Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"Safety of Leadless Pacemaker Insertion in Nonagenarians.","authors":"Jashan Gill, Ahmad Harb, Jobin Varghese, Rezwan Munshi, Michael T Spooner","doi":"10.19102/icrm.2025.16053","DOIUrl":"10.19102/icrm.2025.16053","url":null,"abstract":"<p><p>Increased age is associated with increased frailty and often worse postoperative outcomes. We sought to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. We queried the National Readmission Database for patients who underwent LPM insertion from 2017 to 2020. Patients aged ≥90 years were included in the nonagenarian group and compared to patients aged <90 years. Patient comorbidities were queried using the appropriate International Classification of Diseases, Tenth Revision, codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. At baseline, nonagenarians had higher prevalence rates of hypertension, a history of stroke, atrial fibrillation, atrial flutter, dementia, and hypothyroidism. The control group had more diabetes, coronary artery disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse, and chronic liver disease. Compared to controls, nonagenarians were found to have a shorter length of stay (2.5 days; <i>P</i> < .001); lower mortality (adjusted odds ratio [aOR], 0.7; <i>P</i> = .02); and lower rates of post-procedural cardiac arrest (aOR, 0.3; <i>P</i> = .03), mechanical ventilation (aOR, 0.4; <i>P</i> < .001), and vasopressor use (aOR, 0.6; <i>P</i> = .001). Nonagenarians were only found to have an increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR, 1.6; <i>P</i> = .02). There was no significant difference in 30-day readmissions (aOR, 0.97; <i>P</i> = .7), postoperative bleed (aOR, 0.84; <i>P</i> = .07), or stroke (aOR, 0.586; <i>P</i> = .1). Our study demonstrates that LPM insertion could be safe in the very elderly population. However, our study likely demonstrates survivorship bias, as patients in the nonagenarian group had fewer overall comorbidities. Despite adjustment for known comorbidities, there remain confounders that are difficult to account for. Age itself does not seem to be a risk factor for worse outcomes in this population.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"6272-6277"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249985","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":"Impacts of Premature Atrial Contractions and Biochemical Markers Early After Cryoballoon Versus Radiofrequency Ablation on the Late Recurrence of Atrial Fibrillation.","authors":"Kenichi Sasaki, Daisuke Togashi, Akira Kasagawa, Ikutaro Nakajima, Takumi Higuma, Tomoo Harada, Yoshihiro J Akashi","doi":"10.19102/icrm.2025.16043","DOIUrl":"https://doi.org/10.19102/icrm.2025.16043","url":null,"abstract":"<p><p>We sought to clarify the impacts of premature atrial contractions (PACs) and biochemical markers early after cryoballoon (CB) versus radiofrequency (RF) ablation for atrial fibrillation (AF) on the late recurrence of AF (LRAF). The study population included 138 patients who underwent first-time ablation for paroxysmal AF with CB (<i>n</i> = 69) or RF (<i>n</i> = 69). We compared the levels of the PAC burden on Holter monitoring, myocardial-bound creatine kinase (CK-MB), troponin T (TnT), and C-reactive protein (CRP) the day after ablation, and we assessed the incidence of LRAF, which was defined as AF after a 3-month blanking period. The postprocedural PAC burden was not significantly different between the CB and RF groups (<i>P</i> = .35), whereas the CK-MB and CRP levels were significantly higher in the CB group (both <i>P</i> < .01); the TnT levels of the groups were similar (<i>P</i> = .63). Among these, only a higher PAC burden was significantly associated with LRAF in both the CB (top quartile [≥2.16%]: 58% vs. others: 17%; log-rank <i>P</i> = .01) and RF (top quartile [≥3.05%]: 36% vs. others: 9%; log-rank <i>P</i> < .01) groups. A Cox regression analysis revealed two significant predictors of LRAF: in-hospital recurrence (CB group: hazard ratio [HR], 3.55 [1.67-11.80]; <i>P</i> = .04; RF group: HR, 7.55 [1.67-34.20]; <i>P</i> = .01) and a higher postprocedural PAC burden (CB: HR, 1.54 [1.06-2.22]; <i>P</i> = .02; RF: HR, 1.90 [1.16-3.35]; <i>P</i> = .01). In conclusion, irrespective of the ablation modality, the next-day PAC burden (but not the biochemical markers examined herein) is useful for predicting LRAF. Early AF recurrence should be considered a future risk even at the beginning of the blanking period.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"6251-6259"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040180","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":"Risk Factors Associated with Unsuccessful Dofetilide Initiation Due to Excessive QT Interval Prolongation: A Retrospective Study.","authors":"Johnathon Rast, Grant Whitebloom, Omar M Makram, Priyanshu Nain, Lakshya Seth, Nathaniel Wayne, Patrick Houlihan, Alexander Warner, Daniel Sohinki","doi":"10.19102/icrm.2025.16042","DOIUrl":"https://doi.org/10.19102/icrm.2025.16042","url":null,"abstract":"<p><p>Dofetilide is a class III anti-arrhythmic medication approved for patients with atrial fibrillation to maintain sinus rhythm. Excessive QTc interval prolongation, a potential side effect of dofetilide, increases the risk of torsades de pointes. This risk is mitigated by closely monitoring the QTc interval during an inpatient initiation protocol for the first five doses. Prior studies have demonstrated that dofetilide can be safely used in patients with heart failure after completing the initiation protocol. However, no studies have investigated risk factors associated with dofetilide-induced excessive QTc interval prolongation, resulting in discontinuation of the medicine. This single-center retrospective cohort study analyzed the association between dofetilide-associated excessive QTc prolongation during medication initiation and pertinent medical comorbidities as well as various echocardiographic values of interest. Risk factors found to be significantly associated with excessive QTc prolongation during dofetilide initiation included a clinical history of heart failure, reduced left ventricular ejection fraction, increased left ventricular end-diastolic diameter, increased left atrial diameter, and reduced right ventricular systolic function. Although some studies have demonstrated the safety of dofetilide use in patients with heart failure, our findings suggest that these patients are less likely to tolerate initiation of the medication due to excessive QTc prolongation.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"6240-6246"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022553","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":"Dual-morphology Bundle Branch Re-entrant Ventricular Tachycardia in Non-dilated Cardiomyopathy.","authors":"Ibrahim Alshaghdali, Tyler Alderson, Hakan Paydak, John Paul Mounsey, Subodh Devabhaktuni","doi":"10.19102/icrm.2025.16045","DOIUrl":"https://doi.org/10.19102/icrm.2025.16045","url":null,"abstract":"<p><p>Bundle branch re-entrant (BBR) tachycardia is an uncommon form of ventricular tachycardia (VT). This arrhythmia typically occurs in patients with a structural heart disease, especially dilated cardiomyopathy, and significant conduction system impairment, although affected patients with a structurally normal heart or normal conduction system have been reported. The QRS morphology during tachycardia can vary; it typically has a left bundle branch block (LBBB) morphology in which the antegrade conduction is over the right bundle and the retrograde limb is over the left bundle. The reverse of this circuit results in a right bundle branch block (RBBB) QRS morphology. A re-entrant circuit also can utilize interfascicular conduction, such as antegrade conduction over the left anterior fascicle and retrograde conduction up the left posterior fascicle or vice versa. Although there are reports of BBR tachycardia and interfascicular VT occurring in the same patient, to our knowledge, there are no prior reports of BBR tachycardia that has both LBBB and RBBB morphologies in the same patient. This case illustrated a BBR tachycardia with both left bundle and right bundle branch morphologies occurring in a patient with a non-dilated left ventricle.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"6260-6267"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054240","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":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2025.16046","DOIUrl":"https://doi.org/10.19102/icrm.2025.16046","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049919","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":"Digoxin Dilemma: Diagnosing Toxicity Amidst Dementia.","authors":"Parth Sushil Bajoria, Vinod Nookala","doi":"10.19102/icrm.2025.16041","DOIUrl":"https://doi.org/10.19102/icrm.2025.16041","url":null,"abstract":"<p><p>Digoxin, a cardiac glycoside and sodium-potassium adenosine triphosphatase inhibitor, has a narrow therapeutic index and is primarily prescribed for conditions such as systolic heart failure and atrial fibrillation. This narrow window increases the risk of toxicity, especially among susceptible populations. Although digoxin use has declined in recent decades and cases of toxicity have become less frequent, clinicians must remain vigilant, particularly with geriatric patients, who are more susceptible due to polypharmacy and reduced renal function. Here, we present a case of a 77-year-old woman with dementia who exhibited elevated digoxin levels and was successfully treated with digoxin immune Fab. While the use of immune Fab in chronic toxicity cases remains uncertain, our retrospective review of similar cases, managed both with and without immune Fab, provides insights into its role and limitations. We further underscore the importance of regular digoxin monitoring rather than checking the levels only during toxic episodes, as consistent monitoring can prevent fatal cases and reduce overall mortality.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"6235-6238"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053378","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":"Left Septal Fascicular Block Following Left Bundle Branch Area Pacing.","authors":"Ahmet Lutfu Sertdemir, Ahmet Taha Sahin, Andrés Ricardo Pérez-Riera, Enes Elvin Gul, Adrian Baranchuk","doi":"10.19102/icrm.2025.16044","DOIUrl":"https://doi.org/10.19102/icrm.2025.16044","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) is a type of conduction system pacing wherein the left bundle branch and/or the left side of the interventricular septum are stimulated with a permanent pacing lead to maintain physiological electrical activation of the left ventricle. As understanding grows regarding trifascicular activation in the left ventricle and left septal fascicular block (LSFB), there is an indication that new electrocardiographic alterations may emerge, particularly in instances of arterial occlusions. Here, we present a case study delineating LSFB subsequent to LBBAP.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 4","pages":"6248-6250"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001396","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":"The Rhythms of the Moon: Can the Moon Affect Cardiac Arrhythmias?","authors":"Athanasios Ziakos, Armin Sause, Melchior Seyfarth","doi":"10.19102/icrm.2025.16034","DOIUrl":"10.19102/icrm.2025.16034","url":null,"abstract":"<p><p>Diagnosing paroxysmal cardiac arrhythmias early poses a challenge, yet it holds paramount significance. Certain patients hold strong beliefs regarding the moon's impact on cardiac arrhythmias. This study aims to examine the potential correlation. In our emergency room, each patient presentation is assigned an \"admission diagnosis.\" An analysis was conducted on admission diagnoses from 2012-2020 (before the coronavirus disease 2019 pandemic). The frequency of rhythmological diagnoses was investigated, both collectively and separately, as well as categorized by the underlying pathomechanism, in relation to the lunar phase and the moon's proximity to the Earth at the time of admission. Moreover, the impacts of sex, age, and weight were evaluated. A total of 58,230 patient presentations were recorded, with 16.9% coded with rhythmological diagnoses. No significant differences were found in the distribution of cardiac arrhythmias concerning lunar phases or the moon-Earth distance. Sex, age, and weight did not influence this distribution, except in a small group of underweight patients (<55 kg), where a statistically significant difference was observed with greater moon distance. To verify this result, we investigated all existing Holter records of underweight patients presenting to the emergency room between 2017 and 2020. In 195 24-h Holter recordings, a uniform burden of supraventricular extrasystoles and atrial fibrillation/flutter irrespective of the moon's distance from the Earth was observed. Contrary to patients' beliefs, the moon does not seem to affect the presentations with rhythmological complaints and diagnoses in our single-center analysis, irrespective of age, sex, or the arrhythmia type. The moon cannot aid in diagnosing paroxysmal arrhythmias.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6220-6222"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693813","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":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2025.16038","DOIUrl":"https://doi.org/10.19102/icrm.2025.16038","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693788","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":"\"Optimizing\" the Anesthetic for Cardiac Contractility Modulation Devices.","authors":"Samit Ghia, Ashanay Allen, Ranjit Suri, Himani Bhatt","doi":"10.19102/icrm.2025.16032","DOIUrl":"10.19102/icrm.2025.16032","url":null,"abstract":"<p><p>We present a case report of a patient undergoing implantation of a cardiac contractility modulation (CCM) device. The Optimizer^® Smart Implantable Pulse Generator (Impulse Dynamics, Orangeburg, NY, USA) provides electrical energy to the right ventricular septum to modulate cardiac contractility and improve cardiac function in heart failure patients. The non-excitatory electrical signals are delivered by transvenous leads during the refractory period. Anesthetic administration during implantation can affect appropriate lead positioning. Propofol at high doses can attenuate diaphragmatic contraction and discomfort from inappropriate lead positioning, resulting in diaphragm stimulation. Therefore, local or conscious sedation is preferred during CCM device implantation. In patients undergoing procedures with this CCM device in situ, the Optimizer^® activity causes upward deflections of the RS segment on the electrocardiogram. Also, strong electromagnetic fields can disrupt device function. This case report reviews the novel CCM device and its major anesthetic considerations.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6223-6228"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693818","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}