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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiovascular Electrophysiology  

INTRODUCTION: Right ventricular (RV) pacing sometimes causes left ventricular (LV) systolic dysfunction, also known as pacing-induced cardiomyopathy (PICM). However, the association between specifically paced QRS morphology and PICM development has not been elucidated. This study aimed to investigate the association between paced QRS mimicking a complete left bundle branch block (CLBBB) and PICM development. METHODS: We retrospectively screened 2009 patients who underwent pacemaker implantation from 2010 to 2020 in seven institutions. Patients who received pacemakers for an advanced atrioventricular block or bradycardia with atrial fibrillation, baseline LV ejection fraction (LVEF) ≥ 50%, and echocardiogram recorded at least 6 months postimplantation were included. The paced QRS recorded immediately after implantation was analyzed. A CLBBB-like paced QRS was defined as meeting the CLBBB criteria of the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society in 2009. PICM was defined as a ≥10% LVEF decrease, resulting in an LVEF of <50%. RESULTS: Among the 270 patients analyzed, PICM was observed in 38. Baseline LVEF was lower in patients with PICM, and CLBBB-like paced QRS was frequently observed in PICM. Multivariate analysis revealed that low baseline LVEF (odds ratio [OR]: 0.93 per 1% increase, 95% confidence interval [CI]: 0.89-0.98, p = 0.006) and CLBBB-like paced QRS (OR: 2.69, 95% CI: 1.25-5.76, p = 0.011) were significantly associated with PICM development. CONCLUSION: CLBBB-like paced QRS may be a novel risk factor for PICM. RV pacing, which causes CLBBB-like QRS morphology, may need to be avoided, and patients with CLBBB-like paced QRS should be followed-up carefully.

DOI： 10.1111/jce.16229

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：JACC: Case Reports  

The differential diagnosis of ST-segment elevation on electrocardiogram is multifaceted. Particularly, in cases of precordial ST-segment elevation, considering anterior myocardial infarction is crucial. Herein, we present a case of precordial ST-segment elevation with normal left coronary arteries.

DOI： 10.1016/j.jaccas.2023.102150

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本不整脈心電学会  

症例は60歳代男性で、発作性心房細動(AF)に対する高周波カテーテルアブレーション(CA)の施行歴があり、肺静脈隔離術と右肺静脈のcarina領域へのアブレーションを受けた。18ヵ月後にAFの再発を認め、2回目のアブレーションを目的に入院した。術前のCTおよび左房造影検査で右肺静脈に軽度の狭窄を認めた。右上肺静脈に再伝導を認め、高周波CAを施行した。出力50Wで通電したが肺静脈隔離に難渋し、隔離時のアブレーションインデックスは450であった。右肺静脈と右房の間の心外膜接続を疑い、右肺静脈のcarina領域に追加アブレーションを施行したところ、隔離に成功した。診断用のデカポラカテーテルを右上肺静脈に再挿入しようとしたが通過しなかった。肺静脈造影検査で右上肺静脈入口部に狭窄を認めた。心腔内エコーで観察したところ、右肺静脈およびcarina領域は浮腫性に拡大していた。一過性の心筋浮腫による急性肺静脈狭窄症と診断し、経過観察とした。6ヵ月後のCTで右肺静脈に中等度の狭窄を認め、径狭窄率は右上肺静脈で-71%、右下肺静脈は-51%であった。無症候性のため、慎重に経過観察中である。

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

We encountered acute pulmonary vein (PV) stenosis during radiofrequency catheter ablation. PV stenosis was not apparent before redo ablation (A). However, acute PV stenosis was observed after repeat ablation, including carina ablation (B, C). Computed tomography performed 6 months post-ablation revealed chronic PV stenosis (D).

DOI： 10.1002/joa3.12946

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：JACC: Case Reports  

Irregular narrow QRS complex tachycardia is associated with a wide range of differential diagnoses, including atrial fibrillation and atrial tachyarrhythmia with altered atrioventricular conduction. Here, we present a case of narrow QRS complex tachycardia with variable R-R intervals and discrete P waves. (Level of Difficulty: Intermediate.).

DOI： 10.1016/j.jaccas.2023.101753

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Publisher：(株)メディカル･サイエンス･インターナショナル  

DOI： 10.11477/mf.3103900966

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Cardiovascular Electrophysiology  

INTRODUCTION: Ectopic beats originating from the pulmonary vein (PV) trigger atrial fibrillation (AF). The purpose of this study was to clarify the electrophysiological determinant of AF initiation from the PVs. METHODS: Pacing studies were performed with a single extra stimulus mimicking an ectopic beat in the left superior PVs (LSPVs) in 62 patients undergoing AF ablation. Inducibility of AF, effective refractory period (ERP), and conduction properties within the PVs were analyzed. RESULTS: A single extra stimulus in LSPV induced AF in 20 patients (32% of all patients) at the mean coupling interval (CI) of 172 ms. A CI-dependent anisotropic conduction at the AF onset was visualized in a three-dimensional mapping. Onset of AF was site-specific with reproducibility in each individual. Mean ERP in LSPV in the AF-inducible group was shorter than that in the AF-noninducible group (182 ± 55 vs. 254 ± 51 ms, p < .0001). LSPV ERP dispersion was greater in the AF-inducible group than in the AF-noninducible group (45 ± 28 vs. 27 ± 19 ms, p < .01). Circumferential intra-PV conduction time (IPVCT) exhibited decremental properties in response to shortening of CI and the prolongation of IPVCT in the AF-inducible site was greater than that in the AF-noninducible site (p < .05) in each individual. CONCLUSIONS: Location and CI of an ectopic excitation ultimately determine the initiation of AF from the PVs. ERP dispersion and circumferential conduction delay may lead to anisotropic conduction and reentry within the PVs that initiate AF.

DOI： 10.1111/jce.15371

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jce.15469

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：European Heart Journal Cardiovascular Imaging  

DOI： 10.1093/ehjci/jeac006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

Background

Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown to be effective in refractory/persistent AF cases. To make non-PV trigger ablation more standardized, it is essential to develop a simple method to localize the origin of non-PV triggers.

Methods

We retrospectively analyzed 37 non-PV triggers in 751 ablation sessions for symptomatic AF from January 2017 to December 2020. Regarding non-PV triggers, intra-atrial activation interval from the earliest in right atrium (RA) to proximal coronary sinus (CS) (RA-CSp) and that from the earliest in RA to distal CS (RA-CSd) obtained by a basically-positioned duodecapolar RA-CS catheter were compared among 3 originating non-PV areas [RA, atrial septum (SEP) and left atrium (LA)].

Results

RA-CSp of RA non-PV trigger (56.4 ± 23.4 ms) was significantly longer than that of SEP non-PV (14.8 ± 25.6 ms, p = 0.019) and LA non-PV (-24.9 ± 27.9 ms, p = 0.0004). RA-CSd of RA non-PV (75.9 ± 32.1 ms) was significantly longer than that of SEP non-PV (34.2 ± 32.6 ms, p = 0.040) and LA non-PV (-13.3 ± 41.2 ms, p = 0.0008). RA-CSp and RA-CSd of SEP non-PV were significantly longer than those of LA non-PV (p = 0.022 and p = 0.016, respectively). Sensitivity and specificity of an algorithm to differentiate the area of non-PV trigger using RA-CSp (cut-off value: 50 ms) and RA-CSd (cut-off value: 0 ms) were 88% and 97% for RA non-PV, 81% and 73% for SEP non-PV, 65% and 95% for LA non-PV, respectively.

Conclusions

The analysis of intra-atrial activation sequences was useful to differentiate non-PV trigger areas. A simple algorithm to localize the area of non-PV trigger would be helpful to identify non-PV trigger sites in AF ablation.

DOI： 10.1371/journal.pone.0264894

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Language：English   Publisher：Elsevier {BV}  

DOI： 10.1016/j.hrcr.2021.09.004

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Language：English  

DOI： 10.1002/joa3.12625

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Language：English   Publisher：Elsevier {BV}  

DOI： 10.1016/j.jccase.2020.10.010

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Language：English  

DOI： 10.1002/joa3.12492

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Language：English   Publisher：Wiley  

DOI： 10.1002/joa3.12362

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Language：English   Publisher：Oxford University Press ({OUP})  

DOI： 10.1093/ehjcr/ytaa093

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Language：English  

A 44-year-old man was admitted to our hospital due to heart failure. Transthoracic echocardiography demonstrated global hypokinesis with an ejection fraction of 25%, prominent trabeculation and deep intertrabecular recesses, and apical aneurysm with multiple thrombi (10×13 mm in the inferior wall, 15×8×mm in the anterior wall). Cardiac magnetic resonance imaging showed an increased ratio of noncompacted (NC) to compacted (C) myocardium (NC/C ratio >2.3) and apical aneurysm. Coronary angiography revealed no significant stenosis. He was therefore diagnosed with left ventricular noncompaction complicated by apical aneurysm. Four weeks after starting anticoagulation, the multiple apical thrombi disappeared without clinical signs of embolism.

DOI： 10.2169/internalmedicine.3489-19

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DOI： 10.1016/j.jjcc.2019.08.017

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Language：English  

DOI： 10.1038/s41598-019-48669-1

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Language：English   Publisher：Wiley  

DOI： 10.1002/joa3.12150

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Language：English   Publisher：Elsevier {BV}  

DOI： 10.1016/j.jccase.2018.04.004

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Language：English  

DOI： 10.1093/ehjci/jex204

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