The number of patients with heart failure（HF）and atrial fibrillation（AF）is increasing as the elderly population grows. Age is a major concern and determinant of the indication for catheter ablation（CA）of AF. However, there is little safety data on CA of AF in accordance with age in Japan. We assessed the safety of CA of AF using a nationwide database〔Japanese Registry Of All cardiac and vascular Diseases（JROAD）-DPC〕. 135,299 AF patients（65±10 years, 38,952 females）who underwent CA in 456 hospitals between April 2012 and March 2018 were studied and divided into the following age groups : ＜60, 60-65, 65-70, 70-75, 75-80, 80-85, and ≥85 years. The overall in-hospital complication rate was 3.4％（cardiac tamponade 1.2％）and in-hospital mortality was 0.04％. Aged patients had a higher prevalence of female sex, lower body mass index, and a higher burden of comorbidities such as hypertension and HF, all of which were predictors for complications in multivariate analysis. A multivariate adjusted odds ratio revealed that increased age was independently and significantly associated with overall complications（60-65 years : 1.19 ; 65-70 years : 1.29 ; 70-75 years : 1.57 ; 75-80 years : 1.63 ; 80-85 years : 1.90 ; ≥85 years : 2.86 ; reference＜60 years）. In conclusion, the nationwide database of JROAD-DPC demonstrated that the frequency of complications following CA for AF increased with age.

【Aims】The use of heparin in the perioperative period is a clinical predictor of pocket hematoma after cardiac implantable electronic device（CIED）procedures. However, few studies have reported about other predictors. We examined clinical predictors of pocket hematoma using in patients who underwent to CIDE procedures at our hospital.【Methods】We retrospectively analyzed 103 patients who underwent CIED procedures at our hospital from October 2018 through January 2021 to reveal clinical predictors of hematoma.【Results】In univariate analysis, predictors for significantly increased the risk of hematoma were the use of heparin in the perioperative period（odds ratio（OR） : 4.56, 95％ confidence interval（CI） : 1.14-18.2, p＝0.032）, low body weight（body mass index less than 18.5）（OR : 4.0, 95％ CI : 1.02-15.7, p＝0.046）, and absence of oral antihypertensive drugs（OR : 5.57, 95％ CI : 1.60-19.4, p＝0.007）.【Conclusions】 Absence of oral antihypertensive drugs and low weight may become new clinical predictors of pocket hematoma.

A remote monitoring system（RMS）has been recommended as a standard management method for patients with cardiac implantable electronic devices, since it enables early detection and therapeutic intervention in arrhythmic events. We experienced three cases with sustained ventricular tachycardia（Sustained VT）with a tachycardia cycle length near the ventricular tachycardia zone（VTZ）, which was misdiagnosed as non-sustained ventricular tachycardia（NSVT）without anti-tachycardia pacing therapy. Evaluation of device electrocardiogram records led us to a definite diagnosis of sustained VTs and early intervention by device reprogramming. The diagnostic algorithms of device programs for NSVT have some limitations that can lead to misdiagnosis, in cases with a VT cycle length near a VT therapy zone. The knowledge of these limitations is necessary to make the most of the advantages of RMS in the early detection and therapeutic intervention in VTs.

The pattern matching function installed in the CARTO3 system, a 3D mapping device, is an ablation support program that displays on the screen where there is a high correlation between the ventricular extrasystole of the treatment target and the 12-lead ECG QRS complex obtained by local pacing. If the pattern matching function can be applied to identify the origin of premature atrial complex, it should improve the visibility of treatment sites, reduce procedural time, and improve the therapeutic effect. However, the P wave has a lower wave height and shorter duration than the QRS complex and may fuse with the T wave of the preceding beat. Therefore, even if this method is used as is, origin of the P wave cannot be automatically detected. In this study, we devised a pattern matching method using the intracardiac potential of the high right atrium and coronary sinus, in addition to 2 precordial leads. We report two cases in which the origin of premature atrial complex was automatically identified and ablated using this novel system.