Journal of Cardiovascular Electrophysiology最新文献

{"title":"Public Information Content for Pacemaker Implantation: A Need for Quality Over Quantity?","authors":"Wasiq Sheikh, Ulrika Birgersdotter-Green","doi":"10.1111/jce.16564","DOIUrl":"https://doi.org/10.1111/jce.16564","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YouTube Videos of Pacemaker Implantation: An Assessment of Information Content and Quality.","authors":"Pok-Tin Tang, C Fielder Camm, Saffron Rajappan, Richard D Sale, Kim Rajappan","doi":"10.1111/jce.16540","DOIUrl":"https://doi.org/10.1111/jce.16540","url":null,"abstract":"<p><strong>Background: </strong>Permanent pacemaker (PPM) implantation is a commonly performed procedure. Patients increasingly use the Internet for information on medical interventions. We aimed to assess the quality of videos discussing PPM implantation on YouTube for patient consumption.</p><p><strong>Methods: </strong>YouTube was searched on October 19, 2022, for \"PPM implantation\" and \"Pacemaker.\" The first 100 results from each search were screened: all English language videos containing predominant discussion of transvenous PPMs were included; YouTube shorts and advertisements were excluded. Two authors independently assessed videos for information content based on criteria generated using established patient resources supplemented by expert consensus. Video reliability and quality were assessed using a novel scoring system.</p><p><strong>Results: </strong>Thirty-three videos with a cumulative total of 5 864 488 views were included. No video contained all essential information criteria. The average number of essential criteria covered was 8/32 (standard deviation 4.8). Peri-operative management was, particularly, poorly covered: no item relating to preoperative management or postoperative care was covered by more than 40% of videos. None of the videos fulfilled all quality criteria, with a median score of 7.5/13 (interquartile range 6.5-8). Videos performed, particularly, poorly on providing balanced messages, creator disclosures, attribution of source content, and indicating when videos were made.</p><p><strong>Conclusion: </strong>YouTube videos of PPM implantation do not contain sufficient information to allow patients to gain an appropriate understanding of this procedure. Furthermore, the information presented is of insufficient quality to support decision-making. There is a need for a professionally regulated, comprehensive audiovisual patient resource on PPM implantation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Bayesian Interpretation of CABANA and Other Randomized Controlled Trials for Catheter Ablation in Patients With Atrial Fibrillation.","authors":"Alleh Nogueira, Nicole Felix, Felipe Kalil, Lucas Tramujas, Amanda Godoi, Isabele A Miyawaki, Andrea Bellavia, Filipe A Moura, Rhanderson Cardoso, André d'Avila, Gilson C Fernandes","doi":"10.1111/jce.16552","DOIUrl":"https://doi.org/10.1111/jce.16552","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation improves symptoms and quality of life in atrial fibrillation patients, but its effect on adverse cardiovascular outcomes and mortality remains uncertain. Bayesian analysis of randomized controlled trials offers a deeper understanding of treatment effects beyond conventional p-value thresholds.</p><p><strong>Methods: </strong>We conducted a post hoc Bayesian reanalysis of CABANA and four similar trials to estimate catheter ablation's effect on cardiovascular and survival outcomes. Using publicly available, trial-level data, we fitted ordinal Bayesian regression models to assess the impact of catheter ablation on the primary composite outcome-comprising all-cause mortality, stroke with disability, serious bleeding, and cardiac arrest-as well as mortality alone. We considered two sets of prior distributions: (1) a noninformative prior, where all effect sizes are equally probable and inference is primarily based on trial data, and (2) a treatment effect distribution derived from four trials using a random effects model.</p><p><strong>Results: </strong>In this analysis, refined probability distributions for treatment effects were obtained by integrating data from CABANA with diverse priors through Bayes' theorem, offering a novel, nuanced probabilistic understanding of the potential impact of ablation compared with medical therapy on cardiovascular outcomes and all-cause mortality. In contrast to CABANA's original frequentist estimates, which were inconclusive, Bayesian analyses indicated probabilities of 82.6% and 81.1% that ablation is superior in reducing adverse cardiovascular outcomes and mortality, respectively. Incorporating results from four other similar trials increased the probability of improved effects on mortality to 86.0%.</p><p><strong>Conclusions: </strong>Bayesian analysis augmented the interpretation of previously inconclusive findings, suggesting a clinically relevant probability of benefit from catheter ablation compared to medical therapy in a broad population with atrial fibrillation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Atrial Flutter: Electrophysiological Characterization and Effective Catheter Ablation.","authors":"Nicolas Johner, Mehdi Namdar, Dipen C Shah","doi":"10.1111/jce.16543","DOIUrl":"https://doi.org/10.1111/jce.16543","url":null,"abstract":"<p><p>Atrial flutter (AFL), defined as macro-re-entrant atrial tachycardia, is associated with debilitating symptoms, stroke, heart failure, and increased mortality. AFL is classified into typical, or cavotricuspid isthmus (CTI)-dependent, and atypical, or non-CTI-dependent. Atypical AFL is a heterogenous group of re-entrant atrial tachycardias that most commonly occur in patients with prior heart surgery or catheter ablation. The ECG pattern is poorly predictive of circuit anatomy but may still provide mechanistic insight. AFL is difficult to manage medically and catheter ablation is the preferred treatment for most patients. Recent progress in technology and clinical electrophysiology has led to detailed characterization of re-entry circuits and effective ablation strategies. Combined activation and entrainment mapping are key to identifying the re-entry circuit. The presence of a slow-conducting isthmus, localized re-entry, dual-loop re-entry or bystander loops may lead to misleading activation maps but can be identified by electrogram examination and entrainment mapping. In the occasional patient without inducible AFL, substrate mapping in sinus rhythm may be a viable strategy. Long-term ablation success requires the creation of a transmural continuous lesion across a critical component of the re-entry circuit. Procedural endpoints include bidirectional conduction block across linear lesions and non-inducibility of atrial tachycardia. The present review discusses the epidemiology, mechanisms, ECG characteristics, electrophysiological characterization, and catheter ablation of atypical AFL.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AF-FLOW Global Registry Confirms Validity of Electrographic Flow Mapping as a Phenotyping Tool for Atrial Fibrillation.","authors":"Kent R Nilsson, Steven Castellano, Melissa H Kong, Pawel Derejko, Tamás Szili-Torok, Sandeep K Goyal, Sip Wijchers, Mohit Turagam, Vivek Y Reddy, Atul Verma","doi":"10.1111/jce.16568","DOIUrl":"https://doi.org/10.1111/jce.16568","url":null,"abstract":"<p><strong>Background: </strong>Electrographic flow (EGF) mapping allows for the visualization of global atrial wavefront propagations. One mechanism of initiation and maintenance of atrial fibrillation (AF) is stimulation from EGF-identified focal sources that serve as driver sites of fibrillatory conduction. Electrographic flow consistency (EGFC) further quantifies the concordance of observed wavefront patterns, indicating that a healthier substrate shows more organized wavefront propagation and higher EGFC. Freedom from AF (FFAF) recurrence has accordingly been shown to be higher in patients with ablated vs. unablated sources and with high vs. low EGFC.</p><p><strong>Objectives: </strong>(1) Measure FFAF across EGF-derived phenotypes in patients enrolled in the AF-FLOW Global Registry; (2) determine if a relationship exists between EGFC and percentage of healthy voltage as measured from bipolar voltage maps.</p><p><strong>Methods: </strong>The AF-FLOW Global Registry is a multicenter, prospective study of 25 all-comer AF patients who underwent concomitant high-density bipolar voltage mapping with a 16-electrode grid mapping catheter and EGF mapping with a 64-pole basket catheter. The EGF algorithm detects extra-pulmonary vein sources as origins of excitation from a singularity of divergent flow vectors and was used to localize RF ablation targets. Overall, EGFC per atrium was also computed as the average of the modulus of individual EGF vectors, where the vector length represents the consistency of flow patterns. Patients were then assigned phenotypes on the basis of source presence or absence and EGFC, and rates of FFAF at 1-year were compared across the four resulting phenotypes. Atrial EGFC was also compared to the percentage of healthy tissue determined by bipolar voltage mapping.</p><p><strong>Results: </strong>Patients with paroxysmal AF had higher FFAF than persistent AF (PeAF) and long-standing PeAF patients; patients receiving de novo ablation had higher FFAF than those receiving redo ablation. Patient phenotyping revealed that those with high EGFC had higher FFAF than those with low EGFC (p = 0.015). Atrial EGFC was also correlated to the percent of high voltage tissue across all patients (r = 0.651, p < 0.0001).</p><p><strong>Conclusions: </strong>EGF mapping provides insights into the mechanistic nature of AF and the atrial health of the underlying substrate. Therefore, further studies are needed to develop phenotype-specific treatments for the disease.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05481359.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Stroke Prevention in Atrial Fibrillation: One Size Does not Fit All.","authors":"Panteleimon E Papakonstantinou, Gregory Y H Lip","doi":"10.1111/jce.16580","DOIUrl":"https://doi.org/10.1111/jce.16580","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence and Predictors of Atrioventricular Blocks in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: A Cross-Sectional Study.","authors":"Ibrahim Antoun, Alkassem Alkhayer, Aref Jalal Eldin, Alamer Alkhayer, Khaled Yazji, Riyaz Somani, G André Ng, Mustafa Zakkar","doi":"10.1111/jce.16578","DOIUrl":"https://doi.org/10.1111/jce.16578","url":null,"abstract":"<p><strong>Background: </strong>Atrioventricular block (AVB) is a cardiac conduction disorder that can lead to significant clinical outcomes, particularly in resource-limited and conflict-affected regions. In Syria, healthcare infrastructure has been severely impacted by ongoing conflict, potentially affecting the prevalence and management of AVB.</p><p><strong>Methods: </strong>We conducted a cross-sectional study at Tishreen University Hospital in Latakia, Syria, with patients > 40 who presented to the emergency department (ED) from June 1 to August 1, 2024. Routine 12-lead ECGs were performed, with AVB diagnoses confirmed by two independent cardiology consultants. Exclusion criteria included pre-existing AVB, pacemaker presence, hemodynamic instability, and ECG diagnostic discrepancies. Patient demographics and comorbidities were assessed, and logistic regression analyses identified predictors of AVB.</p><p><strong>Results: </strong>The final analysis included 692 patients, of which AVB was detected in 7% of the cohort. Patients with AVB were significantly older (median age 76 vs. 54 years, p < 0.001) and had higher rates of ischemic heart disease (IHD) (62% vs. 14%, p < 0.001) and diabetes (56% vs. 21%, p = 0.01). Logistic regression showed older age (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.6-5.6, p < 0.001), IHD (OR: 1.9, 95% CI: 1.4-4.5, p < 0.001), and DM (OR: 3.9, 95% CI: 2.9-8.3, p < 0.001) were independently associated with AVB.</p><p><strong>Conclusion: </strong>AVB prevalence in the Syrian ED setting is high, with age, IHD, and diabetes as significant predictors. Routine ECG screening in EDs may facilitate early AVB detection in at-risk populations, especially in conflict-affected regions with limited healthcare resources. This approach could improve outcomes by enabling timely intervention in high-risk patients.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periodic Electric Shock in Patient With Pacemaker: An Electrophysiologist's Challenge.","authors":"Sudipta Mondal, Swasthi S Kumar, Jyothi Vijay, Narayanan Namboodiri","doi":"10.1111/jce.16565","DOIUrl":"https://doi.org/10.1111/jce.16565","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long RP Tachycardia and Short RP Tachycardia: Is the Nodoventricular Pathway a Culprit or an Innocent Bystander?","authors":"Akinobu Mizutani, Masato Okada, Koji Tanaka, Nobuaki Tanaka, Koichi Nagashima, Melvin M Scheinman","doi":"10.1111/jce.16574","DOIUrl":"https://doi.org/10.1111/jce.16574","url":null,"abstract":"<p><p>We encountered a single case in which a transition between orthodromic reciprocating tachycardia with a concealed nodoventricular pathway and atrioventricular nodal reentrant tachycardia with a bystander nodoventricular pathway was observed.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Manage Ventricular Arrhythmia Following Durable Left Ventricular Assist Device Implantation.","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1111/jce.16575","DOIUrl":"https://doi.org/10.1111/jce.16575","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}