Heart rhythm最新文献

{"title":"Predictors of left atrial thrombi for subsequent thromboembolisms: Risk factors derived from echocardiography.","authors":"Tomoki Horie, Shinsuke Miyazaki, Yasutoshi Nagata, Ryoichi Miyazaki, Hirofumi Kujiraoka, Satoshi Hara, Tasuku Yamamoto, Hirofumi Arai, Toshiki Michishita, Ryo Tateishi, Shigeo Shimizu, Shu Yamashita, Moe Mukai, Shinsuke Iwai, Hiroyuki Okada, Akifumi Tanaka, Masahito Suzuki, Emiko Nakashima, Yuichi Ono, Seiji Fukamizu, Yasuteru Yamauchi, Hiroshi Tada, Hitoshi Hachiya, Makoto Suzuki, Koji Azegami, Osamu Inaba, Atsushi Takahashi, Takashi Ashikaga, Tetsuo Sasano","doi":"10.1016/j.hrthm.2025.03.164","DOIUrl":"10.1016/j.hrthm.2025.03.164","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the management of left atrial thrombi (LATs) is limited.</p><p><strong>Objectives: </strong>We aimed to investigate factors associated with subsequent thromboembolism in patients with LATs and explored potential management approaches.</p><p><strong>Methods: </strong>This multicenter retrospective study consecutively enrolled patients who underwent morphological assessment of LAT using echocardiography. We evaluated associations between clinical and echocardiographic variables and the occurrence of symptomatic thromboembolism.</p><p><strong>Results: </strong>Two hundred six patients from 15 centers were enrolled. During follow-up period after echocardiographic diagnosis (651 days; interquartile range 174-1316 days), 19 patients (9.2%) developed thromboembolism. Cox regression analysis identified 3 independent predictors of thromboembolism: LAT maximum length > 20 mm (hazard ratio [HR] 2.63; 95% confidence interval [CI] 1.03-6.68; P=.043), reduced left ventricular ejection fraction (≤40%) (HR 2.95; 95% CI 1.14-7.63; P=.026), and thrombus mobility (HR 3.40; 95% CI 1.27-9.11; P=.015). Patients with ≥2 of these factors (52 [25.2%]) were categorized as the high-risk group, while those with <2 factors (154 [74.8%]) formed the low-risk group. Patients in the high-risk group had a higher incidence of thromboembolism (12 [23.1%] vs 7 [4.5%]; P<.001), despite a higher proportion undergoing urgent surgical thrombectomy (UST; 9 [17.3%] vs 9 [5.8%]; P=.025) compared with the low-risk group. In high-risk patients, UST was associated with a significantly lower rate of adverse outcomes, including all-cause mortality, heart failure hospitalizations, major bleeding, and thromboembolisms, at 90 days (0% vs 35.6%; log-rank, P=.048).</p><p><strong>Conclusion: </strong>In patients with LATs, large thrombus size, reduced left ventricular ejection fraction, and thrombus mobility were associated with subsequent thromboembolism. UST was associated with fewer adverse clinical outcomes in patients with ≥2 risk factors.</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":"143585328","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":"Feasibility of repeated on-demand smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: Data from the ISOLATION study.","authors":"Emma Sandgren, Konstanze Betz, Monika Gawalko, Astrid Hermans, Zarina Habibi, Dominique Verhaert, Suzanne Philippens, Bianca Vorstermans, Dennis den Uijl, Sevasti-Maria Chaldoupi, Justin Luermans, Theo Lankveld, Ulrich Schotten, Kevin Vernooy, Dominik Linz","doi":"10.1016/j.hrthm.2025.03.165","DOIUrl":"10.1016/j.hrthm.2025.03.165","url":null,"abstract":"<p><strong>Background: </strong>The preferred outcome after atrial fibrillation (AF) ablation is reducing AF burden, reflected by time spent with AF. Digital tools provide novel strategies to approximate time spent with AF.</p><p><strong>Objectives: </strong>The purpose of this study was to assess the feasibility of repeated on-demand heart rhythm and symptom monitoring and analyze time spent with AF and symptoms over 12 months after AF ablation.</p><p><strong>Methods: </strong>Patients were instructed to monitor heart rhythm and symptoms using an on-demand photoplethysmography-supported smartphone application 3 times daily for 7 days at 3-, 6-, and 12-month follow-ups. Metrics assessed included AF load and density, symptom load and density, and symptom-rhythm correlation.</p><p><strong>Results: </strong>A total of 191 patients (median age 65 years [interquartile range 58-71 years]) 65% (n = 125/191) male) were included. Patient adherence (-7%; P=.04) declined slightly over 12 months. Forty-five patients (24%) had AF recurrence and 136 (71%) symptom recurrence. Among patients with high AF load and density at 3 months, 73% (n = 11/15) and 88% (n = 7/8) remained in the respective high class; among patients with low AF load and density, 0% (n = 0/1 respective n = 0/1) remained in the low class. Among patients with high symptom load and density, 84% (n = 36/43) and 75% (n = 15/20) remained in the respective high class; among patients with low symptom load and density, 0% (n = 0/12 respective n = 0/2) remained in the low class. Symptom-rhythm correlation was high (median 97% [interquartile range 77%-100%]).</p><p><strong>Conclusion: </strong>Repeated on-demand smartphone-based monitoring is feasible after AF ablation. Patient adherence declined slightly over 12 months. At 3 months, high AF and symptom load reliably predicted the following year while low AF and symptom load necessitate repeated monitoring.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585319","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 of arrhythmias in chronic obstructive pulmonary disease, obstructive sleep apnea, and overlap syndrome: A retrospective cohort study.","authors":"Hoang Nhat Pham, Christopher Kanaan, Ramzi Ibrahim, Mahmoud Abdelnabi, Sabrina Soin, George Bcharah, Eiad Habib, Omar Baqal, Juan Farina, Jiang Xie, Amitoj Singh, Chadi Ayoub, Reza Arsanjani, Justin Z Lee, Hicham El Masry, Dan Sorajja, Anwar A Chahal","doi":"10.1016/j.hrthm.2025.02.042","DOIUrl":"10.1016/j.hrthm.2025.02.042","url":null,"abstract":"<p><strong>Background: </strong>New-onset arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). However, scarce data exist regarding arrhythmia risk in overlap syndrome (OS), encompassing COPD and OSA.</p><p><strong>Objective: </strong>We compared the incidence of new-onset atrial and ventricular arrhythmias in patients with COPD, OSA, and OS.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Network, comprising >140 million patients to identify patients with COPD, OSA, and OS. Patients with pre-existing arrhythmias were excluded. Propensity score matching (PSM) was used to adjust for demographics, comorbidities, and medications. Adjusted odds ratios (aORs) were estimated to compare incidence of arrhythmias across cohorts.</p><p><strong>Results: </strong>Between 2010 and 2020, a total of 2,438,454 patients with COPD only, 1,960,845 patients with OSA only, and 440,018 patients with OS (age ≥18 years) were identified. After PSM, we included 359,496 patients per cohort for the OS vs OSA-only comparison and 399,235 patients per cohort for the OS vs COPD-only comparison. Over a mean follow-up of 5.3 years, incidence of new-onset atrial fibrillation/flutter was 10.0% in OS vs 7.0% in COPD (aOR 1.472, 95% confidence interval [CI] 1.449-1.496) and 6.4% in OSA (aOR 1.568, 95% CI 1.541-1.595). Patients with OS had higher incidence of new-onset ventricular tachycardia and cardiac arrest than those with COPD (aOR 1.442 and 1.189, respectively) and OSA (aOR 1.645 and 1.777, respectively). Patients with COPD preceding OSA diagnosis had higher odds of new-onset arrhythmias.</p><p><strong>Conclusion: </strong>Patients with OS have a higher incidence of new-onset atrial fibrillation/flutter, ventricular tachycardia, and cardiac arrest compared with those with OSA and COPD alone.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566919","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":"Adherence to CPAP for patients with atrial fibrillation undergoing catheter ablation: A \"real-world\" analysis.","authors":"Dimitrios Varrias, Andrew Kossack, Jonas Leavitt, Chandra Chhetri, Victoria Roselli, Sara Velichkovikj, Erica Altschul, Kabir Bhasin, Bushra Mina, Margarita Oks, Kristie M Coleman, Stavros E Mountantonakis","doi":"10.1016/j.hrthm.2025.03.163","DOIUrl":"10.1016/j.hrthm.2025.03.163","url":null,"abstract":"<p><strong>Background: </strong>The relationship between obstructive sleep apnea (OSA) and atrial fibrillation (AF) is well established, as the existing literature has concluded that sleep apnea creates a unique, complex, and dynamic substrate for AF with various pathophysiological mechanisms. Little is known about the role of continuous positive airway pressure (CPAP) therapy in reversing the risk of AF recurrence in patients with OSA. Awareness of the therapeutic effects of CPAP in preventing AF recurrence postablation will help create a multidisciplinary team of doctors to treat this complex population of patients.</p><p><strong>Objectives: </strong>The goals of this study were to examine the effect of CPAP adherence on AF-free survival post-catheter ablation and to identify the indicated average CPAP use to maximize AF-free survival postablation.</p><p><strong>Methods: </strong>We selected 190 consecutive patients who underwent catheter ablation for AF at Lenox Hill Hospital in New York and who had a concurrent diagnosis of OSA. In this retrospective case-control study, 97 (51%) patients with OSA adherent to CPAP use were carefully matched with 93 (49%) patients who were not adherent to CPAP guidelines for patients with OSA.</p><p><strong>Results: </strong>The mean age of the population was 66.3 ± 9.4 years, and 78% were male. Patients in the adherent group had a recurrence rate of 24% until their last follow-up visit compared with 42% in the nonadherent group (P=.02). In a stepwise multivariate regression model, adherence to CPAP was independently associated with lower chances of composite AF recurrence with an odds ratio of 0.24 (CI 95% = 0.08-0.68; P = .007). Using the receiver operating characteristic curve, we identified the optimal average nightly CPAP duration required to observe a clinical benefit and reperformed the above analysis. With a new cutoff set at 287 minutes of CPAP per night, the adjusted odds ratio for AF recurrence was 0.17 (CI 95% = 0.12-0.71; P=.004). In a secondary analysis, patients who were not adherent to optimal CPAP use did not show any benefit compared with patients who did not use CPAP at all (56% vs 59%; P = .75).</p><p><strong>Conclusion: </strong>Consistent nightly CPAP use offers a 3-year AF-free survival postablation in 1 of 5 patients with OSA who undergo ablation for AF. Inconsistent CPAP use, defined as <287 minutes per night, offers no benefit compared with no CPAP.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585301","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":"Risk scores inconsistently predict sudden death and ventricular arrhythmias in repaired tetralogy of Fallot.","authors":"Jayant Kakarla, Ayako Ishikita, Adrian Suszko, Rachel Wald, Krishnakumar Nair","doi":"10.1016/j.hrthm.2025.02.041","DOIUrl":"10.1016/j.hrthm.2025.02.041","url":null,"abstract":"<p><strong>Background: </strong>Risk scores designed to predict adverse events (AEs) including sudden death and ventricular arrhythmias can guide heightened surveillance and defibrillator (ICD) implantation. Variability in risk stratification derived from differing scores and guidelines has not been examined in repaired tetralogy of Fallot (rTOF).</p><p><strong>Objectives: </strong>We aimed to determine the consistency in risk prediction of AEs across published scoring systems in patients with rTOF without a secondary prevention ICD indication.</p><p><strong>Methods: </strong>We undertook a retrospective review of patients with rTOF without a secondary prevention ICD indication or severe left ventricular impairment from an institutional database. Predicted AEs were calculated across 5 published scores and 3 clinical management guidelines. The prediction of a \"high-risk\" cohort, using a 4% predicted AE threshold, was compared across the scoring criteria. Observed AE, ICD implantation, and device complications were recorded.</p><p><strong>Results: </strong>A total of 156 patients (median 32, interquartile range [IQR] 25-46 years; 53% female) had 4 AEs (3 sustained ventricular tachycardias [VTs], 1 sudden death) over a median of 24 months (IQR 15-36 months). In total, 41% of patients (n = 64) had risk score variability affecting assignment of high-risk status. Heterogeneity in the predicted AE risk was associated with moderate or worse right ventricular impairment or significant late gadolinium enhancement (P < .001). No criteria predicted all AEs with 2 events only predicted by 1 score. Seven ICD implants treated 3 sustained VT episodes with 3 device-related complications.</p><p><strong>Conclusion: </strong>Risk scores are heterogeneous and imperfect for determination of those at high risk of AEs in rTOF. Use of multiple criteria alongside adjuvant stratification strategies and multidisciplinary discussion remains necessary.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566920","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":"Predictors of atrial fibrillation freedom postablation with the pentaspline pulsed field ablation catheter: Subanalysis of the ADVENT Study.","authors":"Stavros E Mountantonakis, Edward P Gerstenfeld, Moussa Mansour, Frank A Cuoco, Andrea Natale, Chinmay Patel, Douglas N Gibson, Blair D Halperin, Pasquale Santangeli, Benjamin D'Souza, Kristie M Coleman, Elizabeth Richards, Elizabeth M Albrecht, Christopher W Schneider, Brad S Sutton, Vivek Y Reddy","doi":"10.1016/j.hrthm.2025.03.161","DOIUrl":"10.1016/j.hrthm.2025.03.161","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) has proven to be at least noninferior to thermal ablation for paroxysmal atrial fibrillation (AF). Predictors of AF freedom for PFA have not yet been described.</p><p><strong>Objective: </strong>The purpose of this study was to identify clinical and procedural predictors of treatment success in paroxysmal AF patients treated with the pentaspline PFA catheter.</p><p><strong>Methods: </strong>ADVENT (Randomized Controlled Trial for Pulsed Field Ablation versus Standard of Care Ablation for Paroxysmal Atrial Fibrillation) was a prospective randomized trial comparing PFA to thermal ablation with centers designated to randomize patients to either radiofrequency or cryoballoon ablation. Hazard ratios were estimated to evaluate clinical and procedural characteristics associated with ablation success. Subgroup analyses were performed by ablation modality and operator/center experience.</p><p><strong>Results: </strong>Of the 607 randomized patients (age 62.4 years, 34.6% female), treatment failure was documented in 26.7% of PFA and 28.7% of thermal ablation patients. The most common failure was arrhythmia recurrence (73.8% vs 76.5%) with no difference in subtype (non-AF arrhythmia: 12.1% PFA vs 14.6% thermal). Patients who previously failed Class I/III antiarrhythmic drugs (AADs) were more likely to benefit from PFA (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.44-0.96). Shorter left atrial dwell time was associated with higher success (HR 0.48, 95% CI 0.30-0.76), and a trend toward better outcomes was noted for patients enrolled during the second half of the trial (75.5% vs 69.9%, P = .17). PFA patients had similar success across radiofrequency and cryoballoon centers.</p><p><strong>Conclusion: </strong>PFA with the pentaspline catheter is not associated with a higher incidence of postablation atypical flutters/tachycardias. Patients with previous Class I/III AAD failure are more likely to benefit from PFA and greater operator experience, irrespective of previous thermal modality, may be associated with better outcomes.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585323","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":"Association of comorbidity patterns with outcomes and relation with the ABC pathway effectiveness in European patients with atrial fibrillation.","authors":"Giulio Francesco Romiti, Bernadette Corica, Davide Antonio Mei, Marco Vitolo, Tommaso Bucci, Arnaud Bisson, Laurent Fauchier, Giuseppe Boriani, Marco Proietti, Gregory Y H Lip","doi":"10.1016/j.hrthm.2025.02.049","DOIUrl":"10.1016/j.hrthm.2025.02.049","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrial fibrillation (AF) show increasingly complex comorbidity profiles, with detrimental effects on prognosis.</p><p><strong>Objective: </strong>The purpose of this study was to explore patterns of comorbidities in patients with AF.</p><p><strong>Methods: </strong>From a European-wide prospective observational registry of AF patients, we performed a latent class analysis to identify patterns of comorbidities. We analyzed association with use of oral anticoagulant (OAC) and with clinical outcomes at 2 years. Primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Association of the Atrial fibrillation Better Care (ABC) pathway on the risk of primary outcome across groups was also assessed.</p><p><strong>Results: </strong>A total of 9613 AF patients were included (mean age 68.9 ± 11.4 years, 40.2% female). We identified 5 comorbidity patterns, with increasing clinical complexity phenotypes: low morbidity (46.1%), cardiovascular (25.0%), metabolic (11.3%), \"heart failure\" (9.7%), and multisystemic pattern (8.0%). OACs were less used in the \"heart failure\" and multisystemic patterns (odd ratio [OR] 0.69, 95% confidence interval [CI] 0.53-0.90; and OR 0.36, 95% CI 0.26-0.50, respectively), and more used in the metabolic pattern (OR 1.41, 95% CI 1.06-1.86). Compared with the low-morbidity phenotype, all other patterns except for the metabolic pattern were associated with hazard of the primary outcome, with highest magnitude observed for the \"heart failure\" (hazard ratio [HR] 2.18, 95% CI 1.74-2.72) and multisystemic patterns (HR 2.14, 95% CI 1.62-2.82). Adherence to the ABC pathway was similarly associated with reduced hazard of the primary outcome across all groups (P for interaction = .885).</p><p><strong>Conclusion: </strong>Comorbidities patterns are heterogeneously associated with treatment and prognosis in AF patients. Adherence to the ABC integrated pathway showed similar association with outcomes across all comorbidity patterns.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585303","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, William G Stevenson, Travis D Richardson, Arvindh N Kanagasundram, Kanae Hasegawa, Masaaki Kurata, Daisuke Togashi, Salah H Alahwany, Tiffany Hu, Giovanni E Davogustto, Zachary T Yoneda, Sharon T Shen, Jay A Montgomery, Harikrishna Tandri","doi":"10.1016/j.hrthm.2025.02.044","DOIUrl":"10.1016/j.hrthm.2025.02.044","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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_VT).</p><p><strong>Methods: </strong>This was a retrospective review of induced VTs that had a HisRB potential recorded while pacing from the distal right ventricle.</p><p><strong>Results: </strong>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_VT was >135 ms, falling within the QRS in 87% of SRR-VTs, and 30-135 ms in all BBR-VTs (P < .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 >135 ms combined with S-HisRB - Egm-HisRB_VT difference <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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-04","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":"Iatrogenic aortic dissection during catheter ablation for ventricular arrhythmia.","authors":"Ke Chen, Weili Ge, Yiwei Lai, Deyong Long, Caihua Sang, Ronghui Yu, Ribo Tang, Songnan Li, Chenxi Jiang, Xianqing Wang, Weifeng Song, Erpeng Liang, Xiaobiao Zang, Jifang Ma, Jungang Nie, Liguo Jian, Shuiyin Ding, Chuanyu Gao, Rong Bai, Jianzeng Dong, Changsheng Ma","doi":"10.1016/j.hrthm.2025.02.046","DOIUrl":"10.1016/j.hrthm.2025.02.046","url":null,"abstract":"<p><strong>Background: </strong>Attempted catheter manipulation through the retrograde aortic approach carries a risk of aortic dissection (AD) during catheter ablation.</p><p><strong>Objective: </strong>This study aimed to determine the incidence, management, and outcomes of iatrogenic AD associated with ablation of ventricular arrhythmia (VA).</p><p><strong>Methods: </strong>All patients who sustained iatrogenic AD during retrograde aortic VA ablation at 6 centers between January 1, 2011, and September 30, 2023, were prospectively identified.</p><p><strong>Results: </strong>Of 5925 patients who underwent ablation procedures during the study period, iatrogenic AD developed in 18 (0.3%; 8 type A AD, 10 type B AD) during the procedure. The mean age was 65.4 ± 5.3 years, and 5 patients (27.8%) were female. Considerable catheter resistance was reported in all cases. Presenting symptoms included sudden-onset severe chest pain (n = 13 [72.2%]), back pain (n = 9 [50%]), abdominal pain (n = 3 [16.7%]), and syncope (n = 3 [16.7%]). Of the type A AD patients, 3 (37.5%) with antegrade dissection underwent surgical repair, and 2 (25%) with retrograde dissection were successfully managed conservatively. Three (30%) of the type B AD patients underwent endovascular intervention and 7 (70%) were managed medically. Three patients (16.7%) died; all had type A AD and died of severe hemodynamic compromise. None of the 15 survivors had aorta-related complications during a mean follow-up of 72.7 ± 46.8 months.</p><p><strong>Conclusion: </strong>Iatrogenic AD is a rare but potentially lethal complication of retrograde aortic VA ablation. Comprehensive measures should be taken to reduce the risk of iatrogenic AD.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572268","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":"Consequences of electrocardiography screening for prolonged QTc in neonates-A systematic review.","authors":"Anna Leppänen, Emmi Helle, Ilari Kuitunen","doi":"10.1016/j.hrthm.2025.02.045","DOIUrl":"10.1016/j.hrthm.2025.02.045","url":null,"abstract":"<p><strong>Background: </strong>An ongoing discussion has been the effectiveness of neonatal electrocardiography (ECG) screening for long QT syndrome (LQTS).</p><p><strong>Objective: </strong>The aim of this systematic review was to assess the consequences of ECG screening for prolonged corrected QT (QTc) interval in infants younger than 1 month.</p><p><strong>Methods: </strong>We searched the PubMed, Scopus, and Web of Science databases in June 2024. The incidence rates of prolonged QTc, defined as >450 ms, were calculated per 1000 neonates. Prolonged QTc cases, including normalization during follow-up, LQTS diagnosis, and sudden infant death syndrome (SIDS), were analyzed.</p><p><strong>Results: </strong>Eight studies were included. Five studies using a cutoff QTc >450 ms reported incidences ranging from 5 (95% confidence interval [CI], 5-6) to 79 (CI, 60-102) per 1000 neonates. Six studies with a cutoff of >460 ms reported incidences ranging from 1 (CI, 1-2) to 53 (CI, 50-57). Five studies (cutoff QTc >470 ms) had incidences varying from 1 (CI, 0-1) to 28 (CI, 21-35). In 6 studies, QTc normalization during follow-up occurred in 57.1% to 95.2% of neonates with prolonged QTc. The diagnosis of LQTS was reported in 4 studies, with 21 of 51,817 (0.04%) neonates later diagnosed with LQTS. Two studies reported SIDS outcomes, finding prolonged QTc in 8 of 24 and 3 of 3 SIDS cases.</p><p><strong>Conclusion: </strong>The incidence of prolonged QTc varied widely across studies. Only a small proportion of neonates with prolonged QTc were diagnosed with LQTS during follow-up. Further research with standardized study factors and comprehensive genetic analysis is needed to determine the utility of and indications for neonatal ECG screening.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572805","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}