Abstract Background Immediate recurrence of atrial fibrillation (AF) after radiofrequency (RF) catheter ablation is commonly observed within 3 d after the procedure. The mechanism and pharmacological management of immediate AF recurrence remain unclear. Methods A total of 50 consecutive patients with paroxysmal AF were randomized to receive either low‐dose landiolol (landiolol group) or a placebo (placebo group). In the landiolol group, intravenous landiolol (0.5 μg kg −1 min −1 ) was administered for 3 d after AF ablation. Results No serious adverse event associated with RF catheter ablation or landiolol administration was observed. The prevalence of immediate AF recurrence (≤3 d after RF catheter ablation) was significantly lower in the landiolol group than in the placebo group (16% vs. 48%, p =0.015). Although the postprocedural change in heart rate was significantly lower in the landiolol group compared to that in the placebo group, the changes in blood pressure and body temperature were not different between the two groups. Multiple logistic regression analysis revealed that landiolol treatment was the only independent predictor of immediate AF recurrence after ablation (odds ratio: 0.180; 95% confidence interval: 0.044–0.729; p =0.016). Conclusions Prophylactic administration of low‐dose landiolol after AF ablation may be effective and safe for preventing immediate AF recurrence within 3 d after AF ablation.
Background: Directional coronary atherectomy (DCA) revived in Japan since 2014. DCA is a special device to remove the atherosclerotic plaque of coronary artery in percutaneous coronary intervention (PCI). However, DCA procedure is recommended to perform by 8Fr system, which is one of the limitations of DCA. Case Series: Since transradial approach is the main access route for PCI, we considered how to perform DCA by TRA. The external diameter of 8Fr guiding catheter (GC) and 6Fr sheath are 2.70 and 2.67 mm. Then, if 6Fr sheath can be inserted without any resistance, 8Fr GC is considered to be insertable. We performed 5 cases of DCA by the transradial 8Fr sheathless GC approach, all cases were successful without discomfort associated with insertion and removal of the 8Fr GC. Conclusion: DCA by the transradial 8Fr sheathless GC approach might be one of options to avoid bleeding complication and serve more comfortable treatment for the patients.
Introduction: Although complex fractionated atrial electrogram (CFAE) is purported to represent critical site for atrial fibrillation (AF) perpetuation, the mechanism and the significance of CFAE in the genesis of AF remain poorly understood. We investigated relationship between CFAE area and serum level of high-sensitivity C-reactive protein (hs-CRP).
Hypothesis: CFAE area is correlated with serum level of hs-CRP in patients with AF.
Methods: Consecutive 25 patients (20 men, 5 women, mean age 57±10 years) with drug resistant AF underwent first ganglionated plexi (GP) ablation were enrolled. Immediately before radiofrequency energy applications, blood sampling was obtained from systemic circulation. Three dimensional electroanatomical mapping of CFAE during AF was performed at least 100 points in the whole left atrium (LA). CFAE mapping was performed twice in all patients before and after GP ablation if AF was sustained.
Results: CFAE area was estimated in all patients before GP ablation and in 17 patients after GP ablation. CFAE area was decreased after GP ablation (from 10.7±8.6% to 10.2±6.1%). Among 25 patients, positive hs-CRP (≥0.017 mg/dL) was observed in 16 patients and negative (<0.017 mg/dL) in 9 patients. Clinical characteristics were not significantly different between two groups. CFAE area before GP ablation was significantly larger in patients with positive hs-CRP than in those with negative hs-CRP (13.2±9.0% vs. 6.2±5.8%, p=0.04; Figure 1). Serum level of hs-CRP was significantly correlated with CFAE area before GP ablation (r=0.51, p=0.009; Figure 2), but not after GP ablation (r=0.19, p=0.47). Multivariate analysis revealed that only hs-CRP level was significantly related to CFAE area before GP ablation (β=0.39, p=0.044).
Conclusions: Serum level of hs-CRP was correlate with CFAE area before GP ablation in patients with AF. Latent inflammation may contribute to CFAE formation.
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Microsymposiaexperimental data to perform a three-dimensional bond density refinement of the Si(111)-7x7 surface.These two experimental techniques are quite complimentary as electron diffraction is rather more sensitive to the core-screening effects of bonding, while only the x-ray dataset is three dimensional (and is a direct transform of the local charge density).By utilizing a combinatorial ab initio Density Functional Theory (DFT) approach, we have developed a parameterized model for fitting valence charge density in silicon to experimental diffraction data which enhances performance, but adds no additional adjustable parameters.When bonding effects are properly accounted for, the improvement to the refinement of the overall structure is significant to >99% confidence (using a degree-of-freedom reduced Chi figure of merit), and site-specific perturbations due to adatom bonding at the surface are also possible.The experimental results will be compared to a full-potential, allelectron DFT structural relaxation of the Si(111)-7x7 surface slab.
Background The relationship between the neutrophil‐to‐lymphocyte ratio (NLR) and outcome in patients with implantable cardioverter‐defibrillators (ICDs) is unclear. Methods and Results Consecutive patients with cardiomyopathy who had received an ICD (n = 120, mean age 64 ± 11 years) were prospectively enrolled. Blood samples were obtained on the morning of the day of implantation. Patients were followed for a median period of 61.2 months, to an endpoint of all‐cause mortality or appropriate ICD shock, which occurred in 35 (29%) and 28 (23%) patients, respectively. Multivariate Cox analysis revealed that secondary prevention was only associated with appropriate ICD shocks. The NLR, brain natriuretic peptide level, and estimated glomerular filtration rate were independent predictors of all‐cause mortality but not of appropriate ICD shocks. Subgroup analysis revealed that a high NLR (≥2.1) was valuable for anticipating all‐cause mortality among patients who had received ICDs for primary or secondary prevention. A high NLR was also associated with death prior to appropriate ICD shock. Conclusion Evaluating the NLR may be useful for predicting outcomes in patients with cardiomyopathy who have received ICDs.
