Heart rhythm最新文献

{"title":"Sudden Death and Asymptomatic Arrhythmia in Chronic Lymphocytic Leukemia Patients Treated with Ibrutinib.","authors":"Emily Tomasulo, Andy Itsara, Mark Haigney, Douglas R Rosing, Inhye E Ahn, Cody Peer, Beth A Kozel, Teresa Luperchio, Grace Ge, William D Figg, Adrian Wiestner, Clare Sun","doi":"10.1016/j.hrthm.2025.10.014","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.014","url":null,"abstract":"<p><strong>Background: </strong>Ibrutinib (IBR) is a first-in-class Bruton's tyrosine kinase inhibitor (BTKi) approved in multiple hematologic conditions for indefinite use until disease progression or toxicity. Hypertension (HTN) and atrial fibrillation are well-recognized cardiac complications of BTKi; more recently, heart failure, additional arrhythmias, and sudden cardiac death (SCD) have been attributed to IBR. Next-generation covalent BTKi are also associated with cardiovascular complications, including SCD, albeit to a lesser degree.</p><p><strong>Objective: </strong>The incidence and clinical features of patients experiencing SCD and asymptomatic arrhythmias on IBR remain ill-defined. We aim to characterize the incidence of SCD and asymptomatic arrhythmias on IBR.</p><p><strong>Methods: </strong>We report: 1) a retrospective cohort analysis of 131 patients with a median of 66.5 months on IBR utilizing available cardiac testing, genetic sequencing, and autopsy review; 2) a cross-sectional cardiac analysis of 21 asymptomatic patients on IBR including ambulatory EKG, stress tests, and transthoracic echocardiograms.</p><p><strong>Results: </strong>The incidence of SCD in patients on IBR (n=5) was 801 per 100,000 patient-years, approximately 2-4x higher than the general population. All patients with SCD on IBR had at least one cardiac risk factor. Autopsies conducted in 3 of 5 patients with SCD did not reveal acute pathologic processes, but did demonstrate evolving cardiac pathology. Cardiovascular testing in asymptomatic patients on IBR revealed previously unknown clinically significant arrhythmias in 4 (19%) patients, leading to precautionary IBR discontinuation in 2 patients.</p><p><strong>Conclusion: </strong>IBR increases the risk of SCD among patients with cardiac risk factors. Stress and ambulatory EKG on IBR identified asymptomatic arrhythmias altering clinical management in 19% of patients. These data highlight the need for risk-mitigation strategies for patients starting or receiving IBR, and possibly extending to other BTKis.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280029","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 \"EVOQUE potential\" - Implanting a helix-fixation leadless pacemaker through a transcatheter tricuspid valve.","authors":"James E Ip","doi":"10.1016/j.hrthm.2025.10.019","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.019","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280030","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":"Alternative Pacing Strategies Following Transcatheter Tricuspid Valve Interventions: Procedural Challenges and Lessons Learned.","authors":"Emily Tat, Tamim Nazif, Isaac George, Robin Le Ruz, Rebecca T Hahn, Angelo Biviano, Elaine Y Wan, Susheel K Kodali, Hirad Yarmohammadi, Deepak Saluja","doi":"10.1016/j.hrthm.2025.10.013","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.013","url":null,"abstract":"<p><strong>Background: </strong>Decision making regarding new pacemaker implantation following transcatheter tricuspid valve intervention (TTVI), including transcatheter edge-to-edge repair (TEER) or transcatheter tricuspid valve replacement (TTVR), is complex due to anatomic and TTVI-related challenges.</p><p><strong>Objective: </strong>To evaluate the feasibility of non-transvalvular pacing strategies including coronary sinus (CS) or leadless pacemaker (LP) placement, following TTVI.</p><p><strong>Methods: </strong>Consecutive patients undergoing TTVI at a single institution were retrospectively studied for new pacemaker indications and pacing strategy. Procedural challenges and outcomes associated with non-transvalvular pacemaker implantation were assessed.</p><p><strong>Results: </strong>Among 137 patients who underwent TTVI (69 TTVR, 68 TEER) at a single center, 34 (25%) patients were excluded for pre-existing pacemaker, and 15/103 (15%) patients subsequently developed an indication for pacing following TEER (n=5/53, 9%) or TTVR (n = 10/50, 20%). An alternative pacing strategy was attempted after TEER and TTVR. After TEER (n=5), CS lead placement was 50% successful (2/4) and one LP attempt was unsuccessful (0/1). After TTVR (n=10), CS lead placement was 75% successful (6/8) and LP placement was 100% successful (2/2) on initial attempt. CS lead placement was limited by CS anatomy, whereas LP placement was limited by TTVR interaction. A transvenous pacemaker was successfully placed if needed. No pacemaker device-related adverse event occurred in any patient peri-procedurally or at one year follow-up.</p><p><strong>Conclusion: </strong>Alternative non-transvalvular pacing strategies may be feasible and safe in patients who require pacing following TTVI. Pre-procedural planning with a multidisciplinary approach can help optimize procedural success. Further studies and longer-term follow-up are warranted.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279949","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":"Insurance Interference in Electrophysiology: Reclaiming Control for Timely Cardiac Care.","authors":"Jalaj Garg, Dhanunjaya Lakkireddy","doi":"10.1016/j.hrthm.2025.10.016","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.016","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280027","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":"Questioning the Role of Pulmonary Vein Isolation in Multimorbid Patients: A Prospective Analysis in Over 1,400 AF Patients.","authors":"Moritz Rothe, Andreas A Boehmer, Katia Y Schneider, Pascal Spork, Lilli C Wiedenmann, Elena Nussbaum, Christoph Keim, Peter Weiss, Bianca C Dobre, Bernhard M Kaess, Joachim R Ehrlich","doi":"10.1016/j.hrthm.2025.10.017","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.017","url":null,"abstract":"<p><strong>Background: </strong>Early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF) and a high comorbidity burden, but this benefit has been demonstrated primarily through antiarrhythmic drug therapy. It remains unclear whether catheter ablation - particularly pulmonary vein isolation (PVI) - achieves comparable efficacy in this high-risk population.</p><p><strong>Objective: </strong>We aimed to assess the long-term effectiveness and safety of PVI in multimorbid AF patients.</p><p><strong>Methods: </strong>We conducted a prospective, single-centre observational study of 1,402 consecutive patients undergoing first-time cryoballoon-based PVI. Patients were stratified by CHA₂DS₂-VA score; a score ≥4 defined high comorbidity burden. The primary endpoint was the recurrence of any atrial arrhythmia after a 90-day blanking period. Secondary endpoints included procedural safety and mortality.</p><p><strong>Results: </strong>Over a mean follow-up of 2 years (range 6 months to 5 years), recurrence rates were significantly higher in patients with high vs. low comorbidity burden at 5 years (Kaplan-Meier event rates: 64.4% vs. 53.1%; HR 1.26; 95% CI 1.03-1.53; P=0.01). Age ≥75 years was the only independent predictor of recurrence. Safety outcomes and procedural safety were similar across groups.</p><p><strong>Conclusion: </strong>Despite the established prognostic benefit of ERC in multimorbid patients, long-term rhythm control with PVI is significantly less effective in this population. These findings question routine first-line use of ablation-based strategies in patients most likely to benefit from rhythm control, highlighting the need for randomized trials comparing pharmacological and ablative ERC in high-risk AF cohorts.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280028","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":"Gene-Elusive Arrhythmogenic Cardiomyopathy: Roles of Sports, Inflammation and Beyond.","authors":"Lucas Tramèr, Ardan M Saguner, Fernando Beltrami, Cynthia A James, Hugh Calkins, Firat Duru","doi":"10.1016/j.hrthm.2025.09.048","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.048","url":null,"abstract":"<p><p>Arrhythmogenic cardiomyopathy (ACM) represents a leading cause of sudden cardiac death in young adults and in athletes. While inherited cases typically involve genetic variants in desmosomal proteins, impairing cardiac tissue's capacity to withstand mechanical stress, approximately one third of ACM patients harbor no identifiable genetic variant and are classified as gene-elusive. Even if some gene-elusive cases may be due to yet undiscovered variants, the striking observation that gene-elusive ACM predominantly affects high-level endurance athletes without familial disease has generated the concept of exercise-induced ACM, a form of desmosomal damage caused by excessive endurance exercise in the absence of a causal variant, most probably in the presence of a polygenic predisposition. Through mechanical stress and transcriptional pathways, endurance exercise may prompt upregulation of desmosomal proteins before reaching a threshold where chronic stress leads to inflammatory and autoimmune reactions, further destabilizing the intercalated disc and exacerbating cardiomyocyte damage. According to the current understanding, inflammatory and mechanical effects of exercise may thus act synergistically, accelerating the transition from physiological adaptations to pathological remodeling with irreversible structural and arrhythmic manifestations. This comprehensive review examines the evolving understanding of gene-elusive ACM, exploring mechanical and transcriptional explanations, inflammatory triggers to autoimmune responses, while addressing the critical clinical challenge of differentiating pathological remodelling from physiological athletic adaptation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280025","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":"Delayed Coronary Artery Vasospasm leading to Cardiac Arrest After Pulsed Field Ablation for Atrial Fibrillation.","authors":"Gen Matsuura, Hidehira Fukaya, Tomoharu Yoshizawa, Atsuhiko Sugimoto, Junya Ako","doi":"10.1016/j.hrthm.2025.10.010","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.010","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274598","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 Novel Strategy for Left Ventricular Interventions in Patients With Double Mechanical Valves: Stylet-Driven Lead-Guided Transventricular Access.","authors":"Serkan Topaloglu, Ahmet Korkmaz, Elif Hande Ozcan Cetin, Erkan Baysal, Ayhan Küp, Ahmet Tütüncü, Fırat Ozcan, Serkan Cay, Meryem Kara, Duygu Kocyigit, Mustafa Çağın Üreyen, Metin Okşul, Hasan Ari, Omaç Tüfekçioğlu, Dursun Aras, Ozcan Ozeke","doi":"10.1016/j.hrthm.2025.09.047","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.047","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) interventions in patients with double mechanical valves represent one of the most formidable challenges in contemporary practice. Standard routes are unavailable in these \"no-entry LV\" scenarios, necessitating alternative access strategies.</p><p><strong>Objectives: </strong>To evaluate the feasibility, safety, and reproducibility of a novel stylet-driven pacing lead system (SDL) -guided transventricular access technique in patients with double mechanical valves undergoing ventricular tachycardia (VT) ablation or structural interventions.</p><p><strong>Methods: </strong>This multicenter case series included five consecutive patients (mean age 69 ± 8 years) with mechanical prostheses in both aortic and mitral positions. A SDL, originally designed for left bundle branch area pacing (LBBAP), was used to cross the interventricular septum under electrogram and fluoroscopic guidance. Subsequent interventions included VT ablation in four patients and transcatheter paravalvular leak (PVL) closure in one patient.</p><p><strong>Results: </strong>Transventricular access was successfully established in all patients, with a mean access time of 13.4 ± 4.0 minutes. One patient required re-access which was rapidly re-established. All four VT ablation procedures were completed with acute noninducibility after substrate modification or adjunctive ethanol ablation. In the PVL case, two mitral paravalvular leaks were closed successfully. Postprocedural TTE revealed small ventricular septal shunts (mean size 1.5 ± 0.6 mm), which resolved spontaneously within one week in all patients. No major complications, conduction disturbances, or thromboembolic events occurred.</p><p><strong>Conclusions: </strong>The SDL -guided transventricular access technique is a feasible, safe, and reproducible method for achieving LV entry, with promising applicability to both electrophysiologic and structural interventions in \"no-entry LV\" scenarios.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274695","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":"Hemodynamic Collapse Associated with Biallelic SCN5A Variants: A Case Series.","authors":"Elodie Surget, Alexis Hermida, Alice Maltret, Laure Champ-Rigot, Estelle Gandjbakhch, Fabrice Extramiana","doi":"10.1016/j.hrthm.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.042","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274689","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":"Evolution of Primary Prevention Implantable Cardioverter-Defibrillator Clinical Utility Across Therapeutic Eras in Ischemic and Non-Ischemic Cardiomyopathy.","authors":"Maarten Blondeel, Sebastian Ingelaere, Gábor Vörös, Christophe Garweg, Peter Haemers, Joris Ector, Rik Willems, Tomas Robyns, Bert Vandenberk","doi":"10.1016/j.hrthm.2025.10.008","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.008","url":null,"abstract":"<p><strong>Background: </strong>The implantable cardioverter-defibrillator (ICD) serves as cornerstone in the prevention of sudden cardiac death (SCD). Improvements in heart failure treatment have led to a decrease in SCD incidence.</p><p><strong>Objective: </strong>To evaluate temporal trends in appropriate ICD interventions and ICD-resistant mortality (ICDRM) in patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM), and a primary prevention (PP) ICD indication.</p><p><strong>Methods: </strong>All patients with ICM or NICM and a PP ICD indication, who have received an ICD in a tertiary care hospital were included in a single-center retrospective study. Incidences of appropriate ICD interventions, ICDRM, and all-cause mortality were analyzed across three therapeutic eras (era 1:1996-2004; era 2: 2005-2013; era 3: 2014-2022) in the overall population, and for patients with ICM or NICM exclusively. ICDRM is defined as mortality occurring in ICD recipients (1) without the device delivering appropriate therapy, (2) within one year after ICD implantation, or (3) within one month after the first appropriate shock.</p><p><strong>Results: </strong>A total of 1,050 patients were included (20.4% female, median age of 64 years, 44.7% CRT). Across eras, there was a significant decline in appropriate shock incidence for both ICM and NICM (p<0.001). For patients with ICM, the incidence of ICDRM increased from 3.7%/year (50.0% of all mortality) in era 1 to 5.6%/year (88.9%) in era 3. For NICM, incidences increased from 1.2%/year (26.1%) to 3.2%/year (97.0%), respectively.</p><p><strong>Conclusion: </strong>The decline in clinical utility of PP ICDs in both ICM and NICM warrant updated evidence to guide ICD use in contemporary practice.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258106","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}