Publications by authors named "Shinji Miki"
Aims: The clinical significance of bundle branch block (BBB) during atrial fibrillation (AF) rhythm in relation to heart failure (HF) events remains to be elucidated. This study aimed to explore the associations between BBB patterns and HF in AF patients.
Methods And Results: We enrolled 2721 AF patients whose baseline electrocardiography during AF rhythm was available from a community-based prospective survey, the Fushimi AF Registry.
Article Synopsis
- The study investigates the heart's energy dynamics during acute heart failure (HF) to understand what happens during decompensation, which is when the heart can't pump effectively.
- It involved 50 patients with decompensated HF, measuring intracardiac energy loss (EL) using echo-vector flow mapping at both admission and discharge, comparing results with 40 stable patients who do not have HF.
- Findings showed that energy loss in the left ventricle increased significantly in decompensated HF cases compared to compensated ones, indicating energy inefficiency in the heart, especially among patients with preserved ejection fraction.
Article Synopsis
- Atrial fibrillation (AF) ablation often leads to early arrhythmia recurrences due to inflammation, prompting the study of Saireito as a potential treatment to reduce these occurrences.
- A randomized trial with 100 patients compared the effects of a 30-day Saireito treatment against a control group, focusing on the frequency of atrial tachyarrhythmias post-ablation.
- Results showed that while the Saireito group had fewer episodes of arrhythmias in the first two weeks, they also experienced more adverse symptoms compared to the control group.
Article Synopsis
- The study examined the impact of very low levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease, using data from over 39,000 patients who underwent coronary revascularization.
- It was found that patients with very low LDL-C levels (<85 mg/dL) had more health issues and a higher risk of all-cause mortality compared to those with higher levels, revealing significant risks for various types of death and heart failure.
- Overall, the research suggests that lower LDL-C levels correlate with more serious health problems and increased mortality risk, highlighting the need for careful management of cholesterol levels in at-risk patients.
Article Synopsis
- The study focused on how different settings of cryoballoon ablation affect the size of frozen lesions in porcine hearts, particularly examining application duration and push-up technique.
- Results showed that longer application durations (at least 150 seconds) and the push-up technique (especially at 20 seconds post-freezing) significantly increase lesion size.
- Interestingly, the absence of laminar flow didn't lead to larger lesions, even though it resulted in lower balloon temperatures.
Reliable focal and rotational activations in CARTOFINDER mapping using the OctaRay catheter.
J Cardiovasc Electrophysiol
February 2024
Article Synopsis
- * OctaRay identified more focal and rotational activation sites than PentaRay, but had lower reproducibility and stability rates for these activations after pulmonary vein isolation in persistent AF patients.
- * Ultimately, the OctaRay catheter was found to provide high-resolution and reliable identification of focal and rotational activations, which are associated with shorter AF-cycle lengths and increased activation frequency.
Background: This study assessed the prognostic importance of B-type natriuretic peptide (BNP) concentrations for clinical events after catheter ablation for atrial fibrillation (AF).
Methods and results: We enrolled 1,750 consecutive patients undergoing initial AF ablation whose baseline BNP data were available from a large-scale multicenter observational cohort (TRANQUILIZE-AF Registry). The prognostic impact of BNP concentration on clinical outcomes, including recurrent tachyarrhythmias and a composite of heart failure (HF) hospitalization or cardiac death, was evaluated.
Background: Polypharmacy was reported to be associated with major bleeding in various populations. However, there are no data on polypharmacy and its association with bleeding in patients undergoing percutaneous coronary intervention (PCI).
Methods and results: Among 12,291 patients in the CREDO-Kyoto PCI Registry Cohort-3, we evaluated the number of medications at discharge and compared major bleeding, defined as Bleeding Academic Research Consortium Type 3 or 5 bleeding, across tertiles (T1-3) of the number of medications.
Article Synopsis
- The study aimed to investigate the link between ST-segment depression during atrial fibrillation (AF) and future heart failure (HF) events among patients.
- It involved 2,718 AF patients, revealing that 25.4% exhibited ST-segment depression, which was linked to higher rates of cardiac death and hospitalization due to HF during a 6-year follow-up.
- The type of ST-segment depression (e.g., horizontal or downsloping) significantly impacted this risk, with the findings suggesting that not all forms of ST-segment depression indicate the same level of future heart failure risk.
Article Synopsis
- The study aimed to investigate the relationship between intracardiac dynamics during atrial fibrillation (AF) in patients with heart failure (HF) using echo-vector flow mapping.
- 76 patients were categorized into high and low NT-proBNP groups based on their serum levels, which helped assess energy loss during AF and sinus rhythms.
- Results showed that the high NT-proBNP group had significantly greater energy loss during AF, but this improved after restoring sinus rhythm, indicating a link between energy inefficiency and serum NT-proBNP levels.
Article Synopsis
- This study investigates the long-term effects of catheter ablation compared to conservative management in asymptomatic atrial fibrillation (AF) patients to determine the procedure's effectiveness.
- Out of 537 matched pairs of patients, catheter ablation showed significantly fewer major cardiovascular issues among asymptomatic patients with previous AF-related complications, while the benefits were less clear for those without such complications.
- In contrast, symptomatic AF patients consistently benefited from catheter ablation regardless of their history with AF-related complications, suggesting different treatment efficacy based on symptom presence.
Background: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.
Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.
Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry.
Article Synopsis
- - The study compares the long-term outcomes of percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in 2,464 patients with multi-vessel coronary artery disease.
- - Although the 5-year risk of combined events like death, heart attack, or stroke was not significantly different between the two groups, adjusted analysis showed that PCI had a higher risk of myocardial infarction and the need for additional revascularization compared to CABG.
- - The findings suggest that while both procedures have similar outcomes regarding death and stroke, PCI with new-generation DES may carry a greater long-term risk for major cardiovascular issues in patients requiring complex multi-vessel treatments
Filling defect (FD) in left atrial appendage (LAA) is commonly observed in contrast computed tomography (CT) among patients with atrial fibrillation (AF), although its prognostic impact has not been well explored. We enrolled 1,019 consecutive patients who underwent AF ablation with baseline contrast CT images. FD in LAA was graded into 3 groups: grade 0 for complete filling (79.
View Article and Find Full Text PDFReproducibility and stability of atrial fibrillation drivers identified by an automated algorithm: CARTOFINDER.
J Interv Card Electrophysiol
November 2022
Article Synopsis
- The study aimed to evaluate the reliability of atrial fibrillation (AF) drivers identified by CARTOFINDER, focusing on focal and rotational activations before and after pulmonary vein isolation (PVI) in 27 patients with persistent AF.
- It found that focal activation had a reproducibility rate of 57.8%, while rotational activation was lower at 37.4%; both types of activation exhibited variations in stability pre- and post-PVI.
- Overall, while the reproducibility of AF drivers (especially focal activation) was considered favorable, the stability of these drivers post-PVI was found to be poor, highlighting a dependence on the frequency of recordings.
Article Synopsis
- The study examined how stable atrial fibrillation (AF) drivers, identified using ExTRa Mapping™, are over time before and after pulmonary vein isolation (PVI) in patients with persistent AF.
- The researchers analyzed recordings from 26 patients, measuring the nonpassively activated ratio (%NP) across three sessions to determine the consistency and stability of these AF drivers.
- Results indicated that while overall AF driver activity declined after PVI, the instability of these drivers increased, suggesting that more prolonged and repetitive recording is essential for accurate assessment.*
Article Synopsis
- The study investigates the link between fine fibrillatory waves on ECG during atrial fibrillation (AF) and the risk of heart failure (HF) in a group of 2,442 patients from the Fushimi AF Registry.
- Fine fibrillatory waves, found in 24.1% of patients, were associated with older age, higher prevalence of sustained AF, pre-existing HF, and larger left atrial size.
- Over a median follow-up of 5.9 years, patients with fine fibrillatory waves experienced a significantly greater incidence of HF-related hospitalizations or deaths compared to those with coarse waves, indicating fine fibrillatory waves could serve as an independent predictor of HF risk.
Article Synopsis
- * A comparison of matched pairs revealed a significantly lower 5-year incidence of major health issues (like cardiovascular death and hospitalization) for those who underwent ablation (5.2%) compared to those who were managed conservatively (15.6%).
- * Despite the promising results favoring catheter ablation, the authors acknowledged potential selection bias and the impact of unmeasured confounding factors that could influence the outcomes.
Article Synopsis
- This study evaluated how different oral anticoagulants (OACs) affect activated clotting time (ACT) during catheter ablation procedures for atrial fibrillation, involving 554 patients across five types of OACs.
- Dabigatran led to a faster and more stable achievement of target ACT compared to rivaroxaban and apixaban, while edoxaban and warfarin showed similar results to dabigatran in terms of time to reach target ACT.
- The research found no significant differences in periprocedural complications among the five OAC groups, highlighting that dabigatran might be the most efficient option under continuous use in clinical practice.