Journal of Arrhythmia最新文献

{"title":"Editorial to “Long-term outcomes of ventricular tachycardia ablation in repaired tetralogy of Fallot: systematic review and meta-analysis”","authors":"Taisuke Nabeshima MD, Naokata Sumitomo MD, PhD","doi":"10.1002/joa3.13127","DOIUrl":"https://doi.org/10.1002/joa3.13127","url":null,"abstract":"<p>Today, most repaired tetralogy of Fallot (rTOF) patients survive to adulthood because of advances in medical and surgical treatments. As survival rates improve, however, long-term complications such as VT remain significant challenges. A report described ventricular arrhythmia occurring in 44% of postrepair patients, noting that a higher age at repair correlated with an increased incidence of life-threatening events, mostly because of sustained VT. Risk stratification and effective methods of catheter ablation (CA) for VT to prevent further recurrence are the major clinical demands to which Jagannatha et al. tried to answer in this report.<span><sup>1</sup></span>\u0000 </p><p>In their work, first, Jagannatha et al. analyzed risk factors for VT in rTOF patients.<span><sup>1</sup></span> According to the AHA guideline, risk factors for SCD include LV systolic or diastolic dysfunction, nonsustained VT, QRS duration >180 ms, extensive RV scarring, and inducible sustained VT at electrophysiologic study (EPS).<span><sup>2</sup></span> Primary prevention ICD therapy is recommended for rTOF patients with multiple risk factors for SCD (class IIa), but CA for these patients is not mentioned.<span><sup>2</sup></span> According to the JCS guideline, CA is recommended only for patients weighing more than 15 kg when medication therapy has failed (class IIa).<span><sup>3</sup></span> The recommendation level for CA is not high because its efficacy has not been proven in this population so far.</p><p>On the contrary, favorable opinions of CA for patients with ischemic heart disease are growing nowadays. Comparison of CA versus antiarrhythmic drugs (AAD) after ICD therapy for ischemic cardiomyopathy is being addressed in two trials: the ongoing VANISH2 and the recently published SURVIVE-VT trial. In the latter, substrate-based CA reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization because of heart failure, or severe treatment-related complications compared with AAD therapy. These favorable outcomes are mainly because of the technological advancements in the electroanatomical mapping system (3D-EAM) and our deepened understanding of the relationship between the myocardial substrate and the mechanism of clinical VT. Among several findings indicating the location of critical isthmus based on substrate mapping, a slow-conducting anatomical isthmus (SC-AI) is one of the most promising indicators. Kapel et al. established a threshold of <0.5 m/s for the identification of most induced VT circuits, achieving 93% sensitivity and 100% specificity, thereby becoming the gold standard for SC-AI identification.<span><sup>4</sup></span>\u0000 </p><p>In the study by Jagannatha et al., the presence of SC-AI was added to the risk factors for SCD in rTOF patients. More importantly, the study demonstrated the efficacy of VT ablation in rTOF patients, particularly when based on SC-AI. According to their report, the prev","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1169-1170"},"PeriodicalIF":2.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435064","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":"Pacing inhibition from inter-coronary wire interaction during angioplasty","authors":"Jayant Kakarla MBBS,&nbsp;Chloe Nettlefold MBBS,&nbsp;Criselda Manahan CCDS,&nbsp;Vlad Džavík MD,&nbsp;Krishnakumar Nair MD","doi":"10.1002/joa3.13125","DOIUrl":"https://doi.org/10.1002/joa3.13125","url":null,"abstract":"<p>Electro-mechanical noise from the interaction of multiple coronary wires can inhibit pacing with a risk of asystole in pacemaker-dependent patients. Awareness of this phenomenon is important to guide prompt management with adjustment of device sensitivity, asynchronous pacing, removal of a coronary wire or insertion of a temporary pacing system.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1210-1213"},"PeriodicalIF":2.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435149","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":"Increased interleukin-6 levels are associated with atrioventricular conduction delay in severe COVID-19 patients","authors":"Riccardo Accioli MD,&nbsp;Pietro Enea Lazzerini MD,&nbsp;Viola Salvini MD,&nbsp;Alessandra Cartocci PhD,&nbsp;Decoroso Verrengia MD,&nbsp;Tommaso Marzotti MD,&nbsp;Fabio Salvadori MD,&nbsp;Stefania Bisogno MD,&nbsp;Gabriele Cevenini BioEng,&nbsp;Michele Voglino MD,&nbsp;Severino Gallo MD,&nbsp;Sabrina Pacini MD,&nbsp;Martina Pazzaglia MD,&nbsp;Angelica Tansini MD,&nbsp;Ambra Otranto MD,&nbsp;Franco Laghi-Pasini MD,&nbsp;Maurizio Acampa MD,&nbsp;Mohamed Boutjdir PhD,&nbsp;Pier Leopoldo Capecchi MD","doi":"10.1002/joa3.13114","DOIUrl":"https://doi.org/10.1002/joa3.13114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Severely ill patients with coronavirus disease 2019 (COVID-19) show an increased risk of new-onset atrioventricular blocks (AVBs), associated with high rates of short-term mortality. Recent data suggest that the uncontrolled inflammatory activation observed in these patients, specifically interleukin (IL)-6 elevation, may play an important pathogenic role by directly affecting cardiac electrophysiology. The aim of our study was to assess the acute impact of IL-6 changes on electrocardiographic indices of atrioventricular conduction in severe COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated (1) the behavior of PR-interval and PR-segment in patients with severe COVID-19 during active phase and recovery, and (2) their association with circulating IL-6 levels over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During active disease, COVID-19 patients showed a significant increase of PR-interval and PR-segment. Such atrioventricular delay was transient as these parameters rapidly normalized during recovery. PR-indices significantly correlated with circulating IL-6 levels over time. All these changes and correlations persisted also in the absence of laboratory signs of cardiac strain/injury or concomitant treatment with PR-prolonging drugs, repurposed or not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study provides evidence that in patients with severe COVID-19 and high-grade systemic inflammation, IL-6 elevation is associated with a significant delay of atrioventricular conduction, independent of concomitant confounding factors. While transient, such alterations may enhance the risk of severe AVB and associated short-term mortality. Our data provide further support to current anti-inflammatory strategies for severe COVID-19, including IL-6 antagonists.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1137-1148"},"PeriodicalIF":2.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435916","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":"Isolated right atriopathy and microreentry atrial tachycardia in a young male","authors":"Dimitrios Tsiachris MD, PhD,&nbsp;Christos-Konstantinos Antoniou MD, PhD,&nbsp;Georgios Deligiannis MD,&nbsp;Christodoulos Stefanadis MD, PhD,&nbsp;Konstantinos Tsioufis MD, PhD","doi":"10.1002/joa3.13119","DOIUrl":"https://doi.org/10.1002/joa3.13119","url":null,"abstract":"<p>Atrial tachycardias in young patients may portend ominous prognosis. We present the case of a 17-year-old male with atrial tachycardia and extensive low-voltage areas in the right atrium, its treatment, and discuss potential diagnoses.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1187-1191"},"PeriodicalIF":2.2,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435783","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":"Using point-of-care ultrasound to determine incidence of deep vein thrombosis after right-sided radiofrequency catheter ablation","authors":"Reema Qayoom MBBS, FCPS Cardiology,&nbsp;Hannah S. Asghar MD,&nbsp;Irfan Amjad Lutfi MBBS, MD, Fellowship in VIR (Singapore) & Neuro Interventional (USA),&nbsp;Faisal Qadir MBBS, FCPS Medicine, FCPS Cardiology,&nbsp;Ghazala Irfan MBBS, FCPS Cardiology,&nbsp;Azam Shafquat MD","doi":"10.1002/joa3.13111","DOIUrl":"10.1002/joa3.13111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Femoral venous access is routinely used for radiofrequency catheter ablation (RFA) procedures. Deep vein thrombosis (DVT), which is often sub-clinical, is uncommon following RFCA. Point-of-care ultrasound (POCUS) is a cost-effective way to diagnose DVT. Identification of DVT incidence, especially if sub-clinical, can direct change in practice to reduce DVT and lay ground for cost-effective screening strategies postprocedures. The aim of our study is to determine the incidence of DVT after right-sided radiofrequency cardiac catheter ablation using POCUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center prospective cross-sectional study in patients undergoing right-sided RFCA. Within 24 h postprocedure, the participants underwent compression venous duplex ultrasonography using POCUS to look for evidence of DVT in cannulated limb. The contralateral limb that was not cannulated was scanned as a control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 194 patients were scanned post-right-sided RFCA procedures. Average age was 43.5 ± 13.2 years and 131 (67.5%) were women. A total of 148 (76.3%) patients underwent AVNRT ablation. Ten (5.2%) patients developed DVT, of which nine had sub-clinical DVT. Age (&gt;53 years), greater sum of sheaths used (&gt;3) and longer duration of bed rest maintained (up to 4.0 h vs. &gt;4.0 h, <i>p</i> = 0.006) were identified as risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most of the DVTs after right-sided catheter ablation are sub-clinical. Routine scanning for DVT after right-sided catheter ablation as well as reducing number of sheaths and bed rest should be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1131-1136"},"PeriodicalIF":2.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141800231","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 occlusion of the left main coronary artery following impedance rise after high-frequency catheter ablation","authors":"Takafumi Koyama MD,&nbsp;Masato Murakami MD, PhD,&nbsp;Nobuhisa Kodera MD,&nbsp;Shingo Mizuno MD,&nbsp;Shigeru Saito MD","doi":"10.1002/joa3.13123","DOIUrl":"10.1002/joa3.13123","url":null,"abstract":"<p>We present a case of catheter ablation of a premature ventricular complex complicated by left main injury. During ablation from the left coronary cusp, a sudden rise in impedance was followed by ST elevation on the ECG. Angioplasty and stenting were performed immediately; however, the stent subsequently developed repeated stenosis.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1171-1174"},"PeriodicalIF":2.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805049","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 nightmare of catheter ablation in a young male with incessant supraventricular tachycardia","authors":"Dat Cao Tran MD,&nbsp;Chin-Yu Lin MD, PhD","doi":"10.1002/joa3.13120","DOIUrl":"10.1002/joa3.13120","url":null,"abstract":"<p>A case report involving incessant multi-types of supraventricular tachycardia and acute decompensated heart failure required a rescuing electrophysiology study and ablation. Ventricular fibrillation occurred due to coronary spasm, complicating the deteriorating heart. However, aggressive therapies, including extracorporeal support and the timely elimination of the culprit accessory pathway, successfully resolved the patient's condition.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1183-1186"},"PeriodicalIF":2.2,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811907","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":"Intravenous thrombolysis following dabigatran reversal in a patient with acute embolic stroke after atrial fibrillation ablation","authors":"Yi-Sheng Chen MD,&nbsp;Chin-Yu Lin MD, PhD","doi":"10.1002/joa3.13121","DOIUrl":"10.1002/joa3.13121","url":null,"abstract":"<p>This case demonstrated the feasibility of administering emergent intravenous thrombolysis followed by Dabigatran reversal with idarucizumab in a patient who underwent atrial fibrillation ablation. The consideration of transitioning anticoagulant therapy to dabigatran for scheduled AF ablation in patients at high risk of stroke should be carefully evaluated.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1179-1182"},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141815281","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":"Electrical storms induced by multiple shocks in catecholaminergic polymorphic ventricular tachycardia, spotlight","authors":"Hisaaki Aoki MD, PhD,&nbsp;Yoshihide Nakamura MD","doi":"10.1002/joa3.13122","DOIUrl":"10.1002/joa3.13122","url":null,"abstract":"<p>An electrical storm ensued following multiple shocks by an implantable cardioverter defibrillator (ICD). The prevention of such electrical storms is prognostically important and includes revision of medical therapy, modification of ICD settings, cardiac sympathectomy, and ablations.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1214-1216"},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141815146","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":"Efficacy and safety of pulsed-field versus conventional thermal ablation for atrial fibrillation: A systematic review and meta-analysis","authors":"Ahmed Mazen Amin MBBCh,&nbsp;Abubakar Nazir MBBS,&nbsp;Mohamed T. Abuelazm MBBCh,&nbsp;Ahmed A. Ibrahim MBBCh,&nbsp;Hossam Elbenawi MD,&nbsp;Aya Aboutaleb MBBCh,&nbsp;Mohamed Ellabban MBBCh,&nbsp;Moumen Arnaout MD,&nbsp;Mustafa Turkmani MD,&nbsp;Basel Abdelazeem MD,&nbsp;Annabelle S. Volgman MD","doi":"10.1002/joa3.13118","DOIUrl":"10.1002/joa3.13118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed-field ablation (PFA) has emerged as an innovative alternative to radiofrequency (RF) and cryoablation because it selectively targets myocardial tissue. Thus, we aim to estimate the efficacy and safety of PFA versus thermal ablation for atrial fibrillation (AF) ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023480321\u0000 </p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 17 studies with a total of 2255 patients. PFA was significantly associated with a decreased incidence of AF recurrence (RR: 0.66 with 95% CI [0.51, 0.87], <i>p</i> = .003). However, there was no significant difference between PFA and thermal ablation in arrhythmia recurrence (RR: 0.92 with 95% CI [0.74, 1.46], <i>p</i> = .42). PFA was significantly associated with decreased total procedure time (MD: −15.15 with 95% CI [−20.23, −10.07], <i>p</i> &lt; .00001), decreased heart rate change (MD: −7.39 with 95% CI [−12.16, −2.62], <i>p</i> = .002), decreased phrenic nerve palsy (RR: 0.38 with 95% CI [0.15, 0.98], <i>p</i> = .05), and reduced esophageal lesions (RR: 0.09 with 95% CI [0.01, 0.69], <i>p</i> = .02). On the contrary, PFA was significantly associated with increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], <i>p</i> = .01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PFA was significantly associated with decreased AF recurrence, total procedure time, heart rate change, phrenic nerve palsy, esophageal lesion, and increased incidence of pericardial tamponade compared with thermal ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 5","pages":"1059-1074"},"PeriodicalIF":2.2,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141827271","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}