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.
背景：少见的桥粒体基因的致病变异，特别是在plakophilin-2 （PKP2）和desmoglein-2 （DSG2）中，与心律失常性心肌病（ACM）有关；然而，它们潜在的多基因贡献尚不清楚。方法：我们对104名日本ACM患者和46 527名对照进行了全基因组关联研究，调整了病例-对照不平衡。结果：在DSG2上游观察到最强的关联（rs182626537, p = 2.3 × 10-42），但在排除致病DSG2变异的携带者后，该信号被消除，提示由连锁不平衡驱动的合成关联。结论：这些发现突出了ACM的群体特异性遗传结构，DSG2在日本人群中占主导地位。
{"title":"A Genome-Wide Association Study Reveals Desmoglein-2 Predominance in Japanese Arrhythmogenic Cardiomyopathy","authors":"Taisuke Ishikawa, Kyuto Sonehara, Keiko Sonoda, Kenshi Hayashi, Koichi Kato, Satoshi Nagase, Kengo Kusano, Takeshi Aiba, Minoru Horie, Seiko Ohno, Yukinori Okada, Naomasa Makita","doi":"10.1002/joa3.70273","DOIUrl":"10.1002/joa3.70273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rare pathogenic variations of desmosomal genes, particularly in plakophilin-2 (<i>PKP2</i>) and desmoglein-2 (<i>DSG2</i>), have been implicated in arrhythmogenic cardiomyopathy (ACM); however, their potential polygenic contribution remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a genome-wide association study of 104 Japanese patients with ACM and 46 527 controls, adjusting for case–control imbalance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The strongest association was observed upstream of <i>DSG2</i> (rs182626537, <i>p</i> = 2.3 × 10<sup>−42</sup>), but the signal was abolished after excluding carriers of pathogenic <i>DSG2</i> variants, suggesting a synthetic association driven by linkage disequilibrium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings highlight a population-specific genetic architecture of ACM, with <i>DSG2</i> predominating in the Japanese population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093241","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}
Abdul Hakim Almakadma, Ramzi Ibrahim, Hoang Nhat Pham, Eiad Habib, Ahmed K. Mahmoud, Kamal Awad, Mayurkumar D. Bhakta, Eric H. Yang, Hicham Z. El Masry, Chadi Ayoub, Reza Arsanjani
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.
{"title":"Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation in Cardiac Amyloidosis","authors":"Abdul Hakim Almakadma, Ramzi Ibrahim, Hoang Nhat Pham, Eiad Habib, Ahmed K. Mahmoud, Kamal Awad, Mayurkumar D. Bhakta, Eric H. Yang, Hicham Z. El Masry, Chadi Ayoub, Reza Arsanjani","doi":"10.1002/joa3.70274","DOIUrl":"10.1002/joa3.70274","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac amyloidosis (CA) is frequently complicated by atrial fibrillation (AF), yet outcomes after left atrial appendage occlusion (LAAO) in this population remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 532 matched pairs, mortality and major adverse cardiovascular events were similar between groups, whereas major bleeding was higher in CA (HR 1.90).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAAO yields comparable ischemic outcomes in CA, though bleeding risk is increased.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093276","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}
Antonio Di Monaco, Davide Ciliberti, Alberto Martinelli, Federico Quadrini, Federica Troisi, Nicola Vitulano, Massimo Grimaldi
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.
{"title":"Ablation of Ventricular Tachycardia Using the QDOT MICRO Ablation Catheter (VT-MICRO Study)","authors":"Antonio Di Monaco, Davide Ciliberti, Alberto Martinelli, Federico Quadrini, Federica Troisi, Nicola Vitulano, Massimo Grimaldi","doi":"10.1002/joa3.70275","DOIUrl":"10.1002/joa3.70275","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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%) (<i>p</i> < 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) (<i>p</i> < 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) (<i>p</i> < 0.001). No sustained VT was documented at 12 month FU. No adverse events were documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093335","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}
Omnia Kamel, Khalid Sawalha, Mohamed Abdelazem, Amir Abdelghany, Maha Elsaid, Mohamed Sharief, Ahmed Ammar
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.
背景：基于导管的肺静脉隔离（PVI）是房颤（AF）的既定治疗方法。低温球丸消融（CBA）是一种经过验证的单次热技术，而脉冲场消融（PFA）已经成为一种主要的非热方式，它利用高压电场来实现选择性心肌消融，潜在地将附带损伤降到最低。然而，PFA和CBA之间的比较证据仍然有限。目的：系统回顾和比较PFA与CBA治疗PVI的疗效、安全性和程序效率。方法和结果：按照PRISMA指南，到2025年8月进行了结构化的系统数据库检索。纳入18项研究（n = 5638； 2396 PFA和3242 CBA），包括2项随机对照试验。PFA显著缩短了手术时间（平均差-13.7分钟；95% CI -16.7至-10.8;p = 0.003），而再次消融无差异。结论：与CBA相比，PFA具有更高的手术效率和安全性，手术时间更短，并发症更少，中期随访心律失常复发率更低。需要采用标准化方案和长期随访的大型多中心随机试验来证实这些发现并评估不断发展的PFA技术。
{"title":"Outcomes of Pulsed Field Versus Cryoballoon Ablation in Atrial Fibrillation: A Comprehensive Systematic Review and Meta-Analysis","authors":"Omnia Kamel, Khalid Sawalha, Mohamed Abdelazem, Amir Abdelghany, Maha Elsaid, Mohamed Sharief, Ahmed Ammar","doi":"10.1002/joa3.70277","DOIUrl":"10.1002/joa3.70277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To systematically review and compare the efficacy, safety, and procedural efficiency of PFA versus CBA for PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A structured systematic database search was conducted up to August 2025, following PRISMA guidelines. Eighteen studies (<i>n</i> = 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; <i>p</i> < 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; <i>p</i> = 0.003) with no difference in redo ablation. Overall complications were fewer with PFA (OR 0.53; 95% CI 0.32–0.87; <i>p</i> < 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093270","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}
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.
{"title":"Supraventricular Tachycardias Using Multiple Accessory Pathways","authors":"Takumi Yamada","doi":"10.1002/joa3.70276","DOIUrl":"10.1002/joa3.70276","url":null,"abstract":"<p>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.\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":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093284","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}
Sunu Budhi Raharjo, Charles Saputra, Andre Tritansa Faizal, Dony Yugo Hermanto, Dicky Armein Hanafy, Ario Soeryo Kuncoro, Amiliana Mardiani Soesanto, Rina Ariani, Estu Rudiktyo, Daniel Valentino Chrismara, Andi Muhammad Zharfan, Yoga Yuniadi
Background
Localizing the site of origin of outflow tract ventricular arrhythmias (OTVA) before ablation remains challenging despite existing ECG algorithms. Anatomical alterations of the aortic root associated with left ventricular outflow tract (LVOT) origin can be visualized through aortoseptal angle measurement. This study investigated the aortoseptal angle for predicting LVOT origin and improving the predictive power of current ECG algorithms.
Methods
Patients undergoing successful OTVA ablation at a national cardiovascular referral hospital were enrolled. Transthoracic echocardiography measured the aortoseptal angle before ablation. Patients with structural abnormalities, multifocal arrhythmias, reduced ejection fraction, unsuccessful ablation, or non-inducible VAs were excluded. Multivariable logistic regression was used to develop a diagnostic model.
Results
Forty-eight patients were included (44.9 ± 12.2 years, 79.8% female). Patients with LVOT origin (17.1%) had higher hypertension prevalence (71.4% vs. 17.6%; p < 0.001) and smaller aortoseptal angles (128.0 ± 6.2 vs. 136.7 ± 5.8; p < 0.001) than right ventricular outflow tract (RVOT) origin. The aortoseptal angle demonstrated good diagnostic performance (AUC 85.5%), comparable to ECG algorithms (V2 transition ratio 90.3%, V2S/V3R index 81.4%). Multivariable analysis identified three independent predictors: hypertension (OR 10.35; 95% CI: 1.07–99.87; p = 0.043), aortoseptal angle (OR 0.79; 95% CI: 0.65–0.96; p = 0.033), and V2 transition ratio (OR 12.12; 95% CI: 1.03–141.48; p = 0.026). The integrated model substantially improved performance (AUC 0.966, sensitivity 92.31%, specificity 88.24%).
Conclusions
Aortoseptal angle measurement by echocardiography effectively identifies LVOT origin. Integration with hypertension status and V2 transition ratio substantially enhances diagnostic accuracy, supporting the use in pre-ablation assessment.
背景：尽管现有的ECG算法，在消融前定位流出道室性心律失常（OTVA）的起源位置仍然具有挑战性。主动脉根部与左心室流出道（LVOT）起源相关的解剖改变可以通过主动脉间隔角测量可视化。本研究探讨了主动脉间隔角对LVOT起源的预测，提高了当前心电算法的预测能力。方法：选取在某国家级心血管转诊医院成功行OTVA消融术的患者。经胸超声心动图测量消融前主动脉间隔角。排除结构异常、多灶性心律失常、射血分数降低、消融不成功或非诱导性VAs的患者。采用多变量logistic回归建立诊断模型。结果：纳入48例患者（44.9±12.2岁，女性79.8%）。LVOT起源患者（17.1%）高血压患病率（71.4% vs. 17.6%; p p p = 0.043）、主动脉间隔角（OR 0.79; 95% CI: 0.65 ~ 0.96; p = 0.033）和V2转换比（OR 12.12; 95% CI: 1.03 ~ 141.48; p = 0.026）较高。综合模型显著提高了诊断效果（AUC 0.966，灵敏度92.31%，特异度88.24%）。结论：超声心动图测量主动脉间隔角能有效识别左室血栓的起源。结合高血压状态和V2转换比大大提高了诊断准确性，支持在消融前评估中的应用。
{"title":"A Novel Multiparametric Model Integrating Aortoseptal Angle to Predict the Origin of Outflow Tract Ventricular Arrhythmias","authors":"Sunu Budhi Raharjo, Charles Saputra, Andre Tritansa Faizal, Dony Yugo Hermanto, Dicky Armein Hanafy, Ario Soeryo Kuncoro, Amiliana Mardiani Soesanto, Rina Ariani, Estu Rudiktyo, Daniel Valentino Chrismara, Andi Muhammad Zharfan, Yoga Yuniadi","doi":"10.1002/joa3.70269","DOIUrl":"10.1002/joa3.70269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Localizing the site of origin of outflow tract ventricular arrhythmias (OTVA) before ablation remains challenging despite existing ECG algorithms. Anatomical alterations of the aortic root associated with left ventricular outflow tract (LVOT) origin can be visualized through aortoseptal angle measurement. This study investigated the aortoseptal angle for predicting LVOT origin and improving the predictive power of current ECG algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing successful OTVA ablation at a national cardiovascular referral hospital were enrolled. Transthoracic echocardiography measured the aortoseptal angle before ablation. Patients with structural abnormalities, multifocal arrhythmias, reduced ejection fraction, unsuccessful ablation, or non-inducible VAs were excluded. Multivariable logistic regression was used to develop a diagnostic model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight patients were included (44.9 ± 12.2 years, 79.8% female). Patients with LVOT origin (17.1%) had higher hypertension prevalence (71.4% vs. 17.6%; <i>p</i> < 0.001) and smaller aortoseptal angles (128.0 ± 6.2 vs. 136.7 ± 5.8; <i>p</i> < 0.001) than right ventricular outflow tract (RVOT) origin. The aortoseptal angle demonstrated good diagnostic performance (AUC 85.5%), comparable to ECG algorithms (V2 transition ratio 90.3%, V2S/V3R index 81.4%). Multivariable analysis identified three independent predictors: hypertension (OR 10.35; 95% CI: 1.07–99.87; <i>p</i> = 0.043), aortoseptal angle (OR 0.79; 95% CI: 0.65–0.96; <i>p</i> = 0.033), and V2 transition ratio (OR 12.12; 95% CI: 1.03–141.48; <i>p</i> = 0.026). The integrated model substantially improved performance (AUC 0.966, sensitivity 92.31%, specificity 88.24%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aortoseptal angle measurement by echocardiography effectively identifies LVOT origin. Integration with hypertension status and V2 transition ratio substantially enhances diagnostic accuracy, supporting the use in pre-ablation assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970372","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}
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.
{"title":"Wild Type Transthyretin Amyloid Cardiomyopathy Hidden Under Ablation-Refractory Atrial Arrhythmias and the Potential Contribution of Tafamidis in Rhythm Control","authors":"Tomoki Horie, Yasutoshi Nagata, Toshihiro Nozato, Shinsuke Miyazaki, Takashi Ashikaga","doi":"10.1002/joa3.70271","DOIUrl":"10.1002/joa3.70271","url":null,"abstract":"<p>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.\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":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970441","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}
Michio Ogano, Yu-ki Iwasaki, Jun Tanabe, Wataru Shimizu, Kuniya Asai
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.
{"title":"Cardiac Resynchronization Therapy: Reconsidering Its Essence as a Treatment for Electrical Dyssynchrony in Heart Failure","authors":"Michio Ogano, Yu-ki Iwasaki, Jun Tanabe, Wataru Shimizu, Kuniya Asai","doi":"10.1002/joa3.70268","DOIUrl":"10.1002/joa3.70268","url":null,"abstract":"<p>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.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952213","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}
Ramanathan Velayutham, Anish Bhargav, Barathkrishnan Janarthanan, Raja J. Selvaraj
Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.
{"title":"Atrial Tram Tracks and Ventricular Step Ladder: Decoding the Dot Plot","authors":"Ramanathan Velayutham, Anish Bhargav, Barathkrishnan Janarthanan, Raja J. Selvaraj","doi":"10.1002/joa3.70266","DOIUrl":"10.1002/joa3.70266","url":null,"abstract":"<p>Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.\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":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952166","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}
Right ventricular (RV) dysfunction is independently predictive of sudden cardiac death. This study aimed to compare the performance of different risk stratification methods for death and appropriate implantable cardioverter-defibrillator (ICD) therapy using echocardiography and cardiac magnetic resonance imaging (CMR) to quantify RV function.
Methods
Consecutive patients undergoing ICD implantations who had completed both preprocedural echocardiography and CMR were retrospectively enrolled. Patients with channelopathies or arrhythmogenic right ventricular disease were excluded. The RV fractional area change (RVFAC) and estimated pulmonary artery pressure (EPAP) were calculated from echocardiography. The contraction pressure index (CPI) was defined as the quotient of the RVFAC divided by the EPAP. Both metrics were used to predict the composite endpoint of death and an appropriate ICD therapy. RV dysfunction was defined by either RVFAC < 35% or RV ejection fraction (RVEF) < 45%.
Results
In total, 88 patients (60.4 ± 14.7 years, 61 males) including 15 with ischemic cardiomyopathy were retrospectively enrolled. Forty-two patients received ICDs as secondary prevention. The mean RVFAC, CPI, and RVEF were 35.9% ± 9.22%, 1.4% ± 0.7%/mmHg, and 39.5% ± 14.4%, respectively. Regarding the composite endpoint, the best cut-off value of the CPI was 1.59 (specificity 0.45, sensitivity 0.96, ROC-AUC 0.68). The hazard ratio of a low RVFAC was 3.28 (95% CI: 1.39–7.77, p = 0.007, concordance = 0.622), a low CPI, 14.2 (95% CI: 1.91–104.9, p = 0.010, c = 0.665), and a low RVEF, 3.44 (95% CI: 1.17–10.1, p = 0.003, c = 0.620).
Conclusion
Both CMR-derived RVEF and the echocardiographic CPI predicted appropriate ICD therapy and death. The CPI may provide superior risk stratification.
背景：右心室功能障碍是心源性猝死的独立预测因素。本研究旨在比较使用超声心动图和心脏磁共振成像（CMR）量化RV功能的不同死亡风险分层方法和适当的植入式心律转复除颤器（ICD）治疗的性能。方法：回顾性纳入连续接受ICD植入并完成术前超声心动图和CMR的患者。排除有通道病变或致心律失常的右心室疾病的患者。超声心动图计算右心室分数面积变化（RVFAC）和肺动脉压（EPAP）。收缩压力指数（CPI）定义为RVFAC除以EPAP的商。这两个指标被用来预测死亡的复合终点和适当的ICD治疗。结果：共纳入88例患者（60.4±14.7岁，61例男性），包括15例缺血性心肌病患者。42例患者接受icd作为二级预防。RVFAC、CPI、RVEF平均值分别为35.9%±9.22%、1.4%±0.7%/mmHg、39.5%±14.4%。综合终点CPI的最佳临界值为1.59（特异性0.45，敏感性0.96,ROC-AUC 0.68）。低RVFAC的风险比为3.28 (95% CI: 1.39 ~ 7.77, p = 0.007，一致性= 0.622)，低CPI的风险比为14.2 (95% CI: 1.91 ~ 104.9, p = 0.010, c = 0.665)，低RVEF的风险比为3.44 （95% CI: 1.17 ~ 10.1, p = 0.003, c = 0.620）。结论：cmr衍生的RVEF和超声心动图CPI均可预测适当的ICD治疗和死亡。CPI可以提供更好的风险分层。
{"title":"Novel Echocardiographic Index for Risk Stratification of Ventricular Arrhythmias and Mortality Based on Right Ventricular Function","authors":"Toshinori Chiba, Takatsugu Kajiyama, Yusuke Kondo, Hiroyuki Takaoka, Noriko Suzuki-Eguchi, Masahiro Nakano, Miyo Nakano, Satoko Ryuzaki, Yukiko Takanashi, Yuya Komai, Yusei Nishikawa, Yoshio Kobayashi","doi":"10.1002/joa3.70244","DOIUrl":"10.1002/joa3.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Right ventricular (RV) dysfunction is independently predictive of sudden cardiac death. This study aimed to compare the performance of different risk stratification methods for death and appropriate implantable cardioverter-defibrillator (ICD) therapy using echocardiography and cardiac magnetic resonance imaging (CMR) to quantify RV function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients undergoing ICD implantations who had completed both preprocedural echocardiography and CMR were retrospectively enrolled. Patients with channelopathies or arrhythmogenic right ventricular disease were excluded. The RV fractional area change (RVFAC) and estimated pulmonary artery pressure (EPAP) were calculated from echocardiography. The contraction pressure index (CPI) was defined as the quotient of the RVFAC divided by the EPAP. Both metrics were used to predict the composite endpoint of death and an appropriate ICD therapy. RV dysfunction was defined by either RVFAC < 35% or RV ejection fraction (RVEF) < 45%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 88 patients (60.4 ± 14.7 years, 61 males) including 15 with ischemic cardiomyopathy were retrospectively enrolled. Forty-two patients received ICDs as secondary prevention. The mean RVFAC, CPI, and RVEF were 35.9% ± 9.22%, 1.4% ± 0.7%/mmHg, and 39.5% ± 14.4%, respectively. Regarding the composite endpoint, the best cut-off value of the CPI was 1.59 (specificity 0.45, sensitivity 0.96, ROC-AUC 0.68). The hazard ratio of a low RVFAC was 3.28 (95% CI: 1.39–7.77, <i>p</i> = 0.007, concordance = 0.622), a low CPI, 14.2 (95% CI: 1.91–104.9, <i>p</i> = 0.010, <i>c</i> = 0.665), and a low RVEF, 3.44 (95% CI: 1.17–10.1, <i>p</i> = 0.003, <i>c</i> = 0.620).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both CMR-derived RVEF and the echocardiographic CPI predicted appropriate ICD therapy and death. The CPI may provide superior risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952144","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号