Journal of Arrhythmia最新文献

{"title":"Extra-cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia","authors":"Jose Carlos Pachon-M MD, PhD, CCDS, FHRS, FLAHRS, FEHRA,&nbsp;Enrique Pachon-M MD, PhD, LAHRS,&nbsp;Tasso Lobo MD,&nbsp;Tomas Santillana-P MD,&nbsp;Carlos Pachon MD,&nbsp;Juan Pachon-M MD, PhD,&nbsp;Christian Higuti MD,&nbsp;Maria Zelia Pachon MD,&nbsp;John Clark MD, FHRS","doi":"10.1002/joa3.70134","DOIUrl":"https://doi.org/10.1002/joa3.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The differential diagnosis of supraventricular tachycardias (SVTs) is essential during radiofrequency-(RF) ablation. The extracardiac vagal stimulation (ECVS), introduced in 2015, offers new insights for electrophysiological studies and ablation, allowing controlled cardiac vagal effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study of 625 SVT ablation patients. ECVS was performed using a regular electrophysiology catheter to study atrioventricular (AV) and ventriculo-atrial (VA) conduction and their effects on tachycardia. Baseline ECVS was performed to determine the optimal position for right or left ECVS, near the jugular foramen. ECVS was repeated during atrial and ventricular pacing (VP) to monitor the procedure's progression and ensure successful endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ECVS was successful in 611/625 patients (98%), 381 (62.3%) had AV node reentry tachycardia-(AVNRT), and 230 (37.6%) accessory pathway (AP), including 135-(58.7%) anterograde AP (WPW) and 95 (41.3%) concealed AP. ECVS + VP in 33 patients with atypical AVNRT yielded VA block in 32-(97%), suggesting VA conduction solely via the AV node. In contrast, 57 patients with concealed para-septal AP maintained VA conduction during ECVS, confirming AP. ECVS proved to be a fast, reliable, and practical additional EP tool: VA block indicated AVNRT, while persistent VA conduction suggested AP. Additionally, ECVS was highly effective in revealing and confirming successful AP ablation by demonstrating the absence of AV and VA anomalous conduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ECVS was a valuable tool in the diagnosis and ablation of SVTs. It allowed reproducible AV and VA block through normal pathways, easily identifying AVNRT and concealed, intermittent, or subtle AP. It was particularly useful in complex cases involving concealed AP and atypical AVNRT tachycardia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624270","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":"Commentary on Chronic Kidney Disease and Increased LAVI as Risk Factors of New-Onset Heart Failure in Atrial Fibrillation: A Case–Control Study","authors":"Hafsa Ali,&nbsp;Manayim Fatima,&nbsp;Muhammad Saeed Qazi,&nbsp;Tazeen Saeed Ali,&nbsp;Javed Iqbal","doi":"10.1002/joa3.70142","DOIUrl":"https://doi.org/10.1002/joa3.70142","url":null,"abstract":"&lt;p&gt;It was interesting to read the article Chronic Kidney Disease and Increased LAVI as Risk Factors of New-Onset Heart Failure in Atrial Fibrillation: A Case–Control Study, by Resultanti Irwan Muin et al. [&lt;span&gt;1&lt;/span&gt;] This study discusses a significant association between chronic kidney disease (CKD) and increased left atrial volume index (LAVI) with new-onset heart failure (HF) in individuals with existing atrial fibrillation. Determining and detecting these risk factors is essential for the prevention and prognosis of HF in AF patients. However, several methodological aspects warrant further discussion.&lt;/p&gt;&lt;p&gt;First, the study adopts a retrospective case–control design based on a single institution, with several limitations. Retrospective data relies mainly on the patient's memory when interviewed and can often introduce a recall bias. The authors did not mention blinding in the study design, which could lead to an interview or measurement bias. As the study analyzes patients from a single institution, it is not population-based; therefore, generalizing the results and computing incidence is impossible [&lt;span&gt;2&lt;/span&gt;]. Moreover, selection bias is possible as the control group was picked randomly using a computerized generator (www.random.org), whereas the case group was selected using purposive sampling. Adding on, the study's small sample size, that is, 132 patients in total and only 44 cases, considering that there were 9110 records retrieved for AF, out of which 6465 AF patients have HF, limits the statistical power and generalizability of the study [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Secondly, the study reports significant differences in the AF type and duration between the case and control groups. Persistent AF was more prevalent (43.2%) in the case group, while paroxysmal AF was more common (50%) in the control group; these were not accounted for in multivariate modeling. Persistent AF and longer duration are individual risk factors for HF and are linked to a higher incidence of HF compared to paroxysmal AF [&lt;span&gt;3&lt;/span&gt;]. Failing to adjust for them might lead to a complication when determining the association with CKD and LAVI.&lt;/p&gt;&lt;p&gt;Thirdly, while LAVI was used as a predictive variable, it was only measured once after the diagnosis of AF. The authors did not state the timing or consistency of this echocardiographic evaluation. LAVI might fluctuate based on body size, age, blood pressure, medical history, tobacco and alcohol use, diastolic dysfunction, and technician variability. The lack of standardization can compromise confidence in the utility of LAVI as a stable predictor [&lt;span&gt;4&lt;/span&gt;]. We understand that retrospective data often limit measurement frequency, but acknowledging this in interpretation could improve balance. Moreover, medication data are absent; the authors have not mentioned the usage of any medications for AF and HF, which can significantly impact both HF and LAVI outcomes.&lt;/p&gt;&lt;p&gt;Finally, for statistical analysis, we app","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624733","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":"Early Deterioration of the Right Ventricular Pacing Threshold Predicts the Increase in His-Bundle Pacing Threshold During the Chronic Phase: A Single-Center Retrospective Study","authors":"Kenji Baba,&nbsp;Shogo Sakamoto,&nbsp;Moritoshi Irishio,&nbsp;Tomotaka Yoshiyama,&nbsp;Yusuke Hayashi,&nbsp;Toru Kataoka,&nbsp;Daiju Fukuda","doi":"10.1002/joa3.70144","DOIUrl":"https://doi.org/10.1002/joa3.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>His-bundle pacing (HBP) facilitates physiological ventricular activation. However, concerns about long-term threshold deterioration persist. The predictors of chronic threshold elevation are not yet well established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between February 2018 and December 2021, HBP was attempted in 95 patients undergoing pacemaker implantation. Strict success criteria (threshold ≤ 2.0 V/0.4 ms) were applied, and 47 patients with successful HBP were monitored for over 3 years. We assessed pacing thresholds for both the His-bundle and right ventricle (RV) at implantation, 1 week, 1 month, and annually thereafter. Lead shape was evaluated using chest radiography. Patients were categorized into two groups based on their His-bundle pacing threshold: stable (≤ 3.5 V/0.4 ms) and deteriorated (&gt; 3.5 V/0.4 ms).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Deterioration in His-bundle pacing thresholds was associated with increased RV pacing thresholds. Deterioration in RV pacing occurred earlier, with significant differences observed at 1 week post-implantation (median RV: 1.87 vs. 3.25 V/0.4 ms, <i>p</i> = 0.032; His-bundle: 1.0 vs. 1.25 V/0.4 ms, <i>p</i> = 0.212). Multivariate analysis identified an RV threshold ≥ 3.0 V/0.4 ms at 1 week (OR 10.7, <i>p</i> = 0.036) and lead bending on chest radiography (OR 12.8, <i>p</i> = 0.018) as independent predictors of chronic His-bundle pacing threshold deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An elevated RV pacing threshold at 1 week post-implantation and lead flexion at implantation may serve as early indicators of long-term deterioration in His-bundle pacing thresholds. When the RV pacing threshold increase is detected, it is important to closely monitor the patient and frequently adjust the output settings to prevent pacing failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624732","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":"Arrhythmogenic mitral valve prolapse—a systematic review of ventricular arrhythmia and sudden cardiac death outcomes before and after mitral valve surgery","authors":"James N. Cameron BSc, MEng, MBBS,&nbsp;Nigel Sutherland BPhysio, MD, FRACP,&nbsp;Chee Loong Chow MBBS, FRACP,&nbsp;Hui-Chen Han MBBS, PhD, FRACP,&nbsp;Matias Yudi MBBS, PhD, FRACP,&nbsp;Rajiv Mahajan MBBS, MD, PhD, FRACP,&nbsp;Anand Ganesan MBBS, PhD, FRACP,&nbsp;Avi Sabbag MD, PhD,&nbsp;Kristina H. Haugaa MD, PhD, FESC,&nbsp;Jai Raman MBBS, PhD, FRACS,&nbsp;Prashanthan Sanders MBBS, PhD, FRACP,&nbsp;Omar Farouque MBBS, PhD, FRACP,&nbsp;Han S. Lim MBBS, PhD, FRACP","doi":"10.1002/joa3.70108","DOIUrl":"https://doi.org/10.1002/joa3.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Several autopsy and observational studies have investigated the link between mitral valve prolapse (MVP) and sudden cardiac death (SCD) given the well accepted yet rare occurrence of ventricular arrhythmias (VA). Whether surgical intervention for arrhythmogenic MVP (aMVP) reduces VA and SCD risk remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature review was conducted using the PubMed database in December 2024. Studies documented in English were included if patients had undergone mitral valve (MV) surgery (MVS; repair or replacement) for MVP with documented rates of VA or SCD pre- and postintervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen identified studies (8 cohort and 8 case studies) comprised 1233 patients (receiving medical or surgical treatment) with a pooled mean age of 61.5 years and 41.9% being female. A total of 657 MVP patients underwent MVS. Seven cohort studies reported rates of VA pre- and postintervention, with six of these and all case studies reporting a significant reduction. The remaining cohort study reported a reduction in SCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This systematic review indicates a reduction in VA following current guideline-directed MVS for MVP. However, a residual risk of VA and SCD may remain postintervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635315","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":"Cardiac arrhythmias in cancer patients using the nationwide claim-based database in Japan","authors":"Takashi Kobayashi MD, PhD,&nbsp;Kengo Kusano MD, PhD","doi":"10.1002/joa3.70079","DOIUrl":"https://doi.org/10.1002/joa3.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardio-oncology has recently developed as a new discipline. No study using a Nationwide Claim-Based Database has examined the association between cancer and arrhythmia in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>JROAD-DPC (Japanese Registry Of All cardiac and vascular Diseases - Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 11 297 525 records found between April 2012 and March 2021 from 1119 hospitals, 2 976 362 patients with arrhythmias were studied and divided into categories using cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence rate of cancers was 7.51% of the patients hospitalized for arrhythmias, and the prevalence of cancer increased with time. The prevalence rate of Atrial fibrillation (AF) and/or atrial flutter (AFL) was 70.6% and 60.7% of arrhythmic patients with and without cancer, respectively. Pneumonia (7.41%) was the first major infectious complication in arrhythmic patients with cancers. Arrhythmic patients with cancers had significantly higher Barthel index (65.2 at admission and 72.5 at discharge) and prevalences of hyperuricemia (HU) and chronic kidney disease (CKD) (6.13% and 9.67%) than those without cancer. The rate of emergency hospitalization was higher in arrhythmic patients with cancers than those without cancer (58.9% vs. 57.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cancers were frequently observed in arrhythmic patients, and the prevalences increased with time. AF and/or AFL were the most common arrhythmias of cancer patients. Arrhythmic patients with cancers had significantly higher Barthel index and prevalences of HU and CKD than those without cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624271","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 study of the clinical usefulness of the eMEMO®","authors":"Hinako Nakayama,&nbsp;Nobuhisa Watanabe,&nbsp;Misa Tsukamoto,&nbsp;Miyu Mori,&nbsp;Eri Nakakubo,&nbsp;Shogo Watanabe,&nbsp;Manabu Taniguchi MD, PhD","doi":"10.1002/joa3.70137","DOIUrl":"https://doi.org/10.1002/joa3.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Taking advantage of the characteristics of the novel compact external loop recorder (ELR; eMEMO®), which is waterproof and has an automatic arrhythmia detection and monitoring function for up to 14 days, we investigated the usefulness of ELR measurement, especially during bathing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 294 patients (102 males and 192 females) who presented with palpitations as their main complaint from April 2021 to September 2022, with a mean age of 57.0 ± 17.4 years. The average wearing period of the ELR was 4.5 ± 0.9 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ELR for longer than 24 h led to the first arrhythmia detection in 170 (21.3%) of the 799 cases of all detected arrhythmias, including 11 with premature atrial contraction, 50 with premature ventricular contraction, 8 with atrial fibrillation, 32 with supraventricular tachycardia, and 21 with sick sinus syndrome. They had low noise contamination during measurement. Arrhythmic events during bathing were observed in 52 patients, effectively detecting arrhythmia during bathing, which was difficult with the usual 24-h Holter electrocardiography (ECG). In addition, the itching and rash of the skin at the electrode attachment over a period of up to 5 days were very mild, indicating the comfort of the waterproof patch-type electrode.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The patch-type ELR (eMEMO®) with waterproof design is capable of continuous recording regardless of restrictions such as bathing or exercise and is useful for detecting stable arrhythmias in patients with palpitations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581980","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":"Differing impacts of cardiac implantable electronic device leads on tricuspid regurgitation","authors":"Sophie A. Leon MD,&nbsp;Melissa Austin MD,&nbsp;Nayeem Nasher MD,&nbsp;Daler Rahimov MD,&nbsp;Faizaan Siddique,&nbsp;Chitra Parikh MD,&nbsp;Danial Ahmad MD,&nbsp;Vakhtang Tchantchaleishvili MD,&nbsp;Behzad B. Pavri MD","doi":"10.1002/joa3.70133","DOIUrl":"https://doi.org/10.1002/joa3.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Placement of cardiac implantable electronic devices (CIED) with leads that traverse the tricuspid valve is thought to contribute to tricuspid regurgitation (TR). However, there are relatively limited data comparing the impact of different CIED lead types on the incidence and progression of TR. This study sought to quantify the change in TR severity following implantation of CIEDs with different lead types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patient data were collected on individuals with implantable cardioverter defibrillators (ICD), right ventricular-paced pacemakers (RV-PM), and His bundle-paced pacemakers (His-PM) placed by a single provider at a single institution between 2016 and 2019. Patients with extravascular CIED placement or with existing devices undergoing upgrade procedures were excluded. Severity of TR after CIED implantation was compared to baseline TR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 97 patients receiving CIEDs were analyzed, including 63 with RV-PMs, 23 with ICDs, and 11 with His-PMs. Median patient age was 72 [interquartile range (IQR) 63–81] years, and 44% of patients were female. Echocardiograms were obtained a median of 20 [4–91] days before CIED implantation and 31 [17.9–43.0] months following implantation. Baseline TR grade was comparable between groups (<i>p</i> = 0.65). TR severity significantly worsened after ICD implantation (<i>p</i> = 0.035), RV-PM implantation trended toward worsening TR severity (<i>p</i> = 0.099), and no statistically significant difference was observed after His-PM implantation (<i>p</i> = 0.68).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The effect of CIED leads on TR represents a spectrum related to the type of lead traversing the tricuspid valve.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573176","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":"Association between aortomitral continuity calcification and conduction disturbances following transcatheter aortic valve implantation with the balloon-expandable Myval valve","authors":"Serkan Aslan M.D.,&nbsp;Aysel Türkvatan M.D.,&nbsp;Mehmet Kanyılmaz M.D.,&nbsp;Burçin Yılmaz M.D.,&nbsp;Dilara Pay M.D.,&nbsp;Kadir Sadıkoğlu M.D.,&nbsp;Hande Uysal M.D.,&nbsp;Gökhan Demirci M.D.,&nbsp;Mehmet Altunova M.D.,&nbsp;Serkan Kahraman M.D.,&nbsp;Mehmet Ertürk M.D.","doi":"10.1002/joa3.70140","DOIUrl":"https://doi.org/10.1002/joa3.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Given the anatomical proximity of the cardiac conduction system, aortomitral continuity calcification (AMCC) may contribute to conduction disturbances (CD) during transcatheter aortic valve implantation (TAVI) due to radial force on the AMCC. This study aimed to investigate the impact of AMCC on new-onset CD in patients undergoing TAVI with the balloon-expandable Myval valve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 160 patients who underwent TAVI. AMCC was assessed using Agatston and calcium volume scores from preprocedural computed tomography (CT). Multivariable logistic regression was used to identify independent predictors of CD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High-grade atrioventricular block (HAVB) occurred in 13.1% of patients, and 17.5% required permanent pacemaker implantation (PPM). Patients with HAVB and PPM exhibited a higher prevalence of AMCC and significantly higher AMCC scores. An AMCC score &gt;180 was an independent predictor of HAVB (OR, 5.58; 95% CI, 1.43–21.70; <i>p</i> = .013) and PPM (OR, 5.39; 95% CI, 1.75–16.55; <i>p</i> = .002). When classified by AMCC proximity type, right fibrous trigone (RFT)-dominant calcification was a strong independent predictor of HAVB (OR, 9.22; 95% CI, 1.63–51.99; <i>p</i> = .012) and PPM (OR, 7.62; 95% CI, 1.91–30.38; <i>p</i> = .004). Prolonged QRS duration, greater implantation depth, and shorter membranous septum length were also independent predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AMCC is a strong independent predictor of HAVB and PPM following TAVI, particularly with scores &gt;180 or when AMCC is anatomically close to the RFT. Preprocedural CT-based assessment of AMCC burden and proximity may improve risk stratification and procedural planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573177","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":"Prevalence of cardiac fibrosis and infiltrative cardiomyopathy in patients with advanced conduction system disease","authors":"Jeremy William MBBS,&nbsp;Haider Muthana MBBS,&nbsp;Joseph Hogarty MBBS,&nbsp;Andrew Taylor MBBS, PhD,&nbsp;James L. Hare MBBS, PhD,&nbsp;Justin Mariani MBBS, PhD,&nbsp;Hitesh Patel MBBS, PhD,&nbsp;Geoff Wong MBBS, PhD,&nbsp;Dion Stub MBBS, PhD,&nbsp;David M. Kaye MBBS, PhD,&nbsp;Sandeep Prabhu MBBS, PhD,&nbsp;Peter M. Kistler MBBS, PhD,&nbsp;Aleksandr Voskoboinik MBBS, PhD","doi":"10.1002/joa3.70109","DOIUrl":"https://doi.org/10.1002/joa3.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conduction system disease may represent an early manifestation of underlying structural heart disease, including infiltrative disorders. Timely diagnosis of underlying cardiomyopathy has significant implications for clinical management, guiding both disease-modifying medical therapy and decisions around device implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We sought to investigate the utility of cardiac magnetic resonance imaging (CMR) in patients with conduction system disease and preserved LV function on echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated all patients undergoing CMR between 2005 and 2023 at our institution for the investigation of advanced conduction system disease (complete heart block, Mobitz II block, or bifascicular block). We excluded patients with known systolic heart failure (LVEF&lt;50%) prior to CMR. We evaluated the prevalence of CMR-detected myocardial fibrosis and infiltrative cardiomyopathy in this cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred nineteen patients were identified (mean age 49 ± 15 years, 52% male). Complete heart block was the most common indication (50%), followed by bifascicular block (27%) and Mobitz II block (23%). Mean LVEF on echocardiography prior to CMR was 60.0 ± 3.1%. CMR-detected late gadolinium enhancement (LGE) was present in 32/119 patients (26.9%). Cardiac sarcoid was the most common final diagnosis (<i>n</i> = 19, 16%), of whom only five (26%) had known extracardiac sarcoid prior to CMR. Cardiac fibrosis was observed in a similar proportion of patients across the three subtypes of conduction disease studied (<i>p</i> = 0.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiac fibrosis is present in a substantial proportion of patients undergoing CMR for the investigation of conduction disease, even when LV function appears preserved on echocardiography. Cardiac MRI may be an important adjunctive tool for the investigation of conduction disease, particularly in younger patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573411","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":"AI-ECG for early detection of atrial fibrillation: First-year results from a stroke prevention study in Shimizu, Japan","authors":"Mayumi Masumura MD,&nbsp;Atsuyuki Ohno MD,&nbsp;Haruhiko Yoshinaga MD,&nbsp;Takeshi Sasaki MD,&nbsp;Yasuteru Yamauchi MD,&nbsp;Hitoshi Hachiya MD,&nbsp;Atsushi Takahashi MD,&nbsp;Yasushi Imai MD,&nbsp;Hideo Fujita MD,&nbsp;Kensuke Ihara MD,&nbsp;Yusuke Ebana MD,&nbsp;Toshihiro Tanaka MD,&nbsp;Tetsushi Furukawa MD,&nbsp;Tetsuo Sasano MD","doi":"10.1002/joa3.70132","DOIUrl":"https://doi.org/10.1002/joa3.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>An artificial intelligence algorithm-guided electrocardiogram (AI-ECG) has been developed to detect atrial fibrillation (AF) in patients with sinus rhythm (SR). However, its utility for population-based screening remains unclear in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and Results</h3>\u0000 \u0000 <p>In this prospective cohort study, “SPAFS” (Stroke Prevention by Early Detection of AF in Shimizu), participants who underwent health examinations at the Shimizu Medical Association Examination Center from January 2022 to July 2023 were enrolled, with known AF excluded. ECGs were categorized by AI as low-, moderate-, or high risk: non-SR were labeled as non-applicable (NA). All participants underwent 7-day single-lead ECG monitoring. Among 362 participants (61.1 ± 10.5 years, 38% male, CHADS2 score 0.49 ± 0.70), AF was newly detected in 3.0% (<i>n</i> = 11), with increasing prevalence across AI risk categories. The non-low-risk group (moderate, high, and NA) had a significantly higher AF detection rate than the low-risk group (OR 9.36, 95% CI 1.99–44.01). Subgroup analysis in those aged ≥65 years showed a similar trend (OR 8.09 [95%CI 1.63–39.7]). When the NA group (not eligible for AI) was excluded, similar trends were observed, although statistical significance was attenuated (OR 4.89 [95% CI 0.88–27.1] in the total, 5.09 [95% CI 0.89–29.0] in those aged ≥65 years). In the total cohort, AI-ECG showed higher discriminative ability than the CHADS₂ score ≥1 in both the total cohort (AUC 0.75 vs. 0.68) and participants aged ≥65 years (AUC 0.73 vs. 0.61).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI-ECG risk determination correlated with AF detection in a Japanese healthy cohort, especially in the aged population, supporting its utility as a population-based screening tool.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558303","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}