Arrhythmia and Electrophysiology Review

Vasovagal syncope (VVS) is due to a common autonomic reflex involving the cardiovascular system. It is associated with bradycardia (cardioinhibitory response) and/or hypotension (vasodepressor response), likely mediated by parasympathetic activation and sympathetic inhibition. While generally a situational, isolated and/or self-limited event, for some, VVS is recurrent, unpredictable and debilitating. Conservative, non-pharmacological management may help, but no specific medical therapy has been proven widely effective. Permanent pacing may have specific benefit, but its value has been debated. The temporal causative association of bradycardia with syncope in those with VVS may help identify which patient could benefit from pacing but the timing and type of pacing in lieu of blood pressure changes may be critical. The mode, rate, pacing algorithm and time to initiate dual-chamber pacing preferentially with respect to the vasovagal reflex may be important to prevent or ameliorate the faint but completely convincing data are not yet available. Based on available data, DDD pacing with the closed loop stimulation algorithm appears a viable, if not the best, alternative presently to prevent recurrent VVS episodes. While several knowledge gaps remain, permanent pacing appears to have a role in managing select patients with VVS.

Rakesh Gopinathannair

Benjamin C Salgado

Brian Olshansky

Arrhythmia & Electrophysiology Review

Pacing for Vasovagal Syncope

Syncope is defined by transient and spontaneous loss of consciousness with rapid recovery. Vasovagal syncope (VVS) is the most common form of syncope and is strongly associated with hypervagotonia. There is, however, a lack of effective therapies for VVS. Cardioneuroablation (CNA) is an emerging and promising intervention for VVS with favourable outcomes. CNA has been shown to suppress excessive excitation of vagal activity through ablating the cardiac ganglionated plexi. CNA in the management of VVS requires more structured and comprehensive studies and several issues concerning patient selection, selection of ablation targets, ablation endpoints and the long-term effect of CNA are yet to be determined. This review describes its clinical applications and future directions based on current research data and the authors' own experiences.

Le Li

Sunny Po

Yan Yao

Cardioneuroablation for Treating Vasovagal Syncope: Current Status and Future Directions

心脏神经消融治疗血管迷走性晕厥：现状与未来方向

Functional substrate mapping has emerged as an essential tool for electrophysiologists, overcoming many limitations of conventional mapping techniques and demonstrating favourable long-term outcomes in clinical studies. However, a consensus on the definition of ‘functional substrate’ mapping remains elusive, hindering a structured approach to research in the field. In this review, we highlight the differences between ‘functional mapping’ techniques (which assess tissue response to the ‘electrophysiological stress’ using short coupled extrastimuli) and those highlighting regions of slow conduction during sinus rhythm. We also address fundamental questions, including the optimal degree of electrophysiological stress that best underpins the critical isthmus and the role of wavefront activation in determining the most effective ablation site.

Jaffar Al-Sheikhli

Patrick Tran

Rafaella Siang

Maria Niespialowska-Steuden

Joseph Mayer

Tarvinder Dhanjal

Functional Substrate Mapping: A New Frontier in the Treatment of Ventricular Tachycardia in Structural Heart Disease

功能性基质标测：结构性心脏病中室性心动过速治疗的新前沿

Idiopathic arrhythmias originating from the mitral and tricuspid annuli are commonly encountered in clinical practice. This review focuses on distinguishing features of ventricular arrhythmias arising from these structures and the importance of distinguishing idiopathic arrhythmias from those associated with structural heart disease. Each region along the mitral and tricuspid annuli (including the cardiac crux and para-Hisian region) is then discussed separately, with a particular emphasis on the ablation strategies and pitfalls for each. Although this review series is centred around idiopathic ventricular arrhythmias, the strategies for ablation techniques in these regions are broadly applicable.

Zachary T Yoneda

William G Stevenson

Idiopathic Annular Ventricular Arrhythmias

特发性环形室性心律失常

Background: AF is a common complication of an acute MI (AMI) and goes along with adverse events. Nevertheless, the therapeutical guidelines and pharmacological possibilities have improved over the past years. Therefore, this contemporary study aimed to clarify the effect of AF on long-term mortality in patients with incident AMI. Methods: This study included 2,313 patients aged 25–84 years with initial AMI that occurred from 2009 until 2017, documented within the population-based Augsburg Myocardial Infarction Registry. Patients were monitored from hospital admission, with a median follow-up duration of 4.5 years (interquartile range 4.4 years). Survival analysis and multivariable Cox regression analysis were conducted to explore the relationship between AF and long-term all-cause and cardiovascular disease mortality. Results: Altogether, 156 individuals had AF on their admission ECG, while the remaining 2,157 presented with sinus rhythm (SR). Patients with AF were significantly older, more frequently had arterial hypertension, non-ST-segment elevation MI, worse kidney function, smaller AMIs, and were more often former and non-smokers. An increased long-term all-cause mortality was observed among the AF group. (AF patients 39.1%, SR group 16.7%), Upon multivariable adjustment, a HR of 1.40 (95% CI [1.05–1.87]; p=0.023) was calculated when comparing the AF with SR patients. Conclusion: An independently increased risk of long-term mortality for patients with AF compared with patients with SR in case of incident AMI was identified. Therefore, AF should be considered as a serious risk factor in AMI patients, and must be treated aggressively to reduce mortality risk.

Ferdinand Bauke

Christa Meisinger

Philip Raake

Jakob Linseisen

Timo Schmitz

Association Between Atrial Fibrillation and Long-term Mortality in Acute MI Patients

急性心肌梗死患者心房颤动与长期死亡率的关联

In this review, we summarise the ongoing debate surrounding the anatomy of the atrioventricular conduction axis and its relevance to pacing. We highlight previous disagreements and emphasise the importance of understanding the anatomical location of the axis. We give credit and support to the initial descriptions by His and Tawara, in particular their attention to the relationship of the atrioventricular conduction axis with the membranous septum. We express our disagreements with recent diagrams that incorrectly, in our opinion, depict the left bundle and right bundle branches. We offer our own latest understanding of the location and relationships of the atrioventricular conduction axis, including details of its development, and differences between human and animal hearts. We also emphasise the importance of understanding the relationship between the inferior pyramidal space and the inferoseptal recess so as appropriately to place the axis within the heart. We conclude by emphasising the need to consider the heart in the context of the body, describing its component parts by using attitudinally appropriate nomenclature.

Robert H Anderson

Damián Sánchez-Quintana

Diane E Spicer

Yolanda Macías

Andrew C Cook

José-Angel Cabrera

Rehan Mahmud

Eduardo Back Sternick

Justin T Tretter

Revisiting the Atrioventricular Conduction Axis for the 21st Century

重温21世纪的房室传导轴

Permanent cardiac pacing in children with congenital complete atrioventricular block (CCAVB) and/or congenital heart disease (CHD) is challenging. Conduction system pacing (CSP) represents a novel pacing strategy aiming to preserve physiological ventricular activation. Patients with CCAVB or CHD are at high risk of developing pacing-induced cardiomyopathy with chronic conventional right ventricular myocardial pacing. CSP may be a valuable pacing modality in this particular setting because it can preserve ventricular synchrony. In this review, we summarise implantation techniques, the available clinical evidence and future directions related to CSP in CCAVB and CHD.

Óscar Cano

Jeremy P Moore

Conduction System Pacing in Children and Congenital Heart Disease

儿童及先天性心脏病中的传导系统起搏

Abbreviation	Arrhythm Electrophysiol Rev
Journal Impact	2.67
Quartiles(Global)	CARDIAC & CARDIOVASCULAR SYSTEMS(Q2)

ISSN	2050-3369, 2050-3377
h-index	30

Publication Information	Publisher: Radcliffe Group Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2015，Proportion of original research papers: 26.32%，Self Citation Rate:7.70%， Gold OA Rate: 100.00%
Journal Fees	$Details
Average review cycle	网友分享经验：7 Weeks

Arrhythmia and Electrophysiology Review

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Pacing for Vasovagal Syncope

Cardioneuroablation for Treating Vasovagal Syncope: Current Status and Future Directions

Functional Substrate Mapping: A New Frontier in the Treatment of Ventricular Tachycardia in Structural Heart Disease

Idiopathic Annular Ventricular Arrhythmias

Association Between Atrial Fibrillation and Long-term Mortality in Acute MI Patients

Functional Substrate Mapping: A New Frontier in the Treatment of Ventricular Tachycardia in Structural Heart Disease

Idiopathic Annular Ventricular Arrhythmias

Revisiting the Atrioventricular Conduction Axis for the 21st Century

Conduction System Pacing in Children and Congenital Heart Disease

Association Between Atrial Fibrillation and Long-term Mortality in Acute MI Patients