Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity.
Case
A 76-year-old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre-fixation mapping to avoid the VSD patch.
Conclusion
This case illustrates the effectiveness of pre-mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.
{"title":"Successful Leadless Pacemaker Implantation After Lead Extraction in a Patient With Ventricular Septal Defect Patch","authors":"Keigo Misonou, Michio Nagashima, Hiroyuki Kono, Koumei Onuki, Maiko Kuroda, Jun Hirokami, Rei Kuji, Tomonori Katsuki, Kengo Korai, Masato Fukunaga, Kenichi Hiroshima, Kenji Ando","doi":"10.1002/joa3.70231","DOIUrl":"https://doi.org/10.1002/joa3.70231","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>A 76-year-old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre-fixation mapping to avoid the VSD patch.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case illustrates the effectiveness of pre-mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70231","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619066","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}
Heart rate score (HrSc) ≥ 70% reflects chronotropic incompetence and predicts prognosis in patients with cardiac implantable electronic devices (CIEDs) and left ventricular (LV) systolic dysfunction. However, its prognostic value in Japanese patients remains underexplored, and longitudinal changes in HrSc and their contributing factors are poorly characterized.
Methods
This post hoc analysis of the Heart Failure Indication and Sudden Cardiac Death Prevention Trial in Japan (HINODE) included 172 patients with CIEDs and LV ejection fraction ≤ 50%. HrSc, defined as the percentage of all atrial-paced and sensed beats in a single tallest 10 beat/min device histogram bin, was assessed using remote monitoring.
Results
At baseline, the median HrSc was 53% (interquartile range, 41%–83%), with 68 (39.5%) patients having HrSc ≥ 70%. During the 2-year follow-up, the incidence of all-cause death or heart failure (HF) events was similar between patients with HrSc ≥ 70% and < 70% (31.1% vs. 29.4%, log-rank p = 0.862). However, among 142 patients whose follow-up data were available, HrSc increased from < 70% to ≥ 70% in 13 patients (13%) and decreased from ≥ 70% to < 70% in 19 (9.1%). An increase in HrSc was associated with lower LV ejection fraction, antiarrhythmic drug initiation, increased lower rate limit, and HF events.
Conclusion
In the HINODE study, baseline HrSc ≥ 70% was not predictive of 2-year cardiovascular outcomes. However, HrSc changed in approximately one-quarter of patients and was associated with clinical and device-related factors, as well as HF events. HrSc is not a static measure but a dynamic marker that reflects evolving patient conditions and CIED programming.
{"title":"Prognostic Implications of Heart Rate Score and Its Temporal Change in Left Ventricular Systolic Dysfunction: Insights From the HINODE Study","authors":"Masato Okada, Koichi Inoue, Nobuaki Tanaka, Koji Tanaka, Yuko Hirao, Torri Schwartz, Torsten Kayser, Akihiko Nogami, Takeshi Mitsuhashi, Toyoaki Murohara, Wataru Shimizu, Takanori Ikeda, Nobuhiro Nishii, Kenji Ando, Yasushi Sakata, Kazutaka Aonuma, the HINODE Investigators","doi":"10.1002/joa3.70216","DOIUrl":"10.1002/joa3.70216","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart rate score (HrSc) ≥ 70% reflects chronotropic incompetence and predicts prognosis in patients with cardiac implantable electronic devices (CIEDs) and left ventricular (LV) systolic dysfunction. However, its prognostic value in Japanese patients remains underexplored, and longitudinal changes in HrSc and their contributing factors are poorly characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This post hoc analysis of the Heart Failure Indication and Sudden Cardiac Death Prevention Trial in Japan (HINODE) included 172 patients with CIEDs and LV ejection fraction ≤ 50%. HrSc, defined as the percentage of all atrial-paced and sensed beats in a single tallest 10 beat/min device histogram bin, was assessed using remote monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the median HrSc was 53% (interquartile range, 41%–83%), with 68 (39.5%) patients having HrSc ≥ 70%. During the 2-year follow-up, the incidence of all-cause death or heart failure (HF) events was similar between patients with HrSc ≥ 70% and < 70% (31.1% vs. 29.4%, log-rank <i>p</i> = 0.862). However, among 142 patients whose follow-up data were available, HrSc increased from < 70% to ≥ 70% in 13 patients (13%) and decreased from ≥ 70% to < 70% in 19 (9.1%). An increase in HrSc was associated with lower LV ejection fraction, antiarrhythmic drug initiation, increased lower rate limit, and HF events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the HINODE study, baseline HrSc ≥ 70% was not predictive of 2-year cardiovascular outcomes. However, HrSc changed in approximately one-quarter of patients and was associated with clinical and device-related factors, as well as HF events. HrSc is not a static measure but a dynamic marker that reflects evolving patient conditions and CIED programming.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12642820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604236","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 Japanese Heart Rhythm Society established a nationwide, mandatory, multi-center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J-LEX) in 2018. As of the end of 2024, a cumulative total of approximately 5400 cases has been registered across 140 participating centers since 2018. The registry includes all consecutive transvenous extractions, excluding surgical-only cases. The indication of TLE was an infection in 54.5%, and the guideline classification was class I in 59.8% and class IIa in 21.8%. As for non-infectious indications, TLE is performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty with radiation therapy. In 2024, the TLE procedure was attempted on patients with a median age of 71.3 years, female in 32.7%, in the hybrid operating room in 73.3%, and in a standard OR with a C-arm fluoroscope in 11.5%. The average implantation duration of the target leads was 8.5 years. Complete removal was achieved in 96.7% of the target leads, and clinical success in 97.3% of the patients. Perioperative complications were observed in 4.8% of the patients. Three patients died during a TLE operation, and 11 patients died in-hospital (cardiac death in three patients and non-cardiac death in eight patients).
{"title":"The Japanese Lead Extraction Registry (J-LEX): Annual Report in 2024","authors":"Masahiko Goya, Morio Shoda, Kengo Kusano, Haruka Matsuura, Koshiro Kanaoka, Nobuhiro Nishii, Katsuhiko Imai, Yoji Okamoto, Yuji Narita, Katsuhide Hayashi, Hitoshi Minamiguchi, Masahiko Takagi, Yoshihiro Miyamoto, Mitsuru Wada, Akihiko Nogami, Wataru Shimizu, Hiroshi Tada, J-LEX Registry Investigators","doi":"10.1002/joa3.70229","DOIUrl":"10.1002/joa3.70229","url":null,"abstract":"<p>The Japanese Heart Rhythm Society established a nationwide, mandatory, multi-center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J-LEX) in 2018. As of the end of 2024, a cumulative total of approximately 5400 cases has been registered across 140 participating centers since 2018. The registry includes all consecutive transvenous extractions, excluding surgical-only cases. The indication of TLE was an infection in 54.5%, and the guideline classification was class I in 59.8% and class IIa in 21.8%. As for non-infectious indications, TLE is performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty with radiation therapy. In 2024, the TLE procedure was attempted on patients with a median age of 71.3 years, female in 32.7%, in the hybrid operating room in 73.3%, and in a standard OR with a C-arm fluoroscope in 11.5%. The average implantation duration of the target leads was 8.5 years. Complete removal was achieved in 96.7% of the target leads, and clinical success in 97.3% of the patients. Perioperative complications were observed in 4.8% of the patients. Three patients died during a TLE operation, and 11 patients died in-hospital (cardiac death in three patients and non-cardiac death in eight patients).</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12641452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604199","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}
Y. Mizunuma, M. Takahashi, T. Sasaki, et al., “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets-Late Rate Tools,” Journal of Arrhythmia 41, no. 4 (2025): e70161, https://doi.org/10.1002/joa3.70161.
In the originally published article, the title incorrectly included the word “Rate.” The correct title should read: “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets Late Tools.” Furthermore, the term “Early meets-late” was incorrectly used in several parts of the article. Specifically, this error appears in the article title, in the Background section of the Abstract (“…visualization of the SVC–RA conduction block line as a white line with the extended early meets-late (EEML) tool…”), and in the Background section of the main text (“The extended early meets-late (EEML) feature, which indicates a white line…”). In all of these locations, the correct wording should be “Early meets late,” without a hyphen.
In addition, in Table 2 on page 5, the label “Early meets rate lower threshold, %” should read “Early meets late lower threshold, %.”
The authors apologize for these errors.
Y. Mizunuma， M. Takahashi， T. Sasaki，等，“使用扩展的早期会议-晚期心率工具的白线方法对上腔静脉-右心房自发传导阻滞线耐久性的长期随访”，《心律失常杂志》第41期。4 (2025): e70161, https://doi.org/10.1002/joa3.70161.In原发表的文章，标题中错误地包含了“Rate”一词。正确的标题应该是：“使用延长早期与晚期工具相结合的白线方法对上腔静脉-右心房自发传导阻滞线耐久性的长期随访。”此外，文章的几个部分错误地使用了术语“早会晚会”。具体来说，这个错误出现在文章标题、摘要的背景部分（“…SVC-RA传导块线作为扩展的早期会议-晚（EEML）工具的白线的可视化…”）和正文的背景部分（“扩展的早期会议-晚（EEML）特征，表示白线…”）中。在所有这些地方，正确的措辞应该是“早见晚”，不带连字符。此外，在第5页的表2中，标签“早期满足利率较低的阈值，%”应该读作“早期满足较低的阈值，%”。作者为这些错误道歉。
{"title":"Correction to “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets-Late Rate Tools”","authors":"","doi":"10.1002/joa3.70228","DOIUrl":"https://doi.org/10.1002/joa3.70228","url":null,"abstract":"<p>Y. Mizunuma, M. Takahashi, T. Sasaki, et al., “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets-Late Rate Tools,” <i>Journal of Arrhythmia</i> 41, no. 4 (2025): e70161, https://doi.org/10.1002/joa3.70161.</p><p>In the originally published article, the title incorrectly included the word “Rate.” The correct title should read: “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets Late Tools.” Furthermore, the term “Early meets-late” was incorrectly used in several parts of the article. Specifically, this error appears in the article title, in the Background section of the Abstract (“…visualization of the SVC–RA conduction block line as a white line with the extended early meets-late (EEML) tool…”), and in the Background section of the main text (“The extended early meets-late (EEML) feature, which indicates a white line…”). In all of these locations, the correct wording should be “Early meets late,” without a hyphen.</p><p>In addition, in Table 2 on page 5, the label “Early meets rate lower threshold, %” should read “Early meets late lower threshold, %.”</p><p>The authors apologize for these errors.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70228","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581043","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}
Saeed Aftab Khan, Arfa Ahmed Assad, Maria Qadri, Sabahat Ul Ain Munir Abbasi, Hira Saleem, Muhammad Saeed, Shafiq Ur Rahman, Tahir Nawaz, Aala Saleh, Hamza Ashraf
Background
Arrhythmias are an important contributing cause of death in patients with heart failure (HF). Despite advancements in cardiovascular care, the burden of arrhythmia-related mortality in HF patients remains a significant public health concern. This study aims to evaluate national trends in arrhythmia-related mortality in HF patients from 1999 to 2023.
Methods
Mortality data for patients with arrhythmias (ICD-10 codes: I44.0–I49.9) and HF (ICD-10 codes: I11.0, I13.0, I13.2, I50.0, I50.1, and I50.9) was obtained from the CDC WONDER Database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 populations. Joinpoint regression was used to assess the annual percentage changes in AAMR.
Results
Between 1999 and 2023, arrhythmias and HF were responsible for 1 428 953 deaths in the United States. A notable increase in arrhythmia-related mortality among HF patients during 2018–2021 (APC = 5.77%) was observed. Sex-based disparities revealed higher mortality (AAMR: 37.61) in males. Racial and ethnic disparities were evident, with non-Hispanic American Indians showing the highest AAPC (2.95). State-level variations indicated that Oregon reported the highest AAMR (47.106), while Nevada reported the lowest (16.74). Geographic analysis showed higher mortality rates in non-metropolitan areas.
Conclusion
The observed reduction in arrhythmia-related mortality in HF patients over the last two decades suggests promising advancements in public health strategies and cardiovascular care. However, the persistent disparities across geographic, demographic, and healthcare access lines underscore the need for deeper investigation into the underlying causes of these trends.
{"title":"National Trends in Arrhythmias and Heart Failure Related Mortality in the United States From 1999 to 2023: A CDC Wonder Analysis","authors":"Saeed Aftab Khan, Arfa Ahmed Assad, Maria Qadri, Sabahat Ul Ain Munir Abbasi, Hira Saleem, Muhammad Saeed, Shafiq Ur Rahman, Tahir Nawaz, Aala Saleh, Hamza Ashraf","doi":"10.1002/joa3.70222","DOIUrl":"10.1002/joa3.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Arrhythmias are an important contributing cause of death in patients with heart failure (HF). Despite advancements in cardiovascular care, the burden of arrhythmia-related mortality in HF patients remains a significant public health concern. This study aims to evaluate national trends in arrhythmia-related mortality in HF patients from 1999 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mortality data for patients with arrhythmias (ICD-10 codes: I44.0–I49.9) and HF (ICD-10 codes: I11.0, I13.0, I13.2, I50.0, I50.1, and I50.9) was obtained from the CDC WONDER Database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 populations. Joinpoint regression was used to assess the annual percentage changes in AAMR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2023, arrhythmias and HF were responsible for 1 428 953 deaths in the United States. A notable increase in arrhythmia-related mortality among HF patients during 2018–2021 (APC = 5.77%) was observed. Sex-based disparities revealed higher mortality (AAMR: 37.61) in males. Racial and ethnic disparities were evident, with non-Hispanic American Indians showing the highest AAPC (2.95). State-level variations indicated that Oregon reported the highest AAMR (47.106), while Nevada reported the lowest (16.74). Geographic analysis showed higher mortality rates in non-metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The observed reduction in arrhythmia-related mortality in HF patients over the last two decades suggests promising advancements in public health strategies and cardiovascular care. However, the persistent disparities across geographic, demographic, and healthcare access lines underscore the need for deeper investigation into the underlying causes of these trends.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564021","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}
Rhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy.
Methods
We analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not.
Results
At baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37–1.51, p = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43–1.30, p = 0.30 in the combination therapy group).
Conclusions
The initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.
背景：心律控制治疗可改善心房颤动（AF）患者的生活质量和预后。我们评估了房颤合并稳定冠状动脉疾病（CAD）患者接受心律控制治疗的特点和临床结果。方法：我们分析了2215名来自利伐沙班治疗稳定型冠状动脉疾病（AFIRE）患者心房颤动和缺血性事件试验的参与者，其中588名患者接受了心律控制治疗，1627名患者未接受心律控制治疗。结果：在基线时，接受心律控制治疗的患者通常更年轻，阵发性房颤患病率更高，心力衰竭发生率更低，CHADS2评分（CHF、高血压、年龄≥75岁、2型糖尿病、既往卒中或短暂性脑缺血发作[翻倍]）低于未接受治疗的患者。在利伐沙班单药和联合治疗组中，有节律控制治疗史的患者的主要疗效终点（卒中、全身栓塞、心肌梗死、需要血运重建的不稳定型心绞痛或死亡）的发生率较低。然而，通过多因素分析和倾向评分匹配，未观察到接受和未接受过心律控制治疗的患者在主要疗效终点上的差异（利伐沙班组调整HR 0.75, 95% CI 0.37-1.51, p = 0.43；联合治疗组调整HR 0.75, 95% CI 0.43-1.30, p = 0.30）。结论：在利伐沙班联合或不联合抗血小板治疗的房颤和稳定型CAD患者的基线特征调整后，最初观察到的心律控制治疗的益处并不显著。
{"title":"Association Between History of Rhythm Control Therapy and Clinical Outcomes in Atrial Fibrillation Patients With Stable Coronary Artery Disease: A Sub-Analysis of the AFIRE Trial","authors":"Daisuke Wakatsuki, Hiroshi Suzuki, Koichi Kaikita, Masaharu Akao, Junya Ako, Tetsuya Matoba, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui, Hisao Ogawa, Satoshi Yasuda","doi":"10.1002/joa3.70210","DOIUrl":"10.1002/joa3.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37–1.51, <i>p</i> = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43–1.30, <i>p</i> = 0.30 in the combination therapy group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564047","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}
Jason Hui, Samual Turnbull, Ashwin Bhaskaran, Saurabh Kumar, Stefan Dieleman
Introduction
Catheter ablation is highly efficacious for the treatment of ventricular tachycardia (VT). In patients with structural heart disease, catheter ablation may be performed under general anesthesia (GA). There are limited data on the effect of anesthetic agents on VT inducibility. We compared VT inducibility using total intravenous anesthesia (TIVA) versus volatile anesthesia.
Methods
In this retrospective observational study, patients who underwent catheter ablation for VT between January 2019 and May 2023 were included. Clinical data, procedural reports, and long-term outcomes were collected from the electronic medical records. Patients were grouped based on the type of anesthetic agent used to maintain GA during the procedure.
Results
There were 207 patients maintained under GA using TIVA and 56 patients using volatile anesthesia. One hundred and seventy-five of the 207 (84.5%) patients in the TIVA group were inducible for VT compared to 38 of 56 (67.9%) in the volatile group (OR [95% CI]: 3.8 [1.4–10.4], p = 0.01). Male sex was identified as a potential factor associated with increased VT inducibility (OR [95% CI]: 4.7 [1.4–16.0], p = 0.01). TIVA patients had a shorter ventricular effective refractory period. However, there was no difference between either the number of extra stimuli needed to induce the VT, the proportion of VTs induced spontaneously, acute ablation success rate, or the incidence of VA recurrence.
Conclusion
Use of volatile GA agents was associated with a higher incidence of VT non-inducibility compared to TIVA. TIVA was associated with a lower risk of VA recurrence in follow-up. The observed effect on VT inducibility could be explained by effects on ventricular effective refractory period.
导读：导管消融治疗室性心动过速疗效显著。对于结构性心脏病患者，导管消融可在全身麻醉（GA）下进行。关于麻醉药对室速诱导性影响的数据有限。我们比较了全静脉麻醉（TIVA）和挥发性麻醉的VT诱导性。方法：在这项回顾性观察研究中，纳入了2019年1月至2023年5月期间因室性心动过速接受导管消融的患者。从电子病历中收集临床数据、程序报告和长期结果。根据手术过程中用于维持GA的麻醉剂类型对患者进行分组。结果：有207例患者采用TIVA维持GA， 56例采用挥发性麻醉维持GA。TIVA组207例患者中有175例（84.5%）可诱发VT，而挥发性肺栓塞组56例患者中有38例（67.9%）可诱发VT （OR [95% CI]: 3.8 [1.4-10.4], p = 0.01）。男性被认为是与VT诱发性增加相关的潜在因素（OR [95% CI]: 4.7 [1.4-16.0], p = 0.01）。TIVA患者心室有效不应期较短。然而，诱发室性心动过速所需的额外刺激次数、自发诱发室性心动过速的比例、急性消融成功率或室性心动过速复发率之间均无差异。结论：与TIVA相比，使用挥发性GA药物与更高的VT不可诱导性发生率相关。在随访中，TIVA与较低的VA复发风险相关。观察到的对室速诱导的影响可以通过对心室有效不应期的影响来解释。
{"title":"Comparison of Total Intravenous Anesthesia Versus Volatile Anesthesia on Arrhythmia Inducibility and Clinical Outcomes During Catheter Ablation for Ventricular Tachycardia","authors":"Jason Hui, Samual Turnbull, Ashwin Bhaskaran, Saurabh Kumar, Stefan Dieleman","doi":"10.1002/joa3.70218","DOIUrl":"10.1002/joa3.70218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catheter ablation is highly efficacious for the treatment of ventricular tachycardia (VT). In patients with structural heart disease, catheter ablation may be performed under general anesthesia (GA). There are limited data on the effect of anesthetic agents on VT inducibility. We compared VT inducibility using total intravenous anesthesia (TIVA) versus volatile anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective observational study, patients who underwent catheter ablation for VT between January 2019 and May 2023 were included. Clinical data, procedural reports, and long-term outcomes were collected from the electronic medical records. Patients were grouped based on the type of anesthetic agent used to maintain GA during the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 207 patients maintained under GA using TIVA and 56 patients using volatile anesthesia. One hundred and seventy-five of the 207 (84.5%) patients in the TIVA group were inducible for VT compared to 38 of 56 (67.9%) in the volatile group (OR [95% CI]: 3.8 [1.4–10.4], <i>p</i> = 0.01). Male sex was identified as a potential factor associated with increased VT inducibility (OR [95% CI]: 4.7 [1.4–16.0], <i>p</i> = 0.01). TIVA patients had a shorter ventricular effective refractory period. However, there was no difference between either the number of extra stimuli needed to induce the VT, the proportion of VTs induced spontaneously, acute ablation success rate, or the incidence of VA recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Use of volatile GA agents was associated with a higher incidence of VT non-inducibility compared to TIVA. TIVA was associated with a lower risk of VA recurrence in follow-up. The observed effect on VT inducibility could be explained by effects on ventricular effective refractory period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12624363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556922","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}
Radiation-free catheter ablation is feasible with modern electroanatomic mapping systems. We aimed to evaluate the feasibility, safety, and outcomes of non-fluoroscopic ablation (NFA) in patients with congenital heart disease (CHD).
Methods
We retrospectively reviewed CHD patients who underwent NFA between November 2016 and January 2025. All procedures were performed using the CARTO 3D electroanatomic mapping system. Atrial, ventricular, and aortic geometries were reconstructed as needed. Catheter navigation and sheath placement were guided without fluoroscopy; intracardiac echocardiography was used selectively.
Results
Forty-two patients (23 females) with CHD underwent NFA. The median age was 14 years (range 4–56), and median weight was 55 kg (range 19–145). Twenty-one patients had mild, 16 moderate complexity and 5 great complexity CHD. Arrhythmia mechanisms included AVNRT (14%), manifest WPW (21%), high-risk WPW without SVT (5%), concealed pathway AVRT (26%), AFL (12%), AT (14%), and VT (7%). Two patients had both AVNRT and AVRT. Acute success was achieved in all cases without fluoroscopy or acute complications. Over a median 48-month follow-up, three patients had recurrences: one with WPW and Ebstein anomaly, one with ASD/PLSVC and concealed pathway, and one with dual arrhythmia substrates.
Conclusion
Zero-fluoroscopy ablation of arrhythmias in select patients with mild moderate or great complexity CHD is feasible, safe, and effective, offering high acute success and low recurrence while eliminating radiation exposure.
{"title":"Zero Fluoroscopy Ablation of Arrhythmias in Patients With Congenital Heart Disease","authors":"Shailendra Upadhyay, Jenna Schermerhorn, Whitney Fairchild, Jamie Bopp, Irfan Warsy","doi":"10.1002/joa3.70225","DOIUrl":"https://doi.org/10.1002/joa3.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Radiation-free catheter ablation is feasible with modern electroanatomic mapping systems. We aimed to evaluate the feasibility, safety, and outcomes of non-fluoroscopic ablation (NFA) in patients with congenital heart disease (CHD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed CHD patients who underwent NFA between November 2016 and January 2025. All procedures were performed using the CARTO 3D electroanatomic mapping system. Atrial, ventricular, and aortic geometries were reconstructed as needed. Catheter navigation and sheath placement were guided without fluoroscopy; intracardiac echocardiography was used selectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two patients (23 females) with CHD underwent NFA. The median age was 14 years (range 4–56), and median weight was 55 kg (range 19–145). Twenty-one patients had mild, 16 moderate complexity and 5 great complexity CHD. Arrhythmia mechanisms included AVNRT (14%), manifest WPW (21%), high-risk WPW without SVT (5%), concealed pathway AVRT (26%), AFL (12%), AT (14%), and VT (7%). Two patients had both AVNRT and AVRT. Acute success was achieved in all cases without fluoroscopy or acute complications. Over a median 48-month follow-up, three patients had recurrences: one with WPW and Ebstein anomaly, one with ASD/PLSVC and concealed pathway, and one with dual arrhythmia substrates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Zero-fluoroscopy ablation of arrhythmias in select patients with mild moderate or great complexity CHD is feasible, safe, and effective, offering high acute success and low recurrence while eliminating radiation exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572375","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}
Ibrahim Antoun, Ahmed Abdelrazik, Xin Li, Mahmoud Eldesouky, Kaung Myat Thu, Riyaz Somani, G. André Ng
Background
Pulmonary vein isolation (PVI) is central to controlling paroxysmal atrial fibrillation (AF). Pulsed-field ablation (PFA) offers a non-thermal alternative to conventional thermal techniques. The study compares changes in P-wave parameters following PFA, radiofrequency ablation (RF), and cryoballoon ablation (Cryo).
Methods
We retrospectively analysed 283 patients undergoing first-time PVI (RF 101, Cryo 125, PFA 57). Digital electrocardiograms (ECGs) were evaluated for P-wave duration (PWD), voltage (PWV), dispersion (PWDisp), and terminal force in lead V1 (PTFV1) before and immediately after ablation. AF recurrence was assessed at 12 months. Analyses were adjusted for left atrial volume index (LAVI) and post-procedural anti-arrhythmic drug (AAD) use.
Results
At 12 months, 215 patients (76%) remained free of AF (RF 76%, Cryo 74%, PFA 79%; p = 0.78). Baseline PWD was 128.5 ± 14 ms (RF), 123.7 ± 15 ms (Cryo), and 124.2 ± 16 ms (PFA). Post-ablation, mean ΔPWD was +12.2 ms (RF), +8.5 ms (Cryo), and + 4.7 ms (PFA). PTFV1 decreased after all modalities: RF −3.3 to −4.6 mm·ms (p < 0.001), Cryo −3.4 to −5.3 mm·ms (p = 0.002), PFA −3.6 to −5.2 mm·ms (p = 0.005). No significant intergroup differences were observed (p = 0.39). Patients with AF recurrence (n = 68) had longer baseline PWD (128 ± 16 vs. 125 ± 14 ms, p = 0.12), longer post-procedural PWD (138 ± 17 vs. 129 ± 15 ms, p = 0.004), and larger LAVI (29.1 ± 7.9 vs. 25.3 ± 8.5 mL/m2,p = 0.03). In multivariable Cox models, increased post-procedural PWD independently predicted recurrence (HR: RF 1.17, Cryo 1.14, PFA 1.13; all p < 0.05).
Conclusions
PFA, RF, and Cryo produce similar acute ECG changes. Post-procedural PWD was the strongest predictor of AF recurrence, independent of atrial size and AAD use.
背景：肺静脉隔离（PVI）是控制阵发性心房颤动（AF）的核心。脉冲场烧蚀（PFA）是传统热技术的一种非热替代技术。该研究比较了PFA、射频消融（RF）和低温球囊消融（Cryo）后p波参数的变化。方法：回顾性分析283例首次行PVI的患者（RF 101, Cryo 125, PFA 57）。在消融前和消融后立即评估数字心电图（ecg）的p波持续时间（PWD）、电压（PWV）、弥散（PWDisp）和导联V1末端力（PTFV1）。12个月时评估房颤复发。分析调整左心房容积指数（LAVI）和术后抗心律失常药物（AAD）的使用。结果：12个月时，215例（76%）患者仍无房颤（RF 76%, Cryo 74%, PFA 79%; p = 0.78）。基线PWD为128.5±14 ms (RF), 123.7±15 ms （Cryo）和124.2±16 ms （PFA）。消融后，平均ΔPWD为+12.2 ms (RF), +8.5 ms （Cryo）和+ 4.7 ms （PFA）。所有模式后PTFV1均下降：RF -3.3至-4.6 mm·ms (p = 0.002), PFA -3.6至-5.2 mm·ms （p = 0.005）。组间差异无统计学意义（p = 0.39）。AF复发患者（n = 68）基线PWD较长（128±16 vs 125±14 ms, p = 0.12），术后PWD较长（138±17 vs 129±15 ms, p = 0.004）， LAVI较大（29.1±7.9 vs 25.3±8.5 mL/m2,p = 0.03）。在多变量Cox模型中，术后PWD升高独立预测复发(HR: RF 1.17, Cryo 1.14, PFA 1.13；所有p结论：PFA、RF和Cryo产生相似的急性心电图变化。术后PWD是房颤复发的最强预测因子，与心房大小和AAD使用无关。
{"title":"P-Wave Parameter Changes After Pulsed-Field Ablation, Cryoballoon Ablation and Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: An Observational Cohort Study","authors":"Ibrahim Antoun, Ahmed Abdelrazik, Xin Li, Mahmoud Eldesouky, Kaung Myat Thu, Riyaz Somani, G. André Ng","doi":"10.1002/joa3.70224","DOIUrl":"10.1002/joa3.70224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) is central to controlling paroxysmal atrial fibrillation (AF). Pulsed-field ablation (PFA) offers a non-thermal alternative to conventional thermal techniques. The study compares changes in P-wave parameters following PFA, radiofrequency ablation (RF), and cryoballoon ablation (Cryo).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 283 patients undergoing first-time PVI (RF 101, Cryo 125, PFA 57). Digital electrocardiograms (ECGs) were evaluated for P-wave duration (PWD), voltage (PWV), dispersion (PWDisp), and terminal force in lead V1 (PTFV1) before and immediately after ablation. AF recurrence was assessed at 12 months. Analyses were adjusted for left atrial volume index (LAVI) and post-procedural anti-arrhythmic drug (AAD) use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 12 months, 215 patients (76%) remained free of AF (RF 76%, Cryo 74%, PFA 79%; <i>p</i> = 0.78). Baseline PWD was 128.5 ± 14 ms (RF), 123.7 ± 15 ms (Cryo), and 124.2 ± 16 ms (PFA). Post-ablation, mean ΔPWD was +12.2 ms (RF), +8.5 ms (Cryo), and + 4.7 ms (PFA). PTFV1 decreased after all modalities: RF −3.3 to −4.6 mm·ms (<i>p</i> < 0.001), Cryo −3.4 to −5.3 mm·ms (<i>p</i> = 0.002), PFA −3.6 to −5.2 mm·ms (<i>p</i> = 0.005). No significant intergroup differences were observed (<i>p</i> = 0.39). Patients with AF recurrence (<i>n</i> = 68) had longer baseline PWD (128 ± 16 vs. 125 ± 14 ms, <i>p</i> = 0.12), longer post-procedural PWD (138 ± 17 vs. 129 ± 15 ms, <i>p</i> = 0.004), and larger LAVI (29.1 ± 7.9 vs. 25.3 ± 8.5 mL/m<sup>2</sup>,<i>p</i> = 0.03). In multivariable Cox models, increased post-procedural PWD independently predicted recurrence (HR: RF 1.17, Cryo 1.14, PFA 1.13; all <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PFA, RF, and Cryo produce similar acute ECG changes. Post-procedural PWD was the strongest predictor of AF recurrence, independent of atrial size and AAD use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549455","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}
This case demonstrates an unintentional bidirectional mitral isthmus block created during pulmonary vein isolation using a pentaspline pulsed-field ablation catheter. The finding underscores the importance of careful sheath–catheter alignment at the left inferior pulmonary vein to prevent unintended lesion extension toward the mitral annulus.
{"title":"Unintentional Mitral Lateral Isthmus Block During Pulmonary Vein Isolation With a Pentaspline Pulsed-Field Ablation Catheter","authors":"Yuhei Kasai, Takayuki Kitai, Junji Morita, Kei Murakami, Kazuhiro Satomi","doi":"10.1002/joa3.70226","DOIUrl":"10.1002/joa3.70226","url":null,"abstract":"<p>This case demonstrates an unintentional bidirectional mitral isthmus block created during pulmonary vein isolation using a pentaspline pulsed-field ablation catheter. The finding underscores the importance of careful sheath–catheter alignment at the left inferior pulmonary vein to prevent unintended lesion extension toward the mitral annulus.\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":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549436","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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