Heart Rhythm O2最新文献

{"title":"Sodium-glucose cotransporter-2 inhibitor use in type 2 diabetes mellitus is associated with a lower rate of atrial arrhythmias in a hospitalized real-world population","authors":"Kathryn D. Tiver BSc, BMBS ,&nbsp;Derek P. Chew MBBS, MPH, PhD ,&nbsp;Jia Y. Tan MBBS ,&nbsp;Kristina Lambrakis BSc ,&nbsp;Carmine G. De Pasquale BMBS, PhD ,&nbsp;Anand N. Ganesan MBBS, PhD","doi":"10.1016/j.hroo.2024.12.004","DOIUrl":"10.1016/j.hroo.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been associated with lower rates of cardiac arrhythmias in <em>post hoc</em> analyses. The real-world effect on cardiac arrhythmias is incompletely defined.</div></div><div><h3>Objective</h3><div>The purpose of this study was to determine the effects of SGLT2i on cardiac arrhythmias in a real-world, hospitalized population.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed in South Australia, Australia. Patients (n = 882) with type 2 diabetes mellitus (T2DM) on oral diabetic therapy (33.6% females, median age 62.3 years) who received SGLT2i (for T2DM) were identified through public hospital admissions from 2011–2019. Patients were matched with 3282 contemporaneous controls with T2DM who did not receive SGLT2i. Baseline characteristics were adjusted using inverse probability treatment weighting. The primary outcome was incidence of atrial arrhythmias. Secondary outcomes included incidence of ventricular arrhythmias and cardiac arrest at 2 years.</div></div><div><h3>Results</h3><div>All-cause mortality was higher in the SGLT2i group (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.55–2.63, <em>P</em> &lt;.001) despite propensity matching, highlighting the greater unmeasured comorbidity burden of the SGLT2i-treated group. Despite this, SGLT2i treatment was associated with fewer atrial arrhythmias (HR 0.17, 95% CI 0.07–0.41, <em>P</em> &lt;.001) at 2 years. The relationship between SGLT2i use and ventricular arrhythmias (HR 0.25, 95% CI 0.06–1.03, <em>P</em> = .055) and cardiac arrest (HR 0.82, 95% CI 0.20–3.45, <em>P</em> = .796) did not reach statistical significance.</div></div><div><h3>Conclusion</h3><div>In this real-world, comorbid inpatient cohort, SGLT2i treatment was associated with a lower incidence of atrial arrhythmias. Prospective randomized trials evaluating SGLT2i as specific atrial fibrillation pharmacotherapy are underway.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 299-306"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684528","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":"Prognostic value of the modified Model for End-Stage Liver Disease score in patients treated with cardiac resynchronization therapy","authors":"Tianxin Long MD, PhD ,&nbsp;Yu Yu MD, PhD ,&nbsp;Sijing Cheng MD, PhD,&nbsp;Hao Huang MD, PhD,&nbsp;Wei Hua MD, PhD, FHRS","doi":"10.1016/j.hroo.2024.12.014","DOIUrl":"10.1016/j.hroo.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Hepatorenal dysfunction is prevalent among individuals with heart failure (HF).</div></div><div><h3>OBJECTIVE</h3><div>This study investigated prognostic value of the modified Model for End-Stage Liver Disease (Model for End-Stage Liver Disease excluding international normalized ratio [MELD-XI] scores and Model for End-Stage Liver Disease with albumin replacing international normalized ratio [MELD-Albumin]) score in patients undergoing cardiac resynchronization therapy (CRT).</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 365 patients (mean age 58.7 ± 11.1 years; 64.9% men) undergoing CRT implantation between 2007 and 2019. Patients were divided into 4 groups based on the modified MELD score quartiles before CRT. The primary endpoint was the combination of all-cause mortality and HF hospitalization, whereas the secondary endpoint was CRT response at 6 months.</div></div><div><h3>Results</h3><div>During mean follow-up of 3.3 years (interquartile range 1.9–5.2 years), 168 patients reached the primary endpoint. Logistic regression revealed the MELD-Albumin score was independently associated with CRT response, even after adjusting for covariates (odds ratio 1.10; 95% confidence interval [CI] 1.02–1.19; <em>P</em> = .013). Kaplan-Meier analysis revealed that patients with a higher MELD-XI and MELD-Albumin score had a greater risk of adverse outcomes (log-rank test: <em>P &lt;</em> .001). A Cox proportional hazards analysis showed that the modified MELD score remained significantly associated with adverse outcomes after adjusting for clinical and echocardiographic factors (MELD-XI: hazard ratio 1.06, 95% CI 1.02–1.11, <em>P =</em> .006; MELD-Albumin: hazard ratio 1.10, 95% CI 1.05–1.16, <em>P &lt;</em> .001). Furthermore, receiver-operating characteristic analysis indicated that the MELD-Albumin score provided a stronger prognostic value for long-term adverse outcomes in patients undergoing CRT than the MELD-XI score (MELD-Albumin: area under the curve 0.692, 95% CI 0.644–0.742; MELD-XI: area under the curve 0.659, 95% CI 0.608–0.715; <em>P =</em> .008).</div></div><div><h3>Conclusion</h3><div>The MELD-Albumin score may be useful for stratifying patients at risk for CRT response and adverse outcomes in those undergoing CRT for HF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 339-349"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684579","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":"Effectiveness of cryoballoon ablation for atrial fibrillation in patients with left common pulmonary vein variant","authors":"Adi Elias MD, MPH ,&nbsp;Ibrahim Marai MD ,&nbsp;Alon Eyal MD, PhD ,&nbsp;Wisam Darawsha MD ,&nbsp;Faheem Shehadeh MD ,&nbsp;Robert Glueck MD ,&nbsp;Roy Beinart MD ,&nbsp;Eyal Nof MD ,&nbsp;Yoav Michowitz MD ,&nbsp;Michael Glikson MD ,&nbsp;Yuval Konstantino MD ,&nbsp;Moti Haim MD ,&nbsp;David Luria MD ,&nbsp;Alexander Omelchenko MD ,&nbsp;Avishag Laish-Farkash MD, PhD ,&nbsp;Mahmoud Suleiman MD ,&nbsp;Israeli Working Group on Pacing and Electrophysiology","doi":"10.1016/j.hroo.2024.12.002","DOIUrl":"10.1016/j.hroo.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) with cryoballoon technology is widely used for rhythm control in atrial fibrillation (AF). However, there are limited data on its effectiveness in patients with the left common pulmonary vein (LCPV) variant.</div></div><div><h3>Objective</h3><div>The study aimed to examine the outcomes of cryoballoon ablation in patients with the LCPV variant.</div></div><div><h3>Methods</h3><div>The Israeli Catheter Ablation Registry is a prospective, multicenter cohort that included citizens who underwent PVI during the years 2019–2021. Study endpoints were acute isolation success of the pulmonary veins (PVs), AF recurrence, and the need for a repeat ablation procedure at 12 months.</div></div><div><h3>Results</h3><div>The study included 74 patients with the LCPV variant and 822 patients with standard PV anatomy. The acute isolation success rate of the LPVs was significantly lower in LCPV variant patients compared with those with a standard anatomy. However, there was no significant difference in the acute isolation success rate of the right PVs between the 2 groups. At 12 months, the rates of AF recurrence did not differ significantly between the LCPV variant group (17.6%) and the standard anatomy group (11.1%) (<em>P =</em> .09), and multivariable adjustment LCPV was not associated with AF recurrence (hazard ratio 0.86, 95% confidence interval 0.43–1.74). Similarly, the rate of repeat ablation for recurrent AF did not differ significantly.</div></div><div><h3>Conclusion</h3><div>In our study, we found that isolating the LCPV using cryoballoon PVI was more challenging than isolating standard anatomy. Despite this, the effectiveness of cryoballoon ablation in patients with LCPV anatomy did not differ significantly from that in the standard anatomy group.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 290-298"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684932","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":"Local epicardial robotic-enhanced hybrid ablation efficacy predictors for persistent atrial fibrillation","authors":"Eduardo Celentano MD, FACC, FHRS ,&nbsp;Ernesto Cristiano MD ,&nbsp;Stefano Schena MD, PhD, FACC ,&nbsp;Mario Gasparri MD ,&nbsp;Barbara Ignatiuk MD, PhD ,&nbsp;Martina Renda MD ,&nbsp;Elena Bia MD, PhD ,&nbsp;Raffaele Rainone PhD ,&nbsp;Ascanio Graniero MD ,&nbsp;Laura Giroletti MD ,&nbsp;Alfonso Agnino MD ,&nbsp;Natasja M.S. De Groot MD, PhD","doi":"10.1016/j.hroo.2024.11.023","DOIUrl":"10.1016/j.hroo.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Hybrid ablation can manage persistent atrial fibrillation (PsAF) and long-standing persistent atrial fibrillation (LSPAF). Robotic-enhanced hybrid ablation (RE-HA) offers greater precision and stability. However, biophysical predictors of effective local epicardial radiofrequency ablation (ELRF) during epicardial ablation are unknown.</div></div><div><h3>Objective</h3><div>The purpose of this study was to compare the time course of biophysical predictors of ELRF and no-ELRF during the first stage of RE-HA in patients with PsAF and LSPAF.</div></div><div><h3>Methods</h3><div>We conducted a dual-center retrospective cohort study involving 92 consecutive patients with PsAF or LSPAF who underwent RE-HA between January 2021 and May 2024. Epicardial electrogram disappearance, defined as a reduction of bipolar voltages to &lt;0.05 mV, baseline impedance (BI), and impedance drop (ID), were compared between ELRF and no-ELRF cases. Univariate and multivariate logistic regression models were used to identify predictive variables. Optimal cutoff values were determined using receiver operating characteristic curves.</div></div><div><h3>Results</h3><div>Among 2474 radiofrequency (RF) applications, significant predictors of ELRF included BI and ID at 1 and 8 seconds, with optimal cutoff values of &lt;107, 0–7, and 5–17 Ω. The composite predictive model had an area under the receiver operating characteristic of 0.775, with 94% sensitivity, 53% specificity, and 65% accuracy. Our predictive ELRF score ranged from 0–4, and the Youden J test identifying a cutoff value of 3 as optimal.</div></div><div><h3>Conclusion</h3><div>BI and progressive ID were strong predictors of local epicardial RE-HA efficacy. The composite model was a reliable tool for early identification of ELRF, potentially reducing RF delivery and enhancing procedural efficiency. Larger prospective studies are needed to validate these findings.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 280-289"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684933","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":"Expedited and safe discharge path for extraction patients utilizing a temporary permanent pacemaker","authors":"Angela Krebsbach PA-C,&nbsp;Duna Alkhalaileh MD,&nbsp;Ryle Przybylowicz MD,&nbsp;Jose Lozano Garcia MD,&nbsp;Francis Phan MD,&nbsp;Karen Paladino RN,&nbsp;Emily McLain RN,&nbsp;Anne Glover PA-C,&nbsp;Peter M. Jessel MD,&nbsp;Charles A. Henrikson MD","doi":"10.1016/j.hroo.2024.11.028","DOIUrl":"10.1016/j.hroo.2024.11.028","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 388-389"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679175","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":"Narrative review of adalimumab for the treatment of cardiac sarcoidosis","authors":"Arnaud Dominati MD ,&nbsp;Christian Ascoli MD ,&nbsp;Israel Rubinstein MD ,&nbsp;Mark D. McCauley MD, PhD ,&nbsp;Nadera J. Sweiss MD","doi":"10.1016/j.hroo.2024.12.012","DOIUrl":"10.1016/j.hroo.2024.12.012","url":null,"abstract":"<div><div>Cardiac sarcoidosis (CS) remains the second leading cause of death in patients with sarcoidosis, primarily because of its association with heart failure and arrhythmias. While corticosteroids are first-line therapy, their long-term use in CS is associated with serious adverse events, necessitating alternative immunosuppressive therapies, such as tumor necrosis factor inhibitors. Although infliximab is the most studied tumor necrosis factor inhibitor for refractory CS, adalimumab has emerged as a potential alternative. To that end, we reviewed the literature on adalimumab treatment in CS, identifying 12 publications published between January 2000 and September 2024 encompassing 240 patients, of whom 100 (42%) received adalimumab and were followed for at least 6 months. Most patients demonstrated stable or improved left ventricular ejection fraction, even those with initially low left ventricular ejection fraction and reduced cardiac ¹⁸F-fluorodeoxyglucose uptake on positron emission tomography–computed tomography. Adalimumab was generally well-tolerated with few reported infections or adverse events. However, these findings are limited by significant heterogeneity in study design, variability in patient populations, and a lack of standardized outcome measures, which restrict their generalizability. While adalimumab shows promise as a therapeutic option for refractory CS, robust, multicenter, randomized controlled trials are needed to validate these findings and define adalimumab’s role in clinical practice.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 368-382"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684573","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":"Noninvasive electrocardiographic imaging assessment of conduction system pacing: A novel algorithm to assess intraventricular synchrony","authors":"Ivan Eltsov MD ,&nbsp;Alvise Del Monte MD ,&nbsp;Luigi Pannone MD ,&nbsp;Ingrid Overeinder MD ,&nbsp;Domenico Della Rocca MD, PhD ,&nbsp;Roberto Scacciavillani MD ,&nbsp;Frederik H. Verbrugge MD, PhD ,&nbsp;Qingguo Zeng PhD ,&nbsp;Gezim Bala MD, PhD ,&nbsp;Andrea Maria Paparella MSc ,&nbsp;Giacomo Talevi MSc ,&nbsp;Erwin Stroker MD, PhD ,&nbsp;Juan Sieira MD, PhD ,&nbsp;Ali Gharaviri PhD ,&nbsp;Andrea Sarkozy MD, PhD ,&nbsp;Gian-Battista Chierchia MD, PhD ,&nbsp;Mark La Meir MD, PhD ,&nbsp;Carlo de Asmundis MD, PhD ,&nbsp;Alexandre Almorad MD","doi":"10.1016/j.hroo.2024.11.026","DOIUrl":"10.1016/j.hroo.2024.11.026","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch area pacing (LBBAP) has become the procedure of choice for various indications including atrioventricular block and considered to be physiologic modality of pacing compared with right ventricular apex pacing.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess ventricular activation and synchrony in patients with an LBBAP device using electrocardiographic imaging (ECGI).</div></div><div><h3>Methods</h3><div>A total of 25 consecutive patients underwent an LBBAP device implantation were included in the study. Electrocardiography (ECG) and ECGI analyses have been performed the day after implantation. Native and paced QRS, left ventricular activation time, right ventricular activation time, and V1–V6 activation delay were calculated using ECG. Total ventricular activation time, left ventricular activation time, intrinsic left ventricular activation time, right ventricular activation time, intrinsic right ventricular activation time, and intraventricular dyssynchrony were calculated based on ECGI. All patients have been followed up to 12 months.</div></div><div><h3>Results</h3><div>All patients were divided in 2 groups (wide and narrow QRS) based on intrinsic ECG and then based on paced ECG parameters. The study showed that for initially narrow QRS group activation time and synchrony during pacing was comparable to native. In wide QRS group these parameters were significantly improved. For paced rhythm analysis classic ECG LBBAP parameters (paced QRS and left ventricular activation time) were not sufficient to properly evaluate the ventricular activation for paced rhythm. Discordance between classic ECG parameters and ECGI analysis was identified. Two additional 12-lead ECG parameters predicting the ECGI measurements were found. Follow-up did not show any worsening of ejection fraction, paced QRS, or pacing parameters.</div></div><div><h3>Conclusion</h3><div>ECG imaging can bring a significant value into assessing the efficacy of new pacing modalities and provide much more data for precise determination of implantation outcome including detailed activation assessment and comparison with intrinsic conduction. Key ECGI values confirming proper ventricular activation have been defined, and corresponding 12-lead parameters were also identified, which allows to predict ventricular activation by using 12-lead ECG only.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 329-338"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684580","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":"Current clinical practice versus remote monitoring recommendations for cardiovascular implantable electronic devices: A real-world analysis from a remote monitoring database","authors":"Matteo Bertini MD, PhD ,&nbsp;Antonio D’Onofrio MD ,&nbsp;Marcello Piacenti MD ,&nbsp;Carlo Lavalle MD ,&nbsp;Carmelo La Greca MD ,&nbsp;Claudia Amellone MD ,&nbsp;Paolo Compagnucci MD ,&nbsp;Leonardo Calò MD ,&nbsp;Antonio Rapacciuolo MD ,&nbsp;Vincenzo Ezio Santobuono MD ,&nbsp;Patrizia Pepi MD ,&nbsp;Gianluca Savarese MD ,&nbsp;Erika Taravelli MD ,&nbsp;Vincenzo Russo MD ,&nbsp;Gennaro Vitulano MD ,&nbsp;Francesco Villella MD ,&nbsp;Francesco Vitali MD ,&nbsp;Nicola Pierucci MD ,&nbsp;Monica Campari MS ,&nbsp;Sergio Valsecchi PhD ,&nbsp;Luca Santini MD","doi":"10.1016/j.hroo.2024.11.024","DOIUrl":"10.1016/j.hroo.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>The recently published Consensus Statement on the Practical Management of Remote Device Clinics offers recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). They recommend activating remote monitoring (RM) soon after implantation and maintaining connectivity. Moreover, it is reasonable to replace scheduled device follow-up with alert-based RM, with alert parameters customized to clinical indications to reduce RM workload.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate current clinical practice to inform adjustments to better follow recommendations and improve use of RM.</div></div><div><h3>Methods</h3><div>Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 centers between 2010 and 2023 were analyzed. Median RM duration was 40 months.</div></div><div><h3>Results</h3><div>Patient enrollment significantly increased over the observation period. The proportion of patients enrolled within 2 weeks of implantation was 73% and within 3 months was 94%. At the time of data extraction, 14% of patients had interrupted connectivity. Scheduled device transmissions were programmed at least once every 3 months in 96% of patients for all CIED types. In 2023, 6600 in-office interrogations were performed, and 70,453 remote transmissions were reviewed. Scheduled transmissions accounted for 52% of the total, patient-initiated interrogations for 28% and alert transmissions for 20%.</div></div><div><h3>Conclusion</h3><div>The use of RM in clinical practice is increasing, with more in-office and remote visits. Centers are not adopting the alert-based RM strategy, which would enable them to reduce the significant burden of nonactionable remote and in-office visits.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 246-252"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684934","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":"Adjunctive posterior wall isolation for patients with persistent atrial fibrillation: A systematic review and meta-analysis","authors":"André Rivera ,&nbsp;Antônio S. Menezes MD, PhD ,&nbsp;Douglas Mesadri Gewehr MD ,&nbsp;Bárbara Nascimento MD ,&nbsp;Isabele Ayumi Miyawaki ,&nbsp;Luís E. Rohde MD, PhD ,&nbsp;Caique M.P. Ternes MD, PhD ,&nbsp;Arash Aryana MD, PhD, FHRS ,&nbsp;André d’Avila MD, PhD, FHRS","doi":"10.1016/j.hroo.2024.12.008","DOIUrl":"10.1016/j.hroo.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Its effectiveness for persistent atrial fibrillation (PeAF) is limited, and the benefits of adjunctive posterior wall ablation are uncertain.</div></div><div><h3>Objective</h3><div>The purpose of this study was to perform a systematic review and meta-analysis of PVI with/without adjunctive PWI in patients with PeAF.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases for randomized controlled trials (RCTs) comparing PVI with/without PWI in patients with PeAF. Random-effects model was used for the meta-analysis. Atrial tachyarrhythmia (ATA) was a composite of AF, atrial flutter, or atrial tachycardia.</div></div><div><h3>Results</h3><div>Our meta-analysis included eight RCTs with 1104 patients (546 PVI, 558 PVI plus PWI). Compared with PVI alone, adjunctive PWI significantly increased freedom from ATA recurrence (relative risk [RR] 1.13, 95% confidence interval [CI] 1.01–1.27, <em>P</em> = .036). A subanalysis of patients with long-standing PeAF showed a greater effect of PWI (RR 1.76, 95% CI 1.02–3.04, <em>P</em> = .04). A subgroup analysis of PWI techniques indicated no significant difference for ATA recurrence with box isolation alone (RR 1.13, 95% CI 0.97–1.33, <em>P</em> = .12), whereas a pooled analysis using only studies with direct posterior wall ablation favored the adjunctive PWI group (RR 1.39, 95% CI 1.11–1.74, <em>P</em> &lt;.01). Adverse events did not significantly differ between groups.</div></div><div><h3>Conclusion</h3><div>Our findings support that adjunctive PWI to PVI is an effective strategy compared with PVI alone for reducing ATA recurrence in patients with PeAF without compromising safety. Notably, patients with long-standing PeAF may benefit more from PWI.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 317-328"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684581","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":"Spontaneous type 1 ECG and arrhythmic risk in Brugada syndrome: A meta-analysis of adjusted time-to-event data","authors":"Sotirios Chiotis MD ,&nbsp;Luigi Pannone MD ,&nbsp;Ioannis Doundoulakis MD, PhD ,&nbsp;Domenico Giovanni Della Rocca MD, PhD ,&nbsp;Stefanos Zafeiropoulos MD, PhD ,&nbsp;Antonio Sorgente MD, PhD ,&nbsp;Lorenzo Marcon MD ,&nbsp;Giampaolo Vetta MD ,&nbsp;Leonidas Koliastasis MD, PhD ,&nbsp;Alvise Del Monte MD ,&nbsp;Kazutaka Nakasone MD, PhD ,&nbsp;Stavritsa T. Varvara MD ,&nbsp;Mark La Meir MD, PhD ,&nbsp;Ingrid Overeinder MD ,&nbsp;Gezim Bala MD, PhD ,&nbsp;Alexandre Almorad MD ,&nbsp;Erwin Ströker MD, PhD ,&nbsp;Juan Sieira MD, PhD ,&nbsp;Dimitrios Tsiachris MD, PhD ,&nbsp;Vasileios Vassilikos MD, PhD ,&nbsp;Carlo de Asmundis MD, PhD, FHRS","doi":"10.1016/j.hroo.2024.11.022","DOIUrl":"10.1016/j.hroo.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Brugada syndrome (BrS) is associated with an increased risk of major arrhythmic events (MAEs), particularly in patients with a spontaneous type 1 electrocardiographic (ECG) pattern.</div></div><div><h3>Objective</h3><div>Because previous meta-analyses used mainly crude or unadjusted data from observational studies, we conducted an updated meta-analysis on the prognostic role of spontaneous type 1 ECG in BrS patients combining adjusted and unadjusted data separately.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of PubMed and Cochrane Central Register of Controlled Trials from inception to May 2024. Studies providing hazard ratios for MAEs associated with spontaneous type 1 ECG in BrS patients were included.</div></div><div><h3>Results</h3><div>Eighteen studies comprising 7238 patients were included, with 10 providing adjusted and 17 providing unadjusted data. Separate pooled analyses using a random-effects model demonstrated a significantly increased risk of MAEs in BrS patients with spontaneous type 1 ECG compared with those without, with a pooled adjusted hazard ratio (aHR) of 2.05 (95% CI 1.38–3.03) and an unadjusted hazard ratio of 2.97 (95% CI 2.04–4.34). Subgroup analysis revealed higher risks in studies with non-Asian populations and those including patients with no history of aborted cardiac arrest (aHR 2.36, 95% CI 1.35–4.11; and aHR 3.56, 95% CI 2.35–5.41, respectively) and a persistent significant risk in studies accounting for syncope as a covariate (aHR 2.01, 95% CI 1.24–3.27).</div></div><div><h3>Conclusion</h3><div>Our analysis indicates that patients with BrS and spontaneous type 1 ECG are at higher risk of MAEs. This is consistent across various subgroups, including asymptomatic individuals.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 195-203"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444245","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}