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Background: Radiofrequency (RF) ablation of typical atrioventricular nodal reentrant tachycardia (tAVNRT) is performed without revealing out the location of antegrade slow pathway (ASp). In this study, we studied a new electrophysiological method of identifying the site of ASp. Methods: This study included 19 patients. Repeated series of very high‐output single extrastimulations (VhoSESts) were delivered at the anatomical slow pathway region during tAVNRT. Tachycardia cycle length (TCL), coupling interval (CI), and return cycle (RC) were measured and the prematurity of VhoSESts [ΔPM (= TCL – CI)] and the prolongation of RCs [ΔPL (= RC – TCL)] were calculated. Pacing sites were classified into two categories: (i) ASp capture sites [DSPC(+) sites], where two different RCs were shown, and ASp non‐capture sites [DSPC(‐) sites], where only one RC was shown. RF ablation was performed at DSPC(+) sites and/or sites with catheter‐induced mechanical trauma (CIMT) to ASp. Results: DSPC(+) sites were shown in 13 patients (68%). RF ablation was successful in all patients without any degree of atrioventricular block nor recurrence. Total number of RF applications was 1.8 ± 1.1. Minimal distance between successful ablation sites and DSPC(+)/CIMT sites and His bundle (HB) electrogram recording sites was 1.9 ± 0.8 mm and 19.8 ± 6.1 mm, respectively. ΔPL of more than 92.5 ms, ΔPL/TCL of more than 0.286, and ΔPL/ΔPM of more than 1.565 could identify ASp with sensitivity of 100%, 91.1%, and 88.9% and specificity of 92.9%, 97.0%, and 97.6%, respectively. Conclusions: Sites with ASp capture and CIMT were close to successful ablation sites and could be useful indicators of tAVNRT ablation. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the usefulness of the ratio of the early diastolic transmitral flow velocity (E) to the mitral annular velocity (e′) calculated from simultaneously recorded E and e′ in atrial fibrillation (AF). Background: The ratio of the E to the e′ (E/e′) has been reported as a useful index even in AF patients. However, E and e′ were measured during different beats in the previous studies. Methods: Fifty-six AF patients with preserved systolic function (mean age 66 ± 11 years) underwent routine echocardiographic study. The E/e′ was calculated from the E and e′ simultaneously recorded by the dual Doppler echocardiography. A single-beat E/e′ was calculated from simultaneously recorded E and e′ when the preceding RR interval/pre-preceding RR interval = 1. Brain natriuretic peptide (BNP) levels were also examined. Twenty-one patients underwent simultaneous pulmonary artery catheterization. Results: The single-beat lateral E/e′ correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.74, p < 0.001). The single-beat lateral E/e′ of ≥11 could predict elevated PCWP (≥15 mm Hg) with a sensitivity of 90% and a specificity of 90%. The single-beat lateral E/e′ also correlated well with the log BNP concentration. The single-beat lateral E/e′ of ≥9.2 predicted a plasma BNP level of ≥200 pg/ml with 88% sensitivity and 84% specificity. Conclusions: The single-beat lateral E/e′ correlated with plasma BNP level and PCWP in AF patients with preserved systolic function. In addition, the single-beat lateral E/e′ (≥11) was a good predictor of elevated PCWP (≥15 mm Hg). Dual Doppler echocardiography offers an advantage of providing the single-beat lateral E/e′ correctly even in AF patients, for the evaluation of left ventricular diastolic function. [Copyright &y& Elsevier]

Objective: The purpose of this study was to provide detailed information as to the modification of electrophysiological properties of pulmonary veins (PVs) and adjacent left atrial (LA) tissue caused by circumferential ablation (ABL) of superior and inferior pulmonary vein ostia using a novel radio-frequency balloon catheter (RBC), and to correlate such changes with recurrence or non-recurrence of atrial fibrillation (AF). Background: Although isolation of the triggering foci in PVs using conventional ABL techniques is useful in the treatment of AF, ABL of PVs per se is time consuming and tends to be associated with high AF recurrence rate. Methods and Results: Forty-nine patients with AF refractory to antiarrhythmic medication underwent circumferential ablation of PV-LA junction by RBC. Post ablation changes in electrophysiological properties around the PV ostia were studied with a basket catheter and were correlated with AF recurrence in 34 (1st study) early cases (ablating 68 superior PVs) and 15 (2nd study) later cases (53 superior and inferior PVs). Total elimination of PV potentials or PV-LA dissociation was achieved in 93% (63/68 PVs) and 93% (49/53 PVs), respectively. During mean follow-up periods of 24.1 ± 4.1 and 13.3 ± 1.7 months, AF recurred in 38% (13/34 cases) and 13% (2/15) in early and later groups, respectively, but no case developed severe PV stenosis. Although the amplitude of PV and periostial LA potentials were decreased (p < 0.0001) in all patients, the remaining PV potentials in 34 non-recurrence cases were definitely smaller than those in 15 recurrence cases (p <0.0001). When a cut-off level of less than 0.4 mV in receiver operating characteristic curves was used, its negative predictive value for non-recurrence of AF was 93% and specificity was 95%. Conclusions: Circumferential ablation around the PV ostia using the RBC is effective in the treatment of AF even in a single session, and AF recurrence may well be predicted by precisely measuring the amplitude of remaining PV-LA potentials. [Copyright &y& Elsevier]

Abstract: Acute pulmonary thromboembolism (PTE) is mainly caused by deep vein thrombosis (DVT) and sometimes leads to a fatal outcome. Few cases of sport-related lower extremity DVT, involving direct external trauma, have been reported. A 58-year-old man, without any risk factors for thromboembolism suffered acute PTE from DVT after playing tennis. A detailed history revealed that he had hit his popliteal vein with each swing of his tennis racket and the site of the trauma, at popliteal fossa, was exactly the same as the site of the DVT formation. Therefore, the cause of DVT was suspected to be the repeated trauma to the popliteal vein. The repeated external trauma to the popliteal vein may have caused vascular endothelial damage, leading to DVT. [Copyright &y& Elsevier]

Abstract: The two patients were males aged over 30 years. To treat testicular tumors, combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP) had been employed. In case 1, during the 4th course of BEP therapy, thoracic pain suddenly appeared. Emergency coronary angiography revealed thrombus formation. Under a diagnosis of thrombus-related acute myocardial infarction, thrombus aspiration was conducted, and stent implantation was performed because mild stenosis and residual thrombus were observed. In case 2, during the 2nd course of BEP therapy, thoracic pain suddenly appeared. Emergency coronary angiography revealed thrombus formation. Intracoronary infusion of pro-urokinase was performed, and additional balloon dilatation was conducted because mild stenosis and residual thrombus were observed. In both cases, the courses were favorable, and the levels of coagulation markers on admission were high. When selecting combination chemotherapy in patients with coronary risk factors, such as obesity and smoking, despite a young age, as demonstrated in these two patients, it may be important to consider combination therapy with anticoagulants or switching to anticancer drugs that do not show vascular toxicity. [Copyright &y& Elsevier]

Summary: A 71-year-old female had worked on a farm in the mountains and noticed itching of the left 3rd toe. She visited a local hospital due to a color change to purple in this area. Attachment of a tick was observed between the left 2nd and 3rd toes, and it was extracted. However, due to persistent pain, she was referred to our department of cardiovascular medicine for close examination and treatment. Lower extremity angiography showed that vascular visualization was poor in the area supplied by the arteries distal to the tick bite site, but the other blood vessels of the toe were clearly visualized. Toe amputation was performed and pathological examination of a surgical specimen revealed that most blood vessels near the necrosis were occluded by thrombi. We speculated that tick bite reactions were associated with thrombogenic vasculopathy. This report shows a patient who developed toe necrosis due to poor blood circulation after an interdigital tick bite. [ABSTRACT FROM AUTHOR]

Summary: Integrated backscatter intravascular ultrasound (IB-IVUS) capable of assessing plaque properties has recently become clinically applicable. We observed short-term atorvastatin-induced changes in coronary arterial plaque properties using IB-IVUS. The patient was a 57-year-old man who underwent coronary angiography when admitted to our hospital for cerebrovascular surgery, and lesions were observed in 2 branches: 99% and 90% stenoses in the proximal anterior descending branch (LAD) and middle region of the circumflex, respectively. Stenting was performed for the LAD on November 4, 2009 and for the circumflex on December 9. Oral atorvastatin administration at 10mg/day was initiated on November 5 because the LDL-cholesterol level was high (160mg/dl). A region about 5mm in length proximal to the stent placed in the LAD was analyzed using IB-IVUS. Atorvastatin lowered the LDL cholesterol level from 160 to 79mg/dl. On IB image analysis, although the period was as short as about 1 month, a marked decrease in the fatty component (44%→26%) and an increase in the fibrous component (53%→66%) were observed in the plaque. It was suggested that atorvastatin changes the tissue properties of coronary arterial plaques from a very early phase. It might be associated with the stabilization of coronary plaque. [ABSTRACT FROM AUTHOR]