Journal of Arrhythmia最新文献

Dementia risk reduction between DOACs and VKAs in AF: A systematic review and meta-analysis 降低心房颤动患者 DOACs 和 VKAs 的痴呆风险：系统综述和荟萃分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-18 DOI: 10.1002/joa3.13142

Anthipa Chokesuwattanaskul MD, Narut Prasitlumkum MD, Ryan Cooley MD, T. Jared Bunch MD, Ronpichai Chokesuwattanaskul MD, Leenhapong Navaravong MD, FACC, FHRS

Introduction

Direct oral anticoagulants (DOACs) become the recommended treatment over vitamin K antagonists (VKA) in patients with non-valvular atrial fibrillation (AF). However, their effectiveness in reducing cognitive impairment and dementia compared to VKA remains unclear.

Methods

A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Database. Randomized controlled trials, cohort, or case–control study that assessed incident dementia between AF patients who received DOAC compared to VKA were selected. Relevant study characteristics and the number of incident dementia diagnosis or hazard ratios (HRs) for incident dementia and each dementia subtypes were extracted. Random-effects model was used to perform meta-analysis. Standardized mean differences (SMDs) were used to estimate effect sizes for continuous data.

Results

Twelve cohort studies comprising 1 451 069 individuals were included. The incidence of dementia was lower in AF patients prescribed DOACs compared to VKA (HR 0.88, 95% CI 0.83–0.93, I ² = 61.2%). A lower incident dementia in DOACs group relative to VKA was significantly observed in those less than 75 years of age (< 65 years, HR 0.83 (95% CI 0.72–0.97, I ² = 0%); 65–74 years, HR 0.86 (95% CI 0.81–0.92, I ² = 55.4%); and ≥ 75 years, HR 1.07 (95% CI 0.74–1.55, I ² = 92.5%)) and for the subgroup of patients with vascular dementia (HR 0.91, 95% CI 0.824–0.997, I ² = 0%).

Conclusions

This meta-analysis reveals a reduction in incidence of dementia in AF patients prescribed DOACs compared to VKA, particularly in those less than 75 years old and in the vascular dementia subtype.

导言：对于非瓣膜性心房颤动（房颤）患者，直接口服抗凝剂（DOACs）已成为维生素 K 拮抗剂（VKA）的推荐治疗药物。然而，与 VKA 相比，DOACs 在减少认知障碍和痴呆症方面的有效性仍不明确。方法在 Ovid MEDLINE、EMBASE 和 Cochrane 数据库中进行了系统性文献检索。选择了评估接受 DOAC 与 VKA 的房颤患者之间发生痴呆的随机对照试验、队列或病例对照研究。提取了相关研究的特征、痴呆诊断事件的数量或痴呆事件与各痴呆亚型的危险比（HRs）。采用随机效应模型进行荟萃分析。连续数据采用标准化均值差异（SMD）估算效应大小。结果纳入了 12 项队列研究，共 1 451 069 人。与 VKA 相比，服用 DOAC 的房颤患者痴呆症发病率较低（HR 0.88，95% CI 0.83-0.93，I 2 = 61.2%）。与 VKA 相比，DOACs 组的痴呆发生率在 75 岁以下人群中明显较低（65 岁，HR 0.83（95% CI 0.72-0.97，I 2 = 0%）；65-74 岁，HR 0.86（95% CI 0.81-0.92，I 2 = 55.4%）。92，I 2 = 55.4%）；≥ 75 岁，HR 1.07（95% CI 0.74-1.55，I 2 = 92.5%））以及血管性痴呆患者亚组（HR 0.91，95% CI 0.824-0.997，I 2 = 0%）。结论该荟萃分析显示，与 VKA 相比，服用 DOACs 的房颤患者痴呆症发病率有所降低，尤其是 75 岁以下患者和血管性痴呆亚型患者。

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引用次数: 0

Electro-anatomically confirmed sites of origin of ventricular tachycardia and premature ventricular contractions and occurrence of R wave in lead aVR: A proof of concept study 经电解剖证实的室性心动过速和室性早搏起源部位以及 aVR 导联 R 波的出现：概念验证研究

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-08 DOI: 10.1002/joa3.13147

Zainul Abedin MD, Seth Smith BS, Lakshmi Kattamuri MD, Amy Melendez CEPS, Moeen Abedin MD

Background

The R wave in lead aVR, during the wide QRS complex tachycardia, is commonly observed in a ventricular tachycardia (VT) arising from certain locations in the ventricles.

Objectives

This was a retrospective and a proof of concept study to correlate the sites of origin of VT and premature ventricular contractions (PVCs) with the occurrence of R wave in lead aVR.

Methods

Patients with VT or high density of PVCs were included. Surface and intracardiac electrograms were recorded during the arrhythmia. VTs and PVCs arising from the inferior, inferolateral, or apical region of the ventricles were grouped into Zone 2. Those arising from the other areas of the ventricles were grouped into Zone 1.

Results

Sixty-four patients were included in the study. The mean age was 57 years. There were 47 males. Among 64 patients with VT or PVCs, 28 patients had an R wave in aVR (43.7%), In 26 of 28 patients with an R wave in aVR, the site of origin of the arrhythmia was in Zone 2. The R wave in aVR was absent in 36 patients, 34 of whom had the origin of arrhythmia focus in Zone 1. The presence of an R wave in aVR correctly identified Zone 2 as a site of origin of the arrhythmia with high sensitivity (93%) and specificity (94%).

Conclusions

The presence of an R wave in aVR during wide QRS complex tachycardia or PVC is a valuable observation for identifying the site of origin of the arrhythmia and hence in distinguishing supraventricular tachycardia with aberrancy from VT.

背景在宽 QRS 波群心动过速时，aVR 导联出现 R 波，这在心室某些位置出现的室性心动过速（VT）中很常见。目的这是一项回顾性的概念验证研究，目的是将 VT 和室性早搏（PVC）的起源部位与 aVR 导联 R 波的出现相关联。方法纳入 VT 或高密度 PVC 患者。在心律失常期间记录心表和心内电图。来自心室下部、下外侧或心尖区的 VT 和 PVC 被归入 2 区。心室其他区域的 VT 和 PVC 被归入 1 区。结果研究共纳入 64 名患者。平均年龄为 57 岁。男性 47 人。在 64 名 VT 或 PVC 患者中，28 名患者的 aVR 中出现了 R 波（43.7%），28 名 aVR 中出现 R 波的患者中有 26 人的心律失常起源部位位于 2 区。36 名患者的 aVR 中没有 R 波，其中 34 人的心律失常病灶起源于 1 区。aVR 中出现 R 波可正确确定 2 区为心律失常的起源区，灵敏度（93%）和特异性（94%）均很高。结论在宽 QRS 波群心动过速或 PVC 时，aVR 中出现 R 波对于确定心律失常的起源部位，从而将室上性心动过速与 VT 区分开来非常有价值。

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引用次数: 0

Slow left atrial conduction velocity in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation recurrence after catheter ablation—Systematic review and meta-analysis 通过电解剖图计算的前壁左心房缓慢传导速度可预测导管消融术后心房颤动复发--系统回顾和荟萃分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-05 DOI: 10.1002/joa3.13146

Antonia Anna Lukito MD, PhD, Wilson Matthew Raffaello MD, Raymond Pranata MD

Background

This study aimed to investigate and perform diagnostic test meta-analysis on whether slow left atrial conduction velocity (LACV) in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation (AF) recurrence after catheter ablation.

Methods

Extensive literature search was performed on PubMed, SCOPUS, and EuropePMC up to June 5, 2024. The exposure group included AF patients with slow LACV in the anterior wall, while the control group included AF patients without slow LACV in the anterior wall. Slow LACV in the anterior wall was defined as LACV below study-specific cut-off points in m/s, measured by invasive electroanatomic mapping. The primary outcome of this study was AF recurrence, defined as AF/Atrial Flutter/Atrial Tachyarrhythmias lasting over 30 s at least 3 months after the blanking period postablation.

Results

This systematic review and meta-analysis included seven studies, involving a sample size of 1428 patients with mean follow-up duration were 13 months. Patients with AF recurrence has slower LACV in the anterior wall (mean difference − 0.16 m/s [−0.18, −0.15], p < .001). Slow LACV in the anterior wall defined as LACV below 0.70–0.88 m/s was associated with increased AF (adjusted OR 3.41 [1.55, 7.50], p = .002). Slow LACV in the anterior wall has an AUROC of 0.80 [0.76–0.83], sensitivity of 70% [52, 84], specificity of 76% [67, 83], positive likelihood ratio of 2.9 [2.3, 3.6], negative likelihood ratio of 0.39 [0.25, 0.63] for predicting AF recurrence postablation.

Conclusion

Slow LACV in the anterior wall was associated with AF recurrence after catheter ablation.

背景本研究旨在调查通过电解剖图计算出的前壁左心房缓慢传导速度（LACV）是否能预测导管消融术后心房颤动（AF）复发，并进行诊断测试荟萃分析。方法截至 2024 年 6 月 5 日，在 PubMed、SCOPUS 和 EuropePMC 上进行了广泛的文献检索。暴露组包括前壁慢速 LACV 的房颤患者，对照组包括前壁无慢速 LACV 的房颤患者。前壁慢速 LACV 的定义是通过有创电解剖图测量的 LACV 低于研究特定的临界点（单位：m/s）。本研究的主要结果是房颤复发，定义为消融术后空白期至少 3 个月后房颤/房扑/房性快速性心律失常持续时间超过 30 秒。结果本次系统回顾和荟萃分析共纳入 7 项研究，样本量为 1428 例患者，平均随访时间为 13 个月。房颤复发患者的前壁 LACV 较慢（平均差异 - 0.16 m/s [-0.18, -0.15]，p < .001）。定义为 LACV 低于 0.70-0.88 m/s 的前壁 LACV 缓慢与房颤增加有关（调整 OR 3.41 [1.55, 7.50]，p = .002）。前壁缓慢 LACV 的 AUROC 为 0.80 [0.76-0.83]，敏感性为 70% [52，84]，特异性为 76% [67，83]，预测消融术后房颤复发的阳性似然比为 2.9 [2.3，3.6]，阴性似然比为 0.39 [0.25，0.63]。结论前壁缓慢的 LACV 与导管消融后房颤复发有关。

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引用次数: 0

The Japanese Catheter Ablation Registry (J-AB): Annual report in 2022 日本导管消融注册中心（J-AB）：2022 年年度报告

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-05 DOI: 10.1002/joa3.13141

Kengo Kusano MD, PhD, Koichi Inoue MD, PhD, Koshiro Kanaoka MD, PhD, Koji Miyamoto MD, PhD, Yasuo Okumura MD, PhD, Yu-ki Iwasaki MD, PhD, Kazuhiro Satomi MD, PhD, Seiji Takatsuki MD, PhD, Kohki Nakamura MD, PhD, Yoshitaka Iwanaga MD, PhD, Teiichi Yamane MD, PhD, Wataru Shimizu MD, PhD, J-AB registry investigators

The Japanese Catheter Ablation (J-AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. From January 2022, the data registration system was changed from Research Electronic Data Capture (REDCap) system to Fountayn system. The purpose of this registry was to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real-world settings. During the year of 2022, we have collected a total of 90,042 procedures (mean age of 66.7 years and 65.9% male) from 614 participant hospitals. Detailed data were shown in Figures and Tables.

日本导管消融（J-AB）登记始于 2017 年 8 月，是由日本心律学会（JHRS）与国立脑心血管中心合作开展的一项自愿性、全国性、多中心、前瞻性、观察性登记。自 2022 年 1 月起，数据登记系统由研究电子数据采集系统（REDCap）改为 Fountayn 系统。该登记系统旨在收集目标心律失常、消融程序（包括目标心律失常的类型）、疗效以及真实世界中急性并发症的详细信息。在 2022 年期间，我们从 614 家参与医院共收集了 90,042 例手术（平均年龄为 66.7 岁，65.9% 为男性）。详细数据见图和表。

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引用次数: 0

“Real-world” performance of the Confirm Rx™ SharpSense AF detection algorithm: UK Confirm Rx study Confirm Rx™ SharpSense AF 检测算法的 "真实世界 "性能：英国 Confirm Rx 研究

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-03 DOI: 10.1002/joa3.13124

Andre Briosa e Gala MD, Michael T. B. Pope BM, BSc, Milena Leo MD, PhD, Alexander J. Sharp MBBS, BSc, Abhirup Banerjee PhD, Duncan Field MD, Honey Thomas MD, Richard Balasubramaniam Mb, ChB, PhD, Ross Hunter PhD, Roy S. Gardner MD, David Wilson DM, Mark M. Gallagher MD, Julian Ormerod PhD, John Paisey MD, Nick Curzen PhD, Timothy R. Betts MD

Introduction

The novel Confirm Rx™ implantable cardiac monitor (ICM) with SharpSense™ technology incorporates a new P-wave discriminator designed to improve AF detection. This study aimed to evaluate the diagnostic performance of the Confirm Rx™ ICM in detecting AF episodes of varying durations.

Methods

We conducted a multicenter retrospective analysis of consecutive patients implanted with a Confirm Rx™ ICM (v1.2) across nine UK hospitals, all with documented AF lasting at least 6 min. Electrocardiograms (ECGs) were manually adjudicated by cardiologists. To account for intra- and inter-reviewer variability, a random sample of 10% of ECGs underwent additional review. Disagreements were resolved by a third reviewer. Diagnostic performance was determined by calculating the gross and patient-averaged positive predictive value (PPV) for AF episodes of different duration. The source of false positive (FP) detection was also categorized.

Results

Overall, 16,230 individual ECGs from 232 patients were included. The median AF episode duration was 14 min. R-wave amplitude remained stable during follow-up (0.52 ± 0.27 mV [initial] vs. 0.54 ± 0.29 mV [end of follow-up], p = .10). The gross and patient-averaged PPV were 75.0% and 67.0%, respectively. Diagnostic performance (gross) increased with progressively longer AF episodes: 88.0% for ≥1 h, 97.3% for 6 h, and 100% for 24 h. The main source of FP during tachycardia was T-wave oversensing (54.2%), while in non-tachycardic episodes it was predominantly ectopy (71.2%). The AF burden precision was excellent (93.3%).

Conclusion

The Confirm Rx™ ICM diagnostic performance was modest for all AF episodes (75%), with accuracy increasing for longer AF episodes.

导言：采用 SharpSense™ 技术的新型 Confirm Rx™ 植入式心脏监护仪 (ICM) 集成了新型 P 波鉴别器，旨在提高房颤检测能力。本研究旨在评估 Confirm Rx™ ICM 在检测不同持续时间的房颤发作方面的诊断性能。方法我们对英国九家医院连续植入 Confirm Rx™ ICM（v1.2 版）的患者进行了多中心回顾性分析，所有患者都有至少持续 6 分钟的房颤记录。心电图 (ECG) 由心脏病专家人工判定。为考虑审查者内部和审查者之间的差异，随机抽取 10% 的心电图进行额外审查。出现分歧时由第三位审查员解决。通过计算不同持续时间的房颤发作的总阳性预测值 (PPV) 和患者平均阳性预测值 (PPV)，确定诊断性能。假阳性 (FP) 检测的来源也进行了分类。结果共纳入 232 名患者的 16,230 张心电图。房颤发作持续时间的中位数为 14 分钟。随访期间 R 波振幅保持稳定（0.52 ± 0.27 mV [初始] vs. 0.54 ± 0.29 mV [随访结束]，p = .10）。总 PPV 和患者平均 PPV 分别为 75.0% 和 67.0%。心动过速时 FP 的主要来源是 T 波超感（54.2%），而非心动过速发作时主要是异位（71.2%）。房颤负荷精确度非常高（93.3%）。结论 Confirm Rx™ ICM 诊断所有房颤发作的准确率都不高（75%），房颤发作时间越长，准确率越高。

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引用次数: 0

The incidence and risk factors of atrial high-rate episodes in patients with a dual-chamber pacemaker 双腔起搏器患者心房高频率发作的发生率和风险因素

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-03 DOI: 10.1002/joa3.13143

Son Khac Le Nguyen MD, Dung Ngoc Kieu MD, Phuong Le Uyen Tran MD, Chuong Khac Thien Nguyen MD, Toan Quang Dang MD, Chieu Van Ly MD, Sy Van Hoang MD, PhD, Thuc Tri Nguyen MD, PhD

Background and Objectives

Cardiovascular implantable electronic devices can detect atrial high-rate episodes (AHREs). However, the predictors of clinically relevant AHREs have not been well identified.

Methods

This prospective study included 145 patients (median age 64.5 ± 16.4 years, 53.1% females) without atrial fibrillation (AF) from December 2020 to January 2022. AHREs were defined as a programmed atrial detection rate >190 beats per minute. Cox regression analysis was used to identify the risk factors of AHREs.

Results

During 6 months of follow-up, AHREs occurred in 30.3% of patients. Multivariable Cox regression analysis showed factors related to development of AHREs including using anti-arrhythmic drugs (AAD) before implantation (Hazard ratio (HR) 7.71; 95% confidence interval [95% CI], 2.58–23.02, p < .001), history of paroxysmal supraventricular tachycardia (PSVT; HR 2.45; [95% CI], 1.18–5.09, p = .016), the percentage of premature atrial contraction (PAC) on 24-h Holter electrocardiogram (ECG) monitoring (HR 1.008; [95% CI], 1.003–1.014, p = .003), and left ventricular global longitudinal strain (GLS-LV; HR 0.92;[95% CI], 0.84–0.99, p = .049).

Conclusions

This study showed that a history of PSVT and using AAD, the percentage of PAC on 24-h Holter ECG monitoring, and GLS-LV were the independent predictors of new-onset AHREs.

背景和目的心血管植入式电子设备可检测心房高频率发作（AHRE）。然而，临床相关 AHRE 的预测因素尚未得到很好的确定。方法这项前瞻性研究纳入了 2020 年 12 月至 2022 年 1 月期间 145 名无心房颤动（AF）的患者（中位年龄为 64.5 ± 16.4 岁，53.1% 为女性）。AHRE定义为程序性心房检测率>190次/分钟。Cox回归分析用于确定AHREs的风险因素。结果在 6 个月的随访期间，30.3% 的患者发生了 AHRE。多变量 Cox 回归分析显示，与发生 AHREs 相关的因素包括植入前使用抗心律失常药物（AAD）（危险比 (HR) 7.71; 95% 置信区间 [95% CI], 2.58-23.02, p <.001）、阵发性室上性心动过速（PSVT；HR 2.45；[95% CI]，1.18-5.09，p = .016）、24 小时 Holter 心电图（ECG）监测中房性早搏（PAC）的百分比（HR 1.008；[95% CI]，1.003-1.014，p = .003）和左室整体纵向应变（GLS-LV；HR 0.92；[95% CI]，0.84-0.99，p = .049）。结论本研究表明，PSVT 病史和使用 AAD、24 h Holter ECG 监测中 PAC 的百分比以及 GLS-LV 是新发 AHRE 的独立预测因素。

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引用次数: 0

Editorial to “Atypical atrial resetting with ventricular extrastimulus during tachycardia: What is the mechanism?” 为 "心动过速时心室外刺激导致的非典型心房复位：机制是什么？

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-09-02 DOI: 10.1002/joa3.13144

Tatsuya Hayashi MD, PhD, Hideo Fujita MD, PhD

<p>Editorial to “Atypical atrial resetting with ventricular extrastimulus during tachycardia: What is the mechanism?”<span><sup>1</sup></span> </p><p>The use of catheter ablation to treat tachyarrhythmias initially involved targeting the atrioventricular node (AV node). Over time, as specific arrhythmic circuits have been discovered, it has become feasible to perform ablations at safer and more efficient locations beyond the AV node. This technique is now utilized to address a wide range of arrhythmias. Supraventricular tachycardia (SVT) is generally classified into atrioventricular nodal reentrant tachycardia (AVNRT), orthodromic reciprocating tachycardia (ORT), and atrial tachycardia (AT), all of which have been successfully treated with catheter ablation, and SVT treatment is now largely established.<span><sup>2</sup></span> However, despite these successes already achieved, recent electrophysiological study (EPS) advancements have uncovered new insights into SVT, suggesting that the success of catheter ablation and understanding the true mechanism of the tachycardia circuit are different things. This is exemplified by the recent “re-discovery” of the nodoventricular (NVP) and nodofascicular pathways (NFP), which can often exist as a bystander pathway in successful AVNRT cases with slow pathway ablation.<span><sup>3</sup></span> These evolving insights have added complexity to SVT differentiation, necessitating a broader differential diagnosis approach during treatment. We electrophysiologists have witnessed the maturation of diagnosis and treatment of SVT over decades, and now we realize that it is further developing into something like “SVT -Season 2.” In this study, Kobari et al. reported a complex case of supraventricular tachycardia that required detailed analysis for diagnosis and was successfully ablated.<span><sup>1</sup></span> In this case, the first EPS findings suggested that the mechanism of SVT was ORT. For example, the initial atrial (A) and ventricular (V) activation at the time of overdrive ventricular stimulation cessation was a V-A-V sequence, and the postpacing interval at the stimulation site minus the tachycardia cycle length was 67 ms. The treatment approach for “pre-modern” SVT may involve directly ablating the earliest atrial excited site without further detailed examination. However, this approach is insufficient in the current “SVT-season 2,” and a deeper understanding is essential. It is crucial to distinguish whether the diagnosis is ORT via a slow conduction accessory pathway (AP) or through an NVP. In ORT involving a typical or slow conduction AP, the atrium is an essential part of the tachycardia circuit, whereas in ORT using an NVP, the atrium is not involved in the tachycardia circuit. Based on this background, this paper determined that the atrium is not a crucial part of the tachycardia circuit as the AH duration during tachycardia is significantly different from the AH duration during atrial sti

为 "心动过速时心房复位与心室外刺激的非典型心房复位：1 使用导管消融治疗快速性心律失常的最初目标是房室结（AV 结）。随着时间的推移，随着特定心律失常回路的发现，在房室结以外更安全、更有效的位置进行消融已变得可行。现在，这种技术已被广泛用于治疗各种心律失常。室上性心动过速（SVT）一般分为房室结返律性心动过速（AVNRT）、正交往复性心动过速（ORT）和房性心动过速（AT），所有这些心动过速都已通过导管消融术成功治疗，SVT 的治疗方法现已基本确立。2 然而，尽管已经取得了这些成功，最近的电生理研究（EPS）进展却揭示了 SVT 的新见解，表明导管消融的成功与对心动过速回路真正机制的了解是两回事。最近对结节室（NVP）和结节筋膜通路（NFP）的 "重新发现 "就是一个很好的例子，在慢通路消融成功的房室传导阻滞病例中，NFP 通路往往作为旁观者通路存在。几十年来，我们电生理学家见证了 SVT 诊断和治疗的成熟，现在我们意识到 SVT 正在进一步发展成为类似于 "SVT 第二季 "的疾病。在这项研究中，Kobari 等人报告了一例复杂的室上性心动过速病例，该病例需要详细分析才能确诊并成功消融1。例如，过速心室刺激停止时的初始心房（A）和心室（V）激活为 V-A-V 序列，刺激部位的后起搏间隔减去心动过速周期长度为 67 毫秒。对 "前现代 "室上性心动过速的治疗方法可能是直接消融最早的心房兴奋点，而无需进一步详细检查。然而，在当前的 "SVT 第二季 "中，这种方法是不够的，必须进行更深入的了解。关键是要区分诊断是通过慢传导辅助通路（AP）还是通过 NVP 的 ORT。在涉及典型或缓慢传导 AP 的 ORT 中，心房是心动过速回路的重要组成部分，而在使用 NVP 的 ORT 中，心房不参与心动过速回路。基于这一背景，本文确定心房不是心动过速回路的重要组成部分，因为心动过速时的心房颤动持续时间与相同心动过速周期长度的心房刺激时的心房颤动持续时间明显不同，4 从而确定了 NVP 的存在。这种方法对于区分复杂性心动过速至关重要，尤其是在排除快速性心律失常时，因为快速性心律失常包括心房进入基本回路，如使用通常房室 AP 的 AT 或 ORT。除上述讨论外，在本病例中，EPS 的关键发现是在 His 束（HB）折返时，心房预激与持续性心动过速期间发出的单次室性早搏刺激，而未对冠状窦（CS）的心室激活序列产生形态学变化。这一发现表明 APs 存在于心室-心房传导中，而且室外刺激传导至心房时并未捕获二尖瓣环附近最早激活心房的对侧心室，这表明该心室位置并非心动过速回路的重要组成部分。只有当 AP 的心室插入点位于心室的更顶端位置时，这一观察结果才有可能出现，而且附属通路的长度可能比 "通常的 "房室 AP 更长。最近的文献强调了 "矛盾性复位"，即在 HB 折返期单次室性早搏刺激可延长心房周期长度，而不是缩短心房周期。5 在这种情况下，"非典型复位 "意味着 CS 在复位时的心室激活顺序与心动过速时的心室激活顺序一致，这提供了一个新的视角。这一 "非典型复位 "发现非常重要，因为它提供了对 AP 心室插入位置的洞察力，可改变消融策略。换句话说，本文强调了在复位现象中密切观察 CS 中心室激活序列的重要性。未来的研究应探讨这种不典型的复位现象是 NVP ORT 所特有的，还是也会发生在具有长 APs 的典型 ORT 中。此外，应该注意的是，在本病例中，副房室起搏时的心室传导表现出明显的房室结模式，而非 AP 模式。如果通过房室结的传导比通过 AP 的传导足够快，那么通过 AP 的传导就会被掩盖。SVT 第二季 "应继续保持势头，我们必须不断更新自己。作者声明与本文无利益冲突。

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引用次数: 0

Distribution of anti-factor Xa activity in patients with nonvalvular atrial fibrillation receiving 15 mg dose of edoxaban 接受 15 毫克剂量埃多沙班治疗的非瓣膜性心房颤动患者体内抗因子 Xa 活性的分布情况

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-08-27 DOI: 10.1002/joa3.13139

Shotaro Hiramatsu MD, Hiroyuki Osanai MD, Yuichiro Sakai MD, Yoshiki Sogo MD, Yuki Tanaka MD, Hikari Matsumoto MD, Shun Miyamoto MD, Kensuke Tagahara MD, Kenji Arai MD, Takashi Watanabe MD, Yusuke Sakamoto MD, Teruhiro Sakaguchi MD, PhD, Shioh Oguchi MD, Takahiro Kanbara MD, PhD, Yoshihito Nakashima MD, Hiroshi Asano MD, Masayoshi Ajioka MD

Background

The distribution of anti-factor Xa activity (AXA) in patients with nonvalvular atrial fibrillation (NVAF) taking edoxaban 15 mg has not been fully elucidated.

Methods and Results

The trough and peak AXA were measured in 19 NVAF patients taking edoxaban 15 mg. We compared these results with those in patients taking edoxaban 30 mg. The peak AXA differed significantly between the 15 mg and the 30 mg groups (0.74 ± 0.40 IU/mL vs. 1.25 ± 0.48 IU/mL, respectively; p < 0.0001).

Conclusions

Peak but trough AXA in the patients receiving edoxaban 15 mg were significantly lower than those in patients receiving edoxaban 30 mg.

背景尚未完全阐明服用埃多沙班 15 毫克的非瓣膜性心房颤动（NVAF）患者体内抗因子 Xa 活性（AXA）的分布情况。方法和结果对服用埃多沙班 15 毫克的 19 名非瓣膜性心房颤动患者的 AXA 谷值和峰值进行了测量。我们将这些结果与服用埃多沙班 30 毫克的患者进行了比较。15 毫克组和 30 毫克组的 AXA 峰值差异显著（分别为 0.74 ± 0.40 IU/mL 对 1.25 ± 0.48 IU/mL；p < 0.0001）。结论接受埃多沙班 15 毫克治疗的患者的 AXA 峰值和谷值均明显低于接受埃多沙班 30 毫克治疗的患者。

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引用次数: 0

Decremental conduction property in the slow conduction zone of adenosine-sensitive atrial tachycardia 腺苷敏感性房性心动过速慢传导区的传导特性下降

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-08-27 DOI: 10.1002/joa3.13140

Takahiko Kinjo MD, PhD, Masaomi Kimura MD, PhD, Noriyoshi Kaname MD, PhD, Daisuke Horiuchi MD, PhD, Hirofumi Tomita MD, PhD

In the case of adenosine-sensitive atrial tachycardia originating near the atrioventricular (AV) node, overdrive pacing from the anterior right atrium showed constant and progressive fusion, indicating that the pacing site is proximal to slow conduction. Shortening the pacing cycle length prolonged conduction times to the orthodromic capture sites; they remained unchanged at the antidromic capture sites. Limited decremental conduction property in the slow conduction zone supports the hypothesis that AV node-like tissue remnants along the AV annulus are involved.

对于起源于房室结附近的腺苷敏感性房性心动过速，从右心房前部开始的超速起搏显示出持续和渐进的融合，表明起搏部位位于慢速传导的近端。缩短起搏周期长度可延长正向捕获点的传导时间，而反向捕获点的传导时间则保持不变。慢速传导区有限的递减传导特性支持了房室结样组织残余沿房室环参与其中的假设。

引用次数: 0

Prevalence of atrial fibrillation based on tertiary hospital survey in Indonesia: A smartphone-based diagnosis 基于印度尼西亚三级医院调查的心房颤动患病率：基于智能手机的诊断

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-08-22 DOI: 10.1002/joa3.13137

Yoga Yuniadi MD PhD, Alice I. Supit MD, Dicky A. Hanafy MD PhD, Sunu B. Raharjo MD PhD, Dony Y. Hermanto MD, Faris Basalamah MD PhD, Benny Hartono MD, Reynold Agustinus MD, Agung F. Chandranegara MD, Chaerul Ahmad MD PhD, Mohammad Iqbal MD PhD, Alexander E. Tondas MD PhD, Hauda El-Rasyid MD, Haryadi Haryadi MD, Antonia A. Lukito MD PhD, Daniel Tanubudi MD, Ignatius Yansen MD, Erika Maharani MD, Rerdin Julario MD, Ardian Rizal MD, Putra S. Antara MD, Muzakkir Amir MD PhD

Objective

Atrial fibrillation (AF) is one of the most common arrhythmic disorders worldwide. This study aims to describe the prevalence of AF in various cities in Indonesia using single-lead hand held electrocardiography linked to a smartphone-based application.

Methods

This is a cross-sectional epidemiological study conducted at tertiary hospital of major cities in Indonesia, between January 2018 and July 2019. The AliveCor Kardia™ Mobile system device was used as a screening tool for AF and confirmed its finding with clinical diagnoses made by cardiologists.

Results

A total of 9773 subjects were enrolled in this study. The prevalence of AF reported by the device and cardiologist was 3.2% and 3.5%, respectively. AF prevalences are equal in men than women. The majority of subjects (56%) are having low risk for stroke or systemic thromboembolism. Prevalence of risk factors such as heart failure, hypertension, diabetes, and history of stroke among AF patients were 50%, 22.9%, 31.9%, 13.5%, and 5.8%, respectively.

Conclusion

The prevalence of AF at referral hospitals visitors based on smartphone diagnosis in Indonesia is 3.2%.

目的心房颤动（AF）是全球最常见的心律失常疾病之一。本研究旨在使用与智能手机应用程序相连接的单导联手持心电图，描述心房颤动在印度尼西亚不同城市的流行情况。方法这是一项横断面流行病学研究，于 2018 年 1 月至 2019 年 7 月期间在印度尼西亚主要城市的三级医院进行。AliveCor Kardia™ 移动系统设备被用作房颤筛查工具，并与心脏病专家的临床诊断结果相印证。结果共有 9773 名受试者参加了这项研究。设备和心脏病专家报告的房颤患病率分别为 3.2% 和 3.5%。男性心房颤动患病率与女性相同。大多数受试者（56%）的中风或全身血栓栓塞风险较低。心房颤动患者中心力衰竭、高血压、糖尿病和中风病史等危险因素的患病率分别为 50%、22.9%、31.9%、13.5% 和 5.8%。结论印度尼西亚转诊医院的心房颤动患病率为 3.2%，而这些患者是通过智能手机诊断出来的。

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引用次数: 0