Background: Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, |LORENZO Et aL. | INTRODUC TI ONGout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. 1 Its prevalence increased steadily in various countries: 2.7% in the 1990s to 3.9% in early 2000 in the United States and from 3.4 per 1000 in 2007 to 7.6 per 1000 persons in 2015 in Korea. 2,3 The prevalence is higher in certain ethnic groups.The risk for tophi formation tends to be higher after controlling for age, gender, hypertension, diuretic use, and kidney function. 4 Varying prevalence across ethnic groups indicates that genetics affects its development and the individual's risk when exposed to environmental or dietary variables. 5,6 Despite scientific advancements, disease control of gout is suboptimal. 2,3 Clinical practice guidelines (CPG) from Western and several Asian countries have provided recommendations for the management of gout. [7][8][9] However, the need to formulate unified Asia-Pacific recommendations was recognized. This CPG aims to provide evidence-based recommendations in managing gout in its different phases: asymptomatic hyperuricemia, acute gout, intercritical gout, and chronic tophaceous or complicated gout. It covers both pharmacologic and non-pharmacologic interventions (NPI) with consideration of the unique needs of patients with gout in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in different clinical settings in these regions. | G UIDELINE DE VELOPMENT ME THODSThe Steering Committee (SC) formed the guideline development working groups (GDG), formulated the guideline questions (Table 1) in PICO (population, intervention, comparator, and outcome) format, and oversaw the CPG processes (Figure 1). The Technical Working Group (TWG) appraised and summarized the evidence, applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to determine the certainty of evidence, and drafted the recommendations.The Consensus Panel (CP) was composed of 9 key stakeholders (rheumatologists, general practitioners, academicians, and a patient representative) from Australia,

Atrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X, has been recommended for stroke prevention for decades. Non-Vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding. With the increasing prevalence of AF, prescription of the appropriate oral anticoagulants (OACs) according to patient's characteristics becomes a challenge. This review article aims to provide an overview of anticoagulant use in AF patients with difficult scenarios.

Introduction: Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs.Methods: Twenty patients (58 ± 10 y/o, 15 males) with complex ATs were included.We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval < 20 ms), CV < 0.3 m/s and local fractionated electrograms were evaluated.Results: Twenty-six complex ATs were mapped (mean: 1.3 ± 0.7 maps/pt; 4 focal, 22 isthmus-dependent). Coherent mapping was better in identifying CI/breakout sites where ablation terminated the tachycardia (96.2% vs 69.2%; P = .010) and identified significantly more CI (mean/chamber 2.0 ± 1.1 vs 1.0 ± 0.7; P < .001) with narrower width (19.8 ± 10.5 vs 43.0 ± 23.9 mm; P < .001) than conventional mapping. Ablation at origin and CI sites was successful in 25 (96.2%) with long-term recurrence in 25%. ---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Conclusions: Coherent mapping with conduction velocity vectors derived from adjacent mapping sites significantly improved the identification of CI sites in scar-related ATs with isthmus-dependent re-entry better than conventional mapping. It may be used in conjunction with conventional mapping strategies to facilitate recognition of slow conduction areas and critical sites that are important targets of ablation. K E Y W O R D S activation mapping, atrial tachycardia, coherent mapping, focal atrial tachycardia, scar-related macro re-entrant 1438 | VICERA ET AL.

There was no difference in AF recurrence after catheter ablation between CBA and RFCA, but significant increases of non-PV triggers and LA flutter during the second procedure suggest the importance of the atrial substrate in maintaining AF during the second procedure after previous CBA.

Introduction Identifying the critical isthmus (CI) in scar‐related macroreentrant atrial tachycardia (AT) is challenging, especially for patients with cardiac surgery. We aimed to investigate the electrophysiological characteristics of scar‐related macroreentrant ATs in patients with and without cardiac surgery. Methods A prospective study of 31 patients (mean age 59.4 ± 9.81 years old) with scar‐related macroreentrant ATs were enrolled for investigation of substrate properties. Patients were categorized into the nonsurgery (n = 18) and surgery group (n = 13). The CIs were defined by concealed entrainment, conduction velocity less than 0.3 m/s, and the presence of local fractionated electrograms. Results Among the 31 patients, a total of 65 reentrant circuits and 76 CIs were identified on the coherent map. The scar in the surgical group is larger than the nonsurgical group (18.81 ± 9.22 vs. 10.23 ± 5.34%, p = .016). The CIs in surgical group have longer CI length (15.27 ± 4.89 vs. 11.20 ± 2.96 mm, p = .004), slower conduction velocity (0.46 ± 0.19 vs. 0.69 ± 0.14 m/s, p < .001), and longer total activation time (45.34 ± 9.04 vs. 38.24 ± 8.41%, p = .016) than those in the nonsurgical group. After ablation, 93.54% of patients remained in sinus rhythm during a follow‐up of 182 ± 19 days. Conclusion The characteristics of the isthmus in macroreentrant AT are diverse, especially for surgical scar‐related AT. The identification of CIs can facilitate the successful ablation of scar‐related ATs.