Tomonori Kanaeda

Right-Sided Heart Wall Thickening and Delayed Enhancement Caused by Chronic Active Myocarditis Complicated by Sustained Monomorphic Ventricular Tachycardia

An asymptomatic healthy 65-year-old man was referred to a hospital for inverted T waves in the precordial leads (Figure 1) with paroxysmal advanced atrioventricular block in the ECG. Chest x-ray showed mild cardiac enlargement (Figure 2), and an echocardiogram showed right ventricular (RV) wall thickening (arrow in Figure 3). Five months later, the patient was referred to another hospital complaining of chest discomfort. Coronary angiogram was normal, but sustained monomorphic ventricular tachycardia (VT) occurred. Suffering from incessant VT, the patient was transferred to our hospital. The ECG and echocardiogram were …

Estimation of the origin of ventricular outflow tract arrhythmia using synthesized right-sided chest leads

AIMS For successful ablation of ventricular outflow tract arrhythmia, estimation of its origin prior to the procedure can be useful. Morphology and lead placement in the right thoracic area may be useful for this purpose. Electrocardiography using synthesized right-sided chest leads (Syn-V3R, Syn-V4R, and Syn-V5R) is performed using standard leads without any additional leads. This study evaluated the usefulness of synthesized right-sided chest leads in estimating the origin of ventricular outflow tract arrhythmia. METHODS AND RESULTS This retrospective study included 63 patients in whom successful ablation of ventricular outflow tract arrhythmia was performed. Numbers of arrhythmias originating from the left ventricle, the septum of the right ventricle, and the free wall of the right ventricle were 11, 40, and 13, respectively. In one patient, two different left ventricular outflow tract origins were found. Electrocardiographic recordings from right-sided chest leads were divided into three types as follows: those in which an R > S concordance, a transitional zone, or an R < S concordance were detected. In all left arrhythmia cases, R > S concordance was observed. A transitional zone was evident in 34 of 40 cases of right ventricular outflow tract arrhythmia originating in the ventricular septum, and an R < S concordance was observed in 6 of the 40 cases. However, an R < S concordance was found in all cases of right ventricular outflow tract arrhythmia originating in the free wall. CONCLUSION Synthesized right-sided chest lead electrocardiography may be useful for estimating the origin of ventricular outflow tract arrhythmia.

Evaluation of periesophageal nerve injury after pulmonary vein isolation using the 13C-acetate breath test

Pulmonary vein isolation (PVI) has become an important option for treating patients with atrial fibrillation (AF). Periesophageal nerve (PEN) injury after PVI causes pyloric spasms and gastric hypomotility. This study aimed to clarify the impact of PVI on gastric motility and assess the prevalence of gastric hypomotility after PVI.

Unexpected and unmanageable malfunctions of current co-radial pacemaker leads

We read with interest the paper by Reinhart Dorman et al. 1 regarding the high failure rate of 5 Fr Sorin Hepta 4B pacemaker leads with a co-radial structure. Its entity was similar to our experience regarding another co-radial transvenous pacemaker lead available for sale. We experienced six cases of failures with Petite™ 58ERB (OSCOR, Inc.) leads which are co-radial ventricular leads with a multi-wound coil structure like the Hepta™ 4B (Sorin CRM). Between July 2010 and December 2012, 124 patients (67 men and 57 women, age 73.6 ± 10.8) underwent pacemaker implantations at our institution with the Petite™ 58ERB for ventricular pacing through an …

IDENTIFICATION OF LEFT ATRIUM ACTIVE GANGLIONATED PLEXI BY DENSE EPICARDIAL MAPPING AS ABLATION TARGETS FOR THE TREATMENT OF ATRIAL FIBRILLATION

methods: Thirteen patients (age, 67±11 years; 9 males, 69%) with heart failure and concomitant atrial fibrillation (duration 67±105 months) underwent intraoperative epicardial electrophysiological mapping and GP ablation using the maze procedure at our institution. Twenty-four site, highfrequency stimulation (1000/min; output, 18 V; pulse width, 0.75 ms) was performed by placing tweezers directly onto the potential GP sites on the left atrial epicardium. The diagram of the epicardial mapping location is shown in the figure.