Validation of dual atrioventricular nodal physiology in dual atrioventricular nodal non-reentrant tachycardia via adenosine triphosphate injection during atrial pacing: A novel insight into the role of leftward inferior extension.

INTRODUCTION: Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT) is a rare and challenging-to-diagnose arrhythmia, without previous reports associating it with a leftward inferior extension (LIE). METHODS: Diagnosis was made using adenosine triphosphate (ATP) injection during atrial pacing in a suspected DAVNNT patient. RESULTS: Ablation of the rightward inferior extension was unsuccessful in eliminating DAVNNT; however, subsequent ablation of the LIE successfully eradicated the arrhythmia. CONCLUSION: This unique case, marked by the first instance of DAVNNT caused by LIE, diagnosed through ATP injection, underscores the utility of this diagnostic approach and broadens the spectrum of our understanding and management of this condition.

Retrograde fast pathway cryoablation inside the coronary sinus for slow-fast atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava.

INTRODUCTION: Persistent left superior vena cava (PLSVC) is accompanied by enlarged coronary sinus (CS) and deformation of the triangle of Koch. This makes anatomical evaluation of the atrioventricular (AV) nodal pathways difficult. METHODS: We attempted cryoablation of retrograde fast pathway located in the enlarged CS roof of PLSVC for slow-fast AV nodal reentrant tachycardia (AVNRT) induced by inadvertent antegrade fast pathway elimination during ablation of left atrial tachycardia. RESULTS: Slow-fast AVNRT was successfully eliminated without AV block progression. CONCLUSIONS: This is the first case of successful retrograde fast pathway ablation of the CS ostial roof for slow-fast AVNRT with PLSVC.

How to perform effective cryoballooon ablation of the left atrial roof: Considerations after experiencing more than 1000 cases.

INTRODUCTION: Cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to a pulmonary vein isolation has been expected to improve the clinical outcomes post-atrial fibrillation (AF) ablation. We demonstrated the characteristics and efficacy of CBA of the LA roof through our experience with a large volume of procedures. METHODS: Among 1036 AF ablation procedures with CBA of the LA roof, 834 patients who underwent a de novo ablation were analyzed. RESULTS: Complete LA roof line conduction block was obtained in 767 patients (92.0%) solely by CBA (Group A). Compared with the other patients (Group B), the mean nadir balloon temperature during CBA of the LA roof (-44.5 ± 5.6°C for Group A vs. -40.5 ± 7.5°C for Group B, p < .01) and number of cryoballoon applications during the LA roof ablation with a circular mapping catheter located in the left superior pulmonary vein (1.3 ± 0.8 for Group A vs. 1.6 ± 1.0 for Group B, p = .02) were significantly lower in Group A. A multivariate analysis revealed that those were predictors of a complete LA roof conduction block after only CBA. The 1-year Kaplan-Meier atrial arrhythmia free rate estimates were 80.6% for Group A and 59.0% for Group B (p < .01). CONCLUSION: Complete LA roof line conduction block could be obtained with a cryoballoon without touch-up ablation in most cases. The LA roof CBA with a circular mapping catheter located in the right superior pulmonary vein was preferable to obtaining complete LA roof conduction block, which was important with regard to the clinical outcomes.

Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing atrial fibrillation ablation: results from the multicentre end-stage kidney disease-atrial fibrillation ablation registry.

AIMS: The optimal anticoagulation regimen in patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation is unknown. We sought to describe the real-world practice of peri-procedural anticoagulation management in patients with ESKD undergoing AF ablation. METHODS AND RESULTS: Patients with ESKD on haemodialysis undergoing catheter ablation for AF in 12 referral centres in Japan were included. The international normalized ratio (INR) before and 1 and 3 months after ablation was collected. Peri-procedural major haemorrhagic events as defined by the International Society on Thrombosis and Haemostasis, as well as thromboembolic events, were adjudicated. A total of 347 procedures in 307 patients (67 ±9 years, 40% female) were included. Overall, INR values were grossly subtherapeutic [1.58 (interquartile range: 1.20-2.00) before ablation, 1.54 (1.22-2.02) at 1 month, and 1.22 (1.01-1.71) at 3 months]. Thirty-five patients (10%) suffered major complications, the majority of which was major bleeding (19 patients; 5.4%), including 11 cardiac tamponade (3.2%). There were two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was the only independent predictor of major bleeding [odds ratio, 3.3 (1.2-8.7), P = 0.018]. No cerebral or systemic thromboembolism occurred. CONCLUSION: Despite most patients with ESKD undergoing AF ablation showing undertreatment with warfarin, major bleeding events are common while thromboembolic events are rare.

Leadless pacemaker implantation sites confirmed by computed tomography and their parameters and complication rates.

BACKGROUND: Implantations of leadless pacemakers in the septum lower the risk of cardiac perforation. However, the relationship between the implantation site and the success rate, complication rate, and pacemaker parameters are not well-investigated. METHODS: Patients who underwent leadless pacemaker implantation with postprocedural computed tomography (CT) between September 2017 and November 2020 were analyzed. Septum was targeted with fluoroscopic guidance with contrast injection. We divided patients into two groups based on the implantation site confirmed by CT: septal and non-septal, which included the anterior/posterior edge of the septum and free wall. We compared the complication rates and pacemaker parameters between the two groups. RESULTS: A total of 67 patients underwent CT after the procedure; among them, 28 were included in the septal group and 39 were included in the non-septal group. The non-septal group had significantly higher R wave amplitudes (6.5 ± 3.3 vs. 9.7 ± 3.9 mV, p = .001), lower pacing threshold (1.0 ± 0.94 vs. 0.63 ± 0.45 V/0.24 ms, p = .02), and higher pacing impedance (615 ± 114.1 vs. 712.8 ± 181.3 ohms, p = .014) after the procedure compared to the septal group. Cardiac injuries were observed in four patients (one cardiac tamponade, one possible apical hematoma, two asymptomatic pericardial effusion), which were only observed in the non-septal group. CONCLUSIONS: Leadless pacemaker implantation may be technically challenging with substantial number of patients with non-septal implantation when assessed by CT. Septal implantation may have a lower risk of cardiac injury but may lead to inferior pacemaker parameters than non-septal implantation.

Echinacea purpurea water extracts suppress the release of chemical mediators from mast cells.

Histamine and leukotrienes (LTs), the chemical mediators released from mast cells, play an important role in type-I allergies such as hay fever. Echinacea purpurea (EP) has traditionally been used for herbal tea and has been reported to show biological functions. We evaluated the inhibitory activity of water extracts of EP petals, leaves, and stems against the chemical mediators released from mast cell lines. Petal and leaf extracts exhibited a significant inhibitory effect on histamine release from the stimulated cells, while the stem extract did not exert any effect. Activity of the petal extract was much stronger than that of the leaf extract. All the extracts significantly suppressed LTB4 production in the stimulated cells and displayed similar activities. The petal extract decreased Syk phosphorylation and Ca2+ influx associated with signal transduction in the stimulated cells. These results suggest that EP petal extract may have a relieving effect on allergic symptoms.

Effects of oolonghomobisflavan A on oxidation of low-density lipoprotein.

Oxidation of low-density lipoprotein (LDL) by reactive oxygen species (ROS) and reactive nitrogen species (RNS) has been suggested to be involved in the onset of atherosclerosis. Oolong tea contains unique polyphenols including oolonghomobisflavan A (OFA). In this study, the effects of OFA on LDL oxidation by ROS and RNS were investigated in vitro. OFA suppressed formation of cholesterol ester hydroperoxides in LDL oxidized by peroxyl radical and peroxynitrite, and formation of thiobarbituric acid reactive substances in LDL oxidized by Cu2+. In addition, OFA inhibited fragmentation, carbonylation, and nitration of apolipoprotein B-100 (apo B-100) in the oxidized LDL, in which heparin-binding activity of apo B-100 was protected by OFA. Our results suggest that OFA exhibits antioxidant activity against both lipid peroxidation and oxidative modification of apo B-100 in LDL oxidized by ROS and RNS. Polyphenols in oolong tea may prevent atherosclerosis by reducing oxidative stress.

Oxidative modification of lipoproteins.

Lipoproteins consist of lipids and apolipoproteins that have functional roles in lipid metabolism. It has been suggested that oxidation of lipoproteins by reactive oxygen species (ROS) may be involved in the inception of various diseases. In particular, the relationship between low-density lipoprotein (LDL) oxidation and atherosclerosis has been studied in great detail. The main target molecules of lipoprotein oxidation are polyunsaturated fatty acid residues of lipids and apolipoproteins. Extensive investigations have characterized oxidative modifications of apolipoprotein B100 (apo B100) in LDL. Furthermore, modifications of apo B100 by oxidized lipids have been confirmed in oxidized LDL and atherosclerotic lesions using immunological techniques. In this chapter, characteristics and oxidation mechanisms of lipoproteins by ROS are described from in vitro and in vivo studies. Oxidative modifications of apo B100 by lipid hydroperoxides, major products of lipid peroxidation at the early stage, are principally reported.

Assessment of adenosine triphosphate content in sausages stuffed in different modified casing treatments added with orange extracts, utilising hyperspectral imaging combined with multivariate analysis.

Introduction: An investigation was conducted using a hyperspectral imaging (HSI) system to non-invasively estimate adenosine triphosphate (ATP) content in vacuum packaged sausages in different modified casing treatments added with orange extracts after a year of storage at 4°C. Methods: Various pre-processing combinations were applied to the spectra to enhance the performance of partial least squares regression (PLSR). Results and discussion: PLSR models, utilising the full absorbance spectrum with pre-treatment of standard normal variate combined with 1st derivative,exhibited prediction coefficients of determination (Rp2) reaching up to 0.6629. A distribution map developed through MATLAB was employed to display the location and concentration of ATP content in these unique sausages for the first time. The integration of HSI and multivariate analysis not only quantifies but also visually represents the changes in ATP content response to the different casing treatments, demonstrating the significant potential for real-time inspection in the processed meat industry.

Evaluating Moisture Content in Immersion Vacuum-Cooled Sausages with Citrus Peel Extracts Using Hyperspectral Imaging.

The moisture content of immersion vacuum-cooled sausages with modified casings containing citrus fruit extracts under different storage conditions was studied using hyperspectral imaging (HSI) associated with chemometrics. Different pre-processing combinations were applied to improve the robustness of the model. The partial least squares regression model, employing the full reflectance spectrum with pre-treatment of the standard normal variate, showed calibration coefficients of determination (Rc2) of 0.6160 and a root mean square error of calibration (RMSEC) of 2.8130%. For the first time, prediction maps developed via HSI visualized the distribution of moisture content in the immersion vacuum-cooled sausages with unique modified casings in response to fluctuating storage conditions. The prediction maps showed exact parts with high water content, which will help us to monitor and prevent mold growth. The combination of HSI with multivariate analysis not only quantifies changes in moisture content but also visually represents them in response to various casing treatments under different storage conditions, illustrating the significant potential for real-time inspection and early mold detection in sausages within the processed meat industry.

Phrenic nerve injury after atrial fibrillation ablation: different recovery courses among cryoballoon, laser balloon, and radiofrequency ablation.

BACKGROUND: Phrenic nerve injury (PNI) is one of the common complications in atrial fibrillation (AF) ablation, which often recovers spontaneously. However, the course of its recovery has not been examined fully, especially in regard to the different ablation methods. We sought to compare the recovery course of PNI in cryoballoon, laser balloon, and radiofrequency ablation. METHODS: This multicenter retrospective study analyzed 355 patients who suffered from PNI during AF ablation. PNI occurred during cryoballoon ablation (CB group) and laser balloon ablation (LB group) for a pulmonary vein isolation in 288 and 20 patients, and radiofrequency ablation for a superior vena cava (SVC) isolation (RF-SVC group) in 47 patients, respectively RESULTS: There was a significant difference in the estimated probability of PNI recovery after the procedure between the methods (p = 0.01). PNI recovered significantly earlier in the CB group, especially within 24 h and 3 months post-procedure (the percentage of the recovery within 24 h and 3 months: 49.7% and 71.5% in the CB group, 15.0% and 22.2% in the LB group, and 23.4% and 41.9% in the RF-SVC group, respectively). Persistent PNI after 12 months was observed in only seven patients in the CB group, one in the LB group, and four in the RF-SVC group, respectively. CONCLUSION: PNI rarely persists over 12 months after AF ablation; however, there is a difference in the timing of its recovery. PNI recovers quicker with cryoballoon ablation than with laser balloon ablation or radiofrequency ablation of the SVC.

Anatomical approach to suppression of para-Hisian ventricular arrhythmias with changes in QRS morphology after ablation at the earliest activation site.

BACKGROUND: The anatomical approach for the management of para-Hisian ventricular arrhythmias (VAs) with QRS morphological changes after catheter ablation (CA) has not been well investigated. OBJECTIVE: We aimed to evaluate the electrocardiographic and electrophysiological findings and ablation outcomes of para-Hisian VAs with QRS morphological changes after CA. METHODS: Of the 30 patients who underwent CA for para-Hisian VAs at 4 institutions, 10 (33%) had QRS morphological changes after ablation. All 10 patients underwent an anatomical approach, targeting the site anatomically opposite to the site where the QRS morphology had been changed by ablation. We investigated the safety and efficacy of the anatomical approach. RESULTS: Of the 10 patients evaluated, the approach was switched from the right ventricular septum to the left ventricular septum/aortic root in 7 (70%) (RL group) whereas 3 (30%) underwent left-to-right switches (LR group). After CA, the precordial transition zone tended to be earlier in the RL group and later in the LR group. In the RL group, successful VA suppression was achieved, despite suboptimal pace map concordance from the left side or a relatively delayed earliest activation time. Of the 10 patients who underwent an anatomical approach, 8 (80%) had procedural success, and ablation was discontinued in 1 (10%) because of the risk of atrioventricular block. CONCLUSION: The anatomical approach showed promising results regarding safety and efficacy. Therefore, it should be considered when QRS morphological changes are observed during or after CA of para-Hisian VAs.

Effect of combination of dietary fish protein and fish oil on lipid metabolism in rats.

This study examined the effects of fish protein in combination with fish oil on rat lipid metabolism. Male Wistar rats were divided into four groups and fed an AIN93G-based diet with casein (20%) + soybean oil (7%), casein (10%) + fish protein (10%) + soybean oil (7%), casein (20%) + soybean oil (5%) + fish oil (2%), and casein (10%) + fish protein (10%) + soybean oil (5%) + fish oil (2%) for 4 weeks. The dietary combination of fish protein and fish oil decreased the contents of serum triacylglycerol, serum cholesterol, liver triacylglycerol and liver cholesterol in addition to altering liver lipid fatty acid composition. These effects are partly due to the increase in fecal cholesterol, bile acid excretion, and increased enzyme activities of fatty acid ß-oxidation in the liver. These data suggest that combined intake of fish protein and fish oil lead to both hypocholesterolemic and hypotriglyceridemic in serum and the liver, while sole intake of fish protein or fish oil decrease only cholesterol and triglyceride levels, respectively. These results suggest that combined intake of fish protein and fish oil may play beneficial roles in the prevention of lifestyle-related diseases as compared with sole fish protein intake.

Hyperspectral Imaging Combined with Chemometrics Analysis for Monitoring the Textural Properties of Modified Casing Sausages with Differentiated Additions of Orange Extracts.

The textural properties (hardness, springiness, gumminess, and adhesion) of 16-day stored sausages with different additions of orange extracts to the modified casing solution were estimated by response surface methodology (RSM) and a hyperspectral imaging system in the spectral range of 390-1100 nm. To improve the model performance, normalization, 1st derivative, 2nd derivative, standard normal variate (SNV), and multiplicative scatter correction (MSC) were applied for spectral pre-treatments. The raw, pretreated spectral data and textural attributes were fit to the partial least squares regression model. The RSM results show that the highest R2 value achieved at adhesion (77.57%) derived from a second-order polynomial model, and the interactive effects of soy lecithin and orange extracts on adhesion were significant (p < 0.05). The adhesion of the PLSR model developed from reflectance after SNV pretreatment possessed a higher calibration coefficient of determination (0.8744) than raw data (0.8591). The selected ten important wavelengths for gumminess and adhesion can simplify the model and can be used for convenient industrial applications.

Multi-view image-based behavior classification of wet-dog shake in Kainate rat model.

The wet-dog shake behavior (WDS) is a short-duration behavior relevant to the study of various animal disease models, including acute seizures, morphine abstinence, and nicotine withdrawal. However, no animal behavior detection system has included WDS. In this work, we present a multi-view animal behavior detection system based on image classification and use it to detect rats' WDS behavior. Our system uses a novel time-multi-view fusion scheme that does not rely on artificial features (feature engineering) and is flexible to adapt to other animals and behaviors. It can use one or more views for higher accuracy. We tested our framework to classify WDS behavior in rats and compared the results using different amounts of cameras. Our results show that the use of additional views increases the performance of WDS behavioral classification. With three cameras, we achieved a precision of 0.91 and a recall of 0.86. Our multi-view animal behavior detection system represents the first system capable of detecting WDS and has potential applications in various animal disease models.

Effect of Polyphenols in Sea Buckthorn Berry on Chemical Mediator Release from Mast Cells.

Sea buckthorn (Hippophae rhamnoides L.) is a deciduous shrub of the Elaeagnaceae family and is widely distributed in northern Eurasia. Sea buckthorn berry (SBB) has attracted attention for its use in many health foods, although its physiological function remains unknown. In this study, we investigated the inhibitory effect of SBB extract and its fractions on Type-I allergy using mast cell lines. Among these fractions, SBB fraction with the highest amount of antioxidant polyphenols significantly inhibited the release of chemical mediators such as histamine and leukotriene B4 (LTB4) from the stimulated mast cells. This fraction also inhibited the influx of calcium ions (Ca2+) and the phosphorylation of tyrosine residues in proteins, including spleen tyrosine kinase, which is associated with signal transduction during the release of chemical mediators. The active SBB fraction contained isorhamnetin as its major flavonol aglycon. Isorhamnetin inhibited histamine and LTB4 release from the stimulated cells and suppressed intracellular Ca2+ influx. These results indicate that isorhamnetin is the primary substance responsible for the antiallergic activity in SBB. In conclusion, SBB may alleviate Type-I allergy by inhibiting the release of chemical mediators from mast cells, and polyphenols may contribute to this effect.

The angle of the tines before the pull and hold test predicts engagement of the tines in Micra leadless pacemaker implantation.

Background: Micra leadless pacemaker is secured to the myocardium by engagement of at least 2/4 tines confirmed with pull and hold test. However, the pull and hold test is sometimes difficult to assess. This study was performed to evaluate whether the angle of the tines before the pull and hold test predicts engagement of the tines in Micra leadless pacemaker implantation. Methods: We retrospectively enrolled 93 consecutive patients (52.7% male, age 82.4 ± 9.4 years), who received Micra implantation from September 2017 to June 2020 at our institution. After deployment and before the pull and hold test, the angle of the visible tines to the body of the pacemaker was measured using the RAO view of the fluoroscopy image. The engagement of the tines was then confirmed with the pull and hold test. Results: A total of 326 tines were analyzed. The angle of the engaged tines was significantly lower than the non-engaged tines (9.2 degrees [4.0-14.0] vs. 16.6 degrees [14.2-18.8], p < .0001). All tines with angles <10 degrees were engaged. In higher angles, engagement could not be predicted. Conclusion: A low angle of the tines before the pull and hold test can predict engagement of the tines in Micra leadless pacemaker implantation. The tines which are already open after deployment may be presumed that they are engaged.

Evaluation of pH in Sausages Stuffed in a Modified Casing with Orange Extracts by Hyperspectral Imaging Coupled with Response Surface Methodology.

The pH values of sausages stuffed in natural hog casings with different modifications (soy lecithin, soy oil, orange extracts (OE) from waste orange peels, lactic acid in slush salt, and treatment time) after 16-day 4 °C storage were evaluated for the first time by hyperspectral imaging (350−1100 nm) coupled with response surface methodology (RSM). A partial least squares regression (PLSR) model was developed to relate the spectra to the pH of sausages. Spectral pretreatment, including first derivative, second derivative, multiplicative scatter correction (MSC), standard normal variate (SNV), normalization, and normalization, with different combinations was employed to improve model performance. RSM showed that only soy lecithin and OE interactively affected the pH of sausages (p < 0.05). The pH value decreased when the casing was treated with a higher concentration of soy lecithin with 0.26% OE. As the first and second derivatives are commonly used to eliminate the baseline shift, the PLSR model derived from absorbance pretreated by the first derivative in the full wavelengths showed a calibration coefficient of determination (R2) of 0.73 with a root mean square error of calibration of 0.4283. Twelve feature wavelengths were selected with a comparable R2 value compared with the full wavelengths. The prediction map enables the visualization of the pH evolution of sausages stuffed in the modified casings added with OE.

Femoral Vein Occlusion or Stenosis Using a Suture-Mediated Vascular Closure Device After Catheter Ablation.

A suture-mediated vascular closure device is useful for hemostasis of the femoral vein after catheter ablation; however, venous complications remain unclear. We encountered 2 cases of femoral vein occlusion and stenosis using a suture-mediated vascular closure device. Both patients underwent surgical repair and recovered venous flow. (Level of Difficulty: Intermediate.).