European heart journal open最新文献

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.

Aims: Cardiac pacing aims to replicate physiological heart rhythm. While left bundle area pacing (LBAP) enhances left ventricular (LV) activation, it often struggles to fully address interventricular dyssynchrony. Bipolar LBAP with anodal ring capture (LBAP-ARC) offers a potential solution by synchronously activating both left and right bundle branches. This study aims to compare the effects of unipolar LBAP and LBAP-ARC on ventricular synchrony and myocardial function.

Methods and results: A prospective cohort study was conducted with enroling 32 patients undergoing successful LBAP implantation. Pacing thresholds, lead impedance, QRS duration, and echocardiographic parameters-including LV and right ventricular (RV) global longitudinal strain (GLS), systolic dyssynchrony index, and interventricular mechanical delay (IVMD)-were assessed under unipolar LBAP and LBAP-ARC configurations. Left bundle area pacing with anodal ring capture significantly improved LV GLS (-16.09% vs. -14.85%, P = 0.0006) and reduced IVMD (5.13 ms vs. 21.76 ms, P < 0.0001) compared to unipolar LBAP at 1-week follow-up, and these improvements persisted at 3 months (-16.70% vs. -14.98%, P = 0.0005 for LV GLS; 8.01 ms vs. 21.75 ms, P = 0.0045 for IVMD). Subgroup analysis showed enhanced LV (-16.47% vs. -14.76%, P = 0.0094) and RV GLS (-16.24% vs. -15.86%, P = 0.0344) in patients with biphasic QRS patterns in leads II/III. Improvements in RV GLS were less pronounced in patients with predominantly positive QRS patterns in leads II/III.

Conclusion: Left bundle area pacing with anodal ring capture enhances ventricular synchrony and improves subclinical myocardial function compared to unipolar LBAP, establishing itself as a promising approach in physiological cardiac pacing.

Aims: This study characterizes the under-recognized normotensive cardiogenic shock (CS) phenotype by analysing fatal cases, comparing haemodynamics, shock trajectories, and management gaps with hypotensive CS.

Methods and results: We analysed 112 patients who died from CS between 2017 and 2022. Patients > 70 were excluded due to local eligibility criteria. Normotensive (n = 51) and hypotensive CS (n = 61) had similar degrees of cardiac impairment, with cardiac indices well below 2.0 L/min/m² and LVEF < 35%. Both groups exhibited comparable end-organ dysfunction, including lactate levels (7.0 ± 5.0 vs. 6.1 ± 5.6 mmol/L, P = 0.441) and acute liver injury (51-56%). Hypotensive CS typically followed a predictable decline in shock stage [75.4% deteriorated to Society for Cardiovascular Angiography Interventions (SCAI) stages D-E], whereas normotensive CS demonstrated less predictable trajectories, with 51% showing apparent stability before rapid deterioration and death. Receiver operating characteristic analysis revealed that only the rise in serum creatinine weakly predicted deterioration to advanced SCAI stages (Area under the curve 0.62, P = 0.035), while initial lactate and liver function tests lacked predictive value. Normotensive cases had a median 14 h longer referral window from onset of CS but were referred less frequently. Twenty-six were considered potential candidates for advanced heart failure therapy but were not referred.

Conclusion: Normotensive and hypotensive CS share similar degrees of hypoperfusion but differ in their shock trajectories. The delay in referrals for normotensive CS highlights the need for earlier recognition of this phenotype and standardized protocols to ensure timely referrals for mechanical circulatory support.