Nadhem Abdallah MD, Mohammed Samra MD, Momen Alsayed MBBS
Background
Sex disparities in cardiovascular disorders are well-documented, but data on hospitalization and readmission outcomes in the context of sex for Complete Heart Block (CHB) remains limited.
Methods
We analyzed the 2016–2020 Nationwide Readmission Database to identify patients with a principal diagnosis of CHB. Men served as the control group, while women comprised the study cohort. The primary outcome was mortality. Secondary outcomes included odds of cardiac arrest, ventricular tachycardia, heart failure, mechanical ventilation use, all-cause 30-day readmission, total and early pacemaker use, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models adjusted for confounders.
Results
Among 175,257 patients with CHB, 45% were female. Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.42, 95% CI 1.3–1.55) compared to males. Additionally, females had higher odds of cardiac arrest (aOR 1.13, 95% CI 1.06–1.2), ventricular tachycardia (aOR 1.1, 95% CI 1.05–1.17), heart failure (aOR 1.18, 95% CI 1.14–1.22), mechanical ventilation use (aOR 1.1, 95% CI 1.03–1.17), and all-cause 30-day readmission (aOR 1.1, 95% CI 1.03–1.14). Women also had lower odds of total pacemaker use (aOR 0.92, 95% CI 0.88–0.96) and early pacemaker use (aOR 0.89, 95% CI 0.86–0.82). Female patients exhibited longer LOS (4.13 days vs. 3.86 days, p < 0.001) but incurred lower THC ($89,908 vs. $94,590, p = 0.002).
Conclusion
Female sex in CHB patients was associated with higher mortality and adverse events but lower pacemaker use compared to male patients.
{"title":"Sex based disparities in hospitalization and readmission outcomes for complete atrioventricular block: Insights from United States readmission data","authors":"Nadhem Abdallah MD, Mohammed Samra MD, Momen Alsayed MBBS","doi":"10.1002/joa3.70013","DOIUrl":"https://doi.org/10.1002/joa3.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sex disparities in cardiovascular disorders are well-documented, but data on hospitalization and readmission outcomes in the context of sex for Complete Heart Block (CHB) remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the 2016–2020 Nationwide Readmission Database to identify patients with a principal diagnosis of CHB. Men served as the control group, while women comprised the study cohort. The primary outcome was mortality. Secondary outcomes included odds of cardiac arrest, ventricular tachycardia, heart failure, mechanical ventilation use, all-cause 30-day readmission, total and early pacemaker use, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models adjusted for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 175,257 patients with CHB, 45% were female. Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.42, 95% CI 1.3–1.55) compared to males. Additionally, females had higher odds of cardiac arrest (aOR 1.13, 95% CI 1.06–1.2), ventricular tachycardia (aOR 1.1, 95% CI 1.05–1.17), heart failure (aOR 1.18, 95% CI 1.14–1.22), mechanical ventilation use (aOR 1.1, 95% CI 1.03–1.17), and all-cause 30-day readmission (aOR 1.1, 95% CI 1.03–1.14). Women also had lower odds of total pacemaker use (aOR 0.92, 95% CI 0.88–0.96) and early pacemaker use (aOR 0.89, 95% CI 0.86–0.82). Female patients exhibited longer LOS (4.13 days vs. 3.86 days, <i>p</i> < 0.001) but incurred lower THC ($89,908 vs. $94,590, <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Female sex in CHB patients was associated with higher mortality and adverse events but lower pacemaker use compared to male patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362768","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 Sudo MD, Kenji Kuroki MD, PhD, Yasuteru Yamauchi MD, PhD, Akira Sato MD, PhD, Kazutaka Aonuma MD, PhD
This is the case of a 29-year-old female with sudden palpitations due to tachycardia. The atrial activation focusing point (AFP) was presumed to be the atrial entrance site within the reentry circuit of slow/fast atrioventricular nodal reentrant tachycardia by postpacing interval mapping. AFP is a novel ablation site because it is more distal to the His-bundle recording site and more atrial site compared to the conventional SP ablation site.
{"title":"A novel ablation strategy of slow/fast atrioventricular nodal reentrant tachycardia targeting the atrial activation focusing point at the inferior Koch's triangle: Identification of entrance site of slow pathway using high-resolution 3D mapping","authors":"Koji Sudo MD, Kenji Kuroki MD, PhD, Yasuteru Yamauchi MD, PhD, Akira Sato MD, PhD, Kazutaka Aonuma MD, PhD","doi":"10.1002/joa3.70019","DOIUrl":"https://doi.org/10.1002/joa3.70019","url":null,"abstract":"<p>This is the case of a 29-year-old female with sudden palpitations due to tachycardia. The atrial activation focusing point (AFP) was presumed to be the atrial entrance site within the reentry circuit of slow/fast atrioventricular nodal reentrant tachycardia by postpacing interval mapping. AFP is a novel ablation site because it is more distal to the His-bundle recording site and more atrial site compared to the conventional SP ablation site.\u0000 <figure>\u0000 <div><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362764","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}
Adenosine-sensitive atrial tachycardia (AT) is typically associated with a slow conduction zone (SCZ) near the atrioventricular node or tricuspid annulus. We report an unusual case of adenosine-sensitive AT with a SCZ located between the left atrial appendage and the left atrial anterior septum, which was successfully ablated 9.2 mm from the left atrial earliest activation site. This case highlights the importance of advanced mapping and entrainment techniques in the identification and management of rare left-sided SCZ variants of adenosine-sensitive AT.
{"title":"Unusual left-sided variant orientation of the slow conduction zone in adenosine-sensitive atrial tachycardia","authors":"Shuhei Arai MD, PhD, Taku Asano MD, PhD, Yuki Takai MD, Yuya Nakamura MD, PhD, Toshiro Shinke MD, PhD","doi":"10.1002/joa3.70015","DOIUrl":"https://doi.org/10.1002/joa3.70015","url":null,"abstract":"<p>Adenosine-sensitive atrial tachycardia (AT) is typically associated with a slow conduction zone (SCZ) near the atrioventricular node or tricuspid annulus. We report an unusual case of adenosine-sensitive AT with a SCZ located between the left atrial appendage and the left atrial anterior septum, which was successfully ablated 9.2 mm from the left atrial earliest activation site. This case highlights the importance of advanced mapping and entrainment techniques in the identification and management of rare left-sided SCZ variants of adenosine-sensitive AT.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362765","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}
Device implantation with a generator pocket raises cosmetic concerns regarding external appearance. We present a case of successful left bundle branch area pacing and left axillary pacemaker generator implantation via a two-incision approach in a young female patient, resulting in favorable cardiac function and cosmetic satisfaction.
{"title":"Feasibility of left bundle branch area pacing with left axillary pacemaker implantation in a young female patient with heart failure","authors":"Hiroyuki Kato MD, PhD, Yuji Narita MD, PhD, Satoshi Yanagisawa MD, PhD, Yasuya Inden MD, PhD, Toyoaki Murohara MD, PhD","doi":"10.1002/joa3.70022","DOIUrl":"https://doi.org/10.1002/joa3.70022","url":null,"abstract":"<p>Device implantation with a generator pocket raises cosmetic concerns regarding external appearance. We present a case of successful left bundle branch area pacing and left axillary pacemaker generator implantation via a two-incision approach in a young female patient, resulting in favorable cardiac function and cosmetic satisfaction.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362761","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}
Mirza Muhammad Hadeed Khawar MBBS, Muneeb Khawar MBBS, Javed Iqbal, Abdul Qadeer MD
<p>We write to address critical issues in the main findings of the study, “<i>Novel Omnipolar Mapping Technology for Effective Superior Vena Cava Isolation: A Randomized Clinical Trial</i>” by Oguri et al.<span><sup>1</sup></span> While the study aims to demonstrate the superiority of omnipolar mapping technology (OT) over conventional methods (CM) in superior vena cava (SVC) isolation, the results are undermined by several methodological inconsistencies, questionable conclusions, and significant gaps in transparency. These issues call into question the study's overall validity and its implications for clinical practice.</p><p>The authors report that OT requires fewer radiofrequency (RF) applications (13.6 ± 6.0 vs 19.8 ± 10.9) and shorter procedure times (9.6 ± 6.8 min vs 14.3 ± 6.8 min) compared to CM. Although these differences are statistically significant, their clinical relevance is dubious because of the absence of clearly defined procedural criteria. The reported RF applications for OT are notably higher than the averages documented in previous SVC isolation studies,<span><sup>2</sup></span> which typically highlight more efficient procedural workflows. This discrepancy raises concerns about whether OT genuinely represents an advancement or merely reflects methodological differences.</p><p>Moreover, the lack of transparency regarding operator variability—such as differences in experience levels and techniques—further complicates interpretation. Operator-dependent factors are known to substantially impact RF application times and procedural outcomes; yet the study does not adequately address these influences. Without controlling for such variability, the reported superiority of OT remains speculative and difficult to generalize.</p><p>The authors claim that OT identified the SN location in three out of 25 patients where bipolar mapping failed. While this assertion suggests a potential advantage of OT, the study does not provide robust quantitative evidence to support the claim. For example, no clear validation framework for comparing the accuracy of OT versus bipolar mapping was included, nor was there external confirmation of the identified SN locations. Without such standardization, conclusions regarding OT's accuracy are speculative at best.</p><p>In a related analysis, the study describes the performance of an 8-spline catheter, reporting higher point density (59 ± 10 vs 18 ± 4 electrograms/cm<sup>2</sup>; <i>p</i> < .01) and faster point acquisition rates (1332 ± 208 vs 308 ± 69 electrograms/min; <i>p</i> < .01) compared to the 5-spline catheter during sustained atrial tachycardia mapping.<span><sup>3</sup></span> However, these results, while statistically impressive, fail to demonstrate clinical relevance in the context of SN localization. The lack of consistent criteria for measuring and validating mapping accuracy undermines the credibility of these findings.</p><p>The study defines RA-SVC conduction blocks using a color spe
{"title":"Critique of omnipolar mapping claims in superior vena cava isolation: A call for standardization","authors":"Mirza Muhammad Hadeed Khawar MBBS, Muneeb Khawar MBBS, Javed Iqbal, Abdul Qadeer MD","doi":"10.1002/joa3.70020","DOIUrl":"https://doi.org/10.1002/joa3.70020","url":null,"abstract":"<p>We write to address critical issues in the main findings of the study, “<i>Novel Omnipolar Mapping Technology for Effective Superior Vena Cava Isolation: A Randomized Clinical Trial</i>” by Oguri et al.<span><sup>1</sup></span> While the study aims to demonstrate the superiority of omnipolar mapping technology (OT) over conventional methods (CM) in superior vena cava (SVC) isolation, the results are undermined by several methodological inconsistencies, questionable conclusions, and significant gaps in transparency. These issues call into question the study's overall validity and its implications for clinical practice.</p><p>The authors report that OT requires fewer radiofrequency (RF) applications (13.6 ± 6.0 vs 19.8 ± 10.9) and shorter procedure times (9.6 ± 6.8 min vs 14.3 ± 6.8 min) compared to CM. Although these differences are statistically significant, their clinical relevance is dubious because of the absence of clearly defined procedural criteria. The reported RF applications for OT are notably higher than the averages documented in previous SVC isolation studies,<span><sup>2</sup></span> which typically highlight more efficient procedural workflows. This discrepancy raises concerns about whether OT genuinely represents an advancement or merely reflects methodological differences.</p><p>Moreover, the lack of transparency regarding operator variability—such as differences in experience levels and techniques—further complicates interpretation. Operator-dependent factors are known to substantially impact RF application times and procedural outcomes; yet the study does not adequately address these influences. Without controlling for such variability, the reported superiority of OT remains speculative and difficult to generalize.</p><p>The authors claim that OT identified the SN location in three out of 25 patients where bipolar mapping failed. While this assertion suggests a potential advantage of OT, the study does not provide robust quantitative evidence to support the claim. For example, no clear validation framework for comparing the accuracy of OT versus bipolar mapping was included, nor was there external confirmation of the identified SN locations. Without such standardization, conclusions regarding OT's accuracy are speculative at best.</p><p>In a related analysis, the study describes the performance of an 8-spline catheter, reporting higher point density (59 ± 10 vs 18 ± 4 electrograms/cm<sup>2</sup>; <i>p</i> < .01) and faster point acquisition rates (1332 ± 208 vs 308 ± 69 electrograms/min; <i>p</i> < .01) compared to the 5-spline catheter during sustained atrial tachycardia mapping.<span><sup>3</sup></span> However, these results, while statistically impressive, fail to demonstrate clinical relevance in the context of SN localization. The lack of consistent criteria for measuring and validating mapping accuracy undermines the credibility of these findings.</p><p>The study defines RA-SVC conduction blocks using a color spe","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362769","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}
Catalin Pestrea MD, PhD, Ecaterina Cicala MD, Roxana Enache MD, Marcela Rusu MD, Radu Gavrilescu MD, Adrian Vaduva MD, Sever Risca MD, Dana Clapon MD, Florin Ortan MD
Background
Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are known markers for adverse cardiac events. Previous studies have shown that the incidence of new-onset AHREs in patients with right ventricular pacing reaches 50%. At the same time, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) were associated with significantly fewer AHRE. This study aimed to compare the incidence of new-onset AHRE between HBP and LBBAP in patients with atrioventricular block and no history of atrial fibrillation.
Methods
One hundred and forty-two patients, fifty-nine with HBP and eighty-three with LBBAP for advanced atrioventricular block, were prospectively followed for new-onset AHRE.
Results
The mean follow-up period was 624 ± 148.6 days for the HBP patients and 663.4 ± 157.4 days for the LBBAP patients. New-onset AHRE was encountered in 8 of 59 patients (13.5%) with HBP and 14 of 83 (16.8%) with LBBAP (hazard ratio—0.91, log rank p = .84). In the multivariate Cox regression model, HBP and LBBAP had similar predictive values, while only age and diabetes mellitus were significantly associated with new-onset AHRE occurrence.
Conclusion
HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.
{"title":"Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block","authors":"Catalin Pestrea MD, PhD, Ecaterina Cicala MD, Roxana Enache MD, Marcela Rusu MD, Radu Gavrilescu MD, Adrian Vaduva MD, Sever Risca MD, Dana Clapon MD, Florin Ortan MD","doi":"10.1002/joa3.70009","DOIUrl":"https://doi.org/10.1002/joa3.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are known markers for adverse cardiac events. Previous studies have shown that the incidence of new-onset AHREs in patients with right ventricular pacing reaches 50%. At the same time, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) were associated with significantly fewer AHRE. This study aimed to compare the incidence of new-onset AHRE between HBP and LBBAP in patients with atrioventricular block and no history of atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and forty-two patients, fifty-nine with HBP and eighty-three with LBBAP for advanced atrioventricular block, were prospectively followed for new-onset AHRE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up period was 624 ± 148.6 days for the HBP patients and 663.4 ± 157.4 days for the LBBAP patients. New-onset AHRE was encountered in 8 of 59 patients (13.5%) with HBP and 14 of 83 (16.8%) with LBBAP (hazard ratio—0.91, log rank <i>p</i> = .84). In the multivariate Cox regression model, HBP and LBBAP had similar predictive values, while only age and diabetes mellitus were significantly associated with new-onset AHRE occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111505","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}
Atrial fibrillation (AF) poses significant risks of heart failure and stroke, emphasizing effective treatment. Catheter ablation using thermal energy sources, such as radiofrequency or cryoballoon ablation, has shown greater success in maintaining sinus rhythm compared with drug therapy. However, thermal ablation (TA) is associated with serious complications, such as atrial-esophageal fistula, phrenic nerve palsy, and pulmonary vein stenosis. Pulsed-field ablation (PFA) is an emerging ablation energy source that uses electroporation to selectively target cardiac tissue while sparing adjacent structures such as nerves and blood vessels. Two randomized controlled trials have demonstrated that PFA is comparable to TA in both efficacy and safety at a 1-year follow-up and had shorter procedure times. A review of six meta-analyses consistently showed shorter procedural times for PFA across all studies. Additionally, three out of the four recent studies with large samples reported lower recurrence rates with PFA. Regarding complication rates, four out of four studies showed lower incidences of phrenic nerve injury with PFA, and two out of three studies reported lower rates of esophageal injury with PFA. However, four out of four studies indicated higher incidences of cardiac tamponade with PFA, highlighting the need for caution among early-career operators. Furthermore, careful monitoring is required considering the possible unforeseen complications specific to PFA and the lack of long-term follow-up data. Despite these concerns, PFA shows promise as a safer, more effective, and efficient alternative to TA for AF, particularly as operator experience and device technology continue to advance.
{"title":"Catheter ablation using pulsed-field energy: Advantages and limitations compared with conventional energy","authors":"Kenji Kuroki MD, PhD, Hiroshi Tada MD, PhD","doi":"10.1002/joa3.70011","DOIUrl":"https://doi.org/10.1002/joa3.70011","url":null,"abstract":"<p>Atrial fibrillation (AF) poses significant risks of heart failure and stroke, emphasizing effective treatment. Catheter ablation using thermal energy sources, such as radiofrequency or cryoballoon ablation, has shown greater success in maintaining sinus rhythm compared with drug therapy. However, thermal ablation (TA) is associated with serious complications, such as atrial-esophageal fistula, phrenic nerve palsy, and pulmonary vein stenosis. Pulsed-field ablation (PFA) is an emerging ablation energy source that uses electroporation to selectively target cardiac tissue while sparing adjacent structures such as nerves and blood vessels. Two randomized controlled trials have demonstrated that PFA is comparable to TA in both efficacy and safety at a 1-year follow-up and had shorter procedure times. A review of six meta-analyses consistently showed shorter procedural times for PFA across all studies. Additionally, three out of the four recent studies with large samples reported lower recurrence rates with PFA. Regarding complication rates, four out of four studies showed lower incidences of phrenic nerve injury with PFA, and two out of three studies reported lower rates of esophageal injury with PFA. However, four out of four studies indicated higher incidences of cardiac tamponade with PFA, highlighting the need for caution among early-career operators. Furthermore, careful monitoring is required considering the possible unforeseen complications specific to PFA and the lack of long-term follow-up data. Despite these concerns, PFA shows promise as a safer, more effective, and efficient alternative to TA for AF, particularly as operator experience and device technology continue to advance.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111580","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>We appreciated the report by Shahid et al., which underscores chronic kidney disease (CKD) as a significant risk factor for cardiovascular disease (CVD), with cardiac arrest (CA) emerging as a leading cause of death among patients with impaired renal function.<span><sup>1</sup></span> This study provides a detailed analysis of CKD-related CA mortality trends in the United States over two decades, using data from the Centers for Disease Control and Prevention (CDC). Notably, it highlights persistent disparities in mortality across sex, racial/ethnic, and geographic subpopulations, with the Social Vulnerability Index (SVI) emerging as a critical determinant of excess mortality. These findings stress the urgent need for interventions targeting healthcare inequities in CKD and cardiovascular outcomes.</p><p>CKD has long been recognized as a major risk factor for CVD, with CA being a predominant cause of mortality in renal dysfunction patients.<span><sup>2</sup></span> The underlying pathophysiology involves electrolyte imbalances, autonomic dysfunction, systemic inflammation, and structural changes in the heart. CKD and CVD mutually exacerbate each other, increasing arrhythmic susceptibility, particularly in patients with advanced renal impairment.<span><sup>3</sup></span> Despite advancements in renal and cardiovascular care, the persistently high mortality rates among CKD patients experiencing CA underscore the need for more effective preventive and therapeutic strategies.</p><p>The study reveals that the age-adjusted mortality rate (AAMR) for CKD-related CA has remained stable over the past two decades, while general mortality has declined. This suggests potential gaps in risk factor management and the implementation of evidence-based interventions for CKD patients. It also highlights significant disparities across demographic and geographic groups. Men had higher mortality rates than women, possibly due to differences in CKD progression, cardiovascular risk, and healthcare access. Racial and ethnic disparities were evident, with non-Hispanic (NH) Black and Hispanic populations experiencing disproportionately high CA-related mortality. Socioeconomic factors, captured by the SVI, were critical in these disparities, highlighting the role of social determinants of health (SDoH) like income inequality, healthcare access, education, and neighborhood safety. While NH Black populations had the highest mortality rates, the study reports a decline in CA-related mortality among them, likely due to improvements in healthcare access and CKD management. However, more efforts are needed to extend these gains to other high-risk groups. The study also identifies regional disparities, with urban areas showing higher mortality rates than rural regions. Although urban areas have better access to healthcare, environmental stressors like air pollution and socioeconomic deprivation may exacerbate cardiovascular risk. Surprisingly, the highest mortality rates were se
{"title":"Editorial to “disparities in cardiac arrest mortality among patients with chronic kidney disease: A US based epidemiological analysis”","authors":"Masamichi Yano MD, PhD","doi":"10.1002/joa3.70008","DOIUrl":"https://doi.org/10.1002/joa3.70008","url":null,"abstract":"<p>We appreciated the report by Shahid et al., which underscores chronic kidney disease (CKD) as a significant risk factor for cardiovascular disease (CVD), with cardiac arrest (CA) emerging as a leading cause of death among patients with impaired renal function.<span><sup>1</sup></span> This study provides a detailed analysis of CKD-related CA mortality trends in the United States over two decades, using data from the Centers for Disease Control and Prevention (CDC). Notably, it highlights persistent disparities in mortality across sex, racial/ethnic, and geographic subpopulations, with the Social Vulnerability Index (SVI) emerging as a critical determinant of excess mortality. These findings stress the urgent need for interventions targeting healthcare inequities in CKD and cardiovascular outcomes.</p><p>CKD has long been recognized as a major risk factor for CVD, with CA being a predominant cause of mortality in renal dysfunction patients.<span><sup>2</sup></span> The underlying pathophysiology involves electrolyte imbalances, autonomic dysfunction, systemic inflammation, and structural changes in the heart. CKD and CVD mutually exacerbate each other, increasing arrhythmic susceptibility, particularly in patients with advanced renal impairment.<span><sup>3</sup></span> Despite advancements in renal and cardiovascular care, the persistently high mortality rates among CKD patients experiencing CA underscore the need for more effective preventive and therapeutic strategies.</p><p>The study reveals that the age-adjusted mortality rate (AAMR) for CKD-related CA has remained stable over the past two decades, while general mortality has declined. This suggests potential gaps in risk factor management and the implementation of evidence-based interventions for CKD patients. It also highlights significant disparities across demographic and geographic groups. Men had higher mortality rates than women, possibly due to differences in CKD progression, cardiovascular risk, and healthcare access. Racial and ethnic disparities were evident, with non-Hispanic (NH) Black and Hispanic populations experiencing disproportionately high CA-related mortality. Socioeconomic factors, captured by the SVI, were critical in these disparities, highlighting the role of social determinants of health (SDoH) like income inequality, healthcare access, education, and neighborhood safety. While NH Black populations had the highest mortality rates, the study reports a decline in CA-related mortality among them, likely due to improvements in healthcare access and CKD management. However, more efforts are needed to extend these gains to other high-risk groups. The study also identifies regional disparities, with urban areas showing higher mortality rates than rural regions. Although urban areas have better access to healthcare, environmental stressors like air pollution and socioeconomic deprivation may exacerbate cardiovascular risk. Surprisingly, the highest mortality rates were se","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143110994","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}
Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS.
Methods
This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation.
Results
One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group (p = 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, p = 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, p = 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, p = 0.002), but parameters remained stable at 1 year.
Conclusions
LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.
{"title":"Comparative analysis of left bundle branch area pacing in patients with and without a history of open-heart surgery","authors":"Yasumasa Nohno MD, Ryosuke Kozu MD, Kii Ito MD, Yuta Chikazawa MD, Shusaku Maruyama MD, Tomoya Hasegawa MD, Hiromi Tsuchiya MD, Takahiro Tachibana MD, Hikaru Kimura MD, Yoshikazu Yazaki MD, PhD","doi":"10.1002/joa3.70010","DOIUrl":"10.1002/joa3.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group (<i>p =</i> 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, <i>p =</i> 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, <i>p =</i> 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, <i>p =</i> 0.002), but parameters remained stable at 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065935","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 complex signal identification function of CARTO version 8 enables quantitative evaluation of local potential fractionation. We present a case where this advanced technology successfully identified non-pulmonary vein foci associated with fractionated potentials during sinus rhythm.
{"title":"Novel mapping techniques for ablation of non-pulmonary vein foci using complex signal identification","authors":"Hiroyuki Kono MD, Kenichi Hiroshima MD, Kengo Korai MD, Kenji Ando MD","doi":"10.1002/joa3.13222","DOIUrl":"10.1002/joa3.13222","url":null,"abstract":"<p>The complex signal identification function of CARTO version 8 enables quantitative evaluation of local potential fractionation. We present a case where this advanced technology successfully identified non-pulmonary vein foci associated with fractionated potentials during sinus rhythm.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052700","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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