Heart Rhythm O2最新文献

{"title":"Exploring serum and glucocorticoid-regulated kinase 1: A promising target for COVID-19 and atrial fibrillation treatment","authors":"Jamal E-Fatima PhD ,&nbsp;Faez Iqbal Khan PhD ,&nbsp;Dakun Lai PhD","doi":"10.1016/j.hroo.2025.02.015","DOIUrl":"10.1016/j.hroo.2025.02.015","url":null,"abstract":"<div><div>Serum and glucocorticoid-regulated kinase 1 (SGK1) is a serine/threonine kinase that is involved in various cellular pathways, such as ion transport, cell survival, proliferation, and immune responses. Dysregulation of this enzyme is increasingly being associated with the progression of 2 prominent types of diseases, namely viral infections, such as COVID-19, and cardiovascular disorders, such as atrial fibrillation (AF), positioning it as a potential therapeutic target. With regard to coronavirus 2019 (COVID-19), SGK1 detrimentally affects inflammatory pathways and modulates the cytokine storm, leading to lung tissue damage. Considering this dysregulation, researchers are exploring SGK1 inhibition as a potential strategy for mitigating severe COVID-19 outcomes. SGK1 also regulates pumps and ion channels, significantly affecting cardiac performance in AF. This protein is responsible for promoting fibrosis and inflammation in the cardiac tissue, making it a potential target for reducing atrial fibrillation. SGK1 inhibition offers a new avenue for therapeutic targets against both COVID-19 and AF. This review is aimed at providing a comprehensive overview of SGK1 dysregulation in both diseases, underscoring the urgent need for more preclinical and clinical trials to evaluate effective SGK1 inhibitors for patients with coexisting COVID-19 and AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 720-732"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed field ablation for paroxysmal atrial fibrillation in a dextrocardia case: A first-in-human experience","authors":"Tongshuai Chen PhD ,&nbsp;Kai Zhang PhD ,&nbsp;Bing Rong MD ,&nbsp;Mingjie Lin PhD ,&nbsp;Jingquan Zhong PhD, MD, FHRS","doi":"10.1016/j.hroo.2025.03.013","DOIUrl":"10.1016/j.hroo.2025.03.013","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 736-738"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vein of Marshall ethanol infusion improves ablation outcomes in patients with persistent atrial fibrillation","authors":"Mohammed Al-Sadawi MB BCH,&nbsp;Rushil N. Shah MBBS, DNB, MHS,&nbsp;Amrish Deshmukh MD,&nbsp;Jackson J. Liang DO,&nbsp;Krit Jongnarangsin MD,&nbsp;Fred Morady MD,&nbsp;Hakan Oral MD,&nbsp;Aman Chugh MD,&nbsp;Michael Ghannam MD","doi":"10.1016/j.hroo.2025.01.020","DOIUrl":"10.1016/j.hroo.2025.01.020","url":null,"abstract":"<div><h3>Background</h3><div>Vein of Marshall ethanol infusion (VoMEI) may improve outcomes among patients with persistent atrial fibrillation (AF) undergoing catheter ablation procedures. Prior investigations used heterogeneous ablation strategies, limiting the understanding of VoMEI utility.</div></div><div><h3>Objective</h3><div>The study sought to examine the safety and efficacy of a uniform ablation approach utilizing VoMEI compared with patients undergoing pulmonary vein isolation (PVI) only or PVI and posterior wall isolation (PWI).</div></div><div><h3>Methods</h3><div>Patients undergoing first-time ablation for persistent AF utilizing VoMEI with PVI, PWI, and ablation of induced macro–re-entry arrhythmias were included. Two propensity-matched control groups (PVI only and PVI + PWI) were identified with 2:1 matching. Safety and efficacy rates between the groups were examined.</div></div><div><h3>Results</h3><div>A total of 155 patients were included (VoMEI, n = 31; PVI, n = 62; PVI + PWI, n = 62), consisting of 98 (63%) males 66 ± 10 years of age, with left atrial diameter 49 ± 7 mm, ejection fraction 50 ± 16%, and follow-up time 3.2 ± 2.2 years, with no demographic differences between the groups (<em>P &gt;</em> .05). The 1-year rate of freedom from atrial arrhythmias after a single procedure was 84%, 67%, and 54% for patients undergoing VoMEI, PVI only, and, PVI + PWI, respectively (log rank <em>P</em> = .021). Patients who underwent VoMEI had improved outcomes compared with patients who did not (hazard ratio 0.32, 95% confidence interval 0.12–0.78, <em>P =</em> .01), with fewer repeat procedures (10% vs 37%, <em>P &lt;</em> .01). Procedure, radiofrequency, and fluoroscopy times were greater in the VoMEI groups (<em>P &gt;</em> .05).</div></div><div><h3>Conclusion</h3><div>Among patients with persistent AF, an ablation strategy incorporating VoMEI improved long-term ablation outcomes compared with groups of propensity-matched patients undergoing PVI only or PVI + PWI.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 598-605"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation?","authors":"Argyrios Petras PhD ,&nbsp;Gerard Amoros Figueras PhD ,&nbsp;Zoraida Moreno Weidmann MD ,&nbsp;Tomás García-Sánchez PhD ,&nbsp;David Viladés Medel MD, PhD ,&nbsp;Antoni Ivorra PhD ,&nbsp;Jose M. Guerra MD, PhD ,&nbsp;Luca Gerardo-Giorda PhD","doi":"10.1016/j.hroo.2025.02.014","DOIUrl":"10.1016/j.hroo.2025.02.014","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed-field ablation (PFA) is a novel cardiac ablation technology based on irreversible electroporation (IRE). PFA computational models rely on identification of a lethal electric field threshold to predict the IRE area. However, the predicted lesion anisotropy ratios (width over depth) vary extensively among recent studies, and these discrepancies remain a subject of discussion.</div></div><div><h3>Objective</h3><div>This work aims to evaluate the predicted lesion anisotropy ratios using a PFA computational model by applying it to an open-chest in vivo porcine model geometry.</div></div><div><h3>Methods</h3><div>Six domestic swine underwent epicardial PFA applications using a previously described waveform protocol. Animals were killed at least 3 hours after the last ablation, and lesions were assessed using triphenyltetrazolium chloride (TTC) staining. Numeric simulations were performed on a segmented and meshed porcine thoracic computed tomography (CT) scan, mimicking the open-chest experimental setup.</div></div><div><h3>Results</h3><div>The maximum width of all simulated lesions was observed at the epicardial surface. The anisotropy ratios (AR) of the experimental lesions were smaller than the simulated ones (AR experimental vs simulated, 1.0–1.7 vs 2–2.7; Q1–Q3 quartiles). Increasing the peak voltage resulted in larger lesions; however, the computational model clearly underestimated the increase in lesion depth compared with the experimental data.</div></div><div><h3>Conclusion</h3><div>Our computational model shows that a single lethal electric field threshold is insufficient to accurately predict both lesion depth and width in cardiac PFA. Our study suggests that for the given PFA waveforms, a threshold between 270 and 500 V/cm provides satisfactory lesion depth estimations, and a higher threshold between 790 and 1000 V/cm better captures the lesion width.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 671-677"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning–based risk prediction model for atrial fibrillation in critically ill patients","authors":"Laith Alomari MD ,&nbsp;Yaman Jarrar MD ,&nbsp;Zaid Al-Fakhouri MD ,&nbsp;Emmanuel Otabor MBBS ,&nbsp;Justin Lam MD ,&nbsp;Jana Alomari","doi":"10.1016/j.hroo.2025.02.008","DOIUrl":"10.1016/j.hroo.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) in critically ill patients increases morbidity, hospital stays, and costs. Existing prediction tools are limited in intensive care unit (ICU) settings.</div></div><div><h3>Objective</h3><div>This study developed a machine learning–based model to enable early AF risk identification and prevention.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, adult patients admitted to the ICU were identified from the MIMIC-IV (Medical Information Mart for Intensive Care-IV) database, including 47 clinical and laboratory variables. The primary outcome was AF within the first 48 hours of admission. Multiple machine learning models were trained to predict AF, with the top-performing model undergoing hyperparameter tuning. A compact model was developed using 15 variables and 2 novel features—one identifying patients 70 years of age or older with sepsis and another representing a composite score of pre-existing cardiac risk factors. Model performance was evaluated using accuracy, area under the receiver-operating characteristic curve (AUROC), and predictive values. SHAP (Shapley Additive exPlanations) analysis interpreted individual feature contributions to the model's predictions.</div></div><div><h3>Results</h3><div>The cohort comprised 46,266 ICU patients, with 4.6% developing AF within 48 hours. The CatBoost classifier model achieved an AUROC of 0.850 on the test set, while the compact model with new features yielded an AUROC of 0.820. SHAP analysis highlighted total serum magnesium, age, and the newly created features as key predictors of AF development.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the potential of machine learning models in predicting AF development in ICU patients. The compact model, with a satisfactory AUROC, can be a valuable tool for identifying high-risk patients and facilitating timely interventions.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 652-660"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of triple-site versus dual-site cardiac resynchronization therapy using temporary pacing to guide individualized implantation","authors":"Michio Ogano MD, PhD ,&nbsp;Yu-ki Iwasaki MD, PhD ,&nbsp;Jun Tanabe MD ,&nbsp;Wataru Shimizu MD, PhD, FHRS ,&nbsp;Kuniya Asai MD, PhD","doi":"10.1016/j.hroo.2025.02.013","DOIUrl":"10.1016/j.hroo.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy (CRT) is an effective treatment for chronic heart failure, but dual-site (2V) pacing may not fully eliminate electrical dyssynchrony. Triple-site (3V) pacing, adding an additional left ventricle (LV) pacing site, may enhance CRT outcomes.</div></div><div><h3>Objective</h3><div>This study examines the long-term effects of 2V vs 3V CRT, using temporary pacing to individualize lead placement.</div></div><div><h3>Methods</h3><div>From 2010 to 2016, 92 patients with New York Heart Association (NYHA class II-IV heart failure, left ventricular ejection fraction (LVEF) &lt; 35%, and QRS duration &gt; 120 ms received CRT guided by temporary pacing. Patients underwent invasive pacing studies to measure electrical and hemodynamic improvements between 2V and 3V configurations. Based on QRS narrowing and LV dP/dtmax improvements, 27 patients were assigned to the 3V group and 65 to the 2V group. Clinical outcomes, including the clinical composite score (CCS), NYHA class, QRS duration, heart failure (HF) events, and mortality, were followed up over an average 8.3 years.</div></div><div><h3>Results</h3><div>At 1 year, the 3V group had significantly better CCS outcomes compared with the 2V group (<em>P</em> = .018). Long-term follow-up showed a significantly lower HF event rate in the 3V group (<em>P</em> = .002), although overall mortality did not differ. Multivariate analysis identified 3V pacing as an independent predictor of reduced HF events (hazard ratio [HR] = 0.275; <em>P</em> = .018). Despite shorter battery life in the 3V group, device replacement rates were similar.</div></div><div><h3>Conclusion</h3><div>Temporary pacing-guided 3V CRT provides significant long-term benefits over 2V CRT by reducing HF events. These findings support the necessity of individualized assessment and approach to eliminate electrical dyssynchrony when considering multi-site pacing CRT.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 557-565"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left bundle branch area pacing in patients with severe interventricular septal hypertrophy: A multicenter study assessing feasibility, safety, and outcomes of lumenless and stylet-driven leads","authors":"Sanjai Pattu Valappil MD, DM ,&nbsp;Abhinav B. Anand MD, DM ,&nbsp;Anindya Ghosh MD, DM ,&nbsp;Krishnaswamy Subramanyan MD, DM ,&nbsp;Pramod Jaiswal MD, DM ,&nbsp;Krishnan Jayanthi MD, DNB ,&nbsp;Golla N. Prasad MD, DNB ,&nbsp;Tirupattur S. Srinath MD, DNB ,&nbsp;Shilpa Menon MD, DM ,&nbsp;Sharan Shreedhar MD ,&nbsp;Karthikeyan D DMRD, DNB, Radiology ,&nbsp;Velayudhan Bashi MS, MCH ,&nbsp;Justin Paul MD, DNB, DM ,&nbsp;Elangovan Elavarasi Manimegalai MD, DM ,&nbsp;Immanuel Sathiakumar Arunkumar MD (General Medicine), DM (Cardiology) ,&nbsp;Sriram Veeraraghavan MD, DM ,&nbsp;Saran G. Kumar BSc ,&nbsp;Soli Rajaram Ramkumar MD, DM ,&nbsp;Raniya Palliyedath MBBS ,&nbsp;Shaima Hafeez MBBS ,&nbsp;Ulhas M. Pandurangi MD, DM","doi":"10.1016/j.hroo.2025.02.018","DOIUrl":"10.1016/j.hroo.2025.02.018","url":null,"abstract":"<div><h3>Background</h3><div>There has been limited success using left bundle branch area pacing (LBBAP) in patients with severe interventricular septal hypertrophy (IVSH).</div></div><div><h3>Objective</h3><div>This study assesses the feasibility, safety, and outcome of LBBAP in patients with severe IVSH.</div></div><div><h3>Methods</h3><div>19 adult patients with severe IVSH who underwent LBBAP were enrolled. Baseline patient characteristics, procedural data, and postprocedural results were collected. The feasibility of LBBAP in patients with severe IVSH using the lumenless leads (LLL) and stylet-driven leads (SDL) were analyzed.</div></div><div><h3>Results</h3><div>19 IVSH and 529 normal septal thickness (NST) patients underwent LBBAP. Implant success was achieved in 497 patients with NST (93.9%) and 14 patients with severe IVSH (73.6%). Among the 19 patients with severe IVSH, 7 patients underwent attempted LBBAP using LLL, with successful outcomes in 4 (57.1%). The remaining 12 patients underwent LBBAP with SDL, of which 10 were successful (83.3%). Mean septal thickness (20 ± 1.9 vs 21 ± 2.2), paced QRS duration (123 ± 17 vs 121 ± 9), and left ventricular activation time (LVAT) (75 ± 6 vs 74 ± 9) were comparable in the LLL and SDL groups. The lead thresholds (0.8 ± 0.3) remained stable over the mean follow-up duration of 36 ± 28.67 months without any lead-related complications.</div></div><div><h3>Conclusion</h3><div>LBBAP in patients with severe IVSH is safe and feasible. Although the overall success rates in this subgroup were lower (73.6%) compared with patients with NST, this was not significantly different with the use of SDL (83.3%) (<em>P</em> = .15).</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 588-597"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde aortic access for ventricular arrhythmia ablation: A novel plug and suture strategy for vascular closure","authors":"Rebecca Arnet MD ,&nbsp;Sven Knecht DSc ,&nbsp;Behnam Subin MD ,&nbsp;Philipp Krisai MD ,&nbsp;Nicolas Schärli MD ,&nbsp;Felix Mahfoud MD ,&nbsp;Christian Sticherling MD ,&nbsp;Michael Kühne MD ,&nbsp;Patrick Badertscher MD","doi":"10.1016/j.hroo.2025.02.009","DOIUrl":"10.1016/j.hroo.2025.02.009","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 733-735"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced continuity index with proactive esophageal cooling compared to luminal temperature monitoring during radiofrequency ablation","authors":"Catherine Lazarus BA ,&nbsp;Jacob Sherman ,&nbsp;Natalie Putzel ,&nbsp;Cameron Randolph ,&nbsp;William Zagrodzky BA ,&nbsp;Tiffany Sharkoski MPH, MBE ,&nbsp;Alex Ro MD, FHRS ,&nbsp;Jose Nazari MD, FHRS ,&nbsp;Westby Fisher MD, FHRS ,&nbsp;Erik Kulstad MD, MS ,&nbsp;Mark D. Metzl MD, FHRS","doi":"10.1016/j.hroo.2025.02.010","DOIUrl":"10.1016/j.hroo.2025.02.010","url":null,"abstract":"<div><h3>Background</h3><div>Proactive esophageal cooling is Food and Drug Administration (FDA) cleared to reduce the likelihood of esophageal injury during radiofrequency ablation for treatment of atrial fibrillation (AF). Long-term follow-up data have also shown improved freedom from arrhythmia with proactive esophageal cooling compared with luminal esophageal temperature (LET) monitoring during pulmonary vein isolation (PVI). One hypothesized mechanism is improved lesion contiguity (as measured by the continuity index) with the use of cooling.</div></div><div><h3>Objective</h3><div>We aimed to compare the continuity index of PVI cases using proactive esophageal cooling with those using LET monitoring.</div></div><div><h3>Methods</h3><div>We calculated the continuity index for PVI cases at 2 different hospitals within the same health system, using a slightly modified continuity index to facilitate retrospective determination from review of recorded cases. The results were then compared between cases using proactive esophageal cooling and those using LET monitoring.</div></div><div><h3>Results</h3><div>Continuity Indices for a total of 236 cases were determined: 118 cases using proactive esophageal cooling and 118 cases using traditional LET monitoring. With proactive esophageal cooling, the average continuity index was 10.6 (5.6 on the left pulmonary vein and 4.9 on the right pulmonary vein). With LET monitoring, the average continuity index was 37.0 (18.7 on the left and 18.3 on the right), for a difference of 26.4 (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Proactive esophageal cooling during PVI is associated with significantly improved lesion contiguity when compared with LET monitoring. This finding may offer a mechanism for the greater freedom from arrhythmia seen with proactive cooling in long-term follow-up.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 606-611"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement on site of latest electrical activation between right ventricular pacing and intrinsic conduction as target for left ventricular lead position in cardiac resynchronization therapy","authors":"Henrik Laurits Bjerre MD ,&nbsp;Jens Cosedis Nielsen MD, PhD, DMSc ,&nbsp;Anders Lehmann Dahl Pedersen MD ,&nbsp;Christian Gerdes MD, PhD ,&nbsp;Jens Kristensen MD, PhD ,&nbsp;Jesper Møller Jensen MD, PhD, DMSc ,&nbsp;Bjarne Linde Nørgaard MD PhD, DMSc ,&nbsp;Mads Brix Kronborg MD, PhD, DMSc","doi":"10.1016/j.hroo.2025.02.006","DOIUrl":"10.1016/j.hroo.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>In cardiac resynchronization therapy (CRT), studies indicate that targeting the left ventricular (LV) lead toward the site of latest electrical activation could improve clinical outcomes. Whether this site should be determined during right ventricular (RV) pacing or intrinsic conduction is unknown.</div></div><div><h3>Objective</h3><div>The study sought to investigate agreement between RV pacing and intrinsic conduction in identifying the site of latest electrical activation in patients undergoing CRT.</div></div><div><h3>Methods</h3><div>During CRT implantation, we obtained pairwise measurements of the interval from QRS onset to local LV activation during intrinsic conduction (Q-LV) and the interval from the paced signal on the RV lead electrogram to the sensed local LV activation during RV pacing (RV_p-LV_s) in the basal, mid, and apical positions of eligible veins in patients randomized to the intervention arm in the DANISH-CRT (Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS) trial. Venous anatomy and final lead positions were verified by computed tomography.</div></div><div><h3>Results</h3><div>We included 61 patients and measured intervals in 209 veins with 531segments. We found substantial agreement between RV_p-LV_s and Q-LV in identifying the latest activated vein (Cohen’s weighted kappa coefficient 0.69 [95% confidence interval 0.62–0.76]). The RV lead was predominantly positioned toward the anteroseptal region and RV_p-LV_s favored a posterior vein more often than Q-LV. We found high intra- and interobserver reliability for RV_p-LV_s and Q-LV measurements.</div></div><div><h3>Conclusion</h3><div>There is substantial agreement between RV_p-LV_s during RV pacing and Q-LV during intrinsic conduction in identifying the optimal target for LV lead position in CRT. Still, the optimal target vein changed for one-third of patients as RV_p-LV_s favored a posterior target vein more often than Q-LV.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 566-575"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}