RESUMO
Vascular toxicity is one of serious complications following cisplatin-based chemotherapy. This case suggests that cisplatin has a potential risk of delayed occurrence of vasospastic angina. It is important to perform careful history taking including discontinued drugs for differential diagnosis of chest pain.
RESUMO
BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited myocardial disease characterized by fibrofatty replacement and ventricular arrhythmias. ARVC is believed to be a disease of the young, with most cases being diagnosed before the age of 40 years. We report here a case of newly diagnosed ARVC in an octogenarian associated with a pathogenic variant in the plakophilin 2 gene (PKP2). CASE PRESENTATION: An 80-year-old Japanese man was referred for sustained ventricular tachycardia. His baseline electrocardiogram showed negative T waves in V1-V4. Right ventriculography showed right ventricular aneurysm. Because this case met three major criteria, ARVC was diagnosed. He was successfully treated with radiofrequency ablation and oral amiodarone. Genetic analysis identified an insertion mutation in exon 8 of PKP2 (1725_1728dupGATG), which caused a frameshift and premature termination of translation (R577DfsX5). CONCLUSIONS: To the best of our knowledge, this is the first report of newly diagnosed ARVC in an octogenarian associated with a loss-of-function PKP2 pathogenic variant. Although the late clinical presentation of ARVC is rare, it should be included in the differential diagnosis when treating older patients with ventricular tachyarrhythmias.
Assuntos
Displasia Arritmogênica Ventricular Direita/genética , Mutação com Perda de Função , Placofilinas/genética , Idoso de 80 Anos ou mais , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Displasia Arritmogênica Ventricular Direita/terapia , Ablação por Cateter , Predisposição Genética para Doença , Humanos , Masculino , Fenótipo , Fatores de Risco , Resultado do TratamentoRESUMO
Previous studies suggested that right ventricular pacing was associated with pacing-induced cardiac dysfunction (PICD). The purpose of this study was to investigate the clinical characteristics including the incidence of undiagnosed cardiac sarcoidosis (CS) in patients with atrioventricular block (AVB) who manifest PICD. We retrospectively investigated consecutive patients with permanent pacemaker (PPM) undergoing a first-generator replacement surgery with a new PPM or an upgrade procedure to a cardiac resynchronization therapy (CRT) device between December 1, 2011 and June 30, 2017. Patients with AVB showing normal echocardiographic findings before PPM implantation were included and divided into 2 groups: patients with post-PPM left ventricular ejection fraction (LVEF) < 40% and/or undergoing an upgrade procedure to CRT (PICD group) and patients with post-PPM LVEF ≥ 40% who underwent replacement surgery with a new PPM (no-PICD group). There were 15 and 41 patients in the PICD and no-PICD groups, respectively. A wider-paced QRS duration just after the PPM implantation and/or lower pre-PPM LVEF was observed in the PICD group. Furthermore, 46.7% of the PICD patients (7/15) satisfied the diagnostic criteria for CS according to the guideline of the Japanese Circulation Society, although no patients fulfilled these criteria before PPM implantation. In conclusion, a high incidence of CS was observed in patients with AVB who had PICD. However, none of these patients was diagnosed with CS before PPM implantation.
Assuntos
Bloqueio Atrioventricular/terapia , Cardiomiopatias/epidemiologia , Erros de Diagnóstico/estatística & dados numéricos , Marca-Passo Artificial/efeitos adversos , Sarcoidose/epidemiologia , Função Ventricular Esquerda/fisiologia , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/complicações , Sarcoidose/diagnósticoAssuntos
Potenciais de Ação , Complexos Atriais Prematuros/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Taquicardia Ventricular/fisiopatologia , Idoso , Complexos Atriais Prematuros/diagnóstico , Bloqueio de Ramo/diagnóstico , Estimulação Cardíaca Artificial , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Masculino , Taquicardia Ventricular/diagnóstico , Fatores de TempoRESUMO
A 74-year-old woman who developed atrial tachycardia following the Cox-Maze IV procedure underwent catheter ablation. The reentrant circuit included the coronary sinus (CS), Marshall bundle (MB), distal MB-left atrial (LA) connection, and anterolateral mitral annulus. The distal MB-LA connection was the last barrier in the conduction pathway between the CS and the left atrium.
Assuntos
Nó Atrioventricular/cirurgia , Bloqueio de Ramo/etiologia , Ablação por Cateter/métodos , Eletrocardiografia , Taquicardia por Reentrada no Nó Atrioventricular/complicações , Adulto , Nó Atrioventricular/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/cirurgia , Progressão da Doença , Feminino , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgiaRESUMO
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and carries an increased risk of cardiogenic embolism. Oral anticoagulants (OACs) including warfarin and/or non-vitamin K antagonists can prevent the majority of these events. The Saitama AF Registry was a community-based survey of patients with AF in Saitama City, which represents an urban community in Japan. A total of 75 institutions participated in the registry and attempted to enroll consecutive patients with AF from September 2014 to August 2015. The aim of the present study was to examine the clinical characteristics of patients with AF using data of the Saitama AF Registry. In addition, we investigated the difference in clinical characteristics of the patients between small-sized hospitals and large-sized hospitals. A total of 3591 patients were enrolled; 57.7% of all patients were enrolled from small-sized hospitals, whereas 42.3% were from large-sized hospitals. The patients from small-sized hospitals had higher CHADS2 score than those from large-sized hospitals. Approximately, 80% of all patients were treated with OACs, and the prescription rate was higher in patients with CHADS2 score ≥ 2 from both small-sized hospitals and large-sized hospitals. In conclusion, the present study demonstrated an appropriate use of OACs for high-risk patients with CHADS2 score ≥2 in Saitama City regardless of hospital size.
Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Embolia/epidemiologia , Sistema de Registros , Medição de Risco , Inquéritos e Questionários , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Embolia/etiologia , Embolia/prevenção & controle , Feminino , Humanos , Japão/epidemiologia , Masculino , Prognóstico , Fatores de RiscoAssuntos
Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Taquicardia Reciprocante/diagnóstico , Taquicardia Supraventricular/diagnóstico , Potenciais de Ação , Idoso , Estimulação Cardíaca Artificial , Ablação por Cateter , Diagnóstico Diferencial , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Taquicardia Reciprocante/fisiopatologia , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgiaAssuntos
Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/fisiopatologia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/fisiopatologia , Idoso de 80 Anos ou mais , Eletrocardiografia/métodos , Feminino , Humanos , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Fibrilação Ventricular/diagnóstico por imagemAssuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Sistema de Condução Cardíaco/cirurgia , Valva Mitral/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Valva Mitral/fisiopatologia , Pericárdio/fisiopatologiaAssuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Seio Coronário/cirurgia , Valva Mitral/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Estimulação Cardíaca Artificial , Angiografia Coronária , Seio Coronário/diagnóstico por imagem , Seio Coronário/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to determine whether re-entrant circuits were associated with the ligament of Marshall (LOM). BACKGROUND: Peri-mitral atrial tachycardias (PMATs) following pulmonary vein isolation (PVI) or mitral valve surgery are common. METHODS: Six PMATs involving epicardial circuits were identified from 38 patients. Of these, 4 PMATs involved the LOM (PMAT-LOM, mean cycle length 308 ± 53 ms), as confirmed by the insertion of a 2-F electrode in the vein of Marshall (VOM). All patients underwent PVI and mitral isthmus ablation. The PMAT-LOMs were diagnosed based on left atrium (LA) activation maps that covered <90% of tachycardia cycle length (TCL), and a difference between the post-pacing interval and TCL that was: 1) ≤20 ms at the VOM, the ridge between the left pulmonary vein and appendage, the anterior wall of the LA, and along the 6 to 11 o'clock direction of the mitral annulus; and 2) >20 ms at the distal coronary sinus (CS), the posterior wall of the LA, and the mitral isthmus ablation line (or noncapture). Catheter ablation was performed at the ridge for all PMAT-LOMs. RESULTS: Three tachycardias were successfully terminated at the ridge, which showed continuous fractionated potential lasting >100 ms, confirming the bidirectional block of Marshall bundle (MB)-LA connections. The remaining tachycardia required ablation for the CS-MB connections, confirming bidirectional block of CS-MB connections. CONCLUSIONS: PMAT-LOMs following PVI or valve surgery accounted for up to 11% of PMATs. The bidirectional block of either MB-LA or CS-MB connections is required to eliminate PMAT-LOMs.
Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Eletrocardiografia , Idoso , Fibrilação Atrial/diagnóstico , Humanos , Masculino , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgiaAssuntos
Cardiomiopatia Hipertrófica/complicações , Taquicardia por Reentrada no Nó Atrioventricular/etiologia , Idoso , Antiarrítmicos/uso terapêutico , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ablação por Cateter , Eletrocardiografia , Mapeamento Epicárdico , Feminino , Átrios do Coração/fisiopatologia , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , UltrassonografiaAssuntos
Nó Atrioventricular/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Eletrocardiografia/métodos , Frequência Cardíaca/fisiologia , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Cateterismo Cardíaco , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologiaRESUMO
A 47-year-old man underwent slow pathway ablation for slow-fast atrioventricular nodal reentrant tachycardia. Following the procedure, he felt palpitations while swallowing, and swallowing-induced atrial tachycardia was diagnosed. Swallowing-induced atrial tachycardia arose from the right atrium-superior vena cava junction and was cured by catheter ablation. After the procedure, the patient's heart rate variability changed significantly, indicating suppression of parasympathetic nerve activity. In this case, swallowing-induced atrial tachycardia was related to the vagal nerve reflex. Analysis of heart rate variability may be helpful in elucidating the mechanism of swallowing-induced atrial tachycardia.