Annals of Noninvasive Electrocardiology最新文献_第7页

Cardiac Adverse Events in Patients Receiving Immune Checkpoint Inhibitors in the Adjuvant Setting: An FDA Pooled Analysis 接受免疫检查点抑制剂辅助治疗的患者心脏不良事件：FDA汇总分析

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-07 DOI: 10.1111/anec.70087

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。

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引用次数: 0

Identifying Demographic Factors Affecting the ECG Duration Collected Using a Single-Lead ECG Patch Device 使用单导联心电图贴片装置识别影响心电图持续时间的人口统计学因素

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-04 DOI: 10.1111/anec.70068

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

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引用次数: 0

Narrowed Right Bundle Branch Block Pattern in Tachycardia 心动过速右束支狭窄阻滞模式

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-28 DOI: 10.1111/anec.70072

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.

66岁男性5年间歇性心悸接受电生理（EP）研究。入院时心电图显示窦性心律伴右束支传导阻滞。心悸时，发生规律性心动过速伴RBBB。通过详细分析，确定Wolff-Parkinson-White （WPW）综合征合并正畸型房室再入性心动过速（AVRT）的诊断。本病例强调比较窦性心律和心动过速心电图对准确诊断的意义。

引用次数: 0

A Case Report: Electrotonic Modulation-Related T-Wave Over-Sensing After Left Bundle Branch Pacing 左束支起搏后电紧张调节相关t波过感1例报告

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-28 DOI: 10.1111/anec.70083

Linlin Li, Manxin Lin, Jincun Guo, Qiang Li, Fanqi Meng, Xinyi Huang, Simei Chen, Binni Cai

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.

66岁男性，诊断为扩张型心肌病、心力衰竭伴EF降低（32%）、完全性左束支传导阻滞（CLBBB），接受心脏再同步化治疗(CRT)-D植入。左束支起搏（LBBP）成功实施，但在6周后的随访中，心电图显示窦性心律由心室起搏跟踪，其比例约为2:1，这可能是由于电紧张调节和高钾血症引起的t波形态改变或ICD自动感知算法设置的较低灵敏度阈值所致。缩短心室后心房不应期（PVARP）恢复心房心室起搏追踪，t波变化随时间延长而改善。

引用次数: 0

Evaluatıon of Depressıon and Anxıety Status in Patıents After Cardıac Devıce Implantatıon “Depressıon”中的“Evaluatıon”和“Anxıety”中的“Patıents”中的“状态”

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-25 DOI: 10.1111/anec.70085

Murat Özmen, Onur Altunkaya, Selim Aydemir, Sidar Şiyar Aydın, Faruk Aydınyılmaz, Emrah Aksakal, Emre Alkan

Introduction

Implantable cardioverter defibrillator (ICD) and pacemaker (PM) implantation may lead to anxiety and depression, which may reduce patients' quality of life. The aim of our study was to compare depression and anxiety following device implantation.

Methods

This prospective study was conducted on 202 patients admitted to our hospital with ICD and PM implants between January 2024 and January 2025.

Results

The prevalence of anxiety in PM and ICD recipients was 25.9% and 38.8%, respectively. There was a significant difference in anxiety in ICD patients (< 0.001). In terms of depression, the results in the PM and ICD groups were 18.9 and 38.9, respectively. The results showed a significant difference in the prevalence of depression between PM and ICD recipients. The tendency toward depression was statistically significant in both device recipients (PM; p = 0.008, ICD; p < 0.001).

Conclusion

Considering the prevalence of anxiety and depression, it seems necessary to pay closer attention to the anxiety and depression states of patients who have been treated with PM and ICD devices and to provide more widespread education to these patients.

导言植入式心律转复除颤器（ICD）和起搏器（PM）可能会导致焦虑和抑郁，从而降低患者的生活质量。我们的研究旨在比较植入设备后的抑郁和焦虑情况。方法对 2024 年 1 月至 2025 年 1 月期间本院收治的 202 名植入 ICD 和 PM 的患者进行了前瞻性研究。结果 PM 和 ICD 患者的焦虑发生率分别为 25.9% 和 38.8%。ICD 患者的焦虑程度有明显差异（< 0.001）。在抑郁方面，PM 组和 ICD 组的结果分别为 18.9% 和 38.9%。结果显示，PM 和 ICD 患者的抑郁症患病率存在明显差异。在统计学上，两种设备的接受者都有抑郁倾向（PM；p = 0.008，ICD；p < 0.001）。结论考虑到焦虑和抑郁的普遍性，似乎有必要更加密切地关注接受 PM 和 ICD 装置治疗的患者的焦虑和抑郁状态，并向这些患者提供更广泛的教育。

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引用次数: 0

Transesophageal Atrial Pacing for the Evaluation of Accessory Atrioventricular Pathways in Wolff-Parkinson-White Syndrome: A Pediatric Case Report and Literature Review 经食管心房起搏评价沃尔夫-帕金森-怀特综合征的副房室通路：一份儿科病例报告和文献综述

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-23 DOI: 10.1111/anec.70084

Jing Chen, Ping Zuo, Xiaoyun Yang, Bei Wang

Arrhythmia induction and identifying the functional characteristics of accessory pathways in Wolff-Parkinson-White (WPW) syndrome typically requires an invasive electrophysiological study. This case reports a 13-year-old boy with a five-year history of paroxysmal palpitations, where transesophageal atrial pacing (TEAP) was used to identify accessory pathways. TEAP revealed multiple tachycardia forms, differentiating orthodromic atrioventricular reentrant tachycardia with narrow and wide QRS complexes. EPS confirmed two pathways, diagnosing WPW syndrome. TEAP effectively assessed accessory pathways' functional characteristics and their roles in tachycardia, showcasing its potential as a minimally invasive diagnostic tool for this condition.

在Wolff-Parkinson-White （WPW）综合征中诱发心律失常和识别副通路的功能特征通常需要有侵入性的电生理研究。这个病例报告了一个13岁的男孩，有5年的阵发性心悸病史，经食管心房起搏（TEAP）用于识别副通路。TEAP显示多种心动过速形式，可区分正畸型房室折返性心动过速与窄宽QRS复音。EPS证实两条通路，诊断WPW综合征。TEAP有效地评估了辅助通路的功能特征及其在心动过速中的作用，显示了其作为该疾病的微创诊断工具的潜力。

引用次数: 0

Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study 追踪视觉专家在心电图解释：一项眼动追踪试点研究

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-18 DOI: 10.1111/anec.70082

Alessandro Bortolotti, Fabrizio Ricci, Carmelita Cieri, Federica Cocco, Chiara Martini, Marcello Panunzi, Davide Rossi, Anna Sorella, Silvio Saraullo, Davide Scordo, Giulia Renda, Sabina Gallina, Riccardo Palumbo

Background

Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.

Methods

First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.

Results

Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; p < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (p < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; p < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; p = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; p = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; p = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; p = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; p = 0.041).

Conclusions

In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.

视觉专业知识对于准确的心电解释至关重要。我们的目的是在使用眼动追踪技术进行心电图分析时，识别和测量视觉搜索模式、认知负荷和诊断准确性方面的专业差异。方法1 - 3年住院医师和委员会认证的心脏病专家解释疑似急性冠脉综合征患者的心电图，同时眼动追踪眼镜记录注视次数、持续时间和瞳孔扩张。通过NASA任务负荷指数分析诊断准确性和认知负荷。热图说明了认知负荷、感知负荷和自我评估性能之间的关系，包括经验水平和ECG任务复杂性。结果专家读者解读心电图的速度明显快于普通居民（107.6±32.8 vs. 205.31±57.43 s）；P < 0.001)，并在所有任务难度水平上表现出更高的诊断准确性（P < 0.001）。眼球追踪分析显示，专家的注视次数较少（67.7±25.7 vs. 143.7±29.9）；P < 0.001)和更长的固定时间(3.9±0.7 vs. 3.2±1 s；P = 0.032)。专家还显示瞳孔扩张变化(4.8%±2% vs. 10.5%±4.2%；p = 0.015)。任务难度的增加与瞳孔扩大有关，特别是在新手中(困难任务的平均瞳孔扩大13.4%±4.1%，而简单任务的平均瞳孔扩大7.3%±2.3%；P = 0.008)，表明认知需求较高。专家保持较好的自我评估表现（8±0比7±1.2）；P = 0.009)，报告的感知负工作负荷较低(4.5±1.45比6±0.55；p = 0.041)。在本初步研究中，专家读者的诊断速度更快、更准确，表现出更高效的视觉搜索模式和更低的认知负荷。在外部验证之前，我们的研究结果表明，ECG训练计划应侧重于开发有针对性的视觉技术，认知效率和适应性应对策略，以提高准确的解释。

{"title":"Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study","authors":"Alessandro Bortolotti, Fabrizio Ricci, Carmelita Cieri, Federica Cocco, Chiara Martini, Marcello Panunzi, Davide Rossi, Anna Sorella, Silvio Saraullo, Davide Scordo, Giulia Renda, Sabina Gallina, Riccardo Palumbo","doi":"10.1111/anec.70082","DOIUrl":"https://doi.org/10.1111/anec.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; <i>p</i> < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (<i>p</i> < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; <i>p</i> < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; <i>p</i> = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; <i>p</i> = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; <i>p</i> = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; <i>p</i> = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; <i>p</i> = 0.041).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845926","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}

引用次数: 0

The Effect of Sacubitril/Valsartan on Supraventricular and Ventricular Arrhythmias in Patients With Heart Failure 沙比利/缬沙坦对心力衰竭患者室上性和室性心律失常的影响

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-15 DOI: 10.1111/anec.70081

Alireza Arzhangzadeh, Mohammad Hossein Nikoo, Majid Haghjoo, Fatemeh Rasekh, Shayan Shojaei, Asma Mousavi, Salma Nozhat, Roozbeh Narimani-Javid, Helia Bazroodi, Sana Neisi, Mitra Mojibpour, Mohammad Abedini, Saghi Eslamzadeh, Hamed Bazrafshan Drissi, Sasan Shafiei

Background

Patients with heart failure with reduced ejection fraction (HFrEF) frequently experience electrical disturbances, such as ventricular or atrial fibrillation (AF). Sacubitril/Valsartan (SV) therapy has been linked to lower rates of mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF), with decreased reliance on implantable cardioverter-defibrillator (ICD) therapy. However, studies on the antiarrhythmic effects of SV in patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) devices are limited. This study aimed to evaluate the impact of SV therapy on antiarrhythmic pacing, defibrillation shock occurrences, and the burden of ventricular arrhythmias in patients with HFrEF who have ICD or CRT-D devices.

Method

This study was conducted at a HF outpatient clinic involving patients with HFrEF treated with SV. Primary outcomes included the incidence of VT, VF, non-sustained VT (NsVT), supraventricular tachycardia (SVT), and related interventions such as antiarrhythmic pacing (ATP) and defibrillation shocks.

Result

A total of 181 HFrEF patients completed at least 12 months of follow-up, with a mean age of 63.39 ± 12 years; 36.5% were male, and 60.8% had an ICD. Device interrogation revealed a significant reduction in VF incidents (7 vs. 15, p = 0.025) and a decrease in the combined outcome of VT and VF (17 vs. 24, p = 0.047). The need for ICD interventions such as ATP and shocks also significantly decreased following the initiation of SV therapy (10 vs. 24, p = 0.012).

Conclusion

SV therapy significantly reduces the incidence of cardiac arrhythmias, particularly VT and VF, while decreasing the need for clinical interventions related to implanted devices.

背景：心力衰竭伴射血分数降低（HFrEF）患者经常出现电干扰，如心室或心房颤动（AF）。Sacubitril/缬沙坦（SV）治疗与较低的死亡率、室性心动过速（VT）和心室颤动（VF）有关，并降低了对植入式心律转复除颤器（ICD）治疗的依赖。然而，关于SV在ICD或心脏再同步化除颤器（CRT-D）患者中的抗心律失常作用的研究有限。本研究旨在评估SV治疗对使用ICD或CRT-D装置的HFrEF患者抗心律失常起搏、除颤休克发生率和室性心律失常负担的影响。方法本研究在一家HF门诊进行，研究对象为接受SV治疗的HFrEF患者。主要结局包括VT、VF、非持续性VT （NsVT）、室上性心动过速（SVT）的发生率，以及相关干预措施，如抗心律失常起搏（ATP）和除颤休克。结果共有181例HFrEF患者完成了至少12个月的随访，平均年龄63.39±12岁；36.5%为男性，60.8%患有ICD。设备询问显示，VF事件显著减少（7比15，p = 0.025）， VT和VF的综合结果显著减少（17比24，p = 0.047）。在开始SV治疗后，对ATP和电击等ICD干预的需求也显著减少（10比24，p = 0.012）。结论SV治疗可显著降低心律失常，尤其是室性心动过速和室性心动过速的发生率，同时减少与植入器械相关的临床干预需求。

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引用次数: 0

Predicting Ventricular Tachyarrhythmias in Patients With Left Ventricular Ejection Fraction Improvement Following Cardiac Resynchronization Therapy 心脏再同步化治疗后左心室射血分数改善患者的室性心动过速预测

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-08 DOI: 10.1111/anec.70059

Adam Visca, Saadia Sherazi, Ilan Goldenberg, Scott McNitt, Nikhila Rao, Nilesh Rao, Ahmed Shah, Mehmet Aktas, Valentina Kutyifa, Wojciech Zareba, Krishna Rao

Background

Patients undergoing cardiac resynchronization therapy with a defibrillator (CRT-D) often experience improvements in the left ventricular ejection fraction (LVEF). This study aimed to identify predictors of ventricular tachyarrhythmias (VTA) in patients with CRT-D devices and LVEF improvement beyond guideline recommendations for a defibrillator.

Methods

Patients randomized to the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial who improved their LVEF to > 35% at 12 months following CRT-D implant were included in this analysis (N = 651). Predictors of an appropriate implantable cardioverter defibrillator (ICD) Rx VTA were evaluated by Cox proportional hazards regression modeling.

Results

We identified three predictors of VTA among patients treated with CRT-D subsequent to LVEF improvement > 35%: Lower range improvement in LVEF 36%–40% versus improvement to > 40% (HR, 1.97; 95% CI, 1.21–3.20; p = 0.006); Baseline non-LBBB ECG morphology (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.23–3.04; p = 0.004); Occurrence of VTA during the first year post-CRT-D (HR, 4.91; 95% CI, 2.99–8.07; p < 0.001).

Conclusions

We identified a sub-group of patients with risk factors who remain at high risk of VTA despite improvement in LVEF following CRT implant. These patients require close monitoring despite improvement in LVEF beyond guideline recommendations for an ICD.

背景：接受心脏再同步化除颤器（CRT-D）治疗的患者通常会经历左心室射血分数（LVEF）的改善。本研究旨在确定使用CRT-D装置和LVEF改善超出指南推荐除颤器的患者室性心动过速（VTA）的预测因素。方法将随机分配到多中心自动除颤器植入试验与心脏再同步化治疗试验的CRT-D组的患者纳入本分析（N = 651），这些患者在CRT-D植入后12个月LVEF改善至35%。采用Cox比例风险回归模型评估合适的植入式心脏除颤器（ICD） Rx VTA的预测因子。结果：在LVEF改善（35%）后接受CRT-D治疗的患者中，我们确定了三个预测VTA的因素：LVEF较低范围改善（36%-40%）与改善（40%）(HR, 1.97；95% ci, 1.21-3.20；p = 0.006)；基线非lbbb心电图形态(危险比[HR]， 1.93；95%置信区间[CI]， 1.23-3.04；p = 0.004)；ct - d后第一年VTA的发生率(HR, 4.91；95% ci, 2.99-8.07；p < 0.001)。结论：我们确定了一个具有危险因素的亚组患者，尽管CRT植入后LVEF有所改善，但他们仍然处于VTA的高风险。尽管LVEF的改善超出了指南建议的ICD，但这些患者仍需要密切监测。

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引用次数: 0

The Evaluation of P-Wave Parameters in Patients With Percutaneous Closure of Atrial Septal Defect 经皮房间隔缺损闭合术患者p波参数的评价

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-04-08 DOI: 10.1111/anec.70076

Ramazan Astan, Fehmi Kacmaz, Ersin Saricam, Erdogan Ilkay

Background

Atrial septal defect (ASD) can lead to volume overload and related changes in P-wave parameters in surface electrocardiograms of these patients. In this study, we aimed to evaluate the effect of volume overload on P-wave parameters in patients with ASD.

Materials and Methods

This study is a retrospective cohort analysis. A total of 142 patients with secundum ASD who underwent percutaneous closure were evaluated. P-wave duration (Pmax) and P-wave dispersion (PWD) were measured on the surface ECG before and 1 h after the closure procedure. We evaluated P-wave parameters in terms of defect size, duration of the volume overload, and closure device sizes.

Results

Pmax and PWD were significantly decreased after the procedure compared with the values before the procedure (p < 0.001). Pmax values had a statistically significant correlation with ASD size (< 20 mm or ≥ 20 mm) both before and after the procedure. Pmax values were significantly higher in patients older than 30 years of age (119.6 ± 19.5 vs. 102.7 ± 17.1 ms, respectively; p = 0.039). A significantly positive correlation was found between pre- and post-procedural Pmax and defect sizes (r = 0.474, p = 0.019 and r = 0.4233, p = 0.04, respectively). However, no positive correlation between PWD and defect age and size was present.

Conclusion

Percutaneous closure of ASD is associated with an immediate decrease in both Pd and Pmax that seems to be related to the acute volume overload cessation in cardiac chambers.

背景房间隔缺损（房间隔缺损，ASD）可导致房间隔缺损患者体表心电图容量过载及相关p波参数改变。在这项研究中，我们旨在评估容量过载对ASD患者p波参数的影响。材料与方法本研究采用回顾性队列分析。对142例经皮缝合的继发性ASD患者进行了评估。在闭合前和闭合后1 h测量体表心电图p波持续时间（Pmax）和p波弥散度（PWD）。我们根据缺陷大小、体积过载持续时间和闭合装置大小来评估p波参数。结果术后Pmax和PWD较术前显著降低（p < 0.001）。术前和术后Pmax值与ASD大小（≤20 mm或≥20 mm）均有统计学意义。30岁以上患者的Pmax值明显更高（分别为119.6±19.5 ms和102.7±17.1 ms）；p = 0.039)。术前和术后Pmax与缺陷大小呈显著正相关（r = 0.474, p = 0.019和r = 0.4233, p = 0.04）。然而，PWD与缺陷年龄和尺寸没有正相关。结论经皮ASD闭合与Pd和Pmax的立即下降有关，这似乎与心室容量过载的急性停止有关。

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引用次数: 0