Journal of Arrhythmia最新文献

{"title":"Electrocardiographic parameter profiles for differentiating hypertrophic cardiomyopathy stages","authors":"Muhammad Shaheer Bin Faheem MBBS, Nisha Khatri MBBS, Shamikha Cheema MBBS, Muhammad Rehan Zahid MBBS, Sumaya Samadi MBBS","doi":"10.1002/joa3.70086","DOIUrl":"https://doi.org/10.1002/joa3.70086","url":null,"abstract":"<p>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.<span><sup>1</sup></span> While providing valuable insights, it is important to acknowledge specific concerns that merit our attention.</p><p>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.<span><sup>2</sup></span> 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.<span><sup>3</sup></span> 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.</p><p>Because of ethnic and demographic variations, different genetic predispositions to HCM, and significant disparities in healthcare access, these findings may not be widely applicable,<span><sup>4</sup></span> 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.<span><sup>5</sup></span></p><p>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}

{"title":"The “16-gram window” of contact-force: A new criterion for very high-power short-duration ablation","authors":"Dimitrios Bismpos MD,&nbsp;Jan Wintrich MD,&nbsp;Valerie Pavlicek MD,&nbsp;Raphael Spittler MD, MSc,&nbsp;Alexander P. Benz MD,&nbsp;Michael Böhm MD,&nbsp;German Fernandez Ferro MD,&nbsp;Felix Mahfoud MD, MA,&nbsp;Thomas Rostock MD,&nbsp;Christian Ukena MD, MA","doi":"10.1002/joa3.70076","DOIUrl":"https://doi.org/10.1002/joa3.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Very high-power short-duration (vHPSD) ablation with the novel QDOT™ catheter allows the regulation of target temperature by automatically adjusting flow and power during a 4 s application of 90 W. However, the optimal contact force for sufficient lesion creation is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 73 patients with symptomatic atrial fibrillation undergoing pulmonary vein isolation (PVI) using the QDOT catheter in the vHPSD mode (90 W, 4 s). Ablation metrics associated with suboptimal applications, defined as either an impedance drop of ≤5% or a cumulative temperature-limited energy ≤330 J, were collected and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 3881 vHPSD applications (53.2 applications per patient) with a mean contact force (CF) of 12.8 ± 6.6 g were analyzed. Significant CF variability and intermittent loss of contact were documented in 18.2% and 8.8% of the applications, respectively. A ΔImp ≤ 5% occurred in 3.9% of vHPSD applications, while a cumulative energy ≤ 330 J was observed in 3% of the applications. Applications with a mean CF &lt; 6 g and &gt;22 g were associated with an inadequate impedance drop (10.3%, Phi coefficient 0.118, <i>p</i> &lt; .001) and total applied energy (7.8%, Phi coefficient 0.094, <i>p</i> &lt; .001) respectively. At superior PV segments with thick atrial walls, significantly more applications with cumulative energy ≤330 J (4.2% vs. 2.5%; <i>p</i> = .007) were observed, especially when mean CF &gt; 18 g was applied (8.4%, Phi coefficient 0.093, <i>p</i> = .003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A lower but also a higher mean contact-force was associated with suboptimal vHPSD applications. Hence, a “16-gram window” of contact-force, from 6 to 22 g, could optimize energy application in vHPSD ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909437","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 insights into the role of bepridil in recurrence prevention after ablation of persistent atrial fibrillation","authors":"Moyuru Hirata MD,&nbsp;Koichi Nagashima MD, PhD,&nbsp;Ryuta Watanabe MD, PhD,&nbsp;Yuji Wakamatsu MD, PhD,&nbsp;Naoto Otsuka MD, PhD,&nbsp;Shu Hirata MD,&nbsp;Masanaru Sawada MD,&nbsp;Yuji Saito MD,&nbsp;Sayaka Kurokawa MD, PhD,&nbsp;Kenta Murotani MD, PhD,&nbsp;Yasuo Okumura MD, PhD","doi":"10.1002/joa3.70083","DOIUrl":"https://doi.org/10.1002/joa3.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of bepridil in preventing atrial fibrillation (AF) recurrence following ablation for persistent atrial fibrillation (PerAF) remains uncertain, particularly in patients with severe atrial substrates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 232 consecutive PerAF patients who underwent AF ablation between 2014 and 2019. Among them, 162 received bepridil for 3 months post-ablation (Bepridil group), while 70 received no antiarrhythmic drugs (No-AADs group). Baseline characteristics, procedural details, and outcomes were compared. Kaplan–Meier analysis and Cox regression models were used to evaluate AF/atrial tachycardia (AT) recurrence, with bepridil use treated as a time-dependent covariable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Bepridil group had a higher body mass index (25.1 ± 3.7 vs. 23.8 ± 3.9), a higher prevalence of patients with a LAD &gt;40 mm and a LAV &gt;50 mL (67.9% vs. 47.1%, 64.2% vs. 48.5%, respectively), and lower left atrial appendage flow velocity (37.6 ± 15.0 vs. 42.7 ± 20.5 cm/min). They more frequently underwent intracardiac atrial cardioversion (61.7% vs. 40.0%) and additional extra-pulmonary vein ablation (35.2% vs. 15.7%), but were less likely to receive balloon-based ablation (39.5% vs. 62.9%) (<i>p</i> &lt; 0.05 for all comparison). During a median follow-up of 23.3 months, AF/AT-free survival at 2 years was comparable between the Bepridil and No-AADs groups (80.4% vs. 81.7%; <i>p</i> = 0.61). This finding remained consistent after adjusting for baseline characteristics and considering bepridil as a time-dependent covariable. No bepridil-related adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bepridil may have a limited role in preventing AF/AT recurrence in PerAF patients, particularly those with severe atrial substrates. However, its overall impact appears to be small, warranting further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905337","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":"Author's reply to the letter entitled “Critique of omnipolar mapping claims in superior vena cava isolation: A call for standardization”","authors":"Naoto Oguri MD,&nbsp;Yousaku Okubo MD, PhD,&nbsp;Takehito Tokuyama MD, PhD,&nbsp;Noboru Oda MD, PhD,&nbsp;Yukiko Nakano MD, PhD","doi":"10.1002/joa3.70082","DOIUrl":"https://doi.org/10.1002/joa3.70082","url":null,"abstract":"&lt;p&gt;We appreciate the insightful critique by Khawar et al. regarding our study, “Novel Omnipolar Mapping Technology for Effective Superior Vena Cava Isolation: A Randomized Clinical Trial.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Their engagement in this discourse underscores the importance of methodological rigor and transparency in the advancement of electrophysiology.&lt;/p&gt;&lt;p&gt;Regarding the concerns raised about procedural criteria and the relevance of reduced radiofrequency (RF) applications, our study followed a standardized protocol informed by previous literature and clinical experience. Although we acknowledge that the number of RF applications in our study may appear higher than some historical averages, as discussed in our original manuscript, the use of circumferential isolation—as opposed to a selective point-by-point ablation strategy targeting sequential ablation of fast potential sites in the superior vena cava (SVC)—likely contributed to the observed differences in RF application numbers and overall procedure times. Previous studies using high-density mapping for SVC isolation have reported that successful isolation requires an average of 10–15 RF applications.&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt; Our findings are consistent with these reported values.&lt;/p&gt;&lt;p&gt;Operator variability is indeed a critical factor in electrophysiological studies. In this study, all procedures were performed by four experienced electrophysiologists, and the cases were evenly distributed among the operators across the groups. In the omnipolar mapping technology (OT) group, operators A, B, C, and D performed 4, 9, 7, and 5 cases, respectively. In the conventional method (CM) group, operators A, B, C, and D performed 8, 9, 5, and 3 cases, respectively. Accordingly, no significant difference was found in the distribution of cases performed (&lt;i&gt;p&lt;/i&gt; = .54). Although this study is a randomized controlled trial, it is an open-label study; thus, the possibility of bias due to unboundedness cannot be excluded.&lt;/p&gt;&lt;p&gt;In terms of sinoatrial node (SN) localization, we acknowledge that external validation is lacking. As noted, this study did not include a formal validation method or employ additional modalities to confirm the SN location. Therefore, although our observations suggest that OT can help identify the SN in cases in which bipolar mapping fails, any potential advantage of OT remains speculative without standardized or external validation.&lt;/p&gt;&lt;p&gt;In this study, the color contour was configured to display 15 distinct colors, each representing a 10 ms interval, to enhance the delineation of the right atrium (RA)–SVC conduction block line. Despite the relatively high number of color bands, the conduction block line was still defined based on an activation delay of ≥30 ms, which is consistent with the criteria used in previous studies.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Thus, although the original method was used, the fundamental definition of the conduction block remains unchanged.&lt;/p&gt;&lt;p&gt;We appreciate","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888987","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":"Characteristics of atrioventricular block during slow pathway ablation for atrioventricular nodal re-entrant tachycardia: A comparative study of cryoablation and radiofrequency ablation","authors":"Shinichi Tachibana MD,&nbsp;Tetsuya Asakawa MD,&nbsp;Yuichiro Sagawa MD,&nbsp;Manabu Kurabayashi MD,&nbsp;Kazuya Nakagawa MD,&nbsp;Kaoru Okishige MD,&nbsp;Shinsuke Miyazaki MD,&nbsp;Tetsuo Sasano MD,&nbsp;Yasuteru Yamauchi MD","doi":"10.1002/joa3.70072","DOIUrl":"https://doi.org/10.1002/joa3.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Slow-pathway ablation with cryoablation is a useful tool for treating atrioventricular nodal re-entrant tachycardia (AVNRT). However, reports on the characteristics of atrioventricular block (AVB) during cryoablation are limited. Therefore, we investigated the differences in the appearance of AVB between cryoablation and radiofrequency ablation (RFA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This dual-center retrospective study included 341 patients who underwent slow-pathway ablation of AVNRT using cryoablation or RFA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 137 patients underwent cryoablation (CRYO group, <i>n</i> = 137), and 204 underwent RFA (RF group, <i>n</i> = 204). Transient AVB during slow-pathway ablation occurred in 33 patients (24.1%) in the CRYO group and 13 patients (6.4%) in the RF group. The time from the beginning of the P-R interval prolongation to the occurrence of second- or third-degree AVB was significantly longer in the CRYO group (6.6 ± 3.7 s) compared to the RF group (1.2 ± 0.3 s, <i>p</i> &lt; 0.01). Three patients in the RF group developed complete AVB requiring pacemaker implantation, whereas none of the patients in the CRYO group developed permanent AVB. After a median follow-up of 221 ± 186 days, AVNRT recurred in 13 patients (9.5%) in the CRYO group and in 7 patients (3.4%) in the RF group (<i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cryoablation gradually induces atrioventricular conduction disturbances when AVB occurs inadvertently, taking longer than RFA. Compared to RFA, cryoablation has a relatively high incidence of transient AVB during slow-pathway ablation but does not result in permanent AVB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888991","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":"Lower loop re-entrant flutter","authors":"Anish Bhargav MD, DM, DNB,&nbsp;Ramanathan Velayutham MD, DM,&nbsp;Raja J. Selvaraj MD, DNB, FCE","doi":"10.1002/joa3.70081","DOIUrl":"https://doi.org/10.1002/joa3.70081","url":null,"abstract":"<p>An elderly man with a history of a prior inferior wall myocardial infarction underwent ablation for an atypical right atrial flutter. Electroanatomic mapping revealed diffuse scarring on the anterior, anterolateral, and posterior right atrium, presumably due to atrial infarction from the prior inferior wall myocardial infarction, forcing the activation wavefront through an area of slow conduction across the lower end of the crista terminalis, leading to lower loop reentry in a counterclockwise fashion around the inferior vena cava and a 12-lead ECG showing positive flutter waves in the inferior leads reflecting septal activation in a cranio-caudal direction.\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":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888986","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":"Prediction of difficulty in cryoballoon ablation with a three-dimensional deep learning model using polygonal mesh representation","authors":"Kazutaka Nakasone MD, PhD,&nbsp;Makoto Nishimori MD, PhD,&nbsp;Masakazu Shinohara MD, PhD,&nbsp;Kunihiko Kiuchi MD, PhD,&nbsp;Mitsuru Takami MD, PhD,&nbsp;Kimitake Imamura MD, PhD,&nbsp;Yu Izawa MD, PhD,&nbsp;Toshihiro Nakamura MD, PhD,&nbsp;Yusuke Sonoda MD, PhD,&nbsp;Hiroyuki Takahara MD, PhD,&nbsp;Kyoko Yamamoto MD, PhD,&nbsp;Yuya Suzuki MD, PhD,&nbsp;Kenichi Tani MD,&nbsp;Hidehiro Iwai MD,&nbsp;Yusuke Nakanishi MD,&nbsp;Ken-ichi Hirata MD, PhD,&nbsp;Koji Fukuzawa MD, PhD","doi":"10.1002/joa3.70078","DOIUrl":"https://doi.org/10.1002/joa3.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cryoballoon ablation (CBA) is useful for pulmonary vein (PV) isolation. However, some cases are challenging, requiring multiple applications and/or touch-up ablations. Although several predictors of CBA difficulty have been reported, none have assessed the spatial location and morphology of the left atrium and PVs. This study aimed to develop a three-dimensional (3D) deep learning (DL) model to predict CBA difficulty and compare its accuracy with conventional manual measurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 28-mm cryoballoon (Arctic Front Advance, Medtronic) was used in all cases. CBA difficulty was defined as requiring touch-up ablation and/or more than three applications per PV. We developed a DL model that can learn polygonal meshes and predict CBA difficulty. In the conventional method, predictors included a thinner left lateral ridge, higher left superior PV (LSPV) ovality index, longer LSPV ostium-bifurcation distance, and shorter right inferior PV ostium-bifurcation distance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 189 patients who underwent CBA for drug-resistant atrial fibrillation between January 2015 and January 2022 were included. The DL model was superior to the conventional method in accuracy (0.793 vs. 0.630, <i>p</i> = .042) and specificity (0.796 vs. 0.609, <i>p</i> = .022), with the AUC-ROC of 0.821.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed a 3D DL model that can detect CBA difficulty using a polygonal mesh representation. By predicting difficult cases in advance, strategies can be developed to increase success rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of difficult removal of lumen-less lead inserted near the tricuspid valve","authors":"Shogo Sakamoto MD, PhD,&nbsp;Kenji Baba MD,&nbsp;Moritoshi Irishio MD,&nbsp;Toru Kataoka MD, PhD,&nbsp;Daiju Fukuda MD, PhD","doi":"10.1002/joa3.70080","DOIUrl":"https://doi.org/10.1002/joa3.70080","url":null,"abstract":"<p>Learning Objectives: (1) Excessive rotation of a lumen-less lead near the tricuspid valve leaflet can complicate its removal. (2) A laser sheath can be used to extract a lumen-less lead entrapped within a tricuspid valve leaflet.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}