Heart rhythm最新文献

Background: Combining pulsed field ablation (PFA) and left atrial appendage occlusion (LAAO) to one procedure is appealing for atrial fibrillation treatment.

Objective: To compare the outcome of combined and standalone procedures METHODS: This is a retrospective cohort study of consecutive patients undergoing combined PFA and LAAO procedures in 3 centers in 2023. They underwent PFA pulmonary vein isolation (PVI) with Farapulse, followed by LAAO with Watchman FLX guided by transesophageal echocardiogram (TEE). Pulmonary ridge thickness was measured at 45 degrees, 5mm from tip of the ridge, before and after PFA. At 3-month, TEE or computed tomography was performed for LAAO patients to assess occlusion result. Peri-device leak (PDL) of more than 3mm was defined as significant. Consecutive PFA or LAAO standalone procedures served as control.

Results: This cohort included 36 combined, 48 standalone LAAO and 52 standalone PFA cases. Acute PVI was achieved in all combined and PFA standalone procedures. Successful LAAO implantation with Watchman FLX was achieved in 97.2% combined procedures, and all standalone LAAO procedures. In the combined cohort, pulmonary ridge thickness increased after ablation by 2.72±1.19mm (p<0.001) or 69.4%±51.4%. At 3-month, the rate of PDL did not differ between combined and standalone LAAO cohorts (26.7 vs 15.2%, p=0.22). However, significant PDL (>3mm) occurred more commonly in the combined cohort compared to standalone LAAO cohort (20% vs 2.2%, P=0.013).

Conclusion: Combined PFA and LAAO was feasible. However, we observed a mean 69.4% increase in pulmonary ridge thickness immediately following PFA. Significant PDL was more prevalent in combined procedure.

Sudden cardiac death is an important cause of mortality in patients with kidney failure undergoing renal replacement therapy, either hemodialysis or peritoneal dialysis. The risk factors associated with sudden cardiac death in these patients only partly overlap with those in the general population. Kidney failure per se and hemodialysis therapy expose these patients to an increased risk of sudden cardiac death compared with individuals with preserved renal function. Studies of the implantable cardioverter defibrillator for primary prevention of sudden cardiac death in patients with kidney failure have failed to demonstrate its usefulness. Moreover, the incidence of complications associated with cardiac electronic device implantation in this population is extremely high. This review aims to provide an update on the available studies on the pathophysiology and prevention of sudden cardiac death in patients with kidney failure undergoing dialysis, and to propose the adoption of clinical practices to reduce its incidence.

Background: The electrocardiogram (ECG) is important in the diagnostic evaluation of arrhythmogenic cardiomyopathy (ACM).

Objective: The purpose of this study was to identify ECG features associated with TMEM43 p.S358L ACM over long-term assessment.

Methods: A total of 634 ECGs were collected from a retrospective cohort of 68 patients with TMEM43 p.S358L ACM. Abnormalities in repolarization, depolarization, conduction intervals, QRS voltage, and rhythm were analyzed.

Results: 68 patients (32 males, 36 females) with ≥ 5 ECGs (median 9, range 5-17) over 20.5 ± 8.0 years were included. Over follow-up, 56/68 (82.4%) had an abnormality. Task Force Criteria (TFC) repolarization abnormalities were rare. Terminal activation duration ≥ 55 ms was common (20/32 males - 62.5%, 13/36 females - 36.1%). An epsilon wave was demonstrated in 2 female patients. Significant prolongation in the QRS duration occurred for males (97.3±11.6 ms to 137.6±24.8 ms, p <0.001) and females (90.4 ± 12.1 ms to 117.4 ±24.0ms, p <0.001). The most common finding was R wave < 3 mm in V3 (PRWP). Loss of the R wave in V3 < 3mm followed by development of an intraventricular conduction delay or complete left bundle branch block was seen in the majority of patients (42/68, 61.8%), occurring earlier in males than females (p <0.02).

Conclusion: Repolarization TFC criteria and epsilon waves are rare in TMEM43 p.S358L ACM. The ECG in TMEM43 p.S358L ACM is characterized by loss of the R wave in V3 to < 3mm and QRS prolongation with development of an IVCD or LBBB.

Background: Atrial fibrillation (AF) is closely linked to autonomic nervous system activity, with activation of the cardiac ganglionated plexus (GP) often presents in AF. Piezo, a mechanosensitive ion channel, plays a pivotal role in neuronal modulation. However, its involvement in the GP and AF remains poorly understood.

Objective: This study investigates the expression of Piezo2 in GP and its potential role in AF.

Methods: GP tissues were collected from patients undergoing cardiac transplantation, and Piezos expression levels were assessed. Rapid atrial pacing (RAP) was performed in a large animal model to induce AF, and Piezos expression in GP tissues was also evaluated. Piezo2 knockdown in GP was achieved via adeno-associated virus in animals subjected to RAP. Atrial electrophysiological parameters, AF inducibility, neural activity and GP function, were subsequently analyzed. RNA sequencing was employed to elucidate underlying mechanisms.

Results: In the AF group and in people with higher left atrial pressure, Piezo2 expression was increased in the GP. Knockdown of Piezo2 in GP impaired GP function and neural activity, thereby decreasing AF susceptibility. RNA-seq analysis revealed significant down-regulation of the Notch signaling pathway.

Conclusions: These findings suggest that Piezo2 expressed in GP may serve as a novel therapeutic target for the treatment of AF.

Background: The human sinoatrial node (SAN) pacemaker is a complex structure located at the right atrium- superior vena cava (SVC) junction.

Objective: This study aims to (1) perform in-vivo endocardial and epicardial electroanatomical mapping (EAM) of human SAN in inappropriate sinus node tachycardia (IST) and (2) correlate electrical findings with anatomical observations from thoracoscopy during hybrid SAN sparing IST ablation.

Methods: All consecutive patients with 1) Diagnosis of symptomatic IST, refractory or intolerant to drugs and 2) Endocardial and epicardial mapping of SAN during hybrid ablation were included. Local activation time (LAT) was defined using steepest -dV/dT on unipolar electrogram (EGM). Exit zone (SAN-EZ) was defined as the earliest activation site on endocardial and epicardial maps. Endo-epicardial delay (EED) was the time difference between the first endo-epicardial activations. Bipolar EGM morphology and SVC sleeves extension were analyzed.

Results: A total of 61 patients were included. The SAN-EZ area was 1.4 cm² ± 0.6 and was located in the superior anterior region of the RA in 46 (75.4%) of patients and in the mid RA in 15 (24.6%) of patients. The earliest activation occurred on epicardial SAN-EZ in all patients. The LAT of the epicardial vs endocardial SAN-EZ was -30.8 ms vs -12.4 ms, p<0.001. EED was 19.7 ms. Bipolar EGM reversed polarity at SAN-EZs was observed in 43 (70.5%) patients. SVC sleeves extension was 31.2 mm and inversely correlated with age.

Conclusion: Earliest SAN-EZ was found in the epicardium. Bipolar EGM reversed polarity is a novel electrophysiological marker for SAN-EZs.

Background: Epicardial access (EA) is an essential tool for ablation of certain arrhythmias, but conventional techniques carry inherent risks. Carbon dioxide (CO₂) insufflation in the pericardium through the coronary sinus (CS) aims to facilitate EA but is time consuming and not widely used. Transatrial pericardial insufflation of CO₂ (TAPI-CO₂) offers a simplified alternative, underexplored in electrophysiology procedures.

Objective: To evaluate the efficacy and safety of TAPI-CO₂ for EA in electrophysiology procedures.

Methods: This retrospective study included all patients undergoing EA with TAPI-CO₂ at a tertiary care center between December 2020 and November 2024. The procedure involved intentional right atrial appendage (RAA) perforation for CO₂ insufflation, followed by subxiphoid puncture for EA. Success rates, procedural characteristics and complications were assessed.

Results: 15 patients (6 with atrial arrythmias and 9 with ventricular arrythmias) were included. TAPI-CO₂ was successfully performed in 14 patients (93.3%), and subxiphoid EA was achieved in 13 (86.7%). There were major adhesions in 2 patients (13.3%). No significant bleeding was observed after RAA perforation. One patient (6.7%) had delayed pericardial effusion related to TAPI-CO₂. No patient required surgery. Median procedural duration was 265 minutes [IQR 190-288], and fluoroscopy time was 28 minutes [IQR 24-32].

Conclusion: TAPI-CO₂ is a feasible, efficient, and relatively safe technique for facilitating EA. It provides a simplified alternative to CO₂ insufflation through the CS. Further studies are needed to confirm these results and to identify the patient populations that would benefit most from this technique.

Background: Despite the obvious benefits, the use of implantable cardioverter defibrillators (ICDs) is associated with serious complications, including infections. In particular, device replacement or revision procedures are associated with an increased risk of infection.

Objective: The aim of the study was to compare the cardiac device infection rate with and without the use of a gentamycin-collagen sponge (GCS) in patients undergoing device replacement or revision procedures of implanted ICDs.

Methods: A total of 507 consecutive ICD patients from a prospective single-center ICD-registry who underwent elective device replacement, system upgrade or lead revision between 2017 and 4/2024 were analyzed. From September 2020 onwards, a GCS was inserted into the device pocket (GCS group, n = 277). These patients were compared with patients who underwent surgery between 2017 and 8/2020 (control group, n = 230).

Results: The baseline characteristics were similar between both groups. The GCS was well tolerated and there were no complications associated with the GCS. The Kaplan-Meier estimated infection rate after one year was 0.7% in the GCS group and 3.9% in the control group (p = 0.005). The use of the GCS was an independent predictor for a lower device infection rate during follow-up (HR 0.23, 95% CI 0.07 - 0.84).

Conclusion: The additional use of a GCS was associated with a lower incidence of device infections than standard-of-care infection-prevention strategies alone.