A case of cough syncope diagnosed by the Valsalva maneuver and cough induction test under invasive arterial pressure measurement.

Following the loss of consciousness during the Valsalva maneuver and cough induction test, real-time arterial pressure measurement could clarify the significant blood pressure decrease in a patient with cough syncope.

Pacemaker implantation for persistent sinus node dysfunction in a patient with COVID-19.

A 46-year-old woman was admitted with coronavirus disease-2019 infection. Symptomatic sinus bradycardia occurred, followed by congestive heart failure. Therapeutics such as isoproterenol, theophylline, and cilostazol could not safely improve her symptoms.

Biomechanical Analysis of Serious Neck Injuries Resulting from Judo.

To establish a basis for initial diagnosis and for proposing preventive measures for the serious neck injuries occasionally experienced by judo practitioners, the biomechanical mechanisms of these injuries were analyzed. Two male judo experts repeatedly threw an anthropomorphic test device (POLAR dummy) using three throwing techniques (, , and ). The dummy's kinematic data were captured using a high-speed digital camera, and the load and moment of the neck were measured with load cells.

Differences in severity of injuries between motorcyclist and bicyclist fatalities in single vehicle collisions.

To understand the injury severity of bicyclists and motorcyclists in single vehicle collisions, we performed a retrospective analysis of forensic autopsy cases of 25 motorcyclists and 14 bicyclists performed from 1999 to 2018. Collision details, injury characteristics, and involvement of alcohol were examined. The injury severity between bicyclists and motorcyclists was compared.

Trans-aortic pulmonary vein isolation using magnetic navigation system for paroxysmal atrial fibrillation in a patient with dextrocardia, situs inversus, and inferior vena cava continuity with azygos vein.

A 51-year-old male with dextrocardia and situs inversus underwent catheter ablation for paroxysmal atrial fibrillation. Because the procedure through the trans-septal approach was impossible due to the inferior vena cava continuity with azygos vein, we performed pulmonary vein isolation using magnetic navigation system through the retrograde trans-aortic approach. Superior and inferior left-sided and superior right-sided pulmonary veins could be isolated which was confirmed by the ablation catheter.

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.

Circulating intermediate CD14++CD16+monocytes are increased in patients with atrial fibrillation and reflect the functional remodelling of the left atrium.

Aims: A recent large clinical study demonstrated the association between intermediate CD14++CD16+monocytes and cardiovascular events. However, whether that monocyte subset contributes to the pathogenesis of atrial fibrillation (AF) has not been clarified. We compared the circulating monocyte subsets in AF patients and healthy people, and investigated the possible role of intermediate CD14++CD16+monocytes in the pathophysiology of AF.

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.

Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: Clinical outcomes after a single endocardial ablation.

Background: Outcomes related to prophylactic catheter ablation (PCA) for ventricular tachycardia (VT) before implantable cardioverter-defibrillator (ICD) implantation in non-ischemic cardiomyopathy (NICM) are not well characterized. We assessed the efficacy of single endocardial PCA in NICM patients.

Methods: We retrospectively analyzed 101 consecutive NICM patients with sustained VT.

The Relationship Between Cardiac Vulnerability and Restitution Properties of the Ventricular Activation Recovery Interval.

Introduction: The restitution of the action potential duration (APD) is an important contributor to ventricular fibrillation (VF) initiation by a single critically timed ectopic beat. We hypothesized that a steep slope of the activation recovery interval restitution curve was related to the upper limit of vulnerability (ULV).

Methods And Results: Fifty-four consecutive patients with implantable cardioverter defibrillators (ICDs) implanted between April 2012 and July 2013 were included.

Reduction in coronary microvascular resistance through cardiac resynchronization and its impact on chronic reverse remodelling of left ventricle in patients with non-ischaemic cardiomyopathy.

Aims: Left bundle branch block (LBBB) induces mechanical dyssynchrony, thereby compromising the coronary circulation in non-ischaemic cardiomyopathy. We sought to examine the effects of cardiac resynchronization therapy (CRT) on coronary flow dynamics and left ventricular (LV) function.

Methods And Results: Twenty-two patients with non-ischaemic cardiomyopathy (New York Heart Association class, III or IV; LV ejection fraction, ≤35%; QRS duration, ≥130 ms) were enrolled.

Crista Terminalis as the Anterior Pathway of Typical Atrial Flutter: Insights from Entrainment Map with 3D Intracardiac Ultrasound.

Background: The precise location of truly active reentry circuits of typical atrial flutter (AFL) has not been well identified. The purpose of this study was to verify our hypothesis that the posterior block line is located along the posteromedial right atrium (PMRA) and the crista terminalis (CT) is the anterior pathway of AFL, with real-time intracardiac echo (ICE).

Methods: The entire right atrium (RA) three-dimensional activation and entrainment mapping were evaluated during AFL in 18 patients using CARTO sound.

Visualization of the antegrade fast and slow pathway inputs in patients with slow-fast atrioventricular nodal reentrant tachycardia.

Introduction: Mapping of the antegrade fast pathway (A-FP) exact sites and antegrade slow pathway (A-SP) input locations has not been well described.

Methods: In 56 patients with slow-fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), pacing during sinus rhythm and entrainment pacing during SF-AVNRT were performed at various sites in the triangle of Koch and coronary sinus (CS) to identify the A-FP and A-SP inputs. User-defined three-dimensional electro-anatomical mapping of the stimulus-His potential (St-H) interval and anatomical location was performed.

Upper limit of vulnerability during defibrillator implantations predicts the occurrence of appropriate shock therapy for ventricular fibrillation.

Background: The utility of the upper limit of vulnerability (ULV) test in patients undergoing defibrillator implantation has been reported, so the purpose of this study was to evaluate the difference in the clinical outcomes between patients with ULV ≤15 J or >15 J.

Methods And Results: A total of 165 patients receiving an implantable cardioverter-defibrillator underwent a vulnerability test. At the time of the implantation, we delivered a 15-J shock on the T-peak and ±20 ms later to cover the most vulnerable part of the cardiac cycle.

Discrepancy between electrical and mechanical dyssynchrony in patients with heart failure and an electrical disturbance.

Background: Cardiac resynchronization therapy (CRT) improves the survival rates of patients with heart failure, but 30-40% of them do not respond to CRT, partially because of the position of the left ventricular (LV) lead. The relationship between the electrical and mechanical activation of the left ventricle is unknown. The aim of this study was to compare the electrical and mechanical dyssynchrony.

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.

Time-dependent effect of cardiac resynchronization therapy on ventricular repolarization and ventricular arrhythmias.

Aims: Cardiac resynchronization therapy (CRT) improves the clinical status of patients with congestive heart failure, although left ventricular epicardial pacing may increase transmural dispersion of repolarization (TDR). The aim of this study was to investigate the time-dependent effect of CRT on ventricular repolarization and ventricular arrhythmia at mid-term follow-up.

Methods And Results: The study group consisted of 84 patients treated with CRT.

Dabigatran in the peri-procedural period for radiofrequency ablation of atrial fibrillation: efficacy, safety, and impact on duration of hospital stay.

Purpose: Dabigatran is effective for both the prevention of stroke and bleeding in patients with atrial fibrillation (AF). However, the safety and efficacy of the use of dabigatran in the peri-procedural period for radiofrequency catheter ablation (RFCA) of AF is unknown. Therefore, the purpose of this study was to evaluate the safety and efficacy of dabigatran in the peri-procedural period for RFCA of AF and the duration of hospital stay.

[Successful management of a patient with myotonic dystrophy under total intravenous anesthesia with propofol, remifentnil and rocuronium bromide, combined with epidural anesthesia].

In general anesthesia for a patient with dystrophia myotonica (DM), respiratory depression and muscle weakness by opioid, as well as prolongation of the effect of muscle relaxant are seen postoperatively. Therefore it is desirable to choose agents with short duration of action and to dose these medicines to the minimum. We report a case of a 45-year-old woman with DM who underwent laparotomy for uterine cancer under general anesthesia combined with epidural anesthesia.

A case of coronary lesion with lotus root appearance treated by percutaneous coronary intervention with intravascular ultrasound guidance.

A 66-year-old man underwent percutaneous coronary intervention (PCI). Coronary angiography showed a diffuse lesion with lotus root appearance and severe stenosis in the left anterior descending artery (LAD). Multiple channels were observed by intravascular ultrasound (IVUS).