Background
Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post‐ablation medication and clinical outcomes remains to be ...fully investigated.
Methods
We divided 682 patients who had undergone AF ablation in 2014–2019 (420 paroxysmal AFs PAF, 262 persistent AFs PerAF) into three groups according to the period, that is, the 2014–2015 (n = 139), 2016–2017 (n = 244), and 2018–2019 groups (n = 299), respectively.
Results
Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra‐pulmonary vein (PV)‐LA ablation was more frequently performed in the 2014–2015 group than in the 2016–2017 and 2018–2019 groups (41.1% vs. 9.1% and 8.1%; p < .001). The 2‐year freedom rate from AF/atrial tachycardias for PAF was similar among the three groups (84.0% vs. 83.1% vs. 86.7%; p = .98) but lowest in the 2014–2015 group for PerAF (63.9% vs. 82.7% and 86.3%; p = .025) despite the highest post‐ablation antiarrhythmic drug use. Cardiac tamponade was significantly decreased in the 2018–2019 group (3.6% vs. 2.0% vs. 0.33%; p = 0.021). There was no difference in the 2‐year clinically relevant events among the three groups.
Conclusion
Although ablation was performed in a more diseased LA and extra‐PV‐LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased. Clinically relevant events remained unchanged over the recent 6 years, suggesting that the impact of the recent ablation modalities and strategies on remote clinically relevant events may be small during this study period.
Although ablation was performed in a more diseased left atrium (LA) and extra‐PV LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Purpose
Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an ...upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit.
Methods
The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial LA roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus.
Results
Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%,
P
= 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%,
P
= 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations.
Conclusion
AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.
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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
Background
Atrioventricular nodal reentrant tachycardia (AVNRT) sometimes recurs even after anatomical slow pathway (SP) ablation targeting the rightward inferior extension (RIE). This multicenter ...study aimed to determine the reasons for AVNRT recurrence.
Methods and Results
Forty‐six patients were treated successfully for recurrent AVNRT. Initial treatment was for 38 slow‐fast AVNRTs, 3 fast‐slow AVNRTs, 2 slow‐slow AVNRTs, 2 slow‐fast and fast‐slow AVNRTs, and 1 noninducible AVNRT. All initial treatments were of RF application to the RIE; SP elimination was achieved in 11, dual AVN physiology was seen in 29, and AVNRT remained inducible in 5. The recurrent AVNRTs included 34 slow‐fast AVNRTs, 6 fast‐slow AVNRTs, 3 slow‐slow AVNRTs, 2 slow‐fast and fast‐slow AVNRTs, and 1 slow‐fast and slow‐slow AVNRTs. Successful ablation site was within the RIE in 39 and left inferior extension in 7. In 30 of 39, the successful RIE site was in the same area or higher than that of the initial procedure.
Conclusion
For a high majority (around 85%) of patients in whom AVNRT recurs after initial ablation success, the site of a second successful procedure will be within the RIE even though the RIE was originally targeted. Furthermore, a high majority (around 86%) of sites of successful ablation will be higher than those originally targeted.
Eighty‐five percent of a successful re‐ablation site will remain within the rightward inferior extension (RIE). Furthermore, 86% of successful RIE sites will be higher than those initially targeted.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background: The success rates for ablation of persistent atrial fibrillation (PerAF) are lower than those for ablation of paroxysmal AF (PAF). We investigated whether a relation exists between the ...presence of sinus rhythm(SR) early in the procedure and the ablation outcome in patients with PerAF.Methods and Results: The study involved 46 patients with persistent AF (< 7 days duration; 7 women, 39men, aged 60.8 ± 10.0 years; AF duration, 14 5, 48 months) who underwent pulmonary vein isolation (PVI). Ablation outcomes were compared between patients who were in SR early during the procedure, because 1) SR waspresent at the start of the procedure (SR group), 2) AF was electrically cardioverted to SR before PVI (DC group),or 3) PVI was performed during AF (AF group). After a 3-month blank period, the incidence of freedom from AFafter the single procedure was significantly higher in the SR group compared with that in the DC and AF groups(100%, 46% and 50%, respectively, P = 0.0110), during median follow-up periods of 15.5, 19.4, and 28.2 months,respectively.Conclusion: The presence of spontaneous SR before ablation for PerAF appears to be related to AF-free survival.
Aims
Multi‐organ dysfunction was recently reported to be a common condition in patients with heart failure (HF). The Model for End‐stage Liver Disease eXcluding International normalized ratio ...(MELD‐XI) score reflects liver and kidney function. The prognostic relevance of this score has been reported in patients with a variety of cardiovascular diseases who are undergoing interventional therapies. However, the relationship between the severity of hepatorenal dysfunction assessed by the MELD‐XI score and the long‐term clinical outcomes of HF patients receiving cardiac resynchronization therapy (CRT) has not been evaluated.
Methods and results
Clinical records of 283 patients who underwent CRT implantation between March 2003 and October 2020 were retrospectively evaluated (mean age 67 ± 12, 22.6% female). Blood samples were collected before CRT implantation. Patients were divided into three groups based on tertiles of the MELD‐XI score: first tertile (MELD‐XI = 9.44, n = 95), second tertile (9.44 < MELD‐XI < 13.4, n = 94), and third tertile (MELD‐XI ≥ 13.4, n = 94). The primary endpoint was all‐cause mortality. Compared with the other groups, the third tertile group exhibited significantly older age, higher prevalence of diabetes mellitus and hypertension, lower haemoglobin level, and higher N‐terminal pro‐brain natriuretic peptide level (all P < 0.05). The functional CRT response rate was also significantly lower in the third tertile group (P = 0.011). During a median follow‐up of 30 months (inter‐quartile range, 9–67), 105 patients (37.1%) died. Kaplan–Meier analysis revealed that patients with a higher MELD‐XI score had a greater risk of all‐cause mortality (log‐rank test: P < 0.001). Even after adjustment for clinically relevant factors and a conventional risk score, the MELD‐XI score was still associated with mortality (adjusted hazard ratio: 1.04, 95% confidence interval: 1.00–1.07, P = 0.014, and adjusted hazard ratio: 1.04, 95% confidence interval: 1.01–1.09, P = 0.005, respectively). A higher MELD‐XI score was associated with a greater risk of all‐cause mortality than a lower MELD‐XI score regardless of whether a pacemaker or defibrillator was implanted (log‐rank test: P = 0.010 and P < 0.001, respectively).
Conclusions
Impaired hepatorenal function assessed by the MELD‐XI score was associated with older age, higher prevalence of multiple co‐morbidities, severity of HF, lower CRT response rates, and subsequent all‐cause mortality in HF patients undergoing CRT implantation. These results suggest that the MELD‐XI score can provide additional prognostic information and may be useful for improving risk stratification in this population.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Graphene is generally synthesized at high temperatures. Here we demonstrate a simple method to synthesize graphene at 150 °C. Carbon foils were irradiated with Ar
+
ions at 1 keV with a simultaneous ...supply of catalyst metal without any intentional heating to survey the novel catalyst for graphene growth at low temperature. The ion irradiated surfaces were covered with densely distributed conical structures sometimes with a nanofiber on their respective tips. As revealed by high resolution (HR) transmission electron microscopy (TEM), the conical tips featured few layer graphene only for the newly selected catalyst metal, In, which is rarely used for the chemical vapor deposition (CVD) synthesis of graphene. This observation gives a new insight into the catalytic activity during graphene synthesis. Encouraged by this ion-induced graphene formation, samples of a thin, amorphous carbon film on SiO
2
substrates overlaid with this novel catalyst film were prepared, and finally, graphene growth was achieved by simple vacuum heating at 150 °C.
Graphene was synthesized at 150 °C. Carbon foils were irradiated with Ar
+
ions with a simultaneous supply of indium to synthesize conical structures with nanofibers giving new insight into the catalytic activity of indium in graphene synthesis.
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IJS, KILJ, NUK, UL, UM, UPUK
Here, we report a controllable direct graphene growth process on an insulating substrate (SiO 2 /Si and sapphire) by the solid phase reaction of a polymer layer. Water soluble polyvinyl alcohol (PVA) ...was spin coated on the SiO 2 /Si substrate and graphitized in presence of a Ni catalyst cap layer. Graphene growth occurs with decomposition and dehydrogenation of the polymer layer with metal catalyzation. The role of gas atmosphere, temperature, thickness of polymer and catalyst layers are investigated in the solid phase reaction process for graphene nucleation and growth. Formation of graphene flakes directly on the substrate surface is confirmed by Raman spectroscopy, optical and atomic force microscopy analysis. The as-synthesized graphene flakes interconnect with each other to create a network like structure. In the growth process, decomposing the polymeric film at an elevated temperature, atomic carbon can diffuse and segregate at the Ni/substrate interface to create the graphene structure. The developed direct growth process of the graphene structure using a simple polymer by a solid phase reaction can be significant for device integration.
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IJS, KILJ, NUK, UL, UM, UPUK
Background
This study aimed to establish a systematic method for diagnosing atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed nodoventricular pathway (cNVP).
Methods
We ...analyzed 13 cases of AVNRT with a bystander cNVP, 11 connected to the slow pathway (cNVP‐SP) and two to the fast pathway (cNVP‐FP), along with two cases of cNVP‐related orthodromic reciprocating tachycardia (ORT).
Results
The diagnostic process was summarized in three steps. Step 1 was identification of the presence of an accessory pathway by resetting the tachycardia with delay (n = 9) and termination without atrial capture (n = 4) immediately after delivery of a His‐refractory premature ventricular contraction (PVC). Step 2 was exclusion of ORT by atrio‐His block during the tachycardia (n = 4), disappearance of the reset phenomenon after the early PVC (n = 7), or dissociation of His from the tachycardia during ventricular overdrive pacing (n = 1). Moreover, tachycardia reset/termination without the atrial capture (n = 2/2) 1 cycle after the His‐refractory PVC was specifically diagnostic. Exceptionally, the disappearance of the reset phenomenon was also observed in the two cNVP‐ORTs. Step 3 was verification of the AVN as the cNVP insertion site, evidenced by an atrial reset/block preceding the His reset/block in fast–slow AVNRT with a cNVP‐SP and slow–fast AVNRT with a cNVP‐FP or His reset preceding the atrial reset in slow–fast AVNRT with a cNVP‐SP.
Conclusion
AVNRT with a bystander cNVP can be diagnosed in the three steps with few exceptions. Notably, tachycardia reset/termination without atrial capture one cycle after delivery of a His‐refractory PVC is specifically diagnostic.
The three steps to diagnosing AVNRT with a bystander concealed nodoventricular pathway (cNVP) are as follows. Step 1: identification of a concealed accessory pathway; Step 2: exclusion of orthodromic reciprocating tachycardia; and Step 3: verification of insertion of the cNVP in the AVN.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background
The possibility of permanent cardiovascular damage causing cardiovascular long COVID has been suggested; however, data are insufficient. This study investigated the prevalence of ...cardiovascular disorders, particularly in patients with cardiovascular long COVID using multi-modality imaging.
Methods
A total of 584 patients admitted to the hospital due to COVID-19 between January 2020 and September 2021 were initially considered. Upon outpatient follow-up, 52 (9%) were suspected to have cardiovascular long COVID, had complaints of chest pain, dyspnea, or palpitations, and were finally enrolled in this study. This study is registered with the Japanese University Hospital Medical Information Network (UMIN 000047978).
Results
Of 52 patients with long COVID who were followed up in the outpatient clinic for cardiovascular symptoms, cardiovascular disorders were present in 27% (14/52). Among them, 15% (8/52) had myocardial injury, 8% (4/52) pulmonary embolisms, and 4% (2/52) both. The incidence of a severe condition (36% 5/14 vs. 8% 3/38,
p
= 0.014) and in-hospital cardiac events (71% 10/14 vs. 24% 9/38,
p
= 0.002) was significantly higher in patients with cardiovascular disorders than in those without. A multivariate logistic regression analysis revealed that a severe condition (OR, 5.789; 95% CI 1.442–45.220;
p
= 0.017) and in-hospital cardiac events (OR, 8.079; 95% CI 1.306–25.657;
p
= 0.021) were independent risk factors of cardiovascular disorders in cardiovascular long COVID patients.
Conclusions
Suspicion of cardiovascular involvement in patients with cardiovascular long COVID in this study was approximately 30%. A severe condition during hospitalization and in-hospital cardiac events were risk factors of a cardiovascular sequalae in CV long COVID patients.
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