PA-TDI duration was an independent predictor of POAF following OPCAB. Awareness of risk of POAF may lead to the prevention of POAF, a rapid response to POAF, shortened hospital stay, and improved prognosis.

No abstract

Unexplained cardiac arrest (UCA) with documented ventricular fibrillation (VF) is a major cause of sudden cardiac death. Abnormal sympathetic innervations have been shown to be a trigger of ventricular fibrillation. Further, adequate expression of SEMA3A was reported to be critical for normal patterning of cardiac sympathetic innervation. We investigated the relevance of the semaphorin 3A (SEMA3A) gene located at chromosome 5 in the etiology of UCA. Eighty-three Japanese patients diagnosed with UCA and 2,958 healthy controls from two different geographic regions in Japan were enrolled. A nonsynonymous polymorphism (I334V, rs138694505A>G) in exon 10 of the SEMA3A gene identified through resequencing was significantly associated with UCA (combined P = 0.0004, OR 3.08, 95%CI 1.67–5.7). Overall, 15.7% of UCA patients carried the risk genotype G, whereas only 5.6% did in controls. In patients with SEMA3A I334V, VF predominantly occurred at rest during the night. They showed sinus bradycardia, and their RR intervals on the 12-lead electrocardiography tended to be longer than those in patients without SEMA3A I334V (1031±111 ms versus 932±182 ms, P = 0.039). Immunofluorescence staining of cardiac biopsy specimens revealed that sympathetic nerves, which are absent in the subendocardial layer in normal hearts, extended to the subendocardial layer only in patients with SEMA3A I334V. Functional analyses revealed that the axon-repelling and axon-collapsing activities of mutant SEMA3A I334V genes were significantly weaker than those of wild-type SEMA3A genes. A high incidence of SEMA3A I334V in UCA patients and inappropriate innervation patterning in their hearts implicate involvement of the SEMA3A gene in the pathogenesis of UCA.

rugada syndrome (BS) is characterized by ST-segment elevation in leads V1-3 with a right bundle branch block pattern and nocturnal sudden cardiac death caused by ventricular fibrillation (VF). 1,2 Patients with this syndrome who have experienced syncopal episodes or have been resuscitated from cardiac arrest have a poor prognosis if they do not receive an implantable cardioverter defibrillator (ICD). Although the prevalence of Brugada-type ECG change in healthy subjects is approximately 0.1-1%, their prognosis of is relatively good compared with symptomatic patients. 3-10 However, some asymptomatic patients become symptomatic and sudden cardiac death can occur with the first VF attack, so it is a problem in Japan of how to treat asymptomatic patients with a typical Brugada-type ECG who are detected by daily medical checkup. The results of some recent studies regarding the prognostic value of programmed electrical stimulation (PES) for patients with BS are conflicting; 6-9 Priori et al reported that the factors that predicted cardiac events were spontaneous ST elevation in leads V1-3 and episodes of syncope, but that VF inducible by PES did not indicate an increased risk of cardiac arrest, 7 whereas Brugada et al reported that induci-bility of ventricular arrhythmia and an abnormal ECG without provocation were predictors of arrhythmic events. 8,9 However, an electrophysiological study (EPS) is expensive and invasive, and sometimes results in complications, so it should not be carried out for all asymptomatic patients who show a Brugada-type ECG, but only for those patients for whom there is a high risk for a cardiac event. Because it is currently impossible to accurately predict the occurrence of cardiac events in asymptomatic patients, the present study was designed to determine noninvasive methods that could predict induction of VF by PES in asymptomatic patients with Brugada syndrome. For this purpose, the clinical characteristics of asymptomatic patients in whom VF was induced by PES were assessed, and the differences between the clinical values in asymptomatic patients with PES-induced VF and those without PES-induced VF were studied using noninvasive methods (a sodium channel blocker [pilsicainide] challenge test and a signal averaged electro-gram). Methods Patients The subjects of this study were 41 male asymptomatic patients with BS (age 27-66 years; mean age, 45±10 years). A Brugada-type ECG was defined as late r' wave (>0.2 mV) and ST segment elevation (>0.1 mV). 3 All of the subjects Circ J 2003; 67: 312-316 Ventricular fibrillation (VF) is induced in some asymptomatic patients with Brugada syndrome (BS), but the pro-gnostic value of programmed electrical stimulation (PES) in such patients is controversial. The clinical characteristics of 41 asymptomatic BS patients, divided into 2 groups according to whether VF was induced by PES (inducible VF group: n=13, non-inducible VF group: n=28) were evaluated. ST levels in the right precordial leads were measured before and after administration of pilsicainide...

Aims. Historical records provide evidence of extreme magnetic storms with equatorward auroral extensions before the epoch of systematic magnetic observations. One significant magnetic storm occurred on February 15, 1730. We scale this magnetic storm with auroral extension and contextualise it based on contemporary solar activity. Methods. We examined historical records in East Asia and computed the magnetic latitude (MLAT)Hayakawa et al. 2of observational sites to scale magnetic storms. We also compared them with auroral records in Southern Europe. We examined contemporary sunspot observations to reconstruct detailed solar activity between 1729 and 1731.Results. We show 29 auroral records in East Asian historical documents and 37 sunspot observations.Conclusions. These records show that the auroral displays were visible at least down to 25.8°MLAT throughout East Asia. In comparison with contemporary European records, we show that the boundary of the auroral display closest to the equator surpassed 45.1° MLAT and possibly came down to 31.5° MLAT in its maximum phase, with considerable brightness. Contemporary sunspot records show an active phase in the first half of 1730 during the declining phase of the solar cycle.This magnetic storm was at least as intense as the magnetic storm in 1989, but less intense than the Carrington event.

Lack of the circadian variation of autonomic function occurs in Brs, and this may contribute to the pathogenesis of VF.

Variable Strategies for CTI AblationObjectivesThis study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies.Methods and ResultsThis study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02).ConclusionChanging the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.

Heart rate control during AF without sinus conversion may result in an incomplete cure of TIC, suggesting the advantages of rhythm control with ablation in patients with TIC.