Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Accumulating evidence indicates a link between inflammation and AF, and important advances in understanding mechanisms of AF are arising from studies of the critical components involved in the modulation of the immunoinflammatory balance within the atrium. However, molecular mechanisms remain unclear. Indeed, although preclinical and clinical studies suggest that chronic inflammation may promote development of AF, the roles of inflammation in the process are complex and incompletely understood. The purpose of this review is to briefly highlight current evidence on relationships between inflammation and AF, and to discuss possible mechanisms of development of AF and/or possible therapeutic approaches targeting components of the inflammatory response.

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The ISSUE 3 Trial is designed to demonstrate which patients with vasovagal syncope over the age of 40 years will benefit from pacing dual chamber with the rate drop response. The trial has completed its recruitment of 521 patients and 78 have now been randomized in Phase 2, which is the Pacing ON versus Pacing OFF comparison. During this Phase the end-points are recurrence of syncope or two years of follow-up without recurrence. It has been calculated that 27 early end-points will be sufficient to determine a significant difference between the groups. The background, details and design of the trial are explained. Some early findings are presented. Definitive results are expected by the end of 2011.

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Background: Optimizing the atrio-ventricular delay (AVD) is important for increasing the left ventricular (LV) preload in patients receiving cardiac resynchronization therapy (CRT). The optimal AVD may be considered an AVD in which the maximum LV filling time (LVFT) is obtained. However, it is unclear whether or not the optimal AVD determined by Ritter’s method (AVD-Ritter) is identical to the AVD in which the maximum LVFT is obtained. The aim of this study was to clarify this point.
Methods: In 17 patients who received CRT, the optimal AVD was determined by Ritter’s method and the FT method. Eleven (65%) patients had 1° AV block. We measured the LVFT and R-R time when the AVD was prolonged by 20 ms increments from 80 ms to 180 ms. In the FT method, the optimal AVD (AVD-FT) was defined as the AVD in which the corrected LVFT (LVFTc) was maximally prolonged. The AVD-Ritter and AVD-FT were both determined during atrial pacing (Ap) and sensing (As). The LVFTc at each optimal AVD was also measured and compared.
Results: During As, the AVD-Ritter (114±20 ms) showed a marginally significant difference when compared to the AVD-FT (95±18 ms; p=0.053). However, during Ap, the AVD-Ritter (138±32 ms) was significantly longer than the AVD-FT (113±20 ms; p=0.017). The LVFTc with the AVD-Ritter was shorter than the AVD-FT (As: 538±40 vs. 557±34 [ms], p=0.002; Ap: 532±37 vs. 563±33 [ms], p=0.023). These results were comparable with those obtained in the 11 patients with 1° AV block.
Conclusions: The AVD-Ritter during Ap may become shorter than that for the AVD-FT because of the latency in patients receiving CRT. The FT method might be better than the AVD-Ritter method to optimize the AVD in those patients.

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Background: Japan started using the CARELINK^® (Medtronic, Inc, Minneapolis, MN, USA) remote monitoring system in April 2009. However, in some cases, the device failed to transmit a message after registration or according to schedule. We investigated the difference between patients who could make effective use of CARELINK^® system and those who could not.
Subjects and Method: Sixty patients who had registered until December 2009 at our institution were analyzed. These patients were divided into two groups: those who were able to use the device effectively (group G, n=49) and those who were not (group F=11). Patient background, automatic or manual telemetries, new or existing implant patient, presence of adverse events, and the use or non-use of a checklist at the time of introduction were compared between the two groups.
Results: In group G, more patients used a checklist at the time of introduction than that in group F (use of checklist/total, 31/49 in group G vs. 3/11 in group F; P, 0.029). No significant difference was observed in other factors between the two groups.
Conclusion: We consider that the method used to explain the system are important to make the patients understand handling methods of CARELINK^® system. The number of patients introduced to remote monitoring of implantable devices will continue to increase in the future; therefore, we must continue to develop innovative approaches for their effective use.

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Introduction: Bepridil is effective for atrial fibrillation (AF), but it can induce torsades de pointes. Thus we examined the efficacy and safety of bepridil when started at 100 mg/day for AF after failed electrical cardioversion (EC).
Methods and Results: We studied 28 consecutive patients (58±12 years old) with failed EC. After administration of bepridil, we examined the time to restore the sinus rhythm, the duration of the maintained sinus rhythm. Our patients were divided into the two groups and various clinical factors were compared, including medication and echocardiographic and electrocardiographic parameters: the SR group who maintained sinus rhythm during follow-up period and the AF group who still had AF. Sixteen patients (57%) could maintain sinus rhythm (SR group). Adverse arrhythmic events were not observed. There were no significant differences in any clinical factors between the two groups before and after bepridil.
Conclusions: Bepridil was effective and safe for persistent AF with failed EC.

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We report on a case of a 23-year-old male with Wolff-Parkinson-White syndrome. At baseline, constant right atrial pacing induced antidromic atrioventricular reentrant tachycardia (AVRT), whereas constant right ventricular (RV) pacing only revealed a normal His-Purkinje system. Mapping below the mitral annulus during sinus rhythm revealed fusion of atrial and ventricular potentials at multiple lateral sites. After unsuccessful ablation at these sites, constant RV pacing induced a long RP interval, orthodromic AVRT with the earliest atrial site being located at an anterior aspect, where successful ablation was later achieved. These phenomena may indicate an unexpected arrhythmogenic effect of initial ablations.

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A 16-year-old girl with a known history of asymptomatic Wolff-Parkinson-White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow-up. A 12-lead surface ECG showed pre-excitation, a predominantly negative delta wave in V₁ and left axis deviation, which was consistent with the presence of a right free-wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium-to-ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free-wall accessory pathway and LV dysfunction without tachycardia.

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A 78-year-old man was implanted with a cardiac resynchronization therapy defibrillator. One month later, chest X-ray and electrocardiography suggested left ventricular (LV) lead dislodgement. However, the LV lead pacing threshold obtained by a programmer was unchanged because anodal capture had developed, which made it difficult to confirm the LV lead dislodgement. Radiographs obtained in the catheterization laboratory revealed that the tip of the LV lead had dislodged into the right atrium. The LV lead was relocated into another lateral coronary vein. Electrocardiography showed the QRS duration to be shorter than prior to this revision.

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