{"title":"A Different Way to Slow Down in Catecholaminergic Polymorphic Ventricular Tachycardia","authors":"Gregory Webster MD, MPH","doi":"10.1016/j.jacep.2024.12.009","DOIUrl":"10.1016/j.jacep.2024.12.009","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 279-281"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan E. LaBreck PharmD , Nagesh Chopra MD , Andrea Robinson MSN, ACNP , Sreedhar R. Billakanty MD , Eugene Y. Fu MD , David M. Nemer MD , Ankur N. Shah MD , Jaret D. Tyler MD , Cody Ash CNP , Allyson Farrah PA , Jennifer James CNP , Victoria Murnane CNP , Beth Loessin CNP , Afton Smith CNP , Jill Swinning CNS , Auroa Badin MD , Anish K. Amin MD
{"title":"Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring","authors":"Megan E. LaBreck PharmD , Nagesh Chopra MD , Andrea Robinson MSN, ACNP , Sreedhar R. Billakanty MD , Eugene Y. Fu MD , David M. Nemer MD , Ankur N. Shah MD , Jaret D. Tyler MD , Cody Ash CNP , Allyson Farrah PA , Jennifer James CNP , Victoria Murnane CNP , Beth Loessin CNP , Afton Smith CNP , Jill Swinning CNS , Auroa Badin MD , Anish K. Amin MD","doi":"10.1016/j.jacep.2024.10.003","DOIUrl":"10.1016/j.jacep.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor’s Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the safety, feasibility, and patient adherence to protocol-driven, pharmacist-led outpatient sotalol initiation using the Kardia Mobile 6L for remote ECG monitoring and to compare these outcomes with patients completing inpatient sotalol protocol for initiation.</div></div><div><h3>Methods</h3><div>Patients who underwent outpatient sotalol initiation through an antiarrhythmic clinic for the treatment of both atrial and ventricular arrhythmias over a period of approximately 3 years, from September 1, 2020, to June 16, 2023, were retrospectively reviewed and compared with a cohort of inpatients initiated on sotalol. The outpatient cohort had a minimum longitudinal follow-up of 90 days.</div></div><div><h3>Results</h3><div>A total of 263 patients using the outpatient sotalol initiation protocol were compared with 28 age- and sex-matched inpatients who underwent inpatient sotalol initiation. The outpatient cohort included 179 men (68%), with an age of 68.8 ± 10.1 years, CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 3.48 ± 1.43, baseline 12-lead QTc interval of 440.77 ± 33.42 ms, and a left ventricular ejection fraction of 57.4% ± 9.23%. Outpatients were started on a median (minimum-maximum) dose of 120 (80-160) mg of sotalol twice a day (120-mg dose; n = 227; 86.3%) and ended at a median (minimum-maximum) dose of 120 (60-160) mg twice a day (120-mg dose; n = 217; 82.5%). The proportions of patients prescribed low-, moderate-, or high-dose sotalol twice a day (60 mg, 80 mg, 120 mg, and 160 mg) at the end of initiation were similar between the inpatient and outpatient groups (<em>P</em> = 0.5). The majority (98.9%; 260 of 263) of patients completed the 3-day outpatient initiation. Outpatient adherence was high during the 3-day initiation period among patients with varied age and socioeconomic background; 258 patients (98.1%) completed the ECG on day 1, and 240 (91.3%) completed the ECG on day 3. No significant QTc interval prolongation was observed during the outpatient postinitiation study period. There were similar sotalol discontinuation rates within 30 days of initiation in the inpatient vs outpatient cohorts (7% vs 8%; <em>P</em> > 0.90). A total of 17 (6.5%) patients stopped sotalol because of symptomatic bradycardia, and 1 death was observed over a 90-day follow-up period in the outpatient cohort.</div></div><d","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 386-396"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jorge E. Romero MD , Angel E. Armas MD , Mohamed Gabr MD , Alejandro Velasco MD , Ely Gracia MD , Christian A. Gozzo BS , Daniel A. Zapata MD , Nathaniel A. Steiger MD , Usha B. Tedrow MD, MS , William H. Sauer MD
{"title":"Vascular Balloon-Assisted Lysis of Pericardial Adhesions to Facilitate Epicardial Ventricular Tachycardia Ablation","authors":"Jorge E. Romero MD , Angel E. Armas MD , Mohamed Gabr MD , Alejandro Velasco MD , Ely Gracia MD , Christian A. Gozzo BS , Daniel A. Zapata MD , Nathaniel A. Steiger MD , Usha B. Tedrow MD, MS , William H. Sauer MD","doi":"10.1016/j.jacep.2024.09.036","DOIUrl":"10.1016/j.jacep.2024.09.036","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 441-447"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bringing the Message Home","authors":"Thomas A. Boyle MD, Timothy M. Markman MD","doi":"10.1016/j.jacep.2024.11.013","DOIUrl":"10.1016/j.jacep.2024.11.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 397-399"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keita Watanabe MD , Moritz Nies MD , Steffy Rodrigues MEng , Vivek Y. Reddy MD , Jacob S. Koruth MD
{"title":"Contact Force Increases During Radiofrequency Ablation","authors":"Keita Watanabe MD , Moritz Nies MD , Steffy Rodrigues MEng , Vivek Y. Reddy MD , Jacob S. Koruth MD","doi":"10.1016/j.jacep.2024.10.010","DOIUrl":"10.1016/j.jacep.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Contact force (CF) changes after onset of radiofrequency (RF) delivery are not well understood and often ascribed to catheter instability.</div></div><div><h3>Objectives</h3><div>This study sought to characterize CF changes during RF-based pulmonary vein (PV) isolation.</div></div><div><h3>Methods</h3><div>Catheter-tip parameters including CF for all RF sessions were extracted from a novel catheter-mapping system from 6 patients undergoing PV isolation.</div></div><div><h3>Results</h3><div>Of a total 416 RF sessions, 241 demonstrated progressive increases in CF during RF delivery (group 1). Zero to 5 seconds of RF delivery demonstrated the greatest increase in CF, with no differences between right and left PV sites (2.2 ± 2.2 g vs 1.9 ± 2.3 g, <em>P</em> = 0.26). Subsequent 5-second intervals demonstrated greater increases for right vs left PV sites (eg, 1.2 ± 1.3 g vs 0.5 ± 0.3 g, <em>P</em> = 0.01 for 20 to 25 seconds). CF increment was greater for posterior vs anterior PV sites (3.4 ± 3.1 g vs 1.4 ± 1.4 g, <em>P</em> < 0.001), but similar for roof and floor sites. Higher power and greater impedance drops were associated with greater CF increases. Perpendicular contact had greater CF increases, followed by diagonal and parallel contact. The remaining 175 of 416 sessions demonstrated at least 1 CF decrement, typically occurring after 15 seconds of RF (group 2). This was observed least frequently at inferior PV sites. Except for minor differences in power, there were no differences in CF, tip excursion, and impedance drop between groups.</div></div><div><h3>Conclusions</h3><div>Progressive CF increase during RF ablation is a distinct phenomenon that likely reflects the “push-back” effect of local myocardial swelling against the catheter tip. This may explain certain catheter-tip behaviors such as tip displacement and instability during ablation.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 337-349"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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