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Catheter-directed intra-arterial thrombolysis (CDT) is useful for not only patients with acute limb ischemia but also those with chronic total occlusions (CTOs) of the lower extremity arteries. However, it is difficult to determine whether CTO lesions have significant thrombi, which can be treated by CDT, or not in a clinical setting. Angioscopy can accurately detect thrombi. We investigated the clinical impact of angioscopy guided endovascular therapy following thrombolysis (AGET) for in-stent occlusions (ISOs) in iliac or femoropopliteal arteries.We performed AGET in 7 patients with ISOs whose occlusion duration was less than 1 year. We performed angioscopy to evaluate the area of the thrombi after a successful wire crossing of an ISO lesion. In addition, we performed biopsies of ISO lesions to confirm whether the angioscopic findings coincided with the histopathological findings at 20 sites. We selectively performed a continuous infusion of urokinase using a fountain infusion catheter for ISO lesions. The next day, we evaluated the lesion flow and performed intervention only at the plaque stenosis site if necessary.AGET could achieve TIMI 3 flow in all patients, and preserved a 1-year patency in 5 patients (71.4%). The angioscopic findings of thrombi and plaque perfectly coincided with the histopathological findings.In conclusion, this new endovascular therapy technique, AGET, was observed to be feasible and safe for iliac or femoropopliteal artery ISO lesions.

Although much has been discussed about the early recurrence of atrial fibrillation (ERAF) after cryoballoon ablation (CBA), the clinical impact of very early recurrence of atrial fibrillation (VERAF) after CBA remains unclear. This study aimed to investigate the impact of VERAF after CBA.We enrolled 236 consecutive patients who underwent an initial CBA for paroxysmal atrial fibrillation between February 2017 and December 2020 in our hospital. These patients were categorized into three groups: VERAF group who experienced an initial recurrence of atrial tachyarrhythmia within 48 h after CBA, late-ERAF (LERAF) group who experienced an initial recurrence of atrial tachyarrhythmia between 48 h and 3 months after CBA, and non-ERAF (NERAF) group who did not experience a recurrence of atrial tachyarrhythmia within 3 months after CBA. We investigated the late recurrence of AF (LRAF, defined as recurrence of atrial tachyarrhythmia more than 3 months after CBA), and the incidence of non-pulmonary vein (PV) triggers in the patients who experienced a repeat ablation procedure due to LRAF.VERAF group had a higher incidence of freedom from LRAF than LERAF group (p = 0.032) and a lower incidence of freedom from LRAF than NERAF group (p = 0.002). Moreover, VERAF group had the highest incidence of non-PV triggers at repeat ablation procedure among the three groups (p = 0.003).While ERAF was a predictor of LRAF, VERAF was less related to LRAF among the patients with ERAF after CBA. Furthermore, VERAF might be associated with non-PV triggers.

Persistent sciatic artery (PSA) is a rare vascular anomaly that can cause acute limb ischaemia (ALI) due to peripheral thromboembolism following aneurysm formation, and surgical repair or exclusion with or without femoropopliteal bypass is the standard treatment for these symptomatic cases of PSA. Here, we report a case of a 70-year-old man with right PSA aneurysm who suffered from recurrent ALI despite the history of right femoropopliteal bypass at the age of 58 for occlusion of right PSA and graft (femoropopliteal bypass graft)-to-tibial bypass at the age of 68 for occlusion of right posterior tibial artery. We performed a catheter angiographic examination using an intravascular ultrasound and performed an endovascular therapy (EVT) for the purpose of jailing the internal iliac artery. This is a rare case of PSA aneurysm presenting with recurrent ALI after femoropopliteal bypass successfully treated with EVT.

Little has been reported on the impact of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients with left atrial enlargement (LAE). A total of 706 patients underwent an initial RFCA for AF between September 2014 and September 2019 in our hospital. These patients were categorized into two groups according to the pre-procedural left atrial diameter (LAD) measured by transthoracic echocardiography (TTE): LAE group with LAD ≥ 50 mm and non-LAE group with LAD 50 mm. We compared the patient characteristics, ablation procedures, and late recurrence of AF (LRAF, defined as a recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) between the two groups. In addition, we performed follow-up TTE at 12 months after RFCA and investigated the factors associated with left atrium (LA) reverse remodeling in each group. LAE group and non-LAE group consisted of 155 and 551 patients, respectively. There were no significant differences in ablation procedures, procedure-related complications, and the incidence of LRAF between the two groups. Furthermore, non-PAF was identified as an independent predictor of LA reverse remodeling in LAE group by multiple regression analysis (P = 0.020). RFCA might be an effective and safe procedure even in patients with LAD ≥ 50 mm, using the contemporary 3D-guided mapping and ablation technologies. Moreover, RFCA can lead to LA reverse remodeling in 1 year if they have non-PAF before ablation.

At present, it remains unclear whether the effect on cryoinjury can be strongly exerted by contact of the balloon with the pulmonary vein (PV) ostium. The present study included 204 paroxysmal atrial fibrillation (PAF) patients who underwent an initial pulmonary vein isolation (PVI) using a cryoballoon from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The total balloon contact angle was measured from the equator line (sum of the angles of the upper side and bottom side in all PVs) under fluoroscopic imaging. The patients were stratified into three tertile groups according to the total balloon contact angle. We evaluated the relationship between the total balloon contact angle and clinical outcomes, including the value of acute myocardial injury marker (high-sensitive cardiac troponin I [hs-TnI]), arrhythmia recurrence, and PV reconnections in the repeated ablation. The total balloon contact angle was significantly associated with the hs-TnI value among the tertile groups (p 0.001) and a multiple regression analysis showed that the total balloon contact angle significantly correlated with the hs-TnI value (standardized beta-coefficient = 0.572, p 0.001). The balloon contact angle in PVs with PV reconnections was significantly lower than in those without (p = 0.044), while no significant differences in the recurrence of atrial fibrillation among the tertile groups were observed in the enrolled patients. The total balloon contact angle was significantly associated with the acute myocardial injury marker, hs-TnI. The total balloon contact angle was significantly associated with PV reconnections after cryoballoon ablation in patients who underwent a repeat ablation.

Purpose:Ultra-thin strut polymer-free sirolimus eluting stent (UPF-SES) have two novel characteristics, ultra-thin strut and polymer-free coating, which have the potential to achieve early re-endotherialization. However, a little is known whether early vascular healing of UPF-SES can be achieved in patients with acute coronary syndrome (ACS).The aim of this study was to evaluate the vascular healing after an implantation of UPF-SES in patients with ACS using optical coherence tomography (OCT) at 3 months after the stent implantation. Methods:From September 2020 and January 2021, a total of 31 consecutive patients presenting with ACS who underwent OCT examinations at the initial percutaneous coronary intervention (PCI) and 3-month follow-up were enrolled in the USUI-ACS study. The endpoints of this study were neointimal strut coverage, malapposition, and mean neointimal hyperplasia (NIH) thickness at 3-month follow-up.Results:Over a mean follow-up of 91 days after the initial PCI, the follow-up OCT was examined. The median percentage of covered struts was 98.4% and malapposed struts 0%, and the mean NIH thickness was 60μm.Conclusions:UPF-SES exhibited an excellent early vascular healing at 3-months in patients with ACS.

An ablation index (AI)-guided pulmonary vein isolation (PVI) or 2nd generation cryoballoon (CB)-PVI has been shown to reduce the atrial fibrillation (AF) burden by 99% despite the absence of ablation of non-pulmonary vein (PV) triggers in patients with paroxysmal AF. The purpose of this study was to investigate the effects of PVI alone strategy using 2nd generation CB compared with AI-guided PVI with an additional induction test and subsequent AF trigger ablation.We investigated 223 patients with symptomatic paroxysmal AF who underwent an initial PVI between August 2018 and August 2020. The study patients were divided into 2 groups: CB-PVI without an induction test (CB-PVI alone group, n = 82) and AI-guided PVI with an induction test and subsequent additional ablation of non-PV triggers (AI-PVI plus group, n = 141). In the AI-PVI plus group, a total of 62 non-PV triggers were induced in 38 patients, and non-PV triggers in 22 patients were completely ablated. The procedure time and left atrium dwell time were significantly shorter in the CB-PVI alone group than AI-PVI plus group. There were no significant differences in the incidence of procedural complications between the 2 groups (P = 0.650). The AF free survival rate in the CB-PVI alone group and AI-PVI plus group was 80% vs. 80% at 24 months (P = 0.969).An PVI alone strategy using advanced generation CB did not differ in the clinical outcomes compared with an AI-guided PVI strategy with an induction test and subsequent ablation of non-PV triggers in the patients with paroxysmal AF.

PURPOSE Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)-guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)-guided PVI. METHODS Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period. RESULTS A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P

Background Cryoballoon ablation (CBA) and laser balloon ablation (LBA) were developed as alternatives to conventional radiofrequency ablation for paroxysmal atrial fibrillation (PAF). Pathological findings after ablation such as myocardial injury and inflammation are thought to be different between CBA and LBA. However, the different impact of myocardial injury and inflammation after ablation on short- and mid-term outcomes remains unclear. Methods Consecutive PAF patients who underwent CBA and LBA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The difference of the acute myocardial injury marker (hs-TnI), and changes of inflammation markers (C reactive protein; ΔCRP, and white blood cell; ΔWBC) after catheter ablation and the difference of the short-term (within 3 months after ablation) and mid-term (from 3 months to 6 months after ablation) outcomes were evaluated between the two groups. Results The CBA and LBA groups consisted of 55 and 56 patients, respectively. After propensity score matching, CBA and LBA groups consisted of 37 patients, respectively. Hs-TnI value was significantly higher in CBA than LBA group, while ΔCRP and ΔWBC were significantly higher in LBA than CBA group. In the propensity score-matched pairs, the LBA group had a significantly greater risk of short-term arrhythmia recurrence than the CBA group, whereas no significant difference of mid-term arrhythmia recurrence were found between the two groups. Conclusion Myocardial injury and inflammation status differ between CBA and LBA groups. LBA group had stronger inflammation after ablation and had a significantly greater risk of short-term arrhythmia recurrence after PVI than CBA group.

Heart failure (HF) is reported to be one of the major risks of bleeding events. On the other hand, HF patients frequently receive anticoagulants or antiplatelet therapy to manage various co-morbidities. However, predictors of bleeding events in patients with HF have rarely been reported. This study aimed to evaluate the predictors of bleeding events and relationship between bleeding events and HF re-hospitalizations.We included 1660 acute decompensated heart failure (ADHF) patients from the AURORA registry between January 2015 and December 2020. A total of 1429 patients were excluded because of history of HF admission, missing echocardiographic data at discharge, lost to follow-up, haemodialysis and no antithrombotic drugs. Finally, we evaluated 231 patients from AURORA registry. The bleeding events were defined as Type 2 to 5 bleeding according to the Bleeding Academic Research Consortium definition. We divided our patients into the bleeding group and non-bleeding group. We compared the baseline characteristics, medications, laboratory data, and echocardiographic data between the two groups. Median age was 78 (IQR 71-82) years old and male accounted for 59%. Approximately half of the patients had an antiplatelet therapy and 70% had an anticoagulant therapy. During a median follow-up of 651 (IQR 357-1139) days, 32 patients (13.8%) suffered from bleeding events. The major driver of the registered events was gastrointestinal bleeding (n = 21, 65.6%), and the other events were cerebral bleeding (n = 4, 12.5%), intraarticular bleeding (n = 2, 6.3%), urogenital bleeding (n = 2, 6.3%), haemorrhagic pericardial effusions (n = 1, 3.1%), subcutaneous hematomas (n = 1, 3.1%), and haemothorax (n = 1, 3.1%). There was a significantly lower haemoglobin level (P 0.01), higher proportion of inferior vena cava (IVC) diameter ≥21 mm (P 0.01), and higher furosemide equivalent doses per kilogram (P 0.01) in the bleeding group than non-bleeding group. A multivariate analysis revealed an equivalent dose of furosemide per kilogram ≥0.66 mg/kg (hazard ratios (HR) of 2.64, 95% confidence interval (CI) 1.26-5.68, P = 0.01), haemoglobin ≤10.3 g/dL (HR of 2.43, 95% CI 1.14-5.03, P = 0.02), and IVC diameter ≥21 mm (HR of 2.79, 95% CI 1.16-6.29, P = 0.02) were independently associated with bleeding events. The Kaplan-Meier analysis showed that HF re-hospitalization rates were higher in the bleeding group than non-bleeding group (P = 0.04).High doses of oral loop diuretics, IVC dilatation, and anaemia were predictors of bleeding events in patients hospitalized with ADHF patients. In addition, bleeding events were associated with HF re-hospitalizations.

Various predictors of atrial fibrillation (AF) recurrence have been shown based on the baseline characteristics before catheter ablation (CA). This study aimed to develop a novel scoring system for predicting very late recurrences of AF (VLRAFs) after an initial CA, taking the postprocedural clinical data into account and reassessing VLRAFs in 12-month patients' condition using previously known preprocedural predictors of AF recurrences. We retrospectively studied 327 patients who underwent an initial CA with freedom from AF for over 12 months. We elucidated the predictors of VLRAFs and created a new score to predict VLRAFs in the discovery AF cohort (n = 181). Thereafter, we investigated whether the new scoring system could accurately predict VLRAFs in the validation AF cohort (n = 146). In the discovery AF cohort, VLRAFs were observed in 53 patients (29%) during the follow-up period (mean follow-up duration: 55 months). The univariate and multivariate Cox proportional-hazards model demonstrated that non-pulmonary vein foci, early recurrences of AF (ERAFs), atrial premature contraction (APC) burden ≥ 142/24 hours, and minimum prematurity index of the APCs ≤ 48% were associated with VLRAFs after CA. We created a new scoring system to predict VLRAFs, the n-PReDCt score (non-pulmonary vein: 1 point, early recurrences of AFs (Recurrences of AF in early phase after CA): 1 point, APC burden ≥ 142/24 hours: 1 point, and minimum prematurity index (= Coupling interval) of the APCs of ≤ 48%: 1 point). The n-PReDCt score was significantly associated with VLRAFs by a Kaplan-Meier analysis in the discovery AF and validation AF cohorts (p0.0001 and p0.0001, respectively).

Blood urea nitrogen (BUN) reflects decreased glomerular filtration rate (GFR). The effect of BUN on clinical outcomes, excluding the impact of GFR, in heart failure with preserved ejection fraction (HFpEF) patients remains unknown.We enrolled HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure (HF) from PURSUIT-HFpEF registry which was prospective, multicenter and observational study. For excluding the effect of renal function on BUN value, propensity score-matching was performed using the variables which were associated with GFR. The incidence of composite of all-cause death and HF readmission among the patients stratified by BUN and the association between BUN and echocardiographic parameters in HFpEF patients were evaluated.We finally analyzed 1029 patients. In the present study, BUN cut-off value was defined as 24.4 mg/dL, which was the median value in overall population. The high and low BUN groups consisted of 193 patients after 1:1 propensity score-matching, respectively. The median follow-up duration was 401 days and the composite endpoint occurred in 129 patients (33.4%). Kaplan-Meier analysis showed the high BUN group had a significantly greater risk of the composite endpoint than the low group in the propensity score-matched pairs (p = 0.032). BUN value significantly correlated with left atrial volume index by multiple regression analysis using echocardiographic parameters (standardized beta-coefficient = 0.139, p = 0.043).BUN was a useful marker for the composite of all-cause death and HF readmission, regardless of the baseline renal function and correlated with left atrial function in HFpEF patients.UMIN000021831https://uplaod.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414; PURSUIT-HFpEF.

INTRODUCTION It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA-SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure. METHODS Seventy-three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line. The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture. RESULTS Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients. The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA-SVC junction was higher in the anterior portion (anterior-septal, anterior, and anterior-lateral) than in the posterior portion (posterior-septal, posterior, and posterior-lateral) (-2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p

Local impedance (LI) drop during radiofrequency (RF) application is monitored to assess the lesion formation. Recently, a novel ablation catheter has been introduced to clinical setting, which is capable of monitoring LI and catheter contact parameters including contact force (CF) and contact angle (CA). This study aimed to clarify the correlation between LI drop and catheter contact parameters.This prospective study included 15 paroxysmal atrial fibrillation (AF) patients who underwent initial pulmonary vein isolation (PVI). First-pass encircling point-by-point PV ablation was performed by using a 4.5-mm irrigated ablation catheter, with monitoring LI, CF, and CA. RF energy was applied for 30 s at each site with 30 W. Stable ablation points were analyzed to examine the correlation between LI drop and catheter contact parameters. Among 903 ablation points, 499 stable ablation points (55.2%) were analyzed. CA showed good correlation with LI drop (ρ = 0.418, p.001). Maximum CF, minimum CF, average CF, and initial CF all showed weak correlation with LI drop (ρ = 0.201, p.001; ρ = 0.224, p.001; ρ = 0.258, p.001; and ρ = 0.212, p.001, respectively). Multivariate analysis demonstrated that CA was an independent factor of LI drop among the catheter contact parameters (β = 0.139, 95% CI = 0.111-0.167, p.001). The LI drop in the blocked segments was significantly higher than that in the electrical conduction gap segments (27.3 ± 9.8 vs. 19.6 ± 6.4 Ω, p.001) CONCLUSION: In clinical PVI use, both CF and CA were correlated with LI drop. More parallel CA could induce higher LI drop, which may lead to effective lesion formation.

(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan–Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV.

Right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcomes in heart failure patients. We aimed to elucidate the relationship between RV-PA uncoupling and late arrhythmia recurrence after ablation in persistent atrial fibrillation (PerAF) patients whose phenotypes have impaired right ventricular function and pulmonary hypertension.The present study included 203 PerAF patients from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who underwent an initial ablation. We assigned the patients based on the value of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio that could predict late recurrence of AF/atrial tachycardia (LRAF) as an indicator of RV-PA uncoupling. We evaluated the following factors: the difference in the relationship between TASPE/PASP before ablation and incidence of LRAF among the 2 groups stratified by TAPSE/PASP based on the above cut-off value and TAPSE/PASP change from before to one-year after ablation.A receiver operating characteristic curve analysis revealed a good accuracy of predicting LRAF by TAPSE/PASP ratio with a cutoff of 0.57. The patients with TAPSE/PASP ratios ≤ 0.57 had a significantly greater LRAF risk than TAPSE/PASP ratios 0.57. A multivariate Cox proportional hazards analysis showed that TAPSE/PASP (HR 0.12, 95% CI; 0.019-0.724, p = 0.026) was independently and significantly associated with LRAF. The TAPSE/PASP significantly improved more one-year after the ablation than before (p = 0.016).RV-PA uncoupling was independently associated with LRAF, independent of left atrial function, and significantly improved more one-year after the ablation than before in PerAF patients.

This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 49 lesions from 49 ACS patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared vascular healing using OCT between O-SESs and X-EESs at 8 months after stenting. The protocol was approved by the Osaka Rosai Hospital ethics committee. Among 49 lesions, the X-EES group consisted of 24 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8 months were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 92.5%; p = 0.010). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 0.3%, p = 0.609). The O-SES group had the significantly thinner neointima compared to the X-EES group (60 μm vs 84 μm, p = 0.001). Compared to X-EESs, O-SESs showed better strut coverage and thinner neointima in ACS patients at 8 months follow-up. Ultra-thin strut and silicon carbide passive coating may play a key role in better vascular healing.

The obesity paradox states higher body mass index (BMI) is associated with better outcomes than normal weight in patients with heart failure with preserved ejection fraction (HFpEF). However, underweight was defined by BMI < 18.5 kg/m2, and results have been inconclusive, in part due to small number of participants. The number of underweight patients with HFpEF is higher in Asian than in Western countries. In this study, we aim to determine the prognostic impact of underweight in patients with HFpEF in Asian population.We enrolled 846 consecutive patients from the PURSUIT-HFpEF registry. We then divided them into three groups by BMI, namely, underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 23), and overweight (23 ≤ BMI). The underweight group consisted of 187 patients (22%). Over a mean follow-up of 407 days, 105 deaths were reported as all-cause mortality. On multivariable Cox analysis, the underweight group was determined to be significantly associated with higher risk of all-cause mortality than the normal and overweight groups (Hazard ratios [HR]: 2.33; 95% confidence intervals [CI]: 1.45-3.75, P < 0.001; HR: 3.54; 95% CI: 1.99-6.29, P < 0.001, respectively), after adjustment for age, sex, vital signs, and comorbidities.Underweight is a useful predictor of poor prognosis in patients with HFpEF in Asian population.

This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure (TLF) in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 50 lesions from 50 ACS patients who underwent OCT-guided percutaneous coronary intervention (PCI) were enrolled. We compared mid-term vascular healing using OCT between O-SESs and X-EESs at 8-month after stenting. The protocol was approved by the Osaka Rosai Hospiral ethics committee. Among 50 lesions, the X-EES group consisted of 25 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8-month were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 86.0%; p = 0.001). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 1.0%, p = 0.238). The O-SES group had the tendency of thinner neointima compared to the X-EES group (60µm vs 76µm, p = 0.089). Compared to X-EESs, O-SESs showed better mid-term vascular healing and tended to have thinner neointima in ACS patients. Ultra-thin strut may play a key role in better vascular healing.

Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) causes myocardial injury and induces high-sensitive cardiac troponin I (hs-TnI) release into the systemic circulation. Several factors are considered to be associated with myocardial injury after ablation, but few studies showed the relationship between the value of myocardial injury marker after the RFCA and relevant factors. AF patients who underwent primary RFCA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The relationship between hs-TnI after the RFCA and PV reconnection (PVR) was evaluated. The impact of relevant factors, including baseline patient characteristics, detail of procedure on myocardial injury was investigated. This study included 407 patients (median age was 71 years, the ratio of female was 30.7%). Late arrhythmia recurrence was observed in 111 patients (27.3%) and 66 patients were underwent repeated ablation. PVR was observed in 33 patients (50.0%). The hs-TnI level was significantly lower in the patients with PVR than those without PVR (1.150 ng/ml vs 1.921 ng/ml, p = 0.040). Paroxysmal AF and age were significantly associated with acute myocardial injury after the RFCA (standardized beta coefficient = 0.206 and p

Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)-guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)-guided PVI.Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period.A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269-0.639, P 0.001).AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.

Little has been reported on the impact of very early recurrence of atrial fibrillation (VERAF) after radiofrequency catheter ablation (RFCA).We enrolled 201 consecutive patients who underwent an initial RFCA of atrial fibrillation (AF) between September 2014 and April 2019 in our hospital and experienced early recurrence of AF (ERAF, defined as recurrence of atrial tachyarrhythmia within 3 months after RFCA). These patients were categorized into three groups: Group A who experienced recurrence of atrial tachyarrhythmia only within 48 h after RFCA, Group B who experienced recurrence of atrial tachyarrhythmia both within 48 h and between 48 h and 3 months after RFCA, and Group C who experienced the first recurrence of atrial tachyarrhythmia between 48 h and 3 months after RFCA. We compared the patient characteristics, ablation procedure and procedure-related complications, and clinical outcomes among the three groups. In addition, we investigated the pulmonary vein (PV) reconnections in the patients who experienced a repeat ablation procedure due to late recurrence of AF (LRAF, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after RFCA).The Group A, B, and C consisted of 54, 40, and 107 patients, respectively. The inflammatory markers on the second day of RFCA were significantly higher in Group A. Moreover, Group A had a lower incidence of LRAF (p 0.001) and PV reconnections at repeat ablation procedure (p = 0.023).VERAF may have better clinical outcomes including lower incidence of LRAF and PV reconnections among patients with ERAF.

Right bundle branch block (RBBB) is one of the most frequent alterations of the electrocardiogram. Several studies have shown that RBBB is a risk factor of cardiovascular diseases. However, the clinical outcomes after pulmonary vein isolation (PVI) in patients with RBBB remain unclear. We enrolled consecutive atrial fibrillation (AF) patients who underwent PVI from the Osaka Rosai Atrial Fibrillation (ORAF) registry. We excluded patients with other wide QRS morphologies (left bundle branch block, ventricular pacing, and unclassified intraventricular conduction disturbances) and divided them into 2 groups: RBBB (QRS duration ≥120msec) and No-RBBB (QRS duration120) groups. We compared the incidence of late recurrence of AF and/or atrial tachycardia (AT) (LRAF) between the 2 groups using a propensity score-matched analysis and evaluated the risk of LRAF using Cox regression model. We finally analyzed 671 consecutive AF patients. The RBBB group consisted of 50 patients (7.5%) and the No-RBBB group of 621 patients. Median follow-up duration was 734 [496, 1,049] days. Hypertension and diabetes mellitus were significantly higher in RBBB group than No-RBBB group. Among the 46 matched patients pairs, Kaplan-Meier analysis demonstrated that RBBB group had a significantly greater risk of LRAF than the No-RBBB group (p = 0.046). The Cox regression model revealed significantly higher risks of LRAF (HR, 2.30; 95% CI, 1.00 to 5.33; p=0.044) in RBBB group compared with No-RBBB group. Non-PV AF triggers were significantly higher in RBBB group than No-RBBB group (p = 0.048). In conclusion, RBBB can be an important predictor of LRAF after PVI.

A 77-year-old woman with frequent palpitations was referred to our institution for catheter ablation. Transthoracic echocardiography did not reveal any abnormalities. This article is protected by copyright. All rights reserved.