Accessory pathway analysis using a multimodal deep learning model.

Cardiac accessory pathways (APs) in Wolff-Parkinson-White (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.

Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures　- Large-Scale Multicenter Analysis.

BACKGROUND: Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS: CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography.

BACKGROUND: Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. METHODS: We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RESULTS: RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P<0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P<0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P=0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P=0.002) compared with RVA and RVMS pacing. CONCLUSIONS: These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.

Familial Carney complex with biatrial cardiac myxoma.

We report a case of Carney complex (CNC) with biatrial cardiac myxoma. The patient had left and right atrial myxomas which were resected in a surgery. She showed bilateral adrenal tumors and multiple mammary tumors. She had pigmentation on her lower lip. Previously, her daughter was also diagnosed with CNC with cardiac myxoma. Both of them showed mutations in the PRKAR1A gene. .

Successful treatment of prolonged cardiopulmonary arrest of Kounis syndrome during coronary angioplasty.

We experienced a case of Kounis syndrome with cardiopulmonary arrest and severe coronary spasm. A 70-year-old man with cardiac pacemaker and chronic dialysis was treated for angina pectoris of the right coronary artery. After diagnostic coronary angiography of the right coronary artery, optical coherence tomography was performed with contrast medium and low-molecular-weight dextran. The patient's blood pressure unexpectedly dropped to 40 mmHg and erythema of the breast was noted. Electrocardiogram showed remarkable ST elevation in II, III, aVF leads. Coronary angiography showed total occlusion of the proximal right coronary artery. Although intracoronary infusion of sodium nitrate did not dilate the coronary artery promptly, coronary balloon angioplasty recovered the artery flow. Since severe anaphylaxis-related shock was contemplated, methyl prednisolone and epinephrine were administered intravenously. We could not introduce percutaneous cardiopulmonary support due to kinking of the vein. After 1 hour of cardiopulmonary resuscitation with frequent ventricular fibrillation and direct current shock, the sinus rhythm and blood pressure recovered. Following 2 months of intensive care treatment for other complications, including infection, the patient was discharged from hospital without any residual disability.

Percutaneous interventional techniques to remove embolized silicone port catheters from heart and great vessels.

Rupture of a silicon port catheter is a relatively rare complication and sometimes it is difficult to remove it. We experienced three cases of retrieval of silicone port catheters migrating into cardiac ventricle or pulmonary artery. Several devices such as a snare wire, an ablation catheter, and a basket catheter in combination with interventional guiding catheter were applied to retrieve them. These interventional techniques are applicable for retrieval of embolized vascular access port system and other catheter fragments.

A case of coronary lesion with lotus root appearance treated by percutaneous coronary intervention with intravascular ultrasound guidance.

A 66-year-old man underwent percutaneous coronary intervention (PCI). Coronary angiography showed a diffuse lesion with lotus root appearance and severe stenosis in the left anterior descending artery (LAD). Multiple channels were observed by intravascular ultrasound (IVUS). Different channels were connected to the first diagonal branch, the first septal branch and LAD lumen separately. To prevent obstruction of side branches, we made connections to the branches from the main channel of LAD with tapered-tip guide wire, followed by balloon dilatation and stenting without side branch obstruction. IVUS findings were helpful for the PCI with a lotus root appearance lesion.