Biomedical subjects

Taro Okada

Publications and source records attributed to Taro Okada.

At least 19 recordsLinked to original sources

PubMed2007

A novel catheter for simultaneous angiography of ipsilateral pulmonary veins.

We designed a novel catheter for simultaneous angiography of ipsilateral pulmonary veins (PVs), so that the catheter tip with side holes can be introduced into the inferior PVs and a second curve with side holes into the superior PVs. The simultaneous angiogram of the ipsilateral PVs, using this novel catheter, reveals more clearly the PV ostium to antrum, because simultaneous injection of contrast medium into two adjacent PVs reduces the dilution of contrast medium by blood flow through these veins.

Atrial Fibrillation↗

PubMed2006

Plasma atrial natriuretic Peptide and brain natriuretic Peptide levels after radiofrequency catheter ablation of atrial fibrillation.

It has been reported that plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels are elevated in patients with atrial fibrillation (AF). The aim of this study was to investigate the change in these patients after pulmonary vein isolation (PVI). In 66 patients with paroxysmal AF (PAF) and without any structural heart disease, plasma ANP and BNP levels were measured before and 3 months after successful PVI. At baseline, in 14 patients, ANP and BNP levels were elevated, and in 52 patients, only BNP levels were elevated. There were no significant relations between the attack frequency or the duration of PAF episodes and ANP or BNP levels. Neither ANP nor BNP level at baseline was a valid predictor of AF recurrence. Even in 31 patients (47%) with recurrent PAF, attacks of PAF were significantly reduced. In 66 patients with elevated ANP and/or BNP levels at baseline, levels were significantly reduced after PVI independent of PAF recurrence (ANP: 69.0+/-23.0 vs 25.0+/-7.7 pg/ml, p<0.0001; BNP: 58.4+/-50.7 vs 22.5+/-27.1 pg/ml, p<0.0001). In 42 patients without AF recurrences, ANP and BNP levels were reduced to within the normal range. In conclusion, in patients with PAF without any structural heart disease, ANP and/or BNP levels were elevated. In those patients, relief of the AF burden by successful PVI significantly reduced elevated plasma ANP and BNP levels.

Atrial Fibrillation↗

PubMed2006

Usefulness of esophageal leads for determining the strategy of pulmonary vein ablation to avoid complications associated with the esophagus.

To avoid fatal complications after extensive pulmonary vein (PV) ablation, it has been proved important to comprehend the anatomic relation between the PVs and the esophagus. In 42 consecutive patients with atrial fibrillation, PV ostial isolation was performed using a basket catheter. The shortest distance and anatomic relation between the esophageal lead and PV ostium, determined by successful PV ostial isolation, was analyzed in biplane fluoroscopic views. In 18 left superior PVs (LSPVs) (43%), 13 left inferior PVs (32%) (LIPVs), and all the right PVs (group A), the shortest distance was > 10 mm in > or = 1 of the biplane fluoroscopic views. In 4 LSPVs (10%) and 2 LIPVs (5%) (group B), the shortest distance was < or = 5 mm in the fluoroscopic views. In the remaining PVs (group C), the esophagus was situated directly behind 10 LSPVs (24%) and 12 LIPVs (29%) (group C1), posteromedial to 1 LSPV (2%) and 9 LIPVs (22%) (group C2), and medial to 9 LSPVs (21%) and 5 LIPVs (12%) (group C3). The risk of esophagus-associated complications with ablation around the left PV ostia was suggested to be high in group B, very low in group A, and relatively low in group C. In group C3, extensive PV ablation might increase the risk of that complication. In conclusion, esophageal leads are useful for determining strategies for PV ablation to avoid esophagus-associated complications, because they enable comprehension of the anatomic relation between the PVs and the esophagus.

Atrial Fibrillation↗

PubMed2006

Incidence, location, and cause of recovery of electrical connections between the pulmonary veins and the left atrium after pulmonary vein isolation.

AIMS: The aim of this study was to reveal the incidence, location, and cause of recovery of the electrical connections (ECs) between the left atrium and the pulmonary veins (PVs) after the segmental ostial PV isolation (PVI). METHODS AND RESULTS: Pulmonary vein mapping and successful PVI were performed using a computerized three-dimensional mapping system (QMS2trade mark) with a basket catheter in 167 PVs in 53 consecutive patients with atrial fibrillation (AF). In 14 patients with recurrent AF after PVI, the same PV mapping and isolation as in the first procedure were performed, and the PV potential maps constructed by QMS2 in two different procedures were compared. Forty-nine recovered ECs were observed in 27 PVs, and all were eliminated by a few local radiofrequency (RF) applications. Thirty-four (69%) of those ECs recovered at the edge of original ECs, and another 15 (31%) recovered at the mid-portion of the continuous broad original ECs. CONCLUSION: Electrical connection recovery occurred most commonly at the edges of original ECs and occasionally at the mid-portion of continuous broad original ECs after PVI probably due to tissue oedema neighbouring the segmental RF lesions. Further RF lesions at the edge of original ECs and linear ablation to the continuous broad ECs may help reduce AF recurrence.

Atrial Fibrillation↗

PubMed2006

Electrophysiological pulmonary vein antrum isolation with a multielectrode basket catheter is feasible and effective for curing paroxysmal atrial fibrillation: efficacy of minimally extensive pulmonary vein isolation.

BACKGROUND: How extensive should an appropriate pulmonary vein (PV) ablation be is a matter of controversy. OBJECTIVE: The study's aim was to investigate the efficacy of minimally extensive PV ablation for isolating the PV antrum (PVA) with the guidance of electrophysiological parameters. METHODS: Fifty-five consecutive symptomatic paroxysmal atrial fibrillation (PAF) patients underwent PV mapping with a multielectrode basket catheter (MBC). A 31-mm MBC was deployed in 3-4 PVs as proximally as possible without dislodgement, and the longitudinal PV mapping enabled us to recognize single sharp potentials formed by the total fusion of the PV and left atrial potentials around the PV ostium or the transverse activation patterns that were observed. Those potentials were defined as PVA potentials. Radiofrequency ablation was performed circumferentially targeting PVA potentials with the end point being their elimination. RESULTS: After circumferential PVA ablation, electrical disconnection was achieved in 77% and residual PVA conduction gaps were observed in 23% of all targeted PVs. Those residual conduction gaps were mainly located at the border between ipsilateral PVs (42%) and between the left PVs and left atrial appendage (33%) and were eliminated by a mean of 3 +/- 2 minutes of local radiofrequency deliveries. During the follow-up period (11 +/- 5 months), 46 (84%) patients were free of symptomatic PAF without any anti-arrhythmic drugs. No PV stenosis or spontaneous left atrial flutter occurred. CONCLUSIONS: Electrophysiological PVA ablation with an MBC is feasible and effective for curing PAF because this minimally extensive PVA isolation technique targets the optimal sites, achieving both high efficacy and safety.

Aged↗

PubMed2006

Focal atrial fibrillation associated with multiple breakout sites at the crista terminalis.

A 34-year-old man with permanent atrial fibrillation (AF) underwent electrophysiologic testing. Spontaneous AF was observed even after successful pulmonary vein (PV) isolation of all four PVs. Intracardiac electrograms recorded from a basket catheter deployed around the crista terminalis during triggered atrial premature beats exhibited low-amplitude potentials which were suggested to reflect focal ectopic activity, preceding high-frequency atrial potentials. The firing from those focal activity sites induced a shift in the breakout sites and conduction block to the right atrium, which suggested the participation of preferential conduction. Radiofrequency catheter ablation targeting the focal origin and preferential conduction sites eliminated the AF.

Adult↗

PubMed2006

Does RV lead positioning provide additional benefit to cardiac resynchronization therapy in patients with advanced heart failure?

BACKGROUND AND OBJECTIVES: The left ventricular (LV) stimulation site is currently recommended to position the lead at the lateral wall. However, little is known as to whether right ventricular (RV) lead positioning is also important for cardiac resynchronization therapy. This study compared the acute hemodynamic response to biventricular pacing (BiV) at two different RV stimulation sites: RV high septum (RVHS) and RV apex (RVA). METHODS AND RESULTS: Using micro-manometer-tipped catheter, LV pressure was measured during BiV pacing at RV (RVA or RVHS) and LV free wall in 33 patients. Changes in LV dP/dt(max) and dP/dt(min) from baseline were compared between RVA and RVHS. BiV pacing increased dP/dt(max) by 30.3 +/- 1.2% in RVHS and by 33.3 +/- 1.7% in RVA (P = n.s.), and decreased dP/dt(min) by 11.4 +/- 0.7% in RVHS and by 13.0 +/- 1.0% in RVA (P = n.s.). To explore the optimal combination of RV and LV stimulation sites, we assessed separately the role of RV positioning with LV pacing at anterolateral (AL), lateral (LAT), or posterolateral (PL) segment. When the LV was paced at AL or LAT, the increase in dP/dt(max) with RVHS pacing was smaller than that with RVA pacing (AL: 12.2 +/- 2.2% vs 19.3 +/- 2.1%, P < 0.05; LAT: 22.0 +/- 2.7% vs 28.5 +/- 2.2%, P < 0.05). There was no difference in dP/dt(min) between RVHS- and RVA pacing in individual LV segments. CONCLUSIONS: RVHS stimulation has no overall advantage as an alternative stimulation site for RVA during BiV pacing. RVHS was equivalent with RVA in combination with the PL LV site, while RVA was superior to RVHS in combination with AL or LAT LV site.

Cardiac Pacing, Artificial↗

PubMed2006

The distal protection during primary percutaneous coronary intervention alleviates the adverse effects of large thrombus burden on myocardial reperfusion.

BACKGROUND: The presence of intracoronary large thrombus burden (LTB) in the infarct-related artery increases the risk of distal embolization and no-reflow during percutaneous coronary intervention (PCI). Evaluation of whether the distal protection (DP) during primary PCI reduces adverse effects of LTB on myocardial reperfusion and infarct size was investigated. METHODS AND RESULTS: A consecutive series of 88 patients with acute myocardial infarction undergoing primary PCI using DP were compared with 81 consecutive patients treated by primary PCI alone. The DP use showed similar post-procedural myocardial blush grade (MBG)-3 and infarct size, but improved corrected thrombolysis in myocardial infarction frame count (cTFC) (29+/-11 vs 35+/-20, p=0.011) and the incidence of ST-segment resolution (80.7% vs 66.7%, p=0.038). In patients with LTB present, however, the DP use reduced occurrences of no-reflow (0% vs 11.8%, p=0.036) and distal embolization (4.8% vs 17.6%, p=0.129), resulting in higher occurrences of MBG-3 (61.9% vs 35.3%, p=0.021) and ST-segment resolution (78.6% vs 50.0%, p=0.009), lower cTFC values (30+/-8 vs 40+/-22, p=0.012) and smaller infarct size (12.2+/-11.2 vs 18.7+/-11.1, p=0.015). CONCLUSIONS: With an improved myocardial reperfusion and smaller infarct size in patients with LTB, the DP during primary PCI might be a better strategy in this particular setting compared with conventional strategy.

Acute Disease↗

PubMed2006

Can segmental pulmonary vein ablation reduce the recurrence of atrial fibrillation when using a higher RF power, larger tip electrode catheter, and additional RF deliveries?: the limitations of point-by-point RF ablation.

The aim of this study was to investigate whether segmental ostial catheter ablation (SOCA) designed to prevent the electrical connections (ECs) between the left atrium and pulmonary veins (PVs) might help increase the efficacy of SOCA in paroxysmal atrial fibrillation (PAF). PV mapping and successful SOCA were performed with a basket catheter in 108 consecutive patients with PAF. Radiofrequency energy was delivered using a maximum output of 30 W with a 4 mm tip catheter (group I; 47) or 40 W with an 8 mm tip catheter (group II; 61). Only in the group II patients were additional radiofrequency deliveries to the specific sites where the ECs tended to recover performed after successful SOCA. After the first procedure, PAF recurred in 47% of the group I patients and 32% of the group II patients. In all 27 patients who underwent repeat procedures, EC recoveries were observed more frequently in group I than in group II (69% versus 49%; P < 0.05). After multiple procedures, there was more freedom from PAF in group II (84%) than in group I (66%) (P < 0.05). SOCA with a higher RF power, larger tip catheter, and additional RF deliveries could achieve a more effective SOCA.

Aged↗

PubMed2006

The critical roles of serum/glucocorticoid-regulated kinase 3 (SGK3) in the hair follicle morphogenesis and homeostasis: the allelic difference provides novel insights into hair follicle biology.

Mutation in the serum/glucocorticoid regulated kinase 3 (Sgk3, also known as Sgkl or Cisk) gene causes both defective hair follicle development and altered hair cycle in mice. We examined Sgk3-mutant YPC mice (YPC-Sgk3(ypc)/Sgk3(ypc)) and found expression of SGK3 protein with altered function. In the hair follicles of YPC mice, the aberrant differentiation and poor proliferation of hair matrix keratinocytes during the period of postnatal hair follicle development resulted in a complete lack of hair medulla and weak hair. Surprisingly, the length of postnatal hair follicle development and anagen term was shown to be dramatically shortened. Also, phosphorylation of GSK3beta at Ser9 and the nuclear accumulation of beta-catenin were reduced in the developing YPC hair follicle, suggesting that phosphorylation of GSK3beta and WNT-beta-catenin pathway takes part in the SGK3-dependent regulation of hair follicle development. Moreover, the above-mentioned features, especially the hair-cycling pattern, differ from those in other Sgk3-null mutant strains, suggesting that the various patterns of dysfunction in the SGK3 protein may result in phenotypic variation. Our results indicate that SGK3 is a very important and characteristic molecule that plays a critical role in both hair follicle morphogenesis and hair cycling.

Alleles↗

PubMed2006

[Promising efficacy of the sirolimus-eluting stent in patients with acute myocardial infarction].

OBJECTIVES: This study investigated the safety and efficacy of sirolimus-eluting stents (SESs) on early and late outcomes in patients with acute myocardial infarction. METHODS: A series of 100 consecutive patients (September 2004 to November 2005)with acute myocardial infarction undergoing primary stenting using SES ptember 24 hr) was compared with 100 consecutive patients (September 2003 to August 2004) treated with bare metal stent (BMS). The frequency of major adverse cardiac events (MACE) and stent thrombosis, and status of ticlopidine administration were assessed at 270 days. RESULTS: The rates of premature discontinuation of ticlopidine (SES group <3 months: 11%, BMS group <1 month: 11%, p = NS) and stent thrombosis (SES group: 1%, BMS group: 0%, p = NS) were similar in the two groups. At follow-up, restenosis rate and target vessel revascularization rate were lower in the SES group(4% vs 19%, p < 0.001 and 4% vs 10%, p = 0.149, respectively). Furthermore, the occurrence of MACE at 270 days was significantly less frequent in the SES group compared with the BMS group (6% vs. 17%, p = 0.038). Multivariate analysis showed SES use tended to predict 270-day MACE (hazard ratio 0.37, 95% confidence interval 0.14-1.02, p = 0.055). Culprit lesion located in the left main trunk was identified as an independent predictor of 270-day MACE (hazard ratio 5.43, 95% confidence interval 1.07-27.59, p = 0.041). CONCLUSIONS: The use of a SES was not associated with increased risk of stent thrombosis compared with a BMS. With lower rates of restenosis and subsequent target vessel revascularization, SES placement could provide superior outcomes in patients with acute myocardial infarction.

Aged↗

PubMed2005

Involvement of N-terminal-extended form of sphingosine kinase 2 in serum-dependent regulation of cell proliferation and apoptosis.

Sphingosine kinase (SPHK) 1 is implicated in the regulation of cell proliferation and anti-apoptotic processes by catalyzing the formation of an important bioactive messenger, sphingosine 1-phosphate. Unlike the proliferative action of SPHK1, another isozyme, SPHK2, has been shown to possess anti-proliferative or pro-apoptotic action. Molecular mechanisms of SPHK2 action, however, are largely unknown. The present studies were undertaken to characterize the N-terminal-extended form of SPHK2 (SPHK2-L) by comparing it with the originally reported form, SPHK2-S. Real-time quantitative PCR analysis revealed that SPHK2-L mRNA is the major form in several human cell lines and tissues. From sequence analyses it was concluded that SPHK2-L is a species-specific isoform that is expressed in human but not in mouse. At the protein level it has been demonstrated by immunoprecipitation studies that SPHK2-L is the major isoform in human hepatoma HepG2 cells. SPHK2-L, when expressed in human embryonic kidney (HEK) 293 cells, did not show any inhibition of DNA synthesis in the presence of serum, whereas it showed marked inhibition in the absence of serum. Moreover, serum deprivation resulted in the translocation of SPHK2-L into the nuclei. In addition, serum deprivation induced SPHK2-L expression in HEK293 cells. Furthermore, suppression of SPHK2 by small interfering RNA treatment prevented serum deprivation- or drug-induced apoptosis in HEK293 cells. Taken together, these results indicate that a major form of SPHK2 splice variant, SPHK2-L, in human cells does not inhibit DNA synthesis under normal conditions and that SPHK2-L accumulation in the nucleus induced by serum deprivation may be involved in the cessation of cell proliferation or apoptosis depending on the cell type.

Amino Acid Sequence↗

PubMed2005

Computerized three-dimensional potential mapping with a multielectrode basket catheter can be useful for pulmonary vein electrical disconnection.

INTRODUCTION: Pulmonary vein (PV) isolation (PVI) has been recently proposed as an effective technique to cure atrial fibrillation (AF). AIMS OF THE STUDY: The aim of this study was to investigate the efficacy of a novel technique utilizing a computerized three-dimensional mapping system (QMS2) with a multielectrode basket catheter (MBC) for PVI and to reveal the relation between the style of breakthrough and the network of the PV musculature. METHODS: Sixty-five consecutive patients with frequent AF attacks underwent PV mapping with a 31-mm MBC, and a three-dimensional color animation of the potential map was constructed by the QMS2. The animation color schema was arranged to minimize the low-amplitude left atrial (LA) potentials and emphasize the high-amplitude PV potentials (PVPs). The longitudinal PVP map enabled us to recognize the true breakthroughs and reveal the network of the PV musculature. RESULTS: A total of 205 PVs (65 left superior PVs, 65 right superior PVs, 57 left inferior PVs and 18 right inferior PVs) were mapped and successful PVI was achieved in all PVs, except one that had no PVPs, with a mean radiofrequency duration of 7 +/- 5 minutes per PV. In about 90% of the PVs, a final radiofrequency application eliminated all the distal PVPs simultaneously because the PVI was performed at the appropriate LA-PV junction. A single segmental breakthrough was detected in 17 PVs, single broad breakthrough in 83 PVs, multiple separate breakthroughs with a distal connection between the PV musculatures extending from each separate breakthrough in 88 PVs and multiple separate breakthroughs without that connection in 16 PVs. During the follow-up period, fifty-one (78%) patients were free of symptomatic AF without any antiarrhythmic drugs after multiple procedures (thirty-three (51%) of those patients after the first procedure) and no PV stenosis was found. CONCLUSIONS: Computerized three-dimensional potential mapping can be useful for PVI because it can not only identify the true breakthrough, but can also confirm the elimination of the breakthroughs by the change in the activation sequence through the network of the PV musculature.

Analysis of Variance↗

PubMed2004

A mutation in the serum and glucocorticoid-inducible kinase-like kinase (Sgkl) gene is associated with defective hair growth in mice.

YPC is a mutant mouse strain with defective hair growth characterized by thin, short hairs and poorly developed hair bulbs and dermal papillae. To identify the gene associated with the phenotype, we performed genome-wide linkage analysis using 1010 backcross progeny and 123 microsatellite markers covering all chromosomes. The mutant locus (ypc) was mapped to a 0.2-cM region in the proximal part of mouse chromosome 1. This 0.2-cM region corresponds to a 450-kb region of genome sequence that contains two genes with known functions and five ESTs or predicted genes with unknown functions. Sequence analysis revealed a single C-to-A nucleotide substitution at nucleotide 1382 in the Sgkl gene, causing a nonsense mutation at codon 461. Sgkl encodes serum and glucocorticoid-inducible kinase-like kinase (SGKL), which belongs to a subfamily of serine/threonine protein kinases and has been suggested to have a role downstream of lipid signals produced by activation of phosphoinositide 3-kinase (PI3K). In the mutant SGKL, a serine residue in the C-terminal end of the protein (Ser486), which is indispensable for activation of SGKL upon phosphorylation, is abolished by premature termination. Specific expression of the Sgkl gene in the inner root sheath of growing hair follicles was also identified by in situ hybridization. Therefore, we concluded that the nucleotide substitution in the Sgkl gene is the causative mutation for defective hair growth in the ypc mutant mouse and that the signaling pathway involving SGKL plays an essential role in mammalian hair development.

Animals↗

PubMed2004

Delta-catenin/NPRAP (neural plakophilin-related armadillo repeat protein) interacts with and activates sphingosine kinase 1.

Sphingosine kinase (SPHK) is a key enzyme catalysing the formation of sphingosine 1-phosphate (SPP), a lipid messenger that is implicated in the regulation of a wide variety of important cellular events acting through intracellular, as well as extracellular, mechanisms. However, the molecular mechanism of intracellular actions of SPP remains unclear. Here, we have identified delta-catenin/NPRAP (neural plakophilin-related armadillo repeat protein) as a potential binding partner for SPHK1 by yeast two-hybrid screening. From co-immunoprecipitation analyses, the C-terminal portion of delta-catenin/NPRAP containing the seventh to tenth armadillo repeats was found to be required for interaction with SPHK1. Endogenous delta-catenin/NPRAP was co-localized with endogenous SPHK1 and transfected delta-catenin/NPRAP was co-localized with transfected SPHK1 in dissociated rat hippocampal neurons. MDCK (Madin-Darby canine kidney) cells stably expressing delta-catenin/NPRAP contained elevated levels of intracellular SPP. In a purified system delta-catenin/NPRAP stimulated SPHK1 in a dose-dependent manner. Furthermore, delta-catenin/NPRAP-induced increased cell motility in MDCK cells was completely inhibited by dimethylsphingosine, a specific inhibitor of SPHK1. These results strongly suggest that at least some of delta-catenin/NPRAP functions, including increased cell motility, are mediated by an SPHK-SPP signalling pathway.

Animals↗

PubMed2004

Down-regulation of melanogenesis by phospholipase D2 through ubiquitin proteasome-mediated degradation of tyrosinase.

The involvement of phospholipase D (PLD) in the regulation of melanogenesis was examined. Treatment of B16 mouse melanoma cells with 12-O-tetradecanoylphorbol-13-acetate (TPA) resulted in the activation of PLD and a decrease in melanin content. 1-Butanol, but not 2-butanol, completely blocked the TPA-induced inhibition of melanogenesis, suggesting the involvement of PLD in this event. Reverse transcription-PCR and immunoblot analyses revealed the existence of both PLD isozymes, PLD1 and PLD2, in B16 cells. When PLD1 or PLD2 was introduced into those cells by an adenoviral gene-transfer technique, both PLD1 and PLD2 were activated by TPA. When PLD1 and PLD2 were overexpressed, PLD2 potently caused a decrease in melanin content, whereas the effect of PLD1 expression on melanin content was minimal. Over-expression of PLD2 itself did not affect protein kinase C activity, as assessed by the intracellular distribution and levels of expression of each isoform expressed in B16 cells. The effects of TPA on the down-regulation of basal or alpha-melanocyte-stimulating hormone-enhanced melanogenesis were almost completely blocked by expressing a lipase activity-negative mutant, LN-PLD2, but not by LN-PLD1. Further, the PLD2-induced decrease in melanin content was accompanied by a decrease in the amount and activity of tyrosinase, a key enzyme in melanogenesis, whereas the mRNA level of tyrosinase was unchanged by the over-expression of PLD2. Moreover, treatment with proteasome inhibitors completely blocked the PLD2-induced down-regulation of melanogenesis. Taken together, the present results indicate that the TPA-induced down-regulation of melanogenesis is mediated by PLD2 but not by PLD1 through the ubiquitin proteasome-mediated degradation of tyrosinase. This suggests that PLD2 may play an important role in regulating pigmentation in vivo.

1-Butanol↗

PubMed2004

Simple and accurate catheter mapping technique to predict atrial fibrillation foci in the pulmonary veins or posterior right atrium.

OBJECTIVES: The purpose of this study was to investigate the efficacy of a novel catheter mapping technique for predicting atrial fibrillation (AF) foci. BACKGROUND: Most AF originates from pulmonary veins (PVs), but some originate from the right atrium. METHODS: We developed an algorithm by correlating the cardiac recordings obtained from multielectrode catheters placed in the posterior right atrium (RA) and esophagus during pacing from the PVs and superior vena cava (SVC) or crista terminalis (CT) in 10 AF patients. We tested the algorithm's accuracy prospectively in 46 AF patients. RESULTS: During pacing from the left PVs, the esophageal potentials preceded all other potentials. During pacing from both the right PVs and SVC-CT, the first component (FP) of the double potential (DP) recorded in the posterior RA preceded all other potentials. The amplitude of the FP was higher than that of the second DP component during pacing from the SVC-CT, whereas the reverse occurred from the right PVs. The activation sequence of the FPs and esophageal potentials was from superior to inferior during pacing from the superior PVs, whereas the reverse occurred from the inferior PVs. The accuracy of predicting 34 foci in the right PVs, 28 foci in left PVs, and 6 foci in SVC-CT was 100% for all, respectively. The accuracy of discriminating foci in the superior PVs from those in the inferior PVs was 97% in the right PVs and 96% in the left PVs. CONCLUSIONS: The technique using mapping catheters placed in the posterior RA and esophagus is feasible and effective for mapping and ablating AF.

Algorithms↗

PubMed2004

Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium.

INTRODUCTION: The right pulmonary veins (RPVs) and posterior wall of the right atrium (PRA) are anatomically located adjacent to each other. The aim of this study was to demonstrate the electrophysiologic characteristics of atrial tachycardia (AT) originating from the PRA or RPVs. METHODS AND RESULTS: A total of 26 consecutive patients with AT originating from the RPVs or PRA underwent detailed atrial endocardial mapping and successful radiofrequency catheter ablation. Eight foci were found in the PRA and 18 foci in the RPVs. Analysis of P wave configuration showed that lead V1 was the most helpful in distinguishing the AT foci between these two sites. In all cases, double potential (DP) configurations were recorded from several electrodes of a multielectrode catheter placed in the PRA, and the first DP component (FP) was the earliest potential recorded from the right atrium during the tachycardia. The amplitude of the FP was higher than that of the second DP component (SP) for AT foci originating in the PRA, whereas the reverse occurred for those in the RPV. The activation sequence of the FP was from superior to inferior for the AT foci in the superior RPV, whereas the reverse occurred for the AT foci in the inferior RPV. CONCLUSION: P wave configuration in lead V1 is helpful in distinguishing AT foci between those originating in the PRA and RPVs. The DPs obtained from the PRA can be useful in predicting whether AT foci originate from the PRA or RPVs.

Adolescent↗