Journal of Arrhythmia最新文献_第6页

Exploring the Therapeutic Potential of Antidiabetic Drugs in Cardiac Arrhythmia Management: A Drug Target Mendelian Randomization Study 探索抗糖尿病药物在心律失常治疗中的治疗潜力：一项药物靶向孟德尔随机研究

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-12-04 DOI: 10.1002/joa3.70241

Zheng-Qi Song, Zhi-Bo Zhou, Bo-Xiang Wang, Sheng-Ke Wu, Yi-Han Sun, Yi-He Chen, Su-Yin Feng, Run-Feng Sun

Background

Cardiac arrhythmias pose a major health concern while the role of antidiabetic medications in cardiac arrhythmic risks is not fully understood.

Method

We conducted a two-sample Mendelian Randomization (MR) analysis using genetic instruments extracted from hemoglobin A1C (HbA1c) as proxies for antidiabetic drug targets to evaluate their causal relationship with five cardiac arrhythmias derived from the Finngen database. Summary-data-based Mendelian randomization (SMR) utilizing gene expression data from the eQTLgen consortium was further employed to assess the role of antidiabetic drug targets in cardiac arrhythmias from the gene expression perspective.

Results

Three significant associations were identified. Sulfonylurea targets KCNJ11/ABCC8 were associated with a decreased incidence of paroxysmal tachycardia (OR: 0.69, 95% CI: 0.56, 0.86, P_FDR = 0.022). Sodium-glucose cotransporter 2 inhibitor (SGLT2i) target SLC5A2 was linked to a reduced risk of right bundle branch block (OR: 0.85, 95% CI: 0.77, 0.94, PFDR = 0.022), and thiazolidinediones (TZDs) targeting RXRB were associated with a lowered atrial fibrillation occurrence (OR: 0.88, 95% CI: 0.82, 0.94, P_FDR = 0.019). No significant relationships were found between any antidiabetic drug targets and left bundle branch block or atrioventricular block. SMR analysis indicated that lowered expression of KCNJ11 was related to a decreased paroxysmal tachycardia risk (OR: 1.05, 95% CI: 1.01, 1.08, P_SMR = 0.010), further confirming the role of KCNJ11 in paroxysmal tachycardia.

Conclusion

Our findings suggest that several antidiabetic drug targets may have potential therapeutic applications in the management of cardiac arrhythmias.

背景：心律失常是一个主要的健康问题，而抗糖尿病药物在心律失常风险中的作用尚不完全清楚。方法采用从血红蛋白A1C （HbA1c）中提取的遗传仪器作为降糖药物靶点的代理，进行两样本孟德尔随机化（MR）分析，以评估其与Finngen数据库中导出的五种心律失常的因果关系。利用来自eQTLgen联盟的基因表达数据，采用基于汇总数据的孟德尔随机化（SMR），进一步从基因表达角度评估降糖药物靶点在心律失常中的作用。结果确定了三个显著相关性。磺脲类靶点KCNJ11/ABCC8与阵发性心动过速发生率降低相关（OR: 0.69, 95% CI: 0.56, 0.86, PFDR = 0.022）。钠-葡萄糖共转运蛋白2抑制剂（sgltti）靶点SLC5A2与降低右束分支阻滞的风险相关（OR: 0.85, 95% CI: 0.77, 0.94, PFDR = 0.022），而以RXRB为靶点的噻唑烷二酮类药物（TZDs）与降低房颤发生率相关（OR: 0.88, 95% CI: 0.82, 0.94, PFDR = 0.019）。降糖药物靶点与左束支传导阻滞或房室传导阻滞无明显关系。SMR分析显示KCNJ11表达降低与阵发性心动过速风险降低相关（OR: 1.05, 95% CI: 1.01, 1.08, PSMR = 0.010），进一步证实了KCNJ11在阵发性心动过速中的作用。结论几种降糖药物靶点可能在心律失常的治疗中具有潜在的应用价值。

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引用次数: 0

Successful Treatment With Ivabradine for Junctional Ectopic Tachycardia–Induced Cardiomyopathy With Hypoplastic Left Heart Syndrome 伊伐布雷定成功治疗结缔性异位心动过速性心肌病伴左心发育不全综合征

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-12-04 DOI: 10.1002/joa3.70223

Yuto Fukuda, Hisaaki Aoki, Kiyohiro Takigiku, Noboru Inamura

A patient with hypoplastic left heart syndrome developed heart failure due to tachycardia-induced cardiomyopathy from junctional ectopic tachycardia. Conventional antiarrhythmic therapy was ineffective, but ivabradine successfully controlled the arrhythmia and improved both ventricular function and heart failure.

一例左心发育不全综合征患者因结性异位心动过速引起的心动过速性心肌病而发生心力衰竭。传统的抗心律失常治疗无效，但伊伐布雷定成功地控制心律失常，改善心室功能和心力衰竭。

引用次数: 0

Trends in Mortalities due to Sudden Cardiac Arrest in the United States Population 美国人口心脏骤停死亡率趋势

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-12-02 DOI: 10.1002/joa3.70240

Muhammad Shaheer Bin Faheem, Tehreem Asghar, Faheem Feroze, Fatima Naveed, Natasha Chowdhury, Sumaya Samadi, Muhammad Aamir Laghari, Jamal S. Rana, Marat Fudim

Background

Sudden cardiac arrest is a leading cause of cardiovascular mortality, often occurring without warning and resulting in high fatality rates. Despite advances in prevention and emergency response, disparities in mortality remain rampant across demographic and geographic groups. This study examines long-term trends in sudden cardiac arrest-related mortality in the United States from 1999 to 2023, stratified by sex, race/ethnicity, region, and urbanization level.

Methods

Mortality data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons using the 2000 U.S. standard population. Joinpoint regression analysis was applied to estimate annual percent changes (APCs) and identify significant shifts in mortality trends.

Results

A total of 8 523 980 SCA deaths were reported during the study period. Overall, the AAMR declined from 196.03 in 1999 to 131.55 in 2023, with the most marked reductions observed after 2021 (APC: –9.63; 95% CI: −13.51 to −5.20; p < 0.000001). Men consistently exhibited higher AAMRs than women (156.08 vs. 111.09 in 2023). Non-Hispanic Black individuals had the highest mortality rates (235.18), followed by Hispanics (184.38). Geographic disparities were evident, with the Northeast and metropolitan areas reporting the greatest AAMRs.

Conclusions

Mortality due to sudden cardiac arrest has declined substantially over the past 25 years, likely driven by improvements in cardiovascular prevention, acute care, and resuscitation practices. However, significant sex, racial, and regional disparities persist, highlighting the need for interventions that are tailored to reduce inequities and improve survival from sudden cardiac arrest.

背景：心脏骤停是心血管疾病死亡的主要原因，通常在没有预警的情况下发生，并导致高死亡率。尽管在预防和应急方面取得了进展，但不同人口和地理群体之间的死亡率差距仍然很大。本研究考察了1999年至2023年美国心脏骤停相关死亡率的长期趋势，并按性别、种族/民族、地区和城市化水平分层。方法：死亡率数据从CDC WONDER数据库中提取。使用2000年美国标准人口计算每10万人的年龄调整死亡率（AAMRs）。采用连接点回归分析估计年百分比变化（APCs）并确定死亡率趋势的显著变化。结果：研究期间共报告SCA死亡8 523 980例。总体而言，AAMR从1999年的196.03下降到2023年的131.55，在2021年之后观察到最显著的下降（APC: -9.63; 95% CI: -13.51至-5.20;p）结论：心脏骤停死亡率在过去25年中大幅下降，可能是由于心血管预防、急性护理和复苏实践的改善。然而，显著的性别、种族和地区差异仍然存在，这突出表明需要采取针对性的干预措施，以减少不平等现象，提高心脏骤停患者的存活率。

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引用次数: 0

Economic Burden Associated With Cardiac Implantable Electronic Device (CIED) Infections in New South Wales, Australia: A Population-Based Study Using Linked Administrative Data 澳大利亚新南威尔士州与心脏植入式电子设备（CIED）感染相关的经济负担：一项使用相关管理数据的基于人群的研究。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-12-02 DOI: 10.1002/joa3.70237

Md Shajedur Rahman Shawon, Behnoosh Hosseinloui Khalaj, Michelle Hill, Gabrielle Challis, Liesl Strachan, Louisa Jorm

Background

Cardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%–3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia.

Methods

This retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in-hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection-related hospitalizations.

Results

We identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow-up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high-risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)-pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT-defibrillator patients).

Conclusions

Our findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.

背景：心脏植入式电子装置（CIED）感染是一种严重的并发症，发生率约为1%-3%。然而，在澳大利亚，与CIED感染相关的总医疗费用数据很少。本研究旨在全面估计澳大利亚CIED感染的总医疗费用。方法：这项回顾性队列研究纳入了2017年7月至2022年9月在新南威尔士州诊断为CIED感染的18岁以上患者。使用相关的管理数据，估计了在CIED感染相关住院治疗前28天至后42天期间的住院治疗、急诊就诊、门诊服务、医疗保险索赔、救护车运输和分配药物的成本。结果：我们确定了726例CIED感染患者，其中233例（32.1%）在平均35.6个月的随访期间死亡。平均治疗费用为77 746美元，主要是住院费用（88.3%）。主要的医院成本驱动因素包括器械类型、机械通气、重症监护病房（ICU）住院时间、临时起搏、住院时间、高危患者和多种合并症。接受完整系统移除并再植入术的患者（31.7%）的费用最高（120 792美元），其次是仅完成系统移除的患者（15.7%；98 453美元）和未完成系统移除的患者（52.6%；45 649美元）。对于接受完整系统移除和/或再植入手术的患者，费用因设备类型而异（起搏器患者为9089美元，心脏再同步化治疗（CRT）起搏器患者为111677美元，植入式心脏除颤器患者为12864美元，CRT除颤器患者为14888美元）。结论：我们的研究结果强调了与CIED感染相关的大量医疗保健费用，在患者因素和临床护理途径之间存在很大差异。

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引用次数: 0

Discrepant Versus Appropriate Responses to Differential Atrial Pacing in Atrioventricular Reentrant Tachycardia: What Is the Mechanism? 房室折返性心动过速差异心房起搏的差异反应与适当反应：其机制是什么？

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-30 DOI: 10.1002/joa3.70235

Can Ozkan, Ozcan Ozeke, Ahmet Korkmaz, Dursun Aras, Serkan Topaloglu

The example illustrates the analysis and measurement of the ventriculo-atrial (VA) interval following atrial overdrive pacing from both the right atrium and the coronary sinus. At first glance, VA linking does not appear to be present in response to the AOP; however, closer inspection reveals that VA linking is, in fact, observed in the subsequent cycle.

本例说明了右心房和冠状窦心房超速起搏后心室-心房（VA）间隔的分析和测量。乍一看，VA链接似乎没有出现在对AOP的响应中；然而，仔细观察就会发现，VA连接实际上是在随后的循环中观察到的。

引用次数: 0

Clinical Profiles and In-Hospital Outcomes of Pre-Existing Versus Newly Diagnosed Atrial Fibrillation in Coronary Care Units: Insights From the MORCOR-TURK National Registry 冠状动脉监护室中既往房颤与新诊断房颤的临床概况和住院结果：来自MORCOR-TURK国家登记处的见解

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-28 DOI: 10.1002/joa3.70238

Ertan Aydin, Muhammed Mürsel Öğütveren, Gurbet Özge Mert, Mehtap Yeni, Sevil Gülaşti, Uğur Küçük, Başar Candemir, İbrahim Halil Tanboğa, Aymet Seyda Yilmaz

Objective

To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.

Methods

This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.

Results

Pre-existing AF (n = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; p = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; p < 0.001). Newly diagnosed AF (n = 216) more frequently presented with heart failure (45.8% vs. 28.4%; p < 0.001) and dyspnea (67.1% vs. 48.5%; p < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; p < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; p < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; p = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; p = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.

Conclusion

In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.

目的比较土耳其冠状动脉监护病房（CCUs）住院患者中已有（慢性）房颤（AF）和新诊断房颤（AF）的人口学、临床和实验室资料以及短期预后，并确定房颤亚型中住院死亡率的相关因素。这项多中心前瞻性国家登记分析纳入了土耳其七个地理区域50个CCU中心的540名连续房颤患者（MORCOR-TURK national registry; September 1 - 30,2022）。患者分为已存在的房颤（入院前或入院时记录的房颤）和新诊断的房颤（住院期间首次发现）。记录人口统计学、合并症、入院诊断、实验室生物标志物（包括NT-proBNP和hs-肌钙蛋白I）、管理和结果。多变量logistic回归确定了住院死亡率的独立预测因子。结果既往房颤（n = 324）患者糖尿病患病率（42.3%比31.5%,p = 0.012）和急性冠脉综合征患病率（58.6%比34.7%,p < 0.001）较高。新诊断的房颤（n = 216）更常出现心力衰竭（45.8% vs. 28.4%; p < 0.001）和呼吸困难（67.1% vs. 48.5%; p < 0.001）。新诊断的AF表现出较高的炎症负担（CRP中值28.4 vs 12.6 mg/L; p < 0.001）和较低的血红蛋白（11.8±2.1 vs 12.9±1.8 g/dL; p < 0.001）。两组患者NT-proBNP均升高，新诊断的AF患者NT-proBNP更高（中位数4850 vs 3240 pg/mL； p = 0.003）。新诊断为房颤的住院死亡率更高（12.0%比6.8%;p = 0.042）。独立的死亡率预测因素包括年龄、慢性肾病、心源性休克、log-转化NT-proBNP、hs-肌钙蛋白I和CRP。结论：在土耳其ccu中，已存在和新诊断的房颤构成不同的临床表型，具有不同的表现、生物标志物特征和短期风险。新诊断的房颤与更大的炎症和血流动力学应激以及更高的住院死亡率相关。生物标志物富集的风险分层可以改善AF亚型的预后和指导有针对性的管理。

{"title":"Clinical Profiles and In-Hospital Outcomes of Pre-Existing Versus Newly Diagnosed Atrial Fibrillation in Coronary Care Units: Insights From the MORCOR-TURK National Registry","authors":"Ertan Aydin, Muhammed Mürsel Öğütveren, Gurbet Özge Mert, Mehtap Yeni, Sevil Gülaşti, Uğur Küçük, Başar Candemir, İbrahim Halil Tanboğa, Aymet Seyda Yilmaz","doi":"10.1002/joa3.70238","DOIUrl":"https://doi.org/10.1002/joa3.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pre-existing AF (<i>n</i> = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; <i>p</i> = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; <i>p</i> < 0.001). Newly diagnosed AF (<i>n</i> = 216) more frequently presented with heart failure (45.8% vs. 28.4%; <i>p</i> < 0.001) and dyspnea (67.1% vs. 48.5%; <i>p</i> < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; <i>p</i> < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; <i>p</i> < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; <i>p</i> = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; <i>p</i> = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Clinical Utility of 3D Electroanatomical Mapping for Atrial Fibrillation Ablation by Pulsed Field Ablation 心房颤动脉冲场消融三维电解剖定位的临床应用

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-27 DOI: 10.1002/joa3.70234

Robert N. Kerley, David Keane

Background

Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.

Objective

This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.

Methods

Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.

Results

In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.

Conclusion

Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.

脉冲场消融（PFA）是一种组织选择性消融能量源，最近被引入心房颤动（AF）消融。使用三维电解剖定位（EAM）的数据在PFA消融房颤中是有限的，许多中心选择忽略它。目的探讨PFA高密度三维EAM在房颤消融中的应用。方法74例有症状的房颤患者行pfa肺静脉隔离术（PVI）。在一部分患者中进行了额外的消融，包括左心房后壁（LAPW）和二尖瓣峡（MI）消融。主要疗效终点是12个月时无房性心律失常。主要安全终点是没有严重的程序和设备相关的不良事件。结果74例患者pfa后3D EAM显示早期PV重连7/74例（9%；PV 289/296例，2.4% PV），最常见于右侧PV上（6/7,85.7%）。LAPW再连接3/55例（5.5%），而MI线再连接6/14例（30%），前路比后路更常见（57%比15%）。手术时间88.3±40.7 min，透视时间12.1±8.0 min。1年后，估计房性心律失常的自由率为78.4% （95% CI， 70.1至88.7）。心包填塞1例。结论我们的研究结果表明，尽管PFA治疗PVI的发生率较低，但仍然可以发生早期PV重连。总体而言，3D EAM在PFA消融房颤中仍具有临床价值。

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引用次数: 0

Pulmonary Vein Isolation Using a Circular Multielectrode Pulsed Field Ablation Catheter via a Jugular Vein Approach 颈静脉入路环形多电极脉冲场消融导管分离肺静脉

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-27 DOI: 10.1002/joa3.70239

Takahiko Nagase, Haruwo Tashiro, Chiyo Yoshino, Ryuichi Kato, Masao Kuwada

PVI by catheter ablation for atrial fibrillation via a superior approach is technically challenging. However, the circular multielectrode PFA catheter is feasible for PVI via a superior jugular vein approach. AP, anteroposterior; LAO, left anterior oblique; PA, posteroanterior; PFA, pulsed field ablation; PVI, pulmonary vein isolation.

通过导管消融治疗房颤在技术上具有挑战性。然而，圆形多电极PFA导管经颈上静脉入路治疗PVI是可行的。美联社,前后的;LAO，左前斜；PA,后前位的;PFA：脉冲场消融；PVI，肺静脉隔离

引用次数: 0

Relationship Between Complex Signal Identification and Non-Pulmonary Vein Foci 复杂信号识别与非肺静脉病灶的关系

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-26 DOI: 10.1002/joa3.70230

Hiroyuki Kono, Kenichi Hiroshima, Keigo Misonou, Koumei Onuki, Maiko Kuroda, Jun Hirokami, Tomonori Katsuki, Rei Kuji, Kengo Korai, Masato Fukunaga, Michio Nagashima, Kenji Ando

Background

Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, recurrences often originate from non-pulmonary vein (non-PV) foci. The Complex Signal Identification (CSI) algorithm in CARTO 3 assigns electrogram-fractionation scores (0–10). This study evaluated the feasibility of CSI-assisted mapping for identifying non-PV triggers.

Methods

We retrospectively analyzed 23 consecutive patients undergoing first-time AF ablation between January and June 2024. After PVI, non-PV triggers were induced using isoproterenol and adenosine triphosphate (ATP). When ectopy was absent, rapid pacing during isoproterenol infusion followed by defibrillation was performed, and ATP testing was repeated. High-density CSI mapping was conducted during sinus rhythm or high right atrial pacing using system default settings, targeting atrial components after ventricular blanking.

Results

A total of 33 non-PV foci were localized (20 left atrium [LA], 13 right atrium [RA]). The mean CSI scores of LA and RA foci were 9.0 ± 2.3 and 8.8 ± 2.7, respectively. ROC analysis showed an AUC of 0.917 for discriminating non-PV foci, with an optimal cutoff of 8.5 (sensitivity 87.9%, specificity 88.3%). At 12 months, arrhythmia-free survival was 82.4% under symptom-driven follow-up. Ablation was selectively performed at the earliest activation and adjacent high-CSI points, avoiding indiscriminate lesion delivery.

Conclusions

CSI-assisted mapping provided practical, adjunctive guidance to provocation and activation mapping for non-PV focus localization. While apparent discrimination was promising, the 8.5 threshold remains exploratory. Larger multicenter studies with standardized CSI settings and systematic post-ablation assessment are warranted to validate these preliminary findings.

背景肺静脉隔离（PVI）是房颤（AF）消融的基石；然而，复发通常起源于非肺静脉（非pv）灶。CARTO 3中的复杂信号识别（CSI）算法分配电图分数（0-10）。本研究评估了csi辅助测绘识别非pv触发器的可行性。方法回顾性分析2024年1月至6月连续23例首次房颤消融患者。PVI后，使用异丙肾上腺素和三磷酸腺苷（ATP）诱导非pv触发器。当异丙肾上腺素输注期间进行快速起搏，随后进行除颤，并重复ATP检测。在窦性心律或高右心房起搏时，使用系统默认设置进行高密度CSI制图，目标是心室空白后的心房成分。结果33个非pv灶被定位，其中左心房[LA] 20个，右心房[RA] 13个。LA和RA病灶CSI平均评分分别为9.0±2.3分和8.8±2.7分。ROC分析显示，鉴别非pv病灶的AUC为0.917，最佳截断值为8.5（敏感性87.9%，特异性88.3%）。12个月时，在症状驱动的随访中，无心律失常生存率为82.4%。选择性地在最早的激活点和邻近的高csi点进行消融，避免不加区分的病变递送。结论csi辅助定位为非pv病灶定位的激发和激活定位提供了实用的辅助指导。虽然明显的歧视是有希望的，但8.5的门槛仍然是探索性的。采用标准化CSI设置和系统消融后评估的大型多中心研究有必要验证这些初步发现。

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引用次数: 0

Reduced Kidney Function and Left Atrial Dilatation as Predictors of Incident Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy 肾功能降低和左房扩张作为肥厚性心肌病患者房颤发生的预测因素

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-11-25 DOI: 10.1002/joa3.70232

Yuriko Tsumaya, Kenshi Hayashi, Toyonobu Tsuda, Akihiro Nomura, Yusuke Nakade, Mariko Oura, Takeo Yuno, Masako Nakata, Takako Terakami, Hiroyasu Oe, Megumi Oshima, Yoichiro Nakagawa, Takashi Kusayama, Shohei Yoshida, Hayato Tada, Mika Mori, Takeshi Kato, Kenji Sakata, Soichiro Usui, Noboru Fujino, Masayuki Takamura, Hajime Kanamori

Background

Atrial fibrillation (AF), the most frequently occurring sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), is linked to poor quality of life and increased thromboembolic risk. Chronic kidney disease (CKD) and reduced kidney function are known cardiovascular risk factors; however, their contributions to new-onset AF in patients with HCM remain unclear. Estimated glomerular filtration rate (eGFR) is a key marker for CKD management. This study aimed to elucidate the incidence of new-onset AF and to identify predictive factors in patients with HCM.

Methods

We analyzed 198 patients with HCM (121 men; mean age, 58 ± 17 years) without prior AF. The incidence and predictors of new-onset AF were evaluated with a focus on kidney function and left atrial (LA) size. Cox proportional hazards modeling was used to assess the associations.

Results

Impaired kidney function (eGFR < 60 mL/min/1.73 m²) was present in 35 patients (17.7%). Over a median follow-up of 7.52 years, 43 patients (21.7%) developed new-onset AF for an incidence rate of 2.8 per 100 person-years. The multivariate analysis identified reduced eGFR and increased LA diameter (LAD) as independent predictors of AF. Kaplan–Meier curves showed a significantly higher cumulative AF incidence among patients with an eGFR ≤ 76.1 mL/min/1.73 m² or an LAD ≥ 48.0 mm.

Conclusions

Decreased kidney function and LA dilatation were significantly associated with new-onset AF among patients with HCM. These findings suggest that this patient population requires closer monitoring for the early detection of AF.

背景房颤（AF）是肥厚性心肌病（HCM）患者中最常见的持续性心律失常，与生活质量差和血栓栓塞风险增加有关。慢性肾脏疾病（CKD）和肾功能下降是已知的心血管危险因素；然而，它们在HCM患者新发房颤中的作用尚不清楚。估计肾小球滤过率（eGFR）是CKD管理的关键指标。本研究旨在阐明HCM患者新发房颤的发生率，并确定其预测因素。方法我们分析了198例HCM患者（121例男性，平均年龄58±17岁），无房颤病史。评估新发房颤的发生率和预测因素，重点关注肾功能和左心房（LA）大小。采用Cox比例风险模型评估相关性。结果35例（17.7%）患者存在肾功能损害（eGFR < 60 mL/min/1.73 m2）。在中位随访7.52年期间，43名患者（21.7%）发展为新发房颤，发病率为每100人年2.8例。多因素分析发现，eGFR降低和LA直径（LAD）增加是AF的独立预测因素。Kaplan-Meier曲线显示，eGFR≤76.1 mL/min/1.73 m2或LAD≥48.0 mm的患者，累积AF发病率显著升高。结论HCM患者肾功能下降和左室扩张与新发房颤显著相关。这些发现表明，这些患者需要更密切地监测AF的早期发现。

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