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Background Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device has potential to assess fluid accumulation in patients with heart failure (HF), but it has failed to reduce HF-related hospitalization because of a high false-positive rate. Objective We aimed to examine whether a modified algorithm (OptiVol 2.0) could reduce false-positive HF events documented in our multicenter trial (MOMOTARO). Methods The MOMOTARO trial assessed the potential that fluid index could predict fluid accumulation and therefore HF. The MOMOTARO trial assessed whether HF events could be detected based on fluid accumulation as assessed by fluid index. We re-analyzed raw data of ITI trends of the threshold-crossing events with the modified algorithm. Results The study consisted of 195 patients who had been implanted with a high-energy device. During a mean follow-up period of 658 ± 165 days, there were 154 primary HF events detected by the previous algorithm (OptiVol 1.0). With the previous algorithm, there was no significant difference in log concentration of brain natriuretic peptide (BNP) between baseline and alert ( p = 0.21). Among 150 alerts of the previous algorithm, only 37 reached the threshold by the modified algorithm, and log BNP was significantly higher in these 37 events compared with the baseline value (2.40 ± 0.46 vs. 2.27 ± 0.52, p Conclusion Our simulation study demonstrates that fluid index calculated with the modified algorithm reduces the number of false-positive threshold-crossing HF events and is promising for accurate diagnosis of fluid accumulation in patients.

A relationship between serum polyunsaturated fatty acids (PUFAs) and cardiovascular disease has been reported; however, the existence of a relationship between serum PUFAs and extent of vessel disease (VD) in patients with ST elevation myocardial infarction (STEMI) remains unclear.Between July 2011 and June 2015, 866 consecutive STEMI patients underwent emergent percutaneous coronary intervention, 507 of whom were enrolled and classified into three groups according to the initial angiograms: 1VD, 294 patients; 2VD, 110 patients; and 3VD/left main trunk disease (LMTD), 103 patients. Serum levels of PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid, and other laboratory data during hospitalization were evaluated.The serum EPA level in the 3VD/LMTD group was significantly lower than that in the 1VD group (55.5 ± 22.1 versus 66.2 ± 28.7, P = 0.002) and was slightly lower than that in the 2VD group (55.5 ± 22.1 versus 65.2 ± 28.9, P = 0.0167). Multivariate adjustment analysis revealed that age ≥ 70 years (odds ratio, 1.72; 95% confidence interval, 1.03-2.89; P = 0.038) and a low serum EPA level (odds ratio, 0.98; 95% confidence interval, 0.99-1.00; P = 0.023) were independent risk factors for 3VD/LMTD, while a low serum DHA level was not.A low serum EPA level may be more strongly related than a low serum DHA level to the extent of VD in STEMI patients. Age ≥ 70 years and a low serum EPA level may be independent risk factors for 3VD/LMTD.

Background Point-by-point catheter ablation is an established treatment for drug-refractory paroxysmal atrial fibrillation (PAF). However, it is time consuming, requires excellent technique to achieve complete pulmonary vein (PV) isolation, and is associated with severe complications. Objectives The purpose of this study was to evaluate the safety and effectiveness of a HotBalloon ablation (HBA) compared with antiarrhythmic drug therapy (ADT) for the treatment of PAF. Methods A prospective multicenter randomized controlled study was conducted in Japan. Patients with symptomatic PAF refractory to antiarrhythmic drugs (Class I to IV) were randomized to HBA or ADT at a 2:1 ratio and assessed for effectiveness in a comparable 9-month follow-up period. Results A total of 100 patients in the HBA group and 43 patients in the ADT group received treatment at 17 sites. HBA procedure produced acute complete PV isolation in 98.0% (392 of 400) of the PVs and in 93.0% (93 of 100) of patients in the HBA group. The chronic success rates after the 9-month effective evaluation period were 59.0% in the HBA group (n = 100) and 4.7% in the ADT group (n = 43; p 70%) and transient phrenic nerve injury were 5.2% and 3.7%, respectively. The mean fluoroscopy time was 49.4 ± 26.6 min (n = 134), and the mean procedure duration was 113.9 ± 31.9 min (n = 133). Conclusions This study demonstrates the superiority of HBA compared with ADT for treatment of patients with PAF, and a favorable safety profile.

A subset of patients undergoing cardiac resynchronization therapy (CRT) for heart failure (HF) with severe left ventricular (LV) dysfunction experience only short-lived LV reverse remodeling. Little is known about the incidence and prognosis of this finding. We sought to identify predictors of a brief response and investigated the prognosis in a retrospective study.A total of 528 patients from a Japanese multicenter database with full echocardiography datasets were enrolled. Follow-up was 3.4±1.3years. Based on relative reduction in LV end-systolic volume (LVESV) at 6months, we categorized patients as responders (reduction in LVESV ≥15%) and non-responders (NRs; reduction in LVESV15%). Based on reduction in LVESV at 1-2years, responders were subdivided into long-lasting responders (reduction in LVESV ≥15%) and brief responders (reduction in LVESV15%).Of 328 responders, 50 (15%) were brief responders. Predictors of brief response were prior ventricular tachyarrhythmia, a non-left bundle-branch block (LBBB) intrinsic QRS pattern, and prior hospitalization for HF. The risk of all-cause death in brief responders was significantly lower than that in NRs (P=0.034) and tended to be higher than that in long-lasting responders (P=0.080).Approximately 15% of responders were brief responders. Prior ventricular tachyarrhythmia, a non-LBBB pattern, and HF hospitalization were independent predictors of a brief response. Brief response was significantly associated with decreased risk of all-cause death compared with NRs and had a tendency toward increased risk of all-cause death compared with long-lasting responders.

BACKGROUND Differences in long-term outcome between early stent thrombosis (EST), late stent thrombosis (LST), and very late stent thrombosis (VLST) are unknown. METHODS AND RESULTS A total of 152 patients who had undergone percutaneous coronary intervention for stent thrombosis between January 2001 and October 2011 were enrolled, and the clinical outcome compared between EST (55 patients), LST (34 patients), and VLST (63 patients) after drug-eluting stent (DES) and bare-metal stent (BMS) implantation. Major adverse cardiac events (MACE), including cardiac death, recurrent stent thrombosis, non-fatal myocardial infarction, and target lesion revascularization (TLR), were evaluated at 5 years. The in-hospital mortality was similar between EST, LST, and VLST (P=0.37). The incidence of MACE was significantly lower in VLST (21.9%) than in EST (66.9%, P

Point-by-point catheter ablation is an established treatment for drug-refractory paroxysmal atrial fibrillation (PAF). However, it is time consuming, requires excellent technique to achieve complete pulmonary vein (PV) isolation, and is associated with severe complications.The purpose of this study was to evaluate the safety and effectiveness of a HotBalloon ablation (HBA) compared with antiarrhythmic drug therapy (ADT) for the treatment of PAF.A prospective multicenter randomized controlled study was conducted in Japan. Patients with symptomatic PAF refractory to antiarrhythmic drugs (Class I to IV) were randomized to HBA or ADT at a 2:1 ratio and assessed for effectiveness in a comparable 9-month follow-up period.A total of 100 patients in the HBA group and 43 patients in the ADT group received treatment at 17 sites. HBA procedure produced acute complete PV isolation in 98.0% (392 of 400) of the PVs and in 93.0% (93 of 100) of patients in the HBA group. The chronic success rates after the 9-month effective evaluation period were 59.0% in the HBA group (n = 100) and 4.7% in the ADT group (n = 43; p 0.001). The incidence of major complications was 11.2% (15 of 134 patients). The incidences of PV stenosis (70%) and transient phrenic nerve injury were 5.2% and 3.7%, respectively. The mean fluoroscopy time was 49.4 ± 26.6 min (n = 134), and the mean procedure duration was 113.9 ± 31.9 min (n = 133).This study demonstrates the superiority of HBA compared with ADT for treatment of patients with PAF, and a favorable safety profile.

Background The predictive value of T-wave alternans (TWA) for lethal ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction is controversial. Also, long-term arrhythmia risk of patients ineligible for the TWA test is unknown. Methods This was a multicenter, prospective observational study of patients with LV ejection fraction ≤40% due to ischemic or non-ischemic cardiomyopathies, designed to evaluate the prognostic value of TWA for lethal ventricular tachyarrhythmia. The primary end point was a composite of sudden cardiac death, sustained rapid ventricular tachycardia (VT) or ventricular fibrillation (VF), and appropriate defibrillator therapy for rapid VT or VF. Results Among 453 patients enrolled in the study, 280 (62%) were eligible for the TWA test. TWA was negative in 82 patients (29%), who accounted for 18% of the total population. The median of follow-up was 36 months. The 3-year event-free rate for the primary end point was significantly higher in TWA-negative patients (97.0%) than in TWA non-negative patients (89.5%, P = 0.037) and those ineligible for the TWA test (84.4%, P = 0.003). Multivariable analysis identified both non-negative TWA [hazard ratio (HR) 4.43; 95% confidence interval (CI) 1.02–19.2; P = 0.047) and ineligibility for the TWA test (HR 6.89; 95% CI 1.59–29.9; P = 0.010) to be independent predictors of the primary end point. Conclusions TWA showed high negative predictive ability for lethal ventricular tachyarrhythmia in patients with LV dysfunction, although the TWA-negative patients accounted for only 18% of the entire population. Those ineligible for the TWA test had the highest risk for lethal ventricular tachyarrhythmia. Electronic supplementary material The online version of this article (doi:10.1007/s00392-011-0368-2) contains supplementary material, which is available to authorized users.

The efficacy of drug-eluting stents (DES) has been proven, but concerns about late complications after DES have been raised. Polymers that do not increase inflammatory or hypersensitivity reactions which may contribute to late complications are needed for new generation DES. To evaluate the safety and efficacy of phosphorylcholine-polymer coating, we investigated serial clinical and angiographic outcomes after phosphorylcholine-coated stent placement. Seventy-five consecutive patients treated with a BiodivYsio phosphorylcholine-coated stent for de novo lesions at our institute between October 2001 and August 2002 were enrolled. Six-month follow-up angiography was performed in 71 lesions (94.7%), and angiographic restenosis was found in 19 lesions (26.8%). Target lesion revascularization (TLR) was performed in 10 lesions (14.1%). Eighteen-month follow-up angiography was performed in 58 (95.1%) of the remaining 61 lesions (excluding TLR lesions), and angiographic restenosis was found in only 3 lesions. The cumulative MACE-free survival rate was 86.3%, 83.6%, and 78.6% at 6-month, 18-month, and 8-year follow-up, respectively. There were no episodes of stent thrombosis. Late loss decreased significantly from 0.74 ± 0.40 mm (6-months) to 0.51 ± 0.46 mm (18-months) (P < 0.0001). Phosphorylcholine-coated stent implantation was associated with acceptable clinical and angiographic results. Phosphorylcholine-coating may be an ideal polymer for new generation DESs.

Objectives: We evaluated the predictors of recurrent restenosis and the impact of lesion length and vessel size on outcomes in patients treated with routine sirolimus-eluting stent (SES) implantation for in-stent restenosis (ISR) of bare-metal stent (BMS). Methods: In this study, 250 consecutive patients with 275 lesions after SES implantation for ISR of BMS were enrolled. Follow-up angiogram was obtained in 239 patients with 258 lesions eight months after implantation (follow-up rate: 95.6%). We compared characteristics of patients and lesions between the two groups (the recurrent restenosis group and the no-restenosis group). Results: Recurrent restenosis was angiographically documented in 43 lesions (16.7%). Recurrent restenosis was found in 30.4% with small vessel lesions (reference diameter of less than 2.5 mm, 92 lesions) and 23% with the diffuse type lesions (106 lesions). Seventy-two per cent of patients had a focal pattern of recurrent restenosis. Previously recurrent ISR lesions (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.94 to 4.06, p = 0.05), reference diameter of less than 2.5 mm (OR 2.41, CI 1.05 to 5.41, p = 0.03), diffuse type restenosis (OR 4.48, CI 2.12 to 9.94, p = 0.0001) and dialysis patients (OR 4.72, CI 1.42 to 15.7, p = 0.01) were independent predictors of recurrent restenosis. Conclusions: Small vessels, diffuse type restenosis and dialysis patients were still the predictors of recurrent restenosis in patients treated with SES for ISR of BMS.

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug-resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III-IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re-operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course.

Background Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF). Methods and results HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%). Conclusions BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).

A 69-year-old female suffering from third-degree atrioventricular block with syncope underwent permanent pacemaker implantation. However, she developed shortness of breath 2 months after the implantation. Blood tests revealed elevated levels of LDH, CRP, BNP, and SIL-2R. Transthoracic echocardiography showed thickened left and right atrial walls with mild pericardial effusion. A diagnosis was made based on a CT scan and histology. Although most primary cardiac malignant lymphomas are associated with a poor prognosis, the patient was treated successfully with chemotherapy.

A new guiding catheter for PTCA is described. In our department, 302 patients (405 lesions) underwent transradial coronary angioplasty using the 6 Fr Kimny guiding catheter since January 1996. The total engagement rate using the Kimny guiding catheter was 91.3% (370/405). The engagement rate after the modified Kimny guiding catheter was introduced in May 1996 increased to 96.0% (243/253). The stent delivery success rate was 98.4%. We had two dislodged stents. PTCA for both left and right coronary arteries in a single procedure with the Kimny guiding catheter was performed via the radial artery in 27 patients. In 24 of these patients (89%) we engaged both coronaries successfully. In the remaining 3 patients we switched to another catheter. Except for 4 patients with non-Q-wave myocardial infarction, no major cardiac complications were encountered. No major entry site-related complications were seen, and no patient required vascular surgery or blood transfusions. In one patient the Kimny guiding catheter tip caused a minor dissection of the LMT, but no ischemic event occurred as a result. In conclusion, the Kimny device is a useful PTCA guiding catheter for routine angioplasty and stenting. Cathet. Cardiovasc. Diagn. 43:344–351, 1998. © 1998 Wiley-Liss, Inc.

BACKGROUND The superiority of drug-eluting stents (DES) over bare-metal stents (BMS) 7 years after unprotected left main coronary artery (LMCA) stenting has not been investigated. METHODS AND RESULTS From 2003 to 2005, 182 patients underwent stent implantation for unprotected LMCA disease (DES, 96 patients; BMS, 86 patients; acute coronary syndrome cases excluded), and the 7-year clinical outcomes between the DES and BMS groups were compared. The incidence of cardiac death or non-fatal myocardial infarction was similar between the DES and BMS groups (11.0% vs. 13.5%, P=0.78). The incidence of target lesion revascularization (TLR) at 7 years was significantly lower in the DES group than in the BMS group (26.4% vs. 40.5%, P=0.009); the incidence from 1 to 4 years and that beyond 4 years were similar between the DES and BMS groups (8.9% vs. 7.9%, P=0.97; 10.0% vs. 8.7%, P=0.74, respectively). Among patients with bifurcation lesions, whereas the incidence of 7-year TLR was significantly lower in the DES group than the BMS group in patients undergoing single-stent procedures (15.9% vs. 48.6%, P=0.002), it was similar between the 2 groups in patients undergoing 2-stent procedures (38.5% vs. 39.3%, P=0.49). CONCLUSIONS With the exception of the 2-stent procedure, the 7-year outcomes after DES implantation for LMCA disease were superior to those after BMS implantation because of the lower TLR rate, when considering TLR during the late phase.

Limited data are available with which to compare the clinical characteristics of patients with very late stent thrombosis (VLST) after drug-eluting stent (DES) or bare-metal stent (BMS) implantation. The purpose of this study was to investigate the differences in the characteristics of VLST after DES and BMS implantation by reviewing the clinical and angiographic data. A total of 28 patients (30 lesions) with VLST after DES implantation and 33 patients (33 lesions) with VLST after BMS implantation were identified. The occurrence of VLST after BMS implantation (2,647±996 days) was much later than that after DES implantation (1,194±558 days, P0.001). The number of VLST after DES implantation increased gradually each year; however VLST after BMS implantation started to occur50 months later, and its number increased subsequently. The prevalence of VLST related to surgical procedures involving discontinuation of antiplatelet therapy in VLST patients was higher after DES implantation (14.3%) than after BMS implantation (0%, P=0.039). Angiographic stent fracture was seen in 36.7% of VLST lesions after DES implantation at different times (464-2,102 days after procedure), while none was seen in VLST lesions after BMS implantation (P0.001). The timing of VLST was different after DES and BMS implantation. Stent fracture was a specific finding of VLST after DES implantation.

Objectives. The aim of this study was to examine the effect of ischemic preconditioning on the manner of ventricular repolarization by assessing the change in QT dispersion during coronary angioplasty. Background. QT interval dispersion regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have suggested that increased QT dispersion is associated with an increased incidence of malignant ventricular arrhythmias, whereas brief episodes of myocardial ischemia can render the heart more resistant to subsequent ischemic episodes, a phenomenon called ischemic preconditioning. Methods. To assess the effects of ischemic preconditioning on myocardial repolarization by examining the change in QT dispersion during coronary angioplasty, we studied 47 consecutive patients (39 men and 8 women; mean age 57 ± 16 years). QT dispersion was measured after each balloon inflation during coronary angioplasty. Statistical analysis was performed by using repeated measurement of analysis of variance. Results. There were significant differences in QT dispersion as the number of balloon inflations increased (mean ± SD 52 ± 14, 42 ± 11, 36 ± 9, 31 ± 10 and 29 ± 11 ms, respectively [p < 0.01], for the first, second, third, fourth and fifth balloon inflations). The magnitude of decrease in QT dispersion was significant in the first and second balloon inflations, then became insignificant with later inflations. Conclusions. These data indicate that the gradual decrease in OT dispersion provoked by coronary artery occlusion and reperfusion during coronary angioplasty may be associated with electrophysiologic effects of ischemic preconditioning on myocardium in the human heart.

Giant-cell myocarditis is a fatal autoimmune disorder that is often associated with other autoimmune diseases. We herein describe a case of giant-cell myocarditis complicated by heparin-induced thrombocytopenia (HIT). A 71-year-old woman was admitted to our hospital due to palpitations and ptosis. Echocardiography revealed hypokinesis in the left basal ventricular walls. Heart failure gradually developed, and the condition was complicated by HIT. The patient died of cardiogenic and septic shock caused by agranulocytosis. An autopsy showed giant-cell myocarditis. When severe left ventricular dysfunction due to an unknown cause is complicated by HIT, potential diagnoses of giant-cell and other types of autoimmune myocarditis should thus be investigated.

Background— We have sometimes noted abnormal angiographic coronary dilatation, Methods and Results— Between May 2008 and March 2010, we performed optical coherence tomography for 90 in-stent restenosis lesions after sirolimus-eluting stent implantation. We found PSS in 20 of the 90 lesions by coronary angiography. The differences in optical coherence tomography findings, including incomplete stent apposition, multiple interstrut hollows (MIH), strut coverage, and thrombus, were compared between lesions with PSS and those without PSS. PSS is defined as contrast staining outside the stent contour extending to >20% of the stent diameter measured by quantitative coronary angiography. MIH is defined as multiple hollows (the maximum depth >0.5 mm) existing between and outside well-apposed stent struts. Both incomplete stent apposition (60.0% versus 10%; P P P =0.001), malapposed struts (2.0% versus 0.0%; P P =0.012) were frequently observed in lesions with PSS than in lesions without PSS. Conclusions— PSS might be closely associated with 2 different optical coherence tomography findings, MIH and incomplete stent apposition, in lesions after sirolimus-eluting stent implantation.

Methods & Results: CUBIC study is a multi-center registry of Japanese patients undergoing CRT between Apr. 2004 and Dec. 2008. Data of 680 patients from 11 institutions were available. The population of this study consisted of 445 patients with baseline LVEF≤45% and paired UCG data (at baseline and 6 months after CRT). We compared improvement in LV function between patients with and without CAF (74 and 371patients, respectively). The baseline characteristics were as follows; Age: 72 vs. 68 (years); Male: 74 vs. 68 (%); NYHA IV: 12 vs. 11 (%);Previous PM: 53 vs 29 (%)*; Diabetes: 30 vs 33 (%);Creatinine > 1.5 (mg/dl): 31 vs 26 (%); IHD: 20 vs. 31 (%); LVEF: 29 vs. 26 (%);LVEDV: 201 vs 214 (ml) BNP: 554 vs. 678 (pg/dl); QRS duration:154 vs. 147 (msec); (CAF vs. non-CAF, *p

Two-third of patients who received cardiac resynchronization therapy (CRT) is classified as responders. However, the response to CRT would be transient and beneficial effect would diminish during long-term follow up in some of responders. We termed these patients transient responders (TR), and

Recently a considerable number of patients have Non-vitamin K antagonist oral anticoagulant (NOAC) for Atrial fibrillation (AF). Some AF patients have NOAC concurrent antiplatelet therapy for atherosclerosis. However there are few reports about bleeding events among NOAC patients with concurrent

Background: A major cause of heart failure (HF) related hospitalizations is fluid accumulation. Recent studies have suggested that intrathoracic impedance (ITI) may be a useful parameter to track daily changes in pulmonary fluid status. OptiVol alert (OA), which is a fluid status algorithm calculated from ITI, can detect impending fluid accumulation at an early stage. However, the sensitivity and specificity of OA for deteriorated HF have not been sufficient for it to be a clinically useful parameter. Therefore, we sought to examine the difference of various parameters between OA and baseline. Objectives: The purpose of study 1 was to examine how various parameters changed in OA compared to baseline. And the purpose of study 2 was to evaluate what parameters could predict increased log BNP. Methods: This study was a prospective multicenter study. Patients who suffered from structural heart disease and who had been implanted with a high energy device with an OptiVol feature were included in this study. The patients underwent various examinations at enrolment and following an OA. In study 1, primary endpoint was to examine how log BNP changed between OA and baseline. Secondary endpoint was to examine how other parameters changed between OA and baseline. We defined low ITI as equal or less than 96% of ITI at baseline. Results: From 2010 to 2011, 200 patients in 12 institutes were enrolled in the present study. Mean age was 65.3 years, mean ejection fraction was 44.2% and mean log BNP was 2.2 ng/ml. We had 376 OA events and 289 periodical follow-up events. In primary endpoint of study 1, there was no significant difference in log BNP between OA and baseline. However, the change rate of ITI was negatively correlated with the change rate of log BNP (r = -0.35, p < 0.01). In 115 OA events with low ITI, log BNP was significantly higher than that at baseline (2.33 vs 2.19, p < 0.01). In secondary endpoint of study 1, there was no significant difference in body weight, cardio-thoracic ratio in chest X ray, end diastolic volume, end systolic volume and tricuspid regurgitation pressure gradient between OA and baseline. In study 2, we searched what parameters could predict increased log BNP by 0.4 compared to that at baseline. To predict increased log BNP by 0.4, the area under ROC curve for OA events with low ITI was significantly larger than that for only OA events (0.78 vs 0.62, p < 0.01). Conclusions: There was no significant difference in log BNP between OA and baseline. However, OA events with low ITI can predict increased BNP, but only OA events.

Background: It is well known that CRT is effective to reduce heart failure hospitalization and prolong survival. However, the impact of response to CRT on ventricular arrhythmias (VA) is not well established. Methods: We investigated 436 patients without history of VA, who could obtain pre and 6 month echo data, from CUBIC study which is a Japanese multi-center 32%, ischemic etiology 29%, LVEF 28+⁄−10%, LVEDD 62+⁄−9 mm, QRS duration 151+⁄−37 ms, CRT-D 54%) and divided into two groups, 262 (60%) CRT responders (R-group) and 174 (40%) CRT non-responders (NR group). Results: After mean follow up 26+/14 months, survival rate, event free survival rate from heart failure hospitalization and event free survival rate from combined death and heart failure hospitalization were all significantly higher in R group compared to NR group (95% vs. 78% at 2-year, Log-rank p

Introduction: Heart failure is one of the most common causes for hospitalizations. OptiVol alert, which was fluid status algorism calculated from intrathoracic impedance, may detect impending fluid accumulation. Then, we tried to examine the relationship of OptiVol alert or intrathoracic impedance with various parameters. Methods: The patients who were implanted high energy device with OptiVol feature were included in this study. The patients were evaluated various examinations at enrolment and following an OptiVol alert. We examined how various parameters were different between baseline and OptiVol alert, and the relationships among the factors included in OptiVol alert and intrathoracic impedance were evaluated by factor analysis. Results: From April in 2010, 191 patients were eligible for the present study. In all patients, there was no significant difference in all parameters between OptiVol alert and baseline. However, in the patients with ejection fraction less than 35%, BNP value was likely to increase in OptiVol alert compared with that in baseline, but not significantly. In factor analysis, there was no parameter correlated with OptiVol alert. However, intrathoracic impedance was negatively correlated with BNP value. Conclusions: Intrathoracic impedance, but OptiVol alert, seems to represent fluid retention.

Introduction: Implantable loop recorder (ILR) has been reported to provide a symptom-rhythm correlation in patients with recurrent unexplained syncope. Method: ILR was implanted in 11 patients with recurrent unexplained syncope. Results: ILR revealed the mechanism of syncope in 5 patients (45.5%) and the median period after implantation was 52.8±31.9 days, which was a similar rate to those of previous reports. We found 3 patients with intermittent atrioventricular block and 1 patient with sick sinus syndrome whose electrophysiological study was almost normal. Conclusions: Among patients without major structural heart disease, ILR can be useful to detect the mechanism of recurrent unexplained syncope. It is particularly helpful to find intermittent bradycardia which frequently vanishes during an electrophysiology study.

Introduction: Echocardiographic parameters are useful for the prediction of the long-term preservation of sinus rhythm in patients with successful cardioversion of atrial fibrillation . We assessed the echocardiographic parameters and left atrial volume by 3D-CT in 44 consecutive patients who had undergone circumferential pulmonary vein isolation for persistent AF. Methods: Transthoracic echocardiographic data, transesophageal echocardiographic data and LAV by 3D-CT of 44 consecutive patients were analyzed. We examined left atrial appendage flow, left atrial spontaneous echocardiographic contrast, mitral valve regurgitation during TEE, and also left atrial parasternal diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction in TTE. Results: At a half year follow-up, 59.1% of the patients who had undergone pulmonary vein isolation continued to have SR. LAV was significantly smaller in patients remaining in SR for a half year than in those with AF recurrence . Between SR groups and AF recurrence groups, there were no significant differences in echocardiographic parameters. Conclusions: In echocardiography and 3D-CT guided management of persistent AF, LAV will be useful to predict the long-term SR maintenance after circumferential pulmonary vein isolation.

Introduction: Fidelis implantable cardioverter-defibrillator leads are prone to fractures that lead to adverse events. Approximately 268,000 patients have Fidelis leads worldwide and about 4900 in Japan. The lead failure rate in some reports was higher than in the Medtronic performance report. Thus, we investigated the longevity of Fidelis leads and compared it with that of Quattro leads. Methods and Results: From November 2005 to May 2011, 115 Fidelis and 95 Quattro leads were implanted and followed up at our hospital. Six lead fractures occurred in the Fidelis group at 5.4 years and no lead fracture in the Quattro group at 3.4 years. No deaths or injuries occurred as a result of lead failure, but all 6 fractures caused inappropriate shocks. The survival rate in the Fidelis group at 5.4 years was 92.0%, whereas that in the Fidelis group at 3.4 years was 96.5% and in the Quattro group at 3.4 years was 100%. Conclusions: The survival rate of Fidelis leads was similar to that of the Medtronic update. The difference in the survival rate at 3.4 years was not significant between Fidelis and Quattro leads. Given the small sample size and short observation period, it is impossible to conclude that Fidelis leads are inferior to Quattro leads at 3.4 years.

Objectives The aim of this study was to investigate the efficacy of a paclitaxel-eluting balloon (PEB) for the treatment of sirolimus-eluting stent (SES) restenosis. Background Because drug-eluting stents (DES) are being used in increasingly complicated settings, DES restenosis is no longer an uncommon phenomenon, and its optimal treatment is unknown. Methods This study was a prospective single-blind randomized trial conducted in 50 patients with SES restenosis. Patients were randomly assigned to a PEB group (n = 25) or a conventional balloon angioplasty (BA) group (n = 25). The primary end point was late lumen loss at 6-month follow-up. Secondary end points included the rate of binary restenosis (in-segment analysis) and major adverse cardiac events (MACE) at 6-month follow-up. Results At 6-month angiographic follow-up (follow-up rate: 94%), in-segment late lumen loss was lower in the PEB group than in the BA group (0.18 ± 0.45 mm vs. 0.72 ± 0.55 mm; p = 0.001). The incidence of recurrent restenosis (8.7% vs. 62.5%; p = 0.0001) and target lesion revascularization (4.3% vs. 41.7%; p = 0.003) was also lower in the PEB group than in the BA group. The cumulative MACE-free survival was significantly better in the PEB group than in the BA group (96% vs. 60%; p = 0.005). Conclusions In patients with SES restenosis, PEB provided much better clinical, angiographic outcomes than conventional BA.

Some heart failure (HF) patients with ventricular dyssynchrony shows drastic improvement of left ventricular (LV) function by cardiac resynchronization therapy (CRT), which we call super-response. However, there were few reports concerning the predictors of super-response to CRT. The purpose of this

Only a few multicenter trials have provided controversial data on the beneficial effects of atrioventricular (AV) and interventricular (VV) intervals optimization on clinical outcomes in patients with cardiac resynchronization therapy (CRT). The objective of this study is to investigate the impact