Background: Catheter ablation (CA) of atrial fibrillation (AF) triggers, including non-pulmonary vein (PV) foci, contributes to improved procedural outcomes. However, the clinical significance of an AF trigger ablation during second CA procedures for nonparoxysmal AF is unknown.

Methods and Results: We enrolled 94 patients with nonparoxysmal AF undergoing a second CA. Intracardiac cardioversion during AF using high-dose isoproterenol was performed to determine the presence or absence of AF triggers. PV re-isolations were performed if PV potentials recurred, and if AF triggers appeared from any non-PV sites, additional ablation was added to those sites. We investigated the incidence of atrial arrhythmia recurrence (AAR) >3 months post-CA. Of the 94 enrolled patients, AF triggers were identified in 65 (69.1%), and of those with AF triggers, successful elimination of the triggers was achieved in 47 patients (72.3%). Multivariate analysis revealed that no observed AF triggers were a significant predictor of AAR (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.21–3.46, P=0.019). In a subanalysis of the patients with AF triggers, multivariate analysis showed that unsuccessful trigger ablation was significantly associated with AAR (HR 5.84, 95% CI 2.79–12.22, P<0.01).

Conclusions: Having no observed AF triggers during a second CA session significantly increased the risk of AAR, as did unsuccessful CA of AF triggers.

Background: We developed a convolutional neural network (CNN) model to detect atrial fibrillation (AF) using the sinus rhythm ECG (SR-ECG). However, the diagnostic performance of the CNN model based on different ECG leads remains unclear.

Methods and Results: In this retrospective analysis of a single-center, prospective cohort study, we identified 616 AF cases and 3,412 SR cases for the modeling dataset among new patients (n=19,170). The modeling dataset included SR-ECGs obtained within 31 days from AF-ECGs in AF cases and SR cases with follow-up ≥1,095 days. We evaluated the CNN model’s performance for AF detection using 8-lead (I, II, and V1–6), single-lead, and double-lead ECGs through 5-fold cross-validation. The CNN model achieved an area under the curve (AUC) of 0.872 (95% confidence interval (CI): 0.856–0.888) and an odds ratio of 15.24 (95% CI: 12.42–18.72) for AF detection using the eight-lead ECG. Among the single-lead and double-lead ECGs, the double-lead ECG using leads I and V1 yielded an AUC of 0.871 (95% CI: 0.856–0.886) with an odds ratio of 14.34 (95% CI: 11.64–17.67).

Conclusions: We assessed the performance of a CNN model for detecting AF using eight-lead, single-lead, and double-lead SR-ECGs. The model’s performance with a double-lead (I, V1) ECG was comparable to that of the 8-lead ECG, suggesting its potential as an alternative for AF screening using SR-ECG.

Background: Neither the efficacy nor safety of elobixibat has been investigated in the treatment of chronic constipation in patients with heart failure (HF).

Methods and Results: In this prospective, single-center, single-arm study elobixibat (10 mg/day) was administered for 12 weeks to 18 HF patients with chronic constipation defined according to the Rome IV criteria. Spontaneous bowel movement (SBM), stool consistency as measured by the Bristol Stool Form Scale, and degree of straining during defecation were recorded. In addition, biomarkers, blood pressure (BP) measured by ambulatory monitoring, and adverse events were assessed. Although there was no significant difference, the frequency of SBM increased by 2.0/week from baseline to Week 12. Both the degree of straining during defecation and low-density lipoprotein cholesterol (LDL-C) levels were significantly decreased at Week 12 (straining, −0.79 [95% confidence interval (CI), −1.40 to −0.17]; LDL-C, −10.4 mg/dL [95% CI, −17.9 to −2.9]). Although not significant, the difference in BP before and after defecation tended to decrease from baseline by approximately 10 mmHg at Week 12. Serious adverse events were not observed.

Conclusions: Elobixibat reduced the degree of straining during defecation, and improved the lipid profile in HF patients with chronic constipation.

Background: Although the clinical factors that predict major bleeding in Western patients with acute coronary syndrome (ACS) are becoming elucidated, they have not been fully investigated, especially coronary lesion characteristics, in a Japanese population.

Methods and Results: ACS patients (n=1,840) were divided into a “bleeding group” and a “no-bleeding group,” according to whether they had major bleeding during the 2-year follow-up period, to investigate the prognostic effect of bleeding and the predictive factors of bleeding. Among them, patients who underwent primary percutaneous coronary intervention with optical coherence tomography (OCT) guidance (n=958) were examined to identify the effect of coronary lesion characteristics on bleeding. Of the 1,840 enrolled patients, 124 (6.7%) experienced major bleeding during the 2-year follow-up period. Incidence of cardiovascular death during the 2-year follow-up period was significantly higher among patients with major bleeding (26.4% vs. 8.5%, P=0.001). OCT examination showed that disrupted fibrous cap (DFC: 68% vs. 48%, P=0.014) and calcified plaque (63% vs. 42%, P=0.011) were more prevalent in the bleeding group. DFC was a predictor of major bleeding in the multivariate Cox proportional hazards analyses (hazard ratio 2.135 [95% confidence interval 1.070–4.263], P<0.001).

Conclusions: ACS patients with major bleeding had poorer cardiac outcomes. Advanced atherosclerosis at the culprit lesion influences the higher incidence of major bleeding in ACS patients.

Background: Alcohol septal ablation (ASA) and septal myectomy (SM) are 2 options for septal reduction therapy (SRT) to treat medication-resistant symptomatic obstructive hypertrophic cardiomyopathy (HCM). Because differences in mortality rates after these different SRT methods have not been extensively investigated in real-world settings, in this study compared the 1-year mortality rates after ASA and SM using population-based database.

Methods and Results: Utilizing New York Statewide Planning and Research Cooperative System (SPARCS) data from 2005 to 2016, we performed a comparative effectiveness study of ASA vs. SM in patients with HCM. The outcome was all-cause death up to 360 days after SRT. We constructed a multivariable logistic regression model and performed sensitivity analysis with propensity score (PS)-matching and inverse probability of treatment weighting (IPTW) methods. We identified 755 patients with HCM who underwent SRT: 348 with ASA and 407 with SM. The multivariable analysis showed that all-cause deaths were significantly fewer in the ASA group at 360 days after SRT (adjusted odds ratio=0.34; 95% confidence interval [CI] 0.13-0.84; P=0.02). The PS-matching and IPTW methods also supported a lower mortality rate in the ASA group at 360 days post-SRT.

Conclusions: In this population-based study of patients with HCM who underwent SRT in a real-world setting, the 1-year all-cause mortality rate was significantly lower in patients who underwent ASA compared with SM.

Background: The relationship between the prognosis of patients with both chronic thromboembolic pulmonary hypertension (CTEPH) and a mental disorder (MD) remains unclear.

Methods and Results: The study group comprised 157 patients with CTEPH who underwent right heart catheterization and were subdivided into 2 groups according to the presence of MDs: MD and non-MD. The patients with MDs were defined as those who had visited a psychiatrist and were under psychotropic drug treatment. The primary outcome was a composite of all-cause death and worsening of PH. The median follow-up period was 1,164 days. The incidence of the primary composite outcome was higher in the MD group than in the non-MD group (24.0% vs. 6.8%), whereas the all-cause mortality rate was comparable between groups (12.0% vs. 6.1%). The mean pulmonary arterial pressure, cardiac index, and pulmonary vascular resistance at baseline were all similar between groups. The Cox proportional hazards model indicated that MD was an independent risk factor for the primary composite outcome (hazard ratio, 2.990; 95% confidence interval, 1.034–8.642).

Conclusions: In the present study, concomitant CTEPH and MD was significantly associated with a poor prognosis and such patients should be carefully followed.

Background: This study reports prescribing patterns and the 1-year effectiveness and safety of edoxaban in an Asian cohort of Edoxaban Treatment in routiNe clinical prActice (ETNA)-Atrial Fibrillation (AF) patients.

Methods and Results: The Global ETNA-AF program integrates prospective, observational, noninterventional regional studies, collecting data on characteristics and clinical outcomes of patients with AF receiving edoxaban for stroke prevention. Baseline characteristics, medical history, and 1-year clinical event rates were assessed in patients from South Korea, Taiwan, Hong Kong, and Thailand. Clinically relevant events assessed at 12 months included all-cause death, cardiovascular death, ischemic and hemorrhagic stroke, systemic embolic events (SEEs), bleeding, and net clinical outcome (NCO). Overall, 3,359 patients treated with edoxaban 60 or 30 mg once daily completed 1-year follow-up; 70.9% of patients received recommended dosing according to local labels. Baseline mean±standard deviation age was 71.7±9.6 years, CHA₂DS₂-VASc score was 3.1±1.5, and modified HAS-BLED score was 2.3±1.1. Mean age and sex were similar across countries/regions. The 1-year event rate for all-cause death was 1.8%; major bleeding, 1.3%; ischemic stroke, 1.1%; cardiovascular mortality, 0.7%; hemorrhagic stroke, 0.3%; SEEs, 0%; and NCO, 4.1%; with differences observed between countries/regions and dosing groups.

Conclusions: Most Asian patients with AF were prescribed recommended edoxaban dosing in routine care settings. At 1-year follow-up, this analysis supports the effectiveness and safety of edoxaban in these patients.