Journal of Arrhythmia最新文献

{"title":"Helix-fixation leadless pacemaker as a potential alternative to conventional transvenous pacemaker in post-Mustard baffle stenosis","authors":"Kenichi Sasaki MD, PhD,&nbsp;Ikutaro Nakajima MD, PhD,&nbsp;Akira Kasagawa MD, PhD,&nbsp;Tomoo Harada MD, PhD,&nbsp;Yoshihiro J. Akashi MD, PhD","doi":"10.1002/joa3.13108","DOIUrl":"10.1002/joa3.13108","url":null,"abstract":"<p>Obstruction of a systemic venous pathway is relatively common after the Mustard operation. A helix-fixation leadless pacemaker was successfully implanted in the subpulmonic but morphologic LV in a d-TGA patient with post-Mustard baffle stenosis and failure of a previously implanted epicardial lead.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1041-1044"},"PeriodicalIF":2.2,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975750","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 “Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures”","authors":"Yuichi Hori MD, PhD,&nbsp;Hideyuki Aoki MD,&nbsp;Shiro Nakahara MD, PhD","doi":"10.1002/joa3.13102","DOIUrl":"10.1002/joa3.13102","url":null,"abstract":"&lt;p&gt;Editorial comment on “Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The utility of pulmonary vein isolation (PVI) as an initial therapy for patients with atrial fibrillation (AF) has been established. The elimination of PV electrical firing was initially targeted to prevent AF occurrence, however, the achievement of high therapeutic outcomes led to focusing on the secondary effects of the PVI such as modification of imbalances of the autonomic nervous system. Simultaneously, the need to control an overreaction of the autonomic nervous reflex during the PVI has been reported. In particular, excessive activity of the parasympathetic nervous system is considered one of the pathological causes of coronary artery spasms (CASs) during the PVI, which may also cause unstable hemodynamics. In this issue, Kawai et al. report interesting cases of the use of atropine sulfate in CAS patients with hemodynamic instability during AF ablation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The autonomic nervous system is maintained by the balance of the sympathetic and parasympathetic nervous systems and is controlled by both nervous systems activating together in an optimal tone. Therefore, a precise interpretation of the autonomic nervous tone is complex and is difficult to control just by the hemodynamic information. Regarding the case of CASs with unstable hemodynamics, an excessive tone of the parasympathetic response is expected, however, how the sympathetic nervous system is reacting is obscure. As suggested by Kawai et al., the use of atropine sulfate would simply block the excessive parasympathetic activation and lead to a remarkable recovery of the hemodynamics. Although the direct effect of atropine sulfate in relieving CASs is not proven and requires further study, its usefulness in maintaining the patient's condition is noteworthy.&lt;/p&gt;&lt;p&gt;The occurrence of CASs during the PVI has been reported by Nakamura et al. and was 0.19% among 22,232 patients.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Fifty percent of the CASs were observed during the PV ablation, and the left superior pulmonary vein (LSPV) was the most frequent site. Those results were considered to be the effects of the epicardial ganglion plexus (GP) located at the periphery of the PVs, which is strongly innervated by the parasympathetic nervous system.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; In addition, they highlighted that 17% (7/42) of CASs result in a serious condition, such as ventricular fibrillation or cardiopulmonary arrest, requiring cardiopulmonary resuscitation. In those cases, the onset of an uncontrollable autonomic nervous condition is expected to contribute to the failure of a spontaneous recovery and to progress to an unstable hemodynamic state. As mentioned previously, the autonomic nervous system is controlled continuously by having the sympathetic and parasympathetic nervous systems c","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1016-1017"},"PeriodicalIF":2.2,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977631","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":"Authors reply regarding “A-V-V-A response to single atrial premature depolarization in a narrow QRS tachycardia: What is the mechanism?”","authors":"Shingo Yoshimura MD,&nbsp;Yosuke Nakatani MD,&nbsp;Kenichi Kaseno MD,&nbsp;Kohki Nakamura MD,&nbsp;Shigeto Naito MD","doi":"10.1002/joa3.13107","DOIUrl":"10.1002/joa3.13107","url":null,"abstract":"<p>We respond to a letter by Dr. A. Goyal. If the tachycardia were junctional ectopic tachycardia (JET), the occurrence of the ventriculoatrial block following an atrial premature depolarization could not be explained. Therefore, we conclude that atrioventricular nodal reentrant tachycardia was more likely than JET.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1051-1052"},"PeriodicalIF":2.2,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975740","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":"Blood pressure variability as a risk factor of recurrent paroxysmal atrial fibrillation after catheter ablation","authors":"Minoru Yambe MD, PhD,&nbsp;Yuki Kurose MD,&nbsp;Kaoru Hasegawa MD, PhD,&nbsp;Hisashi Kikuta MD,&nbsp;Takenori Sumiyoshi MD, PhD,&nbsp;Yuko Sekiguchi MD, PhD,&nbsp;Takeyoshi Kameyama MD, PhD,&nbsp;Tatsuya Komaru MD, PhD,&nbsp;Koji Kumagai MD, PhD","doi":"10.1002/joa3.13094","DOIUrl":"10.1002/joa3.13094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blood pressure variability has been found to be a predictor of a stroke, heart failure, and ischemic heart disease that is independent of blood pressure control. This study used the variability independent of the mean (VIM) to evaluate the visit-to-visit blood pressure variability in patients previously undergoing catheter ablation (CA) of paroxysmal atrial fibrillation (PAF), and its relationship with AF recurrence was examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and Results</h3>\u0000 \u0000 <p>The subjects were 274 consecutive PAF patients who underwent CA at our hospital. Finally, 237 subjects were included in the analysis. The mean follow-up period was 29.6 months, during which 37 subjects had recurrences, and 200 did not. During the outpatient blood pressure examinations, the VIM of the systolic blood pressure (VIM SBP) was significantly higher in the recurrence group, suggesting that blood pressure variability is associated with recurrence. The Cox proportional hazards ratio of the VIM SBP was significantly higher in the recurrence (4.839) than no-recurrence group, even after an adjustment, suggesting that the extent of the variability was a risk factor of recurrence post-CA. In addition, the Cox proportional hazard ratio for recurrence was significantly lower in the patients taking dihydropyridine calcium channel blockers, suggesting that the risk of recurrence may differ depending on the type of antihypertensive drug.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Blood pressure variability may be a risk for AF recurrence after CA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"858-866"},"PeriodicalIF":2.2,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975741","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":"Explainable localization of premature ventricular contraction using deep learning-based semantic segmentation of 12-lead electrocardiogram","authors":"Kota Kujime MS,&nbsp;Hiroshi Seno PhD,&nbsp;Kenzaburo Nakajima MD, PhD,&nbsp;Masatoshi Yamazaki MD, PhD,&nbsp;Ichiro Sakuma PhD,&nbsp;Kenichiro Yamagata MD, PhD,&nbsp;Kengo Kusano MD, PhD,&nbsp;Naoki Tomii PhD","doi":"10.1002/joa3.13096","DOIUrl":"10.1002/joa3.13096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Predicting the origin of premature ventricular contraction (PVC) from the preoperative electrocardiogram (ECG) is important for catheter ablation therapies. We propose an explainable method that localizes PVC origin based on the semantic segmentation result of a 12-lead ECG using a deep neural network, considering suitable diagnosis support for clinical application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The deep learning-based semantic segmentation model was trained using 265 12-lead ECG recordings from 84 patients with frequent PVCs. The model classified each ECG sampling time into four categories: background (BG), sinus rhythm (SR), PVC originating from the left ventricular outflow tract (PVC-L), and PVC originating from the right ventricular outflow tract (PVC-R). Based on the ECG segmentation results, a rule-based algorithm classified ECG recordings into three categories: PVC-L, PVC-R, as well as Neutral, which is a group for the recordings requiring the physician's careful assessment before separating them into PVC-L and PVC-R. The proposed method was evaluated with a public dataset which was used in previous research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The evaluation of the proposed method achieved neutral rate, accuracy, sensitivity, specificity, F1-score, and area under the curve of 0.098, 0.932, 0.963, 0.882, 0.945, and 0.852 on a private dataset, and 0.284, 0.916, 0.912, 0.930, 0.943, and 0.848 on a public dataset, respectively. These quantitative results indicated that the proposed method outperformed almost all previous studies, although a significant number of recordings resulted in requiring the physician's assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The feasibility of explainable localization of premature ventricular contraction was demonstrated using deep learning-based semantic segmentation of 12-lead ECG.</p>\u0000 \u0000 <p>Clinical trial registration: M26-148-8.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"948-957"},"PeriodicalIF":2.2,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975749","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 comment to “Recurrent episodes of atrioventricular nodal reentrant tachycardia: Sites of ablation success, ablation endpoint, and primary culprits for recurrence”","authors":"Shiro Nakahara MD, PhD,&nbsp;Yuichi Hori MD, PhD","doi":"10.1002/joa3.13101","DOIUrl":"10.1002/joa3.13101","url":null,"abstract":"&lt;p&gt;In this issue, Hirata et al. describe a retrospective multicenter study conducted to determine the reasons for recurrence of atrioventricular nodal reentrant tachycardia (AVNRT).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Catheter ablation is the first-line treatment for patients with symptomatic AVNRT, and, for quite some time, disappearance of 1:1 slow-pathway conduction has been considered the optimal endpoint of successful treatment. Emergence of a junctional rhythm during radiofrequency (RF) energy delivery has also been considered a sensitive endpoint marker of procedural success. However, recent studies have shown residual slow pathway conduction after targeted slow pathway ablation not to be a factor influencing the recurrence of AVNRT.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; A recent multicenter study showed emergence of a junctional rhythm to be a sensitive but not specific marker of procedural success.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Furthermore, residual dual AV nodal physiology is not a predictor of recurrence. The most reliable marker of success is noninduction of the arrhythmia when isoproterenol is administered after ablation has induced a junctional rhythm. Despite the increased sophistication of clinical endpoints, the recently reported AVNRT recurrence rate is 2.1%–3.9%.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Although some patients suffering recurrence may have undergone a second session, there have been no detailed studies of patients requiring re-treatment for AVNRT recurrence.&lt;/p&gt;&lt;p&gt;Hirata et al. studied 46 cases of recurrent AVNRT treated by a second ablation procedure. The 46 cases represented 1.3% of a total 3663 cases in which an initial slow pathway modification procedure had been performed. Specifically, the types of AVNRT, sites of successful ablation during the first and second sessions, treatment endpoints, and procedural data were examined in detail. The recurrent AVNRT was of the same conduction pattern as the AVNRT treated initially in 84% of patients. The site of successful ablation for the recurrent AVNRT was within the right inferior extension (RIE) of the AV node in 85% of patients, even though the initial procedure also targeted the RIE. In addition, approximately 15% of the patients with recurrent AVNRT required ablation within the coronary sinus or within the left inferior extension (LIE) on the intraatrial septum. The Hirata et al. study stands as unique and yielded novel findings, as it analyzes in detail, case by case, previously unaddressed questions regarding AVNRT recurrence.&lt;/p&gt;&lt;p&gt;Given the need for the creation of high-quality ablation lesions, a possible reason for the recurrence of AVNRT may be unstable contact between the catheter tip and the target tissue during RF energy delivery. Factors contributing to such instability could include increased respiratory variability and body movements due to discomfort during the RF energy delivery and sometimes a prominent Eustachian ridge preventing placement of the ablation catheter on the atrial septum. ","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"794-795"},"PeriodicalIF":2.2,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977629","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":"Tachycardia with cycle length alternans in Ebstein's anomaly","authors":"Pratap J. Nathani DM,&nbsp;Abhinav B. Anand DM,&nbsp;Khushmi A. Shah MD,&nbsp;Yash Y. Lokhandwala DM","doi":"10.1002/joa3.13099","DOIUrl":"10.1002/joa3.13099","url":null,"abstract":"<p>The tachycardia which presents with regularly irregular rhythm consists of a broad set of differential diagnoses. We present a case of cycle length alternans tachycardia in a patient, with Ebstein's anomaly and describe how a diagnosis was arrived at after careful analysis of electrocardiogram and EGMs.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1026-1028"},"PeriodicalIF":2.2,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975753","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":"Effect of hyperuricemia on paroxysmal atrial fibrillation after catheter ablation and influence of alcohol consumption","authors":"Kazuki Shimojo MD,&nbsp;Itsuro Morishima MD, PhD,&nbsp;Yasuhiro Morita MD,&nbsp;Yasunori Kanzaki MD,&nbsp;Hiroyuki Miyazawa MD,&nbsp;Naoki Watanabe MD, PhD,&nbsp;Naoki Yoshioka MD, PhD,&nbsp;Naoki Shibata MD, PhD,&nbsp;Yoshihito Arao MD, PhD,&nbsp;Ryota Yamauchi MD,&nbsp;Takuma Ohi MD,&nbsp;Hiroki Goto MD,&nbsp;Hoshito Karasawa MD,&nbsp;Kenji Okumura MD, PhD","doi":"10.1002/joa3.13092","DOIUrl":"10.1002/joa3.13092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence regarding the association between hyperuricemia and arrhythmia recurrence after catheter ablation for paroxysmal atrial fibrillation (AF) is scarce. We investigated whether hyperuricemia predicts arrhythmia recurrence after catheter ablation for paroxysmal AF and the relationship between hyperuricemia and alcohol consumption in AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent catheter ablation for paroxysmal AF were divided into the hyperuricemia (index serum uric acid [UA] &gt;7.0 mg/dL; <i>n</i> = 114) and control (UA ≤7.0 mg/dL; <i>n</i> = 609) groups and were followed for a median of 24 (12–48) months after ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The hyperuricemia group had more patients with an alcohol intake of ≥20 g/day (33.3% vs. 22.7%, <i>p</i> = .017) and a lower incidence of AF-free survival (<i>p</i> = .019). Similarly, those with an alcohol intake of ≥20 g/day had a lower incidence of AF-free survival than other patients. Multivariate Cox regression analysis revealed the following independent predictors of AF recurrence (adjusted hazard ratio, 95% confidence interval): hyperuricemia (1.64, 1.12–2.40), female gender (1.91, 1.36–2.67), brain natriuretic peptide level &gt;100 pg/mL (1.59, 1.14–2.22), and alcohol consumption ≥20 g/day (1.49, 1.03–2.15) (all <i>p</i> &lt; .05). In addition, causal mediation analysis revealed that alcohol consumption of ≥20 g/day directly affected AF recurrence, independent of hyperuricemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with hyperuricemia may be at a high risk of arrhythmia recurrence after catheter ablation for paroxysmal AF. Although high alcohol consumption may contribute to increased UA levels, the presence of hyperuricemia may independently predict AF recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"849-857"},"PeriodicalIF":2.2,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975748","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 “Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure-first strategy”","authors":"Yusuke Kondo MD, PhD,&nbsp;Satoko Ryuzaki MD, PhD,&nbsp;Yoshio Kobayashi MD, PhD","doi":"10.1002/joa3.13097","DOIUrl":"10.1002/joa3.13097","url":null,"abstract":"&lt;p&gt;Editorial comment on “Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure-first strategy.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For patients with symptomatic nonvalvular atrial fibrillation (NVAF), physicians usually recommend atrial fibrillation ablation to alleviate symptoms. However, many patients hope for a life without the need for anticoagulation therapy. This expectation can increase the risk of stroke, because stopping anticoagulation therapy against clinical guidelines may lead to postablation asymptomatic NVAF recurrence. Moreover, several issues are associated with anticoagulation therapy, such as difficulties in continuing therapy due to bleeding complications or recurrent thromboembolism despite appropriate therapy. The WATCHMAN device has been available in Japan since 2019. This device was approved by the FDA to reduce the risk of thromboembolism originating from the left atrial appendage (LAA) in patients who have a valid reason to avoid oral anticoagulation therapy. According to the JCS/JHRS guidelines, left atrial appendage closure (LAAC) may be considered a Class IIb indication for patients with NVAF who require thromboembolism prevention and for whom a long-term alternative to anticoagulation therapy is being considered.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In recent years, favorable outcomes of LAAC have been reported in Japan. However, there is no consensus regarding the optimal postoperative antithrombotic therapy regimen.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Additionally, reports on the effectiveness and safety of LAAC following catheter ablation (CA) are scarce.&lt;/p&gt;&lt;p&gt;Chatani et al. found no differences in procedure-related and cardiovascular adverse events between percutaneous LAAC and percutaneous CA for NVAF.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Furthermore, after both procedures were completed, the LAAC-first group experienced no device-related adverse events, such as device-related thrombus, new peri-device leakage, progressive increase in peri-device leakage, or device dislodgement. In contrast, the CA-first group experienced four device-related adverse events. Additionally, the primary reason for performing CA after LAAC was heart failure events. The main reason for opting for LAAC first was the presence of patients with a history of LAA thrombosis or LAA sludge who had also experienced major bleeding or were at a high risk of bleeding, as indicated by a HAS-BLED score of 3 or higher.&lt;/p&gt;&lt;p&gt;While it is ideal to perform both procedures simultaneously, there are limited data comparing the implantation of the WATCHMAN device with anticoagulation therapy. Additionally, the specific disadvantages of simultaneous procedures have not been thoroughly investigated.&lt;/p&gt;&lt;p&gt;The OPTION study will assess whether LAAC with the WATCHMAN FLX device is a viable alternative to oral anticoagulation therapy following CA for NVAF.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This is a multi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"891-892"},"PeriodicalIF":2.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975746","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":"In-hospital outcomes among amyloidosis patients with atrial fibrillation: A propensity score-matched analysis","authors":"Yong-Hao Yeo MBBS,&nbsp;Boon-Jian San MBBS,&nbsp;Qi-Xuan Ang MBBS,&nbsp;Min-Choon Tan MD,&nbsp;Jian Liang Tan MD","doi":"10.1002/joa3.13100","DOIUrl":"10.1002/joa3.13100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of atrial fibrillation (AF) among patients with amyloidosis on in-hospital outcomes is not well-established. We aimed to examine in-hospital outcomes among patients admitted with a primary diagnosis of AF with and without amyloidosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We queried the Nationwide Readmissions Database to compare the in-hospital outcomes among AF patients with and without amyloidosis. Our study demonstrated that in-hospital all-cause mortality, adverse events, and 30-day readmission were comparable between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with AF and concurrent amyloidosis did not have worse in-hospital outcomes than those with AF alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1001-1004"},"PeriodicalIF":2.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975752","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}