We have reported that high sodium excretion ≥ 4.0 g/day, assessed by repeated measurements of spot urine, is associated with composite cardiovascular (CV) events of heart failure (HF) ...hospitalization, acute coronary syndrome, cerebrovascular events, and documented CV deaths in Japanese high-risk patients with either stable and compensated congestive HF, high brain natriuretic peptide, coronary artery disease, cerebrovascular disease, chronic kidney disease, or atrial fibrillation. A total of 520 patients were enrolled. During the median follow-up period of 5.2 years, 105 (20%) experienced composite CV events, which were predominantly driven by 60 (12%) HF hospitalizations. The aim of the present study was to elucidate which subgroups of patients with high sodium excretion were associated with HF hospitalization. We divided the enrolled patients into three groups according to the amount of sodium excretion (< 3.0 g/day, 3.0–3.99 g/day (reference), and ≥ 4.0 g/day) based on a median of 14 measurements during follow-up. We assessed the hazard ratio for HF hospitalization according to age, bodyweight, and gender, using the Cox hazard model. In the total population, high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization hazard ratio (HR) 1.75, confidence interval (CI) 1.05–2.83 after adjustment for gender, age, and bodyweight, but was not associated with other CV events. In older patients (≥ 75 years old), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for gender and bodyweight (HR 3.25, CI 1.55–6.55), which was not observed in younger (< 75 years old) patients. In patients with lower bodyweight (< 60 kg), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for age and gender (HR 3.05, CI 1.34–6.61), which was not observed in heavier (≥ 60 kg) patients. High sodium excretion is associated with HF hospitalization in patients with older age and lower bodyweight in Japanese high-risk patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Background The mortality and morbidity rates of various cardiovascular diseases differ between Western countries and Japan. The age- and gender-specific prevalence rate of atrial ...fibrillation (AF) in the general population of Japan was determined using the data from periodic health examinations in 2003. Methods Data of 630,138 subjects aged 40 years or more (47% were men and 34% were employees of companies and local governments) were collected from northern to southern Japan. The prevalence of diagnosed AF in each 10-year age group of both men and women was determined. Based on these prevalence rates and the Registry of Residents, the number of people having AF in Japan was estimated. Results The prevalence rate of AF increased as both male and female subjects aged, and it was 4.4% for men but only 2.2% for women aged 80 years or more ( p < 0.0001). As a whole, the AF prevalence of men was three times that of women (1.35 versus 0.43%, p < 0.0001). There may be approximately 716,000 people (95% confidence interval (CI), 711,000–720,000) with AF in Japan, an overall prevalence of 0.56%. The number of people having AF was projected to be 1.034 (95% CI, 1.029–1.039) million, an overall prevalence of 1.09%, in 2050. Conclusions The prevalence of AF increased in Japan as the population aged, as in Western countries. The overall prevalence of AF in Japan is approximately two-thirds of that in the USA. The projected increase in the number of people having AF is modest in Japan in 2050.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The optimal level of sodium intake remains controversial, and the effects on a broad range of cardiovascular (CV) conditions remain unknown. The Evaluation of sodium intake for the prediction of ...cardiovascular events in Japanese high-risk patients (ESPRIT) is a prospective observational study designed to investigate whether sodium intake assessed by spot urine testing is associated with adverse CV events. A total of 520 patients who visited our cardiology clinic with various cardiovascular risk profiles were included. Sodium intake was estimated by spot urine testing at the time of entry, and the measurement was repeated at least every 6 months during follow-up. The primary endpoint was composed of (1) hospitalization due to heart failure, (2) acute coronary syndrome, (3) cerebrovascular events, and (4) documented CV deaths. The secondary endpoint was all-cause mortality. During the median follow-up period of 5.2 years, there were 105 composite CV events (3.9%/year), including 60 hospitalizations due to heart failure, 9 acute coronary syndromes, 21 cerebrovascular events, 15 CV deaths, and 26 cases of all-cause mortality. The average sodium excretion (from a median of 14 measurements) during the follow-up period was 3.52 ± 0.67 g/day. After adjustment for age, sex, and body weight, higher sodium excretion ( ≥ 4.0 g/day) was associated with composite CV events (hazard ratio 1.79, confidence interval 1.01-3.15 compared with the reference value of 3.0-3.49 g/day) but not all-cause mortality. The ESPRIT study showed that high sodium excretion (≥ 4.0 g/day) was associated with the predefined composite CV events (UMIN ID: UMIN000005419).
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Background Protocols on the use of novel oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) are lacking. Aim The ...study was aimed at evaluating the efficacy of dabigatran (Dabi) treatment in preventing peri-ECV stroke. Methods A retrospective survey of the incidence and fate of left atrial (LA) thrombus during Dabi therapy in patients with AF was conducted between December 2012 and January 2013 by the Japanese Heart Rhythm Society. Results A total of 198 patients from 299 institutions underwent transesophageal echocardiography (TEE) to rule out LA thrombus before ECV. Of these, LA thrombus was found in eight patients (4%), who tended to be older (67.3 vs. 61.3 years, p =0.175), had higher CHADS2 scores (1.88 vs. 0.95, p =0.058), and a higher prevalence of prior stroke or transient ischemic attack (22.2% vs. 2.6%, p =0.034) than those without LA thrombus. Of the eight patients with LA thrombus, one had LA thrombus during a Dabi 150 mg b.i.d treatment, whereas the remaining seven were receiving 110 mg b.i.d for 3 weeks or longer. In 6 of the 8 patients with LA thrombus, a second TEE was performed, revealing complete resolution of LA thrombus in five; among these five patients, one received Dabi dosage of 150 mg b.i.d unchanged, two received an increased dosage from 110 mg to 150 mg b.i.d, and two were switched to warfarin. Two patients had a stroke 3 and 15 days after ECV, and one had a major large intestine bleeding episode during Dabi therapy. Conclusions LA thrombus developed in 4% of patients with AF receiving Dabi. Older patients with a higher CHADS2 score receiving a lower Dabi dosage were more likely to develop LA thrombus, which was resolved with a prolonged or increased dosage. A higher Dabi dosage may be more beneficial before ECV but prospective randomized studies would be needed to confirm these results.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Diffuse large B-cell lymphoma (DLBCL)-associated arrhythmias may be due to cardiac involvement or may be chemotherapy-induced. There have been no reports of significant arrhythmias with normal ...cardiac function occurring during the complete remission of DLBCL. A 57-year-old female, who had had no history of abnormal electrocardiograms (ECGs) in annual medical checkups, was admitted to our hospital because of low-grade fever, night sweats, and weight loss. On admission, ECG revealed a variable rhythm consisting of sinus beats and occasional escape beats. Computed tomography and 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) revealed two masses in the right atrium (RA) and the uterus. Total hysterectomy was performed, and pathological findings were consistent with diffuse large B-cell lymphoma (DLBCL). Chemotherapy (R-CHOP) was initiated. After two chemotherapy cycles, RA tumors disappeared, and bradyarrhythmia simultaneously converted to sinus rhythm without antiarrhythmic drug therapy. Six months after completion of chemotherapy, FDG-PET/CT revealed negative uptake in the RA and the uterus. The patient attained complete remission of DLBCL, but ECG showed bradycardia because of sinus arrest. Our case suggests that DLBCL-induced arrhythmia can occur even after its remission and should be monitored.
Abbreviations A-ATP atrial anti-tachycardia pacing ACC American College of Cardiology ACP advance care planning ACT activated clotting time AF atrial fibrillation AHA American Heart Association AHRE ...atrial high-rate episodes AVNRT atrioventricular nodal reentrant tachycardia BARC Bleeding Academic Research Consortium CBA cryoballoon ablation CIED cardiac implantable electronic device COR class of recommendation CRT cardiac resynchronization therapy CRT-D cardiac resynchronization therapy defibrillator CRT-P cardiac resynchronization therapy pacemaker CT computed tomography DAP dose–area product DAPT dual antiplatelet therapy DNAR Do Not Attempt Resuscitation DOAC direct oral anticoagulant EBM evidence-based medicine ESC European Society of Cardiology FDA Food and Drug Administration GOR grade of recommendation HF heart failure HFrEF heart failure with reduced ejection fraction HPSD high-power short-duration HRS Heart Rhythm Society ICD implantable cardioverter-defibrillator JCS Japanese Circulation Society JHRS Japanese Heart Rhythm Society LOE level of evidence LVEF left ventricular ejection fraction MRI magnetic resonance imaging MVP minimal ventricular pacing NASPE North American Society of Pacing and Electrophysiology NYHA New York Heart Association QOL quality of life RCT randomized controlled trial RFCA radio-frequency catheter ablation SCAF subclinical atrial fibrillation vHPSD very high-power short-duration Abbreviations of Research Names AATAC Ablation vs Amiodarone for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure and an Implanted ICD/CRTD ABRIDGE-J Ablation Perioperative Dabigatran in Use Envisioning in Japan ARISTESiA Apixaban for the Reduction of Thrombo-Embolism in Patients with Device-Detected Sub-Clinical Atrial Fibrillation ASSERT Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial ASAP ASA Plavix Feasibility Study with Watchman Left Atrial Appendage Closure Technology ATTEST Atrial Therapy Efficacy and Safety Trial AXAFA AFNET 5 Anticoagulation Using the Direct Factor Xa Inhibitor Apixaban during Atrial Fibrillation Catheter Ablation: Comparison to VKA Therapy CABANA Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients with Atrial Fibrillation CASTLE-AF Catheter Ablation for Atrial Fibrillation with Heart Failure CIRCA-DOSE Study Cryoballoon vs. Novel Anticoagulation Agents in Atrial Fibrillation PREVAIL Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients with Atrial Fibrillation versus Long-term Warfarin Therapy PROTECT-AF Percutaneous Closure of the Left Atrial Appendage versus Warfarin Therapy for Prevention of Stroke in Patients with Atrial Fibrillation RATE Registry of Atrial Tachycardia and Atrial Fibrillation Episodes RE-CIRCUIT Randomized Evaluation of Dabigatran Etexilate Compared to Warfarin in Pulmonary Vein Ablation: Assessment of an Uninterrupted Periprocedural Anticoagulation Strategy SALUTE A Study to Evaluate the Safety and Effectiveness of the Left Atrial Appendage Closure Therapy Using WATCHMAN for Patients with NVAF at Increased Risk of Thromboembolism in Japanese Medical Environment SAVE PACe Search AV Extension and Managed Ventricular Pacing for Promoting Atrio-Ventricular Conduction SOS AF Stroke Prevention Strategies Based on Atrial Fibrillation Information from Implanted Devices STOP AF First Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation STOP PERSISTENT AF Stop Persistent AF TACTIC-AF Tailored anticoagulation for non-continuous atrial fibrillation TRENDS A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics VENTURE-AF Study Exploring Two Treatment Strategies in Patients with Atrial Fibrillation who Undergo Catheter Ablation Therapy WASP Watchman Occlusion in Long-standing Persistent Atrial Fibrillation Table of Contents I. Introduction 2 II. ...the main features of these focused updated guidelines are as follows. When the previous guidelines were announced, there were no guidelines or expert consensus that clarified the recommended therapeutic level; however, the new ACC/AHA/HRS guidelines in 2019 stated a recommended level, 3 and the initial concept of His bundle pacing was extended to conduction system pacing including both His bundle and left bundle pacing. ...based on the present consideration, we describe recommended levels of conduction system pacing.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
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