Heart rhythm最新文献

{"title":"How to Perform Loco-regional Anaesthetic Blocks for Modern Implantable Cardioverter-Defibrillator (ICD) Implantation- a guide for Cardiologists.","authors":"Christopher Monkhouse, Charles Butcher, Julian Rios, Filip Zemrak, Alexander Bell, Robert Lendrum, Sam Curtis, Martin Lees, James Bird, Bhavisha Patel, Georgia Riepl, Hetal Kumar Vadera, Ross J Hunter, Pier D Lambiase, Syed Ahsan","doi":"10.1016/j.hrthm.2025.09.043","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.043","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":"145258167","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":"Incidence and Clinical Implications of Microbubble Formation During Pulsed Field Ablation.","authors":"Shuhei Yano, Seiji Takatsuki, Taiki Kotajima, Kohei Sasajima, Shun Yamanaka, Yukihiro Himeno, Shuhei Yamashita, Koki Yamaoka, Yoshinori Katsumata, Takahiko Nishiyama, Takehiro Kimura, Masaki Ieda","doi":"10.1016/j.hrthm.2025.09.040","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.040","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":"145258182","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":"From Blood to Heartbeat: Plasma Proteins and Brugada Syndrome Revealed by Mendelian Randomization.","authors":"Zehao Zhao, Binbin Cao, Haotian Guo, Jiahui Li, Xiaomin Chen","doi":"10.1016/j.hrthm.2025.09.039","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.039","url":null,"abstract":"<p><strong>Background: </strong>Brugada syndrome (BrS) is a hereditary arrhythmia characterized by distinctive electrocardiographic patterns and a high risk of sudden cardiac death. While SCN5A mutations account for 20-30% of cases, the majority remain unexplained. Recent evidence suggests plasma proteins may contribute to BrS pathogenesis through non-ion channel mechanisms such as inflammation and metabolism, though causal roles are unclear.</p><p><strong>Objective: </strong>To assess the causal relationship between plasma proteins and BrS using Mendelian randomization (MR) and explore underlying molecular mechanisms.</p><p><strong>Methods: </strong>Using pQTL proteomic data from a Finnish cohort, we evaluated causal associations between 4,185 plasma proteins and BrS via MR. The inverse variance weighted (IVW) method served as the primary analysis, supported by additional MR methods and sensitivity tests to ensure robustness. MR-CAUSE was used to identify proteins with unique causal patterns. For significant proteins, we constructed PPI networks and performed Gene Ontology and KEGG enrichment analyses. A machine learning-based model integrated these results to prioritize candidate proteins.</p><p><strong>Results: </strong>Twenty plasma proteins were identified as potentially associated with BrS. Sensitivity analyses supported the robustness of these findings. HSPB1, MAPKAPK2, PDLIM4, and MMP1 emerged as top candidates based on causal strength, biological relevance, and network centrality.</p><p><strong>Conclusion: </strong>This study provides insight into the molecular landscape of BrS and identifies high-priority plasma proteins for further investigation. Experimental and clinical validation is needed to evaluate their diagnostic and therapeutic potential.</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":"145258099","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":"Durability of Initial Pulmonary Vein Isolation Assessed by 3D PATRIOT and Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging.","authors":"Nikki van Pouderoijen, Luuk H G A Hopman, Michiel J B Kemme, Cornelis P Allaart, Marco J W Götte","doi":"10.1016/j.hrthm.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.10.009","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":"145258136","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 extravascular ICD: Evolving paradigms in sudden death prevention.","authors":"Timothy M Markman, Thomas D Callahan","doi":"10.1016/j.hrthm.2025.09.038","DOIUrl":"10.1016/j.hrthm.2025.09.038","url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) remain the mainstay of prevention of sudden cardiac death in patients at risk of lethal ventricular arrhythmias. Current ICD systems use leads placed via transvenous, subcutaneous, or surgical epicardial approaches. The extravascular ICD (EV-ICD) is a novel device that avoids transvenous lead placement while enabling defibrillation and limited pacing including antitachycardia pacing. This review summarizes key features of the EV-ICD system and synthesizes published trial and real-world evidence. Collectively, these studies demonstrate high defibrillation success, effective antitachycardia pacing, and low complication rates. The EV-ICD is an attractive option for patients without previous sternotomy or pacing indications for bradycardia or resynchronization, particularly those at an elevated risk of transvenous lead-related complications. Further research is needed to define long-term outcomes and refine patient selection. This review offers an evidence-based evaluation of the EV-ICD's role in contemporary arrhythmia management including limitations of the device and unknowns regarding patient selection and durability.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232453","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":"Impact of atrial fibrillation and atrial fibrillation therapies on sports performance in athletes","authors":"Ali K. Khan MD, PhD ,&nbsp;Hyon Jae Lee MD, FHRS ,&nbsp;Mellanie True Hills BS ,&nbsp;Melissa Moss BA ,&nbsp;Brenna Lara JD ,&nbsp;Raymond Baumann PhD ,&nbsp;Cynthia Brandt MD, MPH ,&nbsp;Rachel Lampert MD, FHRS","doi":"10.1016/j.hrthm.2024.11.020","DOIUrl":"10.1016/j.hrthm.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>It has been hypothesized that both atrial fibrillation (AF) and medications for AF are poorly tolerated in athletes.</div></div><div><h3>Objective</h3><div>The purpose of this study was to determine the impact of AF and AF treatments on sports performance.</div></div><div><h3>Methods</h3><div>An Internet-based survey, initiated via StopAfib.org, queried the impact of AF and treatment modalities on sports performance, training, and symptoms. Performance (rated in comparison to personal best), frequency of training, and competition were compared before onset of AF symptoms vs when symptoms at worst, via paired Wilcoxon, and then similarly compared in relation to participants’ AF treatments.</div></div><div><h3>Results</h3><div>Between May 13, 2019, and February 29, 2020, 1055 athletes responded (78% male, median age 61–70 years). The sports most reported were cycling (25%) and running (20%). Development of AF was associated with declining sports performance, competition, and training frequency. Of 565 participants who detrained, 31% reported no change in symptoms, 56% reported decreased frequency, and 13% reported no further AF. Among athletes who received treatment, ablation was associated with greater improvement in sports performance than use of medications. Of 262 athletes currently taking medication, 27% reported that it was completely effective, 58% partially effective, and 15% not effective. Of 653 athletes who have taken medication currently and/or in the past, 43% reported side effects, most commonly fatigue, low energy, or decreased athletic performance.</div></div><div><h3>Conclusion</h3><div>Athletes reported that AF was associated with worsening sports performance. Among AF treatment modalities, ablation was associated with the greater reported improvement in sports performance than use of medications, which also had a high frequency of side effects.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2562-2569"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667520","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":"Mechanisms of ventricular tachycardias with a 1:1 His-V relation in patients with heart disease","authors":"Shunsuke Uetake MD,&nbsp;William G. Stevenson MD, FHRS,&nbsp;Travis D. Richardson MD,&nbsp;Arvindh N. Kanagasundram MD, FHRS,&nbsp;Kanae Hasegawa MD,&nbsp;Masaaki Kurata MD,&nbsp;Daisuke Togashi MD,&nbsp;Salah H. Alahwany MD,&nbsp;Tiffany Hu MD,&nbsp;Giovanni E. Davogustto MD,&nbsp;Zachary T. Yoneda MD,&nbsp;Sharon T. Shen MD,&nbsp;Jay A. Montgomery MD,&nbsp;Harikrishna Tandri MD, FHRS","doi":"10.1016/j.hrthm.2025.02.044","DOIUrl":"10.1016/j.hrthm.2025.02.044","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular tachycardia (VT) with a 1:1 V-His relation can be seen in bundle branch reentry or with passive retrograde activation from scar-related VT or reentry using left ventricular Purkinje fascicles.</div></div><div><h3>Objective</h3><div>This study aimed to review the frequency with which 1:1 V-His relation occurs and to identify differentiating characteristics of these arrhythmias, including new measures obtained during right ventricular (RV) pacing based on orthodromic His–proximal right bundle potential (HisRB) capture and the stimulus to HisRB (S-HisRB) interval approximating RV electrogram to His interval (Egm-HisRB_<em>VT</em>).</div></div><div><h3>Methods</h3><div>This was a retrospective review of induced VTs that had a HisRB potential recorded while pacing from the distal right ventricle.</div></div><div><h3>Results</h3><div>From 147 patients, 158 VTs were analyzed. A 1:1 V to HisRB was observed in 86 VTs (54%): 18 bundle branch reentrant VTs (BBR-VTs), 8 LV fascicular/Purkinje-related reentrant VTs (FPVTs), and 60 scar-related reentrant VTs (SRR-VTs). The HisRB-QRS_<em>VT</em> was &gt;135 ms, falling within the QRS in 87% of SRR-VTs, and 30–135 ms in all BBR-VTs (<em>P</em> &lt; .001). With RV pacing, the HisRB remained 1:1 in 100% of BBR-VTs and 23 (69.7%) of 33 SRR-VTs. An S-HisRB of &gt;135 ms combined with S-HisRB – Egm-HisRB_<em>VT</em> difference &lt;30 ms was specific for BBR-VT. In FPVTs, the HisRB-QRS timing was more variable, and RV pacing was helpful in distinguishing these from BBR-VTs.</div></div><div><h3>Conclusion</h3><div>Retrograde HisRB activation is common in all forms of VT. HisRB timing and new features based on consideration of orthodromic HisRB activation during RV pacing can help distinguish BBR-VT, SRR-VT, and FPVT.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2497-2506"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572396","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":"Establishing and managing a mortality and morbidity program in the electrophysiology lab: An essential component of quality","authors":"Bruce A. Koplan MD, MPH, FHRS ,&nbsp;Anne Marie Smith MBA ,&nbsp;John N. Catanzaro MD, MBA, FHRS","doi":"10.1016/j.hrthm.2025.05.026","DOIUrl":"10.1016/j.hrthm.2025.05.026","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1024-e1025"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119338","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":"Echocardiographic response from left bundle branch area pacing optimized cardiac resynchronization therapy (LOT-CRT) vs traditional CRT","authors":"Gaurav A. Upadhyay MD, FHRS ,&nbsp;Marek Jastrzębski MD, PhD ,&nbsp;Paul Foley MBChB, MDRes, FRCP ,&nbsp;Badrinathan Chandrasekaran BSc, MD Res, FCRP ,&nbsp;Zachary Whinnett MD, PhD, FHRS ,&nbsp;Robert D. Schaller DO, FHRS ,&nbsp;Rafał Gardas MD ,&nbsp;Travis Richardson MD, FHRS ,&nbsp;Pawel Moskal MD ,&nbsp;D’Anne Kudlik MS ,&nbsp;Robert W. Stadler PhD ,&nbsp;Patrick Zimmerman PhD ,&nbsp;James Burrell MS ,&nbsp;Robert Waxman MS ,&nbsp;Richard N. Cornelussen PhD ,&nbsp;Jonathan Lyne MD ,&nbsp;Bengt Herweg MD, FHRS ,&nbsp;Pugazhendhi Vijayaraman MD, FHRS","doi":"10.1016/j.hrthm.2025.04.026","DOIUrl":"10.1016/j.hrthm.2025.04.026","url":null,"abstract":"<div><h3>Background</h3><div>Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.</div></div><div><h3>Objective</h3><div>We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.</div></div><div><h3>Methods</h3><div>Patients with conventional CRT indications and preferentially NIVCD were recruited. Echocardiographic parameters, including absolute percentage change in LV ejection fraction (LVEF) and relative percentage change in LV end-systolic volume (LVESV), were evaluated at implantation and 6-month follow-up. The BVP cohort was from an independent study, selected using 1:1 propensity-matching. LOT-CRT patients were subclassified into “successful LOT-CRT” (LBBAP; presence of r’ in electrode electrocardiography [ECG] V1) and “deep septal optimized therapy” (DOT-CRT) (functional deep septal capture).</div></div><div><h3>Results</h3><div>LOT-CRT patients (N = 34; age 64 years, women 38%, NIVCD 47%, LBBB 53%, implantable cardiac monitor 21%, QRSd 175 ms, and LVEF 27.6%) had significantly greater LVEF improvement (16.1% vs 6.1%; <em>P</em> &lt;.01) and LVESV reduction (−43.5% vs −20.9%; <em>P</em> &lt;.01) compared with BVP patients. After adjusting for baseline characteristics, LOT-CRT patients still had significantly greater LVEF improvement (7.5%; <em>P</em> &lt;.01) and LVESV reduction (18.4%; <em>P</em> &lt;.01) than BVP patients. The response was consistent across LBBB and NIVCD subgroups. LOT-CRT patients with QRS ≥ 171 ms showed greater benefit (<em>P</em> = .04; both LVEF and LVESV). No significant differences were observed between successful LOT-CRT and DOT-CRT.</div></div><div><h3>Conclusion</h3><div>LOT-CRT resulted in superior LVEF and LVESV improvements compared with BVP in NIVCD and LBBB patients and enhanced CRT response.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2616-2624"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984111","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 vestigial fold in humans: Characterization of a potential novel target for selective cardiac sympathetic denervation","authors":"Takanori Sato MD, PhD ,&nbsp;Michael C. Fishbein MD ,&nbsp;Peter Hanna MD, PhD, FHRS ,&nbsp;Olujimi A. Ajijola MD, PhD, FHRS ,&nbsp;Kalyanam Shivkumar MD, PhD, FHRS ,&nbsp;Shumpei Mori MD, PhD","doi":"10.1016/j.hrthm.2025.03.1957","DOIUrl":"10.1016/j.hrthm.2025.03.1957","url":null,"abstract":"<div><h3>Background</h3><div>The vestigial fold is an epicardial structure related to the posterior hilum of the heart, containing the remnant of the left superior vena cava. It is the superior continuation of the ligament/vein of Marshall. Although neural structures along the human ligament/vein of Marshall have been characterized, those within the human vestigial fold remain unexplored.</div></div><div><h3>Objective</h3><div>This study aimed to characterize the neural structures within the human vestigial fold.</div></div><div><h3>Methods</h3><div>Twelve human vestigial fold samples (67% men, 50.0 ± 12.7 years) were analyzed. Nerve fascicles ≥ 50 μm in diameter were counted and characterized by immunohistochemistry staining. Percentage area of sympathetic, parasympathetic, and sensory nerve fibers (axons) within individual nerve fascicles was measured.</div></div><div><h3>Results</h3><div>A total of 87 nerve fascicles were analyzed. The size of the vestigial fold averaged 12.7 ± 5.1 mm in length and 3.6 ± 1.7 mm in width. Each vestigial fold contained 7.3 ± 4.2 nerve fascicles (102.0 ± 51.8 μm in diameter). The minimum distance from the epicardium to nerve fascicles was 487.1 ± 440.2 μm. Immunohistochemistry showed sympathetic predominance (Percentage area within each fascicle; sympathetic 16.9 ± 12.7%, parasympathetic 1.6 ± 1.0%, and sensory 1.2 ± 1.0%, <em>P</em> &lt; .001). Representative whole-mount staining of the tissue-cleared sample also confirmed 3-dimensional distribution of the predominant sympathetic nerve fascicles within the vestigial fold.</div></div><div><h3>Conclusion</h3><div>The vestigial fold predominantly contains sympathetic nerve fascicles. This epicardial structure is a potential novel target for selective human cardiac sympathetic denervation, especially in cases with uncontrollable ventricular arrhythmia arising from the inferior left ventricle.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2711-2721"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663334","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}