Rahul Devathu, Kushal Chatterjee, Erick Godinez, Samhith Kambampati, Daniel Joseph Gonzalez, Michael H. Kim, Jiaqi Li, Ishan Paranjpe, Muhammad Fazal, Rachel Brucker, Tina Baykaner
Background
Titanium hypersensitivity is an uncommon but important challenge in patients requiring cardiac implantable electronic devices (CIEDs). Reactions are difficult to predict, often mimic infection, and complicate timely diagnosis.
Methods
We reviewed diagnostic considerations, therapeutic strategies, regulatory pathways, and global distribution of coated devices. Data sources included prior case reports, regulatory guidelines, and industry distribution records.
Results
Management options range from conservative observation to prophylactic implantation of hypoallergenic devices. Gold-coated and polymer-coated alternatives are effective but constrained by production costs, lack of reimbursement, and limited availability. In the United States, access is possible through custom device and compassionate use pathways, both requiring extensive regulatory approvals. Globally, most requests originate from the U.S. and Europe, with fewer from other regions due to economic and cultural barriers.
Conclusions
Improved awareness, streamlined regulatory frameworks, and multidisciplinary collaboration are essential to expand access and optimize outcomes for patients with titanium hypersensitivity.
{"title":"Treatment Options, Regulatory Pathways and Global Patterns of Use for Cardiac Implantable Devices in Patients With Titanium Allergy","authors":"Rahul Devathu, Kushal Chatterjee, Erick Godinez, Samhith Kambampati, Daniel Joseph Gonzalez, Michael H. Kim, Jiaqi Li, Ishan Paranjpe, Muhammad Fazal, Rachel Brucker, Tina Baykaner","doi":"10.1111/jce.70195","DOIUrl":"10.1111/jce.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Titanium hypersensitivity is an uncommon but important challenge in patients requiring cardiac implantable electronic devices (CIEDs). Reactions are difficult to predict, often mimic infection, and complicate timely diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed diagnostic considerations, therapeutic strategies, regulatory pathways, and global distribution of coated devices. Data sources included prior case reports, regulatory guidelines, and industry distribution records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Management options range from conservative observation to prophylactic implantation of hypoallergenic devices. Gold-coated and polymer-coated alternatives are effective but constrained by production costs, lack of reimbursement, and limited availability. In the United States, access is possible through custom device and compassionate use pathways, both requiring extensive regulatory approvals. Globally, most requests originate from the U.S. and Europe, with fewer from other regions due to economic and cultural barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Improved awareness, streamlined regulatory frameworks, and multidisciplinary collaboration are essential to expand access and optimize outcomes for patients with titanium hypersensitivity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"190-193"},"PeriodicalIF":2.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Enevoldsen, Vibeke Sødring Elbrønd, Morten B. Thomsen, Kirstine Calloe
Introduction
The domesticated pig (Sus scrofa domesticus) is widely used as a large animal model in cardiovascular research due to its anatomical and physiological similarities of its heart to the human heart, particularly concerning coronary circulation. However, notable differences in action potential shape, electrical activation pattern, as well as ion channel composition between porcine and human hearts limit translatability.
Methods and Results
This study investigates the relationship between the distribution of the cardiac Purkinje fiber network in the pig and the heart's mean electrical axis. We hypothesize that an intramural Purkinje fiber network results in ventricular electrical activation in an apex-to-base direction. The morphology and distribution of the porcine conduction system were assessed histologically, while electrical activation was evaluated using ECG recordings in both the Einthoven and orthogonal lead configurations. The Purkinje fiber network was found in the subendocardium and extended deep into the ventricular walls. The mean electrical axis exhibited a cranial orientation consistent with apex-to-base ventricular activation.
Conclusion
These results suggest that in the pig, the mean electrical axis is influenced more by the presence of an intramural Purkinje fiber network rather than by left ventricular mass as seen in humans. This study underscores important species-specific differences in ventricular electrical activation and highlights the need for caution when extrapolating electrophysiological findings from porcine models to humans.
{"title":"Characterization of the Porcine Cardiac Conduction System and Electrocardiogram: Implications for Using the Pig in Translational Arrhythmia Research","authors":"Sara Enevoldsen, Vibeke Sødring Elbrønd, Morten B. Thomsen, Kirstine Calloe","doi":"10.1111/jce.70197","DOIUrl":"10.1111/jce.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The domesticated pig (<i>Sus scrofa domesticus</i>) is widely used as a large animal model in cardiovascular research due to its anatomical and physiological similarities of its heart to the human heart, particularly concerning coronary circulation. However, notable differences in action potential shape, electrical activation pattern, as well as ion channel composition between porcine and human hearts limit translatability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>This study investigates the relationship between the distribution of the cardiac Purkinje fiber network in the pig and the heart's mean electrical axis. We hypothesize that an intramural Purkinje fiber network results in ventricular electrical activation in an apex-to-base direction. The morphology and distribution of the porcine conduction system were assessed histologically, while electrical activation was evaluated using ECG recordings in both the Einthoven and orthogonal lead configurations. The Purkinje fiber network was found in the subendocardium and extended deep into the ventricular walls. The mean electrical axis exhibited a cranial orientation consistent with apex-to-base ventricular activation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results suggest that in the pig, the mean electrical axis is influenced more by the presence of an intramural Purkinje fiber network rather than by left ventricular mass as seen in humans. This study underscores important species-specific differences in ventricular electrical activation and highlights the need for caution when extrapolating electrophysiological findings from porcine models to humans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 2","pages":"242-253"},"PeriodicalIF":2.6,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Methodological Concerns and Interpretive Limitations in \"Transvenous Lead Extraction Outcomes in Hemodialysis Patients\".","authors":"Ayesha Khalid, Ashok Kumar","doi":"10.1111/jce.70201","DOIUrl":"https://doi.org/10.1111/jce.70201","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Dan Itaya, Caique M. P. Ternes, Andre d'Avila
{"title":"Marshall Pulse Ablation and Ethanol Infusion: Competing or Complementary Approaches?","authors":"Eduardo Dan Itaya, Caique M. P. Ternes, Andre d'Avila","doi":"10.1111/jce.70203","DOIUrl":"10.1111/jce.70203","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"209-210"},"PeriodicalIF":2.6,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amir Askarinejad, Tommaso Bucci, Enrico Tartaglia, Michele Rossi, Gregory Y. H. Lip, Majid Haghjoo
Background and Objectives
Proper stroke and bleeding risk assessment is an essential part of clinical decision-making in patients with atrial fibrillation (AF). This study aims to determine whether the dynamic assessment of CHA2DS2-VASc and HAS-BLED scores over time enhances stroke and bleeding risk prediction.
Methods
In this prospective longitudinal study—based on data from the Iranian Atrial Fibrillation Registry (IRAF)—patients with available CHA₂DS₂-VASc and HAS-BLED scores at baseline, first follow-up (after 6 months), and second follow-up (after 12 months) were included. Univariable and multivariable logistic regression analyses were performed to evaluate the association of CHA₂DS₂-VASc and HAS-BLED scores (i.e., scores at baseline, first follow-up, and their difference defined as delta) with stroke and bleeding risk, respectively.
Results
A total of 529 patients (mean age 61.2 ± 14.3 years; 59.7% male) were included. CHA₂DS₂-VASc and HAS-BLED scores increased significantly after 6 and 12 months from recruitment. delta CHA₂DS₂-VASc score (AUC 0.69; 95% CI: 0.54–0.84) and First follow-up CHA₂DS₂-VASc score (AUC 0.70; 95% CI: 0.51–0.88) achieved higher AUCs compared to baseline CHA₂DS₂-VASc score (AUC 0.63; 95% CI: 0.44–0.82). delta HAS-BLED score had the highest AUC (AUC 0.73; 95% CI: 0.55–0.91) compared to baseline (AUC 0.58; 95% CI: 0.43–0.74) and first follow-up HAS-BLED (AUC 0.60; 95% CI: 0.44–0.80) scores.
Conclusions
Regular reassessment of CHA₂DS₂-VASc and HAS-BLED scores is essential in AF patients, as stroke and bleeding risks change over time, emphasizing the need for dynamic risk stratification.
{"title":"Stroke and Bleeding Risks in Atrial Fibrillation Are Not Static but Dynamic: A Dynamic Assessment of CHA2DS2-VASc and HAS-BLED Scores in the Iranian Registry of Atrial Fibrillation (IRAF)","authors":"Amir Askarinejad, Tommaso Bucci, Enrico Tartaglia, Michele Rossi, Gregory Y. H. Lip, Majid Haghjoo","doi":"10.1111/jce.70190","DOIUrl":"10.1111/jce.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Proper stroke and bleeding risk assessment is an essential part of clinical decision-making in patients with atrial fibrillation (AF). This study aims to determine whether the dynamic assessment of CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED scores over time enhances stroke and bleeding risk prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective longitudinal study—based on data from the Iranian Atrial Fibrillation Registry (IRAF)—patients with available CHA₂DS₂-VASc and HAS-BLED scores at baseline, first follow-up (after 6 months), and second follow-up (after 12 months) were included. Univariable and multivariable logistic regression analyses were performed to evaluate the association of CHA₂DS₂-VASc and HAS-BLED scores (i.e., scores at baseline, first follow-up, and their difference defined as delta) with stroke and bleeding risk, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 529 patients (mean age 61.2 ± 14.3 years; 59.7% male) were included. CHA₂DS₂-VASc and HAS-BLED scores increased significantly after 6 and 12 months from recruitment. <i>delta</i> CHA₂DS₂-VASc score (AUC 0.69; 95% CI: 0.54–0.84) and <i>First follow-up</i> CHA₂DS₂-VASc score (AUC 0.70; 95% CI: 0.51–0.88) achieved higher AUCs compared to <i>baseline</i> CHA₂DS₂-VASc score (AUC 0.63; 95% CI: 0.44–0.82). <i>delta</i> HAS-BLED score had the highest AUC (AUC 0.73; 95% CI: 0.55–0.91) compared to <i>baseline</i> (AUC 0.58; 95% CI: 0.43–0.74) and <i>first follow-up</i> HAS-BLED (AUC 0.60; 95% CI: 0.44–0.80) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Regular reassessment of CHA₂DS₂-VASc and HAS-BLED scores is essential in AF patients, as stroke and bleeding risks change over time, emphasizing the need for dynamic risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"110-118"},"PeriodicalIF":2.6,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matteo Parollo, Niccolò Biasi, Marco Torre, Lorenzo Pistelli, Federico Fiorentini, Mario Giannotti Santoro, Antonio Canu, Raffaele De Lucia, Gino Grifoni, Andrea Di Cori, Luca Segreti, Alessandro Tognetti, Giulio Zucchelli
Background
High density electroanatomical mapping (EAM) is the standard for identifying functional substrate in scar-related ventricular tachycardia (VT), but it is limited by its two-dimensional nature and increased procedural complexity. Imaging-based strategies provide anatomical characterization but lack functional information. We evaluated a novel digital twin model (CardioMat) to non-invasively predict functional substrate in three-dimensions.
Objective
To validate a novel digital twin model for noninvasive prediction of functional substrate in scar-related ventricular tachycardia.
Methods
Fifteen patients with ischemic or nonischemic cardiomyopathy undergoing VT ablation were retrospectively analyzed. High-density EAM, cardiac magnetic resonance (CMR) post-processing with ADAS3D, and CardioMat modeling were performed. CardioMat-generated three-dimensional activation maps were integrated into the CARTO EAM suite. Deceleration zones (DZs) identified by CardioMat were compared with EAM-derived DZs and CMR-based heterogeneous tissue channels (HTCs) and scar areas.
Results
A total of 255 cardiac segments were analyzed. CardioMat-derived DZs demonstrated high diagnostic accuracy (79% sensitivity, 93% specificity, 81% PPV, 92% NPV, 89% accuracy) for predicting EAM-DZ localization, outperforming CMR scar and HTCs. Multivariate analysis confirmed CardioMat DZs are the strongest independent predictor of EAM-DZ localization (OR 17.4, 95% CI 6.9–43.8, p > 0.001).
Conclusions
This study provides preliminary evidence supporting the feasibility of a digital twin model for noninvasive functional substrate characterization. CardioMat integrates anatomical and functional information, outperforming conventional CMR-based assessment. Prospective multicenter validation is needed to establish its role in VT ablation guidance.
背景：高密度电解剖制图（EAM）是识别疤痕相关性室性心动过速（VT）功能底物的标准，但其二维性质和增加的程序复杂性限制了它的应用。基于成像的策略提供解剖特征，但缺乏功能信息。我们评估了一种新的数字孪生模型（CardioMat），可以在三维上无创地预测功能底物。目的：验证一种新的数字孪生模型，用于无创预测疤痕相关性室性心动过速的功能底物。方法：回顾性分析15例行房室消融术的缺血性或非缺血性心肌病患者。进行高密度EAM、ADAS3D心脏磁共振（CMR）后处理和CardioMat建模。cardiomat生成的三维激活图被集成到CARTO EAM套件中。将CardioMat识别的减速区（DZs）与eam衍生的DZs和基于cmr的异质组织通道（HTCs）和疤痕区域进行比较。结果：共分析255个心脏节段。cardiomat衍生的DZs在预测EAM-DZ定位方面表现出很高的诊断准确性（79%的敏感性，93%的特异性，81%的PPV， 92%的NPV， 89%的准确性），优于CMR疤痕和hcc。多变量分析证实CardioMat dz是EAM-DZ定位的最强独立预测因子（OR 17.4, 95% CI 6.9-43.8, p < 0.001）。结论：本研究提供了初步证据，支持数字双胞胎模型用于无创功能底物表征的可行性。CardioMat集成了解剖和功能信息，优于传统的基于cmr的评估。需要前瞻性的多中心验证来确定其在VT消融指导中的作用。
{"title":"Validation of a Digital Twin Model for Three-Dimensional Noninvasive Functional Substrate Prediction in Scar Related Ventricular Tachycardia","authors":"Matteo Parollo, Niccolò Biasi, Marco Torre, Lorenzo Pistelli, Federico Fiorentini, Mario Giannotti Santoro, Antonio Canu, Raffaele De Lucia, Gino Grifoni, Andrea Di Cori, Luca Segreti, Alessandro Tognetti, Giulio Zucchelli","doi":"10.1111/jce.70184","DOIUrl":"10.1111/jce.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High density electroanatomical mapping (EAM) is the standard for identifying functional substrate in scar-related ventricular tachycardia (VT), but it is limited by its two-dimensional nature and increased procedural complexity. Imaging-based strategies provide anatomical characterization but lack functional information. We evaluated a novel digital twin model (CardioMat) to non-invasively predict functional substrate in three-dimensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To validate a novel digital twin model for noninvasive prediction of functional substrate in scar-related ventricular tachycardia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifteen patients with ischemic or nonischemic cardiomyopathy undergoing VT ablation were retrospectively analyzed. High-density EAM, cardiac magnetic resonance (CMR) post-processing with ADAS3D, and CardioMat modeling were performed. CardioMat-generated three-dimensional activation maps were integrated into the CARTO EAM suite. Deceleration zones (DZs) identified by CardioMat were compared with EAM-derived DZs and CMR-based heterogeneous tissue channels (HTCs) and scar areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 255 cardiac segments were analyzed. CardioMat-derived DZs demonstrated high diagnostic accuracy (79% sensitivity, 93% specificity, 81% PPV, 92% NPV, 89% accuracy) for predicting EAM-DZ localization, outperforming CMR scar and HTCs. Multivariate analysis confirmed CardioMat DZs are the strongest independent predictor of EAM-DZ localization (OR 17.4, 95% CI 6.9–43.8, <i>p</i> > 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides preliminary evidence supporting the feasibility of a digital twin model for noninvasive functional substrate characterization. CardioMat integrates anatomical and functional information, outperforming conventional CMR-based assessment. Prospective multicenter validation is needed to establish its role in VT ablation guidance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"102-109"},"PeriodicalIF":2.6,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xuan Ci Mee, Ramzi Ibrahim, Ghee Kheng Lim, Hoang Nhat Pham, Mahmoud Abdelnabi, Eiad Habib, Juan Farina, Justin Z. Lee, Steven J. Lester, Luis R. Scott, Dan Sorajja, Kwan Lee, Chadi Ayoub, Reza Arsanjani
{"title":"Response to Letter Regarding “Sodium–Glucose Cotransporter-2 Inhibitors and Stroke Risk in Patients With Atrial Fibrillation”","authors":"Xuan Ci Mee, Ramzi Ibrahim, Ghee Kheng Lim, Hoang Nhat Pham, Mahmoud Abdelnabi, Eiad Habib, Juan Farina, Justin Z. Lee, Steven J. Lester, Luis R. Scott, Dan Sorajja, Kwan Lee, Chadi Ayoub, Reza Arsanjani","doi":"10.1111/jce.70189","DOIUrl":"10.1111/jce.70189","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"216-217"},"PeriodicalIF":2.6,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriele Dell'Era, Domenico D'Amario, Leonardo Grisafi, Anna Degiovanni, Anthea Tonia D'Amico, Maria Gabriella Guidetti, Luca Pescarmona, Marco Mennuni, Giuseppe Patti
Background
Atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices are associated with a higher risk of developing subsequent atrial fibrillation. Thus, risk stratification for AHREs is essential to guide patient management and improve outcome. Left atrial strain (LAS) parameters have been proposed as markers of atrial mechanical dysfunction, but their predictive value for AHRE prediction is not definitely established.
Methods
We performed a retrospective, single-center study on consecutive patients undergoing pacemaker implantation. Pre-implant echocardiographic assessment included the measurement of LAS parameters. AHREs were defined as asymptomatic episodes with atrial rate > 175 bpm lasting ≥ 5 min by pacemaker evaluation. Primary endpoint was the predictive accuracy of LAS values for AHRE occurrence during follow-up.
Results
A total of 269 patients (age 78.0 ± 11.2 years; CHA₂DS₂-VASc score 3.8 ± 1.6) were included. Median follow-up was 28 months. ROC analysis showed that LAS contraction had superior predictive value for AHREs than LAS reservoir (AUC 0.75 vs. 0.63, p = 0.001). A 10.2% cutoff of LAS contraction had sensitivity of 77%, specificity of 64%, and negative predictive value (NPV) of 90% for AHRE occurrence. Kaplan–Meier analysis showed a higher AHRE incidence in patients with LAS contraction < 10.2% (45% vs. 10% in those with LAS contraction ≥ 10.2%; log-rank p < 0.001). Multivariate analysis confirmed LAS contraction < 10.2% as an independent predictor of AHREs (adjusted hazard ratio [aHR] 5.0 (95% CI 2.7–9.3); p < 0.001). The risk increase was even higher when a LAS contraction < 10.2% was associated with age ≥ 70 years (aHR 16.3; 95% CI 2.0–131.7; p = 0.009).
Conclusions
In patients with a permanent pacemaker, pre-implant LAS contraction by echocardiography is an independent predictor of future AHRE development, with a very high NPV. The evaluation of LAS contraction may represent a valuable tool for identifying in clinical practice those individuals at low risk for AHREs.
背景：心脏植入式电子装置检测到的心房高率发作（AHREs）与随后发生心房颤动的高风险相关。因此，AHREs的风险分层对于指导患者管理和改善预后至关重要。左心房应变（LAS）参数已被提出作为心房机械功能障碍的标志物，但其对AHRE预测的预测价值尚未确定。方法：我们对连续接受心脏起搏器植入的患者进行回顾性、单中心研究。植入前超声心动图评估包括LAS参数的测量。心脏起搏器评估将心房率> 175 bpm的无症状发作定义为持续≥5分钟。主要终点是随访期间LAS值对AHRE发生的预测准确性。结果：共纳入269例患者（年龄78.0±11.2岁；CHA₂DS₂-VASc评分3.8±1.6）。中位随访时间为28个月。ROC分析显示，LAS收缩对AHREs的预测价值优于LAS储层（AUC 0.75 vs. 0.63, p = 0.001）。10.2%的LAS收缩临界值对AHRE的敏感性为77%，特异性为64%，阴性预测值（NPV）为90%。Kaplan-Meier分析显示LAS收缩患者AHRE发生率较高。结论：在永久性起搏器患者中，超声心动图显示植入前LAS收缩是未来AHRE发展的独立预测指标，具有非常高的NPV。在临床实践中，LAS收缩的评估可能是识别AHREs低风险个体的一种有价值的工具。
{"title":"Predictive Value of Left Atrial Strain for Atrial High-Rate Episodes in Patients With Permanent Cardiac Pacing","authors":"Gabriele Dell'Era, Domenico D'Amario, Leonardo Grisafi, Anna Degiovanni, Anthea Tonia D'Amico, Maria Gabriella Guidetti, Luca Pescarmona, Marco Mennuni, Giuseppe Patti","doi":"10.1111/jce.70186","DOIUrl":"10.1111/jce.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices are associated with a higher risk of developing subsequent atrial fibrillation. Thus, risk stratification for AHREs is essential to guide patient management and improve outcome. Left atrial strain (LAS) parameters have been proposed as markers of atrial mechanical dysfunction, but their predictive value for AHRE prediction is not definitely established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective, single-center study on consecutive patients undergoing pacemaker implantation. Pre-implant echocardiographic assessment included the measurement of LAS parameters. AHREs were defined as asymptomatic episodes with atrial rate > 175 bpm lasting ≥ 5 min by pacemaker evaluation. Primary endpoint was the predictive accuracy of LAS values for AHRE occurrence during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 269 patients (age 78.0 ± 11.2 years; CHA₂DS₂-VASc score 3.8 ± 1.6) were included. Median follow-up was 28 months. ROC analysis showed that LAS contraction had superior predictive value for AHREs than LAS reservoir (AUC 0.75 vs. 0.63, <i>p</i> = 0.001). A 10.2% cutoff of LAS contraction had sensitivity of 77%, specificity of 64%, and negative predictive value (NPV) of 90% for AHRE occurrence. Kaplan–Meier analysis showed a higher AHRE incidence in patients with LAS contraction < 10.2% (45% vs. 10% in those with LAS contraction ≥ 10.2%; log-rank <i>p</i> < 0.001). Multivariate analysis confirmed LAS contraction < 10.2% as an independent predictor of AHREs (adjusted hazard ratio [aHR] 5.0 (95% CI 2.7–9.3); <i>p</i> < 0.001). The risk increase was even higher when a LAS contraction < 10.2% was associated with age ≥ 70 years (aHR 16.3; 95% CI 2.0–131.7; <i>p</i> = 0.009).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with a permanent pacemaker, pre-implant LAS contraction by echocardiography is an independent predictor of future AHRE development, with a very high NPV. The evaluation of LAS contraction may represent a valuable tool for identifying in clinical practice those individuals at low risk for AHREs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 12","pages":"3343-3352"},"PeriodicalIF":2.6,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siddharth Agarwal, Harsh P. Patel, Zain Ul Abideen Asad, Muhammad Bilal Munir, Alan Sugrue, Nicholas Y. Tan, Freddy Del-Carpio Munoz, Daniel DeSimone, Yong-Mei Cha, Siva K. Mulpuru, Christopher V. DeSimone, Abhishek Deshmukh
Background
Transvenous lead removal (TLR) in patients with a history of mediastinal radiation poses unique challenges due to potential radiation-induced fibrosis, vascular changes, and anatomical distortion, which may increase procedural complexity and complication risk. However, contemporary data on clinical outcomes in this population remain limited.
Methods
We analyzed the National Readmissions Database (2016–2021) to identify adults (≥ 18 years) undergoing TLR. Patients were stratified by prior mediastinal radiation. Baseline characteristics were compared using standard statistical tests. Multivariable logistic regression was used to evaluate the association between prior mediastinal radiation and in-hospital outcomes, 30-day mortality, and 30-day readmissions after adjustment for demographics and comorbidities.
Results
A total of 48,985 patients underwent TLR, of whom 735 (1.5%) had a history of mediastinal radiation. Compared with patients without radiation, those with prior radiation were older (70.1 vs. 66.2 years, p < 0.01), were more frequently females (38.2% vs. 31.6%, p < 0.01), and had higher rates of valvular heart disease, atrial fibrillation, and peripheral vascular disease. Adjusted analyses demonstrated no increased risk of in-hospital mortality (2.3% vs. 3.4%; adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.41–1.18, p = 0.29) or major complications, including cardiac arrest, pericardial complications, vascular injury, pulmonary complications, or embolic events. Similarly, (3.6% vs. 5.3%; aOR 0.76, 95% CI 0.48–1.43, p = 0.35) and 30-day all-cause readmissions (8.7% vs. 9.1%; aOR 0.81, 95% CI 0.64–1.28, p = 0.70) were not significantly different between groups. Subgroup analyses by indication for TLR (infection vs. mechanical complication) revealed no differences in outcomes.
Conclusion
Despite theoretical concerns, prior mediastinal radiation was not associated with excess procedural risk or worse short-term outcomes after TLR. These findings may inform procedural planning and risk counseling in clinical practice.
{"title":"Outcomes of Transvenous Lead Removal in Patients With Prior Mediastinal Radiation","authors":"Siddharth Agarwal, Harsh P. Patel, Zain Ul Abideen Asad, Muhammad Bilal Munir, Alan Sugrue, Nicholas Y. Tan, Freddy Del-Carpio Munoz, Daniel DeSimone, Yong-Mei Cha, Siva K. Mulpuru, Christopher V. DeSimone, Abhishek Deshmukh","doi":"10.1111/jce.70192","DOIUrl":"10.1111/jce.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transvenous lead removal (TLR) in patients with a history of mediastinal radiation poses unique challenges due to potential radiation-induced fibrosis, vascular changes, and anatomical distortion, which may increase procedural complexity and complication risk. However, contemporary data on clinical outcomes in this population remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the National Readmissions Database (2016–2021) to identify adults (≥ 18 years) undergoing TLR. Patients were stratified by prior mediastinal radiation. Baseline characteristics were compared using standard statistical tests. Multivariable logistic regression was used to evaluate the association between prior mediastinal radiation and in-hospital outcomes, 30-day mortality, and 30-day readmissions after adjustment for demographics and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 48,985 patients underwent TLR, of whom 735 (1.5%) had a history of mediastinal radiation. Compared with patients without radiation, those with prior radiation were older (70.1 vs. 66.2 years, <i>p</i> < 0.01), were more frequently females (38.2% vs. 31.6%, <i>p</i> < 0.01), and had higher rates of valvular heart disease, atrial fibrillation, and peripheral vascular disease. Adjusted analyses demonstrated no increased risk of in-hospital mortality (2.3% vs. 3.4%; adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.41–1.18, <i>p</i> = 0.29) or major complications, including cardiac arrest, pericardial complications, vascular injury, pulmonary complications, or embolic events. Similarly, (3.6% vs. 5.3%; aOR 0.76, 95% CI 0.48–1.43, <i>p</i> = 0.35) and 30-day all-cause readmissions (8.7% vs. 9.1%; aOR 0.81, 95% CI 0.64–1.28, <i>p</i> = 0.70) were not significantly different between groups. Subgroup analyses by indication for TLR (infection vs. mechanical complication) revealed no differences in outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite theoretical concerns, prior mediastinal radiation was not associated with excess procedural risk or worse short-term outcomes after TLR. These findings may inform procedural planning and risk counseling in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"186-189"},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号