Anatomical consideration for safe pericardiocentesis assessed by three-dimensional computed tomography: Should an anterior or posterior approach be used?

AbstractBackgroundThe efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined.MethodsThirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT.ResultsFor the anterior approach, the distance was 54±11mm and the needle angle was 37±11° toward the left scapula and 34±12° towards the back of the body. For the posterior approach, the distance was 56±10mm and the corresponding needle angles were 60±9° and 86±13°. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r2=0.43, P<0.001; posterior approach: r2=0.49, P<0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients.ConclusionsPerforming subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach

Intra-cardiac echocardiography guided catheter ablation of a right posterior accessory pathway in a patient with Ebstein׳s anomaly

AbstractWe report a case of Ebstein׳s anomaly in which radiofrequency catheter ablation of an accessory pathway was successfully performed under intra-cardiac echocardiography. A 50-year-old woman was referred to our hospital for radiofrequency catheter ablation of a paroxysmal supraventricular tachycardia. A 12-lead surface electrocardiogram revealed ventricular pre-excitation associated with type B Wolff–Parkinson–White syndrome. In the baseline electrophysiological study, an orthodromic atrioventricular reciprocating tachycardia with a right posterior accessory pathway was induced. A phased-array intra-cardiac echo probe was positioned in the right atrium to visualize the atrioventricular junction. The key structures for catheter ablation, such as the atrialized right ventricle, atrioventricular junction, and tricuspid valve, were clearly visualized on intra-cardiac echocardiography. Radiofrequency current was successfully delivered at the atrioventricular junction, where a Kent potential was recorded. During a 6-month follow-up period, the patient was free from arrhythmias. The findings in this case suggest that phased-array intra-cardiac echocardiography is useful for ablation of right-sided accessory pathways in patients with Ebstein׳s anomaly

わが国の大学における教養体育の開講状況に関する悉皆調査研究

The purpose of this study was to clarify and overview the current status of all colleges and universities (hereinafter, CUs) in Japan offering physical education courses as a component of liberal arts in higher education (hereinafter, PE in higher education) since the first complete survey that was conducted in 2000. Out of the 775 CUs existing as of August 2016, 742 CUs excluding 24 graduate universities and nine PE colleges were included in the survey. The following five items of information were extracted on PE in higher education from the CUs rules，handbook for students and syllabus posted on each CU website: 1) present/not present, 2) course type, 3) compulsory/optional, 4) number of compulsory credits, and 5) integrated title of the courses group. Among the 742 CUs surveyed, 97.7% (725 CUs) offered PE in higher education, except for 17 CUs (2.3%) that did not offer PE in higher education. The 725 CUs offering PE in higher education were categorized into courses comprising mainly practical skills (98.2%; 712 CUs), lectures (63.4%; 460 CUs) and compulsory for all departments (28.0%; 203 CUs), and compulsory for some departments (40.8%; 296 CUs) including practical skills (94.6%; 280 CUs), lectures (31.1% ; 92 CUs), and practical skills and lectures (25.7%; 76 CUs) in undergraduate departments. The number of PE in higher education credits offered as compulsory subjects was 2.15 ± 0.84 (mean ± standard deviation) and 0.5 to 5.0 (minimum - maximum) credits. The terms included in the integrated titles of PE in higher education courses for 725 CUs offering such courses were “Sports” (42.8%; 310 CUs), “Physical education” (39.9%; 289 CUs), “Health” (37.8%; 274 CUs), “Health education” (18.6%; 135 CUs), “Health and physical education” (17.8%; 129 CUs), and “Science” (14.8%; 107 CUs). The results revealed that PE in higher education was offered at approximately 98% of all CUs in Japan, and that the courses were compulsory at approximately 40% of them. Therefore, it can be said that PE in higher education is currently being offered at most CUs. This study has provided an overview of PE in higher education in Japan for the first time since 2000. Future research will involve conducting current status surveys of the curriculum contents focusing on the educational system for PE

Topographic variability of the left atrium and pulmonary veins assessed by 3D-CT predicts the recurrence of atrial fibrillation after catheter ablation

AbstractBackgroundCatheter ablation (CA) is an established therapy for atrial fibrillation (AF). However, the assessment of anatomical information and predictors of AF recurrence remain unclear. We investigated the relationship between anatomical information on the left atrium (LA) and pulmonary veins (PVs) from three-dimensional computed tomography images and the recurrence of AF after CA.MethodsSixty-seven consecutive AF patients (mean age: 62±10 years, median AF history: 42 (12; 60) months, mean LA size: 41±7mm, paroxysmal: 56%) underwent CA and were followed for 19±10 months. The segmented surface areas (antral, posterior, septal, and lateral) and dimensions (between the anterior and posterior walls, the right inferior PV and mitral annulus [MA], the right superior PV and MA, the left superior PV and MA, and the mitral isthmus) of the LA were evaluated three dimensionally using the NavX system. The cross-sectional areas of the PVs were also evaluated.ResultsAfter the follow-up period, 49 patients (73%) remained free from AF. A multivariate analysis showed that the diameter of the mitral isthmus and cross-sectional area of the right upper PV were associated with AF recurrence (odds ratio: 1.070, CI: 1.02–1.12, p=0.001; odds ratio: 0.41, CI: 0.21–0.77, p=0.006).ConclusionEnlargement of the mitral isthmus and a smaller right superior PV cross-sectional area were associated with AF recurrence

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography

AbstractBackgroundThe radiofrequency (RF) lesions for atrial fibrillation (AF) ablation can be visualized by delayed enhancement magnetic resonance imaging (DE-MRI). However, the quality of anatomical information provided by DE-MRI is not adequate due to its spatial resolution. In contrast, magnetic resonance angiography (MRA) provides similar information regarding the left atrium (LA) and pulmonary veins (PVs) as computed tomography angiography. We hypothesized that DE-MRI fused with MRA will compensate for the inadequate image quality provided by DE-MRI.MethodsDE-MRI and MRA were performed in 18 patients who underwent AF ablation (age, 60±9 years; LA diameter, 42±6mm). Two observers independently assessed the DE-MRI and DE-MRI fused with MRA for visualization of the RF lesion (score 0–2; where 0: not visualized and 2: excellent in all 14 segments of the circular RF lesion).ResultsDE-MRI fused with MRA was successfully performed in all patients. The image quality score was significantly higher in DE-MRI fused with MRA compared to DE-MRI alone (observer 1: 22 (18, 25) vs 28 (28, 28), p<0.001; observer 2: 24 (23, 25) vs 28 (28, 28), p<0.001).ConclusionsDE-MRI fused with MRA was superior to DE-MRI for visualization of the RF lesion owing to the precise information on LA and PV anatomy provided by DE-MRI