Hideyuki Kishima

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity

BACKGROUND The shape of the left atrial appendage (LAA) might affect thrombus formation. The chicken wing-type LAA (CW) has been reported as unlikely to influence stroke events in atrial fibrillation (AF) patients, so we investigated whether LAA shapes could influence LAA function. METHODS AND RESULTS We studied 102 patients (64 men, age 65±9 years) who underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac computed tomography prior to catheter ablation (CA) for AF. LAA morphology were classified into 2 types: (1) CW: LAA with a bend in its shape and (2) non-CW type (NCW): LAA without any bends. All patients were classified into these groups using a cutoff value of LAA flow velocity (LAAFV). Patients with LAAFV <35 cm/s were classified as the low LAAFV group (Low FV, n=37). The patients with LAAFV >35 cm/s were classified as normal LAAFV group (Normal FV, n=65). The NCW type was detected in 25/102 patients (25%). In multivariate analysis, the patients with Low FV were associated with NCW type (P=0.0429, odds ratio [OR] 9.664, 95% confidence interval [CI] 1.075-86.900) and higher B-type natriuretic peptide (BNP) (P=0.0350, OR 1.012 for each 1 pg/ml increase in BNP, 95% CI 1.001-1.022). CONCLUSIONS The NCW-type LAA and higher BNP were associated with lower LAAFV. One reason for the frequent cardiogenic stroke in patients with the NCW-type LAA may be the lower LAAFV.

The impact of elevated left atrial pressure in sinus rhythm after cardioversion on outcomes after catheter ablation for atrial fibrillation

Some patients with atrial fibrillation (AF) exhibit elevated left atrial pressure (LAP) in sinus rhythm (SR). The aim of the study was to investigate whether LAP changes between SR and AF are associated with outcomes after catheter ablation (CA) for AF.

Morphologic remodeling of left atrial appendage in patients with atrial fibrillation

BACKGROUND Left atrial appendage (LAA) has recently been of significant focus because of the development of the LAA closure device. OBJECTIVE The purpose of this study was to test the hypothesis that atrial fibrillation (AF) leads to a morphologic change in the LAA and to investigate the characteristics of LAA morphology in patients with and without AF. METHODS This retrospective study included 225 patients (persistent AF [PeAF], n = 76; paroxysmal AF [PAF], n = 70; control, n = 79] who underwent echocardiography and computed tomography (CT). All patients were classified into 2 types (chicken wing [CW] or non-chicken wing [non-CW]) using CT. RESULTS The prevalence of non-CW-type LAA was 39.5%, 15.7%, and 8.9% in the PeAF, PAF, and control groups, respectively. Patients in the PeAF group had a higher prevalence of non-CW-type LAA than did those in the PAF and control groups (P = .0014 and P <.0001, respectively). In addition, all patients were divided into 5 groups based on the type of cardiac rhythm (PeAF, PAF, or sinus rhythm) and left atrial volume index (cutoff value; 34 mL/m(2)): group A (Control), group B (PAF/Small-LA), group C (PAF/Large-LA), group D (PeAF/Small-LA), group E (PeAF/Large-LA). The prevalence of non-CW-type LAA was 9%, 14%, 17%, 29%, and 41% in groups A, B, C, D, and E, respectively. CONCLUSION Presence of persistent AF was associated with a higher prevalence of non-chicken wing-type LAA. Our analysis suggests that remodeling in patients with persistent AF can lead to a change in LAA morphology.

The Impact of Transforming Growth Factor‐β1 Level on Outcome After Catheter Ablation in Patients With Atrial Fibrillation

Transforming growth factor‐β1 (TGF‐β1) is an important factor that induces atrial fibrosis and atrial fibrillation (AF). The purpose of this study was to evaluate the association between TGF‐β1 level and clinical factors before catheter ablation (CA), and to investigate the impact of TGF‐β1 level on the outcome after CA for AF.

Spontaneous subclavian venous occlusion before electronic device implantation

Background Subclavian venous occlusion sometimes precludes the ability to insert leads during placement of a cardiac implantable electronic device. This study was performed to identify the risk factors for spontaneous subclavian venous occlusion prior to placement of an implantable electronic device. Methods We studied 446 patients who underwent axillary-subclavian venography to assess for occlusion and/or anomaly of the subclavian vein or associated veins before electronic device implantation. Results Six (1.3%) patients had venous occlusion (left subclavian vein in 5, left innominate vein in 1). There was a significantly higher incidence of previous cancer in the occlusion group than in the nonocclusion group (11.5% vs. 50%, p = 0.03). Conclusions Subclavian venous occlusion may be present before cardiac implantable electronic device placement. A history of cancer represents a risk factor subclavian venous occlusion, and patients with this risk factor should undergo subclavian venography prior to electronic device placement.

Left ventricular systolic dysfunction in a patient with accidental hypothermia: a case report

IntroductionHypothermia is a relatively rare condition, and the effects of unintentional hypothermia on the heart are not known.Case presentationThis report describes the case of an 88-year-old Japanese man found in a coma and presenting with heart failure associated with hypothermia. He experienced sinus arrest, junctional rhythm and left ventricular systolic dysfunction with prolonged ejection time. With rewarming and treatment of his heart failure, he completely recovered over a period of two weeks.ConclusionProlonged ejection time might be a characteristic finding in hypothermia.

Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation

Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF.

PREDICTORS OF LEFT ATRIAL THROMBI AND SPONTANEOUS ECHOCARDIOGRAPHY CONTRAST IN PATIENTS WITH ATRIAL FIBRILLATION TAKING NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS

Some patients develop left atrial thrombi (LAT) despite administration of anticoagulants. Non-vitamin K antagonist oral anticoagulants (NOAC) have been reported to be useful for prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). We aimed to clarify the characteristics of

LEFT ATRIAL APPENDAGE MORPHOLOGY INFLUENCES FLOW VELOCITY

Patients with chickenwing (CW) -like left atrial appendage (LAA) morphology have been reported to be less likely to have stroke events in patients with atrial fibrillation (AF). Differences in the LAA morphology might affect thrombus formation both morphologically and functionally. We investigated

Hemodynamic effects of Purkinje potential pacing in the left ventricular endocardium in patients with advanced heart failure.

Various difficulties can occur in patients who undergo cardiac resynchronization therapy for drug‐refractory heart failure with respect to placement of the left ventricular (LV) lead, because of anatomical features, pacing thresholds, twitching, or pacing lead anchoring, possibly requiring other pacing sites. The goal of this study was to determine whether Purkinje potential (PP) pacing could provide better hemodynamics in patients with left bundle branch block and heart failure than biventricular (BiV) pacing.