Journal of Arrhythmia最新文献

{"title":"Reduced Left Atrial Appendage Flow Velocity as a Risk of Thromboembolic Events After Catheter Ablation of Atrial Fibrillation","authors":"Shintaro Yamagami,&nbsp;Satoshi Shizuta,&nbsp;Munekazu Tanaka,&nbsp;Shushi Nishiwaki,&nbsp;Takanori Aizawa,&nbsp;Akihiro Komasa,&nbsp;Takashi Yoshizawa,&nbsp;Tetsuma Kawaji,&nbsp;Chihiro Ota,&nbsp;Naoaki Onishi,&nbsp;Yasuhiro Sasaki,&nbsp;Mitsuhiko Yahata,&nbsp;Kentaro Nakai,&nbsp;Mamoru Hayano,&nbsp;Tetsushi Nakao,&nbsp;Koji Hanazawa,&nbsp;Koji Goto,&nbsp;Takahiro Doi,&nbsp;Toshihiro Tamura,&nbsp;Koh Ono,&nbsp;Takeshi Kimura","doi":"10.1002/joa3.70233","DOIUrl":"https://doi.org/10.1002/joa3.70233","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reduced left atrial appendage flow velocity (LAAFV) on transesophageal echocardiography (TEE) is recognized as a predictor of thromboembolic events (TEs) in patients with atrial fibrillation (AF). However, its long-term prognostic value following AF ablation remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively evaluated 1521 patients undergoing AF ablation who underwent preprocedural TEE. Patients were categorized into two groups based on LAAFV: reduced (≤ 21.4 cm/s, <i>n</i> = 99) and preserved (&gt; 21.4 cm/s, <i>n</i> = 1422). The primary outcome was TEs. Secondary outcomes included arrhythmia recurrence and major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, stroke, major bleeding, and heart failure hospitalization, as well as individual components and cardiovascular mortality. Over a mean follow-up of 49 ± 32 months, TEs occurred in 19 patients (1.2%). The 5-year cumulative incidence of TEs was significantly higher in the reduced LAAFV group (6.7% vs. 0.9%, <i>p</i> &lt; 0.0001), despite a lower rate of anticoagulation discontinuation (20.1% vs. 57.1%, <i>p</i> &lt; 0.0001). Multivariable analysis identified reduced LAAFV as an independent predictor of TEs. It was also associated with higher risks for all secondary endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reduced preprocedural LAAFV is associated with adverse long-term clinical outcomes after AF ablation, including a significantly increased risk of thromboembolic events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brief Comment on “The Role of Ventricular Arrhythmias Inducibility in Arrhythmic Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: A Meta-Analysis of Observational Studies”","authors":"Sidra Afzal,&nbsp;Nimra Afzal","doi":"10.1002/joa3.70254","DOIUrl":"https://doi.org/10.1002/joa3.70254","url":null,"abstract":"&lt;p&gt;I read with keen interest the recent meta-analysis by Bazoukis G, Saplaouras A, Pillai N, Efthymiou P, Lee S, Sfairopoulos D, et al. analyzing the role of ventricular arrhythmias (VA) inducibility in arrhythmic risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) [&lt;span&gt;1&lt;/span&gt;]. All authors are to be acknowledged for summarizing data from different observational studies to shed light on a clinically faced key challenge. This letter focuses on some considerations about methodology and interpretation, which may provide assistance to clinicians in applying these outcomes strategically.&lt;/p&gt;&lt;p&gt;Firstly, while the meta-analysis aims to provide pooled estimates of studies, the heterogeneity of the included studies requires scrutiny. Different factors such as study design, population, sites of stimulation, inducibility criteria, and different ventricular arrhythmia inducibility protocols played an important role in this variability. Such variations can influence the rate of arrhythmia detection and may restrict the applicability of pooled end results. Acknowledgment of this variability is crucial for the interpretation of risk stratification on the basis of inducibility.&lt;/p&gt;&lt;p&gt;Secondly, the studies that were included in the meta-analysis were observational, increasing susceptibility to reporting and selection biases. For example, patients being subjected to electrical stimulation could have higher baseline risk profiles leading to a greater association between arrhythmic events and inducibility. Clinicians should reflect on all these confounding factors when projecting outcomes to wider ARVC populations.&lt;/p&gt;&lt;p&gt;Thirdly, the applicability of VA inducibility for risk prediction remained subtle. While VA inducibility can help in detecting higher-risk patients, it should supplement rather than substitute comprehensive risk assessment comprising diagnostic imaging, genetic assessment, and standard clinical parameters. Different factors such as right ventricular dysfunction, male gender, age, fragmentation of the QRS complex, previous history of ventricular tachyarrhythmia, and syncope on initial evaluation are important predictors of arrhythmic events [&lt;span&gt;2&lt;/span&gt;]. Programmed ventricular stimulation offers predictive information only when integrated with a risk calculator [&lt;span&gt;3&lt;/span&gt;]. Integration of these modalities reinforces a comprehensive approach towards sudden cardiac death risk stratification in ARVC.&lt;/p&gt;&lt;p&gt;Lastly, this meta-analysis highlights the importance of multicenter prospective studies with standard protocols. Such studies might offer more reliable estimates of the VA inducibility predictive value and assist in the development of guidelines for the management of ARVC.&lt;/p&gt;&lt;p&gt;To conclude, authors offered a significant synthesis of recent evidence on VA inducibility in ARVC. Prudent reflection on observational biases, heterogeneity, and incorporation with comprehensive clinical assessment is cruci","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase Variance Analysis for Identifying Heterogeneous Conduction Regions in Persistent Atrial Fibrillation: Impact of Recording Duration","authors":"Hiroshi Seno,&nbsp;Yilin Wang,&nbsp;Toshiya Kojima,&nbsp;Tsukasa Oshima,&nbsp;Kenichiro Yamagata,&nbsp;Masatoshi Yamazaki,&nbsp;Ichiro Sakuma,&nbsp;Katsuhito Fujiu,&nbsp;Naoki Tomii","doi":"10.1002/joa3.70246","DOIUrl":"https://doi.org/10.1002/joa3.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Phase variance analysis, which quantifies the spatial heterogeneity of local activation, has been proposed as a method to characterize complex conduction patterns in atrial fibrillation (AF). However, the influence of recording duration on its reliability remains unclear. This study aimed to determine how recording duration affects the accuracy and reproducibility of identifying heterogeneous conduction regions by phase variance analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Intracardiac electrogram recordings (30 s) were obtained from 16 left atrial sites in 5 patients with persistent AF. A reference phase variance map (REF) was generated by averaging instantaneous phase variance maps over the full 30-s dataset to represent the frequency of local conduction heterogeneity. Thirteen recording durations (0.01–25 s) were defined as experimental conditions. For each duration, 100 randomly selected segments were extracted, and estimated phase variance maps (ESTs) were computed using the same temporal averaging method. Accuracy was evaluated by calculating the structural similarity index measure (SSIM) between ESTs and REF, while reproducibility was assessed using pixel-wise standard deviations across subsamplings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Longer recording durations produced higher SSIM values and lower standard deviations. With durations ≥ 10 s, SSIM consistently exceeded 0.95, including outliers, and standard deviations fell below 0.015, indicating accurate and stable estimation of complex conduction patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adequate recording duration enables accurate and reproducible estimation of heterogeneous conduction regions using phase variance analysis, even in persistent AF with complex conduction patterns. This method may support optimal ablation target selection and improve treatment outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70246","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Interpretation of Cardiopulmonary Exercise Testing “Availability” After Cardiac Resynchronization Therapy: Methodological and Data Considerations","authors":"Hidetoshi Yanagi","doi":"10.1002/joa3.70252","DOIUrl":"10.1002/joa3.70252","url":null,"abstract":"&lt;p&gt;I read with great interest a recent article by Kuhara et al. titled “Factors influencing the availability of cardiopulmonary exercise testing for patients undergoing cardiac resynchronization therapy in Japan” [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This nationwide analysis provides valuable insights into the current state of cardiopulmonary exercise testing (CPET) among patients undergoing cardiac resynchronization therapy (CRT) or CRT defibrillator (CRT-D) implantation in Japan.&lt;/p&gt;&lt;p&gt;Although I commend the authors for their valuable contribution to this important area, I would like to highlight several methodological and interpretative considerations that could improve the clarity and reliability of the reported findings.&lt;/p&gt;&lt;p&gt;A significant numerical inconsistency was noticed between this study and the authors' earlier publications using the same Diagnosis Procedure Combination (DPC) dataset [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Both studies explicitly referenced the same ethics approval code (R2-007, University of Occupational and Environmental Health) and covered an identical study period (2014–2018).&lt;/p&gt;&lt;p&gt;In the 2022 study, 6531 CRT and CRT-D devices were included after excluding patients aged &lt; 15 years and emergency admissions.&lt;/p&gt;&lt;p&gt;Conversely, the current report states that only 3965 CRT/CRT-D cases were initially identified, and 3859 were retained for analysis following exclusion.&lt;/p&gt;&lt;p&gt;Given an identical data source and timeframe, a 39% reduction in eligible cases raises concerns about potential changes in the extraction codes, diagnostic inclusion criteria, or exclusion logic.&lt;/p&gt;&lt;p&gt;Clarifying the precise differences in data selection between the two analyses is essential for reproducibility and to determine whether the present cohort represents a subset of a previously published population.&lt;/p&gt;&lt;p&gt;As noted by the authors, approximately 21% of hospitals in Japan are equipped with CPET systems.&lt;/p&gt;&lt;p&gt;Consequently, many patients in the DPC dataset were hospitalized in facilities where CPET could not be performed.&lt;/p&gt;&lt;p&gt;Including such cases in the same regression model may have introduced bias in the estimated odds ratios, as “no CPET” outcomes in these hospitals reflect institutional capability rather than patient-related factors.&lt;/p&gt;&lt;p&gt;A stratified or multilevel logistic model limited to CPET-capable hospitals or a sensitivity analysis including hospitals with at least one recorded CPET would help isolate true patient-level determinants from structural constraints. This adjustment would also allow for a clear separation between facility-level accessibility and individual-level clinical determinants.&lt;/p&gt;&lt;p&gt;In the multivariate model, both the Barthel Index and rehabilitation type (none, other, or cardiac) were included as explanatory variables.&lt;/p&gt;&lt;p&gt;However, in real-world practice, the Barthel Index (Activities of Daily Living (ADL) score) is a major determinant of whether a patient receives cardiac or other forms of rehabilitation.&lt;/p&gt;&lt;p&gt;When cardiac rehabi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Considerations Regarding Pacemaker Syndrome Under VVIR Pacing","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/joa3.70255","DOIUrl":"10.1002/joa3.70255","url":null,"abstract":"&lt;p&gt;The authors should be commended for conducting a rigorously designed study in which pacemaker syndrome (PMS) was defined using both subjective symptoms and objective improvement following restoration of AV synchrony [&lt;span&gt;1&lt;/span&gt;]. This approach is particularly important because the clinical diagnosis of PMS is often challenging, especially in older adults whose symptoms are sometimes nonspecific. Their finding that a higher physical activity index predicts PMS is intuitively acceptable, yet it is meaningful that this relationship was demonstrated quantitatively. Several issues merit further clarification and discussion.&lt;/p&gt;&lt;p&gt;In this study, PMS was evaluated after switching all dual-chamber pacemakers to VVIR mode at discharge [&lt;span&gt;1&lt;/span&gt;]. In real-world practice, however, VVIR pacing is rarely selected in patients with intact sinus rhythm, except in limited settings such as permanent atrial fibrillation with bradycardia. Modern leadless pacemakers now provide VDD (Micra AV) or DDD (Aveir DR) capabilities, and VVIR activation during sinus rhythm is uncommon in contemporary clinical practice [&lt;span&gt;2, 3&lt;/span&gt;]. Therefore, we would appreciate clarification regarding the clinical scenarios the authors envision where these findings would alter pacing-mode decision-making. Does the discussion refer to older single-chamber VVI devices, resource-limited settings, or a theoretical framework for physiological understanding? The relevance of PMS induced under intentionally dyssynchronous conditions, which are rarely encountered in modern practice, deserves further elaboration.&lt;/p&gt;&lt;p&gt;The authors propose that increased physical activity exacerbates atrial contraction against a closed mitral valve, leading to PMS [&lt;span&gt;1&lt;/span&gt;]. However, this explanation is based on physiologic speculation rather than direct hemodynamic measurements. An alternative mechanism may exist in patients with preserved sinus node function but impaired AV conduction. During exercise, the sinus rate may exceed the VVIR pacing rate at a certain workload, causing intermittent intrinsic beats with higher degrees of AV block. This could reproduce the hemodynamics of advanced AV block and provoke exertional dyspnea even without classical PMS mechanisms.&lt;/p&gt;&lt;p&gt;Cardiopulmonary exercise testing combined with pacing-mode changes might have provided objective insight into the precise workload at which symptoms began. Such physiologic data could meaningfully strengthen the mechanistic conclusions.&lt;/p&gt;&lt;p&gt;The authors briefly mention dyssynchrony as a contributor to PMS [&lt;span&gt;1&lt;/span&gt;]. Given the rapid adoption of conduction-system pacing (His-bundle or left bundle branch pacing), which substantially reduces ventricular dyssynchrony, it would be valuable to consider whether PMS occurs—or is mitigated—under conduction-system pacing strategies [&lt;span&gt;4&lt;/span&gt;]. This question is clinically relevant because newer pacing modalities aim to preserve or restore physiologic synchrony, potential","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Guideline-Directed Medical Therapy Reduce the Incidence of Ventricular Arrhythmias in Patients With HFrEF?","authors":"Yu Nomoto,&nbsp;Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/joa3.70253","DOIUrl":"10.1002/joa3.70253","url":null,"abstract":"<p>In the present study, among 139 patients with heart failure with reduced ejection fraction (HFrEF) who had a dual chamber implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D), twelve patients (8.6%) experienced sustained ventricular tachycardia (VT). Of these, seven (58%) were non-compliant with heart failure guideline-directed medical therapy (GDMT) [<span>1</span>]. This finding suggests a strong correlation between poor adherence to GDMT and the occurrence of VT. Recent reports indicate that the proportion of sudden cardiac death among HFrEF patients has been decreasing, likely due to the advent of novel heart failure medications and the widespread implementation of GDMT [<span>2</span>]. From the perspective of GDMT, we believe several points in this study warrant further discussion.</p><p>GDMT was defined as the use of both beta-blockers and a renin–angiotensin system inhibitor (RASi)—including an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, or an angiotensin receptor-neprilysin inhibitor—while mineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter 2 (SGLT2) inhibitors were not included. According to current heart failure guidelines, GDMT now encompasses all four drug classes, including MRAs and SGLT2 inhibitors. Therefore, the definition of GDMT in this study does not fully align with contemporary standards.</p><p>The study categorized patients simply based on whether GDMT was administered or not, without considering dose optimization. However, the up-titration of GDMT agents to target or maximally tolerated doses is a key component of effective therapy. Previous studies have shown that patients with HFrEF who achieved up-titration of RASi, beta-blockers, and MRAs had significantly lower mortality rates [<span>3</span>]. While the prescription rate was high in the present study, it remains unclear whether adequate dose escalation was achieved.</p><p>Beyond the GDMT perspective, another interesting finding is the high incidence of nonsustained VT, despite the relatively young cohort. Compared with prior studies, this may be due to differences in the underlying etiology. In older populations, valvular heart disease and coronary artery disease are more prevalent, whereas cardiomyopathies may have been overrepresented in this cohort. Therefore, a detailed analysis of the underlying cardiac pathology in these patients would be essential for further interpretation.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>The manuscript does not include any original data.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Pulmonary Veins: The Influence of Pulsed Field Ablation on the Superior Vena Cava","authors":"Eiji Yoshida,&nbsp;Yusuke Sakamoto,&nbsp;Hiroyuki Osanai,&nbsp;Hiroshi Asano","doi":"10.1002/joa3.70249","DOIUrl":"10.1002/joa3.70249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) selectively ablates myocardial tissue while minimizing damage to surrounding structures. However, its effects on the superior vena cava (SVC) during right superior pulmonary vein (RSPV) isolation remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to assess the impact of PFA on the SVC and determine whether anatomical proximity contributes to conduction delay or isolation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, single-center observational study analyzed 15 patients with paroxysmal atrial fibrillation (AF) who underwent PFA at our institution between December 2024 and February 2025. A 12-F multipolar PFA catheter (FARAWAVE) was used. The shortest RSPV-SVC distance was measured using preprocedural contrast-enhanced CT and intraprocedural electroanatomic mapping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 15 patients, 10 (67%) exhibited PFA-induced conduction abnormalities in the SVC, including conduction delay or partial isolation. Partial SVC isolation was observed in seven patients (47%), with three (20%) developing SVC-originating AF that required additional SVC ablation. The shortest RSPV-SVC distance on CT was significantly shorter in the impact group (6.25 ± 1.7 mm) than in the nonimpact group (9.7 ± 2.0 mm; <i>p</i> = 0.04). Electroanatomic mapping showed no significant difference in the application-SVC distance between groups (<i>p</i> = 0.12). ROC analysis identified 7.15 mm as the cutoff for predicting SVC involvement (AUC = 0.86; 95% CI, 0.63–1.00).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PFA for RSPV isolation can cause SVC conduction abnormalities, with anatomical proximity as a key determinant. Preprocedural CT assessment may predict unintentional SVC involvement, which may alter arrhythmogenicity. Further studies are needed to assess long-term clinical implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic Management in Patients With Atrial Fibrillation Following Percutaneous Coronary Intervention: An Updated Clinical Review","authors":"Yuichi Saito,&nbsp;Yoshio Kobayashi","doi":"10.1002/joa3.70248","DOIUrl":"https://doi.org/10.1002/joa3.70248","url":null,"abstract":"<p>Patients with atrial fibrillation (AF) often develop acute coronary syndrome and undergo percutaneous coronary intervention (PCI), and vice versa. Acute coronary syndrome and PCI mandate the use of dual antiplatelet therapy, while oral anticoagulation is recommended in patients with AF to mitigate thromboembolic risks. Clinical evidence concerning antithrombotic treatment in patients with either AF or PCI has been accumulated, but when combined, the therapeutic strategy becomes complex. Although triple therapy, a combination of oral anticoagulation with dual antiplatelet therapy, has been employed in patients with AF undergoing PCI as an initial antithrombotic strategy, less intensive regimens may be associated with a lower rate of bleeding without an increased risk of thrombotic events. This narrative review article summarizes currently available evidence of antithrombotic therapy in patients with AF undergoing PCI.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and In-Hospital Outcomes of Bradycardia or Atrioventricular Conduction Disorder in Patients With Type 2 Myocardial Infarction: A Nationwide Inpatient Analysis","authors":"Chanokporn Puchongmart,&nbsp;Koravich Lorlowhakarn,&nbsp;Dina Soliman,&nbsp;Pojsakorn Danpanichkul,&nbsp;Nattanicha Chaisrimaneepan,&nbsp;Natnicha Leelaviwat,&nbsp;Deephak Swaminath,&nbsp;Ben Thiravetyan","doi":"10.1002/joa3.70243","DOIUrl":"https://doi.org/10.1002/joa3.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Type 2 myocardial infarction (T2MI), caused by an imbalance between oxygen supply and demand without significant coronary obstruction, is increasingly recognized yet remains underexplored, particularly regarding conduction abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the National Inpatient Sample from 2017 to 2022. Adult patients hospitalized with T2MI were identified by ICD-10-CM code. Bradycardia or atrioventricular (AV) conduction delay was defined using diagnostic codes for bradycardia and all degrees of AV block. We compared baseline characteristics, comorbidities, and causes of T2MI, and used multivariable logistic regression to evaluate associations with in-hospital mortality and cardiogenic shock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1 960 410 patients with T2MI, 118 025 (6.0%) had bradycardia or AV conduction delay. These patients were older, more often male, and had higher rates of hypertension, heart failure, chronic kidney disease, and diabetes. The pacemaker implantation was significantly more prevalent (8.7% vs. 0.3%, <i>p</i> &lt; 0.01). They also showed an increase in in-hospital mortality (10.4% vs. 9.8%, <i>p</i> &lt; 0.01), cardiogenic shock (5.1% vs. 3.2%, <i>p</i> &lt; 0.01), and AKI (47.9% vs. 46.3%, <i>p</i> &lt; 0.01). After adjustment, conduction disorders remained associated with higher odds of mortality (aOR 1.09, 95% CI 1.04–1.14) and cardiogenic shock (aOR 1.71, 95% CI 1.61–1.83).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bradycardia or AV conduction delay occurred in 6% of T2MI hospitalizations and was independently linked to worse in-hospital outcomes, underscoring the need for close monitoring in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Clinical Outcomes of Transvenous Lead Extraction for Cardiac Device Infections in the Very Elderly","authors":"Khalid Sawalha,&nbsp;John P. Marenco,&nbsp;Laurence M. Epstein,&nbsp;Shayal Pundlik,&nbsp;Kyle Gobeil,&nbsp;Marshal Fox,&nbsp;Fadi Chalhoub","doi":"10.1002/joa3.70245","DOIUrl":"https://doi.org/10.1002/joa3.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The increasing use of cardiac implantable electronic devices (CIEDs) has led to a rise in transvenous lead extractions (TLE), particularly for device-related infections. The elderly represent a growing subgroup undergoing TLE, but data on their outcomes are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the safety and in-hospital outcomes of TLE in patients aged ≥ 80 years with device-related infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the National Inpatient Sample (NIS) from 2016 to 2020 to identify hospitalizations involving TLE for device-related infections. Patients were stratified by age: &lt; 80 years and ≥ 80 years. The primary outcome was in-hospital mortality. Secondary outcomes included major procedural complications and length of stay. Multivariate logistic regression identified independent predictors of in-hospital mortality and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 30 670 patients who underwent TLE, 6530 (21.3%) were aged ≥ 80 years. In-hospital mortality did not differ significantly between groups (4.0% vs. 4.6%, <i>p</i> = 0.40), nor did overall complication rates (6.7% vs. 6.9%, <i>p</i> = 0.81). However, elderly patients had higher rates of post-procedural stroke (0.3% vs. 0.02%, <i>p</i> = 0.002) and bleeding (1.6% vs. 0.8%, <i>p</i> = 0.04). Independent predictors of mortality included chronic kidney disease (aOR 2.2, 95% CI: 1.2–4.2), cirrhosis (aOR 12.2, 95% CI: 1.1–133), and respiratory failure (aOR 50.7, 95% CI: 6–425). Elderly patients were more frequently discharged to rehabilitation facilities (40.3% vs. 25.5%, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elderly patients undergoing TLE for infections had similar in-hospital mortality and complication rates compared to younger patients. Age alone should not preclude TLE. However, increased risks of stroke and bleeding warrant targeted perioperative assessment. Further studies are needed to assess long-term outcomes in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695279","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}