Journal of Arrhythmia最新文献

{"title":"Critique of omnipolar mapping claims in superior vena cava isolation: A call for standardization","authors":"Mirza Muhammad Hadeed Khawar MBBS, Muneeb Khawar MBBS, Javed Iqbal, Abdul Qadeer MD","doi":"10.1002/joa3.70020","DOIUrl":"https://doi.org/10.1002/joa3.70020","url":null,"abstract":"<p>We write to address critical issues in the main findings of the study, “<i>Novel Omnipolar Mapping Technology for Effective Superior Vena Cava Isolation: A Randomized Clinical Trial</i>” by Oguri et al.<span><sup>1</sup></span> While the study aims to demonstrate the superiority of omnipolar mapping technology (OT) over conventional methods (CM) in superior vena cava (SVC) isolation, the results are undermined by several methodological inconsistencies, questionable conclusions, and significant gaps in transparency. These issues call into question the study's overall validity and its implications for clinical practice.</p><p>The authors report that OT requires fewer radiofrequency (RF) applications (13.6 ± 6.0 vs 19.8 ± 10.9) and shorter procedure times (9.6 ± 6.8 min vs 14.3 ± 6.8 min) compared to CM. Although these differences are statistically significant, their clinical relevance is dubious because of the absence of clearly defined procedural criteria. The reported RF applications for OT are notably higher than the averages documented in previous SVC isolation studies,<span><sup>2</sup></span> which typically highlight more efficient procedural workflows. This discrepancy raises concerns about whether OT genuinely represents an advancement or merely reflects methodological differences.</p><p>Moreover, the lack of transparency regarding operator variability—such as differences in experience levels and techniques—further complicates interpretation. Operator-dependent factors are known to substantially impact RF application times and procedural outcomes; yet the study does not adequately address these influences. Without controlling for such variability, the reported superiority of OT remains speculative and difficult to generalize.</p><p>The authors claim that OT identified the SN location in three out of 25 patients where bipolar mapping failed. While this assertion suggests a potential advantage of OT, the study does not provide robust quantitative evidence to support the claim. For example, no clear validation framework for comparing the accuracy of OT versus bipolar mapping was included, nor was there external confirmation of the identified SN locations. Without such standardization, conclusions regarding OT's accuracy are speculative at best.</p><p>In a related analysis, the study describes the performance of an 8-spline catheter, reporting higher point density (59 ± 10 vs 18 ± 4 electrograms/cm<sup>2</sup>; <i>p</i> < .01) and faster point acquisition rates (1332 ± 208 vs 308 ± 69 electrograms/min; <i>p</i> < .01) compared to the 5-spline catheter during sustained atrial tachycardia mapping.<span><sup>3</sup></span> However, these results, while statistically impressive, fail to demonstrate clinical relevance in the context of SN localization. The lack of consistent criteria for measuring and validating mapping accuracy undermines the credibility of these findings.</p><p>The study defines RA-SVC conduction blocks using a color spe","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362769","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":"Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block","authors":"Catalin Pestrea MD, PhD,&nbsp;Ecaterina Cicala MD,&nbsp;Roxana Enache MD,&nbsp;Marcela Rusu MD,&nbsp;Radu Gavrilescu MD,&nbsp;Adrian Vaduva MD,&nbsp;Sever Risca MD,&nbsp;Dana Clapon MD,&nbsp;Florin Ortan MD","doi":"10.1002/joa3.70009","DOIUrl":"https://doi.org/10.1002/joa3.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are known markers for adverse cardiac events. Previous studies have shown that the incidence of new-onset AHREs in patients with right ventricular pacing reaches 50%. At the same time, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) were associated with significantly fewer AHRE. This study aimed to compare the incidence of new-onset AHRE between HBP and LBBAP in patients with atrioventricular block and no history of atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and forty-two patients, fifty-nine with HBP and eighty-three with LBBAP for advanced atrioventricular block, were prospectively followed for new-onset AHRE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up period was 624 ± 148.6 days for the HBP patients and 663.4 ± 157.4 days for the LBBAP patients. New-onset AHRE was encountered in 8 of 59 patients (13.5%) with HBP and 14 of 83 (16.8%) with LBBAP (hazard ratio—0.91, log rank <i>p</i> = .84). In the multivariate Cox regression model, HBP and LBBAP had similar predictive values, while only age and diabetes mellitus were significantly associated with new-onset AHRE occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111505","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":"Catheter ablation using pulsed-field energy: Advantages and limitations compared with conventional energy","authors":"Kenji Kuroki MD, PhD,&nbsp;Hiroshi Tada MD, PhD","doi":"10.1002/joa3.70011","DOIUrl":"https://doi.org/10.1002/joa3.70011","url":null,"abstract":"<p>Atrial fibrillation (AF) poses significant risks of heart failure and stroke, emphasizing effective treatment. Catheter ablation using thermal energy sources, such as radiofrequency or cryoballoon ablation, has shown greater success in maintaining sinus rhythm compared with drug therapy. However, thermal ablation (TA) is associated with serious complications, such as atrial-esophageal fistula, phrenic nerve palsy, and pulmonary vein stenosis. Pulsed-field ablation (PFA) is an emerging ablation energy source that uses electroporation to selectively target cardiac tissue while sparing adjacent structures such as nerves and blood vessels. Two randomized controlled trials have demonstrated that PFA is comparable to TA in both efficacy and safety at a 1-year follow-up and had shorter procedure times. A review of six meta-analyses consistently showed shorter procedural times for PFA across all studies. Additionally, three out of the four recent studies with large samples reported lower recurrence rates with PFA. Regarding complication rates, four out of four studies showed lower incidences of phrenic nerve injury with PFA, and two out of three studies reported lower rates of esophageal injury with PFA. However, four out of four studies indicated higher incidences of cardiac tamponade with PFA, highlighting the need for caution among early-career operators. Furthermore, careful monitoring is required considering the possible unforeseen complications specific to PFA and the lack of long-term follow-up data. Despite these concerns, PFA shows promise as a safer, more effective, and efficient alternative to TA for AF, particularly as operator experience and device technology continue to advance.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111580","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 “disparities in cardiac arrest mortality among patients with chronic kidney disease: A US based epidemiological analysis”","authors":"Masamichi Yano MD, PhD","doi":"10.1002/joa3.70008","DOIUrl":"https://doi.org/10.1002/joa3.70008","url":null,"abstract":"&lt;p&gt;We appreciated the report by Shahid et al., which underscores chronic kidney disease (CKD) as a significant risk factor for cardiovascular disease (CVD), with cardiac arrest (CA) emerging as a leading cause of death among patients with impaired renal function.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This study provides a detailed analysis of CKD-related CA mortality trends in the United States over two decades, using data from the Centers for Disease Control and Prevention (CDC). Notably, it highlights persistent disparities in mortality across sex, racial/ethnic, and geographic subpopulations, with the Social Vulnerability Index (SVI) emerging as a critical determinant of excess mortality. These findings stress the urgent need for interventions targeting healthcare inequities in CKD and cardiovascular outcomes.&lt;/p&gt;&lt;p&gt;CKD has long been recognized as a major risk factor for CVD, with CA being a predominant cause of mortality in renal dysfunction patients.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The underlying pathophysiology involves electrolyte imbalances, autonomic dysfunction, systemic inflammation, and structural changes in the heart. CKD and CVD mutually exacerbate each other, increasing arrhythmic susceptibility, particularly in patients with advanced renal impairment.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Despite advancements in renal and cardiovascular care, the persistently high mortality rates among CKD patients experiencing CA underscore the need for more effective preventive and therapeutic strategies.&lt;/p&gt;&lt;p&gt;The study reveals that the age-adjusted mortality rate (AAMR) for CKD-related CA has remained stable over the past two decades, while general mortality has declined. This suggests potential gaps in risk factor management and the implementation of evidence-based interventions for CKD patients. It also highlights significant disparities across demographic and geographic groups. Men had higher mortality rates than women, possibly due to differences in CKD progression, cardiovascular risk, and healthcare access. Racial and ethnic disparities were evident, with non-Hispanic (NH) Black and Hispanic populations experiencing disproportionately high CA-related mortality. Socioeconomic factors, captured by the SVI, were critical in these disparities, highlighting the role of social determinants of health (SDoH) like income inequality, healthcare access, education, and neighborhood safety. While NH Black populations had the highest mortality rates, the study reports a decline in CA-related mortality among them, likely due to improvements in healthcare access and CKD management. However, more efforts are needed to extend these gains to other high-risk groups. The study also identifies regional disparities, with urban areas showing higher mortality rates than rural regions. Although urban areas have better access to healthcare, environmental stressors like air pollution and socioeconomic deprivation may exacerbate cardiovascular risk. Surprisingly, the highest mortality rates were se","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143110994","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":"Comparative analysis of left bundle branch area pacing in patients with and without a history of open-heart surgery","authors":"Yasumasa Nohno MD,&nbsp;Ryosuke Kozu MD,&nbsp;Kii Ito MD,&nbsp;Yuta Chikazawa MD,&nbsp;Shusaku Maruyama MD,&nbsp;Tomoya Hasegawa MD,&nbsp;Hiromi Tsuchiya MD,&nbsp;Takahiro Tachibana MD,&nbsp;Hikaru Kimura MD,&nbsp;Yoshikazu Yazaki MD, PhD","doi":"10.1002/joa3.70010","DOIUrl":"10.1002/joa3.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group (<i>p =</i> 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, <i>p =</i> 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, <i>p =</i> 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, <i>p =</i> 0.002), but parameters remained stable at 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065935","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":"Novel mapping techniques for ablation of non-pulmonary vein foci using complex signal identification","authors":"Hiroyuki Kono MD,&nbsp;Kenichi Hiroshima MD,&nbsp;Kengo Korai MD,&nbsp;Kenji Ando MD","doi":"10.1002/joa3.13222","DOIUrl":"10.1002/joa3.13222","url":null,"abstract":"<p>The complex signal identification function of CARTO version 8 enables quantitative evaluation of local potential fractionation. We present a case where this advanced technology successfully identified non-pulmonary vein foci associated with fractionated potentials during sinus rhythm.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052700","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":"Comparative analysis of left atrial size and appendage morphology in paroxysmal and persistent atrial fibrillation patients","authors":"J. Pongratz MD,&nbsp;L. Riess MD,&nbsp;S. Hartl MD,&nbsp;B. Brueck MD,&nbsp;C. Tesche MD, MHBA, FESC, FSCCT,&nbsp;D. Olbrich MD,&nbsp;M. Wankerl MD,&nbsp;U. Dorwarth MD,&nbsp;E. Hoffmann MD, FESC,&nbsp;F. Straube MD, FEHRA, FESC, FHRS","doi":"10.1002/joa3.13224","DOIUrl":"10.1002/joa3.13224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) is effective in treating atrial fibrillation (AF), but outcomes are worse for persistent AF (persAF) patients than paroxysmal AF (PAF) patients. The study aimed to identify differences in left atrial (LA) and left atrial appendage (LAA) anatomy in different AF types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a single-center observational study, a blinded retrospective analysis of preprocedural cardiac computed tomography angiography (CCTA) images was performed. The study evaluated the dimensions of the LA and pulmonary veins (PV), as well as the size and morphology of the LAA using a 3D electroanatomical mapping system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2012 and 2016, a total of 1103 patients underwent second-generation cryoballoon PVI. Of these, 725 patients (65.7%) had CCTA available, and 473 of these (65.2%) had sufficient quality for measurements. The mean age of the patients was 66.3 ± 9.5 years, and PAF was present in 277 (58.6%) participants. The study found that in persAF patients, LA dimensions such as LA volume [mL] (108; 125; <i>p</i> &lt; .001) or PV ostial dimensions were significantly larger than in those with PAF. LAA volume [mL] (8.3; 9.2; <i>p</i> = .005) and LAA ostial area [mm²] (325; 353; <i>p</i> = .01) were enlarged in persAF. There were no significant differences regarding LAA morphology, with the overall distribution being “windsock” (51%), “chicken-wing” (20%), “cauliflower” (15%), and “cactus” (13%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared to PAF, persAF patients had significantly larger LA as well as LAA dimensions. LAA morphological types were distributed equally in both groups suggesting that LAA morphology may not be associated with the underlying AF type.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046770","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 “Novel mapping techniques for ablation of non-pulmonary vein foci using complex signal identification”","authors":"Yoshiaki Mizutani MD, PhD,&nbsp;Satoshi Yanagisawa MD, PhD,&nbsp;Yasuya Inden MD, PhD","doi":"10.1002/joa3.70006","DOIUrl":"10.1002/joa3.70006","url":null,"abstract":"&lt;p&gt;A mechanism of paroxysmal atrial fibrillation (AF) involves trigger activity mainly originating from a pulmonary vein (PV). Catheter ablation of PV isolation, using recent advanced technologies, is a promising approach to prevent AF incidence and related complications. However, some AF triggers originate from non-PV foci, which are associated with AF recurrence despite complete PV isolation.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Although various approaches and techniques have been introduced for induction and provocation of non-PV foci, identifying the exact location of non-PV foci in the broad area of the left and right atriums is still challenging. Fractionated signal area in the atrial muscle (FAAM) map-guided ablation is a recently developed technique that highlights the fractionated signal area using the LUMIPOINT software in the ultrahigh-density RHYTHMIA mapping system (Boston Scientific, Marlborough, MA). These fractionated signal areas are significantly associated with the location of non-PV foci.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The FAAM-guided ablation previously demonstrated a lower recurrence rate of atrial tachyarrhythmia compared to the non-FAAM ablation in patients with recurrent AF who underwent catheter ablation targeting non-PV foci.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Unfortunately, this specific FAAM map can only be used in the RHYTHMIA mapping system, underscoring the need for broader utility of this algorithm across all mapping systems in clinical practice.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of arrhythmia&lt;/i&gt;, Kono. et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported a successful non-PV foci ablation case for paroxysmal AF using a Complex Signal Identification (CSI) algorithm equipped with CARTO™ 3 system version 8 to automatically identify and tag complex fractionated potentials in atria. After PV isolation and cavotricuspid isthmus ablation, an additional ablation was performed using the CSI algorithm to target non-PV foci triggered by isoproterenol infusion, high-rate burst pacing, and adenosine triphosphate administration. High CSI tag scores were found in the anterior carina of the right superior PV (RSPV), extending to the anterior wall. The earliest activation site in the non-PV-foci corresponded to the highest CSI score of 9.8, with fractionated potentials where effective energization was applied. Additionally, the PV isolation line for the right superior PV was slightly extended to include the high CSI area of ≥7.5. At the end of the ablation, no AF was induced, and the patient maintained sinus rhythm without antiarrhythmic drugs for 6 months.&lt;/p&gt;&lt;p&gt;The CSI algorithm can arbitrarily calculate the abnormal potentials using four parameters: minimum fractionated score, time frame within the window of interest, bipolar amplitude of the complex signal, and minimum duration, implying a strict stratification for the relevant fractionated potentials from broad perspectives. Unfortunately, appropriate CSI setting and cutoff points have not been established,","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046809","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":"Novel omnipolar mapping technology for effective superior vena cava isolation: A randomized clinical trial","authors":"Naoto Oguri MD,&nbsp;Yousaku Okubo MD, PhD,&nbsp;Naoki Ishibashi MD,&nbsp;Junji Maeda MD,&nbsp;Takumi Sakai MD,&nbsp;Yukimi Uotani MD,&nbsp;Motoki Furutani MD,&nbsp;Shogo Miyamoto MD,&nbsp;Shunsuke Miyauchi MD, PhD,&nbsp;Sho Okamura MD, PhD,&nbsp;Takehito Tokuyama MD, PhD,&nbsp;Noboru Oda MD, PhD,&nbsp;Yukiko Nakano MD, PhD","doi":"10.1002/joa3.70007","DOIUrl":"10.1002/joa3.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Successful isolation of the superior vena cava (SVC) using a functional conduction block between the right atrium (RA) and SVC has been documented. However, a comparison of this approach with the conventional method (CM) of circumferential ablation of the RA-SVC junction, based on angiography, remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In this study, we employed the innovative omnipolar mapping technology (OT) to discern the RA-SVC connection and compared clinical outcomes with those from CM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-two patients undergoing SVC isolation were randomly assigned in a 1:1 ratio to either the OT or CM group. No significant differences in the baseline characteristics were observed between the two groups. We assessed the efficacy and safety of both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups showed comparable acute success rates (96%) in SVC isolation, but the procedure in the OT group required fewer radiofrequency (RF) applications (13.6 ± 6.0 vs. 19.8 ± 10.9, <i>p</i> = .046) and shorter procedure time (9.6 ± 6.8 min vs. 14.3 ± 6.8 min, <i>p</i> = .007). The overall absorbed dose was notably lower in the OT group (69.6 ± 47.6 mGy vs. 90.3 ± 30.3 mGy, <i>p</i> = .023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The OT enhances the efficacy of SVC isolation, requiring fewer RF applications and reducing procedure time compared to conventional treatment methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046814","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 successful salvage despite right ventricular perforation during AVEIR VR leadless pacemaker implantation","authors":"Masanori Matsuo MD, PhD,&nbsp;Kenji Shimeno MD, PhD,&nbsp;Naoki Matsumoto MD,&nbsp;Yukio Abe MD, PhD,&nbsp;Daiju Fukuda MD, PhD","doi":"10.1002/joa3.70000","DOIUrl":"10.1002/joa3.70000","url":null,"abstract":"<p>To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046765","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}