Heart rhythm最新文献

{"title":"To the Editor - Additional value of venous flow pattern for ultrasound-guided venous closure with suture-mediated vascular closure device.","authors":"Akio Chikata, Takeshi Kato, Kazuo Usuda, Masayuki Takamura","doi":"10.1016/j.hrthm.2024.10.077","DOIUrl":"10.1016/j.hrthm.2024.10.077","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618778","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":"First-in-human experience of high-energy ElectroPulse pulsed field ablation: Acute results for pulmonary veins and posterior wall isolation.","authors":"Suraya H Kamsani, Mehrdad Emami, Glenn D Young, Catherine Dimasi, Rajeev K Pathak, Bradley Wilsmore, Martin K Stiles, Peter M Kistler, Jonathan M Kalman, Prashanthan Sanders","doi":"10.1016/j.hrthm.2024.10.070","DOIUrl":"10.1016/j.hrthm.2024.10.070","url":null,"abstract":"<p><strong>Background: </strong>Different iterations of catheter and energy delivery system configurations are evolving for pulsed field ablation (PFA); however, some have used large and complex catheters, required large sheaths, and had a recognized risk of hemolysis.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the acute safety and efficacy of a custom designed 8F variable loop multielectrode mapping and PFA catheter with contact sensing.</p><p><strong>Methods: </strong>This acute feasibility study recruited 30 patients undergoing de novo ablation of paroxysmal or persistent atrial fibrillation (AF). The ElectroPulse Study is a first-in-human, nonrandomized, prospective study of a novel PFA system that utilizes an 8F, 10-electrode variable loop steerable mapping and ablation catheter with 2800-V biphasic bipolar waveform. All patients had pulmonary vein isolation (PVI) and posterior wall isolation (PWI) using the PFA system. The main outcomes were the acute success of PV/PWI and periprocedural serious adverse events.</p><p><strong>Results: </strong>Complete PVI/PWI was successfully achieved in all 30 patients using 59.7 ± 7.2 applications. Total procedural time was 113.6 ± 26.3 minutes, fluoroscopy time 8.0 ± 5.5 minutes, and left atrial dwell time 78.7 ± 18.6 minutes. There was no esophageal injury, phrenic nerve palsy, clinical stroke, or death. Brain magnetic resonance imaging detected 2 new but transient silent cerebral lesions. Two patients (6.7%) had vascular access complications. Although there were changes in the biomarkers for hemolysis, none of the patients experienced clinical hemolysis or related acute kidney injury.</p><p><strong>Conclusion: </strong>This first-in-human study demonstrated that PFA using a novel variable loop catheter with a contact sensing system safely achieved 100% acute PVI/PWI with safety profile comparable to existing PFA systems.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618798","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 technique and assessment of available 3-dimensional delivery sheath for endomyocardial biopsy during cardiac device implantation.","authors":"Koji Sudo, Kenji Kuroki, Kazuto Nakamura, Yosuke Watanabe, Manabu Uematsu, Chisa Asahina, Yuya Tanaka, Tsuyoshi Kobayashi, Akira Sato","doi":"10.1016/j.hrthm.2024.10.069","DOIUrl":"10.1016/j.hrthm.2024.10.069","url":null,"abstract":"<p><strong>Background: </strong>Early cardiomyopathy diagnosis allows timely treatment and may help resolve problems that occur after cardiac implantable electronic device (CIED) implantation.</p><p><strong>Objective: </strong>This study aims to describe a novel technique for endomyocardial biopsy (EMB) using a 3-dimensional (3D) delivery sheath during CIED implantation. In addition, we investigated 3D delivery-sheath characteristics using sheath deflection during bioptome insertion.</p><p><strong>Methods: </strong>This study of 20 patients undergoing CIED implantation analyzed the EMB success rate and pathologic findings. Fluoroscopic images assessed 3D delivery sheath characteristics before and after bioptome insertion in 3 sheaths. CIEDs were implanted for sick sinus syndrome (n =3), atrioventricular conduction disorder (n = 16), and left ventricular dysfunction (n = 1). Fluoroscopic verification was performed using right anterior oblique (RAO) and left anterior oblique (LAO) views. EMB was performed with Selectra 3D (BIOTRONIK, Berlin, Germany), CSP Locator 3D (Abbott, Chicago, IL), and SSPC (Boston Scientific, Marlborough, MA) (12, 4, and 4 patients, respectively). The distance moved toward the right ventricular apex (RVA) in RAO was defined as Dis-RAO (mm) and that moved toward the RVA in LAO was defined as Dis-LAO (mm).</p><p><strong>Results: </strong>Among the 3 sheaths, only the CSP Locator 3D and Selectra 3D showed significant differences in Dis-RAO (13.2 ± 2.0 mm vs 19.8 ± 3.8 mm, P < .01) and Dis-LAO (8.1 ± 1.3 mm vs 15.3 ± 3.9 mm, P < .01). A total of 77 EMB samples from 20 patients were collected without any complication, and 4 patients (20%) were diagnosed with cardiac amyloidosis (CA) based on pathologic findings.</p><p><strong>Conclusion: </strong>All 3D delivery sheaths were safe and effective for performing EMB from the RVS during CIED implantation, enabling early CA diagnosis in 20% of patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618805","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":"Complications associated with pulsed field ablation vs radiofrequency catheter ablation of atrial fibrillation.","authors":"Min Soo Cho, So-Ryoung Lee, Eric Black-Maier, Kevin P Jackson, Daniel J Friedman, Sean D Pokorney, Zak Loring, Janice Febre, Jonathan P Piccini","doi":"10.1016/j.hrthm.2024.10.063","DOIUrl":"10.1016/j.hrthm.2024.10.063","url":null,"abstract":"<p><strong>Background: </strong>The first commercial systems for pulsed field ablation (PFA) were recently approved by the Food and Drug Administration, but their safety profile in nationwide practice remains underexplored.</p><p><strong>Objectives: </strong>This study aimed to describe reported adverse events with PFA systems after their market release and to compare the relative proportion of complications associated with PFA vs radiofrequency (RF) ablation catheters.</p><p><strong>Methods: </strong>We conducted a search of the Manufacturer and User Facility Device Experience database for adverse event reports involving Food and Drug Administration-approved PFA and RF catheters from January 1, 2024, to July 31, 2024.</p><p><strong>Results: </strong>A total of 1237 reports detailing clinical complications (n=156 for PFA and n=315 for RF) or catheter malfunctions (n=336 for PFA and n=430 for RF) were analyzed. The most common adverse events reported for PFA were pericardial effusion, vasovagal response, and hemolysis, compared with pericardial effusion, ischemic stroke, and esophageal damage for RF ablation. The proportion of reported adverse events that were deaths was lower with PFA than with RF (2.6% vs 8.9%; P=.010). Hemolysis (9.0% vs 0%), coronary events (5.8% vs 0.6%), and vasovagal responses (14.1% vs 0%) were reported more frequently after PFA (P<.001 for all). In contrast, esophageal damage (0% vs 4.1%; P<.001) and pulmonary vein stenosis (0% vs 1.9%; P=.184) were not reported with PFA, but only with RF. Regarding catheter malfunctions, mechanical problems were reported in higher proportion after PFA than after RF (87.2% vs 17.2%; P<.001).</p><p><strong>Conclusion: </strong>The reported complications associated with PFA and RF ablation differ significantly. Close attention to PFA-specific complications is essential for ensuring the safe use of PFA and for mitigating risk.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618786","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":"Machine Learning Identifies Arrhythmogenic Features of QRS Fragmentation in Human Cardiomyopathy: Implications for Improving Risk Stratification.","authors":"Cathy Ong Ly, Adrian M Suszko, Nathan C Denham, Praloy Chakraborty, Mahbod Rahimi, Chris McIntosh, Vijay S Chauhan","doi":"10.1016/j.hrthm.2024.11.002","DOIUrl":"10.1016/j.hrthm.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Heterogeneous ventricular activation can provide the substrate for ventricular arrhythmias (VA), but its manifestation on the electrocardiogram (ECG) as a risk stratifier is not well-defined.</p><p><strong>Objective: </strong>To characterize the spatiotemporal features of QRS peaks that best predict VA in patients with cardiomyopathy (CM) using machine learning (ML).</p><p><strong>Methods: </strong>Prospectively enrolled CM patients with prophylactic defibrillators (n=95) underwent digital, high-resolution ECG recordings during intrinsic rhythm and ventricular pacing at 100 to 120 beats/min. Intra QRS peaks in the signal-averaged precordial leads were identified and their characteristics (amplitude, width, and timing within the QRS) were transformed into 4-bin histograms. Random forest models of these characteristics in each lead alongside clinical data were trained on 76 patients and tested on 19 patients with cross-validation to determine the features that predicted VA.</p><p><strong>Results: </strong>Patients were followed up for 45 (22-48) months, and 21% had VA. The individual machine learning (ML) models determined (area under the receiver operating characteristic curve [AUROC]) intrinsic QRS peak amplitude (0.88), width (0.78), and location (0.84) to all predict VA. In a combined model including all QRS peak characteristics, peaks with amplitude < 31 μV in V1, a width of 4 to 8 ms in V1, and location in the final quarter of the QRS of V1 were most predictive. Neither clinical data nor QRS peak characteristics assessed during ventricular pacing improved VA prediction when combined with intrinsic QRS peak characteristics.</p><p><strong>Conclusions: </strong>Arrhythmogenic QRS fragmentation is characterized by narrow, low-amplitude peaks in the terminal QRS of lead V1. These features alone without clinical variables or ventricular pacing are sufficient to accurately risk stratify CM patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation in Black American patients: A review of genetics, risk factors, and outcomes.","authors":"Aseel Houmsse, Nipun Malhotra, Sakima A Smith, Mona El Refaey","doi":"10.1016/j.hrthm.2024.10.074","DOIUrl":"10.1016/j.hrthm.2024.10.074","url":null,"abstract":"<p><p>Atrial fibrillation (AF), the most common arrhythmia in the United States, affects 6 million Americans, with numbers projected to increase to 12 million by 2030. A racial paradox difference in the incidence and prevalence of AF exists between Black and White Americans. Black Americans are less prone than White Americans to development of AF, but they display a higher burden of modifiable risk factors for cardiovascular disease and higher rates of ischemic stroke. Data pertaining to the American Heart Association Life's Simple 7 (LS7) health metrics show that Black Americans have suboptimal LS7 scores compared with White Americans on average despite lower genetic predisposition to AF. This trend suggests the impact of cardiovascular health on the development and progression of AF. Social, genetic, and lifestyle risk factors have been shown to play a role in the racial paradox and AF outcomes in Black Americans. This review summarizes factors contributing to the racial paradox and discusses suggestions for improved health outcomes in Black Americans with AF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618782","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":"Intramyocardial fibrofatty deposits in ischemic sudden cardiac death.","authors":"Henrik Appel, Lasse Pakanen, Anne Ahtikoski, Lauri Holmström, Risto Kerkelä, Heikki Huikuri, Cristina Basso, Robert J Myeburg, Riitta Kaarteenaho, M Juhani Junttila","doi":"10.1016/j.hrthm.2024.11.004","DOIUrl":"10.1016/j.hrthm.2024.11.004","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618801","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":"Behavior of leadless atrioventricular synchronous pacing during exercise.","authors":"Christophe Garweg, Thomas Van Weyenbergh, Todd Sheldon, Ciarra Cece Anders, Alexander Dorrestijn, Patricia Poels, Sofie Van Soest, Bert Vandenberk, Rik Willems","doi":"10.1016/j.hrthm.2024.10.065","DOIUrl":"10.1016/j.hrthm.2024.10.065","url":null,"abstract":"<p><strong>Background: </strong>The leadless Micra AV pacemaker is designed to provide atrioventricular (AV) synchronous tracking by detecting atrial contraction. Detection of the mechanical atrial signals can become challenging at a fast sinus rate.</p><p><strong>Objective: </strong>The purpose of the study was to evaluate the AV synchronous performance during exercise in outpatients implanted with a Micra AV pacemaker.</p><p><strong>Methods: </strong>Patients were enrolled at least 1 month after Micra AV implantation and underwent a cycle test protocol. Serial device interrogations (each minute) and continuous electrocardiograms were collected to measure AV synchrony and determine maximum achieved sinus and ventricular rates for each patient. In addition, the A1, A2, A3, and A4 accelerometer signal amplitudes were measured at the start and peak of exercise.</p><p><strong>Results: </strong>Thirty-five patients (mean age 75.6 ± 13.4 years; 28 (80%) male) were enrolled in the study; 22 (64%) were predominantly ventricular paced (>90%) during exercise. Mean AV synchrony was 90.4% in the entire cohort and 84.7% in patients with high-degree AV block. The mean amplitude of the accelerometer signals increased significantly from the start to the peak of exercise: A1, 4.1-6.3 m/s²; A2, 2.4-3.8 m/s²; and A4, 4.5-7.6 m/s² (P < .01 for all). The time from the ventricular ecvent (VS/VP) to A2 showed a decrease of 25 ms for each 100 ms decrease of the R-R interval.</p><p><strong>Conclusion: </strong>Maintaining AV synchrony during maximal exercise in elderly patients is achievable by adequate detection of atrial contraction at fast sinus rates by the leadless Micra AV pacemaker. All components of the accelerometer signal increased, likely because of increased contractility related to exercise.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618784","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":"Twin atrioventricular nodes and accessory pathways in congenital heart diseases with abnormal atrioventricular connections: Association with the developmental hierarchy of cardiac morphology.","authors":"Mei-Hwan Wu, Sheunn-Nan Chiu, Chun-An Chen, Wei-Chieh Tseng, Chun-Wei Lu, Ming-Tai Lin, Jou-Kou Wang","doi":"10.1016/j.hrthm.2024.10.072","DOIUrl":"10.1016/j.hrthm.2024.10.072","url":null,"abstract":"<p><strong>Background: </strong>Twin atrioventricular (AV) nodes (TWAVNs) are common in heterotaxy syndrome.</p><p><strong>Objective: </strong>The purpose of this study was to investigate the presence and implications of TWAVNs and accessory pathways in congenital heart diseases (CHDs) with abnormal AV connections.</p><p><strong>Methods: </strong>A retrospective study of a 1980-2022 cohort with sufficient electrocardiographic (ECG) data for review was conducted.</p><p><strong>Results: </strong>We enrolled 136 patients with heterotaxy syndrome, 70 with congenitally corrected transposition of the great arteries (ccTGA) (4 with Ebstein anomaly), 47 with double-inlet ventricle (DIV), and 63 with isolated AV canal defect. TWAVNs, detected in the same ECG (18%), in separate ECGs (70.8%), or after electrophysiological study (11.2%), were present in 43.4% of heterotaxy, 10.6% of DIV, 10% of ccTGA, and 1.6% of AV canal defect cases. Accessory pathways were noted in 11.4% of ccTGA and 4.4% of heterotaxy cases, but none of the DIV and AV canal cases. Actuarial incidence of supraventricular tachycardia (SVT) by age 10 was 0.354, 0.121, 0.022, and 0 in heterotaxy, ccTGA, DIV, and AV canal, respectively. In patients with TWAVNs, the risk of SVT varies according to the rate of TWAVNs in each CHD type, with risks of 65.5%, 58.3%, and 0% for TWAVNs rates >50%, 10%-50%, and <10%, respectively. Onset age of tachycardia did not differ between those with TWAVNs and those with accessory pathways.</p><p><strong>Conclusion: </strong>In CHD with abnormal AV connections, evidence suggested a developmental hierarchy in the propensity to exhibit TWAVNs, but not for accessory pathways. The earlier cardiac developmental errors occur, the higher the likelihood of TWAVNs and the greater the chance of SVT.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618817","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 substrate of the right ventricle in valvular pulmonary stenosis: Early observations from electrophysiology studies before pulmonary valve replacement.","authors":"Jeff Hong, Amr El-Bokl, Nicola Maschietto, Edward T O'Leary","doi":"10.1016/j.hrthm.2024.10.075","DOIUrl":"10.1016/j.hrthm.2024.10.075","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618808","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}