Journal of Cardiology Cases最新文献

{"title":"Uncommon cause of paradoxical low-flow low-gradient severe aortic stenosis due to pulmonary arterial hypertension","authors":"Tsutomu Murakami MD,&nbsp;Yohei Ohno MD,&nbsp;Satoshi Noda MD,&nbsp;Kaho Hashimoto MD,&nbsp;Hitomi Horinouchi MD,&nbsp;Ryosuke Ohmura MD,&nbsp;Junichi Miyamoto MD,&nbsp;Norihiko Kamioka MD,&nbsp;Yuji Ikari MD, FJCC","doi":"10.1016/j.jccase.2025.06.008","DOIUrl":"10.1016/j.jccase.2025.06.008","url":null,"abstract":"<div><div>A 74-year-old female presented with dyspnea [New York Heart Association (NYHA) class IV and 94 % percutaneous oxygen saturation at room air]. She was diagnosed with pre-capillary pulmonary arterial hypertension (PAH) due to connective tissue disease [mean pulmonary arterial wedge pressure (mPAWP): 6 mmHg; pulmonary arterial pressure (PAP): 93/36 [59] mmHg; pulmonary vascular resistance (PVR): 12.2 Wood units; cardiac index (CI): 2.95 L/min/m²] and paradoxical low-flow low-gradient severe aortic stenosis (AS) [mean gradient: 16.7 mmHg; max jet velocity: 2.87 m/s; aortic valve area: 0.70 cm²; left ventricular ejection fraction (LVEF): 65 %; stroke volume index (SVi): 31.1 mL/m²]. The patient was treated for PAH, which was considered to be the underlying cause of the paradoxical low-flow low-gradient severe AS. After 10-month titration of riociguat (7.5 mg/day) and selexipag (1.6 mg/day), PAH [mPAWP: 9 mmHg; PAP: 55/23 (36) mmHg; PVR: 5.9 Wood units; CI: 3.10 L/min/m²] improved and normal-flow high-gradient severe AS became evident (mean gradient: 41.9 mmHg; max jet velocity: 4.04 m/s; aortic valve area: 0.70 cm²; LVEF: 65 %; SVi: 41.7 mL/m²). Although symptoms improved to NYHA class II, exertional dyspnea persisted. Accordingly, medication dosages were further increased, and transcatheter aortic valve replacement was successfully performed 12 months after treatment initiation.</div></div><div><h3>Learning objective</h3><div>We aimed to understand how group 1 pulmonary arterial hypertension (PAH) can lead to paradoxical low-flow low-gradient severe aortic stenosis (AS), recognize its key clinical and hemodynamic features, and differentiate it from group 2 pulmonary hypertension (PH) associated with left heart disease, including isolated post-capillary PH and combined post- and pre-capillary PH. We also explored hemodynamic changes after PAH therapy, including transition to normal-flow high-gradient severe AS.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 119-122"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-resolution mapping of an aortic sinus cusp for two outflow tract premature ventricular contractions","authors":"Yuto Tamura MD ,&nbsp;Kentaro Ozu MD ,&nbsp;Takafumi Oka MD, PhD ,&nbsp;Takayuki Sekihara MD ,&nbsp;Tomohito Ohtani MD, PhD, FJCC ,&nbsp;Yasushi Sakata MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.06.002","DOIUrl":"10.1016/j.jccase.2025.06.002","url":null,"abstract":"<div><div>In catheter ablation for outflow tract premature ventricular contraction (PVC), electrical mapping of the aortic sinus cusp (ASC) provides critical information for identifying the origin of the PVC. The OCTARAY™ (Biosense Webster, Diamond Bar, CA, USA), a multispline 48-polar electrode catheter with TRUEref™ technology, fits the shape of the ASC and enables detailed and prompt high-resolution ASC mapping without inducing PVCs due to mechanical stimulation. We present a case of successful catheter ablation for two similar PVCs from the ASC based on activation and voltage mapping using TRUEref™ technology. High-resolution mapping could be helpful for the visual assessment of the detailed wavefront propagations of PVC.</div></div><div><h3>Learning objective</h3><div>In catheter ablation for outflow tract premature ventricular contraction (PVC), mapping the aortic sinus cusp is useful to identify the origin; however, it is sometimes challenging with a conventional electrode catheter. High-resolution mapping using OCTARAY™ might be helpful for detailed assessment of outflow tract PVC.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 114-118"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multitechnique approach for peri-mitral flutter: A case report of combining direct vein of Marshall ethanol infusion and alpha loop ablation","authors":"Taishi Fukushima MD ,&nbsp;Yoshihiro Sobue MD, PhD, FJCC ,&nbsp;Eiichi Watanabe MD, PhD ,&nbsp;Hideo Izawa MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.05.009","DOIUrl":"10.1016/j.jccase.2025.05.009","url":null,"abstract":"<div><div>The management of peri-mitral flutter often necessitates a vein of Marshall (VOM) ethanol infusion (EI) and radiofrequency ablation within the coronary sinus (CS). These procedures can be technically demanding due to the anatomical constraints and require a nuanced understanding of catheter techniques. We report a patient who experienced dual tachycardias involving a peri-mitral flutter and roof-dependent atrial tachycardia after cryoballoon pulmonary vein isolation. Since linear ablation of the lateral mitral isthmus failed to eliminate the tachycardia, the involvement of epicardial structures such as the VOM and CS was suggested. Attempts at a VOM-EI using a catheter with a lumen succeeded in delivering ethanol but failed to terminate the arrhythmia. Standard techniques for catheter insertion into the CS were unsuccessful. By employing an alpha loop catheter configuration via the right femoral vein, a successful catheter insertion was achieved, enabling the ablation and immediate termination of the tachycardia. This case underscores the importance of employing innovative techniques, such as the alpha loop method and the direct VOM-EI via small-lumen catheters, in cases where standard approaches are insufficient. These methods provide viable alternatives for achieving successful outcomes in peri-mitral flutter management, especially when epicardial connections complicate the procedure.</div></div><div><h3>Learning objective</h3><div>When standard catheter insertion into the coronary sinus is unsuccessful via the femoral vein, employing an alpha loop configuration can be an effective alternative.</div><div>Direct ethanol infusion through a catheter with an inner lumen, rather than using over-the-wire balloon techniques, can be a viable option for a vein of Marshall ethanol infusion in anatomically challenging cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 142-145"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate optimization to reduce tricuspid regurgitation in patients with atrial fibrillation and relative bradycardia: A case report","authors":"Daisuke Nagatomo MD,&nbsp;Akihito Ishikita MD, PhD,&nbsp;Ryo Miyake MD,&nbsp;Masatsugu Nozoe MD, PhD,&nbsp;Keiji Oi MD, PhD,&nbsp;Nobuhiro Suematsu MD, PhD,&nbsp;Toru Kubota MD, PhD","doi":"10.1016/j.jccase.2025.05.011","DOIUrl":"10.1016/j.jccase.2025.05.011","url":null,"abstract":"<div><div>A 74-year-old male with end-stage renal disease was referred for treatment of syncope and hypotension episodes during dialysis. The patient had a history of sick sinus syndrome that was managed with a VVI pacemaker, maintaining a heart rate of approximately 60 bpm, due to atrial fibrillation. Transthoracic echocardiography revealed massive tricuspid regurgitation (TR), which was identified as a significant contributor to the patient's symptoms. Surgical intervention for TR was initially considered, however echocardiographic examination with pulse Doppler of the tricuspid inflow waveform indicated that ventricular filling efficiency could be improved by increasing the pacemaker's heart rate to 80 bpm. This adjustment was validated during right heart catheterization, confirming enhanced efficiency and leading to the decision to monitor the patient's condition with the new pacemaker setting instead of proceeding with surgery. Over the next 5 months, the patient's condition significantly improved, with TR severity decreasing to moderate. This case highlights the importance of tailored heart rate optimization in managing complex heart failure, demonstrating the effectiveness of noninvasive methods in improving outcomes for patients with significant tricuspid valve disease and relative bradycardia with atrial fibrillation.</div></div><div><h3>Learning objective</h3><div>Assessing the optimal heart rate in patients with heart failure is crucial, requiring a case-by-case evaluation rather than relying on evidence from large clinical trials. In this case, characterized by relative bradycardia with chronic atrial fibrillation and severe tricuspid valve regurgitation, we determined the optimal heart rate using the Doppler waveform of the tricuspid valve inflow to assess whether an increase in heart rate could enhance cardiac output without reducing stroke volume.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 134-137"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful percutaneous coronary intervention using an inverted Amplatz left type guiding catheter for cannulation into an acutely angled saphenous vein graft: A case report","authors":"Mariko Shinozaki MD,&nbsp;Keita Miki MD, PhD,&nbsp;Shohei Ikeda MD, PhD,&nbsp;Koichi Sato MD, PhD,&nbsp;Morihiko Takeda MD, PhD","doi":"10.1016/j.jccase.2025.06.006","DOIUrl":"10.1016/j.jccase.2025.06.006","url":null,"abstract":"<div><div>Successful percutaneous coronary intervention (PCI) requires selecting an appropriate guiding catheter to ensure adequate back-up support and optimal visualization. PCI for saphenous vein grafts<span><span> (SVGs) is particularly challenging because of factors such as acute angulation<span> at the anastomosis and severe stenosis. We herein describe a novel approach utilizing an inverted Amplatz left (AL)-1.0 guiding catheter to achieve coaxial alignment in a patient with an acute SVG-to-aorta angle and significant stenosis at the SVG entry site. The patient, a man in his mid-60s with a history of </span></span>coronary artery disease<span>, had undergone multiple PCI procedures and coronary artery bypass grafting<span>, including SVG to the right coronary artery<span><span>. He presented with unstable angina caused by severe stenosis at the SVG anastomosis. Standard Judkins right-4.0 and AL-1.0 catheters failed to achieve the coaxial alignment necessary for adequate back-up support. However, by inverting the AL-1.0 catheter, coaxial alignment was successfully achieved, enabling PCI with stent deployment. This inverted AL </span>catheter technique is a simple, cost-effective method for addressing complex SVG PCI cases and may expand the options available for managing challenging PCI procedures.</span></span></span></span></div></div><div><h3>Learning objective</h3><div>Achieving coaxial alignment with standard guiding catheter manipulation during percutaneous coronary intervention for a saphenous vein graft (SVG) can be challenging. In our case, inverting the Amplatz left guiding catheter allowed precise coaxial alignment with the SVG, enabling successful treatment in a complex scenario. This simple, cost-effective, and practical technique offers a valuable option for percutaneous coronary intervention in SVGs with sharp aortic branching angles.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous resolution of right ventricular thrombus in congestive heart failure due to alcoholic cardiomyopathy: A case report","authors":"Takuji Nakamura MD","doi":"10.1016/j.jccase.2025.06.004","DOIUrl":"10.1016/j.jccase.2025.06.004","url":null,"abstract":"<div><div><span><span>Right ventricular thrombus<span> (RVT) is rare, and differentiating it from other right ventricular masses is challenging. Additionally, clear guidelines for managing right heart thrombi, particularly type C thrombi, are lacking. A 44-year-old man with congestive heart failure<span> secondary to alcoholic cardiomyopathy was admitted. </span></span></span>Echocardiography<span> revealed a highly mobile, elongated mass in the right ventricle<span>, attached to the tendinous cords of the tricuspid valve. Initial treatment for heart failure was administered without </span></span></span>anticoagulants<span><span>. On the 13th day of admission, follow-up echocardiography showed no mass, and pulmonary computed tomography angiography indicated no abnormalities. The patient exhibited no symptoms of </span>pulmonary embolism post-admission. We presumed the mass to be a thrombus, which resolved as the patient's condition improved.</span></div><div><span>The patient was discharged without anticoagulation therapy. Follow-up echocardiography at 1, 3, and 5 months showed no recurrence of the RVT. We speculated the thrombus to be type C, which unexpectedly resolved as the patient's </span>general condition improved, prior to initiation of anticoagulation therapy.</div><div>This case suggests that, in select cases, improvements in hemodynamics and heart function could influence thrombus resolution. However, this finding does not imply that anticoagulation therapy should be initially withheld in similar cases.</div></div><div><h3>Learning objective</h3><div>Type C right ventricular thrombus (RVT) is rare and its management is not well established. Spontaneous resolution of type C RVT may occur with improved systemic conditions without anticoagulation therapy, suggesting that, in select cases, improvements in hemodynamics and heart function could influence thrombus resolution. However, this finding does not imply that anticoagulation therapy should be initially withheld in similar cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 105-108"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of left ventricular systolic function after surgical repair for adult aortic coarctation","authors":"Akito Kuwano MD,&nbsp;Masaru Yoshikai MD, PhD,&nbsp;Satoshi Ohtsubo MD, PhD,&nbsp;Kiyokazu Koga MD, PhD,&nbsp;Nozomi Yoshida MD","doi":"10.1016/j.jccase.2025.06.001","DOIUrl":"10.1016/j.jccase.2025.06.001","url":null,"abstract":"<div><div><span><span>We report a case of aortic coarctation<span> complicated by type B aortic dissection in an elderly patient, whose left ventricular (LV) systolic dysfunction improved after surgical repair. A 71-year-old male presented with </span></span>back pain<span><span>, and contrast-enhanced computed tomography<span> (CT) revealed aortic coarctation and aortic dissection. The aortic dissection was uncomplicated type B, so the patient was managed conservatively. Transthoracic echocardiography (TTE) on admission showed eccentric hypertrophy in the Lang classification. LV wall motion was diffusely impaired, with an </span></span>LV ejection fraction<span><span> (EF) of 27 %. Parachute-like morphology of mitral valve and mild </span>mitral stenosis, with an elevation of an E/e′ ratio of 32.6, were also recognized. Three months later, CT revealed rapid expansion of the descending aorta, so the patient underwent resection of the coarctated segment and a graft replacement of the descending aorta. TTE three months postoperatively revealed normalization of LV </span></span></span>systolic function<span>, with an LVEF of 58 %, and of LV dilatation, and regression of hypertrophy, along with decrease in an E/e′ ratio of 19.5. Preoperative LV systolic dysfunction seems to be attributed to afterload mismatch. Two years after the surgery, the patient remains in good health without experiencing heart failure or any aortic-related events.</span></div></div><div><h3>Learning objective</h3><div>The prognosis of adult aortic coarctation is poor, with the impact on cardiac function due to chronic increased afterload. We present a case of aortic coarctation in an elderly patient, whose left ventricular systolic dysfunction improved after surgical repair. We considered that surgical repair of aortic coarctation resolved eccentric hypertrophy and corrected the afterload mismatch that existed preoperatively, leading to improvement in left ventricular systolic function.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 123-125"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral isthmus ablation with pulsed field ablation technology through an epicardial approach with the CENTAURI system","authors":"Giovanni Marano MD ,&nbsp;Vincenzo Schillaci MD ,&nbsp;Alberto Arestia MD ,&nbsp;Armando Mariano Salito MD ,&nbsp;Marta Allegra MD ,&nbsp;Gergana Shopova MD ,&nbsp;Andrea Spadaro Guerra MSc ,&nbsp;Francesco Solimene MD","doi":"10.1016/j.jccase.2025.05.010","DOIUrl":"10.1016/j.jccase.2025.05.010","url":null,"abstract":"<div><div><span>Mitral isthmus (MI) ablation is an essential part of persistent atrial fibrillation<span><span> (AF) ablation, particularly in redo procedures where pulmonary vein isolation<span> (PVI) is durable, but AF recurs. While radiofrequency (RF) ablation is commonly used, creating a complete MI line can be challenging and associated with significant risks. Pulsed field ablation (PFA) offers a safer alternative, providing tissue selectivity with fewer complications. This case report explores a hybrid endocardial and epicardial approach for PFA of mitral isthmus. Specifically, a 64-year-old woman with recurrent AF underwent a redo-ablation after two prior PVI procedures performed with RF. Electroanatomical mapping of the </span></span>left atrium<span><span> was performed using the INTELLAMAP ORION mini-basket catheter (Boston Scientific, Marlborough, MA, USA). Mitral isthmus ablation was attempted with a linear contact force catheter connected to the CENTAURI PFA generator (CardioFocus, Inc., Marlborough, MA, USA). Initial endocardial PFA failed to achieve bidirectional block of the mitral isthmus. Additional RF bursts were deployed to injure Marshall bundle autonomic component since PFA alone is known to be ineffective in achieving nerve damage. The ablation catheter was then advanced into the coronary sinus for </span>epicardial mapping<span>, where a gap in the isthmus was identified. PFA delivered through the epicardium successfully achieved bidirectional block with no complications. Hybrid </span></span></span></span><em>endo</em>-epicardial ablation of mitral isthmus by PFA technology is effective and safe, providing a promising alternative to RF ablation in complex AF procedures.</div></div><div><h3>Learning objective</h3><div><span>Mitral isthmus (MI) block in addition to pulmonary vein isolation ablation could be required for treatment of patients with persistent atrial fibrillation and high post-ablation recurrence rates. MI ablation with pulsed field ablation (PFA) technology can address challenges in traditional radiofrequency ablation, particularly in complex redo procedures. PFA based on a hybrid </span><em>endo</em>-epicardial approach with the CENTAURI system has shown to be effective and safe, offering a promising alternative to conventional techniques to achieve complete isthmus block.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 138-141"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of atrial fibrillation on sleep-disordered breathing: Insights from two heart failure cases","authors":"Naoya Kataoka MD, PhD,&nbsp;Teruhiko Imamura MD, PhD, FJCC,&nbsp;Koichiro Kinugawa MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.06.005","DOIUrl":"10.1016/j.jccase.2025.06.005","url":null,"abstract":"<div><div><span><span>Respiratory stability time (RST) has been proposed as an index for assessing heart failure-related sleep-disordered breathing. This case report examines the impact of catheter ablation for </span>atrial fibrillation<span> (AF) on RST and its relationship with heart failure. Two patients were analyzed: one with preserved ejection fraction<span><span> (Case 1) and one with reduced ejection fraction (Case 2). In Case 1, RST improved significantly following ablation, accompanied by a decrease in plasma B-type </span>natriuretic peptide levels. In contrast, while B-type natriuretic peptide levels decreased post-ablation in Case 2, RST showed minimal change, suggesting that the </span></span></span>hemodynamic effects<span> of restoring sinus rhythm had a lesser impact on respiratory stability. These findings indicate that the contribution of AF to the worsening of sleep-disordered breathing in heart failure differs between preserved and reduced ejection fraction. Further investigation of the association between RST and AF may offer valuable insights into the complex relationship between AF and heart failure.</span></div></div><div><h3>Learning objective</h3><div>This case report is the first to demonstrate changes in nocturnal respiratory dysfunction after catheter ablation for atrial fibrillation<span> in heart failure. Quantitative assessment of respiratory stability may help elucidate the role of atrial fibrillation in heart failure.</span></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 130-133"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual ventricular atrial conduction shift from the slow pathway to the fast pathway","authors":"Yasuharu Matsunaga-Lee MD,&nbsp;Yasuyuki Egami MD,&nbsp;Koji Yasumoto MD,&nbsp;Masamichi Yano MD, PhD,&nbsp;Masami Nishino MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.06.003","DOIUrl":"10.1016/j.jccase.2025.06.003","url":null,"abstract":"<div><div><span>A 63-year-old woman underwent an electrophysiological study for a treatment of narrow QRS tachycardia, which was diagnosed as a slow-fast </span>atrioventricular nodal reentrant tachycardia<span><span><span>. She exhibited dual nodal retrograde conduction, with transitions from the fast pathway to the slow pathway and back to the fast pathway. After focal cryoapplications to the mid-septal region of the right atrial septum, both antegrade and retrograde slow pathway conduction were eliminated without affecting the antegrade fast pathway conduction. The mechanism of transition of retrograde conduction between the fast and slow pathways was explained by the following two scenarios: First, the slow pathway was initially concealed by the fast pathway and became evident only when the fast pathway was blocked due to a gap phenomenon. Second, the slow pathway conducted earlier than the fast pathway at a specific point between the ventricle and </span>atrium, thereby masking fast pathway conduction. This could be attributed to the high levels of </span>connexin 43 reported around the lower nodal bundle.</span></div></div><div><h3>Learning objectives</h3><div>When retrograde conduction transitioned from the fast pathway to the slow pathway and then back to the fast pathway, the mechanism was considered a gap phenomenon. This suggested that the slow pathway was initially masked by the fast pathway and could conduct only when the fast pathway was blocked. However, recent findings on the distribution of connexin 43 suggested another possibility that the slow pathway might also mask the fast pathway.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 3","pages":"Pages 126-129"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}