Journal of Arrhythmia最新文献

{"title":"Prospective Multicenter Registry to Investigate the Clinical Feasibility of Combination Workflow With 90 W/4 s and Ablation Index-Guided 50 W Ablation (PRECISE—COMBO 90 W/50 W Study)","authors":"Yuji Saito,&nbsp;Ryuta Watanabe,&nbsp;Koichi Nagashima,&nbsp;Yuji Wakamatsu,&nbsp;Shu Hirata,&nbsp;Moyuru Hirata,&nbsp;Masaomi Kimura,&nbsp;Junjiroh Koyama,&nbsp;Hideharu Okamatsu,&nbsp;Yuki Komatsu,&nbsp;Kenichi Hiroshima,&nbsp;Kaoru Tanno,&nbsp;Takahiro Furuya,&nbsp;Naoki Aizawa,&nbsp;Yuichiro Sakamoto,&nbsp;Taishi Kuwahara,&nbsp;Toshio Makita,&nbsp;Kenta Takahashi,&nbsp;Shiro Nakahara,&nbsp;Hirotsugu Sato,&nbsp;Hideyuki Aoki,&nbsp;Masahide Harada,&nbsp;Yuji Motoike,&nbsp;Jin Teranishi,&nbsp;Shin Takahara,&nbsp;Kenta Murotani,&nbsp;Yasuo Okumura","doi":"10.1002/joa3.70199","DOIUrl":"https://doi.org/10.1002/joa3.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-power short-duration (HPSD) ablation is an established therapy for pulmonary vein (PV) isolation (PVI) in atrial fibrillation (AF), aiming to form efficient transmural lesions. Very HPSD (vHPSD) can further shorten ablation time but may increase the risk of acute PVI failure compared with HPSD. A combined HPSD and vHPSD strategy (90 W/50 W combination workflow) potentially balances efficiency and durability, though its clinical feasibility remains unknown. Therefore, this multicenter registry evaluated the acute and long-term efficacy of a 90 W/50 W combination workflow for PVI in patients with paroxysmal AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective study, a total of 101 consecutive patients with paroxysmal AF underwent PVI using radiofrequency ablation with a 90 W/50 W combination workflow. We evaluated acute outcomes, including first-pass isolation and acute PV reconnection, and monitored atrial tachyarrhythmia recurrences over 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median PVI procedure time was 35 min, with total procedure time at 105 min. First-pass PVI was achieved in 58.4% of patients, including 74.3% in the right PV and 72.3% in the left PV. Acute PV reconnection occurred in 31.7% (32/101). In multivariate analysis, carina sites independently predicted acute PVI failure in both HPSD and vHPSD groups, while contact force also predicted failure in the HPSD group. After 1 year, 89.9% of patients remained free from documented atrial tachyarrhythmias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 90 W/50 W combination workflow did not notably shorten procedure time or enhance first-pass success. More standardized strategies, particularly in carina segments with higher contact force and ablation index under HPSD, may be required to ensure optimal lesion durability and favorable outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172037","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 Tick of the Clock: Finding the Sweet Spot in Tilt Table Test. The Effectiveness of Short-Duration Head-Up Tilt Test as a Diagnostic Tool in Suspected Vasovagal Patients: A Retrospective Observational Study in a Tertiary Syncope Unit","authors":"Parvin Kalhor,&nbsp;Parichehr Ghahari,&nbsp;Nader Asgari,&nbsp;Arash Jalali,&nbsp;Saeed Sadeghian","doi":"10.1002/joa3.70190","DOIUrl":"https://doi.org/10.1002/joa3.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The head-up tilt test (HUTT) has been markedly changed over the years, especially in the specified time for the passive and active phases. However, a consensus-based protocol has yet to be established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven hundred twenty-four patients suspected of vasovagal syncope who underwent HUTT through one of the protocols of 15to 20-min testing for each active/passive phase (the whole test duration was 30 or 40 min, respectively) were evaluated. Then, the positive responses were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>470 (64.9%) and 254 (35.1%) patients in the 15- and 20-min groups, respectively. Overall, 238 patients (50.6%) in the 15-min group and 140 patients (55.1%) in the 20-min group had positive responses (<i>p</i> = 0.25). There was no significant difference in the number of positive responses between the 15- and 20-min groups in any of the passive (<i>p</i> = 0.53) and active (<i>p</i> = 0.3) phases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 15-min HUTT protocol has similar results to the 20-min protocol. Saving 10 min for each test has several potential benefits, such as increasing patient acceptance, decreasing patient discomfort, and enabling the conduct of more tests in a day in a syncope unit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146433","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":"Real-World Outcomes of Repeat Ablation Strategies for Atrial Fibrillation: Insights From the Japanese Catheter Ablation Registry","authors":"Yasuhiro Matsuda,&nbsp;Masaharu Masuda,&nbsp;Koshiro Kanaoka,&nbsp;Toshiaki Mano,&nbsp;Koichi Inoue,&nbsp;Seigo Yamashita,&nbsp;Yu-Ki Iwasaki,&nbsp;Kohki Nakamura,&nbsp;Koichi Nagashima,&nbsp;Koji Miyamoto,&nbsp;Kazuhiro Satomi,&nbsp;Seiji Takatsuki,&nbsp;Kengo Kusano,&nbsp;Teiichi Yamane,&nbsp;Wataru Shimizu","doi":"10.1002/joa3.70200","DOIUrl":"https://doi.org/10.1002/joa3.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Repeat ablation is often required in patients with atrial fibrillation (AF) due to recurrent arrhythmias. Although pulmonary vein isolation (PVI) is the only recommended ablation technique for repeat ablation, various additional strategies are commonly used in clinical practice. The purpose of this study was to evaluate the implementation, efficacy, and safety of repeat ablation strategies in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted by using the Japanese Catheter Ablation Registry (J-AB registry). A total of 26 684 patients who underwent a second ablation procedure for AF between August 2017 and December 2020 were included and analyzed for patient characteristics, procedural characteristics, and complications. Additionally, the AF recurrence rate over a 12-month follow-up period was also investigated in 1508 s ablation procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the second ablation procedure, repeat-pulmonary vein isolation (re-PVI) was performed for 20 938 (78%) patients and 14 552 (55%) patients underwent left atrial additional ablation. Both of re-PVI and left atrial additional ablation were performed for 10 086 (38%) patients. As the number of left atrial additional ablations in the second ablation procedure increased, the overall complication rate also significantly increased (paroxysmal AF, <i>p</i> &lt; 0.001; persistent AF, <i>p</i> &lt; 0.001). The rate of freedom from AF recurrence during the follow-up period was 87.6% for paroxysmal AF and 80.6% for persistent AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the second ablation procedure performed in Japan, re-PVI was required in 78% of patients, and both of re-PVI and left atrial additional ablation were performed for 38% of patients. As the number of left atrial additional ablations increased, the overall complication rate also increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The J-AB registry is registered in the UMIN Clinical Trial Registry (UMIN 000028288) and ClinicalTrials.gov (NCT03729232)</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111420","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":"Factors Influencing the Availability of Cardiopulmonary Exercise Testing for Patients Undergoing Cardiac Resynchronization Therapy in Japan","authors":"Satoshi Kuhara,&nbsp;Ryutaro Matsugaki,&nbsp;Hideaki Itoh,&nbsp;Yasushi Oginosawa,&nbsp;Kiyohide Fushimi,&nbsp;Shinya Matsuda,&nbsp;Satoru Saeki","doi":"10.1002/joa3.70198","DOIUrl":"https://doi.org/10.1002/joa3.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to investigate the implementation rate of cardiopulmonary exercise testing (CPET) in patients undergoing cardiac resynchronization therapy (CRT) or cardiac resynchronization therapy-defibrillator (CRT-D), as well as the associated factors, using real-world data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Data from the Diagnostic Procedure Combination System in Japan (2014–2018) was analyzed. The participants were cardiac patients who underwent CRT or CRT-D device implantation (<i>n</i> = 3859). The primary outcome was whether CPET was performed after device implantation. Unpaired t-tests and chi-squared tests were used to compare the characteristics of the CPET (+) and CPET (−) groups. Multivariate analysis was used to identify factors associated with CPET performance. CPET was performed in 134 patients (3%). The CPET (−) group was older and had lower Barthel Index (BI) scores at discharge. CPET (+) patients had a higher rate of cardiac rehabilitation. Multivariate analysis revealed that age &lt; 70 years and BI score ≥ 85 at discharge were associated with CPET implementation. In-hospital cardiac rehabilitation is also an important determinant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CPET implementation after CRT or CRT-D was low. Emphasizing the importance of CPET may improve these rates. Future studies should explore strategies to increase its use in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111419","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":"Potential Confounders of the Different Impact of Alcohol Intake Between Sexes on the Incidence of Atrial Fibrillation","authors":"Yu Nomoto,&nbsp;Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/joa3.70201","DOIUrl":"https://doi.org/10.1002/joa3.70201","url":null,"abstract":"<p>The association between alcohol intake and the development of atrial fibrillation (AF) has been well documented across various populations. Nevertheless, the potential influence of sex differences on this relationship has remained unresolved. The present study provides important insights by showing that higher alcohol intake was consistently associated with an incremental risk of AF in both sexes, while even lower levels of alcohol intake conferred an elevated risk only in men, but not in women [<span>1</span>]. These findings are intriguing and merit careful interpretation.</p><p>The underlying pathophysiological mechanisms responsible for the observed sex-specific differences are still uncertain. The authors suggested that different beverage preferences between sexes may play a role [<span>1</span>]. Women may consume wine more frequently than men, and wine contains potentially protective compounds such as polyphenols. However, this explanation remains insufficient because prior epidemiological studies have also demonstrated that heavy wine consumption in women is associated with a higher incidence of AF.</p><p>The interaction between alcohol consumption and dietary patterns should not be overlooked. Alcohol is commonly consumed alongside meals, and certain dietary components may influence the risk of AF. For example, the Mediterranean diet, which is generally considered cardioprotective, includes abundant marine omega-3 fatty acids, yet recent evidence paradoxically suggests that high omega-3 intake may increase the risk of AF [<span>2</span>]. Such factors could act as hidden confounders when interpreting the relationship between alcohol and AF prevalence.</p><p>Lifestyle-related factors that differ by sex may have contributed to the findings. Recent studies have linked low-carbohydrate diets, sometimes preferred by Japanese women, with an increased incidence of AF [<span>3</span>]. Moreover, differences in body composition, hormonal milieu, alcohol metabolism, and the prevalence of comorbidities such as hypertension or obesity may all interact with alcohol exposure to influence AF risk differently in men and women [<span>4</span>]. These factors highlight the complexity of disentangling the causal pathway linking alcohol to AF across sexes.</p><p>While the cross-sectional nature of the present study provides valuable epidemiological evidence, it cannot establish causality. Well-designed prospective cohort studies, and ideally randomized controlled trials stratified by sex, will be required to confirm whether alcohol restriction can effectively reduce the incidence of AF.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110691","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":"The Efficacy of 2-Week Holter Monitoring for Detecting Atrial Tachyarrhythmia Recurrence After Initial Ablation in Patients With Atrial Fibrillation","authors":"Hirokazu Naganawa,&nbsp;Yuichiro Sakamoto,&nbsp;Yuko Uemura,&nbsp;Ryo Yamaguchi,&nbsp;Daisuke Yoshimoto,&nbsp;Maria Kristina Recio,&nbsp;Takahiko Suzuki","doi":"10.1002/joa3.70196","DOIUrl":"https://doi.org/10.1002/joa3.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Holter monitoring is widely used to detect atrial tachyarrhythmia (AT) recurrence after catheter ablation (CA) in patients with atrial fibrillation (AF). However, patients experience few subjective symptoms after CA, leading to potential underdiagnosis of recurrence. Two-week Holter monitoring may be more effective compared to 24-h Holter monitoring. This study aimed to evaluate the efficacy of 2-week Holter monitoring for the detection of AT recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2019 to December 2021, 755 consecutive patients with AF (paroxysmal: 449, persistent: 256, long-standing: 50) who underwent initial CA with wide-area pulmonary vein isolation at our center were enrolled. Two-week Holter monitoring was conducted at 3, 6, 12, 18, and 24 months after CA. Twenty-four-hour Holter monitoring was substituted for the first 24 h of the 2-week Holter monitoring. Freedom from AT recurrence was defined as the absence of AT lasting &gt; 30 s beyond a 3-month blanking period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-nine (9.1%) patients dropped out. Among the remaining 686 patients, AT recurrence was detected over the 2-year follow-up period in 173 cases (25.2%) using 2-week Holter monitoring and in 46 cases (6.7%) using 24-h Holter monitoring (<i>p</i> &lt; 0.001). Holter monitoring-based analysis revealed that asymptomatic recurrence was significantly more common in patients with persistent and long-standing AF (85.0%, 96/113 records) compared to those with paroxysmal AF (50.0%, 76/152 records) (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Two-week Holter monitoring was significantly more effective than conventional 24-h Holter monitoring for detecting AT recurrence after CA, particularly in patients with persistent and long-standing AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110709","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":"Comments on the Study of Aortomitral Continuity Calcification and Conduction Disturbances After TAVI","authors":"Hafsa Azam,&nbsp;Fatima Yaseen,&nbsp;Bariyah Ahmed,&nbsp;Maham Ejaz,&nbsp;Laiba Bibi","doi":"10.1002/joa3.70195","DOIUrl":"https://doi.org/10.1002/joa3.70195","url":null,"abstract":"<p>Aortomitral continuity calcification (AMCC) may contribute to conduction disturbances after TAVI. This Letter highlights key methodological limitations including short-term endpoints, omission of pre-existing RBBB, and lack of spatial AMCC assessment that must be addressed to enhance the accuracy and clinical relevance of AMCC as a risk stratification tool.\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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102022","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":"Establishing a Cardiac Implantable Electronic Device Lead Extraction Program in a Resource-Limited Setting","authors":"Giselle G. Gervacio,&nbsp;Jhobeleen D. De Leon,&nbsp;Michael Joseph C. Agbayani,&nbsp;Paula Victoria Cheng-Bromeo,&nbsp;Tam Adrian P. Aya-ay,&nbsp;Jonaiha G. Rangiris,&nbsp;Richard S. Nicolas,&nbsp;Felix Eduardo R. Punzalan,&nbsp;John C. Añonuevo","doi":"10.1002/joa3.70163","DOIUrl":"https://doi.org/10.1002/joa3.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The rising number of cardiac implantable electronic device (CIED) implantations in Asia is expected to increase CIED-related infections and lead malfunctions. Establishing a lead extraction program is therefore essential. We describe the set-up and early implementation of the University of the Philippines-Philippine General Hospital (UP-PGH) Lead Extraction Program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on preoperative, intraoperative, and postoperative management were collected, along with details on resources, personnel, and workflows. A descriptive analysis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The UP-PGH Lead Extraction Program was launched on September 1, 2023. Key components-including personnel training, equipment procurement, hospital support, and workflow development-were successfully implemented. Within the first year, four procedures (eight leads) were completed (mean patient age: 60.75 years; lead dwell time: median of 6.2 years [IQR 10.15]; indication: infected pacemaker and ICD leads). All leads were completely removed without complications. The workflow included a structured preoperative process, including risk assessment, required investigations, antibiotic initiation, and subspecialty input. Intraoperative procedure included workflow optimization, materials readiness, and complication monitoring, which were prioritized during lead extraction. Post-procedure care involved completion of antibiotic treatment, culture processing, device reimplantation, and follow-up. These measures enabled safe lead removal by an electrophysiologist-led extraction team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This successful launch of the UP-PGH Lead Extraction Program demonstrated that developing countries can feasibly establish such programs with well-defined workflows and adequate resource planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057811","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":"Cardiomyopathy With Preexcitation and Conduction Abnormalities in a Child","authors":"Gorav Sharma,&nbsp;Ansh Goswami,&nbsp;Siddharthan Deepti,&nbsp;Neeraj Parakh,&nbsp;Sudheer Kumar Arava","doi":"10.1002/joa3.70191","DOIUrl":"https://doi.org/10.1002/joa3.70191","url":null,"abstract":"<p>An 11-year-old boy presented with dilated cardiomyopathy in association with a fasciculoventricular pathway and sinus node and atrioventricular conduction abnormalities. Whole exome sequencing revealed a novel variant of uncertain significance in LIM domain-binding protein 3 (LDB3) which has not been heretofore described. This variant was predicted to be deleterious by the computational prediction tools: Polyphen2 and SIFT. The mutated allele was heterozygous in the patient. Segregation analysis revealed that his father carried the same variant in heterozygous form. The case is reported for its rarity.\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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038380","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":"Reply to “Challenges to the Long-Term Safety Claims of Extremely Low-Dose Amiodarone: Pulmonary, Thyroid, Hepatic, and Statistical Concerns”","authors":"Kentaro Yoshida","doi":"10.1002/joa3.70194","DOIUrl":"https://doi.org/10.1002/joa3.70194","url":null,"abstract":"&lt;p&gt;We appreciate and thank Rasheed et al. very much for their interest in our article [&lt;span&gt;1&lt;/span&gt;] and for highlighting important limitations. However, we believe that these authors did not well understand the most unique point in our study compared with previous studies. First of all, the strength of the present study was its focus on amiodarone 50 mg daily. There are no or few organized data on amiodarone 50 mg therapy in previous studies, as we described in detail in the Discussion section. We would encourage Rasheed et al. to correctly recognize that in most previous studies, “low-dose” would actually mean 200 mg daily. Although we agree that our study size was not so large, our focus on a 50 mg dose was still a significant strength of the study, and we believe that our organized data on amiodarone 50 mg therapy are quite novel and worthy of publication.&lt;/p&gt;&lt;p&gt;Rasheed et al. likely misunderstood the results of the previous study by Tsaban et al. that was also cited in our manuscript. Although amiodarone did show a small clinically marginal statistical association with increased risk of interstitial lung disease between 2 and 8 years of follow-up in that study, those authors concluded that this increased risk was clinically negligible and did not significantly affect the patients' overall prognosis because the incidence of interstitial lung disease was low (~2%) and, of note, the mortality risk was lower among patients exposed to amiodarone and remained so for all follow-up years. We truly sympathize with the final description by Tsaban et al. that “the results of this study may encourage an increase in amiodarone use for rhythm control in AF.” Again, the median daily amiodarone dose was approximately 200 mg in that study, much higher than the dose in our study, making direct comparison with our study difficult.&lt;/p&gt;&lt;p&gt;We agree that thyrotoxicosis is a clinically critical side effect of amiodarone use. However, Guðjónsson et al. never emphasized dose-independent risks in thyroid dysfunction in their study. On the contrary, a higher dose of amiodarone was actually associated with an increased risk of thyrotoxicosis [HR 2.0 (95% CI 1.1–3.5)]. The mean daily amiodarone dose of 193 mg in their study—again, much higher than that in our study—makes it difficult to directly compare their study with ours.&lt;/p&gt;&lt;p&gt;We agree that hepatotoxicity may be underdiagnosed in amiodarone use because abnormal liver function and symptoms are not necessarily apparent even if hepatotoxicity is present. In our cohort, no patients had abnormal liver tests or suffered from liver dysfunction. Dual-energy computed tomography may be a useful modality that can contribute to the early detection of hepatotoxicity, but such an assessment was beyond the scope of our retrospective study. Also, the assessment and description of all three of these toxicities (lung, thyroid, and liver) in the manuscript of a study would be difficult due to the word limits imposed by the &lt;i&gt;Journa","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038117","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}