Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures　- Large-Scale Multicenter Analysis.

BACKGROUND: Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS: CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

Spectral Image Processing for Museum Lighting Using CIE LED Illuminants.

This work presents a spectral color-imaging procedure for the detailed colorimetric study of real artworks under arbitrary illuminants. The results demonstrate this approach to be a powerful tool for art and heritage professionals when deciding which illumination to use in museums, or which conservation or restoration techniques best maintain the color appearance of the original piece under any illuminant. Spectral imaging technology overcomes the limitations of common area-based point-measurement devices such as spectrophotometers, allowing a local study either pixelwise or by selected areas. To our knowledge, this is the first study available that uses the proposed CIE (Commission Internationale de l'Éclairage) light-emitting diode (LED) illuminants in the context of art and heritage science, comparing them with the three main CIE illuminants A, D50, and D65. For this, the corresponding colors under D65 have been calculated using a chromatic adaptation transform analogous to the one in CIECAM02. For the sample studied, the CIE LED illuminants with the lowest average CIEDE2000 color differences from the standard CIE illuminants are LED-V1 for A and LED-V2 for D50 and D65, with 1.23, 1.07, and 1.57 units, respectively. The work studied is a Moorish epigraphic frieze of plasterwork with a tiled skirting from the Nasrid period (12th-15th centuries) exhibited in the Museum of the Alhambra (Granada, Spain).

A Decision Tree-Based Survival Analysis of Patients with a History of Inappropriate Implantable Cardioverter-Defibrillator Therapy.

Implantable cardioverter-defibrillators (ICDs) improve survival in patients who are at risk of sudden death. However, inappropriate therapy is commonly given to ICD recipients, and this situation may be associated with an increased risk of death. This study aimed to construct a risk stratification scheme by using decision tree analysis in patients who received inappropriate ICD therapy.Mortality was calculated from a retrospective data analysis of a multicenter cohort involving 417 ICD recipients. Inappropriate therapy was defined as therapy for nonventricular arrhythmias, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation/flutter, oversensing, and lead failure. Inappropriate therapy included antitachycardia pacing, cardioversion, and defibrillation. The prognostic factors were identified by a Cox proportional hazards regression analysis, and we constructed a decision tree.During an average follow-up of 5.2 years, 48 patients (12%) had all-cause death. A multivariate Cox hazard model revealed that the age (hazard ratio [HR] 1.06, P < 0.001), ln B-type natriuretic peptide (BNP) (HR 1.47, P = 0.02), nonsinus rhythm at implantation (HR 2.70, P < 0.05), and inappropriate therapy occurring during sedentary/awake conditions (HR 3.51, P = 0.001) correlated with an increased risk of mortality. An inappropriate therapy due to abnormal sensing (HR 0.16, P = 0.04) decreased the risk of mortality. Furthermore, a decision tree analysis stratified the patients well by using 4 covariates: BNP, activity at the time of inappropriate therapy, mechanism of inappropriate therapy, and baseline rhythm at ICD implantation (log-rank test, P < 0.0001).We identified the predictors of mortality in inappropriate ICD therapy recipients and constructed a risk stratification scheme by using decision tree analysis.

Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial.

AIMS: Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. METHODS AND RESULTS: A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73-0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79-1.09; P = 0.38). CONCLUSION: Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase.

Usefulness of non-contrast-enhanced MRI with two-dimensional balanced steady-state free precession for the acquisition of the pulmonary venous and left atrial anatomy pre catheter ablation of atrial fibrillation: Comparison with contrast enhanced CT in clinical cases.

BACKGROUND: To investigate the feasibility of substituting non-contrast-enhanced MR (non-CE-MR) imaging with a two-dimensional (2D) balanced steady-state free precession (b-SSFP) sequence for contrast-enhanced computed tomography (CE-CT) for atrial fibrillation (AF) ablation. METHODS: Fifty-four patients that underwent AF ablation under the guidance of a 3D electro-anatomical mapping system with CE-CT (n = 27) or non-CE-MR images (n = 27) were studied. Procedural results were compared between the two groups. Furthermore, in 22 patients who underwent both CE-CT and non-CE-MRI, two cardiologists independently scored the multiplanar reformatted images on a scale of 1 to 4 (from 1, poor, to 4, excellent). RESULTS: The image score was nearly 0.5 point higher with the CE-CT method. However, the procedural results such as the surface registration error (1.0 [0.8-1.6] mm versus 1.0 [0.8-1.35] mm, P = 0.88) and procedure time (185 [159-199] min versus 185 [142-221] min, P = 0.86) did not significantly differ between the CE-CT and non-CE-MR groups. CONCLUSION: The non-CE-MR method with a 2D-b-SSFP sequence can give us adequate information on AF ablation without any radiation exposure or contrast medium usage

Eating with our eyes: From visual hunger to digital satiation.

One of the brain's key roles is to facilitate foraging and feeding. It is presumably no coincidence, then, that the mouth is situated close to the brain in most animal species. However, the environments in which our brains evolved were far less plentiful in terms of the availability of food resources (i.e., nutriments) than is the case for those of us living in the Western world today. The growing obesity crisis is but one of the signs that humankind is not doing such a great job in terms of optimizing the contemporary food landscape. While the blame here is often put at the doors of the global food companies - offering addictive foods, designed to hit 'the bliss point' in terms of the pleasurable ingredients (sugar, salt, fat, etc.), and the ease of access to calorie-rich foods - we wonder whether there aren't other implicit cues in our environments that might be triggering hunger more often than is perhaps good for us. Here, we take a closer look at the potential role of vision; Specifically, we question the impact that our increasing exposure to images of desirable foods (what is often labelled 'food porn', or 'gastroporn') via digital interfaces might be having, and ask whether it might not inadvertently be exacerbating our desire for food (what we call 'visual hunger'). We review the growing body of cognitive neuroscience research demonstrating the profound effect that viewing such images can have on neural activity, physiological and psychological responses, and visual attention, especially in the 'hungry' brain.

Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial.

AIMS: Most of recurrent atrial tachyarrhythmias after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are due to reconnection of PVs. The aim of the present study was to evaluate whether elimination of adenosine triphosphate (ATP)-induced dormant PV conduction by additional energy applications during the first ablation procedure could reduce the incidence of recurrent atrial tachyarrhythmias. METHODS AND RESULTS: We randomly assigned 2113 patients with paroxysmal, persistent, or long-lasting AF to either ATP-guided PVI (1112 patients) or conventional PVI (1001 patients). The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of Vaughan Williams class I or III antiarrhythmic drugs at 1 year with the blanking period of 90 days post ablation. Among patients assigned to ATP-guided PVI, 0.4 mg/kg body weight of ATP provoked dormant PV conduction in 307 patients (27.6%). Additional radiofrequency energy applications successfully eliminated dormant conduction in 302 patients (98.4%). At 1 year, 68.7% of patients in the ATP-guided PVI group and 67.1% of patients in the conventional PVI group were free from the primary endpoint, with no significant difference (adjusted hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.74-1.09; P = 0.25). The results were consistent across all the prespecified subgroups. Also, there was no significant difference in the 1-year event-free rates from repeat ablation for any atrial tachyarrhythmia between the groups (adjusted HR 0.83; 95% CI 0.65-1.08; P = 0.16). CONCLUSION: In the catheter ablation for AF, we found no significant reduction in the 1-year incidence of recurrent atrial tachyarrhythmias by ATP-guided PVI compared with conventional PVI.

Motion perception under mesopic vision.

Mesopic and scotopic vision extend over an illuminance range of 106. The goal of the present study was to determine the effect of decreasing light level on the underlying motion mechanism that integrates spatiotemporally separated motion signals. To accomplish this, we took advantage of the phenomenon of visual motion priming, in which the perceived direction of a directionally ambiguous test stimulus is influenced by the directional movement of a preceding priming stimulus. After terminating a drifting priming stimulus, a 180° phase-shifted grating was presented as a test stimulus. The priming and test stimuli were separately presented to the central and peripheral retinas, respectively. The participants judged the perceived direction of this test stimulus at various light levels from photopic to scotopic levels. We found that the effects of motion priming disappeared over 1 log unit of mesopic light levels. When the test stimulus was presented before the offset of the priming stimulus to compensate for the temporal delay in the rod pathway or when both stimuli were presented at the same location in the periphery, a motion-priming effect appeared at mesopic light levels. These results suggest that different temporal characteristics between the cone pathway and rod pathway disturb the function of the putative motion mechanism responsible for the spatiotemporal integration of motion signals, which leads to specific modulation of motion perception over a wide range of mesopic vision.

Distribution of Ventricular Fibrosis Associated With Life-Threatening Ventricular Tachyarrhythmias in Patients With Nonischemic Dilated Cardiomyopathy.

BACKGROUND: Current guidelines recommend the implantation of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) in a subgroup of patients with nonischemic cardiomyopathy (NICM) who have a left ventricular ejection fraction (LVEF) ≤ 30-35%, and are NYHA functional class II or III. However, the majority of patients with an ICD implantation for primary prevention did not receive appropriate ICD therapy. The purpose of this study was to evaluate the association between myocardial fibrosis detected by cardiovascular magnetic resonance (CMR) imaging and life-threatening ventricular arrhythmic events in NICM patients. METHODS: One hundred and seventy-five NICM patients with an LVEF ≦ 35 % and NYHA functional class II or III, (60 ± 15 years, LVEF 29 ± 5.4%) were studied. Myocardial fibrosis was identified with a late gadolinium enhancement (LGE) on CMR. Clinical events were defined as SCD or life-threatening ventricular arrhythmic events and were followed up for 5.1 ± 3.3 years. RESULTS: The presence of an LGE was detected in 122 patients (70%). No life-threatening ventricular arrhythmia events occurred in patients with the absence of an LGE. A total of 18 ventricular tachycardia and 8 ventricular fibrillation events were found in patients with the presence of an LGE (P < 0.01). Sensitivity, specificity, and positive and negative predictive value of LGE in predicting life-threatening ventricular arrhythmia events were 100%, 34%, and 15% and 100%, respectively. Multivariate analysis showed that the presence of both septal and lateral mid-wall LGE was associated with life-threatening ventricular arrhythmic events (hazard ratio 23.1 CI; 2.88-184.9, P = 0.003). CONCLUSIONS: The absence of an LGE predicts a low potential risk of SCD and life-threatening ventricular arrhythmia events in the near future. CMR may be a useful tool for selecting suitable patients for primary ICD implantations in NICM patients.

Novel Compression Tool to Prevent Hematomas and Skin Erosions After Device Implantation.

BACKGROUND: The incidence of hematoma formation following implantation of a cardiovascular implantable electronic device (CIED) is estimated to be 5% even if a pressure dressing is applied. It is unclear whether a pressure dressing can really compress the pocket in different positions. Furthermore, the adhesive tape for fixing pressure dressings can tear the skin. We developed a new compression tool for preventing hematomas and skin erosions. METHODS AND RESULTS: We divided 46 consecutive patients receiving anticoagulation therapy who underwent CIED implantation into 2 groups (Group I: conventional pressure dressing, Group II: new compression tool). The pressure on the pocket was measured in both the supine and standing positions. The incidence of hematomas was compared between the 2 groups. The pressure differed between the supine and standing positions in Group I, but not in Group II (Group I: 14.8±7.1 mmHg vs. 11.3±9.9 mmHg, P=0.013; Group II: 13.5±2.8 mmHg vs. 13.5±3.5 mmHg, P=0.99). The incidence of hematomas and skin erosions was documented in 2 (8.7%) and 3 (13%) Group I patients, respectively. No complications were documented in Group II. CONCLUSIONS: The new compression tool can provide adequate continuous pressure on the pocket, regardless of body position. This device may reduce the incidence of hematomas and skin erosions after CIED implantation.

Late re-conduction sites in the second session after pulmonary vein isolation using adenosine provocation for atrial fibrillation.

AIMS: Intravenous adenosine triphosphate (ATP) administration could reveal dormant conduction (DC) gaps on the ablation line of a pulmonary vein isolation (PVI). We compared the ATP-provoked DC sites in the initial PVI with the PV re-conduction sites in the second session in patients with paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: We conducted a multicenter, observational study from a prospective registry undergoing AF ablation. A total of 110 consecutive drug-refractory paroxysmal AF patients were enroled in this study. Dormant conduction was detected by an ATP provocation of up to 40 mg during a continuous isoproterenol infusion (0.5-2 µg/min). The DC sites at each of the right and left PVs were precisely determined by using double spiral catheters under the guidance of a three-dimensional constructed anatomical mapping system. In the initial session, DC was observed in 35 patients (31.8%, 1.3 gaps/patient), and the sites of the DC were commonly observed in the carina region (43.5%). Atrial fibrillation recurrence was confirmed in 33 patients (30.0%) during follow-up (27.1 months), and a second session was performed in 24 of 33 patients (70.6%). In the second session, the re-conduction sites were also commonly observed in the carina region (59.5%). CONCLUSION: The carina region was still a dominant re-conduction site even after the elimination of any ATP-provoked DC in the index procedure.

Fat embolism syndrome: A severe case diagnosed early using dual-energy CT and saved with VA-ECMO and inhaled nitric oxide.

Diagnosing FES is difficult and time-consuming, and identify FES as an etiology of right ventricular volume overload for early diagnosis. Because FES is a reversible condition, even severe cases can bse treated if the patient survives the acute phase.

A case of cough syncope diagnosed by the Valsalva maneuver and cough induction test under invasive arterial pressure measurement.

Following the loss of consciousness during the Valsalva maneuver and cough induction test, real-time arterial pressure measurement could clarify the significant blood pressure decrease in a patient with cough syncope.

Statistical quantification of the effects of viewing distance on texture perception.

In general, viewers are more attracted to local features in images at a shorter viewing distance and to global features in images at a longer viewing distance. However, numerical analysis of the effect of viewing distance on human texture perception and how the perception of global and local changes under certain conditions are still undetermined. In this paper, we present statistical prediction of the relationship between the domination ratio of global and local features and the viewing distances under the control of several factors, using the logistic regression model. We synthesized textures by separately controlling global and local textural features using a texture model based on mathematical morphology, namely the primitive, grain, and point configuration texture model. Visual sensory tests were carried out on 80 subjects during two sets of experiments. The collected data were statistically analyzed using logistic regression and Akaike information criteria. Besides the main factor of viewing distance, the factors including gender, changing the order of viewing positions, and prior knowledge were also shown quantitatively to have significant influence on human texture perception. Our results showed that (1) local features of a texture were more attractive to females than males, (2) the first impression might have affected subsequent decisions in texture perception, and (3) subjects who had prior knowledge (supervised) were more sensitive to the changes in global and local dominance. (4) Regarding the interactions of the factors, prior knowledge reduced the effects of individual differences and perception condition differences on human texture perception. This study is dedicated to the construction of numerical relationships between viewing distance and human texture perception as well as to cognitive investigation of biases in global and local perceptions.

Image statistics on the age perception of human skin.

BACKGROUND/PURPOSE: Recent research on the age-dependent changes of facial skin has analyzed their correlation with changes in image and colorimetric properties using mainly first- and second-order statistics. The aim of this study is to reveal the importance of third-order statistics and relate those image properties to skin age perception. METHODS: Photographs of the faces of 118 Japanese women ranging in age from 13 to 80 years were taken in a controlled environment. Subsequently, 10 Japanese subjects rated the age perception of skin patches from the cheek area of the original facial images. RESULTS: The age estimation of the skin patches was highly correlated with its chronological age proving that our skin patches contain enough information for age estimation. Also, the perceived age was significantly high correlated to color and lightness statistical values. Specifically, age perception was significantly high correlated with third-order statistics of all channels in CIELAB1976. CONCLUSION: Our results reveal the importance of higher order statistics for the development of nonintrusive skin quality assessments of the skin.

Daylights with high melanopsin stimulation appear reddish in fovea and greenish in periphery.

Melanopsin reportedly contributes to brightness and color appearance in photopic vision in addition to cone photoreceptor cells. However, the relationship between the contribution of melanopsin to color appearance and retinal location is unclear. Herein, we generated metameric daylights (5000 K/6500 K/8000 K) with different melanopsin stimulations while keeping the size and colorimetric values intact and measured the color appearance of the stimuli in the fovea and periphery. The experiment included eight participants with normal color vision. We found that with high melanopsin stimulation, the color appearance of the metameric daylight shifts to reddish at the fovea and greenish in the periphery. These results are the first to show that the color appearance of visual stimuli with high melanopsin stimulation can be completely different in the foveal and peripheral vision even when the spectral power distribution of visual stimuli in both visions is the same. Both colorimetric values and melanopsin stimulation must be considered when designing spectral power distributions for comfortable lighting and safe digital signage in photopic vision.

Pacemaker implantation for persistent sinus node dysfunction in a patient with COVID-19.

A 46-year-old woman was admitted with coronavirus disease-2019 infection. Symptomatic sinus bradycardia occurred, followed by congestive heart failure. Therapeutics such as isoproterenol, theophylline, and cilostazol could not safely improve her symptoms. She underwent pacemaker implantation 53 days after admission. Atrial pacing remained was at 60% after 6 months.

Reverse remodelling induces progressive ventricular resynchronization after cardiac resynchronization therapy 'from vicious to virtuous cycle'.

AIMS: Cardiac resynchronization therapy (CRT) can stop the vicious cycle resulting from dyssynchrony and generates left ventricular (LV) reverse remodelling. Our objective was to assess the time course and the relationship between improvement in LV dyssynchrony and reverse remodelling after CRT. METHODS AND RESULTS: Sixty-four consecutive patients were evaluated before, immediately after, and 3- and 6 months after CRT. We measured LV volumes, ejection fraction (EF), and sphericity index, and dyssynchrony was assessed using speckle-tracking radial strain. Response was defined as a >15% decrease in end-systolic volume (ESV) 6 months after CRT, and event-free survival was followed for 24 months. Responders and non-responders had similar baseline LV volumes and EF. During the first and the following 3 months after CRT, LV volumes gradually decreased (end-diastolic volume: 195±73 to 164±60* to 129±51 mL†, ESV: 141±70 to 110±47* to 82±40 mL†), and sphericity index and EF progressively increased (sphericity index: 1.52±0.20 to 1.75±0.31* to 1.94±0.34†, EF: 28±7 to 34±7* to 38±8%†, *†P<0.001) in responders. No such changes were observed in non-responders. Furthermore, dyssynchrony diminished progressively during the first and the following 3 months after CRT and patients with progressive resynchronization experienced fewer major cardiovascular events than those without (P<0.001). CONCLUSION: CRT can stop the vicious cycle of remodelling and dyssynchrony, and actually, turn it into the virtuous cycle of reverse remodelling and further resynchronization.

The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study.

BACKGROUND: The relationship between the timing of the first early recurrence and late recurrence after a single catheter ablation procedure for atrial fibrillation is controversial. METHODS: The Efficacy of Short-Term Use of Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation trial followed 2038 patients who underwent radiofrequency catheter ablation for atrial fibrillation. RESULTS: Of the patients, 907 (45%) had early recurrences within 90 days after the initial ablation. We divided these patients into two groups according to the timing of the first early recurrence episode, namely the ER1 group (early recurrence during the early phase; 0-30 days, n = 814) and ER2 group (early recurrence during the late phase; 31-90 days, n = 93). Three years after ablation, patients with early recurrences had a significantly lower event-free rate from late recurrences after a 90-day blanking period than patients without early recurrences (36.2% and 74.2%, respectively; log-rank, P < 0.0001). Three years after ablation, the event-free rate was significantly higher in the ER1 than the ER2 group (38.3% and 17.1%, respectively; log-rank, P < 0.0001). Moreover, the event-free rate at 3 years in the ER2 group was extremely low (5.6%) in patient with non-paroxysmal atrial fibrillation. CONCLUSION: Early recurrences were strongly associated with late recurrences, especially in patients with the first recurrence episode at >1 month within the blanking period after a single ablation procedure. Therefore, these patients should undergo close observation during follow-up, when they had especially with non-paroxysmal atrial fibrillation.

Influence of luminance distribution on the appetizingly fresh appearance of cabbage.

We investigated the effect that the parameters of luminance distribution in fresh food have on our visual perception of its freshness. We took pictures of the degradation over 32 h in freshness of a cabbage. We used original images, which were patches of the pictures taken at different sampling hours, and artificially generated pictures, called "matched images," created by fitting the luminance histogram shape of the original image (taken at the 1st hour) to those at various freshness stages using a luminance histogram-matching algorithm. Nine participants rated the perceived freshness of the original and the matched images on a scale of degradation. As a result, we found that the participants could quantitatively estimate the degradation in freshness of the cabbage simply by looking at the presented images. Some parameters of the luminance histograms monotonically change with decreasing freshness, indicating that the freshness of cabbage can be estimated using these parameters. However, the freshness ratings for the matched images after the 8th hour of degradation had lower modification than those for the respective original images. These results suggest that the luminance distribution in the vegetable texture partly contributes to visual freshness perception but other variables, such as spatial patterns, might also be important for estimating visual freshness.