Pub Date : 2024-09-18DOI: 10.1016/j.hrthm.2024.09.036
Miloud Cherbi, Léa Benabou, Maxime Faure, Matteo Pozzi, Estelle Gandjbakhch, Shaida Varnous, Karim Benali, Redwane Rakza, Raphael P Martins, Clément Delmas, Philippe Maury
{"title":"What happens to patients awaiting urgent transplantation for refractory electrical storm when they are not transplanted?","authors":"Miloud Cherbi, Léa Benabou, Maxime Faure, Matteo Pozzi, Estelle Gandjbakhch, Shaida Varnous, Karim Benali, Redwane Rakza, Raphael P Martins, Clément Delmas, Philippe Maury","doi":"10.1016/j.hrthm.2024.09.036","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.036","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.hrthm.2024.09.029
Haran Yogasundaram, Muralidhar Reddy Papireddy, Saman Nazarian, Gustavo S Guandalini, Timothy M Markman, Robert D Schaller, Michael P Riley, David Lin, Sanjay Dixit, Benjamin D'Souza, Ramanan Kumareswaran, David J Callans, David S Frankel, Fermin C Garcia, Erica Zado, Rajat Deo, Andrew E Epstein, Gregory E Supple, Francis E Marchlinski, Matthew C Hyman
Background: Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter requires ablation of the tricuspid annulus overlying the right coronary artery (RCA). While considered safe, reports of acute and subacute RCA injury in human and animal studies raise the possibility of late RCA stenosis.
Objective: To compare the incidence and severity of angiographic RCA stenoses in patients who have undergone CTI RFA to a control group to assess the long-term risk of RCA damage.
Methods: A two-center retrospective case-cohort study was performed including all patients from 2002-2018 undergoing atrial fibrillation (AF) with CTI ablation (CTI+AF) or AF ablation alone with subsequent coronary angiography (CAG). The AF alone group served as controls due to anticipated similarity of baseline characteristics. Coronary arteries that are anatomically remote to the CTI were examined as prespecified falsification endpoints. CAG was scored by a blinded observer.
Results: 156 patients who underwent PVI with subsequent CAG (CTI+AF, n=81; AF alone, n=75) had no difference in baseline characteristics including age, sex, comorbidities, and medications. Mean time from ablation to CAG was similar (CTI+AF 5.0±3.7 years vs AF alone 5.4 ±3.9 years, p=0.5). The mid and distal RCA showed no difference in the average number of angiographic stenoses or lesion severity. In regression analysis, CTI ablation was not a predictor of RCA stenosis severity (p=0.6). There was no difference in coronary disease at sites remote to the CTI ablation (p=NS for all).
Conclusion: There was no observed relationship between CTI RFA and the number or severity of angiographically apparent RCA stenoses in long-term follow up.
{"title":"Long-term Risk of Right Coronary Artery Injury Following Catheter Ablation of Cavotricuspid Isthmus-dependent Flutter.","authors":"Haran Yogasundaram, Muralidhar Reddy Papireddy, Saman Nazarian, Gustavo S Guandalini, Timothy M Markman, Robert D Schaller, Michael P Riley, David Lin, Sanjay Dixit, Benjamin D'Souza, Ramanan Kumareswaran, David J Callans, David S Frankel, Fermin C Garcia, Erica Zado, Rajat Deo, Andrew E Epstein, Gregory E Supple, Francis E Marchlinski, Matthew C Hyman","doi":"10.1016/j.hrthm.2024.09.029","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.029","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter requires ablation of the tricuspid annulus overlying the right coronary artery (RCA). While considered safe, reports of acute and subacute RCA injury in human and animal studies raise the possibility of late RCA stenosis.</p><p><strong>Objective: </strong>To compare the incidence and severity of angiographic RCA stenoses in patients who have undergone CTI RFA to a control group to assess the long-term risk of RCA damage.</p><p><strong>Methods: </strong>A two-center retrospective case-cohort study was performed including all patients from 2002-2018 undergoing atrial fibrillation (AF) with CTI ablation (CTI+AF) or AF ablation alone with subsequent coronary angiography (CAG). The AF alone group served as controls due to anticipated similarity of baseline characteristics. Coronary arteries that are anatomically remote to the CTI were examined as prespecified falsification endpoints. CAG was scored by a blinded observer.</p><p><strong>Results: </strong>156 patients who underwent PVI with subsequent CAG (CTI+AF, n=81; AF alone, n=75) had no difference in baseline characteristics including age, sex, comorbidities, and medications. Mean time from ablation to CAG was similar (CTI+AF 5.0±3.7 years vs AF alone 5.4 ±3.9 years, p=0.5). The mid and distal RCA showed no difference in the average number of angiographic stenoses or lesion severity. In regression analysis, CTI ablation was not a predictor of RCA stenosis severity (p=0.6). There was no difference in coronary disease at sites remote to the CTI ablation (p=NS for all).</p><p><strong>Conclusion: </strong>There was no observed relationship between CTI RFA and the number or severity of angiographically apparent RCA stenoses in long-term follow up.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.hrthm.2024.09.032
Kei Honde, Yu Izawa, Takayoshi Toba, Hiromi Hashimura, Kyle Adlaka, Toshio Makita, Koji Fukuzawa, Ken-Ichi Hirata, Shumpei Mori
Background: Hemothorax caused by a right intercostal artery (ICA) injury behind the left atrium (LA) is a potentially fatal complication during pulmonary vein isolation. However, their anatomical relationship has not been fully elucidated.
Objective: This study aimed to investigate the clinical anatomy of the right ICA in relation to the LA.
Methods: This retrospective study included 100 patients (70.2 ± 10.6 years, 39.0% female) who underwent cardiac computed tomography. The patients were divided into sinus rhythm (SR) and atrial fibrillation (AF) groups. We focused on the distance between the LA and right ICAs and its predictive factors.
Results: On average, 3.7 ± 0.7 right ICAs were found behind the LA. Among these, the eighth ICA was the closest in 54% of the cases, followed by the seventh ICA in 29%, and the ninth ICA in 14%. The average closest distance between them was 3.8 ± 3.8 mm, which was significantly shorter in the AF group than in the SR group (3.0 ± 3.2 mm vs. 4.7 ± 4.2 mm, p = 0.006). Multivariate analysis revealed that a thinner chest cavity (β = -0.512, p = 0.002) and LA dilatation (β = -0.432, p = 0.001) were predictors of shorter distance. The closest points distributed along the vertebral column, generally near the inferior pulmonary vein orifices.
Conclusions: Right ICA-LA proximity was systematically clarified. Particularly in cases with an enlarged LA and/or thin chest cavity, operators should be aware of the potential risk of injuring the right ICA during pulmonary vein isolation.
背景:左心房(LA)后方的右肋间动脉(ICA)损伤导致的血胸是肺静脉隔离术中潜在的致命并发症。然而,它们之间的解剖关系尚未完全阐明:本研究旨在探讨右侧 ICA 与 LA 的临床解剖关系:这项回顾性研究纳入了 100 名接受心脏计算机断层扫描的患者(70.2 ± 10.6 岁,39.0% 为女性)。患者被分为窦性心律(SR)组和心房颤动(AF)组。我们重点研究了 LA 和右 ICAs 之间的距离及其预测因素:结果:平均有 3.7 ± 0.7 个右侧 ICAs 位于 LA 后方。其中,54%的病例中第八ICA距离最近,其次是29%的病例中第七ICA距离最近,14%的病例中第九ICA距离最近。它们之间的平均最近距离为 3.8 ± 3.8 毫米,房颤组明显短于 SR 组(3.0 ± 3.2 毫米 vs. 4.7 ± 4.2 毫米,P = 0.006)。多变量分析显示,较薄的胸腔(β = -0.512,p = 0.002)和 LA 扩张(β = -0.432,p = 0.001)是预测较短距离的因素。最近的点沿椎体分布,一般靠近下肺静脉口:结论:右侧 ICA-LA 近距离得到了系统性的明确。特别是在 LA 扩大和/或胸腔较薄的病例中,操作者应注意在肺静脉分离过程中损伤右 ICA 的潜在风险。
{"title":"Clinical anatomy of the right intercostal arteries: Another neighbor to know before pulmonary vein isolation.","authors":"Kei Honde, Yu Izawa, Takayoshi Toba, Hiromi Hashimura, Kyle Adlaka, Toshio Makita, Koji Fukuzawa, Ken-Ichi Hirata, Shumpei Mori","doi":"10.1016/j.hrthm.2024.09.032","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.032","url":null,"abstract":"<p><strong>Background: </strong>Hemothorax caused by a right intercostal artery (ICA) injury behind the left atrium (LA) is a potentially fatal complication during pulmonary vein isolation. However, their anatomical relationship has not been fully elucidated.</p><p><strong>Objective: </strong>This study aimed to investigate the clinical anatomy of the right ICA in relation to the LA.</p><p><strong>Methods: </strong>This retrospective study included 100 patients (70.2 ± 10.6 years, 39.0% female) who underwent cardiac computed tomography. The patients were divided into sinus rhythm (SR) and atrial fibrillation (AF) groups. We focused on the distance between the LA and right ICAs and its predictive factors.</p><p><strong>Results: </strong>On average, 3.7 ± 0.7 right ICAs were found behind the LA. Among these, the eighth ICA was the closest in 54% of the cases, followed by the seventh ICA in 29%, and the ninth ICA in 14%. The average closest distance between them was 3.8 ± 3.8 mm, which was significantly shorter in the AF group than in the SR group (3.0 ± 3.2 mm vs. 4.7 ± 4.2 mm, p = 0.006). Multivariate analysis revealed that a thinner chest cavity (β = -0.512, p = 0.002) and LA dilatation (β = -0.432, p = 0.001) were predictors of shorter distance. The closest points distributed along the vertebral column, generally near the inferior pulmonary vein orifices.</p><p><strong>Conclusions: </strong>Right ICA-LA proximity was systematically clarified. Particularly in cases with an enlarged LA and/or thin chest cavity, operators should be aware of the potential risk of injuring the right ICA during pulmonary vein isolation.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1016/j.hrthm.2024.09.031
Patricia Poels, Jonas Vermeulen, Boukje Hoekman, Alexander Dorrestijn, Rik Willems, Bert Vandenberk
{"title":"Implantable Cardioverter-Defibrillator Therapies during Sexual Activities - Rare but Fearsome.","authors":"Patricia Poels, Jonas Vermeulen, Boukje Hoekman, Alexander Dorrestijn, Rik Willems, Bert Vandenberk","doi":"10.1016/j.hrthm.2024.09.031","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.031","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends in Alcohol Consumption among Adults with Presumed Atrial Fibrillation in the United States, 2001 to 2018.","authors":"Alyssa J Shepherd, Cancan Zhang, Gregory M Marcus, Kenneth J Mukamal","doi":"10.1016/j.hrthm.2024.09.033","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.033","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acutely effective repeat radiofrequency catheter ablation (RFCA) after previous atrial fibrillation ablation depends on several parameters including local impedance (LI), contact force (CF) and power.
Objective: To investigate the relationship of LI, CF and power to the LI drop in a repeat atrial RFCA environment.
Methods: Consecutive patients undergoing repeat atrial RFCA were studied. High-quality local electrograms (EGMs) were analyzed regarding morphology changes indicating effective RFCA and associated LI dynamics. The influence of baseline LI, mean CF and power on the LI drop was analyzed. Investigated power levels included ≤25 W, 30 W and ≥40 W.
Results: 1390 RFCA points from 48 patients (48 % female, median age 70 years) were analyzed. 40.5% of 309 analyzed EGMs showed effective RFCA morphology changes with a higher median LI drop (effective 19.7 Ω vs partially effective 14.1 Ω, p<0.001). CF showed the highest correlation to the LI drop within high baseline LI and when applying ≥40 W (low baseline LI, R=0.39; intermediate, R=0.66; high, R=0.72). Within low baseline LI regions, CF levels showed a lower correlation to the LI drop (≤25 W, R=0.30; 30 W, R=0.35; ≥40 W, R=0.39). A mean CF ≥10 g resulted in elevated LI drops with higher power compared to lower power within all baseline LI tertiles (p<0.001 each).
Conclusion: Within rather high baseline LI regions, CF plays a greater role for the maximum LI drop when higher power is chosen. A mean CF ≥10 g ensures increased LI drops with increasing power levels.
背景:既往心房颤动消融术后重复射频导管消融术(RFCA)的急性有效取决于几个参数,包括局部阻抗(LI)、接触力(CF)和功率:研究重复心房 RFCA 环境中 LI、CF 和功率与 LI 下降的关系:方法:对接受重复心房 RFCA 的连续患者进行研究。对高质量的局部电图(EGM)进行分析,了解表明有效 RFCA 的形态变化和相关 LI 动态变化。分析了基线 LI、平均 CF 和功率对 LI 下降的影响。研究的功率水平包括≤25 W、30 W和≥40 W:分析了 48 名患者(48% 为女性,中位年龄为 70 岁)的 1390 个 RFCA 点。在分析的 309 个 EGM 中,40.5% 显示出有效的 RFCA 形态变化,中位 LI 下降幅度较大(有效为 19.7 Ω,部分有效为 14.1 Ω,p):在基线 LI 相当高的区域内,当选择更高功率时,CF 对最大 LI 下降的作用更大。平均 CF ≥10 g 可确保随着功率水平的增加,LI 下降幅度增大。
{"title":"Interactions of contact force, impedance and power during repeat atrial arrhythmia ablation after previous atrial fibrillation ablation.","authors":"Fares-Alexander Alken, Katharina Scherschel, Ernan Zhu, Bahram Wafaisade, Ann-Kathrin Kahle, Christian Meyer","doi":"10.1016/j.hrthm.2024.09.026","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.026","url":null,"abstract":"<p><strong>Background: </strong>Acutely effective repeat radiofrequency catheter ablation (RFCA) after previous atrial fibrillation ablation depends on several parameters including local impedance (LI), contact force (CF) and power.</p><p><strong>Objective: </strong>To investigate the relationship of LI, CF and power to the LI drop in a repeat atrial RFCA environment.</p><p><strong>Methods: </strong>Consecutive patients undergoing repeat atrial RFCA were studied. High-quality local electrograms (EGMs) were analyzed regarding morphology changes indicating effective RFCA and associated LI dynamics. The influence of baseline LI, mean CF and power on the LI drop was analyzed. Investigated power levels included ≤25 W, 30 W and ≥40 W.</p><p><strong>Results: </strong>1390 RFCA points from 48 patients (48 % female, median age 70 years) were analyzed. 40.5% of 309 analyzed EGMs showed effective RFCA morphology changes with a higher median LI drop (effective 19.7 Ω vs partially effective 14.1 Ω, p<0.001). CF showed the highest correlation to the LI drop within high baseline LI and when applying ≥40 W (low baseline LI, R=0.39; intermediate, R=0.66; high, R=0.72). Within low baseline LI regions, CF levels showed a lower correlation to the LI drop (≤25 W, R=0.30; 30 W, R=0.35; ≥40 W, R=0.39). A mean CF ≥10 g resulted in elevated LI drops with higher power compared to lower power within all baseline LI tertiles (p<0.001 each).</p><p><strong>Conclusion: </strong>Within rather high baseline LI regions, CF plays a greater role for the maximum LI drop when higher power is chosen. A mean CF ≥10 g ensures increased LI drops with increasing power levels.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Risk stratification in patients with Brugada syndrome (BrS) is challenging, especially in those at intermediate risk. The Predicting Arrhythmic evenT (PAT) score has recently been demonstrated to be excellent for predicting future arrhythmic events in patients without prior ventricular fibrillation (VF). However, validation studies are lacking.
Objective: This study aimed to assess the performance of a novel risk stratification model in predicting future VF events in patients with BrS in a Japanese multicenter cohort.
Methods: The PAT score was calculated for 413 patients with BrS (mean age, 50.9±13.6 years; 395 men) from 59 hospitals in Japan, including 314 patients without prior VF. The incidence of developing VF during the follow-up period was investigated.
Results: During the 106.8-month follow-up period, 54 patients (13.1%) experienced VF events. Of the 314 patients without prior VF at enrollment, 14 (4.5%) experienced VF events. The incidence of VF events during the follow-up period was significantly higher in patients with PAT scores ≥10 than in those with scores <10 (41/173 [23.7%] vs. 13/240 [5.4%], p<0.0001) in the total cohort. No difference was observed in the incidence of VF events between patients with PAT scores ≥10 and <10 among the 314 patients without prior VF (6/86 [7.0%] vs. 8/228 [3.5%], p=0.22). PAT scores ≥10 predicted future VF events with a sensitivity and specificity of 42.9% and 73.3%, respectively.
Conclusion: This Japanese multicenter registry demonstrated that the novel risk stratification model could not accurately predict future VF events in patients with BrS, but without prior VF.
{"title":"Validation of Novel Risk Prediction Models in Patients with Brugada Syndrome: A Multicenter Study in Japan.","authors":"Tsukasa Kamakura, Masahiko Takagi, Yuki Komatsu, Tetsuji Shinohara, Yoshiyasu Aizawa, Yukio Sekiguchi, Yasuhiro Yokoyama, Naohiko Aihara, Masayasu Hiraoka, Kazutaka Aonuma","doi":"10.1016/j.hrthm.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.024","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification in patients with Brugada syndrome (BrS) is challenging, especially in those at intermediate risk. The Predicting Arrhythmic evenT (PAT) score has recently been demonstrated to be excellent for predicting future arrhythmic events in patients without prior ventricular fibrillation (VF). However, validation studies are lacking.</p><p><strong>Objective: </strong>This study aimed to assess the performance of a novel risk stratification model in predicting future VF events in patients with BrS in a Japanese multicenter cohort.</p><p><strong>Methods: </strong>The PAT score was calculated for 413 patients with BrS (mean age, 50.9±13.6 years; 395 men) from 59 hospitals in Japan, including 314 patients without prior VF. The incidence of developing VF during the follow-up period was investigated.</p><p><strong>Results: </strong>During the 106.8-month follow-up period, 54 patients (13.1%) experienced VF events. Of the 314 patients without prior VF at enrollment, 14 (4.5%) experienced VF events. The incidence of VF events during the follow-up period was significantly higher in patients with PAT scores ≥10 than in those with scores <10 (41/173 [23.7%] vs. 13/240 [5.4%], p<0.0001) in the total cohort. No difference was observed in the incidence of VF events between patients with PAT scores ≥10 and <10 among the 314 patients without prior VF (6/86 [7.0%] vs. 8/228 [3.5%], p=0.22). PAT scores ≥10 predicted future VF events with a sensitivity and specificity of 42.9% and 73.3%, respectively.</p><p><strong>Conclusion: </strong>This Japanese multicenter registry demonstrated that the novel risk stratification model could not accurately predict future VF events in patients with BrS, but without prior VF.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1016/j.hrthm.2024.09.021
Xi Wang, Yuanning Xu, Lijun Zeng, Kun Tan, Xueli Zhang, Xu Han, Tianyuan Xiong, Zhengang Zhao, Yong Peng, Jiafu Wei, Qiao Li, Sen He, Yong Chen, Minggang Zhou, Xi Li, Xin Wei, Yujia Liang, Wenxia Zhou, Lingyun Jiang, Xingbin Liu, Wei Meng, Rui Zhou, Guojun Xiong, Min Dai, Xiaojian Deng, Yuan Feng, Mao Chen
Background: New-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI) with adverse clinical outcomes.
Objective: To investigate whether left bundle branch area pacing (LBBAP) improves long-term clinical results compared to traditional right ventricular pacing (RVP) in patients requiring PPMI following TAVI.
Methods: A total of 237 consecutive patients undergoing RVP (N=117) or LBBAP (N=120) following TAVI were retrospectively included. Long-term outcomes including all-cause death, heart failure rehospitalization (HFH) and left ventricular ejection fraction (LVEF) change compared to baseline were obtained until 5 years post-TAVI.
Results: The mean age of the overall population was 74 years with a mean surgical risk score as 4.4%. The paced QRS duration was significantly longer in RVP group compared to LBBAP group (151 ± 18 vs. 122 ± 12 ms, P<0.001). There was no difference between two groups in all-cause death (13.7% vs. 13.3%, adjusted HR: 0.76; 95% CI: 0.37 to 1.58; P=0.466) or the composite endpoint of death and HFH (29.9% vs. 19.2%, adjusted HR: 1.22; 95% CI: 0.70 to 2.13; P=0.476), however, the risk of HFH was significantly higher in RVP group at 5 years after TAVI (21.4% vs. 7.5%, adjusted HR: 2.26; 95% CI: 1.01 to 5.08; P=0.048). There was a greater improvement of LVEF over time in LBBAP group (P=0.046 for LVEF changes over time between groups).
Conclusions: LBBAP improved long-term clinical outcomes compared to RVP in patients undergoing PPMI after TAVI in terms of less HFH and better LVEF improvement.
背景:新发永久性起搏器植入术(PPMI)仍是经导管主动脉瓣植入术(TAVI)后的常见并发症,会带来不良的临床结果:与传统的右室起搏(RVP)相比,左束支区起搏(LBBAP)是否能改善TAVI术后需要PPMI患者的长期临床效果:回顾性纳入了237例在TAVI术后接受RVP(117例)或LBBAP(120例)治疗的连续患者。研究结果显示,TAVI术后5年前的长期结果包括全因死亡、心衰再住院(HFH)和左室射血分数(LVEF)与基线相比的变化:所有患者的平均年龄为74岁,平均手术风险评分为4.4%。与LBBAP组相比,RVP组的起搏QRS持续时间明显更长(151 ± 18 vs. 122 ± 12 ms):与RVP相比,LBBAP可改善TAVI术后PPMI患者的长期临床预后,减少HFH,改善LVEF。
{"title":"Long-term outcomes of left bundle branch area pacing compared to right ventricular pacing in TAVI patients.","authors":"Xi Wang, Yuanning Xu, Lijun Zeng, Kun Tan, Xueli Zhang, Xu Han, Tianyuan Xiong, Zhengang Zhao, Yong Peng, Jiafu Wei, Qiao Li, Sen He, Yong Chen, Minggang Zhou, Xi Li, Xin Wei, Yujia Liang, Wenxia Zhou, Lingyun Jiang, Xingbin Liu, Wei Meng, Rui Zhou, Guojun Xiong, Min Dai, Xiaojian Deng, Yuan Feng, Mao Chen","doi":"10.1016/j.hrthm.2024.09.021","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.021","url":null,"abstract":"<p><strong>Background: </strong>New-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI) with adverse clinical outcomes.</p><p><strong>Objective: </strong>To investigate whether left bundle branch area pacing (LBBAP) improves long-term clinical results compared to traditional right ventricular pacing (RVP) in patients requiring PPMI following TAVI.</p><p><strong>Methods: </strong>A total of 237 consecutive patients undergoing RVP (N=117) or LBBAP (N=120) following TAVI were retrospectively included. Long-term outcomes including all-cause death, heart failure rehospitalization (HFH) and left ventricular ejection fraction (LVEF) change compared to baseline were obtained until 5 years post-TAVI.</p><p><strong>Results: </strong>The mean age of the overall population was 74 years with a mean surgical risk score as 4.4%. The paced QRS duration was significantly longer in RVP group compared to LBBAP group (151 ± 18 vs. 122 ± 12 ms, P<0.001). There was no difference between two groups in all-cause death (13.7% vs. 13.3%, adjusted HR: 0.76; 95% CI: 0.37 to 1.58; P=0.466) or the composite endpoint of death and HFH (29.9% vs. 19.2%, adjusted HR: 1.22; 95% CI: 0.70 to 2.13; P=0.476), however, the risk of HFH was significantly higher in RVP group at 5 years after TAVI (21.4% vs. 7.5%, adjusted HR: 2.26; 95% CI: 1.01 to 5.08; P=0.048). There was a greater improvement of LVEF over time in LBBAP group (P=0.046 for LVEF changes over time between groups).</p><p><strong>Conclusions: </strong>LBBAP improved long-term clinical outcomes compared to RVP in patients undergoing PPMI after TAVI in terms of less HFH and better LVEF improvement.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.hrthm.2024.09.020
Borislav Dinov, Carsten Henfling, Hans Ebbinghaus, Konrad Latuscynski, Ingo Paetsch, Cosima Jahnke, Samuel Sossalla, Ulrich Laufs, Laura Ueberham
Background: Atrioventricular block (AVB) is a frequent initial presentation of cardiac sarcoidosis (CS), but dangerous ventricular arrhythmias (VA) can occur. Despite the scarcity of data, guidelines recommend ICD rather than a pacemaker implantation whenever a device is needed.
Objective: In this study, we aimed to establish predictors for sustained VA in patients with CS presenting with pacing indication due to an AVB.
Methods: We prospectively enrolled 112 patients with CS. Excluding those with VA, 82 patients remained and were divided into 2 groups: 34 individuals with AVB as initial presentation and 48 with other symptoms as first presentation (OSF). Both groups were compared for clinical characteristics, rates of VA, LVAD implantation, heart transplantation and mortality.
Results: During follow-up, VA was detected in 50% in the AVB and 10.4% in the OSF group; P = 0.001. Death, LVAD implantation, heart transplantation occurred in 11.8% in AVB vs. 10.4% in the OSF; P = 0.847. Late gadolinium enhancement (LGE) was equally observed in both groups: 70% vs. 70.5%; P = 0.966, whereas more patients in the AVB group exhibited abnormal PET uptake: 86.2% vs. 54.3%; P = 0.007. In multivariate analysis, AVB (HR 25.15), RV LGE in CMR (HR 7.39) were predictors for VA occurrence, whereas the use of immunosuppressive therapy was associated with less VA (HR 4.3).
Conclusions: Patients with CS presenting with AVB have a high risk of sustained VA. Although immunosuppressive drugs may reduce the occurrence of VA, ICD implantation is reasonable, especially in case of right ventricular LGE.
背景:房室传导阻滞(AVB)是心脏肉瘤病(CS)的常见首发症状,但也可能发生危险的室性心律失常(VA)。尽管数据稀少,但指南仍建议在需要时植入 ICD 而不是起搏器:在这项研究中,我们旨在确定因房室传导阻滞而出现起搏指征的 CS 患者持续 VA 的预测因素:我们前瞻性地招募了 112 名 CS 患者。方法:我们前瞻性地招募了 112 名 CS 患者,剔除有 VA 的患者后,剩下 82 名患者被分为两组:34 名以房室传导阻滞为首发症状,48 名以其他症状为首发症状(OSF)。两组患者的临床特征、VA发生率、LVAD植入率、心脏移植率和死亡率进行了比较:结果:在随访期间,50%的AVB组和10.4%的OSF组发现了VA;P = 0.001。AVB 组有 11.8%的患者死亡、植入 LVAD 或接受心脏移植;OSF 组有 10.4%的患者死亡、植入 LVAD 或接受心脏移植;P = 0.847。两组患者均观察到晚期钆增强(LGE):70% vs. 70.5%;P = 0.966,而 AVB 组患者 PET 摄取异常的比例更高:86.2% vs. 54.3%;P = 0.007。在多变量分析中,AVB(HR 25.15)和CMR中的RV LGE(HR 7.39)是VA发生的预测因素,而使用免疫抑制剂治疗与较少的VA有关(HR 4.3):结论:伴有 AVB 的 CS 患者发生持续 VA 的风险很高。尽管免疫抑制剂可减少 VA 的发生,但植入 ICD 是合理的,尤其是在右心室 LGE 的情况下。
{"title":"Rates and predictors for sustained ventricular tachycardia in patients with cardiac sarcoidosis and AV block as first cardiac presentation: implications for device implantation.","authors":"Borislav Dinov, Carsten Henfling, Hans Ebbinghaus, Konrad Latuscynski, Ingo Paetsch, Cosima Jahnke, Samuel Sossalla, Ulrich Laufs, Laura Ueberham","doi":"10.1016/j.hrthm.2024.09.020","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.020","url":null,"abstract":"<p><strong>Background: </strong>Atrioventricular block (AVB) is a frequent initial presentation of cardiac sarcoidosis (CS), but dangerous ventricular arrhythmias (VA) can occur. Despite the scarcity of data, guidelines recommend ICD rather than a pacemaker implantation whenever a device is needed.</p><p><strong>Objective: </strong>In this study, we aimed to establish predictors for sustained VA in patients with CS presenting with pacing indication due to an AVB.</p><p><strong>Methods: </strong>We prospectively enrolled 112 patients with CS. Excluding those with VA, 82 patients remained and were divided into 2 groups: 34 individuals with AVB as initial presentation and 48 with other symptoms as first presentation (OSF). Both groups were compared for clinical characteristics, rates of VA, LVAD implantation, heart transplantation and mortality.</p><p><strong>Results: </strong>During follow-up, VA was detected in 50% in the AVB and 10.4% in the OSF group; P = 0.001. Death, LVAD implantation, heart transplantation occurred in 11.8% in AVB vs. 10.4% in the OSF; P = 0.847. Late gadolinium enhancement (LGE) was equally observed in both groups: 70% vs. 70.5%; P = 0.966, whereas more patients in the AVB group exhibited abnormal PET uptake: 86.2% vs. 54.3%; P = 0.007. In multivariate analysis, AVB (HR 25.15), RV LGE in CMR (HR 7.39) were predictors for VA occurrence, whereas the use of immunosuppressive therapy was associated with less VA (HR 4.3).</p><p><strong>Conclusions: </strong>Patients with CS presenting with AVB have a high risk of sustained VA. Although immunosuppressive drugs may reduce the occurrence of VA, ICD implantation is reasonable, especially in case of right ventricular LGE.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.hrthm.2024.09.022
Shaojie Chen, Nan Wu, Yike Zhang, Zhiqiao Lin, Jiuzhou Chen, Huiyuan Qin, Hongwu Chen, Chang Cui, Gang Yang, Minglong Chen
Background: Postmenopausal women with atrial fibrillation (AF) exhibit a higher level of atrial fibrosis and a higher recurrence rate after ablation compared to men. However, the underlying mechanism remains unclear.
Objective: To investigate the mechanism through which menopause promotes atrial fibrosis.
Methods: In a prospective cohort of women with AF, regression analyses were conducted to assess the relationship between low-voltage area (LVA) and sex hormone levels. CREM-IbΔC-X mice, a spontaneous AF model, underwent bilateral ovariectomy (OVX). Electrocardiograms, echocardiograms, and Masson staining were performed. FSH stimulation was applied in male mice for three months. OVX was also applied in an angiotensin II (Ang II) induced pressure overload mouse model, following programmed electrical stimulation and structural analyses. Bulk RNA sequencing (RNA-seq) was performed to elucidate potential mechanisms.
Results: Women demonstrated a significantly higher LVA burden than men (P<0.001). A positive correlation was observed between LVA burden and FSH level (P=0.002). Mice in the OVX group exhibited a significantly higher incidence of AF (P=0.040) and atrial fibrosis (P=0.021) compared to the Sham group, which could be attenuated by AAV-siFshr. In male CREM-IbΔC-X mice, FSH stimulation promoted the occurrence of AF (P=0.035) and atrial fibrosis (P=0.002). In Ang II-induced female mice, OVX prompted atrial fibrosis, increased AF inducibility, and shortened atrial effective refractory period, which could be attenuated with knockdown of Fshr. RNA-seq indicated mitochondrial dysfunction.
Conclusion: Postmenopausal women exhibited a higher LVA burden than men, which was positively correlated with FSH level. FSH promoted atrial fibrosis through oxidative stress.
{"title":"Follicle-stimulating hormone promotes atrial fibrosis in menopausal women with atrial fibrillation.","authors":"Shaojie Chen, Nan Wu, Yike Zhang, Zhiqiao Lin, Jiuzhou Chen, Huiyuan Qin, Hongwu Chen, Chang Cui, Gang Yang, Minglong Chen","doi":"10.1016/j.hrthm.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.hrthm.2024.09.022","url":null,"abstract":"<p><strong>Background: </strong>Postmenopausal women with atrial fibrillation (AF) exhibit a higher level of atrial fibrosis and a higher recurrence rate after ablation compared to men. However, the underlying mechanism remains unclear.</p><p><strong>Objective: </strong>To investigate the mechanism through which menopause promotes atrial fibrosis.</p><p><strong>Methods: </strong>In a prospective cohort of women with AF, regression analyses were conducted to assess the relationship between low-voltage area (LVA) and sex hormone levels. CREM-IbΔC-X mice, a spontaneous AF model, underwent bilateral ovariectomy (OVX). Electrocardiograms, echocardiograms, and Masson staining were performed. FSH stimulation was applied in male mice for three months. OVX was also applied in an angiotensin II (Ang II) induced pressure overload mouse model, following programmed electrical stimulation and structural analyses. Bulk RNA sequencing (RNA-seq) was performed to elucidate potential mechanisms.</p><p><strong>Results: </strong>Women demonstrated a significantly higher LVA burden than men (P<0.001). A positive correlation was observed between LVA burden and FSH level (P=0.002). Mice in the OVX group exhibited a significantly higher incidence of AF (P=0.040) and atrial fibrosis (P=0.021) compared to the Sham group, which could be attenuated by AAV-siFshr. In male CREM-IbΔC-X mice, FSH stimulation promoted the occurrence of AF (P=0.035) and atrial fibrosis (P=0.002). In Ang II-induced female mice, OVX prompted atrial fibrosis, increased AF inducibility, and shortened atrial effective refractory period, which could be attenuated with knockdown of Fshr. RNA-seq indicated mitochondrial dysfunction.</p><p><strong>Conclusion: </strong>Postmenopausal women exhibited a higher LVA burden than men, which was positively correlated with FSH level. FSH promoted atrial fibrosis through oxidative stress.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}