Recurrence of Atrial Fibrillation within Three Months after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation : Analysis Using an External Loop Recorder with Auto-trigger Function

Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective option for patients with symptomatic paroxysmal atrial brillation (AF). The recurrence of AF within 3 months after PVI is not considered a failure of the ablation procedure because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with auto-trigger function (ELR-AUTO) to detect AF following PVI to characterize early recurrence and determine the implication of AF within 3 months after PVI. The study included 53 consecutive patients with symptomatic paroxysmal AF (age, 61.6 ± 12.6 years ; 77％ male) who underwent PVI, and were fitted with an ELR-AUTO for 7 ± 2 days within 3 months after PVI. Of the 33 patients(62.2％) who did not have AF within the 3-month period, only 1 patient had AF recurrence at 12 months. Seven of 20 patients (35％) who experienced AF within 3 months had symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence was 87.5％, 71.1％, 35.0％, and 96.9％, respectively. Thus, AF recurrence detected by ELR-AUTO within 3 months after PVI can predict late AF recurrence. Freedom from AF in the firrst 3 months following ablation significantly predicts long-term freedom from AF. An ELR-AUTO is useful for detecting symptomatic and asymptomatic AF

Drug-induced Brugada syndrome

Brugada syndrome (BrS) is an inherited cardiac disorder that is associated with an electrocardiogram pattern of ST segment elevation on right precordial leads and a high incidence of sudden death. Diagnosis requires documentation of a coved-type ST segment that occurs spontaneously or in the presence of a class IA or IC antiarrhythmic agent. A wide variety of other drugs, including antianginals, antidepressants, antipsychotics, and antihistamines, have been reported to unmask or induce the electrocardiographic and arrhythmic manifestations of BrS. This review focuses on drug-induced BrS phenotypes, prevalence, and underlying mechanisms

Effects of Feeding-Related Peptides on Neuronal Oscillation in the Ventromedial Hypothalamus

The ventromedial hypothalamus (VMH) plays an important role in feeding behavior, obesity, and thermoregulation. The VMH contains glucose-sensing neurons, the firing of which depends on the level of extracellular glucose and which are involved in maintaining the blood glucose level via the sympathetic nervous system. The VMH also expresses various receptors of the peptides related to feeding. However, it is not well-understood whether the action of feeding-related peptides mediates the activity of glucose-sensing neurons in the VMH. In the present study, we examined the effects of feeding-related peptides on the burst-generating property of the VMH. Superfusion with insulin, pituitary adenylate cyclase-activating polypeptide, corticotropin-releasing factor, and orexin increased the frequency of the VMH oscillation. In contrast, superfusion with leptin, cholecystokinin, cocaine- and amphetamine-regulated transcript, galanin, ghrelin, and neuropeptide Y decreased the frequency of the oscillation. Our findings indicated that the frequency changes of VMH oscillation in response to the application of feeding-related peptides showed a tendency similar to changes of sympathetic nerve activity in response to the application of these substances to the brain

Serum Soluble Thrombomodulin Level on Admission Is a Useful Predictor of Treatment Response in Patients with Acute Pulmonary Thromboembolism

Previous studies have reported elevated serum soluble thrombomodulin (sTM) concentrations in acute pulmonary thromboembolism (APTE), but no study has evaluated the relationship between the serum sTM concentration and prognosis. In the present study we investigated the correlation between the serum sTM concentration on admission and the duration of oxygen supplementation in patients admitted to the coronary care unit (CCU) for APTE to evaluate whether serum sTM is a useful predictor of treatment response. The study included 38 consecutive patients [14 men, 24 women; mean (±SD) age 59.9±16.8 years] admitted to the CCU between March 2012 and July 2014 with a diagnosis of APTE confirmed by contrast-enhanced computed tomography within 7 days of onset. The severity of pulmonary embolism was classified as collapse and cardiac arrest type in three patients (8%), massive type in two (5%), submassive type in 19 (50%), and non-massive type in 14 (38%). Significant positive correlations were found for both age and creatinine clearance with duration of hospitalization, but not with duration of oxygen supplementation. There was a significant positive correlation between admission sTM concentrations and both days of hospitalization (R=0.57, P<0.005) and duration of oxygen supplementation (R=0.56, P<0.01). The findings of the present study suggest that serum sTM concentrations are promising predictors of treatment response and short-term prognosis in patients with APTE

Thrombomodulin can Predict the Incidence of Second Events in Patients with Acute Myocardial Infarction

Biomarkers of atherothrombosis can predict the risk of cardiovascular events. However, it is difficult to predict second adverse events using these biomarkers at the point in time when the first cardiovascular event occurs. Therefore, we evaluated atherothrombosis-related biomarkers to determine their associations with prognosis after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. A total of 309 AMI patients were enrolled in this study. The patients had undergone successful coronary interventions and the levels of various atherothrombosis-related biomarkers were assessed within the first postoperative hour. Biomarkers other than those assessed by routine biochemical tests were analyzed, including defined endothelial cell damage markers such as thrombomodulin (TM), inflammatory markers such as C-reactive protein (CRP), and coagulation and fibrinolysis system markers such as D-dimer, prothrombin fragment F1+2 (F1+2) and plasminogen activator inhibitor-1 (PAI-1). Major adverse cardiac events (MACEs) occurred in 98 patients during the follow-up period (872.6±579.8 days). Multivariate analysis revealed that clinical parameters such as decreased levels of left ventricular ejection fraction and elevated levels of brain natriuretic peptide, hemoglobin A1c and TM were significantly associated with MACEs. The association between TM and MACEs was especially high (OR: 3.65, 95% CI; 1.75–7.68). Neither dyslipidemia, hypertension, smoking, advanced age, a history of cardiac events nor the type of AMI were associated with MACEs. TM is independently associated with MACEs and may be predictive of second events following PCI in patients with AMI