Predictors of nonpulmonary vein triggers for atrial fibrillation: A clinical risk score.

Background: Targeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation may reduce atrial fibrillation (AF) recurrence. Isoproterenol infusion and cardioversion of spontaneous or induced AF can provoke NPVTs but typically require vasopressor support and increased procedural time.

Objective: The purpose of this study was to identify risk factors for the presence of NPVTs and create a risk score to identify higher-risk subgroups.

Impact of a formula combining local impedance and conventional parameters on lesion size prediction.

Background: Although ablation energy (AE) and force-time integral (FTI) are well-known active predictors of lesion characteristics, these parameters do not reflect passive tissue reactions during ablation, which may instead be represented by drops in local impedance (LI). This study aimed to investigate if additional LI data improves predicting lesion characteristics and steam pops.

Methods: RF applications at a range of powers (30 W, 40 W, and 50 W), contact forces (8 g, 15 g, 25 g, and 35 g), and durations (10-180 s) using perpendicular/parallel catheter orientations were performed in excised porcine hearts (N = 30).

Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study.

Purpose: Clinical implication of local impedance (LI) for radiofrequency (RF) ablation has not been fully established. This study aimed to investigate this point using IntellaNav MiFi OI catheter.

Methods: LI and generator impedance drops (ΔLI and ΔGI) were evaluated in excised porcine hearts (N = 16) during RF applications at a range of powers (30 and 50 W), contact forces (5-40 g), and durations (10-180 s) using perpendicular or parallel catheter orientation.

A prospective multicenter study of direct comparison of feasibility and safety of pulmonary vein isolation using the minimally interrupted apixaban between second-generation cryoballoon and radiofrequency ablation of paroxysmal atrial fibrillation: J-HIT apixaban.

Background: The feasibility and safety of pulmonary vein isolation (PVI) using cryoballoon (CB) for paroxysmal atrial fibrillation (PAF) with minimally interrupted apixaban has not fully explored.

Methods: In this multicenter, randomized prospective study, we enrolled patients with PAF undergoing CB or radiofrequency (RF) ablation with interrupted (holding 1 dose) apixaban. The primary composite end point consisted of bleeding events, including pericardial effusion and major bleeding requiring blood transfusion, or thromboembolic events at 4 weeks after ablation; secondary end points included early recurrence of AF and procedural duration.

Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation.

Background: Recent studies have shown the improvement in long-term effectiveness with standardized pulmonary vein isolation (PVI) aimed at creating durable and contiguous lesions with VISITAG SURPOINT (VS) in paroxysmal atrial fibrillation (PAF).

Objective: We aimed to assess efficacy of PVI alone strategy using VS in non-PAF patients and evaluate factors associated with corresponding clinical outcomes.

Methods: Consecutive patients who underwent PVI for persistent/long-standing persistent AF between May 2017 to July 2019 were studied retrospectively.

Pulmonary vein narrowing after visually guided laser balloon ablation: Occurrence and clinical correlates.

Introduction: There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.

Methods And Results: Patients with paroxysmal atrial fibrillation treated with VGLB were screened.

Long-Term Performance of Right Ventricular Implantable Cardioverter-Defibrillator Leads in Arrhythmogenic Right Ventricular Cardiomyopathy and Hypertrophic Cardiomyopathy.

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and hypertrophic cardiomyopathy (HCM) implanted with implantable cardioverter-defibrillators (ICDs) may show a large decrease in R-wave amplitude during long-term follow-up. However, it is unclear whether this decrease is higher in these patients than in those without structural heart disease. This study investigated ICD-lead intracardiac parameters over a long duration in patients with ARVC and HCM and compared these parameters with those of a control group.

Utility of a ripple map for the interpretation of atrial propagation during atrial tachycardia.

Purpose: Ripple map (RM) is a novel method for displaying activation pattern on the surface of a cardiac chamber. The aim of this study was to determine the utility of the RM in interpreting the atrial propagation in atrial tachycardia (AT) in comparison with a conventional local activation (LAT) map.

Methods: Three-dimensional electroanatomical mapping and ablation of AT were performed using multielectrode catheters and the CARTO3 ConfiDENSE Module (Biosense Webster).

Transvenous excimer laser-assisted lead extraction of cardiac implantable electrical devices in the Japanese elderly population.

Background: The feasibility and safety of lead extraction of cardiac implantable electronic devices (CIEDs) in the elderly Asian population remain uncertain. We report the outcome and safety of transvenous excimer laser-assisted lead extraction of CIEDs in Japanese patients aged ≥80 years.

Methods: Consecutive 235 patients (age 67±15 years, 167 male) undergoing lead extraction of CIED with an excimer laser system (Philips, Andover, MA, USA) were included.

Excessive Prolongation of Coagulation Time During Treatment With Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation.

Background: Conventional coagulation assays have poor sensitivity and specificity for assessing the anticoagulant effect of direct oral anticoagulants (DOACs). This study aimed to evaluate the causes and consequences of the excessive prolongation of coagulation time in patients with nonvalvular atrial fibrillation who receive DOACs.

Methods: We retrospectively analysed 1521 patients (age, 66 ± 12 years).

Bilateral cardiac sympathetic denervation of a recurrent refractory ventricular tachycardia occurring after catheter ablation of atrial fibrillation and outflow tract premature ventricular contractions.

Recent studies have demonstrated the utility of cardiac sympathetic denervation (CSD) in patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and catheter or surgical ablation. We present our experience with bilateral CSD in a patient with a recurrent VT despite attempts at treatment with catheter ablation and antiarrhythmic drugs, and this is the first description of the successful management of an idiopathic refractory VT with a bilateral CSD and concomitant oral amiodarone, occurring after catheter ablation of persistent atrial fibrillation and idiopathic outflow tract premature ventricular contractions.

Safety and Efficacy of Transvenous Lead Extraction With a High-Frequency Excimer Laser - A Single Center Experience.

Background: Transvenous lead extractions have been performed using 40-Hz laser sheaths. Recently, a new 80-Hz laser sheath became available, but only a few reports have compared the effectiveness of the 40- and 80-Hz laser sheaths.

Methods and results: This study included 215 patients.

Comparison of direct oral anticoagulants and warfarin regarding midterm adverse events in patients with atrial fibrillation undergoing catheter ablation.

Background: Oral anticoagulants, including direct oral anticoagulants (DOACs), are usually required in atrial fibrillation (AF) patients who are at a high risk of thromboembolism (TE), even if they had undergone catheter ablation (CA). Although several studies have reported the safety and efficacy of DOACs around CA in AF patients, there are only limited data regarding the midterm incidence of TE and bleeding complications post-CA among AF patients treated with warfarin or DOACs.

Methods: We studied 629 AF patients (mean age: 65.

Early Transfer of Patients with Acute Heart Failure from a Core Hospital to Collaborating Hospitals and Their Prognoses.

Japan is facing problems associated with "heart failure (HF) pandemics" and bed shortages in core hospitals that can accommodate patients with acute HF. The prognosis is currently unknown for acute HF patients who were transferred from core hospitals to collaborating hospitals during the very early treatment phase and whose treatment strategies are in place.We enrolled 166 acute HF patients who were hospitalized between January 1, 2015, and December 31, 2015, and compared the conditions of transferred patients (n = 53, median duration before transfer = 6 days) and nontransferred patients (n = 113).

Impact of impedance decrease during radiofrequency current application for atrial fibrillation ablation on myocardial lesion and gap formation.

Background: The clinical impact of a decrease in impedance during radiofrequency catheter ablation (RFCA) has not been fully clarified. The aim of the study was to analyze the impact of impedance decrease and to determine its optimal cutoff value during RFCA.

Methods: We evaluated 34 consecutive patients (total 3264 lesions, mean age 66 ± 8.

Treatment Outcomes of Anticoagulant Therapy and Temporary Inferior Vena Cava Filter Implantation for Pregnancy Complicated by Venous Thrombosis.

: Although deep vein thrombosis (DVT) followed by pulmonary thromboembolism (PE) is a critical complication during pregnancy, there have been few reports about its intrapartum management. We evaluated intrapartum management by using a temporary inferior vena cava filter (IVCF) in pregnant women with PE/DVT. : Eleven women with PE/DVT during pregnancy between January 2004 and December 2016 were included.

Assessment of the Safety and Efficacy of Edoxaban for the Treatment of Venous Thromboembolism Secondary to Active Malignancy.

: To assess the safety and efficacy of edoxaban for the treatment of venous thromboembolism (VTE) secondary to active malignancy. : We enrolled 48 patients with newly diagnosed VTE secondary to active malignancy that was treated with oral edoxaban for 1 year between September 2014 and August 2015. We retrospectively examined the presence or absence of recurrent symptomatic VTE, VTE-related mortality, and bleeding events.

Cardiac Magnetic Resonance Imaging of Very Late Intrapericardial Hematoma 8 Years after Coronary Artery Bypass Grafting.

A 55-year-old man presented with dyspnea, edema, and appetite loss. He had undergone coronary artery bypass grafting 8 years previously. He had jugular venous distention and Kussmaul's sign.

Atrial fibrillation type matters: greater infarct volume and worse neurological defects seen in acute cardiogenic cerebral embolism due to persistent or permanent rather than paroxysmal atrial fibrillation.

Aims: Some studies have shown that the type of atrial fibrillation (AF), whether paroxysmal AF (PAF) or persistent or permanent AF (PeAF), affects the incidence of ischaemic stroke. This study sought to determine the relationship between the AF pattern and the severity and brain volume of infarction in an AF population including transient ischaemic attack (TIA) patients.

Methods And Results: This was a retrospective observational study.

A new mapping method to estimate exit sites of ventricular arrhythmias using intracardiac echocardiography and M-mode for catheter ablation.

Background: Catheter ablation of premature ventricular complexes (PVCs) has been used as a curative therapy in many cases. Intracardiac ultrasound with a magnetic sensor probe has recently become available for catheter ablation. In this study, we assessed a new mapping method, contraction mapping, for determining the optimal ablation sites using intracardiac ultrasound and M-mode.

Recurrent pulmonary emboli with characteristic histopathology.

We report a unique case of recurrent thromboembolism and its histological findings that were revealed in an autopsy. Although it is well known that repeating thrombosis presents organization and recanalization, we also observed rare findings of thickening of the bronchial artery and fixation of the valve of the lower extremity vein in this case.

Prognosis of super-elderly healthy Japanese patients after pacemaker implantation for bradycardia.

Background: The prognosis of super-elderly patients (age≥85 years) who undergo bradycardia pacemaker (PM) implantation remains unknown.

Methods: We retrospectively enrolled 868 patients (men 49.0%, 76.