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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]

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.)

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.)