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Mizutani Y, Yanagisawa S, Ichikawa M, Nishio K, Sakai H, Nonokawa D, Makino Y, Suzuki H, Ichimiya H, Uchida Y, Watanabe J, Kanashiro M, Inden Y, Murohara T. Evaluation of microembolic signals on carotid ultrasound during pulmonary vein isolation with high-power short-duration and cryoballoon ablations: When and where do bubble and solid emboli arise? J Cardiovasc Electrophysiol 2024. [PMID: 38837477 DOI: 10.1111/jce.16337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The underlying risks of asymptomatic embolization during high-power short-duration (HPSD) ablation for atrial fibrillation remain unclear. We aimed to evaluate microembolic signals (MESs) during HPSD ablation with power settings of 50 and 90 W in comparison with those during cryoballoon (CB) ablation using a novel carotid ultrasound-Doppler system that classifies solid and air bubble signals using real-time monitoring. METHODS AND RESULTS Forty-seven patients underwent HPSD ablation using radiofrequency (RF), and 13 underwent CB ablation. MESs were evaluated using a novel pastable soft ultrasound probe equipped with a carotid ultrasound during pulmonary vein isolation. We compared the detailed MESs and their timing between RF and CB ablations. The number of MESs and solid signals were significantly higher in the RF group than in CB group (209 ± 229 vs. 79 ± 32, p = .047, and 83 ± 89 vs. 28 ± 17, p = .032, respectively). In RF ablation, the number of MESs, solid, and bubble signals per ablation point, or per second, was significantly higher at 90 W than at 50 W ablation. The MESs, solid, and bubble signals were detected more frequently in the bottom and anterior walls of the left pulmonary vein (LPV) ablation. In contrast, many MESs were observed before the first CB application and decreased chronologically as the procedure progressed. Signals were more prevalent during the CB interval rather than during the freezing time. Among the 28 patients, 4 exhibited a high-intensity area on postbrain magnetic resonance imaging (MRI). The MRI-positive group showed a trend of larger signal sizes than did the MRI-negative group. CONCLUSION The number of MESs was higher in the HPSD RF group than in the CB group, with this risk being more pronounced in the 90 W ablation group. The primary detection site was the anterior wall of the LPV in RF and the first interval in CB ablation.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mizuki Ichikawa
- Department of Clinical Laboratory, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Keisuke Nishio
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hiroya Sakai
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Daishi Nonokawa
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hitomi Suzuki
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Tachi M, Tanaka A, Teraoka T, Furuta T, Matsushita E, Hayashi K, Shimojo M, Yanagisawa S, Inden Y, Murohara T. Feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated vascular closure device. Heart Rhythm 2024:S1547-5271(24)02368-3. [PMID: 38608918 DOI: 10.1016/j.hrthm.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Venous vascular access complications are usually nonfatal but are the most common complications after transvenous catheter intervention. Vascular closure devices (VCDs) have recently become available for venous closure. OBJECTIVE This study aimed to evaluate the feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated VCDs in patients who underwent catheter ablation. METHODS This single-center observational study enrolled 226 consecutive patients who underwent elective catheter ablation with femoral venipuncture. For hemostasis, vessel closure by VCD was performed with real-time ultrasound guidance after 2022 (n = 123) and without ultrasound guidance in 2021 (n = 103). The occurrence of venous access site-related complications (major, minor, or other) was compared. RESULTS The rate of device failure was significantly lower in patients with ultrasound guidance than in those without (1.6% vs 6.3%; P = .048). The occurrence of all venous access site-related complications was significantly lower in patients with ultrasound guidance than in those without (4.9% vs 18.4%; P = .001). Time to ambulation was shorter in patients with ultrasound guidance than in those without (2.0 ± 0.1 hours vs 2.2 ± 0.6 hours; P < .001). CONCLUSION Real-time ultrasound guidance can reduce device failure, access site-related complications, and time to ambulation in performing venous closure with a VCD.
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Affiliation(s)
- Masaya Tachi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tsubasa Teraoka
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Tappei Furuta
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Etsushi Matsushita
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Kazunori Hayashi
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Suga K, Kato H, Akita S, Sakurai T, Ota R, Okada T, Murakami H, Kada K, Tsuboi N, Yanagisawa S, Inden Y, Murohara T. Optimal ablation settings of TactiFlex SE laser-cut irrigated-tip catheter: comparison with ThermoCool SmartTouch SurroundFlow porous irrigated-tip catheter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01797-9. [PMID: 38573538 DOI: 10.1007/s10840-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The TactiFlex SE catheter (TFSE, Abbott) with a contact force (CF) sensor and a laser-cut irrigated-tip has recently become available but lacks a lesion quality marker. This study aimed to explore distinctions in lesion characteristics between the TFSE and the ThermoCool SmartTouch SurroundFlow catheter (STSF, Biosense Webster), which utilizes a porous irrigated tip, and to assess the most effective application settings for the TFSE. METHODS Lesions were generated using varying settings of radiofrequency power (30-50 W), CF (10-20 g), application duration (10-40 s), and catheter orientation (perpendicular or parallel) in an ex vivo porcine model. Comparative analysis between the TFSE and STSF was conducted for lesion characteristics and incidence of steam pops using predictive models in regression analyses. RESULTS Among 720 applications, the TFSE exhibited a significantly lower incidence of steam pops compared to the STSF (0.6% vs. 36.8%, P < 0.001). Moreover, coefficients of determination (R2) for the TFSE were higher than those for the STSF concerning lesion depth (0.710 vs. 0.541) and volume (0.723 vs. 0.618). The lesion size generated with the TFSE was notably smaller than that with the STSF under identical application settings. Additionally, to achieve a lesion depth ≥ 4.0 mm, the TFSE required an application duration 8-12 s longer than the STSF under similar settings. CONCLUSIONS The TFSE demonstrated a lower incidence of steam pops and superior predictability in lesion size compared to the STSF. However, the TFSE necessitated a longer application duration than the STSF to achieve an adequate lesion size.
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Affiliation(s)
- Kazumasa Suga
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shigeki Akita
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Taku Sakurai
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Ryusuke Ota
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Takuya Okada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hisashi Murakami
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Kenji Kada
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Naoya Tsuboi
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, Nagoya, 466-8550, Japan
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Yanagisawa S, Inden Y, Sato Y, Watanabe R, Goto T, Kondo S, Tachi M, Iwawaki T, Yamauchi R, Hiramatsu K, Shimojo M, Tsuji Y, Shibata R, Murohara T. Comparison of novel intrinsic versus conventional antitachycardia pacing for ventricular tachycardia among implantable cardioverter-defibrillator recipients. J Cardiovasc Electrophysiol 2024; 35:821-831. [PMID: 38424678 DOI: 10.1111/jce.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Intrinsic antitachycardia pacing (iATP) is a novel automated antitachycardia pacing (ATP) that provides individual treatment to terminate ventricular tachycardia (VT). However, the clinical efficacy of iATP in comparison with conventional ATP is unknown. We aim to compare the termination rate of VT between iATP and conventional ATP in patients with implantable cardioverter-defibrillators using a unique setting of different sequential orders of both ATP algorisms. METHODS Patients with the iATP algorithm were assigned to iATP-first and conventional ATP-first groups sequentially. In the iATP-first group, a maximum of seven iATP sequences were delivered, followed by conventional burst and ramp pacing. In contrast, in the conventional ATP-first group, two bursts and ramp pacing were initially programmed, followed by iATP sequences. We compared the success rates of VT termination in the first and secondary programmed ATP zones between the two groups. RESULTS Fifty-eight and 56 patients were enrolled in the iATP-first and conventional ATP-first groups, and 67 and 44 VTs were analyzed in each group, respectively. At the first single ATP therapy, success rates were 64% and 70% in the iATP and conventional groups, respectively. At the end of the first iATP treatment zone, the success rate increased from 64% to 85%. Moreover, secondary iATP therapy following the failure of conventional ATPs increased the success rate from 80% to 93%. There was a significant benefit of alternative iATP for VT termination compared to secondary conventional ATP (100% vs. 33%, p = .028). CONCLUSIONS iATP may be beneficial as a secondary therapy after failure of conventional ATP to terminate VT.
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Affiliation(s)
- Satoshi Yanagisawa
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Sato
- Department of Clinical Engineering, Nagoya University Hospital, Nagoya, Japan
| | - Ryo Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Goto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shun Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Tachi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoya Iwawaki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Hiramatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiomi Tsuji
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shinohara T, Takagi M, Kamakura T, Komatsu Y, Aizawa Y, Sekiguchi Y, Yokoyama Y, Aihara N, Hiraoka M, Aonuma K. Late life-threatening arrhythmia in patients with Brugada syndrome: Results from long-term follow-up in a large Japanese cohort. J Cardiovasc Electrophysiol 2024; 35:701-707. [PMID: 38329163 DOI: 10.1111/jce.16205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Most patients with Brugada syndrome (BrS) are first diagnosed in their 40s, with sudden cardiac death (SCD) often occurring in their 50s. Ventricular fibrillation (VF) may occur in some patients with BrS despite having been asymptomatic for a long period. This study aimed to assess the incidence and risk factors for late life-threatening arrhythmias in patients with BrS. METHODS Patients with BrS (n = 523; mean age, 51 ± 13 years; male, n = 497) were enrolled. The risk of late life-threatening arrhythmia was investigated in 225 patients who had experienced no cardiac events (CEs: SCD or ventricular tachyarrhythmia) for at least 10 years after study enrollment. The incidence of CEs during the follow-up period was examined. RESULTS During the follow-up of the 523 patients, 59 (11%) experienced CEs. The annual incidences of CEs were 2.87%, 0.77%, and 0.09% from study enrollment to 3, 3-10, and after 10 years, respectively. Among 225 patients who had experienced no CEs for at least 10 years after enrollment, four patients (1.8%) subsequently experienced CEs. Kaplan-Meier analysis revealed significant differences in the incidence of late CEs between patients with and without a history of symptoms (p = .032). The positive and negative predictive values of late CEs for the programmed electrical stimulation (PES) test were 2.9% and 100%, respectively. CONCLUSION Our results suggest that patients with BrS who are asymptomatic and have no ventricular tachycardia/VF inducibility by PES are at extremely low risk of experiencing late life-threatening arrhythmias.
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Affiliation(s)
- Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Masahiko Takagi
- Department of Medicine II, Kansai Medical University, Moriguchi, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiovascular Internal Medicine, Sakakibara Heart Institute, Fuchu, Japan
| | - Yasuhiro Yokoyama
- Department of Internal Medicine, Division of Cardiology, Daisan Kitashinagawa Hospital, Tokyo, Japan
| | - Naohiko Aihara
- Department of Internal Medicine, Senri Central Hospital, Suita, Japan
| | | | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Hiroki J, Mizukami A, Ueshima D, Mashiki J, Miyakuni S, Kono T, Ono M, Miyazaki S, Matsumura A, Sasano T. Propensity-score matched comparison of renal and neurohormonal effects of catheter ablation for frequent premature ventricular contractions in patients with and without systolic dysfunction. J Arrhythm 2024; 40:306-316. [PMID: 38586839 PMCID: PMC10995584 DOI: 10.1002/joa3.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/09/2023] [Accepted: 12/26/2023] [Indexed: 04/09/2024] Open
Abstract
Background Catheter ablation (CA) for premature ventricular contractions (PVCs) restores cardiac and renal functions in patients with reduced left ventricular ejection fraction (LVEF); however, its effects on preserved EF remain unelucidated. Methods The study cohort comprised 246 patients with a PVC burden of >10% on Holter electrocardiography. Using propensity matching, we compared the changes in B-type natriuretic peptide (BNP) levels and estimated glomerular filtration rate (eGFR) in patients who underwent CA or did not. Results Postoperative BNP levels were decreased significantly in the CA group, regardless of the degree of LVEF, whereas there was no change in those of the non-CA group. Among patients who underwent CA, BNP levels decreased from 44.1 to 33.0 pg/mL in those with LVEF ≥50% (p = .002) and from 141.0 to 87.9 pg/mL in those with LVEF <50% (p < .001). Regarding eGFR, postoperative eGFR was significantly improved in the CA group of patients with LVEF ≥50% (from 71.4 to 74.7 mL/min/1.73 m2, p = .006), whereas it decreased in the non-CA group. A similar trend was observed in the group with a reduced LVEF. Adjusted for propensity score matching, there was a significant decrease in the BNP level and recovery of eGFR after CA in patients with LVEF >50%. Conclusions This study showed that CA for frequent PVCs decreases BNP levels and increases eGFR even in patients with preserved LVEF.
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Affiliation(s)
- Jiro Hiroki
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Akira Mizukami
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | | | - Jun Mashiki
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Shota Miyakuni
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Toshikazu Kono
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Maki Ono
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityBunkyo‐kuJapan
| | | | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityBunkyo‐kuJapan
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Kuroda M, Takeo A, Kobayashi H, Kuji R, Mori H, Tsutsui K, Fukunaga M, Nagashima M, Korai K, Ando K, Hiroshima K. Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model. J Interv Card Electrophysiol 2024; 67:589-597. [PMID: 37691083 DOI: 10.1007/s10840-023-01633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Lesion formation during catheter ablation is influenced by the power, contact force (CF), time, and catheter stability. However, the influence of the irrigation effects on lesion formation remains unknown. METHODS An ex vivo experiment using conductive gel was performed. Using three different catheter designs (TactiFlex ™ SE [TF], IntellaNav MiFi ™ OI [MiFi], QDOT MICRO™ [QDOT]), a cross-sectional analysis of the lesion size and surface lesion type of 10g/40W lesions with a combination of various ablation times was performed in protocol 1. A longitudinal analysis (combination of various powers [30, 40, and 50W] and various ablation times with a 10g setting) was performed to investigate the influence of the auto-regulated irrigation system (QDOT) on lesion formation in protocol 2. RESULTS The lesion formation with the QDOT catheter tended to create larger ablation lesions, while that with the TF catheter created smaller lesions than the other catheters. The lesion surface characteristics were divided into two patterns: ring (MiFi catheter and QDOT) and crescent (TF) patterns. The auto-regulated irrigation system did not influence the lesion formation, and the relationship between the lesion formation and RF energy exhibited similar changes regardless of the ablation power setting. CONCLUSION The lesion formation and lesion surface characteristics differed among the different irrigation tip designs. An auto-regulated irrigation system did not affect the lesion creation or surface lesion characteristics. Care should be given to the inter-product differences in the lesion characteristics during RF catheter ablation, partly due to the irrigation flow control and tip design.
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Affiliation(s)
- Maiko Kuroda
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Ayaka Takeo
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Kobayashi
- Department of Clinical Engineering, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Rei Kuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hitoshi Mori
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Kenta Tsutsui
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michio Nagashima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kengo Korai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Tsutsui K, Terazaki Y, Kanai R, Ishii M, Ohno S, Sasaki Y, Kitamura A, Kudo D, Sasaki W, Tanaka N, Narita M, Matsumoto K, Mori H, Ikeda Y, Arai T, Nakano S, Kato R. Postoperative intravenous patient-controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation. J Arrhythm 2024; 40:349-355. [PMID: 38586843 PMCID: PMC10995597 DOI: 10.1002/joa3.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Postoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S-ICD). In 2020, we introduced intravenous patient-controlled analgesia (IV-PCA) in addition to the conventional, request-based analgesia for postoperative pain control in S-ICD. To determine the effect and safety, we quantitatively assessed the effect of IV-PCA after S-ICD surgery over conventional methods. Methods During the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S-ICD implantation under general anesthesia. While the postoperative pain was addressed with either request-based analgesia (by nonsteroid anti-inflammatory drugs, N = 68, dubbed as "PCA absent") or fentanyl-based IV-PCA in addition to the standard care (N = 45, dubbed as "PCA present"). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1-3: mild pain, 4-6: moderate pain, 7-10: severe pain). Results Although IV-PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter-group difference was not found significant. Conclusion IV-PCA suppresses postoperative pain in S-ICD without major safety concerns.
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Affiliation(s)
- Kenta Tsutsui
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoshitaka Terazaki
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Risa Kanai
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Masako Ishii
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Seika Ohno
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoko Sasaki
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akira Kitamura
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Daisuke Kudo
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Wataru Sasaki
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Naomichi Tanaka
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Masataka Narita
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Kazuhisa Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Takahide Arai
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
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Aoyama D, Miyazaki S, Amaya N, Tama N, Hasegawa K, Nomura R, Tsuji T, Nakano A, Uzui H, Tada H. Treatment with catheter ablation for patients with arrhythmia-induced cardiomyopathy caused by atrial fibrillation promises a good prognosis. Heart Vessels 2024; 39:240-251. [PMID: 37872308 DOI: 10.1007/s00380-023-02329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
Clinical outcomes after catheter ablation in patients with reduced left ventricular (LV) ejection fraction (EF) and atrial fibrillation (AF) remain unclear. This study aimed to explore the clinical outcomes of patients with arrhythmia-induced cardiomyopathy (AIC) and the influence of pharmacological treatment on clinical outcomes in patients with AIC after the procedure. Ninety-six patients with AF with a reduced LVEF (LVEF < 50%, 66.7 ± 10.9 years; 72 males) underwent AF ablation. AIC was defined as patients whose LVEF recovered ≥ 50% after catheter ablation (n = 67) and patients whose LVEF remained reduced were defined as non-AIC (n = 29). During a median follow-up of 25 (13-40) months, Kaplan-Meier analysis demonstrated that patients with AIC were associated with less frequent cardiovascular death (p = 0.025) and hospitalization for worsening heart failure (p < 0.001) than those without AIC. Freedom from AF recurrence was similar between the two groups (p = 0.47). In multivariate analysis, the LV end-diastolic diameter (p = 0.0002) and the CHA2DS2-VASc scores (p = 0.0062) were independent predictors of AIC. Among the 67 patients with AIC, no significant differences in baseline characteristics, except for LV chamber size and cryoballoon use, were observed between patients with AIC with (n = 31) and without renin-angiotensin system (RAS) inhibitors (n = 36). In the Kaplan-Meier analysis, cardiovascular death, hospitalization for worsening heart failure, and AF recurrence after catheter ablation did not differ between patients treated with and without RAS inhibitors (all p > 0.05). Catheter ablation in patients with AIC due to AF is associated with a good post-procedural prognosis.IRB information The study was approved by the Research Ethics Committee of the University of Fukui (No. 20220151) and clinical trial registration (UMIN000050391).
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Affiliation(s)
- Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Amaya
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Ryohei Nomura
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Toshihiko Tsuji
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Akira Nakano
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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10
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Riku S, Inden Y, Yanagisawa S, Fujii A, Tomomatsu T, Nakagomi T, Shimojo M, Okajima T, Furui K, Suga K, Suzuki S, Shibata R, Murohara T. Distributions and number of drivers on real-time phase mapping associated with successful atrial fibrillation termination during catheter ablation for non-paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:303-317. [PMID: 37354370 DOI: 10.1007/s10840-023-01588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/31/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Real-time phase mapping (ExTRa™) is useful in determining the strategy of catheter ablation for non-paroxysmal atrial fibrillation (AF). This study aimed to investigate the features of drivers of AF associated with its termination during ablation. METHODS Thirty-six patients who underwent catheter ablation for non-paroxysmal AF using online real-time phase mapping (ExTRa™) were enrolled. A significant AF driver was defined as an area with a non-passively activated ratio of ≥ 50% on mapping analysis in the left atrium (LA). All drivers were simultaneously evaluated using a low-voltage area, complex fractionated atrial electrogram (CFAE), and rotational activity by unipolar electrogram analysis. The electrical characteristics of drivers were compared between patients with and without AF termination during the procedure. RESULTS Twelve patients achieved AF termination during the procedure. The total number of drivers detected on the mapping was significantly lower (4.4 ± 1.6 vs. 7.4 ± 3.8, p = 0.007), and the drivers were more concentrated in limited LA regions (2.8 ± 0.9 vs. 3.9 ± 1.4, p = 0.009) in the termination group than in the non-termination group. The presence of drivers 2-6 with limited (≤ 3) LA regions showed a tenfold increase in the likelihood of AF termination, with 83% specificity and 67% sensitivity. Among 231 AF drivers, the drivers related to termination exhibited a greater overlap of CFAE (56.8 ± 34.1% vs. 39.5 ± 30.4%, p = 0.004) than the non-related drivers. The termination group showed a trend toward a lower recurrence rate after ablation (p = 0.163). CONCLUSIONS Rotors responsible for AF maintenance may be characterized in cases with concentrated regions and fewer drivers on mapping.
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Affiliation(s)
- Shuro Riku
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshifumi Nakagomi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Okajima
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Koichi Furui
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazumasa Suga
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
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11
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Onishi N, Suenaga A, Yoshida A, Kobayashi T, Kyo S, Oi M, Higashitani N, Nakazeki F, Oyamada N, Jinnai T, Kaitani K. Rethinking appropriate blanking period after atrial fibrillation ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01754-6. [PMID: 38363431 DOI: 10.1007/s10840-024-01754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Early recurrence (ER) within a 90-day blanking period (BP) in catheter ablation (CA) for atrial fibrillation (AF) is a risk factor for late recurrence (LR) after 90 days postoperatively. However, few reports have examined them in the second CA and compared them to the first CA. Moreover, in recent years, there have been reports suggesting that BP should be reduced from 90 to 30 days. Therefore, the association between ER and LR in the first and the second CA was examined, and the validity of a 30-day BP was evaluated. METHODS A total of 511 consecutive patients undergoing the first CA and 116 of these patients undergoing the second CA for AF at a single institution from November 2016 to December 2020 were analyzed retrospectively. RESULTS When ER within a 90-day BP was divided into 0-30 days and 31-90 days according to the timing of the last ER episode, the hazard ratios on LR of them relative to no ER were 2.7 {95% confidence interval (CI) 1.7-4.2} and 9.7 (95% CI 6.6-14.3), respectively, for the first CA and 15.3 (95% CI 4.7-50.1) and 44.1 (95% CI 14.0-139.4), respectively, for the second CA. CONCLUSIONS ER was strongly associated with LR, especially in patients with the last episode of ER more than 30 days after CA. This was pronounced in cases after the second CA, when PVI appeared to be completed. With the current improvement in PVI durability, BP may be acceptable for 30 days.
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Affiliation(s)
- Naoaki Onishi
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Akihira Suenaga
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Akinori Yoshida
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Takayasu Kobayashi
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Shokan Kyo
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
- Kusatsu Heart Center, Kusatsu, 520-0014, Japan
| | - Maki Oi
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Nobuya Higashitani
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Fumiko Nakazeki
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Naofumi Oyamada
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Toshikazu Jinnai
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan.
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12
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Kaneko Y, Naruse Y, Narumi T, Sano M, Urushida T, Maekawa Y. Evaluation and comparison of impedance and amplitude changes in lesion index-guided pulmonary vein isolation. J Arrhythm 2024; 40:100-108. [PMID: 38333375 PMCID: PMC10848590 DOI: 10.1002/joa3.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/29/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024] Open
Abstract
Background The lesion index (LSI) has been used to estimate lesion formation after radiofrequency catheter ablation. However, the impedance drop and decrease in bipolar amplitude of intracardiac electrograms, which are parameters that are traditionally used to predict effective ablation lesions, are not used to calculate LSI. Therefore, we aimed to investigate the association between LSI and traditional parameters. Methods We retrospectively investigated 1355 ablation points from 31 patients who underwent LSI-guided pulmonary vein isolation (PVI) using TactiCath. All points were classified into 3 groups based on the impedance drop: (i) <10 Ω (n = 67), (ii) 10-20 Ω (n = 909), and (iii) >20 Ω (n = 379). The LSI targets were 4.5 for the posterior left atrium and 5.2 for the anterior left atrium. After excluding 583 points at which it was difficult to measure the amplitude, 772 ablation points during sinus rhythm were included in the analysis of bipolar amplitude. Results The target LSI was achieved at 1177 points (86.9%). The median total impedance drop and amplitude just after ablation were 16.0 [13.0-20.0] Ω and 0.21 [0.14-0.30] mV, respectively. There were significant differences among the 3 groups in the impedance and amplitude before ablation, power, target LSI, final LSI, contact force, and interlesion distance. An impedance drop of >10 Ω or an amplitude reduction of >50% was achieved at 95% and 82% of the study points, respectively. There were no major complications at any of the ablation points. Conclusion LSI-guided PVI seemed to be useful for making sufficient ablation lesions, as assessed by the conventional parameters of impedance and amplitude change.
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Affiliation(s)
- Yutaro Kaneko
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Yoshihisa Naruse
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Taro Narumi
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Makoto Sano
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Tsuyoshi Urushida
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Yuichiro Maekawa
- Division of Cardiology, Department of Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
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13
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Yokoshiki H, Shimizu A, Mitsuhashi T, Ishibashi K, Kabutoya T, Yoshiga Y, Kondo Y, Abe H, Shimizu W. Improved outcomes of cardiac resynchronization therapy with a defibrillator in systolic heart failure: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2024; 40:30-37. [PMID: 38333398 PMCID: PMC10848589 DOI: 10.1002/joa3.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 02/10/2024] Open
Abstract
Background Temporal change in outcomes of heart failure patients receiving cardiac resynchronization therapy with a defibrillator (CRT-D) is unknown. Methods We assess outcomes and underlying heart diseases of patients receiving CRT-D with analyzing database of the Japan cardiac device treatment registry (JCDTR) at the implantation year 2011-2015 and New JCDTR at the implantation year 2018-2021. Results Proportion of nonischemic heart diseases was about 70% in both the groups (JCDTR: 69%; New JCDTR: 72%). Cardiac sarcoidosis increased with the rate of 5% in the JCDTR to 9% in the New JCDTR group. During an average follow-up of 21 months, death from any cause occurred in 167 of 906 patients in the JCDTR group (18%) and 79 of 611 patients in the New JCDTR group (13%) (adjusted hazard ratio [aHR] in the New JCDTR group, 0.72; 95% confidence interval [CI]: 0.55-0.94; p = .017). The superiority was mainly driven by reduction in the risk of noncardiac death. With regard to appropriate and inappropriate implantable cardioverter-defibrillator (ICD) therapy, there was a significant reduction in the New JCDTR group versus the JCDTR group (aHR in the New JCDTR group, 0.76; 95% CI: 0.59-0.98; p = .032 for appropriate ICD therapy; aHR in the New JCDTR group, 0.24; 95% CI: 0.12-0.50; p < .0001 for inappropriate ICD therapy). Conclusions All-cause mortality was reduced in CRT-D patients implanted during 2018-2021 compared to those during 2011-2015, with a significant reduction in noncardiac death.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | | | - Takeshi Mitsuhashi
- Department of Cardiovascular MedicineHoshi General HospitalKoriyamaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineShimotsukeJapan
| | - Yasuhiro Yoshiga
- Division of Cardiology, Department of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineUbeJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolBunkyo‐kuJapan
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14
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Kataoka N, Imamura T, Koi T, Uchida K, Kinugawa K. Adverse Events Requiring Hospitalization Following Catheter Ablation for Atrial Fibrillation in Heart Failure with versus without Systolic Dysfunction. J Cardiovasc Dev Dis 2024; 11:35. [PMID: 38392249 PMCID: PMC10888582 DOI: 10.3390/jcdd11020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The safety and efficacy of atrial fibrillation (AF) ablation in individuals with heart failure (HF) with preserved ejection fraction (EF), particularly concerning the occurrence of post-procedural adverse events necessitating hospitalization, including anticoagulant-associated major bleeding, still lack conclusive determination. METHODS Data from patients with HF and AF who underwent catheter ablation for AF between 2019 and 2022 at our institution were retrospectively reviewed. All participants were divided into an EF < 50% group or an EF ≥ 50% group according to their baseline left ventricular EF. The composite incidence of the clinical events following catheter ablation was compared between the two groups: (1) all-cause death, (2) HF hospitalization, (3) stroke or systemic embolism, and (4) major bleeding. RESULTS A total of 122 patients (75 years old, 68 male) were included. Of them, 62 (50.8%) patients had an EF ≥ 50%. EF ≥ 50% was an independent predictor of the composite endpoint (adjusted odds ratio 6.07, 95% confidence interval 1.37-26.99, p = 0.018). The incidences of each adverse event were not significantly different between the two groups, except for a higher incidence of major bleeding in the EF ≥ 50% group (12.7% vs. 0%, p = 0.026). CONCLUSIONS Among patients with HF coupled with AF, the incidence of adverse events following AF ablation proved notably elevated in patients with EF ≥ 50% in contrast to their counterparts with EF < 50%. This disparity primarily stems from a heightened occurrence of major bleeding within the EF ≥ 50% cohort. The strategy to reduce adverse events, especially in patients with EF ≥ 50%, remains the next concern.
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Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Takahisa Koi
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Sugitani, Toyama 930-0194, Japan
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15
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Melero-Polo J, Cabrera-Ramos M, Alfonso-Almazán JM, Marín-García I, Montilla-Padilla I, Ruiz-Arroyo JR, López-Rodríguez G, Ramos-Maqueda J. Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach. Front Cardiovasc Med 2024; 10:1322743. [PMID: 38239876 PMCID: PMC10794657 DOI: 10.3389/fcvm.2023.1322743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. Methods We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. Results A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. Conclusions LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.
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Affiliation(s)
- Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | | | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
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16
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Tsurumi N, Inden Y, Yanagisawa S, Hiramatsu K, Yamauchi R, Watanabe R, Suzuki N, Shimojo M, Suga K, Tsuji Y, Murohara T. Clinical outcomes and predictors of delayed echocardiographic response to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2024; 35:97-110. [PMID: 37897084 DOI: 10.1111/jce.16125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy (CRT) remain unclear. We aimed to investigate the differences in outcomes and gain insight into the mechanisms of early and delayed responses to CRT. METHODS This retrospective study included 110 patients who underwent CRT implantation. Positive response to CRT was defined as ≥15% reduction of left ventricular (LV) end-systolic volume on echocardiography at 1 year (early phase) and 3 years (delayed phase) after implantation. The latest mechanical activation site (LMAS) of the LV was identified using two-dimensional speckle-tracking radial strain analysis. RESULTS Seventy-eight (71%) patients exhibited an early response 1 year after CRT implantation. Of 32 non-responders in the early phase, 12 (38%) demonstrated a delayed response, and 20 (62%) were classified as non-responders after 3 years. During the follow-up time of 10.3 ± 0.5 years, the delayed and early responders had a similar prognosis of mortality and heart failure (HF) hospitalization. In contrast, non-responders had a worse prognosis. Multivariate analysis revealed that a longer duration (months) between initial HF hospitalization and CRT (odds ratio [OR]: 1.126; 95% confidence interval [CI]: 1.036-1.222; p = .005), non-exact concordance of LV lead location with LMAS (OR: 32.744; 95% CI: 1.101-973.518; p = .044), and pre-QRS duration (OR: 0.901; 95% CI: 0.827-0.981; p = .016) were independent predictors of delayed response to CRT compared with early response. CONCLUSION The prognoses were similar regardless of the response time after CRT. A longer history of HF, suboptimal LV lead position, and shorter pre-QRS duration were related to delayed response than early response.
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Affiliation(s)
- Naoki Tsurumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kei Hiramatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryo Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Noriyuki Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazumasa Suga
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukiomi Tsuji
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Okubo Y, Oguri N, Sakai T, Uotani Y, Furutani M, Miyamoto S, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Conduction velocity mapping in atrial fibrillation using omnipolar technology. Pacing Clin Electrophysiol 2024; 47:19-27. [PMID: 38041418 DOI: 10.1111/pace.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Recent studies have shown that atrial slow conduction velocity (CV) is associated with the perpetuation of atrial fibrillation (AF). However, the criteria of CV measurement have not been standardized. The aim of this study was to evaluate the relationship between the slow CV area (SCVA) measured by novel omnipolar technology (OT) and AF recurrence. METHODS This study included 90 patients with AF who underwent initial pulmonary vein isolation (PVI). The segmented surface area of the SCVA was measured by left atrial (LA) electrophysiological mapping using OT before the PVI. The proportion of the SCVA at each cutoff value of CV (from < 0.6 to < 0.9 m/s) was compared between the patients with and without AF recurrence. RESULTS During a mean follow-up period of 516 ± 197 days, the recurrence of AF after the initial PVI was observed in 23 (25.5%) patients. In patients with AF recurrence, the proportion of the SCVA in the LA posterior, LA appendage (LAA), and LA anterior were significantly higher than those without AF recurrence. The multivariate analysis indicated that the proportion of the low voltage area and the SCVA in the LA anterior (local CV < 0.7 m/s) were independent predictors of AF recurrence (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01-1.14; p = 0.03; HR, 1.40; 95% CI, 1.07-1.83; p = 0.01, respectively). CONCLUSION By evaluating the local CV using OT, it was indicated that SCVA with CV < 0.7 m/s in the LA anterior is strongly associated with AF recurrence after PVI.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takumi Sakai
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Motoki Furutani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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18
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Tsuji T, Aoyama D, Ishida T, Nomura R, Kakehashi S, Mukai M, Hasegawa K, Uzui H, Tada H. Contrast-enhanced computed tomography in the venous rather than the arterial phase is essential for the evaluation of the right phrenic nerve. Pacing Clin Electrophysiol 2023; 46:1526-1535. [PMID: 37899685 DOI: 10.1111/pace.14842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Preprocedural detection of the running course of the right pericardiophrenic bundles (PBs) is considered to be useful in preventing phrenic nerve (PN) injury during catheter ablation for atrial fibrillation (AF). However, previous studies using the arterial phase of contrast-enhanced computed tomography (CT) reported a relatively low right PBs detection rate. METHODS This study included 63 patients with AF who underwent catheter ablation and preoperative contrast-enhanced CT imaging of the venous and arterial phases (66.7 ± 10.2 years; 44 male). The venous phase of contrast-enhanced CT significantly improved the detection rate of PBs compared to the arterial phase (96.8% vs. 60.3%, p < .001), and PBs were detected in the venous phase only in 23 (36.7%) patients. No significant differences were observed between the right PBs detection rate using non-contrast CT versus the arterial phase of contrast-enhanced CT (p = .37). Patients without visualization of the right PBs during the arterial phase had a higher frequency of chronic heart failure (p = .0083), lower left ventricular ejection fraction (p = .021), and a higher CHADS2 score (p = .048) than those with visualization. In five patients whose right PBs could only be detected during the venous phase of contrast-enhanced CT, the reconstructed running course of the right PBs corresponded with the PN generated by electrical high-output pacing. CONCLUSION Contrast-enhanced CT images of the venous phase, rather than the arterial phase, are useful in detecting the right PBs, especially in patients with heart failure or reduced left ventricular ejection fraction.
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Affiliation(s)
- Toshihiko Tsuji
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomokazu Ishida
- Department of Radiography, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ryohei Nomura
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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19
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Takenaka S, Ueno A, Iida D, Sakakibara M. The efficacy of right ventricular pacing for symptomatic left mid-ventricular obstruction. J Arrhythm 2023; 39:988-991. [PMID: 38045452 PMCID: PMC10692842 DOI: 10.1002/joa3.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
The serial changes in intraventricular pressure gradient in the left ventricle and NYHA functional classification in each case. Both the left intraventricular pressure gradient and symptoms improved after right ventricular pacing. In one case, the left intraventricular pressure gradient disappeared immediately after right ventricular pacing, while in the others it disappeared during the chronic phase, more than a year later.
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Affiliation(s)
- Sou Takenaka
- Department of CardiologyIMS Katsushika Heart CenterTokyoJapan
| | - Akihiko Ueno
- Department of CardiologyIMS Katsushika Heart CenterTokyoJapan
| | - Daisuke Iida
- Department of CardiologyIMS Katsushika Heart CenterTokyoJapan
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20
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Chen J, Qiu Y, Chen H, Jin C, Wang Y, Ju W, Yang G, Gu K, Liu H, Wang Z, Jiang X, Li M, Wang D, Chen M. Persistent left superior vena cava isolation in patients with atrial fibrillation: Selective or empirical? Pacing Clin Electrophysiol 2023; 46:1379-1386. [PMID: 37943014 DOI: 10.1111/pace.14872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/14/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is the most prevalent form of thoracic venous abnormality and can serve as a significant arrhythmogenic source in atrial fibrillation (AF). METHODS AND RESULTS Among the 3950 patients who underwent radiofrequency ablation for AF between September 2014 to April 2020, 17 patients (mean age 59.4 ± 8.0 years, 64.7% male) with PLSVC were identified. Among them, nine patients (52.9%) had a prior history of pulmonary vein isolation (PVI) alone. Eight out of nine patients who experienced AF recurrence underwent PLSVC isolation with or without pulmonary vein (PV) reconnection. For the remaining eight patients (47.1%), PVI plus PLSVC isolation were performed during the index procedure. Ectopy originating from PLSVC was documented in 11 patients (64.7%) and successful PLSVC isolation was achieved in 16 patients (94.1%). After a median follow-up of 28.3 months, freedom from AF/ atrial tachycardia (AT) was observed in 13 patients (76.5%). CONCLUSION Empirical PLSVC isolation beyond PVI appears to be a feasible and safe strategy to prevent AF recurrence in patients with concomitant PLSVC.
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Affiliation(s)
- Jianquan Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Qiu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Caiyi Jin
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxuan Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohong Jiang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Daowu Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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21
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Kawakami H, Saito M, Fujisawa T, Nagai T, Nishimura K, Akazawa Y, Miyoshi T, Higaki A, Seike F, Higashi H, Inoue K, Ikeda S, Yamaguchi O. A cost-effectiveness analysis of remote monitoring after pacemaker implantation for bradycardia in Japan. J Cardiol 2023; 82:388-397. [PMID: 37343930 DOI: 10.1016/j.jjcc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Although remote monitoring (RM) after pacemaker implantation is common, its cost-effectiveness has not been fully investigated. Therefore, we assessed the cost-effectiveness of RM compared with conventional follow-up (CFU) in Japanese patients with pacemakers. METHODS A Markov model was constructed to analyze costs and quality-adjusted life years after pacemaker implantation. The target population was Japanese patients implanted with a dual-chamber pacemaker for bradycardia. Transition probabilities (e.g. atrial fibrillation, stroke, and device trouble) were obtained from literature and expert sources. Additionally, stroke risk was determined according to anticoagulation and CHADS2 scores. We used a 10-year horizon with sensitivity analyses for significant variables. RESULTS Compared to CFU, RM was more effective; however, it was also more expensive. When the range of the Japanese willingness-to-pay threshold was considered to be ¥5,000,000, RM was at least cost-neutral relative to the CFU in all elderly patients with pacemakers for bradycardia. The cost-effectiveness of RM relative to CFU could be higher for patients with high CHADS2 scores, especially in patients with a CHADS2 score ≥ 3. Scenario analyses changing the interval between visits to an in-office evaluation in the CFU also demonstrated the same conclusions. In particular, when the interval between office visits was 1 year for the CFU, the RM could be more cost-effective. CONCLUSIONS This study demonstrated that RM can be a cost-effective option for Japanese patients, especially those with high CHADS2 scores and long-term intervals between office visits.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan.
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Tomoki Fujisawa
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akinori Higaki
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Fumiyasu Seike
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
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22
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Iwawaki T, Morishima I, Kanzaki Y, Morita Y, Watanabe N, Yoshioka N, Shibata N, Miyazawa H, Shimojo K, Yanagisawa S, Inden Y, Murohara T. Elevated liver fibrosis-4 index predicts recurrence after catheter ablation for atrial fibrillation in patients with heart failure. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01661-2. [PMID: 37855993 DOI: 10.1007/s10840-023-01661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The fibrosis-4 (FIB-4) index is a noninvasive scoring system that is used to assess the progression of liver fibrosis. This study aimed to assess whether the FIB-4 index is associated with recurrent atrial fibrillation (AF) after catheter ablation in patients with and without heart failure (HF). METHODS We included 1,184 patients who underwent initial AF catheter ablation between 2016 and 2021. The patients were classified into low-risk (< 1.3), intermediate-risk (1.3-2.67), and high-risk (> 2.67) groups based on their FIB-4 indices at baseline. The patients were divided into HF (n = 552) and non-HF groups (n = 632); the HF group was further divided into paroxysmal AF (PAF) and non-PAF groups. AF recurrence after catheter ablation was then compared among the groups. RESULTS In the non-HF group, no significant differences in recurrence after ablation were observed between the low-(n = 219), intermediate-(n = 364), and high-risk (n = 49) groups. In contrast, in the HF group, the intermediate-(n = 341) and high-risk (n = 112) groups had significantly higher recurrence rates than the low-risk group (n = 99) (log-rank test, p = 0.005). This association remained significant after multivariate analysis (hazard ratio [HR]:1.374; p = 0.027). The FIB-4 index increased incrementally as the brain natriuretic peptide levels and severity of tricuspid regurgitation increased. The FIB-4 index was an independent predictor of recurrence in the non-PAF HF group (HR:1.498; p = 0.007) but not in the PAF group. CONCLUSIONS The FIB-4 index may be a useful predictor of AF recurrence after catheter ablation in patients with HF, particularly in those with non-PAF.
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Affiliation(s)
- Tomoya Iwawaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Hiroyuki Miyazawa
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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23
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Goya M, Hirao K, Aonuma K, Nogami A, Yamane T, Yamauchi Y, Okishige K, Yotsukura A, Kimura M, Naito S, Kato R, Nitta J, Inaba O, Satomi K, Morita N, Kobayashi Y, Inden Y, Yoshida Y, Kakita K, Kobori A, Kusano K, Inoue K, Masuda M, Hiroshima K, Koyama J, Kumagai K, Okumura K. Initial multicenter clinical experience with the first-generation endoscopic guided laser balloon in Japan. J Interv Card Electrophysiol 2023; 66:1713-1721. [PMID: 36765021 DOI: 10.1007/s10840-023-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Isolation of the pulmonary veins (PVs) is the golden standard for atrial fibrillation (AF) ablation. To achieve a permanent PV isolation, the endoscopic guided HeartLight laser balloon system was invented. We analyzed the safety and efficacy of this laser balloon system. METHODS AND RESULTS Three hundred four patients from 21 investigational sites inside Japan were enrolled in this study. One thousand sixty-two out of 1175 PVs (90.4%) were isolated using the HeartLight laser balloon. The isolation rate of the left superior, left inferior, right superior, and right inferior PVs was 87.8%, 91.3%, 91.6%, and 92.1%, respectively. The procedure time, defined as the time from the venous access to taking out the balloon, was 155 ± 39 min. The fluoroscopic time was 44 ± 25 min. The mean follow-up period was 309 ± 125 days. The freedom from AF recurrence at 3 months was 89.0% and at 12 months 82.1%. Adverse events occurred in 22 patients (7.2%) including phrenic nerve injury lasting more than 3 months in 1.6% and strokes in 1.0% of the patients. CONCLUSIONS This initial experience demonstrated that the laser balloon ablation was feasible for PV isolation in Japanese AF patients.
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Affiliation(s)
- Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Akihiko Yotsukura
- Department of Cardiovascular Medicine, Hokko Memorial Hospital, Sapporo, Japan
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Junichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Ken Kakita
- Department of Arrhythmia, Koseikai Takeda Hospital, Kyoto, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Koichiro Kumagai
- Heart Rhythm Center Fukuoka Sanno Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
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24
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Iwakawa H, Suzuki T, Terata K, Watanabe H. Successful treatment of lead-related superior vena cava syndrome in combination with transvenous lead extraction and venous stenting. J Arrhythm 2023; 39:813-815. [PMID: 37799792 PMCID: PMC10549838 DOI: 10.1002/joa3.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
We experienced a case of lead-related SVC syndrome, which was successfully treated using unique transvenous lead extraction technique and endovascular stenting. This case also suggests that intravascular ultrasound facilitates decision-making on whether the interventionist should perform TLE alone or add stenting in case of a lead-related venous obstruction.
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Affiliation(s)
- Hidehiro Iwakawa
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Tomohito Suzuki
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Ken Terata
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | - Hiroyuki Watanabe
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
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25
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Ogano M, Iwasaki YK, Okada T, Tanabe J, Shimizu W, Asai K. Preferred left ventricular lead position for upgrade from right ventricular pacing to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2023; 34:1925-1932. [PMID: 37449446 DOI: 10.1111/jce.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is well-established for treating symptomatic heart failure with electrical dyssynchrony. The left ventricular (LV) lead position is recommended at LV posterolateral to lateral sites in patients with left bundle branch block; however, its preferred region remains unclear in patients being upgraded from right ventricular (RV) apical pacing to CRT. This study aimed to identify the preferred LV lead position for upgrading conventional RV apical pacing to CRT. METHODS We used electrode catheters positioned at the RV apex and LV anterolateral and posterolateral sites via the coronary sinus (CS) branches to measure the ratio of activation time to QRS duration from the RV apex to the LV anterolateral and posterolateral sites during RV apical pacing. Simultaneous biventricular pacing was performed at the RV apex and each LV site, and the differences in QRS duration and LV dP/dtmax from those of RV apical pacing were measured. RESULTS Thirty-seven patients with anterolateral and posterolateral LV CS branches were included. During RV apical pacing, the average ratio of activation time to QRS duration was higher at the LV anterolateral site than at the LV posterolateral site (0.90 ± 0.06 vs. 0.71 ± 0.11, p < .001). The decreasing ratio of QRS duration and the increasing ratio of LV dP/dtmax were higher at the LV anterolateral site than at the posterolateral site (45.7 ± 18.0% vs. 32.0 ± 17.6%, p < .001; 12.7 ± 2.9% vs. 3.7 ± 8.2%, p < .001, respectively) during biventricular pacing compared with RV apical pacing. CONCLUSION The LV anterolateral site is the preferred LV lead position in patients being upgraded from conventional RV apical pacing to CRT.
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Affiliation(s)
- Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Taiji Okada
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Jun Tanabe
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
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Yamashita S, Mizukami A, Ono M, Hiroki J, Miyakuni S, Ueshima D, Matsumura A, Miyazaki S, Sasano T. Higher power achieves greater local impedance drop, shorter ablation time, and more transmural lesion formation in comparison to lower power in local impedance guided radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1869-1877. [PMID: 37529869 DOI: 10.1111/jce.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Since the local impedance (LI) of the ablation catheter reflects tissue characteristics, the efficacy of higher power (HP) compared to lower power (LP) in LI-guided ablation may differ from other index-guided ablations. OBJECTIVE This study aimed to assess the efficacy of HP ablation in LI-guided ablation of atrial fibrillation (AF). METHODS A prospective observational study was conducted, enrolling patients undergoing de novo ablation for AF. Pulmonary vein isolation was performed using point-by-point ablation with a RHYTHMIA HDxTM Mapping System and an open-irrigated ablation catheter with mini-electrodes (IntellaNav MIFI OI). Ablation was stopped when the LI drop reached 30 ohms, three seconds after the LI plateaued, or when ablation time reached 30 s. To balance the baseline differences, a unique method was used in which the power was changed between HP (45 W to anterior wall/40 W to posterior wall) and LP (35 W/30 W) alternately for each adjacent point. RESULTS A total of 551 ablations in 10 patients were analyzed (HP, n = 276; LP, n = 275). The maximum LI drop was significantly larger (HP: 28.3 ± 5.4 vs. LP: 24.8 ± 6.3 ohm), and the time to minimum LI was significantly shorter (HP: 15.0 ± 6.3 vs. LP: 19.3 ± 6.6 s) in the HP setting. The unipolar electrogram analysis of three patients revealed that the electrogram indicating transmural lesion formation was observed more frequently in the HP setting. CONCLUSION In LI-guided ablation, the HP could achieve a larger LI drop and shorter time to minimum LI, which may result in more transmural lesion formation compared to a LP setting.
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Affiliation(s)
- Shu Yamashita
- Department of Cardiology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Maki Ono
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Jiro Hiroki
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Shota Miyakuni
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Ueshima
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | | | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Nodera M, Igarashi M, Hasegawa K, Aonuma K, Nogami A, Tada H. The R Wave Amplitude in Lead aVL Could Predict Successful Catheter Ablation of Ventricular Arrhythmias Originating below the His Bundle Region of the Right Ventricle. Int Heart J 2023; 64:614-622. [PMID: 37460316 DOI: 10.1536/ihj.23-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Radiofrequency catheter ablation (RFCA) to treat ventricular arrhythmias (VAs) originating below the His bundle (HB) region of the right ventricular (RV) septum could impair the atrioventricular node conduction. This study aimed to clarify the parameters of the 12-lead electrocardiography that predict successful RFCA of VAs originating from this region. This study included 20 consecutive patients (13 men; mean age, 68 ± 7 years) with monomorphic VAs in whom the earliest ventricular activation during the VA was below the HB region of the RV septum. According to the ablation results, the patients were divided into two groups: successful ablation (S-group; n = 10) and failed ablation groups (F-group; n = 10). The electrocardiographic parameters during the VAs and RFCA results were assessed. The R wave amplitudes in leads aVL (P = 0.001) and I (P = 0.010) in the S-group were both smaller than those in the F-group. In addition, the S-group had smaller negative deflection amplitudes in leads III (P = 0.002) and aVF (P = 0.003) than the F-group. According to the receiver operating characteristic curve analysis, the most useful electrocardiographic parameter for predicting successful ablation was the R wave amplitude in lead aVL (area under the curve, 0.895; P < 0.001); a cutoff value of < 1.3 mV predicted a successful RFCA with the highest accuracy (sensitivity, 90%; specificity, 80%; positive predictive value, 82%; negative predictive value, 89%). The R wave amplitude in lead aVL was the most useful parameter for predicting a successful RFCA to treat VAs originating below the HB region of the RV septum.
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Affiliation(s)
- Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Miyako Igarashi
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Kazutaka Aonuma
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Akihiko Nogami
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
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Suzuki N, Inden Y, Yanagisawa S, Shimizu Y, Narita S, Hiramatsu K, Yamauchi R, Watanabe R, Tsurumi N, Shimojo M, Suga K, Tsuji Y, Shibata R, Murohara T. Different time course effect of autonomic nervous modulation after cryoballoon and hotballoon catheter ablations for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01581-1. [PMID: 37354369 DOI: 10.1007/s10840-023-01581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Few studies have reported on the quantitative evaluation of autonomic nerve modification after balloon ablation. Therefore, this study aimed to evaluate the effects of cryoballoon and hotballoon ablations on the autonomic nervous system (ANS) and their relationship with prognosis. METHODS We included 234 patients who underwent cryoballoon ablation (n = 190) or hotballoon ablation (n = 44) for paroxysmal atrial fibrillation. Heart rate variability (HRV) analysis was performed on all patients using a 3-min electrocardiogram at baseline, 1, 3, 6, and 12 months after ablation. HRV parameters and prognoses were compared between the two balloon systems. RESULTS Ln low-frequency (LF), Ln high-frequency (HF), standard deviation of the R-R intervals (SDNN), and RR intervals significantly decreased after 1 month in both groups, but the changes were more pronounced in the cryoballoon group than in the hotballoon group. In contrast, HRV indices in the hotballoon ablation group decreased gradually and reached their lowest point 3-to-6 months after the procedure, which was later than in the cryoballoon ablation group. The recurrence rate did not differ between the two groups. HRV parameters changed similarly in the cryoballoon group, regardless of recurrence. However, patients with recurrence had significantly higher SDNN and Ln LF at 12 months than those without recurrence in the hotballoon group (41.2 ± 39.3 ms vs. 18.5 ± 12.6 ms, p = 0.006, and 2.2 ± 0.7 ms2 vs. 1.5 ± 0.7 ms2, p = 0.003, respectively). CONCLUSIONS The time course of HRV changes differed between cryoballoon and hotballoon ablations. Hence, the two balloon systems may have distinct effects on the ANS and its role in prognosis.
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Affiliation(s)
- Noriyuki Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Yuuki Shimizu
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Shingo Narita
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kei Hiramatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ryo Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Tsurumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kazumasa Suga
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Yukiomi Tsuji
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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Nakamura T, Aiba T, Shimizu W, Furukawa T, Sasano T. Prediction of the Presence of Ventricular Fibrillation From a Brugada Electrocardiogram Using Artificial Intelligence. Circ J 2023; 87:1007-1014. [PMID: 36372400 DOI: 10.1253/circj.cj-22-0496] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Brugada syndrome is a potential cause of sudden cardiac death (SCD) and is characterized by a distinct ECG, but not all patients with A Brugada ECG develop SCD. In this study we sought to examine if an artificial intelligence (AI) model can predict a previous or future ventricular fibrillation (VF) episode from a Brugada ECG.Methods and Results: We developed an AI-enabled algorithm using a convolutional neural network. From 157 patients with suspected Brugada syndrome, 2,053 ECGs were obtained, and the dataset was divided into 5 datasets for cross-validation. In the ECG-based evaluation, the precision, recall, and F1score were 0.79±0.09, 0.73±0.09, and 0.75±0.09, respectively. The average area under the receiver-operating characteristic curve (AUROC) was 0.81±0.09. On per-patient evaluation, the AUROC was 0.80±0.07. This model predicted the presence of VF with a precision of 0.93±0.02, recall of 0.77±0.14, and F1score of 0.81±0.11. The negative predictive value was 0.94±0.11 while its positive predictive value was 0.44±0.29. CONCLUSIONS This proof-of-concept study showed that an AI-enabled algorithm can predict the presence of VF with a substantial performance. It implies that the AI model may detect a subtle ECG change that is undetectable by humans.
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Affiliation(s)
- Tomofumi Nakamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsushi Furukawa
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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30
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Sawada M, Kurokawa S, Okumura Y. Trends over the recent 6 years in ablation modalities and strategies, post-ablation medication, and clinical outcomes of atrial fibrillation ablation. J Arrhythm 2023; 39:366-375. [PMID: 37324765 PMCID: PMC10264728 DOI: 10.1002/joa3.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post-ablation medication and clinical outcomes remains to be fully investigated. Methods We divided 682 patients who had undergone AF ablation in 2014-2019 (420 paroxysmal AFs [PAF], 262 persistent AFs [PerAF]) into three groups according to the period, that is, the 2014-2015 (n = 139), 2016-2017 (n = 244), and 2018-2019 groups (n = 299), respectively. Results Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra-pulmonary vein (PV)-LA ablation was more frequently performed in the 2014-2015 group than in the 2016-2017 and 2018-2019 groups (41.1% vs. 9.1% and 8.1%; p < .001). The 2-year freedom rate from AF/atrial tachycardias for PAF was similar among the three groups (84.0% vs. 83.1% vs. 86.7%; p = .98) but lowest in the 2014-2015 group for PerAF (63.9% vs. 82.7% and 86.3%; p = .025) despite the highest post-ablation antiarrhythmic drug use. Cardiac tamponade was significantly decreased in the 2018-2019 group (3.6% vs. 2.0% vs. 0.33%; p = 0.021). There was no difference in the 2-year clinically relevant events among the three groups. Conclusion Although ablation was performed in a more diseased LA and extra-PV-LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased. Clinically relevant events remained unchanged over the recent 6 years, suggesting that the impact of the recent ablation modalities and strategies on remote clinically relevant events may be small during this study period.
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Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Satoshi Hayashida
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Masanaru Sawada
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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31
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Yodogawa K, Fujimoto Y, Hagiwara K, Oka E, Hayashi H, Murata H, Yamamoto T, Iwasaki YK, Shimizu W. Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block. Letter to the editor (response to Koshida H, et al.). Heart Vessels 2023; 38:615. [PMID: 35802183 DOI: 10.1007/s00380-022-02138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kanako Hagiwara
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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32
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Subcutaneous ICDs implantation following removal of normally functioning non-infected transvenous ICDs in two young patients. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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33
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Kataoka S, Yagishita D, Yazaki K, Hasegawa S, Kanai M, Ejima K, Shoda M. Lead switching to resolve undersensing of ventricular tachycardia by a cardiac resynchronization therapy defibrillator. Pacing Clin Electrophysiol 2023; 46:264-267. [PMID: 36161665 DOI: 10.1111/pace.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/02/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
A 63-year-old man was admitted to the hospital due to ventricular tachycardia (VT) undersensing, caused by decreased R-wave amplitude in a cardiac resynchronization therapy defibrillator. The R-wave amplitude of VT sensed by the left ventricular (LV) lead was markedly higher than that by the right ventricular (RV) lead; therefore, we reconnected the IS-1 RV lead to the LV IS-1 port and the IS-1 LV lead to the RV IS-1 port to resolve this issue. After discharge, it was confirmed that VT was successfully terminated by the second sequence of intrinsic ATP (iATP, Medtronic, Minneapolis, MN, USA) from the LV lead.
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Affiliation(s)
- Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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34
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Shimojo M, Inden Y, Yanagisawa S, Suzuki N, Tsurumi N, Watanabe R, Nakagomi T, Okajima T, Suga K, Tsuji Y, Murohara T. A novel practical algorithm using machine learning to differentiate outflow tract ventricular arrhythmia origins. J Cardiovasc Electrophysiol 2023; 34:627-637. [PMID: 36651347 DOI: 10.1111/jce.15823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Diagnosis of outflow tract ventricular arrhythmia (OTVA) localization by an electrocardiographic complex is key to successful catheter ablation for OTVA. However, diagnosing the origin of OTVA with a precordial transition in lead V3 (V3TZ) is challenging. This study aimed to create the best practical electrocardiogram algorithm to differentiate the left ventricular outflow tract (LVOT) from the right ventricular outflow tract (RVOT) of OTVA origin with V3TZ using machine learning. METHODS Of 498 consecutive patients undergoing catheter ablation for OTVA, we included 104 patients who underwent ablation for OTVA with V3TZ and identified the origin of LVOT (n = 62) and RVOT (n = 42) from the results. We analyzed the standard 12-lead electrocardiogram preoperatively and measured 128 elements in each case. The study population was randomly divided into training group (70%) and testing group (30%), and decision tree analysis was performed using the measured elements as features. The performance of the algorithm created in the training group was verified in the testing group. RESULTS Four measurements were identified as important features: the aVF/II R-wave ratio, the V2S/V3R index, the QRS amplitude in lead V3, and the R-wave deflection slope in lead V3. Among them, the aVF/II R-wave ratio and the V2S/V3R index had a particularly strong influence on the algorithm. The performance of this algorithm was extremely high, with an accuracy of 94.4%, precision of 91.5%, recall of 100%, and an F1-score of 0.96. CONCLUSIONS The novel algorithm created using machine learning is useful in diagnosing the origin of OTVA with V3TZ.
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Affiliation(s)
- Masafumi Shimojo
- Department of Cardiovascular Research and Innovation, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Noriyuki Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki Tsurumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryo Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshifumi Nakagomi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Okajima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazumasa Suga
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukiomi Tsuji
- Department of Cardiovascular Research and Innovation, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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35
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Koi T, Kataoka N, Uchida K, Imamura T, Kinugawa K. Urinary isoxanthopterin as a novel predictor following catheter ablation for atrial fibrillation. J Arrhythm 2023; 39:159-165. [PMID: 37021030 PMCID: PMC10068925 DOI: 10.1002/joa3.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 03/07/2023] Open
Abstract
Background Oxidative stress is associated with atrial fibrillation recurrence following catheter ablation. Urinary isoxanthopterin (U-IXP) is one of the noninvasive markers which reflect the reactive oxygen species; however, its ability to predict atrial tachyarrhythmias (ATAs) occurrence following catheter ablation remains uncertain. Methods Among the patients who received scheduled catheter ablation for atrial fibrillation, baseline U-IXP levels were measured just before the procedure. The prognostic impact of baseline U-IXP upon postprocedural ATAs occurrence was investigated. Results Among 107 patients (71 years old, 68% men), baseline U-IXP level was 0.33 nmol/gCr on the median. During a mean of 603 days of follow-up, 32 patients had ATAs. Baseline higher U-IXP was independently associated with the occurrence of ATAs following catheter ablation with a hazard ratio of 4.69 (95% confidence interval: 1.82-12.37, p = .001) adjusted for the left atrial diameter, a persistent type, and hypertension which were potential confounders, with a cutoff of 0.46 nmol/gCr, which stratified cumulative incidence of ATAs occurrence ( p < .001). Conclusion U-IXP can be used as the noninvasive predictive biomarker for ATAs following catheter ablation for atrial fibrillation.
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Affiliation(s)
- Takahisa Koi
- Second Department of Internal Medicine University of Toyama Toyama Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine University of Toyama Toyama Japan
| | - Keisuke Uchida
- Second Department of Internal Medicine University of Toyama Toyama Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine University of Toyama Toyama Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine University of Toyama Toyama Japan
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36
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Matsumoto K, Kawano D, Sasaki W, Tanaka N, Narita M, Mori H, Tsutsui K, Ikeda Y, Arai T, Nakano S, Kato R, Matsumoto K. Detailed investigation of the lesion formation with a novel contact force sensing catheter with a mesh‐shaped irrigation tip. J Arrhythm 2023; 39:166-174. [PMID: 37021033 PMCID: PMC10068932 DOI: 10.1002/joa3.12835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Background Recently, a novel contact force (CF) sensing catheter with mesh-shaped irrigation tip (TactiFlex SE, Abbott) was invented and is expected to be useful for safe and effective radiofrequency ablation. However, this catheter's detailed characteristics of the lesion formation are unknown. Methods With an in vitro model, TactiFlex SE and its predecessor, FlexAbility SE, were used. A cross-sectional analysis of 60 s lesions (combination of various energy power settings [30, 40, and 50 W], and CFs [10, 30, and 50 g]) and longitudinal analysis (combination of various powers [40 or 50 W], CFs [10, 30, and 50 g] and ablation times [10, 20, 30, 40, 50, and 60 s]) of both catheters were analyzed and compared. Results One hundred eighty RF lesions were created in protocol 1 and 300 in protocol 2. The lesion formation, impedance changes, and steam pops characteristics were similar between the two catheters. Higher CFs were related to higher incidences of steam pops. A nonlinear, time-dependent increase in the lesion depth and diameter was observed for all power and CF settings, and linear, positive correlations between the RF delivery time and lesion volume were observed for all power settings. Compared with 40 W, a 50 W ablation created greater lesions. Longer durations with higher CF settings had a higher steam pop incidence. Conclusions The lesion formation and incidence of steam pops with TactiFlex SE and FlexAbility SE were similar. A 40 or 50 W ablation with careful CF control not to exceed 30 g in addition to monitoring impedance drops was required to safely create transmural lesions.
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Affiliation(s)
- Kazuhisa Matsumoto
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Daisuke Kawano
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Wataru Sasaki
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Naomichi Tanaka
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Masataka Narita
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Hitoshi Mori
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Kenta Tsutsui
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Yoshifumi Ikeda
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Takahide Arai
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Shintaro Nakano
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Ritsushi Kato
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
| | - Kazuo Matsumoto
- Department of Cardiology Saitama Medical University International Medical Center Hidaka Japan
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Aoyama D, Miyazaki S, Tsuji T, Nomura R, Kakehashi S, Mukai M, Ikeda H, Ishida K, Uzui H, Tada H. Low troponin I levels predict the presence of arrhythmia-induced cardiomyopathy in patients with atrial fibrillation and left ventricular systolic dysfunction. Heart Vessels 2023; 38:929-937. [PMID: 36823474 DOI: 10.1007/s00380-023-02242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023]
Abstract
Successful atrial fibrillation (AF) ablation can improve reduced left ventricular ejection fraction (LVEF) with AF, which is defined as arrhythmia-induced cardiomyopathy (AIC). However, it is difficult to pre-procedurally predict the presence of AIC. We aimed to explore the pre-procedural predictors of AIC in patients with AF and reduced LVEF. This study included 60 patients with a reduced LVEF (LVEF < 50%; 69.1 ± 8.8 years; 45 men) who underwent successful AF ablation. Responders were defined as patients whose LVEF post-procedurally improved to the normal range (≥ 50%). Multivariate analysis revealed that the log-transformed pre-procedural troponin I (TnI) levels (odds ratio [OR] = 0.059; 95% confidence interval [CI] = 0.0052-0.42, p = 0.003) and age (OR = 0.91; 95% CI = 0.82-1.00, p = 0.044) were independent predictors of post-procedural LVEF recovery; further, low TnI levels (< 11.1 pg/ml) predicted LVEF recovery (sensitivity, 79.1%; specificity, 76.5%; positive predictive value, 89.5%; and negative predictive value, 59.1%). There were no significant differences in TnI levels between the baseline and 1 month after the procedure. However, four patients with high baseline TnI levels showed a > 50% reduction in the TnI levels post-procedurally, with three of these patients showing LVEF recovery. Low pre-procedural TnI levels can predict LVEF recovery after successful AF ablation in patients with reduced LVEF.
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Affiliation(s)
- Daisetsu Aoyama
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan.
| | - Shinsuke Miyazaki
- The Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiko Tsuji
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Ryohei Nomura
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Shota Kakehashi
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- The Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
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Magnano M, Devecchi C, Oriente D, Occhetta E, Rametta F. Proarrhythmic effect of bipolar epicardial left ventricular stimulation in CRT resolved maintaining biventricular pacing with unipolar‐cathodical configuration: A peculiar case report. J Arrhythm 2023; 39:192-197. [PMID: 37021028 PMCID: PMC10068944 DOI: 10.1002/joa3.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background The effect of cardiac resynchronization therapy (CRT) on the risk of ventricular arrhythmias is controversial. Several studies reported a decreased risk, but some studies reported a potential proarrhythmic effect of epicardial left ventricular pacing resolved upon discontinuation of biventricular pacing (BiVp). Case Summary A 67-year-old woman with a history of heart failure due to nonischemic cardiomyopathy and left bundle branch block was hospitalized for CRT device implantation. Unpredictably, as soon as the leads have been connected to the generator, an electrical storm (ES) occurred with relapsing self-resolving polymorphic ventricular tachycardia (PVT) triggered by ventricular extra beats with short-long-short sequences. The ES was resolved without interrupting BiVp switching to unipolar left ventricular (LV) pacing. This allowed to keep CRT active with extreme clinical benefit for the patient and to demonstrate that the cause of the PVT was the anodic capture of bipolar LV stimulation. Reverse electrical remodeling was also demonstrated after 3 months of effective BiVp. Discussion Proarrhythmic effect of CRT is a rare but significant complication of CRT, and it may compel to discontinuation of the BiVp. The reversal of the physiological transmural activation sequence of epicardial LV pacing and subsequent prolonging of corrected QT interval have been speculated as the most probable explanation, but our case highlights the possibility that the anodic capture may play a relevant role in PVT genesis.
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Tonegawa-Kuji R, Inoue YY, Nakai M, Kanaoka K, Sumita Y, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Wada M, Kamakura T, Yamagata K, Ishibashi K, Miyamoto K, Nagase S, Aiba T, Miyamoto Y, Iwanaga Y, Kusano K. Differences in patient characteristics, clinical practice and outcomes of cardiac implantable electric device therapy between Japan and the USA: a cross-sectional study using data from nationally representative administrative databases. BMJ Open 2023; 13:e068124. [PMID: 36639209 PMCID: PMC9843182 DOI: 10.1136/bmjopen-2022-068124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To identify differences in patient characteristics, clinical practice and outcomes of cardiac implantable electronic device (CIED) therapy between Japan and the USA. DESIGN A cross-sectional study. SETTING Nationally representative administrative databases from Japan and the USA containing hospitalisations with first-time implantations of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac-resynchronisation therapy with or without defibrillators (CRTP/CRTD). PARTICIPANTS Patients hospitalised with first-time implantations of CIEDs. OUTCOME MEASURES In-hospital mortality, in-hospital complication and 30-day readmission rates. RESULTS Overall, 107 339 (median age 78 (71-84), 48 415 women) and 295 584 (age 76 (67-83), 127 349 women) records with CIED implantations were included from Japan and the USA, respectively. Proportion of women in defibrillator recipients was lower in Japan than in the USA (ICD, 21% vs 28%, p<0.001; CRTD, 24% vs 29%, p<0.001). Length of stay after CIED implantation was longer in Japan than in the USA for all device types (conventional pacemaker, 8(7-11) vs 1 (1-3) days, p<0.001; leadless pacemaker, 5 (3-9) vs 2 (1-5) days, p<0.001; ICD, 8 (7-11) vs 1 (1-3) days, p<0.001, CRTP, 9 (7-13) vs 2 (1-4) days, p<0.001; CRTD, 9 (8-14) vs 2 (1-4) days, p<0.001). In-hospital mortality after CIED implantation was similar between Japan and the USA ((OR) (95% CI), conventional pacemaker 0.58 (0.83 to 1.004); ICD 0.77 (0.57 to 1.03); CRTP 0.85 (0.51 to 1.44); CRTD 1.11 (0.81 to 1.51)), except that after leadless pacemaker implantation in Japan was lower than that in the USA (0.32 (0.23 to 0.43)). 30-day readmission rates were lower in Japan than in the USA for all device types (conventional pacemaker 0.55 (0.53 to 0.57); leadless pacemaker 0.50 (0.43 to 0.58); ICD 0.54 (0.49 to 0.58); CRTP 0.51 (0.42 to 0.62); CRTD 0.57 (0.51 to 0.64)). CONCLUSIONS International variations in patient characteristics, practice and outcomes were observed. In-hospital mortality after CIED implantation was similar between Japan and the USA, except in cases of leadless pacemaker recipients.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuko Y Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Hasegawa K, Miyazaki S, Okada A, Ishida T, Tada H. Arrhythmogenic superior vena cava manifesting after a right-sided pneumonectomy and mediastinal lymph node dissection. J Arrhythm 2022; 39:84-87. [PMID: 36733322 PMCID: PMC9885308 DOI: 10.1002/joa3.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
No case of AF ablation after right-sided pneumonectomy has been reported, presumably because the pneumonectomy renders the ablation procedure more difficult than lobectomy because of the marked mediastinal displacement. In the case of catheter ablation of AF after right-sided pneumonectomy, it is extremely important to insert a mapping catheter not only into the PV but also into the SVC to accurately diagnose the site of abnormal electrical activity.
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Affiliation(s)
- Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Akitoshi Okada
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Tomokazu Ishida
- Department of Radiography, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
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Sasaki S, Noda T, Okumura K, Nitta T, Aizawa Y, Ohe T, Kurita T. Effectiveness of Implantable Cardioverter Defibrillator in Patients With Non-Ischemic Heart Failure With Systolic Dysfunction - Subanalysis of the Nippon Storm Study. Circ J 2022; 87:92-100. [PMID: 35922910 DOI: 10.1253/circj.cj-22-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prospective observational Nippon Storm Study aggregated clinical data from Japanese patients receiving implantable cardioverter-defibrillator (ICD) therapy. This study investigated the usefulness of prophylactic ICD therapy in patients with non-ischemic heart failure (NIHF) enrolled in the study.Methods and Results: We analyzed 540 NIHF patients with systolic dysfunction (left ventricular ejection fraction <50%). Propensity score matching was used to select patient subgroups for comparison; 126 patients were analyzed in each of the primary (PP) and secondary (SP) prophylaxis groups. The incidence of appropriate ICD therapy during follow-up in the PP and SP groups was 21.4% and 31.7%, respectively (P=0.044). The incidence of electrical storm (ES) was higher in SP than PP patients (P=0.024). Cox proportional hazard analysis revealed that increased serum creatinine in SP patients (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.02-1.33; P=0.013) and anemia in PP patients (HR 0.92; 95% CI 0.86-0.98; P=0.008) increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation in PP patients (HR, 0.64 [95% CI, 0.45-0.91], P=0.013) decreased that likelihood. CONCLUSIONS In propensity score-matched Japanese NIHF patients, the incidence of appropriate ICD therapy and ES was significantly higher in SP than PP patients. Impaired renal function in SP patients and anemia in PP patients increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation reduced that likelihood in PP patients.
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Affiliation(s)
- Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Ken Okumura
- Advanced Arrhythmia Therapeutic Branch Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Hanyu General Hospital
| | - Yoshifusa Aizawa
- Department of Research and Development, Tachikawa Medical Center
| | | | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University
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Tonegawa-Kuji R, Inoue YY, Nakai M, Kanaoka K, Sumita Y, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Kataoka N, Wada M, Yamagata K, Ishibashi K, Miyamoto K, Nagase S, Aiba T, Miyamoto Y, Iwanaga Y, Kusano K. Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope. CJC Open 2022; 5:259-267. [PMID: 37124961 PMCID: PMC10140738 DOI: 10.1016/j.cjco.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Implantable cardiac monitors (ICMs) help investigate the cause of unexplained syncope, but the probability and predictors of needing a pacing device thereafter remain unclear. Methods We retrospectively analyzed the data of patients who received ICM insertion for unexplained syncope with suspected arrhythmic etiology. The data were obtained from a nationwide database obtained between April 1, 2012 and March 31, 2020. Multivariable mixed-effects survival analysis was performed to identify predictors of pacing device implantation (PDI), and a risk score model was developed accordingly. Results In total, 2905 patients (age: 72 years [range: 60-78]) implanted with ICMs to investigate the cause of syncope were analyzed. During the median follow-up period of 128 days (range: 68-209) days, 473 patients (16%) underwent PDI. Older age, history of atrial fibrillation, bundle branch block (BBB), and diabetes were independent predictors of PDI in multivariable analysis. A risk score model was developed with scores ranging from 0 to 32 points. When patients with the lowest quartile score (0-13 points) were used as a reference, those with higher quartiles had a higher risk of PDI (second quartile: 14-15 points, hazard ratio [HR]: 3.86, 95% confidence interval [CI]: 2.62-5.68; third quartile: 16-18 points, HR: 4.67, 95% CI: 3.14-6.94; fourth quartile: 19-32 points, HR: 6.59, 95% CI: 4.47-9.71). Conclusions The 4 identified predictors are easily assessed during the initial evaluation of patients with syncope. They may help identify patients with a higher risk of requiring permanent PDI.
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Yanagisawa S, Suzuki H, Kanzaki Y, Ishikawa S, Kamikubo Y, Okumura S, Kato H, Mizutani Y, Murase Y, Nakasuka K, Warita S, Sekimoto S, Takemoto Y, Takasugi N, Ohguchi S, Senga M, Yokoi K, Shibata R, Inden Y, Murohara T. Efficacy and feasibility of cryoballoon ablation for atrial fibrillation in patients with heart failure: A large-scale multicenter study. J Cardiovasc Electrophysiol 2022; 33:2447-2464. [PMID: 36168875 DOI: 10.1111/jce.15691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Data are limited regarding outcomes of cryoballoon ablation for atrial fibrillation (AF) in patients with heart failure (HF). This large-scale multicenter study aimed to evaluate the prognosis of patients with HF after cryoballoon ablation for AF. METHODS Among 3655 patients undergoing cryoballoon ablation at 17 institutions, 549 patients (15%) (391 with paroxysmal AF and 158 with persistent AF) diagnosed with HF preoperatively were analyzed. Clinical endpoints were recurrence, mortality, and HF hospitalization after ablation. RESULTS Most patients had a preserved left ventricular ejection fraction (LVEF) ≥ 50%. During a mean follow-up period of 25.7 months, recurrence, all-cause death, and HF hospitalization occurred in 29%, 4.0%, and 4.8%, respectively. Cardiac function on echocardiography and B-type natriuretic peptide (BNP) levels significantly improved postoperatively, and the effect was more pronounced in the nonrecurrence group. Major complications occurred in 33 patients (6.0%), but most complications were phrenic nerve palsy (3.6%). Although death and HF hospitalization occurred more frequently in patients with LVEF ≤ 40% (n = 73) and New York Heart Association (NYHA) class III-IV (n = 19) than other subgroups, the BNP levels, and LVEF significantly improved after ablation in all LVEF and NYHA class subgroups. High BNP levels, NHYA class, CHADS2 score, and structural heart disease, but not postablation recurrence, independently predicted death, and HF hospitalization on multivariate analysis. The patients with tachycardia-induced cardiomyopathy had better recovery of BNP levels and LVEF after ablation than those with structural heart disease. CONCLUSIONS Cryoballoon ablation for AF in HF patients is feasible and leads to significantly improved cardiac function.
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Affiliation(s)
- Satoshi Yanagisawa
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohiko Suzuki
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shinji Ishikawa
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Kamikubo
- Department of Cardiology, Toyota Memorial Hospital, Toyota, Japan
| | - Satoshi Okumura
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hiroyuki Kato
- Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Yosuke Murase
- Department of Cardiology, Komaki City Hospital, Komaki, Japan
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunichiro Warita
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Satoru Sekimoto
- Department of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Yoshio Takemoto
- Department of Cardiology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Nobuhiro Takasugi
- Division of Cardiovascular Medicine, Gifu University Hospital, Gifu, Japan
| | - Shiou Ohguchi
- Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Michiharu Senga
- Department of Cardiology, Kuwana City Medical Center, Kuwana, Japan
| | | | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Matsumoto K, Kodama Y, Ito S, Nakamura Y, Fujiwara R, Kajio K, Kasamatsu K, Murata E, Nakamura Y, Kawase Y. Clinical predictors of cardiac syncope in patients with unexplained syncope after the implantation of an insertable cardiac monitor. Heart Vessels 2022; 38:731-739. [PMID: 36443457 DOI: 10.1007/s00380-022-02212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Syncope prognosis is related to both its etiology and comorbidities, with cardiac syncope (CS) having higher risks for mortality and cardiovascular events than syncope of non-cardiac causes. Although a novel insertable cardiac monitor (ICM) is an effective diagnostic tool for unexplained syncope, decision regarding ICM implantation with a high pre-test likelihood of CS should contribute to economic cost reduction and avoidance of unnecessary complications. This study aimed to investigate clinical factors associated with CS after ICM implantation in patients with unexplained syncope. This retrospective observational study included 31 consecutive patients with ICM implantation for syncope between September 2016 and August 2021. The initial examinations for syncope included a detailed history, physical examination, blood tests, 12-lead electrocardiograms, and transthoracic echocardiography. Of the 31 patients, 13 (41.9%) experienced recurrent CS during follow-up (676 ± 469 days). Among several clinical factors, syncope-related minor injuries (p = 0.017) and higher brain natriuretic peptide (BNP; p = 0.043) levels were significantly associated with CS. Moreover, multivariable analysis showed that both syncope-related minor injuries (odds ratio, 11.2; 95% confidence interval, 1.4-88.4; p = 0.022) and BNP higher than 64.0 pg/mL (odds ratio, 7.0; 95% confidence interval, 1.1-44.2; p = 0.038) were independent predictors of CS after ICM implantation. In conclusion, a history of minor injury secondary to syncope and higher BNP levels were independent CS predictors in patients receiving ICM for syncope. These results emphasized the utility of ICM implantation early in the diagnostic journey of patients presenting with CS predictors requiring specific treatments.
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Affiliation(s)
- Kenji Matsumoto
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan.
| | - Yuka Kodama
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Shinji Ito
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yuka Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Ryosuke Fujiwara
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kajio
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kasamatsu
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Eriko Murata
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yasuhiro Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yoshio Kawase
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
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Mizukami A, Miyakuni S, Nakada R, Kobayashi T, Kawakami T, Takegawa K, Arai H, Hiroki J, Yoshioka K, Otani H, Ono M, Yamashita S, Ueshima D, Suzuki M, Matsumura A, Goya M, Sasano T. The angle of the tines before the pull and hold test predicts engagement of the tines in Micra leadless pacemaker implantation. J Arrhythm 2022; 39:10-17. [PMID: 36733332 PMCID: PMC9885318 DOI: 10.1002/joa3.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Micra leadless pacemaker is secured to the myocardium by engagement of at least 2/4 tines confirmed with pull and hold test. However, the pull and hold test is sometimes difficult to assess. This study was performed to evaluate whether the angle of the tines before the pull and hold test predicts engagement of the tines in Micra leadless pacemaker implantation. Methods We retrospectively enrolled 93 consecutive patients (52.7% male, age 82.4 ± 9.4 years), who received Micra implantation from September 2017 to June 2020 at our institution. After deployment and before the pull and hold test, the angle of the visible tines to the body of the pacemaker was measured using the RAO view of the fluoroscopy image. The engagement of the tines was then confirmed with the pull and hold test. Results A total of 326 tines were analyzed. The angle of the engaged tines was significantly lower than the non-engaged tines (9.2 degrees [4.0-14.0] vs. 16.6 degrees [14.2-18.8], p < .0001). All tines with angles <10 degrees were engaged. In higher angles, engagement could not be predicted. Conclusion A low angle of the tines before the pull and hold test can predict engagement of the tines in Micra leadless pacemaker implantation. The tines which are already open after deployment may be presumed that they are engaged.
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Affiliation(s)
| | | | - Ryo Nakada
- Department of CardiologyKameda Medical CenterChibaJapan
| | | | | | - Koki Takegawa
- Department of CardiologyKameda Medical CenterChibaJapan
| | - Hirofumi Arai
- Department of CardiologyYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Jiro Hiroki
- Department of CardiologyKameda Medical CenterChibaJapan
| | | | | | - Maki Ono
- Department of CardiologyKameda Medical CenterChibaJapan
| | - Shu Yamashita
- Department of CardiologyKameda Medical CenterChibaJapan
| | | | - Makoto Suzuki
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | | | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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Ohguchi S, Inden Y, Yanagisawa S, Fujita R, Yasuda K, Katagiri K, Oguri M, Murohara T. Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area. BMC Cardiovasc Disord 2022; 22:457. [PMID: 36319975 PMCID: PMC9628089 DOI: 10.1186/s12872-022-02881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Left atrial (LA) conduction velocity (CV) is an electrical remodeling parameter of atrial fibrillation (AF) substrate. However, the pathophysiological substrate of LA-CV and its impact on outcomes after catheter ablation for AF have not been well evaluated. Methods We retrospectively evaluated 119 patients with AF who underwent catheter ablation and electroanatomical mapping during sinus rhythm. To measure regional LA-CV, we took triplet sites (A, B, and C) on the activation map and calculated the magnitude of the matched orthogonal projection vector between vector-AB and vector-AC, indicating two-dimensional CV. The median of the LA-CVs from four triad sites in both the anterior and posterior walls was set as the ‘model LA-CV’. We evaluated the impact of the model LA-CV on recurrence after ablation and relationship between the model LA-CV and LA-low voltage area (LVA) of < 0.5 mV. Results During the 12-month follow-up, 29 patients experienced recurrence. The LA-CV model was significantly correlated with ipsilateral LVA. The lower anterior model LA-CV was significantly associated with recurrence, with the cut-off value of 0.80 m/s having a sensitivity of 72% and specificity of 67%. Multivariable analysis revealed that the anterior model LA-CV (hazard ratio, 0.09; 95% confidence interval, 0.01–0.94; p = 0.043) and anterior LA-LVA (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) were independently associated with AF recurrence. The anterior LA-LVA was mildly correlated with the anterior model LA-CV (r = -0.358; p < 0.001), and patients with both lower LA-CV and greater anterior LA-LVA based on each cut-off value had the worst prognosis. However, decreased LA-CV was more likely to be affected by the distribution pattern of the LVA rather than the total size of the LVA. Conclusion Decreased anterior LA-CV was a significant predictor of AF recurrence and was a useful electrical parameter in addition to LA-LVA for estimating AF arrhythmogenicity. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02881-6.
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Affiliation(s)
- Shiou Ohguchi
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan ,grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan ,grid.27476.300000 0001 0943 978XDepartment of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550 Nagoya, Aichi Japan
| | - Rin Fujita
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Kenichiro Yasuda
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Ken Katagiri
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Mitsutoshi Oguri
- grid.415067.10000 0004 1772 4590Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Toyoaki Murohara
- grid.27476.300000 0001 0943 978XDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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47
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Tateishi K, Kondo Y, Saito Y, Kitahara H, Fukushima K, Takahashi H, Yamashita D, Ohashi K, Suzuki K, Hashimoto O, Sakai Y, Kobayashi Y. Implantable cardioverter-defibrillator therapy after resuscitation from cardiac arrest in vasospastic angina: A retrospective study. PLoS One 2022; 17:e0277034. [PMID: 36315563 PMCID: PMC9621437 DOI: 10.1371/journal.pone.0277034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with vasospastic angina (VSA) who are resuscitated from sudden cardiac arrest (SCA) are at a high risk of recurrent lethal arrhythmia and cardiovascular events. However, the benefit of the implantable cardioverter-defibrillator (ICD) therapy in this population has not been fully elucidated. The present study aimed to analyze the prognostic impact of ICD therapy on patients with VSA and SCA. A total of 280 patients who were resuscitated from SCA and received an ICD for secondary prophylaxis were included in the present multicenter registry. The patients were divided into two groups on the basis of the presence of VSA. The primary endpoint was a composite of all-cause death and appropriate ICD therapy (appropriate anti-tachycardia pacing and shock) for recurrent ventricular arrhythmias. Of 280 patients, 51 (18%) had VSA. Among those without VSA, ischemic cardiomyopathy was the main cause of SCA (38%), followed by non-ischemic cardiomyopathies (18%) and Brugada syndrome (7%). Twenty-three (8%) patients were dead and 72 (26%) received appropriate ICD therapy during a median follow-up period of 3.8 years. There was no significant difference in the incidence of the primary endpoint between patients with and without VSA (24% vs. 33%, p = 0.19). In a cohort of patients who received an ICD for secondary prophylaxis, long-term clinical outcomes were not different between those with VSA and those with other cardiac diseases after SCA, suggesting ICD therapy may be considered in patients with VSA and those with other etiologies who were resuscitated from SCA.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
- * E-mail:
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Kenichi Fukushima
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Hidehisa Takahashi
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Ko Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Osamu Hashimoto
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshiaki Sakai
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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48
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Mitarai K, Kondo H, Shinohara T, Uchida N, Wakabayashi T, Shinozaki K, Zaizen H, Takahashi N. Adolescent Persistent Atrial Fibrillation Concomitant with Pectus Excavatum. Intern Med 2022. [PMID: 36288988 DOI: 10.2169/internalmedicine.0744-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 19-year-old man with pectus excavatum developed symptomatic persistent atrial fibrillation (AF). He had no remarkable medical history or comorbidities and had not exercised intensely during childhood. Electrical cardioversion and pre-treatment with amiodarone for two months failed to maintain sinus rhythm. Computed tomography before ablation revealed compression of the right and left atria between the sternal bone and vertebral bodies. Voltage mapping revealed that the right and left atrial voltages were preserved within the normal limit. However, radiofrequency catheter ablation successfully eliminated recurrent persistent AF. No recurrence was observed during eight months of follow-up.
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Affiliation(s)
- Kazuki Mitarai
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Naoki Uchida
- Medical Engineering Equipment Center, Oita University Hospital, Japan
| | | | | | - Hirofumi Zaizen
- Department of Cardiology, Oita Koseiren Tsurumi Hospital, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
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49
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Ikeda S, Sakamoto K, Tokudome D, Kawai S, Ogawa K, Nagaoka K, Takase S, Kowase S, Mukai Y, Nogami A, Tsutsui H. Electrophysiological features of repetitive focal Purkinje ventricular arrhythmias originating from the proximal cardiac conduction system. J Arrhythm 2022; 38:1070-1079. [DOI: 10.1002/joa3.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shota Ikeda
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Cardiology Yokohama Rosai Hospital Yokohama Japan
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Daigo Tokudome
- Clinical Engineering Department Yokohama Rosai Hospital Yokohama Japan
| | - Shunsuke Kawai
- Department of Cardiology Fukuoka Red Cross Hospital Fukuoka Japan
| | - Kiyohiro Ogawa
- Department of Cardiology Fukuoka City Hospital Fukuoka Japan
| | | | - Susumu Takase
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Shinya Kowase
- Department of Cardiology Yokohama Rosai Hospital Yokohama Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Cardiology Fukuoka Red Cross Hospital Fukuoka Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
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50
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Kamada H, Mori K, Ueda N, Wakamiya A, Nakajima K, Kamakura T, Wada M, Ishibashi K, Yamagata K, Inoue Y, Miyamoto K, Nagase S, Noda T, Izumi C, Noguchi T, Kusano K, Aiba T. Impact of Pre-Ablation Direct Current Cardioversion for Persistent Atrial Fibrillation to Predict Recurrence of Atrial Fibrillation after Catheter Ablation. Int Heart J 2022; 63:828-836. [DOI: 10.1536/ihj.22-135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hiroyuki Kamada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuki Mori
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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