Journal of Arrhythmia最新文献_第5页

Assessment of adverse events stratified by timing of leadless pacemaker implantation with cardiac implantable electronic devices extraction due to infection: A systematic review and meta-analysis 评估无导联起搏器植入与心脏植入式电子装置因感染拔出的时间分层不良事件：一项系统回顾和荟萃分析。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-26 DOI: 10.1002/joa3.13208

Naoya Inoue MD, Yuji Ito MD, Takahiro Imaizumi MD, Shuji Morikawa MD, Toyoaki Murohara MD, PhD

Background

Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.

This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.

Methods

Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.

Results

Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, I²: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, I²: 4%) for LP implantation after CIED extraction (p = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, I²: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, I²: 21%) after extraction (p = 0.008). Reinfection was not observed in any of these studies.

Conclusion

Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.

背景：对于心脏植入式电子装置（cied）相关感染，强烈建议移除植入式电子装置（cied），无铅起搏器（LPs）越来越多地用于再植入式心脏起搏器。然而，CIED切除感染后LP植入的最佳时机和安全性仍不清楚。本系统综述和荟萃分析旨在评估LP植入与CIED移除同时或之后的并发症发生率（全因死亡率和再感染）。方法：检索PubMed、Cochrane Library和谷歌Scholar中2015 - 2024年9月发表的研究。关于CIED移除和LP植入的观察性研究和病例系列是合格的。主要结局是全因死亡率和lp植入后再感染。利用Freedman-Tukey二重反正弦变换得到混合估计。采用未成年人标准评估研究质量，由两位作者进行数据提取和独立评估。结果：在396份记录中，16项研究纳入分析，653例患者（平均年龄：76.9岁）。孤立性口袋感染发生率为46.7% (95% CI: 32.7% ~ 61.2%)，全身性感染发生率为46.3% （95% CI: 29.5% ~ 64.0%）。CIED拔牙同时植入LP的主要结局发生率为19.4% (95% CI: 12.8%-28.3%, i2.0%)，而CIED拔牙后植入LP的主要结局发生率为7.79% (4.37%-13.5%,i2.4%) （p = 0.009）。同期种植的全因死亡率为22.8% (95% CI: 15.9% ~ 31.6%, i2:0 %)，拔牙后的全因死亡率为8.71% (4.46% ~ 16.3%,i2:21 %) （p = 0.008）。在这些研究中均未观察到再感染。结论：因感染而同时进行CIED拔除和LP植入可能与全因死亡风险增加有关。

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引用次数: 0

Atrial arrhythmias with mediastinal lymphadenopathy presentation of isolated atrial myocarditis 房性心律失常伴纵隔淋巴结病变表现为孤立性心房心肌炎。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-25 DOI: 10.1002/joa3.13206

Muneeb Khawar MBBS, Mirza Muhammad Hadeed Khawar MBBS, Hannan Saeed MBBS

<p>We have read with great interest the article by Kumar et al., titled “Atrial Arrhythmias with Mediastinal Lymphadenopathy: Presentation of Isolated Atrial Myocarditis,” published in <i>Journal of Arrhythmia</i> (2024). The work provides valuable insights into the relationship between atrial arrhythmias and isolated atrial myocarditis (AM), emphasizing the relevance of this connection in young patients without conventional risk factors. The authors are to be commended for their efforts in addressing the diagnostic and therapeutic challenges posed by this condition. They aptly conclude that granulomatous myocarditis caused by sarcoidosis or tuberculosis should be considered the primary cause of atrial inflammation and its subsequent role in arrhythmogenesis.</p><p>The study employs a comprehensive approach to diagnosing AM in patients with unexplained atrial arrhythmias, utilizing a combination of histopathological examination and <sup>18</sup>F-FDG PET/CT. This methodology proves invaluable in distinguishing AM from other inflammatory and structural heart diseases. A particular strength of this work is the clear correlation established between imaging findings and clinical or histopathological data. The authors effectively employ a diagnostic algorithm that integrates atrial imaging, biopsy, and clinical assessment, thereby offering a systematic framework for diagnosis.</p><p>Another noteworthy aspect of the study is the emphasis on individualized treatment plans. Immunosuppressive therapy, including corticosteroids and methotrexate for patients with sarcoidosis, as well as anti-tuberculous regimens for those with <i>Mycobacterium tuberculosis</i>, demonstrated significant clinical benefits. These interventions led to improvements in functional class, reductions in inflammatory markers, and the reversal of abnormal imaging findings, highlighting the therapeutic potential of these strategies. Furthermore, the authors' insights into the management of anticoagulation therapy for stroke prevention in patients with atrial arrhythmias are particularly relevant, as 26.7% of the patients in the study presented with ischemic strokes. This underscores the importance of vigilant monitoring and tailored management in this patient population.</p><p>Kumar et al. also highlights the potential of AM to serve as an independent substrate for atrial arrhythmias, even in the absence of common risk factors. This observation aligns with previous studies suggesting that inflammation, particularly granulomatous inflammation, can interfere with atrial electrophysiological properties and promote arrhythmogenesis.<span><sup>1, 2</sup></span> Granulomatous infiltration has been shown to remodel atrial tissue, leading to electrical disturbances and an increased thromboembolic risk.<span><sup>3</sup></span> Kumar et al.'s work reinforces these findings and provides clinical data that support the inflammatory hypothesis of arrhythmogenesis.</p><p>While the study offers signi

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引用次数: 0

Utility of using far-field R-wave signals in the detection of fatal ventricular arrhythmia 远场r波信号在致命性室性心律失常检测中的应用。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-23 DOI: 10.1002/joa3.13207

Yousaku Okubo MD, PhD, Hisayasu Matsuzaki BE, Shogo Miyamoto MD, Sho Okamura MD, PhD, Yukiko Nakano MD, PhD

Current guidelines recommend cardioverter-defibrillator (ICD) programming, including faster detection rates, longer detection durations, and strict discrimination for supraventricular tachycardia (SVT) to prevent unnecessary ICD treatment. This delayed-style ICD programming could lead to a rise in the possibility of VF undersensing. To avoid this risk, an innovative algorithm known as VF Therapy Assurance (VFTA; Abbott, Sylmar, CA) has been developed. VFTA uses far-field R-wave signals during VT or VF episodes to provide ICD therapy in cases of near-field R-wave signal undersensing.

目前的指南建议制定心律转复除颤器（ICD）规划，包括更快的检出率、更长的检测持续时间和严格区分室上性心动过速（SVT），以防止不必要的ICD治疗。这种延迟式ICD编程可能导致VF感知不足的可能性增加。为了避免这种风险，一种创新的算法被称为VF治疗保证(VFTA；雅培，Sylmar， CA)已经开发。在近场r波信号感应不足的情况下，VFTA在VT或VF发作时使用远场r波信号提供ICD治疗。

引用次数: 0

Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach 植入式心律转复-除颤器治疗后患者的管理-多方面方法的重要性。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-22 DOI: 10.1002/joa3.13204

Karshana Selvarajah MSc, Parisha Khan MSc, Nishat Jahagirdar Pgdip, Antonio Cannatà MD, Rahul Mukherjee MBBS, PhD, Daniel I. Bromage MBChB, PhD, Theresa McDonagh MD, Francis Murgatroyd MA, FRCP, Paul A. Scott DM, FRCP

Background

The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone.

Methods

Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy.

Results

During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (n = 80), 43% lower risk and ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 8).

Conclusion

An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.

背景：首次ICD治疗后最有效的治疗方法尚不清楚。我们假设，在第一次ICD治疗后，与单独治疗相比，结合不同的治疗策略可以降低后续治疗的风险。方法：收集2009年1月至2019年12月在国王学院医院连续接受ICD植入的患者的数据。我们评估了7种特定治疗策略的使用情况，这些策略是在第一次治疗后引入的-受体阻滞剂、预后心力衰竭药物、抗心律失常药物以及ICD重编程、消融、ICD升级/翻修和冠状动脉血运重建。我们评估了这些治疗策略与后续ICD治疗风险之间的关系。结果：在平均50个月的随访中，267例患者接受了首次ICD治疗（212例合适，55例不合适）。与0/7策略相比，联合治疗策略与适当治疗的后续治疗风险显著降低相关（第一次适当的ICD治疗，1/7治疗策略（n = 80），风险降低43%；≥2/7治疗策略（n = 73），风险降低58%，p = n = 22）；≥2/7治疗策略（n = 25），风险降低94%，p n = 8)。结论：对于首次ICD治疗后出现的患者，联合治疗策略可能比单独使用单一策略更有效地预防后续治疗。

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引用次数: 0

Preprocedural imaging guiding ventricular tachycardia ablation in structural heart disease 术前影像学指导结构性心脏病室性心动过速消融。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-19 DOI: 10.1002/joa3.13205

Afonso Nunes-Ferreira MD, Joana Brito MD, Nuno Cortez-Dias MD, PhD, Gustavo da Lima da Silva MD, PhD, Fausto J. Pinto MD, PhD, João de Sousa MD

Background

Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub-optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long-term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM).

Methods

In this prospective, single-center study, consecutive patients referred for scar-related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging-predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30-day mortality. Long-term efficacy was assessed by survival free from appropriate ICD shocks at 36 months.

Results

102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE-CMR. Procedural safety (4% 30-day mortality, p = .95) and 36-month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate-based ablation alone (94.5% vs. 80.6%, HR 4.00; p < .05).

Conclusion

A preprocedural imaging protocol integrated into the invasive mapping system may improve safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM. Activation mapping of the VT on top of substrate ablation may improve prognosis.

背景：室性心动过速（VT）消融术前成像技术的整合可以提高对致心律失常底物的识别，特别是对预后不理想的非缺血性心肌病（NICM）患者。我们比较了NICM和缺血性心肌病（ICM）患者，评估了先进的术前成像对射频导管消融（RCA）治疗VT的安全性和长期疗效的影响。方法：在这项前瞻性的单中心研究中，接受疤痕相关VT消融治疗的连续患者接受了多探测器计算机断层扫描（MDCT）和晚期钆增强心脏磁共振（LGE-CMR）。使用ADAS 3D软件对图像进行分割，并整合到制图系统中。基底图收集针对成像预测的感兴趣区域，消融旨在消除所有局部异常心室活动。以30天死亡率评估手术安全性。通过36个月无适当ICD电击的生存来评估长期疗效。结果：纳入102例患者（67±11岁），94%为男性；75icm, 27nicm)。所有患者都接受了MDCT检查，35%的患者还接受了LGE-CMR检查。两组的手术安全性（30天死亡率4%，p = 0.95）和36个月疗效相似(88.0% vs. 74.1%, HR 2.09；p =。ICM和NICM中的13个)。VT激活定位与VT峡部消融辅助基质消融相比，单纯基质消融的疗效更高(94.5% vs 80.6%, HR 4.00；p结论：将手术前成像方案整合到有创测绘系统中可以提高安全性和长期疗效，NICM患者的预后与ICM患者相当。基底消融之上的VT激活定位可能改善预后。

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引用次数: 0

High-density mapping in catheter ablation for atrial fibrillation in Asia Pacific region: An observational study 亚太地区房颤导管消融的高密度定位：一项观察性研究。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-18 DOI: 10.1002/joa3.13168

Yu-Shan Huang, Hui-Nam Pak, Kenichi Hiroshima, Takanori Yamaguchi, Yung-Lung Chen, Hidehira Fukaya, Kyoko Soejima, Bryan Ping-Yen Yan, Itsuro Morishima, Satoshi Shizuta, Kenji Okubo, Qiangsun Zheng, Jong-Il Choi, Chenyang Jiang, Masaki Ieda, Eric Emil Horvath, Li-Wei Lo

Background

Few clinical studies of atrial fibrillation (AF) have focused on Asian patients; data are lacking on current mapping and ablation strategies in the Asia Pacific region (APAC).

Objective

The HD Mapping Observational Study (NCT04022954) was designed to characterize electroanatomic mapping (EAM) with market-released high-density mapping (HDM) catheters in subjects with AF in APAC.

Methods

Subjects undergoing HDM and indicated for radiofrequency ablation (RFA) to treat AF were prospectively enrolled in APAC. Data included mapping strategy and ablation targets. EAM was performed using one of two commercially available HDM catheters (Advisor™ HD Grid, Sensor Enabled™, Abbott [GRID] or Inquiry™ AFocus II™ Double Loop, Abbott [DL]). Procedure-related adverse events were collected.

Results

Two hundred subjects were enrolled at 15 centers: 164 with symptomatic paroxysmal (PAF) and 36 with symptomatic persistent (PersAF) AF for de novo ablation. GRID and DL were used in 186 and 14 cases, respectively. All subjects underwent voltage mapping, with conservative thresholds (low voltage ≤0.5 mV and very low voltage/electrical scar ≤0.1 mV) used in 60.2% and 35.4% of maps, respectively. Focal impulses, rotors, complex fractionated electrograms, and other substrate targets were each searched for in <3% of subjects. Median time to generate a map was 9.0 (Q1: 5.0, Q3: 13.0) minutes. Ablation strategy included pulmonary vein (PV) isolation in all, and non-PV triggers in 75/200 (37.5%) subjects. Five serious adverse events were reported.

Conclusions

The study demonstrated an efficient strategy with the feasibility and safety of using HDM during AF ablation procedures in APAC.

背景：房颤（AF）的临床研究很少关注亚洲患者；目前缺乏有关亚太地区（APAC）测绘和消融策略的数据。目的：高清晰度定位观察研究（NCT04022954）旨在表征市场上发布的高密度定位（HDM）导管在亚太地区房颤受试者中的电解剖定位（EAM）。方法：接受HDM和射频消融（RFA）治疗AF的受试者被纳入APAC前瞻性研究。数据包括制图策略和消融目标。EAM使用两种市售HDM导管（Advisor™HD Grid, Sensor Enabled™，Abbott [Grid]或Inquiry™AFocus II™Double Loop， Abbott [DL]）中的一种进行。收集与手术相关的不良事件。结果：在15个中心招募了200名受试者：164名症状性阵发性房颤（PAF）患者和36名症状性持续性房颤（PersAF）患者进行了从头消融。GRID和DL分别用于186例和14例。所有受试者都进行了电压作图，60.2%和35.4%的作图采用保守阈值（低电压≤0.5 mV和极低电压/电疤痕≤0.1 mV）。结论：本研究证明了在亚太地区AF消融过程中使用HDM是一种有效的策略，具有可行性和安全性。

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引用次数: 0

Editorial to “Carbon dioxide insufflation to facilitate epicardial access in ECMO-supported ventricular tachycardia ablation” “在ecmo支持的室性心动过速消融中，二氧化碳注入促进心外膜通路”的社论。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-18 DOI: 10.1002/joa3.13200

Wen-Han Cheng MD, Fa-Po Chung MD, PhD

<p>In this issue of the Journal, Takase et al. present a compelling case involving a patient with myocardial disease secondary to scleroderma. The patient underwent a repeat epicardial catheter ablation for recurrent VT after the failure of initial endocardial ablation. The authors employed carbon dioxide (CO<sub>2</sub>) insufflation to expand the pericardial space under extracorporeal membrane oxygenation (ECMO) support. This approach mitigated the technical challenges typically associated with epicardial access, particularly in patients with minimal pericardial fluid. The technique demonstrates a significant leap in safety and efficacy, addressing the risks of traditional epicardial access methods.<span><sup>1</sup></span></p><p>Catheter ablation has emerged as an alternative treatment option for patients suffering from sustained, monomorphic ventricular tachycardia (VT). Traditional endocardial ablation techniques, leveraging electrophysiological or substrate-based mapping, have shown promise in reducing the burden of ventricular arrhythmia, achieving acute success rates of 60%–80%.<span><sup>2</sup></span> However, the complex pathology and 3-dimentional architecture of VT isthmus, often involving diffuse myocardial regions, including the epicardium, poses significant challenges to the long-term success of these procedures. This has driven interest in epicardial approaches, which are particularly relevant for nonischemic cardiomyopathy-associated ventricular arrhythmias, where endocardial ablation alone may be insufficient. Recent advancements in endo-epicardial ablation strategies have demonstrated their potential to enhance outcomes, especially in patients with extensive myocardial involvement. Epicardial ablation becomes crucial in cases when endocardial-only approaches fail to achieve clinical success. The introduction of innovative techniques for epicardial access has further expanded the possibilities of safe and effective VT management.<span><sup>2</sup></span></p><p>The epicardial approach, initially introduced by Sosa et al., involved the use of a nonsurgical transthoracic 18-G needle for pericardial space access.<span><sup>3</sup></span> Over the years, several innovations have refined this technique to enhance safety and success rates. Methods such as needle-in-needle systems, CO<sub>2</sub> insufflation, real-time pressure monitoring, blunt-tip concealed needle devices, video-assisted approaches, and the SAFER (Safe Access for Epicardial Radiofrequency) technique have reduced complications and improved procedural outcomes.<span><sup>4</sup></span></p><p>Among these innovations, the use of CO<sub>2</sub> insufflation is noteworthy. Initially, intentional CO<sub>2</sub> insufflation was performed via the right atrial appendage exit. Though previously described, it has not been widely adopted in clinical practice. Later, CO<sub>2</sub> insufflation via coronary venous system has been introduced to offer a safer, more efficient means

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引用次数: 0

Association between ventricular arrhythmia (premature ventricular contractions burden and nonsustained ventricular tachycardia) and cardiovascular events in patients without structural heart disease 非结构性心脏病患者室性心律失常（室性早搏负荷和非持续性室性心动过速）与心血管事件的关系

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-15 DOI: 10.1002/joa3.13203

Sho Ogiso MD, Takuto Arita MD, Shinya Suzuki MD, PhD, Naomi Hirota MD, PhD, Naoharu Yagi MD, Takayuki Otsuka MD, PhD, Mikio Kishi MD, Hiroto Kano MD, Shunsuke Matsuno MD, Yuko Kato MD, PhD, Tokuhisa Uejima MD, PhD, Yuji Oikawa MD, PhD, Junya Ako MD, PhD, Junji Yajima MD, PhD, Takeshi Yamashita MD, PhD

Background

Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are common arrhythmias in cardiovascular clinical settings. However, the clinical significance of PVCs and NSVT in the absence of structural heart disease has not yet been fully elucidated. This study aimed to evaluate the association between PVCs, NSVT, and clinical outcomes.

Methods

A study population of 26,117 patients was drawn from the Shinken Database established in June 2004. We enrolled 6332 patients without structural heart disease who underwent 24-h Holter monitoring and were registered up to March 2019. We focused on ventricular arrhythmias and cardiovascular events in patients without structural heart diseases. The study population was divided by the number of baseline PVCs (PVCs: <1000 (n = 5507), 1000–9999 (n = 531), and 10 000 ≤(n = 294)). The study population was also divided according to the presence or absence of NSVT (n = 454 and n = 5878, respectively).

Result

During the follow-up period up to 3 years, there were 16 deaths, 24 heart failure-related hospitalizations, 14 acute coronary syndromes, and 37 embolism events. The frequency of PVCs was not associated with mortality or heart failure. On the other hand, the presence of NSVT was significantly associated with heart failure hospitalization in a multivariate model (hazard ratio: 3.02; 95% CI: 1.03–8.83; p = .044).

Conclusion

In patients without structural heart disease, NSVT was associated with a higher risk of heart failure hospitalization. Patients with NSVT but no structural heart diseases require careful follow-up and management of heart failure risk factors.

背景：室性早搏（PVCs）和非持续性室性心动过速（NSVT）是心血管临床常见的心律失常。然而，在没有结构性心脏病的情况下，室性早搏和非室性心动过速的临床意义尚未完全阐明。本研究旨在评估室性早搏、非svt和临床结果之间的关系。方法：从2004年6月建立的Shinken数据库中抽取26117例患者作为研究对象。我们招募了6332名无结构性心脏病的患者，他们接受了24小时动态心电图监测，并登记至2019年3月。我们的研究重点是无结构性心脏病患者的室性心律失常和心血管事件。研究人群按基线室性早搏数（n = 5507）、1000-9999 （n = 531）和10000≤(n = 294)进行分组。研究人群也根据有无非svt进行分组（n = 454和n = 5878）。结果：在长达3年的随访期间，有16例死亡，24例心力衰竭相关住院，14例急性冠状动脉综合征，37例栓塞事件。室性早搏的频率与死亡率或心力衰竭无关。另一方面，在多变量模型中，非svt的存在与心力衰竭住院显著相关(风险比：3.02；95% ci: 1.03-8.83；p = .044)。结论：在无结构性心脏病的患者中，非svt与心力衰竭住院的高风险相关。非svt但无结构性心脏病的患者需要仔细的随访和心力衰竭危险因素的管理。

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引用次数: 0

Editorial to “comparison of ex vivo lesion formation for two adjacent radiofrequency applications with very-high-power short-duration in various inter-lesion times” 对“在不同的病变间时间内，两个相邻的高功率短时间射频应用的离体病变形成比较”的评论。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-10 DOI: 10.1002/joa3.13202

Koji Fukuzawa MD, Mitsuru Takami MD, Kimitake Imamura MD

<p>Durable pulmonary vein isolation is the cornerstone of radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Sufficient RF energy deliveries at each target point are essential, and “sequential” energy applications with a close inter-lesion distance would be one of the solutions for a first-pass isolation without any gaps. What are the differences in the lesion formation created by sequential or point-by-point RF application maneuvers? Regarding this issue, Dr. Hanaki and his colleagues reported important observations about both the efficacy and safety when delivering very high-power short-duration (vHPSD, 90-watt power setting for 4 s) RF applications by focusing on the inter-lesion “time”.<span><sup>1</sup></span> Various methods to achieve uniform, transmural lesions during pulmonary vein isolation while minimizing collateral damage have been studied, such as the RF power settings, contact force with the tissue, and application duration, and those parameters are integrated into the index to detect the lesion formation. A close inter-lesion distance of less than 6 mm with adequate index values promises a gap-less isolation line. In addition to those previous pieces of knowledge, the authors gave us an important awareness of the inter-lesion time.</p><p>According to the authors' report, the lesion depth between sequential vHPSD RF applications (intermediate lesion depth) with a shorter inter-lesion time of less than 20 s was 3 mm, which was comparable to the lesion depth with a single vHPSD RF application and deeper than that with sequential applications with an inter-lesion time of 60 s. RF ablation lesions result from thermal injury that occurs in 2 consecutive phases: resistive and conductive heating phases.<span><sup>2</sup></span> The vHPSD ablation system was developed to create a uniform, transmural lesion while avoiding collateral damage. Conceptually, it was thought that vHPSD ablation is mainly based on resistive heating with a minimum impact of conductive heating (thermal latency).<span><sup>2</sup></span> Conversely, Dr. Nakagawa stated that the majority of effective tissue heating and, thereby, lesion formation with vHPSD RF applications occur due to conductive tissue heating after termination of the RF delivery.<span><sup>3</sup></span> The latter theory can explain the authors' results of the deeper intermediate lesion depth by sequential applications with a shorter time interval. Sequential RF applications during the persistence of thermal latency in the surrounding tissue can cause an additional impact on lesion formation of the intermediate lesion.</p><p>A uniform and adequate transmural lesion with vHPSD ablation promises a first-pass isolation with a short procedure time. However, the left atrial wall has a thickness of 1–3 mm and is not uniform depending on the region and patient. A uniform RF application throughout the isolation line targeting a lesion depth of 3 mm can cause both insufficient RF applications

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引用次数: 0

How to consider the indication of leadless pacemaker versus conventional transvenous pacemaker following their comparison in cost-effectiveness 如何考虑无导线起搏器与传统经静脉起搏器在成本-效果比较后的适应证。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-12-06 DOI: 10.1002/joa3.13198

Naoya Kataoka MD, Teruhiko Imamura MD

Micra VR, a single-chamber, leadless trans-catheter pacing system, represents a significant advancement in pacemaker technology. By eliminating the need for traditional pacemaker leads and subcutaneous pockets, it substantially reduces the risk of infection—a primary complication associated with conventional transvenous pacemakers (TVPM). In a comprehensive study conducted within a large-scale Australian healthcare system, Makino and colleagues assessed the cost-effectiveness of Micra VR in comparison with TVPM.¹ Their findings revealed a higher incidence of procedure-related complications in the Micra VR group; however, the costs associated with device-related infections and re-implantations of devices were notably higher in the TVPM group. Consequently, Micra VR demonstrated superior cost-effectiveness in managing patients with symptomatic bradycardia. Several concerns have been raised.

Beyond infection reduction, Micra VR offers additional advantages, such as preserving systemic venous access critical for patients requiring hemodialysis, as well as feasibility for patients with superior vena cava obstruction or those with replaced tricuspid valves.^{2, 3} In this study, the outcomes assessed included infection, infectious endocarditis, device revisions, repeated lead implantations, repeated device implantations, and device retrievals.¹ The cost-effectiveness of Micra VR may be even more pronounced when considering other TVPM-associated adverse events, such as the need for repeated shunt creation due to TVPM-related vascular obstruction, bradycardia-induced exacerbation of heart failure from unsuccessful TVPM implantation, and surgical implantation of epicardial leads following tricuspid valve replacement.

Leadless pacemakers are typically preferred for elderly patients, likely due to the limitations of Micra AV in achieving optimal AV synchronization.⁴ Nonetheless, in this study, Micra VR was associated with a higher quality of life than TVPM, potentially attributable to the absence of a subcutaneous pocket. Given this improvement in quality of life, Micra VR could, in fact, be considered a viable option for younger patients as well. How do the authors evaluate the clinical indications for Micra VR in comparison with TVPM in the contemporary era?

None.

The authors declare no conflicts of interest.

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引用次数: 0