- Email: [email protected]
P6-113
Poster 6 tiple generalized tonic-clonic seizures. The tonic phase of each seizure was characterized by 21- 34 seconds of extremely rapid, sustained high-frequency myopotentials that transitioned to a clonic phase. The hallmark of each clonic phase were periodic bursts of muscle artifact, which had an initial rapid frequency of 4-5 Hz before slowing to1-2 Hz prior to seizure termination. Comparative REVEAL and video EEG recordings of generalized tonic-clonic seizures for these patients were identical. Conclusion: It is important to recognize this characteristic tonic-clonic myopotential pattern on a REVEAL implant as it might establish a diagnosis of seizures in patients who had undergone ILR implantation for presumed syncope.
S339 planted. The QRS duration became 145 msec during bi-ventricular pacing. After 6 months of effective bi-ventricular pacing, the patient’s functional class improved from New York Heart Association class III to I, cardiothoracic ratio decreased from 62 to 48%, LV ejection fraction increased from 17 to 33%, and B-type natriuretic peptide level decreased from 547 to 37 pg/ml. The Doppler velocity data were compared during spontaneous rhythm and bi-ventricular pacing. In Fig B and C, the lines are regional myocardial velocity curves obtained by tissue Doppler imaging at the basal, mid, and apical lateral free wall. There were significant delays in the peak systolic contraction without pacing (Fig B). During bi-ventricular pacing, systolic synchronicity in the lateral free wall segments was achieved as reflected by the perfect overlapping of the myocardial velocity curves (Fig C, the arrow indicates an overlapped peak systolic contraction). Bi-ventricular pacing achieved resynchronization not only between the LV septum and free wall but also within the noncompacted LV free wall. CRT with ICD may improve the prognosis in this rare disease.
P6-114 ASSESSMENT OF THE FLUCTUATION OF LATE POTENTIAL AND QT INTERVAL DURING SLEEP IN A PATIENT WITH ENDSTAGED HYPERTROPHIC CARDIOMYOPATHY WHO HAS NOCTURNAL VENTRICULAR TACHYCARDIA AND OBSTRUCTIVE SLEEP APNEA Keiko Gomita, MD, Dai Yumino, MD, Youichi Ajiro, MD, Katsuya Kajimoto, MD, Kohei Tanizaki, MD, Morio Shoda, MD, PhD, Nobuhisa Hagiwara, MD and Hiroshi Kasanuki, MD. The Tokyo Women’s Medical University, Tokyo, Japan.
P6-113 CARDIAC RESYNCHRONIZATION THERAPY IN A PATIENT WITH ISOLATED NONCOMPACTION OF THE LEFT VENTRICLE AND NARROW QRS COMPLEXES Shoichi Kubota, MD, Akihiko Nogami, MD, Shinya Kowase, MD, Yasushi Oginosawa, MD, Aiko Sugiyasu, MD, Shoichi Kubota, MD, Masayuki Igawa, MD, Chieko Arai, MD, Atsushi Sakamoto, MD, Naihisa Nakajima, MD, Hajime Aoki, MD, Kazuhiko Yumoto, MD, Toshiyuki Tamaki, MD and Kenichi Kato, MD. Yokohama Rosai Hospital, Kanagawa, Japan and Hiratsuka Kyosai Hospital, Hiratsuka, Japan. We report a case with isolated noncompaction of left ventricle (LV) in whom cardiac resynchronization therapy (CRT) was performed although the QRS complex was narrow. A 30-year-old man was referred to our hospital because of heart failure and ventricular tachycardia. The 12-lead ECG demonstrated sinus rhythm and the QRS duration was 120 msec. Echocardiography revealed numerous prominent trabeculations and deep intertrabecular recesses (Fig A) localized to the regions of hypertrophy in the LV apex and adjacent postero-lateral free wall. There was a significant mechanical asynchrony between the LV septum and free wall. An implantable cardioverter/defibrillator (ICD) with bi-ventricular pacing was im-
Background: It is reported that obstructive sleep apnea (OSA) contributes to arrhythmogenesis. However, the affect of OSA to arrhythmogenic substrate remains unclear. Today, we can evaluate the profile of signalaveraged ECG (SAECG) and corrected QT interval (QTC) during sleep by means of continuous high-resolutional holter recording (Spider View ™, Ela Medical Corp., France). Case report: A 69-year-old male with endstaged hypertrophic cardiomyopathy and frequent ventricular tachycardia (VT) had treated with dual chamber implantable cardioverter-defibrillator and antiarrhythmic agents (amiodarone and sotalol). He had two times histories of electrical storm, and the majority of VTs occurred during sleep. He also had severe OSA and required continuous positive airway pressure (CPAP). To evaluate the relationship between OSA and the nocturnal profile of SAECG and QTC, simultaneous recording of polysomnography and continuous high-resolutional holter recording was undergone before and after CPAP treatment. Three SAECG variables were evaluated quantatively, and RMS40 values showed pathognostically fluctuated. As a result, abrupt decrease in RMS40 value (we defined this phenomenon as “LP surge”) was observed before CPAP treatment, and the LP surge was disappeared after CPAP treatment (Figure). Furthermore, it also turned out following findings after CPAP treatment compared with before treatment: (1) decrease of the number of premature ventricular contraction; (2) improvement of mean SAECG variables; (3) elevation of mean QTC values; and (4) decrease of QT dispersion (Table). Conclusion: Together with these findings, it is suggested that OSA dynamically affects arrhythmogenic substrate, such as depolarization and repolarization abnormalities.
S339 planted. The QRS duration became 145 msec during bi-ventricular pacing. After 6 months of effective bi-ventricular pacing, the patient’s functional class improved from New York Heart Association class III to I, cardiothoracic ratio decreased from 62 to 48%, LV ejection fraction increased from 17 to 33%, and B-type natriuretic peptide level decreased from 547 to 37 pg/ml. The Doppler velocity data were compared during spontaneous rhythm and bi-ventricular pacing. In Fig B and C, the lines are regional myocardial velocity curves obtained by tissue Doppler imaging at the basal, mid, and apical lateral free wall. There were significant delays in the peak systolic contraction without pacing (Fig B). During bi-ventricular pacing, systolic synchronicity in the lateral free wall segments was achieved as reflected by the perfect overlapping of the myocardial velocity curves (Fig C, the arrow indicates an overlapped peak systolic contraction). Bi-ventricular pacing achieved resynchronization not only between the LV septum and free wall but also within the noncompacted LV free wall. CRT with ICD may improve the prognosis in this rare disease.
P6-114 ASSESSMENT OF THE FLUCTUATION OF LATE POTENTIAL AND QT INTERVAL DURING SLEEP IN A PATIENT WITH ENDSTAGED HYPERTROPHIC CARDIOMYOPATHY WHO HAS NOCTURNAL VENTRICULAR TACHYCARDIA AND OBSTRUCTIVE SLEEP APNEA Keiko Gomita, MD, Dai Yumino, MD, Youichi Ajiro, MD, Katsuya Kajimoto, MD, Kohei Tanizaki, MD, Morio Shoda, MD, PhD, Nobuhisa Hagiwara, MD and Hiroshi Kasanuki, MD. The Tokyo Women’s Medical University, Tokyo, Japan.
P6-113 CARDIAC RESYNCHRONIZATION THERAPY IN A PATIENT WITH ISOLATED NONCOMPACTION OF THE LEFT VENTRICLE AND NARROW QRS COMPLEXES Shoichi Kubota, MD, Akihiko Nogami, MD, Shinya Kowase, MD, Yasushi Oginosawa, MD, Aiko Sugiyasu, MD, Shoichi Kubota, MD, Masayuki Igawa, MD, Chieko Arai, MD, Atsushi Sakamoto, MD, Naihisa Nakajima, MD, Hajime Aoki, MD, Kazuhiko Yumoto, MD, Toshiyuki Tamaki, MD and Kenichi Kato, MD. Yokohama Rosai Hospital, Kanagawa, Japan and Hiratsuka Kyosai Hospital, Hiratsuka, Japan. We report a case with isolated noncompaction of left ventricle (LV) in whom cardiac resynchronization therapy (CRT) was performed although the QRS complex was narrow. A 30-year-old man was referred to our hospital because of heart failure and ventricular tachycardia. The 12-lead ECG demonstrated sinus rhythm and the QRS duration was 120 msec. Echocardiography revealed numerous prominent trabeculations and deep intertrabecular recesses (Fig A) localized to the regions of hypertrophy in the LV apex and adjacent postero-lateral free wall. There was a significant mechanical asynchrony between the LV septum and free wall. An implantable cardioverter/defibrillator (ICD) with bi-ventricular pacing was im-
Background: It is reported that obstructive sleep apnea (OSA) contributes to arrhythmogenesis. However, the affect of OSA to arrhythmogenic substrate remains unclear. Today, we can evaluate the profile of signalaveraged ECG (SAECG) and corrected QT interval (QTC) during sleep by means of continuous high-resolutional holter recording (Spider View ™, Ela Medical Corp., France). Case report: A 69-year-old male with endstaged hypertrophic cardiomyopathy and frequent ventricular tachycardia (VT) had treated with dual chamber implantable cardioverter-defibrillator and antiarrhythmic agents (amiodarone and sotalol). He had two times histories of electrical storm, and the majority of VTs occurred during sleep. He also had severe OSA and required continuous positive airway pressure (CPAP). To evaluate the relationship between OSA and the nocturnal profile of SAECG and QTC, simultaneous recording of polysomnography and continuous high-resolutional holter recording was undergone before and after CPAP treatment. Three SAECG variables were evaluated quantatively, and RMS40 values showed pathognostically fluctuated. As a result, abrupt decrease in RMS40 value (we defined this phenomenon as “LP surge”) was observed before CPAP treatment, and the LP surge was disappeared after CPAP treatment (Figure). Furthermore, it also turned out following findings after CPAP treatment compared with before treatment: (1) decrease of the number of premature ventricular contraction; (2) improvement of mean SAECG variables; (3) elevation of mean QTC values; and (4) decrease of QT dispersion (Table). Conclusion: Together with these findings, it is suggested that OSA dynamically affects arrhythmogenic substrate, such as depolarization and repolarization abnormalities.