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Uehara Y, Yoshida K, Kimata A, Ogawa K, Abe D, Tsumagari Y, Tsuneoka H, Yui Y, Ito Y, Ebine M, Takeyasu N, Aonuma K, Nogami A. Underrecognized entity of the transient rise in the atrial capture threshold early after dual-chamber pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1396-1404. [PMID: 29139149 DOI: 10.1111/pace.13235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/05/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Steroid-eluting pacemaker leads suppress acute rises in pacing threshold by preventing inflammatory processes. However, we occasionally encounter not persistent but transient rise in the atrial capture threshold (TRACT) early after pacemaker implantation. We believe that this phenomenon is underrecognized in clinical practice and may potentially lead to unnecessary reintervention. We aimed to clarify the prevalence, predictors, and possible mechanisms of TRACT. METHODS AND RESULTS We reviewed clinical records from 239 consecutive patients who underwent dual-chamber pacemaker implantation for sick sinus syndrome (SSS) (N = 102) or atrioventricular block (AVB) (N = 137). Atrial capture threshold was measured at implantation and 7 days, 2 months, and 8 months postimplantation. TRACT was defined as a rise in the threshold at day 7 to ≥twice that at implantation, with an absolute value ≥1.0 V/0.4 ms, and full recovery by 8 months into follow-up. TRACT was observed in 15 patients (6%), of whom13 (87%) suffered from SSS but not AVB. Patients with TRACT had greater body mass index (BMI) (25 ± 5 kg/m2 vs 23 ± 4 kg/m2 , P = 0.01), larger left atrium (42 ± 5 mm vs 38 ± 7 mm, P = 0.03), and were more likely to suffer from paroxysmal atrial fibrillation (60% vs 31%, P = 0.02) than those without TRACT. In multivariable logistic regression analysis, BMI and SSS were the independent predictors of TRACT (odds ratio [OR], 1.172; 95% confidence interval [CI], 1.019-1.349; P = 0.03 and OR, 11.53; 95% CI, 2.010-66.21; P = 0.006, respectively). CONCLUSIONS The distinct phenomenon of TRACT was not rare in clinical practice early after dual-chamber pacemaker implantation, and its occurrence was strongly associated with SSS.
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Affiliation(s)
- Yoshiko Uehara
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Kimata
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kojiro Ogawa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Daisuke Abe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuaki Tsumagari
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hidekazu Tsuneoka
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Yoshiaki Yui
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoko Ito
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mari Ebine
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Noriyuki Takeyasu
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Miyazaki S, Nakamura H, Taniguchi H, Hachiya H, Kajiyama T, Watanabe T, Igarashi M, Ichijo S, Hirao K, Iesaka Y. Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second-generation cryoballoon. J Cardiovasc Electrophysiol 2017; 28:1015-1020. [PMID: 28569421 DOI: 10.1111/jce.13262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The intrinsic cardiac autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF) mechanisms. This study evaluated the incidence and impact of intraprocedural vagal reactions and ANS modulation by pulmonary vein isolation (PVI) using second-generation cryoballoons on outcomes. METHODS One hundred three paroxysmal AF patients underwent PVI with one 28-mm second-generation balloon. The median follow-up was 15.0 (12.0-18.0) months. ANS modulation was defined as a >20% cycle length decrease on 3-minute resting electrocardiograms at 1, 3, 6, and 12 months postindex procedure relative to baseline if sinus rhythm was maintained. RESULTS Marked sinus arrests/bradycardia and atrioventricular block (intraprocedural vagal reaction) occurred in 14 and 2 patients, and all sinus arrest/bradycardia occurred in 44 patients with left superior pulmonary veins (PVs) targeted before right PVs. ANS modulation was identified in 66 of 95 (69.5%) patients, and it persisted 12-month postprocedure in 36 (37.9%) patients. Additional β-blocker administration was required in 9 patients for sinus tachycardia. ANS modulation was similarly observed in patients with and without intraprocedural vagal reactions (P = 0.443). Forty-eight (46.6%) patients experienced early recurrences, and the single procedure success at 12 months was 72.7%. Neither intraprocedural vagal reactions nor ANS modulation predicted AF freedom within or after the blanking period. Thirty-three patients underwent second procedures, and reconnections were detected in 39 of 130 (30.0%) PVs among 23 (69.7%) patients. The incidence of reconnections was similar in patients with and without ANS modulation. CONCLUSIONS Increased heart rate persisted in 37.9% of patients even at 12-month post-second-generation cryoballoon PVI. Neither intraprocedural vagal reactions nor increased heart rate predicted a single procedure clinical outcome.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takatsugu Kajiyama
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Tomonori Watanabe
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Miyako Igarashi
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Sadamitsu Ichijo
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshito Iesaka
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Yoshida K, Hasebe H, Tsumagari Y, Tsuneoka H, Ebine M, Uehara Y, Seo Y, Aonuma K, Takeyasu N. Comparison of Pulmonary Venous and Left Atrial Remodeling in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy Versus With Hypertensive Heart Disease. Am J Cardiol 2017; 119:1262-1268. [PMID: 28214001 DOI: 10.1016/j.amjcard.2016.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Left ventricular diastolic dysfunction in hypertrophic cardiomyopathy (HC) increases susceptibility to atrial fibrillation. Although phenotypical characteristics of the hypertrophied left ventricle are clear, left atrial (LA) and pulmonary venous (PV) remodeling has rarely been investigated. This study aimed to identify differences in LA and PV remodeling between HC and hypertensive heart disease (HHD) using 3-dimensional computed tomography. Included were 33 consecutive patients with HC, 25 with HHD, and 29 without any co-morbidities who were referred for catheter ablation of atrial fibrillation. Pre-ablation plasma atrial and brain natriuretic peptide levels, post-ablation troponin T level, and LA pressure were measured, and LA and PV diameters were determined 3 dimensionally. LA transverse diameter in the control group was smaller than that in the HHD or HC group (55 ± 6 vs 63 ± 9 vs 65 ± 12 mm, p = 0.0003). PV diameter in all 4 PVs was greatest in the HC group and second greatest in the HHD group (21.0 ± 3.1 vs 23.8 ± 2.8 vs 26.8 ± 4.1 mm, p <0.0001 for left superior PV). Differences in PV size between the HHD and HC groups were enhanced by indexing to the body surface area (12.4 ± 1.9 vs 13.1 ± 1.4 vs 16.1 ± 3.3 mm/m2, p <0.0001). The PV/LA diameter ratio was greater in the HC than in the other groups (0.38 ± 0.06 vs 0.38 ± 0.05 vs 0.42 ± 0.07, p = 0.01). Atrial natriuretic peptide, brain natriuretic peptide, troponin T levels, and LA pressure were highest in the HC group (all p <0.05). In conclusion, the stiff LA caused from atrial hypertrophy may account for higher levels of biomarkers, higher LA pressure, and PV-dominant remodeling in HC.
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Legallois D, Sorbets E, Chenevier-Gobeaux C, Hallouche M, Boubaya M, Charnaux N, Lebon A, Levy V, Beygui F, Meune C. Score Using Measurements of Plasma Midregional Pro–Atrial Natriuretic Peptide to Estimate the Duration of Atrial Fibrillation. ACTA ACUST UNITED AC 2017; 1:522-531. [DOI: 10.1373/jalm.2016.021477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
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Jawad-Ul-Qamar M, Kirchhof P. Almanac 2015: atrial fibrillation research in Heart. Heart 2016; 102:573-80. [PMID: 26791994 PMCID: PMC4819630 DOI: 10.1136/heartjnl-2015-307809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 01/21/2023] Open
Abstract
Atrial fibrillation continues to attract interest in the cardiovascular community and in Heart. Over 60 original research and review papers published in Heart in 2014–2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published in Heart in 2014–2015, highlighting new developments, emerging concepts and novel approaches to treatment.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK UHB NHS Trust, Birmingham, UK Atrial Fibrillation NETwork (AFNET), Münster, Germany Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
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Kimata A, Yoshida K, Takeyasu N, Nakagami R, Osada J, Mitsuhashi T, Aonuma K, Nogami A. Bradycardia-dependent rise in the atrial capture threshold early after cardiac pacemaker implantation in patients with sick sinus syndrome. HeartRhythm Case Rep 2015; 2:27-31. [PMID: 28491626 PMCID: PMC5412638 DOI: 10.1016/j.hrcr.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Akira Kimata
- Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Japan.,Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kentaro Yoshida
- Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Japan.,Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noriyuki Takeyasu
- Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Japan.,Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Rieko Nakagami
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Jun Osada
- Department of Cardiology, Yokosuka General Hospital Uwamachi, Yokosuka, Japan
| | - Takeshi Mitsuhashi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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