Clinical, electrocardiographic and electrophysiological characteristics, and catheter ablation results of left upper septal premature ventricular complexes.

BACKGROUND: To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system. METHODS: Thirty-one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping. RESULTS: The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential-ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His-ventricular (H-V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H-V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow-up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow-up duration of 24.3 ± 15.4 months. CONCLUSIONS: LUS-PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.

Evaluation of self-administered versus interviewer-administered completion of Edinburgh Claudication Questionnaire.

BACKGROUND: The aim of this study was to determine the impacts of different administration modes on sensitivity and specificity of Edinburgh Claudication Questionnaire (ECQ) in estimation of Ankle Brachial Index (ABI) detecting lower extremity arterial disease (LEAD). METHODS: Eligible respondents aged fifty years or older underwent first a self-administered (SA-) ECQ, and then an interviewer-administered (IA-) ECQ. Interviewing included additional guidance on symptoms relevant to claudication. ABI was measured by hand-held Doppler. RESULTS: A total of 177 respondents (age: 64.67±9.19, male/female: 80/97) were enrolled. Questions 1, 2, 3, and 5 (collectively defines claudication) were responded significantly different on SA-ECQ and IA-ECQ modes. Markings of pain on the figure of ECQ also changed significantly when the procedure was guided. Of the respondents, none on SA-ECQ and 13.6% on IA-ECQ with positive claudication had a low ABI. Subjects with higher formal education level did similar to the whole group in both modes. Sensitivity and specificity of IA-ECQ was calculated as 25% and 88.5%, respectively, for ABI detected LEAD. CONCLUSIONS: Respondents' perceptions of pain, discomfort, exertion or body regions described on ECQ may subject to errors without guidance. ECQ seems reliable in evaluating claudication only when specifically interviewed by an observer.

Reduction in myocardial infarct size at 48 hours after brief intravenous infusion of ATL-146e, a highly selective adenosine A2A receptor agonist.

This study was undertaken to determine whether the myocardial infarct-sparing effect of ATL-146e, a selective adenosine A(2A) receptor agonist, persists without a rebound effect for at least 48 h and to determine the optimal duration of ATL-146e treatment in anesthetized dogs. Reperfusion injury after myocardial infarction (MI) is associated with inflammation lasting 24-48 h that contributes to ongoing myocyte injury. We previously showed that an ATL-146e infusion, starting just before reperfusion, decreased inflammation and infarct size in dogs examined 2 h after MI without increasing coronary blood flow. In the present study, adult dogs underwent 90 min of left anterior descending coronary artery occlusion. Thirty minutes before reperfusion, ATL-146e (0.01 microg x kg(-1) x min(-1); n = 21) or vehicle (n = 12) was intravenously infused and continued for 2.5 h (protocol 1) or 24 h (protocol 2). At 48 h after reperfusion hearts were excised and assessed for histological risk area and infarct size. Infarct size based on triphenyltetrazolium chloride (TTC) staining as a percentage of risk area was significantly smaller in ATL-146e-treated vs. control dogs (16.7 +/- 3.7% vs. 33.3 +/- 6.2%, P < 0.05; protocol 1). ATL-146e reduced neutrophil accumulation into infarcted myocardium of ATL-146e-treated vs. control dogs (30 +/- 7 vs. 88 +/- 16 cells/high-power field, P < 0.002). ATL-146e infusion for 24 h (protocol 2) conferred no significant additional infarct size reduction compared with 2.5 h of infusion. A 2.5-h ATL-146e infusion initiated 30 min before reperfusion results in marked, persistent (48 h) reduction in infarct size as a percentage of risk area in dogs with a reduction in infarct zone neutrophil infiltration. No significant further benefit was seen with a 24-h infusion.