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Hasebe H.,Shizuoka Saiseikai General Hospital | Yoshida K.,Ibaraki Prefectural Central Hospital | Yoshida K.,University of Tsukuba | Iida M.,Shizuoka Saiseikai General Hospital | And 3 more authors.
Heart Rhythm | Year: 2016

Background A left-to-right dominant frequency (DF) gradient commonly exists in paroxysmal atrial fibrillation (AF). AF initiated by right atrial (RA) ectopy (AF-RAE) is rare. Objective This study aimed to investigate characteristics of AF-RAE using pharmacological maneuvers and spectral analysis. Methods Seventy-nine consecutive patients referred for catheter ablation of paroxysmal AF were enrolled. Infusions of isoproterenol and adenosine triphosphate (ATP) were used to induce AF. Patients with AF-RAE and patients with AF initiated only by pulmonary vein (PV) ectopies were classified into the RA-ectopy group (n = 7[9%]) and PV-ectopy group (n = 32[41%]), respectively. ATP was also injected during ongoing AF to unmask the driver of AF. High RA, coronary sinus, and PV-left atrial junction electrograms and electrocardiogram lead V1 underwent spectral analyses. Results Patients in the RA-ectopy group were younger (51 ± 13 years vs 63 ± 7 years; P =.01) and more commonly had a family history of AF (71% vs 9%; P <.001) than patients in the PV-ectopy group. There was a baseline right-to-left DF gradient in the RA-ectopy group (PV-left atrial junction: 6.0 ± 0.4 Hz; coronary sinus: 5.7 ± 0.6 Hz; RA: 7.3 ± 0.8 Hz; P <.05) in contrast to a left-to-right DF gradient in the PV-ectopy group (5.9 ± 0.8, 5.3 ± 0.7, 5.2 ± 0.8 Hz; P <.01). ATP injection predominantly increased the DF of the high RA in the RA-ectopy group and augmented a right-to-left DF gradient (7.9 ± 1.8, 7.6 ± 1.0, 10.7 ± 0.7 Hz; P <.001), whereas it augmented a left-to-right DF gradient in the PV-ectopy group (7.9 ± 1.0, 6.4 ± 0.5, 6.6 ± 1.2 Hz; P <.05). Conclusion A rare type of paroxysmal AF initiated by RA ectopy may be maintained by a reentrant driver localized in the RA (so-called RA fibrillation). © 2016 Heart Rhythm Society. Source

Naruse Y.,University of Tsukuba | Tada H.,University of Tsukuba | Harimura Y.,Tsukuba Medical Center Hospital | Hayashi M.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background-Recent evidence has linked early repolarization (ER) to idiopathic ventricular fibrillation (VF) in patients without structural heart disease. However, no studies have clarified whether or not there is an association between ER and the VF occurrences after the onset of an acute myocardial infarction (AMI). Methods and Results-This study retrospectively included 220 consecutive patients with an AMI (57 female; mean age, 69±11 years) in whom the 12-lead ECGs before the AMI onset could be evaluated. The patients were classified on the basis of a VF occurrence within 48 hours after the AMI onset. Early repolarization was defined as an elevation of the QRS-ST junction of >0.1 mV from baseline in at least 2 inferior or lateral leads, manifested as QRS slurring or notching. Twenty-one (10%) patients had a VF occurrence within 48 hours of the AMI onset. A multivariate analysis revealed that ER (odds ratio [OR], 7.31; 95% confidence interval [CI], 2.21-24.14; P<0.01), a time from the onset to admission of <180 minutes (OR, 3.77; 95% CI, 1.13-12.59; P<0.05), and a Killip class greater than I (OR, 13.60; 95% CI, 3.43-53.99; P<0.001) were independent predictors of VF occurrences. As features of the ER pattern, a J-point elevation in the inferior leads, greater magnitude of the J-point elevation, notched morphology of the ER, and ER with a horizontal/descending ST segment, all were significantly associated with a VF occurrence. Conclusions-The presence of ER increased the risk of VF occurrences within 48 hours after the AMI onset. Clinical Trial Registration Information-http://www.umin.ac. jp; Identifier: UMIN000005533. © 2012 American Heart Association, Inc. Source

Naruse Y.,University of Tsukuba | Tada H.,University of Tsukuba | Harimura Y.,Tsukuba Medical Center Hospital | Ishibashi M.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2014

Background-We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI.Methods and Results-This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences.Conclusions-ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death. © 2014 American Heart Association, Inc. Source

Nagai K.,Ibaraki Prefectural Central Hospital | Aadachi K.,University of Tsukuba | Saito H.,Ibaraki Prefectural Central Hospital
International Journal of Clinical Oncology | Year: 2010

We present the case of a huge pedunculated benign mesenchymal myxoid tumor that developed on the right labia majora of a 48-year-old-woman. The excised mass weighed 4534 g and was 23 cm in diameter; the cut surface was yellowish and elastic. Microscopic examination revealed spindle and plump oval tumor cells arranged with abundant capillary vessels in an edematous stroma. Immunohistochemical staining showed that the tumor cells were positive for vimentin, desmin, estrogen receptor, and progesterone receptor, but negative for α-smooth muscle actin, CD34, CD45, CD68, and S-100. Based on these features, the pathological diagnosis was angiomyofibroblastoma. A pedunculated angiomyofibroblastoma is extremely rare and, to the best of our knowledge, this is the biggest such tumor in terms of size and weight reported to date. It is especially important in such a huge mass greater than 10 cm that angiomyofibroblastoma is differentiated from aggressive angiomyxoma, which is a deeply invasive and recurrent neoplasm. © 2010 Japan Society of Clinical Oncology. Source

Naruse Y.,University of Tsukuba | Sato A.,University of Tsukuba | Hoshi T.,University of Tsukuba | Takeyasu N.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Cardiovascular Interventions | Year: 2013

Background-Triple antithrombotic therapy increases the risk of bleeding events in patients undergoing percutaneous coronary intervention. However, it remains unclear whether good control of percent time in therapeutic range is associated with reduced occurrence of bleeding complications in patients undergoing triple antithrombotic therapy. Methods and Results-This study included 2648 patients (70±11 years; 2037 men) who underwent percutaneous coronary intervention with stent in the Ibaraki Cardiovascular Assessment Study registry and received dual antiplatelet therapy with or without warfarin. Clinical end points were defined as the occurrence of major bleeding complications (MBC), major adverse cardiac and cerebrovascular event, and all-cause death. Among these 2648 patients, 182 (7%) patients received warfarin. After a median follow-up period of 25 months (interquartile range, 15-35 months), MBC had occurred in 48 (2%) patients, major adverse cardiac and cerebrovascular event in 484 (18%) patients, and all-cause death in 206 (8%) patients. Multivariable Cox regression analysis revealed that triple antithrombotic therapy was the independent predictor for the occurrence of MBC (hazard ratio, 7.25; 95% confidence interval, 3.05-17.21; P<0.001). The time in therapeutic range value did not differ between the patients with and without MBC occurrence (83% [interquartile range, 50%-90%] versus 75% [interquartile range, 58%-87%]; P=0.7). However, the mean international normalized ratio of prothrombin time at the time of MBC occurrence was 3.3±2.1. Triple antithrombotic therapy did not have a predictive value for the occurrence of all-cause death (P=0.1) and stroke (P=0.2). Conclusions-Triple antithrombotic therapy predisposes patients to an increased risk of MBC regardless of the time in therapeutic range. © 2013 American Heart Association, Inc. Source

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