Andrew G. Kim MD, Sandeep Banga MD, Qi Xuan Ang MD, Lalitsiri Atti MD, Harith Ghnaima MD, Saif AlAttal MD, Preeti Banga MD, Matthew D. Wilcox DO
Background
The transdermal patch of bisoprolol available in Japan has been reported to demonstrate superior efficacy in preventing postoperative atrial fibrillation, possibly surpassing its oral counterpart. However, there has been no systematic review and meta-analysis assessing the efficacy of transdermal bisoprolol.
Methods
A comprehensive systematic literature search was conducted on PubMed, Embase, and Cochrane to identify all relevant studies assessing the efficacy of transdermal bisoprolol in preventing postoperative atrial fibrillation. The search covered studies from inception up to December 4, 2023. For data analysis, Review Manager (RevMan) 5.4 software was employed, using a random-effects model to calculate risk ratios (RR) and 95% confidence intervals (CI).
Results
Three studies, comprising a total of 551 patients (transdermal bisoprolol 228 and control 323), were included. There was a decreased risk of postoperative atrial fibrillation or atrial tachyarrhythmias in patients treated with transdermal bisoprolol (RR 0.43, 95% CI 0.27–0.67, p = .0002, I2 = 0%).
Conclusion
Transdermal administration of bisoprolol has consistently shown efficacy, and this pooled analysis supports its effectiveness. The heterogeneity of the included studies limits certain interpretations. Future randomized clinical trials may elucidate the superiority of transdermal administration over oral administration.
{"title":"Transdermal bisoprolol for prevention of postoperative atrial fibrillation: A systematic review and meta-analysis","authors":"Andrew G. Kim MD, Sandeep Banga MD, Qi Xuan Ang MD, Lalitsiri Atti MD, Harith Ghnaima MD, Saif AlAttal MD, Preeti Banga MD, Matthew D. Wilcox DO","doi":"10.1002/joa3.13049","DOIUrl":"10.1002/joa3.13049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The transdermal patch of bisoprolol available in Japan has been reported to demonstrate superior efficacy in preventing postoperative atrial fibrillation, possibly surpassing its oral counterpart. However, there has been no systematic review and meta-analysis assessing the efficacy of transdermal bisoprolol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive systematic literature search was conducted on PubMed, Embase, and Cochrane to identify all relevant studies assessing the efficacy of transdermal bisoprolol in preventing postoperative atrial fibrillation. The search covered studies from inception up to December 4, 2023. For data analysis, Review Manager (RevMan) 5.4 software was employed, using a random-effects model to calculate risk ratios (RR) and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three studies, comprising a total of 551 patients (transdermal bisoprolol 228 and control 323), were included. There was a decreased risk of postoperative atrial fibrillation or atrial tachyarrhythmias in patients treated with transdermal bisoprolol (RR 0.43, 95% CI 0.27–0.67, <i>p</i> = .0002, <i>I</i><sup>2</sup> = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Transdermal administration of bisoprolol has consistently shown efficacy, and this pooled analysis supports its effectiveness. The heterogeneity of the included studies limits certain interpretations. Future randomized clinical trials may elucidate the superiority of transdermal administration over oral administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"434-439"},"PeriodicalIF":2.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141022489","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}
Peri-esophageal vagal nerve injury (PNI) can unpredictably occur during atrial fibrillation ablation procedures. Yoshimura and colleagues have demonstrated an association between symptomatic PNI and high contact force near the esophagus.1 However, several concerns have been raised.
While the authors identify contact force as a major cause of PNI,1 other factors such as baseline impedance and the rate of rise of esophageal temperature during ablation have also been proposed.2, 3
The authors limited ablation power to <30 W and ablation duration to within 30 s, irrespective of the ablation index, when ablating the left atrial posterior wall near the esophagus.1 Ablation was terminated promptly if the esophageal temperature reached 40°C. Nevertheless, recent literature indicates that high-power short-duration ablation may offer advantages over moderate-power moderate-duration ablation, including improved durability of ablation, reduced procedure time, and decreased risk of irreversible tissue injury.4 Additionally, concerns persist regarding the optimal placement of ablation lines on the left atrial posterior wall to prevent PNI.
In the current era, moderate-power ablation, as employed by the authors, is seldom the initial choice. Instead, cryoballoon and pulsed-field ablations are preferred. How do the authors' findings translate to contemporary procedures?
None.
Authors declare no conflict of interests for this article.
{"title":"How to demonstrate factors associated with peri-esophageal vagal nerve injury during catheter ablation for atrial fibrillation","authors":"Naoya Kataoka MD, Teruhiko Imamura MD","doi":"10.1002/joa3.13048","DOIUrl":"10.1002/joa3.13048","url":null,"abstract":"<p>Peri-esophageal vagal nerve injury (PNI) can unpredictably occur during atrial fibrillation ablation procedures. Yoshimura and colleagues have demonstrated an association between symptomatic PNI and high contact force near the esophagus.<span><sup>1</sup></span> However, several concerns have been raised.</p><p>While the authors identify contact force as a major cause of PNI,<span><sup>1</sup></span> other factors such as baseline impedance and the rate of rise of esophageal temperature during ablation have also been proposed.<span><sup>2, 3</sup></span></p><p>The authors limited ablation power to <30 W and ablation duration to within 30 s, irrespective of the ablation index, when ablating the left atrial posterior wall near the esophagus.<span><sup>1</sup></span> Ablation was terminated promptly if the esophageal temperature reached 40°C. Nevertheless, recent literature indicates that high-power short-duration ablation may offer advantages over moderate-power moderate-duration ablation, including improved durability of ablation, reduced procedure time, and decreased risk of irreversible tissue injury.<span><sup>4</sup></span> Additionally, concerns persist regarding the optimal placement of ablation lines on the left atrial posterior wall to prevent PNI.</p><p>In the current era, moderate-power ablation, as employed by the authors, is seldom the initial choice. Instead, cryoballoon and pulsed-field ablations are preferred. How do the authors' findings translate to contemporary procedures?</p><p>None.</p><p>Authors declare no conflict of interests for this article.</p><p>None.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"652"},"PeriodicalIF":2.2,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468131","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 relationship between liver fibrosis and left atrial (LA) remodeling in atrial fibrillation (AF) remains uncertain. We examined the associations between the fibrosis-4 (FIB4) index, an indicator of liver fibrosis, and both LA low-voltage areas (LVAs) on electroanatomic mapping and AF recurrence postablation.
Methods
We recruited 343 patients who underwent radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CBA) for AF. First, the association between the FIB4 index and LA LVAs (<0.5 mV) was evaluated in RFCA using electroanatomic mapping (n = 214). Next, the utility of a FIB4 index ≥1.3, recommended cut-off value of liver fibrosis, was verified to assess the risk for AF recurrence in CBA without additional LVA ablation (n = 129).
Results
Patients with a FIB4 index ≥1.3 had a higher prevalence of LA LVAs (>5 cm2) compared to those without. Additionally, the quantitative size of LVAs showed a positive correlation with the FIB4 index (R = .642, p < .001). In multivariate logistic models, a FIB4 index ≥1.3 was related to the presence of LVAs after adjusting for LA diameter, right atrial end-systolic area, and nonparoxysmal AF (odds ratio 2.508; p = 0.039). In CBA, AF recurrence rate was 13.1% during 3–12 months postablation. In multivariate Cox models, a FIB4 index ≥1.3 was an important predictor of AF recurrence (hazard ratio 3.796; p = .037), suggesting that LVAs might be associated with AF recurrence after CBA.
Conclusion
The FIB4 index was a novel predictor of the existence of LA LVAs on electroanatomic mapping and AF recurrence after CBA.
{"title":"Associations of the fibrosis-4 index with left atrial low-voltage areas and arrhythmia recurrence after catheter ablation: cardio-hepatic interaction in patients with atrial fibrillation","authors":"Shinya Yamada MD, Takashi Kaneshiro MD, Minoru Nodera MD, Kazuaki Amami MD, Takeshi Nehashi MD, Masayoshi Oikawa MD, Takayoshi Yamaki MD, Kazuhiko Nakazato MD, Takafumi Ishida MD, Yasuchika Takeishi MD","doi":"10.1002/joa3.13045","DOIUrl":"10.1002/joa3.13045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The relationship between liver fibrosis and left atrial (LA) remodeling in atrial fibrillation (AF) remains uncertain. We examined the associations between the fibrosis-4 (FIB4) index, an indicator of liver fibrosis, and both LA low-voltage areas (LVAs) on electroanatomic mapping and AF recurrence postablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited 343 patients who underwent radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CBA) for AF. First, the association between the FIB4 index and LA LVAs (<0.5 mV) was evaluated in RFCA using electroanatomic mapping (<i>n</i> = 214). Next, the utility of a FIB4 index ≥1.3, recommended cut-off value of liver fibrosis, was verified to assess the risk for AF recurrence in CBA without additional LVA ablation (<i>n</i> = 129).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with a FIB4 index ≥1.3 had a higher prevalence of LA LVAs (>5 cm<sup>2</sup>) compared to those without. Additionally, the quantitative size of LVAs showed a positive correlation with the FIB4 index (<i>R</i> = .642, <i>p</i> < .001). In multivariate logistic models, a FIB4 index ≥1.3 was related to the presence of LVAs after adjusting for LA diameter, right atrial end-systolic area, and nonparoxysmal AF (odds ratio 2.508; <i>p</i> = 0.039). In CBA, AF recurrence rate was 13.1% during 3–12 months postablation. In multivariate Cox models, a FIB4 index ≥1.3 was an important predictor of AF recurrence (hazard ratio 3.796; <i>p</i> = .037), suggesting that LVAs might be associated with AF recurrence after CBA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The FIB4 index was a novel predictor of the existence of LA LVAs on electroanatomic mapping and AF recurrence after CBA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"585-593"},"PeriodicalIF":2.2,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468130","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}
Ayaka Kobayashi BSHS, Hideyuki Hasebe MD, Kentaro Yoshida MD
Uncoupling of the endocardial bundles in the left atrium was suggested during modified posterior wall isolation. Although this fact may not be observed because of the possible bridging conduction by epicardial bundles in humans, partially failed transmural ablation in the atrial roof may have iatrogenically unveiled this fact.
{"title":"Uncoupling endocardial bundles coupled by an epicardial bundle in the left atrium and pulmonary veins","authors":"Ayaka Kobayashi BSHS, Hideyuki Hasebe MD, Kentaro Yoshida MD","doi":"10.1002/joa3.13046","DOIUrl":"10.1002/joa3.13046","url":null,"abstract":"<p>Uncoupling of the endocardial bundles in the left atrium was suggested during modified posterior wall isolation. Although this fact may not be observed because of the possible bridging conduction by epicardial bundles in humans, partially failed transmural ablation in the atrial roof may have iatrogenically unveiled this fact.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"624-628"},"PeriodicalIF":2.2,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140663885","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}
We explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature-control setting.
Methods
We conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS-irrigation) and Half NS-irrigation (HNS-irrigation) in an ex-vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS-irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS-irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.
Results
In Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS-irrigation and 34 in HNS-irrigation (p = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS-irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. The optimal %impedance-drop cutoff to predict steam pops was 20% with a negative-predictive-value (NPV) = 95.1% including NS- and HNS-irrigation groups, and 22% with an NPV = 96.1% in NS-irrigation group. In Step 2, similar to the ex-vivo model, lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. Steam pops were absent with NS-irrigation (0/35) even with the largest %impedance-drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS-irrigation (6/21, 29%). The optimal %impedance-drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS- and HNS-irrigation groups.
Conclusions
Rather than using HNS-irrigation, very long-duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS-irrigation.
{"title":"An optimized approach for increasing lesion size in temperature-controled setting using a catheter with a surface thermocouple and efficient irrigation","authors":"Masateru Takigawa MD, PhD, Junji Yamaguchi MD, PhD, Masahiko Goya MD, PhD, Hidehiro Iwakawa MD, PhD, Tasuku Yamamoto MD, PhD, Miki Amemiya MD, Takashi Ikenouchi MD, PhD, Miho Negishi MD, Iwanari Kawamura MD, PhD, Kentaro Goto MD, PhD, Takatoshi Shigeta MD, PhD, Takuro Nishimura MD, PhD, Tomomasa Takamiya MD, PhD, Susumu Tao MD, PhD, Katsuhiro Ohuchi PhD, Sayaka Suzuki DVM, Shinsuke Miyazaki MD, PhD, Tetsuo Sasano MD, PhD","doi":"10.1002/joa3.13040","DOIUrl":"10.1002/joa3.13040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature-control setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS-irrigation) and Half NS-irrigation (HNS-irrigation) in an ex-vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS-irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS-irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS-irrigation and 34 in HNS-irrigation (<i>p</i> = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS-irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. The optimal %impedance-drop cutoff to predict steam pops was 20% with a negative-predictive-value (NPV) = 95.1% including NS- and HNS-irrigation groups, and 22% with an NPV = 96.1% in NS-irrigation group. In Step 2, similar to the ex-vivo model, lesion size significantly increased with longer-duration ablation but not with HNS-irrigation. Steam pops were absent with NS-irrigation (0/35) even with the largest %impedance-drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS-irrigation (6/21, 29%). The optimal %impedance-drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS- and HNS-irrigation groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rather than using HNS-irrigation, very long-duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS-irrigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"536-551"},"PeriodicalIF":2.2,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674675","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}
We have seen ischemic stroke associated with a high-grade device-related pedunculated thrombosis after left atrial appendage closure (LAAC) after discontinuation of oral anticoagulations (OACs). Continuation of OACs, including half-dose direct oral anticoagulations after LAAC, may be a better option for patients at high risk of thromboembolism to prevent further thromboembolic events.
{"title":"Ischemic stroke associated with high-grade pedunculated device-related thrombosis following left atrial appendage closure","authors":"Ryuki Chatani MD, Shunsuke Kubo MD, Hiroshi Tasaka MD, Takeshi Maruo MD, Kazushige Kadota MD","doi":"10.1002/joa3.13042","DOIUrl":"10.1002/joa3.13042","url":null,"abstract":"<p>We have seen ischemic stroke associated with a high-grade device-related pedunculated thrombosis after left atrial appendage closure (LAAC) after discontinuation of oral anticoagulations (OACs). Continuation of OACs, including half-dose direct oral anticoagulations after LAAC, may be a better option for patients at high risk of thromboembolism to prevent further thromboembolic events.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"620-623"},"PeriodicalIF":2.2,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673671","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}
Hemidiaphragm paralysis, a complication of catheter ablation for atrial fibrillation, can severely affect respiratory function and can lead to paradoxical breathing and dyspnea on exertion. A 75-year-old woman with iatrogenic diaphragm paralysis showed improved symptoms, respiratory function, and exercise tolerance after video-assisted thoracoscopic diaphragm plication.
{"title":"Improvement in respiratory function and exercise tolerance following video-assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation","authors":"Yuhei Kasai MD, Ryunosuke Hase MD, Takayuki Kitai MD, Junji Morita MD, Tsutomu Fujita MD","doi":"10.1002/joa3.13039","DOIUrl":"10.1002/joa3.13039","url":null,"abstract":"<p>Hemidiaphragm paralysis, a complication of catheter ablation for atrial fibrillation, can severely affect respiratory function and can lead to paradoxical breathing and dyspnea on exertion. A 75-year-old woman with iatrogenic diaphragm paralysis showed improved symptoms, respiratory function, and exercise tolerance after video-assisted thoracoscopic diaphragm plication.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"614-617"},"PeriodicalIF":2.2,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678756","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}
<p>In the current issue of the <i>Journal of Arrhythmia</i>, Oseto et al.<span><sup>1</sup></span> presented a retrospective study that included paroxysmal (<i>n</i> = 200) and persistent atrial fibrillation (<i>n</i> = 200) (PAF and PeAF) patients who underwent their first catheter ablation and evaluated the association of hyperuricemia (HU) with AF recurrence after catheter ablation. While the PAF patients underwent cryoballoon (CB)-based pulmonary vein isolation (PVI), the PeAF patients underwent radiofrequency (RF)-based PVI plus linear lines (roof and posterolateral mitral isthmus lines). Serum uric acid (SUA) levels were measured both 1 day before and 1, 3, and 6 months after the catheter ablation (the HU was defined as an SUA level of >7 mg/dL). As the ablation technique and strategy differed for both PAF and PeAF patients, the association of SUA/HU with AF recurrence after catheter ablation was assessed separately. The study results showed higher preablation SUA levels (6.5 ± 1.3 vs. 5.8 ± 1.3 mg/dL, <i>p</i> < .001) and HU rate (36% vs. 17%, <i>p</i> < .0001) in patients with PeAF than in patients with PAF. At 57 ± 24 months follow-up, AF-free survival in PAF patients was higher than in PeAF patients (84% vs. 58%, <i>p</i> < .0001), and post-ablation HU (postprocedural 1st-, 3rd-, and 6th-month samples) was significantly associated with AF recurrence only in PeAF patients. There was no association of peri-procedural SUA levels and HU with AF recurrence after catheter ablation in PAF patients. The post-ablation SUA reduction rate was higher in PeAF patients (<i>p</i> < .01). Reverse left atrial remodeling (reduction in left atrial diameter) 3 months after catheter ablation was also higher in PeAF patients without AF recurrence than in PeAF patients with AF recurrence. Although the authors recommended quitting alcohol intake before and after catheter ablation, there was no data about quitting rate or amount of alcohol intake per person and no specific dietary recommendation for patients with HU. While pre- and post-ablation rates of SUA-lowering medications were similar, there was a significant decrease in SUA level in PeAF after catheter ablation. No reasonable explanation was given for this reduction. No details are given in the paper about medications such as diuretics that may affect SUA levels before and after ablation. Furthermore, similar confounding factors for HU and AF recurrence including body mass index (BMI) and hypertension/heart failure rate were significantly higher in PeAF patients than in PAF patients. Since post-ablation HU is associated with AF recurrence in PeAF patients, post-ablation inflammatory marker levels could provide more valuable data to show the relationship with SUA. As the PeAF patients underwent RF ablation which was associated with more postprocedural tissue inflammation, edema, and necrosis, they could highlight the pathophysiological role of HU in AF recurrence. There was also no data ab
在最近的一项荟萃分析（PeAF > PAF > 新发房颤 > 无房颤）中，不同房颤亚型的 SUA 水平存在明显差异，这与 Oseto 等人的研究结果一致，证实了 SUA 水平与心房重塑程度的关系。尽管之前的研究仅评估了消融前 SUA 水平与导管消融术后房颤复发的关系，但 Oseto 等人1 评估了序列 SUA 水平（消融前、消融后第 1、3 和 6 个月）与导管消融术后房颤复发的关系。结果发现，只有消融后的 SUA 水平而非消融前的 SUA 水平是预测 PeAF 患者导管消融后房颤复发的独立因素。Oseto 等人1 的研究表明，PeAF 患者消融术后 HU 率的降低与 SUA 降低药物的使用率无关。与 Oseto 等人的这一发现相同，Aoyama 等人5 在 12 个月的随访中也发现消融术后 SUA 水平显著降低，与炎症指标和肾功能无关。他们还发现，PeAF 患者消融后 SUA 水平的下降幅度明显高于 PAF 患者（0.8 ± 1.0 vs. 0.2 ± 0.8 mg/dL，p < .001）。然而，SUA 和 HU 下降的确切机制尚不清楚。与房颤复发的 PeAF 患者相比，没有房颤复发的 PeAF 患者消融术后 SUA 水平和 HU 率的明显降低与消融术后左心房直径的缩小（左心房反向重塑）平行，这可能解释了 Oseta 等人的研究中 SUA 水平/HU 与心房重塑的双向关联。总之，所有这些先前和当前的研究结果都强调了SUA水平和HU的升高作为心房重塑的一个有用指标的潜力，可用于导管消融术后房颤复发的风险分层，尤其是在PeAF中。
{"title":"Editorial to “The association between hyperuricemia and atrial fibrillation recurrence after catheter ablation”","authors":"Ugur Canpolat MD","doi":"10.1002/joa3.13044","DOIUrl":"10.1002/joa3.13044","url":null,"abstract":"<p>In the current issue of the <i>Journal of Arrhythmia</i>, Oseto et al.<span><sup>1</sup></span> presented a retrospective study that included paroxysmal (<i>n</i> = 200) and persistent atrial fibrillation (<i>n</i> = 200) (PAF and PeAF) patients who underwent their first catheter ablation and evaluated the association of hyperuricemia (HU) with AF recurrence after catheter ablation. While the PAF patients underwent cryoballoon (CB)-based pulmonary vein isolation (PVI), the PeAF patients underwent radiofrequency (RF)-based PVI plus linear lines (roof and posterolateral mitral isthmus lines). Serum uric acid (SUA) levels were measured both 1 day before and 1, 3, and 6 months after the catheter ablation (the HU was defined as an SUA level of >7 mg/dL). As the ablation technique and strategy differed for both PAF and PeAF patients, the association of SUA/HU with AF recurrence after catheter ablation was assessed separately. The study results showed higher preablation SUA levels (6.5 ± 1.3 vs. 5.8 ± 1.3 mg/dL, <i>p</i> < .001) and HU rate (36% vs. 17%, <i>p</i> < .0001) in patients with PeAF than in patients with PAF. At 57 ± 24 months follow-up, AF-free survival in PAF patients was higher than in PeAF patients (84% vs. 58%, <i>p</i> < .0001), and post-ablation HU (postprocedural 1st-, 3rd-, and 6th-month samples) was significantly associated with AF recurrence only in PeAF patients. There was no association of peri-procedural SUA levels and HU with AF recurrence after catheter ablation in PAF patients. The post-ablation SUA reduction rate was higher in PeAF patients (<i>p</i> < .01). Reverse left atrial remodeling (reduction in left atrial diameter) 3 months after catheter ablation was also higher in PeAF patients without AF recurrence than in PeAF patients with AF recurrence. Although the authors recommended quitting alcohol intake before and after catheter ablation, there was no data about quitting rate or amount of alcohol intake per person and no specific dietary recommendation for patients with HU. While pre- and post-ablation rates of SUA-lowering medications were similar, there was a significant decrease in SUA level in PeAF after catheter ablation. No reasonable explanation was given for this reduction. No details are given in the paper about medications such as diuretics that may affect SUA levels before and after ablation. Furthermore, similar confounding factors for HU and AF recurrence including body mass index (BMI) and hypertension/heart failure rate were significantly higher in PeAF patients than in PAF patients. Since post-ablation HU is associated with AF recurrence in PeAF patients, post-ablation inflammatory marker levels could provide more valuable data to show the relationship with SUA. As the PeAF patients underwent RF ablation which was associated with more postprocedural tissue inflammation, edema, and necrosis, they could highlight the pathophysiological role of HU in AF recurrence. There was also no data ab","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"527-528"},"PeriodicalIF":2.2,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687174","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}
<p>Editorial to predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation.<span><sup>1</sup></span></p><p>In patients with atrial fibrillation (AF) or atrial tachycardia (AT), achieving an optimal rate control is essential for improving the outcomes and enhancing the quality of life. Beta-blockers or calcium channel blockers are commonly used to significantly reduce the ventricular response. However, a subset of AF patients may experience an inadequate rate control even after receiving the maximum-tolerated dose of bradycardic agents. Catheter ablation is one of the effective options, but its success rate varies among patients. For example, in patients with hypertrophic cardiomyopathy, additional catheter ablation after the first ablation exhibits a low success rate below 50%.<span><sup>2, 3</sup></span> Furthermore, recurrent ATs can often trigger a rapid ventricular response more easily than AF, presenting significant challenges for the diagnosis and treatment due to factors such as epicardial bridges or complex circuits during catheter ablation. In such cases, atrioventricular nodal ablation (AVNA) combined with the simultaneous implantation of a pacing device has been established as a viable solution.<span><sup>4</sup></span> AVNA is reportedly effective in improving symptoms,<span><sup>5</sup></span> functional capacity,<span><sup>6</sup></span> and echocardiographic parameters.<span><sup>7, 8</sup></span> The main advantage of the AVNA is that its therapeutic effect is less uncertain than medications and catheter ablation. The heart rate is completely regulated by the pacemaker after the AVNA, and reconduction of the intrinsic conduction is rare. Moreover, the recent advancements in physiological pacing techniques, such as para-Hisian pacing, left bundle branch area pacing, and biventricular pacing, have made AVNA more appealing by reducing the risk of pacing-induced cardiomyopathy. The ability to control and regularize the heart rate after the AVNA is advantageous for maximizing the cardiac output and minimizing the patient symptoms. The symptomatic, echocardiographic, and functional benefits of AVNA have been reported in multiple reports. If some AF is refractory to repeated catheter ablation procedures, AVNA might offer a substantial benefit not only from the patient's perspective but also from an economic standpoint.</p><p>In the original investigation in this issue of the Journal of Arrhythmia, Calvert et al. identified a female sex, ischemic heart disease, preexisting pacemakers, and persistent AF as predictors of an AVNA after a second attempt at catheter ablation of AF. As mentioned above, catheter ablation of AF does not always meet the clinical expectations, leaving room for considering an AVNA as an alternative and more reliable treatment, albeit more invasive. If the physicians acknowledge the clinical predictors of an AVNA before a second session with limited efficacy, it should
{"title":"Editorial to predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation","authors":"Takatsugu Kajiyama MD, PhD, Yusuke Kondo MD, PhD, Yoshio Kobayashi MD, PhD","doi":"10.1002/joa3.13041","DOIUrl":"10.1002/joa3.13041","url":null,"abstract":"<p>Editorial to predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation.<span><sup>1</sup></span></p><p>In patients with atrial fibrillation (AF) or atrial tachycardia (AT), achieving an optimal rate control is essential for improving the outcomes and enhancing the quality of life. Beta-blockers or calcium channel blockers are commonly used to significantly reduce the ventricular response. However, a subset of AF patients may experience an inadequate rate control even after receiving the maximum-tolerated dose of bradycardic agents. Catheter ablation is one of the effective options, but its success rate varies among patients. For example, in patients with hypertrophic cardiomyopathy, additional catheter ablation after the first ablation exhibits a low success rate below 50%.<span><sup>2, 3</sup></span> Furthermore, recurrent ATs can often trigger a rapid ventricular response more easily than AF, presenting significant challenges for the diagnosis and treatment due to factors such as epicardial bridges or complex circuits during catheter ablation. In such cases, atrioventricular nodal ablation (AVNA) combined with the simultaneous implantation of a pacing device has been established as a viable solution.<span><sup>4</sup></span> AVNA is reportedly effective in improving symptoms,<span><sup>5</sup></span> functional capacity,<span><sup>6</sup></span> and echocardiographic parameters.<span><sup>7, 8</sup></span> The main advantage of the AVNA is that its therapeutic effect is less uncertain than medications and catheter ablation. The heart rate is completely regulated by the pacemaker after the AVNA, and reconduction of the intrinsic conduction is rare. Moreover, the recent advancements in physiological pacing techniques, such as para-Hisian pacing, left bundle branch area pacing, and biventricular pacing, have made AVNA more appealing by reducing the risk of pacing-induced cardiomyopathy. The ability to control and regularize the heart rate after the AVNA is advantageous for maximizing the cardiac output and minimizing the patient symptoms. The symptomatic, echocardiographic, and functional benefits of AVNA have been reported in multiple reports. If some AF is refractory to repeated catheter ablation procedures, AVNA might offer a substantial benefit not only from the patient's perspective but also from an economic standpoint.</p><p>In the original investigation in this issue of the Journal of Arrhythmia, Calvert et al. identified a female sex, ischemic heart disease, preexisting pacemakers, and persistent AF as predictors of an AVNA after a second attempt at catheter ablation of AF. As mentioned above, catheter ablation of AF does not always meet the clinical expectations, leaving room for considering an AVNA as an alternative and more reliable treatment, albeit more invasive. If the physicians acknowledge the clinical predictors of an AVNA before a second session with limited efficacy, it should ","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"508-509"},"PeriodicalIF":2.2,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693944","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}
Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) can detect various events early. However, the diagnostic ability of CIEDs has not been sufficient, especially for lead failure. The first notification of lead failure was almost noise events, which were detected as arrhythmia by the CIED. A human must analyze the intracardiac electrogram to accurately detect lead failure. However, the number of arrhythmic events is too large for human analysis. Artificial intelligence (AI) seems to be helpful in the early and accurate detection of lead failure before human analysis.
Objective
To test whether a neural network can be trained to precisely identify noise events in the intracardiac electrogram of RM data.
Methods
We analyzed 21 918 RM data consisting of 12 925 and 1884 Medtronic and Boston Scientific data, respectively. Among these, 153 and 52 Medtronic and Boston Scientific data, respectively, were diagnosed as noise events by human analysis. In Medtronic, 306 events, including 153 noise events and randomly selected 153 out of 12 692 nonnoise events, were analyzed in a five-fold cross-validation with a convolutional neural network. The Boston Scientific data were analyzed similarly.
Results
The precision rate, recall rate, F1 score, accuracy rate, and the area under the curve were 85.8 ± 4.0%, 91.6 ± 6.7%, 88.4 ± 2.0%, 88.0 ± 2.0%, and 0.958 ± 0.021 in Medtronic and 88.4 ± 12.8%, 81.0 ± 9.3%, 84.1 ± 8.3%, 84.2 ± 8.3% and 0.928 ± 0.041 in Boston Scientific. Five-fold cross-validation with a weighted loss function could increase the recall rate.
Conclusions
AI can accurately detect noise events. AI analysis may be helpful for detecting lead failure events early and accurately.
{"title":"Artificial intelligence to detect noise events in remote monitoring data","authors":"Nobuhiro Nishii MD, PhD, Kensuke Baba PhD, Ken'ichi Morooka PhD, Haruto Shirae, Tomofumi Mizuno MD, Takuro Masuda MD, Akira Ueoka MD, PhD, Saori Asada MD, PhD, Masakazu Miyamoto MD, Kentaro Ejiri MD, PhD, Satoshi Kawada MD, PhD, Koji Nakagawa MD, PhD, Kazufumi Nakamura MD, PhD, Hiroshi Morita MD, PhD, Shinsuke Yuasa MD, PhD","doi":"10.1002/joa3.13037","DOIUrl":"10.1002/joa3.13037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) can detect various events early. However, the diagnostic ability of CIEDs has not been sufficient, especially for lead failure. The first notification of lead failure was almost noise events, which were detected as arrhythmia by the CIED. A human must analyze the intracardiac electrogram to accurately detect lead failure. However, the number of arrhythmic events is too large for human analysis. Artificial intelligence (AI) seems to be helpful in the early and accurate detection of lead failure before human analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To test whether a neural network can be trained to precisely identify noise events in the intracardiac electrogram of RM data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 21 918 RM data consisting of 12 925 and 1884 Medtronic and Boston Scientific data, respectively. Among these, 153 and 52 Medtronic and Boston Scientific data, respectively, were diagnosed as noise events by human analysis. In Medtronic, 306 events, including 153 noise events and randomly selected 153 out of 12 692 nonnoise events, were analyzed in a five-fold cross-validation with a convolutional neural network. The Boston Scientific data were analyzed similarly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The precision rate, recall rate, F1 score, accuracy rate, and the area under the curve were 85.8 ± 4.0%, 91.6 ± 6.7%, 88.4 ± 2.0%, 88.0 ± 2.0%, and 0.958 ± 0.021 in Medtronic and 88.4 ± 12.8%, 81.0 ± 9.3%, 84.1 ± 8.3%, 84.2 ± 8.3% and 0.928 ± 0.041 in Boston Scientific. Five-fold cross-validation with a weighted loss function could increase the recall rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI can accurately detect noise events. AI analysis may be helpful for detecting lead failure events early and accurately.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"560-577"},"PeriodicalIF":2.2,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140714331","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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