Journal of Arrhythmia最新文献_第9页

Editorial to “Improvement in respiratory function and exercise tolerance following video-assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation”—An essential respiratory physiology every electrophysiologist should know- 视频辅助胸腔镜膈肌成形术治疗射频导管消融术后症状性先天性持续性膈肌麻痹后呼吸功能和运动耐量的改善》的社论--每位电生理学家都应掌握的呼吸生理学基本知识

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-14 DOI: 10.1002/joa3.13064

Tatsuya Hayashi MD, PhD, Hideo Fujita MD, PhD

<p>Editorial comment on “Improvement in respiratory function and exercise tolerance following video-assisted thoracoscopic diaphragm plication for symptomatic iatrogenic persistent diaphragm paralysis after radiofrequency catheter ablation.<span><sup>1</sup></span>”</p><p>Complications of catheter ablation for atrial fibrillation include right phrenic nerve palsy. In conventional radiofrequency (RF) ablation, this complication is known to occur during procedures such as superior vena cava (SVC) isolation or right pulmonary vein isolation. While improvements have been observed with treatment modalities such as high-power short-duration ablation,<span><sup>2</sup></span> complete prevention of right phrenic nerve palsy remains challenging. Catheter ablation using cryoballoon, introduced after RF ablation, is considered a safer treatment option for atrial fibrillation. However, it is essential to note that compared to RF ablation, cryoballoon ablation has been associated with a higher incidence of right phrenic nerve palsy at the time of discharge after catheter ablation.<span><sup>3</sup></span> Recent evidence has shown that in cases of persistent atrial fibrillation treated with cryoballoon ablation, there is a higher incidence of phrenic nerve palsy, particularly in long-standing persistent atrial fibrillation cases.<span><sup>4</sup></span> As ablation procedures for persistent atrial fibrillation continue to be explored and utilized more frequently, the likelihood of encountering this complication may increase. Phrenic nerve palsy is often asymptomatic and may spontaneously resolve in many cases, leading it to be perceived as a relatively benign complication. However, some patients may experience severe symptoms, warranting careful attention.</p><p>In this report by Kasai et al., a case of respiratory failure resulting from right phrenic nerve palsy following catheter ablation for atrial fibrillation is described.<span><sup>1</sup></span> While phrenic nerve palsy often does not cause symptoms because of adequate oxygenation by the unaffected lung, the patient in this case, who was elderly and obese, exhibited significant symptoms after the onset of right phrenic nerve palsy. The mechanism of respiratory distress because of phrenic nerve palsy involves “paradoxical breathing” during lung expansion, wherein the flaccid diaphragm on the affected side is drawn toward the pulmonary hilum by negative pressure from the unaffected lung, reducing the inspiratory volume of the unaffected lung.</p><p>Given that phrenic nerve palsy often resolves over time, observation may suffice as a treatment strategy, even in cases where symptoms are present. However, this report suggests that more aggressive intervention may be warranted in cases of severe symptoms. One such intervention involves surgical plication of the affected diaphragm to reduce its flexibility, thereby inhibiting the “rebound” of air from the affected lung to the unaffected lung during lung ex

关于 "视频辅助胸腔镜膈肌成形术治疗射频导管消融术后症状性先天性持续性膈肌麻痹后呼吸功能和运动耐量的改善 "的编辑评论1 "心房颤动导管消融术的并发症包括右侧膈神经麻痹。在传统的射频（RF）消融术中，上腔静脉（SVC）隔离或右肺静脉隔离等手术都会出现这种并发症。虽然高功率短时消融2 等治疗模式已有所改善，但完全避免右膈神经麻痹仍具有挑战性。在射频消融术之后引入的冷冻球囊导管消融术被认为是治疗心房颤动的一种更安全的方法。但必须注意的是，与射频消融相比，冷冻球囊消融与导管消融后出院时右膈神经麻痹的发生率较高有关3。最近的证据显示，在使用冷冻球囊消融术治疗持续性心房颤动的病例中，膈神经麻痹的发生率较高，尤其是在长期持续性心房颤动病例中。4 随着持续性心房颤动消融术的不断探索和更频繁地使用，出现这种并发症的可能性可能会增加。膈神经麻痹通常没有症状，在许多病例中可自发缓解，因此被认为是一种相对良性的并发症。1 虽然膈神经麻痹通常不会引起症状，因为未受影响的肺部有足够的供氧，但本病例中的患者年老且肥胖，在右侧膈神经麻痹发生后表现出明显的症状。膈神经麻痹导致呼吸困难的机制包括肺扩张时的 "矛盾呼吸"，即受影响一侧松弛的膈肌被未受影响肺的负压向肺门吸引，从而减少了未受影响肺的吸气量。然而，本报告表明，在症状严重的病例中，可能需要采取更积极的干预措施。其中一种干预方法是通过手术切除受影响的横膈膜，以降低其弹性，从而抑制肺扩张时空气从受影响的肺部 "反弹 "到未受影响的肺部。这种方法简单的外科手术可以通过胸腔镜技术以相对无创的方式进行。在报告的病例中，术后呼吸困难立即得到改善，呼吸功能测试和 X 光图像也有明显改善。该病例强调了在心房颤动导管消融术后及时采取适当干预措施治疗膈神经麻痹的重要性。在另一份报告中，一名在冷冻球囊消融术后出现右侧膈神经麻痹并同样接受机器人辅助胸腔镜手术治疗的患者也被发现高度肥胖。心房颤动导管消融术后出现膈神经麻痹的情况并不少见，而且必须注意症状偶尔会明显恶化。我们必须牢记的另一个关键点是，对于膈神经麻痹，预防重于治疗。我们必须优先采取预防措施来降低风险。即使采用高功率短时消融术，仍然存在膈神经麻痹的风险。因此，为确保有效的膈神经起搏，除非使用逆转剂，否则应避免在使用肌肉松弛剂的全身麻醉下进行 SVC 隔离。

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引用次数: 0

Recurrent episodes of atrioventricular nodal reentrant tachycardia: Sites of ablation success, ablation endpoint, and primary culprits for recurrence 复发性房室结再发性心动过速：消融成功的部位、消融终点和复发的罪魁祸首

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-14 DOI: 10.1002/joa3.13060

Shu Hirata MD, Koichi Nagashima MD, PhD, Yoshiaki Kaneko MD, PhD, Shuntaro Tamura MD, PhD, Hitoshi Mori MD, PhD, Suguru Nishiuchi MD, PhD, Michifumi Tokuda MD, PhD, Tetsuma Kawaji MD, PhD, Tatsuya Hayashi MD, PhD, Takuro Nishimura MD, PhD, Masato Fukunaga MD, PhD, Jun Kishihara MD, PhD, Hidehira Fukaya MD, PhD, Jin Teranishi MD, Mitsuru Takami MD, PhD, Masato Okada MD, Naoko Miyazaki MD, Ryuta Watanabe MD, PhD, Yuji Wakamatsu MD, PhD, Yasuo Okumura MD, PhD

Background

Atrioventricular nodal reentrant tachycardia (AVNRT) sometimes recurs even after anatomical slow pathway (SP) ablation targeting the rightward inferior extension (RIE). This multicenter study aimed to determine the reasons for AVNRT recurrence.

Methods and Results

Forty-six patients were treated successfully for recurrent AVNRT. Initial treatment was for 38 slow-fast AVNRTs, 3 fast-slow AVNRTs, 2 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 noninducible AVNRT. All initial treatments were of RF application to the RIE; SP elimination was achieved in 11, dual AVN physiology was seen in 29, and AVNRT remained inducible in 5. The recurrent AVNRTs included 34 slow-fast AVNRTs, 6 fast-slow AVNRTs, 3 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 slow-fast and slow-slow AVNRTs. Successful ablation site was within the RIE in 39 and left inferior extension in 7. In 30 of 39, the successful RIE site was in the same area or higher than that of the initial procedure.

Conclusion

For a high majority (around 85%) of patients in whom AVNRT recurs after initial ablation success, the site of a second successful procedure will be within the RIE even though the RIE was originally targeted. Furthermore, a high majority (around 86%) of sites of successful ablation will be higher than those originally targeted.

房室结再发性心动过速（AVNRT）有时会复发，即使在针对右下延伸（RIE）的解剖性慢通路（SP）消融术后也是如此。这项多中心研究旨在确定房室缺血性心动过速复发的原因。46名患者成功治疗了复发性房室念珠菌病，其中38例为慢-快房室念珠菌病，3例为快-慢房室念珠菌病，2例为慢-慢房室念珠菌病，2例为慢-快和快-慢房室念珠菌病，1例为非诱导性房室念珠菌病。所有初始治疗都是在 RIE 上应用射频；11 例实现了 SP 消除，29 例出现了双重 AVN 生理现象，5 例仍可诱导 AVNRT。复发性 AVNRT 包括 34 个慢-快 AVNRT、6 个快-慢 AVNRT、3 个慢-慢 AVNRT、2 个慢-快和快-慢 AVNRT 以及 1 个慢-快和慢-慢 AVNRT。39 例成功消融的部位位于 RIE 内，7 例位于左下延伸。在 39 例患者中，有 30 例成功消融的 RIE 位于与初次手术相同或更高的区域。对于初次消融成功后复发房室念珠菌病的绝大多数患者（约 85%）而言，第二次成功消融的部位将位于 RIE 内，即使 RIE 原本是靶点。此外，绝大多数（约 86%）成功消融的部位将高于最初的目标部位。

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引用次数: 0

Editorial to “Associations of the Fibrosis-4 index with left atrial low-voltage areas and arrhythmia recurrence after catheter ablation: Cardio-hepatic interaction in patients with atrial fibrillation” 纤维化-4 指数与左心房低电压区和导管消融术后心律失常复发的关系 "的社论：心房颤动患者的心肝相互作用"

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-14 DOI: 10.1002/joa3.13065

Satoshi Higa MD, PhD, FHRS

<p>In the current issue of the <i>Journal of Arrhythmia</i>, Yamada et al.<span><sup>1</sup></span> retrospectively evaluated the association of the fibrosis-4 (FIB-4) index with left atrial low-voltage areas (LA LVAs) and arrhythmia recurrences postcatheter ablation (CA) in patients with atrial fibrillation (AF) (<i>n</i> = 343). In this study, patients with FIB-4 indices ≥1.3 had higher prevalences of LA LVAs (>5 cm<sup>2</sup>) than those without. Furthermore, there was a positive correlation between the quantitative LVA size and FIB-4 index. In multivariate Cox models, a FIB-4 indices ≥1.3 were an independent predictor of AF recurrence after a CB-based PVI without additional LVA ablation. Therefore, the authors proposed a preprocedural assessment of the FIB-4 index could be a useful predictor of the existence of LA LVAs and AF recurrence after a CB-based PVI.</p><p>The PVs are major sources of triggering foci initiating AF. Therefore, PVI has become the corner stone of AF ablation but still has not been standardized because additional ablation strategies are required to reduce AF recurrence. Previous reports demonstrated that the extent of LVAs revealed by electroanatomic mapping correlated with the progression of atrial electrical remodeling. Thus, additional ablation of the LVAs post-PVI is one of the key strategies to reduce atrial arrhythmia recurrence. Masuda et al.<span><sup>2</sup></span> evaluated the prognosis of 1488 consecutive patients who underwent AF ablation according to the LVA size. In that study, patients with LVAs were more likely to receive substrate ablation beyond the PVI than those without. Patients with LVAs were more often older and females, patients with a previous history of diabetes mellitus, heart failure, or a stroke. Furthermore, patients with LVAs more often had persistent AF. Masuda et al.<span><sup>2</sup></span> concluded that both an LVA presence and its extent are associated with poor long-term composite endpoints of death, heart failure, and strokes, irrespective of AF recurrence. Therefore, preprocedural predictors of the existence of LVAs are important for determining the indication for CA, appropriate strategy, and modality.</p><p>Liver disease can cause inflammation and autonomic dysfunction, which can contribute to arrhythmogenesis. Huang et al.<span><sup>3</sup></span> reported a high prevalence and incidence of AF in patients with liver disease. Although, liver diseases have been suggested to cause the AF to develop and progress, pathological assessments by liver biopsies are contraindicated in anticoagulated patients. In contrast, the FIB-4 index is a noninvasive scoring tool that is available for predicting liver impairment and fibrosis by quickly calculating the constitutional and time-sensitive parameters without an expensive cost. Furthermore, the FIB-4 index has also been suggested to be a risk assessment tool for several chronic diseases including cardiovascular diseases. The prognostic i

在本期《心律失常杂志》（Journal of Arrhythmia）上，Yamada 等人1 回顾性评估了心房颤动（房颤）患者纤维化-4（FIB-4）指数与左心房低电压区（LA LVAs）和导管消融术（CA）后心律失常复发的关系（n = 343）。在这项研究中，FIB-4指数≥1.3的患者比无FIB-4指数的患者有更高的LA LVA（>5 cm2）发生率。此外，LVA的定量大小与FIB-4指数呈正相关。在多变量 Cox 模型中，FIB-4 指数≥1.3 是基于 CB 的 PVI 后房颤复发的独立预测因素，而无需额外的 LVA 消融。因此，作者提出，术前评估 FIB-4 指数可有效预测 LA LVA 的存在以及基于 CB 的 PVI 后房颤的复发。因此，PVI 已成为房颤消融的基石，但仍未标准化，因为还需要其他消融策略来减少房颤复发。之前的报告显示，电解剖图显示的 LVA 范围与心房电重塑的进展相关。因此，PVI 后对 LVA 进行额外消融是减少房性心律失常复发的关键策略之一。Masuda 等人2 根据 LVA 的大小评估了 1488 例连续接受房颤消融术的患者的预后。在该研究中，有 LVA 的患者比没有 LVA 的患者更有可能接受 PVI 以外的基底消融。有 LVA 的患者多为老年女性，既往有糖尿病、心衰或中风病史。此外，LVA 患者多为持续性房颤。Masuda 等人2 认为，无论房颤是否复发，LVA 的存在及其程度都与死亡、心衰和中风等不良的长期综合终点相关。因此，术前预测 LVA 的存在对于确定 CA 的适应症、适当的策略和方式非常重要。Huang 等人3 报道了肝病患者房颤的高患病率和发病率。虽然肝脏疾病被认为会导致房颤的发生和发展，但通过肝脏活检进行病理评估是抗凝患者的禁忌。相比之下，FIB-4 指数是一种无创评分工具，可通过快速计算宪法和时间敏感参数来预测肝功能损害和肝纤维化，且无需昂贵的费用。此外，FIB-4 指数还被认为是包括心血管疾病在内的多种慢性疾病的风险评估工具。FIB-4 指数对房颤患者心血管事件和死亡率风险分层的预后影响也有报道。Saito 等人4 之前进行的一项日本多中心研究（n = 3067）评估了 FIB-4 指数对心房颤动患者心血管事件和死亡率风险分层的影响。该研究表明，FIB-4 指数≥2.51 与心血管事件和全因死亡率独立相关。此外，该研究还表明，FIB-4 指数和 CHA2DS2-VASc 评分的联合评估提高了心血管事件和全因死亡率的预测价值。在 CHADS2 评分较高的房颤患者中，FIB-4 指数≥2.51 与心血管事件和全因死亡率的关系最为密切。此外，FIB-4指数≥2.51的患者中，持续性和长期持续性房颤的发病率明显更高，接受CA手术的比例也更低。因此，FIB-4指数≥2.51的患者比FIB-4指数<2.51的患者有更复杂的房颤负担。根据这项研究的结果，FIB-4 指数是识别房颤负担复杂程度的独立预后指标，也是对 CHADS2 高分的房颤患者进行额外风险分层的重要工具。有趣的是，在非 HF 患者中，FIB-4 指数低（<1.3）组、中（1.3-2.67）组和高（>2.67）组的心房颤动术后复发率无明显差异。相比之下，FIB-4 指数只对特定人群（与 HF 相关的非阵发性房颤）的复发有独立预测作用，而对阵发性房颤则没有作用。Yamada 等人的研究1 提供了重要的临床意义，强调了 LA LVA 的存在和 PVI 后房颤复发的有用预测指标，并确定了适当的策略和合适的消融设备。

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引用次数: 0

Revitalizing brain perfusion: Unveiling advancements through rhythm control strategies in atrial fibrillation—A systematic review 振兴脑灌注：揭示心房颤动节律控制策略的进展--系统综述

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-13 DOI: 10.1002/joa3.13056

Shinta Dewi Rasti MD, Adra Achirultan Ramainaldo Sugiarto MD, Audia Putri Amalia Nuryandi MD, Militanisa Zamzara Arvianti MD, Romadhana Trisnha Yomara MD, Jeffri Nagasastra MD, Rerdin Julario MD, Rosi Amrilla Fagi MD, Diah Mustika Hesti Windrati MD

Background

Recent evidence suggests an elevated risk of cognitive impairment and dementia in individuals with atrial fibrillation (AF), irrespective of stroke occurrence. AF, known to reduce brain perfusion, particularly through silent cerebral ischemia, underscores the intricate relationship between cardiac and cerebral health. The heart plays a crucial role in supporting normal brain function, and rhythm control, a standard AF treatment, has demonstrated enhancements in brain perfusion. This systematic review aimed to examine published data concerning the influence of rhythm control on brain perfusion in patients with atrial fibrillation.

Methods

A systematic search for relevant studies was carried out in Scopus, PubMed, Cochrane Reviews, ProQuest, and EBSCOhost, spanning from their inception until April 30, 2023. Studies that specifically examined brain perfusion following any form of rhythm control in atrial fibrillation were included in the review.

Results

The review encompassed 10 studies involving 436 participants. Among these, six utilized electrical cardioversion for rhythm control. The majority (8 out of 10) demonstrated that restoring sinus rhythm markedly enhances brain perfusion. In one of the two remaining studies, notable improvement was observed specifically in a region closely linked to cognition. Additionally, both studies reporting data on the Mini-Mental State Examination (MMSE) showed a consistent and significant increase in scores following rhythm control.

Conclusion

Successful rhythm control in AF emerges as a significant contributor to enhanced brain perfusion, suggesting a potential therapeutic avenue for reducing cognitive impairment incidence. However, further validation through larger prospective studies and randomized trials is warranted.

最近的证据表明，无论是否发生中风，心房颤动（房颤）患者发生认知障碍和痴呆的风险都会升高。众所周知，心房颤动会减少脑灌注，尤其是通过无声脑缺血减少脑灌注，这凸显了心脑健康之间错综复杂的关系。心脏在支持大脑正常功能方面起着至关重要的作用，而心律控制作为一种标准的房颤治疗方法，已被证明能增强脑灌注。本系统性综述旨在研究已发表的有关心律控制对房颤患者脑灌注影响的数据。我们在 Scopus、PubMed、Cochrane Reviews、ProQuest 和 EBSCOhost 等网站上对相关研究进行了系统性检索，检索时间跨度从开始到 2023 年 4 月 30 日。回顾性研究包括了专门研究心房颤动患者在接受任何形式的节律控制后脑灌注情况的研究。其中，6 项研究采用了电复律来控制心律。大多数研究（10 项研究中的 8 项）表明，恢复窦性心律能显著增强脑灌注。在其余两项研究中，有一项研究观察到与认知密切相关的区域有明显改善。此外，这两项报告了迷你精神状态检查（MMSE）数据的研究均显示，在控制心律后，得分持续显著增加。成功控制心房颤动的心律是增强脑灌注的重要因素，表明这是减少认知障碍发生率的潜在治疗途径。然而，还需要通过更大规模的前瞻性研究和随机试验来进一步验证。

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引用次数: 0

Editorial to “Characteristics of radiofrequency lesions in patients with symptomatic periesophageal vagal nerve injury after pulmonary vein isolation” "肺静脉隔离术后无症状食管周围迷走神经损伤患者射频病变的特征 "的社论

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-12 DOI: 10.1002/joa3.13057

Koichiro Ejima MD

<p>Because the left atrium (LA) and esophagus are adjacent to each other, collateral damage to the periesophageal vagal nerve after ablation of atrial fibrillation (AF) is not uncommon.<span><sup>1</sup></span> The left vagal nerve branches form a plexus anterior to the esophagus and control the esophageal and gastric motility, maintain a lower esophageal sphincter tone, and induce pyloric relaxation. Damage to the periesophageal nerve fibers may result in both reflux (facilitating progression of esophageal lesions) and gastric motility disorders/food retention. The exact pathophysiologic mechanisms of vagal nerve injury are not well understood. Besides the direct thermic effects on neural action potentials, edema and hematomas (disruption of vessels supplying the esophageal wall and giving rise to necrosis) may cause local pressure on vagal nerve branches.</p><p>In this issue of the <i>Journal of Arrhythmia</i>, Yoshimura et al. provided an important assessment of the relationship between the incidence of symptomatic periesophageal vagal nerve injury (PNI) during radiofrequency (RF) catheter ablation of AF and the RF lesion characteristics and distance between the RF lesions and esophagus.<span><sup>1</sup></span> Of 1391 patients who underwent a first-time ablation index-guided pulmonary vein isolation (PVI) using a CARTO system for AF, 10 (0.72%) were diagnosed with symptomatic PNI. In that study, the ablation procedure was performed after integrating the LA electroanatomical maps with the computed tomography (CT) images obtained preprocedure. On the LA posterior wall near the esophagus, they restricted RF applications to a power setting of <30 W and RF duration of <30 s, regardless of the ablation index. Further, the RF delivery was stopped when the esophageal temperature (ET) reached >41°C. They found that the contact force (CF) at the lesion-esophageal distance (LED), defined as the shortest perpendicular distance from the RF-lesion tag on the circumferential ablation line to the anterior aspect of the esophagus, of 0–5 mm was an independent predictor of symptomatic PNI using a multivariate logistic analysis. It is known that the proximity of LA posterior wall to the esophagus is associated with esophageal injury. The clinical significance of this study was that it revealed that not only the proximity of the esophagus to the LA posterior wall but also the characteristics of the RF lesions, not the ablation index or RF power but the CF, were associated with symptomatic PNI. The fact that the LEDs in this study were not necessarily accurate and may have underestimated the PNI because the assessment of the PNI was dependent on the presence or absence of symptoms, was a limitation that should be noted when interpreting this study's results. Grosse Meininghaus et al.<span><sup>2</sup></span> reported that PVI-induced PNI and gastric motility disorders detected by electrogastrography are quite common and are observed in one-third of pati

一些报告显示，食管主动冷却装置和机械移位食管可有效防止食管损伤，但这两种方法仅在全身麻醉的情况下使用。据报告，在射频导管消融过程中，在 PVI 的基础上对 LA 后壁进行进一步消融与食管热损伤有关。高功率短持续时间（HPSD）射频消融可在电阻加热阶段产生浅、宽、持久的病灶，并通过缩短传导加热阶段（传导加热阶段可产生较深的病灶）减少附带组织损伤。一项随机对照研究显示，无论是否进行 ET 监测，HPSD 射频房颤消融术都很少出现食道相关并发症。笔者在 1000 多名患者中使用 CF 传感导管在电解剖图（CARTO）结合图像集成的引导下进行 HPSD 射频房颤消融术，在无 ET 监测的情况下，仅有一例患者在消融术后出现症状性胃蠕动障碍，患者在保守治疗后 1 周痊愈。为实现安全有效的 HPSD 射频消融，在邻近食管的 LA 后壁进行射频应用时，射频应用的 CF 应限制在 <10 g，CF 的呼吸变异性最小，射频应用持续时间为 <5 s，间隔距离为 <5 mm。

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引用次数: 0

Clinical implication of hyperuricemia on the recurrence of atrial fibrillation after catheter ablation 高尿酸血症对导管消融术后心房颤动复发的临床影响

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-11 DOI: 10.1002/joa3.13047

Naoya Kataoka MD, Teruhiko Imamura MD, PhD

Hyperuricemia has been linked to a heightened incidence of atrial fibrillation (AF). Oseto and colleagues have demonstrated a significant elevation in serum uric acid levels among patients with persistent AF compared to those with paroxysmal AF.¹ Moreover, the presence of post-ablation hyperuricemia has been associated with the recurrence of AF in patients with persistent AF. However, several concerns have been raised.

Uric acid is primarily synthesized by xanthine oxidases, predominantly found in the liver, thus indicating a substantial influence of liver function on serum uric acid levels.² In the authors' study, both uric acid and γ-glutamyl transpeptidase levels were elevated in patients with persistent AF.¹ Elevated γ-glutamyl transpeptidase levels may be linked to alcohol consumption, which has been associated with the onset and recurrence of AF.³ It is highly recommended to adjust for these potential confounders to accurately assess the impact of serum uric acid levels on AF recurrence.

While the authors focused on the association between uric acid and left atrial remodeling,¹ noteworthy that only a small fraction of xanthine oxidase is located in the left atrium.² Did the author correlate serum uric acid levels with left atrial size, which may be more appropriate? Additionally, investigating the prognostic impact of xanthine oxidase, rather than uric acid, could yield more relevant insights.⁴

The clinical implications of predicting recurrent AF using post-ablation data remain uncertain. Risk stratification of ablation candidates can be enhanced, allowing for more intensive ablation procedures, with reference to pre-procedural risk factors instead of post-procedural ones. Given their findings that serum uric acid levels were higher in patients with persistent AF compared to those with paroxysmal AF,¹ post-ablation elevated uric acid levels may simply reflect ongoing AF recurrence.

Authors declare no conflict of interests for this article.

高尿酸血症与心房颤动（房颤）发病率增高有关。Oseto 及其同事证实，与阵发性房颤患者相比，持续性房颤患者的血清尿酸水平显著升高。尿酸主要由黄嘌呤氧化酶合成，而黄嘌呤氧化酶主要存在于肝脏中，因此肝功能对血清尿酸水平有很大影响。2 在作者的研究中，持续性房颤患者的尿酸和γ-谷氨酰转肽酶水平均升高。2 作者是否将血清尿酸水平与左心房大小相关联，这可能更为恰当？此外，研究黄嘌呤氧化酶而非尿酸对预后的影响可能会得出更相关的结论。参考消融前的风险因素而非消融后的风险因素，可加强对消融候选者的风险分层，从而进行更密集的消融手术。鉴于他们发现持续性房颤患者的血清尿酸水平高于阵发性房颤患者1，消融术后尿酸水平升高可能只是反映了房颤的持续复发。

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引用次数: 0

Correction to “Short QT Syndrome: The Current Evidences of Diagnosis and Management” 更正 "短 QT 综合征：诊断和管理的现有证据"

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-10 DOI: 10.1002/joa3.13043

Dewi IP, Dharmadjati BB. Short QT syndrome: The current evidences of diagnosis and management. J Arrhythm. 2020;36(6):962–966.

In the third paragraph of the “Introduction” section, we add “Due to its rarity and potential lethality, understanding the pathogenesis and clinical implications of SQTS is crucial. This literature review aims to provide a comprehensive and detailed overview of SQTS. Additionally, this article updates prior review by Reviriego et al.,^a to incorporate the latest advancements and insights of SQTS.”

In the last paragraph of the “Genetic Factors in SQTS” section, we cite reference b at the end of the following sentence, as in “Templin et al, described another mutation in the CACNA2D1 gene that causes a decrease in the flow of Ca-type L channels (SQTS 6).^b”

We add two citations as follows.

a. Reviriego SM, Merino JL. Short QT Syndrome. ESC Council for Cardiology Practice. 2010; 9(2).

b. Templin C, Ghadri JR, Rougier JS, Baumer A, Kaplan V, Albesa M, et al. Identification of a novel loss-of-function calcium channel gene mutation in short QT syndrome (SQTS6). Eur Heart J. 2011;32(9):1077–88. https://doi.org/10.1093/eurheartj/ehr076

We apologize for these errors.

Dewi IP, Dharmadjati BB.短 QT 综合征：当前诊断和管理的证据。J Arrhythm.2020；36（6）：962-966.在 "引言 "部分的第三段，我们添加了 "由于其罕见性和潜在致死性，了解 SQTS 的发病机制和临床意义至关重要。本文献综述旨在提供有关 SQTS 的全面而详细的概述。此外，本文更新了 Reviriego 等人之前的综述，a 纳入了有关 SQTS 的最新进展和见解。"在 "SQTS 的遗传因素 "部分的最后一段，我们在以下句子的末尾引用了参考文献 b，如 "Templin 等人描述了 CACNA2D1 基因的另一种突变，这种突变会导致 Ca 型 L 通道流量减少（SQTS 6）。"我们添加了以下两个引文：a. Reviriego SM, Merino JL.短 QT 综合征。ESC心脏病学实践委员会。2010; 9(2).b. Templin C, Ghadri JR, Rougier JS, Baumer A, Kaplan V, Albesa M, et al. Identification of a new loss-of-function calcium channel gene mutation in short QT syndrome (SQTS6).Eur Heart J. 2011; 32(9):1077-88. https://doi.org/10.1093/eurheartj/ehr076We 对这些错误深表歉意。

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引用次数: 0

Remote monitoring of cardiac implantable electronic devices using smart device interface versus radiofrequency-based interface: A systematic review 使用智能设备接口与基于射频的接口对心脏植入式电子设备进行远程监控：系统综述

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-09 DOI: 10.1002/joa3.13054

Vern Hsen Tan MBBS, MRCP, Hui Xin See Tow, Khi Yung Fong MBBS, Yue Wang MD, MRCP, Colin Yeo MBBS, FRCP, Chi Keong Ching MBBS, MRCP, Toon Wei Lim MBBS, PhD

Background

Guidelines recommended remote monitoring (RM) in managing patients with Cardiac Implantable Electronic Devices. In recent years, smart device (phone or tablet) monitoring-based RM (SM-RM) was introduced. This study aims to systematically review SM-RM versus bedside monitor RM (BM-RM) using radiofrequency in terms of compliance, connectivity, and episode transmission time.

Methods

We conducted a systematic review, searching three international databases from inception until July 2023 for studies comparing SM-RM (intervention group) versus BM-RM (control group).

Results

Two matched studies (21 978 patients) were retrieved (SM-RM arm: 9642 patients, BM-RM arm: 12 336 patients). There is significantly higher compliance among SM-RM patients compared with BM-RM patients in both pacemaker and defibrillator patients. Manyam et al. found that more SM-RM patients than BM-RM patients transmitted at least once (98.1% vs. 94.3%, p < .001), and Tarakji et al. showed that SM-RM patients have higher success rates of scheduled transmissions than traditional BM-RM methods (SM-RM: 94.6%, pacemaker manual: 56.3%, pacemaker wireless: 77.0%, defibrillator wireless: 87.1%). There were higher enrolment rates, completed scheduled and patient-initiated transmissions, shorter episode transmission time, and higher connectivity among SM-RM patients compared to BM-RM patients. Younger patients (aged <75) had more patient-initiated transmissions, and a higher proportion had ≥10 transmissions compared with older patients (aged ≥75) in both SM-RM and BM-RM groups.

Conclusion

SM-RM is a step in the right direction, with good compliance, connectivity, and shorter episode transmission time, empowering patients to be in control of their health. Further research on cost-effectiveness and long-term clinical outcomes can be carried out.

指南建议对植入心脏电子设备的患者进行远程监护（RM）。近年来，推出了基于智能设备（手机或平板电脑）监测的远程监护（SM-RM）。本研究旨在从依从性、连通性和发作传输时间等方面，系统回顾 SM-RM 与使用射频的床旁监护仪远程监护（BM-RM）的比较。我们进行了一项系统回顾，检索了三个国际数据库，从开始到 2023 年 7 月，比较 SM-RM（干预组）与 BM-RM（对照组）的研究。在起搏器和除颤器患者中，SM-RM 患者的依从性明显高于 BM-RM 患者。Manyam 等人发现，与 BM-RM 患者相比，更多的 SM-RM 患者至少进行过一次传输（98.1% vs. 94.3%，p < .001），Tarakji 等人的研究表明，与传统的 BM-RM 方法相比，SM-RM 患者的计划传输成功率更高（SM-RM：94.6%，手动起搏器：56.3%，无线起搏器：12,336）：56.3%，起搏器无线：77.0%，除颤器无线：87.1%）。与 BM-RM 患者相比，SM-RM 患者的注册率、完成计划传输和患者主动传输的比率更高，发作传输时间更短，连接性更高。在SM-RM和BM-RM两组患者中，年轻患者（年龄小于75岁）与年长患者（年龄大于75岁）相比，由患者发起的传输次数更多，传输次数≥10次的患者比例更高。可以对成本效益和长期临床结果开展进一步研究。

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引用次数: 0

Meta-analysis evaluating apixaban in patients with atrial fibrillation and end-stage renal disease requiring dialysis 评估阿哌沙班在心房颤动和需要透析的终末期肾病患者中应用情况的 Meta 分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-06 DOI: 10.1002/joa3.13051

Ahmed AlTurki MD, Mariam Marafi MD, Ahmed Dawas MD, Jacqueline Joza MD, Riccardo Proietti MD, PhD, Vincenzo Russo MD, PhD, Thomas Mavrakanas MD, Emilie Trinh MD, MSc, Catherine Weber MD, Rita Suri MD, Vidal Essebag MD, PhD, Thao Huynh MD, PhD

Background

Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can offer significant stroke prevention in this population, the accompanying major bleeding risks make warfarin nearly prohibitive. Apixaban was shown to be superior to warfarin in preventing stroke or systemic embolism, with a lower risk of bleeding and mortality in a large, randomized trial of individuals with mostly normal renal function but none with ESRD.

Methods

We systematically reviewed evidence comparing apixaban versus warfarin for atrial fibrillation in this population, and evaluated outcomes of stroke or systemic embolism, and major bleeding using random-effects models. The main safety outcome was major bleeding, and the main effectiveness outcome was stroke or systemic embolism.

Results

We found five observational studies of 10 036 patients (2638 receiving apixaban, and 7398 receiving warfarin) meeting inclusion criteria. Pooled analysis demonstrated a significant reduction in major bleeding with apixaban as compared to warfarin (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42–0.61; p < .0001). Apixaban was also associated with a reduction in intracranial bleeding (OR 0.58, 95% CI 0.37–0.92; p = .02) and in gastrointestinal bleeding (OR 0.61, 95% CI 0.51–0.73; p < .0001). Furthermore, apixaban was associated with a reduction in stroke/systemic embolism (OR 0.64, 95% CI 0.50–0.82; p < .0001).

Conclusion

Apixaban was associated with superior outcomes and reduced adverse events compared to warfarin in observational studies of patients with atrial fibrillation on dialysis. Randomized controlled studies are needed to confirm these findings.

华法林被认为是心房颤动和需要透析的终末期肾病 (ESRD) 患者的主要口服抗凝药。虽然华法林可以有效预防这类人群的中风，但伴随而来的大出血风险让华法林几乎望而却步。阿哌沙班在预防中风或全身性栓塞方面优于华法林，而且出血风险和死亡率较低。我们系统地回顾了阿哌沙班与华法林治疗该人群心房颤动的比较证据，并使用随机效应模型评估了中风或全身性栓塞以及大出血的结局。我们发现有五项观察性研究的 10 036 名患者（2638 人接受阿哌沙班治疗，7398 人接受华法林治疗）符合纳入标准。汇总分析表明，与华法林相比，阿哌沙班可显著减少大出血（几率比 [OR] 0.51，95% 置信区间 [CI] 0.42-0.61; p < .0001）。阿哌沙班还可减少颅内出血（OR 0.58，95% CI 0.37-0.92；P = .02）和胃肠道出血（OR 0.61，95% CI 0.51-0.73；P < .0001）。此外，阿哌沙班还能减少中风/系统性栓塞（OR 0.64，95% CI 0.50-0.82；p < .0001）。在对透析中的心房颤动患者进行的观察性研究中，阿哌沙班的疗效优于华法林，不良反应也少于华法林。需要进行随机对照研究来证实这些发现。

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引用次数: 0

Notched P-wave on digital electrocardiogram predicts the recurrence of atrial fibrillation in patients who have undergone catheter ablation 数字心电图上的缺口 P 波可预测接受导管消融术患者的心房颤动复发率

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2024-05-02 DOI: 10.1002/joa3.13050

Takafumi Okuyama MD, Tomoyuki Kabutoya MD, PhD, Kazuomi Kario MD, PhD

Background

A notched P-wave is associated with the occurrence of atrial fibrillation (AF). However, the association between a notched P-wave and AF recurrence in patients who have undergone a catheter ablation for AF is unclear.

Methods

We enrolled 100 subjects who underwent catheter ablation for AF (paroxysmal AF: 60 cases; persistent AF: 40 cases). Twelve-lead electrocardiography (ECG) was conducted, and the peak-to-peak distance in the M shape was calculated automatically using a 12-lead ECG analysis system. A notched P-wave was defined as a P-wave with an M-shape and a peak-to-peak distance of ≥20 ms in lead II. We compared the recurrence of AF in the patients with notched P-wave and the others.

Results

The mean follow-up period was 12 ± 8 months, and a recurrence of AF was observed in 28 patients. The recurrence of AF in the notched P-wave group was significantly higher than that in the controls (log rank 5.14, p = .023). A notched P-wave was a significant predictor of the recurrence of AF after adjustment for age, gender, history of heart failure, history of catheter ablation, persistent AF, use of antiarrhythmic drugs, and the left atrial volume index (hazard ratio 2.470, 95% confidence interval 1.065–5.728, p = .035).

Conclusions

Automatically identified notched P-waves with peak-to-peak distance ≥20 ms were associated with AF recurrence in patients who had undergone catheter ablation.

P波凹陷与心房颤动（房颤）的发生有关。我们招募了 100 名因房颤接受导管消融术的受试者（阵发性房颤：60 例；持续性房颤：40 例）。我们对 100 名因房颤接受导管消融术的受试者（阵发性房颤：60 例；持续性房颤：40 例）进行了十二导联心电图检查，并使用十二导联心电图分析系统自动计算了 M 型的峰峰距。缺口 P 波的定义是：P 波呈 M 型，且在 II 导联中峰峰间距≥20 毫秒。我们比较了有缺口 P 波患者和其他患者的房颤复发情况。P波缺口组的房颤复发率明显高于对照组（对数秩5.14，P = .023）。在对年龄、性别、心衰病史、导管消融病史、持续性房颤、抗心律失常药物的使用和左心房容积指数进行调整后，缺口 P 波是房颤复发的一个重要预测因素（危险比 2.470，95% 置信区间 1.065-5.728，p = .035）。自动识别出的峰-峰距离≥20 毫秒的缺口 P 波与导管消融患者的房颤复发有关。

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