Variations in the phenological patterns of a caddisfly inhabiting the same mountain massifs: Life-history differences in different altitudinal zones.

Organisms inhabiting mountainous regions can experience large vertical environmental changes, and show different ecological characteristics between altitudes, thus facilitating allopatric fragmentation even in geographically close populations. This study compared the life-history patterns of a species of limnephilid caddisfly, Asynarchus sachalinensis, in several genetically differentiated populations between alpine and sub-alpine zones in a temperate mountainous region. We showed that in the sub-alpine populations, larval development started earlier with increasing water temperature in spring, and adult emergence was also earlier. The occurrence of adults was extremely low in mid-summer, probably due to summer diapause, followed by a larger number of ovary-developed females in autumn. On the other hand, in the alpine zone, increasing water temperature was delayed compared to the sub-alpine zone, and larval development occurred from early to mid-summer. Adult emergence and ovary-developed individuals were concentrated in mid-summer. Hence, summer diapause was not observed. These results indicated life-history differences between genetically differentiated populations at different altitudes. As the timing of adult occurrence and ovarian developmental patterns differ between populations at different altitudes, it is possible that reproductive isolation is facilitated or maintained between populations.

Evolutionary history of a cold-adapted limnephilid caddisfly: Effects of climate change and topography on genetic structure.

The distribution of organisms is influenced by complex factors such as the phylogenetic evolutionary histories of species, the physiological and ecological characteristics of organisms, climate, and geographical and geohistorical features. In this study, we focused on a caddisfly, Asynarchus sachalinensis (Trichoptera: Limnephilidae), which has adapted to cold habitats. From phylogeographic analyses based on the mitochondrial DNA (mtDNA) cytochrome c oxidase subunit I (COI) and 16S rRNA regions and the nuclear DNA (nDNA) 18S rRNA, 28S rRNA, carbamoyl-phosphate synthetase (CAD), elongation factor-1 alpha (EF1-α), and RNA polymerase II (POLII) regions, two distinct genetic clades were detected. Clade I was shown to be widely distributed from Sakhalin to Honshu, whereas Clade II was only distributed within Honshu. The distributions of these clades overlapped in Honshu. The habitats were located at relatively lower altitudes for Clade I and higher altitudes for Clade II. The divergence time of these clades was estimated to be during the Pleistocene, indicating that repeated climatic changes facilitated distributional shifts. Haplotype network and demographic analyses based on the mtDNA COI region showed contrasting genetic structures in the two clades. It was indicated that the population sizes of Clade I had expanded rapidly in a recent period, whereas Clade II had maintained stable population sizes. The habitats of Clade II were typically isolated and scattered at high altitudes, resulting in restricted migration and dispersal because of their discontinuous "Sky Island" habitats. The habitats of Clade I were located at relatively low altitudes, and it was assumed that the populations were continuous, which resulted in a higher frequency of migration and dispersal between populations. Thus, differences in the spatial scale of the adapted habitats of each clade may have resulted in different patterns of population connectivity and fragmentation associated with repeated climatic changes during the Pleistocene. Our study provided new insight into the distributional patterns of cold-adapted aquatic insects in the Japanese Archipelago. Furthermore, the distributional shifts predicted by ecological niche modeling under future climatic change conditions were different for each clade. Therefore, different principles are required in the assessment of each clade to predict temporal changes in their distributions.

New species of the genus Trichosetodes Ulmer, 1915 (Trichoptera, Leptoceridae) from Ratanakiri province, Cambodia, based on morphological and molecular data.

Three new species of Trichosetodes, namely T.carmelaesp. nov., T.katiengensissp. nov. and T.ratanakiriensissp. nov. are described and illustrated by male specimens. The male genitalia of T.carmelaesp. nov. can be distinguished from the other 16 species of the genus found in Southeast Asia by the shape of the phallicata. The phallicata of T.carmelaesp. nov. bears a tuft of long hairs in the middle of the dorsal edge. Trichosetodeskatiengensissp. nov. can be distinguished from the other species in Southeast Asia by the shape of the phallicata which is divided into dorsal and ventral branches in lateral view, and T.ratanakiriensissp. nov. by the characters of the left inferior appendage and the shape of segment IX. The posterior end of the left inferior appendage of T.ratanakiriensissp. nov. is not forked and the ventral and lateral views of the posteroventral lobes of segment IX are rounded. Illustrations of male genitalia of Trichosetodeskampongspeuensis Malicky & Kong, 2020 are provided for comparison. The molecular diversity of new Trichosetodes species was analyzed using the mitochondrial large subunit ribosomal rRNA gene region (16S rRNA). In terms of their genetic divergence, T.ratanakiriensissp. nov. and T.kampongspeuensis exhibited remarkable proximity, with only a 1.4% distance. On the contrary, T.carmelaesp. nov. displayed genetic disparity exceeding 6.3% when compared to both T.ratanakiriensissp. nov. and T.kampongspeuensis.

Phylogeography of the true freshwater crab, Geothelphusa dehaani: Detected dual dispersal routes via land and sea.

Dispersal is an important factor that determines the potential for colonization to pioneer sites. Although most decapods employ seaward migration for reproduction with a planktonic larval phase, true freshwater crabs spend their entire life cycle in freshwater. Therefore, it is expected that genetic regionality can be easily detected. In this study, we focused on true freshwater crabs, Geothelphusa Stimpson, 1858. Herein, we reveal the evolutionary history and dispersal patterns of freshwater crustaceans. We collected and genetically analyzed 283 specimens at 138 localities across the Japanese Islands. Phylogenetic analyses were conducted on the combined dataset (mtDNA COI, 16S, and nDNA ITS1, histone H3 regions) and the data set based on the mtDNA COI region. The phylogenetic relationships detected 10 clades that were highly monophyletic. The highlights of this study were the discovery of several cryptic species or undescribed species, and the completely different heterogeneous dual dispersal pathways within a single species; i.e., both land and ocean routes. Although it was concluded that Japanese crabs are basically genetically divided by straits, strong evidence for dispersion via ocean currents was also detected (i.e., a "sweepstake"). It was also confirmed that Geothelphusa dehaani (White, 1847) could survive in seawater.

The potential of dynamic 99mTc-sestamibi cadmium zinc telluride-single-photon emission computed tomography camera assessing myocardial flow reserve in patients with heart failure with preserved ejection fraction.

Aims: Coronary microvascular dysfunction (CMD) is related to the pathophysiology, mortality, and morbidity of heart failure with preserved ejection fraction (HFpEF). A novel single-photon emission computed tomography (SPECT) camera with cadmium zinc telluride (CZT) detectors allows for the quantification of absolute myocardial blood flow and myocardial flow reserve (MFR) in patients with coronary artery disease. However, the potential of CZT-SPECT assessing for CMD has never been evaluated in patients with HFpEF. Methods and results: The clinical records of 127 consecutive patients who underwent dynamic CZT-SPECT were retrospectively reviewed. Rest and stress scanning were started simultaneously with 3 and 9 MBq/kg of 99mTc-sestamibi administration, respectively. Dynamic CZT-SPECT imaging data were analysed using a net-retention model with commercially available software. Transthoracic echocardiography was performed in all patients. The MFR value was significantly lower in the HFpEF group (mean ± SEM = 2.00 ± 0.097) than that in the non-HFpEF group (mean ± SEM = 2.74 ± 0.14, P = 0.0004). A receiver operating characteristic analysis indicated that if a cut-off value of 2.525 was applied, MFR could efficiently distinguish HFpEF from non-HFpEF. Heart failure with preserved ejection fraction had a consistently low MFR, regardless of the diastolic dysfunction score. Heart failure with preserved ejection fraction patients with MFR values lower than 2.075 had a significantly higher incidence of heart failure exacerbation. Conclusion: Myocardial flow reserve assessed by CZT-SPECT was significantly reduced in patients with HFpEF. A lower MFR was associated with a higher hospitalization rate in these patients. Myocardial flow reserve assessed by CZT-SPECT has the potential to predict future adverse events and stratify the severity of disease in patients with HFpEF.

Behavior of snow monkeys hunting fish to survive winter.

Japanese macaques, Macaca fuscata, of Kamikochi in the Japanese Alps endure one of the coldest and harshest environments during winter when scarcity of food puts them at risk. However, various behaviors have evolved to mitigate potential mortality. These macaques typically eat bamboo leaves and the bark of woody plants in winter, but our previous study using the feces of Japanese macaques collected in the winter and DNA metabarcoding analysis revealed conclusively for the first time consumption of riverine benthos and brown trout. In this paper, we investigate how Japanese macaques hunt fish and collect these riverine biota by extensively observing their behavior, including the use of infrared sensor cameras. Many researchers have tracked Japanese macaques as part of behavioral and ecological studies, but previously the techniques by which Japanese macaques capture swimming fish has not been documented. Herein, for the first time we consider how novel macaque foraging behavior traits have evolved to secure valuable animal protein for winter survival when food resources are scarce.

Seasonal modifications of longitudinal distribution patterns within a stream: Interspecific interactions in the niche overlap zones of two Ephemera mayflies.

Niche differentiation between closely related species leads to differentiation of their habitats. Segregation based on slight differences in environmental factors, that is niche differentiation on the microhabitat scale, allows more species to inhabit a certain geographic space. Therefore, such fine scale niche differentiation is an important factor in the support of species diversity. In addition, niche differentiation on the microhabitat scale and/or the differentiation of breeding seasons can be considered typical mechanisms that facilitate multispecies' co-existence. In this study, sister species (Commonly, Ephemera japonica inhabit at upstream region and Ephemera strigata inhabit at middle stream region), which often coexist in the upper to middle reaches of river systems of the Japanese Islands, were targeted and the following aspects were investigated. First, differences in habitat preference and interspecific differences in flow distribution patterns on a geographically fine scale were tracked in detail. Subsequently, the temporal transitions of their distribution patterns were investigated in detail and seasonal changes were investigated. Finally, we thoroughly investigated the disappearance of nymphs of each species from the river due to emergence affected the distribution of each species (by conducting daily emergence surveys). Combining results of these multiple studies also suggested that there may be spatiotemporal interspecial interaction between these two species within/around their overlapping regions. Traditionally, the longitudinal distribution pattern of these two Ephemera mayflies has been thought to be established based on a difference in habitat preferences, but this study revealed that the interspecific interaction between the two species also plays an important role. This study provides new insights into species diversity and distribution pattern formation in river-dwelling species.

Winter diet of Japanese macaques from Chubu Sangaku National Park, Japan incorporates freshwater biota.

The Japanese macaque (Macaca fuscata) is native to the main islands of Japan, except Hokkaido, and is the most northerly living non-human primate. In the Chubu Sangaku National Park of the Japanese Alps, macaques live in one of the coldest areas of the world, with snow cover limiting the availability of preferred food sources. Winter is typically a bottleneck for food availability potentially resulting in marked energy deficits, and mortality may result from famine. However, streams with groundwater upwelling flow during the winter with a constant water temperature of about 5 °C are easily accessible for Japanese macaques to search for riverine biota. We used metabarcoding (Cytochrome c oxidase I) of fecal samples from Japanese macaques to determine their wintertime diet. Here we provide the first robust evidence that Japanese macaques feed on freshwater biota, including brown trout, riverine insects and molluscs, in Chubu Sangaku National Park. These additional food sources likely aid their winter survival.

Phylogeography of the northernmost distributed Anisocentropus caddisflies and their comparative genetic structures based on habitat preferences.

Knowledge of the factors that determine the distribution ranges of organisms is necessary to understand their evolutionary and ecological significance and contribution to biodiversity. A very effective mean of studying such factors is to compare the distribution characteristics and genetic structures of closely related species with differing habitat preferences. Freshwater aquatic insects are relatively easy to observe and the basis of their corresponding niche differentiation easier to identify. Freshwater habitats are categorized lotic or lentic water according to flow regime. In Japanese Islands, the genus Anisocentropus of the calamoceratid caddisfly, the target group in this study, was morphologically reconfirmed that three species, that is, Anisocentropus kawamurai, A. pallidus, and A. magnificus. Among these, A. kawamurai prefers lotic environments and A. pallidus is adapted to lentic water habitats. The distribution range of these sister species overlaps within the Japanese Islands. We estimated the phylogeny and the evolutionary history of Anisocentropus caddisflies worldwide. We estimated divergence periods by two methods, a single locus with various specimens and multiple loci with reduced numbers of the specimens. As a result, we elucidated the phylogenetic position of Japanese species within the cosmopolitan genus Anisocentropus, and also revealed their dual origin. In addition, we demonstrated that the contrasting genetic structures between the sister species distributed in widely overlapping areas were due to differentiation in their respective adapted environmental preferences. Although, in general, it is known that species adapted to lentic water have greater dispersal potential and so are associated with wider distribution areas by means of examining their comparative genetic structures, we revealed a new pattern of genetic locality existing in the genetic structures of the species adapted to lentic water. We then present evidence that suggests the ecological preferences of a species are an important factor in understanding the evolutionary history of that species.

Wide-Scale Gene Flow, Even in Insects that have Lost their Flight Ability: Presence of Dispersion Due to a Unique Parasitic Ecological Strategy of Piggybacking Hosts.

We focused on Meloe beetles that have lost all flight ability, and conducted molecular phylogeographic analyses based on their mitochondrial DNA COI and nuclear DNA EF1- α regions. Meloe beetles infiltrate bumblebee nests by attaching to bumblebees as they pollinate flowers and thereafter have a unique and specific life history as they complete their life-cycle within the host nest; flight-based dispersal is achieved by piggybacking on bumblebees. In fact, Meloe beetles, which cannot fly, even inhabit remote islands (i.e., "Oceanic Islands"). Regarding four species, i.e., Meloe coarctatus, Meloe proscarabaeus, Meloe violaceus and Meloe corvinus, the conventional morphological classification system based on morphological characteristics was strongly supported by the molecular markers. On the other hand, for two species, Meloe menoko and Meloe auriculatus, it was found that M. menoko may be evaluated as having a paraphyletic relationship with M. auriculatus. Furthermore, two other cryptic, undescribed species were also discovered in this study. One was collected in the Nikko Highland, and inhabited the area sympatrically with M. coarctatus. The other was collected from Hachijo-jima Island. These cryptic species were highly differentiated, independent lineages in terms of mitochondrial and nuclear gene regions. That is to say, a new level of species diversity was revealed among the Meloe beetle species, known for their unique and strange ecological and ethological characteristics.

Development of microsatellite markers for a giant water bug, Appasus japonicus, distributed in East Asia.

We developed microsatellite markers for Appasus japonicus (Heteroptera: Belostomatidae). This belostomatid bug is distributed in East Asia (Japanese Archipelago, Korean Peninsula and mainland China) and often listed as an endangered species in the Red List or the Red Data Book at the national and local level in Japan. Here, we describe twenty novel polymorphic microsatellite loci developed for A. japonicus, and marker suitability was evaluated using 56 individuals from four A. japonicus populations (Nagano, Hiroshima and Yamaguchi prefectures, Japan, and Chungcheongnam-do, Korea). The number of alleles per locus ranged from 1 to 12 (mean = 2.5), and the average observed and expected heterozygosity and fixation index per locus were 0.270, 0.323 and 0.153, respectively. In addition, a population structure analysis was conducted using the software STRUCTURE, and its result suggested that the 20 markers described here will be useful for investigating the genetic structure of A. japonicus populations, which should contribute to population genetics studies of this species.

The impact of the dominant frequency of body surface electrocardiography in patients with persistent atrial fibrillation.

The dominant frequency (DF) of atrial fibrillation (AF) reflects atrial electrical activity. However, the relationship between DF measured using surface electrocardiography (ECG) and AF ablation success remains unclear. This study aimed to clarify whether the DF of surface ECG in patients with persistent AF could predict arrhythmia recurrence after catheter ablation. We investigated 125 patients with persistent AF who underwent catheter ablation between January 2009 and December 2016. Thirty-four patients (27%) had arrhythmia recurrence after catheter ablation. These patients showed a significantly high DF value in leads aVL (7.2 ± 0.7 Hz vs 6.6 ± 0.9 Hz, p < 0.001) and V1 (7.4 ± 0.8 Hz vs 6.7 ± 0.7 Hz, p < 0.001). We set the cutoff value of DF as 6.9 Hz in lead aVL (sensitivity, 80%; specificity, 63%) and as 7.1 Hz in lead V1 (sensitivity, 72%; specificity, 67%). Patients with DF < 6.9 Hz in lead aVL showed a significantly higher recurrence-free rate than those with DF ≥ 6.9 Hz (88% vs 45%; p < 0.001). Patients with DF of < 7.1 Hz in lead V1 showed a significantly higher recurrence-free rate than those with DF of ≥ 7.1 (87% vs 47%; p < 0.001). Patients with a high DF in leads aVL and V1 showed a lower success rate of persistent AF ablation. The DF measured from surface ECG can be a useful marker to predict ablation success.

Genealogical Position of Japanese Populations of the Globally Distributed Mayfly Cloeon dipterum and Related Species (Ephemeroptera, Baetidae): A Molecular Phylogeographic Analysis.

In the present study, we add genetic data of the mayfly Cloeon dipterum collected from the Japanese Islands to the established molecular phylogenetic knowledge in the mitochondrial COI gene of Cloeon mayflies. Cloeon dipterum is a typical cosmopolitan species that includes six intraspecific haplotype groups. The present phylogenetic analysis revealed that haplotypes of the Japanese C. dipterum constitute a seventh group together with a haplotype from Korea. This East Asian group forms a sister group with previously known European and North American haplotype groups (i.e., the clade CT1 to CT3). The present phylogenetic analysis further revealed the occurrence of two described species (C. dipterum and Cloeon ryogokuensis) and possibly three species (Cloeon sp. 1 to 3) in Japan. Consideration is given to the degree of genetic differentiation, divergence time, and differentiation process among these seven genetic groups.

Concordance between molecular biogeography of Dipteromimus tipuliformis and geological history in the local fine scale (Ephemeroptera, Dipteromimidae).

Species distribution area is determined by both biotic and abiotic factors. In particular, significant geological events influence the biodiversity and the genetic structures of the organisms inhabiting the area. The establishment of physical barriers (e.g., mountains, rivers), drives species differentiation by their interference with biological dispersal or gene flow. The Japanese Islands have a high degree of biodiversity. This study focused on the Kii Peninsula, which stands out as a region of exhibiting particularly high biodiversity, and also exceptionally high endemism. The Kii Peninsula has experienced active mountain formation ever since the Quaternary period. In this study, we investigate the influence of geological events on the establishment of genetic diversity. We focused on the mayfly, Dipteromimus tipuliformis. Phylogenetic analyses were performed utilizing the mitochondrial DNA 16S rRNA and COI regions, and the nuclear DNA histone H3, PEPCK and 28S rRNA regions. As a result, it was shown that this mayfly exhibits a genetic structure that strongly reflects the geological history of the Kii Peninsula, and detected their dispersal process across the Median Tectonic Line. This is a unique and significant study, in that it clearly shows the relationship between the phylogenetic evolution of this mayfly and the corresponding geological history in surprisingly geographic fine scale.

Correction to: Differences in prothrombotic response between the uninterrupted and interrupted apixaban therapies in patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation: a randomized controlled study.

In the original publication of the article, the table 2 was published incorrectly.

The First Establishment of "Hand-Pairing" Cross-Breeding Method for the Most Ancestral Wing Acquired Insect Group.

Insects are the most diverse organisms in the world and have been in existence since ca. 480 Ma; given this, they can provide profound insights into evolution. Among them, the order Ephemeroptera is one of the most basal clades of winged insects. This makes Ephemeroptera a significant key taxon in understanding the macro-evolution or the insect groundplan. In the development of biological evolutionary studies of this taxon, it is important to establish a technique for cross-breeding. Furthermore, the establishment of these techniques also makes a great contribution in the fields of micro-evolution. In a non-model taxon, the mayfly, subcultivation in the laboratory has been thus far considered impossible. With the exception of some parthenogenetic strains, it is extremely difficult to mate these insects in artificial environments. In this study, we established a successful artificial mating technique, i.e., a "hand-pairing" based cross-breeding method for mayflies. Furthermore, we also succeeded in clearly verifying by a genotyping method that the offspring reproduced by hand-pairing were in fact derived from the actual male and female which were used for hand-pairing. We established a reproductive experimental technique for hand-pairing of Dipteromimus tipuliformis and verified this technique by means genotyping. This technique could allow the artificial control of fertilization timing, and result in offspring which can be verified as to their status by means of genotyping. This achievement will be extremely important in the future for both the macro- and micro-evolutionary studies of insects.

Differences in prothrombotic response between the uninterrupted and interrupted apixaban therapies in patients undergoing cryoballoon ablation for paroxysmal atrial fibrillation: a randomized controlled study.

Periprocedural bleeding and thromboembolic events are worrisome complications of catheter ablation for atrial fibrillation (AF). Periprocedural anticoagulation management could decrease the risk of these complications. However, evaluation of the complications from pulmonary vein isolation using cryoballoon related to different anticoagulation strategies is limited. Therefore, we aimed to compare prothrombotic responses as assessed on the basis of D-dimer levels between the uninterrupted and interrupted apixaban therapies during cryoballoon ablation. Ninety-seven consecutive patients with paroxysmal AF scheduled to undergo cryoballoon ablation were randomly assigned in a 1:2 ratio to uninterrupted apixaban therapy (Group 1, n = 32) or interrupted apixaban therapy (Group 2, n = 65). D-Dimer levels were measured immediately before the ablation, at the end of the ablation, and 24 and 48 h after the procedure. No statistical difference was observed in the baseline characteristics between the two groups. The rates of hemorrhagic complications were similar in both groups (major bleeding: 3.1 vs. 1.5%; p = 0.61, and minor bleeding: 3.1 vs. 4.6%; p = 0.73, respectively). No thromboembolic events occurred in either group. However, D-dimer levels 48 h after the ablation increased more markedly following the procedure in Group 2 than in Group 1 (from 0.58 ± 0.16 to 1.01 ± 0.42 µg/mL vs. 0.58 ± 0.20 to 0.82 ± 0.25 µg/mL; p = 0.01). In conclusion, uninterrupted apixaban therapy during the periprocedural period of cryoballoon ablation for AF did not increase the risk of bleeding in this study and might reduce the periprocedural risk of subclinical hypercoagulable state.

Myocardial viability as shown by left ventricular lead pacing threshold and improved dyssynchrony by QRS narrowing predicts the response to cardiac resynchronization therapy.

INTRODUCTION: Patients with advanced heart failure and dyssynchrony can benefit from cardiac resynchronization therapy (CRT). To predict the response to CRT, myocardial viability and improved dyssynchrony are suggested to be important. METHODS: We retrospectively investigated 93 patients who underwent CRT implantation in Nagoya University Hospital. We assessed QRS narrowing the day after implantation to measure the improvement in dyssynchrony and measured the left ventricular pacing threshold (LVPT) to determine the local myocardial viability in all patients. Responders to CRT were defined as those having a greater than or equal to 15% decrease in left ventricular end-systolic volume by echocardiography at their 6-month follow-up. RESULTS: Sixty-two patients (67%) were classified as responders. The QRS width before CRT implantation, QRS narrowing after implantation, left atrial diameter, septal-to-posterior wall motion delay, left ventricular end-diastolic diameter, radial strain, and LVPT were significantly different between the responder and nonresponder groups. On multivariate analysis, QRS narrowing (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = 0.005) and LVPT (OR, 0.42; 95% CI, 0.22-0.82; P = 0.011) were independent predictors of a response to CRT. We calculated the cutoff values from the receiver operating characteristic curves as 22.5 milliseconds of QRS narrowing and 1.55 V of LVPT. The response rates in patients with both predictive factors (QRS narrowing ≥ 22.5 milliseconds and LVPT ≤ 1.55 V), one factor, and no factors were 91%, 61%, and 25%, respectively (P < 0.001). CONCLUSION: Both myocardial viability and improved electrical dyssynchrony may be essential to predict a good response to CRT.

Uninterrupted Direct Oral Anticoagulant and Warfarin Administration in Elderly Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Comparison With Younger Patients.

OBJECTIVES: The goal of this study was to evaluate the efficacy and safety of uninterrupted direct oral anticoagulant (DOAC) use and uninterrupted warfarin administration in elderly patients undergoing catheter ablation for atrial fibrillation (AF). BACKGROUND: There is limited knowledge regarding the uninterrupted use of oral anticoagulant agents in elderly patients undergoing catheter ablation for AF. METHODS: This retrospective study included 2,164 patients (n = 325 ≥75 years of age and n = 1,839 <75 years of age) who underwent catheter ablation for AF. All the patients received uninterrupted oral anticoagulant agents during the procedure. We investigated the occurrences of periprocedural events and compared these between the DOAC and warfarin groups of the elderly and younger groups. RESULTS: Major bleeding events (3.1% vs. 1.3%; p = 0.023) and minor bleeding events (9.2% vs. 5.0%; p = 0.002), except for thromboembolic events (0% vs. 0.8%; p = 0.248), were significantly higher in the elderly group than in the younger group. No significant differences in thromboembolic and bleeding events were found between the DOAC and warfarin groups of both the elderly and younger groups. Adverse complications did not differ between the groups after adjustment using propensity score matching analysis. Multivariate analysis revealed that lower body weight (odds ratio: 0.96; p = 0.010) and antiplatelet drug use (odds ratio: 2.21; p = 0.039) were independent predictors of adverse events in the elderly group. CONCLUSIONS: The periprocedural bleeding risk during the use of uninterrupted oral anticoagulants was higher in the elderly group than in the younger group. This area needs more attention for these patients in whom caution is required.

Assessment of autonomic nervous system modulation after novel catheter ablation techniques for atrial fibrillation using multiple short-term electrocardiogram recordings.

PURPOSE: The effect of novel catheter ablation techniques for atrial fibrillation (AF) on the autonomic nervous system (ANS) is unclear. This study aimed to assess the ANS after three novel catheter ablation techniques for paroxysmal AF by evaluating heart rate variability (HRV) parameters using a 3-min electrocardiogram recording. METHODS: Two hundred and thirty-five patients who underwent catheter ablation for paroxysmal AF (119 in irrigated-tip, 51 in contact-force sensing-guided, and 65 patients in second-generation cryoballoon ablation) were included. HRV analysis was performed at baseline and 1, 3, 6, and 12 months after the ablation. RESULTS: The three ablation groups had similarly decreased HRV parameters after the ablation, and this change was maintained > 1 year. A reduction in parasympathetic nervous function was more apparent after the ablation, compared to changes in the sympathetic nervous function. Of the total population, 45 patients had recurrence. Ln high frequency (HF) 12 months after the ablation was significantly higher in the recurrence group than in the non-recurrence group (1.52 ± 0.47 vs. 1.26 ± 0.57 ms2, p = 0.007). Multivariate analysis demonstrated that AF duration (hazards ratio 1.09, 95% confidence interval 1.04-1.15, p = 0.001) and ln HF 12 months after ablation (hazards ratio 1.91, 95% confidence interval 1.12-3.25, p = 0.017) were independent predictors of AF recurrence after the ablation. CONCLUSIONS: ANS modulation after the three catheter ablation methods was similar and maintained > 1 year after the procedure. Higher parasympathetic nervous function at 1 year after ablation was associated with AF recurrence after the ablation.