Heart failure is an ambiguous term as a technical terminology, which means sometimes an existence of ventricular dysfunction, and sometimes a decompensated heart failure with symptoms and signs due to clinical congestion. Diagnostic procedure for congestive heart failure, so called Framingham Criteria, has been no changed for approximately half a century, however, the therapeutic strategy has been improved considerably, resulting in the congestion could be managed and heart failure patients released from symptoms and signs by congestion. Ironically, that makes the word heart failure more complex and obscure. Chronic heart failure is a new concept that is constructed by NYHA functional class as a degree of symptoms and by stage of heart failure as a degree of remodeling of myocardium due to neurohumoral activation, renin-angiotensin-aldosterone system and sympathetic nerve system, and would be able to cover all conditions of heart failure and also to provide the managements for patients in each stage. More understanding for the concept of chronic heart failure is beneficial regarding clinical managements of heart failure for not only cardiologists, but also all attending physicians.
Background: The mechanisms underlying self-perpetuation of persistent atrial fibrillation (AF) are not well understood. To gain insight into these mechanisms, we compared biatrial electroanatomic maps, obtained during sinus rhythm, in patients with paroxysmal AF, patients with persistent AF, and patients without AF (control patients). Methods: The study involved 12 patients with paroxysmal AF (9 men, 3 women; 62 ± 11 years of age), 6 patients (5 men, 1 woman; 62 ± 6 years of age) with persistent AF treated unsuccessfully by direct-current cardioversion, and 6 patients (1 man, 5 women; 53 ± 16 years of age) with a left-sided accessory pathway but no AF (control patients). Biatrial voltage mapping was performed during sinus rhythm using the CARTO system. The clinical and electroanatomic characteristics of the 3 groups of patients were evaluated and analyzed statistically. Results: The proportions of normal and low voltage areas in the right and left atria were not different between the control and paroxysmal AF groups. The proportion of the right atrial (RA) low voltage (< 0.5 mV) area did not differ between the 3 groups; however, the RA and left atrial (LA) normal voltage (≥ 1.5 mV) areas were significantly smaller in the persistent AF group. The LA low voltage area was significantly larger in patients with persistent AF. Conclusion: The relatively large RA normal voltage and LA low voltage areas that we observed in patients with persistent AF may play a crucial role in the self-perpetuation of AF.
Background: The optimal technique for recording of the electrogram to detect complete cavo-tricuspid isthmus (CTI) block during radiofrequency ablation (RFA) of the typical atrial flutter (AFL) using non-contact mapping system remains unclear. The aim of this study was to investigate the characteristics of the local virtual unipolar electrogram recorded at the ablation line during coronary sinus pacing after RFA of the CTI. Methods: Non-contact mapping was performed in 8 patients with AFL. Non-contact virtual unipolar electrograms were obtained before and after CTI linear ablation. All unipolar electrograms were acquired with both wide-band (0.5-300 Hz and 0.5-IC 150 Hz) and narrow-band filtering (32-300 Hz). The unipolar electrogram measurements included both the peak-to-peak voltage and peak-negative voltage for both filter settings, and the morphological characteristics of the second component of double potentials. Results: Comparison of the electrogram voltage along the ablation line before and after ablation demonstrated: 1) peak-negative voltage reduction at the mid-portion of the ablation line by 0.5-IC 150 Hz filtering, and 2) the second component of unipolar electrogram morphologies of R, Rs or rSR were the most sensitive and speci-c recording technique to predict conduction block. Conclusions: Non-contact unipolar electrograms using the peak-negative voltage with 0.5-IC 150 Hz and a predominant R-wave pattern in the second component at the ablation line indicate complete CTI block, even in the presence of transcristal conduction.
A 66-year-old man underwent follow up for chronic hepatitis type B and hepatocellular carcinoma, about 20 mm in size, was found. The preoperative liver function was ICGR15 15%. Liver damage A, and Child-Pugh score 5 points, class A. The clinical cancer stage was T1N0M0 stage I. The tumor was found deep in the liver, it is determined to be located in Segment 7 during preoperative simulation with 3D-CT. While it was difficult to identify the tumor during intraoperative ultrasonography, we identified segment 7 using counterstaining. We performed complete resection of liver segment 7. The patient was discharged on the ninth day after the operation without postoperative complications.
We experienced a case of thyroid microcarcinoma with lymph node metastasis. A 68-year-old woman presented with the complaint of common cold-like symptoms. We performed chest CT. The CT showed no pneumonia, but multiple masses were seen in both lobes of the thyroid. The ultrasonography revealed multiple lesions in her thyroid. We performed aspiration biopsy cytology for these thyroid tumors. One tumor, located in the left lobe, 5 mm in diameter, was diagnosed as Class IV. The other tumors were diagnosed as Class II. Subtotal thyroidectomy with lymph nodes dissection (D1) was performed. The pathological diagnosis was papillary carcinoma of the thyroid with paratracheal lymph node metastasis. It is known that the prognosis of microcarcinoma of the thyroid is good. However, microcarcinoma of the thyroid with lymph node metastasis requires careful serial observations.
Isolated left ventricular noncompaction (IVNC) is a cardiac abnormality of unknown etiology characterized by prominent left ventricular trabeculations and deep intertrabecular recesses. IVNC sometimes develops as life threatening cardiac arrhythmias, i.e., ventricular tachycardia and ventricular fibrillation. Herein, we present a rare case of supraventricular tachycardia in a patient with IVNC.
A 55-year-old female visited our hospital with the chief complaint of general fatigue, and was admitted emergently because of unstable hemodynamics with elevated cardiac enzymes. Cardiac catheterization was performed, which showed no significant stenosis in the coronary arteries, and the patient was therefore diagnosed as having fulminant myocarditis. Assisted circulation with intraaortic balloon pumping and percutaneous cardiopulmonary support were performed immediately. Furthermore, implantation of a biventricular assist device (BVAD) was necessary. Despite intensive care, the patient died without recovering. Fulminant myocarditis is a fatal disease that is likely to cause cardiogenic shock, requiring intensive care with emergency surgery. We report a case of fulminant myocarditis, for which management with a BVAD was attempted.