Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"Outcomes and Safety of Catheter Ablation in the Elderly.","authors":"Khalid Sawalha, Anis John Kadado, Shayal Pundlik, Kyle Gobeil, Mohamed Abdelazeem, Fadi Chalhoub","doi":"10.19102/icrm.2025.16084","DOIUrl":"10.19102/icrm.2025.16084","url":null,"abstract":"<p><p>Catheter ablation has emerged as a first-line therapy for many arrhythmias. However, data on the safety and outcomes of catheter ablation in the elderly population remain limited. Here, we aimed to study the outcomes of catheter ablation in octogenarians. The data used in this study were obtained from the National Inpatient Sample database through years 2016-2019. We identified patients ≥80 years old who were diagnosed with atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), or ventricular tachycardia (VT) as primary diagnoses. The patients' characteristics and common procedure complications were extracted. We investigated the predictors of mortality and in-hospital complications using multivariable logistic regression. A total of 18,595 patients were included in our analysis. The most common procedure performed was ablation for AF (46%), followed by AFL ablation (23%), VT ablation (18%), and SVT ablation (12%). Higher rates of tamponade (1.6%) were seen in patients undergoing VT ablation. A Charlson's comorbidity index (CCI) score of ≥3 points was used as an independent predictor for complications (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.4-3.3, <i>P</i> = .001). Mortality was higher in VT ablation (4.2%) compared to AFL (1.3%), AF (0.9%), and SVT (0.3%). After logistic regression analysis, a CCI score of ≥3 points (OR, 14.7; 95% CI, 1.88-114.9; <i>P</i> = .01) and tamponade (OR, 4.9; 95% CI, 1.65-14.8; <i>P</i> = .004) were independent predictors of mortality. We found a low incidence of procedural complication rates across all ablation groups in octogenarians. Those undergoing VT ablation were more likely to have complications and a higher mortality rate. Baseline comorbidities can be used to risk-stratify patients when deciding on the best treatment strategy.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 8","pages":"6412-6419"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001513","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 Electrophysiology Lab of the Future.","authors":"John Cochran, Michael M Shehata","doi":"10.19102/icrm.2025.16081","DOIUrl":"10.19102/icrm.2025.16081","url":null,"abstract":"<p><p>Electrophysiology (EP) labs are fundamental in cardiovascular medicine, especially for the diagnosis and treatment of cardiac arrhythmias. Nowadays, continuous advances in technology have led to significant improvements in the design and functioning of EP labs, including the development of more sensitive and accurate sensors and algorithms as well as three- and four-dimensional imaging and guidance systems. However, there are still significant challenges related to the reduction of radiation exposure, space constraints, and the integration and compatibility between the different EP systems. Future advances in technology will lead to equipment and space improvements as well as the addition of advanced communication and collaboration tools, speech-recognition software, and the development of standardized data formats and centralized cloud-based data storage systems. The EP lab of the future will present multifunctional configurations that will integrate all the advances in technology, optimize workflows, and potentiate collaboration while assuring patient data protection.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 8","pages":"6391-6397"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001515","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":"Breaking the Circuit: A Case of Macro-re-entrant Biatrial Tachycardia.","authors":"Mustafa Gabarin, Javier Bonacina, Syamkumar Divakara Menon","doi":"10.19102/icrm.2025.16082","DOIUrl":"10.19102/icrm.2025.16082","url":null,"abstract":"<p><p>We present a case of a 71-year-old woman with symptomatic paroxysmal atrial fibrillation and atypical atrial flutter (AFL), ultimately diagnosed with a rare type 3 macro-re-entrant biatrial tachycardia (BiAT). Despite initial pulmonary vein isolation and anterior line ablation for atypical AFL, she experienced recurrent AFL requiring a complex redo ablation. Successful termination of the tachycardia was achieved by extending ablation to the septal regions of both atria. This case highlights the complexity of managing BiAT.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 8","pages":"6399-6405"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016394","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.2025.16085","DOIUrl":"10.19102/icrm.2025.16085","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 8","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001554","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 Novel Technique for Conduction System Pacing in Patients Undergoing Simultaneous Ablation of the Atrioventricular Node Using Axillary Venous Access.","authors":"Hussam Abuissa, Ahmed Elawad","doi":"10.19102/icrm.2025.16083","DOIUrl":"10.19102/icrm.2025.16083","url":null,"abstract":"<p><p>Conduction system pacing has emerged as a new pacing technique to achieve cardiac physiologic pacing, but its utility and safety in patients with atrial fibrillation undergoing simultaneous ablation of the atrioventricular node remains seemingly unknown. Here, we present a case series of 10 patients with long-standing persistent or permanent atrial fibrillation who failed rate-control therapy and elected to proceed with simultaneous ablation of the atrioventricular node and His-bundle pacemaker implantation.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 8","pages":"6407-6411"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001525","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":"Preserved Subcutaneous Implantable Cardioverter-defibrillator Function Following Septal Myectomy and Coronary Artery Unroofing in a Pediatric Patient with Severe Hypertrophic Cardiomyopathy.","authors":"Leon Przybylowski, John J Parent, Jeremy L Herrmann, Adam C Kean","doi":"10.19102/icrm.2025.16074","DOIUrl":"10.19102/icrm.2025.16074","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is an inherited disease present in 1 in 500 individuals and is the most common cause of sudden cardiac death in children. We present the case of a 17-year-old boy with HCM and a primary prevention subcutaneous implantable cardioverter-defibrillator (S-ICD) who developed left ventricular outflow tract obstruction and a myocardial bridge of the left anterior descending coronary artery. The patient underwent a septal myectomy/myotomy and muscular bridge unroofing. The S-ICD system was undisturbed during the surgery, with no loss of function. Septal myectomy may be accomplished in pediatric HCM patients following optimal S-ICD placement with maintained S-ICD function.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 7","pages":"6385-6390"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790172","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":"Electrogram Dynamics at the Site of Ventricular Tachycardia Termination During Radiofrequency Ablation.","authors":"Wissam Harmouch, Ali Saad Al-Shammari, Muhie Dean Sabayon, Arun Narayanan, Haider Al Taii","doi":"10.19102/icrm.2025.16071","DOIUrl":"10.19102/icrm.2025.16071","url":null,"abstract":"<p><p>Ventricular tachycardia (VT) is a life-threatening arrhythmia associated with high morbidity and mortality, particularly in patients with structural heart disease. Radiofrequency ablation is an effective procedure to treat patients with this malignant arrhythmia. We report three cases of successful termination of VT using unique catheter ablation techniques. Through these cases and techniques, we highlight the advantages of specific localization of abnormal circuits within the cardiac layer involved, as well as electrogram evidence of tachycardia termination.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 7","pages":"6346-6353"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790169","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":"Functional Substrate Mapping of the Right Atrium: A Novel Method to Identify Critical Isthmus of Re-entry in Atrial Tachycardia.","authors":"Hikmet Yorgun, Cem Çöteli, Gül Sinem Kılıç, Samuray Zekeriyeyev, Muhammet Dural, Kudret Aytemir","doi":"10.19102/icrm.2025.16073","DOIUrl":"10.19102/icrm.2025.16073","url":null,"abstract":"<p><p>Right atrial tachycardia (AT) is a frequent rhythm disorder in patients with atrial scar mainly due to surgical incisions or congenital heart diseases. Despite the mounting evidence about AT mechanisms and types, data are scarce regarding the conduction properties as well as the functional characteristics of the atrial substrate during sinus rhythm, which plays a role in the maintenance of tachycardia. We sought to evaluate the relationship between the functional substrate mapping (FSM) characteristics of the right atrium (RA) and the critical isthmus (CI) of re-entrant ATs in patients with underlying atrial scar. Patients with a history of right AT who underwent catheter ablation with three-dimensional mapping were retrospectively enrolled. A voltage map and isochronal late activation map were created during the sinus/paced rhythm using multielectrode catheters to detect deceleration zones (DZs). Subsequently, AT was induced with programmed stimulation, and activation mapping was performed to detect the CI of the tachycardia. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of atrial fibrillation or AT (≥30 s) during follow-up. A total of 24 patients (mean age, 46 ± 15 years; 13 [54%] women) with right AT were included. A total of 36 ATs were mapped (16 [44.4%] localized re-entry, 20 [55.6%] macro-re-entry). Atrial low-voltage zones composed 23.3% ± 13.0% of the total RA. The mean values of bipolar voltage, electrogram duration, and conduction velocity during sinus rhythm corresponding to the CI of ATs were 0.18 ± 0.10 mV, 121.7 ± 29.4 ms, and 0.06 ± 0.04 m/s, respectively. The total number of DZs per chamber was 1.1 ± 0.3, with all being located in the low-voltage zone (<0.5 mV) detected by high-density mapping. All CIs of non-cavotricuspid isthmus (CTI)-dependent re-entry were co-localized with DZs detected during FSM. The positive predictive value of DZs to detect the CI of inducible ATs was 80.8%. During a mean follow-up of 11.7 ± 8.1 months, freedom from atrial tachyarrhythmias was 87.5%. Although CTI-dependent macro-re-entry is the most common mechanism in patients with RA scar, our findings demonstrated the relevance of FSM to predict non-CTI-dependent ATs. Conduction slowing manifested as DZs with continuous-fragmented signal morphology may guide ablation strategy tailoring in the case of underlying RA scar.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 7","pages":"6374-6384"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790170","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":"Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Valve Replacement: An Umbrella Review.","authors":"Alina Sami Khan, Abdullah Lnu, Zain Ul Abideen, Muhammad Usman Baig, Muhammad Hudaib, Hammad Ur Rehman, Noreen Haider, Shahzaib Khaliq, Shifa Batool, Rimsha Bint-E-Hina, Noor Mahal Azam, Sahr Syed Asif, Mahima Khatri, Satesh Kumar","doi":"10.19102/icrm.2025.16075","DOIUrl":"10.19102/icrm.2025.16075","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is a major sequela after bioprosthetic valve replacement (BPVR) in patients with valvular heart disease. This study evaluates the data compiled from different meta-analyses in an umbrella review. We investigated the anticoagulation efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with AF and BPVR. A comprehensive search of the Cochrane Database of Systematic Reviews, EMBASE, and PubMed was completed to find papers published up until June 2024 that could be included in this umbrella review. Randomized controlled trials (RCTs) and retrospective observational/cohort studies were primarily identified as the foundation of meta-analyses and peer-reviewed systematic reviews. The quality of the included publications was determined using the AMSTAR 2 tool and the Cochrane Collaboration's risk-of-bias tool, while the overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. A total of 20 systematic reviews and meta-analyses of RCTs and observational studies were included in this umbrella review. Among the primary outcomes, the pooled analysis exhibited a significant reduction in all-cause mortality (risk ratio [RR], 0.95; 95% confidence interval [CI], 0.91-1.00; <i>P</i> = .05; <i>I</i>2 = 0%), risk of major/life-threatening bleeding (RR, 0.73; 95% CI, 0.66-0.82; <i>P</i> ≤ .00001; <i>I</i>2 = 66%), and stroke/thromboembolism (RR, 0.74; 95% CI, 0.67-0.82; <i>P</i> = .00001; <i>I</i>2 = 0%) in patients who were administered DOAC pharmacotherapy as compared to VKAs. The only primary outcome that demonstrated clinically insignificant results was all-cause stroke (RR, 0.9; 95% CI, 0.79-1.04; <i>P</i> = .16; <i>I</i>2 = 54%). Secondary outcomes such as intracranial bleeding, any bleeding, and minor or clinically insignificant bleeding all showed a significantly decreased risk in the DOAC group versus the VKA group. Only two outcomes revealed an increased risk of cardiovascular events and risk of ischemic stroke in patients who received DOACs; however, these outcomes were statistically insignificant. According to our analysis, DOACs exhibit a superior safety and efficacy profile to that of VKAs when it comes to treating patients with BPVR. DOACs do not require continuous monitoring; therefore, they could be an effective substitute for VKAs in these individuals.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 7","pages":"6355-6373"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790234","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.2025.16072","DOIUrl":"10.19102/icrm.2025.16072","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 7","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790171","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}