Many cardiovascular diseases including atherosclerotic ischemic heart diseases, chronic heart failure, and cerebrovascular disorders are associated with chronic and acute inflammatory activation.1, 2 In mechanisms of developing arrhythmias, inflammation has recently been reported as one of the important pathogenic factors. In this important and a novel finding has also been recognized as the mechanism of rhythm disturbance complicated with COVID-19 infection.3 Especially, Interleukin-6 has been focused because of possible influence to gap junction of connexin 40 or 43 which is important for the maintenance of normal heart rhythms.4, 5 In current issue of this journal, Accioli et al.1 reported the important role of Interleukin-6 of COVID-19 infection. The study is for the first time conducting prospective study on the role of Interleukin-6 for developing atrioventricular conduction disturbance, even if the numbers of study population was small of 33 patients. Since development of heart rhythm disturbance in patients of COVID-19 is sign for untoward outcome of COVID-19, clarifying the mechanism of atrioventricular conduction disturbance and founding Interleukin-6 possibly become treatment target is very important for treatment of long COVID-19 and severe COVID-19 patients. In this aspect, Accioli et al.'s findings should be confirmed in larger cohort.
Besides, COVID-19 infection, Interleukin-6 levels could be related with pathogenesis of HFpEF patients2 or other cardiovascular disorders so that Accioli et al. study could be incentive for further advance in the research of the role of Interleukin-6 in the field of arrhythmia disease other than atrioventricular conduction disturbance.
Authors declare no conflict of interests for this article.
Five ASQ extraction cases from our hospital were showed in this list. All leads were completely removed and there were no serious complications. Laser sheaths were used in four of the five cases. In cases 2 and 4, LV leads were successfully reimplanted after the removal of the ASQ, and the original target branches where the ASQ had been implanted remained patent.
Causes of paradoxical response include Pure His capture and inadvertent intermittent direct atrial capture. In the index case , we postulate that the likely mechanism of paradoxical prolongation could be due to decrement in the AV node due to the shortening of HH interval which happened as a result of a narrower H + Vc beat following a wider Vc beat during decremetal pacing output.
CARTONET® enables automatic ablation site classification and reconnection site prediction using machine learning. However, the accuracy of the site classification model and trends of the site prediction model for potential reconnection sites are uncertain.
We studied a total of 396 cases. About 313 patients underwent pulmonary vein isolation (PVI), including a cavotricuspid isthmus (CTI) ablation (PVI group) and 83 underwent PVI and additional ablation (i.e., box isolation) (PVI+ group). We investigated the sensitivity and positive predictive value (PPV) for automatic site classification in the total cohort and compared these metrics for PV lesions versus non-PV lesions. The distribution of potential reconnection sites and confidence level for each site was also investigated.
A total of 29,422 points were analyzed (PV lesions [n = 22 418], non-PV lesions [n = 7004]). The sensitivity and PPV of the total cohort were 71.4% and 84.6%, respectively. The sensitivity and PPV of PV lesions were significantly higher than those of non-PV lesions (PV lesions vs. non-PV lesions, %; sensitivity, 75.3 vs. 67.5, p < .05; PPV, 91.2 vs. 67.9, p < .05). CTI and superior vena cava could not be recognized or analyzed. In the potential reconnection prediction model, the incidence of potential reconnections was highest in the posterior, while the confidence was the highest in the roof.
The automatic site classification of the CARTONET®R12.1 model demonstrates relatively high accuracy in pulmonary veins excluding the carina. The prediction of potential reconnection sites feature tends to anticipate areas with poor catheter stability as reconnection sites.
Various surgical procedures have employed microporous polysaccharide hemosphere (MPH) hemostatic agents. However, data regarding their effectiveness in preventing pocket hematomas (PHs) during the implantation of cardiac implantable electronic devices (CIED) among the Asian population are limited. Therefore, this study aimed to investigate the potential benefits of using MPH hemostatic agents during CIED implantations as a preventive measure against post-procedural PHs.
We conducted a retrospective, single-center, observational study involving 255 consecutive Japanese patients who underwent CIED implantation between November 2017 and April 2021. We compared PH occurrences within 28 days after CIED implantation between patients who received MPH hemostatic agents (n = 145) and those who did not (n = 110).
PH development was observed in nine (6.2%) patients who received MPH hemostatic agents and in 13 (11.8%) patients without MPH hemostatic (p = .111). Kaplan–Meier analysis of PH development revealed no significant difference between the two groups (log-rank p = .102). However, utilizing MPH hemostatic agents among patients taking antithrombotic drugs, including antiplatelet medications, direct oral anticoagulants, and warfarin, significantly reduced PH incidence (log-rank p = .03). The multivariate Cox proportional hazards model demonstrated that MPH hemostatic agent utilization independently correlated with a decreased PH risk (hazard ratio 0.22, 95% confidence interval 0.08–0.63, p = .004).
The findings of this study suggest that the incorporation of MPH hemostatic agents into standard practice may benefit to mitigate PH risk during CIED implantations in patients on antithrombotic therapy. This simple and practical measure may be valuable, especially in high-risk patients, such as those taking antithrombotic medications.
Patients with atrial fibrillation (AF) often develop acute coronary syndrome and undergo percutaneous coronary intervention (PCI), and vice versa. Acute coronary syndrome and PCI mandate the use of dual antiplatelet therapy, while oral anticoagulation is recommended in patients with AF to mitigate thromboembolic risks. Clinical evidence concerning antithrombotic treatment in patients with AF and PCI has been accumulated, but when combined, the therapeutic strategy becomes complex. Although triple therapy, a combination of oral anticoagulation with dual antiplatelet therapy, has been used for patients with AF undergoing PCI as an initial antithrombotic strategy, less intensive regimens may be associated with a lower rate of bleeding without an increased risk in thrombotic events. This narrative review article summarizes currently available evidence of antithrombotic therapy in patients with AF undergoing PCI.
This atypical atrial resetting with ventricular extrastimulus delivered during supraventricular tachycardia is characterized by no capture of local ventricular deflection contralateral to the earliest atrial site and is a finding unmasking the presence of a nodoventricular pathway, the ventricular insertion of which is located apically, away from the mitral annulus.
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