Radiofrequency hot balloon catheter ablation for the treatment of atrial fibrillation: A 3-center study in Japan

Background: The safety and efficacy of radiofrequency hot balloon catheter (Toray-Satake balloon [TSB]) ablation for the treatment of atrial fibrillation (AF) was evaluated in a 3-center pilot study. Methods: Thirty patients (24 men; age, 61±8 years) with drug-resistant AF (paroxysmal, n=24; persistent, n=6) were evaluated in this study. The pulmonary veins (PVs) and PV antrum were isolated using the TSB under general anesthesia (n=12) or deep sedation (n=18). Results: Complete PV isolation was achieved in 110 (92%) of 120 PVs, and decreased PV potentials were observed in the right superior PV in 4 patients (13%), left superior PV in 4 patients (13%), and left inferior PV in 2 patients (7%). The mean total procedure time was 104±27 min. The mean total fluoroscopic and total application times were 32±14 min and 12±2 min, respectively. After a single session, 22 (73%) and 20 (67%) of the 30 patients were free from AF after 6 and 11.4±2.2 months of follow-up, respectively. There were no device-related severe complications such as stroke, esophageal fistula, symptomatic PV stenosis, phrenic nerve palsy, or pyloric spasm. Conclusion: TSB catheter ablation might be a promising approach for the treatment of drug-resistant AF

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting