Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for ...persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area with low-voltage electrograms, a surrogate marker for atrial fibrosis. Ablation for non-PV triggers in addition to PVAI improves the outcome of persistent AF. Further, durable isolation of the left atrial posterior wall may reduce AF recurrence. These ablation strategies with concomitant use of the emerging technologies are strongly expected to enhance the effectiveness of catheter ablation for persistent AF.
Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted ...anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation.
In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2.0 to 3.0). Ablation was performed after 4 to 8 weeks of uninterrupted anticoagulation, which was continued during and for 8 weeks after ablation. The primary end point was the incidence of major bleeding events during and up to 8 weeks after ablation; secondary end points included thromboembolic and other bleeding events.
The trial enrolled 704 patients across 104 sites; 635 patients underwent ablation. Baseline characteristics were balanced between treatment groups. The incidence of major bleeding events during and up to 8 weeks after ablation was lower with dabigatran than with warfarin (5 patients 1.6% vs. 22 patients 6.9%; absolute risk difference, -5.3 percentage points; 95% confidence interval, -8.4 to -2.2; P<0.001). Dabigatran was associated with fewer periprocedural pericardial tamponades and groin hematomas than warfarin. The two treatment groups had a similar incidence of minor bleeding events. One thromboembolic event occurred in the warfarin group.
In patients undergoing ablation for atrial fibrillation, anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted warfarin. (Funded by Boehringer Ingelheim; RE-CIRCUIT ClinicalTrials.gov number, NCT02348723 .).
There are currently doubts about the correct genus of many Japanese species of coelotine spider provisionally classified in the genus Coelotes. Thus, taxonomic revisions were performed on 16 species ...with two retromarginal teeth on their chelicerae. Consequently, three new genera of the subfamily Coelotinae are described here. Aeolocoelotes gen. n. consists of seven species, which are characterized by extremely diverse variations in their genital organs and by the clear parapatric distributions among the congeneric species. Individuals in Aeolocoelotes gen. n. have large and dark-colored bodies, and females have a stiff chitinous epigyne. Curticoelotes gen. n. consists of six species, which are characterized by a short cymbium in the male palp. Finally, Griseidraconarius gen. n. consists of three species, which are characterized by their pale-colored bodies, spiraled conductors in the male palp, and tiny epigynal teeth.
Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2‐fold increase in mortality and a 5‐fold increase in stroke. The Asian population is rapidly aging, and in 2050, the ...estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF‐associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF‐associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non‐vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub‐committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub‐committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician׳s decision remains the most important factor in the management of AF.
Background: The prospective observational Nippon Storm Study aggregated clinical data from Japanese patients receiving implantable cardioverter-defibrillator (ICD) therapy. This study investigated ...the usefulness of prophylactic ICD therapy in patients with non-ischemic heart failure (NIHF) enrolled in the study.Methods and Results: We analyzed 540 NIHF patients with systolic dysfunction (left ventricular ejection fraction <50%). Propensity score matching was used to select patient subgroups for comparison; 126 patients were analyzed in each of the primary (PP) and secondary (SP) prophylaxis groups. The incidence of appropriate ICD therapy during follow-up in the PP and SP groups was 21.4% and 31.7%, respectively (P=0.044). The incidence of electrical storm (ES) was higher in SP than PP patients (P=0.024). Cox proportional hazard analysis revealed that increased serum creatinine in SP patients (hazard ratio HR 1.18; 95% confidence interval CI 1.02–1.33; P=0.013) and anemia in PP patients (HR 0.92; 95% CI 0.86–0.98; P=0.008) increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation in PP patients (HR, 0.64 95% CI, 0.45–0.91, P=0.013) decreased that likelihood.Conclusions: In propensity score-matched Japanese NIHF patients, the incidence of appropriate ICD therapy and ES was significantly higher in SP than PP patients. Impaired renal function in SP patients and anemia in PP patients increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation reduced that likelihood in PP patients.
Morphological and phylogenetic analyses have shown that five species of coelotine spiders that inhabit East China Sea islands, previously classified into the genus Coelotes, are distinct from all the ...other known genera. Therefore, a new genus, Nesiocoelotes is established to accommodate these species and the classification of the corresponding species is revised. Each species of the new genus is characterized by having two retromarginal teeth on chelicerae, large patellar apophysis on the male palp, epigynal teeth close together, protruding from the center of the anterior margin of the epigyne. Phylogenetic analyses support the monophily of the genus and its early divergence from other coelotine lineages. Geographic variation is observed in specimens collected from the Goto Islands. In addition, the genetic analysis of Coelotes iheyaensis Shimojana 2000, which is known to resemble the genus Griseidraconarius Okumura 2020 in morphological characteristics, was performed. As a result, it became clear that C. iheyaensis inhabiting the Okinawa Islands belongs to the genus Griseidraconarius. Therefore, the systematic position of this species is also revised.
A coelotine species, Femoracoelotes platnicki, previously known only from Taiwan, is newly recorded from Iriomote Island, southwest Japan. The genus Femoracoelotes is characterized by the presence of ...a palpal femoral apophysis, the absence of a median apophysis, the absence of epigynal teeth, and broad, saclike copulatory ducts connected or overlapped medially. The morphology of F. platnicki specimens collected from Taiwan, including the type specimens are reassessed. Morphological data including variation in male palpal morphology, coloration and markings are provided on the basis of fresh specimens from Iriomote Island.
A new synonymy of coelotine spider is proposed through a comparison of the morphological characteristics and the results of our molecular analysis. Coelotes hachijoensis Ono 2008, described on the ...basis of specimens from Hachijo Island, is a junior synonym of Coelotes oshimaensis Shimojana 2000. The original distribution of C. oshimaensis is considered to be on Amami-oshima Island and the Tokara Islands in southwestern Japan, far from Hachijo Island. Various circumstantial evidences suggested that C. oshimaensis on Hachijo Island may have been artificially introduced from Amami-oshima Island.
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