Japanese Journal of Electrocardiology
Online ISSN : 1884-2437
Print ISSN : 0285-1660
ISSN-L : 0285-1660
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Volume 29, Issue 5
Displaying 1-12 of 12 articles from this issue
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Editorial
  • Identification of unusual reentry circuit sites of non-ischemic ventricular outflow tract tachycardia by entrainment mapping
    Emi Nakano, Tomoo Harada, Hirofumi Wakimoto, Keizo Osada, Ryouji Kishi ...
    2009 Volume 29 Issue 5 Pages 319-331
    Published: 2009
    Released on J-STAGE: May 21, 2010
    DOIhttps://doi.org/10.5105/jse.29.319
    JOURNAL FREE ACCESS
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    Background : Reentrant ventricular outflow tract (OT) tachycardia is rare in patients with non-ischemic heart disease. Ventricular tachycardia (VT) originating from the aortic sinus cusp (ASC) regions usually seems to be focal or nonreentrant mechanism. It has been often unclear whether the reentrant circuit exists in OT and ASC. Objectives : The purpose of this study was to evaluate whether it is possible to identify the reentry circuit between ASC and OT using entrainment mapping techniques. Methods : We performed the electrophysiological study in 51 consecutive patients (26 men and 25 women, mean age 50.3 ± 14.5 years, range 26 to 77 years) with symptomatic VT arising from OT. As a result, the reentrant VTs were observed in 6 patients. To examine a VT circuit, pacing for entrainment and radiofrequency (RF) catheter ablation were performed on 8 reentrant VTs in 6 patients. Result : Pacing for entrainment was performed at 93 sites in these VTs and 52 sites where the post-pacing interval was identical to VT cycle length were reentry circuit sites; 6 sites in ASC, 43 sites below the aortic valve and 3 sites in right OT below the pulmonary valve. Reentry circuit sites were identified as exit (n=7), central-proximal (n=1), inner loop (n=19) and outer loop (n=25). RF ablation terminated VT at 4 sites of 6 total ASC sites and 4 sites of 46 total OT sites (p=0.0002). Conclusions : Reentry circuit is identified in ASC and OT in patients with non-ischemic OT-VT. Entrainment mapping was useful as a guide for RF catheter ablation even in ASC.
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Editorial Comment
  • Compartion of the Right Ventricular Outflow Tract Pacing with the Right Ventricular Apex Pacing in the Chronic Phase
    Masanori Seino, Kazuhiko Tanaka, Noritaka Toratani, Shiro Nakahara, Yo ...
    2009 Volume 29 Issue 5 Pages 333-340
    Published: 2009
    Released on J-STAGE: May 21, 2010
    DOIhttps://doi.org/10.5105/jse.29.333
    JOURNAL FREE ACCESS
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    Background : Right ventricular apex (RVA) pacing has been thought to be an published effect for the heart function in some studies. Instead, the pacing site of right ventricular outflow tract (RVOT) is known as the alternative pacing site. Previous studies have reported the differences between RVA and RVOT pacing in the early short-term. Therefore the aim of this study is to describe the advantages of RVOT pacing in the chronic phase. Methods : We compared QRS duration, threshold, sense, lead impedance, BNP, left ventricular ejection fraction (EF), left ventricular diastolic/systolic diameter, septal to posterior wall motion delay (SPWMD) and incident rate of atrial fibrillation in the RVA group (20pts) and in the RVOT group (20pts) for two years among patients who don' t have cardiac dysfunction (EF>40%). Results : The QRS intervals was significantly shorter in the RVOT group than the RVA group (142 ± 22 vs176 ± 18 msec. p<0.001), but the QRS duration has not been changed in the RVA group. The threshold (0.5 ± 0.1 vs 0.7 ± 0.3mv/0.4msec), sense (17 ± 8 vs13 ± 8) and impedance (615 ± 123 vs 660 ± 231) were not significantly different. The BNP (70.6 ± 56 vs 192 ± 189), EF and LV Dd/Ds were not significant different between both groups. SPWMD measurement tended to be better in the RVOT group (112 ± 65Vs152 ± 36). Incidence of atrial fibrillation after the pacemaker implantation RVOT grop was less than that of the RVA group (18% Vs 50%). The total duration time of the atrial fibrillation in the RVOT group did not increase compared to the RVA group. Conclusion : The RVOT group avoids the risk of disynchronization of the left ventricle, and atrial fibrillation does not worsen. We considered that the RVOT pacing is safe and has more clinical merits compared to the RVA pacing in the chronic phase.
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Editorial Comment
  • QRS morphology in the 87-lead body surface electrocardiograms predicts positive response to cardiac resynchronization therapy in patients with chronic heart failure
    Miki Yokokawa, Wataru Shimizu, Takashi Noda, Hideo Okamura, Kazuhiro S ...
    2009 Volume 29 Issue 5 Pages 342-349
    Published: 2009
    Released on J-STAGE: May 21, 2010
    DOIhttps://doi.org/10.5105/jse.29.342
    JOURNAL FREE ACCESS
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    The QRS morphology in electrocardiograms (ECGs) shows the local activation pattern of the ventricular myocardium. The 87-lead body surface ECGs were recorded before and after (at 1 day, 1 month, and 3 months) cardiac resynchronization therapy (CRT) in 35 dilated cardiomyopathy patients with chronic heart failure (28 males, 58 ± 16 years, left ventricular ejection fraction 20 ± 8%). QRS morphology was evaluated in the two regions : 1) outflow tract (OT), reflecting the latest activation site in normal ventricle, 2) left ventricular (LV) postero-lateral wall (PL), reflecting LV epicardial pacing site. The OT-region was defined as D-F/5-6 (upper anterior chest leads), and the PL region was defined as J-L/3-4 (lower left back leads) among 87 leads, respectively. Among the 6 leads in each region, we compared the number of leads with dominant R-wave pattern (R-leads) and QS-wave pattern (QS-leads) between 21 responders and 14 non-responders. Before CRT, the number of R-leads and QS-leads were not different between responders and non-responders. After CRT, the number of R-leads in the OT region (R-OT) increased in responders, but did not change in non-responders. Furthermore, the number of QS-leads in the PL region (QS-PL) significantly increased in responders, but did not change in non-responders. The number of both R-OT and QS-PL after CRT did not change throughout the follow-up periods. The increase of R-wave pattern in the upper anterior chest leads and QS-wave pattern in the lower left back leads after CRT may predict responders to CRT.
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