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BackgroundA drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non–type 1 ECG. We investigated the associations of future risk for ventricular fibrillation with SCB‐induced ECG changes and ventricular tachyarrhythmias (VTAs).Methods and ResultsWe administered intravenous pilsicainide to 245 consecutive patients with Brugada syndrome (181 patients with spontaneous type 1 ECG, 64 patients with non–type 1 ECG). ECG parameters before and after the test and occurrence of drug‐induced VTAs were evaluated. During a mean follow‐up period of 113±57 months, fatal VTA events occurred in 31 patients (sudden death: n=3, ventricular tachycardia/ventricular fibrillation: n=28). Symptomatic patients and spontaneous type 1 ECG were associated with future fatal arrhythmic events. Univariable analysis of ECG parameters after the test showed that long PQ and QRS intervals, high ST level, and SCB‐induced VTAs were associated with later VTA events during follow‐up. Multivariable analysis showed that symptomatic patients, high ST level (V1) ≥0.3 mV after the test, and SCB‐induced VTAs were independent predictors for future fatal arrhythmic events (hazard ratios: 3.28, 2.80, and 3.62, 95% confidence intervals: 1.54–7.47, 1.32–6.35, and 1.64–7.75, respectively; P<0.05).Conclusions SCB‐induced VTAs and ST‐segment augmentation are associated with an increased risk of the development of ventricular tachycardia/ventricular fibrillation events during follow‐up in patients with Brugada syndrome.

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The distribution of fQRS is associated with prognosis in Brugada syndrome, further supporting the association of fQRS and arrhythmia substrate.

CRBBB was a predictor of ineligibility for S-ICD in patients with BrS. Sinus tachycardia changes ECG morphology in some patients and stress testing should be considered before S-ICD implantation.

The image quality (IQ) of imaging systems must be sufficiently high for image‐guided radiation therapy (IGRT). Hence, users should implement a quality assurance program to maintain IQ. In our routine IQ tests of the kV cone‐beam CT system (Elekta XVI), image noise was quantified by noise standard deviation (NSD), which was the standard deviation of CT numbers measured in a small area in an image of an IQ test phantom (Catphan), and the high spatial resolution (HSR) was evaluated by the number of line‐pairs (LPN) visually recognizable in the image. We also measured the image uniformity, the low contrast resolution, and the distances of two points for geometrical accuracy. For this study, we did an additional evaluation of the XVI data for 12 monthly IQ tests by using noise power spectrum (NPS) for noise, modulation transfer function (MTF) for HSR, and CT number‐to‐density relationship. NPS was obtained by applying Fourier analysis in a small area on the uniformity test section of Catphan. The MTF analysis was performed by applying the Droege‐Morin (D‐M) method to the line‐pair bar regions in the phantom. The CT number‐to‐density relationship was obtained for insert materials in the low‐contrast test section of the phantom. All the quantities showed a noticeable change over the one‐year period. Especially the noise level improved significantly after a repair of the imager. NPS was more sensitive to the IQ change than NSD. MTF could provide more quantitative and objective evaluation of HSR. The CT number was very different from the expected CT number, but the CT number‐to‐density curves were constant within 5% except for two months. Since the D‐M method is easy to implement, we recommend using MTF instead of LPN even for routine QA. The IQ of the imaging systems was constantly changing; hence, IQ tests should be periodically performed. Additionally, we found the importance of IQ tests after every service work, including detector calibration as well as preventive maintenance.PACS number(s): 87.56Da, 87.57.C‐, 87.57.N‐, 8757.Q‐

The main clinical characteristic of responders to treatment with tolvaptan is that kidney size is preserved.

Background:The safety and efficacy of the leadless pacemaker (LP) have been confirmed in previous reports, yet studies on LPs in superelderly patients are limited. Methods and Results:A total of 62 patients aged over 85 years old were implanted with singlechamber pacemakers due to symptomatic bradyarrhythmia at Sakakibara Heart Institute from May 2014 through July 2019. We divided them into two groups, a transvenous (TV) singlechamber pacemaker group (35 patients) and an LP group (27 patients), and compared the groups.Mean participant age was 90.3 ± 3.8 y.o., 41.9% were male, and mean participant body mass index (BMI) was 21.3 kg/m 2 . The LP group contained a significantly larger proportion of patients with dementia than the TV group did (63% vs. 37.1%, P = .04). The complication-free rate tended to be lower in the LP group in spite of the higher frequency of dementia (88.6% vs. 92.6%, P = .68). At implantation, the pacing threshold was significantly higher in the LP group than in the TV group (1.30 ± 0.91 V vs. 0.71 ± 0.23 V, P < .01), but over the first 3 months after the operation the pacing threshold in the LP group gradually improved (0.82 ± 0.2 V vs. 1.05 ± 1.02 V, P = .16). The procedure time and time from operation to discharge were also shorter in the LP group. Conclusions: LP implantation appears to be safe and is accordingly becoming the cornerstone for Japanese superelderly patients indicated for single-chamber pacemakers, even for those with small bodies and dementia. However, careful procedures and long follow-ups are needed until a greater volume of data is reported. K E Y W O R D S leadless pacemaker, Micra Transcatheter Pacing System, single-chamber pacemaker 1 The reported risk factors of cardiac injury related to the LP operation are as follows; age ≥ 85, body mass index (BMI) <20 kg/m 2 , 374 c ○ 2020 Wiley Periodicals, Inc.Pacing Clin Electrophysiol. 2020;43:374-381. wileyonlinelibrary.com/journal/pace