Heart rhythm最新文献

{"title":"Understanding electrical pulmonary vein antrum for paroxysmal atrial fibrillation: Further look into superhigh-density electroanatomic mapping of the left atrium","authors":"Jingcheng Chen MD ,&nbsp;Gang Yang MD ,&nbsp;Chang Cui MD ,&nbsp;Weizhu Ju MD ,&nbsp;Hailei Liu MD ,&nbsp;Mingfang Li MD ,&nbsp;Hongwu Chen MD ,&nbsp;Kai Gu MD ,&nbsp;Zidun Wang MD ,&nbsp;Minglong Chen MD, FHRS","doi":"10.1016/j.hrthm.2024.09.014","DOIUrl":"10.1016/j.hrthm.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>An isolation line placed at the pulmonary vein antrum (PVA) area is superior to ostium level in atrial fibrillation (AF) control. However, less is known about the electrophysiologic characteristics of the PVA.</div></div><div><h3>Objective</h3><div>The aim of this study was to describe the electrophysiologic properties of the PVA.</div></div><div><h3>Methods</h3><div>High-density mapping of the left atrium was performed in 18 paroxysmal AF (PAF) patients and 9 age- and sex-matched paroxysmal supraventricular tachycardia (PSVT) patients. Each PVA was divided into 8 segments, and the pulmonary vein (PV) was divided into 4 segments. The electrophysiologic properties included slow conduction, complex fractionated electrograms, and effective refractory period (ERP).</div></div><div><h3>Results</h3><div>Slow conduction was more prevalent at the PVA (43.2% ± 19.5% vs 14.7% ± 13.0%; <em>P</em> = .001) and PV (61.9% ± 16.4% vs 9.1% ± 9.0%; <em>P</em> &lt; .001) in PAF patients than in PSVT patients during sinus rhythm. Similarly, the area with complex fractionated electrograms was significantly larger at the PVA (133.8 [61.6–233.2] mm² vs 0.0 [0.0–41.4] mm²; <em>P</em> = .011) in PAF patients during sinus rhythm. The ERP of the PVA was longer in PAF patients than in control at the drive length of 600 ms (260 [230–280] ms vs 220 [190–250] ms; <em>P</em> = .001) and 400 ms (230 [205–250] ms vs 200 [190–220] ms; <em>P</em> = .007). The ERP net difference between the PV and PVA is larger in PAF patients than in control both at 600-ms pacing (40 [20–70] ms vs 10 [10–30] ms; <em>P</em> &lt; .001) and at 400-ms pacing (40 [20–60] ms vs 20 [10–30] ms; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>PAF patients have the PVA electrical substrate including slow conduction, complex fractionated electrograms, and ERP dispersion.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1394-1400"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284529","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":"Prognostic impact of diagnosis-to-ablation time on outcomes following catheter ablation in persistent atrial fibrillation and left ventricular systolic dysfunction","authors":"Louise Segan MBBS ,&nbsp;Peter M. Kistler MBBS, PhD, FHRS ,&nbsp;David Chieng MBBS, PhD ,&nbsp;Rose Crowley MBBS ,&nbsp;Jeremy William MBBS ,&nbsp;Kenneth Cho MBBS ,&nbsp;Hariharan Sugumar MBBS, PhD ,&nbsp;Liang-Han Ling MBBS, PhD ,&nbsp;Aleksandr Voskoboinik MBBS, PhD ,&nbsp;Joshua Hawson MBBS ,&nbsp;Joseph B. Morton MBBS, PhD ,&nbsp;Geoffrey Lee MBChD, PhD ,&nbsp;Prashanthan Sanders MBBS, PhD, FHRS ,&nbsp;Jonathan M. Kalman MBBS, PhD, FHRS ,&nbsp;Sandeep Prabhu MBBS, PhD","doi":"10.1016/j.hrthm.2024.09.059","DOIUrl":"10.1016/j.hrthm.2024.09.059","url":null,"abstract":"<div><h3>Background</h3><div>The optimal timing of catheter ablation in individuals with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) remains uncertain.</div></div><div><h3>Objective</h3><div>We examined whether AF diagnosis to ablation time (DAT) influences outcomes following catheter ablation (CA) in patients with persistent AF (PsAF) and LVSD from the CAMERA-MRI and CAPLA randomized studies.</div></div><div><h3>Methods</h3><div>We evaluated clinical outcomes according to DAT &lt; 1 year (“shorter DAT”) and ≥1 year (“longer DAT”), comparing AF recurrence, AF burden, left ventricular ejection fraction (LVEF), and LV recovery (LVEF ≥ 50%) at 12 months. DAT was also compared according to the median (24 months).</div></div><div><h3>Results</h3><div>Two hundred and ten individuals with AF and LVSD were identified, with a median DAT of 24 months. Shorter DAT was associated with lower LA global and posterior wall scar (&lt;0.05 mV; both <em>P</em> &lt; .05). At 12 months, 69.4% with shorter DAT (&lt;1year) were free from recurrent atrial arrhythmias vs 53.6% in longer DAT (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.01–2.65, <em>P</em> = .040). Median AF burden was 0% in both groups (shorter DAT: interquartile range [IQR] 0.0–2.0% vs longer DAT: IQR 0.0–7.3%, <em>P</em> = .017). At 12 months, shorter DAT was associated with higher LVEF (55.3% vs 51.0%, <em>P</em> = .009), greater LVEF improvement (+20.8 ± 13.0% vs +13.9 ± 13.2% longer DAT, <em>P</em> &lt; .001) and LV recovery (75.0% vs longer DAT: 57.2%, <em>P</em> = .011). Shorter DAT was associated with fewer hospitalizations and electrical cardioversions at 12 months.</div></div><div><h3>Conclusion</h3><div>In individuals with AF and LVSD, shorter DAT was associated with greater LVEF improvement and arrhythmia-free survival with lower AF burden and rehospitalization at 12 months, highlighting the prognostic benefit of early CA in AF and LVSD.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1429-1436"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345228","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":"Outcome of repeat ablation for premature ventricular contractions in patients with prior ablation failure: Impact of advanced techniques","authors":"Kenichi Tokutake MD,&nbsp;Shunsuke Uetake MD,&nbsp;Masaaki Kurata MD,&nbsp;Kanae Hasegawa MD,&nbsp;Ikutaro Nakajima MD,&nbsp;Travis D. Richardson MD, FHRS,&nbsp;Jay A. Montgomery MD,&nbsp;Sharon Shen MD,&nbsp;J.C. Estrada MD,&nbsp;Pablo Saavedra MD,&nbsp;Arvindh Kanagasundram MD, FHRS,&nbsp;Gregory F. Michaud MD, FHRS,&nbsp;William G. Stevenson MD, FHRS","doi":"10.1016/j.hrthm.2024.11.021","DOIUrl":"10.1016/j.hrthm.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the outcomes of repeat ablation and the use of different techniques in patients who failed prior PVC ablation.</div></div><div><h3>Methods</h3><div>We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half-normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Clinical and procedural findings, PVC origins, and acute and follow-up outcomes were compared in those with and without a prior failed ablation procedure.</div></div><div><h3>Results</h3><div>Of 239 patients, 75 (31%) had failed a prior ablation procedure, and they more often had left ventricular outflow tract PVCs. Despite failing prior ablation, repeat standard ablation was acutely successful in 59% of patients, and 75% of these patients had long-term success. Acute standard ablation success rate was lower and long-term recurrence rate was higher than in patients without prior ablation (59% vs 95%, <em>P</em> &lt;.001; and 29% vs 17%, <em>P</em> &lt;.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 needle, 5 epicardial, 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%.</div></div><div><h3>Conclusion</h3><div>Although success is lower for patients with prior failed ablation, repeat ablation seems reasonable for many, and the use of advanced techniques increased success to 71% in this group.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1455-1461"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667529","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":"Temperature-based rate response in a leadless pacemaker system","authors":"Mayer Y. Rashtian MD, FHRS ,&nbsp;James E. Ip MD, FHRS ,&nbsp;Derek V. Exner MD, FHRS ,&nbsp;Vivek Y. Reddy MD ,&nbsp;Rahul N. Doshi MD, FHRS ,&nbsp;Pascal Defaye MD ,&nbsp;Robert C. Canby MD ,&nbsp;Maria Grazia Bongiorni MD ,&nbsp;Morio Shoda MD ,&nbsp;Gerhard Hindricks MD ,&nbsp;Jordan R. Nevo MS ,&nbsp;David Ligon MS ,&nbsp;Anu Bulusu MS ,&nbsp;Reinoud E. Knops MD, PhD","doi":"10.1016/j.hrthm.2024.11.032","DOIUrl":"10.1016/j.hrthm.2024.11.032","url":null,"abstract":"<div><h3>Background</h3><div>A new dual-chamber leadless pacemaker (DR-LP) system, composed of 2 implantable devices in the right ventricle and right atrium, uses a less common temperature-based rate-response sensor. There is a need to understand the effectiveness of the rate response during exercise in both the ventricular (VR-LP) and atrial (AR-LP) devices.</div></div><div><h3>Objective</h3><div>We sought to determine whether temperature-based rate-responsive pacing is proportional to metabolic workload during an exercise test in a leadless pacemaker system.</div></div><div><h3>Methods</h3><div>After 6 weeks of implantation, we administered a treadmill exercise protocol to eligible participants concurrently enrolled in the LEADLESS II–Phase 2 and Aveir DR i2i studies. Programmed settings were optimized after a prior 6-minute walk test. We evaluated the ventricular and atrial rate-response sensors in participants implanted with the VR-LP and DR-LP system, respectively. For each device, the normalized slopes of sensor-indicated rate vs metabolic workload were aggregated across all analyzable patients. If the mean slope’s 95% confidence interval (CI) fell within the prespecified 0.65 and 1.35 acceptance range, the rate response was considered proportional to metabolic demand.</div></div><div><h3>Results</h3><div>Seventeen participants had a mean ventricular rate-response slope of 0.93 ± 0.29 (CI, 0.78–1.08), which fell within the acceptance criteria (<em>P</em> = .001). Twenty participants had a mean atrial rate-response slope of 0.91 ± 0.28 (CI, 0.78–1.05), also falling within the prespecified criteria (<em>P &lt;</em> .001).</div></div><div><h3>Conclusion</h3><div>The temperature-based sensor in a dual-chamber leadless pacemaker system was shown to be effective at modulating pacing rate in response to increased metabolic demand for right ventricular and atrial devices.</div></div><div><h3>ClinicalTrials.gov identifier</h3><div><span><span>NCT04559945</span><svg><path></path></svg></span> (LEADLESS II–Phase 2 study) and <span><span>NCT05252702</span><svg><path></path></svg></span> (Aveir DR i2i study)</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1533-1540"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709857","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":"Pulsed field ablation for atrial fibrillation with a novel simplified protocol: The PFA dose study","authors":"Patrick Badertscher MD ,&nbsp;Corinne Isenegger MD ,&nbsp;Rebecca Arnet MD ,&nbsp;Fabian Jordan MD ,&nbsp;Sven Knecht DSc ,&nbsp;Philipp Krisai MD ,&nbsp;Gian Völlmin MS ,&nbsp;Jeanne du Fay de Lavallaz MD, PhD ,&nbsp;Josip Katic MD ,&nbsp;David Spreen MS ,&nbsp;Stefan Osswald MD ,&nbsp;Christian Sticherling MD ,&nbsp;Michael Kühne MD","doi":"10.1016/j.hrthm.2024.11.031","DOIUrl":"10.1016/j.hrthm.2024.11.031","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) with use of a pentaspline catheter for the treatment of atrial fibrillation is performed in a standardized fashion. Whether a reduced number of applications results in similar clinical outcomes has not been fully investigated.</div></div><div><h3>Objective</h3><div>This study aimed to assess a simplified PFA dosing protocol for pulmonary vein isolation (PVI) compared with a standard protocol.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing their first PVI by PFA were enrolled. In the simple PFA group, patients received 4 applications per pulmonary vein (2× basket and 2× flower configuration), whereas 8 applications per pulmonary vein (4× basket and 4× flower configuration) were used in the standard PFA group.</div></div><div><h3>Results</h3><div>We included 245 patients (32% female; median age, 66 years), 96 (39%) in the simple PFA group and 149 (61%) in the standard PFA group. Median procedure duration, left atrial dwell time, and fluoroscopy time were significantly shorter in the simple PFA group compared with the standard PFA group at 40 (25–55) minutes vs 53 (41–67) minutes (<em>P</em> &lt; .001), 22 (13–37) minutes vs 37 (27–50) minutes (<em>P</em> &lt; .001), and 9 (7–12) minutes vs 11 (9–14) minutes (<em>P</em> &lt; .001), respectively. First-pass isolation was similar for the simple PFA group and the standard PFA group (95% vs 95%; <em>P</em> &gt; .999). Overall, 4 procedural complications were observed, all in the standard PFA group (<em>P</em> = .303). During a median follow-up of 373 days, freedom from atrial arrhythmias was 79% in the simple PFA group and 77% in the standard PFA group (<em>P</em> = .767). Findings were confirmed in comparing only patients who received PVI with or without electroanatomic mapping.</div></div><div><h3>Conclusion</h3><div>The novel simplified PFA protocol was associated with increased procedural efficiency while maintaining noninferior efficacy and safety compared with the standard PFA protocol.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1375-1383"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709903","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":"Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group","authors":"Pugazhendhi Vijayaraman MD, FHRS ,&nbsp;Francesco Zanon MD, FHRS ,&nbsp;Shunmuga Sundaram Ponnusamy MD ,&nbsp;Bengt Herweg MD, FHRS ,&nbsp;Parikshit Sharma MD, MPH, FHRS ,&nbsp;Manuel Molina-Lerma MD ,&nbsp;Marek Jastrzębski MD, PhD ,&nbsp;Zachary Whinnett MD, PhD ,&nbsp;Kevin Vernooy MD, PhD ,&nbsp;Rajeev K. Pathak MBBS, PhD ,&nbsp;Roderick Tung MD, FHRS ,&nbsp;Gaurav Upadhyay MD, FHRS ,&nbsp;Karol Curila MD, PhD ,&nbsp;Dipen Zalavadia MD ,&nbsp;Nischay Shah MD ,&nbsp;Lina Marcantoni MD ,&nbsp;Mohamed Gad MD ,&nbsp;Ramez Morcos MD ,&nbsp;Pawel Moskal MD ,&nbsp;Akriti Naraen MD ,&nbsp;Oscar Cano MD, PhD","doi":"10.1016/j.hrthm.2024.09.030","DOIUrl":"10.1016/j.hrthm.2024.09.030","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%–50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).</div></div><div><h3>Objective</h3><div>The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent BVP or CSP with HFmrEF between January 2018 and June 2023 at 16 international centers were included. The primary outcome was the composite end point of time to death or heart failure hospitalization (HFH). Secondary end points included change in left ventricular ejection fraction (LVEF) and individual end points of death and HFH.</div></div><div><h3>Results</h3><div>A total of 1004 patients met inclusion criteria: BVP, 178; CSP, 826 (His bundle pacing, 154; left bundle branch area pacing, 672). Mean age was 73 ± 13 years; female, 34%; and LVEF, 42% ± 5%. Paced QRS duration in CSP was significantly narrower compared with BVP (129 ± 21 ms vs 144 ± 19 ms; <em>P</em> &lt; .001). LVEF improved during follow-up in both groups (49% ± 10% vs 48% ± 10%; <em>P</em> = .32). CSP was independently associated with significant reduction in the primary end point of time to death or HFH compared with BVP (22% vs 34%; hazard ratio, 0.64; 95% confidence interval, 0.43–0.94; <em>P</em> = .025).</div></div><div><h3>Conclusion</h3><div>CSP was associated with improved clinical outcomes compared with BVP in this large cohort of patients with HFmrEF undergoing CRT. Randomized controlled trials comparing CSP with BVP will be necessary to confirm these results.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1512-1522"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345220","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":"Atrial fibrillation nomenclature, definitions, and mechanisms: Position paper from the international Working Group of the Signal Summit","authors":"Natasja M.S. de Groot MD, PhD ,&nbsp;Andre Kleber MD, PhD ,&nbsp;Sanjiv M. Narayan MD, PhD ,&nbsp;Edward J. Ciaccio PhD ,&nbsp;Olaf Doessel PhD ,&nbsp;Olivier Bernus MD, PhD ,&nbsp;Omer Berenfeld PhD ,&nbsp;David Callans MD, PhD ,&nbsp;Vadim Fedorov PhD ,&nbsp;John Hummel MD, PhD ,&nbsp;Michel Haissaguerre MD, PhD ,&nbsp;Andrea Natale MD, PhD ,&nbsp;Natalia Trayanova PhD ,&nbsp;Peter Spector PhD ,&nbsp;Edward Vigmond PhD ,&nbsp;Elad Anter MD","doi":"10.1016/j.hrthm.2024.11.012","DOIUrl":"10.1016/j.hrthm.2024.11.012","url":null,"abstract":"<div><div>The international Working Group of the Signal Summit is a consortium of experts in the field of cardiac electrophysiology dedicated to advancing knowledge on understanding and clinical application of signal recording and processing techniques. In 2023, the working group met in Reykjavik, Iceland, and laid the foundation for this manuscript.</div><div>Atrial fibrillation (AF) is the most common arrhythmia in adults, with a rapidly increasing prevalence worldwide. Despite substantial research efforts, advancements in elucidating the underlying mechanisms of AF have been relatively modest. Since the discovery of pulmonary veins as a frequent trigger region for AF initiation more than 2½ decades ago, advancements in patient care have primarily focused on technologic innovations to improve the safety and efficacy of pulmonary vein isolation (PVI). Several factors may explain the limited scientific progress made. First, whereas AF initiation usually begins with an ectopic beat, the mechanisms of initiation, maintenance, and electrical propagation have not been fully elucidated in humans, largely owing to suboptimal spatiotemporal mapping. Second, underlying structural changes have not been clarified and may involve different types of reentry. Third, inconsistent definitions and terminology regarding fibrillatory characteristics contribute to the challenges of comparing results between studies. Fourth, a growing appreciation for phenotypical differences probably explains the wide range of clinical outcomes to catheter ablation in patients with seemingly similar AF types. Last, restoring sinus rhythm in advanced phenotypic forms of AF is often not feasible or may require extensive ablation with minimal or no positive impact on quality of life. The aims of this international position paper are to provide practical definitions as a foundation for discussing potential mechanisms and mapping results and to propose pathways toward meaningful advancements in AF research, ultimately leading to improved therapies for AF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1480-1491"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675267","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":"Long-term outcomes of ganglionated plexus ablation as sole therapy for paroxysmal atrial fibrillation","authors":"Jamie Kay MRCP ,&nbsp;Min-Young Kim MRCP, PhD ,&nbsp;Clare Coyle MRCP ,&nbsp;David R. Tomlinson MD ,&nbsp;Louisa Malcolme-Lawes MRCP, PhD ,&nbsp;Elaine Lim BSc ,&nbsp;Michael Fudge BSc ,&nbsp;Ian J. Wright BSc ,&nbsp;Michael Koa-Wing PhD ,&nbsp;Fu Siong Ng FRCP, PhD ,&nbsp;Norman A. Qureshi MRCP, PhD ,&nbsp;Zachary I. Whinnett PhD ,&nbsp;Nicholas S. Peters MD, FRCP, FHRS ,&nbsp;Gurpreet Dhillon MRCP ,&nbsp;Ross J. Hunter PhD ,&nbsp;Phang Boon Lim MRCP, PhD ,&nbsp;Nicholas W.F. Linton MEng, MRCP, PhD ,&nbsp;Prapa Kanagaratnam PhD, FRCP","doi":"10.1016/j.hrthm.2024.12.010","DOIUrl":"10.1016/j.hrthm.2024.12.010","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1620-1621"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828238","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":"Autoimmune cardiac channelopathies and heart rhythm disorders: A contemporary review","authors":"Pietro Enea Lazzerini MD ,&nbsp;Mohamed Boutjdir PhD, FAHA","doi":"10.1016/j.hrthm.2025.03.1879","DOIUrl":"10.1016/j.hrthm.2025.03.1879","url":null,"abstract":"<div><div>Cardiac arrhythmias still represent a major health problem worldwide, at least in part because the fundamental pathogenic mechanisms are not fully understood, thus affecting the efficacy of therapeutic measures. In fact, whereas cardiac arrhythmias are in most cases due to structural heart diseases, the underlying cause remains elusive in a significant number of patients despite intensive investigations even including postmortem examination and molecular autopsy. A large body of data progressively accumulated during the last decade provides strong evidence that autoimmune mechanisms may be involved in a significant number of such unexplained or poorly explained cardiac arrhythmias. Several proarrhythmic anti–cardiac ion channel autoantibodies have been discovered, in all cases able to directly interfere with the electrophysiologic properties of the heart but leading to different arrhythmic phenotypes, including long QT syndrome, short QT syndrome, and atrioventricular block. These autoantibodies, which may develop independent of a history of autoimmune diseases, could help explain a percentage of arrhythmic events of unknown origin, thereby opening new frontiers for diagnosis and treatment of heart rhythm disorders. Based on this evidence, the novel term <em>autoimmune cardiac channelopathies</em> was coined in 2017. Since then, the interest in the field of cardioimmunology has shown a tumultuous growth, so much so that the number of arrhythmogenic anti–ion channel autoantibodies reported has significantly increased, also in association with not previously described arrhythmic phenotypes, such as atrial fibrillation, Brugada syndrome, and ventricular fibrillation/cardiac arrest. Thus, an updated reassessment of this topic, also highlighting perspectives and unmet needs, has become necessary and represents the main objective of this review.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1541-1561"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585306","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":"Stretch syncope in humans: Evidence for symptomatic neural reflex hypotension triggered by stretching of shoulder and upper back muscles","authors":"Marinos Kosmopoulos MD ,&nbsp;Jorge L. Reyes MD ,&nbsp;Sima Patel MD ,&nbsp;Hannah Simpson RN ,&nbsp;Richard Sutton MB BS, DSc ,&nbsp;Ciana Keller MD ,&nbsp;Roland D. Thijs MD, PhD ,&nbsp;J. Gert Van Dijk MD, PhD ,&nbsp;David G. Benditt MD, FHRS","doi":"10.1016/j.hrthm.2025.03.166","DOIUrl":"10.1016/j.hrthm.2025.03.166","url":null,"abstract":"<div><h3>Background</h3><div>Stretch-induced syncope (SIS) is a poorly understood condition that we hypothesized may be due to a neural reflex hypotensive response triggered by stretching of shoulder/upper back muscles.</div></div><div><h3>Objective</h3><div>This study compared the impact of shoulder/upper back stretching on heart rate (HR) and blood pressure (BP) responses in patients with SIS, with the findings in controls evaluated for symptoms unrelated to stretching.</div></div><div><h3>Methods</h3><div>The study population comprised 33 individuals: 9 otherwise healthy patients with SIS and 24 healthy controls. Beat-to-beat HR and systolic BP (SBP) and mean arterial pressure (MAP) responses were recorded during active standing (AS), Valsalva maneuver, and respiratory sinus arrhythmia. Patients with SIS also underwent carotid sinus massage while seated. In addition, all subjects undertook an active shoulder/upper back extension maneuver for approximately 10–15 seconds while keeping forearms still and breathing normally.</div></div><div><h3>Results</h3><div>Stretch elicited a drop in BP to nadir values of SBP and MAP (95.9 ± 24.2 and 76.2 ± 17.3 mm Hg in patients with SIS and controls, respectively). However, stretch-induced SBP and MAP decrease was greater in patients with SIS (<em>P</em>=.003 and <em>P</em>=.013). Further, the ratio of the ΔHR increase to ΔBP drop was lower (<em>P</em>=.001) during stretch-induced hypotension than during comparable hypotension induced immediately after AS.</div></div><div><h3>Conclusion</h3><div>Shoulder/upper back stretching induces a transient hypotensive response in humans, with BP fall greater in patients with SIS than in controls. Further, compensatory HR increment associated with stretch-induced hypotension was less in both patients with SIS and controls than comparable transient BP fall with AS, suggesting chronotropic restraint. Thus, SIS results from exaggerated stretch-induced vasodepression with limited compensatory tachycardia favoring a neural reflex mechanism.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 6","pages":"Pages 1464-1471"},"PeriodicalIF":5.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585400","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}