Pub Date : 2025-02-03DOI: 10.1016/j.hrthm.2025.01.040
Andrew D Krahn, Benjamin M Moore
{"title":"What Lies Beneath: Provoking the QT to Identify Risk in Long QT syndrome.","authors":"Andrew D Krahn, Benjamin M Moore","doi":"10.1016/j.hrthm.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.01.040","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255597","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 : 2025-02-03DOI: 10.1016/j.hrthm.2025.01.039
Corentin Chaumont, Adrian M Petzl, Cory M Tschabrunn, Alireza Oraii, Oriol Rodriguez-Queralto, Alan M Sugrue, Maiwand Mirwais, Timothy M Markman, Gregory E Supple, Matthew C Hyman, Saman Nazarian, David J Callans, Fermin C Garcia, David S Frankel, Frederic Anselme, Francis E Marchlinski
Background: The best approach for ablating ventricular tachycardia (VT) targeting right ventricular (RV) free wall aneurysms in arrhythmogenic right ventricular cardiomyopathy (ARVC) remains undefined.
Objective: We aimed to describe the technical approach, safety, and long-term efficacy of endocardial ablation of VT originating from RV free wall aneurysms in ARVC patients.
Methods: We identified ARVC patients with VT mapped to intracardiac echocardiography (ICE)-defined RV free wall aneurysms who underwent endocardial ablation targeting the aneurysmal area. RV free wall aneurysm on ICE was defined as an akinetic or dyskinetic area with diastolic bulging. The primary ablation end point was VT control, defined as freedom from any or multiple (>1) VT recurrences.
Results: From 2012 to 2023, 14 ARVC patients underwent endocardial VT ablation within ICE-defined RV free wall aneurysms. The median age at first arrhythmia event was 55.5 years (interquartile range [IQR], 32.3-59.8 years). Pathogenic genetic variants were identified in 82% of the patients. Ablation inside the RV aneurysms during ICE monitoring used prolonged radiofrequency applications (median, 111 seconds; IQR, 81-180 seconds), with power titrated up to 29 W (IQR, 29-33 W) to achieve 10%-15% impedance drops. No steam pops occurred. VT noninducibility was achieved in 86% with no complications. During median follow-up of 4.3 years (IQR, 3.1-6.0 years), the primary end point was achieved in 13 patients (93%): 10 VT free and 3 with a single episode of VT.
Conclusion: Endocardial ablation targeting VT from ICE-defined RV free wall aneurysms in ARVC patients using prolonged radiofrequency applications is safe and effective, precluding the need for adjunctive epicardial ablation. Patients with aneurysm-dependent VT were typically older and carried pathogenic genetic variants.
{"title":"Ablation of ventricular tachycardia from right ventricular aneurysms in patients with arrhythmogenic cardiomyopathy guided by intracardiac echocardiography.","authors":"Corentin Chaumont, Adrian M Petzl, Cory M Tschabrunn, Alireza Oraii, Oriol Rodriguez-Queralto, Alan M Sugrue, Maiwand Mirwais, Timothy M Markman, Gregory E Supple, Matthew C Hyman, Saman Nazarian, David J Callans, Fermin C Garcia, David S Frankel, Frederic Anselme, Francis E Marchlinski","doi":"10.1016/j.hrthm.2025.01.039","DOIUrl":"10.1016/j.hrthm.2025.01.039","url":null,"abstract":"<p><strong>Background: </strong>The best approach for ablating ventricular tachycardia (VT) targeting right ventricular (RV) free wall aneurysms in arrhythmogenic right ventricular cardiomyopathy (ARVC) remains undefined.</p><p><strong>Objective: </strong>We aimed to describe the technical approach, safety, and long-term efficacy of endocardial ablation of VT originating from RV free wall aneurysms in ARVC patients.</p><p><strong>Methods: </strong>We identified ARVC patients with VT mapped to intracardiac echocardiography (ICE)-defined RV free wall aneurysms who underwent endocardial ablation targeting the aneurysmal area. RV free wall aneurysm on ICE was defined as an akinetic or dyskinetic area with diastolic bulging. The primary ablation end point was VT control, defined as freedom from any or multiple (>1) VT recurrences.</p><p><strong>Results: </strong>From 2012 to 2023, 14 ARVC patients underwent endocardial VT ablation within ICE-defined RV free wall aneurysms. The median age at first arrhythmia event was 55.5 years (interquartile range [IQR], 32.3-59.8 years). Pathogenic genetic variants were identified in 82% of the patients. Ablation inside the RV aneurysms during ICE monitoring used prolonged radiofrequency applications (median, 111 seconds; IQR, 81-180 seconds), with power titrated up to 29 W (IQR, 29-33 W) to achieve 10%-15% impedance drops. No steam pops occurred. VT noninducibility was achieved in 86% with no complications. During median follow-up of 4.3 years (IQR, 3.1-6.0 years), the primary end point was achieved in 13 patients (93%): 10 VT free and 3 with a single episode of VT.</p><p><strong>Conclusion: </strong>Endocardial ablation targeting VT from ICE-defined RV free wall aneurysms in ARVC patients using prolonged radiofrequency applications is safe and effective, precluding the need for adjunctive epicardial ablation. Patients with aneurysm-dependent VT were typically older and carried pathogenic genetic variants.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255596","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 : 2025-02-01DOI: 10.1016/j.hrthm.2024.08.019
Ivana Fiserova MSc, PhD , Ondrej Fiser PhD , Marek Novak PhD , Jan Trnka PhD , Antonia Gibalova PhD , David Kvapil , Barbora Bacova MD, PhD , Marek Hozman MD , Dalibor Herman MD, PhD , Klara Benesova MSc , Pavel Osmancik MD, PhD
Background
Pulsed field ablation (PFA) of atrial fibrillation is a new method in clinical practice. Despite a favorable safety profile of PFA in atrial fibrillation ablation, rare cases of renal failure, probably due to hemolysis, have recently been reported.
Objective
The aim of this study was to determine the rate of hemolysis and cardiac cell death during in vitro PFA with different electric field intensities.
Methods
Blood samples from healthy volunteers and mouse HL-1 cardiomyocyte cell lines were subjected to in vitro irreversible electroporation using 216 bipolar pulses, each lasting 2 μs with intervals of 5 μs, repeated 20 times at a frequency of 1 Hz. These pulses varied from 500 V to 1500 V. Cell-free hemoglobin levels were assessed spectrophotometrically, and red blood cell microparticles were evaluated by flow cytometry. Cardiomyocyte death was quantified with propidium iodide.
Results
Pulsed field energy (1000 V/cm, 1250 V/cm, and 1500 V/cm) was associated with a significant increase in cell-free hemoglobin (0.32 ± 0.16 g/L, 2.2 ± 0.96 g/L, and 5.7 ± 0.39 g/L; P < .01) and similar increase in the concentration of red blood cell microparticles. Significant rates of cardiomyocyte death were observed at electric field strengths of 750 V/cm, 1000 V/cm, 1250 V/cm, and 1500 V/cm (26.5% ± 5.9%, 44.3% ± 6.2%, 55.5% ± 6.9%, and 74.5% ± 17.8% of cardiomyocytes; P < .01).
Conclusion
The most effective induction of cell death in vitro was observed at 1500 V/cm. This intensity was also associated with a significant degree of hemolysis.
{"title":"Significant hemolysis is present during irreversible electroporation of cardiomyocytes in vitro","authors":"Ivana Fiserova MSc, PhD , Ondrej Fiser PhD , Marek Novak PhD , Jan Trnka PhD , Antonia Gibalova PhD , David Kvapil , Barbora Bacova MD, PhD , Marek Hozman MD , Dalibor Herman MD, PhD , Klara Benesova MSc , Pavel Osmancik MD, PhD","doi":"10.1016/j.hrthm.2024.08.019","DOIUrl":"10.1016/j.hrthm.2024.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) of atrial fibrillation is a new method in clinical practice. Despite a favorable safety profile of PFA in atrial fibrillation ablation, rare cases of renal failure, probably due to hemolysis, have recently been reported.</div></div><div><h3>Objective</h3><div>The aim of this study was to determine the rate of hemolysis and cardiac cell death during in vitro PFA with different electric field intensities.</div></div><div><h3>Methods</h3><div>Blood samples from healthy volunteers and mouse HL-1 cardiomyocyte cell lines were subjected to in vitro irreversible electroporation using 216 bipolar pulses, each lasting 2 μs with intervals of 5 μs, repeated 20 times at a frequency of 1 Hz. These pulses varied from 500 V to 1500 V. Cell-free hemoglobin levels were assessed spectrophotometrically, and red blood cell microparticles were evaluated by flow cytometry. Cardiomyocyte death was quantified with propidium iodide.</div></div><div><h3>Results</h3><div>Pulsed field energy (1000 V/cm, 1250 V/cm, and 1500 V/cm) was associated with a significant increase in cell-free hemoglobin (0.32 ± 0.16 g/L, 2.2 ± 0.96 g/L, and 5.7 ± 0.39 g/L; <em>P</em> < .01) and similar increase in the concentration of red blood cell microparticles. Significant rates of cardiomyocyte death were observed at electric field strengths of 750 V/cm, 1000 V/cm, 1250 V/cm, and 1500 V/cm (26.5% ± 5.9%, 44.3% ± 6.2%, 55.5% ± 6.9%, and 74.5% ± 17.8% of cardiomyocytes; <em>P</em> < .01).</div></div><div><h3>Conclusion</h3><div>The most effective induction of cell death in vitro was observed at 1500 V/cm. This intensity was also associated with a significant degree of hemolysis.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 466-474"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hrthm.2024.10.046
JungMin Choi MD , So-Ryoung Lee MD, PhD , Tae-Hoon Kim MD , Hee Tae Yu MD, PhD , Junbeom Park MD, PhD , Jin-Kyu Park MD, PhD , Ki-Woon Kang MD, PhD , Jaemin Shim MD, PhD , Jae-Sun Uhm MD, PhD , Jun Kim MD, PhD , Hyung Wook Park MD, PhD , Jin-Bae Kim MD , Young Soo Lee MD, PhD , Boyoung Joung MD, PhD , Eue-Keun Choi MD, PhD
Background
Atrial fibrillation (AF) may have different clinical features in its early phase.
Objective
The purpose of this study was to compare the characteristics and clinical outcomes of early-phase AF with later-phase AF using a large multicenter prospective registry (CODE-AF [COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation]).
Methods
Patients enrolled between June 2016 and March 2021 were divided into 2 groups based on AF duration: (1) newly diagnosed (AF duration ≤90 days); and (2) previously diagnosed (AF duration >90 days). Baseline characteristics and clinical outcomes were compared.
Results
Among the 10,001 study participants (mean age 67.0 ± 14.5 years; 64% men), 22% were defined as newly diagnosed and 78% as previously diagnosed. Newly diagnosed patients had fewer comorbidities and more unhealthy social behaviors. Despite lower prescription rates of oral anticoagulant, direct oral anticoagulants were more frequently used. The newly diagnosed group also had a higher composite clinical outcome risk within 90 days (adjusted hazard ratio 1.81, 95% confidence interval 1.30–2.53, P <.001) and revealed a higher risk of all bleeding and heart failure admission within 90 days. No significant differences remained between the groups over 36-month follow-up.
Conclusion
Patients with early-stage AF were younger and had fewer comorbidities. Although there was a higher risk of heart failure admissions and minor bleeding, the risks of death, stroke, and major bleeding were not significantly increased. Structured monitoring and management during the initial months are essential to address these risks.
{"title":"Clinical outcomes of Asian patients with newly diagnosed atrial fibrillation and previously diagnosed atrial fibrillation: Insights from the CODE-AF Registry","authors":"JungMin Choi MD , So-Ryoung Lee MD, PhD , Tae-Hoon Kim MD , Hee Tae Yu MD, PhD , Junbeom Park MD, PhD , Jin-Kyu Park MD, PhD , Ki-Woon Kang MD, PhD , Jaemin Shim MD, PhD , Jae-Sun Uhm MD, PhD , Jun Kim MD, PhD , Hyung Wook Park MD, PhD , Jin-Bae Kim MD , Young Soo Lee MD, PhD , Boyoung Joung MD, PhD , Eue-Keun Choi MD, PhD","doi":"10.1016/j.hrthm.2024.10.046","DOIUrl":"10.1016/j.hrthm.2024.10.046","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) may have different clinical features in its early phase.</div></div><div><h3>Objective</h3><div>The purpose of this study was to compare the characteristics and clinical outcomes of early-phase AF with later-phase AF using a large multicenter prospective registry (CODE-AF [COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation]).</div></div><div><h3>Methods</h3><div>Patients enrolled between June 2016 and March 2021 were divided into 2 groups based on AF duration: (1) newly diagnosed (AF duration ≤90 days); and (2) previously diagnosed (AF duration >90 days). Baseline characteristics and clinical outcomes were compared.</div></div><div><h3>Results</h3><div>Among the 10,001 study participants (mean age 67.0 ± 14.5 years; 64% men), 22% were defined as newly diagnosed and 78% as previously diagnosed. Newly diagnosed patients had fewer comorbidities and more unhealthy social behaviors. Despite lower prescription rates of oral anticoagulant, direct oral anticoagulants were more frequently used. The newly diagnosed group also had a higher composite clinical outcome risk within 90 days (adjusted hazard ratio 1.81, 95% confidence interval 1.30–2.53, <em>P</em> <.001) and revealed a higher risk of all bleeding and heart failure admission within 90 days. No significant differences remained between the groups over 36-month follow-up.</div></div><div><h3>Conclusion</h3><div>Patients with early-stage AF were younger and had fewer comorbidities. Although there was a higher risk of heart failure admissions and minor bleeding, the risks of death, stroke, and major bleeding were not significantly increased. Structured monitoring and management during the initial months are essential to address these risks.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 424-431"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499179","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 : 2025-02-01DOI: 10.1016/j.hrthm.2024.07.098
Eduardo J. Pérez-Guerrero MD , Isha Mehrotra BS , Sneha S. Jain MD , Marco V. Perez MD
{"title":"Introduction to wearable technology in arrhythmia management","authors":"Eduardo J. Pérez-Guerrero MD , Isha Mehrotra BS , Sneha S. Jain MD , Marco V. Perez MD","doi":"10.1016/j.hrthm.2024.07.098","DOIUrl":"10.1016/j.hrthm.2024.07.098","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 572-578"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758286","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}
The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).
Objective
The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.
Methods
In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM. Multivariate Cox regression model was also used for VA risk stratification.
Results
One hundred eighteen patients (71 female patients [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44–158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25–130 months) postimplantation. Males had a higher VA incidence (male patients 18 of 47 [38.3%] vs female patients 17 of 71 [23.9%]; P = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (P = .001). Less than a 20% decrease in LVM increased VA risk (P < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001–1.009; log-rank, P = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters.
Conclusion
VA risk after CRT implantation in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.
背景：心脏再同步化治疗（CRT）后室性心律失常（VA）的风险与缺血性疾病/瘢痕、性别以及可能的左心室质量（LVM）有关：目的：评估非缺血性心肌病（NICM）和左束支传导阻滞患者植入 CRT 后的性别差异和 LVM 基线/植入后变化 [Δ]对 VA 风险的影响：在符合标准的患者中，获取基线和随访超声心动图图像以评估左心室容积。通过设备诊断和治疗报告VA事件。根据基线 LVM 和 ΔLVM 的 ROC（Youden 指数切点）以及使用多变量 Cox 回归模型的基线患者特征对 VA 风险进行分层：118 名患者（71[60.2%] 名女性，年龄 60.5 ±11.3 岁，LVEF 19.2 ±7.0%, QRS 165.6 ±20 ms, LVM 313.9 ±108.8 g）入组并接受了中位 90 (IQR 44-158) 个月的随访。35名患者（29.6%）在植入后中位数73.5个月（IQR 25-130）时接受了适当的电击或抗心动过速起搏。男性的 VA 发生率更高（男性 18/47 [38.3%] 对女性 17/71 [23.9%]，P=0.02）。基线 LVM >308.9g 的患者有较高的 VA 风险（P=0.001）。LVM 下降少于 20% 会增加 VA 风险（结论：CRT 后，NCD 患者的 VA 风险会增加：NICM患者CRT后的VA风险与基线LV>308.9g和LVM下降≤20%有关，无性别差异。
{"title":"Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB","authors":"Koji Higuchi MD, PhD, FHRS , Mahesh Manne MD, MPH , Patrick Tchou MD , Bryan Baranowski MD , Mandeep Bhargava MD , Thomas Callahan MD , Mina Chung MD, FHRS , Thomas Dresing MD , Ayman Hussein MD, FHRS , Mohamed Kanj MD , Kenneth Mayuga MD, FHRS , Shady Nakhla MD , Walid Saliba MD, FHRS , John Rickard MD , Oussama Wazni MD, FHRS , Pasquale Santangeli MD , Jakub Sroubek MD, PhD , Niraj Varma MA, MD, PhD","doi":"10.1016/j.hrthm.2024.07.106","DOIUrl":"10.1016/j.hrthm.2024.07.106","url":null,"abstract":"<div><h3>Background</h3><div>The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.</div></div><div><h3>Methods</h3><div>In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM. Multivariate Cox regression model was also used for VA risk stratification.</div></div><div><h3>Results</h3><div>One hundred eighteen patients (71 female patients [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44–158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25–130 months) postimplantation. Males had a higher VA incidence (male patients 18 of 47 [38.3%] vs female patients 17 of 71 [23.9%]; <em>P</em> = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (<em>P</em> = .001). Less than a 20% decrease in LVM increased VA risk (<em>P</em> < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001–1.009; log-rank, <em>P</em> = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters.</div></div><div><h3>Conclusion</h3><div>VA risk after CRT implantation in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 339-348"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859490","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 : 2025-02-01DOI: 10.1016/j.hrthm.2024.08.050
Nadeev Wijesuriya MBBS , Vishal Mehta MBBS , Felicity De Vere MBChB , Sandra Howell MBBS , Nilanka Mannakkara MBBS , Baldeep Sidhu MBBS, PhD , Mark Elliott MBBS, PhD , Paolo Bosco MBBS , Prashanthan Sanders MD, FHRS , Jagmeet P. Singh MD, PhD, FHRS , Mary Norine Walsh MD , Steven A. Niederer DPhil , Christopher A. Rinaldi MBBS, MD, FHRS
Background
Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology. Predictors of response to leadless CRT are poorly understood. Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates.
Objective
The purpose of this study was to examine the association between Q-LV and echocardiographic remodeling response to leadless CRT delivered with the WiSE-CRT system.
Methods
A post hoc analysis (n = 122) of the SOLVE-CRT trial examined the relationship between LV pacing site Q-LV with rate of left ventricular end-systolic volume (LVESV) reduction >15% at 6 months. Multivariable regression analysis, adjusting for age, sex, previous CRT nonresponse, cardiomyopathy etiology, QRS morphology, and QRS duration was performed, followed by receiver operating characteristic analysis and analysis of variance by Q-LV quartile. A subgroup analysis of the ischemic cardiomyopathy cohort was undertaken.
Results
Complete Q-LV data were available for 122 of 153 patients (80%) in the active arms SOLVE-CRT. Overall, the 6-month LVESV response rate was 46%. Logistic regression identified Q-LV as an independent response predictor with borderline significance (adjusted odds ratio 1.015; P = .05). Analysis by Q-LV quartile demonstrated a significant improvement in response rate in quartile 4 (longest Q-LV 64%) compared to quartile 1 (shortest Q-LV 28%) (P <.01). This association was primarily driven by strong Q-LV-response correlation in patients with ischemic cardiomyopathy, demonstrated by subgroup logistic regression (adjusted odds ratio 1.034; P = .004).
Conclusion
Increased Q-LV was associated with improved reverse remodeling following leadless CRT. Targeting LV endocardial sites of high Q-LV may deliver additional benefit compared to empirical LV electrode implantation.
{"title":"Left ventricular electrical delay predicts volumetric response to leadless cardiac resynchronization therapy","authors":"Nadeev Wijesuriya MBBS , Vishal Mehta MBBS , Felicity De Vere MBChB , Sandra Howell MBBS , Nilanka Mannakkara MBBS , Baldeep Sidhu MBBS, PhD , Mark Elliott MBBS, PhD , Paolo Bosco MBBS , Prashanthan Sanders MD, FHRS , Jagmeet P. Singh MD, PhD, FHRS , Mary Norine Walsh MD , Steven A. Niederer DPhil , Christopher A. Rinaldi MBBS, MD, FHRS","doi":"10.1016/j.hrthm.2024.08.050","DOIUrl":"10.1016/j.hrthm.2024.08.050","url":null,"abstract":"<div><h3>Background</h3><div>Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology. Predictors of response to leadless CRT are poorly understood. Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates.</div></div><div><h3>Objective</h3><div>The purpose of this study was to examine the association between Q-LV and echocardiographic remodeling response to leadless CRT delivered with the WiSE-CRT system.</div></div><div><h3>Methods</h3><div>A <em>post hoc</em> analysis (n = 122) of the SOLVE-CRT trial examined the relationship between LV pacing site Q-LV with rate of left ventricular end-systolic volume (LVESV) reduction >15% at 6 months. Multivariable regression analysis, adjusting for age, sex, previous CRT nonresponse, cardiomyopathy etiology, QRS morphology, and QRS duration was performed, followed by receiver operating characteristic analysis and analysis of variance by Q-LV quartile. A subgroup analysis of the ischemic cardiomyopathy cohort was undertaken.</div></div><div><h3>Results</h3><div>Complete Q-LV data were available for 122 of 153 patients (80%) in the active arms SOLVE-CRT. Overall, the 6-month LVESV response rate was 46%. Logistic regression identified Q-LV as an independent response predictor with borderline significance (adjusted odds ratio 1.015; <em>P</em> = .05). Analysis by Q-LV quartile demonstrated a significant improvement in response rate in quartile 4 (longest Q-LV 64%) compared to quartile 1 (shortest Q-LV 28%) (<em>P</em> <.01). This association was primarily driven by strong Q-LV-response correlation in patients with ischemic cardiomyopathy, demonstrated by subgroup logistic regression (adjusted odds ratio 1.034; <em>P</em> = .004).</div></div><div><h3>Conclusion</h3><div>Increased Q-LV was associated with improved reverse remodeling following leadless CRT. Targeting LV endocardial sites of high Q-LV may deliver additional benefit compared to empirical LV electrode implantation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 357-364"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with atrial fibrillation and malignant left atrial appendage (LAA) may benefit from LAA closure (LAAC); however, evidence is limited.
Objective
The purpose of this study was to determine management strategies and clinical outcomes in patients with atrial fibrillation and malignant LAA.
Methods
Malignant LAA was defined as a history of ischemic stroke and/or evidence of LAA thrombus despite continuous oral anticoagulation (OAC) therapy (continuous for ≥3 weeks). We studied 80 patients with malignant LAA treated with LAAC. We compared these patients first against 44 patients with malignant LAA treated with OAC alone and second against 114 patients without malignant LAA who were treated with LAAC for conventional indications.
Results
Among patients with malignant LAA (first comparison), those treated with LAAC had a higher 1-year cumulative incidence rate of ischemic stroke than did patients treated with OAC alone (6.3% vs 5.3%; log-rank, P = .09) whereas the difference in stroke risk while receiving OAC was comparable (2.7% vs 5.3%; log-rank, P = .84). Furthermore, all disabling stroke events in patients with malignant LAA treated with LAAC occurred only while not receiving OAC. Among patients treated with LAAC (second comparison), those with malignant LAA had a higher 1-year cumulative incidence rate of ischemic stroke (and ischemic stroke due to device-related thrombosis) than did those without malignant LAA (6.3% vs 2.2%; log-rank, P = .009 and 2.2% vs 0%; log-rank, P = .04, respectively). However, these differences in stroke risk were no longer significant while receiving OAC (2.7% vs 1.0%; log-rank, P = .11).
Conclusion
Combination performing LAAC and continuation of OAC may be options to prevent ischemic stroke in patients with high thromboembolic risk and malignant LAA.
{"title":"Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage","authors":"Ryuki Chatani MD, Shunsuke Kubo MD, Hiroshi Tasaka MD, Naoki Nishiura MD, Kazunori Mushiake MD, Sachiyo Ono MD, Takeshi Maruo MD, Kazushige Kadota MD, PhD","doi":"10.1016/j.hrthm.2024.10.061","DOIUrl":"10.1016/j.hrthm.2024.10.061","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atrial fibrillation and malignant left atrial appendage (LAA) may benefit from LAA closure (LAAC); however, evidence is limited.</div></div><div><h3>Objective</h3><div>The purpose of this study was to determine management strategies and clinical outcomes in patients with atrial fibrillation and malignant LAA.</div></div><div><h3>Methods</h3><div><em>Malignant LAA</em> was defined as a history of ischemic stroke and/or evidence of LAA thrombus despite continuous oral anticoagulation (OAC) therapy (continuous for ≥3 weeks). We studied 80 patients with malignant LAA treated with LAAC. We compared these patients first against 44 patients with malignant LAA treated with OAC alone and second against 114 patients without malignant LAA who were treated with LAAC for conventional indications.</div></div><div><h3>Results</h3><div>Among patients with malignant LAA (first comparison), those treated with LAAC had a higher 1-year cumulative incidence rate of ischemic stroke than did patients treated with OAC alone (6.3% vs 5.3%; log-rank, <em>P</em> = .09) whereas the difference in stroke risk while receiving OAC was comparable (2.7% vs 5.3%; log-rank, <em>P</em> = .84). Furthermore, all disabling stroke events in patients with malignant LAA treated with LAAC occurred only while not receiving OAC. Among patients treated with LAAC (second comparison), those with malignant LAA had a higher 1-year cumulative incidence rate of ischemic stroke (and ischemic stroke due to device-related thrombosis) than did those without malignant LAA (6.3% vs 2.2%; log-rank, <em>P</em> = .009 and 2.2% vs 0%; log-rank, <em>P</em> = .04, respectively). However, these differences in stroke risk were no longer significant while receiving OAC (2.7% vs 1.0%; log-rank, <em>P</em> = .11).</div></div><div><h3>Conclusion</h3><div>Combination performing LAAC and continuation of OAC may be options to prevent ischemic stroke in patients with high thromboembolic risk and malignant LAA.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 475-485"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618803","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 : 2025-02-01DOI: 10.1016/j.hrthm.2024.11.041
Fabrizio Ricci MD, PhD, MSc , Lorenzo V. Molinari MD , Davide Mansour MD , Kristian Galanti MD , Fabio Vagnarelli MD, PhD , Giulia Renda MD, PhD , Sabina Gallina MD , Anjali Owens MD , Jasmine A. Luzum PharmD, PhD , Iacopo Olivotto MD , Mohammed Y. Khanji MBBCh, PhD, MRCP , Anwar A. Chahal MBChB, PhD, MRCP
Mavacamten is a selective, allosteric, and reversible cardiac myosin inhibitor, representing the first disease-specific treatment for obstructive hypertrophic cardiomyopathy (HCM) that targets the core pathophysiological mechanism of this condition. Clinical evidence supports its efficacy in improving symptoms, cardiac function, and remodeling, thereby supplementing established treatment regimens. However, mavacamten is extensively metabolized by hepatic cytochromes, and its half-life is contingent upon CYP2C19 phenotype. Consequently, coadministered medications that inhibit or induce these enzymes may significantly alter mavacamten pharmacokinetics, potentially leading to reversible systolic dysfunction or diminished therapeutic efficacy. This paper provides a comprehensive analysis of mavacamten pharmacokinetics and its potential interactions with antithrombotic and antiarrhythmic agents, which are the cornerstones of atrial fibrillation management in HCM population. Our aim is to offer clinicians practical guidance on safely administering mavacamten in conjunction with these medications, discuss the role of pharmacogenomics, and outline rigorous patient safety monitoring strategies to ensure effective and individualized treatment.
{"title":"Managing drug–drug interactions with mavacamten: A focus on combined use of antiarrhythmic drugs and anticoagulants","authors":"Fabrizio Ricci MD, PhD, MSc , Lorenzo V. Molinari MD , Davide Mansour MD , Kristian Galanti MD , Fabio Vagnarelli MD, PhD , Giulia Renda MD, PhD , Sabina Gallina MD , Anjali Owens MD , Jasmine A. Luzum PharmD, PhD , Iacopo Olivotto MD , Mohammed Y. Khanji MBBCh, PhD, MRCP , Anwar A. Chahal MBChB, PhD, MRCP","doi":"10.1016/j.hrthm.2024.11.041","DOIUrl":"10.1016/j.hrthm.2024.11.041","url":null,"abstract":"<div><div>Mavacamten is a selective, allosteric, and reversible cardiac myosin inhibitor, representing the first disease-specific treatment for obstructive hypertrophic cardiomyopathy (HCM) that targets the core pathophysiological mechanism of this condition. Clinical evidence supports its efficacy in improving symptoms, cardiac function, and remodeling, thereby supplementing established treatment regimens. However, mavacamten is extensively metabolized by hepatic cytochromes, and its half-life is contingent upon CYP2C19 phenotype. Consequently, coadministered medications that inhibit or induce these enzymes may significantly alter mavacamten pharmacokinetics, potentially leading to reversible systolic dysfunction or diminished therapeutic efficacy. This paper provides a comprehensive analysis of mavacamten pharmacokinetics and its potential interactions with antithrombotic and antiarrhythmic agents, which are the cornerstones of atrial fibrillation management in HCM population. Our aim is to offer clinicians practical guidance on safely administering mavacamten in conjunction with these medications, discuss the role of pharmacogenomics, and outline rigorous patient safety monitoring strategies to ensure effective and individualized treatment.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 510-525"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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