- Clinical Study Regarding Arrhythmogenic Risk Factors and Oxidative Stress Inductibility in Young People. [Journal Article]
- CHCurr Health Sci J 2015 Jul-Sep; 41(3):251-258
- CONCLUSIONS: Arrhythmogenic risk factors and biomarkers of oxidative stress are important, especially in young people cases, for monitoring the cardiovascular risk, for primary prevention and early treatment.
- Catheter ablation of ventricular tachycardia associated with cardiac sarcoidosis: Targeting a low-voltage area with strict voltage criteria. [Journal Article]
- JCJ Cardiol Cases 2014; 10(4):159-161
- The usefulness of voltage mapping with strict voltage criteria for catheter ablation of postinfarction ventricular tachycardia (VT) has been reported but not for VT associated with cardiac sarcoidosi...
The usefulness of voltage mapping with strict voltage criteria for catheter ablation of postinfarction ventricular tachycardia (VT) has been reported but not for VT associated with cardiac sarcoidosis (CS). A 62-year-old man with CS was referred for catheter ablation of VT refractory to antiarrhythmic and immunosuppressive therapy. Voltage mapping during sinus rhythm using strict voltage criteria with an upper limit of the low-voltage area (LVA) of ≤0.8 mV revealed an LVA on the posterior side of the interventricular septum, and a narrow isthmus was observed in the LVA. Concealed entrainment was observed at the narrow isthmus during the VT. The VT was eliminated and was no longer inducible after a focal radiofrequency application targeting the narrow isthmus. As with postinfarction VT, targeting the LVA with strict voltage criteria might be a feasible method for the catheter ablation of VT associated with CS. <Learning objective: The activation mapping strategy during ongoing ventricular tachycardia is sometimes difficult to illustrate a complete map. Adjusting the voltage limits of the bipolar maps with strict voltage criteria for identifying the critical isthmus of the macroreentrant circuits during sinus rhythm might be a feasible method to eliminate ventricular tachycardia associated with not only myocardial infarctions, but also cardiac sarcoidosis.>.
- Restored left ventricular function following transcatheter closure of a persistent ductus arteriosus in an adult. [Journal Article]
- JCJ Cardiol Cases 2013; 7(3):e64-e67
- Recently, transcatheter device occlusion has become the first choice treatment for adult persistent ductus arteriosus (PDA). However, various complications such as atrial fibrillation requiring antic...
Recently, transcatheter device occlusion has become the first choice treatment for adult persistent ductus arteriosus (PDA). However, various complications such as atrial fibrillation requiring anticoagulation, pulmonary hypertension, and ventricular dysfunction may challenge the interventionist. We report a 61-year-old patient with a large PDA complicated by left ventricular dysfunction, atrial fibrillation, and left atrial thrombus. Computed tomography documented the PDA of Krichenko type A with the narrowest diameter of 8 mm. We successfully closed the PDA using an Amplatzer duct occluder under anticoagulation with wafarin. His post-operative course was complicated by ventricular tachycardia and deteriorating left ventricular pump function. Although endomyocardial biopsy from the left ventricle showed myocardial hypertrophy and interstitial fibrosis, possibly caused by chronic volume overload, left ventricular pump function improved dramatically with restoration of sinus rhythm during follow-up. Left ventricular dysfunction, even when associated with histological changes, may be nearly normalized by volume unloading in an adult with a large PDA. <Learning objective: Transcatheter device occlusion has become the first choice for adult persistent ductus arteriosus (PDA). It is important to note various complications associated with transcatheter occlusion of PDA in adult, such as arrhythmia, pulmonary hypertension, and ventricular dysfunction. Temporally dysfunction of left ventricular (LV) systolic performance usually occurs following PDA closure, because of reduced muscle fiber stretch by the sudden reduction in LV volume overload and increased LV afterload. Although histological remodeling of LV may be caused by volume overload due to significant left-to-right shunt in adults, volume unloading can, not only prevent further deterioration of LV function, but also may also reverse the substrate of arrhythmia.>.
- Various morphologies of bidirectional ventricular tachycardia caused by aconite "Torikabuto" poisoning. [Journal Article]
- JCJ Cardiol Cases 2013; 7(2):e42-e44
- A 43-year-old man presented with nausea. The patient developed ventricular fibrillation (VF), which was refractory to antiarrhythmic drugs and defibrillation. A coronary angiogram showed no coronary ...
A 43-year-old man presented with nausea. The patient developed ventricular fibrillation (VF), which was refractory to antiarrhythmic drugs and defibrillation. A coronary angiogram showed no coronary artery stenosis. We recorded various fatal arrhythmias, including bidirectional ventricular tachycardia (BVT). The presence of multiple types of BVTs that were refractory to drugs such as adenosine triphosphate, isoproterenol, verapamil, propranolol, and pilsicainide, and easily recurred after defibrillation indicated aconite poisoning. After persisting for 24 h, VF spontaneously resolved and sinus rhythm was restored. Laboratory data revealed lethal concentrations of aconitine. To the best of our knowledge, this is the first report of aconite poisoning-induced BVTs manifesting with multiple morphologies on 12-lead electrocardiogram. The arrhythmogenic effects of aconitine are well recognized. In addition to causing VT and VF, aconitine also can cause BVT. Aconitine can lead to delayed afterdepolarization which has an important role in triggering and maintaining BVT. However, in this case, the concentration of aconitine was high enough to render these drugs ineffective. Prompt application of percutaneous cardio-pulmonary support, which was continued until the aconitine was metabolized, proved successful in this case and should be considered as a management approach in cases of severe aconite poisoning.
- Retrograde fast pathway ablation with the EnSite NavX mapping system for slow-fast atrioventricular node reentrant tachycardia and a prolonged PR interval during sinus rhythm. [Journal Article]
- JCJ Cardiol Cases 2011; 3(3):e143-e148
- An 84-year-old male had experienced palpitations. He was transported to our hospital for treatment of palpitations. A 12-lead electrocardiogram (ECG) showed regular tachycardia with a wide QRS comple...
An 84-year-old male had experienced palpitations. He was transported to our hospital for treatment of palpitations. A 12-lead electrocardiogram (ECG) showed regular tachycardia with a wide QRS complex of 153 bpm, and the P wave was not clear. The ECG after the tachycardia stopped showed a sinus rhythm, and there was a prolonged PR interval of 312 ms and complete right bundle branch block. We recorded a prolonged AH interval (235 ms) in electrophysiology study (EPS). As for the St-A interval (185 ms) by consecutive pacing from the right ventricular apex, it was short in comparison with the anterograde conduction. As a result of detailed EPS, we diagnosed the tachycardia as slow-fast atrioventricular nodal reentrant tachycardia. The anterograde conduction depended on the slow pathway (SP), and the fast pathway (FP) was considered to have only retrograde conduction. It was thought that a complete atrioventricular block been caused by the SP ablation. Therefore we carried out FP ablation with three-dimensional computed tomography and the EnSite NavX mapping system (St. Jude Medical, St Paul, MN, USA), which was superior in space resolution power, and were able to effect a radical cure without complications.
- Catheter ablation of multiple focal atrial tachycardias originating from the tricuspid annulus using non-contact mapping system. [Journal Article]
- JCJ Cardiol Cases 2010; 2(3):e170-e173
- We describe an 81-year-old man with multiple focal atrial tachycardias (ATs) originating from the tricuspid annulus. Non-contact mapping showed 3 incessant ATs, originating from the vicinity of His b...
We describe an 81-year-old man with multiple focal atrial tachycardias (ATs) originating from the tricuspid annulus. Non-contact mapping showed 3 incessant ATs, originating from the vicinity of His bundle region, inferior portion of coronary sinus ostium, and coronary sinus ostium, and 2 premature atrial contractions (PACs) originating from the tricuspid annulus in the 5 o'clock position and 6 o'clock position in the left anterior oblique view. Radiofrequency energy application to these 5 sites successfully eliminated the ATs and PACs. The patient has remained free from ATs or any symptoms without medication during the 16-month follow-up period. Non-contact mapping was useful in identifying the multiple AT origins, especially even if the tachycardia origin shifted occasionally or the tachycardia was non-sustained.
- The usefulness of chemotherapy for control of ventricular arrhythmias secondary to cardiac metastasis of germ cell tumor. [Journal Article]
- JCJ Cardiol Cases 2010; 2(3):e132-e134
- A 14-year-old boy was referred to our hospital because of treatment of germ cell tumor in the anterior mediastinum. Computerized tomographic (CT) scan of the chest and abdomen revealed a large tumor ...
A 14-year-old boy was referred to our hospital because of treatment of germ cell tumor in the anterior mediastinum. Computerized tomographic (CT) scan of the chest and abdomen revealed a large tumor in the anterior mediastinum and multiple metastatic tumors in the lung, liver, kidney, pancreas, and heart. There was a mass in the interventricular septum. A 24-h Holter monitor showed sinus rhythm with 358 premature ventricular complexes (VPC) and 30 ventricular runs including 9 non-sustained ventricular tachycardias per day. The patient was treated with 4 cycles of chemotherapy with good response. Approximately 12 weeks after the start of the chemotherapy, serial CT scan showed regression of the tumors in the anterior mediastinum, lung, and kidney, and disappearance of the tumors in the liver, pancreas, and heart. Repeat Holter monitor showed that VPC and ventricular runs disappeared completely. The chemotherapy for the germ cell tumor was very useful for ventricular arrhythmias secondary to cardiac metastasis of the tumor.
- Characteristics, Mechanism and Long-Term Ablation Outcome of Atrial Tachycardias After Mitral Valvular Surgery and Concomitant Cox-MAZE IV Procedure. [Journal Article]
- IHInt Heart J 2018 Dec 05
- The incidence of atrial tachycardia (AT) after rheumatic mitral valvular (RMV) surgery has been well described. However, there have been few reports on the characteristics, mechanism, and long-term a...
The incidence of atrial tachycardia (AT) after rheumatic mitral valvular (RMV) surgery has been well described. However, there have been few reports on the characteristics, mechanism, and long-term ablation outcome of ATs after RMV surgery and concomitant Cox-MAZE IV procedure.The present study reviewed consecutive patients who underwent AT ablation between May 2008 and July 2013. All patients were refractory to antiarrhythmic drugs (AADs) and had a history of RMV surgery and Cox-MAZE IV procedure. A total of 34 patients underwent AT ablation after RMV surgery and concomitant Cox-MAZE IV procedure, and presented 57 mappable and 2 unmappable ATs. The 57 mappable ATs included 14 focal-ATs and 43 reentry-ATs. Ten of the 14 focal-like ATs were located at the pulmonary vein (PV) antrum and border of a box lesion. Of the 43 reentry-ATs, 16 were marco-reentrant around the mitral annulus (MA) and 16 around the tricuspid annulus. There were 41 atypical ATs (non-cavotricuspid isthmus related) including 16 ATs related to the box lesion and 21 ATs related to other Cox-MAZE IV lesions. The AT were successfully terminated in 33 (97.1%) patients. After mean follow-up of 46.9 ± 15.7 months, 25 (73.5%) patients maintained sinus rhythm without AADs after a single procedure and 28 (82.4%) patients after repeated procedures.The recurrent ATs after RMV surgery and concomitant Cox-MAZE IV were mainly reentry mechanism, and largely related to LA. An incomplete lesion or re-conductive gaps in a prior lesion might be the predominant mechanisms for these ATs. Catheter-based mapping and ablation of these ATs seems to be effective and safe during a long-term follow-up.
- Focal atrial tachycardia ablation: Highly successful with conventional mapping. [Journal Article]
- JIJ Interv Card Electrophysiol 2018 Dec 01
- CONCLUSIONS: Conventional mapping-guided RFCA of FAT had high success (96.8%) with low complication (3.2%) and recurrence rates (6.5%). TCM was fully reversible. These results are comparable to those achieved with the more expensive electro-anatomical mapping, which may be reserved for more complex cases or for those failing the conventional approach.
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- [A toddler with a rare complication of scarlet fever]. [Journal Article]
- NTNed Tijdschr Geneeskd 2018 11 26; 162
- CONCLUSIONS: Although GAS infections are common, complications such as thyroiditis are rare. When a paediatric patient is diagnosed with infectious thyroiditis, a fistula from the pyriform sinus should be considered. Patients with such a congenital malformation have an increased risk of recurrent infectious thyroiditis and thyroid abscess formation.