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Impact of Operator Experience on Left Atrial Appendage Occlusion Outcomes. 操作员经验对左心房阑尾闭塞术结果的影响
IF 7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-19 DOI: 10.1016/j.jacep.2024.07.010
Tingting Zhang,Chao Gao,Jianzheng Liu,Guotao Fu,Boyu Li,Haitao Liu,Ruining Zhang,Ping Wang,Zhongping Ning,Bing Yang,Huimin Chu,Ben He,Junfeng Zhang,Ling Zhou,Yuechun Li,Yushun Zhang,Hao Hu,Yawei Xu,Jie Zeng,Jun Guo,Xi Su,Osama Soliman,Patrick W Serruys,Ling Tao,
BACKGROUNDThe relationship between long-term outcomes and operator experience for left atrial appendage occlusion (LAAO) is still unknown.OBJECTIVESThis study sought to explore the association between operator LAAO experience and one-year clinical outcomes.METHODSThe RECORD study (Registry to Evaluate Chinese Real-World Clinical Outcomes in Patients With AF Using the WATCHMAN Left Atrial Appendage Closure Technology; NCT03917563) was a multicenter, prospective registry that included patients with the WATCHMAN LAAO device (Boston Scientific) in China from April 1, 2019, to October 31, 2020. The current analyses included patients with solely LAAO from the registry; those who had concomitant LAAO and ablation/other procedures were excluded. The primary outcome was a composite endpoint of death, stroke, systemic embolism, and Bleeding Academic Research Consortium (BARC)-defined type 3 or 5 bleeding at 1 year.RESULTSA total of 1,547 LAAO patients and 111 operators were included. The mean ± SD CHA2DS2-VASc and HAS-BLED scores of patients were 4.0 ± 1.8 and 2.5 ± 1.1, respectively. The mean ± SD age of operators was 47.0 ± 7.2 years, 15 (13.5%) were female, and 52 (46.8%) were electrophysiologists. Utilizing maximally selected log-rank statistics, the thresholds to categorize an experienced operator were performing ≥32 LAAOs annually or ≥134 LAAOs in total. Performing ≥32 LAAOs annually is the better criterion than ≥134 LAAOs in total (absolute net reclassification index: 25.79%; P < 0.001). Compared with the ≥32 LAAO annually group, the <32 group was associated with a 1.8-fold (HRadjusted: 1.79; 95% CI: 1.16-2.78; P = 0.009) increase in the risk of the primary endpoint, and such risk in the <32 group can be reduced by ∼12% after performing each additional 5 cases (HRadjusted per 5 cases: 0.88; 95% CI: 0.78-0.99; P = 0.033).CONCLUSIONSPerforming ≥32 LAAOs annually could be a threshold to categorize an experienced operator. Before reaching this threshold, the risk of death, stroke, systemic embolism, and BARC-defined type 3 or 5 bleeding decreased by 12% after every 5 cases performed.
背景左心房阑尾闭塞术(LAAO)的长期疗效与操作者经验之间的关系尚不清楚。目的本研究旨在探讨操作者的 LAAO 经验与一年临床疗效之间的关系。方法RECORD研究(使用WATCHMAN左心房阑尾闭塞技术评估中国房颤患者真实世界临床结局的注册研究;NCT03917563)是一项多中心、前瞻性注册研究,纳入了2019年4月1日至2020年10月31日期间在中国使用WATCHMAN LAAO设备(波士顿科学公司)的患者。目前的分析包括登记中仅患有 LAAO 的患者;同时患有 LAAO 和消融术/其他手术的患者不包括在内。主要结果是1年内死亡、中风、全身性栓塞和出血学术研究联盟(BARC)定义的3型或5型出血的复合终点。结果共纳入1547名LAAO患者和111名操作者。患者的 CHA2DS2-VASc 和 HAS-BLED 评分的平均值(± SD)分别为 4.0 ± 1.8 和 2.5 ± 1.1。操作人员的平均(±SD)年龄为 47.0 ± 7.2 岁,15 人(13.5%)为女性,52 人(46.8%)为电生理学家。利用最大选择对数秩统计法,将每年进行的 LAAO ≥32 例或总共进行的 LAAO ≥134 例作为有经验操作者的阈值。每年进行的 LAAO ≥32 例是比总共进行的 LAAO ≥134 例更好的标准(绝对净重新分类指数:25.79%;P <0.001)。与每年 LAAO ≥32 例组相比,<32 例组的主要终点风险增加了 1.8 倍(调整后 HR:1.79;95% CI:1.16-2.78;P = 0.009),而每增加 5 例,<32 例组的主要终点风险可降低 12%(每 5 例调整后 HR:0.结论每年进行≥32例LAAO可作为划分有经验操作者的阈值。在达到这一阈值之前,每完成 5 例手术,死亡、中风、全身性栓塞和 BARC 定义的 3 型或 5 型出血的风险就会降低 12%。
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引用次数: 0
Triple Transition Sign in Simultaneous Bilateral Bundle Branch Capture. 同步双侧束支捕获的三重转换信号
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-12 DOI: 10.1016/j.jacep.2024.07.008
Hao Wu, Weilin Chen, Jiabo Shen, Longfu Jiang
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引用次数: 0
The Diagnostic Utility of Holter Monitoring in Catecholaminergic Polymorphic Ventricular Tachycardia. Holter 监测对儿茶酚胺能多态性室性心动过速的诊断作用。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-12 DOI: 10.1016/j.jacep.2024.06.028
Borna Naderi, Brianna Davies, Habib Khan, Shubhayan Sanatani, Jason G Andrade, Matthew T Bennett, Nathaniel M Hawkins, Santabhanu Chakrabarti, John A Yeung-Lai-Wah, Marc W Deyell, Zachary W M Laksman, Thomas M Roston, Andrew D Krahn

Background: Holter monitoring may raise suspicion of an underlying catecholaminergic polymorphic ventricular tachycardia (CPVT) diagnosis. Although not a primary investigation for CPVT, Holter monitoring is ubiquitously used as a diagnostic tool in the heart rhythm clinic.

Objectives: The objective of this study was to explore Holter monitoring in CPVT diagnosis.

Methods: This retrospective cohort study analyzed off-therapy Holter monitoring from 13 ryanodine receptor 2-positive CPVT and 34 healthy patients from the Canadian Hearts in Rhythm Organization national registry. Using the Edwards method, the ratio of ambient-maximum heart rate during Holter monitoring was correlated with exertion level to separate premature ventricular contractions (PVCs) during periods of adrenergic and nonadrenergic stress. A receiver operating characteristic curve analysis determined the optimal threshold for isolating CPVT-induced PVCs during adrenergic states.

Results: PVC burden differed between groups (P = 0.001) but was within population norm, suggesting ambient PVCs are uncommon in CPVT. CPVT patients had higher PVC counts than healthy controls (P = 0.002), with a different distribution based on adrenergic state. The optimal threshold for separating PVCs into periods of adrenergic and nonadrenergic stress in CPVT patients was 76% of the maximum heart rate during the monitoring period. Compared with healthy controls, CPVT patients had a higher PVC count, limited to periods of adrenergic stress, defined by >76% maximum heart rate threshold (P = 0.002; area under the receiver operating characteristic curve: 0.84). Below this threshold, there was no significant PVC difference (P = 0.604).

Conclusions: Holter monitor PVC counts alone are inadequate for CPVT diagnosis, owing to the adrenergic nature of the disease. Quantifying PVC prevalence at a heart rate threshold >76% identified CPVT with moderate sensitivity (69%) and high specificity (94%).

背景:Holter 监测可能会引起对潜在儿茶酚胺能多形性室性心动过速(CPVT)诊断的怀疑。虽然 Holter 监测不是 CPVT 的主要检查方法,但在心律临床中被普遍用作诊断工具:本研究旨在探讨 Holter 监测在 CPVT 诊断中的应用:这项回顾性队列研究分析了来自加拿大心律组织国家登记处的 13 名里约丁受体 2 阳性 CPVT 患者和 34 名健康患者的非治疗 Holter 监测结果。采用爱德华兹方法,将 Holter 监测期间的环境-最大心率比值与用力程度相关联,以区分肾上腺素能和非肾上腺素能应激期间的室性早搏(PVC)。接收器操作特征曲线分析确定了在肾上腺素能状态下分离 CPVT 诱导的 PVC 的最佳阈值:各组间的 PVC 负荷存在差异(P = 0.001),但均在人群标准范围内,这表明 CPVT 中的环境 PVC 并不常见。CPVT 患者的 PVC 计数高于健康对照组(P = 0.002),其分布因肾上腺素能状态而异。将 CPVT 患者的 PVC 分成肾上腺素能应激期和非肾上腺素能应激期的最佳阈值是监测期间最大心率的 76%。与健康对照组相比,CPVT 患者的 PVC 计数较高,仅限于最大心率阈值大于 76% 的肾上腺素能应激期(P = 0.002;接收器操作特征曲线下面积:0.84)。在此阈值以下,PVC差异不显著(P = 0.604):结论:由于 CPVT 的肾上腺素能性质,仅凭 Holter 监测器的 PVC 计数不足以诊断 CPVT。在心率阈值大于 76% 时量化 PVC 患病率可确定 CPVT,灵敏度为 69%,特异性为 94%。
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引用次数: 0
Renal Outcomes of Rhythm Control in Patients Recently Diagnosed With Atrial Fibrillation. 新近确诊的心房颤动患者节律控制对肾脏的影响
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-10 DOI: 10.1016/j.jacep.2024.07.007
Daehoon Kim, Pil-Sung Yang, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Hui-Nam Pak, Moon-Hyoung Lee, Gregory Y H Lip, Jung-Hoon Sung, Boyoung Joung

Background: Atrial fibrillation (AF) is associated with impaired renal function and chronic kidney disease (CKD).

Objectives: This study assessed the effects of rhythm control on renal function compared with rate control among patients recently diagnosed with AF.

Methods: A total of 20,886 patients with AF and available baseline estimated glomerular filtration rate (eGFR) data undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005 to 2015, were identified from the Korean National Health Insurance Service database. The composite outcome of ≥30% decline in eGFR, acute kidney injury, kidney failure, or death from renal or cardiovascular causes was compared with the use of propensity overlap weighting between rhythm or rate control strategies in patients with or without significant CKD (eGFR <60 mL/min/1.73 m2).

Results: Of the included patients (median age 62 years, 32.7% female), 2,213 (10.6%) had eGFR <60 mL/min/1.73 m2. Among patients with significant CKD, early rhythm control, compared with rate control, was associated with a lower risk of the primary composite outcome (weighted incidence rate: 2.77 vs 3.92 per 100 person-years; weighted HR: 0.70; 95% CI: 0.52-0.95). In patients without significant CKD, there was no difference in the risk of the primary composite outcome between rhythm and rate control groups (weighted incidence rate: 3.41 vs 3.21 per 100 person-years; weighted HR: 1.06; 95% CI: 0.96-1.18). No differences in safety outcomes were found between rhythm and rate control strategies in patients without or with significant CKD.

Conclusions: Among patients with AF and CKD, early rhythm control was associated with lower risks of adverse renal outcomes than rate control was.

背景:心房颤动与肾功能受损和慢性肾脏病(CKD)有关:心房颤动(房颤)与肾功能受损和慢性肾病(CKD)有关:本研究评估了与心率控制相比,心律控制对新近确诊的房颤患者肾功能的影响:方法:从韩国国民健康保险服务数据库中筛选出2005年至2015年期间接受节律控制(抗心律失常药物或消融)或心率控制治疗的20886名心房颤动患者,这些患者均有估计肾小球滤过率(eGFR)基线数据。在有或无明显慢性肾功能衰竭(eGFR 2)的患者中,采用倾向重叠加权法对节律或心率控制策略的综合结果(eGFR 下降≥30%、急性肾损伤、肾衰竭或肾脏或心血管原因导致的死亡)进行了比较:在有严重慢性肾功能衰竭的患者中,与心率控制相比,早期心律控制与较低的主要综合结果风险相关(加权发病率:2.77 vs 3.92 per 100 person-years;加权 HR:0.70;95% CI:0.52-0.95)。在无明显慢性肾脏病的患者中,节律组和速率对照组的主要综合结果风险没有差异(加权发病率:每 100 人年 3.41 例与每 100 人年 3.21 例;加权 HR:0.70;95% CI:0.52-0.95):加权 HR:1.06;95% CI:0.96-1.18)。在无严重慢性肾脏病或有严重慢性肾脏病的患者中,心律控制策略和心率控制策略的安全性结果没有差异:结论:在房颤合并慢性肾脏病的患者中,早期控制心律比控制心率的不良肾功能风险更低。
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引用次数: 0
Discordant Treatment Goals for Patients With Atrial Fibrillation and Clinical Trials Metrics. 心房颤动患者不一致的治疗目标与临床试验指标。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-08 DOI: 10.1016/j.jacep.2024.06.026
Brian Zenger, John A Spertus, Michael Torre, Ann Lyons, T Jared Bunch, Rachel Hess, Yue Zhang, Jonathan P Piccini, Morgan M Millar, Trudie Lobban, Benjamin A Steinberg

Background: Most clinical trials define successful atrial fibrillation (AF) treatment as no AF episodes longer than 30 seconds. Yet, there has been minimal study of how patients define successful treatment and whether their perspectives align with trial outcomes.

Objectives: Survey patients with AF to identify: 1) what aspect of AF is most important to address (frequency, duration, or severity of AF episodes); 2) what AF burden would be considered acceptable to consider treatment successful; and 3) to establish patient preferences for successful treatment thresholds for a validated patient-reported outcome (PRO) score.

Methods: We surveyed patients receiving active care for AF at a single tertiary care center modeled after the Toronto AF Severity Scale (AFSS). The survey consisted of current and "successful treatment" AF frequency, burden, and symptom domains; and baseline socioeconomic information.

Results: Of 7,000 invitations, 852 individuals completed the survey (12% response) with a mean age of 65 ± 13 years, 36.5% were female, and they had a mean CHA2DS2-VAsc score of 2.9 ± 1.9. Overall, 114 (13%) selected a decrease in AF episode duration as their top treatment priority, 505 (59%) episode frequency, and 230 (27%) episode severity. Overall, 207 (24%) patients would only consider a treatment successful if they never had AF again, whereas 645 (76%) patients considered success to be fewer AF episodes. A total of 341 (40%) patients would only consider a treatment successful if AF episodes lasted less than a few minutes, whereas 509 (60%) patients would accept AF episodes lasting >30 minutes. An AFSS symptom score ≤5 was considered a good outcome by 80% of respondents.

Conclusions: Patients prioritize decreased AF frequency over improvements in severity or duration, and an AFSS ≤5 would be a reasonable outcome of AF treatment. Most patients would consider treatment successful if they had more than 1 AF episode lasting longer than 30 seconds. Future clinical trial design should consider patients' perspectives when designing outcomes.

背景:大多数临床试验将成功的房颤治疗定义为房颤发作不超过 30 秒。然而,关于患者如何定义成功治疗以及他们的观点是否与试验结果一致的研究却很少:调查房颤患者,以确定目标:调查房颤患者,确定:1)房颤最需要解决的方面(房颤发作的频率、持续时间或严重程度);2)可接受的房颤负担是多少,才能认为治疗成功;3)确定患者对成功治疗阈值的偏好,以进行有效的患者报告结果(PRO)评分:我们以多伦多房颤严重程度量表(AFSS)为模型,对在一家三级医疗中心接受房颤积极治疗的患者进行了调查。调查内容包括当前和 "成功治疗 "房颤的频率、负担和症状领域,以及基线社会经济信息:在 7000 份邀请函中,852 人完成了调查(回复率为 12%),平均年龄为 65 ± 13 岁,36.5% 为女性,平均 CHA2DS2-VAsc 得分为 2.9 ± 1.9。总体而言,有 114 人(13%)将减少房颤发作持续时间作为首要治疗目标,505 人(59%)将减少发作频率作为首要治疗目标,230 人(27%)将减少发作严重程度作为首要治疗目标。总体而言,207 名(24%)患者认为只有当房颤不再发作时治疗才算成功,而 645 名(76%)患者则认为房颤发作次数减少才算成功。共有 341 名(40%)患者认为只有房颤发作持续时间少于几分钟的治疗才算成功,而 509 名(60%)患者则接受房颤发作持续时间大于 30 分钟的治疗。80%的受访者认为 AFSS 症状评分≤5 为良好结果:患者优先考虑的是降低房颤频率,而不是改善严重程度或持续时间,AFSS 评分≤5 分是房颤治疗的合理结果。如果房颤发作超过一次,持续时间超过 30 秒,大多数患者会认为治疗是成功的。未来的临床试验设计在设计结果时应考虑患者的观点。
{"title":"Discordant Treatment Goals for Patients With Atrial Fibrillation and Clinical Trials Metrics.","authors":"Brian Zenger, John A Spertus, Michael Torre, Ann Lyons, T Jared Bunch, Rachel Hess, Yue Zhang, Jonathan P Piccini, Morgan M Millar, Trudie Lobban, Benjamin A Steinberg","doi":"10.1016/j.jacep.2024.06.026","DOIUrl":"https://doi.org/10.1016/j.jacep.2024.06.026","url":null,"abstract":"<p><strong>Background: </strong>Most clinical trials define successful atrial fibrillation (AF) treatment as no AF episodes longer than 30 seconds. Yet, there has been minimal study of how patients define successful treatment and whether their perspectives align with trial outcomes.</p><p><strong>Objectives: </strong>Survey patients with AF to identify: 1) what aspect of AF is most important to address (frequency, duration, or severity of AF episodes); 2) what AF burden would be considered acceptable to consider treatment successful; and 3) to establish patient preferences for successful treatment thresholds for a validated patient-reported outcome (PRO) score.</p><p><strong>Methods: </strong>We surveyed patients receiving active care for AF at a single tertiary care center modeled after the Toronto AF Severity Scale (AFSS). The survey consisted of current and \"successful treatment\" AF frequency, burden, and symptom domains; and baseline socioeconomic information.</p><p><strong>Results: </strong>Of 7,000 invitations, 852 individuals completed the survey (12% response) with a mean age of 65 ± 13 years, 36.5% were female, and they had a mean CHA<sub>2</sub>DS<sub>2</sub>-VAsc score of 2.9 ± 1.9. Overall, 114 (13%) selected a decrease in AF episode duration as their top treatment priority, 505 (59%) episode frequency, and 230 (27%) episode severity. Overall, 207 (24%) patients would only consider a treatment successful if they never had AF again, whereas 645 (76%) patients considered success to be fewer AF episodes. A total of 341 (40%) patients would only consider a treatment successful if AF episodes lasted less than a few minutes, whereas 509 (60%) patients would accept AF episodes lasting >30 minutes. An AFSS symptom score ≤5 was considered a good outcome by 80% of respondents.</p><p><strong>Conclusions: </strong>Patients prioritize decreased AF frequency over improvements in severity or duration, and an AFSS ≤5 would be a reasonable outcome of AF treatment. Most patients would consider treatment successful if they had more than 1 AF episode lasting longer than 30 seconds. Future clinical trial design should consider patients' perspectives when designing outcomes.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing the Distribution of Ablation Lesions to Prevent Postablation Atrial Tachycardia: A Personalized Digital-Twin Study. 优化消融病灶分布以预防消融术后房性心动过速:个性化数字孪生研究。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-06 DOI: 10.1016/j.jacep.2024.07.002
Kensuke Sakata, Ryan P Bradley, Adityo Prakosa, Carolyna A P Yamamoto, Syed Yusuf Ali, Shane Loeffler, Eugene G Kholmovski, Sunil Kumar Sinha, Joseph E Marine, Hugh Calkins, David D Spragg, Natalia A Trayanova

Background: Although targeting atrial fibrillation (AF) drivers and substrates has been used as an effective adjunctive ablation strategy for patients with persistent AF (PsAF), it can result in iatrogenic scar-related atrial tachycardia (iAT) requiring additional ablation. Personalized atrial digital twins (DTs) have been used preprocedurally to devise ablation targeting that eliminate the fibrotic substrate arrhythmogenic propensity and could potentially be used to predict and prevent postablation iAT.

Objectives: In this study, the authors sought to explore possible alternative configurations of ablation lesions that could prevent iAT occurrence with the use of biatrial DTs of prospectively enrolled PsAF patients.

Methods: Biatrial DTs were generated from late gadolinium enhancement-magnetic resonance images of 37 consecutive PsAF patients, and the fibrotic substrate locations in the DT capable of sustaining reentries were determined. These locations were ablated in DTs by representing a single compound region of ablation with normal power (SSA), and postablation iAT occurrence was determined. At locations of iAT, ablation at the same DT target was repeated, but applying multiple lesions of reduced-strength (MRA) instead of SSA.

Results: Eighty-three locations in the fibrotic substrates of 28 personalized biatrial DTs were capable of sustaining reentries and were thus targeted for SSA ablation. Of these ablations, 45 resulted in iAT. Repeating the ablation at these targets with MRA instead of SSA resulted in the prevention of iAT occurrence at 15 locations (18% reduction in the rate of iAT occurrence).

Conclusions: Personalized atrial DTs enable preprocedure prediction of iAT occurrence after ablation in the fibrotic substrate. It also suggests MRA could be a potential strategy for preventing postablation AT.

背景:虽然针对心房颤动(AF)驱动因素和基质的消融策略已被用作持续性心房颤动(PsAF)患者的有效辅助消融策略,但它可能导致先天性瘢痕相关性房性心动过速(iAT),需要额外的消融治疗。个性化心房数字孪生(DT)已被用于术前设计消融靶点,以消除纤维基质致心律失常倾向,并有可能用于预测和预防消融术后 iAT:在本研究中,作者试图利用前瞻性入组的 PsAF 患者的 Biatrial DTs 探索消融病灶的可能替代配置,以预防 iAT 的发生:根据 37 例连续 PsAF 患者的晚期钆增强磁共振图像生成双心房 DT,并确定 DT 中能够维持再入的纤维基质位置。在 DT 中以正常功率(SSA)代表单个复合消融区域对这些位置进行消融,并确定消融后 iAT 的发生情况。在出现 iAT 的位置,重复进行相同 DT 目标的消融,但使用多个减弱强度(MRA)的病灶来代替 SSA:结果:在 28 个个性化双房 DT 的纤维化基质中,有 83 个位置能够维持再进入,因此成为 SSA 消融的目标。在这些消融术中,有 45 例出现了 iAT。用 MRA 代替 SSA 在这些靶点重复消融,可防止 15 个位置发生 iAT(iAT 发生率降低 18%):结论:个性化的心房 DT 可以在术前预测纤维基底消融后 iAT 的发生率。结论:个性化心房 DT 可以在术前预测纤维化基底消融术后 iAT 的发生,这也表明 MRA 可能是预防消融术后 AT 的一种潜在策略。
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引用次数: 0
Effects of Glucagon-Like Peptide-1 Receptor Agonists on Atrial Fibrillation Recurrence After Catheter Ablation 胰高血糖素样肽-1 受体激动剂对导管消融术后心房颤动复发的影响
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.jacep.2024.03.031

Background

Relationship between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use prior to atrial fibrillation (AF) ablation and subsequent AF recurrence is not well-understood.

Objectives

This study investigated the effects of GLP-1 RA use within 1 year before ablation and its association with AF recurrence and associated outcomes.

Methods

The TriNetX research database was used to identify patients aged ≥18 years undergoing AF ablation (2014-2023). Patients were categorized into 2 groups, and propensity score matching (1:1) between preablation GLP-1 RA users and nonusers was performed based on demographics, comorbidities, body mass index, laboratory tests, AF subtype, and medications. Primary outcome was composite of cardioversion, new antiarrhythmic drug therapy, or repeat AF ablation after a 3-month blanking period following the index ablation. Additional outcomes included ischemic stroke, all-cause hospitalization, and mortality during 12-month follow-up period.

Results

After 1:1 propensity score matching, the study cohort comprised 1,625 GLP-1 RA users and 1,625 matched GLP-1 RA nonusers. Preablation GLP-1 RA therapy was not associated with a lower risk of cardioversion, new AAD therapy, and repeat AF ablation after the index procedure (HR: 1.04 [95% CI: 0.92-1.19]; log-rank P = 0.51). Furthermore, the risk of ischemic stroke, all-cause hospitalization, and mortality during the 12-month follow-up period did not differ between the 2 groups.

Conclusions

These findings suggest that preprocedural use of GLP-1 RAs is not associated with a reduced risk of AF recurrence or associated adverse outcomes following ablation, and underscore the need for future research to determine whether these agents improve outcome in AF patients.

背景:心房颤动(房颤)消融术前使用胰高血糖素样肽-1受体激动剂(GLP-1 RA)与随后的房颤复发之间的关系尚不十分清楚:本研究调查了消融术前一年内使用 GLP-1 RA 的影响及其与房颤复发和相关结果的关系:方法:使用 TriNetX 研究数据库识别年龄≥18 岁接受房颤消融术的患者(2014-2023 年)。根据人口统计学、合并症、体重指数、实验室检查、房颤亚型和药物,将患者分为两组,并在消融前GLP-1 RA使用者和非使用者之间进行倾向得分匹配(1:1)。主要结果是心脏复律、新的抗心律失常药物治疗或在指数消融术后 3 个月空白期后重复房颤消融术的综合结果。其他结果包括缺血性中风、全因住院和 12 个月随访期间的死亡率:经过1:1倾向评分匹配后,研究队列由1625名GLP-1 RA使用者和1625名匹配的GLP-1 RA非使用者组成。消融前 GLP-1 RA 治疗与心脏复律、新的 AAD 治疗和指数手术后重复房颤消融的较低风险无关(HR:1.04 [95% CI:0.92-1.19];对数秩 P = 0.51)。此外,两组患者在12个月的随访期间发生缺血性中风、全因住院和死亡的风险没有差异:这些研究结果表明,术前使用 GLP-1 RAs 与降低房颤复发风险或消融术后相关不良预后无关,并强调了未来研究确定这些药物是否能改善房颤患者预后的必要性。
{"title":"Effects of Glucagon-Like Peptide-1 Receptor Agonists on Atrial Fibrillation Recurrence After Catheter Ablation","authors":"","doi":"10.1016/j.jacep.2024.03.031","DOIUrl":"10.1016/j.jacep.2024.03.031","url":null,"abstract":"<div><h3>Background</h3><p><span>Relationship between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use prior to </span>atrial fibrillation (AF) ablation and subsequent AF recurrence is not well-understood.</p></div><div><h3>Objectives</h3><p>This study investigated the effects of GLP-1 RA use within 1 year before ablation and its association with AF recurrence and associated outcomes.</p></div><div><h3>Methods</h3><p><span>The TriNetX research database was used to identify patients aged ≥18 years undergoing AF ablation (2014-2023). Patients were categorized into 2 groups, and propensity score matching<span> (1:1) between preablation GLP-1 RA users and nonusers was performed based on demographics, comorbidities, body mass index, </span></span>laboratory tests<span><span><span>, AF subtype, and medications. Primary outcome was composite of cardioversion, new </span>antiarrhythmic drug therapy, or repeat AF ablation after a 3-month blanking period following the index ablation. Additional outcomes included </span>ischemic stroke, all-cause hospitalization, and mortality during 12-month follow-up period.</span></p></div><div><h3>Results</h3><p><span>After 1:1 propensity score matching, the study cohort comprised 1,625 GLP-1 RA users and 1,625 matched GLP-1 RA nonusers. Preablation GLP-1 RA therapy was not associated with a lower risk of cardioversion, new AAD therapy, and repeat AF ablation after the index procedure (HR: 1.04 [95% CI: 0.92-1.19]; log-rank </span><em>P =</em><span> 0.51). Furthermore, the risk of ischemic stroke, all-cause hospitalization, and mortality during the 12-month follow-up period did not differ between the 2 groups.</span></p></div><div><h3>Conclusions</h3><p>These findings suggest that preprocedural use of GLP-1 RAs is not associated with a reduced risk of AF recurrence or associated adverse outcomes following ablation, and underscore the need for future research to determine whether these agents improve outcome in AF patients.</p></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141096970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Idiopathic Isolated Left Atrial Appendage 特发性孤立左心房阑尾:一个罕见但无法忽视的问题。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.jacep.2024.04.012
{"title":"Idiopathic Isolated Left Atrial Appendage","authors":"","doi":"10.1016/j.jacep.2024.04.012","DOIUrl":"10.1016/j.jacep.2024.04.012","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Life-Threatening Arrhythmias in Patients With Takotsubo Syndrome Takotsubo 综合征患者中危及生命的心律失常:病理生理学和治疗创新的启示。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.jacep.2024.03.034

Takotsubo syndrome (TTS) is a reversible form of acute myocardial injury due to a neurocardiogenic mechanism associated with a relevant risk for life-threatening ventricular arrhythmias, occurring in up to 25% of all patients and including both ventricular arrhythmias (especially) in the context of QT prolongation and atrial tachy- or bradyarrhythmias. The pathogenetic mechanisms of TTS-related arrhythmic complications are not completely understood, and there are no randomized clinical trials addressing the pharmacologic and nonpharmacologic management in this specific setting. In this narrative review, the authors provide an overview of the pathogenesis and the therapeutic management of arrhythmic complications in patients with TTS, along with the future perspectives and the remaining knowledge gaps in this field.

塔克次氏综合征(TTS)是一种可逆的急性心肌损伤,由神经心源性机制引起,具有危及生命的室性心律失常的相关风险,发生率高达 25%,包括 QT 延长背景下的室性心律失常(尤其是)和房性心动过速或过缓。与 TTS 相关的心律失常并发症的发病机制尚不完全清楚,也没有针对这种特殊情况下的药物和非药物治疗的随机临床试验。在这篇叙述性综述中,作者概述了 TTS 患者心律失常并发症的发病机制和治疗方法,以及该领域的未来展望和尚存的知识空白。
{"title":"Life-Threatening Arrhythmias in Patients With Takotsubo Syndrome","authors":"","doi":"10.1016/j.jacep.2024.03.034","DOIUrl":"10.1016/j.jacep.2024.03.034","url":null,"abstract":"<div><p>Takotsubo syndrome<span> (TTS) is a reversible form of acute myocardial injury<span><span><span> due to a neurocardiogenic mechanism associated with a relevant risk for life-threatening ventricular arrhythmias<span><span>, occurring in up to 25% of all patients and including both ventricular arrhythmias (especially) in the context of </span>QT prolongation and atrial tachy- or </span></span>bradyarrhythmias. The pathogenetic mechanisms of TTS-related arrhythmic complications are not completely understood, and there are no </span>randomized clinical trials addressing the pharmacologic and nonpharmacologic management in this specific setting. In this narrative review, the authors provide an overview of the pathogenesis and the therapeutic management of arrhythmic complications in patients with TTS, along with the future perspectives and the remaining knowledge gaps in this field.</span></span></p></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cocaine and Cardiac Conduction System 可卡因与心脏传导系统:年轻可卡因吸食者与非吸食者的综合形态学比较。
IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.jacep.2024.04.014
{"title":"Cocaine and Cardiac Conduction System","authors":"","doi":"10.1016/j.jacep.2024.04.014","DOIUrl":"10.1016/j.jacep.2024.04.014","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
JACC. Clinical electrophysiology
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