Yuya Suzuki

and 15 more

Aims Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades. Methods A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade (n = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade (n = 10), and group 3, non-CS patients (n = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated. Results The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; p=0.039, ΔESV: 3.0 mL vs. -12.7 mL vs. -37.2 mL; p = 0.008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups (p = 0.19). No cardiovascular deaths occurred in group 1. Conclusion CS patients taking corticosteroids before the CRT upgrade had lower echocardiographic responses but higher freedom rates from a composite endpoint. The timing of corticosteroid use would affect the clinical course following a CRT upgrade.

Mitsuru Takami

and 13 more

Introduction: In the COVID-19 era, demand is growing for remote ECG monitoring systems with less or no in-person contact. However, the practical usage of wearable ECG devices has been little studied in Japan. This study aimed to report our initial experience of using the postal system in the delivery of the self-wearable ECG device (Duranta) and long-term ECG monitoring in outpatient care. Methods:   The Duranta is small, light (35 g), and easy to attach to the chest with two patch electrodes. Real-time ECG data were automatically transmitted to a cloud server via iPhones. The devices were packed in prepaid envelopes that could be put in any postbox for delivery between the hospital and patients’ homes. Results: Twenty-five patients (61 ± 17 years) were enrolled. The median distance to the hospital from the patients’ homes was 10 km (range: 1.1–183). The patients had no difficulties with either the postal delivery or wearing the ECG devices. A total of 57 hours (range: 20–179) of ECG monitoring per patient was performed, and the data were successfully transmitted to the hospital. The median percentage of noise/artifact burden during the ECG monitoring was 0.9%. Arrhythmic events were observed in 8 patients. Most patients were satisfied with the ECG system and delivery via the postal service. Conclusion: The use of a postal delivery of a wearable ECG device could work in clinical practice with to achieve less or no in-person contact. This system can be applicable for telehealth, home care, and arrhythmia screening.

Kazutaka Nakasone

and 14 more

Toshihiro Nakamura

and 18 more

Background: Some of atrial fibrillation (AF) drivers are found in lesser late-gadolinium enhancement (LGE) areas, as well as heterogenous ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in lesser LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping). Lesser LGE areas were defined as areas with a volume ratio of the enhancement voxel of <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI. Results: NPAs were found in 20 (18.0%) of 131 lesser LGE areas where the AWT was significantly thicker than that in the passively activated areas (PAs) (2.46±0.26 vs. 2.20±0.25 mm, p<0.001). However, NPAs were found in 61 (21.3%) of 287 LGE areas where the AWT was similar to that of the PAs (2.24±0.24 vs. 2.22±0.25 mm, p=0.58). An ROC curve analysis yielded an optimal cutoff value of 2.24 mm for predicting the presence of an NPA in lesser LGE areas. Conclusion: The location of AF drivers in lesser LGE areas might be more accurately identified by evaluating the AWT.

Toshihiro Nakamura

and 18 more

Background: A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy fibrotic tissue and play an important role in AF drivers. However, this was not validated in humans. Objective: The purpose of this study was to evaluate the fibrotic tissue properties of AF rotors in patients with persistent AF. Methods: A total of 287 segments in 15 patients with persistent AF (longstanding persistent AF in 9 patients) that underwent AF ablation were assessed. Non-passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real-time phase mapping (ExTRa Mapping). Atrial fibrosis was detected by late-gadolinium enhancement magnetic resonance imaging (LGE-MRI), and the fibrotic heterogeneity and density were assessed by the entropy (LGE-entropy) and volume ratio of the enhancement voxel (LGE-volume ratio), respectively. Results: NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7 and 10% for the LGE-entropy and LGE-volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE-entropy of >5.7 and LGE-volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments, p = 0.001). No NPAs were found at segments with an LGE-volume ratio of >50% regardless of the LGE-entropy. Conclusion: AF rotors are mostly distributed in relatively weak and much more heterogenous fibrotic tissue.

kunihiko kiuchi

and 20 more