Biomedical subjects
Publications and source records attributed to R Kuniyoshi.
We report the case of a 42-year-old female with fatigue on exertion and palpitation consequent to the existence of isolated noncompaction of the myocardium. We discuss clinical and familial findings, diagnostic possibilities, and prognostic and therapeutical implications of this rare disorder of endomyocardial morphogenesis.
PURPOSE: The aim of this study is to verify whether the persistence of conduction over the slow pathway is related to an increased trend for recurrence. METHODS: Recurrence rate was retrospectively analyzed in 126 patients who underwent slow pathway radiofrequency (RF) catheter ablation during a follow-up of 20 +/- 12 months. The ablative procedure was interrupted when AVNRT was no longer induced by atrial stimulation after intravenous infusion of isoproterenol. Ninety-eight patients had no evidence of slow pathway whereas 28 patients persisted with AV node jump and atrial echo beat. RESULTS: There were 15 recurrences: 9% of those who had no evidence of slow pathway (9 of 98 patients) and 21% of those with AV node jump and/or atrial echo beat but this difference was not statistically significant. CONCLUSION: As long as AVNRT cannot be induced by atrial pacing and isoproterenol infusion after slow pathway RF catheter ablation, the presence of AV node jump and/or atrial echo beat does not increase the risk of recurrence of AVNRT.
In order to identify ECG characteristics of overt mid-septal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid-septal AP. Mean patient age was 31 +/- 16 years, and 13 were male. The 40 degrees right anterior oblique view was used to divide the mid-septal area into 3 zones: 1 (anterior portion); 2 (intermediate); and 3 (posterior portion). The 12-lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V2 in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid-septal AP in close proximity to the AV conduction system.
We describe three cases of the pseudo-pacemaker syndrome. One of them due to selective fast pathway fulguration of atrioventricular nodal reentrant tachycardia and two others have occurred in spontaneous form. All cases were related with the presence of first-degree atrioventricular block and sinus node tachycardia. The treatment was done with complete atrioventricular block induction catheter ablation and permanent pacemaker implantation in two patients. In conclusion, the procedure of radiofrequency ablation to control AV nodal reentry tachycardia must preserve the fast nodal pathway in order to avoid the pseudo-pacemaker syndrome and this syndrome can spontaneously occur and must be considered during investigation of etiology of syncope.
PURPOSE: To verify the efficacy and safety of the creation of a barrier with radiofrequency (RF) in the tricuspid annulus and the vena cava ostium (TA-IVC). METHODS: Nine consecutive patients, 7 males, with age ranging from 36 to 76 years, with paroxysmal (7 patients) or permanent (2) type I atrial flutter (negative P wave in lead II, III and F) were submitted to RF ablation of TA-IVC istmo. One deflectable catheter with 4mm size tip was introduced into the right ventricle apex and pulled back to the inferior vena cava. When the atrial electrogram was detected the RF application was started. The RF was applied (20 watts during 60s) up to the proximity of inferior vena cava ostium. The end point was to stop atrial flutter. Then a vigorous atrial stimulation protocol, including isoproterenol infusion was used. In the next day, patients were submitted to transesophageal stimulation with the same protocol. RESULTS: Atrial flutter was interrupted in all patients (100%) with 4 to 28 (mean 16.7 +/- 7.7) applications. Eight patients (88.8%) with one session and 1 (11.1%) with two sessions. The mean time spent to stop the atrial flutter with one application was 30.5 +/- 18.5s. There were no complications. After a mean follow up of 3 +/- 1.6 month all patients (100%) are asymptomatic. Two of them are taking propranolol to control symptomatic atrial and ventricular ectopic beats. CONCLUSION: RF ablation of the TA-IVC istmo is efficient and safe in a short term follow up to interrupt and prevent re-induction and recurrence of type I atrial flutter.
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