Heart rhythm最新文献

英文中文

Effect of posture on position of subcutaneous implantable cardioverter-defibrillator 姿势对皮下植入式除颤器位置的影响。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.07.122

Shari Pepplinkhuizen MD, Anje M. Spijkerboer MD, PhD, Willeke van der Stuijt MD, PhD, Jolien A. de Veld MD, Leonard A. Dijkshoorn MD, Zosja E. Stenchlak MSc, Marlin A.A. Reijerink MSc, Anouk de Weger MSc, Lonneke Smeding PhD, Louise R.A. Olde Nordkamp MD, PhD, Arthur A.M. Wilde MD, PhD, Reinoud E. Knops MD, PhD

Background

The PRAETORIAN score was developed as an alternative for defibrillation testing after subcutaneous implantable cardioverter-defibrillator implantation to assess 3 aspects of implant position on a bidirectional chest radiograph. The score is validated on a standard standing chest radiograph with arms elevated in the lateral view.

Objective

We aimed to evaluate the effect of different anatomic positions on the PRAETORIAN score.

Methods

Thirty patients with a subcutaneous implantable cardioverter-defibrillator underwent standard posterior-anterior and lateral chest radiography, including additional lateral views in 2 positions: standing with arms down and supine with arms alongside the body. PRAETORIAN score and weighted κ coefficient were calculated for each position.

Results

In 8 of 30 patients, the PRAETORIAN score was ≥90 in standard position. The agreement in PRAETORIAN score was substantial (κ = 0.677) for the position with the arms down and fair (κ = 0.399) for the supine position. With the arms down, the PRAETORIAN score decreased in 10 patients (33%), 4 of whom changed to a lower risk category. In supine position, the PRAETORIAN score decreased in 16 patients (53%), 7 of whom changed to a lower risk category, 1 from high to low risk.

Conclusion

A supine or arms-down position during chest radiography can result in lower PRAETORIAN scores and underestimation of associated risk on defibrillation testing failure. This emphasizes the importance of correct anatomic positioning (arms up) during chest radiography when the PRAETORIAN score is used.

背景：PRAETORIAN 评分是作为皮下植入式心律转复除颤器 (S-ICD) 植入术后除颤测试 (DFT) 的替代方法而开发的，该评分通过双向胸部 X 光片对植入位置的三个方面进行评估。该评分在双臂抬高侧视的标准站立胸部 X 光片上进行验证：我们旨在评估不同解剖位置对 PRAETORIAN 评分的影响：30 名 S-ICD 患者接受了标准的后前方 (PA) 和侧方胸部 X 光检查，包括两种体位下的额外侧方视图：站立时双臂下垂和仰卧时双臂并拢。计算了每种体位的 PRAETORIAN 评分和加权卡帕系数：结果：30 名患者中有 8 名患者在标准体位下 PRAETORIAN 评分≥90 分。双臂下垂体位的 PRAETORIAN 评分一致性很好（κ=0.677），仰卧位的一致性一般（κ=0.399）。10名患者（33%）在双臂下垂的情况下，PRAETORIAN评分下降，其中4人转为较低的风险类别。仰卧位时，16 名患者（53%）的 PRAETORIAN 评分下降，其中 7 人转为较低风险类别，1 人从高风险转为低风险：结论：胸部 X 光检查时采取仰卧位或双臂下垂位会导致 PRAETORIAN 评分降低，低估 DFT 失败的相关风险。这强调了在使用 PRAETORIAN 评分时，胸部 X 光检查时正确的解剖定位（"双臂上举"）的重要性。

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引用次数: 0

Outcome of cardiac implantable electronic devices in pediatric heart transplant recipients 小儿心脏移植受者植入心脏电子设备的结果。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.08.042

Shankar Baskar MD, FHRS , Edward T. O’Leary MD , Robert Whitehill MD , Lanier Jackson MD , Clifford Chin MD , Douglas Y. Mah MD, FHRS , Tam Dan N. Pham MD

引用次数: 0

The association between antithrombotic drug regimen changes and clinical outcomes after stroke in atrial fibrillation 心房颤动患者中风后抗血栓药物治疗方案变化与临床结果之间的关系。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.07.115

Jo-Nan Liao MD , Yi-Hsin Chan MD , Ling Kuo MD , Chuan-Tsai Tsai MB, BS , Chih-Min Liu MD , Tzeng-Ji Chen MD , Gregory Y.H. Lip MD , Shih-Ann Chen MD , Tze-Fan Chao MD

Background

The impact of post-stroke antithrombotic regimen in atrial fibrillation is uncertain.

Objective

This study aimed to describe antithrombotic therapy prescribing patterns after ischemic stroke and the impact on outcomes.

Methods

A total of 23,165 patients with atrial fibrillation experiencing ischemic stroke were identified. Subsequent post-stroke events included recurrent ischemic stroke, intracranial hemorrhage, major bleeding, mortality, and composite outcomes.

Results

Of those who were nonanticoagulated before a stroke, 33.5% remained nonanticoagulated and 39.2% were prescribed only antiplatelet agents (APs) after a stroke. Compared with non–vitamin K antagonist oral anticoagulants (NOACs) after stroke, there was a significant increase in ischemic stroke and mortality in nonanticoagulated patients (adjusted hazard ratio [aHR], 2.09 and 3.92) and AP users (aHR, 1.32 and 1.28). Post-stroke warfarin was associated with a significantly increased risk of major bleeding compared with NOACs (aHR, 1.23). Of 769 patients receiving NOACs before stroke and continuing NOACs after stroke, those switching to a different NOAC were associated with significantly higher risk of ischemic stroke (aHR, 2.07) and composite outcomes (aHR, 1.36–1.85) with no difference in intracranial hemorrhage, major bleeding, or mortality compared with those receiving the same NOAC after stroke. Of patients receiving NOACs before stroke, the risks of clinical events were similar between patients taking NOACs alone and those taking NOAC plus AP after stroke.

Conclusion

NOAC alone after stroke was associated with a better clinical outcome compared with nonanticoagulation, AP, or warfarin. Of patients already taking NOACs before stroke, the addition of AP did not confer additional benefits compared with NOACs alone. A change of NOAC types after stroke was associated with a 2-fold higher risk of ischemic stroke and composite outcomes.

背景：卒中后抗血栓治疗对心房颤动（房颤）的影响尚不确定：心房颤动（房颤）患者卒中后抗血栓治疗方案的影响尚不确定：目的：描述缺血性中风后抗血栓治疗的处方模式及其对预后的影响：方法：共识别了 23,165 名发生缺血性中风的房颤患者。中风后的后续事件包括复发性缺血性中风、颅内出血（ICH）、大出血、死亡率和综合结果：结果：在卒中前未接受抗凝治疗的患者中，33.5%仍未接受抗凝治疗，39.2%在卒中后仅服用抗血小板药物（AP）。与卒中后使用 NOAC 相比，未使用抗凝药者（aHRs 2.09 和 3.92）和使用抗血小板者（aHRs 1.32 和 1.28）的缺血性卒中发生率和死亡率显著增加。与 NOACs 相比，脑卒中后华法林导致大出血的风险明显增加（aHR 1.23）。在卒中前接受 NOACs 且卒中后继续使用 NOACs 的 769 例患者中，与卒中后使用相同 NOACs 的患者相比，转用不同 NOACs 的患者发生缺血性卒中的风险（aHR 2.07）和复合结局（aHR 1.36-1.85）明显升高，而发生 ICH、大出血或死亡的风险则无差异。在卒中前接受 NOACs 治疗的患者中，卒中后单用 NOACs 和 NOAC 加 AP 的患者发生临床事件的风险相似：结论：与不抗凝、AP 或华法林相比，卒中后单用 NOAC 可获得更好的临床预后。在卒中前已服用 NOACs 的患者中，与单用 NOACs 相比，加用 AP 并不会带来额外的益处。中风后更换NOAC类型与缺血性中风和综合结果风险增加两倍有关。

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引用次数: 0

Table of Content

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/S1547-5271(24)03690-7

引用次数: 0

Catheter ablation approach targeting epicardial connections to the right pulmonary vein antrum detected before pulmonary vein isolation 针对肺静脉隔离前检测到的右肺静脉窦心外膜连接的导管消融方法。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.07.104

Yosuke Nakatani MD , Yutaka Take MD , Shingo Yoshimura MD , Ryoya Takizawa MD , Koji Goto MD , Kenichi Kaseno MD , Yumiko Haraguchi MD , Koki Kimura MD , Takehito Sasaki MD , Yuko Miki MD , Kohki Nakamura MD , Shigeto Naito MD

Background

Epicardial connections from surrounding structures to the right pulmonary vein (PV) antrum impede PV isolation.

Objective

This study aimed to evaluate the efficacy of an ablation approach targeting epicardial connections for right PV isolation.

Methods

We prospectively enrolled 124 patients with atrial fibrillation undergoing initial PV isolation. We identified the activation breakthrough into the right PV antrum (BT-RPV) on the activation map created during high right atrial pacing before PV isolation. BT-RPV sites were targeted when right PV isolation was not achieved by wide antral circumferential ablation (WACA).

Results

BT-RPV was observed in 83 patients (67%). PV isolation was achieved by WACA in all 41 patients without BT-RPV. Among patients with BT-RPV, PV isolation was achieved by WACA in 48 patients when all BT-RPV sites were covered by the PV isolation line. Conversely, PV isolation was completed by WACA in only 5 of 35 patients when not all BT-RPV sites were covered. In patients where WACA failed, 35 sites were targeted for BT-RPV ablation. Initial BT-RPV ablation led to PV isolation at 20 sites, while the remaining 15 BT-RPV sites required repeat BT-RPV ablation. The ablated area of successful BT-RPV ablation was 0.9 (0.6–1.2) cm², corresponding to the area activated within 15 (14–16) ms after BT-RPV emergence. Ablating the area activated within 14 ms of BT-RPV emergence was associated with successful PV isolation (sensitivity 91%; specificity 100%).

Conclusion

Ablation targeting BT-RPV sites is effective for right PV isolation. Extensive ablation is required to eliminate BT-RPV.

背景：从周围结构到右肺静脉（PV）窦的心外膜连接阻碍了PV隔离：本研究旨在评估针对心外膜连接的消融方法对右侧 PV 分离的疗效：我们前瞻性地招募了124名接受初始PV隔离的心房颤动患者。我们在 PV 隔离前右心房高起搏时绘制的激活图上确定了进入右 PV 腔的激活突破点（BT-RPV）。当通过宽前叶环形消融术（WACA）无法实现右侧 PV 隔离时，我们就以 BT-RPV 位点为目标：结果：83 个病例（67%）观察到 BT-RPV。所有 41 例无 BT-RPV 的病例均通过 WACA 实现了 PV 隔离。在有 BT-RPV 的病例中，当所有 BT-RPV 位点都被 PV 隔离线覆盖时，有 48 例病例通过 WACA 实现了 PV 隔离。相反，在 35 个未覆盖所有 BT-RPV 位点的病例中，只有 5 个病例通过 WACA 完成了 PV 隔离。在 WACA 失败的病例中，有 35 个部位被列为 BT-RPV 消融的目标。最初的 BT-RPV 消融导致 20 个部位的 PV 隔离，而其余 15 个 BT-RPV 位点需要重复 BT-RPV 消融。成功的 BT-RPV 消融面积为 0.9 [0.6-1.2] 平方厘米，相当于 BT-RPV 出现后 15 [14-16] 毫秒内激活的区域。消融 BT-RPV 出现后 14 毫秒内激活的区域与成功隔离 PV 相关（敏感性 91%，特异性 100%）：结论：以 BT-RPV 位点为目标的消融对右侧 PV 隔离有效。结论：针对 BT-RPV 位点的消融对右侧 PV 隔离有效。

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引用次数: 0

Analysis of survival time in patients receiving cardiac implantable devices after heart transplantation 分析心脏移植后接受心脏植入装置的患者的存活时间。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.07.100

Ewa Świerżyńska-Wodarska MSc , Christopher T. Bowles PhD , Binu Raj MSc , María Monteagudo-Vela MD, PhD , Laura Załucka MD , Maciej Sterliński MD, PhD , Rebecca Lane MD

引用次数: 0

Paroxysmal atrial fibrillation history is associated with earlier recurrence after first cardioversion compared with primary persistent atrial fibrillation 与原发性持续性心房颤动相比，阵发性心房颤动史与首次心脏复律后更早复发有关。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.07.030

Christine Rutlen MD , Cassie Mullen MD , Francis Phan MD , Merritt Raitt MD, FHRS , Khidir Dalouk MD , Ignatius Zarraga MD, FHRS , David Shim MD, PhD, FHRS , Peter M. Jessel MD, FHRS

Background

Paroxysmal atrial fibrillation (pAF) may progress through cardiac remodeling to persistent atrial fibrillation (psAF). However, some may present in psAF without a preceding history of pAF. A preceding history of pAF may affect recurrence after direct current cardioversion (DCCV).

Objective

The aim of this study was to determine whether a preceding history of pAF is associated with a difference in recurrence rates after DCCV compared with patients without a preceding history of pAF.

Methods

A prospective procedural database at a Veterans Affairs center identified 565 patients who underwent their first DCCV for psAF. Initial rhythm history was separated by prior pAF, and those with none were considered primary psAF. Electrocardiography follow-up was standardized at 1 month and 3 months after cardioversion.

Results

Patients who underwent their first DCCV for psAF were more likely to have presented with primary psAF (81.6%). Those with pAF had a similar left atrial size but were more likely to have chronic kidney disease, sleep apnea, previous stroke, and use of antiarrhythmic drugs at the time of cardioversion. Patients with pAF had earlier recurrence and shorter median AF survival time, 1.6 months compared with 5 months (Kaplan-Meier plot, P = .0101). This difference persisted in controlling for antiarrhythmic drug use. Recurrence type was mostly persistent AF, similar in both groups.

Conclusion

Patients with primary psAF may have a more sustained response to DCCV compared with those with a preceding history of pAF. Thus, those patients with pAF may benefit from a more aggressive, early rhythm control strategy because of higher likelihood of recurrence with DCCV.

背景：阵发性心房颤动（pAF阵发性心房颤动（paroxysmal atrial fibrillation，pAF）可能会通过心脏重塑发展为持续性心房颤动（persistent atrial fibrillation，psAF）。然而，有些患者在出现持续性心房颤动（psAF）时并无先前的心房颤动病史。先前的心房颤动病史可能会影响直流电心律转复术（DCCV）后的复发：目的：确定与无 pAF 既往史的患者相比，pAF 既往史是否与 DCCV 后复发率的差异有关：退伍军人事务中心的前瞻性程序数据库确定了 565 名因 psAF 首次接受 DCCV 的患者。初始心律史按先前的 pAF 区分，没有 pAF 的患者被视为原发性 psAF。心电图随访在心脏复律后 1 个月和 3 个月进行：结果：首次因 psAF 接受 DCCV 的患者更有可能出现原发性 psAF（81.6%）。pAF患者的左心房大小相似，但更有可能患有慢性肾病、睡眠呼吸暂停、中风以及在心脏复律时服用抗心律失常药物。pAF患者复发较早，中位房颤存活时间较短，为1.6个月，而pAF患者为5个月（Kaplan-Meier图，P=0.0101）。在控制了AAD的使用后，这一差异依然存在。复发类型大多为持续性房颤，两组患者的情况相似：结论：与有过房颤病史的患者相比，原发性房颤患者对 DCCV 的反应可能更持久。因此，由于使用 DCCV 后复发的可能性更高，pAF 患者可能会从更积极的早期节律控制策略中获益。

{"title":"Paroxysmal atrial fibrillation history is associated with earlier recurrence after first cardioversion compared with primary persistent atrial fibrillation","authors":"Christine Rutlen MD , Cassie Mullen MD , Francis Phan MD , Merritt Raitt MD, FHRS , Khidir Dalouk MD , Ignatius Zarraga MD, FHRS , David Shim MD, PhD, FHRS , Peter M. Jessel MD, FHRS","doi":"10.1016/j.hrthm.2024.07.030","DOIUrl":"10.1016/j.hrthm.2024.07.030","url":null,"abstract":"<div><h3>Background</h3><div>Paroxysmal atrial fibrillation (pAF) may progress through cardiac remodeling to persistent atrial fibrillation (psAF). However, some may present in psAF without a preceding history of pAF. A preceding history of pAF may affect recurrence after direct current cardioversion (DCCV).</div></div><div><h3>Objective</h3><div>The aim of this study was to determine whether a preceding history of pAF is associated with a difference in recurrence rates after DCCV compared with patients without a preceding history of pAF.</div></div><div><h3>Methods</h3><div>A prospective procedural database at a Veterans Affairs center identified 565 patients who underwent their first DCCV for psAF. Initial rhythm history was separated by prior pAF, and those with none were considered primary psAF. Electrocardiography follow-up was standardized at 1 month and 3 months after cardioversion.</div></div><div><h3>Results</h3><div>Patients who underwent their first DCCV for psAF were more likely to have presented with primary psAF (81.6%). Those with pAF had a similar left atrial size but were more likely to have chronic kidney disease, sleep apnea, previous stroke, and use of antiarrhythmic drugs at the time of cardioversion. Patients with pAF had earlier recurrence and shorter median AF survival time, 1.6 months compared with 5 months (Kaplan-Meier plot, <em>P</em> = .0101). This difference persisted in controlling for antiarrhythmic drug use. Recurrence type was mostly persistent AF, similar in both groups.</div></div><div><h3>Conclusion</h3><div>Patients with primary psAF may have a more sustained response to DCCV compared with those with a preceding history of pAF. Thus, those patients with pAF may benefit from a more aggressive, early rhythm control strategy because of higher likelihood of recurrence with DCCV.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 2","pages":"Pages 418-423"},"PeriodicalIF":5.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733900","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}

引用次数: 0

To the Editor — Hemodynamic consequences of left atrial appendage occlusion 左心房阑尾闭塞的血液动力学后果。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.05.065

Claudia Stöllberger MD , Josef Finsterer MD, PhD , Birke Schneider MD

引用次数: 0

A fleck of light: Drug superiority for idiopathic pediatric PVCs "一束光治疗特发性小儿 PVC 的药物优势"。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2025-02-01 DOI: 10.1016/j.hrthm.2024.08.029

Mitchell I. Cohen MD, FACC, FHRS

引用次数: 0