Background:Although clinical trials demonstrate that the elderly with atrial fibrillation have risks of thrombosis and bleeding, the relationship between aging and coagulation fibrinolytic system in "real-world" cardiology outpatients is uncertain. Methods and Results:We retrospectively evaluated 773 patients (mean age: 58 years; 52% men; Asian ethnicity). To thoroughly investigate markers of coagulation and fibrinolysis, we simultaneously measured levels of D-dimer, prothrombin-fragment1+2 (F1+2), plasmin-α2 plasmin inhibitor complex (PIC), and thrombomodulin (TM). There were correlations between aging and levels of F1+2, D-dimer, PIC, and TM (R=0.61, 0.57, 0.49, and 0.30, respectively). We compared 3 age groups, which were defined as the Y group (<64 years), M group (65-74 years), and the O group (>75 years). Levels of markers were higher in older individuals (D-dimer: 1.0±0.8 vs. 0.8±0.8 vs. 0.6±0.4 μg/ml, F1+2: 281.8±151.3 vs. 224.6±107.1 vs. 155.5±90.0 pmol/L, PIC: 0.9±0.3 vs. 0.8±0.3 vs. 0.6±0.5 μg/ml, and TM: 2.9±0.8 vs. 2.7±0.7 vs. 2.5±0.7FU/ml). We performed logistic regression analysis to determine F1+2 and PIC levels. Multivariate analysis revealed that aging was the most important determinant of high F1+2 and PIC levels.Conclusions: Hypercoagulable states develop with advancing age in "real-world" cardiology outpatients. (Circ J 2016; 80: 2133 -2140
Syncope is induced by various causes in Japan. It is important that we understand the characteristics of each syncope cause. The consent rate for implanting an ILR in appropriate unexplained syncope patients is low. We need to educate these patients about the importance of making a diagnosis of syncope.
This study suggests that patients with NMRS present with daily vagal hyperactivity and sympathetic dysfunction. ABPM may support the diagnosis of NMRS.
AF recurrence measured by ELR-AUTO within 3 months after PVI can predict the late recurrence of AF. Freedom from AF in the first 3 months following ablation significantly predicts long-term AF freedom. ELR-AUTO is useful for the detection of symptomatic and asymptomatic AF.
2216CHIBA Y et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jpIn this study we evaluated the clinical significance of syncope and J-wave. Although it has been reported that syncope is a sign of sudden cardiac death (SCD) in patients with J-wave, 9 the management of syncope in patients with J-wave remains controversial.To our knowledge, there are few studies on the prevalence of J-wave in patients with syncope. To evaluate the possibility that syncope in patients with/without J-wave is caused by NMRS, we investigated whether head-up tilt test (HUT), a useful tool for diagnosing NMRS, can provide further insights into the relationship between syncope and J-wave.We therefore determined the prevalence of J-wave in patients with syncope in order to clarify the association between NMRS and J-wave. Methods SubjectsThree hundred and twenty-six consecutive patients with syncope who presented to the Department of Cardiology, Showa he presence of J-wave, also known as early repolarization (ER), is a common finding on electrocardiogram (ECG) that is seen in 1-10% of the general population, 1,2 especially in young people. J-wave is characterized by a positive deflection at the terminal of the QRS complex or notching/slurring at the terminal of the QRS complex on ECG. Its potential arrhythmogenicity, more recently, has been reported in clinical and experimental studies. 3-5 Fatal arrhythmia, however, is not commonly seen in patients with J-wave. 6 Editorial p 2110Syncope is also a common occurrence in 1-5% of the general population. 7,8 Neurally mediated reflex syncope (NMRS) is a most frequent cause of syncope. Cardiovascular event and life-threatening arrhythmia are also causes of syncope or cardiac arrest. These are important risk factors for mortality, but clinical diagnosis in some patients with syncope is difficult in the primary care setting. Fatal arrhythmia is not commonly seen in patients with syncope. Background: Syncope is a common occurrence. The presence of J-wave, also known as early repolarization, on electrocardiogram is often seen in the general population, but the relationship between syncope and J-wave is unclear.
: The risk of cardiogenic cerebral infarction is quanti ed by the CHA 2 DS 2 -VASc score in patients with atrial brillation, with female gender shown to be one of the risk factors. However, the relationships between gender and blood coagulation markers have not been investigated. Thus, the aim of the present study was to investigate relationships between gender and the coagulation and fibrinolysis systems. In the present study, 1025 patients 517 females F group , 508 males M group who visited the outpatient clinic and had markers of the brinolytic and coagulation systems measured at the Division of Cardiology of Showa University Hospital from June 2011 to June 2014 were evaluated retrospectively. Thrombomodulin TM , prothrombin fragment 1 2 PTF 1 2 , thrombin-antithrombin complex TAT , plasmin-2 -plasmin inhibitor complex PIC , and D-dimer levels were analyzed. Furthermore, patients without diabetes mellitus and vascular disease were divided into two groups according to age : a younger Y group 75 years and an elderly E group ≥ 75 years . In the Y group, TM levels were signi cantly lower in the F than M group P 0.0001 , but in the E group there was no signi cant difference in TM levels between these two groups. PTF 1 2 levels were signi cantly higher in the F group for each age group Y group, P 0.0426 ; E group, P 0.0214 . In the Y group, PIC levels were signi cantly higher in the F than M group P 0.0015 , but there was no difference in PIC levels between the F and M groups in the E group. Thus, in the F group, vascular endothelial dysfunction progressed in the E group. These observations suggest that the coagulation system is relatively accelerated, without any acceleration in the brinolytic system, in the F group with aging. The present study has shown that, in outpatients of a cardiovascular department, gender is a signi cant factor affecting blood coagulation systems.
Introduction Left bundle branch block (LBBB) with superior axis is common in patients with idiopathic‐ventricular arrhythmia (VA) originating from the tricuspid annulus (TA) and rarely from the cardiac basal crux and mitral annulus (MA). We described the electrocardiography and electrophysiological findings of idiopathic‐VA presenting with LBBB and superior axis. Methods and Results We described 42 idiopathic‐VA patients who had an LBBB and superior axis; 15 basal crux‐VA, 17 TA‐VA, and 10 MA‐VA. No patient had a structural heart disease. Among patients with idiopathic‐VA referred for ablation, we investigated the electrocardiogram and clinical characteristics of basal crux‐VA as compared with other LBBB and superior axis‐VA. The left ventricular ejection fraction with MA‐VA was significantly lower in comparison with basal crux‐VA (P = .01). All patients had a positive R wave in lead I and aVL. The maximum deflection index with basal crux‐VA was significantly higher in comparison with TA‐VA or MA‐VA (P = .01). Patients with basal crux‐VA presented with QS wave in lead II more frequently as compared with TA‐VA or MA‐VA (P = .001). All MA‐VA patients had Rs wave in V6, and basal crux‐VA, and TA‐VA patients had a monophasic R wave or Rs wave in V6. Basal crux‐VA patients underwent ablation in the middle cardiac vein (MCV) or coronary sinus (success rate: 94%, recurrence rate: 6%). Conclusions We could distinguish basal crux‐VA, TA‐VA, and MA‐VA, using a combination of clinical and electrocardiographic findings. These findings might be useful for counseling patients about an ablation strategy. Ablation via the MCV is effective for eliminating basal crux‐VA.
BackgroundLeft atrial–esophageal fistulas (LAEFs) are serious complications with high mortality after atrial fibrillation radiofrequency ablation (AFRA). Decreasing the incidence of esophageal thermal lesions (EsoTLs) that may lead to LAEFs is important. The aim of this study was to suppress EsoTL development and determine the appropriate alarm setting for a temperature-monitoring probe by using steerable sheath (STS) methods.MethodsWe enrolled 82 consecutive patients (mean, 61.9±11.7 years; 75.6% men) who underwent AFRA, including pulmonary vein isolation for symptomatic, drug-refractory atrial fibrillation with esophageal temperature monitoring by using STS between January 2011 and April 2014. All patients underwent upper gastrointestinal endoscopy (UGE) 1–3 days after AFRA. The timing of ablation discontinuation in the first 17 patients was determined by each physician during AFRA (only monitoring group, OM). In the next 65 patients, physicians were to immediately discontinue ablation when an alarm set at 39 °C went off (instruction group, INS). We compared two groups with respect to the incidence of EsoTLs.ResultsAmong the 82 patients, 5 (6.1%) had EsoTLs after AFRA. EsoTLs occurred in 3 of 17 patients (17.6%) and 2 of 65 patients (3.1%) in the OM and INS groups, respectively. The incidence of EsoTLs in the INS group was significantly lower than that in the OM group (p=0.0254). EsoTL did not occur at maximal temperature less than 39 °C, measured by using esophageal temperature-monitoring probe.ConclusionsImmediate discontinuation of ablation during pulmonary vein isolation remarkably decreased the incidence of EsoTLs, even when using STS.
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