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ABSTRACT: Defecation syncope (DS) and micturition syncope (MS) are daily excretion-related syndromes that are both classified as situational. However, their clinical features seem to be very different, so the present comparative study aimed to clarify those of DS.
The study population consisted of 20 consecutive patients with DS and 37 consecutive patients with MS. The DS patients were significantly older than the MS patients (63+/-15 vs 52+/-17 years, P=0.026). Gender was significantly different (P=0.026): women predominated in the DS group (60%) whereas men more commonly had MS (70%). The diurnal distribution of syncope differed (P=0.0054): 88% of MS episodes occurred between 6 pm and 6 am, whereas DS occurred almost equally throughout the 24 h. Syncope after drinking alcohol was less common with DS (10%) than with MS (60%) (P=0.0003), whereas gastrointestinal tract (GIT) symptoms as a premonitory sign were more common with DS (55%) than with MS (3%) (P<0.0001). Positive responses to head-up tilt testing did not differ between the DS and MS groups.
DS tends to occur in elderly women and without any significant daily distribution. Alcohol-related syncope was uncommon in patients with DS, and preceding GIT symptoms may be important as predictors or triggering factors.
Circulation Journal 02/2010; 74(2):307-11. · 3.77 Impact Factor
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ABSTRACT: In the present study, clarification of the prevalence of the Brugada-type electrocardiogram (ECG) and the incidence of spontaneous ventricular fibrillation (VF) that occurred with the Brugada-type ECG in patients with sick sinus syndrome (SSS) was determined.
A total of 487 consecutive patients (men 45%, mean age 69.9+/-12.3 years), who were defined as having an indication for cardiac pacemaker (PM) for SSS, were investigated. The ECG before an initial PM implantation and occurrence of VF or sudden cardiac death (SCD) was examined retrospectively. Brugada-type ECG was found in 14 patients (2.87%) including 4 (0.82%) with type 1 and 10 (2.05%) with type 2. During the follow-up period of 7.2+/-5.4 years, 2 out of the 4 patients with type 1 ECG had experienced a VF episode after the device implantation. In 10 patients with type 2 ECG, none had VF or SCD. The incidence of spontaneous VF (Brugada syndrome) in SSS patients was calculated as 14.1 per 100 person-years with type 1 ECG.
The prevalence of typical Brugada-type (type 1) ECG in SSS patients seems to be higher compared with the general population. In addition, SSS patients with the typical Brugada-type ECG might be a high risk for spontaneous VF.
Circulation Journal 12/2009; 74(2):271-7. · 3.77 Impact Factor
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ABSTRACT: Clinical features of micturition syncope (MS) seem to be differ according to age and the present study sought to clarify this.
The 37 consecutive patients (mean age: 52.2 +/-16.8 years, 26 men) with MS were divided into 2 groups by median age of 55: younger group (YG) consisting of 18 patients <55 years (average 38.2) and an older group (OG) consisting of 19 patients >or=55 years (average 65.5). Alcohol-related MS was significantly more frequent in the YG than in the OG (78% vs 42%, P=0.027). Daily distribution of MS was significantly different (P=0.0009): 85% of the MS in the YG occurred before midnight (PM), whereas 75% of the MS in the OG occurred after midnight (AM). Although overall positive responses of head-up tilt testing were more common in the OG (P=0.046), gender, number of syncope, and association with vasovagal syncope or cardiovascular disease were not different between both groups.
In the YG, MS tended to occur in the evening or nighttime before midnight, whereas MS in the OG tended to occur after midnight or early in the morning. Alcohol intake may be an important precipitating factor for MS in young subjects.
Circulation Journal 07/2009; 73(9):1651-4. · 3.77 Impact Factor
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ABSTRACT: Bepridil hydrochloride (Bpd) has attracted attention as an effective drug for atrial fibrillation (AF) and atrial flutter (AFL). However, serious adverse effects, including torsade de pointes (Tdp), have been reported.
Adverse effects of Bpd requiring discontinuation of treatment were evaluated. Bpd was administered to 459 patients (361 males, 63+/-12 years old) comprising 378 AF and 81 AFL cases. Mean left ventricular ejection fraction and atrial dimension (LAD) were 66+/-11% and 40+/-6 mm, respectively. Adverse effects were observed in 19 patients (4%) during an average follow-up of 20 months. There was marked QT prolongation greater than 0.55 s in 13 patients, bradycardia less than 40 beats/min in 6 patients, dizziness and general fatigue in 1 patient each. In 4 of 13 patients with QT prolongation, Tdp occurred. The major triggering factors of Tdp were hypokalemia and sudden decrease in heart rate. There were no differences in the clinical backgrounds of the patients with and without Tdp other than LAD and age, which were larger and older in the patients with Tdp.
Careful observation of serum potassium concentration and the ECG should always be done during Bpd administration, particularly in elderly patients.
Circulation Journal 07/2006; 70(6):662-6. · 3.77 Impact Factor
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ABSTRACT: A 14-year-old boy was admitted for the evaluation of recurrent syncope. His ECG on admission revealed a sinus rhythm with an undetermined QRS axis, T wave inversion at leads V3, V4 and abnormal q at leads I, aVL, V5 and V6. However, no underlying disease could be detected by any morphological examination. Programmed ventricular stimulation also induced no ventricular tachycardia or fibrillation (VF). Only signal-averaged ECG showed ventricular late potential and the cause of syncope was not clarified. As his brother with a similar ECG had died suddenly, he was prophylactically treated with an ICD. However, 14 months later he died suddenly after playing a video game. The ICD recorded VF, which was not converted despite 6 cardioversion attempts by the ICD. Progression of myocardial damages and/or elevation of defibrillation threshold may have been the cause of unsuccessful cardioversion.
Internal Medicine 09/2005; 44(8):829-31. · 0.94 Impact Factor
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ABSTRACT: A genetic correlation between Brugada syndrome (BS) and sinus node dysfunction (SND) has been proposed, although the clinical and electrophysiologic characteristics of this concomitant condition are unknown.
The study comprised 5 patients with symptomatic BS (4 with spontaneous episodes of ventricular fibrillation (VF) and 1 with syncope) of whom 3 had a documented sinus pause > 3 s (a 42- and 62-year-old man, and a 49-year-old woman). Only 1 of them had a family history of sudden death; 2 of them had also had an episode of atrial fibrillation or flutter. Electrophysiologic study demonstrated prolonged sinus node recovery time in 2 patients (2.6 s and > 5 s), in whom a cardiac pacemaker had been implanted before the diagnosis of BS was made after episodes of VF. Finally, all 3 patients received an implantable cardioverter defibrillator, including 2 upgrades from pacemaker.
SND is not a rare concomitant disorder in BS and there is a possible genetic connection.
Circulation Journal 08/2005; 69(8):946-50. · 3.77 Impact Factor
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Yuji Nakazato,
Masayuki Yasuda,
Akitoshi Sasaki,
Youji Iida,
Yasunobu Kawano,
Kaoru Nakazato, Takashi Tokano,
Yoriaki Mineda,
Masataka Sumiyoshi,
Yasuro Nakata,
Hiroyuki Daida
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ABSTRACT: Bepridil has multiple ion-channel blocking effects similar to amiodarone and is expected to have anti-arrhythmic effects that are useful for the management of atrial fibrillation (AF). The aim of this study was to clarify the conversion of persistent AF and maintenance of sinus rhythm (SR) by oral bepridil.
Oral bepridil was administered to 112 patients (83 males, 29 females; age: 59.0+/-10.8 years) with persistent AF lasting an average of 5 months. The conversion effects and maintenance of SR after pharmacological or direct current (DC) cardioversion, as well as the incidence of adverse complications, were evaluated. In 65 of 112 (58%) patients, SR was restored within 6 months (average: 2.1 months) following bepridil administration. DC cardioversion was carried out for 21 of the remaining 47 patients with unsuccessful pharmacological conversion, and all had restoration of SR. Eventually, of the 86 patients in total who were restored to SR by either bepridil or DC cardioversion, 70 (81%) patients maintained SR after a mean follow-up of 18 months. No serious adverse complications were observed, except for marked QT prolongation in 2 cases.
Bepridil showed favorable conversion effects in patients with persistent AF and was highly effective for maintaining SR after pharmacological or electrical cardioversion. However, careful follow-up is necessary for the prevention of torsade de pointes caused by QT prolongation.
Circulation Journal 02/2005; 69(1):44-8. · 3.77 Impact Factor
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Takashi Tokano,
Yuji Nakazato,
Akitoshi Sasaki,
Haruyo Yamashita,
Yoji Iida,
Yasunobu Kawano,
Yoriaki Mineda,
Kaoru Nakazato,
Masayuki Yasuda,
Masataka Sumiyoshi,
Yasuro Nakata,
Hiroyuki Daida
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ABSTRACT: Dislodgment of an atrial screw-in pacing lead is quite rare. This report describes a rare case of an atrial screw-in lead dislodgment 10 years after implantation. Although it is an uncommon complication, very late dislodgment can occur postoperatively, and careful follow-up is necessary.
Pacing and Clinical Electrophysiology 03/2004; 27(2):264-5. · 1.35 Impact Factor
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ABSTRACT: Isoproterenol is widely used as a provocative medium for vasovagal responses during tilt testing. Dose of isoproterenol infusion is generally titrated empirically by increase in resting heart rate before tilt up. To determine the optimal increase in resting heart rate with isoproterenol for tilt-induced vasovagal responses, we studied 97 consecutive patients with unexplained syncope. After the end of a negative baseline tilt (80 degrees for 30 min), the isoproterenol tilt was performed using one of two protocols: two-stage isoproterenol-tilt protocol, with doses of 0.01 and 0.02 microg/kg per min for 10 min each, or one-stage isoproterenol-tilt protocol, with a dose of 1 or 2 microg/min for 10 min. The resting heart rate increase was defined as a percentage increase in the resting heart rate after isoproterenol infusion, compared to the baseline heart rate before the tilt test. In 117 tilt procedures, 28 (93%) of the 30 positive responses occurred with a resting heart rate increase of > or = 21%. With the resting heart rate increase of 60 and 100%, 18 (60%) and 27 (90%) positive responses were observed, respectively. In conclusion, the minimum resting heart rate increase of > or = 21% was required to provoke a vasovagal response during subsequent isoproterenol-tilt (80 degrees for 10 min). Preferably, heart rate should be increased to 60-100% by isoproterenol titration before tilting.
Journal of Cardiovascular Pharmacology 12/2003; 42 Suppl 1:S19-22. · 2.29 Impact Factor
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ABSTRACT: A 70-year-old Japanese woman was admitted to our hospital because of transient second degree atrioventricular (AV) block. An electrophysiologic study (EPS) was performed, and Mobitz type II infra-Hisian block during atrial pacing at a rate of 130/min was noted. An AV nodal reentrant tachycardia (AVNRT) was induced by ventricular pacing at a rate of 180/min, and 2:1-3:1 infra-Hisian block during AVNRT was observed. The AV block and AVNRT rarely occurred in the clinical setting, and the patient did not complain of any symptoms related to these arrhythmias. Therefore, the patient refused permanent pacemaker implantation, although she continued to be followed in our outpatient clinic. However, the patient was re-admitted one year later because of palpitations and dyspnea upon exertion related to the AV block. The 12-lead ECG showed high degree AV block with narrow QRS complexes. The patient underwent pacemaker implantation during the subsequent hospitalization, and her symptoms improved postoperation. AV block during AVNRT is sometimes observed, and it has been considered as a functional AV block. In the present case, a pathologic conduction disturbance in the His-Purkinje system caused the high degree AV block during AVNRT. The high degree AV block during AVNRT may indicate the existence of a conduction disturbance in the His-Purkinje system in some of these types of cases.
Japanese Heart Journal 10/2003; 44(5):789-97. · 0.40 Impact Factor
