Kazuhiro Satomi

Radiofrequency Applications for Spontaneous Dissociated Pulmonary Vein Activity: Background: The aim is to evaluate the efficacy of additional radiofrequency ablation (RFCA) for spontaneous dissociated pulmonary vein activity (DPV‐spike) after PV isolation (PVI) in patients with paroxysmal atrial fibrillation (AF).Methods: One hundred fifty‐two consecutive patients with paroxysmal AF referred for RFCA were enrolled. When DPV‐spike was documented after PVI, we randomly assigned these patients to receive additional RFCA for DPV‐spike or only PVI. We divided them into 4 groups: 87 patients without DPV‐spike after PVI (No‐spike group), 31 without DPV‐spike after additional RFCA (Successful group), 8 with remaining DPV‐spike after additional RFCA (Unsuccessful group), and 26 with DPV‐spike after only PVI (Spike group). AF recurrence was evaluated among the 4 groups.Results: After PVI, DPV‐spike was documented in 87 PVs (14%) from 65 patients. During 16 ± 9 months of follow‐up, the incidence of the freedom from AF was significantly higher in the No‐spike group than that in the Spike group and Unsuccessful group (P < 0.05), and tended to be higher in the Successful group than that in the Spike group and Unsuccessful group (P = 0.08 and 0.11, respectively). In a multivariate analysis, the remaining PV‐spike after ablation was an independent predictor of AF recurrence (HR 2.44; CI 1.10–5.43, P < 0.05). No major complications including PV stenosis were observed during the follow‐up.Conclusions: DPV‐spike after PVI may be associated with higher electrical activity within the PVs and may be one of the risk factors for AF recurrence. Additional RFCA for DPV‐spike was effective to reduce the AF recurrence after PVI.

心室頻拍（VT）を合併する特殊心筋疾患は，催不整脈性右室心筋症（ARVC）や心サルコイドーシスが主である．【方法】VTを合併するARVC 84例，および心サルコイドーシス17例におけるアブレーション成績と長期予後を検討した．【結果】ARVCでは，平均9.2±6.5年の経過観察中に，VTの再発は31例（37％），心不全での入院は18例（21％），心原性死亡は7例（8％），心臓突然死は5例（6％），心不全死は2例（2％）に認めた．アブレーションは48例に施行し，81％でVTの誘発不能となった．経過観察中31％でVTの再発を認めた．心サルコイドーシスに伴うVT 17例に対し，アブレーションを施行したところ，9例（53％）で成功，１例は心外膜アプローチが必要であった．平均49±58ヵ月の経過観察期間中，アブレーション成功例9例中2例（22％）でVTが再発した．【結果】ARVCおよび心サルコイドーシス患者に対するVTアブレーション成績はいまだ不十分であり，今後の成績改善が待たれる．

Background: The intervals of the driving restrictions after an implantable cardioverter defibrillator (ICD) replacement vary across the different countries around the world. However, little is known regarding the appropriate duration for driving restrictions after an ICD replacement. The aim of this study was to investigate the clinical effect of ICD replacements and to elucidate when to resume driving an automobile after an ICD replacement. Methods and Results: The study reviewed 139 consecutive patients with an ICD replacement in order to evaluate the incidence of ICD therapies before and after ICD replacements, and to assess the time-dependence of the ICD therapies after the ICD replacement. There was no significant difference in the incidence of ICD therapies delivered during durations of 3 months and 6 months before and after the ICD replacement (P=0.28, and 1.0, respectively). ICD therapies after the replacements were observed in 8.6% of the patients who were legally eligible to drive according to the Japanese guidelines at 1 year, and that was associated with a relatively low annual risk of death or injury to others. Conclusions: Implantable cardioverter defibrillator replacements did not affect the future ICD therapies under similar algorithms. The appropriate interval for driving restrictions after an ICD replacement is recommended to be a week or so, with a system integrity check performed before resumption of driving. (Circ J 2010; 74: 2301-2307)

心機能の比較的保たれた器質的心疾患における心室頻拍（VT）患者の予後は十分には明らかにされていない．今回われわれは，器質的心疾患患者における持続性単形性VT（SMVT）に対して，抗不整脈薬内服ないしカテーテルアブレーション（CA）治療後の電気生理学的検査（EPS）と予後に関する検討を行った．すなわち，SMVTの既往があり左室駆出率が35％以上の65例（虚血性心筋症21例，拡張型心筋症13例，肥大型心筋症3例，心サルコイドーシス6例，催不整脈性右室心筋症17例，ファロー四徴症術後5例）を対象にEPSを施行し，VT誘発性と全死亡，心臓突然死，VT再発との関連について調査した．その結果，43ヵ月の平均フォローアップ期間中，死亡例は認められなかったものの，VTの再発が18例（28％）に認められた．他方でVT誘発群は，非誘発群と比較し，有意にVTの再発率が高かった．また，CAを施行された44例の分析においても，手技終了時VT誘発群でのVT再発率が有意に高かった．結論として，心機能が比較的保たれた器質的心疾患患者のVTは高い再発率を認めるものの生命予後は良好であること，VT誘発性はVT再発の予測因子となりうることが示された．

Japan's largest platform for academic e-journals: J-STAGE is a full text database for reviewed academic papers published by Japanese societies