Arrhythmia & Electrophysiology Review最新文献

{"title":"Genetics of Sudden Cardiac Arrest: Overview of Genetic Risk Factors and Aetiologies.","authors":"Sarah Ming Li Tan, Shir Lynn Lim, Marcus Eh Ong, Kevin Mw Leong","doi":"10.15420/aer.2025.11","DOIUrl":"10.15420/aer.2025.11","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) is one of the leading causes of death worldwide. Coronary artery disease (CAD) is the predominant cause of SCD in older individuals, while inherited cardiomyopathies and channelopathies are more common in younger individuals under the age of 35 years. Genetic disorders associated with SCD have traditionally been perceived as monogenic disorders. However, increasing evidence suggests that many of these disorders have complex genetic architecture with contributions from multiple genetic variants, known as polygenic inheritance, along with environmental factors. Improved understanding of genetic contributions and variants in SCD may help elucidate the cause of SCD, enable risk stratification, and identify novel disease mechanisms to guide preventative and therapeutic strategies in SCD. This review provides an overview of the genetic risk factors and clinical implications for the most common cardiac disorders related to SCD in both old and young individuals: specifically CAD, as well as the inherited cardiomyopathies and channelopathies, respectively.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e18"},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013755","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":"Anatomical Determinants of Papillary Muscle Arrhythmias in Apparently Normal Hearts.","authors":"Santiago Rivera, Maria de la Paz Ricapito, Ricardo Ronderos, Paul Ga Volders","doi":"10.15420/aer.2025.10","DOIUrl":"10.15420/aer.2025.10","url":null,"abstract":"<p><strong>Background: </strong>Myocardial connections of left ventricular (LV) papillary muscles (PM) are determinants of QRS variability in the case of PM arrhythmias. We investigated the anatomical substrate of monomorphic versus polymorphic LV PM arrhythmias in patients with apparently normal hearts, as well as ablation outcomes.</p><p><strong>Methods: </strong>Thirty-two patients were eligible for analysis. Thirteen patients underwent ablation. With advanced cardiac imaging (cardiac MRI or multidetector CT), we determined the number of PM-PM and PM-surrounding myocardium connections, PM architecture according to the number of strands and the level of LV trabeculation.</p><p><strong>Results: </strong>Combinations of unifocal (monomorphic premature ventricular complexes [PVCs]), multiform PVCs and/or runs of polymorphic PM arrhythmias (≥3 beats) were recorded in 24 patients. The remaining eight patients had only unifocal monomorphic PVCs. The mean [± SD] number of PM connections was higher than that of PM-PM or PM-myocardial connections in patients with multiform PVCs (30 ± 1.5 versus 4 ± 1, respectively) or polymorphic arrhythmias (136 ± 4 versus 26 ± 3, respectively; p=0.004). Compared with the unifocal group, the frequency of multistranded PMs was higher (1 versus 22, respectively; p<0.001) and LV trabeculation was more pronounced in the group with multiform arrhythmia (multiform PVCs and/or polymorphic arrhythmias). All patients ablated for unifocal PVCs remained free of recurrence, compared with only half of those ablated for multiform PVCs.</p><p><strong>Conclusion: </strong>Patients with multiform PM arrhythmias have more PM connections, PM strands and trabeculation than patients without QRS variability. The long-term effectiveness of catheter ablation in this patient group is limited.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e16"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079415","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":"Cardioneuroablation for Asystolic Reflex Syncope: How to Identify the Best Candidate and How to Predict Success.","authors":"Piotr Kulakowski","doi":"10.15420/aer.2025.25","DOIUrl":"10.15420/aer.2025.25","url":null,"abstract":"<p><p>Cardioneuroablation is a relatively new method to treat asystolic reflex syncope. The short- and mid-term efficacy ranges between 70% and 94%. Although the method is increasingly used worldwide, there are many unresolved issues associated with the use of this technique. One such issue is the correct identification of optimal candidates for cardioneuroablation. This article reviews the demographic, clinical and procedural parameters that may be of value in predicting the efficacy of cardioneuroablation.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e17"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013776","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 Fasciculoventricular Accessory Pathway Featuring Functional Decremental Conduction and QRS Variability.","authors":"Pin Wang, Yanwei Wang, Chenglong Miao, Lu Xu","doi":"10.15420/aer.2025.12","DOIUrl":"10.15420/aer.2025.12","url":null,"abstract":"<p><p>Fasciculoventricular accessory pathways (FVAPs), once considered rare variants of pre-excitation syndrome, are now recognised as ubiquitous in both humans and murine. Nonetheless, most FVAPs are likely electrically silent. However, they can become evident, as reported for some glycogen storage diseases (such as Danon disease and <i>PRKAG2</i>) and during high-voltage septal pacing. Typically, FVAPs only exhibit antegrade and non-decremental conducting properties. A block at the FVAP results in a normal His-to-ventricle interval and a narrow QRS complex without signs of pre-excitation. Decremental conduction over FVAP was once reported in a setting of <i>PRKAG2</i> mutation. However, in the present case, incremental atrial pacing revealed varying His-to-ventricle intervals, with functional decremental conduction that was accompanied by varied QRS morphologies. These findings underscore the diagnostic challenges posed by FVAPs, and highlight the need for meticulous electrophysiological assessment to accurately distinguish them from other pre-excitation syndromes. This case exemplifies the nuanced behaviour of FVAPs, emphasising their clinical and diagnostic complexity in electrophysiological practice.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e15"},"PeriodicalIF":3.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793357","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":"One-year Outcomes of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: CONDUCT Registry: A Propensity Score-Matched Comparison.","authors":"Michal Droppa, Tobias Geisler, Jans Baan, Niels-Erik Nielsen, Jacek Baranowski, Wilbert Wesselink, Jana Kurucova, Luis Hack, Anjaly Vijayan, Peter Bramlage, Tanja K Rudolph","doi":"10.15420/aer.2024.52","DOIUrl":"10.15420/aer.2024.52","url":null,"abstract":"<p><strong>Objectives: </strong>The occurrence of new conduction abnormalities necessitating permanent pacemaker implantation (PPI) is a complication of transcatheter aortic valve replacement (TAVR). Previous studies have shown inconsistent results about the clinical impact of new PPI after TAVR.</p><p><strong>Methods: </strong>CONDUCT was a prospective observational registry that enrolled 295 patients undergoing TAVR at four European centres. The primary goal of this registry was to compare 1-year clinical outcomes in TAVR patients with or without PPI, using one-to-four propensity score matched (PSM) analysis. It also assessed major adverse cardiac events (MACE) in patients undergoing right ventricular pacing after PPI.</p><p><strong>Results: </strong>Out of 160 PSM patients, 36 underwent PPI and the other 124 had no PPI within 30 days post-TAVR. The median age of the patients was 80 years, with more men (80.6% and 84.7% in patients with and without PPI, respectively) and similar EuroSCORE II and Society of Thoracic Surgeons scores. Patients with PPI had higher diabetes prevalence (p=0.055) and lower left ventricular ejection fraction percentages (p=0.034), but higher systolic pulmonary artery pressure (p=0.013) than those without PPI. However, these differences diminished after PSM. At 1 year, PPI patients had a nonsignificant but slightly higher incidence of MACE (22.2% versus 13.7%; p=0.216) (HR 1.63; 95% CI [0.72-3.71]) driven by increased heart failure (11.1% versus 2.4%; p=0.046) (HR 5.05; 95% CI [1.09-23.4]). Freedom from all-cause mortality, cardiovascular death, stroke and endocarditis at 1-year follow-up was comparable between groups.</p><p><strong>Conclusion: </strong>Despite a higher incidence of congestive heart failure rehospitalisation in patients undergoing PPI, 1-year clinical outcomes were similar in both groups.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e14"},"PeriodicalIF":2.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551819","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":"The Atrioventricular Node Revisited.","authors":"Demosthenes G Katritsis","doi":"10.15420/aer.2025.29","DOIUrl":"10.15420/aer.2025.29","url":null,"abstract":"","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e13"},"PeriodicalIF":2.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551820","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":"Inappropriate Sinus Tachycardia Following Cardioneuroablation for Reflex Syncope: A Case Report and Review of the Literature Illustrating this Underappreciated Adverse Effect.","authors":"Piotr Kulakowski, Roman Piotrowski","doi":"10.15420/aer.2025.01","DOIUrl":"10.15420/aer.2025.01","url":null,"abstract":"<p><p>Inappropriate sinus tachycardia (IST) is a clinical syndrome that generally affects young patients and is associated with distressing symptoms. Cardioneuroablation (CNA) is a promising method for the treatment of asystolic reflex syncope, functional bradycardia or atrioventricular block. Because CNA involves parasympathetic denervation, one potential adverse effect may be IST. We present an educational case of a patient with mixed vasovagal syncope and symptomatic sinus bradycardia who underwent CNA, as a result of which bradycardia converted to IST and the patient required subsequent pacemaker implantation. We also review the incidence of IST after CNA and difficulties around the definition and treatment of post-CNA IST.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e12"},"PeriodicalIF":2.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551818","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":"3D Anatomy of the Atrioventricular Conduction Axis Reconstructed Relative to Gross Anatomical Landmarks Using Hierarchical Phase-contrast Tomography.","authors":"Justin T Tretter, Robert H Anderson, Kenneth A Ellenbogen, ShlomoA Ben-Haim","doi":"10.15420/aer.2025.18","DOIUrl":"10.15420/aer.2025.18","url":null,"abstract":"<p><p>Anatomical investigations aiming to delineate the 3D anatomy of the conduction system have been limited. Hierarchical phase-contrast tomography now provides the ability for 3D imaging at the micron-level spatial resolution. In this report, we present 3D reconstructions of the atrioventricular conduction axis within a structurally normal autopsied heart.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e11"},"PeriodicalIF":2.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282243","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":"Fascicular and Papillary Muscle Arrhythmias in the Structurally Normal Heart.","authors":"Travis D Richardson, Roy M John","doi":"10.15420/aer.2024.54","DOIUrl":"10.15420/aer.2024.54","url":null,"abstract":"<p><p>Arrhythmias originating from the specialised cardiac conduction system and papillary muscles can occur in both structurally normal and diseased hearts. Conduction system associated arrhythmias include bundle branch re-entry, fascicular re-entry, non-re-entrant fascicular ventricular tachycardia and idiopathic ventricular fibrillation. Each type of arrhythmia requires a unique diagnostic and therapeutic approach. The papillary muscles may also be a source of ventricular arrhythmias. Ablation of papillary muscle associated arrhythmias may be difficult due to the complexities of mapping, structural abnormalities and potentially the deep location of arrhythmia foci. Tools, such as intracardiac echocardiography, can be valuable.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e10"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207439","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":"The Management of Obesity Before Catheter Ablation of AF: The Missing Piece?","authors":"Kyaw Z Win, Matthew J Armstrong, Richard P Steeds, Manish Kalla","doi":"10.15420/aer.2024.45","DOIUrl":"10.15420/aer.2024.45","url":null,"abstract":"<p><p>Obesity independently increases AF risk and negatively affects the outcomes of catheter ablation. This review examines the relationship between obesity and AF, focusing on structural and electrical remodelling. Multiple studies demonstrate worse ablation outcomes in patients with obesity. Pre-ablation weight loss improves outcomes and maintaining weight loss post-ablation is equally important. Risk factor modification programmes show promise, however they require a large investment in resources. Less intensive strategies focusing on diet and exercise have shown mixed results. Glucagon-like peptide-1 receptor agonists have been identified as potential adjunct therapies. They have multiple effects, including preferential reduction of epicardial adipose tissue and an anti-inflammatory action. Further research is needed to establish their efficacy in improving ablation outcomes. This review highlights the importance of weight management in AF treatment and suggests potential monitoring strategies using cardiac imaging. Future studies may shift the paradigm for the management of AF patients with obesity who are undergoing ablation.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e09"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207440","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}