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Comparison of rhythm versus rate control of atrial fibrillation in heart failure subgroups: Systematic review and meta-analysis of randomized controlled trials. 心力衰竭亚组心房颤动节律控制与心率控制的比较:随机对照试验的系统回顾和荟萃分析。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-11 DOI: 10.1016/j.ipej.2024.09.004
Rabbia Siddiqi, Anas Fares, Mona Mahmoud, Kanwal Asghar, Ragheb Assaly, Ehab Eltahawy, Blair Grubb, George V Moukarbel

Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients. In HF patients overall, we found high certainty evidence that rhythm control decreased all-cause and cardiovascular mortality (hazard ratio [HR, 95 % confidence interval] 0.64 [0.43-0.94]) and HR 0.50 [0.34-0.74] respectively). Rhythm control was associated with decreased HF hospitalization (risk ratio [RR] 0.79 [0.63-0.99], moderate certainty), but did not significantly decrease thromboembolic events (RR 0.67 [0.32-1.39], low certainty). The mean difference in left ventricular ejection fraction [LVEF] from baseline to last follow-up was greater in rhythm control group by 6.01 % [2.73-9.28 %] compared with rate control. Subgroup analyses by age, HF etiology (ischemic or non-ischemic), LVEF, presence of diabetes and hypertension did not reveal any significant differences in treatment effect. The survival and hospitalization reduction benefit of rhythm control of AF in HF patients likely reflects the success of catheter ablation especially in HF with reduced ejection fraction. These data are important to guide shared decision-making when managing AF in HF patients.

并发心力衰竭(HF)和心房颤动(AF)的患者预后不佳。将心律控制方法与心房颤动的心率控制进行比较的随机临床试验得出了相互矛盾的结果,而且缺乏最新、全面的证据总结,无法为心力衰竭患者的最佳治疗提供参考。因此,我们进行了一项系统性回顾和荟萃分析,比较了不同亚组的高血压患者房颤节律控制与心率控制的结果。在所有心房颤动患者中,我们发现高度确定的证据表明,节律控制可降低全因死亡率和心血管死亡率(危险比 [HR, 95 % 置信区间] 分别为 0.64 [0.43-0.94]) 和 HR 0.50 [0.34-0.74])。节律控制与心房颤动住院率降低有关(风险比 [RR] 0.79 [0.63-0.99],中等确定性),但并不能显著降低血栓栓塞事件(RR 0.67 [0.32-1.39],低确定性)。与心率控制相比,心律控制组左室射血分数[LVEF]从基线到最后一次随访的平均差异更大,为6.01% [2.73-9.28 %]。按年龄、心房颤动病因(缺血性或非缺血性)、LVEF、是否患有糖尿病和高血压进行的亚组分析未发现治疗效果有任何显著差异。心房颤动节律控制对心房颤动患者的生存和减少住院的益处可能反映了导管消融的成功,尤其是在射血分数降低的心房颤动患者中。这些数据对于指导心房颤动患者的共同决策非常重要。
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引用次数: 0
A case report of a combined implantation technique of a cardioverter-defibrillator in an infant with long QT syndrome type 8 (Timothy's syndrome). 长 QT 8 型综合征(蒂莫西综合征)婴儿心律转复除颤器联合植入技术病例报告。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-04 DOI: 10.1016/j.ipej.2024.09.002
Sergei Viktorovich Nemtsov, Roman Borisovich Tatarskiy, Sergei Arturovich Termosesov, Dmitriy Sergeevich Lebedev

We present a case of successful implantation of a cardioverter-defibrillator (ICD) using combined technique in a child with Timothy's syndrome. Due to high risk of sudden cardiac death (SCD) such patients often need ICD for primary or secondary prevention but implantation technique in young children remains controversial. The subcutaneous cardioverter-defibrillators could be an option in some cases, however, reliable cardiac pacing should be implemented for patients with bradyarrhythmias. An ICD implantation technique with the epicardial pacing lead placement and subcutaneous tunnel formation for endocardial defibrillation lead seems to be promising in SCD prevention also providing the opportunity for permanent pacing.

我们介绍了一例采用联合技术为蒂莫西综合征患儿成功植入心律转复除颤器(ICD)的病例。由于心脏性猝死(SCD)的高风险,此类患者通常需要 ICD 进行一级或二级预防,但在幼儿中的植入技术仍存在争议。在某些情况下,皮下心律转复除颤器可能是一种选择,但对于心律过缓的患者,应采用可靠的心脏起搏。心外膜起搏导线植入和心内膜除颤导线皮下隧道形成的 ICD 植入技术在预防 SCD 方面似乎很有前景,同时也为永久起搏提供了机会。
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引用次数: 0
The Janus Heads of ventricular Tachycardia: Single-circuit with dual exits. 室性心动过速的杰纳斯头:单回路双出口。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-31 DOI: 10.1016/j.ipej.2024.08.005
Devendra S Bisht, Kamal Kishor

In the setting of ischemic heart disease (IHD), ventricular tachycardia (VT) commonly originates from areas of incomplete scar tissue. High-density electroanatomic mapping has enhanced our understanding of VT circuits, predominantly characterised by dense scar and surviving myocyte bundles. We present a case of a 58-year-old male with IHD and sustained monomorphic VT, successfully treated with radiofrequency ablation following high-density mapping and entrainment techniques. Two inducible VT phenotypes were identified, with ablation at one site effectively terminating both VT morphologies. This case illustrates the importance of precise circuit localisation and targeted ablation in managing post-infarction VT, leading to a satisfactory patient outcome.

在缺血性心脏病(IHD)的情况下,室性心动过速(VT)通常起源于瘢痕组织不完整的区域。高密度电解剖图增强了我们对室性心动过速回路的了解,其主要特征是致密的瘢痕和存活的心肌细胞束。我们介绍了一例患有心肌缺血和持续性单形室性心动过速的 58 岁男性病例,该病例在采用高密度绘图和夹带技术后,成功地接受了射频消融治疗。确定了两种可诱发的 VT 表型,在一个部位进行消融可有效终止两种 VT 形态。该病例说明了精确电路定位和定向消融在治疗梗死后 VT 方面的重要性,从而为患者带来了令人满意的结果。
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引用次数: 0
Urinary NT-proBNP compared head-to-head to plasmatic NT-proBNP in a real life collective with an ICD. 尿液 NT-proBNP 与血浆 NT-proBNP 在 ICD 患者的实际生活中进行了正面比较。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-10-24 DOI: 10.1016/j.ipej.2024.10.006
Benedikt Seither, Alexander Schober, Raphael Allgaier, Christine Meindl, Michael Paulus, Ute Hubauer, Andreas Schober, Ekrem Ücer, Sabine Fredersdorf, Petra Lehn, Andreas Keyser, Andreas Luchner, Lars Maier, Stefan Wallner, Carsten Jungbauer

Aims: Plasma NT-proBNP is an established marker of heart failure. Previous studies suggested urinary NT-proBNP has potential as marker of chronic heart failure as well. The objective of this study was to compare urinary NT-proBNP to plasma NT-proBNP in a real-life collective of patients with an ICD, especially regarding ICD-therapies.

Methods & results: NT-proBNP was assessed in plasma and fresh spot urine (the latter related to urinary creatinine) from 322 patients of our ICD outpatient clinic. 54 healthy individuals served as a control group. Follow-up regarding mortality and ICD therapies was performed after 32 months (IQR 5-35 months). Plasma and urinary NT-proBNP was positively correlated (r = 0.89, p < 0,001). According to ROC analysis urinary NT-proBNP detected LV dysfunction (EF<35 % vs. healthy CTRL) with very satisfying predictive values (AUC 0.95), but plasma NT-proBNP showed slightly better values (AUC 0.99). Patients who received appropriate ICD-shock-therapies showed significantly higher plasma (p < 0.001) as well as urinary NT-proBNP levels (p = 0.011) compared to patients without shock-therapy. In Kaplan-Meier analysis, plasma as well as urinary NT-proBNP levels > Youden-Index showed significantly higher event rates for appropriate ICD-shock therapies (p < 0.001 and p = 0.016) and the combined endpoint of all-cause-mortality and shock therapies (each p < 0.001). Urinary and plasma NT-proBNP were independent predictors for appropriate ICD-shock-therapies and for the combined endpoint of all-cause mortality and appropriate ICD-shock-therapies (each p < 0.001).

Conclusion: Urinary NT-proBNP as a marker for LV dysfunction and symptomatic heart failure showed promising predictive values. Associations between plasma as well as urinary NT-proBNP and ICD shock-therapies could be shown.

目的:血浆 NT-proBNP 是心力衰竭的既定标志物。先前的研究表明,尿液中的 NT-proBNP 也有可能成为慢性心力衰竭的标志物。本研究的目的是在 ICD 患者的实际生活中比较尿液 NT-proBNP 和血浆 NT-proBNP,尤其是在 ICD 治疗方面:我们对 ICD 门诊 322 名患者的血浆和新鲜尿液(后者与尿肌酐有关)中的 NT-proBNP 进行了评估。54 名健康人作为对照组。在 32 个月(IQR 5- 35 个月)后对死亡率和 ICD 治疗进行了随访。血浆和尿液中的 NT-proBNP 呈正相关(r=0.89,p Youden-Index 显示,采用适当 ICD 休克疗法的事件发生率明显更高(pConclusion):尿液 NT-proBNP 作为左心室功能障碍和无症状心力衰竭的标志物,显示出良好的预测价值。血浆和尿液中的 NT-proBNP 与 ICD 电击疗法之间存在关联。
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引用次数: 0
Feasibility of a using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Correspondence. 使用胸带和干电极系统进行长期心律失常监测的可行性:通讯。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1016/j.ipej.2024.10.003
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Feasibility of using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Response to Correspondence to the Editor. 使用胸带和干电极系统进行长期心律失常监测的可行性:对致函编辑的回复。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-11-08 DOI: 10.1016/j.ipej.2024.11.002
Daljeet Kaur Saggu, Madappa Nagamalesh Udigala, Shantanu Sarkar, Arunkumar Sathiyamoorthy, Satyaprakash Dash, P V R Mohan, Vinayakrishnan Rajan, Calambur Narasimahan
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引用次数: 0
Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism? 房室同步起搏时的冲突反应。其机制是什么?
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI: 10.1016/j.ipej.2024.08.004
Suresh Kumar Sukumaran, Anish Bhargav, Sridhar Balaguru, Raja J Selvaraj
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引用次数: 0
Transient pacing pulse on the T-wave: What is the mechanism? T 波上的瞬时起搏脉冲:机制是什么?
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-11 DOI: 10.1016/j.ipej.2024.09.005
Yuta Sudo

A patient with a dual-chamber pacemaker for sick sinus syndrome was hospitalized for heart failure. The electrocardiography (ECG) during hospitalization displayed seemingly abnormal pacing artifacts. This report focuses on the problem-solving of an abnormal-looking paced ECG and identifies the pacemaker's operational behavior as the underlying reason.

一名因病窦综合征安装了双腔起搏器的患者因心力衰竭住院。住院期间的心电图(ECG)显示出看似异常的起搏伪像。本报告的重点是如何解决看起来异常的起搏心电图问题,并找出起搏器运行行为的根本原因。
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引用次数: 0
Paradoxical under-sensing of atrial lead at high sensitivity setting in dual chamber pacemaker during atrial flutter - What is the mechanism? 心房扑动时,双腔起搏器在高灵敏度设置下对心房导联的反常感应不足--其机制是什么?
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI: 10.1016/j.ipej.2024.08.002
Than Htike, Saroj Choudhury, Debabrata Bera

Introduction: The causes of atrial undersensing in a dual chamber pacemaker include true undersensing (low amplitude electrogram), functional undersensing (related to the effect of special timing cycles in the presence of an adequate signal) and paradoxical undersensing. This case report describes paradoxical atrial undersensing at a higher programmed atrial sensitivity and with the return of normal atrial sensing at a lower programmed sensitivity.

导言:导致双腔起搏器心房传感不足的原因包括真正的传感不足(低振幅电图)、功能性传感不足(在信号充足的情况下与特殊定时周期的影响有关)和矛盾性传感不足。本病例报告描述了在较高的编程心房灵敏度下出现的矛盾性心房感应不足,以及在较低的编程灵敏度下恢复正常的心房感应。
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引用次数: 0
Late onset of two concurrent and dissociated arrhythmias in a transplanted heart. 移植心脏晚期同时出现两种不同的心律失常。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI: 10.1016/j.ipej.2024.09.009
Gala Caixal, Paz Garre, Lluis Mont, Ivo Roca-Luque

A 53-year-old patient with a history of heart transplant is referred for atrial tachycardia ablation. Two dissociated concomitant rhythms are observed: a focal atrial tachycardia in the donor atrium and atrial fibrillation in the remaining recipient atrium.

一名 53 岁的患者曾接受过心脏移植手术,现转诊接受房性心动过速消融术。患者出现了两种不同的并发心律:供体心房出现局灶性房性心动过速,其余受体心房出现心房颤动。
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引用次数: 0
期刊
Indian Pacing and Electrophysiology Journal
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