Association of left pulmonary vein trunk and subclinical atrial fibrillation in patients with cardiac implantable electronic device.

The relationship between subclinical atrial fibrillation (SCAF) and left pulmonary vein anatomy is unknown. This study sought to investigate whether left pulmonary vein trunk predict the development of SCAF in patients with cardiac implantable electronic device (CIED). We also examined the relationship between the duration of SCAF and left pulmonary vein trunk. We retrospectively enrolled 162 patients who underwent implantation of dual-chamber CIEDs and follow-up by remote monitoring system. Computed tomography was used to measure the length of the left pulmonary vein. During median follow up of 2.7 years, the episodes of > 6 min and > 24 h SCAF were observed in 61 (37.7%) and 24 (14.8%) patients, respectively. The diagnosis of sinus node disease (HR: 3.66 [2.06-6.52], P < 0.01 and HR: 2.68 [1.09-6.62], P = 0.04) and left atrial diameter (HR: 1.04 [1.00-1.07], P = 0.04 and HR: 1.05 [1.00-1.10], P = 0.04) were independent predictors for > 6 min and > 24 h SCAF, respectively. Length of the left pulmonary vein trunk was an independent predictor for > 6 min SCAF (HR: 1.06 [1.02-1.10], P < 0.01), but not for > 24 h SCAF (P = 0.06). Sinus node disease, size of the left atrium and length of the left pulmonary vein trunk were related to SCAF. The left pulmonary vein trunk might especially contribute as a trigger rather than as a driver of development of atrial fibrillation.

Transvenous permanent pacemaker implantation after debranching thoracic endovascular aortic repair; A case series.

Debranching thoracic endovascular aortic repair may disturb the implantation of a cardiac implantable electronic device in the anterior thoracic region. In case 1, the bypass graft between the right axillary artery, left axillary artery, and left common carotid artery disturbed pacemaker implantation from the left anterior thoracic region. Therefore, right-sided implantation was selected. By contrast, in case 2, the bypass graft between axillary arteries in the anterior thoracic region was visible on fluoroscopy, and we performed conventional left-sided pacemaker implantation with extra-thoracic puncture. The pacemaker implantations were successful in both cases. The implantation strategies were affected by the number of debranched arteries and visibility of the bypass graft.

Relationship between postoperative atrial fibrillation and its recurrence after lung resection.

PURPOSE: Atrial fibrillation (AF) frequently occurs after pulmonary resection and is commonly referred to as postoperative atrial fibrillation (POAF). This study explored whether or not POAF is related to the recurrence of AF in the chronic phase. METHODS: A total of 1311 consecutive patients without a history of AF who underwent lung resection based on a diagnosis of lung tumor were retrospectively analyzed. RESULTS: POAF occurred in 46 patients (3.5%), and a logistic regression analysis revealed that the age (p < 0.05), history of hyperthyroidism (p < 0.05), and major lung resection (p < 0.05) were independent predictors of POAF. AF events in the chronic phase were observed in 15 (32.6%) and 45 (3.6%) patients with and without POAF, respectively. A Cox regression analysis revealed that POAF was the only independent predictor of AF development in the chronic phase (p < 0.01). The Kaplan-Meier curve and log-rank test revealed that the cumulative incidence of AF in the chronic phase was significantly higher in patients with POAF than in those without POAF (p < 0.01). CONCLUSION: POAF was an independent predictor for AF in the chronic phase after lung resection. Further investigations including cases of catheter ablation and optimal medical therapy for patients with POAF after lung resection are needed.

Impact of pulmonary vein anatomy and left atrial size on postoperative atrial fibrillation after esophagectomy for esophageal cancer.

BACKGROUND: This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) after esophagectomy and pre-existing cardiac substrate. METHODS: We retrospectively analyzed 212 consecutive patients from between July 2010 and December 2022 who were scheduled to undergo esophagectomy for esophageal cancer without previous history of atrial fibrillation. All the patients underwent both echocardiography and contrast-enhanced multi-detector computed tomography (MDCT). RESULTS: POAF occurred in 49 patients (23.1%). Multivariable logistic analysis demonstrated that independent predictors for POAF were age [OR; 1.06 (1.01-1.10), P < 0.01), three-field lymph node dissection [OR; 2.55 (1.25-5.23), P < 0.01), left atrial dilatation (> 35 mm) assessment by echocardiography [OR; 3.05 (1.49-6.25), P < 0.01) and common left pulmonary vein [OR; 3.03 (1.44-6.39), P < 0.01). The correlation coefficient was high for left atrial dimensions assessed by echocardiography and MDCT (r = 0.91, P < 0.01). Combination of left atrial dilatation by echocardiography and common left pulmonary vein had high odds ratio [OR; 8.10 (2.62-25.96), P < 0.01). Instead of echocardiographic assessment, combination of left atrial enlargement (> 35 mm) assessed by MDCT and common left pulmonary vein also showed high odds ratio for POAF [OR; 11.23 [2.19-57.63], P < 0.01). CONCLUSION: Incidence of POAF after esophagectomy was related to both left atrial enlargement and common left pulmonary vein assessed by preoperative MDCT. Additional analysis of atrial size and pulmonary vein variation would facilitate preoperative assessment of the risk of POAF, but future studies must ascertain therapeutic strategy.

Hsc70 is required for E-cadherin expression in epithelial-like NRK-52E cells.

Heat-shock cognate protein 70 (Hsc70), a molecular chaperone, is involved in multiple cellular functions. We previously demonstrated that Hsc70 is required for TGF-ß-induced Smad signaling in mesenchymal-like NRK-49F cells. In the present study, to compare the Hsc70 functions in TGF-ß-related signaling between epithelial and mesenchymal cells, we examined the effect of Hsc70 downregulation on TGF-ß-induced signaling in epithelial-like NRK-52E cells. TGF-ß-induced Smad signaling was suppressed in cells treated with small interfering RNA (siRNA) for Hsc70. Interestingly, despite interference with TGF-ß signaling, TGF-ß-induced suppression of E-cadherin expression was not affected by Hsc70 knockdown. Instead, Hsc70 knockdown itself caused the suppression of E-cadherin expression at the transcription level in cells treated with Hsc70 siRNA. We also examined the effects of Hsc70 knockdown on the level of E-cadherin-gene repressors, such as Snail1, Slug, Zeb1, Zeb2, and Twist1, and found that transcription of the repressors was upregulated after 24- or 36-h treatment with Hsc70 siRNA. Collectively, these results indicate that, in addition to a supportive role in TGF-ß-induced signaling, Hsc70 supports E-cadherin expression through downregulation of the E-cadherin-gene repressors in NRK-52E cells, suggesting that Hsc70 plays a functional role to maintain the epithelial cell phenotype.

Hsc70 facilitates TGF-ß-induced activation of Smad2/3 in fibroblastic NRK-49F cells.

Heat-shock cognate protein 70 (Hsc70), a molecular chaperone constitutively expressed in the cell, is involved in the regulation of several cellular signaling pathways. In this study, we found that TGF-ß-induced phosphorylation and nuclear translocation of Smad2/3 were suppressed in fibroblastic NRK-49F cells treated with small interfering RNA (siRNA) for Hsc70. In the cells underexpressing Hsc70, transcriptional induction of connective tissue growth factor (CTGF), a target gene of the TGF-ß signaling, was also suppressed in the early phase of TGF-ß stimulation. Upon stimulation with TGF-ß, Hsc70 interacted with Smad2/3, suggesting functional interactions of Hsc70 and Smad2/3 for the activation of TGF-ß-induced Smad signaling. Although the expression of heat-shock protein 70 (Hsp70) was upregulated in the cells treated with Hsc70 siRNA, TGF-ß-induced Smad activation was not affected in the cells overexpressing Hsp70. Collectively, these results indicate that Hsc70, but not Hsp70, supportively regulates TGF-ß-induced Smad signaling in NRK-49F cells.

Cryoablation for atrial tachycardia with cycle length variability originating from the vicinity of the sinus node.

This case is about atrial tachycardia with cycle length variability originating from the vicinity of the sinus node and diagnostic pacing maneuvers to assess the tachycardia circuit were not achieved. Activation mapping revealed that the origin of atrial tachycardia was 15 mm away from the sinus node and the phrenic nerve was captured by pacing at the posterior portion of atrial tachycardia. A multipolar catheter was placed in the right brachiocephalic vein to capture the right phrenic nerve by pacing. The absence of phrenic nerve palsy was confirmed by palpation of constant diaphragmatic movement. The cryoablation could be safely and efficiently performed without ablation-induced injury of sinus node and phrenic nerve palsy by confirming constant diaphragmatic movement. The efficacy of cryoablation in the vicinity of the conduction system and phrenic nerve will be increasingly confirmed in the future. Learning Objective: Cryoablation for atrial tachycardia might be more safe and effective in terms of ablation-induced injury of conduction system and phrenic nerve palsy compared with conventional radiofrequency ablation when diagnostic pacing maneuvers are not able to estimate the circuit due to variability of tachycardia cycle length.

Impact of tag index and local electrogram for successful first-pass cavotricuspid isthmus ablation.

Background: The optimal ablation index (AI) value for cavotricuspid isthmus (CTI) ablation is unknow. Objective: This study investigated the optimal AI value and whether preassessment of local electrogram voltage of CTI could predict first-pass success of ablation. Methods: Voltage maps of CTI were created before ablation. In the preliminary group, the procedure was performed in 50 patients targeting an AI ≥450 on the anterior side (two-thirds segment of CTI) and AI ≥400 on the posterior side (one-third segment of CTI). The modified group also included 50 patients, but the target AI for the anterior side was modified to ≥500. Results: In the modified group, the first-pass rate of success was higher (88% vs 62%; P < .01) than in the preliminary group, and there were no differences in the average bipolar and unipolar voltages at the CTI line. Multivariate logistic regression analysis revealed that ablation with an AI ≥500 on the anterior side was the only independent predictor (odds ratio 4.17; 95% confidence interval 1.44-12.05; P < .01). The bipolar and unipolar voltages were higher at sites without conduction block than at sites with conduction block (both P < .01). The cutoff values for predicting conduction gap were ≥1.94 mV and ≥2.33 mV with areas under the curve of 0.655 and 0.679, respectively. Conclusions: CTI ablation with a target AI >500 on the anterior side was shown to be more effective than an AI >450, and local voltage at a conduction gap was higher than without a conduction gap.

Pericardial Lipoma With Fat Necrosis.

A pericardial lipoma is a rare benign cardiac tumor, and fat necrosis is an uncommon clinical condition. This is the first reported case of pericardial lipoma with fat necrosis, which showed clinical presentations of a malignant tumor despite imaging findings consistent with benign lipoma. (Level of Difficulty: Advanced.).