Heart Rhythm O2最新文献

{"title":"A proposed algorithm for management of patients with left bundle branch block post-TAVR: 1-year follow-up","authors":"Avia Bar-Moshe BsC ,&nbsp;Amjad Abu-Salman MD ,&nbsp;Einat Frumkin BsC ,&nbsp;Carlos Cafri MD ,&nbsp;Miri Merkin MD ,&nbsp;Sergiy Bereza MD ,&nbsp;Louise Kezerle MD ,&nbsp;Moti Haim MD ,&nbsp;Yuval Konstantino MD","doi":"10.1016/j.hroo.2024.09.015","DOIUrl":"10.1016/j.hroo.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis and has become the standard of care across a broad spectrum of patients with aortic stenosis. However, it is still associated with high incidence of conduction abnormalities, particularly new left bundle branch block (LBBB). Management of these patients remains a challenge.</div></div><div><h3>Objective</h3><div>The study sought to assess the clinical outcomes of patients with post-TAVR conduction disorders managed according to a prespecified institutionally developed algorithm.</div></div><div><h3>Methods</h3><div>A retrospective analysis including all patients undergoing TAVR in our institute between October 2018 and December 2022 was performed. Patients with new LBBB were managed according to the algorithm comprising QRS width and electrophysiology study. In-hospital and 1-year clinical outcomes were assessed.</div></div><div><h3>Results</h3><div>A total of 230 patients were included in the present analysis. Seventy (30.4%) patients developed new LBBB after TAVR. Overall, 44 (19.1%) patients required permanent pacemaker (PPM) implantation: 20 (8.7%) patients with Mobitz II, complete atrioventricular block, or alternating bundle branch block; 21 (9.1%) patients with persistent new LBBB; and 3 (1.3%) patients per physician discretion. During 1-year follow-up, only 3 patients required late PPM implantation, of whom there was only 1 patient with new LBBB. There was no difference in mortality or heart failure hospitalizations between the per PPM and no PPM groups. Multivariable analysis identified atrial fibrillation, chronic kidney disease, and pre-TAVR right bundle branch block as independent predictors for PPM implantation following TAVR.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the presented algorithm may serve as a safe and efficacious strategy for management of patient with post-TAVR LBBB, although the PPM implantation rate may be further reduced.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 873-882"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972288","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}

{"title":"Percutaneous left atrial appendage closure using a modified single-operator-technician approach under deep sedation: A single-center experience","authors":"Alejandro José Quiroz Alfaro MD ,&nbsp;Noah E. Russell DO ,&nbsp;Ruhul Munshi MD ,&nbsp;Waleed Hassan MD ,&nbsp;James E. Stone MD ,&nbsp;Elsheikh M. Abdelrahim MD ,&nbsp;Karl J. Crossen MD ,&nbsp;Karthik Venkatesh Prasad MD","doi":"10.1016/j.hroo.2024.10.004","DOIUrl":"10.1016/j.hroo.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.</div></div><div><h3>Objective</h3><div>The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.</div></div><div><h3>Methods</h3><div>A total of 150 patients, with elevated CHA₂DS₂-VASc scores (a mean of 4 points), underwent transesophageal echocardiography–guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.</div></div><div><h3>Results</h3><div>The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.</div></div><div><h3>Conclusion</h3><div>Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 936-941"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972322","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}

{"title":"Use of continuous cardiac monitoring to assess the influence of atrial fibrillation burden and patterns on patient symptoms and healthcare utilization: The DEFINE AFib study","authors":"Dhanunjaya R. Lakkireddy MD ,&nbsp;Andrea M. Russo MD ,&nbsp;Elaine M. Hylek MD, MPH ,&nbsp;Suneet Mittal MD ,&nbsp;James Peacock MD, MS ,&nbsp;Mellanie True Hills ,&nbsp;Evan J. Stanelle MS, MA ,&nbsp;Jeffrey D. Lande MS, PhD ,&nbsp;Noreli C. Franco PhD ,&nbsp;Lawrence C. Johnson PhD ,&nbsp;Rahul Kanwar MS ,&nbsp;Rod S. Passman MD, MHS ,&nbsp;Jonathan P. Piccini MD, MHS","doi":"10.1016/j.hroo.2024.09.018","DOIUrl":"10.1016/j.hroo.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) has a significant impact on health and quality of life. The relationship of AF burden and temporal patterns of AF on patient symptoms, outcomes, and healthcare utilization is unknown. Insertable cardiac monitors (ICMs) are a strategic and as yet untapped, tool to investigate these relationships.</div></div><div><h3>Objective</h3><div>The DEFINE Atrial Fibrillation (DEFINE AFib) study will evaluate how AF burden and patterns are associated with changes in AF-related healthcare utilization (AFHCU) and patient-reported quality of life.</div></div><div><h3>Methods</h3><div>This is a prospective, observational, multicenter study with a unique design that supports a complete method of assessing AF as a multifactorial disease. Patients with AF implanted with an ICM will be enrolled in the study and managed through an app-based research platform on their smartphone. Patients will be remotely monitored and patient-reported outcomes will be collected via the app. AFHCU will be confirmed via the participant’s medical record.</div></div><div><h3>Results</h3><div>The primary analysis will evaluate whether summary and episodic measurements collected by ICMs are associated with changes in AFHCU. Secondary analyses will determine the relationship between AF characteristics and quality of life, timing and severity of AF-related complications, patient engagement, reliability of patient-reported outcomes, data from other digital rhythm detectors, and heterogeneity in care quality and AFHCU.</div></div><div><h3>Conclusion</h3><div>The DEFINE AFib study will provide valuable insights into the association between dynamic measures of AF and AFHCU in a patient population with known AF. The results may demonstrate the impact of ICM-detected AF on patient outcomes and help isolate novel AF patterns predictive of clinical risk.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 951-956"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972327","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}

{"title":"A deep learning modular ECG approach for cardiologist assisted adjudication of atrial fibrillation and atrial flutter episodes","authors":"Quentin Fleury MSc ,&nbsp;Rémi Dubois PhD ,&nbsp;Sylvain Christophle-Boulard MSc ,&nbsp;Fabrice Extramiana MD, PhD ,&nbsp;Pierre Maison-Blanche MD","doi":"10.1016/j.hroo.2024.09.007","DOIUrl":"10.1016/j.hroo.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Detection of atrial tachyarrhythmias (ATA) on long-term electrocardiogram (ECG) recordings is a prerequisite to reduce ATA-related adverse events. However, the burden of editing massive ECG data is not sustainable. Deep learning (DL) algorithms provide improved performances on resting ECG databases. However, results on long-term Holter recordings are scarce.</div></div><div><h3>Objective</h3><div>We aimed to build and evaluate a DL modular software using ECG features well known to cardiologists with a user interface that allows cardiologists to adjudicate the results and drive a second DL analysis.</div></div><div><h3>Methods</h3><div>Using a large (n = 187 recordings, 249,419 one-minute samples), beat-to-beat annotated, two-lead Holter database, we built a DL algorithm with a modular structure mimicking expert physician ECG interpretation to classify atrial rhythms. The DL network includes 3 modules (cardiac rhythm regularity, electrical atrial waveform, and raw voltage by time data) followed by a decision network and a long-term weighting factor. The algorithm was validated on an external database.</div></div><div><h3>Results</h3><div>F1 scores of our classifier were 99% for ATA detection, 95% for atrial fibrillation, and 90% for atrial flutter. Using the external Massachusetts Institute of Technology database, the classifier obtains an F1-score of 97% for the normal sinus rhythm class and 96% for the ATA class. Residual errors could be corrected by manual deactivation of 1 module in 7 of 15 of the recordings, with an accuracy &lt; 90%.</div></div><div><h3>Conclusion</h3><div>A DL modular software using ECG features well known to cardiologists provided an excellent overall performance. Clinically significant residual errors were most often related to the classification of the atrial arrhythmia type (fibrillation vs flutter). The modular structure of the algorithm helped to edit and correct the artificial intelligence–based first-pass analysis and will provide a basis for explainability.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 862-872"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972339","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}

{"title":"Atrial fibrillation catheter ablation decreases the duration of antiarrhythmic drug treatment for United States active-duty military personnel","authors":"Andrea N. Keithler DO,&nbsp;Matthew A. Tunzi DO,&nbsp;Andrew S. Wilson DO,&nbsp;Kelvin N.V. Bush MD","doi":"10.1016/j.hroo.2024.10.002","DOIUrl":"10.1016/j.hroo.2024.10.002","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 960-963"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972293","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}

{"title":"Ventricular tachycardia ablation across age groups: Outcomes, trends and demographics. Insights from the National Inpatient Sample Database","authors":"Ramez Morcos MD, MBA ,&nbsp;Saad Malik MD ,&nbsp;Peter Hanna MD, PhD ,&nbsp;Amr Barakat MD ,&nbsp;Haider Al Taii MD ,&nbsp;Luigi Di Biase MD, PhD ,&nbsp;Jeff Winterfield MD ,&nbsp;Pugazhendhi Vijayaraman MD, FHRS ,&nbsp;Parash Pokharel MD","doi":"10.1016/j.hroo.2024.09.014","DOIUrl":"10.1016/j.hroo.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular tachycardia ablation (VTA) is an important treatment option for ventricular tachycardia, with increasing use across all age groups. However, age-related differences in outcomes remain a concern.</div></div><div><h3>Objective</h3><div>This study aimed to investigate age-related trends in VTA procedures and their associated adverse events across the United States from 2011 to 2021. The primary objective was to analyze VTA outcomes across different age groups. Secondary objectives included examining variation in VTA rate by sex and geographic region.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of the National Inpatient Sample, focusing on adult patients (≥18 years of age) hospitalized with a primary diagnosis of ventricular tachycardia. Patients were divided into 3 age groups: ≤59, 60 to 79, and ≥80 years. We evaluated VTA frequency, in-hospital mortality, and complications using propensity score matching to control for confounders. Secondary analyses examined sex and geographic differences.</div></div><div><h3>Results</h3><div>The study included 95,913 VTA procedures. The mean age of patients undergoing VTA increased over time, with a growing proportion of procedures performed in older patients. While overall adverse events did not significantly differ across age groups, specific outcomes such as mortality and hemorrhage were significantly higher in patients ≥80 years of age. In-hospital mortality was highest in the ≥80 years age group (5.1%), compared with 1.6% in the ≤59 years age group and 2.7% in the 60 to 79 years age group. Significant differences by sex and region were also observed.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that while the overall incidence of adverse events with VTA did not significantly increase with age, specific severe outcomes, such as in-hospital mortality and hemorrhage, were more prevalent in older patients. These findings suggest that VTA can be safely performed across age groups, but careful consideration is essential for elderly patients. Future research should focus on understanding the impact of age-related physiological changes and comorbidities on VTA outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 900-909"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972329","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}

{"title":"Introduction: Cardiorhythm-Virtual 2024","authors":"Muzahir H. Tayebjee MD ,&nbsp;Hani Assaad MD ,&nbsp;Mervat Aboulmaaty MD","doi":"10.1016/j.hroo.2024.10.019","DOIUrl":"10.1016/j.hroo.2024.10.019","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Page S1"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179712","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}

{"title":"Right anterolateral abdominal wall hematoma following a concealed left anterolateral accessory pathway ablation","authors":"Salah H. Alahwany MD, PhD,&nbsp;Munveer Thind MD,&nbsp;Shunsuke Uetake MD, PhD,&nbsp;Bantayehu Sileshi MD,&nbsp;Harikrishna Tandri MD","doi":"10.1016/j.hroo.2024.09.006","DOIUrl":"10.1016/j.hroo.2024.09.006","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 957-959"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972324","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}

{"title":"Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: A real-world observational cohort study","authors":"Ibrahim Antoun PhD ,&nbsp;Alkassem Alkhayer MSc ,&nbsp;Majed Aljabal MBBS ,&nbsp;Yaman Mahfoud MD ,&nbsp;Alamer Alkhayer MD ,&nbsp;Peter Simon MD ,&nbsp;Ahmed Kotb MSc ,&nbsp;Joseph Barker MRCP ,&nbsp;Akash Mavilakandy BSc ,&nbsp;Rita Hani MSc ,&nbsp;Riyaz Somani PhD ,&nbsp;G. André Ng PhD ,&nbsp;Mustafa Zakkar PhD","doi":"10.1016/j.hroo.2024.05.010","DOIUrl":"10.1016/j.hroo.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding 30-day readmission following index admission for AF in the developing world are poorly described.</div></div><div><h3>Objectives</h3><div>The study aimed to assess the rate, predictors, and trends of 30-day readmission after index admission for AF in Syria.</div></div><div><h3>Methods</h3><div>We included adult patients who had an index admission with AF to Latakia’s tertiary center between June 2021 and October 2023. Patients were monitored for readmission for 30 days after index discharge. Data were taken from patients’ medical notes.</div></div><div><h3>Results</h3><div>A total of 661 patients were included in the final analysis, of which 282 (43%) were readmitted to hospital within 30 days following index admission. Cardiac causes were the most common cause of readmission in 72% of patients, of which 60% were AF. Readmitted patients had a higher median age (62 years vs 57 years, <em>P =</em> .001), and there were fewer males (58% vs 51%, <em>P =</em> .001). In multivariate analysis, factors that independently increased 30-day readmission risk were older age (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.1–1.9), female sex (HR 1.3, 95% CI 1.02–1.4), diabetes mellitus (HR 1.7, 95% CI 1.3–2.3), and congestive heart failure (HR 2.2, 95% CI 1.7–2.9). Most cardiac readmissions happened during the first 15 days (79%).</div></div><div><h3>Conclusion</h3><div>Almost 1 in 2 patients were readmitted within 30 days after an index admission for AF. Female sex, advancing age, diabetes mellitus, and congestive heart failure were independently associated with an increased risk of 30-day readmission.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 854-859"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972326","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}

{"title":"VO-02 ACCURACY AND CONFIDENCE OF ELECTROCARDIOGRAM INTERPRETATION AMONG DOCTORS WORKING AT THE EMERGENCY MEDICINE DEPARTMENT OF A TERTIARY HOSPITAL IN TANZANIA","authors":"Emmanuel Mmbando,&nbsp;Said Kilindimo,&nbsp;Alphonce Simbila,&nbsp;Evelyne Mapunda,&nbsp;Peter Kisenge,&nbsp;Reuben Mutagaywa","doi":"10.1016/j.hroo.2024.10.013","DOIUrl":"10.1016/j.hroo.2024.10.013","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Page S3"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180955","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}