Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.07.022
Michela Casella MD, PhD , Yari Valeri MD , Paolo Compagnucci MD, PhD , Luca Finori MD , Giovanni Volpato MD , Laura Cipolletta MD , Quintino Parisi MD , Riccardo Grandin MD , Francesca Campanelli MD , Leonardo D’Angelo MD , Giorgio Giacomini MD , Francesco Cardinali MD , Giacomo Castellucci MD , Enrico Rita MD , Loredana Messano MD , Giuseppe Ciliberti MD , Maurizio Malacrida MSc , Antonio Dello Russo MD, PhD
Background
There is a lack of data on the temporal dynamics of cardiac biomarkers after radiofrequency and pulsed field ablation (PFA) catheter ablation of atrial fibrillation.
Objective
To evaluate the kinetics of release of several biomarkers following pulmonary vein isolation (PVI).
Methods
All patients underwent baseline and regular post-procedural blood sampling (at 3, 24, and 48 hours) to assess major markers of myocardial injury (troponin I, creatinine kinase-MB, and myoglobin) and inflammatory (C-reactive protein [CRP]). The population was stratified into 3 groups according to the ablation system: radiofrequency (RF) ablation catheter (RF group), pentaspline FarapulseTM PFA system (PFA-FAR group), and variable-loop VaripulseTM PFA system (PFA-VAR group).
Results
A total of 186 patients were included: 79 RF (42.5%), 69 PFA-FAR (37.1%), and 38 PFA-VAR (20.4%). A greater extent of myocardial injury was noticed in the PFA groups vs RF, and cellular electroporation via pentaspline PFA resulted in a greater biomarker increase compared with loop-variable PFA. Kinetics of biomarkers of inflammation increase following PVI with both PFA technologies and RF. However, both PFA systems resulted in a faster CRP biomarker recovery compared with RF, while CRP continued to increase beyond 24 hours post-ablation only in the RF group. PVI was achieved in all patients (100%) using only PFA or RF.
Conclusion
Cellular electroporation induced by pentaspline PFA was associated with a significantly greater elevation in these cardiac biomarkers compared with variable-loop PFA and RF. After an initial increase, both PFA systems were associated with a more rapid decline in CRP levels compared with RF.
{"title":"Cardiac biomarker temporal dynamics after radiofrequency and pulsed field catheter ablation of atrial fibrillation","authors":"Michela Casella MD, PhD , Yari Valeri MD , Paolo Compagnucci MD, PhD , Luca Finori MD , Giovanni Volpato MD , Laura Cipolletta MD , Quintino Parisi MD , Riccardo Grandin MD , Francesca Campanelli MD , Leonardo D’Angelo MD , Giorgio Giacomini MD , Francesco Cardinali MD , Giacomo Castellucci MD , Enrico Rita MD , Loredana Messano MD , Giuseppe Ciliberti MD , Maurizio Malacrida MSc , Antonio Dello Russo MD, PhD","doi":"10.1016/j.hroo.2025.07.022","DOIUrl":"10.1016/j.hroo.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of data on the temporal dynamics of cardiac biomarkers after radiofrequency and pulsed field ablation (PFA) catheter ablation of atrial fibrillation.</div></div><div><h3>Objective</h3><div>To evaluate the kinetics of release of several biomarkers following pulmonary vein isolation (PVI).</div></div><div><h3>Methods</h3><div>All patients underwent baseline and regular post-procedural blood sampling (at 3, 24, and 48 hours) to assess major markers of myocardial injury (troponin I, creatinine kinase-MB, and myoglobin) and inflammatory (C-reactive protein [CRP]). The population was stratified into 3 groups according to the ablation system: radiofrequency (RF) ablation catheter (RF group), pentaspline Farapulse<sup>TM</sup> PFA system (PFA-FAR group), and variable-loop Varipulse<sup>TM</sup> PFA system (PFA-VAR group).</div></div><div><h3>Results</h3><div>A total of 186 patients were included: 79 RF (42.5%), 69 PFA-FAR (37.1%), and 38 PFA-VAR (20.4%). A greater extent of myocardial injury was noticed in the PFA groups vs RF, and cellular electroporation via pentaspline PFA resulted in a greater biomarker increase compared with loop-variable PFA. Kinetics of biomarkers of inflammation increase following PVI with both PFA technologies and RF. However, both PFA systems resulted in a faster CRP biomarker recovery compared with RF, while CRP continued to increase beyond 24 hours post-ablation only in the RF group. PVI was achieved in all patients (100%) using only PFA or RF.</div></div><div><h3>Conclusion</h3><div>Cellular electroporation induced by pentaspline PFA was associated with a significantly greater elevation in these cardiac biomarkers compared with variable-loop PFA and RF. After an initial increase, both PFA systems were associated with a more rapid decline in CRP levels compared with RF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1688-1695"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546943","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.2025.07.021
Laura T. Derry MD, MBA , Mary A. Whooley MD , Merritt H. Raitt MD, FHRS , Thomas L. Rotering MPH , Hui Shen MS , Gary Tarasovsky BS , Sanket S. Dhruva MD, MHS
Background
Traditionally, patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) attend routine in-person evaluations at least annually, paired with remote monitoring (RM). Because similar data can be obtained through RM and in-person evaluations, it is unclear whether routine in-person evaluations are necessary.
Objective
This study aimed to compare major adverse cardiac events (MACE) in patients who did vs did not receive in-person CIED care while participating in RM.
Methods
We classified patients who received their CIED care within the Veterans Health Administration and sent ≥1 RM transmission between July 1, 2020, and June 30, 2021, into 2 groups based on clinician evaluation type for their CIED care: (1) at least 1 in-person evaluation or (2) remote-only evaluations. The primary outcome was MACE, a composite of all-cause mortality, stroke, and cardiac hospitalization, in the following year (July 1, 2021, to June 30, 2022). We performed multivariable logistic regression, adjusting for patient- and device-related characteristics.
Results
Of 40,367 patients, 38,213 (94.7%) had at least 1 in-person evaluation for CIED care. The mean patient age was 72.8 years and 97.4% were male. There were 11,248 total MACEs (27.9%), 10,777 (28.2%) among patients who had at least 1 in-person evaluation and 471 (21.9%) among those with remote-only evaluations for CIED care. After multivariable adjustment, there was no significant difference in MACE (odds ratio 1.11; 95% confidence interval 0.98–1.25) between patients who had any in-person evaluation and those who had remote-only evaluations for CIED care.
Conclusion
Among patients engaged in RM, the odds of MACE were similar regardless of whether patients had any in-person evaluations vs remote-only evaluations for CIED care.
{"title":"Outcomes associated with remote monitoring without in-person evaluations for patients with cardiovascular implantable electronic devices","authors":"Laura T. Derry MD, MBA , Mary A. Whooley MD , Merritt H. Raitt MD, FHRS , Thomas L. Rotering MPH , Hui Shen MS , Gary Tarasovsky BS , Sanket S. Dhruva MD, MHS","doi":"10.1016/j.hroo.2025.07.021","DOIUrl":"10.1016/j.hroo.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, patients with cardiovascular implantable electronic devices (CIEDs) (pacemakers and implantable cardioverter-defibrillators) attend routine in-person evaluations at least annually, paired with remote monitoring (RM). Because similar data can be obtained through RM and in-person evaluations, it is unclear whether routine in-person evaluations are necessary.</div></div><div><h3>Objective</h3><div>This study aimed to compare major adverse cardiac events (MACE) in patients who did vs did not receive in-person CIED care while participating in RM.</div></div><div><h3>Methods</h3><div>We classified patients who received their CIED care within the Veterans Health Administration and sent ≥1 RM transmission between July 1, 2020, and June 30, 2021, into 2 groups based on clinician evaluation type for their CIED care: (1) at least 1 in-person evaluation or (2) remote-only evaluations. The primary outcome was MACE, a composite of all-cause mortality, stroke, and cardiac hospitalization, in the following year (July 1, 2021, to June 30, 2022). We performed multivariable logistic regression, adjusting for patient- and device-related characteristics.</div></div><div><h3>Results</h3><div>Of 40,367 patients, 38,213 (94.7%) had at least 1 in-person evaluation for CIED care. The mean patient age was 72.8 years and 97.4% were male. There were 11,248 total MACEs (27.9%), 10,777 (28.2%) among patients who had at least 1 in-person evaluation and 471 (21.9%) among those with remote-only evaluations for CIED care. After multivariable adjustment, there was no significant difference in MACE (odds ratio 1.11; 95% confidence interval 0.98–1.25) between patients who had any in-person evaluation and those who had remote-only evaluations for CIED care.</div></div><div><h3>Conclusion</h3><div>Among patients engaged in RM, the odds of MACE were similar regardless of whether patients had any in-person evaluations vs remote-only evaluations for CIED care.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1752-1760"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546466","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.2025.08.034
Jackeline P. Vajta Gomez MD , Michele M. Pelter RN, PhD , Geoffrey H. Tison MD, MPH , David Mortara PhD , Fabio Badilini PhD , Yumiko Abe-Jones MS , Sandra Oreper MPH , Margaret C. Fang MD, MPH , Priya A. Prasad PhD, MPH
{"title":"Association of ventricular tachycardia burden with 30-day in-hospital mortality in an intensive care unit cohort","authors":"Jackeline P. Vajta Gomez MD , Michele M. Pelter RN, PhD , Geoffrey H. Tison MD, MPH , David Mortara PhD , Fabio Badilini PhD , Yumiko Abe-Jones MS , Sandra Oreper MPH , Margaret C. Fang MD, MPH , Priya A. Prasad PhD, MPH","doi":"10.1016/j.hroo.2025.08.034","DOIUrl":"10.1016/j.hroo.2025.08.034","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1769-1772"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546469","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.2025.08.040
William H. Swain MD , John R. Giudicessi MD, PhD , Jeffrey B. Geske MD , Darrell B. Newman MD , J. Martijn Bos MD, PhD , Shahid Karim MBChB , Peter A. Noseworthy MD, MBA , Zachi I. Attia PhD , Paul A. Friedman MD , Adelaide M. Arruda-Olson MD, PhD , Michael J. Ackerman MD, PhD , Steve R. Ommen MD , Konstantinos C. Siontis MD
Background
The characteristics of patients with hypertrophic cardiomyopathy (HCM) who present with sudden cardiac arrest as the initial manifestation of the disease are not well known.
Objective
The purpose of this study was to evaluate artificial intelligence–enhanced electrocardiography (AI-ECG) and sudden cardiac death (SCD) risk factors in patients with HCM presenting with sudden cardiac arrest (SCA).
Methods
We identified patients within the Mayo Clinic enterprise (2001–2022) who were newly diagnosed with HCM after surviving SCA. Index clinical, electrocardiographic, and imaging characteristics were documented. Risk models for SCD in HCM were retrospectively applied. An AI-ECG algorithm designed for the detection of HCM was also applied to the patients’ first ECG obtained at our institution.
Results
Twenty-seven patients met the inclusion criteria. Eight patients (30%) had documented cardiac symptoms preceding SCA. Twenty-four patients (89%) had an abnormal electrocardiogram at index evaluation, and 16 (59%) had ≥1 SCD risk factor that could have qualified them for an implantable cardioverter-defibrillator if HCM had been diagnosed before SCA. Retrospective application of the European Society of Cardiology 5-year HCM Risk-SCD tool yielded a median score of 4.6% (interquartile range 3.2%–7.2%), with 12 patients (44%) having an estimated SCD risk of <4%, implying a low risk. AI-ECG indicated a high prediction score for HCM in 26 patients (96%), suggesting its potential utility as an early detector of the disease if applied before SCA.
Conclusion
Among patients with SCA who were then newly diagnosed with HCM, conventional SCD risk factors were common but not universal in this post hoc assessment. AI-ECG may facilitate the early detection of HCM.
{"title":"Artificial intelligence–enhanced electrocardiography and sudden death risk factors in cardiac arrest survivors diagnosed with hypertrophic cardiomyopathy","authors":"William H. Swain MD , John R. Giudicessi MD, PhD , Jeffrey B. Geske MD , Darrell B. Newman MD , J. Martijn Bos MD, PhD , Shahid Karim MBChB , Peter A. Noseworthy MD, MBA , Zachi I. Attia PhD , Paul A. Friedman MD , Adelaide M. Arruda-Olson MD, PhD , Michael J. Ackerman MD, PhD , Steve R. Ommen MD , Konstantinos C. Siontis MD","doi":"10.1016/j.hroo.2025.08.040","DOIUrl":"10.1016/j.hroo.2025.08.040","url":null,"abstract":"<div><h3>Background</h3><div>The characteristics of patients with hypertrophic cardiomyopathy (HCM) who present with sudden cardiac arrest as the initial manifestation of the disease are not well known.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate artificial intelligence–enhanced electrocardiography (AI-ECG) and sudden cardiac death (SCD) risk factors in patients with HCM presenting with sudden cardiac arrest (SCA).</div></div><div><h3>Methods</h3><div>We identified patients within the Mayo Clinic enterprise (2001–2022) who were newly diagnosed with HCM after surviving SCA. Index clinical, electrocardiographic, and imaging characteristics were documented. Risk models for SCD in HCM were retrospectively applied. An AI-ECG algorithm designed for the detection of HCM was also applied to the patients’ first ECG obtained at our institution.</div></div><div><h3>Results</h3><div>Twenty-seven patients met the inclusion criteria. Eight patients (30%) had documented cardiac symptoms preceding SCA. Twenty-four patients (89%) had an abnormal electrocardiogram at index evaluation, and 16 (59%) had ≥1 SCD risk factor that could have qualified them for an implantable cardioverter-defibrillator if HCM had been diagnosed before SCA. Retrospective application of the European Society of Cardiology 5-year HCM Risk-SCD tool yielded a median score of 4.6% (interquartile range 3.2%–7.2%), with 12 patients (44%) having an estimated SCD risk of <4%, implying a low risk. AI-ECG indicated a high prediction score for HCM in 26 patients (96%), suggesting its potential utility as an early detector of the disease if applied before SCA.</div></div><div><h3>Conclusion</h3><div>Among patients with SCA who were then newly diagnosed with HCM, conventional SCD risk factors were common but not universal in this post hoc assessment. AI-ECG may facilitate the early detection of HCM.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1807-1814"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546470","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.2025.08.036
Jose Eric M. Lacsa, Doctor in Religious, Values Education
{"title":"Can safety and innovation coexist in the global expansion of laser balloon ablation?","authors":"Jose Eric M. Lacsa, Doctor in Religious, Values Education","doi":"10.1016/j.hroo.2025.08.036","DOIUrl":"10.1016/j.hroo.2025.08.036","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Page 1858"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546471","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}
{"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}
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