Pub Date : 2026-03-01Epub Date: 2025-06-13DOI: 10.1016/j.hrthm.2025.06.004
Kenneth K. Cho MBBS, MPhil , Sandeep Prabhu MBBS, PhD , Louise Segan MBBS , Jeremy B. William MBBS , Rose F. Crowley MBBS , Nicholas D’Elia MBBS , David Chieng MBBS, PhD , Hariharan Sugumar MBBS, PhD , Liang-Han Ling MBBS, PhD , Aleksandr Voskoboinik MBBS, PhD , Joseph B. Morton MBBS, PhD , Geoffrey Lee MBChD, PhD , Alex J. McLellan MBBS, PhD , Justin Lineham MD , Matthew Morton MD , Sonia Azzopardi RN , Annie Curtin RN , Michael W. Lim MBBS , Youlin Koh MBBS , Michael Wong MBBS, PhD , Peter M. Kistler MBBS, PhD, FHRS
Background
Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns that AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence after catheter ablation on heart failure is not well understood.
Objective
We sought to examine the clinical outcomes and hospitalization patterns in patients with AF HFrEF after catheter ablation.
Methods
This multicenter study reports the readmission outcomes for patients with AF and HFrEF (left ventricular ejection fraction [LVEF] ≤40%) after catheter ablation.
Results
A total of 231 patients (60.5 ± 11.1 years, 37 female patients, mean LVEF 30.7% ± 7.1%, persistent AF 87.9%) with AF and HFrEF underwent catheter ablation. At 3-year follow-up, recurrent AF occurred in 120 (51.9%) and complete left ventricular systolic recovery (LVEF ≥50%) in 125 patients (54%). There were 366 hospitalizations among 123 patients: 240 cardiac and 126 noncardiac. Arrhythmia-related hospitalizations occurred in 179: 151 recurrent atrial arrhythmia without heart failure, 4 AF with heart failure, 3 supraventricular tachycardia, and 21 ventricular arrhythmia. Other cardiac hospitalizations (61) included heart failure without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3), and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery after ablation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11–12.55; P = .03), persistent AF vs paroxysmal AF recurrence (OR, 1.76; 95% CI, 1.21–27.72; P = .03), ischemic cardiomyopathy (OR, 3.62; 95% CI, 1.16–11.30; P = .02), and furosemide use (OR, 4.96; 95% CI, 1.55–15.91; P < .01) were associated with future heart failure hospitalization.
Conclusion
After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF and heart failure, but more commonly present with heart failure without AF or AF without heart failure.
{"title":"Heart failure hospitalization from recurrent atrial fibrillation is uncommon after catheter ablation in patients with heart failure with reduced ejection fraction","authors":"Kenneth K. Cho MBBS, MPhil , Sandeep Prabhu MBBS, PhD , Louise Segan MBBS , Jeremy B. William MBBS , Rose F. Crowley MBBS , Nicholas D’Elia MBBS , David Chieng MBBS, PhD , Hariharan Sugumar MBBS, PhD , Liang-Han Ling MBBS, PhD , Aleksandr Voskoboinik MBBS, PhD , Joseph B. Morton MBBS, PhD , Geoffrey Lee MBChD, PhD , Alex J. McLellan MBBS, PhD , Justin Lineham MD , Matthew Morton MD , Sonia Azzopardi RN , Annie Curtin RN , Michael W. Lim MBBS , Youlin Koh MBBS , Michael Wong MBBS, PhD , Peter M. Kistler MBBS, PhD, FHRS","doi":"10.1016/j.hrthm.2025.06.004","DOIUrl":"10.1016/j.hrthm.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns that AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence after catheter ablation on heart failure is not well understood.</div></div><div><h3>Objective</h3><div>We sought to examine the clinical outcomes and hospitalization patterns in patients with AF HFrEF after catheter ablation.</div></div><div><h3>Methods</h3><div>This multicenter study reports the readmission outcomes for patients with AF and HFrEF (left ventricular ejection fraction [LVEF] ≤40%) after catheter ablation.</div></div><div><h3>Results</h3><div>A total of 231 patients (60.5 ± 11.1 years, 37 female patients, mean LVEF 30.7% ± 7.1%, persistent AF 87.9%) with AF and HFrEF underwent catheter ablation. At 3-year follow-up, recurrent AF occurred in 120 (51.9%) and complete left ventricular systolic recovery (LVEF ≥50%) in 125 patients (54%). There were 366 hospitalizations among 123 patients: 240 cardiac and 126 noncardiac. Arrhythmia-related hospitalizations occurred in 179: 151 recurrent atrial arrhythmia without heart failure, 4 AF with heart failure, 3 supraventricular tachycardia, and 21 ventricular arrhythmia. Other cardiac hospitalizations (61) included heart failure without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3), and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery after ablation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11–12.55; <em>P</em> = .03), persistent AF vs paroxysmal AF recurrence (OR, 1.76; 95% CI, 1.21–27.72; <em>P</em> = .03), ischemic cardiomyopathy (OR, 3.62; 95% CI, 1.16–11.30; <em>P</em> = .02), and furosemide use (OR, 4.96; 95% CI, 1.55–15.91; <em>P</em> < .01) were associated with future heart failure hospitalization.</div></div><div><h3>Conclusion</h3><div>After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF <em>and</em> heart failure, but more commonly present with heart failure <em>without</em> AF or AF <em>without</em> heart failure.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e384-e391"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293653","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: 2025-10-10DOI: 10.1016/j.hrthm.2025.10.014
Emily Tomasulo DO , Andy Itsara MD , Mark Haigney MD, FHRS , Douglas R. Rosing MD , Inhye E. Ahn MD , Cody Peer PhD , Beth A. Kozel MD, PhD , Teresa Luperchio PhD , Grace Ge BS , William D. Figg PharmD , Adrian Wiestner MD, PhD , Clare Sun MD
Background
Ibrutinib (IBR) is a first-in-class Bruton’s tyrosine kinase inhibitor (BTKi) approved in multiple hematologic conditions for indefinite use until disease progression or toxicity. Hypertension and atrial fibrillation are well-recognized cardiac complications of BTKi; more recently, heart failure, additional arrhythmias, and sudden cardiac death (SCD) have been attributed to IBR. Next-generation covalent BTKi are also associated with cardiovascular complications, including SCD, albeit to a lesser degree.
Objective
The incidence and clinical features of patients experiencing SCD and asymptomatic arrhythmias on IBR remain ill defined. We aimed to characterize the incidence of SCD and asymptomatic arrhythmias on IBR.
Methods
We report (1) a retrospective cohort analysis of 131 patients with a median of 66.5 months on IBR using available cardiac testing, genetic sequencing, and autopsy review and (2) a cross-sectional cardiac analysis of 21 asymptomatic patients on IBR including ambulatory electrocardiogram, stress tests, and transthoracic echocardiograms.
Results
The incidence of SCD in patients on IBR (n = 5) was 801 per 100,000 patient-years, approximately 2–4× higher than the general population. All patients with SCD on IBR had at least 1 cardiac risk factor. Autopsies conducted in 3 of 5 patients with SCD did not reveal acute pathologic processes, but did demonstrate evolving cardiac pathology. Cardiovascular testing in asymptomatic patients on IBR revealed previously unknown clinically significant arrhythmias in 4 patients (19%), leading to precautionary IBR discontinuation in 2 patients.
Conclusion
IBR increases the risk of SCD among patients with cardiac risk factors. Stress and ambulatory electrocardiogram on IBR identified asymptomatic arrhythmias altering clinical management in 19% of patients. These data highlight the need for risk-mitigation strategies for patients starting or receiving IBR, possibly extending to other BTKis.
{"title":"Sudden death and asymptomatic arrhythmia in chronic lymphocytic leukemia patients treated with ibrutinib","authors":"Emily Tomasulo DO , Andy Itsara MD , Mark Haigney MD, FHRS , Douglas R. Rosing MD , Inhye E. Ahn MD , Cody Peer PhD , Beth A. Kozel MD, PhD , Teresa Luperchio PhD , Grace Ge BS , William D. Figg PharmD , Adrian Wiestner MD, PhD , Clare Sun MD","doi":"10.1016/j.hrthm.2025.10.014","DOIUrl":"10.1016/j.hrthm.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Ibrutinib (IBR) is a first-in-class Bruton’s tyrosine kinase inhibitor (BTKi) approved in multiple hematologic conditions for indefinite use until disease progression or toxicity. Hypertension and atrial fibrillation are well-recognized cardiac complications of BTKi; more recently, heart failure, additional arrhythmias, and sudden cardiac death (SCD) have been attributed to IBR. Next-generation covalent BTKi are also associated with cardiovascular complications, including SCD, albeit to a lesser degree.</div></div><div><h3>Objective</h3><div>The incidence and clinical features of patients experiencing SCD and asymptomatic arrhythmias on IBR remain ill defined. We aimed to characterize the incidence of SCD and asymptomatic arrhythmias on IBR.</div></div><div><h3>Methods</h3><div>We report (1) a retrospective cohort analysis of 131 patients with a median of 66.5 months on IBR using available cardiac testing, genetic sequencing, and autopsy review and (2) a cross-sectional cardiac analysis of 21 asymptomatic patients on IBR including ambulatory electrocardiogram, stress tests, and transthoracic echocardiograms.</div></div><div><h3>Results</h3><div>The incidence of SCD in patients on IBR (n = 5) was 801 per 100,000 patient-years, approximately 2–4× higher than the general population. All patients with SCD on IBR had at least 1 cardiac risk factor. Autopsies conducted in 3 of 5 patients with SCD did not reveal acute pathologic processes, but did demonstrate evolving cardiac pathology. Cardiovascular testing in asymptomatic patients on IBR revealed previously unknown clinically significant arrhythmias in 4 patients (19%), leading to precautionary IBR discontinuation in 2 patients.</div></div><div><h3>Conclusion</h3><div>IBR increases the risk of SCD among patients with cardiac risk factors. Stress and ambulatory electrocardiogram on IBR identified asymptomatic arrhythmias altering clinical management in 19% of patients. These data highlight the need for risk-mitigation strategies for patients starting or receiving IBR, possibly extending to other BTKis.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 766-773"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280029","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: 2025-10-31DOI: 10.1016/j.hrthm.2025.10.057
Jonathan P. Ariyaratnam MB BChir, PhD , Gregory Horsfall MD , Scott A. Gall MBBS , Gavin S. Chu MB BChir, PhD , Aruna V. Arujuna MBChB, MD(Res) , Shajil Chalil MBBS
{"title":"The impact of prolonged waiting list times for ablation of atrial fibrillation on arrhythmia recurrence after ablation","authors":"Jonathan P. Ariyaratnam MB BChir, PhD , Gregory Horsfall MD , Scott A. Gall MBBS , Gavin S. Chu MB BChir, PhD , Aruna V. Arujuna MBChB, MD(Res) , Shajil Chalil MBBS","doi":"10.1016/j.hrthm.2025.10.057","DOIUrl":"10.1016/j.hrthm.2025.10.057","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e492-e494"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431259","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: 2025-11-13DOI: 10.1016/j.hrthm.2025.11.014
Le Li MD , Sheng Su MD , Lingmin Wu MD , Zhicheng Hu MD , Limin Liu MD , Likun Zhou MD , Xi Peng MD , Mengtong Xu MD , Tao Zhang MD , Yulong Xiong MD , Zhenhao Zhang MD , Lihui Zheng MD , Ligang Ding MD , Yan Yao MD, FHRS
Background
Although atrial fibrillation (AF) raises heart failure (HF) risk and inflammation is associated with cardiovascular disease, the role of inflammation in linking AF to HF remains unclear.
Objective
This study aimed to assess whether systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), elevates HF risk in patients with AF.
Methods
This prospective study included 32,502 AF participants from the UK Biobank without baseline HF, significant mitral valve disease, or inflammatory conditions. Hs-CRP was analyzed both as quartiles and using a clinical cutoff value of ≥2 mg/dL. The association with incident HF was evaluated using Cox models and Fine-Gray regression. Sensitivity analyses included sequential exclusion of comorbidities and early events, as well as propensity score matching.
Results
Over a median follow-up of 13.3 years, 6805 incident HF cases were documented. The cumulative incidence of HF increased significantly across hs-CRP quartiles, from 16.5% (1386 of 8419) in quartile 1 to 26.9% (2096 of 7786) in quartile 4 (log-rank P < .001). In fully adjusted models, quartile 4 had 61% higher HF risk than quartile 1 (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.51–1.73). Elevated hs-CRP (≥2 mg/dL) (HR 1.39; 95% CI 1.33–1.46) and per-standard-deviation increase (HR 1.12; 95% CI 1.10–1.15) were consistently associated with higher HF risk. These findings remained robust across all sensitivity analyses, subgroup comparisons, propensity score matching cohorts, and competing risk models.
Conclusion
Elevated hs-CRP is an independent predictor of increased HF risk in patients with AF, supporting its potential role in improving HF risk stratification.
背景：虽然房颤（AF）增加心力衰竭（HF）的风险，炎症与心血管疾病相关，但炎症在房颤与HF之间的联系中所起的作用尚不清楚。目的：评估高敏c反应蛋白（hs-CRP）测量的全身性炎症是否会增加房颤患者HF的风险。方法：这项前瞻性研究包括来自英国生物银行的32,502名房颤参与者，他们没有基线HF、明显的二尖瓣疾病或炎症状况。Hs-CRP以四分位数和临床临界值≥2mg /dL进行分析。使用Cox模型和Fine-Gray回归评估与事件HF的关联。敏感性分析包括顺序排除合并症和早期事件，以及倾向评分匹配（PSM）。结果：在13.3年的中位随访中，记录了6805例心衰事件。HF的累积发病率在hs-CRP四分位数中显著增加，从第一季度的16.5%（1,386/8,419）增加到第四季度的26.9% (2,096/7,786)（Log-rank P < 0.001）。在完全调整的模型中，Q4的HF风险比Q1高61%（风险比[HR] 1.61, 95%可信区间[CI] 1.51-1.73）。hs-CRP升高（≥2 mg/dL） （HR 1.39, 95% CI 1.33-1.46）和每标准偏差增加（HR 1.12, 95% CI 1.10-1.15）与较高的HF风险一致相关。这些发现在所有敏感性分析、亚组比较、PSM队列和相互竞争的风险模型中都是可靠的。结论：hs-CRP升高是房颤患者HF风险增加的独立预测因子，支持其在改善HF风险分层中的潜在作用。
{"title":"Inflammation and heart failure risk in atrial fibrillation: Prospective evidence from UK Biobank","authors":"Le Li MD , Sheng Su MD , Lingmin Wu MD , Zhicheng Hu MD , Limin Liu MD , Likun Zhou MD , Xi Peng MD , Mengtong Xu MD , Tao Zhang MD , Yulong Xiong MD , Zhenhao Zhang MD , Lihui Zheng MD , Ligang Ding MD , Yan Yao MD, FHRS","doi":"10.1016/j.hrthm.2025.11.014","DOIUrl":"10.1016/j.hrthm.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Although atrial fibrillation (AF) raises heart failure (HF) risk and inflammation is associated with cardiovascular disease, the role of inflammation in linking AF to HF remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to assess whether systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), elevates HF risk in patients with AF.</div></div><div><h3>Methods</h3><div>This prospective study included 32,502 AF participants from the UK Biobank without baseline HF, significant mitral valve disease, or inflammatory conditions. Hs-CRP was analyzed both as quartiles and using a clinical cutoff value of ≥2 mg/dL. The association with incident HF was evaluated using Cox models and Fine-Gray regression. Sensitivity analyses included sequential exclusion of comorbidities and early events, as well as propensity score matching.</div></div><div><h3>Results</h3><div>Over a median follow-up of 13.3 years, 6805 incident HF cases were documented. The cumulative incidence of HF increased significantly across hs-CRP quartiles, from 16.5% (1386 of 8419) in quartile 1 to 26.9% (2096 of 7786) in quartile 4 (log-rank <em>P</em> < .001). In fully adjusted models, quartile 4 had 61% higher HF risk than quartile 1 (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.51–1.73). Elevated hs-CRP (≥2 mg/dL) (HR 1.39; 95% CI 1.33–1.46) and per-standard-deviation increase (HR 1.12; 95% CI 1.10–1.15) were consistently associated with higher HF risk. These findings remained robust across all sensitivity analyses, subgroup comparisons, propensity score matching cohorts, and competing risk models.</div></div><div><h3>Conclusion</h3><div>Elevated hs-CRP is an independent predictor of increased HF risk in patients with AF, supporting its potential role in improving HF risk stratification.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e339-e347"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530627","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}
{"title":"Reply to— DNA methylation and the potential role of extracellular vesicles in epilepsy-associated atrial fibrillation","authors":"Zequn Zheng PhD , Yanbin Chen MMSc , Xuerui Tan MD, PhD","doi":"10.1016/j.hrthm.2025.11.051","DOIUrl":"10.1016/j.hrthm.2025.11.051","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Page e508"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774413","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: 2026-02-25DOI: 10.1016/j.hrthm.2025.12.025
Agustín Pastor Fuentes MD, PhD , José Jalife MD, PhD, FHRS
{"title":"In Memoriam: Francisco G Cosío, MD, FHRS, a pioneer in arrhythmology","authors":"Agustín Pastor Fuentes MD, PhD , José Jalife MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.12.025","DOIUrl":"10.1016/j.hrthm.2025.12.025","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e509-e510"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316666","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: 2025-05-22DOI: 10.1016/j.hrthm.2025.05.042
Chen He MD , Shun Xu MD , Chuangshi Wang PhD , Xiaofei Li MD , Haojie Zhu MD , Jiaxin Zeng MD , Enrui Zhang MD , Jiangang Zou MD, PhD, FHRS , Xiaohan Fan MD, PhD, FHRS
Background
Pacing-induced cardiomyopathy (PICM) occurs in some patients requiring a high burden of right ventricular pacing (RVP). Whether left bundle branch area pacing (LBBAP) might be superior to biventricular pacing delivering cardiac resynchronization therapy remains unclear.
Objective
The present study aimed to evaluate the effectiveness of LBBAP compared with BiVP in patients with PICM.
Methods
This prospective, 2-center observational study enrolled consecutive patients with PICM who underwent upgrading to either LBBAP or BiVP. LBBAP was further classified into left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP). The primary end point was the change in left ventricular ejection fraction (LVEF) from baseline to 6-month follow-up. Other echocardiographic parameters, N-terminal pro–B-type natriuretic peptide levels, New York Heart Association functional class, and clinical events (all-cause mortality, heart failure hospitalization, and malignant ventricular arrhythmias) were evaluated during follow-up.
Results
In total, 78 patients were included in the final analysis (33% patients with LVEF < 35%), including 40 patients with LBBAP (30 with LBBP and 10 with LVSP) and 38 patients with BiVP. At the 6-month follow-up, LVEF improvement was significantly greater in patients with LBBAP than those with BiVP (9.59 ± 7.48% vs 4.91 ± 7.73%; P = .008), and higher in LBBP than LVSP (10.62 ± 7.28% vs 6.47 ± 7.57). During a mean follow-up duration of 20.5 ± 12.5 months, clinical outcomes did not differ between BiVP and LBBAP groups (26.3% vs 17.5%; adjusted hazard ratio = 1.57 [0.55–4.48], P = .395) after adjustment for confounders.
Conclusions
PICM upgrading to LBBAP or BiVP demonstrated similar clinical outcomes, but upgrading to LBBAP was associated with greater improvement in LVEF.
{"title":"Effectiveness of upgrading to left bundle branch area pacing compared with biventricular pacing in patients with right ventricular pacing-induced cardiomyopathy","authors":"Chen He MD , Shun Xu MD , Chuangshi Wang PhD , Xiaofei Li MD , Haojie Zhu MD , Jiaxin Zeng MD , Enrui Zhang MD , Jiangang Zou MD, PhD, FHRS , Xiaohan Fan MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.05.042","DOIUrl":"10.1016/j.hrthm.2025.05.042","url":null,"abstract":"<div><h3>Background</h3><div><span>Pacing-induced cardiomyopathy (PICM) occurs in some patients requiring a high burden of right ventricular pacing (RVP). Whether left </span>bundle branch<span> area pacing (LBBAP) might be superior to biventricular pacing delivering cardiac resynchronization therapy remains unclear.</span></div></div><div><h3>Objective</h3><div>The present study aimed to evaluate the effectiveness of LBBAP compared with BiVP in patients with PICM.</div></div><div><h3>Methods</h3><div><span>This prospective, 2-center observational study enrolled consecutive patients with PICM who underwent upgrading to either LBBAP or BiVP. LBBAP was further classified into left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP). The primary end point was the change in left ventricular ejection fraction<span> (LVEF) from baseline to 6-month follow-up. Other echocardiographic parameters, N-terminal pro–B-type natriuretic peptide levels, </span></span>New York Heart Association functional class, and clinical events (all-cause mortality, heart failure hospitalization, and malignant ventricular arrhythmias) were evaluated during follow-up.</div></div><div><h3>Results</h3><div>In total, 78 patients were included in the final analysis (33% patients with LVEF < 35%), including 40 patients with LBBAP (30 with LBBP and 10 with LVSP) and 38 patients with BiVP. At the 6-month follow-up, LVEF improvement was significantly greater in patients with LBBAP than those with BiVP (9.59 ± 7.48% vs 4.91 ± 7.73%; <em>P</em> = .008), and higher in LBBP than LVSP (10.62 ± 7.28% vs 6.47 ± 7.57). During a mean follow-up duration of 20.5 ± 12.5 months, clinical outcomes did not differ between BiVP and LBBAP groups (26.3% vs 17.5%; adjusted hazard ratio = 1.57 [0.55–4.48], <em>P</em> = .395) after adjustment for confounders.</div></div><div><h3>Conclusions</h3><div>PICM upgrading to LBBAP or BiVP demonstrated similar clinical outcomes, but upgrading to LBBAP was associated with greater improvement in LVEF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e411-e419"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142351","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: 2025-05-27DOI: 10.1016/j.hrthm.2025.05.032
Marina Cerrone MD , Arthur A.M. Wilde MD, FHRS
{"title":"Does a novel regulator of ion channel trafficking relate to sudden cardiac death? Your help is needed","authors":"Marina Cerrone MD , Arthur A.M. Wilde MD, FHRS","doi":"10.1016/j.hrthm.2025.05.032","DOIUrl":"10.1016/j.hrthm.2025.05.032","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e442-e443"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180661","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}
Evaluating the peak frequency electrograms (EGMs) has the potential to differentiate near-field from far-field components.
Objective
This study examined how peak frequency analyses of EGMs preceding idiopathic ventricular arrhythmias (VAs) affect catheter ablation outcomes.
Methods
A retrospective analysis was conducted on 111 VAs from 104 patients. EGMs at the earliest activation site, detected using high-density activation maps, were analyzed to assess the association with a successful elimination after a single radiofrequency delivery.
Results
In outflow tract VAs (n = 77), the first deflection timing was similar for VAs with and without a successful elimination. The peak frequency timing was earlier (right ventricular outflow tract −21 ms [−32 to −16 ms] vs −11 ms [−20 to 0 ms], P = .002; left ventricular outflow tract −26 ms [−33 to −4 ms] vs 0 ms [−6 to 10 ms], P = .005) and the difference between the first deflection and peak frequency timing (delta F-P) shorter (right ventricular outflow tract 7 ms [5–13 ms] vs 17 ms [11–24 ms], P < .001; left ventricular outflow tract 10 ms [6–19 ms] vs 22 ms [20–27 ms], P = .001) for VAs with a successful elimination than for those without. The delta F-P correlated with the time to elimination of outflow tract VAs (P = .01; r = 0.45). None of the outflow tract VAs with a delta F-P of >22 ms achieved a successful elimination. For non–outflow tract VAs (n = 34), no parameters were associated with a successful elimination.
Conclusion
The first component of the EGM at the earliest activation site may reflect a far-field recording from the site of origin of idiopathic VAs. A novel delta F-P EGM index may predict quick, successful endocardial ablation of outflow tract VAs.
{"title":"Comparison of far-field and peak frequency electrogram characteristics at the earliest activation sites during idiopathic ventricular arrhythmias: A novel index to predict ablation success","authors":"Takuro Nishimura MD , Natsuki Kanazawa MD , Yasutoshi Nagata MD , Shinsuke Iwai MD , Yukio Sekiguchi MD , Kenji Okubo MD , Yoshihide Takahashi MD , Yasuteru Yamauchi MD , Naoyuki Miwa MD , Akira Mizukami MD , Miho Negishi MD , Masaki Honda MD , Ryo Tateishi MD , Iwanari Kawamura MD , Kentaro Goto MD , Kazuya Yamao MD , Susumu Tao MD , Masateru Takigawa MD , Shinsuke Miyazaki MD, FHRS , Tetsuo Sasano MD","doi":"10.1016/j.hrthm.2025.09.015","DOIUrl":"10.1016/j.hrthm.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Evaluating the peak frequency electrograms (EGMs) has the potential to differentiate near-field from far-field components.</div></div><div><h3>Objective</h3><div>This study examined how peak frequency analyses of EGMs preceding idiopathic ventricular arrhythmias (VAs) affect catheter ablation outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 111 VAs from 104 patients. EGMs at the earliest activation site, detected using high-density activation maps, were analyzed to assess the association with a successful elimination after a single radiofrequency delivery.</div></div><div><h3>Results</h3><div>In outflow tract VAs (n = 77), the first deflection timing was similar for VAs with and without a successful elimination. The peak frequency timing was earlier (right ventricular outflow tract −21 ms [−32 to −16 ms] vs −11 ms [−20 to 0 ms], <em>P</em> = .002; left ventricular outflow tract −26 ms [−33 to −4 ms] vs 0 ms [−6 to 10 ms], <em>P</em> = .005) and the difference between the first deflection and peak frequency timing (delta F-P) shorter (right ventricular outflow tract 7 ms [5–13 ms] vs 17 ms [11–24 ms], <em>P</em> < .001; left ventricular outflow tract 10 ms [6–19 ms] vs 22 ms [20–27 ms], <em>P</em> = .001) for VAs with a successful elimination than for those without. The delta F-P correlated with the time to elimination of outflow tract VAs (<em>P</em> = .01; r = 0.45). None of the outflow tract VAs with a delta F-P of >22 ms achieved a successful elimination. For non–outflow tract VAs (n = 34), no parameters were associated with a successful elimination.</div></div><div><h3>Conclusion</h3><div>The first component of the EGM at the earliest activation site may reflect a far-field recording from the site of origin of idiopathic VAs. A novel delta F-P EGM index may predict quick, successful endocardial ablation of outflow tract VAs.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 645-653"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058356","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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