Journal of Arrhythmia最新文献

{"title":"Atrial arrhythmias with mediastinal lymphadenopathy presentation of isolated atrial myocarditis","authors":"Sharath Kumar MD,&nbsp;Sachin Yalagudri MD,&nbsp;Daljeet Saggu MD,&nbsp;M. Mansoor MD,&nbsp;Vijaya K. Tourani MD,&nbsp;Calambur Narasimhan MD","doi":"10.1002/joa3.13181","DOIUrl":"10.1002/joa3.13181","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We present a case series of patients with granulomatous myocarditis presenting as atrial arrhythmias accompanied by lymphadenopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial myocarditis (AM) may be the cause of atrial fibrillation (AF) in patients without risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with atrial fibrillation without risk factors underwent 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We performed biopsy of lymph nodes or myocardium in patients with atrial uptake of 18F-FDG-PET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AM was observed in 15 patients. The median age of the patients was 42 years and left ventricular ejection fraction (LVEF) at presentation was 45%. All patients had AF, atrial flutter was noted in 4 patients (26.7%) and 2 patients (13.3%) had atrioventricular nodal reentrant tachycardia (AVNRT). 18F-FDG-PET uptake was noted in the atria in all patients and in the ventricles in 3 patients (20%). Cardiac sarcoidosis was the diagnosis in 12 patients (80%) while 3 patients (20%) had tuberculosis. The median CHA2DS2 VASc score was 1. Four patients (26.7%) presented with ischemic stroke. All patients were treated with disease-specific therapy in addition to antiarrhythmic medications. Over a median follow up of 26 months, a significant improvement in clinical status commensurate with a decline in atrial uptake was noted. A non-significant improvement in LVEF to 56% with disease-specific therapy was observed. (<i>p</i> = 0.09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Atrial fibrillation with granulomatous lymphadenopathy may be a presenting feature of AM. The risk of stroke is high in these individuals. AM should be suspected in young individuals presenting with atrial fibrillation and stroke without conventional risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005938","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":"Investigating the role of electroanatomical mapping in single-shot pulsed field catheter ablation","authors":"Ourania Kariki MD,&nbsp;Panagiotis Mililis MD,&nbsp;Athanasios Saplaouras MD,&nbsp;Theodoros Efremidis MD,&nbsp;Anastasios Chatziantoniou MD,&nbsp;Ioannis Panagiotopoulos MD,&nbsp;Stylianos Dragasis MD,&nbsp;Konstantinos P. Letsas MD, PhD, FEHRA,&nbsp;Michael Efremidis MD, PhD","doi":"10.1002/joa3.13180","DOIUrl":"10.1002/joa3.13180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) is a form of nonthermal energy that has been recently introduced for pulmonary vein isolation (PVI). A multi-electrode pentaspline catheter for delivery of PFA guided by fluoroscopy has become widely available for clinical use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In this study, we aimed to assess whether the addition of electroanatomical mapping (EAM) for confirmation of PVI in the acute phase can increase the efficacy of the procedure in terms of arrhythmia recurrences. A total of 51 patients with atrial fibrillation (AF) scheduled for first time PVI were included in the study. Participants were assigned to receive PVI using fluoroscopy guidance only (Fluoro-only group: 31 patients) or additional validation with EAM (EAM group: 20 patients). Endpoints included arrhythmia recurrence and procedural characteristics. During a 11.2 ± 1.3 months follow-up period, arrhythmia recurrences did not statistically differ between groups (16.1% vs. 20%, <i>p</i> .72). Procedure time was longer in the EAM group (86.5 ± 11.4 vs. 78.4 ± 9.3 min, <i>p</i> .008). EAM revealed 5 nonisolated PVs that were re-ablated using the same catheter. Four patients of the cohort underwent a redo-procedure during the follow-up period. In all 4 cases, at least one reconnected PV was identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a cohort of patients with AF undergoing first time PVI using a pentaspline PFA catheter, PVI validation with EAM did not lead to significantly different arrhythmia recurrence rates compared to PVI without EAM. In the acute phase, the rate of nonisolated PVs was low.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1374-1378"},"PeriodicalIF":2.2,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818064","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 “investigating the role of electroanatomical mapping in single-shot pulsed field catheter ablation”","authors":"Yoshiaki Mizutani MD, PhD,&nbsp;Satoshi Yanagisawa MD, PhD,&nbsp;Yasuya Inden MD, PhD","doi":"10.1002/joa3.13184","DOIUrl":"10.1002/joa3.13184","url":null,"abstract":"&lt;p&gt;Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with an increased risk of stroke, heart failure, dementia, and mortality. Pulmonary vein isolation (PVI) is an effective rhythm control strategy for treating AF.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Safe and effective treatments for PVI have been established with cryoballoon and radiofrequency ablation, both of which use thermal energy in the myocardium. Meanwhile, pulsed field ablation (PFA), a novel ablation technology that uses non-thermal energy, provides electrical pulses to cause non-thermal irreversible electroporation and induce cardiac cell death.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of arrhythmia&lt;/i&gt;, Kariki et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; compared the arrhythmia recurrence and procedural characteristics of PFA for AF between the electroanatomical mapping (EAM) and fluoroscopy groups. Fifty-one patients with AF who underwent PVI for the first time were included in their study (fluoro-only group, 31 patients; EAM group, 20 patients). PVI was performed using the FARAPULSE™ PFA system (Boston Scientific, Natick, MA, USA). In the EAM group, the ablation catheter was exchanged with a multipolar mapping catheter (Advisor™ HD Grid catheter [Abbott Laboratories, Abbott Park, Ill, USA]) after PVI, and the EAM of the left atrium was subsequently generated. As a result of the acute procedures, the procedure time was significantly longer in the EAM group than in the fluoroscopy-only group, whereas there was no significant difference in the fluoroscopy time between the two groups. During a mean follow-up period of 11.2 months, PVI with EAM did not lead to significantly different arrhythmia recurrence rates compared with PVI without EAM. No complications were observed in either of the groups.&lt;/p&gt;&lt;p&gt;In their study, EAM was performed only after fluoroscopy-guided PFA and not before ablation in the EAM group. Obtaining an EAM with a mapping catheter preoperatively is useful for understanding the pulmonary vein (PV) and left atrial anatomy, which may support the learning curve for PV identification and increase the certainty of catheter manipulation, especially for young fellows and residents. Perhaps the acquisition of EAM prior to ablation, in addition to post-mapping, may have influenced the procedure outcomes differently, despite the small number of samples in the current study. A recent non-randomized study with 197 patients undergoing first PVI using the same PFA catheter at a tertiary referral center reported the same efficacy of recurrence-free rate after a 12-month follow-up between the pre- and post-mapping group (&lt;i&gt;n&lt;/i&gt; = 127) and non-mapping group (&lt;i&gt;n&lt;/i&gt; = 70), and the median procedure duration, left atrial dwell time, and fluoroscopic time were significantly shorter in the non-mapping group than in the mapping group.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These findings suggest that the creation of a preoperative EAM is unnecessary. Similarly, the current study demonstrated several po","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1379-1380"},"PeriodicalIF":2.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818023","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":"Achieving reduced radiation exposure with maintained fluoroscopy effectiveness using ultralow-dose settings in cryoballoon ablation","authors":"Takashi Kaneshiro M.D.,&nbsp;Sadahiro Murota M.D.,&nbsp;Takeshi Nehashi M.D.,&nbsp;Minoru Nodera M.D.,&nbsp;Shinya Yamada M.D.,&nbsp;Masamitsu Ikeda R.T.,&nbsp;Yasuchika Takeishi M.D.","doi":"10.1002/joa3.13179","DOIUrl":"10.1002/joa3.13179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Optimization of fluoroscopic image quality for reducing radiation exposure in cryoballoon pulmonary vein isolation (CB-PVI) has not yet been fully investigated. Therefore, we tried to compare the radiation doses among three different X-ray system settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive 148 patients scheduled for their first CB-PVI were prospectively enrolled: low dose with the use of an anti-scatter grid for the first 51 patients (LD + G group), low dose without an anti-scatter grid for the subsequent 46 patients (LD-G group), and ultralow dose (ULD group) with an anti-scatter grid for the remaining 51 patients. We compared the radiation doses required to complete CB-PVI procedures among the groups. There were 27 patients for whom CB-PVI was performed without cine acquisition, but with fluoroscopy only, and the radiation doses were also compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median procedure time and fluoroscopy time were 119 and 35.5 min, respectively, with no significant differences among the groups. The median cumulative air Kerma (AK) decreased in both the LD-G group (71.8 mGy, <i>p</i> &lt; .001) and the ULD group (73.0 mGy, <i>p</i> &lt; .001), compared to the LD + G group (145.0 mGy). Among 27 patients who underwent CB-PVI without cine acquisition, the median cumulative AK further decreased in both the LD-G group (31.4 mGy, <i>p</i> &lt; .05) and the ULD group (22.7 mGy, <i>p</i> &lt; .01), compared to the LD + G group (64.6 mGy).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using an ULD X-ray setting and avoiding cine acquisition, we can reduce radiation exposure, while ensuring the necessary fluoroscopy time for the CB-PVI procedure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1400-1407"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818081","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":"Factors related to the choice of warfarin for treating newly diagnosed nonvalvular atrial fibrillation are associated with safety outcomes during anticoagulation: A new-user, active-comparator, retrospective cohort study","authors":"Yoshiko Takagi BA, MSc,&nbsp;Shinichiro Ueda MD, PhD","doi":"10.1002/joa3.13160","DOIUrl":"10.1002/joa3.13160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Direct oral anticoagulants (DOACs) are preferred for stroke prevention in nonvalvular atrial fibrillation (NVAF); however, warfarin is still used. This study examined why physicians may choose warfarin over DOACs and the associated safety outcomes in patients with NVAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a new-user, active-comparator cohort study in newly diagnosed patients with NVAF to assess safety outcomes after the introduction of DOACs in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median observation period was 1120 days; 1428 patients started anticoagulation therapy with warfarin and 1551 with DOACs. Warfarin was chosen for patients with lower creatinine clearance and left ventricular ejection fractions and those using aspirin and verapamil. The unadjusted risk of major bleeding was considerably higher in the warfarin group but was nonsignificant after adjusting for variables associated with the choice of warfarin, in addition to age and sex. The risk of death was higher in the warfarin group, even after adjustments for relevant variables. However, high-risk subgroups, including those with older ages and multiple comorbidities, such as renal impairment, for whom warfarin was more likely to be selected, had severely compromised prognoses with either anticoagulant. The risk of stroke/systemic embolism was not significantly different between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Warfarin is often chosen for older patients with multiple comorbidities characterized by reduced renal function, which is associated with a higher risk of major bleeding and mortality. These high-risk patients seem to have a poor prognosis regardless of the type of anticoagulant used. Thus, safe anticoagulant therapy remains a challenge for such patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1408-1424"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818044","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":"Critical ablation targets of ventricular tachycardia revealed by activation mapping with both last deflection and peak frequency annotations in a patient of cardiac sarcoidosis","authors":"Shinya Yamada MD,&nbsp;Takashi Kaneshiro MD,&nbsp;Minoru Nodera MD,&nbsp;Sadahiro Murota MD,&nbsp;Yasuchika Takeishi MD","doi":"10.1002/joa3.13177","DOIUrl":"10.1002/joa3.13177","url":null,"abstract":"<p>Different rotation activation pattern (RAP) sites with good pacemap score were identified by activation mapping with both last deflection and peak frequency annotations. These two RAP sites were considered to be the critical ablation targets of ventricular tachycardia in cardiac sarcoidosis, which led to successful ablation without an extensive lesion.\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 6","pages":"1510-1513"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817357","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 “The Japanese catheter ablation registry (J-AB): Annual report in 2022”","authors":"Germaine Loo MBBS,&nbsp;Chi Keong Ching MBBS, FHRS","doi":"10.1002/joa3.13176","DOIUrl":"10.1002/joa3.13176","url":null,"abstract":"&lt;p&gt;In recent years, several nationwide registries for patients undergoing catheter ablation have been published.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This provides perspective on real-world practice, reporting in depth information on the current trends, efficacy, and safety data on catheter ablation. There is a rise in prevalence of atrial fibrillation and other arrhythmias, due to global ageing populations, increased patient comorbidities, and technological advancements in arrhythmia detection.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This translates to an increasing volume and trend of patients undergoing catheter ablation—most prominent for atrial fibrillation. Comparing data from the Japanese Catheter Ablation Registry (J-AB) from 2018 to 2022, there has been an increasing overall number and proportion of atrial fibrillation ablation cases: 40, 422 cases (72.8%) versus 68, 378 cases (75.9%), respectively.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The biggest strength of the J-AB registry lies in its numbers, recording the acute procedural characteristics and outcomes of a total of 90,042 cases, which is one of the largest reported nationwide registries to date. Knowing the ablation trends and volume would aid healthcare cost projection at both hospital and nationwide levels. In addition, this would serve as an important data repository for investigators to explore further regarding the mechanisms and treatment of arrhythmias.&lt;/p&gt;&lt;p&gt;Marked advancements in the field of catheter ablation over the past decades have led to improvements in durability and safety of catheter ablation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The development and utilization of electro-anatomical mapping systems, novel catheters and energy sources for ablation, as well as innovative ablation strategies have revamped the catheter ablation landscape. Cryoablation ablation has showed high acute procedural success and lower incidence of procedural complications compared to radiofrequency ablation (RFA).&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Despite this, looking at the current data from the J-AB 2022 registry, majority of pulmonary vein isolation (PVI) ablation were performed with RFA alone (72.7%), with the rest utilizing alternative techniques with or without concurrent RFA.&lt;/p&gt;&lt;p&gt;Pulsed field ablation (PFA), utilizing electric pulses to produce non-thermal irreversible electroporation and cell death, is emerging as a suitable alternative to achieve PVI. The penta-spline catheter design allows for rapid and efficient PVI, and the integration of PFA catheters with current 3-D electro-anatomical mapping systems can reduce fluoroscopy duration. Although prospective trials have validated the clinical efficacy of PFA, large randomized controlled trials comparing radiofrequency ablation to PFA are awaited.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; We hypothesize that there will be a greater trend towards using PFA for PVI in the coming years and in turn increase the volume of AF ablation.&lt;/p&gt;&lt;p&gt;Results from the J-AB registry showed an acute procedural success ","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1357-1358"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818040","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 “Utility of cardiac implantable electronic device algorithm for detecting severe sleep-disordered breathing in cardiomyopathy”","authors":"Mitsuharu Kawamura MD, PhD","doi":"10.1002/joa3.13167","DOIUrl":"10.1002/joa3.13167","url":null,"abstract":"&lt;p&gt;In this issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Li et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; described the relationship between severe sleep-disordered breathing (SDB) and transthoracic impedance sensing to calculate respiratory disturbance index (RDI) in patients with implantable cardiac defibrillator (ICD). Severe SDB was defined as polysomnography (PSG)–apnea–hypopnea index (AHI) ≥30 episodes/h and was diagnosed by PSG in 66.7% of the patients. RDI was found to have a positive correlation with PSG-AHI (&lt;i&gt;r&lt;/i&gt; = .473, &lt;i&gt;p&lt;/i&gt; = .027). Using the cutoff threshold of RDI for screening of severe SDB of 32 produces a sensitivity of 91.7% and specificity of 16.7%. RDI of 48 episodes/h demonstrated a specificity of 100% and a sensitivity of 58.3% for severe SDB. Defaye et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; reported a prevalence of 78% in moderate to severe SDB and 56% in severe SDB in patients with pacemakers. An optimal cutoff of 20 events/h for the sleep apnea monitoring RDI value was validated to identify severe SDB with a sensitivity of 88.9%, a positive predictive value of 88.9%, and a specificity of 84.6%. SDB is highly prevalent in patients with cardiovascular diseases including heart failure. A transthoracic impedance sensor with an advanced algorithm, the sleep apnea monitoring algorithm, could be used to identify severe SDB in patients with pacemakers. Khayat et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; supported that over 80% of patients with heart failure may have SDB and these patients confers significant disease burden, as well as high morbidity. A recent meta-analysis by Messaoud et al.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; assessing the utility of all ICDs (pacemakers and ICDs) revealed that among the 16 included studies, only four examined patients with implanted ICDs, all within Caucasian populations and indicated that the sensitivity of cardiac implants for SDB diagnosis ranged from 60% to 100%, with specificity from 50% to 100%.&lt;/p&gt;&lt;p&gt;Chen et al.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; reported 64 patients were enrolled, who had never been diagnosed with SDB or underwent PSG examination. After PSG examination, 76.4% patients were diagnosed as combining with SDB (20% severe, 18.2% moderate, and 38.2% mild). RDI calculated by pace markers has a strong positive correlation with PSG-AHI (&lt;i&gt;r&lt;/i&gt; = .76, &lt;i&gt;p&lt;/i&gt; &lt; .001, 95% CI 0.61–0.85). The optimal cutoff value of PM-RDI for advanced SDB (PSG-AHI ≥15) diagnosis was 26, with area under the curve of 0.89. The best cutoff value for severe SDB (PSG-AHI ≥30) identification was 41, with a sensitivity of 81.6%, a specificity of 88.6%. Pacemaker patients present a high prevalence of undiagnosed SDB. Detection of SDB by pacemaker is feasible and accurate in SDB screening and monitoring.&lt;/p&gt;&lt;p&gt;In this issue, Li et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; studied 18 patients completed PSG study and all patients had an ICD. The ICD algorithm uses transthoracic impedance sensing to calculate RDI. Twelve patients (66.7%) had ICD implanted for primary pr","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1460-1461"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817885","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":"Predictors of long-term success after high-density mapping-guided substrate ablation procedures for ventricular tachycardia in patients with ischemic cardiomyopathy","authors":"J. C. Balt MD, PhD,&nbsp;B. G. S. Abeln MD,&nbsp;V. F. van Dijk MD, PhD,&nbsp;M. C. E. F. Wijffels MD, PhD,&nbsp;M. Liebregts MD, PhD,&nbsp;L. V. A. Boersma MD, PhD","doi":"10.1002/joa3.13175","DOIUrl":"10.1002/joa3.13175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>High-density (HD) substrate mapping may increase success of catheter ablation targeting ventricular tachycardia (VT). However, despite its use, recurrent VT is not uncommon. We aim to investigate factors that are associated with outcomes after HD mapping-guided substrate ablation procedures for VT in patients with ischemic cardiomyopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Observational cohort study includes patients with ischemic heart disease who underwent HD mapping-guided substrate ablation of VT. Baseline and procedural characteristics were associated with outcomes after VT ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>VT ablation employing HD mapping was performed in 80 patients. Median follow-up was 2.3 years. VT-free survival at one, two, and five years were 65%, 49%, and 40%. One-, two-, and five-year implantable cardioverter defibrillator (ICD) shock-free survival rates were 90%, 81%, and 70%. Complications occurred in 3 patients (3.8%, 1 vascular, 2 tamponades). Left ventricular ejection fraction (LVEF) and 45 W (vs. 35 W) ablation power were associated with VT-free survival. High ablation power was also associated with shock-free survival. All-cause mortality during follow-up was associated with higher age, the presence of chronic obstructive pulmonary disease (COPD), LVEF, and urgent ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with ischemic cardiomyopathy that had HD substrate mapping-guided VT ablation, ablation power was associated with both VT-free and shock-free survival, underlining the importance of effective target elimination. All-cause mortality during follow-up was associated with several factors (age, COPD, LVEF, and urgent vs. elective ablation), which could be used to guide patient selection for VT ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1442-1451"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818107","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":"Contemporary outcomes of catheter ablation of the structural ventricular tachycardias in severe ischemic and non-ischemic cardiomyopathies in Turkish population","authors":"Emir Baskovski MD,&nbsp;Timucin Altin MD,&nbsp;Omer Akyurek MD,&nbsp;Mahmut Ekrem Cunetoglu MD,&nbsp;Volkan Kozluca MD,&nbsp;Irem Muge Akbulut MD,&nbsp;Nail Burak Ozbeyaz MD,&nbsp;Nazli Turan Serifler MD,&nbsp;Eralp Tutar MD","doi":"10.1002/joa3.13169","DOIUrl":"10.1002/joa3.13169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Currently, there are no data regarding outcomes of the catheter ablation for structural ventricular tachycardia (VT) in Türkiye. In this observational study, we aim to investigate cardiac outcomes of patients undergoing catheter VT ablation at a tertiary center in Türkiye.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational study performed at a single university center. Patients with a confirmed ischemic or non-ischemic cardiomyopathy, undergoing structural VT ablation were included. Procedural and mid-term outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 124 patients were enrolled in the study. 54(43.5%) patients presented with an electrical storm. During the mean follow-up of 351 ± 232 days 10(8.1%) patients experienced a recurrence. There was only one peri-procedural death and cardiac tamponade occurred in two patients.14(11.3%) patients died during the follow-up, most commonly due to a cardiovascular death. In the multivariate analysis only age &gt;70 was found to be correlated with death during follow-up, with <i>p</i> =.008, HR = 4.923.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A good acute success with low complications was observed in patients undergoing VT ablation for structural heart disease in a tertiary center in Türkiye. Mid-term outcomes are comparable with international studies with no difference in VT recurrence in ischemic and non-ischemic patients. Similar to international studies, significant mid-term mortality was observed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1425-1431"},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818072","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}