Background Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with thromboembolic and bleeding risk. We sought to determine the prevalence and characteristics of patients with AF ablation who are potential candidates for WATCHMAN implantation in a Japanese population. Methods We enrolled 2443 consecutive patients who had previously undergone AF ablation and transesophageal echocardiography (TEE). We assessed their clinical characteristics and measured their LAA orifice diameter and depth retrospectively using the obtained TEE images. We defined patients who met both anatomical criteria (LAA orifice max diameter: 17-31 mm and LAA max depth > LAA orifice max diameter) and clinical criteria (CHA 2 DS 2 -VASc score ≥ 2 and HAS-BLED score ≥ 3) as LAAO candidates. Results Among the 2443 enrolled patients, 361 (15%) met the clinical criteria, and 1928 (79%) met the anatomical criteria. Thus 12% (293/2443) of the total patient group met the criteria of LAAO candidates. LAAO candidates showed larger left atrial (LA) volume (77.6 ± 30.1 vs. 67.7 ± 29.1 mL, P < 0.001), larger LAA orifice diameter (22.5 ± 3.2 vs. 22.0 ± 4.3 mm, P = 0.026), and larger LAA depth (28.9 ± 4.6 vs. 27.0 ± 4.8 mm, P < 0.001). LAAO candidates made up only 23% of patients with CHA 2 DS 2 -VASc score ≥ 2 (N = 1295), whereas 78% of patients with a HAS-BLED score ≥ 3 (N = 378) were LAAO candidates. Conclusion Twelve percent of patients who underwent AF ablation were potential candidates for LAAO using a WATCH-MAN device in this Japanese population. It is imperative to evaluate bleeding risk when considering the indications for LAAO.
Hypertension guidelines recommend isometric handgrip exercise (IHG) as a nonpharmacological treatment. The aim of this study was to investigate whether IHG is safe for hypertensive patients. The participants were mostly middle-aged to elderly patients with hypertension. Participants wore a pedometer for 4 weeks and were then divided into two groups: Those who had taken at least 7000 steps per day were placed in an IHG-only group (n = 11), and those who took fewer steps were placed in an IHG + walking group (n = 4). Both groups then performed IHG for 12 weeks. No significant blood pressure reduction occurred from before to after intervention in either group. In the IHG-only group, brain natriuretic peptide (BNP) was significantly higher and left atrial (LA) volume (24.6 ± 9.1 to 36.4 ± 17.9 mL, P = .007) was significantly larger after intervention than before. Long-term IHG may induce both LA enlargement and increased BNP in hypertensive patients.
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