Masataka Sumiyoshi

Cardiac hemangioma: a report of two cases and review of the literature

Cardiac hemangioma is extremely rare. We encountered two patients with cardiac hemangioma detected by thoracic echocardiography during a medical checkup. In the first case, transthoracic echocardiography revealed a pedunculated tumor in the left ventricle. Selective left coronary angiography demonstrated that the main feeding artery of the tumor arose from the third diagonal branch of the left anterior descending coronary artery. In the second case, thoracic and transesophageal echocardiography showed an oval tumor arising from the right atrium. Both tumors were successfully resected. Histopathological examination revealed that one of the tumors was a capillary hemangioma and the other was a mixed capillary and cavernous hemangioma. After operation, both patients had an uneventful recovery without any complications.

Clinical and Electrophysiological Characteristics of Atrial Standstill

NAKAZATO, Y., et al.: Clinical and Electrophysiological Characteristics of Atrial Standstill. To clarify the clinical and electrophysiological characteristics of atrial standstill (AS) we studied 11 patients (7 males and 4 females), whose average age was 62 years and who were followed over a period of 4–179 months. Underlying heart disease was present in nine patients and two cases were idiopathic. Major clinical symptoms in the 11 cases included Adams‐Stokes attacks, and dyspnea on exertion. In the standard 12‐lead ECGs obtained on admission, the P wave was absent in six cases. Atrial flutter (AF) was noted in 3, atrial fibrillation (Af) in 1, and multifocal atrial tachycardia in 1. In some cases, the ECG initially showed AF or Af, and was transformed after several years into ectopic atrial tachycardia or an ectopic atrial rhythm with a markedly decreased amplitude of the P wave. Finally, the P wave disappeared over a prolonged period. When intracardiac mapping was performed, the atrial electrograms tended to diminish at the site of high, mid‐lateral right atrium (RA). Electrograms were remained present in the vicinity of the tricuspid valve (TV) annulus. A repeated mapping and pacing study conducted in two patients revealed that the “silent” area spread toward the lower site of RA. During the average follow‐up period of 64 months, four patients died. The interval until death in one patient with myocarditis was 6 months, and in another with dilated cardiomyopathy (DCM) it was 8 months. It appears that the atrial muscular lesion starts in the high lateral RA and progresses toward the lower RA, then to the vicinity of the TV annulus. A diffuse and progressive disturbance may occur not only in the atrial muscle, but also in the atrioventricular conduction system in patients with AS who had progressive myocarditis or DCM.

Response to head-up tilt testing in patients with situational syncope.

The results of head-up tilt testing were compared between 24 patients with situational syncope and 44 age-matched patients with typical vasovagal syncope. Patients with situational syncope showed poor positive responses, especially in the passive tilt results (8.3% vs. 39%, p = 0.0078).

Circadian variation of vasovagal syncope.

Circadian Variation of Vasovagal Syncope. Introduction. Circadian patterns have been demonstrated for several cardiovascular catastrophes. Chronobiologic factors play a role in the emergence of vasovagal syncope (VVS); however, diurnal variation of syncopal episodes in VVS has not been reported previously.

Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports

Two patients with glossopharyngeal neuralgia associated with cardiac syncope were treated with temporary cardiac pacemakers for cardiac syncope and then microvascular decompression. The offending arteries were the posterior inferior cerebellar artery in one patient and the anterior inferior cerebellar artery in the other. The offending arteries were attached to the glossopharyngeal nerve and the vagal nerve at the root entry zones. After surgery, the patients were free from neuralgia and cardiac syncope did not occur after the pacemakers were extracted. Implantation of a temporary cardiac pacemaker in the perioperative period ensures safe microvascular decompression.

Effects of Orthostatic Self‐Training on Head‐Up Tilt Testing for the Prevention of Tilt‐Induced Neurocardiogenic Syncope: Comparison of Pharmacological Therapy

Although a wide variety of medical treatments for neurocardiogenic syncope have been proposed, therapy has largely been emperic based on the mechanisms commonly believed to lead to neurocardiogenic fainting. To determine the utility and efficacy of drug therapy and an orthostatic self‐training program in the prevention of tilt‐induced neurocardiogenic syncope, we investigated 43 consecutive patients who had shown syncope and were induced by head‐up tilt test reproducibly, with either traditional medical treatments or orthostatic self‐training at home. The initial 19 of 43 patients were treated with either oral propranolol or disopyramide therapies. The remaining 24 patients were treated with an orthostatic self‐training program alone. Effects of these therapies on head‐up tilt test were reevaluated in all patients. Propranolol prevented syncope in only six (32%) and disopyramide in five (26%) of the 19 patients. There was no significant difference in the effectiveness between them. Syncope was prevented in nine (47%) patients with either propranolol or disopyramide therapy alone, while in the remaining 10 patients it was not. On the other hand, orthostatic self‐training program prevented syncope in 22 (92%) of 24 patients. We concluded that orthostatic self‐training program is far more effective than traditional drug therapies. Orthostatic self‐training is an effective, safe and well accepted therapy in the prevention of tilt‐induced neurocardiogenic syncope.

Clinical Significance of QRS Duration During Ventricular Pacing

To clarify the clinical significance of an abnormally prolonged paced QRS duration, we studied 114 patients who had undergone pacing for atrioventricular block (AVB). Patients were divided into two groups: group I consisted of 29 patients with at least one paced QRS duration ≥ 180 msec during the follow‐up period; group II consisted of 85 patients with paced QRS durations < 180 msec. The clinical background, QRS complexes before pacing, and the echocardiographic findings were assessed. Males (P < 0.05), those with H‐V block (P< 0.05) and a wider QRS complex of conducted and escape beats (both P < 0.01) were dominant in group I. The incidence of underlying heart disease was greater in group I than in group II (83% vs 32%, P < 0.01). Reduced left ventricular ejection fraction (LVEF) and increased left ventricular end‐diastolic dimension (LVDd) were more prominent in group I than in group II (LVEF 0.49 ± 0.17 vs 0.68 ± 0.10, P < 0.01, LVDd 57.1 ± 7.9 mm vs 48.5 ± 5.6 mm, P < 0.01). The paced QRS duration correlated with LVEF (r = ‐0.61) and LVDd (r = 0.81). A paced QRS duration ≥ 180 msec was sensitive and specific for a LVEF < 0.5 (83.3% and 85.2%) and LVDd ≥ 60 mm (100% and 81.4%). We conclude that patients with a prolonged paced QRS duration have more serious heart disease, and the paced QRS duration can be a useful indicator of impaired LV function.

Does an Early Increase in Heart Rate During Tilting Predict the Results of Passive Tilt Testing

Head‐up tilt testing is a useful but time‐consuming procedure. If we could accurately predict the tilt testing results; we would be able to substantially shorten the duration of tilt protocol. To clarify the hypothesis that an early increase in heart rate (HR) during tilting can predict the passive tilt results in our protocol (80‐degree angle for 30 minutes), we studied 115 consecutive patients (72 men, 43 women, mean age 46 ± 19 years) who were clinically diagnosed with neurally mediated syncope. Twentynine (25%) patients had a positive tilt test (P group), whereas 86 (75%) patients had a negative test (N group). The early HR increase was defined as the maximum HR during the first 5 minutes of tilting minus the resting HR before tilting. The early HR increase was significantly higher in the P group (23.8 ± 9.5 beats/min) than in the N group (17.5 ± 8.2 beats/min, P = 0.0008), but it was negatively correlated with the tilt duration to positive response (r =−0.52, P = 0.0032) and the patient age in the entire study population (r = 0.62, P < 0.0001). Results of multiple regression analysis indicated that age, tilt result, and tilt duration were independently associated with the early HR increase. As a result, an early HR increase ± 18 beats/min, the best apparent cut‐off point obtained in our study, was a sensitive (100%) marker for prediction of a positive response at ± 15 minutes of tilting, but it showed a low specificity (61 %). In conclusion, an early HR increase during 80‐degree tilting may be only predictive for a positive result ± 15 minutes because it depends on the tilt duration to a positive response and patient age.

Paroxysmal Atrioventricular Block Induced During Head‐Up Tilt Testing in an Apparently Healthy Man

Paroxysmal AV Block During HUT Testing. Introduction: Prolonged asystole during head‐up tilt testing has been reported, but the occurrence of paroxysmal AV block appears to he rare.

Gender-related differences on signal-averaged electrocardiograms in healthy subjects

Abstract In conclusion, filtered QRS duration in time-domain analysis of SAEs was influenced by gender and body characteristics in healthy subjects; however, the parameters in spectral turbulence analysis were not.