A trial fibrillation (AF) ablation procedures are generally effective and safe; however, devastating complications occasionally occur. Coronary artery spasms (CASs) have recently been reported as a complication of AF ablation, and some patients develop serious Editorial p ????

BackgroundThe aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch‐specified ablation strategy.MethodsThis study included 94 atrial fibrillation (AF) patients (56 males, age 68 ± 8.0 years). With intracardiac echocardiography, the isthmus length and pouch depth were precisely measured. After a standard AF ablation, all patients underwent the CTI ablation along the lateral isthmus. If bidirectional block could not be achieved, the ablation catheter was deflected more than 90 degrees to ablate inside the pouch (knuckle‐curve ablation).ResultsSeventy‐two patients (76.6%) had a sub‐Eustachian pouch. Bidirectional block could be achieved in all patients. By a univariate logistic regression analysis, only the pouch depth was significantly correlated with the RF duration (P = .005) and RF energy (P = .006). A multivariate logistic regression analysis also revealed the pouch depth was the sole factor that influenced the RF duration (P = .001) and RF energy (P = .001). Among the 72 patients, 21 patients needed a knuckle‐curve ablation. Using a receiver operating characteristic curve, the optimal cutoff value of the pouch depth for a knuckle‐curve ablation was 3.7 mm with a sensitivity of 90% and specificity of 69%.ConclusionsThe sub‐Eustachian pouch depth was the sole factor that influenced the RF duration and energy in the CTI ablation. If the pouch was deeper than 3.7 mm, a deep pouch‐specified ablation strategy would be needed.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp theromatous plaques of the aorta have been regarded as a potential source of emboli. 1-12 As transesophageal echocardiography (TEE) provides clear images of the aorta, the thickness, morphology, and mobility of the plaques can be evaluated by TEE. 13,14 However, there are few reports 4-6,15 about the frequency and prognosis of patients with thoracic aortic plaques and about the relationship between aortic plaque morphology and prognosis of patients, especially, there are no reports with regard to the long-term follow-up data among the Japanese population.The purpose of this study was to clarify the frequency and prognosis of patients with severe atheromatous plaques in the thoracic aorta and the impact of aortic plaque morphology on the survival rate and on the incidence of subsequent embolic events. Methods Study PatientsWe retrospectively investigated 2,382 consecutive patients who underwent TEE between 1991 and 2003. Clinical indications for TEE in our hospital are as follows: 40% of the patients underwent TEE for evaluating valvular heart disease, 15% to discover the source of a recent embolism, 15% for evaluating left atrial thrombus prior to cardioversion, 7% for assessing aortic atherosclerosis prior to cardiac catheterization, 7% for evaluating congenital heart disease, 6% for evaluation of thoracic aortic disease, and 10% for other reasons. Patients who had other potential cardiac sources of emboli, including atrial fibrillation, cardiac tumor, vegetations, patent foramen ovale and atrial septal defect were excluded from the study. In addition, patients with aortic dissection, Background: There are no reports about the long-term follow-up data of patients with aortic plaques among the Japanese population. The purpose of this study was to clarify the frequency of patients with severe aortic plaques and the impact of aortic plaque morphology on the prognosis.

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LAA largely contributes to LA booster function, particularly in the maze group, because LA booster function is deteriorated in this group of patients.