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

State of the Journal 2026 《华尔街日报现状》，2026

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.12.001

Jeanne E. Poole MD, FHRS

引用次数: 0

Association between non-ablated left atrial surface area and rhythm outcome in patients treated with cryoballoon and radiofrequency ablation 低温球囊和射频消融治疗患者未消融的左心房表面积与心律预后的关系

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2026-01-01 DOI: 10.1016/j.hroo.2025.11.009

Moon-Hyun Kim MD , Oh-Seok Kwon PhD , Daehoon Kim MD , Hae-Min Lee BS , Kyeung-Se Im BS , Hee Tae Yu MD, PhD , Tae-Hoon Kim MD , Jae-Sun Uhm MD, PhD , Boyoung Joung MD, PhD , Moon-Hyoung Lee MD, PhD , Hui-Nam Pak MD, PhD, FHRS

Background

Cryoballoon (CB) pulmonary vein isolation (PVI) offers outcomes comparable to radiofrequency PVI (RF-PVI) in patients with atrial fibrillation (AF) but has limitations for wide circumferential PVI and extra-pulmonary vein (PV) trigger (ExPVT) ablations.

Objective

This study aimed to compare long-term outcomes of CB-PVI vs RF-PVI in patients without ExPVT and explore underlying electroanatomical mechanisms.

Methods

We identified 1902 patients undergoing de novo AF ablation without ExPVT. After propensity matching for age, sex, AF type, and left atrium anteroposterior (LAAP) diameter in patients, we compared AF recurrence in 403 CB-PVI and 403 RF-PVI cases, considering AF type and LAAP diameter. Using a Cox model, we identified the optimal LAAP diameter cutoff for differentiating outcomes and examined the relationship between PVI modality and reduction in electrically active LA area via computational modeling.

Results

During a median follow-up of 24 months, CB-PVI had poorer rhythm outcomes than RF-PVI in propensity-matched patients (log-rank P = .009). Outcomes were comparable in those with an LAAP diameter <40 mm or paroxysmal AF. However, CB-PVI was associated with higher AF recurrence in patients with a LAAP diameter ≥40 mm (hazard ratio [HR] 1.54 [1.01–2.36]; log-rank P = .047) or persistent AF (HR 2.17 [1.36–3.45]; log-rank P = .001). In computational modeling, a larger non-ablated LA area post-PVI was independently related to a higher AF recurrence risk. RF-PVI reduced LA surface area more than CB-PVI, especially in patients with a large LA or persistent AF.

Conclusion

CB-PVI showed inferior rhythm outcomes compared with RF-PVI in patients with a LAAP diameter ≥40 mm or persistent AF, possibly because of a smaller reduction in LA critical mass.

低温球囊（CB）肺静脉隔离（PVI）在房颤（AF）患者中提供与射频PVI （RF-PVI）相当的结果，但对于宽周PVI和肺静脉外（PV）触发（ExPVT）消融有局限性。目的本研究旨在比较CB-PVI与RF-PVI在无ExPVT患者中的长期预后，并探讨潜在的电解剖学机制。方法我们收集了1902例无ExPVT的房颤消融患者。在对患者的年龄、性别、房颤类型和左心房前后方（LAAP）直径进行倾向匹配后，考虑房颤类型和LAAP直径，我们比较了403例CB-PVI和403例RF-PVI的房颤复发情况。使用Cox模型，我们确定了区分结果的最佳LAAP直径截止点，并通过计算建模检查了PVI模式与电活性LA面积减少之间的关系。结果在中位随访24个月期间，倾向匹配患者的CB-PVI节律结局比RF-PVI差（log-rank P = 0.009）。LAAP直径为40 mm或阵发性房颤患者的结果具有可比性。然而，LAAP直径≥40 mm的患者（风险比[HR] 1.54 [1.01-2.36]; log-rank P = 0.047）或持续性房颤患者（风险比[HR] 2.17 [1.36-3.45]; log-rank P = .001）， CB-PVI与房颤复发率较高相关。在计算模型中，pvi后较大的未消融的LA面积与较高的房颤复发风险独立相关。RF-PVI比CB-PVI更能减少LA表面积，尤其是在LAAP直径≥40 mm或持续性AF患者中。结论与RF-PVI相比，CB-PVI在LAAP直径≥40 mm或持续性AF患者中表现出更差的心律结果，可能是因为LA临界质量的减少较小。

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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

High-amplitude pacing can identify epicardial connections in the posterior wall during ablation for atrial fibrillation 在房颤消融期间，高振幅起搏可识别心外膜后壁连接

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.023

Arshad Muhammad Iqbal MD , Suhaib Bajwa MD , Cory Smith MD , Supraja Thunuguntla MD , Sandeep Gautam MD, FHRS

Background

Posterior wall isolation (PWI) is a supplemental modality to pulmonary vein isolation in radiofrequency ablation for persistent atrial fibrillation. Residual epicardial connections may contribute to nondurable PWI and increased atrial fibrillation recurrence.

Objective

The study aimed to investigate the use of a novel high-amplitude pacing (HAP) technique to unmask epicardial connections after PWI.

Methods

100 consecutive patients underwent pulmonary vein isolation/PWI radiofrequency ablation with roof and floor lines and segmental ablation for posterior wall (PW) entrance block. The PW was divided into 4 quadrants, each subdivided into 4 segments, labeled 1–16. After the PW entrance block, bipolar pacing was performed in each segment with standard pacing (10 mA at 2 ms) and HAP (20 mA at 2 ms). Exit block was defined as a lack of atrial capture from within PW.

Results

Patients were divided into groups 1 (unable to achieve complete PWI) and 2 (PWI achieved). We categorized patients into subgroups based on the presence/absence of entrance blocks, captures, and exit blocks. PW entrance block was not achieved in 2 patients (2%); 17 patients (17%) demonstrated bidirectional PW block with standard pacing. HAP-only capture was seen in 74 of the remaining 81 patients. Mid-PW had the highest frequency of HAP-only capture. Additional ablation was performed in 63 HAP patients without PW exit block, with final PWI achieved in 51 of 63 patients (80.9%) compared with 18 of 18 (100%) in the cohort with HAP noncapture/exit block (P = .045).

Conclusion

Our novel protocol of HAP unmasked possible epicardial capture in 63% of patients, with true PWI with additional ablation in 80.9% patients. HAP may help unmask epicardial connections and facilitate durable PWI to improve long-term procedural success.

背景：在射频消融治疗持续性房颤时，后壁隔离（PWI）是肺静脉隔离的补充方式。残留的心外膜连接可能导致非持续性PWI和增加房颤复发。目的探讨一种新型的高振幅起搏（HAP）技术在PWI后揭露心外膜连接的应用。方法连续100例患者行肺静脉隔离/PWI射频顶底线消融和后壁入口阻断段性消融。将PW分为4个象限，每个象限再细分为4个片段，标记为1-16。在PW入口阻断后，采用标准起搏（10ma, 2ms）和HAP （20ma, 2ms）在每段进行双极起搏。出口阻滞被定义为PW内缺乏心房捕获。结果患者分为1组（未完成PWI）和2组（完成PWI）。我们根据是否存在入口块、捕获块和出口块将患者分为亚组。2例（2%）患者未实现PW入口阻塞；17例（17%）患者在标准起搏时表现为双向PW阻滞。其余81例患者中有74例仅出现hap捕获。pw中期仅捕获hap的频率最高。63例没有PW出口阻断的HAP患者进行了额外的消融，63例患者中有51例（80.9%）最终实现了PWI，而在HAP未捕获/出口阻断的队列中，18例（100%）实现了PWI （P = 0.045）。结论：我们的新HAP方案在63%的患者中发现了可能的心外膜捕获，在80.9%的患者中发现了真正的PWI并进行了额外的消融。HAP可帮助揭露心外膜连接并促进持久PWI提高长期手术成功率。

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引用次数: 0

Clonal hematopoiesis of indeterminate potential as a risk factor for atrial fibrillation: Evidence of a causal relationship by Mendelian randomization study 潜力不确定的克隆造血作为心房颤动的危险因素：孟德尔随机化研究的因果关系证据

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.024

Qing Zhang MD, PhD , Guohao Wang PhD , Zhangpu Yan BS , Weiling Xu MD , Shaofeng Zhang BS , Jun Li MD , Ling Liang MD, PhD , Changqing Sun MD, PhD , Rong Tang MD , Joachim Pircher MD, PhD , Qiang Xie MD, PhD, FHRS , Wuyang Zheng MD, PhD

Background

Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an independent cardiovascular risk factor, with recent studies suggesting a link to atrial fibrillation (AF). However, the causal nature of this relationship, particularly the role of DNMT3a and TET2 mutations, remains unclear.

Objective

This study aimed to assess the causal relationship between CHIP and AF and identify potential mediating pathways.

Methods

We conducted a bidirectional Mendelian randomization (MR) analysis using genome-wide association study data for CHIP from the UK Biobank (n = 368,526) and AF data from 2 large, independent cohorts (287,805 individuals from FinnGen and 1,030,836 from 6 additional AF studies). A 2-step MR mediation analysis was used to explore potential intermediate risk factors.

Results

Inverse variance weighted MR analysis demonstrated a causal effect of CHIP on increased AF risk (meta-inverse variance weighted, odds ratio [OR] 1.057; P = .001), including both DNMT3a- and TET2-related CHIP (DNMT3a, OR 1.048, P = 4.56 × 10^-4; TET2, OR 1.038, P = .025). Causal associations between overall CHIP, including DNMT3a-CHIP, and AF were validated by a 2-sample MR study in 2 independent cohorts. Reverse MR showed no evidence of AF causing CHIP. The mediation analysis identified elevated systolic blood pressure as a key mediator in the DNMT3a-CHIP–AF pathway, accounting for 7.8% of the effect (P = .034).

Conclusion

Our findings provide genetic evidence that CHIP, particularly DNMT3a-related mutations, causally but modestly increases AF risk. There is no support for reverse causation. Elevated systolic blood pressure was identified as a significant mediator linking DNMT3a-CHIP to AF.

克隆造血不确定电位（CHIP）已成为一个独立的心血管危险因素，最近的研究表明其与心房颤动（AF）有关。然而，这种关系的因果性质，特别是DNMT3a和TET2突变的作用仍不清楚。目的探讨CHIP与房颤之间的因果关系，并确定可能的介导途径。方法：我们使用来自UK Biobank的CHIP全基因组关联研究数据（n = 368,526）和来自2个大型独立队列的AF数据（来自FinnGen的287,805名个体和来自另外6项AF研究的1,030,836名个体）进行了双向孟德尔随机化（MR）分析。采用两步MR中介分析探讨潜在的中间危险因素。结果反向方差加权MR分析显示CHIP与AF风险增加有因果关系（meta-inverse方差加权，优势比[OR] 1.057; P = .001），包括DNMT3a和TET2相关CHIP （DNMT3a, OR 1.048, P = 4.56 × 10-4; TET2, OR 1.038, P = 0.025）。包括DNMT3a-CHIP在内的总体CHIP与房颤之间的因果关系通过2个独立队列的2样本MR研究得到验证。反向MR未显示AF引起CHIP的证据。中介分析发现收缩压升高是DNMT3a-CHIP-AF通路的关键中介，占7.8%的效应（P = 0.034）。结论：我们的研究结果提供了遗传证据，证明CHIP，特别是dnmt3a相关突变，会导致但适度地增加房颤风险。没有证据支持反向因果关系。收缩压升高被确定为DNMT3a-CHIP与房颤之间的重要中介。

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引用次数: 0

Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review 心脏植入式电子装置患者生物电阻抗分析的安全性：系统综述

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.026

Leonardo J. Uribe-Cavero MD , Fabian A. Chavez-Ecos MD , Kiara Camacho-Caballero MD , José Carlos Grados-Pintos MD , Patricia Vera-Maccha MD , Anthony Siguas-Huasasquiche MD , Dinesh Sharma MD , Carlos J. Toro-Huamanchumo MD MMed

Background

Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).

Objective

This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.

Methods

We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.

Results

Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.

Conclusion

Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.

生物电阻抗分析（BIA）被广泛用于评估人体成分。然而，由于潜在的电磁干扰（EMI），其在心脏植入式电子装置（cied）患者中的安全性仍不确定。目的：根据现有证据，本研究旨在评估cied患者使用临床级BIA的潜在并发症。方法我们对截至2024年12月26日发表的研究进行了系统综述，通过PubMed、Embase、Scopus和Cochrane图书馆进行了鉴定。主要结局是不良事件的发生，包括EMI、设备故障或心律失常。结果在3668份记录中，6项队列研究（n = 531例患者）符合纳入标准。其中包括使用起搏器（n = 175）、植入式心律转复除颤器（n = 268）和心脏再同步化治疗除颤器（n = 154）的患者。BIA协议的频率（5-500 kHz）和电流强度（通常≤0.8 mA）不同。没有研究报告临床显著的EMI、设备故障或cia诱发的心律失常。器件参数（如引线阻抗、起搏阈值）在BIA暴露前后保持稳定。1项研究的偏倚风险被评为良好，5项研究的偏倚风险被评为一般。结论：目前的证据表明，临床级BIA对cied患者是安全的，没有不良反应或设备干扰的报道。这些发现有助于告知和潜在地更新先前劝阻该人群BIA的建议。然而，需要进一步的高质量研究来确认不同BIA协议和设备类型的安全性。重要的是，这些发现适用于临床级BIA，不应推断到消费级可穿戴设备，这可能会带来理论上的CIED干扰风险。

{"title":"Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review","authors":"Leonardo J. Uribe-Cavero MD , Fabian A. Chavez-Ecos MD , Kiara Camacho-Caballero MD , José Carlos Grados-Pintos MD , Patricia Vera-Maccha MD , Anthony Siguas-Huasasquiche MD , Dinesh Sharma MD , Carlos J. Toro-Huamanchumo MD MMed","doi":"10.1016/j.hroo.2025.09.026","DOIUrl":"10.1016/j.hroo.2025.09.026","url":null,"abstract":"<div><h3>Background</h3><div>Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).</div></div><div><h3>Objective</h3><div>This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.</div></div><div><h3>Results</h3><div>Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.</div></div><div><h3>Conclusion</h3><div>Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1985-1992"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771988","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

Epicardial adipose tissue and ablation outcomes in obese patients with paroxysmal atrial fibrillation: A comparison of pulsed field and radiofrequency ablation 肥胖阵发性心房颤动患者的心外膜脂肪组织和消融结果：脉冲场和射频消融的比较

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.020

Florian Englert MD , Theresa Obermeyer , Fabian Bahlke MD , Miruna Popa MD , Hannah Krafft MD , Alex Tunsch Martinez MD , Jan Syväri MD , Madeleine Tydecks MD , Dominic Dischel MD , Eva Koops MD , Theresa Reiter MD , Marta Telishevska MD , Sarah Lengauer MD , Kenno Bressem MD , Martin Hadamitzky MD , Gabriele Hessling MD , Isabel Deisenhofer MD, FHRS , Nico Erhard MD

Background

Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels.

Objective

Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation.

Methods

103 patients with body mass index of >29 kg/m² with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n = 41; RF n = 62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy.

Results

Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group (P = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group (P = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; P = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; P = .846).

Conclusion

PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of >29 kg/m². However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.

Trial Registration Number

NCT06559787

背景：临床前研究显示脂肪组织对脉冲场消融术（PFA）效果的影响结果不一致，这就对其对心外膜脂肪组织（EAT）水平升高患者的疗效提出了质疑。目的：与高功率、短时间射频消融（RF）相比，PFA肺静脉隔离术后EAT水平升高可能导致心房颤动（AF）复发率升高。方法前瞻性纳入103例首次行房颤消融术的阵发性或短期持续性房颤患者（PFA n = 41; RF n = 62）。所有患者均接受消融前光子计数计算机断层成像，定量量化左心房和右心房EAT水平。PFA采用pentaspline导管，射频消融采用高功率、短时间能量。结果RF组中位EAT体积为71.85 mL（四分位数范围50.35 ~ 93.35 mL）， PFA组中位EAT体积为65.61 mL（四分位数范围40.45 ~ 90.8 mL）（P = 0.1352）。中位随访为367天，不包括6周的空白期。RF组1年房性心律失常复发率为33.87%，PFA组为17.07% （P = 0.077）。Cox回归显示，在PFA组中，左心房EAT是复发的唯一显著预测因子（风险比1.06；95%可信区间1.01-1.12;P = 0.022），对应于每mL风险增加6.2%。在RF组中，左心房EAT与复发无显著相关（风险比1.00；95%可信区间0.97-1.03;P = 0.846）。结论对于体重指数为29 kg/m2的患者，肺静脉隔离后1年pfa效果良好。然而，与射频消融相比，进食对PFA后房颤复发的影响可能更为显著。试验注册号：06559787

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引用次数: 0

High impedance alert in a hybrid pacemaker system 混合起搏器系统的高阻抗报警

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.022

Siddharth Agarwal MD, Abhishek Deshmukh MD, Ammar M. Killu MBBS, Alan Sugrue MBBCH, MSc

引用次数: 0

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