Background-In patients with atrial fibrillation (AF), most thrombus forms in the left atrial appendage (LAA). However, the relation of LAA morphology with LAA thrombus is unknown. Methods and Results-We prospectively enrolled 633 consecutive patients who were candidates for catheter ablation for symptomatic drug-resistant AF. Transesophageal echocardiography (TEE) was performed to assess LAA thrombus. LAA structure was assessed by 3-dimensional TEE. LAA orifice area, depth, volume, and number of lobes were measured on reconstructed 3-dimensional images. Clinical characteristics and echocardiographic measures were compared to determine variables predicting LAA thrombus.

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Background In the population with cardiac sarcoidosis (CS), approximately one third lacks extracardiac involvement and is considered to have isolated CS. Recently, the Japanese Circulation Society updated the diagnostic criteria for CS, providing a methodology for diagnosing isolated CS. We aimed to assess the characteristics of isolated CS diagnosed using a multimodal imaging approach according to the updated Japanese Circulation Society guidelines. Methods and Results We retrospectively identified 161 consecutive patients who underwent 18F‐fluorodeoxyglucose positron emission tomography for suspected CS between 2012 and 2019. According to the guidelines, patients were classified as having CS with extracardiac involvement, isolated CS, or no CS. We compared the characteristics of multimodality imaging and the prevalence of major adverse cardiovascular events. The Japanese Circulation Society criteria classified 28 patients (17%) as having CS with 4 (2%) with histological confirmation, 21 (13%) as isolated CS, and 112 (70%) as no CS. Compared with CS, isolated CS showed higher left ventricular volume and reduced left ventricular ejection fraction ( P <0.01 for all). During the median follow‐up period of 522 days, 24 patients had major adverse cardiovascular events. Isolated CS (hazard ratio, 3.35; [95% CI, 1.08–10.39], P =0.036) was independently associated with major adverse cardiovascular events after adjusting for reduced left ventricular ejection fraction and steroid. In the subgroup of 41 patients with serial 18F‐fluorodeoxyglucose positron emission tomography evaluation, only updated CS criteria were associated with improvement in myocardial inflammation on 18F‐fluorodeoxyglucose positron emission tomography. Conclusions Isolated CS detected using the updated Japanese Circulation Society guidelines was associated with poor event‐free survival and should be managed with caution.

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Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new class of antidiabetic drug that have pleiotropic effects including improving cardiovascular outcomes [1]. Medicines of this class are known to have several adverse effects, including euglycemic diabetic ketoacidosis (DKA), which has been reported increasingly [2]. Here, we report a case of SGLT2 inhibitor-associated euglycemic DKA that was complicated with cardiac arrest from acute myocardial infarction. Case report A 49-year-old Asian man with a 1-year history of type 2 diabetes mellitus and vasospastic angina, whose body mass index was 22.1 kg/m 2 , suddenly lost consciousness while sightseeing, shortly after he complained of nausea. An automated external defibrillator was initiated 5 min later, without bystander cardiopulmonary resuscitation. On the basis of initial cardiac rhythm of ventricular fibrillation, the automated external defibrillator delivered 2 shocks. The emergency medical service arrived and started basic life support, and delivered 4 shocks. Return of spontaneous circulation was achieved after a total resuscitation time of 16 min. He was rushed to the emergency department (ED) of our hospital while unconscious. Upon arrival at the ED, his Glasgow coma scale was E1V2M2. His blood pressure was 136/90 mmHg and heart rate was 85 beats/ min. His respiration rate was 20 breaths/min, and peripheral oxygen saturation was 100% on 100% oxygen delivery. His initial 12-lead electrocardiograms showed ST-segment elevation in precordial leads, I, and aVL and reciprocal ST-segment depression in III and aVF (Fig. 1A). A transthoracic echocardiography demonstrated hypokinesis of basal to apical left ventricular (LV) anteroseptal wall. We, therefore, diagnosed him as having acute anteroseptal myocardial infarction. After intubation and a brain computed tomography ruling out an intracranial event, we initiated targeted temperature (34 8C) management (TTM). Emergency coronary angiography revealed a subtotal stenosis in proximal left anterior descending (LAD) artery under nitrate administration (Fig. 1B), which was most likely to be organic stenosis. We did not utilize intravascular imaging modalities, in