Heart Rhythm O2最新文献

英文中文

Ethanol infusion into the vein of Marshall reduced atrial tachyarrhythmia recurrence during catheter ablation: A systematic review and meta-analysis 将乙醇注入马歇尔静脉可减少导管消融过程中心房快速性心律失常的复发：系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.011

Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD

Background

Ethanol infusion into the vein of Marshall (EIVoM) may increase mitral isthmus bidirectional block (MIBB) and cause local autonomic denervation that may improve outcome.

Objective

This meta-analysis aimed to investigate whether the addition of EIVoM to atrial fibrillation (AF) ablation led to a better outcome.

Methods

Systematic literature search was performed using PubMed, Scopus, ScienceDirect, and Europe PMC for studies that compared the addition of EIVoM during AF ablation with radiofrequency ablation. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after the blanking period.

Results

There were 2821 patients from 11 studies, and EIVoM was successful in 77% (95% confidence interval [CI] 62%–92%). ATa recurrence was 27% (95% CI 20%–34%) in the EIVoM group and 42% (95% CI 33%–51%) in ablation-only group. EIVoM reduced ATa recurrence (odds ratio [OR] 0.52; 95% CI 0.36–0.76; P < .001; I² = 76.92). The rate of MIBB was 85% (95% CI 77%–94%) in the EIVoM group and 73% (95% CI 61%–85%) in the ablation-only group, which was significantly higher (OR 3.87; 95% CI 1.46–10.28; P < .001; I² = 83.68). The mitral isthmus reconnection rate (OR 0.44; 95% CI 0.15–1.29; P = .14; I² = 63.6) and repeat procedure rate (OR 0.76; 95% CI 0.53–1.08; P = .12; I² = 48) were similar; however, a leave-one-out sensitivity analysis showed P < .05 for both. The benefits of EIVoM were not affected by age, left atrial diameter, and left ventricular ejection fraction (P > .05). Age (P = .029) and left atrial diameter (P = .042) were inversely associated with EIVoM benefits in terms of repeat ablation and mitral isthmus reconnection (age; P = .003).

Conclusion

The addition of EIVoM to ablation increased MIBB and reduced ATa recurrence.

背景向马歇尔静脉注入乙醇（EIVoM）可能会增加二尖瓣峡部双向阻滞（MIBB），并引起局部自主神经去神经化，从而改善预后。目的本荟萃分析旨在研究在房颤消融术中加入 EIVoM 是否会带来更好的预后。方法使用PubMed、Scopus、ScienceDirect和Europe PMC对房颤消融过程中添加EIVoM与射频消融进行比较的研究进行系统文献检索。主要结果是房性快速性心律失常（ATa）复发，定义为空白期后的房颤/房扑/房性心动过速。结果11项研究中有2821名患者，EIVoM成功率为77%（95%置信区间[CI] 62%-92%）。EIVoM组的ATA复发率为27%（95%置信区间为20%-34%），单纯消融组为42%（95%置信区间为33%-51%）。EIVoM 降低了 ATa 复发率（几率比 [OR] 0.52；95% CI 0.36-0.76；P < .001；I2 = 76.92）。EIVoM组的MIBB率为85%（95% CI 77%-94%），纯消融组为73%（95% CI 61%-85%），明显高于EIVoM组（OR 3.87; 95% CI 1.46-10.28; P < .001; I2 = 83.68）。二尖瓣峡部再连接率（OR 0.44；95% CI 0.15-1.29；P = .14；I2 = 63.6）和重复手术率（OR 0.76；95% CI 0.53-1.08；P = .12；I2 = 48）相似；但是，留出一例的敏感性分析显示，两者的 P < .05。EIVoM 的益处不受年龄、左心房直径和左心室射血分数的影响（P >.05）。年龄（P = .029）和左房直径（P = .042）与 EIVoM 在重复消融和二尖瓣峡部重新连接（年龄；P = .003）方面的益处成反比。

{"title":"Ethanol infusion into the vein of Marshall reduced atrial tachyarrhythmia recurrence during catheter ablation: A systematic review and meta-analysis","authors":"Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD","doi":"10.1016/j.hroo.2024.08.011","DOIUrl":"10.1016/j.hroo.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Ethanol infusion into the vein of Marshall (EIVoM) may increase mitral isthmus bidirectional block (MIBB) and cause local autonomic denervation that may improve outcome.</div></div><div><h3>Objective</h3><div>This meta-analysis aimed to investigate whether the addition of EIVoM to atrial fibrillation (AF) ablation led to a better outcome.</div></div><div><h3>Methods</h3><div>Systematic literature search was performed using PubMed, Scopus, ScienceDirect, and Europe PMC for studies that compared the addition of EIVoM during AF ablation with radiofrequency ablation. The primary outcome was <em>atrial tachyarrhythmia</em> (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after the blanking period.</div></div><div><h3>Results</h3><div>There were 2821 patients from 11 studies, and EIVoM was successful in 77% (95% confidence interval [CI] 62%–92%). ATa recurrence was 27% (95% CI 20%–34%) in the EIVoM group and 42% (95% CI 33%–51%) in ablation-only group. EIVoM reduced ATa recurrence (odds ratio [OR] 0.52; 95% CI 0.36–0.76; <em>P</em> < .001; I<sup>2</sup> = 76.92). The rate of MIBB was 85% (95% CI 77%–94%) in the EIVoM group and 73% (95% CI 61%–85%) in the ablation-only group, which was significantly higher (OR 3.87; 95% CI 1.46–10.28; <em>P</em> < .001; I<sup>2</sup> = 83.68). The mitral isthmus reconnection rate (OR 0.44; 95% CI 0.15–1.29; <em>P</em> = .14; I<sup>2</sup> = 63.6) and repeat procedure rate (OR 0.76; 95% CI 0.53–1.08; <em>P</em> = .12; I<sup>2</sup> = 48) were similar; however, a leave-one-out sensitivity analysis showed <em>P</em> < .05 for both. The benefits of EIVoM were not affected by age, left atrial diameter, and left ventricular ejection fraction (<em>P</em> > .05). Age (<em>P</em> = .029) and left atrial diameter (<em>P</em> = .042) were inversely associated with EIVoM benefits in terms of repeat ablation and mitral isthmus reconnection (age; <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>The addition of EIVoM to ablation increased MIBB and reduced ATa recurrence.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 728-738"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534953","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

Global voices on atrial fibrillation care in China 关于中国心房颤动治疗的全球声音

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.004

Mingfang Li MD, PhD , Minglong Chen MD , Yutao Guo MD , Gregory Y.H. Lip MD

An aging population, coupled with the high prevalence of physical inactivity, obesity, dyslipidemia, hypertension, and diabetes mellitus, has led to a significant increase in the incidence and prevalence of atrial fibrillation (AF) in China. Managing clinical complexity of AF patients poses significant challenges. Current guidelines advocate for holistic or integrated management using the ABC (Atrial fibrillation Better Care) pathway. Compliance with the ABC pathway has demonstrated promising benefit in improving clinical outcomes. The mAFA II trial (the mHealth technology for improved screening, patient involvement, and optimized integrated care in Atrial Fibrillation) explores the potential of a mobile health technology–supported integrated care approach in reducing the risks of rehospitalization and clinical adverse events. However, disparities persist between urban and rural areas, with the likelihood of rural older individuals by themselves using intelligent devices being extremely low. Therefore, the application prospects of the mobile AF application strategy in rural areas are greatly limited. The ongoing MIRACLE-AF trial (A Novel Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China) aims to address unique healthcare challenges faced by rural older patients with AF through a novel integrated care model, which is led by village doctors and supported by a digital health platform. In conclusion, innovative integrated care approaches using digital technologies offer promising solutions to enhance AF care across diverse settings in China, catering to the needs of both urban and rural populations.

人口老龄化，加上缺乏运动、肥胖、血脂异常、高血压和糖尿病的高发，导致中国心房颤动（房颤）的发病率和患病率显著增加。房颤患者的临床复杂性给管理带来了巨大挑战。目前的指南提倡采用 ABC（心房颤动更好护理）路径进行整体或综合管理。实践证明，遵从 ABC 方案有望改善临床疗效。mAFA II 试验（移动医疗技术改善心房颤动筛查、患者参与和优化综合护理）探索了移动医疗技术支持的综合护理方法在降低再住院风险和临床不良事件方面的潜力。然而，城乡之间的差距依然存在，农村老年人自己使用智能设备的可能性极低。因此，移动心房颤动应用策略在农村地区的应用前景非常有限。目前正在进行的 MIRACLE-AF 试验（中国农村老年房颤患者综合治疗新模式）旨在通过由乡村医生主导、数字医疗平台支持的新型综合治疗模式，解决农村老年房颤患者面临的独特医疗挑战。总之，利用数字技术的创新综合护理方法为加强中国不同环境下的房颤护理提供了前景广阔的解决方案，同时满足了城市和农村人口的需求。

{"title":"Global voices on atrial fibrillation care in China","authors":"Mingfang Li MD, PhD , Minglong Chen MD , Yutao Guo MD , Gregory Y.H. Lip MD","doi":"10.1016/j.hroo.2024.08.004","DOIUrl":"10.1016/j.hroo.2024.08.004","url":null,"abstract":"<div><div>An aging population, coupled with the high prevalence of physical inactivity, obesity, dyslipidemia, hypertension, and diabetes mellitus, has led to a significant increase in the incidence and prevalence of atrial fibrillation (AF) in China. Managing clinical complexity of AF patients poses significant challenges. Current guidelines advocate for holistic or integrated management using the ABC (Atrial fibrillation Better Care) pathway. Compliance with the ABC pathway has demonstrated promising benefit in improving clinical outcomes. The mAFA II trial (the mHealth technology for improved screening, patient involvement, and optimized integrated care in Atrial Fibrillation) explores the potential of a mobile health technology–supported integrated care approach in reducing the risks of rehospitalization and clinical adverse events. However, disparities persist between urban and rural areas, with the likelihood of rural older individuals by themselves using intelligent devices being extremely low. Therefore, the application prospects of the mobile AF application strategy in rural areas are greatly limited. The ongoing MIRACLE-AF trial (A Novel Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China) aims to address unique healthcare challenges faced by rural older patients with AF through a novel integrated care model, which is led by village doctors and supported by a digital health platform. In conclusion, innovative integrated care approaches using digital technologies offer promising solutions to enhance AF care across diverse settings in China, catering to the needs of both urban and rural populations.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 693-697"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535018","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

Associations between atrial fibrillation symptom clusters and major adverse cardiovascular events following catheter ablation 心房颤动症状群与导管消融术后主要不良心血管事件之间的关系

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.013

Danielle Scharp PhD, APRN , Yihong Zhao PhD , Liesbet Van Bulck PhD, RN , Alexander Volodarskiy MD , David Slotwiner MD , Meghan Reading Turchioe PhD, MPN, RN

引用次数: 0

Double Perclose increases the efficiency of leadless pacemaker implantation: A propensity score–matched analysis 双周缝合提高了无导联起搏器植入术的效率：倾向得分匹配分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.07.018

Joan Rodriguez-Taveras MD , Carlos Patino MD , Carlos D. Matos MD , Alejandro Velasco MD , Isabella Alviz MD , Thomas Tadros MD , Bruce Koplan MD , Sunil Kapur MD , William Sauer MD , Jorge E. Romero MD, FHRS

引用次数: 0

Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis 脉冲场消融术治疗心房颤动时，在使用五线导管进行肺静脉隔离的同时进行左心房后壁隔离：系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

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

Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD

Background

Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA).

Objective

This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.

Methods

Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.

Results

There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%–29%; I² = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R² = 100%, P < .001, I² = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50–1.21, P = .27; I² = 0%, P = .86). Procedure time and fluoroscopy time did not significantly differ (P > .05).

Conclusion

LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain.

背景持续性心房颤动（房颤）可能需要广泛的消融策略。本荟萃分析旨在研究在脉冲场消融（PFA）治疗房颤时，除使用五线导管进行肺静脉隔离（PVI）外，使用左心房后壁隔离（LAPWI）的可行性和有效性。方法通过PubMed、SCOPUS、ScienceDirect和EuropePMC进行全面检索，以了解在房颤的PFA消融中使用五线导管进行LAPWI+PVI的研究报告。主要结果是房性心动过速（ATa）复发，定义为空白期后的房颤/房扑/房性心动过速。使用平均/中值 16 至 20 次的额外 PFA 应用，LAPWI 的成功率为 100%，无急性左房后壁重接和食管并发症的报道。在平均 240 ± 91 天的随访中，LAPWI+PVI 组的 ATa 复发率为 21% (95% CI 13%-29%; I2 = 84.8%)。元回归分析表明，年龄、左室射血分数和重复手术对 ATa 复发无明显影响（P > .05）。左心房直径每增加 1 毫米，ATa 复发几率增加 6%（R2 = 100%，P < .001，I2 = 0%）。Meta 分析表明，LAPWI+PVI 患者的 ATa 复发率与未进行 LAPWI 的患者相比没有差异（几率比 0.78，95% 置信区间 0.50-1.21，P = 0.27；I2 = 0%，P = 0.86）。手术时间和透视时间无明显差异（P >.05）。结论在 PFA 期间使用五针导管进行 LAPWI 是可行的，不会延长手术/透视时间，但不会减少 ATa 复发。在 PFA 期间可考虑进行 LAPWI，但其益处尚不确定。

{"title":"Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis","authors":"Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD","doi":"10.1016/j.hroo.2024.08.006","DOIUrl":"10.1016/j.hroo.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA).</div></div><div><h3>Objective</h3><div>This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.</div></div><div><h3>Methods</h3><div>Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.</div></div><div><h3>Results</h3><div>There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%–29%; I<sup>2</sup> = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (<em>P</em> > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R<sup>2</sup> = 100%, <em>P</em> < .001, I<sup>2</sup> = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50–1.21, <em>P</em> = .27; I<sup>2</sup> = 0%, <em>P</em> = .86). Procedure time and fluoroscopy time did not significantly differ (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 720-727"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535067","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

A rare case of atypical AVNRT in a patient with Ebstein anomaly 一例罕见的埃布斯坦畸形患者非典型房室传导阻滞（AVNRT）病例

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.005

Sai Vikram Alampoondi Venkataramanan MD, Robert Schneider MD, Shane Tsai MD, MBA

引用次数: 0

Healthcare professionals’ perspective on the acceptance of gene therapy 医护人员对接受基因疗法的看法

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.07.019

Lian Y. Rekker MsC , Erik Renkema PhD , Femke Hilverda PhD , Linda W. van Laake MD, PhD , Pieter A. Doevendans MD, PhD , Joost P.G. Sluijter PhD , Pim van der Harst MD, PhD , J. Peter van Tintelen MD, PhD , Anneline S.J.M. te Riele MD, PhD

引用次数: 0

Ventricular stimulation in patients with myotonic dystrophy type 1 may not predict future ventricular arrhythmias 1 型肌营养不良症患者的心室刺激可能无法预测未来的室性心律失常

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.001

Lukasz Cerbin MD , Amneet Sandhu MD, MSc , Michael Rosenberg MD , Christopher Barrett MD , Rafay Sabzwari MD , Lohit Garg MD , Alexis Tumolo MD , Wendy Tzou MD , Paul Varosy MD , Johannes Von Alvensleben MD , Matthew Zipse MD , Ryan Aleong MD

Background

Myotonic dystrophy type 1 (DM1) is associated with progressive conduction disease. Furthermore, DM1 patients are at risk ventricular arrhythmias (VAs), although prediction remains difficult. The 2022 Heart Rhythm Expert Consensus Statement gives a IIb recommendation to the use of electrophysiology study (EPS) to risk-stratify patients for VAs. The utility of EPS in predicting the development of VAs, however, has not been explored in this patient population.

Objective

The study sought to examine the natural history of DM1 patients with positive and negative ventricular stimulation (v-stim) during EPS.

Methods

Patients with a history of DM1 undergoing EPS with associated v-stim from 2008 to present were retrospectively identified.

Results

From 2008 to 2022, 26 consecutive DM1 patients presented for EPS with v-stim. Four v-stim protocols were positive for sustained or hemodynamically significant ventricular tachycardia (VT), one of which was induced with 600 doubles, the others with triple extrastimuli. A total of 22 of 26 subjects received a device implant, with 18 receiving permanent pacemakers and 4 implantable cardioverter-defibrillators. All 4 of the patients with positive v-stims underwent ICD implantation. After a mean of 5.7 years of follow-up, 7 patients had sustained VT, 6 of whom had negative v-stims. Of the 4 patients with positive v-stims, only 1 developed sustained VT in follow-up. Other than baseline QT interval at time of EPS, no baseline characteristics were significantly different between patients with and without subsequent VT.

Conclusion

In this single center, v-stim in DM1 patients did not predict clinical VAs, as a vast majority of DM1 patients who developed VAs had negative v-stims.

背景1型肌营养不良症（DM1）与进行性传导疾病有关。此外，DM1 患者还存在室性心律失常（VAs）的风险，但预测仍很困难。2022 年《心脏节律专家共识声明》（The 2022 Heart Rhythm Expert Consensus Statement）建议使用电生理学研究（EPS）对室性心律失常患者进行风险分级，建议等级为 IIb。方法回顾性鉴定 2008 年至今接受 EPS 并伴有 v-stim 的 DM1 患者。结果从 2008 年到 2022 年，连续有 26 例 DM1 患者接受 EPS 并伴有 v-stim。四项v-stim方案对持续性或血流动力学显著性室性心动过速（VT）呈阳性反应，其中一项用600倍频诱导，其他则用三倍外刺激诱导。26 名受试者中共有 22 人接受了设备植入，其中 18 人接受了永久起搏器，4 人接受了植入式心律转复除颤器。所有 4 名 V-stims 阳性患者都接受了 ICD 植入术。在平均 5.7 年的随访后，7 名患者出现持续 VT，其中 6 名患者的 v-stims 呈阴性。在 4 名 v-stims 呈阳性的患者中，只有 1 人在随访期间出现持续性 VT。除 EPS 时的基线 QT 间期外，随后出现 VT 和未出现 VT 的患者的基线特征无显著差异。

{"title":"Ventricular stimulation in patients with myotonic dystrophy type 1 may not predict future ventricular arrhythmias","authors":"Lukasz Cerbin MD , Amneet Sandhu MD, MSc , Michael Rosenberg MD , Christopher Barrett MD , Rafay Sabzwari MD , Lohit Garg MD , Alexis Tumolo MD , Wendy Tzou MD , Paul Varosy MD , Johannes Von Alvensleben MD , Matthew Zipse MD , Ryan Aleong MD","doi":"10.1016/j.hroo.2024.08.001","DOIUrl":"10.1016/j.hroo.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Myotonic dystrophy type 1 (DM1) is associated with progressive conduction disease. Furthermore, DM1 patients are at risk ventricular arrhythmias (VAs), although prediction remains difficult. The 2022 Heart Rhythm Expert Consensus Statement gives a IIb recommendation to the use of electrophysiology study (EPS) to risk-stratify patients for VAs. The utility of EPS in predicting the development of VAs, however, has not been explored in this patient population.</div></div><div><h3>Objective</h3><div>The study sought to examine the natural history of DM1 patients with positive and negative ventricular stimulation (v-stim) during EPS.</div></div><div><h3>Methods</h3><div>Patients with a history of DM1 undergoing EPS with associated v-stim from 2008 to present were retrospectively identified.</div></div><div><h3>Results</h3><div>From 2008 to 2022, 26 consecutive DM1 patients presented for EPS with v-stim. Four v-stim protocols were positive for sustained or hemodynamically significant ventricular tachycardia (VT), one of which was induced with 600 doubles, the others with triple extrastimuli. A total of 22 of 26 subjects received a device implant, with 18 receiving permanent pacemakers and 4 implantable cardioverter-defibrillators. All 4 of the patients with positive v-stims underwent ICD implantation. After a mean of 5.7 years of follow-up, 7 patients had sustained VT, 6 of whom had negative v-stims. Of the 4 patients with positive v-stims, only 1 developed sustained VT in follow-up. Other than baseline QT interval at time of EPS, no baseline characteristics were significantly different between patients with and without subsequent VT.</div></div><div><h3>Conclusion</h3><div>In this single center, v-stim in DM1 patients did not predict clinical VAs, as a vast majority of DM1 patients who developed VAs had negative v-stims.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 698-704"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535017","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

Progression of myocardial dysfunction and prediction of arrhythmic events in patients with exercise-induced arrhythmogenic cardiomyopathy 运动诱发心律失常性心肌病患者心肌功能障碍的进展和心律失常事件的预测

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.08.003

Linda T. Aaserud MD , Christine Rootwelt-Norberg MD, PhD , Christian K. Five MD , Eivind W. Aabel MD, PhD , Nina E. Hasselberg MD, PhD , Erik Lyseggen MD, PhD , Kristina H. Haugaa MD, PhD , Øyvind H. Lie MD, PhD

Background

Several reports exist of an acquired exercise-induced arrhythmogenic cardiomyopathy. Little is known about myocardial disease progression and arrhythmia prediction in this population.

Objective

The study sought to explore the evolution of myocardial function and structure and its relation to incident life-threatening ventricular arrhythmias (VA), to identify markers of impending events.

Methods

We included athletes (individuals with exercise doses >24 metabolic equivalent of task hours per week, >6 consecutive years, participating in organized and competitive sports) who had VA, absence of family history and known genetic variants associated with cardiac disease, and no other identified etiology, in a tertiary referral single-center, longitudinal cohort study of patients with exercise-induced arrhythmogenic cardiomyopathy (EiAC). Evolution of myocardial function and structure was assessed by repeated echocardiographic examinations during long-term follow-up. Life-threatening VA were assessed at baseline and during long-term follow-up.

Results

Forty-one EiAC patients (15% women, age 45 ± 13 years) were followed for 80 (interquartile range 48–115) months. There were no changes in myocardial function or structure in the overall population during follow-up. We observed high incidence rate and high recurrence rate of life-threatening VA in EiAC patients. Subtle deterioration of right ventricular function was strongly associated with subsequent first-time VA (odds ratio 1.12, 95% confidence interval 1.01–1.25, P = .031, per 1% deterioration of right ventricular free wall longitudinal strain).

Conclusion

There were no clear changes in myocardial function or structure during follow-up in the overall population, but there was a high incidence rate and high recurrence rate of life-threatening VA. Subtle right ventricular deterioration by free wall longitudinal strain was a strong predictor of impending first-time life-threatening VA during follow-up.

背景关于后天运动诱发心律失常性心肌病的报道不胜枚举。本研究旨在探讨心肌功能和结构的演变及其与危及生命的室性心律失常（VA）事件的关系，以确定即将发生事件的标志物。方法我们在一项针对运动诱发心律失常性心肌病（EiAC）患者的三级转诊单中心纵向队列研究中，纳入了患有室性心律失常、无家族史、与心脏病相关的已知基因变异且无其他已确定病因的运动员（每周运动量相当于24个代谢任务小时，连续6年参加有组织的竞技运动）。在长期随访期间，通过重复超声心动图检查评估了心肌功能和结构的变化。结果对 41 名 EiAC 患者（15% 为女性，年龄为 45 ± 13 岁）进行了 80 个月（四分位数区间为 48-115 个月）的随访。在随访期间，所有患者的心肌功能和结构均无变化。我们观察到，EiAC 患者中危及生命的 VA 发生率高，复发率也高。右心室功能的细微恶化与随后的首次 VA 密切相关（几率比 1.12，95% 置信区间 1.01-1.25，P = 0.031，右心室游离壁纵向应变每恶化 1%）。随访期间，右心室游离壁纵向应变的细微恶化是预测即将发生的首次危及生命的VA的有力因素。

{"title":"Progression of myocardial dysfunction and prediction of arrhythmic events in patients with exercise-induced arrhythmogenic cardiomyopathy","authors":"Linda T. Aaserud MD , Christine Rootwelt-Norberg MD, PhD , Christian K. Five MD , Eivind W. Aabel MD, PhD , Nina E. Hasselberg MD, PhD , Erik Lyseggen MD, PhD , Kristina H. Haugaa MD, PhD , Øyvind H. Lie MD, PhD","doi":"10.1016/j.hroo.2024.08.003","DOIUrl":"10.1016/j.hroo.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Several reports exist of an acquired exercise-induced arrhythmogenic cardiomyopathy. Little is known about myocardial disease progression and arrhythmia prediction in this population.</div></div><div><h3>Objective</h3><div>The study sought to explore the evolution of myocardial function and structure and its relation to incident life-threatening ventricular arrhythmias (VA), to identify markers of impending events.</div></div><div><h3>Methods</h3><div>We included athletes (individuals with exercise doses >24 metabolic equivalent of task hours per week, >6 consecutive years, participating in organized and competitive sports) who had VA, absence of family history and known genetic variants associated with cardiac disease, and no other identified etiology, in a tertiary referral single-center, longitudinal cohort study of patients with exercise-induced arrhythmogenic cardiomyopathy (EiAC). Evolution of myocardial function and structure was assessed by repeated echocardiographic examinations during long-term follow-up. Life-threatening VA were assessed at baseline and during long-term follow-up.</div></div><div><h3>Results</h3><div>Forty-one EiAC patients (15% women, age 45 ± 13 years) were followed for 80 (interquartile range 48–115) months. There were no changes in myocardial function or structure in the overall population during follow-up. We observed high incidence rate and high recurrence rate of life-threatening VA in EiAC patients. Subtle deterioration of right ventricular function was strongly associated with subsequent first-time VA (odds ratio 1.12, 95% confidence interval 1.01–1.25, <em>P =</em> .031, per 1% deterioration of right ventricular free wall longitudinal strain).</div></div><div><h3>Conclusion</h3><div>There were no clear changes in myocardial function or structure during follow-up in the overall population, but there was a high incidence rate and high recurrence rate of life-threatening VA. Subtle right ventricular deterioration by free wall longitudinal strain was a strong predictor of impending first-time life-threatening VA during follow-up.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 705-712"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535019","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

Global voices on atrial fibrillation management: Brazil 关于心房颤动管理的全球声音：巴西

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-10-01 DOI: 10.1016/j.hroo.2024.06.010

Itamar S. Santos BMath, MD, PhD , Alessandra C. Goulart PhD , Paulo A. Lotufo PhD , Kamila V. Silva MD , Tiotrefis G. Fernandes PhD , Thais M.V. Nascimento MD , Luis M.A. Camargo MD, PhD , G. Neil Thomas PhD , Gregory Y.H. Lip PhD , Isabela M. Bensenor PhD

Atrial fibrillation (AF) and stroke are prevalent conditions worldwide, and the AF burden is expected to concentrate in low- and middle-income countries like Brazil. The National Institute for Health and Care Excellence–funded Global Health Research Group on Atrial Fibrillation Management (GHRG-AF) had a Brazilian arm that addressed AF epidemiology and care in Brazil. GHRG-AF analyzed data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a long-term cohort of 15,105 middle-aged adults in Brazil, focused on cardiovascular disease and diabetes. Additionally, the GHRG-AF used data from the Brazilian Study of Stroke Mortality and Morbidity (EMMA) study to understand AF impact on this cohort of 1863 stroke survivors, all admitted to a community hospital. The GHRG-AF also surveyed healthcare practices and the pathways of individuals who live with AF, interviewing health professionals and patients treated in different healthcare units in São Paulo. Despite these multiple approaches, those data were restricted to individuals living in large urban centers. Approximately 70% of the Brazilian territory comprises sparsely populated cities (<10 inhabitants/km²), which, as a group, are home to 15 million individuals. In a new step, the GHRG-AF collaborators aim to improve cardiovascular research capacity in distant locations of the Brazilian Amazon, develop patient-centered protocols, empower community health agents in the region, and intensify collaboration with other research groups in remote parts of the country.

心房颤动（房颤）和中风是全球普遍存在的疾病，预计房颤负担将集中在巴西等中低收入国家。由美国国家健康与护理卓越研究所资助的心房颤动管理全球健康研究小组（GHRG-AF）在巴西设有分支机构，负责研究巴西的心房颤动流行病学和护理问题。GHRG-AF分析了巴西成人健康纵向研究（ELSA-Brasil）的数据，该研究是巴西15105名中年人的长期队列，重点关注心血管疾病和糖尿病。此外，GHRG-AF 还使用了巴西中风死亡率和发病率研究 (EMMA) 的数据，以了解房颤对这批 1863 名中风幸存者的影响，这些幸存者都住进了社区医院。GHRG-AF 还调查了医疗实践和心房颤动患者的生活路径，采访了圣保罗不同医疗单位的医疗专业人员和接受治疗的患者。尽管采取了上述多种方法，但这些数据仅限于生活在大城市中心的人群。巴西约 70% 的领土由人口稀少的城市（10 人/平方公里）组成，这些城市作为一个群体，居住着 1500 万人。在新的一步中，GHRG-AF 合作者的目标是提高巴西亚马逊偏远地区的心血管研究能力，制定以患者为中心的方案，增强该地区社区卫生人员的能力，并加强与该国偏远地区其他研究小组的合作。

{"title":"Global voices on atrial fibrillation management: Brazil","authors":"Itamar S. Santos BMath, MD, PhD , Alessandra C. Goulart PhD , Paulo A. Lotufo PhD , Kamila V. Silva MD , Tiotrefis G. Fernandes PhD , Thais M.V. Nascimento MD , Luis M.A. Camargo MD, PhD , G. Neil Thomas PhD , Gregory Y.H. Lip PhD , Isabela M. Bensenor PhD","doi":"10.1016/j.hroo.2024.06.010","DOIUrl":"10.1016/j.hroo.2024.06.010","url":null,"abstract":"<div><div>Atrial fibrillation (AF) and stroke are prevalent conditions worldwide, and the AF burden is expected to concentrate in low- and middle-income countries like Brazil. The National Institute for Health and Care Excellence–funded Global Health Research Group on Atrial Fibrillation Management (GHRG-AF) had a Brazilian arm that addressed AF epidemiology and care in Brazil. GHRG-AF analyzed data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a long-term cohort of 15,105 middle-aged adults in Brazil, focused on cardiovascular disease and diabetes. Additionally, the GHRG-AF used data from the Brazilian Study of Stroke Mortality and Morbidity (EMMA) study to understand AF impact on this cohort of 1863 stroke survivors, all admitted to a community hospital. The GHRG-AF also surveyed healthcare practices and the pathways of individuals who live with AF, interviewing health professionals and patients treated in different healthcare units in São Paulo. Despite these multiple approaches, those data were restricted to individuals living in large urban centers. Approximately 70% of the Brazilian territory comprises sparsely populated cities (<10 inhabitants/km<span><span><sup>2</sup></span></span>), which, as a group, are home to 15 million individuals. In a new step, the GHRG-AF collaborators aim to improve cardiovascular research capacity in distant locations of the Brazilian Amazon, develop patient-centered protocols, empower community health agents in the region, and intensify collaboration with other research groups in remote parts of the country.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 10","pages":"Pages 679-686"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707742","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

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Heart Rhythm O2

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀