Heart rhythm最新文献

Background: Interatrial block (IAB) has been associated with atrial fibrillation (AF) and stroke in broader cardiovascular populations. Whether these associations extend to hypertrophic cardiomyopathy (HCM), and how IAB relates to underlying left atrial (LA) remodeling, remain unknown.

Objective: This study aims to investigate the prevalence, morpho-functional correlates, and prognostic value of IAB in HCM patients.

Methods: This multicenter study included 259 HCM patients without prior history of AF/stroke. IAB was defined by P-wave duration >120 milliseconds. Associations between morphological and functional parameters of the LA and IAB were assessed using cardiac magnetic resonance imaging. The primary composite endpoint was new-onset AF, transient ischemic attack, or ischemic stroke.

Results: IAB was present in 10% of the cohort. Patients with IAB exhibited larger LA diameter (median 47.4 vs. 43.2mm; p=0.022), indexed maximum LA volume (median 52.5 vs. 46.9 ml/m²; p=0.043), and with impaired LA ejection fraction (median 48% vs. 51%; p=0.043), reduced LA reservoir strain (median 22.0% vs. 29.3%; p=0.018) and reduced LA conduit strain (median 8.3% vs. 12.1%; p=0.012). During a median 5.8-year follow-up, IAB was independently associated with a twofold increased risk of the composite endpoint (HR 2.11; 95%CI: 1.13-3.95; p=0.019) and new-onset AF (HR 2.10; 95%CI: 1.07-4.16; p=0.031).

Conclusion: In HCM patients, IAB is associated with significant LA structural and functional impairments, indicative of advanced atrial cardiomyopathy. Its presence was independently associated with an increased risk of incident AF and stroke, suggesting its value as a simple, accessible electrocardiographic marker for enhanced risk stratification.

Background: Pulmonary vein isolation (PVI) is a well-established treatment for atrial fibrillation (AF), however, strategies for patients with recurrent AF and isolated pulmonary veins remains elusive.

Objective: To evaluate the effectiveness of a personalized artificial intelligence (AI)-guided spatio-temporal dispersion mapping and ablation in patients undergoing a repeat ablation and whose PVs remain isolated from prior ablation procedures.

Methods: The RESTART trial (NCT05477147) was an interventional, prospective, single-arm, multicenter clinical trial. Patients with previous catheter or surgical ablation for paroxysmal, persistent or long-standing persistent AF and with documented symptomatic AF recurrences were enrolled. Patients with documented reconnected PVs during the procedure were prospectively withdrawn from the trial. Follow-up included 3- 6- and 12-month visits with 12-lead ECG and 24-hour Holter. The primary endpoint of the study was freedom from documented AF at 12-month after a single AI-guided repeat ablation procedure.

Results: Of the 213 patients enrolled, the main causes for premature study exit were PV reconnection (n=80) or non-inducibility of AF (n=14). The primary endpoint was achieved in 83% [77/93] of patients and freedom from any atrial arrhythmia after a single procedure was 70% [65/93]. Notably, AF termination during ablation was achieved in 54% of patients, and right atrial dispersion was identified in 59%. The procedure was associated with improvements in quality of life metrics (AFEQT and SF-36 scores).

Conclusion: In patients with documented isolated PVs, AI-guided dispersion ablation is safe, effective and represents an alternative to other ablative strategies.

Background: Although pulsed field ablation (PFA) is generally considered safe, the mechanisms underlying both symptomatic and silent embolic events remain unclear.

Objectives: This study aimed to investigate the timing, number, size, and characteristics of microembolic signals (MES) during each step of the pentaspline PFA procedure using real-time carotid Doppler monitoring.

Methods: MES were assessed during ablation procedures in 32 patients, including 27 who underwent pulmonary vein isolation (PVI) with the pentaspline PFA system and 5 control patients who received radiofrequency ablation limited to the right atrium.

Results: The PFA group showed significantly more MES than the control group. MES were detected throughout the PFA procedure, with the highest counts observed during PFA delivery to the right pulmonary veins (RPVs). Bubble signals were seen in all procedural steps. In contrast, high-intensity transient signals, which are mainly composed of solid components, were more common during PFA energy delivery. All 303 overcurrent errors-events in which energy delivery is stopped due to overcurrent detection-occurred during basket-type PFA applications and were associated with a marked increase in MES. Basket-configuration energy delivery resulted in a significantly higher number of MES than the flower-configuration, particularly in the RPVs. The size of MES was significantly larger during PFA energy delivery than during catheter or sheath manipulation.

Conclusions: This study demonstrated the characteristic timing, frequency, and morphology of MES during pentaspline PFA procedures, providing insights that may help reduce embolic risks in future practice.

Background: Pulsed field ablation (PFA) has emerged as a tissue-selective modality for atrial fibrillation (AF) ablation. Early recurrence of any atrial tachyarrhythmia (ERAT) during the blanking period are considered transient, however their association with late recurrence of any atrial tachyarrhythmias (LRAT) remains unclear.

Objective: The present meta-analysis aimed to elucidate the association between ERAT and LRAT post-PFA for different blanking cut-offs.

Methods: A search of MEDLINE, Scopus, and Cochrane (up to January 12, 2026) identified observational or randomized studies of PFA with ≥1-year follow-up. Double independent study selection, data extraction and quality assessment were performed. Random-effects frequentist models were used to pool odds ratios (OR), hazard ratios (HR), proportions and diagnostic accuracy measures with 95% confidence intervals (CI).

Results: Seven observational studies (3003 patients) were analyzed. ERATs within 0-90 days were strongly associated with LRATs (OR=8.98, 95%CI=[5.61,14.37]; I²=68%; 7 studies), without subgroup differences by AF type, use of event recorders or PFA technology. The positive predictive value (PPV) of ERATs was 0.66 (95%CI=[0.55,0.76]; I²=75%; 7 studies) within 0-90 days, 0.73 (95%CI=[0.63,0.81]; I²=23%; 3 studies) within 0-60 days and 0.56 (95%CI=[0.16,0.90]; I²=85%; 2 studies) within 0-30 days. ERATs within 0-90 days demonstrated high specificity (0.93, 95%CI=[0.90,0.95]) and positive likelihood ratio (5.83, 95%CI=[4.09,8.32]) for LRATs. Age, heart failure and non-pulmonary vein ablation were significant effect modifiers in metaregression analysis.

Conclusions: ERATs within 0-90 days and 0-60 days post-PFA are robust LRAT predictors, whereas first-month ERATs remain insufficiently investigated. Further studies are required to define the optimal blanking period post-PFA.

Background: Accurate assessment of arrhythmia propagation can help identify ablation targets, but current methods are limited by local activation time (LAT) variability, catheter orientation dependence, and inconsistent sampling density.

Objective: To extend LAT-independent omnipolar technology (OT) to catheters with arbitrary electrode arrangements, compare estimates to LAT-derived equivalents, and demonstrate a weighted resampling algorithm that produces clear and robust visualizations of wavefront propagation.

Methods: Omnipolar estimates of conduction velocity (CV), activation direction (AD), and voltage were computed from electroanatomic mapping data from 34 scar-related reentrant atrial tachycardias (ATs) and one ventricular tachycardia mapped with PENTARAY and OCTARAY catheters. Estimates were compared with conventional analogs to assess concordance, both globally and after stratification by anatomic region. To overcome sampling non-uniformity, a distance-weighted vector estimation, resampling and smoothing algorithm (VERSA) was devised to render propagation metrics (CV and AD) into intuitive visualizations. Resulting VERSA maps were assessed qualitatively for their ability to convey local propagation and their agreement with conventional activation maps.

Results: Across all cases, omnipolar CV was higher than LAT-based CV, while differences in AD were negligible. Omnipolar voltages were significantly higher than corresponding maximum bipolar voltages. The proposed VERSA maps intuitively depicted wavefront propagation, agreed broadly with activation maps, and illustrated conduction block, conduction breakthrough, and overall patterns of reentry.

Conclusion: Extending OT to arbitrary electrode arrangements and visualizing measurements in VERSA maps can elucidate wavefront propagation in reentrant tachycardias without the need for LAT annotation. These methods could facilitate better interpretation of complex arrhythmia patterns and more effective ablation.