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Lyme disease is a tick-borne spirochetal infection that may affect the heart. Cardiac manifestations include conduction disturbances and other pathologies of the heart. We report on a 37-year old male, who was admitted to the emergency department because of dizziness and generalized tiredness. Physical examination and the initial laboratory values revealed no abnormalities. The patient's electrocardiogram on admission revealed newly diagnosed bradycardia due to atrioventricular heart block. The ventricular heart rate was 35/min. The patient was admitted to the ICU. Lyme serology and Western blot were positive for Borrelia antibodies. After institution of antibiotic therapy with ceftriaxone, atrioventricular heart block resolved rapidly. We therefore have to assume that in this patient Lyme carditis was the cause of third-degree AV block.

A bstract We report a search for B decays to selected final states with the η c meson: B ± → K ± η c π + π − , B ± → K ± η c ω , B ± → K ± η c η and B ± → K ± η c π 0 . The analysis is based on 772 × 10 6 B B ¯ pairs collected at the Υ(4 S ) resonance with the Belle detector at the KEKB asymmetric-energy e + e − collider. We set 90% confidence level upper limits on the branching fractions of the studied B decay modes, independent of intermediate resonances, in the range (0 . 6–5 . 3) × 10 −4 . We also search for molecular-state candidates in the D 0 D ¯ ∗ 0 − D ¯ 0 D ∗ 0 , D 0 D ¯ 0 + D ¯ 0 D 0 and D ∗ 0 D ¯ ∗ 0 + D ¯ ∗ 0 D ∗ 0 combinations, neutral partners of the Z (3900) ± and Z (4020) ± , and a poorly understood state X (3915) as possible intermediate states in the decay chain, and set 90% confidence level upper limits on the product of branching fractions to the mentioned intermediate states and decay branching fractions of these states in the range (0 . 6–6 . 9) × 10 −5 .

Apixaban is increasingly used for stroke prevention in patients with atrial fibrillation. Data about the safety of left atrial radiofrequency ablation procedures under continuous apixaban therapy are lacking. We performed a matched-cohort study of patients undergoing left atrium ablation procedures for atrial fibrillation or left atrial flutter. For each patient on apixaban, 2 patients on phenprocoumon were matched by age, gender, and type of arrhythmia. The primary safety end point was a composite of bleeding, thromboembolic events, and death. We identified 105 consecutive patients (35 women; mean age 63 years) on apixaban and matched 210 phenprocoumon patients (70 women, mean age 64 years). The primary end point was met in 11 patients of the apixaban group and 26 patients of the phenprocoumon group (10.5% vs 12.3%, p = 0.71). Major bleeding complications occurred in 1 patient of the apixaban group and 1 patient of the phenprocoumon group (1% vs 0.5%, p >0.99). Minor bleeding complications were observed in 10 patients of the apixaban group and 25 patients of the phenprocoumon group (9.5% vs 11.9%, p = 0.61). No patient in either group experienced a thromboembolic event and no patient died. In patients on apixaban, no clinical variable was predictive for bleeding complications. Left atrial ablation procedures under continuous oral anticoagulation with apixaban are feasible and as safe as under continuous oral anticoagulation with phenprocoumon.

We report a search for B decays to selected final states with the ηc meson: B± → K±ηcπ+π-, B± → K±ηcω, B± → K±ηcη and B± → K±ηcπ0. The analysis is based on 772 × 106 BB-bar pairs collected at the Υ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider. We set 90% confidence level upper limits on the branching fractions of the studied B decay modes, independent of intermediate resonances, in the range (0.6–5.3) × 10-4. We also search for molecular-state candidates in the D0D*-bar0 - D-bar0D*0, D0D-bar0 + D-bar0D0 and D*0D*-bar0 + D*-bar0D*0 combinations, neutral partners of the Z(3900)± and Z(4020)±, and a poorly understood state X(3915) as possible intermediate states in the decay chain, and set 90% confidence level upper limits on the product of branching fractions to the mentioned intermediate states and decay branching fractions of these states in the range (0.6–6.9) × 10-5.

We present measurements of absolute branching fractions of hadronic and lep-tonic \\( D_s^{+} \\) decays to K - K + π +, \\( {{\\overline{K}}^0} \\) K +, ηπ +, μ + ν μ and τ + ν τ and report a search for the leptonic \\( D_s^{+} \\) → e + ν e decays. The results are obtained from a data sample of 913 fb-1 collected at or near the \\( \\varUpsilon \\) (4 S ) and \\( \\varUpsilon \\) (5 S ) resonances with the Belle detector at the KEKB asymmetric-energy e + e - collider. The branching fractions of hadronic decays are measured to be $$ \\begin{array}{*{20}{c}} {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {K^{-}}{K^{+}}{\\pi^{+}}} \\right) = \\left( {5.06\\pm 0.15\\pm 0.21} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {{\\overline{K}}^0}{K^{+}}} \\right) = \\left( {2.95\\pm 0.11\\pm 0.09} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ \\eta {\\pi^{+}}} \\right) = \\left( {1.82\\pm 0.14\\pm 0.07} \\right)\\%,} \\\ \\end{array} $$ where the first and second uncertainties are statistical and systematic, respectively. The branching fractions of leptonic decays are measured to be $$ \\begin{array}{*{20}{c}} {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {\\mu^{+}}{\\nu_{\\mu }}} \\right)=\\left( {0.531\\pm 0.028\\pm 0.020} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\to {\\tau^{+}}{\\nu_{\\tau }}} \\right)=\\left( {5.70\\pm 0.21_{-0.30}^{-0.31 }} \\right)\\%,} \\\ \\end{array} $$ which are combined to determine the \\( D_s^{+} \\) meson decay constant $$ {f_{{{D_s}}}=\\left( {255.5\\pm 4.2\\pm 5.1} \\right)\\ \\mathrm{MeV}. $$ We find no significant signal for \\( D_s^{+} \\) → e + ν e decays and set an upper limit of \\( \\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {e^{+}}{\\nu_e}} \\right) \\) < 1 . 0(0 . 83) × 10-4 at 95% (90%) confidence level.

We present measurements of absolute branching fractions of hadronic and lep-tonic$ D_s^{+} $decays to K − K + π + ,$ {{\\overline{K}}^0} $K + , ηπ + , μ + ν μ and τ + ν τ and report a search for the leptonic$ D_s^{+} $→ e + ν e decays. The results are obtained from a data sample of 913 fb −1 collected at or near the$ \\varUpsilon $(4 S ) and$ \\varUpsilon $(5 S ) resonances with the Belle detector at the KEKB asymmetric-energy e + e − collider. The branching fractions of hadronic decays are measured to be$ \\begin{array}{*{20}{c}} {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {K^{-}}{K^{+}}{\\pi^{+}}} \\right) = \\left( {5.06\\pm 0.15\\pm 0.21} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {{\\overline{K}}^0}{K^{+}}} \\right) = \\left( {2.95\\pm 0.11\\pm 0.09} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ \\eta {\\pi^{+}}} \\right) = \\left( {1.82\\pm 0.14\\pm 0.07} \\right)\\%,} \\\ \\end{array} $where the first and second uncertainties are statistical and systematic, respectively. The branching fractions of leptonic decays are measured to be$ \\begin{array}{*{20}{c}} {\\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {\\mu^{+}}{\\nu_{\\mu }}} \\right)=\\left( {0.531\\pm 0.028\\pm 0.020} \\right)\\%,} \\\ {\\mathcal{B}\\left( {D_s^{+}\\to {\\tau^{+}}{\\nu_{\\tau }}} \\right)=\\left( {5.70\\pm 0.21_{-0.30}^{-0.31 }} \\right)\\%,} \\\ \\end{array} $which are combined to determine the$ D_s^{+} $meson decay constant$ {f_{{{D_s}}}=\\left( {255.5\\pm 4.2\\pm 5.1} \\right)\\ \\mathrm{MeV}. $We find no significant signal for$ D_s^{+} $→ e + ν e decays and set an upper limit of$ \\mathcal{B}\\left( {D_s^{+}\\ \\to\\ {e^{+}}{\\nu_e}} \\right) $< 1 . 0(0 . 83) × 10 −4 at 95% (90%) confidence level.

Right bundle branch block (RBBB) configuration is an unexpected finding during right ventricular (RV) pacing that raises the suspicion of inadvertent left ventricular lead positioning. The aim of this study was to evaluate the prevalence of paced RBBB pattern in relation to RV lead location. This is a secondary analysis of a prospective, multicenter study, which randomized implantable cardioverter defibrillator recipients to an apical versus midseptal defibrillator lead positioning. A 12-lead electrocardiogram was recorded during intrinsic rhythm and RV pacing. Paced RBBB–like pattern was defined as positive (>0.05 mV) net amplitude of QRS complex in leads V1 and/or V2. In total, 226 patients (65.6 ± 12.0 years, 20.8% women, 53.1% apical site) were included in the study. The prevalence of paced RBBB pattern in the total population was 15.5%. A significantly lower percentage of patients in the midseptal group demonstrated RBBB-type configuration during RV pacing compared with the apical group (1.9% vs 27.5%, p <0.001). Baseline RBBB, prolonged QRS duration during intrinsic rhythm, and reduced ejection fraction were not associated with increased likelihood of paced RBBB. In the subgroup of patients with RBBB type during pacing, 91.4% of patients had a paced QRS axis from −30° to −90°, whereas 100% of patients displayed a negative QRS vector at lead V3. In conclusion, RBBB configuration is encountered in a considerable percentage of device recipients during uncomplicated RV pacing. Midseptal lead positioning is associated with significantly lower likelihood of paced RBBB pattern compared with apical location.

The aim of this study was to compare safety and feasibility of a subcutaneous purse-string suture (PSS) with manual compression (MC) to gain hemostasis in patients after multiple femoral venous punctures undergoing electrophysiological procedures on uninterrupted oral anticoagulation (OAK). A total of 784 patients who underwent catheter ablation for atrial fibrillation (n = 564) or (a)typical atrial flutter (n = 220) were assessed. Four hundred sixty-two patients received PSS (58.9%) and 322 patients (41.1%) received MC to gain hemostasis. All patients were on uninterrupted full-dose OAK. During the procedure, weight-adapted heparin was applied. Venous sheath diameter were 8Fr (n = 2)/11.5Fr (n = 1) for left atrial or 8Fr (n = 1)/6Fr (n = 2) for right atrial procedures. No protamine was administered at the end of the procedure. After PSS, patients' had 6 hours of bed rest compared with 10 hours after MC (sheath removal after 4 hours followed by a bandage for 6 hours). PSS was removed the following day. All patients underwent duplex sonography of the access site the following day. Using the PSS, hemostasis was achieved in 453 of 462 patients (98%). MC leads to hemostasis in all 322 patients. No difference was found between the 2 approaches regarding hematomas (<5 cm or >5 cm), arterio-venous fistulas, or pseudoaneurysms. No major complication such as ipsilateral leg ischemia, the need of vascular surgery, or deep vein thrombosis occurred. In conclusion, PSS is a safe and effective way to gain immediate hemostasis after multiple punctures of the femoral vein in patients undergoing catheter ablation on OAK. PSS avoids MC and leads to shorter patient immobilization.