Notes

Patient-centred treatment: improving medical benefits.
On ablation, local fragmented potentials with low voltage zones were observed in accordance with the LGE distribution. Multiple VTs originating from the periaortic region were provoked in the sessions.

Acute OTVT was found in 5% of patients after SAVR. Arrhythmia risk stratification by SAECG, Holter ECG, and cardiac MRI should be considered for a long period in patients after SAVR.
Acute OTVT was found in 5% of patients after SAVR. Arrhythmia risk stratification by SAECG, Holter ECG, and cardiac MRI should be considered for a long period in patients after SAVR.
Leadless pacemaker (LP) therapy has been proved effective in cases where traditional transvenous right pacing (TRP) failed. TRP through a bioprosthetic tricuspid valve (BTV) has always been considered an unpreferable solution because of possible deleterious effect of permanent pacing leads on BTV function and specifically on tricuspid regurgitation (TR). Very limited data exist about the feasibility and safety of LP implantation in this setting.

We describe two cases of LP implantation through BTV in patients with failure of epicardial pacemaker implanted after cardiac surgery. The focus is on technical description of the procedure and on electrical and echocardiographic evaluation at implantation and at the follow-up.

In both cases, skilled and careful handling of the delivery system as well as proper use of X-ray oblique views was determinant for atraumatic successful valve crossing. Likewise, an accurate selection of the deployment site inside the right ventricle, far enough from the valve to avoid valvular dysfunction, was important for successful implantation. Electrical parameters of LP were satisfying at implantation and at the follow-up. The echocardiogram after implantation and at the follow-up showed no mechanical interference of LP with prosthetic valve, no significant TR, and absence of significant changes in the biventricular function.

Our data seem to support feasibility and safety of this type of procedure in skilled hands, allowing efficacious pacing without valvular dysfunction or right ventricular (RV) physiology impairment.
Our data seem to support feasibility and safety of this type of procedure in skilled hands, allowing efficacious pacing without valvular dysfunction or right ventricular (RV) physiology impairment.
Dermatologic evaluation for cardiac implantable electronic devices (CIEDs) has not been established. N-acetylcysteine We sought to ascertain baseline wound scar features using quantifiable surgical tools and scar scales on post-CIED patients.

A single-center, prospective observational case-control study was performed where 92 study subjects (40 healthy volunteers and 52 post-CIED patients) completed the study. Durometer was used to quantify skin pliability before CIED placement, postprocedure, and 2weeks postprocedure. Higher durometer readings signified reduced skin pliability. Durometer readings were compared to the patients' contralateral pectoral skin and to a healthy volunteer's cohort skin within the prepectoral region. Patient wounds were observed and graded using the Patient Observer Scar Assessment Scale (POSAS) and Manchester Scar Scale (MSS).

Baseline pectoral skin pliability readings were similar in healthy volunteers and CIED patient population. In comparison to preprocedural measurements, surgical site skin pliability decreased in postprocedural and 2weeks follow-up time points (
-value .004 and <.001, respectively). The increases in durometer readings were higher in the older population (age >75 over time,
=.008). POSAS evaluations showed on average a thin painless hypopigmented scar with moderate stiffness. MSS scar evaluation showed a palpable scar with slight contour differences and color mismatch and appeared to be slightly better in the African American population. There was no difference in scar characteristics with preprocedural use of antiplatelet or anticoagulation or staple closure or gender.

Serial measurements could be of value for development of new strategies for cosmesis and improved wound healing.
Serial measurements could be of value for development of new strategies for cosmesis and improved wound healing.
It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF.

This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD-10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre-existing AF and gout.

In 2016, we identified 3844057 patients admitted to the hospitals in NIS with history of AF, of which 240875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97-2.19],
<.001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01-1.11],
=.041). However, presence of gout in patients with AF was not associated with all-cause in-hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility.

Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Studies indicate that uninterrupted anticoagulation (UA) is superior to interrupted anticoagulation (IA) in the periprocedural period during catheter ablation of atrial fibrillation. Still IA is followed in many centers considering the bleeding risk. This meta-analysis compares interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.

A systematic search into PubMed, EMBASE, and the Cochrane databases was performed and five studies were selected that directly compared IA vs UA before ablation and reported procedural outcomes, embolic, and bleeding events. The primary outcome of the study was major adverse cerebro-cardiovascular events.

The meta-analysis included 840 patients with UA and 938 patients with IA. Median follow-up was 30days. Activated clotting time (ACT) before first heparin bolus was significantly longer with UA (
=.006), whereas mean ACT was similar between the two groups (
=.19). Total heparin dose needed was significantly higher with IA (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55;
=.003). Mean procedure time did not vary between groups (
=.81). Overall complication rates were low, with similar major adverse cerebro-cardiovascular event (
=.40) and total bleeding (
=.55) rates between groups. Silent cerebral events (SCEs) were significantly more frequent with IA (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22;
<.01;

, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.

UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.
UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.
Direct oral anticoagulants (DOACs) are the recommended first-line therapy for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the safety and effectiveness of edoxaban for this indication requires monitoring over the long term in real-world settings.

ETNA-AF-Japan (trial no. UMIN000017011) was a prospective, multicenter observational study (part of postmarketing surveillance in Japan). NVAF patients due to receive edoxaban to prevent ischemic stroke were enrolled between 13 April 2015 and 30 September 2017.

A total of 11569 patients were enrolled. For the 11111 patients (female, 40.6%) whose data comprised the safety analysis set, age, body weight, creatinine clearance (CLcr), and CHADS
score were 74.2±10.0years, 60.0±12.7kg, 63.9±25.8mL/min, and 2.2±1.3, respectively (mean±SD). The majority (86.3%) received edoxaban in accordance with package insert information. The mean duration of treatment was 561.9±261.2days. The annual incidence (95% confidence interval) of all bleeding events and major bleeding events was 5.60% (5.25%-5.98%) and 1.02% (0.88%-1.18%), respectively. The annual incidence of ischemic stroke (excluding transient ischemic attack, TIA) or systemic embolism was 1.08% (0.93%-1.25%). Multivariate analysis showed low body weight, low CLcr, history of gastrointestinal bleeding, anemia, and use of an antiplatelet agent to be associated with major bleeding, and history of ischemic stroke or TIA, vascular disease, and antiplatelet agent use to be associated with ischemic stroke (excluding TIA) or systemic embolism.

These results provide real-world evidence for the long-term good safety and effectiveness profile of edoxaban in Japanese NVAF patients under clinical practice.
These results provide real-world evidence for the long-term good safety and effectiveness profile of edoxaban in Japanese NVAF patients under clinical practice.Prior to ventricular tachycardia ablation, this patient's cardiac implantable electronic device (CIED) was temporarily programmed to backup pacing mode with tachycardia therapies disabled. During radiofrequency energy delivery, the patient developed ventricular fibrillation requiring emergent cardioversion. Electrogram interrogation showed that the CIED switched to noise reversion mode during ablation. The consequent asynchronous pacing resulted in a paced QRS landing on an intrinsic T wave, inducing ventricular fibrillation. This serves as an important reminder that asynchronous pacing consequent to CIED oversensing could occur in any procedure that could cause electromagnetic interference such as radiofrequency cathteter ablation.
Cryoballoon ablation is a commonly used approach to treat patients with atrial fibrillation (AF).

Report on the safety and efficacy of cryoballoon ablation for the treatment of AF in the largest global cohort of cryoablated patients prospectively studied within a single registry.

The
is a prospective, multi-center registry. Patients with paroxysmal AF (PAF) or persistent AF (PsAF) were treated with the cryoballoon catheter according to routine practices at 93 sites across 36 countries. Primary efficacy endpoints included freedom from AF and freedom from AF/atrial flutter (AFL)/atrial tachycardia (AT) ≥30seconds. The primary safety endpoint was serious device- or procedure-related adverse events over 12month follow-up.

During this evaluation window, 2922 subjects completed an index cryoballoon procedure, and 1440 completed 12month follow-up. The cohort was 61±12years of age, 36.3% female, and 78.7% PAF. Serious device- and procedure-related adverse event rates were 1.5% and 3.4%, respectively. Freedom from AF/AFL/AT after the 90day blanking period was 86.
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