Yoshiro Tsuruta MD, Toshihiko Goto MD, PhD, Yomei Sakurai MD, Kento Mori MD, PhD, Yoshihiro Seo MD, PhD
{"title":"Successful pacemaker implantation using left bundle branch area pacing in a patient with dextrocardia: A case report","authors":"Yoshiro Tsuruta MD, Toshihiko Goto MD, PhD, Yomei Sakurai MD, Kento Mori MD, PhD, Yoshihiro Seo MD, PhD","doi":"10.1002/joa3.70118","DOIUrl":"https://doi.org/10.1002/joa3.70118","url":null,"abstract":"<p>The left image shows an intraoperative fluoroscopic view with left–right inversion, and the right image is a postoperative noncontrast CT. Both demonstrate the right ventricular lead positioned in the interventricular septum.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An emerging role of inflammatory biomarker (suPAR) for prognostic evaluation of atrial fibrillation","authors":"Nihar Jena MD","doi":"10.1002/joa3.70116","DOIUrl":"https://doi.org/10.1002/joa3.70116","url":null,"abstract":"<p>Atrial fibrillation (AFib) is a chronic cardiovascular condition that poses a significant global challenge due to difficulties in identification and treatment. The global burden of AFib and atrial flutter has been rising over the past decade, with a prevalence of 52.5 million reported in 2021 and 10.55 million reported in the United States in 2019.<span><sup>1</sup></span> Although various risk scores, such as CHAD2-VASc and HAS-BLED, as well as inflammatory biomarkers like C-reactive protein (CRP), are available, there is a need for further research in this area. This research could enhance our ability to prognosticate both short-term and long-term outcomes for individuals with AFib. Wisborg et al.<span><sup>2</sup></span> provided a timely and thought-provoking prospective analysis of AFib patients admitted to the emergency department with elevated soluble urokinase plasminogen activator receptor (suPAR) levels, showing an increased all-cause mortality at 1 year.</p><p>The novel biomarker suPAR has been identified as a stable biomarker for cardiovascular disease associated with chronic inflammation. suPAR is a cleaved product of plasminogen activator receptor and a component of the fibrinolytic system, which is usually formed due to an immunological response to inflammation from the cell surface.<span><sup>3</sup></span> Various studies have shown promising results for predicting long-term cardiovascular outcomes like acute myocardial infarction, atherosclerosis, and coronary calcifications.<span><sup>4, 5</sup></span> In a study by Ichihara, the prevalence of suPAR level was shown to be higher in nonparoxysmal AFib patients.<span><sup>6</sup></span> This prospective cohort study, comprising 339 patients, showed higher mortality in the patient group with a higher level of suPAR. The authors depicted a 12% mortality increase per unit ng/mL increase in suPAR despite adjusting for age, sex, smoking, creatinine, and another inflammatory biomarker like CRP.</p><p>This study highlights the importance of suPAR in AFib for several compelling reasons. First, stratifying high-risk AFib patients based on a higher level of suPAR can help determine the level of care and predict outcomes in patients presenting to the emergency department or inpatient setting. Second, suPAR has a longer half-life than other cardiac biomarkers, making it a more reliable long-term prognostic marker, especially given the often delayed presentation and chronic nature of AFib.</p><p>The study is well-designed and has an adequate sample size with a statistically significant outcome. The statistical modeling is robust, and the variables were adjusted using multivariate Cox regression, along with adjustments for other variables. Nonetheless, the major limitation is that the study is a prospective analysis in a single center, so generalizability is questionable. Furthermore, the cause of death was not pinpointed to cardiovascular etiology, making it challenging to determine whether","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu-ki Iwasaki, Takashi Noda, Masaharu Akao, Tadashi Fujino, Teruyuki Hirano, Koichi Inoue, Kengo Kusano, Toshiyuki Nagai, Kazuhiro Satomi, Tetsuji Shinohara, Kyoko Soejima, Yohei Sotomi, Shinya Suzuki, Teiichi Yamane, Tsukasa Kamakura, Hiroyuki Kato, Arimi Katsume, Yusuke Kondo, Kenji Kuroki, Hisaki Makimoto, Hiroshige Murata, Takafumi Oka, Nobuaki Tanaka, Nobuhiko Ueda, Hiro Yamasaki, Seigo Yamashita, Ryobun Yasuoka, Kenji Yodogawa, Kazutaka Aonuma, Takanori Ikeda, Toru Minamino, Hideo Mitamura, Akihiko Nogami, Ken Okumura, Hiroshi Tada, Takashi Kurita, Wataru Shimizu, Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group
{"title":"JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias","authors":"Yu-ki Iwasaki, Takashi Noda, Masaharu Akao, Tadashi Fujino, Teruyuki Hirano, Koichi Inoue, Kengo Kusano, Toshiyuki Nagai, Kazuhiro Satomi, Tetsuji Shinohara, Kyoko Soejima, Yohei Sotomi, Shinya Suzuki, Teiichi Yamane, Tsukasa Kamakura, Hiroyuki Kato, Arimi Katsume, Yusuke Kondo, Kenji Kuroki, Hisaki Makimoto, Hiroshige Murata, Takafumi Oka, Nobuaki Tanaka, Nobuhiko Ueda, Hiro Yamasaki, Seigo Yamashita, Ryobun Yasuoka, Kenji Yodogawa, Kazutaka Aonuma, Takanori Ikeda, Toru Minamino, Hideo Mitamura, Akihiko Nogami, Ken Okumura, Hiroshi Tada, Takashi Kurita, Wataru Shimizu, Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group","doi":"10.1002/joa3.70033","DOIUrl":"https://doi.org/10.1002/joa3.70033","url":null,"abstract":"<p>\u0000 \u0000 </p><p>Several randomized controlled trials (RCTs) have investigated the role of ICDs for primary prevention in patients with reduced left ventricular ejection fraction (LVEF), and have shown efficacy in preventing sudden cardiac death (SCD) in heart failure patients with LVEF ≤35%.<span><sup>8, 9</sup></span> On the other hand, the DANISH trial, a prospective comparative study of ICDs in 1,116 patients with nonischemic cardiomyopathy, showed no clear mortality benefit of ICDs for primary prevention in patients with nonischemic cardiomyopathy.<span><sup>10</sup></span> A meta-analysis of 6 trials for nonischemic cardiomyopathy, including DANISH,<span><sup>11</sup></span> showed that ICDs significantly reduced relative mortality; however; it was unclear whether the ICD was more useful in selected patients. It is necessary to identify the patient population in which ICDs are most useful.</p><p>In the subanalysis of the Nippon Storm study, Sasaki et al. reported that the incidence of appropriate ICD therapy in nonischemic cardiomyopathy patients for primary prevention was 21%, during a mean follow-up of 775 days.<span><sup>12</sup></span> The HINODE study<span><sup>13</sup></span> showed that the mortality and appropriate ICD therapy rates were similar to those in MADIT-RIT for Japanese heart failure patients. In that study, 171 propensity-matched patients for primary prevention from among 354 enrolled patients were compared to 985 patients in the MADIT-RITstudy,<span><sup>14</sup></span> which revealed no significant differences in annual survival rates (96.3% in the HINODE group vs. 96.9% in the MADIT-RIT group, P=0.29) or annual appropriate ICD therapy-free rates (94.7% vs. 96.8%, P=0.61) between the 2 groups. The incidence of fatal arrhythmias in patients with heart failure in Japan in recent years is comparable to that in Europe and the USA, but higher than previously thought.</p><p>Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas of unknown cause.<span><sup>47</sup></span> Among the affected organs, pulmonary involvement is the most common, but cardiac involvement (cardiac sarcoidosis) is observed in ≈5% of patients, and cardiac involvement is responsible for about half of all deaths due to sarcoidosis.<span><sup>48, 49</sup></span> In recent years, isolated cardiac sarcoidosis with lesions only in the heart<span><sup>50</sup></span> and a poor prognosis<span><sup>51</sup></span> as been reported, which has increased the importance of differential diagnosis.</p><p>The indications for leadless pacemakers (<b>Figures</b> 2,3) were discussed in the 2021 JCS/JHRS Guideline Focus Update for Non-pharmacologic Treatment of Arrhythmias<span><sup>6</sup></span> regarding venous obstruction and stenosis, and the need for preservation of venous access. Since then, the indications for leadless pacemakers have continued to expand, and various evidences have emerged. This Focus Update desc","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial to “Initial experiences and technical insights of pulmonary vein isolation with FARAPULSE pulsed field ablation in patients implanted with WATCHMAN left atrial appendage closure devices: The first report in Japan”","authors":"Masato Fukunaga MD","doi":"10.1002/joa3.70105","DOIUrl":"https://doi.org/10.1002/joa3.70105","url":null,"abstract":"<p>Editorial comment on “Initial experiences and technical insights of pulmonary vein isolation with FARAPULSE pulsed field ablation in patients implanted with WATCHMAN left atrial appendage closure devices: The first report in Japan.”<span><sup>1</sup></span></p><p>Pulsed field ablation (PFA) has recently emerged as a promising technique for atrial fibrillation (AF) ablation, rapidly gaining popularity due to its favorable safety and efficacy profile. Unlike conventional thermal ablation, PFA devices exhibit significant variation in catheter design, workflow, and clinical evidence—differences that may be even more pronounced across platforms. Notably, among current systems, only the FARAPULSE PFA system (Boston Scientific) can be used in patients with a preexisting left atrial appendage closure (LAAC) device, according to the instructions for use. While PFA can theoretically be applied in such settings, metallic interference between the PFA catheter and LAAC device remains a potential procedural challenge.</p><p>In a recent issue of the <i>Journal of Arrhythmia</i>, Chatani et al.<span><sup>1</sup></span> presented a small case series demonstrating the feasibility of PFA in patients with prior WATCHMAN device implantation (3 months–2 years postimplantation), under intracardiac echocardiography (ICE) guidance. In Case 2 of their report, catheter artifact interference was observed when the FARAWAVE catheter was configured in its flower formation. This issue was resolved by adjusting catheter depth and position posteriorly. The LAAC device in that case was implanted proximally, protruding 4.4 mm from the ridge of the left superior pulmonary vein. The authors also noted that the Amplatzer Amulet device may pose a higher risk of interference due to its design. Importantly, all cases were completed without procedural complications, supporting the feasibility of PFA in this population.</p><p>Despite this success, certain concerns persist. Metal artifact interference remains a technical hurdle, particularly in anatomically complex or combined procedures. The concept of a combined AF ablation and LAAC—often termed the “one-stop procedure”—has gathered increasing interest. The OPTION trial evaluated LAAC as an alternative to oral anticoagulation in patients post-AF ablation. The trial permitted both concomitant LAAC (within 10 days of ablation) and delayed LAAC (90–180 days postablation). Results demonstrated that LAAC was associated with a lower incidence of nonprocedure-related major or clinically relevant nonmajor bleeding, and it was noninferior to oral anticoagulation for a composite endpoint of all-cause death, stroke, or systemic embolism at 36 months.<span><sup>2</sup></span> While these findings have not yet led to widespread procedural changes, the combined approach remains appealing to both clinicians and patients.</p><p>The ongoing OPTION-A trial (NCT06686485), a prospective, single-arm, multicenter postmarket study, is the first to formally e","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Slow–fast atrioventricular nodal reentrant tachycardia mimicking junctional tachycardia following atrial extrastimulation","authors":"Koki Yamaoka MD, Seiji Takatsuki MD, PhD, Terumasa Yamashita MD, PhD, Hideo Mitamura MD, PhD, Masaki Ieda MD, PhD","doi":"10.1002/joa3.70107","DOIUrl":"https://doi.org/10.1002/joa3.70107","url":null,"abstract":"<p>Intracardiac electrocardiograms were recorded during a narrow QRS supraventricular tachycardia following atrial extrastimulation. What is the mechanism?\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anish Singhal MD, Billa Anala MD resident, Madhuri Taranikanti MD, Nitin Ashok John MD, Naveen Ravi MD
{"title":"Bi-peaked R wave in HRV: A technical pitfall or ventricular pathology","authors":"Anish Singhal MD, Billa Anala MD resident, Madhuri Taranikanti MD, Nitin Ashok John MD, Naveen Ravi MD","doi":"10.1002/joa3.70111","DOIUrl":"https://doi.org/10.1002/joa3.70111","url":null,"abstract":"<p>During routine heart rate variability recording in an elderly male, bi-peaked R waves were recorded consistently. Initially, it was thought to be because of technical issues, which were ruled out systematically; next, it was believed to have been caused by cardiac pathology, which was evaluated using ECG and echocardiography.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sun Young Jeong MD, MPH, Nigel Gupta MD, Zhilin Qu PhD, Sen Ji MD, PhD
{"title":"Quantitative analyses of the distal bipolar electrogram for focal premature ventricular contraction ablation","authors":"Sun Young Jeong MD, MPH, Nigel Gupta MD, Zhilin Qu PhD, Sen Ji MD, PhD","doi":"10.1002/joa3.70103","DOIUrl":"https://doi.org/10.1002/joa3.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate interpretation of the distal bipolar electrogram (bi-EGM) is essential for successful ablation of idiopathic focal PVC. Sharp, early, and fractionated bi-EGM is often considered to be near-field and targeted, but in an empiric fashion rather than by quantitative criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To quantify the distal bi-EGM with five parameters to elucidate quantitative criteria distinguishing near-field from far-field bi-EGM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The distal bi-EGM was quantified and analyzed using: half time of activation (<i>t</i><sub>½</sub>), slope factor (<i>S</i>, derived by fitting the Boltzmann equation), linear slope (<i>dV/dt</i>), time from onset of bi-EGM to surface ECG (<i>T</i><sub>s</sub>) and number of deflections (<i>De</i>#).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 41 patients, 26 were ablated successfully and 15 unsuccessfully. <i>t</i><sub>½</sub> and <i>S</i>, defining the sharpness of the activation process, were significantly different between the two groups (3.2 ± 0.3 vs. 5.9 ± 0.6 ms, <i>p</i> < 0.001 and 0.8 ± 0.1 vs. 4.8 ± 2.0, <i>p</i> = 0.01). <i>T</i><sub>s</sub> was earlier in the successful group (35.6 ± 1.3 vs. 25.8 ± 1.6 ms, <i>p <</i> 0.01). <i>dV/dt</i> and <i>De#</i> were not statistically different (0.2 ± 0.04 vs. 0.1 ± 0.02 mV/ms, <i>p</i> = 0.06; and 2.7 ± 0.2 vs. 2.3 ± 0.3, <i>p</i> = 0.22). The 5 parameters showed indifference across anatomic locations. AUCs of ROC curve are >0.8 (<i>t</i><sub>½</sub> 0.85, <i>S</i> 0.85 and <i>T</i><sub>s</sub> 0.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p><i>t</i><sub>½</sub>, <i>S</i> and <i>T</i><sub>s</sub> are precise in quantifying the sharpness and earliness of distal bi-EGM; therefore, discriminating the near-field from far-field bi-EGM for guiding successful ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}