Heart rhythm最新文献

{"title":"miR-363-5p- and IL-34-mediated modulation of pacemaker channel, HCN4, on iPSC-CM: Translation into the human sinus node microenvironment","authors":"Zeyuan Yin MD, PhD ,&nbsp;Tong Fu BMBS ,&nbsp;Lu Fu MD, PhD ,&nbsp;Chengbiao Zhang PhD ,&nbsp;Andrew Atkinson PhD ,&nbsp;Abimbola Aminu PhD ,&nbsp;Filip Perde MD, PhD ,&nbsp;Peter Molenaar PhD ,&nbsp;Amy Feather MRes ,&nbsp;Joseph Adu-Amankwaah MRes ,&nbsp;Chaoqun Zhang MD, PhD ,&nbsp;Bei Zhang MD, PhD ,&nbsp;Xueyan Zhou PhD ,&nbsp;Hong Sun MD, PhD ,&nbsp;Halina Dobrzynski PhD, DSc","doi":"10.1016/j.hrthm.2025.07.008","DOIUrl":"10.1016/j.hrthm.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>The human sinus node (SN) contains cardiac fibroblasts and resident macrophages, with microRNAs (miRNAs) and interleukins as regulators of SN function. However, the mechanisms by which they influence heart rate remain unclear.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the SN microenvironment, encompassing miRNAs, interleukins, macrophages, and fibroblasts and modulating induced pluripotent stem cell–derived cardiomyocytes (iPSC-CMs) and hence beating rate.</div></div><div><h3>Methods</h3><div>Multiomics analysis was conducted to compare human SN with the right atria. Human iPSC-CMs were cocultured with M2-type macrophages (M2s) and fibroblasts. Mechanistic studies involved the application of interleukin 34 (IL-34) and the silencing or overexpression of colony-stimulating factor 1 receptor and signal transducer and activator of transcription 3. Messenger RNA–miRNA interactions were predicted using the Ingenuity Pathway Analysis. miR-363-5p was applied to 3 cell lines and a coculture system and, along with IL-34, was tested in human serum samples.</div></div><div><h3>Results</h3><div>M2 and fibroblast markers were identified. Coculturing iPSC-CMs with M2s induced a more nodal-like phenotype. Elevated IL-34 in the coculture medium suggested that M2s may secrete IL-34, driving these nodal-like features. IL-34 promoted a nodal-like phenotype in iPSC-CMs by upregulating hyperpolarization-activated cyclic nucleotide-gated channel subtype 4 expression probably through colony-stimulating factor 1 receptor/signal transducer and activator of transcription 3 signaling. Three key miRNAs were identified, with miR-363-5p inhibiting the differentiation of macrophages into the M2 phenotype. The nodal-like shift of iPSC-CMs in the coculture system was reversed by miR-363-5p. Although miR-363-5p (together with miR-486-3p) was highly expressed, IL-34 was reduced in aged individuals with SN dysfunction.</div></div><div><h3>Conclusion</h3><div>M2s contribute to the SN microenvironment by secreting IL-34 and thus enhance SN function by upregulating hyperpolarization-activated cyclic nucleotide-gated channel subtype 4. Elevated miR-363-5p, seen in age-related SN dysfunction, may reverse these effects.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2695-2710"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144617168","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":"Updated Evidence on Perioperative Neutrophil-to-Lymphocyte Ratio in Cardiac Surgery: A Dual Analysis of Prognostic and Diagnostic Value for Postoperative Atrial Fibrillation.","authors":"Mohamed K A Awad, Ahmed E Ali, Muhammad S Mazroua, Karim Ali, Radwa K Awad, Toqa R Mohamed, Mohamed Abdelmaksoud, Mahmoud A Hashim, Redi Nikollari, Panos N Vardas, Hussein Abu-Daya","doi":"10.1016/j.hrthm.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.036","url":null,"abstract":"<p><strong>Background: </strong>Post-operative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, increasing morbidity. The neutrophil/lymphocyte ratio (NLR), a simple marker of systemic inflammation, has been studied as a predictor.</p><p><strong>Objective: </strong>Assess association between NLR and new-onset POAF.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Web of Science, and Embase through June 2025 for studies reporting preoperative or postoperative NLR and incidence of POAF in adult cardiac surgery patients. Diagnostic test accuracy (DTA) was assessed to evaluate the predictive performance of preoperative NLR for postoperative atrial fibrillation, using pooled sensitivity, specificity, and likelihood ratios. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.</p><p><strong>Results: </strong>Thirty-two studies (20,056 patients) were included. In 27 studies excluding preoperative AF (13,630 patients), POAF was associated with significantly higher preoperative NLR (SMD = 0.51; 95% CI: 0.34-0.67; p < 0.001; I² = 94.0%). Postoperative NLR was also elevated in POAF patients (SMD = 0.30; 95% CI: 0.13-0.47; p < 0.001; I² = 70.7%). Among four studies including patients with prior AF (6,364 patients), no significant association was observed (SMD = 0.04; p = 0.21). DTA analysis of 12 studies showed pooled sensitivity of 0.52, specificity of 0.71, and diagnostic odds ratio of 3.74 (AUC = 0.713), indicating moderate diagnostic accuracy.</p><p><strong>Conclusion: </strong>Elevated NLR is associated with increased risk of POAF. Distinguishing new-onset POAF and accounting for surgical type are essential when evaluating NLR as a predictive biomarker.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212495","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 anatomy of atrial conduction: a review of anatomical landmarks integrated with computed tomographic virtual dissection to provide a road map for right atrial pacing.","authors":"Justin T Tretter, Shunmuga Sundaram Ponnusamy, Pugazhendhi Vijayaraman, Andrew C Cook, Damián Sánchez-Quintana, Robert H Anderson, Shlomo Ben-Haim","doi":"10.1016/j.hrthm.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.032","url":null,"abstract":"<p><p>Pacing of the atrial chambers has recently gained increased attention. Major barriers, however, relate to the understanding of the underlying anatomy relative to fluoroscopic positioning of pacing leads, and on the reliance of using the morphology of the electrocardiographic P-wave in guiding intended capture of the preferential pathways for interatrial conduction. There remains a gap in knowledge both in the understanding of the location of the sinus and atrioventricular nodes, and the arrangement of the intervening myocardial preferential conduction pathways, coupled with an appreciation of how to apply such understanding towards guiding and improving the success rate of pacing procedures. In this review, we delineate the three-dimensional anatomy of the atriums, and show how this relates to the pathways for atrial conduction. Although we recognize that, as yet, the locations of the sinus and atrioventricular nodes cannot be shown directly when using clinical imaging, we describe and illustrate how interrogation using three-dimensional cardiac computed tomography is now able accurately to predict their location, along with the preferential pathways of electrical atrial activation. We submit that such understanding may provide practical guidance for those undertaking pacing procedures, permitting the personalization of cardiac care as related to atrial conduction.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206265","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":"Patient-reported outcomes of deep sedation during pulsed field ablation for atrial fibrillation with a novel variable-loop catheter.","authors":"Vanessa Sciacca, Philipp Lucas, Thomas Fink, Angeliki Darma, Denise Guckel, Maxim Didenko, Maximilian Mörsdorf, Martin Braun, Moneeb Khalaph, Yuri Bocchini, Nadica Trajkovska, Karen Harutyunyan, Philipp Sommer, Christian Sohns","doi":"10.1016/j.hrthm.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.033","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190942","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":"Premature Ventricular Contractions on Healthy and Diseased Hearts: Differential Acute Effect of Coupling Interval and Location.","authors":"Marc Soriano-Amores, Zoraida Moreno-Weidmann, Esther Jorge-Martín, Andreu Ferrero-Gregori, Bieito Campos-Garcia, S Casabella-Ramon, Concepción Alonso-Martín, Enrique Rodríguez-Font, Chi-Hion Li, Xavier Viñolas-Prat, Vicenta Llorente-Cortés, Sònia Mirabet-Pérez, Gerard Amorós-Figueras, Jose M Guerra","doi":"10.1016/j.hrthm.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.035","url":null,"abstract":"<p><strong>Background: </strong>The precise pathophysiological mechanisms underlying PVC-induced cardiomyopathy remain unclear.</p><p><strong>Objectives: </strong>To compare the acute physiological effects of PVCs delivered at different coupling intervals and anatomical sites in healthy hearts and in hearts with an established dilated cardiomyopathy.</p><p><strong>Methods: </strong>Ten swine were studied: five served as controls, and five underwent pacemaker implantation with 180 bpm pacing for four weeks to induce non-ischemic dilated cardiomyopathy (NIDCM). PVCs were delivered from 14 left ventricular and 6 right ventricular sites at four coupling intervals in both groups. QRS duration and hemodynamic parameters (aortic flow, dP/dt max and DP/dt min) were assessed.</p><p><strong>Results: </strong>PVC QRS duration increased as coupling interval shortened in both groups (Control: 85±7 ms at 500 ms vs. 93±7 ms at 350 ms, p<0.01; NIDCM: 103±6 ms vs. 119±6 ms, p<0.01). Hemodynamic deterioration paralleled QRS prolongation and was more pronounced in the NIDCM group. PVCs from the left ventricle had greater hemodynamic impact.</p><p><strong>Conclusions: </strong>Shorter PVC coupling intervals prolong QRS duration and worsen hemodynamics, being these effects more pronounced in the dilated cardiomyopathy hearts. This could correlate with a greater long-term decline in the LVEF, thereby increasing the risk of developing PVC-induced cardiomyopathy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185475","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":"Electrical Impedance Spectroscopy Facilitates Quantitative Depth Monitoring of Pulsed Field Ablation: An Impedimetric Approach with Preclinical Validation.","authors":"Yuyi Guo, Rui Han, Rongrong Liu, Kai Zhu, Jinsong Guo, Junfeng Rao, Qun Wang, Qiancheng Zhao, Fukun Shi, Jie Zhuang","doi":"10.1016/j.hrthm.2025.09.034","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.034","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is an emerging therapy for cardiac ablation, where ablation depth (D) is critical to procedural success. However, real-time intraprocedural assessment of D remains a challenging task.</p><p><strong>Objective: </strong>Electrical impedance spectroscopy (EIS) has been proposed to predict ablation zone, but its applicability and mechanism for quantifying D is still unclear.</p><p><strong>Methods: </strong>Monopolar and bipolar PFA were conducted via two catheter types, along with in-situ EIS measurements. The change rate of low-frequency resistance (LFR), derived from Cole-Cole modeling of EIS data, was used to evaluate D in both in vitro (205 potato samples) and in vivo canine models (n=5).</p><p><strong>Results: </strong>LFR versus ablation depths followed a classical Gompertz growth model within 0∼15 mm (R²=0.8789). A quadratic function provided a good fit for evaluating ablation depths within 1∼9 mm (R²=0.7561). Furthermore, LFR_5min could detect a depth difference of approximately 0.8 mm in canine cardiac ablation (P=0.0003).</p><p><strong>Conclusions: </strong>LFR_5min robustly correlated with PFA lesion depth, fitting quantitative quadratic and Gompertz models. Validated in vivo in a clinically relevant canine cardiac model, LFR_5min resolved sub-millimeter depth differences, positioning it as a promising intraoperative metric for real-time PFA guidance.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185505","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":"Rapid Direct Mapping of the Superior Vena Cava Using an Extended Circular Array Pulsed-Field Catheter to Identify Sinus Node Activation Prior to Ablation.","authors":"Akiko Kodama, Suguru Nishiuchi, Kohjiro Hattori, Taiki Masuyama, Kenichi Kaseno, Shingo Yoshimura, Takehito Sasaki, Kohki Nakamura, Shigeto Naito","doi":"10.1016/j.hrthm.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.031","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182031","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":"Expanding the Indications for Flecainide: Good Idea or CAST Reprise?","authors":"Peter R Kowey, Farah Olleik","doi":"10.1016/j.hrthm.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.030","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of alternative efficacy endpoint definitions on reported outcomes after ablation of paroxysmal atrial fibrillation - insights from the COMPARE-CRYO study using continuous rhythm monitoring.","authors":"Salik Ur Rehman Iqbal, Thomas Kueffer, Sven Knecht, Patrick Badertscher, Jens Maurhofer, Philipp Krisai, Corinne Jufer, Gregor Thalmann, Dik Heg, Helge Servatius, Hildegard Tanner, Michael Kühne, Laurent Roten, Christian Sticherling, Tobias Reichlin","doi":"10.1016/j.hrthm.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.026","url":null,"abstract":"<p><strong>Background: </strong>Recurrence after atrial fibrillation (AF) ablation is commonly defined as any atrial arrhythmia lasting >30sec. It is unclear how alternative efficacy endpoint definitions would change the observed success rates and how they would relate to patients' disease burden or healthcare utilization metrics.</p><p><strong>Objective: </strong>To evaluate the impact of alternative endpoint definitions after AF ablation based on AF-burden, duration or number of episodes using implantable cardiac monitors (ICM).</p><p><strong>Methods: </strong>This is a prespecified substudy of the COMPARE-CRYO study, which enrolled patients with paroxysmal AF undergoing cryoballoon ablation. All patients underwent ICM implantation and the blanking period was 90 days. Details were collected on timing, duration and number of episodes and AF-burden between 91-365 days. Outcome measures were redo ablations and AF-related hospitalizations.</p><p><strong>Results: </strong>The primary endpoint of any recurrence lasting >30 sec occurred in 89 of 201 patients (44%). One-year success rates increased with increasing arrhythmia duration thresholds from 56% (≥30 sec) to 97% (≥24h), with number of episode thresholds from 56% (≥1 episode) to 98% (≥100 episodes) and with AF-burden thresholds from 56% (AF-burden >0%) to 93% (AF-burden >2%). Rates of redo ablations and AF-related hospitalizations increased for AF-episode durations >1h, >6 AF-episodes and an AF-burden >0.1%, and were highest for AF-episode durations >24h, >33 AF-episodes and an AF-burden >1%.</p><p><strong>Conclusion: </strong>Alternative efficacy endpoint definitions have a significant impact on reported outcomes and healthcare utilization metrics after AF ablation. These findings are important when considering endpoint definitions other than the traditional 30 seconds in the design of future AF-ablation trials.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112979","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":"Ventricular Tachycardia Substrate Mapping with Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging: Head-to-head Comparison of Two Clinically Available Post-processing Platforms.","authors":"Damian Laan, Luuk H G A Hopman, Rosa M Figueras I Ventura, Bruno Soré, Cornelis P Allaart, Michiel J B Kemme, Marco Götte, Pieter G Postema, Pranav Bhagirath","doi":"10.1016/j.hrthm.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.09.028","url":null,"abstract":"<p><strong>Background: </strong>Advanced postprocessing of late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) and computed tomography (CCT) imaging increasingly guides ventricular tachycardia (VT) ablation. However, a direct comparison between two widely adopted platforms, ADAS 3D LV (ADAS3D Medical) and inHEART (IHU LIRYC/Inria), is lacking.</p><p><strong>Objective: </strong>To compare CMR- and CCT-derived ventricular substrate models generated by ADAS 3D and inHEART in patients with ischemic and non-ischemic cardiomyopathy undergoing VT ablation.</p><p><strong>Methods: </strong>Patients who underwent both CCT and LGE-CMR prior to ablation were retrospectively included. ADAS 3D models were generated on-site, while inHEART models were processed remotely. Substrate models were evalauted using a custom scoring system incorporating quantitative (scar mass, transmurality) and qualitative (wall thickness, scar delineation, conduction corridors) parameters. Electroanatomical maps (EAM) assessed correspondence between low-voltage and ablation regions, with imaging-defined corridors.</p><p><strong>Results: </strong>Sixteen patients (n=8 ischemic, n=8 non-ischemic) were analysed, 12 had detailed EAM data. Scar core and border zone measurements were comparable between platforms in both subgroups (all p>0.05). ADAS 3D showed slightly higher visualization scores, particularly in non-ischemic cardiomyopathy, though differences were not statistically significant. Spatial concordance between imaging-derived scar and EAM-defined ablation areas was good to excellent in 10 of 12 cases.</p><p><strong>Conclusion: </strong>ADAS 3D and inHEART demonstrated high concordance in scar quantification and substrate characterization, with comparable performance across cardiomyopathy types. Given their complementary strengths, platform choice should be guided by procedural goals, imaging availability, operator experience, and institutional context, as each system offers distinct advantages. Prospective studies are needed to evaluate impact on procedural success and long-term outcomes.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112940","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}