Mitsuhiro Nishizaki

Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism

Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year.

PR deviation as a risk marker for cardiac events in patients with takotsubo syndrome

PR segment deviation (PRD: defined as PR elevation in aVR and PR depression in lead II/III) on electrocardiography is frequently observed in patients with acute pericarditis; however, there have been few studies that explore the occurrence of PRD in patients with Takotsubo syndrome (TTS). The clinical significance of PRD in TTS is not clearly elucidated.

Bundle Branch Reentrant Ventricular Tachycardia

Macroreentrant circuit involving the bundle branches or the fascicles can develop bundle branch reentrant ventricular tachycardia (BBR-VT) in patients with conduction disturbance within the His-Purkinje system, which is associated with organic heart diseases and severe LV dysfunction. BBR-VT usually exhibits the QRS morphology with a left bundle branch block (LBBB) configuration or rarely a right bundle branch block (RBBB) pattern. In LBBB type BBR-VT, the right bundle branch (RB) constitutes the antegrade limb of reentrant circuit, and the retrograde limb is the left bundle branch (LB).

Combination of hemoglobin and low-flow duration can predict neurological outcome in the initial phase of out-of-hospital cardiac arrest

Purpose: To predict neurological outcome following out‐of‐hospital cardiac arrest (OHCA) using a combination of hemoglobin (Hb) and low‐flow duration (LFD). Materials and methods: We retrospectively examined 131 patients (75 ± 13 years, 64 men) with return of spontaneous circulation (ROSC) following non‐traumatic OHCA. The LFD was the duration from the start of cardiopulmonary resuscitation to ROSC. To obtain the Hb/LFD value, we divided the Hb level by the LFD. Multivariate logistic regression analyses were performed to predict full neurological recovery (FNR), defined as Cerebral Performance Category scale scores of 1 or 2 at discharge. Results: Nineteen patients (15%) achieved FNR. Patients with FNR had high Hb levels (14.9 ± 2.1 vs. 11.3 ± 2.7 g/dl, p = 0.001) and short LFDs (10 [5, 18] vs. 35 [28, 43] min, p = 0.001). Multivariate analyses identified the initial ventricular fibrillation rhythm and Hb/LFD as significant predictors for FNR (odds ratio: 24.9, 3.58; p = 0.001, 0.02, respectively). Receiver operating characteristic (ROC) curve analyses indicated that a high Hb/LFD predicted FNR (cut‐off value: 0.50, sensitivity: 94.7%, specificity: 84.5%, area under the curve: 0.933). Conclusions: Patients with FNR following OHCA had high Hb levels and short LFDs; the Hb/LFD value significantly predicted FNR. HighlightsHemoglobin (Hb) and Low‐flow duration (LFD) could predict neurological outcome of out‐of‐hospital cardiac arrest (OHCA).We hypothesize that both Hb and LFD could reflect the burden of cerebral ischemia during cardiac arrest.In the present study, patients who achieved full neurological recovery (FNR) following OHCA had high Hb and short LFD.Multivariate analysis reveals that Hb/LFD could be a significant predictor for FNR along with initial VF rhythm.