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Tokioka K.,Okayama University of Science | Kusano K.F.,Japan National Cardiovascular Center Research Institute | Morita H.,Okayama University of Science | Miura D.,Okayama University of Science | And 6 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives This study aimed to determine the usefulness of the combination of several electrocardiographic markers on risk assessment of ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). Background Detection of high-/low-risk BrS patients using a noninvasive method is an important issue in the clinical setting. Several electrocardiographic markers related to depolarization and repolarization abnormalities have been reported, but the relationship and usefulness of these parameters in VF events are unclear. Methods Baseline characteristics of 246 consecutive patients (236 men; mean age, 47.6 ± 13.6 years) with a Brugada-type electrocardiogram, including 13 patients with a history of VF and 40 patients with a history of syncope episodes, were retrospectively analyzed. During the mean follow-up period of 45.1 months, VF in 23 patients and sudden cardiac death (SCD) in 1 patient were observed. Clinical/genetic and electrocardiographic parameters were compared with VF/SCD events. Results On univariate analysis, a history of VF and syncope episodes, paroxysmal atrial fibrillation, spontaneous type 1 pattern in the precordial leads, and electrocardiographic markers of depolarization abnormalities (QRS duration >120 ms, and fragmented QRS [f-QRS]) and those of repolarization abnormalities (inferolateral early repolarization [ER] pattern and QT prolongation) were associated with later cardiac events. On multivariable analysis, a history of VF and syncope episodes, inferolateral ER pattern, and f-QRS were independent predictors of documented VF and SCD (odds ratios: 19.61, 28.57, 2.87, and 5.21, respectively; p < 0.05). Kaplan-Meier curves showed that the presence/absence of inferolateral ER and f-QRS predicted a worse/better prognosis (log-rank test, p < 0.01). Conclusions The combination of depolarization and repolarization abnormalities in BrS is associated with later VF events. The combination of these abnormalities is useful for detecting high- and low-risk BrS patients. © © 2014 by the American College of Cardiology Foundation Published by Elsevier Inc. Source

Tamura K.,Sakakibara Heart Institute of Okayama | Uchida N.,Hiroshima University | Katayama A.,Hiroshima City Asa Hospital | Sutoh M.,Hiroshima City Asa Hospital | And 2 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective The operative strategies for retrograde acute type A aortic dissection with a primary intimal tear remain controversial because resection of an intimal tear via a median sternotomy is difficult. We evaluated the frozen elephant trunk technique for treating this type of aortic dissection. Methods The frozen elephant trunk technique was used for acute retrograde type A aortic dissection with a primary intimal tear in the descending aorta in 25 consecutive patients (16 men, 9 women; median age, 64 years) seen between 1997 and 2011 at the Hiroshima City Asa Hospital. Three patients had Marfan syndrome. Fourteen patients had ischemia of the lower half of the body, 2 had stroke, 3 had coronary ischemia, and 10 had pericardial tamponade. Results There were no hospital deaths. Postoperative complications occurred in 2 patients, including stroke and mediastinitis. Two late deaths occurred over a median follow-up period of 58 months (12-169 months), one caused by stroke and the other by colon cancer. Two patients needed additional operations: one required a second operation for descending aorta replacement because of ulceration caused by the stent graft, and the other required an endovascular stent graft because of dilatation of the descending aorta. Computed tomography follow-up scans revealed that the false lumen was completely thrombosed and obliterated in all 25 patients with stent grafts. Conclusions The frozen elephant trunk technique for retrograde type A aortic dissection yielded acceptable outcomes, despite the high preoperative morbidity, and might improve the prognosis of dissection. Copyright © 2014 by The American Association for Thoracic Surgery. Source

Tsunoda M.,Sakakibara Heart Institute of Okayama
Japanese Journal of Clinical Radiology | Year: 2015

Isophasic images with uniform distribution of contrast medium can be obtained on 320-detector-row computed tomography (CT) by using simultaneous data acquisition of the whole imaging volume. The shunt flow is visualized as the positive or negative contrast jet in routine coronary CT angiography by using an optimized administration protocol of contrast medium and saline chaser to fill the left side of the heart with contrast medium and wash out the right side of the heart. Various diseases with intercardiac and/or cardiopulmonary shunt were diagnosed with the positive or negative contrast jets. Source

Take Y.,Okayama University of Science | Take Y.,Sakakibara Heart Institute of Okayama | Morita H.,Okayama University of Science
Indian Pacing and Electrophysiology Journal | Year: 2012

Fragmented QRS (fQRS) is a convenient marker of myocardial scar evaluated by 12-lead electrocardiogram (ECG) recording. fQRS is defined as additional spikes within the QRS complex. In patients with CAD, fQRS was associated with myocardial scar detected by single photon emission tomography and was a predictor of cardiac events. fQRS was also a predictor of mortality and arrhythmic events in patients with reduced left ventricular function. The usefulness of fQRS for detecting myocardial scar and for identifying high-risk patients has been expanded to various cardiac diseases, such as cardiac sarcoidosis, arrhythmogenic right ventricular cardiomyopathy, acute coronary syndrome, Brugada syndrome, and acquired long QT syndrome. fQRS can be applied to patients with wide QRS complexes and is associated with myocardial scar and prognosis. Myocardial scar detected by fQRS is associated with subsequent ventricular dysfunction and heart failure and is a substrate for reentrant ventricular tachyarrhythmias. Source

Take Y.,Okayama University of Science | Morita H.,Okayama University of Science | Toh N.,Okayama University of Science | Nishii N.,Okayama University of Science | And 5 more authors.
Heart Rhythm | Year: 2012

BACKGROUND: Syncope in patients with Brugada syndrome is usually associated with ventricular tachyarrhythmia, but some episodes of syncope can be related to autonomic disorders. OBJECTIVE: The purpose of this study was to investigate the characteristics of syncope to differentiate high-risk syncope episodes from low-risk events in patients with Brugada syndrome. METHODS: We studied 84 patients with type 1 electrocardiogram and syncope. Patients were divided into 2 groups: patients with prodrome (prodromal group; n = 41) and patients without prodrome (nonprodromal group; n = 43). RESULTS: Ventricular fibrillation (VF) was documented at index event in 19 patients: 4 patients (21%) with documented VF experienced a prodrome prior to the onset of VF, whereas 15 patients (79%) did not have symptoms prior to documented VF (P <.01). Twenty-seven patients in the prodromal group and 7 patients in the nonprodromal group were considered to have syncope related to autonomic dysfunction. Syncope in other patients was defined as unexplained syncope. During the follow-up period (48 ± 48 months), recurrent syncope due to VF occurred in 13 patients among patients with only unexplained syncope and was more frequent in the nonprodromal group (n = 10) than in the prodromal group (n = 3; P = .044). In multivariate analysis, blurred vision (hazard ratio [HR] 0.20) and abnormal respiration (HR 2.18) and fragmented QRS (HR 2.39) were independently associated with the occurrence of VF. CONCLUSION: Syncope with prodrome, especially blurred vision, suggests a benign etiology of syncope in patients with Brugada syndrome. © 2012 Heart Rhythm Society. Source

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