Journal of Arrhythmia最新文献

{"title":"Successful debulking of vegetation extending into the right ventricle using a steerable sheath and leadless retrieval system","authors":"Yoshiki Aono MD,&nbsp;Hiro Yamasaki MD, PhD,&nbsp;Yuto Iioka MD,&nbsp;Kentaro Minami MD,&nbsp;Tomoko Ishizu MD, PhD","doi":"10.1002/joa3.70125","DOIUrl":"https://doi.org/10.1002/joa3.70125","url":null,"abstract":"<p>Lead-associated endocarditis, characterized by large vegetations, poses a significant risk of embolization during transvenous lead extraction, necessitating surgical intervention that may be contraindicated in critically ill patients. We describe a successful catheter-based debulking of massive vegetation extending to the right ventricular apex using a steerable sheath and leadless retrieval system.\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 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515107","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 feasibility of high-power short-duration strategy at the sites adjacent to the esophagus during laser balloon-based pulmonary vein isolation","authors":"Haruta Kato MD,&nbsp;Yoshihisa Naruse MD, PhD,&nbsp;Yutaro Kaneko MD,&nbsp;Taro Narumi MD, PhD,&nbsp;Makoto Sano MD, PhD,&nbsp;Yuichiro Maekawa MD, PhD","doi":"10.1002/joa3.70121","DOIUrl":"https://doi.org/10.1002/joa3.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Laser balloon-based pulmonary vein isolation is an established therapeutic option for atrial fibrillation. However, elevated esophageal temperature is sometimes problematic and increases the risk of collateral esophageal damage. This study aimed to evaluate the efficacy and safety of different power settings at sites where sudden esophageal temperature increases were documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 50 ablation sites in 11 patients where the esophageal temperature reached 39°C within 5 s after ablation. We applied four power settings (12, 10, 8.5, and 5.5 W), and ablation was immediately stopped when the esophageal temperature reached 39°C. Efficacy outcomes included ablation time and total energy, calculated as the product of power and ablation time. Safety outcomes included maximal esophageal temperature and area under the temperature–time curve above 39°C.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Although ablation time was the longest in the 5.5 W group (12 W: 3.1 ± 2.1 s, 10 W: 3.6 ± 2.7 s, 8.5 W: 4.7 ± 3.9 s, 5.5 W: 8.0 ± 7.2 s; <i>p</i> &lt; 0.001), total energy did not differ among the four groups (40 ± 35, 35 ± 26, 38 ± 31, and 40 ± 39 J, respectively; <i>p</i> = 0.864). There were no significant differences in maximal esophageal temperature (40.2 ± 1.7, 40.3 ± 1.9, 40.1 ± 1.5, and 39.8 ± 1.1°C, respectively; <i>p</i> = 0.532) or the area under the temperature–time curve above 39°C (16 ± 49, 18 ± 57, 12 ± 29, and 7 ± 14°C･<i>t</i>, respectively; <i>p</i> = 0.564) among the four groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A high-power, short-duration strategy might allow comparable energy application without excessive esophageal collateral damage, as estimated by the esophageal temperature. However, further research using gastrointestinal endoscopy to evaluate esophageal injury is needed to confirm our results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519619","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":"Quantitative metrics of bipolar electrograms predict ablation success in focal PVCs","authors":"Brijesh Sathian PhD,&nbsp;Syed Muhammad Ali MBBS, FCPS,&nbsp;Javed Iqbal RN, MHA,&nbsp;Ayesha Parvaiz Malik MBBS","doi":"10.1002/joa3.70128","DOIUrl":"https://doi.org/10.1002/joa3.70128","url":null,"abstract":"<p>We read with much interest the paper by Jeong et al. entitled “Quantitative analyses of the distal bipolar electrogram for focal premature ventricular contraction ablation”.<span>¹</span> The authors are to be welcomed for their effort to bring in objective electrogram parameters into a field long under the grip of empirical interpretation. Their application of t½, slope factor (S), and onset-to-surface ECG time (Ts) offers a robust statistical basis for the discrimination of near-field vs. far-field bipolar electrograms (bi-EGMs) in catheter ablation of idiopathic PVCs. These parameters showed good discrimination using area under the curve (AUC) values greater than 0.85.</p><p>Yet, there are some points to note and areas of potential improvement. First, the retrospective single-center study with just 41 cases could be a drawback regarding external generalizability. Prospective multicenter validation with different operators and variable anatomical complexity is called for. Second, though the authors excluded unipolar EGM analysis owing to previously reported limitations,<span>²</span> comparative analysis would have given interesting insight into the incremental value of bipolar quantification.</p><p>The incorporation of these parameters into electroanatomic mapping platforms also poses questions regarding feasibility. For instance, whereas t½ and Ts are easy to compute, the calculation of the slope factor S through nonlinear regression might not be practical in real-time without software development or adaptation.<span>³</span> Further, while the authors propose Ts values can be used to predict lesion depth (~4 mm), this presumption must be histologically validated since lesion depth is also determined by catheter force, duration, and tissue thickness.<span>⁴</span></p><p>Another noteworthy point is that the count of deflections (De#), a venerable target in scar-based VT ablation, lacked predictive ability regarding ablation success in this series. This contradicts common practices and favors a move toward sharper and earlier bi-EGM features as better indicators of effective lesion targeting. But fractionation morphology analysis instead of mere deflection count may provide greater insight into future work.<span>⁵</span></p><p>Despite such restraints, the study is a valuable step toward standardization of EGM interpretation and could potentially have important clinical applications if used in conjunction with real-time mapping systems. We would support further multicenter prospective investigations and further development of automated tools to compute these parameters during ablation (Table 1).</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514773","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 associated with successful electrical cardioversion for atrial fibrillation","authors":"Naoya Kataoka MD, PhD,&nbsp;Teruhiko Imamura MD, PhD","doi":"10.1002/joa3.70124","DOIUrl":"https://doi.org/10.1002/joa3.70124","url":null,"abstract":"<p>Electrical cardioversion is occasionally employed in routine clinical practice for the management of atrial fibrillation (AF). Its success is associated with the avoidance of hospitalization. The authors have identified several predictors of AF recurrence following electrical cardioversion, such as nonhigh-density lipoprotein cholesterol (non-HDL C) and the number of cardioversions<span>¹</span>; however, several important considerations warrant discussion.</p><p>Given the retrospective nature of the study, the scenario of electrical cardioversion likely varied across patients. For example, clinicians may have administered antiarrhythmic agents prior to performing electrical cardioversion, particularly in symptomatic individuals. Such pharmacologic pre-treatment could increase the likelihood of achieving and maintaining sinus rhythm.<span>²</span></p><p>Definitions of successful cardioversion differ across studies. In investigations examining the role of pre-ablation electrical cardioversion, success has been defined as the absence of AF recurrence within 24 hours.<span>³</span> In contrast, this study reports that 81 patients remained free from AF recurrence over a median follow-up period of 60 months—a markedly favorable outcome that surpasses that of contemporary catheter ablation strategies.<span>¹</span></p><p>Recent literature has introduced the concept of “acute atrial fibrillation,” which arises secondary to acute systemic illnesses.<span>⁴</span> In these cases, AF may resolve entirely without recurrence following elimination of the precipitating factor. It is conceivable that patients with this self-limited form of AF were included among those deemed successfully treated in this study.</p><p>The authors propose an association between non-HDL-C, chronic inflammation, and AF recurrence.<span>¹</span> However, the specific mechanistic link between non-HDL-C levels and myocardial inflammation remains unclear. Previous studies have demonstrated a relationship between AF and chronic inflammation or chronic myocardial injury, as indicated by elevated serum levels of high-sensitivity C-reactive protein or troponin.<span>^{5, 6}</span> Typically, elevated non-HDL-C is associated with coronary artery disease, which itself may confound the observed relationship with recurrent AF. Analyzing the correlation between non-HDL-C levels and serum inflammatory markers or troponin may clarify the relationship among these parameters.</p><p>None.</p><p>The authors declare no conflict of interest.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case with congenital absence of the left atrial appendage","authors":"Kosuke Muto MD,&nbsp;Naomichi Tanaka MD, PhD,&nbsp;Hitoshi Mori MD, PhD,&nbsp;Yoshifumi Ikeda MD, PhD,&nbsp;Ritsushi Kato MD, PhD","doi":"10.1002/joa3.70120","DOIUrl":"https://doi.org/10.1002/joa3.70120","url":null,"abstract":"<p>Congenital absence of the left atrial appendage (LAA) is an extremely rare anatomical variation with important implications for the management of atrial fibrillation (AF). Additionally, atrial natriuretic peptide (ANP) production may be compensated by the right atrial appendage (RAA) in cases of congenital LAA deficiency.\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 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339547","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":"Pulmonary vein isolation does not alter cardiovascular afferent autonomic reflexes in atrial fibrillation","authors":"Varun Malik MBBS, PhD,&nbsp;Adrian D. Elliott PhD,&nbsp;Gijo Thomas PhD,&nbsp;Bradley Pitman CCDS, PhD,&nbsp;John L. Fitzgerald MBBS, PhD,&nbsp;Glenn D. Young MBBS,&nbsp;Leonard F. Arnolda MBBS, PhD,&nbsp;Dennis H. Lau MBBS, PhD,&nbsp;Prashanthan Sanders MBBS, PhD","doi":"10.1002/joa3.70119","DOIUrl":"https://doi.org/10.1002/joa3.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. We previously demonstrated abnormal cardiac volume-sensitive reflexes (whose receptors are co-located in veno-atrial tissue) in AF patients. Whether PVI disrupts afferent nerves is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Evaluate whether PVI disrupts afferent volume-sensitive reflexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We consecutively studied autonomic reflexes in AF patients undergoing PVI, repeating the study post-PVI, if AF-free &gt;6 months. We excluded patients with AF recurrence/procedural complications, allowing repeat procedures. We measured beat-to-beat mean arterial pressure (MAP) and heart rate (HR) continuously during low-level Lower Body Negative Pressure (LBNP), at 0, −20 and −40 mmHg (predominantly testing volume baroreceptors); Valsalva reflex (predominantly arterial baroreceptors); and Isometric Handgrip reflex (IHR, both). LBNP produces reflex vasoconstriction, evaluated from forearm blood flow (FBF ∝ 1/vascular resistance).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>18 patients were studied pre-PVI; <i>n</i> = 9 completed both visits. Mean age was 64 ± 3 years (78% male); BMI 28 ± 1 kg/m²; LA size 37 ± 2 mL/m²; and left ventricular function 65 ± 3%. Despite alterations in heart rate variability (HRV), there was no difference in IHR, Valsalva, or LBNP responses pre- versus post-PVI. During LBNP, MAP decreased slightly both pre- (−1.6 ± 3%) and post-PVI (−2.8 ± 1.8%); <i>p</i> = .7. HR increased similarly (<i>p</i> = .7) pre- (10.6 ± 6.4%) and post-PVI (7.2 ± 1.5%). FBF response was unchanged (<i>p</i> = .8). Resting (arterial) baroreflex sensitivity was unaltered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PVI does not impair cardiovascular reflexes involving afferent baroreceptors, suggesting HRV changes reflect efferent modulation or ablation adequacy rather than afferent disruption. Whether disrupting sino-atrial efferent nerves represents a marker of adequate ablation or influences PVI outcomes requires evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367273","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":"Challenges in warfarin versus DOACs for elderly atrial fibrillation: A critique of Takagi and Ueda's study","authors":"Sanjana MBBS,&nbsp;Tazeen Saeed Ali RM, RN, BSN, MS Epidemiology, PhD,&nbsp;Ashfaq Ahmad MBBS,&nbsp;Javed Iqbal RN, BSN, CHN, OTRN, EMBA, MHA, CCITP, PPCR, PhD,&nbsp;Iqra Khan MBBS","doi":"10.1002/joa3.70114","DOIUrl":"https://doi.org/10.1002/joa3.70114","url":null,"abstract":"&lt;p&gt;The article titled “Factors related to the choice of warfarin for treating newly diagnosed non-valvular atrial fibrillation is associated with safety outcomes during anticoagulation: A new-user, active-comparator, retrospective cohort study”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; by the authors Yoshiko Takagi and Shinichiro Ueda clearly outlines the study's comparison of warfarin and direct oral anticoagulants (DOACs) for anticoagulation therapy in nonvalvular atrial fibrillation (NVAF).&lt;/p&gt;&lt;p&gt;I truly appreciate the valuable insights into the safe and unsafe use of warfarin and direct oral anticoagulants provided by this study. Still, a few knowledge gaps affect the generalizability and applicability of the well-defined retrospective cohort study. The article reported the outcomes after giving trials of warfarin and direct oral anticoagulants in patients with nonvalvular atrial fibrillation and found that warfarin is the first choice of physicians over direct oral anticoagulants for old age patients with nonvalvular atrial fibrillation considering their chronic health issues. Hence, warfarin is also associated with a high risk of bleeding as compared to direct oral anticoagulants, which leads to a low risk of bleeding. Still, it remains a challenge whether to prescribe warfarin or direct oral anticoagulants for high-risk patients.&lt;/p&gt;&lt;p&gt;I want to highlight the robust study design, including a large sample size of 2979 patients and using propensity scores ideally to evaluate the effectiveness and safety of warfarin and direct oral anticoagulants. A great approach to organizing an article's writing style is to reflect a broader audience to get access to reading and use it as a citation in their studies. The findings of the study indicate the potential risks for prescribing warfarin and direct oral anticoagulants in older age patients and make it feasible to use or not use them by justifying the outcomes according to the health issues of patients. The authors have comprehensively provided the section on limitations, declared the potential biases, and stated the research domains for future studies.&lt;/p&gt;&lt;p&gt;“Despite the study's strengths and limitations,” I sense that the authors could work on some weak areas to strengthen the findings. For instance, the authors did not lay out the information about medical adherence, which is a significant drawback in this study to prove the efficiency of the final results. A population-based cohort study distinctly stated that availing medical adherence as a potent tool for their study aided in acquiring the profound desired results for comparing different anticoagulants.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; For clinical trials, it is very mandatory to keep an eye on the drugs properly being administered to the patients participating in the study because this is how the study gets its final unbiased results; otherwise, patients can skip the medications, which proves to be the most significant disadvantage of highly comprehensive studies. Th","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339575","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":"Successful pacemaker implantation using left bundle branch area pacing in a patient with dextrocardia: A case report","authors":"Yoshiro Tsuruta MD,&nbsp;Toshihiko Goto MD, PhD,&nbsp;Yomei Sakurai MD,&nbsp;Kento Mori MD, PhD,&nbsp;Yoshihiro Seo MD, PhD","doi":"10.1002/joa3.70118","DOIUrl":"https://doi.org/10.1002/joa3.70118","url":null,"abstract":"<p>The left image shows an intraoperative fluoroscopic view with left–right inversion, and the right image is a postoperative noncontrast CT. Both demonstrate the right ventricular lead positioned in the interventricular septum.\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 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315380","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":"An emerging role of inflammatory biomarker (suPAR) for prognostic evaluation of atrial fibrillation","authors":"Nihar Jena MD","doi":"10.1002/joa3.70116","DOIUrl":"https://doi.org/10.1002/joa3.70116","url":null,"abstract":"&lt;p&gt;Atrial fibrillation (AFib) is a chronic cardiovascular condition that poses a significant global challenge due to difficulties in identification and treatment. The global burden of AFib and atrial flutter has been rising over the past decade, with a prevalence of 52.5 million reported in 2021 and 10.55 million reported in the United States in 2019.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although various risk scores, such as CHAD2-VASc and HAS-BLED, as well as inflammatory biomarkers like C-reactive protein (CRP), are available, there is a need for further research in this area. This research could enhance our ability to prognosticate both short-term and long-term outcomes for individuals with AFib. Wisborg et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; provided a timely and thought-provoking prospective analysis of AFib patients admitted to the emergency department with elevated soluble urokinase plasminogen activator receptor (suPAR) levels, showing an increased all-cause mortality at 1 year.&lt;/p&gt;&lt;p&gt;The novel biomarker suPAR has been identified as a stable biomarker for cardiovascular disease associated with chronic inflammation. suPAR is a cleaved product of plasminogen activator receptor and a component of the fibrinolytic system, which is usually formed due to an immunological response to inflammation from the cell surface.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Various studies have shown promising results for predicting long-term cardiovascular outcomes like acute myocardial infarction, atherosclerosis, and coronary calcifications.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; In a study by Ichihara, the prevalence of suPAR level was shown to be higher in nonparoxysmal AFib patients.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; This prospective cohort study, comprising 339 patients, showed higher mortality in the patient group with a higher level of suPAR. The authors depicted a 12% mortality increase per unit ng/mL increase in suPAR despite adjusting for age, sex, smoking, creatinine, and another inflammatory biomarker like CRP.&lt;/p&gt;&lt;p&gt;This study highlights the importance of suPAR in AFib for several compelling reasons. First, stratifying high-risk AFib patients based on a higher level of suPAR can help determine the level of care and predict outcomes in patients presenting to the emergency department or inpatient setting. Second, suPAR has a longer half-life than other cardiac biomarkers, making it a more reliable long-term prognostic marker, especially given the often delayed presentation and chronic nature of AFib.&lt;/p&gt;&lt;p&gt;The study is well-designed and has an adequate sample size with a statistically significant outcome. The statistical modeling is robust, and the variables were adjusted using multivariate Cox regression, along with adjustments for other variables. Nonetheless, the major limitation is that the study is a prospective analysis in a single center, so generalizability is questionable. Furthermore, the cause of death was not pinpointed to cardiovascular etiology, making it challenging to determine whether","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292284","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":"JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias","authors":"Yu-ki Iwasaki,&nbsp;Takashi Noda,&nbsp;Masaharu Akao,&nbsp;Tadashi Fujino,&nbsp;Teruyuki Hirano,&nbsp;Koichi Inoue,&nbsp;Kengo Kusano,&nbsp;Toshiyuki Nagai,&nbsp;Kazuhiro Satomi,&nbsp;Tetsuji Shinohara,&nbsp;Kyoko Soejima,&nbsp;Yohei Sotomi,&nbsp;Shinya Suzuki,&nbsp;Teiichi Yamane,&nbsp;Tsukasa Kamakura,&nbsp;Hiroyuki Kato,&nbsp;Arimi Katsume,&nbsp;Yusuke Kondo,&nbsp;Kenji Kuroki,&nbsp;Hisaki Makimoto,&nbsp;Hiroshige Murata,&nbsp;Takafumi Oka,&nbsp;Nobuaki Tanaka,&nbsp;Nobuhiko Ueda,&nbsp;Hiro Yamasaki,&nbsp;Seigo Yamashita,&nbsp;Ryobun Yasuoka,&nbsp;Kenji Yodogawa,&nbsp;Kazutaka Aonuma,&nbsp;Takanori Ikeda,&nbsp;Toru Minamino,&nbsp;Hideo Mitamura,&nbsp;Akihiko Nogami,&nbsp;Ken Okumura,&nbsp;Hiroshi Tada,&nbsp;Takashi Kurita,&nbsp;Wataru Shimizu,&nbsp;Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group","doi":"10.1002/joa3.70033","DOIUrl":"https://doi.org/10.1002/joa3.70033","url":null,"abstract":"<p>\u0000 \u0000 </p><p>Several randomized controlled trials (RCTs) have investigated the role of ICDs for primary prevention in patients with reduced left ventricular ejection fraction (LVEF), and have shown efficacy in preventing sudden cardiac death (SCD) in heart failure patients with LVEF ≤35%.<span>^{8, 9}</span> On the other hand, the DANISH trial, a prospective comparative study of ICDs in 1,116 patients with nonischemic cardiomyopathy, showed no clear mortality benefit of ICDs for primary prevention in patients with nonischemic cardiomyopathy.<span>¹⁰</span> A meta-analysis of 6 trials for nonischemic cardiomyopathy, including DANISH,<span>¹¹</span> showed that ICDs significantly reduced relative mortality; however; it was unclear whether the ICD was more useful in selected patients. It is necessary to identify the patient population in which ICDs are most useful.</p><p>In the subanalysis of the Nippon Storm study, Sasaki et al. reported that the incidence of appropriate ICD therapy in nonischemic cardiomyopathy patients for primary prevention was 21%, during a mean follow-up of 775 days.<span>¹²</span> The HINODE study<span>¹³</span> showed that the mortality and appropriate ICD therapy rates were similar to those in MADIT-RIT for Japanese heart failure patients. In that study, 171 propensity-matched patients for primary prevention from among 354 enrolled patients were compared to 985 patients in the MADIT-RITstudy,<span>¹⁴</span> which revealed no significant differences in annual survival rates (96.3% in the HINODE group vs. 96.9% in the MADIT-RIT group, P=0.29) or annual appropriate ICD therapy-free rates (94.7% vs. 96.8%, P=0.61) between the 2 groups. The incidence of fatal arrhythmias in patients with heart failure in Japan in recent years is comparable to that in Europe and the USA, but higher than previously thought.</p><p>Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas of unknown cause.<span>⁴⁷</span> Among the affected organs, pulmonary involvement is the most common, but cardiac involvement (cardiac sarcoidosis) is observed in ≈5% of patients, and cardiac involvement is responsible for about half of all deaths due to sarcoidosis.<span>^{48, 49}</span> In recent years, isolated cardiac sarcoidosis with lesions only in the heart<span>⁵⁰</span> and a poor prognosis<span>⁵¹</span> as been reported, which has increased the importance of differential diagnosis.</p><p>The indications for leadless pacemakers (<b>Figures</b> 2,3) were discussed in the 2021 JCS/JHRS Guideline Focus Update for Non-pharmacologic Treatment of Arrhythmias<span>⁶</span> regarding venous obstruction and stenosis, and the need for preservation of venous access. Since then, the indications for leadless pacemakers have continued to expand, and various evidences have emerged. This Focus Update desc","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292286","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}