Journal of Arrhythmia最新文献

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) [1]. 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 [2]. From the perspective of GDMT, we believe several points in this study warrant further discussion.

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.

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 [3]. While the prescription rate was high in the present study, it remains unclear whether adequate dose escalation was achieved.

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.

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The authors declare no conflicts of interest.

The manuscript does not include any original data.

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.

A patient with hypoplastic left heart syndrome developed heart failure due to tachycardia-induced cardiomyopathy from junctional ectopic tachycardia. Conventional antiarrhythmic therapy was ineffective, but ivabradine successfully controlled the arrhythmia and improved both ventricular function and heart failure.

The example illustrates the analysis and measurement of the ventriculo-atrial (VA) interval following atrial overdrive pacing from both the right atrium and the coronary sinus. At first glance, VA linking does not appear to be present in response to the AOP; however, closer inspection reveals that VA linking is, in fact, observed in the subsequent cycle.