Search

Aska Toda,1 Kenjiro Sawada,1 Keigo Osuga,2 Noboru Maeda,2 Hiroki Higashihara,2 Tomoyuki Sasano,1 Noriyuki Tomiyama,2 Tadashi Kimura1 1Department of Obstetrics and Gynecology, 2Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan Aim: The aim of this study was to retrospectively analyze the efficacies of uterine artery embolization (UAE) using gelatin sponge for symptomatic uterine fibroids.Methods: A series of 60 consecutive premenopausal women underwent UAE using gelatin sponge particles or porous gelatin particles. Patients were routinely followed up at 1, 3, 6, and 12 months after the procedure and asked to report any procedure-related complications. At each follow-up, an original clinical questionnaire was completed by the patients to evaluate changes in fibroid-related symptoms. Pelvic magnetic resonance imaging was performed before and at 3 and 12 months after the procedure, and the changes in volume of the dominant fibroid were calculated.Results: Bilateral UAE was successfully performed in all the patients. Median age was 45 years (range 34–53 years), and median follow-up period was 25.2 months (range 1–116 months). At the 3- and 12-month follow-up, the dominant fibroid volumes were found to be significantly decreased by 33.4% (95% confidence interval [CI]: 24.9–41.1) and 48.4% (95% CI: 40.7–56.1) compared to baseline volumes, respectively. Excluding patients not having menorrhagia or bulk-related symptoms, at 12 months 49 of 50 (98%) women showed improvement in menorrhagia, and 45 of 47 (95.7%) women showed improvement in bulk-related symptoms. During the follow-up period, ten patients (16.7%) required further interventions including two patients who had undergone hysterectomy. No sequelae were experienced by any of the patients.Conclusion: UAE using gelatin sponge was associated with a high clinical success rate and good fibroid volume reduction compared to UAE using other embolic agents. Keywords: embolic agent, gelatin sponge, uterine artery embolization, uterine fibroid

Mihoko Kawabata,1 Yasuhiro Yokoyama,1 Takeshi Sasaki,1 Susumu Tao,1 Kensuke Ihara,1 Yasuhiro Shirai,1 Tetsuo Sasano,2 Masahiko Goya,1 Tetsushi Furukawa,3 Mitsuaki Isobe,4 Kenzo Hirao1 1Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Biofunctional Informatics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 3Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan; 4Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan Purpose: Drug-induced bradycardia is common during antiarrhythmic therapy; the major culprits are beta-blockers. However, whether other antiarrhythmic drugs are also a significant cause of this, alone or in combination with beta-blockers, is not well known. Methods: We retrospectively investigated the records of all patients hospitalized at our institution for drug-related bradycardia from the years 2004 to 2012. Patients with cardiac disease and electrolytic or hormonal abnormalities that could cause bradyarrhythmias were excluded. Results: Eight patients were identified (mean age, 79±5 years; range, 71–85 years; 6 women). Three patients were taking only beta-blockers (hereafter referred to as the BB group), while five patients were on both beta-blockers and Na channel blockers (hereafter referred to as the BB + Na group). Heart rates ranged from 20~49 beats/minute on arrival. The initial electrocardiogram showed sinus bradycardia (n=6) or sinus arrest with escape beats (n=2). QRS duration was 80–100 ms. The clinical presentation of the BB + Na group was considerably worse than that of the BB group, and included cardiogenic shock and heart failure. Four of the BB + Na patients had been on their medications for over 300 days. The BB group recovered solely with drug discontinuation, while 4 of the 5 patients in the BB + Na group needed additional treatments, such as intravenous administration of atropine or adrenergic agonist and temporary pacing. Bradycardia did not recur during follow-up (median, 687 days). Conclusion: Although wide QRS ventricular tachyarrhythmia is a better known proarrhythmic effect of Na channel blockers, life-threatening bradycardia may also occur in combination with beta-blockers in the elderly, even months after the start of medication, and at plasma concentrations that do not prolong QRS width. Keywords: proarrhythmia, elderly, QRS duration

Purpose: The aim of this study was to investigate the prognostic impact of a preoperative leukocyte alteration in patients with surgically-treated early-stage cervical cancer. Materials and Methods: The baseline characteristics and outcome data of early-stage cervical cancer patients who were treated with radical hysterectomy between 1996 and 2011 were collected and retrospectively reviewed. The patients were separated into three risk groups (low-risk, intermediate-risk, and high-risk) according to the pathological risk factors exhibited by their tumors. A Cox proportional hazards regression model was used to investigate the prognostic significance of a preoperative leukocytosis (≥ 10,000 µ/l). Results: A preoperative leukocytosis was observed in 0.9%, 6.6%, and 8.6% of the patients in the low-risk, intermediate-risk, and high-risk groups, respectively. In multivariate analysis, a preoperative leukocytosis was found to be an independent prognostic factor in intermediate-risk or high-risk groups. Conclusion: The preoperative leukocytosis is an independent predicator of shorter progression-free survival (PFS) in surgically-treated early-stage cervical cancer patients, especially those with intermediate-risk or high-risk factors. [ABSTRACT FROM AUTHOR]

Purpose of investigation. To investigate the prognosis of high-risk early-stage cervical cancer patients who did not receive postoperative concurrent chemoradiotherapy (CCRT). Materials and Methods. The characteristics and outcomes of high-risk early-stage cervical cancer patients who did not receive postoperative CCRT were collected. They were separated into two groups according to the type of adjuvant treatment: no further therapy (NFT group) or chemotherapy (chemotherapy group), and the clinico-pathological characteristics, recurrence rate, progression-free survival (PFS), and overall survival (OS) were investigated. Results.A total of 23 patients were included. After a median follow-up period of 115 months, 19 had developed recurrent disease, and 17 had died of disease progression. The median PFS and OS of all patients were ten and 29 months, respectively. The recurrence rate of the NFT group (n=10) was similar to that of the chemotherapy group (n=13) (80% vs. 85%, p > 0.05). Although the PFS and OS of the chemotherapy group were slightly longer than those of the NFT group, the differences were not statistically significant (PFS, 10 vs. 36 months, p > 0.05; OS, 28 vs. 59 months p > 0.05). Conclusion. High-risk early-stage cervical cancer patients who did not receive postoperative CCRT have dismal prognosis irrespective of the type of adjuvant treatment. [ABSTRACT FROM AUTHOR]

Objective We analyzed the diagnostic performance of the MR imaging findings of the parotid, submandibular, and sublingual glands to discriminate between patients with and without Sjögren's syndrome. Methods We retrospectively analyzed the correlation between the MR imaging and histopathological findings obtained from 69 patients with clinically suspected Sjögren's syndrome. We evaluated the heterogeneous signal intensity distribution on T1- and T2-weighted images, the multiple high-signal-intensity spots on MR sialograms, and the volume of the parotid, submandibular, and sublingual salivary glands. Results The multiple high-signal-intensity spots in the parotid gland showed the highest sensitivity and diagnostic accuracy (82% and 83%, respectively). In addition, the multiple high-signal-intensity spots and the heterogeneous signal intensity distribution in the submandibular gland showed high specificity (100% and 88%, respectively). The volume of the submandibular gland, but not that of the parotid or sublingual gland, was smaller in patients with Sjögren's syndrome. Conclusions The presence of multiple high-signal-intensity spots on an MR sialogram in the parotid gland should be considered the best diagnostic indicator for Sjögren's syndrome. The presence of spots, heterogeneity, and the change to smaller volumes in the submandibular gland were also helpful because of their high specificity, particularly in advanced cases. [ABSTRACT FROM AUTHOR]

There is a desire that a carbon-ion radiotherapy facility will produce various ion species for fundamental research. Although the present Kei2-type ion sources are dedicated for the carbon-ion production, a future ion source is expected that could provide: (1) carbon-ion production for medical use, (2) various ions with a charge-to-mass ratio of 1/3 for the existing Linac injector, and (3) low cost for modification. A prototype compact electron cyclotron resonance (ECR) ion source, named Kei3, based on the Kei series has been developed to correspond to the Kei2 type and to produce these various ions at the National Institute of Radiological Sciences (NIRS). The Kei3 has an outer diameter of 280 mm and a length of 1120 mm. The magnetic field is formed by the same permanent magnet as Kei2. The movable extraction electrode has been installed in order to optimize the beam extraction with various current densities. The gas-injection side of the vacuum chamber has enough space for an oven system. We measured dependence of microwave frequency, extraction voltage, and puller position. Charge state distributions of helium, carbon, nitrogen, oxygen, and neon were also measured. [ABSTRACT FROM AUTHOR]

We report here a case of masticatory disturbance evoked by trigeminal schwannoma, in which we have evaluated the changes in occlusal force and masticatory sensation before and after treatment for the tumour. The patient was a 43-year-old woman and her chief complaint was a loss of masticatory sensation on her left side. MR imaging revealed an enhanced tumour in the left cavernous sinus/Meckel's cave. The left masseter muscle function and occlusal force showed remarkable decreases before treatment; however, the sensory thresholds of her facial skin and dental pulp were not significantly different from the control side, indicating that her loss of masticatory sensation was not due to sensory disturbance but to occlusal force weakness. Gamma-knife radiosurgery resulted in a significant improvement in masticatory sensation following an increase in occlusal force. [ABSTRACT FROM AUTHOR]

Oral epithelium might be the first barrier against oral bacteria in periodontal tissue. We hypothesized that oral epithelium is endowed with innate immune receptors for bacterial components, which play roles in host defense against bacterial infection without being accompanied by excessive inflammatory responses. We found clear expression of Toll-like receptor (TLR)4 as well as TLR2, and strong expression of NOD1 and NOD2 in normal oral epithelial tissues by immunohisto-chemical analysis. We also showed that primary oral epithelial cells in culture expressed these molecules using PCR, flow cytometry, and immunostaining. In inflamed oral epithelium, cell-surface localizations of TLR2 and TLR4 were more clearly observed than in healthy tissue. Upon stimulation with synthetic ligands for these receptors, the expression of β-defensin 2 was markedly up-regulated. These findings indicate that these molecules in oral epithelial cells are functional receptors that induce antibacterial responses. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate changes in disc position, mobility, and morphology in patients with temporomandibular joint disorders (TMD) in response to four different treatments, splint therapy, pumping manipulation, arthrocentesis, and arthroscopic surgery, using magnetic resonance imaging (MRI). Methods: Eighty-five joints (85 patients) with unilateral internal derangement or osteoarthritis that were successfully treated were included in this study. The patients were divided into four groups as follows: splint therapy group, pumping manipulation group, arthrocentesis group, and arthroscopic surgery group. Changes in the disc position, mobility, and morphology before and after treatment were compared among the four groups using MRI. Results: All discs showed anterior disc displacement (ADD) without reduction before treatment. Only 10% of the joints became ADD with reduction after treatment, and the other joints remained ADD without reduction in spite of treatment. Discs treated by arthroscopic surgery were located more anteriorly compared with pre-treatment. In pre-treatment MRI, the rate of stuck disc increased as the stage of the treatment advanced. In post-treatment MRI, all temporomandibular joints (TMJs) had mobile discs. The disc deformity advanced after arthrocentesis and arthroscopic surgery. Conclusions: Even though clinical signs and symptoms were alleviated by treatment, most discs remained ADD without reduction on MRI in spite of treatment. This suggests that the four treatments do not necessarily improve the position and deformity of the disc, and that arthroscopic surgery advances the deformity and anterior displacement of the disc. Disc mobility is important for improving clinical signs and symptoms. [ABSTRACT FROM AUTHOR]

Peptidoglycan recognition proteins (PGRPs), a novel family of pattern recognition molecules (PRMs) in innate immunity conserved from insects to mammals, recognize bacterial cell wall peptidoglycan (PGN) and are suggested to act as anti-bacterial factors. In humans, four kinds of PGRPs (PGRP-L, -Iα, -Iβ and -S) have been cloned and all four human PGRPs bind PGN. In this study, we examined the possible regulation of the expression of PGRPs in oral epithelial cells upon stimulation with chemically synthesized pathogen-associated molecular patterns (PAMPs) in bacterial cell surface components:Escherichia coli-type tryacyl lipopeptide (Pam3CSSNA),E. coli-type lipid A (LA-15-PP), diaminopimelic acid containing desmuramyl peptide (γ-d-glutamyl-meso-DAP; iE-DAP), and muramyldipeptide (MDP). These synthetic PAMPs markedly upregulated the mRNA expression of the four PGRPs and cell surface expression of PGRP-Iα and -Iβ, but did not induce either mRNA expression or secretion of inflammatory cytokines, in oral epithelial cells. Suppression of the expression of Toll-like receptor (TLR)2, TLR4, nucleotide-binding oligomerization domain (NOD)1 and NOD2 by RNA interference specifically inhibited the upregulation of PGRP mRNA expression induced by Pam3CSSNA, LA-15-PP, iE-DAP and MDP respectively. These PAMPs definitely activated nuclear factor (NF)-κB in the epithelial cells, and suppression of NF-κB activation clearly prevented the induction of PGRP mRNA expression induced by these PAMPs in the cells. These findings suggested that bacterial PAMPs induced the expression of PGRPs, but not proinflammatory cytokines, in oral epithelial cells, and the PGRPs might be involved in host defence against bacterial invasion without accompanying inflammatory responses. [ABSTRACT FROM AUTHOR]

Evaluates the significance of heavily T2 weighted (T2W) magnetic resonance imaging for the differential diagnosis of parotid tumors. Examination of the obtained T2W from patients with parotid tumors; Emphasis on the homogeinity and signal intensity displayed by the solid portions of the tumors during examination of patients; Ability of T2W images to distinguish plemorphic adenoma from Warthin's tumor and malignant tumors.

Objectives: To determine the most appropriate sequences for the visualization of small parotid ducts in MR sialography. Methods: MR images of a phantom consisting of distilled water in polyethylene tubes were obtained with turbo-spin echo (TSE), single-shot turbo-spin echo (SSTSE), half-fourier acquisition, single-shot turbo-spin echo (HASTE) and turbo gradient-spin echo (TGSE) pulse sequences and compared visually and quantitatively. MR sialograms obtained from healthy volunteers and patients with Sjögren's syndrome (SS) were obtained using the same four sequences. Results: In the phantom, TSE images were best and the contrast-noise ratio (CNR) highest. In the volunteers, the main ducts were especially clearly visualized with TSE and in SSTSE; however, the majority of secondary and/or tertiary parotid ducts were not depicted by any of the sequences used. In SS patients, images of small main ducts and small pseudocysts were clearer using TSE. However, TSE could not depict the narrow main ducts or peripheral ducts or very small pseudocysts. Conclusions: TSE is considered the most suitable MR sequence for assessing small parotid gland ducts. However, further improvement is needed since it does not always visualize them sufficiently. [ABSTRACT FROM AUTHOR]

The existence and nature of parasympathetic nerve fibers in the dental pulp have long been a subject for discussion; indeed, vasodilator responses mediated by such nerve fibers have yet to be conclusively demonstrated in the dental pulp. This study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat dental pulp. Dynamic changes in pulpal blood flow (PBF), with mandibular lip blood flow (LBF) recorded as a control, were investigated in cat mandibular canine teeth by means of laser Doppler velocimetry. Peripheral trigeminal afferents (see below) were stimulated electrically to confirm that somato-parasympathetic reflex vasodilatation could be induced. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were then stimulated intracranially. Electrical stimulation of trigeminal afferents (in the infra-orbital nerve or the maxillary buccal gingiva) caused no change in PBF but did increase ipsilateral LBF. Neither facial nor glossopharyngeal nerve root stimulation caused a PBF increase, though both elicited increases in ipsilateral LBF. The vasodilator responses in the lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilatation via activation of parasympathetic vasodilator fibers. In contrast, intracranial stimulation of the trigeminal nerve root induced increases in both PBF and LBF which were reduced by pre-treatment with tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that a parasympathetic vasodilator mechanism is not present in feline dental pulp. [ABSTRACT FROM AUTHOR]

Antidromic stimulation of sensory nerves has been shown to increase blood flow in the tissue they innervate. This study was designed to determine if antidromic vasomotor responses occur in feline dental pulp and if they are mediated by branched axons supplying both tooth pulp and gingiva. Dynamic changes in pulpal blood flow (PBF) elicited by electrical stimulation, pinching, heating, and capsaicin application to the gingivae were investigated in cat mandibular canine teeth by means of Laser Doppler Velocimetry. All inferior alveolar nerve bundles and the cervical sympathetic trunk had been previously sectioned to avoid the occurrence of brainstem reflexes, e.g., somato-autonomic vasomotor reflexes. Increases in PBF were observed in seven out of 12 cats when a restricted gingival area adjacent to the canine teeth was stimulated as described, but the increases were abolished after the sensitive gingival area was painted with lidocaine jelly, a surface anesthetic. These vasodilator responses, remarkably reduced following repeated application of 30 mM of capsaicin, are considered to be induced via antidromic activation of capsaicin-sensitive nociceptive nerve fibers, presumably by axon reflex mechanisms, suggesting that nerve terminals supplying the gingiva originate from parent axons which have collaterals that innervate the canine tooth pulp. [ABSTRACT FROM AUTHOR]

Dynamic changes of pulpal blood flow (PBF) and gingival blood flow (GBF) induced by intra-venous injection of two kinds of vasoactive drugs were observed in dogs by means of Laser Doppler Velocimetry. Intra-venous injection of norepinephrine caused PBF to increase, corresponding to the blood pressure (BP) increase, while GBF decreased. Orciprenaline sulfate caused PBF to decrease parallel to the BP decrease, as compared with a GBF increase. The effects of these vasoactive drugs lasted longer on GBF than on PBF and BP. These results indicate that the regulation of bloodflow in the dental pulp is more dependent on systemic blood pressure than on local vasoconstriction or vasodilation. [ABSTRACT FROM AUTHOR]

The purpose of the study was to calibrate the laser Doppler signals with simultaneous measurements made by the H2 gas clearance method in the cat gingiva. Four young adult cats were used, weighing from 2.5 to 4.8 kg for the study. The GBF values measured and those measured by the H2 gas clearance were plotted. The results suggest that stimulation of the ipsilateral cervical sympathetic trunk for 5 mm induced a stable and long-lasting decrease in gingival blood flow (GBF) during stimulation.

This article focuses on a study on the acute response of periodontal ligament blood flow to external force application. For this study ten adult cats were used, each weighing from 2.4 to 4.5 kg. They were anesthetized with an i.m. injection of ketamine hydrochloride, 35 mg/kg initially, and then with an i.v. injection of Nembutal 35 mg/kg, supplemented when necessary with additional doses of 5 mg/kg. The trachea was cannulated, and the blood pressure in the femoral artery was monitored continuously by means of a pressure transducer, and recorded on a polygraph. The animal's head and jaws were fixed by a steel rod secured to the jaws by dental acrylic.

Abstract: Using laser-Doppler flowmetry we investigated whether reflex vasodilator responses would be evoked by the painful stimulation of the trigeminal region in human gingiva. GBF increases were elicited by the painful electrical stimulation to the tooth-pulp or gingiva, in addition to application by capsaicin onto the tongue, without an increase in systemic blood pressure. Thus, the pain of various oral tissues would cause the reflex vasodilatation in human gingiva. [Copyright &y& Elsevier]

Abstract: The activities of the histamine-forming enzyme, histidine decarboxylase (HDC), were measured in the dental pulp, gingiva, ear skin and liver in mice, following an intravenous injection of lipopolysaccharide (LPS). LPS induced a remarkable increase in the HDC activity in the dental pulp and the gingiva. These results suggest that the newly formed histamine produced by the induced HDC could be involved in formation of pulpitis or gingivitis (periodontits). [Copyright &y& Elsevier]

Background: An indicator of successful cryoballoon (CB)-assisted pulmonary vein (PV) isolation is complete PV occlusion. However, CBs may exhibit a weaker freezing effect on the equatorial plane. This study investigates the predictors of failed left superior PV (LSPV) isolation despite complete occlusion with novel CBs., Methods: This retrospective analysis enrolled 300 consecutive patients who underwent first-time ablation with POLARx or POLARxFIT between November 2021 and October 2023. Of the total, complete occlusion of the LSPV was achieved in 200 patients. Patients in whom LSPV isolation was achieved with additional nonocclusive freezing of the LSPV roof due to nonisolation of LSPV despite complete occlusion (Group A) were compared with those in whom isolation was achieved with complete PV occlusion alone (Group B)., Results: Group A had a larger LSPV diameter (21.5 ± 4.6 mm vs. 18.8 ± 3.3 mm, p = 0.052), larger left atrial volume on CT (142.3 ± 47.8 cc vs. 117.8 ± 39.0 cc, p = 0.028), higher nadir temperature (-54.1 ± 5.1°C vs. -60.2 ± 4.4°C, p < 0.001), and smaller northern latitude of the balloon contact site on the LSPV roof side (20.9° ± 3.8° vs. 38.9° ± 6.7°, p < 0.001) compared with Group B. A 27.5° north latitude was observed in most of Group A (sensitivity, 100%; specificity, 96%)., Conclusions: Adequate contact positioning of the northern hemisphere to the LSPV is critical for effective isolation, particularly when isolation is challenging despite complete occlusion. In such cases, nonocclusive cryoablation against the LSPV roof might be effective., (© 2025 Wiley Periodicals LLC.)

Background: The effectiveness of cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to pulmonary vein isolation (PVI) using a novel cryoballoon catheter, POLARx, remains unclear., Methods: This study compared the efficacy of LA roof line ablation and PVI using POLARx (Boston Scientific) or AFA-Pro (Medtronic) in 100 patients with persistent atrial fibrillation. The right superior pulmonary vein (PV) anchoring and raise-up techniques were consistently used for LA roof line ablation, and rapid right ventricular pacing was applied if the cryoballoon temperature did not reach -40°C., Results: Complete conduction block at the LA roof could be obtained in all patients with POLARx and in 98.0% of patients with AFA-Pro. Rapid right ventricular pacing was needed in 64.0% of patients with AFA-Pro and in no patients with POLARx. During LA roof line ablation, the nadir cryoballoon temperature was significantly lower with POLARx than with AFA-Pro (right: -54.2°C ± 4.4°C vs. -46.0°C ± 5.4°C; central: -56.8°C ± 4.4°C vs. -45.7°C ± 4.8°C; left: -56.1°C ± 4.3°C vs. -46.1°C ± 5.7°C), and the cryoballoon temperature reached -40°C earlier with POLARx than with AFA-Pro (right: 30.8 ± 7.4 s vs. 74.1 ± 37.7 s; central: 28.2 ± 5.2 s vs. 62.9 ± 30.9 s; left: 29.8 ± 5.8 s vs. 69.6 ± 40.7 s)., Conclusion: The nadir cryoballoon temperature with POLARx was approximately 10°C lower than with AFA-Pro, consistently dropping below -40°C during LA roof line CBA. Thus, a complete conduction block of the LA roof line can be easily accomplished using right superior PV anchoring and the raise-up techniques without the need for rapid right ventricular pacing with POLARx., (© 2024 Wiley Periodicals LLC.)

Background: Ethanol infusion into the vein of Marshall (EIVOM) has been performed as an adjunctive atrial fibrillation therapy. However, the time course change, quantitative lesion investigation, and effects on epicardial fat pads and fractionated atrial electrograms created by EIVOM have never been investigated., Objective: This study aimed to perform a quantitative analysis of lesions created by EIVOM., Methods: We created voltage maps using a 3-dimensional mapping system immediately before and 30 minutes and 60 minutes after performing EIVOM to study the time course change in the lesions. We compared differences in the average contact force value required for successful conduction block in the Marshall vein area of patients with and without EIVOM. We also investigated effects of EIVOM on the area of complex fractionated atrial electrograms before and after EIVOM. We measured the total epicardial fat pad volume before and after EIVOM by computed tomography., Results: Voltage was significantly reduced after EIVOM, and there were significant differences in voltage reduction between the control status and 30 minutes and 60 minutes after EIVOM (P < .05). The average contact force value was significantly lower with vs without EIVOM (P < .05). The total epicardial fat volume and complex fractionated atrial electrogram area also significantly decreased after EIVOM (P < .05)., Conclusion: EIVOM provided significant therapeutic effects on the left atrial tissue perpetuating atrial fibrillation, which was demonstrated by a quantitative analysis., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Cryoballoon ablation is less operator-dependent than radiofrequency ablation. Recently, size-adjustable cryoballoons (SA-CBs) have become available. We sought to analyze the individual baseline operator experience's impact on procedural results., Methods: This multicenter observational study included atrial fibrillation (AF) patients who underwent pulmonary vein (PV) isolation using SA-CBs capable of 28-mm or 31-mm balloon sizes. Experienced (E-group) or less experienced (LE-group) operators were defined as experiencing > 100 or ≤ 100 cryoballoon procedures, respectively., Results: Among 510 patients (67 ± 11 years, 355 men, 325 paroxysmal AF [PAF]) who underwent an SA-CB ablation, 240 and 270 were in the E-group and LE-group, respectively. All cryoballoon parameters were similar between the groups, except for a significantly higher 31-mm balloon isolation rate in the E-group than LE-group, especially for right superior PVs. Cryoballoon-related phrenic nerve injury occurred in 34 (6.7%) patients and tended to be higher in the LE-group than E-group (8.1% vs. 5.0%, p = 0.16). The AF freedom was comparable between the groups for both PAF and non-PAF patients. A total of 36(7.1%) patients underwent re-do procedures at 5.2 ± 2.6 months post-index procedure. The PV reconnection rate was significantly higher in the LE-group than E-group (27.1% vs. 8.9%, p < 0.01), and this trend was more pronounced for right PVs than left PVs., Conclusions: In AF ablation using SA-CBs, the overall procedural efficacy and safety were comparable between the E-group and LE-group. However, 100 CB procedures seemed to still be in the middle of a learning curve for selecting the balloon size and balloon position, especially for right PVs., (© 2024 Wiley Periodicals LLC.)

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., Methods and Results: In 21 patients undergoing catheter ablation for atrial fibrillation, left atrial (LA) substrate maps using an HD-grid catheter were performed during SR, and pacing from the sinus-node region with cycle lengths (CLs) of 300 ms (SN-P300) and 600 ms (SN-P600). Mapping time, omnipolar voltage, peak-frequency of electrograms, and global LA activation time were compared among the three maps. The SR-map more frequently required automap-setting changes (p < 0.01), and one SR-map was not completed due to CL-fluctuation. Compared to SR, mapping time significantly decreased (833 [702-1097] seconds for SR vs. 615 [530-700] seconds for SN-P600 and 463 [404-542] seconds for SN-P300, p < 0.01). Mean voltage and peak-frequency of electrograms significantly decreased in SN-P600 and SN-P300 (mean voltage: 2.5 [2.1-3.2] mV for SR vs. 2.3 [2.1-2.8] mV for SN-P600 and 2.2 [2.0-2.7] mV for SN-P300, p < 0.01; mean peak-frequency: 308 [299-325] Hz for SR vs. 303 [288-314] Hz for SN-P600 and 281 [258-295] Hz for SN-P300, p < 0.01). The wavefront collision site shifted in 3/20 (15%) between SR and SN-P600, remaing within 30° along the mitral annulus, but this shift reached 9/20 (45%) between SR and SN-P300, including one patient showing a shift up to 60°., Conclusion: SN-P maps provide faster, higher-resolution substrate maps, but the amplitude and frequency of electrograms may be reduced as the CL shortens. Maps with SN-P600 may be acceptable, maintaining electrophysiological information in SR., (© 2024 Wiley Periodicals LLC.)

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., Methods: This study included 350 consecutive patients who underwent initial AF ablation (53.7 % paroxysmal AF (PAF)). Preoperative multidetector row computed tomography assessed LA-EAT, categorized into three segments: anterior-EAT, posterior-EAT, and interatrial septal adipose tissue (IAS-AT)., Results: During a mean follow-up period of 351 ± 109 days, 56 patients (16.0 %) experienced AF/AT recurrence. The mean LA-EAT volume was 20.7 ± 11.1 ml and LA-EAT ≥26.8 ml was an independent risk factor for AF/AT recurrence (HR 2.21, 95 % confidence interval (CI): 1.24-3.93, P = 0.007). Receiver operating characteristic analyses revealed the area under the curve for IAS-AT was 0.669 (95 % CI: 0.596-0.743) with an optimal cut-off point of 1.3 ml (sensitivity 76.8 %; specificity 50.0 %), significantly outperforming the anterior- and posterior-EAT in predicting recurrent AF/AT. Multivariate analysis indicated IAS-AT was an independent predictor of AF/AT recurrence in patients with persistent AF (PeAF) (HR 3.52, 95 % CI: 1.52-8.13, P = 0.003), but not in patients with PAF., Conclusions: LA-EAT predicts AF/AT recurrence after AF ablation, with IAS-AT proving significantly more effective than other LA-EAT segments in predicting recurrence. Notably, IAS-AT emerged as an independent predictor of AF/AT recurrence in patients with PeAF but not in those with PAF., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

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., Methods: We retrospectively investigated 204 left anterior descending artery (LAD) territories in CCS. All patients underwent physiological assessment using a pressure-temperature wire and S-TDE before elective fractional flow reserve (FFR)-guided percutaneous coronary intervention. The concordance rate was evaluated using κ values., Results: In the final analysis, the median age was 72 years, and 72.5% of patients were male. The median FFR value was 0.69. MRR S-TDE and MRR B-Thermo were similar (3.41 vs. 3.48, P=0.877), whereas only a weak, albeit significant relationship was observed between these two metrics (r=0.167, P=0.017). CMD was diagnosed in 20.6% and 32.8% of patients using S-TDE and B-Thermo, respectively, when a cutoff MRR value of 2.7 was applied. The concordance rate of CMD diagnosis between the two methods was low (κ=0.079)., Conclusions: MRR S-TDE and MRR B-Thermo showed a very weak correlation in the LAD territory with functionally significant stenosis in patients with CCS. The prevalence of CMD diagnosed using MRR S-TDE and MRR B-Thermo was not comparable, and the diagnostic concordance of CMD using these two methods was very low., (Copyright © 2024 Hellenic Society of Cardiology. Publishing services by Elsevier Inc. All rights reserved.)

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, 27.2% female). Study cohort was historically divided into three groups: MPLD (30-35 W for up to 30 s) using TactiCath (TC-MPLD, N = 38) and MPLD and HPSD (50 W for 12 s) using TactiFlex (TF-MPLD, N = 23; TF-HPSD, N = 52). Primary endpoint was first-pass bidirectional isthmus block (BIB). Study 2: lesion geometries created by each ablation strategy were compared using an ex-vivo model., Results: Study 1: TF-HPSD ablation strategy demonstrated a higher success rate of first-pass BIB than MPLD protocol (TC-MPLD, 58%; TF-MPLD, 48%; TF-HPSD, 94%, p < 0.001), without any complications. TF-HPSD group was associated with shorter total procedure and RF application times, as well as fewer ablation points and gaps, compared to the MPLD groups. Study 2: TF-HPSD created greater lesion surface length, width, and area than MPLD strategies., Conclusion: HPSD CTI-Abl performed by EP trainees using TactiFlex SE catheter demonstrated a higher first-pass BIB rate, shorter total procedure and RF application times, and fewer ablation points and gaps compared to the conventional method, without increasing complication rates., (© 2024 Wiley Periodicals LLC.)