Kotaro Miyaji

Cardiac Pacing Suppressed Macroscopic T Wave Alternans in a Patient with Heart Failure Caused by Non-ischemic Cardiomyopathy

A 67‐year‐old male with dilated cardiomyopathy and chronic renal failure who received chronic hemodialysis for 9 years admitted with pulmonary edema. Three days after admission, electrocardiogram showed transient prolongation of QT interval which was followed by macroscopic T wave alternans (TWA) and ventricular fibrillation (VF). Temporary pacing from right ventricular apex suppressed TWA and VF effectively. Combined cardiac resynchronization therapy and implantable cardioverter defibrillator device was implanted for the secondary prevention of VF. Both prolongation of QT interval and TWA disappeared for 10 days after therapy and no arrhythmic event occurred since then.

Suppression of Ventricular Tachycardia Associated with Cardiac Sarcoidosis by Steroid Therapy

In patients with cardiac sarcoidosis, ventricular tachycardia (VT) is observed in some cases. However, effective therapies for the VT are still unknown.

Idiopathic Premature Ventricular Contraction Originating from Left Epicardial Outflow Tract —Effects of Antiarrhythmic Drugs, Autonomic Provocation and Radiofrequency Catheter Ablation—

We present a patient with frequent episodes of palpitation who had idiopathic premature ventricular contraction (PVC. with QRS morphology exhibiting a right bundle branch block pattern with an inferior axis. Neither administration of procainamide, propranolol, lidocaine or verapamil could inhibit PVC, whereas administration of adenosine triphosphate, carotid sinus massage and Valsalva maneuver could effectively eliminate PVC. The earliest activation preceding the QRS complex by 25 msec at occurrence of the PVC was recorded at the distal site of the coronary sinus and within the left coronary cusp. Pacemapping in the supravalvular site during sinus rhythm produced a QRS complex more similar to PVC than that produced in the infravalvular site of the left ventricular outflow tract (LVOT). Radiofrequency catheter ablation was performed at the supravalvular site close to the epicardial LVOT, which resulted in successful elimination of PVCs.