<p>This is an editorial comment to “An extremely wide QRS complex tachycardia induced by anamorelin.” presented by Shimojo et al.<span><sup>1</sup></span> in the current issue of <i>Journal of Arrhythmia</i>.</p><p>Cancer cachexia is a multifocal syndrome in patients with cancer characterized by reduced muscle mass and malnutrition, causing progressive functional disability and reduced quality of life. Conventional nutritional support cannot completely reverse cancer cachexia, and useful pharmacologic therapies for cachexia management are limited. Since 2021, anamorelin has been licensed for production and marketing in Japan as a pharmacologic therapy for cancer cachexia. Anamorelin functions as a ghrelin-like agonist and may stimulate the secretion of growth hormones and appetite by activating the ghrelin receptor, known as growth hormone release promoting factor receptor type 1a (GHS-R1a). Anamorelin is a drug of interest in the field of cancer cachexia, as several randomized controlled trials have demonstrated efficacy in improving total body weight, lean body mass, quality of life, and appetite in patients with refractory cancer compared with placebo.<span><sup>2, 3</sup></span> In all adverse events or serious adverse events, the investigators reported no significant differences in terms of safety.<span><sup>2, 3</sup></span> However, this drug exhibited serious side effects, such as conduction disturbance, hyperglycemia, diabetes worsening, and hepatic dysfunction; thus, patient selection and posttreatment monitoring are very important.</p><p>Anamorelin generally demonstrates an inhibitory effect on the conduction system because of its Na channel-blocking properties. Therefore, electrocardiographic abnormalities, atrioventricular block, tachycardia, and bradycardia may appear after anamorelin administration. Additionally, anamorelin is contraindicated in patients with heart failure, ischemic heart disease, severe conduction disturbance, and moderate-to-severe hepatic dysfunction. It is administered cautiously to those with a history or risk of QT prolongation and those with conduction disturbances. Periodic electrocardiogram (ECG), pulse, and blood pressure measurements are warranted after anamorelin administration. The mechanism behind anamorelin's proarrhythmic effects remains unknown, but weak binding to sodium channels and L-type calcium channels was revealed.<span><sup>4</sup></span> Decreased sodium current may predispose to sudden cardiac death, as studies on arrhythmia suppression have demonstrated that sodium channel blockers increase the incidence of sudden cardiac death. Sodium channel blockade-induced conduction disturbances may cause reentrant arrhythmias because of excitability gap widening.</p><p>In the current issue of the <i>Journal of Arrhytumia</i>, Shimojo et al. reported a case of drug-induced wide QRS tachycardia by anamorelin.<span><sup>1</sup></span> Healthcare provider should understand the risk of conduction distur
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{"title":"Editorial to “An extremely wide QRS complex tachycardia induced by anamorelin”","authors":"Shujiro Inoue MD, PhD","doi":"10.1002/joa3.13091","DOIUrl":"10.1002/joa3.13091","url":null,"abstract":"<p>This is an editorial comment to “An extremely wide QRS complex tachycardia induced by anamorelin.” presented by Shimojo et al.<span><sup>1</sup></span> in the current issue of <i>Journal of Arrhythmia</i>.</p><p>Cancer cachexia is a multifocal syndrome in patients with cancer characterized by reduced muscle mass and malnutrition, causing progressive functional disability and reduced quality of life. Conventional nutritional support cannot completely reverse cancer cachexia, and useful pharmacologic therapies for cachexia management are limited. Since 2021, anamorelin has been licensed for production and marketing in Japan as a pharmacologic therapy for cancer cachexia. Anamorelin functions as a ghrelin-like agonist and may stimulate the secretion of growth hormones and appetite by activating the ghrelin receptor, known as growth hormone release promoting factor receptor type 1a (GHS-R1a). Anamorelin is a drug of interest in the field of cancer cachexia, as several randomized controlled trials have demonstrated efficacy in improving total body weight, lean body mass, quality of life, and appetite in patients with refractory cancer compared with placebo.<span><sup>2, 3</sup></span> In all adverse events or serious adverse events, the investigators reported no significant differences in terms of safety.<span><sup>2, 3</sup></span> However, this drug exhibited serious side effects, such as conduction disturbance, hyperglycemia, diabetes worsening, and hepatic dysfunction; thus, patient selection and posttreatment monitoring are very important.</p><p>Anamorelin generally demonstrates an inhibitory effect on the conduction system because of its Na channel-blocking properties. Therefore, electrocardiographic abnormalities, atrioventricular block, tachycardia, and bradycardia may appear after anamorelin administration. Additionally, anamorelin is contraindicated in patients with heart failure, ischemic heart disease, severe conduction disturbance, and moderate-to-severe hepatic dysfunction. It is administered cautiously to those with a history or risk of QT prolongation and those with conduction disturbances. Periodic electrocardiogram (ECG), pulse, and blood pressure measurements are warranted after anamorelin administration. The mechanism behind anamorelin's proarrhythmic effects remains unknown, but weak binding to sodium channels and L-type calcium channels was revealed.<span><sup>4</sup></span> Decreased sodium current may predispose to sudden cardiac death, as studies on arrhythmia suppression have demonstrated that sodium channel blockers increase the incidence of sudden cardiac death. Sodium channel blockade-induced conduction disturbances may cause reentrant arrhythmias because of excitability gap widening.</p><p>In the current issue of the <i>Journal of Arrhytumia</i>, Shimojo et al. reported a case of drug-induced wide QRS tachycardia by anamorelin.<span><sup>1</sup></span> Healthcare provider should understand the risk of conduction distur","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"786-787"},"PeriodicalIF":2.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265690","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>Frail patients with non-valvular atrial fibrillation (NVAF) are a growing population in super-aged societies such as Japan, posing treatment and management challenges. Catheter ablation (CA) for atrial fibrillation (AF) is a widely accepted therapy that has recently been shown to improve symptoms, quality of life, and clinical outcomes compared to medical treatment. However, there is a need for discussion regarding whether CA is a treatment option that can be actively proposed for elderly people, especially frail elderly patients with AF. In this issue of the journal, Soejima et al.<span><sup>1</sup></span> presented new insights into the improvement of frailty after CA in patients with NVAF.</p><p>There are skeptical views on the active indication of CA for AF in the elderly owing to the increased complications,<span><sup>2</sup></span> and there have been concerns particularly negative opinions have been shown in the past for frail patients. In the United States, a retrospective study using Medicare fee-for-service billing codes has been conducted on the prognosis of frail patients who received CA for AF.<span><sup>3</sup></span> Among the 5070 patients who received CA, 1955 were judged to be frail based on the Hospital Frailty Risk Score. The long-term mortality rates (up to 630 days) in a group of patients with a mean age of 74.9 years increased as the frailty risk score increased. Restricted cubic spline regression analysis revealed an adjusted hazard ratio for long-term mortality of 1.065 (95% CI: 1.054–1.077). Another retrospective study using the National Health Insurance Service claims database in Korea examined the therapeutic effects of CA and medication treatment in frail and non-frail elderly patients with AF.<span><sup>4</sup></span> Over a median follow-up of 28 months, the risk of all-cause death and composite outcomes including heart failure admission, stroke/systemic embolism, and sudden cardiac arrest were evaluated. While CA reduced the risk of these outcomes in non-frail patients, it did not show a beneficial effect in frail patients. These findings suggest that clinicians should avoid invasive treatments such as CA when managing frail patients.</p><p>Soejima et al.<span><sup>1</sup></span> conducted sub-analysis of the RYOUMA registry,<span><sup>5</sup></span> a multi-center prospective observational study on perioperative and long-term anticoagulation therapy management of CA in patients with AF in Japan, and yielded different results. They evaluated frailty in elderly patients who received CA for NVAF with a simple 5-item frailty index and analyzed the outcomes of CA for each degree of frailty. Of 3027 patients in the RYOUMA registry,<span><sup>5</sup></span> 203 who completed the 5-item frailty index were analyzed. Among them, 26 patients (12.8%) were frail, 109 patients (53.7%) were pre-frail, and 68 patients (33.5%) were robust. In all groups, the rate of freedom from AF recurrence up to 6 months was relatively good,
{"title":"Editorial to “Impact of frailty in patients with non-valvular atrial fibrillation undergoing catheter ablation”","authors":"Sayaka Kurokawa MD, Yasuo Okumura MD","doi":"10.1002/joa3.13074","DOIUrl":"10.1002/joa3.13074","url":null,"abstract":"<p>Frail patients with non-valvular atrial fibrillation (NVAF) are a growing population in super-aged societies such as Japan, posing treatment and management challenges. Catheter ablation (CA) for atrial fibrillation (AF) is a widely accepted therapy that has recently been shown to improve symptoms, quality of life, and clinical outcomes compared to medical treatment. However, there is a need for discussion regarding whether CA is a treatment option that can be actively proposed for elderly people, especially frail elderly patients with AF. In this issue of the journal, Soejima et al.<span><sup>1</sup></span> presented new insights into the improvement of frailty after CA in patients with NVAF.</p><p>There are skeptical views on the active indication of CA for AF in the elderly owing to the increased complications,<span><sup>2</sup></span> and there have been concerns particularly negative opinions have been shown in the past for frail patients. In the United States, a retrospective study using Medicare fee-for-service billing codes has been conducted on the prognosis of frail patients who received CA for AF.<span><sup>3</sup></span> Among the 5070 patients who received CA, 1955 were judged to be frail based on the Hospital Frailty Risk Score. The long-term mortality rates (up to 630 days) in a group of patients with a mean age of 74.9 years increased as the frailty risk score increased. Restricted cubic spline regression analysis revealed an adjusted hazard ratio for long-term mortality of 1.065 (95% CI: 1.054–1.077). Another retrospective study using the National Health Insurance Service claims database in Korea examined the therapeutic effects of CA and medication treatment in frail and non-frail elderly patients with AF.<span><sup>4</sup></span> Over a median follow-up of 28 months, the risk of all-cause death and composite outcomes including heart failure admission, stroke/systemic embolism, and sudden cardiac arrest were evaluated. While CA reduced the risk of these outcomes in non-frail patients, it did not show a beneficial effect in frail patients. These findings suggest that clinicians should avoid invasive treatments such as CA when managing frail patients.</p><p>Soejima et al.<span><sup>1</sup></span> conducted sub-analysis of the RYOUMA registry,<span><sup>5</sup></span> a multi-center prospective observational study on perioperative and long-term anticoagulation therapy management of CA in patients with AF in Japan, and yielded different results. They evaluated frailty in elderly patients who received CA for NVAF with a simple 5-item frailty index and analyzed the outcomes of CA for each degree of frailty. Of 3027 patients in the RYOUMA registry,<span><sup>5</sup></span> 203 who completed the 5-item frailty index were analyzed. Among them, 26 patients (12.8%) were frail, 109 patients (53.7%) were pre-frail, and 68 patients (33.5%) were robust. In all groups, the rate of freedom from AF recurrence up to 6 months was relatively good,","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"792-793"},"PeriodicalIF":2.2,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975743","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}