Kaoru Komatsu

Transbrachial intra-aortic balloon pumping for a patient with fulminant myocarditis

A 57-year-old man with acute myocarditis was transferred to our hospital from a local clinic. The patient experienced unexpected sudden cardiac arrest 16 h after admission. Mechanical cardiopulmonary support was started using percutaneous cardiopulmonary support, intra-aortic balloon pumping (IABP), continuous hemodialysis filtration, and temporary cardiac pacing with percutaneous cannulation of the femoral vessels. Hematoma developed at the IABP insertion site on the 5th day after admission. The IABP was removed, and another IABP system was inserted via the left brachial artery. The patient’s condition improved, and the IABP was removed on the 9th day after admission. The remainder of the patient’s in-hospital treatment was uneventful, and he showed near-normal left ventricular systolic function 1 year after discharge.

Rapid Improvement and Long-term Stability of Pacing Threshold with Active-fixation Screw-in Lead

Background: Active‐fixation screw‐in leads are associated with initially high thresholds. However, pacing thresholds have been shown to improve within several minutes after screwin. The aim of this study is to investigate the long‐term stability of rapidly improved pacing thresholds following the implantation of active‐fixation screw‐in leads.

The use of serum bepridil concentration as a safe rhythm control strategy in patients with atrial tachyarrhythmias

The aim of this study was to evaluate the clinical significance of serum bepridil (Bep) concentration (SBC) for safely managing patients with atrial tachyarrhythmias (AT).

Infective endocarditis associated with acute myocardial infarction caused by septic emboli

A 53-year-old Japanese man presented with severe chest pain. He had suffered from persistent fever, muscle pain, arthralgia, and dyspnea on exertion (New York Heart Association class I) for two and half months prior to admission. He had been treated with several antibiotics for two months and prednisolone for almost one month prior to admission. On the day of admission, he had suffered from chest pain at rest, and had come to our hospital. Electrocardiography showed a normal sinus rhythm with significant ST segment elevation in leads V3-6 and abnormal Q waves in leads V4-6. Transthoracic echocardiography demonstrated left ventricular ejection fraction of 52% with severe mitral regurgitation and an 18-mm vegetation on the anterior mitral valve leaflet. Multiple blood cultures identified Streptococcus sanguis. The diagnosis was acute myocardial infarction and mitral regurgitation associated with infective endocarditis (IE). The incidence of acute coronary syndrome caused by IE is quite low in patients with native valves. After a 6-week course of antibiotics, mitral valve replacement and partial cardiomyotomy were performed. Two years after the surgery, follow-up echocardiography showed almost normal left ventricle function and no mitral regurgitation, and the patient has been living an active life without any complications.

Twiddler's syndrome detected by patient's complaint of implantable cardioverter-defibrillator rotation in the subcutaneous pocket

Twiddlers syndrome presents as a rare implantable‐cardioverter defibrillator (ICD) malfunction that is potentially fatal. The following case is that of a 79‐year‐old woman, who was implanted with an ICD and experienced Twiddlers syndrome. Five months after the implantation, the patient complained that the generator sometimes rotated in the subcutaneous pocket. Fluoroscopy showed that the generator had rotated and the leads were twisted, which is compatible with Twiddlers syndrome. Although all the leads were functioning normally, a procedure to repair the twisted leads was performed. Twiddlers syndrome is usually detected due to a serious device malfunction; however, this case study suggests that it can be detected prior to ICD malfunction by the patients complaint.

Variations in cephalic vein venography for device implantation–Relationship to success rate of lead implantation

Lead implantation using the cephalic vein (CV) cutdown technique has been well established, but is not always expected to achieve high success rates. We studied the relationship between preoperative CV venography and the success rate of lead implantation.