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Sex differences in global electrical heterogeneity: The Hispanic Community Health Study/Study of Latinos
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.11.019
Larisa G. Tereshchenko MD, PhD , Kazi T. Haq PhD , Stacey J. Howell MD , Evan C. Mitchell MD , Jessica Hyde BS , Jesús Martínez BS, BA , Cassandra A. Ahmed MD , Genesis Briceno MD , Hetal Patel MSc , Jose Pena MD , Akram Khan MD , Elsayed Z. Soliman MD, MSc, MS , João A.C. Lima MD, MBA , Samir R. Kapadia MD , Anita D. Misra-Hebert MD, MPH , Mayank M. Kansal MD , Martha L. Daviglus MD, PhD , Robert Kaplan PhD
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引用次数: 0
Reply: Safety profile of pulsed field ablation regarding phrenic nerve function
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.11.014
Alan Sugrue MBBCh, MSc, Samuel J. Asirvatham MD
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引用次数: 0
Current state of arrhythmia care in Latin America: A statement from the Latin American Heart Rhythm Society
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.11.010
Ulises Rojel MD, FHRS (LAHRS Co-Chair) , Juan C. Diaz MD , Marcio Jansen de Oliveira Figueiredo MD (LAHRS Co-Chair) , Luigi Di Biase MD, FHRS (HRS Co-Chair) , Eduardo Saad MD, FHRS (HRS Co-Chair) , Luis Aguinaga-Arrascue MD , Floreal Cueto MD , Juan Cruz Lopez Diez MD , Remberto Torres-Molina MD , Cristiano F. Pisani MD , Fatima Dumas Cintra MD , Luis Quininir MD , Armando Pérez-Silva MD, PhD , Jorge Marin MD , Federico Malavassi MD , Elibet Chavez-Gonzalez MD , Fernando A. Vidal-Bett MD , Eliany Mejia-Lopez MD , Jose Llorente MD , Jorge Arbaiza MD , Nestor Lopez-Cabanillas MD (LAHRS Co-Chair)

Background

On May 18, 2023, the Latin American Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders committed to arrhythmia care in Latin America to discuss clinical and health care policy issues and the barriers to delivering world-class standards in electrophysiology (EP) services, discuss potential future solutions, and share experiences and best practices.

Methods

A questionnaire on clinical arrhythmia problems, access to EP procedures, annual numbers of arrhythmia and device implantation procedures, and the largest medical issues that face each country was sent to 15 Latin American Heart Rhythm Society representatives from 15 different countries of the 20 that make up Latin America and was completed by all of them before the meeting. The event was organized as a series of individual reports, provided by the representatives as well as 11 regional leaders, followed by open discussion among the chair and meeting participants.

Results

Atrial fibrillation is the major clinical arrythmia–related problem throughout the region, followed by Chagas disease in some countries. There is significant variability in access to advanced arrhythmia care (ranging from 5 ablation procedures and 16 device implantation procedures per million inhabitants [PMIs] in Venezuela to 189 ablation procedures and 617 device implantation procedures PMIs in Uruguay) due to differences in workforce availability (ranging from 0.36 electrophysiologists PMIs in Cuba to 13.03 electrophysiologists PMIs in Argentina), resources (ranging from 0.74 EP centers PMIs in Brazil to 4.68 EP centers PMIs in Uruguay), technology (ranging from 0 operational and new generation 3D mapping systems PMIs in Cuba, Bolivia, and El Salvador to 1.98 operational and new generation 3D mapping systems PMIs in Argentina), drug availability, and national health policies. Collaboration in the area already occurs on an individual country basis, but no systematic regional efforts for working together is present.

Conclusion

Although atrial fibrillation is the most common arrhythmia problem, Chagas disease is highly prevalent in several countries of Latin America. Although there are significant variations concerning the practice of EP (including differences in policies and access to technology, drugs, and devices), overall there is limited access to implantable cardiac defibrillators, complex ablation procedures, resources (including 3-dimensional mapping systems, intracardiac echocardiography, and remote monitoring), trained physicians, and centers of excellence; thus, access to adequate health care is limited.
{"title":"Current state of arrhythmia care in Latin America: A statement from the Latin American Heart Rhythm Society","authors":"Ulises Rojel MD, FHRS (LAHRS Co-Chair) ,&nbsp;Juan C. Diaz MD ,&nbsp;Marcio Jansen de Oliveira Figueiredo MD (LAHRS Co-Chair) ,&nbsp;Luigi Di Biase MD, FHRS (HRS Co-Chair) ,&nbsp;Eduardo Saad MD, FHRS (HRS Co-Chair) ,&nbsp;Luis Aguinaga-Arrascue MD ,&nbsp;Floreal Cueto MD ,&nbsp;Juan Cruz Lopez Diez MD ,&nbsp;Remberto Torres-Molina MD ,&nbsp;Cristiano F. Pisani MD ,&nbsp;Fatima Dumas Cintra MD ,&nbsp;Luis Quininir MD ,&nbsp;Armando Pérez-Silva MD, PhD ,&nbsp;Jorge Marin MD ,&nbsp;Federico Malavassi MD ,&nbsp;Elibet Chavez-Gonzalez MD ,&nbsp;Fernando A. Vidal-Bett MD ,&nbsp;Eliany Mejia-Lopez MD ,&nbsp;Jose Llorente MD ,&nbsp;Jorge Arbaiza MD ,&nbsp;Nestor Lopez-Cabanillas MD (LAHRS Co-Chair)","doi":"10.1016/j.hroo.2024.11.010","DOIUrl":"10.1016/j.hroo.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>On May 18, 2023, the Latin American Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders committed to arrhythmia care in Latin America to discuss clinical and health care policy issues and the barriers to delivering world-class standards in electrophysiology (EP) services, discuss potential future solutions, and share experiences and best practices.</div></div><div><h3>Methods</h3><div>A questionnaire on clinical arrhythmia problems, access to EP procedures, annual numbers of arrhythmia and device implantation procedures, and the largest medical issues that face each country was sent to 15 Latin American Heart Rhythm Society representatives from 15 different countries of the 20 that make up Latin America and was completed by all of them before the meeting. The event was organized as a series of individual reports, provided by the representatives as well as 11 regional leaders, followed by open discussion among the chair and meeting participants.</div></div><div><h3>Results</h3><div>Atrial fibrillation is the major clinical arrythmia–related problem throughout the region, followed by Chagas disease in some countries. There is significant variability in access to advanced arrhythmia care (ranging from 5 ablation procedures and 16 device implantation procedures per million inhabitants [PMIs] in Venezuela to 189 ablation procedures and 617 device implantation procedures PMIs in Uruguay) due to differences in workforce availability (ranging from 0.36 electrophysiologists PMIs in Cuba to 13.03 electrophysiologists PMIs in Argentina), resources (ranging from 0.74 EP centers PMIs in Brazil to 4.68 EP centers PMIs in Uruguay), technology (ranging from 0 operational and new generation 3D mapping systems PMIs in Cuba, Bolivia, and El Salvador to 1.98 operational and new generation 3D mapping systems PMIs in Argentina), drug availability, and national health policies. Collaboration in the area already occurs on an individual country basis, but no systematic regional efforts for working together is present.</div></div><div><h3>Conclusion</h3><div>Although atrial fibrillation is the most common arrhythmia problem, Chagas disease is highly prevalent in several countries of Latin America. Although there are significant variations concerning the practice of EP (including differences in policies and access to technology, drugs, and devices), overall there is limited access to implantable cardiac defibrillators, complex ablation procedures, resources (including 3-dimensional mapping systems, intracardiac echocardiography, and remote monitoring), trained physicians, and centers of excellence; thus, access to adequate health care is limited.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 112-126"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180543","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
Evaluating ChatGPT-4’s correctness in patient-focused informing and awareness for atrial fibrillation
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.10.005
Ivan Zeljkovic MD, PhD , Matea Novak JD , Ana Jordan MD , Ante Lisicic MD , Tatjana Nemeth-Blažić MD, PhD , Nikola Pavlovic MD, PhD , Šime Manola MD, PhD

Background

As artificial intelligence and large language models continue to evolve, their application in health care is expanding. OpenAI’s Chat Generative Pre-trained Transformer 4 (ChatGPT-4) represents the latest advancement in this technology, capable of engaging in complex dialogues and providing information.

Objective

This study explores the correctness of ChatGPT-4 in informing patients about atrial fibrillation.

Methods

This cross-sectional observational study involved ChatGPT-4 in responding to a structured set of 108 questions across 10 categories related to atrial fibrillation. These categories included basic information, treatment options, lifestyle adjustments, and more, reflecting common patient inquiries. The model's responses were evaluated by a panel of 3 cardiologists on the basis of accuracy, comprehensiveness, clarity, relevance to clinical practice, and patient safety. The total correctness of ChatGPT-4 was quantitatively assessed through scores assigned in each category, and statistical analysis was performed to identify significant differences in performance across categories.

Results

ChatGPT-4 provided correct and relevant answers with considerable variability across categories. It excelled in "Lifestyle Adjustments" and "Daily Life and Management" with perfect and near-perfect scores but struggled with "Miscellaneous Concerns" scoring lower. Statistical analysis confirmed significant differences in total scores across categories (P = .020).

Conclusion

Our results suggest that while ChatGPT-4 is reliable in categories with structured and direct queries, it shows limitations when handling complex medical queries that require in-depth explanations or clinical judgment. ChatGPT-4 demonstrates promising potential as a tool for patient-focused informing in atrial fibrillation, particularly in straightforward informing content.
背景随着人工智能和大型语言模型的不断发展,它们在医疗保健领域的应用也在不断扩大。OpenAI 的 Chat Generative Pre-trained Transformer 4(ChatGPT-4)代表了这一技术的最新进展,它能够进行复杂的对话并提供信息。 Objective This study exploes the correctness of ChatGPT-4 in informing patients about atrial fibrillation.Methods This cross-sectional observational study involving ChatGPT-4 in responding to a structured set of 108 questions across 10 categories related to atrial fibrillation.这些类别包括基本信息、治疗方案、生活方式调整等,反映了患者常见的询问。这些类别包括基本信息、治疗方案、生活方式调整等,反映了患者的常见咨询。由 3 位心脏病专家组成的小组根据准确性、全面性、清晰度、与临床实践的相关性和患者安全性对该模型的回答进行了评估。ChatGPT-4 的总正确率通过每个类别的评分进行量化评估,并进行统计分析以确定不同类别之间的显著差异。它在 "生活方式调整 "和 "日常生活与管理 "方面表现出色,得分满分或接近满分,但在 "其他关注点 "方面得分较低。我们的结果表明,虽然 ChatGPT-4 在结构化和直接询问的类别中表现可靠,但在处理需要深入解释或临床判断的复杂医疗询问时却表现出局限性。ChatGPT-4 作为以患者为中心的心房颤动告知工具,尤其是在直接告知内容方面,显示出了巨大的潜力。
{"title":"Evaluating ChatGPT-4’s correctness in patient-focused informing and awareness for atrial fibrillation","authors":"Ivan Zeljkovic MD, PhD ,&nbsp;Matea Novak JD ,&nbsp;Ana Jordan MD ,&nbsp;Ante Lisicic MD ,&nbsp;Tatjana Nemeth-Blažić MD, PhD ,&nbsp;Nikola Pavlovic MD, PhD ,&nbsp;Šime Manola MD, PhD","doi":"10.1016/j.hroo.2024.10.005","DOIUrl":"10.1016/j.hroo.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>As artificial intelligence and large language models continue to evolve, their application in health care is expanding. OpenAI’s Chat Generative Pre-trained Transformer 4 (ChatGPT-4) represents the latest advancement in this technology, capable of engaging in complex dialogues and providing information.</div></div><div><h3>Objective</h3><div>This study explores the correctness of ChatGPT-4 in informing patients about atrial fibrillation.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study involved ChatGPT-4 in responding to a structured set of 108 questions across 10 categories related to atrial fibrillation. These categories included basic information, treatment options, lifestyle adjustments, and more, reflecting common patient inquiries. The model's responses were evaluated by a panel of 3 cardiologists on the basis of accuracy, comprehensiveness, clarity, relevance to clinical practice, and patient safety. The total correctness of ChatGPT-4 was quantitatively assessed through scores assigned in each category, and statistical analysis was performed to identify significant differences in performance across categories.</div></div><div><h3>Results</h3><div>ChatGPT-4 provided correct and relevant answers with considerable variability across categories. It excelled in \"Lifestyle Adjustments\" and \"Daily Life and Management\" with perfect and near-perfect scores but struggled with \"Miscellaneous Concerns\" scoring lower. Statistical analysis confirmed significant differences in total scores across categories (<em>P</em> = .020).</div></div><div><h3>Conclusion</h3><div>Our results suggest that while ChatGPT-4 is reliable in categories with structured and direct queries, it shows limitations when handling complex medical queries that require in-depth explanations or clinical judgment. ChatGPT-4 demonstrates promising potential as a tool for patient-focused informing in atrial fibrillation, particularly in straightforward informing content.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 58-63"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179271","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
Trends in health care expenditures and incremental health care cost in adults with atrial fibrillation in the United States
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.10.003
Frans Serpa MD , Archana Tale MPH , Peter J. Zimetbaum MD , Daniel B. Kramer MD, MPH

Background

Atrial fibrillation (AF) is associated with increased health care costs; however, comprehensive data on the financial burden of AF remain limited.

Objective

The purpose of this study was to delineate health care expenditures among patients with AF.

Methods

We used the longitudinal panels from the Medical Expenditure Panel Survey covering 2016–2019 to estimate health care expenditures associated with AF. We identified individuals 18 years and older with AF in the first year of each panel (2016–2018) by using the International Classification of Disease, Tenth Revision codes. Covariates included sociodemographic characteristics and comorbidities. Health care expenditures were derived from the second year of each panel (2017–2019) to reflect the cost of having the condition for an entire year. Adjusted mean annual costs were calculated, including total health care expenditure, hospital inpatient, emergency department visits, office-based visits, outpatient visits, home health visits, prescribed medicines, and other expenses. Adjusted models were used to estimate the mean annual incremental total health care cost associated with AF.

Results

The weighted study population included 3,080,055 adults with AF (382 respondents; mean age 71.5; 89.9% white). The adjusted annual total health care cost in adults with AF totaled $14,083 (95% confidence interval $10,887–$17,279) compared with $8771 (95% confidence interval $8106–$9436) for those without AF. The primary drivers of cost over time were hospital inpatient care, office-based visits, and prescribed medications. The annual incremental total health care cost associated with AF was $5312 per adult (in 2019 U.S. dollars).

Conclusion

Adults with AF in the United States face a higher financial burden across various health care services than do those without the condition, with consistently increasing expenses in inpatient care and prescribed medicines. Further research is needed to identify the independent contribution of AF to these costs.
{"title":"Trends in health care expenditures and incremental health care cost in adults with atrial fibrillation in the United States","authors":"Frans Serpa MD ,&nbsp;Archana Tale MPH ,&nbsp;Peter J. Zimetbaum MD ,&nbsp;Daniel B. Kramer MD, MPH","doi":"10.1016/j.hroo.2024.10.003","DOIUrl":"10.1016/j.hroo.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is associated with increased health care costs; however, comprehensive data on the financial burden of AF remain limited.</div></div><div><h3>Objective</h3><div>The purpose of this study was to delineate health care expenditures among patients with AF.</div></div><div><h3>Methods</h3><div>We used the longitudinal panels from the Medical Expenditure Panel Survey covering 2016–2019 to estimate health care expenditures associated with AF. We identified individuals 18 years and older with AF in the first year of each panel (2016–2018) by using the <em>International Classification of Disease, Tenth Revision</em> codes. Covariates included sociodemographic characteristics and comorbidities. Health care expenditures were derived from the second year of each panel (2017–2019) to reflect the cost of having the condition for an entire year. Adjusted mean annual costs were calculated, including total health care expenditure, hospital inpatient, emergency department visits, office-based visits, outpatient visits, home health visits, prescribed medicines, and other expenses. Adjusted models were used to estimate the mean annual incremental total health care cost associated with AF.</div></div><div><h3>Results</h3><div>The weighted study population included 3,080,055 adults with AF (382 respondents; mean age 71.5; 89.9% white). The adjusted annual total health care cost in adults with AF totaled $14,083 (95% confidence interval $10,887–$17,279) compared with $8771 (95% confidence interval $8106–$9436) for those without AF. The primary drivers of cost over time were hospital inpatient care, office-based visits, and prescribed medications. The annual incremental total health care cost associated with AF was $5312 per adult (in 2019 U.S. dollars).</div></div><div><h3>Conclusion</h3><div>Adults with AF in the United States face a higher financial burden across various health care services than do those without the condition, with consistently increasing expenses in inpatient care and prescribed medicines. Further research is needed to identify the independent contribution of AF to these costs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 11-20"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179413","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
Electrocardiographic correlates of ventricular arrhythmias in repaired congenital heart disease
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.10.006
Satoshi Kawada MD, PhD , Hiroshi Morita MD, PhD , Koji Nakagawa MD, PhD , Tomofumi Mizuno MD , Takuro Masuda MD , Akira Ueoka MD, PhD , Saori Asada MD, PhD , Masakazu Miyamoto MD, PhD , Norihisa Toh MD, PhD , Nobuhiro Nishii MD, PhD , Shingo Kasahara MD, PhD , Shinsuke Yuasa MD, PhD

Background

Sudden cardiac death (SCD) is a major cause of mortality in congenital heart disease (CHD). Ventricular arrhythmias (VAs) are responsible for 80% of SCD. However, the clinical characteristics of patients with CHD and VAs are not fully understood.

Objective

This study was undertaken to evaluate clinical and electrocardiographic characteristics of patients with CHD based on the presence or absence of VAs.

Methods

We identified 28 patients with CHD with VAs (men, n = 15; 35.9 ± 16.5 years). Two patients with channelopathies were excluded from the analysis.

Results

The most common diagnoses in patients with VAs were a transposition of the great arteries (n = 8, 30.8%), followed by tetralogy of Fallot (n = 7, 26.9%). Compared with patients without VA (n = 43), those with VAs had a longer QRS (160.6 ± 52.9 ms vs 133.4 ± 29.3 ms; P = .004), a higher prevalence of fragmented QRS (65.4% vs 37.2%; P = .022) and more epsilon wave (23.1% vs 2.3%; P = .005). Multivariable analysis showed that QRS > 180 ms (odds ratio [OR], 22.23; 95% confidence interval [CI], 2.40–206.53) and epsilon wave (OR, 14.33; 95% CI, 1.47–139.58) were significantly associated with VAs. During a median follow-up duration of 5.4 years, 5 patients (19.2%) received appropriate ICD therapy, and 3 patients (11.5%) died of heart failure.

Conclusion

The assessment of QRS duration and the presence of fQRS and epsilon waves in patients with CHD could improve risk prediction for the development of VAs. These electrocardiogram (ECG) features could assist in clinical decision-making and might consequently reduce mortality.
背景心脏性猝死(SCD)是先天性心脏病(CHD)的主要致死原因。室性心律失常(VAs)是造成 80% SCD 的原因。本研究旨在根据是否存在室性心律失常评估 CHD 患者的临床和心电图特征。结果VA患者最常见的诊断是大动脉转位(8例,30.8%),其次是法洛四联症(7例,26.9%)。与无 VA 患者(n = 43)相比,有 VA 的患者 QRS 更长(160.6 ± 52.9 ms vs 133.4 ± 29.3 ms;P = .004),QRS 片断的发生率更高(65.4% vs 37.2%;P = .022),ε波更多(23.1% vs 2.3%;P = .005)。多变量分析显示,QRS > 180 ms(几率比 [OR],22.23;95% 置信区间 [CI],2.40-206.53)和ε波(OR,14.33;95% CI,1.47-139.58)与 VAs 显著相关。中位随访时间为 5.4 年,5 名患者(19.2%)接受了适当的 ICD 治疗,3 名患者(11.5%)死于心力衰竭。这些心电图(ECG)特征有助于临床决策,从而降低死亡率。
{"title":"Electrocardiographic correlates of ventricular arrhythmias in repaired congenital heart disease","authors":"Satoshi Kawada MD, PhD ,&nbsp;Hiroshi Morita MD, PhD ,&nbsp;Koji Nakagawa MD, PhD ,&nbsp;Tomofumi Mizuno MD ,&nbsp;Takuro Masuda MD ,&nbsp;Akira Ueoka MD, PhD ,&nbsp;Saori Asada MD, PhD ,&nbsp;Masakazu Miyamoto MD, PhD ,&nbsp;Norihisa Toh MD, PhD ,&nbsp;Nobuhiro Nishii MD, PhD ,&nbsp;Shingo Kasahara MD, PhD ,&nbsp;Shinsuke Yuasa MD, PhD","doi":"10.1016/j.hroo.2024.10.006","DOIUrl":"10.1016/j.hroo.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac death (SCD) is a major cause of mortality in congenital heart disease (CHD). Ventricular arrhythmias (VAs) are responsible for 80% of SCD. However, the clinical characteristics of patients with CHD and VAs are not fully understood.</div></div><div><h3>Objective</h3><div>This study was undertaken to evaluate clinical and electrocardiographic characteristics of patients with CHD based on the presence or absence of VAs.</div></div><div><h3>Methods</h3><div>We identified 28 patients with CHD with VAs (men, n = 15; 35.9 ± 16.5 years). Two patients with channelopathies were excluded from the analysis.</div></div><div><h3>Results</h3><div>The most common diagnoses in patients with VAs were a transposition of the great arteries (n = 8, 30.8%), followed by tetralogy of Fallot (n = 7, 26.9%). Compared with patients without VA (n = 43), those with VAs had a longer QRS (160.6 ± 52.9 ms vs 133.4 ± 29.3 ms; <em>P</em> = .004), a higher prevalence of fragmented QRS (65.4% vs 37.2%; <em>P</em> = .022) and more epsilon wave (23.1% vs 2.3%; <em>P</em> = .005). Multivariable analysis showed that QRS &gt; 180 ms (odds ratio [OR], 22.23; 95% confidence interval [CI], 2.40–206.53) and epsilon wave (OR, 14.33; 95% CI, 1.47–139.58) were significantly associated with VAs. During a median follow-up duration of 5.4 years, 5 patients (19.2%) received appropriate ICD therapy, and 3 patients (11.5%) died of heart failure.</div></div><div><h3>Conclusion</h3><div>The assessment of QRS duration and the presence of fQRS and epsilon waves in patients with CHD could improve risk prediction for the development of VAs. These electrocardiogram (ECG) features could assist in clinical decision-making and might consequently reduce mortality.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 1","pages":"Pages 39-47"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179270","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
Antithrombotic therapy in atrial flutter: To anticoagulate or not, that is the question
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.11.003
Fabian Wesołek MD , Przemysław Szyszka MD , Małgorzata Cichoń MD, PhD , Katarzyna Mizia-Stec MD, PhD , Maciej T. Wybraniec MD, PhD
Atrial fibrillation (AF) represents an arrhythmia fraught with significant morbidity, mortality, and financial burden for the health care system. Less attention is given to atrial flutter (AFL), which may occur as a stand-alone arrhythmia or coexist with AF in the same patient. Moreover, it is known that AF frequently develops after AFL ablation. Despite different pathophysiologies of AF and AFL, current guidelines provide identical indications for anticoagulation therapy in both arrhythmias, given the lack of trials in patients with AFL. This study attempts at providing an up-to-date literature review on the thromboembolic risk profile in AFL, focusing on differences between AFL and AF. Echocardiographic studies showed that the presence of spontaneous echocardiographic contrast (SEC) and thrombus are much less prevalent in patients with AFL than in those with AF. Patients with AFL had overall better left atrial appendage (LAA) function and lower coagulation marker levels than did patients with AF. Observational studies showed a significantly lower risk of stroke in patients with AFL than in those with AF. One study found a significantly higher ischemic stroke incidence in the AFL cohort only at CHA2DS2-VASc scores from 5 to 9 than in patients without AF or AFL. These findings imply that the thromboembolic risk inherent in AFL seems lower than that in AF. This should be considered in the context of a high chance of permanent AFL termination after successful cavotricuspid isthmus ablation, in contrast to the chronic clinical nature of AF. Although thromboembolic risk exists in AFL, prospective studies are warranted to establish the true prothrombotic properties of AFL, allowing the reassessment of anticoagulant treatment strategy.
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引用次数: 0
Design of a post-market registry for the extravascular implantable cardioverter-defibrillator: The Enlighten Study
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-01 DOI: 10.1016/j.hroo.2024.09.022
Lucas V.A. Boersma MD, PhD , Anish Amin MD , Nicolas Clémenty MD, PhD , David Duncker MD , Gregory Engel MD , Laurence Epstein MD , Vikas Kuriachan MD , Camille Frazier-Mills MD , Marianne Gwechenberger MD , Nobuhiro Nishii MD , Jeff Lande PhD , Christopher Wiggenhorn PhD , Ian Crozier MB ChB

Background

The extravascular implantable cardioverter-defibrillator (EV-ICD) with substernal lead placement has been shown to terminate ventricular arrhythmias safely and effectively while being outside the vasculature. The performance of the EV-ICD system with a novel inappropriate shock-reducing algorithm in a real-world setting has yet to be investigated.

Objective

The objective of the Enlighten Study: the EV-ICD Post-Approval Registry is to provide a comprehensive measure of the safety and performance of the EV-ICD system in real-world clinical practice over the lifetime of the device.

Methods

The Enlighten Study is a global, prospective, observational, multicenter, post-approval study utilizing the manufacturer’s Product Surveillance Registry. Eligible patients implanted with an Aurora EV-ICD system at participating centers will be included. Follow-up clinical data will be collected approximately every 6 months throughout the lifetime of the device, enrolling a minimum of 500 patients.

Results

The primary endpoint of the study is major system-related complication-free survival at 5 years post-implantation, with a minimum threshold of >79%. The study will also characterize device performance that includes, but is not limited to, freedom from system- or procedure-related complications, performance of antitachycardia pacing, characterization of sensing and detection, inappropriate therapy, shock effectiveness, battery depletion, and system revisions.

Conclusion

The Enlighten Study: the EV-ICD Post-Approval Registry will examine the real-world performance of the post-market EV-ICD system. Additionally, this study will allow for a robust assessment of EV-ICD–related complications, device revisions, and extractions over chronic (>5 years) implant durations.

ClinicalTrials.gov ID

NCT06048731
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引用次数: 0
VO-07 NATIONAL HEART INSTITUTE EXPERIENCE IN TRANSVENOUS LEAD EXTRACTION WITHOUT ADVANCED EXTRACTION TOOLS
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 DOI: 10.1016/j.hroo.2024.10.018
Samhaa Alsayed Hamed, Azza Katta, Mohamed Ossama
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引用次数: 0
VO-01 ATRIAL FIBRILLATION IN SUB-SAHARAN AFRICA: INSIGHTS FROM THE AFRICA REGISTRY (ATRIAL FIBRILLATION REGISTRY IN COUNTRIES OF AFRICA)
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 DOI: 10.1016/j.hroo.2024.10.012
Kassi Anicet Adoubi, Adama Kane, Iklo Coulibaly, Anastase Dudzie, Liliane Mfeukeu-Kuate, Martin Houenassi, Alassane Mbaye, Claude Kouakam, Laurent Fauchier, AFRICA Investigators
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引用次数: 0
期刊
Heart Rhythm O2
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