Circulation journal : official journal of the Japanese Circulation Society
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The case of a 41-year-old man with Brugada syndrome (BS) who suffered electrical storms (ES) of ventricular fibrillation (VF) is presented. Although intravenous infusion of isoproterenol (ISP) suppressed the VF occurrence, he consistently experienced recurrence of VF following discontinuation of ISP infusion. Quinidine and cilostazol were ineffective. ⋯ On electrophysiological study, the VF-triggering PVC was found to originate from the posterior portion of the right ventricular outflow tract area and their elimination, which was achieved with radiofrequency catheter ablation (RFCA), resulted in the suppression of ES. Although several other PVCs were still observed, the patient has been free of VF during the 29-month follow-up period. This case indicates that RFCA of VF-triggering PVCs may be useful in the treatment of drug-resistant ES in patients with BS.
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Comparative Study
Comparison of electropharmacological effects of bepridil and sotalol in halothane-anesthetized dogs.
Bepridil is known to have a multiple ion channel-blocking property in the heart, which has been applied for the treatment of atrial fibrillation and drug-refractory ventricular tachyarrhythmias. In this study, the electro-pharmacological effects of bepridil were compared with those of dl-sotalol, a representative class III antiarrhythmic drug, using the halothane-anesthetized canine model. ⋯ The electropharmacological effects of bepridil and dl-sotalol were similar, although their potency for each cardiovascular variable varied significantly. These findings can be useful when selecting these drugs according to the pathophysiological condition of a patient.
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Sepsis can be exacerbated by an inappropriate immune response and the severe impact of this disease on the cardiovascular system is well documented. High mobility group box 1 (HMGB1) protein is an important mediator in the pathogenesis of sepsis and its role in cardiovascular system dysfunction was investigated in an lipopolysaccharide (LPS)-induced rat model of sepsis. ⋯ HMGB1 stimulation produces a negative inotropic effect during septic shock, suggesting an important role for this molecule in cardiovascular system dysfunction during sepsis.
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Clinical Trial
Use of bepridil in combination with Ic antiarrhythmic agent in converting persistent atrial fibrillation to sinus rhythm.
It has been reported that bepridil is as good as amiodarone in converting persistent atrial fibrillation (AF) to sinus rhythm (SR). The conversion effect of bepridil alone is not always satisfactory, however. The efficacy of pharmacological cardioversion by the combination of bepridil and a class Ic antiarrhythmic drug for persistent AF is studied. ⋯ Combined therapy of bepridil and a class Ic antiarrhythmic drug is efficient for pharmacological cardioversion of refractory long-lasting persistent AF.
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Sinus node dysfunction has been reported most frequently among the adverse cardiovascular effects of lithium. In the present case, complete atrioventricular (AV) block with syncopal attacks developed secondary to lithium therapy, necessitating permanent pacemaker implantation. Serum lithium levels remained under or within the therapeutic range during the syncopal attacks. Lithium should be used with extreme caution, especially in patients with mild disturbance of AV conduction.