Heart Rhythm O2最新文献

{"title":"Association between dementia and left atrial appendage occlusion in patients with atrial fibrillation: A TriNetX-based retrospective cohort study with target trial emulation","authors":"Kuan-Hsien Lu MD ,&nbsp;Cheng-Yang Hsieh MD, PhD ,&nbsp;Daniel Hsiang-Te Tsai MClinPharm ,&nbsp;Edward Chia-Cheng Lai PhD ,&nbsp;Meng-Tsang Hsieh MD ,&nbsp;Wan-Hsuan Hsu MD, MPH ,&nbsp;Kuan-Hung Lin MD","doi":"10.1016/j.hroo.2024.11.012","DOIUrl":"10.1016/j.hroo.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a common cardiac arrhythmia linked to an elevated risk of stroke and dementia. Emerging observational evidence suggests that left atrial appendage occlusion (LAAO) may reduce the risk of dementia in patients with AF; however, further research is required to confirm this potential benefit.</div></div><div><h3>Objective</h3><div>This study aimed to compare the effectiveness of LAAO vs direct oral anticoagulants (DOACs) in reducing the risk of dementia in patients with AF.</div></div><div><h3>Methods</h3><div>We conducted target trial emulation using data from the TriNetX research network. Patients with AF were allocated to 2 cohorts (2270 patients in each one), treated either with LAAO or with DOACs, and balanced with propensity score matching. The primary end points were composite dementia, vascular dementia, and Alzheimer disease. Secondary end points included mortality, ischemic stroke, intracranial hemorrhage, and major adverse cardiovascular events. Follow-up was conducted over 3 years.</div></div><div><h3>Results</h3><div>At 3-year follow-up, the risk of composite dementia was lower in the LAAO group than in the DOAC group (hazard ratio 0.57; 95% confidence interval 0.38–0.85). Subgroup analyses demonstrated consistent results, favoring the LAAO group. No significant differences were observed in the incidence of secondary outcomes.</div></div><div><h3>Conclusion</h3><div>This real-world study suggests that LAAO is associated with a lower risk of dementia in patients with AF compared with DOACs. Further prospective research with long-term follow-up is needed to validate our findings in the population with AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 151-158"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444580","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":"A MacGyvering way to left bundle branch area pacing: Using the modified V1/V6 leads connected to the pacing system analyzer","authors":"Sanjai Pattu Valappil 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;Uma Sirisha Pusapati MBBS ,&nbsp;Abhinav B. Anand MD, DM","doi":"10.1016/j.hroo.2024.11.021","DOIUrl":"10.1016/j.hroo.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>There is a significant impediment to the availability of a fully capable electrophysiology (EP) procedure room and EP recording system due to healthcare cost restraints in resource-poor settings.</div></div><div><h3>Objective</h3><div>The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test machine 12-lead ECG system and modified V1 and V6 leads connected to the pacing system analyzer (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP).</div></div><div><h3>Methods</h3><div>LBBaP was attempted by a single operator using the Medtronic 3830 lumenless leads and St. Jude/Abbott stylet-driven leads in a mixed cohort of patients at hospitals lacking an EP recording system. Conduction system capture was assessed using modified V1 and V6 leads.</div></div><div><h3>Results</h3><div>LBBaP was successful in 18 (94.7%) of 19 patients. There was excellent correlation between 12-lead ECG and modified V1 and V6 leads connected to the PSA regarding the measurement of V6 left ventricular activation time and QRS morphology change in V1 during selective to nonselective left bundle branch capture. Patient characteristics were the following: mean age of 66.7 ± 11.47 years, 52.63% male, 10.52% with ischemic cardiomyopathy, and 5.26% with nonischemic cardiomyopathy. LBBaP resulted in a QRS duration of 112.77 ±11.27 ms with a left ventricular activation time of 70.55 ± 8.02 ms. Left ventricular ejection fraction improved in the patients with cardiomyopathy from 33.4 ± 5.77% to 48.2 ± 12.37% (<em>P</em> = .028).</div></div><div><h3>Conclusion</h3><div>The modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful LLBaP.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 237-241"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444250","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":"Phenotypes of atrial fibrillation in a Taiwanese longitudinal cohort: Insights from an Asian perspective","authors":"Jung-Chi Hsu MD, PhD ,&nbsp;Yen-Yun Yang MD ,&nbsp;Shu-Lin Chuang PhD ,&nbsp;Lian-Yu Lin MD, PhD","doi":"10.1016/j.hroo.2024.11.009","DOIUrl":"10.1016/j.hroo.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a condition with heterogeneous underlying causes, often involving multiple cardiovascular comorbidities. Large-scale studies examining the heterogeneity of patients with AF in the Asian population are limited.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to identify distinct phenotypic clusters of patients with AF and evaluate their associated risks of ischemic stroke, heart failure hospitalization, cardiovascular mortality, and all-cause mortality.</div></div><div><h3>Methods</h3><div>We analyzed 5002 adult patients with AF from the National Taiwan University Hospital between 2014 and 2019 using an unsupervised hierarchical cluster analysis based on the CHA₂DS₂-VASc score.</div></div><div><h3>Results</h3><div>We identified 4 distinct groups of patients with AF: cluster I included diabetic patients with heart failure preserved ejection fraction as well as chronic kidney disease (CKD); cluster II comprised older patients with low body mass index and pulmonary hypertension; cluster III consisted of patients with metabolic syndrome and atherosclerotic disease; and cluster IV comprised patients with left heart dysfunction, including reduced ejection fraction. Differences in the risk of ischemic stroke across clusters (clusters I, II, and III vs cluster IV) were statistically significant (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.00–3.48; HR 2.06, 95% CI 1.06–4.01; and HR 1.70, 95% CI 1.02–2.01). Cluster II was independently associated with the highest risk of hospitalization for heart failure (HR 1.19, 95% CI 0.79–1.80), cardiovascular mortality (HR 2.51, 95% CI 1.21–5.22), and overall mortality (HR 2.98, 95% CI 1.21–4.2).</div></div><div><h3>Conclusion</h3><div>A data-driven algorithm can identify distinct clusters with unique phenotypes and varying risks of cardiovascular outcomes in patients with AF, enhancing risk stratification beyond the CHA₂DS₂-VASc score.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 129-138"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444254","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":"Left atrial appendage electrical isolation in long-standing persistent atrial fibrillation: Lupus in fabula","authors":"Marco Schiavone MD ,&nbsp;Luigi Di Biase MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.01.003","DOIUrl":"10.1016/j.hroo.2025.01.003","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 149-150"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444579","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":"Outcomes of pregnancy-related hospitalizations in women with pacemakers and defibrillators","authors":"Vardhmaan Jain MD ,&nbsp;Kartik Gupta MD ,&nbsp;Neal K. Bhatia MD ,&nbsp;Mikhael F. El-Chami MD ,&nbsp;Kamala P. Tamirisa MD ,&nbsp;Annabelle S. Volgman MD ,&nbsp;Faisal M. Merchant MD","doi":"10.1016/j.hroo.2024.11.016","DOIUrl":"10.1016/j.hroo.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>There is limited information on pregnancy outcomes in women who have previously undergone implantation of cardiac implantable electronic devices (CIEDs).</div></div><div><h3>Objective</h3><div>The study sought to describe outcomes of pregnancy related hospitalizations in women with CIEDs.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample database was analyzed to identify pregnancy-related hospitalizations between 2016 and 2021.</div></div><div><h3>Results</h3><div>We identified 23,611,200 weighted pregnancy-related hospitalizations, of which 11,220 (0.05%) had a history of CIED implantation. Of these, 5105 had permanent pacemakers (PPMs) and 6115 had implantable cardioverter-defibrillators (ICDs). The mortality rate during pregnancy-related hospitalization was significantly higher among women with ICDs (0.9%) compared with those without CIEDs (0.01%). Of note, there were no in-hospital deaths among pregnant women with PPMs. After adjusting for covariates, the excess mortality risk in women with ICDs was no longer noted. However, pregnant women with ICDs remained at higher risk of cardiogenic shock (odds ratio 3.06, 95% confidence interval 2.17–4.30) and need for mechanical circulatory support (odds ratio 2.37, 95% confidence interval 1.48–3.80).</div></div><div><h3>Conclusion</h3><div>In a nationwide cohort of pregnancy-related hospitalizations, a history of CIED implantation was rare, occurring in about 0.05% of women. In-hospital mortality was significantly higher among pregnant women with ICDs. However, after adjustment for covariates, the excess mortality risk was no longer observed. Pregnant women with ICDs remain at increased risk of cardiogenic shock and need for mechanical circulatory support, even after adjusting for covariates. Outcomes for pregnant women with PPMs are generally excellent and comparable to those without CIEDs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 176-182"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444239","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":"Establishing an intravenous sotalol loading program","authors":"Keturah DelGrosso PharmD, BCPS ,&nbsp;Kathryn Wood PhD, RN, FAHA, FAAN","doi":"10.1016/j.hroo.2024.11.011","DOIUrl":"10.1016/j.hroo.2024.11.011","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 233-236"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444249","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":"Impact of atrial functional substrate in patients with atrial fibrillation: The potential utility of decremental evoked potential mapping in the atrium","authors":"Yasuhito Kotake MD, PhD ,&nbsp;Fumiyasu Hirano MD ,&nbsp;Shunsuke Kawatani MD ,&nbsp;Aiko Takami MD ,&nbsp;Takuya Tomomori MD ,&nbsp;Akihiro Okamura MD, PhD ,&nbsp;Masaru Kato MD, PhD ,&nbsp;Kazuhiro Yamamoto MD, PhD, FJCS","doi":"10.1016/j.hroo.2024.11.015","DOIUrl":"10.1016/j.hroo.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Decremental evoked potential (DEEP) is one of the functional substrates mainly used in the field of ventricular arrhythmias, which is suggested to be a critical target of reentrant ventricular tachycardia.</div></div><div><h3>Objective</h3><div>The purpose of this study is to investigate the characteristics of patients with atrial functional substrates expressed by DEEP and their clinical significance.</div></div><div><h3>Methods</h3><div>Patients presenting for atrial fibrillation (AF) ablation from April 2023 to March 2024 at Tottori University Hospital were analyzed. After cryoballoon pulmonary vein isolation, DEEP was evaluated at the left atrial roof and posterior wall by extrastimulus pacing maneuvers. To verify the clinical significance of atrial DEEP, the relationship between atrial DEEP and various clinical valuables including the pericardial fat volume and clinical outcomes was assessed.</div></div><div><h3>Results</h3><div>A total of 102 patients were included and 45% had persistent AF. Fifty-three percent of patients exhibited DEEP properties. DEEP was more prevalent in patients with persistent AF (61% vs 39%, <em>P &lt;</em> .001), higher brain natriuretic peptide levels (194 [interquartile range (IQR) 106–270] pg/mL vs 90 [IQR 23–174] pg/mL, <em>P =</em> .01), and a greater pericardiac fat volume (112 [IQR 63–76] cm³ vs 75 [IQR 53–95] cm³, <em>P =</em> .001). The patients with atrial DEEP had more early AF recurrence after ablation procedure (<em>P &lt;</em> .001).</div></div><div><h3>Conclusion</h3><div>This study demonstrated a correlation between atrial DEEP and longer duration of AF, higher brain natriuretic peptide levels, greater pericardial fat volume, and more early AF recurrence, suggesting that DEEP reflects a certain aspect of atrial electrophysiological remodeling and is a potential ablation target for AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 159-165"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444581","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":"Physical activity benchmarks for implantable loop recorder patients: The role of ILRs in cardiovascular disease management","authors":"Maeve M. Sargeant BS ,&nbsp;Camden Harrell MS ,&nbsp;Steven Mullane MS ,&nbsp;Alireza Ghajar MD ,&nbsp;Michael Li BA ,&nbsp;Ghanshyam Shantha MD ,&nbsp;Samuel F. Sears PhD","doi":"10.1016/j.hroo.2024.11.008","DOIUrl":"10.1016/j.hroo.2024.11.008","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Pages 183-187"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444240","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":"To the Editor— Functional substrate mapping of ventricular arrhythmia","authors":"Henry H. Hsia MD, FACC, FHRS,&nbsp;Won-Seok Choe MD","doi":"10.1016/j.hroo.2024.04.015","DOIUrl":"10.1016/j.hroo.2024.04.015","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 2","pages":"Page 242"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444251","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":"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}