Deep Sedation with Intravenous Anesthesia Is Associated with Outcome in Patients Undergoing Cryoablation for Paroxysmal Atrial Fibrillation.

Whether deep sedation with intravenous anesthesia will affect the recurrence after cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (AF) is yet to be examined. Thus, in this study, we hypothesize that there is difference in terms of the recurrence between local anesthesia and deep sedation with intravenous anesthesia after an index ablation procedure.In total, 109 patients were enrolled and received CBA, of which 68 (58.2 years) patients underwent pulmonary vein (PV) isolation with a local anesthesia (group 1) and 41 patients (63.2 years) underwent PV isolation with deep sedation using intravenous anesthesia (group 2).During the index procedure, isolation of all major PVs was achieved in 66 patients in group 1 and in 41 patients in group 2. There was no difference in non-PV triggers between the two groups. The periprocedural complication was found to be similar between the two groups (2.9% in group 1 and 4.9% in group 2). Further, 17 patients in group 1 and 4 patients in group 2 experienced recurrences after a follow-up of 19.3 months (P = 0.019). Repeat procedures revealed similar PV reconnection rates between the two groups. It has also been noted that the number of reconnected PV and incidence of atypical flutter seem to increase in group 1.Deep sedation with intravenous anesthesia during CBA for paroxysmal AF is safe and had a better long-term outcome than those with local anesthesia.

Effective prediction of response to cardiac resynchronization therapy using a novel program of gated myocardial perfusion single photon emission computed tomography.

AIMS: The limitation of QRS duration as a surrogate measure for left ventricular (LV) mechanical dyssynchrony (LVMD) in cardiac resynchronization therapy (CRT) patient selection encourages seeking alternatives to QRS duration. Exploring the potential of an analysis program of electrocardiographically gated myocardial perfusion single photon emission computed tomography (SPECT) (GMPS) for the estimation of LVMD to predict CRT response. METHODS AND RESULTS: Twenty-four patients undergoing CRT for advanced heart failure caused by non-ischaemic cardiomyopathy were studied. Gated myocardial perfusion single photon emission computed tomographies were performed in the setting of temporary CRT suspension after 1 week of CRT adoption. The GMPS data were computed with a novel program capable of segmental LV time-volume analysis. When a brain natriuretic peptide (BNP) value decreased >50% at 6-month follow-up, the patient was defined as a CRT responder. Receiver operating characteristic (ROC) curves for identification of responders were analysed for standard deviation of time to end systole (TES-SD) among 17 LV segments. Linear regression analyses demonstrated that an increase in percentage reduction in BNP level at 6-month follow-up was predicted by an increase in TES-SD (R(2) = 0.21, P = 0.023). The TES-SD in responders (n = 15, 62.5%) was higher than that in non-responders (100 ± 51 vs. 41 ± 17 ms, P = 0.0008). A cutoff value of TES-SD >49 ms predicted responders with 100% sensitivity and 78.8% specificity and the area under the ROC curve was 0.881 for TES-SD (P = 0.002). CONCLUSIONS: The estimation of LVMD using this novel GMPS program could be an alternative or a complementary approach to QRS duration in CRT patient selection. This finding warrants further assessment of our approach in larger studies.

Impact of pacing and high-pass filter settings on ventricular bipolar electrograms in implantable cardioverter defibrillator systems. - Implication of predictors for inappropriate therapy caused by oversensing of repolarization electrograms-.

BACKGROUND: Predictors of T wave oversensing with implantable cardioverter-defibrillator (ICD) systems remains to be clarified. METHODS AND RESULTS: Thirteen consecutive patients who underwent ICD implantations were included. The depolarization (R) and repolarization (T) of bipolar electrograms during baseline, AAI and DDD modes, and an isoproterenol (ISO) infusion were evaluated. The R wave amplitude during DDD was significantly lower as compared to that during the other conditions in all high-pass filter settings. In contrast, there was no significant difference in the T wave amplitude during the DDD as compared to the other conditions. With the DDD, there was a significantly higher incidence of a T/R ratio of greater than 0.25 as compared to that with the other conditions. T wave amplitude in Brugada syndrome was significantly higher than that in non-Brugada syndrome. The existence of Brugada syndrome and T/R ratio during the AAI with a high-pass filter setting of 10/20 Hz was an excellent predictor of T wave oversensing in the follow-up period. CONCLUSIONS: DDD had a significant impact on the R wave amplitude reduction and the T/R ratio during AAI can be predictors of T wave oversensing. These findings have important implications for inappropriate shocks due to T wave oversensing.

Diabetes and Endocrine Disorders (Hyperthyroidism/Hypothyroidism) as Risk Factors for Atrial Fibrillation.

Risk factors including cardiometabolic and endocrine disorders have a significant impact on atrial remodeling causing atrial fibrillation (AF). Diabetes mellitus and hyperthyroidism are strong independent risk factors for AF and worsen outcomes of rhythm control strategies. An early diagnosis and intervention for these risk factors combined with rhythm control strategies may improve the overall cardiovascular mortality and morbidity. This review summarizes the current state of knowledge about the AF risk factors diabetes mellitus and thyroid disease, and discusses the impact of the modification of these risk factors on primary and secondary prevention of AF.