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The purpose of this study was to investigate the predictor of long-term outcomes in patients after stent implantation for unprotected left main coronary artery (LMCA) disease. Coronary stenting has recently been advocated as an alternative procedure for LMCA disease. Information on the predictors of long-term outcomes in patients after stent implantation for unprotected LMCA disease is not clear. Seventy six patients (51 men and 25 women, age 68 ± 10 years) with medically refractory angina received coronary stenting for unprotected LMCA disease. During a follow-up period of 40 ± 26 months, 7 patients (9%) died because of cardiovascular disease in 5 (7%) and noncardiovascular disease in 2 (3%). In the other 69 patients, 19 patients (25%) needed repeated percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). In a univariate analysis, only female sex was related to the repeated PCI and/or CABG ( P = 0.04). A history of cerebral vascular attack (CVA) ( P = 0.005), anemia ( P = 0.03) and lower left ventricular ejection fraction (LVEF) ( P = 0.008) were related to the cardiovascular mortality. A history of myocardial infarction ( P = 0.03), a history of CVA ( P = 0.02), anemia ( P = 0.02), and lower LVEF ( P = 0.002) were related to the total mortality. In a multivariate analysis, female sex ( P = 0.007; odds ratio 5.29, 95% confidence interval [CI] 1.57–17.80) and young age ( P = 0.025; odds ratio 3.92, 95% CI 1.19–12.98) could predict the repeated PCI and/or CABG. Only a history of CVA could predict the cardiovascular mortality ( P = 0.027; odds ratio 34.18, 95% CI 1.49–783) and only lower LVEF could predict the total mortality ( P = 0.027; odds ratio 13.26, 95% CI 1.34–131). Female sex and young age could predict the repeated PCI and/or CABG in patients after stent implantation for unprotected LMCA disease. Furthermore, a history of CVA could predict the cardiovascular mortality and lower LVEF could predict the total mortality. [ABSTRACT FROM AUTHOR]

Objective We studied the response of the superior vena cava (SVC) myocardial sleeve to atrial fibrillation (AF). Methods and results We examined adult male dogs without pacing (N=6) and after rapid atrial pacing (600 bpm) for 2 weeks (P2w; N=5) and 6-8 weeks (P6-8w; N=5). After pacing, the sleeve was increased in thickness (non-paced vs. either paced group, both P<0.05). This was associated with an increase in proliferative activity, which was higher in the P2w than the P6-8w animals (P < 0.05). In addition, collagen content increased, and the component cardiomyocytes become more unevenly oriented and shorter and narrower in shape (non-paced vs. either paced group, both P < 0.05). Pacing had different effects on connexin40 (Cx40) and Cx43 gap junctions. There was a 98% increase in Cx43 signal in P2w, and a 74% increase in P6-8w animals (non-paced vs. each paced group, both P < 0.05). In contrast, Cx40 signal decreased 47% in P2w but increased 44% in P6-8w animals (nonpaced vs. each paced group, both P < 0.05). Conclusions Rapid atrial pacing results in a specific pattern of remodeling of the canine SVC sleeve, including changes in size and shape, spatial orientation, and gap junction expression profile of the component cardiomyocytes. These changes may co-operatively affect the electrical properties and contribute to the formation and maintenance of the arrhythmogenic substrate of AF [ABSTRACT FROM AUTHOR]

Background The superior vena cava (SVC) might serve as the trigger and/or substrate for paroxysmal atrial fibrillation (AF). However, the electrophysiological properties of the SVC with chronic AF are unknown. The purposes of this study were to investigate the electrophysiological properties of the SVC and the electropharmacological effects of intravenous dl-sotalol on the canine SVC after chronic rapid atrial pacing (RAP). Methods and results In the control group, the effective refractory period (ERP), conduction velocity, and AF inducibility of the SVC were assessed in 6 normal dogs before and after an infusion of dl-sotalol. In the experimental group, the ERP, conduction velocity, and AF inducibility of the SVC were assessed before and after dl-sotalol administration in 10 dogs after 8 weeks of RAP. The SVC showed a shorter ERP, decreased slope of rate-adaptation of the ERP, increased ERP dispersion, a decreased conduction velocity, and increased inducibility and duration of AF initiated from the SVC in the RAP dogs. In the RAP dogs, intravenous dl-sotalol significantly increased the ERP, but dlsotalol did not change the slope of rate-adaptation of the ERP, dispersion of the ERP, conduction velocity, inducibility, or duration of AF initiated from the SVC. Conclusions The present study demonstrates that the canine SVC shows significant electrical remodeling and increased AF vulnerability after chronic RAP. Intravenous dl-sotalol was unable to decrease the inducibility or duration of AF initiated from the SVC. [ABSTRACT FROM AUTHOR]

Introduction: The outcome of patients with early recurrence of atrial fibrillation (AF) (within one month) after ablation procedure is controversial. Furthermore, the predictors of early and late (up to mean follow-up 30 months) recurrence of AF are not investigated in depth.Aims of the Study: The aim of the present study was to investigate the predictors of early and late recurrence of AF after catheter ablation of arrhythmogenic foci initiating AF in patients with paroxysmal AF.Methods and Results: The study included 207 patients (155 men; mean age 62 ± 13 years) who received catheter ablation of paroxysmal AF. Eighty-one (39%) patients had early recurrence of AF. Five clinical variables were related to the early recurrence of AF: (1) old age (≥65 years) (P = 0.004); (2) presence of associated cardiovascular disease (P = 0.01); (3) presence of multiple AF foci (P = 0.004); (4) presence of AF foci from left atrial free wall (P = 0.039); (5) left atrial enlargement (P = 0.038). Multivariate analysis demonstrated that presence of multiple AF foci could predict early recurrence of AF (P = 0.013; ratio = 2.24; 95% CI 1.18 to 4.25). During the follow-up period (30 ± 11 months), 70 (34%) patients had late recurrence of AF, and two clinical variables were related to the late recurrence of AF: (1) presence of early recurrence of AF (P = 0.025); (2) presence of multiple AF foci (P = 0.034). Multivariate analysis found that presence of early recurrence of AF could predict late recurrence of AF (P = 0.046; hazard ratio = 1.62; 95% CI 1.01 to 2.59). Late recurrence of AF happened in 35 (43%) of the 81 patients with early recurrence of AF, and in 35 (28%) of the 126 patients without early recurrence of AF.Conclusions: Early AF recurrence could predict late AF recurrence. [ABSTRACT FROM AUTHOR]