Journal of Arrhythmia最新文献

This case discusses the differential diagnosis of the double transition sign during bipolar threshold testing following conduction system pacing and delves into the details of electrophysiologic parameters of successful left bundle capture.

In recent years, the number of cases diagnosed with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) has been increasing. However, ATTRwt-CM frequently coexists with atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), often necessitating management for arrhythmias. Additionally, ventricular arrhythmias sometimes occur, or conduction disturbances often develop, requiring management for bradycardia, frequently needing device therapy such as pacemakers, implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillators. Therefore, for arrhythmia specialists, who primarily focus on non-pharmacological treatments, arrhythmias associated with ATTRwt-CM are unavoidable encounters, and becoming proficient in their management is increasingly important and considered essential. However, we sometimes encounter AF, AFL, or AT that are extremely difficult to treat with catheter ablation, and there are many situations to struggle with: how to manage each arrhythmia and whether catheter ablation should be performed at all. Furthermore, while the usefulness of ICDs for primary prevention of sudden cardiac death remains a subject of debate, we occasionally encounter patients with ventricular arrhythmias in fact. This review primarily addresses and focuses on catheter ablation therapy for atrial arrhythmias associated with ATTRwt-CM, as well as device therapy for bradyarrhythmias and ventricular arrhythmias, aiming to provide insights for treatment planning in the future as a total management approach to arrhythmia in ATTRwt-CM patients, especially for arrhythmia specialists.

Background: The increasing use of cardiovascular implantable electronic devices (CIEDs) has heightened the need for transvenous lead extraction (TLE). Although Japan has a certification system for TLE-capable hospitals, nationwide trends and regional disparities remain unclear.

Methods: We retrospectively analyzed the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination/Per Diem Payment System, including patients undergoing TLE or other CIED-related procedures between April 2015 and March 2022.

Results: Among 3573 TLE cases from 108 hospitals, procedure volumes steadily increased. The median patient age increased from 74 to 77 years, and comorbidity burden also rose over time. During this period, the proportion of non-infectious indications rose from 17.0% in 2015 to 38.9% in 2021. Cardiac tamponade was the most frequent complication, and advanced age and renal disease independently predicted complications or in-hospital death. Marked regional disparities were observed in CIED implantation patterns, TLE volume, and indications across Japan.

Conclusions: Non-infectious TLEs have increased safely in Japan, contributing to an overall growth in TLE procedures. However, substantial regional disparities persist in both procedural volume and indications. Standardized care strategies addressing these disparities are warranted to optimize TLE practice nationwide.

Background: Although artificial intelligence (AI) has been developed to identify patients with paroxysmal atrial fibrillation (PAF) during sinus rhythm, information on its variability remains limited. We evaluated the reproducibility and effect of recording condition on the estimation of AF risk using an electrocardiography (ECG) machine equipped with an AI-based program.

Methods: We extracted two ECG data from a single ECG test in 149 patients to evaluate reproducibility within 4 min. We also recorded ECG signals under 12 conditions (standard, two conditions shifting precordial electrodes, five conditions moving limb electrodes to the torso, three conditions contaminating noise, and reproducibility over 15 min) in 30 participants to evaluate changes from the standard. The results of the AF risk estimation are expressed at four levels.

Results: The rate of participants within one level of error was 95% for reproducibility within 4 min and 87% for reproducibility over 15 min. Shifting the precordial electrodes upward or downward and replacing the left leg electrode with the torso electrode frequently caused a two- or three-level change. In clinical information, increased brain natriuretic peptide tended to increase the variability.

Conclusions: The AF risk estimated by the AI-based program exhibited temporal variability. Shifting the precordial electrodes influenced AI-based AF risk estimation.

[This corrects the article DOI: 10.1002/joa3.70261.].

Background: Catheter ablation is an effective treatment for symptomatic supraventricular tachycardia (SVT). Most studies target the general adult population; data on the elderly are less robust. We studied the clinical and procedural characteristics and outcomes in elderly patients undergoing SVT ablation.

Methods: All patients undergoing atrioventricular nodal re-entry tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), and/or atrial tachycardia (AT) ablation between May 2011 and May 2022 at a tertiary center were included. Cases with concurrent ablation of atrial flutter, atrial fibrillation, and ventricular arrhythmias were excluded. Clinical and procedural characteristics and outcomes were compared between patients aged ≥ 70 years and those aged < 70 years.

Results: There were 1758 cases of SVT ablation; 1608 patients were < 70 years old, and 150 patients were ≥ 70 years old. Elderly patients were more likely to have underlying structural heart disease and/or ischemic heart disease, more likely to have AVNRT and less likely to have AVRT (p < 0.001). Consequently, elderly patients were more likely to undergo right-sided ablation (p < 0.001). The use of stereotaxis, intracardiac echocardiography, and electroanatomical mapping did not differ significantly. Procedure time, radiofrequency application time and fluoroscopy time were shorter in elderly patients (p < 0.05). Importantly, immediate complication and success rates did not differ significantly.

Conclusion: In our study, the acute success rates are high, and complication rates are low across both cohorts despite differences in clinical and procedural characteristics. SVT ablation should be considered for symptomatic patients regardless of age. Further data including patient comorbidities and longer-term outcomes may help patient selection.

Background: The Worldwide Randomized Antibiotic Envelope Infection Prevention Trial (WRAP-IT) demonstrated a 40% reduction of major cardiac implantable electronic device (CIED) infection with the use of an absorbable antibacterial envelope in patients at high risk of infection. The objective of this analysis was to determine the cost-effectiveness of this envelope in a high-risk patient population treated in the Australian public healthcare system.

Methods: A decision tree model compared the use of an antibacterial envelope versus no envelope over the lifetime of a patient with a high risk of infection as defined in WRAP-IT. Detailed clinical outcomes were based on 12-month data from WRAP-IT and other local inputs derived from local sources including linked-administrative data in New South Wales (NSW).

Results: The use of an antibacterial envelope results in a cost saving of A$157 at 12 months and an incremental cost of A$62 over a lifetime. Incremental quality-adjusted life-years (QALYs) with the envelope were 0.00144 at 12 months and 0.00872 over a lifetime. Both the 12 month and the lifetime cost/QALY gained resulted in an ICER that was "dominant." That is, the envelope did not result in a significant increased cost over a lifetime; however, it resulted in increased QALYs.

Conclusions: An antibacterial envelope is a dominant strategy in patients at high risk of infection. Use of the envelope was essentially cost neutral to the Australian public healthcare system, and increases the quality and length of life of the patient.

Introduction: The impact of protein-energy malnutrition (PEM) on patients hospitalized for conventional pacemaker implantation remains poorly understood.

Methods: We utilized the 2020 U.S. National Inpatient Sample (NIS) database to evaluate the impact of PEM on the in-hospital outcomes of patients who underwent conventional pacemaker implantation. Patients aged 18 and older were identified by ICD-10 CM and PCS codes. Multivariable survey logistic and linear regression analyses were employed to examine in-hospital outcomes, including in-patient mortality, system-based outcomes, and post-procedural complications.

Results: A total of 108 020 patients were identified with 4315 (3.99%) diagnosed with PEM. The mean age of the cohort was 76 years, and 47.5% were female. The overall mortality rate among patients undergoing pacemaker implantation was 1.07%. After adjusting for various patient and hospital confounding factors, PEM was significantly associated with an increased risk of in-hospital mortality (aOR 3.30, 95% CI 2.33-4.88, p < 0.001), prolonged hospital stay (β_LOS 7.89, 95% CI 6.88-8.90, p < 0.001), and an increased risk of various complications such as sepsis (aOR 2.56, 95% CI 1.56-4.19, p < 0.001) along with other post-procedural complications including bleeding/anemia (aOR 2.48, 95% CI 1.98-3.10, p < 0.001), pneumothorax (aOR 2.47, 95% CI 1.71-3.58, p < 0.001), and pericardial complications (aOR 1.65, 95% CI 1.14-2.40, p = 0.008).

Conclusion: PEM was associated with an increased risk of in-hospital mortality, extended hospital stays, and various post-procedural complications in patients undergoing conventional pacemaker implantation. Hence, prompt identification and effective management of PEM are essential for improving post-procedural outcomes in these patients.

Background: Rare pathogenic variations of desmosomal genes, particularly in plakophilin-2 (PKP2) and desmoglein-2 (DSG2), have been implicated in arrhythmogenic cardiomyopathy (ACM); however, their potential polygenic contribution remains unclear.

Methods: We performed a genome-wide association study of 104 Japanese patients with ACM and 46 527 controls, adjusting for case-control imbalance.

Results: The strongest association was observed upstream of DSG2 (rs182626537, p = 2.3 × 10^-42), but the signal was abolished after excluding carriers of pathogenic DSG2 variants, suggesting a synthetic association driven by linkage disequilibrium.

Conclusions: These findings highlight a population-specific genetic architecture of ACM, with DSG2 predominating in the Japanese population.

Background: Cardiac amyloidosis (CA) is frequently complicated by atrial fibrillation (AF), yet outcomes after left atrial appendage occlusion (LAAO) in this population remain poorly defined.

Methods: We conducted a retrospective TriNetX study of adults with AF undergoing LAAO, comparing patients with and without CA after 1:1 propensity matching. Outcomes were assessed using Kaplan-Meier analyses and Cox regression.

Results: Among 532 matched pairs, mortality and major adverse cardiovascular events were similar between groups, whereas major bleeding was higher in CA (HR 1.90).

Conclusions: LAAO yields comparable ischemic outcomes in CA, though bleeding risk is increased.