Journal of Arrhythmia最新文献

{"title":"Editorial to “Can lead damage be ruled out using defibrillation threshold testing in patients with very high-impedance shock leads?”","authors":"Taro Temma MD, PhD, Toshihisa Anzai MD, PhD","doi":"10.1002/joa3.70040","DOIUrl":"https://doi.org/10.1002/joa3.70040","url":null,"abstract":"<p>Defibrillation threshold (DFT) testing has long been debated in the field of implantable cardioverter defibrillator (ICD) management, with contemporary practice leaning towards its selective rather than routine use. The study by Narita et al.<span><sup>1</sup></span> presents a compelling case where DFT testing played a pivotal role in evaluating the function of an ICD lead with very high shock impedance, ultimately guiding clinical decision-making. Their findings provide valuable insights into the evolving role of impedance monitoring and highlight the limitations of low-voltage subthreshold measurement (LVSM) in assessing true shock impedance (TSI).</p><p>The report describes a case in which an Endotak Reliance 0296 lead exhibited a progressive increase in shock impedance over 11 years, eventually surpassing 200 Ω. This raised concerns about potential lead dysfunction, necessitating a clinical approach to determine the safety, and efficacy of continued use. The authors convincingly demonstrate that despite the alarmingly high impedance recorded by LVSM, the lead remained functional, as confirmed by successful DFT testing with a true shock impedance of 103 Ω.</p><p>The discrepancy between LVSM and TSI is a critical finding. LVSM has been widely adopted for its non-invasive, pain-free nature, but, as shown in this case, it may not always provide an accurate reflection of true lead function. The authors postulate that lead encapsulation and environmental stress cracking may have contributed to the impedance increase. These factors, along with the known risk of calcification in GORE-expanded polytetrafluoroethylene (ePTFE)-coated coils, raise important considerations for long-term lead surveillance.</p><p>DFT testing has been largely deemphasized in recent years due to concerns about procedural risks and limited impact on patient outcomes in standard ICD implants.<span><sup>2</sup></span> However, this case underscores its utility in specific clinical scenarios. In the presence of suspected lead dysfunction, particularly with high-voltage impedance concerns, DFT testing can provide a definitive functional assessment of lead replacement and decrease the LVSM to the normal range, making it easy to detect future lead fractures using LVSM. Furthermore, prior study suggests that a commanded low-energy impedance test (0.1 Joule) is a safer and more reliable method for identifying and verifying potential open shock line conditions compared to high-energy shock testing.<span><sup>3</sup></span> This raises the possibility that a combined approach using both low- and high-energy shocks could enhance the assessment of lead function in such cases. By incorporating both strategies, clinicians may improve diagnostic accuracy and ensure the long-term functionality of ICD leads while minimizing unnecessary interventions. The study by Narita et al. presents a well-documented case highlighting the complexities of ICD lead impedance monitoring. Their findings sup","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595497","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":"Implantable cardiac defibrillator outcomes in octogenarians","authors":"Muhammad Rehan Zahid MBBS, Syed Tawassul Hassan MBBS, Muhammad Shaheer Bin Faheem MBBS, Aleeza Rehman MBBS, Syed Muhammad Ali MD","doi":"10.1002/joa3.70039","DOIUrl":"https://doi.org/10.1002/joa3.70039","url":null,"abstract":"<p>We read the article “Implantable cardiac defibrillator outcomes in octogenarians” and appreciate the authors, Stringer et al., for their efforts in examining the outcomes of implantable cardiac defibrillator (ICD) in overlooked elderly population (80 or <) having increased susceptibility to sudden cardiac death (SCD).<span><sup>1</sup></span> We highly commend their work for analyzing outcomes like mortality, frailty, and usage frequency related to ICD treatment and acknowledge their contribution to the ongoing discussion of ICD therapy in older adults. However, we found several methodological gaps that can significantly affect this study's findings.</p><p>Firstly, the study relied on univariate statistical tests without any multivariate adjustments. This can fail to provide the accurate relationship of covariates such as demographics that include age and gender and comorbidities like hypertension, diabetes, and atrial fibrillation with the study outcomes, excluding necessary confounders that can significantly impact the effect of ICD and study conclusions.<span><sup>2</sup></span> Although the Dalhousie frailty score helps in risk stratification and better frailty assessment in octogenarians, it requires detailed data on patients' health conditions, while the study documented a significant loss of device records and follow-up data that can lead to inaccurate findings. Further, it requires subjective clinical judgment rather than relying on medical records, as in this study. Authors had assumed the patients to be alive who had a clinical or emergency visit in the last 3 months of the study, inducing misclassification bias as the patients who were not able to report due to any reason might be classified as dead, distorting mortality outcomes. Among patients in the primary prevention group, a set threshold of 188 bpm for ventricular tachycardia (VT)/Ventricular fibrillation (VF) is not suitable for those who experience severe arrhythmias at lower cardiac rates, and a nonindividualized programming approach can cause excessive shocks affecting the quality of life of these patients.<span><sup>3</sup></span> Also, aggressive ATP usage before shocks can delay the needed shocks for patients with prolonged ventricular arrhythmias.<span><sup>3</sup></span> A total of five patients (6.3%) were classified as critically frail; this underpowered subgroup analysis can increase the risk of type 2 errors, undermining the outcomes of this study.<span><sup>4</sup></span> Women have a higher risk of procedural and postimplantation ICD-related complications, but only 14% of the total population of this study were female, limiting the generalizability of findings toward the female population.<span><sup>5</sup></span></p><p>Lastly, to control confounders, we recommend using multivariable regressions and adapting the electronic frailty index designed for retrospective study designs to enhance the data's reliability. However, misclassification bias can be avoided b","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595264","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":"Low voltage areas on the cavotricuspid isthmus—An underrecognized cause of a prolonged post-pacing interval after entrainment of typical atrial flutter","authors":"Naoko Miyazaki MD,&nbsp;Masato Okada MD,&nbsp;Akinobu Mizutani,&nbsp;Nobuaki Tanaka MD","doi":"10.1002/joa3.70034","DOIUrl":"https://doi.org/10.1002/joa3.70034","url":null,"abstract":"<p>Post-pacing interval (PPI)-tachycardia cycle length &gt;100 ms after entrainment from the cavotricuspid isthmus (CTI) is rare in typical atrial flutter (AFL). Low-voltage areas (LVAs) in the CTI can create conduction blocks or alter wavefront propagation, highlighting their underrecognized role in prolonged PPI in typical AFL.\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":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595263","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":"Yasushi Oginosawa MD, PhD","doi":"10.1002/joa3.70035","DOIUrl":"https://doi.org/10.1002/joa3.70035","url":null,"abstract":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; They concluded that negative left atrial pressure is not rare even with ASVs, so great caution should be exercised.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;Hippocrates once said, “First, do no harm” (&lt;i&gt;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":"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 “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":"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}