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Isolated premature ventricular complexes (PVCs) are the most common arrhythmias observed in patients even if without structural heart disease. 1 Although most PVCs originate from the right ventricular outflow tract (RVOT), there are some PVCs that originate near the HIS bundle. 2 The synthesized 18-lead ECG consists of right-sided thoracic (V3R, V4R, V5R) and dorsal (V7, V8, V9) ECG leads derived from a mathematical calculation of the 12-lead ECG, and the detailed mathematical formula is shown in Figure 1. The synthesized 18-lead ECGs of 13 consecutive patients who underwent radiofrequency catheter ablation (RFCA) of idiopathic PVCs from near the HIS bundle at the Japan Community Healthcare Organization Osaka Hospital, Osaka General Medical Center, and Nara Prefectural Seiwa Medical Center from January 2018 to December 2020 were included in this retrospective analysis. ETHICS APPROVAL This study was approved by the Ethics Committee of Japan Community Healthcare Organization Osaka Hospital, Osaka General Medical Center, and Nara Prefectural Seiwa Medical Center in accordance with the Declaration of Helsinki.

Percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) undergoing hemodialysis (HD) remains challenging, with limited long-term outcome data. We investigated the long-term prognosis of ACS due to de novo coronary artery lesions and stent thrombosis (ST) in patients with and without HD. We analyzed 187 patients with ACS from the Osaka Cardiovascular Conference Long ST registry, a retrospective, multicenter registry of definite ST, and 1,856 patients with ACS due to de novo coronary artery lesions at Kansai Rosai Hospital. Patients were grouped by HD status and ACS etiology ( de novo - and ST-ACS). The primary outcome was the 6-year incidence of major adverse cardiac events (MACE) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization, and subsequent ST. The 6-year MACE rate was highest in ST-ACS with HD, followed by de novo -ACS with HD, ST-ACS without HD, and de novo -ACS without HD (82.1 vs. 62.5 vs. 38.3 vs. 24.2%, respectively, p  < 0.001). Multivariate analysis identified HD (hazard ratio [HR]: 2.50, 95% confidence interval [CI]: 1.89–3.32, p  < 0.001) and ST-ACS (HR: 1.69, 95% CI: 1.17–2.45, p  = 0.006) as independent MACE predictors. The long-term prognoses following ACS are unfavorable in patients on HD, particularly those with ST-ACS.

It remains unknown whether the recent trend of short dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy can simply be applied to patients undergoing complex percutaneous coronary intervention (PCI). We performed a systematic review and meta-analysis to evaluate P2Y12 inhibitor monotherapy vs. conventional DAPT in patients undergoing complex PCI and non-complex PCI (PROSPERO: CRD42022335723). Primary endpoint was the 1-year Net Adverse Clinical Event (NACE). Among 5,323 screened studies, six randomized trials fulfilled the eligibility criteria. A total of 10,588 complex PCI patients (5,269 vs. 5,319 patients) and 25,618 non-complex PCI patients (12,820 vs 12,798 patients) were randomly assigned to P2Y12 inhibitor monotherapy vs. conventional DAPT. In complex PCI patients, P2Y12 inhibitor monotherapy was associated with a lower risk of NACE than conventional DAPT [Odds ratio (OR) 0.76, 95% confidence interval (CI) 0.63–0.91, P = 0.003], whereas in non-complex PCI patients, P2Y12 inhibitor monotherapy was associated with a trend toward lowering the risk of NACE (OR 0.86, 95% CI 0.72–1.02, P = 0.09). This meta-analysis across randomized trials demonstrated that a strategy of short DAPT followed by P2Y12 inhibitor monotherapy reduces the risk of 1-year NACE in patients undergoing complex PCI.

Identifying patients who would benefit from extensive catheter ablation along with pulmonary vein isolation (PVI) among those with persistent atrial fibrillation (AF) has been a subject of controversy. The objective of this study was to apply uplift modeling, a machine learning method for analyzing individual causal effect, to identify such patients in the EARNEST-PVI trial, a randomized trial in patients with persistent AF. We developed 16 uplift models using different machine learning algorithms, and determined that the best performing model was adaptive boosting using Qini coefficients. The optimal uplift score threshold was 0.0124. Among patients with an uplift score ≥ 0.0124, those who underwent extensive catheter ablation (PVI-plus) showed a significantly lower recurrence rate of AF compared to those who received only PVI (PVI-alone) (HR 0.40; 95% CI 0.19–0.84; P -value = 0.015). In contrast, among patients with an uplift score < 0.0124, recurrence of AF did not significantly differ between PVI-plus and PVI-alone (HR 1.17; 95% CI 0.57–2.39; P -value = 0.661). By employing uplift modeling, we could effectively identify a subset of patients with persistent AF who would benefit from PVI-plus. This model could be valuable in stratifying patients with persistent AF who need extensive catheter ablation before the procedure.

Background Implantable cardioverter‐defibrillator (ICD) has been demonstrated to improve survival outcomes compared to amiodarone. However, this effectiveness in cancer patients remains unclear. Given the complexity of cardiovascular management in this population, including cancer stage considerations, we evaluated the relative effectiveness of ICD versus amiodarone in cancer patients. Methods and Results We linked cancer registry data with administrative records to identify patients newly prescribed amiodarone or who underwent ICD implantation between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. Among 161,125 cancer patients, 339 met the inclusion criteria (amiodarone: n = 281; ICD: n = 58), with a median follow‐up of 762 days. Kaplan–Meier analysis revealed that the ICD group had a significantly reduced risk of all‐cause mortality compared to the Amiodarone group (Log‐rank test, p < .003). Multivariable Cox proportional hazard regression model showed that ICD was an independent prognostic factor (Hazard ratio: 0.47, 95% confidence interval: 0.29–0.79, p = .004). These results were confirmed in a propensity‐matched analysis. Among patients with cancer stage: in situ or localized, no significant difference in survival risk was observed between the ICD and Amiodarone groups, and ICD was not significantly associated with all‐cause death. Conversely, among patients with cancer stage: regional or distant, the ICD group had a significantly reduced risk of all‐cause death compared to the Amiodarone group, and ICD was an independent prognostic factor. Conclusion In cancer patients, ICD may improve long‐term prognosis compared to amiodarone, especially in patients with advanced cancer stages. The effectiveness of implantable cardioverter‐defibrillator (ICD) versus amiodarone in cancer patients remains unclear. Using 2010–2015 cancer registry data from 36 hospitals in Osaka, Japan, we found that ICD significantly improves cancer patients' prognosis compared to amiodarone.

Background Under‐sensing (US) in implantable loop recorders (ILRs) interferes with the accurate diagnosis of arrhythmia, but there is little information available on the details of US of ILRs. The aim of this study was to clarify the frequency of US in patients with ILRs and to investigate the predictors of US in ILRs prior to implantation. Methods and Results We studied 46 consecutive patients implanted ILR. During the mean follow‐up period of 499 ± 363 days, 15 events of US were observed in five patients. There were no significant differences in patient characteristics between patients with and without US. In standard 12‐lead electrocardiogram (ECG), QRS complex amplitude in anterolateral chest leads (V2 to V5) were significantly lower in patients with than without US (V2: 0.88 [0.66, 1.22] mV vs. 1.67 [1.23, 2.29] mV, p = .010 V3: 1.25 [1.00, 1.26] mV vs. 1.90 [1.41, 2.29] mV, p = .013; V4: 1.14 [0.96, 1.38] mV vs. 1.93 [1.65, 2.64] mV, p = .023; V5: 0.57 [0.50, 0.75] mV vs. 1.60 [1.20, 1.98] mV, p = .011, respectively). ROC curve analysis showed that cut‐off values of 1.30 mV of QRS complex amplitude in V2, 1.26 mV of that in V3, and 0.75 mV of that in V5 had moderate accuracy for predicting US (V2: sensitivity 68%, specificity 100%, area under the curve [AUC] 0.86; V3: sensitivity 85%, specificity 80%, AUC 0.85; V5: sensitivity 98%, specificity 80%, AUC 0.85, respectively). Conclusions US was observed in 10.9% patients with an ILR. QRS complex amplitude in anterolateral chest leads (V2 to V5) on ECG might be useful for predicting US in patients with ILRs. Under‐sensing (US) of second‐generation implantable loop recorder (ILR) was observed in 10.9% of patients. QRS complex amplitude in anterolateral chest leads on standard 12 lead ECG might be useful for predicting US in patients with second‐generation ILRs.

IntroductionNeither the pathophysiology nor an effective treatment for heart failure with preserved ejection fraction (HFpEF) has been elucidated to date. The purpose of this ongoing study is to elucidate the pathophysiology and prognostic factors for patients with HFpEF admitted to participating institutes. We also aim to obtain insights into the development of new diagnostic and treatment methods by analysing patient background factors, clinical data and follow-up information.Methods and analysisThis study is a prospective, multicentre, observational study of patients aged ≥20 years admitted due to acute decompensated heart failure with preserved left ventricular ejection fraction (≥50%) and elevated N-terminal-pro brain natriuretic peptide (NT-proBNP) (≥400 pg/mL). The study began in June 2016, with the participation of Osaka University Hospital and 31 affiliated facilities. We will collect data on history in detail, accompanying diseases, quality of life, frailty score, medication history, and laboratory and echocardiographic data. We will follow-up each patient for 5 years, and collect outcome data on mortality, cause of death, and the number and cause of hospitalisation. The target number of registered cases is 1500 cases in 5 years.Ethics and disseminationThe protocol was approved by the Institutional Review Board (IRB) of Osaka University Hospital on 24 February 2016 (ID: 15471), and by the IRBs of the all participating facilities. The findings will be disseminated through peer-reviewed publications and conference presentations.

Background Continuous anticoagulation based on the CHA2DS2‐VASc score is recommended to prevent embolism caused by atrial fibrillation (AF), but it does not consider AF episodes. The Apple Watch's continuous heart rhythm monitoring and fast‐acting direct oral anticoagulants (DOACs) could enable precise, episode‐tailored anticoagulation, reducing bleeding risks while preventing stroke. This study evaluates Apple Watch‐guided personalized anticoagulation therapy, adjusting DOAC usage based on real‐time AF detection. Methods This multicenter prospective single‐arm study will enroll patients who have maintained sinus rhythm post‐ablation and are on DOACs. The target enrollment is 50 patients free of AF for at least 30 days following the initiation of Apple Watch monitoring. If no AF occurs for the first 30 days of monitoring, anticoagulants will be discontinued on day 31. If AF is confirmed after day 31, DOAC administration will be resumed and continued until the end of the observation period. The primary endpoint is the reduction in the total number of days with DOACs from day 31 to day 360 compared to the conventional method of continuing anticoagulation. Secondary endpoints include all‐cause mortality, stroke, systemic thromboembolism, bleeding events, and Apple Watch malfunctions. Results Enrollment of a total of 50 patients was completed in April 2024. Follow‐up of the last enrolled patient will be completed in April 2025 and primary results are expected to be available in late 2025. Conclusions The Up to AF trial is the first trial to evaluate Apple Watch‐guided personalized anticoagulation therapy. This trial represents a potential advancement in personalized medicine for AF management. The Up to AF trial evaluates Apple Watch‐guided personalized anticoagulation therapy for atrial fibrillation (AF), adjusting DOAC use based on real‐time AF detection. In this single‐arm study, 50 post‐ablation patients are monitored, aiming to reduce DOAC days while assessing mortality, stroke, and bleeding events. Results are expected in 2025.

Background Major adverse cardiac and cerebrovascular event (MACCE) is one of most common complications of hemodialysis patients. Heart rate variability (HRV) is the predictor of death in heart disease patients. However, there are no studies on the role of HRV in hemodialysis patients. Methods From September 2009 to March 2011, 24-h electrocardiography was performed in 101 hemodialysis patients. Standard deviation of sequential 5-minute N-N interval means (SDANN) and standard deviation of the N-N interval (SDNN) was examined by a 24-h ECG analysis. Patients were observed prospectively. The primary endpoints were incidence of MACCE and MACCE-free survival. Results We studied 90 hemodialysis patients (64 males, 63.4 ± 11.8 years old). During a follow-up period of 32.0 ± 11.7 months, 33 patients developed MACCE. 24-h ECG showed mean SDNN 93.4 ± 33.4 ms and mean SDANN 83.2 ± 31.3 ms. MACCE group showed significantly lower SDNN and SDANN than event-free group. In Kaplan-Meier analysis higher SDNN and SDANN group showed significantly higher event-free survival rate than lower group. Using a Cox proportional hazards model, SDNN was independent prognostic factor while SDANN or diabetic status was not significant. In diabetic cases, there were no differences in any factors for the incidence of MACCE between higher SDNN, SDANN groups and lower groups. On the other hand in non-diabetic cases, lower SDNN or SDANN group developed significantly higher MACCE than higher groups. Conclusion Measurement of HRV by Holter ECG is useful to predict MACCE in hemodialysis patients, especially non-diabetic group.

It is unclear whether adaptive servo-ventilation (ASV) therapy for heart failure with preserved ejection fraction (HFpEF) is effective. The aim of this study was to investigate the details of ASV use, and to evaluate the effectiveness and safety of ASV in real-world HFpEF patients. We retrospectively enrolled 36 HFpEF patients at nine cardiovascular centers who initiated ASV therapy during hospitalization or on outpatient basis and were able to continue using it at home from 2012 to 2017 and survived for at least one year thereafter. The number of hospitalizations for heart failure (HF) during the 12 months before and 12 months after introduction of ASV at home was compared. The median number of HF hospitalizations for each patient was significantly reduced from 1 [interquartile range: 1–2] in the 12 months before introduction of ASV to 0 [0–0] in the 12 months after introduction of ASV (p < 0.001). In subgroup analysis, reduction in heart failure hospitalization was significantly greater in female patients, patients with a body mass index < 25, and those with moderate or severe tricuspid valve regurgitation. In patients with HFpEF, the number of HF hospitalizations was significantly decreased after the introduction of ASV. HFpEF patients with female sex, BMI < 25, or moderate to severe tricuspid valve regurgitation are potential candidates who might benefit from ASV therapy.