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Aims: Catheter ablation (CA) of idiopathic ventricular arrhythmias (VAs) from the epicardial left ventricular summit is challenging. The endocardial approach targets two sites: the endocardial closest site (ECS) to the epicardial earliest activation site (epi-EAS) and the endocardial earliest activation site (endo-EAS). We aimed to differentiate between cases where CA at the ECS was effective and where CA at the endo-EAS yielded success., Methods and Results: Fifty-eight patients (47 men; age 60 ± 13 years) were analysed with VAs in which the EAS was observed in the coronary venous system (CVS). Overall, VAs were successfully eliminated in 42 (72%) patients: 8 in the CVS, 8 where the ECS matched with the endo-EAS, 11 at the ECS, and 15 at the endo-EAS. A successful ECS ablation was associated with a shorter epi-EAS-ECS distance (10.2 ± 4.7 vs. 18.8 ± 5.3 mm; P < 0.001) and shorter epi-EAS-left main coronary trunk (LMT) ostial distance (20.3 ± 7.6 vs. 30.3 ± 8.4 mm; P = 0.005), with optimal cut-off values of ≤12.6 and ≤24.0 mm, respectively. A successful endo-EAS ablation was associated with an earlier electrogram at the endo-EAS [23 (8, 36) vs. 15 (0, 19) ms preceding the QRS; P < 0.001] and shorter epi-EAS-endo-EAS interval [6 (1, 8) vs. 22 (12, 25) ms; P < 0.001], with optimal cut-off values of ≥18 and ≤9 ms, respectively., Conclusion: Shorter anatomical distances between the epi-EAS and ECS, and between the epi-EAS and LMT ostium, predict a successful ECS ablation. The prematurity of the endo-EAS electrogram and a shorter interval between the epi-EAS and endo-EAS predicted a successful endo-EAS ablation., Competing Interests: Conflict of interest: K.N. received speaker honoraria from Johnson & Johnson, Medtronic Japan, Boston Scientific Japan, Abbott Japan, and Daiichi-Sankyo. S.T. received honoraria from Medtronic Japan, Daiichi-Sankyo, Johnson & Johnson, Boston Scientific Japan, Abbott Japan, Bayer Yakuhin, and Japan Lifeline and is affiliated with the endowed research courses supported by Medtronic Japan, Japan Lifeline, Boston Scientific Japan, Abbott Japan, and Biotronik Japan. Y.O. received research grants unrelated to this study from Johnson & Johnson KK and Biosense Webster, Inc., scholarship funds from Nippon Boehringer Ingelheim, and remuneration from Daiichi-Sankyo, AstraZeneca, Bayer Healthcare, Bristol-Myers Squibb, and Johnson & Johnson KK and additionally belongs to the endowed departments of Boston Scientific Japan, Biotronik Japan, Abbott Medical Japan, Japan Lifeline, and Medtronic Japan. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: The slow pathway potential is difficult to annotate because it is buried within the atrial potential. Omnipolar technology near field can automatically annotate the peak frequency potential associated with acquired intracardiac electrograms., Objectives: This study aimed to visualize the junction between the transitional cells and the slow pathway using a peak frequency map with omnipolar technology near field and evaluate whether the high-frequency site around the tricuspid annulus (TA) is an effective target for slow pathway ablation., Methods: This prospective observational study enrolled 37 patients with typical atrioventricular nodal reentrant tachycardia. Patients underwent slow pathway ablation using a peak frequency map (n = 17) and the conventional approach based on anatomical and electrophysiological findings (n = 20)., Results: High-frequency sites were distributed at the TA side of the 4-5 o'clock position in all patients mapped using the peak frequency map of OTNF. The distance to the His bundle from the successful ablation site was farther (24.0 ± 4.8 mm vs 12.7 ± 4.0 mm; P < .0001), junctional rhythm was slower (88 ± 17 beats/min vs 115 ± 12 beats/min; P < .0001), the time to junctional rhythm after radiofrequency application was shorter (3.4 ± 1.4 seconds vs 8.2 ± 4.6 seconds; P < .0001), and the elimination rate of jump ups (71% vs 30%; P = .02) was higher in the peak frequency map-guided group., Conclusion: The high-frequency site of the TA at 4-5 o'clock in the peak frequency map could be a novel target of slow pathway ablation with high safety, efficiency, and efficacy., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Although previous studies have shown the isolated areas after pulmonary vein isolation (PVI) using cryoballoons (CB) (CB-PVI), no studies have investigated the association between the isolated area and recurrence of atrial fibrillation (AF) and atrial tachycardia (AT). This single-center observational study investigated the association between the ablated area and recurrence rate after durable CB-PVI for paroxysmal AF., Methods: This study included 76 patients with paroxysmal AF who underwent CB-PVI and established durable PVI with a second procedure, regardless of AF/AT recurrence, 6 months after the first procedure. To compare the ablated zones, we quantified the left- and right-sided PV antral isolation areas and non-ablated posterior wall (PW) area. We examined non-ablated areas of the PW and AF/AT recurrence in the chronic phase., Results: In total, 16 of the 76 patients had AF/AT recurrence. The mean follow-up duration was 34 months. The non-ablated PW area (14.0 ± 4.6 cm 2 vs. 11.5 ± 3.7 cm 2 ; p = 0.0213) and the ratio of the non-ablated PW area to the whole PW area (NAPW) (52.9 ± 9.1% vs. 44.8 ± 9.8%; p = 0.003) were significantly higher in the AF/AT recurrence group than in the AF/AT non-recurrence group. NAPW > 50% was an independent predictor of AF/AT recurrence., Conclusion: The NAPW after durable CB-PVI is associated with AF/AT recurrence. PW isolation or additional applications on the PV antrum with cryoballoon may be considered in addition to PVI in paroxysmal AF, especially in patients with dilated left atria., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In recent years, hydrogen bonding (H bonding) as an intramolecular locking strategy has been proposed to enhance photoluminescence, color purity, and photostability in thermally activated delayed fluorescence (TADF) materials. Rigidification as a design strategy is particularly relevant when using electron-deficient N -heterocycles as electron acceptors, because these materials often suffer from poor performance as orange to near-infrared emitters as a result of the energy gap law. To critically evaluate the presence of H bonding in such materials, two TADF-active donor-acceptor dyads, ACR-DQ and ACR-PQ, were synthesized. Despite their potential sites for intramolecular H bonding and emissions spanning yellow to deep red, computational analyses (including frequency, natural bond orbital, non-covalent interaction, and potential energy surface assessments) and crystal structure examinations collectively suggest the absence of H bonding in these materials. Our results indicate that invoking intramolecular H bonding should be done with caution in the design of rigidified TADF materials.

Background: The effect of His bundle pacing (HBP) on the incidence of new-onset atrial fibrillation (AF) after pacemaker implantation (PMI) for atrioventricular conduction disturbance (AVCD) remains unknown. We compared the incidence of new-onset atrial high-rate episode (AHRE) in conventional right ventricular (RV) septum pacing (RVSP) and His bundle pacing (HBP) after PMI for AVCD., Methods: One hundred and four consecutive patients who underwent dual chamber PMI for AVCD in our hospital were screened. Thirty-five patients with mitral or aortic valve disease, history of open-heart surgery, prior AF, subclinical AF, cumulative ventricular pacing percentage < 90%, and RV lead revision were excluded, and 69 patients were effectively enrolled in this study. The primary endpoint was new-onset AHRE within the follow-up period. New-onset AHRE was defined as an atrial high-rate episode that occurred 3 months after PMI and lasted for > 6 min at an atrial heart rate > 190 bpm. RV leads were placed in the His bundle region and RV septum region in 22 and 47 patients, respectively. The mean follow-up period was 539 ± 218 days. The follow-up period was 2 years after PMI or until the new-onset AHRE occurred., Results: The incidence of new-onset AHRE was lower in the HBP group than in the RVSP group (11% vs. 43%, p = 0.01). Multivariate analysis in the Cox regression hazard model showed that HBP had a significantly lower risk of new-onset AHRE compared with RVSP (HR = 0.21; 95% confidence interval 0.04-0.78, p = 0.02)., Conclusion: The incidence of new-onset AHRE was significantly less in HBP compared to RVSP during the 2-year follow-up period after pacemaker implantation in AVCD patients with RV pacing dependence., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Organic small molecules with high photothermal conversion efficiencies that absorb near-infrared light are desirable for photothermal therapy due to their improved biocompatibility compared to inorganic materials and their ability to absorb light in the biological transparency window (650-1350 nm). Here we report three donor-acceptor organic materials DM-ANDI, O-ANDI, and S-ANDI that show high photothermal conversion efficiencies of 46-68 % with near-infrared absorption. The design of these molecules is based on the rational modification of a thermally activated delayed fluorescence material to favour a low photoluminescence quantum yield by reducing HOMO-LUMO overlap. Encapsulating these materials into either neat nanoparticles or aggregated organic dots modulates their photothermal conversion efficiencies, and also facilitates dispersion in water., (© 2023 The Authors. Chemistry - A European Journal published by Wiley-VCH GmbH.)

Background: The relationship between coronary blood flow during atrial fibrillation (AF) and improvement of cardiac function after catheter ablation (CA) for persistent AF (PeAF) is not prominent; this study was conducted to evaluate this relationship., Methods: This was a retrospective case-control study. Eighty-five patients with PeAF (resting heart rate < 100 bpm) and heart failure with reduced ejection fraction (left ventricular ejection fraction (LVEF) < 40%) who had undergone coronary angiography within 1 week before CA were included. All patients could maintain a sinus rhythm for > 6 months after CA. The primary outcome was improvement of cardiac function with an LVEF cutoff value of > 50% during sinus rhythm 6 months after CA., Results: In the LVEF improvement group (N = 57), patients were younger, with a higher baseline diastolic blood pressure and lower baseline brain natriuretic peptide level than the no LVEF improvement group (N = 28). Heart rate at baseline and 6 months after CA and AF duration did not differ between the two groups. Thrombolysis in myocardial infarction frame count parameters was significantly higher in the LVEF improvement (P < 0.001) than in the no LVEF improvement group. Multivariate logistic regression analysis revealed mean thrombolysis in myocardial infarction frame count as an independent factor for LVEF improvement (odds ratio, 1.72 (95% confidence interval 1.17-2.54); P = 0.006)., Conclusion: Coronary blood flow in patients with PeAF is strongly associated with improved left ventricular systolic function after the restoration of sinus rhythm by CA for PeAF and heart failure with reduced ejection fraction., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Multiple resonance thermally activated delayed fluorescent (MR-TADF) materials offer higher color purity than conventional TADF materials but suffer from aggregation-caused quenching (ACQ) and rarely exhibit red emission. Herein, two malononitrile-substituted emitters are synthesized from a quinolino[3,2,1- de ]acridine-5,9-dione ( QAO ) MR-TADF precursor. Both materials maintain MR-TADF, while they display red-shifted fluorescence. They also overcome ACQ, displaying enhanced emission upon aggregation in solution and forming red-emissive J-aggregates in the solid state with photoluminescent quantum yields of 9 and 11%.

A 72-year-old man was treated for recurrent atrial tachycardia (AT) and underwent ablation. The AT was diagnosed as bi-AT based on the activation map and the postpacing interval. Another AT appeared and was diagnosed as bi-AT by the same method. Surprisingly, the circuits of both ATs were perfectly matched and rotated in opposite directions. The left atrial anteroseptal wall was ablated during the AT. The AT was immediately stopped and was no longer induced., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Triplet-triplet energy transfer (EnT) is a powerful activation pathway in photocatalysis that unlocks new organic transformations and improves the sustainability of organic synthesis. Many current examples, however, still rely on platinum-group metal complexes as photosensitizers, with associated high costs and environmental impacts. Photosensitizers that exhibit thermally activated delayed fluorescence (TADF) are attractive fully organic alternatives in EnT photocatalysis. However, TADF photocatalysts incorporating heavy atoms remain rare, despite their utility in inducing efficient spin-orbit-coupling, intersystem-crossing, and consequently a high triplet population. Here, we describe the synthesis of imidazo-phenothiazine (IPTZ), a sulfur-containing heterocycle with a locked planar structure and a shallow LUMO level. This acceptor is used to prepare seven TADF-active photocatalysts with triplet energies up to 63.9 kcal mol -1 . We show that sulfur incorporation improves spin-orbit coupling and increases triplet lifetimes up to 3.64 ms, while also allowing for tuning of photophysical properties via oxidation at the sulfur atom. These IPTZ materials are applied as photocatalysts in five seminal EnT reactions: [2 + 2] cycloaddition, the disulfide-ene reaction, and Ni-mediated C-O and C-N cross-coupling to afford etherification, esterification, and amination products, outcompeting the industry-standard TADF photocatalyst 2CzPN in four of the five studied scenarios. Detailed photophysical and theoretical studies are used to understand structure-activity relationships and to demonstrate the key role of the heavy atom effect in the design of TADF materials with superior photocatalytic performance.

Introduction: Posterior wall isolation (PWI) combined with pulmonary vein isolation (PVI) has proven effective for persistent atrial fibrillation (AF). However, when performing PWI, creating transmural lesions with subendocardial ablation is sometimes difficult. Endocardial unipolar voltage amplitude had a higher sensitivity than bipolar voltage mapping for identifying intramural viable myocardium in the atria. In this study, we aimed to retrospectively investigate the correlation between the residual potential in the posterior wall (PW) following PWI for persistent AF and atrial arrhythmia recurrence using endocardial unipolar voltage., Methods: This was a single-center observational study. Patients who underwent PVI and PWI for persistent AF in the first procedure between March 2018 and December 2021 at the Tokyo Metropolitan Hiroo Hospital were included in this study. The patients were divided into two groups based on the presence of residual unipolar PW potentials after PWI with a cutoff of 1.08 mV and the recurrence of atrial arrhythmias was compared., Results: In total, 109 patients were included in the analysis. Forty-three patients had residual unipolar potentials after PWI and 66 patients had no residual unipolar potentials. The atrial arrhythmia recurrence rate was significantly higher in the group with residual unipolar potential (41.8% vs. 17.9%, p = 0.003). The residual unipolar potential was an independent predictor of recurrence (odds ratio: 4.53; confidence interval: 1.67-12.3, p = 0.003)., Conclusion: Residual unipolar potential after PWI for persistent AF is associated with recurrent atrial arrhythmias., (© 2023 Wiley Periodicals LLC.)

The LUMIPOINT™ software allows visualization of arrhythmia circuits through the MB. In cases where the full extent of the arrhythmia circuit cannot be identified and epicardial conduction is suspected, it is better to perform the analysis while adjusting the confidence slider in LUMIPOINT™., Competing Interests: Authors declare no conflict of interests for this article., (© 2023 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Aims: The optimal anticoagulation regimen in patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation is unknown. We sought to describe the real-world practice of peri-procedural anticoagulation management in patients with ESKD undergoing AF ablation., Methods and Results: Patients with ESKD on haemodialysis undergoing catheter ablation for AF in 12 referral centres in Japan were included. The international normalized ratio (INR) before and 1 and 3 months after ablation was collected. Peri-procedural major haemorrhagic events as defined by the International Society on Thrombosis and Haemostasis, as well as thromboembolic events, were adjudicated. A total of 347 procedures in 307 patients (67 ±9 years, 40% female) were included. Overall, INR values were grossly subtherapeutic [1.58 (interquartile range: 1.20-2.00) before ablation, 1.54 (1.22-2.02) at 1 month, and 1.22 (1.01-1.71) at 3 months]. Thirty-five patients (10%) suffered major complications, the majority of which was major bleeding (19 patients; 5.4%), including 11 cardiac tamponade (3.2%). There were two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was the only independent predictor of major bleeding [odds ratio, 3.3 (1.2-8.7), P = 0.018]. No cerebral or systemic thromboembolism occurred., Conclusion: Despite most patients with ESKD undergoing AF ablation showing undertreatment with warfarin, major bleeding events are common while thromboembolic events are rare., Competing Interests: Conflict of interest: None declared, (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The development of deep-red thermally activated delayed fluorescence (TADF) emitters is important for applications such as organic light-emitting diodes (OLEDs) and biological imaging. Design strategies for red-shifting emission include synthesizing rigid acceptor cores to limit nonradiative decay and employing strong electron-donating groups. In this work, three novel luminescent donor-acceptor compounds based on the dibenzo[ a , c ]dipyrido[3,2-h:20-30- j ]-phenazine-12-yl ( BPPZ ) acceptor were prepared using dendritic carbazole-based donors 3,3″,6,6″-tetramethoxy-9' H -9,3':6',9″-tercarbazole ( TMTC ), N 3 , N 3 , N 6 , N 6 -tetra- p -tolyl-9 H -carbazole-3,6-diamine ( TTAC ), and N 3 , N 3 , N 6 , N 6 -tetrakis(4-methoxyphenyl)-9 H -carbazole-3,6-diamine ( TMAC ). Here, dimethoxycarbazole, ditolylamine, and bis(4-methoxyphenyl)amine were introduced at the 3,6-positions of carbazole to increase the strength of these donors and induce long-wavelength emission. Substituent effects were investigated with experiments and theoretical calculations. The emission maxima of these materials in toluene were found to be 562, 658, and 680 nm for BPPZ-2TMTC , BPPZ-2TTAC , and BPPZ-2TMAC , respectively, highlighting the exceptional strength of the TMAC donor, which pushes the emission into the deep-red region of the visible spectrum as well as into the biological transparency window (650-1350 nm). Long-lived emission lifetimes were observed in each emitter due to TADF in BPPZ-2TMC and BPPZ-2TTAC , as well as room-temperature phosphorescence in BPPZ-2TMAC . Overall, this work showcases deep-red emissive dendritic donor-acceptor materials which have potential as bioimaging agents with emission in the biological transparency window.

Three donor-acceptor compounds based on the imidazo-pyrazine-5,6-dicarbonitrile (IPDC) acceptor were synthesized. The IPDC emitters exhibit blue to near-infrared (NIR) emission with up to 54 % photoluminescent quantum yield. 9,9-Dimethyl-9,10-dihydroacridine (ACR), phenoxazine (POX), and phenothiazine (PTZ) served as electron donors. IPDC-POX displayed NIR emission in toluene solution, while showing room-temperature phosphorescence in the solid state. IPDC-ACR exhibited yellow thermally activated delayed fluorescence. Interestingly, dual-emissive behavior as well as excitation-dependent thermally activated delayed fluorescence (TADF) was found for IPDC-PTZ, arising from the two conformers of phenothiazine derivatives. Overall, this work describes a novel strong electron acceptor from the fusion of imidazole, pyrazine, and nitrile functional groups into one conjugated heterocycle for materials exhibiting NIR emission, TADF, and/or room-temperature phosphorescence (RTP)., (© 2023 Wiley-VCH GmbH.)

Planarized emitters exhibiting thermally activated delayed fluorescence (TADF) have attracted attention due to their narrow emission spectra, improved photostability, and high quantum yields, but with large singlet-triplet energy gaps (Δ E ST ) and no heavy atoms, the origin of their TADF remains a subject of debate. Here we prepare two isomeric, coplanar donor-acceptor compounds, with HMAT-2PYM performing dual TADF and room-temperature phosphorescence but with HMAT-4PYM exhibiting only prompt fluorescence. Although conventional TADF design principles suggest that neither isomer should exhibit TADF, we reveal differences in the excited state potential energy surfaces that enable spin-flip processes in only one isomer. We also find that hydrogen bonding is absent between the planar units of these emitters, despite earlier claims of intramolecular hydrogen bonding in similar compounds. Overall, this work demonstrates that potential energy surface analysis is a practical strategy for designing coplanar TADF materials that might otherwise be overlooked by conventional TADF design metrics.

Background: In adult patients, subcutaneous implantable cardioverter defibrillators (S-ICDs) have been reported to be non-inferior to transvenous ICDs with respect to the incidence of device-related complications and inappropriate shocks. Only a few reports have investigated the efficacy of S-ICDs in the pediatric field. This study aimed to investigate the utility and safety of S-ICDs in patients ≤18 years old., Methods: This study was a multicenter, observational, retrospective study on S-ICD implantations. Patients <18 years old who underwent S-ICD implantations were enrolled. The detailed data on the device implantations and eligibility tests, incidence of appropriate- and inappropriate shocks, and follow-up data were assessed., Results: A total of 62 patients were enrolled from 30 centers. The patients ranged in age from 3 to 18 (median 14 years old [IQR 11.0-16.0 years]). During a median follow up of 27 months (13.3-35.8), a total of 16 patients (26.2%) received appropriate shocks and 13 (21.3%) received inappropriate shocks. The common causes of the inappropriate shocks were sinus tachycardia (n = 4, 30.8%) and T-wave oversensing (n = 4, 30.8%). In spite of the physical growth, the number of suitable sensing vectors did not change during the follow up. No one had any lead fractures or device infections in the chronic phase., Conclusions: Our study suggested that S-ICDs can prevent sudden cardiac death in the pediatric population with a low incidence of lead complications or device infections. The number of suitable sensing vectors did not change during the patients' growth., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Local impedance (LI) parameters of IntellaNav STABLEPOINT for successful pulmonary vein isolation (PVI) of atrial fibrillation (AF) remain unclear. The purpose of this study was to seek LI data achieving successful PVI., Methods: Consecutive AF patients who underwent catheter ablation with STABLEPOINT were prospectively enrolled in two centers. PVI was performed under a constant 35-or 40-watt power, 20-s duration, and >5-g contact force. The operators were blinded to the LI data. The characteristics of all ablation points with/without conduction gaps (Unsuccess or Success tags) after the first-attempt PVI were evaluated for the right/left PVs and anterior/posterior wall (RPV/LPV and AW/PW, respectively), and cutoff values of LI data were calculated for successful lesion formation., Results: A total of 5257 ablation points in 102 patients (65 [58-72] years old, 65.7% male) were evaluated. The LI drop values were higher in the Success tags than Unsuccess tags on the LPV-AW and RPV-AW/PW (p < .001), except for the LPV-PW (p = .105). The %LI drop values (LI drop/initial LI) were higher for the Success tags in all areas (15.8 [12.2%-19.6%] vs. 11.6 [9.7%-15.6%] in LPV-AW: p < .001, 15.0 [11.5%-19.3%] vs. 11.4 [8.7%-17.3%] in LPV-PW: p = .035, 15.3 [11.5%-19.4%] vs. 9.9 [8.1%-13.7%] in RPV-AW: p < .001, and 13.3 [10.1%-17.4%] vs. 8.1 [6.3%-9.5%] in RPV-PW, p < .001). The LI drop and %LI drop cutoff values were 20.0 ohms and 11.6%, respectively., Conclusions: An insufficient LI drop with STABLEPOINT was associated with a gap formation during PVI, and the best cutoff values for the LI drop and %LI drop were 20.0 ohms and 11.6%, respectively., (© 2022 Wiley Periodicals LLC.)

Background: Ventricular arrhythmia inducibility is one of the ideal endpoints of ventricular tachycardia (VT) ablation. However, it may be challenging to implement programmed electrical stimulation (PES) at the end of the procedure under several circumstances. The long-term outcome of patients who did not undergo PES after VT ablation remains largely unknown., Purpose: To investigate the details and long-term outcome of VT ablation in patients who did not undergo PES at the end of the ablation procedure., Methods: Among 183 VT ablation procedures in patients with structural heart disease who underwent VT ablation using an irrigated catheter, we enrolled those who did not undergo PES after VT ablation. VT ablation strategy involved targeting clinical VT plus pacemap-guided substrate ablation if inducible. When VT was not inducible, substrate-based ablation was performed. The primary endpoint was VT recurrence., Results: In 58 procedures, post-ablation VT inducibility was not assessed. The causes were non-inducibility of sustained VT before ablation (27/58, 46.6%), long procedure time (27.6%, mean 392 min), complications (10.3%), intolerant hemodynamic state (10.3%), and inaccessible or unsafe target (6.9%). With regard to the primary endpoint, 23 recurrences (39.7%) were observed during a mean follow-up period of 2.5 years. Patients with non-inducibility before ablation showed less VT recurrences (4/27, 14.8%) during follow-up than patients with other causes of untested PES after ablation (19/31, 61.2%) (Log-rank < 0.001)., Conclusions: VT recurrence was not observed in approximately 60% of the patients who did not undergo PES at the end of the ablation procedure. PES after VT ablation may be not needed among patients with pre-ablation non-inducibility., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

The patient was a 60-year-old woman who underwent thoracoabdominal aorta replacement for type B aortic dissection three years ago and aortic root replacement and total aortic arch replacement due to asymptomatic type A aortic dissection two years previously. Her clinical course was uneventful until follow-up computed tomography (CT) disclosed anastomotic insufficiency in the innominate artery and left main coronary artery stenosis owing to hematoma. Emergent percutaneous coronary intervention and stent graft insertion into the innominate artery were performed successfully. Seven months later, however, CT scan revealed a perforation in the posterior wall of the artificial graft damaged by the edge of the implanted stent graft. The patient underwent open surgery and perforation of artificial graft was sutured and redundant stent graft edge was resected. Artificial graft damage by stent graft placement is rare to date, but may increase in the future in accordance with broader application of endovascular treatment.

Competing Interests: None declared.

Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, β-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022-0.959, p = 0.045; OR, 0.077, 95% CI, 0.007-0.805, p = 0.032; OR, 6.494, 95% CI, 1.228-34.34, p = 0.028; OR, 0.890, 95% CI, 0.828-0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era., (© 2021. The Author(s).)

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.

Background: Previous studies have demonstrated that some patients have spontaneous right atrium (RA)-superior vena cava (SVC) conduction block, which could be utilized to isolate the SVC effectively by using the Rhythmia mapping system (Boston Scientific). However, employing this approach for SVC isolation using the CARTO electroanatomical mapping system (Biosense Webster) has not yet been clarified. This study aimed to evaluate the safety and efficacy of SVC isolation using the extended early meets late (EEML) tool with the CARTO system., Methods: The patients who underwent SVC isolation using the CARTO system were enrolled in this study. The RA-SVC conduction block was visualized with an EEML tool. We prospectively assessed the safety and efficacy of SVC isolation using this system., Results: We analyzed 54 patients, and all SVCs were successfully isolated with no complications. Altogether, 44 patients (81.5%) had spontaneous RA-SVC conduction block, and the remaining 10 patients (18.5%) did not. The block group required fewer radiofrequency deliveries for the SVC isolation than the nonblock group (10.7 ± 5.0 vs 15.5 ± 4.8, P  = .009). The size of the isolated area in the block group was larger than that in the nonblock group (15.2 ± 5.1 cm 2 vs 12.4 ± 2.5 cm 2 , P  = .017)., Conclusions: Approximately 80% of the patients in this study developed a spontaneous RA-SVC conduction block, which might contribute to shortening the time of ablation and avoiding complications., Competing Interests: The authors have no financial conflicts of interest directly relevant to this study., (© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Background: The termination of bi-atrial tachycardia (BiAT) via the ablation of the Bachmann's bundle (BB) and mitral isthmus (MI) has been previously reported; however, the strategy and long-term results of catheter ablation for BiAT remain unclear., Methods: The data of nine patients with BiAT who underwent low voltage zone (LVZ) ablation of the left atrial anterior wall (LAAW) after pulmonary vein isolation were reviewed. Patients with a P wave duration <100 ms during sinus rhythm underwent MI ablation and those with a P wave duration >100 ms underwent BB ablation., Results: MI ablation was performed in three patients and six patients underwent BB ablation. The difference in the P wave duration before and after ablation was significantly different between the ablation sites (MI group: 5.0 ms difference; BB group; 38.5 ms difference; P  = .024). The P wave duration was prolonged by >20 ms and was 120 ms or more after ablation in 5/6 patients who underwent BB ablation. The total recurrence rate was 11.0% (mean: 26.9 months)., Conclusion: The recurrence of BiAT after MI or BB ablation is low. When BB ablation was performed, the P wave duration was prolonged by >20 ms and was at least 120 ms after the ablation, which may be an endpoint that can be used to measure the success of the ablation., Competing Interests: Authors declare no conflict of interests for this article., (© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

The Accufix bipolar active fixation atrial pacing lead (Model 330-801; Telectronics) can have mechanical complications due to a fracture of its J retention wire. An 80-year-old man had the Accufix atrial pacing lead implanted 29 years prior, and surgical removal was required because a part of the lead was perforating the apex of the right ventricle. Regular follow-up examinations are recommended to eliminate the possibility of protrusion and detachment of the J retention wire, even if the clinical course after implantation is stable for a prolonged period., (© 2021 Wiley Periodicals LLC.)

Introduction: It is important to consider recurrent arrhythmia after catheter ablation for persistent atrial fibrillation (AF) for planning an ablation strategy. However, the studies are limited to pulmonary vein isolation (PVI) plus posterior wall isolation (PWI), which were reported to improve procedural outcomes. The objective of this study is to evaluate the effect of PWI on recurrent arrhythmia., Methods: This is an observational study on patients with persistent AF comparing PVI plus PWI and PVI only strategies. In PVI plus PWI group, linear ablation of the left atrium roofline and bottom line were performed to achieve PWI after PVI. Some patients with AF recurrence underwent the second procedure. The presence of recurrent arrhythmia and results of the second procedures were evaluated., Results: A total of 181 patients (mean age, 66.9 ± 10.2 years; male, 76.8%) were included. PVI plus PWI group and PVI only group consisted of 90 and 91 patients, respectively. AF recurrence was observed in 28 of 90 (31.1%) patients with PVI plus PWI and in 43 of 91 (47.3%) with PVI only, and log-rank test did not show any significant difference (p = .35). The occurrence of recurrent persistent AF was significantly lower in PVI plus PWI group than in PVI only group (5/90; 5.6% vs. 18/91; 20.9%, p = .002). There was no significant difference between the two groups in recurrent paroxysmal AF and atrial tachycardia (AT)., Conclusion: PWI, in addition to PVI, for persistent AF was significantly related to fewer episodes of recurrent persistent AF, and it did not increase recurrent AT., (© 2021 Wiley Periodicals LLC.)

Introduction: In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS., Methods: This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low-voltage area (LA-LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA-LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non-LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups., Results: LA volume, age, CHA 2 DS 2 VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non-LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p = .001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA-LVA (<0.5 mV) greater than 5%. The areas under the receiver operating characteristic curves for predicting LA-LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women., Conclusion: Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men., (© 2020 Wiley Periodicals LLC.)

Objectives: This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT)., Background: Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging., Methods: We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference)., Results: More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT., Conclusions: Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT., Competing Interests: Author Disclosures This study was supported by departmental resources only. Dr. Ueda has received an endowment from Abbott Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)