Peter Calvert MBChB, Yang Chen MBChB, Ying Gue PhD, Dhiraj Gupta MD, Jinbert Lordson Azariah MSc, A. George Koshy MD, Geevar Zachariah MD, Gregory Y. H. Lip MD, Bahuleyan Charantharayil Gopalan MD, the Kerala AF Registry Investigators
Background
There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala-AF represents the largest prospective AF cohort study from the Indian subcontinent.
Objectives
To compare 12-month outcomes between rate and rhythm control strategies.
Methods
Patients aged ≥18 years with non-transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all-cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression.
Results
A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p = .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p = .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p = .013), BMI <18 (aOR 1.51; p = .025), permanent AF (aOR 0.78; p = .010), HFpEF (aOR 1.40; p = .023), HFrEF (aOR 1.39; p = .004), chronic kidney disease (aOR 1.36; p < .001), and prior thromboembolism (aOR 1.31; p = .014).
Conclusion
In the Kerala-AF registry, 12-month outcomes did not differ between rate and rhythm control cohorts.
关于心房颤动（房颤）治疗的心率控制策略和心律控制策略的争论一直存在，但大部分数据来自西方国家的队列研究。喀拉拉邦心房颤动研究是印度次大陆最大的前瞻性心房颤动队列研究。该研究从喀拉拉邦的 53 家医院招募了年龄≥18 岁的非短暂性心房颤动患者。患者按心率或节律控制进行分层。主要结果是12个月内的全因死亡率、动脉血栓栓塞、急性冠状动脉综合征或因心力衰竭或心律失常住院的综合结果。次要结果包括出血事件和主要结果的各个组成部分。共纳入 2901 名患者（平均年龄 64.6 岁，51% 为女性）（其中 2464 名为心率控制患者，437 名为节律控制患者）。各组间主要综合结果的发生率无差异（29.7% vs 30.0%; p = .955），主要结果的任何组成部分也无差异。出血结果也相似（1.6% vs 1.9%; p = .848）。主要复合结局的独立预测因素是年龄较大（aOR 1.01；p = .013）、BMI <18（aOR 1.51；p = .025）、永久性房颤（aOR 0.78；p = .010）、HFpEF（aOR 1.40；p = .023）、HFrEF（aOR 1.在 Kerala-AF 登记中，心率控制组和心律控制组的 12 个月结果没有差异。
{"title":"One-year outcomes of rate versus rhythm control of atrial fibrillation in the Kerala-AF Registry","authors":"Peter Calvert MBChB, Yang Chen MBChB, Ying Gue PhD, Dhiraj Gupta MD, Jinbert Lordson Azariah MSc, A. George Koshy MD, Geevar Zachariah MD, Gregory Y. H. Lip MD, Bahuleyan Charantharayil Gopalan MD, the Kerala AF Registry Investigators","doi":"10.1002/joa3.13059","DOIUrl":"10.1002/joa3.13059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala-AF represents the largest prospective AF cohort study from the Indian subcontinent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare 12-month outcomes between rate and rhythm control strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥18 years with non-transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all-cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; <i>p</i> = .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; <i>p</i> = .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; <i>p</i> = .013), BMI <18 (aOR 1.51; <i>p</i> = .025), permanent AF (aOR 0.78; <i>p</i> = .010), HFpEF (aOR 1.40; <i>p</i> = .023), HFrEF (aOR 1.39; <i>p</i> = .004), chronic kidney disease (aOR 1.36; <i>p</i> < .001), and prior thromboembolism (aOR 1.31; <i>p</i> = .014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the Kerala-AF registry, 12-month outcomes did not differ between rate and rhythm control cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"822-829"},"PeriodicalIF":2.2,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141117504","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}
Phuuwadith Wattanachayakul MD, Thanathip Suenghataiphorn MD, Thitiphan Srikulmontri MD, Pongprueth Rujirachun MD, John Malin DO, Pojsakorn Danpanichkul MD, Natchaya Polpichai MD, Sakditad Saowapa MD, Bruce A. Casipit MD, Aman Amanullah MD
Introduction
Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF.
Methods
We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications.
Results
We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, p < 0.001), prolonged length of stay (βLOS 2.82; 95% CI 1.71, 3.93, p < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, p 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, p < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, p 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, p 0.002).
Conclusion
Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.
心房颤动（AF）和心力衰竭（HF）通常同时存在，会造成不良的健康和经济后果，如心室功能下降、死亡率升高和生活质量下降。我们分析了 2020 年美国全国住院病人样本，以调查 COVID-19 对主要因高血压住院的房颤患者的影响。我们使用相关的 ICD-10 CM 代码确定了 18 岁及以上的参与者。通过多变量逻辑回归计算出结果的调整赔率比。我们确定了 322,090 名主要出院诊断为合并房颤的心房颤动患者。其中，0.73%（2355/322,090）的患者同时诊断为 COVID-19。在调整了患者和医院因素的多变量逻辑和线性回归调查模型中，COVID-19 感染与较高的院内死亡率（aOR 3.17; 95% CI 2.25, 4.47, p < 0.001）、住院时间延长（βLOS 2.82; 95% CI 1.71, 3.93, p < 0.001）、急性心肌炎（aOR 6.64; 95% CI 1.45, 30.45, p 0.我们的研究显示，COVID-19 与因心房颤动住院的房颤患者较高的院内死亡率和不良结局增加有关。
{"title":"Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from the National Inpatient Sample (NIS) database 2020","authors":"Phuuwadith Wattanachayakul MD, Thanathip Suenghataiphorn MD, Thitiphan Srikulmontri MD, Pongprueth Rujirachun MD, John Malin DO, Pojsakorn Danpanichkul MD, Natchaya Polpichai MD, Sakditad Saowapa MD, Bruce A. Casipit MD, Aman Amanullah MD","doi":"10.1002/joa3.13071","DOIUrl":"10.1002/joa3.13071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, <i>p</i> < 0.001), prolonged length of stay (<i>β</i><sub>LOS</sub> 2.82; 95% CI 1.71, 3.93, <i>p</i> < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, <i>p</i> 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, <i>p</i> < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, <i>p</i> 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, <i>p</i> 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"895-902"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122031","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}
I read with great interest the case report by Yoshimura et al. entitled “A-V-V-A response to single atrial premature depolarization in a narrow QRS tachycardia: What is the mechanism?”.1 The authors have discussed a very interesting case and tried to differentiate atypical atrioventricular nodal re-entrant tachycardia (AVNRT) from junctional ectopic tachycardia (JET) based on the available literature.2 However, discussion seems insufficient to withdraw a definite conclusion.
Firstly, the authors discuss the responses to atrial premature depolarization (APD) delivered during tachycardia based on article published by Padanilam et al.2 Padanilam et al. described that when a APD is timed to His refractoriness, any perturbation of the subsequent His indicates that impulse travels via anterograde slow pathway conduction and confirms the diagnosis of AVNRT. Timing of APD is very critical, and perturbation of the next tachycardia beat is confirmatory for AVNRT only when the APD could not have influenced the immediate beat. This response seems to be applicable in slow fast type of AVNRT as majority of the patients had short ventricular to high right atrium(V-HRA) interval. V-HRA interval was 80 ms in 20 of the 26 cases of AVNRT group, and the interval ranged from 102 to 140 ms (mean 121 ms) in the remaining six patients. The V-HRA interval in JET group of patients ranged from 15 to 62 ms (mean 36 ms). Whereas current report describes a case of fast slow type of AVNRT. Hence, approach suggested by Padanilam is not applicable here.
Second argument is based on the fact that the interval between the His-bundle potential before and one beat after APD was significantly longer than that of two beats of tachycardia cycle length (300 + 375 ms > 320 ms × 2), a finding that is unlikely in JET. On the contrary, it is possible in JET. Enhanced automaticity is postulated as the mechanism of JET3; hence, APD can supress this automatic focus transiently, which can gradually accelerate to tachycardia cycle length (TCL). This is also evident in current case report where HH interval gradually increases (375 msec➔ 345 msec ➔320 msec) post-APD stimulus. This explains why the interval before and one beat after APD is not the exact multiple of TCL.
Although it appears to be AVNRT based on the two discrete discontinuities observed in the AH conduction curve during programmed atrial extrastimulation, manoeuvres described in this case report appear to be insufficient to conclusively establish the diagnosis of AVNRT. Other manoeuvres such as delta H-A interval (H-A interval pacing minus the H-A tachycardia) and atrial-His-His-atrial response during atrial overdrive pacing of tachycardia might have been helpful.4, 5
N/A.
Authors declare no conflict of interests for this article.
{"title":"Yoshimura et al. A-V-V-A response to single atrial premature depolarization in a narrow QRS tachycardia: What is the mechanism?","authors":"Abhishek Goyal MD, DM","doi":"10.1002/joa3.13075","DOIUrl":"10.1002/joa3.13075","url":null,"abstract":"<p>I read with great interest the case report by Yoshimura et al. entitled “A-V-V-A response to single atrial premature depolarization in a narrow QRS tachycardia: What is the mechanism?”.<span><sup>1</sup></span> The authors have discussed a very interesting case and tried to differentiate atypical atrioventricular nodal re-entrant tachycardia (AVNRT) from junctional ectopic tachycardia (JET) based on the available literature.<span><sup>2</sup></span> However, discussion seems insufficient to withdraw a definite conclusion.</p><p>Firstly, the authors discuss the responses to atrial premature depolarization (APD) delivered during tachycardia based on article published by Padanilam et al.<span><sup>2</sup></span> Padanilam et al. described that when a APD is timed to His refractoriness, any perturbation of the subsequent His indicates that impulse travels via anterograde slow pathway conduction and confirms the diagnosis of AVNRT. Timing of APD is very critical, and perturbation of the next tachycardia beat is confirmatory for AVNRT only when the APD could not have influenced the immediate beat. This response seems to be applicable in slow fast type of AVNRT as majority of the patients had short ventricular to high right atrium(V-HRA) interval. V-HRA interval was 80 ms in 20 of the 26 cases of AVNRT group, and the interval ranged from 102 to 140 ms (mean 121 ms) in the remaining six patients. The V-HRA interval in JET group of patients ranged from 15 to 62 ms (mean 36 ms). Whereas current report describes a case of fast slow type of AVNRT. Hence, approach suggested by Padanilam is not applicable here.</p><p>Second argument is based on the fact that the interval between the His-bundle potential before and one beat after APD was significantly longer than that of two beats of tachycardia cycle length (300 + 375 ms > 320 ms × 2), a finding that is unlikely in JET. On the contrary, it is possible in JET. Enhanced automaticity is postulated as the mechanism of JET<span><sup>3</sup></span>; hence, APD can supress this automatic focus transiently, which can gradually accelerate to tachycardia cycle length (TCL). This is also evident in current case report where HH interval gradually increases (375 msec➔ 345 msec ➔320 msec) post-APD stimulus. This explains why the interval before and one beat after APD is not the exact multiple of TCL.</p><p>Although it appears to be AVNRT based on the two discrete discontinuities observed in the AH conduction curve during programmed atrial extrastimulation, manoeuvres described in this case report appear to be insufficient to conclusively establish the diagnosis of AVNRT. Other manoeuvres such as delta H-A interval (H-A interval pacing minus the H-A tachycardia) and atrial-His-His-atrial response during atrial overdrive pacing of tachycardia might have been helpful.<span><sup>4, 5</sup></span></p><p>N/A.</p><p>Authors declare no conflict of interests for this article.</p><p>N/A.</p><p>N/A.</p><p>N/A.</p><p>N/A.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1049-1050"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121822","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}
Masking of preexcitation from a slow-conducting, decremental AP due to preexcitation via an FV pathway.
通过 FV 通路引起的慢传导递减 AP 预激的掩蔽。
{"title":"Hide and seek: Masking of preexcitation from a slow-conducting, decremental right lateral accessory pathway due to preexcitation via a fasciculoventricular pathway","authors":"Utkarsh Kohli MD, Mehar Hoda MD","doi":"10.1002/joa3.13068","DOIUrl":"10.1002/joa3.13068","url":null,"abstract":"<p>Masking of preexcitation from a slow-conducting, decremental AP due to preexcitation via an FV pathway.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1018-1021"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123580","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}
Masayoshi Mori MD, Hisaaki Aoki MD, PhD, Kumiyo Matsuo MD, Dai Asada MD, PhD, Yoichiro Ishii MD, PhD
Progress of treadmill exercise testing in Case 1 Each electrocardiogram shows the maximum load. Before left cardiac sympathetic denervation, polymorphic ventricular tachycardias were observed. After left cardiac sympathetic denervation, no ventricular arrhythmias were induced during exercise.
{"title":"Cardiac sympathetic denervation for catecholaminergic polymorphic ventricular tachycardia in the light of the medical situation in Japan","authors":"Masayoshi Mori MD, Hisaaki Aoki MD, PhD, Kumiyo Matsuo MD, Dai Asada MD, PhD, Yoichiro Ishii MD, PhD","doi":"10.1002/joa3.13069","DOIUrl":"10.1002/joa3.13069","url":null,"abstract":"<p>Progress of treadmill exercise testing in Case 1 Each electrocardiogram shows the maximum load. Before left cardiac sympathetic denervation, polymorphic ventricular tachycardias were observed. After left cardiac sympathetic denervation, no ventricular arrhythmias were induced during exercise.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1005-1009"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141119222","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 safety of hyperbaric oxygen treatment (HBO2) in patients with cardiovascular implanted electronic devices (CIED) remains unclear.
Methods
We conducted a retrospective analysis of seven CIED patients (median age 79 [73–83] years, five males [71.4%]), including five with pacemakers and two with implantable cardioverter defibrillators (ICD), who underwent HBO2 between June 2013 and April 2023. During the initial session, electrocardiogram monitoring was conducted, and CIED checks were performed before and after the treatment. In addition, the medical records were scrutinized to identify any abnormal CIED operations.
Results
All seven CIED patients underwent HBO2 within the safety pressure range specified by the CIED manufacturers or general pressure test by the International Organization for Standardization (2.5 [2.5–2.5] atmosphere absolute × 18 [5–20] sessions). When comparing the CIED parameters before and after HBO2, no significant changes were observed in the waveform amplitudes, pacing thresholds, lead impedance of the atrial and ventricular leads, or battery levels. All seven patients, including two with the rate response function activated, exhibited no significant changes in the pacing rate or pacing failure. Two ICD patients did not deactivate the therapy, including the defibrillation; however, they did not experience any arrhythmia or inappropriate ICD therapy during the HBO2.
Conclusion
CIED patients who underwent HBO2 within the safety pressure range exhibited no significant changes in the parameters immediately after the HBO2 and had no observable abnormal CIED operations during the treatment. The safety of defibrillation by an ICD during HBO2 should be clarified.
{"title":"The impact of hyperbaric oxygen treatment for cardiovascular implantable electronic devices","authors":"Kentaro Goto MD, Shinsuke Miyazaki MD, Takuya Oyaizu MD, Miho Negishi MD, Takashi Ikenouchi MD, Tasuku Yamamoto MD, Iwanari Kawamura MD, Takuro Nishimura MD, Tomomasa Takamiya MD, Susumu Tao MD, Masateru Takigawa MD, Kazuyoshi Yagishita MD, Tetsuo Sasano MD","doi":"10.1002/joa3.13070","DOIUrl":"10.1002/joa3.13070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The safety of hyperbaric oxygen treatment (HBO<sub>2</sub>) in patients with cardiovascular implanted electronic devices (CIED) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of seven CIED patients (median age 79 [73–83] years, five males [71.4%]), including five with pacemakers and two with implantable cardioverter defibrillators (ICD), who underwent HBO<sub>2</sub> between June 2013 and April 2023. During the initial session, electrocardiogram monitoring was conducted, and CIED checks were performed before and after the treatment. In addition, the medical records were scrutinized to identify any abnormal CIED operations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All seven CIED patients underwent HBO<sub>2</sub> within the safety pressure range specified by the CIED manufacturers or general pressure test by the International Organization for Standardization (2.5 [2.5–2.5] atmosphere absolute × 18 [5–20] sessions). When comparing the CIED parameters before and after HBO<sub>2</sub>, no significant changes were observed in the waveform amplitudes, pacing thresholds, lead impedance of the atrial and ventricular leads, or battery levels. All seven patients, including two with the rate response function activated, exhibited no significant changes in the pacing rate or pacing failure. Two ICD patients did not deactivate the therapy, including the defibrillation; however, they did not experience any arrhythmia or inappropriate ICD therapy during the HBO<sub>2</sub>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CIED patients who underwent HBO<sub>2</sub> within the safety pressure range exhibited no significant changes in the parameters immediately after the HBO<sub>2</sub> and had no observable abnormal CIED operations during the treatment. The safety of defibrillation by an ICD during HBO<sub>2</sub> should be clarified.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"958-964"},"PeriodicalIF":2.2,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141120317","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}
Enrico Brunetta MD, PhD, Guido Del Monaco MD, Stefano Rodolfi MD, Donah Zachariah MD, Kostantinos Vlachos MD, Alessia Chiara Latini MD, Maria De Santis MD, PhD, Carlo Ceriotti MD, Paola Galimberti MD, Antonio Taormina MD, Vincenzo Battaglia MD, Giulio Falasconi MD, Diego Penela Maceda MD, PhD, Michael Efremidis MD, Konstantinos P. Letsas MD, Carlo Selmi MD, PhD, Giulio Giuseppe Stefanini MD, PhD, Gianluigi Condorelli MD, PhD, Antonio Frontera MD, PhD
Introduction
Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers.
Methods
We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery.
Results
Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28-day arrhythmia-free survival was lower in patients undergoing lung and cardiovascular surgery (p < .001). Patients who developed POAF had higher levels of C-reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p < .001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log-scale = 1.81 (95% CI 1.18–2.79); p = .007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04–1.08); I < .001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65–98.73); p < .001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48–26.49; p = .013).
Conclusions
Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia.
心房颤动（AF）是术后最常见的心律失常。我们旨在调查术后房颤（POAF）的发生率，并确定其预测因素，特别关注炎症标志物。我们进行了一项回顾性单一三级中心队列研究，研究对象包括在 2016 年 1 月至 2020 年 1 月期间接受过大型外科手术的连续成年患者。在纳入的53387名患者中（79.4%为男性，年龄为（64.5±9.5）岁），有570人（1.1%）发生了POAF，术后平均潜伏期为（3.4±2.6）天。90名患者（0.17%）在平均 13.7 ± 8.4 天后死亡。肺部和心血管手术患者的 28 天无心律失常存活率较低（P < .001）。发生POAF的患者C反应蛋白（CRP）水平较高（0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl；P < .001）。在调整混杂因素的多变量 Cox 回归分析中，CRP 是 POAF 的独立预测因子[对数范围每增加 1 mg/dL 的 HR = 1.81 (95% CI 1.18-2.79)；p = .007]。此外，年龄（HR/1 年增加 = 1.06 (95% CI 1.04-1.08); I < .001）、肺部和心血管手术（HR 23.62; (95% CI 5.65-98.73); p < .001）以及腹部和食管手术（HR 6.26; 95% CI 1.48-26.49; p = .013）也是预测 POAF 的独立因素。CRP是POAF的独立预测因子，手术后炎症可能是心律失常病理生理学的主要驱动因素。
{"title":"Incidence and predictors of post-surgery atrial fibrillation occurrence: A cohort study in 53,387 patients","authors":"Enrico Brunetta MD, PhD, Guido Del Monaco MD, Stefano Rodolfi MD, Donah Zachariah MD, Kostantinos Vlachos MD, Alessia Chiara Latini MD, Maria De Santis MD, PhD, Carlo Ceriotti MD, Paola Galimberti MD, Antonio Taormina MD, Vincenzo Battaglia MD, Giulio Falasconi MD, Diego Penela Maceda MD, PhD, Michael Efremidis MD, Konstantinos P. Letsas MD, Carlo Selmi MD, PhD, Giulio Giuseppe Stefanini MD, PhD, Gianluigi Condorelli MD, PhD, Antonio Frontera MD, PhD","doi":"10.1002/joa3.13058","DOIUrl":"10.1002/joa3.13058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28-day arrhythmia-free survival was lower in patients undergoing lung and cardiovascular surgery (<i>p</i> < .001). Patients who developed POAF had higher levels of C-reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; <i>p</i> < .001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log-scale = 1.81 (95% CI 1.18–2.79); <i>p</i> = .007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04–1.08); I < .001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65–98.73); <i>p</i> < .001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48–26.49; <i>p</i> = .013).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"815-821"},"PeriodicalIF":2.2,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124077","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}
Anamorelin, a ghrelin receptor agonist, is used for cancer-related cachexia but can induce life-threatening arrhythmias. A case study illustrates an extremely wide QRS tachycardia, posing diagnostic challenges. Anamorelin cessation led to normalization, highlighting the importance of ECG monitoring, particularly in liver-compromised patients, and hemodynamic support are crucial during suspected toxicity.
{"title":"An extremely wide QRS complex tachycardia induced by anamorelin","authors":"Kazuki Shimojo MD, Yasunori Kanzaki MD, Hiroyuki Miyazawa MD, Itsuro Morishima MD, PhD","doi":"10.1002/joa3.13072","DOIUrl":"10.1002/joa3.13072","url":null,"abstract":"<p>Anamorelin, a ghrelin receptor agonist, is used for cancer-related cachexia but can induce life-threatening arrhythmias. A case study illustrates an extremely wide QRS tachycardia, posing diagnostic challenges. Anamorelin cessation led to normalization, highlighting the importance of ECG monitoring, particularly in liver-compromised patients, and hemodynamic support are crucial during suspected toxicity.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"1022-1025"},"PeriodicalIF":2.2,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gusti Ngurah Prana Jagannatha, I. Made Putra Swi Antara, Anastasya Maria Kosasih, Jonathan Adrian, Brian Mendel, Nikita Pratama Toding Labi, Wingga Chrisna Aji, Bryan Gervais de Liyis, Made Refika Widya Apsari Tangkas, Yosep Made Pius Cardia, Alif Hakim Alamsyah
Background
Catheter ablation in the pediatric population using fluoroscopy has been known to cause adverse events. This study aims to assess the effectiveness and safety of zero fluoroscopy (ZF) and near-ZF-guided catheter ablation for the treatment of arrhythmias in the pediatric population.
Methods
The PubMed, Embase, and Cochrane library databases were searched and reviewed for relevant studies. Outcomes of interest include safety, short-term, and long-term effectiveness. We classified patients ≤21 years old who underwent ZF or near-ZF ablation with fluoroscopy time ≤1.5 min as our study group and patients within the same age range who underwent conventional fluoroscopy and/or near-ZF ablation with a mean fluoroscopy time >1.5 min as our control group. Both ZF and near-ZF ablation utilized 3D-electroanatomical mapping (3D-EAM).
Results
Ten studies composed of 2279 patients were included in this study. Total fluoroscopy time (MD –15.93 min, 95% CI (−22.57 – (−9.29), p < .001; I2 = 84%)) and total procedural time (MD –22.06 min, 95% CI (−44.39 – (−0.28), p < .001; I2 = 88%)) were significantly lower in the near-ZF group. Both ZF and near-ZF demonstrated a trend towards improved success rates compared to conventional fluoroscopy but did not achieve statistical significance for all subgroup analyses. Ablation in the study group also decreased incidence of complication compared to the control (RR 0.35; 95% CI (0.14–0.90); p = .03; I2 = 0%).
Conclusion
ZF and near-ZF ablation reduced the overall duration, compares in effectiveness, and shows a superior safety profile compared to control group.
众所周知，在儿科人群中使用透视导管消融术会导致不良事件。本研究旨在评估零透视（ZF）和近零透视引导导管消融治疗儿科心律失常的有效性和安全性。研究人员检索并审查了 PubMed、Embase 和 Cochrane 图书馆数据库中的相关研究。关注的结果包括安全性、短期和长期有效性。我们将年龄小于21岁、接受ZF或近ZF消融术且透视时间小于1.5分钟的患者列为研究组，将同一年龄范围内接受常规透视和/或近ZF消融术且平均透视时间大于1.5分钟的患者列为对照组。ZF和近ZF消融术均采用三维电子解剖图（3D-EAM）。近ZF组的总透视时间（MD -15.93分钟，95% CI (-22.57 - (-9.29)，p < .001；I2 = 84%）和总手术时间（MD -22.06分钟，95% CI (-44.39 - (-0.28)，p < .001；I2 = 88%）显著低于ZF组。与传统透视相比，中频和近中频的成功率都有提高的趋势，但在所有亚组分析中均未达到统计学意义。与对照组相比，研究组的消融术还降低了并发症的发生率（RR 0.35；95% CI (0.14-0.90)；P = .03；I2 = 0%）。
{"title":"Safety and feasibility of 3D-electroanatomical mapping-guided zero or near-zero fluoroscopy catheter ablation for pediatric arrhythmias: Meta-analysis","authors":"Gusti Ngurah Prana Jagannatha, I. Made Putra Swi Antara, Anastasya Maria Kosasih, Jonathan Adrian, Brian Mendel, Nikita Pratama Toding Labi, Wingga Chrisna Aji, Bryan Gervais de Liyis, Made Refika Widya Apsari Tangkas, Yosep Made Pius Cardia, Alif Hakim Alamsyah","doi":"10.1002/joa3.13062","DOIUrl":"10.1002/joa3.13062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Catheter ablation in the pediatric population using fluoroscopy has been known to cause adverse events. This study aims to assess the effectiveness and safety of zero fluoroscopy (ZF) and near-ZF-guided catheter ablation for the treatment of arrhythmias in the pediatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PubMed, Embase, and Cochrane library databases were searched and reviewed for relevant studies. Outcomes of interest include safety, short-term, and long-term effectiveness. We classified patients ≤21 years old who underwent ZF or near-ZF ablation with fluoroscopy time ≤1.5 min as our study group and patients within the same age range who underwent conventional fluoroscopy and/or near-ZF ablation with a mean fluoroscopy time >1.5 min as our control group. Both ZF and near-ZF ablation utilized 3D-electroanatomical mapping (3D-EAM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies composed of 2279 patients were included in this study. Total fluoroscopy time (MD –15.93 min, 95% CI (−22.57 – (−9.29), <i>p</i> < .001; <i>I</i><sup>2</sup> = 84%)) and total procedural time (MD –22.06 min, 95% CI (−44.39 – (−0.28), <i>p</i> < .001; <i>I</i><sup>2</sup> = 88%)) were significantly lower in the near-ZF group. Both ZF and near-ZF demonstrated a trend towards improved success rates compared to conventional fluoroscopy but did not achieve statistical significance for all subgroup analyses. Ablation in the study group also decreased incidence of complication compared to the control (RR 0.35; 95% CI (0.14–0.90); <i>p</i> = .03; <i>I</i><sup>2</sup> = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ZF and near-ZF ablation reduced the overall duration, compares in effectiveness, and shows a superior safety profile compared to control group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 4","pages":"913-934"},"PeriodicalIF":2.2,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140971341","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}
Jae-Hyuk Lee MD, Iksung Cho MD, PhD, Sung Hwa Choi MD, Hee Tae Yu MD, PhD, Tae-Hoon Kim MD, Jae-Sun Uhm MD, PhD, Boyoung Joung MD, PhD, Moon-Hyoung Lee MD, PhD, Geu-Ru Hong MD, PhD, Chun Hwang MD, Hui-Nam Pak MD, PhD
Background
Hypertrophic cardiomyopathy (HCM) is frequently associated with atrial fibrillation (AF). We compared clinical, echocardiographic, and electrophysiological parameters between HCM subtypes and those without HCM at AF catheter ablation (AFCA) and analyzed post-AFCA reverse remodeling and AF recurrence based on HCM presence and subtype.
Methods
Among 5161 consecutive patients who underwent de novo AFCA, we included HCM patients and control patients who were age-, gender-, and AF type-matched. Between AF-HCM patients and controls, we compared baseline values for left atrium (LA) wall thickness (LAWT), reverse remodeling at 1-year follow-up, and procedural outcomes over the course of follow-up between two groups.
Results
A total of 122 AF-HCM patients and 318 control patients were included. AF-HCM patients had more frequent heart failure and higher LA diameter, E/Em, and LA pressure (all, p < .001). However, LAWT did not differ from control group. A year after AFCA, degree of LA reverse remodeling was significantly lower in AF-HCM than in control group (ΔLA dimension, p = .025). Nonapical HCM (HR 1.71; 95% CI 1.05–2.80), persistent AF (HR 1.46; 95% CI 1.05–2.04), and LA dimension (HR 1.04; 95% CI 1.01–1.06) were independent risk factors for AF recurrence. During 78.0 months of follow-up, nonapical HCM patients showed higher AF recurrence rate than both apical HCM (log-rank p = .005) and control patients (log-rank p = .002).
Conclusions
The presence of HCM, particularly nonapical HCM, displayed increased LA hemodynamic loading with diastolic dysfunction and had poorer rhythm outcomes after AFCA compared to both apical HCM and control group.
肥厚型心肌病（HCM）常伴有心房颤动（AF）。我们比较了 HCM 亚型和无 HCM 患者在房颤导管消融（AFCA）时的临床、超声心动图和电生理参数，并根据 HCM 的存在和亚型分析了 AFCA 后的反向重塑和房颤复发。在房颤-HCM 患者和对照组之间，我们比较了两组患者的左心房（LA）壁厚度（LAWT）基线值、随访 1 年的反向重塑情况以及随访期间的手术结果。心房颤动-心肌梗死患者的心力衰竭发生率更高，LA直径、E/Em和LA压力更高（均为P < .001）。但 LAWT 与对照组无差异。AFCA 一年后，房颤-HCM 的 LA 逆重塑程度明显低于对照组（ΔLA 尺寸，P = .025）。非典型 HCM（HR 1.71；95% CI 1.05-2.80）、持续房颤（HR 1.46；95% CI 1.05-2.04）和 LA 尺寸（HR 1.04；95% CI 1.01-1.06）是房颤复发的独立风险因素。在78.0个月的随访期间，非心尖型HCM患者的房颤复发率高于心尖型HCM患者（对数秩P = .005）和对照组患者（对数秩P = .002）。与心尖型HCM和对照组相比，HCM患者，尤其是非心尖型HCM患者的LA血流动力学负荷增加，并伴有舒张功能障碍，其AFCA后的心律转归较差。
{"title":"Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation","authors":"Jae-Hyuk Lee MD, Iksung Cho MD, PhD, Sung Hwa Choi MD, Hee Tae Yu MD, PhD, Tae-Hoon Kim MD, Jae-Sun Uhm MD, PhD, Boyoung Joung MD, PhD, Moon-Hyoung Lee MD, PhD, Geu-Ru Hong MD, PhD, Chun Hwang MD, Hui-Nam Pak MD, PhD","doi":"10.1002/joa3.13061","DOIUrl":"10.1002/joa3.13061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertrophic cardiomyopathy (HCM) is frequently associated with atrial fibrillation (AF). We compared clinical, echocardiographic, and electrophysiological parameters between HCM subtypes and those without HCM at AF catheter ablation (AFCA) and analyzed post-AFCA reverse remodeling and AF recurrence based on HCM presence and subtype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 5161 consecutive patients who underwent de novo AFCA, we included HCM patients and control patients who were age-, gender-, and AF type-matched. Between AF-HCM patients and controls, we compared baseline values for left atrium (LA) wall thickness (LAWT), reverse remodeling at 1-year follow-up, and procedural outcomes over the course of follow-up between two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 122 AF-HCM patients and 318 control patients were included. AF-HCM patients had more frequent heart failure and higher LA diameter, E/Em, and LA pressure (all, <i>p</i> < .001). However, LAWT did not differ from control group. A year after AFCA, degree of LA reverse remodeling was significantly lower in AF-HCM than in control group (ΔLA dimension, <i>p</i> = .025). Nonapical HCM (HR 1.71; 95% CI 1.05–2.80), persistent AF (HR 1.46; 95% CI 1.05–2.04), and LA dimension (HR 1.04; 95% CI 1.01–1.06) were independent risk factors for AF recurrence. During 78.0 months of follow-up, nonapical HCM patients showed higher AF recurrence rate than both apical HCM (log-rank <i>p</i> = .005) and control patients (log-rank <i>p</i> = .002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of HCM, particularly nonapical HCM, displayed increased LA hemodynamic loading with diastolic dysfunction and had poorer rhythm outcomes after AFCA compared to both apical HCM and control group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"40 3","pages":"479-488"},"PeriodicalIF":2.2,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.13061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号