Journal of Arrhythmia最新文献

{"title":"Novel anticoagulation therapy using apple watch after catheter ablation for atrial fibrillation—Up to AF trial: Design and rationale","authors":"Akihiro Sunaga MD, PhD,&nbsp;Nobuaki Tanaka MD,&nbsp;Yasuyuki Egami MD,&nbsp;Hitoshi Minamiguchi MD,&nbsp;Takafumi Oka MD, PhD,&nbsp;Masato Kawasaki MD,&nbsp;Koichi Inoue MD, PhD,&nbsp;Masaharu Masuda MD, PhD,&nbsp;Miwa Miyoshi MD, PhD,&nbsp;Nobuhiko Makino MD, PhD,&nbsp;Tetsuya Watanabe MD, PhD,&nbsp;Daisaku Nakatani MD, PhD,&nbsp;Katsuki Okada MD, PhD,&nbsp;Hirota Kida MAS,&nbsp;Yuki Matsuoka MD,&nbsp;Daisuke Sakamoto MD,&nbsp;Tetsuhisa Kitamura MD, MSc, DrPH,&nbsp;Tomomi Yamada PhD,&nbsp;Yohei Sotomi MD, PhD,&nbsp;Yasushi Sakata MD, PhD,&nbsp;the OCVC-Arrhythmia Investigators","doi":"10.1002/joa3.13194","DOIUrl":"10.1002/joa3.13194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Continuous anticoagulation based on the CHA2DS2-VASc score is recommended to prevent embolism caused by atrial fibrillation (AF), but it does not consider AF episodes. The Apple Watch's continuous heart rhythm monitoring and fast-acting direct oral anticoagulants (DOACs) could enable precise, episode-tailored anticoagulation, reducing bleeding risks while preventing stroke. This study evaluates Apple Watch-guided personalized anticoagulation therapy, adjusting DOAC usage based on real-time AF detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter prospective single-arm study will enroll patients who have maintained sinus rhythm post-ablation and are on DOACs. The target enrollment is 50 patients free of AF for at least 30 days following the initiation of Apple Watch monitoring. If no AF occurs for the first 30 days of monitoring, anticoagulants will be discontinued on day 31. If AF is confirmed after day 31, DOAC administration will be resumed and continued until the end of the observation period. The primary endpoint is the reduction in the total number of days with DOACs from day 31 to day 360 compared to the conventional method of continuing anticoagulation. Secondary endpoints include all-cause mortality, stroke, systemic thromboembolism, bleeding events, and Apple Watch malfunctions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Enrollment of a total of 50 patients was completed in April 2024. Follow-up of the last enrolled patient will be completed in April 2025 and primary results are expected to be available in late 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Up to AF trial is the first trial to evaluate Apple Watch-guided personalized anticoagulation therapy. This trial represents a potential advancement in personalized medicine for AF management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006100","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":"Impact of prolonged QTc interval on mortality risk with hypertrophic cardiomyopathy","authors":"Shun Hasegawa MD,&nbsp;Satoshi Higuchi MD, PhD,&nbsp;Yuichiro Minami MD., PhD,&nbsp;Masayuki Sakai MD,&nbsp;Yuko Matsui MD,&nbsp;Shota Shirotani MD,&nbsp;Shintaro Haruki MD, PhD,&nbsp;Daigo Yagishita MD, PhD,&nbsp;Morio Shoda MD, PhD,&nbsp;Junichi Yamaguchi MD, PhD","doi":"10.1002/joa3.13199","DOIUrl":"10.1002/joa3.13199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between corrected QT (QTc) interval and life-threatening cardiac events in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study sought to investigate whether the prolonged QTc was associated with HCM-related death in patients with HCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 445 patients with HCM (mean age 51 ± 16 years, 67% men). The QTc interval was measured at the time of the initial evaluation and the patients were classified into those with and without QTc prolongation, which was defined as a QTc interval &gt;450 ms. HCM-related death was defined as a combined endpoint of sudden death or potentially lethal arrhythmic events, heart failure-related death, and stroke-related death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Prolonged QTc interval was found in 120 patients (26.4%) at the time of enrollment. Over a median (IQR) follow-up period of 8.1 (4.6–11.9) years, a total of 67 patients (15.1%) experienced HCM-related deaths including 57 (12.8%) with the endpoint of sudden death or potentially lethal arrhythmic events. In a multivariable analysis that included prolonged QTc interval and the risk factors for life-threatening events, prolonged QTc interval was independently associated with an HCM-related death (adjusted hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.16–3.16; <i>p</i> = .011) and this trend also persisted for the combined endpoint of sudden death or potentially lethal arrhythmic events (adjusted HR: 2.01: 95% CI: 1.17–3.46; <i>p</i> = .012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort of patients with HCM, QTc prolongation may be associated with HCM-related death, including the endpoint of sudden death or potentially lethal arrhythmic events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006093","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":"Sex differences in atrial fibrillation in India: Insights from the Kerala-AF registry","authors":"Peter Calvert MBChB,&nbsp;Yang Chen MBChB,&nbsp;Ying Gue PhD,&nbsp;Dhiraj Gupta MD,&nbsp;Jinbert Lordson Azariah MSc,&nbsp;A. George Koshy MD,&nbsp;Geevar Zachariah MD,&nbsp;K. U. Natarajan MD,&nbsp;Gregory Y. H. Lip MD,&nbsp;Bahuleyan Charantharayil Gopalan MD,&nbsp;the Kerala AF Registry Investigators","doi":"10.1002/joa3.13195","DOIUrl":"10.1002/joa3.13195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Much data informing sex differences in atrial fibrillation (AF) comes from Western cohorts. In this analysis, we describe sex differences in Kerala, India, using the Kerala-AF registry—the largest AF registry from the Indian subcontinent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥18 years were recruited from 53 hospitals across Kerala. Patients were compared for demographics, treatments, and 12-month outcomes, including major adverse cardiovascular events (MACE) and bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Male patients were more likely to have a smoking and/or alcohol history and had more ischaemic heart disease (46.2% vs. 25.5%; <i>p</i> &lt; 0.001). Female patients had more valvular AF (35.1% vs. 18.0%; <i>p</i> &lt; 0.001), and more use of calcium-channel blockers (23.3% vs. 16.5%; <i>p</i> &lt; 0.001) or digoxin (39.6% vs. 28.5%; <i>p</i> &lt; 0.001). Almost one in four patients were not anticoagulated despite raised CHA₂DS₂-VASc scores. 12-month MACE outcomes did not differ by sex (male: 30.2% vs. female: 29.4%; <i>p</i> = 0.685), though bleeding events were more common in male patients (2.4% vs. 1.3%; <i>p</i> = −0.038), driven by minor bleeding (1.2% vs. 0.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this large AF cohort from India, male patients had a higher prevalence of ischaemic heart disease, smoking, and alcohol use, while female patients had a higher prevalence of valvular heart disease. MACE did not differ by sex, though bleeding was more common in males. Almost a quarter of patients were not anticoagulated despite raised thromboembolic risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005227","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":"Malnutrition and risks of atrial fibrillation recurrence after catheter ablation","authors":"Phuuwadith Wattanachayakul MD,&nbsp;Thitiphan Srikulmontri MD,&nbsp;Vitchapong Prasitsumrit MD,&nbsp;Thanathip Suenghataiphorn MD,&nbsp;Pojsakorn Danpanichkul MD,&nbsp;Jakrin Kewcharoen MD,&nbsp;Nipith Charoenngam MD,&nbsp;Sumeet Mainigi MD","doi":"10.1002/joa3.13196","DOIUrl":"10.1002/joa3.13196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent data showed an association between malnutrition and increased all-cause mortality and thromboembolic risk in patients with atrial fibrillation (AF). However, the impact of malnutrition on the clinical outcomes for patients undergoing catheter ablation for AF is still debated. Our study aimed to examine this relationship using all existing available data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review of MEDLINE and EMBASE databases from inception to April 2024, analyzing the association between malnutrition, assessed by the Geriatric Nutritional Risk Index (GNRI), and the risk of AF recurrence in patients who underwent catheter ablation for AF, compared to those without malnutrition. Relative Risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 3 cohort studies with 1697 participants undergoing AF ablation (10.9%) who had malnutrition indicated by GNRI score below 98. Patients with malnutrition had a higher risk of AF recurrence following catheter ablation for AF compared to those without malnutrition (Pooled RR = 2.74, 95% CI 1.36–5.51, <i>I</i>² = 67%, <i>p</i> = .005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our pooled analysis indicates that malnourished patients undergoing catheter ablation for AF have an increased risk of AF recurrence compared to non-malnourished patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006096","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":"First in Asia: Ventricular tachycardia ablation in patients with mechanical aortic and mitral valves using right atrium to left ventricle approach","authors":"Bai Sitti Ameerah Asleah B. Tago MD,&nbsp;Chin-Yu Lin MD, PhD,&nbsp;Ting-Yung Chang MD","doi":"10.1002/joa3.13186","DOIUrl":"10.1002/joa3.13186","url":null,"abstract":"<p>With the cases of mechanical valves, especially double mitral and aortic valves, ablation at the left ventricle is very challenging. This case report used equipments that are readily available in the Electrophysiology laboratory, which can make the access feasible. \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":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006067","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":"Clinical implication of ANTWERP score in patients receiving catheter ablation for atrial fibrillation","authors":"Naoya Kataoka MD,&nbsp;Teruhiko Imamura MD","doi":"10.1002/joa3.13193","DOIUrl":"10.1002/joa3.13193","url":null,"abstract":"<p>Catheter ablation for atrial fibrillation (AF) in patients with systolic heart failure is a well-established therapeutic procedure. However, predicting the degree of improvement in left ventricular ejection fraction (LVEF) following catheter ablation remains challenging. Ling and colleagues recently applied the ANTWERP score, a novel predictive tool, to estimate postablation LVEF improvement in an Asian cohort.<span>¹</span> They determined a specific ANTWERP score cutoff to identify “responders” — patients who are likely to experience significant LVEF enhancement after ablation. Nonetheless, several concerns warrant attention.</p><p>The clinical utility of the ANTWERP score for assessing catheter ablation candidacy in AF patients remains ambiguous. For instance, recent studies have introduced a novel classification for response to cardiac resynchronization therapy (CRT). Following CRT initiation, patients exhibiting early LVEF stabilization demonstrate superior clinical outcomes compared to those with subsequent LVEF decline.<span>²</span> Notably, an LVEF increase is not a requisite for classifying responders to CRT. Similarly, in the context of AF catheter ablation, LVEF improvement may be limited in patients with a history of myocardial infarction. Nevertheless, ablation remains indicated in such cases to prevent heart failure exacerbation. Furthermore, catheter ablation may also be indicated to reduce AF burden, potentially leading to LVEF improvement, regardless of the ANTWERP score. Thus, ablation could be justified in patients with reduced LVEF irrespective of their ANTWERP score.</p><p>The ANTWERP score does not appear to predict AF recurrence postablation effectively.<span>¹</span> In their study, nonresponders experience early AF recurrence, whereas responders are more likely to encounter recurrence beyond 1 year postprocedure. Nonresponders with elevated ANTWERP scores frequently exhibited larger left atria and pulmonary veins, which may facilitate reconnection gaps. In contrast, late-phase AF recurrence in responders may stem from nonpulmonary vein foci.<span>³</span> Did the authors collect data regarding the specific origins of AF recurrence? Tailoring the therapeutic approach for AF catheter ablation may benefit from stratification by ANTWERP score.</p><p>Authors declare no conflict of interests for this article.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006001","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":"Paroxysmal atrial fibrillation is associated with poor sleep quality: Tamagawa cross-sectional study on the relationship between lifestyle and atrial fibrillation (TAMAGAWA-AF study)","authors":"Toshiaki Otsuka,&nbsp;Haruhiko Ikegami,&nbsp;Eitaro Kodani,&nbsp;Kouichi Sakabe,&nbsp;Hirokazu Hatano,&nbsp;Mitsuaki Takami,&nbsp;Manabu Hironaka,&nbsp;Kenichi Fukai,&nbsp;Kazuya Yoshimoto,&nbsp;the TAMAGAWA-AF Study","doi":"10.1002/joa3.13189","DOIUrl":"10.1002/joa3.13189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quality of life (QOL) is reduced in patients with atrial fibrillation (AF). However, data regarding the association between sleep quality, one of the major components of QOL, and AF are insufficient. This cross-sectional study aimed to elucidate whether sleep quality is reduced in patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited 2054 consecutive outpatients (64 ± 10 years, 1089 men) who had regularly presented to 26 clinics affiliated with the Tamagawa Medical Association, Tokyo, Japan. The patients were divided into paroxysmal AF (PaAF), persistent or permanent AF (PeAF), and non-AF groups. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The global PSQI score was calculated according to the answer to each question, and poor sleep quality was defined as a global PSQI score ≥6 points. Logistic regression analysis was used to obtain odds ratio for poor sleep quality in the PaAF and PeAF groups, relative to the non-AF group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PaAF group showed significantly increased odds ratio for poor sleep quality (1.49, 95% confidence interval 1.02–2.17), after adjusting for multiple potential confounders. In contrast, no significant odds ratio for poor sleep quality was observed in the PeAF group (1.09, 95% confidence interval 0.70–1.71). Among the PSQI components, poor subjective sleep quality and sleep disturbances were the main determinants of poor sleep quality in the PaAF group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sleep quality was found to be reduced in patients with PaAF, and this may be attributed to poor subjective sleep quality and sleep disturbances.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006105","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":"Feasibility and efficacy of 50 W ablation with the TactiFlex catheter for the initial pulmonary vein isolation of atrial fibrillation","authors":"Kazuhisa Matsumoto MD, PhD,&nbsp;Naomichi Tanaka MD, PhD,&nbsp;Wataru Sasaki MD,&nbsp;Tsukasa Naganuma MD,&nbsp;Masataka Narita MD,&nbsp;Daisuke Kawano MD,&nbsp;Hitoshi Mori MD, PhD,&nbsp;Kenta Tsutsui MD, PhD,&nbsp;Yoshifumi Ikeda MD, PhD,&nbsp;Takahide Arai MD, PhD,&nbsp;Shintaro Nakano MD, PhD,&nbsp;Kazuo Matsumoto MD, PhD,&nbsp;Ritsushi Kato MD, PhD","doi":"10.1002/joa3.13191","DOIUrl":"10.1002/joa3.13191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A novel contact force (CF) sensing catheter with a mesh-shaped irrigation tip (TactiFlexTM SE, Abbott), is expected to provide safe and effective radiofrequency ablation. Our previous study revealed that the TactiFlex catheter needs a higher power for pulmonary vein isolation (PVI) due to the long tip length. This study aimed to examine the feasibility and safety of a 50 W ablation with the TactiFlex for PVI of atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A PVI was performed in 100 AF patients using TactiFlex catheters with a 50 W setting, 5-20 g CF, and 15–20 s ablation time. The primary outcomes included a successful PVI, the incidence of first-pass isolations (FPIs), the presence of PV conduction gaps, and the incidence of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FPIs were achieved for 82/100 (82%) right pulmonary veins (RPVs) and 87/100 (87%) left PVs (LPVs). Among the unsuccessful RPV FPIs, residual carina potentials were observed in 16/18 cases (89%), PV gaps in 1/18 cases (5.5%), and both carina and PV gaps in 1/18 cases (5.5%). Similarly, among the unsuccessful LPV FPIs, residual carina potentials were observed in 11/13 cases (84.6%), PV gaps in 1/13 cases (7.7%), and both carina and PV gaps in 1/13 cases (7.7%). Periesophageal nerve injury occurred in 1/100 cases (1%), and no cardiac tamponade occurred. The overall AF-free rate at one-year was 81.7%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 50 W ablation with the TactiFlex demonstrated a high rate of an FPI, low incidence of PV gaps, and proved to be a safe and effective approach for the initial PVI of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006065","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":"Impact of polypharmacy on clinical outcomes in patients with advanced heart failure undergoing cardiac resynchronization therapy","authors":"Yuma Ono MD,&nbsp;Hidekazu Kondo MD, PhD,&nbsp;Taisuke Harada MD,&nbsp;Kunio Yufu MD, PhD,&nbsp;Hiroki Sato MD, PhD,&nbsp;Kazuki Mitarai MD,&nbsp;Keisuke Yonezu MD, PhD,&nbsp;Katsunori Tawara MD,&nbsp;Hidefumi Akioka MD, PhD,&nbsp;Naohiko Takahashi MD, PhD","doi":"10.1002/joa3.13185","DOIUrl":"10.1002/joa3.13185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prevalence rates of heart failure (HF) and hyperpolypharmacy have increased with the aging population. While a negative impact of hyperpolypharmacy on HF clinical outcomes has already been reported, the effects of hyperpolypharmacy on patients with advanced HF with reduced ejection fraction (HFrEF) undergoing cardiac resynchronization therapy (CRT) remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated data from 147 patients with advanced HFrEF who underwent CRT between March 2004 and June 2020. Patients were divided into nonpolypharmacy (&lt;5 medications) and polypharmacy (≥5 medications) groups, as well as nonhyperpolypharmacy (&lt;10 medications) and hyperpolypharmacy (≥10 medications) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the study population was 70.6 ± 9.7 years, and 90 patients (67.2%) were male. The median number of medications used was 10 (interquartile range: 7–13, range: 2–24); Kaplan–Meier survival analysis revealed that the hyperpolypharmacy group had a significantly worse long-term survival rate in terms of major adverse cardiovascular events (MACE; <i>p</i> = 0.004) and all-cause mortality (<i>p</i> = 0.005). Long-term survival in terms of MACE and all-cause mortality was not significantly different between the polypharmacy with cardiovascular medication and nonpolypharmacy with cardiovascular medication groups. By contrast, the polypharmacy with noncardiovascular medication group had a significantly worse long-term survival rate in terms of MACE (<i>p</i> = 0.006) and all-cause mortality (<i>p</i> = 0.003) than the nonpolypharmacy with noncardiovascular medication group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hyperpolypharmacy was significantly associated with adverse cardiovascular outcomes in patients with advanced HFrEF who underwent CRT. Noncardiovascular polypharmacy may underlie the harmful effects of hyperpolypharmacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006091","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 on “Usefulness of peak frequency in electrograms for elimination of left atrial posterior wall residual potentials via epicardial connections”","authors":"Tetsuji Shinohara MD, PhD","doi":"10.1002/joa3.13187","DOIUrl":"10.1002/joa3.13187","url":null,"abstract":"&lt;p&gt;In this issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Ishikura et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported a case of persistent atrial fibrillation (AF) with residual endocardial conduction after left atrial posterior wall (LAPW) isolation. Patients with AF have been treated with either sinus rhythm maintenance (rhythm control) or adequate heart rate control (rate control) to improve symptoms. The EAST-AFNET 4 trial&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; showed that rhythm control is associated with better outcomes, at least in patients with early AF, and that rhythm control should be preferred in such patients. However, in catheter ablation of AF, pulmonary vein isolation (PVI) alone is not effective in maintaining sinus rhythm in some cases, especially in patients with persistent AF. Therefore, several strategies have been investigated in addition to PVI to reduce recurrent AF. Among them, the LAPW isolation has been widely performed with the promise of additional benefits. The LAPW isolation is performed by extending the PVI in lines along the roof and the bottom of the LAPW. However, in the KAPLA study by Kistler et al.,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; the addition of LAPW isolation to PVI in patients with persistent AF did not significantly improve freedom from atrial arrhythmias compared with PVI alone. On the other hand, the addition of LAPW isolation was reported to improve outcomes in patients with persistent AF who did not have low-potential regions in the left atrium and in whom atrial arrhythmias were induced by continuous pacing.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The exact reason for this discrepancy is unknown, but the re-conduction on the LAPW isolation may be part of the cause. When LAPW isolation is performed, transmural conduction block by linear ablation of the left atrial roof and bottom remains challenging, mainly because of epicardial muscle fibers bridging epicardial and endocardial conduction, such as the septopulmonary bundle. Recently, the EnSite X mapping system became available with a new algorithm, the Omnipolar Technology (OT) Near-Field algorithm (Abbott, St. Paul, MN). The algorithm can automatically annotate the highest peak frequency (PF) in local electrograms, resulting in accurate near-field potential annotation.&lt;/p&gt;&lt;p&gt;In this issue, Ishikura et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; described that the residual potentials via epicardial connections (ECs) could be eliminated by using PF analysis of the OT Near-Field algorithm. The conventional absolute &lt;i&gt;dV&lt;/i&gt;/&lt;i&gt;dt&lt;/i&gt; annotation algorithm annotates high-amplitude electrograms. Therefore, the &lt;i&gt;dV&lt;/i&gt;/&lt;i&gt;dt&lt;/i&gt; algorithm probably may not accurately identify the location of an endocardial residual conduction gap in situations when both endocardial and epicardial electrograms are recorded together. In contrast, the OT Near-Field algorithm using the PF value can identify whether the obtained electrograms are near- or far-field signals. In fact, it has been reported that the OT Near-Field algorithm can d","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005950","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}