Search

Background Early recurrences of atrial arrhythmias (ERAAs) after ablation may require therapeutic intervention. The optimal medical therapy that prevents ERAAs requires clarification. This study aimed to compare the incidence of ERAAs between patients who received or did not receive bisoprolol transdermal patches (BTPs) at 3 months postablation. Methods This single‐center retrospective study enrolled 203 consecutive patients with paroxysmal atrial fibrillation (AF) who had undergone their first ablation, comprising 59 in the BTP group and 144 in the non‐BTP group. Follow‐up assessments were conducted monthly for 3 months. We evaluated the incidence of ERAAs. Results During the initial 1‐week observational period, the rate of ERAAs was lower in the BTP group (5.0%) than that in the non‐BTP group (18.8%) (P = .013). At 3 months postablation, the rate of ERAAs was lower in the BTP group (6.8%) than that in the non‐BTP group (25.7%) (P = .002). The cumulative freedom from ERAAs was significantly lower in the BTP group than in the non‐BTP group (log‐rank: P = .003). Administering BTPs was an independent factor that protected against ERAAs (odds ratio 0.181, [95% confidence interval 0.059‐0.559], P = .003). Conclusion BTPs may prevent ERAAs after ablation., The patients who were administered bisoprolol transdermal patches (BTPs) immediately after atrial fibrillation (AF) ablation showed significant reductions in the incidence of early recurrence of atrial arrhythmias (ERAAs) compared with the patients who were not administered BTPs. The efficacy of BTPs at preventing ERAAs was confirmed not only immediately after ablation, but also during the short period after AF ablation.

Recently, 4-dimensional computed tomography (4DCT) has become available for the preoperative planning of transcatheter aortic valve intervention.1 The 4DCT is reconstructed at 10% increments over the cardiac cycle, so that the 4DCT can evaluate not only the displacement of perivalvular structures but also the displacement of the myocardium.2 Most premature ventricular contractions (PVCs) arise from normal hearts. Further, it has been reported that PVCs arise from low-voltage areas and/or scar areas observed on voltage maps during electrophysiological studies, despite a structurally normal heart.3,4 Further, it has also been reported that a heterogeneous distribution of collagen within an infarct and the subendocardial layer is consistent with voltage mapping.5 From the above, we considered that an impaired myocardium would be displayed as having low dynamics on the 4DCT, whereas it would be displayed as a low-voltage or scar region on the voltage map. We herein describe our case, in which catheter ablation of PVCs was successfully performed, and a low-displacement area on the 4DCT corresponded to a low-voltage region on the voltage map.

The primordial He abundance $Y_\mathrm{P}$ is a powerful probe of cosmology. Currently, $Y_\mathrm{P}$ is best determined by observations of metal-poor galaxies, while there are only a few known local extremely metal-poor ($, Comment: 22 pages, 9 figures, accepted for publication in ApJ

Strong high-ionization lines such as HeII of young galaxies are puzzling at high and low redshift. Although recent studies suggest the existence of non-thermal sources, whether their ionizing spectra can consistently explain multiple major emission lines remains a question. Here we derive the general shapes of the ionizing spectra for three local extremely metal-poor galaxies (EMPGs) that show strong HeII$λ$4686. We parameterize the ionizing spectra composed of a blackbody and power-law radiation mimicking various stellar and non-thermal sources. We use photoionization models for nebulae, and determine seven parameters of the ionizing spectra and nebulae by Markov Chain Monte Carlo methods, carefully avoiding systematics of abundance ratios. We obtain the general shapes of ionizing spectra explaining $\sim 10$ major emission lines within observational errors with smooth connections from observed X-ray and optical continua. We find that an ionizing spectrum of one EMPG has a blackbody-dominated shape, while the others have convex downward shapes at $>13.6$ eV, which indicate a diversity of the ionizing spectrum shapes. We confirm that the convex downward shapes are fundamentally different from ordinary stellar spectrum shapes, and that the spectrum shapes of these galaxies are generally explained by the combination of the stellar and ultra-luminous X-ray sources. Comparisons with stellar synthesis models suggest that the diversity of the spectrum shapes arises from differences in the stellar age. If galaxies at $z\gtrsim 6$ are similar to the EMPGs, high energy ($>54.4$ eV) photons of the non-stellar sources negligibly contribute to cosmic reionization due to relatively weak radiation., Accepted for publication by ApJ

A nanometric Rh overlayer formed on a metal foil substrate enables much higher turnover frequencies in NO reduction than the Rh nanoparticles used in conventional three-way catalysis. However, the thermal stability of the Rh overlayer structure needs to be improved for practical applications. In the present study, a Zr buffer layer inserted between the Rh overlayer and the foil substrate efficiently overcame the thermal deterioration at 900 °C for 25 h. A honeycomb catalyst consisting of a 7 nm-thick Rh overlayer, a 500 nm-thick Zr buffer layer and a 30 μm-thick Fe–Cr–Al metal (SUS) foil was prepared by pulsed arc-plasma deposition. After thermal ageing, the Rh/Zr/SUS demonstrated steep light-off characteristics in simulated NO–CO–C3H6–O2 reactions. In contrast, the neat catalyst without the buffer layer (Rh/SUS) was totally deactivated by the Al2O3 passivation layer that formed over the active Rh overlayer. The Zr buffer layer preserves the outermost surface of the Rh overlayer by blocking the interaction between the Rh and Al2O3 layers. Consequently, the Rh surface coverage of Rh/Zr/SUS exceeded 80% after thermal ageing at 900 °C, versus almost 0% for Rh/SUS.

In this paper, we provide new experimental data of the wave-induced steady forces (the added resistance, wave-induced steady lateral force, and yaw moment) acting on a full hull ship in regular waves, and we verify the validity of existing prediction methods for wave-induced steady forces by performing comparisons with results obtained experimentally. For the prediction methods, we consider the zero-speed three-dimensional panel method (3DPM) and the method based on formulas of the wave-induced steady forces that are expressed using the Kochin-function assuming a slender ship (strip theory-based Kochin-function method: SKFM). The results show that the calculation accuracy obtained using 3DPM and SKFM for added resistance and steady lateral force is acceptable for practical purposes although the accuracy is insufficient for the steady yaw moment. In order to confirm the applicability of both methods to the problem of maneuvering in waves, we predict the turning motions of the ship in irregular waves using the calculation results obtained by 3DPM and SKFM for the wave-induced steady forces, and we compare the turning motions with the free-running model test results. Both methods are useful for predicting turning motions in irregular waves.

50 μm-thick Fe−Cr−Al metal foils covered by 7 nm-thick Rh overlayers were prepared by pulsed arc-plasma (AP) and r.f. magnetron sputtering technique to compare their catalytic activities. As-prepared metal foil catalysts were wrapped into a honeycomb structure with a density of 900 cells per square inches and the stoichiometric NO−CO−C3H6−O2 reaction was performed at space velocity of 1.2 × 105 h−1. During temperature ramp at 10 °C min−1, honeycomb catalysts showed steep light-off of NO, CO, and C3H6 at above 200 °C and their conversions soon reached to almost 100%. Both catalysts exhibited high turnover frequencies close to or more than 50-fold greater compared with those for a reference Rh/ZrO2 powder-coated cordierite honeycomb prepared using a conventional slurry coating. When the temperature ramping was repeated, however, the catalytic activity was decreased to the different extent depending on the preparation procedure. Significant deactivation occurred only when prepared by sputtering, whereas the sample prepared by AP showed no signs of deactivation. The deactivation is associated with the formation of passivation layers consisting of Fe, Cr, and Al oxides, which covered the surface and decreased the surface concentration of Rh. The Rh overlayer formed by AP was found to be thermally stable because of the strong adhesion to the metal foil surface, compared to the sample prepared by sputtering.

Objectives Clostridium perfringens is a common anaerobic pathogen causing enteritis/enterocolitis and wound infections in humans. We analyzed clonal diversity and toxin gene prevalence in C. perfringens clinical isolates from humans in northern Japan. Methods Prevalence of nine toxin genes was analyzed for 585 C. perfringens isolates from patients collected for 20-month period between May 2019 and December 2020 by molecular methods. Sequence type (ST) based on multilocus sequence typing (Xiao's scheme) and alpha-toxin (PLC) sequence type were determined for a total of 124 isolates selected in the present study along with those in our previous study (2017–2018). Results Toxinotypes A (68.2%) was the most frequent, followed by F (31.6%), and G (0.2%), while additional toxin genes encoding binary enterotoxin (BEC/CPILE) and beta2 toxin were identified in one and six isolates, respectively. Among the 124 isolates with various toxin gene profiles, 62 STs including 53 novel types were identified, revealing the presence of six clonal complexes (CCs) consisting of 27 STs. Most of enterotoxin gene (cpe)-positive isolates belonged to CC36, CC41, and CC117. Based on 22 key amino acids in alpha toxin sequence, four PLC types (I-IV) including 21 subtypes were classified, and their relation to individual STs/CCs was clarified. Two isolates harboring bec/cpile belonged to different STs (ST95, ST131) and PLC types (If, IVb), indicating distribution of this toxin gene to distinct lineages. Conclusions The present study revealed the diversity in C. perfringens clones of human origin with various toxin gene profiles represented by ST/CC and PLC type.

This study investigated the thermal decomposition behaviors of platinum oxide (PtO2) nanoparticles deposited on polycrystalline TiO2 in different crystal phases. The dissociation of PtO2 to metallic platinum in air occurred at 400 °C on anatase TiO2 (Pt/TiO2-A), but required 650 °C or higher on rutile TiO2 (Pt/TiO2-R). The higher thermal stability of PtO2 on rutile TiO2 is caused by thermodynamic effect and rather than kinetic effect. In contrast to the thermodynamic prediction, metallic Pt (Pt0) on TiO2-R was reversibly oxidized to PtO2 (Pt4+) at 650 °C. This behavior was attributed to the coherent interface structure formed by strong interactions between PtO2 and rutile TiO2, as revealed by combined extended X-ray adsorption spectroscopy (EXAFS) and density functional theory (DFT) studies. At the optimized interface structure, between the (100) planes of α-PtO2 and rutile TiO2, the interface formation energy was −17.04 kJ mol–1 A–2 versus −9.84 kJ mol–1 A–2 in the anatase TiO2 model. The larger interfac...

Background The relationship between pulmonary vein (PV) arrhythmogenicity and its anatomy has been reported. However, that of the superior vena cava (SVC) has not been well discussed. Arrhythmogenic response induced by pacing stimulation at SVC might help with identifying SVC arrhythmogenicity. The purpose of this study was to investigate the relationship between the anatomical dilatation of SVC and the arrhythmogenic response induced by pacing at SVC. Methods Forty-three patients who underwent atrial fibrillation (AF) ablation were enrolled in this study. After PV isolation, scan pacing (up to triple extra stimulation following intrinsic sinus beats) was performed at SVC. The arrhythmogenic response was defined as following: (1) repetitive atrial responses, (2) non-sustained, and (3) sustained AF/ atrial tachycardia. To assess the dilatation of SVC, we measured the cross-sectional area of the SVC (SVC-area) using multi-planar reconstruction CT imaging. Results Arrhythmogenic responses were documented in 24 patients (Group 1). No arrhythmogenic responses were documented in the remaining 19 patients (Group 2). The SVC-area was significantly larger in Group 1 than Group 2 (3.1±0.9 vs. 2.2±0.8 cm 2 , P =0.004). A multivariate analysis revealed only SVC-area was associated with arrhythmogenic responses (odds ratio=2.87, CI 1.05–7.82, P =0.04). Furthermore, AF recurrence rate was significantly higher in patients with SVC-area>2.56 cm 2 than those with SVC-area 2 (9 [42.9%] of 21 vs. 3 [13.6%] of 22, P =0.026). Conclusion Dilatation of SVC was associated with an arrhythmogenic response, and the AF recurrence rate was significantly higher in patients with large SVC-area. Adjunctive catheter intervention for the SVC might be indicated in patients with a dilated SVC and an arrhythmogenic response.

Nanometric Rh overlayers were formed on Fe–Cr–Al stainless steel (SUS) foils by pulsed cathodic arc-plasma (AP) technique to investigate the thermal evolution of the structure and catalytic activity for stoichiometric NO–CO–C3H6–O2 reaction. As-prepared Rh overlayer catalysts (Rh/SUS) with 2000–8000 AP pulsing showed steep light-off of NO, CO and C3H6 at around 250 °C and their conversions soon reached to almost 100%. After thermal aging at 900 °C in H2O/air, however, the catalytic activity was decreased to the different extent depending on the number of AP pulsing. The most significant deactivation was observed for the smallest numbers of AP pulsing (2000), because Al in the foil was oxidized during the aging to form a passivation layer of α-Al2O3, which covered the surface of the foil and decreased the surface concentration of Rh. To overcome this deactivation, the Rh overlayer was formed by AP after preheating the foil at 1000 °C in air. This modified preparation process enables the deposition of Rh overlayer on the highly crystalline α-Al2O3 layer at the surface of the foil, which is found to be much more stable against thermal deactivation.

BACKGROUND Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed. METHODS We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period. RESULTS Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P < 0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093). CONCLUSIONS One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.

Background Cardiac resynchronization therapy (CRT) could be an effective therapy for patients suffering from severe heart failure (HF) despite optimal medical therapy. However, it has been reported that about 30% of patients receive ineffective results even if CRT has been performed. In a recent study, four-dimensional computed tomography (4DCT) was shown to be useful for pre-operative planning in transcatheter aortic valve intervention. The 4DCT is reconstructed with 10% increments over the cardiac cycle so that the displacement of the myocardium can be evaluated over time. From the above, we considered that the most delayed site where we would implant the left ventricular (LV) lead could be recognized by 4DCT. Case summary A 55-year-old man with a recurrent admission for HF indicated for CRT was referred to our hospital. In this patient, the 12-lead electrocardiogram (ECG) showed a relatively narrow QRS complex with a left bundle branch block pattern. An echocardiography demonstrated severe LV dysfunction. Although no dyssynchrony was detected, the LV lead was inserted into the most delayed site based on the 4DCT. Three-month later, the ejection fraction increased and the cardiothoracic ratio obviously shortened. Discussion We experienced a case in which we could evaluate the effective implantation site for the LV lead based on the 4DCT even though the effective site was not detected by echocardiography, and we could implant the LV lead at that effective site. The 4DCT may be useful for implanting LV leads in effective sites.

A comparative turnover frequency (TOF) study for structure-sensitive CO–NO reactions between overlayer (thin-film) and nanoparticle Rh catalysts was performed using a combined experimental and theoretical approach. Two types of honeycomb catalysts were prepared: one by the arc-plasma deposition of a 3 nm Rh overlayer having a (111) preferential orientation atop a 20-μm Fe–Cr–Al metal foil and the other by a conventional wet coating of Rh/ZrO2 powders comprised of Rh nanoparticles onto a cordierite honeycomb. The reaction rate of the overlayer was found to be more superior to the nanoparticles, despite a smaller surface area, as the TOF was 14-fold greater on the overlayer than on the nanoparticle. In situ infrared spectroscopy suggested that a hollow-site NO formed onto the overlayer in contrast to the bridge- and on-top-NO adsorptions on the nanoparticles. The energy barriers for surface reactions of adsorbed NO molecules were analyzed using a density functional theory based molecular dynamics approach f...

Background Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT. Methods A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography. Results Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61–0.86, P < 0.001; Deep V shape: odds ratio: 0.19, CI: 0.04–0.82, P = 0.03; LAVi: odds ratio: 1.05, CI: 1.02–1.07, P = 0.001). A receiver-operating characteristic curve analysis yielded an optimal cut-off value of 15.5 mm and 55.7 mL/m2 for the d-PVI and LAVi, respectively. Conclusion The shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT.

We herein report a case of disseminated Mycobacterium avium infection that involved both optic nerves, the conjunctiva, the right lower lung, and multiple skin lesions, including a thoracic nodule. The patient was a 65-year-old man without any significant medical history. The pathogen was detected in the patient's eye discharge, sputum, bronchial lavage fluid, and thoracic nodule. Anti-mycobacterial chemotherapy, including clarithromycin, rifampicin, and ethambutol, was administered, and the thoracic nodule was resected. An autoantibody to interferon-γ was detected in the patient's serum. Bilateral swelling of his optic nerves and facial dermatitis improved after initiating anti-mycobacterial chemotherapy.

Background: We reviewed the effectiveness and safety of cardiac resynchronization therapy (CRT) for patients with New York Heart Association (NYHA) class IV non-ambulatory heart failure (NAHF). Methods: From 2006 to 2011, 310 patients underwent CRT at Kobe University Hospital and Himeji Cardiovascular Center because of heart failure. Of these, 29 NAHF patients were retrospectively analyzed. The control group comprised 21 age- and ejection fraction-matched patients with NAHF who did not undergo CRT from the ICU database of Kobe University Hospital. The primary endpoint was all-cause death and hospitalization for heart failure. Response was defined as a >15% reduction in left ventricular end-systolic volume (LVESV). Results: CRT was performed successfully without serious complications in all patients. Twenty-three patients (79%) were discharged 19±15 days after CRT implantation, while 6 (21%) died during their hospital stay due to progressive heart failure. Compared with the control group, patients in the CRT group showed significant improvements in the primary endpoint (log-rank p=0.04). Six patients (21%) were defined as responders and the Kaplan–Meier curve showed that responders experienced a better outcome than non-responders (log-rank p=0.029). LV dyssynchrony before implantation was significantly related to the occurrence of the primary endpoint (p=0.02). Conclusions: CRT can be safely used in patients with NAHF and can improve long-term patient outcomes, especially in treatment responders.

Upper Limit of Vulnerability and the APD DynamicsIntroduction The restitution of the action potential duration (APD) is an important contributor to ventricular fibrillation (VF) initiation by a single critically timed ectopic beat. We hypothesized that a steep slope of the activation recovery interval restitution curve was related to the upper limit of vulnerability (ULV). Methods and Results Fifty-four consecutive patients with implantable cardioverter defibrillators (ICDs) implanted between April 2012 and July 2013 were included. At the implantation, pacing from the right ventricular (RV) coil to an indifferent electrode inserted in the ICD pocket was performed, and the unipolar electrograms from the RV coil were simultaneously recorded. We assessed the standard restitution by introducing extra-stimuli, while measuring the activation recovery interval (ARI). Our protocol for the vulnerability test consisted of delivering three 15 J shocks on the T-peak and within ±20 milliseconds of it. If VF was not induced by that procedure, a ULV of ≤15 J was defined. The relationship between the ULV and maximum slope of the restitution curve was analyzed. A restitution curve could finally be obtained in a total of 40 patients. The background characteristics were similar between the two groups. The maximum slope of the restitution curve was steeper in the ULV > 15 J group than ULV ≤ 15 J group (1.55 ± 0.45 vs. 0.91 ± 0.64, P 15 J from a ULV ≤ 15 J (sensitivity 61.5% and specificity 96.3%). Conclusion The maximum slope of the restitution curve was significantly related to the ULV. High defibrillation threshold patients could be detected by the ARI dynamics.

Background The precise location of truly active reentry circuits of typical atrial flutter (AFL) has not been well identified. The purpose of this study was to verify our hypothesis that the posterior block line is located along the posteromedial right atrium (PMRA) and the crista terminalis (CT) is the anterior pathway of AFL, with real-time intracardiac echo (ICE). Methods The entire right atrium (RA) three-dimensional activation and entrainment mapping were evaluated during AFL in 18 patients using CARTO sound. Results The CT was clearly visualized by ICE and the local electrograms along the CT were single potentials in all the patients. The CT was recognized as the truly active anterior pathway based on entrainment mapping in all patients. Double potentials were recorded along the PMRA. Entire RA entrainment mapping could be performed in 16 patients. The reentry circuits were separated into three passages. The first was around the tricuspid annulus (TA), the second the anterior superior vena cava (SVC; AFL waves passed between the anterior SVC and RA appendage), and the last the posterior SVC (between the posterior SVC and upper limit of the PMRA). All three of these passages were active in four, around the TA and anterior SVC in eight, around the TA and posterior SVC in three, and around only the anterior SVC in one patient. Conclusions The CT functions as the anterior pathway of typical AFL, and the posterior block line was located along the PMRA. Dual or triple circuits were recognized in the majority of AFL patients.

The impact of a cryoballoon ablation is reported to be similar to that of a radiofrequency (RF) ablation in patients with atrial fibrillation. Delayed enhancement magnetic resonance imaging (DE-MRI) could visualize the scar region induced by the cryoballoon ablation as well as RF ablation. Cryoballoon ablation could induce extensive scar lesions around the PVs. However, the distribution of the scar lesions after the cryoballoon ablation has not been well discussed. We, herein, described a case with an eccentric scar distribution after cryoballoon ablation.

Background Cardiac resynchronization therapy (CRT) improves the survival rates of patients with heart failure, but 30–40% of them do not respond to CRT, partially because of the position of the left ventricular (LV) lead. The relationship between the electrical and mechanical activation of the left ventricle is unknown. The aim of this study was to compare the electrical and mechanical dyssynchrony. Methods We inserted electrode catheters into the coronary sinus (CS) and venous branches of the CS during CRT implantations and constructed electroanatomical contact maps in 16 patients using the EnSite NavX™ system. Mechanical activation was evaluated by speckle-tracking echocardiography and the latest mechanical and electrical sites were compared. The degrees of the electrical and mechanical delays of the implanted LV lead were also compared. Results The electroanatomical maps revealed that the latest electrical sites were anterior in one, anterolateral in five, lateral in eight, and posterolateral in two. Echocardiographic imaging revealed that the latest mechanical sites were anteroseptal in two, anterior in four, lateral in five, posterior in two, and inferior in three. The latest electrical and mechanical sites matched in only three patients. The degree of the local mechanical delay for the LV lead was significantly larger in the responders than nonresponders, whereas the local electrical delay did not differ. Conclusion A discrepancy between the electrical and mechanical dyssynchrony might affect an adequate LV lead positioning.

Aims Cardiac resynchronization therapy (CRT) improves the clinical status of patients with congestive heart failure, although left ventricular epicardial pacing may increase transmural dispersion of repolarization (TDR). The aim of this study was to investigate the time-dependent effect of CRT on ventricular repolarization and ventricular arrhythmia at mid-term follow-up. Methods and results The study group consisted of 84 patients treated with CRT. Twelve-lead electrocardiogram was digitally recorded and Tpeak-to-Tend interval (Tp-e) was measured at baseline, 1 week, 1 month, and 3, 6, and 12 months after device implantation. We determined the time-dependent changes in Tp-e, ventricular tachycardia and ventricular fibrillation (VT/VF) during 12 months of follow-up, in both CRT responders and non-responders. Seventeen of 84 patients (20%) had VT/VF during first year. Six of those 17 patients (35%) experienced VT/VF within 1 month of implantation and diminished over time. Tp-e decreased significantly at 6 and 12 months after implantation compared with 1 week [108 ± 14 ms at 1 week vs. 97 ± 21 ms at 6 months (P = 0.03) and 95 ± 19 ms at 12 months (P = 0.01)]. Responders demonstrated a greater time-dependent reduction of Tp-e at 6 and 12 months of CRT and had a lower rate of VT/VF compared with non-responders (log-rank test, P = 0.004). Conclusion Transmural dispersion of repolarization and the number of patients with VT/VF decreased over time after CRT. Patients with reverse remodelling demonstrated a lower rate of VT/VF and a greater time-dependent reduction of TDR.

We report the case of a 13-year-old boy with bilateral osteochondritis dissecans in the lateral femoral trochlea of the knees. They were classified as grade 4 in the right knee and grade 1 in the left knee on the basis of the Nelson classification within 1 year after first consultation. In the right knee, the fragment was surgically fixed, but the left knee healed with conservative treatment. This case indicates the possibility that osteochondritis dissecans of the lateral femoral trochlea may develop bilaterally at different times and present at different stages. The case shows the importance of early diagnosis and appropriate treatment on the basis of the stage.

Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed.We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period.Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093).One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.

Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT.A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography.Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61-0.86, P0.001; Deep V shape: odds ratio: 0.19, CI: 0.04-0.82, P = 0.03; LAVi: odds ratio: 1.05, CI: 1.02-1.07, P = 0.001). A receiver-operating characteristic curve analysis yielded an optimal cut-off value of 15.5 mm and 55.7 mL/mThe shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT.