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Journal of Arrhythmia

Subscription journal
ISSN (Print) 1880-4276 - ISSN (Online) 1883-2148
Published by Elsevier

[2565 journals]

Editorial Board
- Pages: i - ii
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-06-01
  DOI: 10.1016/S1880-4276(13)00084-7
  Issue No: Vol. 29, No. 3 (2013)
Cardiac resynchronisation and defibrillation therapy: Advances and challenges
- Authors: Chu-Pak Lau
  Pages: 143 - 143
  Abstract: In patients with systolic heart failure and a wide QRS complex, cardiac resynchronisation therapy (CRT) using left ventricular (LV) pacing has been shown to enhance survival, reduce heart failure hospitalisation and enhance exercise capacity in patients with all classes of heart failure. The patient subsets most likely to benefit are those with class II–IV heart failure, LBBB and a QRS width ≥ 150ms . The application of CRT in patients with less wide QRS, non-LBBB and atrial fibrillation may be associated with less benefit. Coronary sinus placement of LV lead is the main channel of CRT delivery. This can be challenging at times during implantation, and can restrict LV pacing to suboptimal site . There are post-implant complications such as LV lead dislodgment, diaphragmatic pacing and device infection.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-06-05
  DOI: 10.1016/j.joa.2013.05.002
  Issue No: Vol. 29, No. 3 (2013)
Remote monitoring of ICDs and CRTs
- Authors: Niraj Varma
  Pages: 144 - 152
  Abstract: Abstract: Cardiac implantable electronic devices are increasing in prevalence and functionality. Post-implant follow-up is important for monitoring both device function and patient condition. However, practice is inconsistent. For example, ICD follow-up schedules vary from 3 months to yearly according to facility and physician preference and availability of resources. Recommended follow-up schedules impose significant burden. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. Results from large randomized prospective trials of all types of CIEDs from different manufacturers, and conducted in different countries, consistently indicate superior performance to conventional care for achieving the current follow-up goals of patient retention and early problem discovery, improving patient safety and convenience, yet promoting clinic efficiencies. Thus, automatic remote home monitoring is a transforming technology in the evolution of CIEDs, and is poised for remarkable gains in disease management.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-06-03
  DOI: 10.1016/j.joa.2013.05.001
  Issue No: Vol. 29, No. 3 (2013)
The role of AV and VV optimization for CRT
- Authors: William W. Brabham; Michael R. Gold
  Pages: 153 - 161
  Abstract: Abstract: Cardiac resynchronization therapy is an effective therapy for patients with left ventricular systolic dysfunction and a ventricular conduction delay; however, approximately 30% of patients do not experience significant clinical improvement with this treatment. Modern devices allow individualized programming of the AV delay and VV offset, which offer the possibility of improving clinical response rates with optimized programming. AV and VV delay optimization techniques have included echocardiography, device-based algorithms, and several other novel noninvasive techniques. While an acute improvement in hemodynamic function has been clearly demonstrated with optimized device settings, long-term clinical benefit is limited. In the majority of cases, an empiric AV delay with simultaneous biventricular or left ventricular pacing is adequate. The value of optimization of these intervals in “non-responders” still requires further investigation.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-03-18
  DOI: 10.1016/j.joa.2013.02.001
  Issue No: Vol. 29, No. 3 (2013)
Perioperative management of anticoagulation in patients on warfarin therapy undergoing surgery for cardiac implantable electronic devices
- Authors: Dennis Weixi Zhu; Imdad Ahmed
  Pages: 162 - 167
  Abstract: Abstract: Many patients on chronic warfarin therapy are undergoing surgery for permanent pacemakers and implantable defibrillators, collectively known as cardiac implantable electronic device (CIED). The perioperative management of anticoagulation in these patients is a challenging clinical situation that requires balance between the risk of acute thrombosis and perioperative hemorrhage. This issue however, is inadequately addressed in the guidelines published by professional organizations. Increasing evidence suggests that temporarily interrupting anticoagulation is associated with a small but real thromboembolic risk, whereas cessation of warfarin with heparin bridging anticoagulation frequently leads to a higher incidence of pocket hematoma. Continuing warfarin with a therapeutic international normalized ratio appears to be a safe and cost-effective approach for CIED surgery in most patients with moderate to high thromboembolic risk. An algorithm is proposed for the practical management of anticoagulation and antiplatelet therapy in these patients during the perioperative period.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-03-19
  DOI: 10.1016/j.joa.2013.01.010
  Issue No: Vol. 29, No. 3 (2013)
Current status of cardiac resynchronization therapy with defibrillators and factors influencing its prognosis in Japan
- Authors: Akihiko Shimizu; Takeshi Mihashi, Hiroshi Furushima, Yukio Sekiguchi, Tetsuyuki Manaka, Nobuhiro Nishii, Takeshi Ueyama, Hisashi Yokoshiki, Norishige Morita, Takashi Nitta, Ken Okumura
  Pages: 168 - 174
  Abstract: Abstract: Purpose: The purpose of this study was to clarify the prognosis of cardiac resynchronization therapy with defibrillators (CRT-Ds) in Japan.Methods: We selected 384 patients implanted with a CRT-D device from the observation database (n=1482) of the Japanese Cardiac Device Therapy Registry. We investigated the CRT criteria, including the presence of New York Heart Association (NYHA) class III/IV symptoms, left ventricular ejection fraction (LVEF) ≤35%, and QRS duration ≥120ms. The patients were divided into 2 groups: the group fulfilling all of the 3 criteria (Group A, n=229) and the group not fulfilling the criteria (Group B, n=155). We compared mortality and appropriate shock rates between the 2 groups.Results: There was no significant difference in mortality (17.9% vs. 13.5%) or appropriate shock rates (32.5% vs. 31.6%) during the observation period of 29.0±15.7 months between the 2 groups. A logistic multivariate analysis showed that appropriate shocks (hazard ratio [HR]=1.85) and class III antiarrhythmic agents (HR=2.33) were independently associated with all-cause death, and that age ≥70 years (HR=0.55), male gender (HR=2.07), and presence of a single-chamber device (HR=1.78) were associated with appropriate shocks. The prognosis of Group A was better than that of the COMPANION trial.Conclusions: Japanese patients with CRT-D devices had a better prognosis than did those in the COMPANION trial, but no significant differences were observed between patients fulfilling and those not fulfilling the above mentioned criteria.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-05-20
  DOI: 10.1016/j.joa.2013.04.006
  Issue No: Vol. 29, No. 3 (2013)
Current status of cardiac resynchronization therapy device optimization in Japan
- Authors: Kentaro Doi; Takashi Noda, Kentaro Yoshida, Hiro Yamasaki, Yukio Sekiguchi, Shiro Kamakura, Wataru Shimizu, Kazutaka Aonuma
  Pages: 175 - 179
  Abstract: Abstract: Background: Cardiac resynchronization therapy (CRT) is known to be effective for patients with heart failure. However, despite data suggesting that routine atrioventricular (AV) and interventricular (VV) delay optimization may play significant roles in CRT, there is no standard on how and when the CRT device should be optimized. The aim of this study was to characterize the current practice of CRT optimization in Japan.Methods: A survey was conducted to collect information on the procedural aspects of AV and VV delay optimization. The key survey items concerned what method is used for optimization, when optimization is performed, and what factors limit repetitive optimization.Results: Fifty-two physicians participated in the survey. Echocardiography was the chosen method for assessing AV and VV delays by 79.6% and 65.3% of physicians, respectively, and routine optimization was performed by 28.3%. The majority optimized the settings only once at pre-hospital discharge or on an “as-needed” basis. The factors limiting repeated optimization were the lack of available time (71.2%), qualified staff (53.8%), and reliable methods (55.8%).Conclusions: Repetitive CRT optimization is infrequently performed in Japan. Lack of time, human resource, and reliable methods were the major factors affecting the number of routine CRT optimization.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-04-29
  DOI: 10.1016/j.joa.2013.04.002
  Issue No: Vol. 29, No. 3 (2013)
Detection of regional low myocardial perfusion helps predict a response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy: Results of the Find Index by Nuclear Imaging for Dyssynchrony (FIND) study
- Authors: Takehiko Keida; Itsuro Morishima, Taketsugu Tsuchiya, Kouichi Sagara, Kaoru Okishige, Kenta Kumagai, Yoshiaki Mibiki, Kentaro Nakamura, Tamon Yamanaka, Yukihiko Yoshida, Akira Yamamoto, Mitsuaki Takami
  Pages: 180 - 186
  Abstract: Abstract: Background: The aim of this study was to investigate the use of imaging techniques to predict the response to cardiac resynchronization therapy (CRT) in patients with non-ischemic cardiomyopathy (NICM) by simultaneous assessment of left ventricular (LV) dyssynchrony and myocardial perfusion in a single nuclear scan of the heart.Methods: Patients indicated for CRT device implantation underwent a resting myocardial perfusion assessment with single photon emission computed tomography (MP-SPECT) examination using technetium-99m methoxyisobutylisonitrile prior to device implantation. CardioGRAF and cardioBull software (FUJIFILM RI Pharma, Tokyo, Japan) were used to analyze the LV mechanical dyssynchrony and myocardial viability, respectively. Patient follow-ups were performed at 6 months after device implantation. CRT response was defined as a ≥10% decrease in the LV end systolic volume.Results: A total of 43 patients with NICM were analyzed. Using the cutoff points of 6.2 for the dyssynchrony index and 66% for LV myocardial perfusion, the combined indices predicted CRT response with a sensitivity of 77.8% and specificity of 91.2%.Conclusion: Combined assessment of MP-SPECT and a measure of LV mechanical dyssynchrony showed good predictive ability in patients with non-ischemic heart failure.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-01-21
  DOI: 10.1016/j.joa.2012.12.004
  Issue No: Vol. 29, No. 3 (2013)
Unheralded failure of Riata defibrillator lead identified at defibrillation threshold testing
- Authors: Matthew R. Webber; Rosemary F. Allen, Martin K. Stiles
  Pages: 187 - 189
  Abstract: Abstract: Background: St Jude Medical “Riata” implantable cardioverter-defibrillator leads have a higher-than-expected failure rate and carry a Class 1 recall. Failure usually relates to an insulation breach that may not be identified by lead fluoroscopic or electrical changes.Case presentation: We report a case of Riata lead failure identified by the aborted delivery of effective therapy for ventricular fibrillation at the time of defibrillation threshold testing. Lead fluoroscopic appearances were normal. Shock impedance on attempted shock delivery was unrecordably low, and all other electrical parameters were within normal limits.Conclusion: Riata lead failure may be unrecognised until there is failure to deliver necessary therapy. Strong consideration ought to be given to lead examination under high-voltage shock delivery through the device.
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-05-20
  DOI: 10.1016/j.joa.2013.04.003
  Issue No: Vol. 29, No. 3 (2013)
The APHRS's 2013 statement on antithrombotic therapy of patients with nonvalvular atrial fibrillation
- Authors: Satoshi Ogawa; Kazutaka Aonuma, Hung-Fat Tse, Dejia Huang, Jin-Long Huang, Jonathan Kalman, Shiro Kamakura, Mohan Nair, Dong-Gu Shin, Martin Stiles, Wee Siong Teo, Teiichi Yamane
  Pages: 190 - 200
  Abstract: Atrial fibrillation (AF) has been gaining much attention as one of the major causes of cerebral infarction . For practitioners to effectively manage this risk, it is imperative to establish an antithrombotic treatment for AF patients. To date, guidelines for antithrombotic treatment in the management of AF patients have been published in the United States , Europe , Australia , Canada , and Japan , which include verification of the efficacy of direct thrombin and factor Xa inhibitors. A look at the needs of patient populations in the Asia-Pacific region shows that antithrombotic treatment has not yet been defined and no such guidelines exist. The Asia Pacific Heart Rhythm Society (APHRS)—Practice Guideline Subcommittee conducted a Web-based survey from June 2011 to August 2011 to elucidate the current status of antithrombotic treatment in 9 countries. When research was completed, the APHRS published a report entitled, “Fact-finding survey of antithrombotic treatment for prevention of cerebral and systemic thromboembolism in patients with non-valvular atrial fibrillation in 9 countries of the Asia-Pacific region” in the Journal of Arrhythmia .
  Citation: Journal of Arrhythmia 29, 3 (2013)
  PubDate: 2013-06-03
  DOI: 10.1016/j.joa.2013.03.002
  Issue No: Vol. 29, No. 3 (2013)