Journal of Arrhythmia最新文献

{"title":"Prediction of difficulty in cryoballoon ablation with a three-dimensional deep learning model using polygonal mesh representation","authors":"Kazutaka Nakasone MD, PhD,&nbsp;Makoto Nishimori MD, PhD,&nbsp;Masakazu Shinohara MD, PhD,&nbsp;Kunihiko Kiuchi MD, PhD,&nbsp;Mitsuru Takami MD, PhD,&nbsp;Kimitake Imamura MD, PhD,&nbsp;Yu Izawa MD, PhD,&nbsp;Toshihiro Nakamura MD, PhD,&nbsp;Yusuke Sonoda MD, PhD,&nbsp;Hiroyuki Takahara MD, PhD,&nbsp;Kyoko Yamamoto MD, PhD,&nbsp;Yuya Suzuki MD, PhD,&nbsp;Kenichi Tani MD,&nbsp;Hidehiro Iwai MD,&nbsp;Yusuke Nakanishi MD,&nbsp;Ken-ichi Hirata MD, PhD,&nbsp;Koji Fukuzawa MD, PhD","doi":"10.1002/joa3.70078","DOIUrl":"https://doi.org/10.1002/joa3.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cryoballoon ablation (CBA) is useful for pulmonary vein (PV) isolation. However, some cases are challenging, requiring multiple applications and/or touch-up ablations. Although several predictors of CBA difficulty have been reported, none have assessed the spatial location and morphology of the left atrium and PVs. This study aimed to develop a three-dimensional (3D) deep learning (DL) model to predict CBA difficulty and compare its accuracy with conventional manual measurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 28-mm cryoballoon (Arctic Front Advance, Medtronic) was used in all cases. CBA difficulty was defined as requiring touch-up ablation and/or more than three applications per PV. We developed a DL model that can learn polygonal meshes and predict CBA difficulty. In the conventional method, predictors included a thinner left lateral ridge, higher left superior PV (LSPV) ovality index, longer LSPV ostium-bifurcation distance, and shorter right inferior PV ostium-bifurcation distance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 189 patients who underwent CBA for drug-resistant atrial fibrillation between January 2015 and January 2022 were included. The DL model was superior to the conventional method in accuracy (0.793 vs. 0.630, <i>p</i> = .042) and specificity (0.796 vs. 0.609, <i>p</i> = .022), with the AUC-ROC of 0.821.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed a 3D DL model that can detect CBA difficulty using a polygonal mesh representation. By predicting difficult cases in advance, strategies can be developed to increase success rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871740","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":"A case of difficult removal of lumen-less lead inserted near the tricuspid valve","authors":"Shogo Sakamoto MD, PhD,&nbsp;Kenji Baba MD,&nbsp;Moritoshi Irishio MD,&nbsp;Toru Kataoka MD, PhD,&nbsp;Daiju Fukuda MD, PhD","doi":"10.1002/joa3.70080","DOIUrl":"https://doi.org/10.1002/joa3.70080","url":null,"abstract":"<p>Learning Objectives: (1) Excessive rotation of a lumen-less lead near the tricuspid valve leaflet can complicate its removal. (2) A laser sheath can be used to extract a lumen-less lead entrapped within a tricuspid valve leaflet.\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 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871587","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":"Cost-effectiveness analyses to assess the value of reactive atrial-based anti-tachycardia pacing for patients with pacemakers and defibrillators: An Australian private healthcare system perspective","authors":"Adam Gordois MSc,&nbsp;Yuji Tanaka MSc,&nbsp;Tatsuhiro Uenishi MSc,&nbsp;Hiroko Yamaguchi BEc,&nbsp;Ayako Shoji PhD,&nbsp;Michelle Hill PhD","doi":"10.1002/joa3.70043","DOIUrl":"https://doi.org/10.1002/joa3.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac implantable electronic devices (CIED) with reactive atrial-based anti-tachycardia pacing (rATP) have been developed to stop the progression of atrial fibrillation (AF), a frequently occurring arrhythmia. This study assessed the value of rATP from the Australian private healthcare payer perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A Markov state-transition model, including bradycardia, stroke, heart failure (HF), and death, was used to evaluate the value of rATP in conjunction with either pacemakers (PM), implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy pacemakers (CRT-P), or CRT defibrillators (CRT-D). It was assumed that PM patients have bradycardia with no AF, and other patients have mild HF at insertion. Efficacy inputs, battery life, and device costs varied between devices. Conservatively, outpatient/follow-up costs of stroke and HF were excluded. All analyses were conducted using a cost-effectiveness threshold of 50 000 Australian dollars (A$) per quality-adjusted life year (QALY) gained, and deterministic sensitivity analysis was performed on key inputs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using a 30-year horizon and a 5% discount rate, rATP was cost-effective up to a value of A$5609 (PM), A$11 628 (CRT-D), A$14 142 (CRT-P), and A$17 858 (ICD). In sensitivity analysis, varying patient age, rATP efficacy, HF and stroke mortality, stroke recurrence risk, utility values, time horizon, battery life, and the discount rate, the value of rATP ranged from A$3122 to A$11 375 (PM), A$1455 to A$26 409 (ICD), A$1171 to A$20 674 (CRT-P), and A$973 to A$16 907 (CRT-D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reactive ATP provides clinical benefits to patients who require a CIED. These benefits justify a value premium for devices with rATP functionality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861868","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":"Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic biomarker in acutely admitted patients with atrial fibrillation","authors":"Frederik Dencker Wisborg MD,&nbsp;Nora Olsen El Caidi MD,&nbsp;Ida Arentz Taraldsen MD,&nbsp;Sandra Tonning MD,&nbsp;Aginsha Kandiah MD,&nbsp;Mohammed El-Sheikh MD,&nbsp;Hashmat S. Z. Bahrami MD,&nbsp;Ove Andersen MDD, MSc,&nbsp;Line Jee Hartmann Rasmussen MSc, PhD,&nbsp;Jens Hove MD, MSc, PhD,&nbsp;Ulrik Dixen MD, PhD,&nbsp;Johannes Grand MD, MPH, PhD","doi":"10.1002/joa3.70077","DOIUrl":"https://doi.org/10.1002/joa3.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is associated with a higher incidence of stroke, heart failure, and mortality. Risk assessment of clinical outcomes in patients hospitalized acutely with AF remains a challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate if soluble urokinase plasminogen activator receptor (suPAR) levels at admission to the Emergency Department (ED) are associated with 1-year all-cause mortality in patients admitted with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort study of patients consecutively admitted to the medical ED of a university hospital in Copenhagen, Denmark, between 2020 and 2022 with symptoms of COVID-19. Patients were included if they were admitted with AF as the primary or secondary diagnosis. All patients had suPAR measured at the index admission, and follow-up was up to 1 year. The association between suPAR and 1-year mortality was investigated with multivariate Cox regression. We adjusted for age, sex, smoking, C-reactive protein, creatinine, hemoglobin, albumin, and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 7,258 patients included during the period, 362 (5.0%) patients were admitted with AF as the primary or secondary diagnosis. Due to missing data, 23 (6.4%) patients were excluded. Among the remaining 339 patients, 68 (20.1%) patients were dead at follow-up. The multivariate Cox regression showed that elevated suPAR was independently associated with an increased risk of 1-year mortality, with a hazard ratio of 1.12 (95% confidence interval: 1.05–1.20, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elevated suPAR levels were significantly associated with 1-year all-cause mortality in patients acutely admitted with AF to the ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861867","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":"Snare technique is useful for leadless pacemaker implantation in a patient with severe right atrial dilatation","authors":"Kosuke Hirose MD,&nbsp;Tomoki Fukui MD,&nbsp;Miwa Miyoshi MD, PhD,&nbsp;Nobuyuki Ogasawara MD","doi":"10.1002/joa3.70075","DOIUrl":"https://doi.org/10.1002/joa3.70075","url":null,"abstract":"<p>Leadless pacemaker implantation in a patient with severe right atrium dilation was unsuccessful using the conventional approach. The delivery system failed to gain sufficient backup force from the atrial wall and moved upward within the dilated atrium. To overcome this, the snare technique was employed. By securing the slightly distal portion of the top of the shaft curve, the pushing force was effectively transmitted to the tip of the system, creating a stable gooseneck shape for successful implantation.\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 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861869","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":"Critical evaluation of ECG parameter analysis in hypertrophic cardiomyopathy staging: A closer look","authors":"Brijesh Sathian PhD,&nbsp;Hanadi Al Hamad MD","doi":"10.1002/joa3.70074","DOIUrl":"https://doi.org/10.1002/joa3.70074","url":null,"abstract":"&lt;p&gt;We commend the authors for their comprehensive study, &lt;i&gt;“Electrocardiographic Parameter Profiles for Differentiating Hypertrophic Cardiomyopathy Stages”&lt;/i&gt; (Hirota et al.) in the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While the study provides valuable insights into ECG parameter variations across various stages of hypertrophic cardiomyopathy (HCM), we believe that some aspects of the study's design and interpretation require further examination. Below are several critical points that challenge the findings or methodological choices presented in the article.&lt;/p&gt;&lt;p&gt;Hirota et al. attempt to define a set of ECG parameters that can differentiate HCM from its dilated phase (dHCM), yet they fail to account for the well-established heterogeneity of ECG manifestations across HCM subtypes. For example, in HCM-apical cases, T-wave inversions are often observed, whereas dHCM cases may present more subtle ECG changes because of the progression of left ventricular dysfunction. A study by Hughes et al. emphasizes that distinct ECG abnormality patterns are typically seen in the apical variant compared to the basal form.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The authors' grouping of all HCM types may lead to overlooking crucial features that could impact differential diagnosis. A more subtype-specific analysis would provide clearer, actionable insights for clinicians.&lt;/p&gt;&lt;p&gt;While the authors rely on AI-enhanced ECG analysis, they do not adequately discuss inter-observer variability, which is a known issue in ECG interpretation. AI models, while promising, can be susceptible to errors in clinical environments where interpretations by multiple clinicians may vary. A study by Sharma et al. shows that ECG interpretation in HCM is highly dependent on the experience of the practitioner, with significant inter-observer variability leading to inconsistent results.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Although AI can help mitigate some of these issues, the authors' study does not sufficiently address the limitations of their model in handling such clinical variability or the real-world challenges of using AI models across different healthcare settings.&lt;/p&gt;&lt;p&gt;The study overlooks the fact that coexisting conditions, such as hypertension, atrial fibrillation, and diabetes, which are prevalent in patients with HCM, can significantly influence ECG readings. For example, left ventricular hypertrophy because of hypertension may present similarly to HCM on an ECG, particularly in terms of QRS complex alterations, but these conditions require different management strategies. Hwang et al. and Mekhaimar et al. argue that failure to account for such comorbidities in diagnostic models for HCM can lead to incorrect classification, reducing diagnostic accuracy.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; The absence of adjustment for these confounding factors in the authors' analysis diminishes the clinical applicability and external validity of their findings.&lt;/p&gt;&lt;p&gt;In conclusion, while Hirota et al.'s st","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850977","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":"Prophylactic implantation of cardioverter-defibrillator in patients with advanced light-chain amyloidosis—A pilot study","authors":"Hui-Qiang Wei MD,&nbsp;Jinghua Wang MD,&nbsp;Yuanhong Liang MD,&nbsp;Shuang Xia MD,&nbsp;Liwen Li MD,&nbsp;Liye Zhong MD","doi":"10.1002/joa3.70068","DOIUrl":"https://doi.org/10.1002/joa3.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular arrhythmias (VAs) and electromechanical dissociation have been observed as the most common causes of sudden cardiac death (SCD) in patients with light chain (AL) amyloidosis. However, an implantable cardioverter-defibrillator (ICD) has rarely been implanted in patients with advanced AL amyloidosis due to very poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between July 2021 and December 2022, 10 patients with advanced cardiac AL amyloidosis referred to our institute who received prophylactic ICD implantation were prospectively recruited. The primary endpoint was the prevalence of VAs and appropriate ICD therapies determined by ICD interrogation. The secondary endpoint was all-cause mortality during the follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a mean follow-up of 12.1 ± 4.4 months, sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) occurred in 4 of 10 (40%) patients. One patient had spontaneous termination of VT before the delivery of ICD therapy, and the remaining 3 patients had ICD therapies used, either ATP or shock. Inappropriate shock was not recorded in any patients. Patients with sustained VT/VF had wider QRS duration (143 ± 41 vs. 99 ± 10 ms, <i>p</i> = 0.03) and a higher incidence of bundle branch block (BBB)/interventricular conduction delay (IVCD) (75% vs. 0%, <i>p</i> = 0.01) compared to those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VAs are commonly observed among patients with advanced AL amyloidosis, and ICD therapy can be effective in successfully treating sustained VA in these patients. On the basis of our preliminary data, prophylactic ICD implantation may be proposed to the advanced AL amyloidosis to improve the survival rate in selected patients with advanced AL amyloidosis, especially for the patients with wider QRS duration and BBB/IVCD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850979","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":"Pulmonary hypertension and outcomes following left atrial appendage occlusion device placement for atrial fibrillation: A population-based analysis","authors":"Nadhem Abdallah MD,&nbsp;Momen Alsayed MBBS","doi":"10.1002/joa3.70071","DOIUrl":"https://doi.org/10.1002/joa3.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary hypertension (PH) is linked to poor outcomes in cardiac procedures, but data on left atrial appendage occlusion device (LAAOD) placement are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the 2016–2020 Nationwide Readmission Database, we compared in-hospital outcomes between AF patients with and without PH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 48,692 AF-LAAOD patients, 5.9% had PH. PH was associated with higher mortality, prolonged ventilation, AKI, vasopressor use, interatrial septum repair, LOS, and costs. No differences were found in the odds of readmissions, major bleeding events, vascular complications, stroke, or cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PH in AF-LAAOD patients is associated with higher fatal and nonfatal adverse outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850978","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":"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":"Ryuki Chatani MD,&nbsp;Hiroshi Tasaka MD,&nbsp;Shunsuke Kubo MD,&nbsp;Mitsuru Yoshino MD,&nbsp;Kazushige Kadota MD, PhD","doi":"10.1002/joa3.70065","DOIUrl":"https://doi.org/10.1002/joa3.70065","url":null,"abstract":"<p>We performed pulsed field ablation using FARAPULSE after left atrial appendage closure (LAAC). We should confirm flower configurations did not overlap with the LAAC device using intracardiac echocardiography and 3-D mapping system and without LAAC device artifacts by real-time electrograms. If overlapping, push the flower configuration deeper and tilt posteriorly to resolve.\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 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831097","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 “Efficacy of an alternative positioning of intracardiac defibrillation catheters in atrial fibrillation ablation”","authors":"Hideharu Okamatsu MD,&nbsp;Ken Okumura MD","doi":"10.1002/joa3.70066","DOIUrl":"https://doi.org/10.1002/joa3.70066","url":null,"abstract":"&lt;p&gt;Atrial fibrillation (AF) is the most prevalent atrial arrhythmia in developed countries. With the increase in the aging population, the number of patients with AF has been increasing. Catheter ablation has become a widely used treatment for AF, with pulmonary vein (PV) isolation (PVI) being the standard approach. As the technologies of ablation advance, complete PVI can be achieved within a shorter procedure time. In radiofrequency catheter ablation, lesion size markers incorporating contact force, radiofrequency application power, and radiofrequency application time enable the operator to create PVI lesions efficiently. Cryoballoon ablation is another technology that allows PVI more easily. Pulsed-field ablation is a new technology that accomplishes PVI without causing collateral organ damage and PV stenosis. With the progress of these ablation technologies, many operators have streamlined the procedure workflow to reduce procedure time and minimize procedure-related complications. Internal jugular vein puncture has been performed to advance the electrode catheter into the coronary sinus (CS) to evaluate the anatomy of the CS, record the left atrial and CS potentials, and perform cardioversion to convert AF to sinus rhythm with the use of specific intracardiac defibrillation catheters (ICDC). However, with the advancement of ablation technologies, some operators insert the electrode catheter into the CS via the femoral vein and inferior vena cava (IVC) instead of the internal jugular vein and superior vena cava (SVC) to avoid internal jugular vein puncture, which has some risk of complications, including vascular injury, hematoma, and pneumothorax, and simplify the workflow. BeeAT via IVC approach (Japan Lifeline, Tokyo) is an ICDC designed to insert the electrode catheter into the CS via the IVC. In performing cardioversion, the operator is recommended to insert the distal part of electrodes in the CS and locate the proximal part in the right atrium (RA), forming an alpha-loop configuration (CS/RA configuration). The operator sometimes needs to insert the distal part into the CS deeply to position the proximal part in the RA. However, inserting the distal part deeply into the CS to make an alpha-loop configuration is difficult in some patients because of variations in the location and configuration of the CS ostium. Moreover, unintentional insertion of the distal part of electrodes into the branch of the CS may result in venous perforation and cardiac tamponade. Thus, placement of the ICDC in the CS and RA is sometimes challenging and time-consuming, needs extra fluoroscopy, and causes a risk of CS perforation.&lt;/p&gt;&lt;p&gt;Ohashi et al. studied the efficacy of the new ICDC configuration in performing cardioversion by evaluating 81 patients undergoing cardioversion with ICDC during the AF ablation procedure.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They initially evaluated the ICDC configuration, inserting the distal part of electrodes in CS and locating the proxi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830976","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}