Heart Rhythm O2最新文献

英文中文

Effect of conflict on atrial fibrillation outcomes in the Middle East: Multicenter international cohort study 冲突对中东地区房颤结局的影响：多中心国际队列研究

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.06.001

Ibrahim Antoun PhD , Malik Alta'amreh MD , Alkassem Alkhayer MSc , Alamer Alkhayer MD , Aref Jalal Eldin MD , Georgia R. Layton MRCS , Riyaz Somani PhD , G. André Ng PhD , Mustafa Zakkar PhD

Background

Atrial fibrillation (AF) outcomes vary depending on the stability of the health care system.

Objective

This study compared AF outcomes in 2 neighboring Levant countries: Syria, a conflict-affected country, and Jordan, a country with a stable health care system.

Methods

We conducted a retrospective observational cohort study of patients with AF from Tishreen University Hospital in Latakia, Syria, and the Jordanian Atrial Fibrillation Registry. Propensity score matching was performed to adjust for baseline characteristics. Primary outcomes included 1-year readmission rates and the 1-month incidence of cerebrovascular accidents (CVAs) or major bleeding.

Results

The study included 2677 patients (657 from Syria and 2020 from Jordan). Syrian patients were younger (median age 60 years vs 70 years; P < .001) and had higher rates of smoking (39% vs 14%; P < .001) and ischemic heart disease (26% vs 12%; P < .001) but lower rates of hypertension and diabetes. One-year readmission rates were significantly higher in Syria (64% vs 9%; P < .001), as were the incidences of 1-month CVAs (3% vs 1%; P < .001) and major bleeding (4% vs 0.5%; P < .001). These differences remained significant after propensity score matching. Compared with Jordanian patients, Syrian patients were associated with a substantial increase in all-cause readmission (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.5–2.6; P < .001). Furthermore, Syrian patients had a considerable increase in incidences of 1-month CVA (OR 6.5; 95% CI 2.5–16.5; P < .001) and major bleeding (OR 20.6; 95% CI 6.7–63.3; P < .001).

Conclusion

AF outcomes are significantly worse in Syria than in Jordan. Health care disruptions contribute to increased readmissions and complications. Strengthening AF management in conflict zones through improved access to medications and structured follow-up is essential to mitigating adverse outcomes.

背景：房颤（AF）的结局取决于医疗系统的稳定性。目的本研究比较了两个邻近的黎凡特国家：受冲突影响的叙利亚和卫生保健系统稳定的约旦的房颤结局。方法：我们对来自叙利亚拉塔基亚Tishreen大学医院和约旦房颤登记处的房颤患者进行了一项回顾性观察队列研究。进行倾向评分匹配以调整基线特征。主要结局包括1年再入院率和1个月脑血管意外（CVAs）或大出血发生率。结果共纳入2677例患者（657例来自叙利亚，2020例来自约旦）。叙利亚患者更年轻（中位年龄60岁vs 70岁；P < .001），吸烟率（39% vs 14%; P < .001）和缺血性心脏病（26% vs 12%; P < .001）更高，但高血压和糖尿病的发病率较低。叙利亚的1年再入院率明显更高（64%对9%；P < .001）， 1个月CVAs的发生率（3%对1%；P < .001）和大出血的发生率（4%对0.5%;P < .001）也是如此。这些差异在倾向评分匹配后仍然显著。与约旦患者相比，叙利亚患者的全因再入院率显著增加（优势比[OR] 1.8； 95%可信区间[CI] 1.5-2.6; P < 0.001）。此外，叙利亚患者1个月CVA （OR 6.5; 95% CI 2.5-16.5; P < 0.001）和大出血（OR 20.6; 95% CI 6.7-63.3; P < 0.001）的发生率显著增加。结论叙利亚的治疗结果明显差于约旦。卫生保健中断导致再入院和并发症增加。通过改善药物获取和有组织的随访来加强冲突地区的房颤管理，对于减轻不良后果至关重要。

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引用次数: 0

Mapping of real-time myocardial metabolism to guide ablation 实时心肌代谢成像指导消融

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.007

Jonathan P. Piccini Sr. MD, MHS, FHRS , Terrance J. Ransbury BSEE

引用次数: 0

Effect of pulsed field ablation delivered from noncontact catheter electrodes on hemolysis: A tissue proximity indication–based analysis 非接触式导管电极脉冲场消融对溶血的影响：一项基于组织接近指征的分析

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.002

Shingo Yoshimura MD, Kenichi Kaseno MD, PhD, Akiko Kodama MD, Suguru Nishiuchi MD, PhD, Kojiro Hattori MD, Taiki Masuyama MD, Takehito Sasaki MD, Kohki Nakamura MD, PhD, Shigeto Naito MD, PhD

Background

Pulsed field ablation (PFA) for atrial fibrillation can induce hemolysis, particularly when pulsed field (PF) energy is delivered from catheter electrodes that are not in contact with myocardial tissue. The variable-loop circular catheter (VLCC) incorporates tissue proximity indication (TPI) software to identify catheter-tissue contact. Whether PFA applications delivered from TPI-negative (noncontact) VLCC electrodes contribute to hemolysis remains unclear.

Objective

The purpose of this study was to determine whether PFA delivered from TPI-negative VLCC electrodes is associated with postprocedural hemolysis.

Methods

We retrospectively analyzed 20 consecutive patients who underwent their first PFA using the VLCC and CARTO 3 system (Biosense Webster Inc.). For each 3-pulse application set, catheter-tissue contact was assessed using TPI. We counted the cumulative number of VLCC electrode uses delivering PF energy; among these, those that were TPI-negative were summed and defined as the cumulative number of TPI-negative electrode uses (nTPI-EU). Postoperative lactate dehydrogenase (LDH), total bilirubin (T-Bil), and the postoperative-to-preoperative haptoglobin ratio served as hemolysis markers.

Results

A mean of 78.3 ± 20.0 PFA applications (772.9 ± 204.1 VLCC electrode uses) were delivered per patient; the mean nTPI-EU was 438.8 ± 238.1. Compared with preoperative values, postoperative LDH and T-Bil increased significantly whereas haptoglobin decreased (P < .01 for all). nTPI-EU correlated positively with LDH (r = 0.663; P < .01) and T-Bil (r = 0.736; P < .01) and negatively with the postoperative-to-preoperative haptoglobin ratio (r = −0.556; P = .01).

Conclusion

The cumulative number of noncontact catheter electrodes delivering PF energy was associated with hemolysis. Strategies that minimize the number of noncontact catheter electrodes, in addition to limiting total PFA applications, may reduce the risk of hemolysis.

背景：心房颤动的脉冲场消融（PFA）可以诱导溶血，特别是当脉冲场（PF）能量从不与心肌组织接触的导管电极传递时。可变环环形导管（VLCC）采用组织接近指示（TPI）软件来识别导管与组织的接触。tpi阴性（非接触）VLCC电极的PFA应用是否有助于溶血尚不清楚。目的本研究的目的是确定tpi阴性VLCC电极输送的PFA是否与术后溶血有关。方法回顾性分析20例连续使用VLCC和CARTO 3系统（Biosense Webster Inc.）进行首次PFA的患者。对于每个3脉冲应用集，使用TPI评估导管与组织的接触。计算了VLCC电极输送PF能量的累计次数；其中tpi阴性的将其相加，定义为tpi阴性电极使用的累计次数（nTPI-EU）。术后乳酸脱氢酶（LDH）、总胆红素（T-Bil）、术后与术前触珠蛋白比值作为溶血指标。结果每例患者平均使用78.3±20.0个PFA（772.9±204.1个VLCC电极）；nTPI-EU平均值为438.8±238.1。与术前比较，术后LDH和T-Bil显著升高，而触珠蛋白显著降低（P < 0.01）。nTPI-EU与LDH （r = 0.663; P < 0.01）、T-Bil （r = 0.736; P < 0.01）呈正相关，与术后-术前触珠蛋白比值呈负相关（r = - 0.556; P = 0.01）。结论输送PF能量的非接触式导管电极累计数目与溶血有关。除了限制PFA的总应用外，减少非接触式导管电极数量的策略可能会降低溶血的风险。

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引用次数: 0

Larger spatial ventricular gradient magnitude is associated with higher rates of response to cardiac resynchronization therapy 较大的空间心室梯度大小与较高的心脏再同步化治疗反应率相关

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.08.024

Alyssa J. Shepherd MD , Hans F. Stabenau MD, PhD , Arunashis Sau MBBS, PhD , Patricia Tung MD, MPH , Timothy R. Maher MD , Shu Yang MD , Andrew H. Locke MD , Peter Zimetbaum MD, FHRS , Gregory F. Michaud MD , Andre d’Avila MD, PhD , Nicholas S. Peters MBBS, MD, FHRS , Alfred E. Buxton MD , Fu Siong Ng MBBS, PhD, FHRS , Daniel B. Kramer MD, MPH , Jonathan W. Waks MD

Background

Cardiac resynchronization therapy (CRT) improves systolic heart failure (HF) outcomes, but many patients do not benefit. Improved methods for identifying patients likely to benefit from CRT are needed. The spatial ventricular gradient (SVG) is a vectorcardiographic measure of myocardial electromechanical heterogeneity that is associated with incident HF. The relationship between SVG and CRT response is unknown.

Objective

This study aimed to investigate associations between SVG and CRT response.

Methods

Retrospective analysis of patients presenting for clinically-indicated CRT implant in 2015–2022. Pre-CRT electrocardiograms (ECGs) were transformed into vectorcardiograms (VCGs), and SVG vector X, Y, and Z components were calculated as areas under the X, Y and Z VCG QRST complexes, respectively. SVG magnitude (SVGmag) was calculated as SVG vector length. CRT response, defined as left ventricular ejection fraction (LVEF) increase ≥10% post-CRT, was assessed using multivariable logistic regression.

Results

Among 162 patients (median age 68 years, 62% male, 76% non-ischemic HF, median LVEF 26%, median QRS duration 162ms, 89% left bundle branch block), 69% had CRT response. After adjustment, larger pre-CRT SVGmag was associated with higher odds of CRT response: adjusted odds ratio (OR_adj) 1.78 per 1 standard deviation increase, P = .009. Predicted probabilities of CRT response ranged between ∼50% for the lowest SVGmag values, to ∼90% for the highest SVGmag values, and patients in the highest pre-CRT SVGmag tertile had and OR_adj 4.5, P = .003 for CRT response. Larger post-CRT decreases in SVGmag were also associated with increased CRT response. SVGmag performed better than QRS area for predicting CRT response.

Conclusion

SVGmag is independently associated with CRT response and warrants prospective study.

背景：心脏再同步化治疗（CRT）可改善收缩期心力衰竭（HF）的预后，但许多患者并未从中获益。需要改进方法来识别可能从CRT获益的患者。空间心室梯度（SVG）是与心衰事件相关的心肌机电异质性的矢量心动图测量。SVG与CRT响应之间的关系尚不清楚。目的探讨SVG与CRT反应的关系。方法回顾性分析2015-2022年临床指征CRT植入患者。将crt前心电图（ecg）转换为矢量心电图（VCG），并计算SVG矢量X、Y、Z分量分别作为X、Y、Z VCG QRST复合物下面积。SVG大小（SVGmag）作为SVG矢量长度计算。CRT反应，定义为左心室射血分数（LVEF）增加≥10%，使用多变量logistic回归评估。结果162例患者中（中位年龄68岁，男性62%，非缺血性HF 76%，中位LVEF 26%，中位QRS持续时间162ms， 89%左束支阻滞），69%有CRT反应。校正后，CRT前SVGmag越大，CRT反应的几率越高：校正优势比（ORadj）为1.78 / 1标准差，P = 0.009。CRT反应的预测概率在最低SVGmag值为~ 50%，最高SVGmag值为~ 90%之间，CRT前SVGmag值最高的患者的CRT反应的ORadj为4.5,P = 0.003。CRT后SVGmag的大幅下降也与CRT反应的增加有关。SVGmag对CRT反应的预测效果优于QRS区。结论svgmag与CRT反应独立相关，值得进行前瞻性研究。

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引用次数: 0

Daily home ECG monitoring for assessing the blanking period after catheter ablation in persistent atrial fibrillation 持续性房颤患者导管消融后每日家庭心电图监测评估空白期

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.08.006

Daiki Shako MD , Keitaro Senoo MD, PhD , Arito Yukawa MD , Satoaki Matoba MD, PhD

引用次数: 0

Atrioventricular interval modulation therapy for management of hypertension 房室间期调节治疗高血压

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.08.001

Steven J. Evans MD, Avi Fischer MD FHRS

引用次数: 0

Sham-controlled trials and the future of electrophysiology: Reflections on SHAM-PFA 假对照试验和电生理学的未来：对SHAM-PFA的思考

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.017

Mohammed Mhanna MD, MPH, MSc , John M. Mandrola MD , Brian Olshansky MD, FHRS

引用次数: 0

Emerging antiarrhythmic drug therapy for atrial fibrillation 新兴的抗心律失常药物治疗心房颤动

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.09.006

Steven A. Lubitz MD, MPH , Andrew K.P. Taggart PhD , Claudio Gimpelewicz MD , Christopher J. O’Donnell MD, MPH

引用次数: 0

Preparticipation electrocardiogram screening in a Gulf Coast community: A prospective study 墨西哥湾沿岸社区参与前心电图筛查：一项前瞻性研究

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.07.104

Lane A. McLendon MD , Madhuri S. Mulekar PhD , Lynn A. Batten MD

Background

Sudden cardiac death in young athletes is a devastating event unparalleled in the sports community. The debate over electrocardiogram (ECG) screening of young athletes has been ongoing for many years and recommendations vary widely.

Objective

We prospectively studied students in coastal Alabama to compare the detection rate of life-threatening cardiac pathology using a 12-lead ECG vs a preparticipation questionnaire.

Methods

A total of 2604 students in coastal Alabama aged 5–22 years (median age, 15 years) were included between 2014 and 2019. They completed the American Heart Association (AHA) 14-point preparticipation questionnaire and underwent a 12-lead ECG.

Results

Of participants answering the questionnaire, 60.2% were men, 81.4% were White, and 10.7% were Black. There were 306 (11.9%) of 2565 students who reported symptoms that would have triggered referral to a cardiologist, with the most common (88.2%) being chest pain, shortness of breath, and palpitations. Of 2604 ECGs, 86 (3.3%) were abnormal, with the most frequent findings (54.7%) being T wave inversions and pathologic Q waves. The AHA screening questionnaire had a sensitivity of 33.0% and specificity of 78.7%, while the ECG screening had 100% sensitivity and 97.0% specificity. Three students (0.1%) were found to have conditions associated with sudden cardiac arrest which were detected by ECG, although only 1 of these students reported symptoms on the questionnaire which would have prompted a referral.

Conclusion

The 14-point AHA questionnaire raised suspicion for unnecessary referrals while missing 66.0% of the life-threatening pathologies detected with ECG.

年轻运动员的心源性猝死是体育界无可比拟的毁灭性事件。关于年轻运动员心电图（ECG）筛查的争论已经持续了很多年，建议也有很大的不同。目的对阿拉巴马州沿海地区的学生进行前瞻性研究，比较12导联心电图和参与前问卷对危及生命的心脏病变的检出率。方法2014 - 2019年，阿拉巴马州沿海地区2604名5-22岁的学生（中位年龄为15岁）。他们完成了美国心脏协会（AHA）的14点参与前问卷，并进行了12导联心电图检查。结果男性占60.2%，白人占81.4%，黑人占10.7%。2565名学生中有306名（11.9%）报告了可能引发转诊心脏病专家的症状，其中最常见的（88.2%）是胸痛、呼吸短促和心悸。2604例心电图中，异常86例（3.3%），以T波倒位和病理性Q波最为常见（54.7%）。AHA筛查问卷的敏感性为33.0%，特异性为78.7%，而ECG筛查的敏感性为100%，特异性为97.0%。3名学生（0.1%）被发现有心电图检测到的与心脏骤停相关的条件，尽管这些学生中只有1人在问卷上报告了症状，这将促使转诊。结论14点的AHA问卷对不必要的转诊有怀疑，对心电图发现的危及生命的病理有66.0%的漏诊。

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引用次数: 0

CineECG detects abnormal electrical activity in the 12-lead ECG of preclinical plakophilin-2 variant carriers CineECG检测临床前plakophilin-2变异携带者的12导联心电图异常电活动

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-11-01 DOI: 10.1016/j.hroo.2025.07.105

Iris van der Schaaf MD , Manon Kloosterman MSc , Anton P.M. Gorgels MD, PhD , Anneline S.J.M. te Riele MD, PhD , Peter M. van Dam PhD , Peter Loh MD, PhD

Background

Carriers of (likely) Plakophilin-2 pathogenic variants (PKP2-(L)PV) are at risk of developing arrhythmogenic cardiomyopathy. Early disease detection is crucial because life-threatening arrhythmias may occur early. CineECG is a novel electrocardiogram (ECG) analysis tool that reconstructs the average trajectory of ventricular electrical activity.

Objective

The study aimed to describe the electrical depolarization and repolarization CineECG trajectories in PKP2-(L)PV carriers with a normal ECG as per evaluation of 2 cardiologists, who meet no Task Force Criteria other than their PV.

Methods

PKP2-(L)PV carriers were 2:1-matched to control subjects, who had atrioventricular nodal reentry tachycardia but no other cardiac abnormalities. Sinus rhythm ECGs of controls were used to create a normal distribution of trajectories. PKP2-(L)PV carriers’ trajectories were compared with the normal distribution. A trajectory was considered abnormal if it fell less than 95% within the normal distribution.

Results

Overall, 104 subjects were included (age 24 years [19–36], 43% men): 37 PKP2-(L)PV carriers and 67 controls. Depolarization and repolarization trajectories were abnormal in 51% and 24% of carriers, respectively. In carriers with abnormal depolarization trajectories, significant differences were observed in the direction of the initial depolarization trajectory when compared with controls in the inferior-superior axis (P = .005) and posterior-anterior axis (P = .020). In the left-right axis, the direction significantly differed from carriers with a normal trajectory (P = .020).

Conclusion

Abnormal electrical activity was identified in over half of preclinical PKP2-(L)PV carriers with a normal ECG. CineECG could be a sensitive tool to unveil early, subtle abnormalities in ventricular electrical activity that would otherwise not be detected.

Plakophilin-2致病变异（PKP2-(L)PV）的携带者（可能）有发生心律失常性心肌病的风险。早期疾病检测是至关重要的，因为危及生命的心律失常可能发生在早期。CineECG是一种重建心室电活动平均轨迹的新型心电图分析工具。目的：本研究旨在描述PKP2-(L)PV携带者的电去极化和复极化CineECG轨迹，根据2名心脏病专家的评估，他们的心电图正常，除了他们的PV外没有满足任何工作组标准。方法spkp2 -(L)PV携带者与有房室结型再入性心动过速但无其他心脏异常的对照组2:1匹配。对照组的窦性心律心电图用于创建轨迹的正态分布。PKP2-(L)PV载流子轨迹与正态分布比较。如果轨迹在正态分布范围内的下降幅度小于95%，则认为轨迹异常。结果共纳入104例受试者（24岁[19-36]，男性43%）：37例PKP2-(L)PV携带者，67例对照组。去极化和复极化轨迹分别在51%和24%的携带者中异常。在去极化轨迹异常的携带者中，在初始去极化轨迹的方向上，与对照组相比，上下轴（P = 0.005）和前后轴（P = 0.020）存在显著差异。在左右轴上，与正常轨迹携带者的方向有显著差异（P = 0.020）。结论半数以上临床前心电图正常的PKP2-(L)PV携带者存在异常电活动。CineECG可能是一种敏感的工具，可以揭示早期的、微妙的心室电活动异常，否则无法检测到。

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