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Comparative cardiac electrophysiological analysis between sinus rhythm and atrial fibrillation: The correlation of left atrial low-voltage substrate of sex and rhythm. 窦性心律与心房颤动心脏电生理对比分析:左房低压底物性与心律的相关性。
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-05 eCollection Date: 2026-02-01 DOI: 10.1016/j.hroo.2025.11.026
Guifang Zhao, Xuefeng Zhu, Pingping Liu, Faxin Ren, Ronghang Liu, Yanyan Jing, Hongxia Chu

Background: It is uncertain whether bipolar voltage cutoffs should be adjusted based on rhythm, sex, or region.

Objective: This study aimed to determine (1) the bipolar voltage cutoff values for the entire left atrium (LA) and the low-voltage areas in different regions of the LA and (2) whether sex-based differences exist in the bipolar voltage cutoff points for low-voltage areas.

Methods: 30 patients with persistent atrial fibrillation (AF) underwent high-density voltage mapping first in sinus rhythm and subsequently during induced AF. The 7 parts of the map are respectively taken from 9 regions with the same position and location. The average low voltage of these area points was analyzed. Correlation was assessed using scatter plots, and agreement was evaluated with Bland-Altman analysis. The generalized additive model was used to predict the bipolar voltage cutoff points.

Results: A total of 1268 regions were obtained. For the entire LA, a cutoff of 0.27 mV in AF predicted a sinus rhythm voltage of 0.5 mV (95% confidence interval 0.12-2.02). Region-specific AF voltage cutoffs were as follows: posterior wall 0.19 mV, inferior wall 0.17 mV, anterior wall 0.27 mV, LA appendage 0.27 mV, and roof 0.45 mV. Regarding different sexes, the values were 0.13 mV for males and 0.32 mV for females, respectively.

Conclusion: It is possible to establish a new cutoff value for AF with acceptable validity in predicting sinus voltage of <0.5 mV, but sex differences need to be taken into account.

背景:双极电压截止是否应该根据节律、性别或地区进行调整尚不确定。目的:本研究旨在确定(1)整个左心房(LA)和左心房不同区域低压区的双极电压截止值;(2)低压区的双极电压截止点是否存在性别差异。方法:对30例持续性心房颤动(AF)患者分别在窦性心律和诱发性房颤期间进行高密度电压测图,在9个部位、相同位置分别取7份测图。对这些区域点的平均低压进行了分析。用散点图评估相关性,用Bland-Altman分析评估一致性。采用广义加性模型预测双极电压截止点。结果:共获得1268个区域。对于整个LA, AF的截止值为0.27 mV,预测窦性心律电压为0.5 mV(95%置信区间0.12-2.02)。区域特异性AF电压截止值为:后壁0.19 mV,下壁0.17 mV,前壁0.27 mV,上附肢0.27 mV,顶板0.45 mV。从性别上看,男性为0.13 mV,女性为0.32 mV。结论:有可能建立新的房颤截止值,预测心房窦电压的有效性可接受
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引用次数: 0
A custom analysis of R-R interval properties reveals alterations in the brain-heart axis in experimental animals with metabolic syndrome. 对R-R区间特性的自定义分析揭示了代谢综合征实验动物脑-心轴的改变。
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-05 eCollection Date: 2026-02-01 DOI: 10.1016/j.hroo.2025.11.025
Olivier Meste, Michael Y Sun, Daniel O Cervantes, Giulia Piccinini, Bob Qian, Zoë Volney, Belinda Nyantakyi, Georgette A Cosentino, Aaron Yancoskie, Sudhir Jain, Jason T Jacobson, Malik Bisserier, Marcello Rota

Background: Metabolic syndrome (MetS) is a cluster of conditions that increases the risk of cardiovascular complications and all-cause mortality. MetS manifests reduced heart rate variability, but factors underlying the process remain to be fully elucidated.

Objective: To gain new insights into the effects of MetS on heart rhythm dynamics, we developed a custom algorithm to analyze the distribution and span of R-R intervals.

Methods: MetS was induced in male and female mice by Western diet feeding (WD mice), whereas animals on regular chow were used as controls (Ctrl mice). The sequence of R-R intervals of electrocardiograms and their deviation were sorted and normalized using an approximation of the distribution function to obtain sequences of the R-R interval duration (sortRR) and the R-R interval deviation (sortRRdev).

Results: sortRR sequences revealed shorter intervals in WD mice than in Ctrl mice within the range of intermediate and long R-R intervals, indicating that mice with MetS have limited capability to lower heart rate. Moreover, sortRRdev sequences had smaller amplitudes for WD mice, consistent with reduced heart rate variability. Inhibition of sympathetic inputs abrogated differences in sortRR sequences for the 2 groups of mice, whereas inhibition of parasympathetic inputs suppressed differences in the sortRRdev series. Interestingly, Western diet feeding in animals lacking β-adrenergic receptors minimally affected heart rate dynamics in female mice, but revealed significant alterations in male animals, which were abrogated by parasympathetic inhibition.

Conclusion: These results support the notion that sympathoexcitation and parasympathetic withdrawal occur with MetS and affect the duration, functional range, and variability of R-R intervals.

背景:代谢综合征(MetS)是一组增加心血管并发症和全因死亡率风险的疾病。MetS表现为心率变异性降低,但该过程的潜在因素仍有待充分阐明。目的:为了进一步了解MetS对心律动力学的影响,我们开发了一种自定义算法来分析R-R间期的分布和跨度。方法:以西式饮食喂养的雄性和雌性小鼠(WD小鼠)为研究对象,以常规饮食喂养的小鼠(Ctrl小鼠)为对照组。对心电图R-R区间序列及其偏差进行排序,采用近似分布函数进行归一化,得到R-R区间持续时间(sortRR)和R-R区间偏差(sortRRdev)序列。结果:在中R-R间隔和长R-R间隔范围内,WD小鼠的sortRR序列较Ctrl小鼠短,表明met小鼠降低心率的能力有限。此外,sortRRdev序列在WD小鼠中具有较小的振幅,与降低的心率变异性一致。在两组小鼠中,抑制交感神经输入消除了sortRR序列的差异,而抑制副交感神经输入则抑制了sortRRdev序列的差异。有趣的是,在缺乏β-肾上腺素能受体的动物中,西方饮食喂养对雌性小鼠的心率动态影响最小,但在雄性动物中显示出显著的变化,这被副交感神经抑制所消除。结论:这些结果支持这样的观点,即交感神经兴奋和副交感神经戒断发生于MetS,并影响R-R间隔的持续时间、功能范围和变异性。
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引用次数: 0
High-density vs point-by-point mapping in ventricular tachycardia ablation: A comparative analysis of substrate characterization. 室性心动过速消融的高密度与逐点定位:底物特征的比较分析。
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-04 eCollection Date: 2026-02-01 DOI: 10.1016/j.hroo.2025.11.023
Adrian M Petzl, Haran Yogasundaram, Corentin Chaumont, Andrea Hammond, Rory P Dowd, David Lin, Cory Tschabrunn, Timothy M Markman, Andres Enriquez, Francis E Marchlinski, Jeffrey R Winterfield, Matthew C Hyman
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引用次数: 0
High-amplitude pacing can identify epicardial connections in the posterior wall during ablation for atrial fibrillation 在房颤消融期间,高振幅起搏可识别心外膜后壁连接
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.023
Arshad Muhammad Iqbal MD , Suhaib Bajwa MD , Cory Smith MD , Supraja Thunuguntla MD , Sandeep Gautam MD, FHRS

Background

Posterior wall isolation (PWI) is a supplemental modality to pulmonary vein isolation in radiofrequency ablation for persistent atrial fibrillation. Residual epicardial connections may contribute to nondurable PWI and increased atrial fibrillation recurrence.

Objective

The study aimed to investigate the use of a novel high-amplitude pacing (HAP) technique to unmask epicardial connections after PWI.

Methods

100 consecutive patients underwent pulmonary vein isolation/PWI radiofrequency ablation with roof and floor lines and segmental ablation for posterior wall (PW) entrance block. The PW was divided into 4 quadrants, each subdivided into 4 segments, labeled 1–16. After the PW entrance block, bipolar pacing was performed in each segment with standard pacing (10 mA at 2 ms) and HAP (20 mA at 2 ms). Exit block was defined as a lack of atrial capture from within PW.

Results

Patients were divided into groups 1 (unable to achieve complete PWI) and 2 (PWI achieved). We categorized patients into subgroups based on the presence/absence of entrance blocks, captures, and exit blocks. PW entrance block was not achieved in 2 patients (2%); 17 patients (17%) demonstrated bidirectional PW block with standard pacing. HAP-only capture was seen in 74 of the remaining 81 patients. Mid-PW had the highest frequency of HAP-only capture. Additional ablation was performed in 63 HAP patients without PW exit block, with final PWI achieved in 51 of 63 patients (80.9%) compared with 18 of 18 (100%) in the cohort with HAP noncapture/exit block (P = .045).

Conclusion

Our novel protocol of HAP unmasked possible epicardial capture in 63% of patients, with true PWI with additional ablation in 80.9% patients. HAP may help unmask epicardial connections and facilitate durable PWI to improve long-term procedural success.
背景:在射频消融治疗持续性房颤时,后壁隔离(PWI)是肺静脉隔离的补充方式。残留的心外膜连接可能导致非持续性PWI和增加房颤复发。目的探讨一种新型的高振幅起搏(HAP)技术在PWI后揭露心外膜连接的应用。方法连续100例患者行肺静脉隔离/PWI射频顶底线消融和后壁入口阻断段性消融。将PW分为4个象限,每个象限再细分为4个片段,标记为1-16。在PW入口阻断后,采用标准起搏(10ma, 2ms)和HAP (20ma, 2ms)在每段进行双极起搏。出口阻滞被定义为PW内缺乏心房捕获。结果患者分为1组(未完成PWI)和2组(完成PWI)。我们根据是否存在入口块、捕获块和出口块将患者分为亚组。2例(2%)患者未实现PW入口阻塞;17例(17%)患者在标准起搏时表现为双向PW阻滞。其余81例患者中有74例仅出现hap捕获。pw中期仅捕获hap的频率最高。63例没有PW出口阻断的HAP患者进行了额外的消融,63例患者中有51例(80.9%)最终实现了PWI,而在HAP未捕获/出口阻断的队列中,18例(100%)实现了PWI (P = 0.045)。结论:我们的新HAP方案在63%的患者中发现了可能的心外膜捕获,在80.9%的患者中发现了真正的PWI并进行了额外的消融。HAP可帮助揭露心外膜连接并促进持久PWI提高长期手术成功率。
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引用次数: 0
Clonal hematopoiesis of indeterminate potential as a risk factor for atrial fibrillation: Evidence of a causal relationship by Mendelian randomization study 潜力不确定的克隆造血作为心房颤动的危险因素:孟德尔随机化研究的因果关系证据
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.024
Qing Zhang MD, PhD , Guohao Wang PhD , Zhangpu Yan BS , Weiling Xu MD , Shaofeng Zhang BS , Jun Li MD , Ling Liang MD, PhD , Changqing Sun MD, PhD , Rong Tang MD , Joachim Pircher MD, PhD , Qiang Xie MD, PhD, FHRS , Wuyang Zheng MD, PhD

Background

Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an independent cardiovascular risk factor, with recent studies suggesting a link to atrial fibrillation (AF). However, the causal nature of this relationship, particularly the role of DNMT3a and TET2 mutations, remains unclear.

Objective

This study aimed to assess the causal relationship between CHIP and AF and identify potential mediating pathways.

Methods

We conducted a bidirectional Mendelian randomization (MR) analysis using genome-wide association study data for CHIP from the UK Biobank (n = 368,526) and AF data from 2 large, independent cohorts (287,805 individuals from FinnGen and 1,030,836 from 6 additional AF studies). A 2-step MR mediation analysis was used to explore potential intermediate risk factors.

Results

Inverse variance weighted MR analysis demonstrated a causal effect of CHIP on increased AF risk (meta-inverse variance weighted, odds ratio [OR] 1.057; P = .001), including both DNMT3a- and TET2-related CHIP (DNMT3a, OR 1.048, P = 4.56 × 10-4; TET2, OR 1.038, P = .025). Causal associations between overall CHIP, including DNMT3a-CHIP, and AF were validated by a 2-sample MR study in 2 independent cohorts. Reverse MR showed no evidence of AF causing CHIP. The mediation analysis identified elevated systolic blood pressure as a key mediator in the DNMT3a-CHIP–AF pathway, accounting for 7.8% of the effect (P = .034).

Conclusion

Our findings provide genetic evidence that CHIP, particularly DNMT3a-related mutations, causally but modestly increases AF risk. There is no support for reverse causation. Elevated systolic blood pressure was identified as a significant mediator linking DNMT3a-CHIP to AF.
克隆造血不确定电位(CHIP)已成为一个独立的心血管危险因素,最近的研究表明其与心房颤动(AF)有关。然而,这种关系的因果性质,特别是DNMT3a和TET2突变的作用仍不清楚。目的探讨CHIP与房颤之间的因果关系,并确定可能的介导途径。方法:我们使用来自UK Biobank的CHIP全基因组关联研究数据(n = 368,526)和来自2个大型独立队列的AF数据(来自FinnGen的287,805名个体和来自另外6项AF研究的1,030,836名个体)进行了双向孟德尔随机化(MR)分析。采用两步MR中介分析探讨潜在的中间危险因素。结果反向方差加权MR分析显示CHIP与AF风险增加有因果关系(meta-inverse方差加权,优势比[OR] 1.057; P = .001),包括DNMT3a和TET2相关CHIP (DNMT3a, OR 1.048, P = 4.56 × 10-4; TET2, OR 1.038, P = 0.025)。包括DNMT3a-CHIP在内的总体CHIP与房颤之间的因果关系通过2个独立队列的2样本MR研究得到验证。反向MR未显示AF引起CHIP的证据。中介分析发现收缩压升高是DNMT3a-CHIP-AF通路的关键中介,占7.8%的效应(P = 0.034)。结论:我们的研究结果提供了遗传证据,证明CHIP,特别是dnmt3a相关突变,会导致但适度地增加房颤风险。没有证据支持反向因果关系。收缩压升高被确定为DNMT3a-CHIP与房颤之间的重要中介。
{"title":"Clonal hematopoiesis of indeterminate potential as a risk factor for atrial fibrillation: Evidence of a causal relationship by Mendelian randomization study","authors":"Qing Zhang MD, PhD ,&nbsp;Guohao Wang PhD ,&nbsp;Zhangpu Yan BS ,&nbsp;Weiling Xu MD ,&nbsp;Shaofeng Zhang BS ,&nbsp;Jun Li MD ,&nbsp;Ling Liang MD, PhD ,&nbsp;Changqing Sun MD, PhD ,&nbsp;Rong Tang MD ,&nbsp;Joachim Pircher MD, PhD ,&nbsp;Qiang Xie MD, PhD, FHRS ,&nbsp;Wuyang Zheng MD, PhD","doi":"10.1016/j.hroo.2025.09.024","DOIUrl":"10.1016/j.hroo.2025.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an independent cardiovascular risk factor, with recent studies suggesting a link to atrial fibrillation (AF). However, the causal nature of this relationship, particularly the role of DNMT3a and TET2 mutations, remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to assess the causal relationship between CHIP and AF and identify potential mediating pathways.</div></div><div><h3>Methods</h3><div>We conducted a bidirectional Mendelian randomization (MR) analysis using genome-wide association study data for CHIP from the UK Biobank (n = 368,526) and AF data from 2 large, independent cohorts (287,805 individuals from FinnGen and 1,030,836 from 6 additional AF studies). A 2-step MR mediation analysis was used to explore potential intermediate risk factors.</div></div><div><h3>Results</h3><div>Inverse variance weighted MR analysis demonstrated a causal effect of CHIP on increased AF risk (meta-inverse variance weighted, odds ratio [OR] 1.057; <em>P</em> = .001), including both DNMT3a- and TET2-related CHIP (DNMT3a, OR 1.048, <em>P</em> = 4.56 × 10<sup>-4</sup>; TET2, OR 1.038, <em>P</em> = .025). Causal associations between overall CHIP, including DNMT3a-CHIP, and AF were validated by a 2-sample MR study in 2 independent cohorts. Reverse MR showed no evidence of AF causing CHIP. The mediation analysis identified elevated systolic blood pressure as a key mediator in the DNMT3a-CHIP–AF pathway, accounting for 7.8% of the effect (<em>P</em> = .034).</div></div><div><h3>Conclusion</h3><div>Our findings provide genetic evidence that CHIP, particularly DNMT3a-related mutations, causally but modestly increases AF risk. There is no support for reverse causation. Elevated systolic blood pressure was identified as a significant mediator linking DNMT3a-CHIP to AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1949-1959"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review 心脏植入式电子装置患者生物电阻抗分析的安全性:系统综述
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.026
Leonardo J. Uribe-Cavero MD , Fabian A. Chavez-Ecos MD , Kiara Camacho-Caballero MD , José Carlos Grados-Pintos MD , Patricia Vera-Maccha MD , Anthony Siguas-Huasasquiche MD , Dinesh Sharma MD , Carlos J. Toro-Huamanchumo MD MMed

Background

Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).

Objective

This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.

Methods

We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.

Results

Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.

Conclusion

Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.
生物电阻抗分析(BIA)被广泛用于评估人体成分。然而,由于潜在的电磁干扰(EMI),其在心脏植入式电子装置(cied)患者中的安全性仍不确定。目的:根据现有证据,本研究旨在评估cied患者使用临床级BIA的潜在并发症。方法我们对截至2024年12月26日发表的研究进行了系统综述,通过PubMed、Embase、Scopus和Cochrane图书馆进行了鉴定。主要结局是不良事件的发生,包括EMI、设备故障或心律失常。结果在3668份记录中,6项队列研究(n = 531例患者)符合纳入标准。其中包括使用起搏器(n = 175)、植入式心律转复除颤器(n = 268)和心脏再同步化治疗除颤器(n = 154)的患者。BIA协议的频率(5-500 kHz)和电流强度(通常≤0.8 mA)不同。没有研究报告临床显著的EMI、设备故障或cia诱发的心律失常。器件参数(如引线阻抗、起搏阈值)在BIA暴露前后保持稳定。1项研究的偏倚风险被评为良好,5项研究的偏倚风险被评为一般。结论:目前的证据表明,临床级BIA对cied患者是安全的,没有不良反应或设备干扰的报道。这些发现有助于告知和潜在地更新先前劝阻该人群BIA的建议。然而,需要进一步的高质量研究来确认不同BIA协议和设备类型的安全性。重要的是,这些发现适用于临床级BIA,不应推断到消费级可穿戴设备,这可能会带来理论上的CIED干扰风险。
{"title":"Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review","authors":"Leonardo J. Uribe-Cavero MD ,&nbsp;Fabian A. Chavez-Ecos MD ,&nbsp;Kiara Camacho-Caballero MD ,&nbsp;José Carlos Grados-Pintos MD ,&nbsp;Patricia Vera-Maccha MD ,&nbsp;Anthony Siguas-Huasasquiche MD ,&nbsp;Dinesh Sharma MD ,&nbsp;Carlos J. Toro-Huamanchumo MD MMed","doi":"10.1016/j.hroo.2025.09.026","DOIUrl":"10.1016/j.hroo.2025.09.026","url":null,"abstract":"<div><h3>Background</h3><div>Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).</div></div><div><h3>Objective</h3><div>This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.</div></div><div><h3>Results</h3><div>Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.</div></div><div><h3>Conclusion</h3><div>Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1985-1992"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epicardial adipose tissue and ablation outcomes in obese patients with paroxysmal atrial fibrillation: A comparison of pulsed field and radiofrequency ablation 肥胖阵发性心房颤动患者的心外膜脂肪组织和消融结果:脉冲场和射频消融的比较
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.020
Florian Englert MD , Theresa Obermeyer , Fabian Bahlke MD , Miruna Popa MD , Hannah Krafft MD , Alex Tunsch Martinez MD , Jan Syväri MD , Madeleine Tydecks MD , Dominic Dischel MD , Eva Koops MD , Theresa Reiter MD , Marta Telishevska MD , Sarah Lengauer MD , Kenno Bressem MD , Martin Hadamitzky MD , Gabriele Hessling MD , Isabel Deisenhofer MD, FHRS , Nico Erhard MD

Background

Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels.

Objective

Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation.

Methods

103 patients with body mass index of >29 kg/m2 with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n = 41; RF n = 62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy.

Results

Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group (P = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group (P = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; P = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; P = .846).

Conclusion

PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of >29 kg/m2. However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.

Trial Registration Number

NCT06559787
背景:临床前研究显示脂肪组织对脉冲场消融术(PFA)效果的影响结果不一致,这就对其对心外膜脂肪组织(EAT)水平升高患者的疗效提出了质疑。目的:与高功率、短时间射频消融(RF)相比,PFA肺静脉隔离术后EAT水平升高可能导致心房颤动(AF)复发率升高。方法前瞻性纳入103例首次行房颤消融术的阵发性或短期持续性房颤患者(PFA n = 41; RF n = 62)。所有患者均接受消融前光子计数计算机断层成像,定量量化左心房和右心房EAT水平。PFA采用pentaspline导管,射频消融采用高功率、短时间能量。结果RF组中位EAT体积为71.85 mL(四分位数范围50.35 ~ 93.35 mL), PFA组中位EAT体积为65.61 mL(四分位数范围40.45 ~ 90.8 mL) (P = 0.1352)。中位随访为367天,不包括6周的空白期。RF组1年房性心律失常复发率为33.87%,PFA组为17.07% (P = 0.077)。Cox回归显示,在PFA组中,左心房EAT是复发的唯一显著预测因子(风险比1.06;95%可信区间1.01-1.12;P = 0.022),对应于每mL风险增加6.2%。在RF组中,左心房EAT与复发无显著相关(风险比1.00;95%可信区间0.97-1.03;P = 0.846)。结论对于体重指数为29 kg/m2的患者,肺静脉隔离后1年pfa效果良好。然而,与射频消融相比,进食对PFA后房颤复发的影响可能更为显著。试验注册号:06559787
{"title":"Epicardial adipose tissue and ablation outcomes in obese patients with paroxysmal atrial fibrillation: A comparison of pulsed field and radiofrequency ablation","authors":"Florian Englert MD ,&nbsp;Theresa Obermeyer ,&nbsp;Fabian Bahlke MD ,&nbsp;Miruna Popa MD ,&nbsp;Hannah Krafft MD ,&nbsp;Alex Tunsch Martinez MD ,&nbsp;Jan Syväri MD ,&nbsp;Madeleine Tydecks MD ,&nbsp;Dominic Dischel MD ,&nbsp;Eva Koops MD ,&nbsp;Theresa Reiter MD ,&nbsp;Marta Telishevska MD ,&nbsp;Sarah Lengauer MD ,&nbsp;Kenno Bressem MD ,&nbsp;Martin Hadamitzky MD ,&nbsp;Gabriele Hessling MD ,&nbsp;Isabel Deisenhofer MD, FHRS ,&nbsp;Nico Erhard MD","doi":"10.1016/j.hroo.2025.09.020","DOIUrl":"10.1016/j.hroo.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels.</div></div><div><h3>Objective</h3><div>Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation.</div></div><div><h3>Methods</h3><div>103 patients with body mass index of &gt;29 kg/m<sup>2</sup> with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n = 41; RF n = 62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy.</div></div><div><h3>Results</h3><div>Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group (<em>P</em> = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group (<em>P</em> = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; <em>P</em> = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; <em>P</em> = .846).</div></div><div><h3>Conclusion</h3><div>PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of &gt;29 kg/m<sup>2</sup>. However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.</div></div><div><h3>Trial Registration Number</h3><div>NCT06559787</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1901-1910"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High impedance alert in a hybrid pacemaker system 混合起搏器系统的高阻抗报警
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.022
Siddharth Agarwal MD, Abhishek Deshmukh MD, Ammar M. Killu MBBS, Alan Sugrue MBBCH, MSc
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引用次数: 0
Electrophysiological outcomes of radiofrequency ablation for supraventricular tachycardias in patients with congenitally corrected transposition of the great arteries 射频消融治疗先天性大动脉转位患者室上性心动过速的电生理结果
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.016
Toshihiro Nakamura MD, PhD , Yoshiaki Kato MD, PhD , Heima Sakaguchi MD, PhD , Kenzaburo Nakajima MD, PhD , Aki Mori MD, PhD , Kenichi Kurosaki MD, PhD , Hideo Ohuchi MD, PhD , Kengo Kusano MD, PhD, FHRS

Background

Patients with congenitally corrected transposition of the great arteries (cc-TGA) are predisposed to supraventricular tachycardias; however, data regarding the outcomes of catheter ablation (CA) remain limited.

Objective

This study aimed to assess the clinical impact of CA for supraventricular tachycardias in patients with cc-TGA.

Methods

This retrospective, single-center cohort study evaluated 29 of 112 cc-TGA patients (26%) who underwent CA. Patients were stratified into 3 groups based on surgical history: anatomical repair (n = 10/43, 23%), physiologic repair (n = 14/32, 44%), and no prior surgery (n = 5/37, 14%). Clinical characteristics and procedural outcomes were analyzed.

Results

Of the 29 patients who underwent CA, 10 belonged to the anatomical repair group, 14 to the physiologic repair group, and 5 to the non-surgical group. Median age at ablation was significantly lower in the anatomical repair group (25.6 years), compared with physiologic (40.6 years, P = .005) and non-surgical patients (43.8 years, P = .01). The arrhythmia types included intra-atrial reentrant tachycardia (n = 20), focal atrial tachycardia (n = 3), paroxysmal supraventricular tachycardia (n = 2), and atrial fibrillation (n = 6). Cavomitral isthmus ablation was frequently required across all groups. Over a median follow-up of 5.6 years, 3 patients required repeat ablation; all experienced new arrhythmia mechanisms distinct from the index procedure.

Conclusion

Supraventricular tachycardia patterns varied by surgical background, but cavomitral isthmus ablation was commonly indicated. CA is a key therapeutic strategy in the long-term rhythm management of cc-TGA patients.
背景:先天性纠正性大动脉转位(cc-TGA)患者易发生室上性心动过速;然而,关于导管消融(CA)结果的数据仍然有限。目的评价CA对cc-TGA患者室上性心动过速的临床影响。方法回顾性、单中心队列研究评估112例cc-TGA患者中的29例(26%),根据手术史将患者分为解剖修复组(n = 10/43, 23%)、生理性修复组(n = 14/32, 44%)和无手术史组(n = 5/37, 14%)。分析临床特点和手术结果。结果29例CA患者中解剖修复组10例,生理性修复组14例,非手术组5例。解剖修复组消融时的中位年龄(25.6岁)明显低于生理性修复组(40.6岁,P = 0.005)和非手术修复组(43.8岁,P = 0.01)。心律失常类型包括房内重入性心动过速(n = 20)、局灶性房性心动过速(n = 3)、阵发性室上性心动过速(n = 2)和房颤(n = 6)。在所有组中,腔二尖瓣峡部经常需要消融。在中位随访5.6年期间,3例患者需要重复消融;所有患者都经历了不同于索引程序的新的心律失常机制。结论室上型心动过速因手术背景而异,但腔二尖瓣峡部消融术是常见的。CA是cc-TGA患者长期节律管理的关键治疗策略。
{"title":"Electrophysiological outcomes of radiofrequency ablation for supraventricular tachycardias in patients with congenitally corrected transposition of the great arteries","authors":"Toshihiro Nakamura MD, PhD ,&nbsp;Yoshiaki Kato MD, PhD ,&nbsp;Heima Sakaguchi MD, PhD ,&nbsp;Kenzaburo Nakajima MD, PhD ,&nbsp;Aki Mori MD, PhD ,&nbsp;Kenichi Kurosaki MD, PhD ,&nbsp;Hideo Ohuchi MD, PhD ,&nbsp;Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.09.016","DOIUrl":"10.1016/j.hroo.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Patients with congenitally corrected transposition of the great arteries (cc-TGA) are predisposed to supraventricular tachycardias; however, data regarding the outcomes of catheter ablation (CA) remain limited.</div></div><div><h3>Objective</h3><div>This study aimed to assess the clinical impact of CA for supraventricular tachycardias in patients with cc-TGA.</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study evaluated 29 of 112 cc-TGA patients (26%) who underwent CA. Patients were stratified into 3 groups based on surgical history: anatomical repair (n = 10/43, 23%), physiologic repair (n = 14/32, 44%), and no prior surgery (n = 5/37, 14%). Clinical characteristics and procedural outcomes were analyzed.</div></div><div><h3>Results</h3><div>Of the 29 patients who underwent CA, 10 belonged to the anatomical repair group, 14 to the physiologic repair group, and 5 to the non-surgical group. Median age at ablation was significantly lower in the anatomical repair group (25.6 years), compared with physiologic (40.6 years, <em>P =</em> .005) and non-surgical patients (43.8 years, <em>P =</em> .01). The arrhythmia types included intra-atrial reentrant tachycardia (n = 20), focal atrial tachycardia (n = 3), paroxysmal supraventricular tachycardia (n = 2), and atrial fibrillation (n = 6). Cavomitral isthmus ablation was frequently required across all groups. Over a median follow-up of 5.6 years, 3 patients required repeat ablation; all experienced new arrhythmia mechanisms distinct from the index procedure.</div></div><div><h3>Conclusion</h3><div>Supraventricular tachycardia patterns varied by surgical background, but cavomitral isthmus ablation was commonly indicated. CA is a key therapeutic strategy in the long-term rhythm management of cc-TGA patients.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1893-1900"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prediction of cardiac resynchronization therapy super-response by left bundle branch area pacing using an artificial intelligence–enabled electrocardiogram 利用人工智能心电图预测左束支区起搏对心脏再同步化治疗的超反应
IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.08.038
Xiaoke Liu MD, PhD , Xiaoyan Li MD , Paul Friedman MD , Yong-Mei Cha MD , Abhishek Deshmukh MD , Siva Mulpuru MD , Samuel Asirvatham MD
{"title":"Prediction of cardiac resynchronization therapy super-response by left bundle branch area pacing using an artificial intelligence–enabled electrocardiogram","authors":"Xiaoke Liu MD, PhD ,&nbsp;Xiaoyan Li MD ,&nbsp;Paul Friedman MD ,&nbsp;Yong-Mei Cha MD ,&nbsp;Abhishek Deshmukh MD ,&nbsp;Siva Mulpuru MD ,&nbsp;Samuel Asirvatham MD","doi":"10.1016/j.hroo.2025.08.038","DOIUrl":"10.1016/j.hroo.2025.08.038","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 2019-2021"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Heart Rhythm O2
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