bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Sinus Activation Pattern in Patients with Atrioventricular Nodal Reentrant Tachycardia
Authors: Yagi Tetsuo , Scheinman Melvin M
Published: August 2012

Patterns of left atrial (far‐field signals) or coronary sinus (CS) muscle (near‐field) have been defined in CS recordings. The purpose of this study was to define the activation patterns from the coronary sinus in patients with anterior and posterior type of atrioventricular nodal reentrant tachycardia (AVNRT) circuits.

Methods and Results: This retrospective study involved a total of 149 patients with 155 episodes of AVNRT which were divided into 3 patterns. In the anterior pattern (123 tachycardias), the atrial deflection from the His bundle electrogram preceded that from the proximal CS electrogram. In the posterior pattern (23 tachycardias), the proximal CS electrogram (CSp) was recorded earlier than the His bundle atrial electrogram. In the left atrial pattern (9 tachycardias), activation of distal CS sites preceded both proximal CS and atrial activation from the His bundle electrogram. A decapolar catheter with a 5‐mm interelectrode distance was used for CS recording. The CS electrograms were analyzed to determine the total signal duration as well as the duration of the initial component. An initial slow wave was defined as a duration exceeding 10 ms. 1) The duration of the initial component in patients with the anterior pattern was longer than in those with the posterior pattern in CSp (7.3 ± 3.1 ms vs. 4.5 ± 2.0 ms), CS7‐8 (7.4 ± 2.9 ms vs. 3.8 ± 1.5 ms), CS5‐6 (7.3 ms ± 3.3 ms vs. 4.4 ms ± 2.5 ms) and CS3‐4 (6.7 ms ± 2.4 ms vs. 4.5 ms ± 2.0 ms) (p < 0.01). 2) Similarly the total electrogram duration in the CS was longer in patients with an anterior compared to a posterior pattern in CSp (38.3 ms ± 10.1 ms vs. 26.8 ± 6.1 ms), CS7‐8 (31.8 ms ±6.6 ms vs. 27.2 ms ± 6.0 ms), CS5‐6 (31.3 ms ± 6.8 ms vs. 26.5 ms ± 4.9 ms), and CS3‐4 (30.0 ms ± 6.3 ms vs. 25.0 ms ± 5.1 ms) (p < 0.01). 3) The percentage of tachycardias showing an initial slow wave followed by rapid activation was higher for anterior pattern patients compared with posterior pattern patients in CSp (62% vs. 13%), CS7‐8 (79% vs. 4%), CS5‐6 (72% vs. 4%), CS3‐4 (54% vs. 9%) and distal CS (47% vs. 0%) (p < 0.01).

Conclusions: The pattern of an initial slow wave followed by a rapid wave in the CS was characteristic of an anterior AVNRT circuit and is explained by the initial involvement of far field left atrial components. In contrast, the predominant early rapid waves in the posterior AVNRT circuit are compatible with early CS activation from the right atrium.
Electrophysiological and Histological Evaluation of Acute Efficacy and Safety of Balloon Occlusive Ablation at Superior Vena Cava‐Right Atrial Junction
Authors: Tanaka Kazushi , Hiura Norikazu , Sohara Hiroshi , Tanaka Michio , Satake Shutaro , Watanabe Yoshio
Published: August 2012

We evaluated efficacy and safety of occlusive radiofrequency catheter ablation (o‐RFA) using our thermal balloon catheter (TBC) at superior vena cava (SVC)‐right atrial (RA) junction (SVCJ) compared to that of RFA with a standard‐tip catheter. Methods: To electrically isolate (SVCI) SVC from RA in 10 pigs (group 1), the initial o‐RFA at a balloon surface temperature of 53.9 ± 3.0°C for 3–5 min (13.56 MHz) was achieved at the SVCJ completely obstructed with an inflated balloon. If unsuccessful, subsequent o‐RFA was repeated in a ࣘ5°C increments until reaching either SVCI or sinus arrest. Before and after each o‐RFA, stimulation protocol from the RA was performed. Additionally, in 5 different pigs (group 2), RFA at 55°C (ࣘ50 W) for 1 min with a 4 mm‐tip catheter was achieved at multiple sites along the SVCJ. Finally, the neighboring tissues of the SVCJ were histologically investigated. Results: In group 1, successful SVCI could be easily accomplished at the final temperature of 57.2 ± 2.4°C; however, in 3 pigs, a new atrial tachycardia was induced after o‐RFA at <55°C and in 2 pigs sinus arrest occurred during o‐RFA at 60°C. Histologically, transmural and circumferential contraction band necrosis was mainly confirmed around the SVCJ without damage to collateral tissue. In group 2, coagulation necrosis occupied almost all the ablative lesions, leading to severe degeneration of collateral tissue. Conclusion: O‐RFA at the SVCJ may be more feasible and safer than RFA.
Primary Prevention of Sudden Cardiac Death in Patients with Ischemic Heart Disease —Possible Role of the Shock Device in the Asia—
Authors: Kurita Takashi
Published: August 2012

Recently several randomized trials have demonstrated the excellent role of the implantable cardioverter‐defibrillator (ICD) in improving the mortality rate in patients with a high risk of sudden cardiac death regardless of its purpose or the underlying heart disease. However, because such large clinical trials have only been carried out in Western countries, those results may not be fully applicable to Japanese or other Asian patient populations.

According to a Japanese study, the total mortality in the patients was approximately 20% during 5 years of follow up, which was comparable to, or slightly better than that in the MADIT‐II patients with ICDs. In such a patient population with an excellent prognosis, the MADIT‐II criteria can not easily be applied. Therefore, we should strengthen the criteria, i.e. from an EF ≤ 35% to 25% or adopt the usage of additional examinations (e.g. signal averaging ECG, micro‐volt T wave alternance or EPS).
A Case of Transient Rise of Pacing Threshold during the Chronic Phase of Pacemaker Implantation
Authors: Kawachi Keisuke , Higashi Yukei , Yanagisawa Fumiko , Shimojima Hisa , Tsutsumi Takeshi , Takeyama Youichi
Published: August 2012

We experienced a case of pacing failure with transient rise of the pacing threshold more than one year after implantation. Neither the generator nor lead system was found to be defective. During the antibiotics therapy to treat cholecystitis, which was found on admission, pacing failure was improved. The clinical course suggested that the infection was related to the improvement, although accurate mechanisms were unknown.
Suppression of Ventricular Tachycardia Associated with Cardiac Sarcoidosis by Steroid Therapy
Authors: Miyaji Kotaro , Suzuki Makoto , Mizukami Akira , Iwatsuka Ryota , Kumasaka Reon , Ichihara Naoaki , Nagahori Wataru , Oono Masakazu , Arakawa Tetsuo , Masaki Nobuyuki , Matsumura Akihiko , Hashimoto Yuji
Published: August 2012

In patients with cardiac sarcoidosis, ventricular tachycardia (VT) is observed in some cases. However, effective therapies for the VT are still unknown.

Case: A 50‐year old female with cardiac sarcoidosis underwent DDD pacemaker implantation for a high degree atrioventricular block with symptoms of faintness and shortness of breath. One month after the surgery, she was admitted for frequent episodes of non‐sustained VT. In the electrophysiologic study (EPS), sustained monomorphic VT and ventricular fibrillation were induced; therefore pacemaker was replaced with implantable cardioverter‐defibrillator (ICD). Amiodarone was started orally but it couldn't suppress frequent VT episodes, and frequent ICD shocks were delivered. When the oral steroid therapy was initiated for the cardiac sarcoidosis, it not only suppressed the frequent VT but also improved the atrioventricular nodal dysfunction.

In conclusion, steroid therapy might be an option to consider in cardiac sarcoidosis with refractory VT.
The Prognosis of Patients who Received Automated External Defibrillator Treatment in Hospital
Authors: Kato Isao , Iwa Toru , Suzuki Yasushi , Ito Takayuki
Published: August 2012

Introduction: Unlike cardiac arrest occurring out‐of‐hospital, the safety and efficacy of automated external defibrillators (AED) in the hospital has not been assessed. This study examined the conditions of AED use in hospital and the prognosis of these patients.

Methods and Results: We examined the condition and prognosis of 32 patients who were given AED treatment while they were in an unconscious state in the hospital, between May 2004 and January 2007. During this period, AED was used only for patients, not for visitors or hospital personnel.

Ventricular fibrillation (VF) or ventricular tachycardia (VT) was observed in 7 patients, and in the other 25 the initial rhythm of the patients did not require AED. Two patients survived with the help of AED, but it did not deliver shock in two patients with VF and VT. There was no significant difference in vital prognosis due to the presence or absence of shock delivery in the VF or VT patients.

Conclusion: The situation of AED use may be different whether it is used in hospital or outof‐hospital. This study suggests that using AED in the hospital may have limited effect when it is used for critically ill patients.
Clinical Efficacy of Bepridil for Class I Antiarrhythmic Drug‐Induced Atrial Flutter in Patients with Paroxysmal Atrial Fibrillation
Authors: Hayashi Hidemori , Sumiyoshi Masataka , Suwa Satoru , Sakurai Hidehiko , Kawano Yasunobu , Sekita Gaku , Tokano Takashi , Nakazato Yuji , Daida Hiroyuki
Published: August 2012

Background: Class I antiarrhythmic drugs can promote the organization of atrial fibrillation (AF) and sometimes converts AF into atrial flutter (AFL) concomitant with difficulty of rate control. We studied the usefulness of Bepridil, which exhibits a class III‐like effect, for class I drug‐induced AFL in patients with paroxysmal AF.

Methods: The study population consisted of 17 consecutive patients (15 men, mean age 65 ± 8 years) with AFL converted from paroxysmal AF following oral treatment of class IA or IC antiarrhythmic agents including pilsicainide (n = 8), cibenzoline (n = 5), flecainide (n = 2), aprindine (n = 1), and propafenone with cibenzoline (n = 1). After the occurrence of AFL, class I drug was replaced by bepridil with a dose of 100–200 mg per day in all patients.

Results: After the treatment with bepridil, 15 (88%) out of the 17 patients restored sinus rhythm after 1 to 68 days (average of 21 days). In 12 (80%) of the 15 patients, sinus rhythm was maintained for an average of 23.6 months (range of 1 to 62 months) follow‐up period. Although torsade de pointes was not recognized, a marked QT prolongation (0.60 sec) was observed in one patient during the administration of bepridil at a daily dose of 200 mg. In this patient, QT interval was normalized (0.45 sec) after reduction of bepridil to 150 mg daily.

Conclusion: Bepridil treatment may be safe and effective for class I drug‐induced AFL in patients with paroxysmal AF to restore and maintain sinus rhythm as an alternative therapy for catheter ablation. However, the QT interval must be carefully monitored during this medication.
Pacemaker System Malfunction Resulting from External Electrical Cardioversion: A Case Report
Authors: Nishida Taku , Nakajima Tamio , Goryo Yutaka , Ishigami Ken‐ichi , Kawata Hiroyuki , Horii Manabu , Uemura Shiro , Saito Yoshihiko
Published: August 2012

In May 2005 a 68‐year‐old woman received a VDD pacemaker implantation in the right pectoral region at our hospital for the treatment of complete atrioventricular block. In July 2008, she was diagnosed with dilated cardiomyopathy based on histological testing. In November 2008, she developed syncope due to ventricular tachycardia while at another hospital. She underwent external electrical cardioversion with an anterior‐lateral paddle position using a single shock of 100 J. This shock led to severe bradycardia resulting in a transfer to our hospital. The physician who provided the shock could not have been aware that the patient had an implanted pacemaker. The skin above the pulse generator was burned. The electrocardiogram showed no pacing spikes or ventricular escape rhythm. Investigation of the pacemaker 3 hours after cardioversion revealed reprogramming of the device and a marked rise in the lead impedance (>3,000 ohm). Removal of the generator and implantation of a biventricular cardioverter defibrillator were required. The emergency situation, the small size of the generator, the small incision made using the buried suture method, and the patient's obesity all probably contributed to the physician's not noticing the implanted pacemaker. It is important to increase awareness of the severe consequences that may follow if the physician administering external defibrillation does not know about the patient's implanted pacemaker.
Sudden Cardiac Death and Coronary Artery Disease —Pathophysiology and Risk Stratification
Authors: EI‐Sherif Nabil , Khan Abdullah , Savarese Joseph , Turitto Gioia
Published: August 2012

Management of Sudden Cardiac Death (SCD) is undergoing a radical change in direction. It is becoming increasingly appreciated that besides depressed left ventricular systolic function and the conventional risk stratification tools, new markers for plaque vulnerability, enhanced thrombogenesis, specific genetic alterations of the autonomic nervous system, cardiac sarcolemmal and contractile proteins, and familial clustering may better segregate patients with atherosclerotic coronary artery disease who are at high risk for SCD from those who may suffer from nonfatal ischemic events. Better understanding of pathophysiological processes, such as postmyocardial infarction remodeling, the transition from compensated hypertrophy to heart failure, and the increased cardiovascular risk of coronary artery disease in the presence of diabetes or even a prediabetic state will help to improve both risk stratification and management. The rapidly developing fields of microchips technology and proteomics may allow rapid and cost‐effective mass screening of multiple risk factors for SCD. The ultimate goal is to identify novel methods for risk stratification, risk modification, and prevention of SCD that could be applied to the general public at large.
Attenuating Effects of Anti‐Arrhythmic Agents on Changes in Fibrillation Cycle Length in Very Early Phase Paroxysmal Atrial Fibrillation —Spectral Analysis of Fibrillation Waves in Surface ECG—
Authors: Fukaya Hidehira , Niwano Shinichi , Sasaki Takeshi , Kiryu Michiro , Kurokawa Sayaka , Hatakeyama Yuko , Sato Daisuke , Yumoto Yoshihiro , Moriguchi Masahiko , Niwano Hiroe , Fujiki Akira , Izumi Tohru
Published: August 2012

Background: Antiarrhythmic agents may affect electrical remodeling but little is known regarding clinical cases. We evaluated fibrillation cycle length (FCL) of atrial fibrillation (AF) by spectral analysis of fibrillation waves (FW) in surface ECG for patients on antiarrhythmic agents.

Methods and Results: 18 patients (14 males; 58 ± 2 year‐old) with paroxysmal AF (pAF) lasting over 30 minutes recorded by Holter ECG were enrolled. FW was purified by subtraction of QRS‐T, and calculated by fast Fourier transformation analysis. FCL was defined as reciprocal of mean peak frequency. Temporal variability was expressed as FCL coefficient of variation (FCL‐CV). FCL and FCL‐CV were calculated at 0, 1, 5, 10, and 30 minutes after the onset of AF. We evaluated three groups: control group (6 patients with no medication), class I group (6 patients with pilsicainide or flecainide), and bepridil group (6 patients with bepridil). FCL showed quick‐shortening at first minute in control group (p < 0.001), and relatively slow‐shortening in class I group. In bepridil group, FCL was not significantly shortened within 30 minutes. FCL‐CV did not change, but was significantly larger in bepridil group.

Conclusions: FCL of pAF showed significant shortening in control group, but FCL shortening was suppressed and FCL‐CV was larger in bepridil group. This result may indicate the specific effect of bepridil for electrical changes in early phase of pAF.
Prompt and Long‐term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome
Authors: Tasaki Hirofumi , Nagao Shoichi , Shinagawa Tatsuo , Nakao Kojiro , Komiya Norihiro , Maemura Koji , Yano Katsusuke , Saito Atsushi
Published: August 2012

A 72‐year‐old woman with sick sinus syndrome (SSS), who had frequent paroxysmal atrial fibrillations (PAfs) and normal cardiac function, was admitted to our hospital due to syncope. PAfs frequently occurred during the first week after DDD pacemaker implantation (PMI), with closed loop stimulation (CLS) rate‐adaptive mode off, but were completely suppressed during the second week, with CLS on, and had been well‐controlled over three years thereafter. However, PAfs occasionally occurred under intense sympathetic activity during 6 months after PMI as well, and were effectively terminated by disopyramide which had anticholinergic effect. Thus, the development and maintenance of PAf were thought to be associated with destabilized cardiac autonomic activities, that is, sympathetic and parasympathetic dominance, respectively. Additionally, heart rate variability analyses after implementation of CLS revealed the restoration of sympathetic and parasympathetic components. Accordingly, CLS mode was considered to play a critical role in preventing PAf by reflecting autonomic activity in heart rhythm in this SSS patient.
Clinical Background and Evaluation of Drug‐Induced Prolongation of QT Interval
Authors: Katoh Takao
Published: August 2012

Prolongation of QT/QTc interval during medical treatment can occur not only with cardiovascular drugs but also with non‐cardiovascular drugs. It may result in ventricular tachyarrhythmia, a high‐risk condition which may trigger sudden cardiac death. Thus, to avoid drug‐induced long QT syndrome and serious complications careful attention should be paid in the clinical setting.

Moreover, in the last several years objective evaluation by strictly applying electrocardiogram (ECG) data has been strongly recommended for the development of all new drugs in discussions held at the International Conference on Harmonization (ICH). This recommendation has already been adopted in the USA and the EU and is expected to be announced shortly in our country.

Not only the drugs but a variety of patient background factors may influence ECG parameters, especially the QT/QTc interval. It is necessary to introduce an appropriate study protocol that can evaluate the risk for QT/QTc prolongation related to the drug. Additionally, an adequate system to record, measure, and evaluate ECG with high objectivity must be applied to all clinical trials.
Implantable Cardioverter Defibrillator in a Patient with Eisenmenger Syndrome after Senning Repair for Transposition of the Great Arteries
Authors: Arimoto Takanori , Tada Hiroshi , Sekiguchi Yukio , Igarashi Miyako , Yamasaki Hiro , Kuroki Kenji , Horigome Hitoshi , Aonuma Kazutaka
Published: August 2012

An implantation of a cardioverter‐defibrillator was attempted in a 32‐year‐old man with atrial tachycardia, ventricular tachycardia and sinus node dysfunction. He had undergone a Senning operation and half closure of ventricular septal defect in order to correct a transposition of the great arteries. Cardiac catheterization revealed severe pulmonary hypertension and Eisenmenger syndrome. Prior knowledge of the complex cardiac anatomy obtained by magnetic resonance imaging helped in determining the suitable site for implanting the leads and planning the procedural strategy. With repletion of a large amount of saline and oral anticoagulation with warfarin, no complications related to thromboembolism occurred during a 10‐month follow‐up period.
Catheter Ablation of Reentrant Left Ventricular Tachycardia Associated with Fabry disease: A Case Report
Authors: Nakano Emi , Harada Tomoo , Soejima Kyoko , Sasaki Toshio , Mizuno Koichi , Miyake Fumihiko
Published: August 2012

A 51‐year‐old man, who was diagnosed with Fabry disease resulting from a kidney biopsy for proteinuria and renal failure in 2002, was admitted to our hospital for sustained ventricular tachycardia (VT). In the electrophysiological study, VT (cycle length: 310 ms) was successfully induced by right ventricle programmed stimulation and the twelve‐lead electrocardiogram showed a right bundle branch block configuration with right axis deviation. The mechanism of the VT was considered to be reentry by entrainment phenomenon. An electro‐anatomical mapping system identified a low voltage area located close to the left ventricular anterior‐apical wall. During VT an isolated pre‐potential was recorded 42 ms prior to the QRS onset near the border zone which was located between the low and normal voltage areas. At this mapping site entrainment with fusion and a post‐pacing interval that matched the VT cycle length were observed. A radiofrequency energy delivery at this site terminated the VT after 35 seconds. The entrainment mapping could be useful for identifying a critical reentry circuit path. This case is the first description of reentrant VT originating from the thickened left ventricle wall in a patient with Fabry disease.
AV Nodal Reentrant Tachycardia in a Patient with Persistent Left Superior Vena Cava: Distinction between AV Nodal Versus Atrial Reentry
Authors: Fukuda Terunobu , Haruna Tetsuya , Ito Hidehiro , Sasaki Kenichi , Abe Tomomi , Nakane Eisaku , Miyamoto Shouichi , Uehara Kyoukun , Ooba Muneo , Ueyama Kouji , Inoko Moriaki , Nohara Ryuji
Published: August 2012

A 75‐year‐old male presented with palpitation on exertion. He suffered from frequent tachycardia attacks. His 12‐leads electrocardiogram showed irregular cycle lengths (400–550 ms) of tachycardia with occasional 2:1 atrioventricular conduction (thus AV reentry was excluded). He had a complex anatomy of persistent left superior vena cava (PLSVC)/ enlarged coronary sinus (CS). The activation map in a 3‐dimensional CARTO system (Biosense‐Webster, USA) was merged with the multi‐detector computed tomography image and revealed that the tachycardia spread centrifugally from the junction between the PLSVC and enlarged CS. However, delivery of radio frequency (RF) energy to the earliest atrial activation site did not affect the tachycardia. Finally, the tachycardia was diagnosed as a fast/ slow type atrioventricular nodal reentrant tachycardia (AVNRT) because the tachycardia was cured only after the anterograde/retrograde AV conduction was disturbed by the application of RF energy to the posteroseptal perimitral area, possibly due to the injury to the AV node.
Role of Heart Rate Variability in Non‐Invasive Electrophysiology: Prognostic Markers of Cardiovascular Disease
Authors: Takase Bonpei
Published: August 2012

Conventional heart rate variability (HRV) indices comprise time domain and frequency domain HRV indices that not only reflect the autonomic control of the heart but also serve as prognostic markers of various cardiovascular disorders. These indices have been extensively investigated as prognostic factors for patients who develop coronary artery diseases including myocardial infarction (MI). Non‐linear indices of HRV such as the long (β)‐ and short (α1 and β2)‐term fractal component indices and approximate entropy analysis have been clinically applied. In addition, heart rate turbulence (HRT) and the deceleration capacity (DC) of heart rate have been studied as potential HRV indices for predicting untoward outcomes of cardiovascular diseases. This overview examines HRV indices and their roles in the setting of cardiovascular disorders including sudden cardiac death. We describe changes in HRV indices and clarify the relationship between prognosis and the indices in critically ill patients admitted to intensive care units.
Prevention of Torsade de Pointes during the Pharmacologic Treatment of Atrial Fibrillation
Authors: Mitamura Hideo
Published: August 2012

Potassium channel blockers are sometimes effective in the rhythm management of persistent atrial fibrillation. However, on rare occasions, a life‐threatening episode of torsade de pointes develops during treatment with these agents. Among several precautions against this tragedy, preventing exaggerated QT prolongation is of paramount importance. One of the difficulties in monitoring the QT interval during atrial fibrillation is the fact that its length varies depending not only on the fluctuating preceding intervals, but on other factors such as neurohumoral activation. In fact, even at the same preceding RR interval, the QT interval may vary from day to night, between atrial fibrillation and sinus rhythm. Accordingly, the QTc interval may not be a reliable parameter for predicting proarrhythmic events. As the result, close monitoring of the QT interval itself, just like INR monitoring during warfarin treatment, is mandatory both before and during treatment with these agents.
A Case of Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia Using Transseptal Approach, Guided by Electro‐Anatomical Mapping System
Authors: Higuchi Takafumi , Takenaka Kotoe , Yamauchi Ryoko , Haruna Yoshizumi , Takenaka Hiroyuki , Ozaki Masaaki , Kitaguchi Shouji
Published: August 2012

A 65 year‐old female was admitted to our hospital because of syncope. She has been previously diagnosed with dilated cardiomyopathy. Twelve‐lead electrocardiogram (ECG) presented narrow QRS tachycardia. Electrophysiological study and radiofrequency catheter ablation was performed. Under isoproterenol infusion, supraventricular tachycardia (SVT) was easily induced followed by critical AH interval. The mechanism of SVT was diagnosed with slow‐fast atrioventricular nodal reentrant tachycardia (AVNRT). We tried slow‐pathway ablation from venous approach targeted at the triangle of Koch using electrogram guide and anatomical approach. Slow‐pathway conduction was not eliminated, however, and SVT still could be easily induced. Therefore we delivered radiofrequency (RF) from the left atrial (LA) septum by transseptal approach using an electro‐anatomical mapping (EAM) system. After RF application at mid‐septum from the LA, the slow‐pathway conduction was modified and SVT could not be induced.
Focal and Reentrant Mechanisms of Torsades de Pointes: EAD, Reentry, or Chimera?
Authors: Murakawa Yuji
Published: August 2012

Torsades de pointes (TdP. is characterized not only by its electrocardiographic morphology but also by a tendency to spontaneously terminate. Although clinical and experimental studies suggested that TdP is triggered exclusively by early afterdepolarization, the reentrant mechanism seems to play a certain role in its maintenance. In this article, I review the studies that investigated the origin and activation sequences of the twisting QRS complexes of TdP, and discuss whether it is fortunate or unfortunate for us if TdP has something to do with reentry.
Efficacy and Safety of Bepridil for Patients with Persistent Atrial Fibrillation after Failed Electrical Cardioversion
Authors: Egami Yasuyuki , Nishino Masami , Taniike Masayuki , Makino Nobuhiko , Kato Hiroyasu , Shutta Ryu , Tanouchi Jun , Yamada Yoshio
Published: August 2012

Introduction: Bepridil is effective for atrial fibrillation (AF), but it can induce torsades de pointes. Thus we examined the efficacy and safety of bepridil when started at 100 mg/day for AF after failed electrical cardioversion (EC).

Methods and Results: We studied 28 consecutive patients (58 ± 12 years old) with failed EC. After administration of bepridil, we examined the time to restore the sinus rhythm, the duration of the maintained sinus rhythm. Our patients were divided into the two groups and various clinical factors were compared, including medication and echocardiographic and electrocardiographic parameters: the SR group who maintained sinus rhythm during followup period and the AF group who still had AF. Sixteen patients (57%) could maintain sinus rhythm (SR group). Adverse arrhythmic events were not observed. There were no significant differences in any clinical factors between the two groups before and after bepridil.

Conclusions: Bepridil was effective and safe for persistent AF with failed EC.
An Asymptomatic Case of Wolff‐Parkinson‐White Syndrome with Right‐sided Free‐wall Accessory Pathway and Left Ventricular Dysfunction
Authors: Mine Takanao , Kodani Takeshi , Hamaoka Mamoru , Masuyama Tohru
Published: August 2012

A 16‐year‐old girl with a known history of asymptomatic Wolff‐Parkinson‐White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow‐up. A 12‐lead surface ECG showed pre‐excitation, a predominantly negative delta wave in V1 and left axis deviation, which was consistent with the presence of a right free‐wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium‐to‐ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free‐wall accessory pathway and LV dysfunction without tachycardia.
Box Isolation for Atrial Fibrillation
Authors: Kumagai Koichiro
Published: August 2012

Since the first report of catheter ablation curing atrial fibrillation (AF), numerous techniques have evolved, from linear ablation to segmental pulmonary vein (PV) isolation, extensive encircling PV isolation, LA linear ablation, ablation of complex fragmented atrial electrograms (CFAE) and stepwise ablation. We developed a new approach for complete isolation of the posterior LA including all PVs, namely box isolation. In the post erior LA, there are many arrhythmogenic substrates for AF, including the triggers, reentries and ganglionated plexi. Box isolation can contain these abnormal substrates in the posterior LA. Box isolation is associated with a high clinical success rate in paroxysmal AF. However, in persistent AF or longstanding persistent AF, only box isolation may not be sufficient, therefore, additional ablation at sites with CFAE outside the box area is needed to improve the clinical outcome. A hybrid approach of combining box isolation with CFAE ablation is highly effective in the majority of patients with persistent AF or longstanding persistent AF. Thus, AF ablation is an effective and safe treatment for AF that offers an excellent chance for a lasting cure.
Postural Orthostatic Tachycardia Syndrome (POTS)
Authors: Mizumaki Koichi
Published: August 2012

Postural orthostatic tachycardia syndrome (POTS) is defined as the development of orthostatic symptoms associated with a rapid (within 10 minutes) increase in heart rate by more than 30 beats per minute or to a heart rate that exceeds 120 beats per minute without orthostatic hypotension. The symptoms of orthostatic intolerance are due to brain hypoper fusion and sympathetic overaction. Patients are usually female and aged 15 to 50 years. POTS represents a category of disease rather than a single distinct illness. Patients with POTS can experience difficulty with daily routines including housework, shopping, eating, and attending work or school. Reports of patients with “POTS‐like symptoms” have been made for over 100 years.

The pathophysiologic mechanisms of POTS include peripheral denervation, β‐receptor supersensitivity, hypovolemia and impaired cerebral auto regulation. Prolonged deconditioning may also interact with these mechanisms to exacerbate symptoms. Although 3 types of POTS (low‐flow, normal‐flow, and high‐flow POTS) have been distinguished based on differences in peripheral blood flow and peripheral arterial resistance, thoracic hypovolemia is the common final pathophysiologic mechanism.

Therapies are directed at relieving the central hypovolemia or at compensating for the circulatory dysfunctions. Treatments include use of water, saline infusion, α‐agonists, β‐antagonists, and other agents that may correct the central hypovolemia. These have resulted in varying degrees of success, and they are often used in combination.
Impact of Antiarrhythmic Drugs on Complex Fractionated Atrial Electrograms
Authors: Kumagai Koichiro , Toyama Hideko
Published: August 2012

Background: Ablation of complex fractionated atrial electrograms (CFAE) is now performed in patients with persistent atrial fibrillation (AF). However, extensive ablation is often necessary to eliminate all CFAE or to terminate AF. The purpose of this study was to evaluate the effects of antiarrhythmic drugs (AAD) on CFAE.

Methods and Results: Sixty patients, including 38 with longstanding persistent AF and 22 with persistent AF, underwent box isolation. After box isolation, CFAE maps were created before and after infusion of a pure Na+ blocker, pilsicainide (1 mg/kg), in 30 patients or a pure IKr blocker, nifekalant (0.3 mg/kg), in 30 patients. Nifekalant had a greater effect on AF termination than pilsicainide (33.3% versus 6.7%, P = 0.01). Both AADs similarly reduced CFAE. Ablation of CFAE localized by nifekalant and pilsicainide terminated AF in 26.7% and 20% of the patients, respectively. After a single ablation procedure, patients in whom AF was terminated by CFAE ablation had a lower recurrence rate than those in whom AF was not terminated despite CFAE ablation (19.2% vers us 35.3%, P = 0.04).

Conclusions: Both pilsicainide and nifekalant reduce CFAE, and nifekalant has a greater effect on AF termination than pilsicainide. Ablation of only CFAE localized with AAD may be sufficient for clinical efficacy.
Effects of Cardiac Resynchronization Therapy on the Arrhythmic Substrate in a Patient with Long QT and Torsades de pointes
Authors: Ikutomi Masayasu , Matsusita Masashiro , Arashi Hiroyuki , Watari Yuji , Endo Goro , Yamaguchi Jun‐ichi , Yamasaki Masao , Ohnishi Satoshi
Published: August 2012

We describe a patient with torsades de pointes (TdP) who was implanted with cardiac resynchronization therapy defibrillator (CRT‐D). At the time of CRT‐D implantation, left ventricular (LV) epicardial pacing exacerbated TdPs and developed into electrical storm, which was triggered even by biventricular pacing. We needed to inactivate the LV lead for 2 weeks. At the next device check testing of LV pacing still induced TdPs, whe reas biventricular pacing did not. After starting the continuous biventricular pacing no ventricular arrhythmias happened, and furthermore the QT intervals prolonged by LV pacing were obviously shortened only after 2 weeks as ventricular systolic function recovered. Then even continuous LV alone pacing induced no TdP. These findings indicate novel electrical effects of cardiac resynchronization therapy.
Hyperbolicity in the volume-preserving scenario
Authors: ARBIETO ALEXANDER , CATALAN THIAGO
Published: August 2012

Extending a result of Mañé, Hayashi proved that every diffeomorphism$f$which has a$C^1$-neighborhood$\mathcal {U}$where all periodic points of any$g\in \mathcal {U}$are hyperbolic is an Axiom A diffeomorphism. Here we prove the analogous result in the volume-preserving scenario.
Transition to turbulence at the bottom of a solitary wave
Authors: Blondeaux Paolo , Pralits Jan , Vittori Giovanna
Published: August 2012

A linear stability analysis of the laminar flow in the boundary layer at the bottom of a solitary wave is made to determine the conditions leading to transition and the appearance of turbulence. The Reynolds number of the phenomenon is assumed to be large and a ‘momentary’ criterion of instability is used. The results show that the laminar regime becomes unstable during the decelerating phase, when the height of the solitary wave exceeds a threshold value which depends on the ratio between the boundary layer thickness and the local water depth. A comparison of the theoretical results with the experimental measurements of Sumer et al. (J. Fluid Mech., vol. 646, 2010, pp. 207–231) supports the analysis.
Linear global instability of non-orthogonal incompressible swept attachment-line boundary-layer flow
Authors: Pérez José Miguel , Rodríguez Daniel , Theofilis Vassilis
Published: August 2012

Flow instability in the non-orthogonal swept attachment-line boundary layer is addressed in a linear analysis framework via solution of the pertinent global (BiGlobal) partial differential equation (PDE)-based eigenvalue problem. Subsequently, a simple extension of the extended Görtler–Hämmerlin ordinary differential equation (ODE)-based polynomial model proposed by Theofilis et al. (2003) for orthogonal flow, which includes previous models as special cases and recovers global instability analysis results, is presented for non-orthogonal flow. Direct numerical simulations have been used to verify the analysis results and unravel the limits of validity of the basic flow model analysed. The effect of the angle of attack, $\mathit{AoA}$, on the critical conditions of the non-orthogonal problem has been documented; an increase of the angle of attack, from $\mathit{AoA}= 0$ (orthogonal flow) up to values close to $\lrm{\pi} / 2$ which make the assumptions under which the basic flow is derived questionable, is found to systematically destabilize the flow. The critical conditions of non-orthogonal flows at $0\leq \mathit{AoA}\leq \lrm{\pi} / 2$ are shown to be recoverable from those of orthogonal flow, via a simple algebraic transformation involving $\mathit{AoA}$.
Compound capillary rise
Authors: Weislogel Mark M.
Published: August 2012

Irregular conduits, complex surfaces, and porous media often manifest more than one geometric wetting condition for spontaneous capillary flows. As a result, different regions of the flow exhibit different rates of flow, all the while sharing common dynamical capillary pressure boundary conditions. The classic problem of sudden capillary rise in tubes with interior corners is revisited from this perspective and solved numerically in the self-similar ${\ensuremath{\sim} }{t}^{1/ 2} $ visco-capillary limit à la Lucas–Washburn. Useful closed-form analytical solutions are obtained in asymptotic limits appropriate for many practical flows in conduits containing one or more interior corner. The critically wetted corners imbibe fluid away from the bulk capillary rise, shortening the viscous column length and slightly increasing the overall flow rate. The extent of the corner flow is small for many closed conduits, but becomes significant for flows along open channels and the method is extended to approximate hemiwicking flows across triangular grooved surfaces. It is shown that an accurate application of the method depends on an accurate a priori assessment of the competing viscous cross-section length scales, and the expedient Laplacian scaling method is applied herein toward this effect.
A pulse-based diet is effective for reducing total and LDL-cholesterol in older adults
Authors: Abeysekara Saman , Chilibeck Philip D. , Vatanparast Hassanali , Zello Gordon A.
Published: August 2012

Our purpose was to determine the effects of a pulse-based diet in individuals 50 years or older for reducing CVD risk factors. A total of 108 participants were randomised to receive pulse-based foods (two servings daily of beans, chickpeas, peas or lentils; about 150 g/d dry weight) or their regular diet for 2 months, followed by a washout of 1 month and a cross-over to the other diet for 2 months. Anthropometric measures, body composition and biochemical markers (i.e. serum LDL-cholesterol (LDL-C), as the primary outcome, and other lipids, glucose, insulin and C-reactive protein) were assessed before and after each diet phase. A total of eighty-seven participants (thirty males and fifty-seven females; 59·7 (sd6·3) years, body mass 76 (sd16) kg) completed the study. Compared with the regular diet, the pulse-based diet decreased total cholesterol by 8·3 % (pulse, 4·57 (sd0·93) to 4·11 (sd0·91) mmol/l; regular, 4·47 (sd0·94) to 4·39 (sd0·97) mmol/l;P < 0·001) and LDL-C by 7·9 % (pulse, 2·93 (sd0·84) to 2·55 (sd0·75) mmol/l; regular, 2·96 (sd0·86) to 2·81 (sd0·83) mmol/l;P = 0·01). In a sub-analysis of individuals with high lipid levels at baseline (twenty individuals with high cholesterol), the pulse-based diet reduced cholesterol by 6 % compared with the regular diet (pulse, 5·62 (sd0·78) to 5·26 (sd0·68) mmol/l; regular, 5·60 (sd0·91) to 5·57 (sd0·85) mmol/l;P = 0·05). A pulse-based diet is effective for reducing total cholesterol and LDL-C in older adults and therefore reduces the risk of CVD.
Pulse grain consumption and obesity: effects on energy expenditure, substrate oxidation, body composition, fat deposition and satiety
Authors: Marinangeli Christopher P. F. , Jones Peter J. H.
Published: August 2012

Pulses have been identified as important components of a healthy diet. Assessment of pulse grains' nutritional composition alongside data from available preclinical and clinical trials suggests that pulses can modulate biological processes that lead to obesity. Components of pulse grains, including pulse-derived fibre and resistant starch, have been shown to alter energy expenditure, substrate trafficking and fat oxidation as well as visceral adipose deposition. Although mechanistic studies are scarce, studies have indicated that fibres found in pulses can have an impact on the expression of genes that modulate metabolism. Arginine and glutamine may produce thermogenic effects as major components of pulse grain proteins. Finally, evidence suggests that pulse-derived fibres, trypsin inhibitors and lectins may reduce food intake by inducing satiety via facilitating and prolonging cholecystokinin secretion. Nonetheless, the aforementioned data remain controversial and associations between dietary pulse grains and energy intake require further study. Given the available evidence, it can be concluded that pulses could be useful as functional foods and food ingredients that combat obesity.
In vitro investigations of the potential health benefits of Australian-grown faba beans (Vicia faba L.): chemopreventative capacity and inhibitory effects on the angiotensin-converting enzyme, α-glucosidase and lipase
Authors: Siah Siem D. , Konczak Izabela , Agboola Samson , Wood Jennifer A. , Blanchard Christopher L.
Published: August 2012

The functional properties, including antioxidant and chemopreventative capacities as well as the inhibitory effects on angiotensin-converting enzyme (ACE), α-glucosidase and pancreatic lipase, of three Australian-grown faba bean genotypes (Nura, Rossa and TF(Ic*As)*483/13) were investigated using an array of in vitro assays. Chromatograms of on-line post column derivatisation assay coupled with HPLC revealed the existence of active phenolics (hump) in the coloured genotypes, which was lacking in the white-coloured breeding line, TF(Ic*As)*483/13. Roasting reduced the phenolic content, and diminished antioxidant activity by 10–40 % as measured by the reagent-based assays (diphenylpicrylhydrazyl, 2,2′-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid) and oxygen radical absorbance capacity) in all genotypes. Cell culture-based antioxidant activity assay (cellular antioxidant activity) showed an increase of activity in the coloured genotypes after roasting. Faba bean extracts demonstrated cellular protection ability against H2O2-induced DNA damage (assessed using RAW264.7 cells), and inhibited the proliferation of all human cancer cell lines (BL13, AGS, Hep G2 and HT-29) evaluated. However, the effect of faba bean extracts on the non-transformed human cells (CCD-18Co) was negligible. Flow cytometric analyses showed that faba bean extracts successfully induced apoptosis of HL-60 (acute promyelocytic leukaemia) cells. The faba bean extracts also exhibited ACE, α-glucosidase and pancreatic lipase inhibitory activities. Overall, extracts from Nura (buff-coloured) and Rossa (red-coloured) were comparable, while TF(Ic*As)*483/13 (white-coloured) contained the lowest phenolic content and exhibited the least antioxidant and enzyme inhibition activities. These results are important to promote the utilisation of faba beans in human diets for various health benefits.
Metabolomic analysis of the effects of edible dry beans (Phaseolus vulgarisL.) on tissue lipid metabolism and carcinogenesis in rats
Authors: Mensack Meghan M. , McGinley John N. , Thompson Henry J.
Published: August 2012

Metabolite profiling using liquid chromatography–time-of-flight MS was undertaken to identify candidate metabolic processes that account for dry bean effects on disease risk with a specific focus on the development of breast cancer. Normal mammary gland and mammary carcinomas from previously reported experiments were evaluated. Principal component analysis (PCA) of mass spectral data revealed that tissue of both types from control-fedv.bean-fed rats could be distinguished by their metabolomic profiles. Candidate ion identification using MassTRIX analysis software revealed that alterations in eicosanoid, fatty acid, TAG and steroid metabolism partially accounted for the differences observed in both PCA. In addition, evidence was obtained consistent with the hypothesis that the varying inhibitory effects on mammary carcinogenesis of genetically distinct dry bean types were mirrored by differential patterns of lipid metabolites in mammary carcinoma. The use of MassTRIX provided links for metabolite profile enrichment with metabolic pathways in theKyoto Encyclopedia of Genes and Genomes. Implicated pathways included a linkage between diacylglycerol and protein kinase C and eicosanoid metabolites and inducible cyclo-oxygenase-2 and/or eicosanoid degradation mediated via 15-PG dehydrogenase. These pathways have been reported to be misregulated during the development of cancer. The differences observed between control-fed and bean-fed rats in lipid metabolism require validation using targeted analytical methods and detailed analyses of how bean bioactive food components regulate genes that control lipid biosynthesis, interconversion and catabolism.
Metabolism and performance during extended high-intensity intermittent exercise after consumption of low- and high-glycaemic index pre-exercise meals
Authors: Bennett Christine B. , Chilibeck Philip D. , Barss Trevor , Vatanparast Hassanali , Vandenberg Albert , Zello Gordon A.
Published: August 2012

The metabolic and performance benefits of prior consumption of low-glycaemic index (GI) meals v. high-GI meals were determined in extended high-intensity intermittent exercise. Participants (ten males and four females, aged 25·8 (sd 7·3) years) completed two testing days (each consisting of back-to-back 90-min intermittent high-intensity treadmill running protocols separated by 3 h) spaced by at least 7 d. Using a randomised counterbalanced cross-over design, low-GI, lentil-based meals (GI about 42) or high-GI, potato-based meals (GI about 78) matched for energy value were consumed 2 h before, and within 1 h after, the first exercise session. Performance was measured by the distance covered during five 1-min sprints (separated by 2·5 min walking) at the end of each exercise session. Peak postprandial blood glucose was higher by 30·8 % in the high-GI trial compared with the low-GI trial, as was insulin (P = 0·039 and P = 0·003, respectively). Carbohydrate oxidation was lower by 5·5 % during the low-GI trials compared with the high-GI trials at the start of the first exercise session (P < 0·05). Blood lactate was significantly higher (6·1 v. 2·6 mmol/l; P = 0·019) and blood glucose significantly lower (4·8 v. 5·4 mmol/l; P = 0·039) at the end of the second exercise session during the high-GI trial compared with the low-GI trial. Sprint distance was not significantly different between conditions. A low-GI meal improved the metabolic profile before and during extended high-intensity intermittent exercise, but did not affect performance. Improvements in metabolic responses when consuming low-GI meals before exercise may be beneficial to the long-term health of athletes.