Journal of Arrhythmia最新文献

{"title":"Association Between Inferior Vena Cava Location and the Number of Deployments of a Leadless Pacemaker","authors":"Tomoya Kimura,&nbsp;Yusuke Yoshikawa,&nbsp;Mari Nezu,&nbsp;Fumihiro Sakakibara,&nbsp;Takahiro Iseda,&nbsp;Takanari Fujita,&nbsp;Shuhei Tsuji,&nbsp;Satoshi Shizuta,&nbsp;Takeshi Morimoto","doi":"10.1002/joa3.70431","DOIUrl":"10.1002/joa3.70431","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While some patients faced the difficulty to implant leadless pacemaker, the relationship between inferior vena cava (IVC) location and procedural difficulty was uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center, cross-sectional study including 96 consecutive patients who underwent implantation of Micra leadless pacemakers between July 2022 and November 2024. Based on the positional relationship between the IVC and the right ventricular septum assessed by preprocedural computed tomography, patients were classified into right-sided and left-sided IVC groups. The primary outcome was multiple deployments defined as the number of device deployments ≥ 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 96 patients were analyzed, including 81 in the right-sided and 15 in the left-sided IVC group. The mean age was 84, and 55 (57%) were male patients. Multiple deployments were observed in 39 (41%) patients. The risk of the primary outcome was significantly higher in the left-sided IVC group than in the right-sided (67% vs. 36%), with an adjusted odds ratio of 9.5 (95% CI: 1.5–58.7, <i>p</i> = 0.02). Procedure time was numerically longer in the left-sided group (36 vs. 25 min, <i>p</i> = 0.11). Pericardial effusion occurred only in two patients in the right-sided group, none requiring intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The left-sided IVC was associated with multiple deployments of a leadless pacemaker and preoperative computed tomography was useful in assessing the procedural difficulty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603304","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":"Diamond-Embedded Temperature Control Catheter Enables Faster and More Efficient Cavotricuspid Isthmus Ablation Compared to Contact Force Sensing Catheters","authors":"Megumi Toraiwa,&nbsp;Hidehira Fukaya,&nbsp;Wataru Shinkai,&nbsp;Sho Ogiso,&nbsp;Yuki Arakawa,&nbsp;Shuhei Kobayashi,&nbsp;Hironori Nakamura,&nbsp;Naruya Ishizue,&nbsp;Jun Kishihara,&nbsp;Jun Oikawa,&nbsp;Shinichi Niwano,&nbsp;Junya Ako","doi":"10.1002/joa3.70427","DOIUrl":"https://doi.org/10.1002/joa3.70427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cavotricuspid isthmus (CTI) ablation is a well-established treatment for atrial flutter (AFL). The DiamondTemp (DT) catheter provides precise real-time tissue temperature feedback during radiofrequency (RF) ablation, optimizing energy delivery. While the efficacy of DT in ablation procedures has been demonstrated, its performance in CTI ablation compared with contact force (CF)-sensing irrigated catheters remains underexplored. This study assessed the efficiency and safety of the DT catheter in CTI ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients who underwent CTI ablation between August 2022 and May 2024. Patients were classified into DT and non-DT groups (TactiFlex, QDOT MICRO, SmartTouch SF, or StablePoint). The primary endpoint was total RF application time. Secondary endpoints included the number of RF applications, total procedure time, acute success rate defined as bidirectional conduction block, and periprocedural complications. All procedures were performed under general anesthesia, using 3D mapping systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 126 patients (mean age 67.4 years, 81.0% male) were included. Bidirectional block was achieved in all patients. Median total RF time was significantly shorter in the DT group compared with the non-DT group (131.0 [89.0–212.0] vs. 269.0 [196.0–469.0] sec, <i>p</i> &lt; 0.001). The DT group required fewer RF applications (<i>p</i> &lt; 0.001) and had a shorter total procedure time (<i>p</i> &lt; 0.001). No complications occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CTI ablation with the DiamondTemp catheter significantly reduced total RF time and the number of RF applications while maintaining acute procedural success and safety. These findings suggest that the DiamondTemp catheter offers procedural efficiency advantages over conventional CF-sensing catheters in CTI ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467131","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":"Divergent Atrial Transcriptomic Signatures in Diabetic and Nondiabetic Atrial Fibrillation","authors":"Kenshi Yoshimura,&nbsp;Yuya Kiriake,&nbsp;Hiroki Osanai,&nbsp;Mengyan Wei,&nbsp;Shinichiro Kume,&nbsp;Tatsuki Kurokawa,&nbsp;Masaki Morishima,&nbsp;Ryusuke Suzuki,&nbsp;Shinji Miyamoto,&nbsp;Katsushige Ono","doi":"10.1002/joa3.70407","DOIUrl":"https://doi.org/10.1002/joa3.70407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetes mellitus (DM) increases the risk of atrial fibrillation (AF), but the molecular mechanisms underlying DM-related atrial remodeling remain unclear. This study aimed to characterize transcriptomic differences, including microRNA (miRNA) profiles, between atrial tissue from AF patients with and without DM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Right atrial appendage samples were collected from 12 patients with AF undergoing cardiac surgery (six with DM and six without DM). Total RNA was analyzed by high-throughput RNA sequencing. Differentially expressed genes (DEGs) and miRNAs were identified using Welch's <i>t</i>-test (<i>p</i> &lt; 0.05), and pathway analyses were performed using Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-six protein-coding genes and nine miRNAs were differentially expressed between the two groups. Upregulated genes in the DM group, including <i>MYH6</i> and <i>SLN</i>, were related to contractile and calcium-handling functions, while downregulated genes, such as <i>ADAMTS4</i>, <i>CP</i>, and histone family members, were linked to extracellular matrix and chromatin regulation. GO and GSEA analyses revealed activation of mitochondrial ATP synthesis pathways and suppression of immune and inflammatory signaling. Additionally, distinct miRNA expression changes—such as upregulation of <i>miR-3120</i> and downregulation of <i>miR-4524B</i> and <i>miR-6503</i>—suggested potential epigenetic regulation mechanisms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Transcriptomic profiling revealed that AF with DM is characterized by enhanced mitochondrial metabolism, suppressed immune pathways, and altered miRNA expression. These findings suggest that DM modifies the atrial substrate through metabolic and epigenetic mechanisms, providing novel insights into AF pathogenesis in diabetic patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467344","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":"Fractionated Atrial Electrograms Identify Sites of Autonomic Responses During Pulmonary Vein Isolation: Insights for Cardioneuroablation","authors":"Juan F. Agudelo-Uribe,&nbsp;Rafael Correa-Velásquez,&nbsp;Juan D. Ramírez-Barrera,&nbsp;Margarita Londoño-Arango,&nbsp;Teresa Barrio-López,&nbsp;Jesús Almendral","doi":"10.1002/joa3.70423","DOIUrl":"https://doi.org/10.1002/joa3.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardioneuroablation (CNA) targets atrial ganglionated plexuses (GP) to treat vagally mediated bradyarrhythmias. Automated electrogram fractionation mapping has been proposed as a surrogate tool for GP localization, but optimal parameter settings remain undefined. We aimed to systematically evaluate automated fractionation mapping parameters and their association with autonomic responses during ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 26 patients were analyzed, including 12 patients undergoing atrial fibrillation (AF) ablation in sinus rhythm and 14 patients undergoing CNA. Using high-density electroanatomical mapping, three predefined values were tested for each fractionation parameter—signal width, refractoriness, and amplitude threshold—yielding 27 automated configurations. A purely anatomical localization strategy was also evaluated. In the AF cohort, all configurations were systematically assessed, generating 336 fractionation maps and 870 ablation sites. Autonomic response during radiofrequency delivery was defined as an absolute RR interval change &gt; 10%. Selected high-performing configurations were subsequently evaluated in the CNA cohort (614 ablation sites).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the AF cohort, 25 of 27 configurations showed a significant association with autonomic response. After Bonferroni correction, 15 configurations remained significant. The configuration with signal width 15 ms, refractoriness 25 ms, and amplitude threshold 0.05 mV demonstrated the highest sensitivity, although several configurations showed comparable performance. When evaluated in the CNA cohort, this configuration yielded a sensitivity of 74.1% and specificity of 73.9%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This pilot study provides a reproducible framework for evaluating automated fractionation mapping parameters associated with autonomic responses during CNA. The findings support biologically plausible parameter–performance relationships and identify parameter ranges potentially suitable for procedural use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467271","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":"Bisoprolol Treatment and Adherence in Pediatric Patients With Genotype-Positive Long QT Syndrome","authors":"Eemil Taipalus,&nbsp;Minna Mecklin,&nbsp;Antti Tikkakoski,&nbsp;Tuija Poutanen,&nbsp;Kaisa Ylänen","doi":"10.1002/joa3.70422","DOIUrl":"10.1002/joa3.70422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-selective beta-blockers, such as propranolol, are highly effective in reducing arrhythmia risk in long QT Syndrome (LQTS). The study aim was to evaluate the use of beta-blockers, especially beta-1-selective bisoprolol, and their efficacy in Finnish children with genotype-positive LQTS type 1 or 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed the medical records of children with genetically confirmed LQTS1 or LQTS2 diagnosis, who were treated at Tampere University Hospital in Finland between 2006 and 2020. Data on cardiac events, beta-blocker use and adherence, ECG, clinical exercise tests, and genetic testing were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-eight children were diagnosed with a genotype-positive type 1 or 2 LQTS, and 84% of them had a family history of LQTS associated gene mutations. Four Finnish founder mutations accounted for 68% of the cases. At diagnosis, 63% had a normal QTc interval. No cardiac events occurred during follow-up among patients receiving beta-blocker therapy. For children aged 0–7 years, propranolol was the primary medication in 90% of cases, and for &gt; 7-year-olds, bisoprolol was used in 77% of cases. At the last follow-up visit, 87/88 were on beta-blockers, most commonly bisoprolol (66%). Medication adherence was high, with 84% of patients using beta-blockers as prescribed. In clinical exercise tests, maximal heart rate remained &lt; 160 beats per minute in 76% of tests, indicating effective beta-blockade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cascade screening identified asymptomatic patients, most with normal QTc intervals. Bisoprolol was the most commonly used beta-blocker with good adherence, effective heart rate control, and no cardiac events observed during follow-up among these Finnish children with LQTS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446751","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":"Lead-Related and Procedural Outcomes of His Bundle Pacing Versus Left Bundle Branch Area Pacing in Patients Undergoing Atrioventricular Node Ablation: A Systematic Review and Meta-Analysis","authors":"Norma N. Gamarra-Valverde,&nbsp;Bezalel Hakkeem,&nbsp;Joseph E. Marine,&nbsp;Jhordan Chilon-Cerdan,&nbsp;Adriana C. Mares,&nbsp;Juliana Giorgi","doi":"10.1002/joa3.70419","DOIUrl":"10.1002/joa3.70419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients undergoing atrioventricular node ablation (AVNA), permanent pacing is required, making lead performance and procedural durability important. His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are physiologic pacing strategies used in this setting, but comparative evidence remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed/MEDLINE and Embase through January 31, 2026, for comparative studies of HBP versus LBBAP in adults undergoing AVNA. The primary outcome was chronic lead-related dysfunction, defined as clinically significant chronic capture-threshold elevation. Secondary outcomes were AVNA procedural duration and atrioventricular nodal reconduction requiring repeat ablation. Random-effects models generated pooled risk ratios (RRs) or mean differences (MDs). Certainty was assessed using GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three observational studies comprising 434 patients were included. Two studies (<i>n</i> = 270) contributed to chronic lead-related dysfunction, which occurred more often with HBP than LBBAP (RR 15.43, 95% CI 2.80–85.04); the estimate was imprecise because of sparse events. Two studies (<i>n</i> = 262) contributed to procedural duration, which was longer with HBP (MD 11.33 min, 95% CI 6.64–16.02; <i>I</i>² = 0%). Two studies (<i>n</i> = 262) contributed to atrioventricular nodal reconduction, which was more frequent with HBP (RR 19.34, 95% CI 2.60–143.61; <i>I</i>² = 0%). Certainty was low for procedural duration and very low for the other outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients undergoing AVNA, LBBAP was associated with more favorable lead-related and procedural outcomes than HBP across available observational studies. Because evidence is limited by small cohorts, sparse events, and nonrandomized designs, these findings should be considered hypothesis-generating.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>This systematic review was registered in the PROSPERO database (registration number: CRD420261424072)</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446736","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":"Introduction of Low-Voltage Bridge Mapping for Radiofrequency Ablation of AVNRT in Children: One-Year Follow-Up Results","authors":"Tomasz M. Książczyk,&nbsp;Klaudia Obsznajczyk,&nbsp;Radosław Pietrzak","doi":"10.1002/joa3.70421","DOIUrl":"10.1002/joa3.70421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low-voltage bridge mapping (LVBM) is a recently introduced approach to atrioventricular nodal reentry tachycardia (AVNRT) ablation that may facilitate precise slow-pathway targeting. Our center implemented LVBM for radiofrequency (RF) AVNRT ablation in children in April 2023. Early results demonstrated procedural advantages without prolonging procedure time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study evaluates one-year follow-up outcomes after the introduction of LVBM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed all pediatric AVNRT RF ablations performed between January 1, 2019, and August 31, 2024. Outcomes of procedures performed using a traditional approach were compared with those guided by LVBM. Clinical success, complications, RF application parameters, and total procedure time were assessed at one-year follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 105 patients were included (61 controls, 44 LVBM). Baseline characteristics did not differ significantly between groups. At one-year follow-up, clinical success was higher in the LVBM group (90% vs. 80%), although the difference was not statistically significant. No complications were observed in either group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Introduction of low-voltage bridge mapping for RF AVNRT ablation in children reduces the number and duration of RF applications without prolonging procedure time. One-year follow-up demonstrates durable efficacy and safety, supporting LVBM as a valuable refinement of pediatric AVNRT ablation strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436884","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":"Midterm Efficacy of SubcutAneous Implantable CardioVErter-Defibrillator in ≤ 18 Year-Old CHILDREN (SAVE CHILDREN-II Registry)","authors":"Hitoshi Mori,&nbsp;Taisuke Nabeshima,&nbsp;Kota Nagaoka,&nbsp;Hideo Fukunaga,&nbsp;Hidemori Hayashi,&nbsp;Osamu Inaba,&nbsp;Yuhei Isonaga,&nbsp;So Asano,&nbsp;Junichi Nitta,&nbsp;Shigeo Watanabe,&nbsp;Sou Otsuki,&nbsp;Hiroshi Suzuki,&nbsp;Hidehira Fukaya,&nbsp;Jun Kishihara,&nbsp;Toshiyuki Chisaka,&nbsp;Takashi Higaki,&nbsp;Ayako Okada,&nbsp;Hideki Kobayashi,&nbsp;Takayuki Sekihara,&nbsp;Takafumi Oka,&nbsp;Seiichi Sato,&nbsp;Keisuke Yoshino,&nbsp;Hidekazu Kondo,&nbsp;Naohiko Takahashi,&nbsp;Ken Kato,&nbsp;Masaru Miura,&nbsp;Jun Maeda,&nbsp;Shuntaro Tamura,&nbsp;Kentaro Ikeda,&nbsp;Hiroko Goto,&nbsp;Takashi Murakami,&nbsp;Tsutomu Wada,&nbsp;Motoki Takamuro,&nbsp;Tsugutoshi Suzuki,&nbsp;Yuji Ishida,&nbsp;Shingo Sasaki,&nbsp;Takuro Nishimura,&nbsp;Masateru Takigawa,&nbsp;Tomomi Matsuura,&nbsp;Tomohiko Imamura,&nbsp;Satoshi Shizuta,&nbsp;Masato Fukunaga,&nbsp;Maiko Kuroda,&nbsp;Rintaro Hojo,&nbsp;Seiji Fukamizu,&nbsp;Hirohiko Suzuki,&nbsp;Yukihiko Yoshida,&nbsp;Itsuro Morishima,&nbsp;Kenji Kuraishi,&nbsp;Eiki Nishihara,&nbsp;Yoshihisa Naruse,&nbsp;Tomoyuki Sato,&nbsp;Yoshiyasu Aizawa,&nbsp;Kimitaka Nishizaki,&nbsp;Kentaro Nakamura,&nbsp;Norihito Nuruki,&nbsp;Masao Yoshinaga,&nbsp;Yukitoshi Ikeya,&nbsp;Yasuo Okumura,&nbsp;Shota Muraji,&nbsp;Yusuke Kondo,&nbsp;Makoto Nakano,&nbsp;Machiko Kito,&nbsp;Yasuya Inden,&nbsp;Satoshi Higuchi,&nbsp;Takahiko Kinjo,&nbsp;Kazuhisa Matsumoto,&nbsp;Masataka Narita,&nbsp;Wataru Sasaki,&nbsp;Tsukasa Naganuma,&nbsp;Daisuke Kawano,&nbsp;Naomichi Tanaka,&nbsp;Kei Matsumoto,&nbsp;Takuro Kojima,&nbsp;Yoshifumi Ikeda,&nbsp;Ritsushi Kato,&nbsp;Naokata Sumitomo","doi":"10.1002/joa3.70420","DOIUrl":"10.1002/joa3.70420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The subcutaneous implantable cardioverter-defibrillator (S-ICD) avoids transvenous leads and is a promising option for sudden cardiac death (SCD) prevention in pediatric patients. However, mid-term outcomes and post-shock management strategies remain insufficiently characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective observational study included pediatric patients (≤ 18 years) who underwent S-ICD implantation between February 2016 and July 2021. Clinical characteristics, pre-implant screening, procedural details, device-related events, and follow-up data were analyzed. The incidence and management of appropriate and inappropriate therapies and subsequent recurrence were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-six patients (median age 14.5 years) were enrolled and followed for a median of 70 months (29–75.0 months). Sensing vector suitability remained stable despite somatic growth. Appropriate shocks occurred in 32 patients (33.7%), while inappropriate shocks occurred in 27 (28.4%). After appropriate therapy, intensified pharmacological treatment and catheter ablation prevented recurrent device therapy in 45.5% and 50.0% of cases, respectively, although device shock occurred in 50.9% despite intervention. Following inappropriate therapy, device reprogramming and lifestyle guidance prevented recurrence in 71.4% of patients (15/21). Device-related infection was rare (2 cases), and no lead fractures were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>S-ICD therapy demonstrated favorable mid-term safety and efficacy in pediatric patients, with durable sensing performance and a low incidence of device-related infection. Although inappropriate shocks were not uncommon, appropriate post-shock management effectively reduced recurrence, supporting S-ICD as a viable option for selected pediatric patients without pacing requirements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446812","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 of Silicone Allergy Induced by a Subcutaneous Implantable Cardioverter Defibrillator","authors":"Wataru Shinkai,&nbsp;Jun Kishihara,&nbsp;Megumi Toraiwa,&nbsp;Yuki Arakawa,&nbsp;Shuhei Kobayashi,&nbsp;Hironori Nakamura,&nbsp;Naruya Ishizue,&nbsp;Jun Oikawa,&nbsp;Hidehira Fukaya,&nbsp;Junya Ako","doi":"10.1002/joa3.70417","DOIUrl":"10.1002/joa3.70417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Allergic reactions associated with subcutaneous implantable cardioverter-defibrillator (S-ICD) are extremely rare, and silicone-related cases are scarcely reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A 54-year-old man with a transvenous implantable cardioverter-defibrillator (TV-ICD) for idiopathic ventricular fibrillation underwent removal of an infected TV-ICD system, followed by S-ICD implantation. Seven months later, a granulomatous lesion developed at the xiphoid incision site without signs of infection. Conservative management was initially selected; however, progressive wound deterioration and eventual device exposure necessitated complete system removal. Patch testing demonstrated a positive reaction to silicone, a device component corresponding to the lesion site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This case highlights that silicone-related hypersensitivity, although extremely rare, should be considered when evaluating noninfectious wound complications after S-ICD implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436863","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":"Stokes–Adams Syncope and Ventricular Standstill","authors":"Khalid Shakfeh,&nbsp;Takumi Yamada,&nbsp;Aditya Saini","doi":"10.1002/joa3.70418","DOIUrl":"10.1002/joa3.70418","url":null,"abstract":"<p>Stokes–Adams syncope has various etiologies including atrioventricular conduction delays, ischemia, or vagal mechanisms. Careful EKG analysis including serial EKGs, may help identify contributory mechanisms to the etiology of syncope, even after permanent pacemaker implantation.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421304","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}