Heart Rhythm O2最新文献

英文中文

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

引用次数: 0

Cardiac lead perforation: Mechanisms, detection, and therapeutic approaches 心脏导联穿孔：机制、检测和治疗方法

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.08.008

Ameer Awashra MD , Mohammed AbuBaha MD , Hossam Salameh MD , Hammam Jallad MD , Aya Milhem MD , Anwar Zahran MD , Aseel Badwan MD , Fathi Milhem MD , Abdalhakim Shubietah MD

Cardiac lead perforation is an infrequent but serious complication of cardiac implantable electronic devices, with possibly lethal consequences if left untreated. Because of its very varied clinical appearance and lack of established criteria, perforation still presents diagnostic and therapeutic hurdles despite continuous improvements in lead design and insertion procedures. This review summarizes current research on the processes, risk factors, and clinical range of lead perforation. Thin myocardial walls, especially at the right ventricular apex; active-fixation leads; and operator-dependent elements, such as lead placement and torque, are important anatomic and procedural contributions. Steroid usage, low body mass index, and female sex all increase risk. A strong index of suspicion is often required for prompt diagnosis because presentations vary from asymptomatic instances to severe tamponade. Device interrogation must be integrated with imaging modalities, particularly computed tomography and echocardiography, which each have unique benefits based on the clinical setting, to achieve accurate detection. From cautious observation in stable patients to immediate percutaneous or surgical intervention in unstable or worsening situations, management approaches are highly customized. New technologies, including subcutaneous implantable cardioverter-defibrillators and leadless pacemakers, have the potential to lower the incidence of perforations, but they also present new difficulties that need to be further investigated. Importantly, the lack of consistent diagnostic standards hinders study/ comparability and postpones the creation of guidelines. Standardizing diagnostic criteria, establishing multicenter prospective registries, developing machine learning-based risk stratification tools, and conducting clinical trials to inform the treatment of asymptomatic or delayed perforations are among the top goals for the future. To improve patient outcomes and advance clinical practice, international cooperation and uniform reporting standards are crucial.

心导联穿孔是一种罕见但严重的心脏植入式电子设备并发症，如果不及时治疗可能导致致命后果。尽管导联设计和插入方法不断改进，但由于穿孔的临床表现非常多样，且缺乏确定的标准，因此仍然存在诊断和治疗障碍。本文综述了目前关于铅穿孔的过程、危险因素和临床范围的研究。心肌壁薄，尤其是右心室尖部；active-fixation领导;与操作人员相关的因素，如引线放置和扭矩，是重要的解剖和程序贡献。使用类固醇、低体重指数和女性都会增加患病风险。由于表现从无症状到严重的填塞不等，因此经常需要强烈的怀疑指数来迅速诊断。设备检查必须与成像模式相结合，特别是计算机断层扫描和超声心动图，它们各自具有基于临床环境的独特优势，以实现准确的检测。从稳定患者的谨慎观察到不稳定或恶化情况下的立即经皮或手术干预，管理方法都是高度定制的。包括皮下植入式心律转复除颤器和无导线起搏器在内的新技术有可能降低穿孔的发生率，但它们也带来了新的困难，需要进一步研究。重要的是，缺乏一致的诊断标准阻碍了研究/可比性，并推迟了指南的制定。标准化诊断标准，建立多中心前瞻性注册，开发基于机器学习的风险分层工具，并进行临床试验，以告知无症状或延迟穿孔的治疗是未来的首要目标。为了改善患者的治疗效果和推进临床实践，国际合作和统一的报告标准至关重要。

{"title":"Cardiac lead perforation: Mechanisms, detection, and therapeutic approaches","authors":"Ameer Awashra MD , Mohammed AbuBaha MD , Hossam Salameh MD , Hammam Jallad MD , Aya Milhem MD , Anwar Zahran MD , Aseel Badwan MD , Fathi Milhem MD , Abdalhakim Shubietah MD","doi":"10.1016/j.hroo.2025.08.008","DOIUrl":"10.1016/j.hroo.2025.08.008","url":null,"abstract":"<div><div>Cardiac lead perforation is an infrequent but serious complication of cardiac implantable electronic devices, with possibly lethal consequences if left untreated. Because of its very varied clinical appearance and lack of established criteria, perforation still presents diagnostic and therapeutic hurdles despite continuous improvements in lead design and insertion procedures. This review summarizes current research on the processes, risk factors, and clinical range of lead perforation. Thin myocardial walls, especially at the right ventricular apex; active-fixation leads; and operator-dependent elements, such as lead placement and torque, are important anatomic and procedural contributions. Steroid usage, low body mass index, and female sex all increase risk. A strong index of suspicion is often required for prompt diagnosis because presentations vary from asymptomatic instances to severe tamponade. Device interrogation must be integrated with imaging modalities, particularly computed tomography and echocardiography, which each have unique benefits based on the clinical setting, to achieve accurate detection. From cautious observation in stable patients to immediate percutaneous or surgical intervention in unstable or worsening situations, management approaches are highly customized. New technologies, including subcutaneous implantable cardioverter-defibrillators and leadless pacemakers, have the potential to lower the incidence of perforations, but they also present new difficulties that need to be further investigated. Importantly, the lack of consistent diagnostic standards hinders study/ comparability and postpones the creation of guidelines. Standardizing diagnostic criteria, establishing multicenter prospective registries, developing machine learning-based risk stratification tools, and conducting clinical trials to inform the treatment of asymptomatic or delayed perforations are among the top goals for the future. To improve patient outcomes and advance clinical practice, international cooperation and uniform reporting standards are crucial.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 156-170"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969323","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

Initial experience with the extravascular implantable cardioverter-defibrillator in pediatric patients 儿童患者血管外植入式心律转复除颤器的初步经验

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.020

Mark Walsh MD , Ciara Ryan MD , Terence Prendiville MD , Frank Casey MD , Brian McCrossan MD , Colin McMahon MD , Kevin P. Walsh MD

Background

There is growing experience worldwide with the extravascular implantable cardioverter-defibrillator (EV-ICD). It is a single-lead implantable cardioverter-defibrillator that is implanted behind the sternum and can provide emergency pacing.

Objective

We describe the initial experience of 12 implantations in pediatric patients at our hospital.

Methods

The data on all Aurora EV-ICD (Medtronic) implantations from a single center from May 2024 to April 2025 were reviewed. Patient demographics, procedural characteristics, complications, outcome data, and device follow-up data were reviewed. The data are presented as medians and ranges.

Results

A total of 12 patients underwent implantation of the EV-ICD. The median age at the time of implantation was 14.5 years (9–16 years), and the median weight was 51 kg (27–82 kg). All patients underwent successful implantation. There was 1 pleural lead placement, which was rectified 5 days later; there were no other complications. The median procedure time was 1 hour and 50 minutes (range 1 hour and 43 minutes to 2 hours and 14 minutes), and the median fluoroscopy time was 2 minutes and 12 seconds (range 1 minute and 34 seconds to 3 minutes and 23 seconds). Except for the lead repositioning, no patients required extraction of the device to date, nor have any received inappropriate shocks. Device parameters such as sensing and impedance remained stable over time.

Conclusion

The EV-ICD can safely be implanted in pediatric patients with good short-term results. Further studies are required to establish the longer-term safety of the device in young people.

在世界范围内，血管外植入式心律转复除颤器（EV-ICD）的应用越来越广泛。它是一种单导联植入式心律转复除颤器，植入胸骨后方，可提供紧急起搏。目的介绍我院12例小儿植入术的初步经验。方法回顾2024年5月至2025年4月同一中心所有Aurora EV-ICD（美敦力）植入的数据。回顾了患者人口统计学、手术特征、并发症、结局数据和器械随访数据。数据以中位数和范围表示。结果12例患者成功植入EV-ICD。植入时的中位年龄为14.5岁（9-16岁），中位体重为51公斤（27-82公斤）。所有患者均成功植入。1例胸膜铅置入，5 d后予以纠正；没有其他并发症。中位手术时间为1小时50分钟（范围为1小时43分钟至2小时14分钟），中位透视时间为2分12秒（范围为1分34秒至3分23秒）。除导联复位外，迄今为止没有患者需要拔出装置，也没有患者受到不适当的电击。器件参数如传感和阻抗随时间保持稳定。结论EV-ICD可安全植入儿科患者，近期效果良好。需要进一步的研究来确定该设备在年轻人中的长期安全性。

{"title":"Initial experience with the extravascular implantable cardioverter-defibrillator in pediatric patients","authors":"Mark Walsh MD , Ciara Ryan MD , Terence Prendiville MD , Frank Casey MD , Brian McCrossan MD , Colin McMahon MD , Kevin P. Walsh MD","doi":"10.1016/j.hroo.2025.10.020","DOIUrl":"10.1016/j.hroo.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>There is growing experience worldwide with the extravascular implantable cardioverter-defibrillator (EV-ICD). It is a single-lead implantable cardioverter-defibrillator that is implanted behind the sternum and can provide emergency pacing.</div></div><div><h3>Objective</h3><div>We describe the initial experience of 12 implantations in pediatric patients at our hospital.</div></div><div><h3>Methods</h3><div>The data on all Aurora EV-ICD (Medtronic) implantations from a single center from May 2024 to April 2025 were reviewed. Patient demographics, procedural characteristics, complications, outcome data, and device follow-up data were reviewed. The data are presented as medians and ranges.</div></div><div><h3>Results</h3><div>A total of 12 patients underwent implantation of the EV-ICD. The median age at the time of implantation was 14.5 years (9–16 years), and the median weight was 51 kg (27–82 kg). All patients underwent successful implantation. There was 1 pleural lead placement, which was rectified 5 days later; there were no other complications. The median procedure time was 1 hour and 50 minutes (range 1 hour and 43 minutes to 2 hours and 14 minutes), and the median fluoroscopy time was 2 minutes and 12 seconds (range 1 minute and 34 seconds to 3 minutes and 23 seconds). Except for the lead repositioning, no patients required extraction of the device to date, nor have any received inappropriate shocks. Device parameters such as sensing and impedance remained stable over time.</div></div><div><h3>Conclusion</h3><div>The EV-ICD can safely be implanted in pediatric patients with good short-term results. Further studies are required to establish the longer-term safety of the device in young people.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 103-108"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969363","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

In-hospital outcomes of catheter ablation for ventricular tachycardia in patients with prior coronary artery bypass grafting 既往冠状动脉旁路移植术患者室性心动过速导管消融的住院疗效

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.09.001

Mahmoud Eisa MD, FHRS , Hossam Elbenawi MD , Magdi Zordok MD , Ehab Hassan Hady MD , Riyadh Saif MD , Amir Hanafi MD , Mohan Rao MD , Harsh Patel MD, FHRS , Justin Z. Lee MD , Abhishek J. Deshmukh MD , Christopher V. DeSimone MD, PhD, FHRS

Background

Catheter ablation is an established therapy for recurrent ventricular tachycardia (VT). However, outcomes in patients with prior coronary artery bypass grafting (CABG) remain poorly defined.

Objective

This study aimed to evaluate in-hospital outcomes following VT ablation in patients with and without a history of CABG.

Methods

We used the National Inpatient Sample database (2008–2022) to identify adults with a primary diagnosis of VT who underwent ablation. Patients were stratified by prior CABG status. Propensity score weighting (PSW) was applied to adjust for baseline characteristics. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications and measures of health care utilization. A subgroup analysis was performed for patients with coronary artery disease (CAD).

Results

Among 35,860 patients undergoing VT ablation, 18.2% had a history of CABG. After PSW, in-hospital mortality was similar between CABG and non-CABG groups (2.0% vs 2.3%, P = 0.771). Prior CABG was associated with higher rates of cardiac arrest (2.2% vs 1.1%, P = 0.03) and acute myocardial infarction (AMI) (5.2% vs 2.7%, P = 0.014), but lower rates of pericardial complications (0.9% vs 7.3%, P < 0.001). In the CAD subgroup, the association between CABG and AMI was attenuated and trended toward a higher incidence in the CABG group.

Conclusion

In this national cohort, prior CABG was not associated with increased in-hospital mortality or major complications after VT ablation. Patients who underwent CABG experienced higher rates of AMI and cardiac arrest but fewer pericardial complications. In a CAD- subgroup, the AMI association was attenuated and trended in the same direction.

背景：导管消融是复发性室性心动过速（VT）的常用治疗方法。然而，既往冠状动脉旁路移植术（CABG）患者的预后仍然不明确。目的：本研究旨在评估有和无冠脉搭桥病史患者行室速消融后的住院结果。方法：我们使用国家住院患者样本数据库（2008-2022）来识别初步诊断为室性心动过速的接受消融术的成年人。患者按既往冠脉搭桥状态分层。倾向得分加权（PSW）用于调整基线特征。主要终点是住院死亡率。次要结局包括手术并发症和医疗保健利用措施。对冠状动脉疾病（CAD）患者进行亚组分析。结果35860例接受房室消融术的患者中，18.2%有冠脉搭桥病史。PSW后，CABG组和非CABG组的住院死亡率相似（2.0% vs 2.3%, P = 0.771）。先前CABG与心脏骤停（2.2%对1.1%,P = 0.03）和急性心肌梗死（AMI）（5.2%对2.7%,P = 0.014）发生率较高相关，但心包并发症发生率较低（0.9%对7.3%,P < 0.001）。在CAD亚组中，CABG和AMI之间的相关性减弱，并且在CABG组中呈较高发生率的趋势。结论：在这个国家队列中，先前的冠状动脉搭桥与VT消融后住院死亡率或主要并发症的增加无关。接受CABG的患者AMI和心脏骤停的发生率较高，但心包并发症较少。在CAD亚组中，AMI相关性减弱，且呈相同趋势。

{"title":"In-hospital outcomes of catheter ablation for ventricular tachycardia in patients with prior coronary artery bypass grafting","authors":"Mahmoud Eisa MD, FHRS , Hossam Elbenawi MD , Magdi Zordok MD , Ehab Hassan Hady MD , Riyadh Saif MD , Amir Hanafi MD , Mohan Rao MD , Harsh Patel MD, FHRS , Justin Z. Lee MD , Abhishek J. Deshmukh MD , Christopher V. DeSimone MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.09.001","DOIUrl":"10.1016/j.hroo.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Catheter ablation is an established therapy for recurrent ventricular tachycardia (VT). However, outcomes in patients with prior coronary artery bypass grafting (CABG) remain poorly defined.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate in-hospital outcomes following VT ablation in patients with and without a history of CABG.</div></div><div><h3>Methods</h3><div>We used the National Inpatient Sample database (2008–2022) to identify adults with a primary diagnosis of VT who underwent ablation. Patients were stratified by prior CABG status. Propensity score weighting (PSW) was applied to adjust for baseline characteristics. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications and measures of health care utilization. A subgroup analysis was performed for patients with coronary artery disease (CAD).</div></div><div><h3>Results</h3><div>Among 35,860 patients undergoing VT ablation, 18.2% had a history of CABG. After PSW, in-hospital mortality was similar between CABG and non-CABG groups (2.0% vs 2.3%, <em>P =</em> 0.771). Prior CABG was associated with higher rates of cardiac arrest (2.2% vs 1.1%, <em>P =</em> 0.03) and acute myocardial infarction (AMI) (5.2% vs 2.7%, <em>P =</em> 0.014), but lower rates of pericardial complications (0.9% vs 7.3%, <em>P <</em> 0.001). In the CAD subgroup, the association between CABG and AMI was attenuated and trended toward a higher incidence in the CABG group.</div></div><div><h3>Conclusion</h3><div>In this national cohort, prior CABG was not associated with increased in-hospital mortality or major complications after VT ablation. Patients who underwent CABG experienced higher rates of AMI and cardiac arrest but fewer pericardial complications. In a CAD- subgroup, the AMI association was attenuated and trended in the same direction.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 109-118"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969364","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

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

引用次数: 0

Early prediction of the efficacy of local epicardial radiofrequency ablation for the robotic treatment of persistent atrial fibrillation 早期预测局部心外膜射频消融在机器人治疗持续性心房颤动中的疗效

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.003

Daniele Salvi MS , Eduardo Celentano MD, FHRS , Ernesto Cristiano MD , Stefano Schena MD , Alfonso Agnino MD , Ettore Lanzarone MS, PhD

Background

Early prediction of the efficacy of local epicardial radiofrequency ablation (LERFA) is crucial for optimizing the robotic treatment of persistent atrial fibrillation.

Objective

This study aimed to develop a machine learning model that accurately predicts LERFA efficacy within the first 5 seconds of the procedure, to stop ineffective procedures and reduce unnecessary cardiac tissue damage.

Methods

Impedance data from 92 patients who underwent robotic LERFA were analyzed, with a total of 2486 LERFAs included in the final dataset. LERFA efficacy predictors, including zero-time impedance value, slope, and harmonic components, were extracted from the first 5 seconds of each time-impedance curve. Several supervised machine learning approaches were then tested to predict LERFA efficacy.

Results

Random Forest demonstrated the highest performance, achieving 94.5% accuracy, 88.3% sensibility, and 97.2% specificity. This Random Forest model significantly outperformed the benchmark approach based on the zero-time impedance value alone, which achieved an accuracy of only 55.6% and a specificity of only 37.7%.

Conclusion

The developed model enables fast and accurate prediction of LERFA efficacy, potentially reducing the number of completed LERFAs by 56.8%. This reduction results in minimal damage to cardiac tissue, a lower risk of complications, a reduction in operating time, and greater precision and safety in the ablation process.

背景：准确预测局部心外膜射频消融（LERFA）的疗效对于优化机器人治疗持续性心房颤动至关重要。本研究旨在开发一种机器学习模型，在手术前5秒内准确预测LERFA的疗效，以停止无效的手术并减少不必要的心脏组织损伤。方法分析92例接受机器人LERFA的患者的阻抗数据，最终数据集中共纳入2486例LERFA。从每个时间-阻抗曲线的前5秒提取LERFA疗效预测因子，包括零时间阻抗值、斜率和谐波分量。然后测试了几种有监督的机器学习方法来预测LERFA的有效性。结果随机森林的准确率为94.5%，敏感性为88.3%，特异性为97.2%。该随机森林模型明显优于仅基于零时间阻抗值的基准方法，其准确率仅为55.6%，特异性仅为37.7%。结论所建立的模型能够快速准确地预测LERFA的疗效，可将完成的LERFA数量减少56.8%。这种减少导致对心脏组织的损伤最小，并发症风险较低，手术时间缩短，消融过程更加精确和安全。

{"title":"Early prediction of the efficacy of local epicardial radiofrequency ablation for the robotic treatment of persistent atrial fibrillation","authors":"Daniele Salvi MS , Eduardo Celentano MD, FHRS , Ernesto Cristiano MD , Stefano Schena MD , Alfonso Agnino MD , Ettore Lanzarone MS, PhD","doi":"10.1016/j.hroo.2025.10.003","DOIUrl":"10.1016/j.hroo.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Early prediction of the efficacy of local epicardial radiofrequency ablation (LERFA) is crucial for optimizing the robotic treatment of persistent atrial fibrillation.</div></div><div><h3>Objective</h3><div>This study aimed to develop a machine learning model that accurately predicts LERFA efficacy within the first 5 seconds of the procedure, to stop ineffective procedures and reduce unnecessary cardiac tissue damage.</div></div><div><h3>Methods</h3><div>Impedance data from 92 patients who underwent robotic LERFA were analyzed, with a total of 2486 LERFAs included in the final dataset. LERFA efficacy predictors, including zero-time impedance value, slope, and harmonic components, were extracted from the first 5 seconds of each time-impedance curve. Several supervised machine learning approaches were then tested to predict LERFA efficacy.</div></div><div><h3>Results</h3><div>Random Forest demonstrated the highest performance, achieving 94.5% accuracy, 88.3% sensibility, and 97.2% specificity. This Random Forest model significantly outperformed the benchmark approach based on the zero-time impedance value alone, which achieved an accuracy of only 55.6% and a specificity of only 37.7%.</div></div><div><h3>Conclusion</h3><div>The developed model enables fast and accurate prediction of LERFA efficacy, potentially reducing the number of completed LERFAs by 56.8%. This reduction results in minimal damage to cardiac tissue, a lower risk of complications, a reduction in operating time, and greater precision and safety in the ablation process.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 2-8"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969326","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

Atrial fibrillation detection performance of an insertable cardiac monitor: Results from an Assert-IQ post-market clinical study and a novel artificial intelligence algorithm 一种可插入心脏监护仪的房颤检测性能：来自Assert-IQ上市后临床研究和一种新的人工智能算法的结果

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.10.021

Ulrika Birgersdotter-Green MD, FHRS , Willibaldo Ojeda MD , Harish Manyam MD , Alvaro Manrique Garcia MD , George E. Manoukian MD , Mohammad-Ali Jazayeri MD , Frank Cuoco MD, MBA, MS , Frederick Han MD, FACC, FHRS , Michael Katcher MD, FHRS , Rakesh Gopinathannair MD, MA, FAHA, FHRS , Dale Yoo MD , Lin Feng PhD , Fujian Qu DSc , Wenjiao Lin MS , Kwangdeok Lee PhD , Vishnu Charan MS, MBA , Suneet Mittal MD, FACC, FHRS , Dhanunjaya Lakkireddy MD, MBA, FHRS

Background

Accurate atrial fibrillation (AF) detection and burden assessment are critical features of modern insertable cardiac monitors (ICMs), enabling precise determination of AF episode patterns, frequency, duration, and total burden to guide treatments.

Objective

This study aimed to evaluate the AF detection performance of the Assert-IQ ICM and assess the impact of an artificial intelligence (AI) algorithm designed for reducing false-positive AF episodes.

Methods

This prospective, single-arm, multicenter study enrolled 151 subjects with symptomatic, drug-refractory paroxysmal or persistent AF. A Holter assessment was conducted after ICM insertion. AF detection metrics—sensitivity, specificity, positive predictive value (PPV), and negative predictive value—were evaluated by comparing ICM detections with core laboratory–annotated Holter AF events. The impact of an AI algorithm on AF detection performance was then assessed.

Results

Among 135 analyzable patients, 39 had Holter-confirmed AF with 522 episodes lasting ≥2 minutes. Assert-IQ ICM correctly identified all patients with true AF. Duration-based sensitivity, specificity, PPV, negative predictive value, and accuracy were 93.0%, 99.3%, 97.4%, 98.0%, and 97.9%, respectively. Episode detection sensitivity was 99.4% (gross) and 99.9% (patient average). AF burden correlation between ICM and Holter was excellent (r = 0.99). The AI algorithm retained all true positives and reduced 72.6% of false positives, improving PPV from 79.9% to 93.6%.

Conclusion

Assert-IQ ICM accurately detects AF and quantifies burden for long-term monitoring. The AI algorithm effectively reduces false positives while maintaining high sensitivity.

准确的心房颤动（AF）检测和负担评估是现代可插入式心脏监护仪（ICMs）的关键特征，能够精确确定AF发作模式、频率、持续时间和总负担，以指导治疗。目的本研究旨在评估Assert-IQ ICM的AF检测性能，并评估人工智能（AI）算法对减少AF假阳性发作的影响。方法：本前瞻性、单臂、多中心研究纳入151例有症状、药物难治性阵发性或持续性房颤患者。置入ICM后进行动态心电图评估。通过比较ICM检测与核心实验室注释的Holter AF事件，评估AF检测指标-敏感性，特异性，阳性预测值（PPV）和阴性预测值。然后评估人工智能算法对自动对焦检测性能的影响。结果135例可分析患者中，39例为霍尔特确诊房颤，522例发作时间≥2分钟。Assert-IQ ICM正确识别出所有真正的房颤患者。基于病程的敏感性、特异性、PPV、阴性预测值和准确性分别为93.0%、99.3%、97.4%、98.0%和97.9%。发作检测灵敏度为99.4%（总）和99.9%（患者平均）。ICM与Holter的心房颤动负荷相关性极好（r = 0.99）。人工智能算法保留了所有真阳性，减少了72.6%的假阳性，将PPV从79.9%提高到93.6%。结论assert - iq ICM能准确检测房颤，量化长期监测负担。人工智能算法在保持高灵敏度的同时，有效地减少了误报。

{"title":"Atrial fibrillation detection performance of an insertable cardiac monitor: Results from an Assert-IQ post-market clinical study and a novel artificial intelligence algorithm","authors":"Ulrika Birgersdotter-Green MD, FHRS , Willibaldo Ojeda MD , Harish Manyam MD , Alvaro Manrique Garcia MD , George E. Manoukian MD , Mohammad-Ali Jazayeri MD , Frank Cuoco MD, MBA, MS , Frederick Han MD, FACC, FHRS , Michael Katcher MD, FHRS , Rakesh Gopinathannair MD, MA, FAHA, FHRS , Dale Yoo MD , Lin Feng PhD , Fujian Qu DSc , Wenjiao Lin MS , Kwangdeok Lee PhD , Vishnu Charan MS, MBA , Suneet Mittal MD, FACC, FHRS , Dhanunjaya Lakkireddy MD, MBA, FHRS","doi":"10.1016/j.hroo.2025.10.021","DOIUrl":"10.1016/j.hroo.2025.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Accurate atrial fibrillation (AF) detection and burden assessment are critical features of modern insertable cardiac monitors (ICMs), enabling precise determination of AF episode patterns, frequency, duration, and total burden to guide treatments.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the AF detection performance of the Assert-IQ ICM and assess the impact of an artificial intelligence (AI) algorithm designed for reducing false-positive AF episodes.</div></div><div><h3>Methods</h3><div>This prospective, single-arm, multicenter study enrolled 151 subjects with symptomatic, drug-refractory paroxysmal or persistent AF. A Holter assessment was conducted after ICM insertion. AF detection metrics—sensitivity, specificity, positive predictive value (PPV), and negative predictive value—were evaluated by comparing ICM detections with core laboratory–annotated Holter AF events. The impact of an AI algorithm on AF detection performance was then assessed.</div></div><div><h3>Results</h3><div>Among 135 analyzable patients, 39 had Holter-confirmed AF with 522 episodes lasting ≥2 minutes. Assert-IQ ICM correctly identified all patients with true AF. Duration-based sensitivity, specificity, PPV, negative predictive value, and accuracy were 93.0%, 99.3%, 97.4%, 98.0%, and 97.9%, respectively. Episode detection sensitivity was 99.4% (gross) and 99.9% (patient average). AF burden correlation between ICM and Holter was excellent (r = 0.99). The AI algorithm retained all true positives and reduced 72.6% of false positives, improving PPV from 79.9% to 93.6%.</div></div><div><h3>Conclusion</h3><div>Assert-IQ ICM accurately detects AF and quantifies burden for long-term monitoring. The AI algorithm effectively reduces false positives while maintaining high sensitivity.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 61-69"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969355","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

Body surface potential mapping of ventricular depolarization and repolarization in phospholamban and plakophilin-2 cardiomyopathy 磷蛋白和嗜血小板素-2型心肌病患者心室去极化和复极化的体表电位映射

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.09.027

Iris van der Schaaf MD , Manon Kloosterman MSc , Machteld J. Boonstra PhD , Rob W. Roudijk MD, PhD , Anneline S.J.M. te Riele MD, PhD , Peter M. van Dam PhD , Peter Loh MD, PhD

Background

Pathogenic variants in plakophilin-2 (PKP2) and phospholamban (PLN) are associated with arrhythmogenic cardiomyopathy. Early disease detection is important to prevent adverse events. Body surface potential mapping (BSPM) may detect local electrical abnormalities earlier than the 12-lead electrocardiogram.

Objective

This study aimed to determine abnormalities in R-, S-, and T-wave amplitudes in PKP2- and PLN-pathogenic variant carriers using BSPM.

Methods

67 lead BSPM was performed in controls and PKP2 and PLN carriers. R-, S-, and T-wave amplitudes across all leads in controls were used as reference. Amplitudes of carriers exceeding these ranges were considered abnormal and assessed across disease stages (presymptomatic, electrical, and structural, as done previously). Follow-up BSPM (≥2 years) was performed in a subset of carriers.

Results

152 subjects (40 [27;54] years; 51% women) (40 controls and 112 carriers [53 PKP2 and 59 PLN]) were included. Amplitude abnormalities were most frequent in structural disease, predominantly in T waves (PKP2 20 [10;29]; PLN 25 [22;30] leads). Abnormalities in electrical disease were more prevalent in PLN carriers than PKP2 carriers (R wave 4 [1;7] vs 13 [8;16] leads, P = .002; S wave 2 [1;3] vs 4 [3;12] leads, P < .001; T wave 1 [0;3] vs 20 [16;28] leads, P < .001). Presymptomatic carriers typically had abnormalities outside the 12-lead configuration. As the disease progressed, abnormalities became more frequent and extended toward V1–V6. Follow-up BSPM (23 PKP2 and 16 PLN) showed consistency in locations of abnormalities with increased frequency (maximal increase 31%).

Conclusion

BSPM detected abnormal amplitudes within and beyond the 12-lead electrocardiogram, even in presymptomatic carriers. Follow-up BSPM suggests that these abnormalities are associated with disease progression, highlighting the potential benefit of BSPM in early disease detection.

白细胞介素-2 （PKP2）和磷蛋白（PLN）的致病变异与心律失常性心肌病有关。早期发现疾病对预防不良事件非常重要。体表电位映射（BSPM）可能比12导联心电图更早发现局部电异常。目的利用BSPM检测PKP2和pln致病变异携带者R-、S-和t -波幅的异常情况。方法对正常对照组和PKP2、PLN携带者进行导联BSPM。对照中所有引线的R、S和t波振幅作为参考。超过这些范围的携带者的振幅被认为是异常的，并在疾病的各个阶段进行评估（如前所述，症状前、电性和结构性）。对一部分携带者进行BSPM随访（≥2年）。结果共纳入152例（40[27；54]岁，女性占51%），其中对照组40例，携带者112例（53例PKP2, 59例PLN）。波幅异常最常见于结构性疾病，以T波为主（PKP2 20 [10;29]; PLN 25[22；30]导联）。PLN携带者比PKP2携带者更容易出现电异常（R波4 [1；7]vs 13[8；16]导联，P = .002； S波2 [1；3]vs 4[3；12]导联，P < 001； T波1 [0；3]vs 20[16；28]导联，P < 001）。症状前的携带者通常在12导联外有异常。随着病情的发展，异常变得更加频繁，并向V1-V6扩展。随访BSPM（23个PKP2和16个PLN）显示异常位置的一致性，频率增加（最大增加31%）。结论bspm检测到12导联以内及以外的异常幅度，即使在症状前携带者中也是如此。随访BSPM提示这些异常与疾病进展有关，突出了BSPM在早期疾病检测中的潜在益处。

{"title":"Body surface potential mapping of ventricular depolarization and repolarization in phospholamban and plakophilin-2 cardiomyopathy","authors":"Iris van der Schaaf MD , Manon Kloosterman MSc , Machteld J. Boonstra PhD , Rob W. Roudijk MD, PhD , Anneline S.J.M. te Riele MD, PhD , Peter M. van Dam PhD , Peter Loh MD, PhD","doi":"10.1016/j.hroo.2025.09.027","DOIUrl":"10.1016/j.hroo.2025.09.027","url":null,"abstract":"<div><h3>Background</h3><div>Pathogenic variants in plakophilin<em>-</em>2 (<em>PKP2</em>) and phospholamban (<em>PLN</em>) are associated with arrhythmogenic cardiomyopathy. Early disease detection is important to prevent adverse events. Body surface potential mapping (BSPM) may detect local electrical abnormalities earlier than the 12-lead electrocardiogram.</div></div><div><h3>Objective</h3><div>This study aimed to determine abnormalities in R-, S-, and T-wave amplitudes in <em>PKP2-</em> and <em>PLN-</em>pathogenic variant carriers using BSPM.</div></div><div><h3>Methods</h3><div>67 lead BSPM was performed in controls and <em>PKP2</em> and <em>PLN</em> carriers. R-, S-, and T-wave amplitudes across all leads in controls were used as reference. Amplitudes of carriers exceeding these ranges were considered abnormal and assessed across disease stages (presymptomatic, electrical, and structural, as done previously). Follow-up BSPM (≥2 years) was performed in a subset of carriers.</div></div><div><h3>Results</h3><div>152 subjects (40 [27;54] years; 51% women) (40 controls and 112 carriers [53 <em>PKP2</em> and 59 <em>PLN</em>]) were included. Amplitude abnormalities were most frequent in structural disease, predominantly in T waves (<em>PKP2</em> 20 [10;29]; <em>PLN</em> 25 [22;30] leads). Abnormalities in electrical disease were more prevalent in <em>PLN</em> carriers than <em>PKP2</em> carriers (R wave 4 [1;7] vs 13 [8;16] leads, <em>P</em> = .002; S wave 2 [1;3] vs 4 [3;12] leads, <em>P</em> < .001; T wave 1 [0;3] vs 20 [16;28] leads, <em>P</em> < .001). Presymptomatic carriers typically had abnormalities outside the 12-lead configuration. As the disease progressed, abnormalities became more frequent and extended toward V1–V6. Follow-up BSPM (23 <em>PKP2</em> and 16 <em>PLN</em>) showed consistency in locations of abnormalities with increased frequency (maximal increase 31%).</div></div><div><h3>Conclusion</h3><div>BSPM detected abnormal amplitudes within and beyond the 12-lead electrocardiogram, even in presymptomatic carriers. Follow-up BSPM suggests that these abnormalities are associated with disease progression, highlighting the potential benefit of BSPM in early disease detection.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 1","pages":"Pages 130-142"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969366","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

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Heart Rhythm O2

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀