Preferential conduction travelling from the left coronary cusp to the right ventricular outflow tract via the right coronary cusp of the aorta.

This report describes a case of premature ventricular contractions with the preferential pathway traveling from the left coronary cusp (LCC) to the right ventricular outflow tract (RVOT) via the right coronary cusp (RCC). The earliest activation was recorded within the LCC, while the successful ablation site was the RCC, where the second earliest prepotential was recorded. The remediable ablation site for ventricular arrhythmias (VAs) arising from the left ventricular (LV) ostium may not necessarily be the site of the earliest activation, but may be the site with the potential representing the preferential pathway.

Long-term outcome of drug-eluting vs. bare-metal stents in patients with acute myocardial infarction. Subgroup analysis of the nagoya acute myocardial infarction study (NAMIS).

BACKGROUND: The purpose of the present study was to compare the 5-year clinical outcomes after implantation of drug-eluting stent (DES) and bare-metal stent (BMS) in Japanese patients with acute myocardial infarction (AMI). METHODS AND RESULTS: This study was a subgroup analysis of the Nagoya Acute Myocardial Infarction Study (NAMIS). It included 658 AMI patients, of which 280 were treated with a DES and 378 with a BMS. The major adverse cardiac event (MACE)-free rates during the 5-year follow-up period were similar between the 2 groups (95.7% vs. 96.8%, P=0.482). A significant difference was seen, however, in the target lesion revascularization (TLR) rates (7.9% vs. 17.7%, P<0.0001). Interestingly, there was no significant difference between the 2 groups from year 1 to 5 with regard to late TLR (2.5% vs. 2.1%, P=0.906), despite the markedly lower incidence of TLR within the first year in the DES group compared with the BMS group (5.4% vs. 15.6%, P<0.0001). CONCLUSIONS: In this long-term follow-up analysis of DES compared to BMS in Japanese patients with AMI, there was no significant difference in the incidence of MACE. Although a lower rate of TLR was observed in DES group within the first year, the superiority of DES in relation to the incidence of TLR disappeared after the first year following primary percutaneous coronary intervention.

Nifekalant versus lidocaine for in-hospital shock-resistant ventricular fibrillation or tachycardia.

OBJECTIVE: To compare the efficacy and safety of nifekalant, a pure class III anti-arrhythmic drug, and lidocaine in patients with shock-resistant in-hospital ventricular fibrillation (VF) or ventricular tachycardia (VT). PATIENTS AND METHODS: Between August 2005 and March 2008, we conducted a prospective, two-arm, cluster observational study, in which participating hospitals were pre-registered either to the nifekalant arm or the lidocaine arm. Patients were enrolled if they had in-hospital VF or VT resistant to at least two defibrillation shocks. Congenital or drug-induced long QT syndrome was excluded. The primary end-point was termination of VF or VT with/without additional shock. The secondary end-points were return of spontaneous circulation (ROSC), 1-month survival and survival to hospital discharge. We also assessed the frequency of adverse events, including asystole, pulseless electrical activity and torsade de pointes. RESULTS: In total, 55 patients were enrolled. After nifekalant, 22 of 27 patients showed termination of VF or VT, as compared with 15 of 28 patients treated with lidocaine with/without additional shock (odds ratio (OR): 3.8; 95% confidence interval (CI): 1.1-13.0; P=0.03). Twenty-three of 27 patients given nifekalant showed ROSC, as compared with 15 of 28 patients given lidocaine (OR: 5.0; 95% CI: 1.4-18.2; P=0.01). There was no difference in 1-month survival or survival to hospital discharge between the nifekalant and lidocaine arms. There was a higher incidence of asystole with lidocaine (7 of 28 patients) than with nifekalant (0 of 27 patients) (P=0.005). Torsade de pointes was not observed. CONCLUSION: Nifekalant was more effective than lidocaine for termination of arrhythmia and for ROSC in patients with shock-resistant in-hospital VF or VT (umin-CTR No. UMIN 000001781).

Development of the performance measure for activities of daily living-8 for patients with congestive heart failure: a preliminary study.

BACKGROUND: Functional limitations often lead to hospitalization, disease progression, and mortality in patients with congestive heart failure (CHF). Functional limitations become a particular problem among older patients. Self-reported questionnaires have been found to be a reliable and accurate methodology for obtaining information on functional limitations. However, current measures have been criticized for their inability to guide therapy on the basis of outcome data and for the lack of specificity of questions related to disease-specific symptoms. OBJECTIVE: To develop the Performance Measure for Activities of Daily Living-8 (PMADL-8) to assess functional limitations in CHF patients and to provide preliminary data on internal consistency of the PMADL-8, as well as its reliability and validity. METHODS: Using the International Classification of Functioning, Disability and Health model, functional limitation questionnaire items to assess difficulty in 8 common daily tasks in CHF patients were developed. The instrument was constructed based on input from a panel of experts and by pilot testing. Its construct and convergent validity, Rasch analysis, internal consistency, and test-retest reliability were evaluated in 50 CHF patients. Discriminative/known-group validity was investigated by comparing 37 elderly CHF patients and 37 age- and sex-matched controls from the general population. RESULTS: Cronbach's alpha of the PMADL-8 was 0.94. The intraclass correlation coefficient was 0.96. The PMADL-8 was unidimensional and fitted the Rasch model. Expected differences in the PMADL-8 scores of known-groups show its discriminative/known-group validity. The PMADL-8 had good correlations with the dyspnea (r=0.77, p<0.01) and fatigue scores of the Marianna Heart Failure Questionnaire (r=0.69, p<0.01) and the New York Heart Association classification (F=26.7, p<0.01), demonstrating its convergent validity. Between 2 groups divided by the median scores of PMADL-8, there were significant differences in some disease-specific measures: grip strength, knee extensor muscle strength, and brain natriuretic peptide levels. CONCLUSION: The PMADL-8 had good internal consistency and test-retest reliability, as well as discriminative and convergent validity in CHF patients. Therefore, the PMADL-8 has the potential to be used to assess disease-specific functional limitations in CHF patients.

Long-term clinical performance of AAI pacing in patients with sick sinus syndrome: a comparison with dual-chamber pacing.

AIMS: In this clinical study, we compared two groups of age-matched patients, AAI and DDD, to evaluate the clinical benefits of AAI pacing in patients with sick sinus syndrome (SSS) and normal atrioventricular (AV) conduction. METHODS AND RESULTS: Ninety-five patients with SSS implanted with AAI pacemakers were compared with 101 SSS patients implanted with DDD pacemakers. Mortality, chronic atrial fibrillation, lead survival rates, and reoperation rates were compared by Kaplan-Meier analysis. Eight AAI devices were switched to DDD due to high-degree (grade 2-3) AV block. The incidence of high-degree AV block was 1.104%/year, with a freedom rate of 88.6% at 10 years. There were no significant differences between the two groups in survival rates (87.8% in AAI vs. 93.4% in DDD at 10 years), freedom from atrial fibrillation (93.6% vs. 90.6%), or freedom from reoperation (71.3% vs. 76.3%). On the other hand, lead failure was twice as frequent in the DDD group than in the AAI group (relative risk=2.045, P=0.0382). CONCLUSION: AAI pacing, a simple system using a single lead and single-chamber pacemaker, can achieve a clinical outcome similar to that of the DDD mode in patients with SSS and normal AV conduction.

Hair analysis of flecainide for assessing the individual drug-taking behavior.

OBJECTIVE: The concentration of flecainide in hair was measured to determine its value as an index of individual drug-taking history. METHODS: Hair samples obtained from 15 patients treated with flecainide for more than 1 month were cut into 1-cm-long portions successively from its scalp end. The concentration of flecainide in each hair portion was measured using high-performance liquid chromatography. RESULTS: Flecainide was detected in the 1-cm-long hair portion at the scalp end in the concentration range of 38.0-411.9 ng x mg(-1), which significantly correlated with the area under the plasma flecainide concentration versus time curve. The axial centimeter-by-centimeter distribution of flecainide along the hair shaft well reflected the individual history of drug use. CONCLUSION: The present study suggests the usefulness of determining flecainide in hair to provide retrospective information on the individual drug-taking behavior qualitatively.