Journal of Arrhythmia最新文献

{"title":"Two-year clinical outcomes of Taiwanese and other Asian ethnicities with atrial fibrillation treated with edoxaban in the ETNA-AF Asia registry","authors":"Chun-Chieh Wang,&nbsp;Cheng-I Cheng,&nbsp;Kwo-Chang Ueng,&nbsp;Wei-Shiang Lin,&nbsp;Tze-Fan Chao,&nbsp;Lian-Yu Lin,&nbsp;Chien-Lung Huang,&nbsp;Kuan-Cheng Chang,&nbsp;Guang-Yuan Mar,&nbsp;Yu-Cheng Hsieh,&nbsp;Martin Unverdorben,&nbsp;Cathy Chen","doi":"10.1002/joa3.13212","DOIUrl":"10.1002/joa3.13212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The non-vitamin K oral anticoagulant (NOAC), edoxaban, is approved for stroke prevention in patients with atrial fibrillation (AF) in many Asian countries. Nonetheless, data on its long-term effectiveness and safety in routine clinical practice are limited in Taiwan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Global ETNA-AF (Edoxaban Treatment in routiNe clinical prActice) registry is an observational study that integrates data of AF patients receiving edoxaban from multiple regional registries. Here, we report the subgroup analysis of two-year outcomes in Taiwan (<i>N</i> = 973) and three Asian countries (South Korea, Hong Kong, Thailand; <i>N</i> = 2326).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with other Asian ethnicities, edoxaban users in Taiwan were older and had lower creatinine clearance levels. The incidence of clinical events was low and comparable in four Asian countries. Upon 2 years of observation, the annualized rates of cardiovascular death and ischemic stroke/systemic embolic event were 0.50% and 0.90% in Taiwan and 0.33% and 0.91% in other Asian ethnicities, respectively. The annualized rates of major/clinically relevant non-major bleeding and major gastrointestinal bleeding were 2.06% and 0.39% in Taiwan and 2.06% and 0.49% in other Asian ethnicities, respectively. Intracranial hemorrhage was rarely reported in four Asian countries (annualized rate: 0.35%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although some differences in patient characteristics were observed among Asian ethnicities, the low clinical event rates in two-year ETNA-AF data reassure the effectiveness and safety of edoxaban in routine care for AF patients in Taiwan, South Korea, Hong Kong, and Thailand.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005846","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":"Retrieval of a dislodged leadless pacemaker: An example of the double-snare technique","authors":"Momo Taira,&nbsp;Hiroshi Kawakami MD, PhD,&nbsp;Yasushi Asagi,&nbsp;Kazuhisa Nishimura MD, PhD,&nbsp;Osamu Yamaguchi MD, PhD","doi":"10.1002/joa3.13210","DOIUrl":"10.1002/joa3.13210","url":null,"abstract":"<p>A video demonstration presents the retrieval of a dislodged leadless pacemaker using the double-snare technique. Sharing troubleshooting strategies in such cases is clinically important for managing rare pacemaker complications.\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":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005105","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":"Assessment of adverse events stratified by timing of leadless pacemaker implantation with cardiac implantable electronic devices extraction due to infection: A systematic review and meta-analysis","authors":"Naoya Inoue MD,&nbsp;Yuji Ito MD,&nbsp;Takahiro Imaizumi MD,&nbsp;Shuji Morikawa MD,&nbsp;Toyoaki Murohara MD, PhD","doi":"10.1002/joa3.13208","DOIUrl":"10.1002/joa3.13208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.</p>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, <i>I</i>²: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, <i>I</i>²: 4%) for LP implantation after CIED extraction (<i>p</i> = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, <i>I</i>²: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, <i>I</i>²: 21%) after extraction (<i>p</i> = 0.008). Reinfection was not observed in any of these studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005930","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":"Atrial arrhythmias with mediastinal lymphadenopathy presentation of isolated atrial myocarditis","authors":"Muneeb Khawar MBBS,&nbsp;Mirza Muhammad Hadeed Khawar MBBS,&nbsp;Hannan Saeed MBBS","doi":"10.1002/joa3.13206","DOIUrl":"10.1002/joa3.13206","url":null,"abstract":"&lt;p&gt;We have read with great interest the article by Kumar et al., titled “Atrial Arrhythmias with Mediastinal Lymphadenopathy: Presentation of Isolated Atrial Myocarditis,” published in &lt;i&gt;Journal of Arrhythmia&lt;/i&gt; (2024). The work provides valuable insights into the relationship between atrial arrhythmias and isolated atrial myocarditis (AM), emphasizing the relevance of this connection in young patients without conventional risk factors. The authors are to be commended for their efforts in addressing the diagnostic and therapeutic challenges posed by this condition. They aptly conclude that granulomatous myocarditis caused by sarcoidosis or tuberculosis should be considered the primary cause of atrial inflammation and its subsequent role in arrhythmogenesis.&lt;/p&gt;&lt;p&gt;The study employs a comprehensive approach to diagnosing AM in patients with unexplained atrial arrhythmias, utilizing a combination of histopathological examination and &lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT. This methodology proves invaluable in distinguishing AM from other inflammatory and structural heart diseases. A particular strength of this work is the clear correlation established between imaging findings and clinical or histopathological data. The authors effectively employ a diagnostic algorithm that integrates atrial imaging, biopsy, and clinical assessment, thereby offering a systematic framework for diagnosis.&lt;/p&gt;&lt;p&gt;Another noteworthy aspect of the study is the emphasis on individualized treatment plans. Immunosuppressive therapy, including corticosteroids and methotrexate for patients with sarcoidosis, as well as anti-tuberculous regimens for those with &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt;, demonstrated significant clinical benefits. These interventions led to improvements in functional class, reductions in inflammatory markers, and the reversal of abnormal imaging findings, highlighting the therapeutic potential of these strategies. Furthermore, the authors' insights into the management of anticoagulation therapy for stroke prevention in patients with atrial arrhythmias are particularly relevant, as 26.7% of the patients in the study presented with ischemic strokes. This underscores the importance of vigilant monitoring and tailored management in this patient population.&lt;/p&gt;&lt;p&gt;Kumar et al. also highlights the potential of AM to serve as an independent substrate for atrial arrhythmias, even in the absence of common risk factors. This observation aligns with previous studies suggesting that inflammation, particularly granulomatous inflammation, can interfere with atrial electrophysiological properties and promote arrhythmogenesis.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Granulomatous infiltration has been shown to remodel atrial tissue, leading to electrical disturbances and an increased thromboembolic risk.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Kumar et al.'s work reinforces these findings and provides clinical data that support the inflammatory hypothesis of arrhythmogenesis.&lt;/p&gt;&lt;p&gt;While the study offers signi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005992","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":"Utility of using far-field R-wave signals in the detection of fatal ventricular arrhythmia","authors":"Yousaku Okubo MD, PhD,&nbsp;Hisayasu Matsuzaki BE,&nbsp;Shogo Miyamoto MD,&nbsp;Sho Okamura MD, PhD,&nbsp;Yukiko Nakano MD, PhD","doi":"10.1002/joa3.13207","DOIUrl":"10.1002/joa3.13207","url":null,"abstract":"<p>Current guidelines recommend cardioverter-defibrillator (ICD) programming, including faster detection rates, longer detection durations, and strict discrimination for supraventricular tachycardia (SVT) to prevent unnecessary ICD treatment. This delayed-style ICD programming could lead to a rise in the possibility of VF undersensing. To avoid this risk, an innovative algorithm known as VF Therapy Assurance (VFTA; Abbott, Sylmar, CA) has been developed. VFTA uses far-field R-wave signals during VT or VF episodes to provide ICD therapy in cases of near-field R-wave signal undersensing.\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":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005821","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":"Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach","authors":"Karshana Selvarajah MSc,&nbsp;Parisha Khan MSc,&nbsp;Nishat Jahagirdar Pgdip,&nbsp;Antonio Cannatà MD,&nbsp;Rahul Mukherjee MBBS, PhD,&nbsp;Daniel I. Bromage MBChB, PhD,&nbsp;Theresa McDonagh MD,&nbsp;Francis Murgatroyd MA, FRCP,&nbsp;Paul A. Scott DM, FRCP","doi":"10.1002/joa3.13204","DOIUrl":"10.1002/joa3.13204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (<i>n</i> = 80), 43% lower risk and  ≥2/7 treatment strategies (<i>n</i> = 73) 58% reduction, <i>p</i> = &lt;.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (<i>n</i> = 22) 86% lower risk and  ≥2/7 treatment strategies (<i>n</i> = 25), 94% reduction, <i>p</i> &lt; 0.001) compared to patients with 0/7 treatment strategies (<i>n</i> = 8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006098","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":"Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease","authors":"Afonso Nunes-Ferreira MD,&nbsp;Joana Brito MD,&nbsp;Nuno Cortez-Dias MD, PhD,&nbsp;Gustavo da Lima da Silva MD, PhD,&nbsp;Fausto J. Pinto MD, PhD,&nbsp;João de Sousa MD","doi":"10.1002/joa3.13205","DOIUrl":"10.1002/joa3.13205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, <i>p</i> = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; <i>p</i> = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; <i>p</i> &lt; .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006107","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":"High-density mapping in catheter ablation for atrial fibrillation in Asia Pacific region: An observational study","authors":"Yu-Shan Huang,&nbsp;Hui-Nam Pak,&nbsp;Kenichi Hiroshima,&nbsp;Takanori Yamaguchi,&nbsp;Yung-Lung Chen,&nbsp;Hidehira Fukaya,&nbsp;Kyoko Soejima,&nbsp;Bryan Ping-Yen Yan,&nbsp;Itsuro Morishima,&nbsp;Satoshi Shizuta,&nbsp;Kenji Okubo,&nbsp;Qiangsun Zheng,&nbsp;Jong-Il Choi,&nbsp;Chenyang Jiang,&nbsp;Masaki Ieda,&nbsp;Eric Emil Horvath,&nbsp;Li-Wei Lo","doi":"10.1002/joa3.13168","DOIUrl":"10.1002/joa3.13168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Few clinical studies of atrial fibrillation (AF) have focused on Asian patients; data are lacking on current mapping and ablation strategies in the Asia Pacific region (APAC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The HD Mapping Observational Study (NCT04022954) was designed to characterize electroanatomic mapping (EAM) with market-released high-density mapping (HDM) catheters in subjects with AF in APAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Subjects undergoing HDM and indicated for radiofrequency ablation (RFA) to treat AF were prospectively enrolled in APAC. Data included mapping strategy and ablation targets. EAM was performed using one of two commercially available HDM catheters (Advisor™ HD Grid, Sensor Enabled™, Abbott [GRID] or Inquiry™ AFocus II™ Double Loop, Abbott [DL]). Procedure-related adverse events were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred subjects were enrolled at 15 centers: 164 with symptomatic paroxysmal (PAF) and 36 with symptomatic persistent (PersAF) AF for de novo ablation. GRID and DL were used in 186 and 14 cases, respectively. All subjects underwent voltage mapping, with conservative thresholds (low voltage ≤0.5 mV and very low voltage/electrical scar ≤0.1 mV) used in 60.2% and 35.4% of maps, respectively. Focal impulses, rotors, complex fractionated electrograms, and other substrate targets were each searched for in &lt;3% of subjects. Median time to generate a map was 9.0 (Q1: 5.0, Q3: 13.0) minutes. Ablation strategy included pulmonary vein (PV) isolation in all, and non-PV triggers in 75/200 (37.5%) subjects. Five serious adverse events were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study demonstrated an efficient strategy with the feasibility and safety of using HDM during AF ablation procedures in APAC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006071","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 ECMO-supported ventricular tachycardia ablation”","authors":"Wen-Han Cheng MD,&nbsp;Fa-Po Chung MD, PhD","doi":"10.1002/joa3.13200","DOIUrl":"10.1002/joa3.13200","url":null,"abstract":"&lt;p&gt;In this issue of the Journal, Takase et al. present a compelling case involving a patient with myocardial disease secondary to scleroderma. The patient underwent a repeat epicardial catheter ablation for recurrent VT after the failure of initial endocardial ablation. The authors employed carbon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;) insufflation to expand the pericardial space under extracorporeal membrane oxygenation (ECMO) support. This approach mitigated the technical challenges typically associated with epicardial access, particularly in patients with minimal pericardial fluid. The technique demonstrates a significant leap in safety and efficacy, addressing the risks of traditional epicardial access methods.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Catheter ablation has emerged as an alternative treatment option for patients suffering from sustained, monomorphic ventricular tachycardia (VT). Traditional endocardial ablation techniques, leveraging electrophysiological or substrate-based mapping, have shown promise in reducing the burden of ventricular arrhythmia, achieving acute success rates of 60%–80%.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; However, the complex pathology and 3-dimentional architecture of VT isthmus, often involving diffuse myocardial regions, including the epicardium, poses significant challenges to the long-term success of these procedures. This has driven interest in epicardial approaches, which are particularly relevant for nonischemic cardiomyopathy-associated ventricular arrhythmias, where endocardial ablation alone may be insufficient. Recent advancements in endo-epicardial ablation strategies have demonstrated their potential to enhance outcomes, especially in patients with extensive myocardial involvement. Epicardial ablation becomes crucial in cases when endocardial-only approaches fail to achieve clinical success. The introduction of innovative techniques for epicardial access has further expanded the possibilities of safe and effective VT management.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The epicardial approach, initially introduced by Sosa et al., involved the use of a nonsurgical transthoracic 18-G needle for pericardial space access.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Over the years, several innovations have refined this technique to enhance safety and success rates. Methods such as needle-in-needle systems, CO&lt;sub&gt;2&lt;/sub&gt; insufflation, real-time pressure monitoring, blunt-tip concealed needle devices, video-assisted approaches, and the SAFER (Safe Access for Epicardial Radiofrequency) technique have reduced complications and improved procedural outcomes.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Among these innovations, the use of CO&lt;sub&gt;2&lt;/sub&gt; insufflation is noteworthy. Initially, intentional CO&lt;sub&gt;2&lt;/sub&gt; insufflation was performed via the right atrial appendage exit. Though previously described, it has not been widely adopted in clinical practice. Later, CO&lt;sub&gt;2&lt;/sub&gt; insufflation via coronary venous system has been introduced to offer a safer, more efficient means","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005962","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 ventricular arrhythmia (premature ventricular contractions burden and nonsustained ventricular tachycardia) and cardiovascular events in patients without structural heart disease","authors":"Sho Ogiso MD,&nbsp;Takuto Arita MD,&nbsp;Shinya Suzuki MD, PhD,&nbsp;Naomi Hirota MD, PhD,&nbsp;Naoharu Yagi MD,&nbsp;Takayuki Otsuka MD, PhD,&nbsp;Mikio Kishi MD,&nbsp;Hiroto Kano MD,&nbsp;Shunsuke Matsuno MD,&nbsp;Yuko Kato MD, PhD,&nbsp;Tokuhisa Uejima MD, PhD,&nbsp;Yuji Oikawa MD, PhD,&nbsp;Junya Ako MD, PhD,&nbsp;Junji Yajima MD, PhD,&nbsp;Takeshi Yamashita MD, PhD","doi":"10.1002/joa3.13203","DOIUrl":"10.1002/joa3.13203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are common arrhythmias in cardiovascular clinical settings. However, the clinical significance of PVCs and NSVT in the absence of structural heart disease has not yet been fully elucidated. This study aimed to evaluate the association between PVCs, NSVT, and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A study population of 26,117 patients was drawn from the Shinken Database established in June 2004. We enrolled 6332 patients without structural heart disease who underwent 24-h Holter monitoring and were registered up to March 2019. We focused on ventricular arrhythmias and cardiovascular events in patients without structural heart diseases. The study population was divided by the number of baseline PVCs (PVCs: &lt;1000 (<i>n</i> = 5507), 1000–9999 (<i>n</i> = 531), and 10 000 ≤(<i>n</i> = 294)). The study population was also divided according to the presence or absence of NSVT (<i>n</i> = 454 and <i>n</i> = 5878, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>During the follow-up period up to 3 years, there were 16 deaths, 24 heart failure-related hospitalizations, 14 acute coronary syndromes, and 37 embolism events. The frequency of PVCs was not associated with mortality or heart failure. On the other hand, the presence of NSVT was significantly associated with heart failure hospitalization in a multivariate model (hazard ratio: 3.02; 95% CI: 1.03–8.83; <i>p</i> = .044).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients without structural heart disease, NSVT was associated with a higher risk of heart failure hospitalization. Patients with NSVT but no structural heart diseases require careful follow-up and management of heart failure risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005937","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}