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To investigate the long-term outcome of Percutaneous transluminal intervention (PCI) for chronic total occlusion (CTO). The subjects were 606 patients (1,145 lesions) who were treated for CTO between January 1996 and December 2003 at our institution. Among them, 436 patients with early success and confirmed patency at the CTO by follow-up coronary angiography after 6 months were classified as the patent group (Group P), while 170 patients without early success or with occlusion on follow-up angiography were classified as the occluded group (Group O). In April 2006 (mean: 660 ± 602 days), the outcome of CTO was investigated and the major adverse cardiac events (MACE)-free rate was calculated. Multivariate analysis was performed to identify determinants of death. The early success rate was 76.4% before 2003 when Conquest guidewires were not available. However, it subsequently showed significant improvement to 89%. The cumulative survival rate was significantly higher for Group P (92%) than for Group O (64%) and the MACE-free rate (free from, death, bypass surgery, myocardial infarction, and revascularization) showed a similar trend. The cumulative survival rate of patients without myocardial viability in the territory of the vessel with CTO was significantly higher for Group P (88%) than for Group O (55%). The outcome was significantly worse for patients with occlusion of other vessels (90%) than for patients without additional occlusion (42%). It was significantly better when the left ventricular ejection fraction (LVEF) was ≥40% than when the LVEF was ≤40% (90 vs. 68%). Multivariate analysis identified occluded CTO, other vessel occlusion, low ejection fraction (EF), unimproved EF, and old age as determinants of death from CTO. If early success is obtained and patency is maintained, the long-term outcome after PCI for CTO is significantly better than when failure occurs Occluded CTO, other vessel occlusion, low EF, unimproved EF, and old age are important determinants of the outcome.

ベプリジル継続投与中の有効血中濃度は明確にされておらず, 同様に有効性との関連も明確にされていない.そこで頻脈性不整脈治療を目的にベプリジル継続投与中の101例で血中濃度を測定し, 血中濃度とべプリジル摂取後の時間経過との関連を検討した.ベプリジルは100～200mg/日を朝, 夕の2回あるいは朝, 昼夕の3回服用し, 全例が服用開始後30日以上経過した継続例であった.服用後1時間での最高値は0, 7μg/mL, 最低値は0.27μg/mL, 2時間の最高値は1.37μg/mL, 最低値は0.20μg/mL, 3時間では1.83μg/mLと0.17μg/mL, 4時間は1.69μg/mLと0.05μg/mL, 5時間は1.59μg/mLと0.26μg/mLであった.また, ベプリジルが有効であった症例の血中濃度と服用後の時間経過をみると2時間後も10時間後も血中濃度は0、6μg/mL以上であった.一方, ベプリジルが有効でない症例の血中濃度と服用後の時間経過をみると, 2時間後および4, 5時間後の血中濃度は0.3μ9/mL前後であった.ベプリジルの血中濃度は用量依存性を示した、また, 慢性腎不全で血液透析を受けている3症例に心房細動予防の目的で投与されたべプリジルの血中濃度を透析前後で比較してみると, ベプリジルは透析で除去されることなく, 透析前後でほぼ同様の値を示した.

Pharmacological treatment for atrial fibrillation has a variety of purposes, such as pharmacological defibrillation, maintenance of sinus rhythm, heart rate control to prevent congestive heart failure and prevention of both cerebral infarction and atrial remodeling. Sodium channel blockers are superior to potassium channel blockers for atrial defibrillation, while both sodium and potassium channel blockers are effective in the maintenance of sinus rhythm. In general, digitalis or Ca antagonists are used to control heart rate during atrial fibrillation to prevent congestive heart failure, while amiodarone or bepridil also reduce heart rates during atrial fibrillation. Anticoagulant therapy with warfarin is recommended to prevent cerebral infarction and angiotensin converting enzyme antagonists or angiotensin II receptor blockers are also used to prevent atrial remodeling. One should select appropriate drugs for treatment of atrial fibrillation according to the patient's condition.

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: We reported that as for the placement parts of generator, to place the generator at left axillary fossa with axillary vein puncture was thought to be useful from the mental, functional and cosmetic standpoint. But objective assessment was different. Purpose: The purpose of this study is to make comparative study of mental, functional and cosmetic situation by the generator planting part of pacemaker. Method and Patients: The questioner investigation concerning impact shock from out side of body, electromagnetic wave interference, cosmetic condition and satisfaction rating to present pacemaker planting part was performed to 10 patients at left axillary fossa (F) and 119 patients at the anterior chest (A). Result: 1) There were 66% worry in A for the impact shock to pacemaker planting part from the outside, and 90% in F had the sense of security. 2) 42.3% thought pacemaker to be remarkable and 57.1% was not satisfied in A but 90% was satisfied in F with the placement parts of generator. Conclusion: Though A was 119 and F was 10, and comparative study is difficult. F is giving a good effect as a tendency in the function, the mental and cosmetic aspect compared with A. It is scheduled that the more cases are examined in the future.