American Journal of Cardiology最新文献

{"title":"Enhanced Expression of Hemoglobin Scavenger Receptor is Associated With Aortic Valve Stenosis in Patients With Bicuspid Aortic Valve","authors":"Tsukasa Matsushita MD ,&nbsp;Yoshiki Matsumura MD ,&nbsp;Masashi Nakagawa MD ,&nbsp;Kenji Shimeno MD ,&nbsp;Ryo Matsumoto MD ,&nbsp;Yukio Abe MD ,&nbsp;Yasuyuki Bito MD ,&nbsp;Takanobu Aoyama MD ,&nbsp;Yosuke Takahashi MD ,&nbsp;Toshihiko Shibata MD ,&nbsp;Takahiko Naruko MD ,&nbsp;Daiju Fukuda MD","doi":"10.1016/j.amjcard.2025.08.025","DOIUrl":"10.1016/j.amjcard.2025.08.025","url":null,"abstract":"<div><div>Recent studies suggest that intraleaflet hemorrhage is more common in bicuspid aortic valves (BAV) than in tricuspid valves (TAV), possibly contributing to the faster progression of aortic stenosis (AS) in BAV. Hemoglobin (Hb)-induced oxidative damage occurs via haptoglobin (Hp), which irreversibly binds extracorpuscular Hb, forming an Hp-Hb complex. In valve leaflets, this complex is cleared only by macrophages mediated by the CD163 receptor. Oxidative stress has also been implicated in AS progression. In this study, we examined the relationship between intraleaflet hemorrhage, oxidative stress, and CD163 expression in aortic valves from AS patients with TAV (n = 35) or BAV (n = 34). Valve specimens were collected during surgery. Immunohistochemistry was performed using antibodies against macrophages, glycophorin A (an erythrocyte membrane marker), CD31, CD163, and 4-hydroxy-2-nonenal (4-HNE), a marker of lipid peroxidation. Quantitative analysis showed that BAV specimens had significantly greater macrophage infiltration, glycophorin A, 4-HNE, microvessel density, and CD163-positive macrophages than TAV (all p &lt;0.05). CD163-positive macrophage scores positively correlated with 4-HNE and glycophorin A areas (both p &lt;0.0005). These results indicate a strong association between CD163 expression and both intraleaflet hemorrhage and lipid peroxidation. In conclusion, intraleaflet hemorrhage–associated oxidative stress may promote rapid AS progression in BAV patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 125-129"},"PeriodicalIF":2.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implication of Angio-based Microvascular Resistance, A Measure of Coronary Microvascular Dysfunction Severity, for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy","authors":"Yingqi Pei MD ,&nbsp;Haobo Xu MD ,&nbsp;Chong Pan MD ,&nbsp;Fasheng Zhu MD ,&nbsp;Dong Liu MD ,&nbsp;Ying Xiao MD ,&nbsp;Yu Ren MD ,&nbsp;Tao Tian MD ,&nbsp;Juan Wang MD ,&nbsp;Weixian Yang MD ,&nbsp;Tianjie Wang MD ,&nbsp;Jiansong Yuan MD","doi":"10.1016/j.amjcard.2025.08.021","DOIUrl":"10.1016/j.amjcard.2025.08.021","url":null,"abstract":"<div><div>Coronary microvascular dysfunction (CMD) is a common feature in patients with hypertrophic cardiomyopathy (HCM). CMD is a risk factor for atrial fibrillation (AF) in the general population. However, the relationship between CMD and AF prevalence in HCM patients has not been fully explored. This study aimed to investigate whether angio-based microvascular resistance (AMR), as an index of coronary microcirculatory function, is associated with the prevalence of AF in a large cohort of HCM patients. A total of 607 patients with HCM who underwent coronary angiography were included. AMR was retrospectively calculated using a wire-free angiography method in coronary arteries, and an average value of AMR ≥250 mmHg*s/m was defined as indicative of CMD. Our results showed that patients with CMD were more often male, with higher smoking rates and a higher prevalence of hypertension The prevalence of AF increased in patients with CMD (26.3% vs 11.0%; p &lt;0.001), or across AHI quartiles (7.1%, 11.3%, 16.2%, and 26.8%, respectively; <em>P</em> for trend &lt;0.001). After adjusting for age, sex, BMI, Hyperlipidemia, hypertension, left atrial diameter, creatinine and obstructive HCM, the presence of CMD (odds ratio, 3.12; 95% CI 1.89 to 5.18, p &lt;0.001) or highest AMR quartile (odds ratio, 6.08 95% CI 2.76 to 13.38, p &lt;0.001) were significantly associated with AF. In conclusion, AMR, as a marker of microvascular dysfunction, is independently associated with the prevalence of AF in patients with HCM. For HCM patients, these findings suggest that evaluating AMR could provide valuable insights into the risk of AF.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 107-114"},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Prognosis of Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease","authors":"Han Xia PhD ,&nbsp;Junlei Li PhD ,&nbsp;Jianzeng Dong PhD","doi":"10.1016/j.amjcard.2025.08.020","DOIUrl":"10.1016/j.amjcard.2025.08.020","url":null,"abstract":"<div><div>This study describes clinical profiles of acute heart failure (AHF) patients from the Heart Failure Registry of Patient Outcomes (HERO) study and evaluates the prognostic impact of chronic obstructive pulmonary disease (COPD). HERO enrolled 5,620 hospitalized AHF patients (November 2017 to 2018); 4,428 were followed. Primary endpoint: composite all-cause death or heart failure (HF) readmission. Secondary endpoints included all-cause death, HF readmission, and cardiovascular death. Patients were stratified by COPD status. Clinical characteristics were compared. Adjusted multivariate Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for COPD's impact on outcomes. Kaplan-Meier analysis (log-rank test) compared time-to-event data; sensitivity analyses were performed. Of 4,428 patients, 405 (9.2%) had COPD. COPD patients were older, more often male, had lower education, higher smoking rates, and received care predominantly in secondary hospitals. They had lower body mass index (BMI), higher heart rate, elevated hemoglobin (Hb), higher New York Heart Association (NYHA) class IV prevalence, but lower N-terminal pro–B-type natriuretic peptide (NT-proBNP). Hypertension, diabetes, and coronary artery disease were less frequent; hyponatremia was more common. Use of renin-angiotensin-aldosterone system (RAAS) inhibitors, β-blockers, statins, and diuretics was significantly lower in the COPD group. After adjustment, COPD independently predicted higher risks for the composite endpoint (HR = 1.38, 95% CI: 1.17 to 1.62, p &lt;0.001), HF readmission (HR = 1.26, 95% CI: 1.02 to 1.55, p = 0.047), cardiovascular death (HR = 1.38, 95% CI: 1.09 to 1.74, p = 0.008), and all-cause death (HR = 1.40, 95% CI: 1.15 to 1.72, p = 0.001). Survival curves showed early and widening separation, indicating worse COPD outcomes. COPD independently increases adverse outcome risk in AHF patients. These individuals often present with poorer baseline health, leading to unfavorable prognosis. Integrated multidisciplinary care and individualized treatment are crucial to improve survival.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 101-109"},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Treatment of Unrecognized Spontaneous Coronary Artery Dissection in Young Women Presenting With an Acute Coronary Syndrome","authors":"Jin Al-Gully BSc ,&nbsp;Jose M. Montero-Cabezas MD, PhD ,&nbsp;Jeroen Eikenboom MD, PhD ,&nbsp;Paul L. den Exter MD, PhD ,&nbsp;Frank van der Kley MD, PhD ,&nbsp;Wouter Jukema MD, PhD ,&nbsp;Brian O. Bingen MD, PhD ,&nbsp;Ibtihal Al Amri MD, PhD","doi":"10.1016/j.amjcard.2025.08.017","DOIUrl":"10.1016/j.amjcard.2025.08.017","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is often overlooked as a cause of acute coronary syndrome (ACS), particularly in young women. SCAD requires distinct management, underscoring the importance of its timely and accurate diagnosis for effective treatment. This study aims to evaluate the frequency of SCAD underdiagnosis in young women with ACS and pinpoints potential SCAD indicators. All consecutive women ≤55 years with ACS who underwent coronary angiography (CAG) at our tertiary center from 2012 to 2024, were included. Clinical data at baseline and follow-up were retrospectively collected. All coronary angiography's (CAGs) were reviewed for SCAD-signs using the Yip-Saw criteria. Accurately diagnosed SCAD patients were compared to those with initially unrecognized SCAD and patients with other ACS causes. Of 394 patients (mean age 48.4 ± 5.8 years) evaluated, 23% (<em>n</em> = 92) had SCAD, but 41% (<em>n</em> = 38) were not initially correctly diagnosed. SCAD type 3 was most often missed. SCAD patients were younger and more frequently lacked traditional cardiovascular risk factors. They also showed higher coronary tortuosity scores, which were significantly associated with SCAD in multivariate analysis. Invasively treated SCAD patients received more stents than non-SCAD patients, largely due to hematoma extension. Follow-up revealed fewer atherosclerotic ACS in SCAD patients, with recurrent SCAD occurring only in undiagnosed cases. In conclusion, underdiagnosis of SCAD in young women with ACS is common and leads to inappropriate treatment, highlighting the need for increased awareness and improved diagnostic approaches. Young ACS patients with minimal cardiovascular risk factors and high coronary tortuosity scores should be carefully evaluated for SCAD.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"255 ","pages":"Pages 116-125"},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Oral Iron on Transferrin Saturation in Iron-deficient HFrEF: A Secondary Analysis of IRONOUT HF","authors":"António Angélico-Gonçalves MD ,&nbsp;Pedro Marques MD ,&nbsp;Ana Rita Leite MD ,&nbsp;João Sérgio Neves MD, PhD ,&nbsp;Francisco Vasques-Nóvoa MD ,&nbsp;Adelino Leite-Moreira MD, PhD ,&nbsp;João Pedro Ferreira MD, PhD","doi":"10.1016/j.amjcard.2025.08.016","DOIUrl":"10.1016/j.amjcard.2025.08.016","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 139-142"},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Coated Balloons for the Treatment of Coronary Artery Disease.","authors":"Debabrata Mukherjee","doi":"10.1016/j.amjcard.2025.08.011","DOIUrl":"10.1016/j.amjcard.2025.08.011","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Review of Inflammatory Pathways and Immune Modulation in Atherosclerotic Cardiovascular Disease.","authors":"Qian Wang, Yi-Xuan Sui, Le-Tong Zhang, Nan Meng, Hang-Yu Chen","doi":"10.1016/j.amjcard.2025.08.013","DOIUrl":"10.1016/j.amjcard.2025.08.013","url":null,"abstract":"<p><p>Inflammation is a central contributor to atherosclerotic cardiovascular disease (ASCVD), and targeted immune modulation may provide added benefit beyond lipid-lowering. We conducted a systematic review (PRISMA 2020-compliant) of 57 studies published between 2000 and 2025, including randomized trials, observational cohorts, biomarker analyses and genetic studies, to evaluate inflammatory pathways and immunomodulatory therapies in ASCVD. Interleukin-1 beta (IL-1β) inhibitors and colchicine consistently reduced major cardiovascular events without affecting lipid levels, with colchicine showing benefit even at low CRP. interleukin-6 (IL-6) inhibitors demonstrated strong biomarker suppression, though outcome trials are still in progress. Methotrexate showed no clinical benefit, and biologics carried a modest infection risk. Risk of bias was low across most included studies. In conclusion, anti-inflammatory therapy appears to be a promising adjunct in ASCVD prevention, especially for patients with residual inflammatory risk. Colchicine has the most consistent supporting evidence, and further trials are warranted to clarify the role of IL-6 inhibition and personalized treatment strategies.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"134-142"},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus-Coated Balloon Versus Drug-Eluting Stent in Elderly Patients With Coronary Artery Disease: A Matched-based Comparison","authors":"Filippo Luca Gurgoglione MD ,&nbsp;Sylwia Iwańczyk MD ,&nbsp;Wojciech Wańha MD ,&nbsp;Davide Donelli MD ,&nbsp;Dario Gattuso Eng ,&nbsp;Giampaolo Niccoli MD, PhD ,&nbsp;Bernardo Cortese MD","doi":"10.1016/j.amjcard.2025.08.012","DOIUrl":"10.1016/j.amjcard.2025.08.012","url":null,"abstract":"<div><div>Coronary artery disease (CAD) is the leading cause of mortality in elderly patients (≥75 years). While percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) is commonly used in elderly patients with CAD, drug-coated balloons (DCB) have emerged as a promising alternative. The aim of this study was to compare the safety and efficacy of PCI with Sirolimus-Coated Balloons (SCB) and second-generation DES in this population. We included elderly patients who underwent PCI from the prospective, investigator-driven EASTBOURNE study (n= 534 patients treated with Magic Touch SCB) and the Complex Registry (n = 234 patients treated with second-generation DES). The primary endpoint was net adverse cardiovascular events (NACE), a composite of all-cause death, target lesion revascularization (TLR), nonfatal myocardial infarction (MI), and major bleedings at the 2-year follow-up. The cardinality score matching and Cox regression analysis were employed. After matching, 220 patients were included in each group. The incidence of NACE was similar between groups (HR 1.28; 95% CI: 0.85–1.93; p = 0.239). No significant differences were observed in the rates of nonfatal MI, or TLR. However, the SCB group exhibited a significantly lower rate of the secondary BARC 3–5 bleeding endpoint compared to the DES group (HR 0.17; 95% CI: 0.04–0.77; p = 0.030). In conclusion, CI with SCB demonstrated comparable safety and efficacy to second-generation DES in elderly patients with CAD at 2-year follow-up, with a notable reduction in major bleeding risk in the SCB group.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"255 ","pages":"Pages 99-105"},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Sleep Duration and Cardiovascular Disease: A Prospective Cohort Study Based on Charls","authors":"Yong He MD,&nbsp;Hongkun Wu MD,&nbsp;Yongjin Luo MD,&nbsp;Xin Wen MD,&nbsp;Hao Chen MD","doi":"10.1016/j.amjcard.2025.08.014","DOIUrl":"10.1016/j.amjcard.2025.08.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The association between sleep disturbances and chronic diseases has attracted growing scholarly interest. Nevertheless, comprehensive national data on the longitudinal relationship between sleep duration and cardiovascular disease (CVD), along with its regional distribution characteristics, remain scarce. particularly for the Chinese population. Given the substantial burden of CVD and pronounced regional health disparities among middle-aged and older adults in China, a deeper investigation into the role of sleep is warranted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This research sought to systematically examine the dynamic relationship between sleep duration and cardiovascular disease (CVD) in individuals aged 45 years and older, employing multiple waves of data from the China Health and Retirement Longitudinal Study (CHARLS). The study also evaluated nonlinear associations and subgroup heterogeneity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This prospective cohort study comprised participants with complete data across 3 waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011 (N = 13,078), 2013 (N = 9,075), and 2015 (N = 12,397). Data on sleep duration and cardiovascular disease (CVD) diagnoses were obtained through structured questionnaires. To evaluate the association between sleep duration and CVD, multivariable logistic regression models were utilized, with adjustments sequential adjustments for demographic characteristics, lifestyle factors, and comorbidities. Restricted cubic spline (RCS) models were employed to investigate potential nonlinear associations, and subgroup analyses were conducted to identify heterogeneity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Individuals diagnosed with cardiovascular disease (CVD) consistently reported shorter average sleep duration compared to their counterparts without CVD, exemplified by an average of 6.00 hours versus 6.41 hours in 2011 (p &lt; 0.001). A short sleep duration, defined as less than 5 hours, was significantly associated with an elevated risk of CVD, whereas a sleep duration of 6 to 8 hours was correlated with the lowest risk. After full adjustment, each additional hour of sleep was associated with an approximate 9% reduction in the odds of CVD. Restricted cubic spline (RCS) analyses indicated a nonlinear inverse relationship, with the risk of CVD decreasing as sleep duration increased. The protective effects of adequate sleep were more pronounced among older adults, individuals with higher educational attainment, and nonsmokers. Predictive models incorporating sleep duration exhibited enhanced accuracy and sensitivity across all study waves, with the area under the curve (AUC) consistently improving.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study provides strong longitudinal evidence of an inverse relationship between sleep duration and cardiovascular disease (CVD) risk among middle-aged and older Chinese adults. Specifically, sleep duration of","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 91-100"},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory Atrial Tachyarrhythmias Management in Severely Dilated Right Atrium Due to Complex Congenital Heart Disease: Clinical Perspectives Beyond Catheter Ablation","authors":"Aya Miyazaki MD, PhD ,&nbsp;Yoshifumi Fujimoto MD ,&nbsp;Junya Tomida ,&nbsp;Hiroshi Tsuneyoshi MD, PhD ,&nbsp;Masaaki Koide MD, PhD ,&nbsp;Hiroki Sakamoto MD ,&nbsp;Hiroki Uchiyama MD, PhD ,&nbsp;Nao Inoue MD, PhD ,&nbsp;Ryuta Henmi MD, PhD ,&nbsp;Akio Ikai MD, PhD ,&nbsp;Yasuhiko Tanaka MD ,&nbsp;Yasumi Nakashima MD, PhD","doi":"10.1016/j.amjcard.2025.08.009","DOIUrl":"10.1016/j.amjcard.2025.08.009","url":null,"abstract":"<div><div>Refractory atrial tachyarrhythmias frequently occur in patients with congenital heart disease (CHD) who have a markedly enlarged right atrium (RA). The obfective of this study was to elucidate arrhythmogenic substrates and evaluate the comprehensive treatment outcomes in patients with complex CHD and a giant RA (≥190 mL). Ten patients with complex CHD and a giant RA who underwent catheter ablation (CA) were evaluated (median age, 40 [interquartile range (IQR), 33 to 52] years). A total of 23 tachyarrhythmias were identified during CA. Three distinct electrophysiological mechanisms were observed: atrial fibrillation with coexisting reentrant atrial tachycardia in 3 patients, reentrant atrial tachycardia localized to low-voltage scar areas (&lt;0.03 mV) in 2 patients, and atrial tachycardia likely involving epicardial pathways in 3 patients. CA alone achieved an overall success rate of 70%, with partial success in 50% of cases. Post-CA, 6 patients underwent surgical intervention, including RA volume reduction (RAVR) and RA/coronary sinus cryoablation, while 8 patients received pacemaker-based rhythm management. Among the 9 patients treated with either surgical or device-based therapy, the clinical arrhythmia severity score showed significant improvement (median Δ, −3 [IQR, −4.5 to −2], p = 0.004), accompanied by reductions in brain natriuretic peptide levels (median Δ = −39.5 [IQR, −114.7 to −26.0] pg/mL, p = 0.004) and cardiothoracic ratio (Δ = −6.8 [IQR, −11.9 to 0.1]%, p = 0.039). In conlusion, in CHD patients with markedly enlarged RA, CA alone is often insufficient. A combined strategy involving surgical intervention and pacemaker-based rhythm control appears to offer superior outcomes for both arrhythmia management and hemodynamic status.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 93-101"},"PeriodicalIF":2.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}