Right ventriculography was very useful in aiding accurate anchoring of the lead to the RVS. Further, pacing from mid-RVS may be more effective in minimizing the QRS duration than pacing from other RVS sites.
Atrial fibrillation (AF) is the most common arrhythmia, and the number of patients in need of treatment has been increasing [1,2]. AF is associated with increased risk of severe life-threatening complications, such as heart failure and embolism, including stroke [3,4]. As a result, AF can be the cause of not only troublesome symptoms that reduce the quality of life (QoL), activity of daily living (ADL), and exercise performance, but can also cause a life crisis [5][6][7]. Some patients suffer from disabling symptoms but others do not present with specific clinical signs, reporting such general symptoms as fatigue and dyspnea. In fact, some patients do not have any symptoms. It has been reported that persistent AF (per-AF), defined as exceeding 1 week, tends to be asymptomatic compared with paroxysmal AF [8]. Importantly, asymptomatic AF patients have a higher risk factor for complications than symptomatic patients [9]. Therefore, early detection and
Introduction
The electrocardiograms (ECG) criteria to anchor the lead to the right ventricular septum have not been established. This study aimed to identify ECG criteria of pacing at the right ventricular mid septum (RVMS) and investigate whether the paced QRS duration (pQRSd) from the RVMS was narrow.
Methods and results
In 42 patients, ECG pacing at the basal anterior wall (BA), mid‐anterior wall (MA), apex (AP), and mid septum (MS) was recorded. The pacing sites were validated by using right ventriculography and computed tomography. We estimated the ECG parameters and compared them among the four pacing sites. The combination of simple four paced‐ECG parameters could reliably confirm the pacing at the RVMS. The area under the receiver‐operating characteristics curve for the number of positive findings among the following: (a) positive QRS in lead aVL, (b) QRS notching in lead I, (c) precordial leads transition at less than V5, and (d) presence of isoelectric QRS in the inferior leads was 0.95 (95% confidence interval, 0.91‐0.98) and the number of positive findings (≥3) had a sensitivity of 83.3% and a specificity of 93.7% for discriminating MS from the other sites. The pQRSd with three or more positive findings was significantly narrower than that with less than three positive findings (≥3: 137.4 ± 9.2 ms, <3: 151.8 ± 13.1 ms, P ≤ .05).
Conclusion
The combination of ECG parameters can help identify right ventricular mid‐septal pacing. The use of these parameters may enable the implantation of the pacing lead in the RVMS accurately and obtain a narrower QRS duration.
Aim: Neopterin is an activation marker for monocytes/macrophages. We prospectively investigated the predictive value of plasma neopterin levels on 2-year and long-term cardiovascular events in patients with stable angina pectoris (SAP) undergoing coronary stent implantation.Methods: We studied 123 consecutive patients with SAP who underwent primary coronary stenting (44 patients with bare metal stent: BMS group and 79 with drug-eluting stent: DES group). Plasma neopterin levels were measured on admission using HPLC. Moreover, one frozen coronary artery specimen after DES and three frozen coronary specimens after BMS were obtained by autopsy or endarterectomy, followed by immunohistochemical staining for neopterin.Results: Plasma neopterin levels were significantly higher in patients with cardiovascular events than in those without them (P < 0.001). In subgroup analyses, higher levels of plasma neopterin in patients with cardiovascular events (P < 0.001) and a positive correlation between neopterin levels and late lumen loss after stenting (P = 0.008) were observed in the BMS group but not in the DES group (P = 0.53 and P = 0.17, respectively). In long-term cardiovascular events, multivariate Cox regression analysis identified the significance of the high-neopterin group as independent determinants of cardiovascular events (hazard ratio, 2.225; 95% CI, 1.283–3.857; P = 0.004). Immunohistochemical staining showed abundant neopterin-positive macrophages in the neointima after BMS implantation but no neopterin-positive macrophages in the neointima after DES implantation.Conclusion: These findings suggest that neopterin is associated with cardiovascular events after coronary stent implantation in patients with SAP. However, there might be a strong association between neopterin and cardiovascular events after BMS but not after DES in these patients.
Highlights
Differences in risk factors for SBI between paroxysmal and persistent AF was studied.
NVAF patients (119 paroxysmal, 71 persistent) underwent brain MRI, TTE, and TEE.
DM and CKD, which represents microvascular disease, predicted SBI in paroxysmal AF.
There was no obvious therapeutic target for SBI after progression to persistent NVAF.
Intervention for DM and CKD from paroxysmal NVAF may prevent SBI and future stroke.
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