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Background Fever is associated with the manifestation of Brugada phenotype and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). The thermal effect on the pathogenesis of functional substrates in BrS remains unknown. Objective This study aimed to elucidate the thermal effect on BrS phenotype, VT/VF, and electrophysiological characteristics of epicardial functional substrates in BrS. Methods We consecutively studied 15 patients with BrS receiving radiofrequency catheter ablation for drug-refractory ventricular tachyarrhythmias. Baseline characteristics, electrocardiographic features, and changes in epicardial functional substrates before and after epicardial warm water instillation (n = 6) were recorded and analyzed. Results A total of 15 male patients (mean age 41.3 ± 10.3 years) with type 1 BrS presenting with ventricular tachyarrhythmias were consecutively enrolled. Epicardial mapping in 11 patients demonstrated a significantly larger epicardial scar/low-voltage zone (LVZ) area within the right ventricular outflow tract and anterior right ventricular free wall than within the endocardium (6.32 ± 12.74 cm2 vs 52.91 ± 45.25 cm2; P = .007). Epicardial warm water instillation in 6 patients led to a significant enlargement of the functional scar/LVZ area (123.83 ± 35.26 cm2 vs 63.53 ± 40.57 cm2; P = .03), accelerated conduction velocity of the endocardium and epicardium without scar/LVZ area, and increased VT/VF inducibility (16.7% vs 100%; P = .02). Ablation by targeting premature ventricular complexes and/or epicardial abnormal substrates rendered noninducibility of VT/VF and prevented the recurrences of VT/VF. Conclusion Epicardial warm water instillation enhanced functional epicardial substrates, which contributed to the increased inducibility of ventricular tachyarrhythmias in BrS. Ablation by targeting the triggers and abnormal epicardial substrates provided an effective strategy for preventing ventricular tachyarrhythmia recurrences in BrS.

This paper reports on transient dynamics of electrospray driven by high step voltage and its dependence on voltage rise time. Three rise times (50 ns, 1.8 μs, and 400 μs) were used to compare influence on liquid dynamics. It was found that, when the applied voltage exceeds a certain level, minute differences in voltage rise time significantly affect jet formation time. A rise time of 50 ns accelerates the jet ejection by about 20% compared with other rise times. These results indicate that optimization of rise time may enable drastic improvement of controllability of drop-on-demand electrospray.

In-stent restenosis after drug-eluting stent implantation (DES-ISR) in the left main coronary artery remains challenging to manage. Our aim was to assess the effectiveness of paclitaxel-coated balloon angioplasty for DES-ISR in the left main coronary artery. We identified 91 DES-ISR lesions in the

Catheter ablation of the right bundle branch was performed on an 11-month-old infant for the treatment of drug-resistant bundle branch reentrant ventricular tachycardia. The occurrence of right bundle branch block could not be used as an endpoint of treatment because the patient had presented with incomplete right bundle branch block pattern during sinus rhythm. We performed ablation of the right bundle branch and utilized changes of duration and morphology of the QRS complex as indicators. Eight years have passed with no development of any atrioventricular block or tachycardia episode.

Impact of direct oral anticoagulants (DOAC) on frail and non-frail patients with atrial fibrillation (AF), in comparison with that of warfarin is unknown. We enrolled 1209 consecutive AF patients between January 2013 and December 2015. Of whom, 486 elderly patients, including 436 patients receiving

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug-resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III-IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re-operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course.

Recently a considerable number of patients have Non-vitamin K antagonist oral anticoagulant (NOAC) for Atrial fibrillation (AF). Some AF patients have NOAC concurrent antiplatelet therapy for atherosclerosis. However there are few reports about bleeding events among NOAC patients with concurrent