Heart rhythm最新文献

Background: ¹⁸F-FDG-PET/MR can identify inflammation and fibrosis, high-risk features in cardiac sarcoidosis.

Objective: To evaluate whether the involvement of certain myocardial segments is associated with higher risk compared to others.

Methods: 124 patients with suspected clinical sarcoidosis underwent ¹⁸F-FDG-PET/MR. Late gadolinium enhancement (LGE) and focal ¹⁸F-FDG uptake were evaluated globally and in the 16 myocardial segments. Presence of LGE was defined when the percentage of LGE exceeded 5.7% globally (relative to myocardial volume) and in each myocardial segment. Patients were followed up for 5.5 years. Events were defined as ventricular arrhythmia (VA, including sustained ventricular tachycardia, ventricular fibrillation, and appropriate ICD discharge), heart failure hospitalization, or all-cause death.

Results: Mean age was 57.1±8.9 years, and 39.5% were female; 22 patients (17.6%) had an event at follow-up, and 9 (7.2%) presented VA. LGE and ¹⁸F-FDG uptake were more frequent in patients with than without events (36.4% vs 7.8%, p=0.001). Presence of LGE or ¹⁸F-FDG in the basal anterior segment were independent predictors for events after adjustment by left ventricular ejection fraction and relative enhanced volume (LGE: OR 10.5[1.2-92.4]; p=0.034;¹⁸F-FDG: OR 5.5[1.1-27.5], p=0.038). LGE presence in basal to mid anterior, mid anteroseptal, and basal to mid inferoseptal segments was an independent predictor for VA. Presence of ¹⁸F-FDG in basal to mid anterior, mid inferoseptal and mid inferior segments was an independent predictor for VA.

Conclusion: Involvement of specific myocardial segments, particularly basal to mid anterior and mid septal segments, is associated with higher rates of events in patients with suspected cardiac sarcoidosis.

Background: Mortality related to conduction abnormalities in the US population is not well-documented. Population-based stratification approaches can improve public health policies and targeted strategies.

Objective: To evaluate all-cause mortality related to conduction abnormalities in the US population METHODS: The CDC WONDER database was utilized to calculate the Age-Adjusted Mortality Rate (AAMR) per 100,000 individuals above 35 years old related to conduction abnormalities between 1999 and 2022.

Results: A total of 207,861 deaths were attributed to conduction abnormalities throughout the study period with 56,186 of these deaths occurring between 2020 and 2022. All-cause mortality related to conduction abnormalities has increased during the past decade with an exponential growth in 2020-2021 (COVID-19 era; Annual Percent Change (APC) of 16.6% per year). Although the mortality rates decreased in 2022, they remained elevated compared to 2019-2020. Throughout the past two decades, males consistently exhibited higher mortality rates than females, with the rate in 2022 being 1.5 times higher (AAMR 11.4 vs 7.0 per 100,000). Non-Hispanic Black patients experienced a significantly higher mortality rate compared to non-Hispanic White individuals in the study period (AAMR 13.7 vs. 8.6 per 100,000 in 2022). In the past two decades, mortality has been persistently higher in rural and small-medium-sized metro areas than in large metro urban areas.

Conclusions: Mortality rates related to conduction abnormalities have increased over the past decade, and persistent disparities have been observed. These data suggest that continued innovative outreach approaches and engagement with under-represented populations remain essential.

Background: The "epileptic heart" concept is emerging, but the causal relationship between epilepsy and atrial fibrillation (AF) remains unclarified.

Objective: This study explores the genetic correlations and bidirectional causality between various epilepsy phenotypes and AF.

Methods: Genome-wide association study (GWAS) statistics for 10 epilepsy subtypes (29,944 cases, 52,538 controls) and AF (60,620 cases, 970,216 controls) were sourced from the International League Against Epilepsy (ILAE) and HGRI-EBI Catalog-GWAS, respectively. Linkage disequilibrium score regression (LDSC) and genome-wide Mendelian Randomization (MR) evaluated genetic correlations and bidirectional causal relationships. Epilepsy-related DNA methylation data (N= ∼800) from EWAS catalog were analyzed to identify causal CpG sites influencing AF risk through epigenetic MR.

Results: LDSC revealed significant genetic correlations between four epilepsy subtypes and AF (rg from 0.116 to 0.241). Forward MR suggested a significant causal effect of focal epilepsy with hippocampal sclerosis (FE with HS) on AF risk (IVW and MR-PRESSO: OR = 1.046, P ≤ 0.004), with results robust against heterogeneity, horizontal pleiotropy, and outliers. Epigenetic MR indicated that lower methylation at cg06222062 (OR = 0.994, P = 3.16E-04) mapped to PLA2G5 and cg08461451 mapped to SPPL2B gene (OR = 0.954, P = 1.19E-03), and higher cg10541930 in the C10orf143 promoter (OR = 1.043, P = 4.18E-22) increases AF risk. Sensitivity analyses affirmed no pleiotropic bias.

Conclusion: FE with HS significantly increases AF risk, highlighting the natural neural-cardiac connection and the need for cardiac monitoring in epilepsy patients. Specific methylated CpG sites may serve as biomarkers and preventive targets for AF susceptibility.

Background: Post-operative arrhythmias are most often transient and medically treated, but some patients may require electrophysiology study (EPS) and ablation.

Objective: To describe the efficacy and safety of early post-operative ablation.

Methods: Retrospective series of patients who underwent EPS within 12 months of surgery for congenital heart disease (CHD) between 2000-2021. Procedural outcome included complete or partial success, failure or empirical ablation and complications. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score (documented arrhythmia, arrhythmia severity, cardioversion, antiarrhythmic medication).

Results: From 28,902 surgeries during the study period, 24 (0.1%) patients underwent EPS within 3 months of surgery and 26 (0.1%) 3-12 months after surgery. Most patients had great (n=27, 50%) or moderate (n=21, 42%) CHD complexity. Mechanisms of arrhythmias included intraatrial reentrant tachycardia (n=23, 46%), ectopic atrial tachycardia (n=13, 26%), accessory pathway (n=6, 12%), atrioventricular nodal reentrant tachycardia (n=7, 14%), twin atrioventricular node (n=1, 2%), atrial fibrillation (n=1, 2%), junctional ectopic tachycardia (n=1, 2%) and ventricular tachycardia (n=2, 4%). Procedure was acutely successful in 41 (82%) patients, empiric in 5 (10%) and unsuccessful in 4 (8%). Complications occurred in 4 patients (major in 1, moderate in 1, minor in 2). Recurrence of arrhythmia was documented in 27 (54%) patients, although the burden of arrhythmia was significantly reduced.

Conclusion: A minority of patient require early post-operative EPS and ablation. For those, the procedure can be performed with reasonable acute success and manageable morbidity even in critically ill patients with complex surgical anatomy.

Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are comorbid conditions that are increasingly prevalent and have a high socioeconomic burden. This article discusses their shared pathophysiology, focusing on the triad of hypertension, obesity, and aging. We highlight the misperception that pharmacologic heart rate lowering is beneficial, which has resulted in an overprescription of beta-blockers in HFpEF and AF. In contrast, heart rate modulation through accelerated pacing provides hemodynamic and structural advantages, which have yielded significant improvements in quality of life, physical activity, and AF burden in the myPACE trial of patients with preclinical or overt HFpEF.

Background: Vascular access-site complications are the most frequent complications of percutaneous catheter ablation (CA) of ventricular arrhythmias (VAs). Whether arterial/venous vascular closure devices (VCDs) prevent vascular complications is unknown.

Objective: We investigated the benefit of VCDs in patients undergoing CA of VAs.

Methods: Consecutive CA of VAs were included (2018-2022). Vascular accesses were obtained with ultrasound guidance. At the discretion of the operator, arterial and/or venous VCDs were used. Cases were divided into 3 groups: no use of VCDs for any of the arterial/venous accesses (manual compression - MC), use of VCDs for some but not the all of the accesses (Partial-VCDs), use of VCDs for all of the accesses (Complete-VCDs). Vascular complications were defined minor if they didn't require intervention or major if they required intervention.

Results: A total of 1,016 procedures were performed in 872 patients (62±13 years, BMI 30±6 kg/m², 27% female) during the study period. Femoral arterial access was obtained in 887 procedures (875 single access - 7.4±1.5 Fr size, 12 two accesses - 7.3±3 Fr and 6.9±1.8 Fr). Femoral venous access was obtained in 1,014 procedures (unilateral in 17%, bilateral in 83%, mean N. 2.6±0.7, 8.4±1.3 Fr). Hemostasis was achieved with MC in 192 (19%) procedures, Partial-VCD in 275 (27%), and Complete-VCD in 549 (54%). A vascular complication occurred in 52 (5.1%) procedures, including a minor hematoma in 3.9% and/or a major complication in 1.7%. The rate of vascular complications was 6.8% (5.2% minor and 1.6% major) in the MC group, 7.6% (5.1% minor and 3.3% major) in the Partial-VCD group, and 3.3% (2.9% minor and 0.9% major, P=0.014 for comparison) in the Complete-VCD group. At multivariable analysis, Complete-VCD remained independently associated with lower risk of vascular complications (odds ratio 0.69, 95% confidence interval 0.48 to 0.96, P=0.036).

Conclusions: In patients undergoing CA of VAs, Complete-VCD is associated with lower rates of vascular-related complications compared to MC or Partial-VCD.

Background: The DECAAF-II randomized trial showed no difference in AF recurrence with additional delayed enhancement MRI (DE-MRI) fibrosis-targeted ablation to pulmonary vein isolation (PVI) in persistent AF.

Objectives: We evaluated the impact of lesion delivery on ablation-induced scarring and AF recurrence.

Methods: Lesions delivered, targeting fibrotic and non-fibrotic areas identified from pre-ablation DE-MRI, were studied in relation to ablation-induced scarring on 3-months DE-MRI, including their association with arrhythmia recurrence.

Results: 593 patients, treated with radiofrequency were analyzed: 293 underwent PVI and 300 underwent additional fibrosis-guided ablation. Lesion analysis showed that 80.9% in the MRI fibrosis-guided group vs 16.5% in the PVI group (p<0.001), had ≥ 40% of baseline fibrosis targeted. MRI assessment of ablation-induced scar showed that 44.8% of fibrosis-guided ablation and 15.5% of PVI had ≥ 40% of their fibrosis covered by scar (P<0.001), demonstrating a significant attenuation from lesions delivered to scar formed. In the overall population, fibrosis coverage with scar was not associated with recurrence (HR 0.90, 95% confidence interval [CI] 0.80-1.01, p = 0.08 per 20% increase). In patients with baseline fibrosis <20%, fibrosis coverage with scar was associated with lower recurrence than PVI (HR 0.85; 95% CI [0.73-0.97]; p=0.03), whereas the association was not significant when baseline fibrosis ≥20% (HR 0.97; [0.80-1.17], p=0.77). Significant center variation was observed in fibrosis targeting and coverage with scarring.

Conclusions: Radiofrequency ablation lesions do not uniformly result in scar formation. Post hoc analysis suggests reduced arrhythmia recurrence when ablation-induced scarring covers fibrotic regions in patients with low baseline fibrosis.