Journal of Arrhythmia最新文献

{"title":"Editorial to “Improvement in respiratory function and exercise tolerance following video-assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation”—An essential respiratory physiology every electrophysiologist should know-","authors":"Tatsuya Hayashi MD, PhD, Hideo Fujita MD, PhD","doi":"10.1002/joa3.13064","DOIUrl":"10.1002/joa3.13064","url":null,"abstract":"<p>Editorial comment on “Improvement in respiratory function and exercise tolerance following video-assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation.<span><sup>1</sup></span>”</p><p>Complications of catheter ablation for atrial fibrillation include right phrenic nerve palsy. In conventional radiofrequency (RF) ablation, this complication is known to occur during procedures such as superior vena cava (SVC) isolation or right pulmonary vein isolation. While improvements have been observed with treatment modalities such as high-power short-duration ablation,<span><sup>2</sup></span> complete prevention of right phrenic nerve palsy remains challenging. Catheter ablation using cryoballoon, introduced after RF ablation, is considered a safer treatment option for atrial fibrillation. However, it is essential to note that compared to RF ablation, cryoballoon ablation has been associated with a higher incidence of right phrenic nerve palsy at the time of discharge after catheter ablation.<span><sup>3</sup></span> Recent evidence has shown that in cases of persistent atrial fibrillation treated with cryoballoon ablation, there is a higher incidence of phrenic nerve palsy, particularly in long-standing persistent atrial fibrillation cases.<span><sup>4</sup></span> As ablation procedures for persistent atrial fibrillation continue to be explored and utilized more frequently, the likelihood of encountering this complication may increase. Phrenic nerve palsy is often asymptomatic and may spontaneously resolve in many cases, leading it to be perceived as a relatively benign complication. However, some patients may experience severe symptoms, warranting careful attention.</p><p>In this report by Kasai et al., a case of respiratory failure resulting from right phrenic nerve palsy following catheter ablation for atrial fibrillation is described.<span><sup>1</sup></span> While phrenic nerve palsy often does not cause symptoms because of adequate oxygenation by the unaffected lung, the patient in this case, who was elderly and obese, exhibited significant symptoms after the onset of right phrenic nerve palsy. The mechanism of respiratory distress because of phrenic nerve palsy involves “paradoxical breathing” during lung expansion, wherein the flaccid diaphragm on the affected side is drawn toward the pulmonary hilum by negative pressure from the unaffected lung, reducing the inspiratory volume of the unaffected lung.</p><p>Given that phrenic nerve palsy often resolves over time, observation may suffice as a treatment strategy, even in cases where symptoms are present. However, this report suggests that more aggressive intervention may be warranted in cases of severe symptoms. One such intervention involves surgical plication of the affected diaphragm to reduce its flexibility, thereby inhibiting the “rebound” of air from the affected lung to the unaffected lung during lung ex","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"618-619"},"PeriodicalIF":2.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980283","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":"Recurrent episodes of atrioventricular nodal reentrant tachycardia: Sites of ablation success, ablation endpoint, and primary culprits for recurrence","authors":"Shu Hirata MD,&nbsp;Koichi Nagashima MD, PhD,&nbsp;Yoshiaki Kaneko MD, PhD,&nbsp;Shuntaro Tamura MD, PhD,&nbsp;Hitoshi Mori MD, PhD,&nbsp;Suguru Nishiuchi MD, PhD,&nbsp;Michifumi Tokuda MD, PhD,&nbsp;Tetsuma Kawaji MD, PhD,&nbsp;Tatsuya Hayashi MD, PhD,&nbsp;Takuro Nishimura MD, PhD,&nbsp;Masato Fukunaga MD, PhD,&nbsp;Jun Kishihara MD, PhD,&nbsp;Hidehira Fukaya MD, PhD,&nbsp;Jin Teranishi MD,&nbsp;Mitsuru Takami MD, PhD,&nbsp;Masato Okada MD,&nbsp;Naoko Miyazaki MD,&nbsp;Ryuta Watanabe MD, PhD,&nbsp;Yuji Wakamatsu MD, PhD,&nbsp;Yasuo Okumura MD, PhD","doi":"10.1002/joa3.13060","DOIUrl":"10.1002/joa3.13060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrioventricular nodal reentrant tachycardia (AVNRT) sometimes recurs even after anatomical slow pathway (SP) ablation targeting the rightward inferior extension (RIE). This multicenter study aimed to determine the reasons for AVNRT recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Forty-six patients were treated successfully for recurrent AVNRT. Initial treatment was for 38 slow-fast AVNRTs, 3 fast-slow AVNRTs, 2 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 noninducible AVNRT. All initial treatments were of RF application to the RIE; SP elimination was achieved in 11, dual AVN physiology was seen in 29, and AVNRT remained inducible in 5. The recurrent AVNRTs included 34 slow-fast AVNRTs, 6 fast-slow AVNRTs, 3 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 slow-fast and slow-slow AVNRTs. Successful ablation site was within the RIE in 39 and left inferior extension in 7. In 30 of 39, the successful RIE site was in the same area or higher than that of the initial procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For a high majority (around 85%) of patients in whom AVNRT recurs after initial ablation success, the site of a second successful procedure will be within the RIE even though the RIE was originally targeted. Furthermore, a high majority (around 86%) of sites of successful ablation will be higher than those originally targeted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"552-559"},"PeriodicalIF":2.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978331","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 “Associations of the Fibrosis-4 index with left atrial low-voltage areas and arrhythmia recurrence after catheter ablation: Cardio-hepatic interaction in patients with atrial fibrillation”","authors":"Satoshi Higa MD, PhD, FHRS","doi":"10.1002/joa3.13065","DOIUrl":"10.1002/joa3.13065","url":null,"abstract":"&lt;p&gt;In the current issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Yamada et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; retrospectively evaluated the association of the fibrosis-4 (FIB-4) index with left atrial low-voltage areas (LA LVAs) and arrhythmia recurrences postcatheter ablation (CA) in patients with atrial fibrillation (AF) (&lt;i&gt;n&lt;/i&gt; = 343). In this study, patients with FIB-4 indices ≥1.3 had higher prevalences of LA LVAs (&gt;5 cm&lt;sup&gt;2&lt;/sup&gt;) than those without. Furthermore, there was a positive correlation between the quantitative LVA size and FIB-4 index. In multivariate Cox models, a FIB-4 indices ≥1.3 were an independent predictor of AF recurrence after a CB-based PVI without additional LVA ablation. Therefore, the authors proposed a preprocedural assessment of the FIB-4 index could be a useful predictor of the existence of LA LVAs and AF recurrence after a CB-based PVI.&lt;/p&gt;&lt;p&gt;The PVs are major sources of triggering foci initiating AF. Therefore, PVI has become the corner stone of AF ablation but still has not been standardized because additional ablation strategies are required to reduce AF recurrence. Previous reports demonstrated that the extent of LVAs revealed by electroanatomic mapping correlated with the progression of atrial electrical remodeling. Thus, additional ablation of the LVAs post-PVI is one of the key strategies to reduce atrial arrhythmia recurrence. Masuda et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; evaluated the prognosis of 1488 consecutive patients who underwent AF ablation according to the LVA size. In that study, patients with LVAs were more likely to receive substrate ablation beyond the PVI than those without. Patients with LVAs were more often older and females, patients with a previous history of diabetes mellitus, heart failure, or a stroke. Furthermore, patients with LVAs more often had persistent AF. Masuda et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; concluded that both an LVA presence and its extent are associated with poor long-term composite endpoints of death, heart failure, and strokes, irrespective of AF recurrence. Therefore, preprocedural predictors of the existence of LVAs are important for determining the indication for CA, appropriate strategy, and modality.&lt;/p&gt;&lt;p&gt;Liver disease can cause inflammation and autonomic dysfunction, which can contribute to arrhythmogenesis. Huang et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; reported a high prevalence and incidence of AF in patients with liver disease. Although, liver diseases have been suggested to cause the AF to develop and progress, pathological assessments by liver biopsies are contraindicated in anticoagulated patients. In contrast, the FIB-4 index is a noninvasive scoring tool that is available for predicting liver impairment and fibrosis by quickly calculating the constitutional and time-sensitive parameters without an expensive cost. Furthermore, the FIB-4 index has also been suggested to be a risk assessment tool for several chronic diseases including cardiovascular diseases. The prognostic i","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"594-595"},"PeriodicalIF":2.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980474","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":"Revitalizing brain perfusion: Unveiling advancements through rhythm control strategies in atrial fibrillation—A systematic review","authors":"Shinta Dewi Rasti MD,&nbsp;Adra Achirultan Ramainaldo Sugiarto MD,&nbsp;Audia Putri Amalia Nuryandi MD,&nbsp;Militanisa Zamzara Arvianti MD,&nbsp;Romadhana Trisnha Yomara MD,&nbsp;Jeffri Nagasastra MD,&nbsp;Rerdin Julario MD,&nbsp;Rosi Amrilla Fagi MD,&nbsp;Diah Mustika Hesti Windrati MD","doi":"10.1002/joa3.13056","DOIUrl":"10.1002/joa3.13056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent evidence suggests an elevated risk of cognitive impairment and dementia in individuals with atrial fibrillation (AF), irrespective of stroke occurrence. AF, known to reduce brain perfusion, particularly through silent cerebral ischemia, underscores the intricate relationship between cardiac and cerebral health. The heart plays a crucial role in supporting normal brain function, and rhythm control, a standard AF treatment, has demonstrated enhancements in brain perfusion. This systematic review aimed to examine published data concerning the influence of rhythm control on brain perfusion in patients with atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search for relevant studies was carried out in Scopus, PubMed, Cochrane Reviews, ProQuest, and EBSCOhost, spanning from their inception until April 30, 2023. Studies that specifically examined brain perfusion following any form of rhythm control in atrial fibrillation were included in the review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review encompassed 10 studies involving 436 participants. Among these, six utilized electrical cardioversion for rhythm control. The majority (8 out of 10) demonstrated that restoring sinus rhythm markedly enhances brain perfusion. In one of the two remaining studies, notable improvement was observed specifically in a region closely linked to cognition. Additionally, both studies reporting data on the Mini-Mental State Examination (MMSE) showed a consistent and significant increase in scores following rhythm control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Successful rhythm control in AF emerges as a significant contributor to enhanced brain perfusion, suggesting a potential therapeutic avenue for reducing cognitive impairment incidence. However, further validation through larger prospective studies and randomized trials is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"411-422"},"PeriodicalIF":2.2,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984918","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 “Characteristics of radiofrequency lesions in patients with symptomatic periesophageal vagal nerve injury after pulmonary vein isolation”","authors":"Koichiro Ejima MD","doi":"10.1002/joa3.13057","DOIUrl":"10.1002/joa3.13057","url":null,"abstract":"&lt;p&gt;Because the left atrium (LA) and esophagus are adjacent to each other, collateral damage to the periesophageal vagal nerve after ablation of atrial fibrillation (AF) is not uncommon.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The left vagal nerve branches form a plexus anterior to the esophagus and control the esophageal and gastric motility, maintain a lower esophageal sphincter tone, and induce pyloric relaxation. Damage to the periesophageal nerve fibers may result in both reflux (facilitating progression of esophageal lesions) and gastric motility disorders/food retention. The exact pathophysiologic mechanisms of vagal nerve injury are not well understood. Besides the direct thermic effects on neural action potentials, edema and hematomas (disruption of vessels supplying the esophageal wall and giving rise to necrosis) may cause local pressure on vagal nerve branches.&lt;/p&gt;&lt;p&gt;In this issue of the &lt;i&gt;Journal of Arrhythmia&lt;/i&gt;, Yoshimura et al. provided an important assessment of the relationship between the incidence of symptomatic periesophageal vagal nerve injury (PNI) during radiofrequency (RF) catheter ablation of AF and the RF lesion characteristics and distance between the RF lesions and esophagus.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Of 1391 patients who underwent a first-time ablation index-guided pulmonary vein isolation (PVI) using a CARTO system for AF, 10 (0.72%) were diagnosed with symptomatic PNI. In that study, the ablation procedure was performed after integrating the LA electroanatomical maps with the computed tomography (CT) images obtained preprocedure. On the LA posterior wall near the esophagus, they restricted RF applications to a power setting of &lt;30 W and RF duration of &lt;30 s, regardless of the ablation index. Further, the RF delivery was stopped when the esophageal temperature (ET) reached &gt;41°C. They found that the contact force (CF) at the lesion-esophageal distance (LED), defined as the shortest perpendicular distance from the RF-lesion tag on the circumferential ablation line to the anterior aspect of the esophagus, of 0–5 mm was an independent predictor of symptomatic PNI using a multivariate logistic analysis. It is known that the proximity of LA posterior wall to the esophagus is associated with esophageal injury. The clinical significance of this study was that it revealed that not only the proximity of the esophagus to the LA posterior wall but also the characteristics of the RF lesions, not the ablation index or RF power but the CF, were associated with symptomatic PNI. The fact that the LEDs in this study were not necessarily accurate and may have underestimated the PNI because the assessment of the PNI was dependent on the presence or absence of symptoms, was a limitation that should be noted when interpreting this study's results. Grosse Meininghaus et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; reported that PVI-induced PNI and gastric motility disorders detected by electrogastrography are quite common and are observed in one-third of pati","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"518-519"},"PeriodicalIF":2.2,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986519","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 hyperuricemia on the recurrence of atrial fibrillation after catheter ablation","authors":"Naoya Kataoka MD,&nbsp;Teruhiko Imamura MD, PhD","doi":"10.1002/joa3.13047","DOIUrl":"10.1002/joa3.13047","url":null,"abstract":"<p>Hyperuricemia has been linked to a heightened incidence of atrial fibrillation (AF). Oseto and colleagues have demonstrated a significant elevation in serum uric acid levels among patients with persistent AF compared to those with paroxysmal AF.<span>¹</span> Moreover, the presence of post-ablation hyperuricemia has been associated with the recurrence of AF in patients with persistent AF. However, several concerns have been raised.</p><p>Uric acid is primarily synthesized by xanthine oxidases, predominantly found in the liver, thus indicating a substantial influence of liver function on serum uric acid levels.<span>²</span> In the authors' study, both uric acid and γ-glutamyl transpeptidase levels were elevated in patients with persistent AF.<span>¹</span> Elevated γ-glutamyl transpeptidase levels may be linked to alcohol consumption, which has been associated with the onset and recurrence of AF.<span>³</span> It is highly recommended to adjust for these potential confounders to accurately assess the impact of serum uric acid levels on AF recurrence.</p><p>While the authors focused on the association between uric acid and left atrial remodeling,<span>¹</span> noteworthy that only a small fraction of xanthine oxidase is located in the left atrium.<span>²</span> Did the author correlate serum uric acid levels with left atrial size, which may be more appropriate? Additionally, investigating the prognostic impact of xanthine oxidase, rather than uric acid, could yield more relevant insights.<span>⁴</span></p><p>The clinical implications of predicting recurrent AF using post-ablation data remain uncertain. Risk stratification of ablation candidates can be enhanced, allowing for more intensive ablation procedures, with reference to pre-procedural risk factors instead of post-procedural ones. Given their findings that serum uric acid levels were higher in patients with persistent AF compared to those with paroxysmal AF,<span>¹</span> post-ablation elevated uric acid levels may simply reflect ongoing AF recurrence.</p><p>Authors declare no conflict of interests for this article.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"651"},"PeriodicalIF":2.2,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140989220","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":"Correction to “Short QT Syndrome: The Current Evidences of Diagnosis and Management”","authors":"","doi":"10.1002/joa3.13043","DOIUrl":"10.1002/joa3.13043","url":null,"abstract":"<p>Dewi IP, Dharmadjati BB. Short QT syndrome: The current evidences of diagnosis and management. J Arrhythm. 2020;36(6):962–966.</p><p>In the third paragraph of the “Introduction” section, we add “Due to its rarity and potential lethality, understanding the pathogenesis and clinical implications of SQTS is crucial. This literature review aims to provide a comprehensive and detailed overview of SQTS. Additionally, this article updates prior review by Reviriego et al.,^a to incorporate the latest advancements and insights of SQTS.”</p><p>In the last paragraph of the “Genetic Factors in SQTS” section, we cite reference b at the end of the following sentence, as in “Templin et al, described another mutation in the CACNA2D1 gene that causes a decrease in the flow of Ca-type L channels (SQTS 6).^b”</p><p>We add two citations as follows.</p><p>a. Reviriego SM, Merino JL. Short QT Syndrome. ESC Council for Cardiology Practice. 2010; 9(2).</p><p>b. Templin C, Ghadri JR, Rougier JS, Baumer A, Kaplan V, Albesa M, et al. Identification of a novel loss-of-function calcium channel gene mutation in short QT syndrome (SQTS6). Eur Heart J. 2011;32(9):1077–88. https://doi.org/10.1093/eurheartj/ehr076</p><p>We apologize for these errors.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"653"},"PeriodicalIF":2.2,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993531","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":"Remote monitoring of cardiac implantable electronic devices using smart device interface versus radiofrequency-based interface: A systematic review","authors":"Vern Hsen Tan MBBS, MRCP,&nbsp;Hui Xin See Tow,&nbsp;Khi Yung Fong MBBS,&nbsp;Yue Wang MD, MRCP,&nbsp;Colin Yeo MBBS, FRCP,&nbsp;Chi Keong Ching MBBS, MRCP,&nbsp;Toon Wei Lim MBBS, PhD","doi":"10.1002/joa3.13054","DOIUrl":"10.1002/joa3.13054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommended remote monitoring (RM) in managing patients with Cardiac Implantable Electronic Devices. In recent years, smart device (phone or tablet) monitoring-based RM (SM-RM) was introduced. This study aims to systematically review SM-RM versus bedside monitor RM (BM-RM) using radiofrequency in terms of compliance, connectivity, and episode transmission time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review, searching three international databases from inception until July 2023 for studies comparing SM-RM (intervention group) versus BM-RM (control group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two matched studies (21 978 patients) were retrieved (SM-RM arm: 9642 patients, BM-RM arm: 12 336 patients). There is significantly higher compliance among SM-RM patients compared with BM-RM patients in both pacemaker and defibrillator patients. Manyam et al. found that more SM-RM patients than BM-RM patients transmitted at least once (98.1% vs. 94.3%, <i>p</i> &lt; .001), and Tarakji et al. showed that SM-RM patients have higher success rates of scheduled transmissions than traditional BM-RM methods (SM-RM: 94.6%, pacemaker manual: 56.3%, pacemaker wireless: 77.0%, defibrillator wireless: 87.1%). There were higher enrolment rates, completed scheduled and patient-initiated transmissions, shorter episode transmission time, and higher connectivity among SM-RM patients compared to BM-RM patients. Younger patients (aged &lt;75) had more patient-initiated transmissions, and a higher proportion had ≥10 transmissions compared with older patients (aged ≥75) in both SM-RM and BM-RM groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SM-RM is a step in the right direction, with good compliance, connectivity, and shorter episode transmission time, empowering patients to be in control of their health. Further research on cost-effectiveness and long-term clinical outcomes can be carried out.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"596-604"},"PeriodicalIF":2.2,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995505","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":"Meta-analysis evaluating apixaban in patients with atrial fibrillation and end-stage renal disease requiring dialysis","authors":"Ahmed AlTurki MD,&nbsp;Mariam Marafi MD,&nbsp;Ahmed Dawas MD,&nbsp;Jacqueline Joza MD,&nbsp;Riccardo Proietti MD, PhD,&nbsp;Vincenzo Russo MD, PhD,&nbsp;Thomas Mavrakanas MD,&nbsp;Emilie Trinh MD, MSc,&nbsp;Catherine Weber MD,&nbsp;Rita Suri MD,&nbsp;Vidal Essebag MD, PhD,&nbsp;Thao Huynh MD, PhD","doi":"10.1002/joa3.13051","DOIUrl":"10.1002/joa3.13051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can offer significant stroke prevention in this population, the accompanying major bleeding risks make warfarin nearly prohibitive. Apixaban was shown to be superior to warfarin in preventing stroke or systemic embolism, with a lower risk of bleeding and mortality in a large, randomized trial of individuals with mostly normal renal function but none with ESRD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically reviewed evidence comparing apixaban versus warfarin for atrial fibrillation in this population, and evaluated outcomes of stroke or systemic embolism, and major bleeding using random-effects models. The main safety outcome was major bleeding, and the main effectiveness outcome was stroke or systemic embolism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found five observational studies of 10 036 patients (2638 receiving apixaban, and 7398 receiving warfarin) meeting inclusion criteria. Pooled analysis demonstrated a significant reduction in major bleeding with apixaban as compared to warfarin (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42–0.61; <i>p</i> &lt; .0001). Apixaban was also associated with a reduction in intracranial bleeding (OR 0.58, 95% CI 0.37–0.92; <i>p</i> = .02) and in gastrointestinal bleeding (OR 0.61, 95% CI 0.51–0.73; <i>p</i> &lt; .0001). Furthermore, apixaban was associated with a reduction in stroke/systemic embolism (OR 0.64, 95% CI 0.50–0.82; <i>p</i> &lt; .0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Apixaban was associated with superior outcomes and reduced adverse events compared to warfarin in observational studies of patients with atrial fibrillation on dialysis. Randomized controlled studies are needed to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"440-447"},"PeriodicalIF":2.2,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141007774","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":"Notched P-wave on digital electrocardiogram predicts the recurrence of atrial fibrillation in patients who have undergone catheter ablation","authors":"Takafumi Okuyama MD,&nbsp;Tomoyuki Kabutoya MD, PhD,&nbsp;Kazuomi Kario MD, PhD","doi":"10.1002/joa3.13050","DOIUrl":"10.1002/joa3.13050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A notched P-wave is associated with the occurrence of atrial fibrillation (AF). However, the association between a notched P-wave and AF recurrence in patients who have undergone a catheter ablation for AF is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 100 subjects who underwent catheter ablation for AF (paroxysmal AF: 60 cases; persistent AF: 40 cases). Twelve-lead electrocardiography (ECG) was conducted, and the peak-to-peak distance in the M shape was calculated automatically using a 12-lead ECG analysis system. A notched P-wave was defined as a P-wave with an M-shape and a peak-to-peak distance of ≥20 ms in lead II. We compared the recurrence of AF in the patients with notched P-wave and the others.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up period was 12 ± 8 months, and a recurrence of AF was observed in 28 patients. The recurrence of AF in the notched P-wave group was significantly higher than that in the controls (log rank 5.14, <i>p</i> = .023). A notched P-wave was a significant predictor of the recurrence of AF after adjustment for age, gender, history of heart failure, history of catheter ablation, persistent AF, use of antiarrhythmic drugs, and the left atrial volume index (hazard ratio 2.470, 95% confidence interval 1.065–5.728, <i>p</i> = .035).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Automatically identified notched P-waves with peak-to-peak distance ≥20 ms were associated with AF recurrence in patients who had undergone catheter ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"472-478"},"PeriodicalIF":2.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141022179","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}