Tomohito Inage

Chronic cardiac resynchronization therapy reverses cardiac remodelling and improves invasive haemodynamics of patients with severe heart failure on optimal medical treatment

AIMS The aim of this study was to assess chronic invasive haemodynamic effects of cardiac resynchronization therapy (CRT) in patients with severe heart failure. METHODS AND RESULTS Seventeen patients with New York Heart Association (NYHA) class III or IV and QRS duration >120 ms on optimal treatments underwent CRT. Haemodynamic data were obtained by cardiac catheterization before and 1 month after CRT. Clinical parameters and exercise tolerance were also evaluated. Chronic CRT improved haemodynamics significantly; mean pulmonary capillary wedge pressure decreased from 15.9 +/- 6.1 to 10.2 +/- 5.3 mmHg (P < 0.05), systolic pulmonary artery pressure decreased from 36.5 +/- 13.2 to 26.7 +/- 11.9 mmHg (P < 0.05), left ventricular end-diastolic pressure decreased from 15.6 +/- 7.2 to 10.5 +/- 7.3 mmHg (P < 0.05), end-diastolic volume decreased from 358.8 +/- 84.6 to 322.9 +/- 99.0 mL (P < 0.05), end-systolic volume decreased from 264.1 +/- 67.6 to 219.2 +/- 74.3 mL (P < 0.05), left ventricular ejection fraction increased from 25.4 +/- 6.2 to 33.1 +/- 4.9% (P < 0.05), and cardiac index increased from 1.9 +/- 0.4 to 2.2 +/- 0.5 L/min/m(2) (P < 0.05). Chronic CRT significantly improved functional capacity such as NYHA classification, 6 min walk distance, and peak oxygen uptake. CONCLUSION Chronic CRT improved not only symptoms and exercise tolerance but also invasive haemodynamics associated with reversed cardiac remodelling.

P Wave Signal-Averaged Electrocardiography Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome Who Underwent Successful Catheter Ablation: A Prospective Study

P‐SAECG Predicts Recurrence of PAF After Ablation. Introduction: Paroxysmal atrial fibrillation (PAF) frequently occurs in patients with Wolff‐Parkinson‐White (WPW) syndrome. Catheter ablation of the accessory pathway eliminates PAF in some patients, but PAF frequently recurs in other patients. The present study was designed to determine prospectively whether P wave signal‐averaged electrocardiography (P‐SAECG) predicts the recurrence of PAF after successful ablation in patients with WPW syndrome.

Implantation of pacemaker for sick sinus syndrome in a patient with persistent left superior vena cava and absent right superior vena cava

Absent right superior vena cava with persistent left superior vena cava in normal situs is an exceedingly rare congenital anomaly. In such cases, pacemaker implantation (PMI) is very difficult or even impossible. We report the case of a patient with sick sinus syndrome in whom PMI was easily performed via the left superior vena cava by using a steerable stylet.

J-wave syndrome with giant negative T-wave in severely activated arrhythmogenicity on 12-lead electrocardiography

J-wave syndrome is one of the causes for idiopathic ventricular fibrillation (VF), characterized by early repolarization at the end of QRS wave, especially in the inferior leads. A 42-year-old man with focal …

How to Avoid Development of AV block during RF Ablation: Anatomical and Electrophysiological Analyses at the Time of AV Node Ablation

Background: With an aim to identify risk factors that can serve for prevention of atrioventricular (AV) block (AVB) during radiofrequency (RF) ablation, we conducted anatomical and electrophysiological investigations at the time of AV node ablation (AVNA).

Detection of coronary artery stenosis after successful percutaneous coronary intervention by dipyridamole stress portable type signal-averaged electrocardiography: a prospective study

In our previous studies, using portable type signalaveraged electrocardiography (portable SAECG) with dipyridamole stress we reported that patients with coronary artery disease were identified at the bedside with high sensitivity and specificity. In this study we prospectively investigated whether coronary artery stenosis after successful percutaneous coronary intervention (PCI) could be detected. Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 61 patients 8.0 ± 9.4 months after successful PCI for myocardial infarction or angina pectoris (46 males and 15 females, mean age 66 ± 12 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by the multiphasic oscillation method at each lead of the standard 12 leads, and the maximal value of changes in fQRSd (MAX ΔfQRSd) among the 12 leads was determined. The positive test was defined as MAX ΔfQRSd ≥5 ms, and negative as MAX ΔfQRSd <5 ms based on our previous studies. Then selective coronary arteriography was performed. In the positive group (n = 24), 21 patients had stenosis (≥50%) of the coronary artery and 3 did not. In the negative group (n = 37), 8 patients had stenosis and 29 did not. The sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy for the detection of coronary artery stenosis by SAECG were 72%, 91%, 88%, and 78%, respectively. Dipyridamole stress portable SAECG is useful to detect patients with coronary artery stenosis after successful PCI.

Authors' reply to Ozeke et al.

We thank Dr Ozeke et al .1 for their interest in our manuscript in which we described a case of idiopathic ventricular fibrillation with prominent J-wave augmentation.2 As they mentioned, complete right bundle branch block (CRBBB) sometimes masks the characteristic ECG of Brugada syndromes (BrSs). Our group recently clarified this phenomenon in serial series …