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Implantations of leadless pacemakers in the septum lower the risk of cardiac perforation. However, the relationship between the implantation site and the success rate, complication rate, and pacemaker parameters are not well-investigated.Patients who underwent leadless pacemaker implantation with postprocedural computed tomography (CT) between September 2017 and November 2020 were analyzed. Septum was targeted with fluoroscopic guidance with contrast injection. We divided patients into two groups based on the implantation site confirmed by CT: septal and non-septal, which included the anterior/posterior edge of the septum and free wall. We compared the complication rates and pacemaker parameters between the two groups.A total of 67 patients underwent CT after the procedure; among them, 28 were included in the septal group and 39 were included in the non-septal group. The non-septal group had significantly higher R wave amplitudes (6.5 ± 3.3 vs. 9.7 ± 3.9 mV, p = .001), lower pacing threshold (1.0 ± 0.94 vs. 0.63 ± 0.45 V/0.24 ms, p = .02), and higher pacing impedance (615 ± 114.1 vs. 712.8 ± 181.3 ohms, p = .014) after the procedure compared to the septal group. Cardiac injuries were observed in four patients (one cardiac tamponade, one possible apical hematoma, two asymptomatic pericardial effusion), which were only observed in the non-septal group.Leadless pacemaker implantation may be technically challenging with substantial number of patients with non-septal implantation when assessed by CT. Septal implantation may have a lower risk of cardiac injury but may lead to inferior pacemaker parameters than non-septal implantation.

Background Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear. Aim We sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV). Methods We retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia‐induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary. Results PSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03‐0.06) vs AVRT: 0.03 (0.02‐0.06) vs AT: 0.06 (0.03‐0.12) mg/h, P = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long‐term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation. Conclusions Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long‐term outcome. PSVT remains inducible if ISP is used., Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long‐term outcome. PSVT remains inducible if ISP is used.

Background Venous bleeding complication is often observed after catheter ablation of atrial fibrillation (AF), but the risk factors remain unclear. Methods We retrospectively evaluated 570 consecutive patients who underwent catheter ablation of AF from April 2012 to March 2017. After the procedure, the sheaths were removed, and hemostasis was obtained by manual compression followed by application of rolled gauze with elastic bandage and continuous pressure to the puncture site. We evaluated the risk factors for venous bleeding complications defined as hemorrhage from the puncture site that needed recompression after removal of the elastic bandage and rolled gauze. Results After excluding 11 patients because of missing data, 559 patients (395 [70.7%] men, mean age: 65.6 ± 8.7 years) were included for analysis. Venous bleeding complication was observed in 213 patients (38.1%). In the multivariate logistic regression analysis, low body mass index (BMI; odds ratio [OR] 0.95, 95% CI 0.90‐1.00, P = .04), short compression time (OR 0.77, 95% CI 0.68‐0.88, P, We retrospectively evaluated 570 consecutive patients who underwent catheter ablation of atrial fibrillation. The risk factors for venous bleeding complications were analyzed. Low BMI, short compression time, and antiplatelet therapy were found to be the significant risk factors.

Background and aims Although 18F-fluorodeoxyglucose (FDG) uptake has emerged as a sensitive and reliable marker of atherosclerotic inflammation, its additive predictive value for future coronary disease in older subjects is unknown. The aim of this study was to test the prognostic value of aortic inflammation detected via FDG-positron emission tomography (PET)-computed tomography (CT) in older subjects. Methods We retrospectively utilized the records of 309 subjects aged over 65 years, without a history of coronary artery disease, who underwent 18F-FDG-PET-CT mostly due to the clinical suspicion of cancer, but eventually turned out to be cancer-free. Target-to-background ratio (TBR) was calculated at the ascending aorta. The endpoint was occurrence of coronary heart disease (CHD) events. Results During a median follow-up of 3.9 years, 28 subjects experienced CHD events and 12 patients died due to non-CHD causes. The highest TBR tertile was associated with a high CHD event rate, accounting for death due to non-CHD causes as a competing risk (Gray test, p = 0.005). In a Fine and Gray competing risk proportional hazard regression model, TBR was associated with significantly high CHD events independently of FRS, with a hazard ratio (HR) of 1.19 per 0.1 TBR increase (p Conclusions In older subjects with no history of malignant disease or overt coronary artery disease, arterial inflammation evaluated by FDG uptake provides information on future occurrence of coronary artery events.

The acetylcholine (ACh) provocation test (ACh-test) is used for the diagnosis of vasospastic angina (VSA). However, subjects often show a moderate spasm (MS) response for which diagnosis of VSA is not definitive, and the clinical significance of this response is unknown. We assessed moderate coronary vasomotor response to the ACh test as an indicator of long-term prognosis. A total of 298 consecutive patients who underwent the ACh test for suspected VSA were retrospectively investigated. Coronary spasm severity after intracoronary administration of isosorbide dinitrate was evaluated by measuring epicardial coronary artery diameter reduction after ACh injection. Patients were divided into three groups according to the diameter reduction during the ACh test: severe spasm (SS) showing ≥75 % diameter reduction, MS showing ≥50 % diameter reduction, and others (N). In Kaplan-Meier analysis, the major adverse cardiac event (MACE) rates with a median follow-up of 4.6 years were significantly worse in SS (11.1 %) and MS (8.5 %) than N (1.9 %), (SS vs N; P = 0.009, MS vs N; P = 0.029). Significant difference in MACE rates was not observed between SS and MS (P = 0.534). Cox regression analysis revealed that MS remained an independent predictor of MACE after adjustment for other confounders (HR: 7.18, 95 % CI 1.42-36.4, P = 0.017). Patients with MS by ACh test had a cardiac event rate comparable with that of patients with SS and significantly worse than that of patients with normal vasomotor responses.

A 26-year-old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RAA resection, which terminated the tachycardia and improved the cardiac function. Histological examination of resected RAA provided insights into mechanism of resistance to catheter ablation.

AlthoughWe retrospectively utilized the records of 309 subjects aged over 65 years, without a history of coronary artery disease, who underwentDuring a median follow-up of 3.9 years, 28 subjects experienced CHD events and 12 patients died due to non-CHD causes. The highest TBR tertile was associated with a high CHD event rate, accounting for death due to non-CHD causes as a competing risk (Gray test, p = 0.005). In a Fine and Gray competing risk proportional hazard regression model, TBR was associated with significantly high CHD events independently of FRS, with a hazard ratio (HR) of 1.19 per 0.1 TBR increase (p 0.001). Likewise, a significant increase in the area under the curve (from 0.57 to 0.73, p = 0.028) and a significant improvement in net reclassification (0.42, p = 0.038) were observed when TBR was added to the model with FRS alone.In older subjects with no history of malignant disease or overt coronary artery disease, arterial inflammation evaluated by FDG uptake provides information on future occurrence of coronary artery events.