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Introduction: The decremental properties of the nodoventricular pathway (NVP) are uncertain. Methods and Results: During short RP supraventricular tachycardia, a His‐refractory premature ventricular contraction (PVC) consistently terminated the tachycardia without atrial capture immediately after the PVC. Whereas a slightly earlier PVC failed to reset the subsequent His but terminated the tachycardia without atrial capture one cycle later. Conclusion: These observations are diagnostic of slow‐fast atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed‐NVP and can be explained by decremental properties in the NVP itself; greater prematurity of the PVC resulted in more decremental conduction over the NVP, causing the AVNRT termination one cycle later. [ABSTRACT FROM AUTHOR]

We report a case of a 44‐year‐old male who underwent an electrophysiological study for symptomatic supraventricular tachycardia (SVT) with wide QRS complex. The SVT was diagnosed as an antidromic atrioventricular reentrant tachycardia (AVRT) via antegrade conduction of left‐sided accessory pathway (AP). However, the QRS morphology changed during the SVT, and then the SVT was terminated spontaneously. The mapping of AP was performed during sinus rhythm, and the radiofrequency application successfully eliminated the AP, which rendered tachycardias non‐inducible. This was a rare case of antidromic AVRT during which the QRS morphology changed. [ABSTRACT FROM AUTHOR]

Background: Residual non-pulmonary vein (PV) foci are significantly associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). However, we previously reported among patients with non-PV foci induced only once, none experienced AF recurrence. Thus, we aimed to investigate the correlation between the residual induction number of non-PV foci and ablation outcome in paroxysmal AF patients. Methods and results: We investigated 55 paroxysmal AF patients with residual non-PV foci after PVI and ablation of non-PV-foci. Study patients were classified into the residual one-time induction of non-PV foci (residual OTI-nPVF) group (n = 23) and residual repeatedly induced non-PV foci (residual RI-nPVF) group (n = 32). Furthermore, the residual RI-nPVF group was divided into the low inducibility group (n = 10) and high inducibility group (n = 22) according to the presence or absence of non-PV foci provoked by two sets of drug induction tests (non-PV foci inducibility). In addition, the latter was divided into the ablation group (n = 14) or observation group (n = 8). The 2-year AF recurrence‐free rate in the residual RI-nPVF group was significantly lower compared to the residual OTI-nPVF group (53% vs. 90%, p = 0.018). There was no significant difference of the 2-year AF recurrence‐free rates in the inducibility of non-PV foci (p = 0.913) and the presence or absence of ablation (p = 0.812) in the residual RI-nPVF group. Conclusions: Among paroxysmal AF patients, the presence of residual RI-nPVF was associated with higher AF recurrence compared to residual OTI-nPVF. Furthermore, within residual RI-nPVF subgroup, non-PV foci inducibility or ablation of some residual RI-nPVF did not affect ablation outcome. [ABSTRACT FROM AUTHOR]

Aims: Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). The impact of ST‐segment depression before CA on LVEF recovery and clinical outcomes remains unknown. In the present study, we aimed to investigate the relationship between ST‐segment depression during AF rhythm before CA and improvement in the LVEF and clinical outcomes in persistent atrial fibrillation (PerAF) patients with HFrEF. Methods and results: The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF < 50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1 month were not included in the enrolled patients. We assigned the patients based on the presence of ST‐segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF ≥ 15%) 1 year after CA and the relationship between ST‐segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1 year after CA was significantly lower in the patients with ST‐segment depression than those without (58.6% vs. 79.7%, P = 0.012). Multiple regression analysis showed ST‐segment depression was independently and significantly associated with improvement in the LVEF 1 year after CA (HR: 0.35; 95% CI: 0.129–0.928, P = 0.035). Kaplan–Meier analysis showed that the patients with ST‐segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P = 0.022 and log rank P = 0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST‐segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210–6.584, P = 0.016). Conclusions: ST‐segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF. [ABSTRACT FROM AUTHOR]

Background: Tachycardia‐induced cardiomyopathy (TIC) is a reversible cardiomyopathy with ventricular dysfunction caused by tachyarrhythmias. Notably, atrial fibrillation (AF) is the most common causal arrhythmia leading to TIC. However, the risk factors for the development of TIC due to AF remain unclear. This study aimed to identify the associated factors of TIC due to AF. Methods: Persistent AF patients with heart rate (HR) ≥100 beats per minute who underwent initial catheter ablation were enrolled in this study. TIC was diagnosed as left ventricular ejection fraction (LVEF) < 50% during AF rhythm, which was recovered after the restoration of sinus rhythm. Non‐TIC was defined as LVEF ≥ 50% despite AF rhythm. The patient backgrounds were compared between the TIC group and the non‐TIC group to reveal the contributing factors of TIC. Results: The TIC group comprised 57 patients, while the non‐TIC group consisted of 101 patients. The TIC group was younger than the non‐TIC group (median 64 vs. 70, p = 0.006). Male sex was more frequent in the TIC group than the non‐TIC group (82.5% vs. 58.4%, p = 0.003). HR was higher in the TIC group than in the non‐TIC group (median 130 bpm vs. 111 bpm, p < 0.001). The number of smokers was significantly higher in the TIC group than in the non‐TIC group (p < 0.001). Multivariable analysis demonstrated that higher HR (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.37–2.21; p < 0.001) and current smokers (OR: 5.27; 95% CI: 1.60–17.4; p = 0.006) were the independent factors leading to TIC. Conclusion: Higher HR and current smokers were independent risk factors for the development of TIC due to AF. [ABSTRACT FROM AUTHOR]

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Aims: Low‐density lipoprotein cholesterol (LDL‐C), anaemia and low platelets have been associated with worse clinical outcomes in heart failure patients. We investigated the relationship between the combination of these three components and clinical outcome in patients with heart failure with preserved ejection fraction (HFpEF). Methods and results: We examined the data of 1021 patients with HFpEF hospitalized with acute decompensated heart failure (HF) from the PURSUIT‐HFpEF registry, a prospective, multicenter observational study. The enrolled patients were classified into four groups by an LEP (LDL‐C, Erythrocyte, and Platelet) score of 0 to 3 points, with 1 point each for LDL‐C, erythrocyte and platelet values less than the cut‐off values as calculated by receiver operating characteristic curve analysis. The endpoint, a composite of all‐cause death and HF readmission, was evaluated among the four groups. Median follow‐up duration was 579 [300, 978] days. Risk of the composite endpoint significantly differed among the four groups (P < 0.001). Kaplan–Meier analysis showed that the groups with an LEP score of 2 had higher risk of the composite endpoint than those with an LEP score of 0 or 1 (P < 0.001, and P = 0.013, respectively), while those with an LEP score of 3 had higher risk than those with an LEP score of 0, 1 or 2 (P < 0.001, P < 0.001 and P = 0.020, respectively). Cox proportional hazards analysis showed that an LEP score of 3 was significantly associated with the composite endpoint (P = 0.030). Kaplan–Meier analysis showed that risk of the composite of all‐cause death and HF readmission was significantly higher in low LDL values (less than the cut‐off values as calculated by receiver operating characteristic curve analysis) patients with statin use than in those without statin use (log rank P = 0.002). Conclusions: LEP score, which comprehensively reflects extra‐cardiac co‐morbidities, is significantly associated with clinical outcomes in HFpEF patients. [ABSTRACT FROM AUTHOR]

Heart failure (HF) readmission post-transcatheter aortic valve implantation (TAVI) is common; however, its anatomical predictors remain unclear. This study identified a small systolic left ventricular inflow-outflow (LVIO) angle, evaluated using computed tomography, as a potential anatomical predictor associated with HF readmission post-TAVI. Patients with a small systolic LVIO angle may require close follow-up post-TAVI. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 54-year-old man undergoing radiofrequency ablation for atrial fibrillation, encountering an irregular tachycardia during the procedure. Topics discussed include the mechanism of irregular tachycardia, interpretation challenges due to its irregularity, and the diagnosis of orthodromic reciprocating tachycardia.

Purpose: Ablation index (AI)–guided ablation improves the incidence of arrhythmia recurrence as compared to conventional contact force (CF)–guided ablation. The aim of this study was to elucidate the differences in the biomarkers associated with myocardial injury and inflammation between conventional CF–guided and AI-guided ablation. Methods: Atrial fibrillation (AF) patients who underwent pulmonary vein isolation (PVI) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry were enrolled. We divided the patients into two groups: conventional CF–guided PVI (CF group) and AI-guided PVI (AI group). The differences in biomarkers associated with myocardial injury and inflammation, and long-term durability of PVI between the two groups were evaluated. Results: This study population included a total of 794 patients (CF-guided, 241 patients; AI-guided, 553 patients). Total application time was significantly shorter, and total application number was significantly smaller in AI than CF group. High-sensitive troponin I (hs-TnI) post-ablation was significantly higher in AI than CF group (p < 0.001), even after taking the total application number and total application time into consideration. No significant differences in inflammatory markers changes from pre- to post-ablation were observed between the two groups. AI-guided ablation was significantly associated with the hs-TnI post-ablation by multiple regression analysis. The PV reconnection ratio was significantly smaller in AI than CF group (p = 0.037). Conclusions: AI-guided ablation had the ability to create larger lesions than CF-guided ablation despite no increase in inflammation and achieved the better PVI durability than that of CF-guided. [ABSTRACT FROM AUTHOR]

Background: An ablation index (AI)-guided pulmonary vein isolation (PVI) or 2nd generation cryoballoon (CB)-PVI has been shown to reduce the atrial fibrillation (AF) burden by 99% despite the absence of ablation of non-pulmonary vein (PV) triggers in patients with paroxysmal AF. The purpose of this study was to investigate the effects of PVI alone strategy using 2nd generation CB compared with AI-guided PVI with an additional induction test and subsequent AF trigger ablation. Methods and results: We investigated 223 patients with symptomatic paroxysmal AF who underwent an initial PVI between August 2018 and August 2020. The study patients were divided into 2 groups: CB-PVI without an induction test (CB-PVI alone group, n = 82) and AI-guided PVI with an induction test and subsequent additional ablation of non-PV triggers (AI-PVI plus group, n = 141). In the AI-PVI plus group, a total of 62 non-PV triggers were induced in 38 patients, and non-PV triggers in 22 patients were completely ablated. The procedure time and left atrium dwell time were significantly shorter in the CB-PVI alone group than AI-PVI plus group. There were no significant differences in the incidence of procedural complications between the 2 groups (P = 0.650). The AF free survival rate in the CB-PVI alone group and AI-PVI plus group was 80% vs. 80% at 24 months (P = 0.969). Conclusions: An PVI alone strategy using advanced generation CB did not differ in the clinical outcomes compared with an AI-guided PVI strategy with an induction test and subsequent ablation of non-PV triggers in the patients with paroxysmal AF. [ABSTRACT FROM AUTHOR]

Introduction: Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). Methods: We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow‐up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one‐grade improvement of TR) and non‐improvement of TR: IM group and Non‐IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all‐cause death) more than 12 months after the RFCA. Results: IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event‐free survival than Non‐IM group. Conclusions: Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) is reported to be one of the major risks of bleeding events. On the other hand, HF patients frequently receive anticoagulants or antiplatelet therapy to manage various co‐morbidities. However, predictors of bleeding events in patients with HF have rarely been reported. This study aimed to evaluate the predictors of bleeding events and relationship between bleeding events and HF re‐hospitalizations. Methods and results: We included 1660 acute decompensated heart failure (ADHF) patients from the AURORA registry between January 2015 and December 2020. A total of 1429 patients were excluded because of history of HF admission, missing echocardiographic data at discharge, lost to follow‐up, haemodialysis and no antithrombotic drugs. Finally, we evaluated 231 patients from AURORA registry. The bleeding events were defined as Type 2 to 5 bleeding according to the Bleeding Academic Research Consortium definition. We divided our patients into the bleeding group and non‐bleeding group. We compared the baseline characteristics, medications, laboratory data, and echocardiographic data between the two groups. Median age was 78 (IQR 71–82) years old and male accounted for 59%. Approximately half of the patients had an antiplatelet therapy and 70% had an anticoagulant therapy. During a median follow‐up of 651 (IQR 357–1139) days, 32 patients (13.8%) suffered from bleeding events. The major driver of the registered events was gastrointestinal bleeding (n = 21, 65.6%), and the other events were cerebral bleeding (n = 4, 12.5%), intraarticular bleeding (n = 2, 6.3%), urogenital bleeding (n = 2, 6.3%), haemorrhagic pericardial effusions (n = 1, 3.1%), subcutaneous hematomas (n = 1, 3.1%), and haemothorax (n = 1, 3.1%). There was a significantly lower haemoglobin level (P < 0.01), higher proportion of inferior vena cava (IVC) diameter ≥21 mm (P < 0.01), and higher furosemide equivalent doses per kilogram (P < 0.01) in the bleeding group than non‐bleeding group. A multivariate analysis revealed an equivalent dose of furosemide per kilogram ≥0.66 mg/kg (hazard ratios (HR) of 2.64, 95% confidence interval (CI) 1.26–5.68, P = 0.01), haemoglobin ≤10.3 g/dL (HR of 2.43, 95% CI 1.14–5.03, P = 0.02), and IVC diameter ≥21 mm (HR of 2.79, 95% CI 1.16–6.29, P = 0.02) were independently associated with bleeding events. The Kaplan–Meier analysis showed that HF re‐hospitalization rates were higher in the bleeding group than non‐bleeding group (P = 0.04). Conclusions: High doses of oral loop diuretics, IVC dilatation, and anaemia were predictors of bleeding events in patients hospitalized with ADHF patients. In addition, bleeding events were associated with HF re‐hospitalizations. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 48-year-old man with a dual atrioventricular nodal physiology that has a narrow QRS tachycardia. Scanning and stimulation showed double ventricular response and a stim-H2 interval with a diagnosis of SVT-2 as a junctional tachycardia (JT). Additional radio frequency (RF) was not applied and the patient has been free from any tachycardia for 32 months.

Ultra-thin strut polymer-free sirolimus-eluting stent (UPF-SES) have two novel characteristics, ultra-thin strut and polymer-free coating, which have the potential to achieve early re-endotherialization. However, a little is known whether early vascular healing of UPF-SES can be achieved in patients with acute coronary syndrome (ACS). The aim of this study was to evaluate the vascular healing after an implantation of UPF-SES in patients with ACS using optical coherence tomography (OCT) at 3 months after the stent implantation. From September 2020 and January 2021, a total of 31 consecutive patients presenting with ACS who underwent OCT-guided percutaneous coronary intervention (PCI) and 3 month follow-up OCT examination were enrolled in the USUI-ACS study. The endpoints of this study were neointimal strut coverage, malapposition, and mean neointimal hyperplasia (NIH) thickness at 3 month follow-up. Over a mean follow-up of 91 days after the initial PCI, the follow-up OCT was examined. The median percentage of covered struts was 98.4% and malapposed struts 0%, and the mean NIH thickness was 80 μm. UPF-SES exhibited an excellent early vascular healing at 3 months in patients with ACS. [ABSTRACT FROM AUTHOR]

Little has been reported on the impact of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients with left atrial enlargement (LAE). A total of 706 patients underwent an initial RFCA for AF between September 2014 and September 2019 in our hospital. These patients were categorized into two groups according to the pre-procedural left atrial diameter (LAD) measured by transthoracic echocardiography (TTE): LAE group with LAD ≥ 50 mm and non-LAE group with LAD < 50 mm. We compared the patient characteristics, ablation procedures, and late recurrence of AF (LRAF, defined as a recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) between the two groups. In addition, we performed follow-up TTE at 12 months after RFCA and investigated the factors associated with left atrium (LA) reverse remodeling in each group. LAE group and non-LAE group consisted of 155 and 551 patients, respectively. There were no significant differences in ablation procedures, procedure-related complications, and the incidence of LRAF between the two groups. Furthermore, non-PAF was identified as an independent predictor of LA reverse remodeling in LAE group by multiple regression analysis (P = 0.020). RFCA might be an effective and safe procedure even in patients with LAD ≥ 50 mm, using the contemporary 3D-guided mapping and ablation technologies. Moreover, RFCA can lead to LA reverse remodeling in 1 year if they have non-PAF before ablation. [ABSTRACT FROM AUTHOR]

At present, it remains unclear whether the effect on cryoinjury can be strongly exerted by contact of the balloon with the pulmonary vein (PV) ostium. The present study included 204 paroxysmal atrial fibrillation (PAF) patients who underwent an initial pulmonary vein isolation (PVI) using a cryoballoon from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The total balloon contact angle was measured from the equator line (sum of the angles of the upper side and bottom side in all PVs) under fluoroscopic imaging. The patients were stratified into three tertile groups according to the total balloon contact angle. We evaluated the relationship between the total balloon contact angle and clinical outcomes, including the value of acute myocardial injury marker (high-sensitive cardiac troponin I [hs-TnI]), arrhythmia recurrence, and PV reconnections in the repeated ablation. The total balloon contact angle was significantly associated with the hs-TnI value among the tertile groups (p < 0.001) and a multiple regression analysis showed that the total balloon contact angle significantly correlated with the hs-TnI value (standardized beta-coefficient = 0.572, p < 0.001). The balloon contact angle in PVs with PV reconnections was significantly lower than in those without (p = 0.044), while no significant differences in the recurrence of atrial fibrillation among the tertile groups were observed in the enrolled patients. The total balloon contact angle was significantly associated with the acute myocardial injury marker, hs-TnI. The total balloon contact angle was significantly associated with PV reconnections after cryoballoon ablation in patients who underwent a repeat ablation. [ABSTRACT FROM AUTHOR]

Background: Although much has been discussed about the early recurrence of atrial fibrillation (ERAF) after cryoballoon ablation (CBA), the clinical impact of very early recurrence of atrial fibrillation (VERAF) after CBA remains unclear. This study aimed to investigate the impact of VERAF after CBA. Methods: We enrolled 236 consecutive patients who underwent an initial CBA for paroxysmal atrial fibrillation between February 2017 and December 2020 in our hospital. These patients were categorized into three groups: VERAF group who experienced an initial recurrence of atrial tachyarrhythmia within 48 h after CBA, late‐ERAF (LERAF) group who experienced an initial recurrence of atrial tachyarrhythmia between 48 h and 3 months after CBA, and non‐ERAF (NERAF) group who did not experience a recurrence of atrial tachyarrhythmia within 3 months after CBA. We investigated the late recurrence of AF (LRAF, defined as recurrence of atrial tachyarrhythmia more than 3 months after CBA), and the incidence of non‐pulmonary vein (PV) triggers in the patients who experienced a repeat ablation procedure due to LRAF. Results: VERAF group had a higher incidence of freedom from LRAF than LERAF group (p = 0.032) and a lower incidence of freedom from LRAF than NERAF group (p = 0.002). Moreover, VERAF group had the highest incidence of non‐PV triggers at repeat ablation procedure among the three groups (p = 0.003). Conclusions: While ERAF was a predictor of LRAF, VERAF was less related to LRAF among the patients with ERAF after CBA. Furthermore, VERAF might be associated with non‐PV triggers. [ABSTRACT FROM AUTHOR]

This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 49 lesions from 49 ACS patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared vascular healing using OCT between O-SESs and X-EESs at 8 months after stenting. The protocol was approved by the Osaka Rosai Hospital ethics committee. Among 49 lesions, the X-EES group consisted of 24 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8 months were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 92.5%; p = 0.010). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 0.3%, p = 0.609). The O-SES group had the significantly thinner neointima compared to the X-EES group (60 μm vs 84 μm, p = 0.001). Compared to X-EESs, O-SESs showed better strut coverage and thinner neointima in ACS patients at 8 months follow-up. Ultra-thin strut and silicon carbide passive coating may play a key role in better vascular healing. [ABSTRACT FROM AUTHOR]

Introduction: Local impedance (LI) drop during radiofrequency (RF) application is monitored to assess the lesion formation. Recently, a novel ablation catheter has been introduced to clinical setting, which is capable of monitoring LI and catheter contact parameters including contact force (CF) and contact angle (CA). This study aimed to clarify the correlation between LI drop and catheter contact parameters. Methods and results: This prospective study included 15 paroxysmal atrial fibrillation (AF) patients who underwent initial pulmonary vein isolation (PVI). First‐pass encircling point‐by‐point PV ablation was performed by using a 4.5‐mm irrigated ablation catheter, with monitoring LI, CF, and CA. RF energy was applied for 30 s at each site with 30 W. Stable ablation points were analyzed to examine the correlation between LI drop and catheter contact parameters. Among 903 ablation points, 499 stable ablation points (55.2%) were analyzed. CA showed good correlation with LI drop (ρ = 0.418, p <.001). Maximum CF, minimum CF, average CF, and initial CF all showed weak correlation with LI drop (ρ = 0.201, p <.001; ρ = 0.224, p <.001; ρ = 0.258, p <.001; and ρ = 0.212, p <.001, respectively). Multivariate analysis demonstrated that CA was an independent factor of LI drop among the catheter contact parameters (β = 0.139, 95% CI = 0.111–0.167, p <.001). The LI drop in the blocked segments was significantly higher than that in the electrical conduction gap segments (27.3 ± 9.8 vs. 19.6 ± 6.4 Ω, p <.001) Conclusion: In clinical PVI use, both CF and CA were correlated with LI drop. More parallel CA could induce higher LI drop, which may lead to effective lesion formation. [ABSTRACT FROM AUTHOR]

Purpose: Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)–guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)–guided PVI. Methods: Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period. Results: A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269–0.639, P < 0.001). Conclusions: AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI. [ABSTRACT FROM AUTHOR]

Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) causes myocardial injury and induces high-sensitive cardiac troponin I (hs-TnI) release into the systemic circulation. Several factors are considered to be associated with myocardial injury after ablation, but few studies showed the relationship between the value of myocardial injury marker after the RFCA and relevant factors. AF patients who underwent primary RFCA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The relationship between hs-TnI after the RFCA and PV reconnection (PVR) was evaluated. The impact of relevant factors, including baseline patient characteristics, detail of procedure on myocardial injury was investigated. This study included 407 patients (median age was 71 years, the ratio of female was 30.7%). Late arrhythmia recurrence was observed in 111 patients (27.3%) and 66 patients were underwent repeated ablation. PVR was observed in 33 patients (50.0%). The hs-TnI level was significantly lower in the patients with PVR than those without PVR (1.150 ng/ml vs 1.921 ng/ml, p = 0.040). Paroxysmal AF and age were significantly associated with acute myocardial injury after the RFCA (standardized beta coefficient = 0.206 and p < 0.001, standardized beta coefficient = − 0.114 and p = 0.043, respectively). The hs-TnI after RFCA was significantly higher in PAF patients than PerAF (p < 0.001), even if application number and total application time were taken into consideration. Acute myocardial injury after RFCA was significantly lower in the patients with PVR than those without PVR. Age and AF type were significantly and strongly associated with acute myocardial injury after the RFCA. [ABSTRACT FROM AUTHOR]

Background: The detailed electrophysiological characteristics of atrial fibrillation (AF) initiating non-pulmonary vein (PV) triggers excluding origins from the superior vena cava (SVC) and left atrial posterior wall (LAPW) (Non-PV-SVC-LAPW triggers) remain unclear. This study aimed to clarify the detailed electrophysiological characteristics of non-PV-SVC-LAPW triggers. Methods: Among 446 AF ablation procedures at 2 institutions, patients with reproducible AF initiating non-PV-SVC-LAPW triggers were retrospectively enrolled. The trigger origin was mapped using the self-reference mapping technique. The following electrophysiological parameters were evaluated: the voltage during sinus rhythm and at the onset of AF at the earliest activation site, coupling interval of the trigger between the prior sinus rhythm and AF trigger, and voltage change ratio defined as the trigger voltage at the onset of AF divided by the sinus voltage. Results: Detailed electrophysiological data were obtained at 28 triggers in 21 patients. The median trigger voltage at the onset of AF was 0.16mV and median trigger coupling interval 182msec. Normal sinus voltages (≧0.5mV) were observed at 16 triggers and low voltages (<0.5mV) at 12 triggers. The voltage change ratio was significantly lower for the normal sinus voltage than low sinus voltage (0.20 vs. 0.60, p = 0.002). The trigger coupling intervals were comparable between the normal sinus voltage and low sinus voltage (170ms vs. 185ms, p = 0.353). Conclusions: The trigger voltage at the onset of AF was low, regardless of whether the sinus voltage of the trigger was preserved or low. [ABSTRACT FROM AUTHOR]

Background and Aims: There are two types of serum uric acid‐lowering agents, the xanthine oxidoreductase (XO) inhibitor and non‐XO inhibitor. We investigated whether febuxostat, XO inhibitor, could produce more favorable effects on coronary endothelial function (CEF) and renal function than benzbromarone, non‐XO inhibitor, in hyperuricemic coronary artery disease (CAD) patients. Methods: We divided 21 hyperuricemic patients with stenting for left anterior descending (LAD) or left circumflex (LCX) artery into patients started on febuxostat (F group) and those on benzbromarone (B group). After 8 months, all patients underwent CEF evaluations (acetylcholine provocation test) and optical coherence tomography (OCT) for non‐culprit vessels (e.g. if patients received LAD stenting, we evaluated LCX). We compared the diameter ratio induced by acetylcholine and baseline (CEF ratio), thin‐cap fibroatheroma and calcified plaque by OCT, uric acid, oxidative stress biomarkers, and renal function including estimated glomerular filtration rate (eGFR) between F and B groups. Creatinine 2 days after stenting was measured to evaluate contrast‐induced nephropathy (CIN). Results: Change of eGFR was significantly lower in F group (n= 11) than B group over 8 months while the other parameters including CEF ratio were similar. F group showed favorable effects for CIN. Conclusion: In conclusion, 8‐months of febuxostat, XO inhibitor, does not significantly protect CEF but can protect the renal function including CIN in hyperuricemic patients with CAD compared to benzbromarone, non‐XO inhibitor. [ABSTRACT FROM AUTHOR]

The article describes the case of a 79-year-old man with ischemic heart disease who underwent catheter ablation of persistent atrial tachycardia (AT). The man received a pulmonary vein isolation, left atrial (LA) posterior wall isolation, and lateral mitral isthmus linear ablation of atrial fibrillation and AT. Also discussed are the earliest activation site in the LA and the need of physicians to pay attention when using AT entertainment pacing in macro-reentrant tachycardias.

The article presents a case of a 72-year-old female who was presented for radiofrequency ablation of narrow QRS tachycardia with ventriculoatrial block (VAB) to discuss the mechanism of VAB in tachychardia. Also cited are the use of atrial extra-stimulation to monitor her dual atrioventricular nodal physiology and VAB during atrioventricular nodal reentrant tachycardia (AVNRT).

The article presents a case study of a 72-year-old man with regular narrow QRS tachycardia after pulmonary vein isolation and cavotricuspid isthmus (CTI) ablation. Topics include accidental ventricular premature depolarization timed to the His‐refractory period not reseting the tachycardia; and tachycardia being induced and terminated by atrial burst pacing and atrial extra‐ stimulation.

The role of sigmoid septum (SS) observed using preprocedural transthoracic echocardiography (TTE) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. This study aimed to compare clinical outcomes of TAVI using the current-generation transcatheter heart valves in patients with and without SS. We divided 140 consecutive patients, excluding four patients who underwent pacemaker implantation before TAVI, into two groups (those with and without SS) and compared the periprocedural outcomes, including new pacemaker implantation, within 30 days post-TAVI. Thirty-five patients (25%; 32 female patients) had SS before TAVI. The body surface area and aortic annulus area measured using computed tomography were significantly smaller in patients with SS than in those without SS (1.40 m2 vs. 1.48 m2, P = 0.03; and 372 mm2 vs. 409 mm2, P < 0.01; respectively). Device success was achieved in all patients with SS. Postprocedural TTE on 30 days post-TAVI showed no significant differences in the valvular hemodynamics between patients with and without SS. No severe prosthesis-patient mismatch was noted on TTE, although the transcatheter heart valve size tended to be smaller in patients with SS. Within 30 days of the TAVI, three (8.6%) and eight (7.6%) patients with and without SS, respectively, had new pacemaker implantation (P = 0.86). The presence of SS was not associated with periprocedural outcomes following TAVI in patients without pre-existing pacemakers. No specific assessment or treatment strategy is required for the TAVI in patients with SS using the current-generation devices. [ABSTRACT FROM AUTHOR]

The article describes a case of a male patient who was hospitalized due to symptomatic palpitations. Topics mentioned include the mechanism of a narrow QRS tachycardia with different atrial sequence during ventricular pacing, the atrial activation sequences of ventriculoatrial conduction, and the rare existence of atrioventricular nodal reentrant tachycardia with retrograde activation.

Although several studies have suggested that catheter ablation (CA) of atrial fibrillation (AF) can improve left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF), the predictor of improvement of LVEF is unclear. A total of 401 patients with persistent AF underwent an initial CA between September 2014 and October 2019 in our hospital. Among them, we analyzed consecutive patients with moderately or severely reduced LVEF (< 50%) measured by transthoracic echocardiography (TTE) within 2 months before CA and underwent follow-up TTE during sinus rhythm at 6 months or more after CA. These patients were categorized into two groups: improve group (I group) with the absolute improvement of LVEF ≥ 10% at follow-up TTE, and non- improve group (NI group) with the absolute improvement of LVEF < 10% at follow-up TTE. We compared patient characteristics, ablation procedures, and clinical outcomes between the two groups. 81 patients were analyzed, and I group consisted of 48 patients (59%). In the univariate analysis, absence of ischemic cardiomyopathy, left ventricular end-diastolic diameter (LVEDD), and absence of recurrence of AF between 3 and 6 months after CA were associated with improvement of LVEF. A receiver operating characteristics analysis determined the suitable cut-off value for LVEDD was 53 mm (sensitivity: 62.2%, specificity: 86.2%, area under curve: 0.762). A multivariate analysis showed that LVEDD < 53 mm was independently associated with improvement of LVEF (odds ratio 2.58, 95% confidence interval 1.29–6.12; P = 0.021). In conclusion, LVEDD < 53 mm might be an independent predictor of improvement of LVEF after CA of persistent AF in HFrEF patients. [ABSTRACT FROM AUTHOR]

Aims: The impacts of high density lipoprotein cholesterol (HDL‐C) as an anti‐inflammatory and C reactive protein (CRP) as inflammatory properties on the pathogenesis of heart failure were reported. At present, the clinical significance of the HDL‐C/CRP ratio in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. Methods and results: We examined the data on 796 consecutive HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT‐HFpEF registry, a prospective, multicentre observational study. We calculated the HDL/CRP ratios and evaluated the relationship between the values and clinical outcomes, including degree of cardiac function. The mean follow‐up duration was 420 ± 346 days. All‐cause death occurred in 118 patients, of which 51 were cardiac deaths. HDL/CRP ≤ 4.05 was independently and significantly associated with all‐cause death (odds ratio = 1.84, 95% CI: 1.06–3.20, P = 0.023), and HDL/CRP ≤ 3.14 was associated with cardiac death by multivariate Cox proportional hazard analysis (odds ratio = 2.86, 95% CI: 1.36–6.01, P = 0.003). HDL‐C/CRP ratio significantly correlated with the product of the left atrial volume and left ventricular mass index as well as the tricuspid annular plane systolic excursion by multiple regression analysis (standardized beta‐coefficient = −0.085, P = 0.034 and standardized beta‐coefficient = 0.081, P = 0.044, respectively). Conclusions: HDL‐C/CRP ratio was a useful marker for predicting all‐cause death and cardiac death and correlated with left ventricular diastolic function and right ventricular systolic function in HFpEF patients. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) readmissions with preserved ejection fraction (HFpEF) are increasing in the elderly, which is a major socioeconomic problem. We investigated the clinical impact of HF readmissions (HFR) on octogenarians with HFpEF. Methods and results: We enrolled consecutive octogenarians (≥80 years old) from June 2016 to February 2020 in PURSUIT‐HFpEF registry. We divided them into HFR group readmitted for HF during the follow‐up period and non‐HF readmission (non‐HFR) group. We evaluated the impact of HFR on all‐cause mortality, cardiac death, and quality of life (QOL). Additionally, we evaluated the factors at discharge correlated with HFR. HFR group comprised 116 patients (21.4%). Among all‐cause deaths, 40 patients suffered cardiac deaths (48.2%). The Kaplan–Meier analysis revealed a similar prognosis between HFR and non‐HFR groups as well as similar incidences of HF deaths. The QOL scores had significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001), while it was similar at 1 year in the non‐HFR group. In the multivariate analysis, diabetes mellitus (DM) (P = 0.019), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP) levels ≥ 1611 pg/mL (P < 0.001), and serum albumin level ≤ 3.7 g/dL (P = 0.011) were useful markers for HFR in octogenarians. Conclusions: In octogenarians with HFpEF, HF readmission was not directly correlated with the prognosis but was well correlated with the QOL. Close follow‐up is essential to decrease HFR of octogenarians with HFpEF with DM, high NT‐pro BNP (≥1611 pg/mL) and low albumin (≤3.7 g/dL) levels at discharge. [ABSTRACT FROM AUTHOR]

The comparison of bioabsorbable-polymer and durable-polymer stents has continued to be debated, and there is ongoing concern regarding vascular healing and late stent thrombosis. This study compared the vascular healing at 8-month follow-up by optical coherence tomography (OCT) between 4 different kinds of new generation drug-eluting stents (DESs). We enrolled 112 patients (112 de novo lesions) who underwent OCT guided percutaneous coronary intervention with 4 kinds of new generation DESs including bioabsorbable-polymer everolimus-eluting stents (BP-EESs), bioabsorbable-polymer sirolimus-eluting stents (BP-SESs), durable-polymer everolimus-eluting stents (DP-EESs), and durable-polymer zotarolimus-eluting stents (DP-ZESs) and an 8-month follow-up angiogram and OCT were performed between July 2016 and April 2018. We divided them into two groups, namely BP and DP groups. We compared the OCT parameters including the percentage of uncovered struts, malapposed struts and the mean neointimal hyperplasia (NIH) thickness between the two groups. BP group consisted of 51 lesions (BP-EESs were used in 27, BP-SESs in 24 lesions) and DP group consisted of 61 lesions (DP-EESs were used in 35 and DP-ZESs in 26 lesions). The percentage of uncovered struts and malapposed struts were significantly lower (7.2 ± 8.9 vs. 15.0 ± 17.1%, p = 0.01, 0.9 ± 1.7 vs. 2.7 ± 5.2%, p = 0.03) and the mean NIH thickness was significantly thicker in BP group than DP group (112 ± 54 vs. 83 ± 31 µm, p < 0.01). The present OCT study demonstrated that uncovered struts and malapposed struts were less common with bioabsorbable-polymer stents than with durable-polymer stents. [ABSTRACT FROM AUTHOR]

Introduction: It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA–SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure. Methods: Seventy‐three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line. The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture. Results: Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients. The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA–SVC junction was higher in the anterior portion (anterior‐septal, anterior, and anterior‐lateral) than in the posterior portion (posterior‐septal, posterior, and posterior‐lateral) (−2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p <.001). The SVC isolation at the electrophysiological RA–SVC junction was successful in all patients without any injury to the sinus node function. Asymptomatic phrenic nerve injury was observed in three patients (4.5%). Conclusion: In all patients, the electrophysiological RA–SVC junction determined by slow conduction or conduction block was identified and the electrophysiological SVC isolation was performed successfully and safely. [ABSTRACT FROM AUTHOR]

It is unclear whether uninterrupted oral anticoagulants (OACs) are acceptable in elderly patients as compared to non-elderly patients. This study aimed to assess the clinical impact of an uninterrupted OAC strategy during atrial fibrillation (AF) ablation in elderly patients. We enrolled 439 consecutive patients who underwent AF ablation with an uninterrupted OAC strategy at our institute. The incidence of bleeding and thromboembolic complications during the AF ablation or within 4 weeks after and the anticoagulation status during the AF ablation were compared between the elderly (age ≧ 75, n = 144) and non-elderly groups (n = 295). There were 22 bleeding complications in the elderly group and 31 in the non-elderly group (15% vs. 11%, p = 0.162) and 3 major bleeding complications in the elderly group and 2 in the non-elderly group (2% vs. 0.7%, p = 0.336). Thromboembolic events were observed in 1 patient in the elderly group and 2 in the non-elderly group (0.7% vs. 0.7%, p = 1.000). The ACT at the end of the procedure was longer in the elderly group than in the non-elderly group (350 s vs. 341 s, p = 0.007) and the proportion of a prolonged ACT of > 400 s (27% vs. 18%, p = 0.046) was more frequent in the elderly group than non-elderly group. A propensity score matched population excluding the age and body weight, revealed that the anticoagulation status during AF ablation was comparable between the two groups. Thus, in the patients undergoing AF ablation with uninterrupted OAC strategy, bleeding complications in elderly patients were similar to those in non-elderly patients. The anticoagulation status during the procedure in elderly patients was more prolonged than that in non-elderly patients. [ABSTRACT FROM AUTHOR]

Backgrounds: Several studies have shown the serum high sensitive cardiac troponin I (hs‐TnI) a biomarker of myocardium injury, and C‐reactive protein (CRP), a biomarker of inflammation, are associated with worse cardiovascular outcomes. We evaluated the relationship between the hs‐TnI level in patients with paroxysmal atrial fibrillation (PAF) after pulmonary vein isolation (PVI) and atrial fibrillation (AF) recurrence. Methods and Results: We enrolled 263 consecutive PAF patients who underwent PVI from May 2017 to April 2018. We investigated the difference in the relationship between the myocardial injury marker (serum hs‐TnI), inflammatory marker (CRP, white blood cell) at 36 to 48 hours after the PVI, and early or late recurrence of AF (ERAF; <3 months and LRAF; from 3 months to 1 year) between the radiofrequency ablation group (R group) and cryoballoon ablation group (C group). The R group consisted of 147 patients and the C groups consisted of 116 patients. The serum hs‐TnI level in R group was significantly lower than in the C group (2.33 vs 5.08 ng/mL; P <.001), while the CRP was significantly higher in the R group than C group (2.02 vs 1.10 mg/dL; P <.001). The incidences of an ERAF/LRAF were similar between the two groups. Conclusion: Cryoballoon ablation may cause more myocardial injury than radiofrequency catheter ablation, on the contrary, radiofrequency catheter ablation, may cause more inflammation than cryoballoon ablation. However, these phenomena may not affect the recurrence of AF after the PVI in patient with PAF. [ABSTRACT FROM AUTHOR]

Aim: In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. In contrast, acute decompensated heart failure (ADHF) in older patients is associated with a high risk of a long stay. To manage older ADHF patients with HFpEF, it is important to reveal the risk factors for a long stay on admission. Methods: We enrolled consecutive older patients (aged >75 years) with HFpEF (ejection fraction ≥50%) who were admitted to control ADHF from May 2014 to April 2016 using the acute heart failure registry in Osaka Rosai Hospital. We compared various factors, including age; sex; body mass index; heart rate; systolic blood pressure (SBP); atrial fibrillation; atherosclerotic risk factors, including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease; laboratory data, including brain natriuretic peptide and albumin; and medications, including loop diuretics, on pre‐admission between short‐stay (<14 days) and long‐stay groups. Results: The long‐stay group consisted of 122 patients (59.5%). Multivariate analysis showed that male sex, SBP and albumin were independent predictors for long stays. According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission, including male sex, relatively low SBP (<155 mmHg) and hypoalbuminemia (<3.4 g/dL) could well predict the patients that would require long stays (area under curve 0.738). Conclusions: Among older ADHF patients with HFpEF, male patients with relatively low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. Geriatr Gerontol Int 2019; 19: 1084–1087. [ABSTRACT FROM AUTHOR]

Aim: The factors correlated with prognosis in heart failure with mid‐range ejection fraction (HFmrEF) is unclear, especially for acute heart failure (AHF) with HFmrEF. Thus, we investigated the factors correlated with the improvement in the ejection fraction (EF) over 1 year in AHF patients with HFmrEF. Methods and results: In Acute Heart Failure Registry in the Osaka Rosai Hospital, we examined 159 consecutive HFmrEF patients out of 1051 HF patients who were admitted to our hospital for AHF from January 2015 to December 2017. We divided them into improved EF (IM) group whose EF improved (≧10%) and non‐IM group who had no improvement. We compared the baseline characteristics, echocardiographic data, medications, examinations for ischaemia, invasive treatments, and clinical outcomes between IM group and non‐IM group. IM group consisted of 21 patients (20%). IM group had a significantly more de novo heart failure, higher serum albumin (Alb), lower EF, smaller left ventricular dimension during diastole, more frequent coronary angiogram during hospitalization, and coronary intervention. Multivariate analysis revealed that Alb, left ventricular dimension during diastole, and coronary angiogram performed during hospitalization were independently associated with the improvement in the EF. In addition, IM group had less rehospitalizations over 1 year and a greater reduction in the B‐type natriuretic peptide level during the follow‐up than non‐IM group. Conclusions: In AHF patients with HFmrEF, we should evaluate for any ischaemic heart disease during hospitalization, especially in patients with non‐enlarged left ventricular and non‐reduced serum Alb. AHF patients with HFmrEF who showed improvement in the EF tended to have better prognosis than those without improvement. [ABSTRACT FROM AUTHOR]

We report the autopsy case of 68‐year‐old woman who received cryoballoon (CB) ablation for paroxysmal atrial fibrillation 7 months before death. Both macroscopic and microscopic findings revealed no thrombus formation around pulmonary veins. Previous experimental studies have shown the lower risk of thrombus formation in CB ablation as compared to radiofrequency ablation. Our findings in the human autopsy case may support this merit of CB ablation. To confirm this benefit of CB ablation, further studies regarding histopathology of CB ablation should be performed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 77-year-old woman with palpitations. An electrocardiogram during the tachycardia showed a narrow complex tachycardia with a long RP supraventricular tachycardia which was diagnosed as atypical atrioventricular nodal reentrant tachycardia (AVNRT) with a concealed nodofascicular (NF) or nodoventricular (NV) bypass tract. Also noted is the condition's termination by a ventricular premature depolarization (VPD).

(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan–Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV. [ABSTRACT FROM AUTHOR]

The role of B-type natriuretic peptide (BNP) levels as a predictor of arrhythmia recurrence (AR) after atrial fibrillation (AF) ablation remains unclear. In this study, we investigated the association of BNP levels before and 3 months after ablation with the risk of AR. A total of 234 patients undergoing their first session of AF ablation were included (68% male, mean age of 69 years). The cut-off value for discriminating AR was determined based on the maximum value of the area under the receiver operating characteristic (ROC) curve. The impact of BNP levels on AR was evaluated using Cox regression analysis. ROC curve analysis showed that the area under the curve for BNP at 3 months after the procedure was larger (0.714) compared to BNP levels before ablation (0.593). Elevated levels of BNP 3 months after the procedure (>40.5 pg/mL, n = 96) was associated with a higher risk of AR compared to those without elevated levels (34.4% vs. 10.9%, p < 0.01). Multivariate Cox regression analysis revealed that elevated BNP levels were associated with an increased risk of AR (hazard ratio 2.43; p = 0.014). Elevated BNP levels 3 months after AF ablation were a significant prognostic factor in AR, while baseline BNP levels were not. [ABSTRACT FROM AUTHOR]