Heart rhythm最新文献

{"title":"Arrhythmogenicity of the Pulmonary Veins An Anatomical Perspective.","authors":"Demosthenes G Katritsis, Damian Sanchez-Quintana, Robert H Anderson","doi":"10.1016/j.hrthm.2025.09.041","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.041","url":null,"abstract":"<p><p>In this short review, we discuss the issue of arrhythmogenicity of the pulmonary veins from an anatomical perspective. Based on classical studies, we summarise the current evidence, discussing it in the context of the anatomical and histological structure of the pulmonary veins and their junctions with the left atrium.</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":"145258156","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 ceiling effect of heart failure pharmacotherapy in acute left ventricular recovery for patients with AF mediated cardiomyopathy prior to rhythm control.","authors":"Kenneth K Cho, Peter M Kistler, Louise Segan, Jeremy B William, Rose F Crowley, David Chieng, Nicholas D'Elia, Hariharan Sugumar, Liang-Han Ling, Aleksandr Voskoboinik, Joseph B Morton, Geoffrey Lee, Alex J McLellan, Sonia Azzopardi, Annie Curtin, Georgia Rendell, Kevin Cheung, Jessica Wang, Kartik Sehgal, Michael W Lim, Youlin Koh, Michael Wong, Jonathan M Kalman, Sandeep Prabhu","doi":"10.1016/j.hrthm.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.004","url":null,"abstract":"","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":"145258089","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 implantable electronic device software reset and damage following pulsed field ablation using a monopolar lattice-tip catheter.","authors":"Devi G Nair, Kirollos Gabrah, Brandon Doty, Ganesh Nair, Vivek Y Reddy","doi":"10.1016/j.hrthm.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.027","url":null,"abstract":"","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":"145258124","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":"Antegrade Approach for Left Ventricular Tachyarrhythmia in Patients with Previous Transcatheter Edge-to-Edge Mitral Valve Repair.","authors":"Moneeb Khalaph, Philipp Lucas, Sebastian Dittrich, Jakob Lüker, Christian-Hendrik Heeger, Feifan Ouyang, Niklas Schenker, Andreas Rillig, Andreas Metzner, Maxim Didenko, Sebastian E Beyer, Denise Guckel, Thomas Fink, Vanessa Sciacca, Maximilian Mörsdorf, Martin Braun, Hazem Omran, Tanja Rudolph, Volker Rudolph, Guram Imnadze, Christian Sohns, Mustapha El Hamriti, Daniel Steven, Philipp Sommer","doi":"10.1016/j.hrthm.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.002","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation of left ventricular tachyarrhythmias (LVT) in patients with prior mitral valve transcatheter edge-to-edge repair (MV-TEER) can be challenging. The antegrade (transseptal) approach offers several advantages over the conventional retrograde (transaortic) route. However, real-world data on the efficacy and safety of antegrade approach in MV-TEER are limited.</p><p><strong>Objective: </strong>To assess the feasibility, safety, and clinical effectiveness of antegrade transseptal catheter ablation for LVT in patients with prior MV-TEER.</p><p><strong>Methods: </strong>This prospective, multicenter study included patients with drug-refractory ventricular tachycardia (VT) and a history of MV-TEER. All underwent the procedure via a transseptal approach. Mitral valve clip position was assessed on the first post-procedural day using transthoracic echocardiography.</p><p><strong>Results: </strong>All 34 patients (mean age 70.9±8.7 years, 79% male) underwent VT ablation. The median interval between TEER and VT ablation was 2 years [IQR 2-3.5]. Patients had a median of 2 mitral clips [IQR 1-2]: 44.1% had 1 clip, 50.0% had 2 clips, and 5.9% had 3 clips. Catheter manipulation through both septal and lateral openings of the mitral valve was feasible in all cases, regardless of clip number. Complete left ventricular (LV) mapping was achieved without restrictions. No clip dislocations were detected on the first post-procedural day. During a median follow-up of 32 months [IQR 17.5-48.5], VT recurrence occurred in 4 patients (11.8%).</p><p><strong>Conclusion: </strong>An antegrade approach for LVT ablation is feasible and safe despite previous MV-TEER. Mapping was not impaired by clip presence, and no periprocedural cardiac complications or clip dislocations were observed.</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":"145258169","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":"Phenotypic Spectrum and Prognostic Stratification in desmoglein-2-Associated Arrhythmogenic Cardiomyopathy: Results from a Pooled Analysis.","authors":"Marika Martini, Luigi Filippo Brizzi, Serena Pinci, Ilaria Rigato, Kalliopi Pilichou, Barbara Bauce","doi":"10.1016/j.hrthm.2025.09.046","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.046","url":null,"abstract":"<p><strong>Background: </strong>Increasing knowledge of genotype-phenotype correlations in Arrhythmogenic cardiomyopathy (ACM) is leading to more refined diagnostic and risk stratification strategies, encompassing both arrhythmic outcomes and heart failure (HF) progression. DSG2 mutations represent a clinically relevant genetic subset, taking into consideration both their relative prevalence and their association with severe phenotypic expression.</p><p><strong>Objective: </strong>To provide a comprehensive characterization of DSG2-associated ACM in terms of clinical presentation, phenotypic expression, and predictors of adverse outcomes.</p><p><strong>Methods: </strong>Clinical and genetic data from patients carrying pathogenic or likely pathogenic DSG2 variants were pooled with individual-level data extracted from previously published series. Demographic features, clinical history, phenotypic expression, and outcome measures during follow-up were harmonized and analysed.</p><p><strong>Results: </strong>The final cohort included 202 patients, 64.8% males and 60.9% probands. Life-threatening ventricular arrhythmias (LTVAs) were the most common clinical presentation (25.8%). Most of the patients exhibited a right-dominant (38.12%) or biventricular (31.19%) phenotype. After a median follow-up of 92.8 months, 35.3% of patients experienced LTVAs, and 10.9% developed HF. Patients with LTVAs had more severe right ventricular dysfunction, whereas those developing HF exhibited biventricular involvement. Probands exhibit a more severe phenotype in comparison to first-degree relatives, with a trend toward higher rate of major adverse cardiovascular events (MACE). Non-sustained ventricular tachycardia (NSVT) on Holter monitoring was the only independent predictor of MACE.</p><p><strong>Conclusion: </strong>DSG2-related ACM is characterized by a high arrhythmic burden, both at clinical onset and during follow-up. HF development is associated with biventricular involvement, and NSVT represents an independent predictor of MACE, supporting its role in early risk stratification.</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":"145258091","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 and Micra AV leadless pacemaker: A Challenge for Atrioventricular Synchrony?","authors":"Thomas Van Weyenbergh, Rik Willems, Bert Vandenberk, Alexander Dorrestijn, Gabor Vörös, Christophe Garweg","doi":"10.1016/j.hrthm.2025.10.006","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.006","url":null,"abstract":"","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":"145258174","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":"BMAL1 Mediates Sex-Specific Circadian Regulation of Cardiac Ion Channels and Temporal Arrhythmia Vulnerability.","authors":"Brian P Delisle, Ezekial Rozmus, Abhilash Prabhat, Spencer B Procopio, Xiping Zhang, Emilia Entcheva, Karyn A Esser, Elizabeth A Schroder","doi":"10.1016/j.hrthm.2025.10.007","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.007","url":null,"abstract":"","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":"145258126","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":"Optimizing Radiofrequency-Assisted Lead Penetration into Swine Interventricular Septum Using Pacing Leads: A Systematic In Vitro Assessment.","authors":"Binbin Luo, Longfu Jiang, Lingping Gao, Wenni Zhu, Lu Zhang, Ding Yuan","doi":"10.1016/j.hrthm.2025.09.045","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.045","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is a promising physiological pacing modality, but fibrotic or calcified interventricular septal tissue can prevent lead advancement. Radiofrequency (RF) energy has been applied in transseptal puncture and lead extraction, but its optimal use for pacing lead penetration has not been systematically evaluated.</p><p><strong>Objective: </strong>To assess the safety and efficacy of different RF energy settings for facilitating pacing lead penetration through the interventricular septum in an ex vivo swine model.</p><p><strong>Methods: </strong>Freshly excised swine hearts (n=6) were immersed in a temperature-controlled (37°C) circulating saline bath. The SelectSecure 3830 lead was positioned manually against the septum under fluoroscopic guidance. RF energy was delivered using an ERBE VIO300S electrosurgical generator in cutting mode across 12 combinations: four energy levels (10, 20, 30, 55 W) and three durations (1, 2, 3 s). Additionally, spark mode(20,30W) was tested with 3 times and 5 times of sparking. Each combination was tested six times. Outcome metrics included penetration success (rupture of the RV septal endocardium), safety markers (significant bubble formation, tissue charring), and histological assessment of myocardial injury.</p><p><strong>Results: </strong>At 10 W, penetration was not achieved in any trial. At 20 W, application for 1-2 seconds achieved an 88.9% success rate with minimal collateral injury. In contrast, power ≥30 W or durations >2 seconds significantly increased bubble formation (up to 94%) and deep myocardial necrosis. Histology confirmed that 20 W/1-2 seconds produced sharp cleavage of fibrotic tissue with preservation of deeper myocardial architecture. Spark mode was less stable and reproducible compared with optimized continuous settings.</p><p><strong>Conclusions: </strong>RF-assisted pacing lead delivery using 20 W for 1∼2s represents an effective and safe strategy for overcoming superficial septal fibrosis in ex vivo settings. This technique may offer a viable rescue option during challenging LBBAP procedures.</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":"145258116","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 Prognosis in Early-Onset Atrial Fibrillation Without Overt Cardiovascular Disease.","authors":"Anders Holt, Jarl Emanuel Strange, Gunnar H Gislason, Morten Schou, Morten Lamberts, Morten Lock Hansen, Peter Vibe Rasmussen","doi":"10.1016/j.hrthm.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.044","url":null,"abstract":"<p><strong>Background: </strong>The prognostic implications of early-onset atrial fibrillation (AF) in patients without coexisting cardiovascular conditions are not clear.</p><p><strong>Objective: </strong>To investigate the risk of long-term stroke, heart failure (HF), and mortality in patients with early-onset AF.</p><p><strong>Methods: </strong>Using nationwide registers, we included adult patients with early-onset AF (18-45 years old) with a first-time AF diagnosis during 1999-2023 without co-existing cardiovascular conditions. All AF patients were matched with a control group from the background population without AF. The long-term absolute risks of stroke, HF, and death were estimated as well as standardized risk ratios (RR) comparing patients with and without AF.</p><p><strong>Results: </strong>Among 7,632 patients with AF (median age: 39 years, 71% men, 1.9% cancer, 2.1% diabetes), clinically relevant crude risks of stroke (20-year risk: 6.89%, 95% CI 5.96%-7.82%), HF (20-year risk: 6.45%, 95% CI 5.60%-7.31%), and death (20-year risk: 7.10%, 95% CI 6.18%-8.02%) were observed. Comparing the AF cohort with a matched sample from the background population (median age: 38 years, 71% men, 1.1% cancer, 1.3% diabetes) revealed elevated standardized risks of stroke (RR: 2.00, 95% CI 1.67-2.33), HF (RR: 4.33, 95% CI 3.55-5.11), and death (RR: 1.37, 95% CI 1.17-1.57).</p><p><strong>Conclusions: </strong>Early-onset AF in patients without concomitant cardiovascular conditions was associated with increased long-term risk of cardiovascular complications, most notably a four- to five-fold increased risk of HF. Hence, AF in otherwise healthy young patients should be considered an important marker of increased risks of a future cardiomyopathy and HF events.</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":"145258149","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":"Use of a large-area focal lattice-tip catheter for cavotricuspid isthmus ablation.","authors":"Gregor Thalmann, Thomas Kueffer, Theresa Storz, Alvaro Osca, Corinne Jufer, Helge Servatius, Hildegard Tanner, Valon Spahiu, Boldizsar Kovacs, Nikola Kozhuharov, Claudia Herrera, Laurent Roten, Tobias Reichlin","doi":"10.1016/j.hrthm.2025.10.005","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.005","url":null,"abstract":"","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":"145258151","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}