Background:The outcome of catheter ablation could probably differ among patients with atrial fibrillation (AF), depending on age and AF type. We aimed to investigate the difference in predictors of outcome after catheter ablation for AF among the patient categories divided by age and AF type. Methods and Results:A total of 396 patients with AF (mean age 65.69 ± 11.05 years, 111 women [28.0%]) who underwent catheter ablation from January 2018 to December 2019 were retrospectively analyzed. We divided the patients into four categories: patients with paroxysmal AF (PAF) or persistent AF (PeAF) who were 75 years or younger (≤75 years) or older than 75 years (>75 years). Kaplan-Meier survival analysis demonstrated that patients with PAF aged ≤75 years had the lowest AF recurrence among the four groups (log-rank test, p = .0103). In the patients with PAF aged ≤75 years (N = 186, 46.7%), significant factors associated with recurrence were female sex (p = .008) and diabetes (p = .042). In the patients with PeAF aged ≤75 years (N = 142, 35.9%), the only significant factor associated with no recurrence was medication with a renin-angiotensin system inhibitor (p = .044). In the patients with PAF aged >75 years (N = 53, 14.4%), diabetes was significantly associated with AF recurrence (p = .021). No significant parameters were found in the patients with PeAF aged >75 years (N = 15, 4.1%).
Background Wolff–Parkinson–White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia. Patients with Wolff–Parkinson–White syndrome usually have one accessory pathway, whereas cases with multiple accessory pathways are rare. Persistent left superior vena cava is a vascular anomaly in which the vein drains into the right atrium through the coronary sinus at the junction of the left internal jugular and subclavian veins due to abnormal development of the left cardinal vein. The simultaneous presence of multiple accessory pathways and persistent left superior vena cava has not been reported before. Case presentation A 56-year-old Japanese man with a 5-year history of palpitations was referred for radiofrequency catheter ablation due to increased frequency of tachycardia episodes in the previous 2 months. Persistent left superior vena cava was confirmed by transthoracic echocardiography and computed tomography. An electrophysiological study revealed that the accessory pathways were located in the left lateral wall, anterolateral wall, and posteroseptal region. They were completely ablated with radiofrequency energy application. Conclusions We reported an extremely rare case of a patient with multiple accessory pathways and persistent left superior vena cava. Our case may suggest a potential embryological relationship between the multiple accessory pathways and persistent left superior vena cava.
Introduction : Sarcopenia, defined as skeletal muscle depletion, has been associated with poor cardiovascular outcomes in patients with chronic heart failure (CHF). Hypothesis : This study aimed to determine possible associations between sarcopenia and poor cardiovascular outcomes in patients with CHF after cardiac resynchronization therapy (CRT). Methods: This retrospective study evaluated 120 patients who underwent CRT implantation between March 2004 and June 2018. Only 58 patients who underwent computed tomography (CT) within 30 days of CRT were eligible for inclusion, and their data were analyzed (25 women; 33 men; mean age, 71.6 ± 8.7 years). The skeletal muscle area was measured at the third lumbar vertebra, and the skeletal muscle index (SMI) was calculated (Figure 1). Major adverse cardiovascular events (MACE) included cardiovascular death, hospitalization due to heart failure, cerebral infarction, acute myocardial infarction, and cardiac arrest. Results: During the follow-up period (mean, 868 ± 617 days), MACE occurred in 22 of 58 patients (38%). The patients were allocated to two groups according to sex-based tertiles of SMI. The lowest tertile was defined as the low SMI group. Kaplan-Meier survival analysis demonstrated that the low SMI group had a greater incidence of MACE (log-rank 4.38; P = 0.036, Figure 2). Cox proportional hazards regression analysis also revealed that low SMI was significantly associated with MACE (hazard ratio 3.08; 95% CI: 1.26-7.66, P = 0.014). Conclusions: Decreases in SMI on CT imaging may predict the occurrence of MACE in patients with CHF who underwent CRT.
Background: Interatrial conduction time (IACT) prolongs in fibrotic left atrium. We tested the hypothesis that IACT is related to left atrial low voltage area (LVA) and predicts the recurrence after single atrial fibrillation (AF) ablation. Methods:One hundred sixty-four consecutive AF patients (79 non-paroxysmal) who underwent initial ablation in our institute were analyzed. IACT and LVA were defined as interval from the onset of P-wave to the basal left atrial appendage (P-LAA) activation, and area with bipolar electrogram < 0.5 mV covering over 5% of the total left atrial surface area during sinus rhythm, respectively. Pulmonary vein antrum isolation, non-PV foci ablation, and atrial tachycardia (AT) ablation were performed without substrate modification.Results: LVA was frequently identified in patients with prolonged P-LAA ≥ 84 ms (n = 28) compared with patients with P-LAA < 84 ms (n = 136). Patients with P-LAA ≥ 84 ms were older (71 ± 10 vs. 65 ± 10 years, p = .0061), and had more frequent non-paroxysmal AF (75% vs. 43%, p = .0018), larger left atrial diameter (43.5 ± 4.5 vs. 39.3 ± 5.7 mm, p = .0003), and higher E/e' ratio (14.4 ± 6.5 vs. 10.5 ± 3.7, p < .0001) compared with P-LAA < 84 ms patients. After a mean follow-up period of 665 ± 153 days, Kaplan-Meier curve analysis showed that AF/AT recurrences was more frequently observed in patients with prolonged P-LAA (Log-rank p = .0001). Additionally, univariate analysis revealed that P-LAA prolongation (OR = 1.055 per 1 ms, 95% CI: 1.028-1.087, p < .0001) and the existence of LVA (OR = 5.000, 95% CI: 1.653-14.485 p = .0053) were predictors of AF/AT recurrences after single AF ablation. Conclusions:Our results suggested that prolonged IACT as measured by P-LAA was associated with LVA and predicts AT/AF recurrence after single AF ablation.
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