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Objective To evaluate the outcomes of patients with concomitant Brugada syndrome and coronary artery vasospasm. Methods Patients diagnosed with Brugada syndrome with an implantable cardiac defibrillator were retrospectively investigated, and the coexistence of vasospasm was evaluated. The clinical features and outcomes were evaluated, especially in patients with coexistent vasospasm. A provocation test using acetylcholine was performed in patients confirmed to have no organic stenosis on percutaneous coronary angiography to confirm the presence of vasospasm. Implantable cardiac defibrillator shock status was checked every three months. Statistical comparisons of the groups with and without vasospasm were performed. A univariate analysis was also performed, and the odds ratio for the risk of implantable cardiac defibrillator shock was calculated. Patients Thirty-five patients with Brugada syndrome, of whom six had coexistent vasospasm. Results There were no significant differences in the laboratory data, echocardiogram findings, disease, or the history of taking any drugs between patients with and without vasospasm. There were significant differences in the clinical features of Brugada syndrome, i.e. cardiac events such as resuscitation from ventricular fibrillation or appropriate implantable cardiac defibrillator shock. Four patients with vasospasm had cardiac events such as resuscitation from ventricular fibrillation and/or appropriate defibrillator shock; three of them had no cardiac events with calcium channel blocker therapy to prevent vasospasm. The coexistence of vasospasm was a potential risk factor for an appropriate implantable cardiac defibrillator shock (odds ratio: 13.5, confidence interval: 1.572-115.940, p value: 0.035) on a univariate analysis. Conclusion Coronary artery vasospasm could be a risk factor for cardiac events in patients with Brugada syndrome.

BACKGROUND The purpose of the present study was to categorize and develop lists of contents of problems, goals, solution plans generated through the brainstorming work in therapy, and selected solutions for execution, that treated in problem-solving therapy (PST) for cancer patients in clinical settings, and to describe their characteristics. Additionally, examining the associations of problem domains with characteristics of participants, was also aimed. METHODS We conducted content analysis using records of thirty-one cancer patients (M = 62.6 years old; SD = 10.5) who participated in PST program. RESULTS Problems were categorized into four domains (e.g. psychological and existential problems; physical problems; social relations; social living environment). Participants under treatment at baseline reported psychological and existential problems most often (P < 0.05). Goals were categorized into four domains (e.g. improving mental health; improving physical functions; improving social relations and improving one's social living environment). Solution plans generated through the brainstorming work in therapy were categorized into four domains (e.g. emotion regulation/cognitive adjustment; health behaviors; adjustment of social relationships and adjusting one's social living environment). Selected solutions for execution were categorized into four domains (e.g. emotion regulation/cognitive adjustment; health behaviors; adjustment of social relationships and adjusting one's social living environment). CONCLUSIONS We found that various problems, goals and solutions were treated in PST of realistic clinical setting. Creating lists based on our study and making use of it for the materials as aids while implementing the PST or being shared with patients and medical staff would be expected.

Background Pacemaker generators are routinely implanted in the anterior chest. However, where to place the generator may need to be considered from the mental, functional, and cosmetic standpoints. Methods In this study, we performed the left axillary pacemaker generator implantation with a direct puncture of the left axillary vein in 40 consecutive patients, and evaluated the late safety and efficacy of this implantation. Complications, changes in the lead sensing, pacing threshold, and impedance were used as safety indexes for a mean follow-up of 3.4 years. In addition, the efficacy was also evaluated by comparing their questionnaire survey results to 119 patients in a control group of anterior chest implantation. Results Lead dislodgements were observed in two patients of the experiment group. There were no migrations of generators from the implantation site or abnormal variations in the pacing threshold, lead sensing, or impedance. In the left anterior chest and left axillary groups, 85% and 10% of the patients were worried about an external impact, 80% and 25% were worried about electromagnetic interference, and 68% and 0% answered that the pacemaker implantation site was noticeable, respectively. Apparently, more patients had a sense of security and cosmetic satisfaction with the left axillary implantation. Conclusion The left axillary generator implantations may reduce the mental burden and cause no safety concerns, and may be performed if functional or cosmetic outcomes are required.

Objective Electrical cardioversion (EC) is associated with an increased risk of thrombotic events in patients with non-valvular atrial fibrillation (NVAF). Patients who experience AF for a period of >48 hours therefore require adequate anticoagulation therapy for at least 3 weeks before and 4 weeks after EC. While the guidelines address the management of vitamin K antagonists (VKAs), there are limited data on the use of novel oral anticoagulants (NOAC). One NOAC, rivaroxaban, has a rapid onset of action and might therefore shorten the time for which anti-coagulant treatment is required before a patient undergoes EC. Methods This study included 91 patients with NVAF of >48 hours in duration or in whom the time of onset was unknown who were undergoing EC after pretreatment with rivaroxaban. All of the patients were pretreated with rivaroxaban for at least 2 hours before EC and the same dose of rivaroxaban was prescribed for 4 weeks after EC. The primary endpoint was a successful EC without any thrombotic events or bleeding complications within 30 days after EC. The secondary endpoint was the time to EC. Results The mean age was 63±12 years and 70 of the 91 patients were male. The CHADS2 and HAS-BLED scores were 1.0±1.0 and 1.7±1.3, respectively. Although there were no thrombotic events, minor bleeding (gingival hemorrhage) occurred 20 days after the initiation of rivaroxaban treatment in one patient. The average time to EC was 11.9±11.1 days. Conclusion Rivaroxaban is safe and effective drug for NVAF patients who are scheduled for an EC. Furthermore, since VKAs take a substantial amount of time to establish adequate anticoagulation, pretreatment with rivaroxaban could shorten the time to the EC.

The current report provides the result of a Phase II clinical trial regarding the effectiveness and feasibility of problem-solving therapy for psychological distress experienced by Japanese early-stage breast cancer patients.Participants were 36 post-surgery Japanese breast cancer patients in a university hospital located in Osaka Prefecture, Japan. After screening for psychological distress using the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale, highly distressed patients were exposed to 5 weekly sessions of the problem-solving therapy program.Nineteen patients completed the intervention and follow-up. There was a significant difference between the pre-intervention and the 3-month follow-up in the total Hospital Anxiety and Depression Scale score (P = 0.02), and the mean change score from the pre-intervention to the follow-up was 6.05 (SD = 1.94). The intervention had a large effect size (d = 0.82). There were also significant changes in worry, self-efficacy and quality of life measures.The findings of our study suggest that the problem-solving therapy program has potential to be effective for alleviating psychological distress experienced by Japanese early-stage breast cancer patients. The true effectiveness of the program should be confirmed by a future randomized control trial.

Background: Radiofrequency catheter ablation (RF) has recently become widely available for the treatment of atrial fibrillation (AF) and has broadened treatment options while confusing the selection of medication therapy or RF. Methods and Results: Two drugs for the maintenance of sinus rhythm (Ry) and 2 drugs for control of the pulse rate (Ra) were selected and the costs of medication therapy were calculated. RF procedures were grouped into 2 groups each for persistent or paroxysmal AF (RF) and for chronic AF (RFChr), according to the cost of the devices used. The calculated cost of medication therapy was 5,270-23,560 yen per month. The calculated cost of RF procedures was 1,063,200-2,029,640 yen. The costs of RF corresponded to those of Ry for 3.8-14.3 years. The costs of RFChr corresponded to those of Ra for 16.6-63.9 years. The treatment of complications ranged from 360,000 to 1,241,500 yen. Conclusions: From the aspect of medical costs and complications, RF should be considered for the treatment of patients with AF detected early or early-stage AF, whereas treatment for its complications should be given priority in patients with chronic AF associated with reduced cardiac function. (Circ J 2011; 75: 1860-1866)

BACKGROUND To reduce myocardial damage caused by implantable cardioverter defibrillator (ICD) shock, the left axilla was studied as an alternative pulse generator implantation site, and compared with the traditional implantation site, the left anterior chest. METHODS AND RESULTS Computer simulation was used to study the defibrillation conduction pattern and estimate the simulated defibrillation threshold (DFT) and myocardial damage when pulse generators were placed in the left axilla and left anterior chest, respectively; pulse generators were also newly implanted in the left axilla (n=30) and anterior chest (n=40) to compare the corresponding DFT. On simulation, when ICD generators were implanted in the left axilla, compared with the left anterior chest, the whole heart may be defibrillated with a lower defibrillation energy (left axilla 6.4 J vs. left anterior chest 12.0 J) and thus the proportion of cardiac myocardial damage may be reduced (2.1 vs. 4.2%). Clinically, ventricular fibrillation was successfully terminated with a defibrillation output ≤5 J in 86.7% (26/30) of the left axillary group, and in 27.5% (11/40) of the left anterior group (P

Background Subcutaneous implantable cardiac defibrillator (S-ICD) systems have a lower invasiveness than traditional ICD systems, and expand the indications of ICD implantations. The S-ICD standard defibrillation shock output energy, however, is approximately 4 times that of the traditional ICD system. This raises concern about the efficacy of the defibrillation and myocardial injury. In this study, we investigated the defibrillation efficacy and myocardial injury with S-ICD systems based on computer simulations. Methods and results First, computer simulations were performed based on the S-ICD system configurations proposed in a previous study. Furthermore, simulations were performed by placing the lead at the left or right parasternal margin and the pulse generator in the superior and inferior positions (0-10 cm) of the recommended site. The simulated defibrillation threshold (DFT) for the 4 S-ICD system configurations were 30.1, 41.6, 40.6, and 32.8 J, which were generally similar to the corresponding clinical results of 33.5, 40.4, 40.1, and 34.3 J. Conclusions The simulated DFT were generally similar to their clinical counterparts. In the simulation, the S-ICD system had a higher DFT but relatively less severe myocardial injury compared with the traditional ICD system. Further, the lead at the right parasternal margin may correspond to a lower DFT and cause less myocardial injury.

We assessed the relationship between frequencies of engaging in pleasant activities and mood and depressive symptoms in undergraduate students by using a daily-diary method. Undergraduates were administered the Pleasant Events Schedule (Lewinsohn, Youngren, Munoz, & Zeiss, 1978) and the Japanese version of the Positive Affect and Negative Affect Schedule (Sato & Yasuda, 2001) for seven days and the Japanese version of the Beck Depression Inventory (Hayashi, 1988). While the BDI scores did not directly correlate with the frequencies of pleasant activities, the intra-subject mean correlation coefficients indicated that the frequencies of pleasant activities were positively related to positive mood. This result offers partial support for the behavioral model of depression.

Pacemaker generators are routinely implanted in the anterior chest. However, where to place the generator may need to be considered from the mental, functional, and cosmetic standpoints.In this study, we performed the left axillary pacemaker generator implantation with a direct puncture of the left axillary vein in 40 consecutive patients, and evaluated the late safety and efficacy of this implantation. Complications, changes in the lead sensing, pacing threshold, and impedance were used as safety indexes for a mean follow-up of 3.4 years. In addition, the efficacy was also evaluated by comparing their questionnaire survey results to 119 patients in a control group of anterior chest implantation.Lead dislodgements were observed in two patients of the experiment group. There were no migrations of generators from the implantation site or abnormal variations in the pacing threshold, lead sensing, or impedance. In the left anterior chest and left axillary groups, 85% and 10% of the patients were worried about an external impact, 80% and 25% were worried about electromagnetic interference, and 68% and 0% answered that the pacemaker implantation site was noticeable, respectively. Apparently, more patients had a sense of security and cosmetic satisfaction with the left axillary implantation.The left axillary generator implantations may reduce the mental burden and cause no safety concerns, and may be performed if functional or cosmetic outcomes are required.

Radiofrequency catheter ablation (RF) has recently become widely available for the treatment of atrial fibrillation (AF) and has broadened treatment options while confusing the selection of medication therapy or RF.Two drugs for the maintenance of sinus rhythm (Ry) and 2 drugs for control of the pulse rate (Ra) were selected and the costs of medication therapy were calculated. RF procedures were grouped into 2 groups each for persistent or paroxysmal AF (RF) and for chronic AF (RFChr), according to the cost of the devices used. The calculated cost of medication therapy was 5,270-23,560 yen per month. The calculated cost of RF procedures was 1,063,200-2,029,640 yen. The costs of RF corresponded to those of Ry for 3.8-14.3 years. The costs of RFChr corresponded to those of Ra for 16.6-63.9 years. The treatment of complications ranged from 360,000 to 1,241,500 yen.From the aspect of medical costs and complications, RF should be considered for the treatment of patients with AF detected early or early-stage AF, whereas treatment for its complications should be given priority in patients with chronic AF associated with reduced cardiac function.

Background: The number of geriatric patients is increasing in Japan. Catheter Ablation (CA) is considered the useful treatment of choice for patient with supraventricular tachycardia (SVT). Therefore, it is tend to increase Catheter Ablation (CA) for geriatric patients of SVT. Objective: The aim of this study is to asses the efficacy and safety of CA for SVT except for Atrial Fibrillation (AF) in geriatric patients. Methods and Results: We studied thirty-one consecutive patients aged 75 and older (men 21 cases, median age 78±3, oldest age 88 years old) who underwent CA for SVT between January 2006 and March 2011 in our institution. 31 cases include 15 cases of typical atrial flutter (AFL), 1 case of atypical AFL, 9 cases of atrioventricular nodal re-entrant tachycardia, 5 cases of atrioventricular re-entrant tachycardia, and 1 case of ectopic atrial tachycardia. Initial CA success rate was 100% for all ablation types. And there were no major complications under the operation and after the operation. During observation periods (2.1±1.2 years), there were no recurrence cases except for the atypical AFL (recurrence rate 3.2%). Conclusion: CA of SVT has efficacy and safty and low rates of recurrence. CA is an excellent choice therapy option for geriatric patients with SVT except for atrial fibrillation.

Background: It is thought that the existence of asymptomatic paroxysmal atrial fibrillation (Paf) make the necessity of treatment or the therapy evaluation difficult. There are few report that when the subjective feel palpitation, whether Paf has actually occurred or not. Purpose: The purpose of this study is to evaluate whether Paf has occurred when the subjective symptom of Paf for the long term. The Object and the Method: Ten patients administering the anti-arrhythmia medicine for Paf were enrolled. ECG was recorded at twice a day (morning, evening) and at the subjective symptom of Paf for 30 seconds using portable event recorder (Omron. HCG-801). The result: The total recorded number was 5772, and the average observation period was 286.8 days. The recorded number at the subjective symptom of Paf was 412, and among them, Paf was recorded in 135 (32.8%). Conclusion: When the subjective felt that Paf has occurred, actual occurrence of Paf was few. It was thought that it is because the patients who reacted to arrhythmia in excess existed in the patients with Paf contrary to asymptomatic or something related to anti-arrhythmia. It was considered to be difficult further to evaluate Paf only by the subjective symptom.

Background: Little is known about autonomic nerve mechanisms just before onset of life-threatening cardiovascular events. Very few attempts have been made at dissection of dynamic alteration of autonomic tone when we get into a panic. Purpose: We examined the dynamic alteration of autonomic-nerve tone just before and after Great Eastern-Japan Earthquake struck on Mar. 11, 2011 by using new analyzed method for heart rate variability (HRV). Methods: Three patients (male:female=2:1) were selected for this study, of whom sinus rhythm was documented in Holter electrocardiogram on that day. HRV was analyzed by the maximum entropy method (MemCalc/CHIRAM, Suwa Trust Japan). This method enabled us to achieve a reliable analysis of HRV component at 10 second intervals for 30 second periods from 30 minutes before earthquake. The high frequency band (HF: 0.15–0.4 Hz), the low frequency band (LF: 0.04–0.15 Hz), and the very low frequency band (VLF: 0.003–0.04 Hz) were measured. Results: HRV tended to show normal circadian fluctuation before the earthquake; however, unexpected suppression of both HF and LF/HF were simultaneously seen just after abrupt earthquake. In contrast, remarkable sinus tachycardia was seen in all patients. Soon after that, HF suppression and surge of LF/HF were sustained for a while under continued stress of aftershock activity. Conclusions: There is a fair possibility that we can put the MemCalc method to observe catastrophe of autonomic-nerve systems after big stress such as the greatest earthquake on record.

Aims: We evaluated the influence of vasospasm in Brugada syndrome. Method and Result: In 86 consecutive patients, we classified into 60 patients with Brugada syndrome and 26 patients with non-Brugada syndrome. First, the prevalence of vasospasm was compared between these two groups. Second, in Brugada syndrome, we evaluated the relationship between vasospasm and any factors, which is a history of syncope, a family history of Brugada syndrome or sudden death and a history of induced ventricular arrhythmia by electrophysiological study. Finally, we evaluated the occurrence of implantable cardioverter defibrillator (ICD) shock. Vasospasm was more prevalent in patients with the Brugada than in the non-Brugada syndrome. Vasospasm was more prevalent on right coronary artery. No specific relationship was found between vasospasm and any factors of Brugada syndrome. The occurrence of ICD shocks was more frequent in patients with a combination of a history of syncope and vasospasm. Conclusion: In Brugada syndrome, vasospasm frequently coexists, and there were no specific factors of coexistence. ICD shocks were more common in patients with a combination of a history of syncope and vasospasm. Determination of the presence of vasospasm may help predict the occurrence of cardiac events, especially with a history of syncope.

We experienced the two cases of the undersensing of ventricular fibrillation (VF) at the time of defibrillation threshold test. These patients were Brugada syndrome with implantable cardioverter-defibrillator (ICD). After we inducted the VF by shock on T stimulation, the undersensing of VF immediately occurred because of the very low amplitude of intracardiac electrocardiogram (EGM). After three to five seconds, the amplitude of EGM gradually increased and the undersensing of VF did not occur. But after we induced the VF by the fast ventricular pacing, the amplitude of EGM was high and the undersensing of VF did not occur at all. These phenomenons were reproducibility observed in two cases of Brugada syndrome. It was suspected that the reasons of these phenomenons were caused by the mechanical problem of ICD generator and lead or the inducing method of VF.