Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: the JANIES-SHD study.

Background: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD).

Simultaneous assessment of T-wave alternans and heart rate turbulence on holter electrocardiograms as predictors for serious cardiac events in patients after myocardial infarction.

Background: T-wave alternans based on the modified moving average method (MMA-TWA) and heart rate turbulence (HRT) have been introduced as predictors for cardiac mortality. In this study, we simultaneously recorded MMA-TWA and HRT in patients after myocardial infarction (MI) and designed a prospective observational study.

Methods And Results: We prospectively enrolled 313 consecutive post-MI patients (age 70 ± 12 years, 232 men).

Risk stratification for serious arrhythmic events using nonsustained ventricular tachycardia and heart rate turbulence detected by 24-hour holter electrocardiograms in patients with left ventricular dysfunction.

Background: Previous studies have described the clinical usefulness of the presence of nonsustained ventricular tachycardia (NSVT) and defined heart rate turbulence (HRT) in stratifying patients at risk. We prospectively assessed whether HRT can facilitate the predictive accuracy of NSVT for identifying patients at risk for serious arrhythmic events in patients with left ventricular (LV) dysfunction.

Methods: We enrolled 299 consecutive patients with LV dysfunction (ejection fraction ≤ 40%) including ischemic (n = 184) and nonischemic causes (n = 115).

Selective site pacing from the right ventricular mid-septum. Follow-up of lead performance and procedure technique.

Pacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied.

Various patterns of intracardiac electrogram T-wave alternans prior to ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients.

Background: It has been reported that intracardiac electrogram T-wave alternans (IE-TWA) is greater prior to spontaneous ventricular tachyarrhythmia (VTA) than for baseline recordings.

Objective: To investigate IE-TWA just prior to VTA episodes and at baseline and compare these with microvolt TWA (M-TWA) measured during exercise.

Methods: We analyzed right ventricular ring-can electrogram recordings just prior to VTA episodes and compared T-wave pattern and degree of variation to baseline recordings from 3 patients (2 with idiopathic ventricular fibrillation and 1 with hypertrophic cardiomyopathy) who were enrolled in the Japan Intracardiac Electrogram TWA Study of ICD Recipients.

Heart rate turbulence can predict cardiac mortality following myocardial infarction in patients with diabetes mellitus.

Background: Previous studies have described the clinical utility of heart rate turbulence (HRT) as an autonomic predictor in risk-stratifying patients after myocardial infarction (MI). Some reports showed that diabetes mellitus (DM) affects the prognostic value of autonomic markers. We assessed the utility of HRT as a risk marker in post-MI patients with DM and without DM.

Circadian variation in out-of-hospital cardiac arrests due to cardiac cause in a Japanese patient population.

Background: It has been reported that cardiovascular events occur more frequently in the morning than in the evening. The purpose of the present study was to assess the characteristics of out-of-hospital cardiac arrests due to cardiac cause in a 24-h period in Japanese patients.

Methods And Results: Of 2,199 consecutive patients with cardiopulmonary resuscitation outside hospital, 1,293 cardiogenic patients were enrolled.

Effects of landiolol, an ultra-short-acting beta1-selective blocker, on electrical storm refractory to class III antiarrhythmic drugs.

Background: Occasionally it is difficult to inhibit electrical storm (ES) with standard pharmacological treatment. In the present study the effect of landiolol, an ultra-short-acting beta(1)-selective blocker, on ES refractory to class III antiarrhythmic drugs was evaluated.

Methods And Results: The study group comprised 42 consecutive patients who developed ES for which intravenous class III antiarrhythmic drugs, such as amiodarone and nifekalant, were ineffective.

Circadian variation of late potentials in idiopathic ventricular fibrillation associated with J waves: insights into alternative pathophysiology and risk stratification.

Background: The presence of J waves on ECGs is related to idiopathic ventricular fibrillation (VF).

Objective: The purpose of this study was to investigate the pathophysiology of J waves by assessing risk markers that reflect electrophysiologic abnormalities.

Methods: The study enrolled 22 idiopathic VF patients (17 men and 5 women; mean age 36 +/- 13 years).

Effects of intravenous nifekalant as a lifesaving drug for severe ventricular tachyarrhythmias complicating acute coronary syndrome.

Background: Intravenous amiodarone (AMD) has been used for the treatment of ventricular tachycardia/fibrillation (VT/VF) in emergency care medicine. However, AMD acts slowly and is occasionally accompanied by hypotension and bradycardia. The antiarrhythmic effect of intravenous nifekalant (NIF) was assessed in patients with VT/VF complicating acute coronary syndrome (ACS) according to our study protocol.

Quantitative assessment of cibenzoline administration for vagally mediated paroxysmal atrial fibrillation using frequency-domain heart rate variability analysis.

Background: Cibenzoline (CBZ), a class I antiarrhythmic drug, has been widely used to maintain sinus rhythm in patients with paroxysmal atrial fibrillation (P-AF). This agent has an anticholinergic action and will become the drug of first choice for vagally mediated P-AF. We assessed its efficacy quantitatively by analyzing the frequency-domain heart rate variability (FD-HRV) of the Holter electrocardiogram (ECG) in patients with vagal P-AF.

Heart rate turbulence as a predictor of cardiac mortality and arrhythmic events in patients with dilated cardiomyopathy: a prospective study.

Background: Few studies have described the clinical usefulness of heart rate turbulence (HRT), an autonomic predictor of mortality, in stratifying patients with dilated cardiomyopathy (DCM) at risk of cardiac mortality and arrhythmic events. We prospectively assessed the utility of HRT for risk stratification in patients with ischemic or nonischemic DCM.

Methods: We enrolled 375 consecutive patients with DCM including ischemic (n = 241) and nonischemic causes (n = 134).

Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study.

Background: Time-domain T-wave alternans (TWA) is useful for identifying patients at risk for serious events after myocardial infarction.

Objective: The purpose of this study was to prospectively evaluate the utility of time-domain TWA measured from Holter ECGs in predicting cardiac mortality in patients with left ventricular (LV) dysfunction.

Methods: Two hundred ninety-five consecutive patients with LV dysfunction were enrolled in the study.

Antiarrhythmic effect of bisoprolol, a highly selective beta1-blocker, in patients with paroxysmal atrial fibrillation.

In the treatment of arrhythmia, beta-blockers are mainly used to regulate the heart rate. However, beta-blockers are also known as drugs with an antiarrhythmic effect due to the suppression of sympathetic activity. We evaluated the antiarrhythmic effects of a highly selective beta(1)-blocker, bisoprolol, in patients with diurnal paroxysmal atrial fibrillation (P-AF).

Risk stratification for sudden cardiac death.

Sudden cardiac death (SCD) is a leading cause of mortality in industrialized countries, and ventricular fibrillation and sustained ventricular tachycardia are the major causes of SCD. Although there are now effective devices and medications that can prevent such serious arrhythmias, it is crucial to have methods of identifying patients at risk. Numerous studies suggest that most patients dying of SCD have coronary artery disease or cardiomyopathy.

The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome.

Introduction: Autonomic modulation, particularly high vagal tone, plays an important role in the occurrence of ventricular tachyarrhythmias in the Brugada syndrome. Food intake modulates vagal activity. We assessed the usefulness of a novel diagnostic technique, the "full stomach test," for identifying a high-risk group in patients with a Brugada-type electrocardiogram (ECG).