Currently, two types of cryoballoon (CB) systems are available for catheter ablation of atrial fibrillation (AF). Since the POLARx (Boston Scientific) is softer during freezing than the Arctic Front Advance Pro (AFA-Pro; Medtronic), it tends to go more deeply into the pulmonary vein (PV), risking PV stenosis.
Methods
Ninety-one patients underwent initial CB ablation for paroxysmal AF (AFA-Pro 56; POLARx 35). Twenty-six from each group were extracted using propensity score matching. The PV cross-sectional area (PVA) was measured by tracing the area within the PV plane at 5-mm intervals from the PV ostium in a distal direction for 20 mm or to the bifurcation in each PV. The PVA was compared before and 3 months after ablation.
Results
Time to balloon temperatures of −30 and − 40°C was significantly shorter and the nadir temperature was significantly lower with POLARx than with AFA-Pro. In the left inferior (LI) PV and right superior (RS) PV, the freezing balloon position was significantly deeper in POLARx than in AFA-pro. The freezing position in RSPV with mild to moderate narrowing was deeper than those without (10.2 ± 3.3 mm vs. 8.2 ± 1.8 mm, p = .01). In RSPV, the reduction of PVA tended to be greater with the POLARx than with the AFA-Pro (26.1% ± 14.1% vs. 19.9% ± 10.3%, p = .07).
Conclusion
There was no significant difference in the incidence of PV stenosis between POLARx and AFA-Pro. However, if POLARx goes deep into the PVs, we will still have to be careful.
{"title":"Incidence of pulmonary vein stenosis in two types of cryoballoon systems","authors":"Satoko Shiomi MD, Michifumi Tokuda MD, PhD, Ryutaro Sakurai MD, Yoshito Yamazaki MD, Takuya Matsumoto MD, Hidenori Sato MD, PhD, Hirotsuna Oseto MD, Masaaki Yokoyama MD, PhD, Kenichi Tokutake MD, PhD, Mika Kato MD, PhD, Seigo Yamashita MD, PhD, Teiichi Yamane MD, PhD, FHRS, Michihiro Yoshimura MD, PhD","doi":"10.1002/joa3.13087","DOIUrl":"10.1002/joa3.13087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Currently, two types of cryoballoon (CB) systems are available for catheter ablation of atrial fibrillation (AF). Since the POLARx (Boston Scientific) is softer during freezing than the Arctic Front Advance Pro (AFA-Pro; Medtronic), it tends to go more deeply into the pulmonary vein (PV), risking PV stenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety-one patients underwent initial CB ablation for paroxysmal AF (AFA-Pro 56; POLARx 35). Twenty-six from each group were extracted using propensity score matching. The PV cross-sectional area (PVA) was measured by tracing the area within the PV plane at 5-mm intervals from the PV ostium in a distal direction for 20 mm or to the bifurcation in each PV. The PVA was compared before and 3 months after ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Time to balloon temperatures of −30 and − 40°C was significantly shorter and the nadir temperature was significantly lower with POLARx than with AFA-Pro. In the left inferior (LI) PV and right superior (RS) PV, the freezing balloon position was significantly deeper in POLARx than in AFA-pro. The freezing position in RSPV with mild to moderate narrowing was deeper than those without (10.2 ± 3.3 mm vs. 8.2 ± 1.8 mm, <i>p</i> = .01). In RSPV, the reduction of PVA tended to be greater with the POLARx than with the AFA-Pro (26.1% ± 14.1% vs. 19.9% ± 10.3%, <i>p</i> = .07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was no significant difference in the incidence of PV stenosis between POLARx and AFA-Pro. However, if POLARx goes deep into the PVs, we will still have to be careful.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"830-838"},"PeriodicalIF":2.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141338301","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}
Lukas Urbanek MD, Stefano Bordignon MD, Shota Tohoku MD, Jun Hirokami MD, Takahiko Nagase MD, Shaojie Chen MD, David Schaack MD, K. R. Julian Chun MD, Boris Schmidt MD
Background
Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long-term follow-up and procedural data of LB-PVI and we compare the first and second LB generation.
Methods
Patients undergoing LB ablation with first- (LB1) or second-generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period.
Results
538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch-up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; p < .001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; p < .001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; p = .067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1-year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; p < .001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; p = .491).
Conclusion
LB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second-generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1-year, with comparable results among both generations.
{"title":"Long-term follow-up of patients treated with laser balloon for atrial fibrillation: A high volume center experience with the first- and second-generation laser balloon","authors":"Lukas Urbanek MD, Stefano Bordignon MD, Shota Tohoku MD, Jun Hirokami MD, Takahiko Nagase MD, Shaojie Chen MD, David Schaack MD, K. R. Julian Chun MD, Boris Schmidt MD","doi":"10.1002/joa3.13088","DOIUrl":"10.1002/joa3.13088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long-term follow-up and procedural data of LB-PVI and we compare the first and second LB generation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing LB ablation with first- (LB1) or second-generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch-up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; <i>p</i> < .001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; <i>p</i> < .001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; <i>p</i> = .067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1-year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; <i>p</i> < .001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; <i>p</i> = .491).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second-generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1-year, with comparable results among both generations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"839-848"},"PeriodicalIF":2.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141341159","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}
<p>Editorial comment on “Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy.”<span><sup>1</sup></span></p><p>The management of atrial fibrillation (AF) has been sophisticated and getting more complicated because treatment options have emerged over the decades. Oral anticoagulation is still the mainstream to prevent ischemic stroke, yet sometimes difficult in patients with chronic kidney disease, elderly, and frailty. Cather ablation showed evidence to reduce heart failure hospitalization and mortality recently in a limited population, still even after the successful ablation, the recurrence of AF is casual during the longer follow-up period. Based on their background, such as CHA<sub>2</sub>DS<sub>2</sub>-VASc score, the continuation of oral anticoagulation is also common in daily practice.</p><p>Left atrial appendage closure (LAAC) has emerged as an alternative to long-term anticoagulation for patients with high bleeding risk. The procedural success rate is quite high, especially using a newer generation of WATCHMAN FLX. A certain rate of patients actually need both treatment options. Recent Japanese registry data showed 32.5% of the study cohort had a history of AF ablation.<span><sup>2</sup></span> A question comes up: Which comes first and how safe it is?</p><p>In the issue of Journal of Arrhythmia Chatani et al.<span><sup>1</sup></span> presented new evidence to understand this clinical question. A single-center interventional study retrospectively analyzed 46 consecutive patients with AF who had undergone CA and LAAC within 2 years. During the study period, this center performed 1992 AF ablation and 234 LAAC, which means 2.3% from the AF ablation side and 19.7% from the LAAC side. Of 46 patients, AF ablation was performed first in 31 patients and LAAC first in 15 patients. There were no differences in procedure-related adverse events and cardiovascular adverse events after both procedures. In the AF ablation first group, four device-related adverse events (three new peri-device leaks and one peri-device leak increase). They also found that three peri-device leaks were detected with TEE at 12 months follow-up in the early phase (within 180 days) LAAC after the AF ablation group. Events from the first procedure to the second procedure (median 7–9 months) are also interesting. More bleeding events occurred in the AF ablation first group, and a similar rate of ischemic stroke events occurred.</p><p>Combined AF ablation and LAAC is not a new idea, yet the best strategy for patients requiring both procedures needs to be elucidated. A meta-analysis of 16 studies comprising 1428 patients showed that the pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59–0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00–1.00), and ischemic stroke/transient ischemic attack/systemic
{"title":"Editorial to “Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy”","authors":"Masato Fukunaga MD","doi":"10.1002/joa3.13098","DOIUrl":"10.1002/joa3.13098","url":null,"abstract":"<p>Editorial comment on “Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy.”<span><sup>1</sup></span></p><p>The management of atrial fibrillation (AF) has been sophisticated and getting more complicated because treatment options have emerged over the decades. Oral anticoagulation is still the mainstream to prevent ischemic stroke, yet sometimes difficult in patients with chronic kidney disease, elderly, and frailty. Cather ablation showed evidence to reduce heart failure hospitalization and mortality recently in a limited population, still even after the successful ablation, the recurrence of AF is casual during the longer follow-up period. Based on their background, such as CHA<sub>2</sub>DS<sub>2</sub>-VASc score, the continuation of oral anticoagulation is also common in daily practice.</p><p>Left atrial appendage closure (LAAC) has emerged as an alternative to long-term anticoagulation for patients with high bleeding risk. The procedural success rate is quite high, especially using a newer generation of WATCHMAN FLX. A certain rate of patients actually need both treatment options. Recent Japanese registry data showed 32.5% of the study cohort had a history of AF ablation.<span><sup>2</sup></span> A question comes up: Which comes first and how safe it is?</p><p>In the issue of Journal of Arrhythmia Chatani et al.<span><sup>1</sup></span> presented new evidence to understand this clinical question. A single-center interventional study retrospectively analyzed 46 consecutive patients with AF who had undergone CA and LAAC within 2 years. During the study period, this center performed 1992 AF ablation and 234 LAAC, which means 2.3% from the AF ablation side and 19.7% from the LAAC side. Of 46 patients, AF ablation was performed first in 31 patients and LAAC first in 15 patients. There were no differences in procedure-related adverse events and cardiovascular adverse events after both procedures. In the AF ablation first group, four device-related adverse events (three new peri-device leaks and one peri-device leak increase). They also found that three peri-device leaks were detected with TEE at 12 months follow-up in the early phase (within 180 days) LAAC after the AF ablation group. Events from the first procedure to the second procedure (median 7–9 months) are also interesting. More bleeding events occurred in the AF ablation first group, and a similar rate of ischemic stroke events occurred.</p><p>Combined AF ablation and LAAC is not a new idea, yet the best strategy for patients requiring both procedures needs to be elucidated. A meta-analysis of 16 studies comprising 1428 patients showed that the pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59–0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00–1.00), and ischemic stroke/transient ischemic attack/systemic","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"893-894"},"PeriodicalIF":2.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141342824","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}
Coronary artery spasms related to atrial fibrillation ablation procedures could cause lethal ventricular fibrillation or cardiopulmonary arrest. It may be useful to try intravenous atropine sulfate while preparing urgent coronary artery angiography in hemodynamically unstable coronary artery spasms cases to prevent development of the lethal arrhythmias.
{"title":"Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures","authors":"Shunsuke Kawai MD, PhD, Arihide Okahara MD, PhD, Masaki Tokutome MD, PhD, Hirohide Matsuura MD, PhD, Yasushi Mukai MD, PhD","doi":"10.1002/joa3.13090","DOIUrl":"10.1002/joa3.13090","url":null,"abstract":"<p>Coronary artery spasms related to atrial fibrillation ablation procedures could cause lethal ventricular fibrillation or cardiopulmonary arrest. It may be useful to try intravenous atropine sulfate while preparing urgent coronary artery angiography in hemodynamically unstable coronary artery spasms cases to prevent development of the lethal arrhythmias.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1013-1015"},"PeriodicalIF":2.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339567","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}
Bonpei Takase, Takanori Ikeda, Wataru Shimizu, Haruhiko Abe, Takeshi Aiba, Masaomi Chinushi, Shinji Koba, Kengo Kusano, Shinichi Niwano, Naohiko Takahashi, Seiji Takatsuki, Kaoru Tanno, Eiichi Watanabe, Koichiro Yoshioka, Mari Amino, Tadashi Fujino, Yu-ki Iwasaki, Ritsuko Kohno, Toshio Kinoshita, Yasuo Kurita, Nobuyuki Masaki, Hiroshige Murata, Tetsuji Shinohara, Hirotaka Yada, Kenji Yodogawa, Takeshi Kimura, Takashi Kurita, Akihiko Nogami, Naokata Sumitomo, the Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group
<p>The purpose of diagnosing arrhythmia is to improve symptoms, quality of life (QOL), and prognosis by preventing sudden cardiac death that is caused by fatal ventricular arrhythmias. Organic heart disease, such as myocardial infarction, accounts for the majority of etiologies, whereas inherited diseases, such as Brugada syndrome, are also involved. Risk assessment using various test methods can help to prevent sudden cardiac death to a certain degree. Syncope is a precursor to sudden cardiac death, and the diagnosis of arrhythmic syncope can lead to the prevention of sudden cardiac death. Furthermore, fatal arrhythmia often occurs during activity and exercise, which makes diagnosis equally important in the field of sports. There are also other pathologies that require a detailed diagnosis of arrhythmias, such as detecting atrial fibrillation (AF) in patients with suspected non-fatal arrhythmias or cardiogenic cerebral infarction.</p><p>Recently, it was decided to summarize the guidelines on the diagnosis and treatment of arrhythmia into 3 major categories, diagnosis, pharmacotherapy, and non-pharmacotherapy. Several guidelines on diagnosis and treatment have already been published for the cardiovascular system; however, there are many descriptions that overlap. Thus, revising the guidelines to make each one for each field more concise and revising multiple guidelines at once would make utilization of the guidelines more effective. Similarly, in the field of arrhythmia, a revised version of the Guideline on the diagnosis and treatment of arrhythmia was published first. The 2020 revised edition of the 2020 JCS/HHRS Guideline on pharmacotherapy of cardiac arrhythmias<span><sup>1</sup></span> was published in 2020, and for non-pharmacotherapy there is the 2018 JCS/HHRS Guideline on non-pharmacotherapy of cardiac arrhythmias (2018 revision)<span><sup>2</sup></span> and a Supplementary Edition of the 2021 JCS/HHRS Guideline focused update on non-pharmacotherapy of cardiac arrhythmias.<span><sup>3</sup></span></p><p>Of the aforementioned 3 major categories related to the diagnosis and treatment of arrhythmias, this guideline is intended to address the “diagnosis”. It is an attempt to integrate the Guidelines for diagnosis and management of syncope (JCS 2012),<span><sup>4</sup></span> the Guidelines for clinical cardiac electrophysiologic studies (JCS 2011),<span><sup>5</sup></span> as well as the Guidelines for exercise eligibility at schools, work-sites, and sports in patients with heart diseases (JCS 2008),<span><sup>6</sup></span> focusing mainly on revising the Guidelines for risks and prevention of sudden cardiac death (JCS 2010).<span><sup>7</sup></span> In addition, sections of the Guidelines for diagnosis and management of inherited arrhythmias (JCS 2017)<span><sup>8</sup></span> related to diagnosis have been partially updated to include information such as the current status and concept of insurance coverage for genetic testing. These revisi
{"title":"JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia","authors":"Bonpei Takase, Takanori Ikeda, Wataru Shimizu, Haruhiko Abe, Takeshi Aiba, Masaomi Chinushi, Shinji Koba, Kengo Kusano, Shinichi Niwano, Naohiko Takahashi, Seiji Takatsuki, Kaoru Tanno, Eiichi Watanabe, Koichiro Yoshioka, Mari Amino, Tadashi Fujino, Yu-ki Iwasaki, Ritsuko Kohno, Toshio Kinoshita, Yasuo Kurita, Nobuyuki Masaki, Hiroshige Murata, Tetsuji Shinohara, Hirotaka Yada, Kenji Yodogawa, Takeshi Kimura, Takashi Kurita, Akihiko Nogami, Naokata Sumitomo, the Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group","doi":"10.1002/joa3.13052","DOIUrl":"10.1002/joa3.13052","url":null,"abstract":"<p>The purpose of diagnosing arrhythmia is to improve symptoms, quality of life (QOL), and prognosis by preventing sudden cardiac death that is caused by fatal ventricular arrhythmias. Organic heart disease, such as myocardial infarction, accounts for the majority of etiologies, whereas inherited diseases, such as Brugada syndrome, are also involved. Risk assessment using various test methods can help to prevent sudden cardiac death to a certain degree. Syncope is a precursor to sudden cardiac death, and the diagnosis of arrhythmic syncope can lead to the prevention of sudden cardiac death. Furthermore, fatal arrhythmia often occurs during activity and exercise, which makes diagnosis equally important in the field of sports. There are also other pathologies that require a detailed diagnosis of arrhythmias, such as detecting atrial fibrillation (AF) in patients with suspected non-fatal arrhythmias or cardiogenic cerebral infarction.</p><p>Recently, it was decided to summarize the guidelines on the diagnosis and treatment of arrhythmia into 3 major categories, diagnosis, pharmacotherapy, and non-pharmacotherapy. Several guidelines on diagnosis and treatment have already been published for the cardiovascular system; however, there are many descriptions that overlap. Thus, revising the guidelines to make each one for each field more concise and revising multiple guidelines at once would make utilization of the guidelines more effective. Similarly, in the field of arrhythmia, a revised version of the Guideline on the diagnosis and treatment of arrhythmia was published first. The 2020 revised edition of the 2020 JCS/HHRS Guideline on pharmacotherapy of cardiac arrhythmias<span><sup>1</sup></span> was published in 2020, and for non-pharmacotherapy there is the 2018 JCS/HHRS Guideline on non-pharmacotherapy of cardiac arrhythmias (2018 revision)<span><sup>2</sup></span> and a Supplementary Edition of the 2021 JCS/HHRS Guideline focused update on non-pharmacotherapy of cardiac arrhythmias.<span><sup>3</sup></span></p><p>Of the aforementioned 3 major categories related to the diagnosis and treatment of arrhythmias, this guideline is intended to address the “diagnosis”. It is an attempt to integrate the Guidelines for diagnosis and management of syncope (JCS 2012),<span><sup>4</sup></span> the Guidelines for clinical cardiac electrophysiologic studies (JCS 2011),<span><sup>5</sup></span> as well as the Guidelines for exercise eligibility at schools, work-sites, and sports in patients with heart diseases (JCS 2008),<span><sup>6</sup></span> focusing mainly on revising the Guidelines for risks and prevention of sudden cardiac death (JCS 2010).<span><sup>7</sup></span> In addition, sections of the Guidelines for diagnosis and management of inherited arrhythmias (JCS 2017)<span><sup>8</sup></span> related to diagnosis have been partially updated to include information such as the current status and concept of insurance coverage for genetic testing. These revisi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"655-752"},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352955","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}
Gusti Ngurah Prana Jagannatha, Brian Mendel, Nikita Pratama Toding Labi, Wingga Chrisna Aji, Anastasya Maria Kosasih, Jonathan Adrian, Bryan Gervais de Liyis, Putu Febry Krisna Pertiwi, I Made Putra Swi Antara
Background
Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long-term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation.
Methods
We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all-cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow-conducting anatomical isthmus (SCAI)-based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre-ablation history of VT.
Results
Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non-inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI-based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow-up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all-cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant.
Conclusions
SCAI-based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation.
{"title":"Long-term outcomes of ventricular tachycardia ablation in repaired tetralogy of Fallot: Systematic review and meta-analysis","authors":"Gusti Ngurah Prana Jagannatha, Brian Mendel, Nikita Pratama Toding Labi, Wingga Chrisna Aji, Anastasya Maria Kosasih, Jonathan Adrian, Bryan Gervais de Liyis, Putu Febry Krisna Pertiwi, I Made Putra Swi Antara","doi":"10.1002/joa3.13095","DOIUrl":"10.1002/joa3.13095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long-term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all-cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow-conducting anatomical isthmus (SCAI)-based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre-ablation history of VT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non-inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI-based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. <i>p</i> < 0.001; I<sup>2</sup> = 0%) with no recurrence in patients with preventive ablation (mean follow-up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all-cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SCAI-based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"935-947"},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141350604","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}
Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost-effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy.
Methods
A systematic review and meta-analysis were performed. The primary outcome for the meta-analysis was long-term AF recurrence. Following the results of the meta-analysis, the cost-effectiveness of CBA versus RFA in Japan was assessed.
Results
The meta-analysis included 12 randomized controlled trials and six propensity-score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81–1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77–1.19), but no significant difference was found. A cost-minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355).
Conclusion
Our meta-analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA.
{"title":"A meta-analysis and cost-minimization analysis of cryoballoon ablation versus radiofrequency ablation for paroxysmal atrial fibrillation","authors":"Yoshimi Nitta MSPH, Michiko Nishimura MSc, Hidetoshi Shibahara PhD, Teiichi Yamane MD, PhD","doi":"10.1002/joa3.13055","DOIUrl":"10.1002/joa3.13055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost-effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were performed. The primary outcome for the meta-analysis was long-term AF recurrence. Following the results of the meta-analysis, the cost-effectiveness of CBA versus RFA in Japan was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis included 12 randomized controlled trials and six propensity-score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81–1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77–1.19), but no significant difference was found. A cost-minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our meta-analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"802-814"},"PeriodicalIF":2.2,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141366959","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}
<p>Editorial comment to “Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from National Inpatient Sample (NIS) database 2020” by Wattanachayakul P, et al.<span><sup>1</sup></span></p><p>Numerous clinical studies have continuously reported the increased incidence and worse clinical outcomes of cardiovascular diseases associated with COVID-19. Relevant cardiovascular diseases include myocarditis, acute coronary syndrome, heart failure (HF), thromboembolisms, and arrhythmias.<span><sup>2</sup></span> It is also important to note that having COVID-19 results in more complicated clinical courses and higher mortalities in patients with preexisting cardiac conditions.<span><sup>3</sup></span> The present study by Wattanachayakul et al. utilized a big database of the US Healthcare systems and revealed a strong relation between COVID-19 infection and adverse outcomes in hospitalized HF patients with atrial fibrillation (AF).</p><p>A number of retrospective studies reported more severe conditions and a higher mortality among HF patients with COVID-19, and that HF was an independent risk factor for acute circulatory failure, renal failure, and multiorgan failure in patients with COVID-19.<span><sup>2</sup></span> It was also reported that COVID-19 infection is associated with an increasing incidence of atrial fibrillation.<span><sup>4</sup></span> A preexisting AF is associated with an increased mortality of over twofold in COVID-19 Patients.<span><sup>5</sup></span> From another aspect, the present study demonstrated that hospitalized HF patients with AF and COVID-19 had over threefold higher in-hospital mortality compared with those without COVID-19. More adverse outcomes such as prolonged length of stay or mechanical ventilation in the studied patients with COVID-19 were also striking. Whereas COVID-19 itself can elicit critical conditions, it is also conceivable that COVID-19 induces or even exacerbates HF and/or AF, which result in adverse clinical outcomes.</p><p>Cardiovascular involvement of COVID-19 can be largely explained by its inflammatory mechanisms called cytokine storm, myocardial damage, and relevant endothelial dysfunction.<span><sup>2</sup></span> Adverse effects of COVID-19 on cardiac function may also include an increased adrenergic drive because of fever and hypoxemia, which increases myocardial damage along with cardiomyocyte infection and cytokine storm. An increased inflammatory response is also related to the occurrence of AF.<span><sup>2, 4</sup></span> Indeed, atrial electrical instability and atrial tissue remodeling could be elicited in relation to various cytokine signaling. In addition to systemic inflammation, local mechanisms that contribute to atrial electrical instability associated with COVID-19 have been considered.<span><sup>4</sup></span> Angiotensin-converting enzyme-2 (ACE-2) has been identified as a functional receptor at ce
Wattanachayakul P 等人撰写的 "COVID-19 感染对合并心房颤动的心力衰竭住院患者院内预后的影响：Wattanachayakul P 等人撰写的 "COVID-19 感染对合并心房颤动的心力衰竭住院患者院内预后的影响：来自 2020 年全国住院患者抽样（NIS）数据库的启示 "1的编辑评论。相关的心血管疾病包括心肌炎、急性冠状动脉综合征、心力衰竭（HF）、血栓栓塞和心律失常。2 同样重要的是，患有 COVID-19 的患者的临床病程会更复杂，原有心脏病患者的死亡率会更高。Wattanachayakul 等人的这项研究利用了美国医疗保健系统的大型数据库，揭示了 COVID-19 感染与心房颤动（房颤）住院高频患者不良预后之间的密切关系。一些回顾性研究报告称，感染 COVID-19 的高频患者病情更严重，死亡率更高，而且高频是 COVID-19 患者发生急性循环衰竭、肾功能衰竭和多器官功能衰竭的独立危险因素。5 从另一个角度来看，本研究表明，与未感染 COVID-19 的患者相比，合并房颤和 COVID-19 的住院高血压患者的院内死亡率高出三倍多。研究中，COVID-19 患者的住院时间延长或机械通气等不良后果也很突出。COVID-19对心血管的影响在很大程度上可以用它的炎症机制--细胞因子风暴、心肌损伤和相关的内皮功能障碍--来解释。COVID-19 对心脏功能的不良影响还可能包括发热和低氧血症导致肾上腺素能驱动增加，从而加重心肌细胞感染和细胞因子风暴对心肌的损伤。2、4 事实上，心房电不稳定和心房组织重塑可能与各种细胞因子信号传导有关。4 血管紧张素转换酶-2（ACE-2）已被确认为冠状病毒细胞膜上的功能受体。ACE-2 在肺炎细胞、巨噬细胞、内皮细胞、周细胞和心肌细胞中均有表达，因此应在心房壁中普遍表达。在正常情况下，ACE-2 是血管紧张素 II（AngII）诱导的细胞信号传导的抑制因子。血管紧张素 II 诱导的信号传导导致心肌细胞肥大、血管收缩、组织纤维化和氧化应激增加，其中大部分与房颤的发生和持续有关。ACE-2 与 SARS-CoV-2 结合会导致细胞膜上的 ACE-2 功能降低，这可能会增强 Ang II 诱导的信号传导。COVID-19 对心血管系统的不良影响可导致包括房颤在内的多种疾病，并与更差的临床预后有关。未来的研究需要进一步了解如何处理这种临床难题。
{"title":"Editorial comment to “Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from National Inpatient Sample (NIS) database 2020”","authors":"Yasushi Mukai MD, PhD","doi":"10.1002/joa3.13093","DOIUrl":"10.1002/joa3.13093","url":null,"abstract":"<p>Editorial comment to “Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from National Inpatient Sample (NIS) database 2020” by Wattanachayakul P, et al.<span><sup>1</sup></span></p><p>Numerous clinical studies have continuously reported the increased incidence and worse clinical outcomes of cardiovascular diseases associated with COVID-19. Relevant cardiovascular diseases include myocarditis, acute coronary syndrome, heart failure (HF), thromboembolisms, and arrhythmias.<span><sup>2</sup></span> It is also important to note that having COVID-19 results in more complicated clinical courses and higher mortalities in patients with preexisting cardiac conditions.<span><sup>3</sup></span> The present study by Wattanachayakul et al. utilized a big database of the US Healthcare systems and revealed a strong relation between COVID-19 infection and adverse outcomes in hospitalized HF patients with atrial fibrillation (AF).</p><p>A number of retrospective studies reported more severe conditions and a higher mortality among HF patients with COVID-19, and that HF was an independent risk factor for acute circulatory failure, renal failure, and multiorgan failure in patients with COVID-19.<span><sup>2</sup></span> It was also reported that COVID-19 infection is associated with an increasing incidence of atrial fibrillation.<span><sup>4</sup></span> A preexisting AF is associated with an increased mortality of over twofold in COVID-19 Patients.<span><sup>5</sup></span> From another aspect, the present study demonstrated that hospitalized HF patients with AF and COVID-19 had over threefold higher in-hospital mortality compared with those without COVID-19. More adverse outcomes such as prolonged length of stay or mechanical ventilation in the studied patients with COVID-19 were also striking. Whereas COVID-19 itself can elicit critical conditions, it is also conceivable that COVID-19 induces or even exacerbates HF and/or AF, which result in adverse clinical outcomes.</p><p>Cardiovascular involvement of COVID-19 can be largely explained by its inflammatory mechanisms called cytokine storm, myocardial damage, and relevant endothelial dysfunction.<span><sup>2</sup></span> Adverse effects of COVID-19 on cardiac function may also include an increased adrenergic drive because of fever and hypoxemia, which increases myocardial damage along with cardiomyocyte infection and cytokine storm. An increased inflammatory response is also related to the occurrence of AF.<span><sup>2, 4</sup></span> Indeed, atrial electrical instability and atrial tissue remodeling could be elicited in relation to various cytokine signaling. In addition to systemic inflammation, local mechanisms that contribute to atrial electrical instability associated with COVID-19 have been considered.<span><sup>4</sup></span> Angiotensin-converting enzyme-2 (ACE-2) has been identified as a functional receptor at ce","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"903-904"},"PeriodicalIF":2.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379991","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}
Deepti Ranganathan MBChB, Mussa Saad MD, Sheldon M. Singh MD
A 56-year-old man presented following an aborted cardiac arrest. His initial ECGs showed episodes of transient repolarization abnormalities. Coronary vasospasm can be a precipitant for ventricular arrhythmia in these patients, underpinning the importance of continuous ECG for accurate diagnosis and management.
{"title":"“Spasms in Silence”: A case of coronary vasospasm-induced ventricular fibrillation","authors":"Deepti Ranganathan MBChB, Mussa Saad MD, Sheldon M. Singh MD","doi":"10.1002/joa3.13083","DOIUrl":"10.1002/joa3.13083","url":null,"abstract":"<p>A 56-year-old man presented following an aborted cardiac arrest. His initial ECGs showed episodes of transient repolarization abnormalities. Coronary vasospasm can be a precipitant for ventricular arrhythmia in these patients, underpinning the importance of continuous ECG for accurate diagnosis and management.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1010-1012"},"PeriodicalIF":2.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267395","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