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YouTube Videos of Pacemaker Implantation: An Assessment of Information Content and Quality. YouTube关于心脏起搏器植入的视频:信息内容和质量的评估。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1111/jce.16540
Pok-Tin Tang, C Fielder Camm, Saffron Rajappan, Richard D Sale, Kim Rajappan

Background: Permanent pacemaker (PPM) implantation is a commonly performed procedure. Patients increasingly use the Internet for information on medical interventions. We aimed to assess the quality of videos discussing PPM implantation on YouTube for patient consumption.

Methods: YouTube was searched on October 19, 2022, for "PPM implantation" and "Pacemaker." The first 100 results from each search were screened: all English language videos containing predominant discussion of transvenous PPMs were included; YouTube shorts and advertisements were excluded. Two authors independently assessed videos for information content based on criteria generated using established patient resources supplemented by expert consensus. Video reliability and quality were assessed using a novel scoring system.

Results: Thirty-three videos with a cumulative total of 5 864 488 views were included. No video contained all essential information criteria. The average number of essential criteria covered was 8/32 (standard deviation 4.8). Peri-operative management was, particularly, poorly covered: no item relating to preoperative management or postoperative care was covered by more than 40% of videos. None of the videos fulfilled all quality criteria, with a median score of 7.5/13 (interquartile range 6.5-8). Videos performed, particularly, poorly on providing balanced messages, creator disclosures, attribution of source content, and indicating when videos were made.

Conclusion: YouTube videos of PPM implantation do not contain sufficient information to allow patients to gain an appropriate understanding of this procedure. Furthermore, the information presented is of insufficient quality to support decision-making. There is a need for a professionally regulated, comprehensive audiovisual patient resource on PPM implantation.

背景:永久起搏器(PPM)植入是一种常见的手术。患者越来越多地使用互联网获取有关医疗干预措施的信息。我们的目的是评估YouTube上讨论PPM植入的视频的质量,以供患者使用。方法:于2022年10月19日在YouTube上搜索“PPM植入”和“Pacemaker”。筛选每个搜索的前100个结果:包括所有主要讨论经静脉PPMs的英语视频;YouTube短片和广告被排除在外。两位作者独立评估视频的信息内容,基于使用已建立的患者资源并辅以专家共识的标准。视频的可靠性和质量用一种新颖的评分系统进行评估。结果:共纳入视频33段,累计浏览量为5 864 488次。没有视频包含所有必要的信息标准。涵盖的基本标准的平均数目为8/32(标准差为4.8)。围手术期管理的报道尤其少:与术前管理或术后护理相关的项目在40%以上的视频中都没有涉及。没有一个视频达到所有的质量标准,中位数得分为7.5/13(四分位数范围为6.5-8)。视频在提供平衡的信息、创作者披露、源内容的归属以及显示视频制作时间方面表现得尤其糟糕。结论:YouTube上关于PPM植入术的视频没有提供足够的信息,无法让患者对该手术有适当的了解。此外,所提供的信息质量不足,无法支持决策。需要一个专业规范的,全面的视听患者资源的PPM植入。
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引用次数: 0
A Bayesian Interpretation of CABANA and Other Randomized Controlled Trials for Catheter Ablation in Patients With Atrial Fibrillation. 房颤患者导管消融CABANA和其他随机对照试验的贝叶斯解释。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1111/jce.16552
Alleh Nogueira, Nicole Felix, Felipe Kalil, Lucas Tramujas, Amanda Godoi, Isabele A Miyawaki, Andrea Bellavia, Filipe A Moura, Rhanderson Cardoso, André d'Avila, Gilson C Fernandes

Background: Catheter ablation improves symptoms and quality of life in atrial fibrillation patients, but its effect on adverse cardiovascular outcomes and mortality remains uncertain. Bayesian analysis of randomized controlled trials offers a deeper understanding of treatment effects beyond conventional p-value thresholds.

Methods: We conducted a post hoc Bayesian reanalysis of CABANA and four similar trials to estimate catheter ablation's effect on cardiovascular and survival outcomes. Using publicly available, trial-level data, we fitted ordinal Bayesian regression models to assess the impact of catheter ablation on the primary composite outcome-comprising all-cause mortality, stroke with disability, serious bleeding, and cardiac arrest-as well as mortality alone. We considered two sets of prior distributions: (1) a noninformative prior, where all effect sizes are equally probable and inference is primarily based on trial data, and (2) a treatment effect distribution derived from four trials using a random effects model.

Results: In this analysis, refined probability distributions for treatment effects were obtained by integrating data from CABANA with diverse priors through Bayes' theorem, offering a novel, nuanced probabilistic understanding of the potential impact of ablation compared with medical therapy on cardiovascular outcomes and all-cause mortality. In contrast to CABANA's original frequentist estimates, which were inconclusive, Bayesian analyses indicated probabilities of 82.6% and 81.1% that ablation is superior in reducing adverse cardiovascular outcomes and mortality, respectively. Incorporating results from four other similar trials increased the probability of improved effects on mortality to 86.0%.

Conclusions: Bayesian analysis augmented the interpretation of previously inconclusive findings, suggesting a clinically relevant probability of benefit from catheter ablation compared to medical therapy in a broad population with atrial fibrillation.

背景:导管消融可改善房颤患者的症状和生活质量,但其对不良心血管结局和死亡率的影响仍不确定。随机对照试验的贝叶斯分析提供了超越常规p值阈值的治疗效果的更深层次的理解。方法:我们对CABANA和四个类似的试验进行了事后贝叶斯再分析,以评估导管消融对心血管和生存结果的影响。使用公开可用的试验级数据,我们拟合了有序贝叶斯回归模型,以评估导管消融对主要复合结局(包括全因死亡率、卒中伴残疾、严重出血和心脏骤停)以及单独死亡率的影响。我们考虑了两组先验分布:(1)非信息性先验,其中所有效应大小都是等概率的,推断主要基于试验数据;(2)使用随机效应模型从四个试验中得出的治疗效应分布。结果:在本分析中,通过贝叶斯定理整合CABANA与不同先验的数据,获得治疗效果的精细概率分布,为消融与药物治疗相比对心血管结局和全因死亡率的潜在影响提供了一种新颖、细致的概率理解。与CABANA最初的不确定的频率估计相反,贝叶斯分析表明,消融在减少心血管不良结局和死亡率方面分别具有82.6%和81.1%的优势。结合其他四个类似试验的结果,将改善死亡率的可能性提高到86.0%。结论:贝叶斯分析增强了对先前不确定结果的解释,提示在广泛的房颤人群中,与药物治疗相比,导管消融有临床相关的获益概率。
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引用次数: 0
Atypical Atrial Flutter: Electrophysiological Characterization and Effective Catheter Ablation. 不典型心房扑动:电生理特征和有效的导管消融。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-17 DOI: 10.1111/jce.16543
Nicolas Johner, Mehdi Namdar, Dipen C Shah

Atrial flutter (AFL), defined as macro-re-entrant atrial tachycardia, is associated with debilitating symptoms, stroke, heart failure, and increased mortality. AFL is classified into typical, or cavotricuspid isthmus (CTI)-dependent, and atypical, or non-CTI-dependent. Atypical AFL is a heterogenous group of re-entrant atrial tachycardias that most commonly occur in patients with prior heart surgery or catheter ablation. The ECG pattern is poorly predictive of circuit anatomy but may still provide mechanistic insight. AFL is difficult to manage medically and catheter ablation is the preferred treatment for most patients. Recent progress in technology and clinical electrophysiology has led to detailed characterization of re-entry circuits and effective ablation strategies. Combined activation and entrainment mapping are key to identifying the re-entry circuit. The presence of a slow-conducting isthmus, localized re-entry, dual-loop re-entry or bystander loops may lead to misleading activation maps but can be identified by electrogram examination and entrainment mapping. In the occasional patient without inducible AFL, substrate mapping in sinus rhythm may be a viable strategy. Long-term ablation success requires the creation of a transmural continuous lesion across a critical component of the re-entry circuit. Procedural endpoints include bidirectional conduction block across linear lesions and non-inducibility of atrial tachycardia. The present review discusses the epidemiology, mechanisms, ECG characteristics, electrophysiological characterization, and catheter ablation of atypical AFL.

心房扑动(AFL),定义为宏观再入性房性心动过速,与衰弱症状、中风、心力衰竭和死亡率增加有关。AFL分为典型或颈三尖瓣峡部(CTI)依赖性和非典型或非CTI依赖性。非典型AFL是一种异质性的再入性房性心动过速,最常见于既往心脏手术或导管消融的患者。心电图模式对电路解剖的预测很差,但仍然可以提供机制的见解。AFL难以医学治疗,导管消融是大多数患者的首选治疗方法。技术和临床电生理学的最新进展导致了再入回路的详细特征和有效的消融策略。结合激活和夹带映射是识别再入回路的关键。传导缓慢的峡部、局部再入、双环再入或旁观者环的存在可能导致误导性的激活图,但可以通过电图检查和夹带图识别。对于偶尔没有诱导性AFL的患者,窦性心律的底物定位可能是一种可行的策略。长期消融的成功需要在再入回路的关键部分建立一个跨壁连续病变。程序终点包括双向传导阻滞跨越线性病变和非诱发性房性心动过速。现就非典型AFL的流行病学、发病机制、心电图特征、电生理特征及导管消融进行综述。
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引用次数: 0
AF-FLOW Global Registry Confirms Validity of Electrographic Flow Mapping as a Phenotyping Tool for Atrial Fibrillation. AF-FLOW全球注册表证实了电图流图作为房颤表型工具的有效性。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-16 DOI: 10.1111/jce.16568
Kent R Nilsson, Steven Castellano, Melissa H Kong, Pawel Derejko, Tamás Szili-Torok, Sandeep K Goyal, Sip Wijchers, Mohit Turagam, Vivek Y Reddy, Atul Verma

Background: Electrographic flow (EGF) mapping allows for the visualization of global atrial wavefront propagations. One mechanism of initiation and maintenance of atrial fibrillation (AF) is stimulation from EGF-identified focal sources that serve as driver sites of fibrillatory conduction. Electrographic flow consistency (EGFC) further quantifies the concordance of observed wavefront patterns, indicating that a healthier substrate shows more organized wavefront propagation and higher EGFC. Freedom from AF (FFAF) recurrence has accordingly been shown to be higher in patients with ablated vs. unablated sources and with high vs. low EGFC.

Objectives: (1) Measure FFAF across EGF-derived phenotypes in patients enrolled in the AF-FLOW Global Registry; (2) determine if a relationship exists between EGFC and percentage of healthy voltage as measured from bipolar voltage maps.

Methods: The AF-FLOW Global Registry is a multicenter, prospective study of 25 all-comer AF patients who underwent concomitant high-density bipolar voltage mapping with a 16-electrode grid mapping catheter and EGF mapping with a 64-pole basket catheter. The EGF algorithm detects extra-pulmonary vein sources as origins of excitation from a singularity of divergent flow vectors and was used to localize RF ablation targets. Overall, EGFC per atrium was also computed as the average of the modulus of individual EGF vectors, where the vector length represents the consistency of flow patterns. Patients were then assigned phenotypes on the basis of source presence or absence and EGFC, and rates of FFAF at 1-year were compared across the four resulting phenotypes. Atrial EGFC was also compared to the percentage of healthy tissue determined by bipolar voltage mapping.

Results: Patients with paroxysmal AF had higher FFAF than persistent AF (PeAF) and long-standing PeAF patients; patients receiving de novo ablation had higher FFAF than those receiving redo ablation. Patient phenotyping revealed that those with high EGFC had higher FFAF than those with low EGFC (p = 0.015). Atrial EGFC was also correlated to the percent of high voltage tissue across all patients (r = 0.651, p < 0.0001).

Conclusions: EGF mapping provides insights into the mechanistic nature of AF and the atrial health of the underlying substrate. Therefore, further studies are needed to develop phenotype-specific treatments for the disease.

Trial registration: ClinicalTrials.gov identifier: NCT05481359.

背景:电图流(EGF)映射允许可视化整体心房波前传播。房颤(AF)发生和维持的一个机制是来自egf识别的病灶源的刺激,这些病灶源作为纤颤传导的驱动位点。电图流动一致性(EGFC)进一步量化了观察到的波前模式的一致性,表明更健康的衬底波前传播更有组织,EGFC更高。因此,在消融源与未消融源、高EGFC与低EGFC患者中,AF (FFAF)复发的自由度更高。目的:(1)在AF-FLOW全球注册中心登记的患者中测量egf衍生表型的FFAF;(2)确定EGFC与双极电压图测量的健康电压百分比之间是否存在关系。方法:AF- flow全球注册是一项多中心、前瞻性研究,25例所有角房颤患者同时接受高密度双极电压测绘,使用16电极网格测绘导管,使用64极篮导管进行EGF测绘。EGF算法从发散流矢量的奇异点中检测肺外静脉源作为激励源,并用于定位射频消融目标。总的来说,每个心房的EGFC也被计算为单个EGF向量模量的平均值,其中向量长度代表了流型的一致性。然后根据来源是否存在和EGFC为患者分配表型,并比较四种结果表型的1年FFAF率。心房EGFC也与双极电压测图确定的健康组织的百分比进行了比较。结果:阵发性房颤患者FFAF高于持续性房颤(PeAF)和长期房颤患者;重新消融患者的FFAF高于再次消融患者。患者表型分析显示,EGFC高的患者FFAF高于EGFC低的患者(p = 0.015)。在所有患者中,心房EGFC也与高电压组织的百分比相关(r = 0.651, p)。结论:EGF图谱提供了对房颤的机制性质和潜在底物的心房健康的见解。因此,需要进一步的研究来开发针对该疾病的表型特异性治疗方法。试验注册:ClinicalTrials.gov标识符:NCT05481359。
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引用次数: 0
Rethinking Stroke Prevention in Atrial Fibrillation: One Size Does not Fit All. 重新思考心房颤动的卒中预防:不能 "一刀切"。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-14 DOI: 10.1111/jce.16580
Panteleimon E Papakonstantinou, Gregory Y H Lip
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引用次数: 0
The Prevalence and Predictors of Atrioventricular Blocks in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: A Cross-Sectional Study. 冲突期间叙利亚急诊患者房室传导阻滞的发生率和预测因素:一项横断面研究
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1111/jce.16578
Ibrahim Antoun, Alkassem Alkhayer, Aref Jalal Eldin, Alamer Alkhayer, Khaled Yazji, Riyaz Somani, G André Ng, Mustafa Zakkar

Background: Atrioventricular block (AVB) is a cardiac conduction disorder that can lead to significant clinical outcomes, particularly in resource-limited and conflict-affected regions. In Syria, healthcare infrastructure has been severely impacted by ongoing conflict, potentially affecting the prevalence and management of AVB.

Methods: We conducted a cross-sectional study at Tishreen University Hospital in Latakia, Syria, with patients > 40 who presented to the emergency department (ED) from June 1 to August 1, 2024. Routine 12-lead ECGs were performed, with AVB diagnoses confirmed by two independent cardiology consultants. Exclusion criteria included pre-existing AVB, pacemaker presence, hemodynamic instability, and ECG diagnostic discrepancies. Patient demographics and comorbidities were assessed, and logistic regression analyses identified predictors of AVB.

Results: The final analysis included 692 patients, of which AVB was detected in 7% of the cohort. Patients with AVB were significantly older (median age 76 vs. 54 years, p < 0.001) and had higher rates of ischemic heart disease (IHD) (62% vs. 14%, p < 0.001) and diabetes (56% vs. 21%, p = 0.01). Logistic regression showed older age (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.6-5.6, p < 0.001), IHD (OR: 1.9, 95% CI: 1.4-4.5, p < 0.001), and DM (OR: 3.9, 95% CI: 2.9-8.3, p < 0.001) were independently associated with AVB.

Conclusion: AVB prevalence in the Syrian ED setting is high, with age, IHD, and diabetes as significant predictors. Routine ECG screening in EDs may facilitate early AVB detection in at-risk populations, especially in conflict-affected regions with limited healthcare resources. This approach could improve outcomes by enabling timely intervention in high-risk patients.

背景:房室传导阻滞(AVB)是一种心脏传导障碍,可导致显著的临床结果,特别是在资源有限和受冲突影响的地区。在叙利亚,医疗基础设施受到持续冲突的严重影响,可能影响到AVB的流行和管理。方法:我们在叙利亚拉塔基亚的Tishreen大学医院对2024年6月1日至8月1日在急诊科(ED)就诊的患者bb40进行了横断面研究。行常规12导联心电图,经两名独立心脏科顾问确诊为AVB。排除标准包括先前存在的AVB、起搏器存在、血流动力学不稳定和ECG诊断差异。评估患者人口统计学和合并症,并通过logistic回归分析确定AVB的预测因素。结果:最终分析纳入692例患者,其中7%的队列检测到AVB。AVB患者明显年龄较大(中位年龄76岁vs. 54岁)。结论:叙利亚ED的AVB患病率较高,年龄、IHD和糖尿病是重要的预测因素。在急诊科进行常规心电图筛查可能有助于高危人群早期发现AVB,特别是在医疗资源有限的受冲突影响地区。这种方法可以通过及时干预高危患者来改善预后。
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引用次数: 0
Periodic Electric Shock in Patient With Pacemaker: An Electrophysiologist's Challenge. 带起搏器患者的周期性电击:电生理学家的挑战。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1111/jce.16565
Sudipta Mondal, Swasthi S Kumar, Jyothi Vijay, Narayanan Namboodiri
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引用次数: 0
Long RP Tachycardia and Short RP Tachycardia: Is the Nodoventricular Pathway a Culprit or an Innocent Bystander? 长RP型心动过速和短RP型心动过速:瘤室通路是罪魁祸首还是无辜的旁观者?
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1111/jce.16574
Akinobu Mizutani, Masato Okada, Koji Tanaka, Nobuaki Tanaka, Koichi Nagashima, Melvin M Scheinman

We encountered a single case in which a transition between orthodromic reciprocating tachycardia with a concealed nodoventricular pathway and atrioventricular nodal reentrant tachycardia with a bystander nodoventricular pathway was observed.

我们遇到了一个单独的病例,其中观察到正交往性心动过速与隐蔽的结节室通路和房室结折返性心动过速之间的过渡。
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引用次数: 0
How to Manage Ventricular Arrhythmia Following Durable Left Ventricular Assist Device Implantation. 如何处理持久左心室辅助装置植入后的室性心律失常。
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1111/jce.16575
Naoya Kataoka, Teruhiko Imamura
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引用次数: 0
The Role of RyR2 Mutations in Congenital Heart Diseases: Insights Into Cardiac Electrophysiological Mechanisms. RyR2突变在先天性心脏病中的作用:洞察心脏电生理机制
IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1111/jce.16569
Tingting Lv, Siyuan Li, Qing Li, Lingbing Meng, Jing Yang, Lianfeng Liu, Changhua Lv, Ping Zhang

Ryanodine receptor 2 (RyR2) protein, a calcium ion release channel in the sarcoplasmic reticulum (SR) of myocardial cells, plays a crucial role in regulating cardiac systolic and diastolic functions. Mutations in RyR2 and its dysfunction are implicated in various congenital heart diseases (CHDs). Studies have shown that mutations in the RYR2 gene, which encodes the RyR2 protein, are linked to several cardiac arrhythmias, including catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), calcium release deficiency syndrome (CRDS), and atrial fibrillation (AF). Additionally, RyR2 mutations have been associated with multiple genetic cardiomyopathies, such as left ventricular non-compaction cardiomyopathy (LVNC), arrhythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Through various cell and animal models, researchers have developed mutant RyR2 models demonstrated that these mutations often lead to calcium dysregulation, typically resulting in either a gain or loss of function. This comprehensive review delves into the current understanding of RyR2 mutations and their impact on cardiac electrophysiology, focusing on the molecular mechanisms linking these mutations to arrhythmias and cardiomyopathies-an essential step in advancing diagnostic and therapeutic strategies.

Ryanodine receptor 2 (RyR2)蛋白是心肌细胞肌浆网(SR)中的钙离子释放通道,在调节心脏收缩和舒张功能中起重要作用。RyR2的突变及其功能障碍与各种先天性心脏病(CHDs)有关。研究表明,编码RYR2蛋白的RYR2基因突变与几种心律失常有关,包括儿茶酚胺能多态性室性心动过速(CPVT)、长QT综合征(LQTS)、钙释放缺乏症(CRDS)和心房颤动(AF)。此外,RyR2突变与多种遗传性心肌病有关,如左室非压实性心肌病(LVNC)、致心律失常性右室心肌病(ARVC)、肥厚性心肌病(HCM)和扩张性心肌病(DCM)。通过各种细胞和动物模型,研究人员已经建立了突变的RyR2模型,证明这些突变经常导致钙失调,通常导致功能的获得或丧失。这篇综述深入研究了目前对RyR2突变及其对心脏电生理的影响的理解,重点是将这些突变与心律失常和心肌病联系起来的分子机制,这是推进诊断和治疗策略的重要一步。
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引用次数: 0
期刊
Journal of Cardiovascular Electrophysiology
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