Complete free wall isolation of arrhythmogenic persistent left superior vena cava

Sekihara T., Oka T., Ozu K., et al. Complete free wall isolation of arrhythmogenic persistent left superior vena cava. Journal of Cardiovascular Electrophysiology 35, 862 (2024); https://doi.org/10.1111/jce.16207.Introduction: Persistent left superior vena cava (PLSVC) is one of the major sources of triggers and drivers of atrial fibrillation (AF). There has been no established PLSVC ablation procedure to eliminate the arrhythmogenicity along the entire length of PLSVC. Methods and Results: A 70-year-old woman with a history of two previous catheter ablations for AF, mitral valvuloplasty, and an unroofed coronary sinus-type atrial septal defect closure underwent the redo AF ablations. The AF trigger and driver were identified within the patient's enlarged PLSVC. The AF was treated by complete PLSVC free wall isolation. Conclusion: Complete PLSVC free wall isolation may be an effective ablation method to eliminate the arrhythmogenicity along the entire length of the PLSVC

An autoencoder-classified cluster of SARS-CoV-2 strain with two mutations in helicase

Using an autoencoder-based analysis to classify genomes of SARS-CoV-2 coronaviruses, we found a cluster consisting only of a specific genotype with two mutations in the helicase. This virus genotype, called C-type SARS-CoV-2, was almost exclusively prevalent in the United States from March to July 2020. This type of virus, characterized by a pair of the C17747T (P504L) and A17858G (Y541C) mutations on the nsp13 gene, had never been highly prevalent at any other time or in any other part of the world. In the U.S., Washington State was the center of the epidemic, and the C-type viruses, along with the viruses with wild-type helicase, seemed to have aroused the pandemic. In Washington State, USA, the CoViD-19 epidemic during the first two months of the year, starting at the end of February 2020, was mainly caused by the type-C virus. During this period, the infection spread rapidly; from May onwards, the number of viruses with wild-type helicases became higher than that of type-C viruses, and no type-C viruses have been collected since early July. The involvement of the helicase in this COVID-19 disease was discussed

Effect of vasodilators in patient with pulmonary hypertension associated with hemolytic anemia

AbstractPulmonary arterial hypertension (PAH) has been described to associate with hemolytic anemia in updated clinical classification of pulmonary hypertension. A 56-year-old woman, diagnosed with warm antibody autoimmune hemolytic anemia (AIHA), was treated with oral corticosteroids at the Department of Hematology, Osaka University Hospital for 30 years. Her AIHA worsened 3 months before the admission, and she was treated with rituximab and cyclosporine in combination with prednisolone. Soon after she left the hospital, she developed dyspnea on effort and leg edema, therefore she was re-admitted to the Department of Cardiovascular Medicine. Echocardiogram and cardiac catheterization demonstrated PAH associated with AIHA. She was treated with three types of vasodilatory agents, resulting in an improvement in pulmonary arterial pressure and pulmonary vascular resistance after 6 weeks. A few weeks after she left the hospital, her hemolytic anemia became in remission without intensifying AIHA therapy, and did not worsen for a year of follow-up. Although corticosteroids are the first-line treatment for AIHA, medications for PAH should be considered when the first-line therapy for AIHA failed to improve PAH

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

Effect of lead design and pacing vector on electrical parameters of quadripolar coronary sinus leads: The RALLY-X4 study

Abstract Background Various lead designs have been developed to accommodate different coronary sinus anatomies. Our objectives were to compare electrical parameters of straight and spiral left ventricular leads, to evaluate capture thresholds and impedances using different pacing vectors, and to study evolution of thresholds over time. Methods The RALLY-X4 study enrolled patients implanted with a lead from the Acuity X4 family (Straight, Spiral Short or Spiral Long). Electrical parameters (including capture thresholds from all 17 vectors) were measured at baseline and follow-up. Results Data from 795 patients who were successfully implanted were analysed. Straight and spiral leads had similar proportions of patients with thresholds 80% of patients. Pacing vectors significantly affect electrical parameters, with higher thresholds in more proximal electrodes and lower thresholds with unipolar and extended bipolar configurations. Capture thresholds slightly decreased over a mean follow-up of one year. This article is protected by copyright. All rights reservedPeer reviewe