Background Poor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited. Objective The purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF. Methods Patient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. Results A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82%) patients underwent follow-up at 1 month, 107 (79%) at 3 months, and 96 (71%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93%) and 10 (7%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group. Conclusions The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful.

The novel automated software package reduced time for quantification of MV with similar accuracy compared to the manual method. Automated quantification is useful and may be a key to widespread adoption of three-dimensional quantification in clinical practice.

Background: Hypertension in patients with atrial fibrillation (AF) is a known independent risk factor for stroke. The Complete blood pressure (BP) monitor (Omron Healthcare, Kyoto, Japan) was developed as the first BP monitor with electrocardiogram (ECG) capability in a single device to simultaneously monitor ECG and BP readings. This study investigated whether the Complete can accurately differentiate sinus rhythm (SR) from AF during BP measurement. Methods and Results: Fifty-six consecutive patients with persistent AF admitted for catheter ablation were enrolled in the study (mean age 65.8 years; 83.9% male). In all patients, 12-lead ECGs and simultaneous Complete recordings were acquired before and after ablation. The Complete interpretations were compared with physician-reviewed ECGs, whereas Complete recordings were reviewed by cardiologists in a blinded manner and compared with ECG interpretations. Sensitivity, specificity, and κ coefficient were also determined. In all, 164 Complete and ECG recordings were simultaneously acquired from the 56 patients. After excluding unclassified recordings, the Complete automated algorithm performed well, with 100% sensitivity, 86% specificity, and a κ coefficient of 0.87 compared with physician-interpreted ECGs. Physician-interpreted Complete recordings performed well, with 99% sensitivity, 85% specificity, and a κ coefficient of 0.85 compared with physician-interpreted ECGs. Conclusions: The Complete, which combines BP and ECG monitoring, can accurately differentiate SR from AF during BP measurement.

SummaryA 54-year-old woman with a history of multiple cardiac surgeries suffered from hypoxemia caused by a right-to-left intra-cardiac shunt due to coronary sinus (CS) anomaly with persistent left superior vena cava (PLSVC). Both the contrast echocardiography and enhanced computed tomography (CT) provided conclusive diagnosis of this rare congenital anomaly, which was overlooked for a long time. However, an important diagnostic clue was left-arm injection of the contrast media. In the present case, previously performed enhanced CT with its routine manner, i.e., contrast through the right arm, missed this anomaly. It is crucial to note that the unusual type of unroofed CS with PLSVC, presenting with an entirely right-to-left intra-cardiac shunt, cannot be delineated on an enhanced routine chest CT if the contrast media is injected through the right arm.(Int Heart J 2017; 58: 1008-1011) Key words: Echocardiography, Computed tomography, Diagnosis U nroofed coronary sinus (CS) is a rare congenital cardiac anomaly with a reported prevalence of only 0.1% among all congenital heart diseases. 1) In this pathology, there is a significant communication between the CS and the left atrium (LA) due to complete or partial absence of the roof or septum between the CS and the LA. Other than persistent left superior vena cava (PLSVC), which is complicated with as much as 75% of the cases of this pathology, 1) other complicated malformations could critically affect the clinical manifestations of unroofed CS. 2) Here, we describe an adult case who suffered from hypoxemia due to a variant form of this pathology overlooked for a long time; then, we reemphasize "classical" diagnostic clues and pitfalls of this pathology that we learned from the present case. Case ReportA 54-year-old woman was referred to our department for evaluation of hypoxemia. She had a history of multiple cardiac surgeries: repair of pulmonary artery stenosis during childhood, repair of ruptured sinus of Valsalva at 25 years of age, and aortic valve replacement at 35 years of age. She underwent aortic valve re-replacement for prosthetic valve regurgitation 13 months ago. She had taken medications for hypertension after the latest surgery. Although hypoxemia was noted before she underwent the latest cardiac surgery, the etiology was considered as transient pulmonary congestion caused by a prosthetic valve regurgitation. Following successful surgery, arterial oxygen saturation of less than 90% at rest on room air was finally recognized as hypoxemia of unknown etiology. Her physical examination was unremarkable, without grade 2/6 systolic ejection murmur heard at the aortic area. A chest radiogram did not show pulmonary congestion. Transthoracic echocardiography revealed abnormal ventricular septal motion, presumably due to postoperative pericardial adhesions. However, there was neither evidence of elevated left ventricular filling pressure nor abnormalities in the postsurgical lesions. Moreover, the CS did not appear dilated on the transthoracic echocardiography....

sistent on the association of CD with MS in patients with a balloon-expandable valve (BEV). 9,10 Therefore, we examined whether computed tomography (CT) assessment of the MS anatomy could provide useful information about the risk of CD, PPM implantation or CLBBB, following TAVR with BEV. Methods Study Population The study population comprised 132 consecutive patients with symptomatic severe AS who underwent TAVR at Kyoto Prefectural University of Medicine between February 2016 and July 2019; 26 patients were excluded for the following reasons: 13 did not have sufficient quality of CT T ranscatheter aortic valve replacement (TAVR) has become one of the best treatment options for patients with severe aortic stenosis (AS) and high or extreme surgical risk. 1-3 The periprocedural complication rate for TAVR has markedly decreased, 4 but cardiac conduction disturbance (CD) following TAVR, such as atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation or complete left-bundle-branch block (CLBBB), is a frequent complication. 5 This is because the atrioventricular node is continuous with the His bundle and pierces the membranous septum (MS), which is just below the left ventricular (LV) outflow tract. 6,7 A previous report showed that short MS length predicted PPM implantation after TAVR with a self-expandable valve (SEV). 8 However, results from 2 studies have been incon