Masatsugu Ohe

Chronic cardiac resynchronization therapy reverses cardiac remodelling and improves invasive haemodynamics of patients with severe heart failure on optimal medical treatment

AIMS The aim of this study was to assess chronic invasive haemodynamic effects of cardiac resynchronization therapy (CRT) in patients with severe heart failure. METHODS AND RESULTS Seventeen patients with New York Heart Association (NYHA) class III or IV and QRS duration >120 ms on optimal treatments underwent CRT. Haemodynamic data were obtained by cardiac catheterization before and 1 month after CRT. Clinical parameters and exercise tolerance were also evaluated. Chronic CRT improved haemodynamics significantly; mean pulmonary capillary wedge pressure decreased from 15.9 +/- 6.1 to 10.2 +/- 5.3 mmHg (P < 0.05), systolic pulmonary artery pressure decreased from 36.5 +/- 13.2 to 26.7 +/- 11.9 mmHg (P < 0.05), left ventricular end-diastolic pressure decreased from 15.6 +/- 7.2 to 10.5 +/- 7.3 mmHg (P < 0.05), end-diastolic volume decreased from 358.8 +/- 84.6 to 322.9 +/- 99.0 mL (P < 0.05), end-systolic volume decreased from 264.1 +/- 67.6 to 219.2 +/- 74.3 mL (P < 0.05), left ventricular ejection fraction increased from 25.4 +/- 6.2 to 33.1 +/- 4.9% (P < 0.05), and cardiac index increased from 1.9 +/- 0.4 to 2.2 +/- 0.5 L/min/m(2) (P < 0.05). Chronic CRT significantly improved functional capacity such as NYHA classification, 6 min walk distance, and peak oxygen uptake. CONCLUSION Chronic CRT improved not only symptoms and exercise tolerance but also invasive haemodynamics associated with reversed cardiac remodelling.

P Wave Signal-Averaged Electrocardiography Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome Who Underwent Successful Catheter Ablation: A Prospective Study

P‐SAECG Predicts Recurrence of PAF After Ablation. Introduction: Paroxysmal atrial fibrillation (PAF) frequently occurs in patients with Wolff‐Parkinson‐White (WPW) syndrome. Catheter ablation of the accessory pathway eliminates PAF in some patients, but PAF frequently recurs in other patients. The present study was designed to determine prospectively whether P wave signal‐averaged electrocardiography (P‐SAECG) predicts the recurrence of PAF after successful ablation in patients with WPW syndrome.

Detection of coronary artery stenosis after successful percutaneous coronary intervention by dipyridamole stress portable type signal-averaged electrocardiography: a prospective study

In our previous studies, using portable type signalaveraged electrocardiography (portable SAECG) with dipyridamole stress we reported that patients with coronary artery disease were identified at the bedside with high sensitivity and specificity. In this study we prospectively investigated whether coronary artery stenosis after successful percutaneous coronary intervention (PCI) could be detected. Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 61 patients 8.0 ± 9.4 months after successful PCI for myocardial infarction or angina pectoris (46 males and 15 females, mean age 66 ± 12 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by the multiphasic oscillation method at each lead of the standard 12 leads, and the maximal value of changes in fQRSd (MAX ΔfQRSd) among the 12 leads was determined. The positive test was defined as MAX ΔfQRSd ≥5 ms, and negative as MAX ΔfQRSd <5 ms based on our previous studies. Then selective coronary arteriography was performed. In the positive group (n = 24), 21 patients had stenosis (≥50%) of the coronary artery and 3 did not. In the negative group (n = 37), 8 patients had stenosis and 29 did not. The sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy for the detection of coronary artery stenosis by SAECG were 72%, 91%, 88%, and 78%, respectively. Dipyridamole stress portable SAECG is useful to detect patients with coronary artery stenosis after successful PCI.

Mitral Regurgitation as the Cause of Atrial Tachycardia – 3-Dimensional Mapping and 3-Dimensional Transesophageal Echocardiography –

Received October 20, 2014; revised manuscript received February 11, 2015; accepted February 19, 2015; released online March 20, 2015 Time for primary review: 32 days Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan Mailing address: Masatsugu Ohe, MD, PhD, Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. E-mail: masaax@mint.ocn.ne.jp ISSN-1346-9843 doi: 10.1253/circj.CJ-14-1134 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Mitral Regurgitation as the Cause of Atrial Tachycardia – 3-Dimensional Mapping and 3-Dimensional Transesophageal Echocardiography –