Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation.

In 1924, the Dutch physiologist Willem Einthoven received the Nobel Prize in Physiology or Medicine for his discovery of the mechanism of the electrocardiogram (ECG). Anno 2024, the ECG is commonly used as a diagnostic tool in cardiology. In the paper 'Le Télécardiogramme', Einthoven described the first recording of the now most common cardiac arrhythmia: atrial fibrillation (AF). The treatment of AF includes rhythm control, aiming to alleviate symptoms and improve quality of life. Recent studies found that early rhythm control might additionally improve clinical outcomes. However, current therapeutic options have suboptimal efficacy and safety, highlighting a need for better rhythm-control strategies. In this review, we address the challenges related to antiarrhythmic drugs (AADs) and catheter ablation for rhythm control of AF, including significant recurrence rates and adverse side effects such as pro-arrhythmia. Furthermore, we discuss potential solutions to these challenges including novel tools, such as atrial-specific AADs and digital-twin-guided AF ablation. In particular, digital twins are a promising method to integrate a wide range of clinical data to address the heterogeneity in AF mechanisms. This may enable a more mechanism-based tailored approach that may overcome the limitations of previous precision medicine approaches based on individual biomarkers. However, several translational challenges need to be addressed before digital twins can be routinely applied in clinical practice, which we discuss at the end of this narrative review. Ultimately, the significant advances in the detection, understanding, and treatment of AF since its first ECG documentation are expected to help reduce the burden of this troublesome condition.

被引量：- 发表：2024

Impact of hospital lead extraction volume on management of cardiac implantable electronic device-associated infective endocarditis.

Utilization of transvenous lead extraction/removal (TLE) for the management of cardiac implantable electronic device (CIED)-associated infective endocarditis (IE) remains low. The aim of this study was to examine the impact of hospital TLE procedural volume on TLE utilization and outcomes for patients with CIED-associated IE. Using the Nationwide Readmissions Database, we evaluated 21 545 admissions for patients (mean age 70 years, 39% female) with CIEDs hospitalized with IE at TLE centres. Hospitals were categorized based on annual volume tertiles: (i) low-volume (1-17 TLEs/year), (ii) medium-volume (18-45 TLEs/year), and (iii) high-volume centres (>45 TLEs/year). Between 2016 and 2019, 57% of admissions in the study were to low-volume TLE centres. Transvenous lead extraction/removal was performed during 6.9, 19.3, and 26% of admissions for CIED-associated IE at low-, medium-, and high-volume TLE centres, respectively (P < 0.001). After adjustment for age and comorbidities, hospitalization for IE at high-volume centres was independently associated with TLE when compared with low-volume centres (adjusted odds ratio 4.26; 95% confidence interval 3.53-5.15). Transvenous lead extraction/removal-associated complication rates were similar at 2.5, 2.3, and 3.4% at low-, medium-, and high-volume centres, respectively (P = 0.493). Overall inpatient mortality during admissions to low-, medium-, and high-volume centres was also similar. Admissions to high-volume TLE centres were associated with higher utilization of TLE for management of CIED-associated IE. Transvenous lead extraction/removal-associated complications and mortality among patients hospitalized with CIED-associated IE were similar when stratified by hospital TLE volume, but this needs to be considered in context of significant differences in patient comorbidity burden between centres.

被引量：- 发表：2024

Monitoring and modulating cardiac bioelectricity: from Einthoven to end-user.

In 2024, we celebrate the 100th anniversary of Willem Einthoven receiving the Nobel Prize for his discovery of the mechanism of the electrocardiogram (ECG). Building on Einthoven's legacy, electrocardiography allows the monitoring of cardiac bioelectricity through solutions to the so-called forward and inverse problems. These solutions link local cardiac electrical signals with the morphology of the ECG, offering a reversible connection between the heart's electrical activity and its representation on the body surface. Inspired by Einthoven's work, researchers have explored the transition from monitoring to modulation of bioelectrical activity in the heart for the development of new anti-arrhythmic strategies, e.g. via optogenetics. In this review, we demonstrate the lasting influence that Einthoven has on our understanding of cardiac electrophysiology in general, and the diagnosis and treatment of cardiac arrhythmias in particular.

被引量：- 发表：2024

Lifetime cumulative activity burden is associated with symptomatic heart failure and arrhythmic risk in patients with arrhythmogenic right ventricular cardiomyopathy: a retrospective cohort study.

被引量：- 发表：2024

Relationship between activity and sleep, as measured through a wearable accelerometer, and appropriate cardioverter defibrillator interventions: a prospective SafeHeart substudy.

被引量：- 发表：2024