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Abstract The impacts of large‐scale disturbance events on the species diversity of rocky intertidal sessile assemblages across multiple spatial scales are not well understood. To evaluate the influence of the 2011 Tohoku Earthquake on alpha and beta diversities of rocky intertidal sessile assemblages, we surveyed sessile assemblages in the mid‐shore zone from 2011 to 2019 and compared the data with those collected from 2003 to 2010 before the earthquake at the same region. The census was conducted across 22 study plots on five rocky shores along 30 km of the Sanriku Coast of Japan, which is located 150–160 km north–northwest of the earthquake epicenter. Alpha diversity was measured with three Hill numbers (H0, H1, and H2), which represent the number of equally common species that would exist in a community with the same diversity as the sampled community, with higher values of the subscript indicating more weight placed on abundant species. Beta diversity was measured with two metrics (BDtotal at two spatial scales). Values were compared between the post‐earthquake period (2011–2019) and the pre‐earthquake period (2003–2010). The results show that the Tohoku Earthquake significantly altered the species diversity of intertidal sessile assemblages across multiple spatial scales. All diversity metrics obtained at multiple spatial scales (i.e., alpha diversities: H0, H1, and H2; beta diversities: BDtotal at the shore and regional scales) decreased immediately after the earthquake and then increased in subsequent years. At 2 years after the earthquake, H0 recovered to within the range of pre‐earthquake values and H1 and H2 became significantly higher than pre‐earthquake values. Most metrics of alpha and beta diversities recovered to pre‐earthquake levels after several years, but regional BDtotal remained low for a longer period.

Abstract The effects of seed dispersers on plant fitness (seed dispersal effectiveness, SDE) have been evaluated based on the number (quantity) and recruitment probability (quality) of dispersed seeds. Although seeds of most zoochorous species are dispersed by two or more animal species, which may interact with each other, SDE has often been studied assuming a one-plant and one-animal species system. We compared the SDE of Japanese walnut (Juglans ailanthifolia) between squirrel-only and squirrel-mouse sites in natural forests of Hokkaido, Japan, and found that the SDE from the red squirrel (Sciurus vulgaris), considered a primary seed disperser, was altered by an alternative seed disperser species, the Japanese wood mouse (Apodemus speciosus). Seed removal rates at the squirrel-mouse site were significantly higher than those at the squirrel-only site, and both dispersed seeds and seedlings were less aggregated, with a strongly repulsive relationship with adult conspecific trees at the squirrel-mouse site. Seedlings established themselves at a location with fewer medium-sized trees (

Abstract Introduction Cardiac implantable electronic devices are used in patients with cardiac rhythm disorders. Computed tomography irradiation is not prohibited for patients with cardiac implantable electronic devices, despite adverse events being reported. Hence, appropriate preparation and knowledge are required before computed tomography irradiation can be carried out in these patients. Since there is limited knowledge or literature about the influence of computed tomography irradiation in cases with recent cardiac implantable electronic devices, we aimed to evaluate the adverse events and elucidate the necessary and sufficient safety measures associated with this therapy. Methods and Results We placed cardiac implantable electronic devices on an anthropomorphic phantom model and observed their electrical activity in electrograms, while various protocols of computed tomography irradiation were implemented and adverse events evaluated. Oversensing with pauses of up to 3.2 s was observed in standard computed tomography protocols, but ventricular tachyarrhythmia or other clinically significant events could not be confirmed. Oversensing with pauses of up to 8.0 s was observed and ventricular tachyarrhythmia was detected in the maximum‐dose protocols. However, treatments such as antitachycardia pacing or shock therapy for ventricular tachyarrhythmia were not observed because of their absence. Conclusion Computed tomography irradiation for patients using cardiac implantable electronic devices is highly unlikely to cause clinically significant adverse events with the device settings and computed tomography protocols currently being used. Changing or monitoring the device settings routinely before computed tomography irradiation is not necessarily required for most patients.

There has been a limited number of studies on the effects of harmful algal blooms (HABs) on natural rocky intertidal ecosystems. From mid-September to early November 2021, an unprecedented HAB caused by Karenia selliformis hit the Pacific coast of southeast Hokkaido, Japan, for the first time, causing massive mortalities among marine organisms. To clarify the immediate impacts of the HAB on the abundance of 10 rocky intertidal species in four functional groups (macroalgae, sessile invertebrates, molluscan grazers, and molluscan carnivores), we focused on two questions: (1) How did the HAB affect the abundance of each species differently at the regional scale? and (2) How did the impacts of the HAB on the abundance of each functional groups vary spatially, and was the spatial variation of the HAB impacts related to the spatial distribution of the cell density of HAB species? To study these issues, we compared census data for 17 years before the HAB and within one month after it for five shores on the southeast coast of Hokkaido. The results showed that two macroalgae species and all three molluscan grazer species declined significantly after the HAB. Moreover, the decrease in molluscan grazers was significantly correlated with cell density. These results suggest that the impacts of the HAB in southeast Hokkaido on the abundance of rocky intertidal organisms are highly variable depending on species and locality, presumably because of differences in species-specific tolerances to HAB toxins and the spatial variation in the density of the HAB organisms.

The frequency and duration of marine heat waves (MHWs) have recently increased. There is therefore an urgent need to understand the response of marine organisms to MHWs. However, most estimates of MHW impacts on abundances include the effects of environmental stochasticity other than the MHWs. In addition, although MHWs sometimes persist for year-round or occur repeatedly for shorter periods, the accumulative carryover effects (ACEs)— the effects of sequential events accumulating additively over time— of MHWs on organisms have never been evaluated. Furthermore, the relationship between species niche traits other than thermal niches and susceptibility to MHWs is unknown. We examined the impacts of MHWs in southeastern Hokkaido, northern Japan, in summer from 2010 to 2016 on rocky intertidal communities by distinguishing MHW effects from environmental stochasticity. We asked (1) Did MHWs have ACEs on four major functional groups: macroalgae, sessile invertebrates, herbivorous invertebrates, and carnivorous invertebrates? (2) Does ignoring ACEs lead to biased assessments? (3) How did the effects of the MHWs on functional groups and their subsequent recovery differ? And (4) How does the susceptibility to MHWs differ with species niche (thermal and vertical) traits? We detected ACEs of MHWs and found that if they are ignored, the effects of MHWs can be underestimated. Although MHWs are known to reduce the abundance of macroalgae and increase that of sessile invertebrates in rocky intertidal habitats, our results show that macroalgal abundance increased during and after MHWs, whereas sessile invertebrates showed no change during or after MHWs. The abundance of herbivorous mollusks decreased during and after MHWs. Carnivorous invertebrates declined during MHWs and in the first year after MHWs. During and after MHWs, abundances of species with low thermal niches decreased and those with high thermal niches increased. There were no differences in response to MHWs between vertical niches when accumulative carryover effects were ignored. These results emphasize the importance of considering ACEs when assessing the response of marine organisms to MHWs, and that more studies of these responses are needed for a variety of ecosystems, regions and organisms to predict the responses of marine organisms.

Abstract Background Despite distinct pathophysiology, arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome (BrS) exhibit overlapping phenotypes. We investigated the prevalence and characteristics of the Brugada electrocardiogram (ECG) pattern in ARVC patients. Methods A total of 114 ARVC patients fulfilling the revised Task Force Criteria were enrolled. The Brugada ECG pattern was evaluated according to the consensus report on right precordial leads, and 1141 ECGs (median, 1; interquartile range, 1‐16 ECGs/patient) were analyzed. Results Five patients (4%) showed a Brugada ECG pattern, which disappeared in four patients with ECGs recorded more than 2 years afterward. ARVC patients with the Brugada ECG pattern had a longer PQ interval (220 ± 62 ms vs 180 ± 35 ms, P = .02) and longer QRS duration (138 ± 25 ms vs 102 ± 23 ms, P

Abstract Aims The number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta‐blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio‐selective beta‐blocker use on the long‐term outcomes of patients with HF and COPD. Methods and results Among the 5232 patients with HFrEF (left ventricular ejection fraction of

Abstract Background Anti‐tachycardia pacing (ATP) delivered from an implantable device is a useful tool to terminate ventricular tachycardia (VT). But its real‐world efficacy for those patients having multiple VTs with varying VT rates has not been fully studied. Methods Using the Nippon‐storm study database, efficacy of patient‐by‐patient basis ATP programing for Japanese patients having both non‐fast (120‐187 bpm) and fast VT (≥188 bpm) was assessed. According to the useful criteria of ≥50% success termination by ATP, patients were divided into three subgroups; success ≥50% for both non‐fast and fast VT (both useful), ≥50% only for non‐fast VT (non‐fast VT useful), or ≥50% for neither non‐fast nor fast VT (neither useful). Results During a median follow‐up of 28 months, ATP terminated 184 of the 203 non‐fast VT episodes (91%) and 86 of the 113 fast VT episodes (76%) in all 41 patients. In the patient‐by‐patient analysis, efficacy of ATP was not different between non‐fast and fast VT in most of the patients (36/41 = 88%); 32 patients were in the both useful and four other patients in the neither useful. Neither ischemic nor non‐ischemic structural heart disease was associated with the ATP efficacy, whereas LVEF more than 37.0% and non‐prescribed amiodarone were characteristics of the patients classified into the both useful. Conclusions ATP well terminated both non‐fast and fast VT occurring in individual Japanese patients with various structural heart diseases in the real‐world device treatment and this finding further supports ATP programing for all device tachycardia detection zones in most patients with multiple VTs.

Abstract Various forms of supraventricular tachycardia (SVT) occur in patients with severe pulmonary hypertension (PH). Despite the high efficacy of radiofrequency catheter ablation (RFCA) for SVT, insufficient data exist regarding patients with PH. Thirty SVTs in 23 PH patients (age 47 [35–60] years; mean pulmonary artery pressure 44 [32–50] mmHg) were analyzed. Procedural success rate, short- and long-term clinical outcomes, were evaluated during a median follow-up of 5.1 years. Single-procedure success rate was 83%; 94% (17/18) in typical atrial flutter, 73% (8/11) in atrial tachycardia (AT), and 100% (1/1) in atrioventricular nodal reentrant tachycardia. Antiarrhythmic drugs, serum brain natriuretic peptide levels and number of hospitalizations significantly decreased after RFCA than that before (p = 0.002, 0.04, and 0.002, respectively). Four patients had several procedures. After last RFCA, 12 patients had SVT and 8 patients died. Kaplan–Meier curves showed that patients with SVT after the last RFCA had a lower survival rate compared to those without (p = 0.0297). Multivariate analysis identified any SVT after the last RFCA as significant risk factor of mortality (hazard ratio: 9.31; p = 0.016). RFCA for SVT in patients with PH is feasible and effective in the short-term, but SVT is common during long-term follow-up and associated with lower survival.

Abstract Long-term patterns in trajectories of natural communities provide insights into ecological resilience, but their assessment requires long-term census data. We analyzed 16-year census data for intertidal communities from 30 rocky shores along Japan’s Pacific coast to assign community change to four possible trajectories (stable, reversible, abrupt, or linear) representing different aspects of ecological resilience, and to estimate multiple metrics of temporal invariability (species richness, species composition, and community abundance). We examined (1) how the prevalence of the four trajectories differs among regions, (2) how the features (model coefficients) of each trajectory vary among regions, and (3) how the temporal invariabilities differ among trajectories and regions. We found that the stable trajectory was the most common. Its features differed among regions, with a faster recovery to steady-state equilibrium in low-latitude regions. Furthermore, trajectories and temporal invariabilities both varied among regions, seemingly in association with the strength of ocean current fluctuations. Thus, the relationship between community temporal invariability and trajectory may be weak or absent, at least at the regional scale.

Background: The Nippon Storm Study was a prospective observational study designed to gather clinical data on implantable cardioverter-defibrillator (ICD) therapy in Japanese patients. Objective: The purpose of this subanalysis was to compare the incidence of ICD therapy in patients with left ventricular dysfunction owing to coronary artery disease (CAD) for primary and secondary prophylaxis of sudden cardiac death. Methods: We analyzed data of 493 patients with CAD and ICDs (men, 87%; age, 68 ± 10 years; left ventricular ejection fraction, 36% ± 13%; primary prophylaxis, 36%). All patients were followed up for at least 2 years. Propensity score matching was used to select patient subgroups for comparison: 133 patients with ICD for primary prophylaxis and 133 with ICD for secondary indications. Results: There were no significant differences between primary and secondary prophylaxis groups with respect to the incidence of appropriate ICD therapy within 2 years (0.153 vs 0.239; hazard ratio, 1.565 [95% confidence interval (CI), 0.898–2.727]; P = .114). Two-year electrical storm risks were 3.3% and 9.6% with HR = 3.236 (95% CI, 1.058–9.896; P = .039) in patients with primary and secondary prophylaxis, respectively. Conclusion: The incidence of ICD therapy received by patients with CAD for primary and secondary prophylaxis was not significantly different based on our propensity score–matched analysis. However, secondary-prophylaxis ICD therapy seems to be associated with a significantly higher risk for electrical storm than primary-prophylaxis ICD therapy.

Abstract Background Catheter ablation of atrial fibrillation (AF) is increasingly performed worldwide in patients with heart failure (HF). However, it has been recently emphasized that AF ablation in patients with HF is associated with increased risks of procedure‐related complications and mortality. There are little data about the differences in the efficacy and safety between cryoballoon (CB) and radiofrequency (RF) ablation of AF in patients with HF. Methods The CRABL‐HF study is designed as a prospective, multicenter, open‐label, controlled, and randomized clinical trial comparing the efficacy and safety of AF ablation between CB and RF ablation in patients with HF (LVEF ≤40%) (UMIN Clinical Trials Registry UMIN000032433). The CRABL‐HF study will consist of 110 patients at multicenter in Japan. The patients will be registered and randomly assigned to either the CB ablation or RF ablation group with a 1:1 allocation. The primary endpoint of this study is the occurrence of atrial tachyarrhythmias (ATs) at 1 year with a blanking period of 90 days after ablation. Key secondary endpoints are the success rate of the pulmonary vein isolation, total procedural time, left atrial dwelling time, total fluoroscopy time, radiation exposure, complication rate, composite of all‐cause mortality or HF hospitalizations, cardiovascular events, change in left ventricular ejection fraction, and change in quality of life. Results The results of this study are currently under investigation. Conclusion The CRABL‐HF study is being conducted to compare the efficacy and safety of catheter ablation of AF between CB and RF ablation in patients with HF.

In an effort to further extend bearing life, the authors have attempted to acquire greater knowledge regarding lubricating grease behavior in a bearing. While conducting experiments, some kinds of difficulties commonly arise when attempting to observe grease behavior directly from the bearing exterior without removing seals and shields. Making a breakthrough such a troubling aspect, X-ray computed tomography (CT), which is one of the non-destructive inspection techniques, was employed and resulted in visualizing remarkable details of grease distribution in a resin ball bearing. Hydrodynamic grease transition from churning to channeling state was well revealed by the mixture distribution of urea and barium-based greases which have different properties of X-ray absorption capability. Furthermore, the three dimensional unsteady liquid-gas multi-phase flows analysis was performed. Hydrodynamic feature of grease was regarded as a non-Newtonian fluid, which shows a highly non-linear flow curve, and the constitutive equation of modified Bingham plastic model proposed by Papanastasiou was applied to rheological property. Through these novel experimental and calculation approaches, several new insights about grease behavior inside a ball bearing were brought out.

Introduction: Various risk factors for the first inappropriate implantable cardioverter-defibrillator (ICD) therapy event have been reported, including a history of atrial fibrillation/atrial flutter (AF/AFL), younger age, and multiple zones. Nonetheless, which factors are concordant with real-world data has not been clarified, and risk factors for the second inappropriate ICD therapy event have not been well examined. This study aimed to clarify the risk factors for the first and second inappropriate ICD therapy events. Methods: We conducted a post-hoc secondary analysis of data from a multicenter, prospective observational study (the Nippon Storm Study) designed to clarify the risk factors for electrical storm. Results: The analysis included data from 1549 patients who received ICD or cardiac resynchronization therapy with defibrillator (CRT-D). Over a median follow-up of 28 months, 293 inappropriate ICD therapy events occurred in 153 (10.0%) patients. On multivariate Cox regression analysis, the risk factors for the first inappropriate ICD therapy event were younger age (hazard ratio [HR], 0.986; p = 0.028), AF/AFL (HR, 2.324; p = 0.002), ICD without CRT implantation (HR, 2.377; p = 0.004), and multiple zones (HR, 1.852; p = 0.010). “No-intervention” after the first inappropriate ICD therapy event was the sole risk factor for the second inappropriate ICD therapy event. Conclusions: Risk factors for the first inappropriate ICD therapy event were similar to those previously reported. Immediate intervention after the first inappropriate ICD therapy event could reduce the risk of the second inappropriate event.

Background Aging is one of the major concerns and determinants of the indications for catheter ablation (CA) for atrial fibrillation. This study aimed to assess the safety of CA in older patients with atrial fibrillation undergoing CA. Methods and Results The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases‐Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 6 632 484 records found between April 2012 and March 2018 from 1058 hospitals, 135 299 patients with atrial fibrillation (aged 65±10 years, 38 952 women) who underwent CA in 456 hospitals were studied and divided into the following age groups:

Abstract Background Right ventricular lead placement is one of the fundamental procedures during pacemaker implantation through the subclavian vein. Currently, there are two techniques to deliver the lead to the right ventricle: the catheter and stylet delivery systems. Surgeons, especially trainees in the early stage of training, are known to face difficulty while delivering the lead to the right ventricle. The objective of this study is to investigate and compare the two techniques of lead delivery by trainees in patients who are scheduled to undergo pacemaker implantation. Methods This is a prospective, single‐center, randomized controlled clinical trial. One‐hundred patients who were scheduled to undergo pacemaker implantation with a right ventricular lead will be randomized such that the pacemaker can be implanted via either the catheter delivery system or the stylet delivery system at a 1:1 ratio. The primary endpoint is the total number of attempts needed to place the lead in the ideal position. Secondary endpoints are the efficacy and safety of the implantation procedure. All implantation procedures will be performed by trainees under the supervision of expert cardiologists. Results The results of this study are currently under investigation. Conclusion This will be the first clinical trial to compare the efficacy and safety of the catheter delivery system and the stylet delivery system during the implantation of the ventricular lead in pacemaker implantation. Our findings are expected to improve the lead implantation procedure by providing information about which delivery system to choose in which situation.

Abstract Background Although late gadolinium enhancement magnetic resonance imaging (LGE‐MRI) allows the identification of lesions and gaps after a cryothermal balloon (CB) ablation of paroxysmal atrial fibrillation (PAF), the accuracy has not yet been well established. Methods The subjects consisted of 10 consecutive patients who underwent a second ablation procedure among our cohort of 80 patients who underwent LGE‐MRI after the CB ablation of PAF. LGE‐MRI scar regions were compared with electroanatomical mapping during the second procedure. In the analysis, the unilateral pulmonary vein (PV) antrum was divided into 7 regions. Results The gap characterization analysis was performed in 140 regions around 40 PVs in total. There were 16 LGE‐MRI gaps around 11 PVs (mean 1.6 ± 1.4 gaps/patient) in 7 patients and 14 electrical gaps around 10 PVs in 8 patients (mean 1.4 ± 1.1 gaps/patient). The locations of 13 electrical gaps were well matched to that on the LGE‐MRI, whereas the remaining 1 electrical gap had not been predicted on the LGE‐MRI. Compared to the electrical gaps in the second procedure, the sensitivity and specificity of the LGE‐MRI gaps were 93% (13 LGE‐MRI gaps of 14 electrical gaps) and 98% (123 LGE‐MRI scars out of 126 electrical scars), respectively. Conclusion LGE‐MRI can accurately localize the lesion gaps after CB ablation of PAF.

Background: Patients with implantable cardioverter defibrillator (ICD) use for primary prevention (primary prevention patients) of sudden cardiac death have lower incidence of appropriate ICD therapy (app-Tx) compared with those with ICD use for secondary prevention (secondary prevention patients). However, detail analysis of a second app-Tx after a first app-Tx is still lacking. Objective: This study aimed to compare the incidence of a second app-Tx in primary vs secondary prevention patients. Methods: We conducted sub-analysis of the Nippon Storm Study, which was a prospective, observational study involving 985 patients with structural heart disease (left ventricular ejection fraction ≤ 50%). Of these, we selected 251 patients (62 ± 14 years old, 82% men) who experienced at least one appropriate ICD therapy, and compared occurrence of a second app-Tx between primary (n = 116) and secondary (n = 135) prevention patients. Results: There was no significant difference in the incidence of a second app-Tx between primary and secondary prevention patients (the cumulative incidence for a second app-Tx was 59% at 1 year and 79% at 3 years in primary prevention patients vs the cumulative incidence for the second app-Tx was 59% at 1 year and 75% at 3 years in secondary prevention patients).Additionally, we evaluated the incidence of a second app-Tx according to basal structural disease (ischemic and non-ischemic cardiomyopathy) and found no significant difference between primary and secondary prevention patients. Conclusion: Once app-Tx occurs, primary prevention patients acquire the high risk of subsequent ventricular arrhythmias because there is a comparable incidence of a second app-Tx in secondary prevention patients.

Abstract A 31‐year‐old female with 10 years indwelled Hickman catheter for idiopathic pulmonary hypertension presented infectious findings. We decided to remove it but simple traction did not work. Although it was an off labeled use, we could remove it using a laser sheath and snare technique without any complication.

A 76-year-old man who had been diagnosed with long-QT syndrome type 2 had frequent syncopal attacks. The electrocardiogram was monitored, and frequent torsades de pointes (TdP) was detected despite administration of conventional medications: oral propranolol, verapamil, intravenous magnesium sulfate, verapamil, and lidocaine. In contrast, 2 μg/kg/min landiolol could completely suppress TdP. Subsequently, an implantable cardioverter defibrillator was placed, and he was diagnosed with silent myocardial ischemia using myocardial perfusion scintigraphy and coronary angiography. This is the first case report wherein landiolol effectively suppressed TdP due to long-QT syndrome with silent myocardial ischemia.

Background: Pulmonary vein isolation (PVI) is a cornerstone of catheter ablation in patients with paroxysmal atrial fibrillation (PAF), and balloon-based ablation has been recently performed worldwide. Ablation using the second-generation cryoballoon (CB2) (Arctic Front AdvanceTM, Medtronic, MN, USA) is useful for PVI; however, there is some debate concerning the optimal freezing time and number of cycles after PVI is achieved. Methods: The AD-Balloon study was designed as a prospective, multicenter, randomized clinical trial to evaluate the optimal strategy (freezing cycles) of CB2 ablation (UMIN Clinical Trials Registry UMIN000020130). The main objective of this study is to investigate the need for an additional freezing cycle after PVI in patients treated with CB2 ablation. Patients will be randomly assigned in a 1:1 ratio to treatment with additional freezing (AD group) or without additional freezing (non-AD group). In the AD group, 3 min of additional freezing time will be applied in all pulmonary veins after PVI is confirmed at the previous freezing cycle. In the non-AD group, no additional freezing will be applied in all pulmonary veins after PVI is confirmed. The primary endpoint of this study is the occurrence of atrial tachyarrhythmias within a 1-year follow-up period. We will enroll 110 consecutive patients with PAF. We will also investigate the usefulness of delayed-enhancement magnetic resonance imaging to assess the ablation lesions caused by CB2 ablation. Results: The results of this study are currently under investigation. Conclusion: The AD-Balloon study would assess the need for an additional freezing cycle after PVI is achieved. Our findings may contribute to further improvement of the CB2 ablation procedure.

In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.

Background: Landiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure. Methods: A total of 39 patients with AF/AFL with ventricular response ≥120 bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110 bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24 h after the initiation of landiolol. Results: For AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events. Conclusions: Landiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.

We report the case of a 51-year-old patient with Brugada syndrome (BrS) who experienced inappropriate shock due to T-wave oversensing (TWOS) during exercise when the optimal sensing vector was selected based on the automatic analysis by a subcutaneous implantable cardioverter-defibrillator (S-ICD). After selecting another vector during exercise testing, TWOS did not re-occur. Selection of appropriate sensing vector based on analyses under various conditions, including during exercise after S-ICD implantation, should be considered for patients with BrS.

To elucidate how the population dynamics of the acorn barnacle Balanus glandula transitioned after its invasion in 2000 along the Pacific coast of Japan, a population census was conducted from 2004 to 2014 at five shores along 49 km of coastline 144–193 km east outside of the invasion front. Survey areas at each shore consisted of five paired plots (cleared recruitment plots and control plots). Larval recruitment was first detected in 2004 but benthic individuals were not detected until 2 years later. The abundance and occurrence of B. glandula increased until around 2010; abundance then decreased but occurrence remained high (70%) until 2014, suggesting that the metapopulation of this barnacle approached a maximum around 2011. From 2011, the population dynamics of B. glandula changed considerably at two contrasting spatial scales: at a regional scale, the dependency of the number of larvae on stock size decreased, whereas at a local scale, the relative contribution of larval supply as a determinant of local population dynamics decreased. These findings suggest that the major driving force of population dynamics of the introduced barnacle changed in just a few years after invasion; therefore, population census data from just after an invasion, including larval recruitment monitoring just outside the invasion front, is essential to understanding invasion dynamics by sessile marine organisms.

Background Epicardial mapping can reveal low‐voltage areas on the right ventricular outflow tract in patients with Brugada syndrome with several ventricular fibrillation (VF) episodes. A type 1 ECG is associated with an abnormal electrogram on right ventricular outflow tract epicardium. This study investigated the clinical significance of the amplitude of type 1 ECGs in patients with Brugada syndrome. Methods and Results In 209 patients with Brugada syndrome with a spontaneous type 1 ECG (26 resuscitated from VF, 54 with syncope, and 129 asymptomatic), the amplitude of the ECG in leads exhibiting type 1 was measured among V1 to V3 leads positioned in the standard and upper 1 and 2 intercostal spaces. The number of ECG leads exhibiting type 1 did not differ among groups. The averaged amplitude of type 1 ECG was, however, significantly smaller in the group resuscitated from VF than in the asymptomatic group (P

This research proposes a new image visualization method of bulldozer and surrounding dangerous area to operator. Bulldozers are operated on uneven terrain which contains dangerous slope or obstacle. The objective of this research is to visualize the pose of bulldozer and surrounding terrain shape and to emphasis existence of dangerous terrain shape. Our proposed method consists of following three parts. First part is machine pose visualization. Machine pose is measured by on-board IMU and GNSS. The 3DCG model pose is changed according to measurement rotation and translation motion. Second part is terrain shape visualization. Terrain shape is measured by on-board laser radar and change projection plane shape. Third part is danger area detection and visualization. Danger area is detected by point density and incline of ground shape mesh. An experiment was conducted with a real bulldozer. The image which was generated by the proposed method was compared to what generated by the conventional method. Visibility of pose change of bulldozer and surrounding danger environment was improved.

BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

A 65-year-old woman with a history of syncope was diagnosed with hypertrophic cardiomyopathy. She had previously undergone mastectomy of the left breast owing to breast cancer. Holter electrocardiogram (ECG) and monitor ECG revealed sick sinus syndrome (Type II) and non-sustained ventricular tachycardia. Sustained ventricular tachycardia and ventricular fibrillation were induced in an electrophysiological study. Although the patient was eligible for treatment with a dual chamber implantable cardioverter defibrillator (ICD), venography revealed lack of the right superior vena cava (R-SVC). Lead placement from the left subclavian vein would have increased the risk of lymphedema owing to the patient׳s mastectomy history. Consequently, the defibrillation lead was placed in the right ventricle by direct puncture of the right auricle through the tricuspid valve. The atrial lead was sutured to the atrial wall, and the postoperative course was unremarkable. Defibrillation lead placement using a transthoracic transatrial approach can be an alternative method in cases where a transvenous approach for lead placement is not feasible.

Background: There is little evidence of the efficacy and safety of dabigatran in Japanese patients with non-valvular atrial fibrillation (NVAF). Methods and Results: We evaluated 300 consecutive patients with NVAF (68±11 years old, 209 men, 180 paroxysmal) who received 220 mg/day (203 patients) or 300 mg/day dabigatran (97 patients) at our hospital. Most patients (84%) had lower CHADS2 (congestive heart failure, hypertension, age>75 years, diabetes, stroke/transient ischemic attack) scores of 0 (n=60), 1 (n=114), or 2 (n=78) and lower HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition) scores of 0 (n=39), 1 (n=114), or 2 (n=103). The estimated creatinine clearance was 77±24 mL/min, which was inversely correlated to age (r2=0.48, p

Abstract Background Cardiac resynchronization therapy (CRT) has been widely used for the treatment of refractory heart failure (HF). However, the efficacy of CRT is not well established in class IV HF patients on inotropic support. Methods Twenty‐six patients (age 55±18 years, 73% men) with inotrope‐dependent HF were reviewed to evaluate the effectiveness of CRT in class IV HF patients on inotropic support. Results Intravenous inotropic therapy was administered for 72±56 days before CRT and consisted of dobutamine (n=24; 3.0±1.2 μg kg−1 min−1), dopamine (n=2; 4.5±2.1 μg kg−1 min−1), and/or milrinone (n=16; 0.12±0.09 μg kg−1 min−1). CRT did not produce significant reverse remodeling in eligible patients (left ventricular ejection fraction 23±7% to 25±9%; p=0.23, left ventricular end‐diastolic diameter 70±9 mm to 68±9 mm; p=0.14). After CRT device implantation, 13 (50%) patients experienced 1 or more episodes of ventricular tachyarrhythmia or sudden cardiac death. Twenty (77%) patients survived to hospital discharge with weaning from inotropic support (70±70 days after CRT implantation). The 1‐year survival rate was 81%. However, data from long‐term follow‐up showed that 68% of the study patients who attained survival discharge had an HF hospitalization event within the follow‐up period. Conclusion CRT did not result in significant reverse remodeling in patients with inotrope‐dependent class IV end‐stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short‐term period in some patients.

Loss-of-function mutations in the cardiac sodium channel α-subunit gene SCN5A result in multiple inherited arrhythmic syndromes. This case report describes 2 unrelated probands carrying an identical SCN5A frameshift mutation, V1764fsX1786, who exhibited distinct clinical manifestations: progressive cardiac conduction defect (PCCD)/Brugada syndrome (patient #1) and idiopathic ventricular fibrillation (IVF) (patient #2). Using a whole-cell patch clamp technique, cells expressing V1764fsX1786 showed no observable Na+ current. Therefore, a significant phenotypic overlap was found between IVF and PCCD/Brugada syndrome in the 2 probands with the V1764fsX1786, loss-of-function frameshift mutation of the cardiac sodium channel gene SCN5A.

Background: Cardiac resynchronization therapy (CRT) is known to be effective for patients with heart failure. However, despite data suggesting that routine atrioventricular (AV) and interventricular (VV) delay optimization may play significant roles in CRT, there is no standard on how and when the CRT device should be optimized. The aim of this study was to characterize the current practice of CRT optimization in Japan. Methods: A survey was conducted to collect information on the procedural aspects of AV and VV delay optimization. The key survey items concerned what method is used for optimization, when optimization is performed, and what factors limit repetitive optimization. Results: Fifty-two physicians participated in the survey. Echocardiography was the chosen method for assessing AV and VV delays by 79.6% and 65.3% of physicians, respectively, and routine optimization was performed by 28.3%. The majority optimized the settings only once at pre-hospital discharge or on an “as-needed” basis. The factors limiting repeated optimization were the lack of available time (71.2%), qualified staff (53.8%), and reliable methods (55.8%). Conclusions: Repetitive CRT optimization is infrequently performed in Japan. Lack of time, human resource, and reliable methods were the major factors affecting the number of routine CRT optimization.

Implantable cardioverter defibrillators (ICDs) have become very useful for patients with a high risk of sudden cardiac death, based on the results of several clinical trials. Although ICDs can improve survival when used in patients with heart failure (HF) and reduced left ventricular (LV) function, a recent sub-analysis of major clinical trials regarding ICDs has revealed that ICD shock is associated with worsening HF or increase in mortality. ICD settings must be programmed appropriately, guided by clear evidence, to avoid unnecessary and inappropriate shocks. We discuss the benefits and pitfalls of ICD programming, such as tachycardia pacing, detection intervals, detection rates, and discriminators, to offer programming tips in this review.

Introduction: The aim of this study was to clarify the characteristics of lower loop reentry (LLR. in patients who underwent cardiac surgery. Methods: Of 194 patients from 2000 to 2007 with negative flutter waves in the inferior leads (II, III, and aVf), 4 patients had LLR and reentrant circuits identified by a 3D activation sequence mapping system. We studied the characteristics of the surface electrocardiogram (ECG. patterns of those LLRs. Results: All 4 patients had a history of an intracardiac operation. The 3D activation sequence mapping system during the LLR exhibited a clockwise (CW. wavefront around the inferior vena cava (IVC. from the caudal view. During the LLR, the right atrium (RA. free wall was activated in a caudal-cranial sequence and a collision of two activation wavefronts from the lower RA and upper RA occurred at the RA free wall. Conclusions: The 3D activation mapping during the AT revealed an activation wavefront propagating around the IVC and the diagnosis of LLR. Detailed 3D electroanatomical mapping and pacing study are needed to identify the reentrant circuit of LLR in patients with previous intracardiac surgery.

Here, we present a rare case of fetal bradyarrhythmia following magnesium sulfate therapy for preterm labor. After we switched treatment from ritodrine hydrochloride to magnesium sulfate at 25 weeks' gestation, the fetal heart rate dropped from 150 bpm to 80–100 bpm. Fetal echocardiography and magnetocardiography indicated bigeminy and trigeminy of blocked premature atrial contractions. It is well known that magnesium sulfate decreases the baseline and variability of fetal heart rate. Studies have reported a substantial decrease of 2–15 bpm in the baseline fetal heart rate, and magnesium has various effects on fetal heart rate patterns with a lower baseline fetal heart rate within the normal range of 110–160 bpm. This is the first report of magnesium sulfate-induced fetal bradyarrhythmia by prolongation of the refractory period of the atrioventricular node in the case of blocked premature atrial contractions. Clinicians should consider fetal bradyarrhythmia when the baseline fetal heart rate drops to

An understanding of the clinical aspects of electrical storm (E-storms) in patients with implantable cardiac shock devices (ICSDs: ICDs or cardiac resynchronization therapy with defibrillator [CRT-D]) may provide important information for clinical management of patients with ICSDs. The Nippon Storm Study was organized by the Japanese Heart Rhythm Society (JHRS) and Japanese Society of Electrocardiology and was designed to prospectively collect a variety of data from patients with ICSDs, with a focus on the incidence of E-storms and clinical conditions for the occurrence of an E-storm. Forty main ICSD centers in Japan are participating in the present study. From 2002, the JHRS began to collect ICSD patient data using website registration (termed Japanese cardiac defibrillator therapy registration, or JCDTR). This investigation aims to collect data on and investigate the general parameters of patients with ICSDs, such as clinical backgrounds of the patients, purposes of implantation, complications during the implantation procedure, and incidence of appropriate and inappropriate therapies from the ICSD. The Nippon Storm Study was planned as a sub-study of the JCDTR with focus on E-storms. We aim to achieve registration of more than 1000 ICSD patients and complete follow-up data collection, with the assumption of a 5–10% incidence of E-storms during the 2-year follow-up.