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Abstract Background Evidence regarding the association between hyperuricemia and arrhythmia recurrence after catheter ablation for paroxysmal atrial fibrillation (AF) is scarce. We investigated whether hyperuricemia predicts arrhythmia recurrence after catheter ablation for paroxysmal AF and the relationship between hyperuricemia and alcohol consumption in AF recurrence. Methods Patients who underwent catheter ablation for paroxysmal AF were divided into the hyperuricemia (index serum uric acid [UA] >7.0 mg/dL; n = 114) and control (UA ≤7.0 mg/dL; n = 609) groups and were followed for a median of 24 (12–48) months after ablation. Results The hyperuricemia group had more patients with an alcohol intake of ≥20 g/day (33.3% vs. 22.7%, p = .017) and a lower incidence of AF‐free survival (p = .019). Similarly, those with an alcohol intake of ≥20 g/day had a lower incidence of AF‐free survival than other patients. Multivariate Cox regression analysis revealed the following independent predictors of AF recurrence (adjusted hazard ratio, 95% confidence interval): hyperuricemia (1.64, 1.12–2.40), female gender (1.91, 1.36–2.67), brain natriuretic peptide level >100 pg/mL (1.59, 1.14–2.22), and alcohol consumption ≥20 g/day (1.49, 1.03–2.15) (all p

Abstract Background Preprocedural clinical predictors of the successful maintenance of sinus rhythm may contribute to optimal treatment strategies for atrial fibrillation (AF). The CAAP‐AF score, a novel simple tool scored as 0‐13 points (including six independent variables) has been proposed to predict long‐term freedom from AF after catheter ablation. To clarify its reproducibility, we examined the CAAP‐AF score's predictive performance and then created subgroups to best predict AF recurrence by using a machine learning algorithm. Methods We studied 583 consecutive patients who underwent initial AF catheter ablation at our institute (median CAAP‐AF score, 5; age, 66 ± 10 years old; female, 28.3%; coronary artery disease, 10.8%; left atrial diameter, 39.9 ± 6.6 mm; number of antiarrhythmic drugs failed, 0.4 ± 0.6; nonparoxysmal AF, 45.3%). All were systematically followed up with an endpoint of atrial tachyarrhythmia recurrence after the last ablation procedure. Results During the 1.8 ± 1.2‐year follow‐up, 157 patients had atrial tachyarrhythmia recurrence. Repeated procedures were performed (n = 115). Arrhythmia recurrence after the last session occurred in 69 patients. We created Kaplan‐Meier curves for freedom from AF after final AF ablation for ranges of CAAP‐AF scores; these confirmed the original study results. The machine learning using Classification and Regression Trees divided the patients into three categories by the risk score: low (score ≤5), intermediate (score 6‐8), and high (score ≥9). Conclusions The CAAP‐AF score was useful to stratify the atrial tachyarrhythmia recurrence risk in AF patients undergoing catheter ablation into three categories. The score should be considered when deciding whether to perform AF ablation in clinical practice.

Background: Anticoagulation therapy with the vitamin K antagonist (VKA) warfarin has been demonstrated to reduce thromboembolic risk after electrical cardioversion (ECV). However, data concerning ECV with non-VKA oral anticoagulants (NOACs) is limited. The objective of this study was to determine the efficacy and safety of NOACs in patients undergoing ECV in a real-world clinical practice at a single center in Japan. Methods: We retrospectively analyzed the data of 406 consecutive patients who underwent ECV for atrial fibrillation (AF) or flutter under anticoagulation with one of the three NOACs (n=149) or with a VKA (n=257). Results: The CHADS2 and HAS-BLED scores were significantly higher in the VKA group, whereas the NOACs group had a tendency toward greater spontaneous echo contrast grades. After ECV, ischemic stroke occurred in three patients of the VKA group and one patient in the NOAC group, all of whom had persistent AF, indicating no significant difference in the thromboembolic event rate within 30 days following ECV. No other thromboembolic events, major bleeding, or death occurred in either group. Among the NOAC and VKA patients in whom we newly introduced an oral anticoagulant to perform ECV, the number of days leading to ECV was significantly lesser for the NOAC patients. Conclusion: NOACs may be used as an alternative to VKAs for ECV and may allow prompt ECV in clinical practices.

This report describes a case of paradoxical atrial undersensing by a dual-chamber pacemaker during paroxysmal atrial fibrillation. Undersensing of 5.6 mV atrial signals at a programmed sensitivity of 0.5 mV returned to normal sensing by decreasing atrial sensitivity to 1.0 mV. This uncommon phenomenon can be explained by a repeated activation of the quiet timer blanking interval. Knowledge of this phenomenon is important in the current pacemaker management to improve the accuracy of the diagnostic feature for atrial tachyarrhythmia burden and to avoid unnecessary lead revisions.

Introduction: Surgical procedures for pacemaker implantation vary among facilities. The extrathoracic venous puncture method has been utilized for lead insertion, although patients' body movements can displace the targeted vein from the area into which a contrast agent has been injected for imaging. Failed punctures cause edema around the puncture site, spasm, or venous collapse due to bleeding, which may render another puncture impractical. To overcome these problems, we report a new technique for the extrathoracic puncture method. Methods and results: From April 2007 through March 2011, we performed 35 new dual chamber pacemaker implantation procedures. This study compared a conventional puncture group (from April 2007 through March 2009; Group A) with a catheter-guided puncture group (from April 2009 through March 2011; Group B). We analyzed procedure time and procedure-related complications in each group. The procedure time was 138.6±41.8 min in the conventional puncture group (Group A) and 109.8±23.2 in the catheter-guided puncture group (Group B). There was a significant reduction in the procedure time in the catheter-guided puncture group (Group B) compared with the conventional puncture group (Group A; p=0.016). No patients in either group had pneumothorax, hematoma, or any other complications. Conclusion: Our puncture method involving catheter insertion appears to be safe and effective.