I read with keen interest the recent article by Kerley and Keane on the integration of 3D electroanatomical mapping (EAM) with pulsed field ablation (PFA) for atrial fibrillation (AF) [1]. This study gives significant insights into procedure-related feasibility and the prospective benefit of integrating advanced 3D mapping with newly evolving non-thermal cardiac ablation techniques.
In conclusion, although this study has inherent limitations, it also provides meaningful and practical insights into integration of PFA with 3D mapping. By highlighting these findings, this study may guide clinicians for broader adoption of multipatient selection forum for investigations. Moreover, these outcomes serve as a foundation for refining patient selection, optimizing procedural strategies, and enhancing efficacy of PFA in clinical practice. Furthermore, the points reported here could encourage further research based on validating these approaches across diverse patient population.
The authors have nothing to report.
The authors declare no conflicts of interest.
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
{"title":"Brief Comment on “The Clinical Utility of 3D Electroanatomical Mapping for Atrial Fibrillation Ablation by Pulsed Field Ablation”","authors":"Sidra Afzal, Nimra Afzal","doi":"10.1002/joa3.70295","DOIUrl":"10.1002/joa3.70295","url":null,"abstract":"<p>I read with keen interest the recent article by Kerley and Keane on the integration of 3D electroanatomical mapping (EAM) with pulsed field ablation (PFA) for atrial fibrillation (AF) [<span>1</span>]. This study gives significant insights into procedure-related feasibility and the prospective benefit of integrating advanced 3D mapping with newly evolving non-thermal cardiac ablation techniques.</p><p>In conclusion, although this study has inherent limitations, it also provides meaningful and practical insights into integration of PFA with 3D mapping. By highlighting these findings, this study may guide clinicians for broader adoption of multipatient selection forum for investigations. Moreover, these outcomes serve as a foundation for refining patient selection, optimizing procedural strategies, and enhancing efficacy of PFA in clinical practice. Furthermore, the points reported here could encourage further research based on validating these approaches across diverse patient population.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12902448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201687","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}
Süleyman Cihan Kara, Ugur Canpolat, Kudret Aytemir
Our case reinforces that the retained guidewire technique should be abandoned for coronary sinus lead stabilization during cardiac resynchronization therapy. Although rarely encountered today, patients previously implanted using historical methods may present with severe mechanical complications and high-risk extraction profiles. Early recognition and referral to experienced lead extraction centers is essential.
{"title":"Fracture and Perforation of Coronary Sinus Lead due to Retained Guide Wire During Index Cardiac Resynchronization Therapy Implantation","authors":"Süleyman Cihan Kara, Ugur Canpolat, Kudret Aytemir","doi":"10.1002/joa3.70293","DOIUrl":"10.1002/joa3.70293","url":null,"abstract":"<p>Our case reinforces that the retained guidewire technique should be abandoned for coronary sinus lead stabilization during cardiac resynchronization therapy. Although rarely encountered today, patients previously implanted using historical methods may present with severe mechanical complications and high-risk extraction profiles. Early recognition and referral to experienced lead extraction centers is essential.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179905","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}
It remains unclear how P-wave morphology characteristics can be used to stratify the risk of late recurrence after catheter ablation (CA) for atrial fibrillation (AF).
Methods
Patients with paroxysmal AF who underwent an initial CA were enrolled. We investigated the association between P-wave morphology (P-wave duration (Pd), PQ interval, P-wave amplitude (PWA) in leads II, V2, and V6) and late arrhythmia recurrence. Patients were classified into groups using statistical methods, and differences in recurrence and predictive scores for low voltage areas (LVA) among the groups were evaluated.
Results
A total of 1005 paroxysmal AF patients undergoing initial CA were included. Cox regression identified female sex, Pd > 124 ms, PQ > 196 ms, and low PWA in leads II, V2, and V6 as predictors of late recurrence. Hierarchical clustering defined three phenotypes: Phenotype 1 (isolated low PWA), Phenotype 2 (isolated prolonged Pd) and Phenotype 3 (low PWA with prolonged Pd). At 1-year, cumulative recurrence rates were 10.1% (95% CI 0.8–15.7), 7.0% (4.7–9.6), and 36.2% (30.8–42.3) for Phenotypes 1–3; at 3-year, rates were 17.4% (12.8–23.3), 10.2% (7.4–14.0), and 61.2% (54.8–67.6). Phenotype 3 showed the highest risk, with HRs of 4.84 (95% CI 3.42–6.84) versus Phenotype 1 and 7.44 (4.34–12.8) versus Phenotype 2 (both p < 0.001). Phenotype 3 also had higher DR-FLASH and APPLE scores than the other phenotypes.
Conclusions
Low PWA across multiple leads (II, V2, and V6), especially when combined with prolonged Pd, correlates with late arrhythmia recurrence and suggests the potential presence of LVA.
{"title":"Phenotypic Analysis of P-Wave Morphology as a Key Determinant of Late Recurrence Post-Ablation in Paroxysmal Atrial Fibrillation","authors":"Masamichi Yano, Yasuyuki Egami, Noriyuki Kobayashi, Ayako Sugino, Masaru Abe, Mizuki Ohsuga, Hiroaki Nohara, Shodai Kawanami, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masami Nishino","doi":"10.1002/joa3.70285","DOIUrl":"10.1002/joa3.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It remains unclear how P-wave morphology characteristics can be used to stratify the risk of late recurrence after catheter ablation (CA) for atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with paroxysmal AF who underwent an initial CA were enrolled. We investigated the association between P-wave morphology (P-wave duration (Pd), PQ interval, P-wave amplitude (PWA) in leads II, V2, and V6) and late arrhythmia recurrence. Patients were classified into groups using statistical methods, and differences in recurrence and predictive scores for low voltage areas (LVA) among the groups were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1005 paroxysmal AF patients undergoing initial CA were included. Cox regression identified female sex, Pd > 124 ms, PQ > 196 ms, and low PWA in leads II, V2, and V6 as predictors of late recurrence. Hierarchical clustering defined three phenotypes: Phenotype 1 (isolated low PWA), Phenotype 2 (isolated prolonged Pd) and Phenotype 3 (low PWA with prolonged Pd). At 1-year, cumulative recurrence rates were 10.1% (95% CI 0.8–15.7), 7.0% (4.7–9.6), and 36.2% (30.8–42.3) for Phenotypes 1–3; at 3-year, rates were 17.4% (12.8–23.3), 10.2% (7.4–14.0), and 61.2% (54.8–67.6). Phenotype 3 showed the highest risk, with HRs of 4.84 (95% CI 3.42–6.84) versus Phenotype 1 and 7.44 (4.34–12.8) versus Phenotype 2 (both <i>p</i> < 0.001). Phenotype 3 also had higher DR-FLASH and APPLE scores than the other phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low PWA across multiple leads (II, V2, and V6), especially when combined with prolonged Pd, correlates with late arrhythmia recurrence and suggests the potential presence of LVA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179869","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}
Amir Reza Boskabadi, Hoorak Poorzand, Ali Vaezi, Sara Afshar, Mohammad Tayyebi, Negar Morovatdar
Background
COVID-19 infection can cause significant long-term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS-CoV-2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID-19. This study aims to determine the long-term risk of developing cardiac arrhythmias after SARS-CoV-2 infection.
Methods
A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID-19 infection and individuals who recovered from COVID-19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random-effect models.
Results
Fourteen studies were eligible for the meta-analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], I2 = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], I2 = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], I2 = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], I2 = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], I2 = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias.
Conclusions
The risk of developing cardiac arrhythmias is increased after COVID-19 infection in the long term.
背景：COVID-19感染可对患者造成严重的长期健康问题。虽然长冠状病毒没有普遍接受的定义，但它通常是通过在最初的SARS-CoV-2感染后持续4周的持续症状来确定的，没有其他解释。心血管系统是COVID-19长期参与的最重要的系统之一，即使无症状患者也有证据表明COVID-19后心血管损伤。本研究旨在确定SARS-CoV-2感染后发生心律失常的长期风险。方法：于2025年8月24日对Scopus、PubMed、Science Direct、Web of Science等数据库进行全面系统检索。纳入了由无COVID-19感染史的健康对照组和COVID-19康复至少30天的个体组成的队列文章。使用随机效应模型估计风险比（HR）和95%置信区间（CI）。结果：14项研究符合meta分析。长冠状病毒的患者总体心律失常风险较高（HR: 1.74, 95% CI [1.39, 2.10], I 2 = 99.65%）。所检查的特定心律失常包括房颤（HR: 1.49, 95% CI [1.24, 1.73], I 2 = 98.57%）、窦性心动过速（HR: 1.69, 95% CI [1.21, 2.18], I 2 = 99.51%）、窦性心动过缓（HR: 1.58, 95% CI [1.50, 1.66], I 2 = 65.80%）和室性心律失常（HR: 1.72, 95% CI [1.48, 1.95], I 2 = 96.89%）。初始感染较严重的患者发生心律失常的风险较高。结论：长期感染COVID-19后发生心律失常的风险增加。
{"title":"Increased Arrhythmia Risk in Long COVID: A Systematic Review and Meta-Analysis","authors":"Amir Reza Boskabadi, Hoorak Poorzand, Ali Vaezi, Sara Afshar, Mohammad Tayyebi, Negar Morovatdar","doi":"10.1002/joa3.70278","DOIUrl":"10.1002/joa3.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>COVID-19 infection can cause significant long-term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS-CoV-2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID-19. This study aims to determine the long-term risk of developing cardiac arrhythmias after SARS-CoV-2 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID-19 infection and individuals who recovered from COVID-19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random-effect models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen studies were eligible for the meta-analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], <i>I</i><sup>2</sup> = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], <i>I</i><sup>2</sup> = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], <i>I</i><sup>2</sup> = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], <i>I</i><sup>2</sup> = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], <i>I</i><sup>2</sup> = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of developing cardiac arrhythmias is increased after COVID-19 infection in the long term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165742","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}
Yun Young Choi, Hyuk Soon Choi, Joo Hee Jeong, Chang Ok Seo, Yun Gi Kim, Jaemin Shim, Jong-Il Choi, Young-Hoon Kim
Background and Aims
Esophageal injury (EI) is a potentially serious complication of catheter ablation (CA) for atrial fibrillation (AF). However, data on its incidence and risk factors, particularly after radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA), remain limited. This study aimed to identify predictors of EI in patients undergoing RFCA and CBA.
Methods
In this retrospective study, patients with AF who underwent de novo RFCA or CBA between December 2019 and April 2022 were evaluated. All underwent EGD within 2 days post-ablation. EI severity was graded, and clinical predictors were analyzed using multivariate logistic regression.
Results
Among 584 patients (mean age 62.8 ± 11.2 years, 68.6% male), 30 (5.1%) developed EI (RFCA: 5.0%, CBA: 6.3%). Most injuries were mild (Class I), and all resolved with proton pump inhibitor therapy. Compared with those without EI, affected patients had significantly lower body mass index (BMI) (24.5 ± 3.9 vs. 25.9 ± 3.4 kg/m2, p = 0.030) and reduced ejection fraction (EF) (48.9% ± 8.7% vs. 52.8% ± 6.8%, p = 0.023). Multivariate analysis identified BMI ≤ 24 kg/m2 (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.69–7.96) and EF ≤ 40% (OR, 4.08; 95% CI, 1.54–11.56) as independent risk factors.
Conclusions
Esophageal injury after catheter ablation for atrial fibrillation is not rare, but usually mild. Lower BMI and reduced LVEF were independent risk factors, regardless of ablation type. These results support selective endoscopic screening in high-risk patients to enable early detection and prevent severe complications.
背景和目的：食管损伤（EI）是心房颤动（AF）导管消融（CA）的潜在严重并发症。然而，关于其发病率和危险因素的数据，特别是射频导管消融（RFCA）和低温球囊消融（CBA）后的数据仍然有限。本研究旨在确定RFCA和CBA患者EI的预测因素。方法：在这项回顾性研究中，对2019年12月至2022年4月期间接受新手术RFCA或CBA的AF患者进行评估。所有患者均在消融后2天内行EGD检查。对EI严重程度进行分级，并采用多因素logistic回归分析临床预测因素。结果：584例患者（平均年龄62.8±11.2岁，男性68.6%）中有30例（5.1%）发生EI （RFCA: 5.0%, CBA: 6.3%）。大多数损伤是轻微的（I级），并通过质子泵抑制剂治疗全部解决。与未患EI的患者相比，患者的身体质量指数（BMI）显著降低（24.5±3.9 vs. 25.9±3.4 kg/m2, p = 0.030），射血分数（EF）显著降低（48.9%±8.7% vs. 52.8%±6.8%,p = 0.023）。多因素分析确定BMI≤24 kg/m2（比值比[OR]， 3.67； 95%可信区间[CI]， 1.69 ~ 7.96）和EF≤40% （OR, 4.08; 95% CI, 1.54 ~ 11.56）为独立危险因素。结论：房颤导管消融后食管损伤并不罕见，但通常较轻。无论消融类型如何，较低的BMI和较低的LVEF都是独立的危险因素。这些结果支持对高危患者进行选择性内窥镜筛查，以实现早期发现和预防严重并发症。
{"title":"Esophageal Injury Risk Factors in Patients With Atrial Fibrillation Undergoing Catheter Ablation","authors":"Yun Young Choi, Hyuk Soon Choi, Joo Hee Jeong, Chang Ok Seo, Yun Gi Kim, Jaemin Shim, Jong-Il Choi, Young-Hoon Kim","doi":"10.1002/joa3.70259","DOIUrl":"10.1002/joa3.70259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Esophageal injury (EI) is a potentially serious complication of catheter ablation (CA) for atrial fibrillation (AF). However, data on its incidence and risk factors, particularly after radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA), remain limited. This study aimed to identify predictors of EI in patients undergoing RFCA and CBA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, patients with AF who underwent de novo RFCA or CBA between December 2019 and April 2022 were evaluated. All underwent EGD within 2 days post-ablation. EI severity was graded, and clinical predictors were analyzed using multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 584 patients (mean age 62.8 ± 11.2 years, 68.6% male), 30 (5.1%) developed EI (RFCA: 5.0%, CBA: 6.3%). Most injuries were mild (Class I), and all resolved with proton pump inhibitor therapy. Compared with those without EI, affected patients had significantly lower body mass index (BMI) (24.5 ± 3.9 vs. 25.9 ± 3.4 kg/m<sup>2</sup>, <i>p</i> = 0.030) and reduced ejection fraction (EF) (48.9% ± 8.7% vs. 52.8% ± 6.8%, <i>p</i> = 0.023). Multivariate analysis identified BMI ≤ 24 kg/m<sup>2</sup> (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.69–7.96) and EF ≤ 40% (OR, 4.08; 95% CI, 1.54–11.56) as independent risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Esophageal injury after catheter ablation for atrial fibrillation is not rare, but usually mild. Lower BMI and reduced LVEF were independent risk factors, regardless of ablation type. These results support selective endoscopic screening in high-risk patients to enable early detection and prevent severe complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157137","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 Asia-Pacific Heart Rhythm Society Atrial Fibrillation (APHRS-AF) Registry is a prospective study in Asian metropolitan cities, which provides important information on the baseline characteristics, therapeutic patterns, and 1-year clinical outcomes in patients with atrial fibrillation (AF). This report describes data from Japanese patients recruited in this registry.
Methods and Results
A total of 4666 patients with AF were enrolled. Of these, 794 patients were recruited from 28 large cardiovascular centers in Japan between 2015 and 2017. We analyzed 1-year follow-up outcome of these patients. Mean age at recruitment was 65.7 years and 69.0% were males. Major comorbidities were hypertension (37.5%), lipid disorder (29.0%), heart failure (15.9%), and diabetes mellitus (15.0%). Mean CHADS2 score, CHA2DS2-VASc score, and HAS-BLED score were 1.0, 2.0, and 1.1, respectively. At baseline, use of oral anticoagulants was 81%, including 7% prescribed a vitamin K antagonist (VKA) and 74% a direct oral anticoagulant (DOAC). Majority of the patients (N = 459, 57.8%) were planned to undergo catheter ablation. One-year follow-up was conducted in 743 patients. One-year all-cause mortality was 0.1% (n = 1) and the incidence of stroke/thromboembolic events was also 0.1% (n = 1). Major bleeding events were observed in 5 patients (0.7%), including 3 intracranial hemorrhages.
Conclusion
In this 1-year analysis, a high prevalence of oral anticoagulant use was recorded. A low mortality rate and a low incidence of stroke/thromboembolic events were observed in Japanese patients of the APHRS-AF Registry.
{"title":"One-Year Outcome of Japanese Patients With Atrial Fibrillation: Insights From APHRS-AF Registry","authors":"Kenji Yodogawa, Yu-ki Iwasaki, Yasuo Okumura, Koichi Nagashima, Koichi Inoue, Nobuaki Tanaka, Kengo Kusano, Koji Miyamoto, Masahiko Takagi, Kyoko Soejima, Yuichi Momose, Tomohiro Sakamoto, Hideharu Okamatsu, Toyoaki Murohara, Yasuya Inden, Keiichi Fukuda, Seiji Takatsuki, Yasuki Kihara, Yukiko Nakano, Teiichi Yamane, Michifumi Tokuda, Masayoshi Ajioka, Hiroyuki Osanai, Kazuhiro Satomi, Hiroyuki Tsutsui, Akihiko Shimizu, Satoru Sakagami, Eiichi Watanabe, Nobuhisa Hagiwara, Mitsuharu Kawamura, Naohiko Takahashi, Yoshinori Kobayashi, Hirofumi Tomita, Hiroshi Tada, Kazutaka Aonuma, Yukihiro Koretsune, Takanori Ikeda, Masahiko Goya, Wataru Shimizu","doi":"10.1002/joa3.70287","DOIUrl":"10.1002/joa3.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Asia-Pacific Heart Rhythm Society Atrial Fibrillation (APHRS-AF) Registry is a prospective study in Asian metropolitan cities, which provides important information on the baseline characteristics, therapeutic patterns, and 1-year clinical outcomes in patients with atrial fibrillation (AF). This report describes data from Japanese patients recruited in this registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A total of 4666 patients with AF were enrolled. Of these, 794 patients were recruited from 28 large cardiovascular centers in Japan between 2015 and 2017. We analyzed 1-year follow-up outcome of these patients. Mean age at recruitment was 65.7 years and 69.0% were males. Major comorbidities were hypertension (37.5%), lipid disorder (29.0%), heart failure (15.9%), and diabetes mellitus (15.0%). Mean CHADS2 score, CHA2DS2-VASc score, and HAS-BLED score were 1.0, 2.0, and 1.1, respectively. At baseline, use of oral anticoagulants was 81%, including 7% prescribed a vitamin K antagonist (VKA) and 74% a direct oral anticoagulant (DOAC). Majority of the patients (<i>N</i> = 459, 57.8%) were planned to undergo catheter ablation. One-year follow-up was conducted in 743 patients. One-year all-cause mortality was 0.1% (<i>n</i> = 1) and the incidence of stroke/thromboembolic events was also 0.1% (<i>n</i> = 1). Major bleeding events were observed in 5 patients (0.7%), including 3 intracranial hemorrhages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this 1-year analysis, a high prevalence of oral anticoagulant use was recorded. A low mortality rate and a low incidence of stroke/thromboembolic events were observed in Japanese patients of the APHRS-AF Registry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157228","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}
{"title":"Initial Capture Failure With Delayed Resolution in Atrial Leadless Pacemaker Implantation: A Case of ATTR Amyloidosis With Sinus Node Dysfunction","authors":"Yasuyuki Takada, Junichi Kamoshida, Muryo Terasawa, Kazuhiro Satomi, Yoshinao Yazaki","doi":"10.1002/joa3.70288","DOIUrl":"10.1002/joa3.70288","url":null,"abstract":"<p>ATTR amyloidosis patient with initial atrial capture failure showed delayed threshold improvement over time. Stable current of injury and impedance guided expectant management, avoiding unnecessary device repositioning while achieving successful outcomes.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157145","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}
This case discusses the differential diagnosis of the double transition sign during bipolar threshold testing following conduction system pacing and delves into the details of electrophysiologic parameters of successful left bundle capture.
{"title":"Double Transition in Left Bundle Branch Area Pacing","authors":"Sudipta Mondal, Nadeem Afroz Muslim","doi":"10.1002/joa3.70290","DOIUrl":"10.1002/joa3.70290","url":null,"abstract":"<p>This case discusses the differential diagnosis of the double transition sign during bipolar threshold testing following conduction system pacing and delves into the details of electrophysiologic parameters of successful left bundle capture.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142491","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}
In recent years, the number of cases diagnosed with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) has been increasing. However, ATTRwt-CM frequently coexists with atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), often necessitating management for arrhythmias. Additionally, ventricular arrhythmias sometimes occur, or conduction disturbances often develop, requiring management for bradycardia, frequently needing device therapy such as pacemakers, implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillators. Therefore, for arrhythmia specialists, who primarily focus on non-pharmacological treatments, arrhythmias associated with ATTRwt-CM are unavoidable encounters, and becoming proficient in their management is increasingly important and considered essential. However, we sometimes encounter AF, AFL, or AT that are extremely difficult to treat with catheter ablation, and there are many situations to struggle with: how to manage each arrhythmia and whether catheter ablation should be performed at all. Furthermore, while the usefulness of ICDs for primary prevention of sudden cardiac death remains a subject of debate, we occasionally encounter patients with ventricular arrhythmias in fact. This review primarily addresses and focuses on catheter ablation therapy for atrial arrhythmias associated with ATTRwt-CM, as well as device therapy for bradyarrhythmias and ventricular arrhythmias, aiming to provide insights for treatment planning in the future as a total management approach to arrhythmia in ATTRwt-CM patients, especially for arrhythmia specialists.
{"title":"Catheter Ablation and Device Therapy in Patients With Transthyretin Amyloid Cardiomyopathy: A Review of Non-Pharmacological Therapy","authors":"Hisanori Kanazawa, Tadashi Hoshiyama, Shozo Kaneko, Yusei Kawahara, Yuichiro Tsuruta, Yuta Tsurusaki, Kohei Matsunaga, Shunsuke Tamanoi, Naoto Kuyama, Hiroki Usuku, Eiichiro Yamamoto, Yasuhiro Izumiya, Kenichi Tsujita","doi":"10.1002/joa3.70281","DOIUrl":"10.1002/joa3.70281","url":null,"abstract":"<p>In recent years, the number of cases diagnosed with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) has been increasing. However, ATTRwt-CM frequently coexists with atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), often necessitating management for arrhythmias. Additionally, ventricular arrhythmias sometimes occur, or conduction disturbances often develop, requiring management for bradycardia, frequently needing device therapy such as pacemakers, implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillators. Therefore, for arrhythmia specialists, who primarily focus on non-pharmacological treatments, arrhythmias associated with ATTRwt-CM are unavoidable encounters, and becoming proficient in their management is increasingly important and considered essential. However, we sometimes encounter AF, AFL, or AT that are extremely difficult to treat with catheter ablation, and there are many situations to struggle with: how to manage each arrhythmia and whether catheter ablation should be performed at all. Furthermore, while the usefulness of ICDs for primary prevention of sudden cardiac death remains a subject of debate, we occasionally encounter patients with ventricular arrhythmias in fact. This review primarily addresses and focuses on catheter ablation therapy for atrial arrhythmias associated with ATTRwt-CM, as well as device therapy for bradyarrhythmias and ventricular arrhythmias, aiming to provide insights for treatment planning in the future as a total management approach to arrhythmia in ATTRwt-CM patients, especially for arrhythmia specialists.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12881705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142563","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 increasing use of cardiovascular implantable electronic devices (CIEDs) has heightened the need for transvenous lead extraction (TLE). Although Japan has a certification system for TLE-capable hospitals, nationwide trends and regional disparities remain unclear.
Methods
We retrospectively analyzed the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination/Per Diem Payment System, including patients undergoing TLE or other CIED-related procedures between April 2015 and March 2022.
Results
Among 3573 TLE cases from 108 hospitals, procedure volumes steadily increased. The median patient age increased from 74 to 77 years, and comorbidity burden also rose over time. During this period, the proportion of non-infectious indications rose from 17.0% in 2015 to 38.9% in 2021. Cardiac tamponade was the most frequent complication, and advanced age and renal disease independently predicted complications or in-hospital death. Marked regional disparities were observed in CIED implantation patterns, TLE volume, and indications across Japan.
Conclusions
Non-infectious TLEs have increased safely in Japan, contributing to an overall growth in TLE procedures. However, substantial regional disparities persist in both procedural volume and indications. Standardized care strategies addressing these disparities are warranted to optimize TLE practice nationwide.
{"title":"Annual Trends and Regional Disparities in Transvenous Lead Extractions in Japan: Insights From the Nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination Data","authors":"Toshihiro Nakamura, Koji Fukuzawa, Yoko Sumita, Koshiro Kanaoka, Kimitake Imamura, Mitsuru Takami, Hiromasa Otake","doi":"10.1002/joa3.70286","DOIUrl":"10.1002/joa3.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The increasing use of cardiovascular implantable electronic devices (CIEDs) has heightened the need for transvenous lead extraction (TLE). Although Japan has a certification system for TLE-capable hospitals, nationwide trends and regional disparities remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination/Per Diem Payment System, including patients undergoing TLE or other CIED-related procedures between April 2015 and March 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3573 TLE cases from 108 hospitals, procedure volumes steadily increased. The median patient age increased from 74 to 77 years, and comorbidity burden also rose over time. During this period, the proportion of non-infectious indications rose from 17.0% in 2015 to 38.9% in 2021. Cardiac tamponade was the most frequent complication, and advanced age and renal disease independently predicted complications or in-hospital death. Marked regional disparities were observed in CIED implantation patterns, TLE volume, and indications across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Non-infectious TLEs have increased safely in Japan, contributing to an overall growth in TLE procedures. However, substantial regional disparities persist in both procedural volume and indications. Standardized care strategies addressing these disparities are warranted to optimize TLE practice nationwide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12877304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142541","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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