Takumi Yamada

Idiopathic Focal Ventricular Arrhythmias Originating from the Anterior Papillary Muscle in the Left Ventricle

Introduction: Focal ventricular arrhythmias (VAs) have been reported to arise from the posterior papillary muscle in the left ventricle (LV). We report a distinct subgroup of idiopathic VAs arising from the anterior papillary muscle (APM) in the LV.

A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index.

Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias (VA) originating from the outflow tract (OT‐VA), their accuracy and usefulness remain limited. This study was undertaken to develop a more accurate and useful ECG criterion for differentiating between left and right OT‐VA origins.

Idiopathic Left Ventricular Arrhythmias Originating Adjacent to the Left Aortic Sinus of Valsalva: Electrophysiological Rationale for the Surface Electrocardiogram

IVT Arising Adjacent to the Left Sinus of Valsalva. Background: Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV.

Does RV Lead Positioning Provide Additional Benefit to Cardiac Resynchronization Therapy in Patients with Advanced Heart Failure

Background and Objectives: The left ventricular (LV) stimulation site is currently recommended to position the lead at the lateral wall. However, little is known as to whether right ventricular (RV) lead positioning is also important for cardiac resynchronization therapy. This study compared the acute hemodynamic response to biventricular pacing (BiV) at two different RV stimulation sites: RV high septum (RVHS) and RV apex (RVA).

Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: Double Potentials obtained from the posterior wall of the right atrium Can be useful to Predict foci of atrial tachycardia in the right pulmonary veins or posterior right atrium

Introduction: The right pulmonary veins (RPVs) and posterior wall of the right atrium (PRA) are anatomically located adjacent to each other. The aim of this study was to demonstrate the electrophysiologic characteristics of atrial tachycardia (AT) originating from the PRA or RPVs.

Non‐Pulmonary Vein Epicardial Foci of Atrial Fibrillation Identified in the Left Atrium after Pulmonary Vein Isolation

Background: Pulmonary vein (PV) isolation (PVI) has been demonstrated to be an effective technique for curing atrial fibrillation (AF). AF foci that cannot be isolated by PVI (non‐PV foci) can become the cause of AF recurrence. The purpose of this study was to investigate the characteristics of non‐PV AF foci.

Biventricular ICD Implantation Using the Iliofemoral Approach: Providing CRT to Patients with Occluded Superior Venous Access

A 32‐year‐old woman with a history of nonischemic dilated cardiomyopathy, left bundle branch block, left ventricular ejection fraction of 0.15, and New York Heart Association Class III congestive heart failure, despite optimal medical treatment, was referred for cardiac resynchronization therapy with implantation of an implantable cardioverter defibrillator. The patient had prior chemotherapy for non‐Hodgkins lymphoma and was shown to have chronic total occlusion of the superior vena cava (SVC) by magnetic resonance imaging. Cardiac resynchronization was accomplished with an iliofemoral approach without complications resulting in marked clinical improvement. We conclude that the iliofemoral approach allows transvenous implantation of cardiac resynchronization therapy in patients with superior vena cava occlusion.

Renin‐Angiotensin System Blocker Use May Be Associated with Suppression of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation

Introduction: An additional approach may be essential to reduce recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We examined the efficacy of renin‐angiotensin system blockers (RAS‐B) in suppressing AF recurrences after PVI.

Idiopathic mitral annular PVCs with multiple breakouts and preferential conduction unmasked by radiofrequency catheter ablation.

A 39‐year‐old man with idiopathic monomorphic premature ventricular contractions (PVCs), exhibiting a right bundle branch block and inferior axis QRS morphology, underwent electrophysiological testing. After a radiofrequency (RF) application to the anterior mitral annulus (MA) eliminated the spontaneous PVC morphology, a second PVC morphology occurred. Pacing from the first ablation site exhibited an excellent match to the second PVCs with a long stimulus to QRS interval. An RF application delivered near the first lesion eliminated all PVCs. The MA PVCs in this case exhibited a single origin with multiple breakouts and preferential conduction that were unmasked by RF ablation. (PACE 2012; 35:e112–e115)

Evidence for an Intramural Origin of Idiopathic Premature Ventricular Contractions Successfully Ablated within the Great Cardiac Vein

A 37‐year‐old woman with idiopathic premature ventricular contractions (PVCs), exhibiting a right bundle branch block and inferior axis QRS morphology, underwent electrophysiological testing. The earliest ventricular activation with an isolated prepotential was observed within the great cardiac vein during the PVCs. Pacing from this site with an output of 10 mA produced an excellent pace map, whereas that with an output of 2 mA produced a wider QRS with notches in the early phase. A radiofrequency application delivered at this site eliminated the PVCs. These findings suggested that the PVC origin might have been intramural rather than epicardial. (PACE 2011; 34:e112–e114)