Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

INTRODUCTION: The concept of a 3-month blanking period is widely accepted after the first radiofrequency catheter ablation (RFCA) session for atrial fibrillation (AF). We sought to investigate whether this phenomenon was also observed after a 2nd session, and which factors were related to it. METHODS AND RESULTS: We conducted a prospective observational study including all AF patients who underwent RFCA since 2010. The patients who underwent a second RFCA were followed without any antiarrhythmic drugs. Their clinical background, laboratory data, echocardiographic parameters, ablation procedures, and arrhythmia recurrences were analyzed. Recurrences were classified into early period recurrences (EPRs) and late period recurrences (LPRs) recorded within and after the first 3 months postablation, respectively. Among 925 patients who underwent an initial AF ablation, 2nd sessions were performed in 250 patients, and EPRs and LPRs occurred in 53 (21.2%) and 54 (21.6%) patients, respectively. Although EPRs were an independent predictor of LPRs (hazard ratio [HR], 8.01; 95% confidence interval [CI] 4.03-15.93, P < 0.001), 20 of the patients with EPRs (37.7%) did not experience LPRs, supporting the concept of a blanking period. Among 53 patients with EPRs, the E/E' ratio on echocardiography (HR, 1.156; 95% CI 1.00-1.33, P = 0.04) was an independent predictor of LPRs, while other parameters including the maximum serum C-reactive protein level after the session and the ablation procedure details were not. CONCLUSION: A 3-month blanking period was also applicable after the 2nd AF ablation session. This phenomenon was related to a lower left atrial pressure demonstrated by the E/E' ratio.

DOI： 10.1111/jce.13129

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INTRODUCTION: Although catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. METHODS: From 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). RESULTS: When comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). CONCLUSION: Right atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.

DOI： 10.1016/j.ijcha.2023.101297

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BACKGROUND: Ventricular tachycardia (VT) associated with primary cardiac tumors (PCTs) originating from the ventricles is rare, but lethal, in young patients. OBJECTIVES: This study aimed to clarify the mechanisms underlying primary cardiac tumor-related ventricular tachycardia (PCT-VT) and establish a therapeutic strategy for this form of VT. METHODS: Among 67 patients who underwent surgery for VT at our institute between 1981 and 2020, 4 patients aged 1 to 34 years, including 3 males, showed PCT-VT (fibroma, 2; lipoma, 1; and hamartoma, 1), which was investigated using a combination of intraoperative electroanatomical mapping and histopathological studies. RESULTS: All 4 patients developed electrical storms of sustained VTs refractory to multiple drugs and repetitive endocardial ablations. The VT mechanism was re-entry, and intraoperative electroanatomical mapping showed a centrifugal activation pattern originating from the border between the tumor and healthy myocardium, where fractionated potentials were detected during sinus rhythm. Histopathological studies of serial sections of specimens acquired from these areas revealed tumor infiltration into the surrounding myocardium with cell disorganization, exhibiting myocardial disarray. Several myocardia entrapped in the tumor edges contributed to the development and sustainment of re-entrant VT activation. In the 2 patients in whom complete resection was unfeasible, encircling cryoablation to entirely isolate the unresectable tumor was effective in suppressing VT occurrence. CONCLUSIONS: The mechanism underlying PCT-VT involves re-entry localized at the tumor edges. Myocardial disarray associated with tumor infiltration is a substrate for this form of VT. Cryoablation along the border between the tumor and myocardium is a promising therapeutic option for unresectable PCT-VT.

DOI： 10.1016/j.jacep.2023.08.033

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INTRODUCTION: Data are lacking on the extent to which patients with non-valvular atrial fibrillation (AF) who are aged ≥80 years benefit from ablation treatment. The question pertains especially to patients' postablation quality of life (QoL) and long-term clinical outcomes. METHODS AND ANALYSIS: We are initiating a prospective, registry-based, multicentre observational study that will include patients aged ≥80 years with non-valvular AF who choose to undergo treatment by catheter ablation and, for comparison, such patients who do not choose to undergo ablation (either according to their physician's advice or their own preference). Study subjects are to be enrolled from 52 participant hospitals and three clinics located throughout Japan from 1 June 2022 to 31 December 2023, and each will be followed up for 1 year. The planned sample size is 660, comprising 220 ablation group patients and 440 non-ablation group patients. The primary endpoint will be the composite incidence of stroke/transient ischaemic attack (TIA) or systemic embolism (SE), another cardiovascular event, major bleeding and/or death from any cause. Other clinical events such as postablation AF recurrence, a fall or bone fracture will be recorded. We will collect standard clinical background information plus each patient's Clinical Frailty Scale score, AF-related symptoms, QoL (Five-Level Version of EQ-5D) scores, Mini-Mental State Examination (optional) score and laboratory test results, including measures of nutritional status, on entry into the study and 1 year later, and serial changes in symptoms and QoL will also be secondary endpoints. Propensity score matching will be performed to account for covariates that could affect study results. ETHICS AND DISSEMINATION: The study conforms to the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies issued by the Ministry of Health, Labour and Welfare, Japan. Results of the study will be published in one or more peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000047023.

DOI： 10.1136/bmjopen-2022-068894

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

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Background: Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing hemodialysis (HD); AF lowers quality of life (QoL) and increases the risk of dialysis-related complications. The present study aimed to evaluate the effectiveness of AF ablation on the QoL in patients undergoing HD. Methods: Nineteen patients undergoing HD (14 men, age 68 ± 8 years; 15 with paroxysmal AF) who underwent catheter ablation (CA) of AF were enrolled in the study. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was assessed to evaluate the QoL of the HD patients at baseline and 6 months after the ablation. Ablation outcomes and procedural complications were evaluated and compared to those of 1053 consecutive non-HD patients who underwent AF ablation. Results: The KDQOL-SF of the HD patients 6 months after the ablation showed an improvement in physical functioning (54 ± 23 to 68 ± 28, P < 0.01), general health perceptions (38 ± 17 to 48 ± 15, P < 0.01), and symptoms/problems (75 ± 21 to 84 ± 13, P = 0.02), compared to baseline. For intradialytic symptoms, dyspnea during HD significantly improved after the CA in the HD patients without AF recurrence (43% to 7%, P = 0.04), whereas the atrial tachyarrhythmias and hypotension during HD remained unchanged. During the follow-up period of 17 ± 13 months after the last procedure, the incidence of being arrhythmia-free was similar (HD patients, 79% vs non-HD patients, 86%, log-rank P = 0.82). No life-threatening complications occurred in any of the patients. Conclusions: CA of AF improves QoL in patients undergoing chronic HD therapy.

DOI： 10.1016/j.cjco.2022.05.009

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DOI： 10.1007/s00380-022-02138-4

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DOI： 10.1007/s00380-022-02137-5

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Atrioventricular Block (AVB) is one of the common manifestations in cardiac sarcoidosis (CS). Although pacemaker implantation is generally recommended in patients with CS complicated by symptomatic AVB, some case reports have shown that they can be managed by steroid therapy without pacemaker implantation. The aim of this study was to evaluate the feasibility and effectiveness of steroid therapy without pacemaker implantation in patients with CS complicated by symptomatic AVB. We performed medical record review of consecutive ten CS patients who admitted Nippon Medical School Hospital for symptomatic second or third degree AVB between April 2015 and March 2021. Of the studied population, steroid therapy before pacemaker implantation was feasible in three patients with second degree AVB. Two of them showed subsequent recovery of atrioventricular conduction to 1:1, and they were managed by steroid therapy without pacemaker. The remaining one patient showed no improvement of atrioventricular conduction and required pacemaker implantation. Seven patients with third degree AVB required device implantation (pacemaker; n = 7, cardiac resynchronization therapy defibrillator; n = 1) before steroid therapy mainly because of hemodynamic instability. Steroid therapy without pacemaker implantation might be feasible, and possibly be effective in patients with CS presenting second degree AVB. However, the feasibility is limited in patients with third degree AVB.

DOI： 10.1007/s00380-022-02092-1

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

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

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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：臨床心臓電気生理研究会  

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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

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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：臨床心臓電気生理研究会  

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Authorship：Corresponding author   Language：English  

DOI： 10.1007/s10840-022-01161-9

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

DOI： 10.1093/ehjcr/ytac088

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Other Link： https://academic.oup.com/ehjcr/article-pdf/6/2/ytac088/42623200/ytac088.pdf

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

Sustained ventricular tachycardia (sVT), leading to sudden cardiac death, is one of the common manifestations in cardiac sarcoidosis (CS). Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been reported to be associated with sVT, the relationships of its localization to sVT have not been fully evaluated.To evaluate the localization of LGE and its relationships to sVT in patients with CS, we reviewed medical record of consecutive 31 patients with CS who underwent CMR. The localization of LGE was divided into four categories: Left ventricular (LV) septum, LV free wall, right ventricular (RV) septum, and RV free wall. We investigated the association of sVT with localization of LGE and other parameters including serum biomarkers LV ejection fraction on echocardiography and Fluorine-18-fluorodeoxyglucose (FDG) accumulation on positron emission tomography (PET) -CT.Of the studied population, 8 patients (25.8%) were known to present with sVT among 31 CS patients. LGE was observed in the RV free wall in 6 patients with sVT, whereas it was in 5 patients without sVT (75.0% versus 21.7%, P = 0.022). Univariate analysis showed that only LGE in the RV free wall was associated with sVT (odds ratio [OR]: 10.80; 95% confidence interval [CI]: 1.64-70.93, P = 0.013).LGE in the RV free wall was associated with sVT in patients with CS.

DOI： 10.1536/ihj.21-635

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04789&link_issn=&doc_id=20220413510006&doc_link_id=10.1536%2Fihj.21-635&url=https%3A%2F%2Fdoi.org%2F10.1536%2Fihj.21-635&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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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

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). Although coronary artery spasms (CAS) during or after ablation procedures have been described as a rare complication in some case reports, the incidence and characteristics of this complication have not been fully elucidated. The present observational study aimed to clarify the CAS in a large number of patients experiencing AF ablation. METHODS: A total of 2913 consecutive patients (male: 78%, mean 66 ± 10 years) who underwent catheter ablation of AF were enrolled. RESULTS: Nine patients (0.31%, mean 66 ± 10 years, 7 males) had transient ST-T elevation (STE). Eight out of the 9 patients had STE in the inferior leads. STE occurred after the transseptal puncture in 7 patients, after the sheath was pulled out of the left atrium in 1, and 2 h after the ablation procedure in 1. Six patients had definite angiographic CAS without any sign of an air embolization on the emergent coronary angiography. In the3 other patients, the STE improved either directly after an infusion of nitroglycerin or spontaneously before the CAG. The patients with CAS had a higher frequency of a smoking habit (89% vs. 53%; P = .04), smaller left atrial diameter (36 ± 6 vs. 40 ± 7; P = .07), and lower CHADS2 score (0.6 ± 0.5 vs. 1.3 ± 1.1; P = .004) than those without. CONCLUSIONS: Although the incidence was rare (0.31%), CAS should be kept in mind as a potentially life-threatening complication throughout an AF ablation procedure especially performed under conscious sedation.

DOI： 10.1007/s10840-021-01089-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本内科学会  

We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.

DOI： 10.2169/internalmedicine.7729-21

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BACKGROUND: Although epicardial structures around the atrium such as adipose tissue possess arrhythmogenicity, little is known about atrial tachycardias (ATs) originating from epicardial sites (Epi-ATs). This study aimed to elucidate the prevalence, characteristics, and outcome after radiofrequency catheter ablation (RFCA) of Epi-ATs and to reveal the association between Epi-ATs and the epicardial structures. METHODS: The electrocardiographic, electrophysiologic, and anatomical properties and results of RFCA were analyzed in 42 patients with a total of 49 ectopic ATs. RESULTS: Six Epi-ATs (12%) were observed in six patients (14%). Four of six were respiratory cycle-dependent ATs and one was a swallowing-induced AT. The Epi-AT origins were adjacent to a pulmonary vein (five cases) and vein of Marshall (one case). A Valsalva maneuver or atropine infusion to define the arrhythmia mechanism affected the appearance of the Epi-ATs. The congruity rate between epicardial adipose tissue and the AT origin was significantly higher (100% vs. 44%, p = .045), and the epicardial adipose tissue volume of the atrium was significantly larger (104.1 vs. 64.6 ml, p = .04) in the Epi-AT group. Endocardial RFCA targeting the AT foci resulted in acute success in five of five cases. However, electrical isolation including of the AT foci resulted in acute failures (two of three cases) or a recurrence (one of one case). CONCLUSIONS: Six Epi-ATs were associated with thoracic veins and epicardial arrhythmogenic structures. The main cause provoking the Epi-ATs was associated with autonomic nerve activity.

DOI： 10.1002/clc.23577

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Background: Respiratory management during catheter ablation of atrial fibrillation (AF) is important for the efficacy and safety of the procedure. Obstructive apnea due to an upper airway obstruction might cause serious complications including air embolisms and cardiac tamponade. However, real time monitoring of upper airway obstructions during catheter ablation has not been established. The purpose of the present study was to evaluate esophageal pressure monitoring for respiratory management during catheter ablation of AF. Methods and Results: Twenty-four consecutive patients (20 men and 4 women; mean age, 61 ± 13 years) with AF who underwent esophageal pressure monitoring during catheter ablation of AF were retrospectively analyzed. The patients were divided into 2 groups. One was the obstructive apnea (OA) group (n = 17), which required airway management tools including nasal airways and/or non-invasive positive airway pressure (NPPV) and the other was the control group (n = 7), which did not require airway management. Esophageal pressure measurements were obtained in all patients, and the OA group exhibited a substantial negative esophageal pressure as compared to the control group (-41.48 ± 19.58 vs. -12.42 ± 5.77 mmHg, p < 0.001). Airway management in the OA group immediately improved the negative esophageal pressure and returned to a normal range (-41.48 ± 19.58 vs. -16 ± 8.1 mmHg, 0 < 0.001) along with a recovery from desaturation. Conclusions: Esophageal pressure monitoring was a simple and effective method for the evaluation and management of obstructive apnea during AF catheter ablation.

DOI： 10.1016/j.ijcha.2021.100771

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：日本医科大学医学会  

BACKGROUND: Because acute coronary syndrome (ACS) development worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals in recurrent ACS patients are achieved is unknown. METHODS: Consecutive 214 ACS patients were divided into two groups; First ACS (n=182) and Recurrent ACS (n=32), and compared clinical characteristics between the groups. Fifteen patients developed death or cardiovascular (CV) events during hospitalization, and remained 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS: Patients in the Recurrent ACS group were older (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003) than those in the First ACS group. The attainment rate of low-density lipoprotein cholesterol (LDL-C) < 70mg/dl in the Recurrent ACS group was only 28.1%, despite 68.8% of these patients receiving statin. HbA1c < 7.0% was achieved in 66.7% of recurrent ACS patients who had been diagnosed with DM. Overall, 12.5% of recurrent ACS patients had received optimal treatment for secondary prevention. CV events after hospital discharge were identified in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION: Optimal treatment for secondary prevention in recurrent ACS patients was insufficient. Attainment of the guideline-recommended LDL-C goal for secondary prevention was especially low in recurrent ACS patients.

DOI： 10.1272/jnms.JNMS.2021_88-601

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

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Language：Japanese   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：シュプリンガー・ジャパン(株)  

Gastrointestinal (GI) bleeding worsens the outcomes of critically ill patients in the intensive care unit (ICU). Owing to a lack of corresponding data, we aimed to investigate whether GI bleeding during cardiovascular-ICU (C-ICU) admission in acute cardiovascular (CV) disease patients is a risk factor for subsequent CV events. Totally, 492 consecutive C-ICU patients (40.9% acute coronary syndrome, 22.8% heart failure) were grouped into GI bleeding (n = 27; 12 upper GI and 15 lower GI) and non-GI bleeding (n = 465) groups. Thirty-nine patients died or developed CV events during hospitalization, and 453 were followed up from the date of C-ICU discharge to evaluate subsequent major adverse CV events. The GI bleeding group had a higher Acute Physiology and Chronic Health Evaluation II score (20.2 ± 8.2 vs. 15.1 ± 6.8, p < 0.001), higher frequency of mechanical ventilator use (29.6% vs. 13.1%, p = 0.039), and longer C-ICU admission duration (8 [5–16] days vs. 5 [3–8] days, p < 0.001) than the non-GI bleeding group. The in-hospital mortality rate did not differ between the groups. Of those who were followed-up, CV events after C-ICU discharge were identified in 34.6% and 14.3% of patients in the GI and non-GI bleeding groups, respectively, during a median follow-up period of 228 days (log rank, p < 0.001). GI bleeding was an independent risk factor for subsequent CV events (adjusted hazard ratio: 2.23, 95% confidence interval: 1.06–4.71; p = 0.035). GI bleeding during C-ICU admission was independently associated with subsequent CV events in such settings.

DOI： 10.1007/s00380-021-01822-1

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to investigate the incidence and prognostic impact of newly detected AF after cardiac implantable electronic device (CIED) implantation with HCM patients. Fifty-six patients (33 men, age 57 ± 17 years) with HCM who underwent CIED implantations with no previous history of AF at the time of implantation (ICD n = 46, Pacemaker n = 10) were retrospectively enrolled. During 5.7 ± 3.6 years of follow-up, AF was newly detected in 20 (36%) of 56 patients after the CIED implantation (AF group) and the rest of the patients had no newly detected AF (non-AF group). The presence of mitral regurgitation (HR 8.49; 95% CI 2.29-30.6 P < 0.01) and concomitant NYHA II-IV (HR 3.37; 95% CI 1.30-8.86 P = 0.01) were the independent predictors of newly detected AF. During the follow-up, all patients in the AF group started anticoagulation mean 21 days after detection of AF, and none had a stroke during the follow-up period. The rate of appropriate ICD therapy (log-rank P = 0.95), inappropriate ICD therapy (log-rank P = 0.78), and all-cause death (log-rank P = 0.23) were similar between the two groups. However, the incidence of hospitalizations due to heart failure was higher in the AF group (55% vs. 6% log-rank P < 0.01). In conclusion, the incidence of newly detected AF after CIED implantations in HCM patients was high. The newly detected AF was associated with worsening heart failure and careful follow-up is recommended.

DOI： 10.1007/s00380-020-01728-4

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04638&link_issn=&doc_id=20210430310010&doc_link_id=10.1007%2Fs00380-020-01728-4&url=https%3A%2F%2Fdoi.org%2F10.1007%2Fs00380-020-01728-4&type=Crossref&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00002_2.gif

Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

左上大静脈遺残(PLSVC)を予測するための心電図所見の特徴を後ろ向きに検討した。PLSVCと診断された患者12例(男性9例、女性3例、平均55.8±18.4歳)および動悸等の種々の胸部症状を有する対照患者150例(男性77例、女性73例、平均57.3±14.6歳)の、P波幅、軸、形態を含む心電図パラメータを測定・比較した。P波幅に有意差はなかった。第3誘導における陰性または陽性/陰性P波は、100%の感度と81%の特異度でPLSVCを予測した。またPLSVC群におけるP波軸は、対照群と比較して有意な左方向偏位を示し、PLSVCを予測に対するP波軸の受信者操作特性曲線解析では曲線下面積は0.93で、37.5°未満のP波軸は感度92%、特異度83%でPLSVCを予測した。第3誘導における陰性または陽性/陰性P波形態は、PLSVCの存在予測に有用な所見であることが示された。

DOI： 10.1007/s00380-018-1278-2

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

BACKGROUND: An early repolarization electrocardiographic (ER-ECG) pattern is caused by various pathophysiological conditions and is reported to be a predictor of life-threatening ventricular tachyarrhythmias. However, little evidence has been reported on the prevalence and significance of the ER-ECG pattern in acute myocarditis. This study aimed to investigate the prevalence and significance of the ER-ECG pattern and its mechanistic insight based on the cardiac magnetic resonance findings in patients with acute myocarditis. METHODS: Thirty patients (23 men; 39.2±19.1 years) with a diagnosis of acute myocarditis by a clinical presentation between March 2011 and April 2018 were retrospectively evaluated. The patients were divided into 2 groups depending on the presence of an ER-ECG pattern on admission. RESULTS: Nine cases had an ER-ECG pattern, which was defined as terminal QRS notching or slurring with an amplitude of >0.1 mV in at least 2 inferior or lateral leads (early repolarization [ER] group), whereas the remaining 21 cases had broad ST-segment elevation or pathological Q waves (non-ER group). The cardiac troponin T level was significantly higher in the non-ER group than ER group (3.2±4.3 versus 0.9±1.2 ng/mL; P=0.036). The ECG changes returned to baseline along with the normalization of the cardiac biomarkers. Nine of the 21 non-ER group patients, but none of the 9 ER group patients, developed a fulminant course and lethal ventricular tachyarrhythmias. T2-weighted cardiac magnetic resonance showed high-intensity signals over the entire transmural left ventricle in the non-ER group, whereas they were localized to the left ventricular epicardium in the ER group. CONCLUSIONS: The ER-ECG pattern in acute myocarditis was transient and reversible and was not associated with a worse prognosis. Inflammation/swelling localized to the left ventricular epicardium because of acute myocarditis might provide a mechanistic insight into the ER-ECG pattern.

DOI： 10.1161/CIRCEP.118.006969

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

左室機能不全を伴う頻脈性心房細動(AF)または頻脈性心房粗動/心房頻脈(AFl/AT)に対するランジオロールの有効性と安全性を後ろ向きに評価した。当該患者77例のうち、AF群は65例(男性69.2%、平均73.1±12.6歳)、AFl/AT群は12例(男性75.0%、平均68.7±14.0歳)であり、ベースライン時の患者背景に有意差はなかった。高用量にも関わらず、ベースラインから12時間後および24時間後の心拍数(HR)の%変化は、AFl/AT群でそれぞれ-10.2±12.7%および-16.1±19.4%のみであったが、AF群ではそれぞれ-28.3±13.2%および-31.3±11.3%であった(P<0.02)。ランジオロールによる奏効者の割合は、AF群がAFl/AT群よりも有意に高かった(P<0.001)。AFl/AT群の83%でアミオダロン静注および電気的除細動などの代替治療が必要であった。AFl/AT群の3例は、コントロールされないHRと低血圧のためランジオロールを継続することは困難であった。一方、AF群の6例では、HRはコントロールできたが低血圧のためランジオロールを中止した。結論として、大部分のAFl/AT患者においてランジオロールは無効であった。

DOI： 10.1253/circj.CJ-18-1131

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

DOI： 10.1016/j.jacep.2018.11.005

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Language：English   Publisher：(一社)日本内科学会  

症例は46歳男性で、2012年11月に下肢浮腫と心電図異常のため来院し、2013年4月に失神寸前状態となり動悸がみられるため入院した。心電図でリードII、III、aVFに鋸歯状のP波が認められ、2:1の房室伝導を伴う心房粗動が示唆された。心房粗動時の房室伝導は、2:1から食事および運動時には1:1に変動した。洞調律時の心電図でイプシロン波が存在していたことから不整脈原性右室心筋症と診断した。右房内血栓と心房粗動に対してワルファリンによる抗凝固療法を開始したところ、血栓は小さくなり、ビソプロロール投与により房室伝導は4:1まで低下した。しかし、退院から2週間後に心不全が増悪し、全身浮腫のため退院時から体重が10kgも増加した。収縮期血圧は80mmHg以下で、ビソプロロール増量による心拍数制御は困難であったことから、高周波カテーテルアブレーションを行った。その後、洞調律が維持され、心不全は良好に制御された。退院から5ヵ月後に大半の右房内血栓は消失し、1年半経過後に心房粗動の再発や心不全の悪化はみられなかった。

DOI： 10.2169/internalmedicine.55.5520

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

BACKGROUND: Atrial tachycardia (AT) may develop after biatrial surgical ablation of atrial fibrillation. However, the mechanism has not been determined in detail. OBJECTIVE: We aimed to determine the mechanism and treatment of postoperative AT following biatrial surgical ablation in relation to the design and durability of the surgical lesion sets. METHODS: An electrophysiologic study and radiofrequency ablation were performed in 34 consecutive patients (23 male, mean age of 63 ± 9.4 years) who were referred for AT that developed late after biatrial surgical ablation. RESULTS: The mechanism of a total of 53 ATs was macroreentry in 30, a focal mechanism in 20, and localized reentry in 1, and could not be determined in 2. The cause of the macroreentrant AT was residual conduction across a surgical lesion, most of which was located at the annular end of the mitral (n = 18) or tricuspid isthmus incision (n = 7), where cryoablation was applied during the surgery. We did not find any gaps across the cut-and-sew lesions. Radiofrequency (RF) applications to the gap, or an alternative site to transect the circuit, or the earliest activation site of the focus was effective for 48 ATs (91%). After a total of 1.3 ± 0.6 RF sessions, 27 patients (79%) were free of AT (n = 2) or AF (n = 5) during a follow-up period of 50 ± 49 months. CONCLUSIONS: Macroreentry due to a gap in a surgical lesion and focal AT were the major mechanisms of AT in patients after biatrial surgical ablation. Radiofrequency ablation of those ATs is feasible.

DOI： 10.1016/j.hrthm.2015.12.033

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Language：Japanese   Publisher：(株)総合医学社  

＜POINT＞●血行動態が不安定な徐脈は、治療対象である。●完全房室ブロック、モビッツII型房室ブロックでは、症候の有無に関係なく治療する。●時間的猶予のない場合は、経皮ペーシング、準緊急であれば、経静脈的ペーシングを行う。(著者抄録)

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Language：Japanese   Publisher：(株)総合医学社  

＜POINT＞●血行動態が不安定な頻脈性不整脈には、カルディオバージョンを行う。●血行動態が極めて不安定な場合は、カルディオバージョンの実施を遅らせない。●不整脈が頻発する場合は、心筋虚血、電解質異常や心不全コントロールなど是正できる要因がないか検討する。(著者抄録)

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

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Authorship：Lead author   Language：Japanese   Publisher：(株)医学書院  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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

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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：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  

Atrial fibrillation (AF) is a common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and is associated with renal function deterioration. The protective effects of catheter ablation (CA) of AF on renal function in patients with HCM remain unsolved. From 2009 to 2020, a total of 169 consecutive patients with HCM and AF (age 70 ± 12, 87 males) were retrospectively evaluated. The estimated glomerular filtration rate (eGFR) was evaluated at the study enrollment or 1 month before the CA and reevaluated 3 and 12 months later. In the 169 patients, 63 underwent CA of AF (ablation group), and the remaining 106 did not (control group). After propensity score matching, 45 pairs were matched. The baseline eGFR was similar between the 2 groups (p = 0.83). During a mean follow-up period of 34 ± 27 months, sinus rhythm was maintained in 36 patients (80%) after 1.7 ± 0.8 ablation procedures. The eGFR significantly decreased from baseline to 3 months (p <0.01) and from baseline to 1 year (p <0.01) in the control group, whereas the eGFR in the ablation group was maintained both from baseline to 3 months (p = 0.94) and from baseline to 1 year (p = 1.00) after the CA. The change in the eGFR between baseline and 12 months was significantly smaller in the ablation group than in the control group (p <0.01). After logistic regression analysis, CA of AF was the independent predictor of an improvement of eGFR (odds ratio 2.81, 95% confidence interval 1.08 to 7.36, p = 0.04). In conclusion, CA of AF had a protective effect on renal function in patients with HCM.

DOI： 10.1016/j.amjcard.2022.02.055

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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)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本糖尿病学会  

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Language：Japanese   Publisher：(一社)日本不整脈心電学会  

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

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

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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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：Japanese   Publisher：(一社)日本不整脈心電学会  

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

症例は、強皮症に伴う間質性肺炎で在宅酸素療法を導入中の76歳女性。有症候性の持続性心房細動に対してカテーテルアブレーション施行目的で入院。%肺活量が65%と拘束性肺障害あり、局所麻酔と低用量プレセデックスを用いた浅鎮静で手技を行った。心筋焼灼に伴う疼痛を訴えたため、プレセデックス増量とミダゾラムを投与したところ、喀痰排出が困難となり酸素飽和度の低下をきたした。フルマゼニルで拮抗し、呼吸状態を改善させたのちペンタゾシンとヒドロキシジンを使用し拡大両側肺静脈隔離術を施行した。術後経過良好であったが、術翌日に心電図上前胸部誘導でT波の陰転化を認め、その後呼吸困難が出現し、心エコー検査では心尖部の壁運動低下がみられた。CPKは43U/Lであったが、NT-proBNPは4457pg/mLと増加しており、胸部X線では肺うっ血像を示した。心不全加療後に施行した冠動脈造影検査では有意狭窄は認めず、左室造影所見では心尖部の無収縮は改善していた。術後にアブレーション焼灼時の疼痛を我慢していたことが判明し、カテーテルアブレーションを誘因とするたこつぼ心筋症と診断した。心房細動に対するカテーテルアブレーションを契機にたこつぼ心筋症を発症した1例を経験した。(著者抄録)

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

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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：臨床心臓電気生理研究会  

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

うっ血性心不全を合併して入院し、経過中に頻脈性心房細動(AF)を新規に発症し、アミオダロン静注薬を投与した75例(男性40名、女性35名、平均76歳)を対象とした。心疾患内訳は、虚血性心疾患40例、急性心筋梗塞13例、拡張型心筋症6例であった。洞調律復帰は42例であった。アミオダロン投与1時間以内に心拍数が低下した。洞調律復帰群とAF持続群の患者背景を比較すると、性別(男性)、虚血性心疾患、左房径、機械補助換気で有意差を認め、多変量解析の結果、機械補助換気、性別、左房径の順にアミオダロン抵抗性を示した。洞調律復帰した42例中39例が洞調律を維持したまま退院した。退院後は経口アミオダロン12例、他の抗不整脈薬4例、抗不整脈薬非内服23例であった。AF持続群33例中18例で電気的除細動を施行し、16例は洞調律に復帰した。最終的に64例が洞調律に復帰して退院した。死亡例は14例であった。10例に有害事象を認め、洞性徐脈3例、接合部調律3例、低血圧3例、洞停止1例、静脈炎1例で、いずれも軽症で、投与中断には至っていない。

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

症例は72歳、男性。拡張型心筋症に対してCRTD植え込み3年後に右脚ブロック+右軸偏位型の単形性持続性VT(周期480〜520msec)を繰り返した。左室心内膜マッピングでは低電位領域を認めず、CRTDの左室リードペーシング中に心外膜マッピングを施行。左室後壁基部に2×3cmの低電位領域(LVZ)を認め、内部の複数箇所で遅延電位が記録された。ペーシングから260msecのdelayをもってVTと同一波形のQRS波形となる部位を同定、ペーシングや当部位を起源とするectopyにより容易にVTが誘発され、VT中は拡張期電位となった。焼灼中にVT停止し、焼灼を継続すると局所のectopyが進出ブロックによりQRSを捕捉しなくなり、QRSと解離した局所興奮も認め、以後VTは誘発不能となった。緩徐伝導路起源のectopyの進出ブロックにより必須伝導路内のブロックが確認された稀有な症例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

頻脈性心房細動・心房頻拍に対するアミオダロン静注薬の有効性と安全性について検討した。急性冠症候群(ACS)または急性心不全(CHF)で入院し、経過中に頻脈性心房細動・心房粗動に対してアミオダロン静注薬を使用した44例(男性22名、女性22名、平均77歳)を対象とした。急速飽和中に13例、持続静注中に10例が洞調律に復帰し、洞調律復帰までの時間は平均15時間であった。洞調律復帰群の平均心拍数は129→99bpmに低下し、心房細動持続群で123→108bpmに低下した。洞調律に復帰せず、心房組動が持続した21例のうち9例で電気的除細動を行った。12例は効果不十分のため、心拍数コントロールを追加した。アミオダロンによると推測される有害事象が3例(静脈炎1例、血圧低下2例)で発生した。投与後脳梗塞を1例が発症した。

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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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J-GLOBAL

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Language：English   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated. METHODS: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were life-threatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups. RESULTS: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84±3 vs. 82±2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P<0.001) and lower left ventricular ejection fraction (45%±15% vs. 68%±10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO2 narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38). CONCLUSION: Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis.

DOI： 10.1272/jnms.83.62

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Scopus

PubMed

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Language：Japanese   Publisher：Japan Heart Foundation  

&lt;p&gt; 症例は, 72歳男性. 肥大型心筋症, 発作性心房細動のため近医通院していたが, 動悸を自覚しホルター心電図で症状に一致してLong R-P&#039;頻拍が認められ, カテーテルアブレーション目的に当院へ紹介となった. 心臓電気生理学的検査で, 心房単発期外刺激によるjump up現象は認めず, 右室刺激中の心房最早期興奮部位をHis束領域に有する弱い逆行伝導を認めた. 心房頻回刺激で頻拍周期460msecのLong R-P&#039;頻拍が誘発され, 頻拍中の心房最早期興奮部位は冠静脈洞入口部より約2cm遠位であった. 頻拍中に左心房内をmappingしたところ, 左房内僧帽弁輪6時方向からの巣状興奮パターンを呈し, 最早期興奮部位では冠静脈洞内で得られる電位よりも26msec先行する分裂電位が記録された. 心房内各所からのエントレインメントペーシングは, 最早期興奮部位でのみ刺激後の復元周期が頻拍周期に一致した. 同部位で頻拍中に通電を行い頻拍は約8秒で停止したが, イソプロテレノール負荷で再発し, 左房心内膜側からの追加通電を行ったが再発を繰り返した. 左房心内膜側の最早期興奮部位の対側の冠静脈洞側でより早期性のある電位が記録され同部位への通電を行い, 約1秒で頻拍は停止し以降誘発不能となった. 心内膜側, 心外膜側の両者からの焼灼が有効であった僧帽弁輪を起源とする巣状心房頻拍の1例を経験した.&lt;/p&gt;

DOI： 10.11281/shinzo.47.S2_85

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

症例は29歳男性。左室後側壁血管腫に関連する複数個の心室頻拍(VT)を認め、心内膜・心外膜アプローチによるアブレーションが無効であったため開胸下に心内膜・心外膜側から腫瘍辺縁を冷凍凝固した。術後に右脚ブロック・右軸偏位型(VT1)および左脚ブロック・左軸偏位型(VT2)で同一頻拍周期(300 msec)の2種類のVTを認めた。腫瘍-僧帽弁輪間を峡部(mitral isthmus、MI)とし、VT1は僧帽弁輪を反時計方向回転、VT2は時計方向に旋回した。MIの興奮を冠静脈洞内の多極カテーテルにて記録、洞調律中は両方向から興奮の進入する遅延電位として記録され、VT1中は中隔から側壁方向、VT2中はその逆方向へ伝播する拡張期電位となった。洞調律中にMIの側壁出口付近を焼灼したところMI側壁部の興奮が遅延し、焼灼部遠位(前側壁基部)からの刺激で焼灼部のブロックが確認され、VT1、VT2ともに誘発不能となった。冠静脈洞の多極カテーテルでVT中の拡張期電位の興奮伝播および焼灼の効果を評価しえたMI-VTを経験したので報告する。(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：Japanese   Publisher：(一社)日本集中治療医学会  

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J-GLOBAL

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Language：English   Publisher：(一社)日本不整脈心電学会  

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Language：English   Publisher：(一社)日本不整脈心電学会  

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Language：English   Publisher：(一社)日本不整脈心電学会  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

症例は69歳女性で、自転車で停車中にバランスを崩して転倒し、左臀部を打撲した。左股関節と左臀部に疼痛が有り、自力歩行困難であった。鎮痛薬を投与し、ベッド上安静にて経過観察していたが、受傷3時間後、座位にしたところ悪心、冷汗を訴え、血圧84/51mmHg、心拍数95/分となった。血液検査を施行したところHb低下を認め、D-ダイマーが高値であった。腹部造影CTにて両側坐骨骨折、左恥骨骨折を認め、仙骨翼右側前面にも骨折線を認めた。また骨盤腔内に血管外漏出を伴う77×45mm大の後腹膜血腫を認めた。骨盤内出血による出血性ショックと診断した。血管造影にて左内腸骨動脈より分岐する左下殿動脈に血管外漏出を認めたため、上殿動脈分岐後レベルよりGelformにて経カテーテル動脈塞栓術(TAE)を施行した。また右内腸骨動脈の骨盤内左側へ回り込む末梢枝からも血管外漏出が認められたためGelformにてTAEを施行した。その後リハビリテーションを行ったところ、状態は改善したが、受傷4ヵ月後の骨盤単純X線像において、両側恥坐骨の骨折が認められた。

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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

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