Concealed WPW Syndrome with Longitudinal Dissociation in the His Bundle Exhibiting Five Different Electrocardiographic Waveforms During Tachycardia

We examined a patient with concealed WPW syndrome who exhibited five different electrocardiographic waveforms during tachycardia.With the intracardiac electrogram, all tachycardia were artrioventricular reciprocating tachycardia with retrograde conduction through only the accessory pathway where each artrioventricular conduction form varied: i.e., one with anterograde conduction through the fast pathway, one with anterograde conduction through the slow pathway, one with anterograde conduction through the fast pathway and slow pathway alternately, and an irregular R-R interval, one with anterograde conduction through the fast pathway and wide QRS tachycardia with the right bundle branch block type, and one with anterograde conduction through the fast pathway and wide QRS tachycardia with left bundle branch block.His bundle electrogram might be split and H, H′ was recorded at the time of sinus rhythm. Furthermore, the right and left bundle branches exhibited a different refractory period because of longitudinal dissociation in the His bundle. Therefore wide QRS tachycardia with both right and left bundle branch block might appear without complete atrioventricular block.In addition to the association between fast pathway and slow pathway, right and left bundle branch block patterns appeared

Use of Catheter Ablation in the Treatment of Ventricular Tachycardia Triggered by Premature Ventricular Contraction

A 50-year-old man who had suffered from old myocardial infarction presented with an episode of syncope. DC shock was required for the interruption of frequent pleomorphic ventricular tachycardia (VT). Although the treatment for heart failure decreased the frequency of VT attacks, hemodynamically unstable VT occurred several times. A 12-lead Holter electrocardiogram was used to determine the triggering premature ventricular contraction (PVC) and catheter ablation was performed by targeting this PVC. The site of origin of the triggering PVC was considered to be located between damaged cardiac muscle and intact Purkinje's fiber. No episode of PVC and VT was observed after a few days of ablation. An implantable cardioverter defibrillator was implanted but VT did not recur for more than 20 months

The Prognosis of Patients who Received Automated External Defibrillator Treatment in Hospital

Introduction: Unlike cardiac arrest occurring out-of-hospital, the safety and efficacy of automated external defibrillators (AED) in the hospital has not been assessed. This study examined the conditions of AED use in hospital and the prognosis of these patients. Methods and Results: We examined the condition and prognosis of 32 patients who were given AED treatment while they were in an unconscious state in the hospital, between May 2004 and January 2007. During this period, AED was used only for patients, not for visitors or hospital personnel. Ventricular fibrillation (VF) or ventricular tachycardia (VT) was observed in 7 patients, and in the other 25 the initial rhythm of the patients did not require AED. Two patients survived with the help of AED, but it did not deliver shock in two patients with VF and VT. There was no significant difference in vital prognosis due to the presence or absence of shock delivery in the VF or VT patients. Conclusion: The situation of AED use may be different whether it is used in hospital or outof-hospital. This study suggests that using AED in the hospital may have limited effect when it is used for critically ill patients

下腿血行再建術症例の検討: とくに術前血管造影所見と予後の関連性について

金沢大学医薬保健研究域医学