Heart rhythm最新文献

{"title":"Novel approach to left bundle branch area pacing lead implantation using a 3-dimensional stylet","authors":"Bartosz Ludwik MD, PhD ,&nbsp;Michał Labus MD ,&nbsp;Tomasz Roleder MD, PhD ,&nbsp;Paweł Moskal MD, PhD ,&nbsp;Grzegorz Kiełbasa MD, PhD ,&nbsp;Jerzy Śpikowski MD, PhD ,&nbsp;Marek Jastrzębski MD, PhD","doi":"10.1016/j.hrthm.2024.11.016","DOIUrl":"10.1016/j.hrthm.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div><span>Left bundle branch area pacing (LBBAP) requires implantation of the lead deep in the </span>interventricular septum. We developed a novel implantation method that does not require dedicated delivery catheters but only a manually shaped 3-dimensional (3D) stiff stylet.</div></div><div><h3>Objective</h3><div>The aim of the study was to characterize procedural outcomes of this technique when used as a routine approach for LBBAP.</div></div><div><h3>Methods</h3><div>A case-control study compared procedural outcomes of consecutive patients who underwent pacemaker implantation at 2 centers: one using only the 3D stylet–based LBBAP technique and the other using the conventional catheter-based LBBAP lead implantation.</div></div><div><h3>Results</h3><div><span>A total of 400 patients (age, 75.3 ± 9.8 years; 48.5% female) were analyzed and 230 were matched and included in a 1:1 ratio in each arm of the implantation techniques. No differences were observed in the success rate (95.0% vs 94.8%), fluoroscopy time (9.9 minutes vs 9.6 minutes), paced QRS duration (151 ms vs 148 ms), and sensitivity values (8.2 mV vs 8.5 mV) between the 3D stylet–based and catheter-based techniques, respectively. Small differences were observed in V</span>₆ R-wave peak time (73.2 ms vs 76.5 ms) and capture threshold (0.63 V vs 0.83 V), with a higher percentage of confirmed left bundle branch captures (98.3% vs 77.4%) and a numerically higher occurrence of delayed perforations (2/115 vs 0/115) in the 3D stylet group.</div></div><div><h3>Conclusion</h3><div>LBBAP lead implantation with the use of a manually shaped stiff 3D stylet is feasible and results in comparable outcomes to those achieved with leads implanted by dedicated preshaped delivery catheters.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2603-2612"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647618","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":"Clinical effectiveness and safety of transvenous lead extraction of very old leads","authors":"Wissam Mekary MD,&nbsp;Neal K. Bhatia MD,&nbsp;Stacy Westerman MD,&nbsp;Anand Shah MD,&nbsp;Faisal M. Merchant MD, FHRS,&nbsp;Mikhael F. El-Chami MD, FHRS","doi":"10.1016/j.hrthm.2024.11.022","DOIUrl":"10.1016/j.hrthm.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Transvenous lead extraction (TLE) success and safety are heavily influenced by lead dwell time.</div></div><div><h3>Objective</h3><div>In this study, we aim to compare the clinical effectiveness and safety of TLE between young and old leads.</div></div><div><h3>Methods</h3><div>We retrospectively identified all TLE procedures at Emory Healthcare from 2007 to 2023. Baseline patients' characteristics and procedural details were collected. The cohort was categorized based on the oldest lead dwell time in each procedure. The very long dwell time (VLDT) group included all procedures with the oldest lead dwell time, ≥15 years, whereas the control group included all procedures with the oldest lead dwell time &lt;15 years. TLE outcomes were compared between the 2 groups.</div></div><div><h3>Results</h3><div>Of the 1717 TLE procedures, 114 procedures (6.6%) included leads with dwell times ≥15 years. Patients in the VLDT group were older and had a higher number of targeted leads; 57% of TLE in the VLDT group were for infectious indications. Lead extraction procedural and clinical success were significantly lower in the VLDT group compared with the control group (75% vs 95%, 83% vs 97%, <em>P</em> &lt; .001, respectively). There was a trend toward a higher major complications rate in the VLDT group compared with the control group (3.5% vs 1.3%, <em>P</em> = .058).</div></div><div><h3>Conclusion</h3><div>TLE of VLDT leads has a lower procedural and clinical success and a higher complication rate than TLE of leads with a shorter dwell time. These results will allow electrophysiologists to quantify risks and benefits of abandoning leads at the time of lead revisions or upgrades.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2644-2650"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692909","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 MD, MAS ,&nbsp;Guilherme L. da Rocha MD, MSc","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":"22 10","pages":"Pages e839-e840"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","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":"Mitral valve prolapse in sudden cardiac arrest survivors: Coincidence or causal relationship?","authors":"Krzysztof Jaworski MD, PhD ,&nbsp;Ilona Kowalik PhD ,&nbsp;Bohdan Firek MD, PhD ,&nbsp;Hubert Lazarczyk MSc ,&nbsp;Rafal Baranowski MD, PhD ,&nbsp;Zofia Bilinska MD, PhD ,&nbsp;Elzbieta Katarzyna Biernacka MD, PhD ,&nbsp;Tomasz Hryniewiecki MD, PhD ,&nbsp;Magdalena Marczak MD, PhD ,&nbsp;Mateusz Spiewak MD, PhD ,&nbsp;Anna Konopka MD, PhD ,&nbsp;Michal Lewandowski MD, PhD ,&nbsp;Pawel Syska MD, PhD ,&nbsp;Mariusz Pytkowski MD, PhD ,&nbsp;Maciej Sterlinski MD, PhD ,&nbsp;Lukasz Szumowski MD, PhD ,&nbsp;Rafal Dabrowski MD, PhD","doi":"10.1016/j.hrthm.2024.12.042","DOIUrl":"10.1016/j.hrthm.2024.12.042","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Sudden cardiac arrest (SCA) </span>risk stratification in patients with </span>mitral valve prolapse<span> (MVP) may be complicated by other potential causes of arrhythmia.</span></div></div><div><h3>Objective</h3><div>We aimed to characterize SCA survivors with isolated MVP (iMVP) and non–isolated MVP (non-iMVP) and to assess their long-term follow-up.</div></div><div><h3>Methods</h3><div><span>This ambispective study included 75 patients with MVP who experienced SCA and were treated in our center between 2009 and 2024. They were divided into 3 groups according to probability of relation between SCA and comorbidities. The control group comprised 112 participants with MVP but without a history of SCA. We analyzed all available electrocardiograms, Holter electrocardiography monitoring, and </span>echocardiograms, including longitudinal strain. A novel parameter, the systolic atrial-directed notch (SADN), was tested.</div></div><div><h3>Results</h3><div>SCA survivors with iMVP (n = 28) had higher prevalence of mitral annular disjunction (80% vs 35.7%; <em>P</em> = .006), Pickelhaube sign (60% vs 8.3%; <em>P</em> = .008), and SADN &gt;2 mm (69.6% vs 14.3%; <em>P</em><span><span> = .001) as well as higher absolute longitudinal strain values in basal and mid segments of the inferior and inferolateral wall than patients with SCA and non-iMVP without other defined structural heart diseases (n = 14). The differences were also observed in comparison to the control group. The cumulative incidence of appropriate implantable cardioverter-defibrillator </span>shocks within 6 years was 62% in patients with iMVP and 23% in the group with non-iMVP without other defined structural heart diseases.</span></div></div><div><h3>Conclusion</h3><div>Echocardiographic findings such as mitral annular disjunction, SADN, Pickelhaube sign, and increased segmental strain may be useful in the assessment of the relation between SCA and MVP. Malignant arrhythmias often recur in SCA survivors with iMVP.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2447-2456"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: Concomitant and sequential cohorts of the OPTION randomized controlled trial","authors":"Walid Saliba MD, FHRS ,&nbsp;Devi Nair MD, FHRS ,&nbsp;Vijendra Swarup MD, FHRS ,&nbsp;Terri Hall BSc, MBBS ,&nbsp;Vivek Iyer MD, MSE, FHRS ,&nbsp;Germán Calle Pérez MD ,&nbsp;Stanislav Weiner MD, FHRS ,&nbsp;Manish Shah MD ,&nbsp;Nilofar Islam MD ,&nbsp;Marek Grygier MD, PhD, FHRS ,&nbsp;Brian Schuler MD ,&nbsp;José Luis Ibáñez Criado MD, PhD ,&nbsp;Guillaume Duthoit MD ,&nbsp;Y Madhu Reddy MD, FHRS ,&nbsp;Vivek Y. Reddy MD ,&nbsp;Moussa Mansour MD, FHRS ,&nbsp;Andrea Natale MD, FHRS ,&nbsp;Krystal Leger PhD ,&nbsp;Thomas Christen MD, PhD ,&nbsp;Kenneth Stein MD, FHRS ,&nbsp;Oussama Wazni MD, FHRS","doi":"10.1016/j.hrthm.2025.04.029","DOIUrl":"10.1016/j.hrthm.2025.04.029","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage closure (LAAC) can be performed in separate procedures with cardiac ablation (sequentially) or concomitantly in the same operative session.</div></div><div><h3>Objective</h3><div>The OPTION trial aims to compare the efficacy and safety of LAAC with oral anticoagulation (OAC) in patients who have undergone catheter ablation for atrial fibrillation (AF). The objective of this sub-analysis is to evaluate LAAC vs OAC within concomitant and sequential ablation timings.</div></div><div><h3>Methods</h3><div>OPTION is a multicenter, prospective randomized clinical trial. Patients with AF and an elevated CHA₂DS₂-VASc score undergoing catheter ablation were randomly assigned (1:1) to catheter-based LAAC (Device) vs OAC (Control). Randomization was stratified by AF catheter ablation procedure timing: Sequential (90–180 days prior to randomization) or Concomitant (within 10 days of randomization, 99% of procedures happened the same day). The primary safety end point was non-procedural major or clinically-relevant non-major bleeding. The primary efficacy end point was the composite of all-cause death, stroke, or systemic embolism at 36 months.</div></div><div><h3>Results</h3><div>In both the Concomitant (n = 654) and Sequential (n = 946) groups, the Device arm compared with Control had fewer primary safety end point events and similar rates of primary efficacy events and secondary safety events. Rates of acute safety events were low and similar between the Device and Control arms within the Concomitant group; the addition of LAAC to cardiac ablation sessions did not result in increased procedural events.</div></div><div><h3>Conclusions</h3><div>For both Concomitant and Sequential ablation timing strategies, LAAC has similar efficacy compared with OAC and a lower risk of clinically important post-procedure bleeding in high-risk patients following AF ablation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2585-2594"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013738","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":"Right atrial cardioneuroablation of asystolic reflex syncope","authors":"Leonardo Calò MD ,&nbsp;Marco Rebecchi MD ,&nbsp;Ermenegildo De Ruvo MD ,&nbsp;Domenico Giamundo MD ,&nbsp;Antonella Sette MD ,&nbsp;Marco Tomaino MD ,&nbsp;Matthias Hunteruber MD ,&nbsp;Nicola Bottoni MD ,&nbsp;Matteo Iori MD ,&nbsp;Paolo Donateo MD ,&nbsp;Roberto Maggi MD ,&nbsp;Attilio Del Rosso MD ,&nbsp;Martina Rafanelli MD ,&nbsp;Vincenzo Russo MD ,&nbsp;Stefano Strano MD ,&nbsp;Michele Brignole MD","doi":"10.1016/j.hrthm.2025.05.038","DOIUrl":"10.1016/j.hrthm.2025.05.038","url":null,"abstract":"<div><h3>Background</h3><div>Cardioneuroablation (CNA) should focus on the vagal ganglia located in the right atrium<span> close to the sinoatrial and the atrioventricular nodes.</span></div></div><div><h3>Objective</h3><div>The study aimed to evaluate the efficacy and safety of right atrial CNA.</div></div><div><h3>Methods</h3><div>Patients with severe, asystolic reflex syncope identified by implantable loop recorder (ILR) or tilt testing underwent right atrial CNA and were subsequently monitored using ILR.</div></div><div><h3>Results</h3><div><span>The population included 28 patients with a mean age of 40.5 ± 13.4 years, of whom 71% were men. Over a median follow-up period of 12.5 months, 8 patients experienced 44 episodes of asystole lasting longer than 3 seconds, as recorded by an ILR. The burden of asystolic episodes significantly reduced from 0.89 episodes per month before CNA (145 over 163 patient-months) to 0.11 episodes per month after CNA (44 over 397 patient-months), with a relative risk reduction of 0.12, </span><em>P =</em> .0001. Similarly, the burden of syncopal episodes decreased from 0.23 episodes per month before CNA to 0.06 episodes per month after CNA, resulting in an relative risk reduction of 0.24, <em>P =</em><span> .0001. Median heart rate increased from 75 bpm (interquartile range: 72–79) before ablation to 83 bpm (interquartile range: 78–85) after ablation, lasting up to 9 months post-procedure. No patients experienced complications during the procedure. During follow-up, 2 patients received pacemakers, 1 underwent a redo procedure, and 4 experienced mild transient symptoms: 3 had palpitations and 1 had dyspnea, none requiring therapy.</span></div></div><div><h3>Conclusion</h3><div>Right atrial CNA reduced asystolic episodes by 88% and syncopal episodes by 76% during the mid-term follow-up. Adverse events were infrequent and mild.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e951-e958"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142146","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":"Ensuring catheter-tissue contact with intracardiac echocardiography during pulsed-field ablation improves procedure outcome in patients with atrial fibrillation","authors":"Sanghamitra Mohanty MD, MS, FHRS ,&nbsp;Michela Casella MD ,&nbsp;Brandon Doty MD ,&nbsp;Marco Schiavone MD ,&nbsp;Kirollos Gabrah MD ,&nbsp;Yari Valeri MD ,&nbsp;Prem Geeta Torlapati MD, MPH ,&nbsp;Vincenzo Mirco La Fazia MD ,&nbsp;Carola Gianni MD, PHD ,&nbsp;Amin Al-Ahmad MD, FHRS ,&nbsp;John D. Burkhardt MD, FHRS ,&nbsp;G.J. Gallinghouse MD ,&nbsp;Rodney Horton MD ,&nbsp;John Allison MD ,&nbsp;Weeranun Bode MD ,&nbsp;Rashi Sharma MD ,&nbsp;Antonio Dello Russo MD ,&nbsp;Claudio Tondo MD ,&nbsp;Devi G. Nair MD, FHRS ,&nbsp;Andrea Natale MD, FACC, FESC, FHRS","doi":"10.1016/j.hrthm.2025.05.045","DOIUrl":"10.1016/j.hrthm.2025.05.045","url":null,"abstract":"<div><h3>Background</h3><div>Catheter-tissue contact is critical in creating durable lesions during pulsed-field ablation (PFA) of atrial fibrillation (AF).</div></div><div><h3>Objective</h3><div>This study aimed to compare the reconnection rate of previously ablated targets using PFA with vs without intracardiac echocardiography (ICE) guidance for confirmation of tissue contact.</div></div><div><h3>Methods</h3><div>This multicenter prospective study included consecutive patients with paroxysmal and persistent AF<span><span> undergoing their first procedure using the PFA system. Patients were classified as the ICE group if ICE was used for the assessment of catheter-tissue contact (n = 310) or the fluoro group if fluoroscopy-guided ablation was used (n = 286). All patients received isolation of pulmonary veins; left atrial posterior wall isolation was performed in most patients at the index procedure. Further ablations were performed only in the presence of spontaneous triggers or documentation that those triggers were responsible for arrhythmia either spontaneously or after </span>isoproterenol challenge.</span></div></div><div><h3>Results</h3><div>Baseline characteristics were comparable between the groups. At the end of the follow-up, arrhythmia recurrence was noted in 39 (12.6%) and 64 patients (22.3%) in the ICE and fluoro groups, respectively (<em>P</em> = .002). All 39 patients in the ICE group and 54 patients (84%) in the fluoro group received repeat ablation. At the redo procedure, reconnection of previously ablated structures was detected in 4 of 39 (10.3%) and 32 of 54 patients (59.2%) in the ICE and fluoro groups, respectively (<em>P</em> &lt; .001). “Fluoroscopy-guided” ablation was found to be an independent predictor of reconnection (odds ratio 8.548; 95% confidence interval 3.224–22.667; <em>P</em> &lt; .001) and recurrence (odds ratio 1.221; 95% confidence interval 1.001–1.971; <em>P</em> = .021).</div></div><div><h3>Conclusion</h3><div>ICE-guided PFA with confirmed catheter-tissue contact was associated with a better success rate and a significantly lower reconnection rate in patients with AF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e875-e881"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of left atrial appendage occlusion using transesophageal echocardiography vs 3-dimensional intracardiac echocardiography: Insights from a single-center NCDR registry","authors":"Auroa Badin MD, FHRS ,&nbsp;Rayan El-Zein DO ,&nbsp;Rachel Wester DO ,&nbsp;Zeryab Khan DO ,&nbsp;Sreedhar R. Billakanty MD, FHRS ,&nbsp;David M. Nemer MD ,&nbsp;Ankur N. Shah DO ,&nbsp;Jaret D. Tyler MD, FHRS ,&nbsp;Carlos E. Sanchez MD ,&nbsp;Steven J. Yakubov MD ,&nbsp;Arash Arshi MD ,&nbsp;Kevin L. Stiver MD ,&nbsp;Laura D. Flannery MD ,&nbsp;Ileah Reichert CNP ,&nbsp;Andrea K. Robinson CNP ,&nbsp;Marie Lockhart PhD ,&nbsp;Anish K. Amin MD, FHRS ,&nbsp;Nagesh Chopra MD","doi":"10.1016/j.hrthm.2025.05.069","DOIUrl":"10.1016/j.hrthm.2025.05.069","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1037-e1039"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233955","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":"Pulmonary vein isolation and low-voltage area ablation in sinus rhythm for persistent atrial fibrillation: The SCAR-AF randomized trial","authors":"Antoine Lepillier MD ,&nbsp;Julien Pineau MD ,&nbsp;Akli Otmani MD ,&nbsp;Cyril Durand MD ,&nbsp;Xavier Waintraub MD ,&nbsp;Cyril Zakine MD ,&nbsp;Marjorie Niro MD ,&nbsp;Ghassan Moubarak MD ,&nbsp;Alexandre Zhao MD ,&nbsp;Clément Bars MD ,&nbsp;Nicolas Badenco MD ,&nbsp;William Escande MD ,&nbsp;Gilles Macaluso MD ,&nbsp;Olivier Piot MD, MSc","doi":"10.1016/j.hrthm.2025.05.064","DOIUrl":"10.1016/j.hrthm.2025.05.064","url":null,"abstract":"<div><h3>Background</h3><div><span>Targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation (PVI) can improve ablation outcome in </span>persistent atrial fibrillation (AF).</div></div><div><h3>Objective</h3><div>SCAR-AF was a multicenter, prospective, randomized trial, evaluating LVA ablation plus PVI for persistent AF.</div></div><div><h3>Methods</h3><div>Patients with de novo persistent AF were recruited (9 referral centers in France) into the SCAR-AF study (September 2019 to August 2021). Patients without LVA were treated with PVI alone (PVI–), and those with LVA were randomized to either PVI alone (PVI+) or PVI plus LVA ablation (PVI + LVA). The primary outcome was freedom from atrial arrhythmias (AF/atrial tachycardia) after a single procedure.</div></div><div><h3>Results</h3><div>A total of 211 patients (73.5% men, mean ± standard deviation age 63.8 ± 9.3 years, CHA₂DS₂-VASc score 2.1, long-standing AF 44.5%) were included. At 18-month follow-up, the incidence of atrial-arrhythmia-free survival did not differ between groups (79.0% in PVI–, 75.7% in PVI+, and 73.1% in PVI + LVA; PVI– vs PVI+, hazard ratio (HR) 1.28, 95% confidence interval [CI] 0.64–2.55, <em>P</em> = .48; PVI+ vs PVI + LVA, HR 1.28; 95% CI 0.67–2.45, <em>P</em> = .45). On multivariable analysis, presence of LVA was associated with advancing age (HR 1.11, 95% CI 1.06–1.16, <em>P</em><span> &lt; .001) and was inversely correlated with body mass index (HR 0.93, 95% CI 0.87–0.99, </span><em>P</em> = .029) and smoking.</div></div><div><h3>Conclusion</h3><div>In this randomized trial, PVI plus LVA ablation did not improve outcomes in patients with persistent AF. LVA may represent a marker of atrial cardiomyopathy, but its presence does not seem to be an effective target in persistent AF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e858-e865"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225306","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":"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}