This study suggests that the autonomic nervous system plays an important role in both the initiation and termination of PAF. Furthermore, the time of PAF onset influences the autonomic tone at the initiation and termination of PAF.

The phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, has been reported to produce sustained pulmonary vasodilatation in patients with pulmonary hypertension (PH). Recently, vardenafil, a more potent and selective PDE-5 inhibitor than sildenafil, has been approved for the treatment of erectile dysfunction. However, the long-term effects of oral vardenafil in patients with PH are unknown. We studied five consecutive patients with PH; one with primary pulmonary hypertension, two with chronic pulmonary thromboembolism,

A 64-year-old woman was admitted because of persistent chest pain and ST-elevation

No abstract

SUMMARYIntracardiac echocardiography (ICE) serves as an adjunct to fluoroscopy for electrophysiological procedures by identifying critical anatomic landmarks and confirming catheter-endocardial contact. In the present study, we investigated the usefulness of ICE for radiofrequency catheter ablation. ICE was utilized to guide transseptal puncture in 19 patients undergoing radiofrequency catheter ablation. The fossa ovalis, which was one critical anatomic landmark, had an average vertical diameter of 18.5 ± 6.9 mm and an average horizontal diameter of 10.0 ± 2.4 mm, as measured by ICE and fluoroscopy. Although there was only a small shift of the puncture site in the horizontal direction, the puncture site shifted towards the upper edge of the fossa ovalis for 17 patients (89%). Furthermore, we could verify that the distance between the apex of the tent-shape formed by the pressure of the puncture needle in the fossa ovalis and the left atrial wall opposing it was sufficient to carry out the procedure safely. Confirming the puncture site using ICE is useful in carrying out transseptal left heart catheterization safely. (Jpn Heart J 2003; 44: 673-680) Key words: Intracardiac echocardiography, Fossa ovalis, Transseptal catheterization OVER the past few years, atrial septal puncture through the fossa ovalis has become important for radiofrequency catheter ablation in many patients with leftsided accessory pathway and atrial fibrillation.1-3) This procedure has been performed under transthoracic ultrasound and/or right atrial contrast radiography guidance. However, the complication rate for this procedure was reported to be 2% to 6%.2-5) The major reason for this is our inability to identify the fossa ovalis. Recently, the utility of intracardiac echocardiography (ICE) in clearly visualizing