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Very late recurrence of atrial fibrillation (VLRAF) occurring1 year after catheter ablation may influence long-term follow-up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation. The purpose of this study was to investigate the impact of LVAs on VLRAF.This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak-to-peak voltages of0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1-year follow-up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3-12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year.A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow-up of 25 (19, 37) months, VLRAF more than 1 year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan-Meier analysis showed that the AF-free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1-year follow-up (p .001). An additional Kaplan-Meier analysis of the incidence of VLRAF in propensity score-matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs (p = .003).LVAs during the initial AF ablation procedures have an impact on VLRAF occurrence.

Introduction: Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods: We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent atrial fibrillation, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of

Background Pulmonary vein isolation (PVI) with a cryoballoon usually uses iodinated contrast medium for confirmation of venous occlusion. We hypothesized that an alternative to angiography with iodinated contrast, saline bolus-enhanced echocardiography with the microbubbles formed in situ, could be used to assess venous occlusion. We sought to assess the efficacy and safety of the contrast-enhanced intracardiac echocardiographic (ICE) approach. Methods Thirty-four consecutive patients without iodine sensitivity or renal insufficiency were studied to assess the accuracy of ICE-guided PV occlusion underwent both angiographic guidance and ICE guidance (validation group). Twenty consecutive patients with paroxysmal atrial fibrillation (AF) and contraindications to iodinated contrast medium (ICE-guided group) underwent PV occlusion and ablation with ICE guidance alone. Procedural results and clinical outcomes were compared with those of 245 control patients undergoing PVI by the conventional angiographic method (control group). Results In the validation group, ICE-guided PV occlusion was as effective as angiography-guided PV occlusion. In the ICE-guided group, two patients required touch-up ablation using a radiofrequency ablation catheter with fluoroscopic guidance. Procedure time, radiation exposure, and requirements for touch-up ablation were similar between the ICE-guided group and the control group. In patients requiring only PVI, the ICE-guided approach involved significantly less radiation exposure than the conventional approach. There was no significant difference in atrial fibrillation (AF)-free survival rate between the two groups during a follow-up period of 14 ± 6 months. Conclusions An echo-guided approach using saline infusion was effective in terms of avoidance of iodinated contrast use and radiation exposure.

Although the global vascular guidelines recently proposed the Global Limb Anatomic Staging System (GLASS) as an anatomical classification for chronic limb-threatening ischaemia (CLTI), prediction of perioperative outcomes using the GLASS classification in patients with CLTI due to isolated below-the-knee (BTK) lesions has not been well studied.This retrospective study included 585 patients with CLTI due to isolated BTK lesions who underwent endovascular therapy (EVT). The severity of arterial lesions was graded using the GLASS infrapopliteal (IP) and inframalleolar (IM) classifications and defined as follows: non-severe IP, 0-3; severe IP, 4; non-severe IM, P0-1; and severe IM, P2. The outcome measures were technical failure, defined as recanalisation failure of the target artery path, and perioperative failure, defined as a composite of all-cause death, major amputation, or repeat revascularisation within 30 days.Technical and perioperative failures occurred in 9.4% (n = 55) and 9.9% (n = 58) patients, respectively. Compared to patients with non-severe IP and IM, those with both severe IP and IM were significantly associated with technical and perioperative failures (odds ratio [OR]: 13.87 [95% confidence interval (CI) 4.69-41.02, P 0.001] and OR: 2.18 [95% CI 1.08-4.38, P = 0.041], respectively).The GLASS classification may have predictive value for technical and perioperative failure in patients with CLTI due to isolated BTK lesions after EVT.

A recently introduced grid mapping catheter (GMC) is designed for better electrode-tissue contact and can collect bipolar signals both along and across the splines, which may allow more efficient voltage map generation independent of propagation direction. We compared the GMC with a conventional circular mapping catheter (CMC) for left atrial (LA) voltage mapping.This study included 20 consecutive patients undergoing repeat ablation for recurrent atrial fibrillation who had demonstrated LA low-voltage areas (LVAs,0.10 mV). Following pulmonary vein isolation, LA voltage mapping was performed twice, once using the GMC and once using the CMC.Voltage mapping was more efficient using the GMC than the CMC in terms of mapping time (459 [404, 543] vs 602 [496, 814] seconds; P = .014) and the number of mapping points (2446 [2099, 3104] vs 1841 [1494, 2314]; P = .002). The incidence of catheter-induced ectopies was lower (44 [28, 62] vs 114 [74, 188]; P .0001) using the GMC. The GMC utilizing all bipoles detected LVAs in 85% of patients with LVAs detected by CMC. LVA measurements were significantly smaller on maps generated by the GMC using bipoles along or across the splines than those measured with the CMC (11.1 [4.6, 17.2] or 9.7 [2.5, 16.0] vs 16.4 [6.8, 26.8] cmThe GMC allowed a more efficient mapping procedure and enabled more selective identification of LVAs with smaller LVA size.

A 55-year-old male with stable angina pectoris was referred to our hospital. Coronary angiography showed severe stenosis from the proximal to the middle part of the left circumflex artery (LCX). Based on the severity of lesion calcification, we performed percutaneous coronary intervention with rotational atherectomy. After crossing a 0.014-inch guidewire, we replaced it with a rotawire using a microcatheter. Following the retrieval of the microcatheter, we noted that a radiopaque tip of the microcatheter had been detached at the site of severe stenosis in the proximal part of the LCX. We advanced a guide-extension catheter to this site and wedged the detached tip using a balloon catheter (2.0-mm diameter; 12-mm length) in the guide-extension catheter. The detached tip was successfully retrieved along with the guide-extension catheter. After passing two guidewires into the main vessel and the side branch, we dilated the lesion using a 2.5-mm non-compliant balloon. Finally, we implanted two sirolimus-eluting stents, followed by post-dilatation with a 3.75-mm non-compliant balloon. This approach resulted in excellent dilatation and blood flow. Use of the guide-extension catheter trapping technique (i.e. use of a guide-extension catheter and a small balloon catheter) resulted in the successful percutaneous retrieval of a detached microcatheter tip.

Objectives While current guidelines describe the importance of assessing limb characteristics for predicting limb prognosis in patients with critical limb ischaemia (CLI), several reports have also suggested that systemic factors are associated with limb prognosis. The aim of this study was to evaluate whether systemic factors have the same impact on wound healing as limb characteristics in CLI patients undergoing endovascular therapy. Methods A total of 735 patients who were treated for the first time for CLI with tissue loss between April 2010 and December 2015 were extracted from a prospective registry and data for the Wound, Ischaemia, and foot Infection (WIfI) classification were searched retrospectively. The predictors of wound healing were explored with Cox proportional hazards regression. Results The one year wound healing rate was 60.2% in WIfI stage 1–3 patients and 53.6% in WIfI sstage 4 (p = .01). In WIfI stage 1–3, no systemic factors were significantly associated with wound healing, whereas, in WIfI stage 4 patients. Non-ambulatory status [hazard ratio (HR) 1.98; 95% confidence interval (CI) 1.37–2.84], haemodialysis (HR 1.90; 95% CI 1.33–2.72) and an albumin level under 3.0 g/dL (HR 1.53; 95% CI 1.02–2.31), were identified as independent risk factors for failure to achieve wound healing. If none or one of these risk factors were present, wound healing was comparable with WIfI 4 and WIfI 1–3 patients (67.7% vs. 63.6%, p = .89), whereas in patients with two or more risk factors wound healing was worse in WIfI 4 than in WIfI 1–3 patients (35.7% vs. 49.5%, p = .01). Conclusion Non-ambulatory status, haemodialysis, and a low albumin level were additional systemic risk factors for impaired wound healing in patients with WIfI stage 4. The wound healing rate in WIfI stage 4 patients with one or fewer of these risk factors was comparable to that in WIfI stage 1–3.

INTRODUCTION The prevalence of atrial fibrillation (AF) increases with age. Although the efficacy of cryoballoon ablation (CB-A) in patients with AF has been demonstrated, data on the efficacy of this CB-A in elderly patients are limited. The aim of this study was to evaluate the 1-year efficacy and safety of CB-A in patients aged ≥80 years compared with those less than 80 years. METHODS A total of 49 consecutive patients ≥80 years with paroxysmal AF (PAF) who underwent CB-A were compared with 241 patients aged

Background The utility of an ultra‐high‐resolution electroanatomical mapping system (UHR‐EAM, Rhythmia) for repeat atrial fibrillation (AF) ablation has not been evaluated. Hypothesis A second AF ablation procedure performed using UHR‐EAM may demonstrate different outcomes compared with that using a conventional electroanatomical mapping system (C‐EAM, CARTO3). Method This observational study enrolled consecutive patients who underwent a second AF ablation procedure using UHR‐EAM (n = 103) and C‐EAM (n = 153). The second ablation procedure included re‐isolation of reconnected pulmonary veins (PVs) and elimination of clinical or induced non‐PV AF triggers and atrial tachycardia (AT). Other empirical ablations were additionally conducted at the discretion of the operators. Results Re‐isolation of PVs was achieved in 196 patients who had ≥1 left atrial‐PV reconnection. The elimination rate of AT was higher in the UHR‐EAM group than the C‐EAM group (87% vs 65%, P = .040), while that of non‐PV AF triggers was similar (63% vs 63%, P = 1.00). The UHR‐EAM demonstrated shorter radiofrequency application time (21.8 ± 16.8 vs 28.0 ± 21.3 minutes, P = .017), but longer fluoroscopic time (26.2 ± 12.6 vs 21.4 ± 9.3 minutes, P = .0001). No severe complication developed. The total 1‐year AF/AT‐free survival rates were similar between the two groups (off AADs, 59.2% vs 56.2%, P = .62; on AADs, 65.0% vs 69.3%, P = .49). Conclusion The efficacy and safety outcomes of repeat AF ablation using UHR‐EAM was comparable to those using C‐EAM.

Background The earliest activation site (EAS) on a centrifugally-propagated atrial tachycardia (AT) map may represent the true AT origin (true-focal pattern), or the earliest site resulting from passive activation of AT originating from neighboring tissue (pseudo-focal pattern). We assessed the benefits of using the wave-front propagation speed to distinguish between the true- and the pseudo-focal pattern. Methods AT mapping was performed using a novel ultra-high resolution mapping system with a 64-electrode mini-basket catheter. The true AT origin was defined as the site where radiofrequency application eliminated AT. The wave-front propagation speed was estimated from the area surrounded by the centrifugally-propagated wave front over a specific time interval. Results Total of 46 centrifugally propagated AT maps from 34 patients were analyzed, including 18 true-focal and 28 pseudo-focal pattern. The area surrounded by the propagated wave front was significantly smaller for the true-focal pattern than for the pseudo-focal pattern, 1–20 msec after the earliest activation. The true-focal pattern was identified by the area 13 msec after the earliest activation, with the best cut-off area value of Conclusion The presence or absence of a true origin of AT at the EAS on centrifugally-propagated AT maps can be distinguished using a wave-front propagation speed.

The size of the autologous vein graft is an important determinant of prognosis in patients with chronic limb-threatening ischemia (CLTI) undergoing bypass surgery. However, it is unclear whether reconstruction using a small vein graft would directly affect prognosis, or a subgroup having small veins would be subject to a poor prognosis. If the latter is true, having small veins would work as a marker for a poor prognosis even in patients with CLTI undergoing endovascular therapy (EVT). Therefore, we investigated the association between the size of saphenous veins and prognosis in patients with CLTI undergoing EVT.This study included 209 consecutive patients with CLTI who primarily underwent EVT between January 2017 and December 2018. The diameter of the saphenous vein was measured at three locations (saphenous-femoral junction, knee, and ankle joint) per limb before EVT by ultrasonography. A small saphenous vein was defined as the mean diameter3.0 mm.All-cause mortality rate was significantly higher in patients with a small saphenous vein than in those with non-small one (46.3% versus 10.7% at 2 years, p0.001). The multivariate Cox regression analysis revealed that a small saphenous vein was independently associated with an increased risk of all-cause mortality.Having a small saphenous vein was an independent marker for all-cause mortality in patients with CLTI undergoing EVT.

Noi chicken is one of the most popular native breeds in the South of Vietnam because their good meat quality and disease resistance. Therefore, although price of their products (eggs and meat) is always high, they are always preferred. However, there have not been many studies on the morphology of this breed yet. In the current study, a total of 355 Noi chickens (164 males and 191 females) at 28 days old were selected and randomly allotted to individual cages until they reached the market weight at 84 days old. During the experiment, Noi broilers were fed ad libitum a diet with 17% crude protein and 3.000 kcal/kg ME produced by GreenFeed Vietnam Joint Stock Company. Average daily gain, feed conversion ratio and some morphological dimensions were recorded at two different stages of age (28-56 and 56-84 days old). Results were demonstrated that (i) significant differences in feed intake (P=0.006), body weight (P=0.019), beak length (P=0.014), thigh length (P=0.004), shank length (P=0.003), breast diameter (P=0.000), and thigh diameter (P=0.001) were found between males and females as well as between different stages; and (ii) body weight and some dimensions will increase rapidly at the first stage. An understanding on these economic traits helps researchers and producers have a more detailed glance on developing of each part of Noi chicken at different stages of age which they are the basic scientific foundation for further studies on this breed.

The aim of this study is to characterize some quantitative traits of Noi chicken, one of the Vietnamese famous native breeds for meat quality and fighting, at the stage of 0-28 days old. Therefore, 742 chicks were used to measure, record, analyze and evaluate on these traits. As results, there was significant difference in observation traits among stages of age (P=0.000). Interesting, the wings (+64.88%) and keel lengths (+58.83%) rapidly developed within the first week of life, followed by the most of other dimensions, especially breast diameter (+31.85%), thigh diameter (+71.17%) in the second week of age. An increase in the size of the measurements was due to development of the skeleton at observing time points along the experiment. However, there was strong development of muscle tissue in the second week of life as rate of the breast and thigh diameter was greatest. Noi chicks consumed amount of feed of 16.54 g/bird/day and gained a weight of 6.98 g/bird/day. Thus, their feed conversion ratio was 2.37 at the stage of 0-28 days old. Perhaps a direct positive relationship between observed traits and age were randomly established according biological characteristics of animal. This work provided initial benchmarks of Noi chicks for further studies.

Predictors of outcomes in patients with heart failure with preserved left-ventricular ejection fraction (HFpEF) remain unclear. The ratio of early diastolic transmitral flow velocity to early diastolic myocardial velocity (E/e') has been proposed, but the predictive accuracy remains unsatisfactory. We hypothesized that E/e' normalized by the stroke volume (SV), E/e'/SV, could be a good predictor of outcome in HFpEF patients by reflecting the terminal slope of the end-diastolic pressure-volume relation, i.e., stiffness of the left ventricle. This pilot study was conducted to propose a novel echocardiographic index for predicting the outcomes of patients with HFpEF. Echocardiography including E/e'/SV measurement was performed in consecutive 80 HFpEF patients at discharge in index hospitalization due to HF. The end points included the readmission for heart failure and cardiovascular death at 1 year after discharge. 19 patients (24%) met the end points. Receiver-operating characteristic analysis showed that E/e''/SV was a strong predictive factor (AUC = 0.78) compared to E/e' (AUC = 0.74). Kaplan-Meier analysis showed that patients with E/e'/SV > 0.40 had a poorer prognosis than those with E/e'/SV

The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI. The prognostic impact of CAD and LVEF appears different between patients with IC and CLI.

BACKGROUND The efficacy of low-voltage-guided ablation in addition to pulmonary vein (PV) isolation for atrial fibrillation (AF) has been reported with voltage mapping being performed during sinus rhythm (SR) or AF. The study aimed to compare the left atrial voltage between SR and AF in association with the electrogram waveform. METHODS This prospective observational study included 30 consecutive patients with persistent AF. After completion of PV isolation, electrogram points were taken during both SR and AF at the identical locations evenly throughout the left atrium. Electrograms were divided into two types: normal (sharp electrogram with ≤3 peaks or duration 3 peaks and duration ≥50 ms). RESULTS During SR, 14 (47%) patients had low-voltage (0.5 mV) substrate with an area of 6.8 ± 4.5 cm2 . In a total of 1,063 point pairs, 135 (13%) demonstrated a fractionated electrogram during SR and 483 (45%) during AF. The locations with fractionated electrograms during AF more frequently showed fractionation during SR compared to those with normal electrograms during AF (23% vs 5%, P < 0.0001), and had lower amplitude during SR (1.47 ± 1.29 mV vs 2.03 ± 1.19 mV, P < 0.0001). Electrogram amplitude was higher during SR than that during AF (1.77 ± 1.27 mV vs 0.96 ± 0.77 mV, P < 0.0001) with a weak correlation (r = 0.56, P < 0.0001). Subgroup analyses revealed that the correlation was relatively strong (r = 0.73, P < 0.0001) among the electrogram amplitudes with normal waveform during SR and AF. CONCLUSIONS Significant differences in electrogram voltage and fractionation degree may exist between SR and AF at the same locations in patients with persistent AF.

An 80-year-old man received the implantation of a self-expanding stent (Luminexx, Bard, Inc., Murray Hill, NJ, USA) for an in-stent restenosis (ISR) lesion in the superficial femoral artery. However, angiography 141 months after the Luminexx stent implantation showed 90% ISR and a floating fractured stent in the Luminexx site. Furthermore, the floating fractured stent strut itself was completely separated and flowed toward the posterior tibial artery. The stent strut was removed by a catheter for removing intravascular foreign substances.

Global Limb Anatomic Staging System (GLASS) proposed by Global vascular guideline can anatomically stratify infrapopliteal (IP) lesions in patients with chronic limb-threatening ischemia (CLTI). This study investigated the prognostic impact of IP anatomic severity on delayed wound healing (WH) in

Concealed sinus node dysfunction (SND) may become manifest after restoration of sinus rhythm by ablation in patients with persistent atrial fibrillation (AF). The purpose of this study was to investigate the predictors of SND after catheter ablation of persistent AF.Two hundred two consecutive patients who underwent ablation for persistent AF were enrolled. Ipsilateral pulmonary vein isolation followed by, if necessary, electrical cardioversion were performed in all patients. SND was defined when temporary and/or permanent pacemakers were needed due to sinus bradycardia after ablation.SND developed in 12 (5.9 %) patients. There was no difference between the patients with and without SND in terms of the age (with SND, 67 ± 9 and without, 66 ± 10 years old, P = 0.599) and sex (male; 58 vs. 79 %, P = 0.186). However, the patients with SND had a lower amplitude of the fibrillatory waves (0.115 ± 0.086 vs. 0.176 ± 0.077 mV, P = 0.009) and larger left atrial volume index (LAVI; 66 ± 31 vs. 34 ± 13, P = 0.007) than those without. A receiver operating characteristic curve identified a fibrillatory wave amplitude of 0.145 mV (AUC = 0.742; sensitivity = 65 %; specificity = 83 %) and LAVI of 47.5 ml/m(2) (AUC = 0.837; sensitivity = 82 %; specificity = 87 %) as the optimal cutoff values for predicting SND. A multivariate analysis revealed that the amplitude of the fibrillatory waves (odds ratio = 0.84 for 0.010 mV increase, 95 % CI = 0.71-0.98, P = 0.031) and LAVI (odds ratio = 1.08 for 1.0 cm(3)/m(2) increase, 95 % CI = 1.04-1.12, P 0.001) were independent risk factors for SND.A low amplitude of the fibrillatory waves and a large LAVI were predictors of SND after restoration of sinus rhythm by ablation in patients with persistent AF.

Background: Although skin perfusion pressure (SPP) is widely used clinically to predict probability of wound healing, correlation between clinical outcomes and SPP has not been systematically studied. Methods: This subanalysis of the prospective multicenter OLIVE registry of patients who received infrainguinal endovascular therapy (EVT) for critical limb ischemia (CLI) assessed the association between clinical outcomes and postoperative SPP in 211 consecutive patients. Logistic regression analysis was performed, with amputation-free survival (AFS), modified major adverse limb events (MALEs), and complete wound healing as dependent variables and postprocedural SPP as independent variable. Result: Pre- and postprocedural SPP was 28 ± 11 and 46 ± 18 mm Hg, respectively. In logistic regression analysis, postprocedural SPP correlated with 1-year AFS ( P = .018), modified MALEs ( P < .001), and wound healing ( P = .022). Conclusion: Postprocedural SPP correlates with clinical outcomes after EVT for patients with CLI.

The genetic diversity of native chicken populations from Myanmar, Thailand, and Laos was examined by using 102 insertion and/or deletion (indels) markers. Most of the indels loci were polymorphic (71% to 96%), and the genetic variability was similar in all populations. The average observed heterozygosities (H O ) and expected heterozygosities (H E ) ranged from 0.205 to 0.263 and 0.239 to 0.381, respectively. The coefficients of genetic differentiation (Gst) for all cumulated populations was 0.125, and the Thai native chickens showed higher Gst (0.088) than Myanmar (0.041) and Laotian (0.024) populations. The pairwise Fst distances ranged from 0.144 to 0.308 among populations. A neighbor-joining (NJ) tree, using Nei's genetic distance, revealed that Thai and Laotian native chicken populations were genetically close, while Myanmar native chickens were distant from the others. The native chickens from these three countries were thought to be descended from three different origins (K = 3) from STRUCTURE analysis. Genetic admixture was observed in Thai and Laotian native chickens, while admixture was absent in Myanmar native chickens.

ObjectiveThe latest guideline points to life expectancy of 75 years (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.10-2.85), nonambulatory status (HR, 5.32; 95% CI, 2.96-9.56), regular dialysis (HR, 1.90; 95% CI, 1.10-3.26), and ejection fraction 75 years, nonambulatory status, regular dialysis, and ejection fraction

Although the guidelines mention that cardiac failure can negatively affect prognosis in patients with critical limb ischemia (CLI) and should be appropriately evaluated, which parameters of cardiac condition negatively affect CLI prognosis have not been well elucidated. This study was a