Wael Zaher, Lorenzo Marcon, Klaus-Richard Ebinger, Antonio Sorgente
Background
Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability.
Objective
To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters.
Methods
This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed.
Results
Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (p = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.
Conclusion
High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.
{"title":"Comparison of Two High-Power Ablation Strategies for Typical Atrial Flutter: Acute and Long-Term Outcome","authors":"Wael Zaher, Lorenzo Marcon, Klaus-Richard Ebinger, Antonio Sorgente","doi":"10.1111/anec.70089","DOIUrl":"https://doi.org/10.1111/anec.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (<i>p</i> = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank <i>p</i> value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Talebian, Ali Mohammad Shakiba, Adele Malekipoor, Fatemeh Hafezipour, Mohammad Mahdi Heidari, Fatemeh Talebian, Hamid Reza Gilasi
Introduction
QT interval corrected dispersion (QTcd) reflects the heterogeneity of ventricular repolarization and has been proposed as a marker for arrhythmic risk in various neurologic and cardiac conditions. The aim of this study was to evaluate QTcd differences between children with epilepsy and healthy controls, with attention to age and antiepileptic drug use.
Methods
A case–control study was conducted on 50 children with epilepsy and 50 age- and sex-matched control children admitted to Shahid Beheshti Hospital in Kashan in 2019. QTcd was manually measured from 12-lead electrocardiograms (ECGs). Data were analyzed using SPSS version 22.
Results
No overall significant difference was observed in QTcd between groups (p > 0.05). However, children with epilepsy under 5 years of age had significantly higher QTcd than controls of the same age (p = 0.014). Moreover, QTcd was significantly lower in children with epilepsy receiving medication compared with those not on treatment (p = 0.026).
Conclusion
Although overall QTcd did not differ significantly between epileptic and control children, age under five and antiepileptic drug use significantly influenced QTcd. These findings suggest the importance of cardiac evaluation and early treatment in younger patients with epilepsy.
QT间期校正离散度（QTcd）反映了心室复极的异质性，并被认为是各种神经和心脏疾病中心律失常风险的标志。本研究的目的是评估癫痫患儿与健康对照之间的QTcd差异，并注意年龄和抗癫痫药物的使用。方法对2019年卡尚市沙希德·贝赫什蒂医院收治的50例癫痫患儿和50例年龄、性别匹配的对照组患儿进行病例对照研究。QTcd由12导联心电图（ECGs）人工测量。数据分析采用SPSS version 22。结果两组间QTcd总体差异无统计学意义（p > 0.05）。而5岁以下癫痫患儿的QTcd明显高于同龄对照组（p = 0.014）。此外，接受药物治疗的癫痫患儿的QTcd明显低于未接受药物治疗的癫痫患儿（p = 0.026）。结论癫痫患儿与对照组总体QTcd差异不显著，但5岁以下儿童和抗癫痫药物使用对QTcd有显著影响。这些发现提示对年轻癫痫患者进行心脏评估和早期治疗的重要性。
{"title":"QTc Interval Dispersion in Pediatric Epilepsy: A Case–Control Study From Iran","authors":"Ahmad Talebian, Ali Mohammad Shakiba, Adele Malekipoor, Fatemeh Hafezipour, Mohammad Mahdi Heidari, Fatemeh Talebian, Hamid Reza Gilasi","doi":"10.1111/anec.70094","DOIUrl":"https://doi.org/10.1111/anec.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>QT interval corrected dispersion (QTcd) reflects the heterogeneity of ventricular repolarization and has been proposed as a marker for arrhythmic risk in various neurologic and cardiac conditions. The aim of this study was to evaluate QTcd differences between children with epilepsy and healthy controls, with attention to age and antiepileptic drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A case–control study was conducted on 50 children with epilepsy and 50 age- and sex-matched control children admitted to Shahid Beheshti Hospital in Kashan in 2019. QTcd was manually measured from 12-lead electrocardiograms (ECGs). Data were analyzed using SPSS version 22.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No overall significant difference was observed in QTcd between groups (<i>p</i> > 0.05). However, children with epilepsy under 5 years of age had significantly higher QTcd than controls of the same age (<i>p</i> = 0.014). Moreover, QTcd was significantly lower in children with epilepsy receiving medication compared with those not on treatment (<i>p</i> = 0.026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although overall QTcd did not differ significantly between epileptic and control children, age under five and antiepileptic drug use significantly influenced QTcd. These findings suggest the importance of cardiac evaluation and early treatment in younger patients with epilepsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).
Methods
Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.
Results
This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (n = 49) and non-valvular AF-related cardioembolic stroke (n = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, p = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, p = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, p < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, p < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.
Conclusions
LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.
{"title":"The Role of Left Atrial Strain in Differentiating Embolic Stroke of Undetermined Source From Other Acute Ischemic Stroke Subtypes Related to Large-Vessel Occlusion","authors":"Yanjuan Zhang, Jincheng Jiao, Yingying Wang, Sheng Liu, Yuezhou Cao, Haibing Shi, Minglong Chen, Mingfang Li","doi":"10.1111/anec.70093","DOIUrl":"https://doi.org/10.1111/anec.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (<i>n</i> = 49) and non-valvular AF-related cardioembolic stroke (<i>n</i> = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, <i>p</i> = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, <i>p</i> = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, <i>p</i> < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, <i>p</i> < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.
Methods
Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.
Results
A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.
Conclusion
The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.
{"title":"Simulation and Modeling Thrombotic Occlusion in Peripherally Inserted Central Catheters","authors":"Feng-Xian Li, Qiao-hong Guo","doi":"10.1111/anec.70090","DOIUrl":"https://doi.org/10.1111/anec.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.
Methods
A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.
Results
Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.
Conclusion
The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.
{"title":"Evaluating the Role of Multimodal Imaging in the Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy","authors":"Zi-xin Yang, Rong-hui Zheng, Cui-yan Wang, Hai-tao Yuan, Yong-le Sun, Mei Zhu","doi":"10.1111/anec.70086","DOIUrl":"https://doi.org/10.1111/anec.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mustafa Gabarin, Mahmoud Suleiman, Adi Elias, Ibrahim Marai, Roy Beinart, Eyal Nof, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, David Pereg, Avishag Laish-Farkash, Alexander Omelchenko, the Israeli Working Group on Pacing Electrophysiology
Background
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHA2DS2-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.
Aim
To evaluate the association between the CHA2DS2-VASc score and both AF recurrence and adverse clinical outcomes following PVI.
Methods
We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA2DS2-VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re-hospitalization, major adverse cardiovascular events (MACE), and all-cause mortality.
Results
AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA2DS2-VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; p < 0.001). Elevated CHA2DS2-VASc scores also correlated with higher MACE and re-hospitalization rates. No significant difference in all-cause mortality was observed.
Conclusion
The CHA2DS2-VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.
{"title":"CHA2DS2-VASc Score as a Predictor for Atrial Fibrillation Recurrence and Clinical Outcomes Following Pulmonary Vein Isolation","authors":"Mustafa Gabarin, Mahmoud Suleiman, Adi Elias, Ibrahim Marai, Roy Beinart, Eyal Nof, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, David Pereg, Avishag Laish-Farkash, Alexander Omelchenko, the Israeli Working Group on Pacing Electrophysiology","doi":"10.1111/anec.70088","DOIUrl":"https://doi.org/10.1111/anec.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHA<sub>2</sub>DS<sub>2</sub>-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the association between the CHA<sub>2</sub>DS<sub>2</sub>-VASc score and both AF recurrence and adverse clinical outcomes following PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA<sub>2</sub>DS<sub>2</sub>-VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re-hospitalization, major adverse cardiovascular events (MACE), and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA<sub>2</sub>DS<sub>2</sub>-VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; <i>p</i> < 0.001). Elevated CHA<sub>2</sub>DS<sub>2</sub>-VASc scores also correlated with higher MACE and re-hospitalization rates. No significant difference in all-cause mortality was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asma Dilawari, Mori J. Krantz, Ilynn Bulatao, Hee-Koung Joeng, Marc Neilson, Suparna Wedam, Xin Gao, Mallorie H. Fiero, Abhilasha Nair, Marc Theoret, Laleh Amiri-Kordestani
Background
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. By releasing blocks (checkpoints) on the immune system, they elicit powerful antitumor effects. Despite improving survival, ICIs are associated with serious cardiac toxicities. Previous reports have focused on advanced cancer; cardiotoxicity data are therefore limited in the curative setting. We evaluated ICI cardiotoxicity in the non-metastatic setting, where long-term cardiac safety is a growing public health concern.
Methods
ICIs approved in the adjuvant setting were pooled and trials with combination chemotherapy were excluded. Cardiac adverse events (AEs) and emerging cardio-metabolic risks (hyperglycemia, weight gain, hypothyroidism) were assessed. The relative risk (RR) of cardiotoxicity was assessed.
Results
Ten randomized controlled trials of atezolizumab, ipilimumab, nivolumab, and pembrolizumab in multiple solid tumors were evaluated; among 9244 patients, 5338 received ICIs. No trial performed routine cardiac monitoring. Six percent of ICI patients vs. 4.6% in placebo (RR 1.24, 95% CI 1.04, 1.49) had a cardiac AE and 13 (0.2%) of ICI patients experienced a fatal cardiac AE (RR 4.76, 95% CI 1.07, 21.06). Older age and male sex were associated with a higher risk for cardiac fatality. Arrhythmia was the most common cardiac AE; hypothyroidism was more frequent (14% vs. 2.5%) among ICI-treated patients.
Conclusion
This is the largest pooled analysis of cardiac AEs associated with ICIs in the adjuvant setting. Despite no formalized testing for subclinical cardiotoxicity, ICI treatment increased cardiac AEs. These findings are relevant for long-term cancer survivors, clinicians, and particularly in new drug development, where cardiotoxicity may be substantially underestimated.
免疫检查点抑制剂（ICIs）已经彻底改变了癌症治疗。通过在免疫系统上释放阻滞（检查点），它们引发了强大的抗肿瘤作用。尽管可以提高生存率，但ici与严重的心脏毒性有关。以前的报告主要关注晚期癌症；因此，心脏毒性数据在治疗环境中是有限的。我们在非转移性环境中评估了ICI心脏毒性，长期心脏安全是一个日益增长的公共卫生问题。方法汇总已批准用于辅助治疗的ICIs，排除联合化疗的试验。评估心脏不良事件（ae）和新出现的心脏代谢风险（高血糖、体重增加、甲状腺功能减退）。评估心脏毒性的相对危险度（RR）。结果评估了atezolizumab、ipilimumab、nivolumab和pembrolizumab治疗多发性实体瘤的10项随机对照试验；在9244例患者中，5338例接受了ICIs。没有试验进行常规心脏监测。6%的ICI患者与安慰剂组的4.6% （RR 1.24, 95% CI 1.04, 1.49）发生心脏AE， 13例（0.2%）的ICI患者发生致命性心脏AE （RR 4.76, 95% CI 1.07, 21.06）。年龄较大和男性与较高的心脏死亡风险相关。心律失常是最常见的AE；在接受ici治疗的患者中，甲状腺功能减退更为常见（14%对2.5%）。结论：这是对辅助治疗中与ICIs相关的心脏ae进行的最大的汇总分析。尽管没有正式的亚临床心脏毒性测试，但ICI治疗增加了心脏ae。这些发现与长期癌症幸存者、临床医生，特别是新药开发相关，在这些领域，心脏毒性可能被大大低估。
{"title":"Cardiac Adverse Events in Patients Receiving Immune Checkpoint Inhibitors in the Adjuvant Setting: An FDA Pooled Analysis","authors":"Asma Dilawari, Mori J. Krantz, Ilynn Bulatao, Hee-Koung Joeng, Marc Neilson, Suparna Wedam, Xin Gao, Mallorie H. Fiero, Abhilasha Nair, Marc Theoret, Laleh Amiri-Kordestani","doi":"10.1111/anec.70087","DOIUrl":"https://doi.org/10.1111/anec.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. By releasing blocks (checkpoints) on the immune system, they elicit powerful antitumor effects. Despite improving survival, ICIs are associated with serious cardiac toxicities. Previous reports have focused on advanced cancer; cardiotoxicity data are therefore limited in the curative setting. We evaluated ICI cardiotoxicity in the non-metastatic setting, where long-term cardiac safety is a growing public health concern.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ICIs approved in the adjuvant setting were pooled and trials with combination chemotherapy were excluded. Cardiac adverse events (AEs) and emerging cardio-metabolic risks (hyperglycemia, weight gain, hypothyroidism) were assessed. The relative risk (RR) of cardiotoxicity was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten randomized controlled trials of atezolizumab, ipilimumab, nivolumab, and pembrolizumab in multiple solid tumors were evaluated; among 9244 patients, 5338 received ICIs. No trial performed routine cardiac monitoring. Six percent of ICI patients vs. 4.6% in placebo (RR 1.24, 95% CI 1.04, 1.49) had a cardiac AE and 13 (0.2%) of ICI patients experienced a fatal cardiac AE (RR 4.76, 95% CI 1.07, 21.06). Older age and male sex were associated with a higher risk for cardiac fatality. Arrhythmia was the most common cardiac AE; hypothyroidism was more frequent (14% vs. 2.5%) among ICI-treated patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the largest pooled analysis of cardiac AEs associated with ICIs in the adjuvant setting. Despite no formalized testing for subclinical cardiotoxicity, ICI treatment increased cardiac AEs. These findings are relevant for long-term cancer survivors, clinicians, and particularly in new drug development, where cardiotoxicity may be substantially underestimated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dillon J. Dzikowicz, Mehmed Aktas, Betty Mykins, Xiaojuan Xia, Wojciech Zareba, Jean-Phillippe Couderc
Introduction
Atrial fibrillation (AF), affecting 3% of the US adults, is the most common arrhythmia. While ambulatory electrocardiogram (ECG) monitoring is essential for AF detection, conventional technologies have diagnostic limitations due to AF's sporadic nature. ECG patches offer extended monitoring periods, though their effectiveness is primarily limited by deteriorating skin-electrode contact rather than battery or memory constraints.
Objectives
This analysis reports our experience with the Zio ECG patch (iRhythm, San Francisco, CA) in 256 AF patients.
Method
We analyzed human and technical factors and their association with ECG recording duration using previously recorded data which employed the ECG patch as a reference. Descriptive statistics and logistic regression were used to identify associations.
Results
Body mass index (BMI) was found to be an independent predictor of poorer compliance in a dose-dependent manner (B = −0.046, OR = 0.955, 95% CI: 0.916–0.996, p = 0.033). Loss of adhesive was the primary reason for poor compliance (n = 25; 11%). These findings can guide researchers and clinicians in determining the appropriateness of a 14-day ECG patch based on expected wear time and patient compliance.
Conclusion
BMI significantly impacts ECG patch compliance, primarily through adhesive failures. These findings indicate the need for improved adhesive technologies for higher BMI patients. Future device development should prioritize maintaining electrode-skin contact across diverse patient populations.
Trial Registration
ClinicalTrials.gov Identifier: NCT04267133
房颤（AF）是最常见的心律失常，影响3%的美国成年人。虽然动态心电图（ECG）监测对房颤检测至关重要，但由于房颤的散发性，传统技术具有诊断局限性。心电图贴片可以延长监测周期，但其有效性主要受到皮肤电极接触恶化的限制，而不是受到电池或记忆的限制。本分析报告了我们在256例房颤患者中使用Zio ECG贴片（irhym, San Francisco， CA）的经验。方法以心电贴片为参考，分析人为因素和技术因素与心电记录时间的关系。使用描述性统计和逻辑回归来确定关联。结果体重指数（BMI）是依从性较差的独立预测因子，且呈剂量依赖性（B = - 0.046, OR = 0.955, 95% CI: 0.916-0.996, p = 0.033）。粘接剂的丧失是依从性差的主要原因(n = 25；11%)。这些发现可以指导研究人员和临床医生根据预期佩戴时间和患者依从性来确定14天ECG贴片的适当性。结论BMI显著影响心电图贴片的依从性，主要通过贴片失效影响。这些发现表明需要改进黏附技术来治疗高BMI患者。未来的设备开发应优先考虑在不同的患者群体中保持电极-皮肤接触。临床试验注册：ClinicalTrials.gov标识符：NCT04267133
{"title":"Identifying Demographic Factors Affecting the ECG Duration Collected Using a Single-Lead ECG Patch Device","authors":"Dillon J. Dzikowicz, Mehmed Aktas, Betty Mykins, Xiaojuan Xia, Wojciech Zareba, Jean-Phillippe Couderc","doi":"10.1111/anec.70068","DOIUrl":"https://doi.org/10.1111/anec.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation (AF), affecting 3% of the US adults, is the most common arrhythmia. While ambulatory electrocardiogram (ECG) monitoring is essential for AF detection, conventional technologies have diagnostic limitations due to AF's sporadic nature. ECG patches offer extended monitoring periods, though their effectiveness is primarily limited by deteriorating skin-electrode contact rather than battery or memory constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This analysis reports our experience with the Zio ECG patch (iRhythm, San Francisco, CA) in 256 AF patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We analyzed human and technical factors and their association with ECG recording duration using previously recorded data which employed the ECG patch as a reference. Descriptive statistics and logistic regression were used to identify associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Body mass index (BMI) was found to be an independent predictor of poorer compliance in a dose-dependent manner (<i>B</i> = −0.046, OR = 0.955, 95% CI: 0.916–0.996, <i>p</i> = 0.033). Loss of adhesive was the primary reason for poor compliance (<i>n</i> = 25; 11%). These findings can guide researchers and clinicians in determining the appropriateness of a 14-day ECG patch based on expected wear time and patient compliance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BMI significantly impacts ECG patch compliance, primarily through adhesive failures. These findings indicate the need for improved adhesive technologies for higher BMI patients. Future device development should prioritize maintaining electrode-skin contact across diverse patient populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov Identifier: NCT04267133</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhi Luo, Yi Liu, Yuwei Chen, Xiaobo Pu, Xiangbin Xiao
A 66-year-old man with 5-year intermittent palpitation underwent an electrophysiologic (EP) study. Electrocardiograms (ECGs) on admission showed sinus rhythm with right bundle branch block (RBBB). During palpitation, regular tachycardia with RBBB occurred. Through detailed analysis, the diagnosis of Wolff-Parkinson-White (WPW) syndrome with orthodromic atrio-ventricular reentry tachycardia (AVRT) was established. The case emphasizes the significance of comparing sinus rhythm and tachycardia ECGs for accurate diagnosis.
{"title":"Narrowed Right Bundle Branch Block Pattern in Tachycardia","authors":"Zhi Luo, Yi Liu, Yuwei Chen, Xiaobo Pu, Xiangbin Xiao","doi":"10.1111/anec.70072","DOIUrl":"https://doi.org/10.1111/anec.70072","url":null,"abstract":"<p>A 66-year-old man with 5-year intermittent palpitation underwent an electrophysiologic (EP) study. Electrocardiograms (ECGs) on admission showed sinus rhythm with right bundle branch block (RBBB). During palpitation, regular tachycardia with RBBB occurred. Through detailed analysis, the diagnosis of Wolff-Parkinson-White (WPW) syndrome with orthodromic atrio-ventricular reentry tachycardia (AVRT) was established. The case emphasizes the significance of comparing sinus rhythm and tachycardia ECGs for accurate diagnosis.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 66-year-old male patient diagnosed with dilated cardiomyopathy, heart failure with reduced EF (32%), and complete left bundle branch block (CLBBB) received cardiac resynchronization therapy (CRT)-D implantation. Left bundle branch pacing (LBBP) was successfully performed, but during the follow-up 6 weeks later, the electrocardiogram (ECG) showed a sinus rhythm tracked by ventricular pacing with a ratio of approximately 2:1 due to T-wave over-sensing, which might be caused by the changes in T-wave morphology due to electrotonic modulation and hyperkalemia or by the lower sensitivity threshold set by the auto sensing algorithm of the ICD. Shortening post-ventricular atrial refractory period (PVARP) restored the ventricular pacing tracking of the atrium, and the T-wave changes improved as time went by.
{"title":"A Case Report: Electrotonic Modulation-Related T-Wave Over-Sensing After Left Bundle Branch Pacing","authors":"Linlin Li, Manxin Lin, Jincun Guo, Qiang Li, Fanqi Meng, Xinyi Huang, Simei Chen, Binni Cai","doi":"10.1111/anec.70083","DOIUrl":"https://doi.org/10.1111/anec.70083","url":null,"abstract":"<p>A 66-year-old male patient diagnosed with dilated cardiomyopathy, heart failure with reduced EF (32%), and complete left bundle branch block (CLBBB) received cardiac resynchronization therapy (CRT)-D implantation. Left bundle branch pacing (LBBP) was successfully performed, but during the follow-up 6 weeks later, the electrocardiogram (ECG) showed a sinus rhythm tracked by ventricular pacing with a ratio of approximately 2:1 due to T-wave over-sensing, which might be caused by the changes in T-wave morphology due to electrotonic modulation and hyperkalemia or by the lower sensitivity threshold set by the auto sensing algorithm of the ICD. Shortening post-ventricular atrial refractory period (PVARP) restored the ventricular pacing tracking of the atrium, and the T-wave changes improved as time went by.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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