Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.10.003
Megan E. LaBreck PharmD , Nagesh Chopra MD , Andrea Robinson MSN, ACNP , Sreedhar R. Billakanty MD , Eugene Y. Fu MD , David M. Nemer MD , Ankur N. Shah MD , Jaret D. Tyler MD , Cody Ash CNP , Allyson Farrah PA , Jennifer James CNP , Victoria Murnane CNP , Beth Loessin CNP , Afton Smith CNP , Jill Swinning CNS , Auroa Badin MD , Anish K. Amin MD
<div><h3>Background</h3><div>Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor’s Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the safety, feasibility, and patient adherence to protocol-driven, pharmacist-led outpatient sotalol initiation using the Kardia Mobile 6L for remote ECG monitoring and to compare these outcomes with patients completing inpatient sotalol protocol for initiation.</div></div><div><h3>Methods</h3><div>Patients who underwent outpatient sotalol initiation through an antiarrhythmic clinic for the treatment of both atrial and ventricular arrhythmias over a period of approximately 3 years, from September 1, 2020, to June 16, 2023, were retrospectively reviewed and compared with a cohort of inpatients initiated on sotalol. The outpatient cohort had a minimum longitudinal follow-up of 90 days.</div></div><div><h3>Results</h3><div>A total of 263 patients using the outpatient sotalol initiation protocol were compared with 28 age- and sex-matched inpatients who underwent inpatient sotalol initiation. The outpatient cohort included 179 men (68%), with an age of 68.8 ± 10.1 years, CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 3.48 ± 1.43, baseline 12-lead QTc interval of 440.77 ± 33.42 ms, and a left ventricular ejection fraction of 57.4% ± 9.23%. Outpatients were started on a median (minimum-maximum) dose of 120 (80-160) mg of sotalol twice a day (120-mg dose; n = 227; 86.3%) and ended at a median (minimum-maximum) dose of 120 (60-160) mg twice a day (120-mg dose; n = 217; 82.5%). The proportions of patients prescribed low-, moderate-, or high-dose sotalol twice a day (60 mg, 80 mg, 120 mg, and 160 mg) at the end of initiation were similar between the inpatient and outpatient groups (<em>P</em> = 0.5). The majority (98.9%; 260 of 263) of patients completed the 3-day outpatient initiation. Outpatient adherence was high during the 3-day initiation period among patients with varied age and socioeconomic background; 258 patients (98.1%) completed the ECG on day 1, and 240 (91.3%) completed the ECG on day 3. No significant QTc interval prolongation was observed during the outpatient postinitiation study period. There were similar sotalol discontinuation rates within 30 days of initiation in the inpatient vs outpatient cohorts (7% vs 8%; <em>P</em> > 0.90). A total of 17 (6.5%) patients stopped sotalol because of symptomatic bradycardia, and 1 death was observed over a 90-day follow-up period in the outpatient cohort.</div></div><d
{"title":"Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring","authors":"Megan E. LaBreck PharmD , Nagesh Chopra MD , Andrea Robinson MSN, ACNP , Sreedhar R. Billakanty MD , Eugene Y. Fu MD , David M. Nemer MD , Ankur N. Shah MD , Jaret D. Tyler MD , Cody Ash CNP , Allyson Farrah PA , Jennifer James CNP , Victoria Murnane CNP , Beth Loessin CNP , Afton Smith CNP , Jill Swinning CNS , Auroa Badin MD , Anish K. Amin MD","doi":"10.1016/j.jacep.2024.10.003","DOIUrl":"10.1016/j.jacep.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor’s Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the safety, feasibility, and patient adherence to protocol-driven, pharmacist-led outpatient sotalol initiation using the Kardia Mobile 6L for remote ECG monitoring and to compare these outcomes with patients completing inpatient sotalol protocol for initiation.</div></div><div><h3>Methods</h3><div>Patients who underwent outpatient sotalol initiation through an antiarrhythmic clinic for the treatment of both atrial and ventricular arrhythmias over a period of approximately 3 years, from September 1, 2020, to June 16, 2023, were retrospectively reviewed and compared with a cohort of inpatients initiated on sotalol. The outpatient cohort had a minimum longitudinal follow-up of 90 days.</div></div><div><h3>Results</h3><div>A total of 263 patients using the outpatient sotalol initiation protocol were compared with 28 age- and sex-matched inpatients who underwent inpatient sotalol initiation. The outpatient cohort included 179 men (68%), with an age of 68.8 ± 10.1 years, CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 3.48 ± 1.43, baseline 12-lead QTc interval of 440.77 ± 33.42 ms, and a left ventricular ejection fraction of 57.4% ± 9.23%. Outpatients were started on a median (minimum-maximum) dose of 120 (80-160) mg of sotalol twice a day (120-mg dose; n = 227; 86.3%) and ended at a median (minimum-maximum) dose of 120 (60-160) mg twice a day (120-mg dose; n = 217; 82.5%). The proportions of patients prescribed low-, moderate-, or high-dose sotalol twice a day (60 mg, 80 mg, 120 mg, and 160 mg) at the end of initiation were similar between the inpatient and outpatient groups (<em>P</em> = 0.5). The majority (98.9%; 260 of 263) of patients completed the 3-day outpatient initiation. Outpatient adherence was high during the 3-day initiation period among patients with varied age and socioeconomic background; 258 patients (98.1%) completed the ECG on day 1, and 240 (91.3%) completed the ECG on day 3. No significant QTc interval prolongation was observed during the outpatient postinitiation study period. There were similar sotalol discontinuation rates within 30 days of initiation in the inpatient vs outpatient cohorts (7% vs 8%; <em>P</em> > 0.90). A total of 17 (6.5%) patients stopped sotalol because of symptomatic bradycardia, and 1 death was observed over a 90-day follow-up period in the outpatient cohort.</div></div><d","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 386-396"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.09.036
Jorge E. Romero MD , Angel E. Armas MD , Mohamed Gabr MD , Alejandro Velasco MD , Ely Gracia MD , Christian A. Gozzo BS , Daniel A. Zapata MD , Nathaniel A. Steiger MD , Usha B. Tedrow MD, MS , William H. Sauer MD
{"title":"Vascular Balloon-Assisted Lysis of Pericardial Adhesions to Facilitate Epicardial Ventricular Tachycardia Ablation","authors":"Jorge E. Romero MD , Angel E. Armas MD , Mohamed Gabr MD , Alejandro Velasco MD , Ely Gracia MD , Christian A. Gozzo BS , Daniel A. Zapata MD , Nathaniel A. Steiger MD , Usha B. Tedrow MD, MS , William H. Sauer MD","doi":"10.1016/j.jacep.2024.09.036","DOIUrl":"10.1016/j.jacep.2024.09.036","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 441-447"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.11.013
Thomas A. Boyle MD, Timothy M. Markman MD
{"title":"Bringing the Message Home","authors":"Thomas A. Boyle MD, Timothy M. Markman MD","doi":"10.1016/j.jacep.2024.11.013","DOIUrl":"10.1016/j.jacep.2024.11.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 397-399"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.10.010
Keita Watanabe MD , Moritz Nies MD , Steffy Rodrigues MEng , Vivek Y. Reddy MD , Jacob S. Koruth MD
Background
Contact force (CF) changes after onset of radiofrequency (RF) delivery are not well understood and often ascribed to catheter instability.
Objectives
This study sought to characterize CF changes during RF-based pulmonary vein (PV) isolation.
Methods
Catheter-tip parameters including CF for all RF sessions were extracted from a novel catheter-mapping system from 6 patients undergoing PV isolation.
Results
Of a total 416 RF sessions, 241 demonstrated progressive increases in CF during RF delivery (group 1). Zero to 5 seconds of RF delivery demonstrated the greatest increase in CF, with no differences between right and left PV sites (2.2 ± 2.2 g vs 1.9 ± 2.3 g, P = 0.26). Subsequent 5-second intervals demonstrated greater increases for right vs left PV sites (eg, 1.2 ± 1.3 g vs 0.5 ± 0.3 g, P = 0.01 for 20 to 25 seconds). CF increment was greater for posterior vs anterior PV sites (3.4 ± 3.1 g vs 1.4 ± 1.4 g, P < 0.001), but similar for roof and floor sites. Higher power and greater impedance drops were associated with greater CF increases. Perpendicular contact had greater CF increases, followed by diagonal and parallel contact. The remaining 175 of 416 sessions demonstrated at least 1 CF decrement, typically occurring after 15 seconds of RF (group 2). This was observed least frequently at inferior PV sites. Except for minor differences in power, there were no differences in CF, tip excursion, and impedance drop between groups.
Conclusions
Progressive CF increase during RF ablation is a distinct phenomenon that likely reflects the “push-back” effect of local myocardial swelling against the catheter tip. This may explain certain catheter-tip behaviors such as tip displacement and instability during ablation.
背景：射频（RF）给药后接触力（CF）的变化尚未得到很好的理解，通常归因于导管不稳定。目的：本研究旨在描述基于rf的肺静脉（PV）分离期间CF的变化。方法：从一种新型导管定位系统中提取6例PV分离患者的导管尖端参数，包括所有RF时段的CF。结果：在总共416次射频治疗中，有241次在射频治疗过程中表现出CF的进行性增加（第1组）。射频治疗0到5秒表现出CF的最大增加，在右侧和左侧PV位点之间没有差异（2.2±2.2 vs 1.9±2.3 g, P = 0.26）。随后的5秒间隔显示右侧PV位点比左侧PV位点增加更大（例如，1.2±1.3 g vs 0.5±0.3 g, P = 0.01，持续20至25秒）。后PV位置的CF增量大于前PV位置（3.4±3.1 vs 1.4±1.4 g, P < 0.001），但屋顶和地板位置相似。更高的功率和更大的阻抗下降与更大的CF增加相关。垂直接触的CF增加幅度最大，其次是对角线和平行接触。在416个疗程中，其余175个疗程至少有1次CF下降，通常发生在射频治疗15秒后（第二组）。这种情况在较低的PV部位观察到的频率最低。除了功率上的微小差异外，两组之间的CF、尖端偏移和阻抗下降没有差异。结论：RF消融过程中进行性CF增加是一种明显的现象，可能反映了局部心肌肿胀对导管尖端的“推回”作用。这可以解释消融过程中导管尖端的某些行为，如尖端位移和不稳定性。
{"title":"Contact Force Increases During Radiofrequency Ablation","authors":"Keita Watanabe MD , Moritz Nies MD , Steffy Rodrigues MEng , Vivek Y. Reddy MD , Jacob S. Koruth MD","doi":"10.1016/j.jacep.2024.10.010","DOIUrl":"10.1016/j.jacep.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Contact force (CF) changes after onset of radiofrequency (RF) delivery are not well understood and often ascribed to catheter instability.</div></div><div><h3>Objectives</h3><div>This study sought to characterize CF changes during RF-based pulmonary vein (PV) isolation.</div></div><div><h3>Methods</h3><div>Catheter-tip parameters including CF for all RF sessions were extracted from a novel catheter-mapping system from 6 patients undergoing PV isolation.</div></div><div><h3>Results</h3><div>Of a total 416 RF sessions, 241 demonstrated progressive increases in CF during RF delivery (group 1). Zero to 5 seconds of RF delivery demonstrated the greatest increase in CF, with no differences between right and left PV sites (2.2 ± 2.2 g vs 1.9 ± 2.3 g, <em>P</em> = 0.26). Subsequent 5-second intervals demonstrated greater increases for right vs left PV sites (eg, 1.2 ± 1.3 g vs 0.5 ± 0.3 g, <em>P</em> = 0.01 for 20 to 25 seconds). CF increment was greater for posterior vs anterior PV sites (3.4 ± 3.1 g vs 1.4 ± 1.4 g, <em>P</em> < 0.001), but similar for roof and floor sites. Higher power and greater impedance drops were associated with greater CF increases. Perpendicular contact had greater CF increases, followed by diagonal and parallel contact. The remaining 175 of 416 sessions demonstrated at least 1 CF decrement, typically occurring after 15 seconds of RF (group 2). This was observed least frequently at inferior PV sites. Except for minor differences in power, there were no differences in CF, tip excursion, and impedance drop between groups.</div></div><div><h3>Conclusions</h3><div>Progressive CF increase during RF ablation is a distinct phenomenon that likely reflects the “push-back” effect of local myocardial swelling against the catheter tip. This may explain certain catheter-tip behaviors such as tip displacement and instability during ablation.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 337-349"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.10.004
Nithi Tokavanich MD , Anurut Huntrakul MD , Miki Yokokawa MD , Boldizsar Kovacs MD , Michael Ghannam MD , Jackson L. Liang DO , Anil Attili MD , Hubert Cochet MD , Rakesh Latchamsetty MD , Krit Jongnarangsin MD , Fred Morady MD , Frank Bogun MD
Background
Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.
Objectives
The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.
Methods
In a series of 43 consecutive patients with focal PAP arrhythmias referred for ablation, the prevalence and location of structural abnormalities on PAPs were assessed with cardiac magnetic resonance imaging, computed tomographic angiography and intracardiac echocardiography (ICE). Sites of origin of ventricular arrhythmias (VAs) were correlated with structural abnormalities.
Results
On PAPs, late gadolinium enhancement (LGE) was present on cardiac magnetic resonance imaging in 19 of 43 patients, calcifications on computed tomography in 2 of 43 and on ICE in 3 of 43 patients, and increased echogenicity on ICE in 39 of 43 patients. A total of 141 focal PAP arrhythmias were identified, and VA target sites were localized adjacent to areas with increased echogenicity on ICE for 59 of 141 (44%) VAs, adjacent to LGE for 35 of 141 (25%) VAs, and adjacent to calcifications for 14 of 141 (10%) VAs. At least one VA target site was localized to areas of structural abnormalities in 32 of 43 (74%) patients.
Conclusions
Multimodality imaging identifies arrhythmogenic PAPs preprocedurally and in real time during the ablation procedure in most patients. Increased echogenicity, LGE, and calcifications are often seen on PAPs in patients with focal PAP arrhythmias and can indicate the site of origin.
{"title":"Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias","authors":"Nithi Tokavanich MD , Anurut Huntrakul MD , Miki Yokokawa MD , Boldizsar Kovacs MD , Michael Ghannam MD , Jackson L. Liang DO , Anil Attili MD , Hubert Cochet MD , Rakesh Latchamsetty MD , Krit Jongnarangsin MD , Fred Morady MD , Frank Bogun MD","doi":"10.1016/j.jacep.2024.10.004","DOIUrl":"10.1016/j.jacep.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.</div></div><div><h3>Methods</h3><div>In a series of 43 consecutive patients with focal PAP arrhythmias referred for ablation, the prevalence and location of structural abnormalities on PAPs were assessed with cardiac magnetic resonance imaging, computed tomographic angiography and intracardiac echocardiography (ICE). Sites of origin of ventricular arrhythmias (VAs) were correlated with structural abnormalities.</div></div><div><h3>Results</h3><div>On PAPs, late gadolinium enhancement (LGE) was present on cardiac magnetic resonance imaging in 19 of 43 patients, calcifications on computed tomography in 2 of 43 and on ICE in 3 of 43 patients, and increased echogenicity on ICE in 39 of 43 patients. A total of 141 focal PAP arrhythmias were identified, and VA target sites were localized adjacent to areas with increased echogenicity on ICE for 59 of 141 (44%) VAs, adjacent to LGE for 35 of 141 (25%) VAs, and adjacent to calcifications for 14 of 141 (10%) VAs. At least one VA target site was localized to areas of structural abnormalities in 32 of 43 (74%) patients.</div></div><div><h3>Conclusions</h3><div>Multimodality imaging identifies arrhythmogenic PAPs preprocedurally and in real time during the ablation procedure in most patients. Increased echogenicity, LGE, and calcifications are often seen on PAPs in patients with focal PAP arrhythmias and can indicate the site of origin.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 259-269"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.10.006
Jack A. Goergen MD , Graham Peigh MD, MSc , Nathan Varberg BS , Paul D. Ziegler MS , Anthony I. Roberts MSc , Evan Stanelle MS , Dana Soderlund MPH , Sadiya S. Khan MD, MS , Rod S. Passman MD, MSCE
Background
Prior research suggests Black individuals have a lower risk of atrial fibrillation (AF) than White individuals, but this may be related to the underdetection of AF. Whether this trend persists using highly sensitive methods of AF diagnosis has not been well-studied.
Objectives
The objective of this study was to use cardiac implantable electronic devices (CIEDs) capable of AF diagnosis to compare AF incidence between Black and White individuals.
Methods
This was a retrospective observational study involving Black and White patients who had a CIED implanted between January 1, 2007, and June 1, 2019. Patients with insertable cardiac monitors, insufficient monitoring, or prior AF were excluded. The primary endpoint was the overall adjusted incidence of device-detected AF between Black and White individuals.
Results
Of 441,047 patients with a CIED implanted during the study period, 88,427 patients (mean age, 69 ± 13 years; 80,382 White [91%]; 55,840 male [63%]) were included in analysis. The mean follow-up duration was 2.2 ± 1.7 years, and 35,143 patients (40%) had device-detected AF. The crude incidence of AF was greater among White, compared with Black, individuals (27.95 vs 24.86 cases per 100 person-years, P < 0.001). After adjusting for age, sex, and medical comorbidities, the hazard of AF was similar between Black and White individuals (HR: 1.02; 95% CI: 0.98-1.06). In subgroup analysis by type of CIED, White individuals had a greater hazard of AF in the pacemaker cohort, whereas Black individuals had a greater hazard of AF in the implantable cardioverter defibrillator cohort.
Conclusions
The adjusted hazard of AF was similar between Black and White individuals with CIEDs.
{"title":"Racial Differences in Device-Detected Incident Atrial Fibrillation","authors":"Jack A. Goergen MD , Graham Peigh MD, MSc , Nathan Varberg BS , Paul D. Ziegler MS , Anthony I. Roberts MSc , Evan Stanelle MS , Dana Soderlund MPH , Sadiya S. Khan MD, MS , Rod S. Passman MD, MSCE","doi":"10.1016/j.jacep.2024.10.006","DOIUrl":"10.1016/j.jacep.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Prior research suggests Black individuals have a lower risk of atrial fibrillation (AF) than White individuals, but this may be related to the underdetection of AF. Whether this trend persists using highly sensitive methods of AF diagnosis has not been well-studied.</div></div><div><h3>Objectives</h3><div>The objective of this study was to use cardiac implantable electronic devices (CIEDs) capable of AF diagnosis to compare AF incidence between Black and White individuals.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study involving Black and White patients who had a CIED implanted between January 1, 2007, and June 1, 2019. Patients with insertable cardiac monitors, insufficient monitoring, or prior AF were excluded. The primary endpoint was the overall adjusted incidence of device-detected AF between Black and White individuals.</div></div><div><h3>Results</h3><div>Of 441,047 patients with a CIED implanted during the study period, 88,427 patients (mean age, 69 ± 13 years; 80,382 White [91%]; 55,840 male [63%]) were included in analysis. The mean follow-up duration was 2.2 ± 1.7 years, and 35,143 patients (40%) had device-detected AF. The crude incidence of AF was greater among White, compared with Black, individuals (27.95 vs 24.86 cases per 100 person-years, <em>P</em> < 0.001). After adjusting for age, sex, and medical comorbidities, the hazard of AF was similar between Black and White individuals (HR: 1.02; 95% CI: 0.98-1.06). In subgroup analysis by type of CIED, White individuals had a greater hazard of AF in the pacemaker cohort, whereas Black individuals had a greater hazard of AF in the implantable cardioverter defibrillator cohort.</div></div><div><h3>Conclusions</h3><div>The adjusted hazard of AF was similar between Black and White individuals with CIEDs.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 298-308"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jacep.2024.10.007
Hannah K. Wood-Kurland MD , Anne Storgaard Nørskov MD , Nicholas Carlson MD, PhD , Anders Møller Greve MD, PhD , Lars Køber MD, DMSc , Gunnar Gislason MD, PhD , Christian Torp-Pedersen MD, DMSc , Casper N. Bang MD, PhD
Background
Chronic kidney disease (CKD) is frequently complicated by arrhythmias, plausibly leading to the increased risk of sudden cardiac death in this population. However, little is known about the association between CKD and third-degree atrioventricular block (3AVB) and need for permanent pacing.
Objectives
This study aimed to investigate the association between CKD and 3AVB.
Methods
In a population-based nested case-control study, patients with 3AVB were identified between July 1995 and December 2018 using Danish administrative registries. Cases were risk set matched 1:5 with controls on sex and birth year. Multivariable Cox regression was used to analyze the association between CKD and 3AVB, with subsequent logistic regression analyses for computation of odds ratios for pacemaker implantation stratified by dialysis or nondialysis CKD.
Results
A total of 31,301 patients with 3AVB were identified and matched with 155,506 controls. The mean age was 74.7 ± 12 years, and 40.2% were female. A significant association was found between CKD and 3AVB after adjustment for comorbidities and potential atrioventricular node blocking agents (HR: 1.83; 95% CI: 1.73-1.93). In stratified analyses, the association was stronger in patients using dialysis compared with nondialysis patients (HR: 7.71; 95% CI: 5.84-10.18; vs HR: 1.73; 95% CI: 1.64-1.83). The odds of pacemaker implantation were lower for patients using dialysis (OR: 0.77; 95% CI: 0.60-0.98) but comparable between patients with nondialysis CKD (OR: 1.04; 95% CI: 0.96-1.12) and patients without CKD.
Conclusions
CKD was independently associated with a higher rate of 3AVB, especially for patients using dialysis.
{"title":"The Association Between Chronic Kidney Disease and Third-Degree Atrioventricular Block","authors":"Hannah K. Wood-Kurland MD , Anne Storgaard Nørskov MD , Nicholas Carlson MD, PhD , Anders Møller Greve MD, PhD , Lars Køber MD, DMSc , Gunnar Gislason MD, PhD , Christian Torp-Pedersen MD, DMSc , Casper N. Bang MD, PhD","doi":"10.1016/j.jacep.2024.10.007","DOIUrl":"10.1016/j.jacep.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is frequently complicated by arrhythmias, plausibly leading to the increased risk of sudden cardiac death in this population. However, little is known about the association between CKD and third-degree atrioventricular block (3AVB) and need for permanent pacing.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the association between CKD and 3AVB.</div></div><div><h3>Methods</h3><div>In a population-based nested case-control study, patients with 3AVB were identified between July 1995 and December 2018 using Danish administrative registries. Cases were risk set matched 1:5 with controls on sex and birth year. Multivariable Cox regression was used to analyze the association between CKD and 3AVB, with subsequent logistic regression analyses for computation of odds ratios for pacemaker implantation stratified by dialysis or nondialysis CKD.</div></div><div><h3>Results</h3><div>A total of 31,301 patients with 3AVB were identified and matched with 155,506 controls. The mean age was 74.7 ± 12 years, and 40.2% were female. A significant association was found between CKD and 3AVB after adjustment for comorbidities and potential atrioventricular node blocking agents (HR: 1.83; 95% CI: 1.73-1.93). In stratified analyses, the association was stronger in patients using dialysis compared with nondialysis patients (HR: 7.71; 95% CI: 5.84-10.18; vs HR: 1.73; 95% CI: 1.64-1.83). The odds of pacemaker implantation were lower for patients using dialysis (OR: 0.77; 95% CI: 0.60-0.98) but comparable between patients with nondialysis CKD (OR: 1.04; 95% CI: 0.96-1.12) and patients without CKD.</div></div><div><h3>Conclusions</h3><div>CKD was independently associated with a higher rate of 3AVB, especially for patients using dialysis.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 2","pages":"Pages 376-385"},"PeriodicalIF":8.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：