Low atrial septal pacing with dual-chamber pacemakers reduces atrial fibrillation in sick sinus syndrome

SummaryBackgroundSick sinus syndrome (SSS) is often complicated with the additional presence of atrial fibrillation (AF). Atrial septal pacing, compared with right atrial appendage (RAA) pacing, shortens the atrial conduction time and reduces the dispersion of the refractoriness. However, low atrial septal (LAS) pacing's efficacy for preventing AF in SSS remains controversial in Japan.Methods and resultsWe analyzed 95 consecutive patients with SSS who underwent dual-chamber pacemaker implantations. Forty-two patients (44%) had a history of AF at the time of the pacemaker implantation. In the group without a history of AF, LAS pacing was performed in 17 patients, and RAA pacing in 36 patients. In the group with a history of AF, LAS pacing was performed in 15 patients, and RAA pacing in 27 patients. We evaluated whether LAS pacing prevented the development of de novo AF and the persistence of AF after pacemaker implantations. No significant differences were found in the baseline characteristics between the RAA and LAS groups regardless of an AF history. During a 1-year follow-up period, in the SSS patients without a history of AF, 19.0% (7/36) of the RAA group developed de novo AF, however, 5.9% (1/17) of the LAS group developed de novo AF (p=0.20). On the other hand, in the SSS patients with a history of AF, 22.0% (6/27) of the RAA group developed persistent AF, but none of the LAS group developed any persistent AF (p=0.049). There were no post-operative complications related to the LAS pacing.ConclusionsLAS pacing is safe and feasible. LAS pacing may prevent the progression to persistent AF in SSS patients with dual-chamber pacemakers

The usefulness of nifekalant for activation mapping of premature beat-triggered atrial fibrillation: Suppression of atrial fibrillation initiation without inhibiting premature beat

AbstractA 66-year-old man underwent a second ablation for atrial fibrillation (AF). Intravenous isoproterenol administration caused the atrial premature beat (APB), triggering AF. The APB originated in the right atrium and invariably initiated AF. Therefore, contact activation mapping could not be performed without frequent electrocardioversion. To prevent the initiation of AF without inhibiting the APB firing, we administered nifekalant intravenously, which facilitated precise activation mapping and ablation of the AF-triggering APB. The administration of nifekalant may improve clinical outcomes of catheter ablation for AF triggered by non-pulmonary vein APB, which invariably initiates AF

1-Year Results of the ZEPHYR Registry (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery) Predictors of Restenosis

AbstractObjectivesThis study sought to assess the rate and predictors of 1-year restenosis after drug-eluting stent implantation for femoropopliteal (FP) lesions in patients with peripheral arterial disease.BackgroundZilver PTX, a paclitaxel-eluting stent for FP lesions, provides superior outcomes to angioplasty and bare-metal stents in clinical trials. However, its real-world outcomes and the associated features remain unclear.MethodsThis was a prospective multicenter study enrolling 831 FP lesions (797 limbs, 690 patients) treated by Zilver PTX implantation. The primary endpoint was 1-year restenosis. Secondary endpoints included major adverse limb event and stent thrombosis.ResultsMean lesion length was 17 ± 10 cm. One-year restenosis, major adverse limb event, and stent thrombosis rates were 37%, 22%, and 2%, respectively. The generalized linear mixed model showed that lesion length ≥16 cm assessed by angiography and distal external elastic membrane area ≤27 mm2 and minimum stent area ≤12 mm2 assessed by intravascular ultrasound were independent risk factors for restenosis. One-year restenosis rates were 15% in cases with none of these risk factors and 50% in those with ≥2 risk factors.ConclusionsThe current study demonstrated 1-year real-world outcomes after drug-eluting stent treatment for FP lesions, including challenging ones in clinical practice. Lesion length, external elastic membrane area, and minimum stent area were independent predictors for restenosis. (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery—Prospective Multicenter Registry [ZEPHYR]; UMIN000008433

Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction

AbstractBackgroundAcute hyperglycemia (AH) after the onset of acute myocardial infarction (AMI) is a manifestation of transient abnormal glucose metabolism that may reflect AMI severity, and thus be a predictor of poor prognosis. However, it remains unknown whether AH may predict development of de novo diabetes mellitus (dn-DM) in non-diabetic AMI patients.Methods and resultsAmong AMI patients registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2007, we investigated hospital records of 1493 patients who had an admission glycated hemoglobin A1c (HbA1c) level of ≤6.0% and were subjected to glycometabolic profiling after survival discharge. dn-DM was defined as initiation of diabetic medication or documentation of an HbA1c level of ≥6.5% during the 5-year follow-up period. AH, defined as an admission serum glucose level of ≥200mg/dl, was observed in 133 (8.9%) patients. dn-DM development was more frequent in post-AMI patients with AH than those without [24.8% vs 12.0%, adjusted hazard ratio (HR) 1.776, p=0.021], particularly among patients with an HbA1c of <5.6% on admission. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a reduced incidence of dn-DM in patients with AH (adjusted HR 0.397, p=0.031).ConclusionAdmission AH was a predictor of dn-DM in non-diabetic post-AMI patients. Renin–angiotensin system inhibitors were associated with reduced incidence of dn-DM in post-AMI patients with AH

Reduced risk of recurrent myocardial infarction in homozygous carriers of the chromosome 9p21 rs1333049 c risk allele in the contemporary percutaneous coronary intervention era: A prospective observational study

Hara M, Sakata Y, Nakatani D on behalf of the OACIS Investigators, et al. Reduced risk of recurrent myocardial infarction in homozygous carriers of the chromosome 9p21 rs1333049 C risk allele in the contemporary percutaneous coronary intervention era: a prospective observational study. BMJ Open 2014;4:e005438. doi: 10.1136/bmjopen-2014-00543

Association of lifestyle-related factors with circadian onset patterns of acute myocardial infarction: A prospective observational study in Japan

Objective: The onset of acute myocardial infarction (AMI) shows characteristic circadian variations involving a definite morning peak and a less-defined night-time peak. However, the factors influencing the circadian patterns of AMI onset and their influence on morning and night-time peaks have not been fully elucidated. Design, setting and participants: An analysis of patients registered between 1998 and 2008 in the Osaka Acute Coronary Insufficiency Study, which is a prospective, multicentre observational study of patients with AMI in the Osaka region of Japan. The present study included 7755 consecutive patients with a known time of AMI onset. Main outcomes and measures: A mixture of two von Mises distributions was used to examine whether a circadian pattern of AMI had uniform, unimodal or bimodal distribution, and the likelihood ratio test was then used to select the best circadian pattern among them. The hierarchical likelihood ratio test was used to identify factors affecting the circadian patterns of AMI onset. The Kaplan-Meier method was used to estimate survival curves of 1-year mortality according to AMI onset time. Results: The overall population had a bimodal circadian pattern of AMI onset characterised by a high and sharp morning peak and a lower and less-defined night-time peak (bimodal p<0.001). Although several lifestyle-related factors had a statistically significant association with the circadian patterns of AMI onset, serum triglyceride levels had the most prominent association with the circadian patterns of AMI onset. Patients with triglyceride ?150 mg/dL on admission had only one morning peak in the circadian pattern of AMI onset during weekdays, with no peaks detected on weekends, whereas all other subgroups had two peaks throughout the week. Conclusions: The circadian pattern of AMI onset was characterised by bimodality. Notably, several lifestyle-related factors, particularly serum triglyceride levels, had a strong relation with the circadian pattern of AMI onset.Edahiro R, Sakata Y, Nakatani D, et al. Association of lifestyle-related factors with circadian onset patterns of acute myocardial infarction: a prospective observational study in Japan. BMJ Open 2014;4:e005067. doi: 10.1136/bmjopen-2014-00506

Impact of baseline yellow plaque assessed by coronary angioscopy on vascular response after stent implantation

Tsujimura T., Mizote I., Ishihara T., et al. Impact of baseline yellow plaque assessed by coronary angioscopy on vascular response after stent implantation. Journal of Cardiology , (2024); https://doi.org/10.1016/j.jjcc.2024.04.004.Background: The relationship between baseline yellow plaque (YP) and vascular response after stent implantation has not been fully investigated. Methods: This was a sub-analysis of the Collaboration-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention were analyzed. Optical coherence tomography (OCT) and coronary angioscopy (CAS) were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. OCT and CAS findings at 11 months were compared between lesions with baseline YP (YP group) and lesions without baseline YP (Non-YP group). Results: Baseline YP was detected in 37 lesions (42 %). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in the YP group (11 % versus 0 %, p = 0.028) and mean neointimal thickness tended to be lower (104 ± 43 μm versus 120 ± 48 μm, p = 0.098). CAS findings at 11 months demonstrated that the dominant and minimum neointimal coverage grades were significantly lower (p = 0.049 and P = 0.026) and maximum yellow color grade was significantly higher (p < 0.001) in the YP group. Conclusions: Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation