on behalf of the J-RHYTHM Registry Investigators* Background--To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed.

BackgroundAlthough patients taking non-vitamin K antagonist oral anticoagulants (NOACs) do not require routine coagulation monitoring, high-risk patients require monitoring to assess pharmacodynamics.MethodsWe measured (1) anti-factor Xa activity (AXA), using chromogenic assay with the HemosIL Liquid Heparin kit, (2) prothrombin time (PT), and (3) activated partial thromboplastin time (aPTT) in 188 blood samples from 70 patients with non-valvular atrial fibrillation, of whom 36 received rivaroxaban once daily and 34 received apixaban twice daily.ResultsAfter the rivaroxaban therapy, AXA ranged from 0 to 3.65 IU/mL; PT, from 9.6 to 44.5 s; and APTT, from 19.3 to 69.7 s. After the apixaban therapy, AXA ranged from 0.02 to 3.18 IU/mL; PT, from 10.2 to 20.8 s; and APTT, from 21.8 to 59.8 s. At peak time, the AXA of patients who received rivaroxaban and apixaban were almost the same (2.08±0.91 IU/mL vs. 1.71±0.57 IU/mL), but the PT and APTT of patients who received rivaroxaban were more prolonged than those of patients who received apixaban (18.1±5.6 s vs. 13.8±0.9 s, p<0.001 and 40.9±7.3 s vs. 35.5±7.5 s, p<0.01, respectively). At trough time, the AXA and PT of patients who received rivaroxaban were respectively lower and shorter than those of patients who received apixaban (0.28±0.31 IU/mL vs. 1.04±0.72 IU/mL, p<0.001 and 11.9±2.0 s vs. 13.7±2.4 s, p<0.01, respectively), but the APTT of patients who received rivaroxaban and apixaban did not significantly differ (32.3±4.3 s vs. 34.3±3.8 s).ConclusionsMeasurement of AXA might be useful to assess the pharmacodynamics of high-risk patients, such as high age, low body weight, and/or low renal function, and to assess the intensity of anticoagulation by using different methods of administration, such as crushed tablet via the nasogastric tube.

Of 10 patients with typical Sotos sequence, 5 had various congenital heart defects. They included 2 patients with secundum atrial septal defect, and one patient each with patent ductus arteriosus with mitral valve regurgitation, tricuspid atresia plus pulmonary atresia, and ventricular septal defect. Increases of head circumference and weight gain were less accelerated in the patients with congenital heart defects than in those without heart defects, while growth in length was comparable between the 2 groups. In view of these findings, it is suggested that the rate of congenital heart defects in patients with Sotos sequence is much higher than that reported in the literature.

SubjectsThe study included 55 patients (37 men, 18 women, mean age 68±9 years) who have subjective symptoms of palpitation and who had electrocardiographically confirmed AF.Circ J 2007; 71: 46 -51 (Received June 7, 2006; revised manuscript received October 10, 2006; accepted October 17, 2006) Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After CardioversionTakashi Komatsu, MD; Hideaki Tachibana, MD; Yoshihiro Sato; Mahito Ozawa; Motoyuki Nakamura, MD; Ken Okumura, MD* Background It has been previously reported that the efficacy of class I antiarrhythmics in preventing the recurrence of symptomatic paroxysmal and persistent atrial fibrillation (AF) is limited when AF lasts for 48 h or more. However, it is unclear whether the efficacy of amiodarone, a class III drug, is superior to class I antiarrhythmics in patients with long-lasting AF. Method and ResultsThe relationship between the duration of tachycardia and the efficacy of amiodarone in preventing recurrence of tachycardia was examined in 55 patients (37 men, 18 women, mean age 68±9 years) to whom amiodarone was administered after electrical or pharmacological cardioversion for paroxysmal and persistent AF. In 26 patients, paroxysmal and persistent AF ceased within 48 h after onset (Group A), and in the other 29 patients, it ceased after 48 h (Group B). Patient characteristics and actuarial recurrence-free rates were compared between the 2 groups. The mean follow-up period was 30±11 months. No statistically significant difference between the groups was found in patient characteristics. Actuarial recurrence-free rates in Group A and B at 1, 3, 6, 9, and 12 months were 100%, 81%, 69%, 62%, and 54%, and 93%, 79%, 66%, 52%, and 48%, respectively (p= NS at 12 months). The period of maintenance of sinus rhythm was 14.7±3.2 months in group A and 13.3±3.3 months in group B (mean ± SE, p= NS). Conclusion In the case of amiodarone, efficacy for maintaining sinus rhythm after cardioversion of AF was not biased by the duration of arrhythmia. This observation suggests amiodarone is effective in maintaining normal sinus rhythm after cardioversion, even in patients with long-lasting AF and electrical atrial remodeling.(Circ J 2007; 71: 46 -51)

AIM:To evaluate the association between genetic polymorphisms and angiotensin converting enzyme inhibitor (ACEI)-related cough, and the race-or ethnicityrelated difference in the prevalence of cough attributed to ACEI therapy. METHODS:We conducted a search in �ub�ed, E�-BASE, Cinahl, and the Cochrane �atabase without language limitation. A database of 11 studies on ACEIrelated cough, with detailed information regarding ACE I/� or bradykinin B2 receptor polymorphisms, was created. Eligible studies were synthesized using metaanalysis methods, including cumulative meta-analysis. A subgroup analysis was also performed using ethnicity. RESULTS:Six studies were included on ACE I/� polymorphism (398 Caucasians, 723 East Asians), and three studies were included on bradykinin B2 receptor polymorphism (300 East Asians). The distribution of ACE genotypes showed significant differences in the entire population (� = 0.004) and in East Asians (� = 0.005) but not in Caucasians (� = 0.23). Allelic frequencies of ACE showed significant differences in East Asians [odds ratio (OR) = 1.49 (1.11-2.02)]. The meta-analysis with a random effects model showed a significant associa- CONCLUSION: ACE I/� and Bradykinin B2 receptor polymorphisms contributed to the risk of ACEI-related cough in East Asians, but a negative association between ACE I/� polymorphism and ACEI-related cough was observed in Caucasians.