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On May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit‐22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life‐threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region because of differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present. [ABSTRACT FROM AUTHOR]

Introduction: Our aims were to characterize the differences in transit time flow measurement (TTFM) between failed and normal grafts, and to determine the association between TTFM and related clinical factors and the likelihood of graft failure and major adverse cardiac events (MACE) following coronary artery bypass grafting. Material and methods: A retrospective observational analysis was performed on 279 patients admitted between 2017 and 2019, to compare the differences in TTFM between failed and normal grafts, and the association between TTFM and major adverse cardiac events (MACE) - specifically angina, myocardial infarction, and death. Results: There were no differences in TTFM between failed and normal grafts. There was a greater number of failed grafts with pulsatility index (PI) > 5 compared to PI = 5 (χ2 = 4.021, p = 0.045). Multivariate analysis showed no significant association between TTFM and MACE. Increased risk of graft failure is associated with the female gender (p = 0.031), history of congestive heart failure (p = 0.025), and poor renal function (p = 0.034). Increased risk of MACE is associated with a history of coronary intervention (p = 0.041), left coronary dominance (p = 0.018), and renal function (p = 0.009). Conclusions: Patency of graft is influenced by gender, congestive heart failure, and renal function, while MACE is influenced by history of coronary intervention and renal function. [ABSTRACT FROM AUTHOR]

Aims: The aim of the Mid‐Q Response study is to test the hypothesis that adaptive preferential left ventricular‐only pacing with the AdaptivCRT algorithm has superior clinical outcomes compared to conventional cardiac resynchronization therapy (CRT) in heart failure (HF) patients with moderately wide QRS duration (≥120 ms and <150 ms), left bundle branch block (LBBB), and normal atrioventricular (AV) conduction (PR interval ≤200 ms). Methods: This prospective, multi‐center, randomized, controlled, clinical study is being conducted at approximately 60 centers in Asia. Following enrollment and baseline assessment, eligible patients are implanted with a CRT system equipped with the AdaptivCRT algorithm and are randomly assigned in a 1:1 ratio to have AdaptivCRT ON (Adaptive Bi‐V and LV pacing) or AdaptivCRT OFF (Nonadaptive CRT). A minimum of 220 randomized patients are required for analysis of the primary endpoint, clinical composite score (CCS) at 6 months post‐implant. The secondary and ancillary endpoints are all‐cause and cardiovascular death, hospitalizations for worsening HF, New York Heart Association (NYHA) class, Kansas City Cardiomyopathy Questionnaire (KCCQ), atrial fibrillation (AF), and cardiovascular adverse events at 6 or 12 months. Conclusion: The Mid‐Q Response study is expected to provide additional evidence on the incremental benefit of the AdaptivCRT algorithm among Asian HF patients with normal AV conduction, moderately wide QRS, and LBBB undergoing CRT implant. [ABSTRACT FROM AUTHOR]

Aim: The Micra™ Transcatheter Pacing System is a leadless pacemaker that has been introduced recently. We share our experience in a low volume center and the use of right ventricular angiography (RVA) during implantation. Materials & methods: Patients underwent Micra implantation and RVA was performed to predetermine the implant site.Results: Nine patients underwent Micra implantation. The most common indication was atrial fibrillation with bradycardia. The device was implanted at apical-septum in seven and mid-septum in two. The procedure time ranged from 30 to 100 min and fluoroscopic time 4-18 min. Pacing parameters remained stable after 1-month follow-up. Conclusion: The Micra implantation technique can be easily learnt. RVA was helpful in selecting an appropriate site for the Micra implant. [ABSTRACT FROM AUTHOR]

A left atrial appendage occluder device (Watchman) and leadless pacemaker (Micra) was implanted from a single right femoral vein access in a 73-year-old female patient with persistent atrial fibrillation and symptomatic tachybrady syndrome and unable to take oral anticoagulants. Standard methods of implantation were followed for both procedures. The Watchman device was implanted first followed by dilatation of the same venous access site in order to implant Micra transcatheter pacing system. The patient tolerated the procedures well and there were no complications. At the end of 1 month, both the devices were found to be working well. [ABSTRACT FROM AUTHOR]

Examines mice deficient in the Nox2 catalytic subunit of nicotinamide adenoside dinucleotide phosphate (NADPH) oxidase and wild-type littermate controls to probe the potential role of NADPH oxidase in aldosterone-induced cardiac fibrosis and the involvement of this mechanism in angiotensin II (AngII)-induced effects. Involvement of mineralocorticoid receptor (MR) activation in the NADPH oxidase response to AngII; Role of Nox2 in MR-dependent fibrosis in vivo; Critical events in the cardiac fibrosis induced by AngII.

The article presents a study which discussed the pivotal role of NOX-2-containing nicotinamide adenosine dinucleotide phosphate (NADPH) oxidase in early ischemic preconditioning. The study also discussed whether reactive oxygen species (ROS)-independent signaling is also independent of the NADPH oxidase/ROS pathway. Principal findings are given. Conclusions and significance of the study are discussed.

Objectives: This study sought to examine the role of Nox2 in the contractile dysfunction associated with pressure-overload left ventricular hypertrophy (LVH). Background: Reactive oxygen species (ROS) production is implicated in the pathophysiology of LVH. The nicotinamide adenosine dinucleotide phosphate oxidase isoform, Nox2, is pivotally involved in angiotensin II-induced hypertrophy but is not essential for development of pressure-overload LVH. Its possible impact on contractile function is unknown. Methods: The effects of aortic banding or sham surgery on cardiac contractile function and interstitial fibrosis were compared in adult Nox2−/− and matched wild-type (WT) mice. Results: Banding induced similar increases in left ventricular (LV) mass in both groups. Banded Nox2−/− mice had better LV function than WT by echocardiography (e.g., fractional shortening 33.6 ± 2.5% vs. 21.4 ± 2.2%, p < 0.05). Comprehensive LV pressure-volume analyses also showed significant contractile dysfunction in banded WT compared with sham, whereas banded Nox2−/− mice had preserved function (e.g., maximum rate of rise of LV pressure: banded WT, 4,879 ± 213; vs. banded Nox2−/−, 5,913 ± 259 mm Hg/s; p < 0.05). Similar preservation of function was observed in isolated cardiomyocytes. The 24-h to 36-h treatment of banded WT mice with N-acetylcysteine resulted in recovery of contractile function. Cardiac interstitial fibrosis was significantly increased in banded WT but not Nox2−/− mice, together with greater increases in procollagen I and III mRNA expression. Conclusions: The Nox2 oxidase contributes to the development of cardiac contractile dysfunction and interstitial fibrosis during pressure overload, although it is not essential for development of morphologic hypertrophy per se. These data suggest divergent downstream effects of Nox2 on different components of the overall response to pressure overload. [Copyright &y& Elsevier]

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society ., Competing Interests: Conflict of interest: All members provided disclosure statements to assess potential conflicts of interest. Details are available in the Supplementary material., (This article has been co-published with permission in Europace, HeartRhythm, Journal of Arrhythmia and Journal of Interventional Cardiac Electrophysiology. © 2024 Heart Rhythm Society, the European Society of Cardiology, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Any citation can be used when citing this article.)

In this paper, the Asia Pacific Heart Rhythm Society (APHRS) sought to provide practice guidance on AF screening based on recent evidence, with specific considerations relevant to the Asia-Pacific region. A key recommendation is opportunistic screening for people aged ≥65 years (all countries), with systematic screening to be considered for people aged ≥75 years or who have additional risk factors (all countries)., Competing Interests: All other authors declared no conflict of interest related to this paper., (© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

The disease burden of AF is greater in Asia-Pacific than other areas of the world. Direct oral anticoagulants (DOACs) have emerged as effective alternatives to vitamin K antagonists (VKA) for preventing thromboembolic events in patients with AF. The Asian Pacific Society of Cardiology developed this consensus statement to guide physicians in the management of AF in Asian populations. Statements were developed by an expert consensus panel who reviewed the available data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting 17 statements provide guidance on the assessment of stroke risk of AF patients in the region, the appropriate use of DOACs in these patients, as well as the concomitant use of DOACs and antiplatelets, and the transition to DOACs from VKAs and vice versa. The periprocedural management of patients on DOAC therapy and the management of patients with bleeding while on DOACs are also discussed., Competing Interests: Disclosure: This work was funded through the Asian Pacific Society of Cardiology with unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. DC has received honoraria from Abbott, Biotronik, Boston Scientific, Boehringer Ingelheim, Johnson & Johnson, Medtronic and Pfizer. FA has received honoraria outside the present work from Amgen, Bayer, BI, BMS, Daiichi Sankyo and Pfizer. PV has received honoraria from Bayer, BI, BMS, Daiichi Sankyo, Leo Pharma, Pfizer and Portola; and research grants from Bayer, Boehringer Ingelheim and Bristol Meyers Squibb. JJD has received honoraria from Bayer and Pfizer. CCW has received honoraria and research grants from Bayer, BI, Daiichi Sankyo and Pfizer. YHL has received honoraria from Amgen, AstraZeneca, Bayer, BI, Daiichi Sankyo, Roche and Sanofi. JJ has received honoraria from Abbott Vascular, Amgen, AstraZeneca, Bayer, Boston Scientific, Medtronic and Pfizer. STHL has received honoraria and travel support from Abbott, Bayer, Bioexcel, BI, Boston Scientific, Medtronic and Pfizer. LHL has received education and travel grants from Sanofi. DQ has received honoraria from Bayer and Pfizer. SJ has received honoraria from Biosense Webster and Medtronic. SCS has received honoraria from Abbott, Bayer, Biotronik and Medtronic. CJH has received honoraria from Amgen, Bayer, BI and Pfizer-MSD. JWCT has received honoraria from Abbott Vascular, Amgen, AstraZeneca, Bayer, Boston Scientific, BI, Medtronic, Orbus Neich and Biotronik; and research grants from Abbott Diagnostics and Beckmann. All other authors have no conflicts of interest to declare., (Copyright © 2021, Radcliffe Cardiology.)

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease., Competing Interests: Disclosure: This work was funded through the Asian Pacific Society of Cardiology, with unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. JWCT reports honoraria from AstraZeneca, Bayer, Amgen, Medtronic, Abbott Vascular, Biosensors, Alvimedica, Boehringer Ingelheim and Pfizer; research and educational grants from Medtronic, Biosensors, Biotronik, Philips, Amgen, AZ, Roche, Otsuka, Terumo and Abbott Vascular; and consulting fees from Elixir and CSL Behring. DS reports honoraria from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Medtronic, Menarini, Merck, Novartis, Otsuka, Pfizer, Roche and Servier. JA reports honoraria from AstraZeneca, Daiichi Sankyo, Bayer and Sanofi, and grants/grants pending from Daiichi Sankyo. MEC reports honoraria, speaking fees or grants from MSD/Merck, Novo Nordisk, AstraZeneca, Boehringer-Ingelheim, Lilly, Bayer, Servier, Novartis and MundiPharma. JJD reports honoraria from Bayer and Pfizer. SJ reports honoraria from Biosense Webster and Medtronic. DKQ reports honoraria from AstraZeneca and Boehringer Ingelheim. BJM reports honoraria and CME grants from AstraZeneca, Boehringer Ingelheim, Lilly-Zuellig, MSD, Novartis, Novo Nordisk, Upjohn-Pfizer, Sanofi, and Servier. CKT reports honoraria from AstraZeneca, Boehringer Ingelheim, Novartis and Johnson & Johnson. SGK reports consulting/lecture fees or research grants from AstraZeneca, Boehringer Ingelheim, MSD, Pfizer, Takeda, Sanofi, Novo Nordisk, Novartis and Abbott. CD reports honoraria from AstraZeneca, Abbott, Bayor, Boehringer, Pfizer and Sanofi Aventis. BWT reports honoraria and consulting fees from Astellas, AstraZeneca, Boehringer Ingelheim and Otsuka. APSK reports honoraria from Abbott, AstraZeneca, Bayer, Eli Lilly and Company, Merck Serono, Nestle, Novo Nordisk, Pfizer and Sanofi. EBR reports consulting fees and speaker’s honoraria from Corbridge, Boehringer Ingelheim, E Merck, Torrent, Innogen and Servier, and research grants from MSD, Novartis and Pfizer. SYG reports advisory board honoraria from AstraZeneca, Boehringer Ingelheim, Bayer, Novo Nordisk and Sanofi. All other authors have no conflicts of interest to declare., (Copyright © 2021, Radcliffe Cardiology.)

The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y 12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared with clopidogrel. However, low numbers of Asian patients participated in pivotal studies and few regional studies comparing DAPTs have been conducted. This article aims to summarise current evidence on the use of newer generation P2Y 12 inhibitors in Asian patients with acute coronary syndrome and provide recommendations to assist clinicians, especially cardiologists, in selecting a DAPT regimen. Guidance is provided on the management of ischaemic and bleeding risks, including duration of therapy, switching strategies and the management of patients with ST-elevation and non-ST-elevation MI or those requiring surgery. In particular, the need for an individualised DAPT regimen and considerations relating to switching, de-escalating, stopping or continuing DAPT beyond 12 months are discussed., Competing Interests: Disclosure: This work was funded through the Asian Pacific Society of Cardiology by unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. JWCT has received honoraria from AstraZeneca, Bayer, Amgen, Medtronic, Abbott Vascular, Biosensors, Orbus Neich, Boehringer Ingelheim and Pfizer; and research grants from Medtronic, Abbott Diagnostics and Beckmann. DPC reports consulting fee from Asian Pacific Society of Cardiology; support for travel to meetings for the study or otherwise from Asian Pacific Society of Cardiology; grants/grants pending from Roche Diagnostics; and payment for development of educational presentations including service on speakers' bureaus from AstraZeneca. JA reports honoraria from AstraZeneca, Daiichi Sankyo, Bayer and Sanofi; and grants/grants pending from Daiichi Sankyo. MC reports consulting fee/honorarium from AstraZeneca. KWP reports consulting fee from Arnold & Porter LLP. DQH reports consulting fee or honorarium from AstraZeneca; and support for travel to meetings for the study or otherwise from AstraZeneca. SJ reports honorarium from Medtronic; and travel/accommodation expenses from Medtronic and Edward Lifesciences. DAJ reports board membership at Menarini; honorarium from AstraZeneca; and travel/accommodation expenses from Boston Scientific. DT reports honorarium from The Meeting Lab; and travel/accommodation expenses paid to institution from The Meeting Lab. GM reports research grants to the institution or consulting/lecture fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation, AstraZeneca, Axis-Santé, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, Idorsia, Elsevier, Fédération Française de Cardiologie, Frequence Medicale, ICAN, Lead-Up, Medtronic, Menarini, MSD, Pfizer, Quantum Genomics, Sanofi, SCOR global life, Servier and WebMD. All other authors have no conflicts of interest to declare., (Copyright © 2021, Radcliffe Cardiology.)

Background: Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the Netherlands) has shown promising results. We share our initial experience with this novel active fixation LV lead., Methods: A Medtronic active fixation lead 20066 was used in eight consecutive patients for CRT. An optimal site was chosen and recommended maneuvers were applied for lead fixation. Push and pull maneuvers were used to test stability., Results: There were two initial dislodgements after which we used a transvalvular insertion (TVI) tool that was used in the hemostatic valve during rotation of the lead so that the torque was easily transmitted to the tip. It also allowed better tactile feedback during push-pull tests. There were no further dislodgements in the subsequent six patients. However, in one patient the lead could not be unscrewed due to the tip getting wedged at a distal smaller vein. Repositioning of the LV lead was done in three patients due to PNS or pacing issues. The median time for LV lead placement was 16.5 minutes (interquartile range 9-25 minutes)., Conclusion: The Medtronic Attain Stability 20066 active fixation LV lead can potentially be implanted at any pacing site avoiding PNS and providing better stability. The learning curve is short and additional tricks can be learnt to improve success. Use of TVI while the lead is rotated is beneficial., (© 2014 Wiley Periodicals, Inc.)