Equally in regards to the Rt PVs

Equally, in regards to the Rt.PVs, because there was a significant difference in the direction of the myocardial activation wavefront between that during CSd and that during HRA pacing, there was a significant difference in the time it nae inhibitor took to activate the PVs (Fig. 6C, D). However, in this study, this pacing method was not useful for discriminating the breakthrough sites for the Rt.PVs. It is necessary, in the future, to establish how to identify the breakthroughs sites especially in the carina region of the Rt.PVs. When PV isolation was not achieved after the initial and/or repeated circumferential PV isolation, detailed mapping of gaps along the PVI isolation line was often performed. Nevertheless, in some cases, it might not have been easy to record visible PV potentials in those ablation regions because the amount of myocardium might have been diminished to a greater or lesser extent by the burn of the ablation application and edema may have been induced. These findings were recognized especially in the anterior carina of the Lt.PVs although the ablation catheter was appropriately placed at the breakthrough site during ablation. For such cases, we recommend that our pacing method might be helpful for the improved recognition of the electrical breakthroughs during the ablation. Although our method did not accurately lead to the detection of the breakthrough point in all PVs, it was relatively easier to identify whether or not the electrical breakthrough sites between the LA and carina were from the region of the Lt.PVs. Consequently, this pacing method may help to minimize ineffective radiofrequency deliveries, complications [8–10,18], hard labor, procedure time, and provide a better ablation outcome.
Conclusions
Conflict of interest
Acknowledgments
Introduction The prevalence of atrial fibrillation (AF) increases with aging in Japan [1]. An epidemiological survey conducted by the Japanese Circulation Society indicated that the prevalence of AF was gradually increasing, and estimated a prevalence rate of 0.79% by 2020 [2]. The results of cohort-based [3] and community-based [4] surveys showed that the prevalence of AF in Japan is already >1%. AF is an important risk factor for stroke. The incidence of stroke in patients with nonvalvular AF (NVAF) was reported to be about 5% per year, and 2- to 7-fold higher than in the population without AF [5,6]. The result of a Japanese study indicated that, among 15,831 patients hospitalized with acute cerebral infarction, AF was observed in 3335 patients, 78.4% of whom were found to have cardiogenic embolism [7]. Medical treatment in patients with AF should thus also be targeted at preventing cerebral thrombosis/embolism, as well as other types of embolisms. Antithrombotic treatment is important for preventing stroke in patients with NVAF, and warfarin and anticoagulants have been the recommended treatments; additionally, aspirin and antiplatelet preparations have been acceptable. The Japanese Guidelines for Treatment of Stroke 2009 [8] recommended warfarin for managing NVAF patients with more than two risk factors (congestive heart failure, hypertension, age >75 years, or diabetes mellitus), whereas antiplatelet preparations are acceptable in patients with contraindications to warfarin. Additionally, the latest Japanese Guidelines for Pharmacotherapy of Atrial Fibrillation [9] addressed the importance of many risk factors when selecting suitable antithrombotic drug therapies such as warfarin, in accordance with the severity of the risk. In March 2011, the new oral direct thrombin inhibitor (DTI) dabigatran, with a novel mechanism of action, was introduced on the market [10], and a new drug application for the factor Xa inhibitor rivaroxaban was filed in 2011. These drugs are superior, or at least not inferior, to warfarin in terms of efficacy and safety [11,12], and are therefore likely to change the standard of antithrombotic therapy in the near future.