Heart Rhythm O2最新文献

{"title":"Electrical isolation of the left atrial appendage in East Asian patients with atrial fibrillation","authors":"Jinsun Park MD ,&nbsp;So-Young Yang MD ,&nbsp;Hyun-Jung Oh MD ,&nbsp;Min Soo Cho MD ,&nbsp;Myung-Jin Cha MD ,&nbsp;Gi-Byoung Nam MD ,&nbsp;Kee-Joon Choi MD ,&nbsp;Jun Kim MD","doi":"10.1016/j.hroo.2024.11.018","DOIUrl":"10.1016/j.hroo.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>The left atrial appendage (LAA) is a source of non–pulmonary vein triggers in patients with atrial fibrillation (AF). Electrical isolation of the LAA (EILAA) improves rhythm outcome with an inherent risk of embolism unless lifelong anticoagulation is continued. However, evidence of the efficacy and safety of EILAA in the East Asian population remains lacking.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the efficacy and safety in East Asian patients who underwent EILAA.</div></div><div><h3>Methods</h3><div>Using the data from a single center, we identified patients who underwent EILAA for AF between January 2009 and August 2023. Clinical and procedural data were analyzed.</div></div><div><h3>Results</h3><div>We included a total of 41 patients who underwent EILAA. EILAA was unsuccessful in 2 patients. The median duration of AF was 5.0 years (interquartile range 4.0–10.0 years). Twenty-five patients (65.8%) underwent more than 1 previous ablation for AF before the index procedure. The mean CHA₂DS₂-VASc score was 2.8 ± 1.6. The mean left atrial dimension was 50.6 ± 8.7 mm. The 1-year recurrence rate of atrial arrhythmia after EILAA was 42.0% (21 patients during follow-up). Six patients (14.6%) underwent redo ablation, and 5 of them had durable isolation of the LAA. One patient had cardiac tamponade, which was drained with pericardiocentesis. All patients had taken lifelong anticoagulation, and 3 of them had stroke or systemic embolism during the follow-up period.</div></div><div><h3>Conclusion</h3><div>EILAA could be a safe and effective strategy for patients with long-standing AF with a history of failed ablation, especially with a high CHA₂DS₂-VASc score. Lifelong anticoagulation is mandatory for patients undergoing EILAA.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 142-148"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes after ventricular tachycardia ablation with or without induction","authors":"Benjamin L. Freedman MD ,&nbsp;Shu Yang MD ,&nbsp;Jonathan W. Waks MD ,&nbsp;Andrew Locke MD ,&nbsp;Timothy R. Maher MD ,&nbsp;Andre d’Avila MD, PhD","doi":"10.1016/j.hroo.2024.10.023","DOIUrl":"10.1016/j.hroo.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Substrate mapping may offer a safer alternative to ventricular tachycardia (VT) mapping by avoiding prolonged episodes of VT during catheter ablation. However, VT induction to gauge procedural efficacy is still routinely attempted following substrate ablation, thereby exposing patients to potentially unnecessary hemodynamic risk.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the efficacy of VT ablation without VT induction.</div></div><div><h3>Methods</h3><div>Patients with implantable cardioverter-defibrillators who underwent VT ablation between August 2020 and May 2023 were assessed retrospectively. Ablation and induction strategies were determined by operator discretion. Patients with or without attempted VT induction were compared with respect to baseline characteristics and clinical outcomes using Cox and competing risks regression.</div></div><div><h3>Results</h3><div>Eighty-nine patients (median age 68 years; 89% male; 51% infarct-related cardiomyopathy, mean left ventricular ejection fraction 38%) were followed for a median of 16 months after VT ablation. VT induction was attempted in 63% of patients. The 1-year incidence of recurrent VT was 37% and 58% in the noninduction and induction groups, respectively (subhazard ratio 0.55, 95% confidence interval [CI] 0.27–1.09, <em>P</em> = .09). The 1-year incidence of recurrent VT, heart transplant, or death was 42% and 62% in the noninduction and induction groups, respectively (hazard ratio 0.58, 95% CI 0.31–1.11, <em>P</em> = .10).</div></div><div><h3>Conclusion</h3><div>In a single-center study of 89 VT ablations, a noninduction strategy was similar to an induction strategy with respect to VT recurrence, heart transplant, or death at 1 year. Our findings suggest that VT induction, recognized as a risk factor for hemodynamic compromise, can be avoided in some patients without sacrificing procedural efficacy.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 214-223"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial access for ventricular tachycardia and premature ventricular complexes ablation: An institutional experience","authors":"Hema Srikanth Vemulapalli MBBS,&nbsp;Juan F. Rodriguez-Riascos MD,&nbsp;Padmapriya Muthu MBBS,&nbsp;Poojan Prajapati MBBS,&nbsp;Aria Raman BS,&nbsp;Shruti Iyengar MBBS, MSc,&nbsp;Komandoor Srivathsan MD, FHRS","doi":"10.1016/j.hroo.2024.11.020","DOIUrl":"10.1016/j.hroo.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Epicardial access for ventricular arrhythmia (VA) ablation is a challenging and relatively uncommon procedure during ventricular ablation.</div></div><div><h3>Objective</h3><div>This study aimed to assess the outcomes, predictors of success, and complications associated with pericardial access during these procedures.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective, observational study included data collected over 20 years (2004–2024) from all Mayo Clinic sites performing VA ablation with epicardial access.</div></div><div><h3>Results</h3><div>A total of 265 patients were included in the analysis: 196 for VT ablation and 69 for PVC ablation. Among them, 184 (69%) had at least 1 previous VA ablation, 51 (19.2%) had ischemic cardiomyopathy, 53 (20%) had structurally normal hearts, and 164 (61.9%) had nonischemic cardiomyopathies (NICMs). Three presented with concomitant ischemic cardiomyopathy and NICM. Within the NICM group, the most common diagnoses were dilated cardiomyopathy (n = 80 [30.2%]), arrhythmogenic right ventricular cardiomyopathy (n = 34 [12.8%]), and sarcoidosis (n = 15 [5.7%]). Acute success, defined as noninducibility, was achieved in 100 (61.7%) of 162 patients tested, while partial success (clinical arrhythmia noninduciblility) was observed in 47 (29%). Before discharge, VT recurred in 20 patients (10.2%). During a median follow-up of 61 months, events were observed as follows: 60 (35.5%) patients died, 26 (13.3%) underwent heart transplantation, and 62 (31.6%) required a repeat ablation for VAs. The event-free survival rates were 50% (95% confidence interval 43%–58%) at 1 year.</div></div><div><h3>Conclusion</h3><div>Successful VT ablation with epicardial access can be achieved in select cases, though event-free survival remains suboptimal. Advanced disease stage and persistent inducibility at the end of the procedure are predictors of poor outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 204-213"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failing hearts are more vulnerable to dobutamine and caffeine–induced ventricular arrhythmias: Ameliorated with dantrolene treatment","authors":"Lisa V. Greco DO,&nbsp;Amanda Charest MS,&nbsp;Ying Li BS,&nbsp;Lars Udo-Bellner PhD,&nbsp;Kaie Ojamaa PhD,&nbsp;A. Martin Gerdes PhD,&nbsp;Youhua Zhang MD, PhD","doi":"10.1016/j.hroo.2024.11.005","DOIUrl":"10.1016/j.hroo.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Compared with normal hearts, failing hearts are more vulnerable to develop atrial fibrillation under sympathetic stimulation. It has been shown that dobutamine and caffeine challenge can induce spontaneous ventricular tachyarrhythmias in normal hearts.</div></div><div><h3>Objective</h3><div>This study was designed to investigate whether failing hearts have increased vulnerability to dobutamine- and caffeine-induced ventricular arrhythmias, and whether dantrolene treatment provides therapeutic benefits in this condition.</div></div><div><h3>Methods</h3><div>A myocardial infarction (MI)–heart failure (HF) rat model was used 2 months after surgery. Sham-surgery animals served as the control animals. MI-HF rats were randomized into MI-HF untreated and MI-HF dantrolene-treated groups. Dobutamine (25 μg/kg, intraperitoneal [IP]) and caffeine (50 mg/kg, IP) were administered acutely to induce ventricular arrhythmias. MI-HF-dantrolene group received dantrolene (10 mg/kg, IP) 30 minutes before the arrhythmia test. Spontaneous Ca²⁺ sparks in isolated ventricular myocytes from control and MI-HF rats were also examined.</div></div><div><h3>Results</h3><div>Dobutamine induced less inotropic response in MI-HF rats than in control rats. Dobutamine + caffeine induced ventricular tachyarrhythmias in 9 of 10 MI-HF rats, while no ventricular arrhythmia was induced in the control rats (<em>P</em> &lt; .01). Dantrolene treatment significantly decreased ventricular arrhythmia inducibility (n = 2 of 10, <em>P &lt;</em> .05) in MI-HF rats. In isolated ventricular myocytes, Ca²⁺ sparks were significantly increased in MI-HF rats, and dantrolene treatment decreased Ca²⁺ sparks in these animals.</div></div><div><h3>Conclusion</h3><div>Although dobutamine evoked less inotropic effects, failing hearts were more vulnerable to dobutamine and caffeine–induced ventricular tachyarrhythmias. Dantrolene treatment decreased Ca²⁺ sparks in isolated ventricular myocytes from failing hearts and ameliorated ventricular tachyarrhythmias induced by dobutamine and caffeine in MI-HF rats in vivo.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 224-232"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Editor— Functional substrate mapping of ventricular arrhythmia","authors":"Konstantinos Vlachos MD ,&nbsp;Antonio Frontera MD ,&nbsp;Karim Benali MD ,&nbsp;Konstantinos P. Letsas MD ,&nbsp;Pierre Jais MD ,&nbsp;Pasquale Santangeli MD","doi":"10.1016/j.hroo.2024.11.017","DOIUrl":"10.1016/j.hroo.2024.11.017","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 242-243"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stylet-driven leads versus lumenless pacing leads in patients with left bundle branch area pacing: A systematic review and meta-analysis","authors":"Giky Karwiky MD ,&nbsp;William Kamarullah MD ,&nbsp;Raymond Pranata MD ,&nbsp;Mohammad Iqbal MD, PhD ,&nbsp;Chaerul Achmad MD, PhD ,&nbsp;Januar Wibawa Martha MD, PhD ,&nbsp;Iwan Setiawan MD, PhD","doi":"10.1016/j.hroo.2024.11.006","DOIUrl":"10.1016/j.hroo.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in lead designs for optimum left bundle branch area pacing (LBBAP), limited data exist on the performance of stylet-driven leads (SDLs).</div></div><div><h3>Objective</h3><div>This meta-analysis sought to compare the performance and safety of SDLs in comparison with lumenless leads (LLLs) following LBBAP.</div></div><div><h3>Methods</h3><div>Systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that compared the outcomes of SDLs during LBBAP compared with LLLs. Study outcomes included periprocedural parameters, pacing metrics, and complications.</div></div><div><h3>Results</h3><div>A total of 6 studies involving 3991 participants were included. LBBAP procedural success was comparable between SDLs and LLLs (90.2% and 90.5%, respectively). Compared with LLLs, SDLs appeared to result in shortened procedural (–11.50 minutes) and fluoroscopy (–2.56 minutes) times, along with increased capture threshold and reduced lead impedance at implantation. However, paced QRS, R-wave amplitude, capture threshold, and lead impedance remained comparable between both groups during follow-up. The number of lead-implantation attempts was similar between SDLs and LLLs (2.6 ± 1.0 vs 2.2 ± 0.6). Lead dislodgement and lead-related complications (except septal perforation) occurred mostly in the SDL group. No statistical differences were found in life-threatening complications.</div></div><div><h3>Conclusion</h3><div>SDLs demonstrated comparable effectiveness in achieving LBBAP, exhibiting similar success rates, mean attempts for lead placement, and pacing parameters, although they were associated with a higher overall incidence of lead-related complications. The reduced overall procedural and fluoroscopy time may be attributed to the ability of SDLs’ different delivery sheath selections in identifying the optimal anatomical site, rather than being lead specific.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 166-175"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma and the risk of cardiac events among patients with long QT syndrome after age 40","authors":"Alon Barsheshet MD ,&nbsp;Ilan Goldenberg MD ,&nbsp;Kirill Buturlin MD ,&nbsp;Aharon Erez MD ,&nbsp;Gustavo Goldenberg MD ,&nbsp;Itamar Zahavi BS ,&nbsp;Bronislava Polonsky MS ,&nbsp;Scott McNitt MS ,&nbsp;Mehmet Aktas MD ,&nbsp;Wojciech Zareba MD, PhD ,&nbsp;Gregory Golovchiner MD","doi":"10.1016/j.hroo.2024.11.007","DOIUrl":"10.1016/j.hroo.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Limited data exist on the impact of asthma on long QT syndrome (LQTS) in middle-aged and older adults.</div></div><div><h3>Objective</h3><div>This study aimed to examine the association between asthma, β2-agonist treatment, and cardiac events (CEs) in LQTS patients over 40 years of age.</div></div><div><h3>Methods</h3><div>The risk of CEs (comprising syncope, aborted cardiac arrest, implantable cardioverter-defibrillator shock, or sudden cardiac death) from age 40 through 75 years, by the presence of asthma with and without treatment with a β2-agonist inhaler, was assessed among 1020 LQTS patients from the Rochester LQTS Registry.</div></div><div><h3>Results</h3><div>Among 1020 LQTS patients, 162 (16%) had asthma by age 40 years or subsequent follow-up, with 63% treated with a β2-agonist inhaler. Patients with asthma vs no asthma had a higher cumulative rate of CEs from age 40 through 75 years (44% vs 26%, <em>P</em> &lt; .001). Consistently, multivariate analysis showed that asthma was associated with a 2-fold (hazard ratio 1.97, <em>P</em> = .001) increased risk of CEs. Subgroup analysis showed that the association of asthma with CEs was consistent within risk subsets of LQTS patients, including QTc duration, syncope prior to age 40 years, β-blocker use, sex, and LQTS genotype (all <em>P</em> values for risk subset-by-asthma interaction &gt;.10). Asthma patients with LQTS who were treated with a β2-agonist inhaler did not show an increased risk compared with those who were not treated (hazard ratio 1.02, <em>P</em> = .963).</div></div><div><h3>Conclusion</h3><div>The presence of asthma is associated with increased risk of CEs among middle-aged and older patients with LQTS regardless of baseline risk factors or treatment with a β2-agonist inhaler.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 188-194"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning to identify phenotypic clusters of patients with atrial fibrillation","authors":"Hani Essa MBChB ,&nbsp;Sandra Ortega-Martorell PhD ,&nbsp;Ivan Olier PhD ,&nbsp;Gregory Y.H. Lip MD","doi":"10.1016/j.hroo.2024.12.001","DOIUrl":"10.1016/j.hroo.2024.12.001","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 139-141"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of ethanol ablation of the vein of Marshall in patients with coronary sinus leads","authors":"Nithi Tokavanich MD,&nbsp;Jasneet Devgun DO,&nbsp;Krit Jongnarangsin MD,&nbsp;Aman Chugh MD, FHRS","doi":"10.1016/j.hroo.2024.10.007","DOIUrl":"10.1016/j.hroo.2024.10.007","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 108-109"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of the Journal 2025","authors":"Jeanne E. Poole MD, FHRS","doi":"10.1016/j.hroo.2024.12.003","DOIUrl":"10.1016/j.hroo.2024.12.003","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 1-2"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}