Heart Rhythm (HEART RHYTHM )

Publisher: Heart Rhythm Society; Cardiac Electrophysiology Society, Elsevier

Description

Heart Rhythm is a unique journal that integrates the entire cardiac electrophysiology (EP) community from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Journal addresses a broad range of topics that affect our EP world. Our major focus is on original research and therapy of heart rhythm disorders, including mechanisms and electrophysiology, both clinical and experimental, genetics, ablation, devices, drugs, and surgery. Other sections include Contemporary and Historical Reviews, unique Case Reports, Viewpoints, Cell to Bedside, Hands On, Featured Arrhythmias, Images with videos viewable on the Internet, Pacing/ICD Problems, Creative Concepts, Humanism in Medicine, EP News, Editorial Commentaries, Basic/Clinical Implications, Historical Vignettes, and Ten Questions for Allied Professionals. As the Official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, we also publish the Plenary address and the Douglas P. Zipes Lecture given at the annual Scientific Sessions of the Heart Rhythm Society, as well as the Gordon K. Moe Lecture presented at the annual Cardiac Electrophysiology Society meeting.

Impact factor 4.92

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    Impact factor
  • 5-year impact
    4.72
  • Cited half-life
    3.60
  • Immediacy index
    2.09
  • Eigenfactor
    0.04
  • Article influence
    1.79
  • Website
    Heart Rhythm website
  • Other titles
    Heart rhythm
  • ISSN
    1547-5271
  • OCLC
    53439711
  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details

Elsevier

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, arXiv.org or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • Heart Rhythm 12/2014;
  • Heart Rhythm 12/2014;
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    ABSTRACT: Background The risk assessment of the complication from atrial fibrillation (AF) ablation is important and needs to be updated. Objective We investigated the clinical and procedural factors associated with AF ablation-related early complications. Methods The Japanese Heart Rhythm Society invited electrophysiology centers in Japan to register data regarding all AF ablation procedures performed in September 2011, March 2012, and September 2012. Of the 46 putative predictors assessed in the univariate analysis, significant variables (p < 0.1) were entered into a stepwise logistic regression model for multivariate analysis. Results Data for 3373 cases were submitted by 165 centers, with 158 early complications reported in 151 patients (4.5%). We identified 13 significant variables in the univariate analysis. Multivariate analysis revealed 8 of them were independent predictors of early complications. Female sex (odds ratio and 95% confidence interval, 1.6; 1.13–2.27), hypertrophic cardiomyopathy (HCM) (2.2; 1.08–4.5), valvular heart disease (2.53; 1.28–5.05) deep sedation during procedure (1.53; 1.09–2.12), and complex fractionated atrial electrocardiogram (CFAE) ablation (1.88; 1.23–2.87) increased early complications. Preprocedural transesophageal echocardiography (0.63; 0.43–0.92), irrigated-tip catheter use (0.46; 0.3–0.69), and periprocedural novel oral anticoagulant (NOAC) use (0.55; 0.32–0.97) decreased them. Conclusions The risk of early complications is increased by female sex, HCM, valvular heart disease, deep sedation, and CFAE ablation. It is decreased by preprocedural transesophageal echocardiography, periprocedural NOAC, and irrigated-tip catheter use.
    Heart Rhythm 12/2014;
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    ABSTRACT: Background St. Jude Medical (SJM) Optim-insulated ICD leads were designed to impart lubricity, strength and abrasion resistance while maintaining flexibility and biostability. No long-term prospective follow-up data have been published. Objective To determine the rates of all-cause mechanical failure and its subtypes (conductor fracture, insulation abrasion, externalized conductors and other mechanical failures) in a prospective cohort of Optim-insulated ICD leads. Methods SJM established 3 prospective registries and enrolled 11,016 leads implanted in 10,835 patients beginning in 2006. There was standardized baseline documentation, 6-monthly follow-up, adverse events reports (verified by expert staff using detailed algorithms) and documentation of lead revisions or inactivation, study withdrawal and death. The Population Health Research Institute (McMaster University) was engaged to review database functions, adjudicate all potential mechanical lead failures and to conduct independent analyses of the data. Results During a median follow-up of 3.2 years, there were 51 mechanical failures (0.46%), with 99.0 % survival free of this outcome by 5 years of follow-up. Freedom from conductor fracture was identified in 99.4% and from all-cause abrasion in 99.8% and there were no reports of externalized conductors. There were no significant differences in survivals among Durata DF-4, Durata DF-1 and Riata ST Optim leads. Conclusion Over a mean follow up of 3.2 years, Optim-insulated leads have low rates of all-cause mechanical failure and no observed externalized conductors. Independent analyses of these registries are designed to provide reliable, long-term follow-up information and are on-going.
    Heart Rhythm 12/2014;
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    ABSTRACT: Background A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain non-responsive to this intervention. Objective To determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes. Methods In 73 patients (age 68±12; 83% male; ejection fraction 27±7%) with CS and PV blood drawn simultaneously at the time of CRT implantation, we measured amino-terminal pro-B type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble (s)ST2 levels. NT-proBNP concentrations>2000 pg/mL, gal-3>25.9 ng/mL, and sST2>35 ng/mL were considered positive, based on established PV cutpoints for identifying “high risk” individuals with HF. CRT response was adjudicated by HF Clinical Composite Score. Major adverse cardiovascular event (MACE) was defined as the composite endpoint of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years. Results NT-proBNP concentrations were 20% higher in the CS than periphery, while gal-3 and sST2 were 10% higher in periphery than CS (all p<0.001). There were 45% CRT non-responders at 6 months and 22% MACE. Triple positive CS values yielded the highest specificity of 95% for predicting CRT non-response. Consistently, CS strategies identified patients at higher risk for developing MACE, with over 11-fold adjusted increase for triple positive CS patients compared to triple negative patients (all p≤0.04). PV strategies were not predictive of MACE. Conclusions Our findings suggest that coronary sinus sampling of HF biomarkers may be better than peripheral venous blood levels for predicting CRT outcomes. Larger studies are needed to confirm our findings.
    Heart Rhythm 12/2014;
  • Heart Rhythm 12/2014;
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    ABSTRACT: Background Left-bundle-branch-block(LBBB) and QT-prolongation are both associated with a worse prognosis. LBBB lengthens the QT-interval. So far it is not known if QT-time prolongation during LBBB differs in repolarization from QT-time prolongation during narrow QRS. Objective The aim of the present proof-of-concept-study is therefore to develop a formula that allows to compare the adjusted QT-interval during LBBB with reference values and thereby allow interpretation of the QT-interval irrespective of the QRS-widening. Methods 60 consecutive patients with sinus-rhythm(SR) and narrow-QRS underwent an EP-study for ablation. In all patients the intrinsic QRS-,QT- and JT-time was measured during SR and ventricular-pacing from the right-ventricular-apex(RVA) and outflow-tract(RVOT) both causing a LBBB. We determined the prolongation of the QT during as compared to SR(ΔQT). ΔQT was then divided by the QRS-length during paced-QRS(QRSb). This describes the percentage of the QRS-duration at LBBB, which must be subtracted from the measured QT(QTb), to determine the modified-QT(QTm). Results The ratio of ΔQT to paced-QRS was calculated as 48,3%(RVA) and 48.8%(RVOT)[mean 48.5%]. The ratio intrinsic-JTi to paced-JT was 1.0055 (RVA) and 1.0087(RVOT). There was no significant difference in intrinsic-JT vs. paced-JT(p=0.2) Conclusion Right-ventricular-pacing causes a prolongation of the QT due to a paced-LBBB without prolongation of the JT-time. In our study, we have shown that the QT-prolongation caused by the LBBB amounts 48.5% of the QRS-width. This is the value that must be subtracted from the measured QT in LBBB in order to estimate the modified-QT. The resulting Formula for „modified-QT" estimation in LBBB is: QTm = QTb – 48,5%*(QRSb).
    Heart Rhythm 12/2014;
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    ABSTRACT: Background Baseline QRS duration (QRSd) ≥150 ms is a recognized predictor of clinical improvement by cardiac resynchronization therapy (CRT), particularly for those with left bundle branch (LBBB). Patients with QRSd <150ms, are considered less likely to respond. Objective We theorized that left ventricular dyssynchrony, while usually associated with wider QRSd, also exhibits lower QRS frequency characteristics and that low frequency content should predict CRT response in LBBB patients. Methods We retrospectively examined the QRS frequency content of 170 heart failure patients with LBBB and QRSd ≥120 ms using the Fourier transformation. Ninety-four responders to CRT (definition; reduction in left ventricular end-systolic volume by ≥15% from baseline) were compared to 76 nonresponders (<15% reduction). The analysis of three standard ECG leads (I, AVF and V3) representing the three dimensions of depolarization, was performed and V3 provided the best predictive value. Results The QRSd of responders (160.3±17.8ms) and nonresponders (161.8±21.1ms; p=0.604) were similar. We found that the percentage of total QRS frequency power <10Hz that exceeded 52% was most predictive of CRT response compared to other cutoff values. However, the percentage of patients with total QRS power >52% below 10 Hz was especially predictive of response in those with QRSd <150ms. In these patients, this power threshold was highly predictive of CRT response (PPV=85.7% and NPV=71.4%). Conclusions In this group of CRT recipients with LBBB, retrospective analysis of QRS frequency content below 10 Hz had greater predictive value for CRT response than baseline QRSd, particularly in those with QRSd<150ms.
    Heart Rhythm 12/2014;
  • Heart Rhythm 12/2014;
  • Heart Rhythm 12/2014;
  • Heart Rhythm 12/2014;
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    ABSTRACT: Background Transcatheter aortic valve implantation (TAVI) has become the standard therapy for high-risk and non-operable patients with severe aortic stenosis. However, the procedure involves several adverse effects such as rhythm and conduction disturbances. Patients with postprocedural left bundle branch block may have an increased mortality risk, whereas patients with preprocedural right bundle branch block display a higher rate of postinterventional bradyarrhythmias. Objectives To investigate the occurrence of high-degree atriventricular block (AVB) in patients with preexisting bundle branch block (BBB) or BBB occurring during TAVI. Methods In this prospective single centre study 50 consecutive patients undergoing TAVI with the Medtronic CoreValve Revalving System were included. Of these, 17 patients with preexisting BBB or BBB occurring during TAVI received a primary prophylactic permanent DDD-pacemaker (PM), programmed to the AAIsafeR-mode and featuring dual channel event counters as well as stored intracardiac electrograms (EGMs). PM readouts and intracardiac EGMs were analysed for the occurrence of high-degree AVB. Results Ten of 17 patients (58.8%) with preexisting BBB or BBB occurring during TAVI developed episodes of high-degree AVB that were immediately terminated due to switch into DDD backup pacing. In 5 (29.4%) of the cases the first documented episode of high-degree AVB occurred after hospital discharge. The mean follow-up period was 578.1 (± 294.9) days. Conclusion Development of high-degree AVB is a common complication in patients with preexisting BBB or BBB occurring during TAVI. Accordingly, intensified monitoring might be reasonable, especially in patients treated with the self-expandable Medtronic CoreValve Revalving System.
    Heart Rhythm 12/2014;
  • Heart Rhythm 11/2014;
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    ABSTRACT: Tachycardia arising from the pulmonary venous atrium (PVA) has not been adequately characterized in the setting of surgically repaired congenital heart disease (CHD).Objective To determine the mechanisms, approach, and outcomes of catheter ablation of PVA tachycardia after CHD repair.Methods The adult CHD procedural database was searched for consecutive ablation procedures over a 4-year period. Procedural characteristics of the population with tachycardia arising from the PVA were compared to those without PVA tachycardia. Groups were classified as 1) biventricular CHD, 2) single ventricle, or 3) DTGA-baffle.ResultsComplete 3D mapping was possible for 113/124 sustained tachycardias during 81 procedures. Of these, 31 (19%) arose from the PVA, including 11 (15%) tachycardias for biventricular CHD, 8 (31%) for single ventricle, and 12 (80%) for DTGA-baffle procedures. IART was less frequently observed in the PVA versus the systemic venous atrium (SVA) (p=0.012). Independent predictors of PVA tachycardia were absence of biventricular CHD (OR 0.19, CI 0.05 to 0.64, p=0.010) and ipsilateral atrial surgery (OR 15.7, CI 4.8 to 59.9, p<0.001). PVA procedure duration was greater than SVA-only procedures (median 5.3 versus 4.0 hours, p=0.012) but acute success rates were similar (87% vs 82%, respectively, p=ns).ConclusionsPVA tachycardia is not unusual after surgical repair of CHD. Predictors include ipsilateral atrial surgery and absence of biventricular CHD. Such procedures involve increased complexity and unique tachycardia substrates but are equally amenable to catheter ablation
    Heart Rhythm 11/2014;
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    ABSTRACT: MRI in patients with LV leads may cause tissue or lead heating, dislodgement, venous damage, or lead dysfunction.Objective Determine the safety of MRI in patients with LV pacing leads.Methods Prospective data were collected in patients with CS LV leads undergoing clinically indicated MRI at 3 institutions. Patients were not pacemaker dependent. Scans were performed under pacing nurse, technician, radiologist, and physicist supervision using continuous vital sign, pulse oximetry, and ECG monitoring and a 1.5 T scanner with SAR < 1.5 Watts/kg. Devices were interrogated pre- and post-MRI, programmed to asynchronous or inhibition mode with tachyarrhythmia therapies off (if present) and reprogrammed to their original settings post-MRI.ResultsMRI scans (n=42) were performed in 40 patients with non-MRI conditional LV leads between 2005-2013 (mean age 67 ± 9 years, n=16 or 40% women, median lead implant duration 740 days with IQ range 125-1173 days). MRIs were performed on the: head/neck/spine (n=35, 83%), lower extremities (n=4, 10%), chest (n=2, 5%), and abdomen (n=1, 2%). There were no overall differences in pre- and post-MRI interrogation LV lead sensing (12.4 ± 6.2 vs. 12.9 ± 6.7 mV, p=0.38), impedance (724 ± 294 vs. 718 ± 312 Ohms, p=0.67), or threshold (1.4 ± 1.1 vs. 1.4 ± 1.0 V, p=0.91). There were no individual LV lead changes requiring intervention.ConclusionMRI scanning was performed safely in non-pacemaker dependent patients with CS LV leads who were carefully monitored during imaging without clinically significant adverse effect on LV lead function.
    Heart Rhythm 11/2014;
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    ABSTRACT: The features of intrinsic gangionated plexi (GPs) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF).Objective We aimed to assess the features of GP response after extensive PVI, and evaluated the relationship between the GP responses and the following AF episodes.Methods The study population consisted of 216 consecutive AF patients (persistent AF; 104) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI.ResultsGP responses were determined in 186 of 216 (85.6%) patients. In the left atrium, the GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%), and left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area; inside the CS in 64 of 216 (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (Hazard ratio 4.04, confidence interval; 1.48-11.0) in patients with paroxysmal, but not persistent AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% versus 8% in those without a GP response (p=0.002).Conclusions The presence of GP responses after extensive PVI was significantly associated with an increased AF recurrence after ablation in patients with paroxysmal AF.
    Heart Rhythm 11/2014;
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    ABSTRACT: Catheter perforations remain a major clinical concern during ablation procedures for treating atrial arrhythmias, and may lead to life-threatening cardiac tamponade. Radiofrequency (RF) ablation alters the biomechanical properties of cardiac tissue, ultimately allowing for perforation to occur more readily. Studies on the effects cryoablation has on perforation force, as well as defining the perforation force of human tissue are limited.Objective Investigate the required force to elicit perforation of cardiac atrial tissue following or during ablation procedures.Methods Effects of RF and cryo- ablation on catheter perforation forces for both swine (n=83 animals, 530 treatments) and human (n=8 specimens, 136 treatments) cardiac tissue were investigated.ResultsOverall average forces resulting in perforation of healthy unablated tissue were 406±170g for swine and 591±240g for humans. Post-RF ablation applications considerably reduced these forces to 246±118g for swine and 362±185g for humans (p<0.001); treatments with cryoablation did not significantly alter forces required to induce perforations. Decreasing catheter sizes resulted in a reduction in forces required to perforate the atrial wall (p<0.001). Catheter perforations occurred over an array of contact forces with a minimum of 38g being observed.Conclusion We consider that the swine model likely underestimates the required perforation forces relative to those of human tissues. We provided novel insights related to the comparative effects of RF and cryo- ablations on the potential for inducing undesired punctures, with RF ablation reducing perforation force significantly. These data are insightful for physicians performing ablation procedures as well as medical device designers.
    Heart Rhythm 11/2014;
  • Heart Rhythm 11/2014;
  • Heart Rhythm 11/2014;