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We describe a case of advanced atrioventricular (AV) block, in which treatment with cilostazol was effective in recovering the AV conduction. The patient was referred to our hospital for close examination of the advanced AV block and permanent pacemaker implantation. Although the patient had experienced thirddegree AV block with occasional AV synchrony for more than two days, the AV conduction completely recovered after treatment with oral cilostazol at 200 mg/day. Here we discuss the possible mechanism of the improvement in the AV conduction by cilostazol.

We describe a case of early repolarization syndrome in which augmented J waves were documented during an electrical storm associated with hypokalemia. The patient was referred to our hospital for therapy to treat recurrent ventricular fibrillation (VF). The 12-lead electrocardiogram showed giant J waves associated with hypokalemia during multiple episodes of VF. Although antiarrhythmic agents or deep sedation were not effective for the VF, an intravenous supplementation of potassium completely suppressed the VF with a reduction in the J-wave amplitude. Our report discusses the possible relationship between hypokalemia and VF in early repolarization syndrome.

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SummaryLarge infarcts are associated with a terminal QRS-distortion in ST-elevation myocardial infarction (STEMI) patients. Late gadolinium enhancement (LGE) on the cardiac MRI (CMR) can depict an infarct distribution. However, less is known about the relationship between the LGE findings and QRS-distortion on admission, including the best ECGlead location to reveal the QRS-distortion (DIS-lead) in STEMI patients. Fifty STEMI patients successfully treated with percutaneous coronary intervention were classified into two groups according to whether the QRS-distortion was positive (+) or negative (-). The LGE on a recent CMR was classified into 12 left ventricular segments (Basal-Middle-Apical × Anterior-Septal-Inferior-Lateral). The coincidences between the segmental LGE scores and DIS-lead were investigated. All patients were divided into 23 QRS-distortion (+) and 27 QRS-distortion (-) groups. The total LGE score was significantly greater in the QRS-distortion (+) group (14.7 ± 6.8 versus 9.6 ± 6.2, P < 0.01). The highest LGE score in 96% of QRS-distortion (+) patients was 4, and a score 4 segment indicated a good selection of the DIS-lead (86.4%). QRSdistortion in the ECG on admission represents severe transmural infarction in the LGE using CMR, which represents large infarcts in STEMI patients. (Int Heart J 2012; 53: 270-275) Key words: Acute myocardial infarction (AMI), Magnetic resonance imaging, Electrocardiography, Electrical damage, Ischemic heart disease, Localization of ventricular injury R ecently, it has been reported that large infarcts are associated with terminal QRS-distortion in patients with ST-elevation myocardial infarctions (STEMIs), [1][2][3][4] and that the ECG pattern of the distortion of the terminal portion of the QRS complex is an independent predictor of the prognosis in STEMI patients, and has a better correlation to the infarct size than the magnitude of the ST segment elevation.5) The evaluation of the infarct size and morphology of the late gadolinium enhancement (LGE) on cardiac MRI (CMR) has been well validated and is currently considered the clinical gold standard for a viability assessment. 6,7) However, it remains to be elucidated whether the LGE findings correlate with the QRS-distortion. Therefore, we investigated the relationship between the LGE findings and the QRS-distortion on admission, including the best location of the ECG-lead showing the QRSdistortion (DIS-lead) in patients with an STEMI. MethodsStudy population: We analyzed 50 consecutive patients (40 men and 10 women; aged 33 to 89 years), who were admitted with an STEMI and successfully treated with percutaneous coronary intervention (PCI) in our hospital between September 2005 and August 2010, and who fulfilled the following criteria: no previous history of a myocardial infarction, admission within 6 hours of the onset of symptoms, typical chest pain lasting for at least 30 minutes, ST-segment elevation of > 0.2 mV and upright T waves in > 2 adjacent precordial leads on the admission ECG, an increase in the se...