Biomedical subjects

K Yano

Publications and source records attributed to K Yano.

At least 145 records · Page 8Linked to original sources

PubMed1999

A theoretical basis for measuring the efficiency of selection in plant breeding

A new index of selection efficiency, i.e. the ratio of the probability of achieving the desired genetic gain in a target population to the cost expended for that gain, is introduced to define the optimum selection procedures that give the most opportunities for producing new commercial varieties. Monte Carlo simulations of mass selection showed that the index gives solutions to some important optimization problems which cannot be solved based on the traditional indices, the expected genetic gain or its ratio to the cost. The optimum cycle and intensity of selection and optimum population size for a target population could be defined by the new index, but not by the traditional indices.

Journal Article↗

PubMed1999

The association of body weight and anthropometry with mortality in elderly men: the Honolulu Heart Program.

OBJECTIVES: To assess the relationship of body weight and anthropometry to all-cause mortality in older men. DESIGN: A prospective cohort study of 3741 elderly Japanese-American men, enrolled in the Honolulu Heart Program. For this report, the follow-up began at baseline examinations (1991-1993), when the men were aged 71-93 y. MEASUREMENTS: Variables of interest were body mass index (BMI), waist-to-hip ratio (WHR), and the sum of the subscapular and triceps skinfold thickness. Possible confounders included age, education, physical activity index, smoking, alcohol consumption, systolic and diastolic blood pressure, cholesterol, glucose and insulin concentrations. RESULTS: After an average of 4.5 y of follow-up, 766 men (21%) had died. Higher BMI was associated with lower adjusted mortality risks (relative risk (RR)) highest vs lowest quintile-based category = 0.5, 95% confidence interval (CI): 0.4-0.6, P-trend < 0.001). Results were independent of WHR, and did not change after excluding current and former smokers or those who died within one year of follow-up. The relation between WHR and mortality appeared to be U-shaped, but after adjustment for BMI, a higher WHR steadily increased the risk of dying (RR highest vs lowest category = 1.5, 95%CI: 1.1-2.0, P-trend=0.004). Especially in subjects with a high BMI, there was a positive association between WHR and mortality. The results for skinfold thickness were similar to the results for BMI, but less strong. CONCLUSIONS: In older men, BMI and skinfold thickness showed a consistent inverse association with mortality, even after accounting for early mortality. The WHR, on the other hand, was positively related to mortality, especially when BMI was high. Thus, excess abdominal fat mass (FM) warrants closer concern than being overweight, in terms of affecting mortality in the elderly.

Aged↗

PubMed1999

Simple and reliably sensitive diagnosis and monitoring of Philadelphia chromosome-positive cells in chronic myeloid leukemia by interphase fluorescence in situ hybridization of peripheral blood cells.

Philadelphia (Ph) chromosome or the bcr/abl fusion gene is the hallmark of chronic myeloid leukemia (CML) and serves as a prognostic marker during its treatment. Its detection has been primarily done by karyotype analysis of bone marrow cells. The major limitation of the karyotypic technique is an absolute need for metaphases, often difficult to obtain in an appropriate number in patients under therapy. Fluorescence in situ hybridization (FISH) is a sensitive and quantitative method to detect the bcr/abl fusion gene in cells in both metaphase and interphase. Using M-bcr and abl probes, we performed the interphase FISH in the peripheral blood of 30 healthy volunteers and in 20 hematologically normal bone marrow samples. False-positive cells were detected in 2.7 +/- 0.7% (mean +/- standard deviation) and 2.3 +/- 0.7% among 500 cells, respectively. Then we tested 31 patients with CML at various stages of disease on 50 occasions. Although there was a good correlation between the percentage of FISH-positive cells in the peripheral blood and that in the bone marrow (r = 0.977), between the percentage of FISH-positive cells in the peripheral blood and that of Ph chromosome in the bone marrow (r = 0.841), and between the percentage of FISH-positive cells and that of Ph chromosome in the bone marrow (r = 0.933), the limits of agreement in each group were not small, and thus the peripheral blood FISH test can not be interpreted as the same method with conventional karyotyping. Additionally, we could easily rule out CML in 15 individuals with leukocytosis without performing bone marrow aspiration. The present study indicates that FISH analysis in the peripheral blood is a simple and reliably sensitive test for the detection and quantitative monitoring of the M-bcr/abl fusion gene in CML in routine clinical practice, although this can not entirely replace karyotype analysis of bone marrow cells.

Adult↗

PubMed1999

Computational simulation of flows in an entire centrifugal heart pump.

A prototype computational code to numerically simulate the blood flows in an entire centrifugal heart pump has been developed. The unsteady incompressible Navier-Stokes equations are solved on a parallel computer, the Cray T3E. By domain decomposition, the whole flow space is decomposed to a number of subdomains for each of which a structured algebraic grid is assigned. The grids for the inlet eye and blade regions are on the rotating frame while grids for other regions are on the nonrotating frame, and the edge of the rotating grids slides over the edge of the nonrotating frame, and the edge of the rotating grids slides over the edge of the nonrotating grids. The code is able to simulate the flows in the rotor, volute, and diffuser as well as to find pump performance indicators. The present paper presents an overview of the code and describes a study on the effect of volute width.

Algorithms↗

PubMed1999

Does the production of nitric oxide contribute to the early improvement after a single low-density lipoprotein apheresis in patients with peripheral arterial obstructive disease?

Low-density lipoprotein (LDL) adsorption using a dextran sulfate cellulose (DSC) column is commonly performed for extracorporeal removal of LDL in hypercholesterolemic patients with peripheral arterial obstructive disease. We investigated whether the use of heparin or nafamostat mesilate as anticoagulants in a single LDL apheresis produced different clinical effects, or brought about the production of bradykinin and endogenous nitric oxide (NO) in these patients. LDL apheresis was performed in ten patients with peripheral arterial obstructive disease. We measured plasma levels of bradykinin, NO and nitrosylhemoglobin as well as skin temperature. Plasma levels of bradykinin increased 12-fold during LDL apheresis with heparin, but did not increase during LDL apheresis with nafamostat mesilate. LDL adsorption resulted in an immediate rise in skin temperatures (1-2 degrees C) of the lower ischemic legs irrespective of the type of anticoagulant used, and this persisted after the end of LDL apheresis for up to 60 min. There was a progressive and significant increase in plasma NO after the commencement of single LDL apheresis in both groups (heparin group: 64.0 +/- 17.3 micromol/l at baseline, 73.3 +/- 15.2 micromol/l 60 min after apheresis, P<0.005; nafamostat mesilate group: 65.0 +/- 18.8 micromol/l at baseline, 75.5 +/- 17.5 micromol/l 60 min after apheresis, P<0.001). On the other hand, levels of nitrosylhemoglobin increased significantly after 1000 ml of plasma treatment but the level decreased thereafter, although it was significantly higher than baseline 60 min after LDL apheresis. Our results suggest that a single LDL apheresis enhanced peripheral microcirculation, probably as a result of increased production of NO, irrespective of changes in bradykinin release.

Aged↗

PubMed1999

Involvement of receptor-type tyrosine kinase gene families in cardiac hypertrophy.

OBJECTIVE: The activation of protein tyrosine kinases (PTKs) has been postulated to be involved in cell differentiation and proliferation. To elucidate the involvement of tyrosine kinase genes in normal and pathological conditions, we analysed the expression patterns of receptor-type PTKs in the normal and hypertensive hypertrophied heart in rats. MATERIALS AND METHODS: Hypertrophied and normal rat hearts were obtained from hypertensive rats; deoxycorticosterone acetate (DOCA)-salt and 2 kidney-1 clip (2K-1C), and their sham-operated rats, respectively. A reverse transcription-polymerase chain reaction (RT-PCR) was performed using degenerated primers which were designed from highly conserved regions in the catalytic domains of receptor-type PTKs. The PCR products were ligated into a sequence vector, and subcloned by transforming bacteria. To compare the expression level of these PTK mRNAs in the normal and hypertrophied heart, we performed semi-competetive RT-PCR and immunohistochemical and Western blot analyses. RESULTS: Nucleotide sequencing of approximately 80 clones of PTKs revealed 10 receptor-type, five nonreceptor-type and two unknown types in the rat heart. Tie-2/Tek, Ryk, insulin-like growth factor-I receptor were abundantly expressed in the rat heart as members of receptor-type PTKs. Immunohistochemistry and RT-PCR demonstrated the presence of platelet-derived growth factor (PDGF)-alpha receptor, PDGF-beta receptor and fibroblast growth factor-3 receptor in both normal and hypertrophied hearts. We also confirmed the presence of Flt-1, KDR/FIk-1, and their ligand vascular endothelial growth factor, c-Met and its ligand hepatocyte growth factor (HGF), and Tie-1, Tie-2/Tek by immunohistochemistry and RT-PCR. The coexpression of cardiac HGF and c-Met in hypertrophied hearts, especially in 2K-1 C rats, was induced more intensively than that in DOCA-salt rats. CONCLUSION: These findings suggest that HGF/c-Met interactions may play an important role in cardiac hypertrophy and remodeling, probably as a result of the activation of the local renin-angiotensin system.

Animals↗

PubMed1999

Electrophysiological properties of the left atrium evaluated by coronary sinus pacing in patients with atrial fibrillation.

Repetitive atrial firing (RAF), marked fragmentation of atrial activity (FAA), and interatrial conduction delay (CD) have been shown to be electrophysiological features of the atrium in patients with atrial fibrillation (AF). Moreover, it has been observed that atrial extrastimuli are more likely to induce AF when delivered from the right atrial appendage (RAA) than from the distal coronary sinus (CSd). We examined the electrophysiological properties of the atrial muscle by CS and RAA stimulation in patients with paroxysmal AF. Patients were divided into two groups: group I, consisting of 18 patients with clinical paroxysmal AF; and group II, consisting of 22 patients with various cardiac arrhythmias in which the substrate does not exist in the atrium. In group I, the following values of electrophysiological parameters of the atrium indicated that AF was more likely to be induced during RAA pacing than CSd pacing: atrial effective refractory period (RAA vs CSd: 201 +/- 28 ms vs 240 +/- 35 ms, P < 0.001), RAF zone (16 +/- 25 ms vs 0 +/- 0 ms, P < 0.03), FAA zone (38 +/- 37 ms vs 5 +/- 19 ms, P < 0.01), maximum interatrial conduction time (144 +/- 19 ms vs 93 +/- 19 ms, P < 0.0001) and CD zone (53 +/- 21 ms vs 9 +/- 18 ms, P < 0.0001). The values of the electrophysiological parameters of the atrium evaluated by CSd pacing in group I patients were not significantly different from those in group II patients. In conclusion, when coronary sinus stimulation is performed, electrophysiological properties of the atrium in patients with AF show a significant decrease in atrial vulnerability compared to stimulation from RAA and also show similar values to those in patients without AF. It might be suggested that the left posterior or posterolateral atrium is electrophysiologically stable even in patients with paroxysmal AF.

Adult↗

PubMed1999

Asymptomatic amebic colitis in a homosexual man.

We describe case of a 75-yr-old Japanese homosexual man who was diagnosed as having amebic colitis. The present case is unique in that invasive amebiasis has occurred in a homosexual man, because Entamoeba histolytica in homosexual patients is considered to be a nonpathogenic and commensal organism in western countries, and that the patient has not complained of any gastrointestinal symptoms associated with minute colonic lesion of an isolated cecal ulcer. This report indicates that the absence of gastrointestinal symptoms does not rule out invasive amebiasis. Therefore, once the ameba is identified in stool specimens, even in homosexual men, it is important to differentiate pathogenic from nonpathogenic species irrespective of whether the patient is symptomatic, and to treat the patient infected with pathogenic species. By means of this strategy, we can prevent pathogenic ameba from spreading in the community.

Aged↗

PubMed1999

Down-regulation of protein kinase C inhibits insulin-like growth factor I-induced vascular smooth muscle cell proliferation, migration, and gene expression.

Insulin-like growth factor-I (IGF-I) plays an important role in regulating vascular smooth muscle cell (VSMC) proliferation, directed migration, differentiation, and apoptosis. The signaling mechanisms used by IGF-I to elicit these actions, however, are not well defined. In this study, we examined the role(s) of protein kinase C (PKC) in mediating the IGF-I actions in cultured porcine VSMCs. Out of the eleven known members of PKC family, PKC-alpha, -betaI, -epsilon, -eta, -lambda, -theta, and -zeta, were detectable by Western immunoblot analysis in these cells. Further analysis indicated that the subcellular distribution of several PKC isoforms is regulated by IGF-I. While IGF-I stimulated membrane translocation of PKC-eta, -epsilon, and -zeta and regulated the cytosolic levels of PKC-betaI, it had no such effect on PKC-alpha and -lambda. To examine whether PKC activation is required for the IGF-I-regulated biological responses, phorbol myristate acetate (PMA) and GF109203X were used to down-regulate or inhibit PKC activity. Both PMA (1 microM) and GF109203X (20 microM) nearly completely suppressed the total PKC activity after a 30-min incubation (> 90%), and this inhibition lasted for at least 24 h. Down-regulation or inhibition of PKC activity abolished the IGF-I-induced DNA synthesis, migration and IGFBP-5 gene expression. In contrast, the IGFBP-5 expression induced by forskolin was unaffected by PKC down-regulation or inhibition, suggesting that PKC activation is required for the IGF-regulated but not the cAMP-regulated events. Because the actions of IGF-I on DNA synthesis and IGFBP-5 gene expression in VSMCs have been shown to be mediated through the phosphatidylinositol 3-kinase (PI3 kinase) signaling pathway in porcine VSMCs, the potential role of PKC in IGF-I-induced activation of PI3 kinase and PKB/Akt were examined. Treatment with either PMA or GF109203X did not significantly affect the effects of IGF-I on PI3 kinase activation or PKB/Akt phosphorylation. These results indicated that PKC-betaI, -eta, -epsilon, and -zeta may play an essential role(s) in IGF-I regulation of VSMC migration, DNA synthesis and gene expression, and that these PKC isoforms may either act independently of the PI3 kinase pathway or act further downstream of PKB/Akt in the IGF signaling network.

Animals↗

PubMed1999

Diurnal rhythms of luteinizing hormone, follicle-stimulating hormone, and testosterone secretion before the onset of male puberty.

To investigate hormonal change before the onset of male puberty, we measured LH and FSH in serum samples drawn every 20 min for 24 h and measured testosterone hourly for 24 h. Forty-six boys (32 prepubertal and 14 pubertal) of short stature, between 4.4-19.3 yr of age, participated in this study. LH and FSH were measured using a time-resolved immunofluorometric assay, and testosterone was measured using high sensitivity RIA capable of detecting a testosterone concentration of 0.01 ng/mL. Diurnal rhythms of LH, FSH, and testosterone were apparent in all subjects, including those aged 4-5 yr. Serum LH and FSH concentrations showed night-day variation in a pulsatile fashion. The serum testosterone concentration was elevated at early morning in all subjects. Mean 24-h LH, FSH, and testosterone concentrations of prepubertal subjects who did not attain puberty for at least 3 yr were 0.10 U/L, 0.63 U/L, and 0.06 ng/mL, respectively, whereas those of prepubertal subjects who attained puberty within 1 yr (0.54 U/L, 1.68 U/L, and 0.10 ng/mL, respectively) were significantly higher. Furthermore, mean 24-h LH, FSH, and testosterone concentrations increased with developing puberty. All of the 46 subjects showed positive cross-correlation between the LH and testosterone time series. The mean lag time from the LH to the testosterone time series in the prepubertal subjects who attained puberty within 1 yr (4.7 +/- 2.4 h, mean +/- SD) was shorter than that in the prepubertal subjects who attained puberty after at least 3 yr (7.3 +/- 2.2 h). This lag time decreased with developing puberty, plateauing at 1.4 +/- 0.9 h at midpuberty. Thus, the diurnal rhythms of LH, FSH, and testosterone already exist at 4-5 yr of age; serum LH, FSH, and testosterone levels increase before the onset of puberty; and a time delay is observed between the LH and testosterone time series that decreases before the onset of puberty.

Adolescent↗

PubMed1999

Pilsicainide intoxication in a patient with dehydration.

An 81-year-old woman developed pilsicainide intoxication associated with dehydration. The patient had been taking pilsicainide (100 mg/day) for 1 year because of paroxysmal atrial fibrillation. Her renal function was within normal limits. One week before admission, she was suffering from pneumonia, and had appetite loss, fever, and severe fatigue. Physical examination revealed dehydration. The electrocardiogram (ECG) on admission showed atrioventricular dissociation, idioventricular rhythm with marked QRS widening and QTc prolongation. The plasma concentration of pilsicainide on admission was markedly elevated at 6.2 microg/ml, approximately 6 times the therapeutic range (0.25-1.0 microg/ml). Continuous saline infusion was initiated for the treatment of dehydration,which progressively improved. As a result, sinus rhythm was recovered 2 h after admission, and the QRS and JT intervals gradually normalized. This is an interesting case because the proarrhythmia of pilsicainide was induced by dehydration.

Aged↗

PubMed1999

Penetrating atherosclerotic ulcer at the proximal aorta complicated with cardiac tamponade and aortic valve regurgitation.

A 56-year-old man had a penetrating atherosclerotic ulcer originating in the proximal ascending aorta, which is an unusual case of penetrating aortic ulcer complicated with the aortic valve regurgitation and cardiac tamponade. This hemodynamically unstable patient was successfully treated by conservative management to control his blood pressure and was also monitored closely with follow-up imaging studies.

Aortic Diseases↗

PubMed1999

Diastolic potentials observed in idiopathic left ventricular tachycardia.

Radiofrequency catheter ablation (RF-CA) has demonstrated a high success rate in eliminating idiopathic left ventricular tachycardia (ILVT), and the target site is determined by the score of pace mapping or the Purkinje potential (PP) preceding the onset of the ventricular activation, which is considered to indicate the exit site of the reentrant circuit. However, only a few reports have described the potential obtained from the slow conduction zone. RF-CA was successfully performed in 8 patients with ILVT. Careful mapping of the left ventricle during tachycardia was carried out to find the diastolic potential (DP). A DP was obtained in 4 patients (group 1), but not in 4 others (group 2). The local electrogram was recorded from the distal tip of the ablation catheter during the RF current application in order to investigate the pattern of termination of ILVT. A DP was recorded at the point where the catheter was slightly pulled back to a site proximal to the exit site of the reentrant circuit at the left interventricular basal septum. In group 1, conduction block between the DP and PP eliminated ILVT in 3 out of 4 cases, and 1 case showed conduction block between the DP and ventricular potential. In 2 out of 4 patients in group 2, the local electrogram showed conduction block between PP and the ventricular potential when VT terminated. The ablation site in group 1 was located relatively more basal than that in group 2 in anatomy. A DP was obtained in a half of the cases with ILVT and RF-CA at this site could eliminate ILVT. A DP was obtained at a site relatively basal to the exit of the reentrant circuit and it is considered that this is a useful marker in terms of the successful ablation of ILVT.

Adolescent↗

PubMed1999

Immunological characterization of circulating osteoprotegerin/osteoclastogenesis inhibitory factor: increased serum concentrations in postmenopausal women with osteoporosis.

Osteoprotegerin (OPG)/osteoclastogenesis inhibitory factor (OCIF) is a soluble member of the tumor necrosis factor receptor family of proteins and plays an important role in the negative regulation of osteoclastic bone resorption. Whether OPG/OCIF circulates in human blood and how its level changes under pathological conditions is not known. To address these issues, a panel of monoclonal antibodies was generated against recombinant OPG/OCIF and screened for reactivity with solid-phase monomeric and homodimeric forms of the recombinant protein. Antibodies that showed high affinity for both forms of OPG/OCIF and those that selectively recognized the homodimer were identified, enabling development of two types of sensitive enzyme-linked immunosorbent assay (ELISA): one that detects both forms of OPG/OCIF equally and one specific for the homodimer. Characterization of circulating OPG/OCIF with these ELISAs revealed that the protein exists in human serum mainly in the monomeric form. The serum concentration of OPG/OCIF increased with age in both healthy Japanese men and women, and was significantly higher in postmenopausal women with osteoporosis than in age-matched controls. Within the osteoporotic group, serum OPG/OCIF concentrations were higher in patients with low bone mass. Serum OPG/OCIF concentrations were also significantly increased in those postmenopausal women with a high rate of bone turnover, as determined by increased serum bone-specific alkaline phosphatase and urinary excretion of pyridinoline and deoxypyridinoline. The results suggested that circulating OPG/OCIF levels are regulated by an age-related factor(s) and that the increased serum concentration may reflect a compensative response to enhanced osteoclastic bone resorption and the resultant bone loss rather than a cause of osteoporosis.

Adult↗

PubMed1999

Chronic Chagas' heart disease in a Japanese-Brazilian traveler. A case report.

A 57-year-old Japanese-Brazilian man, visiting Japan for only 9 days, was admitted to our hospital due to syncope and frequent ventricular premature beats. He grew up in a rural area of Brazil and moved to Sao Paulo in 1959 when he was 20 years old. We suspected chronic Chagas' heart disease, i.e., dilated cardiomyopathy with apical ventricular aneurysm, right bundle branch block with left anterior fascicular block, and various arrhythmias including supraventricular premature beats, ventricular premature beats and non-sustained ventricular tachycardia because he showed typical echo- and electrocardiographic features of the disease. Coronary arteriograms were normal, and left ventriculogram confirmed the existence of apical ventricular aneurysm. A left ventricle biopsy specimen showed hypertrophic cardiac muscle with mild fibrosis. The diagnosis of chronic Chagas' disease was finally confirmed by the demonstration of Trypanosoma cruzi itself in the blood as well as Trypanosoma cruzi antibodies.

Animals↗

PubMed1999

Angiotensin II promotes integrin-mediated collagen gel contraction by adult rat cardiac fibroblasts.

Remodeling is a fundamental cardiac response to injury and involves cardiac fibroblast proliferation and extracellular matrix (ECM) production. Angiotensin II (Ang II) directly promotes these changes in cardiac fibroblasts and thus, plays critical roles in cardiac hypertrophy and wound healing. Osteopontin, fibronectin and laminin mRNA were detected in total RNA harvested from cultured adult rat cardiac fibroblasts. Immunocytochemistry staining of cultured adult rat cardiac fibroblasts grown on coverslips revealed the presence of beta 3 integrins on the surfaces of the cells. In the present study, we investigated the role of Ang II in a model of wound repair using floating collagen gels harboring adult rat cardiac fibroblasts, and we determined which members of the integrin family existed on these cells. The presence of either MPIIIB10, a monoclonal antibody against osteopontin (7.2 micrograms/ml) or RGD (arginine-glycine-aspartate) peptide (10(4) M) had no effect on gel contraction. Osteopontin itself induced gel contraction; however this effect was completely neutralized by MPIIIB10 (7.2 micrograms/ml, RGD peptide (10(4) M) and a monoclonal antibody against rat beta 3 integrin (25 micrograms/ml). We identified alpha v, beta 3 and beta 5 integrins on adult rat cardiac fibroblasts by fluorescence-activated cell sorting and confirmed that RGD peptide and an antibody against beta 3 integrin completely blocked osteopontin-induced gel contraction. These results suggest that Ang II promotes cardiac wound healing and remodeling processes by inducing expression of osteopontin and beta 3 integrin by cardiac fibroblasts.

Angiotensin II↗

PubMed1999

Clinical analysis of hypertrophic cardiomyopathy which evolved into dilated phase during long-term follow-up.

The aim of the present study was to analyze the incidence, clinical features and prognosis of patients with hypertrophic cardiomyopathy (HCM) which evolved into dilated phase HCM. The medical records of 43 patients with HCM followed up for at least 10 years were analyzed retrospectively. The patients were divided into two groups: group A consisting of patients with dilated-phase HCM defined by a left ventricular end diastolic dimension (LVDD) of 55 mm or more and a left ventricular ejection fraction (LVEF) of less than 50% obtained by echocardiography, and group B, consisting of patients with HCM that did not evolve into dilated phase HCM. During the mean follow-up of 16.7 years, 10 patients (23.3%) evolved into dilated phase HCM (group A) while the remaining 33 patients (76.7%) did not (group B). Ventricular tachycardia (VT) occurred in 7 of the 10 patients (70.0%) in group A and in 5 of the 33 patients (15.2%) in group B (p < 0.001). An increase in LVDD and decreases in LVEF and SV1 + RV5 in the electrocardiogram were observed during the early phase of the follow-up period in group A, while these changes were gradual in group B. Cardiac death occurred in 5 (50.0%) of the 10 patients in group A and in 2 (6.1%) of the 33 patients in group B (p < 0.001). In conclusion, dilated-phase HCM is characterized by decreases in LVEF and SV + RV5 and an increase in LVDD during the early phase of follow-up period, and is associated with an increased incidence of VT and a poor prognosis.

Adolescent↗

PubMed1999

Slow-fast form of atrioventricular nodal reentrant tachycardia with eccentric retrograde left-sided activation.

A case of atypical AV nodal reentrant tachycardia (AVNRT) with eccentric retrograde left-sided activation, masquerading as tachycardia using a left-sided accessory pathway, is reported. Initially, it appeared that the tachycardia was a typical slow-fast form of AVNRT. The earliest retrograde activation, however, was registered at a site approximately 3 cm from the coronary sinus orifice (left atrial free wall), indicating atypical AVNRT. Atrial tachycardia and orthodromic AV reciprocating tachycardia using an accessory AV pathway were excluded. Slow pathway ablation at the posteroseptal right atrium eliminated the tachycardia. It was suggested that the anterograde limb of the tachycardia circuit was a slow AV nodal pathway with typical posteroseptal location, whereas the retrograde limb was a long atrionodal pathway connecting the compact AV node and the left atrial free wall near the mid-coronary sinus.

Atrioventricular Node↗