Hacer Kamali MD, Erkut Öztürk MD, Mehtap Çiftçi MD, Hasan Candas Kafali MD, Gülhan Tunca Şahin MD, Sertaç Haydin MD, Ali Can Hatemi MD, İbrahim Cansaran Tanıdır MD, Alper Güzeltaş MD, Yakup Ergül MD
Introduction
Although amiodarone is traditionally used in the treatment of postoperative junctional ectopic tachycardia (JET), the search for new treatments is ongoing. We present our experience with ivabradine at two medical centers.
Materials and Methods
Between January 2022 and January 2023, patients who developed JET after pediatric cardiac surgery were prospectively followed up and documented. The diagnosis of JET was made with the support of the electrophysiology team and treatment was based primarily on whether JET disrupted hemodynamics.
Results
This study was conducted at two high-volume centers, which record a total of 1130 pediatric cardiac surgeries within a year. The study recruited 26 patients with median heart rate 180 beats per minute, and 10 (38%) patients had impaired hemodynamics. Out of the 26 study participants, 14 (54%) cases were treated with ivabradine alone, 10 (38%) cases were treated with amiodarone + ivabradine, and 2 patients (8%) with high heart rates and prolonged junctional arrhythmia were treated with ivabradine and flecainide. The median time to ventricular rate control was 12 h, and the median time to sinus rhythm conversion was 55.5 h. No ivabradine-related side effects were observed in any of the patients, and no patient experienced JET recurrence after discontinuing treatment.
Conclusion
Ivabradine seems to be a safe and effective medical treatment that can be used as the primary treatment in patients with stable hemodynamics, as an adjunctive therapy to amiodarone in patients with impaired hemodynamics.
{"title":"Use of ivabradine in children with junctional ectopic tachycardia after pediatric cardiac surgery; two-centre experience","authors":"Hacer Kamali MD, Erkut Öztürk MD, Mehtap Çiftçi MD, Hasan Candas Kafali MD, Gülhan Tunca Şahin MD, Sertaç Haydin MD, Ali Can Hatemi MD, İbrahim Cansaran Tanıdır MD, Alper Güzeltaş MD, Yakup Ergül MD","doi":"10.1002/joa3.13155","DOIUrl":"10.1002/joa3.13155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although amiodarone is traditionally used in the treatment of postoperative junctional ectopic tachycardia (JET), the search for new treatments is ongoing. We present our experience with ivabradine at two medical centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Between January 2022 and January 2023, patients who developed JET after pediatric cardiac surgery were prospectively followed up and documented. The diagnosis of JET was made with the support of the electrophysiology team and treatment was based primarily on whether JET disrupted hemodynamics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study was conducted at two high-volume centers, which record a total of 1130 pediatric cardiac surgeries within a year. The study recruited 26 patients with median heart rate 180 beats per minute, and 10 (38%) patients had impaired hemodynamics. Out of the 26 study participants, 14 (54%) cases were treated with ivabradine alone, 10 (38%) cases were treated with amiodarone + ivabradine, and 2 patients (8%) with high heart rates and prolonged junctional arrhythmia were treated with ivabradine and flecainide. The median time to ventricular rate control was 12 h, and the median time to sinus rhythm conversion was 55.5 h. No ivabradine-related side effects were observed in any of the patients, and no patient experienced JET recurrence after discontinuing treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ivabradine seems to be a safe and effective medical treatment that can be used as the primary treatment in patients with stable hemodynamics, as an adjunctive therapy to amiodarone in patients with impaired hemodynamics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1473-1480"},"PeriodicalIF":2.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818125","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>Abhinav et al. reported a young patient with atrial standstill who was found to have an HCN4 genetic variant.<span><sup>1</sup></span> This is the first report of an association between HCN4 genetic variant and atrial mechanical and electrical standstill, which is very significant. Several causative genes for familial progressive cardiac conduction disease (PCCD) have been reported, including the gene they reported. As they mentioned in the discussion, the SCN5A mutation is the most well-known PCCD-causing gene. LMNA, MYH6, and TRPM4 have also been reported as PCCD-causing genes in addition to SCN5A.<span><sup>2-4</sup></span> Furthermore, Ishikawa et al. reported that sick sinus syndrome patients with HCN4 genetic variant frequently present with atrial fibrillation (AF) and left ventricular noncompaction (LVNC), which means that genetic variant of HCN4 could be a cause of PCCD; the mechanism by which HCN4 genetic variant generate such atrial and ventricular structural and electrical abnormality is still unclear. Normally, HCN4 is expressed primarily in limited regions of the cardiac conduction system, particularly in the sinoatrial node. It plays a crucial role in slow diastolic depolarization involved in automaticity. However, during the course of early embryonic development, HCN4-positive cells also have been shown to give rise to primitive heart tubes, which eventually form most of the myocytes in the left ventricle and part of the atrium of the adult heart. Ishikawa et al. indicated that the genetic variant in HCN4 may disrupt the normal differentiation of progenitor cells in the primitive heart, resulting in disturbance of structural and electrical properties of the left ventricle and both atria, which may ultimately be a substrate for the development of AF and LVNC.<span><sup>5</sup></span> This speculation could explain how the HCN4 genetic abnormality in this case could cause structural and electrical atrial dysfunction, resulting in the phenotype of atrial standstill.</p><p>We were worried about the penetrance of this unique genetic variant. Multidisciplinary genetic counselling needs to be performed in order to perform genetic testing of his sister, parents, and aunt at an appropriate time, which could assist with the performance of appropriate intervention. Particularly, if the author has the opportunity to see his sister, we will encourage the authors to recommend that she should take a genetic testing along with electrocardiogram, which may help her prevent the development of new stroke at a young age.</p><p>If the patient has the symptoms because of chronotropic incompetence, the indication for a cardiac implantable electrical device (CIED) should be considered. However, decisions on which CIED to be implanted should be made carefully. The present case developed the atrial standstill, which limits the benefit of a dual chamber pacemaker. Since the disadvantages of ventricular lead implantation at a young age have also been propo
{"title":"Editorial to “Atrial standstill in a young patient with ischemic stroke associated with inheritance of a novel HCN4 mutation”","authors":"Hidekazu Kondo MD, PhD, Naohiko Takahashi MD, PhD","doi":"10.1002/joa3.13164","DOIUrl":"10.1002/joa3.13164","url":null,"abstract":"<p>Abhinav et al. reported a young patient with atrial standstill who was found to have an HCN4 genetic variant.<span><sup>1</sup></span> This is the first report of an association between HCN4 genetic variant and atrial mechanical and electrical standstill, which is very significant. Several causative genes for familial progressive cardiac conduction disease (PCCD) have been reported, including the gene they reported. As they mentioned in the discussion, the SCN5A mutation is the most well-known PCCD-causing gene. LMNA, MYH6, and TRPM4 have also been reported as PCCD-causing genes in addition to SCN5A.<span><sup>2-4</sup></span> Furthermore, Ishikawa et al. reported that sick sinus syndrome patients with HCN4 genetic variant frequently present with atrial fibrillation (AF) and left ventricular noncompaction (LVNC), which means that genetic variant of HCN4 could be a cause of PCCD; the mechanism by which HCN4 genetic variant generate such atrial and ventricular structural and electrical abnormality is still unclear. Normally, HCN4 is expressed primarily in limited regions of the cardiac conduction system, particularly in the sinoatrial node. It plays a crucial role in slow diastolic depolarization involved in automaticity. However, during the course of early embryonic development, HCN4-positive cells also have been shown to give rise to primitive heart tubes, which eventually form most of the myocytes in the left ventricle and part of the atrium of the adult heart. Ishikawa et al. indicated that the genetic variant in HCN4 may disrupt the normal differentiation of progenitor cells in the primitive heart, resulting in disturbance of structural and electrical properties of the left ventricle and both atria, which may ultimately be a substrate for the development of AF and LVNC.<span><sup>5</sup></span> This speculation could explain how the HCN4 genetic abnormality in this case could cause structural and electrical atrial dysfunction, resulting in the phenotype of atrial standstill.</p><p>We were worried about the penetrance of this unique genetic variant. Multidisciplinary genetic counselling needs to be performed in order to perform genetic testing of his sister, parents, and aunt at an appropriate time, which could assist with the performance of appropriate intervention. Particularly, if the author has the opportunity to see his sister, we will encourage the authors to recommend that she should take a genetic testing along with electrocardiogram, which may help her prevent the development of new stroke at a young age.</p><p>If the patient has the symptoms because of chronotropic incompetence, the indication for a cardiac implantable electrical device (CIED) should be considered. However, decisions on which CIED to be implanted should be made carefully. The present case developed the atrial standstill, which limits the benefit of a dual chamber pacemaker. Since the disadvantages of ventricular lead implantation at a young age have also been propo","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1523-1524"},"PeriodicalIF":2.2,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818019","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}
Stylianos Tzeis MD, PhD, Edward P. Gerstenfeld MD, Jonathan Kalman MD, PhD, Eduardo B. Saad MD, Alireza Sepehri Shamloo MD, Jason G. Andrade MD, Chirag R. Barbhaiya MD, Tina Baykaner MD, MPH, Serge Boveda MD, PhD, Hugh Calkins MD, Ngai-Yin Chan MD, Minglong Chen MD, Shih-Ann Chen MD, Nikolaos Dagres MD, Ralph J. Damiano MD, Tom De Potter MD, Isabel Deisenhofer MD, Nicolas Derval MD, Luigi Di Biase MD, PhD, Mattias Duytschaever MD, PhD, Katia Dyrda MD, Gerhard Hindricks MD, Meleze Hocini MD, PhD, Young-Hoon Kim MD, Mark la Meir MD, PhD, Jose Luis Merino MD, PhD, Gregory F. Michaud MD, Andrea Natale MD, Isabelle Nault MD, Santiago Nava MD, Takashi Nitta MD, PhD, Mark O’Neill MD, Hui-Nam Pak MD, PhD, Jonathan P. Piccini MD, MHS, Helmut Pürerfellner MD, Tobias Reichlin MD, Luis Carlos Saenz MD, Prashanthan Sanders MD, PhD, Richard Schilling MD, Boris Schmidt MD, Dphil, Gregory E. Supple MD, Kevin L. Thomas MD, Claudio Tondo MD, PhD, Atul Verma MD, Elaine Y. Wan MD
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society
{"title":"2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation","authors":"Stylianos Tzeis MD, PhD, Edward P. Gerstenfeld MD, Jonathan Kalman MD, PhD, Eduardo B. Saad MD, Alireza Sepehri Shamloo MD, Jason G. Andrade MD, Chirag R. Barbhaiya MD, Tina Baykaner MD, MPH, Serge Boveda MD, PhD, Hugh Calkins MD, Ngai-Yin Chan MD, Minglong Chen MD, Shih-Ann Chen MD, Nikolaos Dagres MD, Ralph J. Damiano MD, Tom De Potter MD, Isabel Deisenhofer MD, Nicolas Derval MD, Luigi Di Biase MD, PhD, Mattias Duytschaever MD, PhD, Katia Dyrda MD, Gerhard Hindricks MD, Meleze Hocini MD, PhD, Young-Hoon Kim MD, Mark la Meir MD, PhD, Jose Luis Merino MD, PhD, Gregory F. Michaud MD, Andrea Natale MD, Isabelle Nault MD, Santiago Nava MD, Takashi Nitta MD, PhD, Mark O’Neill MD, Hui-Nam Pak MD, PhD, Jonathan P. Piccini MD, MHS, Helmut Pürerfellner MD, Tobias Reichlin MD, Luis Carlos Saenz MD, Prashanthan Sanders MD, PhD, Richard Schilling MD, Boris Schmidt MD, Dphil, Gregory E. Supple MD, Kevin L. Thomas MD, Claudio Tondo MD, PhD, Atul Verma MD, Elaine Y. Wan MD","doi":"10.1002/joa3.13082","DOIUrl":"10.1002/joa3.13082","url":null,"abstract":"<p>In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1217-1354"},"PeriodicalIF":2.2,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818055","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}
A wearable cardioverter defibrillator (WCD) is indicated for a limited period in patients at high risk of sudden cardiac death (SCD). Nonischemic heart failure (HF) is common among Japanese patients with HF. The aim of this study was to evaluate the incidence of fatal arrhythmias during WCD use and the clinical outcomes after WCD withdrawal in Japanese patients with HF.
Methods
We retrospectively studied 105 hospitalized HF patients who were discharged with a WCD. The main outcome was SCD/ventricular arrhythmias during WCD use and the other outcomes were implantation of an implantable cardioverter-defibrillator (ICD), SCD/ventricular arrhythmias after WCD withdrawal, and changes in left ventricular ejection fraction (LVEF).
Results
Eighty-seven (83%) patients received a WCD for primary prevention of SCD, of whom 60 (69%) were new-onset HF patients with an LVEF ≤35%. The median daily wear time was 22.1 h. Two patients experienced sustained ventricular tachycardia and one patient experienced atrioventricular block with asystole while on WCD. After WCD withdrawal, 81 (77%) patients decided not to receive ICD implantation. The percentage of patients with an LVEF ≥35% increased from 20% at baseline to 70% at 1 year after discharge. During the median follow-up of 50 months, 78 (96%) of the 81 patients who did not have an ICD were free of SCD/ventricular arrhythmias.
Conclusions
The use of a WCD is useful for determining the appropriate indication for ICD implantation in Japanese patients with new-onset HF, a low LVEF, and a risk of SCD.
{"title":"Clinical outcomes during and after wearable cardioverter defibrillator use in Japanese patients with heart failure: A single-center experience","authors":"Noriko Kikuchi MD, Tsuyoshi Shiga MD, Yohei Sugawara MD, Atsushi Suzuki MD, Yoshiaki Minami MD, Hidetoshi Hattori MD, Morio Shoda MD, Nobuhisa Hagiwara MD, Junichi Yamaguchi MD","doi":"10.1002/joa3.13158","DOIUrl":"10.1002/joa3.13158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A wearable cardioverter defibrillator (WCD) is indicated for a limited period in patients at high risk of sudden cardiac death (SCD). Nonischemic heart failure (HF) is common among Japanese patients with HF. The aim of this study was to evaluate the incidence of fatal arrhythmias during WCD use and the clinical outcomes after WCD withdrawal in Japanese patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively studied 105 hospitalized HF patients who were discharged with a WCD. The main outcome was SCD/ventricular arrhythmias during WCD use and the other outcomes were implantation of an implantable cardioverter-defibrillator (ICD), SCD/ventricular arrhythmias after WCD withdrawal, and changes in left ventricular ejection fraction (LVEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven (83%) patients received a WCD for primary prevention of SCD, of whom 60 (69%) were new-onset HF patients with an LVEF ≤35%. The median daily wear time was 22.1 h. Two patients experienced sustained ventricular tachycardia and one patient experienced atrioventricular block with asystole while on WCD. After WCD withdrawal, 81 (77%) patients decided not to receive ICD implantation. The percentage of patients with an LVEF ≥35% increased from 20% at baseline to 70% at 1 year after discharge. During the median follow-up of 50 months, 78 (96%) of the 81 patients who did not have an ICD were free of SCD/ventricular arrhythmias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of a WCD is useful for determining the appropriate indication for ICD implantation in Japanese patients with new-onset HF, a low LVEF, and a risk of SCD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1462-1472"},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818108","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 surface electrocardiograms during a wide QRS complex tachycardia and during the injection of 10 mg of adenosine triphosphate. What is the mechanism of this wide QRS tachycardia?
{"title":"The response to adenosine tells all: What is the mechanism?","authors":"Shu Hirata MD, Koichi Nagashima MD, PhD, Yuji Wakamatsu MD, PhD, Ryuta Watanabe MD, PhD, Yasuo Okumura MD, PhD","doi":"10.1002/joa3.13154","DOIUrl":"10.1002/joa3.13154","url":null,"abstract":"<p>The surface electrocardiograms during a wide QRS complex tachycardia and during the injection of 10 mg of adenosine triphosphate. What is the mechanism of this wide QRS tachycardia?\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 6","pages":"1497-1500"},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818069","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}
Koji Makino MCom, Mia Mudge MMedSci, Michelle Hill PhD, Chelsea Zaunmayr MPH, Dominic Tilden MPH (Hons)
Background
Micra™ VR Transcatheter Pacing System (Micra VR) is a single-chamber transcatheter leadless pacemaker. Absence of leads and subcutaneous pocket reduces or completely eliminates the risk of complications associated with the conventional transvenous pacemakers (TVPM). When compared with TVPM, the leadless technology provides a quicker postimplantation recovery and causes less cosmetic concerns/discomfort providing better patient experiences in the long run. We performed a modeled cost-utility analysis of Micra VR versus TVPM for the management of patients with bradycardia.
Methods
We developed a Markov model comparing Micra VR to TVPM over the device battery life of 17 years. Key data inputs were drawn from the MICRA Coverage with Evidence Development (CED) study. Costs were obtained from Australian sources. The analysis is from the perspective of the Australian healthcare system.
Results
The risks of complications, including device-related events, in real-world clinical practice were relatively low for TVPM. The magnitude of cost savings arising from risk reductions provided by Micra VR was however sizable, offsetting roughly a quarter of its additional device cost. Over the 17-year model period, Micra VR was associated with an estimated incremental cost of A$4277 and an incremental quality-adjusted life years (QALYs) of 0.09 when compared with TVPM, yielding an incremental cost-effectiveness ratio of A$47 379 per QALY gain.
Conclusions
Micra VR is likely to offer a cost-effective alternative to the conventional TVPM technology for the management of patients with bradycardia.
{"title":"Cost-effectiveness of Micra™ VR leadless pacemaker in patients with bradycardia and atrial fibrillation in Australia","authors":"Koji Makino MCom, Mia Mudge MMedSci, Michelle Hill PhD, Chelsea Zaunmayr MPH, Dominic Tilden MPH (Hons)","doi":"10.1002/joa3.13145","DOIUrl":"10.1002/joa3.13145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Micra™ VR Transcatheter Pacing System (Micra VR) is a single-chamber transcatheter leadless pacemaker. Absence of leads and subcutaneous pocket reduces or completely eliminates the risk of complications associated with the conventional transvenous pacemakers (TVPM). When compared with TVPM, the leadless technology provides a quicker postimplantation recovery and causes less cosmetic concerns/discomfort providing better patient experiences in the long run. We performed a modeled cost-utility analysis of Micra VR versus TVPM for the management of patients with bradycardia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a Markov model comparing Micra VR to TVPM over the device battery life of 17 years. Key data inputs were drawn from the MICRA Coverage with Evidence Development (CED) study. Costs were obtained from Australian sources. The analysis is from the perspective of the Australian healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The risks of complications, including device-related events, in real-world clinical practice were relatively low for TVPM. The magnitude of cost savings arising from risk reductions provided by Micra VR was however sizable, offsetting roughly a quarter of its additional device cost. Over the 17-year model period, Micra VR was associated with an estimated incremental cost of A$4277 and an incremental quality-adjusted life years (QALYs) of 0.09 when compared with TVPM, yielding an incremental cost-effectiveness ratio of A$47 379 per QALY gain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Micra VR is likely to offer a cost-effective alternative to the conventional TVPM technology for the management of patients with bradycardia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1481-1489"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818077","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}
Visualizing the specific regions where atrial fibrillation (AF) is maintained is crucial for effective treatment, but it remains challenging in clinical practice. We aimed to address this challenge by developing a mapping approach focused on the cycle length (CL) and its gradient (CL-gradient).
Methods
In 105 patients undergoing initial ablation for persistent AF, pre-ablation CARTOFINDER data were utilized to create maps based on three indicators: (1) CL, the atrial frequency during AF calculated using CARTOFINDER; (2) Short CL, encompassing CLs within 5 ms of the minimum CL; and (3) CL-gradient, the CL range within a 6 mm radius. We evaluated the association between the AF termination through ablation and the measured values and patterns in each map.
Results
AF termination occurred in 17 patients. The AF termination group exhibited the significant large maximum CL-gradient (48.8 ms [interquartile range, 38.6–66.3], p <.001) and the short distance between the minimum CL site and the maximum CL-gradient site (15.8 mm, [interquartile range, 6.0–23.2], p =.029). Of the 17 AF termination cases, 13 exhibited a CL distribution pattern characterized by a steep CL-gradient near the minimum CL site (SG-MCL), defined as the distance of less than 23.2 mm and the maximum CL-gradient greater than 33.1 ms. In these AF termination cases, SG-MCL was also correlated with the ablation area.
Conclusions
The minimum CL area accompanied by significant CL gradients in the immediate vicinity may play a crucial role in sustaining AF.
背景：可视化房颤（AF）维持的特定区域对于有效治疗至关重要，但在临床实践中仍然具有挑战性。我们的目标是通过开发一种专注于周期长度（CL）及其梯度（CL-梯度）的映射方法来解决这一挑战。方法：对105例持续性房颤初始消融患者，利用消融前的CARTOFINDER数据，基于三个指标制作房颤图：(1)CL，即房颤期间使用CARTOFINDER计算的房频；(2)短极限极限，包括距离最小极限极限5毫秒内的极限极限；(3) CL梯度，CL范围在6mm半径内。我们评估了消融引起的房颤终止与每个图谱的测量值和模式之间的关系。结果：17例患者房颤终止。房颤终止组最大cl梯度显著增大（48.8 ms[四分位数间距，38.6-66.3],p p = 0.029）。在17例AF终止病例中，13例的CL分布模式为最小CL位点（SG-MCL）附近CL梯度陡，定义为距离小于23.2 mm，最大CL梯度大于33.1 ms。在这些房颤终止病例中，SG-MCL也与消融面积相关。结论：在房颤的维持中，最小的CL面积和附近明显的CL梯度可能起着至关重要的作用。
{"title":"Identification of regions maintaining atrial fibrillation through cycle length and cycle length gradient mapping","authors":"Masafumi Shimojo M.D., Yasuya Inden M.D., Ph.D., Satoshi Yanagisawa M.D., Ph.D., Ryota Yamauchi M.D., Kei Hiramatsu M.D., Tomoya Iwawaki M.D., Masaya Tachi M.D., Shun Kondo M.D., Takayuki Goto M.D., Yukiomi Tsuji M.D., Ph.D., Toyoaki Murohara M.D., Ph.D.","doi":"10.1002/joa3.13151","DOIUrl":"10.1002/joa3.13151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Visualizing the specific regions where atrial fibrillation (AF) is maintained is crucial for effective treatment, but it remains challenging in clinical practice. We aimed to address this challenge by developing a mapping approach focused on the cycle length (CL) and its gradient (CL-gradient).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 105 patients undergoing initial ablation for persistent AF, pre-ablation CARTOFINDER data were utilized to create maps based on three indicators: (1) CL, the atrial frequency during AF calculated using CARTOFINDER; (2) Short CL, encompassing CLs within 5 ms of the minimum CL; and (3) CL-gradient, the CL range within a 6 mm radius. We evaluated the association between the AF termination through ablation and the measured values and patterns in each map.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AF termination occurred in 17 patients. The AF termination group exhibited the significant large maximum CL-gradient (48.8 ms [interquartile range, 38.6–66.3], <i>p</i> <.001) and the short distance between the minimum CL site and the maximum CL-gradient site (15.8 mm, [interquartile range, 6.0–23.2], <i>p</i> =.029). Of the 17 AF termination cases, 13 exhibited a CL distribution pattern characterized by a steep CL-gradient near the minimum CL site (SG-MCL), defined as the distance of less than 23.2 mm and the maximum CL-gradient greater than 33.1 ms. In these AF termination cases, SG-MCL was also correlated with the ablation area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The minimum CL area accompanied by significant CL gradients in the immediate vicinity may play a crucial role in sustaining AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1389-1399"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818054","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>Atrial fibrillation (AF) is the most common chronic supraventricular arrhythmia, which is associated with thromboembolic complications and heart failure. The early detection of AF is important to avoid those events, but difficult particularly in patients with asymptomatic AF.</p><p>Recently, continuous rhythm monitoring with cardiac implantable electronic devices has been used to diagnose brief episodes of arrhythmia, including paroxysmal AF, which are recorded as atrial high-rate episodes (AHRE). A recent systematic review and meta-analysis demonstrated that the overall AHRE incidence ratio was estimated to be 17.56 cases per 100 person-years. Although AHREs were not associated with a statistically significant increased mortality risk, patients with documented AHREs were 4.45 times more likely to develop clinical AF, and were associated with a 1.90-fold increased stroke risk.<span><sup>1</sup></span> Thus, early detection of AHRE is also crucial to improve prognosis in patients with cardiac implantable electronic devices.</p><p>Pastori et al. evaluated 496 consecutive patients with cardiac implantable electronic devices. They found that AHRE were recorded in 173 patients, and multivariable Cox regression analysis showed that age, prior AF, white cell count, and high C reactive protein were independently associated with AHRE. However, clinical scores using age, left atrial size, renal function, ejection fraction, metabolic syndrome, and cardiomyopathy were nonsignificantly associated with AHRE. Similar results were obtained for CHADS2 and CHA2DS2VASc score.<span><sup>2</sup></span></p><p>P-wave dispersion (PWD) is an ECG parameter and predictor of AF, which is defined as the difference between the maximum and the minimum P-wave durations detected on the body surface 12-lead ECG. Nishinarita et al. reported that PWD was an independent predictor of new-onset AHRE. They showed a greater incidence of sick sinus syndrome and longer PWD were apparent in the AHRE than non-AHRE group. In logistic regression analysis, receiver-operating characteristic curve analysis (area under the curve 0.90; <i>p</i> < .001) suggested the best cutoff value for PWD was 48 mm (sensitivity 73.8%, specificity 77.9%).<span><sup>3</sup></span></p><p>Recently, the four-dimensional automatic LA quantitative analysis (4D Auto LAQ) technology in real-time three-dimensional echocardiography (RT-3DE) has been developed. Using this technology, Wang et al. investigated predicting factors for AHRE. Left atrial contraction longitudinal strain (LASct) obtained by the technology, body surface area (BSA), and LA end-systolic volume (LAESV) were influencing factors for AHRE. Multivariate analysis revealed that LASct was an independent risk factor for the AHRE.<span><sup>4</sup></span></p><p>In this study, the authors examined the prevalence and risk factors associated with the occurrence of AHRE in patients with a dual-chamber pacemaker. Left ventricular global longitudinal strain (G
心房颤动（AF）是最常见的慢性室上性心律失常，它与血栓栓塞并发症和心力衰竭有关。房颤的早期发现对于避免这些事件很重要，但对于无症状房颤患者来说尤其困难。最近，使用心脏植入式电子设备进行持续节律监测已被用于诊断短暂的心律失常发作，包括阵发性房颤，记录为心房高率发作（AHRE）。最近的一项系统综述和荟萃分析表明，AHRE的总发病率估计为每100人年17.56例。虽然AHREs与死亡风险的增加没有统计学上的显著相关性，但记录在案的AHREs患者发生临床房颤的可能性增加4.45倍，卒中风险增加1.90倍因此，早期发现AHRE对于改善心脏植入式电子装置患者的预后也至关重要。Pastori等人评估了496例连续使用心脏植入式电子装置的患者。他们发现173名患者记录了AHRE，多变量Cox回归分析显示，年龄、既往房颤、白细胞计数和高C反应蛋白与AHRE独立相关。然而，使用年龄、左心房大小、肾功能、射血分数、代谢综合征和心肌病的临床评分与AHRE无显著相关性。CHADS2和CHA2DS2VASc评分结果相似。p波色散（PWD）是房颤的一个心电参数和预测指标，定义为体表12导联心电图检测到的最大p波持续时间与最小p波持续时间之差。Nishinarita等人报道PWD是新发AHRE的独立预测因子。他们发现，与非AHRE组相比，AHRE组的病态窦综合征发生率更高，PWD时间更长。在logistic回归分析中，接受者-工作特征曲线分析(曲线下面积0.90；p < .001)提示PWD的最佳临界值为48 mm（敏感性73.8%，特异性77.9%）。最近，实时三维超声心动图（RT-3DE）中的四维自动LA定量分析（4D Auto LAQ）技术得到了发展。Wang等人利用该技术研究了AHRE的预测因素。影响AHRE的因素有左心房收缩纵应变（LASct）、体表面积（BSA）和左心房收缩末容积（LAESV）。多因素分析显示LASct是AHRE的独立危险因素。在这项研究中，作者研究了双室起搏器患者AHRE的患病率和危险因素。采用斑点跟踪超声心动图测量左心室整体纵向应变（GLS-LV）。他们发现，随访6个月后AHRE患病率为30.34%，抗心律失常药物使用史、发作性室上性心动过速史、植入前24小时动态心电图早搏率和GLS-LV是AHRE的独立预测因子。他们的研究结果可能为心脏内装置患者的管理提供有用的信息。然而，正如他们所描述的，抗凝治疗对心内ECG检测到的AHRE患者的作用仍然存在争议。进一步的研究正在评估口服抗凝剂对AHRE患者的益处。综上所述，到目前为止，各种因素被报道与AHRE相关。有必要进行大规模随机对照研究，以揭示AHRE的独立危险因素。作者声明本文无利益冲突。
{"title":"Editorial to “The incidence and risk factors of atrial high-rate episodes in patients with a dual-chamber pacemaker”","authors":"Kenji Yodogawa","doi":"10.1002/joa3.13153","DOIUrl":"10.1002/joa3.13153","url":null,"abstract":"<p>Atrial fibrillation (AF) is the most common chronic supraventricular arrhythmia, which is associated with thromboembolic complications and heart failure. The early detection of AF is important to avoid those events, but difficult particularly in patients with asymptomatic AF.</p><p>Recently, continuous rhythm monitoring with cardiac implantable electronic devices has been used to diagnose brief episodes of arrhythmia, including paroxysmal AF, which are recorded as atrial high-rate episodes (AHRE). A recent systematic review and meta-analysis demonstrated that the overall AHRE incidence ratio was estimated to be 17.56 cases per 100 person-years. Although AHREs were not associated with a statistically significant increased mortality risk, patients with documented AHREs were 4.45 times more likely to develop clinical AF, and were associated with a 1.90-fold increased stroke risk.<span><sup>1</sup></span> Thus, early detection of AHRE is also crucial to improve prognosis in patients with cardiac implantable electronic devices.</p><p>Pastori et al. evaluated 496 consecutive patients with cardiac implantable electronic devices. They found that AHRE were recorded in 173 patients, and multivariable Cox regression analysis showed that age, prior AF, white cell count, and high C reactive protein were independently associated with AHRE. However, clinical scores using age, left atrial size, renal function, ejection fraction, metabolic syndrome, and cardiomyopathy were nonsignificantly associated with AHRE. Similar results were obtained for CHADS2 and CHA2DS2VASc score.<span><sup>2</sup></span></p><p>P-wave dispersion (PWD) is an ECG parameter and predictor of AF, which is defined as the difference between the maximum and the minimum P-wave durations detected on the body surface 12-lead ECG. Nishinarita et al. reported that PWD was an independent predictor of new-onset AHRE. They showed a greater incidence of sick sinus syndrome and longer PWD were apparent in the AHRE than non-AHRE group. In logistic regression analysis, receiver-operating characteristic curve analysis (area under the curve 0.90; <i>p</i> < .001) suggested the best cutoff value for PWD was 48 mm (sensitivity 73.8%, specificity 77.9%).<span><sup>3</sup></span></p><p>Recently, the four-dimensional automatic LA quantitative analysis (4D Auto LAQ) technology in real-time three-dimensional echocardiography (RT-3DE) has been developed. Using this technology, Wang et al. investigated predicting factors for AHRE. Left atrial contraction longitudinal strain (LASct) obtained by the technology, body surface area (BSA), and LA end-systolic volume (LAESV) were influencing factors for AHRE. Multivariate analysis revealed that LASct was an independent risk factor for the AHRE.<span><sup>4</sup></span></p><p>In this study, the authors examined the prevalence and risk factors associated with the occurrence of AHRE in patients with a dual-chamber pacemaker. Left ventricular global longitudinal strain (G","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 6","pages":"1355-1356"},"PeriodicalIF":2.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818034","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}
Abhinav B. Anand PDF, DM, Bhavik S. Shah DM, Girish R. Sabnis DM, Ajay U. Mahajan DM, FESC, FACC
We present a case of HCN4 gene mutation presenting with atrial standstill and stroke in the young.
我们提出了一例HCN4基因突变呈现心房静止和中风的年轻人。
{"title":"Atrial standstill in a young patient with ischemic stroke associated with inheritance of a novel HCN4 mutation","authors":"Abhinav B. Anand PDF, DM, Bhavik S. Shah DM, Girish R. Sabnis DM, Ajay U. Mahajan DM, FESC, FACC","doi":"10.1002/joa3.13150","DOIUrl":"10.1002/joa3.13150","url":null,"abstract":"<p>We present a case of HCN4 gene mutation presenting with atrial standstill and stroke in the young.\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 6","pages":"1519-1522"},"PeriodicalIF":2.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818088","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 describe a case where right superior pulmonary vein was not reconnected at the beginning of the third radiofrequency catheter ablation (RFCA) for atrial fibrillation but was reconnected at the beginning of the fourth RFCA. This is a case of pulmonary vein reconnection in the chronic phase after successful pulmonary vein isolation.
{"title":"A case of pulmonary vein reconnection after long-term success of pulmonary vein isolation for atrial fibrillation","authors":"Kohei Ukita MD, Yasuyuki Egami MD, Yasuharu Matsunaga-Lee MD, Masamichi Yano MD, PHD, Masami Nishino MD, PHD, FACC, FESC","doi":"10.1002/joa3.13149","DOIUrl":"10.1002/joa3.13149","url":null,"abstract":"<p>We describe a case where right superior pulmonary vein was not reconnected at the beginning of the third radiofrequency catheter ablation (RFCA) for atrial fibrillation but was reconnected at the beginning of the fourth RFCA. This is a case of pulmonary vein reconnection in the chronic phase after successful pulmonary vein isolation.\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 6","pages":"1490-1493"},"PeriodicalIF":2.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818057","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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