1
|
Amioka M, Kinoshita H, Sairaku A, Shokawa T, Nakano Y. Impact of ABO blood type on the risk of atrial fibrillation recurrence after catheter ablation. Am Heart J Plus 2024; 40:100384. [PMID: 38586426 PMCID: PMC10994962 DOI: 10.1016/j.ahjo.2024.100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Background Blood types are classified based on the specific antigenic characteristics they possess. Despite documented associations between antigens and inflammation, a scarcity of data exists concerning the impact of antigens on atrial fibrillation (AF). Methods OSHOH-rhythm study is a multi-center, prospective observational study of 601 patients who underwent catheter ablation for AF. We examined the correlation between blood type groups and both the incidence and recurrence of AF. Additionally, we analyzed the recurrence of AF across antigenic profiles. Results The frequencies of individual blood types were 239 (39.8 %), 190 (31.6 %), 122 (20.3 %), and 50 (8.3 %) for A, O, B, and AB, respectively, aligning closely with the prevalent blood type distribution among the Japanese populace. During follow-up period (18.8 months, median), AF recurrence occurred in 96 patients (22.4 %) lacking the B antigen (A and O), and 26 patients (15.1 %) possessing B antigen (B and AB), respectively (Log-rank test: P = 0.034). A multivariate analysis demonstrated that blood types lacking the B antigen (hazard ratio [HR], 1.55; 95 % CI, 1.01 to 2.42; P = 0.037), hypertension (HR, 1.51; 95 % CI, 1.05 to 2.17; P = 0.026) and non-paroxysmal AF (HR, 1.70; 95 % CI, 1.17 to 2.47; P = 0.005) were independently associated with the recurrence of AF. Conclusions This study elucidates that, despite the absence of direct correlation between blood types and the occurrence of AF, blood types devoid of the B antigen exhibit an enhanced predisposition to AF recurrence. Nonetheless, the intricate mechanism linking blood type to recurrence remains elusive, warranting further comprehensive foundational research on blood types.
Collapse
Affiliation(s)
- Michitaka Amioka
- Deparment of Cardiovascular Medicine, Hiroshima General Hospital, Hiroshima, Japan
| | - Hiroki Kinoshita
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Akinori Sairaku
- Deparment of Cardiovascular Medicine, NHO Higashihiroshima Medical Center, Hiroshima, Japan
| | - Tomoki Shokawa
- Deparment of Cardiovascular Medicine, Hiroshima General Hospital, Hiroshima, Japan
| | - Yukiko Nakano
- Deparment of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
2
|
Tomomori S, Suenari K, Sairaku A, Higaki T, Dai K, Oi K, Kawase T, Ohashi N, Nishioka K, Masaoka Y, Shiode N, Nakano Y. Prolonged PR intervals are associated with epicardial adipose tissue and recurrence after catheter ablation in persistent atrial fibrillation. Heart Vessels 2024; 39:232-239. [PMID: 37813984 DOI: 10.1007/s00380-023-02323-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Abstract
Epicardial adipose tissue (EAT) has been reported to promote myocardial fibrosis and to affect intracardiac conduction. The PR interval reflects the conduction from the atria to the Purkinje fibers and may be associated with the EAT volume, especially in persistent atrial fibrillation (AF) patients. We aimed to investigate the relationship between the EAT and PR interval in patients with persistent AF. We enrolled 268 persistent AF patients who underwent catheter ablation (CA) and divided the patients into two groups: the normal PR interval group (PR interval less than 200 ms: Group N) and long PR interval group (PR interval 200 ms or more: Group L). We then analyzed the association between the total EAT volume around the heart and PR interval and calculated the ratio of the duration of the P wave (PWD) to the PR interval (PWD/PR interval). Moreover, we investigated whether a long PR interval was associated with the outcomes after ablation. The total EAT volume was significantly larger in Group L than Group N (Group N: 131.4 ± 51.8 ml vs. Group L: 151.3 ± 63.3 ml, p = 0.039). A positive correlation was also observed between the PWD/PR interval and EAT volume in Group L (r = 0.345, p = 0.039). A multivariate analysis also revealed that a long PR interval was independently associated with AF recurrence after CA (hazard ratio [HR] 2.071, p = 0.032). The total EAT volume was associated with a long PR interval, and a long PR interval was a significant risk factor for recurrence after ablation in persistent AF patients.
Collapse
Affiliation(s)
- Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan.
| | - Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Akinori Sairaku
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Tadanao Higaki
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kuniomi Oi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Tomoharu Kawase
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Norihiko Ohashi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Yoshiko Masaoka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
3
|
Sairaku A, Hashimoto K, Nakano Y. A Novel Hemostatic Belt Allowing Ambulation Soon After Atrial Fibrillation Ablation. J Cardiovasc Transl Res 2023; 16:1439-1446. [PMID: 37526899 DOI: 10.1007/s12265-023-10417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
We aimed to develop a hemostatic device with physiological evidence that allows ambulation soon after atrial fibrillation (AF) ablation. We measured right femoral vein pressure in 57 participants to clarify why groin post-venipuncture rebleeding often occurs during the transition from supine to sitting under compression bandage application and found that it increased more than threefold when raising the upper body (8.6 ± 4.1 to 27.6 ± 6.9 mmHg; P < 0.001). Based on that data, we created a novel hemostatic belt. Its capability test including 25 participants demonstrated that the belt gave much higher compression pressures on the right groin while sitting than the compression bandage (59.5 ± 14.9 vs. 8.1 ± 4 mmHg; P < 0.001), achieving pressures above the maximum femoral vein pressure in 92% of participants. A randomized trial comparing the belt with compression bandage in 74 AF patients demonstrated that the belt reduced time to ambulation without any rebleeding (340 [92.5-360] vs. 360 [360-360] min; P < 0.001) and satisfied more patients. The novel hemostatic belt provided a much higher compression pressure on the right groin during the sitting position than the conventional compression bandage, achieving a pressure above the maximum femoral vein pressure in 92% of the participants.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
| | - Koji Hashimoto
- Hiroshima Prefectural Technology Research Institute, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
4
|
Sairaku A, Nakano Y. Devastating Worsening Renal Function Following the Initiation of Sacubitril/Valsartan: Falling Between Two Stools. Cureus 2023; 15:e46757. [PMID: 37946880 PMCID: PMC10632064 DOI: 10.7759/cureus.46757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023] Open
Abstract
Previously prescribed antihypertensive agents were switched to the maximum dose of sacubitril/valsartan, without any upward titration, in two elderly hypertensive patients with chronic kidney disease who were hospitalized for treatment of congestive heart failure, in the hope of its decongestive, antihypertensive, and potential renoprotective actions. However, they quickly fell into oliguria and finally required hemodialysis. Sacubitril/valsartan should be initiated with careful attention in elderly patients with advanced renal dysfunction.
Collapse
Affiliation(s)
- Akinori Sairaku
- Cardiology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, JPN
| | - Yukiko Nakano
- Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN
| |
Collapse
|
5
|
Dai K, Shiode N, Yoshii K, Kimura Y, Matsuo K, Jyuri Y, Tomomori S, Higaki T, Oi K, Kawase T, Sairaku A, Ohashi N, Suenari K, Nishioka K, Masaoka Y, Nakano Y. Impact of Lipoprotein (a) on Long-Term Outcomes in Patients With Acute Myocardial Infarction. Circ J 2023; 87:1356-1361. [PMID: 37258219 DOI: 10.1253/circj.cj-23-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Lipoprotein (a) (Lp(a)) is a complex circulating lipoprotein, and there is increasing evidence it is a risk factor for atherosclerotic cardiovascular disease (ASCVD). This study aimed to investigate the influence of Lp(a) serum levels on long-term outcomes after acute myocardial infarction (AMI).Methods and Results: Between January 2015 and January 2018, we enrolled 262 patients with AMI who underwent coronary angiography within 24 h of the onset of chest pain and had available Lp(a) data enabling subdivision into 2 groups: high Lp(a) (≥32 mg/dL: n=76) and low Lp(a) (<32 mg/dL: n=186). The primary endpoint was major adverse cardiac events (MACE), which was defined as a composite of cardiac death, nonfatal MI, and readmission for heart failure. Multivariate Cox regression analysis was performed to identify the predictors of MACE. The incidence of MACE was significantly higher in the high Lp(a) group than in the low Lp(a) group (32.8% vs. 19.6%, P=0.004). Multivariate analysis showed that Lp(a) ≥32 mg/dL was an independent predictor of MACE (hazard ratio 2.84, 95% confidence interval 1.25-6.60, P=0.013). CONCLUSIONS High Lp(a) levels were associated with worse long-term outcomes after AMI, so Lp(a) may be useful for risk assessment.
Collapse
Affiliation(s)
- Kazuoki Dai
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kanade Yoshii
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Yuka Kimura
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Keita Matsuo
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Yusuke Jyuri
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Tadanao Higaki
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kuniomi Oi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoharu Kawase
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Akinori Sairaku
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Norihiko Ohashi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Yoshiko Masaoka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| |
Collapse
|
6
|
Sairaku A, Hashimoto K, Nakano Y. Correction to: A Novel Hemostatic Belt Allowing Ambulation Soon After Atrial Fibrillation Ablation. J Cardiovasc Transl Res 2023:10.1007/s12265-023-10430-5. [PMID: 37644297 DOI: 10.1007/s12265-023-10430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
| | - Koji Hashimoto
- Hiroshima Prefectural Technology Research Institute, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
7
|
Oguri N, Sairaku A, Morishima N, Hayashi Y, Muraoka Y, Tomomori S, Okada T, Nakano Y. Progression from paroxysmal to persistent atrial fibrillation in pacemaker patients with tachycardia-bradycardia syndrome: a multicenter study. Heart Vessels 2023:10.1007/s00380-023-02266-5. [PMID: 37029247 DOI: 10.1007/s00380-023-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
Progression from paroxysmal to persistent atrial fibrillation (AF) is occasionally encountered in patients with previous pacemaker implantation (PMI) for the treatment of tachycardia-bradycardia syndrome (TBS). We aimed to determine the rate of its incidence occurring within the early years after PMI and the predictors. We studied TBS patients who received PMI at 5 core cardiovascular centers. The end point was a conversion from paroxysmal to persistent AF. We extracted 342 TBS patients out of 2579 undergoing PMI. During 5 ± 3.1 years of follow-up, 114 (33.3%) reached the end point. The time to the end point was 2.9 ± 2.7 years. The event rates within a year and 3 years after the PMI were 8.8% and 19.6%, respectively. In the multivariate hazard analyses, hypertension (hazard ratio [HR] 3.2, P = 0.03) and congestive heart failure (HR 2.1, P = 0.04) were found to be independent predictors of the end point occurring within a year after the PMI. Congestive heart failure (HR 1.82, P = 0.04), left atrial diameter of ≥ 40 mm (HR 4.55, P < 0.001), and the use of antiarrhythmic agents (HR 0.58, P = 0.04) were independently associated with the 3-year end point. Prediction models including combinations of those 4 parameters for the 1- and 3-year incidence both exhibited a modest risk discrimination (both c-statistics 0.71). In conclusion, early progression from paroxysmal to persistent AF was less frequent than expected in the TBS patients with PMI. Factors related to atrial remodeling and no use of antiarrhythmic drugs may facilitate the progression.
Collapse
Affiliation(s)
- Naoto Oguri
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan
- Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan.
| | - Nobuyuki Morishima
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan
| | - Yasuhiko Hayashi
- Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yuji Muraoka
- Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takenori Okada
- Department of Cardiology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
8
|
Sairaku A, Nakano Y. Increased major bleeding incidence in atrial fibrillation patients with apixaban: a review of Japanese post-marketing surveillance studies of direct oral anticoagulants. Eur J Clin Pharmacol 2023; 79:579-588. [PMID: 36917243 DOI: 10.1007/s00228-023-03471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
Large-scaled post-marketing surveillance studies (PMSSs) of 4 direct oral anticoagulants (DOACs) for stroke prevention in non-valvular atrial fibrillation (AF) were conducted since 2011 in Japan, and the results of the last one have recently been published. Each reported a more than acceptable ischemic stroke prevention. The major bleeding rates were also acceptably low and comparable to each other in the PMSSs of dabigatran (J-dabigatran), rivaroxaban (XAPASS), and edoxaban (ETNA-AF-Japan). However, the incidence in PMSS of apixaban (STANDARD) was more than double the others. This finding appeared to contradict the globally accepted theory that apixaban is less likely than other DOACs to cause bleeding events. Possible responsible mechanisms included (1) the age and kidney function, (2) concomitant antiplatelet therapy, (3) drug actions, (4) follow-up duration, and (5) dose reduction criteria. Similarities in the clinical background shared by the 4 different PMSSs' participants and knowledge from previous studies did not support a dominant contribution of any of those former 4 factors to the increased major bleeding incidence in STANDARD. A possibility of the 5th factor was then examined. An estimated calculation we created showed that apixaban's dose reduction criteria was strict enough to considerably reduce the opportunity for participants to take its reduced rather than standard dose. We then successfully simulated how the "strict" dose reduction criteria would have increased the bleeding event rates under DOAC therapy. The discussion in this review may therefore raise a question about the validity of the current dose reduction criteria of apixaban for Japanese AF patients.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, 739-0041, Higashihiroshima, Japan.
- 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
| |
Collapse
|
9
|
Amioka M, Sanada R, Matsumura H, Kinoshita H, Sairaku A, Morishima N, Nakano Y. Impact of SGLT2 inhibitors on old age patients with heart failure and chronic kidney disease. Int J Cardiol 2023; 370:294-299. [PMID: 36174820 DOI: 10.1016/j.ijcard.2022.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The heart failure (HF) "pandemic" is an ongoing critical issue related to the aging population. Among the new heart failure medications, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to provide clinical benefit in HF patients with chronic kidney disease (CKD). However, the efficacy and safety of SGLT2i in old age patients remains uncertain. METHODS The OSHO-heart (Optimal Solution after Hospitalization in Onomichi for heart failure) is a prospective study of 213 patients aged ≥ 75 years-old hospitalized for acute decompensated HF with stage 3 to 4 CKD. The composite outcomes of HF rehospitalizations or cardiovascular death and the rate of decline in the estimated glomerular filtration rate (eGFR) were compared between the Loop (n = 76), tolvaptan (TLV) (n = 80) and SGLT2i (n = 57) groups, respectively. RESULTS During follow-up (17.2 months, median), composite of HF rehospitalization or cardiovascular death events occurred in 30 (39.5%) in Loop, 19 (23.8%) in TLV and 8 (14%) in SGLT2i groups, respectively (Log-rank: P = 0.015). A multivariate analysis demonstrated that the continuation of SGLT2i (hazard ratio, 0.41; 95% CI, 0.19 to 0.78; P = 0.022) and an EF < 30% (hazard ratio, 2.19; 95% CI, 1.22 to 3.92; P = 0.009) were independently associated with the composite outcome. The rate of decline in the eGFR was significantly less in TLV and SGLT2i groups than Loop group (-1.64 vs. -1.28 vs. -5.41 ml/min/1.73 m2 per year, P = 0.007, respectively). CONCLUSIONS SGLT2i therapy might reduce the combined risk of HF hospitalizations or cardiac death and preserve a worsening renal function in old age patients with HF and CKD.
Collapse
Affiliation(s)
- Michitaka Amioka
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan.
| | - Ryuhei Sanada
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Hiroya Matsumura
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Hiroki Kinoshita
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Akinori Sairaku
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Nobuyuki Morishima
- Deparment of Cardiovascular Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Yukiko Nakano
- Deparment of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
10
|
Sairaku A, Morishima N, Amioka M, Maeda J, Watanabe Y, Nakano Y. Does atrial fibrillation ablation worsen preexisting anemia? Another anemia paradox in DOAC era. J Cardiol 2021; 78:382-387. [PMID: 34256966 DOI: 10.1016/j.jjcc.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a concern about worsening anemia after atrial fibrillation (AF) ablation in anemic patients. We aimed to clarify whether or not patients with anemia who are on an oral anticoagulant therapy are more likely to lose blood after AF ablation. METHODS We studied AF patients in 3 cardiovascular centers who skipped a single dose of a direct oral anticoagulant prior to the ablation, and compared the drop in the hemoglobin level 24 hours after the procedure and bleeding complications between the patients with and without preexisting anemia. RESULTS We identified 183 (15.7%) patients with anemia at baseline out of 1163 patients. The reduction in the hemoglobin level (-0.39±0.71 vs. -0.93±0.9 g/dL; p<0.001) was smaller in the anemic than non-anemic patients. A fall in the hemoglobin level of ≥2 g/dL, which is a guideline-defined significant hemoglobin drop, was less common in anemic patients (1.6% vs. 11.3%; p<0.001). A female gender [odds ratio (OR) 1.62, confidence interval (CI) 1.07-2.45; p=0.02], persistent or long-standing persistent versus paroxysmal AF (OR 1.67, CI 1.13-2.49; p=0.01), ORBIT score ≥3 (OR 3.5, CI 1.34-8.94; p=0.01), and preexisting anemia (OR 0.02, CI 0.004-0.14; p<0.001) were independently associated with the fall in the hemoglobin level of ≥2 g/dL. No difference was noted in the rate of major bleeding complications (1.6% vs. 1.2%; p=0.72). CONCLUSIONS Paradoxically, patients with preexisting anemia may be less likely to lose blood following AF ablation.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Nobuyuki Morishima
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Michitaka Amioka
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Junji Maeda
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Yoshikazu Watanabe
- Department of Cardiology, Cardiovascular Center, Hiroshima General Hospital, Hatsukaichi, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
11
|
Sairaku A, Morishima N, Matsumura H, Amioka M, Maeda J, Watanabe Y, Nakano Y. Intra-procedural anticoagulation and post-procedural hemoglobin fall in atrial fibrillation ablation with minimally interrupted direct oral anticoagulants: comparisons across 4 drugs. J Interv Card Electrophysiol 2020; 61:551-557. [PMID: 32808083 DOI: 10.1007/s10840-020-00851-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Thromboembolic or hemorrhagic complications related to atrial fibrillation (AF) ablation are rare, and thus, it is difficult to compare their frequency across different direct oral anticoagulants (DOACs). We aimed to compare the intra-ablation blood coagulability and post-procedural hemoglobin fall as alternatives to those complications across 4 DOACs. METHODS We enrolled AF patients younger than 65 years old in 3 cardiovascular centers who skipped a single dose of apixaban, dabigatran, edoxaban, and rivaroxaban, prior to the ablation. Endpoints included the activated clotting time (ACT), heparin requirement during the ablation, and drop in the hemoglobin level 24 h after the procedure. RESULTS The time-course curves of the ACT differed significantly across the patients with apixaban (N = 113), dabigatran (N = 130), edoxaban (N = 144), and rivaroxaban (N = 81), with its highest level in the dabigatran group (P < 0.001). The average ACT was greater in the dabigatran group than in the other groups (312.3 ± 34, 334.4 ± 44, 308.1 ± 41, and 305.8 ± 34.7 s; P < 0.001). A significant difference was noted in total heparin requirement across the patient groups (3990.2 ± 1167.9, 3890.4 ± 955.3, 4423.8 ± 1051.6, and 3972 ± 978.7 U/m2/h; P < 0.001), with its greatest amount in the edoxaban group. The reduction in the hemoglobin level was similar (- 0.93 ± 0.92, - 0.88 ± 0.79, - 0.89 ± 0.97, - 0.95 ± 1.23 g/dL; P = 0.94). No inter-group difference was noted in the rate of major or minor bleedings (0.9%, 2.3%, 1.4%, and 3.7%; P = 0.51), and no thromboembolic events were encountered. CONCLUSION A difference in DOACs may have an impact on intra-ablation anticoagulation; however, it may not be on the procedural blood loss in the setting of a single skip.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
| | - Nobuyuki Morishima
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Hiroya Matsumura
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Michitaka Amioka
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Junji Maeda
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan
| | - Yoshikazu Watanabe
- Department of Cardiology, Cardiovascular Center, Hiroshima General Hospital, Hatsukaichi, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
12
|
Sairaku A, Onohara Y, Hironobe N, Matsumura H, Kihara Y, Nakano Y. Remaining activity of temporary interrupted direct oral anticoagulants and its impact on intra‐ablation heparinization in patients with atrial fibrillation: Comparisons across four drugs and two dose regimens. J Cardiovasc Electrophysiol 2020; 31:1996-2004. [DOI: 10.1111/jce.14588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Akinori Sairaku
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Yuko Onohara
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Naoya Hironobe
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Hiroya Matsumura
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Yasuki Kihara
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| | - Yukiko Nakano
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences Hiroshima Japan
| |
Collapse
|
13
|
Kinoshita H, Sairaku A, Morishima N, Dohi Y, Sada Y, Higashi A, Yamabe S, Kihara Y. Prognostic significance of oscillatory ventilation at rest in patients with advanced heart failure undergoing cardiopulmonary exercise testing. Int J Cardiol 2020; 301:142-146. [DOI: 10.1016/j.ijcard.2019.11.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/24/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023]
|
14
|
Sairaku A, Nakano Y, Onohara Y, Hironobe N, Matsumura H, Shimizu W, Kihara Y. Residual anticoagulation activity in atrial fibrillation patients with temporary interrupted direct oral anticoagulants: Comparisons across 4 drugs. Thromb Res 2019; 183:119-123. [DOI: 10.1016/j.thromres.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/25/2019] [Accepted: 10/02/2019] [Indexed: 11/25/2022]
|
15
|
Hironobe N, Sairaku A, Nakano Y, Tokuyama T, Okamura S, Okubo Y, Shimizu W, Kihara Y. Cardiac electrophysiological characteristics of silent paroxysmal atrial fibrillation: What causes asymptomaticity? J Cardiovasc Electrophysiol 2019; 30:2716-2723. [PMID: 31588639 DOI: 10.1111/jce.14216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND A diagnosis of silent paroxysmal atrial fibrillation (AF) is highly challenging due to its asymptomatic and intermittent nature. The goal of the present study was to clarify its asymptomaticity with the use of a comprehensive electrophysiological approach. METHODS We prospectively compared (a) 24-hour Holter monitoring data, (b) invasive cardiac electrophysiological properties, (c) AF inducibility, and (d) outcome of radiofrequency catheter ablation between patients with symptomatic paroxysmal AF and those with silent paroxysmal AF, defined as transient asymptomatic AF detected by chance. RESULTS Patients with silent paroxysmal AF (N = 57) were more likely than patients with symptomatic paroxysmal AF (N = 282) to be male (75.4% vs 56.7%; P = .009), and to have a previous stroke (17.5% vs 6.7%; P = .008), more prolonged atrio-His interval (114.9 ± 29.1 vs 105.5 ± 24.1 ms; P = .01), longer atrioventricular nodal effective refractory period (352.3 ± 103 vs 318.2 ± 77.2 ms; P = .007), slower Wenckebach cycle length (488.5 ± 83.9 vs 443.3 ± 74.9 ms; P < .001), and lower maximum heart rate during AF (128.7 ± 31.9 vs 143.9 ± 29.6 beats/min; P = .02). Atrial ectopy (median [interquartile range], 385 [88, 2430] vs 207 [73.8, 870.8] beats/24 h; P = .02) and pharmacological AF induction (66.7% vs 43.2%; P = .02) were more common in silent paroxysmal AF patients. There was no difference in the 1-year freedom from AF following the ablation between the two patient groups. CONCLUSIONS The more attenuated atrioventricular conduction properties in silent paroxysmal AF patients may explain their asymptomatic nature, and their higher likelihood of atrial arrhythmias may increase the chance to detect AF episodes. Whether or not they benefit from catheter ablation is uncertain.
Collapse
Affiliation(s)
- Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Yosaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
16
|
Nakano Y, Ochi H, Sairaku A, Onohara Y, Tokuyama T, Motoda C, Matsumura H, Tomomori S, Amioka M, Hironobe N, Ohkubo Y, Okamura S, Makita N, Yoshida Y, Chayama K, Kihara Y. HCN4 Gene Polymorphisms Are Associated With Occurrence of Tachycardia-Induced Cardiomyopathy in Patients With Atrial Fibrillation. Circ Genom Precis Med 2019; 11:e001980. [PMID: 29987112 DOI: 10.1161/circgen.117.001980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tachycardia-induced cardiomyopathy (TIC) is a reversible cardiomyopathy induced by tachyarrhythmia, and the genetic background of the TIC is not well understood. The hyperpolarization-activated cyclic nucleotide-gated channel gene HCN4 is highly expressed in the conduction system where it is involved in heart rate control. We speculated that the HCN4 gene is associated with TIC. METHODS We enrolled 930 Japanese patients with atrial fibrillation (AF) for screening, 350 Japanese patients with AF for replication, and 1635 non-AF controls. In the screening AF set, we compared HCN4 single-nucleotide polymorphism genotypes between AF subjects with TIC (TIC, n=73) and without TIC (non-TIC, n=857). Of 17 HCN4 gene-tag single-nucleotide polymorphisms, rs7172796, rs2680344, rs7164883, rs11631816, and rs12905211 were significantly associated with TIC. Among them, only rs7164883 was independently associated with TIC after conditional analysis (TIC versus non-TIC: minor allele frequency, 26.0% versus 9.7%; P=1.62×10-9; odds ratio=3.2). RESULTS We confirmed this association of HCN4 single-nucleotide polymorphism rs7164883 with TIC in the replication set (TIC=41 and non-TIC=309; minor allele frequency, 28% versus 9.9%; P=1.94×10-6; odds ratio=3.6). The minor allele frequency of rs7164883 was similar in patients with AF and non-AF controls (11% versus 10.9%; P=0.908). CONCLUSIONS The HCN4 gene single-nucleotide polymorphism rs7164883 may be a new genetic marker for TIC in patients with AF.
Collapse
Affiliation(s)
- Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.). .,Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.)
| | - Hidenori Ochi
- Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.).,Liver Research Project Center Hiroshima University, Hiroshima, Japan (H.O., K.C.).,Department of Internal Medicine, Chuden Hospital, The Chugoku Electric Power Company, Japan (H.O.).,Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (H.O., K.C.)
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Yousaku Ohkubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Shou Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Naomasa Makita
- Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan (Y.Y.)
| | - Kazuaki Chayama
- Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.).,Liver Research Project Center Hiroshima University, Hiroshima, Japan (H.O., K.C.).,Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (H.O., K.C.)
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| |
Collapse
|
17
|
Sairaku A, Matsumoto T, Kinoshita H, Matsumura H, Oguri N, Morishima N. A mimic of tachycardia-bradycardia syndrome in a patient with long-standing persistent atrial fibrillation. Clin Case Rep 2019; 7:661-664. [PMID: 30997058 PMCID: PMC6452452 DOI: 10.1002/ccr3.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/26/2019] [Indexed: 11/29/2022] Open
Abstract
Pause following incessant tachycardia is often encountered in clinical practice. We encountered a rare arrhythmic condition mimicking tachycardia-bradycardia syndrome. We hereby describe the step-by-step diagnostic process.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| | - Takeshi Matsumoto
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| | - Hiroki Kinoshita
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| | - Hiroya Matsumura
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| | - Naoto Oguri
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| | - Nobuyuki Morishima
- Department of Cardiology, Cardiovascular CenterOnomichi General HospitalOnomichiJapan
| |
Collapse
|
18
|
Tomomori S, Nakano Y, Ochi H, Onohara Y, Sairaku A, Tokuyama T, Motoda C, Matsumura H, Amioka M, Hironobe N, Okubo Y, Okamura S, Kawazoe H, Nishiyama Y, Tahara H, Chayama K, Kihara Y. Chromosome 4q25 Variant rs6817105 Bring Sinus Node Dysfunction and Left Atrial Enlargement. Sci Rep 2018; 8:14565. [PMID: 30275471 PMCID: PMC6167315 DOI: 10.1038/s41598-018-32453-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022] Open
Abstract
Genome-wide association studies have reported a strong association of the single nucleotide polymorphism (SNP) rs6817105 (T > C) on chromosome 4q25 with atrial fibrillation (AF), but phenotype alterations conferred by this SNP have not been described. We genotyped SNP rs6817105 and examined the relationships among rs6817105 genotype, clinical characteristics, echocardiographic parameters, and electrophysiological parameters in 574 AF patients and 1,554 non-AF controls. Further, multiple microRNAs (miRNAs) are reported to be involved in atrial remodeling and AF pathogenesis, so we investigated relationships between rs6817105 genotype and serum concentrations of 2555 miRNAs. The rs6817105 minor allele frequency was significantly higher in AF patients than non-AF controls (66% vs. 47%, odds ratio 2.12, p = 4.9 × 10−26). Corrected sinus node recovery time (CSRT) was longer and left atrial volume index (LAVI) was larger in AF patients with the rs6817105 minor allele than patient non-carriers (CSRT: CC 557 ± 315 ms, CT 486 ± 273 ms, TT 447 ± 234 ms, p = 0.001; LAVI: CC 43.6 ± 12.1, CT 42.4 ± 13.6, TT 39.8 ± 11.6, p = 0.030). There were no significant differences between rs6817105 genotype and the serum concentrations of miRNAs. These findings strongly implicate rs6817105 minor allele in sinus node dysfunction and left atrial enlargement.
Collapse
Affiliation(s)
- Shunsuke Tomomori
- 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.
| | - Hidenori Ochi
- Department of Internal Medicine, Chuden Hospital, The Chugoku Electric Power Company, Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akinori Sairaku
- 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
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shou Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroshi Kawazoe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukie Nishiyama
- Department of Cellular and Molecular Biology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidetoshi Tahara
- Department of Cellular and Molecular Biology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
19
|
Tomomori S, Nakano Y, Ochi H, Onohara Y, Sairaku A, Tokuyama T, Motoda C, Matsumura H, Amioka M, Hironobe N, Ookubo Y, Okamura S, Kawazoe H, Chayama K, Kihara Y. Maintenance of low inflammation level by the ZFHX3 SNP rs2106261 minor allele contributes to reduced atrial fibrillation recurrence after pulmonary vein isolation. PLoS One 2018; 13:e0203281. [PMID: 30180182 PMCID: PMC6122824 DOI: 10.1371/journal.pone.0203281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/19/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The single nucleotide polymorphism (SNP) rs2106261 in the transcription factor gene ZFHX3 (16q22), a major regulator of inflammation, has been reported linking to atrial fibrillation (AF) by genome-wide association studies. Inflammation is known to be a strong predictor of atrial fibrillation recurrence after ablation, so we examined the association of the ZFHX3 SNP rs2106261 to inflammation marker expression and recurrence after AF ablation. METHODS We genotyped ZFHX3 SNP rs2106261 and compared the minor (T) allele frequency between 362 paroxysmal AF (PAF) patients underwent pulmonary vein isolation (PVI) and 627 non-AF controls. We also analyzed associations between ZFHX3 SNP rs2106261 genotype and recurrence rate after pulmonary vein isolation and the inflammation markers. RESULTS The minor (T) allele frequency of the ZFHX3 SNP rs2106261 was significantly higher in AF patients than non-AF controls (odds ratio 1.52, p = 2.2×10-5). Multivariable analysis revealed that the minor allele (T) decreased AF recurrence rate after pulmonary vein isolation (hazard ratio 0.53, p = 0.04). Further, neutrophil/lymphocyte (N/L) ratio, C-reactive protein (CRP), and interleukin-6 (IL-6) expression levels were lower in PAF patients with the ZFHX3 SNP rs2106261 minor allele (TT+TC) than in CC patients (N/L ratio: CC 2.22 ± 0.08, TT+TC 1.98 ± 0.06, p = 0.018; CRP: CC 0.103 ± 0.009 mg/dl, TT+TC 0.076 ±0.007 mg/dl, p = 0.016; IL-6: CC 60.3 ± 3.0 pg/ml, TT+TC 52.8 ± 2.3 pg/ml, p = 0.04). CONCLUSIONS The ZFHX3 SNP rs2106261 minor allele is associated with lower AF recurrence rate after pulmonary vein isolation. Low baseline inflammation conferred by this allele may reduce AF recurrence risk.
Collapse
Affiliation(s)
- Shunsuke Tomomori
- 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
| | - Hidenori Ochi
- Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
- Department of Internal Medicine, Chuden Hospital, The Chugoku Electric Power Company, Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akinori Sairaku
- 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
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Ookubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shou Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroshi Kawazoe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
20
|
Okubo Y, Sairaku A, Morishima N, Ogi H, Matsumoto T, Kinoshita H, Kihara Y. Increased Urinary Liver-Type Fatty Acid-Binding Protein Level Predicts Worsening Renal Function in Patients With Acute Heart Failure. J Card Fail 2018; 24:520-524. [PMID: 30026130 DOI: 10.1016/j.cardfail.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/01/2018] [Accepted: 07/08/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Urinary liver-type fatty acid-binding protein (L-FABP) is a potential biomarker for acute kidney injury, and it in turn increases cardiovascular mortality. We tested whether the urinary L-FABP level predicted short- and mid-term outcomes in patients with acute heart failure. METHODS AND RESULTS We enrolled consecutive patients with acute heart failure, and measured their urinary L-FABP levels before acute treatment. Worsening renal function (WRF), defined as both an absolute increase in the serum creatinine level of ≥0.3mg/dL and a ≥25% relative increase in its level from baseline, occurred in 37 (26.8%) of 138 patients. Patients with a urinary L-FABP level above the upper normal limit (8.4 µg/g creatinine) (n = 49; 35.5%) were more likely than those with a urinary L-FABP level within normal limits (n = 89; 64.5%) to develop WRF (n = 26 [53.1%] vs n = 11 [12.4%]; P < .001). A urinary L-FABP level above the upper limit was independently associated with WRF (hazard ratio 1.8; P = .01). During 1 year of follow-up, 12 patients (8.7%) died, and urinary L-FABP level had no association with all-cause mortality. There was, however, a tendency toward a higher readmission rate in patients with a urinary L-FABP level above the upper normal limit who survived the index hospitalization (n = 46) than in those without an abnormal L-FABP level (n = 88; n = 13 [28.3%] vs n = 13 [14.8%]; log-rank P = .06). CONCLUSIONS Increased urinary L-FABP level before treatment may predict WRF in patients with acute heart failure. Further investigation is warranted for its predictive ability of adverse outcomes.
Collapse
Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Cardiology, Onomichi General Hospital, Onomichi, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Cardiology, Onomichi General Hospital, Onomichi, Japan.
| | | | - Hiroshi Ogi
- Department of Cardiology, Onomichi General Hospital, Onomichi, Japan
| | - Takeshi Matsumoto
- Department of Cardiology, Onomichi General Hospital, Onomichi, Japan
| | - Hiroki Kinoshita
- Department of Cardiology, Onomichi General Hospital, Onomichi, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
21
|
Amioka M, Sairaku A, Nakano Y, Tokuyama T, Matsumura H, Tomomori S, Hironobe N, Kihara Y. Diagnostic performance of the N-terminal pro-brain natriuretic peptide to detect an increased left atrial pressure in patients with persistent atrial fibrillation. Clin Chem Lab Med 2018; 56:e147-e149. [DOI: 10.1515/cclm-2017-0903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Michitaka Amioka
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , 1-2-3 Kasumi , Minami-ku, Hiroshima 734-8551 , Japan , Phone: 81-82-257-5540
| | - Yukiko Nakano
- 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
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| |
Collapse
|
22
|
Sairaku A, Yoshida Y, Nakano Y, Hirayama H, Maeda M, Hashimoto H, Kihara Y. Cardiac resynchronization therapy for patients with cardiac sarcoidosis. Europace 2018; 19:824-830. [PMID: 28339577 DOI: 10.1093/europace/euw223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/27/2016] [Indexed: 12/29/2022] Open
Abstract
Aims Sarcoidosis with cardiac involvement is a rare pathological condition, and therefore cardiac resynchronization therapy (CRT) for patients with cardiac sarcoidosis is even further rare. We aimed to clarify the clinical features of patients with cardiac sarcoidosis who received CRT. Methods and results We retrospectively reviewed the clinical data on CRT at three cardiovascular centres to detect cardiac sarcoidosis patients. We identified 18 (8.9%) patients with cardiac sarcoidosis who met the inclusion criteria out of 202 with systolic heart failure who received CRT based on the guidelines. The majority of the patients were female [15 (83.3%)] and underwent an upgrade from a pacemaker or implantable cardioverter defibrillator [13 (72.2%)]. We found 1 (5.6%) cardiovascular death during the follow-up period (mean ± SD, 4.7 ± 3.0 years). Seven (38.9%) patients had a composite outcome of cardiovascular death or hospitalization from worsening heart failure within 5 years after the CRT. Twelve (66.7%) patients had a history of sustained ventricular arrhythmias or those occurring after the CRT. Among the overall patients, no significant improvement was found in either the end-systolic volume or left ventricular ejection fraction (LVEF) 6 months after the CRT. A worsening LVEF was, however, more likely to be seen in 5 (27.8%) patients with ventricular arrhythmias after the CRT than in those without (P = 0.04). An improved clinical composite score was seen in 10 (55.6%) patients. Conclusions Cardiac sarcoidosis patients receiving CRT may have poor LV reverse remodelling and a high incidence of ventricular arrhythmias.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Haruo Hirayama
- Department of Cardiology, Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Mayuho Maeda
- Department of Cardiology, Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Haruki Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.,Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| |
Collapse
|
23
|
Sairaku A, Nakano Y, Shiode N, Suenari K, Oda N, Ono K, Kihara Y. Head-to-head comparison of the heart rate variability between the bisoprolol transdermal patch and bisoprolol fumarate tablet. Cardiovasc Ther 2018; 36:e12325. [DOI: 10.1111/1755-5922.12325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Akinori Sairaku
- 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
| | - Nobuo Shiode
- Department of Cardiology; Hiroshima City Hospital; Hiroshima Japan
| | | | - Nozomu Oda
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
- Department of Cardiology; Yanai Medical Center; Yanai Japan
| | - Koichi Ono
- Department of Cardiology; Innoshima Medical Association Hospital; Onomichi Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| |
Collapse
|
24
|
Watanabe R, Sairaku A, Yoshida Y, Nanasato M, Kamiya H, Suzuki H, Ogura Y, Aoyama Y, Maeda M, Ando M, Eguchi S, Inden Y, Kihara Y, Murohara T. Head-to-head comparison of acute and chronic pulmonary vein stenosis for cryoballoon versus radiofrequency ablation. Pacing Clin Electrophysiol 2018; 41:376-382. [DOI: 10.1111/pace.13293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/07/2018] [Accepted: 01/18/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Ryo Watanabe
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Mamoru Nanasato
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Hiroki Kamiya
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Hirohiko Suzuki
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yasuhiro Ogura
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yutaka Aoyama
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Mayuho Maeda
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Monami Ando
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Shunsuke Eguchi
- Department of Cardiology, Cardiovascular Center; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yasuya Inden
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Toyoaki Murohara
- Department of Cardiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| |
Collapse
|
25
|
Harima A, Sairaku A, Inoue I, Nishioka K, Oka T, Nakama Y, Dai K, Ohi K, Hashimoto H, Kihara Y. Real-life experience of a stent-less revascularization strategy using a combination of excimer laser and drug-coated balloon for patients with acute coronary syndrome. J Interv Cardiol 2018; 31:284-292. [PMID: 29464846 DOI: 10.1111/joic.12495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/09/2018] [Accepted: 01/18/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES We aimed to test a novel stent-less revascularization strategy using a combination of excimer laser coronary angioplasty (ELCA) and drug-coated balloon (DCB) for patients with acute coronary syndrome (ACS). BACKGROUND Percutaneous coronary intervention with drug eluting stents is a standard invasive treatment for ACS. Some unsolved issues however remain, such as stent thrombosis and bleeding risks associated with dual antiplatelet therapy. METHODS Consecutive ACS patients were planned to receive either a DCB application following ELCA without a stent implantation or conventional revascularization with a coronary stent. The endpoints were (i) major cardiac adverse events (MACEs), defined as the composite of cardiac death, myocardial infarctions, and target lesion revascularization; (ii) target vessel revascularization (TVR); and (iii) angiographic outcome. RESULTS Since a greater than expected number of patients allocated to the stent-less treatment arm eventually received a bailout stenting, the following 3 as-treated groups were compared; DCB with ELCA group (N = 60), Stent with ELCA group (N = 23), and Stent without ELCA group (N = 85). During a mean follow-up period of 420 ± 137 days, and with angiographic 6- and 12-month-follow-up rates of 96.7%, 87%, and 81.2%, and 50%, 65.2%, and 45.9%, respectively, the MACE rate did not differ across the groups (10%, 4.3%, and 3.5%; P = 0.22) while an incidence of TVR was more common (15%, 0, and 4.7%; P = 0.02) and the diameter stenosis at 6-months of follow-up was greater (25.7 ± 18.2, 14.9 ± 13.1 and 16.2 ± 15.4%; P = 0.002) in the DCB with ELCA group. CONCLUSIONS The stent-less revascularization strategy with DCB and ELCA was associated with a higher occurrence of restenosis in ACS patients.
Collapse
Affiliation(s)
- Ayako Harima
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ichiro Inoue
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Toshiharu Oka
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Kuniomi Ohi
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Haruki Hashimoto
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.,Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
26
|
Matsumura H, Nakano Y, Ochi H, Onohara Y, Sairaku A, Tokuyama T, Tomomori S, Motoda C, Amioka M, Hironobe N, Toshishige M, Takahashi S, Imai K, Sueda T, Chayama K, Kihara Y. H558R, a common SCN5A polymorphism, modifies the clinical phenotype of Brugada syndrome by modulating DNA methylation of SCN5A promoters. J Biomed Sci 2017; 24:91. [PMID: 29202755 PMCID: PMC5713129 DOI: 10.1186/s12929-017-0397-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/22/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A common SCN5A polymorphism H558R (c.1673 A > G, rs1805124) improves sodium channel activity in mutated channels and known to be a genetic modifier of Brugada syndrome patients (BrS). We investigated clinical manifestations and underlying mechanisms of H558R in BrS. METHODS AND RESULTS We genotyped H558R in 100 BrS (mean age 45 ± 14 years; 91 men) and 1875 controls (mean age 54 ± 18 years; 1546 men). We compared clinical parameters in BrS with and without H558R (H558R+ vs. H558R- group, N = 9 vs. 91). We also obtained right atrial sections from 30 patients during aortic aneurysm operations and compared SCN5A expression and methylation with or without H558R. H558R was less frequent in BrS than controls (9.0% vs. 19.2%, P = 0.028). The VF occurrence ratio was significantly lower (0% vs. 29.7%, P = 0.03) and spontaneous type 1 ECG was less observed in H558R+ than H558R- group (33.3% vs. 74.7%, P = 0.01). The SCN5A expression level was significantly higher and the methylation rate was significantly lower in sections with H558R (N = 10) than those without (0.98 ± 0.14 vs. 0.83 ± 0.19, P = 0.04; 0.7 ± 0.2% vs. 1.6 ± 0.1%, P = 0.004, respectively). In BrS with heterozygous H558R, the A allele mRNA expression was 1.38 fold higher than G allele expression. CONCLUSION The SCN5A polymorphism H558R may be a modifier that protects against VF occurrence in BrS. The H558R decreased the SCN5A promoter methylation and increased the expression level in cardiac tissue. An allelic expression imbalance in BrS with a heterozygous H558R may also contribute to the protective effects in heterozygous mutations.
Collapse
Affiliation(s)
- Hiroya Matsumura
- 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. .,Laboratory for Digestive Diseases, Center for Genomic Medicine, RIKEN, Hiroshima, Japan.
| | - Hidenori Ochi
- Laboratory for Digestive Diseases, Center for Genomic Medicine, RIKEN, Hiroshima, Japan.,Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akinori Sairaku
- 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
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masaaki Toshishige
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Laboratory for Digestive Diseases, Center for Genomic Medicine, RIKEN, Hiroshima, Japan.,Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
27
|
Sairaku A, Amioka M, Nakano Y, Kihara Y. Does NT-pro BNP Measurement Make Sense in Stable Patients with Persistent Atrial Fibrillation? J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Harada Y, Dohi Y, Izumi K, Susawa H, Kinoshita M, Utsunomiya H, Sairaku A, Hidaka T, Kihara Y. Multiple Segmental Pulmonary Edema Following Acute Pulmonary Embolism in an Obesity Patient. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Ikenaga H, Nakano Y, Oda N, Suenari K, Sairaku A, Tokuyama T, Kawazoe H, Matsumura H, Tomomori S, Kihara Y. Radiofrequency catheter ablation is effective for atrial fibrillation patients with hypertrophic cardiomyopathy by decreasing left atrial pressure. J Arrhythm 2017; 33:256-261. [PMID: 28765754 PMCID: PMC5529325 DOI: 10.1016/j.joa.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) refractory to medical therapy remains controversial in patients with hypertrophic cardiomyopathy (HCM); the acute effects on the direct left atrial (LA) pressure are not completely understood. Methods We consecutively studied patients with HCM (n=15) and without HCM (NHCM, n=106) who underwent extensive encircling pulmonary vein isolation for drug-refractory AF. We compared clinical parameters, echocardiographic parameters, electrophysiological parameters, LA pressures using hemodynamic catheterization and recurrence rate in both groups. Results The LA volume index was significantly higher (51.9±13.6 mL/m2 vs. 41.6±12.7 mL/m2, p=0.02) in the HCM group than the NHCM group. The pre-ablation mean LA pressure was significantly higher in the HCM group than the NHCM group. Among the AF patients, the mean LA pressure decreased more significantly in the HCM group than the NHCM group (post-ablation minus pre-ablation pressures: 4.2±3.7 mmHg vs. 0.9±4.1 mmHg, p=0.03). The early recurrence rate (within 30 days after ablation) tended to be higher in the HCM group than the NHCM group (20% vs. 5.7%, p=0.08), but the rates of late recurrences (>30 days after ablation) were similar (13.3% vs. 7.6%, p=0.83). Discontinuation of antiarrhythmic drugs occurred at rates of 13% and 62% in the HCM and NHCM groups, respectively (p<0.001). Conclusions The LA pressure in the HCM group decreased immediately after AF RFCA. Patients with HCM and drug-refractory AF may benefit from RFCA.
Collapse
Affiliation(s)
- Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Noboru Oda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazuyoshi Suenari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroshi Kawazoe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| |
Collapse
|
30
|
Nakano Y, Ochi H, Onohara Y, Sairaku A, Tokuyama T, Matsumura H, Tomomori S, Amioka M, Hironomobe N, Motoda C, Oda N, Chayama K, Chen CH, Gross ER, Mochly-Rosen D, Kihara Y. Genetic variations of aldehyde dehydrogenase 2 and alcohol dehydrogenase 1B are associated with the etiology of atrial fibrillation in Japanese. J Biomed Sci 2016; 23:89. [PMID: 27927211 PMCID: PMC5142328 DOI: 10.1186/s12929-016-0304-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/25/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Alcohol consumption and oxidative stress are well-known risk factors for developing atrial fibrillation (AF). Single nucleotide polymorphisms (SNPs) of alcohol dehydrogenase (ADH1B) and aldehyde dehydrogenase 2 (ALDH2) genes encoding enzymes of alcohol and reactive aldehyde metabolism, respectively, are prevalent among East Asians. Here, we examined whether these SNPs were associated with AF in Japanese patients. METHODS AND RESULTS Five hundred seventy-seven Japanese patients with AF undergoing catheter ablation and 1935 controls at Hiroshima University Hospital were studied. Alcohol consumption habits, medical history, electrocardiogram (EKG), electrophysiology and cardiac echocardiography were reviewed. Patients were also genotyped for ALDH2 (rs671) and ADH1B (rs1229984). A significant linear correlation was found between ALDH2 genotype and mean alcohol intake (P = 1.7 × 10-6). Further, ALDH2 (rs671) was associated with AF (P = 7.6 × 10-4, odds ratio [OR] = 0.6). Frequency of the ALDH2 SNP allele A which limits acetaldehyde metabolism was lower in patients with AF (18.8%) than in controls (23.5%). In contrast, we found that the frequencies of the ADH1B SNP genotypes were similar in patients with AF and in controls. Subset analysis among the 182 patients with lone AF and 914 controls (control II) (<60 years of age and without hypertension), both ALDH2 and ADH1B SNPs were significantly associated with AF (P = 0.013, OR = 0.7; P = 0.0007, OR = 1.4, respectively). The frequency of the dysfunctional allele A of ALDH2 was significantly lower and the dysfunctional allele G of ADH1B was significantly higher in patients with lone AF than in control II (ALDH2 A allele frequency = 0.176 vs 0.235, OR = 1.3, P = 0.013, ADH1B SNP G allele frequency = 0.286 vs 0.220, OR = 1.4, P = 0.0007). CONCLUSIONS When considering all patients enrolled, the dysfunctional ALDH2 allele was negatively associated with AF. When examining a subset of patients with lone AF, the dysfunctional ALDH2 allele was negatively associated with AF and the slower metabolizing ADH1B allele was positively associated with AF. Hence, prolonged metabolic conversion of alcohol to acetaldehyde may be associated with the occurrence of AF in the Japanese and other East Asian populations.
Collapse
Affiliation(s)
- Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan
| | - Hidenori Ochi
- Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan.,Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical & Health Science, Hiroshima University , Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naoya Hironomobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nozomu Oda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan.,Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical & Health Science, Hiroshima University , Hiroshima, Japan
| | - Che-Hong Chen
- Department of Chemical & Systems Biology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Eric R Gross
- Department of Chemical & Systems Biology, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Anesthesiology, Perioperative and Pain Management, School of Medicine, Stanford University, Stanford, CA, USA
| | - Daria Mochly-Rosen
- Department of Chemical & Systems Biology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| |
Collapse
|
31
|
Amioka M, Sairaku A, Ochi T, Okada T, Asaoku H, Kyo T, Kihara Y. Prognostic Significance of New-Onset Atrial Fibrillation in Patients With Non-Hodgkin's Lymphoma Treated With Anthracyclines. Am J Cardiol 2016; 118:1386-1389. [PMID: 27600461 DOI: 10.1016/j.amjcard.2016.07.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022]
Abstract
Cancer therapeutics-related cardiac dysfunction induced by anthracycline is highly problematic, and its early recognition is of importance. Atrial fibrillation (AF) is sometimes seen after anthracycline chemotherapy. We aimed to test whether new-onset AF predicts anthracycline-induced heart failure. We prospectively studied 249 lymphoma patients who received anthracyclines. The patients were followed up with a frequent electrocardiographic examination. Fifteen patients (6%) newly developed AF after the chemotherapy, and during a mean follow-up of 34 months, they had a higher incidence of acute heart failure (40% vs 3.8%; p <0.001) and greater all-cause mortality (60% vs 14.1%; p <0.001) than those without AF. The onset of AF preceded the development of heart failure by a mean of 2.4 months. New-onset AF was independently associated with both acute heart failure (hazard ratio 12.78; p <0.001) and all-cause mortality (hazard ratio 4.77; p <0.001). The cumulative anthracycline dose did not differ between the patients with and without heart failure, yet it was another independent predictor of the mortality. In conclusion, new-onset AF may predict unfavorable outcomes after anthracycline chemotherapy in patients with malignant lymphoma.
Collapse
|
32
|
Sairaku A, Yoshida Y, Nakano Y, Hirayama H, Maeda M, Hashimoto H, Kihara Y. Don't expect left ventricular reverse remodeling after cardiac resynchronization therapy in patients with systolic heart failure and atrioventricular block: A multicenter study. Int J Cardiol 2016; 221:597-600. [DOI: 10.1016/j.ijcard.2016.06.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/30/2016] [Indexed: 11/26/2022]
|
33
|
Kawazoe H, Nakano Y, Ochi H, Takagi M, Hayashi Y, Uchimura Y, Tokuyama T, Watanabe Y, Matsumura H, Tomomori S, Sairaku A, Suenari K, Awazu A, Miwa Y, Soejima K, Chayama K, Kihara Y. Risk stratification of ventricular fibrillation in Brugada syndrome using noninvasive scoring methods. Heart Rhythm 2016; 13:1947-54. [DOI: 10.1016/j.hrthm.2016.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Indexed: 11/29/2022]
|
34
|
Sairaku A, Nakano Y, Uchimura Y, Tokuyama T, Kawazoe H, Watanabe Y, Matsumura H, Kihara Y. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation. Endocr Connect 2016; 5:101-6. [PMID: 26902318 PMCID: PMC5002958 DOI: 10.1530/ec-16-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The impact of subclinical hypothyroidism on the cardiovascular risk is still debated. We aimed to measure the relationship between subclinical hypothyroidism and the left atrial (LA) pressure. METHODS The LA pressures and thyroid function were measured in consecutive patients undergoing atrial fibrillation (AF) ablation, who did not have any known heart failure, structural heart disease, or overt thyroid disease. RESULTS Subclinical hypothyroidism (4.5≤ thyroid-stimulating hormone <19.9 mIU/L) was present in 61 (13.0%) of the 471 patients included. More subclinical hypothyroidism patients than euthyroid patients (55.7% vs 40.2%; P=0.04).'euthyroid patients had persistent or long-standing persistent AF (55.7% vs 40.2%; P = 0.04). The mean LA pressure (10.9 ± 4.7 vs 9.1 ± 4.3 mmHg; P = 0.002) and LA V-wave pressure (17.4 ± 6.5 vs 14.3 ± 5.9 mmHg; P < 0.001) were, respectively, higher in the patients with subclinical hypothyroidism than in the euthyroid patients. After an adjustment for potential confounders, the LA pressures remained significantly higher in the subclinical hypothyroidism patients. A multiple logistic regression model showed that subclinical hypothyroidism was independently associated with a mean LA pressure of >18 mmHg (odds ratio 3.94, 95% CI 1.28 11.2; P = 0.02). CONCLUSIONS Subclinical hypothyroidism may increase the LA pressure in AF patients.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuko Uchimura
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroshi Kawazoe
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshikazu Watanabe
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular MedicineHiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
35
|
Sairaku A, Yoshida Y, Nakano Y, Maeda M, Hirayama H, Hashimoto H, Kihara Y. Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation. Europace 2016; 18:1352-6. [DOI: 10.1093/europace/euv424] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/15/2015] [Indexed: 11/13/2022] Open
|
36
|
Nakano Y, Ochi H, Onohara Y, Toshishige M, Tokuyama T, Matsumura H, Kawazoe H, Tomomori S, Sairaku A, Watanabe Y, Ikenaga H, Motoda C, Suenari K, Hayashida Y, Miki D, Oda N, Kishimoto S, Oda N, Yoshida Y, Tashiro S, Chayama K, Kihara Y. Common Variant Near
HEY2
Has a Protective Effect on Ventricular Fibrillation Occurrence in Brugada Syndrome by Regulating the Repolarization Current. Circ Arrhythm Electrophysiol 2016; 9:e003436. [DOI: 10.1161/circep.115.003436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yukiko Nakano
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Hidenori Ochi
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Yuko Onohara
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Masaaki Toshishige
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Takehito Tokuyama
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Hiroya Matsumura
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Hiroshi Kawazoe
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Shunsuke Tomomori
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Akinori Sairaku
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Yoshikazu Watanabe
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Hiroki Ikenaga
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Chikaaki Motoda
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Kazuyoshi Suenari
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Yasufumi Hayashida
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Daiki Miki
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Nozomu Oda
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Shinji Kishimoto
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Noboru Oda
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Yukihiko Yoshida
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Satoshi Tashiro
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Kazuaki Chayama
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| | - Yasuki Kihara
- From the Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan (A.S., C.M., H.I., H.K., H.M., K.S., M.T., Noboru Oda, Nozomu Oda, S. Tomomori, S.K., T.T., Y. O., Y.K., Y.N., Y.W.); Laboratory for Digestive Diseases, Center for Integrative Medical Sciences, RIKEN, Hiroshima, Japan (D.M., H.O., K.C., Y.N.); Division of Frontier Medical Science, Department of Gastroenterology and Metabolism, Programs for Biomedical Research
| |
Collapse
|
37
|
Fukuda Y, Nakano Y, Tomomori S, Matsumura H, Kawazoe H, Sairaku A, Tokuyama T, Suenari K, Hidaka T, Kihara Y. Neutrophil to Lymphocyte Ratio Predicts Reduced Left Atrial Appendage Wall Velocity in Patients with Paroxysmal Atrial Fibrillation. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.08.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Watanabe Y, Nakano Y, Hidaka T, Oda N, Kajihara K, Tokuyama T, Uchimura Y, Sairaku A, Motoda C, Fujiwara M, Kawazoe H, Matsumura H, Kihara Y. Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation. Heart Rhythm 2015; 12:490-497. [DOI: 10.1016/j.hrthm.2014.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 11/29/2022]
|
39
|
Sairaku A, Nakano Y, Kihara Y. Catheter ablation of longstanding persistent atrial fibrillation: Let sleeping dogs lie. Int J Cardiol 2015; 181:104-5. [PMID: 25497529 DOI: 10.1016/j.ijcard.2014.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Akinori Sairaku
- 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
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
40
|
Sairaku A, Yoshida Y, Hirayama H, Nakano Y, Kihara Y. Impact of pulmonary vein isolation on fractionated atrial potentials and ganglionated plexi in patients with persistent atrial fibrillation. Int Heart J 2014; 55:494-8. [PMID: 25310931 DOI: 10.1536/ihj.14-147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Some patients with persistent atrial fibrillation (AF) acquire long-term freedom from AF by pulmonary vein (PV) isolation alone. The aim of the present study was to evaluate the characteristics of their atrial substrate.We studied 20 patients with persistent AF to examine the distribution of fractionated atrial potentials (FAP) and that of the anatomic sites of ganglionated plexi (GPs) with vagal reflexes elicited by high frequency stimulation (HFS) with the use of the CARTO system before and after the PV isolation.Both the %FAP area defined as a proportion of the FAP area to the total left atrial area (34.3 ± 10.3 to 21.5 ± 10.2%; P < 0.0001) and number of GP sites with vagal reflexes (4.0 [3.0, 5.0] to 2.0 [1.0, 2.8]; P < 0.0001) were markedly decreased after the PV isolation. Seven (35%) patients had AF recurrences, and they had a greater %FAP area after the PV isolation than those without (32.8 [22.1, 37.3] versus 13.8 [10.9, 19.9]%; P = 0.0049). A %FAP area after the PV isolation of > 20% was significantly associated with an AF recurrence (odds ratio 20.0, 95% confidence interval 2.26470.34; P = 0.018). No significant difference was found between the patients with and without AF recurrence in the reduction rate of anatomic sites of GPs with a vagal reflex induced by the HFS.A more marked reduction in the FAP area by the PV isolation was significantly associated with a better outcome in patients with persistent AF.
Collapse
|
41
|
Sairaku A, Nakano Y, Kihara Y. Does dabigatran interfere with intraablation heparinization? Thromb Res 2014; 134:742-3. [DOI: 10.1016/j.thromres.2014.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
|
42
|
Kajihara K, Nakano Y, Hirai Y, Ogi H, Oda N, Suenari K, Makita Y, Sairaku A, Tokuyama T, Motoda C, Fujiwara M, Watanabe Y, Kiguchi M, Kihara Y. Variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis. J Cardiovasc Electrophysiol 2014; 24:1344-51. [PMID: 23875907 PMCID: PMC4229059 DOI: 10.1111/jce.12231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. Methods and Results This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02). Conclusion Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
Collapse
Affiliation(s)
- Kenta Kajihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
- Address for correspondence: Kenta Kajihara, M.D., Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Fax: +81-82-257-5169; E-mail:
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yukoh Hirai
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Hiroshi Ogi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Noboru Oda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Kazuyoshi Suenari
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yuko Makita
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Mai Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Yoshikazu Watanabe
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| | - Masao Kiguchi
- Department of Radiology, Hiroshima University HospitalHiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences
| |
Collapse
|
43
|
Uchimura-Makita Y, Nakano Y, Tokuyama T, Fujiwara M, Watanabe Y, Sairaku A, Kawazoe H, Matsumura H, Oda N, Ikanaga H, Motoda C, Kajihara K, Oda N, Verrier RL, Kihara Y. Time-domain T-wave alternans is strongly associated with a history of ventricular fibrillation in patients with Brugada syndrome. J Cardiovasc Electrophysiol 2014; 25:1021-1027. [PMID: 24761970 DOI: 10.1111/jce.12441] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/10/2014] [Accepted: 04/18/2014] [Indexed: 01/27/2023]
Abstract
AIMS T-wave alternans (TWA) is an indicator of vulnerability to ventricular arrhythmias and is useful for predicting sudden cardiac death (SCD) in patients with various structural heart diseases. We evaluated whether high levels of time-domain TWA on ambulatory ECG (AECG) are associated with a history of ventricular fibrillation (VF) in Brugada syndrome (BrS) patients. METHODS AND RESULTS We examined the associations among VF history, family history of SCD, spontaneous type 1 electrocardiogram (ECG), late potentials, VF induction by programmed electrical stimulation, and TWA in 45 BrS patients (44 males; mean age, 45 ± 15 years). TWA analyzed from 24-h AECG recordings using the modified moving average method was positive in 13 of 43 patients (30%). Patients with a history of VF had a significantly higher incidence of a positive TWA test (82% vs. 13%; P < 0.001) and spontaneous type 1 ECG (92% vs. 38%; P = 0.007) than those without VF history. Multivariate analysis indicated that positive TWA (OR 7.217; 95% CI 2.503-35.504; P = 0.002) and spontaneous type 1 ECG (OR 5.530; 95% CI 1.651-34.337; P = 0.020) were closely associated with VF history. Spontaneous type 1 ECG had high sensitivity (92%) but low specificity (63%). Positive TWA was a reliable marker with high sensitivity and specificity (82% and 88%, respectively). CONCLUSION Elevated time-domain TWA on AECG confirms arrhythmia risk in symptomatic BrS patients without the need for provocative stimuli.
Collapse
Affiliation(s)
- Yuko Uchimura-Makita
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mai Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshikazu Watanabe
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kawazoe
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nozomu Oda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ikanaga
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenta Kajihara
- Division of Cardiovascular Medicine, Higasihiroshima Medical Center, Hiroshima, Japan
| | - Noboru Oda
- Division of Cardiovascular Medicine, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Richard L Verrier
- Division of Cardiovascular Medicine, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
44
|
Sairaku A, Nakano Y, Oda N, Uchimura Y, Tokuyama T, Kawazoe H, Fujiwara M, Watanabe Y, Matsumura H, Kihara Y. Incomplete cure of tachycardia-induced cardiomyopathy secondary to rapid atrial fibrillation by heart rate control without sinus conversion. J Cardiovasc Electrophysiol 2014; 25:1037-43. [PMID: 24762049 DOI: 10.1111/jce.12445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is uncertain whether rate or rhythm control is more favorable for patients experiencing tachycardia-induced cardiomyopathy (TIC) secondary to rapid atrial fibrillation (AF). METHODS AND RESULTS We compared the electrophysiological and hemodynamic properties and outcome after AF ablation in 20 patients with a history of decompensated TIC who maintained sinus rhythm or had paroxysmal AF (group 1), 32 with a history of decompensated TIC who had persistent or longstanding persistent AF (group 2), 377 without TIC who had paroxysmal AF (group 3), and 225 without TIC who had persistent or longstanding persistent AF (group 4). The corrected sinus node recovery time was more prolonged in group 2 than in groups 1, 3, or 4 (1,066 ± 946 vs. 416 ± 188, 450 ± 322 and 590 ± 329 milliseconds; P < 0.001, respectively). The mean left atrial pressure in group 2 was greater than that in groups 1, 3, or 4 (13.9 ± 6.5 vs. 7.5 ± 3.1, 8.2 ± 4.1 and 10.8 ± 4.2 mmHg; P < 0.001, respectively). The left ventricular ejection fraction assessed after the recovery from the decompensation was more decreased in group 2 than in group 1; however, it almost returned to normal if sinus rhythm was maintained after the AF ablation in group 2. The presence of a history of TIC did not predict an AF recurrence after the ablation. CONCLUSIONS Heart rate control during AF without sinus conversion may result in an incomplete cure of TIC, suggesting the advantages of rhythm control with ablation in patients with TIC.
Collapse
Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Sairaku A, Yoshida Y, Hirayama H, Kihara Y. Conversion from persistent to paroxysmal atrial fibrillation after pulmonary vein isolation is a good sign. Int J Cardiol 2014; 173:322-3. [DOI: 10.1016/j.ijcard.2014.03.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/09/2014] [Indexed: 11/30/2022]
|
46
|
Sairaku A, Yoshida Y, Hirayama H, Nakano Y, Kondo N, Kihara Y. Don't move during ablation of atrial fibrillation! Int J Cardiol 2014; 171:78-81. [DOI: 10.1016/j.ijcard.2013.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/21/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
|
47
|
Fujiwara M, Nakano Y, Hidaka T, Oda N, Uchimura Y, Sairaku A, Kajihara K, Tokuyama T, Motoda C, Watanabe Y, Ikenaga H, Imai K, Sueda T, Kihara Y. Prediction of Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting Using Preoperative Total Atrial Conduction Time Determined on Tissue Doppler Imaging. Circ J 2014; 78:345-52. [DOI: 10.1253/circj.cj-13-0900] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mai Fujiwara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Noboru Oda
- Department of Cardiovascular Medicine, Hiroshima City Asa Hospital
| | - Yuko Uchimura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kenta Kajihara
- Department of Cardiovascular Medicine, Higashihiroshima Medical Center
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoshikazu Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Taijirou Sueda
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| |
Collapse
|
48
|
Sairaku A, Yoshida Y, Hirayama H, Nakano Y, Ando M, Kihara Y. Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial. Europace 2013; 16:994-9. [DOI: 10.1093/europace/eut363] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Sairaku A, Yoshida Y, Nakano Y, Kihara Y. Ablation of atrial fibrillation in Brugada syndrome patients with an implantable cardioverter defibrillator to prevent inappropriate shocks resulting from rapid atrial fibrillation. Int J Cardiol 2013; 168:5273-6. [DOI: 10.1016/j.ijcard.2013.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/17/2013] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
|
50
|
Sairaku A, Yoshida Y, Ando M, Hirayama H, Nakano Y, Kihara Y. A Head-to-Head Comparison of Periprocedural Coagulability Under Anticoagulation with Rivaroxaban Versus Dabigatran in Patients Undergoing Ablation of Atrial Fibrillation. Clin Drug Investig 2013; 33:847-53. [DOI: 10.1007/s40261-013-0134-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|