Excimer LASER coronary atherectomy for ST-segment elevation myocardial infarction: Insights from a multicenter registry.

Background: Excimer laser coronary atherectomy (ELCA) is used for thrombotic culprit lesions in ST-segment elevation myocardial infarction (STEMI), but its effectiveness is still unclear.

Methods: Consecutive patients undergoing primary percutaneous coronary intervention within 24 h of onset were retrospectively investigated. Patients were divided into ELCA and non-ELCA groups.

Hypermethylation of Hif3a and Ifltd1 is associated with atrial remodeling in pressure-overload murine model.

Atrial remodeling is a major pathophysiological mechanism of atrial fibrillation (AF). Atrial remodeling progresses with aging and background diseases, including hypertension, heart failure, and AF itself. However, its mechanism of action and reversibility have not been completely elucidated.

Real-world clinical practice of current periprocedural anticoagulation management in catheter ablation of atrial fibrillation: Data from a large prospective ablation registry.

Background: The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.

Objectives: To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.

Methods: This multicenter observational study included 6232 consecutive AF patients (68.

Filamin C Truncating Variant Causes Severe Conduction Defects and Mild Cardiomyopathy.

Filamin C (FLNC), recently identified as a causative gene of cardiomyopathy, is widely expressed in cardiomyocytes and is involved in signal transduction between the sarcomere and the plasma membrane. In general, the FLNC truncating variant causes severe dilated cardiomyopathy. A 70-year-old female was referred to our hospital with advanced conduction defects and underwent pacemaker implantation.

Clinical and Electrophysiological Characteristics of Marshall Bundle-Related Atrial Tachycardia: Considerations Based on a Definitive Diagnosis.

Background: Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)-related atrial tachycardia (AT).

Objectives: This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.

Methods: Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study.

Feasibility of Atrial Substrate Mapping During Atrial Pacing and Its Impact on the Omnipolar Voltage and the Peak-Frequency of Electrograms.

Introduction: Atrial pacing maps are often used as substitutes for sinus rhythm (SR) maps to expedite mapping procedures. However, the impact of this method on electrophysiological parameters has not been systematically examined. This study aimed to elucidate the advantages and limitations of atrial pacing maps.

Primary Cardiac Lymphoma With Dramatic Response to Chemotherapy Diagnosed by Transvenous Biopsy.

Primary cardiac lymphoma is a rare disease with the potential to be fatal. This case reports a patient who developed primary cardiac lymphoma resulting in cardiac tamponade. Despite a compromised general condition, the lymphoma was diagnosed through a transvenous tumor biopsy.

Discordant Diagnosis of Coronary Microvascular Dysfunction by Microvascular Resistance Reserve: Transthoracic Doppler Echocardiography vs Bolus Thermodilution Method.

Background: Epicardial stenosis and coronary microvascular dysfunction (CMD) may coexist in patients with chronic coronary syndrome (CCS). Microvascular resistance reserve (MRR) has been demonstrated to be a valid cross-modality metric using continuous saline infusion thermodilution and intracoronary Doppler flow velocity methods. This study aimed to investigate the prevalence and diagnostic concordance of CMD defined by MRR using two methods-stress transthoracic Doppler echocardiography (S-TDE) and the invasive bolus thermodilution method (B-Thermo)-in patients with functionally significant epicardial stenosis.

Efficacy and Safety of High-Power Short-Duration Ablation for Cavo-Tricuspid Isthmus With a Flexible-Tip Temperature-Controlled Power Regulation Catheter Performed by Electrophysiology Trainees.

Introduction: The suitability of high-power short-duration (HPSD) cavo-tricuspid isthmus ablation (CTI-Abl) for electrophysiology (EP) trainees, as well as the underlying mechanisms of its efficacy, remain unknown. The aim of this study was to clarify the efficacy and safety of HPSD CTI-Abl performed by EP trainees and assess lesion characteristics between HPSD and moderate-power long duration (MPLD) ablations.

Methods: Study 1: CTI-Abl was performed by first- to fourth-year EP trainees in consecutive 113 patients (67 ± 11 years, 27.

Case Report: Drug-coated balloon after intravascular lithotripsy for the treatment of severely calcified coronary artery lesion.

In patients undergoing percutaneous coronary intervention (PCI), severely calcified lesions remain a great challenge even in the drug-eluting stent (DES) era. Intravascular lithotripsy (IVL) is effective for modification of severely calcified lesions prior to DES implantation. However, the efficacy of PCI with drug-coated balloon (DCB) following IVL has not been fully elucidated.

Impact of coronary revascularization on coronary flow capacity measured by transthoracic Doppler echocardiography in patients with chronic coronary syndrome.

Coronary flow capacity (CFC) integrates quantitative assessment of hyperemic myocardial blood flow and coronary flow reserve. We aimed to evaluate the effect of elective percutaneous coronary revascularization (PCI) on CFC using serial stress transthoracic Doppler echocardiography (STDE). Overall, 148 stable patients underwent STDE of the left anterior descending arteries (LAD), before and after elective PCI.

Significance of the local largest bipolar voltage for the optimized ablation strategy using very high-power short duration mode.

Purpose: Very high-power short-duration (vHPSD) ablation creates shallower lesions, potentially reducing efficacy. This study aims to identify factors leading to insufficient lesions during pulmonary vein antral isolation (PVAI) with vHPSD-ablation and to develop an optimized PVAI strategy using this technology.

Methods: PVAI was performed on 41 atrial fibrillation patients using vHPSD-ablation (90 W/4 s).

Embryological Classification of Arrhythmogenic Triggers Initiating Atrial Fibrillation.

Background: Atrial fibrillation (AF) is a prevalent multifactorial arrhythmia associated with specific single-nucleotide polymorphisms (SNPs). Pulmonary vein (PV) isolation is an established treatment for AF; however, recurrence risk remains caused by AF triggers beyond the PVs. Understanding the embryological origins of these triggers could improve treatment outcomes.

Feasibility and safety assessment of RF double applications in very high power and short duration ablation.

Background: Very high power and short duration (vHPSD) ablation is recently used for pulmonary vein isolation. However, low first-pass isolation rates have been reported, possibly because of shallow lesion formation, necessitating deeper lesions to improve treatment outcomes.

Objective: This study aimed to confirm the safety and efficacy of double radiofrequency applications of vHPSD ablation in an in vivo beating swine heart model.

Machine Learning-Based Clustering Using a 12-Lead Electrocardiogram in Patients With a Implantable Cardioverter Defibrillator to Identify Future Ventricular Arrhythmia.

Background: Implantable cardioverter defibrillators (ICDs) reduce mortality associated with ventricular arrhythmia in high-risk patients with cardiovascular disease. Machine learning (ML) approaches are promising tools in arrhythmia research; however, their application in predicting ventricular arrhythmias in patients with ICDs remains unexplored. We aimed to predict and stratify ventricular arrhythmias requiring ICD therapy using 12-lead electrocardiograms (ECGs) in patients with an ICD.

Atrial Fibrillation and Underlying Structural and Electrophysiological Heterogeneity.

As atrial fibrillation (AF) progresses from initial paroxysmal episodes to the persistent phase, maintaining sinus rhythm for an extended period through pharmacotherapy and catheter ablation becomes difficult. A major cause of the deteriorated treatment outcome is the atrial structural and electrophysiological heterogeneity, which AF itself can exacerbate. This heterogeneity exists or manifests in various dimensions, including anatomically segmental structural features, the distribution of histological fibrosis and the autonomic nervous system, sarcolemmal ion channels, and electrophysiological properties.

Segmental evaluation of predictive value of left atrial epicardial adipose tissue following catheter ablation for atrial fibrillation.

Background: Left atrial epicardial adipose tissue (LA-EAT) is associated with the recurrence of atrial tachyarrhythmias (AF/AT) after catheter ablation for atrial fibrillation (AF). However, no previous studies have assessed the predictive value of segment-specific LA-EAT volumes for AF/AT recurrence. This study aimed to assess the relationship between segmental LA-EAT volume and AF/AT recurrence.