Mio Ebato

Pulmonary vein isolation under direct visual identification of the left atrium—pulmonary vein junction using intra-cardiac echography

Introduction: Intra-cardiac echocardiography (ICE) which has some benefits, can be used to obtain detailed anatomy of the heart chambers or large vessels, and the catheter positions, and it has been considered useful for improving the outcome of the ablation. In the present study, we performed pulmonary vein isolation (PVI) under real time monitoring of ICE imaging utilizing an ICE catheter placed at the junction of the left atrium (LA) and PVs (LA-PV junction).Methods: PVI for atrial fibrillation (AF) was performed in 30 cases with drug-resistant AF (mean age: 66-years-old; including 22 males). An ICE catheter utilizing a 9 MHz frequency was inserted into the LA via the atrial septum, and placed at the LA-PV junction. Circumferential ablation was performed in the LA outside of the PV ostium, encircling both the superior and inferior ostia together under ICE imaging.Results: The anatomy of the LA to the PVs and catheter sites were clearly identified by the ICE during the procedure, which enabled a precise and safe catheter manipulation with minimal fluoroscopy. Further, the wall thickness of the PV and LA, and position of the esophagus could be obtained by ICE, facilitating care in adjusting the power and/or duration of the current delivery.Conclusion: ICE imaging of the LA-PV junction permitted real time monitoring of the target sites for PVI during the ablation procedure, and was considered a useful technique for performing PVI.

Normal Values for Time‐Domain, Frequency‐Domain, and Spectral Turbulence Analyses of Signal‐Averaged Electrocardiograms in Healthy Subjects

Background: Signal‐averaged electrocardiograms (SAE) have mainly been studied in high risk patients with ischemic heart disease. A systemic study of the normal values and the comparative results using analytical methods has not been reported.

Effectiveness of plasma lyso-Gb3 as a biomarker for selecting high-risk patients with Fabry disease from multispecialty clinics for genetic analysis

PurposePlasma globotriaosylsphingosine (lyso-Gb3) is a promising secondary screening biomarker for Fabry disease. Here, we examined its applicability as a primary screening biomarker for classic and late-onset Fabry disease in males and females.MethodsBetween 1 July 2014 and 31 December 2015, we screened 2,360 patients (1,324 males) referred from 169 Japanese specialty clinics (cardiology, nephrology, neurology, and pediatrics), based on clinical symptoms suggestive of Fabry disease. We used the plasma lyso-Gb3 concentration, α-galactosidase A (α-Gal A) activity, and analysis of the α-Gal A gene (GLA) for primary and secondary screens, respectively.ResultsOf 8 males with elevated lyso-Gb3 levels (≥2.0 ng ml–1) and low α-Gal A activity (≤4.0 nmol h–1 ml–1), 7 presented a GLA mutation (2 classic and 5 late-onset). Of 15 females with elevated lyso-Gb3, 7 displayed low α-Gal A activity (5 with GLA mutations; 4 classic and 1 late-onset) and 8 exhibited normal α-Gal A activity (1 with a classic GLA mutation and 3 with genetic variants of uncertain significance).ConclusionPlasma lyso-Gb3 is a potential primary screening biomarker for classic and late-onset Fabry disease probands.

LEFT ATRIAL AREA STRAIN MEASURED BY THREE DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY REPRESENTS GLOBAL AND REGIONAL LEFT ATRIAL FUNCTION AT ONCE

Measurements of left atrial volume and function has become clinically important in aging society. Feasibility and reliability of a novel automatic indexbased on internal surface area change (AS :area strain) of left atrium using three dimensional speckle tracking echocardiography (3DSTE) was

A Case With Apical Hypertrophic Cardiomyopathy, Multiple Coronary Artery–Left Ventricular Fistulae, and a Morphological Structure Mimicking Left Ventricular Noncompaction Statue of Cerberus or Double-Headed Eagle?

Multiple coronary fistulae that drain into the left ventricle are rarely associated with apical hypertrophic cardiomyopathy.1 On the other hand, associations of left ventricular noncompaction (LVNC) and multiple coronary fistulae or hypertrophic cardiomyopathy have previously been reported in several cases.2,3 We report here a unique case of apical hypertrophy of the left ventricle, multiple coronary–left ventricular fistulae, and a morphological structure of the left ventricular myocardium mimicking LVNC. A 59-year-old man was admitted to our hospital for fever and rapidly progressing dyspnea that had persisted for 10 days. He had been diagnosed with apical hypertrophic cardiomyopathy in his 30s, although he had no regular medical checkups and was asymptomatic. On admission, the patient had mild wheezes audible in the midportion of the right lung and a diastolic murmur heard at the Erb and the cardiac apical area. Chest x-ray and computed tomography revealed cardiac enlargement with increased pulmonary vasculature, granular shadows in the lower areas of both lungs, and increased density of the right middle lung area. These findings suggested failure of the left side of the heart with pneumonia. A 12-lead electrocardiogram (ECG) …

A Case With Pulmonary Vein Stenosis and Obstruction After Pulmonary Vein Isolation: A Multimodality Approach

Pulmonary vein stenosis and occlusion are some of the major complications after radiofrequency ablation of atrial fibrillation. The prevalence of pulmonary vein stenosis and pulmonary vein occlusion decreased remarkably after the advent of area circumferential ablation and antral isolation; however

Cardiac Sarcoidosis Mimicking Septal Tumor with Intermittent Complete Atrioventricular Block

A 52-year-old woman with intermittent complete atrioventricular (AV) block detected on exercise was admitted to the hospital. Echocardiography revealed lesions on the right ventricular side of the interventricular septum and free wall of the basal inferolateral area. Gadolinium-enhanced cardiovascular magnetic resonance (CMR) imaging revealed the mass and wall thickening at the same locations with late gadolinium enhancement (LGE). Focal uptake at the septal lesion was detected using 67Ga scintigraphy. Focal on diffuse intense uptake in the lesions was observed on Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging. Whole-body CT and laboratory evaluations uncovered no signs of malignant tumors in other organs. Ophthalmologic evaluation revealed ophthalmologic sarcoidosis. Although the result of endomyocardial biopsy was negative, the presence of cardiac sarcoidosis was strongly suggested on the basis of the new Japanese guidelines published in 2017. AV conduction disturbance and tracer accumulation on 67Ga scintigraphy completely disappeared after 2 weeks of steroid therapy. The size of mass, inferolateral wall thickness in echocardiography and CMR, and standardized uptake value (SUV) of the masses on 18F-FDG PET also decreased over time.

Clinical Outcomes of Oral Tolvaptan Treatment in Patients Hospitalized with Acute Decompensated Heart Failure-Retrospective Cohort Study

was no significant difference regarding age, gender, body mass index, left ventricular function and diameters, and medication for CHF. During the follow-up of 40.3 months, the composite-endpoint occurred 22.5% in patients with DCM and DM, and 6.8% in the patients with DCM alone (p50.039). DM was associated with an increased risk of the composite-endpoint (HR: 3.05; 95% CI: 1.01 to 7.99; p50.049). The coexistent of CAD was seen more in patients with DCM and DM compared to patients with DCM alone (27.5% vs. 11.2%, p50.044). However, there was no statistical relation between the composite-endpoint and the coexistent of CAD. Conclusions: DM may contribute to the prognosis of DCM regardless of CAD.

Left ventricular function and myocardial perfusion before and after cardiac resynchronization therapy in chronic right ventricular apical pacing by echocardiogram-gated myocardial perfusion single photon emission computed tomography

The aim of this study was to evaluate the changes in cardiac performance and myocardial blood perfusion by single photon emission computed tomography (SPECT) in patients upgrading to cardiac resynchronization therapy (CRT) from right ventricular apical pacing (RVAP).