A proposed interval for evaluation of renal function during anticoagulation therapy using direct oral anticoagulants in patients with atrial fibrillation.

Background: Direct oral anticoagulants (DOACs) have been used to prevent cardiogenic embolism in patients with atrial fibrillation (AF). No evidence has been established for the follow-up renal function evaluation intervals. We hypothesized that a proposed follow-up interval of renal function can be estimated by patient's baseline characteristics including creatinine clearance (CCr).

A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography.

Background: Transesophageal echocardiography (TEE) is currently the gold standard technique for diagnosing left atrial appendage (LAA) thrombi. Cardiac computed tomography (CT) has been expected to become an alternative method to TEE; however, a reliable quantitative evaluation method has not been established.

Methods And Results: We enrolled 177 patients with persistent atrial fibrillation who underwent both cardiac CT and TEE before catheter ablation.

Impact of beta-blocker use on the long-term outcomes of heart failure patients with chronic obstructive pulmonary disease.

Aims: The number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta-blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio-selective beta-blocker use on the long-term outcomes of patients with HF and COPD.

Impact of atrial fibrillation/flutter on outcomes of patients with implantable cardioverter defibrillators: A sub-analysis of the Nippon Storm study.

Background: Implantable cardioverter-defibrillator and cardiac resynchronization therapy using a defibrillator (ICD/CRT-D) are established means of reducing mortality due to ventricular arrhythmia. Although atrial fibrillation/flutter (AF) is the most common cardiac arrhythmia in patients with heart disease, the impact of AF on the prognosis of patients with ICD/CRT-D remains controversial.

Methods And Results: We analyzed data from the Nippon Storm Study, a prospective observational study of 1570 patients that was conducted at 48 Japanese ICD centers.

Comparison of second appropriate defibrillator therapy occurrence in patients implanted for primary prevention and secondary prevention - Sub-analysis of the Nippon Storm Study.

Background: Patients with implantable cardioverter defibrillator (ICD) use for primary prevention (primary prevention patients) of sudden cardiac death have lower incidence of appropriate ICD therapy (app-Tx) compared with those with ICD use for secondary prevention (secondary prevention patients). However, detail analysis of a second app-Tx after a first app-Tx is still lacking.

Objective: This study aimed to compare the incidence of a second app-Tx in primary vs secondary prevention patients.

Long-term effects of non-retrieved inferior vena cava filters on recurrences of venous thromboembolism in cancer and non-cancer patients: From the COMMAND VTE registry.

Background: There is a paucity of data comparing the long-term outcomes after inferior vena cava (IVC) filters placement for patients with acute venous thromboembolism (VTE) between those with and without active cancer.

Methods: In the COMMAND VTE Registry, we evaluated the effects of IVC filter use on the long-term clinical outcomes stratified by the presence and absence of active cancer.

Results: Among 2,626 patients with acute symptomatic VTE, there were 604 patients with active cancer, and 2022 patients without active cancer.

Early transient recurrence of ventricular fibrillation after catheter ablation of premature ventricular contraction from Purkinje fibers in two patients with myocardial infarction.

Catheter ablation (CA) targeting premature ventricular contraction (PVC) from Purkinje fibers can be an effective therapy for refractory ventricular fibrillation (VF) after myocardial infarction (MI). We experienced two cases in which catheter ablation targeting PVC initiating VF after percutaneous coronary intervention (PCI) in post-MI patients was effective despite transient early recurrences of VF. The first patient (a 68-year-old woman with MI) developed drug-refractory VF 3 days after PCI to the left anterior descending artery (LAD) and left circumflex artery.

Catheter Ablation of Refractory Ventricular Fibrillation Storm After Myocardial Infarction.

Background: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population.

Particular Morphology of Inferior Pulmonary Veins and Difficulty of Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation.

Background: The CRYO-Japan PMS study indicated that cryoballoon ablation (Cryo-Abl) has a lower acute success rate of pulmonary vein isolation (PVI) for the right and left inferior PVs (RIPV and LIPV, respectively) than for the superior PVs. This study aimed to determine if the orientation and position of the inferior PVs are related to the difficulty of acute success of PVI.

Methods and results: We investigated 30 consecutive patients who underwent Cryo-Abl.

A novel method to estimate blood flow velocity in the left atrial appendage using enhanced computed tomography: role of Hounsfield unit density ratio at two distinct points within the left atrial appendage.

Low blood flow velocity in the left atrial appendage (LAA) indicates a high risk of thromboembolism. Although transesophageal echocardiography (TEE) has been the standard method with which to evaluate the LAA blood flow velocity, a clinically noninvasive method is desired. We hypothesized that the ratio of the Hounsfield unit (HU) density at two distinct points within the LAA represents the blood flow velocity in the LAA.

Cardiac memory-induced T wave change during complete atrioventricular block in a patient with inferior acute myocardial infarction.

Cardiac memory is an electrocardiographic manifestation of transient T wave abnormalities, which is observed after abrupt interruption of abnormal ventricular activation. We report a case with preexisting complete left bundle branch block in whom cardiac memory was induced. This cardiac memory was induced by normalization of QRS morphology after development of complete atrioventricular block due to acute inferior myocardial infarction.

Ectopies from the superior vena cava after pulmonary vein isolation in patients with atrial fibrillation.

Episodes of atrial fibrillation (AF) are mainly initiated by triggers from pulmonary veins (PVs). The superior vena cava (SVC) has been identified as a second major substrate of non-PV foci, but the electrophysiologic features of the SVC have not been fully investigated. We hypothesized that SVC ectopies are suppressed by predominant features of PV ectopies and tend to appear after PV isolation (PVI).

Efficacy and feasibility of the submuscular implantation technique for an implantable cardiac electrical device.

Background: A common complication associated with implantable cardiac electrical device implantation compromises skin lesions caused by overstretching just above a buried device that is relatively large in size. Apart from affecting the cosmetic appearance in some patients, a compromised blood supply to the skin may also lead to ischemic necrosis, which is an important complication. We describe a novel procedure for the implantation of implantable cardiac electrical devices generators under the pectoralis major muscle to avoid such skin-related complications.

Intravenous amiodarone homogeneously prolongs ventricular repolarization in patients with life-threatening ventricular tachyarrhythmia.

Background: The most critical adverse effects of class III drugs are marked QT prolongation and torsade de pointes. Even though intravenous amiodarone (iv-Amio) is a representative class III drug, it peculiarly inhibits both clinical ventricular tachycardia/fibrillation (VT/VF) and proarrhythmic effects. To test the hypothesis that iv-Amio homogeneously prolongs repolarization, we evaluated electrocardiographic changes before and during short-term amiodarone therapy, focusing closely on the ventricular dispersion of repolarization.

Electrical storm in patients with brugada syndrome is associated with early repolarization.

Background: Electrical storms (ESs) in patients with Brugada syndrome (BrS) are rare though potentially lethal.

Methods And Results: We studied 22 men with BrS and ES, defined as ≥3 episodes/d of ventricular fibrillation (VF) and compared their characteristics with those of 110 age-matched, control men with BrS without ES. BrS was diagnosed by a spontaneous or drug-induced type 1 pattern on the ECG in the absence of structural heart disease.

Simultaneous existence of sustained double chamber tachycardias originating from the aortic sinus of Valsalva.

Monomorphic ventricular tachycardia is basically a benign phenomenon in patients without structural heart disease. The focal source of the tachycardia is usually located in the right ventricular outflow tract and more rarely in the left ventricular outflow tract. Aortic sinus of Valsalva (ASV) is a well-known source of atrial and ventricular tachycardias.

Cardiac resynchronization therapy to prevent life-threatening arrhythmias in patients with congestive heart failure.

Various clinical data demonstrate that cardiac resynchronization therapy (CRT) provides a favorable structural as well as electrical remodeling. The CArdiac Resynchronization-Heart Failure study, which tested the pure effect of CRT (using CRT devices without the capability of defibrillation) clearly showed a significant reduction in the total mortality by partly preventing sudden cardiac death. The antiarrhythmic effects of CRT are explained, at least in part, by ionic and genetic modulation of ventricular myocytes.

Rhythm control should be better for the management of patients with atrial fibrillation and heart failure--rhythm control vs. rate control: which is better in the management of atrial fibrillation? (Rhythm-side).

The incidence of atrial fibrillation (AF) increases with advancing NHYA cardiac functional class, and it significantly affects the cardiac function of a failing heart. In such situations, clinicians should aim to maintain sinus rhythm in these patients with heart failure (HF) in order to improve their prognosis. However, according to various randomized clinical studies demonstrating the non-superiority of rhythm control over rate control, many clinicians seem to prefer to take the line of least resistance (ie, rate control).