Heart Rhythm O2最新文献

英文中文

Assessment of physicians’ adherence to guideline-directed medical therapy among patients with heart failure with reduced ejection fraction at the University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2023 2023年埃塞俄比亚西北部贡达尔大学综合专科医院的医生对射血分数降低的心力衰竭患者的依从性评估

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.06.016

Sisay Sitotaw Anberbr MSc , Ousman Abubeker Abdela MSc , Alemneh Ayu Biyazin MSc , Gebremariam Wulie Geremew MSc , Adane Desta Getahun MSc , Getachew Yitayew Tarekegn MSc , Agegnehu Derbew Teshager MD , Masho Tigabe Tekle MSc

Background

Adhering well to guideline-directed medical therapy (GDMT) is essential for improving treatment outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite its significance, studies on the status of GDMT adherence in patients with HF in Ethiopia are scarce.

Objective

This study aimed to assess physicians’ adherence to GDMT and the associated factors in patients with HFrEF.

Methods

A retrospective follow-up study was conducted from September 1, 2018, to July 31, 2023. Quality of Adherence to Guideline Recommendations for Lifesaving Treatment in Heart Failure Survey scores were used to assess physicians’ adherence to GDMT. SPSS version 27.0 was used for analysis, and multinomial logistic regression analysis was performed.

Results

The Quality of Adherence to Guideline Recommendations for Lifesaving Treatment in Heart Failure Survey scores showed that the physicians’ adherence to GDMT was good in 40% (95% confidence interval [CI] 35.30–44.90), moderate in 33.8% (95% CI 29.3–38.6), and poor in 26.2% of the study participants (95% CI 22–30.7). Age of ≥65 years (adjusted odds ratio [AOR] 0.14, 95% CI 0.07–0.29); causes of HF such as ischemic heart disease (AOR 16, 95% CI 6.75–37.90), valvular heart disease (AOR 5.3, 95% CI 2.58–10.92), dilated cardiomyopathy (AOR 8.24, 95% CI 3.97–17.09), and hypertension (AOR 6.62, 95% CI 2.98–14.69); and duration of HFrEF of ≥3 years (AOR 2.59, 95% CI 1.32–5.08) were factors significantly associated with good physicians’ adherence to GDMT.

Conclusion

The use of all indicated medications as per the guideline recommendation for HFrEF was low, and most patients received suboptimal doses of GDMT. Particularly, the beta-blocker dose was very suboptimal. Encouraging healthcare provider training, access to separate cardiac clinics and cardiologists, following guidelines, timely patient appointments, and medication availability are recommended for better clinical outcomes.

背景：严格遵守指导药物治疗（GDMT）对于改善心力衰竭（HF）伴射血分数降低（HFrEF）患者的治疗效果至关重要。尽管具有重要意义，但关于埃塞俄比亚HF患者GDMT依从性的研究很少。目的本研究旨在评估医生在HFrEF患者中对GDMT的依从性及其相关因素。方法于2018年9月1日至2023年7月31日进行回顾性随访研究。对心力衰竭救命治疗指南建议的依从性使用调查得分来评估医生对GDMT的依从性。采用SPSS 27.0版进行分析，采用多项logistic回归分析。结果对心力衰竭救命治疗指南建议的依从性调查得分显示，医生对GDMT的依从性为良好的占40%(95%可信区间[CI] 35.30-44.90)，中等的占33.8% (95% CI 29.3-38.6)，较差的占26.2% （95% CI 22-30.7）。年龄≥65岁（校正优势比[AOR] 0.14, 95% CI 0.07-0.29）；HF的病因包括缺血性心脏病（AOR 16, 95% CI 6.75-37.90）、瓣膜性心脏病（AOR 5.3, 95% CI 2.58-10.92）、扩张性心肌病（AOR 8.24, 95% CI 3.97-17.09）和高血压（AOR 6.62, 95% CI 2.98-14.69）；HFrEF持续时间≥3年（AOR 2.59, 95% CI 1.32-5.08）是与好医生坚持GDMT显著相关的因素。结论HFrEF指南推荐的所有适应症药物的使用率较低，大多数患者接受了次优剂量的GDMT。特别是，受体阻滞剂的剂量非常不理想。为了获得更好的临床结果，建议鼓励对医疗保健提供者进行培训、访问单独的心脏病诊所和心脏病专家、遵循指导方针、及时预约患者和提供药物。

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引用次数: 0

Long-term low-voltage impedance measurements in subcutaneous implantable cardioverter-defibrillators 皮下植入式心律转复除颤器的长期低压阻抗测量

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.06.002

Giacomo Mugnai MD, PhD , Luca Tomasi MD , Luca Ottaviano MD , Stefano Viani MD , Giuseppe Ricciardi MD , Valter Bianchi MD , Valeria Rella MD , Paolo De Filippo MD , Silvana De Bonis MD , Roberto Rordorf MD , Domenico Pecora MD , Gianluca Botto MD , Gerardo Nigro MD, PhD , Gianfranco Tola MD , Fabrizio Caravati MD , Mariolina Lovecchio MS , Sergio Valsecchi MS, PhD , Matteo Ziacchi MD , “S-ICD Rhythm Detect” Investigators

Background

High-voltage impedance (HVI), measured during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation via defibrillation testing or a synchronized shock, is associated with defibrillation efficacy. Recently, S-ICD systems have been upgraded to automatically perform long-term measurements of low-voltage impedance (LVI) using a 1-V subthreshold pulse.

Objective

This study evaluated LVI as a surrogate for HVI and described its long-term trends in S-ICD recipients.

Methods

We analyzed data from 1226 patients who underwent de novo S-ICD implantation across 15 Italian centers. Weekly averages of LVI and HVI were calculated, and agreement between simultaneous measurements was assessed.

Results

Over a median follow-up of 37 months (interquartile range 20–57 months), 373 paired HVI and LVI measurements were analyzed. LVI strongly correlated with HVI (r = 0.90; 95% confidence interval 0.88–0.92; P < .001), with a mean bias of −3 Ω (limits of agreement −21 to 14 Ω). The mean LVI increased significantly during the first 3 months postimplantation (from 59 ± 14 to 76 ± 16 Ω; P < .001) before stabilizing (77 ± 17 Ω; P = .231). Higher LVI values were observed in overweight/obese patients when subcutaneous device positioning and the 3-incision lead deployment technique were used. Similarly, higher values were obtained when significant subcoil fat was observed and the Prospective, RAndomizEd comparison of subcuTaneOus and tRansvenous ImplANtable cardioverter-defibrillator therapy score was ≥90.

Conclusion

LVI showed strong agreement with HVI during follow-up, supporting its potential use as a noninvasive surrogate for HVI. LVI increased during the initial postimplantation period and subsequently stabilized, possibly reflecting physiological changes.

背景：在皮下植入式心律转复除颤器（S-ICD）植入过程中，通过除颤试验或同步电击测量高压阻抗（HVI）与除颤效果相关。最近，S-ICD系统已经升级到使用1 v亚阈值脉冲自动执行低压阻抗（LVI）的长期测量。目的本研究评估LVI作为HVI的替代指标，并描述其在S-ICD受者中的长期趋势。方法：我们分析了来自意大利15个中心的1226例S-ICD植入患者的数据。计算LVI和HVI的周平均值，并评估同时测量的一致性。结果在中位随访37个月（四分位数间距20-57个月）中，分析了373对HVI和LVI测量值。LVI与HVI强相关（r = 0.90； 95%可信区间0.88-0.92;P < .001），平均偏倚为- 3 Ω（一致性限为- 21至14 Ω）。平均LVI在种植后的前3个月显著上升（从59±14上升到76±16 Ω； P < .001），然后趋于稳定（77±17 Ω； P = .231）。超重/肥胖患者使用皮下装置定位和3切口导联部署技术时，观察到更高的LVI值。同样，当观察到明显的下线圈脂肪，并且皮下和经静脉植入式心律转复除颤器治疗评分的前瞻性随机比较评分≥90时，获得更高的值。结论lvi在随访中与HVI表现出强烈的一致性，支持其作为HVI的无创替代品的潜力。LVI在种植后初期有所增加，随后趋于稳定，可能反映了生理变化。

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引用次数: 0

ASSESSING MYOCARDIAL SCAR: A COMPARATIVE STUDY BETWEEN SELVESTER ECG SCORE AND CARDIAC MAGNETIC RESONANCE IMAGING 评价心肌瘢痕：自vester心电图评分与心脏磁共振成像的比较研究

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.08.016

Emna Allouche, Sana Said, Ahmed Chetoui, Wissal Jomni, Mohamed Selmen Aissa, Faten Boudiche, Syrine Neji, Malek El Arbi, Wejdène Ouechtati, Leila Bezdah

引用次数: 0

Efficacy and safety of left bundle branch pacing compared with left ventricular septal pacing: A systematic review and meta-analysis 与左室间隔起搏相比，左束支起搏的有效性和安全性：一项系统回顾和荟萃分析

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.06.006

Iwan Cahyo Santosa Putra MD, Raymond Pranata MD, Mohammad Iqbal MD, PhD, FHRS, Giky Karwiky MD, Chaerul Achmad MD, PhD

Background

Although numerous studies have compared the efficacy and safety of left bundle branch pacing (LBBP) and left ventricular (LV) septal pacing (LVSP), the results remain inconclusive.

Objective

This meta-analysis aimed to systematically compare the efficacy and safety of LBBP with that of LVSP.

Methods

A comprehensive literature search was conducted across PubMed, Europe PMC, and ScienceDirect to identify studies comparing procedural duration, complications, electrophysiological and echocardiographic parameters, and clinical outcomes between LBBP and LVSP.

Results

A total of 22 cohort studies, involving 1360 LBBP and 1186 LVSP procedures, were included. The paced QRS duration (mean difference [MD] = −9.65 ms; 95% confidence interval [CI], −13.35 to −5.96; I² = 84.9%; P < .001) and stimulus-to-LV activation time (MD = −14.62 ms; 95% CI, −16.99 to −12.24; I² = 77.2%; P < .001) were significantly shorter in the LBBP group. In patients with reduced LV ejection fraction (LVEF) and wide QRS duration, the improvement in LVEF was significantly greater in the LBBP group (MD = 6.05%; 95% CI, 2.9–9.2; I² = 51.3%; P < .001). In addition, the LBBP group demonstrated a significant reduction in the risk of all-cause mortality and/or heart failure hospitalization (risk ratio = 0.28; 95% CI, 0.17–0.48; I² = 0%; P < .001). In patients with preserved LVEF and narrow QRS duration, postpacemaker implantation LVEF and LV end-diastolic diameter and the risk of heart failure hospitalization were comparable between the 2 groups. Furthermore, procedural duration, complications, and pacing parameters (sensing amplitude, capture threshold, and lead impedance) did not significantly differ between the groups.

Conclusion

In patients with reduced LVEF and wide QRS duration, LBBP demonstrates superior efficacy compared with LVSP. In contrast, in patients with preserved LVEF and narrow QRS duration, the efficacy of LBBP and LVSP is similar. Both groups exhibit comparable safety profiles and procedural efficiency.

虽然有大量研究比较了左束支起搏（LBBP）和左室（LV）间隔起搏（LVSP）的有效性和安全性，但结果仍然没有定论。目的系统比较LBBP与LVSP的疗效和安全性。方法在PubMed、Europe PMC和ScienceDirect上进行全面的文献检索，以确定比较LBBP和LVSP的手术时间、并发症、电生理和超声心动图参数以及临床结果的研究。结果共纳入22项队列研究，涉及1360例LBBP和1186例LVSP手术。节律性QRS持续时间（平均差[MD] =−9.65 ms； 95%可信区间[CI]，−13.35 ~−5.96;I2 = 84.9%; P < .001）和刺激-左室激活时间（MD =−14.62 ms; 95% CI,−16.99 ~−12.24;I2 = 77.2%; P < 001）在LBBP组显著缩短。在低左室射血分数（LVEF）和宽QRS持续时间的患者中，LBBP组LVEF的改善显著大于LBBP组（MD = 6.05%; 95% CI, 2.9-9.2; I2 = 51.3%; P < 0.001）。此外，LBBP组显示全因死亡率和/或心力衰竭住院的风险显著降低（风险比= 0.28;95% CI, 0.17-0.48; I2 = 0%; P < 0.001）。在LVEF保留且QRS持续时间较短的患者中，起搏器植入后LVEF和左室舒张末期内径以及心力衰竭住院风险在两组之间具有可比性。此外，手术时间、并发症和起搏参数（感应振幅、捕获阈值和导联阻抗）在两组之间没有显著差异。结论在LVEF降低、QRS持续时间较宽的患者中，LBBP的疗效优于LVSP。相比之下，在保留LVEF和QRS持续时间较短的患者中，LBBP和LVSP的疗效相似。两组均表现出相当的安全性和程序效率。

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CARDIAC PERFORATION AFTER CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION: INCIDENCE, DIAGNOSIS, AND MANAGEMENT BASED ON A MULTICENTER STUDY 植入式心脏电子装置插入后心脏穿孔：基于多中心研究的发生率、诊断和处理

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Mervat Aboulmaaty MD , Muzahir H. Tayebjee MD , Hani Assaad MD , Felix Sogade MD, FHRS

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WHEN RESYNCHRONIZATION IS NOT THE ANSWER: MAHAIM PATHWAY MIMICKING LBBB IN A YOUNG HEART FAILURE PATIENT 当再同步不是答案时：mahaim通路模拟年轻心力衰竭患者的LBBB

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Mohamed Sanhoury, Samir Rafla, Sherouk Ramzy, Mohamed Elfiky

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UNPREDICTABLE RHYTHM: CARDIAC ARRHYTHMIAS IN THE YOUNG — A HIDDEN THREAT IN SUB-SAHARAN AFRICA 不可预测的节奏：年轻人的心律失常——撒哈拉以南非洲的一个潜在威胁

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Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.08.014

Ashley Atuti

引用次数: 0

Integrating wearables into the modern electrophysiology practice: A proposed framework for the use of wearables and creation of a remote digital clinic 将可穿戴设备整合到现代电生理学实践中：一个使用可穿戴设备和创建远程数字诊所的拟议框架

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-09-01 DOI: 10.1016/j.hroo.2025.08.002

Krishna Pundi MD , Jason G. Andrade MD, FHRS , Neal Bhatia MD , Thomas Deneke MD, PhD, FHRS , Hamid Ghanbari MD , Matthew Kalscheur MD , Peem Lorvidhaya MD, FHRS , Jennifer N. Avari Silva MD, FHRS, CEPS-P , Amit J. Thosani MD, FHRS , Michael A. Rosenberg MD, FHRS , Gerilynn M. Schott MSN, ACNP , Amy G. Tucker MSN, RN, FHRS, CCDS , Niraj Varma MD, PhD , Omair Yousuf MD , Peter A. Noseworthy MD, MBA, FHRS

引用次数: 0

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Heart Rhythm O2

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