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Sex Differences in Outcomes of an Intensive Risk Factor Modification Program in Patients With Atrial Fibrillation. 心房颤动患者在强化危险因素调整项目中的结果性别差异。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-18 DOI: 10.1161/CIRCEP.123.012534
Jean Jacques Noubiap, Rajeev K Pathak, Gijo Thomas, Adrian D Elliott, Prashanthan Sanders, Melissa E Middeldorp

Background: The outcomes of atrial fibrillation (AF) seem to be variable between males and females. We therefore aimed to determine sex differences in weight loss, cardiorespiratory fitness gain, and recurrence and progression of AF following risk factor management.

Methods: Of 1415 consecutive patients referred for electrophysiology management of AF, 825 had a body mass index of ≥27 kg/m2; after exclusions, 355 (males, 234; females, 121) were offered risk factor management and participation in a tailored exercise program.

Results: Females were older than males (65.5±10.4 versus 62.5±10.6 years; P=0.013) with a higher body mass index (34.1±5.4 versus 32.6±4.1 kg/m2; P=0.003) and more commonly paroxysmal AF (67.8% versus 48.3%; P<0.001). There was no sex difference in clinic attendance (58.7% versus 60%; P=0.82), weight loss (P=0.86), fitness gain (P=0.44), or improvement in AF symptoms (P=0.35). Weight loss (≥10% compared with <10%) was associated with lower total AF recurrence in males (hazard ratio, 0.41 [95% CI, 0.23-0.73]) and females (hazard ratio, 0.41 [95% CI, 0.20-0.83]). Fitness gain (≥2 metabolic equivalents compared with <2 metabolic equivalents) was associated with lower total AF recurrence in females (hazard ratio, 0.13 [95% CI, 0.05-0.30]) but not in males (hazard ratio, 0.63 [95% CI, 0.38-1.04]; P=0.002). There was a trend toward more reversal from persistent to paroxysmal AF in males compared with females (21.8% versus 14.0%; P=0.079).

Conclusions: Males and females with AF demonstrate a similar degree of weight loss and fitness gain through structured risk factor management. However, fitness had a much greater benefit for total arrhythmia recurrence in females compared with males, whereas there was a trend toward more AF reversal in males.

Registration: URL: https://anzctr.org.au; Unique identifier: ACTRN12614001123639.

背景:心房颤动(房颤)的治疗效果在男性和女性之间似乎存在差异。因此,我们旨在确定体重减轻、心肺功能增强以及风险因素控制后房颤复发和进展方面的性别差异:方法:在连续转诊的 1415 名房颤电生理学治疗患者中,有 825 人的体重指数≥27 kg/m2;在排除其他因素后,有 355 人(男性 234 人,女性 121 人)接受了风险因素管理并参加了量身定制的运动计划:女性比男性年龄大(65.5±10.4 岁对 62.5±10.6岁;P=0.013),体重指数高(34.1±5.4 kg/m2 对 32.6±4.1 kg/m2 ;P=0.003),更常见阵发性房颤(67.8% 对 48.3%;PP=0.82)、体重减轻(P=0.86)、体能增强(P=0.44)或房颤症状改善(P=0.35)。体重减轻(≥10%,P=0.002)。与女性相比,男性有更多从持续性房颤逆转为阵发性房颤的趋势(21.8% 对 14.0%;P=0.079):结论:通过结构化的风险因素管理,男性和女性房颤患者的体重减轻和体能增强程度相似。然而,与男性相比,健身对女性心律失常总复发的益处更大,而男性则有更多房颤逆转的趋势:URL: https://anzctr.org.au; Unique identifier:ACTRN12614001123639。
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引用次数: 0
Ablating Myocardium Using Nanosecond Pulsed Electric Fields: Preclinical Assessment of Feasibility, Safety, and Durability. 使用纳秒脉冲电场消融心肌:可行性、安全性和耐久性的临床前评估
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-05-17 DOI: 10.1161/CIRCEP.124.012854
Moritz Nies, Keita Watanabe, Iwanari Kawamura, Bingyan J Wang, Jeffrey Litt, Roman Turovskiy, David J Danitz, Darrin R Uecker, Keith E Linder, Yasuhiro Maejima, Tetsuo Sasano, Vivek Y Reddy, Jacob S Koruth

Background: Unlike conventional microsecond pulsed electrical fields that primarily target the cell membranes, nanosecond pulses are thought to primarily electroporate intracellular organelles. We conducted a comprehensive preclinical assessment of catheter-based endocardial nanosecond pulsed field ablation in swine.

Methods: A novel endocardial nanosecond pulsed field ablation system was evaluated in a total of 25 swine. Using either a low-dose (5-second duration) or high-dose (15-second duration) strategy, thoracic veins and discrete atrial and ventricular sites were ablated. Predetermined survival periods were <1 (n=1), ≈2 (n=7), ≈7 (n=6), 14 (n=2), or ≈28 (n=9) days, and venous isolation was assessed before euthanasia. Safety assessments included evaluation of esophageal effects, phrenic nerve function, and changes in venous caliber. All tissues were subject to careful gross pathological and histopathologic examination.

Results: All (100%) veins (13 low-dose, 34 high-dose) were acutely isolated, and all reassessed veins (6 low-dose, 15 high-dose) were durably isolated. All examined vein lesions (10 low-dose, 22 high-dose) were transmural. Vein diameters (n=15) were not significantly changed. Of the animals assessed for phrenic palsy (n=9), 3 (33%) demonstrated only transient palsy. There were no differences between dosing strategies. Thirteen mitral isthmus lesions were analyzed, and all 13 (100%) were transmural (depth, 6.4±0.4 mm). Ventricular lesions were 14.7±4.5 mm wide and 7.1±1.3 mm deep, with high-dose lesions deeper than low-dose (7.9±1.2 versus 6.2±0.8 mm; P=0.007). The esophagus revealed nontransmural adventitial surface lesions in 5 of 5 (100%) animals euthanized early (2 days) post-ablation. In the 10 animals euthanized later (14-28 days), all animals demonstrated significant esophageal healing-8 with complete resolution, and 2 with only trace fibrosis.

Conclusions: A novel, endocardial nanosecond pulsed field ablation system provides acute and durable venous isolation and linear lesions. Transient phrenic injury and nontransmural esophageal lesions can occur with worst-case assessments suggesting limits to pulsed field ablation tissue selectivity and the need for dedicated assessments during clinical studies.

背景:与主要针对细胞膜的 "传统 "微秒脉冲电场不同,纳秒脉冲被认为主要是电穿孔细胞内的细胞器。我们对基于导管的猪心内膜纳秒脉冲场消融术(nsPFA)进行了全面的临床前评估。方法:在总共 25 头猪身上评估了一种新型心内膜纳秒脉冲场消融系统。采用低剂量(持续时间为 5 秒)或高剂量(持续时间为 15 秒)策略,对胸静脉和离散的心房和心室部位进行消融。猪存活后得出结果:所有(100%)静脉(13 个低剂量,34 个高剂量)都得到了急性隔离,所有重新评估的静脉(6 个低剂量,15 个高剂量)都得到了持久隔离。所有受检静脉病变(低剂量 10 条,高剂量 22 条)均为跨壁病变。静脉直径(n=15)没有明显变化。在接受膈肌麻痹评估的动物(9 只)中,有 3 只(33%)仅表现出短暂的麻痹。不同给药策略之间没有差异。对 13 例二尖瓣峡部病变进行了分析,所有 13 例(100%)均为跨壁病变(深度为 6.4±0.4mm)。心室病变宽 14.7±4.5mm,深 7.1±1.3mm,高剂量病变比低剂量深(7.9±1.2mm vs 6.2±0.8mm,P=0.007)。在消融术后早期(2 天)处死的 5 只动物中,有 5 只(100%)的食管显示出非横隔临膜表面病变。在随后(14-28 天)处死的 10 只动物中,所有动物的食管均有明显愈合--8 只完全愈合,2 只仅有微量纤维化。结论新型心内膜纳秒 PFA 系统可提供急性、持久的静脉隔离和线性病变。最坏情况评估可能会出现短暂的膈肌损伤和非跨膜食管病变,这表明 PFA 组织选择性存在局限性,临床研究期间需要进行专门评估。
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引用次数: 0
Sudden Cardisac Death in Patients With Advanced Heart Failure and Preserved Ejection Fraction. 晚期心力衰竭和射血分数保留患者的心脏性猝死。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-05 DOI: 10.1161/CIRCEP.123.012724
Rachel M Suen, Nicholas Y Tan, Jill M Killian, Yong-Mei Cha, Shannon M Dunlay
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引用次数: 0
Sirt1 Deficiency Promotes Age-Related AF Through Enhancing Atrial Necroptosis by Activation of RIPK1 Acetylation. Sirt1 缺陷通过激活 RIPK1 乙酰化增强心房坏死促进老年性房颤
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-19 DOI: 10.1161/CIRCEP.123.012452
Xuexin Jin, Yun Zhang, Yun Zhou, Yingchun Luo, Xuejie Han, Yunlong Gao, Hui Yu, Yu Duan, Ling Shi, Yue Wu, Yue Li

Background: Aging is one of the most potent risk determinants for the onset of atrial fibrillation (AF). Sirts (sirtuins) have been implicated in the pathogenesis of cardiovascular disease, and their expression declines with aging. However, whether Sirts involved in age-related AF and its underlying mechanisms remain unknown. The present study aims to explore the role of Sirts in age-related AF and delineate the underlying molecular mechanisms.

Methods: Sirt1 levels in the atria of both elderly individuals and aging rats were evaluated using quantitative real-time polymerase chain reaction and Western blot analysis. Mice were engineered to specifically knockout Sirt1 in the atria and right ventricle (Sirt1mef2c/mef2c). Various techniques, such as echocardiography, atrial electrophysiology, and protein acetylation modification omics were employed. Additionally, coimmunoprecipitation was utilized to substantiate the interaction between Sirt1 and RIPK1 (receptor-interacting protein kinase 1).

Results: We discerned that among the diverse subtypes of sirtuin proteins, only Sirt1 expression was significantly diminished in the atria of elderly people and aged rats. The Sirt1mef2c/mef2c mice exhibited an enlarged atrial diameter and heightened vulnerability to AF. Acetylated proteomics and cell experiments identified that Sirt1 deficiency activated atrial necroptosis through increasing RIPK1 acetylation and subsequent pseudokinase MLKL (mixed lineage kinase domain-like protein) phosphorylation. Consistently, necroptotic inhibitor necrosulfonamide mitigated atrial necroptosis and diminished both the atrial diameter and AF susceptibility of Sirt1mef2c/mef2c mice. Resveratrol prevented age-related AF in rats by activating atrial Sirt1 and inhibiting necroptosis.

Conclusions: Our findings first demonstrated that Sirt1 exerts significant efficacy in countering age-related AF by impeding atrial necroptosis through regulation of RIPK1 acetylation, highlighting that the activation of Sirt1 or the inhibition of necroptosis could potentially serve as a therapeutic strategy for age-related AF.

背景:衰老是心房颤动(房颤)发病的最有力的风险决定因素之一。Sirts(sirtuins)被认为与心血管疾病的发病机制有关,它们的表达会随着年龄的增长而下降。然而,Sirts 是否参与了与年龄相关的房颤及其内在机制仍是未知数。本研究旨在探讨 Sirts 在年龄相关性房颤中的作用,并阐明其潜在的分子机制:方法:使用定量实时聚合酶链反应和 Western 印迹分析评估老年人和衰老大鼠心房中的 Sirt1 水平。设计小鼠特异性敲除心房和右心室中的 Sirt1(Sirt1mef2c/mef2c)。采用了各种技术,如超声心动图、心房电生理学和蛋白质乙酰化修饰 omics。此外,我们还利用免疫共沉淀法证实了 Sirt1 与 RIPK1(受体相互作用蛋白激酶 1)之间的相互作用:结果:我们发现,在不同亚型的 Sirtuin 蛋白中,只有 Sirt1 在老年人和老龄大鼠心房中的表达明显减少。Sirt1mef2c/mef2c小鼠的心房直径增大,更易发生房颤。乙酰化蛋白质组学和细胞实验发现,Sirt1 缺乏会通过增加 RIPK1 乙酰化和随后的伪激酶 MLKL(混合系激酶域样蛋白)磷酸化激活心房坏死。同样,坏死抑制剂新磺酰胺减轻了心房坏死,并降低了Sirt1mef2c/mef2c小鼠的心房直径和房颤易感性。白藜芦醇通过激活心房Sirt1和抑制坏死,预防了大鼠与年龄相关的房颤:我们的研究结果首次证明了 Sirt1 可通过调节 RIPK1 乙酰化阻碍心房坏死,从而在对抗老年性房颤方面发挥显著疗效。
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引用次数: 0
Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing. 远端心室起搏治疗药物难治性中腔阻塞性肥厚型心肌病:个性化起搏的随机安慰剂对照试验》。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-19 DOI: 10.1161/CIRCEP.123.012570
James W Malcolmson, Rebecca K Hughes, Tim Husselbury, Kamran Khan, Annastazia E Learoyd, Martin Lees, Eleanor C Wicks, Jamie Smith, Alexander D Simms, James C Moon, Luis R Lopes, Constantinos O'Mahony, Neha Sekhri, Perry M Elliott, Steffen E Petersen, Mehul B Dhinoja, Saidi A Mohiddin

Background: Patients with refractory, symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy have few therapeutic options. Right ventricular pacing is associated with modest hemodynamic and symptomatic improvement, and LV pacing pilot data suggest therapeutic potential. We hypothesized that site-specific pacing would reduce LVMCO gradients and improve symptoms.

Methods: Patients with symptomatic-drug-refractory LVMCO were recruited for a randomized, blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical right ventricular pacing sites were assessed during an invasive hemodynamic study of multisite pacing. Patient-specific pacing-site and atrioventricular delays, defining PPoP, were selected on the basis of LVMCO gradient reduction and acceptable pacing parameters. Patients were randomized to 6 months of active PPoP or backup pacing in a crossover design. The primary outcome examined invasive gradient change with best-site pacing. Secondary outcomes assessed quality of life and exercise following randomization to PPoP.

Results: A total of 17 patients were recruited; 16 of whom met primary end points. Baseline New York Heart Association was 3±0.6, despite optimal medical therapy. Hemodynamic effects were assessed during pacing at the right ventricular apex and at a mean of 8 LV sites. The gradients in all 16 patients fell with pacing, with maximum gradient reduction achieved via LV pacing in 14 (88%) patients and right ventricular apex in 2. The mean baseline gradient of 80±29 mm Hg fell to 31±21 mm Hg with best-site pacing, a 60% reduction (P<0.0001). One cardiac vein perforation occurred in 1 case, and 15 subjects entered crossover; 2 withdrawals occurred during crossover. Of the 13 completing crossover, 9 (69%) chose active pacing in PPoP configuration as preferred setting. PPoP was associated with improved 6-minute walking test performance (328.5±99.9 versus 285.8±105.5 m; P=0.018); other outcome measures also indicated benefit with PPoP.

Conclusions: In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic patients with LVMCO.

Registration: URL: https://clinicaltrials.gov/study; Unique Identifier: NCT03450252.

背景:难治性、有症状的左心室中腔梗阻性肥厚型心肌病患者几乎没有治疗选择。右心室起搏可适度改善血流动力学和症状,左心室起搏试验数据也显示出治疗潜力。我们假设特定部位起搏可降低 LVMCO 梯度并改善症状:方法:我们招募了有症状的药物难治性 LVMCO 患者,进行了个性化起搏处方(PPoP)的随机、盲法试验。在多部位起搏的有创血液动力学研究中,对多个左心室和右心室心尖起搏部位进行了评估。根据 LVMCO 梯度降低情况和可接受的起搏参数,选择患者特定的起搏点和房室延迟,定义 PPoP。在交叉设计中,患者随机接受为期 6 个月的主动 PPoP 或备用起搏。主要结果是检查最佳部位起搏的有创梯度变化。次要结果是评估随机使用 PPoP 后的生活质量和运动情况:共招募了 17 名患者,其中 16 人达到了主要终点。尽管接受了最佳的药物治疗,但基线纽约心脏协会指数为 3±0.6。在右心室心尖和平均 8 个左心室部位起搏时评估了血流动力学效应。通过最佳部位起搏,平均基线梯度(80±29 mm Hg)降至(31±21 mm Hg),降幅达 60%(PP=0.018);其他结果指标也显示 PPoP 有益:结论:在一项随机安慰剂对照试验中,PPoP可减少严重症状的左心室MCO患者的阻塞并改善其运动表现:URL: https://clinicaltrials.gov/study; Unique Identifier:NCT03450252。
{"title":"Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing.","authors":"James W Malcolmson, Rebecca K Hughes, Tim Husselbury, Kamran Khan, Annastazia E Learoyd, Martin Lees, Eleanor C Wicks, Jamie Smith, Alexander D Simms, James C Moon, Luis R Lopes, Constantinos O'Mahony, Neha Sekhri, Perry M Elliott, Steffen E Petersen, Mehul B Dhinoja, Saidi A Mohiddin","doi":"10.1161/CIRCEP.123.012570","DOIUrl":"10.1161/CIRCEP.123.012570","url":null,"abstract":"<p><strong>Background: </strong>Patients with refractory, symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy have few therapeutic options. Right ventricular pacing is associated with modest hemodynamic and symptomatic improvement, and LV pacing pilot data suggest therapeutic potential. We hypothesized that site-specific pacing would reduce LVMCO gradients and improve symptoms.</p><p><strong>Methods: </strong>Patients with symptomatic-drug-refractory LVMCO were recruited for a randomized, blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical right ventricular pacing sites were assessed during an invasive hemodynamic study of multisite pacing. Patient-specific pacing-site and atrioventricular delays, defining PPoP, were selected on the basis of LVMCO gradient reduction and acceptable pacing parameters. Patients were randomized to 6 months of active PPoP or backup pacing in a crossover design. The primary outcome examined invasive gradient change with best-site pacing. Secondary outcomes assessed quality of life and exercise following randomization to PPoP.</p><p><strong>Results: </strong>A total of 17 patients were recruited; 16 of whom met primary end points. Baseline New York Heart Association was 3±0.6, despite optimal medical therapy. Hemodynamic effects were assessed during pacing at the right ventricular apex and at a mean of 8 LV sites. The gradients in all 16 patients fell with pacing, with maximum gradient reduction achieved via LV pacing in 14 (88%) patients and right ventricular apex in 2. The mean baseline gradient of 80±29 mm Hg fell to 31±21 mm Hg with best-site pacing, a 60% reduction (<i>P</i><0.0001). One cardiac vein perforation occurred in 1 case, and 15 subjects entered crossover; 2 withdrawals occurred during crossover. Of the 13 completing crossover, 9 (69%) chose active pacing in PPoP configuration as preferred setting. PPoP was associated with improved 6-minute walking test performance (328.5±99.9 versus 285.8±105.5 m; <i>P</i>=0.018); other outcome measures also indicated benefit with PPoP.</p><p><strong>Conclusions: </strong>In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic patients with LVMCO.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/study; Unique Identifier: NCT03450252.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Observable Atrial and Ventricular Fibrillation Episode Durations Are Conformant With a Power Law Based on System Size and Spatial Synchronization. 可观察到的心房颤动和室颤发作持续时间符合基于系统规模和空间同步性的幂律。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-28 DOI: 10.1161/CIRCEP.123.012684
Dhani Dharmaprani, Kathryn Tiver, Sobhan Salari Shahrbabaki, Evan V Jenkins, Darius Chapman, Campbell Strong, Jing X Quah, Ivaylo Tonchev, Luke O'Loughlin, Lewis Mitchell, Matthew Tung, Waheed Ahmad, Nik Stoyanov, Martin Aguilar, Steven A Niederer, Caroline H Roney, Martyn P Nash, Richard H Clayton, Stanley Nattel, Anand N Ganesan

Background: Atrial fibrillation (AF) and ventricular fibrillation (VF) episodes exhibit varying durations, with some spontaneously ending quickly while others persist. A quantitative framework to explain episode durations remains elusive. We hypothesized that observable self-terminating AF and VF episode lengths, whereby durations are known, would conform with a power law based on the ratio of system size and correlation length ([Formula: see text].

Methods: Using data from computer simulations (2-dimensional sheet and 3-dimensional left-atrial), human ischemic VF recordings (256-electrode sock, n=12 patients), and human AF recordings (64-electrode basket-catheter, n=9 patients; 16-electrode high definition-grid catheter, n=42 patients), conformance with a power law was assessed using the Akaike information criterion, Bayesian information criterion, coefficient of determination (R2, significance=P<0.05) and maximum likelihood estimation. We analyzed fibrillatory episode durations and [Formula: see text], computed by taking the ratio between system size ([Formula: see text], chamber/simulation size) and correlation length (xi, estimated from pairwise correlation coefficients over electrode/node distance).

Results: In all computer models, the relationship between episode durations and [Formula: see text] was conformant with a power law (Aliev-Panfilov R2: 0.90, P<0.001; Courtemanche R2: 0.91, P<0.001; Luo-Rudy R2: 0.61, P<0.001). Observable clinical AF/VF durations were also conformant with a power law relationship (VF R2: 0.86, P<0.001; AF basket R2: 0.91, P<0.001; AF grid R2: 0.92, P<0.001). [Formula: see text] also differentiated between self-terminating and sustained episodes of AF and VF (P<0.001; all systems), as well as paroxysmal versus persistent AF (P<0.001). In comparison, other electrogram metrics showed no statistically significant differences (dominant frequency, Shannon Entropy, mean voltage, peak-peak voltage; P>0.05).

Conclusions: Observable fibrillation episode durations are conformant with a power law based on system size and correlation length.

背景:心房颤动(AF)和心室颤动(VF)发作的持续时间各不相同,有些会很快自发结束,而有些则会持续存在。目前仍未找到解释发作持续时间的定量框架。我们假设,在已知持续时间的情况下,可观察到的自发终止房颤和室颤发作长度将符合基于系统大小和相关长度比值的幂律([公式:见正文]):方法:利用计算机模拟(二维片状和三维左心房)、人体缺血性室颤记录(256 个电极的袜子,12 名患者)和人体房颤记录(64 个电极的篮式导管,9 名患者;16 个电极的高清栅格导管,42 名患者)中的数据,使用阿凯克信息准则、贝叶斯信息准则、决定系数(R2,显著性=PResults)评估与幂律的一致性:在所有计算机模型中,发作持续时间与[公式:见正文]之间的关系符合幂律(阿利耶夫-潘菲洛夫 R2:0.90,P2:0.91,P2:0.61,P2:0.86,P2:0.91,P2:0.92,PPPP>0.05):结论:可观察到的心颤发作持续时间符合基于系统规模和相关长度的幂律。
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引用次数: 0
Road-Map to Epicardial Approach for Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease: Results From a 10-Year Tertiary-Center Experience. 结构性心脏病室速导管消融的心外膜方法路线图:三级中心 10 年经验的结果。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 Epub Date: 2024-06-05 DOI: 10.1161/CIRCEP.123.012181
Caterina Bisceglia, Luca R Limite, Francesca Baratto, Giuseppe D'Angelo, Manuela Cireddu, Paolo Della Bella

Background: Epicardial approach in ventricular tachycardia (VT) ablation is still regarded as a second-step strategy, due to the risk of complications. We evaluated the frequency that epicardial ablation targets were identified and ablation performed following pericardial access compared with unnecessary pericardial access for different VT causes and potential markers of epicardial VT.

Methods: All VT ablation procedures including epicardial approach over a 10-year period were included. First-line epicardial approach was indicated in arrhythmogenic right ventricular cardiomyopathy (ARVC) and postmyocarditis VT; in patients with idiopathic dilated cardiomyopathy (IDCM) and postmyocardial infarction, indications resulted from available imaging techniques or 12-lead VT morphology. The epicardial approach was considered useful if epicardial ablation was performed after epicardial mapping. Feasibility, complications, and long-term outcome were reported.

Results: Four hundred and eighty-eight subjects with a median age of 60 years (interquartile range, 47-65) and of left ventricle ejection fraction 41% (interquartile range, 30-55) underwent 626 epicardial VT ablations. Percutaneous access had a success rate of 92.2% and a complication rate of 3.6%. Overall, epicardial approach was, respectively, indicated to 11.8% of postmyocardial infarction patients, 49.5% in IDCM, 94% in myocarditis, and 90.7% in ARVC. Epicardial ablation at the first ablation attempt was performed in 9.3% of postmyocardial infarction patients, 28.8% in IDCM, 86.5% in myocarditis, and 81.3% in patients with ARVC. In first-line epicardial group, ARVC and myocarditis showed the highest odds for epicardial ablation (OR, 4.057 [95% CI, 1.299-8.937]; P=0.007; OR, 3.971 [95% CI, 1.376-11.465]; P=0.005, respectively). IDCM independently predicted unnecessary epicardial approach (OR, 2.7 [95% CI, 1.7-4.3]; P<0.001). After a follow-up of 41 months (interquartile range, 19-64), patients with IDCM experienced higher rate of recurrences and mortality compared with other causes.

Conclusions: Epicardial approach is integral part of ablation armamentarium regardless of the VT cause, with high feasibility and low complication rate in experienced centers. Our data support its use at first ablation attempt in VTs related to ARVC and myocarditis.

背景:由于存在并发症风险,心外膜入路消融室性心动过速(VT)仍被视为第二步策略。我们评估了针对不同的 VT 病因和心外膜 VT 的潜在标记物,心外膜入路与不必要的心外膜入路相比,确定心外膜消融目标并进行消融的频率:方法:纳入 10 年内所有包括心外膜入路在内的 VT 消融手术。一线心外膜入路适用于心律失常性右室心肌病(ARVC)和心肌炎后 VT;特发性扩张型心肌病(IDCM)和心肌梗死后患者的适应症取决于现有的成像技术或 12 导联 VT 形态学。如果在心外膜测图后进行了心外膜消融,则认为心外膜方法是有用的。报告包括可行性、并发症和长期疗效:488 名受试者的中位年龄为 60 岁(四分位间范围为 47-65),左室射血分数为 41%(四分位间范围为 30-55),接受了 626 次心外膜 VT 消融术。经皮入路的成功率为 92.2%,并发症发生率为 3.6%。总体而言,心外膜入路分别适用于 11.8% 的心肌梗死后患者、49.5% 的 IDCM 患者、94% 的心肌炎患者和 90.7% 的 ARVC 患者。9.3% 的心肌梗死后患者、28.8% 的 IDCM 患者、86.5% 的心肌炎患者和 81.3% 的 ARVC 患者在首次消融尝试中进行了心外膜消融。在一线心外膜组中,ARVC 和心肌炎患者进行心外膜消融的几率最高(OR,4.057 [95% CI,1.299-8.937];P=0.007;OR,3.971 [95% CI,1.376-11.465];P=0.005)。IDCM可独立预测不必要的心外膜入路(OR,2.7 [95% CI,1.7-4.3];PC结论:无论 VT 起因如何,心外膜入路都是消融术中不可或缺的一部分,在经验丰富的中心具有很高的可行性和较低的并发症发生率。我们的数据支持在与 ARVC 和心肌炎相关的 VT 首次消融尝试中使用该方法。
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引用次数: 0
Rate Versus Rhythm Control for Atrial Fibrillation: The Epilogue of the Tale of Two Rhythms. 心房颤动的心率控制与心律控制:两种节律的故事》尾声。
IF 8.4 1区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.1161/CIRCEP.124.012988
Sana M Al-Khatib, Kevin P Jackson
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引用次数: 0
Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study. 主动性心律失常模式:ICD电击的新预测指标--来自 PARTITA 研究的子分析。
IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-01 DOI: 10.1161/CIRCEP.123.012523
Andrea Radinovic, Daniele Giacopelli, Caterina Bisceglia, Gabriele Paglino, Alessio Gargaro, Paolo Della Bella

Background: In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events.

Methods: We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization.

Results: Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; P=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; P<0.001) for patients with an active arrhythmia pattern compared with those without ATPs.

Conclusions: Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.

背景:在 PARTITA 试验(室性心动过速消融时机会影响植入式心律转复除颤器患者的预后吗?第一次电击后对室速进行导管消融可降低死亡或心衰恶化的风险。目前尚不清楚在 ICD 电击前需要进行消融手术的 ATP 临界值。我们的目的是确定可预测电击和心血管事件发生的 ATP 临界值和临床特征:我们分析了 PARTITA 研究 A 阶段 517 名患者的数据。我们使用分类和回归树分析法开发并测试了一个基于心律失常模式和临床数据的风险分层模型,以预测 ICD 震荡。次要终点是心衰恶化和心血管住院:结果:分类和回归树根据电击概率的增加将患者分为 6 叶。6个月内接受过≥5次ATP治疗的患者(活动性心律失常模式)发生ICD电击的风险最高(训练样本和测试样本分别为93%和86%)。无 ATP 患者的风险最低(1% 和 2%)。其他预测因素包括左心室射血分数(P=0.006)和心血管住院(危险比为 7.29 [95% CI, 3.66-14.5];PC结论:心律失常模式活跃(6 个月内≥5 次 ATP)的患者发生 ICD 电击、心衰住院和心血管住院的风险增加。这些数据表明,作为一种降低重大事件发生率的预防策略,额外的治疗可能会对这一高风险人群有所帮助。还需要进一步的前瞻性随机试验来证实早期室性心动过速消融术在这种情况下的益处。
{"title":"Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study.","authors":"Andrea Radinovic, Daniele Giacopelli, Caterina Bisceglia, Gabriele Paglino, Alessio Gargaro, Paolo Della Bella","doi":"10.1161/CIRCEP.123.012523","DOIUrl":"10.1161/CIRCEP.123.012523","url":null,"abstract":"<p><strong>Background: </strong>In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events.</p><p><strong>Methods: </strong>We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization.</p><p><strong>Results: </strong>Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; <i>P</i>=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; <i>P</i><0.001) for patients with an active arrhythmia pattern compared with those without ATPs.</p><p><strong>Conclusions: </strong>Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Women Trainees in Electrophysiology and the Effect of Role Models. 电生理学女学员和榜样的影响。
IF 9.1 1区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-28 DOI: 10.1161/CIRCEP.123.012577
Tina Baykaner, Shana Greif, Ramya S Vajapey, Christine M Albert, Zaid Aziz, Nitish Badhwar, T Jared Bunch, Jim W Cheung, Jonathan Chrispin, Mina K Chung, Paul Clopton, Daniel H Cooper, Joshua M Cooper, Alexandru Costea, Henry D Huang, Jodie L Hurwitz, Lior Jankelson, Ridhima Kapoor, Anne Kroman, Rakesh Latchamsetty, Jackson J Liang, Moussa Mansour, Nassir F Marrouche, Faisal M Merchant, John M Miller, Stavros Mountantonakis, Jonathan P Piccini, Andrea M Russo, Benjamin A Steinberg, Usha Tedrow, Wendy S Tzou, Elaine Y Wan, Paul J Wang, Janet K Han
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引用次数: 0
期刊
Circulation. Arrhythmia and electrophysiology
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