Rungroj Krittayaphong MD, Satchana Pumprueg MD, Ahthit Yindeengam BSc, Gregory Y. H. Lip MD
Background
Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs).
Methods
We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) < and ≥65%.
Results
We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet −37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%.
Conclusion
Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.
{"title":"Number needed to treat for net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation","authors":"Rungroj Krittayaphong MD, Satchana Pumprueg MD, Ahthit Yindeengam BSc, Gregory Y. H. Lip MD","doi":"10.1002/joa3.70023","DOIUrl":"https://doi.org/10.1002/joa3.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) < and ≥65%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet −37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423628","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}
When we recapture the Micra system, we capture the body by pulling the tether attached to the delivery catheter and retrieve it, but sometimes it is difficult, and the Micra is dislodged and fixed in the tricuspid valve annulus. Using a single snare catheter from the superior vena cava and pushing the tines changes the orientation of the device and enables recapture.
{"title":"Single snare pushing technique: A new bailout technique for retrieving Micra fixed in the tricuspid valve annulus","authors":"Keisuke Kojima MD, Atsushi Tanaka MD, PhD, Nozomi Kitade MD, Hiroshi Ikuta MD, Junichiro Nishi MD, PhD","doi":"10.1002/joa3.70027","DOIUrl":"https://doi.org/10.1002/joa3.70027","url":null,"abstract":"<p>When we recapture the Micra system, we capture the body by pulling the tether attached to the delivery catheter and retrieve it, but sometimes it is difficult, and the Micra is dislodged and fixed in the tricuspid valve annulus. Using a single snare catheter from the superior vena cava and pushing the tines changes the orientation of the device and enables recapture.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423627","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}
Azizah Puspitasari Ardinal MD, MSc, Holly P. Morgan PhD, Mark Elliott PhD, Martin Bishop PhD, Christopher Aldo Rinaldi MD, Divaka Perera MD
Background
The leading cause of death in patients with ischemic cardiomyopathy is sudden cardiac death caused by ventricular arrhythmias. Accurate determination of arrhythmic risk in these patients is vital to allow clinicians to take appropriate preventive measures.
Objective
To review and summarize the literature on electrocardiographic imaging (ECGi) metrics that could be used to predict arrhythmic risk in patients with ischemic cardiomyopathy.
Methods
A comprehensive literature search was performed to retrieve research articles on non-invasive electrocardiographic mapping techniques. Inclusion criteria of the studies required the involvement of patients with ischemic cardiomyopathy or ischemic heart disease.
Results
A total of 17 papers were identified, five of which specifically utilized ECGi to acquire metrics associated with an increased risk of ventricular arrhythmia (VA). ECGi metrics, including activation time, repolarization time, activation-recovery interval, and voltage amplitude, were distinguishable between patients with ischemic cardiomyopathy, patients with a history of VA, and healthy controls.
Conclusion
ECGi allows non-invasive measurement of metrics which are associated with an increased risk of ventricular arrhythmias in patients with ischemic cardiomyopathy. ECGi may be a useful tool for risk assessment in these patients. Prospective studies are warranted for further validation and prediction of clinical endpoints.
{"title":"Electrocardiographic imaging metrics to predict the risk of arrhythmia in patients with ischemic cardiomyopathy","authors":"Azizah Puspitasari Ardinal MD, MSc, Holly P. Morgan PhD, Mark Elliott PhD, Martin Bishop PhD, Christopher Aldo Rinaldi MD, Divaka Perera MD","doi":"10.1002/joa3.70024","DOIUrl":"https://doi.org/10.1002/joa3.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The leading cause of death in patients with ischemic cardiomyopathy is sudden cardiac death caused by ventricular arrhythmias. Accurate determination of arrhythmic risk in these patients is vital to allow clinicians to take appropriate preventive measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review and summarize the literature on electrocardiographic imaging (ECGi) metrics that could be used to predict arrhythmic risk in patients with ischemic cardiomyopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was performed to retrieve research articles on non-invasive electrocardiographic mapping techniques. Inclusion criteria of the studies required the involvement of patients with ischemic cardiomyopathy or ischemic heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 17 papers were identified, five of which specifically utilized ECGi to acquire metrics associated with an increased risk of ventricular arrhythmia (VA). ECGi metrics, including activation time, repolarization time, activation-recovery interval, and voltage amplitude, were distinguishable between patients with ischemic cardiomyopathy, patients with a history of VA, and healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ECGi allows non-invasive measurement of metrics which are associated with an increased risk of ventricular arrhythmias in patients with ischemic cardiomyopathy. ECGi may be a useful tool for risk assessment in these patients. Prospective studies are warranted for further validation and prediction of clinical endpoints.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424118","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}
Impact of baseline-pool local impedance (BP-LI) on the lesion size remains unclear.
Methods
Lesion size in the porcine left ventricular myocardium was evaluated using the STABLEPOINT™ catheter across various ablation settings and BP-LIs (100, 140, and 180 ohms).
Results
A total of 184 lesions were created with different durations (15/30/60 s) at 30 watts or with different powers (30/40/50 W) for 15 s. Lesion depth became deeper (2.8/3.0/3.6 mm at 15 s; p = .007, 4.0/4.9/4.6 mm at 30 s; p = .004, and 5.9/5.5/5.2 mm at 60 s; p = .710) and lesion width wider (5.8/6.3/7.6 mm at 15 s; p = .002, 7.0/8.9/8.9 mm at 30 s; p < .001, and 10.5/9.4/10.5 mm at 60 s; p = .262) as the BP-LI increased under 30 W. Similarly, the lesion depth became significantly deeper (2.1/3.4/3.7 mm at 30 W; p < .001, 3.5/4.6/4.6 mm at 40 W; p < .001, and 4.1/4.7/5.2 mm at 50 W; p = .002) and lesion width broader (5.1/6.9/7.0 mm at 30 W; p < .001, 7.0/7.9/8.1 mm at 40 W; p = .004, and 7.7/8.2/9.6 mm at 50 W; p < .001, respectively) as the BP-LI increased with a 15-s ablation. The relationship between the LI drop and lesion size varied with the different BP-LIs. Adjusted %LI drops (absolute LI drop divided by the BP-LI) minimized the differences between the LI values and lesion formation among the three BP-LIs.
Conclusion
Lesion size decreased with lower BP-LI, and the relationship between the LI drops and lesion formation varied across the different BP-LIs. Adjusted %LI drops may serve as a more reliable parameter for predicting the lesion formation.
{"title":"Impact of baseline-pool local impedance on lesion formation using a local impedance-sensing catheter: Lessons from a porcine experimental model","authors":"Hidehira Fukaya MD, PhD, Emiyu Ogawa PhD, Hitoshi Mori MD, PhD, Gen Matsuura MD, PhD, Megumi Toraiwa MD, Sho Ogiso MD, Yuki Arakawa MD, PhD, Shuhei Kobayashi MD, PhD, Hironori Nakamura MD, PhD, Naruya Ishizue MD, PhD, Jun Kishihara MD, PhD, Jun Oikawa MD, PhD, Shinichi Niwano MD, PhD, Junya Ako MD, PhD","doi":"10.1002/joa3.70016","DOIUrl":"https://doi.org/10.1002/joa3.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Impact of baseline-pool local impedance (BP-LI) on the lesion size remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Lesion size in the porcine left ventricular myocardium was evaluated using the STABLEPOINT™ catheter across various ablation settings and BP-LIs (100, 140, and 180 ohms).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 184 lesions were created with different durations (15/30/60 s) at 30 watts or with different powers (30/40/50 W) for 15 s. Lesion depth became deeper (2.8/3.0/3.6 mm at 15 s; <i>p</i> = .007, 4.0/4.9/4.6 mm at 30 s; <i>p</i> = .004, and 5.9/5.5/5.2 mm at 60 s; <i>p</i> = .710) and lesion width wider (5.8/6.3/7.6 mm at 15 s; <i>p</i> = .002, 7.0/8.9/8.9 mm at 30 s; <i>p</i> < .001, and 10.5/9.4/10.5 mm at 60 s; <i>p</i> = .262) as the BP-LI increased under 30 W. Similarly, the lesion depth became significantly deeper (2.1/3.4/3.7 mm at 30 W; <i>p</i> < .001, 3.5/4.6/4.6 mm at 40 W; <i>p</i> < .001, and 4.1/4.7/5.2 mm at 50 W; <i>p</i> = .002) and lesion width broader (5.1/6.9/7.0 mm at 30 W; <i>p</i> < .001, 7.0/7.9/8.1 mm at 40 W; <i>p</i> = .004, and 7.7/8.2/9.6 mm at 50 W; <i>p</i> < .001, respectively) as the BP-LI increased with a 15-s ablation. The relationship between the LI drop and lesion size varied with the different BP-LIs. Adjusted %LI drops (absolute LI drop divided by the BP-LI) minimized the differences between the LI values and lesion formation among the three BP-LIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lesion size decreased with lower BP-LI, and the relationship between the LI drops and lesion formation varied across the different BP-LIs. Adjusted %LI drops may serve as a more reliable parameter for predicting the lesion formation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397148","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}
Implantable cardiac defibrillators (ICDs) are essential for preventing sudden cardiac death. Despite inclusion in national guidelines, older adults are often underrepresented in trials. Evaluating ICD use in the aging population, particularly with advancements in heart failure treatment, is crucial.
Objective
This study examines outcomes in octogenarians undergoing ICD implantation for primary and secondary prevention, focusing on ICD therapies and mortality timing.
Methods
A retrospective observational study at a single Canadian academic center included patients ≥80 years old at ICD implantation, excluding those with <30 days follow-up. Data on demographics, comorbidities, mortality, and ICD therapies were collected from electronic medical records. Clinical frailty was assessed using the Dalhousie Clinical Frailty Scale.
Results
We identified 143 patients (mean age 82.6 ± 2.2 years, 14% female) from May 2015 to October 2023. ICDs were implanted for primary prevention in 63 patients (44%) and secondary prevention in 80 patients (56%). Thirty-seven patients were excluded due to insufficient follow-up. ICD therapies occurred in 30 patients (25%) through anti-tachycardia pacing (ATP) and in 19 patients (18%) through shocks. The mean time to first ATP was 16.9 ± 21.0 months, and to first shock, 21.2 ± 23.6 months. Among 66 patients with mortality data, 19 (24%) died at 31.3 ± 30.4 months. Patients with non-ischemic cardiomyopathy experienced earlier shocks (7.7 vs. 32.2 months, p < 0.05).
Conclusion
Elderly patients undergoing ICD implantation have multiple comorbidities and competing causes of mortality. Device use is overall infrequent but occurs well before observed mortality. Prospective clinical trials are needed to determine ICD benefits in this age cohort.
{"title":"Implantable cardiac defibrillator outcomes in octogenarians","authors":"Bryan Stringer MD, Luke MacLeod MD, Fady Kaldas MD, Gayuni Krishnasamy BSc, Habib Rehman Khan MBBS FRCPUK PhD","doi":"10.1002/joa3.70012","DOIUrl":"https://doi.org/10.1002/joa3.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Implantable cardiac defibrillators (ICDs) are essential for preventing sudden cardiac death. Despite inclusion in national guidelines, older adults are often underrepresented in trials. Evaluating ICD use in the aging population, particularly with advancements in heart failure treatment, is crucial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study examines outcomes in octogenarians undergoing ICD implantation for primary and secondary prevention, focusing on ICD therapies and mortality timing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective observational study at a single Canadian academic center included patients ≥80 years old at ICD implantation, excluding those with <30 days follow-up. Data on demographics, comorbidities, mortality, and ICD therapies were collected from electronic medical records. Clinical frailty was assessed using the Dalhousie Clinical Frailty Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 143 patients (mean age 82.6 ± 2.2 years, 14% female) from May 2015 to October 2023. ICDs were implanted for primary prevention in 63 patients (44%) and secondary prevention in 80 patients (56%). Thirty-seven patients were excluded due to insufficient follow-up. ICD therapies occurred in 30 patients (25%) through anti-tachycardia pacing (ATP) and in 19 patients (18%) through shocks. The mean time to first ATP was 16.9 ± 21.0 months, and to first shock, 21.2 ± 23.6 months. Among 66 patients with mortality data, 19 (24%) died at 31.3 ± 30.4 months. Patients with non-ischemic cardiomyopathy experienced earlier shocks (7.7 vs. 32.2 months, <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elderly patients undergoing ICD implantation have multiple comorbidities and competing causes of mortality. Device use is overall infrequent but occurs well before observed mortality. Prospective clinical trials are needed to determine ICD benefits in this age cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397151","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}
Transseptal catheter ablation resolved ventricular arrhythmias originating from the left ventricular outflow tract following transcatheter aortic valve implantation with a self-expanding Evolut valve. This report highlights the transseptal approach as a safe and effective alternative, overcoming the structural complexities of self-expanding valves while reducing procedural risks and preserving valve integrity.
{"title":"Successful radiofrequency ablation via transseptal approach for premature ventricular contractions originating from left ventricular outflow tract following self-expanding transcatheter aortic valve implantation","authors":"Yuhei Kasai MD, FHRS, Takayuki Kitai MD, Ryo Horita MD, Junji Morita MD, Daisuke Hachinohe MD","doi":"10.1002/joa3.70025","DOIUrl":"https://doi.org/10.1002/joa3.70025","url":null,"abstract":"<p>Transseptal catheter ablation resolved ventricular arrhythmias originating from the left ventricular outflow tract following transcatheter aortic valve implantation with a self-expanding Evolut valve. This report highlights the transseptal approach as a safe and effective alternative, overcoming the structural complexities of self-expanding valves while reducing procedural risks and preserving valve integrity.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397152","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}
The case highlights the possibility of nonischemic cardiomyopathy in patients with coronary artery disease and the complex nature of the isthmus with multiple entry and exit points. A combination of multiple strategies, that is, unipolar mapping, isochronal late activation mapping during sinus rhythm, and positioning of a multielectrode catheter at the putative isthmus during VT induction in the case of hemodynamically unstable VT, was used to achieve a successful outcome.
{"title":"Managing a ventricular tachycardia storm: Looking beyond the horizon","authors":"Sanjai Pattu Valappil M.D. (internal medicine), DM (cardiology), Abhinav B. Anand DM cardiology, Prashanthan Sanders MBBS, PhD, Ramana Murugadass MBBS","doi":"10.1002/joa3.70018","DOIUrl":"https://doi.org/10.1002/joa3.70018","url":null,"abstract":"<p>The case highlights the possibility of nonischemic cardiomyopathy in patients with coronary artery disease and the complex nature of the isthmus with multiple entry and exit points. A combination of multiple strategies, that is, unipolar mapping, isochronal late activation mapping during sinus rhythm, and positioning of a multielectrode catheter at the putative isthmus during VT induction in the case of hemodynamically unstable VT, was used to achieve a successful outcome.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397199","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}
Left bundle branch area pacing (LBBAP) has developed as a strategy for patients with pacing-induced cardiomyopathy (PICM). We aimed to compare the upgrade effectiveness between LBBAP and traditional biventricular pacing (BVP) in PICM patients.
Methods
Consecutive PICM patients with successful device upgrades were enrolled. The primary outcome was the echocardiographic response, defined as absolute left ventricular ejection fraction (LVEF) improvement ≥5% at 6-month follow up.
Results
A total of 92 patients were included. 61 underwent BVP and 31 underwent LBBAP. The median RVP burden was 96.8% (IQR: 93.0–99.0%). LBBAP achieved a shorter paced QRS duration (QRSd) compared with BVP (145.9 ± 22.4 ms vs. 157.5 ± 26.5 ms; p =.031). At 6 months, LBBAP had a higher echocardiographic response rate than BVP (67.7% vs. 39.3%, p =.019). LVEF increased from 37.8% ± 9.2% to 44.8% ± 10.2% (p <.001) in LBBAP compared with an improvement from 35.7% ± 8.9% to 38.2% ± 12.1% (p <.01) in BVP, with significantly greater change from baseline in LBBAP (7.0% ± 7.0% vs. 2.5% ± 8.7%; p =.024). Narrower pacing QRS after upgrade was associated with better echocardiographic response only in LBBAP but not in BVP. (P for interaction <.05). Both groups had similar rates of composite clinical outcome.
Conclusion
LBBAP improved echocardiographic response compared with BVP in PICM patients. The superior efficacy of LBBAP in reverse remodeling was dependent on improved electrical synchrony.
{"title":"Effectiveness of upgrade left bundle branch area pacing for right ventricular pacing-induced cardiomyopathy: Extra QRS shortening matters","authors":"Hao Huang, Xiaofeng Li, Tianxin Long, Yu Yu, Sijing Cheng, Xiaohui Ning, Xuhua Chen, Min Gu, Hongxia Niu, Wei Hua","doi":"10.1002/joa3.70017","DOIUrl":"https://doi.org/10.1002/joa3.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Left bundle branch area pacing (LBBAP) has developed as a strategy for patients with pacing-induced cardiomyopathy (PICM). We aimed to compare the upgrade effectiveness between LBBAP and traditional biventricular pacing (BVP) in PICM patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive PICM patients with successful device upgrades were enrolled. The primary outcome was the echocardiographic response, defined as absolute left ventricular ejection fraction (LVEF) improvement ≥5% at 6-month follow up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 92 patients were included. 61 underwent BVP and 31 underwent LBBAP. The median RVP burden was 96.8% (IQR: 93.0–99.0%). LBBAP achieved a shorter paced QRS duration (QRSd) compared with BVP (145.9 ± 22.4 ms vs. 157.5 ± 26.5 ms; <i>p</i> =.031). At 6 months, LBBAP had a higher echocardiographic response rate than BVP (67.7% vs. 39.3%, <i>p</i> =.019). LVEF increased from 37.8% ± 9.2% to 44.8% ± 10.2% (<i>p</i> <.001) in LBBAP compared with an improvement from 35.7% ± 8.9% to 38.2% ± 12.1% (<i>p</i> <.01) in BVP, with significantly greater change from baseline in LBBAP (7.0% ± 7.0% vs. 2.5% ± 8.7%; <i>p</i> =.024). Narrower pacing QRS after upgrade was associated with better echocardiographic response only in LBBAP but not in BVP. (<i>P</i> for interaction <.05). Both groups had similar rates of composite clinical outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LBBAP improved echocardiographic response compared with BVP in PICM patients. The superior efficacy of LBBAP in reverse remodeling was dependent on improved electrical synchrony.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397149","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}
This is the first report describing a shock lead whose functionality can be assessed using TSI measurement, even in cases where shock impedances derived from LVSM exceed 200 Ω. However, the lead exhibited high shock impedance after the DFT test, highlighting the need to monitor it closely.
{"title":"Can lead damage be ruled out using defibrillation threshold testing in patients with very high-impedance shock leads?","authors":"Masataka Narita MD, Yoshifumi Ikeda MD, PhD, Hitoshi Mori MD, PhD, Ritsushi Kato MD, PhD, Kazuo Matsumoto MD, PhD","doi":"10.1002/joa3.70014","DOIUrl":"https://doi.org/10.1002/joa3.70014","url":null,"abstract":"<p>This is the first report describing a shock lead whose functionality can be assessed using TSI measurement, even in cases where shock impedances derived from LVSM exceed 200 Ω. However, the lead exhibited high shock impedance after the DFT test, highlighting the need to monitor it closely.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396879","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}
In the era of cryoablation and pulsed-field ablation, where large sheaths are commonly used, preventing air embolism is crucial. The lid from SL sheath packaging can be repurposed as a water-seal device for catheter insertion, thereby eliminating the need for additional equipment.
{"title":"Utilizing the lid of SL sheath packaging for a water-seal catheter insertion technique","authors":"Tatsuya Hayashi MD, PhD, Shingo Yamamoto MD, Jumpei Ohashi MD, PhD, Hideo Fujita MD, PhD","doi":"10.1002/joa3.70021","DOIUrl":"https://doi.org/10.1002/joa3.70021","url":null,"abstract":"<p>In the era of cryoablation and pulsed-field ablation, where large sheaths are commonly used, preventing air embolism is crucial. The lid from SL sheath packaging can be repurposed as a water-seal device for catheter insertion, thereby eliminating the need for additional equipment.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362763","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}
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