Izumi Taniguchi

Sorafenib-induced acute myocardial infarction due to coronary artery spasm

A 65-year-old man with advanced renal cell carcinoma was admitted due to continuing chest pain at rest. Two weeks before his admission, sorafenib had been started. He was diagnosed with non-ST-elevation myocardial infarction by laboratory data and electrocardiogram. Enhanced heart magnetic resonance imaging also showed subendocardial infarction. However, there was no stenosis in coronary arteries on angiography. Coronary artery spasm was induced by a provocative test. Cessation of sorafenib and administration of Ca-channel blocker and nitrates ameliorated his symptoms, but relapse occurred after resumption of sorafenib. Addition of oral nicorandil reduced his symptoms and maintained stable angina status. We report the first case of sorafenib-induced coronary artery spasm. Sorafenib is a multikinase inhibitor that targets signaling pathways necessary for cellular proliferation and survival. On the other hand, the Rho/ROCK pathway has an important role in the pathogenesis of coronary artery spasm. Our report may show an adverse effect on the Rho/ROCK pathway by sorafenib use.

An Alternative Approach for Radiofrequency Catheter Ablation for Intra-atrial Reentrant Tachycardia Associated with Open-Heart Surgery

We present case reports of 2 patients with scar‐related intra‐atrial reentrant tachycardia (IART) associated with previous open‐heart surgeries, in which standard ablation strategies failed to eliminate atrial tachycardia (AT). The strategies targeted a narrow conducting channel between the right atrial scars or between the scar and inferior vena cava. In these patients, an alternative approach to transect another narrow conducting pathway between the scar and crista terminalis (CT), which was revealed by a noncontact mapping system, successfully terminated and eliminated the IART. Both the cases were free of recurrent AT at the 24‐and 25‐month follow up visits, respectively. Transection of the corridor between the CT and the incision scar appears to be an effective technique for eliminating scar‐related IART and can be considered as a second‐line procedure for radiofrequency catheter ablation to eliminate IART.