Conduction System Pacing Upgrade in Chronic Heart Failure with Severe Left Ventricular Dysfunction and Chronic Atrial Fibrillation.

Cardiac resynchronization therapy (CRT) is a standard treatment for patients with severe congestive heart failure. However, one-third of patients receiving CRT are non-responders. Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has become an alternative to CRT therapy. Furthermore, CRT therapy with CSP has shown to be more effective than CRT alone. When an implantable cardiac defibrillator or CRT-defibrillator is implanted with CSP, the problem of which port the HBP lead and LBBAP lead should be connected to arises. We report 2 cases of upgrading to CRT with CSP by utilizing the atrial ports for HBP and LBBAP leads. The procedure is a simple, reasonable, and effective therapy for end-stage heart failure.

Giant aneurysm of left circumflex artery branch with fistula to the coronary sinus: a case report.

BACKGROUND: Aneurysm of a coronary artery branch with a fistula is extremely rare. Here, we present a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus treated successfully with aneurysmectomy. CASE PRESENTATION: A 58-year-old woman was referred to our hospital due to an abnormal pericardial mass found by multidetector computed tomography. Imaging examination revealed a dilated left circumflex artery branch with a 30-mm aneurysm. Coronary angiography confirmed a left circumflex artery branch aneurysm with a fistula to the coronary sinus. As percutaneous occlusion of the aneurysm by catheterization was considered unsuccessful, the aneurysm was resected, and the fistula was occluded surgically with excellent outcome. Pathological examination suggested that congenital factors may have contributed to the development of the aneurysm. Computed tomography showed no recurrence of the aneurysm at 1-year postoperative follow-up. CONCLUSIONS: We presented a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus. This is the first report of the combination of a giant coronary artery branch aneurysm with a fistula to the coronary sinus. Surgical aneurysmectomy should be considered in such cases to avoid fatal aneurysmal complications.

Successful Treatment of Refractory Cardiogenic Shock and Electrical Storm Using the IMPELLA 5.0 with Atrial Overdrive Pacing, in a Patient with Severe Peripheral Arterial Disease.

Cardiogenic shock with electrical storm is a challenging condition to manage in patients with acute myocardial infarction despite primary percutaneous coronary interventions. While active mechanical circulatory support devices may improve hemodynamics in this situation, identifying the appropriate arterial access for device deployment is difficult in patients with severe peripheral arterial disease due to severe stenosis or obstruction and tortuous path of the femoral-iliac artery or descending aorta; additionally, this also reduces the mechanical viability of the implanted circulatory support devices, thus posing a risk for limb ischemia. Herein, we report on the effectiveness of the IMPELLA 5.0, deployed via the axillary artery, in combination with atrial overdrive pacing to manage a patient with cardiogenic shock and electrical storm, without extracorporeal membrane oxygenation. Our strategy, which does not require access via the groin area, may be an attractive option for patients with severe peripheral arterial disease, particularly those with aorto-iliac occlusive disease.

Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry.

Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p < 0.001), and all-cause death (p < 0.001), myocardial infarction (p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p < 0.001) and new-onset atrial fibrillation (p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p < 0.001). Similarly, patients with mid-term WRF and acute kidney injury had increased MACE compared to patients with either condition alone (p < 0.001). Multivariate Cox regression analysis revealed mid-term WRF as a strong predictor of MACE (hazard ratio: 2.50, 95% confidence interval 1.57-3.98, p < 0.001). Mid-term WRF after PCI negatively affects MACE, as well as future admission due to heart failure and new-onset atrial fibrillation, chronic kidney disease, and acute kidney injury.

Early vascular response of ultra-thin bioresorbable polymer sirolimus-eluting stents assessed by optical frequency domain imaging: the EVALUATION study.

This study aimed to evaluate the early vascular response of ultra-thin strut bioresorbable polymer sirolimus-eluting stents (BP SES) using optical frequency domain imaging (OFDI). Ultra-thin strut BP SES have superior outcomes in terms of efficacy and safety endpoints when compared to other thin strut new-generation stents. However, the factors contributing to the superiority of BP SES over other thin strut new-generation stents are unclear. A total of 32 patients with multivessel disease requiring staged procedures at 1 month were enrolled from 3 cardiovascular institutions; of these, 31 were immediately assessed by OFDI (n = 31). All patients were assessed at 1 month after ultra-thin strut BP SES implantation. The primary endpoint was % of uncovered struts. A total of 1723 cross sections (17,014 struts) were analyzed at baseline and 1 month after percutaneous coronary intervention. The % uncovered struts at 1-month follow-up was 7.7% (4.0, 13.8). Furthermore, the covered strut % (88.4% and 80.4%, P = 0.013) and malapposition rate (2.7% and 4.3%, P = 0.012) were significantly different between the 60-µm and 80-µm stents. Ultra-thin strut BP SES implantation may feasibly achieve early vascular responses due to the ultra-thin struts. This may ultimately lead to lower stent thrombosis and target lesion failure rates.Clinical trial registration University Hospital Medical Information Network Clinical Trials Registry (No. UMIN000033406).

Determination of acid/base dissociation constants based on a rapid detection of the half equivalence point by feedback-based flow ratiometry.

Acid dissociation constants (Ka) were determined through the rapid detection of the half equivalence point (EP1/2) based on a feedback-based flow ratiometry. A titrand, delivered at a constant flow rate, was merged with a titrant, whose flow rate was varied in response to a control voltage (Vc) from a controller. Downstream, the pH of the mixed solution was monitored. Initially, Vc was increased linearly. At the instance that the detector sensed EP1/2, the ramp direction of Vc changed downward. When EP1/2 was sensed again, Vc was increased again. This series of process was repeated automatically. The pH at EP1/2 was regarded as being pKa of the analyte after an activity correction. Satisfactory results were obtained for different acids in various matrices with good precision (RSD approximately 3%) at a throughput rate of 56 s/determination.

Determination of acid dissociation constants based on continuous titration by feedback-based flow ratiometry.

We propose a method for the determination of acid dissociation constants based on the rapid detection of the equivalence point (EP) by feedback-based flow ratiometry and the subsequent estimation of the half equivalence point (EP(1/2)). The titrant (e.g., NaOH) flow rate F(B) was varied in response to a control voltage V(c) from a controller, while the titrand (e.g., CH(3)COOH) flow rate F(A) was held constant. The pH of the mixed solution was monitored downstream from the confluence point of the solutions following a knotted tubular mixer. Initially, V(c) was increased linearly. At the instance the detector sensed EP, the ramp direction of V(c) changed downward. The pH increased further because of the lag time between the mixing of solutions and the sensing of pH. Following the pH maximum, the pH decreased. The EP was sensed again in this downward scan. The V(c) that gives EP(1/2) was computed from the V(c) just at the time of the EP detection. The V(c) was held constant at this level for 18s, and the plateau pH value thus obtained was taken to be the pK(a) of the analyte subject to activity corrections. Studies on the dependence of the pK(a) on the ionic strength or dielectric constant of the solution were conducted in an automated fashion by delivering NaCl solution or acetonitrile through an additional channel. Satisfactory results were obtained with good throughput (53s per determination) and precision (R.S.D. approximately 0.3%) for various acids.