Chronic kidney disease (CKD) increases cardiac arrest (CA) risk because of renal and cardiovascular interactions.
Methods
Using Centers for Disease Control and Prevention (CDC) data from 1999 to 2020, we analyzed CKD-related CA mortality and the impact of social vulnerability index (SVI).
Results
We identified 336 494 CKD-related CA deaths, with stable age-adjusted mortality rates over time. Disparities were observed across gender, racial/ethnic, and geographic subpopulations, with higher mortality among males, Hispanic and non-Hispanic Black populations, and those in urban and Western regions. Higher SVI correlated with increased mortality.
Conclusions
CKD-related CA mortality rates are stable, with disparities across demographics; higher SVI correlates with increased mortality, highlighting needed interventions.
{"title":"Disparities in cardiac arrest mortality among patients with chronic kidney disease: A US-based epidemiological analysis","authors":"Mahek Shahid MD, Hoang Nhat Pham MD, Ramzi Ibrahim MD, Enkhtsogt Sainbayar DO, Mahmoud Abdelnabi MBBCh, MSc, Girish Pathangey MD, Amitoj Singh MD","doi":"10.1002/joa3.13217","DOIUrl":"10.1002/joa3.13217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) increases cardiac arrest (CA) risk because of renal and cardiovascular interactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Centers for Disease Control and Prevention (CDC) data from 1999 to 2020, we analyzed CKD-related CA mortality and the impact of social vulnerability index (SVI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 336 494 CKD-related CA deaths, with stable age-adjusted mortality rates over time. Disparities were observed across gender, racial/ethnic, and geographic subpopulations, with higher mortality among males, Hispanic and non-Hispanic Black populations, and those in urban and Western regions. Higher SVI correlated with increased mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CKD-related CA mortality rates are stable, with disparities across demographics; higher SVI correlates with increased mortality, highlighting needed interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006023","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}
Ogiso and colleagues demonstrated that nonsustained ventricular tachycardia (NSVT) is associated with an increased risk of heart failure hospitalization in patients without structural heart disease.1 However, several critical concerns warrant further discussion.
A comprehensive methodology detailing the approach to confirm the absence of structural heart disease should be provided. Importantly, various cardiac pathologies with preserved left ventricular ejection fraction cannot be definitively excluded without comprehensive testing. For instance, epicardial cardiomyopathy cannot be ruled out without advanced diagnostic modalities, such as cardiac magnetic resonance imaging and genetic testing.2
The burden of premature ventricular contractions (PVCs) is a well-documented contributor to systolic dysfunction, with a commonly proposed threshold exceeding 20%.3 In this study, however, the total number of PVCs was categorized into tertiles,1 which may limit the precision of the analysis.
Differentiating PVCs with aberrant conduction in patients with atrial fibrillation using Holter electrocardiography presents significant challenges.4 A detailed description of the methodology used to distinguish these phenomena is essential for reproducibility and validity. Additionally, the rationale for administering class III antiarrhythmic agents in patients reportedly free of structural heart disease remains unclear and requires elucidation.
The causal relationship between NSVT and the development of heart failure remains ambiguous.1 Notably, most heart failure hospitalizations occurred within 1 year of observation. It is plausible that patients experiencing elevated left ventricular end-diastolic pressure may develop NSVT as a secondary manifestation. In such cases, subclinical heart failure could potentially be identified through detailed investigations, including chest X-rays, B-type natriuretic peptide levels, and comprehensive echocardiography.
Finally, if PVCs serve merely as bystanders of underlying cardiac pathology, the efficacy of aggressive therapeutic interventions targeting NSVT and PVCs in improving clinical outcomes becomes questionable.
The authors declare no conflicts of interest.
{"title":"The causality between premature ventricular contraction and heart failure","authors":"Naoya Kataoka MD, Teruhiko Imamura MD","doi":"10.1002/joa3.13218","DOIUrl":"10.1002/joa3.13218","url":null,"abstract":"<p>To editor:</p><p>Ogiso and colleagues demonstrated that nonsustained ventricular tachycardia (NSVT) is associated with an increased risk of heart failure hospitalization in patients without structural heart disease.<span><sup>1</sup></span> However, several critical concerns warrant further discussion.</p><p>A comprehensive methodology detailing the approach to confirm the absence of structural heart disease should be provided. Importantly, various cardiac pathologies with preserved left ventricular ejection fraction cannot be definitively excluded without comprehensive testing. For instance, epicardial cardiomyopathy cannot be ruled out without advanced diagnostic modalities, such as cardiac magnetic resonance imaging and genetic testing.<span><sup>2</sup></span></p><p>The burden of premature ventricular contractions (PVCs) is a well-documented contributor to systolic dysfunction, with a commonly proposed threshold exceeding 20%.<span><sup>3</sup></span> In this study, however, the total number of PVCs was categorized into tertiles,<span><sup>1</sup></span> which may limit the precision of the analysis.</p><p>Differentiating PVCs with aberrant conduction in patients with atrial fibrillation using Holter electrocardiography presents significant challenges.<span><sup>4</sup></span> A detailed description of the methodology used to distinguish these phenomena is essential for reproducibility and validity. Additionally, the rationale for administering class III antiarrhythmic agents in patients reportedly free of structural heart disease remains unclear and requires elucidation.</p><p>The causal relationship between NSVT and the development of heart failure remains ambiguous.<span><sup>1</sup></span> Notably, most heart failure hospitalizations occurred within 1 year of observation. It is plausible that patients experiencing elevated left ventricular end-diastolic pressure may develop NSVT as a secondary manifestation. In such cases, subclinical heart failure could potentially be identified through detailed investigations, including chest X-rays, B-type natriuretic peptide levels, and comprehensive echocardiography.</p><p>Finally, if PVCs serve merely as bystanders of underlying cardiac pathology, the efficacy of aggressive therapeutic interventions targeting NSVT and PVCs in improving clinical outcomes becomes questionable.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005433","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}
Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.
{"title":"Once a saint, now a sinner: An appropriate or inappropriate shock?","authors":"Sudipta Mondal MD, DM, Swasthi S. Kumar MD, Jyothi Vijay MD, DM, Narayanan Namboodiri MD, DM","doi":"10.1002/joa3.13209","DOIUrl":"10.1002/joa3.13209","url":null,"abstract":"<p>Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006103","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}
Hironori Nakamura MD, PhD, Hidehira Fukaya MD, PhD, Naruya Ishizue MD, PhD, Jun Kishihara MD, PhD, Junya Ako MD, PhD
We report a case of long RP′ tachycardia diagnosed as fast–slow atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander nodoventricular pathway (NVP). Differential responses to right ventricular extrastimuli from the base and apex highlighted the anatomical proximity of the NVP attachment, contributing to the diagnosis.
{"title":"Differential response to right ventricular extrastimuli from the base and apex during long RP′ supraventricular tachycardia","authors":"Hironori Nakamura MD, PhD, Hidehira Fukaya MD, PhD, Naruya Ishizue MD, PhD, Jun Kishihara MD, PhD, Junya Ako MD, PhD","doi":"10.1002/joa3.13214","DOIUrl":"10.1002/joa3.13214","url":null,"abstract":"<p>We report a case of long RP′ tachycardia diagnosed as fast–slow atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander nodoventricular pathway (NVP). Differential responses to right ventricular extrastimuli from the base and apex highlighted the anatomical proximity of the NVP attachment, contributing to the diagnosis.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006019","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}
Hisashi Yokoshiki MD, PhD, Akihiko Shimizu MD, PhD, Takeshi Mitsuhashi MD, PhD, Kohei Ishibashi MD, PhD, Tomoyuki Kabutoya MD, PhD, Yasuhiro Yoshiga MD, PhD, Yusuke Kondo MD, PhD, Taro Temma MD, PhD, Masahiko Takagi MD, PhD, Hiroshi Tada MD, PhD, Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society
Background
Accurate prediction for survival in individualized patients with cardiac resynchronization therapy with a defibrillator (CRT-D) is difficult.
Methods
We analyzed the New Japan cardiac device treatment registry (JCDTR) database to develop a survival prediction model for CRT-D recipients.
Results
Four hundred and eighty-two CRT-D recipients, at the implantation year 2018–2021, with a QRS width ≥120 ms and left ventricular ejection fraction (LVEF) ≤35% at baseline, were analyzed. During an average follow-up of 21 ± 10 months, death occurred in 66 of 482 CRT-D patients (14%). A prediction model estimating annual survival probability was developed using Cox regression with internal validation. With seven explanation predictors (age >75 years, serum creatinine >1.4 mg/dL, blood hemoglobin <12 g/dL, heart rate ≥90/min, LVEF, prior NSVT, and QRS width <150 ms), the model distinguished patients with and without all-cause death, with an optimism-corrected C-statistics of 0.766, 0.764, and 0.768, and calibration slope of 1.01, 1.00, and 1.00 at 1 year, 2 years, and 3 years. Additionally, we have devised the calculator of survival probability for individual CRT-D recipients.
Conclusions
Using routine available variables, we have developed a survival prediction model for individual CRT-D recipients.
{"title":"A novel prediction model for survival in individual patients with cardiac resynchronization therapy with a defibrillator: Analysis of the new Japan cardiac device treatment registry database","authors":"Hisashi Yokoshiki MD, PhD, Akihiko Shimizu MD, PhD, Takeshi Mitsuhashi MD, PhD, Kohei Ishibashi MD, PhD, Tomoyuki Kabutoya MD, PhD, Yasuhiro Yoshiga MD, PhD, Yusuke Kondo MD, PhD, Taro Temma MD, PhD, Masahiko Takagi MD, PhD, Hiroshi Tada MD, PhD, Members of the Implantable Cardioverter-Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society","doi":"10.1002/joa3.13213","DOIUrl":"10.1002/joa3.13213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate prediction for survival in individualized patients with cardiac resynchronization therapy with a defibrillator (CRT-D) is difficult.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the New Japan cardiac device treatment registry (JCDTR) database to develop a survival prediction model for CRT-D recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred and eighty-two CRT-D recipients, at the implantation year 2018–2021, with a QRS width ≥120 ms and left ventricular ejection fraction (LVEF) ≤35% at baseline, were analyzed. During an average follow-up of 21 ± 10 months, death occurred in 66 of 482 CRT-D patients (14%). A prediction model estimating annual survival probability was developed using Cox regression with internal validation. With seven explanation predictors (age >75 years, serum creatinine >1.4 mg/dL, blood hemoglobin <12 g/dL, heart rate ≥90/min, LVEF, prior NSVT, and QRS width <150 ms), the model distinguished patients with and without all-cause death, with an optimism-corrected C-statistics of 0.766, 0.764, and 0.768, and calibration slope of 1.01, 1.00, and 1.00 at 1 year, 2 years, and 3 years. Additionally, we have devised the calculator of survival probability for individual CRT-D recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using routine available variables, we have developed a survival prediction model for individual CRT-D recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005770","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}
The non-vitamin K oral anticoagulant (NOAC), edoxaban, is approved for stroke prevention in patients with atrial fibrillation (AF) in many Asian countries. Nonetheless, data on its long-term effectiveness and safety in routine clinical practice are limited in Taiwan.
Methods
The Global ETNA-AF (Edoxaban Treatment in routiNe clinical prActice) registry is an observational study that integrates data of AF patients receiving edoxaban from multiple regional registries. Here, we report the subgroup analysis of two-year outcomes in Taiwan (N = 973) and three Asian countries (South Korea, Hong Kong, Thailand; N = 2326).
Results
Compared with other Asian ethnicities, edoxaban users in Taiwan were older and had lower creatinine clearance levels. The incidence of clinical events was low and comparable in four Asian countries. Upon 2 years of observation, the annualized rates of cardiovascular death and ischemic stroke/systemic embolic event were 0.50% and 0.90% in Taiwan and 0.33% and 0.91% in other Asian ethnicities, respectively. The annualized rates of major/clinically relevant non-major bleeding and major gastrointestinal bleeding were 2.06% and 0.39% in Taiwan and 2.06% and 0.49% in other Asian ethnicities, respectively. Intracranial hemorrhage was rarely reported in four Asian countries (annualized rate: 0.35%).
Conclusions
Although some differences in patient characteristics were observed among Asian ethnicities, the low clinical event rates in two-year ETNA-AF data reassure the effectiveness and safety of edoxaban in routine care for AF patients in Taiwan, South Korea, Hong Kong, and Thailand.
{"title":"Two-year clinical outcomes of Taiwanese and other Asian ethnicities with atrial fibrillation treated with edoxaban in the ETNA-AF Asia registry","authors":"Chun-Chieh Wang, Cheng-I Cheng, Kwo-Chang Ueng, Wei-Shiang Lin, Tze-Fan Chao, Lian-Yu Lin, Chien-Lung Huang, Kuan-Cheng Chang, Guang-Yuan Mar, Yu-Cheng Hsieh, Martin Unverdorben, Cathy Chen","doi":"10.1002/joa3.13212","DOIUrl":"10.1002/joa3.13212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The non-vitamin K oral anticoagulant (NOAC), edoxaban, is approved for stroke prevention in patients with atrial fibrillation (AF) in many Asian countries. Nonetheless, data on its long-term effectiveness and safety in routine clinical practice are limited in Taiwan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Global ETNA-AF (Edoxaban Treatment in routiNe clinical prActice) registry is an observational study that integrates data of AF patients receiving edoxaban from multiple regional registries. Here, we report the subgroup analysis of two-year outcomes in Taiwan (<i>N</i> = 973) and three Asian countries (South Korea, Hong Kong, Thailand; <i>N</i> = 2326).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with other Asian ethnicities, edoxaban users in Taiwan were older and had lower creatinine clearance levels. The incidence of clinical events was low and comparable in four Asian countries. Upon 2 years of observation, the annualized rates of cardiovascular death and ischemic stroke/systemic embolic event were 0.50% and 0.90% in Taiwan and 0.33% and 0.91% in other Asian ethnicities, respectively. The annualized rates of major/clinically relevant non-major bleeding and major gastrointestinal bleeding were 2.06% and 0.39% in Taiwan and 2.06% and 0.49% in other Asian ethnicities, respectively. Intracranial hemorrhage was rarely reported in four Asian countries (annualized rate: 0.35%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although some differences in patient characteristics were observed among Asian ethnicities, the low clinical event rates in two-year ETNA-AF data reassure the effectiveness and safety of edoxaban in routine care for AF patients in Taiwan, South Korea, Hong Kong, and Thailand.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005846","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 video demonstration presents the retrieval of a dislodged leadless pacemaker using the double-snare technique. Sharing troubleshooting strategies in such cases is clinically important for managing rare pacemaker complications.
{"title":"Retrieval of a dislodged leadless pacemaker: An example of the double-snare technique","authors":"Momo Taira, Hiroshi Kawakami MD, PhD, Yasushi Asagi, Kazuhisa Nishimura MD, PhD, Osamu Yamaguchi MD, PhD","doi":"10.1002/joa3.13210","DOIUrl":"10.1002/joa3.13210","url":null,"abstract":"<p>A video demonstration presents the retrieval of a dislodged leadless pacemaker using the double-snare technique. Sharing troubleshooting strategies in such cases is clinically important for managing rare pacemaker complications.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005105","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}
Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.
This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.
Methods
Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.
Results
Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, I2: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, I2: 4%) for LP implantation after CIED extraction (p = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, I2: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, I2: 21%) after extraction (p = 0.008). Reinfection was not observed in any of these studies.
Conclusion
Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.
{"title":"Assessment of adverse events stratified by timing of leadless pacemaker implantation with cardiac implantable electronic devices extraction due to infection: A systematic review and meta-analysis","authors":"Naoya Inoue MD, Yuji Ito MD, Takahiro Imaizumi MD, Shuji Morikawa MD, Toyoaki Murohara MD, PhD","doi":"10.1002/joa3.13208","DOIUrl":"10.1002/joa3.13208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.</p>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, <i>I</i><sup>2</sup>: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, <i>I</i><sup>2</sup>: 4%) for LP implantation after CIED extraction (<i>p</i> = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, <i>I</i><sup>2</sup>: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, <i>I</i><sup>2</sup>: 21%) after extraction (<i>p</i> = 0.008). Reinfection was not observed in any of these studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005930","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>We have read with great interest the article by Kumar et al., titled “Atrial Arrhythmias with Mediastinal Lymphadenopathy: Presentation of Isolated Atrial Myocarditis,” published in <i>Journal of Arrhythmia</i> (2024). The work provides valuable insights into the relationship between atrial arrhythmias and isolated atrial myocarditis (AM), emphasizing the relevance of this connection in young patients without conventional risk factors. The authors are to be commended for their efforts in addressing the diagnostic and therapeutic challenges posed by this condition. They aptly conclude that granulomatous myocarditis caused by sarcoidosis or tuberculosis should be considered the primary cause of atrial inflammation and its subsequent role in arrhythmogenesis.</p><p>The study employs a comprehensive approach to diagnosing AM in patients with unexplained atrial arrhythmias, utilizing a combination of histopathological examination and <sup>18</sup>F-FDG PET/CT. This methodology proves invaluable in distinguishing AM from other inflammatory and structural heart diseases. A particular strength of this work is the clear correlation established between imaging findings and clinical or histopathological data. The authors effectively employ a diagnostic algorithm that integrates atrial imaging, biopsy, and clinical assessment, thereby offering a systematic framework for diagnosis.</p><p>Another noteworthy aspect of the study is the emphasis on individualized treatment plans. Immunosuppressive therapy, including corticosteroids and methotrexate for patients with sarcoidosis, as well as anti-tuberculous regimens for those with <i>Mycobacterium tuberculosis</i>, demonstrated significant clinical benefits. These interventions led to improvements in functional class, reductions in inflammatory markers, and the reversal of abnormal imaging findings, highlighting the therapeutic potential of these strategies. Furthermore, the authors' insights into the management of anticoagulation therapy for stroke prevention in patients with atrial arrhythmias are particularly relevant, as 26.7% of the patients in the study presented with ischemic strokes. This underscores the importance of vigilant monitoring and tailored management in this patient population.</p><p>Kumar et al. also highlights the potential of AM to serve as an independent substrate for atrial arrhythmias, even in the absence of common risk factors. This observation aligns with previous studies suggesting that inflammation, particularly granulomatous inflammation, can interfere with atrial electrophysiological properties and promote arrhythmogenesis.<span><sup>1, 2</sup></span> Granulomatous infiltration has been shown to remodel atrial tissue, leading to electrical disturbances and an increased thromboembolic risk.<span><sup>3</sup></span> Kumar et al.'s work reinforces these findings and provides clinical data that support the inflammatory hypothesis of arrhythmogenesis.</p><p>While the study offers signi
{"title":"Atrial arrhythmias with mediastinal lymphadenopathy presentation of isolated atrial myocarditis","authors":"Muneeb Khawar MBBS, Mirza Muhammad Hadeed Khawar MBBS, Hannan Saeed MBBS","doi":"10.1002/joa3.13206","DOIUrl":"10.1002/joa3.13206","url":null,"abstract":"<p>We have read with great interest the article by Kumar et al., titled “Atrial Arrhythmias with Mediastinal Lymphadenopathy: Presentation of Isolated Atrial Myocarditis,” published in <i>Journal of Arrhythmia</i> (2024). The work provides valuable insights into the relationship between atrial arrhythmias and isolated atrial myocarditis (AM), emphasizing the relevance of this connection in young patients without conventional risk factors. The authors are to be commended for their efforts in addressing the diagnostic and therapeutic challenges posed by this condition. They aptly conclude that granulomatous myocarditis caused by sarcoidosis or tuberculosis should be considered the primary cause of atrial inflammation and its subsequent role in arrhythmogenesis.</p><p>The study employs a comprehensive approach to diagnosing AM in patients with unexplained atrial arrhythmias, utilizing a combination of histopathological examination and <sup>18</sup>F-FDG PET/CT. This methodology proves invaluable in distinguishing AM from other inflammatory and structural heart diseases. A particular strength of this work is the clear correlation established between imaging findings and clinical or histopathological data. The authors effectively employ a diagnostic algorithm that integrates atrial imaging, biopsy, and clinical assessment, thereby offering a systematic framework for diagnosis.</p><p>Another noteworthy aspect of the study is the emphasis on individualized treatment plans. Immunosuppressive therapy, including corticosteroids and methotrexate for patients with sarcoidosis, as well as anti-tuberculous regimens for those with <i>Mycobacterium tuberculosis</i>, demonstrated significant clinical benefits. These interventions led to improvements in functional class, reductions in inflammatory markers, and the reversal of abnormal imaging findings, highlighting the therapeutic potential of these strategies. Furthermore, the authors' insights into the management of anticoagulation therapy for stroke prevention in patients with atrial arrhythmias are particularly relevant, as 26.7% of the patients in the study presented with ischemic strokes. This underscores the importance of vigilant monitoring and tailored management in this patient population.</p><p>Kumar et al. also highlights the potential of AM to serve as an independent substrate for atrial arrhythmias, even in the absence of common risk factors. This observation aligns with previous studies suggesting that inflammation, particularly granulomatous inflammation, can interfere with atrial electrophysiological properties and promote arrhythmogenesis.<span><sup>1, 2</sup></span> Granulomatous infiltration has been shown to remodel atrial tissue, leading to electrical disturbances and an increased thromboembolic risk.<span><sup>3</sup></span> Kumar et al.'s work reinforces these findings and provides clinical data that support the inflammatory hypothesis of arrhythmogenesis.</p><p>While the study offers signi","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005992","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}
Current guidelines recommend cardioverter-defibrillator (ICD) programming, including faster detection rates, longer detection durations, and strict discrimination for supraventricular tachycardia (SVT) to prevent unnecessary ICD treatment. This delayed-style ICD programming could lead to a rise in the possibility of VF undersensing. To avoid this risk, an innovative algorithm known as VF Therapy Assurance (VFTA; Abbott, Sylmar, CA) has been developed. VFTA uses far-field R-wave signals during VT or VF episodes to provide ICD therapy in cases of near-field R-wave signal undersensing.
{"title":"Utility of using far-field R-wave signals in the detection of fatal ventricular arrhythmia","authors":"Yousaku Okubo MD, PhD, Hisayasu Matsuzaki BE, Shogo Miyamoto MD, Sho Okamura MD, PhD, Yukiko Nakano MD, PhD","doi":"10.1002/joa3.13207","DOIUrl":"10.1002/joa3.13207","url":null,"abstract":"<p>Current guidelines recommend cardioverter-defibrillator (ICD) programming, including faster detection rates, longer detection durations, and strict discrimination for supraventricular tachycardia (SVT) to prevent unnecessary ICD treatment. This delayed-style ICD programming could lead to a rise in the possibility of VF undersensing. To avoid this risk, an innovative algorithm known as VF Therapy Assurance (VFTA; Abbott, Sylmar, CA) has been developed. VFTA uses far-field R-wave signals during VT or VF episodes to provide ICD therapy in cases of near-field R-wave signal undersensing.\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 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005821","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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