this is a causative factor in DHF. We investigated the association between heart rate and postprocedural DHF in patients undergoing AF ablation. Methods PatientsThe data of a total of 1,004 consecutive patients undergoing initial ablation for AF at the Kansai Rosai Hospital Cardiovascular Center between December 2014 and December 2018 were analyzed retrospectively. Exclusion criteria were age <20 years and incomplete standard electrophysiological studies following pulmonary vein (PV) isolation.This study complied with the Declaration of Helsinki and the ethical standards of the Kansai Rosai Hospital Cardiovascular Center on human experimentation. Written informed consent for catheter ablation and the use of data in this study was obtained from all patients, and the study protocol was approved by the Kansai Rosai Hospital Institutional Review Board (Reference no. 2001030). Catheter ablation is one of several well-established therapies for atrial fibrillation (AF), but is a complex interventional procedure that is associated with a significant risk of complications. 1 A previous study showed an overall incidence of complications of 6.3%. 2 Decompensated heart failure (DHF) can occur after catheter ablation. 3 Previous studies showed that 20-26% of patients undergoing AF ablation suffered symptoms of heart failure within 30 days after the procedure. 4,5There is a wide variety of risk factors for DHF, such as overhydration, tachycardia, bradycardia, and blood pressure elevation. 6 Fluid load from irrigated catheters, sedation, and chemotactic invasion may also cause DHF after catheter ablation. 4 Cardiac output is also known to decrease in more than one-third of patients after cardioversion of AF, recovering by degrees over 4 weeks. 7 Bradycardia and sinus node dysfunction sometimes occur after persistent AF ablation, and bradycardia generally causes a decrease in cardiac output. 8,9 Accordingly, we hypothesized that cardiac output cannot be compensated for by a decrease in heart rate after the procedure, and that

Introduction: Although decompensated heart failure (DHF) can complicate catheter ablation of atrial fibrillation (AF), its incidence and risk factors have not been defined. We sought to investigate the incidence and risk factors for DHF in these patients. Methods: In total, 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; females, 346 [34%]; and persistent AF, 513 [51%]) were enrolled. Δheart rate, which was defined as heart rate after ablation minus heart rate before ablation, were calculated. DHF was defined as heart failure requiring medical therapy during post-procedure hospitalization, or re-hospitalization due to heart failure < 90 days after the procedure. DHF was classified into early peri-procedual DHF, which occurring within 2 days after the procedure, and late peri-procedual DHF, which occurring ≥ 3 days after the procedure. Results: The incidence of DHF was 32/1004 (3%) patients. Patients with DHF had a higher prevalence of a past history of symptomatic heart failure (17/32 [53%] versus 154/972 [16%], P < 0.01) and lower Δheart rate after the procedure than those without (−16 ± 28 versus 2 ± 21 beats/min, P < 0.01). On multivariate analysis, lower Δheart rate was a significant independent predictor of early peri-procedual DHF, while early recurrence of AF was a significant independent predictor of late peri-procedual DHF. Conclusion: In patients with AF, lower Δheart rate was an independent predictor of early peri-procedual DHF, and early recurrence of AF was an independent predictor of late peri-procedual DHF.

Background: Although hemodialysis vintage and serum phosphorus level adversely impact on outcomes in the field of general population on hemodialysis, it has not systematically studied whether these have similar prognostic impacts on clinical outcomes in population with chronic limb-threatening ischemia (CLTI). Methods: The current study retrospectively analyzed 374 hemodialysis patients with CLTI presenting ischemic tissue loss (age: 72.3±9.0 years, male: 73.3%, diabetes mellitus: 39.6%, Rutherford 5: 75.9%, 6: 24.1%, WIFI stage 4: 50.0%) primarily treated with endovascular therapy (EVT) between April 2007 and December 2016. Primary outcome measure was 1-year amputation-free survival (AFS), while secondary outcome measure was 1-year wound healing. Predictors for each outcome were evaluated by Cox proportional hazards model. Result: One-year rate of AFS and wound healing rate were 70.5±2.5%, and 57.1±3.0%, respectively. Multivariate analysis demonstrated that body mass index (hazard ratio [HR], 0.918; 95% confidence interval [CI], 0.859-0.981; p=0.012), non-ambulatory status (HR, 1.887; 95% CI, 1.222-2.913; p=0.004), lower serum albumin level (HR, 0.591; 95% CI, 0.414-0.844; p=0.004), WIfI stage 4 (HR, 1.782; 95% CI, 1.156-2.748; p=0.009) and longer vintages for hemodialysis with higher serum phosphorus levels (HR, 1.670; 95% CI, 1.099-2.537; p=0.016) were significantly associated with 1-year AFS (Figure), while WIfI stage 4 (HR, 0.713; 95% CI, 0.519-0.979; p=0.037) was associated and longer vintages for hemodialysis with higher serum phosphorus levels was close to significant association (HR, 0.684; 95% CI, 0.467-1.000; p=0.050) with 1-year wound healing. Conclusion: Longer hemodialysis vintage with higher serum phosphorus level would adversely affect clinical outcomes after EVT for hemodialysis patients with CLTI presenting ischemic tissue loss.

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