Clinical significance of induced left atrial macro-reentrant tachycardia after pulmonary vein isolation.

BACKGROUND: The clinical significance of induced left atrial macro-reentrant tachycardia (LA-AT) after encircling pulmonary vein isolation (EPVI) is unclear. Our objective was to determine whether induced LA-ATs are associated with the clinical recurrence of ATs. METHODS: We studied 185 consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent their first EPVI with an 8-mm tip, nonirrigated catheter approach. AT was induced by atrial burst pacing after the completion of EPVI, and the atrial activation pattern was evaluated using EnSite NavX. Induced LA-ATs were ablated only in patients with clinical ATs of suspected LA origin. The factors associated with occurrence of AT after the procedure were examined. RESULTS: LA-ATs were induced in 38 patients and ablated in 5 patients. During a follow-up of 23 ± 7 months, the occurrence of AT did not differ between patients with nonablated LA-ATs (4/33, 12 %) and those without any inducible ATs (16/113, 14 %, p > 0.99). In multivariate analysis, the number of ablation points for completing EPVI was the only independent predictor of AT occurrence (odds ratio 1.07, p < 0.01). A repeat procedure was performed in 22 of 26 patients who developed AT. Nineteen patients became free from AT and AF after ablation of the conduction gaps (EPVI, n = 17; another line, n = 4), extra PV firing (n = 4), focal AT (n = 4), and induced LA-ATs (n = 3). CONCLUSIONS: In patients who had EPVI for PAF using an 8-mm tip, nonirrigated catheter, the occurrence of AT after EPVI was mainly due to conduction gaps in the ablation line or extra PV triggers. In patients with PAF, LA-ATs induced during the first procedure did not require ablation if they were not associated with clinical AT.

A new species of the genus Ocadia (Testudines: Geoemydidae) from the middle Miocene of Tanegashima Island, southwestern Japan and its paleogeographic implications.

A new geoemydid turtle, Ocadia tanegashimensis (Testudines: Geoemydidae) is described on the basis of a relatively well-preserved shell from the lower middle Miocene of Tanegashima Island, Kagoshima Prefecture, southwestern Japan. This species is clearly distinguished from two congeneric species (extant O. sinensis and O. nipponica from the middle Pleistocene of eastern Japan) due to the presence of the following character states: length of the entoplastron as long as the interhyoplastral suture, the costals dovetailed with one another in outline, the third pleural overlapping only the sixth and seventh peripherals. The present study suggests that the initial intrageneric diversification of Ocadia began not later than the early Miocene in eastern Asia.