BackgroundSymptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce.ObjectiveWe compared the clinical course of SGH occurring with different energy sources.MethodsThis multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation.ResultsThe data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1–4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5–5) days; the total hospitalization duration was 11 [7–19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for >1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set.ConclusionsThe clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%.

HomeCirculation: Arrhythmia and ElectrophysiologyVol. 16, No. 3Symptomatic Gastroparesis After Cryoballoon-Based Atrial Fibrillation Ablation: Results From a Large Multicenter Registry Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBSymptomatic Gastroparesis After Cryoballoon-Based Atrial Fibrillation Ablation: Results From a Large Multicenter Registry Shinsuke Miyazaki, Atsushi Kobori, Hikari Jo, Takehiko Keida, Kazuyasu Yoshitani, Moe Mukai, Yuichiro Sagawa, Tetsuya Asakawa, Eiji Sato, Kazuya Yamao, Tomoki Horie, Mamoru Manita, Hidehira Fukaya, Hidemori Hayashi, Kojiro Tanimoto, Tadateru Iwayama, Suguru Chiba, Akinori Sato, Yukio Sekiguchi, Kenta Sugiura, Shinsuke Iwai, Yuhei Isonaga, Naoyuki Miwa, Nobutaka Kato, Osamu Inaba, Takayoshi Hirota, Yasutoshi Nagata, Yuichi Ono, Hitoshi Hachiya, Yasuteru Yamauchi, Masahiko Goya, Junichi Nitta, Hiroshi Tada and Tetsuo Sasano Shinsuke MiyazakiShinsuke Miyazaki Correspondence to: Shinsuke Miyazaki, MD, FHRS, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8510, Japan. Email E-mail Address: [email protected] https://orcid.org/0000-0002-0230-0934 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.). , Atsushi KoboriAtsushi Kobori https://orcid.org/0000-0002-5360-5009 Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo (A.K.). , Hikari JoHikari Jo https://orcid.org/0000-0003-1318-7719 Department of Cardiology, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan (H.J.). , Takehiko KeidaTakehiko Keida Department of Cardiology, Edogawa Hospital, Tokyo, Japan (T.K.). , Kazuyasu YoshitaniKazuyasu Yoshitani https://orcid.org/0000-0003-2446-6481 Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (K.Y.). , Moe MukaiMoe Mukai Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Japan (M. Mukai, H.T.). , Yuichiro SagawaYuichiro Sagawa https://orcid.org/0000-0002-2588-3757 Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa (Y.S., Y.Y.). , Tetsuya AsakawaTetsuya Asakawa Department of Cardiology, Yamanashi Kosei Hospital, Japan (T.A.). , Eiji SatoEiji Sato https://orcid.org/0000-0003-0602-6511 Department of Cardiovascular Medicine, Sendai City Hospital, Miyagi, Japan (E.S.). , Kazuya YamaoKazuya Yamao https://orcid.org/0000-0002-4367-078X Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan (K.Y., Y.O.). , Tomoki HorieTomoki Horie https://orcid.org/0000-0002-5378-4422 , Mamoru ManitaMamoru Manita https://orcid.org/0000-0001-8126-5710 Department of Cardiology, Naha City Hospital, Okinawa (M. Manita). , Hidehira FukayaHidehira Fukaya https://orcid.org/0000-0002-7588-554X Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa (H.F.). , Hidemori HayashiHidemori Hayashi https://orcid.org/0000-0002-0927-3705 Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan (H.H.). , Kojiro TanimotoKojiro Tanimoto https://orcid.org/0000-0001-6580-2897 Department of Cardiology, National Hospital Organization Tokyo Medical Center, Japan (K.T.). , Tadateru IwayamaTadateru Iwayama https://orcid.org/0000-0003-3444-9298 Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan (T.I.). , Suguru ChibaSuguru Chiba https://orcid.org/0000-0001-6952-9699 Department of Cardiology, Urasoe General Hospital, Okinawa (S.C.). , Akinori SatoAkinori Sato Cardiovascular Center, Tachikawa General Hospital, Niigata, Japan (A.S.). , Yukio SekiguchiYukio Sekiguchi Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Y.S., J.N.). , Kenta SugiuraKenta Sugiura Department of Cardiology and Geriatrics, Kochi University, Kerala, India (K.S., T. Hirota). , Shinsuke IwaiShinsuke Iwai Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa (S.I., N.K.). , Yuhei IsonagaYuhei Isonaga Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.). , Naoyuki MiwaNaoyuki Miwa https://orcid.org/0000-0001-6971-646X Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (N.M., H.H.). , Nobutaka KatoNobutaka Kato Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa (S.I., N.K.). , Osamu InabaOsamu Inaba https://orcid.org/0000-0003-2179-3786 Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.). , Takayoshi HirotaTakayoshi Hirota https://orcid.org/0000-0001-7132-5804 Department of Cardiology and Geriatrics, Kochi University, Kerala, India (K.S., T. Hirota). , Yasutoshi NagataYasutoshi Nagata https://orcid.org/0000-0002-2484-5919 Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo (Y.I., O.I., T. Horie, Y.N.). , Yuichi OnoYuichi Ono https://orcid.org/0000-0001-8900-0506 Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan (K.Y., Y.O.). , Hitoshi HachiyaHitoshi Hachiya https://orcid.org/0000-0003-2808-1933 Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (N.M., H.H.). , Yasuteru YamauchiYasuteru Yamauchi https://orcid.org/0000-0002-4661-2999 Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa (Y.S., Y.Y.). , Masahiko GoyaMasahiko Goya https://orcid.org/0000-0002-7210-0671 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.). , Junichi NittaJunichi Nitta https://orcid.org/0000-0003-3255-6065 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Y.S., J.N.). , Hiroshi TadaHiroshi Tada https://orcid.org/0000-0001-8578-2328 Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Japan (M. Mukai, H.T.). and Tetsuo SasanoTetsuo Sasano https://orcid.org/0000-0003-3582-6104 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (S.M., M.G., T.S.). Originally published6 Feb 2023https://doi.org/10.1161/CIRCEP.122.011605Circulation: Arrhythmia and Electrophysiology. 2023;16Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 6, 2023: Ahead of Print Cryoballoon-based pulmonary vein isolation (PVI) is widely used for atrial fibrillation (AF) ablation. In real-world clinical practice, cryoballoon is used for left atrial (LA) roof ablation and posterior wall isolation in patients with persistent AF. Gastroparesis is a rare complication characterized by delayed gastric emptying without an obstructing structural lesion in the stomach. It occurs due to the periesophageal vagal nerve injury during posterior LA ablation using radiofrequency1–3 and cryothermal energy,2 although the data are limited. This large multicenter study clarified the real-world incidence and clinical course of symptomatic gastroparesis corresponding to major complications3 secondary to cryoballoon-based AF ablation.The detailed data (patient characteristics and procedural and follow-up data) of patients who presented with symptomatic gastroparesis after cryoballoon-based AF ablation were retrospectively collected using the medical records. All patients were treated with second-generation, fourth-generation, or POLARx cryoballoons (approved in 2022), between July 2014 and May 2022. The total number of patients treated with cryoballoon was investigated at each center, and periprocedural management and follow-up were performed following the latest recommendations.3 The study protocol was approved by each hospital's institutional review board. Patients had approved the use of their data for research purposes by an opt-out method. The data that support the findings of this study are available from the corresponding author upon reasonable request. A freeze cycle of 180 to 240 s was applied with a 28-mm cryoballoon. If the balloon temperature reached −60 °C (−70 °C in POLARx), the diaphragmatic electromyography amplitude significantly decreased or the esophageal temperature reached 15 to 25 °C, freezing was terminated. Although most patients underwent only cryoballoon-PVI, adjunctive LA ablation was performed in a part of the sample, mainly for patients with persistent AF. All patients were prescribed proton-pump inhibitors for 1 month post-procedure. Gastroparesis was defined when the following criteria were met: (1) newly appeared common symptoms (weight loss, early satiety, or gastrointestinal disturbance) post-ablation, (2) confirmed by abdominal radiograph, computed tomography, or gastric endoscopy, and (3) required extended hospitalization or rehospitalization post-discharge or fasting. Continuous data were expressed as mean±SD or median (25th to 75th percentiles) and were compared using a Student t test or Mann-Whitney U test. Categorical variables were compared using the χ2 or Fisher exact tests.Among 23 322 cryoballoon-based AF ablations performed in 37 Japanese centers, symptomatic gastroparesis occurred in 55 (0.23%) patients (69.9±10.1 years; 37 men; 33 with paroxysmal AF and 8 with diabetes; body mass index, 24.3±3.5) from 21 centers. Twenty-six (47.3%) patients underwent cryoballoon-PVI alone (PVI group), whereas the remaining 29 (52.7%) underwent adjunctive LA ablation (adjunctive group) (Figure [A]). The PVI group was older (72.1±8.5 versus 68.0±11.0; P=0.136) and had a significantly higher paroxysmal AF prevalence than the adjunctive group (92.3% versus 31.0%; P<0.0001). POLARx was used in 3 (5.5%) patients. The total PVI freezing duration was 870 (720–1132) s. Freezing duration and nadir balloon temperature in the left inferior pulmonary vein was 180 (180–230) s (Figure [B]) and −51 (−45.3 to −54) °C (Figure [C]), respectively. The LA roof and bottom-line ablation were added by cryoballoon in 15 and 6 patients, respectively. In LA roof and bottom ablation, the total freezing duration was 590.5 (480–780) and 635 (480–967.5) s, and the total number of applications was 4.0 (3.0–4.3) and 4.0 (3.8–5.3), respectively. Esophageal temperature was monitored in 49 (89.1%) patients. The lowest temperature was 23.3±7.4 °C, which reached 15 °C in 5 (10.2%) patients. The estimated symptomatic gastroparesis incidences after cryoballoon-PVI alone, additional cryoballoon-roof ablation, additional cryoballoon-posterior wall isolation, and additional radiofrequency-posterior wall isolation were 0.13%, 0.51%, 1.7%, and 0.74%, respectively.Download figureDownload PowerPointFigure. Lesion set in patients with symptomatic gastroparesis and procedural data. A, Lesion set in patients with symptomatic gastroparesis. Large blue circles indicate cryoballoon ablation (CBA) lesions, and small red circles indicate radiofrequency ablation (RFA) lesions. The numbers indicate the number of patients in each group. B, Total freeze duration in each pulmonary vein (PV) during cryoballoon pulmonary vein isolation (CB-PVI). Box plots display the median, 25th percentile, and 75th percentile values, and whiskers display the maximum and minimum values. C, Nadir balloon temperatures during CB-PVI for each PV. LAPWI indicates left atrial posterior wall isolation; LCPV, left common pulmonary vein; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; MI, mitral isthmus; PVI, pulmonary vein isolation; RF, radiofrequency; RIPV, right inferior pulmonary vein; and RSPV, right superior pulmonary vein.Gastroparesis diagnosis was confirmed at 3.0 (2.0–4.0) days post-procedure, and 18 (32.7%) patients required rehospitalization. In addition to abdominal radiographs, 34 (61.8%), 26 (47.3%), and 7 (12.7%) patients underwent abdominal computed tomography, gastric endoscopy, and upper gastrointestinal series, respectively. Fasting was required in 49 (89.1%) patients for 3.0 (2.0–5.0) days; the total hospitalization duration was 11.0 (7.0–19.3) days. During 17.0 (8.0–38.0) months of follow-up, symptoms completely disappeared in 48 (87.3%) patients at 49.0 (25.0–110.2) days post-procedure (27.3%, 63.8%, 85.9%, and 90.0% at 1, 3, 6, and 12 months, respectively). However, symptoms persisted for >1 year post-procedure in 4 patients. No patients underwent surgery. The single procedure AF freedom rates were 89.6% and 82.8% at 1 and 2 years, respectively.To date, this is the largest study focusing on symptomatic gastroparesis after AF ablation. It could occur after cryoballoon-PVI alone, even with a single short freeze strategy, although approximately half of the population underwent adjunctive LA ablation. Notably, one-third of the patients required rehospitalization because the symptoms were generally exacerbated by a full stomach. These data confirmed that adjunctive LA ablation considerably increased the risk of symptomatic gastroparesis. Indeed, multiple studies have demonstrated that additional radiofrequency-posterior wall isolation significantly increased the risk of asymptomatic gastroparesis compared with radiofrequency-PVI alone.4,5 The study's limitation is the insufficient detailed data on patients without gastroparesis. Therefore, the freezing dose and indications for additional LA ablation should be carefully determined, considering both efficacy and safety.Article InformationSources of FundingNone.Nonstandard Abbreviations and AcronymsAFatrial fibrillationLAleft atriumPVIpulmonary vein isolationDisclosures Dr Miyazaki has received speaker honoraria from Medtronic and Boston Scientific and belongs to the endowed departments of Medtronic and Boston Scientific. Drs Nitta, Sekiguchi, and Tada received speaker honoraria from Medtronic. The other authors report no conflicts.FootnotesFor Sources of Funding and Disclosures, see page 171.Correspondence to: Shinsuke Miyazaki, MD, FHRS, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8510, Japan. Email mmshinsuke@gmail.comReferences1. Shah D, Dumonceau JM, Burri H, Sunthorn H, Schroft A, Gentil-Baron P, Yokoyama Y, Takahashi A. Acute pyloric spasm and gastric hypomotility: an extracardiac adverse effect of percutaneous radiofrequency ablation for atrial fibrillation.J Am Coll Cardiol. 2005; 46:327–330. doi: 10.1016/j.jacc.2005.04.030CrossrefMedlineGoogle Scholar2. Akhtar T, Calkins H, Bulat R, Pollack MM, Spragg DD. Atrial fibrillation ablation-induced gastroparesis: a case report and literature review.HeartRhythm Case Rep. 2020; 6:249–252. doi: 10.1016/j.hrcr.2020.01.004CrossrefMedlineGoogle Scholar3. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.Heart Rhythm. 2017; 14:e445–e494. doi: 10.1016/j.hrthm.2017.07.009CrossrefMedlineGoogle Scholar4. Oikawa J, Fukaya H, Wada T, Horiguchi A, Kishihara J, Satoh A, Saito D, Sato T, Matsuura G, Arakawa Y, et al. Additional posterior wall isolation is associated with gastric hypomotility in catheter ablation of atrial fibrillation.Int J Cardiol. 2021; 326:103–108. doi: 10.1016/j.ijcard.2020.10.069CrossrefMedlineGoogle Scholar5. Yakabe D, Fukuyama Y, Araki M, Nakamura T. Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation.J Arrhythm. 2021; 37:1330–1336. doi: 10.1002/joa3.12625CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails March 2023Vol 16, Issue 3 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCEP.122.011605PMID: 36745559 Originally publishedFebruary 6, 2023 Keywordsgastroparesisatrial fibrillationcatheter ablationPDF download Advertisement SubjectsCatheter Ablation and Implantable Cardioverter-Defibrillator

We herein describe two patients with Brugada syndrome in whom J-waves were successfully modified by drugs. Case 1 was a 54-year-old man who presented with repeated ventricular fibrillations (VF) and J-point elevation in the right precordial and lateral leads. After administration of cilostazol (200 mg/d), J-waves disappeared and coved-type ST-segment elevation changed to a saddleback-type for 25 months. Case 2 was a 31-year-old man who presented with a VF storm and J-point elevation in the lateral leads. After administration of quinidine (300 mg/d), J-waves and coved-type ST-segment elevation disappeared for 20 months. J-wave disappearance and coved-type ST-segment elevation were followed by VF suppression, probably due to transient outward potassium current (Ito) suppression.

Background— Drugs with I Kr -blocking action cause secondary long-QT syndrome. Several cases have been associated with mutations of genes coding cardiac ion channels, but their frequency among patients affected by drug-induced long-QT syndrome (dLQTS) and the resultant molecular effects remain unknown. Methods and Results— Genetic testing was carried out for long-QT syndrome–related genes in 20 subjects with dLQTS and 176 subjects with congenital long-QT syndrome (cLQTS); electrophysiological characteristics of dLQTS-associated mutations were analyzed using a heterologous expression system with Chinese hamster ovary cells together with a computer simulation model. The positive mutation rate in dLQTS was similar to cLQTS (dLQTS versus cLQTS, 8 of 20 [40%] versus 91 of 176 [52%] subjects, P =0.32). The incidence of mutations was higher in patients with torsades de pointes induced by nonantiarrhythmic drugs than by antiarrhythmic drugs (antiarrhythmic versus others, 3 of 14 [21%] versus 5 of 6 [83%] subjects, P <0.05). When reconstituted in Chinese hamster ovary cells, KCNQ1 and KCNH2 mutant channels showed complex gating defects without dominant negative effects or a relatively mild decreased current density. Drug sensitivity for mutant channels was similar to that of the wild-type channel. With the Luo-Rudy simulation model of action potentials, action potential durations of most mutant channels were between those of wild-type and cLQTS. Conclusions— dLQTS had a similar positive mutation rate compared with cLQTS, whereas the functional changes of these mutations identified in dLQTS were mild. When I Kr -blocking agents produce excessive QT prolongation (dLQTS), the underlying genetic background of the dLQTS subject should also be taken into consideration, as would be the case with cLQTS; dLQTS can be regarded as a latent form of long-QT syndrome.

BACKGROUND:The present study investigated whether administration of controlled release matrix metalloproteinase-1 (MMP-1) plasmid DNA prevents left ventricular (LV) remodeling in a rat chronic myocardial infarction (MI) model.METHODS AND RESULTS:Rats with a moderate-sized MI were randomized to 2 groups: injection of phosphate buffered saline (PBS) containing microspheres into the peri-infarct area (MI group, n=14) and injection of cationized gelatin microspheres incorporating MMP-1 plasmid DNA (MI+MMP-1 group, 50 microg MMP-1/20 microl; n=14). As a control group (n=14), rats received neither the coronary artery ligation nor the injection of PBS. Echocardiography, cardiac catheterization and histological studies were performed. At 2 and 4 weeks after the treatment, the MI+MMP-1 group had smaller LV end-diastolic and end-systolic dimensions, better fractional area change and smaller akinetic areas than the MI group. The LV end-systolic elastance and time constant of isovolumic relaxation were also better in the MI+MMP-1 group compared with the MI group 4 weeks after the treatment. Fibrosis evaluated with Masson's trichrome staining was less in the MI+MMP-1 group than the MI group.CONCLUSIONS:Gelatin microspheres for the controlled release of MMP-1 plasmid DNA are promising for improving cardiac remodeling and function when they are administered during the chronic phase of MI.

In a 34-year-old man showing short QT interval (QTc 329 ms), we identified a novel C-terminal KCNH2 mutation, R1135H. Using a heterologous expression system with CHO cells, the mutant channels were found to display a significantly slow deactivation, which resulted in a gain-of-function for reconstituted 'IKr' channels. This mutation could modify clinical phenotypes for this patient.

BACKGROUND:Accelerated intermediate inactivation, which is caused by mutations in the cardiac voltage-gated sodium channel alpha-subunit gene (SCN5A), is one of the molecular mechanisms underlying Brugada syndrome. The N406S mutation associated with Brugada syndrome results in the accelerated intermediate inactivation, in addition to unique pharmacological characteristics. METHODS:Functional sodium channels were expressed transiently in HEK293 cells by transfecting equally the alpha- and beta-subunit plasmids (1 microg/ml) and the sodium current were measured in whole-cell mode of patch-clamp recording. RESULTS:Since the N406S mutant channel has a greatly reduced use-dependent block of lidocaine, we took the advantage of the mutant channel to examine the effect of lidocaine on intermediate inactivation using wild-type (WT) and N406S mutant channels recombinantly expressed in HEK293 cells. Lidocaine (100 microM) slowed the recovery from the fast inactivation similarly for WT and N406S. On the other hand, whereas lidocaine slowed the recovery from the intermediate inactivation for WT, lidocaine accelerated the recovery for N406S. Activity-dependent loss of channel availability by repetitive 500-ms pulses was more strongly enhanced and accelerated by lidocaine for WT, but lidocaine exerted little effect on the N406S channel. CONCLUSION:We demonstrate that lidocaine may suppress Brugada syndrome associated with the N406S mutation by preventing the sodium channel from accumulating in the intermediate inactivation state.

本研究では肺静脈隔離術 (PVI) 後に再発する心房細動 (AF) の検出において, 携帯型心電計によるイベント心電図記録の有用性を検証した.対象は発作性AFに対しPVIを施行した連続27症例.PVI後2～3週間にわたり, 朝夕定時および有症候時にイベント心電図記録 (1139記録) と自覚症状の記載をしてもらったところ, 次の結果を得た, (1) 再発群でAF初検出まで6.0±6.6日, AF検出率は20.6%. (2) PVI後経過は非再発型55, 6%, 緩徐抑制型18.5%, 緩徐再発型14.8%, 汎再発型11.1%の4つに分類. (3) 有症候時記録のうちAFは16.8%のみで, 心房期外収縮 (PAC) が403%も占めた, (4) AF検出における自覚症状の感度73%, 特異度79%, 陽性適中率78%, 陰性適中率75%. (5) AF心拍数が低いと無症候性になりやすかった.以上より, PVI後のAF検出には, ボルター心電図だけでは不十分で, 患者の自覚症状にも頼れないため, 携帯型心電計による間欠的なイベント心電図記録が有用と示唆された.

This chapter contains sections titled: Abstract Introduction Modeling ATP-related Systems Na+/K+-ATPase SERCA and PMCA Contraction ATP-sensitive K+ Channel and L-type Ca2+ Channel Mitochondrial Oxidative Phosphorylation ATP Balance in the Kyoto Model Feedback Control and Ca2+-dependent Regulation of Mitochondria Function References