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Coexisting sick sinus syndrome (SSS) is associated with both electrical and structural atrial remodelling in patients with atrial fibrillation (AF). Limited data are available concerning catheter ablation (CA) for AF in this condition. This study investigated the efficacy of CA as a curative therapy for AF and SSS in a large-scale prospective multicentre registry.The Kansai Plus Atrial Fibrillation registry enrolled 5,010 consecutive patients who underwent CA for AF; this included 3,133 patients with paroxysmal AF (mean age, 66 years; male, 69.3%; mean CHA2DS2-VASc score, 2.05±1.50; SSS, n=315 [tachy-brady syndrome, n=285]). The endpoints included the recurrence of AF with a blanking period of 90 days after CA, and de novo pacemaker implantation during the follow-up period (median duration, 2.93 years).The AF-free survival did not significantly differ between patients with and those without SSS (n=2,818) after the initial (log-rank p=0.864) and final sessions (log-rank p=0.268). Pacemakers were implanted in 48 patients with SSS, and implantation in this group was significantly associated with AF recurrence, including early recurrence (adjusted odds ratio, 3.57; 95% confidence interval, 1.67-7.64; p=0.002). The remaining 85.3% of patients with SSS did not require pacemaker implantation at 3 years after CA.Coexisting SSS did not adversely affect recurrence-free survival after CA for paroxysmal AF. Pacemaker implantation was not required in most patients with SSS, with AF recurrence serving as a strong predictor for this.

The atrial defibrillation threshold (ADFT) for internal cardioversion is theoretically related to the critical mass for sustaining atrial fibrillation (AF).This study aimed to investigate the association of ADFT for internal cardioversion with the outcome of catheter ablation for non-paroxysmal AF (non-PAF).We included 368 consecutive patients who underwent first-time catheter ablation for non-PAF. Based on the degree of ADFT recorded by the internal cardioversion before pulmonary vein isolation, we divided the patients into low ADFT (20 J) and high ADFT (≥20 J) groups and analysed the association between ADFT and atrial tachyarrhythmia recurrence.There were 234 and 134 patients in the low and high ADFT groups, respectively. Of these, 39 patients (16.7%) and 41 (30.6%) patients, respectively, had atrial tachyarrhythmia recurrence during the 2.6±1.0 year follow-up. The high ADFT group showed a significantly higher atrial tachyarrhythmia recurrence than the low ADFT group (p=0.002). This finding was also noted in patients with long-standing persistent AF (p=0.032) but not in patients with persistent AF (p=0.159). The significant predictors of arrhythmia recurrence on multivariate analysis were high ADFT (p=0.004) and long-standing persistent AF (p=0.011). In multivariate analysis within the long-standing persistent AF group, only ADFT remained a significant risk factor for AF recurrence (p=0.035).The high ADFT of internal cardioversion was found to be a risk factor for post-catheter ablation recurrence in patients with long-standing persistent AF but not in those with persistent AF.

Background The relationship between nutritional status and the incidence or prognosis of atrial fibrillation (AF) has been reported, but no studies have described the relationship between the outcomes of AF catheter ablation (CA) and nutritional status as assessed by various scoring tools. We aimed to verify the hypothesis that preoperative nutritional status is associated with arrhythmia recurrence after CA for AF.Methods and Results:We evaluated 913 patients (age, 67±10 years; men, 72%; paroxysmal AF, 56%) who underwent CA for AF between November 2011 and November 2017. Patients were systematically followed with an endpoint of atrial tachyarrhythmia recurrence, the predictive value of which was compared among 3 scoring tools (Controlling Nutritional Status [CONUT] score / Geriatric Nutritional Risk Index [GNRI] / Prognostic Nutritional Index [PNI]). Patients were divided into normal nutrition (CONUT 98 [n=836] / PNI >38 [n=910]) and undernutrition (CONUT ≥2 [n=276] / GNRI ≤98 [n=77] / PNI ≤3 [n=3]) groups. AF recurred in 274 patients (mean follow-up, 2.3±0.8 years). The AF recurrence rate was higher in patients with undernutrition than in those with normal nutrition (CONUT/GNRI) status. Multivariate Cox regression analysis identified undernutrition status (GNRI ≤98) as an independent predictor of atrial tachyarrhythmia recurrence. Conclusions The AF recurrence rate after CA was higher in patients with undernutrition than in those with normal nutrition as stratified by the nutrition scoring tools.

Catheter ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) in patients with persistent left superior vena cava (PLSVC) is challenging because of anatomical abnormalities of Koch's triangle associated with the enlarged coronary sinus ostium. We present the Case of successful ablation in a patient with PLSVC using the cryoablation technique. The ablation was successfully performed without damaging the conduction system by virtue of “cryomapping” and “cryoadhesion.” Cryoablation is a safe and efficacious alternative to radiofrequency catheter ablation for the treatment of AVNRT associated with PLSVC., Highlights • Catheter ablation for AVNRT in patients with PLSVC is challenging • We performed successful ablation in a PLSVC patient with the cryoablation technique • Ablation was successfully performed without damaging the conduction system

Purpose: Clinical outcomes regarding the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated the impact of ELCA on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) compared with manual aspiration thrombectomy using nuclear scintigraphy.Methods: We enrolled 143 consecutive STEMI patients treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We checked peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) level and demonstrated single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3–10 days using 123I-BMIPP and 3 months after percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. Results: There was no significant difference in patients’ and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5–342.0] IU/L vs. aspiration group, 256.5 [157.0–354.8] IU/L, p=0.047). Although there was no significant difference in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2-19.8]% vs. 9.5 [3.9-15.3]%, respectively, p=0.017) and peak emptying rate (-0.54 [-1.02–-0.27] mL/s vs. -0.38 [-0.76–-0.05] mL/s, respectively, p=0.017) were detected.Conclusion: ELCA could suppress myocardial deviation enzymes and potentially improve systolic function in STEMI patients compared to manual aspiration thrombectomy.

Aims We aimed to examine the benefits of catheter ablation in patients with non-paroxysmal atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. Methods and results From 1173 consecutive patients undergoing catheter ablation, 502 with non-paroxysmal AF were divided into three groups: no history of HF [plasma B-type natriuretic peptide (BNP) Conclusion Catheter ablation is highly feasible for restoring sinus rhythm in non-paroxysmal AF with coexisting HFpEF, thereby improving cardiac function and BNP levels. Catheter ablation for AF may be an optional management strategy.

The eastern margin of the Japan Sea is located along an active convergent boundary between the North American and Eurasian tectonic plates. Okushiri Island, which is situated off the southwest coast of Hokkaido, is located in an active tectonic zone where many active submarine faults are distributed. Studying the records of past tsunamis on Okushiri Island is important for reconstructing the history and frequency of fault activity in this region, as well as the history of tsunamis in the northern part of the eastern margin of the Japan Sea. Five tsunami deposit horizons have been identified previously on Okushiri Island, including that of the 1741 tsunami, which are interbedded in the coastal lowlands and Holocene terraces. However, these known tsunami deposits date back only ~3,000 years. A much longer record of tsunami occurrence is required to consider the frequency of submarine fault activity. In this study, we cored from 7 to 25 m depth in the Wasabiyachi lowland on the southern part of Okushiri Island, where previous studies have confirmed the presence of multiple tsunami deposits on peat layer surfaces. The results indicate that the Wasabiyachi lowland comprises an area that was obstructed by coastal barriers between the lowland and the coast at ~8.5 ka and consists of muddy sediment and peat layers formed in lagoons and floodplains, respectively. In addition, event deposits and 15 tsunami horizons were observed among the turbidites and peat layers, dating back as far as 3,000 years. Combined with previous findings, Okushiri Island has sustained 20 tsunami events between ~7.5 ka and the present. These findings are critical for investigating the activities of submarine faults off the southwestern coast of Hokkaido, as well as for determining tsunami risks along the coast of the Japan Sea between North Tohoku and Hokkaido.

Given a set of weighted intervals, the objective of the weighted interval selection problem (WISP) is to select a maximum-weight subset such that the selected intervals are pairwise disjoint. We consider on-line algorithms that process the intervals in order of non-decreasing left endpoints. Preemption is allowed, but rejections are irrevocable. This problem has natural applications in various scheduling problems. We study the class of monotone instances of WISP, i.e., we require that the order of right endpoints of the given intervals coincides with that of the left endpoints. This class includes the case where all intervals have the same length. For monotone instances of WISP, the best possible competitive ratio for deterministic on-line algorithms is known to be 1/4. It has long been an open question whether there exists a randomized algorithm with better competitive ratio. In this paper, we present a new randomized algorithm and prove that it achieves a better competitive ratio 1/3 for the special case of monotone WISP where the sequence of weights of the arriving intervals is non-decreasing. Thus we provide the first result towards a solution of the long-standing open question. Furthermore, we show that no randomized algorithm achieves a competitive ratio strictly larger than 4/5. This is the first non-trivial upper bound for randomized algorithms for monotone WISP.

Recently, many studies on visual function of amblyopia have revealed a part of the pathophysiological feature. Meanwhile, it is significant to analyse the retinal sensitivity in amblyopia in order to comprehend the pathophysiologic features of amblyopia, on which some studies have been done. In this study, the retinal sensitivity in amblyopia was analysed using computerized static perimeter.

Development of binocular visual acuity was examined using the one-hole grating acuity cards in preterm infants and full-term newborn infants. To investigate the effect of visual stimulation after birth on visual development, 205 newborn infants were divided into two groups, 70 preterm infants and 135 full-term infants.