Heart Rhythm O2最新文献_第3页

Assessment of incomplete lesions using 3-dimensional mapping following pentaspline pulsed field ablation for atrial fibrillation 房颤pentaspline脉冲场消融术后不完全病变的三维制图评估

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.010

Atsuhiko Yagishita MD, PhD, Kazuma Iimura MD, Aika Iijima MD, Mari Amino MD, PhD, Yuji Ikari MD, PhD, Koichiro Yoshioka MD, PhD

Background

Pulsed field ablation (PFA) is a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, the completeness of lesion formation following PFA using a pentaspline catheter remains insufficiently studied.

Objective

This study aimed to evaluate the utility of 3-dimensional (3D) electroanatomical mapping in detecting incomplete lesion formation following pentaspline PFA in patients with AF.

Methods

This study included 100 consecutive patients undergoing first-time PFA with the FARAWAVE™ catheter (Boston Scientific) under fluoroscopic guidance. 50 patients with paroxysmal AF underwent PVI alone, whereas 50 with persistent AF received PVI plus posterior wall isolation (PWI). Post-ablation 3D mapping was performed using the CARTO 3 system (Biosense Webster). Incomplete lesions were defined as preserved electrical activity or conduction gaps on activation or electrogram mapping.

Results

Incomplete lesions were identified in 8 of 50 patients (16%) undergoing PVI alone and 24 of 50 patients (48%) undergoing PVI plus PWI (P < .001). The most common sites of residual conduction were the right inferior pulmonary vein (PVI group) and the mid-to-inferior posterior wall (PVI plus PWI group). 5 of 24 patients (21%) with incomplete PWI required multiple application–remapping cycles to achieve lesion completion. Analysis by quartile (n = 25) revealed no significant trend in detection rate over time for paroxysmal (P = .289) or persistent AF (P = .179).

Conclusion

3D electroanatomical mapping effectively identifies incomplete lesions following pentaspline PFA. Detection rates were unaffected by operator learning curve, instead reflecting limitations of conventional guidance based primarily on fluoroscopy in patients with anatomical variability.

背景：脉冲场消融（PFA）是心房颤动（AF）肺静脉隔离（PVI）的一种新型非热模式。然而，使用pentaspline导管PFA后病变形成的完整性仍未得到充分研究。目的本研究旨在评估三维（3D）电解剖定位在检测af患者pentaspline PFA后不完全病变形成中的作用。方法本研究包括100例连续患者在透视引导下使用FARAWAVE™导管（波士顿科学公司）进行首次PFA。50例阵发性房颤患者单独接受PVI，而50例持续性房颤患者接受PVI +后壁隔离（PWI）。消融后3D制图使用CARTO 3系统（Biosense Webster）。不完全病变被定义为保留的电活动或激活或电图映射的传导间隙。结果50例单独行PVI的患者中有8例（16%）未发现完整病变，50例行PVI + PWI的患者中有24例（48%）未发现完整病变（P < 0.001）。最常见的残余传导部位为右下肺静脉（PVI组）和中下后壁（PVI + PWI组）。24例不完全PWI患者中有5例（21%）需要多次应用重新定位周期才能实现病变完全。四分位数分析（n = 25）显示，阵发性（P = 0.289）或持续性房颤（P = 0.179）的检出率随时间变化无显著趋势。结论三维电解剖定位能有效识别pentaspline PFA后的不完全性病变。检出率不受操作人员学习曲线的影响，而是反映了主要基于透视检查的常规指导在解剖变异性患者中的局限性。

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引用次数: 0

PLASMA Chile: A prospective, multicenter observational cohort study of patients with heart failure and reduced left ventricular ejection fraction 血浆智利：一项对心力衰竭和左心室射血分数降低患者的前瞻性、多中心观察队列研究

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.015

Rubén Aguayo MD , Fernando Lanas MSc , Hugo Verdejo MD , Pablo López MD , Álvaro Vargas MD , Richar Aguirre MD , Judith Riesgo BEng , Federico Levy MSc , Svetlana V. Doubova DSc , Ricardo Perez-Cuevas DSc , Claudio Muratore MD.

Background

Chile has limited data on the treatment of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).

Objective

This study aimed to evaluate adherence to the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline recommendations, identify barriers to cardiac implantable electronic device (CIED) use, and assess the association between CIED implantation and mortality.

Methods

From March 2021 to December 2022, we conducted a prospective, multicenter observational cohort study across 6 hospitals. Adults aged ≥18 with HF with reduced EF ≤40% were enrolled. Sociodemographic, clinical, and treatment data were collected. Descriptive statistics and Cox univariable regression were performed.

Results

The study included 243 patients with HF (73.3% male, median age 63 years), with comorbidities, including hypertension (67.1%), diabetes (30%), and obesity (37%); 41.2% had a history of myocardial infarction. At baseline, most patients received beta-blockers (96%), mineralocorticoid receptor antagonists (84%), and diuretics (65%). Of the 215 patients with LVEF ≤35%, 34.4% (n = 74) had a baseline CIED: 41.9% (n = 31) implantable cardioverter-defibrillators (ICD), 25.7% (n = 19) cardiac resynchronization therapy defibrillators (CRT-D), 17.6% (n = 13) CRT with a pacemaker, and 14.9% (n = 11) pacemaker. During follow-up, 27 of 75 eligible patients received ICD or CRT-D as recommended by the 2017 ACC/AHA/HRS guideline, whereas 38 did not because of access issues. There were 26 deaths, with no significant mortality differences between those with and without ICD or CRT-D.

Conclusion

In Chile, patients with HF with reduced LVEF receive pharmacological therapy consistent with international standards; however, they face access barriers to CIEDs, which are underutilized despite their benefits.

智利关于心力衰竭（HF）和左心室射血分数降低（LVEF）患者治疗的数据有限。本研究旨在评估2017年美国心脏协会/美国心脏病学会/心律学会（AHA/ACC/HRS）指南建议的依从性，确定心脏植入式电子设备（CIED）使用的障碍，并评估植入式电子设备植入与死亡率之间的关系。方法从2021年3月至2022年12月，我们在6家医院进行了一项前瞻性、多中心观察性队列研究。纳入年龄≥18岁的HF患者，EF降低≤40%。收集了社会人口学、临床和治疗数据。进行描述性统计和Cox单变量回归分析。结果本研究纳入243例HF患者（男性73.3%，中位年龄63岁），合并高血压（67.1%）、糖尿病（30%）和肥胖（37%）；41.2%有心肌梗死史。在基线时，大多数患者接受β受体阻滞剂（96%），矿皮质激素受体拮抗剂（84%）和利尿剂（65%）。在215例LVEF≤35%的患者中，34.4% （n = 74）的基线CIED: 41.9% （n = 31）为植入式心律转复除颤器（ICD）， 25.7% （n = 19）为心脏再同步化治疗除颤器（CRT- d）， 17.6% （n = 13）为带起搏器的CRT， 14.9% （n = 11）为起搏器。在随访期间，75名符合条件的患者中有27名接受了2017年ACC/AHA/HRS指南推荐的ICD或CRT-D治疗，而38名患者因获取问题而未接受ICD治疗。有26例死亡，有和没有ICD或CRT-D的死亡率没有显著差异。结论在智利，LVEF降低的HF患者接受的药物治疗与国际标准一致；然而，他们面临进入cied的障碍，尽管有好处，但这些障碍没有得到充分利用。

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引用次数: 0

Real-time magnetic resonance-guided radiofrequency ablation and lesion evaluation in an magnetic resonance-compatible isolated beating pig heart platform 实时磁共振引导射频消融和磁共振兼容的离体跳动猪心脏平台的病变评估

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.014

Luuk H.G.A. Hopman PhD , Eric M. Schrauben PhD , Jules L. Nelissen MSc, PhD , Pieter J. Reitzema BSc , Machteld J. Boonstra PhD , Bart L.M. Smeets MSc , Renate W. Boekhoven PhD , Daniel Sunnarborg MSc , Jouke Smink PhD , Hans W.M. Niessen MD, PhD , Cornelis P. Allaart MD, PhD , Aart J. Nederveen PhD , Marco J.W. Götte MD, PhD

Background

Interventional cardiovascular magnetic resonance imaging (MRI) offers real-time, radiation-free guidance for complex procedures such as myocardial ablation, marking a promising advance in electrophysiology. However, further development is limited by challenges in magnetic resonance (MR)-compatible instrument testing, MRI sequence validation, and accurate correlation with histopathology, hindered by the limitations of in vivo tissue evaluation.

Objective

This study investigated the feasibility of real-time MR-guided radiofrequency (RF) ablation in an MR-compatible isolated beating pig heart platform and characterized ablation lesions using MRI and histopathology.

Methods

A heart from a pig slaughtered for human consumption was prepared under regulatory guidelines and connected to a custom-built, MR-compatible perfusion platform supporting left ventricular function in both Langendorff and working modes. Autologous heparinized blood circulated at physiological pressures and temperatures. MR-guided catheter navigation and RF ablation were performed on a Philips 3T scanner using active catheter tracking. Native T1 and T2 mapping were acquired before and after ablation. Lesions were confirmed by histologic analysis.

Results

RF ablation (50 W, 60 seconds) was successfully performed at 5 left ventricular sites. MRI showed focal reductions in T1 (936 ± 80 ms) surrounded by elevated T1 (1357 ± 18 ms) and T2 values (86 ± 10 ms) compared with nonablated myocardium (T1 1192 ± 26 ms; T2 66 ± 6 ms), consistent with necrosis and edema. Histology confirmed a necrotic core with a surrounding rim showing contraction band necrosis and erythrocyte extravasation.

Conclusion

This study demonstrates the feasibility of real-time MR-guided ablation in a beating pig heart platform. The setup allows high-resolution lesion assessment and histologic correlation, supporting future developments in MR-guided therapies.

背景介入性心血管磁共振成像（MRI）为心肌消融等复杂手术提供实时、无辐射的指导，标志着电生理学的一个有希望的进步。然而，进一步的发展受到磁共振（MR）兼容仪器测试，MRI序列验证以及与组织病理学准确相关的挑战的限制，受到体内组织评估的局限性的阻碍。目的探讨实时核磁共振引导射频消融在核磁共振兼容的离体猪心脏跳动平台上的可行性，并利用MRI和组织病理学对消融病变进行表征。方法根据监管指南制备供人食用的屠宰猪心脏，并连接到定制的、支持Langendorff和工作模式左心室功能的mr兼容灌注平台。自体肝素化的血液在生理压力和温度下循环。mri引导导管导航和射频消融在Philips 3T扫描仪上进行，采用主动导管跟踪。消融前后获得原生T1、T2定位。病变经组织学分析证实。结果射频消融术（50 W， 60秒）在5个左心室部位成功完成。与未消融心肌（T1 1192±26 ms; T2 66±6 ms）相比，MRI显示T1（936±80 ms）局灶性缩小，T1（1357±18 ms）升高，T2值（86±10 ms）升高，与坏死和水肿一致。组织学证实坏死核心，周围有收缩带坏死和红细胞外渗。结论本研究证明了在猪心脏跳动平台上进行实时核磁共振引导消融的可行性。该装置允许高分辨率病变评估和组织学相关性，支持未来核磁共振引导治疗的发展。

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引用次数: 0

Atrial electrogram differences between a dual-energy ablation catheter and a conventional mapping catheter 双能消融导管与常规定位导管心房电图的差异

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.008

Vincenzo Mirco La Fazia MD , Elio Zito MD , Sanghamitra Mohanty MD, FHRS , Carola Gianni MD , Giuseppe Stifano MD , J. David Burkhardt MD, FHRS , Rodney Horton MD, FHRS , Amin Al-Ahmad MD, FHRS , Luigi Di Biase MD, FHRS , Andrea Natale MD, FACC, FESC, FHRS

引用次数: 0

Long-term outcomes of upgrading to cardiac resynchronization therapy in patients with left bundle branch block or right ventricular pacing 左束支传导阻滞或右心室起搏患者升级到心脏再同步化治疗的长期结果

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.009

Yoshitake Oshima MD , Nobuhiko Ueda MD, PhD , Kohei Ishibashi MD, PhD , Toshihiro Nakamura MD, PhD , Satoshi Oka MD, PhD , Akinori Wakamiya MD, PhD , Kenzaburo Nakajima MD, PhD , Tsukasa Kamakura MD, PhD , Mitsuru Wada MD, PhD , Yuko Inoue MD, PhD , Koji Miyamoto MD, PhD , Satoshi Nagase MD, PhD , Takeshi Aiba MD, PhD, FHRS , Kengo Kusano MD, PhD, FHRS

Background

Data comparing outcomes between cardiac resynchronization therapy (CRT) upgrade in patients with left bundle branch block (LBBB) or right ventricular (RV) pacing and de novo CRT in LBBB are limited.

Objective

To evaluate long-term outcomes of CRT upgrade in patients with LBBB or RV pacing compared with de novo CRT in LBBB.

Methods

We analyzed 395 consecutive patients who received CRT, classified into 3 groups: CRT upgrade for LBBB or RV pacing (Upgrade group, n = 111), de novo CRT for LBBB (LBBB group, n = 84), and CRT for non-LBBB (non-LBBB group, n = 200). The primary end point was a composite of all-cause mortality and heart failure hospitalization. The secondary end point was CRT response, defined as an improvement of ≥15% in left ventricular end-systolic volume.

Results

During the follow-up of 778 days, the risk of primary end point was higher in the Upgrade group than the LBBB group (log-rank, P = .03), and lower than the non-LBBB group (P = .03). In the Upgrade group, Kaplan-Meier analysis revealed that patients with left atrial diameter >50 mm, determined by receiver operating characteristic analysis, had a higher risk of the primary end point (log-rank, P < .001). Left atrial diameter >50 mm was a negative predictor of CRT response and an independent predictor of primary end point (hazard ratio 2.31, 95% confidence interval 1.10–4.85, P = .03).

Conclusion

CRT upgrade for LBBB or RV pacing offers less prognostic benefit than de novo CRT for LBBB.

背景：比较左束支传导阻滞（LBBB）或右心室起搏（RV）患者心脏再同步化治疗（CRT）升级与LBBB患者重新进行CRT治疗的结果的数据有限。目的评价LBBB或RV起搏患者CRT升级与LBBB患者重新CRT的远期疗效。方法对395例连续接受CRT治疗的患者进行分析，将其分为3组：LBBB或RV起搏的CRT升级组（升级组，n = 111）、LBBB的重新CRT （LBBB组，n = 84）和非LBBB的CRT（非LBBB组，n = 200）。主要终点是全因死亡率和心力衰竭住院率的综合。次要终点是CRT反应，定义为左心室收缩末期容积改善≥15%。结果随访778 d，升级组主要终点发生风险高于LBBB组（log-rank, P = .03），低于非LBBB组（P = .03）。在Upgrade组中，Kaplan-Meier分析显示，经受试者工作特征分析确定的左房直径为50mm的患者发生主要终点的风险更高（log-rank, P < .001）。左房内径>；50 mm是CRT反应的阴性预测因子，也是主要终点的独立预测因子（风险比2.31,95%可信区间1.10-4.85,P = 0.03）。结论对LBBB或RV起搏进行CRT升级治疗的预后效果不如对LBBB重新进行CRT治疗。

{"title":"Long-term outcomes of upgrading to cardiac resynchronization therapy in patients with left bundle branch block or right ventricular pacing","authors":"Yoshitake Oshima MD , Nobuhiko Ueda MD, PhD , Kohei Ishibashi MD, PhD , Toshihiro Nakamura MD, PhD , Satoshi Oka MD, PhD , Akinori Wakamiya MD, PhD , Kenzaburo Nakajima MD, PhD , Tsukasa Kamakura MD, PhD , Mitsuru Wada MD, PhD , Yuko Inoue MD, PhD , Koji Miyamoto MD, PhD , Satoshi Nagase MD, PhD , Takeshi Aiba MD, PhD, FHRS , Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.09.009","DOIUrl":"10.1016/j.hroo.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Data comparing outcomes between cardiac resynchronization therapy (CRT) upgrade in patients with left bundle branch block (LBBB) or right ventricular (RV) pacing and de novo CRT in LBBB are limited.</div></div><div><h3>Objective</h3><div>To evaluate long-term outcomes of CRT upgrade in patients with LBBB or RV pacing compared with de novo CRT in LBBB.</div></div><div><h3>Methods</h3><div>We analyzed 395 consecutive patients who received CRT, classified into 3 groups: CRT upgrade for LBBB or RV pacing (Upgrade group, n = 111), de novo CRT for LBBB (LBBB group, n = 84), and CRT for non-LBBB (non-LBBB group, n = 200). The primary end point was a composite of all-cause mortality and heart failure hospitalization. The secondary end point was CRT response, defined as an improvement of ≥15% in left ventricular end-systolic volume.</div></div><div><h3>Results</h3><div>During the follow-up of 778 days, the risk of primary end point was higher in the Upgrade group than the LBBB group (log-rank, <em>P =</em> .03), and lower than the non-LBBB group (<em>P =</em> .03). In the Upgrade group, Kaplan-Meier analysis revealed that patients with left atrial diameter >50 mm, determined by receiver operating characteristic analysis, had a higher risk of the primary end point (log-rank, <em>P <</em> .001). Left atrial diameter >50 mm was a negative predictor of CRT response and an independent predictor of primary end point (hazard ratio 2.31, 95% confidence interval 1.10–4.85, <em>P =</em> .03).</div></div><div><h3>Conclusion</h3><div>CRT upgrade for LBBB or RV pacing offers less prognostic benefit than de novo CRT for LBBB.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1960-1967"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771849","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

Effect of conflict on atrial fibrillation outcomes in the Middle East: Multicenter international cohort study 冲突对中东地区房颤结局的影响：多中心国际队列研究

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.06.001

Ibrahim Antoun PhD , Malik Alta'amreh MD , Alkassem Alkhayer MSc , Alamer Alkhayer MD , Aref Jalal Eldin MD , Georgia R. Layton MRCS , Riyaz Somani PhD , G. André Ng PhD , Mustafa Zakkar PhD

Background

Atrial fibrillation (AF) outcomes vary depending on the stability of the health care system.

Objective

This study compared AF outcomes in 2 neighboring Levant countries: Syria, a conflict-affected country, and Jordan, a country with a stable health care system.

Methods

We conducted a retrospective observational cohort study of patients with AF from Tishreen University Hospital in Latakia, Syria, and the Jordanian Atrial Fibrillation Registry. Propensity score matching was performed to adjust for baseline characteristics. Primary outcomes included 1-year readmission rates and the 1-month incidence of cerebrovascular accidents (CVAs) or major bleeding.

Results

The study included 2677 patients (657 from Syria and 2020 from Jordan). Syrian patients were younger (median age 60 years vs 70 years; P < .001) and had higher rates of smoking (39% vs 14%; P < .001) and ischemic heart disease (26% vs 12%; P < .001) but lower rates of hypertension and diabetes. One-year readmission rates were significantly higher in Syria (64% vs 9%; P < .001), as were the incidences of 1-month CVAs (3% vs 1%; P < .001) and major bleeding (4% vs 0.5%; P < .001). These differences remained significant after propensity score matching. Compared with Jordanian patients, Syrian patients were associated with a substantial increase in all-cause readmission (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.5–2.6; P < .001). Furthermore, Syrian patients had a considerable increase in incidences of 1-month CVA (OR 6.5; 95% CI 2.5–16.5; P < .001) and major bleeding (OR 20.6; 95% CI 6.7–63.3; P < .001).

Conclusion

AF outcomes are significantly worse in Syria than in Jordan. Health care disruptions contribute to increased readmissions and complications. Strengthening AF management in conflict zones through improved access to medications and structured follow-up is essential to mitigating adverse outcomes.

背景：房颤（AF）的结局取决于医疗系统的稳定性。目的本研究比较了两个邻近的黎凡特国家：受冲突影响的叙利亚和卫生保健系统稳定的约旦的房颤结局。方法：我们对来自叙利亚拉塔基亚Tishreen大学医院和约旦房颤登记处的房颤患者进行了一项回顾性观察队列研究。进行倾向评分匹配以调整基线特征。主要结局包括1年再入院率和1个月脑血管意外（CVAs）或大出血发生率。结果共纳入2677例患者（657例来自叙利亚，2020例来自约旦）。叙利亚患者更年轻（中位年龄60岁vs 70岁；P < .001），吸烟率（39% vs 14%; P < .001）和缺血性心脏病（26% vs 12%; P < .001）更高，但高血压和糖尿病的发病率较低。叙利亚的1年再入院率明显更高（64%对9%；P < .001）， 1个月CVAs的发生率（3%对1%；P < .001）和大出血的发生率（4%对0.5%;P < .001）也是如此。这些差异在倾向评分匹配后仍然显著。与约旦患者相比，叙利亚患者的全因再入院率显著增加（优势比[OR] 1.8； 95%可信区间[CI] 1.5-2.6; P < 0.001）。此外，叙利亚患者1个月CVA （OR 6.5; 95% CI 2.5-16.5; P < 0.001）和大出血（OR 20.6; 95% CI 6.7-63.3; P < 0.001）的发生率显著增加。结论叙利亚的治疗结果明显差于约旦。卫生保健中断导致再入院和并发症增加。通过改善药物获取和有组织的随访来加强冲突地区的房颤管理，对于减轻不良后果至关重要。

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引用次数: 0

Mapping of real-time myocardial metabolism to guide ablation 实时心肌代谢成像指导消融

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.007

Jonathan P. Piccini Sr. MD, MHS, FHRS , Terrance J. Ransbury BSEE

引用次数: 0

Effect of pulsed field ablation delivered from noncontact catheter electrodes on hemolysis: A tissue proximity indication–based analysis 非接触式导管电极脉冲场消融对溶血的影响：一项基于组织接近指征的分析

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.002

Shingo Yoshimura MD, Kenichi Kaseno MD, PhD, Akiko Kodama MD, Suguru Nishiuchi MD, PhD, Kojiro Hattori MD, Taiki Masuyama MD, Takehito Sasaki MD, Kohki Nakamura MD, PhD, Shigeto Naito MD, PhD

Background

Pulsed field ablation (PFA) for atrial fibrillation can induce hemolysis, particularly when pulsed field (PF) energy is delivered from catheter electrodes that are not in contact with myocardial tissue. The variable-loop circular catheter (VLCC) incorporates tissue proximity indication (TPI) software to identify catheter-tissue contact. Whether PFA applications delivered from TPI-negative (noncontact) VLCC electrodes contribute to hemolysis remains unclear.

Objective

The purpose of this study was to determine whether PFA delivered from TPI-negative VLCC electrodes is associated with postprocedural hemolysis.

Methods

We retrospectively analyzed 20 consecutive patients who underwent their first PFA using the VLCC and CARTO 3 system (Biosense Webster Inc.). For each 3-pulse application set, catheter-tissue contact was assessed using TPI. We counted the cumulative number of VLCC electrode uses delivering PF energy; among these, those that were TPI-negative were summed and defined as the cumulative number of TPI-negative electrode uses (nTPI-EU). Postoperative lactate dehydrogenase (LDH), total bilirubin (T-Bil), and the postoperative-to-preoperative haptoglobin ratio served as hemolysis markers.

Results

A mean of 78.3 ± 20.0 PFA applications (772.9 ± 204.1 VLCC electrode uses) were delivered per patient; the mean nTPI-EU was 438.8 ± 238.1. Compared with preoperative values, postoperative LDH and T-Bil increased significantly whereas haptoglobin decreased (P < .01 for all). nTPI-EU correlated positively with LDH (r = 0.663; P < .01) and T-Bil (r = 0.736; P < .01) and negatively with the postoperative-to-preoperative haptoglobin ratio (r = −0.556; P = .01).

Conclusion

The cumulative number of noncontact catheter electrodes delivering PF energy was associated with hemolysis. Strategies that minimize the number of noncontact catheter electrodes, in addition to limiting total PFA applications, may reduce the risk of hemolysis.

背景：心房颤动的脉冲场消融（PFA）可以诱导溶血，特别是当脉冲场（PF）能量从不与心肌组织接触的导管电极传递时。可变环环形导管（VLCC）采用组织接近指示（TPI）软件来识别导管与组织的接触。tpi阴性（非接触）VLCC电极的PFA应用是否有助于溶血尚不清楚。目的本研究的目的是确定tpi阴性VLCC电极输送的PFA是否与术后溶血有关。方法回顾性分析20例连续使用VLCC和CARTO 3系统（Biosense Webster Inc.）进行首次PFA的患者。对于每个3脉冲应用集，使用TPI评估导管与组织的接触。计算了VLCC电极输送PF能量的累计次数；其中tpi阴性的将其相加，定义为tpi阴性电极使用的累计次数（nTPI-EU）。术后乳酸脱氢酶（LDH）、总胆红素（T-Bil）、术后与术前触珠蛋白比值作为溶血指标。结果每例患者平均使用78.3±20.0个PFA（772.9±204.1个VLCC电极）；nTPI-EU平均值为438.8±238.1。与术前比较，术后LDH和T-Bil显著升高，而触珠蛋白显著降低（P < 0.01）。nTPI-EU与LDH （r = 0.663; P < 0.01）、T-Bil （r = 0.736; P < 0.01）呈正相关，与术后-术前触珠蛋白比值呈负相关（r = - 0.556; P = 0.01）。结论输送PF能量的非接触式导管电极累计数目与溶血有关。除了限制PFA的总应用外，减少非接触式导管电极数量的策略可能会降低溶血的风险。

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引用次数: 0

Larger spatial ventricular gradient magnitude is associated with higher rates of response to cardiac resynchronization therapy 较大的空间心室梯度大小与较高的心脏再同步化治疗反应率相关

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.08.024

Alyssa J. Shepherd MD , Hans F. Stabenau MD, PhD , Arunashis Sau MBBS, PhD , Patricia Tung MD, MPH , Timothy R. Maher MD , Shu Yang MD , Andrew H. Locke MD , Peter Zimetbaum MD, FHRS , Gregory F. Michaud MD , Andre d’Avila MD, PhD , Nicholas S. Peters MBBS, MD, FHRS , Alfred E. Buxton MD , Fu Siong Ng MBBS, PhD, FHRS , Daniel B. Kramer MD, MPH , Jonathan W. Waks MD

Background

Cardiac resynchronization therapy (CRT) improves systolic heart failure (HF) outcomes, but many patients do not benefit. Improved methods for identifying patients likely to benefit from CRT are needed. The spatial ventricular gradient (SVG) is a vectorcardiographic measure of myocardial electromechanical heterogeneity that is associated with incident HF. The relationship between SVG and CRT response is unknown.

Objective

This study aimed to investigate associations between SVG and CRT response.

Methods

Retrospective analysis of patients presenting for clinically-indicated CRT implant in 2015–2022. Pre-CRT electrocardiograms (ECGs) were transformed into vectorcardiograms (VCGs), and SVG vector X, Y, and Z components were calculated as areas under the X, Y and Z VCG QRST complexes, respectively. SVG magnitude (SVGmag) was calculated as SVG vector length. CRT response, defined as left ventricular ejection fraction (LVEF) increase ≥10% post-CRT, was assessed using multivariable logistic regression.

Results

Among 162 patients (median age 68 years, 62% male, 76% non-ischemic HF, median LVEF 26%, median QRS duration 162ms, 89% left bundle branch block), 69% had CRT response. After adjustment, larger pre-CRT SVGmag was associated with higher odds of CRT response: adjusted odds ratio (OR_adj) 1.78 per 1 standard deviation increase, P = .009. Predicted probabilities of CRT response ranged between ∼50% for the lowest SVGmag values, to ∼90% for the highest SVGmag values, and patients in the highest pre-CRT SVGmag tertile had and OR_adj 4.5, P = .003 for CRT response. Larger post-CRT decreases in SVGmag were also associated with increased CRT response. SVGmag performed better than QRS area for predicting CRT response.

Conclusion

SVGmag is independently associated with CRT response and warrants prospective study.

背景：心脏再同步化治疗（CRT）可改善收缩期心力衰竭（HF）的预后，但许多患者并未从中获益。需要改进方法来识别可能从CRT获益的患者。空间心室梯度（SVG）是与心衰事件相关的心肌机电异质性的矢量心动图测量。SVG与CRT响应之间的关系尚不清楚。目的探讨SVG与CRT反应的关系。方法回顾性分析2015-2022年临床指征CRT植入患者。将crt前心电图（ecg）转换为矢量心电图（VCG），并计算SVG矢量X、Y、Z分量分别作为X、Y、Z VCG QRST复合物下面积。SVG大小（SVGmag）作为SVG矢量长度计算。CRT反应，定义为左心室射血分数（LVEF）增加≥10%，使用多变量logistic回归评估。结果162例患者中（中位年龄68岁，男性62%，非缺血性HF 76%，中位LVEF 26%，中位QRS持续时间162ms， 89%左束支阻滞），69%有CRT反应。校正后，CRT前SVGmag越大，CRT反应的几率越高：校正优势比（ORadj）为1.78 / 1标准差，P = 0.009。CRT反应的预测概率在最低SVGmag值为~ 50%，最高SVGmag值为~ 90%之间，CRT前SVGmag值最高的患者的CRT反应的ORadj为4.5,P = 0.003。CRT后SVGmag的大幅下降也与CRT反应的增加有关。SVGmag对CRT反应的预测效果优于QRS区。结论svgmag与CRT反应独立相关，值得进行前瞻性研究。

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引用次数: 0

Daily home ECG monitoring for assessing the blanking period after catheter ablation in persistent atrial fibrillation 持续性房颤患者导管消融后每日家庭心电图监测评估空白期

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.08.006

Daiki Shako MD , Keitaro Senoo MD, PhD , Arito Yukawa MD , Satoaki Matoba MD, PhD

引用次数: 0