Journal of Arrhythmia最新文献

{"title":"Editorial to “Association between ventricular arrhythmia (premature ventricular contractions burden and non-sustained ventricular tachycardia) and cardiovascular events in patients without structural heart disease”","authors":"Wei Sheng Jonathan Ong MBBS, Chi Keong Ching MBBS, FHRS","doi":"10.1002/joa3.13219","DOIUrl":"10.1002/joa3.13219","url":null,"abstract":"<p>Whether frequent premature ventricular contractions (PVCs) in patients without structural heart disease are of prognostic significance is a subject of debate.<span><sup>1</sup></span> Once considered to be a benign condition, it is now widely known that it can be causative for tachycardia-induced cardiomyopathy. While only a minority of patients with frequent PVCs (>1000 PVCs/day) develop ventricular dysfunction after 5 years of follow-up,<span><sup>2</sup></span> catheter ablation is curative for these patients with normalization of cardiac function. The minimal threshold for the development of LV dysfunction is a PVC burden of 10% while a PVC burden of >20% portends a higher risk. Upfront catheter ablation is also indicated in symptomatic patients without structural heart disease when the PVCs are of right ventricular outflow tract or fascicular origin.<span><sup>3</sup></span> Beyond the above select patient groups, however, it remains unclear whether frequent PVCs are associated with cardiovascular events in patients without structural heart disease.</p><p>In this issue of the <i>Journal of Arrhythmia</i>, Ogiso et al. conducted a single-center retrospective study with 6332 patients, stratified by the number of baseline PVCs and the presence or absence of non-sustained ventricular tachycardia (NSVT). The primary endpoint was defined as the incidence of cardiovascular events, including all-cause death, acute coronary syndrome, ischemic stroke, systemic embolism, and hospitalization for heart failure. The authors reported that, over a 3 year follow-up period, the frequency of PVCs was not associated with cardiovascular events while the presence of NSVT was associated with a higher risk of heart failure hospitalization. In the NSVT study population, only one of the five cases of heart failure had a reduced ejection fraction.</p><p>Notably, these results differ from previous studies<span><sup>4, 5</sup></span>; however, this can be explained on more careful examination of key study differences. Prior studies have shown that the decrease in cardiac function, increase in heart failure events, and mortality among patients with frequent PVCs were normally noted beyond 5 years of follow-up.<span><sup>4, 5</sup></span> This suggests that the 3 year follow-up period in the study may have been inadequate to detect these differences. Furthermore, as pointed out by the authors, increased use of medical interventions such as anti-arrhythmic drugs and catheter ablation in patients with a larger number of PVCs and NSVT may have contributed to a better prognosis and outcome.</p><p>Ogiso et al. reported that one patient with NSVT and heart failure was later diagnosed with hypertrophic cardiomyopathy. This was not detected at baseline with echocardiography. As frequent PVCs and NSVT may indicate subclinical abnormalities, the authors opined that further investigations, including cardiac magnetic resonance imaging (MRI), may be needed in select patients.","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005957","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 efficacy and safety of intrinsic antitachycardia pacing","authors":"Koumei Onuki MD,&nbsp;Michio Nagashima MD,&nbsp;Masato Fukunaga MD,&nbsp;Keigo Misonou MD,&nbsp;Maiko Kuroda MD,&nbsp;Hiroyuki Kono MD,&nbsp;Tomonori Katsuki MD,&nbsp;Rei Kuji MD,&nbsp;Kengo Korai MD,&nbsp;Kenichi Hiroshima MD,&nbsp;Kenji Ando MD","doi":"10.1002/joa3.13221","DOIUrl":"10.1002/joa3.13221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The clinical outcomes of a novel antitachycardia pacing (ATP) algorithm—intrinsic ATP (iATP)—compared to conventional ATP (cATP) have yet to be fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 128 patients and 1962 ventricular tachycardia (VT) episodes treated with the iATP or the cATP at Kokura Memorial Hospital. Patients were categorized into two groups: the iATP group (23 patients, 182 episodes) and the cATP group (105 patients, 1780 episodes). We evaluated ATP success rates and baseline patient characteristics on a per-patient basis. Additionally, we extracted VT that were not terminated by a single ATP and compared ATP success rates using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Per patient; The iATP group exhibited significantly lower creatinine levels (1.18 ± 0.40 mg/dL vs. 1.82 ± 1.61 mg/dL, <i>p</i> = .021) and a shorter follow-up period (609 ± 323 days vs. 1017 ± 252 days, <i>p</i> &lt; .001) compared to the cATP group. ATP success was observed in 19 patients in the iATP group and 62 patients in the cATP group (82.6% vs. 59%, <i>p</i> = .054). Per episode; there was no significant difference in ATP success rate (91.8% vs. 92.7%, <i>p</i> = .645) or in acceleration rate (1.1% vs. 2.4%, <i>p</i> = .274). However, when limited to episodes in which VT was not terminated by a single ATP and propensity score matching was performed, the iATP showed a higher VT termination rate (84.1% vs. 53.6%, <i>p</i> &lt; .001) and a lower acceleration rate (0% vs. 10.1%, <i>p</i> = .013) than the cATP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The efficacy and safety of the iATP for VT that was not terminated by the first sequence of ATP was demonstrated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005470","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 “Carbon dioxide insufflation to facilitate epicardial access in extracorporeal membrane oxygenation-supported ventricular tachycardia ablation”: Blowing an exhaled gas for easy and safe pericardial puncture","authors":"Ugur Canpolat MD","doi":"10.1002/joa3.13216","DOIUrl":"10.1002/joa3.13216","url":null,"abstract":"&lt;p&gt;In the current issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Takase et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported a challenging patient with scleroderma-related structural heart disease who was admitted with recurrent ventricular tachycardia (VT) episodes after a failed endocardial catheter ablation alone. The authors' first challenge during an index catheter ablation was the hemodynamic instability during VT for mapping. The author's second challenge during the planned second catheter ablation was the anatomical neighboring of the left hepatic lobe to the subxiphoid epicardial access route. The authors have overcome both challenges with the carbon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;) insufflation method for facilitating the visibility of intrapericardial space and the hemodynamic support of extracorporeal membrane oxygenation. The endocardial and epicardial catheter ablation was successfully performed by overcoming these technical obstacles.&lt;/p&gt;&lt;p&gt;Catheter ablation is advised to reduce recurrent VT and the need for implantable cardioverter defibrillator shocks in patients with non-ischemic cardiomyopathy (NICM) and recurrent sustained monomorphic VT when antiarrhythmic medications are ineffective, contraindicated, or poorly tolerated.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; VT developed as a result of left or right ventricular myocardial involvement, and successful catheter ablation has been previously reported in patients with systemic scleroderma.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, due to the underlying mechanism of myocardial disease and VT (primarily caused by scar-related reentry&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;), endocardial catheter ablation alone might be insufficient to eliminate the VT focus. Furthermore, the contribution of ventricular scar to the electrophysiological abnormalities targeted for endocardial ablation of unstable VT differs between ischemic and non-ischemic cardiomyopathies. Since the case of Takase et al. also involved VT due to non-ischemic etiology, endocardial substrate ablation alone may have failed for hemodynamically unstable VT. Epicardial catheter ablation of VT can be useful after the failure of endocardial ablation because of the higher rate of the intramyocardial and epicardial substrate in patients with NICM.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Demonstrating a three-dimensional hyperboloid VT circuit structure is another reason that endocardial catheter ablation alone is ineffective in some patients.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Before epicardial catheter ablation, pre-procedural imaging techniques, such as cardiac computed tomography or magnetic resonance imaging, may play a critical role in procedural guidance and preventing complications by indicating neighboring structures.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Accessing the epicardium is typically achieved through a subxiphoid and trans pericardial puncture. However, epicardial access may be difficult due to anatomical obstacles and poor fluoroscopic visibility, which result in both acute and delayed complications. Carbo","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006034","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":"Real-world clinical practice of current periprocedural anticoagulation management in catheter ablation of atrial fibrillation: Data from a large prospective ablation registry","authors":"Yuta Taomoto MD,&nbsp;Shinsuke Miyazaki MD, FHRS,&nbsp;Yasutoshi Nagata MD,&nbsp;Junichi Nitta MD,&nbsp;Osamu Inaba MD,&nbsp;Yasuhiro Shirai MD,&nbsp;Yasuaki Tanaka MD,&nbsp;Yukio Sekiguchi MD,&nbsp;Yukihiro Inamura MD,&nbsp;Yuichiro Sagawa MD,&nbsp;Akira Mizukami MD,&nbsp;Koji Azegami MD,&nbsp;Shinsuke Iwai MD,&nbsp;Hitoshi Hachiya MD,&nbsp;Yuichi Ono MD,&nbsp;Atsushi Takahashi MD,&nbsp;Takeshi Sasaki MD,&nbsp;Yasuteru Yamauchi MD,&nbsp;Hiroyuki Okada MD,&nbsp;Atsushi Suzuki MD,&nbsp;Makoto Suzuki MD,&nbsp;Keita Handa MD,&nbsp;Kenzo Hirao MD,&nbsp;Jun Nakajima MD,&nbsp;Takuro Nishimura MD,&nbsp;Susumu Tao MD,&nbsp;Masateru Takigawa MD,&nbsp;Tetsuo Sasano MD","doi":"10.1002/joa3.13182","DOIUrl":"10.1002/joa3.13182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean CHADS₂ and CHA₂DS₂VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, <i>p</i> = .003) and thromboembolic event rates (0.03% vs. 0.23%, <i>p</i> = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20–3.08, <i>p</i> = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27–5.9, <i>p</i> = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, <i>p</i> &lt; .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted (<i>n</i> = 2105) than uninterrupted group (<i>n</i> = 821) (1.47% vs. 2.56%, <i>p</i> = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006109","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":"Gastrointestinal bleed mortality disparities in patients with atrial fibrillation: A cross-sectional analysis 1999–2020","authors":"Enkhtsogt Sainbayar DO,&nbsp;Ramzi Ibrahim MD,&nbsp;Sangkyu Noh DO,&nbsp;Hoang Nhat Pham MD,&nbsp;Mahek Shahid MD,&nbsp;Joseph Elias MD,&nbsp;Harneet Grewal MD,&nbsp;Rama Mouhaffel MD,&nbsp;Akira Folk DO,&nbsp;Jack Hartnett MB, BCh, BAO,&nbsp;Kwan Lee MD,&nbsp;Justin Z. Lee MD","doi":"10.1002/joa3.13223","DOIUrl":"10.1002/joa3.13223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gastrointestinal bleeding (GIB) is often encountered among patients with atrial fibrillation (AF) due to the use of anticoagulation. This study assesses disparities in GIB-related mortality among decedents with AF in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>GIB mortality data in patients with AF from 1999 to 2020 was queried from the CDC database. Decedent demographic information (age, sex, race and ethnicity, and geographic residence) was obtained from death certificates. We calculated age-adjusted mortality rates (AAMRs) through the direct method and estimated the annual percentage change (APC) in mortality using log-linear regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 11,209 GIB-related deaths among AF decedents, we observed an increase in AAMR from 0.12 in 1999 to 0.21 in 2020, particularly during the 2009 to 2020 period (APC +4.8, <i>p</i> &lt; .001). Disproportionate mortality rates were noted in males (AAMR 0.18) and White populations (AAMR 0.15) as compared to females (AAMR 0.13) and Black populations (AAMR 0.10), respectively. Rural regions also reported higher mortality (AAMR 0.18) than urban areas (AAMR 0.14). Mortality shifts in urban regions remained stagnant from 1999 to 2009 (APC –0.15, <i>p</i> = .806) followed by an increase from 2009 to 2020 (APC +4.83, <i>p</i> &lt; .001). However, mortality increased consistently from 1999 to 2020 in rural regions (APC +4.08, <i>p</i> &lt; .001). The Northeast US exhibited the highest mortality rate (AAMR 0.18), followed by the Midwest (AAMR 0.16), West (AAMR 0.14), and South (AAMR 0.13).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Disparities in GIB mortality among AF decedents were identified. These findings accentuate the need for targeted interventions to mitigate GIB risks in vulnerable subgroups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006069","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":"Different effects of catheter ablation on exercise tolerance, leg strength, and quality of life in paroxysmal versus persistent atrial fibrillation","authors":"Gen Matsuura MD, PhD,&nbsp;Hidehira Fukaya MD, PhD,&nbsp;Nobuaki Hamazaki PhD,&nbsp;Daiki Saito MD, PhD,&nbsp;Hironori Nakamura MD, PhD,&nbsp;Naruya Ishizue MD, PhD,&nbsp;Tomoharu Yoshizawa MD, PhD,&nbsp;Jun Kishihara MD, PhD,&nbsp;Shinichi Niwano MD, PhD,&nbsp;Jun Oikawa MD, PhD,&nbsp;Junya Ako MD, PhD","doi":"10.1002/joa3.13220","DOIUrl":"10.1002/joa3.13220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Catheter ablation (CA) can improve exercise tolerance and quality of life (QOL) in patients with atrial fibrillation (AF). However, its differential effects on muscle strength between paroxysmal AF (PAF) and nonparoxysmal AF (Non-PAF) remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated 94 patients (67.8 ± 10.3 years old, 71% male) who underwent CA (PAF/Non-PAF 46/48) without AF recurrence. Six-minute walk distance (6MWD), leg strength, and an AF-specific QOL questionnaire (AFQLQ) were evaluated at baseline, 3, and 6 months after CA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the 6MWD and AFQLQ subset 3 score were significantly lower in patients with PAF than in those with Non-PAF, but the parameters of muscle strength were comparable between the two groups. Both 6MWD and AFQLQ significantly improved at 6 months after CA in both groups. However, leg strength at 6 months after CA significantly improved in the Non-PAF group (54.9 ± 16.5 to 58.4 ± 15.2, <i>p</i> &lt; .05) but not in the PAF group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Successful CA for both PAF and Non-PAF improved QOL and exercise tolerance. Additionally, CA improved leg strength in Non-PAF patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006015","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 “Pre-procedural imaging guiding ventricular tachycardia ablation in structural heart disease”","authors":"Yoshiaki Mizutani MD, PhD,&nbsp;Satoshi Yanagisawa MD, PhD,&nbsp;Yasuya Inden MD, PhD","doi":"10.1002/joa3.13211","DOIUrl":"10.1002/joa3.13211","url":null,"abstract":"&lt;p&gt;Ventricular tachycardia (VT) often occurs in patients with damaged hearts and decreased cardiac function, such as those with ischemic cardiomyopathy (ICM). Defibrillation therapy with an implantable cardioverter-defibrillator (ICD) improves prognosis in these patients for both primary and secondary prevention. However, characteristics of nonischemic cardiomyopathy (NICM) are different from those of ICM, leading to variability in prognoses following ICD implantation, especially for primary prevention, and presenting challenges in VT management through catheter ablation. Given the increasing global prevalence of NICM and recent advancements in catheter ablation techniques and imaging modalities, improved prognoses and effective approaches for catheter ablation in patients with NICM are expected.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of arrhythmia&lt;/i&gt;, Ferreira et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; evaluated the safety and efficacy of VT ablation in patients with NICM and ICM using the ADAS 3D system (ADAS3D Medical, Barcelona, Spain). A total of 102 patients with VT were included in this study (ICM, 75 patients; NICM, 27 patients). Multidetector computed tomography (MDCT), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) were used for preprocedural imaging. These were integrated into mapping systems and segmented using ADAS 3D software. The key points of this study are as follows: First, procedural data revealed no significant differences in VT inducibility between the ICM and NICM groups. Approximately half of the patients in each group no longer exhibited VT inducibility, possibly because of the elimination of all late potentials, achieved through preprocedural imaging complemented with the ADAS 3D system and its integration into the three-dimensional electroanatomical mapping system. Second, cumulative survival free from appropriate ICD shocks was similar between the ICM and NICM groups. This suggests that preprocedural imaging-guided ablation for VT may be equally beneficial in patients with NICM and as it is in patients with ICM. Much of the past randomized studies for evaluating VT ablation have been conducted in patients with ICM, while large-scale prospective randomized studies for patients with NICM remain lacking.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Previous studies have demonstrated inferior outcomes following VT ablation in patients with NICM compared to those with ICM, possibly because of the heterogenous VT substrate in patients with NICM.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Typically, the substrate of NICM is characterized by an increased prevalence of damaged tissue expanding into intramyocardial and epicardial sites, which is higher than that of ICM. This complexity poses challenges, such as reduced catheter accessibility and insufficient thermal energy delivery to deep myocardial layers, resulting in a lower VT termination rates and poorer procedural outcomes.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This result aligns with the findings of current ","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006063","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":"Disparities in cardiac arrest mortality among patients with chronic kidney disease: A US-based epidemiological analysis","authors":"Mahek Shahid MD,&nbsp;Hoang Nhat Pham MD,&nbsp;Ramzi Ibrahim MD,&nbsp;Enkhtsogt Sainbayar DO,&nbsp;Mahmoud Abdelnabi MBBCh, MSc,&nbsp;Girish Pathangey MD,&nbsp;Amitoj Singh MD","doi":"10.1002/joa3.13217","DOIUrl":"10.1002/joa3.13217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) increases cardiac arrest (CA) risk because of renal and cardiovascular interactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Centers for Disease Control and Prevention (CDC) data from 1999 to 2020, we analyzed CKD-related CA mortality and the impact of social vulnerability index (SVI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 336 494 CKD-related CA deaths, with stable age-adjusted mortality rates over time. Disparities were observed across gender, racial/ethnic, and geographic subpopulations, with higher mortality among males, Hispanic and non-Hispanic Black populations, and those in urban and Western regions. Higher SVI correlated with increased mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CKD-related CA mortality rates are stable, with disparities across demographics; higher SVI correlates with increased mortality, highlighting needed interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006023","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 causality between premature ventricular contraction and heart failure","authors":"Naoya Kataoka MD,&nbsp;Teruhiko Imamura MD","doi":"10.1002/joa3.13218","DOIUrl":"10.1002/joa3.13218","url":null,"abstract":"<p>To editor:</p><p>Ogiso and colleagues demonstrated that nonsustained ventricular tachycardia (NSVT) is associated with an increased risk of heart failure hospitalization in patients without structural heart disease.<span>¹</span> However, several critical concerns warrant further discussion.</p><p>A comprehensive methodology detailing the approach to confirm the absence of structural heart disease should be provided. Importantly, various cardiac pathologies with preserved left ventricular ejection fraction cannot be definitively excluded without comprehensive testing. For instance, epicardial cardiomyopathy cannot be ruled out without advanced diagnostic modalities, such as cardiac magnetic resonance imaging and genetic testing.<span>²</span></p><p>The burden of premature ventricular contractions (PVCs) is a well-documented contributor to systolic dysfunction, with a commonly proposed threshold exceeding 20%.<span>³</span> In this study, however, the total number of PVCs was categorized into tertiles,<span>¹</span> which may limit the precision of the analysis.</p><p>Differentiating PVCs with aberrant conduction in patients with atrial fibrillation using Holter electrocardiography presents significant challenges.<span>⁴</span> A detailed description of the methodology used to distinguish these phenomena is essential for reproducibility and validity. Additionally, the rationale for administering class III antiarrhythmic agents in patients reportedly free of structural heart disease remains unclear and requires elucidation.</p><p>The causal relationship between NSVT and the development of heart failure remains ambiguous.<span>¹</span> Notably, most heart failure hospitalizations occurred within 1 year of observation. It is plausible that patients experiencing elevated left ventricular end-diastolic pressure may develop NSVT as a secondary manifestation. In such cases, subclinical heart failure could potentially be identified through detailed investigations, including chest X-rays, B-type natriuretic peptide levels, and comprehensive echocardiography.</p><p>Finally, if PVCs serve merely as bystanders of underlying cardiac pathology, the efficacy of aggressive therapeutic interventions targeting NSVT and PVCs in improving clinical outcomes becomes questionable.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005433","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":"Once a saint, now a sinner: An appropriate or inappropriate shock?","authors":"Sudipta Mondal MD, DM,&nbsp;Swasthi S. Kumar MD,&nbsp;Jyothi Vijay MD, DM,&nbsp;Narayanan Namboodiri MD, DM","doi":"10.1002/joa3.13209","DOIUrl":"10.1002/joa3.13209","url":null,"abstract":"<p>Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006103","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}