{"title":"Is transition from nonselective left bundle branch pacing to selective left bundle branch pacing superior to left ventricular septal pacing transition at lead implantation?","authors":"Yoji Iida MD , Tomoaki Izawa MD, PhD , Nobuyuki Makishima MD, PhD","doi":"10.1016/j.hrthm.2025.10.039","DOIUrl":"10.1016/j.hrthm.2025.10.039","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e502-e504"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354675","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 : 2026-03-01Epub Date: 2025-11-18DOI: 10.1016/j.hrthm.2025.11.028
Yichang Zhao MD , Yue Gong MS , Zhenyu Feng PhD , Yang Li MS , Chunkai Li MS , Qianqian Wang MS , Fenglan Huang MS , Yanxiao Su MS , Jinqiu Liu MD , Yunpeng Xie PhD , Feifei Chen MD
Background
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia globally, leading to increased mortality and morbidity. Corin has been shown to play an important role in AF in clinical trials, but the specific mechanism is unknown.
Objective
This study aimed to investigate the molecular mechanisms underlying AF by examining the roles of Corin protein and miR-19b-1-5p in AF pathogenesis.
Methods
The study used an angiotensin II (Ang II)-induced AF mouse model to assess the impact of Corin and miR-19b-1-5p on atrial remodeling. Various techniques including molecular analysis, histological staining, and gene expression profiling were employed to evaluate the effects of Corin and miR-19b-1-5p in the development of AF.
Results
The research demonstrated that knockdown of Corin exacerbated Ang II-induced atrial electrical and structural remodeling, contributing to atrial fibrosis and AF progression. Knockdown of Corin exacerbated atrial electrical and structural remodeling induced by Ang II, resulting in increased atrial size, elevated AF incidence, enhanced fibrosis, and oxidative stress levels. Furthermore, miR-19b-1-5p was identified as a negative regulator of Corin messenger ribonucleic acid expression, influencing atrial remodeling in the Ang II-induced AF model.
Conclusion
The findings suggest that both miR-19b-1-5p and Corin offer valuable insights into the molecular mechanisms of AF. Targeting these molecules may present potential therapeutic strategies for the treatment of AF in the future.
{"title":"Corin is regulated by miR-19b-1-5p to inhibit Ang II-induced atrial fibrillation","authors":"Yichang Zhao MD , Yue Gong MS , Zhenyu Feng PhD , Yang Li MS , Chunkai Li MS , Qianqian Wang MS , Fenglan Huang MS , Yanxiao Su MS , Jinqiu Liu MD , Yunpeng Xie PhD , Feifei Chen MD","doi":"10.1016/j.hrthm.2025.11.028","DOIUrl":"10.1016/j.hrthm.2025.11.028","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia globally, leading to increased mortality and morbidity. Corin has been shown to play an important role in AF in clinical trials, but the specific mechanism is unknown.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the molecular mechanisms underlying AF by examining the roles of Corin protein and miR-19b-1-5p in AF pathogenesis.</div></div><div><h3>Methods</h3><div>The study used an angiotensin II (Ang II)-induced AF mouse model to assess the impact of Corin and miR-19b-1-5p on atrial remodeling. Various techniques including molecular analysis, histological staining, and gene expression profiling were employed to evaluate the effects of Corin and miR-19b-1-5p in the development of AF.</div></div><div><h3>Results</h3><div>The research demonstrated that knockdown of Corin exacerbated Ang II-induced atrial electrical and structural remodeling, contributing to atrial fibrosis and AF progression. Knockdown of Corin exacerbated atrial electrical and structural remodeling induced by Ang II, resulting in increased atrial size, elevated AF incidence, enhanced fibrosis, and oxidative stress levels. Furthermore, miR-19b-1-5p was identified as a negative regulator of Corin messenger ribonucleic acid expression, influencing atrial remodeling in the Ang II-induced AF model.</div></div><div><h3>Conclusion</h3><div>The findings suggest that both miR-19b-1-5p and Corin offer valuable insights into the molecular mechanisms of AF. Targeting these molecules may present potential therapeutic strategies for the treatment of AF in the future.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e463-e475"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563715","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 : 2026-03-01Epub Date: 2025-12-15DOI: 10.1016/j.hrthm.2025.12.022
Damijan Miklavčič PhD , Lea Rems PhD , Matevž Jan MD, PhD , Bor Kos PhD
Pulsed field ablation (PFA) is being adopted as a safer and more efficient alternative to conventional thermal ablation methods for the treatment of cardiac arrhythmias, particularly atrial fibrillation. In this review, we examine the basic biophysics of PFA, focusing on electroporation at the membrane, cellular, and tissue levels to provide mechanistic explanations for the observed clinical outcomes. We analyze both the benefits and limitations of the nonthermal, tissue-selective nature of PFA, examine adverse events, and emphasize the need for standardized comparisons among different manufacturers’ systems. Drawing on decades of electroporation research in other biomedical fields, we suggest that deeper scientific understanding is key to optimizing PFA technology, improving long-term outcomes, and maintaining its strong safety profile. Open questions and future directions for clinical translation and refinement of the procedure are also discussed, considering both atrial and ventricular ablation.
{"title":"Pulsed field ablation: Disrupting technology in cardiac electrophysiology","authors":"Damijan Miklavčič PhD , Lea Rems PhD , Matevž Jan MD, PhD , Bor Kos PhD","doi":"10.1016/j.hrthm.2025.12.022","DOIUrl":"10.1016/j.hrthm.2025.12.022","url":null,"abstract":"<div><div>Pulsed field ablation (PFA) is being adopted as a safer and more efficient alternative to conventional thermal ablation methods for the treatment of cardiac arrhythmias, particularly atrial fibrillation. In this review, we examine the basic biophysics of PFA, focusing on electroporation at the membrane, cellular, and tissue levels to provide mechanistic explanations for the observed clinical outcomes. We analyze both the benefits and limitations of the nonthermal, tissue-selective nature of PFA, examine adverse events, and emphasize the need for standardized comparisons among different manufacturers’ systems. Drawing on decades of electroporation research in other biomedical fields, we suggest that deeper scientific understanding is key to optimizing PFA technology, improving long-term outcomes, and maintaining its strong safety profile. Open questions and future directions for clinical translation and refinement of the procedure are also discussed, considering both atrial and ventricular ablation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 581-592"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774416","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 : 2026-03-01Epub Date: 2025-04-11DOI: 10.1016/j.hrthm.2025.04.007
Guénaëlle Lizot PhD , Jocelyn Bescond PhD , Yves De Koninck PhD , Mohamed Chahine PhD , Patrick Bois PhD , Jean-François Faivre PhD , Aurélien Chatelier PhD
Background
The intrinsic cardiac nervous system is a complex system that plays a critical role in the regulation of cardiac physiologic parameters and has been shown to contribute to cardiac arrhythmias. To date, several types of neurons with distinct neurochemical and electrophysiologic phenotypes have been identified. However, no study has correlated the neurochemical phenotype to a specific electrophysiologic behavior. Calbindin-D28k, a calcium-binding protein, is expressed in numerous cardiac neurons.
Objective
Given that changes in neuronal excitability have been associated with arrhythmia susceptibility and that calbindin expression has been associated with modulations of neuronal excitability, our objective was to assess whether the cardiac calbindin neuronal population has specific properties that could be involved in cardiac regulation and arrhythmias.
Methods
By using a Cre-Lox mouse model to specifically target calbindin neurons with a fluorescent reporter, we characterized the neurochemical and electrophysiologic phenotype of this cardiac neuronal population.
Results
Calbindin neurons exhibit a specific neurochemical expression profile and a larger soma with shorter neurite length compared with other neurons. This was combined with a distinct electrophysiologic signature characterized by a lower excitability with a predominantly phasic profile associated to a lower N-type calcium current density.
Conclusion
Calbindin cardiac neurons display distinct neurochemical, morphologic, and electrophysiologic properties, resembling the cardiac neuronal remodeling observed in pathologic processes such as heart failure. Therefore, we believe that this specific neuronal population deserves investigation in the context of cardiac diseases.
{"title":"Excitability properties of cardiac calbindin neurons: Identifying a unique neuronal population","authors":"Guénaëlle Lizot PhD , Jocelyn Bescond PhD , Yves De Koninck PhD , Mohamed Chahine PhD , Patrick Bois PhD , Jean-François Faivre PhD , Aurélien Chatelier PhD","doi":"10.1016/j.hrthm.2025.04.007","DOIUrl":"10.1016/j.hrthm.2025.04.007","url":null,"abstract":"<div><h3>Background</h3><div><span>The intrinsic cardiac nervous system is a complex system that plays a critical role in the regulation of cardiac physiologic parameters and has been shown to contribute to </span>cardiac arrhythmias<span>. To date, several types of neurons with distinct neurochemical and electrophysiologic phenotypes have been identified. However, no study has correlated the neurochemical phenotype to a specific electrophysiologic behavior. Calbindin-D28k, a calcium-binding protein, is expressed in numerous cardiac neurons.</span></div></div><div><h3>Objective</h3><div><span>Given that changes in neuronal excitability have been associated with arrhythmia susceptibility and that </span>calbindin<span> expression has been associated with modulations of neuronal excitability, our objective was to assess whether the cardiac calbindin neuronal population has specific properties that could be involved in cardiac regulation and arrhythmias.</span></div></div><div><h3>Methods</h3><div>By using a Cre-Lox mouse model to specifically target calbindin neurons with a fluorescent reporter, we characterized the neurochemical and electrophysiologic phenotype of this cardiac neuronal population.</div></div><div><h3>Results</h3><div><span>Calbindin neurons exhibit a specific neurochemical expression profile and a larger soma with shorter </span>neurite<span> length compared with other neurons. This was combined with a distinct electrophysiologic signature characterized by a lower excitability with a predominantly phasic profile associated to a lower N-type calcium current density.</span></div></div><div><h3>Conclusion</h3><div>Calbindin cardiac neurons display distinct neurochemical, morphologic, and electrophysiologic properties, resembling the cardiac neuronal remodeling observed in pathologic processes<span> such as heart failure. Therefore, we believe that this specific neuronal population deserves investigation in the context of cardiac diseases.</span></div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 741-750"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998032","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 : 2026-03-01Epub Date: 2025-09-08DOI: 10.1016/j.hrthm.2025.09.004
Joe Demian MD, Arwa Younis MD, David O. Martin MD, Pasquale Santangeli MD, PhD, Tyler L. Taigen MD, Medhat Farwati MD, Arshneel Kochar MD, Ayman A. Hussein MD, Oussama M. Wazni MD, MBA, Thomas D. Callahan MD
Background
Transvenous lead extraction (TLE) is increasingly performed in older adults, but literature has reported divergent outcomes in very old populations.
Objective
This study aimed to investigate the impact of patient age on TLE outcomes, with an emphasis on older patients.
Methods
Using the ExTRACT registry, the largest TLE registry to date, we analyzed 5090 patients who underwent TLE between August 1996 and 2022 at the Cleveland Clinic, a high-volume center. Patients were stratified into 4 age groups: younger adults (<65 years; n = 2345), youngest old (65–74 years; n = 1430), middle old (75–84 years; n = 1056), and oldest old (≥85 years; n = 259). Baseline characteristics and procedural outcomes were compared. Multivariable logistic regression was conducted to assess age as a predictor of procedural complications.
Results
Complete procedural success exceeded 95% in all groups, highest in those aged ≥85 years (97.6% vs 95.5% in <65 years; P = .035). Major complication rates were low and similar across groups (3.5% in ≥85 vs 2.8% in <65 years; P = .517). In-laboratory mortality was rare (0.77% in ≥85 vs 0.13% in <65 years; P = .175). Multivariable analysis found no significant association between age and complications, including sternotomy, superior vena cava/right atrial tear, or death. Increased hemothorax was observed in the ≥85 group (odds ratio, 11.88; 95% confidence interval, 1.50–68.45; P = .008), although incidence remained <1%. Infection was the leading extraction indication in older adults (75% in ≥85 vs 31% in <65 years; P < .001), yet outcomes remained uniformly favorable.
Conclusion
In a high-volume center, TLE is safe and highly effective across all age groups, yielding similar outcomes, save for an increased risk of hemothorax in patients ≥85 years. These findings support age-neutral referral when clinically indicated.
背景：经静脉铅提取（TLE）越来越多地用于老年人，但文献报道了在非常老的人群中不同的结果。目的：探讨患者年龄对TLE预后的影响，重点关注老年患者。方法：使用ExTRACT注册表（迄今为止最大的TLE注册表），我们分析了1996年8月至2022年期间在克利夫兰诊所（一个大容量中心）接受TLE的5090例患者。患者被分为四组：年轻人(结果：所有组的手术成功率均超过95%，≥85岁的患者成功率最高（97.6% vs 95.5%）结论：在大容量中心，TLE在所有年龄组中都是安全和高效的，除了≥85岁的患者血胸风险增加外，结果相似。这些发现支持临床指征时的年龄中立转诊。
{"title":"Age-stratified outcomes of transvenous lead extraction: A 5090-patient experience from the ExTRACT registry","authors":"Joe Demian MD, Arwa Younis MD, David O. Martin MD, Pasquale Santangeli MD, PhD, Tyler L. Taigen MD, Medhat Farwati MD, Arshneel Kochar MD, Ayman A. Hussein MD, Oussama M. Wazni MD, MBA, Thomas D. Callahan MD","doi":"10.1016/j.hrthm.2025.09.004","DOIUrl":"10.1016/j.hrthm.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Transvenous lead extraction (TLE) is increasingly performed in older adults, but literature has reported divergent outcomes in very old populations.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the impact of patient age on TLE outcomes, with an emphasis on older patients.</div></div><div><h3>Methods</h3><div>Using the ExTRACT registry, the largest TLE registry to date, we analyzed 5090 patients who underwent TLE between August 1996 and 2022 at the Cleveland Clinic, a high-volume center. Patients were stratified into 4 age groups: younger adults (<65 years; n = 2345), youngest old (65–74 years; n = 1430), middle old (75–84 years; n = 1056), and oldest old (≥85 years; n = 259). Baseline characteristics and procedural outcomes were compared. Multivariable logistic regression was conducted to assess age as a predictor of procedural complications.</div></div><div><h3>Results</h3><div>Complete procedural success exceeded 95% in all groups, highest in those aged ≥85 years (97.6% vs 95.5% in <65 years; <em>P</em> = .035). Major complication rates were low and similar across groups (3.5% in ≥85 vs 2.8% in <65 years; <em>P</em> = .517). In-laboratory mortality was rare (0.77% in ≥85 vs 0.13% in <65 years; <em>P</em> = .175). Multivariable analysis found no significant association between age and complications, including sternotomy, superior vena cava/right atrial tear, or death. Increased hemothorax was observed in the ≥85 group (odds ratio, 11.88; 95% confidence interval, 1.50–68.45; <em>P</em> = .008), although incidence remained <1%. Infection was the leading extraction indication in older adults (75% in ≥85 vs 31% in <65 years; <em>P</em> < .001), yet outcomes remained uniformly favorable.</div></div><div><h3>Conclusion</h3><div>In a high-volume center, TLE is safe and highly effective across all age groups, yielding similar outcomes, save for an increased risk of hemothorax in patients ≥85 years. These findings support age-neutral referral when clinically indicated.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 671-678"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033024","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 : 2026-03-01Epub Date: 2025-12-03DOI: 10.1016/j.hrthm.2025.11.048
Ivan Eltsov MD, PhD , Ingrid Overeinder MD , Luigi Pannone MD, PhD , Alvise Del Monte MD , Neal Duong MSc , Kayla Molina MSc , Domenico Della Rocca MD, PhD , Gezim Bala MD, PhD , Giacomo Talevi MSc , Erwin Stroker MD, PhD , Juan Sieira MD, PhD , Ali Gharaviri PhD , Andrea Sarkozy MD, PhD , Gian-Battista Chierchia MD, PhD , Paul Iaizzo PhD, FHRS , Mark La Meir MD, PhD , Alexandre Almorad MD , Carlo de Asmundis MD, PhD, FHRS
Background
Left bundle branch area pacing is currently the procedure of choice for various indications including atrioventricular block and is considered a physiological modality of pacing compared with right ventricular apex pacing especially in young adults.
Objectives
This study aimed to increase the precision of left bundle branch area pacing (LBBAP) lead placement by developing a novel implantation technique using electrocardiographic imaging (ECGI).
Methods
This is a single-center prospective study. 10 consecutive patients who underwent an LBBAP device implantation under real-time ECGI guidance have been included in the study. Lead positioning was initially performed using fluoroscopy and a pacemaker analyzer only; then electrocardiographic (ECG) and ECGI analyses were performed in real time during the implantation at each lead position before and after fixation. ECG and ECGI parameters were measured as previously described. A directional activation map has been created for each attempt before lead fixation to ensure the final position. Correlation analysis between 12-lead ECG and ECGI values has been performed to analyze redundancy.
Results
LBBAP implantation was successful in all patients. ECGI has been shown to be a fast and visual way to assess interventricular activation at every stage of conduction system pacing lead implantation. Inferoposterior sheath positions are associated with long total ventricular activation time using ECGI and higher interventricular dyssynchrony than anterosuperior septal sheath positions. All procedures were performed with only 1 screwing attempt. Screwing depth is mostly characterized by total ventricular activation time and left ventricular activation time using ECGI reduction during the screwing process. Previously described discordance between classic ECG parameters and ECGI analysis was confirmed, and redundancy of certain parameters was confirmed. Correlation analysis confirmed the importance of ECGI measurement of right ventricular activation in general and total activation time and left ventricular activation time for patients with an intrinsic QRS duration of >130 ms.
Conclusion
ECGI can bring significant value to conduction system device implantation. ECGI allows direct visualization of every procedural step, and its values confirm correct lead positioning and physiological ventricular activation. This might be very helpful in clinical practice by reducing the number of fixation attempts and proper activation assessment during the implantation, especially for patients with difficult cardiac and noncardiac anatomy.
{"title":"Innovative approach to conduction system pacing: Real-time ECG imaging guidance for precise left bundle branch area pacemaker lead placement","authors":"Ivan Eltsov MD, PhD , Ingrid Overeinder MD , Luigi Pannone MD, PhD , Alvise Del Monte MD , Neal Duong MSc , Kayla Molina MSc , Domenico Della Rocca MD, PhD , Gezim Bala MD, PhD , Giacomo Talevi MSc , Erwin Stroker MD, PhD , Juan Sieira MD, PhD , Ali Gharaviri PhD , Andrea Sarkozy MD, PhD , Gian-Battista Chierchia MD, PhD , Paul Iaizzo PhD, FHRS , Mark La Meir MD, PhD , Alexandre Almorad MD , Carlo de Asmundis MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.11.048","DOIUrl":"10.1016/j.hrthm.2025.11.048","url":null,"abstract":"<div><h3>Background</h3><div>Left bundle branch area pacing is currently the procedure of choice for various indications including atrioventricular block and is considered a physiological modality of pacing compared with right ventricular apex pacing especially in young adults.</div></div><div><h3>Objectives</h3><div>This study aimed to increase the precision of left bundle branch area pacing (LBBAP) lead placement by developing a novel implantation technique using electrocardiographic imaging (ECGI).</div></div><div><h3>Methods</h3><div>This is a single-center prospective study. 10 consecutive patients who underwent an LBBAP device implantation under real-time ECGI guidance have been included in the study. Lead positioning was initially performed using fluoroscopy and a pacemaker analyzer only; then electrocardiographic (ECG) and ECGI analyses were performed in real time during the implantation at each lead position before and after fixation. ECG and ECGI parameters were measured as previously described. A directional activation map has been created for each attempt before lead fixation to ensure the final position. Correlation analysis between 12-lead ECG and ECGI values has been performed to analyze redundancy.</div></div><div><h3>Results</h3><div>LBBAP implantation was successful in all patients. ECGI has been shown to be a fast and visual way to assess interventricular activation at every stage of conduction system pacing lead implantation. Inferoposterior sheath positions are associated with long total ventricular activation time using ECGI and higher interventricular dyssynchrony than anterosuperior septal sheath positions. All procedures were performed with only 1 screwing attempt. Screwing depth is mostly characterized by total ventricular activation time and left ventricular activation time using ECGI reduction during the screwing process. Previously described discordance between classic ECG parameters and ECGI analysis was confirmed, and redundancy of certain parameters was confirmed. Correlation analysis confirmed the importance of ECGI measurement of right ventricular activation in general and total activation time and left ventricular activation time for patients with an intrinsic QRS duration of >130 ms.</div></div><div><h3>Conclusion</h3><div>ECGI can bring significant value to conduction system device implantation. ECGI allows direct visualization of every procedural step, and its values confirm correct lead positioning and physiological ventricular activation. This might be very helpful in clinical practice by reducing the number of fixation attempts and proper activation assessment during the implantation, especially for patients with difficult cardiac and noncardiac anatomy.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e453-e462"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687359","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 : 2026-03-01Epub Date: 2025-12-19DOI: 10.1016/j.hrthm.2025.12.030
Ato Howard MD, Krishna Kancharla MD, Konstantinos N. Aronis MD, PhD, Aditya Bhonsale MD, PhD, Andrew H. Voigt MD, FHRS, Mehak Dhande MD, Sandeep K. Jain MD, FHRS, Mark Estes MD, FHRS, Samir F. Saba MD, FHRS, Alaa A. Shalaby MD, MSc, FHRS
Background
Increasingly, transvenous lead extractions (TLEs) have become more complex.
Objective
This study aimed to describe a novel technique for femoral snaring using commercially available equipment and study the application of this technique for a tandem approach in TLE cases with long-dwelling leads compared with conventional TLE.
Methods
We include 59 patients with long-dwelling transvenous leads who underwent powered sheath TLE with either upfront femoral snaring (n = 25) or conventional approach (n = 34). Our femoral snaring technique uses a grasping device within telescoped sheaths creating a rail for powered sheath advancement and lead dissection. Clinical and procedural data were obtained via manual electronic medical record review.
Results
Among our study cohort, 74.6% were men, the mean age was 66.1 ± 16.8 years, 57.6% were pacemaker dependent, 72.9% underwent TLE for infection, and the mean dwell time was 15.0 ± 4.7 years. The mean number of cardiac implantable electronic device leads and implantable cardioverter-defibrillator coils was 2.3 ± 1.0 and 1.8 ± 0.8, respectively. Compared with controls, intervention patients were older (72.5 ± 11.4 years vs 61.4 ± 18.6 years; P < .01) and more likely to have ischemic cardiomyopathy (52.0% vs 29.4%; P = .04), lower left ventricular ejection fraction (41.8% ± 15.7% vs 49.8% ± 11.8%; P = .02), hypertension (84.0% vs 61.8%; P = .03), diabetes (76.0% vs 14.7%; P < .01), and right-sided leads (28.0% vs 2.9%; P < .01). No significant differences were observed in procedure or fluoroscopy times with a signal of lower complication rate among the intervention group. The only procedural mortality occurred in the control group.
Conclusion
We describe a novel upfront tandem TLE technique using commercially available items applied to long-dwelling leads. This technique was safe and effective compared with contemporary controls.
{"title":"A simplified method of lead snaring to facilitate a tandem approach for long-dwelling transvenous lead extractions","authors":"Ato Howard MD, Krishna Kancharla MD, Konstantinos N. Aronis MD, PhD, Aditya Bhonsale MD, PhD, Andrew H. Voigt MD, FHRS, Mehak Dhande MD, Sandeep K. Jain MD, FHRS, Mark Estes MD, FHRS, Samir F. Saba MD, FHRS, Alaa A. Shalaby MD, MSc, FHRS","doi":"10.1016/j.hrthm.2025.12.030","DOIUrl":"10.1016/j.hrthm.2025.12.030","url":null,"abstract":"<div><h3>Background</h3><div>Increasingly, transvenous lead extractions (TLEs) have become more complex.</div></div><div><h3>Objective</h3><div>This study aimed to describe a novel technique for femoral snaring using commercially available equipment and study the application of this technique for a tandem approach in TLE cases with long-dwelling leads compared with conventional TLE.</div></div><div><h3>Methods</h3><div>We include 59 patients with long-dwelling transvenous leads who underwent powered sheath TLE with either upfront femoral snaring (n = 25) or conventional approach (n = 34). Our femoral snaring technique uses a grasping device within telescoped sheaths creating a rail for powered sheath advancement and lead dissection. Clinical and procedural data were obtained via manual electronic medical record review.</div></div><div><h3>Results</h3><div>Among our study cohort, 74.6% were men, the mean age was 66.1 ± 16.8 years, 57.6% were pacemaker dependent, 72.9% underwent TLE for infection, and the mean dwell time was 15.0 ± 4.7 years. The mean number of cardiac implantable electronic device leads and implantable cardioverter-defibrillator coils was 2.3 ± 1.0 and 1.8 ± 0.8, respectively. Compared with controls, intervention patients were older (72.5 ± 11.4 years vs 61.4 ± 18.6 years; <em>P</em> < .01) and more likely to have ischemic cardiomyopathy (52.0% vs 29.4%; <em>P</em> = .04), lower left ventricular ejection fraction (41.8% ± 15.7% vs 49.8% ± 11.8%; <em>P</em> = .02), hypertension (84.0% vs 61.8%; <em>P</em> = .03), diabetes (76.0% vs 14.7%; <em>P</em> < .01), and right-sided leads (28.0% vs 2.9%; <em>P</em> < .01). No significant differences were observed in procedure or fluoroscopy times with a signal of lower complication rate among the intervention group. The only procedural mortality occurred in the control group.</div></div><div><h3>Conclusion</h3><div>We describe a novel upfront tandem TLE technique using commercially available items applied to long-dwelling leads. This technique was safe and effective compared with contemporary controls.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e420-e427"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804276","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 : 2026-03-01Epub Date: 2025-04-15DOI: 10.1016/j.hrthm.2025.04.006
Shuaitao Yang MD , Jiu Pu MD , Jinfang Yu MD , Haixiong Wang MD, PhD, FHRS , Yuwei Wu MD , Yang Lu MD, PhD , Ning Zhao MD, PhD , Qiongfeng Wu MD, PhD , Qian Dong MD, PhD , Yimei Du MD, PhD
Background
Transient receptor potential vanilloid 4 (TRPV4), a calcium (Ca2+) permeable channel, is upregulated during myocardial ischemia-reperfusion (IR). Although TRPV4 inhibition has cardioprotective effects, its impact on arrhythmogenesis remains unclear.
Objective
This study aimed to evaluate the antiarrhythmic effects of TRPV4 inhibition, using the TRPV4 antagonist GSK2193874 (GSK219) and TRPV4 knockout (TRPV4−/−) mice, after IR.
Methods
Surface electrocardiogram and optical mapping recordings were performed during 15 minutes of global ischemia and 10 minutes of reperfusion in Langendorff perfused mouse hearts. Ca2+ sparks were detected by confocal microscopy, and protein expression was analyzed by Western blot.
Results
GSK219 or TRPV4 deletion significantly decreased the incidence and duration of ventricular tachycardia during reperfusion. TRPV4 inhibition shortened Ca2+ transient (CaT) recovery, suppressed CaT alternans, and decreased Ca2+ leak without affecting IR-induced prolongation of action potential duration (APD) and APD alternations. Activation of TRPV4 by GSK101790A (GSK101) increased arrhythmia susceptibility and Ca2+ leak. Moreover, GSK101 prolonged CaT recovery and promoted CaT alternans, which were greatly avoided by pretreatment with Ca2+/calmodulin-dependent protein kinase II (CaMKII) inhibitor. Interestingly, IR or GSK101 markedly increased the phosphorylation of CaMKII, ryanodine receptors, and phospholamban, which was significantly blocked by TRPV4 inhibition.
Conclusion
TRPV4 inhibition exerts antiarrhythmic effects after IR by modulating CaMKII-dependent Ca2+ handling abnormalities, reducing CaT alternans and Ca2+ leak, without affecting APD.
{"title":"TRPV4 inhibition suppresses myocardial ischemia-reperfusion arrhythmia of mice by alleviating calcium handling abnormalities","authors":"Shuaitao Yang MD , Jiu Pu MD , Jinfang Yu MD , Haixiong Wang MD, PhD, FHRS , Yuwei Wu MD , Yang Lu MD, PhD , Ning Zhao MD, PhD , Qiongfeng Wu MD, PhD , Qian Dong MD, PhD , Yimei Du MD, PhD","doi":"10.1016/j.hrthm.2025.04.006","DOIUrl":"10.1016/j.hrthm.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div><span>Transient receptor potential vanilloid 4 (TRPV4), a calcium (Ca</span><sup>2+</sup><span>) permeable channel, is upregulated during myocardial ischemia-reperfusion (IR). Although TRPV4 inhibition has cardioprotective effects, its impact on arrhythmogenesis remains unclear.</span></div></div><div><h3>Objective</h3><div><span>This study aimed to evaluate the antiarrhythmic effects of TRPV4 inhibition, using the TRPV4 antagonist GSK2193874 (GSK219) and TRPV4 knockout (TRPV4</span><sup>−/−</sup><span>) mice, after IR.</span></div></div><div><h3>Methods</h3><div><span>Surface electrocardiogram and optical mapping recordings were performed during 15 minutes of global ischemia and 10 minutes of reperfusion in Langendorff perfused mouse hearts. Ca</span><sup>2+</sup><span><span> sparks were detected by confocal microscopy<span>, and protein expression was analyzed by </span></span>Western blot.</span></div></div><div><h3>Results</h3><div><span>GSK219 or TRPV4 deletion significantly decreased the incidence and duration of ventricular tachycardia during reperfusion. TRPV4 inhibition shortened Ca</span><sup>2+</sup><span> transient (CaT) recovery, suppressed CaT alternans, and decreased Ca</span><sup>2+</sup><span><span> leak without affecting IR-induced prolongation of action potential duration (APD) and APD alternations. Activation of TRPV4 by GSK101790A (GSK101) increased </span>arrhythmia susceptibility and Ca</span><sup>2+</sup> leak. Moreover, GSK101 prolonged CaT recovery and promoted CaT alternans, which were greatly avoided by pretreatment with Ca<sup>2+</sup><span><span>/calmodulin-dependent protein kinase II (CaMKII) inhibitor. Interestingly, IR or GSK101 markedly increased the phosphorylation of </span>CaMKII<span><span>, ryanodine receptors, and </span>phospholamban, which was significantly blocked by TRPV4 inhibition.</span></span></div></div><div><h3>Conclusion</h3><div><span>TRPV4 inhibition exerts antiarrhythmic effects after IR by modulating CaMKII-dependent Ca</span><sup>2+</sup> handling abnormalities, reducing CaT alternans and Ca<sup>2+</sup> leak, without affecting APD.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 730-740"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962236","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}
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