Electrophysiological and Pathological Impact of Medium-Dose External Carbon Ion and Proton Beam Radiation on the Left Ventricle in an Animal Model.

Background Medium-dose (25 gray) x-ray radiation therapy has recently been performed on patients with refractory ventricular tachyarrhythmias. Unlike x-ray, carbon ion and proton beam radiation can deliver most of their energy to the target tissues. This study investigated the electrophysiological and pathological changes caused by medium-dose carbon ion and proton beam radiation in the left ventricle (LV).

Late-gadolinium enhancement properties associated with atrial fibrillation rotors in patients with persistent atrial fibrillation.

Background: A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy late-gadolinium enhancement (LGE) areas and play an important role in AF drivers. However, this was not validated in humans.

Objective: The purpose of this study was to evaluate the LGE properties of AF rotors in patients with persistent AF.

Circulating intermediate monocytes and atrial structural remodeling associated with atrial fibrillation recurrence after catheter ablation.

Background: Inflammation, such as that associated with intermediate CD14 CD16 monocytes and atrial structural remodeling (SRM), may be important in the recurrence of atrial fibrillation (AF) after catheter ablation. However, the relationship between the intermediate CD14 CD16 monocytes, SRM, and AF recurrence is unclear.

Methods: Twenty-four patients with AF were enrolled.

Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late-gadolinium enhancement areas.

Background: A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome.

Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force-sensing catheter: Late-gadolinium enhancement magnetic resonance imaging assessment.

Background: Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are characterized as a wider and more continuous than that after conventional radiofrequency catheter ablation (RFCA) without the contact force (CF)-sensing technology. However, the impact on the lesion characteristics of ablation with a CF-sensing catheter has not been well discussed. We sought to assess the lesions using late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) and to compare the differences between the two groups (CB group vs.

Circulating intermediate monocytes and toll-like receptor 4 correlate with low-voltage zones in atrial fibrillation.

Inflammation has been suggested to play a key role in the pathogenesis of atrial fibrillation (AF). Our hypothesis was that this inflammation, mediated by intermediate monocytes and toll-like receptor 4 (TLR4), causes the formation and expansion of low-voltage zones (LVZs). Prior to ablation, the monocyte subsets of 78 AF patients and TLR4 expression of 66 AF patients were analyzed via a flow cytometric analysis.

Different tissue thermodynamics between the 40 W and 20 W radiofrequency power settings under the same ablation index/lesion size index.

Introduction: The ablation index (AI) and lesion size index (LSI) are novel markers for predicting the ablation lesion quality, however, collateral damage is still a concern. This study aimed to compare the lesion characteristics and tissue temperature profiles between 20 W (20 Ws) and 40 W (40 Ws) ablation settings under the same AI and LSI.

Methods: An ex vivo model consisting of swine myocardium (5-6 mm thickness) in a circulating, warmed saline bath was used.

Successful modulation of atrial fibrillation drivers anchoring to fibrotic tissue after box isolation using an online real-time phase mapping system: ExTRa Mapping.

A 41-year-old man with persistent atrial fibrillation (AF) underwent radiofrequency (RF) catheter ablation using an online real-time phase mapping system: ExTRa Mapping. Box isolation could not terminate AF. Subsequently, RF applications on nonpassively activated areas (NPAs), where rotational activations were frequently observed, at the posterior bottom of left atrium outside of box lesion could convert AF to common atrial flutter.

Lesion distribution after cryoballoon ablation and hotballoon ablation: Late-gadolinium enhancement magnetic resonance imaging analysis.

Introduction: Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are wide and continuous, however, the distribution can depend on the pulmonary vein (PV) size. We sought to assess the relationship between the lesion distribution and PV size after CBA and hotballoon ablation (HBA).

Methods And Results: A total of 80 consecutive patients who underwent PVI were enrolled (40 with CBA).

Percutaneous Pericardiocentesis With the Anterior Approach: Demonstration of the Precise Course With Computed Tomography.

Objectives: This study aimed to confirm the precise course of a pericardiocentesis with the anterior approach using post-procedural computed tomography (CT).

Background: Percutaneous epicardial ventricular tachycardia (VT) ablation has been increasingly performed. Although the inferior approach has been the common method, the feasibility of the anterior approach has subsequently been reported.

The lesion characteristics assessed by LGE-MRI after the cryoballoon ablation and conventional radiofrequency ablation.

Background: Rhythm outcomes after the pulmonary vein isolation (PVI) using the cryoballoon (CB) are reported to be excellent. However, the lesions after CB ablation have not been well discussed. We sought to characterize and compare the lesion formation after CB ablation with that after radiofrequency (RF) ablation.

Upfront triple combination therapy-induced pulmonary edema in a case of pulmonary arterial hypertension associated with Sjogren's syndrome.

Clinical efficacy of combination therapy using vasodilators for pulmonary arterial hypertension (PAH) is well established. However, information on its safety are limited. We experienced a case of primary Sjogren's syndrome associated with PAH where the patient developed pulmonary edema immediately after the introduction of upfront triple combination therapy.

Optimal image reconstruction using multidetector-row computed tomography to facilitate cardiac resynchronization therapy.

Preprocedural recognition of the segment of latest mechanical contraction along with the anatomy of the coronary venous system is important for successful and effective cardiac resynchronization therapy. We present a case of ischemic cardiomyopathy who underwent implantation of a cardiac resynchronization therapy device with a defibrillator, which was facilitated by preprocedural computed tomographic images reconstructed to visualize the left ventricular slab and the coronary venous system simultaneously on the cardiac contour. The present reconstruction method using computed tomography is optimal and feasible method to incorporate the echocardiographic findings into the procedure performed under fluoroscopy appropriately.

Successful treatment of prolonged cardiopulmonary arrest of Kounis syndrome during coronary angioplasty.

We experienced a case of Kounis syndrome with cardiopulmonary arrest and severe coronary spasm. A 70-year-old man with cardiac pacemaker and chronic dialysis was treated for angina pectoris of the right coronary artery. After diagnostic coronary angiography of the right coronary artery, optical coherence tomography was performed with contrast medium and low-molecular-weight dextran.