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Background: Percutaneous left atrial appendage closure (LAAC) reduces the incidence of stroke/bleeding events in patients with non-valvular atrial fibrillation, high risk of stroke, and contraindication in continuing anticoagulation therapy. Of them, patients with heart failure may remain at high risk of these events after LAAC. Method: Patients who underwent LAAC and were listed for the multi-center, prospectively collected OCEAN-LAAC registry, were eligible. Of them, individuals without baseline plasma B-type natriuretic peptide (BNP) levels and those dependent on hemodialysis were excluded. The prognostic impact of baseline plasma BNP levels on the incidence of death or stroke/bleeding events after LAAC was evaluated. Results: A total of 937 patients (median 78 years, 596 men) were included. The LAAC device was successfully implanted in 934 (98%) patients. Over the 366 (251, 436) days after the LAAC, 148 patients encountered a primary outcome. The common logarithm of baseline plasma BNP was independently associated with the primary outcome with an adjusted hazard ratio of 1.46 (95% confidence interval 1.06–2.18, p = 0.043). A calculated cutoff of 2.12 (equivalent to 133 pg/mL of plasma BNP level) significantly stratified the cumulative incidence of the primary outcome (29% vs. 21% for 2 years, p = 0.004). Conclusions: Using prospectively collected large-scale multi-center Japanese registry data, we demonstrated that a baseline higher plasma BNP level was independently associated with a higher incidence of stroke/bleeding events and mortality after LAAC. Further studies are warranted to understand the optimal therapeutic strategy for LAAC candidates with elevated baseline plasma BNP levels. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Methods Results Conclusion Research on the impact of angiographically detected residual trabeculation after left atrial appendage closure (LAAC) is limited.To investigate the incidence, characteristics, and clinical implications of angiographically detected residual trabeculation after LAAC using the WATCHMAN device.We analyzed 1350 consecutive patients with atrial fibrillation undergoing LAAC using the WATCHMAN device from the OCEAN‐LAAC registry, which is a prospective ongoing, multicenter Japanese registry. The inclusion criteria comprised patients who successfully underwent LAAC and whose presence or absence of residual trabeculation can be confirmed using a contrast medium. The clinical outcomes were compared between patients with and without angiographically detected residual trabeculation.Residual trabeculation was angiographically detected in 5.6% (75/1350 patients). At the procedure, the proportion of peri‐device leak (PDL) was significantly higher in the residual trabeculation group than in the non‐residual trabeculation group (20% vs. 5.1%, p < 0.001). However, the PDL and device‐related thrombosis at 45 days and 1 year were comparable between the two groups (37% vs. 23%, p = 0.24; 28% vs. 31%, p = 0.84; 2.1% vs. 1.4%, p = 0.50; 6.9% vs. 6.0%, p = 0.69, respectively). The 3‐year cumulative incidence of ischemic stroke, all cardiovascular death, and all‐cause death were comparable between the two groups (5.7% vs. 5.5%, log‐rank p = 0.96; 7.7% vs. 8.9%, log‐rank p = 0.34, 31.4% vs. 22.3%, log‐rank p = 0.71, respectively).The angiographically detected residual trabeculation rate was 5.6%, and this population had a significantly higher prevalence of PDL at the procedure. However, the presence of residual trabeculation did not contribute to PDL or device‐related thrombosis at follow‐up or affect the clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) frequently co-exist and each of them can lead to the other. Catheter ablation (CA) for AF improves LVSD caused by AF, whereas CA for AF secondarily caused by LVSD may not improve LVSD. Discriminating these two pathophysiologies is important but often difficult. Low voltage zone (LVZ) in the left atrium (LA) seems to reflect myocardial fibrosis and can be an AF substrate, leading to AF development. We hypothesized that LA LVZ exists mainly in patients with AF secondarily caused by LVSD and therefore CA for AF may not improve LVSD in such patients. We investigated the relationship between the presence and extent of LA LVZ and the degree of improvement of LVSD after CA for AF. Methods: We studied 28 patients (23 men; mean age, 67±9 years; non-paroxysmal AF in 21; mean LVEF, 32±8%) with LVEF <45% undergoing CA for AF. We defined LVZ as an area with bipolar electrograms <0.5ms and calculated LVZ extent as the percentage of LA surface area. Radiofrequency circumferential pulmonary vein (PV) isolation was performed in all patients and LVZ ablation was added when needed. We measured left ventricular ejection fraction (LVEF) before and 3 months after CA procedure. We defined CA responder as 10% recovery of LVEF after CA procedure. Results: LA LVZ was detected in 16 patients (57%) and LVZ ablation was added in 10 of them. At 3 months after the CA procedure, AF recurred in 2 patients (7%) both of whom had LA LVZ. Of all patients, 14 (50%) were considered as CA responder. The LVZ extent was significantly smaller in CA responder (median, 0% (interquartile range (IQR), 0-6%)) than in CA non-responder (median, 6% (IQR, 3-14%), p=0.01). On multivariate Cox regression analysis, the absence of LVZ was the only significant, independent predictor for CA responder (hazard ratio, 11.2 (95% confidential interval, 1.6-117.4). During 9.2±4.7 months of follow-up, 2 fatal cardiac events (death from heart failure and left ventricular assist device implantation) occurred in patients with extensive LVZ (12% and 100%, respectively) Conclusion: Extensive LA LVZ may indicate that AF is caused secondarily by LVSD, and CA may not improve LVSD. Absence of LA LVZ suggests that CA for AF improves LSVD. [ABSTRACT FROM AUTHOR]

Background: Left atrial appendage closure (LAAC) has demonstrated favorable outcomes as an alternative to permanent anticoagulation in patients with nonvalvular atrial fibrillation (NVAF). In hemodialysis (HD) patients with NVAF, anticoagulation increases bleeding complications, with inconsistent benefits in stroke prevention., Objectives: This study aimed to clarify the benefit of LAAC for HD patients., Methods: Consecutive patients who underwent LAAC, as extracted from the Japanese multicenter registry, were eligible. When comparing HD and non-HD patients, perioperative events, including LAAC procedure success rates and the incidence of death, bleeding events, and ischemic stroke events, were analyzed., Results: Among 1,464 patients (mean age 77.1 ± 7.6 years, mean CHA 2 DS 2 -VASc score 4.9 ± 1.5, mean HAS-BLED score 3.1 ± 1.0), 172 were HD patients. The HD group had higher HAS-BLED scores, whereas more patients in the non-HD group had a history of Bleeding Academic Research Consortium type 3 bleeding. Device implantation success was 97.3% (95% CI: 96.3%-98.0%) (HD group; 97.1% [167 of 172], non-HD group; 97.3% [1,257 of 1,292]; P = 0.88). There were no in-hospital deaths, and perioperative complications were rare and did not differ between the 2 groups. The median follow-up period was 367 days (Q1-Q3: 242-422 days). The ischemic stroke rate following LAAC in the HD group was 1.1% (95% CI: 0.3%-1.9%) per 100 patient-years, comparable to the non-HD group., Conclusions: LAAC is feasible for HD patients and achieves results comparable to those in non-HD patients. Further research is necessary to determine the effectiveness of LAAC in preventing stroke in HD patients., Competing Interests: The OCEAN-LAAC registry, which is part of the OCEAN-SHD registry, is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo Company. Drs Nakashima, Yamamoto, Asami, Hachinohe, Ueno, and Kubo are clinical proctors for Boston Scientific. Dr Yamamoto has received lecture fees from Daiichi-Sankyo and Boston Scientific. Dr Saji has received lecture fees from Daiichi-Sankyo and Abbott Medical Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2025 The Authors.)

Background: Limited data are available regarding clinical outcomes after percutaneous left atrial appendage closure using WATCHMAN FLX (WM-FLX) and WATCHMAN-2.5 (WM2.5) devices in Asian patients., Methods and results: Data of 1,464 consecutive patients (WM-FLX, n=909; WM2.5, n=555) were extracted from a Japanese multicenter registry, and clinical data were compared between the 2 groups. No in-hospital deaths, periprocedural stroke, or device embolization occurred. Procedural success was significantly higher in the WM-FLX than WM2.5 group (95.8% vs. 91.9%; P=0.002) owing to the lower incidence of periprocedural pericardial effusion (0.55% vs. 1.8%; P=0.021). No significant differences in all-cause death, postprocedural stroke, and device-related thrombus were observed between the 2 groups. However, the cumulative bleeding rate at 1 year was substantially lower in the WM-FLX group (7.8% vs. 16.4%; P<0.001). Landmark analysis of bleeding events highlighted lower bleeding rates in the WM-FLX than WM2.5 group within the first 6 months (6.4% vs. 14.8%; P<0.001), with comparable bleeding rates over the 6- to 12-month period (1.5% vs. 3.2%, respectively; P=0.065)., Conclusions: This study demonstrated higher early safety and lower 1-year bleeding rates in the WM-FLX than WM2.5 group. The lower bleeding events with WM-FLX are likely due to multiple factors other than purely difference in devices, such as postprocedural drug regimen.

Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area with low-voltage electrograms, a surrogate marker for atrial fibrosis. Ablation for non-PV triggers in addition to PVAI improves the outcome of persistent AF. Further, durable isolation of the left atrial posterior wall may reduce AF recurrence. These ablation strategies with concomitant use of the emerging technologies are strongly expected to enhance the effectiveness of catheter ablation for persistent AF.

Introduction: Acute aortic dissection (AAD), acute pulmonary embolism (PE) and acute myocardial infarction (AMI) are all emergent diseases with acute chest pain. However, it is sometimes difficult to diagnose these diseases by symptoms, ECG changes and/or cardiac biomarkers, especially immediately after onset. Because these diseases are all thrombogenic diseases, we considered that D-dimer could be helpful to differentiate these diseases. The purpose of this research was to define the D-dimer value for discrimination between AAD, PE and AMI., Methods: Plasma D-dimer values of a consecutive series of 35 AAD, 22 PE and 206 AMI patients on admission were analyzed retrospectively., Results: The D-dimer values of patients with AAD (32.9 ± 66.7 g/ml, p<0.001) and PE (28.5 ± 23.6 g/ ml, p<0.001) were significantly higher than those of AMI patients (2.1 ± 3.7 g/ml). A cutoff value of 5.0 g/ ml was effective in distinguishing AAD and PE from AMI, with a sensitivity of 68% and a specificity of 90%., Conclusions: Our study showed the possibility that D-dimer could enable faster diagnosis and treatment of AAD, PE and AMI patients. We expect that the D-dimer test will be used more often for screening patients with possible AAD, PE or AMI in the emergency room. We would recommend contrast computed tomography first, not coronary angiography, in a patient with a D-dimer level higher than 5.0 g/ml using our diagnostic kit.