Takeshi Kodani

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity

BACKGROUND The shape of the left atrial appendage (LAA) might affect thrombus formation. The chicken wing-type LAA (CW) has been reported as unlikely to influence stroke events in atrial fibrillation (AF) patients, so we investigated whether LAA shapes could influence LAA function. METHODS AND RESULTS We studied 102 patients (64 men, age 65±9 years) who underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac computed tomography prior to catheter ablation (CA) for AF. LAA morphology were classified into 2 types: (1) CW: LAA with a bend in its shape and (2) non-CW type (NCW): LAA without any bends. All patients were classified into these groups using a cutoff value of LAA flow velocity (LAAFV). Patients with LAAFV <35 cm/s were classified as the low LAAFV group (Low FV, n=37). The patients with LAAFV >35 cm/s were classified as normal LAAFV group (Normal FV, n=65). The NCW type was detected in 25/102 patients (25%). In multivariate analysis, the patients with Low FV were associated with NCW type (P=0.0429, odds ratio [OR] 9.664, 95% confidence interval [CI] 1.075-86.900) and higher B-type natriuretic peptide (BNP) (P=0.0350, OR 1.012 for each 1 pg/ml increase in BNP, 95% CI 1.001-1.022). CONCLUSIONS The NCW-type LAA and higher BNP were associated with lower LAAFV. One reason for the frequent cardiogenic stroke in patients with the NCW-type LAA may be the lower LAAFV.

Spontaneous subclavian venous occlusion before electronic device implantation

Background Subclavian venous occlusion sometimes precludes the ability to insert leads during placement of a cardiac implantable electronic device. This study was performed to identify the risk factors for spontaneous subclavian venous occlusion prior to placement of an implantable electronic device. Methods We studied 446 patients who underwent axillary-subclavian venography to assess for occlusion and/or anomaly of the subclavian vein or associated veins before electronic device implantation. Results Six (1.3%) patients had venous occlusion (left subclavian vein in 5, left innominate vein in 1). There was a significantly higher incidence of previous cancer in the occlusion group than in the nonocclusion group (11.5% vs. 50%, p = 0.03). Conclusions Subclavian venous occlusion may be present before cardiac implantable electronic device placement. A history of cancer represents a risk factor subclavian venous occlusion, and patients with this risk factor should undergo subclavian venography prior to electronic device placement.

PREDICTORS OF LEFT ATRIAL THROMBI AND SPONTANEOUS ECHOCARDIOGRAPHY CONTRAST IN PATIENTS WITH ATRIAL FIBRILLATION TAKING NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS

Some patients develop left atrial thrombi (LAT) despite administration of anticoagulants. Non-vitamin K antagonist oral anticoagulants (NOAC) have been reported to be useful for prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). We aimed to clarify the characteristics of

LEFT ATRIAL APPENDAGE MORPHOLOGY INFLUENCES FLOW VELOCITY

Patients with chickenwing (CW) -like left atrial appendage (LAA) morphology have been reported to be less likely to have stroke events in patients with atrial fibrillation (AF). Differences in the LAA morphology might affect thrombus formation both morphologically and functionally. We investigated

Hemodynamic effects of Purkinje potential pacing in the left ventricular endocardium in patients with advanced heart failure.

Various difficulties can occur in patients who undergo cardiac resynchronization therapy for drug‐refractory heart failure with respect to placement of the left ventricular (LV) lead, because of anatomical features, pacing thresholds, twitching, or pacing lead anchoring, possibly requiring other pacing sites. The goal of this study was to determine whether Purkinje potential (PP) pacing could provide better hemodynamics in patients with left bundle branch block and heart failure than biventricular (BiV) pacing.

An Asymptomatic Case of Wolff-Parkinson-White Syndrome with Right-sided Free-wall Accessory Pathway and Left Ventricular Dysfunction

A 16‐year‐old girl with a known history of asymptomatic Wolff‐Parkinson‐White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow‐up. A 12‐lead surface ECG showed pre‐excitation, a predominantly negative delta wave in V1 and left axis deviation, which was consistent with the presence of a right free‐wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium‐to‐ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free‐wall accessory pathway and LV dysfunction without tachycardia.