Shoichi Kubota

Enhancement of J–ST-Segment Elevation by the Glucose and Insulin Test in Brugada Syndrome

NOGAMI, A., et al.: Enhancement of J–ST‐Segment Elevation by the Glucose and Insulin Test in Brugada Syndrome. The effects of glucose and insulin on J–ST‐segment elevation were evaluated in seven men (mean age 45 ± 10 years) with Brugada syndrome. Six patients had been reanimated from VF and one patient had experienced syncope. The effects of intravenous (1) pilsicainide 50 mg, (2) glucose 50 g, and (3) glucose 50 g plus regular insulin 10 IU on the precordial ECG leads were examined. Pilsicainide significantly enhanced J‐ST elevation in all patients and induced VF in 1 patient. A significant accentuation of the abnormal J‐ST configuration was observed in all patients at a mean of 51 ± 40 minutes after glucose and insulin infusion. Changes in blood glucose and serum potassium concentration were 111 ± 158 mg/dL and −0.30 ± 0.48 mEq/L , respectively. These changes were not directly related to the ECG changes. Glucose infusion without insulin caused a subtle increase in J‐ST elevation. In conclusion, the administration of glucose and insulin safely unmasked or accentuation the J–ST‐segment elevation in Brugada syndrome. Blood glucose and insulin concentrations may be factors modulating the circadian or day‐to‐day ECG variations in this syndrome. (PACE 2003; 26[Pt. II]:332–337)

Automated Template Matching to Pinpoint the Origin of Right Ventricular Outflow Tract Tachycardia

Background: Template matching, a technique that examines the similarity between two QRS complexes, has not been broadly applied clinically.

Electrophysiologic and histopathologic findings of the ablation sites for ventricular fibrillation in a patient with ischemic cardiomyopathy

We examined autopsy specimens from a patient with ischemic cardiomyopathy who underwent radiofrequency catheter ablation of ventricular fibrillation. There was site specific arrhythmogenesis of the trigger ventricular premature contractions (VPCs) and Purkinje potentials were recorded before the onset of the QRS. In postmortem examination, fibromuscular bands connecting the posterior papillary muscle and ventricular septum were recognized at the successful ablation sites of the trigger VPCs and the microscopic examinations revealed Purkinje cells in the center of that fibromuscular band.

Transseptal puncture and catheter ablation via the superior vena cava approach for persistent atrial fibrillation in a patient with polysplenia syndrome and interruption of the inferior vena cava: contact force–guided pulmonary vein isolation

Aims We sought to establish the technical feasibility of transseptal puncture and left atrial (LA) ablation through the right internal jugular vein via the superior vena cava (SVC) approach in patients with an interrupted inferior vena cava (IVC). Methods and results A 34-year-old man with persistent atrial fibrillation (AF) and polysplenia syndrome (hypoplasia of the left kidney, aplasia of the pancreas tail, bilaterally bilobed lungs, and an interrupted IVC) was referred to our hospital for radiofrequency ablation. Because transseptal puncture and LA ablation would be impossible by a standard IVC approach via the femoral vein, we performed transseptal puncture and LA ablation through the right internal jugular vein via the SVC approach using a manually curved Brockenbrough needle and intracardiac echocardiographic guidance. We accomplished pulmonary vein (PV) isolation using a deflectable guiding sheath and a contact force-sensing ablation catheter to monitor the contact force and the force-time integral of the tip of the ablation catheter. No complications occurred during or after the procedure. The patient was discharged home without recurrence of AF 3 days after the procedure. He had no recurrence of AF and was taking no medication 5 months after ablation. Conclusions We successfully performed transseptal puncture in a patient with persistent AF, polysplenia syndrome, and complete interruption of the IVC using the superior route through the internal jugular vein. We also accomplished PV isolation using a deflectable guiding sheath and real-time monitoring of the contact force of the ablation catheter.

Externalization of a stiff guide wire via the radial artery: a new technique to facilitate advancement of an Inoue balloon across the aortic valve in patients with aortic stenosis undergoing antegrade balloon aortic valvuloplasty

An 84-year-old woman with aortic stenosis underwent antegrade balloon aortic valvuloplasty (BAV). After transseptal puncture, we introduced a 7-Fr wedge catheter into the left ventricle and across the aortic valve. We then inserted a 0.032-inch soft guide wire, and the tip of the guide wire was advanced into the brachial artery and exchanged for a stiff guide wire. We externalized the tip of the stiff guide wire from the radial artery. Finally, we advanced an Inoue balloon (Toray, Tokyo, Japan) across the aortic valve and inflated the balloon. Transradial externalization makes antegrade BAV an even less invasive procedure.

POST-SYSTOLIC STRAIN INDEX MEASURED BY 2D SPECKLE TRACKING ECHOCARDIOGRAPHY PREDICTS CONGESTIVE HEART FAILURE IN VERY ELDERLY HYPERTENSIVE PATIENTS

We sought to determine echocardiographic indices predicting congestive heart failure (CHF) in very elderly hypertensive patients. We prospectively performed echocardiography with 2D speckle tracking in 61 hypertensive patients over 80 years of age (mean±SD, 84.6±3.8). At baseline echocardiography

Origin of atrial tachycardia: the high right atrium or right superior pulmonary vein?

A 20-year-old woman was referred for an electrophysiological evaluation because of a weak history of incessant palpitations with a loss of appetite, chest oppression and general fatigue. A 12-lead ECG demonstrated a narrow QRS tachycardia with a cycle length of 280–300 msec. An intravenous administration of adenosine triphosphate revealed an atrial tachycardia (AT) with atrioventricular block and a P-wave morphology during the AT that was positive in lead I, the inferior leads, and V1 (Fig. 1A). Direct current cardioversion or medication was not able to terminate the AT, and

A New Device for Protection from Radiation Exposure during Catheter Ablation

Background: As the indications for catheter ablation of complex arrhythmias has expanded, the radiation exposure to the operator has increased. Recently, a radiation protection cabin (RPC) has been developed. However, the effect of reducing the radiation exposure of the operator has not been fully evaluated. The aim of this study was to evaluate the efficacy the RPC during catheter ablation (CA).

Spontaneous Localized Persistent Atrial Fibrillation with an Exit Block Mimicking Atrial Tachycardia at the Left Posterior Wall

We describe a 37‐year‐old man with spontaneous localized atrial fibrillation (AF) with an exit block at the posterior wall of the left atrium (LA). The 12‐lead ECG exhibited an atrial tachycardia‐like pattern, with distinctive P waves and an isoelectric baseline between the P waves. The cycle length of the P waves ranged from 320 to 500 msec. While the fractionated and rapid deflections were recorded from the posterior wall of the LA, the rest of the atria and the coronary sinus exhibited discrete atrial potentials with irregular intervals. Radiofrequency energy applications to the surrounding tissue created complete isolation of the localized AF area, and the AF was terminated. Fibrillatory activation in the posterior wall of the LA can act as a driver as well as an initiator of atrial fibrillation.

A Case with no Hemodynamic Benefit from Right Ventricular Anodal Capture during Biventricular Pacing

This case report describes a patient with a biventricular pacing system in whom right ventricular anodal capture had no hemodynamic benefit. While controlling the ventricular output, three morphologies of the paced QRS complex were obtained: right ventricular stimulation, biventricular stimulation, and biventricular pacing with additional stimulation from the anodal electrode in the right ventricle. While the QRS duration was 5 ms longer, the left ventricular systolic pressure and dP/dtmax during biventricular pacing without anodal capture of the right ventricle were greater than that during biventricular pacing with anodal capture. To avoid useless high output settings, the hemodynamic and clinical data should be compared with and without right ventricular anodal capture in each individual patient.