研究者詳細 - 高月　誠司

論文 - 高月　誠司

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Predictive factors of lead failure in patients implanted with cardiac devices

Aizawa Yoshiyasu, Negishi Masachika, Kashimura Shin, Nakajima Kazuaki, Kunitomi Akira, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Kohsaka Shun, Takatsuki Seiji, Fukuda Keiichi

International Journal of Cardiology 199 277 - 281 2015年09月

ISSN 0167-5273

Introduction Lead failures (LFs) are one of the most common complications in patients implanted with cardiovascular implantable electronic devices. LFs often cause serious secondary complications such as inappropriate ICD shocks or asystole. This study aimed to identify the clinical factors associated with the occurrence of LFs. Methods A total of 735 consecutive device implantations (mean age 67 ± 15 years, males 64%) performed at a single university hospital setting from 1997 to 2014 were included. The implanted devices consisted of 421 pacemakers, 250 implantable cardioverter defibrillators (ICD), 9 cardiac resynchronization therapy pacemakers (CRT-P), and 55 CRT defibrillators (CRT-D). The primary endpoint was the development of an LF. Results During a mean duration of 5.8 ± 4.3 years, 38 LFs developed in 31 patients (mean age 56 ± 14 years). LFs included 32 ICD (7 Sprint Fidelis, 2 Riata), and 6 pacing leads. Nine patients received inappropriate ICD shocks and 1 had syncope due to an LF. All patients underwent lead reinsertions with device replacements. Eight patients required opposite site implantations due to venous occlusions. The predictive factors of LFs were the age, male sex, taller body length, ICD vs. pacemaker, lesser lead number, extra-thoracic puncture of the axillary vein vs. a cut-down of the cephalic vein, use of recalled leads and patients with idiopathic ventricular fibrillation (IVF) and Brugada syndrome (BrS). Conclusion LFs occurred mainly with ICD leads. A lesser age, the puncture method, lead model, and diagnosis of IVF/BrS were associated with the development of LFs.

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Left atrial thrombus formation and resolution during dabigatran therapy

Mitamura Hideo, Nagai Takayuki, Watanabe Atsuyuki, Takatsuki Seiji, Okumura Ken

Journal of Arrhythmia 31 （ 4 ） 226 - 231 2015年08月

ISSN 1880-4276

Background: Protocols on the use of novel oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) are lacking. Aim: The study was aimed at evaluating the efficacy of dabigatran (Dabi) treatment in preventing peri-ECV stroke. Methods: A retrospective survey of the incidence and fate of left atrial (LA) thrombus during Dabi therapy in patients with AF was conducted between December 2012 and January 2013 by the Japanese Heart Rhythm Society. Results: A total of 198 patients from 299 institutions underwent transesophageal echocardiography (TEE) to rule out LA thrombus before ECV. Of these, LA thrombus was found in eight patients (4%), who tended to be older (67.3 vs. 61.3 years, p=0.175), had higher CHADS<inf>2</inf> scores (1.88 vs. 0.95, p=0.058), and a higher prevalence of prior stroke or transient ischemic attack (22.2% vs. 2.6%, p=0.034) than those without LA thrombus. Of the eight patients with LA thrombus, one had LA thrombus during a Dabi 150 mg b.i.d treatment, whereas the remaining seven were receiving 110 mg b.i.d for 3 weeks or longer. In 6 of the 8 patients with LA thrombus, a second TEE was performed, revealing complete resolution of LA thrombus in five; among these five patients, one received Dabi dosage of 150 mg b.i.d unchanged, two received an increased dosage from 110 mg to 150 mg b.i.d, and two were switched to warfarin. Two patients had a stroke 3 and 15 days after ECV, and one had a major large intestine bleeding episode during Dabi therapy. Conclusions: LA thrombus developed in 4% of patients with AF receiving Dabi. Older patients with a higher CHADS<inf>2</inf> score receiving a lower Dabi dosage were more likely to develop LA thrombus, which was resolved with a prolonged or increased dosage. A higher Dabi dosage may be more beneficial before ECV but prospective randomized studies would be needed to confirm these results.

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Optimal conditions for cardiac catheter ablation using photodynamic therapy

Kimura Takehiro, Takatsuki Seiji, Miyoshi Shunichiro, Takahashi Mei, Ogawa Emiyu, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Tanimoto Yoko, Aizawa Yoshiyasu, Arai Tsunenori, Fukuda Keiichi

Europace 17 （ 8 ） 1309 - 1315 2015年06月

ISSN 1099-5129

Aims Photodynamic therapy (PDT) is based on non-thermal injury mediated by singlet oxygen species and is used clinically in cancer therapy. In our continuing efforts to apply this technology to cardiac catheter ablation, we clarified the optimal condition for creating PDT-mediated lesions using a laser catheter. Methods and results In a total of 35 canines, we applied a laser directly to the epicardium of the beating heart during open-chest surgery at 15 min after administration of a photosensitizer, talaporfin sodium. We evaluated the lesion size (depth and width) using hematoxylin-eosin staining under varying conditions as follows: laser output (5, 10, 20 W/cm2), irradiation time (0-60 s), photosensitizer concentration (0, 2.5, 5 mg/kg), blood oxygen concentration (103.5 ± 2.1 vs. 548.0 ± 18.4 torr), and contact force applied during irradiations (low: <20 g, high: >20 g). A laser irradiation at 20 W/cm2 for 60 s under 5 mg/kg (29 μg/mL) of photosensitizer induced a lesion 8.7 ± 0.8 mm deep and 5.2 ± 0.2 mm wide. The lesion size was thus positively correlated to the laser power, irradiation time, and photosensitizer concentration, and was independent of the applied contact force and oxygen concentration. In addition, the concentration of the photosensitizer strongly correlated with the changes in the pulse oximetry data and fluorescence of the backscattering laser, suggesting that a clinically appropriate condition could be estimated in real time. Conclusion Photodynamic therapy-mediated cardiac lesions might be controllable by regulating the photosensitizer concentration, laser output, and irradiation time.

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Aiming for zero deaths

Mitamura Hideo, Iwami Taku, Mitani Yoshihide, Takeda Satoshi, Takatsuki Seiji

Circulation Journal 79 （ 7 ） 1398 - 1401 2015年06月

ISSN 1346-9843

Detection, risk factors and management of the patient with lead failure

Nishiyama Nobuhiro, Takatsuki Seiji

Respiration and Circulation 63 （ 5 ） 447 - 457 2015年05月

ISSN 0452-3458

Huge left atrial appendage after an incomplete surgical ligation and successful catheter ablation of atrial fibrillation

Kimura Takehiro, Inagawa Kohei, Tanimoto Kojiro, Takatsuki Seiji

Annals of Thoracic Surgery 99 （ 5 ） 1826 2015年05月

ISSN 0003-4975

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Visualization of the left atrial appendage by phased-array intracardiac echocardiography from the pulmonary artery in patients with atrial fibrillation

Nishiyama Takahiko, Katsumata Yoshinori, Inagawa Kohei, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Aizawa Yoshiyasu, Tanimoto Kojiro, Fukuda Keiichi, Takatsuki Seiji

Europace 17 （ 4 ） 546 - 551 2015年04月

ISSN 1099-5129

Aims The left atrial appendage (LAA) represents the major source of cardiac thrombus formation in patients with atrial fibrillation (AF). Phased-array intracardiac echocardiography (ICE) has become available and frequently used during catheter ablation of AF. We attempted to study the feasibility of using ICE for the visualization and evaluation of the LAA from the pulmonary artery (PA) in patients with AF. Methods and Results Eighty patients with AF undergoing catheter ablation (70 males, 57.5 ± 9.1 years) were included. Transoesophageal echocardiography was performed on the prior day before the catheter ablation, and ICE was performed just before the transseptal puncture during the catheter ablation. The ICE catheter was advanced up into the PA from the femoral vein, where the LAA was clearly and entirely visualized by manipulating the ICE catheter. We compared the degree of spontaneous echo contrast, and the correlation was obtained between the ICE and TEE (κ = 0.534, P < 0.001). Furthermore, the LAA flow velocity (LAA emptying and filling velocities) measured by ICE had a good correlation to that measured by TEE (R = 0.872, P < 0.01 and R = 0.753, P < 0.01, respectively). No patients developed any complications. Conclusion The utilization of ICE in the PA is feasible for the observation and evaluation of the LAA.

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Tachycardia-dependent augmentation of "notched J waves" in a general patient population without ventricular fibrillation or cardiac arrest

Aizawa Yoshifusa, Sato Masahito, Kitazawa Hitoshi, Aizawa Yoshiyasu, Takatsuki Seiji, Oda Eiji, Okabe Masaaki, Fukuda Keiichi

Heart Rhythm 12 （ 2 ） 376 - 383 2015年02月

ISSN 1547-5271

Background J waves can be observed in individuals of the general population, but electrocardiographic characteristics are poorly understood. Objective The purpose of this study was to examine the J-wave dynamicity in a general patient population. Methods The responses of J waves (>0.1 mV above the isoelectric line in 2 contiguous leads) to varying RR intervals were analyzed. Patients with aborted sudden cardiac death, documented ventricular fibrillation, or a family history of sudden cardiac death were excluded. The J-wave amplitude was measured at baseline, in beats with short RR intervals in conducted atrial premature beats (APBs) or atrial stimulation during the electrophysiology study, and in the beats next to APBs with prolonged RR intervals. Results Mainly notched J waves were identified in 94 of 701 (24.5%) general patients (13.4%), and APBs were present in 23 of 94 (24.5%) patients. The mean baseline amplitude of J waves was 0.20 ± 0.06 mV at the baseline RR interval of 853 ± 152 ms, 0.25 ± 0.11 mV at the RR interval in the conducted APB of 545 ± 133 ms (P =.0018), and 0.19 ± 0.08 mV at the RR interval of 1146 ± 314 ms (P =.3102). The clinical characteristics were not different between patients with and without tachycardia-dependent augmentation of J waves. Augmentation of J waves was confirmed by the electrophysiology study: 0.28 ± 0.12 mV vs 0.42 ± 0.11 mV at baseline and in the beats of atrial stimulation, respectively (P =.0001). However, no bradycardia-dependent augmentation (>0.05 mV) was observed. Such tachycardia-dependent augmentation can represent depolarization abnormality rather than repolarization abnormality. Conclusion J waves in a general patient population were augmented at shorter RR intervals, but not at prolonged RR intervals. Mechanistically, conduction delay is most likely responsible for this.

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Risk factors for early replacement of cardiovascular implantable electronic devices

Aizawa Yoshiyasu, Kunitomi Akira, Nakajima Kazuaki, Kashimura Shin, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Tanimoto Yoko, Kohsaka Shun, Takatsuki Seiji, Fukuda Keiichi

International Journal of Cardiology 178 99 - 101 2015年01月

ISSN 0167-5273

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Operator-blinded contact force monitoring during pulmonary vein isolation using conventional and steerable sheaths

Kimura Takehiro, Takatsuki Seiji, Oishi Ako, Negishi Masachika, Kashimura Shin, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Tanimoto Yoko, Aizawa Yoshiyasu, Fukuda Keiichi

International Journal of Cardiology 177 （ 3 ） 970 - 976 2014年12月

ISSN 0167-5273

Background We performed contact force (CF) monitoring during pulmonary vein (PV) isolation to evaluate CF according to sheath type, catheter position, and inadequate ablation.Methods Thirty consecutive patients (paroxysmal atrial fibrillation, 23; CHADS₂ score, 0.5 ± 0.7; age, 56 ± 10 years) who underwent PV isolation using a CF-sensing catheter were included. Data for operator-blinded CF, impedance, and duration of the "first touch" (first round of ablation in each PV) was collected. We compared the CF, maximum CF, force-time integral, average impedance, and impedance drop (Δ impedance) between different sheaths (Swartz™ vs. Agilis™) in 12 different catheter positions, and in inadequate first touches requiring additional ablation.Results A total of 1283 ablation points (Swartz™, 620 points; Agilis™, 663 points) were evaluated. The average CF was significantly higher in the Agilis™ group (17.8 ± 13.0 g) than the Swartz™ group (15.0 ± 12.4 g; P < 0.001), especially in the anterior, inferior-anterior, and inferior-posterior sections of the right PV, and the top of the roof, and calina of the left PV. The Δ impedance showed a mildly significant negative relationship with the average CF (r = - 0.206; P < 0.001) and with the force-time integral (r = - 0.279; P < 0.001). Compared to first touches, the average CF and Δ impedance were significantly smaller in inadequate first touches in the Swartz™ group, but not in the Agilis™ group.Conclusions CF for PV isolation was significantly different depending on the position of the catheter and the type of sheath.

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Circadian pattern of fibrillatory events in non-Brugada-type idiopathic ventricular fibrillation with a focus on J waves

Aizawa Yoshiyasu, Sato Masahito, Ohno Seiko, Horie Minoru, Takatsuki Seiji, Fukuda Keiichi, Chinushi Masaomi, Usui Tatsuya, Aonuma Kazutaka, Hosaka Yukio, Haissaguerre Michel, Aizawa Yoshifusa

Heart Rhythm 11 （ 12 ） 2261 - 2266 2014年12月

ISSN 1547-5271

Background The circadian pattern of ventricular fibrillation (VF) episodes in patients with idiopathic ventricular fibrillation (IVF) is poorly understood.Methods Excluding Brugada syndrome and other primary electrical diseases, the circadian pattern of VF occurrence was determined in 64 patients with IVF. The clinical and electrocardiographic characteristics were compared among patients with nocturnal (midnight to 6:00 AM) VF and nonnocturnal VF in relation to J waves. A J wave was defined as either notching or a slur at the QRS terminal >0.1 mV above the isoelectric line in contiguous leads.Results The overall distribution pattern of VF occurrence showed 2 peaks at approximately 6:00 AM and around 8:00 PM. Nocturnal VF was observed in 20 patients (31.3%), and J waves were present in 14 of these 20 individuals (70.0%), whereas J waves were less frequent in the 44 nonnocturnal patients with VF: 16 (36.4%) (P =.0117). Among patients with J waves, nocturnal VF was observed in 46.7% with a peak at approximately 4:00 AM. Nocturnal VF was less common in patients without J waves, occurring in only 17.6% (P =.0124). Both the type and location of J waves and the pattern of the ST segment were similar between the nocturnal and nonnocturnal VF groups. J waves were associated with a VF storm and long-term arrhythmia recurrence.Conclusion In IVF, the presence of J waves may characterize a higher nocturnal incidence of VF and a higher acute and chronic risk of recurrence.

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Pericardial endoscopy-guided left atrial appendage ligation

Kimura Takehiro, Takatsuki Seiji, Miyoshi Shunichiro, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Tanimoto Yoko, Aizawa Yoshiyasu, Jinzaki Masahiro, Fukuda Keiichi

Circulation: Cardiovascular Interventions 7 （ 6 ） 844 - 850 2014年12月

ISSN 1941-7640

Background-Approaches for closing the left atrial appendage (LAA) have been developed for stroke prevention. However, the prevailing maneuvers require an open-chest surgery, intravascular access, or transseptal puncture. We evaluated the feasibility and safety of pericardial endoscopy-guided LAA ligation in a canine model. Methods and Results-We used a total of 8 canines and computed tomography was performed before the procedures. After a double percutaneous pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The ENDOLOOP ligature was advanced to the ostium of the LAA by counter pulling the tip of the LAA with forceps. After confirming the positioning guided by transesophageal echocardiography, the ligature was securely tightened. Acute success was evaluated by transesophageal echocardiography and chronic success was evaluated by blood testing, computed tomography, and transesophageal echocardiography. The LAA ligation was safely achieved in all canines without major complications. One month after the ligation, the ligated LAA was replaced by fibrotic tissue, and both the transesophageal echocardiography and computed tomographic images revealed no residual shunt. There was only a localized adhesion of the pericardium, where the original LAA was located, without the need for antibiotic or steroid administration. The postprocedural internal surface of the ligated LAA was smooth by virtue of intimal growth. Blood tests showed a slight elevation of the inflammatory markers, but this normalized spontaneously. Conclusions-Pericardial endoscopy-guided LAA ligation could provide an alternative, minimally invasive, and feasible solution for LAA closure that does not require vascular access or a transseptal puncture.

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Electrical storm in patients with Brugada syndrome is associated with early repolarization

Kaneko Yoshiaki, Horie Minoru, Niwano Shinichi, Kusano Kengo F., Takatsuki Seiji, Kurita Takashi, Mitsuhashi Takeshi, Nakajima Tadashi, Irie Tadanobu, Hasegawa Kanae, Noda Takashi, Kamakura Shiro, Aizawa Yoshiyasu, Yasuoka Ryobun, Torigoe Katsumi, Suzuki Hiroshi, Ohe Toru, Shimizu Akihiko, Fukuda Keiichi, Kurabayashi Masahiko, Aizawa Yoshifusa

Circulation: Arrhythmia and Electrophysiology 7 （ 6 ） 1122 - 1128 2014年12月

ISSN 1941-3149

Background: Electrical storms (ESs) in patients with Brugada syndrome (BrS) are rare though potentially lethal. Methods and Results: We studied 22 men with BrS and ES, defined as ≥3 episodes/d of ventricular fibrillation (VF) and compared their characteristics with those of 110 age-matched, control men with BrS without ES. BrS was diagnosed by a spontaneous or drug-induced type 1 pattern on the ECG in the absence of structural heart disease. Early repolarization (ER) was diagnosed by J waves, ie, >0.1 mV notches or slurs of the terminal portion of the QRS complex. The BrS ECG pattern was provoked with pilsicainide. A spontaneous type I ECG pattern, J waves, and horizontal/descending ST elevation were found, respectively, in 77%, 36%, and 88% of patients with ES, versus 28% (P<0.0001), 9% (P=0.003), and 60% (P=0.06) of controls. The J-wave amplitude was significantly higher in patients with than without ES (P=0.03). VF occurred during undisturbed sinus rhythm in 14 of 19 patients (74%), and ES were controlled by isoproterenol administration. All patients with ES received an implantable cardioverter defibrillator and over a 6.0±5.4 years followup, the prognosis of patients with ES was significantly worse than that of patients without ES. Bepridil was effective in preventing VF in 6 patients. Conclusions: A high prevalence of ER was found in a subgroup of patients with BrS associated with ES. ES appeared to be suppressed by isoproterenol or quinidine, whereas bepridil and quinidine were effective in the long-term prevention of VF in the highest-risk patients.

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Effect of Nocturnal Intermittent Hypoxia on Left Atrial Appendage Flow Velocity in Atrial Fibrillation

Kimura Takehiro, Kohno Takashi, Nakajima Kazuaki, Kashimura Shin, Katsumata Yoshinori, Nishiyama Takahiko, Nishiyama Nobuhiro, Tanimoto Yoko, Aizawa Yoshiyasu, Fukuda Keiichi, Takatsuki Seiji

Canadian Journal of Cardiology 2014年10月

ISSN 0828-282X

Background: The mechanism underlying the associations of sleep-disordered breathing (SDB) with stroke and atrial fibrillation (AF) is not well established. We explored the relationship between nocturnal intermittent hypoxia, a marker of SDB, and left atrial (LA)/LA appendage (LAA) function among AF patients. Methods: We evaluated 134 consecutive AF candidates for catheter ablation (age, 59.6 ± 9.4 years; body mass index [BMI], 24.8 ± 3.2; Congestive Heart Failure, Hypertension, Age (≥75 years), Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age (65-74 years), Sex (Female) (CHA<inf>2</inf>DS<inf>2</inf>-VASc) score, 1.2 ± 1.1, paroxysmal AF, n= 83) using nocturnal pulse oximetry, a noninvasive screening method for nocturnal intermittent hypoxia. Based on 3% oxygen desaturation index (3% ODI), patients were divided into nocturnal intermittent hypoxia (3% ODI > 15; n= 32) and control groups (3% ODI ≤ 15; n= 102). Results: The nocturnal intermittent hypoxia group demonstrated significantly higher weight, BMI, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS<inf>2</inf>) and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores, serum hemoglobin A1c and plasma brain natriuretic peptide levels, LA size, and prevalence of hypertension, vascular disease, and sick sinus syndrome. Echocardiographically, nocturnal intermittent hypoxia was associated with a higher grade of spontaneous echo contrast and low LAA flow velocity. Multiple regression analysis adjusted for type of AF, CHA<inf>2</inf>DS<inf>2</inf>-VASc score, BMI, plasma brain natriuretic peptide level, LA size, and rhythm on echocardiography revealed that 3% ODI was a factor independently associated with LAA flow velocity (β=-0.184; 95% confidence interval,-0.818 to-0.006). Conclusions: Nocturnal intermittent hypoxia was an independent determinant for low LAA flow velocity in patients with AF, suggesting that the connection between SDB and LAA function might underlie the association of AF with stroke.

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Evaluation of differences in automated QT/QTc measurements between Fukuda Denshi and Nihon Koden systems

Sano Motoaki, Aizawa Yoshiyasu, Katsumata Yoshinori, Nishiyama Nobuhiro, Takatsuki Seiji, Kamitsuji Shigeo, Kamatani Naoyuki, Fukuda Keiichi

PLoS ONE 9 （ 9 ） 2014年09月

Background: Automatic measurement becomes a preference, and indeed a necessity, when analyzing 1000 s of ECGs in the setting of either drug-inducing QT prolongation screening or genome-wide association studies of QT interval. The problem is that individual manufacturers apply different computerized algorithms to measure QT interval. We conducted a comparative study to assess the outcomes with different automated measurements of QT interval between ECG machine manufacturers and validated the related heart rate correction methods.Methods and Results: Herein, we directly compared these different commercial systems using 10,529 Fukuda Denshi ECGs and 72,754 Nihon Kohden ECGs taken in healthy Japanese volunteers. Log-transformed data revealed an equal optimal heart rate correction formula of QT interval for Fukuda Denshi and Nihon Kohden, in the form of QTc = QT/RR-^0.347. However, with the raw data, the optimal heart rate correction formula of QT interval was in the form of QTc = QT+0.1566(1- RR) for Fukuda Denshi and QTc = QT+0.1526(1-RR) for Nihon Kohden. After optimization of heart rate correction of QT interval by the linear regression model using either log-transformed data or raw data, QTc interval was ,10 ms longer in Nihon Kohden ECGs than in those recorded on Fukuda Denshi machines. Indeed, regression analysis revealed that differences in the ECG machine used had up to a two-fold larger impact on QT variation than gender difference. Such an impact is likely to be of considerable importance when ECGs for a given individual are recorded on different machines in the setting of multi-institutional joint research.Conclusions: We recommend that ECG machines of the same manufacturer should be used to measure QT and RR intervals in the setting of multi-institutional joint research. It is desirable to unify the computer algorithm for automatic QT and RR measurements from an ECG.

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ICD therapy in RVOT-VT and early stage ARVD/C patients

Aizawa Yoshiyasu, Takatsuki Seiji, Fukuda Keiichi

Journal of Atrial Fibrillation 7 （ 2 ） 2014年08月

Implantable cardioverter-defibrillators (ICDs) improve the survival of patients with ischemic or non-ischemic cardiomyopathy and a reduced ejection fraction. However, the efficacy of ICD therapy in patients with right ventricular outflow tract ventricular tachycardia (RVOT-VT) and early stage arrhythmogenic right ventricular dysplasia / cardiomyopathy (ARVD/C) has not been well clarified. Although the prognosis of RVOT-VT is generally good, malignant forms of RVOT-VT resulting in polymorphic VT have been reported by several investigators. Radiofrequency catheter ablation is still effective in such patients, and thus an ICD implantation is usually not required. On the other hand, according to the current guidelines in patients with ARVD/C, an ICD implantation is recommended for secondary prevention when the patients develop sustained VT or VF. An ICD implantation may also be considered for primary prevention in high-risk patients: extensive disease, family history of sudden cardiac death, or undiagnosed syncope. Since an ICD implantation in the early stage of ARVD/C is controversial, physicians should well consider its risks and benefits. Early intervention with ICD therapy in ARVD/C patients may reduce the arrhythmic death rate but increases the device related complications especially in younger patients.

Thoracic impedance as a therapeutic marker of acute decompensated heart failure

Aizawa Yoshiyasu, Takatsuki Seiji, Kashimura Shin, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Tanimoto Yoko, Tanimoto Kojiro, Fukuda Yukiko, Sato Toshiaki, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 174 （ 3 ） 840 - 842 2014年07月

ISSN 0167-5273

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Coexistence of two distinct fascinating cardiovascular disorders

Egashira Toru, Yuasa Shinsuke, Kimura Mai, Sawano Mitsuaki, Anzai Atsushi, Hayashida Kentaro, Kawamura Akio, Kimura Takehiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Takatsuki Seiji, Tsuruta Hikaru, Murata Mitsushige, Yamada Yoshitake, Kohno Takashi, Maekawa Yuichiro, Sano Motoaki, Kosaki Kenjiro, Fukuda Keiichi

International Journal of Cardiology 174 （ 2 ） 2014年06月

ISSN 0167-5273

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Clinical characteristics of atrial fibrillation detected by implanted devices and its association with ICD therapy

Aizawa Yoshiyasu, Takatsuki Seiji, Negishi Masachika, Kashimura Shin, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Tanimoto Yoko, Tanimoto Kojiro, Kohsaka Shun, Sano Motoaki, Fukuda Keiichi

International Journal of Cardiology 172 （ 3 ） 2014年04月

ISSN 0167-5273

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Idiopathic Ventricular Tachycardia Cured by Radiofrequency Application from the Distal Great Cardiac Vein and the Left Coronary Cusp

Kimura Takehiro, Takatsuki Seiji, Fukumoto Kotaro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Miyoshi Shunichiro, Fukuda Keiichi

Heart Lung and Circulation 23 （ 2 ） 193 - 196 2014年02月

ISSN 1443-9506

A 79 year-old male without structural heart disease suffered from drug refractory ventricular tachycardia (VT). VTs and premature ventricular complexes (PVCs) with the same morphology occurred incessantly with a concordant R pattern in chest leads and a tall R in Lead II, III, and aVF. The origin was expected to be near the left epicardial ventricular outflow tract (LVOT), which was termed the left ventricular summit area. Pace-mapping from the LVOT and the left coronary cusp (LCC) did not match well with the QRS morphology of the PVC. A good match was obtained from the distal great cardiac vein (GCV), and radiofrequency (RF) delivery eliminated the PVC and VT. However, the PVC recurred four times upon cessation of RF delivery. By placing an ablation catheter at the LCC, we obtained pace-mapping showing two different types of QRS morphologies; one was an rS pattern in V1, and the other was an R pattern in V1 with a longer stimulus to QRS interval, which was a nearly perfect match to the PVC. RF application to the LCC permanently eliminated PVCs and VTs. Several VTs from the epicardial LVOT can be cured by RF application from both the distal GCV and the LCC. © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

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