European heart journal open最新文献

Acidic calcium stores significantly influence basal calcium transient amplitude and β-adrenergic responses in cardiomyocytes. Atrial myocytes contain atrial granules (AGs), small acidic organelles that store and secrete atrial natriuretic peptide (ANP) and are absent in healthy ventricular myocytes. AGs are known to be acidic and calcium-rich, but their number and location relative to other signalling sites remain unexplored. Labelling of acidic organelles in adult guinea pig cardiomyocytes showed the presence of acidic puncta throughout the cytosol. Atrial myocytes exhibited an increased concentration of acidic organelles at the nuclear poles. Live cell fluorescent studies using 4-phenyl-3-butenoic acid (PBA) to inhibit peptidylglycine α-amidating monooxygenase, a crucial component of AGs membranes, effectively eliminated staining at the nuclear poles and most acidic puncta in atrial cells, but not in ventricular cells. Our immunofluorescent labelling also emphasizes the differences in acidic punctae between atrial and ventricular myocytes by showing minimal co-localization between AG-specific ANP and lysosomal-associated membrane protein. Electron microscopy studies on goat atrial fibrillation (AF) and sham control tissue allowed visualization of AGs. Quantitative analysis revealed that AGs were positioned significantly further away from the nearest sarcoplasmic reticulum and were closer to mitochondria in AF compared to sinus rhythm control tissue. We raise the question whether the positioning of AGs is strategic for communication with other calcium-containing organelles.

Aims: High-frequency low-tidal volume (HFLTV) ventilation may improve catheter stability and enhance procedural success in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Long-term findings remained unclear.

Methods and results: We conducted a meta-analysis that included all studies that directly compared AF patients who underwent RF ablation under HFLTV compared with standard ventilation. Primary outcomes included acute first-pass pulmonary vein isolation (PVI) and long-term recurrence of AF/atrial arrhythmias after 12 months. Secondary outcomes included total procedure duration, ablation time, and RF time, with pooled standardized mean difference derived using the inverse variance method. Five cohort studies (publication period: 2019-2024) were identified and included in the meta-analysis (final sample: HFLTV n = 460 vs. standard ventilation n = 705). High-frequency low-tidal volume ventilation was significantly associated with lower risk of AF recurrence after 12 months {pooled odds ratio (OR) = 0.62 [95% confidence interval (CI): 0.42-0.92]}, as well as total atrial arrhythmia [OR = 0.59 (95% CI: 0.42-0.81)], with no between-study heterogeneity (I ² = 0%). Acutely, HFLTV was associated with higher probability of first-pass PVI with borderline statistical significance [OR = 1.24 (95% CI: 0.94-1.63)]. Furthermore, HFLTV was associated with significant reductions in total procedure time [-0.71 (95% CI: -1.00 to -0.42), unit in standard deviation], ablation time [-0.83 (95% CI: -1.07 to -0.59)], and total RF time [-0.72 (95% CI: -0.85 to -0.59)] (heterogeneity I ² = 76%). Notably, there was no effect modification by paroxysmal or persistent AF (P > 0.05). All studies reported no major complications in either group.

Conclusion: High-frequency low-tidal volume ventilation is associated with improved long-term success of arrhythmia control in AF patients who undergo RF catheter ablation, regardless of paroxysmal or persistent status.

Aims: We hypothesize that sinus rhythm (SR) maintenance in persistent atrial fibrillation (AF) patients taking anti-arrhythmic drugs (AADs) after pre-procedural electrical cardioversion (ECV) could predict outcomes after catheter ablation procedures.

Methods and results: 219 persistent AF patients on AADs underwent ECV 1-6 months before ablation. Patients were categorized into two groups according to their response to ECV: patients in whom SR was restored and maintained until the ablation procedure (ECV-SR group), and patients with AF recurrence before the procedure (ECV-AF group). Then, 1:1 propensity score matching was used to create study groups (94-94 patients). The efficacy outcomes of the present study were freedom from atrial tachyarrhythmia on/off AADs following a single ablation procedure and recurrence of persistent AF. The median follow-up duration was 42 (20-73) months. Freedom from atrial tachyarrhythmia at 36 months was lower in the ECV-AF group compared to ECV-SR patients (31.4% vs. 51.2%, respectively; crude HR = 2.58, 95% CI = 1.58-3.70, P < 0.001). The most frequent pattern of atrial arrhythmia recurrence was persistent AF in the ECV-AF group and paroxysmal AF in the ECV-SR group. Freedom from persistent AF at 36 months was 54% and 84.3%, respectively (crude HR = 3.72, 95% CI = 1.94-7.14, P < 0.001). Differences in the risk of the efficacy outcomes were similar after multi-variable adjustment and in all analysed subgroups, including pulmonary vein isolation (PVI)-only procedures.

Conclusion: Our findings indicate that the positive response to pre-procedural ECV may be a valuable marker for identifying persistent AF patients in whom a PVI-only strategy is sufficient.

Aims: The study aimed to investigate international trends in the adoption of the radial artery (RA) as a conduit for coronary artery bypass grafting across different national and regional registries.

Methods and results: Data were extracted from four databases: the UK cardiac surgery database, the Ontario provincial administrative database, the Austrian national adult cardiac surgery database, and the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). Radial artery use rates were 4.3% in the UK, 23.3% in Ontario, 4.8% in Austria, and 6.4% in the STS ACSD. Significant uptrends in RA use were observed in Ontario (P = 0.001), Austria (P = 0.004), and the STS ACSD (P = 0.02), while a downtrend was noted in the UK (P = 0.015). Endoscopic RA harvesting was increasingly adopted, particularly in Ontario and the STS ACSD.

Conclusion: Global adoption of RA remains variable and generally low with a general uptrend and higher adoption of endoscopic harvesting.

[This corrects the article DOI: 10.1093/ehjopen/oeaf061.].

Aims: Clinical studies show that pulsatile haemodynamics and pressure waveform analysis are valuable for the diagnosis and prognosis of hypertension and heart failure (HF). While generalized transfer functions (GTFs) have shown clinical significance, some studies report limitations with GTF in capturing central pulsatile haemodynamics. This study introduces a hybrid time-frequency, machine learning-based transfer function that reconstructs central pressure waveforms from peripheral measurements, accurately capturing central pulsatile haemodynamics and arterial wave-based information.

Methods and results: Our method uses Fourier harmonics for approximating the pressure waveform. The model is trained on these harmonics using a feed-forward neural network (FNN) with a custom time-domain cost function that captures the full temporal dynamics of physiological events during a cardiac cycle. The final hybridized-FNN transfer function model is trained, tested, and validated on data from the Framingham Heart Study (6698 participants). Our method produces carotid waveforms with median normalized mean squared error (%NMSE) values of 0.09 and 0.10 for brachial and radial inputs, compared to 0.42 and 0.26 for GTF, with similar accuracy improvements in other metrics. Correlation coefficients for the first and second forward wave times and amplitudes are 0.97, 0.93, 0.82, and 0.79 with brachial input, and 0.97, 0.92, 0.87, and 0.80 with radial input, vs. as low as 0.22 and 0.31 for GTF. Overall, our method significantly improved correlations across similarity, morphology, and wave-based parameters.

Conclusion: Our hybridized FNN transfer function approach enables robust calculation of the central arterial pressure waveform from a single measured peripheral waveform, preserving key physiological sequences in a cardiac cycle.

Aims: With a growing population of women with congenital heart disease (CHD), pregnancies in this group are expected to increase. However, pregnancy in women with CHD is associated with increased adverse outcomes for both mother and child. The aim of this study was to evaluate pregnancy and foetal complications in women with CHD and to test their association with the modified WHO (mWHO) classification.

Methods and results: Using two national registers, the national register for CHD and the Pregnancy Register, primiparous women giving birth between 2014 and 2019 were identified. Women with CHD, n = 829, and women without CHD, n = 4137, were matched by birth year and municipality in a ∼1:5 ratio. The women with CHD were classified according to the mWHO criteria. Caesarean deliveries (25.7 vs. 17.2%, P < 0.001), preterm delivery (10.3 vs. 6.4%, P < 0.001), and preeclampsia (6.2 vs. 4.1%, P = 0.007) were more common in women with CHD compared with controls. Using logistic regression, there was an association between high mWHO class (mWHO III, IV) and caesarean section [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.8-6.7], preterm birth (<37 weeks) (OR 8.3, 95% CI 4.1-17.1), and preeclampsia (OR 3.8, 95% CI 1.5-9.9).

Conclusion: Pregnancy complications are more common in women with CHD. In women with CHD, the mWHO classification is associated with maternal complications and preterm birth. Thus, large national register data corroborate the advice provided in current guidelines, and the mWHO class is deemed a valuable risk stratification tool in women with CHD.

Aims: Ventricular tachycardia (VT) ablation has been shown to reduce the recurrence of VT episodes, but the timing of performing VT ablation (early; at the time of implantable cardioverter defibrillator implantation) or (deferred: after the patient has received ICD shocks) remains controversial. The objective is to conduct a systematic review and meta-analysis of published data from randomized controlled trials (RCTs) in patients with ischaemic cardiomyopathy (ICM) with the aim of comparing outcome of VT ablation stratified by procedural timing.

Methods and results: We conducted a meta-analysis of seven landmark RCTs which included patients with ICM who were either at a high risk of VT or experienced VT/ICD shocks. The primary outcome of VT recurrence was compared according to the timing of performing VT ablation (early vs. deferred). In addition, we also compared the secondary outcome of cardiac mortality. Following a comprehensive search strategy, a total of seven RCTs were included within the final analysis. Based on a pooled analysis, early VT ablation was associated with a significant reduction in the primary outcome [pooled odds ratio (OR) of 0.72, 95% confidence interval (CI): 0.55-0.95, P < 0.05] in comparison with a 'deferred VT ablation' strategy. The cumulative absolute risk reduction (ARR) for the primary outcome was 0.21, and number needed to treat (NNT) to prevent the outcome of VT recurrence was 4.81. Furthermore, the effect size of early VT ablation compared to a deferred VT ablation approach was more pronounced in reduction of ICD shocks in the subgroup of patients with LVEF > 30% vs. those with LVEF < 30% (pooled OR of 0.65, 95% CI of 0.54-0.79, P = 0.01). For the secondary outcomes, we observed that an earlier timing of VT ablation was also associated with both a decrease in cardiac mortality (pooled OR of 0.59, 95% CI of 0.43-0.82) and in the subsequent risk of VT storm (pooled OR of 0.63, 95% CI of 0.51-0.78) when compared with a deferred timing. The cumulative ARR for cardiac mortality was 0.07 and NNT was 15.

Conclusion: The findings from this pooled analysis of seven major RCTs suggest that performing early VT ablation may be beneficial in reducing recurrent VT, ICD shocks, and electrical storm and could also improve cardiac mortality. The benefit of performing early VT ablation was greater in patients with LVEF of >30% amongst this ICM cohort.