bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep Apnea Syndrome in Patients with Atrial Fibrillation —2 Cases Whose Atrial Fibrillation Was Controlled by Treatment for Sleep Apnea Syndrome—
Authors: Fujimoto Manabu , Masakazu Yamamoto
Published: August 2012

A high rate of sleep apnea syndrome (SAS) complicated by atrial fibrillation (AF) has been reported. We reviewed the frequency of SAS complications in AF patients, and reported on the patients for whom SAS was considered to be a cause of the AF. We studied 28 patients with AF who were able to receive a sleep apnea examination. All patients had oxygen saturation measured by an ambulatory percutaneus monitor (PULSOX) during sleep. A sleep apnea examination was performed by polysomnograph (Morpheus) in 19 of the patients. There were 18 patients (64%) with moderate to severe SAS whose apnea hypoxia index (AHI) or 3% oxygen disaturation index was more than 20. In this study, AF was stopped by treating SAS with continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) in 2 cases. Our study shows a high rate of SAS complications with AF, which is in accord with previous studies. We experienced cases in which AF was stopped by treating SAS with CPAP or NPPV, suggesting it is a cause of AF.
Quality of Life and Psychological Factors in Patients with Implantable Cardioverter Defibrillator
Authors: Suyama‐Chishaki Akiko , Miyazono Mami , Tsuchihashi‐Makaya Miyuki , Chishaki Hiroaki , Inoue Syujiro , Mukai Yasushi , Takemoto Masao , Kaji Ryoichi , Koike George , Maruyama Toru , Sunagawa Kenji , Arimura Tatsuyuki , Kubo Chiharu
Published: August 2012

INTRODUCTION: As indication for implantable cardioverter defibrillators (ICDs) has expanded, prophylactic implantations have increased. It has been well understood that some ICD recipients have psychological problems. Some of those problems are recognized as maladjustment syndromes.

METHODS: We studied 35 ICD recipients regularly followed at outpatient department of Kyushu University Hospital in order to clarify the psychological distress and the quality of their daily lives (QOL). By using questionnaire instruments (SF‐8, Beck Depression Inventory, Impact of Event Scale Revised, and State‐Trait Anxiety Inventory), we studied their psychological status.

RESULTS: Depression, anxiety, and post‐stress syndromes existed in 45.5% of the ICD recipients and their QOL was compromised. Female ICD recipients reacted to the stress related to ICD implantation differently from male recipients. Elder ICD recipients had a different way of adjustment from the younger recipients. Various ICD related psychological problems were noted in terms of magnitude and diversity.

CONCLUSION: To support ICD recipients both physically and mentally, not only the cardiologists but also specialists from other fields such as psychologists and nurse specialists are needed. Ancillary care must be provided through the support team. Cardiologists who determine whether ICD implantation is required must keep in mind potential psychological sequelae.
A Case with no Hemodynamic Benefit from Right Ventricular Anodal Capture during Biventricular Pacing
Authors: Kowase Shinya , Nogami Akihiko , Oginosawa Yasushi , Sugiyasu Aiko , Kubota Shoichi , Sakamaki Mihoko , Yamazaki Tetsuo , Nakajima Naohisa , Aoki Hajime , Yumoto Kazuhiko , Tamaki Toshiyuki , Kato Kenichi
Published: August 2012

This case report describes a patient with a biventricular pacing system in whom right ventricular anodal capture had no hemodynamic benefit. While controlling the ventricular output, three morphologies of the paced QRS complex were obtained: right ventricular stimulation, biventricular stimulation, and biventricular pacing with additional stimulation from the anodal electrode in the right ventricle. While the QRS duration was 5 ms longer, the left ventricular systolic pressure and dP/dtmax during biventricular pacing without anodal capture of the right ventricle were greater than that during biventricular pacing with anodal capture. To avoid useless high output settings, the hemodynamic and clinical data should be compared with and without right ventricular anodal capture in each individual patient.
Intracellular Calcium Dynamics and Autonomic Stimulation in Atrial Fibrillation: Mechanisms and Implications
Authors: Chou Chung‐Chuan , Chen Peng‐Sheng , Wu Delon
Published: August 2012

While atrial fibrillation is characterized by the co‐existence of multiple activation waves within the atria, rapid activations in the pulmonary veins play an important role for the initiation and maintenance of atrial fibrillation. In addition to reentry, non‐reentrant mechanisms resulting from abnormal intracellular calcium handling and intracellular calcium overload can also be responsible for these rapid activations in the pulmonary veins. Meanwhile, alterations of autonomic tone, involving both the sympathetic and parasympathetic nervous system, have been implicated in initiating paroxysmal atrial fibrillation. But the effectiveness of autonomic modulation as an adjunctive therapeutic strategy to catheter ablation of atrial fibrillation has been inconsistent. The interactions between the autonomic nervous system and atrial fibrillation are more complex than currently understood and further mechanistic and clinical studies are warranted.
Histopathology of the Posterolateral Myocardium in a Responder to Cardiac Resynchronization Therapy
Authors: Obara Chiaki , Matsuyama Taka‐aki , Mikoshiba Yuki , Isomura Naoei , Ashida Kazuhiro , Araki Hiroshi , Ochiai Masahiko
Published: August 2012

We present a 72‐year‐old man with idiopathic dilated cardiomyopathy, who was in New York Heart Association class III and had left ventricular (LV) dyssynchrony on tissue Doppler imaging. Cardiac resynchronization therapy (CRT) was performed for his heart failure, which improved to class I. Two years later, ventricular arrhythmias recurred, resulting in death. The LV posterior vein containing a pacing lead showed half‐circumferential fibrous thickening. The LV myocardium of this region was relatively well preserved, and interstitial fibrosis due to cardiomyopathy was mild. Absence of a massive fibrotic scar on the LV posterior wall and positioning of the pacing lead in the optimal coronary vein (a posterolateral vein) might have been positive factors determining this patient's response to CRT.
Stent placement to stabilize the left ventricular lead in the coronary sinus
Authors: Fujii Satoki , Tasaka Hiroshi , Kawakami Toru , Mitsudo Kazuaki , Takenaka Sou
Published: August 2012

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug‐resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III‐IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re‐operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course.
Efficacy and Safety of Strict Voltage‐based Substrate Mapping and Radiofrequency Catheter Ablation in Electrical Storms—Review of Substrate‐mapping Guided Ablation in Frequent Appropriate Shocks
Authors: Arimoto Takanori , Tada Hiroshi , Sekiguchi Yukio , Koyama Takashi , Igarashi Miyako , Yamasaki Hiro , Machino Takeshi , Kuroki Kenji , Kuga Keisuke , Aonuma Kazutaka
Published: August 2012

Background: We investigated the efficacy and safety of strict voltage‐based substrate mapping and radiofrequency catheter ablation (SV‐substrate‐map ablation) in patients with electrical storm.

Methods and Results: SV‐substrate‐map ablation was performed in 15 patients suffering from multiple appropriate shocks (6.0 ± 3.8/day) from implantable cardioverter defibrillators (ICDs). Strict voltage criteria were defined as: non‐arrhythmogenic areas, >0.6mV; low voltage areas, >0.1 to ≤0.6 mV; and scar, ≤0.1 mV. Using an electroanatomic mapping system, catheter ablation was performed at every possible arrhythmogenic region inside the low voltage areas. Further, we presented a review of the literature and investigated the published data on substrate‐mapping guided ablation for electrical storm. After repeat endocardial ablation procedures in 4 patients and an epicardial approach in one, the targeted ventricular tachycardias (VTs) were successfully ablated, and the electrical storms were completely controlled in all. During a mean follow‐up period of 801 ± 409 days, only one VT followed by an appropriate ICD shock was observed. No potential complications occurred during the procedure or follow‐up. Our results were comparable or better than that of previous substrate‐mapping guided ablation studies.

Conclusion: SV‐substrate‐mapping ablation may be effective and safe for resolving serious clinical situations and prolonging the longevity of ICD devices in patients with electrical storms.
Adenosine Triphosphate‐sensitive Micro‐reentrant Atrial Tachycardia Originating from the Crista Terminalis in a Patient with Chronic Renal Failure due to Thrombotic Thrombocytopenic Purpura
Authors: Sugiura Shinya , Fujii Eitaro , Senga Michiharu , Matsuo Koji , Tanoue Akiko , Murata Tomohiro , Ishikawa Eiji , Tamada Hiroya , Nakamura Mashio , Nomura Shinsuke , Ito Masaaki
Published: August 2012

A 57‐year‐old woman with chronic renal failure due to the thrombotic thrombocytopenic purpura complained of palpitation. A 12‐lead ECG showed supraventricular tachycardia with a cycle length of 375 ms. During the electrophysiological study, a tachycardia with a cycle length of 375 ms was reproducibly induced and terminated by atrial extrastimulation. The tachycardia exhibited an inverse relationship between the coupling interval of extrastimulus initiating the tachycardia, and the first postpacing return cycle, as well as an increasing pattern of resetting the tachycardia with an atrial extrastimulus. Ventricular burst pacing during tachycardia produced AV dissociation. Intravenous injections of a low dose (4 mg) of adenosine triphosphate (ATP) terminated the tachycardia without a preceding atrio‐His bundle block. The tachycardia was diagnosed as an ATP‐sensitive micro‐reentrant atrial tachycardia. Real‐time endocardial activation mapping using an electroanatomical mapping system revealed that the earliest activation site of the tachycardia was located at the midlateral portion of the crista terminalis. The tachycardia was abolished by focal ablation targeting the earliest activation site during tachycardia. This is the first reported case of an ATP‐sensitive micro‐reentrant atrial tachycardia associated with thrombotic thrombocytopenic purpura.
Prolonged Atrioventricular Block and Ventricular Standstill Following Adenosine Triphosphate Injection in a Patient Taking Dipyridamole and Antiarrhythmic Agents: A Case Report
Authors: Oe Kotaro , Araki Tsutomu , Hayashi Kenshi , Yamagishi Masakazu
Published: August 2012

An 83‐year‐old woman was admitted to our hospital because of palpitation. She had hypertension and paroxysmal atrial fibrillation, treated with digoxin and cibenzoline, and took dipyridamole for microalbuminuria. Before admission, she had taken pilsicainide pills in addition. On admission, electrocardiogram showed regular tachycardia with mildly prolonged QRS width. For the purpose of terminating tachycardia, 10 mg of adenosine triphosphate (ATP) was rapidly injected. About 20 sec later, atrioventricular block and ventricular standstill occurred. She presented loss of consciousness and convulsion, and chest compression was performed. About 30 sec later, the QRS complex reappeared, and she became alert. Serum concentration of digoxin, cibenzoline and pilsicainide was within therapeutic level, respectively. We should be cautious in using ATP for a patient taking dipyridamole and antiarrhythmic agents.
The Utility of Transtelephonic Electrocardiograms for Detecting Arrhythmia Recurrences after Radiofrequency Catheter Ablation for Atrial Fibrillation
Authors: Senga Michiharu , Fujii Eitaro , Sugiura Shinya , Yamazato Shoichiro , Nakamura Mashio , Ito Masaaki
Published: August 2012

Background: Extensive encircling pulmonary vein isolation (EEPVI) is effective for atrial fibrillation (AF). However, the definition of success following ablation is commonly based on the lack of symptoms. The purpose of this study was to determine the incidence of recurrences of AF by daily transtelephonic electrocardiogram (T‐ECG), as compared with Holter ECG, after ablation of AF.

Methods: Twenty‐two patients with AF underwent EEPVI. Holter ECG tests were performed at one, three, and six months, in addition to a daily T‐ECG for the first 180 days after ablation.

Results: A total of 6012 T‐ECGs were obtained. Of these, 18.9% (1136) showed AF. Patients with AF were asymptomatic for 41.4% (470) of the episodes. Additionally, in 64% (14 of 22) of the patients, AF recurrences were recorded by T‐ECG, whereas Holter ECG tests did not detect AF recurrences in 50% of the patients (7 of 14).

Conclusions: T‐ECG is better than Holter ECG in detecting AF relapses. The absence of symptoms should not be interpreted as absence of AF.
A Comparison of the Acute Phase Cardiac Function Between Septal and Apical Right Ventricular Pacing in Individual Patients
Authors: Hirayama Yasutaka , Kawamura Yuichiro , Saito Tatsuya , Yamazaki Kohko , Suzuki Johji , Kashiwagi Yusuke , Gima Mitsuru , Tanaka Hideichi , Shiraga Kotaro , Hotta Daisuke , Tsukamoto Masaru , Yokoyama Hideo , Sato Nobuyuki , Hasebe Naoyuki , Kikuchi Kenjiro , Ohori Katsumi
Published: August 2012

In recent years right ventricular septal pacing (RVSP) has been performed instead of right ventricular apical pacing (RVAP) because of the detrimental effects on the ventricular function associated with the latter type of pacing. However, little information has been available on the comparison of the cardiac function between RVAP and RVSP in individual patients. Therefore, we compared the changes in the cardiac index (CI) between RVAP and RVSP (right ventricular outflow tract or mid‐ventricular tract) in each patient in whom a permanent pacemaker was implanted. We measured both the QRS duration and acute phase of the cardiac function by means of a Swan‐Ganz catheter and compared the results between RVAP and RVSP. RVSP was associated with a shorter QRS duration (139.5 ± 4.6 vs. 180.6 ± 4.6 msec, p < 0.0001) in comparison to RVAP. Although there was no significant difference in the CI between the 2 pacing positions (2.71 ± 0.12 vs. 2.74 ± 0.13 L/min/m2, p = 0.6969), the CI among the patients with complete atrioventricular block (cAVB) had a strong tendency of being better with RVSP patients (2.65 ± 0.19 vs. 2.84 ± 0.19 L/min/m2, p = 0.1444). It is suggested that the beneficial effect of RVSP differs according to the causal disorder for pacemaker implantation.
Antithrombotic Therapy According to the Guidelines Issued by the Japanese Circulation Society in Patients with Nonvalvular Paroxysmal Atrial Fibrillation without Thromboembolic Risk Factors
Authors: Ozawa Mahito , Komatsu Takashi , Tachibana Hideaki , Sato Yoshihiro , Orii Makoto , Kunugita Fusanori , Nakamura Motoyuki
Published: August 2012

Aim and method: There have been few reports about the risk of ischemic stroke in elderly patients with non‐valvular paroxysmal atrial fibrillation (NVPAF). The aim of this study was to evaluate the validity of the guidelines issued by the Japanese Circulation Society to prevent ischemic stroke for NVPAF in patients without a high risk of ischemic stroke. The risk evaluation was made based on the CHADS2 Score. However, we excluded age in this study, but included coronary disease. This study investigated a total of 150 patients with paroxysmal atrial fibrillation (AF) who did not have a high risk of stroke (117 men and 33 women, mean age 68 ± 12 years). The patients were divided into three groups according to age: the patients who were less than 60 years old (Group I, N = 58, Antithrombic therapy (+) = 18), those who were between 60 and 75 years old (Group II, N = 68, Antithrombic therapy (+) = 36) and those who were more than 75 years old (Group III, N = 24, Antithrombic therapy (+) = 7). The annual rates of thromboembolism among three groups were retrospectively analyzed. The mean follow‐up periods were 56 ± 37 months.

Results: (1) The annual rate of thromboembolism in Group III (4.0%) was significantly higher than in Group I (1.4%) and Group II (1.8%) (P < 0:05). (2) The annual rates of thromboembolism in patients without antithrombotic therapy were 2.1% in Group I, 1.3% in Group II and 3.9% in Group III. The annual rate was significantly lower in Group II than in Group III (P < 0:05). (3) The annual rates of thromboembolism with aspirin treatment (80‐ 100 mg/day) were 0% in Group I, 3.0% in Group II and 8.4% in Group III. There was a significant difference in the annual rate among the three groups (P < 0:05). (4) The annual rate of thromboembolism in patients with warfarin treatment was 0% in Group I, 1.5% in Group II and 0% in Group III (P = NS among 3 groups). Conclusion: Antithrombic therapy is required in elderly patients with NVPAF to prevent ischemic stroke. Antithrombic therapy with Warfarin, but not aspirin, reduces ischemic stroke in patients with NVPAF regardless of their age.
Effects of Bepridil on Atrial Electrical Remodeling in Short‐Term Rapid Pacing
Authors: Tsuchiya Hiroto , Nakazato Yuji , Hayashi Hidemori , Suzuki Takeshi , Sekita Gaku , Daida Hiroyuki
Published: August 2012

Introduction: Bepridil is a multi‐ion channel blocker similar to amiodarone. Recent clinical studies have indicated that bepridil shows a favorable efficacy for the treatment of atrial fibrillation (AF). The purpose of this study is to evaluate the effectiveness of bepridil for electrical remodeling induced by rapid atrial stimulation particularly in the acute‐phase.

Methods and Results: We studied 18 pigs subjected to right atrial appendage rapid pacing at 500 beats/min for 3 hours that were randomly assigned to the absence or presence of bepridil administration for 14 days. They were divided into 2 groups, an atrial pacing only group (PG; n = 10) and an atrial pacing plus bepridil group (PBG; n = 8). We measured the effective refractory period (ERP) at the right atrial free wall (RAFW), the right atrial appendage (RAA) and the left atrial free wall (LAFW), as well as the monophasic action potential duration at 90% (MAPD90) in RAA during the rapid pacing phase and recovery phase.

In the PG, the ERP decreased gradually at all atrial sites during the 3 hour phase of rapid pacing. In contrast, the shortening of the ERP was suppressed significantly at the RAFW and LAFW in the PBG. The MAPD90 was also shortened by rapid atrial pacing in the PG. This shortening was suppressed significantly in the PBG.

We evaluated the effect of bepridil on the inducibility of AF during all time spans. The mean number of AF occurrences in the PBG was significantly fewer than in the PG. (2:1 ± 2:4 vs. 8:5 ± 7:0, p < 0:05)

Conclusions: Bepridil prevented the shortening of the ERP and MAPD90 induced by rapid atrial pacing in the acute phase. The results of this study might explain the efficacy of bepridil for preventing the recurrence of paroxysmal AF.
Variation in Lead Impedance according to Pacemaker Analyzing Systems
Authors: Ichiyanagi Hiroshi , Shiga Yoshiko , Ooiwa Noriaki , Nishiki Kazue , Hara Kimiko , Sato Yuki , Hayashi Hiroki , Inden Yasuya
Published: August 2012

Background: The pacing lead system is electrically evaluated by a pacing system analyzer (PSA) during device implantation. However, it remains unknown whether measured data vary according to the PSA or the implantable device. We estimated differences in lead impedance measured by different PSAs and devices using a laboratory model.

Methods: Five pacing and 3 defibrillation leads were used. We fixed the lead tip to a piece of meat immersed in physiologic saline and measured lead impedance using 4 PSA and 13 implantable device models.

Results: The mean impedance of the 5 pacing leads as measured by PSAs was 735 to 611 ohms and the difference between the maximum and minimum values was 126 ohm. The maximum difference according to PSAs was 222 ohm. The mean impedance of the 5 pacing leads as measured by the implantable generators was 770 to 606 ohms, the difference was 175 ohms and the maximum difference was 309 ohms. The 3 defibrillation lead impedances varied from 427 to 1091 ohms and the mean impedance was 706 to 557 ohms. The differences were 149 ohm as measured by the PSAs and 157 ohms by the implantable cardioverter defibrillator (ICD) generators. The maximum differences were 241 ohms by the PSAs and 281 ohms by the ICD generators.

Conclusion: Lead impedance varied according to analyzing systems.
Management of Patients Receiving Warfarin during Invasive Procedures and the Adverse Effects of Warfarin
Authors: Watanabe Norikazu , Tanno Kaoru , Ito Haruyuki , Onuki Tatsuya , Miyoshi Fumito , Minoura Yoshino , Kawamura Mitsuharu , Asano Taku , Katagiri Takashi , Kobayashi Youichi
Published: August 2012

Aim: The aim of this study was to assess the frequency and characteristics of complications in patients on anticoagulant therapy who were to undergo invasive procedure.

Methods and Results: We sent a questionnaire to 2758 doctors who were on the mailing list of the Japanese Society of Cardiac Pacing and Electrophysiology in August 2004. We received 614 questionnaires (response rate, 22.3%). Out of the 614 doctors, 19 (3.1%) reported that their patients had embolic events upon the interruption of warfarin therapy during dental extraction. In patients undergoing invasive procedures such as surgery, endoscopy, pacemaker implantation, and catheterization, 168 (27.4%) of the 614 doctors reported embolic events after the interruption of warfarin therapy. Further, 255 (41.5%) of the 614 doctors reported bleeding episodes when warfarin therapy was continued during the invasive procedures.

Conclusion: Several complications of different types were reported to occur in patients receiving warfarin therapy who underwent elective invasive procedures, regardless of whether warfarin administration was interrupted or continued at the time of the invasive procedure. Therefore, it is necessary to make careful decisions about the management of patients on warfarin therapy who will be undergoing invasive procedures.
Rapid Improvement and Long‐term Stability of Pacing Threshold with Active‐fixation Screw‐in Lead
Authors: Sekita Gaku , Nakazato Yuji , Hayashi Hidemori , Hirano Keiko , Sugihara Masami , Yamase Miki , Komatsu Kaoru , Suzuki Takeshi , Kawano Yasunobu , Tokano Takashi , Sumiyoshi Masataka , Daida Hiroyuki
Published: August 2012

Background: Active‐fixation screw‐in leads are associated with initially high thresholds. However, pacing thresholds have been shown to improve within several minutes after screwin. The aim of this study is to investigate the long‐term stability of rapidly improved pacing thresholds following the implantation of active‐fixation screw‐in leads.

Methods: We performed a prospective observational study on 68 consecutive patients, who were referred for an initial pacemaker or implantable cardioverter defibrillator implantation. Pacing thresholds, sensing amplitudes, and lead impedances were measured immediately after screw‐in. If the initial pacing threshold was higher than 2.0 volts, lead reposition was performed. If the initial pacing threshold was lower than 1.0 volts, the lead position was considered adequate. If the initial pacing threshold was slightly high, i.e., between 1.0 and 2.0 volts, all parameters were measured again 5 minutes after screw‐in without lead repositioning, and 1 week, 1 month, 6 months, and 1 year after the procedure.

Results: Fifty‐three atrial leads and 59 ventricular leads were implanted using activefixation screw‐in leads. The initial pacing threshold was slightly high, i.e., between 1.0 and 2.0 volts in 16 (30%) atrial leads and 28 (47%) ventricular leads. Pacing thresholds significantly improved after 5 minutes in both atrial and ventricular leads as follows: 1:5 ± 0:2 to 0:9 ± 0:3 volts (p < 0:05) in atrial leads and 1:5 ± 0:3 to 0:9 ± 0:3 volts (p < 0:05) in ventricular leads. These improved pacing thresholds remained stable during the first year and were 0:8 ± 0:3 volts in atrial leads and 0:8 ± 0:2 volts in ventricular leads after the initial year. P‐ and R‐wave amplitudes did not change significantly during the follow‐up. Lead impedances decreased 1 week after the procedure and remained stable in both atrial and ventricular leads.

Conclusions: Slightly high pacing thresholds using active‐fixation screw‐in leads improved rapidly and remained stable in the long term. An acute pacing threshold of <2:0 volts immediately after screw‐in may change to an acceptable value without lead repositioning.
Cardiac Resynchronization for Corrected Transposition of the Great Arteries with Systemic Right Ventricle Failure after Tricuspid Valve Replacement and Ventricle Septal Defect Closure
Authors: Fujii Kosuke , Saga Toshihiko , Kitayama Hitoshi , Nakamoto Susumu , Kaneda Toshio , Kawasaki Hiroshi , Takaba Kiyoaki , Imura Masato , Nishino Takako , Yukami Shintaro , Iemura Junzo
Published: August 2012

A 32‐year‐old man developed systemic right ventricular (RV) heart failure after ventricular septal defect (VSD) closure and tricuspid valve replacement for corrected transposition of the great arteries with VSD and Ebstein anomaly. He subsequently experienced RV failure with wide QRS and atrial fibrillation (AF). Because corrective surgery for this condition seemed over risky, we decided to perform cardiac resynchronization therapy with implantation of an implantable cardioverter defibrillator (CRT‐D). After CRT‐D device implantation, the patient showed improved performance status in terms of New York Heart Association functional class, B‐type brain natriuretic peptide levels, RV ejection fraction and cardiac electrical rhythm. CRT‐D implantation is a useful approach for systemic RV failure with wide QRS duration showing right bundle branch block and AF.
Fractured Guidewire during Left Ventricular Lead Insertion: A First Case Report
Authors: Nishihara Shuzo , Anzai Hitoshi , Nishi Yuhtaro , Takao Nobuhiro , Hayashida Noriaki
Published: August 2012

We report on a 77‐year‐old man who had been diagnosed with diabetes and hypertension. He had also been diagnosed with cardiomyopathy, although details were unclear. He was referred from local clinics after becoming aware of shortness of breath on exertion. Electrocardiogram showed a 2:1 atrioventriculer block with a wide QRS beat. Echocardiography and cardiac MRI showed very poor left ventricular contraction with chamber dilatation. Echocardiography showed left bundle branch block with dyssynchrony. On the electrophysiological testing, ventricular tachycardia and ventricular fibrillation were not induced, and no significant findings on coronary angiography had revealed at that time. He had shortness of breath on exertion with bradycardia‐tachycardia syndrome and low cardiac function, and his electrophysiological examination was negative. Therefore we decided to implamt cardiac resynchronization therapy pacemaker (CRT‐P). During a guide‐wire insertion for placement of the left ventricular lead into the coronary venous branch, the tip of the guide‐wire suddenly broke off. We attempted to recover the fragment using a snare catheter, but were unsuccessful. Since then the patient has been under observation, with no clinical manifestations seen.
Summary of the Abstracts Contents at Cardiostim 2010
Authors: Ritter Philippe
Published: August 2012

Cardiostim is a congress dedicated to devices, interventional electrophysiology and noninvasive electrophysiology. It was born in 1978, and imagined by Dr Jacques Mugica for educational purposes, and is held traditionally in Nice, French Riviera, on even years. This 2010 edition had 5700 participants coming from 92 countries. A large Japanese attendance was present and two joint sessions were organized with the Japanese Heart Rhythm Society.

The program was divided into three sections: updates, education, and presentations based on selected submitted abstracts.

Following is a summary of these selected abstracts, which does reflect the trends of our specialty, and of technological advances. For devices, telemedicine, MRI compatibility, full automaticity were the main topics. In cardiac pacing, respect of spontaneous AV conduction is confirmed as being essential, and positioning of the right ventricular lead remains an issue. For ICDs, better definition of candidates, utility of DFT testing, and reduction in inappropriate shocks are the main concerns. In CRT, extension of indications toward earlier stages of HF, implementation of hemodynamic sensors, and new approaches to the left ventricle are at the first row.

Ablation techniques benefit from new technologies: interest and limits of cryo‐ablation, new radio‐frequency catheters, visualization of ablative lesions, contact control, and use of imaging techniques. The goals are: to speed up procedures, make them safer, and more efficient.
Beneficial Effects of Upgrading from Right Ventricular Pacing to Cardiac Resynchronization Therapy in Patients with Heart Failure Compared to de Novo Cardiac Resynchronization Therapy
Authors: Kabutoya Tomoyuki , Mitsuhashi Takeshi , Hata Yoshihito , Hashimoto Toru , Nakagami Rieko , Osada Jun , Watanabe Tomonori , Shimada Kazuyuki , Kario Kazuomi
Published: August 2012

Background: The effects of upgrading from right ventricular (RV) pacing to cardiac resynchronization therapy (CRT) in patients with heart failure remains unclear. The aim of this study was to evaluate the improvement of cardiac function in patients upgraded from RV pacing to CRT.

Methods: We studied 48 consecutive patients who underwent CRT implantation, and were followed up for more than 6 months. This group included 15 patients who were upgraded from RV pacing. We measured left ventricular (LV) dp/dt to determine the timing of LV‐RV sequential pacing. Echocardiographic examination was performed before and 6–12 months after the CRT procedure to assess the LV ejection fraction (LVEF).

Results: In overall patients, LVEF increased after CRT (31.4 ± 9.8 vs. 37.1 ± 13.6%, p = 0.005). The increase of LVEF was more significant in the upgrade group (31.3 ± 9.4% to 41.9 ± 13.9%, p = 0.01) than in the newly implanted group (31.5 ± 10.1% to 35.0 ± 13.1%, p = 0.13). An increase of dp/dt during CRT was significantly positively associated with an increase of LVEF (r = 0.74, p = 0.01) in overall patients.

Conclusion: The upgrading from RV pacing to CRT was associated with greater improvement of LV systolic function than de novo CRT implantation. The change of dp/dt might be useful to predict the improvement of LV systolic function.
Permanent Pacemaker Implantation via the Iliac Vein: An Alternative in 4 Cases with Contraindications to the Pectoral Approach
Authors: Tsutsumi Koji , Hashizume Kenichi , Kimura Naritaka , Taguchi Shinichi , Inoue Yoshito , Kashima Ichiro , Takahashi Ryuichi
Published: August 2012

We report the outcome of the iliac vein approach for permanent pacemaker implantation in 4 patients in whom the conventional pectoral approach was not possible. The reasons for using the iliac vein approach were: recurrent lead infections at bilateral pectoral positions in 1 patient; superior vena cava obstruction following cardiac surgery in 2 patients; and a postoperative dermal scar due to right radical mastectomy secondary to a persistent left superior vena cava with absence of the innominate vein in 1 patient. This technique was safe and effective during the mean follow‐up period of 24.3 months. At the latest follow‐up, no patients showed signs of electrophysiological abnormalities. No short‐ or long‐term complications were seen. Conclusions: The iliac vein approach is a less invasive and more feasible alternative without any complications for patients in whom the pectoral approach cannot be used.
Electromagnetic Interference with Cardiac Implantable Devices by Household and Industrial Appliances
Authors: Yonemura Tomohide , Koyama Junjiroh , Sakai Yoshirou , Morinaga Keiko , Kurosaki Ryousuke , Araki Yasuyuki , Kawano Yosin , Nozoe Masayoshi , Tayama Shinji , Honda Toshihiro , Nakao Koichi
Published: August 2012

Modern cardiac implantable devices (CIDs. such as pacemakers (PMs), implantable cardioverter defibrillators (ICDs), and defibrillators for cardiac resynchronization therapy (CRT‐Ds. are engineered to be resistant to electromagnetic interference (EMI). However, such interference is still a concern when patients are exposed to household and occupational appliances in daily life. The aim of this study was to evaluate the risk of EMI caused by several types of household and industrial appliances. EMI with 20 CIDs (12 PMs, 7 ICDs, 1 CRT‐D. was tested for 16 household and 19 industrial appliances using three methods of measurement: Irnich's human body model, an alternating electric field device, and an alternate‐current and static‐current magnetic field device. The thresholds for the risk of EMI were defined as an alternating electric field of 5000 V/m, an alternate‐current magnetic field of 20 mT, and a static‐current magnetic field of 10 G. In 35 tests, 15 of the 16 household appliances showed no EMI with any CIDs, but an induction oven showed a potential risk of EMI with 2 PMs. None of the 19 industrial appliances showed EMI with any CIDs, provided that an appropriate distance from the appliances was maintained. These findings should allow physicians to evaluate whether patients with a CID can safely return to their homes and workplaces.
Oversensing of a Particular Transient Noise Appearing After the Implantation of an Implantable Cardiac Device
Authors: Okahara Shigeyuki , Nakano Yukiko , Miyamoto Satoshi , Matsuzaki Hisayasu , Takahashi Hidenobu , Oda Noboru , Imai Katsuhiko , Sueda Taijirou , Kihara Yasuki
Published: August 2012

We experienced 2 cases in which oversensing of a particular noise after the implantation of an implantable cardiac device was observed in the acute phase. These were unusual cases in which the noise exhibited a low frequency pattern and appeared several hours after the implantation, but disappeared within 1 week. Here we present these cases and the details of an experiment investigating the origin of the noise and the methods for its prevention.

The noise in these cases led to pacing inhibition and could have induced an inappropriate shock due to oversensing, but its morphology and electromagnetic interference were atypical for a lead failure or myopotentials. The noise spontaneously disappeared from the analysis of the data stored in the device. In an experiment based on the Irnich model, in which it was assumed that blood invaded a damaged grommet, low frequency noise occurred which was similar to the noise in the two cases. We concluded that care must be exercised when handling grommets.
Focus on the Atrial Structure —Useful Anatomical Information for Catheter Ablation—
Authors: Igawa Osamu
Published: August 2012

Catheter ablation of atrial fibrillation (AF) has been making remarkable progress for the last decade. When manipulating the catheter in the procedure, we have to reconstruct the three‐dimensional cardiac structure in our heads by using two‐dimensional fluoroscopic image. The author, an interventional electrophysiologist, developed and proposed a new method for recognizing the cardiac structure by using human body sections.

In order to easily create practical cardiac images, the human bodies were cut sagittally, obliquely and coronally. In the sections obtained, the heart could be observed together with their surroundings within the thorax in the neutral position. The most important point is that the heart is observed without being removed from the body. This concept of the research is to recognize the heart as an object composed of many structures. It was useful for analyzing the mechanism of arrhythmia and to improve catheter technique and mapping systems.
The anti-proliferative effect of TI1B, a major Bowman–Birk isoinhibitor from pea (Pisum sativumL.), on HT29 colon cancer cells is mediated through protease inhibition
Authors: Clemente Alfonso , Carmen Marín-Manzano M. , Jiménez Elisabeth , Carmen Arques M. , Domoney Claire
Published: August 2012

Bowman–Birk inhibitors (BBI) from legumes, such as soyabean, pea, lentil and chickpea, are naturally occurring plant protease inhibitors which have potential health-promoting properties within the mammalian gastrointestinal tract. BBI can survive both acidic conditions and the action of proteolytic enzymes within the stomach and small intestine, permitting significant amounts to reach the large intestine in active form to exert their reported anti-carcinogenic and anti-inflammatory properties. In a previous study, we reported the ability of a recombinant form of TI1B (rTI1B), representing a major BBI isoinhibitor from pea, to influence negatively the growth of human colorectal adenocarcinoma HT29 cellsin vitro.In the present study, we investigate if this effect is related directly to the intrinsic ability of BBI to inhibit serine proteases. rTI1B and a novel engineered mutant, having amino acid substitutions at the P1positions in the two inhibitory domains, were expressed in the yeastPichia pastoris. The rTI1B proved to be active against trypsin and chymotrypsin, showingKivalues at nanomolar concentrations, whereas the related mutant protein was inactive against both serine proteases. The proliferation of HT29 colon cancer cells was significantly affected by rTI1B in a dose-dependent manner (IC50 = 31 (sd7) μm), whereas the inactive mutant did not show any significant effect on colon cancer cell growth. In addition, neither recombinant protein affected the growth of non-malignant colonic fibroblast CCD-18Co cells. These findings suggest that serine proteases should be considered as important targets in investigating the potential chemopreventive role of BBI during the early stages of colorectal carcinogenesis.
Phaseolusbeans: impact on glycaemic response and chronic disease risk in human subjects
Authors: Hutchins Andrea M. , Winham Donna M. , Thompson Sharon V.
Published: August 2012

Consumption ofPhaseolus vulgarisbean species such as pinto, black, navy or kidney may be beneficial in the prevention and treatment of chronic diseases. In particular, conditions that are promoted by increased glycaemic stress (hyperglycaemia and hyperinsulinaemia) including diabetes, CVD and cancer seem to be reduced in individuals who eat more of these beans. The present paper discusses the influence ofP. vulgarisspecies on glycaemic response and the impact that relationship may have on the risk of developing diabetes, CVD and cancer.
Nutritional quality and health benefits of chickpea (Cicer arietinumL.): a review
Authors: Jukanti A. K. , Gaur P. M. , Gowda C. L. L. , Chibbar R. N.
Published: August 2012

Chickpea (Cicer arietinumL.) is an important pulse crop grown and consumed all over the world, especially in the Afro-Asian countries. It is a good source of carbohydrates and protein, and protein quality is considered to be better than other pulses. Chickpea has significant amounts of all the essential amino acids except sulphur-containing amino acids, which can be complemented by adding cereals to the daily diet. Starch is the major storage carbohydrate followed by dietary fibre, oligosaccharides and simple sugars such as glucose and sucrose. Although lipids are present in low amounts, chickpea is rich in nutritionally important unsaturated fatty acids such as linoleic and oleic acids. β-Sitosterol, campesterol and stigmasterol are important sterols present in chickpea oil. Ca, Mg, P and, especially, K are also present in chickpea seeds. Chickpea is a good source of important vitamins such as riboflavin, niacin, thiamin, folate and the vitamin A precursor β-carotene. As with other pulses, chickpea seeds also contain anti-nutritional factors which can be reduced or eliminated by different cooking techniques. Chickpea has several potential health benefits, and, in combination with other pulses and cereals, it could have beneficial effects on some of the important human diseases such as CVD, type 2 diabetes, digestive diseases and some cancers. Overall, chickpea is an important pulse crop with a diverse array of potential nutritional and health benefits.
Body composition in older community-dwelling adults with hip fracture: portable field methods validated by dual-energy X-ray absorptiometry
Authors: Villani Anthony M. , Miller Michelle , Cameron Ian D. , Kurrle Susan , Whitehead Craig , Crotty Maria
Published: August 2012

Ageing is associated with weight loss and subsequently poor health outcomes. The present study assessed agreement between two field methods, bioelectrical impedance spectroscopy (BIS) and corrected arm muscle area (CAMA) for assessment of body composition against dual-energy X-ray absorptiometry (DXA), the reference technique. Agreement between two predictive equations estimating skeletal muscle mass (SMM) from BIS against SMM from DXA was also determined. Assessments occurred at baseline < 14 d post-surgery (n79), and at 6 months (6M;n75) and 12 months (12M;n63) in community-living older adults after surgical treatment for hip fracture. The 95 % limits of agreement (LOA) between BIS and DXA, CAMA and DXA and the equations and DXA were assessed using Bland–Altman analyses. Mean bias and LOA for fat-free mass (FFM) between BIS and DXA were: baseline, 0·7 ( − 10·9, 12·4) kg; 6M, − 0·5 ( − 20·7, 19·8) kg; 12M, 0·1 ( − 8·7, 8·9) kg and for SMM between CAMA and DXA were: baseline, 0·3 ( − 11·7, 12·3) kg; 6M, 1·3 ( − 4·5, 7·1) kg; 12M, 0·9 ( − 5·4, 7·2) kg. Equivalent data for predictive equations against DXA were: equation 1: baseline, 15·1 ( − 9·5, 20·6) kg; 6M, 17·1 ( − 12·0, 22·2) kg; 12M, 17·5 ( − 13·0, 22·0) kg; equation 2: baseline, 12·6 ( − 7·3, 19·9) kg; 6M, 14·4 ( − 9·7, 19·1) kg; 12M, 14·8 ( − 10·7, 18·9) kg. Proportional bias (BIS: β = − 0·337,P< 0·001; CAMA: β = − 0·294,P< 0·001) was present at baseline but not at 6M or 12M. Clinicians should be cautious in using these field methods to predict FFM and SMM, particularly in the acute care setting. New predictive equations would be beneficial.
Association of high-sensitivity C-reactive protein with cardiometabolic risk factors and micronutrient deficiencies in adults of Ouagadougou, Burkina Faso
Authors: Zeba Augustin N. , Delisle Hélène F. , Rossier Clémentine , Renier Genevieve
Published: August 2012

Increasing evidence suggests that high-sensitivity C-reactive protein (hs-CRP) is associated with cardiometabolic risk factors (CMRF) while being also related to micronutrient deficiencies. As part of a project on the double burden of under- and overnutrition in sub-Saharan Africa, we assessed the relationship between hs-CRP and both CMRF and micronutrient deficiencies in a population-based cross-sectional study carried out in the Northern district of Ouagadougou, the capital city of Burkina Faso. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25–60 years and having lived in Ouagadougou for at least 6 months were randomly selected, and underwent anthropometric measurements and blood sample collection. The prevalence of high hs-CRP was 39·4 %, with no sex difference. Vitamin A-deficient subjects (12·7 %) exhibited significant risk of elevated hs-CRP (OR 2·5;P= 0·015). Serum ferritin was positively correlated with log hs-CRP (r0·194;P= 0·002). The risk of elevated hs-CRP was significant in subjects with BMI ≥ 25 kg/m2(OR 6·9; 95 % CI 3·6, 13·3), abdominal obesity (OR 4·6; 95 % CI 2·2, 7·3) and high body fat (OR 10·2; 95 % CI 5·1, 20·3) (P< 0·001, respectively). Independent predictors of hs-CRP in linear regression models were waist circumference (β = 0·306;P= 0·018) and serum TAG (β = 0·158;P= 0·027). In this sub-Saharan population, hs-CRP was consistently associated with adiposity. Assuming that plasma hs-CRP reflects future risk of cardiovascular events, intervention which reduces CRP, or chronic and acute nutrition conditions associated with it, could be effective in preventing their occurrence particularly in sub-Saharan Africa.
Sailing Against the Tide: Exhaustion of Domestic Remedies and the ECOWAS Community Court of Justice
Authors: Enabulele Amos O
Published: August 2012

This article examines the practice of the ECOWAS Community Court of Justice relating to the exhaustion of domestic remedies. It argues that the court is wrong to maintain the view that it is not bound by the doctrine, simply because the court's protocol is silent on the point. The author urges the court to reconsider its view in order to align its practice with prevailing customary international law and treaty trends on the exhaustion of domestic remedies in international suits espoused before international courts by or on behalf of individuals.
New species ofEpacanthion(Nematoda: Thoracostomopsidae) from Patagonia coast, Río Negro and Chubut, Argentina
Authors: Lo Russo V. , Villares G. , Martelli A. , Pastor de Ward C.T. , Harguinteguy C.
Published: August 2012

Two new free-living marine nematodes belonging to the family Thoracostomopsidae, subfamily Enoplolaiminae and the generaEpacanthionare described from Patagonian coastal areas, Río Negro and Chubut provinces of Argentina. InEpacanthion bicuspidatumsp. nov. the main features are: two cusps on distal mandible end; presence of two rings of eight setae in the cervical region; and eight crown-shaped setae along the body, presence of one supplement distant two cloacal body diameter (cbd) from cloacae, gubernaculum and short spicule.Epacanthion ampullatumsp. nov. is characterized by having a tubular and long pre-cloacal supplement, short spicule, presence of gubernaculum, presence of three long setae on the tip of the tail, the presence of one supplement distant three cbd from cloacae and the presence of two small cusps on the distal end of the mandible.
Uptake (un)limited: The mediatization of register shifting in US public discourse
Authors: Cole Debbie , Pellicer Régine
Published: August 2012

We observe thatmediatization(Agha 2011b) creates and maintains the conditions by which some messages and uptake formulations remain unavailable to larger audiences while others are continuously recycled and increasingly accessible. We argue that the maintenance of the unequal divisions of semiotic labor in ways that mirror socioeconomic inequalities at an increasingly global scale can be facilitated by mediatization as currently practiced. An analysis of the way that the uptake formulations of a mediatized fragment of a register-shifting event varied in its pre- and postmediatized contexts reveals how premediatized value projects can be systematically replaced during mediatization, limiting the availability of premediatized value projects for wider uptake. We observe that value projects attached to mediatized fragments work to maintain the hierarchy of perduring semiotic registers (Goebel 2010) in US public discourse in which Standard English repertoires continue to dominate all others. (Mediatization, Standard, semiotic register-shifting, black preaching style)
An intentional basis for corporate personality - RETRACTION
Authors: Amatrudo Anthony
Published: August 2012

This article provides a politico-jurisprudential account of the corporate personality which develops contemporary thinking about collective and shared intentions and their practical applications. It provides a model of corporate personality that is based on recent work by Bratman, Hurley, Raz and Sugden on the issues of shared intentions, interlocking preferences, and other supporting attitudes. The article will additionally detail issues of choice, coercion and will in relation to the work of scholars such as Dworkin and Velleman.