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1.
J Arrhythm ; 38(4): 656-659, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35936041

RESUMO

In this case with antidromic atrioventricular reciprocating tachycardia via the atriofascicular pathway, entrainment from the right ventricular apex showed minor constant fusion. This may indicate that an atriofascicular pathway with distal arborization can connect to the branch of the right bundle and partly to the working myocardium.

2.
J Arrhythm ; 38(3): 468-472, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35785371

RESUMO

His and proximal left bundle (LB) electrogram recordings revealed that His or LB potential always preceded multiple premature ventricular contractions (PVCs). Some ectopic LB discharges showed exit block inside the proximal LB. This appears to implicate pathological His-Purkinje tissue with longitudinal dissociation. Co-treatment with verapamil 240 mg/day and quinidine 300 mg/day could suppress PVCs and eliminate symptoms. Genetic analysis revealed a rare variant in LMNA in this patient.

7.
Heart Rhythm ; 19(7): 1133-1140, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35257978

RESUMO

BACKGROUND: Past studies have shown the sex-related difference in the efficacy of cardiac resynchronization therapy (CRT). However, the data for cardiac sarcoidosis (CS) are limited. OBJECTIVE: The purpose of this study was to assess the sex-related prognostic differences in CS patients with CRT. METHODS: This multicenter CS survey included 430 patients (295 females) who met the diagnostic criteria for CS. Patients were divided into those treated with primary CRT or upgraded CRT from the pacemaker (CRT group; n = 73) and others (control group; n = 357). Sex differences in the incidence of all-cause death, heart failure (HF) death including heart transplantation, ventricular arrhythmia events (VAEs) (sudden death, appropriate device therapy), cardiac adverse events (CAEs) (HF death, VAEs), changes in serum brain natriuretic peptide (BNP) levels, and left ventricular ejection fraction (LVEF) over the follow-up period were analyzed. RESULTS: During median follow-up of 5.2 years, males, but not females, in the CRT group had significantly worse all-cause mortality than patients in the control group (P <.001). In the CRT group, there was no significant sex-related difference in the incidence of HF death; however, females had significantly better VAE- and CAE-free survival than males (P = .033 and P = .008, respectively). Multivariate analysis of the CRT group showed that female sex (hazard ratio 0.37; 95% confidence interval 0.15-0.89; P = .02 and P = .6) independently predicted freedom from CAEs. During follow-up, BNP levels were significantly improved in all groups. LVEF was maintained in females with CRT. CONCLUSIONS: In CS patients with CRT, HF death-free survival was similar between sexes. However, females exhibited better VAE- and CAE-free survival than males.


Assuntos
Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Insuficiência Cardíaca , Sarcoidose , Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Prognóstico , Fatores de Risco , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/terapia , Caracteres Sexuais , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
8.
J Cardiol ; 80(1): 28-33, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35292196

RESUMO

BACKGROUND: Recent studies using an implantable loop recorder (ILR) have reported on clinical predictors of pacemaker implantation in patients with unexplained syncope. However, atrial fibrillation (AF) was not included as a risk factor; this may be because the precise mechanism of AF (persistent or paroxysmal) has not been explicitly investigated. Thus, this study aimed to investigate the relationship between paroxysmal AF and cardiac syncope recurrence requiring pacemaker implantation in patients with an ILR owing to unexplained syncope. METHODS: We included consecutive patients who underwent ILR implantation for unexplained syncope between September 2010 and July 2020. ILR implantation was indicated for syncope that could not be explained even after comprehensive evaluation. RESULTS: Overall, 128 patients (72 men; mean age, 62.5 ±â€¯21.1 years) underwent ILR evaluation. Paroxysmal AF was diagnosed before ILR implantation in 32 patients. Bradyarrhythmia with an indication for pacemaker implantation was detected in 33 patients. The number of syncopal episodes (≥ 3) in the previous 2 years, history of paroxysmal AF/asymptomatic sinus arrest, and bundle branch block were independent predictors of pacemaker implantation. Among patients with a history of paroxysmal AF, the PR interval was longer in those who required pacemaker implantation than in those who did not (194.8 vs 168.8 ms; p = 0.0356). CONCLUSIONS: Paroxysmal AF is a significant predictor of recurrent syncope, leading to pacemaker implantation in patients with unexplained syncope. Careful history taking of paroxysmal AF is essential, and aggressive use of ILR is recommended to detect bradycardic events.


Assuntos
Fibrilação Atrial , Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Bradicardia/terapia , Eletrocardiografia Ambulatorial , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Estudos Retrospectivos , Síncope/etiologia
9.
Heart Rhythm ; 19(6): 909-916, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35158088

RESUMO

BACKGROUND: Current evidence describing the characteristics of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy, its trend, and perioperative outcomes compared with transvenous implantable cardioverter-defibrillator (TV-ICD) based on a real-world, large-scale database is scarce. OBJECTIVE: The purpose of this study was to identify the characteristics of current S-ICD therapy using a nationwide database. METHODS: A retrospective analysis of ICD implantation was performed using a nationwide database obtained between 2016 and 2020. A total of 8690 patients implanted with ICD (median age 65 [52-72] year; 6902 men; 2021 S-ICD recipients) were analyzed. RESULTS: Younger patients were more prone to have S-ICD (P <.001). A history of ventricular fibrillation (VF) (odds ratio [OR] 2.45; 95% confidence interval [CI] 2.04-2.93), nonsustained ventricular tachycardia (VT) (OR 1.73; 95% CI 1.36-2.21), Brugada syndrome (BrS) (OR 3.14; 95% CI 2.48-4.00), and dialysis treatment (OR 2.02; 95% CI 1.44-2.82) were independent predictors of S-ICD selection on mixed-model logistic analysis. The proportion of S-ICD implantations has been increasing (P <.001), especially in patients with BrS (P <.001) and dialysis (P = .04). The proportion of combined complications after S-ICD implantation was low (1.3%) in the unmatched cohort and was comparable to TV-ICD in the 1:1 propensity-matched cohort of 3354 patients (1.5% vs 2.3%; OR 0.65; 95% CI 0.38-1.10). CONCLUSION: S-ICD was more likely to be implanted in younger patients and those with a history of VF, nonsustained VT, BrS, and dialysis treatment. The proportion of S-ICD implantation increased, especially in patients with BrS. The incidence of in-hospital complications was low in S-ICD recipients.


Assuntos
Síndrome de Brugada , Desfibriladores Implantáveis , Taquicardia Ventricular , Idoso , Arritmias Cardíacas/terapia , Síndrome de Brugada/complicações , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Taquicardia Ventricular/complicações , Taquicardia Ventricular/terapia , Resultado do Tratamento
10.
Heart ; 108(11): 840-847, 2022 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-35135837

RESUMO

OBJECTIVE: Human cardiac ryanodine receptor 2 (RYR2) shows autosomal-dominant inheritance in catecholaminergic polymorphic ventricular tachycardia type 1 (CPVT1); however, de novo variants have been observed in sporadic cases. Here, we investigated CPVT1-related RYR2 variant inheritance and its clinical significance between familial and de novo cases. METHODS: We enrolled 82 independent CPVT1 probands (median age: 10.0 (7.0-13.0) years; 45 male) carrying the RYR2 variants and whose biological origin could be confirmed by parental genetic analysis: assured familial inheritance (familial group: n=24) and de novo variants (de novo group: n=58). We examined the clinical characteristics of the probands and their family members carrying the RYR2 variants. RESULTS: In the de novo group, the RYR2 variants were more likely located in the C-terminus domain and less likely in the N-terminus domain than those in the familial group. The cumulative incidence of the first cardiac events (syncope and cardiac arrest (CA) or CA only) of the probands at the age of 5 and 10 years was higher in the de novo group than in the familial group. Nearly half of the probands in both groups experienced CA events before diagnosis. Only 37.5% of their genotype-positive parents had symptoms; however, at least 66.7% of the genotype-positive siblings were symptomatic. CONCLUSIONS: CPVT1 probands harbouring de novo RYR2 variants showed an earlier onset of symptoms than those with assured familial inheritance. Cascade screening may enable early diagnosis, risk stratification and prophylactic therapeutic intervention to prevent sudden cardiac death of probands and potential genotype-positive family members.


Assuntos
Canal de Liberação de Cálcio do Receptor de Rianodina , Taquicardia Ventricular , Criança , Pré-Escolar , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Masculino , Mutação , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/genética , Taquicardia Ventricular/terapia
11.
Drug Discov Ther ; 15(6): 337-340, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34980762

RESUMO

Japan has an ageing population and geographical impediments to healthcare access, so an experimental trial of telepharmacy has recently been implemented in remote islands or remote areas of Japan prior to the formal implementation. This exploratory study was conducted to understand patients' perspectives on telepharmacy in a mountainous depopulated area away from urban areas of Japan. Semi-structured interviews were conducted with four elderly patients, who were all of the patients receiving telepharmacy in Toyone village, Japan, at the time of the survey. The transcribed interview data were qualitatively analyzed by coding and categorization. The subjects thought telepharmacy would be advantageous to overcome poor access to a clinic and to improve convenience in processes ranging from medical examination to obtaining prescribed medicines. However, they pointed out the low digital literacy of the elderly. Also, they had low expectations for pharmacists, because they had previously had no relationship with pharmacists due to lack of pharmacies in the area. To promote telepharmacy, efforts to eliminate resistance to smartphones and to provide support for smartphone operations are needed among the elderly. Work is also needed to establish how pharmacists should best be involved in patient care and health support in remote areas. Our findings suggest that telepharmacy is useful in remote areas of Japan, but in locations where there is no existing relationship with pharmacists, it would be desirable for pharmacists to be actively involved with the community to maximize its effectiveness.


Assuntos
Serviços Comunitários de Farmácia , Telemedicina , Idoso , Acesso aos Serviços de Saúde , Humanos , Japão , Farmacêuticos
12.
J Cardiol ; 79(6): 727-733, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35016810

RESUMO

BACKGROUND: Biomarkers that can predict cardiac resynchronization therapy (CRT) response have not yet been identified. The purpose of this study was to assess whether individual measurements of four brain/B-type natriuretic peptide (BNP) forms, coupled with cyclic guanosine monophosphate (cGMP) might contribute to the prediction of echocardiographic CRT responders. METHODS: A BNP precursor (proBNP) and total BNP (= proBNP + mature BNP) were measured with newly developed kits, while an N-terminal fragment of proBNP (NT-proBNP) and cGMP were measured with commercial kits on the day before CRT implantation. Estimated mature BNP (emBNP = total BNP-proBNP), and the ratio of cGMP to each BNP form, as well as the concentrations of three other BNP forms, were prospectively investigated for their capability in predicting a response to CRT. A CRT responder was defined as an improvement in left ventricular ejection fraction >10% and/or a reduction in left ventricular end-systolic volume >15% at 6-month follow-up. RESULTS: Out of 77 patients, 46 (60%) were categorized as CRT responders. Among the measurement parameters, only the highest quartile of the cGMP to emBNP ratio was an independent predictor of CRT responders (odds ratio 4.87, 95% confidence interval 1.25-18.89, p = 0.02). The cGMP to emBNP ratio was associated with the cumulative events of heart failure hospitalization within one year following CRT implantation (log-rank p = 0.029). CONCLUSIONS: The cGMP to emBNP ratio could be utilized as a predictive biomarker of CRT responders. (Clinical Study on Responder Prediction in Cardiac Resynchronization Therapy Using Individual Molecular Measurement of Natriuretic Peptide: UMIN R000038927).


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Volume Sistólico , Função Ventricular Esquerda
13.
J Echocardiogr ; 20(3): 151-158, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35084686

RESUMO

BACKGROUND: Postprocedural mitral stenosis (MS), or increased transmitral mean pressure gradient (TMPG), is one of the limitations of transcatheter edge-to-edge mitral valve repair using MitraClip (Abbott Vascular Inc., Santa Clara, USA); however, the usefulness of three-dimensional transesophageal echocardiography (3D-TEE) for predicting postprocedural MS in functional mitral regurgitation (MR) has not been fully elucidated. METHODS: Eighty-two consecutive functional MR patients who underwent transcatheter mitral valve repair using MitraClip were retrospectively studied. Postprocedural MS was defined as TMPG ≥ 5 mmHg by echocardiography. RESULTS: Ten patients had postprocedural MS, and 3D-TEE showed that patients with postprocedural MS had smaller preprocedural mitral valve orifice area (MVOA), anteroposterior and mediolateral diameter, leaflet area, and annulus area. Receiver operating characteristic analysis showed that leaflet area (area under the curve (AUC) 0.829), annulus area (AUC 0.813), anteroposterior diameter (AUC 0.797) and mediolateral diameter (AUC 0.803) evaluated using 3D-TEE were predictors of postprocedural MS, and their predictive abilities were higher than those of preprocedural MVOA (AUC 0.756) and preprocedural TMPG (AUC 0.716). Adding leaflet area to TMPG and MVOA resulted in higher C-statistics for predicting postprocedural MS (from 0.716 to 0.845 and from 0.756 to 0.853, respectively). CONCLUSIONS: In functional MR patients treated with MitraClip, leaflet area and annulus area evaluated using 3D-TEE had high predictive values for postprocedural MS, and their predictive abilities were higher than those of preprocedural TMPG or MVOA.


Assuntos
Ecocardiografia Tridimensional , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Plant Mol Biol ; 109(4-5): 595-609, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34822009

RESUMO

KEY MESSAGE: We show that in rice, the amino acid-conjugates of JA precursor, OPDA, may function as a non-canonical signal for the production of phytoalexins in coordination with the innate chitin signaling. The core oxylipins, jasmonic acid (JA) and JA-Ile, are well-known as potent regulators of plant defense against necrotrophic pathogens and/or herbivores. However, recent studies also suggest that other oxylipins, including 12-oxo-phytodienoic acid (OPDA), may contribute to plant defense. Here, we used a previously characterized metabolic defense marker, p-coumaroylputrescine (CoP), and fungal elicitor, chitooligosaccharide, to specifically test defense role of various oxylipins in rice (Oryza sativa). While fungal elicitor triggered a rapid production of JA, JA-Ile, and their precursor OPDA, rice cells exogenously treated with the compounds revealed that OPDA, rather than JA-Ile, can stimulate the CoP production. Next, reverse genetic approach and oxylipin-deficient rice mutant (hebiba) were used to uncouple oxylipins from other elicitor-triggered signals. It appeared that, without oxylipins, residual elicitor signaling had only a minimal effect but, in synergy with OPDA, exerted a strong stimulatory activity towards CoP production. Furthermore, as CoP levels were compromised in the OPDA-treated Osjar1 mutant cells impaired in the oxylipin-amino acid conjugation, putative OPDA-amino acid conjugates emerged as hypothetical regulators of CoP biosynthesis. Accordingly, we found several OPDA-amino acid conjugates in rice cells treated with exogenous OPDA, and OPDA-Asp was detected, although in small amounts, in the chitooligosaccharide-treated rice. However, as synthetic OPDA-Asp and OPDA-Ile, so far, failed to induce CoP in cells, it suggests that yet another presumed OPDA-amino acid form(s) could be acting as novel regulator(s) of phytoalexins in rice.


Assuntos
Oryza , Oxilipinas , Aminoácidos/metabolismo , Quitina/metabolismo , Quitosana , Ciclopentanos/metabolismo , Oligossacarídeos , Oryza/genética , Oxilipinas/metabolismo , Sesquiterpenos
15.
Plant Mol Biol ; 109(4-5): 651-666, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34476681

RESUMO

KEY MESSAGE: This study describes biological functions of the bHLH transcription factor RERJ1 involved in the jasmonate response and the related defense-associated metabolic pathways in rice, with particular focus on deciphering the regulatory mechanisms underlying stress-induced volatile emission and herbivory resistance. RERJ1 is rapidly and drastically induced by wounding and jasmonate treatment but its biological function remains unknown as yet. Here we provide evidence of the biological function of RERJ1 in plant defense, specifically in response to herbivory and pathogen attack, and offer insights into the RERJ1-mediated regulation of metabolic pathways of specialized defense compounds, such as monoterpene linalool, in possible collaboration with OsMYC2-a well-known master regulator in jasmonate signaling. In rice (Oryza sativa L.), the basic helix-loop-helix (bHLH) family transcription factor RERJ1 is induced under environmental stresses, such as wounding and drought, which are closely linked to jasmonate (JA) accumulation. Here, we investigated the biological function of RERJ1 in response to biotic stresses, such as herbivory and pathogen infection, using an RERJ1-defective mutant. Transcriptome analysis of the rerj1-Tos17 mutant revealed that RERJ1 regulated the expression of a typical family of conserved JA-responsive genes (e.g., terpene synthases, proteinase inhibitors, and jasmonate ZIM domain proteins). Upon exposure to armyworm attack, the rerj1-Tos17 mutant exhibited more severe damage than the wildtype, and significant weight gain of the larvae fed on the mutant was observed. Upon Xanthomonas oryzae infection, the rerj1-Tos17 mutant developed more severe symptoms than the wildtype. Among RERJ1-regulated terpene synthases, linalool synthase expression was markedly disrupted and linalool emission after wounding was significantly decreased in the rerj1-Tos17 mutant. RERJ1 appears to interact with OsMYC2-a master regulator of JA signaling-and many OsJAZ proteins, although no obvious epistatic interaction was detected between them at the transcriptional level. These results indicate that RERJ1 is involved in the transcriptional induction of JA-mediated stress-responsive genes via physical association with OsMYC2 and mediates defense against herbivory and bacterial infection through JA signaling.


Assuntos
Oryza , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Ciclopentanos/metabolismo , Regulação da Expressão Gênica de Plantas , Herbivoria , Oryza/metabolismo , Oxilipinas/metabolismo , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Transdução de Sinais , Fatores de Transcrição/metabolismo
16.
J Cardiol ; 79(2): 219-225, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34625314

RESUMO

BACKGROUND: Minimally invasive Maze procedure via right mini-thoracotomy approach is reportedly a promising option for paroxysmal and non-paroxysmal atrial fibrillation (AF), although it is not widely performed. This study aimed to validate feasibility and safety of minimally invasive stand-alone Maze procedure in an institutional first case series. METHODS: This study enrolled an institutional consecutive series of 20 cases who underwent minimally invasive Maze procedure between November 2018 and January 2021. Concomitant tricuspid annuloplasty was performed in five cases who showed moderate tricuspid regurgitation preoperatively. RESULTS: Minimally invasive Maze procedure using cryo-energy source was successfully accomplished with sinus rhythm being restored at the intensive care unit entry in all cases without conversion to the sternotomy approach. All cases were discharged home, while one case was complicated with stroke postoperatively. Nineteen cases (95%) showed sinus rhythm at the last follow-up, whereas one case, who had large left atrium, showed recurrent persistent AF despite optimum medical therapy. Catheter ablations were performed for residual conductions at box lesions and/or mitral/tricuspid isthmus in three cases, who showed medically refractory atrial tachycardia post-Maze procedure. Consequently, these three cases showed sinus rhythm restoration at the last follow-up Conclusions: Minimally invasive stand-alone Maze procedure with or without tricuspid annuloplasty was feasible and safe for AF in the institutional first case series. Catheter ablations for recurrent AF post-Maze procedure would be warranted.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Valva Mitral , Resultado do Tratamento
17.
Heart Vessels ; 37(5): 794-801, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34677657

RESUMO

Factors causing atrial tachyarrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF) remain undetermined. This study aimed to investigate the effect of nocturnal hypoxemia on the recurrence of atrial tachyarrhythmia after CA of AF. Among 594 patients with AF who underwent an ambulatory sleep study at the National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (2014-2019), 365 underwent CA of AF; 290 patients who underwent CA were followed up for > 3 months. Multivariate Cox regression analysis was used to calculate hazard ratios (HRs) using clinical variables, to identify the independent predictors of atrial tachyarrhythmia recurrence after the final CA. Atrial tachyarrhythmia recurred in 45 of 290 (15.5%) patients during the median follow-up period of 479 days (interquartile range 225-1002). On the performing multivariate analysis of the data of patients who did not receive continuous positive airway pressure (CPAP), severe nocturnal hypoxemia [defined as the percentage of sleep time spent with SaO2 of < 90% (T90) over 20%] [HR 8.53, 95% confidence interval (CI) 1.872-38.814; P < 0.01] and an 1 mL/m2 increase in the left atrial volume index (HR 1.02, 95% CI 1.004-1.044; P = 0.02) were found to be independently associated with the recurrence of atrial tachyarrhythmia. In addition, the rates of freedom from atrial tachyarrhythmia after the final AF ablation with CPAP were significantly lower in the group with more severe nocturnal hypoxemia (Log-rank P = 0.03). In conclusion, it is necessary to consider both, AHI and nocturnal hypoxia while performing an ambulatory sleep apnea study. CA may be less effective in patients with more severe nocturnal hypoxia, despite the administration of CPAP.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Átrios do Coração , Humanos , Hipóxia/complicações , Recidiva , Fatores de Risco , Taquicardia/complicações , Taquicardia/cirurgia , Resultado do Tratamento
18.
J Cardiovasc Electrophysiol ; 33(3): 423-429, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34921701

RESUMO

INTRODUCTION: Utilizing a three-dimensional (3-D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans-septal approach and catheter manipulation technique in patients with CIED leads. METHODS AND RESULTS: This study comprised 49 consecutive patients (59% males, median 73 years old) with CIED who underwent catheter ablation for supraventricular tachycardia requiring the trans-septal approach, 15 without fluoroscopy (zero-fluoro group), and 34 with fluoroscopy (conventional-fluoro group), between July 2019 and April 2021. All procedures were performed under a 3-D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were for atrial fibrillation (82%) and atrial tachycardia (76%). Coronary sinus catheter insertion and the trans-septal procedure were successfully performed in all patients. The median time from venipuncture to trans-septal procedure (zero-fluoro vs. conventional-fluoro group: 28 [18-37] min vs. 24 [21-31] min, p = .70), total procedure time (231 [142-274] min vs. 175 [163-225] min, p = .63), and the acute procedural success rate (100% vs. 97%, p = 1.00) did not differ between both groups. No patient showed lead-related complications in both groups. CONCLUSION: This is the first study to show zero-fluoro ablation for supraventricular arrhythmia using 3-D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Supraventricular , Idoso , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Eletrônica , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento
19.
J Cardiol ; 79(1): 127-133, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34518073

RESUMO

BACKGROUND: The optimal right ventricular (RV) pacing site during pacemaker implantation is still unclear due to left ventricular (LV) dyssynchrony by traditional RV pacing. His-bundle (HIS) pacing has achieved narrow QRS and maintained LV synchrony but high failure rate. RV septal pacing occasionally has QRS waveform with wide and narrow component in the early and late phase, respectively, and maintains LV synchrony, reflecting the normal conduction system. We aimed to define this QRS waveform as retrograde penetration pacing into the conduction system (RPP-CS) and compared its effect on LV synchrony as an alternative approach of HIS pacing. METHODS AND RESULTS: We enrolled 42 patients with atrio ventricular block (AVB) or bradycardia atrial fibrillation (AF) requiring pacemaker implantation (RPP-CS, n = 27; no RPP-CS, n = 15). Baseline characteristics were similar between the groups. RPP-CS was observed in 96% and 26% of the RV septum and apex area, respectively. RPP-CS had a significantly shorter QRS width (p < 0.001). The frequency of maintaining LV synchrony was significantly higher in RPP-CS (67% vs. 20%, p = 0.003). The QRS interval's optimal cut-off value during RPP-CS was 132 ms for prediction of LV synchrony (sensitivity 83%, specificity 89%, positive predictive value 94%, and negative predictive value 73%). During RPP-CS, shorter QRS intervals (QRS ≤ 132 ms) had better postoperative LV ejection fraction than longer intervals (p < 0.001). CONCLUSIONS: RPP-CS, especially with short QRS intervals (≤132 ms), had a high frequency of LV synchrony, maintained postoperative cardiac function, and may be an adequate first-line RV pacing site strategy for AVB or bradycardia AF as an alternative approach of HIS pacing.


Assuntos
Estimulação Cardíaca Artificial , Marca-Passo Artificial , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia , Sistema de Condução Cardíaco , Humanos , Função Ventricular Esquerda
20.
J Arrhythm ; 37(6): 1443-1447, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34887948

RESUMO

The Japanese Catheter Ablation (J-AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real-world settings. During the year of 2019, we have collected a total of 80 795 procedures (mean age of 65.2 years and 66.4% male) from 425 participant hospitals. Detailed data are shown in Figures and Tables.

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