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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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Narrow QRS tachycardia

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

Herz 39 （ 2 ） 276 - 278 2014年

ISSN 0340-9937

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Unusual termination by single ventricular extra-stimulus applied during atrioventricular reciprocating tachycardia

Ikegami Yukinori, Takatsuki Seiji, Yoshida Takuo, Momiyama Yukihiko

PACE - Pacing and Clinical Electrophysiology 37 （ 6 ） 774 - 776 2014年

ISSN 0147-8389

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Serum Inflammation Markers Predicting Successful Initial Catheter Ablation for Atrial Fibrillation

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

Heart Lung and Circulation 23 （ 7 ） 636 - 643 2014年

ISSN 1443-9506

Background: We investigated various serum inflammatory markers to predict ablation responders who have no atrial fibrillation (AF) relapse after the initial ablation. Methods: Forty-four consecutive AF patients (age: 59 ± 8 years, paroxysmal: 31, CHADS₂: 1.1 ± 1.1) who underwent an initial pulmonary vein isolation were investigated. Various serum inflammatory markers, such as adiponectin, ANP, BNP, 1CTP, F1+2, hs-CRP, IL-6, intact P1NP, MDA-LDL, MMP-2, TGF-β, TIMP-2, and TNF-α, were evaluated prior to ablation. AF relapse was defined as AF documented in telemonitoring electrocardiograms twice a day during 9.7 ± 2.4 months of follow-up with three months of a blanking-period. Results: A total of 29 patients (paroxysmal: 21) maintained sinus rhythm after the initial catheter ablation. These ablation responders had significantly lower MMP-2 (Sinus vs. Relapsed: 748 ± 132.7 vs. 841.2 ± 152.4 ng/mL, P=0.042) and TNF-α (1.1 ± 0.4 vs. 1.8 ± 1.7 pg/mL, P=0.046) levels prior to ablation. A BNP-adjusted Cox multivariate regression analysis revealed that the independent predictive factor for AF recurrence was high MMP-2 levels (>766 ng/mL) accompanied by high TNF-α levels (>1.2 pg/mL). Conclusions: The levels of MMP-2 and TNF-α might be useful for predicting initial AF catheter ablation responders. © 2014 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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Electrophysiological properties of the superior vena cava and venoatrial junction in patients with atrial fibrillation

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

Journal of Cardiovascular Electrophysiology 25 （ 1 ） 16 - 22 2014年

ISSN 1045-3873

Electrophysiological Properties of the Superior Vena Cava and Venoatrial Junction Background Although the superior vena cava (SVC) has been well known to be one of the important foci triggering atrial fibrillation (AF), its electrophysiological characteristics have received little research attention. The aim of this study was to investigate the electrophysiological properties of the SVC and venoatrial junction (VAJ). Methods Twenty-five consecutive AF patients without structural heart disease undergoing electrical SVC isolation were included in this study. After pulmonary vein isolation, a circular decapolar catheter and 2 multipolar catheters were emplaced in the VAJ, right atrial appendage (RAA), and SVC, respectively. Burst pacing and single extrastimulus were applied from the RAA and SVC. The atrial and caval potentials on the circular catheter in the VAJ were investigated. Results Intracaval conduction delay and various degrees of conduction block over the VAJ were observed with burst pacing from both the RAA and SVC. A single extrastimulus from the RAA and SVC with a basic cycle length of 600 milliseconds prolonged the conduction time via the VAJ by 81 ± 49.7 milliseconds and 61 ± 58.7 milliseconds, respectively. The atrial and caval electrograms at the VAJ, which were separated from each other by pacing applications, facilitated mapping of the earliest activation site at the VAJ. Conclusions Intracaval conduction delay and decremental conduction property via the VAJ were demonstrated using pacing maneuvers. Pacing applications from the RAA or SVC can help distinguish the atrial and caval potentials and can facilitate mapping of the optimal ablation sites to isolate the SVC. © 2014 Wiley Periodicals, Inc.

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Thrombus Formation in the Left Atrial Appendage During Catheter Ablation for Atrial Fibrillation Under Sufficient Heparinization

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

Canadian Journal of Cardiology 30 （ 4 ） 2014年

ISSN 0828-282X

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Myocardial necrosis depth prediction during extracellular photosensitization reaction of talaporfin sodium by defined index using fluorescence measurement

Takahashi M., Ito A., Kimura T., Takatsuki S., Fukuda K., Arai T.

Lasers in Medical Science 29 （ 3 ） 1173 - 1181 2014年

ISSN 0268-8921

An application of photodynamic therapy for myocardial ablation, which would induce myocardial electrical conduction block, is proposed. For the proposed application, an extracellular photosensitization reaction (PR) is performed while photosensitizer is distributed in myocardial interstitial space by employing a short drug-light interval. Because the myocardial necrosis depth must be accurately controlled to prevent surrounding tissue injury during the myocardial ablation procedure, the necrosis depth during PR needs to be predicted. The purpose of this study is to investigate the availability of predicting PR-induced myocardial necrosis depth (d_nec) using a defined fluorescence-fall amount (FA), which is the calculated result of fluorescence intensity decrease from the start of the PR multiplied by irradiation duration and corresponds to photosensitizer consumption amount under an assumption that the photosensitizer consumption rate is faster than the photosensitizer supply rate. The correlation between FA and d_nec was experimentally investigated in vivo using an open-chested canine heart model with 2.5 and 5.0 mg/kg of talaporfin sodium at an irradiance of 5-20 W/cm ² for 5-20 s. The fluorescence measurement was performed at a wavelength of 710 nm during the PR to derive FA. One week after the PR, a uniform necrosis depth was measured histopathologically as d_mnec. A logarithmic correlation between d_mnec and FA was confirmed with R²=0.69-0.80 and a d_mnec range of 0.2-7.1 mm. The defined FA might be useful for predicting d_nec for the extracellular PR in myocardium when using talaporfin sodium. © 2013 Springer-Verlag.

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Efficacy and safety of bepridil for prevention of ICD shocks in patients with Brugada syndrome and idiopathic ventricular fibrillation

Aizawa Yoshiyasu, Yamakawa Hiroyuki, Takatsuki Seiji, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Mitamura Hideo, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 168 （ 5 ） 5083 - 5085 2013年10月

ISSN 0167-5273

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Diagnostic value of portable electrocardiogram (Cardiophone) in patients complaining of palpitation

Aizawa Yoshiyasu, Takatsuki Seiji, Suenaga Yuko, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Kohsaka Shun, Fukuda Yukiko, Murata Mitsushige, Miyoshi Shunichiro, Sato Toshiaki, Iwanaga Shiro, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 168 （ 3 ） 2925 - 2927 2013年10月

ISSN 0167-5273

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A case of Brugada syndrome showing augmentation of electrocardiogram phenotype by complete right bundle branch block

Aizawa Yoshiyasu, Kimura Takehiro, Takatsuki Seiji

Europace 15 （ 10 ） 1525 2013年10月

ISSN 1099-5129

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Nonthermal cardiac catheter ablation using photodynamic therapy

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

Circulation: Arrhythmia and Electrophysiology 6 （ 5 ） 1025 - 1031 2013年10月

ISSN 1941-3149

Background: Radiofrequency ablation has limitations, largely related to creation of lesions by heating. Here, we report the first nonthermal ablation by applying photodynamic therapy (PDT) to cardiac tissues using a custom-made deflectable laser catheter. The present study investigated the feasibility of PDT for cavotricuspid isthmus ablation in a canine model. Methods and Results: We evaluated the pharmacokinetic profiles of 17 canines after administration of a photosensitizer (talaporfin sodium) by various protocols. We succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans. Using a 4-polar 7-French deflectable laser catheter, we performed PDT-mediated cavotricuspid isthmus ablation in 8 canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electric conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation. Hematoxylin and eosin staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at 2 weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency ablation procedures. A ventricular crosssection revealed a solid PDT lesion, which was as deep as a radiofrequency lesion. In addition, endocardial, surficial, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the nonthermal nature of the ablation technique. Conclusions: Nonthermal PDT-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias. © 2013 American Heart Association, Inc.

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Ventricular Fibrillation Associated With J-Wave Manifestation Following Pericarditis After Catheter Ablation for Paroxysmal Atrial Fibrillation

Kimura Takehiro, Takatsuki Seiji, Aizawa Yoshiyasu, Anzai Atsushi, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Okuda Shigeo, Fukuda Keiichi

Canadian Journal of Cardiology 29 （ 10 ） 2013年10月

ISSN 0828-282X

We present a patient with ventricular fibrillation (VF) associated with J-wave manifestation following pericarditis after catheter ablation of paroxysmal atrial fibrillation (AF). The premature ventricular contraction induced VF with J-waves in the inferior leads 2 days after the procedure. The patient's juvenile onset of AF and a family history of sudden cardiac death strongly suggested an underlying hereditable channelopathy. The late gadolinium enhancement in the posterior wall, viewed by cardiac magnetic resonance imaging, matched the leads of the J-waves. VF might develop in juvenile onset of AF especially in individuals with a family history of sudden cardiac death. © 2013 Canadian Cardiovascular Society.

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Electrical storm in idiopathic ventricular fibrillation is associated with early repolarization

Aizawa Yoshifusa, Chinushi Masaomi, Hasegawa Kanae, Naiki Nobu, Horie Minoru, Kaneko Yoshiaki, Kurabayashi Masahiko, Ito Shogo, Imaizumi Tsutomu, Aizawa Yoshiyasu, Takatsuki Seiji, Joo Kunitake, Sato Masahito, Ebe Katsuya, Hosaka Yukio, Haissaguerre Michel, Fukuda Keiichi

Journal of the American College of Cardiology 62 （ 11 ） 1015 - 1019 2013年09月

ISSN 0735-1097

Objectives This study sought to characterize patients with idiopathic ventricular fibrillation (IVF) who develop electrical storms. Background Some IVF patients develop ventricular fibrillation (VF) storms, but the characteristics of these patients are poorly known. Methods Ninety-one IVF patients (86% male) were selected after the exclusion of structural heart diseases, primary electrical diseases, and coronary spasm. Electrocardiogram features were compared between the patients with and without electrical storms. A VF storm was defined as VF occurring ≥3 times in 24 h and J waves >0.1 mV above the isoelectric line in contiguous leads. Results Fourteen (15.4%) patients had VF storms occurring out-of-hospital at night or in the early morning. J waves were more closely associated with VF storms compared to patients without VF storms: 92.9% versus 36.4% (p < 0.0001). VF storms were controlled by intravenous isoproterenol, which attenuated the J-wave amplitude. After the subsidence of VF storms, the J waves decreased to the nondiagnostic level during the entire follow-up period. Implantable cardioverter-defibrillator therapy was administered to all patients during follow-up. Quinidine therapy was limited, but the patients on disopyramide (n = 3), bepridil (n = 1), or isoprenaline (n = 1) were free from VF recurrence, while VF recurred in 5 of the 9 patients who were not given antiarrhythmic drugs. Conclusions The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves, which diminished to below the diagnostic level during follow-up. VF recurred in patients followed up without antiarrhythmic agents. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.

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Brugada syndrome behind complete right bundle-branch block

Aizawa Yoshiyasu, Takatsuki Seiji, Sano Motoaki, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Murata Mitsushige, Komatsu Takashi, Mitamura Hideo, Ogawa Satoshi, Funazaki Toshikazu, Sato Masahito, Aizawa Yoshifusa, Fukuda Keiichi

Circulation 128 （ 10 ） 1048 - 1054 2013年09月

ISSN 0009-7322

BACKGROUND-: The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. METHODS AND RESULTS-: The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V₂ or V₃ in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 145±15 milliseconds in V₁ and 144±19 versus 128±7 milliseconds in V₅ (both P<0.0001). The amplitude of R in V₁ was larger in the BS patients than in the control subjects (P=0.0323), but that of R′ was similar (P=0.0560). CONCLUSIONS-: BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined. © 2013 American Heart Association, Inc.

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An absolute atrial arrhythmia

Fukumoto Kotaro, Nishiyama Nobuhiro, Kinebuchi Osamu, Takatsuki Seiji

Journal of Cardiovascular Electrophysiology 24 （ 9 ） 1056 - 1058 2013年09月

ISSN 1045-3873

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Ventricular fibrillation associated with complete right bundle branch block

Aizawa Yoshiyasu, Takatsuki Seiji, Kimura Takehiro, Nishiyama Nobuhiro, Fukumoto Kotaro, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Suzuki Makoto, Yokoyama Yasuhiro, Chinushi Masaomi, Watanabe Ichiro, Ogawa Satoshi, Aizawa Yoshifusa, Antzelevitch Charles, Fukuda Keiichi

Heart Rhythm 10 （ 7 ） 1028 - 1035 2013年07月

ISSN 1547-5271

Background A substantial number of patients with idiopathic ventricular fibrillation (IVF) present with no specific electrocardiographic (ECG) findings. Objective To evaluate complete right bundle branch block (RBBB) in patients with IVF. Methods Patients with IVF showing complete RBBB were included in the present study. Structural and primary electrical diseases were excluded, and provocation tests were performed to exclude the presence of spastic angina or Brugada syndrome (BrS). The prevalence of complete RBBB and the clinical and ECG parameters were compared either in patients with IVF who did not show RBBB or in the general population and age and sex comparable controls with RBBB. Results Of 96 patients with IVF, 9 patients were excluded for the presence of BrS. Of 87 patients studied, 10 (11.5%) patients showed complete RBBB. None had structural heart diseases, BrS, or coronary spasms. The mean age was 44 ± 15 years, and 8 of 10 patients were men. Among the ECG parameters, only the QRS duration was different from that of the other patients with IVF who did not show complete RBBB. Ventricular fibrillation recurred in 3:2 in the form of storms, which were well suppressed by isoproterenol. Complete RBBB was found less often in control subjects (1.37%; P <.0001), and the QRS duration was more prolonged in patients with IVF: 139 ± 10 ms vs 150 ± 14 ms (P =.0061). Conclusions Complete RBBB exists more often in patients with IVF than in controls. A prolonged QRS complex suggests a conduction abnormality. Our findings warrant further investigation of the role of RBBB in the development of arrhythmias in patients with IVF. © 2013 Heart Rhythm Society.

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The left atrial appendage

Kimura Takehiro, Takatsuki Seiji, Fukuda Keiichi

Future Cardiology 9 （ 4 ） 451 - 453 2013年07月

ISSN 1479-6678

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Three-dimensional imaging and mapping of the right and left phrenic nerves

Fukumoto Kotaro, Takatsuki Seiji, Jinzaki Masahiro, Yamada Minoru, Tanimoto Kojiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Hagiwara Yoko, Fukuda Yukiko, Kimura Takehiro, Miyoshi Shunichiro, Kuribayashi Sachio, Fukuda Keiichi

Europace 15 （ 7 ） 937 - 943 2013年07月

ISSN 1099-5129

AimsPhrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping.Methods and resultsForty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 ± 5.8 mm.ConclusionsThe 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy. © 2013 The Author.

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Ridge-related reentry

Takatsuki Seiji, Fukumoto Kotaro, Igawa Osamu, Kimura Takehiro, Nishiyama Nobuhiro, Aizawa Yoshiyasu, Tanimoto Yoko, Tanimoto Kojiro, Miyoshi Shunichiro, Fukuda Keiichi

Journal of Cardiovascular Electrophysiology 24 （ 7 ） 781 - 787 2013年07月

ISSN 1045-3873

Ridge-Related Reentry Introduction The ridge between the left pulmonary veins (PV) and the left atrial appendage composes part of the lateral mitral isthmus (LMI). Following circumferential PV isolation and LMI linear ablation for the treatment of atrial fibrillation (AF), a critical pathway might develop over the ridge leading to a ridge-related reentry (RRR). Methods and Results Out of 61 patients who underwent circumferential PV isolation appended by LMI ablation, 5 patients developed RRR. The diagnosis of RRR was based on (1) macro-reentrant atrial tachycardia involving the septum, anterior and inferior wall of the left atrium; (2) slow conduction along the ridge; (3) wide-split double potentials in the ventricular aspect of the LMI were identified with the coronary sinus (CS) electrodes. RRR was investigated with electroanatomical mapping and entrainment mapping and catheter ablation was carried out in all patients. The mean cycle length (CL) of RRR was 312 ± 82 milliseconds and the PPIs at the left atrial septum, inferior and anterior wall during RRR were 10 ± 6, 12 ± 8, 9 ± 5 milliseconds longer than the RRR CL. The interval of the double potentials recorded in the CS electrodes crossing the LMI was 164 ± 38 milliseconds during RRR and the PPI on the LMI near the mitral annulus was 57 ± 10 milliseconds longer than the RRR CL. Catheter ablation was performed anatomically by targeting the ridge and successfully terminated RRR. Conclusion After circumferential PV isolation and ablation for LMI in patients with AF, RRR can develop by utilizing the surviving myocardial tissue of the ridge as a critical pathway. © 2013 Wiley Periodicals, Inc.

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Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores

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

Heart Rhythm 10 （ 6 ） 921 - 925 2013年06月

ISSN 1547-5271

BACKGROUND Strokes develop even in patients with low CHADS₂ scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS₂ scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS₂ score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA₂DS₂-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA ₂DS₂-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS₂ scores. © 2013 Heart Rhythm Society. All rights reserved.

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Sudden cardiac arrest and syncope triggered by coronary spasm

Togashi Ikuko, Sato Toshiaki, Soejima Kyoko, Takatsuki Seiji, Miyoshi Shunichiro, Fukumoto Kotaro, Nishiyama Nobuhiro, Suzuki Masaru, Hori Shingo, Ogawa Satoshi, Fukuda Keiichi

International Journal of Cardiology 163 （ 1 ） 56 - 60 2013年02月

ISSN 0167-5273

Background: Patients with coronary spasm generally have a good prognosis, although it can result in sudden cardiac arrest (SCA) and syncope. We hypothesized that the nature of coronary spasm triggering lethal arrhythmias may be different from that which induces angina-only. Methods: Clinical characteristics were examined in patients who had experienced SCA (n = 18) or syncope (n = 28) triggered by coronary spasm. These characteristics were compared to those of patients who had coronary spastic angina-only (n = 52). Results: SCA and syncope occurred frequently during daytime in 57% and 68%, respectively. Spontaneous ST-segment changes during daytime were recorded more often in patients with SCA (50%) and syncope (39%) than angina-only patients (4%, p < 0.01 for each). Nocturnal angina occurred less frequently in patients with SCA (33%) and syncope (32%) than angina-only patients (83%, p < 0.01 for each). Severe multivessel spasm, daytime ST-segment changes, and younger age were significant predictors of SCA. Daytime ST-segment changes and active smoking were related to syncope. Conclusions: The circadian variance of coronary spasm triggering SCA or syncope may be different from that inducing typical coronary spastic angina. The coronary spasm should be evaluated for patients with aborted SCA or recurrent syncope of unknown cause, even though the patients have not experienced the typical nocturnal angina. © 2011 Elsevier Ireland Ltd. All rights reserved.

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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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High take-off left inferior pulmonary vein as an obstacle in creating a conduction block at the lateral mitral isthmus

Takatsuki Seiji, Extramiana Fabrice, Hayashi Meiso, Haggui Abdeddayem, Messali Anne, Milliez Paul, Leenhardt Antoine, Cauchemez Bruno

Europace 11 （ 7 ） 910 - 916 2009年07月

ISSN 1099-5129

AimsCreation of complete linear lesions in the lateral mitral isthmus (LMI) by catheter ablation for treating atrial fibrillation remains technically challenging. We aimed to clarify whether a high take-off left inferior pulmonary vein (LIPV) can hamper the creation of a complete block at the LMI.Methods and resultsWe included 81 consecutive patients who underwent linear ablation at the LMI and cardiac computed tomography (CT) before ablation. We defined a high take-off LIPV when the level of the lower edge of the LIPV ostium was higher than that of the top of mitral annulus on CT. The clinical backgrounds, parameters, and long-term follow-up were then compared between the success (successful creation of a complete LMI block) and failure groups. A complete LMI block was obtained in 60/81 (76) patients. In the failure group, a high take-off LIPV was noted more commonly and the LMI tended to be longer than the success group. Multivariate analysis revealed that a high take-off LIPV was an independent predictor of failure to achieve a complete LMI block. The sinus rhythm maintenance rate was not different between the success and failure groups.ConclusionA high take-off LIPV hampered the creation of complete linear lesions in the LMI.

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Incidence and risk factors of arrhythmic events in catecholaminergic polymorphic ventricular tachycardia

Hayashi Meiso, Denjoy Isabelle, Extramiana Fabrice, Maltret Alice, Buisson Nathalie Roux, Lupoglazoff Jean Marc, Klug Didier, Hayashi Miyuki, Takatsuki Seiji, Villain Elisabeth, Kamblock Joël, Messali Anne, Guicheney Pascale, Lunardi Joël, Leenhardt Antoine

Circulation 119 （ 18 ） 2426 - 2434 2009年05月

ISSN 0009-7322

Background - The pathophysiological background of catecholaminergic polymorphic ventricular tachycardia is well understood, but the clinical features of this stress-induced arrhythmic disorder, especially the incidence and risk factors of arrhythmic events, have not been fully ascertained. Methods and Results - The outcome in 101 catecholaminergic polymorphic ventricular tachycardia patients, including 50 probands, was analyzed. During a mean follow-up of 7.9 years, cardiac events defined as syncope, aborted cardiac arrest, including appropriate discharges from implantable defibrillators, or sudden cardiac death occurred in 27 patients, including 2 mutation carriers with normal exercise tests. The estimated 8-year event rate was 32% in the total population and 27% and 58% in the patients with and without β-blockers, respectively. Absence of β-blockers (hazard ratio [HR], 5.48; 95% CI, 1.80 to 16.68) and younger age at diagnosis (HR, 0.54 per decade; 95% CI, 0.33 to 0.89) were independent predictors. Fatal or near-fatal events defined as aborted cardiac arrest or sudden cardiac death occurred in 13 patients, resulting in an estimated 8-year event rate of 13%. Absence of β-blockers (HR, 5.54; 95% CI, 1.17 to 26.15) and history of aborted cardiac arrest (HR, 13.01; 95% CI, 2.48 to 68.21) were independent predictors. No difference was observed in cardiac and fatal or near-fatal event rates between probands and family members. Conclusions - Cardiac and fatal or near-fatal events were not rare in both catecholaminergic polymorphic ventricular tachycardia probands and affected family members during the long-term follow-up, even while taking β-blockers, which was associated with a lower event rate. Further studies evaluating concomitant therapies are necessary to improve outcome in these patients. © 2009 American Heart Association, Inc.

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Novel three-dimensional imaging of the anatomical relationship between the pulmonary vein and left atrium

Yamada Minoru, Jinzaki Masahiro, Sato Kozo, Tanami Yutaka, Fukumoto Kotaro, Tanimoto Kojiro, Takatsuki Seiji, Ogawa Satoshi, Kuribayashi Sachio

Circulation Journal 73 （ 3 ） 573 - 574 2009年03月

ISSN 1346-9843

Background: Visualization of the inner anatomical relationship of the pulmonary veins (PVs) and left atrium (LA) is important for achieving a better success rate and avoiding complications in circumferential LA ablation for atrial fbrillation (AF). Methods and Results: Twelve patients with AF underwent computed tomography and novel post-processing images that emphasized the boundaries of the PVs and LA were produced. Conclusions: The "Transparent View" images enabled visualization of the inner anatomical relationship of the PVs and LA in the same geometry as in pulmonary venography in all cases.

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The mechanism of PDT-induced electrical blockade

Ito A., Matsuo H., Suenari T., Miyoshi S., Takatsuki S., Ogawa S., Arai T.

2009年

We have proposed a new type of atrial fibrillation treatment with the early state photodynamic therapy (PDT), in which the interval time between the photosensitizer injection and irradiation is shorter than that in conventional way. We had demonstrated the acute electrical blockade by the PDT with talaporfin sodium and a red (670 nm) diodelaser in ex vivo and in vivo experiment using rat normal myocardial tissue. The previous study of intracellular Ca²⁺ concentration measurement in rat cardiac myocytes during the PDT indicated that Ca²⁺ influx induced by the plasma membrane damage might be the main cause of the acute reaction of myocardial tissue. We found that the cell damage of cardiac myocytes triggered by the PDT was mainly influenced by the site where the photosensitizer exists. In this study, we examined the relationship between the sites of talaporfin sodium existing and cell death phenotypes in response to the PDT, in order to clarify the mechanism of the acute electrical blockade induced by the PDT in myocardial tissue. The talaporfin sodium fluorescence was observed after the various incubation times to visualize the time-lapse intracellular photosensitizer localization. The distribution of the photosensitizer was dependent on the incubation time. The change in intracellular Ca²⁺ concentration during the PDT was examined with a fluorescent Ca²⁺ indicator by a high-speed Nipkow confocal laser microscope (CSU-X1, Yokogawa Electric Company). We obtained the Ca²⁺ dynamics during the PDT which can explain the PDT-induced cell death pathways. We concluded that the Ca²⁺ influx induced by plasma membrane damage is the possible mechanism of the electrical blockade by the early state PDT. © 2009 SPIE.

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Short-long-short sequence caused by ventricular safety pacing inducing ventricular tachycardia in a patient with a dual-chamber implantable cardioverter defibrillator

Hayashi Meiso, Takatsuki Seiji, Messali Anne, Milliez Paul, Extramiana Fabrice, Leenhardt Antoine

Europace 10 （ 10 ） 1238 - 1242 2008年10月

ISSN 1099-5129

Ventricular safety pacing (VSP) is an algorithm used to prevent crosstalk inhibition and ventricular capture during the vulnerable period. We report a 78-year-old man with implantable dual-chamber defibrillator, in whom clusters of ventricular tachycardias (VTs) were provoked by the VSP. During rapid DDDR pacing, the delivery of the VSP after every other atrial-paced beat resulted in short-long-short ventricular sequences and induced VTs. An atrial-based lower rate timing, long atrioventricular pacing interval, and automatic gain control also accounted for this arrhythmogenic ventricular sequence. The VSP and the subsequent VT were eliminated by decreasing the pacing rate. © The Author 2008.

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Ventricular Repolarization Restitution Properties in Patients Exhibiting Type 1 Brugada Electrocardiogram With and Without Inducible Ventricular Fibrillation

Hayashi Meiso, Takatsuki Seiji, Maison-Blanche Pierre, Messali Anne, Haggui Abdeddayem, Milliez Paul, Leenhardt Antoine, Extramiana Fabrice

Journal of the American College of Cardiology 51 （ 12 ） 1162 - 1168 2008年03月

ISSN 0735-1097

Objectives: This study aimed to elucidate the contribution of the repolarization restitution property to the sustained ventricular fibrillation (VF) in Brugada syndrome. Background: Although phase 2 re-entry develops as the trigger of VF, the other precipitating factors have remained unclear. Methods: Twenty-one patients with a type 1 Brugada electrocardiogram underwent programmed electrical stimulation. Before the VF induction, single extrastimuli were delivered at 3 basic drive cycle lengths (BCLs) (400 ms, 600 ms, and 750 ms) from the right ventricular apex (RVA) and outflow tract (RVOT), and the activation recovery interval (ARI) was measured at 5-mm vicinity of the pacing site. The maximum ARI restitution slope was determined using the overlapping least-squares linear segments. Results: We found that VF was inducible in 10 patients. A repeated-measure analysis of variance revealed that the slope in the RVA was steeper in patients with inducible VF than in those without but that in the RVOT was similar. The slope was steeper at longer BCLs and also steeper in the RVA than RVOT at BCLs of 600 and 750 ms. In patients with inducible VF, the percentage of patients exhibiting a slope >1 was 0%, 20%, and 75% in the RVA and 0%, 0%, and 14% in the RVOT at BCLs of 400 ms, 600 ms, and 750 ms, respectively. No patients without inducible VF had a slope >1. Conclusions: These results suggest the repolarization restitution property is a contributing factor to the propensity for VF in Brugada syndrome and, regarding this property, the RVA plays more important role than the RVOT. © 2008 American College of Cardiology Foundation.

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A case of vagally mediated idiopathic ventricular fibrillation

Kataoka Masaharu, Takatsuki Seiji, Tanimoto Kojiro, Akaishi Makoto, Ogawa Satoshi, Mitamura Hideo

Nature Clinical Practice Cardiovascular Medicine 5 （ 2 ） 111 - 115 2008年02月

ISSN 1743-4297

Background: A 25-year-old woman experienced three episodes of syncope over the course of 2 years. The attacks all occurred just after she had sat down, and two were accompanied by convulsions. She had no obvious prodromes and no personal or family history of cardiovascular disease. Investigations: Electrocardiography, chest radiography, echocardiography, cerebral and cardiac MRI, electroencephalography, 24 h Holter monitoring, electrophysiological study with drug provocation testing and heart-rate variability analysis. Diagnosis: Vagally mediated ventricular fibrillation initiated by premature ventricular complexes arising from the right ventricular outflow tract. Management: Catheter ablation was performed at the right ventricular outflow tract and an implantable cardioverter-defibrillator was fitted.

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Conduction through the lateral mitral isthmus

Takatsuki Seiji, Extramiana Fabrice, Hayashi Meiso, Leenhardt Antoine

Journal of Cardiovascular Electrophysiology 19 （ 1 ） 98 - 99 2008年01月

ISSN 1045-3873

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Functional bundle branch block and orthodromic reciprocating tachycardia cycle length

Extramiana Fabrice, Takatsuki Seiji, Hayashi Meiso, Leenhardt Antoine

Europace 9 （ 10 ） 920 - 922 2007年10月

ISSN 1099-5129

Aims: To show 2 examples in which the analysis of the effect of bundle branch block on orthodromic reciprocating tachycardia cycle length was misleading. Methods and results: We performed an electrophysiological study in two patients with orthodromic reciprocating tachycardia showing a transition from wide to narrow QRS during tachycardia. Our two cases of left bundle branch block during reciprocating tachycardia using infero-septal pathways show that ventricular to atrial conduction time prolongation may be larger than 30 ms and may be concealed by a shortening of atrial to ventricular conduction time. In the 2 cases, the atrial insertion of the accessory pathway could be successfully ablated from the right atria at the ostium of the coronary sinus. Conclusions: The observation of the association between left bundle branch block and cycle length prolongation during reciprocating tachycardia may be associated with a successful ablation at the ostium of the coronary sinus. © The European Society of Cardiology 2007. All rights reserved.

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T-wave morphology parameters based on principal component analysis reproducibility and dependence on T-offset position

Extramiana Fabrice, Haggui Abdeddayem, Maison-Blanche Pierre, Dubois Rémi, Takatsuki Seiji, Beaufils Philippe, Leenhardt Antoine

Annals of Noninvasive Electrocardiology 12 （ 4 ） 354 - 363 2007年10月

ISSN 1082-720X

Background: T-wave morphology parameters based on principal component analysis (PCA) are candidate to better understand the relation between QT prolongation and torsades de pointes. We aimed to assess the repeatability and to determine the influence of T-end position on PCA parameters. Methods: Digital ECGs recorded from 30 subjects were used to assess short term (5 minutes), circadian and long-term (28 days) repeatability of PCA parameters. The T-end cursor position was moved backward and forward (± 8 ms) from its optimal position. We calculated QRS-T angle, PCA ratio, and T-wave residuum (TWR). Results: At long-term evaluation, coefficients of variation were 11.3 ± 9.9%, 11.7 ± 7.1%, and 23.0 ± 22.0% for the QRS-T angle, PCA ratio, TWR, respectively. After moving the T-end cursor, repeatability was 0.42 ± 0.2%, 1.00 ± 1.04%, 4.0 ± 4.2% for the same PCA parameters. Conclusions: T-wave morphology parameters based on PCA are reproducible with the exception of TWR and QRS-T angle. In addition, PCA is robust, showing only little dependence on T-end cursor position. These data should be taken into account for safety pharmacology trials. © 2007, Copyright the Authors.

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Multiple gap phenomena associated with dual His bundle pathways having a lower common tract

Takatsuki Seiji, Extramiana Fabrice, Mitamura Hideo, Leenhardt Antoine

Journal of Electrocardiology 40 （ 5 ） 437 - 441 2007年09月

ISSN 0022-0736

We report a case showing 4 types of aberrant conduction and 2 types of gap phenomena produced by single atrial extrastimulus during sinus rhythm. One of the gap phenomena was associated with dual His bundle pathways, demonstrating a fast-to-slow jump-up phenomenon. Of note, a sharp potential considered as retrograde His bundle activations was recorded, which indicated that the activation wave front descended the slow His bundle pathway and turned up the fast His bundle pathway. © 2007 Elsevier Inc. All rights reserved.

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Transition to wide QRS tachycardia

Takatsuki Seiji, Mitamura Hideo, Tanimoto Kojiro, Leenhardt Antoine, Ogawa Satoshi

Journal of Cardiovascular Electrophysiology 18 （ 1 ） 111 - 113 2007年01月

ISSN 1045-3873

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Clinical implications of "pure" Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia

Takatsuki Seiji, Mitamura Hideo, Tanimoto Kojiro, Fukuda Yukiko, Ieda Masaki, Miyoshi Shunichiro, Soejima Kyoko, Extramiana Fabrice, Leenhardt Antoine, Ogawa Satoshi

Heart Rhythm 3 （ 12 ） 1412 - 1418 2006年12月

ISSN 1547-5271

Background: Para-Hisian pacing is an effective method of differentiating between pathways for retrograde conduction over the accessory pathway (AP) and over the atrioventricular node (AVN). When performing para-Hisian pacing, the pacing spike sometimes captures only the His bundle, which we named "pure" Hisian pacing (Hc). Objective: We evaluated the significance of pure Hisian pacing for predicting the pathways of ventriculoatrial conduction. Methods: In 62 patients with supraventricular tachycardia, both para-Hisian and pure Hisian pacing were carried out during the sinus rhythm, resulting in three different types of electrocardiographic complexes with wide (local ventricular myocardial capture), slightly narrow (both local myocardial and His bundle capture), and very narrow QRS widths (Hc). A change of atrial activation sequence as demonstrated by these pacing modes indicated the presence of multiple retrograde pathways. The diagnosis of retrograde pathways by para-Hisian pacing with or without Hc was evaluated. Results: In 22 patients with AVN reentrant tachycardia, para-Hisian pacing alone was able to correctly predict ventriculo-atrial conduction exclusively through the AVN without requiring findings from Hc. In 40 AP patients, para-Hisian pacing showed a pattern of retrograde conduction through the AVN in six, through both the AVN and AP in 10, and through an AP in 24 patients. Four of these 24 patients were diagnosed as having multiple pathways (AP+AVN or dual APs) by the addition of Hc. Conclusion: Pure Hisian pacing can help disclose another pathway for retrograde conduction in AP patients, which is unpredicted by ordinary para-Hisian pacing. © 2006 Heart Rhythm Society.

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Dysplasie ventriculaire droite arythmogène

Leenhardt A., Milliez P., Haggui A., Takatsuki S., Hayashi M., Meddane M., Dejode P., Denjoy I., Extramiana F.

Archives des Maladies du Coeur et des Vaisseaux 99 （ SPEC. ISS. 5 ） 7 - 14 2006年12月

ISSN 0003-9683

Arrhythmogenic right ventricular dysplasia (ARVD) is a cardiomyopathy of the right ventricle due to adipose infiltration of the myocardium with surviving myocardial fibres surrounded by fibrosis. It gives rise to right ventricular dilatation, which starts locally before becoming diffuse, and, sometimes in the late stages, to symptoms of cardiac failure. It may also be associated with left ventricular involvement. The main complication is sudden death due to a ventricular arrhythmia. ARVD is responsible for 3 to 10% of all unexplained sudden deaths before 65 years of age. ARVD has a genetic origin, with some recessive but a majority of autosomal dominant forms. Nine different loci have been reported in the autosomal dominant forms and four genes have been identified. A number of these mutations is responsible for abnormalities of cellular junction, more specifically of the desmosomes. These studies have shown several different forms of ARVD and, consequently, the term arrhythmogenic right ventricular cardiomyopathy would be a more appropriate terminology for the pathology. This paper reviews the diagnostic, genetic and therapeutic aspects of the disease. In particular, the evaluation of the arrhythmic risk is underlined as it is an important and difficult problem which has not yet been satisfactorily resolved. It requires integration of clinical and electrocardiographic criteria with morphological and functional imaging methods. Molecular biology could play a role in the prognostic assessment in the future.

Quantitative assessment of ST segment elevation in Brugada patients

Extramiana Fabrice, Seitz Julien, Maison-Blanche Pierre, Badilini Fabio, Haggui Abdeddayem, Takatsuki Seiji, Milliez Paul, Denjoy Isabelle, Cauchemez Bruno, Beaufils Philippe, Leenhardt Antoine

Heart Rhythm 3 （ 10 ） 1175 - 1181 2006年10月

ISSN 1547-5271

Background: ST segment elevation in the right precordial leads constitutes the electrocardiogram (ECG) hallmark of Brugada syndrome (BS). This pattern is variable and can be concealed, but the magnitude and the cause of ST segment fluctuations have been poorly investigated. Objective: Our goal was to quantify ST changes and to assess rate and autonomic influences on ST level. Methods: A 12-lead ECG was continuously recorded during 24 hours in 20 patients with BS (ages 49 ± 12) and 10 healthy subjects (ages 32 ± 7). Using two-dimensional binning we obtained average QRS-T complexes every 30 minutes (time bins) and at different RR intervals (rate bins) for each subject. ST level was measured at five different points located 90, 100, 110, 120, and 140 ms after Q onset (Qo). In BS patients, the highest ST elevation was measured 110 ms after Qo (Qo+110). Results: ST level changes between time points were significantly greater in patients with BS compared with control subjects: on lead V2, the range of ST level at Qo+110 was 264 ± 85 μV in BS and 91 ± 22 μV in control subjects (P <.01). In BS, ST level decreased with heart rate acceleration: the difference in ST level at Qo+110 for RR = 900 and 600 ms was 55 ± 53 μV (P <.01). HFnu was positively, although weakly, correlated with ST level (R² = 0.02, P <.01). Conclusions: ECG changes observed in patients with BS are related in part to heart rate influences on ST segment level. These spontaneous fluctuations over a 24-hour time period suggest that Holter recordings may improve the ECG diagnosis sensitivity in BS. © 2006 Heart Rhythm Society.

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Amiodarone therapy in patients implanted with cardioverter-defibrillator for life-threatening ventricular arrhythmias

Satomi Kazuhiro, Kurita Takashi, Takatsuki Seiji, Yokoyama Yasuhiro, Chinushi Masaomi, Tsuboi Naoya, Nitta Takashi, Shoda Morio, Mitamura Hideo

Circulation Journal 70 （ 8 ） 977 - 984 2006年

ISSN 1346-9843

Background: Whether amiodarone can improve the patient's clinical outcome by reducing implantable cardioverter-defibrillator (ICD) therapy deliveries for ventricular tachycardia or fibrillation (VT/VF) has not been clearly evaluated. Methods and Results: A total of 507 patients with VT/VF due to organic heart disease who had ICDs implanted were enrolled in this study. The patients were divided into 3 groups: Amiodarone (n=247), Class I antiarrhythmic drug (n=103) and Control (n=157) groups, and the total cause mortality and arrhythmic event free survival rates were evaluated between the groups. The mean follow-up period was 38±27 months. The left ventricular ejection fraction was significantly decreased in the Amiodarone group (Amiodarone: 37±15%; Class I: 39±16%; Control: 44±17%). The mortality and arrhythmic events were significantly higher in the Class I group than the Amiodarone group (p<0.05), but there was no significant difference between the Amiodarone and Control groups (arrhythmic event free rate at 5 years: Amiodarone: 53%; Class I: 35%; Control: 48%; 5 year survival: 86%, 74% and 77%, respectively). Side effects from amiodarone were found in 12% of the patients, but no fatal events were observed. Conclusions: The present study could not demonstrate the benefit of amiodarone in ICD patients, probably due to a significant clinical bias exerted in selecting this drug.

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Link between SCN5A mutation and the Brugada syndrome ECG phenotype

Miyoshi Shunichiro, Mitamura Hideo, Fukuda Yukiko, Tanimoto Kojiro, Hagiwara Yoko, Kanki Hideaki, Takatsuki Seiji, Murata Mitsushige, Miyazaki Toshihisa, Ogawa Satoshi

Circulation Journal 69 （ 5 ） 567 - 575 2005年05月

ISSN 1346-9843

Background: The specific changes in the gating kinetics of the sodium current (INa) responsible for its phenotype have remained to be elucidated. In the present study the effect of changes in the gating kinetics of INa on early repolarization (ER) and initiation of phase 2 reentry (P2R) were evaluated in a theoretical epicardial ventricular fiber model. Methods and Results: Miyoshi-ICaL was incorporated into the modified Luo-Rudy dynamic (LRd) model. Dispersion at Ito-density was set within a theoretical fiber composed of serially arranged epicardial cells with gap junctions. The following changes in INa kinetics were made: (1) a -10mV shift in steady-state inactivation, (2) a +10mV shift in steady-state activation curve, (3) a small inactivation time constant (DEC); P2R and ER were observed. A conduction disturbance within the fiber was simulated and only when the INa-density was decreased did DEC, especially, show a marked increase in the likelihood of causing ER and P2R. Conduction disturbance significantly increased the likelihood causing ER or P2R. Conclusions: In this one-dimension model with Ito-density dispersion, DEC-INa precipitates INa-blocker inducible ER. This suggests that the characteristic ST-segment elevation in the Brugada syndrome with SCN5A mutation can be interpreted in part by DEC-INa. Concomitant conduction disturbance may be required to cause P2R at physiological Ito density.

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Temporal patterns of progression and regression of electrical and mechanical remodeling of the atrium

Kinebuchi Osamu, Mitamura Hideo, Shiroshita-Takeshita Akiko, Kurita Yasuo, Ohashi Narutaka, Tanimoto Kojiro, Fukuda Yukiko, Ieda Masaki, Sato Toshiaki, Hara Motoki, Takatsuki Seiji, Ogawa Satoshi

International Journal of Cardiology 98 （ 1 ） 91 - 98 2005年01月

ISSN 0167-5273

Objectives: We evaluated serial changes of electrical and mechanical parameters of atrial remodeling in dogs subjected to rapid atrial pacing. Background: Prolonged rapid atrial excitation causes electrical and mechanical remodeling, which contributes to persistence of atrial fibrillation and clot formation. However, the temporal relationship between these two types of atrial remodeling remains unknown. Methods: In 8 dogs, rapid pacing at 400 ppm was continued for 14 days. The electrophysiologic and transesophageal echocardiographic studies were performed on the day before and after 2, 7, and 14 days of rapid pacing, then 1 and 7 days after the cessation of pacing. These were compared with sham-operated dogs (instrumented but not paced, n=6). Results: With rapid pacing, there was an immediate shortening of the effective refractory period (ERP) and decreases in the transmitral atrial wave velocity (MAV) and the left atrial appendage emptying velocity (LAAV). In contrast, conduction velocity (CV) decreased and the left atrial appendage area (LAAA) increased progressively over 14 days. During the recovery, ERP, MAV, and LAAV returned to the baseline in 1 day, whereas CV and LAAA did in 7 days. ERP was highly positively correlated with LAAV (r=0.78, p<0.001) and MAV (r=0.73, p<0.001), while CV was negatively correlated only with LAAA (r=-0.58, p<0.001). Conclusions: Pacing-induced electrical and mechanical remodeling of the atrium exhibits divergent patterns of progression and regression such that changes of ERP and contractile function take place more rapidly than those of CV and atrial size. © 2004 Elsevier Ireland Ltd. All rights reserved.

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A comparison between calcium channel blocking drugs with different potencies for T- and L-type channels in preventing atrial electrical remodeling

Ohashi Narutaka, Mitamura Hideo, Tanimoto Kojiro, Fukuda Yukiko, Kinebuchi Osamu, Kurita Yasuo, Shiroshita-Takeshita Akiko, Miyoshi Shunichiro, Hara Motoki, Takatsuki Seiji, Ogawa Satoshi

Journal of Cardiovascular Pharmacology 44 （ 3 ） 386 - 392 2004年09月

ISSN 0160-2446

Calcium overload plays a key role in the development of atrial electrical remodeling. The effect of an L-type Ca channel blocker in preventing this remodeling has been reported to be short lasting, partly due to down-regulation of this channel and persisting Ca entry through the T-type Ca channel. To prove if efonidipine, a dual L- and T-type Ca channel blocker exerts a greater effect than an L-type Ca channel blocker verapamil, 21 dogs underwent rapid atrial pacing at 400 bpm for 14 days, pretreatment with efonidipine in 7 (E), verapamil in 7 (V), and none in 7 (C). We measured the atrial effective refractory period (ERP) serially during 14 days of rapid pacing. In response to rapid pacing, ERP decreased progressively in C. In contrast, in E and V, ERP remained greater than ERP in C (P < 0.01) on days 2 through 7. However, on the 14th day, ERP in V decreased to the level seen in C, whereas ERP in E remained significantly longer than ERPs in C or V (P < 0.01). The blockade L-type Ca channel alone is not sufficient, but the addition of a T-type Ca channel blockade shows a more sustained effect to prevent atrial electrical remodeling.

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Oral verapamil attenuates the progression of pacing-induced electrical and mechanical remodeling of the atrium

Kinebuchi Osamu, Mitamura Hideo, Shiroshita-Takeshita Akiko, Kurita Yasuo, Ieda Masaki, Ohashi Narutaka, Fukuda Yukiko, Sato Toshiaki, Miyoshi Shunichiro, Hara Motoki, Takatsuki Seiji, Nagumo Miyako, Ogawa Satoshi

Circulation Journal 68 （ 5 ） 494 - 500 2004年05月

ISSN 1346-9843

Background: Calcium overload plays a major role in the development of electrical and mechanical remodeling during atrial fibrillation, but the potential of verapamil, a Ca blocker, for preventing atrial electrical remodeling remains controversial. Methods and Results: Pacing and recording electrodes were sutured to the right atrium in 16 dogs. After a 5-day recovery period, rapid atrial pacing at 400 ppm was initiated in 8 dogs (control group). In the remaining 8 dogs, oral administration of verapamil (8 mg/kg per day) was started 1 week before the initiation of rapid pacing (verapamil group). On the day before and at 2, 7, 14 days after rapid pacing, electrophysiological (EP) and transesophageal echocardiographic (TEE) studies were performed under autonomic blockade. In response to rapid pacing, EP and TEE parameters changed progressively in the control group (p<0.05 vs day 0), whereas in the verapamil group, no significant changes in the various parameters were observed for the first 7 days. However, verapamil failed to prevent progression of both types of remodeling after 14 days of pacing. Conclusion: Verapamil can attenuate the progression of electrical and mechanical remodeling of the atrium for at least 7 days.

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Preserved effects of potassium channel blockers in the pacing-induced remodeled canine atrium

Shiroshita-Takeshita Akiko, Mitamura Hideo, Sato Toshiaki, Shinagawa Kaori, Kurita Yasuo, Kanki Hideaki, Takatsuki Seiji, Hara Motoki, Ogawa Satoshi

Journal of Cardiovascular Pharmacology 41 （ 5 ） 678 - 685 2003年05月

ISSN 0160-2446

This study was designed to evaluate the electrophysiologic effects of E4031 (a pure IKr blocker) and azimilide (AZ: a combined 1kr + IKs blocker) at various stages of atrial electrical remodeling. Twelve dogs underwent continuous rapid atrial pacing (400/min) for 14 days. The electrophysiologic study was performed on the day before as well as after 2, 7, and 14 days of rapid atrial pacing both before and after the administration of either E4031 (n = 6) or AZ (n = 6). In response to rapid atrial pacing, the atrial effective refractory period (ERP), conduction velocity, and wavelength decreased significantly at pacing cycle lengths (PCLs) of 200 and 400 ms (P < 0.05). E4031 prolonged ERP in a reverse use-dependent manner throughout the study period. AZ also prolonged ERP during the 14 days of rapid pacing. ERP prolongation at a PCL of 200 ms was significantly greater with AZ than with E4031 (P < 0.05). The effects of blocking IKr by E4031 and IKr + IKs by AZ were well preserved at various stages of atrial electrical remodeling. However, the effect of prolonging ERP at a shorter PCL was more prominent by AZ than by E4031. Thus, IKs blockade may add a favorable anti-fibrillatory effect to IKr blockade even in the remodeled atrium.

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Mechanisms of ventricular arrhythmias in myocardial infarction

Takatsuki Seiji

Nippon rinsho. Japanese journal of clinical medicine 61 Suppl 5 365 - 370 2003年

ISSN 0047-1852

心室頻拍

高月誠司，三田村秀雄

循環器科 52 （ 2 ） 109-116 2002年08月

研究論文（学術雑誌）, 共著

RR間隔およびQRS波形が一拍ごとに交代する頻拍症

高月誠司，三田村秀雄

心電図 22 （ 3 ） 191-196 2002年05月

研究論文（学術雑誌）, 共著

Discordant temporal changes in electrophysiological properties during electrical remodeling and its recovery in the canine atrium

Shiroshita-Takeshita Akiko, Mitamura Hideo, Shinagawa Kaori, Sato Toshiaki, Kurita Yasuo, Kanki Hideaki, Takatsuki Seiji, Hara Motoki, Ogawa Satoshi

Japanese Heart Journal 43 （ 2 ） 167-181 2002年03月

研究論文（学術雑誌）, 共著

慢性不全例における心房細動合併の臨床的要因

栗田康生，三田村秀雄，神吉秀明，馬場彰泰，竹下晃子，佐藤俊明，品川香，原幹，高月誠司，吉川勉，小川聡

心臓 34 （ 1 ） 25-30 2002年01月

研究論文（学術雑誌）, 共著

Daily oral verapamil before but not after rapid atrial excitation prevents electrical remodeling

Kurita Y, Mitamura H, Shiroshita-Takeshita A, Yamane A, Ieda M, Kinebuchi O, Sato T, Miyoshi S, Hara M, Takatsuki S, Ogawa S

Cardiovascular research 54 447-455 2002年

研究論文（学術雑誌）, 共著

Discordant Temporal Changes in Electrophysiological Properties during Electrical Remodeling and Its Recovery in the Canine Atrium

Shiroshita-Takeshita A, Mitamura H, Shinagawa K, Sato T, Kurita Y, Kanki H, Takatsuki S, Hara M, Ogawa S

Japanese Heart Journal 43 （ 2 ） 167-181 2002年

研究論文（学術雑誌）, 共著

心房高頻度刺激による心房筋の電気的および機械的リモデリングの形成過程

杵渕修，三田村秀雄，竹下晃子，栗田康生，大橋成孝，谷本耕司郎，福田有希子，家田真樹，佐藤俊明，三好俊一郎，高月誠司，原幹，南雲美也子，小川聡

不整脈 18 481-489 2002年

研究論文（学術雑誌）, 共著

副伝導路を遮断せずに心房細動を抑制できるか：WPW症候群のアブレーションにおける薬物併用療法

福田有希子，高月誠司，三田村秀雄，谷本耕司郎，大橋成孝，杵渕修，家田真樹，栗田康生，三好俊一郎，原幹，小川聡

Progress in medicine 22 2531-2535 2002年

研究論文（学術雑誌）, 共著

CS musculatureと副伝導路の結合が推測された不顕性WPW症候群の1例

高月誠司，三田村秀雄，谷本耕司郎，福田有希子，大橋成孝，家田真樹，杵渕修，栗田康生，三好俊一郎，原幹，小川聡

臨床心臓電気生理 25 （ 5 ） 139-146 2002年

研究論文（学術雑誌）, 共著

ICD植込み患者でPVC後の抗徐拍ペーシングにより誘発された心室細動

谷本耕司郎，三田村秀雄，高月誠司，大橋成孝，福田有希子，杵渕修，家田真樹，栗田康生，三好俊一郎，原幹，小川聡

心臓 34 （ suppl.4 ） 166-171 2002年

研究論文（学術雑誌）, 共著

Daily oral verapamil before but not after rapid atrial excitation prevents electrical remodeling

Kurita Yasuo, Mitamura Hideo, Shiroshita-Takeshita Akiko, Yamane Akiko, Ieda Masaki, Kinebuchi Osamu, Sato Toshiaki, Miyoshi Shunichiro, Hara Motoki, Takatsuki Seiji, Ogawa Satoshi

Cardiovascular Research 54 （ 2 ） 447 - 455 2002年

ISSN 0008-6363

Background: Intravenous verapamil has been reported to prevent electrical remodeling induced by rapid atrial excitation of several minutes to several hours. However, the clinical efficacy of verapamil when taken orally and daily remains controversial. Purpose: We attempted to demonstrate our hypothesis that if verapamil prevents calcium (Ca) overload, its efficacy would be greater when taken before, rather than after, the onset of rapid atrial excitation. Methods: In 24 dogs, pacing and recording electrodes were sutured onto the right atrium. After a 5-day recovery period, rapid atrial pacing at 400 ppm was started, followed 2 days later by oral verapamil (8 mg/kg per day) in eight dogs (After group; A). In another eight dogs, oral verapamil administration was begun 1 week before the initiation of rapid pacing (Before group; B). In the remaining eight dogs, only rapid atrial pacing was started, without oral verapamil (Control group; C). We measured the effective refractory period (ERP) and conduction velocity (CV), and calculated wavelength (WL) at cycle lengths 200 and 300 ms on the day before (P0), and after 2 (P2), 7 (P7), 14(P14) days of rapid pacing. Results: In response to rapid atrial pacing, ERP, CV, WL decreased and progressively and comparably in A and C (P<0.05 vs. P0). In contrast, in B, these parameters did not change significantly and remained greater than those in A and C (P<0.05). Moreover, the adaptation of ERP to rate was preserved only in B. The duration of atrial fibrillation (AF) was shorter in B than in A and C (P<0.05). The inducibility of AF tended to be lower, and the fibrillation cycle length was longer in B than in A and C. Conclusions: Oral verapamil started before but not after rapid atrial excitation prevents electrical remodeling. Verapamil may exert beneficial effects when it is taken during sinus rhythm, but not after more than 2 days of atrial tachyarrhythmia. © 2002 Elsevier Science B.V. All rights reserved.

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Discordant temporal changes in electrophysiological properties during electrical remodeling and its recovery in the canine atrium

Shiroshita-Takeshita Akiko, Mitamura Hideo, Shinagawa Kaori, Sato Toshiaki, Kurita Yasuo, Kanki Hideaki, Takatsuki Seiji, Hara Motoki, Ogawa Satoshi

Japanese Heart Journal 43 （ 2 ） 167 - 181 2002年

ISSN 0021-4868

Prolonged rapid atrial excitation gives rise to atrial electrical remodeling, which perpetuates atrial fibrillation (AF). However, there has been controversy regarding the nature of temporal changes in conduction characteristics during the development and recovery of electrical remodeling. This study was designed to clarify the nature of the development and recovery of electrical remodeling in relation to AF inducibility in dogs subjected to rapid atrial pacing. Eleven dogs underwent rapid atrial pacing (400/min) for 28 days. The electrophysiological study was performed on the day just prior to the commencement of pacing, on days 2, 7, 14, and 28 of rapid pacing, as well as 1 and 7 days after the cessation of pacing. In response to rapid atrial pacing, atrial effective refractory period (ERP), conduction velocity and wavelength decreased significantly (p<0.05). ERP had shortened significantly and rapidly within 2 days of pacing, while conduction velocity decreased more gradually. During the recovery, ERP returned to almost baseline levels within a day, whereas conduction velocity returned to baseline by day 7. Sustained AF became inducible in 37% of the dogs from 7 days of pacing until 1 day after the cessation, when wavelength fell below 8.7 cm. In conclusion, rapid atrial excitation causes a progressive but discordant temporal pattern of a decrease in ERP and conduction velocity. The resultant shortening of the wavelength determines the inducibility and maintenance of AF. The electrophysiological changes produced by one month of rapid atrial pacing can be fully reversed within a week, although in a discordant temporal pattern. Copyright © 2002 by the Japanese Heart Journal.

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同一症例連続72回の心房細動発作の出現様式とNaチャネル遮断薬頓服による停止様式の解析

福田有希子，三田村秀雄，高月誠司，大橋成孝，杵渕修，家田真樹，栗田康生，小川聡

心臓 33 （ suppl 5 ） 18-23 2001年12月

研究論文（学術雑誌）, 共著

心房細動持続時間の電気的除細動後ポーズ長に与える影響

山根明子，三田村秀雄，神吉秀明，佐藤俊明，栗田康生，竹下晃子，高月誠司，小川聡

不整脈 17 （ 5 ） 551-555 2001年12月

研究論文（学術雑誌）, 共著

高度房室ブロックと非持続性心室頻拍を認める運動時失神例

栗田康生，三田村秀雄，高月誠司，岩田道圭林田健太郎，大橋成孝，福田有希子，家田真樹，杵渕修，三好俊一郎，原幹，小川聡

心臓 33 （ suppl 3 ） 19-23 2001年11月

研究論文（学術雑誌）, 共著

Respiratory cycle-dependent left atrial tachycardia

Takatsuki Seiji, Mitamura Hideo, Miyoshi Shunichiro, Ogawa Satoshi

Journal of Cardiovascular Electrophysiology 12 （ 10 ） 1202-1202 2001年10月

研究論文（学術雑誌）, 共著

植込み型除細動器誤作動の予知：過剰感知の原因解析

栗田康生，三田村秀雄，高月誠司，家田真樹，杵渕修，竹下晃子，三好俊一郎，原幹，小川聡，三丸敦洋，申範圭，川田志明

不整脈 17 （ 4 ） 483-489 2001年10月

研究論文（学術雑誌）, 共著

Accessory pathway associated with an anomalous coronary vein in a patient with Wolff-Parkinson-White syndrome

Takatsuki Seiji, Mitamura Hideo, Ieda Masaki, Ogawa Satoshi

Journal of Cardiovascular Electrophysiology 12 （ 9 ） 1080-1082 2001年09月

研究論文（学術雑誌）, 共著

診断に苦慮した肺塞栓症―腫瘍塞栓症と思われた4例

佐藤徹，高月誠司，小山田吉孝，安斉俊久，岩永史郎，吉川勉，山口佳寿博，三田村秀雄，小川聡

Therapeutic Research 22 （ 7 ） 1471-1473 2001年07月

研究論文（学術雑誌）, 共著

Recovery of electrophysiological parameters after conversion of atrial fibrillation

Sato Toshiaki, Mitamura Hideo, Kurita Yasuo, Takeshita Akiko, Shinagawa Kaori, Miyoshi Shunichiro, Kanki Hideaki, Hara Motoki, Takatsuki Seiji, Soejima Kyoko, Ogawa Satoshi

International Journal of Cardiology 79 （ 2-3 ） 183-189 2001年07月

研究論文（学術雑誌）, 共著

Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation

Takatsuki Seiji, Mitamura Hideo, Ogawa Satoshi

Heart 86 （ 1 ） E3 2001年07月

研究論文（学術雑誌）, 共著

迷走神経刺激心房細動誘発モデルにおけるKチャネル遮断薬nifekalantとazimilideの薬理学的効果の比較

佐藤俊明，三田村秀雄，竹下晃子，品川香，神吉秀明，高月誠司，小川聡

心電図 21 （ 3 ） 300-307 2001年05月

研究論文（学術雑誌）, 共著

アミオダロン投与によりICD設定に難渋した1例

栗田康生，三田村秀雄，高月誠司，田中美江，大橋成孝，福田有希子，家田真樹，杵渕修，三好俊一郎，原幹，小川聡，小山卓史，村山晃

Progress in Medicine 21 （ suppl 1 ） 1141-1146 2001年05月

研究論文（学術雑誌）, 共著

失神精査時に冠動脈攣縮，上室性頻拍及び心室頻拍を認めたARVCの1例

家田真樹，高月誠司，三田村秀雄，大橋成孝，福田友希子，杵渕修，栗田康生，三好俊一郎，原幹，吉川勉，小川聡

Therapeutic Research 22 （ 2 ） 343-352 2001年02月

研究論文（学術雑誌）, 共著

心不全を併発した心房粗細動例に対するKチャネル遮断薬nifekalantの効果

高月誠司，三田村秀雄，家田真樹，杵渕修，栗田康生，原幹，小川聡

Therapeutic Research 22 （ 4 ） 852-855 2001年

研究論文（学術雑誌）, 共著

植え込み型除細動器

湯浅慎介，高月誠司，三田村秀雄

からだの科学 221 （ 11 ） 101-106 2001年

研究論文（学術雑誌）, 共著

Accessory pathway associated with an anomalous coronary vein in a patient with Wolff-Parkinson-White syndrome

Takatsuki Seiji, Mitamura Hideo, Ieda Masaki, Ogawa Satoshi

Journal of Cardiovascular Electrophysiology 12 （ 9 ） 1080 - 1082 2001年

ISSN 1045-3873

We report a case of Wolff-Parkinson-White syndrome coexistent with atresia of the coronary sinus (CS) ostium and persistence of the left superior vena cava. The accessory pathway was located at the blind end of the CS, which was bumped with mechanical loss of preexcitation during mapping by a catheter from within the CS. The accessory pathway was successfully ablated with radiofrequency energy applied to this site from the right atrium. This unique combination of anatomically matched anomalies may be important in suggesting a potential embryologic link between the accessory pathway and the coronary vein.

Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation.

Takatsuki S., Mitamura H., Ogawa S.

Heart (British Cardiac Society) 86 （ 1 ） 2001年

A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment.

Efficacy of intravenous nifekalant, a pure Ikr blocker, for atrial tachyarrhythmia with heart failure

Takatsuki S., Mitamura H., Ieda M., Kinebuchi O., Kurita Y., Hara M., Ogawa S.

Therapeutic Research 22 （ 4 ） 852 - 855 2001年

ISSN 0289-8020

We describe 2 cases of congestive heart failure due to atrial tachyarrhythmias, which were successfully treated by a new Ikr blocker, nifekalant. Case 1 was 59-year old male with congestive heart failure caused by atrial fibrillation with rapid ventricular response due to manifest WPW syndrome. Intravenous administration of nifekalant (0.3mg/kg) successfully slowed ventricular response with reducing the frequency of the pre-excitation. Case 2 was 73-year old male having a history of hypertention, also exhibited heart failure caused by atrial flutter with 2 to 1 or 3 to 1 atrioventricular conduction. The atrial flutter was successfully converted to sinus rhythm with the same dose of intravenous nifekalant. In both cases, the heart failure did not aggravated by the use of nifekalant but recovered soon by treating atrial tachyarrhythmias. Intravenous nifekalant may be a useful option in the management of atrial tachyarrhythmia with heart failure.

Recovery of electrophysiological parameters after conversion of atrial fibrillation

Sato Toshiaki, Mitamura Hideo, Kurita Yasuo, Takeshita Akiko, Shinagawa Kaori, Miyoshi Shunichiro, Kanki Hideaki, Hara Motoki, Takatsuki Seiji, Soejima Kyoko, Ogawa Satoshi

International Journal of Cardiology 79 （ 2-3 ） 183 - 189 2001年

ISSN 0167-5273

We investigated the recovery of electrophysiological parameters from electrical remodeling after conversion of chronic lone atrial fibrillation in humans. Clinical studies have shown that the longer atrial fibrillation lasts, the more difficult it becomes to maintain the sinus rhythm after cardioversion. To explore the effects of the duration of atrial fibrillation on changes of electrophysiological parameters after conversion, we determined the atrial effective refractory period and P wave duration during right atrial pacing at 1 and 24 h after electrical cardioversion in 15 patients with chronic lone atrial fibrillation (median duration, 6 months). By 24 h after cardioversion, the effective refractory period at a pacing cycle length of 600 ms increased from 225±19 to 254±27 ms. However, the P wave duration did not decrease significantly 24 h after conversion. As the duration of atrial fibrillation became longer, the prolongation of effective refractory period was more delayed (P<0. 001, r=0.82), and the shortening of P wave duration was significantly smaller within 24 h after cardioversion (P<0. 001, r=0.67). After cardioversion of chronic lone atrial fibrillation, the recovery of shortened atrial refractoriness and prolonged intraatrial conduction time is dependent on the duration of preexisting atrial fibrillation. © 2001 Elsevier Science Ireland Ltd. All rights reserved.

Access to Document (DOI)

Respiratory cycle-dependent left atrial tachycardia

Takatsuki Seiji, Mitamura Hideo, Miyoshi Shunnichiro, Ogawa Satoshi

Journal of Cardiovascular Electrophysiology 12 （ 10 ） 1202 2001年

ISSN 1045-3873

リード不完全断線により洞調律時にショック誤作動を起こしたICD植え込み例

栗田康生，三田村秀雄，高月誠司，前川裕一郎，家田真樹，杵渕修，竹下晃子，原幹，小川聡，三丸敦洋，申範圭，川田志明

心臓 32 （ 12 ） 60-64 2000年12月

研究論文（学術雑誌）, 共著

電気的リモデリングを受けた心房筋の細動誘発性に対する迷走神経緊張の関与

栗田康生，三田村秀雄，竹下晃子，家田真樹，杵渕修，山根明子，佐藤俊明，品川香，神吉秀明，高月誠司，原幹，小川聡

心電図 20 （ 6 ） 628-634 2000年11月

研究論文（学術雑誌）, 共著

Electrophysiologic findings of a patient with inappropriate sinus tachycardia cured by selective radiofrequency catheter ablation

Sato Toshiaki, Mitamura Hideo, Murata Mitsushige, Shinagawa Kaori, Miyoshi Shunichiro, Kanki Hideaki, Takatsuki Seiji, Soejima Kyoko, Miyazaki Toshihisa, Ogawa Satoshi

Journal of Electrocardiology 33 （ 4 ） 381-386 2000年10月

研究論文（学術雑誌）, 共著

心房高頻度刺激による心房の電気的リモデリングおよび心房細動誘発性の経時的変化

竹下晃子，三田村秀雄，栗田康生，品川香，佐藤俊明，家田真樹，杵渕修，神吉秀明，高月誠司，原幹，小川聡

不整脈 16 （ 3 ） 330-336 2000年08月

研究論文（学術雑誌）, 共著

Salutary antiarrhythmic effect of combining a K channel blocker and a beta-blocker in a canine model of 7-day-old myocardial infarction

Takatsuki Seiji, Mitamura Hideo, Kanki Hideaki, Sueyoshi Kouichirou, Ogawa Satoshi

Journal of Cardiovascular Pharmacology 35 （ 6 ） 914-918 2000年06月

研究論文（学術雑誌）, 共著

Diagnostic value of a bedside test for cardiac troponin T in the patient with chest pain presenting to the emergency room

Suzuki Masaru, Hori Shingo, Fujishima Seitaro, Takatsuki Seiji, Nakamura Iwao, Kimura Hiroyuki, Aoki Katsunori, Aikawa Naoki

Keio Journal of Medicine 49 （ 2 ） 74 - 79 2000年06月

ISSN 0022-9717

Identification of patients with acute chest pain due to acute coronary syndrome is a common and difficult challenge for emergency physicians. A prospective study was conducted to assess the diagnostic value of a bedside test of cardiac troponin T in the emergency room setting. Forty-nine consecutive patients, who visited the emergency room within 6 hours of the onset of acute chest pain, were enrolled. Of the 26 patients who were ultimately diagnosed as having acute coronary syndrome, seven patients (27%) had positive cardiac troponin T assay results, whereas none of the patients without acute coronary syndrome had positive results (0%). For patients with acute coronary syndrome who presented later than 3 hours after the onset (n = 4), the test was positive in all cases (positive predictive value: 100%, negative predictive value: 100%, p < 0.01). However, the positive rate was only 14% for those who presented earlier than 3 hours after the onset (n = 22) (positive predictive value: 100%, negative predictive value: 47%, p = 0.84). In conclusion, bedside troponin T test results should be evaluated considering the time interval from the onset of chest symptoms.

Scilian Gambitに基づく臨床における抗不整脈薬使用の実際

三田村秀雄，高月誠司，三好俊一郎，原幹，小川聡

心電図 20 （ 3 ） 209-217 2000年05月

研究論文（学術雑誌）, 共著

駅ホームから軌道内へ転落したNeurally mediated syncopeの一例

鈴木昌，堀進悟，藤島清太郎，木村裕之，横山雅子，高月誠司，山崎元靖，関根和彦，宮武諭，船曳知弘，大須賀房夫，相川直樹

日本救急医学会関東地方会雑誌 20 （ 2 ） 454-455 2000年02月

研究論文（学術雑誌）, 共著

心外膜下後中隔副伝導路に対する中心臓静脈からのカテーテルアブレーション

高月誠司，三田村秀雄，神吉秀明，佐藤俊明，品川香，小川聡，中川博

心電図 20 （ 2 ） 145-151 2000年02月

研究論文（学術雑誌）, 共著

Determination of refractory periods and conduction velocity during atrial fibrillation using atrial capture in dogs -Direct assessment of the wavelength and its modulation by a sodium channel blocker, pilsicainide

Shinagawa Kaori, Mitamura Hideo, Takeshita Akiko, Sato Toshiaki, Kanki Hideaki, Takatsuki Seiji, Ogawa Satoshi

Journal of the American College of Cardiology 35 （ 1 ） 246-253 2000年01月

研究論文（学術雑誌）, 共著

ICDの問題点が複合的に露呈し，near sudden deathを起こしたVT症例

栗田康生，三田村秀雄，高月誠司，家田真樹，杵渕修，竹下晃子，原幹，小川聡，佐伯公子，大木貴博，佐藤俊明

第17回東京不整脈フォーラム記録集 19-30 2000年

研究論文（学術雑誌）, 共著

左室基部起源の心室頻拍と房室結節性リエントリー性頻拍が交代性に出現した1例

高月誠司，三田村秀雄，神吉秀明，佐藤俊明，品川香，竹下晃子，小川聡

臨床心臓電気生理 23 77-84 2000年

研究論文（学術雑誌）, 共著

Basedow病治療中にショックを呈した甲状腺クリーゼの1例

大須賀房夫，藤島清太郎，木村裕之，山崎元靖，堀進悟，横山雅子，高月誠司，鈴木昌，関根和彦，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 2 ） 558-559 1999年12月

研究論文（学術雑誌）, 共著

電気的リモデリングが短時間発作性心房細動の再発様式に与える影響：ホルター心電図による検討

品川香，三田村秀雄，竹下晃子，佐藤俊明，神吉秀明，高月誠司，小川聡

不整脈 15 （ 5 ） 469-474 1999年12月

研究論文（学術雑誌）, 共著

心房細動中の心房連続刺激による捕捉可能域の定量評価とそれに対するNaチャネル遮断薬の影響

竹下晃子，三田村秀雄，品川香，佐藤俊明，神吉秀明，高月誠司，小川聡

不整脈 15 （ 5 ） 475-481 1999年12月

研究論文（学術雑誌）, 共著

偶発性低体温によるCPA後に完全社会復帰した1例

正岡建洋，山崎元靖，木村裕之，堀進悟，藤島清太郎，横山雅子，高月誠司，鈴木昌，関根和彦，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 2 ） 442-443 1999年12月

研究論文（学術雑誌）, 共著

SIRS, ALI患者の重症度評価指標としてのAPACHE IIIスコア，PaO2/FIO2比の検討

藤島清太郎，篠沢洋太郎，堀進悟，青木克憲，木村裕之，横山雅子，堀口崇，高月誠司，鈴木昌，山崎元靖，関根和彦，宮武諭，三村琢也，相川直樹

日本救命医療研究会雑誌 13 119-124 1999年10月

研究論文（学術雑誌）, 共著

ジソピラミドの頻度依存性陰性変化作用

高月誠司，三田村秀雄，末吉浩一郎，神吉秀明，岡田豊，小川聡

循環器科 46 （ 2 ） 194-197 1999年08月

研究論文（学術雑誌）, 共著

妊娠経過中にショックを呈した1例

山崎元靖，堀進悟，藤島清太郎，木村裕之，横山雅子，高月誠司，堀口崇，鈴木昌，関根和彦，宮武諭，三村琢也，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 126-127 1999年07月

研究論文（学術雑誌）, 共著

マジックマッシュルームによる急性中毒により自傷行為に至った1例

三村琢也，横山雅子，堀進悟，藤島清太郎，木村裕之，堀口崇，高月誠司，鈴木昌，山崎元靖，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 26-27 1999年07月

研究論文（学術雑誌）, 共著

失神，ショックを呈し救急来院した肺微小塞栓症の1例

宮武諭，藤島清太郎，堀進悟，木村裕之，横山雅子，高月誠司，堀口崇，鈴木昌，山崎元靖，関根和彦，三村琢也，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 170-1 1999年07月

研究論文（学術雑誌）, 共著

A case of traumatic shock complicated by methamphetamine intoxication

Horiguchi T, Hori S, Shinozawa Y, Fujishima S, Kimura H, Yokoyama M, Sasaki J, Takatsuki S, Suzuki M, Yamazaki M, Aikawa N

Intensive Care Medicine 25 （ 7 ） 758-760 1999年07月

研究論文（学術雑誌）, 共著

大出血を伴ったマロリーワイス症候群に対してEVLが有用であった4例

関根和彦，木村裕之，山崎元靖，三村琢也，青木克憲，堀進悟，藤島清太郎，横山雅子，高月誠司，堀口崇，鈴木昌，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 26-27 1999年07月

研究論文（学術雑誌）, 共著

入浴中に意識障害が発生し救助された一例

鈴木昌，堀進悟，藤島清太郎，木村裕之，横山雅子，高月誠司，山崎元靖，関根和彦，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 102-103 1999年06月

研究論文（学術雑誌）, 共著

ショックを呈し救急来院した肺微小塞栓症の一例

宮武諭，藤島清太郎，堀進悟，木村裕之，横山雅子，高月誠司，鈴木昌，山崎元靖，関根和彦，井上卓，山口佳寿博，相川直樹

日本救急医学会関東地方会雑誌 20 （ 1 ） 170-171 1999年04月

研究論文（学術雑誌）, 共著

一過性室房ブロックを認めた上室性頻拍の1例

高月誠司，三田村秀雄，神吉秀明，佐藤俊明，品川香，小川聡

心臓 31 （ Suppl 5 ） 92-98 1999年02月

研究論文（学術雑誌）, 共著

Discordant prolongation of the refractory period and repolarization time by a class III agent, E4031, in the healing phase of myocardial infarction

Takatsuki Seiji, Mitamura Hideo, Sueyoshi Koichiro, Kanki Hideaki, Furuno Izumi, Ogawa Satoshi

Japanese Heart Journal 39 （ 5 ） 687 - 697 1998年09月

ISSN 0021-4868

Susceptibility to reentrant tachyarrhythmias and the antiarrhythmic efficacy of class III agents are related more to the duration of the refractory period (ERP) than to the repolarization time (RT). We measured both ERP and RT in a canine model of healing myocardial infarction, and evaluated the effect of a class III agent (E4031) on these parameters and on the inducibility of ventricular tachyarrhythmias. ERP and RT on the unipolar electrogram were measured at several cycle lengths in the normal (NZ) and infarct zones (IZ), respectively, in 10 canine myocardial infarction models and extrastimulation was used to induce ventricular arrhythmias. Measurements were repeated after E4031 administration. At baseline, both ERP and RT were significantly longer in IZ than in NZ with ERP/RT ratio also higher in IZ. This ratio tended to increase at longer cycle lengths. E4031 increased ERP and RT both in NZ and IZ at all cycle lengths, but increased the ERP/RT ratio predominantly in IZ. E4031 prevented induction of sustained VT or VF, which was inducible in 3 out of 10 dogs at baseline, although it facilitated induction of VF in 1 dog wth no baseline arrhythmia. By increasing the ERP/RT ratio, class III drugs may shorten the relative refractory period in IZ at the expense of a greater ERP difference created between NZ and IZ.

Catheter ablation of accessory atrioventricular connection between right atrial appendage to right ventricle : A case report

Soejima K, Mitamura H, Miyazaki T, Miyoshi S, Murata M, Sato T, Shinagawa K, Takatsuki S, Ogawa S, Nakagawa H

Journal of Cardiovascular Electrophysiology 9 （ 5 ） 523-528 1998年05月

研究論文（学術雑誌）, 共著

Successful predilation of a resistant, heavily calcified lesion with cutting baloon for coronary stenting : A case report

Asakura Y, Furukawa Y, Ishikawa S, Asakura K, Sueyoshi K, Sakamoto M, Takagi S, Takatsuki S, Oyamada K, Okabe T, Mitamura H, Ogawa S, Hinohara T

Catheterization and Cardiovascular Diagnosis 44 （ 4 ） 420-422 1998年

研究論文（学術雑誌）, 共著

Postrepolarization refractoriness as a potential anti-atrial fibrillation mechanism of pilsicainide, a pure sodium channel blocker with slow recovery kinetics

Kanki H, Mitamura H, Takatsuki S, Sueyoshi K, Shinagawa K, Sato T, Ogawa S

Cardiovascular Drugs and Therapy 12 （ 5 ） 475-482 1998年

研究論文（学術雑誌）, 共著

Cutting baloonのバルーン破裂で生じた冠動脈解離に対し3つのStentを留置し緊急解脱しえた1例

高月誠司，朝倉靖，石川士郎，岩永史郎，末吉浩一郎，三田村秀雄，小川聡

呼吸と循環 45 （ 2 ） 181-185 1998年

研究論文（学術雑誌）, 共著

Cutting balloonのパルーン破裂で生じた冠動脈解離に対し3つのstentを留置し緊急離脱しえた1例

高月誠司，朝倉靖，石川士郎，岩永史郎，末吉浩一郎，三田村秀雄，小川聡

呼吸と循環 45 181-185 1997年

研究論文（学術雑誌）, 共著

Poor LVに合併する心室性不整脈治療の功罪

三田村秀雄，高月誠司

Cardiologist 1 40-40 1996年

研究論文（学術雑誌）, 共著

拡張型心筋症におけるACE阻害薬，β遮断薬治療に伴う心室性不整脈出現頻度の推移

末吉浩一郎，三田村秀雄，高月誠司，神吉秀明，小川聡

循環器科 40 288-291 1996年

研究論文（学術雑誌）, 共著

Cutting balloonによるPTCAで冠動脈穿孔をきたした1例

高月誠司，朝倉靖，石川士郎，末吉浩一郎，坂本宗久，高木俊介，織田孝裕，三田村秀雄，小川聡

Jpn J Intervent Cardiol 11 200-204 1996年

研究論文（学術雑誌）, 共著

心房細動・粗動

高月誠司，三田村秀雄

臨床医 22 132-133 1996年

研究論文（学術雑誌）, 共著

PTCAの適応と予後・・本邦と欧米の比較・・

朝倉靖，茅野眞男，末吉浩一郎，高月誠司，鈴木喜之，三好俊一郎，足立健，石川士郎，小林夏木，宮崎浩司，三谷和彦，永見圭一，根岸耕二，横塚仁，藤井効，三田村秀雄，小川聡

Coronary 12 （ 1 ） 52-57 1995年11月

研究論文（学術雑誌）, 共著

抗不整脈薬の進歩と新しい問題点

高月誠司，小川聡

Medical Practice 12 （ 8 ） 1062-1069 1995年04月

研究論文（学術雑誌）, 共著

梗塞心におけるIII群作用に与えるβ受容体刺激の影響

三田村秀雄，末吉浩一郎，高月誠司，柴田勝，堤規之，好本達司，古野泉，小川聡

Prog Med 15 （ 1 ） 681-688 1995年04月

研究論文（学術雑誌）, 共著

抗不整脈薬

高月誠司，三田村秀雄

臨床医 21 （ 1 ） 935-948 1995年04月

研究論文（学術雑誌）, 共著

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