Heart rhythm最新文献

{"title":"Catheter ablation of paroxysmal atrial fibrillation and disease progression: Magnitude of the antiprogression effect and role of intervention timing.","authors":"Karim Benali, Laurent Macle, Michel Haïssaguerre, Kinan Kneizeh, Konstantinos Vlachos, Maasaki Yokoyamah, Cinzia Monaco, Ruxandra Sava, Antoine Da Costa, Jason G Andrade","doi":"10.1016/j.hrthm.2024.12.026","DOIUrl":"10.1016/j.hrthm.2024.12.026","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized controlled trials (RCTs) have shown that catheter ablation of paroxysmal atrial fibrillation (AF) is associated with a lower incidence of progression to persistent AF compared with the use of antiarrhythmic drug (AAD) therapy.</p><p><strong>Objective: </strong>This meta-analysis aimed to investigate the magnitude of the antiprogression effect of catheter ablation as well as the effect of intervention timing.</p><p><strong>Methods: </strong>MEDLINE/EMBASE databases were searched until April 1, 2024 for RCTs comparing catheter ablation and AAD therapy for the treatment of paroxysmal AF and reporting the rate of progression to persistent AF at 3 years (PROSPERO CRD42024534288).</p><p><strong>Results: </strong>A total of 1287 references were retrieved, of which 5 RCTs met inclusion criteria. The rate of progression to persistent AF was 8.3% (95% confidence interval [CI] 5.4-11.2, I² = 67.2%) at 3 years. The 3-year rate of progression to persistent AF was significantly lower in patients randomized to catheter ablation (1.8%; 95% CI 0.3-3.3; I² = 0%) compared with AAD (14.9%; 95% CI 9.3-20.5; I² = 71.9%); representing a risk ratio of progression to persistent AF at 3 years of 0.15 (95% CI 0.08-0.28; I² = 0%; P < .001) for catheter ablation vs AAD therapy. Catheter ablation appeared similarly efficient in reducing progression of AF when used as first-line or non-first-line therapy (risk ratio [RR] = 0.19; 95% CI 0.07-0.48 and RR = 0.13, 95% CI 0.05-0.29, respectively, P_interaction = .551).</p><p><strong>Conclusion: </strong>The risk of progression to persistent AF at 3 years appears to be reduced by almost 7-fold in patients with paroxysmal AF treated using catheter ablation compared with patients treated using AAD therapy, regardless of the timing of the intervention.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871851","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":"ACT targets during atrial fibrillation ablation.","authors":"Thomas A Boyle, Adrian M Petzl, David S Frankel","doi":"10.1016/j.hrthm.2024.12.023","DOIUrl":"10.1016/j.hrthm.2024.12.023","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871841","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":"Novel cardiac CT method for identifying the atrioventricular conduction axis by anatomic landmarks.","authors":"Justin T Tretter, Francisco Bedogni, Josep Rodés-Cabau, Ander Regueiro, Luca Testa, Mackram F Eleid, Shmuel Chen, Attilio Galhardo, Kenneth A Ellenbogen, Martin B Leon, Shlomo Ben-Haim","doi":"10.1016/j.hrthm.2024.12.022","DOIUrl":"10.1016/j.hrthm.2024.12.022","url":null,"abstract":"<p><strong>Background: </strong>Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy.</p><p><strong>Objective: </strong>Cardiac structures visible with clinical imaging have been demonstrated to correlate with variability in the conduction system course. We aimed to standardize and assess the reproducibility of predicting the location of the atrioventricular conduction axis by cardiac computed tomography.</p><p><strong>Methods: </strong>We evaluated 477 patients with acquired aortic valve disease by cardiac computed tomography to assess variability in cardiac structures established to relate to the conduction system. We standardized 3 points (points A-C) to estimate the course from the atrioventricular node to the nonbranching bundle and left bundle branch origin and further compared this with measures of variability in the aortic root and membranous septum.</p><p><strong>Results: </strong>The mean distances between the aortic valve virtual basal ring and points A, B, and C were 9.5 ± 3.5 (0.3-20.1) mm, 5.0 ± 2.6 (-1.7 to 15.9) mm, and 2.8 ± 2.4 (-5.2 to 12.0) mm, respectively. The midpoint of the membranous septum deviated posteriorly a median of -4.4 (interquartile range, -12.4 to +3.0) degrees relative to the commissure between the right coronary and noncoronary leaflets. Intraclass coefficients for both intraobserver and interobserver variability for all measured points were excellent (≥0.78).</p><p><strong>Conclusion: </strong>These findings further infer the intimate yet highly variable relationship between the conduction axis and aortic root. This reproducible and standardized approach needs validation in populations of patients, requiring accurate identification of the atrioventricular components of the conduction axis, which may serve as a noninvasive means for estimating its location.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871912","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 factors of late arrhythmia recurrences over 12 months after catheter ablation of atrial fibrillation: Insight into atrial cardiomyopathy.","authors":"Yasuharu Matsunaga-Lee, Koichi Inoue, Nobuaki Tanaka, Masaharu Masuda, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Miwa Miyoshi, Masato Okada, Yasuhiro Matsuda, Masato Kawasaki, Shodai Kawanami, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Masamichi Yano, Masami Nishino, Shungo Hikoso, Akihiro Sunaga, Tomoharu Dohi, Katsuki Okada, Daisaku Nakatani, Yohei Sotomi, Yasushi Sakata","doi":"10.1016/j.hrthm.2024.12.018","DOIUrl":"10.1016/j.hrthm.2024.12.018","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864047","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":"Prospective validation of a prespecified algorithm for the management of conduction disturbances after transcatheter aortic valve replacement: The PROMOTE study.","authors":"Josep Rodés-Cabau, Luis Nombela-Franco, Guillem Muntané-Carol, Gabriela Veiga, Ander Regueiro, Tamim Nazif, Vicenç Serra, Lluis Asmarats, Henrique B Ribeiro, Azeem Latib, Anthony Poulin, Asim N Cheema, Pilar Jiménez-Quevedo, Joan Antoni Gomez-Hospital, Aritz Gil Ongay, Rami Gabani, Dabit Arzamendi, Michael Brener, Alvaro Calabuig, Andrea Scotti, Marco Antonio S Gelain, Marino Labinaz, Pedro Cepas-Guillén, Jorge Nuche, Melanie Côté, Juan H Del Portillo, François Philippon","doi":"10.1016/j.hrthm.2024.12.019","DOIUrl":"10.1016/j.hrthm.2024.12.019","url":null,"abstract":"<p><strong>Background: </strong>There is a large variability in the management of conduction disturbances (CDs) after transcatheter aortic valve replacement (TAVR).</p><p><strong>Objective: </strong>This study aimed to validate a prespecified algorithm for managing CDs in patients undergoing TAVR.</p><p><strong>Methods: </strong>This was a prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR. Patients were stratified in different groups according to the presence of prior right bundle branch block (RBBB) and the occurrence of CDs during the procedure: no prior RBBB and no CDs (group NCD), prior RBBB and no CDs (group RBBB-NCD), and occurrence of CDs (group CD). A management algorithm was prespecified for each group. Permanent pacemaker (PPM) and mortality (overall, sudden cardiac death) at 30 days were the primary end points.</p><p><strong>Results: </strong>A total of 2110 TAVR recipients were included. Patients were distributed in NCD (32.0%), RBBB-NCD (5.1%), and CD (62.9%) groups. A total of 329 patients (15.6%) received a PPM at 30 days, with a PPM rate of 5.5%, 15.9%, and 20.7% in the NCD, RBBB-NCD, and CD groups, respectively (P < .001). The PPM rate was 17.4% and 57.2% in patients with procedural new-onset left bundle branch block and high-degree atrioventricular block/complete heart block, respectively. There were no differences in 30-day all-cause mortality and sudden cardiac death between groups (NCD group, 1.2% and 0.2%; RBBB-NCD group, 0% and 0%; CD group, 0.7% and 0.1%; P = .45 and P = .99 for all-cause mortality and sudden cardiac death, respectively).</p><p><strong>Conclusion: </strong>A prespecified strategy for the management of CDs in contemporary TAVR recipients was feasible and safe, with no increased mortality and an extremely low rate of sudden cardiac death in patients with CDs. However, PPM rates remained high, and continued efforts for preventing the occurrence of CDs are warranted.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853347","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":"Pentaspline catheter or cryoballoon for pulmonary vein plus posterior wall isolation in persistent atrial fibrillation: 1-Year outcomes.","authors":"Luigi Pannone, Ioannis Doundoulakis, Domenico Giovanni Della Rocca, Antonio Sorgente, Antonio Bisignani, Giampaolo Vetta, Alvise Del Monte, Giacomo Talevi, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Ali Gharaviri, Mark La Meir, Pedro Brugada, Andrea Sarkozy, Gian Battista Chierchia, Carlo de Asmundis","doi":"10.1016/j.hrthm.2024.12.020","DOIUrl":"10.1016/j.hrthm.2024.12.020","url":null,"abstract":"<p><strong>Background: </strong>Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) can be performed with radiofrequency ablation, cryoballoon ablation (CB-A), or, recently, pulsed field ablation (PFA).</p><p><strong>Objective: </strong>The aims of this study were to evaluate efficacy and safety of the pentaspline PFA catheter for PVI + LAPWI in patients with persistent AF undergoing an index ablation procedure and to compare 1-year outcomes of PVI + LAPWI with PFA vs CB-A.</p><p><strong>Methods: </strong>All consecutive patients undergoing an index ablation for persistent atrial fibrillation (AF) at Universitair Ziekenhuis Brussel, Belgium, between 2021 and 2023 were retrospectively screened. Inclusion criteria were persistent AF diagnosis following current guidelines, first AF ablation procedure with PVI + LAPWI using the CB-A or the pentaspline PFA catheter, and 1-year follow-up completed.</p><p><strong>Results: </strong>A total of 160 patients were included (80 with CB-A and 80 with the pentaspline PFA catheter). PVI + LAPWI was performed with success in 160 (100%) patients, and isolation was confirmed at postprocedure high-density mapping in all. Compared with CB-A, PFA was associated with shorter skin-to-skin procedure time, shorter left atrium dwell time, and shorter fluoroscopy time. At survival analysis, freedom from recurrent atrial tachyarrhythmias at 1-year follow-up was similar between the CB-A and PFA groups (76.2% vs 78.8%; log-rank P = .63).</p><p><strong>Conclusion: </strong>In patients with persistent AF undergoing an index catheter ablation, the pentaspline PFA catheter is safe and effective for PVI + LAPWI. Outcomes after pentaspline PFA catheter ablation at 1 year are favorable and similar to those with the CB-A catheter.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853345","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":"A novel focal lattice-tip catheter toggling between pulsed field energy and radiofrequency for atrial arrhythmia ablation: Results from a real-world, multicenter registry.","authors":"Giampaolo Vetta, Domenico G Della Rocca, Andrea Sarkozy, Roberto Menè, Luigi Pannone, Alexandre Almorad, Antonio Sorgente, Andres Betancur, Lorenzo Marcon, Sahar Mouram, Erwin Stroker, Ioannis Doundoulakis, Ivan Eltsov, Ourania Kariki, Alvise Del Monte, Ingrid Overeinder, Charles Audiat, Kazutaka Nakasone, Vasileios Sousonis, Wael Zaher, Gezim Bala, Kostantinos P Letsas, Stephane Combes, Juan Sieira, Michael Efremidis, Serge Boveda, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1016/j.hrthm.2024.12.021","DOIUrl":"10.1016/j.hrthm.2024.12.021","url":null,"abstract":"<p><strong>Background: </strong>A novel focal lattice-tip catheter allowing the delivery of either pulsed field (PF) or radiofrequency (RF) energy has recently received regulatory approval. The technology features a proprietary 3-dimensional electroanatomic mapping system.</p><p><strong>Objective: </strong>We describe the first real-world and multicenter experience.</p><p><strong>Methods: </strong>Consecutive AF patients undergoing first-time or redo atrial tachyarrhythmia ablation with the Affera system were prospectively enrolled at 3 different centers. PF was the only energy source allowed when ablating the posterior left atrium; anterior applications were performed with either RF (PF/RF strategy) or PF (PF/PF strategy) on the basis of the operator's preference. The primary efficacy end point included acute electrical isolation of pulmonary veins and posterior wall or bidirectional block in case of linear lesions.</p><p><strong>Results: </strong>The study included 130 patients (mean age, 67 ± 10 years; 63.8% [n = 83] male; 61.5% [n = 80] nonparoxysmal AF; 55.4% first-time AF ablation). First-time pulmonary vein isolation was performed in 72 patients: RF/PF in 13 (18.1%) patients and PF/PF in the remaining 59 (81.9%); first-pass isolation for pulmonary vein and posterior wall was achieved in 100% of cases. A total of 289 ablation lines were performed (roof line, 91 patients; inferior line, 83 patients; anterior mitral line, 32 patients; posterior mitral line, 45 patients; cavotricuspid isthmus line, 38 patients). First-pass isolation and primary efficacy end point were 96.2% (roof line, 100%; inferior line, 100%; anterior mitral line, 96.9%; posterior mitral line, 84.4%; cavotricuspid isthmus, 92.1%) and 100%, respectively. We had 2 (1.5%) major complications: 1 ST-segment elevation at the inferolateral leads requiring intracoronary administration of nitrate and 1 complete atrioventricular block.</p><p><strong>Conclusion: </strong>Catheter ablation with a novel 9-mm lattice-tip catheter confirmed high efficacy and safety in a real-world scenario.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853337","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":"Is aging a modifiable risk factor for atrial fibrillation?","authors":"Jason D Roberts, Guilherme L da Rocha","doi":"10.1016/j.hrthm.2024.12.009","DOIUrl":"10.1016/j.hrthm.2024.12.009","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822023","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":"Prediction of atrial and ventricular arrhythmias using multiple cardiovascular risk-factor polygenic risk scores.","authors":"Julia Ramírez, Stefan van Duijvenboden, Michele Orini, Pier D Lambiase, Andrew Tinker, William J Young, Patricia B Munroe","doi":"10.1016/j.hrthm.2024.12.017","DOIUrl":"10.1016/j.hrthm.2024.12.017","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) prediction improves by combining clinical scores with a polygenic risk score (PRS) for AF (AF-PRS), but there are limited studies of PRS for ventricular arrhythmia (VA) prediction.</p><p><strong>Objective: </strong>We assessed the value of including multiple PRS for cardiovascular risk factors (CV-PRS) for incident AF and VA prediction.</p><p><strong>Methods: </strong>We used 158,733 individuals of European ancestry from UK Biobank to build 3 models for AF: CHARGE-AF (AF1), AF1 + AF-PRS (AF2), AF2 + CV-PRS (AF3). Models for VA included sex and age (VA1), VA1 + coronary artery disease (CAD) PRS (CAD-PRS, VA2), and VA2 + CV-PRS (VA3), conducting separate analyses in subjects with and without ischemic heart disease (IHD). Performance was evaluated in individuals of European (N = 158,733), African (N = 7200), South Asian (N = 9241) and East Asian (N = 2076) ancestry from UK Biobank.</p><p><strong>Results: </strong>AF2 had a higher C-index than AF1 (0.762 vs 0.746, P < .001), marginally improving to 0.765 for AF3 (P < .001, including PRS for heart failure, electrocardiogram and cardiac magnetic resonance measures). In South Asians, AF2 C-index was higher than AF1 (P < .001). For VA, the C-index for VA2 was greater than VA1 (0.692 vs 0.681, P < .001) in Europeans, which was also observed in South Asians (P < .001). VA3 improved prediction of VA in individuals with IHD.</p><p><strong>Conclusion: </strong>CV-PRS improved AF prediction compared to CHARGE-AF and AF-PRS. A CAD-PRS improved VA prediction, while CV-PRS contributed in IHD. AF- and CAD-PRS were transferable to individuals of South Asian ancestry. Our results inform of the use of CV-PRS for personalized screening.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846411","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":"Comparative assessment of interatrial conduction delay during Bachmann's bundle pacing and right atrial appendage pacing using biatrial strain rate echocardiography.","authors":"Daisuke Yoshimoto, Yuichiro Sakamoto, Yuko Uemura, Ryo Yamaguchi, Hirokazu Naganawa, Takahiko Suzuki","doi":"10.1016/j.hrthm.2024.12.016","DOIUrl":"10.1016/j.hrthm.2024.12.016","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835368","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}