Daisuke Wakatsuki

Pulmonary vein isolation under direct visual identification of the left atrium—pulmonary vein junction using intra-cardiac echography

Introduction: Intra-cardiac echocardiography (ICE) which has some benefits, can be used to obtain detailed anatomy of the heart chambers or large vessels, and the catheter positions, and it has been considered useful for improving the outcome of the ablation. In the present study, we performed pulmonary vein isolation (PVI) under real time monitoring of ICE imaging utilizing an ICE catheter placed at the junction of the left atrium (LA) and PVs (LA-PV junction).Methods: PVI for atrial fibrillation (AF) was performed in 30 cases with drug-resistant AF (mean age: 66-years-old; including 22 males). An ICE catheter utilizing a 9 MHz frequency was inserted into the LA via the atrial septum, and placed at the LA-PV junction. Circumferential ablation was performed in the LA outside of the PV ostium, encircling both the superior and inferior ostia together under ICE imaging.Results: The anatomy of the LA to the PVs and catheter sites were clearly identified by the ICE during the procedure, which enabled a precise and safe catheter manipulation with minimal fluoroscopy. Further, the wall thickness of the PV and LA, and position of the esophagus could be obtained by ICE, facilitating care in adjusting the power and/or duration of the current delivery.Conclusion: ICE imaging of the LA-PV junction permitted real time monitoring of the target sites for PVI during the ablation procedure, and was considered a useful technique for performing PVI.

Cardiopulmonary arrest due to persistent coronary spasm in a young woman: Are we properly diagnosing vasospastic angina?

Coronary spasm is a risk factor for acute myocardial infarction and sudden cardiac death. This is a case of a young female patient with cardiopulmonary arrest induced by coronary spasm on arrival at our hospital. There has been no case that prolonged spontaneous attack was confirmed in multi-vessels. This case demonstrates that persistent coronary spasm is lethal and an important cause of cardiopulmonary arrest even in young people. It is extremely important to detect patients with coronary spasm before the ischemic events associated with cardiopulmonary arrest occur.

A Case With Pulmonary Vein Stenosis and Obstruction After Pulmonary Vein Isolation: A Multimodality Approach

Pulmonary vein stenosis and occlusion are some of the major complications after radiofrequency ablation of atrial fibrillation. The prevalence of pulmonary vein stenosis and pulmonary vein occlusion decreased remarkably after the advent of area circumferential ablation and antral isolation; however

Sudden cardiac arrest during marathon training in a young adult with short QT syndrome

A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with sudden cardiac death in young athletes and amateur sport participants [1]. Short QT syndrome (SQTS), a condition first described in 2000 [2], is a rare cardiac channelopathy characterized by abnormally short cardiac repolarization. Data from only a small group of patients identified worldwide are available. The annual risk of cardiac arrest among patients in the largest SQTS cohort to date was approximately 1%, and most of the cardiac arrests reported in the cohort occurred during rest or sleep [3]. Risk stratification and management of SQTS remain uncertain, however, as data on the natural history of SQTS are lacking. Here we report a patient with SQTS who suffered a sudden cardiac arrest when marathon training.

Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter ablation of atrial fibrillation

Introduction Even though mitral isthmus block is completely achieved after pulmonary vein (PV) isolation for atrial fibrillation (AF) by adding a linear ablation, in some cases atrial tachycardias (ATs) can occur that break through between the left atrial appendage and left PVs. This type of perimitral flutter has been reported as a ridge-related reentry (RRR). Jiang and colleagues speculated that one of the mechanisms for the appearance of this RRR tachycardia could be reentry through the vein of Marshall (VOM). In a previous report, an AT through the VOM was diagnosed by passing a thin catheter though the VOM and ablating it from the left atrial endocardium. In this report, we describe a novel method of diagnosing and ablating an AT through the VOM.

Direct action of angiotensin II on the conduction through papillary muscle preparations of rat heart immediately after reoxygenation

We investigated the direct action of angiotensin II (Ang II) on myocardial conduction and transmembrane action potential immediately after reoxygenation.

Left ventricular function and myocardial perfusion before and after cardiac resynchronization therapy in chronic right ventricular apical pacing by echocardiogram-gated myocardial perfusion single photon emission computed tomography

The aim of this study was to evaluate the changes in cardiac performance and myocardial blood perfusion by single photon emission computed tomography (SPECT) in patients upgrading to cardiac resynchronization therapy (CRT) from right ventricular apical pacing (RVAP).