Wide QRS tachycardia associated with multiple accessory pathways in a patient with Wolff-Parkinson-White syndrome.

The electrocardiogram of a 14-year-old boy with recurrent palpitation showed a wide QRS regular tachycardia with a right bundle branch block and right-axis deviation of 226 beats per minute. Verapamil infusion terminated the tachycardia after a few minutes. Electrophysiological study revealed that this tachycardia was considered as a reentrant tachycardia associated with the anterograde left posterior accessory pathway (AP) and retrograde right septal AP.

Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury.

Background: Even with the use of a reduced energy setting (20-25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking.

Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation.

Background: Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA.

The effectiveness of cardiac resynchronization therapy for patients with New York Heart Association class IV non-ambulatory heart failure.

Background: We reviewed the effectiveness and safety of cardiac resynchronization therapy (CRT) for patients with New York Heart Association (NYHA) class IV non-ambulatory heart failure (NAHF).

Methods: From 2006 to 2011, 310 patients underwent CRT at Kobe University Hospital and Himeji Cardiovascular Center because of heart failure. Of these, 29 NAHF patients were retrospectively analyzed.

Left atrial anomalous muscular band detected by computed tomography before catheter ablation in a patient with atrial fibrillation.

A 65-year-old man was referred to our hospital with persistent atrial fibrillation (AF). Before the ablation procedure, 3-dimensional computed tomography revealed a left atrial anomalous muscular band connecting the posterior side of the left atrial roof and the right edge of the fossa ovalis. During the first ablation procedure, the band interfered with the manipulation of the catheter, resulting in only the left pulmonary vein (PV) being isolated.

Incidence of esophageal injury after pulmonary vein isolation in patients with a low body mass index and esophageal temperature monitoring at a 39 °C setting.

Background: Esophageal injury following catheter ablation of atrial fibrillation (AF) is reported to occur in 35% of patients. Even with a low energy setting (20-25 W), lesions develop in 10% of patients. Body mass index (BMI) has been reported to be a predictor of esophageal injury, indicating that patients with a low BMI (<24.

Left ventricular outflow tract obstruction caused by massive mitral annular calcification in a patient with hypertensive heart disease.

Mitral annular calcification (MAC) is frequently observed, but it rarely causes left ventricular outflow tract (LVOT) obstruction (LVOTO). An 83-year-old woman with hypertension, diabetes, and dyslipidemia was admitted to our hospital because of exertional dyspnea. She was diagnosed with hypertensive heart disease.

Novel Compression Tool to Prevent Hematomas and Skin Erosions After Device Implantation.

Background: The incidence of hematoma formation following implantation of a cardiovascular implantable electronic device (CIED) is estimated to be 5% even if a pressure dressing is applied. It is unclear whether a pressure dressing can really compress the pocket in different positions. Furthermore, the adhesive tape for fixing pressure dressings can tear the skin.

Evaluation of platelet reactivity using P2Y12 reaction units in acute coronary syndrome with essential thrombocythemia: A case report.

Essential thrombocythemia (ET) has been reported to cause acute coronary disease. However, the efficacy of anti-platelet therapy for ET is unclear since there are individual differences in the platelet function of ET patients. Here we report a case of a 62-year-old man with ET who was admitted to our hospital because of acute coronary syndrome.

Optimal strength and number of shocks at upper limit of vulnerability testing required to predict high defibrillation threshold without inducing ventricular fibrillation.

Background: The upper limit of vulnerability (ULV) closely correlates with the defibrillation threshold (DFT). The aim of this study was to establish the optimal protocol for using the ULV test to predict high DFT (>20 J) without inducing ventricular fibrillation (VF).

Methods And Results: The 10-J and 15-J ULV test with 3 coupling intervals (-20, 0, and +20 ms to the peak of T-wave) and the DFT test were performed in 96 patients receiving implantable cardioverter defibrillator.

Rate-dependent and site-specific conduction block at the posterior right atrium and drug effects evaluated using a noncontact mapping system in patients with typical atrial flutter.

Introduction: Conduction block in the posterior right atrium (RA) plays an important role in perpetuating atrial flutter (AFL). Although conduction blocks have functional properties, it is not clear how the block line changes with the pacing rate, pacing site, and administration of antiarrhythmic drugs.

Methods And Results: Forty patients with typical AFL were enrolled.

Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping.

Purpose: Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites >10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assessed locations of FPs guided by CARTO.

Methods: Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow-fast AVNRT.

Utility of virtual unipolar electrogram morphologies to detect transverse conduction block and turnaround points of typical atrial flutter.

Background: Noncontact mapping is useful for the diagnosis of various arrhythmias. Virtual unipolar electrogram morphologies (VUEM) of the conduction block and the turnaround points, however, are not well defined. We compared the VUEM characteristics of a transverse conduction block in the posterior right atrium (RA) with those of contact bipolar electrograms obtained during typical atrial flutter (AFL).

Dilated phase of hypertrophic cardiomyopathy caused by Fabry disease with atrial flutter and ventricular tachycardia.

We describe a case of a 60-year-old male with dilated phase of hypertrophic cardiomyopathy caused by Fabry disease. He was diagnosed to have a cardiac variant of Fabry disease by an enzyme assay and a right ventricular endomyocardial biopsy which revealed specific features of this disease and cardiac involvement was the sole manifestation. He has developed dilated cardiomyopathy with sustained atrial flutter and frequent non-sustained ventricular tachycardia requiring isthmus ablation and cardiac resynchronization therapy with defibrillator.

Upper turnover portion of the reentry circuit for typical and reverse typical atrial flutter.

Background: The posteromedial right atrium (PMRA) forms a block line during typical atrial flutter (AFL). However, whether upper turnover portion exists at the anterior or posterior superior vena cava (SVC) has not been determined.

Methods: We performed right atrial mapping during AFL in 20 patients (typical AFL, n = 17; reverse typical AFL, n = 3) using an electroanatomical mapping system.

Endocardial substrate mapping for monomorphic ventricular tachycardia ablation in ischemic and non-ischemic cardiomyopathy.

We investigated the differences in the endocardial substrates between ischemic cardiomyopathy (ICM) and non-ICM (NICM) by using electro-anatomical mapping and pace-mapping. We studied 18 patients (ICM and NICM, 9 each) with monomorphic ventricular tachycardia (VT) documented by 12-leads ECG. Low voltage area was defined by signal amplitude <1.

Identification of the right ventricular pacing site for cardiac resynchronization therapy (CRT) guided by electroanatomical mapping (CARTO).

Background: The optimal left ventricle (LV) pacing site for cardiac resynchronization therapy (CRT) has been investigated, but less is known about the optimal site in the right ventricle (RV). The present study examined whether electrical resynchronization guided by electroanatomical mapping (CARTO) results in mechanical resynchronization.

Methods And Results: The study group included 13 patients indicated for CRT: 10 with nonischemic cardiomyopathy, 2 with ischemic cardiomyopathy and 1 with cardiac sarcoidosis, (mean LV ejection fraction: 32+/-10%).