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.
{"title":"Antithrombotic Management in Patients With Atrial Fibrillation Following Percutaneous Coronary Intervention: An Updated Clinical Review","authors":"Yuichi Saito, 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}
Chanokporn Puchongmart, Koravich Lorlowhakarn, Dina Soliman, Pojsakorn Danpanichkul, Nattanicha Chaisrimaneepan, Natnicha Leelaviwat, Deephak Swaminath, Ben Thiravetyan
Background
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.
Methods
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.
Results
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%, p < 0.01). They also showed an increase in in-hospital mortality (10.4% vs. 9.8%, p < 0.01), cardiogenic shock (5.1% vs. 3.2%, p < 0.01), and AKI (47.9% vs. 46.3%, p < 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).
Conclusions
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.
背景2型心肌梗死（T2MI）是由氧供需不平衡引起的，无明显的冠状动脉阻塞，越来越多的人认识到这一点，但仍未得到充分的研究，特别是在传导异常方面。方法采用2017 - 2022年全国住院患者样本进行回顾性队列研究。成年T2MI住院患者采用ICD-10-CM编码进行识别。心动过缓或房室传导延迟被定义为心动过缓和所有程度的房室传导阻滞的诊断代码。我们比较了T2MI的基线特征、合并症和病因，并使用多变量logistic回归来评估其与院内死亡率和心源性休克的关系。结果1 960410例T2MI患者中，118025例（6.0%）出现心动过缓或房室传导延迟。这些患者年龄较大，多为男性，高血压、心力衰竭、慢性肾病和糖尿病的发病率较高。起搏器植入术更为普遍（8.7% vs. 0.3%, p < 0.01）。他们还显示住院死亡率（10.4% vs. 9.8%, p < 0.01）、心源性休克（5.1% vs. 3.2%, p < 0.01）和AKI （47.9% vs. 46.3%, p < 0.01）增加。调整后，传导障碍仍与较高的死亡率（aOR 1.09, 95% CI 1.04-1.14）和心源性休克（aOR 1.71, 95% CI 1.61-1.83）相关。结论：6%的T2MI住院患者发生心动过缓或房室传导延迟，并与较差的住院结果独立相关，强调了对该人群进行密切监测的必要性。
{"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, Koravich Lorlowhakarn, Dina Soliman, Pojsakorn Danpanichkul, Nattanicha Chaisrimaneepan, Natnicha Leelaviwat, Deephak Swaminath, 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> < 0.01). They also showed an increase in in-hospital mortality (10.4% vs. 9.8%, <i>p</i> < 0.01), cardiogenic shock (5.1% vs. 3.2%, <i>p</i> < 0.01), and AKI (47.9% vs. 46.3%, <i>p</i> < 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}
Khalid Sawalha, John P. Marenco, Laurence M. Epstein, Shayal Pundlik, Kyle Gobeil, Marshal Fox, Fadi Chalhoub
Background
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.
Objectives
To evaluate the safety and in-hospital outcomes of TLE in patients aged ≥ 80 years with device-related infections.
Methods
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: < 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.
Results
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%, p = 0.40), nor did overall complication rates (6.7% vs. 6.9%, p = 0.81). However, elderly patients had higher rates of post-procedural stroke (0.3% vs. 0.02%, p = 0.002) and bleeding (1.6% vs. 0.8%, p = 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%, p < 0.001).
Conclusion
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.
{"title":"Safety and Clinical Outcomes of Transvenous Lead Extraction for Cardiac Device Infections in the Very Elderly","authors":"Khalid Sawalha, John P. Marenco, Laurence M. Epstein, Shayal Pundlik, Kyle Gobeil, Marshal Fox, 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: < 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> < 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}
Cardiac arrhythmias pose a major health concern while the role of antidiabetic medications in cardiac arrhythmic risks is not fully understood.
Method
We conducted a two-sample Mendelian Randomization (MR) analysis using genetic instruments extracted from hemoglobin A1C (HbA1c) as proxies for antidiabetic drug targets to evaluate their causal relationship with five cardiac arrhythmias derived from the Finngen database. Summary-data-based Mendelian randomization (SMR) utilizing gene expression data from the eQTLgen consortium was further employed to assess the role of antidiabetic drug targets in cardiac arrhythmias from the gene expression perspective.
Results
Three significant associations were identified. Sulfonylurea targets KCNJ11/ABCC8 were associated with a decreased incidence of paroxysmal tachycardia (OR: 0.69, 95% CI: 0.56, 0.86, PFDR = 0.022). Sodium-glucose cotransporter 2 inhibitor (SGLT2i) target SLC5A2 was linked to a reduced risk of right bundle branch block (OR: 0.85, 95% CI: 0.77, 0.94, PFDR = 0.022), and thiazolidinediones (TZDs) targeting RXRB were associated with a lowered atrial fibrillation occurrence (OR: 0.88, 95% CI: 0.82, 0.94, PFDR = 0.019). No significant relationships were found between any antidiabetic drug targets and left bundle branch block or atrioventricular block. SMR analysis indicated that lowered expression of KCNJ11 was related to a decreased paroxysmal tachycardia risk (OR: 1.05, 95% CI: 1.01, 1.08, PSMR = 0.010), further confirming the role of KCNJ11 in paroxysmal tachycardia.
Conclusion
Our findings suggest that several antidiabetic drug targets may have potential therapeutic applications in the management of cardiac arrhythmias.
{"title":"Exploring the Therapeutic Potential of Antidiabetic Drugs in Cardiac Arrhythmia Management: A Drug Target Mendelian Randomization Study","authors":"Zheng-Qi Song, Zhi-Bo Zhou, Bo-Xiang Wang, Sheng-Ke Wu, Yi-Han Sun, Yi-He Chen, Su-Yin Feng, Run-Feng Sun","doi":"10.1002/joa3.70241","DOIUrl":"https://doi.org/10.1002/joa3.70241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac arrhythmias pose a major health concern while the role of antidiabetic medications in cardiac arrhythmic risks is not fully understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a two-sample Mendelian Randomization (MR) analysis using genetic instruments extracted from hemoglobin A1C (HbA1c) as proxies for antidiabetic drug targets to evaluate their causal relationship with five cardiac arrhythmias derived from the Finngen database. Summary-data-based Mendelian randomization (SMR) utilizing gene expression data from the eQTLgen consortium was further employed to assess the role of antidiabetic drug targets in cardiac arrhythmias from the gene expression perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three significant associations were identified. Sulfonylurea targets KCNJ11/ABCC8 were associated with a decreased incidence of paroxysmal tachycardia (OR: 0.69, 95% CI: 0.56, 0.86, <i>P</i><sub>FDR</sub> = 0.022). Sodium-glucose cotransporter 2 inhibitor (SGLT2i) target SLC5A2 was linked to a reduced risk of right bundle branch block (OR: 0.85, 95% CI: 0.77, 0.94, PFDR = 0.022), and thiazolidinediones (TZDs) targeting RXRB were associated with a lowered atrial fibrillation occurrence (OR: 0.88, 95% CI: 0.82, 0.94, <i>P</i><sub>FDR</sub> = 0.019). No significant relationships were found between any antidiabetic drug targets and left bundle branch block or atrioventricular block. SMR analysis indicated that lowered expression of KCNJ11 was related to a decreased paroxysmal tachycardia risk (OR: 1.05, 95% CI: 1.01, 1.08, <i>P</i><sub>SMR</sub> = 0.010), further confirming the role of KCNJ11 in paroxysmal tachycardia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that several antidiabetic drug targets may have potential therapeutic applications in the management of cardiac arrhythmias.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70241","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695084","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}
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.
{"title":"Successful Treatment With Ivabradine for Junctional Ectopic Tachycardia–Induced Cardiomyopathy With Hypoplastic Left Heart Syndrome","authors":"Yuto Fukuda, Hisaaki Aoki, Kiyohiro Takigiku, Noboru Inamura","doi":"10.1002/joa3.70223","DOIUrl":"https://doi.org/10.1002/joa3.70223","url":null,"abstract":"<p>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.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695085","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}
Muhammad Shaheer Bin Faheem, Tehreem Asghar, Faheem Feroze, Fatima Naveed, Natasha Chowdhury, Sumaya Samadi, Muhammad Aamir Laghari, Jamal S. Rana, Marat Fudim
Background
Sudden cardiac arrest is a leading cause of cardiovascular mortality, often occurring without warning and resulting in high fatality rates. Despite advances in prevention and emergency response, disparities in mortality remain rampant across demographic and geographic groups. This study examines long-term trends in sudden cardiac arrest-related mortality in the United States from 1999 to 2023, stratified by sex, race/ethnicity, region, and urbanization level.
Methods
Mortality data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons using the 2000 U.S. standard population. Joinpoint regression analysis was applied to estimate annual percent changes (APCs) and identify significant shifts in mortality trends.
Results
A total of 8 523 980 SCA deaths were reported during the study period. Overall, the AAMR declined from 196.03 in 1999 to 131.55 in 2023, with the most marked reductions observed after 2021 (APC: –9.63; 95% CI: −13.51 to −5.20; p < 0.000001). Men consistently exhibited higher AAMRs than women (156.08 vs. 111.09 in 2023). Non-Hispanic Black individuals had the highest mortality rates (235.18), followed by Hispanics (184.38). Geographic disparities were evident, with the Northeast and metropolitan areas reporting the greatest AAMRs.
Conclusions
Mortality due to sudden cardiac arrest has declined substantially over the past 25 years, likely driven by improvements in cardiovascular prevention, acute care, and resuscitation practices. However, significant sex, racial, and regional disparities persist, highlighting the need for interventions that are tailored to reduce inequities and improve survival from sudden cardiac arrest.
{"title":"Trends in Mortalities due to Sudden Cardiac Arrest in the United States Population","authors":"Muhammad Shaheer Bin Faheem, Tehreem Asghar, Faheem Feroze, Fatima Naveed, Natasha Chowdhury, Sumaya Samadi, Muhammad Aamir Laghari, Jamal S. Rana, Marat Fudim","doi":"10.1002/joa3.70240","DOIUrl":"10.1002/joa3.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sudden cardiac arrest is a leading cause of cardiovascular mortality, often occurring without warning and resulting in high fatality rates. Despite advances in prevention and emergency response, disparities in mortality remain rampant across demographic and geographic groups. This study examines long-term trends in sudden cardiac arrest-related mortality in the United States from 1999 to 2023, stratified by sex, race/ethnicity, region, and urbanization level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mortality data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons using the 2000 U.S. standard population. Joinpoint regression analysis was applied to estimate annual percent changes (APCs) and identify significant shifts in mortality trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 8 523 980 SCA deaths were reported during the study period. Overall, the AAMR declined from 196.03 in 1999 to 131.55 in 2023, with the most marked reductions observed after 2021 (APC: –9.63; 95% CI: −13.51 to −5.20; <i>p</i> < 0.000001). Men consistently exhibited higher AAMRs than women (156.08 vs. 111.09 in 2023). Non-Hispanic Black individuals had the highest mortality rates (235.18), followed by Hispanics (184.38). Geographic disparities were evident, with the Northeast and metropolitan areas reporting the greatest AAMRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mortality due to sudden cardiac arrest has declined substantially over the past 25 years, likely driven by improvements in cardiovascular prevention, acute care, and resuscitation practices. However, significant sex, racial, and regional disparities persist, highlighting the need for interventions that are tailored to reduce inequities and improve survival from sudden cardiac arrest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668561","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}
Cardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%–3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia.
Methods
This retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in-hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection-related hospitalizations.
Results
We identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow-up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high-risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)-pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT-defibrillator patients).
Conclusions
Our findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.
{"title":"Economic Burden Associated With Cardiac Implantable Electronic Device (CIED) Infections in New South Wales, Australia: A Population-Based Study Using Linked Administrative Data","authors":"Md Shajedur Rahman Shawon, Behnoosh Hosseinloui Khalaj, Michelle Hill, Gabrielle Challis, Liesl Strachan, Louisa Jorm","doi":"10.1002/joa3.70237","DOIUrl":"10.1002/joa3.70237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%–3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in-hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection-related hospitalizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow-up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high-risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)-pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT-defibrillator patients).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668566","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}
Can Ozkan, Ozcan Ozeke, Ahmet Korkmaz, Dursun Aras, Serkan Topaloglu
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.
{"title":"Discrepant Versus Appropriate Responses to Differential Atrial Pacing in Atrioventricular Reentrant Tachycardia: What Is the Mechanism?","authors":"Can Ozkan, Ozcan Ozeke, Ahmet Korkmaz, Dursun Aras, Serkan Topaloglu","doi":"10.1002/joa3.70235","DOIUrl":"10.1002/joa3.70235","url":null,"abstract":"<p>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.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654319","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}
Ertan Aydin, Muhammed Mürsel Öğütveren, Gurbet Özge Mert, Mehtap Yeni, Sevil Gülaşti, Uğur Küçük, Başar Candemir, İbrahim Halil Tanboğa, Aymet Seyda Yilmaz
Objective
To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.
Methods
This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.
Results
Pre-existing AF (n = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; p = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; p < 0.001). Newly diagnosed AF (n = 216) more frequently presented with heart failure (45.8% vs. 28.4%; p < 0.001) and dyspnea (67.1% vs. 48.5%; p < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; p < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; p < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; p = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; p = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.
Conclusion
In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.
目的比较土耳其冠状动脉监护病房（CCUs）住院患者中已有（慢性）房颤（AF）和新诊断房颤（AF）的人口学、临床和实验室资料以及短期预后，并确定房颤亚型中住院死亡率的相关因素。这项多中心前瞻性国家登记分析纳入了土耳其七个地理区域50个CCU中心的540名连续房颤患者（MORCOR-TURK national registry; September 1 - 30,2022）。患者分为已存在的房颤（入院前或入院时记录的房颤）和新诊断的房颤（住院期间首次发现）。记录人口统计学、合并症、入院诊断、实验室生物标志物（包括NT-proBNP和hs-肌钙蛋白I）、管理和结果。多变量logistic回归确定了住院死亡率的独立预测因子。结果既往房颤（n = 324）患者糖尿病患病率（42.3%比31.5%,p = 0.012）和急性冠脉综合征患病率（58.6%比34.7%,p < 0.001）较高。新诊断的房颤（n = 216）更常出现心力衰竭（45.8% vs. 28.4%; p < 0.001）和呼吸困难（67.1% vs. 48.5%; p < 0.001）。新诊断的AF表现出较高的炎症负担（CRP中值28.4 vs 12.6 mg/L; p < 0.001）和较低的血红蛋白（11.8±2.1 vs 12.9±1.8 g/dL; p < 0.001）。两组患者NT-proBNP均升高，新诊断的AF患者NT-proBNP更高（中位数4850 vs 3240 pg/mL； p = 0.003）。新诊断为房颤的住院死亡率更高（12.0%比6.8%;p = 0.042）。独立的死亡率预测因素包括年龄、慢性肾病、心源性休克、log-转化NT-proBNP、hs-肌钙蛋白I和CRP。结论：在土耳其ccu中，已存在和新诊断的房颤构成不同的临床表型，具有不同的表现、生物标志物特征和短期风险。新诊断的房颤与更大的炎症和血流动力学应激以及更高的住院死亡率相关。生物标志物富集的风险分层可以改善AF亚型的预后和指导有针对性的管理。
{"title":"Clinical Profiles and In-Hospital Outcomes of Pre-Existing Versus Newly Diagnosed Atrial Fibrillation in Coronary Care Units: Insights From the MORCOR-TURK National Registry","authors":"Ertan Aydin, Muhammed Mürsel Öğütveren, Gurbet Özge Mert, Mehtap Yeni, Sevil Gülaşti, Uğur Küçük, Başar Candemir, İbrahim Halil Tanboğa, Aymet Seyda Yilmaz","doi":"10.1002/joa3.70238","DOIUrl":"https://doi.org/10.1002/joa3.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pre-existing AF (<i>n</i> = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; <i>p</i> = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; <i>p</i> < 0.001). Newly diagnosed AF (<i>n</i> = 216) more frequently presented with heart failure (45.8% vs. 28.4%; <i>p</i> < 0.001) and dyspnea (67.1% vs. 48.5%; <i>p</i> < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; <i>p</i> < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; <i>p</i> < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; <i>p</i> = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; <i>p</i> = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626348","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}
Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.
Objective
This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.
Methods
Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.
Results
In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.
Conclusion
Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.
{"title":"The Clinical Utility of 3D Electroanatomical Mapping for Atrial Fibrillation Ablation by Pulsed Field Ablation","authors":"Robert N. Kerley, David Keane","doi":"10.1002/joa3.70234","DOIUrl":"https://doi.org/10.1002/joa3.70234","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626202","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}
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