Atrial echo beats as a novel mechanism of periodic fluctuation in cycle length of atrial tachycardia.

Atrial echo beats due to a dual-atrioventricular nodal pathway are a possible cause of fluctuating tachycardia in cycle length (CL) but have not been reported so far. Here, we present a case of an 82-year-old man with symptomatic atrial tachycardia (AT), which was accompanied by periodic fluctuations in atrial sequence at the coronary sinus. Electrophysiological study (EPS) for atrioventricular conduction and three-dimensional (3D) electro-anatomical mapping system explained that the mechanism of periodic fluctuations was due to atrial echo beats through a dual-atrioventricular nodal pathway.

Comparison of uninterrupted anticoagulation with dabigatran etexilate or warfarin in the periprocedural period for atrial fibrillation catheter ablation: Results of the Japanese subgroup of the RE-CIRCUIT trial.

Background: There are limited data on uninterrupted anticoagulation with direct oral anticoagulants during catheter ablation for atrial fibrillation (AF), particularly in Japan. We planned a subgroup analysis of the RE-CIRCUIT study, comparing the use of uninterrupted dabigatran therapy with warfarin therapy during catheter ablation among the Japanese subgroup and with that in the total population.

Methods: The RE-CIRCUIT study utilized a prospective, randomized, open-label, blinded endpoint design, and the primary endpoint was the incidence of major bleeding events (MBEs).

Early detection of twiddler syndrome due a congestion alert by remote monitoring.

There are often false-positive alerts of thoracic impedance monitoring; however, the "false-positive alerts" might indicate any clinical problem of patient. In the present case, an alert for a drop in intrathoracic impedance, which generally indicates exacerbation of heart failure, enabled early detection of twiddler syndrome.

Resolution of left ventricular thrombus secondary to tachycardia-induced heart failure with rivaroxaban.

A 42-year-old man was admitted to our hospital because of lumbago and tachycardia-induced heart failure. Transthoracic echocardiography revealed impaired left ventricular function and a ball mass of thrombus in the left ventricle (LV). He was found to have systemic embolism in the spleen, kidneys, brain, and limbs.

A case of idiopathic giant cell myocarditis with a past history of sarcoidosis.

A 70-year-old woman with back pain and breathlessness was referred to our hospital for suspected myocardial infarction. Coronary angiogram was normal and endomyocardial biopsy showed inflammatory cell infiltrates consisting of eosinophils and multinucleated giant cells. The clinical course was hemodynamically fulminant, but steroid therapy improved the cardiac function.

Midventricular ballooning Takotsubo cardiomyopathy complicated by transient complete atrioventricular block.

A 63-year-old woman had mistakenly drunk detergent stored in a plastic bottle and was transported to our hospital via ambulance due to unconsciousness. In the emergency room, the monitoring electrocardiogram showed complete atrioventricular block and temporary pacing was thus started. Left ventriculography indicated midventricular Takotsubo cardiomyopathy, although coronary angiograms showed a normal appearance.

Acute effect of sodium nitroprusside on microvascular dysfunction in patients who underwent percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

Even in the era of thrombus aspiration and distal protection for ST-segment elevation acute myocardial infarction (STEMI), microvascular dysfunction does exist and improvement of microvascular dysfunction can improve the prognosis and/or left ventricular dysfunction. We evaluated the acute effects of nitroprusside (NTP) on coronary microvascular injury that occurred after primary percutaneous coronary intervention (PCI) for STEMI in 18 patients. The final Thrombolysis in Myocardial Infarction trial (TIMI) flow grade after PCI was 3 in 17 patients and 2 in 1 patient.

Sodium bicarbonate for the prevention of contrast-induced nephropathy: the efficacy of high concentration solution.

Background: The appropriate dose of sodium bicarbonate to prevent contrast-induced nephropathy (CIN) has not been established.

Methods And Results: To determine the efficacy of high-concentration sodium bicarbonate, 123 consecutive patients with renal dysfunction undergoing coronary angiography with/without intervention were administrated either high-concentration (group H: 833 mEq/L, n = 87) or low-concentration (group L: 160 mEq/L, n = 36) sodium bicarbonate at the rate of 3 mL/kg/h for 1 hour before the contrast exposure, and followed by 1 mL/kg/h for 7 hours. A total of 77 patients (group H, n = 54; group L, n = 23) without prophylactic continuous hemodiafiltration were analyzed in this study.

Late in-stent restenosis after sirolimus-eluting stent implantation is related to thrombus formation-Insight from a case with IVUS, OCT, and histological findings.

We experienced a case of very late in-stent restenosis of a sirolimus-eluting stent (SES) (3.0 mm × 18 mm) in the left anterior descending coronary artery in a 62-year-old man with type 2 diabetes mellitus, dyslipidemia, and hypertension. Angina pectoris recurred 39 months after the index percutaneous coronary intervention (PCI).

Ruptured plaque in a bare-metal stent 8 years after implantation-Comparison of IVUS and OCT findings.

Optical coherence tomography (OCT) and intravascular ultrasound tomography (IVUS) findings in a patient with very late in-stent restenosis that was manifested as acute coronary syndrome 8 years after bare-metal stent implantation are presented. This case clearly shows the disruption of thin fibrous cap associated with a white thrombus by OCT. A superficial high signal with deep attenuation by OCT, composing more than half of the plaque, was expressed as heterogeneous tissue, mainly composed of echolucent lesion including outside the struts by IVUS.

Double chambered right ventricle with severe calcification of the tricuspid valve in an elderly woman: a case report.

Introduction: Double chambered right ventricle is a rare congenital cardiac anomaly in which the right ventricle is divided into two chambers by an anomalous muscle bundle. The diagnosis of this disorder is difficult in adults. Calcification of the tricuspid valve is extremely rare, and very few cases have been reported.

Angiographic and clinical characteristics of patients with acetylcholine-induced coronary vasospasm on follow-up coronary angiography following drug-eluting stent implantation.

Unlabelled: Recent studies have shown that drug-eluting stents (DES) induce vascular endothelial dysfunction in both Cypher and Taxus stents. These studies evaluated coronary vasomotion in the peristent coronary segment for 1 lesion with 1 DES. The angiographic and clinical characteristics of real-world patients with coronary spasm following DES implantation have not been well documented.

Idiopathic ventricular arrhythmias originating from the left ventricular summit: anatomic concepts relevant to ablation.

Background: The summit of the left ventricle (LV) is the most superior portion of the epicardial LV bounded by an arc from the left anterior descending coronary artery, superior to the first septal perforating branch to the left circumflex coronary artery. Ventricular arrhythmias (VAs) originating from this region may present challenges for catheter ablation.

Methods And Results: We studied 27 consecutive patients with VAs originating from the LV summit.

Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: relevance for catheter ablation.

Background: Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular papillary muscles (PAMs). This study investigated the electrophysiological characteristics of these VAs and their relevance for the results of catheter ablation.

Methods And Results: We studied 19 patients who underwent successful catheter ablation of idiopathic VAs originating from the anterior (n=7) and posterior PAMs (n=12).

The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques.

Aims: This study examined the difference in autonomic modification (AM) and its effect on paroxysmal atrial fibrillation (PAF) recurrence between segmental pulmonary vein isolation (S-PVI) and circumferential PVI (C-PVI).

Methods And Results: Successful S-PVI or C-PVI with a basket catheter was achieved in 120 consecutive PAF patients. Serial 24 Holter-recordings were obtained before, immediately, and 1, 3, 6, 12 months after the PVI to analyse the heart rate variability (HRV).

Idiopathic left ventricular arrhythmias originating adjacent to the left aortic sinus of valsalva: electrophysiological rationale for the surface electrocardiogram.

Background: Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV.

Premature ventricular contractions arising from the intramural ventricular septum.

A 68-year-old man with symptomatic idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Radiofrequency catheter ablation was unsuccessful at the earliest endocardial ventricular activation site in the left coronary cusp. Epicardial mapping via the cardiac veins was then performed.

Idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation.

Introduction: Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PAMs). This study investigated the prevalence, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of these VAs, and compared them with other LV VAs.

Methods And Results: We studied 71 patients with VAs originating from the LV anterolateral and posteroseptal regions among 159 patients undergoing successful catheter ablation of idiopathic LV VAs.

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study.

Aims: Managed ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms.

Methods And Results: Symptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled.

Vagal modification can be a valid predictor of late recurrence of paroxysmal atrial fibrillation independent of the pulmonary vein isolation technique.

Background: Vagal denervation during pulmonary vein isolation (PVI) may reduce paroxysmal atrial fibrillation (PAF) recurrences. Valid predictors of late PAF recurrence after PVI were examined.

Methods And Results: Successful segmental (S-PVI) or circumferential PVI (C-PVI) was achieved in 120 consecutive PAF patients.