A 61-year-old woman had recurrent syncopal attacks caused by torsades de pointes associated with remarkable QT prolongation (QTc = 740 ms). Left ventriculography showed apical akinesis (ballooning) and basal hyperkinesis, but coronary angiography was normal. This was compatible with takotsubo cardiomyopathy. The wall motion of the left ventricle (LV) normalized within 2 months, and the remarkable QT prolongation and negative T-waves gradually normalized. However, polymorphic ventricular tachycardia recurred at 2.5 months after its initial onset, and we measured repolarization gradients using activation recovery intervals (ARIs) in an electrophysiological study. During atrial pacing at a cycle length of 1000 ms, the negative T-waves were observed in leads II, III, aVF, and V2-6 with QT prolongation, and the ARIs in both the epicardium and the endocardium increased from the basal site to the apical site. Moreover, the ARI tended to be longer in the epicardium than the endocardium at each level of the LV. In contrast, atrial extrastimulation changed the T-wave morphology (from negative to biphasic) in leads II, III, aVF, and V2-6 and changed the ARI gradients both from the LV basal site to the apical site and from the epicardium to the endocardium. These results suggest that the T-wave abnormalities seen in takotsubo cardiomyopathy during sinus rhythm are due to abnormal LV repolarization gradients.
Ventricular tachyarrhythmia was responsible for 38% of hospitalizations in HCM, and SMVT occurred in patients with MVO and/or with abnormal wall motion of the LV apex. Electrical storm was more common in patients with ST elevation in precordial leads V4-V6.
Objective The association between natriuretic peptide levels in atrial fibrillation (AF) patients with advanced left atrial (LA) remodeling and reverse remodeling after rhythm control therapy has not been clarified. The present study assessed the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) measurements to predict LA reverse remodeling after catheter ablation (CA) in persistent AF patients with LA enlargement. Methods This study included 88 persistent AF patients with LA enlargement (volume index >48 mL/m 2 ) who underwent CA. Plasma ANP and BNP levels were analyzed before CA in all patients. The study population was divided into 2 groups according to the extent of decrease in the LA volume index (LAVI) at 6 months after CA: responders were those with a ! 15% reduction in the LAVI, and all others were nonresponders. Results At follow-up, 58 patients (66%) were classified as responders. The preprocedural ANP level was significantly higher in the responders than in the non-responders (p=0.03). Furthermore, the ANP-to-BNP ratio (ANP/BNP) was significantly higher in the responders than in the non-responders (p<0.01). The ANP/ BNP was correlated with the percentage decrease in the LAVI (r = 0.391, p<0.01). A multivariate linear regression analysis revealed that the ANP/BNP before CA was an independent predictor of LA reverse remodeling (p<0.01). Conclusions The preprocedural ANP/BNP was a robust predictor of reverse remodeling of the enlarged LA after sinus rhythm restoration by rhythm control therapy in persistent AF patients.
Unlike the pure I(kr) blocker, E-4031, bepridil exhibited weak properties of reverse use-dependency and protected against sympathetic stimulation-induced VTA. It may be an effective supplemental treatment for recipients of implantable cardioverter defibrillator.
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