Masahiko Setoguchi

Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients

Anemia is a common complication of chronic kidney disease (CKD), and a few studies suggest that both CKD and anemia have a marked impact on the prognosis of patients with cardiovascular disease. We retrospectively analyzed the prevalence of CKD and anemia in 312 patients with acute myocardial infarction (AMI). The patients were divided into four groups according to the presence of CKD and anemia. Chronic kidney disease was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2, and anemia was defined according to the World Health Organization definition. Of 312 AMI patients, 166 (53.2%) had CKD and 87 (27.8%) had anemia. A powerful relationship was observed between both CKD and anemia and major adverse cardiac and cerebrovascular events (MACCE) or death by any cause. After adjustment for comorbidities, the hazard ratio (HR) for MACCE was significantly higher in the anemia-only group (HR 5.42, 95% confidence interval (CI) 1.38–21.27, P = 0.015), the CKD-only group (HR 6.4, 95% CI 2.09–19.58, P = 0.001), and the CKD and anemia group (HR 11.61, 95% CI 3.65–36.89, P < 0.001). With respect to death by any cause, the HR was significantly higher in the CKD-only group (HR 2.68, 95% CI 1.02–7.02, P = 0.045) and the CKD and anemia group (HR 4.40, 95% CI 1.56–12.43, P = 0.005). One-half of the patients with AMI had CKD as well. Furthermore, when anemia coexisted with CKD, these conditions had a multiplicative amplification effect on the risk of MACCE and death by any cause in patients with AMI.

Complete His-ventricular block, atrial flutter and ventricular tachycardia as arrhythmogenic activities in a patient with takotsubo cardiomyopathy

An association of atrial arrhythmias with takotsubo cardiomyopathy (TTC) has not been described previously. Here we report a 65-year-old male patient with TTC. The sudden appearance of atrioventricular block and subsequent bradycardia are believed to be key contributing factors for the development of TTC. Both ventricular tachyarrhythmia and various atrial arrhythmias, such as atrial flutter and atrial fibrillation, were observed during the initial management of the patients TTC. We speculate that both the left ventricular contractile dysfunction and the arrhythmogenic activities may share a common underlying etiology in advanced heart failure patients with TTC. <Learning objective: We describe a case of TTC complicated by ventricular tachycardia, atrial tachyarrhythmias, and an atrioventricular conduction disturbance and discuss the etiology of arrhythmogenic activities in TTC.>.

A Case of Atrial Lead Dislodgement after Surgery for Lung Cancer

Case is a 77 years-old female. She started having episodes of palpitations followed by pre-syncope from 3 months ago. Holter ECG was performed which revealed runs of paroxysmal atrial fibrillation followed by sinus pause up to 4.3 seconds, which was consistent with the symptoms. With the diagnosis of bradycardia-tachycardia syndrome, DDD pacemaker implantation was performed. Tined leads were implanted to right atrial appendage and right ventricular apex without any complications. Shortly after the pacemaker implantation, patient was found to have left lung cancer. Left upper lobe resection and broad partial left lower lobe resection was performed 3 months after the pacemaker implantation. Two days after the surgery, monitor ECG revealed atrial lead sensing and pacing failure, and atrial lead dislodgement was observed on chest rentogenography. The left lung resection caused the mediastinum to shift leftward, resulting in advancement of the leads which lead to the dislodgement. Atrial lead repositioning was performed which only needed a short pull of the lead. We report a case of atrial lead dislodgement after surgery for lung cancer due to the shift of the mediastinum.