Journal of Arrhythmia最新文献

{"title":"Efficacy and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation and kidney failure under hemodialysis: A meta-analysis of controlled randomized trials","authors":"Ting-Yung Chang MD,&nbsp;Yi-Hsin Chan MD,&nbsp;Tze-Fan Chao MD,&nbsp;Chin-Yu Lin MD,&nbsp;Yenn-Jiang Lin MD,&nbsp;Shih-Lin Chang MD,&nbsp;Li-Wei Lo MD,&nbsp;Yu-Feng Hu MD,&nbsp;Fa-Po Chung MD,&nbsp;Shih-Ann Chen MD","doi":"10.1002/joa3.70094","DOIUrl":"https://doi.org/10.1002/joa3.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF)-related strokes are associated with disability and mortality. Stroke prevention with non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) is the cornerstone of holistic management of AF. However, the safety and efficacy of NOACs in patients with AF on hemodialysis remain uncertain. This meta-analysis aimed to evaluate currently available data to determine the potential utility of NOACs in AF patients with kidney failure receiving hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the literature for randomized clinical trials comparing NOACs to VKA therapy in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>About the Principal Efficacy Outcome, NOACs Did Not Decrease the Risk Compared to Warfarin (Relative Risk [RR] 0.79, 95% CI 0.45–1.37) while a Significant Heterogeneity Was Noted (<i>p</i> = 0.03). In the Valkyrie Study, Rivaroxaban Had better Cardiovascular Outcome than Warfarin (RR 0.57, 95% CI 0.43–0.75). For the Principal Safety Outcome, the Risk Was Similar between NOACs and Warfarin (RR 0.81, 95% CI 0.52–1.27) without Significant Heterogeneity (<i>p</i> = 0.11). The Pooled Event Rate of 3 Trials Disclosed a High Risk of all-Cause Mortality (39.9% for NOACs, 34.6% for Warfarin) and Cardiovascular Mortality (10.1% for NOACs, 8.5% for Warfarin) for AF Patients with Kidney Failure Receiving Hemodialysis Even on Oral Anticoagulants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that NOACs (rivaroxaban or apixaban) are as safe and effective as VKAs in patients with AF and kidney failure with hemodialysis. Even on oral anticoagulants, these patients remain at high risk of cardiovascular events and all-cause mortality. Integrated care and holistic management are important for this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085194","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":"Successful accessory pathway ablation in infant with supraventricular tachycardia associated with necrotizing enterocolitis; spotlight","authors":"Yuka Hayashida MD,&nbsp;Hisaaki Aoki MD, PhD,&nbsp;Masayoshi Mori MD,&nbsp;Satoshi Umeda MD, PhD,&nbsp;Keigo Nara MD, PhD","doi":"10.1002/joa3.70091","DOIUrl":"https://doi.org/10.1002/joa3.70091","url":null,"abstract":"<p>A neonate with refractory supraventricular tachycardia complicated by necrotizing enterocolitis. Various antiarrhythmic drugs were ineffective, and the tachycardia was controlled with intravenous nifekalant. The accessory pathway was successfully ablated at a weight of 3.0 kg without complications.\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":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085109","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":"Clinical and electrophysiological significance of residual unipolar voltage after performing pulmonary vein isolation in patients with paroxysmal atrial fibrillation","authors":"Takuya Tomomori MD,&nbsp;Yasuhito Kotake MD, PhD,&nbsp;Fumiyasu Hirano MD,&nbsp;Shunsuke Kawatani MD,&nbsp;Aiko Takami MD,&nbsp;Akihiro Okamura MD, PhD,&nbsp;Masaru Kato MD, PhD,&nbsp;Kazuhiro Yamamoto MD, PhD, FJCS","doi":"10.1002/joa3.70092","DOIUrl":"https://doi.org/10.1002/joa3.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) is the cornerstone strategy for paroxysmal atrial fibrillation (AF). Creating a transmural block line between pulmonary vein (PV) and left atrium (LA) is important for the risk of AF recurrence. Recently, emerging evidence indicates that endocardial unipolar voltage delineates lesions of intramural or epicardial substrate in patients with ventricular tachycardia (VT). However, there are few studies on unipolar voltage evaluation in the atrium. This study describes the clinical and electrophysiological significance of unipolar voltage mapping at the site of PV–LA conjunction after PVI in patients with paroxysmal AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from patients presenting for AF ablation from April 2023 to January 2024 at Tottori University Hospital were prospectively included. To assess the electrical isolation, high-resolution voltage mapping was performed comparing groups with and without residual unipolar voltage at the site of cryo-balloon application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-seven consecutive patients who underwent cryo-balloon ablation for paroxysmal AF were included in this study. Of these, residual unipolar voltage at the site of PV-LA conjunction after PVI was identified in 22 patients. Patients with residual unipolar voltage after PVI showed significantly thicker left atrial wall thickness and larger epicardial adipose tissue volume compared with patients without residual unipolar voltage after PVI. During follow-up periods, patients with residual unipolar voltage after PVI showed a higher AF recurrence rate than those without unipolar voltage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Residual unipolar voltage at the site of PV-LA conjunction after PVI may be related to AF recurrence early after the ablation, suggesting the non-transmural block line between PV and LA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085193","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":"Transient conduction block of the superior vena cava following pulsed field ablation of the right superior pulmonary vein","authors":"Kenta Takahashi MD,&nbsp;Toshio Makita MD,&nbsp;Shinya Shimoshige MD,&nbsp;Taishi Kuwahara MD","doi":"10.1002/joa3.70095","DOIUrl":"https://doi.org/10.1002/joa3.70095","url":null,"abstract":"<p>This case demonstrates that an immediate superior vena cava (SVC) conduction block may occur during pulsed field ablation (PFA) due to anatomical proximity, a positive tissue proximity index, and a narrow SVC diameter. However, lesions not directly influenced by PFA tend to regress and may be reversible, leading to SVC potential reconduction. CS, coronary sinus; d, distal; LAO, left oblique view; LL, left lateral; p, proximal; PA, posteroanterior view; RA, right atrial; RAO, right oblique view; RSPV, right superior pulmonary vein; RV, right ventricular; SUP, superior view.\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":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074431","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 HFA-PEFF score and outcomes in patients with sick sinus syndrome and preserved ejection fraction after pacemaker implantation","authors":"Hironobu Sumiyoshi MD,&nbsp;Hidemori Hayashi MD, PhD,&nbsp;Kenta Yoshida MD,&nbsp;Atsushi Sakata MD,&nbsp;Akira Mizukami MD, PhD,&nbsp;Tohru Minamino MD, PhD,&nbsp;Hiroshi Tasaka MD","doi":"10.1002/joa3.70088","DOIUrl":"https://doi.org/10.1002/joa3.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sick sinus syndrome (SSS) is associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). However, diagnosing HFpEF in patients with SSS and determining its prognosis are challenging. The European Society of Cardiology has recommended the HFA-PEFF score for HFpEF diagnosis. In this study, we utilized the HFA-PEFF score to diagnose HFpEF in patients with SSS and preserved ejection fraction, comparing the prognosis and AF burden between those diagnosed with HFpEF and those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified 131 patients with symptomatic SSS and preserved ejection fraction who underwent pacemaker implantation between January 2019 and December 2021. Of these, 52 (39.7%) had an HFA-PEFF score ≥5 and met the diagnostic criteria for HFpEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with HFpEF experienced more cardiovascular events (28.8% vs. 11.4%; <i>p</i> = .009) within 3 years than those without HFpEF. The median duration of AF per day during the first year was significantly longer in the HFpEF group (10 vs. 30 min/day, <i>p</i> &lt; .001). Additionally, these patients had a higher incidence of AF lasting for ≥7 days (32.9% vs. 16.9%; <i>p</i> = .038) within 3 years. A simplified HFA-PEFF score incorporating E/e′, tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide predicted cardiovascular events and AF burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients diagnosed with HFpEF using the HFA-PEFF score have a higher incidence of cardiovascular events and a greater AF burden within 3 years after pacemaker implantation for SSS. The HFA-PEFF score may be useful for risk stratification in these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938753","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":"Stepwise MRI mode activation in a patient with a non-MRI-conditional VDD lead","authors":"Risa Kanai RN, CCDS,&nbsp;Yoshitaka Terazaki RN, CCDS,&nbsp;Hitoshi Mori MD, PhD,&nbsp;Yoshifumi Ikeda MD, PhD,&nbsp;Ritsushi Kato MD, PhD","doi":"10.1002/joa3.70089","DOIUrl":"https://doi.org/10.1002/joa3.70089","url":null,"abstract":"<p>A Medtronic MRI-conditional device connected to an MRI-non-conditional VDD lead, which required specific adjustments in MRI mode settings to enable safe imaging. Although switching to MRI mode from VDD mode or VVI mode was not possible, it became possible after switching to DDD mode.\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":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938755","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":"Survival benefit of primary prevention implantable cardioverter-defibrillator/cardiac resynchronization therapy with a defibrillator: Analysis of the Japan cardiac device treatment registry and Japanese cardiac registry of heart failure in cardiology","authors":"Hisashi Yokoshiki MD, PhD,&nbsp;Masaya Watanabe MD, PhD,&nbsp;Sanae Hamaguchi MD, PhD,&nbsp;Hiroyuki Tsutsui MD, PhD,&nbsp;Akihiko Shimizu MD, PhD,&nbsp;Takeshi Mitsuhashi MD, PhD,&nbsp;Kohei Ishibashi MD, PhD,&nbsp;Tomoyuki Kabutoya MD, PhD,&nbsp;Yasuhiro Yoshiga MD, PhD,&nbsp;Yusuke Kondo MD, PhD,&nbsp;Taro Temma MD, PhD,&nbsp;Masahiko Takagi MD, PhD,&nbsp;Hiroshi Tada MD, PhD","doi":"10.1002/joa3.70084","DOIUrl":"https://doi.org/10.1002/joa3.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence supporting the benefit from primary prevention implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy with a defibrillator (CRT-D) for heart failure with reduced ejection fraction (HFrEF) is scarce in real-world settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed propensity score matched cohorts of patients eligible for Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) from Japan cardiac device treatment registry (JCDTR) and Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). The former served as the defibrillator therapy group and the latter as the conventional therapy group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During an average follow-up of 24 months, death occurred in 35 of 285 patients (12%) with defibrillator therapy and 65 of 285 patients (23%) with conventional therapy. Adjusted hazard ratios of all-cause death, sudden death, heart failure death, and noncardiac death in defibrillator versus conventional therapy were 0.616 (95% confidence interval [CI]: 0.402–0.943, <i>p</i> = 0.026), 0.274 (95% CI: 0.103–0.731, <i>p</i> = 0.0097), 0.362 (95% CI: 0.172–0.764, <i>p</i> = 0.0077) and 1.45 (95% CI: 0.711–2.949, <i>p</i> = 0.31). After accounting for death without appropriate defibrillator therapy as a competing risk, the cumulative incidence of first appropriate defibrillator therapy in the defibrillator therapy group was nearly identical to that of all-cause death in the conventional therapy group. Subgroup analyses indicated a lack of defibrillator benefit in patients with hypertension (<i>p</i> = 0.01 for interaction).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Primary prevention ICD/CRT-D reduced the risk of all-cause mortality of patients with HFrEF eligible for SCD-HeFT compared to conventional therapy in the real-world cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938754","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":"Electrocardiographic parameter profiles for differentiating hypertrophic cardiomyopathy stages","authors":"Muhammad Shaheer Bin Faheem MBBS,&nbsp;Nisha Khatri MBBS,&nbsp;Shamikha Cheema MBBS,&nbsp;Muhammad Rehan Zahid MBBS,&nbsp;Sumaya Samadi MBBS","doi":"10.1002/joa3.70086","DOIUrl":"https://doi.org/10.1002/joa3.70086","url":null,"abstract":"&lt;p&gt;We read the article “Electrocardiographic parameter profiles for differentiating hypertrophic cardiomyopathy stages” by Hirota et al., published in the Journal of Arrhythmia, with great interest. We appreciate the authors' remarkable efforts in investigating the role of electrocardiographic (ECG) parameters in differentiating between the stages of hypertrophic cardiomyopathy (HCM) and its progression to dilated hypertrophic cardiomyopathy (DCM), optimized with AI-enhanced diagnostic models.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While providing valuable insights, it is important to acknowledge specific concerns that merit our attention.&lt;/p&gt;&lt;p&gt;The study excludes conditions such as active cancers; it does not explicitly account for potential confounders such as undiagnosed metabolic conditions, medication use, or lifestyle factors that could influence ECG findings. A case reported by Garcia-Granja et al. highlights the use of propafenone, a class IC antiarrhythmic drug, which can adversely affect ECG interpretability in patients with hypertrophic cardiomyopathy.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Propafenone significantly altered ECG parameters such as PR interval and QRS duration by worsening conduction delays. These changes obscure cardiac conditions and potentially lead to misdiagnosis. Furthermore, limited follow-up data make it challenging to track gradual changes in ECG parameters that may show the transition from HCM to dHCM. Kagumi et al. provide strong evidence on how serial ECG changes can be early markers of progression from HCM to dHCM.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Moreover, they showed that progression to dHCM was associated with a higher incidence of ventricular tachycardia and cardiac death, underscoring the need for longitudinal ECG monitoring as a predictive and preventive strategy in patients with HCM.&lt;/p&gt;&lt;p&gt;Because of ethnic and demographic variations, different genetic predispositions to HCM, and significant disparities in healthcare access, these findings may not be widely applicable,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; as the study is based on a Japanese cohort. An attempt to use AI-based models to analyze ECG parameters lacks explainability on how AI interprets the ECG features. This makes it difficult for clinicians to rely on and apply the findings in real-world settings.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Hirota et al. present a meticulous analysis and valuable insights into the role of ECG parameters in diagnosing and differentiating HCM and its dilated phase (dHCM), making a significant contribution to cardiovascular medicine. Nevertheless, a more detailed investigation integrating lifestyle influences, genetic testing, and specific comorbidities is needed to better analyze the subgroups with or without comorbidities. Our assessment underscores the importance of broadening the focus of future studies beyond the use of ECG to provide critical validation of findings. Also, improving the study's real-world clinical applicability should be a priority beyond techni","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938756","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":"Acute effect of multipoint pacing and fused AV delay in patients receiving cardiac resynchronization therapy","authors":"Masakazu Miyamoto MD,&nbsp;Nobuhiro Nishii MD, PhD,&nbsp;Tomofumi Mizuno MD,&nbsp;Akira Ueoka MD, PhD,&nbsp;Takuro Masuda MD,&nbsp;Saori Asada MD, PhD,&nbsp;Kentaro Ejiri MD, PhD,&nbsp;Satoshi Kawada MD, PhD,&nbsp;Koji Nakagawa MD, PhD,&nbsp;Kazufumi Nakamura MD, PhD,&nbsp;Hiroshi Morita MD, PhD,&nbsp;Shinsuke Yuasa MD, PhD","doi":"10.1002/joa3.70085","DOIUrl":"https://doi.org/10.1002/joa3.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure with dyssynchrony. However, one-third of patients do not respond positively to it. Recently, multipoint pacing (MPP), which involves pacing from two sites on the left ventricle, has been found to improve symptoms and hemodynamics compared to conventional CRT. An automatic fused atrioventricular (AV) delay that performs fused pacing for intrinsic conduction has also been introduced. However, the combined effect of MPP and fused AV delay on acute hemodynamics is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the acute hemodynamic effects of MPP and fused AV delay in patients undergoing CRT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pressure wire was delivered to the left ventricle, and dp/dt was compared with single atrial stimulation pacing in 52 patients with various pacing configurations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Delta dp/dt was greater in MPP than in conventional CRT (10.5 ± 1.0% vs. 8.2 ± 1.0%, <i>p</i> &lt; 0.001) and in fused AV delay than in short AV delay (10.4 ± 0.8% vs. 8.3 ± 1.1, <i>p</i> &lt; 0.001). Hemodynamic parameters significantly most improved with the combination of MPP and fused AV delay. Delta dp/dt was greater in LV pacing than in biventricular (BiV) pacing with MPP and fused AV delay; however, the delta QRS duration was shorter in LV pacing than in BiV pacing. Delta dp/dt and delta QRS duration were negatively correlated. The super-responder rate was 66%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Combining MPP and fused AV delay has an additional effect. Shortening the QRS duration can increase the dp/dt, but the estimated line differs between LV and BiV pacing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938718","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":"Long-term of epicardial radiofrequency ablation and benefit for recurrent ventricular arrhythmia in Brugada syndrome: A systematic review and meta-analysis","authors":"Arga Setyo Adji,&nbsp;Atiyatum Billah,&nbsp;Juliardi Eka Putra Sit,&nbsp;Bryan Gervais de Liyis,&nbsp;Angga Nugraha,&nbsp;Angela Puspita,&nbsp;Abdillah Maulana Satrioaji,&nbsp;Ragil Nur Rosyadi","doi":"10.1002/joa3.70073","DOIUrl":"https://doi.org/10.1002/joa3.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Brugada syndrome (BrS) is a rare cardiac channelopathy linked to an increased risk of ventricular arrhythmias (VA) and sudden cardiac death. Radiofrequency ablation (RFA), particularly epicardial ablation, is recommended for BrS patients with recurrent VA unresponsive to conventional treatments like implantable cardioverter-defibrillators (ICD) and quinidine. This study aims to evaluate the long-term efficacy of epicardial RFA in preventing VA recurrence in BrS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, ScienceDirect, Cochrane Library, and ProQuest databases was conducted following PRISMA 2020 guidelines. Studies on RFA for VA in BrS were included. Primary outcomes were VA recurrence and all-cause mortality. Statistical analysis was performed using Review Manager 5.4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Epicardial, endocardial, and combined ablation strategies effectively reduced VA recurrence, decreased ICD shocks, and improved clinical outcomes in BrS. Epicardial ablation RFA near coronary arteries showed a notable reduction in VA recurrence, while endocardial ablation remained a viable alternative. Meta-analysis revealed a significant reduction in VA recurrence (RR 0.17; 95% CI 0.07–0.43; <i>p</i> &lt; .0001) and ICD shocks (RR 0.13; 95% CI 0.04–0.44; <i>p</i> = .001). Subgroup analysis suggested greater VA reduction with epicardial ablation, though without statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Epicardial RFA is associated with a significant reduction in recurrent VAs (83%) and ICD shock rates (87%) in patients with BrS. The procedure demonstrates a favorable long-term safety profile, with no mortality reported in the included studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919584","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}