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Narrow QRS tachycardia

Aizawa Y., Takatsuki S., Inagawa K., Katsumata Y., Nishiyama T., Kimura T., Nishiyama N., Sato Y., Fukumoto K., Tanimoto Y., Tanimoto K., Fukuda K.

Herz 39 （ 2 ） 276 - 278 2014年

ISSN 0340-9937

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Serum Inflammation Markers Predicting Successful Initial Catheter Ablation for Atrial Fibrillation

Kimura Takehiro, Takatsuki Seiji, Inagawa Kohei, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Fukumoto Kotaro, Aizawa Yoshiyasu, Tanimoto Yoko, Tanimoto Kojiro, Fukuda Keiichi

Heart Lung and Circulation 23 （ 7 ） 636 - 643 2014年

ISSN 1443-9506

Background: We investigated various serum inflammatory markers to predict ablation responders who have no atrial fibrillation (AF) relapse after the initial ablation. Methods: Forty-four consecutive AF patients (age: 59 ± 8 years, paroxysmal: 31, CHADS₂: 1.1 ± 1.1) who underwent an initial pulmonary vein isolation were investigated. Various serum inflammatory markers, such as adiponectin, ANP, BNP, 1CTP, F1+2, hs-CRP, IL-6, intact P1NP, MDA-LDL, MMP-2, TGF-β, TIMP-2, and TNF-α, were evaluated prior to ablation. AF relapse was defined as AF documented in telemonitoring electrocardiograms twice a day during 9.7 ± 2.4 months of follow-up with three months of a blanking-period. Results: A total of 29 patients (paroxysmal: 21) maintained sinus rhythm after the initial catheter ablation. These ablation responders had significantly lower MMP-2 (Sinus vs. Relapsed: 748 ± 132.7 vs. 841.2 ± 152.4 ng/mL, P=0.042) and TNF-α (1.1 ± 0.4 vs. 1.8 ± 1.7 pg/mL, P=0.046) levels prior to ablation. A BNP-adjusted Cox multivariate regression analysis revealed that the independent predictive factor for AF recurrence was high MMP-2 levels (>766 ng/mL) accompanied by high TNF-α levels (>1.2 pg/mL). Conclusions: The levels of MMP-2 and TNF-α might be useful for predicting initial AF catheter ablation responders. © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

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Electrophysiological properties of the superior vena cava and venoatrial junction in patients with atrial fibrillation

Fukumoto Kotaro, Takatsuki Seiji, Kimura Takehiro, Nishiyama Nobuhiro, Tanimoto Kojiro, Aizawa Yoshiyasu, Tanimoto Yoko, Fukuda Yukiko, Miyoshi Shunichiro, Fukuda Keiichi

Journal of Cardiovascular Electrophysiology 25 （ 1 ） 16 - 22 2014年

ISSN 1045-3873

Electrophysiological Properties of the Superior Vena Cava and Venoatrial Junction Background Although the superior vena cava (SVC) has been well known to be one of the important foci triggering atrial fibrillation (AF), its electrophysiological characteristics have received little research attention. The aim of this study was to investigate the electrophysiological properties of the SVC and venoatrial junction (VAJ). Methods Twenty-five consecutive AF patients without structural heart disease undergoing electrical SVC isolation were included in this study. After pulmonary vein isolation, a circular decapolar catheter and 2 multipolar catheters were emplaced in the VAJ, right atrial appendage (RAA), and SVC, respectively. Burst pacing and single extrastimulus were applied from the RAA and SVC. The atrial and caval potentials on the circular catheter in the VAJ were investigated. Results Intracaval conduction delay and various degrees of conduction block over the VAJ were observed with burst pacing from both the RAA and SVC. A single extrastimulus from the RAA and SVC with a basic cycle length of 600 milliseconds prolonged the conduction time via the VAJ by 81 ± 49.7 milliseconds and 61 ± 58.7 milliseconds, respectively. The atrial and caval electrograms at the VAJ, which were separated from each other by pacing applications, facilitated mapping of the earliest activation site at the VAJ. Conclusions Intracaval conduction delay and decremental conduction property via the VAJ were demonstrated using pacing maneuvers. Pacing applications from the RAA or SVC can help distinguish the atrial and caval potentials and can facilitate mapping of the optimal ablation sites to isolate the SVC. © 2014 Wiley Periodicals, Inc.

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Thrombus Formation in the Left Atrial Appendage During Catheter Ablation for Atrial Fibrillation Under Sufficient Heparinization

Kimura Takehiro, Takatsuki Seiji, Tanimoto Kojiro, Katsumata Yoshinori, Nishiyama Takahiko, Inagawa Kohei, Nishiyama Nobuhiro, Tanimoto Yoko, Aizawa Yoshiyasu, Fukuda Keiichi

Canadian Journal of Cardiology 30 （ 4 ） 2014年

ISSN 0828-282X

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Myocardial necrosis depth prediction during extracellular photosensitization reaction of talaporfin sodium by defined index using fluorescence measurement

Takahashi M., Ito A., Kimura T., Takatsuki S., Fukuda K., Arai T.

Lasers in Medical Science 29 （ 3 ） 1173 - 1181 2014年

ISSN 0268-8921

An application of photodynamic therapy for myocardial ablation, which would induce myocardial electrical conduction block, is proposed. For the proposed application, an extracellular photosensitization reaction (PR) is performed while photosensitizer is distributed in myocardial interstitial space by employing a short drug-light interval. Because the myocardial necrosis depth must be accurately controlled to prevent surrounding tissue injury during the myocardial ablation procedure, the necrosis depth during PR needs to be predicted. The purpose of this study is to investigate the availability of predicting PR-induced myocardial necrosis depth (d_nec) using a defined fluorescence-fall amount (FA), which is the calculated result of fluorescence intensity decrease from the start of the PR multiplied by irradiation duration and corresponds to photosensitizer consumption amount under an assumption that the photosensitizer consumption rate is faster than the photosensitizer supply rate. The correlation between FA and d_nec was experimentally investigated in vivo using an open-chested canine heart model with 2.5 and 5.0 mg/kg of talaporfin sodium at an irradiance of 5-20 W/cm ² for 5-20 s. The fluorescence measurement was performed at a wavelength of 710 nm during the PR to derive FA. One week after the PR, a uniform necrosis depth was measured histopathologically as d_mnec. A logarithmic correlation between d_mnec and FA was confirmed with R²=0.69-0.80 and a d_mnec range of 0.2-7.1 mm. The defined FA might be useful for predicting d_nec for the extracellular PR in myocardium when using talaporfin sodium. © 2013 Springer-Verlag.

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Unusual termination by single ventricular extra-stimulus applied during atrioventricular reciprocating tachycardia

Ikegami Yukinori, Takatsuki Seiji, Yoshida Takuo, Momiyama Yukihiko

PACE - Pacing and Clinical Electrophysiology 37 （ 6 ） 774 - 776 2014年

ISSN 0147-8389

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Efficacy and safety of bepridil for prevention of ICD shocks in patients with Brugada syndrome and idiopathic ventricular fibrillation

Aizawa Yoshiyasu, Yamakawa Hiroyuki, Takatsuki Seiji, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Mitamura Hideo, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 168 （ 5 ） 5083 - 5085 2013年10月

ISSN 0167-5273

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Diagnostic value of portable electrocardiogram (Cardiophone) in patients complaining of palpitation

Aizawa Yoshiyasu, Takatsuki Seiji, Suenaga Yuko, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Kohsaka Shun, Fukuda Yukiko, Murata Mitsushige, Miyoshi Shunichiro, Sato Toshiaki, Iwanaga Shiro, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 168 （ 3 ） 2925 - 2927 2013年10月

ISSN 0167-5273

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A case of Brugada syndrome showing augmentation of electrocardiogram phenotype by complete right bundle branch block

Aizawa Yoshiyasu, Kimura Takehiro, Takatsuki Seiji

Europace 15 （ 10 ） 1525 2013年10月

ISSN 1099-5129

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Nonthermal cardiac catheter ablation using photodynamic therapy

Kimura Takehiro, Takatsuki Seiji, Miyoshi Shunichiro, Fukumoto Kotaro, Takahashi Mei, Ogawa Emiyu, Ito Arisa, Arai Tsunenori, Ogawa Satoshi, Fukuda Keiichi

Circulation: Arrhythmia and Electrophysiology 6 （ 5 ） 1025 - 1031 2013年10月

ISSN 1941-3149

Background: Radiofrequency ablation has limitations, largely related to creation of lesions by heating. Here, we report the first nonthermal ablation by applying photodynamic therapy (PDT) to cardiac tissues using a custom-made deflectable laser catheter. The present study investigated the feasibility of PDT for cavotricuspid isthmus ablation in a canine model. Methods and Results: We evaluated the pharmacokinetic profiles of 17 canines after administration of a photosensitizer (talaporfin sodium) by various protocols. We succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans. Using a 4-polar 7-French deflectable laser catheter, we performed PDT-mediated cavotricuspid isthmus ablation in 8 canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electric conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation. Hematoxylin and eosin staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at 2 weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency ablation procedures. A ventricular crosssection revealed a solid PDT lesion, which was as deep as a radiofrequency lesion. In addition, endocardial, surficial, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the nonthermal nature of the ablation technique. Conclusions: Nonthermal PDT-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias. © 2013 American Heart Association, Inc.

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Ventricular Fibrillation Associated With J-Wave Manifestation Following Pericarditis After Catheter Ablation for Paroxysmal Atrial Fibrillation

Kimura Takehiro, Takatsuki Seiji, Aizawa Yoshiyasu, Anzai Atsushi, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Okuda Shigeo, Fukuda Keiichi

Canadian Journal of Cardiology 29 （ 10 ） 2013年10月

ISSN 0828-282X

We present a patient with ventricular fibrillation (VF) associated with J-wave manifestation following pericarditis after catheter ablation of paroxysmal atrial fibrillation (AF). The premature ventricular contraction induced VF with J-waves in the inferior leads 2 days after the procedure. The patient's juvenile onset of AF and a family history of sudden cardiac death strongly suggested an underlying hereditable channelopathy. The late gadolinium enhancement in the posterior wall, viewed by cardiac magnetic resonance imaging, matched the leads of the J-waves. VF might develop in juvenile onset of AF especially in individuals with a family history of sudden cardiac death. © 2013 Canadian Cardiovascular Society.

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Electrical storm in idiopathic ventricular fibrillation is associated with early repolarization

Aizawa Yoshifusa, Chinushi Masaomi, Hasegawa Kanae, Naiki Nobu, Horie Minoru, Kaneko Yoshiaki, Kurabayashi Masahiko, Ito Shogo, Imaizumi Tsutomu, Aizawa Yoshiyasu, Takatsuki Seiji, Joo Kunitake, Sato Masahito, Ebe Katsuya, Hosaka Yukio, Haissaguerre Michel, Fukuda Keiichi

Journal of the American College of Cardiology 62 （ 11 ） 1015 - 1019 2013年09月

ISSN 0735-1097

Objectives This study sought to characterize patients with idiopathic ventricular fibrillation (IVF) who develop electrical storms. Background Some IVF patients develop ventricular fibrillation (VF) storms, but the characteristics of these patients are poorly known. Methods Ninety-one IVF patients (86% male) were selected after the exclusion of structural heart diseases, primary electrical diseases, and coronary spasm. Electrocardiogram features were compared between the patients with and without electrical storms. A VF storm was defined as VF occurring ≥3 times in 24 h and J waves >0.1 mV above the isoelectric line in contiguous leads. Results Fourteen (15.4%) patients had VF storms occurring out-of-hospital at night or in the early morning. J waves were more closely associated with VF storms compared to patients without VF storms: 92.9% versus 36.4% (p < 0.0001). VF storms were controlled by intravenous isoproterenol, which attenuated the J-wave amplitude. After the subsidence of VF storms, the J waves decreased to the nondiagnostic level during the entire follow-up period. Implantable cardioverter-defibrillator therapy was administered to all patients during follow-up. Quinidine therapy was limited, but the patients on disopyramide (n = 3), bepridil (n = 1), or isoprenaline (n = 1) were free from VF recurrence, while VF recurred in 5 of the 9 patients who were not given antiarrhythmic drugs. Conclusions The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves, which diminished to below the diagnostic level during follow-up. VF recurred in patients followed up without antiarrhythmic agents. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.

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Brugada syndrome behind complete right bundle-branch block

Aizawa Yoshiyasu, Takatsuki Seiji, Sano Motoaki, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Murata Mitsushige, Komatsu Takashi, Mitamura Hideo, Ogawa Satoshi, Funazaki Toshikazu, Sato Masahito, Aizawa Yoshifusa, Fukuda Keiichi

Circulation 128 （ 10 ） 1048 - 1054 2013年09月

ISSN 0009-7322

BACKGROUND-: The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. METHODS AND RESULTS-: The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V₂ or V₃ in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 145±15 milliseconds in V₁ and 144±19 versus 128±7 milliseconds in V₅ (both P<0.0001). The amplitude of R in V₁ was larger in the BS patients than in the control subjects (P=0.0323), but that of R′ was similar (P=0.0560). CONCLUSIONS-: BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined. © 2013 American Heart Association, Inc.

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An absolute atrial arrhythmia

Fukumoto Kotaro, Nishiyama Nobuhiro, Kinebuchi Osamu, Takatsuki Seiji

Journal of Cardiovascular Electrophysiology 24 （ 9 ） 1056 - 1058 2013年09月

ISSN 1045-3873

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Ventricular fibrillation associated with complete right bundle branch block

Aizawa Yoshiyasu, Takatsuki Seiji, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Suzuki Makoto, Yokoyama Yasuhiro, Chinushi Masaomi, Watanabe Ichiro, Ogawa Satoshi, Aizawa Yoshifusa, Antzelevitch Charles, Fukuda Keiichi

Heart Rhythm 10 （ 7 ） 1028 - 1035 2013年07月

ISSN 1547-5271

Background A substantial number of patients with idiopathic ventricular fibrillation (IVF) present with no specific electrocardiographic (ECG) findings. Objective To evaluate complete right bundle branch block (RBBB) in patients with IVF. Methods Patients with IVF showing complete RBBB were included in the present study. Structural and primary electrical diseases were excluded, and provocation tests were performed to exclude the presence of spastic angina or Brugada syndrome (BrS). The prevalence of complete RBBB and the clinical and ECG parameters were compared either in patients with IVF who did not show RBBB or in the general population and age and sex comparable controls with RBBB. Results Of 96 patients with IVF, 9 patients were excluded for the presence of BrS. Of 87 patients studied, 10 (11.5%) patients showed complete RBBB. None had structural heart diseases, BrS, or coronary spasms. The mean age was 44 ± 15 years, and 8 of 10 patients were men. Among the ECG parameters, only the QRS duration was different from that of the other patients with IVF who did not show complete RBBB. Ventricular fibrillation recurred in 3:2 in the form of storms, which were well suppressed by isoproterenol. Complete RBBB was found less often in control subjects (1.37%; P <.0001), and the QRS duration was more prolonged in patients with IVF: 139 ± 10 ms vs 150 ± 14 ms (P =.0061). Conclusions Complete RBBB exists more often in patients with IVF than in controls. A prolonged QRS complex suggests a conduction abnormality. Our findings warrant further investigation of the role of RBBB in the development of arrhythmias in patients with IVF. © 2013 Heart Rhythm Society.

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The left atrial appendage

Kimura Takehiro, Takatsuki Seiji, Fukuda Keiichi

Future Cardiology 9 （ 4 ） 451 - 453 2013年07月

ISSN 1479-6678

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Three-dimensional imaging and mapping of the right and left phrenic nerves

Fukumoto Kotaro, Takatsuki Seiji, Jinzaki Masahiro, Yamada Minoru, Tanimoto Kojiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Hagiwara Yoko, Fukuda Yukiko, Kimura Takehiro, Miyoshi Shunichiro, Kuribayashi Sachio, Fukuda Keiichi

Europace 15 （ 7 ） 937 - 943 2013年07月

ISSN 1099-5129

AimsPhrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping.Methods and resultsForty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 ± 5.8 mm.ConclusionsThe 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy. © 2013 The Author.

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Ridge-related reentry

Takatsuki Seiji, Fukumoto Kotaro, Igawa Osamu, Kimura Takehiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Fukuda Keiichi

Journal of Cardiovascular Electrophysiology 24 （ 7 ） 781 - 787 2013年07月

ISSN 1045-3873

Ridge-Related Reentry Introduction The ridge between the left pulmonary veins (PV) and the left atrial appendage composes part of the lateral mitral isthmus (LMI). Following circumferential PV isolation and LMI linear ablation for the treatment of atrial fibrillation (AF), a critical pathway might develop over the ridge leading to a ridge-related reentry (RRR). Methods and Results Out of 61 patients who underwent circumferential PV isolation appended by LMI ablation, 5 patients developed RRR. The diagnosis of RRR was based on (1) macro-reentrant atrial tachycardia involving the septum, anterior and inferior wall of the left atrium; (2) slow conduction along the ridge; (3) wide-split double potentials in the ventricular aspect of the LMI were identified with the coronary sinus (CS) electrodes. RRR was investigated with electroanatomical mapping and entrainment mapping and catheter ablation was carried out in all patients. The mean cycle length (CL) of RRR was 312 ± 82 milliseconds and the PPIs at the left atrial septum, inferior and anterior wall during RRR were 10 ± 6, 12 ± 8, 9 ± 5 milliseconds longer than the RRR CL. The interval of the double potentials recorded in the CS electrodes crossing the LMI was 164 ± 38 milliseconds during RRR and the PPI on the LMI near the mitral annulus was 57 ± 10 milliseconds longer than the RRR CL. Catheter ablation was performed anatomically by targeting the ridge and successfully terminated RRR. Conclusion After circumferential PV isolation and ablation for LMI in patients with AF, RRR can develop by utilizing the surviving myocardial tissue of the ridge as a critical pathway. © 2013 Wiley Periodicals, Inc.

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Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores

Kimura Takehiro, Takatsuki Seiji, Inagawa Kohei, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Fukumoto Kotaro, Aizawa Yoshiyasu, Tanimoto Yoko, Tanimoto Kojiro, Jinzaki Masahiro, Fukuda Keiichi

Heart Rhythm 10 （ 6 ） 921 - 925 2013年06月

ISSN 1547-5271

BACKGROUND Strokes develop even in patients with low CHADS₂ scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS₂ scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS₂ score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA₂DS₂-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA ₂DS₂-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS₂ scores. © 2013 Heart Rhythm Society. All rights reserved.

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Sudden cardiac arrest and syncope triggered by coronary spasm

Togashi Ikuko, Sato Toshiaki, Soejima Kyoko, Takatsuki Seiji, Miyoshi Shunichiro, Fukumoto Kotaro, Nishiyama Nobuhiro, Suzuki Masaru, Hori Shingo, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 163 （ 1 ） 56 - 60 2013年02月

ISSN 0167-5273

Background: Patients with coronary spasm generally have a good prognosis, although it can result in sudden cardiac arrest (SCA) and syncope. We hypothesized that the nature of coronary spasm triggering lethal arrhythmias may be different from that which induces angina-only. Methods: Clinical characteristics were examined in patients who had experienced SCA (n = 18) or syncope (n = 28) triggered by coronary spasm. These characteristics were compared to those of patients who had coronary spastic angina-only (n = 52). Results: SCA and syncope occurred frequently during daytime in 57% and 68%, respectively. Spontaneous ST-segment changes during daytime were recorded more often in patients with SCA (50%) and syncope (39%) than angina-only patients (4%, p < 0.01 for each). Nocturnal angina occurred less frequently in patients with SCA (33%) and syncope (32%) than angina-only patients (83%, p < 0.01 for each). Severe multivessel spasm, daytime ST-segment changes, and younger age were significant predictors of SCA. Daytime ST-segment changes and active smoking were related to syncope. Conclusions: The circadian variance of coronary spasm triggering SCA or syncope may be different from that inducing typical coronary spastic angina. The coronary spasm should be evaluated for patients with aborted SCA or recurrent syncope of unknown cause, even though the patients have not experienced the typical nocturnal angina. © 2011 Elsevier Ireland Ltd. All rights reserved.

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