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Yokohama-shi, Japan

Fukamizu S.,Tokyo Metropolitan Hiroo Hospital | Sakurada H.,Tokyo Metropolitan Health and Medical Treatment Corporation | Hayashi T.,Tokyo Metropolitan Hiroo Hospital | Hojo R.,Tokyo Metropolitan Hiroo Hospital | And 6 more authors.
Journal of Cardiovascular Electrophysiology

Introduction: Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation; however, few reports describe left atrial MRAT involving the regions of spontaneous scarring. Here, we describe left atrial MRAT in patients without prior cardiac surgery or catheter ablation (CA) and discuss the clinical and electrophysiological characteristics of tachycardia and outcome of CA. Methods and Results: An electrophysiological study and CA were performed in 6 patients (3 men; age 76 ± 6 years) with MRAT originating from the left atrial anterior wall (LAAW). No patient had a history of cardiac surgery or CA in the left atrium. Spontaneous scars (areas with bipolar voltage ≤ 0.05 mV) were observed in all patients. The activation map showed a figure-eight circuit with loops around the mitral annulus (4 counterclockwise and 2 clockwise) and a low-voltage area with LAAW scarring. The mean tachycardia cycle length was 303 ± 49 milliseconds. The conduction velocity was significantly slower in the isthmus between the scar in the LAAW and the mitral annulus than in the lateral mitral annulus (0.17 ± 0.05 m/s vs 0.94 ± 0.35 m/s; P = 0.003). Successful ablation of the isthmus caused interruption of the tachycardia and rendered it noninducible in all patients. Conclusion: Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure-eight configuration. Radiofrequency CA is a feasible and effective treatment in such cases. © 2012 Wiley Periodicals, Inc. Source

Matsue Y.,Kameda Medical Center | Suzuki M.,Kameda Medical Center | Nishizaki M.,Yokohama Minami Kyosai Hospital | Hojo R.,Tokyo Metropolitan Hiroo Hospital | And 2 more authors.
Journal of the American College of Cardiology

The present study was performed to investigate the clinical implications of an implantable cardioverter-defibrillator (ICD) in patients with vasospastic angina (VSA) resuscitated from lethal ventricular arrhythmia. The prognosis of VSA is known to be good with medication; however, ventricular arrhythmia and cardiopulmonary arrest are rare but life-threatening complications of this disease. The ICD is a proven modality for patients with ventricular arrhythmia, but the clinical implications in this population remain to be elucidated. We conducted a retrospective, observational, multicenter study involving patients with an ICD due to documented ventricular arrhythmia and VSA diagnosed by acetylcholine provocation test. All patients were followed up for appropriate ICD therapy, sudden cardiac arrest, or death from all causes. Twenty-three patients were included in the present study and completely followed up. All patients are still alive. During a follow-up of 2.9 years (median 2.1 years), 4 ventricular fibrillations and 1 episode of pulseless electrical activity occurred in 5 patients (21.7%). There were no statistically significant differences in patient characteristics between the recurrence and nonrecurrence groups, including medication, smoking status, and whether the patient was or was not free of symptoms after ICD implantation. Patients with VSA and lethal ventricular arrhythmia are a population at high risk for recurrence of cardiopulmonary arrest, and there is no reliable indicator for predicting recurrence of ventricular arrhythmia. Insertion of an ICD with medication for VSA is appropriate for this high-risk population. © 2012 American College of Cardiology Foundation. Source

Yamada E.,Yokohama City University | Inamori M.,Yokohama City University | Uchida E.,Machida Municipal Hospital | Tanida E.,Machida Municipal Hospital | And 9 more authors.
American Journal of Gastroenterology

OBJECTIVES:No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).METHODS:We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.RESULTS:Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.CONCLUSIONS:Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739). © 2014 by the American College of Gastroenterology. Source

Nishizaki M.,Yokohama Minami Kyosai Hospital | Sakurada H.,Tokyo Metropolitan Hiroo Hospital | Yamawake N.,Yokohama Minami Kyosai Hospital | Ueda-Tatsumoto A.,Tokyo Metropolitan Hiroo Hospital | Hiraoka M.,Tokyo Medical and Dental University
Circulation Journal

The type 1 ST-segment elevation is diagnostic for Brugada syndrome (BS) and its presence may sometimes be associated with a high risk of arrhythmic events. The type 1 ECG is also known to be unmasked by administration of sodium-channel blockers in equivocal or suspected cases of BS, and the drug-challenge test is frequently used in the diagnostic approach. In large cohort studies the spontaneous appearance of the type 1 ECG with symptoms of aborted sudden death or unexplained syncope are indicative of a poor prognosis for patients with BS compared with not having clinical symptoms. Therefore, the spontaneous type 1 ECG appears to represent an important predictive sign for cardiac events. It is unknown, however, whether or not the drug-induced type 1 ECG is as useful as the spontaneous type 1 for predicting cardiac events in asymptomatic subjects showing non-type 1 ECG. Review of the literature for large cohort studies indicates that there is a low incidence of arrhythmic events in asymptomatic patients with either the spontaneous or drug-induced type 1 ECG compared with symptomatic subjects, and the drug-induced type1 ECG in asymptomatic patients does not add to an increase in arrhythmic risk. Therefore, drug testing to unmask the type 1 ECG in asymptomatic patients with a non-type 1 BS ECG does not have an additional value for risk stratification of cardiac events, although it might be useful in symptomatic patients showing only the non-type 1 ECG. Source

Masubuchi T.,Yokohama Minami Kyosai Hospital | Watanabe I.,Yokohama Minami Kyosai Hospital
Japanese Journal of Anesthesiology

Background: Continuous femoral block in total knee arthroplasty gives excellent perioperative pain control and quality of rehabilitation. Although accidental catheter dislodgement and fluid leakage from the puncture site are considered as major complications, there is no standard catheter fixation technique introduced. We tested a novel technique using a new transparent medical dressing combined with instant tissue adhesive to reduce the catheter related complications. Methods: Twenty patients were randomly divided into the Tegadarm™ comfort film dressing® with aron alpha A Sankyo® group (TA group) and the Tegadarm™ film® group(T group). We measured the number of exchanged dressings, fluid leakage and catheter stability. Results: TA group had significantly fewer number of exchanged dressings and fluid leakage than in the T group. The catheters were more stable in the TA group. There were no differences in adverse effects. Conclusions: Using the Tegadarm™ comfort film dressing® with aron alpha A Sankyo® could be an effective fixation method in the continuous femoral nerve block. Source

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