Publications by authors named "Yoshiaki Mizutani"

17 Publications

  • Page 1 of 1

Cryoballoon ablation for atrial fibrillation without the use of a contrast medium: a combination of the intracardiac echocardiography and pressure wave monitoring guided approach.

Heart Vessels 2021 Oct 12. Epub 2021 Oct 12.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

In cryoballoon ablation (CBA), a contrast medium is commonly used to confirm balloon occlusion of the pulmonary veins (PVs). However, a contrast medium cannot always be used in patients with renal dysfunction and allergy. The present study aimed to assess the efficacy and safety of CBA without the use of a contrast medium. We retrospectively examined consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent first-time CBA. We compared the procedural results and outcomes in patients for whom a contrast medium was used (contrast group) and those from whom a contrast medium was not used (non-contrast group). In the non-contrast group, we used saline injection on the intracardiac echocardiography and pressure wave monitoring for PV occlusion. Fifty patients (200 PVs) and 22 patients (88 PVs) underwent CBA with and without a contrast medium, respectively. The success rate of PV isolation with CBA alone was 93% and 90% in the non-contrast and contrast groups, respectively (p = 0.40). The fluoroscopy time and nadir temperature were significantly lower in the non-contrast group as compared to that in the contrast group. The recurrence rate 1 year after ablation did not differ between the two groups (18% vs. 18%, p > 0.99). Furthermore, the number of reconnected PVs in patients with recurrence was significantly lower in the non-contrast group than in the contrast group (6% vs. 36%, p = 0.017). In conclusion, CBA using the intracardiac echocardiography and pressure monitoring approach without the use of a contrast medium was safe and efficient.
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http://dx.doi.org/10.1007/s00380-021-01963-3DOI Listing
October 2021

Earliest pulmonary vein potential-guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: A result from two randomized clinical studies.

J Cardiovasc Electrophysiol 2021 Sep 17. Epub 2021 Sep 17.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Introduction: With regard to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during PV isolation (earliest potential [EP]-guided CBA) has been previously demonstrated. The present study aimed to evaluate the long-term outcome of the EP-guided CBA.

Methods And Results: This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time-to-isolation (TTI) after cryoapplication exceeded 60 and 45 s in the first and second studies, respectively. We compared the clinical outcomes for 1 year after the procedure between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients). The primary endpoint was the recurrence of atrial arrhythmia after ablation. No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤ 90 s (98.5% vs. 90.0%, p < .001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1 year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; p = .019).

Conclusions: The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1 year after ablation.
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http://dx.doi.org/10.1111/jce.15246DOI Listing
September 2021

Reverse-Type Left Posterior Fascicular Ventricular Tachycardia: A New Electrocardiographic Entity.

JACC Clin Electrophysiol 2021 Jul 24;7(7):843-854. Epub 2021 Feb 24.

Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Objectives: This study sought to demonstrate a new type of verapamil-sensitive fascicular ventricular tachycardia (VT) with a reverse circuit.

Background: Left posterior fascicular ventricular tachycardia (LPFVT) is the most common form of verapamil-sensitive fascicular VT. Reverse-type LPFVT has not been reported.

Methods: We searched for a reverse-type LPFVT among 242 patients with verapamil-sensitive VT from February 2006 to September 2019.

Results: Three patients had a reverse-type LPFVT (cycle lengths: 340, 360, and 340 ms). QRS configuration during VT was narrow (140, 150, and 140 ms) and exhibited rSr' morphology in V with an early precordial transition and inferior axis. Two of 3 patients had common-type LPFVT. During reverse-type LPFVT, the earliest ventricular activation was the left superior middle septum. Fragmented Purkinje potentials (P1) buried within the local ventricular electrogram were recorded with an activation sequence from the apex to the base and were linked to the subsequent left ventricular septal activation. After radiofrequency catheter ablation at P1 during LPFVT, the reverse-type LPFVT also became noninducible. In 1 patient with only the reverse-type LPFVT, radiofrequency catheter ablation at the earliest LV activation site suppressed VT. These findings suggest that this new type of verapamil-sensitive fascicular VT shares a re-entrant circuit with a reverse direction of common LPFVT with an intramural exit site at the superior middle septum.

Conclusions: Reverse-type LPFVT can occur. If common LPFVT exists, diastolic P1 during LPFVT can be a common target of ablation. If only reverse-LPFVT is inducible, the earliest ventricular activation site can be a target.
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http://dx.doi.org/10.1016/j.jacep.2020.11.022DOI Listing
July 2021

Disappearance pattern and the last remaining earliest pulmonary vein potential during cryoballoon ablation in predicting recurrence and conduction gap site of pulmonary veins.

Heart Vessels 2021 Aug 26;36(8):1190-1200. Epub 2021 Jan 26.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.

Electrophysiological studies have rarely evaluated the sites prone to pulmonary vein (PV) conduction gap during cryoballoon ablation (CBA) for atrial fibrillation (AF). In addition, no studies have analyzed the sequence of PV potentials just before PV isolation during CBA for AF. Of the 238 patients who underwent first-time CBA for paroxysmal AF, 115 PVs of 29 patients who underwent repeat session due to recurrence after the procedure were retrospectively evaluated in the study. We evaluated the disappearance pattern of PV potential and PV reconnection on intracardiac electrograms and investigated whether the conduction gap site of the PV was related to the last remaining earliest PV potential (EP) and sequence pattern during the first-time CBA. Time to isolation was observed in 81 PVs during the first-time CBA. At the repeat session, PV reconnection was only observed in 22 of 81 PVs. PV potentials disappeared with sequence changes in 36 PVs and without sequence changes in 38 PVs. Multivariate analysis demonstrated that disappearance of PV potentials without change in the EP site but with delay or disappearance of other PV potentials was independently associated with PV reconnection (12/22 PVs [55%] vs. 4/59 PVs [6.8%]; odds ratio 14.4; 95% confidence interval 3.75-55.5; p < 0.001). In 19 of 22 (86%) reconnected PVs, PV conduction gap sites at repeat ablation corresponded with the last remaining EP sites during first-time CBA. In conclusion, disappearance pattern of the PV potential and the last remaining EP during the CBA can predict PV reconnection and gap site.
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http://dx.doi.org/10.1007/s00380-021-01785-3DOI Listing
August 2021

Impact of the clinical frailty scale on clinical outcomes and bleeding events in patients with ST-segment elevation myocardial infarction.

Heart Vessels 2021 Jun 7;36(6):799-808. Epub 2021 Jan 7.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

The Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and may help to predict adverse outcomes in elderly patients. The aim of the present study was to examine the impact of CFS on clinical outcomes and bleeding events after successful percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). We enrolled 266 consecutive patients with STEMI who underwent primary PCI in between January 2015 and June 2018. Patients were categorized into two groups based on the CFS stages: CFS 1-3 and CFS ≥ 4. We collected the data and evaluated the relationship between the CFS grade and the incidence of major adverse cardiovascular events (MACE) and Bleeding Academic Research Consortium 3 or 5 bleeding events. Of these patients, CFS ≥ 4 was present in 59 (22.2%). During the follow-up, 37.3% in the CFS ≥ 4 group and 8.2% in the CFS 1-3 group experienced MACE. In Kaplan-Meier analysis, the proportion of MACE-free survival for 4 years was significantly lower in the CFS ≥ 4 group (log-rank P < 0.001). Additionally, the proportion of bleeding event-free survival was significantly lower in the CFS ≥ 4 group (log-rank P < 0.001). The CFS (per 1-grade increase) remained an independent significant predictor of MACE on multivariate Cox proportional hazard analysis [hazard ratio 1.39 (95% confidence interval: 1.08 to 1.79, P = 0.01)]. In conclusion, CFS was an independent predictor of future adverse cardiac events in patients with STEMI. Therefore, the assessment of CFS is crucial in this population.
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http://dx.doi.org/10.1007/s00380-020-01764-0DOI Listing
June 2021

Safety and efficacy of first-line cryoablation for para-hisian ventricular arrhythmias using a cryomapping protocol approach: A case series.

Clin Case Rep 2020 Dec 12;8(12):3248-3253. Epub 2020 Oct 12.

Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan.

A first-line cryoablation for para-Hisian VAs using a strict cryomapping protocol is useful and safe, even if the His bundle potential is recorded on the ablation catheter.
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http://dx.doi.org/10.1002/ccr3.3401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752434PMC
December 2020

Impact of skeletal muscle mass on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

Cardiovasc Interv Ther 2021 Oct 31;36(4):514-522. Epub 2020 Oct 31.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Low skeletal muscle mass is one of the components of sarcopenia. However, the prognostic impact of skeletal muscle mass on clinical outcomes in patients after transcatheter aortic valve replacement (TAVR) remains unclear. Therefore, we assessed the impact of skeletal muscle mass on future cardiovascular events in patients undergoing TAVR. We enrolled 71 consecutive patients who underwent TAVR for symptomatic severe aortic stenosis. We applied bilateral psoas muscles as an indicator of skeletal muscle mass. Psoas muscle volumes were measured from the origin of psoas at the level of the lumbar vertebrae to its insertion in the lesser trochanter on three-dimensional computed tomography datasets. Psoas muscle mass index (PMI) was calculated as psoas muscle volume/height (cm/m). According to the median value of PMIs (79.8 and 60.0 cm/m for men and women), the enrolled patients were divided into two groups. During the follow-up, 11 (31.4%) patients in low PMI group and 4 (11.1%) in high PMI group experienced major adverse cardiovascular events (MACE) defined as a composite of death from any cause, myocardial infarction, heart failure hospitalization, and stroke. The proportion of MACE-free survival was significantly lower in low PMI group (log-rank P = 0.033), mainly due to the difference of hospital readmission for congestive heart failure. On multivariate Cox proportional hazard analysis, PMI remained an independent negative predictor of MACE [hazard ratio 0.95 (95% confidence interval 0.92-0.98, P = 0.002)]. In conclusion, low skeletal muscle mass independently predicted MACE in patients undergoing TAVR.
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http://dx.doi.org/10.1007/s12928-020-00725-8DOI Listing
October 2021

Earliest pulmonary vein potential-guided cryoballoon ablation for atrial fibrillation.

Heart Vessels 2020 Feb 11;35(2):232-238. Epub 2019 Jul 11.

Department of Cardiology, Nagoya University Hospital, Nagoya, Japan.

No studies have evaluated both the time-to-isolation (TTI) and the sequence of pulmonary vein (PV) potentials in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study aimed to prospectively evaluate the acute results of pulmonary vein isolation (PVI) using a novel CBA technique-the earliest potential (EP) of PV-guided CBA-in paroxysmal AF. We pressed a balloon against the earliest PV potential site during PVI when TTI could not be achieved within 60 s (EP-guided CBA group). We compared 32 patients consecutively treated by EP-guided CBA to 32 patients treated without pressing the balloon against the EP site (conventional CBA group). The cryoapplication protocol was the same, except with regard to the pressing of the balloon. All 256 PVs (EP-guided CBA group, 128 PVs; conventional CBA group, 128 PVs) were isolated successfully. The TTI observation rate was similar in both groups. Compared with conventional CBA, EP-guided CBA was associated with a lower non-success rate of TTI ≤ 90 s (9% vs. 26%; P = 0.040) and shorter left atrial dwell time (38 ± 9 vs. 46 ± 19 min; P = 0.036), total procedure time (76 ± 15 vs. 87 ± 23 min; P = 0.043), and fluoroscopy time (23 ± 8 vs. 30 ± 11 min; P = 0.006). This novel EP-guided CBA approach may help facilitate the ablation procedure.
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http://dx.doi.org/10.1007/s00380-019-01471-5DOI Listing
February 2020

Vagal response in cryoballoon ablation of atrial fibrillation and autonomic nervous system: Utility of epicardial adipose tissue location.

J Arrhythm 2017 Aug 24;33(4):275-282. Epub 2017 Apr 24.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Mechanism and effects of vagal response (VR) during cryoballoon ablation procedure on the cardiac autonomic nervous system (ANS) are unclear. The present study aimed to evaluate the relationship between VR during cryoballoon catheter ablation for atrial fibrillation and ANS modulation by evaluating epicardial adipose tissue (EAT) locations and heart rate variability (HRV) analysis.

Methods: Forty-one patients with paroxysmal atrial fibrillation (11 with VR during the procedure and 30 without VR) who underwent second-generation cryoballoon ablation were included. EAT locations and changes in HRV parameters were compared between the VR and non-VR groups, using Holter monitoring before ablation, immediately after ablation and one month after ablation.

Results: The total EAT volume surrounding the left atrium (LA) in the VR and non-VR groups was 29.0±18.4 cm vs 27.7±19.7 cm, respectively (=0.847). The VR group exhibited greater EAT volume overlaying the LA-left superior pulmonary vein (PV) junction (6.1±3.6 cm vs 3.6±3.3 cm, =0.039) than the non-VR group. HRV parameters similarly changed following ablation in both the groups. EAT volume overlaying LA-right superior PV junction was significantly correlated with the relative changes in root-mean-square successive differences (=-0.317, =0.043) and high frequency (=-0.331, =0.034), immediately after the ablation.

Conclusions: Changes in HRV parameters following ablation were similarly observed in both the groups. EAT volume on the LA-PV junction is helpful for interpretation of VR occurrence and ANS modulation.
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http://dx.doi.org/10.1016/j.joa.2017.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529607PMC
August 2017

An ECG Index of P-Wave Force Predicts the Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation.

Pacing Clin Electrophysiol 2016 Nov 2;39(11):1191-1197. Epub 2016 Nov 2.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Although several prognostic factors of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) have been investigated, the accurate prediction of AF recurrence remains difficult. We propose an electrocardiogram (ECG) index, the P-wave force (PWF), which is the product of the amplitude of the negative terminal phase of the P wave in the V1 electrode and the filtered P-wave duration, obtained by a signal-averaged P-wave analysis. This study was conducted to evaluate the impact of the PWF on the recurrence of AF after PVI.

Methods: We retrospectively evaluated 79 paroxysmal AF patients (64 ± 9 years, 56 males) who underwent PVI by cryoballoon ablation. Standard 12-lead ECG and a P-wave signal-averaged electrocardiogram (SAECG) were recorded the day before and 1 month after the PVI procedure.

Results: During the mean follow-up of 10.2 months, AF recurred in 11 (14%) patients. The PWF 1 month after ablation was significantly higher in the recurrence group compared to that in the nonrecurrence group (8.8 ± 3.1 mVms vs 6.5 ± 2.9 mVms, P = 0.017). The patients with a PWF value ≥9.3 mVms had a significantly greater risk of recurrence after the ablation compared to the patients with a PWF value <9.3 mVms (log-rank test, P < 0.001).

Conclusion: Higher PWF after cryoballoon ablation was associated with poor prognosis during follow-up. The PWF may be a useful and noninvasive marker to predict the recurrence of AF.
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http://dx.doi.org/10.1111/pace.12956DOI Listing
November 2016

Impaired renal function is associated with recurrence after cryoballoon catheter ablation for paroxysmal atrial fibrillation: A potential effect of non-pulmonary vein foci.

J Cardiol 2017 01 5;69(1):3-10. Epub 2016 Aug 5.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related. The present study aimed to evaluate the association between estimated glomerular filtration rate (eGFR) and outcomes after cryoballoon catheter ablation for AF.

Methods: We included a total of 110 patients (64.0±10.1 years, 64% men) with paroxysmal AF who underwent second-generation cryoballoon catheter ablation in this study. Recurrence and change in renal function after ablation were assessed by stratification of eGFR sub-groups.

Results: During a mean follow-up period of 9 months, 20 (18%) patients had AF recurrence after the first catheter ablation procedure. Multivariate Cox regression analysis showed that eGFR [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.93-0.99, p=0.047], non-pulmonary vein (PV) ectopic beats at initial ablation (HR 2.92, 95% CI 1.03-8.27, p=0.043), and history of stroke (HR 7.47, 95% CI 2.30-24.2, p=0.001) were independent predictors of recurrence after the ablation. Among the CKD groups, recurrence was found in 7% (1/15), 12% (9/73), and 46% (10/22) of the eGFR ≥90mL/min/1.73m, eGFR 60-89.9mL/min/1.73m, and eGFR 30-59.9mL/min/1.73m groups, respectively (p=0.001). Kaplan-Meier survival curves demonstrated that patients with eGFR 30-59.9mL/min/1.73m had significantly worse prognosis than did the other groups (log-rank p<0.001). In addition, non-PV ectopic beats at initial ablation were detected in 7% (1/15), 14% (10/73), and 50% (11/22) of the patients among the three CKD groups, respectively (p<0.001). No patients developed contrast-induced nephropathy after the catheter ablation procedure.

Conclusions: Low eGFR at baseline was an independent predictor of recurrence after cryoballoon ablation for paroxysmal AF. The presence of non-PV ectopic beats was significantly increased in patients with impaired renal function, which might be associated with a poor outcome.
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http://dx.doi.org/10.1016/j.jjcc.2016.07.008DOI Listing
January 2017

Effect and Significance of Early Reablation for the Treatment of Early Recurrence of Atrial Fibrillation After Catheter Ablation.

Am J Cardiol 2016 09 29;118(6):833-841. Epub 2016 Jun 29.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

There are few reports on early reablation (ER) for early recurrence of atrial fibrillation (AF) after catheter ablation. The present study evaluated the efficacy and significance of ER for early recurrence within a blanking period of 3 months after ablation of both paroxysmal and persistent AF, using a propensity-matched analysis. Of 874 patients who underwent catheter ablation of AF, 389 (45%) had early recurrence. Of these, 78 patients underwent an ER procedure. A total of 132 matched patients (66 in the ER and 66 in the non-ER groups, 82 patients with paroxysmal AF) were included in the analysis. During a mean follow-up of 15.4 months, the patients who underwent ER had a significantly lower recurrence rate than those who did not (29 [44%] vs 42 patients [64%], p = 0.023). The benefit of ER was especially apparent in patients with paroxysmal AF (p = 0.008) but not in those with persistent AF (p = 0.774). However, 24 patients (36%) in the non-ER group did not experience recurrence after a blanking period without any reablation procedure. The total number of reablation sessions was higher in the ER group than in the non-ER group (1.2 ± 0.5 vs 0.4 ± 0.6, p <0.001). Nonetheless, mean number of arrhythmia outpatient clinic visits at follow-up was significantly fewer in the ER group than in the late reablation group. In conclusion, ER for early recurrence of AF after catheter ablation might be effective for preventing recurrence during follow-up, especially for paroxysmal AF.
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http://dx.doi.org/10.1016/j.amjcard.2016.06.045DOI Listing
September 2016

Elevated Red Blood Cell Distribution Width Predicts Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure - Comparison With Non-Heart Failure Patients.

Circ J 2016 26;80(3):627-38. Epub 2016 Jan 26.

Department of Cardiology, Nagoya University Graduate School of Medicine.

Background: Elevated red blood cell distribution width (RDW) predicts poor prognosis in patients with cardiovascular diseases. However, little is known about the association between RDW and outcomes after catheter ablation of atrial fibrillation (AF).

Methods and results: A total of 757 patients who underwent radiofrequency catheter ablation of AF were divided into heart failure (HF, n=79) and non-HF (n=678) groups; RDW was assessed as a predictor after catheter ablation in each. During a 22.3-month follow-up period, the baseline RDW in the HF group was greater in the recurrence group than in the non-recurrence group (14.5±2.0% vs. 13.5±0.9%, P=0.013). In contrast, no significant difference in RDW at baseline was found in the non-HF group between the recurrence and non-recurrence groups (13.3±0.8% vs. 13.2±0.8%, P=0.332, respectively). Multivariate analysis demonstrated that RDW (hazard ratio 1.20, 95% confidence interval 1.01-1.40, P=0.034) was an independent predictor of AF recurrence in the HF group. The cut-off values of RDW for the recurrence of AF and major adverse events in the HF group were 13.9% and 14.8%, respectively.

Conclusions: High RDW is an independent predictor for the recurrence of AF and major adverse events in patients with HF after catheter ablation. RDW is a potential noninvasive marker in AF patients complicated with HF. (Circ J 2016; 80: 627-638).
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http://dx.doi.org/10.1253/circj.CJ-15-1152DOI Listing
November 2016

Decrease in B-Type Natriuretic Peptide Levels and Successful Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure.

Pacing Clin Electrophysiol 2016 Mar 24;39(3):225-34. Epub 2015 Dec 24.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Little is known about the association between B-type natriuretic peptide (BNP) levels and catheter ablation of atrial fibrillation (AF) in patients with heart failure. This study aimed to examine the impact of elimination of AF by catheter ablation on BNP levels in patients with left ventricular systolic dysfunction.

Methods: Fifty-four AF patients with left ventricular ejection fraction (LVEF) ≤ 50%, who underwent radiofrequency catheter ablation therapy of AF, were included. BNP sampling was performed at baseline, 3 days, and 1 month after ablation.

Results: After a follow-up period of 6 months, the BNP levels decreased significantly in the nonrecurrence group (n = 35; median 126.3 [interquartile 57.2-206.5] pg/mL, 63.5 [23.9-180.2] pg/mL, and 45.9 [21.9-160.3] pg/mL, P < 0.001, respectively), but not in the recurrence group (n = 19; 144.7 [87.1-217.3] pg/mL, 88.8 [12.9-213.2] pg/mL, and 118.5 [51.6-298.2] pg/mL, P = 0.368, respectively). The patients in the nonrecurrence group had a higher percentage relative reduction in BNP levels from baseline to 1 month after ablation than those in the recurrence group (56.5 [-9.0-77.4]% vs -2.4 [-47.1-60.9]%, P = 0.027). Additionally, a relative reduction in BNP levels significantly correlated with an increase in LVEF after ablation (r = 0.486, P < 0.001).

Conclusions: Plasma BNP levels decreased significantly with successful catheter ablation of AF in patients with impaired LVEF. The decrease in BNP levels might be associated with early recovery of cardiac function and subsequent maintenance of sinus rhythm at follow-up.
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http://dx.doi.org/10.1111/pace.12788DOI Listing
March 2016

Body mass index is associated with prognosis in Japanese elderly patients with atrial fibrillation: an observational study from the outpatient clinic.

Heart Vessels 2016 Sep 26;31(9):1553-61. Epub 2015 Oct 26.

Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.

The relationship between body mass index (BMI) and the prognosis of elderly patients with atrial fibrillation (AF) is unknown. We aimed to examine the association of body weight with the clinical outcomes among Japanese elderly patients with a history of documented AF. This observational study of AF patients from an outpatients clinic in Nagoya University Hospital included 413 patients ≥70 years old (99 obese: BMI ≥25 kg/m(2); 256 normal weight: BMI 18.5-24.9 kg/m(2); and 58 underweight patients: BMI <18.5 kg/m(2)). The mean age was 77.5 ± 5.6 years. During a mean follow-up of 19.0 months, all-cause death occurred in 23 patients (obese 1 %, normal weight 5.1 %, and underweight 16 %). The major adverse events including all-cause death, stroke or transient ischemic attack, heart failure requiring admission, and acute coronary syndrome were observed in 53 patients (obese 5.1 %, normal weight 13 %, and underweight 26 %). After adjusting for confounding factors, the underweight group had a significantly greater risk for all-cause death [hazard ratio (HR) 2.91, 95 % confidence interval (CI) 1.12-7.60, p = 0.029], and major adverse events (HR 2.45, 95 % CI 1.25-4.78, p = 0.009) than the normal weight group. In contrast, the obese group had a better prognosis in major adverse events compared with the normal weight group (HR 0.34, 95 % CI 0.13-0.89, p = 0.029). In conclusion, lower BMI was independently associated with poor outcomes among older AF patients. The association between obesity and better prognosis in elderly AF patients was also found.
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http://dx.doi.org/10.1007/s00380-015-0765-yDOI Listing
September 2016

Impact of cardiac resynchronization therapy-defibrillator implantation on the association between body mass index and prognosis in patients with heart failure.

J Interv Card Electrophysiol 2015 Sep 24;43(3):269-77. Epub 2015 May 24.

Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.

Purpose: This study aimed to examine the association between body mass index (BMI) and prognosis in heart failure patients after cardiac resynchronization therapy-defibrillator (CRT-D) implantation.

Methods: We retrospectively investigated 125 patients (33 overweight [BMI ≥25 kg/m(2)], 75 normal weight [BMI 18.5-24.9 kg/m(2)], and 17 underweight patients [BMI <18.5 kg/m(2)]) who underwent CRT-D implantation. The clinical outcome endpoints were all-cause death and appropriate shock therapy.

Results: During the follow-up period (mean 3.1 ± 1.8 years), 23 patients died (1 [3.0 %] overweight, 17 [22.7 %] normal weight, and 5 [29.4 %] underweight patients), and appropriate shock events were observed in 14 patients (2 [6.1 %] overweight, 10 [13.3 %] normal weight, and 2 [11.8 %] underweight patients). All patients survived shock therapy. After adjusting for confounding factors, overweight patients had significantly fewer outcomes relating to all-cause death and appropriate shock events (hazard ratio 0.27, 95 % confidence interval 0.08-0.91, p = 0.034) than normal weight patients. However, the prognostic difference between overweight and normal weight patients could be diminished as a result of the successful shock therapies (p = 0.067). Additionally, prognosis did not differ between overweight and normal weight patients among the responders, but did differ among the non-responders. The underweight patients had a poorer prognosis after CRT-D implantation compared with the other groups.

Conclusions: Although high BMI was associated with better outcomes among heart failure patients with CRT-D implantations, the difference in the prognosis between overweight and normal weight patients was reduced because of defibrillator therapy and the improvement in cardiac function provided by CRT-D implantation.
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http://dx.doi.org/10.1007/s10840-015-0015-3DOI Listing
September 2015

Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation.

Heart Rhythm 2015 Sep 13;12(9):1972-8. Epub 2015 Apr 13.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Close monitoring of intraoperative activated clotting time (ACT) is crucial to prevent complications during the periprocedural period of atrial fibrillation (AF) ablation. However, little is known about the ACT in patients receiving new oral anticoagulant agents (NOACs).

Objective: The purpose of this study was to evaluate change in the ACT among anticoagulant agents used during the periprocedural period of AF ablation.

Methods: We examined 869 consecutive patients who underwent AF ablation between April 2012 and August 2014 and received NOACs (n = 499), including dabigatran, rivaroxaban, and apixaban, or warfarin (n = 370) for uninterrupted periprocedural anticoagulation. Changes in intraprocedural ACT were investigated among the anticoagulant agents. Furthermore, the incidence of periprocedural events was estimated.

Results: The average time in minutes required for achieving a target ACT >300 seconds was significantly longer in the dabigatran group (DG) and apixaban group (AG) than in the warfarin group (WG) and rivaroxaban group (RG) (60 and 70 minutes vs 8 and 9 minutes, respectively; P < .001). In addition, the proportion of patients who achieved the target ACT after initial heparin bolus was significantly lower in the DG and AG than in the WG and RG (36% and 26% vs 84% and 78%, respectively; P < .001). Furthermore, the incidence of periprocedural complications was equivalent among the groups.

Conclusion: The average time required to reach the target ACT was longer in the DG and AG than in the WG and RG.
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http://dx.doi.org/10.1016/j.hrthm.2015.04.016DOI Listing
September 2015
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