{"title":"Reply: Can safety and innovation coexist in the global expansion of laser balloon ablation?","authors":"Ken Kawase MD , Reina Tonegawa-Kuji MD, PhD , Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.08.037","DOIUrl":"10.1016/j.hroo.2025.08.037","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1858-1859"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546472","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}
Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.07.103
Pavel Osmancik MD, PhD , Petr Neuzil MD, PhD , Tomas Karel PhD , Petr Waldauf MD, PhD , Jana Hozmanova MSc , Marek Hozman MD , Stepan Kralovec BS , Dalibor Herman MD, PhD , Jan Petru MD , Lucie Sediva MD , Jakub Fischer PhD , Lubomir Stepanek PhD , Ivana Mala PhD , William Whang MD , Vivek Y. Reddy MD
Background
Compared with antiarrhythmic drugs, pulmonary vein isolation (PVI) reduces atrial fibrillation (AF) recurrences and AF burden. All but one previous study was unblinded, raising the possibility of a placebo effect of catheter ablation.
Objective
This study aimed to compare PVI using pulsed field (PF) energy to a sham procedure in patients with symptomatic AF.
Methods
PFA-SHAM is a single-blind, randomized trial of symptomatic patients with paroxysmal or persistent AF, and an Atrial Fibrillation Effect On Quality-of-Life (AFEQT) questionnaire score ≤50. At enrollment, all patients receive an implantable cardiac monitor, and an electrophysiology study is scheduled 30 days later. After excluding supraventricular tachycardia as a cause of AF, patients are randomized to either sham or PVI using the pentaspline PF ablation catheter. The 2 co-primary outcomes are (1) freedom from recurrent AF, atrial tachycardia, or atrial flutter lasting >30 seconds, assessed as time to first recurrence (post 2-month blanking); and (2) change in quality of life according to the AFEQT score at 6-month post-ablation, compared between groups. Cross-over is permitted for patients with significant symptom worsening according to pre-specified rules. Key secondary outcomes include AF burden at 6 months, and differences in the Hospital Anxiety and Depression Scale, compared between groups.
Results
Enrollment in the study was initiated in September 2023. As of January 2025, 50 patients have been enrolled. Results are expected by the end of 2025.
Conclusion
This study compares PVI using PF energy to a sham procedure. The study will assess the effect of PVI on AF recurrences and quality of life.
{"title":"Pulsed field ablation vs sham ablation to treat atrial fibrillation (the PFA-SHAM trial)","authors":"Pavel Osmancik MD, PhD , Petr Neuzil MD, PhD , Tomas Karel PhD , Petr Waldauf MD, PhD , Jana Hozmanova MSc , Marek Hozman MD , Stepan Kralovec BS , Dalibor Herman MD, PhD , Jan Petru MD , Lucie Sediva MD , Jakub Fischer PhD , Lubomir Stepanek PhD , Ivana Mala PhD , William Whang MD , Vivek Y. Reddy MD","doi":"10.1016/j.hroo.2025.07.103","DOIUrl":"10.1016/j.hroo.2025.07.103","url":null,"abstract":"<div><h3>Background</h3><div>Compared with antiarrhythmic drugs, pulmonary vein isolation (PVI) reduces atrial fibrillation (AF) recurrences and AF burden. All but one previous study was unblinded, raising the possibility of a placebo effect of catheter ablation.</div></div><div><h3>Objective</h3><div>This study aimed to compare PVI using pulsed field (PF) energy to a sham procedure in patients with symptomatic AF.</div></div><div><h3>Methods</h3><div>PFA-SHAM is a single-blind, randomized trial of symptomatic patients with paroxysmal or persistent AF, and an Atrial Fibrillation Effect On Quality-of-Life (AFEQT) questionnaire score ≤50. At enrollment, all patients receive an implantable cardiac monitor, and an electrophysiology study is scheduled 30 days later. After excluding supraventricular tachycardia as a cause of AF, patients are randomized to either sham or PVI using the pentaspline PF ablation catheter. The 2 co-primary outcomes are (1) freedom from recurrent AF, atrial tachycardia, or atrial flutter lasting >30 seconds, assessed as time to first recurrence (post 2-month blanking); and (2) change in quality of life according to the AFEQT score at 6-month post-ablation, compared between groups. Cross-over is permitted for patients with significant symptom worsening according to pre-specified rules. Key secondary outcomes include AF burden at 6 months, and differences in the Hospital Anxiety and Depression Scale, compared between groups.</div></div><div><h3>Results</h3><div>Enrollment in the study was initiated in September 2023. As of January 2025, 50 patients have been enrolled. Results are expected by the end of 2025.</div></div><div><h3>Conclusion</h3><div>This study compares PVI using PF energy to a sham procedure. The study will assess the effect of PVI on AF recurrences and quality of life.</div></div><div><h3>Trial registration number</h3><div>NCT02426944</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1815-1824"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546474","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}
Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.08.032
Moses Mlawa MD, MMed , David G. Paulo MD, MMed , Peter Kisenge MD, MMed, MSc Cardio , Reuben Mutagaywa MD, MMed, MSc Cardio, PhD
Background
Globally, rheumatic heart disease (RHD) affects 30–70 million people, with 90% in developing nations. In Tanzania, the RHD burden is 1%–3%. Patients with RHD show neuropsychiatric manifestations such as cognitive impairment (CI), which affects quality of life, but research in Tanzania is lacking. This study aimed to fill this gap.
Objective
This study aimed to determine the burden of CI and its associated factors among patients with RHD at the Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania.
Methods
We conducted a hospital-based cross-sectional study at JKCI from November 2023 to February 2024. A sample of 216 patients with RHD 14 years or older provided informed consent or assent. Excluding those with preexisting mental illness, recruitment used consecutive sampling. A questionnaire collected sociodemographic and clinical data. The General Practitioner Assessment of Cognition tool assessed cognitive impairment. Data analysis used STATA version 15.1 (StataCorp LLC, College Station, TX). Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences and the JKCI Research and Ethics Committee.
Results
A total of 216 patients diagnosed with RHD were studied. The median age (interquartile range) was 27 (16.0–45.5) years, with a female predominance (51.4%, n = 111). More than half had attained a secondary level of education (56.9%, n = 123) and were insured (58.8%, n = 127), while less than half were employed (40.7%, n = 88). Regarding substance use, less than a quarter were cigarette smokers (5.6%, n = 12) and over a quarter were alcohol drinkers (28.2%, n = 61). The prevalence of cognitive impairment was 20.4% (n = 44). Old age (adjusted prevalence ratio [aPR] 1.04; 95% confidence interval 1.02–1.05; P < .0001), positive human immunodeficiency virus status (aPR 5.00; 95% confidence interval 1.85–13.53; P = .02), undernutrition (aPR 2.44; 95% confidence interval 1.39–4.29; P < .002), history of atrial fibrillation (aPR 3.16; 95% confidence interval 1.08–9.30; P = .036), and history of stroke (aPR 2.58; 95% confidence interval 1.43–4.68; P = .002) were independently associated with cognitive impairment.
Conclusion
Screening of all patients with RHD for cognitive impairment is recommended, particularly those with atrial fibrillation, human immunodeficiency virus, advanced age, undernutrition, and a history of stroke.
{"title":"Burden of cognitive impairment and its associated factors among patients with rheumatic heart disease at a tertiary cardiac center in Tanzania: A hospital-based cross-sectional study","authors":"Moses Mlawa MD, MMed , David G. Paulo MD, MMed , Peter Kisenge MD, MMed, MSc Cardio , Reuben Mutagaywa MD, MMed, MSc Cardio, PhD","doi":"10.1016/j.hroo.2025.08.032","DOIUrl":"10.1016/j.hroo.2025.08.032","url":null,"abstract":"<div><h3>Background</h3><div>Globally, rheumatic heart disease (RHD) affects 30–70 million people, with 90% in developing nations. In Tanzania, the RHD burden is 1%–3%. Patients with RHD show neuropsychiatric manifestations such as cognitive impairment (CI), which affects quality of life, but research in Tanzania is lacking. This study aimed to fill this gap.</div></div><div><h3>Objective</h3><div>This study aimed to determine the burden of CI and its associated factors among patients with RHD at the Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania.</div></div><div><h3>Methods</h3><div>We conducted a hospital-based cross-sectional study at JKCI from November 2023 to February 2024. A sample of 216 patients with RHD 14 years or older provided informed consent or assent. Excluding those with preexisting mental illness, recruitment used consecutive sampling. A questionnaire collected sociodemographic and clinical data. The General Practitioner Assessment of Cognition tool assessed cognitive impairment. Data analysis used STATA version 15.1 (StataCorp LLC, College Station, TX). Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences and the JKCI Research and Ethics Committee.</div></div><div><h3>Results</h3><div>A total of 216 patients diagnosed with RHD were studied. The median age (interquartile range) was 27 (16.0–45.5) years, with a female predominance (51.4%, n = 111). More than half had attained a secondary level of education (56.9%, n = 123) and were insured (58.8%, n = 127), while less than half were employed (40.7%, n = 88). Regarding substance use, less than a quarter were cigarette smokers (5.6%, n = 12) and over a quarter were alcohol drinkers (28.2%, n = 61). The prevalence of cognitive impairment was 20.4% (n = 44). Old age (adjusted prevalence ratio [aPR] 1.04; 95% confidence interval 1.02–1.05; <em>P</em> < .0001), positive human immunodeficiency virus status (aPR 5.00; 95% confidence interval 1.85–13.53; <em>P</em> = .02), undernutrition (aPR 2.44; 95% confidence interval 1.39–4.29; <em>P</em> < .002), history of atrial fibrillation (aPR 3.16; 95% confidence interval 1.08–9.30; <em>P</em> = .036), and history of stroke (aPR 2.58; 95% confidence interval 1.43–4.68; <em>P</em> = .002) were independently associated with cognitive impairment.</div></div><div><h3>Conclusion</h3><div>Screening of all patients with RHD for cognitive impairment is recommended, particularly those with atrial fibrillation, human immunodeficiency virus, advanced age, undernutrition, and a history of stroke.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1846-1852"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546479","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}
Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.08.029
Phaedra Locquet Msc , Eva Van Steijvoort PhD , Pascal Borry PhD , Zilke Claessens Msc , Margaux Reckelbus Msc , Tomas Robyns MD, PhD , Isabelle Huys PharmD, PhD
Background
The revised European Pharmaceutical Legislation emphasizes research and development for unmet medical needs. While gene therapies for arrhythmogenic cardiomyopathies (ACM) are advancing, insight into patients’ lived experiences remains limited.
Objective
This study identifies the unmet health-related needs of ACM carriers to guide policy, research, care, and treatment strategies.
Methods
A cross-sectional survey was conducted among ACM carriers in Belgium using convenience sampling. The Needs Examination, Evaluation, and Dissemination (NEED) framework guided the development of a multilingual (Dutch, French, English) questionnaire assessing health-, health care- and social needs among symptomatic (S) and asymptomatic (A) carriers. Data were collected anonymously via Lime Survey or post. Descriptive and Wilcoxon signed-rank tests were conducted.
Results
Of 112 participants (63 women, 49 men), most were over 40 years old (80%) and symptomatic (67%). Symptomatic carriers reported pain/discomfort (58%), daily activities limitations (51%), and anxiety/depression (49%), whereas asymptomatic carriers experienced anxiety/depression (30%). Despite high treatment satisfaction, half of participants found treatment burdensome, due to side effects (46%) and ongoing need to manage the condition (39%). Dissatisfaction centered on restrictions on competitive sports. Participants faced challenges with hobbies (S: 59%, A: 22%), reduced work intensity (S: 49%, A:19%), and financial consequences (S: 51%, A: 14%). Diagnostic delay of over 1 year persist (26%). Nearly half (45%) fulfilled their family planning before diagnosis, limiting informed reproductive choices. Moreover, 60% did not always receive useful information.
Conclusion
Unmet needs among ACM carriers remain, particularly regarding delayed diagnosis, treatment burden, psychological stress, reproductive decisions, and access to information. Future care and research should address these gaps to improve ACM carriers’ quality of life.
{"title":"Unmet health-related needs of heritable arrhythmogenic cardiomyopathy carriers in Belgium: The UR-HEART survey study","authors":"Phaedra Locquet Msc , Eva Van Steijvoort PhD , Pascal Borry PhD , Zilke Claessens Msc , Margaux Reckelbus Msc , Tomas Robyns MD, PhD , Isabelle Huys PharmD, PhD","doi":"10.1016/j.hroo.2025.08.029","DOIUrl":"10.1016/j.hroo.2025.08.029","url":null,"abstract":"<div><h3>Background</h3><div>The revised European Pharmaceutical Legislation emphasizes research and development for unmet medical needs. While gene therapies for arrhythmogenic cardiomyopathies (ACM) are advancing, insight into patients’ lived experiences remains limited.</div></div><div><h3>Objective</h3><div>This study identifies the unmet health-related needs of ACM carriers to guide policy, research, care, and treatment strategies.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted among ACM carriers in Belgium using convenience sampling. The Needs Examination, Evaluation, and Dissemination (NEED) framework guided the development of a multilingual (Dutch, French, English) questionnaire assessing health-, health care- and social needs among symptomatic (S) and asymptomatic (A) carriers. Data were collected anonymously via Lime Survey or post. Descriptive and Wilcoxon signed-rank tests were conducted.</div></div><div><h3>Results</h3><div>Of 112 participants (63 women, 49 men), most were over 40 years old (80%) and symptomatic (67%). Symptomatic carriers reported pain/discomfort (58%), daily activities limitations (51%), and anxiety/depression (49%), whereas asymptomatic carriers experienced anxiety/depression (30%). Despite high treatment satisfaction, half of participants found treatment burdensome, due to side effects (46%) and ongoing need to manage the condition (39%). Dissatisfaction centered on restrictions on competitive sports. Participants faced challenges with hobbies (S: 59%, A: 22%), reduced work intensity (S: 49%, A:19%), and financial consequences (S: 51%, A: 14%). Diagnostic delay of over 1 year persist (26%). Nearly half (45%) fulfilled their family planning before diagnosis, limiting informed reproductive choices. Moreover, 60% did not always receive useful information.</div></div><div><h3>Conclusion</h3><div>Unmet needs among ACM carriers remain, particularly regarding delayed diagnosis, treatment burden, psychological stress, reproductive decisions, and access to information. Future care and research should address these gaps to improve ACM carriers’ quality of life.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1773-1785"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546482","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}
SMART Pass (SP) deactivation is associated with inappropriate shock from a subcutaneous implantable cardioverter-defibrillator (S-ICD). A low-amplitude subcutaneous electrogram (S-ECG) is a risk factor for SP deactivation; however, the cause of the low-amplitude of S-ECG is unclear.
Objective
We aimed to investigate the relationship between the cardiac anatomical axis and S-ECG amplitude.
Methods
We retrospectively investigated 73 patients who underwent S-ICD implantation between 2016 and 2021 using computed tomography data. The cardiac anatomical axis was defined as the line connecting the summit of the inferior pyramidal space, where the atrioventricular node is supposed to be located, and the apex of the left ventricle. We assessed the relationship between rightward, horizontal, and ventral rotations and the amplitude of the S-ECG in each vector. The primary en d point was SP deactivation.
Results
There were significant correlations between rightward rotation and amplitude of the primary vector (R2 = 0.09, P = .002), rightward rotation and amplitude of the secondary vector (R2 = 0.12, P < .001), and ventral rotation and amplitude of the secondary vector (R2 = 0.06, P = .02). Ten patients experienced SP deactivation. The optimal cutoff value of rightward rotation for SP deactivation was 27° (area under the curve, 0.69; sensitivity, 0.90; specificity, 0.49; P = .02). Kaplan-Meier analysis revealed that patients with rightward rotation > 27° had a higher risk of SP deactivation (log-rank test, P = .02).
Conclusion
The cardiac anatomical axis and S-ECG amplitude are significantly correlated. Rightward rotation is a risk factor for SP deactivation.
背景：smart Pass （SP）失活与皮下植入式心律转复除颤器（S-ICD）引起的不适当电击有关。低振幅皮下电图（S-ECG）是SP失活的危险因素；但S-ECG低幅值的原因尚不清楚。目的探讨心脏解剖轴与S-ECG振幅的关系。方法回顾性分析2016 - 2021年间73例S-ICD植入术患者的ct资料。心脏解剖轴被定义为连接房室结所在的下锥体空间顶点和左心室顶点的线。我们评估了向右、水平和腹侧旋转与每个矢量S-ECG振幅之间的关系。主要终点是SP失活。结果主载体向右旋转与幅值（R2 = 0.09, P = 0.002）、副载体向右旋转与幅值（R2 = 0.12, P < 001）、副载体腹侧旋转与幅值（R2 = 0.06, P = 0.02）具有显著相关性。10例患者出现SP失活。右旋使SP失活的最佳截断值为27°（曲线下面积0.69，敏感性0.90，特异性0.49,P = 0.02）。Kaplan-Meier分析显示，右旋27°的患者有较高的SP失活风险（log-rank检验，P = 0.02）。结论心脏解剖轴与S-ECG振幅有显著相关性。向右旋转是SP失活的危险因素。
{"title":"Significance of 3-dimensional cardiac anatomical axis as the predictor of low QRS amplitude of subcutaneous implantable cardioverter-defibrillator","authors":"Yukihiro Uehara MD , Nobuhiko Ueda MD, PhD , Shumpei Mori MD, PhD , Takanori Kawabata MS , Kohei Ishibashi MD, PhD , Tsukasa Oshima MD, PhD , Toshihiro Nakamura MD, PhD , Satoshi Oka MD, PhD , Yuichiro Miyazaki 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 , Takeshi Aiba MD, PhD , Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.08.041","DOIUrl":"10.1016/j.hroo.2025.08.041","url":null,"abstract":"<div><h3>Background</h3><div>SMART Pass (SP) deactivation is associated with inappropriate shock from a subcutaneous implantable cardioverter-defibrillator (S-ICD). A low-amplitude subcutaneous electrogram (S-ECG) is a risk factor for SP deactivation; however, the cause of the low-amplitude of S-ECG is unclear.</div></div><div><h3>Objective</h3><div>We aimed to investigate the relationship between the cardiac anatomical axis and S-ECG amplitude.</div></div><div><h3>Methods</h3><div>We retrospectively investigated 73 patients who underwent S-ICD implantation between 2016 and 2021 using computed tomography data. The cardiac anatomical axis was defined as the line connecting the summit of the inferior pyramidal space, where the atrioventricular node is supposed to be located, and the apex of the left ventricle. We assessed the relationship between rightward, horizontal, and ventral rotations and the amplitude of the S-ECG in each vector. The primary en d point was SP deactivation.</div></div><div><h3>Results</h3><div>There were significant correlations between rightward rotation and amplitude of the primary vector (R<sup>2</sup> = 0.09, <em>P</em> = .002), rightward rotation and amplitude of the secondary vector (R<sup>2</sup> = 0.12, <em>P</em> < .001), and ventral rotation and amplitude of the secondary vector (R<sup>2</sup> = 0.06, <em>P</em> = .02). Ten patients experienced SP deactivation. The optimal cutoff value of rightward rotation for SP deactivation was 27° (area under the curve, 0.69; sensitivity, 0.90; specificity, 0.49; <em>P</em> = .02). Kaplan-Meier analysis revealed that patients with rightward rotation > 27° had a higher risk of SP deactivation (log-rank test, <em>P</em> = .02).</div></div><div><h3>Conclusion</h3><div>The cardiac anatomical axis and S-ECG amplitude are significantly correlated. Rightward rotation is a risk factor for SP deactivation.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1743-1751"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546957","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}
Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.08.028
Luis Quiñiñir MD, FACC, ECES , Pablo Salazar MD , Pasquale Santangeli MD, PhD
{"title":"Trans–right atrial access to the left ventricle for catheter ablation of ventricular tachycardia in a patient with double left-sided mechanical valves: First case report from Latin America","authors":"Luis Quiñiñir MD, FACC, ECES , Pablo Salazar MD , Pasquale Santangeli MD, PhD","doi":"10.1016/j.hroo.2025.08.028","DOIUrl":"10.1016/j.hroo.2025.08.028","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1843-1845"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546478","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}
The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients whose VOM is not visible.
Objective
We evaluated the feasibility of advancing a guidewire into previously non-visualized VOMs to extend the utility of EIVOM.
Methods
We included 249 patients with atrial fibrillation (AF) undergoing mitral isthmus (MI) ablation. If the VOM was not visualized by coronary sinus (CS) venography, we attempted to locate its entrance using a guidewire and double-coaxial guiding catheter technique at the Vieussens valve (VV). If unveiled, EIVOM was performed.
Results
CS venography visualized the VOM in 166 of 249 patients (67%). Among the remaining 83 patients, we successfully crossed a guidewire and unveiled previously non-visualized VOMs in 15 patients (18%). MI line block was fully achieved in 91% (146/160) of the visualized VOM group (A), 93% (14/15) of the unveiled VOM group (B), and 82% (61/74) of the non-EIVOM group (C) (A vs B, P = .78; A vs C, P < .05; B vs C, P = .29). However, no significant differences in AF recurrence were observed among the groups (A vs B, P = .84; A vs C, P = .63; B vs C, P = .68).
Conclusion
Using the VV as a landmark can enhance the feasibility of the EIVOM procedure. Despite this novel technique, EVIOM did not improve AF ablation outcomes. These findings regarding unveiled VOMs are preliminary, and are limited by the small sample size of this group.
背景乙醇输注到马歇尔静脉（EIVOM）的效用是有限的患者的VOM是不可见的。目的探讨将导丝推进到先前不可见的vom的可行性，以扩大EIVOM的应用范围。方法249例心房颤动（AF）患者行二尖瓣峡部（MI）消融术。如果冠脉窦（CS）静脉造影不能显示VOM，我们尝试在Vieussens瓣膜（VV）处使用导丝和双同轴引导导管技术定位其入口。如果被揭开，EIVOM就会被执行。结果249例患者中，有166例（67%）通过scs静脉造影显示VOM。在剩下的83例患者中，我们成功地穿过导丝，并在15例（18%）患者中发现了先前未可见的VOMs。显影VOM组(A) 91%（146/160）、未显影VOM组(B) 93%（14/15）、非eivom组(C) 82%（61/74）完全实现MI线阻滞（A vs B, P = 0.78; A vs C, P < 05; B vs C, P = 0.29）。然而，两组间房颤复发率无显著差异（A组vs B组，P = 0.84； A组vs C组，P = 0.63； B组vs C组，P = 0.68）。结论以VV为标志可提高EIVOM手术的可行性。尽管这项新技术，EVIOM并没有改善房颤消融的结果。这些关于暴露的VOMs的发现是初步的，并且受到该组小样本量的限制。
{"title":"A novel approach to enhance ethanol infusion utility in the non-visualized vein of Marshall","authors":"Masayuki Ishimura MD, PhD , Yuto Watanabe MD , Masanao Matsuno MD , Akiko Yoshimori CE , Masashi Yamamoto MD, PhD , Toshiharu Himi MD, PhD , Yoshio Kobayashi MD, PhD","doi":"10.1016/j.hroo.2025.08.005","DOIUrl":"10.1016/j.hroo.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients whose VOM is not visible.</div></div><div><h3>Objective</h3><div>We evaluated the feasibility of advancing a guidewire into previously non-visualized VOMs to extend the utility of EIVOM.</div></div><div><h3>Methods</h3><div>We included 249 patients with atrial fibrillation (AF) undergoing mitral isthmus (MI) ablation. If the VOM was not visualized by coronary sinus (CS) venography, we attempted to locate its entrance using a guidewire and double-coaxial guiding catheter technique at the Vieussens valve (VV). If unveiled, EIVOM was performed.</div></div><div><h3>Results</h3><div>CS venography visualized the VOM in 166 of 249 patients (67%). Among the remaining 83 patients, we successfully crossed a guidewire and unveiled previously non-visualized VOMs in 15 patients (18%). MI line block was fully achieved in 91% (146/160) of the visualized VOM group (A), 93% (14/15) of the unveiled VOM group (B), and 82% (61/74) of the non-EIVOM group (C) (A vs B, <em>P =</em> .78; A vs C, <em>P <</em> .05; B vs C, <em>P =</em> .29). However, no significant differences in AF recurrence were observed among the groups (A vs B, <em>P =</em> .84; A vs C, <em>P =</em> .63; B vs C, <em>P =</em> .68).</div></div><div><h3>Conclusion</h3><div>Using the VV as a landmark can enhance the feasibility of the EIVOM procedure. Despite this novel technique, EVIOM did not improve AF ablation outcomes. These findings regarding unveiled VOMs are preliminary, and are limited by the small sample size of this group.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1696-1705"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546944","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}
Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.07.018
Prashanthan Sanders MBBS, PhD, FHRS , Jonathan P. Ariyaratnam MB BChir, PhD , Alexis Puvrez MD, PhD , Melissa E. Middeldorp MPH, PhD , Stephen J. Nicholls MBBS, PhD , Gijo Thomas PhD , Anand Ganesan MBBS, PhD , Vincent Paul MBBS, PhD , Stuart P. Thomas MBBS, PhD , Walter P. Abhayaratna MBBS, PhD , Martin K. Stiles MBBS, PhD, FHRS , Jonathan M. Kalman MBBS, PhD, FHRS
Background
Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) and QRS prolongation on electrocardiogram. However, patients with atrial fibrillation (AF) appear to benefit less from CRT compared to patients in sinus rhythm. Atrioventricular (AV) node ablation has been shown in observational studies to improve the efficacy of CRT in patients with AF.
Objective
We aimed to evaluate the effect of AV node ablation on CRT efficacy in patients with permanent AF.
Methods
Participants with permanent AF and a reduced left ventricular ejection fraction (≤35%) who receive a CRT-defibrillator are randomized in a 1:1 fashion to AV node ablation or medical rate control for treatment of AF. A sample size of 590 participants allows a detection of a 25% reduction in the primary end point at 80% power.
Results
The primary end point is a composite of all-cause mortality and non-fatal HF events after 2 years of follow-up. The secondary end points include all-cause mortality, cardiovascular mortality, non-fatal HF events, 6-minute walking distance, quality-of-life, unscheduled hospitalizations, ventricular arrhythmias requiring device therapies, and biventricular pacing percentage.
Conclusion
The CRT And AV Node ablation trial in AF (CAAN-AF) will be the first randomized controlled trial to investigate the effect of AV node ablation on CRT efficacy in patients with AF and HFrEF. The results will guide physicians regarding the use of AV node ablation for patients with CRT and AF.
{"title":"Cardiac resynchronization therapy and AV node ablation in heart failure with reduced ejection fraction and atrial fibrillation: Rationale and design of the CAAN-AF trial","authors":"Prashanthan Sanders MBBS, PhD, FHRS , Jonathan P. Ariyaratnam MB BChir, PhD , Alexis Puvrez MD, PhD , Melissa E. Middeldorp MPH, PhD , Stephen J. Nicholls MBBS, PhD , Gijo Thomas PhD , Anand Ganesan MBBS, PhD , Vincent Paul MBBS, PhD , Stuart P. Thomas MBBS, PhD , Walter P. Abhayaratna MBBS, PhD , Martin K. Stiles MBBS, PhD, FHRS , Jonathan M. Kalman MBBS, PhD, FHRS","doi":"10.1016/j.hroo.2025.07.018","DOIUrl":"10.1016/j.hroo.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) and QRS prolongation on electrocardiogram. However, patients with atrial fibrillation (AF) appear to benefit less from CRT compared to patients in sinus rhythm. Atrioventricular (AV) node ablation has been shown in observational studies to improve the efficacy of CRT in patients with AF.</div></div><div><h3>Objective</h3><div>We aimed to evaluate the effect of AV node ablation on CRT efficacy in patients with permanent AF.</div></div><div><h3>Methods</h3><div>Participants with permanent AF and a reduced left ventricular ejection fraction (≤35%) who receive a CRT-defibrillator are randomized in a 1:1 fashion to AV node ablation or medical rate control for treatment of AF. A sample size of 590 participants allows a detection of a 25% reduction in the primary end point at 80% power.</div></div><div><h3>Results</h3><div>The primary end point is a composite of all-cause mortality and non-fatal HF events after 2 years of follow-up. The secondary end points include all-cause mortality, cardiovascular mortality, non-fatal HF events, 6-minute walking distance, quality-of-life, unscheduled hospitalizations, ventricular arrhythmias requiring device therapies, and biventricular pacing percentage.</div></div><div><h3>Conclusion</h3><div>The CRT And AV Node ablation trial in AF (CAAN-AF) will be the first randomized controlled trial to investigate the effect of AV node ablation on CRT efficacy in patients with AF and HFrEF. The results will guide physicians regarding the use of AV node ablation for patients with CRT and AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1828-1836"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546476","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}
Although cardiac computed tomography (CT) provides detailed anatomical information on the left atrial (LA), few studies have examined whether it can distinguish paroxysmal atrial fibrillation (PAF) from persistent atrial fibrillation (PerAF) based on structural features in an interpretable manner.
Objective
To develop a convolutional neural network (CNN) model trained on LA morphology derived from cardiac CT for classifying atrial fibrillation (AF) subtypes and to identify spatial remodeling patterns associated with PerAF to enhance understanding of AF progression.
Methods
We developed 3 types of 3-dimensional CNN to classify AF subtypes using cardiac CT-derived LA morphology. A total of 269 patients were used for model development with stratified 10-fold cross-validation. External validation was conducted in 151 independent patients. CNN performance was compared with LA volume and LA volume index from echocardiography and CT. We used gradient-weighted class activation mapping to identify regional remodeling patterns associated with predictions.
Results
Among the 3-dimensional-CNN, the 3D-DenseNet201 model achieved the highest performance in internal validation (area under the receiver operating characteristic curve 0.81 ± 0.08; accuracy 77.0 ± 6.2%) and maintained consistent accuracy in external validation (area under the receiver operating characteristic curve 0.81 ± 0.01; accuracy 76.7 ± 1.6%). gradient-weighted class activation mapping revealed that PerAF classification was primarily driven by activation in the anterosuperior LA wall (72.8%), right superior pulmonary vein antrum (49.4%), and septum (44.3%). The posterior wall showed minimal activation. CNN outperformed echocardiographic or CT-derived volume metrics.
Conclusion
The 3D-DenseNet201 model accurately classified AF subtypes and localized structural remodeling patterns relevant to PerAF. These findings highlight the potential of deep learning to improve the mechanistic understanding of AF progression.
{"title":"Development and validation of explainable deep learning models for classification of atrial fibrillation subtypes using cardiac computed tomography","authors":"Kazuya Takeda MSc , Yoshihiro Sobue MD, PhD , Hitoshi Matsuo MD, PhD , Eiichi Watanabe MD, PhD , Shigeki Kobayashi MD, PhD","doi":"10.1016/j.hroo.2025.08.031","DOIUrl":"10.1016/j.hroo.2025.08.031","url":null,"abstract":"<div><h3>Background</h3><div>Although cardiac computed tomography (CT) provides detailed anatomical information on the left atrial (LA), few studies have examined whether it can distinguish paroxysmal atrial fibrillation (PAF) from persistent atrial fibrillation (PerAF) based on structural features in an interpretable manner.</div></div><div><h3>Objective</h3><div>To develop a convolutional neural network (CNN) model trained on LA morphology derived from cardiac CT for classifying atrial fibrillation (AF) subtypes and to identify spatial remodeling patterns associated with PerAF to enhance understanding of AF progression.</div></div><div><h3>Methods</h3><div>We developed 3 types of 3-dimensional CNN to classify AF subtypes using cardiac CT-derived LA morphology. A total of 269 patients were used for model development with stratified 10-fold cross-validation. External validation was conducted in 151 independent patients. CNN performance was compared with LA volume and LA volume index from echocardiography and CT. We used gradient-weighted class activation mapping to identify regional remodeling patterns associated with predictions.</div></div><div><h3>Results</h3><div>Among the 3-dimensional-CNN, the 3D-DenseNet201 model achieved the highest performance in internal validation (area under the receiver operating characteristic curve 0.81 ± 0.08; accuracy 77.0 ± 6.2%) and maintained consistent accuracy in external validation (area under the receiver operating characteristic curve 0.81 ± 0.01; accuracy 76.7 ± 1.6%). gradient-weighted class activation mapping revealed that PerAF classification was primarily driven by activation in the anterosuperior LA wall (72.8%), right superior pulmonary vein antrum (49.4%), and septum (44.3%). The posterior wall showed minimal activation. CNN outperformed echocardiographic or CT-derived volume metrics.</div></div><div><h3>Conclusion</h3><div>The 3D-DenseNet201 model accurately classified AF subtypes and localized structural remodeling patterns relevant to PerAF. These findings highlight the potential of deep learning to improve the mechanistic understanding of AF progression.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1796-1806"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546591","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}
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