Annals of Noninvasive Electrocardiology最新文献

{"title":"Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study","authors":"Alessandro Bortolotti,&nbsp;Fabrizio Ricci,&nbsp;Carmelita Cieri,&nbsp;Federica Cocco,&nbsp;Chiara Martini,&nbsp;Marcello Panunzi,&nbsp;Davide Rossi,&nbsp;Anna Sorella,&nbsp;Silvio Saraullo,&nbsp;Davide Scordo,&nbsp;Giulia Renda,&nbsp;Sabina Gallina,&nbsp;Riccardo Palumbo","doi":"10.1111/anec.70082","DOIUrl":"https://doi.org/10.1111/anec.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; <i>p</i> &lt; 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (<i>p</i> &lt; 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; <i>p</i> &lt; 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; <i>p</i> = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; <i>p</i> = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; <i>p</i> = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; <i>p</i> = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; <i>p</i> = 0.041).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Sacubitril/Valsartan on Supraventricular and Ventricular Arrhythmias in Patients With Heart Failure","authors":"Alireza Arzhangzadeh,&nbsp;Mohammad Hossein Nikoo,&nbsp;Majid Haghjoo,&nbsp;Fatemeh Rasekh,&nbsp;Shayan Shojaei,&nbsp;Asma Mousavi,&nbsp;Salma Nozhat,&nbsp;Roozbeh Narimani-Javid,&nbsp;Helia Bazroodi,&nbsp;Sana Neisi,&nbsp;Mitra Mojibpour,&nbsp;Mohammad Abedini,&nbsp;Saghi Eslamzadeh,&nbsp;Hamed Bazrafshan Drissi,&nbsp;Sasan Shafiei","doi":"10.1111/anec.70081","DOIUrl":"https://doi.org/10.1111/anec.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with heart failure with reduced ejection fraction (HFrEF) frequently experience electrical disturbances, such as ventricular or atrial fibrillation (AF). Sacubitril/Valsartan (SV) therapy has been linked to lower rates of mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF), with decreased reliance on implantable cardioverter-defibrillator (ICD) therapy. However, studies on the antiarrhythmic effects of SV in patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) devices are limited. This study aimed to evaluate the impact of SV therapy on antiarrhythmic pacing, defibrillation shock occurrences, and the burden of ventricular arrhythmias in patients with HFrEF who have ICD or CRT-D devices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study was conducted at a HF outpatient clinic involving patients with HFrEF treated with SV. Primary outcomes included the incidence of VT, VF, non-sustained VT (NsVT), supraventricular tachycardia (SVT), and related interventions such as antiarrhythmic pacing (ATP) and defibrillation shocks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>A total of 181 HFrEF patients completed at least 12 months of follow-up, with a mean age of 63.39 ± 12 years; 36.5% were male, and 60.8% had an ICD. Device interrogation revealed a significant reduction in VF incidents (7 vs. 15, <i>p</i> = 0.025) and a decrease in the combined outcome of VT and VF (17 vs. 24, <i>p</i> = 0.047). The need for ICD interventions such as ATP and shocks also significantly decreased following the initiation of SV therapy (10 vs. 24, <i>p</i> = 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SV therapy significantly reduces the incidence of cardiac arrhythmias, particularly VT and VF, while decreasing the need for clinical interventions related to implanted devices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Ventricular Tachyarrhythmias in Patients With Left Ventricular Ejection Fraction Improvement Following Cardiac Resynchronization Therapy","authors":"Adam Visca,&nbsp;Saadia Sherazi,&nbsp;Ilan Goldenberg,&nbsp;Scott McNitt,&nbsp;Nikhila Rao,&nbsp;Nilesh Rao,&nbsp;Ahmed Shah,&nbsp;Mehmet Aktas,&nbsp;Valentina Kutyifa,&nbsp;Wojciech Zareba,&nbsp;Krishna Rao","doi":"10.1111/anec.70059","DOIUrl":"https://doi.org/10.1111/anec.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients undergoing cardiac resynchronization therapy with a defibrillator (CRT-D) often experience improvements in the left ventricular ejection fraction (LVEF). This study aimed to identify predictors of ventricular tachyarrhythmias (VTA) in patients with CRT-D devices and LVEF improvement beyond guideline recommendations for a defibrillator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients randomized to the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial who improved their LVEF to &gt; 35% at 12 months following CRT-D implant were included in this analysis (<i>N</i> = 651). Predictors of an appropriate implantable cardioverter defibrillator (ICD) Rx VTA were evaluated by Cox proportional hazards regression modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three predictors of VTA among patients treated with CRT-D subsequent to LVEF improvement &gt; 35%: Lower range improvement in LVEF 36%–40% versus improvement to &gt; 40% (HR, 1.97; 95% CI, 1.21–3.20; <i>p</i> = 0.006); Baseline non-LBBB ECG morphology (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.23–3.04; <i>p</i> = 0.004); Occurrence of VTA during the first year post-CRT-D (HR, 4.91; 95% CI, 2.99–8.07; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified a sub-group of patients with risk factors who remain at high risk of VTA despite improvement in LVEF following CRT implant. These patients require close monitoring despite improvement in LVEF beyond guideline recommendations for an ICD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evaluation of P-Wave Parameters in Patients With Percutaneous Closure of Atrial Septal Defect","authors":"Ramazan Astan,&nbsp;Fehmi Kacmaz,&nbsp;Ersin Saricam,&nbsp;Erdogan Ilkay","doi":"10.1111/anec.70076","DOIUrl":"https://doi.org/10.1111/anec.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial septal defect (ASD) can lead to volume overload and related changes in P-wave parameters in surface electrocardiograms of these patients. In this study, we aimed to evaluate the effect of volume overload on P-wave parameters in patients with ASD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study is a retrospective cohort analysis. A total of 142 patients with secundum ASD who underwent percutaneous closure were evaluated. P-wave duration (Pmax) and P-wave dispersion (PWD) were measured on the surface ECG before and 1 h after the closure procedure. We evaluated P-wave parameters in terms of defect size, duration of the volume overload, and closure device sizes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pmax and PWD were significantly decreased after the procedure compared with the values before the procedure (<i>p</i> &lt; 0.001). Pmax values had a statistically significant correlation with ASD size (&lt; 20 mm or ≥ 20 mm) both before and after the procedure. Pmax values were significantly higher in patients older than 30 years of age (119.6 ± 19.5 vs. 102.7 ± 17.1 ms, respectively; <i>p</i> = 0.039). A significantly positive correlation was found between pre- and post-procedural Pmax and defect sizes (<i>r</i> = 0.474, <i>p</i> = 0.019 and <i>r</i> = 0.4233, <i>p</i> = 0.04, respectively). However, no positive correlation between PWD and defect age and size was present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Percutaneous closure of ASD is associated with an immediate decrease in both Pd and Pmax that seems to be related to the acute volume overload cessation in cardiac chambers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining STEMI Prognosis: Expanding the Role of Noninvasive Cardiac Monitoring Beyond the GRACE Score","authors":"Javeria Akhter,&nbsp;Javed Iqbal","doi":"10.1111/anec.70078","DOIUrl":"https://doi.org/10.1111/anec.70078","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article by Xin et al. “Predictive Value of Noninvasive Cardiac Function Monitoring Combined with GRACE Score for Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction” which provides valuable insights into the potential of noninvasive cardiac function monitoring (NCFM) to augment risk stratification in patients with ST-segment elevation myocardial infarction (STEMI). The authors present a novel approach to improving prognostic accuracy for major adverse cardiovascular events (MACE) by integrating hemodynamic parameters with the established GRACE score (Xin et al. &lt;span&gt;2025&lt;/span&gt;). Although the study contributes implicitly to the field, certain aspects warrant further discussion.&lt;/p&gt;&lt;p&gt;First, the study successfully demonstrates that stroke volume (SV), cardiac output (CO), cardiac index (CI), contractility index (CTI), early diastolic filling ratio (EDFR), end-diastolic volume (EDV), and systemic vascular resistance (SVR) are independent predictors of MACE. Moreover, the authors confirm that including SV and CTI into the GRACE score improves predictive performance. While this finding is promising, the study does not assess whether alternative combinations of hemodynamic parameters might offer even greater predictive accuracy. Considering the interaction of different cardiac function parameters, an exploratory analysis using machine-learning techniques such as decision trees or neural networks could help investigate the most effective predictors of short-term outcomes (Patel and Sengupta &lt;span&gt;2020&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Second, while the study effectively underscores the added predictive value of NCFM in combination with the GRACE score, it does not provide adequate discussion on the probability of integrating NCFM into clinical practice. Extensive implementation of noninvasive cardiac monitoring entails considerations such as availability, cost-effectiveness, and user-friendliness in different healthcare settings (Kim et al. &lt;span&gt;2019&lt;/span&gt;). Addressing these logistical concerns would enhance the study's clinical applicability and guide its possible adoption in routine patient management.&lt;/p&gt;&lt;p&gt;Third, the study does not consider probable confounding variables that may affect the predictive power of NCFM. Variables such as renal function, medication adherence, and previous cardiovascular interventions could affect both hemodynamic parameters and MACE outcomes (Chinwong et al. &lt;span&gt;2021&lt;/span&gt;; Hussain et al. &lt;span&gt;2023&lt;/span&gt;). Adjusting for these factors in a multivariate analysis would support the study's conclusions and provide more precise risk stratification.&lt;/p&gt;&lt;p&gt;Fourth, the study does not investigate the additional benefit of repeated NCFM measurements over time. Although the single-timepoint evaluation at admission provides valuable prognostic information, dynamic changes in cardiac function parameters post-STEMI may offer supplementary predictive value. Future research shou","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digitalis Therapy Is Associated With an Increased Risk of ICD Shock Delivery and Device Revision","authors":"Gerrit Frommeyer,&nbsp;Philipp S. Lange,&nbsp;Thomas Kleemann,&nbsp;Christoph Stellbrink,&nbsp;Hüseyin Ince,&nbsp;Johannes Brachmann,&nbsp;Thorsten Lewalter,&nbsp;Matthias Hochadel,&nbsp;Jochen Senges,&nbsp;Lars Eckardt","doi":"10.1111/anec.70080","DOIUrl":"https://doi.org/10.1111/anec.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digitalis glycosides are employed for rate control of atrial fibrillation and treatment of heart failure. Previous studies suggested potential harmful effects of digitalis therapy. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcomes in patients with systolic failure who were implanted with an ICD- or CRT-ICD system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>The German Device Registry is a nationwide, prospective registry with a 1-year follow-up investigating 4384 patients receiving either ICD or CRT systems in 52 German centers. The present analysis focused on the presence of digitalis therapy in 3826 patients undergoing device implantation. Patients receiving digitalis therapy (<i>n</i> = 800) presented a more severely impaired left ventricular function, higher NYHA class, and an increased incidence of left bundle branch block. Consequently, the implantation of CRT systems was more common in this group. One-year mortality did not significantly differ between both groups (9.1% vs. 7.4%, <i>p</i> = 0.14). Similar results were obtained for the combined endpoint, including death, myocardial infarction, and stroke. ICD shock delivery (19.7% vs. 15.0%, <i>p</i> = 0.006) and device revision (11.4% vs. 7.5%, <i>p</i> &lt; 0.004) were more common in digitalis-treated patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study in patients undergoing ICD or CRT implantation, an association of digitalis therapy with an increased risk of device revision was observed. Of note, mortality or severe cardiovascular events did not differ between both groups. Furthermore, an increased risk of ICD shock delivery was observed in digitalis-treated patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Bundle Branch Pacing Improved the Outcome of End-Stage Hypertrophic Cardiomyopathy: A Case Report","authors":"Manxin Lin,&nbsp;Shufen Huang,&nbsp;Xinyi Huang,&nbsp;Linlin Li,&nbsp;Binni Cai","doi":"10.1111/anec.70073","DOIUrl":"https://doi.org/10.1111/anec.70073","url":null,"abstract":"<p>Patients with hypertrophic cardiomyopathy (HCM) enter the terminal stage when developed left ventricle enlargement and ejection fraction (EF) reduction. The concomitant complete left bundle branch block (LBBB) is considered an important factor related to poor outcome. Previous research suggested that biventricular pacing has limited effects on such patients. We report a case with end-stage hypertrophic cardiomyopathy who had a miraculous recovery after receiving successful left bundle branch pacing (LBBP).</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Long-Term Use Versus Discontinuation of Direct Oral Anticoagulant After Catheter Ablation for Atrial Fibrillation—RYOUMA Registry Subanalysis","authors":"Yuka Oda,&nbsp;Akihiko Nogami,&nbsp;Yuki Komatsu,&nbsp;Kyoko Soejima,&nbsp;Itsuro Morishima,&nbsp;Kenichi Hiroshima,&nbsp;Ritsushi Kato,&nbsp;Satoru Sakagami,&nbsp;Fumiharu Miura,&nbsp;Keisuke Okawa,&nbsp;Masayuki Fukuzawa,&nbsp;Atsushi Takita,&nbsp;Kikuya Uno,&nbsp;Koichiro Kumagai,&nbsp;Takashi Kurita,&nbsp;Masahiko Gosho,&nbsp;Tomoko Ishizu,&nbsp;Kazutaka Aonuma,&nbsp;the RYOUMA Investigators","doi":"10.1111/anec.70067","DOIUrl":"https://doi.org/10.1111/anec.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017–2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0–1, 2, and 3–6, respectively. Among the patients taking DOACs with a CHADS2 score of 0–1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6–2.1] vs. 0.3%/year [95% CI, 0.0–0.7], <i>p</i> = 0.019; 1.8%/year [95% CI, 0.6–3.0] vs. 0.2%/year [95% CI, 0.0–0.6], <i>p</i> = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3–6 (1.6%/year [95% CI, 0.2–3.0] vs. 1.0%/year [95% CI, 0.0–2.1], <i>p</i> = 0.474).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0–1. Conversely, in patients with a CHADS2 score of 3–6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high.</p>\u0000 \u0000 <p><b>Trial Registration:</b> The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry)</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrow QRS Tachycardia With Alternating R-R Interval","authors":"Fenglin Wu,&nbsp;Lijun Zeng,&nbsp;Xiaobo Pu","doi":"10.1111/anec.70075","DOIUrl":"https://doi.org/10.1111/anec.70075","url":null,"abstract":"<p>We report a case of a 21-year-old female manifesting narrow QRS complex tachycardia and alternating R-R intervals. The fixed RP interval suggested ventriculoatrial conduction via an accessory pathway (AP). The alternating PR intervals indicated anterograde conduction through the fast and slow nodal pathways, respectively. The coexistence of AP and dual atrioventricular nodal pathways is not rare, with most of them exhibiting as atrioventricular reentry tachycardia (AVRT) using the fast or slow nodal pathway exclusively as the anterograde limb. We propose that alternating dual nodal pathway AVRT may occur when the fast pathway's effective refractory period is between the cycle lengths of fast-nodal-pathway AVRT and slow-nodal-pathway AVRT.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serendipitous Supernormality","authors":"Behzad B. Pavri,&nbsp;Eitan Frankel","doi":"10.1111/anec.70069","DOIUrl":"https://doi.org/10.1111/anec.70069","url":null,"abstract":"<p>We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation-and-drug-refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250–260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed-coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}