ジゾク セイ シンボウサイドウ アブレーション ゴ ノ サイハツ ヨソク インシ ノ ケントウ : サボウ ケイタイ ・ サ シンジ キノウ ノ ユウヨウ セイ

持続性心房細動に対するカテーテルアブレーション(CA)治療後の再発予測を,術前の心エコー図検査から行い,その有用性について検討した.対象は2011 年1 月からの1 年間,心房細動(AF)に対し,初回CA を施行したAF 連続80 例のうち持続性AF32 例である.CA 前に経胸壁心エコー図検査(TTE)および経食道心エコー図検査(TEE)を施行し,各指標を計測し,術後再発予測因子を検討した.CA 後1 年で14 例(44%)にAF の再発を認めた.再発群は非再発群に比し,左房長径が有意に大きく,左心耳壁運動速度は先端と外側の陰性波計測値が有意に低下していた.多変量解析では左房長径および左心耳先端壁運動速度陰性波(LAAWV apex-d)がCA 後AF 再発の予測因子であった.ROC 曲線にて,左房長径はカットオフ値を58 mmとすると感度92.3%,特異度66.7%,LAAWV apex-d はカットオフ値を9.4 cm/s とすると感度78.6%,特異度83.3%で,両者共CA 後AF の再発を予測し得た.TTE およびTEE からCA 後の再発予測が可能であった.Background:Catheter ablation( CA) of persistent atrial fibrillation (PsAF) has been widely performed. However, echocardiographic predictions for the AF recurrence are not completely understood.Objective:The purpose of this study was to evaluate the value of both the left atrial( LA) longitudinal diameter and left atrial appendage wall velocity (LAAWV) for predicting AF recurrences after CA of PsAF.Methods: We retrospectively analyzed 32 patients with PsAF who had undergone CA. Both the transthoracic and transesophageal echocardiographic parameters, and clinical parameters were assessed.Results:During a one-year follow-up period, 14 patients (44 %) had AF recurrences after a single CA procedure. There was a significant difference in the LA longitudinal diameter (63±3.3 mm vs. 58±5.4 mm;p=0.0029) and LAAWV apex-d (7.9±2.1 cm/s vs. 11.7±3.0 cm/s;p= 0.0003) in the patients with and without AF recurrences. A multivariate analysis revealed that the LA longitudinal diameter (p=0.0247) and LAAWV apex-d (p=0.047) were significant predictors of arrhythmia recurrences. In the receiver operator curve analysis, a longitudinal diameter> 58 mm demonstrated a sensitivity of 92.3 % and specificity of 66.7%, and a LAATDI apex-d of 9.4 cm/s demonstrated a sensitivity of 78.6 % and specificity of 83.3%, in predicting an arrhythmia recurrence.Conclusion:The LA longitudinal diameter and LAAWV could be used as non-invasive pre-procedural predictors of arrhythmia recurrences after single CA procedures in patients with PsAF

Catheter Ablation of Ventricular Tachycardia Originating from the Left Posterior Papillary Muscle Guided by the Shadow of a Multipolar Catheter

A 62-year-old man without structural heart disease underwent electrophysiological testing for ventricular tachycardia (VT). Hemodynamically unstable VT was induced after isoproterenol (ISP) provocation. Electroanatomical mapping using a multipolar catheter identified the earliest activation originating from the posterior papillary muscle (PPM) where prepotentials preceding the local ventricular electrogram were observed. Irrigated radiofrequency current guided by the shadow of a multipolar catheter eliminated the VT. This case suggested that multipolar catheters may be helpful for identifying tachycardia origins arising from the PPM

DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy —A Case Report Which Suggests the Importance of Lead Position and the Mechanism—

We treated a patient with hypertrophic obstructive cardiomyopathy (HOCM) who underwent DDD pacing therapy. He suffered from attacks of paroxysmal atrial fibrillation (PAF) complicated by sick sinus syndrome. Initially, we were unable to decrease the left ventricular outflow tract (LVOT) gradient by pacing from the mid-distal portion of the right ventricular (RV) septum. However, by changing the pacing site to the apical portion guided by right ventriculography, it was possible to decrease the LVOT gradient and at the same time reduce the mitral regurgitation. Tissue Doppler imaging (TDI) revealed a marked motion delay of the ventricular septum during DDD pacing. The mechanism of the therapy for HOCM provided by the DDD pacing was clearly confirmed by TDI. Furthermore, a dramatic effect of preventing symptomatic PAF with the use of overdrive pacing in the region of Bachmann's bundle was also observed. This case report provides new insight into DDD pacing therapy for patients with HOCM