Aims Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades. Methods A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade (n = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade (n = 10), and group 3, non-CS patients (n = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated. Results The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; p=0.039, ΔESV: 3.0 mL vs. -12.7 mL vs. -37.2 mL; p = 0.008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups (p = 0.19). No cardiovascular deaths occurred in group 1. Conclusion CS patients taking corticosteroids before the CRT upgrade had lower echocardiographic responses but higher freedom rates from a composite endpoint. The timing of corticosteroid use would affect the clinical course following a CRT upgrade.

Introduction: In the COVID-19 era, demand is growing for remote ECG monitoring systems with less or no in-person contact. However, the practical usage of wearable ECG devices has been little studied in Japan. This study aimed to report our initial experience of using the postal system in the delivery of the self-wearable ECG device (Duranta) and long-term ECG monitoring in outpatient care. Methods:　　 The Duranta is small, light (35 g), and easy to attach to the chest with two patch electrodes. Real-time ECG data were automatically transmitted to a cloud server via iPhones. The devices were packed in prepaid envelopes that could be put in any postbox for delivery between the hospital and patients’ homes. Results: Twenty-five patients (61 ± 17 years) were enrolled. The median distance to the hospital from the patients’ homes was 10 km (range: 1.1–183). The patients had no difficulties with either the postal delivery or wearing the ECG devices. A total of 57 hours (range: 20–179) of ECG monitoring per patient was performed, and the data were successfully transmitted to the hospital. The median percentage of noise/artifact burden during the ECG monitoring was 0.9%. Arrhythmic events were observed in 8 patients. Most patients were satisfied with the ECG system and delivery via the postal service. Conclusion: The use of a postal delivery of a wearable ECG device could work in clinical practice with to achieve less or no in-person contact. This system can be applicable for telehealth, home care, and arrhythmia screening.

Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.

Background: Some of atrial fibrillation (AF) drivers are found in lesser late-gadolinium enhancement (LGE) areas, as well as heterogenous ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in lesser LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping). Lesser LGE areas were defined as areas with a volume ratio of the enhancement voxel of <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI. Results: NPAs were found in 20 (18.0%) of 131 lesser LGE areas where the AWT was significantly thicker than that in the passively activated areas (PAs) (2.46±0.26 vs. 2.20±0.25 mm, p<0.001). However, NPAs were found in 61 (21.3%) of 287 LGE areas where the AWT was similar to that of the PAs (2.24±0.24 vs. 2.22±0.25 mm, p=0.58). An ROC curve analysis yielded an optimal cutoff value of 2.24 mm for predicting the presence of an NPA in lesser LGE areas. Conclusion: The location of AF drivers in lesser LGE areas might be more accurately identified by evaluating the AWT.