Heart Rhythm O2最新文献

英文中文

Sex differences in procedural characteristics, safety, and clinical outcomes of pulsed field ablation for atrial fibrillation 心房颤动脉冲场消融的程序特征、安全性和临床结果的性别差异

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.010

Fabian Jordan MD , Behnam Subin MD , Corinne Isenegger MD , Jonas Brügger MD , Jeanne du Fay de Lavallaz MD, PhD , Christine S. Zuern MD , Emel Kaplan MD , David Spreen MD , Sven Knecht DSc , Philipp Krisai MD , Nicolas Schaerli MD , Beat Schär MD , Gian Völlmin MS , Felix Mahfoud MD , Christian Sticherling MD , Michael Kühne MD , Patrick Badertscher MD

Background

Previous studies on pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) using conventional thermal techniques have shown inconsistent sex-related outcomes. Pulsed field ablation (PFA) is a novel energy source offering myocardial-selective ablation. However, sex-specific data on its performance are limited.

Objective

This study aimed to compare procedural characteristics, safety, and clinical outcomes of PFA in female and male patients undergoing AF ablation.

Methods

This prospective study included consecutive patients with paroxysmal or persistent AF undergoing PFA-based PVI using a pentaspline catheter. Follow-up was conducted at 3, 6, and 12 months. A 1:1 propensity score-matched cohort was created to evaluate sex-specific outcomes.

Results

Among 425 patients, 134 (32%) were women. Compared with men, women were older (median 70 vs 65 years; P < .001), more frequently had paroxysmal AF (60% vs 45%; P = .006), and had lower rates of coronary artery disease (6% vs 14%; P = .029). Although overall procedural times were similar, female patients with paroxysmal AF had significantly longer procedure, left atrial dwell, and fluoroscopy times than males. Complication rates were comparable (1.5% in women vs 0.7% in men; P = .371). After propensity score matching (133 women to 133 men), arrhythmia recurrence at 1-year follow-up was higher in women (23% vs 12%; P = .017; hazard ratio 2.2; standard error 0.34).

Conclusion

Significant sex-related differences exist in clinical outcomes after PVI with PFA in AF. Further studies exploring underlying mechanisms and tailored approaches may enhance outcomes in female patients.

背景：以往关于肺静脉隔离（PVI）治疗心房颤动（AF）的传统热技术的研究显示出不一致的性别相关结果。脉冲场消融术（PFA）是一种新型的心肌选择性消融术。然而，关于其性能的性别数据是有限的。目的本研究旨在比较女性和男性房颤消融患者PFA的手术特点、安全性和临床结果。方法本前瞻性研究纳入了连续的阵发性或持续性房颤患者，这些患者使用pentaspline导管接受基于pfa的PVI治疗。随访时间为3、6、12个月。建立了一个1:1的倾向评分匹配队列来评估性别差异的结果。结果425例患者中，女性134例（32%）。与男性相比，女性年龄较大（中位年龄为70岁vs 65岁；P < .001），更频繁发生阵发性房颤（60% vs 45%; P = 0.006），冠状动脉疾病发生率较低（6% vs 14%; P = 0.029）。虽然总体手术时间相似，但女性阵发性房颤患者的手术时间、左心房停留时间和透视时间明显长于男性。并发症发生率相似（女性1.5% vs男性0.7%;P = 0.371）。倾向评分匹配后（133名女性对133名男性），1年随访时，女性心律失常复发率较高（23% vs 12%; P = 0.017；风险比2.2；标准误差0.34）。结论房颤患者PVI合并PFA后的临床结果存在显著的性别差异，进一步研究其潜在机制和针对性的治疗方法可能会改善女性患者的预后。

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引用次数: 0

SGLT2 inhibitors and risk of atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis of observational studies SGLT2抑制剂与导管消融后房颤复发的风险：观察性研究的系统回顾和荟萃分析

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.017

Marco Zuin MD, MS, FESC, FACC, FANMCO , Francesco Vitali MD, PhD , Luca Canovi MD , Michele Malagù MD , Cristina Balla MD, PhD , Matteo Serenelli MD , Alessandro Fucili MD, PhD , Matteo Bertini MD, PhD, FAIAC

Background

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) exhibit potential antiarrhythmic effects, but their influence on atrial fibrillation (AF) recurrence after catheter ablation (CA) remains unclear.

Objective

This study aimed to assess the association between SGLT2i therapy and the risk of recurrent AF after CA through an updated systematic review and meta-analysis of observational studies.

Methods

A systematic search of PubMed and Scopus (inception to July 2025) identified eligible observational studies. Pooled hazard ratios for AF recurrence after CA were estimated using Mantel–Haenszel random-effects models, with heterogeneity assessed by I². The protocol was registered in PROSPERO (CRD42024620765).

Results

6 observational studies were included, comprising 2165 patients (mean age 65.2 years; 34.9% female), of whom 663 received SGLT2i therapy and 1502 did not. The average follow-up duration was 19.9 months. Pooled analysis showed a significantly reduced risk of AF recurrence in patients treated with SGLT2i compared with those not receiving SGLT2i (hazard ratio 0.49; 95% confidence interval 0.36–0.67; P < .0001; I² = 68.3%). Subgroup analyses confirmed consistent benefits in both diabetic and nondiabetic patients and with the use of radiofrequency or cryoablation. A multivariable meta-regression model including age, female sex, diabetes mellitus, and follow-up duration accounted for a significant portion of the observed heterogeneity (R² = 58.1%; P = .01).

Conclusion

SGLT2i therapy is associated with a significantly lower risk of AF recurrence after CA, independent of diabetic status. Further randomized controlled trials are warranted to validate these findings and explore the mechanisms underlying this association.

钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）显示出潜在的抗心律失常作用，但其对导管消融（CA）后房颤（AF）复发的影响尚不清楚。目的：本研究旨在通过对观察性研究的最新系统回顾和荟萃分析，评估SGLT2i治疗与CA后房颤复发风险之间的关系。方法系统检索PubMed和Scopus（成立至2025年7月），确定符合条件的观察性研究。使用Mantel-Haenszel随机效应模型估计CA后AF复发的合并风险比，并通过I2评估异质性。该协议在PROSPERO （CRD42024620765）中注册。结果纳入6项观察性研究，包括2165例患者（平均年龄65.2岁，女性34.9%），其中663例接受SGLT2i治疗，1502例未接受SGLT2i治疗。平均随访时间为19.9个月。合并分析显示，与未接受SGLT2i治疗的患者相比，接受SGLT2i治疗的患者AF复发风险显著降低（风险比0.49；95%可信区间0.36-0.67;P < 0.0001; I2 = 68.3%）。亚组分析证实，在糖尿病和非糖尿病患者以及使用射频或冷冻消融均有一致的益处。包括年龄、女性性别、糖尿病和随访时间在内的多变量元回归模型在观察到的异质性中占显著部分（R2 = 58.1%; P = 0.01）。结论sglt2i治疗与CA后AF复发风险显著降低相关，与糖尿病状态无关。需要进一步的随机对照试验来验证这些发现并探索这种关联的机制。

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引用次数: 0

Causality of atrial fibrillation and left atrial traits: Genetic and epigenetic perspectives 心房颤动和左心房特征的因果关系：遗传和表观遗传的观点

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.018

Dihui Cai MMed , Jie Xu MD, PhD , Yuheng Jiao MMSc , Yinyin Shen BMed , Yingying Liao BMed , Wei Han MD, PhD

Background

Atrial fibrillation (AF) is associated with left atrial (LA) abnormalities, yet the causality between them is not well defined.

Objective

This study aimed to investigate the genetic correlations and bidirectional causality between AF and LA traits.

Methods

We used genome-wide association study (GWAS) data from FinnGen and other cohorts. Linkage disequilibrium score regression was applied for estimates of genetic correlations, and Mendelian randomization (MR) analysis was conducted for causality analysis.

Results

Linkage disequilibrium score regression revealed significant genetic correlations between LA traits and AF. Forward MR analyses established causal associations of AF on LA active emptying fraction (LAaEF) (β = −0.092; P = 2.29 × 10⁻¹⁴), LA minimum volume (LAmin) (β = 0.083; P = 1.11 × 10⁻¹¹), and LA maximum volume (β = 0.063; P = 5.43 × 10⁻⁸), whereas no causal relationship was observed with LA passive emptying fraction. Reverse MR indicated a causal effect of LAaEF on AF (odds ratio [OR] 0.736; P = .003). Epigenetic MR identified 3 CpG sites for AF (cg27529934, cg13639451, and cg07191189), which showed causal relationships with LA traits. Moreover, LA traits were causally associated with heart failure (LAaEF, OR 0.879; P = .013; LAmin, OR 1.119; P = .037) and cardioembolic stroke (LAaEF, OR 0.689; P = .010; LA passive emptying fraction, OR 0.556; P = .002; LAmin, OR 1.733; P = .045).

Conclusion

LAaEF is bidirectionally causally linked with AF, underscoring its importance in the management of AF. Epigenetic modifications, as evidenced by specific CpG sites, may contribute to atrial remodeling in AF, offering new avenues for research into the AF pathophysiology.

背景：心房颤动（AF）与左心房（LA）异常相关，但两者之间的因果关系尚不明确。目的探讨AF与LA性状的遗传相关性和双向因果关系。方法使用来自FinnGen和其他队列的全基因组关联研究（GWAS）数据。遗传相关性估计采用连锁不平衡评分回归，因果关系分析采用孟德尔随机化分析。结果连锁不平衡评分回归分析显示，AF与LA主动排空分数（LAaEF）（β =−0.092,P = 2.29 × 10−14）、LA最小体积（LAmin）（β = 0.083, P = 1.11 × 10−11）和LA最大体积（β = 0.063, P = 5.43 × 10−8）存在显著的因果关系，而与LA被动排空分数没有因果关系。反向MR提示LAaEF对房颤有因果关系（比值比[OR] 0.736; P = 0.003）。表观遗传MR鉴定出AF的3个CpG位点（cg27529934、cg13639451和cg07191189），与LA性状存在因果关系。此外，LA特征与心力衰竭（LAaEF, OR 0.879; P = 0.013; LAmin, OR 1.119; P = 0.037）和心脏栓塞性卒中（LAaEF, OR 0.689; P = 0.010； LA被动排空分数，OR 0.556; P = 0.002; LAmin, OR 1.733; P = 0.045）存在因果关系。结论laaef与房颤存在双向因果关系，在房颤治疗中具有重要意义。CpG特异位点的表观遗传修饰可能参与房颤的心房重构，为房颤病理生理研究提供了新的途径。

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IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

引用次数: 0

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

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IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

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Cardiac resynchronization therapy in patients with cancer: A single cancer center experience 癌症患者的心脏再同步化治疗：一个癌症中心的经验

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.006

Nicholas King MD , Meera Kapadia MD , Scott Schubert MD , Jerril Jacob MD , Juhee Song PhD , Salil Kumar MD , Leslie Ynalvez MD , Bharat Kantharia MD, FHRS , Anita Deswal MD , Kaveh Karimzad MD

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IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

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IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

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IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01

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