Heart Rhythm O2最新文献

英文中文

Genetic cardiomyopathy and significant systolic heart failure treated with cardiac contractility modulation therapy 使用心脏收缩力调节疗法治疗遗传性心肌病和明显的收缩性心力衰竭

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-08-01 DOI: 10.1016/j.hroo.2024.06.008

Aaron B. Hesselson MD, BSEE, FACC, FHRS, CCDS, Gaurang Vaidya MD, Andrew Kolodziej MD

引用次数: 0

The Alliance Against Sudden Death, a 17-year journey for an original initiative of the Inter-American Society of Cardiology 防止猝死联盟，美洲心脏病学会原创倡议的 17 年历程

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-08-01 DOI: 10.1016/j.hroo.2024.05.006

Manlio F. Márquez-Murillo MD , Adela Bazbaz MD , Felipe Hernández RN , Jesús Antonio González-Hermosillo MD, FACC

引用次数: 0

Repeat ablation of atrial fibrillation using electrogram dispersion to identify additional areas of mechanistic significance 利用电图弥散重复消融心房颤动以确定更多具有机制意义的区域

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-08-01 DOI: 10.1016/j.hroo.2024.07.007

Junaid A.B. Zaman MA (Oxon), BMBCh, FRCP (Edin), PhD , Abdulhaseeb Khan MS , Jan Nielsen MD, PhD , Steen B. Kristiansen MD, PhD , Mads B. Kronborg MD, DMSc, PhD , Christoffer T. Witt MD, PhD , Christian Gerdes MD, PhD , Jens Kristensen MD, PhD , Henrik K. Jensen MD, PhD , Peter Lukac MD, PhD , Sharad C. Agarwal MBBS

Background

Electrogram dispersion identifies putative atrial fibrillation (AF) drivers in first time ablation procedures, with high acute termination rates and long-term outcomes akin to extensive ablation approaches. Its use in a population that had undergone repeat ablation is unknown, particularly where the pulmonary veins are already isolated.

Objective

This purpose of this study was to assess electrogram dispersion mapping during repeat ablation procedures for persistent AF.

Methods

One hundred sixty-seven patients from the United Kingdom and Denmark, all with persistent AF recurrence after prior ablation procedure(s), were mapped using a five splined catheter for electrogram dispersion before ablation. Areas were manually tagged on biatrial electroanatomic maps and ablated once pulmonary vein isolation was confirmed or reisolated if required. All patients had 12-month continuous monitoring, with most of the cohort having follow-up beyond 24 months.

Results

Of the 167 patients [53 (32%) female; mean age 66 ± 8 years; mean left atrial (LA) diameter 4.8 cm; mean ejection fraction 53%], 108 had pulmonary veins already isolated. Dispersion sites occurred in both atria (3.2 LA, 1.4 right atrium). Acute termination to sinus rhythm occurred in 71 (42%) of the cohort patients, with a further 73 (44%) terminating to atrial tachycardia/flutter. At 12-month follow-up, 95% of patients were free of AF, with 74% overall freedom from all atrial arrhythmias. Heart failure and severely enlarged LA predicted recurrence, and termination to sinus improved freedom from all atrial arrhythmias.

Conclusion

Dispersion mapping is a promising approach at repeat ablation procedures for persistent AF, with high acute termination rates and good clinical outcomes. Further prospective randomized trials are needed to evaluate this approach in a population that had undergone repeat ablation.

背景在首次消融术中，电图弥散可识别推定的房颤（AF）驱动因素，其急性终止率高，长期疗效与广泛消融方法类似。本研究的目的是评估持续性房颤重复消融术中的电图弥散映射。方法对来自英国和丹麦的 167 名患者进行了电图弥散映射，这些患者都是在之前的消融术后复发的持续性房颤患者，在消融术前使用五花键导管进行了电图弥散映射。在心房电解剖图上手动标记区域，并在确认肺静脉隔离后进行消融，或根据需要重新隔离。所有患者均接受了为期 12 个月的连续监测，其中大部分患者的随访时间超过了 24 个月。结果在 167 名患者（53 人（32%）为女性；平均年龄为 66 ± 8 岁；平均左心房（LA）直径为 4.8 厘米；平均射血分数为 53%）中，108 人的肺静脉已被隔离。弥散部位发生在两个心房（3.2 个 LA，1.4 个右心房）。队列中有 71 名患者（42%）急性终止窦性心律，另有 73 名患者（44%）终止房性心动过速/扑动。随访12个月时，95%的患者无房颤，74%的患者无所有房性心律失常。心力衰竭和严重扩大的 LA 预示着复发，而终止至窦性可提高所有房性心律失常的治愈率。需要进一步开展前瞻性随机试验，在接受过重复消融术的人群中评估这种方法。

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引用次数: 0

Comparing outcomes after pulmonary vein isolation in patients with systolic and diastolic heart failure 比较收缩性和舒张性心力衰竭患者肺静脉隔离后的疗效

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-08-01 DOI: 10.1016/j.hroo.2024.07.003

Ahmad B. Allaw MD, Jeremy Treger MD, PhD, Jia Guo MD, Dipayon Roy MD, Amulya Gampa MD, Swati Rao MD, Stephanie A. Besser MSAS, Andrew D. Beaser MD, Zaid Aziz MD, Cevher Ozcan MD, Srinath Yeshwant MD, Gaurav A. Upadhyay MD

Background

The benefit of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) is well established; its efficacy in patients with heart failure preserved ejection fraction (HFpEF) is less clear.

Objective

The objective of the study was to compare AF and heart failure (HF) rehospitalizations after PVI in patients with HFpEF vs HFrEF.

Methods

The IBM MarketScan Database was used to identify patients undergoing PVI for AF. Patients were categorized by HF status: absence of HF, presence of HFrEF, or presence of HFpEF. Primary outcomes were HF and arrhythmia hospitalizations after PVI.

Results

A total of 32,524 patients were analyzed: 27,900 with no HF (86%), 2948 with HFrEF (9%), and 1676 with HFpEF (5%). Compared with those with no HF, both patients with HFrEF and HFpEF were more likely to be hospitalized for HF (hazard ratio [HR] 7.27; P < .01 for HFrEF and HR 9.46; P < .01 for HFpEF) and for AF (HR 1.17; P < .01 for HFrEF and HR 1.74; P < .01 for HFpEF) after PVI. In matched analysis, 23% of patients with HFrEF and 24% patients with HFpEF demonstrated a reduction in HF hospitalizations (P = .31) and approximately one-third demonstrated decreased arrhythmia rehospitalizations (P = .57) in the 6 months after PVI. Compared with those with HFrEF in longer-term follow-up (>1 year), patients with HFpEF were more likely to have HF (HR 1.30; P < .01) and arrhythmia (HR 1.19; P < .01) rehospitalizations.

Conclusion

Reductions in HF and arrhythmia hospitalizations are observed early after PVI across all patients with HF, but patients with HFpEF demonstrate higher HF rehospitalization and arrhythmia recurrence in longer-term follow-up than do patients with HFrEF.

背景肺静脉隔绝术（PVI）对心房颤动（AF）和射血分数降低型心力衰竭（HFrEF）患者的益处已得到公认，但对射血分数保留型心力衰竭（HFpEF）患者的疗效则不太明确。研究目的是比较 HFpEF 与 HFrEF 患者进行肺静脉隔绝术后心房颤动和心力衰竭（HF）再住院情况。患者按房颤状态分类：无房颤、有 HFrEF 或有 HFpEF。结果共分析了 32524 例患者：27900 例无房颤（86%），2948 例有 HFrEF（9%），1676 例有 HFpEF（5%）。与无 HF 患者相比，HFrEF 和 HFpEF 患者在 PVI 后更有可能因 HF（Hazard ratio [HR] 7.27; P < .01 for HFrEF and HR 9.46; P < .01 for HFpEF）和房颤（Hazard ratio [HR] 1.17; P < .01 for HFrEF and HR 1.74; P < .01 for HFpEF）住院。在配对分析中，23% 的 HFrEF 患者和 24% 的 HFpEF 患者在 PVI 术后 6 个月内减少了 HF 住院治疗（P = .31），约三分之一的患者减少了心律失常再住院治疗（P = .57）。与长期随访（>1 年）的 HFrEF 患者相比，HFpEF 患者更容易发生 HF（HR 1.30；P <.01）和心律失常（HR 1.19；P <.01）再住院。

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引用次数: 0

A multimodal deep learning tool for detection of junctional ectopic tachycardia in children with congenital heart disease 用于检测先天性心脏病儿童交界性异位心动过速的多模态深度学习工具

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.04.014

Background

Junctional ectopic tachycardia (JET) is a prevalent life-threatening arrhythmia in children with congenital heart disease. It has a marked resemblance to normal sinus rhythm, often leading to delay in diagnosis and management.

Objective

The study sought to develop a novel multimodal automated arrhythmia detection tool that outperforms existing JET detection tools.

Methods

This is a cohort study performed on 40 patients with congenital heart disease at Texas Children’s Hospital. Electrocardiogram and central venous pressure waveform data produced by bedside monitors are captured by the Sickbay platform. Convolutional neural networks (CNNs) were trained to classify each heartbeat as either normal sinus rhythm or JET based only on raw electrocardiogram signals.

Results

Our best model improved the area under the curve from 0.948 to 0.952 and the true positive rate at 5% false positive rate from 71.8% to 80.6%. Using a 3-model ensemble further improved the area under the curve to 0.953 and the true positive rate at 5% false positive rate to 85.2%. Results on a subset of data show that adding central venous pressure can significantly improve area under the receiver-operating characteristic curve from 0.646 to 0.825.

Conclusion

This study validates the efficacy of deep neural networks to notably improve JET detection accuracy. We have built a performant and reliable model that can be used to create a bedside alarm that diagnoses JET, allowing for precise diagnosis of this life-threatening postoperative arrhythmia and prompt intervention. Future validation of the model in a larger cohort is needed.

背景功能性异位心动过速（JET）是先天性心脏病患儿中普遍存在的一种危及生命的心律失常。该研究旨在开发一种新型多模态自动心律失常检测工具，该工具的性能优于现有的 JET 检测工具。Sickbay 平台采集了床旁监护仪产生的心电图和中心静脉压波形数据。结果我们的最佳模型将曲线下面积从 0.948 提高到了 0.952，在 5% 假阳性率下的真阳性率从 71.8% 提高到了 80.6%。使用 3 个模型集合后，曲线下面积进一步提高到 0.953，5% 误报率下的真阳性率提高到 85.2%。对一个数据子集的研究结果表明，增加中心静脉压可以显著提高接收器工作特征曲线下面积，从 0.646 提高到 0.825。我们建立了一个性能良好且可靠的模型，可用于创建诊断 JET 的床旁警报，从而对这种危及生命的术后心律失常进行精确诊断和及时干预。未来需要在更大的群体中对该模型进行验证。

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引用次数: 0

Concerns on digital health from a cardiac implantable electrical device remote monitoring clinic perspective: results from an international survey 从心脏植入式电子设备远程监控诊所的角度看对数字健康的关注--一项国际调查的结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.06.001

引用次数: 0

Short- and long-term patient-reported outcomes of subcutaneous implantable cardioverter-defibrillator therapy: Results from the RHYTHM DETECT Registry 皮下植入式心律转复除颤器治疗的短期和长期患者报告结果：RHYTHM DETECT 登记的结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.05.009

引用次数: 0

Integrating the quantitative with the qualitative: findings from a mixed methods cardiac rehabilitation exercise trial 定量与定性相结合--混合方法心脏康复锻炼试验的结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.06.003

Background

Cardiac rehabilitation is a core component of cardiovascular disease management. Eastern Corridor Medical Engineering–Cardiac Rehabilitation is a digital health platform for online cardiac rehabilitation exercise. We conducted a mixed methods pilot trial to evaluate Eastern Corridor Medical Engineering–Cardiac Rehabilitation.

Objective

The study sought to examine the difference between objectively measured outcomes and participant perceptions of benefits and improvements gained from participation in a cardiac rehabilitation exercise program.

Methods

Seventeen participants (14 male, 3 female; 69.5 ± 7.3 years of age) took part and were allocated to 1 of 2 groups; an online exercise group (n = 8), or an in-person exercise (n = 9) group. Due to the COVID-19 pandemic, a pragmatic approach to group allocation was adopted. Objective outcomes were assessed at baseline and repeated following the intervention period, with the primary outcome being 6-minute walk test distance. In addition to clinical outcome measurements, we undertook qualitative interviews with participants.

Results

Only 5 participants demonstrated a clinically meaningful improvement in 6-minute walk test distance, following the 8-week exercise program. The main theme emerging from the qualitative interviews was the valued benefits of the cardiac rehabilitation exercise program. Despite the lack of measurable physical change, participants self-defined a range of benefits they valued and attributed directly to participation in the cardiac rehabilitation exercise program.

Conclusion

The findings from this study may offer a useful starting point for further study of community-based cardiac rehabilitation exercise and also highlight the benefit of adopting a mixed methods approach that considers both the objective outcomes measured as well as the subjective reports obtained from participants.

背景心脏康复是心血管疾病管理的核心组成部分。东方走廊医学工程-心脏康复是一个在线心脏康复锻炼的数字健康平台。方法17名参与者（14名男性，3名女性；69.5 ± 7.3岁）参加了这项研究，并被分配到2个小组中的1个；在线锻炼组（n = 8）或现场锻炼组（n = 9）。由于 COVID-19 大流行，因此采用了务实的分组方法。客观结果在基线时进行评估，并在干预期后重复评估，主要结果为 6 分钟步行测试距离。除了临床结果测量外，我们还对参与者进行了定性访谈。结果在为期 8 周的运动计划后，只有 5 名参与者的 6 分钟步行测试距离有了有临床意义的改善。从定性访谈中得出的主要结论是，心脏康复锻炼计划带来了宝贵的益处。尽管缺乏可测量的身体变化，但参与者自我定义了一系列他们重视的益处，并将其直接归功于参与心脏康复运动项目。结论：本研究的结果可为进一步研究社区心脏康复运动提供一个有用的起点，同时也强调了采用混合方法的益处，即既考虑测量的客观结果，也考虑参与者的主观报告。

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引用次数: 0

Arrhythmogenic right ventricular dysplasia: A case of ventricular tachycardia and right ventricular failure 致心律失常性右室发育不良：一例室性心动过速和右室衰竭病例

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.04.013

Laura Bradel DO , Jude ElSaygh MD , Gioia Turitto MD

引用次数: 0

Contributions of France to the field of clinical cardiac electrophysiology and pacing 法国对临床心脏电生理学和起搏领域的贡献

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2024-07-01 DOI: 10.1016/j.hroo.2024.02.005

Bernard Belhassen MD , Nicolas Lellouche MD , Robert Frank MD

引用次数: 0

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