Journal of Cardiovascular Electrophysiology最新文献

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide. However, data regarding readmissions following index admission for AF in the developing world are not well described. This study assessed the rate, predictors, and trends of 6-month readmission after index admission for AF in Syria.

Methods: We included adult patients who had an index admission with AF to Latakia's tertiary center between July 2021 and November 2023. Patients were monitored for readmission for 6 months after index discharge. Data were taken from the patient's medical notes.

Results: A total of 649 patients were included in the final analysis, of which 320 (49%) were readmitted to the hospital within 6 months following index admission. Cardiac causes were the most common cause of readmission in 76% of patients, of which 70% were AF. Readmitted patients had a higher median age (64 vs. 58; p = 0.001) and fewer males (49% vs. 36%; p = 0.001). In multivariate analysis, factors that independently increased 6-month readmission risk were age ≥ 60 years (hazard ratio [HR]: 1.7, 95% CI: 1.4-2.2), females (HR: 2.2, 95% CI: 1.6-2.7), and congestive heart failure (CCF) (HR: 2.1, 95% CI: 1.4-2.6). Most cardiac readmissions (76%) happened during the first 60 days following index discharge.

Conclusion: Almost half the patients were readmitted within 6 months after an index admission for AF. Females, CCF, and advancing age were independently associated with an increased risk of 6-month readmission.

Atrial fibrillation (AF) is the most common cause of arrhythmia-induced cardiomyopathy. Effective management strategies include medical therapy for rate and rhythm control, catheter ablation (CA), and goal-directed medical therapy. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), a novel class of antidiabetic drugs, have shown a promising impact in reducing cardiovascular events in diabetic and nondiabetic heart failure (HF) patients. It is unclear what impact SGLT2i use may have on AF recurrence following CA. To evaluate the effects of SGLT2i on preventing AF recurrence following CA and its impact on other cardiovascular outcomes. We performed a comprehensive literature search through multiple search engines (PubMed, Scopus, Web of Science, and Cochrane) to include eligible studies using the appropriate keywords until 10 April 2024. Our search yielded nine eligible studies with 16 857 patients. Our analysis reveals a significant reduction in AF recurrence after CA among patients receiving SGLT2i compared to non-SGLT2i medications (RR = 0.72, 95% CI [0.67-0.78], p < 0.00001). Additionally, SGLT2i therapy was associated with decreased all-cause hospitalizations and reduced risk of ischemic stroke. However, no significant difference in all-cause mortality was observed between SGLT2i and non-SGLT2i groups. Our study found that SGLT2 inhibitors significantly reduced AF recurrence post-CA in diabetic patients. Moreover, SGLT2i use was associated with lowered hospitalization and ischemic stroke risk. Though no significant difference in mortality was noted, the decrease in hospitalization suggests a possible favorable effect on cardiovascular events.

Introduction: The docking button of the Aveir leadless pacemaker (LP) is occasionally difficult to access due to its inappropriate position in the right ventricle (RV).

Methods and results: We report a case where the Aveir LP was successfully retrieved by releasing the wedged docking button in the inferior wall of the RV using a loop wire technique.

Conclusion: The loop wire technique may be useful to change the position of the Aveir LP. This may be helpful to retrieve the Aveir LP even in a case where the docking button is wedged in the inferior wall of the RV.

Background: Off-label under- and overdosing of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is not uncommon in real-world practice.

Objective: This study aimed to identify efficacy and safety of off-label DOACs dose after AF ablation.

Methods: The RYOUMA registry was a prospective multicenter study of Japanese patients who underwent AF ablation between 2017 and 2018. DOAC prescriptions were categorized into on-label standard dose, on-label reduced dose, off-label underdose, and off-label overdose.

Results: The proportion of off-label doses among patients after AF ablation varied depending on the type of DOAC, ranging from 13.5% to 34.9%. Of 2821 patients, 366 (13.0%) were prescribed an off-label underdose and exhibited significantly higher CHADS₂, CHA₂DS₂-VASc, CHA₂DS₂-VA, HELT-E₂S₂, and HAS-BLED scores, age, concomitant use of antiplatelets, and lower weight when compared to the on-label standard dose (n = 1809). While the incidence of ischemic stroke after 1 year of off-label underdose was notably low (0.28%), the rate of major bleeding was relatively high (1.7%). Off-label overdose was prescribed to 134 patients (4.8%), who showed a significantly higher incidence of major bleeding (3.0%) compared to on-label standard dose (0.91%; p = 0.02). The off-label overdose group did not have any particular background and its thromboembolic risk was, conversely, low. The most likely cause of off-label overdose was clinicians potentially overlooking dose criteria, including advanced age, low body weight, and low creatinine clearance.

Conclusions: In patients after AF ablation, off-label DOAC overdose was infrequent, but significantly associated with higher incidence of major bleeding during the remote period after AF ablation.

Trial registration: The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry).

This review provides a history of physiological pacing from inception to current practice and into the future. This review stems from personal experience and is not formally systematic. Physiological cardiac pacing is covered from 1960s to date. Concepts, and major milestones with their practical applications are reviewed including possible applications in the future. Huge strides have been made in the last 50 years, but consequences of developments have not always been well considered resulting in important adverse effects. The future requires deep electrophysiological thinking to achieve further benefits for our patients.