Heart rhythm最新文献

{"title":"Prospective Randomized Trial of Conduction System Pacing versus Right Ventricular Pacing for Patients with Atrio-Ventricular Block; Prague CSP trial.","authors":"Karol Curila, Jan Mizner, Jan Morava, Radovan Smisek, Jana Vesela, Ondrej Sussenbek, Petr Stros, Jindrich Kupec, Petr Waldauf, Pavel Leinveber, Lukas Poviser, Laszlo Nagy, Jan Cerny, Barbora Bitmanova, Pavel Jurak, Rostislav Polasek","doi":"10.1016/j.hrthm.2025.05.036","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.036","url":null,"abstract":"<p><strong>Background: </strong>Conduction system pacing (CSP) replaces right ventricular pacing (RVP) in bradycardia patients.</p><p><strong>Objective: </strong>To compare CSP vs. RVP in patients with pacemaker indication due to the AV conduction disease.</p><p><strong>Methods: </strong>This study randomized patients to CSP or RVP in 1:1 ratio and followed them for 12 months. CSP received either His bundle pacing (HBP) or left bundle branch area pacing (LBBAP); The primary endpoint was a change in the LVEF. The combined composite clinical endpoint consisted of cardiovascular death, CRT upgrade, or hospitalization for heart failure.</p><p><strong>Results: </strong>Of 249 patients, 125 were randomized to RVP and 124 to CSP; no differences between clinical parameters. In CSP, ten patients received HBP, 96 LBBAP, 15 deep septal pacing, and 3 RVP. Procedural and fluoroscopy times were longer in CSP vs. RVP (63 vs. 40 and 7 vs. 3 min; p < 0.001). In the intention-to-treat analysis, the LVEF decline in CSP was smaller than RVP (-2% vs. -4%, p = 0.03) and a LVEF decrease ≥ 10% occurred more often in RVP 19 (16%) than CSP 6 (5%), p = 0.01. There was no difference in the composite clinical outcome between RVP and CSP (9 vs. 4, p = 0.15). There was also no difference in procedural complications (9 in RVP vs. 2 in CSP, p = 0.09).</p><p><strong>Conclusion: </strong>In patients with severe conduction disease, CSP led to a smaller LVEF decline than RVP after one year of pacing. Both pacing methods had similar rates of clinical endpoints and procedural complications.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141856","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":"Epicardial Placement of Implantable Cardioverter-Defibrillators in Adults: Technical Considerations, System Performance, and Clinical Outcomes.","authors":"Poojita Shivamurthy, Marisa Cevasco, Gregory E Supple, Balaram Krishna Hanumanthu, Timothy M Markman, Gustavo Guandalini, Matthew C Hyman, Andres Enriquez, Ramanan Kumareswaran, Michael G Fradley, Rajat Deo, Vincent Y See, Michael Riley, Fermin Garcia, Saman Nazarian, David Lin, David S Frankel, Sanjay Dixit, Andrew E Epstein, David J Callans, Francis E Marchlinski, Robert D Schaller","doi":"10.1016/j.hrthm.2025.05.034","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.034","url":null,"abstract":"<p><strong>Background: </strong>Surgical implantation of epicardial implantable cardioverter-defibrillator (ICD) is considered when transvenous ICD placement is not feasible due to congenital anomalies, venous obstruction, or prior infections. Epicardial pacemakers are well-studied but less is known about contemporary epicardial ICD systems in adults.</p><p><strong>Objectives: </strong>This case series details the indications, techniques, safety, and long-term performance of surgically implanted epicardial high-voltage (HV) coils and leads in adults.</p><p><strong>Methods: </strong>We included all patients who received epicardial HV coils/leads at the Hospital of the University of Pennsylvania between 2014-2025.</p><p><strong>Results: </strong>Nineteen patients (14 male, median age 64 years) were identified. Indications included ICD replacement after lead extraction for endocarditis (7), placement during concomitant surgery, including for tricuspid regurgitation (6), left ventricular assist device (3), and lack of venous access (3). HV coils were used in 58% and 42% received epicardial leads. All patients received epicardial pace-sense leads; 68% received cardiac resynchronization therapy. HV coils/leads were sewn to the epicardium: 48% posterior left ventricle, 16% anterior right ventricle, 26% on both ventricles and 11% in the transverse sinus. Two patients had impedances >200 Ohms due to a loose set screw and a damaged connector pin, respectively. Two had impedances <20 Ohms without clinical impact. One coil fractured 1.5 years post-implant. No failed shocks or lead migrations occurred. During a median follow-up of 468 days, 26% died, largely from advanced heart failure, none attributable to surgery.</p><p><strong>Conclusion: </strong>Surgical implantation of epicardial ICD systems with HV coils/leads is safe and feasible. Multidisciplinary planning and long-term monitoring are essential.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142358","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 is not associated with altered left atrial microRNA expression profile in advanced heart failure patients.","authors":"Tímea Bálint, Mihály Ruppert, Bence Ágg, Dávid Nagy, Krisztina Pálóczi, Kálmán Szenthe, Ferenc Bánáti, Alex Ali Sayour, Attila Oláh, Bálint András Barta, Javier Barallobre-Barreiro, Péter Ferdinandy, Béla Merkely, Tamás Radovits","doi":"10.1016/j.hrthm.2025.05.041","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.041","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is common in patients with chronic heart failure (HF). Nevertheless, some patients with HF remain in sinus rhythm (SR) even with marked left atrial (LA) dilatation and fibrosis. The underlying mechanisms for the differences in atrial arrhythmogenicity are poorly uncovered. Recent findings indicate that distinct microRNAs (miRNA) might induce LA structural and molecular alterations. However, the impact of miRNA dysregulation on AF development in the context of HF has not been studied independently of LA remodeling.</p><p><strong>Objective: </strong>This study aimed to evaluate the differences in LA miRNA expressions in HF patients with AF or SR.</p><p><strong>Methods: </strong>LA myocardial samples were obtained from advanced HF patients with AF (n=12; paroxysmal n=4, chronic as persistent/permanent n=8) or SR (n=12) undergoing heart transplantation. The extent of LA interstitial fibrosis was evaluated using picrosirius red-staining. The LA load was estimated by measuring LA mRNA expression of the NPPA gene encoding atrial natriuretic peptide with qRT-PCR and circulating N-terminal proatrial natriuretic peptide (NT-proANP) by ELISA. The LA miRNA screening was performed using the NanoString technology.</p><p><strong>Results: </strong>LA dilatation, fibrosis, NPPA gene expression, as well as circulating NT-proANP levels were similar between the AF and SR groups, suggesting a comparable extent of atrial remodeling and load among the study groups. The miRNA analysis revealed no differences in atrial miRNA expression between the groups, even after AF subgroup analysis.</p><p><strong>Conclusion: </strong>The LA miRNA expression profile shows no distinction between AF and SR in advanced HF patients with similar levels of pathological atrial remodeling.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142387","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":"East Asian immigration and direct oral anticoagulant dosing for atrial fibrillation: A population-based cohort study.","authors":"Erika Nakajima, Andrew C T Ha, Feng Qiu, Peter C Austin, Cynthia A Jackevicius, Dennis T Ko, Paul Dorian, Douglas S Lee, Husam Abdel-Qadir","doi":"10.1016/j.hrthm.2025.05.040","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.040","url":null,"abstract":"<p><strong>Background: </strong>Some East Asian (EA) guidelines recommend lower doses of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) than in North America and Europe.</p><p><strong>Objective: </strong>Investigate the association of immigration from EA with DOAC dosing and outcomes in AF.</p><p><strong>Methods: </strong>Population-based cohort study using administrative databases of Ontario immigrants with AF aged ≥66 years who were dispensed DOAC prescriptions from 2012-2019. Birth country was classified as EA or not. We used multivariable logistic regression to assess the association of EA birth with DOAC dose and cause-specific hazards regression for the association of EA birth and DOAC dose with stroke/bleeding/death. Interaction between EA birth and DOAC dosing was studied for each outcome.</p><p><strong>Results: </strong>Among 14,421 immigrants, 3958 (27.4%) were born in EA. EA immigrants had lower odds of receiving full-dose DOACs versus non-EA immigrants (OR 0.64, 95%CI 0.58-0.69, p<0.001). EA birth was not associated with a composite of hospitalization for stroke/bleeding (HR 0.97, 95%CI 0.84-1.12, p= 0.67) nor hospitalization for stroke (HR 0.86, 95%CI 0.71-1.04, p= 0.13), but was associated with higher bleeding hazard (HR 1.15, 95%CI 1.02-1.30, p= 0.02) and lower mortality (HR 0.91, 95%CI 0.84-0.99, p= 0.04). There was no significant interaction between EA birth and DOAC dosing for stroke (p=0.41), bleeding (p=0.27), or death (p=0.33).</p><p><strong>Conclusions: </strong>EA immigrants were less likely to receive full-dose DOACs and had a higher bleeding hazard, similar stroke hazard, and lower mortality risk than non-EA immigrants. There was no evidence that DOAC dosing had a differential treatment effect in EA immigrants.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142394","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":"Effectiveness of upgrading to Left Bundle Branch Area Pacing compared with Biventricular Pacing in Patients with Right Ventricular Pacing-Induced Cardiomyopathy.","authors":"Chen He, Shun Xu, Chuangshi Wang, Xiaofei Li, Haojie Zhu, Jiaxin Zeng, Enrui Zhang, Jiangang Zou, Xiaohan Fan","doi":"10.1016/j.hrthm.2025.05.042","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.042","url":null,"abstract":"<p><strong>Background: </strong>Pacing-induced cardiomyopathy (PICM) occurs in some patients requiring high burden of right ventricular pacing (RVP).Whether left bundle branch area pacing (LBBAP) might be superior to biventricular pacing delivering cardiac resynchronization therapy (BiVP-CRT) remains unclear.</p><p><strong>Objective: </strong>The present study aimed to evaluate the effectiveness of LBBAP compared with BiVP in patients with PICM.</p><p><strong>Methods: </strong>This prospective, two-center observational study enrolled consecutive patients with PICM who underwent upgrading to either LBBAP or BiVP. LBBAP was further classified into left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP). The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to 6-month follow-up. Other echocardiographic parameters, NT-proBNP levels, New York Heart Association (NYHA) functional class, and clinical events (all-cause mortality, heart failure hospitalization, malignant ventricular arrhythmias) were evaluated during follow-up.</p><p><strong>Results: </strong>Totally 78 patients were included into the final analysis (33% patients with LVEF<35%), including 40 patients with LBBAP (30 with LBBP and 10 with LVSP) and 38 patients with BiVP. At the 6-month follow-up, LVEF improvement was significantly greater in patients with LBBAP than those with BiVP (9.59±7.48% vs 4.91±7.73%; P=0.008), and higher in LBBP than LVSP (10.62±7.28% vs 6.47±7.57). During a mean follow-up duration of 20.5 ± 12.5 months, clinical outcomes did not differ between BiVP and LBBAP groups [26.3% vs 17.5%; adjusted HR=1.57(0.55-4.48), P=0.395] after adjustment for confounders.</p><p><strong>Conclusion: </strong>PICM upgrading to LBBAP or BiVP demonstrated similar clinical outcomes, but upgrading to LBBAP was associated with greater improvement in LVEF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142351","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":"Diaphragmatic Hernia with a Non-Ischemic Electrocardiographic Presentation of the Spiked Helmet Sign.","authors":"Chang Dai, Zien Chen, Shulin Wu, Yumei Xue, Fangzhou Liu","doi":"10.1016/j.hrthm.2025.05.033","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.033","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142390","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":"Variability in Implantable Cardioverter-Defibrillator Battery Longevity.","authors":"James V Freeman, Michael Torre, Prashanthan Sanders, Niraj Varma, Tina Baykaner, Thomas Deering, Andrea M Russo, Yue Zhang, Benjamin A Steinberg","doi":"10.1016/j.hrthm.2025.05.031","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.031","url":null,"abstract":"<p><strong>Background: </strong>Implantable cardioverter-defibrillator (ICD) battery longevity impacts the need for generator replacement, with accompanying risk of complications and cost.</p><p><strong>Objective: </strong>We sought to identify factors associated with ICD battery longevity and compare manufacturers.</p><p><strong>Methods: </strong>We used a nationwide, multicenter remote monitoring dataset (PaceMate) to evaluate ICDs implanted between 2003-2023, assessing time from implant to replacement interval (RI). We compared Kaplan-Meier survival curves and device parameters across manufacturers. We evaluated observed vs manufacturer estimated battery longevity in devices that reached RI and compared estimated longevity for devices implanted in the last two years vs older. We performed Cox regression to measure battery longevity by device type, adjusting for manufacturer and parameters.</p><p><strong>Results: </strong>We evaluated 15,029 single-chamber, 10,822 dual-chamber, and 17,247 biventricular ICDs. Each additional lead resulted in approximately 2-3 years of lost battery longevity. Among devices reaching RI, Boston Scientific (BSX) transvenous had the longest longevity for single-chamber, dual-chamber, and biventricular ICDs by 2-3 years. Device parameters did not substantially vary across manufacturers. Among devices reaching RI, estimated and observed longevity were similar for all manufacturers. Estimated longevity improved by 2-4 years with ICDs implanted in the last two years, with attenuated differences between manufacturers. Manufacturer, programmed pulse width, and programmed output were the strongest determinants of longevity.</p><p><strong>Conclusion: </strong>ICD battery longevity varied substantially across device type (2-3 years less per additional lead), and by manufacturer (2-3 year differences). Newer devices had markedly improved longevity (2-4 years). Factors most associated with longevity were manufacturer, programmed pulse width, and programmed output.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142313","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 maternal exposure of digoxin and flecainide in relation to the safety and effectiveness in the treatment of non hydropic fetal tachycardia.","authors":"Rosa M A Smeets, Ingrid M van Beynum, Charlotte van Kesteren, Jérôme M J Cornette, Johanna A van der Zande, Jolien W Roos-Hesselink, Marieke M Beex-Oosterhuis, Robert B Flint","doi":"10.1016/j.hrthm.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.039","url":null,"abstract":"<p><strong>Background: </strong>Sustained fetal tachycardia requires transplacental antiarrhythmic therapy. Little is known about the dose-concentration-effect correlation and safety in the mother, fetus and newborn.</p><p><strong>Objective: </strong>This study evaluates the relationship between maternal dose of digoxin and flecainide therapy for fetal tachycardia, maternal and umbilical cord concentrations and side effects.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Methods: </strong>We included 28 pregnant women initially treated with digoxin monotherapy for fetal tachycardia between June 2007 and January 2023. The main endpoint was the correlation between maternal drug exposure, effect, and side effects.</p><p><strong>Results: </strong>Oral digoxin monotherapy converted 9 (32%) fetuses to sinus rhythm after a median of 4.5 days (IQR 3-6.5) 18 fetuses required additional oral flecainide (300 mg daily), resulting in a total conversion rate of 93% (26/28). Equal starting doses of digoxin caused similar maternal digoxin concentrations regardless of gestational age, with no significant difference between responders and non-responders (p=0.504). Side effects, primarily nausea, led to dose reductions, but treatment remained effective. Maternal digoxin concentrations remained stable throughout pregnancy and little inter-patient variability was observed. Flecainide exposure varied both within and between patients. The median fetus/mother digoxin ratio was similar in both monotherapy (n=3) and combination (n=9) therapy groups (0.51 (IQR 0.28-0.76) vs 0.45 (IQR 0.39-0.64), p=0.864). The median fetus/mother flecainide ratio was 0.82 (IQR 0.69-1.29).</p><p><strong>Conclusion: </strong>Digoxin monotherapy successfully treated fetal tachycardia in only 32% of cases. Adding flecainide improved response to 93%, although it increased side effects, which could be managed with dose reductions. Maternal digoxin levels were stable throughout pregnancy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142230","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":"Utility of ultra-rapid genomic testing for management of malignant pediatric arrhythmia.","authors":"Yuji Doi, Andreas Pflaumer, Ivan Macciocca, Vanessa Connell, Sebastain Lunke, Zornitza Stark, Andrew Davis","doi":"10.1016/j.hrthm.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.037","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142237","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":"Right atrial cardioneuroablation of asystolic reflex syncope.","authors":"Leonardo Calò, Marco Rebecchi, Ermenegildo De Ruvo, Domenico Giamundo, Antonella Sette, Marco Tomaino, Matthias Hunteruber, Nicola Bottoni, Matteo Iori, Paolo Donateo, Roberto Maggi, Attilio Del Rosso, Martina Rafanelli, Vincenzo Russo, Stefano Strano, Michele Brignole","doi":"10.1016/j.hrthm.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.038","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) should focus on the vagal ganglia located in right atrium close to the sinoatrial and the atrioventricular nodes OBJECTIVE: To evaluate efficacy and safety of right atrial CNA METHODS: Patients with severe, asystolic reflex syncopes identified by implantable loop recorder (ILR) or tilt testing underwent right atrial CNA and were subsequently monitored using ILR.</p><p><strong>Results: </strong>The population included 28 patients with a mean age of 40.5±13.4 years, of whom 71% were male. Over a median follow-up period of 12.5 months, 8 patients experienced 44 episodes of asystole lasting longer than 3 seconds, as recorded by an ILR. The burden of asystolic episodes significantly reduced from 0.89 episodes per month before CNA (145 over 163 patient-months) to 0.11 episodes per month after CNA (44 over 397 patient-months), with a relative risk reduction (RRR) of 0.12, p=0.0001. Similarly, the burden of syncopal episodes decreased from 0.23 episodes per month before CNA to 0.06 episodes per month after CNA, resulting in an RRR of 0.24, p=0.0001. Median heart rate increased from 75 bpm (IQR: 72-79) before ablation to 83 bpm (IQR: 78-85) after ablation, lasting up to 9 months post-procedure. No patients experienced complications during the procedure. During follow-up, two patients received pacemakers, one underwent a redo procedure, and four experienced mild transient symptoms: three had palpitations and one had dyspnoea, none requiring therapy.</p><p><strong>Conclusion: </strong>Right atrial CNA reduced asystolic episodes by 88% and syncopal episodes by 76% during the mid-term follow-up. Adverse events were infrequent and mild.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142146","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}