Journal of Arrhythmia最新文献_第4页

Gastrointestinal bleed mortality disparities in patients with atrial fibrillation: A cross-sectional analysis 1999–2020 心房颤动患者胃肠道出血死亡率差异：1999-2020年的横断面分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-14 DOI: 10.1002/joa3.13223

Enkhtsogt Sainbayar DO, Ramzi Ibrahim MD, Sangkyu Noh DO, Hoang Nhat Pham MD, Mahek Shahid MD, Joseph Elias MD, Harneet Grewal MD, Rama Mouhaffel MD, Akira Folk DO, Jack Hartnett MB, BCh, BAO, Kwan Lee MD, Justin Z. Lee MD

Introduction

Gastrointestinal bleeding (GIB) is often encountered among patients with atrial fibrillation (AF) due to the use of anticoagulation. This study assesses disparities in GIB-related mortality among decedents with AF in the United States.

Methods

GIB mortality data in patients with AF from 1999 to 2020 was queried from the CDC database. Decedent demographic information (age, sex, race and ethnicity, and geographic residence) was obtained from death certificates. We calculated age-adjusted mortality rates (AAMRs) through the direct method and estimated the annual percentage change (APC) in mortality using log-linear regression models.

Results

From 11,209 GIB-related deaths among AF decedents, we observed an increase in AAMR from 0.12 in 1999 to 0.21 in 2020, particularly during the 2009 to 2020 period (APC +4.8, p < .001). Disproportionate mortality rates were noted in males (AAMR 0.18) and White populations (AAMR 0.15) as compared to females (AAMR 0.13) and Black populations (AAMR 0.10), respectively. Rural regions also reported higher mortality (AAMR 0.18) than urban areas (AAMR 0.14). Mortality shifts in urban regions remained stagnant from 1999 to 2009 (APC –0.15, p = .806) followed by an increase from 2009 to 2020 (APC +4.83, p < .001). However, mortality increased consistently from 1999 to 2020 in rural regions (APC +4.08, p < .001). The Northeast US exhibited the highest mortality rate (AAMR 0.18), followed by the Midwest (AAMR 0.16), West (AAMR 0.14), and South (AAMR 0.13).

Conclusions

Disparities in GIB mortality among AF decedents were identified. These findings accentuate the need for targeted interventions to mitigate GIB risks in vulnerable subgroups.

导读：胃肠出血（GIB）是房颤（AF）患者经常遇到的，因为使用抗凝剂。本研究评估了美国房颤死者中与gib相关的死亡率差异。方法：从CDC数据库中查询1999 - 2020年AF患者的GIB死亡率数据。死者的人口统计信息（年龄、性别、种族和民族以及地理居住地）是从死亡证明中获得的。我们通过直接法计算年龄调整死亡率（AAMRs），并使用对数线性回归模型估计死亡率的年百分比变化（APC）。结果：在11209例房颤患者与GIB相关的死亡中，我们观察到AAMR从1999年的0.12增加到2020年的0.21，特别是在2009年至2020年期间（APC +4.8, p = 0.806），随后在2009年至2020年期间增加（APC +4.83, p）。这些发现强调需要有针对性的干预措施，以减轻弱势亚群体的GIB风险。

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引用次数: 0

Different effects of catheter ablation on exercise tolerance, leg strength, and quality of life in paroxysmal versus persistent atrial fibrillation 导管消融对阵发性与持续性房颤患者运动耐量、腿部力量和生活质量的不同影响。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-14 DOI: 10.1002/joa3.13220

Gen Matsuura MD, PhD, Hidehira Fukaya MD, PhD, Nobuaki Hamazaki PhD, Daiki Saito MD, PhD, Hironori Nakamura MD, PhD, Naruya Ishizue MD, PhD, Tomoharu Yoshizawa MD, PhD, Jun Kishihara MD, PhD, Shinichi Niwano MD, PhD, Jun Oikawa MD, PhD, Junya Ako MD, PhD

Background

Catheter ablation (CA) can improve exercise tolerance and quality of life (QOL) in patients with atrial fibrillation (AF). However, its differential effects on muscle strength between paroxysmal AF (PAF) and nonparoxysmal AF (Non-PAF) remain unclear.

Methods

We evaluated 94 patients (67.8 ± 10.3 years old, 71% male) who underwent CA (PAF/Non-PAF 46/48) without AF recurrence. Six-minute walk distance (6MWD), leg strength, and an AF-specific QOL questionnaire (AFQLQ) were evaluated at baseline, 3, and 6 months after CA.

Results

At baseline, the 6MWD and AFQLQ subset 3 score were significantly lower in patients with PAF than in those with Non-PAF, but the parameters of muscle strength were comparable between the two groups. Both 6MWD and AFQLQ significantly improved at 6 months after CA in both groups. However, leg strength at 6 months after CA significantly improved in the Non-PAF group (54.9 ± 16.5 to 58.4 ± 15.2, p < .05) but not in the PAF group.

Conclusion

Successful CA for both PAF and Non-PAF improved QOL and exercise tolerance. Additionally, CA improved leg strength in Non-PAF patients.

背景：导管消融（CA）可以改善房颤（AF）患者的运动耐量和生活质量（QOL）。然而，其对阵发性房颤（PAF）和非阵发性房颤（Non-PAF）肌力的差异影响尚不清楚。方法：我们评估了94例（67.8±10.3岁，71%男性）行CA （PAF/Non-PAF 46/48）且无房颤复发的患者。在ca后的基线、3个月和6个月分别评估6分钟步行距离（6MWD）、腿部力量和af特异性生活质量问卷（AFQLQ）。结果：基线时，PAF患者的6MWD和AFQLQ亚群3评分明显低于非PAF患者，但两组之间的肌肉力量参数具有可比性。两组患者术后6个月6MWD和AFQLQ均有显著改善。然而，非PAF组在CA后6个月的腿部力量显著改善（54.9±16.5至58.4±15.2,p）。结论：PAF和非PAF的成功CA改善了生活质量和运动耐量。此外，CA改善了非paf患者的腿部力量。

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引用次数: 0

Editorial to “Pre-procedural imaging guiding ventricular tachycardia ablation in structural heart disease” “手术前成像指导结构性心脏病室性心动过速消融”的社论。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-14 DOI: 10.1002/joa3.13211

Yoshiaki Mizutani MD, PhD, Satoshi Yanagisawa MD, PhD, Yasuya Inden MD, PhD

<p>Ventricular tachycardia (VT) often occurs in patients with damaged hearts and decreased cardiac function, such as those with ischemic cardiomyopathy (ICM). Defibrillation therapy with an implantable cardioverter-defibrillator (ICD) improves prognosis in these patients for both primary and secondary prevention. However, characteristics of nonischemic cardiomyopathy (NICM) are different from those of ICM, leading to variability in prognoses following ICD implantation, especially for primary prevention, and presenting challenges in VT management through catheter ablation. Given the increasing global prevalence of NICM and recent advancements in catheter ablation techniques and imaging modalities, improved prognoses and effective approaches for catheter ablation in patients with NICM are expected.</p><p>In this issue of the <i>Journal of arrhythmia</i>, Ferreira et al.<span><sup>1</sup></span> evaluated the safety and efficacy of VT ablation in patients with NICM and ICM using the ADAS 3D system (ADAS3D Medical, Barcelona, Spain). A total of 102 patients with VT were included in this study (ICM, 75 patients; NICM, 27 patients). Multidetector computed tomography (MDCT), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) were used for preprocedural imaging. These were integrated into mapping systems and segmented using ADAS 3D software. The key points of this study are as follows: First, procedural data revealed no significant differences in VT inducibility between the ICM and NICM groups. Approximately half of the patients in each group no longer exhibited VT inducibility, possibly because of the elimination of all late potentials, achieved through preprocedural imaging complemented with the ADAS 3D system and its integration into the three-dimensional electroanatomical mapping system. Second, cumulative survival free from appropriate ICD shocks was similar between the ICM and NICM groups. This suggests that preprocedural imaging-guided ablation for VT may be equally beneficial in patients with NICM and as it is in patients with ICM. Much of the past randomized studies for evaluating VT ablation have been conducted in patients with ICM, while large-scale prospective randomized studies for patients with NICM remain lacking.<span><sup>2, 3</sup></span> Previous studies have demonstrated inferior outcomes following VT ablation in patients with NICM compared to those with ICM, possibly because of the heterogenous VT substrate in patients with NICM.<span><sup>4</sup></span> Typically, the substrate of NICM is characterized by an increased prevalence of damaged tissue expanding into intramyocardial and epicardial sites, which is higher than that of ICM. This complexity poses challenges, such as reduced catheter accessibility and insufficient thermal energy delivery to deep myocardial layers, resulting in a lower VT termination rates and poorer procedural outcomes.<span><sup>5</sup></span> This result aligns with the findings of current

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引用次数: 0

Disparities in cardiac arrest mortality among patients with chronic kidney disease: A US-based epidemiological analysis 慢性肾病患者心脏骤停死亡率的差异：美国流行病学分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-10 DOI: 10.1002/joa3.13217

Mahek Shahid MD, Hoang Nhat Pham MD, Ramzi Ibrahim MD, Enkhtsogt Sainbayar DO, Mahmoud Abdelnabi MBBCh, MSc, Girish Pathangey MD, Amitoj Singh MD

Background

Chronic kidney disease (CKD) increases cardiac arrest (CA) risk because of renal and cardiovascular interactions.

Methods

Using Centers for Disease Control and Prevention (CDC) data from 1999 to 2020, we analyzed CKD-related CA mortality and the impact of social vulnerability index (SVI).

Results

We identified 336 494 CKD-related CA deaths, with stable age-adjusted mortality rates over time. Disparities were observed across gender, racial/ethnic, and geographic subpopulations, with higher mortality among males, Hispanic and non-Hispanic Black populations, and those in urban and Western regions. Higher SVI correlated with increased mortality.

Conclusions

CKD-related CA mortality rates are stable, with disparities across demographics; higher SVI correlates with increased mortality, highlighting needed interventions.

背景：慢性肾脏疾病（CKD）增加心脏骤停（CA）的风险，因为肾脏和心血管相互作用。方法：利用1999 - 2020年美国疾病控制与预防中心（CDC）的数据，分析ckd相关的CA死亡率和社会脆弱性指数（SVI）的影响。结果：我们确定了336494例ckd相关的CA死亡，随着时间的推移，年龄调整死亡率稳定。在性别、种族/民族和地理亚人群中观察到差异，男性、西班牙裔和非西班牙裔黑人以及城市和西部地区的死亡率较高。SVI越高，死亡率越高。结论：ckd相关的CA死亡率是稳定的，在人口统计学上存在差异；SVI越高，死亡率越高，强调需要采取干预措施。

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引用次数: 0

The causality between premature ventricular contraction and heart failure 室性早搏与心力衰竭之间的因果关系。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-10 DOI: 10.1002/joa3.13218

Naoya Kataoka MD, Teruhiko Imamura MD

To editor:

Ogiso and colleagues demonstrated that nonsustained ventricular tachycardia (NSVT) is associated with an increased risk of heart failure hospitalization in patients without structural heart disease.¹ However, several critical concerns warrant further discussion.

A comprehensive methodology detailing the approach to confirm the absence of structural heart disease should be provided. Importantly, various cardiac pathologies with preserved left ventricular ejection fraction cannot be definitively excluded without comprehensive testing. For instance, epicardial cardiomyopathy cannot be ruled out without advanced diagnostic modalities, such as cardiac magnetic resonance imaging and genetic testing.²

The burden of premature ventricular contractions (PVCs) is a well-documented contributor to systolic dysfunction, with a commonly proposed threshold exceeding 20%.³ In this study, however, the total number of PVCs was categorized into tertiles,¹ which may limit the precision of the analysis.

Differentiating PVCs with aberrant conduction in patients with atrial fibrillation using Holter electrocardiography presents significant challenges.⁴ A detailed description of the methodology used to distinguish these phenomena is essential for reproducibility and validity. Additionally, the rationale for administering class III antiarrhythmic agents in patients reportedly free of structural heart disease remains unclear and requires elucidation.

The causal relationship between NSVT and the development of heart failure remains ambiguous.¹ Notably, most heart failure hospitalizations occurred within 1 year of observation. It is plausible that patients experiencing elevated left ventricular end-diastolic pressure may develop NSVT as a secondary manifestation. In such cases, subclinical heart failure could potentially be identified through detailed investigations, including chest X-rays, B-type natriuretic peptide levels, and comprehensive echocardiography.

Finally, if PVCs serve merely as bystanders of underlying cardiac pathology, the efficacy of aggressive therapeutic interventions targeting NSVT and PVCs in improving clinical outcomes becomes questionable.

The authors declare no conflicts of interest.

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引用次数: 0

Once a saint, now a sinner: An appropriate or inappropriate shock? 曾经是圣人，现在是罪人：合适还是不合适的震惊？

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-10 DOI: 10.1002/joa3.13209

Sudipta Mondal MD, DM, Swasthi S. Kumar MD, Jyothi Vijay MD, DM, Narayanan Namboodiri MD, DM

Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.

对任何给药事件的心电图进行批判性分析，对于确定程序化算法区分室上性心动过速与室性心动过速的病因、特异性和敏感性、有效性以及预防复发的潜在干预措施至关重要。除了上述方面，本案例还探讨了现有算法的潜在局限性和抗心动过速起搏的不良影响。

引用次数: 0

Differential response to right ventricular extrastimuli from the base and apex during long RP′ supraventricular tachycardia 长RP'室上性心动过速时，基底和心尖对右心室外刺激的不同反应。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-07 DOI: 10.1002/joa3.13214

Hironori Nakamura MD, PhD, Hidehira Fukaya MD, PhD, Naruya Ishizue MD, PhD, Jun Kishihara MD, PhD, Junya Ako MD, PhD

We report a case of long RP′ tachycardia diagnosed as fast–slow atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander nodoventricular pathway (NVP). Differential responses to right ventricular extrastimuli from the base and apex highlighted the anatomical proximity of the NVP attachment, contributing to the diagnosis.

我们报告一例长RP’型心动过速，诊断为快-慢房室结折返性心动过速（AVNRT）伴旁观者结室通路（NVP）。基底部和心尖部对右心室外刺激的不同反应突出了NVP附着在解剖上的接近性，有助于诊断。

引用次数: 0

A novel prediction model for survival in individual patients with cardiac resynchronization therapy with a defibrillator: Analysis of the new Japan cardiac device treatment registry database 使用除颤器进行心脏再同步化治疗的个体患者的一种新的生存预测模型：对新的日本心脏装置治疗注册数据库的分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-07 DOI: 10.1002/joa3.13213

Hisashi Yokoshiki MD, PhD, Akihiko Shimizu MD, PhD, Takeshi Mitsuhashi MD, PhD, Kohei Ishibashi MD, PhD, Tomoyuki Kabutoya MD, PhD, Yasuhiro Yoshiga MD, PhD, Yusuke Kondo MD, PhD, Taro Temma MD, PhD, Masahiko Takagi MD, PhD, Hiroshi Tada MD, PhD, Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society

Background

Accurate prediction for survival in individualized patients with cardiac resynchronization therapy with a defibrillator (CRT-D) is difficult.

Methods

We analyzed the New Japan cardiac device treatment registry (JCDTR) database to develop a survival prediction model for CRT-D recipients.

Results

Four hundred and eighty-two CRT-D recipients, at the implantation year 2018–2021, with a QRS width ≥120 ms and left ventricular ejection fraction (LVEF) ≤35% at baseline, were analyzed. During an average follow-up of 21 ± 10 months, death occurred in 66 of 482 CRT-D patients (14%). A prediction model estimating annual survival probability was developed using Cox regression with internal validation. With seven explanation predictors (age >75 years, serum creatinine >1.4 mg/dL, blood hemoglobin <12 g/dL, heart rate ≥90/min, LVEF, prior NSVT, and QRS width <150 ms), the model distinguished patients with and without all-cause death, with an optimism-corrected C-statistics of 0.766, 0.764, and 0.768, and calibration slope of 1.01, 1.00, and 1.00 at 1 year, 2 years, and 3 years. Additionally, we have devised the calculator of survival probability for individual CRT-D recipients.

Conclusions

Using routine available variables, we have developed a survival prediction model for individual CRT-D recipients.

背景：使用除颤器进行心脏再同步化治疗（CRT-D）的个体化患者的准确生存预测是困难的。方法：我们分析了新日本心脏装置治疗注册（JCDTR）数据库，以建立CRT-D受者的生存预测模型。结果：分析了482例植入年份为2018-2021年、QRS宽度≥120ms、基线左室射血分数(LVEF)≤35%的CRT-D受体。在平均随访21±10个月期间，482例CRT-D患者中有66例（14%）死亡。采用Cox回归并进行内部验证，建立年生存概率预测模型。有7个解释预测因子（年龄> - 75岁，血清肌酐> - 1.4 mg/dL，血红蛋白）结论：使用常规可用变量，我们建立了个体CRT-D受体的生存预测模型。

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引用次数: 0

Two-year clinical outcomes of Taiwanese and other Asian ethnicities with atrial fibrillation treated with edoxaban in the ETNA-AF Asia registry 在ETNA-AF亚洲注册中心，台湾和其他亚洲种族心房颤动患者接受依多沙班治疗的两年临床结果

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-07 DOI: 10.1002/joa3.13212

Chun-Chieh Wang, Cheng-I Cheng, Kwo-Chang Ueng, Wei-Shiang Lin, Tze-Fan Chao, Lian-Yu Lin, Chien-Lung Huang, Kuan-Cheng Chang, Guang-Yuan Mar, Yu-Cheng Hsieh, Martin Unverdorben, Cathy Chen

Background

The non-vitamin K oral anticoagulant (NOAC), edoxaban, is approved for stroke prevention in patients with atrial fibrillation (AF) in many Asian countries. Nonetheless, data on its long-term effectiveness and safety in routine clinical practice are limited in Taiwan.

Methods

The Global ETNA-AF (Edoxaban Treatment in routiNe clinical prActice) registry is an observational study that integrates data of AF patients receiving edoxaban from multiple regional registries. Here, we report the subgroup analysis of two-year outcomes in Taiwan (N = 973) and three Asian countries (South Korea, Hong Kong, Thailand; N = 2326).

Results

Compared with other Asian ethnicities, edoxaban users in Taiwan were older and had lower creatinine clearance levels. The incidence of clinical events was low and comparable in four Asian countries. Upon 2 years of observation, the annualized rates of cardiovascular death and ischemic stroke/systemic embolic event were 0.50% and 0.90% in Taiwan and 0.33% and 0.91% in other Asian ethnicities, respectively. The annualized rates of major/clinically relevant non-major bleeding and major gastrointestinal bleeding were 2.06% and 0.39% in Taiwan and 2.06% and 0.49% in other Asian ethnicities, respectively. Intracranial hemorrhage was rarely reported in four Asian countries (annualized rate: 0.35%).

Conclusions

Although some differences in patient characteristics were observed among Asian ethnicities, the low clinical event rates in two-year ETNA-AF data reassure the effectiveness and safety of edoxaban in routine care for AF patients in Taiwan, South Korea, Hong Kong, and Thailand.

背景：非维生素K口服抗凝剂（NOAC）依多沙班在许多亚洲国家被批准用于房颤（AF）患者的卒中预防。然而，台湾常规临床实践中关于其长期有效性和安全性的数据有限。方法：全球ETNA-AF（依多沙班在常规临床实践中的治疗）登记是一项观察性研究，整合了来自多个地区登记的接受依多沙班治疗的房颤患者的数据。结果：与其他亚洲种族相比，台湾依多沙班使用者年龄较大，肌酐清除率较低。4个亚洲国家的临床事件发生率较低且具有可比性。经过2年的观察，心血管死亡和缺血性卒中/全身性栓塞事件的年化率在台湾分别为0.50%和0.90%，在其他亚洲种族分别为0.33%和0.91%。台湾地区的重大/临床相关的非重大出血和重大胃肠道出血的年化率分别为2.06%和0.39%，其他亚洲种族的年化率分别为2.06%和0.49%。颅内出血在四个亚洲国家很少报道（年化率：0.35%）。结论：尽管在亚洲种族中观察到患者特征的一些差异，但在2年ETNA-AF数据中较低的临床事件发生率保证了依多沙班在台湾、韩国、香港和泰国房颤患者常规护理中的有效性和安全性。

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引用次数: 0

Retrieval of a dislodged leadless pacemaker: An example of the double-snare technique 取出移位的无导线起搏器：双圈套技术的一个例子。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-01-07 DOI: 10.1002/joa3.13210

Momo Taira, Hiroshi Kawakami MD, PhD, Yasushi Asagi, Kazuhisa Nishimura MD, PhD, Osamu Yamaguchi MD, PhD

A video demonstration presents the retrieval of a dislodged leadless pacemaker using the double-snare technique. Sharing troubleshooting strategies in such cases is clinically important for managing rare pacemaker complications.

视频演示展示了使用双圈套技术恢复一个移位的无铅起搏器。在这种情况下分享故障诊断策略对于治疗罕见的起搏器并发症具有重要的临床意义。

引用次数: 0