Heart rhythm最新文献

{"title":"Slow/fast atrioventricular nodal reentrant tachycardia catheter ablation guided by atrial resetting: The new insight.","authors":"Saer Abu-Alrub, Finet Florian, Antoine Boudias, Pierre-Antoine Catalan, Frédéric Jean, Guillaume Clerfond, Romain Eschalier, Grégoire Massoullié","doi":"10.1016/j.hrthm.2025.03.1940","DOIUrl":"10.1016/j.hrthm.2025.03.1940","url":null,"abstract":"<p><strong>Background: </strong>Atrial resetting can be used to discern the anterograde pathway in slow/fast atrioventricular nodal reentrant tachycardia (AVNRT).</p><p><strong>Objective: </strong>We aimed to assess the prevalence of right inferior extension (RIE) and left extension (LE) and the potential impact on the ablation approach.</p><p><strong>Methods: </strong>During the electrophysiologic study of patients with slow/fast AVNRT, a decremental supraventricular extrastimulus was delivered within the vulnerability window of the tachycardia cycle at 2 distinct sites: the inferoparaseptal area of the Koch triangle (near the RIE) and the proximal few centimeters of the coronary sinus (near the LE). The site with the latest extrastimulus (longest H-Stim) that could reset the tachycardia was defined as the site of the anterograde slow pathway.</p><p><strong>Results: </strong>Thirty-six patients were enrolled during a 1-year period. Resetting could not be performed in 10 patients (28%) because of nonsustained tachycardia and in 1 patient because of failed atrial capture. Of the remaining 25 patients (69%), 18 (72%) had the best resetting from the RIE, 5 (20%) had the best resetting from the LE, and 2 (8%) had 2 alternating AVNRTs. The mean H-Stim value in the RIE position was longer when resetting favored RIE compared with LE (46 ± 13 ms vs 16 ± 21 ms; P < .001); a similar pattern was observed in the LE position (59 ± 20 ms vs 15 ± 18 ms; P < .001). Ablation of the left inferior extension could be performed from the right side but significantly closer to the His bundle compared with the RIE (9.6 ± 3 mm vs 18.5 ± 4 mm; P < .001).</p><p><strong>Conclusion: </strong>LE AVNRT is a common finding and can be ablated by a right-sided approach in most cases.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630327","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":"Mortality and readmissions after ventricular tachycardia ablation: An analysis of inpatient and outpatient state databases.","authors":"Peter G Brodeur, Enrico G Ferro, Timothy G Maher, Jonathan W Waks, Andre d'Avila, ZhaoNian Zheng, Peter J Zimetbaum, Gregory F Michaud, Shu Yang, Alfred E Buxton, Patricia Tung, Robert W Yeh, Andrew H Locke, Daniel B Kramer","doi":"10.1016/j.hrthm.2025.03.1939","DOIUrl":"10.1016/j.hrthm.2025.03.1939","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is an effective therapy for ventricular tachycardia (VT) and is increasing in use. Assessment of contemporary real-world outcomes of VT ablation requires data inclusive of both inpatient and outpatient encounters.</p><p><strong>Objective: </strong>We aimed to assess factors associated with 1-year in-hospital mortality, all-cause readmission, and recurrent readmission for VT after VT ablation along with the associated costs of care.</p><p><strong>Methods: </strong>Inpatient and outpatient VT ablations were captured in the Healthcare Cost and Utilization Project data in Florida, Maryland, and New York from 2016 to 2020 with 1-year follow-up through 2021. Cox proportional hazards regression was used to identify risk factors associated with 1-year in-hospital mortality, all-cause readmission, and recurrent VT readmission. Costs of inpatient cases and readmission were captured.</p><p><strong>Results: </strong>Of 3899 patients undergoing VT ablation, 2% died during the initial episode of care. The 1-year in-hospital mortality rate, all-cause readmission rate, and recurrent VT readmission rate were 6.8%, 43.4%, and 16.9%, respectively, and were broadly stable during the study period. Coronary artery disease, chronic kidney disease, and heart failure were independently associated with an increased risk of in-hospital mortality and all-cause readmission within 1 year (P < .05). Recurrent VT was the most common cause of readmission. All-cause readmissions increased costs by 55%.</p><p><strong>Conclusion: </strong>Mortality, long-term readmission, and recurrent VT remain high after VT ablation and include measurably important costs. Strategies to improve freedom from recurrent VT while managing comorbid conditions may serve as targets for improving the efficacy and cost-effectiveness of an important procedure applied to a vulnerable population.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630326","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 Efficacy of a Standardized Catheter Ablation Strategy Utilizing Recent Advanced Technologies in Preventing Permanent Atrial Fibrillation.","authors":"Atsuhiko Yagishita, Kyong Hee Lee, Kazuma Iimura, Susumu Sakama, Mari Amino, Yuji Ikari, Koichiro Yoshioka","doi":"10.1016/j.hrthm.2025.03.1885","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1885","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624270","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":"Extent of myocardial injury after pulmonary vein isolation using 3 different pulsed field ablation systems.","authors":"Patrick Badertscher, Jonas Brügger, Corinne Isenegger, Sven Knecht, Behnam Subin, David Spreen, Nicolas Schaerli, Philipp Krisai, Felix Mahfoud, Christian Sticherling, Michael Kühne","doi":"10.1016/j.hrthm.2025.03.1884","DOIUrl":"10.1016/j.hrthm.2025.03.1884","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624267","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":"Comparison of 30-day complications between a tine-based and a screw-in helix fixation single-chamber ventricular leadless pacemaker: Results of a propensity score-matched analysis from a multicenter, nationwide registry.","authors":"Pietro Palmisano, Giovanni Rovaris, Domenico Giovanni Della Rocca, Paolo Della Bella, Ennio Carmine Luigi Pisanò, Lorenzo Mazzocchetti, Zefferino Palamà, Gabriele Dell'Era, Antonio Strangio, Antonio Dello Russo, Vincenzo Paolo Caccavo, Antonio Curcio, Cosimo Mandurino, Giorgio Spiniello, Domenico Gianfrancesco, Giovanni Caroli, Massimo Grimaldi, Giovanni Volpato, Fabio Megna, Giuseppe Patti, Giuseppe Tricarico, Stefano Guarracini, Elena Marino, Marzi Alessandra, D'Angelo Giuseppe, Ingrid Overeinder, Elisabetta Montemerlo, Giuseppe Campisi, Giovanni Coluccia, Antonino Nicosia","doi":"10.1016/j.hrthm.2025.03.1881","DOIUrl":"10.1016/j.hrthm.2025.03.1881","url":null,"abstract":"<p><strong>Background: </strong>Medtronic Micra VR and Abbott Aveir VR are 2 single-chamber ventricular leadless pacemakers (L-PMs) currently available in clinical practice. They differ in their design, fixation mechanism (tine-based fixation for Micra VR, screw-in helix fixation for Aveir VR), and implantation technique. Few comparative safety data are available for these L-PMs.</p><p><strong>Objective: </strong>We aimed to compare the rate of acute procedure-related complications of patients undergoing Aveir VR vs Micra VR implantation.</p><p><strong>Methods: </strong>A prospective, multicenter, observational registry enrolled consecutive patients who underwent Aveir VR or Micra VR implantation. The rate and nature of device-related complications at 30-day follow-up were analyzed and compared between the groups. Individual 1:1 propensity score matching of baseline characteristics was performed.</p><p><strong>Results: </strong>A total of 1141 patients (75.9 ± 14.8 years; 60.2% male) were enrolled: 211 Aveir VR and 930 Micra VR. Propensity score matching yielded 189 matched pairs. In the matched cohort, the risk of device-related complications at 30 days of follow-up of the 2 L-PMs was similar (2.1% vs 2.1%; P = 1). Device migration (1.6% vs 0.5%; P = .315) and vascular complications (0.5% vs 1.1%; P = .562) were the most frequent complications, with no significant differences between the groups. Cardiac perforation was rare (1 case in the Micra VR group, no cases in the Aveir VR group).</p><p><strong>Conclusion: </strong>The risk of acute device-related complications associated with Aveir VR and Micra VR L-PM implantation was similar. These findings suggest that despite differences in design, fixation mechanism, and implantation technique, these 2 devices appear to have a similar short-term safety profile.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614654","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":"Development and validation of a new disease-specific quality-of-life measure for atrial fibrillation derived from patient perspectives: The Atrial Fibrillation Patient-Reported Outcome Measures (AF-PROMs) Questionnaire.","authors":"Vijayabharathy Kanthasamy, Richard J Schilling, Sarah Horan, Victoria Baker, Nikhil Ahluwalia, Ross J Hunter, Shohreh Honarbakhsh, Malcolm Finlay","doi":"10.1016/j.hrthm.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) significantly affects patients' health-related quality of life (HRQoL), influencing physical, psychological, and social wellbeing. Despite existing tools, there is a notable lack of AF-specific instruments that comprehensively assess HRQoL and are developed in collaboration with patients from the outset.</p><p><strong>Objective: </strong>This study aimed to develop and validate the AF specific Patient Reported Outcome Measures questionnaire (AF-PROMs), a novel, patient-centered tool designed to measure HRQoL in patients with AF.</p><p><strong>Methods: </strong>A prospective, observational study was conducted across 2 centers in the United Kingdom, enrolling 856 participants (265 in the pilot phase, 550 in the field-validation phase). Item generation and domain selection were guided by extensive patient and public involvement (PPI), through focus groups and qualitative interviews with patients, ensuring content validity. Psychometric evaluations included exploratory (EFA) and confirmatory factor analyses (CFA), along with assessments of reliability, responsiveness, and known-group validity.</p><p><strong>Results: </strong>The AF-PROMs tool demonstrated excellent internal consistency across all domains (Cronbach's alpha ≥0.89) and strong test-retest reliability (intraclass correlation coefficient [ICC] >0.97), highlighting its stability. The tool showed robust responsiveness to clinical changes, particularly post-catheter ablation, with moderate to large effect sizes (Cohen's d ≥1.0 for overall score), underscoring its sensitivity to meaningful treatment effects. The 3-factor model achieved a satisfactory fit. Known-group validity was confirmed by significant score differences (P < .01) between healthy volunteers and patients with AF across all domains.</p><p><strong>Conclusion: </strong>AF-PROMs is a validated, patient-centered instrument, developed with the largest participant group to date, offering a comprehensive assessment of HRQoL in patients with AF. Its unique strengths include extensive patient involvement, high reliability, and sensitivity to clinical interventions, making it a valuable tool for both clinical practice and research in enhancing the measurement of HRQoL in AF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751903","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":"Biomarkers and prediction models: Envisioning the future of atrial fibrillation detection after stroke.","authors":"Giulio Francesco Romiti, Valeria Trapani, Marco Proietti","doi":"10.1016/j.hrthm.2025.02.051","DOIUrl":"10.1016/j.hrthm.2025.02.051","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585242","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, Mohamed Boutjdir","doi":"10.1016/j.hrthm.2025.03.1879","DOIUrl":"10.1016/j.hrthm.2025.03.1879","url":null,"abstract":"<p><p>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 autoimmune cardiac channelopathies 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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-07","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, Jorge L Reyes, Sima Patel, Hannah Simpson, Richard Sutton, Ciana Keller, Roland D Thijs, J Gert Van Dijk, David G Benditt","doi":"10.1016/j.hrthm.2025.03.166","DOIUrl":"10.1016/j.hrthm.2025.03.166","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (P=.003 and P=.013). Further, the ratio of the ΔHR increase to ΔBP drop was lower (P=.001) during stretch-induced hypotension than during comparable hypotension induced immediately after AS.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-07","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}

{"title":"Quantitative histologic assessment of atrial fibrillation-associated fibrosis in animal models: A systematic review.","authors":"Rikke Marion-Knudsen, Lucas Alexander Lindberg, Thomas Jespersen, Arnela Saljic","doi":"10.1016/j.hrthm.2025.03.1880","DOIUrl":"10.1016/j.hrthm.2025.03.1880","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common sustained arrhythmia, and cardiac fibrosis is a major component in driving its progressive nature. Quantitative histologic assessment of fibrosis in animal models is crucial for understanding AF, but current published studies present various methodologies that limit comparison. This systematic review examines 195 AF studies across multiple animal models (mice, rats, goats, dogs, pigs, and horses) to summarize (1) quantified fibrosis results and (2) methodologies for histologic fibrosis assessment; and (3) evaluate antifibrotic therapies used in these studies. The fibrosis quantified across the studies ranged from 0.34%-60.2% depending on the animal, intervention model, and quantification method. The findings underscore the need for a standardized fibrosis quantification protocol in AF research, enabling comparison across studies and offering greater insight into potential pharmacologic interventions.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585395","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}