Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(公財)日本心臓財団  

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Language：Japanese   Publisher：日本臨床生理学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Atrial flutter (AFL) is a large reentrant circuit located in the right atrium. Anti-arrhythmic drugs (AADs) can provoke AFL with 1:1 atrioventricular conduction (AVC) to cause hemodynamic collapse. We elucidated the characteristics of patients with AFL exhibiting spontaneous 1:1 AVC. Fifteen patients (1:1 AFL group; 11 males, 52.4 ± 13.7 years old) who documented AFL with 1:1 AVC were enrolled and compared to 153 patients without 1:1 AVC (Control group; 137 males, 68.9 ± 11.2 years old). AFL cycle length during maximum AVC was significantly longer in the 1:1 AFL group than in the control group (274.7 ± 37.0 vs. 216.2 ± 25.6 ms, p < 0.001). Among 1:1 AVC group, 9 patients had AADs, and AFL cycle length was significantly longer during 1:1 AVC as compared with 2:1 AVC documented the other day (284.4 ± 41.3 vs. 233.3 ± 26.0 ms, p < 0.001), suggesting enhancement effect of the AADs during 1:1 AVC. Remaining 6 patients who did not take AADs, 2 patients showed enlargement of the tricuspid annulus and 3 patients developed 1:1 AVC during exercise. Multivariate analysis revealed that younger age and the use of AADs was independent risk factors for the development of 1:1 AFL group. Prolonged AFL cycle length associated with the class Ia/Ic AAD use, slower heart rate during sinus rhythm and younger age were important risk factors for the development of 1:1 AVC during AFL.

DOI： 10.1007/s00380-021-01968-y

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound-guided apical approach in patients with chronic pericardial effusion. METHODS: Among 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis. RESULTS: A subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group. CONCLUSION: The subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.

DOI： 10.1002/clc.23810

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Attempting to minimize radiation exposure during catheter ablation of atrial fibrillation (AF) for patients, operators and medical staffs should be performed. This study aimed to investigate the feasibility and safety of a metal interference alert guided septal approach using 3 intracardiac echocardiography viewing positions for near-zero fluoroscopy AF ablation procedures. Methods/results: A total of 668 procedures among 608 consecutive patients with AF (67.2 ± 7.3 years, 408 males) who underwent catheter ablation were retrospectively evaluated and divided into 2 groups, near-zero group (n = 42) and conventional group (n = 595). In the near-zero group, a metal interference alert guided septal approach with 3 different catheter intracardiac echocardiography positions to minimize the fluoroscopy time was applied, and a left atrial access with 2 long sheaths from a single septal puncture without fluoroscopy was successfully achieved in 41 out of 42 cases. The total fluoroscopy time was significantly shorter in the near-zero group than that in the conventional group (0.5 ± 2.0 vs. 21.4 ± 12.9 min p < 0.0001). The total procedure time and time to the septal puncture were both significantly longer in the near-zero group than those in the conventional group (131.4 ± 40.2 vs. 116.6 ± 46.4p = 0.0453, 31.6 ± 9.2 vs. 19.9 ± 10.2 min, p < 0.0001), The ablation time did not differ between the 2 groups (Near-zero: 99.8 ± 41.0 vs. Conventional: 96.8 ± 44.3 min, p = 0.6663). There were no significant differences in the complication rate between the 2 groups (Near-zero: 0 vs. Conventional 14 case, p = 0.6151). Conclusion: A metal interference alert guided septal approach using 3 intracardiac echocardiography viewing positions was feasible and safe for a near-zero fluoroscopy catheter ablation of AF.

DOI： 10.1016/j.ijcha.2021.100896

PubMed

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Language：Japanese   Publisher：(公財)日本心臓財団  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publishing type：Research paper (scientific journal)  

A persistent left superior vena cava (PLSVC) is a congenital venous abnormality and is usually asymptomatic and does not cause hemodynamic disturbances. Therefore, it is difficult to identify it by routine examinations in clinical practice. This study aimed to elucidate the electrocardiographic characteristics for the prediction of a PLSVC. Twelve patients (9 males, 56.2 ± 18.3 years) who were diagnosed with a PLSVC were enrolled. The electrocardiographic parameters, including the P-wave duration, axis, and morphology of the P waves, were automatically measured and compared to 150 controls (77 males, 57.3 ± 14.6 years). There were no significant differences in the P-wave duration. Negative or positive/negative P waves in lead III predicted a PLSVC with a sensitivity of 100% and specificity of 81%. The P-wave axis in PLSVC exhibited a significant leftward deviation as compared to the controls (14.8 ± 21.1 vs. 54.0 ± 17.4°, p < 0.001). A receiver operating characteristic curve analysis of the P-wave axis for predicting a PLSVC exhibited an area under curve of 0.93 [CI 95% (0.87-0.98), p < 0.001), and identified a P-wave axis of less than 37.5° to have a 92% sensitivity and 83% specificity in predicting a PLSVC. A negative or positive/negative P-wave morphology in lead III was a useful finding for suggesting the presence of a PLSVC.

DOI： 10.1007/s00380-018-1278-2

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Landiolol, an ultra-short acting β1-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients. CONCLUSIONS: Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.

DOI： 10.1253/circj.CJ-18-1131

PubMed

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A 46-year-old man was admitted to our hospital for near syncope and palpitations. An electrocardiogram showed a common type of atrial flutter (AFL) with 1:1 atrioventricular conduction. Transthoracic echocardiography revealed a massive right atrial (RA) thrombus with a huge RA and right ventricle. The patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy. It was difficult to control the heart rate with beta-blockers during AFL, which resulted in the deterioration of right-sided heart failure. The effect of anticoagulation therapy for the RA thrombus was also limited. Restoration to sinus rhythm by catheter ablation effectively improved the right-sided heart failure, and the massive RA thrombus eventually disappeared.

DOI： 10.2169/internalmedicine.55.5520

PubMed

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：臨床心臓電気生理研究会  

症例は16歳女性。心電図で心室早期興奮を認め、右房刺激では僧帽弁輪5時付近の冠静脈洞(CS)3-4電極で心房心室波が融合し、ATP 20mg急速静注により、AH間隔の延長と心室早期興奮が強まった後に房室ブロックを呈した。心室刺激での逆行性心房最早期興奮部位は、CS遠位端(1-2電極)で減衰伝導特性を示した。心房期外刺激で順行性副伝導路の不応期の後にAH間隔のjump up現象を認め、心房最早期興奮部位をCS入口部とする頻拍周期430msecのnarrow QRS頻拍が誘発されslow/slow型房室結節リエントリー性頻拍(AVNRT)と診断。頻拍が持続したまま逆行性心房興奮部位が心室刺激と同一の僧帽弁輪5時に変化し頻拍周期は450msecに延長した。心室刺激中に僧帽弁輪5時に留置したアブレーションカテーテルの電極で心室心房波融合電位が得られ、高周波通電1秒で副伝導路が離断され遅伝導路を介する室房伝導に移行した。その後slow/slow型AVNRTが誘発され、遅伝導路への通電で頻拍は誘発不能となった。僧帽弁輪5時に見られた副伝導路はATP感受性かつ減衰伝導特性を示し、解剖学的位置より房室結節心室間副伝導路と考えられた。(著者抄録)

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：臨床心臓電気生理研究会  

症例は49歳、男性。下壁誘導でP&#039;-/+を示すshort RP&#039;頻拍1は、心房単一期外刺激で順行伝導jump upの後、逆行心房エコー波のjump up様所見と共に誘発され、心房最早期興奮部(AEP)は高位心房中隔であった。ATP 20mgでHA時間は不変でAH延長後にブロックで停止、心室刺激中の投与はVAブロックを呈した。順行性遅伝導路を標的としたKoch三角での通電は無効で、冠静脈洞(CS)入口部天井通電でHA時間短縮を伴う頻拍周期延長を来した。逆行伝導の興奮順序は同様で、下部共通路への入力がより心房端でかつ伝導特性がより遅い順行遅伝導路(SP)に乗り換え、下部共通路伝導距離延長で生じた現象と考えた。この付近の通電で右房-CS間伝導障害により左房内興奮順序が変化し頻拍周期が延長、SP左側偏位が示唆された。本頻拍は両心房、CS内で根治せず、バルサルバ洞内の頻拍中AEPへの通電で停止し、SP上方偏位が考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(有)科学評論社  

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Other Link： http://search.jamas.or.jp/link/ui/2016004547