Heart rhythm最新文献

英文中文

Re-examining family history of sudden death as a risk marker in hypertrophic cardiomyopathy 重新研究将猝死家族史作为肥厚型心肌病的风险标记。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.06.034

引用次数: 0

The complex decision of leadless cardiac pacing: How to choose among the expanding options? 无导联心脏起搏的复杂抉择：如何在不断扩展的选项中做出选择？

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.06.051

引用次数: 0

Focal monopolar pulsed field ablation from within the great cardiac vein for idiopathic premature ventricular contractions after failed radiofrequency ablation 从心脏大静脉内进行局部单极脉冲场消融，治疗射频消融失败后的特发性室性早搏。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.07.002

Background

Idiopathic epicardial premature ventricular contractions (PVCs) originating from the left ventricular summit are difficult to eliminate.

Objective

The purpose of this study was to describe the feasibility and procedural safety of monopolar biphasic focal pulsed field ablation (F-PFA) from within the great cardiac vein (GCV) for treatment of idiopathic epicardial PVCs.

Methods

In 4 pigs, F-PFA (Centauri, CardioFocus) was applied from within the GCV followed by macroscopic gross analysis. In 4 patients with previously failed radiofrequency ablation, electroanatomic mapping was used to guide F-PFA from within the GCV and the ventricular outflow tracts. Coronary angiography and optical coherence tomography (OCT) were performed in 2 patients.

Results

In pigs, F-PFA from within the GCV (5 mm away from the coronary arteries) resulted in myocardial lesions with a maximal depth of 4 mm, which was associated with nonobstructive transient coronary spasms. In patients, sequential delivery of F-PFA in the ventricular outflow tracts and from within the GCV eliminated the PVCs. During F-PFA delivery from within the GCV with prophylactic nitroglycerin application, coronary angiography showed no coronary spasm when F-PFA was delivered >5 mm away from the coronary artery and a transient coronary spasm without changes in a subsequent OCT, when F-PFA was delivered directly on the coronary artery. Intracardiac echocardiography and computed tomography integration was used to monitor F-PFA delivery from within the GCV. There were no immediate or short-term complications.

Conclusion

Sequential mapping-guided F-PFA from endocardial ventricular outflow tracts and from within the GCV is feasible with a favorable procedural safety profile for treatment of epicardial PVCs.

背景：特发性心外膜室性早搏（PVC）起源于左心室顶部，很难消除：描述从心脏大静脉（GCV）内进行病灶单极双相脉冲场消融（F-PFA）治疗特发性心外膜早搏的可行性和手术安全性：方法：在 4 头猪的心脏大静脉内应用 F-PFA（CENTAURI，Cardiofocus），然后进行宏观大体分析。在 4 例射频消融失败的患者中，使用电解剖图引导从 GCV 和心室流出道内进行 F-PFA。对2名患者进行了冠状动脉造影和光学相干断层扫描（OCT）：结果：在猪身上，从 GCV 内（距冠状动脉 5 毫米处）进行 F-PFA 会导致最大深度为 4 毫米的心肌病变，这与非阻塞性一过性冠状动脉痉挛有关。在患者中，在心室流出道和 GCV 内连续输送 F-PFA 可消除 PVC。在从 GCV 内输送 F-PFA 并预防性应用硝酸甘油期间，冠状动脉造影显示，当 F-PFA 输送到距离冠状动脉大于 5 毫米处时，冠状动脉无痉挛；而当 F-PFA 直接输送到冠状动脉上时，则会出现短暂的冠状动脉痉挛，但在随后的 OCT 中无变化。心内回声和计算机断层扫描集成用于监测从 GCV 内输送 F-PFA。没有出现直接或短期并发症：结论：在心内膜心室流出道和 GCV 内进行顺序映射引导的 F-PFA 是可行的，而且治疗心外膜 PVC 的程序安全性良好。

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引用次数: 0

Focal atrial tachycardias originating from the aorta-mitral continuity: Anatomical and electrophysiological characteristics 源于主动脉-中轴持续部的局灶性房性心动过速：解剖学和电生理学特征。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.011

Background

The aorta-mitral annulus conjunction (AMC) is an uncommon site of origin of focal atrial tachycardias (ATs). Hence, the electrophysiological and ablation target characteristics are poorly described.

Objective

The purpose of this study was to describe the characteristics of AMC ATs in detail.

Methods

The study enrolled 650 patients with ATs, 21 (3.2%) of whom had ATs originating from the AMC. A comprehensive evaluation, including electrocardiography, electrophysiology study, computed tomography scan, and intracardiac echocardiography, was performed.

Results

The majority (19, 90.5%) of ATs occurred spontaneously. The mean age of this group was 48.9 ± 21.6 years, with 12 being female (57.1%). Seventeen patients had a typical biphasic P wave with a prominent positive component. The earliest activation site in the right atrium was near the His bundle, with average activation −10.3 ± 6.0 ms preceding the P wave. The successful ablation targets were distributed as follows: 1 case at 9 o’clock, 6 cases at 10 o’clock, 7 cases at 11 o’clock, 6 cases at 12 o’clock, and 1 case in the left coronary cusp. The local AMC potential differed from the commonly perceived annular potential and was characterized by a prominent A wave and a smaller V wave (atrial-to-ventricular ratio > 1). The angle of encroachment on the left atrial anterior wall, compressed by the left coronary cusp, was significantly smaller in the AMC ATs group than in the control group consisted of 40 patients who underwent coronary artery CT scans because of the chest pain but without atrial arrhythmias were randomly selected, which may have contributed to the arrhythmia substrate (141.7° ± 11.5° vs 155.2° ± 13.9°; P = .026).

Conclusion

A new strategy for mapping AMC ATs has been introduced. The ablation target should have an atrial-to-ventricular ratio of >1.

背景主动脉-窦房结连线（AMC）是局灶性房性心动过速（AT）不常见的起源部位。本研究的目的是详细描述 AMC ATs 的特征。方法本研究共纳入 650 例 ATs 患者，其中 21 例（3.2%）的 ATs 起源于 AMC。对患者进行了全面评估，包括心电图、电生理学检查、计算机断层扫描和心内超声心动图检查。这组患者的平均年龄为（48.9 ± 21.6）岁，其中 12 人为女性（57.1%）。17名患者的P波为典型的双相波，阳性成分突出。右心房最早激活的部位在 His 束附近，平均激活时间为 P 波前 -10.3 ± 6.0 毫秒。成功消融的目标分布如下：1 例位于 9 点钟位置，6 例位于 10 点钟位置，7 例位于 11 点钟位置，6 例位于 12 点钟位置，1 例位于左冠状动脉尖。局部 AMC 电位与通常认为的环状电位不同，其特点是 A 波突出，V 波较小（房室比为 1）。AMC ATs 组被左冠状动脉尖压迫的左心房前壁的侵袭角明显小于对照组，对照组由 40 名因胸痛接受冠状动脉 CT 扫描但无房性心律失常的患者随机抽取组成，这可能是导致心律失常的基质（141.7° ± 11.5° vs 155.2° ± 13.9°; P = .026）。消融目标的心房与心室比率应为 >1。

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引用次数: 0

Correlation of extent of left ventricular endocardial unipolar low-voltage zones with ventricular tachycardia in nonischemic cardiomyopathy 左心室心内膜单极低电压区的范围与非缺血性心肌病室性心动过速的相关性

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.065

Background

Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication.

Objective

We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM.

Methods

Electroanatomic mapping of the left ventricle was performed. EGM characteristics were correlated with LVEF. Differences between groups with and without VT and predictors of VT were studied.

Results

In 43 patients, unipolar EGM variables had better correlation with baseline LVEF than bipolar EGM variables: unipolar voltage (r = +0.36), peak negative unipolar voltage (r = −0.42), peak positive unipolar voltage (r = +0.38), and percentage area of unipolar low-voltage zone (LVZ; r = −0.41). Global mean unipolar voltage (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2–0.8), extent of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3), and percentage area of unipolar LVZ (HR, 1.6; 95% CI, 1.1–2.3) were significant predictors of VT. For classification of patients with VT, extent of unipolar LVZ had an area under the curve of 0.82 (95% CI, 0.69–0.95; P < .001), and percentage area of unipolar LVZ had an area under the curve of 0.83 (95% CI, 0.71–0.96; P = .01). Cutoff of >3 segments for extent of unipolar LVZ had the best diagnostic accuracy (sensitivity, 90%; specificity, 67%) and cutoff of 33% for percentage area of unipolar LVZ had the best diagnostic accuracy (sensitivity, 95%; specificity, 60%) for VT.

Conclusion

In NICM, extent and percentage area of unipolar LVZs are significant predictors of VT. Cutoffs of >3 segments of unipolar LVZ and >33% area of unipolar LVZ have good diagnostic accuracies for association with VT.

背景尚未充分探讨非缺血性心肌病（NICM）的心内膜电图（EGM）特征对预后的影响。目的我们旨在研究双极和单极 EGM 特征与 NICM 患者左室射血分数（LVEF）和室性心动过速（VT）的相关性。EGM 特征与 LVEF 相关。结果在 43 例患者中，单极 EGM 变量与基线 LVEF 的相关性优于双极 EGM 变量：单极电压（r = +0.36）、单极负电压峰值（r = -0.42）、单极正电压峰值（r = +0.38）和单极低电压区（LVZ；r = -0.41）。全球平均单极电压（危险比 [HR]，0.4；95% 置信区间 [CI]，0.2-0.8）、单极低压区范围（HR，1.6；95% CI，1.1-2.3）和单极低压区面积百分比（HR，1.6；95% CI，1.1-2.3）均可显著预测 VT。对于 VT 患者的分类，单极 LVZ 范围的曲线下面积为 0.82 (95% CI, 0.69-0.95; P < .001)，单极 LVZ 面积百分比的曲线下面积为 0.83 (95% CI, 0.71-0.96; P = .01)。结论在 NICM 中，单极 LVZ 的范围和百分比面积是 VT 的重要预测指标。3段单极左心室区和33%单极左心室区面积的临界值与VT的相关性具有良好的诊断准确性。

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引用次数: 0

2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play 2024 运动员心律失常 HRS 专家共识声明：评估、治疗和重返赛场

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.05.018

Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.

青少年和成年人参与体育运动的人数不断增加，运动员可能会被诊断出潜在的心律失常性心脏病。这份国际多学科文件旨在指导电生理学家、运动心脏病学家和相关医疗团队成员诊断、治疗和管理运动员的心律失常状况，目的是促进运动员重返运动场，避免因限制运动而造成伤害。本文件通篇强调根据运动员的症状和诊断进行专家级的特定疾病风险评估。在进行适当的风险评估后，将讨论如何管理心律失常，以便在可能的情况下重返赛场。其他主题包括共同决策和紧急行动计划。本文件的目标是提供以证据为基础的建议，这些建议影响到心律失常运动员护理的所有领域。此外，还讨论了需要进一步研究的领域。

引用次数: 0

Impact of clinical radiation audits on patient radiation exposure in cardiac implantable electronic device procedures 临床辐射审核对心脏植入式电子设备手术中患者辐射暴露的影响。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.060

引用次数: 0

Underestimated recurrence rates after ablation for Wolff-Parkinson-White syndrome and impact on follow-up practices 被低估的沃尔夫-帕金森-怀特综合征消融术后复发率及其对随访实践的影响。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.071

引用次数: 0

Proarrhythmic drugs, drug levels, and polypharmacy in victims of sudden arrhythmic death syndrome: An autopsy-based study from Denmark 心律失常猝死综合征患者的促心律失常药物、药物水平和多重用药：丹麦一项基于尸检的研究。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.05.013

Background

Sudden arrhythmic death syndrome (SADS), characterized by an unknown or inconclusive cause of death at autopsy together with a negative or nonlethal toxicology screening result, is the most common cause of sudden cardiac death in victims younger than 35 years. The complete causality of SADS remains unclear, with drugs being a potential risk factor.

Objective

This study aimed to describe the toxicologic profiles of SADS victims, focusing on proarrhythmic drugs, drug levels, and polypharmacy.

Methods

All deaths in Denmark of those aged 1–35 years in 2000–2019 and 36–49 years in 2007–2019 were examined through death certificates, national registries, and autopsy reports with toxicology screenings. We investigated all sudden unexpected death victims with an autopsy performed, including negative or nonlethal drug findings, where cause of death was unknown or inconclusive (SADS).

Results

We identified 477 SADS victims; 313 (66%) had a positive toxicology screening result (adjudicated nonlethal), with an average of 2.8 drugs per case. More than half of the SADS victims with a positive toxicology screening result had QT-prolonging or brugadogenic drugs present. Polypharmacy was present in 66%, psychotropic polypharmacy in 37%, and QT-prolonging polypharmacy in 22%, with the most frequent overall and QT-prolonging drug combination being an antipsychotic and a psychoanaleptic drug. QT-prolonging drugs were more often present at suprapharmacologic levels than non–QT-prolonging drugs.

Conclusion

The majority of the SADS population had a positive toxicology screening result, with a notably large proportion having proarrhythmic drugs and polypharmacy. This highlights the need for future focus on drugs as a risk factor for SADS.

背景：心律失常性猝死综合征（SADS）的特点是尸检时死因不明或无法确定，同时毒理学检查结果为阴性或非致死性，是35岁以下患者心脏性猝死（SCD）最常见的原因。SADS的全部病因仍不清楚，而药物是一个潜在的危险因素：描述 SADS 患者的毒理学特征，重点关注促心律失常药物、药物水平和多重用药：通过死亡证明、国家登记和尸检报告以及毒理学筛查，对丹麦 2000-2019 年间 1-35 岁和 2007-2019 年间 36-49 岁的所有死亡病例进行了研究。我们调查了所有进行过尸检、死因不明或无法确定的意外猝死患者，包括阴性或非致死性药物检查结果（SADS）：我们确定了 477 名 SADS 受害者，其中 313 人（66%）的毒理学筛查结果呈阳性（判定为非致命性），平均每例 2.8 种药物。在毒理学检查呈阳性的 SADS 受害者中，半数以上服用了可导致 QT 延长或致癌的药物。66%的受害者服用了多种药物，37%的受害者服用了精神药物，22%的受害者服用了延长QT的药物，其中最常见的药物组合和延长QT的药物组合是抗精神病药物和精神药物。与非QT延长药物相比，QT延长药物更常出现在超药物水平上：结论：大多数 SADS 患者的毒理学结果呈阳性，其中很大一部分患者服用了促心律失常药物和多种药物。结论：大多数 SADS 患者的毒理学结果呈阳性，其中有很大一部分人服用了促心律失常药物和多种药物，这突出表明今后需要重点关注药物这一 SADS 的风险因素。

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引用次数: 0

Transvenous extraction of conduction system pacing leads: An international multicenter (TECSPAM) study 经静脉提取传导系统起搏导线：国际多中心（TECSPAM）研究。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.054

Background

Conduction system pacing (CSP) by His bundle pacing or left bundle branch area pacing (LBBAP) is incorporated into Heart Rhythm Society guidelines for the management of bradycardia and cardiac resynchronization therapy. Despite increasing adoption with both lumenless leads and stylet-driven leads, concerns regarding the feasibility and safety of the extraction of CSP leads remain.

Objective

The aim of the study was to report on the safety, feasibility, and clinical outcomes of the extraction of CSP leads.

Methods

Patients undergoing the extraction of CSP leads from 10 international centers were enrolled in this retrospective study. Data regarding indications, lead location, lead type, extraction tools, procedural success, complications, and reimplantation in the conduction system were collected.

Results

Overall, 341 patients (age 69 ± 15 years; female 117 (34%); cardiomyopathy 157 (46%); lead dwell time 22 ± 26 months) underwent the extraction of 224 His bundle pacing and 117 LBBAP leads (lumenless leads 321; stylet-driven leads 20). Complete procedural success was achieved in 338 (99%), while clinical success was 100% with retained distal fragments in 3 patients (1%). Among patients with a lead dwell time of >6 months (6–193 months; n = 226), manual extraction was successful in 198 (87%), mechanical tools in 22 (10%), and laser in 6 (3%). Femoral tools were necessary in 3 patients. Minor complications occurred in 7 patients (2.1%). Reimplantation in the conduction system was successful in 233 of 244 patients attempted (95%).

Conclusion

The overall success rates of the extraction of CSP leads were very high (although the LBBAP lead dwell time was <3 years), with a low need for extraction tools and minimal complication. Reimplantation in the conduction system is feasible and safe.

背景：通过 His 束起搏或左束支区起搏（LBBAP）进行的传导系统起搏（CSP）已被纳入心脏节律学会用于治疗心动过缓和心脏再同步化治疗的指南。尽管无腔导联和支架驱动导联被越来越多地采用，但提取 CSP 导联的可行性和安全性仍令人担忧：该研究旨在报告抽取 CSP 导联的安全性、可行性和临床结果：这项回顾性研究招募了来自 10 个国际中心的接受 CSP 导联取出术的患者。收集了有关适应症、导联位置、导联类型、抽取工具、手术成功率、并发症和重新植入传导系统的数据：总共有 341 名患者（年龄 69 ± 15 岁；女性 117 人（34%）；心肌病 157 人（46%）；导联停留时间 22 ± 26 个月）接受了 224 个 His 束起搏导联和 117 个 LBBAP 导联（无腔导联 321 个；支架驱动导联 20 个）的抽取手术。手术完全成功的患者有 338 例（99%），临床成功率为 100%，但有 3 例患者（1%）的导联远端碎片残留。在导联停留时间超过 6 个月（6-193 个月；n = 226）的患者中，198 例（87%）人工拔管成功，22 例（10%）使用机械工具，6 例（3%）使用激光。有 3 名患者需要使用股骨工具。7名患者（2.1%）出现了轻微并发症。在 244 例患者中，有 233 例（95%）成功重新植入了传导系统：提取 CSP 导联的总体成功率非常高（尽管 LBBAP 导联的停留时间是

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