Heart rhythm最新文献

英文中文

Optimizing clinical operations with AI 利用人工智能优化临床操作。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.08.006

Janet K. Han MD, FHRS

引用次数: 0

Supraventricular tachycardia with a variable RP relationship but without a change in the cycle length: What is the mechanism? RP关系可变但周期长度不变的 SVT：其机制是什么？

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.042

引用次数: 0

Diagnostic accuracy for detecting atrial fibrillation using a novel machine learning algorithm in a blood pressure monitor 在血压计中使用新型机器学习算法检测心房颤动的诊断准确性

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.086

Background

Early detection of atrial fibrillation (AF) is key for preventing strokes. Blood pressure monitors (BPMs) with built-in AF screening features have the potential for early detection at home. Recently, 2 BPMs (HEM-7371T1-AZ and HEM-7372T1-AZAZ, Omron Healthcare Co., Ltd.) that share a novel AF screening feature have been developed. Their AF screening feature utilizes an algorithm that incorporates machine learning, with the potential to improve diagnostic accuracy.

Objective

The purpose of this study was to evaluate the performance of this AF screening feature in a multicenter, prospective clinical study at 5 sites in the United States.

Methods

A total of 559 subjects were enrolled for this study: 267 in AF cohort and 292 in the non-AF cohort. AF screening was performed in all subjects by the 2 Omron BPMs and by 1 Microlife BPM (BP 3MX1-3, WatchBP Home A, Microlife Corp.), and a simultaneous 12-lead electrocardiogram (ECG) was recorded for comparison. All 12-lead ECGs were interpreted by a board-certified cardiologist who was blinded to the BPM results. Sensitivity, specificity, and accuracy for the diagnosis of AF were calculated.

Results

Omron HEM-7371T1-AZ BPM had sensitivity of 95.1% (95% confidence interval [CI] 91.8%–97.4%), specificity 98.6% (95% CI 96.6%–99.7%), and accuracy of 97.0% (95% CI 95.2%–98.2%). Equivalent results were obtained with the Omron HEM-7371T1-AZAZ BPM. This compared favorably to the Microlife BPM (sensitivity 78.5%, 95% CI 73.1%–83.3%; specificity 97.6%, 95% CI 95.1%–99.0%; accuracy 88.4%, 95% CI 85.5%–91.0%).

Conclusion

These data support both home and professional use of these novel Omron BPMs for the detection of AF.

背景：早期发现心房颤动（房颤）是预防中风的关键。内置房颤筛查功能的血压计（BPM）可在家中进行早期检测。最近，两款血压计（HEM-7371T1-AZ 和 HEM-7372T1-AZAZ，OMRON HEALTHCARE Co.它们的心房颤动筛查功能采用了一种结合了机器学习的算法，有望提高诊断准确性：为了评估该房颤筛查功能的性能，我们在美国的五个地点进行了一项多中心前瞻性临床研究：本研究共招募了 559 名受试者，其中房颤受试者 267 名（房颤队列），非房颤受试者 292 名。通过两台欧姆龙 BPM 和一台百略 BPM（BP 3MX1-3，WatchBP Home A，百略公司）对所有受试者进行房颤筛查，并同时记录 12 导联心电图进行对比。所有 12 导联心电图均由一名获得认证的心脏病专家判读，该专家对 BPM 结果视而不见。计算了诊断房颤的敏感性、特异性和准确性：Omron HEM-7371T1-AZ BPM 的灵敏度为 95.1% [95% CI 91.8-97.4]，特异度为 98.6% [95% CI 96.6-99.7]，准确度为 97.0% [95% CI 95.2-98.2]。欧姆龙 HEM-7371T1-AZAZ BPM 也获得了相同的结果。结论：这些数据支持家庭和专业人员使用 BPM（灵敏度 78.5% [95% CI 73.1-83.3]，特异性 97.6% [95% CI 95.1-99.0]，准确性 88.4% [95% CI 85.5-91.0]）：这些数据支持在家庭和专业人员中使用这些新型欧姆龙 BPM 检测房颤。

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引用次数: 0

To the Editor— Ask not if, but which ablation procedures may be performed in the ambulatory surgical center! 不是问 "是否"，而是问哪些消融术可在 ASC 进行！

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.103

引用次数: 0

Reply to the Editor— Ask not if, but which ablation procedures may be performed in the ambulatory surgical center! 作者对 "不是问是否，而是问哪些消融术可在 ASC 进行 "的回复

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.05.006

引用次数: 0

An international multicenter cohort study on implantable cardioverter-defibrillators for the treatment of symptomatic children with catecholaminergic polymorphic ventricular tachycardia 关于植入式心脏除颤器治疗有症状的儿茶酚胺能多形性室性心动过速患儿的国际多中心队列研究。

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.006

Background

Catecholaminergic polymorphic ventricular tachycardia (CPVT) may cause sudden cardiac death (SCD) despite medical therapy. Therefore, implantable cardioverter-defibrillators (ICDs) are commonly advised. However, there is limited data on the outcomes of ICD use in children.

Objective

The purpose of this study was to compare the risk of arrhythmic events in pediatric patients with CPVT with and without an ICD.

Methods

We compared the risk of SCD in patients with RYR2 (ryanodine receptor 2) variants and phenotype-positive symptomatic CPVT patients with and without an ICD who were younger than 19 years and had no history of sudden cardiac arrest at phenotype diagnosis. The primary outcome was SCD; secondary outcomes were composite end points of SCD, sudden cardiac arrest, or appropriate ICD shocks with or without arrhythmic syncope.

Results

The study included 235 patients, 73 with an ICD (31.1%) and 162 without an ICD (68.9%). Over a median follow-up of 8.0 years (interquartile range 4.3–13.4 years), SCD occurred in 7 patients (3.0%), of whom 4 (57.1%) were noncompliant with medications and none had an ICD. Patients with ICD had a higher risk of both secondary composite outcomes (without syncope: hazard ratio 5.85; 95% confidence interval 3.40–10.09; P < .0001; with syncope: hazard ratio 2.55; 95% confidence interval 1.50–4.34; P = .0005). Thirty-one patients with ICD (42.5%) experienced appropriate shocks, 18 (24.7%) inappropriate shocks, and 21 (28.8%) device-related complications.

Conclusion

SCD events occurred only in patients without an ICD and mostly in those not on optimal medical therapy. Patients with an ICD had a high risk of appropriate and inappropriate shocks, which may be reduced with appropriate device programming. Severe ICD complications were common, and risks vs benefits of ICDs need to be considered.

背景儿茶酚胺能多形性室性心动过速（CPVT）尽管可以通过药物治疗，但仍可能导致心脏性猝死（SCD）。因此，通常建议使用植入式心律转复除颤器（ICD）。方法我们比较了 RYR2（雷诺丁受体 2）变异型患者和表型阳性无症状 CPVT 患者的 SCD 风险，这些患者年龄小于 19 岁，在表型诊断时无心脏骤停病史。主要结果是 SCD；次要结果是 SCD、心脏骤停或适当的 ICD 电击与或不与心律失常性晕厥的复合终点。结果该研究共纳入 235 例患者，其中 73 例有 ICD（31.1%），162 例无 ICD（68.9%）。中位随访时间为 8.0 年（四分位数间距为 4.3-13.4 年），7 名患者（3.0%）发生了 SCD，其中 4 名患者（57.1%）不遵医嘱用药，没有人使用 ICD。使用 ICD 的患者发生两种次要综合结果的风险都更高（无晕厥：危险比 5.85；95% 置信区间 3.40-10.09；P <；.0001；有晕厥：危险比 2.55；95% 置信区间 1.50-4.34；P = .0005）。31名ICD患者（42.5%）经历了适当电击，18名（24.7%）经历了不适当电击，21名（28.8%）经历了设备相关并发症。使用 ICD 的患者发生适当和不适当电击的风险很高，但通过适当的设备编程可以降低这种风险。严重的 ICD 并发症很常见，因此需要考虑 ICD 的风险与益处。

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引用次数: 0

Top stories on intracellular potassium channels in cardiac arrhythmia 有关心律失常中的细胞内钾通道的热门报道

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.07.012

Harpreet Singh PhD , Shridhar Kiran Sanghvi PhD

引用次数: 0

Heart Rhythm Society Awards Subcommittee Update 心脏节律学会奖励小组委员会最新情况

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.06.018

Michael E. Cain MD, FHRS, FACC, FAHA , David J. Callans MD, FHRS, CCDS , Anne M. Gillis MD, FHRS , Douglas L. Packer MD, FHRS , Laurel Kay Racenet MSN, FNP, FHRS, CEPS, CDDS , Crystal M. Ripplinger PhD, FHRS , Diana L. Schmidt BA , Junaid A.B. Zaman MA, MD, PhD, CCDS, FRCP

引用次数: 0

Personalized voltage maps guided by cardiac magnetic resonance in the era of high-density mapping 高密度绘图时代以心脏磁共振为指导的个性化电压图

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.074

Background

Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5–1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) has been proven to be related with VT.

Objective

The purpose of this study was to analyze the diagnostic yield of a personalized voltage map using CMR to guide the adjustment of voltage thresholds.

Methods

All consecutive patients with scar-related VT undergoing ablation after CMR (from October 2018 to December 2020) were included. First, personalized CMR-guided voltage thresholds were defined systematically according to the distribution of the scar and channels. Second, to validate these new thresholds, a comparison with standard thresholds (0.5–1.5 mV) was performed. Tissue characteristics of areas identified as deceleration zones (DZs) were recorded for each pair of thresholds. In addition, the relation of VT circuits with voltage channels was analyzed for both maps.

Results

Thirty-two patients were included [mean age 66.6 ± 11.2 years; 25 (78.1%) ischemic cardiomyopathy]. Overall, 52 DZs were observed: 44.2% were identified as border zone tissue with standard cutoffs vs 75.0% using personalized voltage thresholds (P = .003). Of the 31 VT isthmuses detected, only 35.5% correlated with a voltage channel with standard thresholds vs 74.2% using adjusted thresholds (P = .005). Adjusted cutoff bipolar voltages that better matched CMR images were 0.51 ± 0.32 and 1.79 ± 0.71 mV with high interindividual variability (from 0.14–1.68 to 0.7–3.21 mV).

Conclusion

Personalized voltage CMR-guided personalized voltage maps enable a better identification of the substrate with a higher correlation with both DZs and VT isthmuses than do conventional voltage maps using fixed thresholds.

背景电压测图可确定可能导致室性心动过速（VT）的传导通道。使用双极导管确定了标准阈值（0.5-1.5 mV）。尚未对高密度绘图导管的阈值进行分析。此外，心脏磁共振（CMR）确定的通道已被证明与 VT 有关。本研究旨在分析使用 CMR 指导调整电压阈值的个性化电压图的诊断率。方法纳入所有经 CMR（2018 年 10 月至 2020 年 12 月）消融的瘢痕相关 VT 连续患者。首先，根据瘢痕和通道的分布系统地定义了 CMR 指导下的个性化电压阈值。其次，为了验证这些新阈值，与标准阈值（0.5-1.5 mV）进行了比较。每对阈值都记录了被确定为减速区（DZ）的区域的组织特征。此外，还分析了两种图谱的 VT 电路与电压通道的关系。结果32 例患者被纳入研究[平均年龄 66.6 ± 11.2 岁；25 例（78.1%）缺血性心肌病]。共观察到 52 个 DZ：使用标准临界值时，44.2% 被识别为边界区组织；使用个性化电压临界值时，75.0% 被识别为边界区组织（P = .003）。在检测到的 31 个 VT 峡部中，使用标准阈值时只有 35.5% 与电压通道相关，而使用调整阈值时则为 74.2%（P = .005）。结论与使用固定阈值的传统电压图相比，CMR 引导的个性化电压图能更好地识别基底，与 DZ 和 VT 峡部的相关性更高。

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引用次数: 0

Continuous peripheral electrical nerve stimulation improves cardiac function via autonomic nerve regulation in MI rats 持续外周神经电刺激通过自主神经调节改善心肌梗死大鼠的心功能

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm

Pub Date : 2024-10-01 DOI: 10.1016/j.hrthm.2024.04.070

Background

Peripheral electrical nerve stimulation (PENS) reportedly improves cardiac function after myocardial ischemia (MI) by rebalancing the cardiac autonomic nervous system. The dynamic and continuous influence of PENS on autonomic and cardiac function based on cardiac self-repair is not well understood.

Objectives

This study aimed to explore the relationship between autonomic nervous balance and functional cardiac repair after MI and to clarify the optimal acupoint selection and time course for PENS.

Methods

The activities of the superior cervical cardiac sympathetic nerve and vagus nerve were recorded to evaluate the autonomic tone directly. The pressure-volume loop system was used for left ventricular diastolic and systolic function. Noninvasive continuous electrocardiography and echocardiography were performed to analyze heart rate, heart rate variability, and left ventricular function. The effect of continuous PENS (cPENS) or instant PENS (iPENS) on autonomic and cardiac indications was tested.

Results

Sympathetic nerve activity and vagus nerve activity increased as compensatory self-regulation on days 7 and 14 post-MI, followed by an imbalance of autonomic tone and cardiac dysfunction on day 28. cPENS at acupoint PC6 maintained autonomic hyperexcitability, improved myocardial systolic and diastolic abilities, and reduced myocardial fibrosis on day 28 post-MI, whereas cPENS at acupoint ST36 had a limited effect. Both iPENS at PC6 and ST36 improved the autonomic and cardiac function of rats in the cPENS groups.

Conclusion

Rats showed autonomic fluctuations and cardiac dysfunction 28 days post-MI. cPENS produced sympathomimetic action to sustain cardiac self-compensation, but with acupoint specificity. On the basis of cPENS, iPENS evoked autonomic regulation and cardiac benefits without acupoint differentiation.

背景据报道，周围神经电刺激（PENS）可通过重新平衡心脏自主神经系统来改善心肌缺血（MI）后的心脏功能。本研究旨在探讨心肌缺血后自律神经平衡与心脏功能修复之间的关系，并明确 PENS 的最佳穴位选择和时间过程。方法记录颈上交感神经和迷走神经的活动，直接评估自律神经张力。使用压力-容积循环系统检测左心室舒张和收缩功能。无创连续心电图和超声心动图用于分析心率、心率变异性和左心室功能。结果交感神经活动和迷走神经活动在心肌梗死后第 7 天和第 14 天作为代偿性自我调节而增加，随后在第 28 天出现自律神经张力失衡和心功能障碍。在心肌梗死后第 28 天，PC6 穴位的 cPENS 可维持自律神经过度兴奋，改善心肌收缩和舒张能力，减少心肌纤维化，而 ST36 穴位的 cPENS 作用有限。结论大鼠在心肌梗死后 28 天出现自律神经波动和心功能障碍，cPENS 可产生拟交感作用，维持心脏自我补偿，但具有穴位特异性。在 cPENS 的基础上，iPENS 可唤起自律神经调节，对心脏有益，但无穴位特异性。

{"title":"Continuous peripheral electrical nerve stimulation improves cardiac function via autonomic nerve regulation in MI rats","authors":"","doi":"10.1016/j.hrthm.2024.04.070","DOIUrl":"10.1016/j.hrthm.2024.04.070","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral electrical nerve stimulation<span> (PENS) reportedly improves cardiac function after myocardial ischemia (MI) by rebalancing the cardiac autonomic nervous system. The dynamic and continuous influence of PENS on autonomic and cardiac function based on cardiac self-repair is not well understood.</span></div></div><div><h3>Objectives</h3><div>This study aimed to explore the relationship between autonomic nervous balance and functional cardiac repair after MI and to clarify the optimal acupoint selection and time course for PENS.</div></div><div><h3>Methods</h3><div><span>The activities of the superior cervical cardiac sympathetic nerve and vagus nerve were recorded to evaluate the autonomic tone directly. The pressure-volume loop system was used for left ventricular diastolic and </span>systolic function<span>. Noninvasive continuous electrocardiography<span> and echocardiography<span> were performed to analyze heart rate, heart rate variability, and left ventricular function. The effect of continuous PENS (cPENS) or instant PENS (iPENS) on autonomic and cardiac indications was tested.</span></span></span></div></div><div><h3>Results</h3><div>Sympathetic nerve activity<span><span> and vagus nerve activity<span> increased as compensatory self-regulation on days 7 and 14 post-MI, followed by an imbalance of autonomic tone and cardiac dysfunction on day 28. cPENS at acupoint PC6 maintained autonomic hyperexcitability, improved myocardial systolic and diastolic abilities, and reduced </span></span>myocardial fibrosis on day 28 post-MI, whereas cPENS at acupoint ST36 had a limited effect. Both iPENS at PC6 and ST36 improved the autonomic and cardiac function of rats in the cPENS groups.</span></div></div><div><h3>Conclusion</h3><div><span>Rats showed autonomic fluctuations and cardiac dysfunction 28 days post-MI. cPENS produced sympathomimetic action to sustain cardiac self-compensation, but with acupoint specificity. On the basis of cPENS, iPENS evoked </span>autonomic regulation and cardiac benefits without acupoint differentiation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775494","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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