Kaoru Takami

Dilated phase of hypertrophic cardiomyopathy caused by Fabry disease with atrial flutter and ventricular tachycardia.

We describe a case of a 60-year-old male with dilated phase of hypertrophic cardiomyopathy caused by Fabry disease. He was diagnosed to have a cardiac variant of Fabry disease by an enzyme assay and a right ventricular endomyocardial biopsy which revealed specific features of this disease and cardiac involvement was the sole manifestation. He has developed dilated cardiomyopathy with sustained atrial flutter and frequent non-sustained ventricular tachycardia requiring isthmus ablation and cardiac resynchronization therapy with defibrillator.

Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: Clinical outcomes after a single endocardial ablation

Outcomes related to prophylactic catheter ablation (PCA) for ventricular tachycardia (VT) before implantable cardioverter‐defibrillator (ICD) implantation in non‐ischemic cardiomyopathy (NICM) are not well characterized. We assessed the efficacy of single endocardial PCA in NICM patients.

Rate-Dependent and Site-Specific Conduction Block at the Posterior Right Atrium and Drug Effects Evaluated Using a Noncontact Mapping System in Patients with Typical Atrial Flutter

Functional Block in the Posterior Right Atrium. Introduction: Conduction block in the posterior right atrium (RA) plays an important role in perpetuating atrial flutter (AFL). Although conduction blocks have functional properties, it is not clear how the block line changes with the pacing rate, pacing site, and administration of antiarrhythmic drugs.

Heparin bridging increases the risk of bleeding complications in patients undergoing anticoagulation therapy and device implantation

The purpose of this study is to evaluate the rate of perioperative bleeding complications following anticoagulation therapy in patients undergoing implantable electronic device implantation.

Utility of virtual unipolar electrogram morphologies to detect transverse conduction block and turnaround points of typical atrial flutter

BackgroundNoncontact mapping is useful for the diagnosis of various arrhythmias. Virtual unipolar electrogram morphologies (VUEM) of the conduction block and the turnaround points, however, are not well defined. We compared the VUEM characteristics of a transverse conduction block in the posterior right atrium (RA) with those of contact bipolar electrograms obtained during typical atrial flutter (AFL).MethodsContact bipolar electrograms were used to map the posterior RA during typical AFL in 16 patients. Twenty points of the VUEM recorded along the block line were analyzed and compared with contact bipolar electrograms.ResultsSeventeen AFLs were analyzed. Fifteen AFLs showed an incomplete transverse conduction block in the posterior RA by contact bipolar mapping. A double potential on the block line corresponded to the two components of the VUEM, in which the second component showed an Rs, RS, or rS pattern. At the turnaround point, a fused double potential of the contact bipolar electrograms corresponded to a change of the second component of the VUEM from an rS to a QS morphology. Two AFLs showed a complete block line in the posterior RA. The contact bipolar electrogram showed double potentials from the inferior vena cava to the superior vena cava, whereas the second component of the VUEM remained in an unchanged Rs, RS, or rS pattern.ConclusionVUEM analysis was a reliable method for identifying the posterior block line during AFL. This method may also be applicable for detecting block lines and turnaround points of circuits in other unmappable arrhythmias.

The Efficacy and Safety of Open Irrigation Catheter in Pulmonary Vein Isolation for Atrial Fibrillation

Background: Open irrigation Catheter (OIC) have the advantage of delivering greater power without increasing the temperature of the catheter tip, which can ablate wider and deeper lesions, compared with conventional tip catheter. We study the efficacy and safety of OIC for pulmonary vein isolation (PVI) for atrial fiblillation (AF). Method: Catheter ablation was performed using 3.5 mm OIC (Navistar ThermoCcool) or 8-mm catheter (8MC, Navistar DS). Seventy one consecutive AF patients (60 males, 60.6±15 years, 66 paroxysmal AF, 5 persistent AF) enrolled in the study, and subdivided into two groups, OCI group (n=29) and 8MC group (n=42). PVI was performed with maximum power 35 W at 17 or 30 ml/min of constant saline infusion in OCI group. Result: Isolation of pulmonary vein was achieved in all patients. Fluoroscopy time and the number of energy application have no differerce between two groups (respectively, 144 vs 133 min, p=0.286, 96.8 vs 96.3 p=0.57). The recurrence of AF was significant lower in OIC group compared with 8MC group (48% vs 17%, p=0.0045) during mean 3.5 months follow up period with 2 months blanking period. There was no major complication. However, lung congestion without dyspnea in 3 patients and small cerebral infarction in 1 patient in OIC group after procedure. Conclusion: Although there was a lower rate of AF recurrence with the use of OIC, the setting was associated with increased congestive heart failure due to the volume overload.

P-250 Quality of Life and Mood Disturbance During the First Year of Patients with Implantable Cardioverter Defibrillators

Method: (1) A total of 43 patients with CHF treated at home for 2 years were enrolled in the study from among 115 patients admitted to the CCU of A Hospital due to acute CHF. Patients were treated with drugs, moved to an internal medicine ward, and then discharged. (2) The SF-36 questionnaire was used to measure health-related QOL at discharge and at 1 year (1 year) and 2 years after discharge (2 years). Self-care activities of patients were observed at the same time QOL was measured. Result: (1) At 1 year and 2 years, seven (physical functioning, bodily pain, general health perception, vitality, social functioning, role-emotional, and mental health) of the eight SF-36 subscales were significantly lower than the scores at discharge. (2) Self-care items related to regular exercise and abstaining from smoking were improved at 2 years. Until now, it was thought that QOL in patients with CHF gradually deteriorated after discharge due to repeated hospital admissions. In the present study, patients with CHF practiced self-care activities at home for 2 years after discharge; however, QOL in these patients at 2 years was not improved compared to QOL at discharge. Patients’ self-care activities should be more closely studied in order to identify practices that can effectively improve QOL in patients with CHF receiving at-home care.

Ventricular tachycardia in patients with idiopathic dilated cardiomyopathy is associated with delayed enhancement MRI

of PSVT in the Korean population is limited. In this study, we sought to investigate the differing mechanisms of PSVT according to age and gender in Korean patients. Methods: Database of 3176 patients diagnosed with PSVT excluded atrial flutter or atrial fibrillation and referred for electrophysiologic study from 1986 to 2004 was retrospectively analyzed. The mechanisms of PSVT were classified as: WPW syndrome(WPW), AVRT due to concealed bypass tract(CBT), atrioventricular nodal reentrant tachycardia(AVNRT), atrial tachycardia(AT). Results: The mean age was 40.7 16.0(1-90) and 53.3% of the patients were males. The mean age of females was significantly higher than males.(43.0 16.1 vs 38.6 15.6, p 0.001) Overall, the dominant mechanism of tachycardia was AVRT at 62.6%(WPW: 31.1%, CBT: 31.5%) compared to AVNRT at 34.1% and AT at 3.1%. This was mainly due to the predominance of AVRT(74.2%) in males. The mechanisms of PSVT differed according to gender with 63.2%(1257/1988) of AVRT patients being males where as 64.6%(700/1084) of the AVNRT patients were females. The distribution of PSVT mechanisms differed according to gender. In males, the proportion of AVNRT:CBT:WPW was 22.7%:36.1%:38.1%, whereas in females the proportion was 47.2%:26.3%: 23.0%. Age had a significant influence upon the mechanism of PSVT in both genders with an increasing proportion of AVNRT and a decreasing proportion of AVRT in older age groups. AVRT was the dominant mechanism of PSVT in all age groups for males, where as AVNRT was the dominant mechanism of PSVT for females over 50 years of age. Conclusions: The mechanism of PSVT differs significantly according to age and gender. This may be due to increased degeneration of accessory pathway with age and difference in the conduction properties of the accessory pathway according to gender. In Koreans, the overall dominant mechanism of PSVT was AVRT mainly due to it a greater male population.