Macuare Gorden MD,&nbsp;Alexandra Naughton","doi":"10.1016/j.hrthm.2025.03.1993","DOIUrl":"10.1016/j.hrthm.2025.03.1993","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1026-e1027"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994333","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}