Journal of Arrhythmia最新文献

{"title":"Editorial to “Utilizing the lid of SL sheath packaging for a water seal catheter insertion technique”","authors":"Yasushi Oginosawa MD, PhD","doi":"10.1002/joa3.70035","DOIUrl":"https://doi.org/10.1002/joa3.70035","url":null,"abstract":"<p>Many studies have demonstrated the usefulness of catheter pulmonary vein isolation for atrial fibrillation (AF), and it has become a common and widely performed procedure. On the other hand, we still do not fully understand the pathogenesis of AF; therefore, we cannot guarantee that ablation will cure AF for a lifetime. Furthermore, AF itself is generally not an immediate life-threatening or fatal emergency, and there are alternative treatments, such as drug therapy. Thus, catheter ablation for AF should be performed on a “safety-first” basis.</p><p>AF ablation has a variety of complications, ranging from minor to fatal. Air embolism due to air withdrawal through introducer sheaths is a potentially serious complication.<span><sup>1</sup></span> It is mainly caused by air entering the sheath during the insertion or replacement of a catheter under conditions of negative intrathoracic pressure. In fact, Tsukahara et al. experimentally verified that the amount of air drawn into a cryoballoon sheath during catheter insertion varies depending on the degree of negative pressure and the type of catheter being inserted, and we concluded that careful attention should be taken in situations of negative intrathoracic pressure and that the insertion of mapping catheters, especially those that are not recommended for use in cryoballoon sheaths, should be avoided.<span><sup>2</sup></span></p><p>In Japan, AF ablation is rarely performed under general anesthesia with complete respiratory control. It is often performed under deep sedation with or without airway insertion, bi-level positive airway pressure (BiPAP), or automatic servo ventilation (ASV). However, Ikoma et al. reported in a retrospective analysis of 381 patients who underwent respiratory management using deep-sedation ASVs that negative left atrial pressure averaged −10.1 mmHg in 34.9% of patients.<span><sup>3</sup></span> They concluded that negative left atrial pressure is not rare even with ASVs, so great caution should be exercised.</p><p>On the other hand, the “water seal” method, in which the sheath and catheter are submerged under water during the insertion of the catheter into the sheath, can theoretically completely prevent air retraction during sheath insertion regardless of left atrial pressure. A dedicated container for the water seal technique is already commercially available; however, this method is not widespread enough due to a lack of awareness, limited distribution, and its cost.</p><p>This time, Hayashi et al. reported a method of water sealing by using the shape of the Schwarz sheath package, which is commonly used for ablation, as a water bath.<span><sup>4</sup></span> This method is feasible in all hospitals that commonly use Schwartz sheaths and should be considered to prevent unexpected air embolism, especially in patients suspected of having negative pressure in the left atrium due to respiratory issues.</p><p>Hippocrates once said, “First, do no harm” (<i>Primum non nocer","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581871","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":"Impact of intracardiac pattern matching settings on the activation map of accessory pathways using open-window mapping","authors":"Tomoyoshi Morioku,&nbsp;Yasuyuki Egami MD,&nbsp;Yasuharu Matsunaga-Lee MD,&nbsp;Masamichi Yano MD, PhD,&nbsp;Masami Nishino MD, PhD, FACC, FESC","doi":"10.1002/joa3.70036","DOIUrl":"https://doi.org/10.1002/joa3.70036","url":null,"abstract":"<p>This case report demonstrates that the ICPM-A/V setting in open window mapping reduces misannotations and improves mapping accuracy for accessory pathways.\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":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581870","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 critical analysis of online patient-directed resources on catheter ablation for ventricular arrhythmias","authors":"Ashish Sood MBBS,&nbsp;Yu J. Hui BSc/MD,&nbsp;Samual Turnbull BSc,&nbsp;Kasun De Silva MBBS,&nbsp;Ashwin Bhaskaran MBBS, MSc (Int Med),&nbsp;Timothy G. Campbell BSc, PhD,&nbsp;Richard G. Bennett BSc, MBChB, PhD,&nbsp;Mary S. Wong BSc, PhD,&nbsp;Saurabh Kumar MBBS, PhD","doi":"10.1002/joa3.70026","DOIUrl":"https://doi.org/10.1002/joa3.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients search online content to improve their understanding of medical procedures. The quality of online patient education materials (OPEMs) on catheter ablation of ventricular arrhythmias (VAs) requires investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Six predetermined search terms relating to VA ablation were used to search Google, Bing and Yahoo for written OPEMs, and YouTube for video OPEMs. Written OPEMs were assessed for readability using five readability indices to produce a required reading grade level, and quality using the DISCERN and Journal of the American Medical Association (JAMA) instruments. Video OPEMs were assessed for quality according to compliance with a list of investigator-developed essential discussion points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1200 written and 480 videos were identified using the search strategy, of which 60 and 25 respectively were unique OPEMs included in this study. The mean reading grade level for written OPEMs was 11.3 ± 1.9, with no articles being written at the 6th grade level recommended by the American Medical Association. Using quality metrics, only 26.7% of written OPEMs attained a ‘high-quality’ JAMA rating, and 30% had a DISCERN score of ‘good’ or better. Video OPEMs similarly had poor quality, only discussing a mean of 3.50 ± 2.57 out of 18 total essential criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a paucity of online patient-directed materials on VA catheter ablation. Available OPEMs are of insufficient quality to adequately convey essential information, and written OPEMs are written at a level higher than the recommended reading level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564915","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":"Usefulness of the ripple map and late annotation mapping to visualize an activation pattern within Koch's triangle in a patient with persistent left superior vena cava","authors":"Takashi Kanda MD,&nbsp;Hitoshi Minamiguchi MD,&nbsp;Riku Iwami MT,&nbsp;Osamu Iida MD, PhD,&nbsp;Yoshiharu Higuchi MD, PhD","doi":"10.1002/joa3.70030","DOIUrl":"https://doi.org/10.1002/joa3.70030","url":null,"abstract":"<p>High-resolution mapping with Ripple and LAM modules enabled precise identification of slow pathway ablation targets in a PLSVC patient. This novel approach overcame anatomical challenges, offering a more effective strategy for AVNRT treatment in complex cases.\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":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533395","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 “Can lead damage be ruled out using defibrillation threshold testing in patients with very high-impedance shock leads?”","authors":"Yoshinari Enomoto MD, PhD","doi":"10.1002/joa3.70032","DOIUrl":"https://doi.org/10.1002/joa3.70032","url":null,"abstract":"&lt;p&gt;Implantable cardioverter defibrillators (ICDs) have been shown to reduce overall mortality in both the primary and secondary prevention of sudden cardiac death. However, lead failure remains the Achilles' heel of this therapy. Defibrillation threshold (DFT) testing was historically used to assess device function, including lead integrity, and to confirm device settings, such as sensing functionality. In recent years, however, DFT testing has become less commonly performed because of its procedural risks and limited impact on clinical outcomes.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Narita et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provide valuable insights into the management of high shock impedance in transvenous ICD leads. Clinically, a shock impedance exceeding 200 Ω often raises concerns about lead failure, prompting consideration of lead replacement or additional lead implantation. However, this study revisits an older yet underutilized approach by employing DFT testing to evaluate true shock impedance (TSI). The authors demonstrate that DFT testing confirmed preserved lead functionality in patients with high shock impedance, thereby avoiding unnecessary lead replacement. Shock impedance in ICD leads can be measured using two methods: high-voltage shock impedance (HVSI), which involves delivering a high-energy shock, and low-voltage subthreshold measurement (LVSM), which uses low-energy pulses to approximate TSI. While HVSI is considered more accurate, its invasive nature and associated risks limit its application, particularly in high-risk populations such as elderly patients or those with significant comorbidities. For patients with anatomical challenges, such as a persistent left superior vena cava (PLSVC), lead extraction or additional lead implantation carries significant procedural risks. By utilizing DFT testing to evaluate true shock impedance, Narita et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; propose a less invasive approach, which is particularly relevant in real-world clinical scenarios where minimizing procedural risks is critical.&lt;/p&gt;&lt;p&gt;The frequency of ICD lead failure varies widely depending on lead type, patient characteristics, and follow-up duration. According to previous reports, the annual electrical failure rate for non-recalled ICD leads is approximately 0.6%.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In contrast, certain recalled lead models have reported annual failure rates ranging from 2.6% to 4.8%.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Moreover, a large longitudinal study reported that the 5-year and 8-year lead survival rates were 85% and 60%, respectively, with the annual failure rate increasing significantly over time, reaching as high as 20% per year after 10 years.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; These findings underscore the progressive nature of ICD lead failure and the importance of long-term follow-up. One of the key indicators of ICD lead failure is an increase in shock impedance. Regular in-person device interrogation and remote monitoring a","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554699","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":"Naomi Hirota MD, PhD,&nbsp;Shinya Suzuki MD, PhD,&nbsp;Takuto Arita MD,&nbsp;Naoharu Yagi MD,&nbsp;Mikio Kishi MD,&nbsp;Hiroaki Semba MD, PhD,&nbsp;Hiroto Kano MD,&nbsp;Shunsuke Matsuno MD,&nbsp;Yuko Kato MD, PhD,&nbsp;Takayuki Otsuka MD, PhD,&nbsp;Junji Yajima MD, PhD,&nbsp;Tokuhisa Uejima MD, PhD,&nbsp;Yuji Oikawa MD, PhD,&nbsp;Takeshi Yamashita MD, PhD","doi":"10.1002/joa3.70031","DOIUrl":"https://doi.org/10.1002/joa3.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The efficacy of artificial intelligence (AI)-enhanced electrocardiography (ECG) for detecting hypertrophic cardiomyopathy (HCM) and its dilated phase (dHCM) has been developed, though specific ECG characteristics associated with these conditions remain insufficiently characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 19,170 patients, with 140 HCM or dHCM cases, from the Shinken Database (2010–2017). The 140 cases (HCM-total) were categorized into basal-only HCM (HCM-basal, <i>n</i> = 75), apical involvement (HCM-apical, <i>n</i> = 46), and dHCM (<i>n</i> = 19). We analyzed 438 ECG parameters across the P-wave (110), QRS complex (194), and ST-T segment (134). High parameter importance (HPI) was defined as 1/<i>p</i> &gt; 10⁴ in univariate logistic regression, while multivariate logistic regression was used to determine the area under the receiver operating characteristic curves (AUROC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In HCM-basal and HCM-apical, HPI was predominantly observed in the ST-T segment (49% and 51%, respectively), followed by the QRS complex (29% and 27%). For dHCM, HPI was lower in the ST-T segment (16%) and QRS complex (22%). The P-wave had low HPI across all subtypes. AUROCs for models with total ECG parameters were 0.925 for HCM-basal, 0.981 for HCM-apical, and 0.969 for dHCM. While AUROCs for the top 10 HPI models were lower than the total ECG parameter model for HCM total, they were comparable across HCM subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As HCM progresses to dHCM, a shift in HPI from the ST-T segment to the QRS complex provides clinically relevant insights. For HCM subtypes, the top 10 ECG parameters yield predictive performance similar to the full parameter set, supporting efficient approaches for AI-based diagnostic models.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533310","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 “Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block”","authors":"Takashi Noda MD, PhD","doi":"10.1002/joa3.70029","DOIUrl":"https://doi.org/10.1002/joa3.70029","url":null,"abstract":"&lt;p&gt;Pacemaker implantation with right ventricular pacing is widely used in clinical practice in the treatment of bradycardia, especially in patients with symptomatic AV block. However, right ventricular apical pacing (RVAP) sometimes induces electromechanical dyssynchrony, leading to adverse clinical impacts on clinical outcomes, including an increased risk of new-onset atrial arrhythmias. Physiological conduction system pacing (CSP), His bundle pacing (HBP), and left bundle area pacing (LBBAP) are recommended for patients with reduced left ventricular (LV) systolic function and substantial ventricular pacing (&gt;20%) since CSP has been reported to improve clinical outcomes compared with RVAP. Although several studies suggest that CSP is associated with a lower incidence of new-onset atrial arrhythmias detected as atrial high-rate episodes (AHRE), the performance between HBP pacing and LBBAP on the risk of new-onset AHRE remains unclear.&lt;/p&gt;&lt;p&gt;Pestrea et al. showed that 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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They compared the incidence of device-detected new-onset AHRE between the two groups of patients after HBP (&lt;i&gt;n&lt;/i&gt; = 59) and those after LBBAP (&lt;i&gt;n&lt;/i&gt; = 83) during a mean follow-up of 624 days. New-onset AHRE occurred in 8 (13.5%) in the HBP group and in 14 (16.8%) in the LBBAP group. Multivariable Cox regression analysis showed that HBP and LBBAP had similar predictive values for device-detected new-onset AHRE. Moreover, there was no significant difference between the two groups regarding the total burden of AHRE, which was less than 1% in almost all patients with new-onset AHRE, although there were several limitations such as using different criteria of the current 2020 ESC guideline, which indicated the device-programmed rate criterion for AHRE is greater than or equal to 175 bpm and the duration criterion is greater than or equal to 5 min.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Cardiac electronic implantable devices such as pacemakers have the ability to monitor rhythm abnormalities, which allow us to recognize a new entity of AHRE easily. From a clinical point of view, AHRE has been associated with the development of clinical atrial fibrillation (AF) and an increase in stroke and death risk. There have been reports about the risk factors for AHRE including older age, left atrial volume, prior history of AF, white cell count, high levels of C reactive protein, and CHADS2 score.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; As for the issue related to new-onset AHRE after implantation, a high burden of RVAP is a risk for increased AHRE since RVAP induces paradoxical septal motion and ventricular dyssynchrony. As a result, increased filling pressure in each heart chamber leads to electric remodeling of the left atrium. CSP restores ventricular contraction synchrony by pacing the His-Purkinje conduction system dire","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481513","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 “Utilizing the lid of SL sheath packaging for a water seal catheter insertion technique”","authors":"Mitsuru Takami MD, PhD,&nbsp;Kimitake Imamura MD, PhD,&nbsp;Koji Fukuzawa MD, PhD","doi":"10.1002/joa3.70028","DOIUrl":"https://doi.org/10.1002/joa3.70028","url":null,"abstract":"&lt;p&gt;Radiofrequency ablation, cryoballoon, hot balloon, laser balloon ablation, and, more recently, pulsed field ablation have been developed to improve the efficacy, shorten the procedure time, and enhance the safety. However, all ablation devices follow the same process: they are inserted from outside the body, where air is present, into blood vessels and the heart, where no air exists. This always carries the risk of air bubble intrusion. Newer ablation devices, like balloon-based and pulsed field ablation devices, require larger sheaths and complex catheter shapes, increasing the risk of air bubble intrusion. To minimize the risk of this iatrogenic complication, ablation procedures must be performed with the utmost care and attention.&lt;/p&gt;&lt;p&gt;In this article, Hayashi et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported a novel method to prevent air bubble intrusion. They focused on the packaging of the SL sheath (Swartz™ Braided Transseptal Guiding Introducers SL Series, Abbott, Minneapolis, MN, USA) and demonstrated that by cutting a portion of the lid and filling it with water, an air seal can be created when inserting the catheter into the sheath. They also presented a video demonstrating this method, showing that the catheter can be inserted while keeping the sheath's entry completely submerged in water. According to the image, a slight bend may be necessary to fully submerge the sheath insertion site. However, they reported that the sheath tip remained stable in the left atrium, and after over 500 cases without any complications, they consider the technique highly safe.&lt;/p&gt;&lt;p&gt;The size and number of air bubbles responsible for symptomatic or asymptomatic embolisms in humans remain uncertain. However, larger air bubbles can significantly impact the cerebral and systemic circulation. For instance, the mean diameter of the proximal segment of the cerebral posterior communicating artery is 1.4 ± 0.5 mm. Larger air bubbles could obstruct these vessels, potentially leading to a cerebral infarction. Previously, we conducted an ex vivo study to identify the stages of catheter ablation most prone to air intrusion.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Our findings indicated that massive and large (≥1.5 mm) air intrusion was most likely to occur when inserting a complex-shaped catheter into the sheath under negative pressure in the left atrium (LA) using an inserter. In humans, the LA pressure is usually positive; however, studies have shown that negative pressure can develop in the LA (Inspiratory mean LA pressure: −3.1 ± 9.3 mmHg) during snoring caused by sedation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; At that moment, catheter insertion into the sheath poses the highest risk of a massive air intrusion. Hayashi et al.'s method provides a simple technique with the potential to reduce air intrusion at this critical moment.&lt;/p&gt;&lt;p&gt;Another notable aspect of their method is the use of the plastic tray from the SL sheath packaging, which is usually discarded. Their strong desire to improve the s","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481514","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":"Number needed to treat for net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation","authors":"Rungroj Krittayaphong MD,&nbsp;Satchana Pumprueg MD,&nbsp;Ahthit Yindeengam BSc,&nbsp;Gregory Y. H. Lip MD","doi":"10.1002/joa3.70023","DOIUrl":"https://doi.org/10.1002/joa3.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) &lt; and ≥65%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet −37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423628","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":"Single snare pushing technique: A new bailout technique for retrieving Micra fixed in the tricuspid valve annulus","authors":"Keisuke Kojima MD,&nbsp;Atsushi Tanaka MD, PhD,&nbsp;Nozomi Kitade MD,&nbsp;Hiroshi Ikuta MD,&nbsp;Junichiro Nishi MD, PhD","doi":"10.1002/joa3.70027","DOIUrl":"https://doi.org/10.1002/joa3.70027","url":null,"abstract":"<p>When we recapture the Micra system, we capture the body by pulling the tether attached to the delivery catheter and retrieve it, but sometimes it is difficult, and the Micra is dislodged and fixed in the tricuspid valve annulus. Using a single snare catheter from the superior vena cava and pushing the tines changes the orientation of the device and enables recapture.\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":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423627","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}