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

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BACKGROUND: Diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often made after arrhythmias are detected in the second or third decade but can also present later. OBJECTIVES: The authors sought to compare the phenotypes and the long-term outcome between patients with early- vs late-onset ARVC. METHODS: Patients with a definite ARVC diagnosis fulfilling the 2010 Task Force criteria and symptomatic arrhythmias at initial presentation were candidates. Based on age of onset of symptoms, patients were divided into 2 groups: early ARVC: ≤40 years (E-ARVC) and late ARVC: >40 years (L-ARVC). Clinical characteristics and outcomes were compared between the groups. RESULTS: Between 2004 and 2024, 76 probands were included. Fifty patients were in the E-ARVC group (median 27.5 years) and 26 in L-ARVC (45.5 years). Gender, genotype, family history, and RV function did not show any statistical differences. Patients with L-ARVC were significantly less likely to present with cardiac arrest or syncope than E-ARVC patients (7.6% vs 40.0%; P = 0.003). During follow-up, patients with L-ARVC had a slower VT cycle length (321.5 ms vs 259.5 ms; P < 0.001), lower incidence of electrical storm (19.2% vs 54.0%; P = 0.004), and fewer ICD therapies (42.3% vs 80.0%; P < 0.001) than patients with E-ARVC. During a mean follow-up of 11.1 years, there was a lower incidence of heart failure in L-ARVC patients (46.0% vs 19.2%; P = 0.028). VT ablation was performed with similar success rates. CONCLUSIONS: Clinical onset of ARVC after age 40 years is usually less severe than early-onset disease, despite similar structural phenotype, and is associated with slower VTs and less VT storm, and appears to have a lower risk of progression to clinical heart failure.

DOI： 10.1016/j.jacep.2025.06.011

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BACKGROUND: Ventricular tachycardia (VT) with a 1:1 V-His relation can be seen in bundle branch reentry or with passive retrograde activation from scar-related VT or reentry using left ventricular Purkinje fascicles. OBJECTIVE: This study aimed to review the frequency with which 1:1 V-His relation occurs and to identify differentiating characteristics of these arrhythmias, including new measures obtained during right ventricular (RV) pacing based on orthodromic His-proximal right bundle potential (HisRB) capture and the stimulus to HisRB (S-HisRB) interval approximating RV electrogram to His interval (Egm-HisRBVT). METHODS: This was a retrospective review of induced VTs that had a HisRB potential recorded while pacing from the distal right ventricle. RESULTS: From 147 patients, 158 VTs were analyzed. A 1:1 V to HisRB was observed in 86 VTs (54%): 18 bundle branch reentrant VTs (BBR-VTs), 8 LV fascicular/Purkinje-related reentrant VTs (FPVTs), and 60 scar-related reentrant VTs (SRR-VTs). The HisRB-QRSVT was >135 ms, falling within the QRS in 87% of SRR-VTs, and 30-135 ms in all BBR-VTs (P < .001). With RV pacing, the HisRB remained 1:1 in 100% of BBR-VTs and 23 (69.7%) of 33 SRR-VTs. An S-HisRB of >135 ms combined with S-HisRB - Egm-HisRBVT difference <30 ms was specific for BBR-VT. In FPVTs, the HisRB-QRS timing was more variable, and RV pacing was helpful in distinguishing these from BBR-VTs. CONCLUSION: Retrograde HisRB activation is common in all forms of VT. HisRB timing and new features based on consideration of orthodromic HisRB activation during RV pacing can help distinguish BBR-VT, SRR-VT, and FPVT.

DOI： 10.1016/j.hrthm.2025.02.044

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

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BACKGROUND: Electrical storm (ES) is a cluster of sustained ventricular arrhythmias that may be caused by various triggers on the arrhythmic substrate. The association between infection and ES is unknown. OBJECTIVES: This study sought to investigate the clinical profile and prognosis of concurrent ES and infection. METHODS: Study investigators retrospectively studied patients with ES between May 2004 and March 2022. Participants were divided into 2 groups: those with infection (infection group) and those without concurrent infection (noninfection group). The study compared clinical outcomes and prognoses. RESULTS: A total of 309 patients with ES were included; 68 had concurrent infection, and 28 of these patients had bacteremia. Among those with bacteremia, methicillin-resistant Staphylococcus aureus was the most common pathogen, with 9 patients (32.1%), and lead extraction was performed in 13 (46.4%). Among the patients who clearly did not have preceding infection, 15 (5.3%) developed bacteremia after ES. During the 2-year follow-up period, the infection group had significantly higher mortality than the noninfection group (log-rank P < 0.001). Multivariate logistic regression analysis identified bacteremia (OR: 5.23; 95% CI 1.91-15.02; P = 0.001) and decreased left ventricular ejection fraction (LVEF) (each 1% increase, OR: 0.95; 95% CI: 0.93-0.98; P = 0.002) as independent predictors of mortality. CONCLUSIONS: Among patients with ES, those with concurrent infection have increased mortality. Of patients presenting without infection, >5% developed bacteremia after ES, thereby raising the possibility of iatrogenic infection during prolonged hospitalization. Bacteremia and decreased LVEF are independent predictors of mortality.

DOI： 10.1016/j.jacep.2025.05.005

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BACKGROUND: The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear. OBJECTIVE: The purpose of this study was to assess the outcomes of repeat ablation and the use of different techniques in patients who failed prior PVC ablation. METHODS: We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half-normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Clinical and procedural findings, PVC origins, and acute and follow-up outcomes were compared in those with and without a prior failed ablation procedure. RESULTS: Of 239 patients, 75 (31%) had failed a prior ablation procedure, and they more often had left ventricular outflow tract PVCs. Despite failing prior ablation, repeat standard ablation was acutely successful in 59% of patients, and 75% of these patients had long-term success. Acute standard ablation success rate was lower and long-term recurrence rate was higher than in patients without prior ablation (59% vs 95%, P <.001; and 29% vs 17%, P <.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 needle, 5 epicardial, 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%. CONCLUSION: Although success is lower for patients with prior failed ablation, repeat ablation seems reasonable for many, and the use of advanced techniques increased success to 71% in this group.

DOI： 10.1016/j.hrthm.2024.11.021

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DOI： 10.1016/j.hroo.2024.09.006

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BACKGROUND: Patients with ventricular tachycardia (VT) frequently present in unstable VT and are subject to urgent/high-risk ablation procedures. Clinical predictors of prolonged hospitalization and mortality are needed for optimal management of these patients. OBJECTIVES: This study seeks to identify factors associated with prolonged hospitalization and mortality in emergent unplanned VT ablation procedures. METHODS: Fifty consecutive patients hospitalized emergently for VT with structural heart disease who underwent catheter ablation were prospectively followed up for outcomes and complications. RESULTS: Of the 50 patients (mean age 67.6 ± 12.8 years), 86.0% were male, 62.0% had ischemic cardiomyopathy, and their median left ventricular ejection fraction was 28.5%. Hospital stay <7 days (median 3 days) occurred in 28 (56.0%) patients (Group 1) and >7 days (median 10 days) or death <7 days occurred in 22 (44.0%) patients (Group 2). PAINESD score and left ventricular ejection fraction were similar between the groups. Compared with Group 1, Group 2 had significantly worse NYHA functional class III or higher (25.0% vs 63.6%; P = 0.006), electrical storm (46.4% vs 77.3%; P = 0.027), and prior failed VT ablation (35.7% vs 68.2%; P = 0.023). Multivariable analysis showed that NYHA functional class III or higher and prior failed VT ablation were predictive of prolonged hospital stay. After ablation, compared with Group 1, Group 2 had worse heart failure (10.7% vs 54.5%; P = 0.001), VT recurrences (3.6% vs 68.2%; P < 0.001), and 7 deaths within 30 days. CONCLUSIONS: Patients undergoing emergent VT ablation are at high risk for prolonged hospital stay, which is predicted by NYHA functional class III or higher and a prior failed ablation. Early VT recurrences and worsening heart failure contribute to prolonged hospitalization and a high 30-day mortality.

DOI： 10.1016/j.jacep.2024.08.017

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INTRODUCTION: When ventricular tachycardia (VT) recurs after standard RF ablation (sRFA) some patients benefit from repeat sRFA, whereas others warrant advanced methods such as intramural needle ablation (INA). Our objectives are to assess the utility of repeat sRFA and to clarify the benefit of INA when repeat sRFA fails in patients with VT due to structural heart disease. METHODS: In consecutive patients who were prospectively enrolled in a study for INA for recurrent sustained monomorphic VT despite sRFA, repeat sRFA was considered first. INA was performed during the same procedure if repeat sRFA failed or no targets for sRFA were identified. RESULTS: Of 85 patients enrolled, acute success with repeat sRFA was achieved in 30 patients (35%), and during the 6-month follow-up, 87% (20/23) were free of VT hospitalization, 78% were free of any VT, and 7 were lost to follow-up. INA was performed in 55 patients (65%) after sRFA failed, or no endocardial targets were found abolished or modified inducible VT in 35/55 patients (64%). During follow-up, 72% (39/54) were free of VT hospitalization, 41% were free of any VT, and 1 was lost to follow-up. Overall, 59 out of 77 (77%) patients were free of hospitalization and 52% were free of any VT. Septal-origin VTs were more likely to need INA, whereas RV and papillary muscle VTs were less likely to require INA. CONCLUSIONS: Repeat sRFA was beneficial in 23% (18/77) of patients with recurrent sustained VT who were referred for INA. The availability of INA increased favorable outcomes to 52%.

DOI： 10.1111/jce.16250

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jacep.2022.07.007

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DOI： 10.1253/circrep.CR-22-0026

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BACKGROUND: Modification of the low-voltage zone in the left atrium (LA-LVZ) in addition to pulmonary vein isolation (PVI) has not shown sufficient improvement in arrhythmia-free survival in patients with persistent atrial fibrillation (PerAF). Further, the effect of electrical posterior wall isolation (PWI) is controversial. We investigated the impact of existence of LA-LVZ on the outcome of patients undergoing additional PWI for PerAF. METHODS: A total of 347 patients with PerAF who underwent primary catheter ablation with LA-LVZ based strategy were retrospectively analyzed. Voltage mapping in the left atrium (LA) was performed during sinus rhythm. Additional LVZ ablation was performed in patients with LA-LVZ. The operators decided whether additional PWIs were to be performed. RESULTS: Of 347 patients, 108 had LA-LVZ. In the LVZ group, patients with additional PWI (N = 70) had higher rates of freedom from tachyarrhythmia recurrence than those without (77.1% vs. 42.1%, p < 0.001). Furthermore, even when patients were limited to those with LA-LVZ in areas other than the posterior wall (N = 85), PWI had higher success rates (80.9% vs. 42.1%, p < 0.001). In contrast, in patients without LVZ (N = 239), there was no significant difference in the rate of successful outcome between those with and without PWI (81.3% vs. 88.1%, p = 0.112). On the other hand, the patients with PWI had greater atrial tachycardia (AT) recurrence rate than those without PWI (10.0% vs. 2.5%, p = 0.003). CONCLUSIONS: PWI, in addition to PVI and LVZ modification, may improve single procedural outcomes in patients with PerAF who have LVZ, regardless of the distribution in the LA. A combination of voltage-guided ablation and PWI may be a simple, tailored, and effective ablation strategy.

DOI： 10.1007/s00380-022-02069-0

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Fasciculo-ventricular and nodo-ventricular pathways (FVP and NVP) are rare preexcitation variants. Normally, NVP is electrophysiologically different from FVP. We describe a unique type of NVP emerging from the distal part of the slow pathway, designated as "distal type" NVP. The distal type NVP resembled FVP but was proven by unexpected elimination of the NVP during the slow pathway ablation. Also, NVP was distinguishable from FVP by a careful comparison of the HV intervals during conduction over the fast and slow pathways. Demonstration of this novel type NVP provides insights into how the insertion site of NVP affects its electrophysiologic behaviors.

DOI： 10.1111/pace.14468

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DOI： 10.1111/jce.15256

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INTRODUCTION: Early recurrence (ER) of atrial fibrillation (AF) is defined as the recurrence of atrial tachyarrhythmias within 3 months after AF ablation, however, this definition is based on data from the era of radiofrequency catheter ablation (RFCA), without contact force (CF) technology. We investigated the significance of ER as a risk factor for late recurrence (LR) in paroxysmal AF (PAF) patients treated with CF and non-CF-guided ablation. METHODS AND RESULTS: We studied 395 patients with PAF who underwent RFCA. Of these, 97 patients underwent RFCA without-CF technology (non-CF group) and 298 underwent with CF technology (CF group). Over a 2-year postablation follow-up period, LR occurred in 54 (55.7%) patients in the non-CF group, and in 105 (35.2%) patients in the CF group. ER had a more significant relationship with LR in the CF group, and all patients in the CF group with ER in the third month developed LR. CONCLUSION: PAF patients with ER who have undergone CF-guided ablation have a greater risk of LR than those who have undergone non-CF-guided ablation. ER in the third month after CF-guided ablation may indicate an absolute risk of LR. Blanking period could be defined as 2 months in the CF era.

DOI： 10.1111/jce.14643

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Atrial fibrillation (AF) is characterized by a progression from paroxysmal to persistent or permanent AF. Recent studies have shown that AF progression is related to a worse morbidity and mortality, and poorer outcomes of radiofrequency catheter ablation (RFCA). We previously showed that left ventricular (LV) compliance assessed by diastolic wall strain (DWS) was a strong determinant of prevalent AF.We studied 306 paroxysmal AF patients with structurally normal hearts. The DWS was non-invasively measured with echocardiography. During a follow-up of 35±19 months, AF progression occurred in 60 of 172 (35%) patients treated with medications only (medication group), and 3 of 134 (2%) who underwent RFCA (RFCA group) (p&lt;0.001). In the medication group, patients with a DWS &lt;0.38 had a higher incidence of AF progression than those without (log-rank p&lt;0.001), while the AF progression rate was low irrespective of the DWS in the RFCA group. In a multivariate analysis, the DWS and left atrium volume index (LAVI) were independent predictors of AF progression in the medication group (hazard ratio, 1.13 per 0.01 decrease; 95% CI: 1.08-1.18; p&lt;0.001, and 1.04 per 1mm increase; 95% CI: 1.01-1.08;

DOI： 10.1016/j.jjcc.2019.03.016

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DOI： 10.1111/jce.13423

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DOI： 10.1016/j.hrcr.2017.10.012

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

Atrial fibrillation (AF) itself creates structural and electrophysiological changes such as atrial enlargement, shortening of refractory period and decrease in conduction velocity, called "atrial remodeling", promoting its persistence. Although the remodeling process is considered to be reversible, it has not been elucidated in detail. The aim of this study was to assess the feasibility of P wave dispersion in the assessment of reverse atrial remodeling following catheter ablation of AF. Consecutive 126 patients (88 males, age 63.0 +/- 10.4 years) who underwent catheter ablation for paroxysmal AF were investigated. P wave dispersion was calculated from the 12 lead ECG before, 1 day, 1 month, 3 months and 6 months after the procedure. Left atrial diameter (LAD), left atrial volume index (LAVI), left ventricular ejection fraction (LVEF), transmitral flow velocity waveform (E/A), and tissue Doppler (E/e') on echocardiography, plasma B-type natriuretic peptide (BNP) concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were also measured. Of all patients, 103 subjects remained free of AF for 1 year follow-up. In these patients, P wave dispersion was not changed 1 day and 1 month after the procedure. However, it was significantly decreased at 3 and 6 months (50.1 +/- 14.8 to 45.4 +/- 14.4 ms, p &lt; 0.05, 45.2 +/- 9.9 ms, p &lt; 0.05, respectively). Plasma BNP concentrations, LAD and LAVI were decreased (81.1 +/- 103.8 to 44.8 +/- 38.3 pg/mL, p &lt; 0.05, 38.2 +/- 5.7 to 35.9 +/- 5.6 mm, p &lt; 0.05, 33.3 +/- 14.2 to 29.3 +/- 12.3 mL/m(2), p &lt; 0.05) at 6 months after the procedure. There were no significant changes in LVEF, E/A, E/e', serum creatinine, and eGFR during the follow up period. P wave dispersion was decreased at 3 and 6 months after catheter ablation in patients without recurrence of AF. P wave dispersion is useful for assessment of reverse remodeling after catheter ablation of AF.

DOI： 10.1007/s00380-017-1008-1

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OBJECTIVES: The goal of this study was to determine the diagnostic yield of analyzing the mode of termination during ventricular overdrive pacing (VOP) to differentiate the mechanisms of supraventricular tachycardias (SVTs). BACKGROUND: The majority of the diagnostic criteria for VOP rely on successful entrainment, but termination of SVTs is common during VOP. METHODS: We studied 225 SVTs with a 1:1 atrioventricular relationship, including 34 atrial tachycardias, 67 orthodromic reciprocating tachycardias (ORTs) (including 4 ORTs using accessory pathways [APs] with decremental properties), and 124 atrioventricular nodal re-entrant tachycardias. The total pacing prematurity (TPP) needed to reset or terminate the SVT was calculated by using a simplified method, and the post-pacing interval minus the tachycardia cycle length (PPI - TCL) was predicted from the TPP. RESULTS: VOP terminated 87 SVTs (39%). No atrial tachycardias were terminated by VOP in this study. SVT termination occurred after (n = 71) or before (n = 16) atrial resetting. The predicted PPI - TCL was highly correlated with the measured PPI - TCL (r = 0.96; p < 0.001). The TPP had diagnostic accuracy equivalent to the predicted PPI - TCL. The TPP was measurable irrespective of the termination mode and correctly diagnosed ORTs with decremental APs. All ORTs using septal APs and no atrioventricular nodal re-entrant tachycardias had a TPP <125 ms. Considering other criteria evaluable in terminated SVTs, a combined criteria of a TPP <125 ms and atrial capture/termination within the fusion period were specific for ORTs using free-wall APs, except for left anterolateral/lateral sites. CONCLUSIONS: The termination analyses were useful for differential diagnoses of SVTs terminated during VOP.

DOI： 10.1016/j.jacep.2017.05.014

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DOI： 10.4244/EIJ-D-16-00067

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DOI： 10.1002/clc.22595

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

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DOI： 10.1111/jce.12778

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing Inc.  

DOI： 10.1111/jce.12747

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DOI： 10.1111/jce.12747

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

&lt;p&gt; 症例は68歳, 男性. 再発性のnarrow QRS頻拍を認め, アデノシン三リン酸投与にてP波を伴わずに頻拍は停止した. 右室刺激時には房室結節を介する室房伝導が間欠的に見られるのみだったが, 心房刺激により高位右房を最早期興奮部位とする非持続性の頻拍が誘発された. イソプロテレノール投与後, 右室刺激時1 : 1室房伝導となったが, 心房興奮はHis束領域が早く, 心室の刺激部位を変更しても頻拍時の奇異的な心房興奮順序は再現できなかった. 傍His束ペーシングの結果, 逆伝導は房室結節パターンであった. 以上より心房頻拍を疑い, 心房興奮パターンより右房起源と考え, 頻拍中に右房をmappingすると, 最早期興奮部位は心房中隔であった. 同部位を通電したものの, 頻拍に影響を与えなかった. イソプロテレノール投与下で頻拍は持続性となったため, 頻拍中の心室オーバードライブペーシングを行うと頻拍は毎回停止しエントレインはできなかったが, QRS波がfusionしている段階で心房波を捕捉

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

DOI： 10.1016/j.hrcr.2015.01.017

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BACKGROUND: Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R-V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH. PATIENTS AND METHODS: The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) >35 mmHg, were compared to those in 30 age- and gender-matched normal subjects. RESULTS: The R wave amplitude and R/S ratio in the Syn-ECGs were significantly (P<0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513-0.596, P<0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P<0.001) and R/S ratio (AUC 0.823, P<0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R>0.12 mV, and 2) R/S ratio in V5R>0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10-0.43, specificity 0.90-1.00). CONCLUSION: The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH.

DOI： 10.1272/jnms.82.136

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BACKGROUND: Few reports are available on the characteristics of electrical storms of ventricular tachycardia (VT storm) refractory to intravenous (IV) amiodarone. METHODS AND RESULTS: IV-amiodarone was administered to 60 patients with ventricular tachyarrhythmia between 2007 and 2012. VT storms, defined as 3 or more episodes of VT within 24 h, occurred in 30 patients (68±12 years, 7 female), with 12 having ischemic and 18 non-ischemic heart disease. We compared the clinical and electrocardiographic characteristics of the patients with VT storms suppressed by IV-amiodarone (Effective group) to those of patients not affected by the treatment (Refractory group). IV-amiodarone could not control recurrence of VT in 9 patients (30%). The Refractory group comprised 5 patients with acute myocardial infarctions. Although there was no difference in the VT cycle length, the QRS duration of both the VT and premature ventricular contractions (PVCs) followed by VT was narrower in the Refractory group than in the Effective group (140±30 vs. 178±25 ms, P<0.01; 121±14 vs. 179±22 ms, P<0.01). In the Refractory group, additional administration of IV-mexiletine and/or Purkinje potential-guided catheter ablation was effective. CONCLUSIONS: IV-amiodarone-refractory VT exhibited a relatively narrow QRS tachycardia. The narrow triggering PVCs, suggesting a Purkinje fiber origin, may be treated by additional IV-mexiletine and endocardial catheter ablation.

DOI： 10.1253/circj.CJ-15-0213

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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PURPOSE: Catheter ablation of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is still challenging, and it is unclear whether the difficulty is caused by the hypertrophy of left atrial (LA) myocardial wall thickness. The objective of the study was to compare the LA wall thickness and AF ablation outcomes between patients with HCM and those without structural heart disease. METHODS: The present study enrolled 17 consecutive HCM patients (63 ± 12 years) with drug-refractory AF and 34 control patients without any detectable heart disease, whose age, gender, type of AF, and LA dimension were matched to the HCM patients. The myocardial wall thickness of 11 distinct LA locations, measured using 64-slice computed tomography images, and AF ablation outcomes were compared between the two groups. RESULTS: The LA wall thickness did not differ at 9 of the 11 locations and was significantly thinner in the HCM patients than in the control patients at the mid-posterior wall (1.44 ± 0.17 vs. 1.58 ± 0.22, p = 0.04) and infero-posterior wall (1.62 ± 0.16 vs. 1.74 ± 0.18, p = 0.03). Although antiarrhythmic drugs were used more frequently in the HCM patients (p = 0.008), the rate of maintaining sinus rhythm during the follow-up did not differ between the HCM and control patients (53 vs. 56% after the initial ablation [log-rank p = 0.78] and 82 and 88% after the repeat procedure [log-rank p = 0.35]). CONCLUSIONS: The LA wall in the HCM patients with AF was not thicker than that of the matched patients without structural heart disease. Catheter ablation of AF showed favorable outcomes in both patient groups.

DOI： 10.1007/s10840-014-9894-y

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AIMS: Atrial tachyarrhythmias (AT) commonly recur within the first 3 months after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), and the influence of antiarrhythmic drugs (AADs) on the recurrences has not been fully elucidated. We sought to evaluate the efficacy of a 3-month lower-dose flecainide regime on early and late recurrences of ATs. METHODS AND RESULTS: We randomly assigned 126 patients, who underwent RFCA for AF, to the flecainide group (150 or 100 mg/day according to their body weight) or to the control group receiving no AADs. The primary endpoint was any AT lasting for ≥30 s during the first 3 months and the secondary endpoint was a composite of ATs lasting for ≥24 h or requiring cardioversion or hospitalization during the same period. All AADs were stopped after the first 3 months and the late arrhythmia recurrences were also evaluated. The primary endpoint rates were 37 and 41% in the flecainide (143 ± 19 mg/day) and control groups, respectively (log-rank P = 0.76), and those of the secondary endpoint were 10 and 14%, respectively (log-rank P = 0.45). The estimated rates of maintaining sinus rhythm at 12 months after the first 3 months were 78 and 72%, in the flecainide and control groups, respectively (log-rank P = 0.68), and the rates were 51 and 90% in those with and without the primary endpoint, respectively (log-rank P < 0.001). CONCLUSION: The 3-month lower-dose flecainide therapy after AF ablation did not reduce the early and late arrhythmia recurrences. The clinically significant ATs were also not prevented.

DOI： 10.1093/europace/euu041

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

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AIMS: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are not uncommon in patients hospitalized with acute heart failure (AHF). We sought to evaluate the efficacy of urgent radiofrequency catheter ablation (RFCA) for recurrent VT/VF during AHF decompensations. METHODS AND RESULTS: The present study retrospectively analysed the data of 15 consecutive patients (69 ± 9 years, ischaemic heart disease in 10), who underwent urgent RFCA for frequent drug-refractory VT/VF episodes during an AHF decompensation with pulmonary congestion. The target arrhythmias were clinically documented monomorphic VTs in 10 patients, frequent premature ventricular contractions (PVCs) triggering VF in 4, and both in 1. The mean left ventricular ejection fraction was 26 ± 8%. The maximum number of arrhythmia episodes over 24 h was 9.1 ± 11.7. All RFCA sessions were completed without any major complications except for a temporary deterioration of pulmonary congestion in three patients (20%). Elimination and non-inducibility of the target arrhythmias were achieved in 13 patients (87%). Successful ablation site electrograms showed Purkinje potentials for all 5 PVCs triggering VF and 4 of 14 clinically documented monomorphic VTs (29%). Five patients (33%) underwent second sessions 10 ± 4 days after the first session for acute recurrences. Sustained VT/VF was completely suppressed during admission in 12 patients (80%), and the AHF ameliorated in 13 patients (93%). Twelve patients (80%) were discharged alive. CONCLUSION: Urgent RFCA for drug-resistant sustained ventricular tachyarrhythmias during AHF decompensations would be an appropriate therapeutic option. Purkinje fibres can be ablation targets not only in those with PVCs triggering VF, but also in those with monomorphic VT.

DOI： 10.1093/europace/eut207

PubMed

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BACKGROUND: The periesophageal vagus nerve plexus controls the kinetics of the stomach, digestive tract, and gallbladder, and catheter ablation of atrial fibrillation (AF) can cause vagus nerve injury (VNI). We sought to clarify the incidence, clinical course, and anatomical factors related to periesophageal VNI. METHODS: The present study included 257 consecutive patients with AF (mean age, 62±11 years) who underwent catheter-based pulmonary vein isolation. With 64-slice computed tomographic images, the left atrium (LA)-esophageal contact length, LA diameter, and distances between each mediastinal structure were compared between patients with VNI and those without VNI. RESULTS: VNI occurred in 5 patients (1.9%), gastric hypomotility in 3 patients, and acalculous cholecystitis in 2 patients, within 3 days after ablation, and all patients recovered completely within 2 weeks. Compared with patients without VNI, those with VNI more frequently underwent ablation at the mitral isthmus (p=0.03) and inside the coronary sinus (p=0.03). On computed tomographic images, the esophagus was closer to the aorta than to the spine in 67% of patients and was defined as an aorta-sided esophagus. In patients with VNI, the distance from the LA to the spine or the descending aorta (in patients with an aorta-sided esophagus) was shorter (p=0.03), and the transverse LA-esophageal contact length was longer (p=0.01). CONCLUSION: Acalculous cholecystitis, as well as gastric hypomotility, can develop as a result of periesophageal VNI in patients undergoing AF ablation. The anatomical relationships among the LA, esophagus, spine, and descending aorta may influence the occurrence of VNI.

DOI： 10.1272/jnms.81.248

PubMed

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BACKGROUND: Atrioventricular (AV) block is one of the main clinical manifestations in patients with cardiac sarcoidosis (CS). Although steroid therapy is considered to be effective for AV block, the efficacy has not been demonstrated in detail. METHODS AND RESULTS: Fifteen CS patients presenting with advanced or complete AV block were retrospectively investigated. All patients were treated with 30mg/day of prednisone after device implantation, which was tapered to a maintenance dosage of 5-10mg/day. During a mean follow-up of 7.1 years, AV block resolved to normal conduction or first-degree AV block in 7 patients (recovery group). The improvement was driven within the first week of steroid therapy in 4 patients, while 3 patients showed late recovery of AV conduction. The remaining 8 patients were classified as the non-recovery group. The recovery group showed a higher left ventricular ejection fraction (69.4±8.9% versus 44.1±19.3%, p=0.029) and higher prevalence of advanced AV block (87.5% versus 28.6%, p=0.040) compared with those of the non-recovery group. In patients with the recovery group, there was no late recurrence of AV block during the follow-up period. CONCLUSIONS: Early initiation of steroid therapy may be effective for AV block, and steroid therapy before device implantation is a possible therapeutic strategy for some selected patients.

DOI： 10.1016/j.jjcc.2013.07.007

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Background: Intravenous adenosine can induce atrial fibrillation (AF). However, the role of adenosine for revealing arrhythmogenic foci in patients undergoing radiofrequency ablation is not determined. Method and Results: In 75 patients undergoing pulmonary vein (PV) isolation for either paroxysmal (N=63) or persistent (N=12) AF, adenosine-triphosphate (ATP:40mg) was administered during sinus rhythm to produce asystole for PV venography. We determined the incidence and origin of ectopic beats emerged after intravenous ATP utilizing simultaneous recording of the left and right superior PVs, left inferior PV, coronary sinus, right atrial free wall, septum and superior vena cava. Repetitive beats initiating AF (RBAF, 29 (39%) patients) or single to triplet of premature beats (SPB, 57 (76%) patients) were induced within 1 minute after injection. The origin of 22/29 (76%) RBAF and 37/1 1 1 (33%) SPB emerged from PVs. The AF free rate after 1.3 ± 0.5 sessions in patients with RBAF and SPB from the PV only was 96% and 94%, respectively, and those in patients with extra-PV RBAF and extra-PV SPB was 57% (P=0.15 vs. PV RBAF) and 78% (P=0.35 vs. PV SPB), respectively. Conclusion: Intravenous ATP quickly reveals arrhythmogenic foci. Induction of extra-PV RBAF predicts poorer outcome after PVI. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.OP55_2

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A 69-year-old man underwent the second radiofrequency (RF) ablation for the recurrence of persistent atrial fibrillation (AF). After re-isolation of the PV and making linear lesions to LA roof, bottom, and mitral annulus, AT with the cycle length of 370msec was induced by programmed stimulation. Left atrial activation map exhibited counter-clockwise activation along the mitral annulus, with the total activation time for 290msec and missing period for 80msec at the mitral isthmus line. The post-pacing interval (PPI) at the mitral annulus anterior and inferior to the mitral isthmus line exceeded the tachycardia cycle length (TCL) by 30ms. Extensive RF applications to the mitral isthmus and to the CS failed to terminate the AT. Then, a sharp small potential was recorded when the tip of ablation catheter was wedged in the proximal Marshall vein, which was confirmed by injection of contrast media from the irrigation catheter. The PPI was identical to the TCL. RF application using irrigation catheter successfully terminated the AT. Marshall vein may work as a bridge connecting both sides of mitral isthmus line. This is the first report of the perimitral AT that was successfully eliminated by the RF application in the Marshall vein. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.PE3_039

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

[背景] Brugada型心電図のリスク層別化には, 有効な方法がない. 近年, 心電図の時間周波数解析の有用性が報告されており, Brugada症候群検出における有用性を評価した.&lt;BR&gt;[方法] 対象はBrugada型心電図と診断された18例(女性: 1, 45&amp;plusmn;20歳). 高分解能心電計(sampling, 10kHz)を用いて, V&lt;sub&gt;1&lt;/sub&gt;, V&lt;sub&gt;2&lt;/sub&gt;誘導の通常肋間と上位肋間(第2, 3肋間)の計6誘導を同時記録. Wavelet変換(Gabor関数)を用いて, QRS波後方の周波数成分(40-200Hz)を評価した.&lt;BR&gt;[結果] 検査時にTypeを示した3例を含め6例(すべて男性)がBrugada症候群と診断され(BS群), 残り12例(女性: 1, Type II=8, Type III=4)はBrugada症候群の診断基準を満たさなかった(非BS群). BS群では, 非BS群に比べ高周波数成分(80Hz以上)のパワー値が増高する傾向にあり, 高周波数成分の増高が認められる誘導数(6誘導中)が有意に多かった(4&amp;plusmn;1.4 vs 1.33&amp;plusmn;1.2, p&lt;0.05).&lt;BR&gt;[結語] 異常高周波数成分を検出することで, Brugada型心電図のリスク層別化に有用である可能性が示唆された.

DOI： 10.11281/shinzo.43.S1_3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：日本不整脈学会  

We report a rare case of identical twins that exhibited different types of Brugada type ECG. Forty-one year-old identical twins were referred to our hospital for further evaluation of ECG abnormality. Both of the twins exhibited Brugada type ECG. However, the pattern was different. Twin-A exhibited saddle-back type ST elevation in precordial leads and ventricular pre-excitation suggestive of anteroseptal accessory pathway. During Treadmill exercise testing, ventricular pre-excitation was present only when the heart rate was below 120bpm. The ST level reduced when ventricular pre-excitation abruptly disappeared, and recovered as ventricular preexcitation recovered. On the other hand, twin-B exhibited spontaneous coved type ST elevation for 4mm in precordial leads and no ventricular pre-excitation. Echocardiogram showed no structural abnormality for both. Because both are asymptomatic and had no familial history of cardiac sudden death, they had no further evaluation and were put on regular follow-up. In each follow-up visit, the ECG for twin-A and B always show saddle back and coved type ST elevation, respectively.This is the first report of identical twins with Brugada type ECG. Even in identical twins, the degree and type of ST elevation may differ. Further, ventricular pre-excitation may modify ST elevation in Brugada type ECG. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.PE4_057

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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：臨床心臓電気生理研究会  

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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：(有)科学評論社  

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

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00681&link_issn=&doc_id=20160719110008&doc_link_id=%2Fdn4eleca%2F2016%2F003602%2F012%2F0161-0166%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdn4eleca%2F2016%2F003602%2F012%2F0161-0166%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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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症例は15歳、男性。Gorlin症候群(基底細胞癌、心臓腫瘍)に合併した心室頻拍(VT)の頻回発作を認め、アミオダロン内服、アブレーション施行するも抑制できず、手術目的に当院転院した。術前心内膜マッピングでは、左室後壁に腫瘍浸潤に一致する18cm2の広範囲の低電位領域を認め、その辺縁では全周性に遅延電位が記録された。プログラム刺激により誘発されたVTは2種類。VT#1(RBBB、左軸偏位、CL300ms)は、低電位領域の後中隔側で、VT#2(RBBB、右軸偏位、CL300ms)は後側壁側でpace mapが近似した。開胸下心外膜マッピングでも低電位領域辺縁を最早期とする多種類のVTが誘発され、腫瘍切除が困難であったため腫瘍を隔離するように凍結凝固し頻拍を抑制しえた。低電位領域辺縁の病理では線維腫の浸潤と心筋の錯綜配列様構造異常を認め、これが本頻拍の不整脈基質である可能性が示唆された。(著者抄録)

DOI： 10.11281/shinzo.46.S3_258

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

心筋梗塞の急性期から亜急性期には、薬物療法抵抗性の多形性心室頻拍および心室細動が生じ、いわゆるelectrical storm(ES)の状態となることがある。日本医科大学でカテーテル心筋焼灼術を必要としたES症例では、全例で梗塞境界領域のPurkinje線維から発生する期外収縮がトリガーとなっていた。そのうち2例では、Purkinje線維がリエントリーにも関与することが示され、その広範な焼灼によりトリガーのみならずプログラム刺激による誘発が不能となり、基質の修飾法としての有用性が示唆された。また、心筋梗塞に伴う心室頻拍(VT)のなかで、特発性左室頻拍(ILVT)に類似した束枝内Purkinje VTにおいては、前収縮期Purkinje電位と拡張期Purkinje電位が頻拍中に記録される部位での焼灼が有効であり、ILVTと同様のアプローチが有用であった。(著者抄録)

DOI： 10.5105/jse.34.127

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J00681&link_issn=&doc_id=20141110230007&doc_link_id=%2Fdn4eleca%2F2014%2F003402%2F008%2F0127-0136%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdn4eleca%2F2014%2F003402%2F008%2F0127-0136%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

症例は57歳、男性。持続性心房細動に対してアブレーションを施行。両側肺静脈隔離と後壁隔離後も心房細動が持続し、左房内から僧帽弁輪部を冠静脈洞(CS)に沿って焼灼を行った。焼灼中心房細動は頻拍周期(TCL)270msecの反時計方向回転perimitral ATに移行した。AT中、CS近位部では左房電位の110msec後にCS電位を認め、焼灼によるLA-CS間伝導遅延が示唆された。僧帽弁輪峡部(MI)焼灼中に左房電位が著明に遅延しTCLが延長したものの頻拍は持続した。VOM直下の左房焼灼を行うと頻拍は停止、しかしdifferential pacingで伝導の残存が示された。VOM付着部のCSが最早期であったことからVOMを介する伝導の残存と考え、焼灼線上のVOM付近をさらに焼灼したところブロックが完成した。MI焼灼においてVOMが心内膜側の伝導ブロックを架橋していたものと考えられ報告する。(著者抄録)

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症例は15歳、男性。動悸発作を伴うA型WPW症候群の電気生理学的検査を行った。左側後壁に副伝導路を認め、心室期外刺激で房室結節遅伝導路を逆行し、副伝導路を順行する逆方向性房室回帰性頻拍が容易に誘発された。また、心室連続刺激では、頻拍周期380msec時のみ副伝導路を逆行し、房室結節遅伝導路を順行する正方向性房室回帰性頻拍が誘発された。副伝導路の焼灼後、心室期外刺激でfast-slow 1 echoを認めた。また、isoproterenol投与後に速伝導路の逆行性伝導が出現し、slow-fast型房室結節リエントリー性頻拍が誘発され、遅伝導路の焼灼を行った。遅伝導路が関与する4種の頻拍を呈したWPW症候群を経験したので報告する。(著者抄録)

DOI： 10.11281/shinzo.45.S3_112

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

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72歳、男性。発作性心房細動のカテーテルアブレーションのため紹介。術前3D-CTにて、左房中隔と後壁を結ぶ長さ39mm、径3mmの索状構造物を認めた。心内エコーガイド下に、索状構造物の長軸方向に沿って10極カテーテルを留置。洞調律中は左房後壁端と中隔端の両方向から興奮が進入し、中間でcollisionした。三次元マップでも同様であった。中隔ペーシングでは中隔端から左房後壁方向へ、左房天蓋刺激では左房後壁端から中隔端への伝導を示し、刺激周期を徐々に短縮しても伝導時間は延長せず、緩徐伝導特性は認めなかった。心房細動中はpassiveに興奮、またアデノシン三リン酸(ATP)やisoproterenol投与で期外収縮は誘発されず不整脈源性はなかった。心房細動に対し拡大肺静脈隔離とroof line焼灼を施行。Roof line作成後はその前方からの刺激で中隔端から後壁端方向のみへの伝導となり、また索状構造物を用いたdifferential pacingも行い、roof lineのブロックが確認できた。左房索状構造物は極めて稀であり、その電気生理学的特性を調べ得たことは貴重と考え報告する。(著者抄録)

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症例は69歳、男性。心房細動に対し2回目のセッションを行った。肺静脈再隔離と後壁隔離を行い、mitral isthmusのblock lineを作成した後にCL 370msecのATが誘発された。Activation mapは左肺静脈carina前側のridgeが最早期興奮部位(EAS)で、そこからmitral isthmus焼灼線上の一方には直接、対側には僧帽弁輪を旋回して到達する興奮伝導パターンであった。Total activation timeは280msecと頻拍周期を満たさなかったが、EAS周囲およびmitral isthmus焼灼線の対側で頻拍周期に近く、マクロリエントリーと考えられた。EASと冠静脈(CS)内を広範囲に焼灼したが頻拍は停止しなかった。そこでCSからカテーテル先端をvein of Marshall(VOM)にwedgeさせたところ、左房内の最早期と最遅期興奮の間に棘波上の電位を認め、同部位でのPPIが頻拍周期に一致し、焼灼中にATが停止した。イリゲーションカテーテルから造影したところ成功部位からblock lineを通過し左房ridgeへと続くVOMが造影された。当頻拍はVOMが心内膜側やCS内通電での焼灼線をブリッジする心外膜側の伝導路となっていたと考えられ、mitral isthmus焼灼難渋例の一部にこのような症例が存在すると思われるので報告する。(著者抄録)

DOI： 10.11281/shinzo.44.S3_123

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単形性心室頻拍によるelectrical storm(VT storm)に対するアミオダロン静注薬の有効性を評価し、アミオダロン不応性VT stormについて検討した。心室性不整脈に対してアミオダロン静注薬が使用された45例中、VT stormを発症した19例を対象とした。虚血性心疾患では、経皮的冠動脈インターベンション(PCI)直後に1例、3日後に2例、13日後に1例でVT stormを発症した。副作用のため経口アミオダロンを中止、もしくは減量していたのは3例で、1例に低カリウム血症を認めた。VT波形を確認できた12例中9例で右脚ブロック型を呈し、残りの3例は左脚ブロック型であった。19例中14例でアミオダロンが有効であった。また、アミオダロン投与による副作用は、徐脈、QT延長をそれぞれ1例ずつに認めた。無効例に対する根治治療のために1例はPCIが、残り4例にカテーテルアブレーションを要した。

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

症例は52歳、男性。繰り返す動悸を自覚し、携帯心電計で周期240msのnarrow QRS頻拍と心房細動を認めたため、アブレーションを行った。両側肺静脈を隔離後、冠静脈洞近位部からのburst pacingでWenckebach型房室ブロックを伴う周期240msの心房頻拍(AT)が誘発され、このATはATP 5mg静注で停止した。AT中のelectroanatomicalマッピングでは、右房はHis束領域が最早期であったが、局所の単極電位にR波を認めた。左房は前壁中隔が最早期であったが同部位での焼灼は無効であった。そこで大動脈弁無冠尖(NCC)にカテーテルを留置したところ、His束領域よりも20msec先行し、単極電位ではQSパターンとなる最早期興奮部位を認めた。ここでの通電中にATから周期350msの非通常型房室結節リエントリー頻拍(AVNRT)へと移行。その後、通常型AVNRTも誘発され遅伝導路領域を焼灼し、これらの頻拍はすべて誘発不能となった。NCC起源ATを認め、その焼灼中にAVNRTへの移行が見られた症例を報告する。(著者抄録)

DOI： 10.11281/shinzo.43.S3_34

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

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

症例は62歳、女性。7年前に気管支喘息と皮疹、筋力低下からChurg-Strauss症候群(CSS)と診断された。今回突然の動悸と呼吸困難で受診。頻拍周期280msecの右脚ブロック+左軸偏位型心室頻拍(VT)を認め、直流通電で停止した。超音波検査上左室駆出率21%であり、心筋生検では心内膜の線維化を認めたが、冠動脈に有意狭窄はなかった。電気生理検査を行い左室後中隔に20極電極を留置したところ洞調律中連続的にPurkinje電位(PP)が記録され、PP-QRSは88msecと延長していた。心房および心室ペーシングで非持続性Clinical VTが誘発され、VT中PPはQRSに先行して遠位から近位へ逆行した。三次元マッピングでは中隔および後壁に広くPPが記録され、fragmentしたPPが頻拍中QRSに62msec先行する部位でpacemapが近似し同部位で焼灼を行った。CSSは心内膜心筋炎を合併するが、調べ得るかぎりこれまでにPurkinje線維起源VTの報告はない。(著者抄録)

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

左室特発性心室頻拍(ILVT)は、verapamilに感受性のある緩徐伝導路を有するマクロリエントリーであり、緩徐伝導路は仮性腱索や乳頭筋に存在することが想定されているが詳細に検討されていない。症例は器質的心疾患のない53歳、男性。Verapamilで停止する右脚ブロック・北西軸型VTのため入院。VT中にCARTOを用いて左室マッピングし、3D-CTとmergeしたところ、拡張期電位(P1)は後中隔、下壁と前側壁に広く分布した。後中隔のP1は、後乳頭筋尖部側より後乳頭筋基部側へとゆっくりと伝導し、乳頭筋基部上で前収縮期電位(P2)へと連続した。P2は左脚後枝領域のみで記録され、左脚後枝を逆行性に早く伝導する一方、後乳頭筋上を基部より尖部へと伝導した。後乳頭筋尖部より後中隔を介し基部へと回帰するリエントリー回路を想定し、乳頭筋尖部で通電したところVTは停止した。後乳頭筋が回路の一部と考えられた。(著者抄録)

DOI： 10.11281/shinzo.42.S4_129

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

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Language：Japanese  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2010195394

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

J-GLOBAL

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

J-GLOBAL

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

J-GLOBAL

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J-GLOBAL

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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：(一社)日本不整脈心電学会  

J-GLOBAL

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

J-GLOBAL

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