研究者詳細 - 高月　誠司

論文 - 高月　誠司

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Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia and situs inversus

Aizawa Y., Takatsuki S., Kimura T., Nishiyama N., Fukumoto K., Tanimoto Y., Tanimoto K., Fukuda Y., Miyoshi S., Fukuda K.

Herz 38 （ 1 ） 102 - 104 2013年02月

ISSN 0340-9937

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[Management of atrial fibrillation comorbid with coronary heart disease].

Takatsuki Seiji

Nihon rinsho. Japanese journal of clinical medicine 71 （ 1 ） 142 - 147 2013年01月

ISSN 0047-1852

Atrial fibrillation (AF) and coronary artery disease (CAD) can be comorbid with each other, because they can develop based on common risk factors such as aging, hypertension, diabetes mellitus and obesity. The management for stroke prevention in patients with AF and CAD needs some cautions. The vascular disease including CAD has been approved as one of the risk developing stroke in the CHA2DS2-VASc score for patients with AF. Patients with AF and CAD often should take antiplatelet and anticoagulant and sometimes take double antiplatelets and anticoagulant, which associates with increased bleeding risk. On terms of the management of AF, the medications of the rhythm control therapy for the AF would be limited if a patient has CAD. A K channel blocker would be selected for the 1st line therapy.

Electrophysiological and histological effects on canine right atrium by photosensitization reaction under catheterization in vivo

Takahashi M., Ogawa E., Motohashi S., Nakamura T., Kawakami H., Machida N., Ito A., Kimura T., Takatsuki S., Fukumoto K., Miyoshi S., Fukuda K., Arai T.

2013年

We investigated electrophysiological and histological effect on canine anatomical isthmus in right atrium by photosensitization reaction (PR) of talaporfin sodium operated via a manipulative 7 Fr. laser catheter to establish a nonthermal tachyarrhythmia treatment. We continuously administrated talaporfin sodium via a left femoral vein to maintain photosensitizer concentration of 25-35 μg/ml in blood plasma, which is within the range of clinical use in human. Fifteen-minute after kickoff of the photosensitizer administration, a 663 nm laser was irradiated via the laser catheter for 30 s/point with irradiance of 10 W/cm2. After 17 times irradiations, a 23 ms delay of the electrical signal propagation along tricuspid annulus was observed. This result might demonstrate the acute electrical conduction delay induced by PR. The canine heart was extracted 10 days after PR and Azan staining specimen was histologically evaluated to investigate the myocardial damage by PR. The transmural fibrosis in anatomical isthmus was found. We demonstrated the PR-induced electrical conduction delay in acute phase in vivo using continuous photosensitizer dosed canine model, which maintain the clinical photosensitizer concentrat. © 2013 SPIE.

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Storms of ventricular fibrillation responsive to isoproterenol in an idiopathic ventricular fibrillation patient demonstrating complete right bundle branch block

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

International heart journal 54 （ 4 ） 240 - 242 2013年

ISSN 1349-2365

A 45-year-old male was admitted to our hospital after successful resuscitation of cardiac arrest. Ventricular fbrilla-tion (VF) had occurred during breakfast and was defbrillated by an automated external defbrillator operated by emergency medical service staff. On admission, his ECG demonstrated complete right bundle branch block as the sole abnormality. Intensive examination could not detect any structural disease leading to a diagnosis of idiopathic VF and implantation of an ICD. VF storm occurred one month after hospital discharge and beta-blocker, amiodarone, and sedative administration had no effect on VF. Likewise, catheter ablation for triggering premature ventricular beats failed to control the VF storm. The VF storm then subsided in the following weeks and the patient was discharged on amiodarone. A half month later VF storm recurred and the patient was admitted again. This time, isoproterenol infusion was effective in suppressing VF, and thereafter the patient was administered bepridil and followed up without recurrence of VF for 1.5 years. From these benefcial effects, the VF of the patient was suggested to share common arrhythmogenic characteristics to those of Brugada syndrome or J-wave associated VF.

The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries

Kimura Takehiro, Miyoshi Shunichiro, Okamoto Kazuma, Fukumoto Kotaro, Tanimoto Kojiro, Soejima Kyoko, Takatsuki Seiji, Fukuda Keiichi

Journal of Cardiothoracic Surgery 7 （ 1 ） 2012年11月

Background: The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed.Methods: Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated. Results: The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation. Conclusions: Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space. © 2012 Kimura et al.; licensee BioMed Central Ltd.

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Implantation of the right ventricular lead of an implantable cardioverter-defibrillator complicated by apical myocardial infarction

Nishiyama Nobuhiro, Takatsuki Seiji, Kimura Takehiro, Aizawa Yoshiyasu, Fukumoto Kotaro, Hagiwara Yoko, Tanimoto Kojiro, Fukuda Keiichi

Circulation 126 （ 10 ） 1314 - 1315 2012年09月

ISSN 0009-7322

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Disease characterization using LQTS-specific induced pluripotent stem cells

Egashira Toru, Yuasa Shinsuke, Suzuki Tomoyuki, Aizawa Yoshiyasu, Yamakawa Hiroyuki, Matsuhashi Tomohiro, Ohno Yohei, Tohyama Shugo, Okata Shinichiro, Seki Tomohisa, Kuroda Yusuke, Yae Kojiro, Hashimoto Hisayuki, Tanaka Tomofumi, Hattori Fumiyuki, Sato Toshiaki, Miyoshi Shunichiro, Takatsuki Seiji, Murata Mitsushige, Kurokawa Junko, Furukawa Tetsushi, Makita Naomasa, Aiba Takeshi, Shimizu Wataru, Horie Minoru, Kamiya Kaichiro, Kodama Itsuo, Ogawa Satoshi, Fukuda Keiichi

Cardiovascular Research 95 （ 4 ） 419 - 429 2012年09月

ISSN 0008-6363

Aims Long QT syndrome (LQTS) is an inheritable and life-threatening disease; however, it is often difficult to determine disease characteristics in sporadic cases with novel mutations, and more precise analysis is necessary for the successful development of evidence-based clinical therapies. This study thus sought to better characterize ion channel cardiac disorders using induced pluripotent stem cells (iPSCs). Methods and resultsWe reprogrammed somatic cells from a patient with sporadic LQTS and from controls, and differentiated them into cardiomyocytes through embryoid body (EB) formation. Electrophysiological analysis of the LQTS-iPSC-derived EBs using a multi-electrode array (MEA) system revealed a markedly prolonged field potential duration (FPD). The IKr blocker E4031 significantly prolonged FPD in control- and LQTS-iPSC-derived EBs and induced frequent severe arrhythmia only in LQTS-iPSC-derived EBs. The IKs blocker chromanol 293B did not prolong FPD in the LQTS-iPSC-derived EBs, but significantly prolonged FPD in the control EBs, suggesting the involvement of IKs disturbance in the patient. Patch-clamp analysis and immunostaining confirmed a dominant-negative role for 1893delC in IKs channels due to a trafficking deficiency in iPSC-derived cardiomyocytes and human embryonic kidney (HEK) cells. ConclusionsThis study demonstrated that iPSCs could be useful to characterize LQTS disease as well as drug responses in the LQTS patient with a novel mutation. Such analyses may in turn lead to future progress in personalized medicine. © 2012 The Author.

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Electrical isolation of the superior vena cava using upstream phrenic pacing to avoid phrenic nerve injury

Kimura Takehiro, Takatsuki Seiji, Fukumoto Kotaro, Nishiyama Nobuhiro, Sato Yuriko, Aizawa Yoshiyasu, Fukuda Yukiko, Sato Toshiaki, Miyoshi Shunichiro, Fukuda Keiichi

PACE - Pacing and Clinical Electrophysiology 35 （ 9 ） 1053 - 1060 2012年09月

ISSN 0147-8389

Background: Phrenic nerve (PN) injury is a potential complication that can occur during superior vena cava (SVC) isolation to cure atrial fibrillation (AF). Avoiding radiofrequency (RF) energy delivery is the safer alternative but may result in failed isolation. High-output PN pacing above the ablation site (upstream PN pacing) to confirm whether the PN is intact is a promising technique to avoid PN injury. This study was conducted to elucidate the safety of delivering RF energy at the site of capture of the right PN using upstream high-output pacing during electrical SVC isolation. Methods: SVC isolation was conducted in 41 drug-resistant AF patients. When high-output pacing (25 mA) from the distal tip of the ablation catheter captured the PN at the right atrial-SVC junction, upstream PN pacing (cycle length: 1000-1500 ms) was applied during RF delivery. The application of RF energy was stopped upon the failure or weakness of diaphragmatic twitching. The feasibility of SVC isolation using upstream PN pacing was investigated. Results: In all 41 patients, SVC isolation was successfully achieved. RF energy was delivered at the PN capture site in 26 patients (154 138 second, 18 5 W), and upstream PN pacing was successfully applied in all of the patients. Out of 46 SVC isolations, including five repeated sessions, PN injury occurred in one patient, who recovered spontaneously within 2 weeks. Conclusions: Upstream PN pacing may be effective for the safe completion of SVC isolation and to reduce the severity of PN injury. (PACE 2012; 35:1053-1060) ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

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Trans-telephonic ICD alert due to recommended replacement time notification

Aizawa Yoshiyasu, Negishi Masachika, Fukuda Yukiko, Takatsuki Seiji

International Journal of Cardiology 159 （ 1 ） 2012年08月

ISSN 0167-5273

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Study of blood charring precursor states using backscattering at 663 nm from blood and optical window boundary

Takahashi Mei, Ito Arisa, Miyoshi Shunichiro, Kimura Takehiro, Takatsuki Seiji, Fukumoto Kotaro, Fukuda Keiichi, Arai Tsunenori

Lasers in Surgery and Medicine 44 （ 6 ） 508 - 513 2012年08月

ISSN 0196-8092

Background and Objective Contact laser irradiation is generally used in therapeutic laser procedures such as plastic surgery and laser catheter lead removal. However, it may induce blood charring on the surface of the optical window in blood circumstance so that the laser beam might be blocked. Various charring detection methods have been proposed, but they detect charring only after charring has occurred. This study investigates the transient behavior of red blood cells (RBCs) prior to the charring on the surface of an optical window during red laser irradiation in blood circumstance. Materials and Methods The backscattering light power was continuously measured to investigate the transient behavior of a 1-mm-thick porcine blood model (hematocrit: 40%) during continuous laser irradiation (center wavelength: 663 nm; irradiance: 81 W/cm²). A rabbit blood model was microscopically observed after irradiation. The absorption coefficient (μ_a) and the reduced scattering coefficient (μ_s) were measured using a double integrating sphere setup and the inverse adding-doubling method. The backscattering light power was continuously measured in vivo during contact laser irradiation via a laser catheter in a porcine heart cavity. Results The results reveal that it may be possible to detect a precursory state of charring from a time course of the backscattering light power. μ_a increased monotonically by 15% until charring occurred. μ_s decreased by 10% followed a broad peak until charring occurred. These changes in the optical property correspond to changes in the morphology of RBCs. Changes in the backscattering light power measured in vivo were similar to those measured ex vivo. Conclusions The transient optical changes in blood prior to charring may be caused by changes in the morphology of RBCs on the optical window surface. Backscattering light power measurements may be a practical method to detect the precursor state of charring. Copyright © 2012 Wiley Periodicals, Inc.

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Inadvertent electrical superior vena cava isolation during right pulmonary vein isolation

Kimura Takehiro, Fukumoto Kotaro, Nishiyama Nobuhiro, Takatsuki Seiji

Heart Rhythm 9 （ 7 ） 1177 - 1178 2012年07月

ISSN 1547-5271

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Cor triatriatum sinister

Fukumoto K., Takatsuki S., Miyoshi S., Tanimoto K., Nishiyama N., Aizawa Y., Kimura T., Fukuda Y., Sato T., Fukuda K.

Herz 37 （ 2 ） 217 - 218 2012年03月

ISSN 0340-9937

A 58-year-old male was referred for catheter ablation for atrial fibrillation. He was incidentally diagnosed with cor triatriatum si nister by preoperative transesophageal echocardiography and cardiovascular computed tomography. The patient has since been free from atrial fibrillation for over 24 months following successful electrical pulmonary vein isolation. The rapidly soaring number of cases undergoing catheter ablation for atrial fibrillation and imaging investigation prior to the procedure may increase the incidental detection of asymptomatic congenital heart diseases. © Springer-Verlag 2012.

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Fever-induced ST-segment elevation in a syncopal patient with Brugada syndrome

Suzuki Masaru, Shiroshita-Takeshita Akiko, Kuruihara Tomohiro, Takatsuki Seiji, Satoh Toshiaki, Sato Yoko, Fukuda Keiichi, Hori Shingo

American Journal of Emergency Medicine 30 （ 1 ） 2012年01月

ISSN 0735-6757

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Myocardial electrical conduction block induced by photosensitization reaction in exposed porcine hearts in vivo

Ito Arisa, Miyoshi Shunichiro, Kimura Takehiro, Takatsuki Seiji, Fukumoto Kotaro, Fukuda Keiichi, Arai Tsunenori

Lasers in Surgery and Medicine 43 （ 10 ） 984 - 990 2011年12月

ISSN 0196-8092

Background and Objective This study proposes photosensitization reaction for non-thermal cardiac ablation in arrhythmia therapy. Acute and chronic phase experiments were conducted in exposed porcine hearts to demonstrate the photosensitization reaction-induced myocardial electrical conduction block in vivo. Study Design/Materials and Methods The porcine left atrial appendage was exposed under an open-chest procedure. Then, a water-soluble chlorin photosensitizer, NPe6, was injected into the pigs intravenously at 5 or 10amg/kg. About 15 or 30aminutes after the injection, a 663-nm continuous-wave diode laser was irradiated on the surface of the atrial appendage through a silica optical fiber. The laser energy was delivered to the tissue point by point at an energy density of 50-208aJ/cm ². Results Acute and chronic tissue damages as a result of the photosensitization reaction were determined by electrophysiology and histology, respectively. The change in the myocardial conduction time between two electrodes was measured immediately after the completion of the 35-mm irradiation line between the electrodes. The conduction delay of 35.5amilliseconds might be due to the change in the conduction pathway induced by transmural acute conduction block with the photosensitization reaction. The tissue temperature increase in the irradiated area was approximately 12.8°C. Azan-staining revealed about 1-mm transmural fibrosis of the atrial appendage at 2 weeks after the irradiation (50aJ/cm ²). Conclusions The results suggest that the photosensitization reaction might induce acute and chronic myocardial electrical conduction block. Cardiac ablation with the photosensitization reaction might be a non-temperature- mediated methodology for arrhythmia therapy. © 2011 Wiley Periodicals, Inc.

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Safety and efficacy of pericardial endoscopy by percutaneous subxyphoid approach in swine heart in vivo

Kimura Takehiro, Miyoshi Shunichiro, Takatsuki Seiji, Tanimoto Kojiro, Fukumoto Kotaro, Soejima Kyoko, Fukuda Keiichi

Journal of Thoracic and Cardiovascular Surgery 142 （ 1 ） 181 - 190 2011年07月

ISSN 0022-5223

Objective: A nonsurgical approach from the epicardial surface is useful for various cardiac interventions, such as positioning of the left ventricular lead for cardiac resynchronization therapy and epicardial ablation. Stem cell delivery on the epicardial surface can be considered in the future if good quality of visualization can be obtained. However, because the pericardial space is limited, hemodynamic conditions may deteriorate with pericardial endoscopy. Therefore, the feasibility and efficacy of pericardial endoscopy were examined by using ready-made endoscopes. Methods: Anesthetized swines (26-61 kg; n = 6) were used for the experiment. Electrocardiogram, femoral artery blood pressure, and oxygen saturation by pulse oximetry were continuously monitored during the procedures. Guided by the fluoroscopy, sheaths were advanced to the pericardial space using the modified Seldinger technique from the subxyphoid space. Results: After insertion of an endoscope with a maximum diameter of 6.9 mm, hemodynamic parameters were stable during the procedure with atropine. Stable and acceptable endoscopic images were obtained. Minor operations can be performed with pericardial endoscopic-guided laparoscopic forceps with no complications. Conclusions: The endoscopic pericardial procedure is effective and feasible. This procedure can increase the possibility and efficacy of nonsurgical treatment for cardiac diseases. Copyright © 2011 by The American Association for Thoracic Surgery.

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Arrhythmogenic superior vena cava caused by partial anomalous pulmonary venous return

Fukumoto Kotaro, Takatsuki Seiji, Endo Ayaka

Heart 97 （ 5 ） 437 2011年03月

ISSN 1355-6037

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Non-thermal myocardial electrical conduction block by photosensitization reaction with catheterization in right atrium isthmus of porcine heart in vivo

Ito Arisa, Kajihara Takuro, Suenari Tsukasa, Takahashi Mei, Kimura Takehiro, Fukumoto Kotaro, Takatsuki Seiji, Miyoshi Shunichiro, Arai Tsunenori

2011年

We have studied a new type of myocardial catheter ablation with photosensitization reaction to realize non-thermal therapy for atrial arrhythmia, such as atrial fibrillation. Photochemically-generated reactive oxygen species may induce myocardial electrophysiological damage without heat generation. In this study, to demonstrate photosensitization reaction-induced myocardial electrical conduction block, the inferior vena cava to tricuspid annulus (IVC-TA) isthmus linear ablation was conducted with photosensitization reaction in porcine heart in vivo, using a newly developed laser catheter (7 Fr.). The end point of the procedure was the production of IVC-TA isthmus block under the electrophysiological analysis by diagnostic catheter with 10-bipole electrodes placed in right atrium along the isthmus. Talaporfin sodium (NPe6) as a photosensitizer was injected intravenously to pigs at 2.5-5.0 mg/kg. About 15 min after the injection, the laser light at the wavelength of 663 nm with a catheter output power density of 40-60 W/cm² in about 1.4 mm spot size was irradiated through the laser catheter point by point in line crossing the isthmus under the fluoroscopic guidance. Before the photosensitization procedure, pacing signal from the distal electrodes of the diagnostic catheter, propagated through the isthmus in order. During the irradiation, electrical potential at the irradiated area was diminished. After the completion of the irradiation line, the bidirectional conduction block on the IVC-TA isthmus was validated by pacing from the distal and proximal bipole. These results indicated that photosensitization reaction could achieve the electrical conduction block of myocardial tissue immediately after the irradiation. We think that photosensitization reaction could become a novel therapy for atrial arrhythmia. © 2011 Copyright SPIE - The International Society for Optical Engineering.

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Recurrent torsade de pointes during mild hypothermia therapy for a survivor of sudden cardiac arrest due to drug-induced long-QT syndrome

Matsuhashi Tomohiro, Sato Toshiaki, Aizawa Yoshiyasu, Takatsuki Seiji

Journal of Cardiovascular Electrophysiology 21 （ 4 ） 462 - 463 2010年04月

ISSN 1045-3873

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A danger of induction of Brugada syndrome during pill-in-the-pocket therapy for paroxysmal atrial fibrillation

Aizawa Yoshiyasu, Matsuhashi Tomohiro, Sato Toshiaki, Takatsuki Seiji, Fukuda Keiichi

Drug, Healthcare and Patient Safety 2 （ 1 ） 139 - 140 2010年

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Extracardiac structures are frequently present within close proximity to the left atrium

Takatsuki Seiji, Yamada Minoru, Fukumoto Kotaro, Tanimoto Kojiro, Jinzaki Masahiro, Kuribayashi Sachio, Ogawa Satoshi

Heart Rhythm 6 （ 11 ） 1559 - 1564 2009年11月

ISSN 1547-5271

Background: The coronary sinus (CS) including the great cardiac vein is an important anatomic structure that is considered a landmark for the mitral annulus (MA) and also a target for catheter ablation. Objective: This study evaluated the anatomical relationship between the CS and its surrounding structures visualized by multi-detector computed tomography (MDCT). Methods: We performed MDCT on 42 patients, and the ranges of the coronary arteries (CAs) and esophagus that ran closest (<5 mm) to the CS were examined. In addition, the distances between the CS and the MA and left ventricle and left atrium were compared with the amplitudes of the local atrial and ventricular electrograms in the CS at the most lateral point (3 o'clock) and the inferior point (6 o'clock) in the CS. Results: The distal portion of the right CA ran near the antero-inferior side of the CS ostium in 92% of the patients. The esophagus and the left circumflex CA proximity to the CS ran from 15 to 41 mm and from 53 to 104 mm from the ostium in all patients. At the 3 o'clock and 6 o'clock position of the MA, the distance between the center of the CS and MA was 12 and 13 mm, respectively, and showed negative correlation with the ratio of atrial and ventricular electrograms. Conclusion: The right CA, the left circumflex CA, and the esophagus were frequently located near the CS. The CS was shifted away from the MA, and the CS-MA distance could be predicted with intracardiac electrograms. © 2009 Heart Rhythm Society.

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