Journal of Arrhythmia最新文献

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Catheter-based pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). While cryoballoon ablation (CBA) is a well-validated single-shot thermal technology, pulsed field ablation (PFA) has emerged as a predominantly non-thermal modality that employs high-voltage electric fields to achieve selective myocardial ablation, potentially minimizing collateral damage. However, comparative evidence between PFA and CBA remains limited.

Objectives: To systematically review and compare the efficacy, safety, and procedural efficiency of PFA versus CBA for PVI.

Methods and results: A structured systematic database search was conducted up to August 2025, following PRISMA guidelines. Eighteen studies (n = 5638; 2396 PFA and 3242 CBA) were included including two randomized controlled trials. PFA significantly shortened procedure time (mean difference -13.7 min; 95% CI -16.7 to -10.8; p < 0.001), while fluoroscopy time and radiation dose were similar. Both modalities achieved high acute PVI success (95%-100%). At 12-month follow-up, PFA showed lower arrhythmia recurrence (OR 0.73; 95% CI 0.59-0.90; p = 0.003) with no difference in redo ablation. Overall complications were fewer with PFA (OR 0.53; 95% CI 0.32-0.87; p < 0.001), largely due to reduced phrenic nerve injury, though cardiac tamponade occurred slightly more often in the PFA group. Subgroup analyzes yielded consistent results in paroxysmal AF and when 3D mapping was used.

Conclusion: PFA offers superior procedural efficiency and safety compared with CBA, achieving shorter procedures, fewer complications, and lower arrhythmia recurrence at mid-term follow-up. Larger multicentre randomized trials with standardized protocols and long-term follow-up are needed to confirm these findings and evaluate evolving PFA technologies.

Background: Catheter ablation is useful to treat patients with scar-related heart disease and ventricular tachycardia (VT). QDOT Micro catheter is a next generation catheter. Its optimized temperature control and micro-electrode technology are designed to provide more efficient and consistent lesion creation with an accurate myocardial substrate analysis. This study aims to compare the myocardial electro-anatomic maps obtained using QDOT and Pentaray (PR) catheters.

Method: This study enrolled patients with symptomatic VT and indication to perform CA following the latest guidelines. Myocardial electro-anatomic maps were obtained using QDOT and Pentaray (PR) catheters. The primary objective was to assess the absence of sustained VTs or ICD interventions 12 months after the procedure.

Results: Twelve patients were enrolled. The percentage of myocardial scar was higher using QDOTB map (15.5%) compared to PR (13.5%) and QDOTM-map (9%) (< 0.001). The percentage of myocardial borderzone was higher using QDOTB map (7.5%) compared to PR (6%) and QDOTM-map (3%) (p < 0.001). The average EGM amplitude acquired in the myocardial scar was higher in the QDOTM-map (0.24 mV) compared to PR (0.10 mV) and QDOTB-map (0.10 mV) (p < 0.001). The average EGM amplitude acquired in the myocardial borderzone was higher in the QDOTM-map (1.07 mV) compared to PR (0.80 mV) and QDOTB-map (0.72 mV) (p < 0.001). No sustained VT was documented at 12 month FU. No adverse events were documented.

Conclusion: Microelectrode mapping allows detection of higher voltage electrograms compared to standard bipolar mapping and PR mapping. In our small population, the HPSD protocol was used inside the low voltage areas without acute procedural complications.

Three atrioventricular reciprocating tachycardias (AVRTs) using 3 accessory pathways (APs) occurred with the His bundle eliminated by the previous ablation. Two AVRTs using 2 right APs rotated reversely, and the other AVRT was one with a retrograde conduction through the left AP and anterograde conduction through the 2 right APs.

An octogenarian man with a history of multiple catheter ablation failures for atrial fibrillation and tachycardia was diagnosed with transthyretin amyloid cardiomyopathy. After 1 year of tafamidis therapy, the patient experienced spontaneous restoration of sinus rhythm, and follow-up image of 99mTc-pyrophosphate scintigraphy revealed a marked decrease of tracer accumulation.

Cardiac resynchronization therapy (CRT) essentially targets electrical dyssynchrony, one of the key drivers in heart failure (HF). Its efficacy depends on both the quality (QRS morphology) and quantity (QRS duration) of dyssynchrony, requiring individualized patient selection. While drug therapy for HF has a limited effect on this substrate, early implantation of CRT can prevent irreversible remodeling and facilitate optimization of medical therapy. CRT should be recognized as an essential component within a comprehensive strategy for HF management in patients with appropriate indications.