br Conflict of interest br Introduction Patients with struct
Conflict of interest
Introduction Patients with structural heart disease have an increased risk of sudden cardiac death, secondary to ventricular tachyarrhythmias in most cases. Implantable cardioverter–defibrillators (ICDs) are the treatment of choice. However, ventricular tachyarrhythmias cannot be prevented by ICD itself. Moreover, ICD shocks reduce quality of life, and episodes of ventricular tachycardia (VT) predict an increased risk of death and heart failure despite effective treatment with ICD [1–3]. Catheter ablation has been proven to be an effective choice of treatment for VT and may be indicated for some patients as either a primary therapy or an adjunct to an ICD implantation. Although VT ablation is feasible, multiple morphologies of VT, hemodynamic instability, and non-inducibility limit the success of VT ablation. Recently, ablation of unmappable VTs has become feasible by mapping during sinus rhythm and with ache inhibitors applications targeting delayed potentials or by creating ablation lesions using a three-dimensional (3D) mapping system .
Materials and methods
Conflict of interest
Introduction Catheter ablation has become a potent and feasible therapy for atrial fibrillation (AF). Many clinical studies [1–3] have confirmed the safety, mid-term and long-term effectiveness, and cost-effectiveness of this procedure. However, as technological and technical innovations are continuously being introduced into practice, constant effort is necessary to confirm whether catheter ablation, now carried out worldwide, is performed in accordance with international standards . The Japanese Heart Rhythm Society (JHRS) conducted a nationwide registry of patients who underwent catheter ablation for AF: the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF) [5,6]. Many studies have supported the view that uninterrupted warfarin therapy is superior to interrupted anticoagulation therapy with respect to intra- and post-procedural thromboembolic and bleeding events [7–10]. Additionally, several recent studies have suggested that novel oral anticoagulants (NOACs) could be used a substitute for warfarin to maintain anticoagulant management during AF ablation [11–15]. In this study, we focused on the use of NOACs and warfarin. The aim of this analysis was to assess the safety and feasibility of the use of NOACs as a periprocedural anticoagulant.
Methods The method of this survey has been reported previously . In short, the survey was performed retrospectively using an online questionnaire. JHRS members were notified by e-mail, and data relating to patient background, methods of pulmonary vein isolation and related techniques, complications, and pre- and post-procedural pharmacological treatments were collected for AF ablation sessions performed in September 2011, May 2012, and September 2012. Patient data included age, gender, previous AF ablation, AF type (paroxysmal [PAF], persistent, or long-standing [LS] persistent), thromboembolism risk factors, and echocardiographic parameters. When warfarin or a NOAC was intentionally continued on the day of, or until the day before, the index AF ablation was performed, warfarin or a NOAC was considered to have been used periprocedurally. The continuous variables with a normal distribution were expressed as mean±SD. Comparison of the continuous variables among three study groups was performed by one-way analysis of variance with a post hoc Bonferroni test. Categorical variables were compared using Tukey׳s test. A p<0.05 was considered statistically significant.
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Introduction Para-Hisian pacing (PHP) is useful for making the distinction between retrograde conduction over an accessory pathway (AP) versus over the atrioventricular (AV) node through the measurement of differences in the timing and sequence of retrograde atrial activation depending on whether the His bundle (HB) is captured or not [1–3]. Retrograde activation during PHP is measured as the interval between the pacing stimulus and (a) the earliest atrial electrogram (S–A interval) and (b) the ventriculoatrial (V–A) interval [1–3]. While some existing case reports have described the pitfalls of this technique [4–10], its potential inability to discriminate between retrograde AV nodal and septal AP conduction has not been discussed. The purpose of this study was to clarify this point, with a focus on the limitation of the measurement of the V–A interval from the proximal coronary sinus (CS).