Heart rhythm最新文献

{"title":"To the Editor — An ECG that changed life for the Brugada brothers but also for somebody else","authors":"Bortolo Martini MD","doi":"10.1016/j.hrthm.2024.08.020","DOIUrl":"10.1016/j.hrthm.2024.08.020","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Page 871"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982130","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":"Proportions between short and long runs of atrial ectopy","authors":"Marek Malik PhD, MD, FHRS","doi":"10.1016/j.hrthm.2024.08.045","DOIUrl":"10.1016/j.hrthm.2024.08.045","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 806-807"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072623","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":"Catheter ablation for atrial fibrillation in patients with significant mitral regurgitation: A systematic review and meta-analysis","authors":"Ross A. Okazaki MD ,&nbsp;Lillian C. Flashner MD ,&nbsp;Scott Kinlay MBBS, PhD ,&nbsp;Adelqui O. Peralta MD ,&nbsp;Peter S. Hoffmeister MD ,&nbsp;Hirad Yarmohammadi MD, MPH ,&nbsp;Jacob Joseph MBBS, MD ,&nbsp;Matthew F. Yuyun MD, MPhil, PhD","doi":"10.1016/j.hrthm.2024.07.110","DOIUrl":"10.1016/j.hrthm.2024.07.110","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is commonly associated with cardiac structural abnormalities including mitral regurgitation (MR). Contemporary guidelines recommend consideration of early rhythm control strategies including catheter ablation (CA) for AF. However, the long-term efficacy of CA is highly variable across studies and patient populations, and the effect of coexisting MR on AF recurrence remains unclear.</div></div><div><h3>Objective</h3><div>A systematic review and meta-analysis was performed to determine the impact of significant MR (defined as ≥moderate) on AF recurrence rate after CA and whether CA for AF is associated with significant changes in the severity of MR.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, Web of Science, and Cochrane databases for all English-language studies published to December 31, 2023, was performed.</div></div><div><h3>Results</h3><div>A total of 17 studies (N = 2624 patients) were retained for meta-analysis. The pooled recurrence proportion of AF after CA in patients with baseline significant MR was 36% (95% CI, 27%–46%) compared with 27% (14%–41%) in patients without. The pooled hazard ratio (95% CI) for AF recurrence after CA in the presence of significant MR was 2.47 (1.52–4.01; <em>P</em> &lt; .001; Egger test <em>P</em> value, .0583). The pooled proportion of patients who witnessed MR improvement to nonsignificant (ie, &lt;moderate) or resolution after CA was 46 % (95% CI, 30%–62%).</div></div><div><h3>Conclusion</h3><div>Baseline significant MR was independently predictive of AF recurrence rate after CA. Despite the increased AF recurrence rates after CA associated with significant MR, CA with maintenance of sinus rhythm appeared to improve the severity of MR, suggesting a possible induction of reverse positive atrial and mitral valvular remodeling.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 637-646"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878568","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":"Fetal T-wave and isovolumetric relaxation time alternans can be identified by fetal echocardiography","authors":"Dalton J. Roth MS ,&nbsp;Janette F. Strasburger MD ,&nbsp;Ronald T. Wakai PhD","doi":"10.1016/j.hrthm.2024.08.012","DOIUrl":"10.1016/j.hrthm.2024.08.012","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 856-858"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901463","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":"Power-law properties of nocturnal arrhythmia avalanches: A novel marker for incident cardiovascular events","authors":"Sobhan Salari Shahrbabaki PhD ,&nbsp;Dhani Dharmaprani PhD ,&nbsp;Kathryn D. Tiver BMBS ,&nbsp;Evan Jenkins BEng ,&nbsp;Campbell Strong BSc ,&nbsp;Ivaylo Tonchev MD ,&nbsp;Luke Phillip O’Loughlin BSc ,&nbsp;Dominik Linz MD, PhD ,&nbsp;Darius Chapman BSc ,&nbsp;Bastien Lechat PhD ,&nbsp;Shahid Ullah PhD ,&nbsp;Katie L. Stone PhD ,&nbsp;Danny J. Eckert PhD ,&nbsp;Mathias Baumert PhD ,&nbsp;Anand N. Ganesan MBBS, PhD, FRACP","doi":"10.1016/j.hrthm.2024.08.015","DOIUrl":"10.1016/j.hrthm.2024.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Bursting nonsustained cardiac arrhythmia events are a common observation during sleep.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to investigate the hypothesis that nocturnal arrhythmia episode durations could follow a power law, whose exponent could predict long-term clinical outcomes.</div></div><div><h3>Methods</h3><div>We defined “nocturnal arrhythmia avalanche” (NAA) as any instance of a drop in electrocardiographic (ECG) template-matched R-R intervals ≥30% of R-R baseline, followed by a return to 90% of baseline. We studied NAA in ECG recordings obtained from the Sleep Heart Health Study (SHHS), Osteoporotic Fractures in Men Study (MrOS) Study, and Multi-Ethnic Study of Atherosclerosis (MESA). The association of nocturnal arrhythmia durations with a power-law distribution was evaluated and the association of derived power-law exponents (α) with major adverse cardiovascular (CV) events and mortality assessed with multivariable Cox regression.</div></div><div><h3>Results</h3><div>A total of 9176 participants were studied. NAA episodes distribution was consistent with power-law vs comparator distributions in all datasets studied (positive log likelihood ratio of power-law vs exponential in MESA: 83%; SHHS: 69%; MrOS: 81%; power-law vs log-normal in MESA: 95%; SHHS: 35%; MrOS: 64%). The NAA power-law exponent (α) showed a significant association of with adverse CV outcomes (association with CV mortality: SHHS hazard ratio 1.39 [1.07–1.79], <em>P</em> = .012; MrOS hazard ratio 1.42 [1.02–1.94], <em>P</em> = .039; association with CV events: MESA HR 3.46 [1.46–8.21], <em>P</em> = .005) in multivariable Cox regression, after adjusting for conventional CV risk factors and nocturnal ectopic rate.</div></div><div><h3>Conclusion</h3><div>The NAA power-law exponent is a reproducible, predictive marker for incident CV events and mortality.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 796-805"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912436","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":"Prognostic importance of ischemic heart disease for patients with atrial fibrillation undergoing catheter ablation","authors":"Caroline Espersen MD ,&nbsp;Daniel Modin MD ,&nbsp;Niklas Dyrby Johansen MD ,&nbsp;Kira Hyldekær Janstrup MSc, PhD ,&nbsp;Arne Johannessen MD, DMSc ,&nbsp;Jim Hansen MD, DMSc ,&nbsp;Kristian Eskesen MD, PhD ,&nbsp;Allan Zeeberg Iversen MD, PhD ,&nbsp;René H. Worck MD, PhD ,&nbsp;Martin H. Ruwald MD, PhD ,&nbsp;Morten Lock Hansen MD, PhD ,&nbsp;Gunnar H. Gislason MD, PhD ,&nbsp;Raúl San José Estépar MSc, PhD ,&nbsp;Gregory M. Marcus MD, MAS, FHRS ,&nbsp;Tor Biering-Sørensen MD, MPH, MSc, PhD","doi":"10.1016/j.hrthm.2024.08.022","DOIUrl":"10.1016/j.hrthm.2024.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Ischemic heart disease (IHD) has been linked to an increased risk of atrial fibrillation (AF). However, data are sparse regarding the role of IHD in AF recurrence after catheter ablation.</div></div><div><h3>Objective</h3><div>We sought to investigate whether preexisting or new-onset IHD is associated with a greater risk of AF recurrence after ablation.</div></div><div><h3>Methods</h3><div>With use of Danish nationwide registries, all patients undergoing first-time AF ablation in Denmark from 2010 to 2020 were identified. The primary outcome was AF recurrence defined by AF-related hospital admission or antiarrhythmic drug use within 1 year after ablation excluding a 3-month blanking period. IHD was defined as an <em>International Classification of Diseases, Tenth Revision</em> diagnosis of IHD or prior coronary revascularization.</div></div><div><h3>Results</h3><div>Of 12,162 patients undergoing first-time ablation for AF (mean age, 62 years; 30% female), 20% had preexisting IHD. Preexisting IHD was associated with an increased risk of AF recurrence in univariable log-binomial logistic regression (relative risk, 1.09; 95% CI, 1.04–1.14; <em>P</em> &lt; .001). However, after multivariable adjustment including procedural year, preexisting IHD was no longer associated with an increased risk of AF recurrence (relative risk, 1.02; 95% CI, 0.97–1.06; <em>P</em> = .42). In a nested case-control study of those without preexisting IHD before ablation (n = 9778), newly diagnosed IHD after ablation was associated with an increased risk of AF recurrence in multivariable analysis (hazard ratio, 3.03; 95% CI, 1.84–4.99; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The presence of IHD does not appear to reduce the effectiveness of AF ablation procedures. However, the emergence of IHD after AF ablation may serve as a trigger for AF that is insufficiently suppressed by prior ablation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 668-674"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987831","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":"Efficacy and clinical outcomes of catheter ablation for atrial arrhythmia in cardiac amyloidosis","authors":"Song Peng Ang MD ,&nbsp;Jia Ee Chia MD ,&nbsp;Abhishek J. Deshmukh MBBS, FHRS ,&nbsp;Justin Z. Lee MD ,&nbsp;Kwan Lee MD ,&nbsp;Chayakrit Krittanawong MD, FACC ,&nbsp;Jose Iglesias DO ,&nbsp;Debabrata Mukherjee MD, FACC, MSCAI","doi":"10.1016/j.hrthm.2024.08.025","DOIUrl":"10.1016/j.hrthm.2024.08.025","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 865-867"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995649","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":"Sleep-disordered breathing destabilizes ventricular repolarization: Cross-sectional, longitudinal, and experimental evidence","authors":"Soroosh Solhjoo PhD ,&nbsp;Mark C. Haigney MD, FHRS ,&nbsp;Naresh M. Punjabi MD, PhD","doi":"10.1016/j.hrthm.2024.08.054","DOIUrl":"10.1016/j.hrthm.2024.08.054","url":null,"abstract":"<div><h3>Background</h3><div>Sleep-disordered breathing (SDB) increases the risk of cardiac arrhythmias and sudden cardiac death.</div></div><div><h3>Objective</h3><div>This study sought to characterize the associations between SDB, intermittent hypoxemia, and the beat-to-beat QT variability index (QTVI), a measure of ventricular repolarization lability associated with cardiac arrhythmias and sudden cardiac death.</div></div><div><h3>Methods</h3><div>Three distinct cohorts were used: a matched sample of 122 participants with and without severe SDB for cross-sectional analysis; a matched sample of 52 participants with and without incident SDB for longitudinal analysis; and a sample of 19 healthy adults exposed to acute intermittent hypoxia and ambient air on 2 separate days. The cross-sectional and longitudinal cohorts were the Sleep Heart Health Study participants with no known comorbidities who were not taking any drugs known to affect cardiac repolarization and satisfied the inclusion criteria. Electrocardiographic measures were calculated from 1-lead electrocardiograms.</div></div><div><h3>Results</h3><div>Participants with severe SDB had greater QTVI than those without SDB (<em>P</em> = .027). Total sleep time with &lt;90% oxygen saturation, but not the arousal frequency, was a predictor of QTVI. QTVI during sleep was predictive of all-cause mortality. With incident SDB, mean QTVI increased from −1.23 to −0.86 during 5 years (<em>P</em> = .017). Finally, experimental exposure of healthy adults to acute intermittent hypoxia for 4 hours progressively increased QTVI (<em>P</em> = .016).</div></div><div><h3>Conclusion</h3><div>The results show that both prevalent SDB and incident SDB are associated with ventricular repolarization instability and suggest intermittent hypoxemia as the underlying mechanism that may contribute to increased mortality in SDB.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 808-816"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic brain injury is associated with the subsequent risk of atrial fibrillation or atrial flutter","authors":"Ian J. Stewart MD ,&nbsp;Jeffrey T. Howard PhD ,&nbsp;Megan E. Amuan MPH ,&nbsp;Eamonn Kennedy PhD ,&nbsp;John E. Balke BS ,&nbsp;Eduard Poltavskiy PhD ,&nbsp;Lauren E. Walker MSSW ,&nbsp;Mark Haigney MD ,&nbsp;Mary Jo Pugh PhD","doi":"10.1016/j.hrthm.2024.09.019","DOIUrl":"10.1016/j.hrthm.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury (TBI) is associated with a variety of adverse long-term outcomes and increases sympathetic nervous system activation, which could increase the risk of arrhythmias including atrial fibrillation or atrial flutter (AF/AFL).</div></div><div><h3>Objective</h3><div>We examined episodes of TBI and subsequent AF/AFL in a large cohort of post-9/11 servicemembers and veterans.</div></div><div><h3>Methods</h3><div>The variable of interest was TBI, stratified by severity (mild, moderate/severe, and penetrating). The outcome was a subsequent diagnosis of AF/AFL. We used Fine-Gray competing risks models to evaluate the potential risk imparted by TBI on subsequent AF/AFL.</div></div><div><h3>Results</h3><div>Of the 1,924,900 participants included in the analysis, 369,891 (19.2%) experienced an episode of documented TBI. Most were young (63% &lt;35 years), male (81.7%), and non-Hispanic White (62.7%). AF/AFL was diagnosed in 22,087 patients. On univariate analysis, only penetrating TBI (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.84–2.23; <em>P</em> &lt; .001) was associated with AF/AFL compared with veterans without TBI. After adjustment in the full multivariable model (adjusted for age, sex, race and ethnicity, service branch, rank, component, and comorbidities), mild (HR 1.27, 95% CI 1.22–1.32; <em>P</em> &lt; .001), moderate/severe (HR, 1.34; 95% CI, 1.24–1.44; <em>P</em> &lt; .001), and penetrating TBI (HR, 1.82; 95% CI, 1.65–2.02; <em>P</em> &lt; .001) were significantly associated with AF/AFL compared with no TBI. Post hoc analyses demonstrated that the risk of AF/AFL was concentrated in female and younger patients.</div></div><div><h3>Conclusion</h3><div>We found that an episode of TBI, particularly penetrating TBI, significantly increased the risk for AF/AFL. Further work is needed to delineate the long-term risk of arrhythmias after TBI.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 661-667"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequities in atrial fibrillation trials: An analysis of participant race, ethnicity, and sex over time","authors":"Roy H. Lan MD ,&nbsp;Ishan Paranjpe MD ,&nbsp;Mohammad Saeed MD ,&nbsp;Marco V. Perez MD","doi":"10.1016/j.hrthm.2024.06.052","DOIUrl":"10.1016/j.hrthm.2024.06.052","url":null,"abstract":"<div><h3>Background</h3><div>Despite the importance of racial and ethnic representation in clinical trials, limited data exist about the enrollment trends of these groups in atrial fibrillation (AF) trials over time.</div></div><div><h3>Objective</h3><div>The purpose of this study was to examine the characteristics of contemporary AF clinical trials and to evaluate their association with race and ethnicity over time.</div></div><div><h3>Methods</h3><div>We performed a systematic search of all completed AF trials registered in <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> from conception to December 31, 2023, and manually extracted composition of race/ethnicity. We stratified trials by study characteristics, including impact factor, publication status, funding source, and location. We calculated the participation to prevalence ratio (PPR) by dividing the percentage of non-White participants by the percentage of non-White participants in the disease population (PPR of 0.8–1.2 suggests proportional representation) over time.</div></div><div><h3>Results</h3><div>We identified 277 completed AF trials encompassing a total of 1,933,441 adults, with a median proportion of non-White at 12% (interquartile range, 6%–27%), 121 (43.7%) device focused, and 184 (66.4%) funded by industry. Only 36.1% of trials reported comprehensive race information. Overall, non-White participants were underrepresented (PPR = 0.511; <em>P</em> &lt; .001), including Black (PPR = 0.263) and Hispanic (PPR = 0.337) participants. The proportion of non-White participants did not change significantly between 2000 and 2023 (11% vs 9%; <em>P</em> = .343).</div></div><div><h3>Conclusion</h3><div>Despite greater awareness, race/ethnicity reporting and representation of non-White groups in AF clinical trials are poor and have not improved significantly over time. These findings demand additional recruitment efforts and novel recruitment policies to ensure adequate representation of these demographic subgroups in future AF clinical trials.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 602-608"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476480","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}