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  • Ovid Technologies (Wolters Kluwer Health)  (37)
  • 1
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    Complications Associated With Catheter Ablation in Patients With Atrial Fibrillation: A Report From the JROAD‐DPC Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Heart Association Vol. 10, No. 11 ( 2021-06)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 11 ( 2021-06)
    Abstract: Aging is one of the major concerns and determinants of the indications for catheter ablation (CA) for atrial fibrillation. This study aimed to assess the safety of CA in older patients with atrial fibrillation undergoing CA. Methods and Results The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases‐Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 6 632 484 records found between April 2012 and March 2018 from 1058 hospitals, 135 299 patients with atrial fibrillation (aged 65±10 years, 38 952 women) who underwent CA in 456 hospitals were studied and divided into the following age groups: 〈 60, 60 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥85 years. The overall in‐hospital complication rate was 3.4% (cardiac tamponade 1.2%), and in‐hospital mortality was 0.04%. Older patients had a higher prevalence of women, lower body mass index, and a higher burden of comorbidities such as hypertension, and all of those characteristics were predictors for complications in multivariate analysis. A multivariate adjusted odds ratio revealed that increased age was independently and significantly associated with overall complications (60–64 years, 1.19; 65–69 years, 1.29; 70–74 years, 1.57; 75–79 years, 1.63; 80–84 years, 1.90; and ≥85 years, 2.86; the reference was 〈 60 years). Conclusions The nationwide JROAD‐DPC database demonstrated that the frequency of complications following CA in patients with atrial fibrillation increased according to age.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.120.019701
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 4 ( 2018-02-20)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 4 ( 2018-02-20)
    Abstract: Previously described patients with early repolarization syndrome ( ERS ) may have experienced silent coronary artery spasm ( CAS ) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [ VF ] and inferolateral J wave). Methods and Results The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS , 5 (38%) did not experience chest symptoms before and during VF , and were diagnosed as having silent CAS . The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF . Conclusions Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF , and could have been misdiagnosed as having ERS . The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.117.007942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 3
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    Abstract 6171: High-dose Epoprostenol Therapy Reverses Pulmonary Hypertension by Inducing Pulmonary Artery Smooth Muscle Cell Apoptosis in Patients with Idiopathic Pulmonary Arterial Hypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background: Intravenous epoprostenol has been shown to improve long-term survival in patients with idiopathic pulmonary arterial hypertension (IPAH). Although most experts believe that the appropriate dose range of epoprostenol is between 25 and 40 ng/kg/min, the optimal dose has not been determined. In the present study, we investigated the hemodynamic change induced by high-dose epoprostenol therapy in IPAH patients, and we determined by experiments the reason why high-dose epoprostenol improves hemodynamics. Methods: We evaluated hemodynamics in 16 IPAH patients (11 females and 5 males, mean epoprostenol dosage was 100.7±35.4 ng/kg/min) treated with high-dose epoprostenol. Lung tissues obtained from 2 IPAH patients and one non-PAH patient were assessed by terminal dUTP nick end-labeling (TUNEL) assays. We examined the induction of apoptosis by epoprostenol in cultured PAH-pulmonary artery smooth muscle cells (PASMCs) and non-PAH-PASMCs. To assess the apoptosis in cultured PASMCs, we performed TUNEL assay, caspase-3,-7 assays and transmission electron microscopy. We also examined the expression of survivin by immunocytochemical analysis. Results: Compared with the baseline state, there were significant reductions in mean pulmonary artery pressure (26%) and pulmonary vascular resistance (66%). Hemodynamic improvements in the present study were superior to those in previous studies. Apoptotic cells were detected in lung tissues obtained from IPAH patients treated with high-dose epoprostenol. TUNEL-positive and caspase-3,-7-active cells were observed in cultured PAH-PASMCs treated with epoprostenol at a high concentration. Condensation of chromatin along the nuclear membrane and fragmentation of the nucleus were observed by transmission electron microscopy. Epoprostenol at a high concentration significantly induced apoptosis in cultured PAH-PASMCs compared with that in non-PAH-PASMCs (7.69% versus 1.92%; P 〈 0.01). Immunocytochemical analysis revealed that epoprostenol suppressed expression of survivin in cultured PAH-PASMCs. Conclusions: The results of the present study showed that high-dose epoprostenol therapy reverses pulmonary hypertension by induction of PASMCs apoptosis.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_1074-b
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 4
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    Abstract 10183: Structural Characteristics of Patients With Superior Vena Cava Foci Initiating Atrial Fibrillation: Analysis With Electrocardiogram-Triggered Computed Tomography
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: The superior vena cava is the most common source of non-pulmonary vein foci in atrial fibrillation. Hypothesis: Predicting the existence of non-pulmonary vein foci prior to the catheter ablation procedure is helpful because recent one-shot ablation technologies are designed to isolate only the pulmonary veins. We aimed to clarify the structural characteristics of patients with superior vena cava foci initiating atrial fibrillation. Methods: We enrolled 331 consecutive patients with atrial fibrillation who underwent computed tomography cardiac imaging before radiofrequency catheter ablation treatment. The patients were divided into superior vena cava (+) and (-) groups according to having superior vena cava foci or not. The characteristics of 27 patients per group, identified with propensity score matching, were compared. Results: The superior vena cava (+) group exhibited superior vena cava crescent signs, defined as a curve-shaped superior vena cava with two narrow pointed ends, more frequently (40.7% vs. 7.4%, p =0.004), and a right atrial volume larger than the superior vena cava (-) group (95.6 ± 20.8 vs. 83.5 ± 18.7 mL, p =0.030). Multivariate logistic regression analysis revealed that the superior vena cava crescent sign (odds ratio, 8.45; 95% confidence interval, 1.52-46.99) and right atrial volume ≥ 80 mL (odds ratio, 4.66; 95% confidence interval, 1.22-17.79) were independent predictors of superior vena cava foci. Conclusions: Patients with superior vena cava foci exhibited more frequent superior vena cava crescent signs and larger right atrial volumes. These characteristics may help clinicians choose the appropriate ablation technology.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.10183
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 5
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    Abstract 11668: High Resolution Magnetocardiography as a Novel Noninvasive Tool to Distinguish Between Benign and Malignant Early Repolarization Pattern
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Most of the early repolarization patterns (ERP) in electrocardiography (ECG) are benign but some of them are associated with ventricular fibrillation (VF). We evaluated whether or not a high spatio-temporal resolution magnetocardiography (MCG) could non-invasively detect malignant types of ERP. Methods: Sixty four-channel MCG, standard 12-lead ECG, and signal averaged ECG (SAECG) were recorded in 120 patients with inferolateral ERP in ECG without any major structural heart diseases; 13 of them had a history of VF (VF(+)-group) and the remaining 107 had no VF (VF(-)-group). We evaluated the following novel MCG indexes: MCG-QRS (msec), root mean square of terminal 40 msec magnetic field (MCG-RMS) (msec), and the duration under 10% of maximal amplitude (MCG-LAS) (msec) of the highest amplitude channel. Results: The amplitude and distribution of the J-wave, ST-T morphology in ECG, parameters of SAECG were not significantly different, whereas MCG-QRS and MCG-LAS were significantly longer and MCG-RMS was smaller in ERP-VF(+) compared with ERP-VF(-) group (107(SD=24) vs 84(13) msec, P 〈 0.01, 8(22) vs 22(11) msec, P 〈 0.01, 0.10(0.08) vs 0.28(0.19) msec, P 〈 0.01, respectively). In the multivariate logistic regression model, only MCG-QRS remained significant among the MCG indexes and the existing predictors (odds ratio (OR) 1.08, 95%CI 1.01 to1.17). The predictive ability of VF was significantly higher using MCG-QRS when the c-statistic was compared with that of the existing ECG measure (0.82 vs 0.56, P 〈 0.01, Figure). When cut-offs were set by the least squares method at MCG-QRS 100 msec, MCG-RMS 0.24 msec, MCG-LAS 27 msec, corresponding ORs were calculated as 12.7, 95%CI 3.6 to 45.0, 6.1, 95%CI 1.7 to 21.2, 6.2, 95%CI 1.8 to 20.8, respectively. Conclusions: MCG-QRS 〉 100 msec was a simple and effective criterion for prediction of high risk ERP subjects, thus MCG analysis is an useful screening tool to detect malignant ERP out of the numerous benign ones.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.11668
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 6
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    Abstract 659: Simvastatin Inhibits Proliferation and Migration of Pulmonary Artery Smooth Muscle Cells from Patients with Idiopathic Pulmonary Arterial Hypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Background: Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disease characterized by inappropriate increase of pulmonary artery smooth muscle cells (PASMCs) leading to occlusion of pulmonary arterioles and causing pulmonary hypertension. In this study, we assessed the inhibitory effects of simvastatin, an HMG-CoA reductase inhibitor, on proliferation and migration of PASMCs obtained from patients with IPAH. Methods and Results: PASMCs were obtained from 6 patients with IPAH who underwent lung transplantation, and PASMCs were obtained as control cells from 6 patients with bronchogenic carcinoma who underwent lung lobectomy. Platelet-derived growth factor (PDGF) (10 ng/mL) stimulation caused a significantly higher growth rate of PASMCs from patients with IPAH than that of control cells assessed by 3 H-thymidine incorporation ( P 〈 0.05). Simvastatin at 0.1 Â113 〉 mol/L significantly inhibited PDGF-induced cell proliferation of PASMCs from IPAH patients but did not inhibit proliferation of control cells at the same concentration. Simvastatin at 1 Â113 〉 mol/L also inhibited PDGF-induced migration of PASMCs from IPAH patients assessed by a transwell migration assay ( P 〈 0.05). Immunofluorescence staining revealed that simvastatin at 1 Â113 〉 mol/L inhibited translocation of Rho A from the cytoplasm to membrane and disorganized actin fibers in PASMCs from IPAH patients. Conclusions: Simvastatin had an inhibitory effect on the inappropriate proliferation and migration of PASMCs from IPAH patients. Simvastatin may be useful for treatment of patients with IPAH.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_122
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
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  • 7
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    Sex‐Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 18 ( 2018-09-18)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 18 ( 2018-09-18)
    Abstract: Brugada syndrome ( BS ) is known to be 9 times more prevalent in males than females. However, little is known about the development of sick sinus syndrome in female members with familial BS . Methods and Results Familial BS patients and family members, both from our institutions and collaborating sites that specialize in clinical care of BS , participated in this study. We collected information on their clinical and genetic background, along with the inheritance patterns of BS . Detailed information on each case with familial BS is described. A total of 7 families, including 25 BS patients (12 females and 13 males), were included. Seven were probands and 18 were family members. Ten out of the 12 female patients and none of the 13 male patients developed sick sinus syndrome. Sudden death or spontaneous ventricular fibrillation occurred in 7 out of 13 male patients and 2 out of 12 female patients. Conclusions Familial BS existed in which female patients developed sick sinus syndrome but male patients did not. Some of those female patients with sick sinus syndrome had unrecognized BS . Information should be collected not only regarding a family history of sudden death or BS , but also whether a pacemaker was implanted in female members.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.009387
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 8
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    Systematic Evaluation of KCNQ1 Variant Using ACMG/AMP Guidelines and Risk Stratification in Long QT Syndrome Type 1
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation: Genomic and Precision Medicine , No. 1 ( 2020-09)
    Details
    In: Circulation: Genomic and Precision Medicine, Ovid Technologies (Wolters Kluwer Health), , No. 1 ( 2020-09)
    Abstract: Background - Mutation/variant-site specific risk stratification in long-QT syndrome type 1 (LQT1) has been well investigated, but it is still challenging to adapt current enormous genomic information to clinical aspects caused by each mutation/variant. We assessed a novel variant-specific risk stratification in LQT1 patients. Methods - We classified a pathogenicity of 141 KCNQ1 variants among 927 LQT1 patients (536 probands) based on the American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP) guidelines and evaluated whether the ACMG/AMP-based classification was associated with arrhythmic risk in LQT1 patients. Results - Among 141 KCNQ1 variants, 61 (43.3%), 55 (39.0%), and 25 (17.7%) variants were classified into pathogenic (P), likely pathogenic (LP), and variant of unknown significance (VUS), respectively. Multivariable analysis showed that proband (HR = 2.53; 95%CI = 1.94-3.32; p 〈 0.0001), longer QTc (≥500ms) (HR = 1.44; 95%CI = 1.13-1.83; p = 0.004), variants at membrane spanning (MS) (vs. those at N/C terminus) (HR = 1.42; 95%CI = 1.08-1.88; p = 0.01), C-loop (vs. N/C terminus) (HR = 1.52; 95%CI = 1.06-2.16; p = 0.02), and P variants [(vs. LP) (HR = 1.72; 95%CI = 1.32-2.26; p 〈 0.0001), (vs. VUS) (HR = 1.81; 95%CI = 1.15-2.99; p = 0.009)] were significantly associated with syncopal events. The ACMG/AMP-based KCNQ1 evaluation was useful for risk stratification not only in family members but also in probands. A clinical score (0~4) based on proband, QTc (≥500ms), variant location (MS or C-loop) and P variant by ACMG/AMP guidelines allowed identification of patients more likely to have arrhythmic events. Conclusions - Comprehensive evaluation of clinical findings and pathogenicity of KCNQ1 variants based on the ACMG/AMP-based evaluation may stratify arrhythmic risk of congenital long-QT syndrome type 1.
    Type of Medium: Online Resource
    ISSN: 2574-8300 , 2574-8300
    URL: Article
    DOI: 10.1161/CIRCGEN.120.002926
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Multicenter Study of the Validity of Additional Freeze Cycles for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation : The AD-Balloon Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 12, No. 1 ( 2019-01)
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 1 ( 2019-01)
    Abstract: Pulmonary vein isolation (PVI) is a cornerstone of catheter ablation in patients with paroxysmal atrial fibrillation, and balloon-based ablation has been recently performed worldwide. The second-generation cryoballoon (CB2) ablation has proven to be highly effective in achieving freedom from paroxysmal atrial fibrillation. However, there are some debatable questions, including the ideal number of freeze cycles. Methods: The AD-Balloon study (Multicenter Study of the Validity of Additional Freeze Cycles for Cryoballoon Ablation) was designed as a prospective, multicenter, and randomized clinical trial for investigation of the optimal strategy of freeze cycles for the CB2 ablation. One hundred and ten consecutive patients (aged 64±11 years) were randomly assigned to 2 groups after achieving a PVI by the CB2 ablation: 3-minute freeze cycles were added to each pulmonary vein (AD group: n=55) or not (non-AD group: n=55). Delayed-enhancement magnetic resonance imaging was also performed 1 to 2 months after the PVI to assess the ablation lesions. Results: The patient characteristics did not differ between the 2 groups. A complete PVI was achieved in all patients. The total number of freeze cycles and durations for all pulmonary veins were significantly shorter in the non-AD group than in the AD group (5.7±1.6 versus 9.1±1.6 cycles, P 〈 0.0001, and 932±244 versus 1483±252 seconds, P 〈 0.0001). The cumulative freedom from any atrial tachyarrhythmia at 1 year was 87.3% in the AD group and 89.1% in the non-AD group (log-rank test P =0.78). There was no significant difference in the frequency of gaps on the PVI lines in the delayed-enhancement magnetic resonance imaging (46% in the AD group versus 36% in the non-AD group; P =0.38). Conclusions: No benefit was found in the patients receiving additional 3-minute freeze cycles after the complete PVI with the CB2 ablation, suggesting that an insurance freeze after achieving a PVI with the CB2 may be unnecessary and time consuming.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.118.006989
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 10
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    Low‐Voltage Type 1 ECG Is Associated With Fatal Ventricular Tachyarrhythmia in Brugada Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 21 ( 2018-11-06)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 21 ( 2018-11-06)
    Abstract: Epicardial mapping can reveal low‐voltage areas on the right ventricular outflow tract in patients with Brugada syndrome with several ventricular fibrillation ( VF ) episodes. A type 1 ECG is associated with an abnormal electrogram on right ventricular outflow tract epicardium. This study investigated the clinical significance of the amplitude of type 1 ECGs in patients with Brugada syndrome. Methods and Results In 209 patients with Brugada syndrome with a spontaneous type 1 ECG (26 resuscitated from VF , 54 with syncope, and 129 asymptomatic), the amplitude of the ECG in leads exhibiting type 1 was measured among V1 to V3 leads positioned in the standard and upper 1 and 2 intercostal spaces. The number of ECG leads exhibiting type 1 did not differ among groups. The averaged amplitude of type 1 ECG was, however, significantly smaller in the group resuscitated from VF than in the asymptomatic group ( P 〈 0.05). Moreover, the minimum amplitude of type 1 ECG was significantly smaller in the group resuscitated from VF than in the group with syncope and the asymptomatic group ( P 〈 0.05 and P 〈 0.01, respectively). During follow‐up (56±48 months), VF occurred in 29 patients. Kaplan‐Meier analysis revealed that patients with the minimum amplitude of type 1 ECG lower than or at the median value had a higher incidence of VF (log‐rank test, P 〈 0.01). In multivariate analysis, syncope, past VF episode, and minimum amplitude of type 1 ECG ≤0.8 mV were independent predictors of VF events during follow‐up. Conclusions Low‐voltage type 1 ECG is highly and independently related to fatal ventricular tachyarrhythmia in patients with Brugada syndrome.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.009713
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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