Chronic total occlusion treated with coronary intervention by three-dimensional guidewire manipulation: an experimental study and clinical experience.

Three-dimensional (3D) wiring is one method for accurate guidewire control in chronic total occlusion (CTO) lesions during manipulation of CTO-specific stiff guidewires. However, the construction of a mental 3D image is difficult. We propose the idea of image patterns to allow immediate construction of 3D images from the two perpendicular angles of the X-ray system detector and report a case of CTO treated with 3D wiring.

Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence.

Background: This study aimed to evaluate the association between left atrial (LA) structural remodeling and very late recurrence [VLR; initial recurrence >12 months after catheter ablation (CA)] after successful CA for non-paroxysmal atrial fibrillation (AF).

Methods: We retrospectively evaluated 63 patients who underwent initial, single ablation for drug-refractory persistent or long-standing persistent AF and those who had no recurrence in the first year after CA. We followed patients for a mean of 3.

Prophylactic antiarrhythmic effect of anesthetics at subanesthetic concentration on epinephrine-induced arrhythmias in rats after brain death.

The present study using brain death model of rats was designed to examine whether prophylactic administration of volatile anesthetics and propofol prevent the epinephrine-induced arrhythmias. A Fogarty catheter was placed intracranially for induction of brain death. After brain death, the rats were randomly assigned to five groups: the control group (no anesthetics), the sevoflurane group (0.

Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting†.

Objectives: Left atrial (LA) dimension can predict atrial fibrillation (AF) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding patient selection and late outcome is lacking.

Methods: We studied 160 patients (mean age 70 ± 9 years) with paroxysmal AF who underwent radiofrequency-based PVI during AVR and/or CABG, and were followed up postoperatively for at least 6 months.

Changes in left ventricular relaxation after azelnidipine treatment in hypertensive patients with diabetes: subanalysis of a prospective single-arm multicentre study.

Objectives: We previously demonstrated that a calcium channel blocker, azelnidipine, improves left ventricular relaxation in patients with hypertension and diastolic dysfunction in a multicentre, Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) trial. The objectives of the present subanalysis were to investigate the differences in diastolic function in hypertensive patients with and without diabetes, and the efficacy of azelnidipine on diastolic function among them.

Design: Subanalysis of a prospective single-arm multicentre study.

Clinical and procedural predictors of early complications of ablation for atrial fibrillation: analysis of the national registry data.

Background: The risk assessment of the complication from atrial fibrillation (AF) ablation is important and needs to be updated.

Objective: The purpose of this study was to investigate the clinical and procedural factors associated with AF ablation-related early complications.

Methods: The Japanese Heart Rhythm Society invited electrophysiology centers in Japan to register data regarding all AF ablation procedures performed in September 2011, March 2012, and September 2012.

Long-term clinical outcomes after everolimus- and sirolimus-eluting coronary stent implantation: final 3-year follow-up of the Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial.

Background: Long-term clinical outcomes of everolimus-eluting stent (EES) compared with sirolimus-eluting stent (SES) have not been evaluated fully yet, especially whether EES implantation could positively affect late adverse events reported after SES implantation occurring >1 year.

Methods And Results: In this all-comer prospective multicenter randomized open-label trial, 3196 patients were assigned randomly to implant either EES (n=1596) or SES (n=1600). At 3 years, EES was noninferior to SES on the primary safety end point (all-cause death or myocardial infarction; 10.

Additional diagnostic value of first-pass myocardial perfusion imaging without stress when combined with 64-row detector coronary CT angiography in patients with coronary artery disease.

Objective: Multi-detector coronary CT angiography (CCTA) can detect coronary stenosis, but it has a limited ability to evaluate myocardial perfusion. We evaluated the usefulness of first-pass CT-myocardial perfusion imaging (MPI) in combination with CCTA for diagnosing coronary artery disease (CAD).

Methods: A total of 145 patients with suspected CAD were enrolled.

Regional difference of optimal contact force to prevent acute pulmonary vein reconnection during radiofrequency catheter ablation for atrial fibrillation.

Background: Regional differences in optimal contact force (CF) to prevent acute pulmonary vein reconnection (APVR) during catheter ablation for atrial fibrillation (AF) remain unclear.

Objective: The purpose of this study was to evaluate regional difference in optimal CF during AF ablation.

Methods: This single-center observational study evaluated data from 57 consecutive drug-refractory AF patients (mean age, 62 ± 11 years; 43 males) who underwent initial pulmonary vein isolation (PVI) using the THERMOCOOL® SMARTTOUCH™ (Biosense Webster, Diamond Bar, CA, USA) catheter from June to August 2013.

Current status of catheter ablation for atrial fibrillation--updated summary of the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF).

Background: The purpose of this study was to provide precise data on the current status of catheter ablation for atrial fibrillation (AF) in Japan.

Methods And Results: The Japanese Heart Rhythm Society requested that members retrospectively register data for AF ablation performed in September 2011, March 2012, and September 2012. A total of 165 centers submitted data for 3,373 patients (age, 62±11 years; male, 76.

A simple way to treat mitral valve prolapse: chordal replacement using a new mitral leaflet retractor.

Objectives: The most difficult aspect of chordal replacement during mitral valve repair is to determine the correct length of the new chordae. A simple technique of chordal replacement was developed employing the new mitral leaflet retractor that enables easy adjustment of the length of artificial chordae.

Methods: For prolapse of the anterior mitral leaflet (AML), the level of the normal opposing posterior leaflet can be used to determine the length of new chordae.

Analysis of the sternum for sternal closure with bioabsorbable sternal pins.

Purpose: Poly-L-lactide sternal pins have been reported to be beneficial for sternal closure. However, we sometimes experience a small sternum, and the size characteristics of the sternum have not been fully investigated. We analyzed size features of the sternum to determine the optimal size of sternal pin for sternal closure.

Japanese and non-Japanese patient outcomes in the PLATINUM randomized trial comparing the PROMUS Element and XIENCE V everolimus-eluting stents.

Background: The PLATINUM randomized trial enrolled 1530 patients treated with either the platinum chromium PROMUS Element everolimus-eluting stent (PtCr-EES; Boston Scientific, Natick, MA, USA) or the predicate cobalt chromium PROMUS/XIENCE V EES (CoCr-EES; manufactured as XIENCE V by Abbott Vascular, Santa Clara, CA, USA also distributed as PROMUS by Boston Scientific), including 124 patients from Japanese sites. This substudy examines 2-year outcomes in the Japanese and non-Japanese cohorts.

Methods: Patients with 1 or 2 de novo native coronary artery lesions (baseline vessel diameter ≥2.

Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: from the ATTEND Registry.

Background: Randomized controlled trials concerning pulmonary artery catheters (PACs) use have yielded little evidence of their beneficial effects on survival. This study aimed to evaluate the association between PACs and in-hospital mortality in patients with acute heart failure syndromes (AHFS).

Methods: The Acute Decompensated Heart Failure Syndromes (ATTEND) Registry is a prospective, observational, multicenter cohort study performed in Japan, since April 2007.

Acute ST elevation myocardial infarction in an adult patient with anomalous origin of the left coronary artery from the pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery is rare but causes myocardial ischemia and sudden death. A few patients with this anomaly can survive to adulthood without sufficient collateral coronary flow or surgical intervention. We present here a case of acute inferior myocardial infarction, which may occur due to thrombotic occlusion of the right coronary artery, in a 63-year-old woman with anomalous origin of the left coronary artery from the pulmonary artery, providing specific coronary angiographic findings.

Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction.

Background: Acute hyperglycemia (AH) after the onset of acute myocardial infarction (AMI) is a manifestation of transient abnormal glucose metabolism that may reflect AMI severity, and thus be a predictor of poor prognosis. However, it remains unknown whether AH may predict development of de novo diabetes mellitus (dn-DM) in non-diabetic AMI patients.

Methods And Results: Among AMI patients registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2007, we investigated hospital records of 1493 patients who had an admission glycated hemoglobin A1c (HbA1c) level of ≤6.

Navifocus WR is the promising intravascular ultrasound for navigating the guidewire into true lumen during the coronary intervention for chronic total occlusion.

We describe an initial clinical chronic total occlusion (CTO) case in which CTO-specific intravascular ultrasound (IVUS): Navifocus WR was useful for navigating the second guidewire into the true lumen under the IVUS observation from the subintimal space.

Treatment of collateral channel perforation during percutaneous coronary intervention for chronic total occlusion with retrograde approach.

We describe one case of septal and two cases of epicardial collateral channel perforation during percutaneous coronary intervention by the retrograde approach for chronic total occlusion. After coil embolization of the channel perforation area, additional treatments were required in all three cases to stop bleeding. All three cases required injection of autologous clots, with one case also requiring subsequent injection of fibrin glue.

The impact of systemic vascular resistance on the accuracy of the FloTrac/Vigileo™ system in the perioperative period of cardiac surgery: a prospective observational comparison study.

FloTrac/Vigileo™ system is based on arterial pressure waveform analysis arterial pressure-based CO (APCO). Therefore, systemic vascular resistance (SVR) can influence the accuracy of APCO. The purpose of this study is to evaluate the relationship between SVR and the accuracy of APCO.

Incidence and risk factors for very late recurrence of atrial fibrillation after radiofrequency catheter ablation.

Aims: Although several prognostic factors for atrial fibrillation (AF) recurrence after catheter ablation (CA) have been reported, predictors of very late recurrence (VLR; initial recurrence >12 months after ablation) remain unidentified. This study investigated clinical variables predictive of VLR after CA for AF.

Methods And Results: This retrospective single-centre cohort study evaluated data from 1016 consecutive drug-refractory AF patients who underwent single CA for AF from July 2004 to May 2010.

Modulation of individual susceptibility to the no-reflow phenomenon after acute myocardial infarction.

Coronary reperfusion using primary percutaneous coronary intervention (PCI) dramatically reduces morbidity and mortality among patients with acute myocardial infarction (AMI). Nevertheless, inadequate myocardial perfusion, known as the "no-reflow" phenomenon, is observed in approximately 15% of patients and is associated with poor outcomes. No-reflow is caused not only by mechanical occlusion of the microvasculature due to thromboembolism but also by myocardial injury.

Cause of very late recurrence of atrial fibrillation or flutter after catheter ablation for atrial fibrillation.

The major mechanism underlying the early recurrence of atrial fibrillation (AF) after ablation is mainly reconnection of the isolated pulmonary vein (PV); however, the mechanism responsible for very late recurrence (VLR) has not been fully elucidated. The purpose of the present study was to investigate the mechanism underlying VLR. The study population included 150 consecutive patients with AF who underwent a second session of catheter ablation because of recurrence.

Estimation of left atrial blood stasis using diastolic late mitral annular velocity.

Aims: Diastolic late mitral annular velocity (a') measured by transthoracic echocardiography (TTE) is reported to represent left atrial (LA) pump function and the severity of LA remodelling. The purpose of this study is to investigate the association between a' and LA blood stasis in patients with non-valvular paroxysmal atrial fibrillation.

Methods And Results: We enrolled 138 consecutive patients with non-valvular paroxysmal atrial fibrillation who had spontaneous sinus rhythm at the time of echocardiography.