Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • The arrhythmia free rate was at year after multiple

    2019-05-13

    The arrhythmia-free rate was 67%–91% at 1-year after multiple ablations depending on HF and LVEF status, although repeat ablations were required for more than half of the patients. One of the mechanisms responsible for tachyarrhythmia recurrences was conduction recovery in the PVs or linear lesions. Elimination of the dormant conduction unmasked by administration of ATP can reduce conduction recovery between the PVs and LA [19–21], but even with this SB 431542 approach, conduction recovery in the PVs was still observed. Prevention of conduction recovery in linear lesions is more challenging. Delivery of greater RF power may reduce conduction recovery, but there are risks of complications such as PV stenosis, steam pop, atrioesophageal fistula, and pericarditis. Thus, development of new ablation technologies is necessary for both safety and efficacy issues. However, prevention of conduction recovery in the PVs may not be the sole solution for improvement of efficacy. Our study group included some patients who had AF recurrences that did not show conduction recovery in any PV during repeat ablation. This fact clearly indicates incremental efficacy of ablation targeting the atrial tissue in persistent AF. As reported previously [4,5], this study showed that elimination of AF improved LVEF significantly. In addition, patients with tachyarrhythmia recurrence also had a significant increase in LVEF after the ablation. This may highlight the benefit of catheter ablation for AF in HF patients. We note that all tachyarrhythmia recurrences consisted of occasional paroxysmal episodes (<1/month), suggesting that infrequent episodes of tachyarrhythmias are unlikely to reduce LV function. In clinical practice, the form of AF presentation in HF patients is often persistent, presumably because paroxysmal AF is likely to rapidly progress to the persistent form in these patients [2]. Thus, we focused on persistent rather than paroxysmal AF in this study. We also chose to exclude long-standing persistent AF. Because the duration of continuous AF is a predictor of a clinical outcome after ablation for persistent AF [16], association of LV function with clinical outcome would likely be obscured if patients with long-standing persistent AF were included.
    Conclusion
    Conflict of interest
    Introduction Magnetic resonance imaging (MRI) is a diagnostic technique that has become the imaging modality of choice for many neurological and musculoskeletal disorders. However, a growing number of patients are being treated with cardiac implantable electric devices (CIEDs), such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs), and cardiac resynchronization therapy. The use of MRI has been contraindicated in patients with implanted CIEDs. However, MRI is sometimes necessary in these patients for a variety of practical reasons. A number of cases of MRI scanning in patients with PMs, and some cases in patients with ICDs, have been reported in the United States and Europe [1,2]; however, in Japan there are few reports on MRI use in patients with PMs and, in particular, none on patients with ICDs.
    Case report A 58-year-old man, who had been treated for neurofibromatosis type 1 in the dermatology department and bronchial asthma in the respiratory department of our hospital, presented to the cardiology department with a Brugada-like electrocardiogram (ECG) in 2005. The patient\'s brother had died from sudden death at age 53. The baseline ECG was saddleback type, but intravenous pilsicainide injection at 1mg/kg induced a typical coved-type ECG. Also in his electrophysiological assessment, ventricular fibrillation was induced by 2 extrastimuli from the right ventricular apex. Familial Brugada syndrome was highly suspected and an ICD was implanted. The device was exchanged in 2010 because the battery had become exhausted. In September 2011, the patient suffered right-sided paralysis, which rapidly progressed to all 4 limbs, and was admitted to the neurology department. His ECG showed a saddleback pattern in the right precordial leads consistent with Brugada syndrome. An ICD with an atrial lead and a dual-coil ventricular defibrillation lead was apparent on his chest radiograph (Fig. 1). To identify the etiology of the paralysis, contrast-enhanced computed tomography (CT), CT myelography, cerebral blood flow scintigraphy, and whole-body gallium scintigraphy were performed, but no obvious abnormality was found. In the meantime, his condition worsened and he experienced aspiration with swallowing disturbance; steroid pulse therapy was administered to relieve the symptoms. At this point, fluorodeoxyglucose positron emission tomography (FDG-PET)/CT was performed, and it showed obvious uptake at the patient\'s medulla to his upper cervical spinal cord, suggesting the presence of a malignant tumor. To confirm this diagnosis and establish a treatment plan, we performed MRI. Written informed consent containing the risks of this procedure including ICD dysfunction or damage, fatal arrhythmia, and death was obtained from the patient and his family.