Tomoya Kimura

Introduction: While some patients faced the difficulty to implant leadless pacemaker, the relationship between inferior vena cava (IVC) location and procedural difficulty was uncertain. Methods: We conducted a single‐center, cross‐sectional study including 96 consecutive patients who underwent implantation of Micra leadless pacemakers between July 2022 and November 2024. Based on the positional relationship between the IVC and the right ventricular septum assessed by preprocedural computed tomography, patients were classified into right‐sided and left‐sided IVC groups. The primary outcome was multiple deployments defined as the number of device deployments ≥ 2. Results: A total of 96 patients were analyzed, including 81 in the right‐sided and 15 in the left‐sided IVC group. The mean age was 84, and 55 (57%) were male patients. Multiple deployments were observed in 39 (41%) patients. The risk of the primary outcome was significantly higher in the left‐sided IVC group than in the right‐sided (67% vs. 36%), with an adjusted odds ratio of 9.5 (95% CI: 1.5–58.7, p = 0.02). Procedure time was numerically longer in the left‐sided group (36 vs. 25 min, p = 0.11). Pericardial effusion occurred only in two patients in the right‐sided group, none requiring intervention. Conclusions: The left‐sided IVC was associated with multiple deployments of a leadless pacemaker and preoperative computed tomography was useful in assessing the procedural difficulty.

BACKGROUND: Clopidogrel may have ischemic benefit over aspirin as long-term monotherapy in patients receiving percutaneous coronary intervention. METHODS: Both the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy-2) and STOPDAPT-2 ACS (Short and Optimal Duration of Dual Antiplatelet Therapy-2 Study for the Patients With Acute Coronary Syndrome) were multicenter, open-label, adjudicator-blinded, randomized clinical trials in Japan, with the same protocol except that the STOPDAPT-2 ACS enrolled patients with acute coronary syndrome, exclusively. The patients after percutaneous coronary intervention with cobalt-chromium everolimus-eluting stents were randomized into 1-month dual antiplatelet therapy followed by clopidogrel monotherapy (clopidogrel group) or 12-month dual antiplatelet therapy followed by aspirin monotherapy (aspirin group). Follow-up duration was 5 years. The clinical effect between clopidogrel and aspirin monotherapy was compared by the 1-year landmark analysis in the STOPDAPT-2 ACS and STOPDAPT-2 total cohort, a pooled cohort of the 2 trials. The primary end point was the composite of cardiovascular end point (cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis) and bleeding end point (Thrombolysis in Myocardial Infarction major/minor). The major secondary end points were each of the cardiovascular composite end point and the bleeding end point. RESULTS: Of 2986 patients (clopidogrel group: 1492, aspirin group: 1494) in the 5-year analysis of the STOPDAPT-2 ACS, 2875 (96.3%) completed follow-up. By the 1-year landmark analysis, clopidogrel group was superior to aspirin group for both the primary end point (6.18% and 8.27%; hazard ratio, 0.75 [95% CI, 0.57–0.997]; P =0.048) and the major secondary cardiovascular end point (4.73% and 6.77%; hazard ratio, 0.70 [95% CI, 0.51–0.96]; P =0.03). In the STOPDAPT-2 total cohort, including 5991 patients, the superiority of clopidogrel over aspirin for the cardiovascular end point was highly significant (hazard ratio, 0.74 [95% CI, 0.60–0.91]; P =0.004), although the superiority on the primary end point was insignificant (hazard ratio, 0.86 [95% CI, 0.72–1.03]; P =0.11). There was no between-groups difference in the major secondary bleeding end point, both in the STOPDAPT-2 ACS and STOPDAPT-2 total cohort. CONCLUSIONS: Clopidogrel monotherapy was superior to aspirin monotherapy for cardiovascular outcomes beyond 1 year after percutaneous coronary intervention, without increased bleeding risk. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02619760 and NCT03462498.

Background: Bachmann's bundle pacing (BBp) improves interatrial conduction, but its clinical impact on atrial function has not fully established. Methods and Results: We report eight cases of attempted BBp. Three cases met BBp electrocardiographic criteria with significant P‐wave shortening and P‐wave amplitude increase in the inferior leads, resulting in improved left atrial (LA) function (increased a' velocity, decreased E/e', and reduced LA diameter) and heart failure stabilization. Conversely, the remaining five cases failing to achieve significant P‐wave changes showed no such improvements. Conclusions: Restoring interatrial conduction through successful BBp may optimize LA performance, potentially offering heart failure stabilization.

BACKGROUND: There were no previous studies comparing aspirin with clopidogrel on top of oral anticoagulation (OAC) within 1 year after percutaneous coronary intervention when dual therapy with OAC and clopidogrel was recommended. METHODS: We conducted a subgroup analysis stratified by OAC in the 1-year follow-up of the STOPDAPT-3 trial (Short and Optimal Duration of Dual Antiplatelet Therapy-3), which randomly compared 1-month dual antiplatelet therapy followed by aspirin monotherapy (aspirin group) with 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). This subgroup analysis compared aspirin with clopidogrel in patients with or without OAC by the 30-day landmark analysis. The coprimary end points were the cardiovascular (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke), and bleeding end points (Bleeding Academic Research Consortium 3 or 5). RESULTS: In the 30-day landmark analysis (N=5809), there were 788 patients (13.6%) with OAC at discharge. Regardless of OAC, the incidence rates beyond 30 days up to 1 year were similar between the aspirin and clopidogrel groups for cardiovascular end point (OAC: 3.7% versus 3.9%, hazard ratio, 0.92 [95% CI, 0.44–1.93]; no OAC: 3.7% versus 3.6%; hazard ratio, 1.03 [95% CI, 0.77–1.38]; P interaction=0.78) and for bleeding end point (OAC: 3.5% versus 4.2%, hazard ratio, 0.82 [95% CI, 0.39–1.73]; no OAC 1.5% versus 1.4%, hazard ratio, 1.07 [95% CI, 0.66–1.72]; P interaction=0.57). CONCLUSIONS: Aspirin compared with clopidogrel was associated with similar cardiovascular and bleeding outcomes beyond 30 days and up to 1 year after percutaneous coronary intervention regardless of OAC at discharge. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04609111.