Heart rhythm最新文献

{"title":"Outcomes of device extraction in patients with chronic kidney disease on renal replacement therapy and cardiac implantable electronic devicead infections.","authors":"Ashraf Alzahrani, Lillie Lamont, Mohammed Mhanna, Peter Farjo, E Michael Powers, Steven Bailin, Paari Dominic","doi":"10.1016/j.hrthm.2024.11.052","DOIUrl":"10.1016/j.hrthm.2024.11.052","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) on renal replacement therapy (RRT) are at high risk for cardiovascular implantable electronic device (CIED) infections. Although device extraction is standard management, it is often avoided in these patients because of high procedural risks.</p><p><strong>Objectives: </strong>Evaluate the outcomes of CIED extraction in CKD on RRT patients with device infection.</p><p><strong>Methods: </strong>This study used data from the TriNetX research network. The International Classification of Diseases-10^th Revision-Clinical Modification coding system was used to identify patients. Adults with a history of CKD on RRT and CIED infection were included. Patients with renal transplantation and prosthetic heart valves were excluded. Patients were stratified by device extraction. The primary outcome was mortality at 1 year.</p><p><strong>Results: </strong>A total of 530 patients were identified, of whom 30% (n = 159) underwent device extraction. After propensity score matching (PSM), 302 patients remained, with 151 in each group. Kaplan-Meier survival analysis demonstrated a significant 1-year survival benefit for patients in the device extraction group (59.2%) compared with the no-extraction group (48.8%, P = .043; hazard ratio [HR], 0.696; 95% confidence interval [CI], 0.489-0.991). Freedom from complications such as pericardial effusion was similar between groups. Sensitivity analysis using Cox proportional hazards, adjusted for baseline confounders, confirmed the survival benefit of extraction, with a reduced mortality risk (HR, 0.581; 95% CI, 0.382-0.883; P = .011).</p><p><strong>Conclusion: </strong>In CKD on RRT patients with CIED infection, device extraction is associated with a reduction in all-cause mortality at 1 year. However, the rate of device extraction is low in this group.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768330","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":"Pace and Biopsy.","authors":"John Silberbauer, Christopher Pavitt, Alexander Liu, Christopher Bruce","doi":"10.1016/j.hrthm.2024.11.049","DOIUrl":"10.1016/j.hrthm.2024.11.049","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754853","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":"Cardiac magnetic resonance feature tracking reveals abnormalities in patients with idiopathic ventricular fibrillation.","authors":"Lisa M Verheul, Marco Guglielmo, Alexander Hirsch, Stefano Figliozzi, Pim van der Harst, Mimount Bourfiss, Niek H J Prakken, Birgitta K Velthuis, Sing C Yap, Rutger J Hassink","doi":"10.1016/j.hrthm.2024.11.040","DOIUrl":"10.1016/j.hrthm.2024.11.040","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754923","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":"Managing drug-drug interactions with mavacamten: A focus on combined use of antiarrhythmic drugs and anticoagulants.","authors":"Fabrizio Ricci, Lorenzo V Molinari, Davide Mansour, Kristian Galanti, Fabio Vagnarelli, Giulia Renda, Sabina Gallina, Anjali Owens, Jasmine A Luzum, Iacopo Olivotto, Mohammed Y Khanji, Anwar A Chahal","doi":"10.1016/j.hrthm.2024.11.041","DOIUrl":"10.1016/j.hrthm.2024.11.041","url":null,"abstract":"<p><p>Mavacamten is a selective, allosteric, and reversible cardiac myosin inhibitor, representing the first disease-specific treatment for obstructive hypertrophic cardiomyopathy (HCM) that targets the core pathophysiological mechanism of this condition. Clinical evidence supports its efficacy in improving symptoms, cardiac function, and remodeling, thereby supplementing established treatment regimens. However, mavacamten is extensively metabolized by hepatic cytochromes, and its half-life is contingent upon CYP2C19 phenotype. Consequently, coadministered medications that inhibit or induce these enzymes may significantly alter mavacamten pharmacokinetics, potentially leading to reversible systolic dysfunction or diminished therapeutic efficacy. This paper provides a comprehensive analysis of mavacamten pharmacokinetics and its potential interactions with antithrombotic and antiarrhythmic agents, which are the cornerstones of atrial fibrillation management in HCM population. Our aim is to offer clinicians practical guidance on safely administering mavacamten in conjunction with these medications, discuss the role of pharmacogenomics, and outline rigorous patient safety monitoring strategies to ensure effective and individualized treatment.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754851","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, Henry H Hsia, David Robinson, Nicolas Cedilnik, Lawrence Zeldin, Elaine Y Wan, Angelo B Biviano, Hirad Yarmohammadi, Deepak S Saluja","doi":"10.1016/j.hrthm.2024.11.051","DOIUrl":"10.1016/j.hrthm.2024.11.051","url":null,"abstract":"<p><strong>Background: </strong>Reentrant ventricular tachycardia (VT) properties require further elucidation.</p><p><strong>Objective: </strong>To understand circuit mechanisms and improve ablation targeting.</p><p><strong>Methods: </strong>In postinfarction VT patients undergoing electrophysiology study and catheter ablation, high-density endocardial electrogram contact mapping data was acquired during sinus rhythm (n = 6) and during VT (n = 12) and annotated by the system. Bipolar 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. Linear regression analysis 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.</p><p><strong>Results: </strong>The mean voltage along the isthmus long-axis was 0.234 ± 0.137 mV, vs 0.383 ± 0.290 mV aside boundaries (P < .001). The gradient ΔV/V along the isthmus long-axis was 0.425 ± 0.324, vs 0.823 ± 0.550 at boundaries (P < .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 (P < .001 and P = .003, respectively). Plotting r² vs ∇, parameters of isthmus vs nonisthmus spokes were clearly separable.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","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":"Risk of incident genitourinary cancer following hematuria in patients with atrial fibrillation receiving oral anticoagulants.","authors":"Ling Kuo, Yi-Hsin Chan, Jo-Nan Liao, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen, Tze-Fan Chao","doi":"10.1016/j.hrthm.2024.11.043","DOIUrl":"10.1016/j.hrthm.2024.11.043","url":null,"abstract":"<p><strong>Background: </strong>Hematuria is common in patients with atrial fibrillation (AF) on oral anticoagulants (OACs). However, risks of incident genitourinary (GU) malignancy and detailed etiologies of hematuria have not been well studied.</p><p><strong>Objective: </strong>We aimed to investigate the risk of hematuria and underlying GU malignancy in patients with AF receiving OACs.</p><p><strong>Methods: </strong>A total of 192,728 patients with AF receiving OACs were identified from Taiwan National Health Insurance Research Database. The risk of hematuria was compared between patients receiving warfarin (n = 75,541) and non-vitamin K antagonist OACs (NOACs) (n = 117,187). Among them, 18,509 patients experiencing hematuria without previous history of GU malignancy were defined as the study population. One-year risks of GU cancers were studied and compared between warfarin and NOAC users.</p><p><strong>Results: </strong>Compared with warfarin, NOACs were associated with a higher risk of mild (2.29% per year vs 1.71% per year, adjusted hazard ratio [aHR] 1.107, P < .0001) or moderate hematuria (0.84% per year vs 0.62% per year, aHR 1.075, P = .0189), but a lower risk of severe hematuria (0.15% per year vs 0.17% per year, aHR 0.630, P < .0001). Within 1 year after hematuria, 738 (3.99%) patients were diagnosed with incident GU cancers, and the risk was higher among warfarin compared with NOAC users (4.10% vs 3.89%, odds ratio [OR] 1.1169, P = .041). Age ≥75 years (OR 1.486, P < .0001), male gender (OR 2.342, P < .0001) and abnormal renal function (OR 1.319, P = .0015) were important clinical factors associated with the diagnosis of GU cancer.</p><p><strong>Conclusion: </strong>GU malignancy occurs in approximately 4% of anticoagulated patients with AF experiencing hematuria. Comprehensive evaluations of underlying etiologies of hematuria are necessary.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754939","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":"Salvaged by the stylet: Procedural insights from difficult cases of left bundle branch area pacing.","authors":"Anindya Ghosh, Chenni S Sriram, Ulhas M Pandurangi","doi":"10.1016/j.hrthm.2024.11.053","DOIUrl":"10.1016/j.hrthm.2024.11.053","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768332","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":"Unexpected response to a common pacing maneuver during tachycardia.","authors":"Venkata S Pendyala, Ruchit R Shah, Vineet Kumar, Harish Doppalapudi","doi":"10.1016/j.hrthm.2024.11.045","DOIUrl":"10.1016/j.hrthm.2024.11.045","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754941","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":"Risk of death and thrombosis in patients admitted to the emergency department with supraventricular tachycardias.","authors":"Tommaso Bucci, Luigi Gerra, Steven H M Lam, Antonios A Argyris, Giuseppe Boriani, Riccardo Proietti, Arnaud Bisson, Laurent Fauchier, Gregory Y H Lip","doi":"10.1016/j.hrthm.2024.11.044","DOIUrl":"10.1016/j.hrthm.2024.11.044","url":null,"abstract":"<p><strong>Background: </strong>Few data are available on the clinical course of patients with supraventricular tachycardia (SVT).</p><p><strong>Objective: </strong>The purpose of this study was to assess the 1-year risk of adverse events in patients with SVT.</p><p><strong>Methods: </strong>This was a retrospective observational study conducted within TriNetX. On the basis of the International Classification of Diseases, Tenth Revision, Clinical Modification codes recorded at the emergency department admission, patients not taking oral anticoagulation were categorized into SVT, atrial fibrillation (AF), atrial flutter, or control (CTRL) groups. The primary outcome was the 1-year risk of a composite of all-cause death or thromboembolism. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) after 1:1 propensity score matching. Sensitivity analyses were performed in clinically relevant subgroups. Incident AF and new oral anticoagulation prescriptions were reported during the study period.</p><p><strong>Results: </strong>We identified 23,524 patients with SVT (mean age 54.6±19.3 years; 14,000 [59.5%] women), 5413 with atrial flutter (66.9±15.7 years; 1907 [35.2%] women), 157,715 with AF (72.5±14.0 years, 68,813 [43.6%] women), and 150,807 CTRLs (43.0±17.4 years; 88,540 [58.7%] women). After propensity score matching, the risk of composite outcome in patients with SVT was higher than that in CTRLs (HR 2.89; 95% CI 2.65-3.17) but lower than that in patients with atrial flutter (HR 0.87; 95% CI 0.79-0.97) and those with AF (HR 0.69; 95% CI 0.65-0.73). The risk of adverse events in patients with SVT was more pronounced during the first 30 days in males, those aged ≥65 years, or those with multimorbidity. Patients with SVT had an increased risk of incident AF than did CTRLs.</p><p><strong>Conclusion: </strong>The increased risk of adverse events in patients with SVT appears to be most pronounced in the short term and partly associated with the increased likelihood of incident AF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754858","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 electroanatomic mapping of atriofascicular pathways using multipolar mapping catheters can identify oblique pathways and avoid mechanical bump termination.","authors":"Saket R Sanghai, Babak Nazer, Neal Chatterjee, Srijan Shrestha, Philip M Chang, Shashank Behere, Anjan Batra, Munther Homoud, Melvin Scheinman, Seshadri Balaji","doi":"10.1016/j.hrthm.2024.11.042","DOIUrl":"10.1016/j.hrthm.2024.11.042","url":null,"abstract":"<p><strong>Background: </strong>Atriofascicular fibers (AFFs) are rare accessory pathways that have higher rates of recurrence after ablation because of either failure to identify AFF (M) potentials or mechanical termination with contact.</p><p><strong>Objective: </strong>We aimed to evaluate whether electroanatomic mapping (EAM) using multielectrode, high-density nonlinear catheters can reliably localize AFF potentials and determine a site for ablation without causing mechanical termination.</p><p><strong>Methods: </strong>Seven patients underwent electrophysiology studies (EPS) and EAM using high-density, multielectrode catheters for antidromic tachycardia using AFFs.</p><p><strong>Results: </strong>Mean age at ablation was 15.5 ± 7.4 years, and 2 (29%) were female. Two had Ebstein's anomaly. Three of 7 (43%) had previous ablation attempts. Of the previous attempts, 3 (60%) were complicated by mechanical termination during mapping. None of the previous ablation attempts was performed using high-density mapping catheters. HD Grid with Ensite NavX (Abbott Cardiovascular, Abbott Park, IL) was used in 3; the remainder used the PentaRay (3) or Optrell (1) catheters with CARTO (Biosense Webster, Irvine, CA). The AFF course was mapped to the lateral tricuspid annulus in all. Four of 7 had oblique courses with atrial insertion superior to the ventricular insertion. Multielectrode mapping catheters did not result in mechanical termination in any of these cases, whereas mechanical termination with ablation catheters occurred in 4 (57%). Successful ablation was performed in all with no recurrence over a 15 ± 6-month follow-up.</p><p><strong>Conclusion: </strong>EAM using high-density multielectrode mapping catheters allow localization of atriofascicular pathways without causing mechanical termination and may improve long-term success of ablation. Majority of the pathways had oblique courses with atrial insertion superior to the ventricular insertion.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754848","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}