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Background: The anatomical approach for the management of para-Hisian ventricular arrhythmias (VAs) with QRS morphological changes after catheter ablation (CA) has not been well investigated., Objective: We aimed to evaluate the electrocardiographic and electrophysiological findings and ablation outcomes of para-Hisian VAs with QRS morphological changes after CA., Methods: Of the 30 patients who underwent CA for para-Hisian VAs at 4 institutions, 10 (33%) had QRS morphological changes after ablation. All 10 patients underwent an anatomical approach, targeting the site anatomically opposite to the site where the QRS morphology had been changed by ablation. We investigated the safety and efficacy of the anatomical approach., Results: Of the 10 patients evaluated, the approach was switched from the right ventricular septum to the left ventricular septum/aortic root in 7 (70%) (RL group) whereas 3 (30%) underwent left-to-right switches (LR group). After CA, the precordial transition zone tended to be earlier in the RL group and later in the LR group. In the RL group, successful VA suppression was achieved, despite suboptimal pace map concordance from the left side or a relatively delayed earliest activation time. Of the 10 patients who underwent an anatomical approach, 8 (80%) had procedural success, and ablation was discontinued in 1 (10%) because of the risk of atrioventricular block., Conclusion: The anatomical approach showed promising results regarding safety and efficacy. Therefore, it should be considered when QRS morphological changes are observed during or after CA of para-Hisian VAs., 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 and Aims: Elevated pentraxin-3 (PTX3) values are associated with vulnerable plaque existence and poor outcomes in acute coronary syndrome patients. The clinical significance of PTX3 values in stable angina pectoris (SAP) patients is, however, undetermined. We investigated the relationship of systemic PTX3 values and coronary plaque components and post-percutaneous coronary intervention (PCI) outcomes in SAP patients., Methods: We included 93 consecutive de-novo lesions in 93 SAP patients with a normal pre-PCI high-sensitivity cardiac troponin-T (<0.014 ng/mL), undergoing pre- and post-PCI optical coherence tomography (OCT). Systemic PTX3 values were obtained immediately pre- and post-PCI, at 24-h and 9-month post-PCI., Results: Peak post-PCI PTX3 values correlated with thinnest fibrous cap thickness (r = -0.23, p = 0.03) and lipid length (r = 0.24, p = 0.03), and were higher in patients with lesions having OCT-derived thin-cap fibroatheroma (6.67 (3.19-7.33) vs. 3.13 (2.34-4.11) ng/mL, p = 0.04) and post-stenting irregular tissue protrusion (4.76 (3.31-6.80) vs. 2.98 (2.23-4.06) ng/mL, p = 0.003) than in those without. At 9-month follow-up, cardiac event-free survival was poorer in patients with a peak post-PCI PTX3 value ≥ 4.08 ng/mL (upper tertile) (log-rank test χ 2  = 9.0; p = 0.003). Multivariate Cox regression analysis showed a peak post-PCI PTX3 value ≥ 4.08 ng/mL as an independent predictor of MACE (hazard ratio, 3.915; 95% CI, 1.129-13.583; p = 0.03)., Conclusions: Peak post-PCI PTX3 values correlated with pre-PCI plaque characteristics and post-PCI outcomes, providing a good prognostic factor of outcomes in SAP patients undergoing elective PCI., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Malnutrition is associated with a poor prognosis in heart failure, angina pectoris, and peripheral artery disease. However, the clinical importance of the preprocedural nutrition status of patients requiring pacemaker implantation (PMI) for bradycardia is unclear., Methods: We retrospectively enrolled 521 patients (median 79 years) who underwent their first PMI between January 1, 2012 and June 30, 2017. The nutrition status before implantation was assessed by the geriatric nutritional risk index (GNRI). The association between the preprocedural GNRI-based nutritional status and all-cause mortality was investigated., Results: GNRI-based high (GNRI <82) and moderate (GNRI 82 to <92) malnutrition status were found in 9.2% and 34.0%, respectively. During a median follow-up of 1178 days, 71 patients died. The mortality rate, which was analyzed using survival curves, was significantly stratified by the GNRI-based malnutrition status [high: 52.0% (25/48), moderate: 16.9% (30/177), low: 5.4% (16/296), p<0.001). On a multivariate Cox-proportional hazard analysis, GNRI-based high malnutrition status independently predicted all-cause death (hazard ratio: 4.49, 95% confidence interval: 2.59-7.80, p<0.001). A sensitivity analysis based on the controlling nutritional status score showed consistent results. On a receiver operating characteristic curve analysis, GNRI had a high predictive value for all-cause mortality (area under the curve, 0.78, 95% confidence interval: 0.72-0.84, p<0.001)., Conclusions: Preprocedural malnutrition was significantly associated with poor outcomes of patients who underwent PMI. Assessing the nutritional status in advance is important for risk stratification, and improving the nutritional status may be an option for managing these patients., (Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Echo-attenuated plaque (EA) on intravascular ultrasound (IVUS) is related to poor outcomes after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. However, the clinical significance of EA in stable angina pectoris (SAP) patients compared with that in ACS patients remains unclear. We assessed the relationships between EA and unstable plaque characteristics in patients with ACS and SAP., Methods: We investigated 609 coronary lesions in 609 patients (234 with ACS; 375 with SAP) undergoing pre-intervention IVUS and optical coherence tomography (OCT). The differences in plaque morphology and post-PCI outcomes were assessed according to the clinical status of ACS or SAP and the presence or absence of EA., Results: EA was more frequent in patients with ACS than in those with SAP (44.0% vs. 25.1%, p < 0.001). SAP-EA lesions showed thicker fibrous cap (157 ± 97 μm vs. 100 ± 58 μm, p < 0.001), smaller lipid arc (208 ± 76° vs. 266 ± 99°, p < 0.001), smaller plaque burden (83.0 ± 6.1% vs. 86.5 ± 4.1%, p < 0.001), and lower frequency of transient slow-reflow phenomenon during PCI (21.3% vs. 51.5%, p < 0.001) than ACS-EA lesions, but similar plaque vulnerability compared with ACS-non-EA lesions. SAP-EA lesions had less frequent OCT-thrombus than ACS-non-EA lesions (20.2% vs. 71.2%, p < 0.001)., Conclusions: SAP-EA lesions had less plaque vulnerability than ACS-EA lesions, but were comparable to ACS-non-EA lesions. Less frequent thrombus formation might differentiate SAP-EA lesions from ACS-non-EA lesions. A combined IVUS and OCT approach might be useful to assess plaque vulnerability in SAP-EA lesions compared with ACS lesions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The clinical significance of the extent of tissue prolapse (TP) after percutaneous coronary intervention (PCI) for long-term outcomes remains undetermined. This study investigated the relationship between the quantities of TP immediately after PCI and neointimal hyperplasia (NIH) at follow-up on serial optical coherence tomography (OCT) examination., Methods: We evaluated 145 native coronary lesions (89 lesions with stable angina pectoris [SAP] and 56 with acute coronary syndrome [ACS]). OCT was performed to examine pre-PCI plaque morphologies at the narrowest culprit sites, post-PCI TP area in each cross-sectional area (CSA) and TP volume throughout the stented segments, 9-month follow-up NIH area in each CSA and NIH volume throughout the stented segments. We investigated the relationships between the quantities of TP and NIH and their differences according to clinical presentation., Results: ACS lesions had a larger TP area at the narrowest culprit sites (0.39 [0.14-0.85] vs. 0.11 [0.00-0.32] mm 2 , P<0.001) and at the most protruding sites (0.51 [0.24-1.08] vs. 0.21 [0.10-0.52] mm 2 , P<0.001) compared with SAP lesions. In ACS lesions, TP area was correlated with NIH area at the culprit sites (r=0.283, P=0.042) and at the most protruding sites (r=0.288, P=0.038). In SAP lesions, TP area was correlated with NIH area at the most protruding sites (r=0.244, P=0.030), but not at the culprit sites., Conclusions: The extent of TP immediately after PCI was quantitatively related to the degree of NIH at 9-month follow-up on serial OCT examination. The quantities of TP might influence long-term stent outcomes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The EPA/AA ratio has emerged as a predictor of mortality endpoints in cardiac disease; however, its prognostic value in peripheral artery disease (PAD) patients is unclear. We assessed the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio in patients with PAD caused by femoropopliteal artery lesions, to determine whether it predicts clinical outcomes after endovascular therapy (EVT)., Methods and Results: We obtained serum EPA/AA ratios from 132 consecutive patients with PAD caused by femoropopliteal artery lesions before EVT. Patients were divided into two groups using the median value of serum EPA/AA ratios of the entire cohort; LOW group with the levels ≤0.30 (n = 66) and HIGH group >0.30 (n = 66). The incidence of major adverse events (MAE), including major adverse limb events (MALE) and death from any cause, was determined. At a median follow-up interval of 24 months, MALE occurred in 40 patients (30.3%) and 11 patients (8.3%) died. Kaplan-Meier curve analysis demonstrated the survival probability from MAE was significantly worse in patients with EPA/AA ratio under the median (long-rank test χ(2) = 16.4; p < 0.001). Multivariate Cox regression analysis showed critical limb ischemia (hazard ratio [HR]: 3.44; 95% confidence interval [CI]: 1.84 to 6.46; p < 0.001) and the preprocedural serum EPA/AA ratios ≤0.30 (HR: 2.74; 95% CI: 1.33 to 5.65; p = 0.006) independently predicted MAE after EVT., Conclusions: Lower serum EPA/AA ratios appear to be associated with a greater risk of MALE and death from any cause after EVT in patients with PAD caused by femoropopliteal artery lesions., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)