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Fujito H, Nagashima K, Saito Y, Mizobuchi S, Fukumoto K, Wakamatsu Y, Arai R, Watanabe R, Murata N, Toyama K, Kitano D, Fukamachi D, Yoda S, Okumura Y. Optimal timing of electrical cardioversion for acute decompensated heart failure caused by atrial arrhythmias: The earlier, the better? Heart Vessels 2024:10.1007/s00380-024-02393-7. [PMID: 38656612 DOI: 10.1007/s00380-024-02393-7] [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: 11/02/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
The optimal timing for electrical cardioversion (ECV) in acute decompensated heart failure (ADHF) with atrial arrhythmias (AAs) is unknown. Here, we retrospectively evaluated the impact of ECV timing on SR maintenance, hospitalization duration, and cardiac function in patients with ADHF and AAs. Between October 2017 and December 2022, ECV was attempted in 73 patients (62 with atrial fibrillation and 11 with atrial flutter). Patients were classified into two groups based on the median number of days from hospitalization to ECV, as follows: early ECV (within 8 days, n = 38) and delayed ECV (9 days or more, n = 35). The primary endpoint was very short-term and short-term ECV failure (unsuccessful cardioversion and AA recurrence during hospitalization and within one month after ECV). Secondary endpoints included (1) acute ECV success, (2) ECVs attempted, (3) periprocedural complications, (4) transthoracic echocardiographic parameter changes within two months following successful ECV, and (5) hospitalization duration. ECV successfully restored SR in 62 of 73 patients (85%), with 10 (14%) requiring multiple ECV attempts (≥ 3), and periprocedural complications occurring in six (8%). Very short-term and short-term ECV failure occurred without between-group differences (51% vs. 63%, P = 0.87 and 61% vs. 72%, P = 0.43, respectively). Among 37 patients who underwent echocardiography before and after ECV success, the left ventricular ejection fraction (LVEF) significantly increased (38% [31-52] to 51% [39-63], P = 0.008) between admission and follow-up. Additionally, hospital stay length was shorter in the early ECV group than in the delayed ECV group (14 days [12-21] vs. 17 days [15-26], P < 0.001). Hospital stay duration was also correlated with days from admission to ECV (Spearman's ρ = 0.47, P < 0.001). In clinical practice, early ECV was associated with a shortened hospitalization duration and significantly increased LVEF in patients with ADHF and AAs.
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Affiliation(s)
- Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Saki Mizobuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Katsunori Fukumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuto Toyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Hirata S, Kurokawa S, Okumura Y. Where is the gap after a 90 W/4 s very-high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness. J Arrhythm 2024; 40:256-266. [PMID: 38586851 PMCID: PMC10995583 DOI: 10.1002/joa3.13009] [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] [Received: 09/06/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Background Although pulmonary vein isolation (PVI) for atrial fibrillation (AF) utilizing radiofrequency (RF) applications with a very high-power and short-duration (vHPSD) has shortened the procedure time, the determinants of pulmonary vein (PV) gaps in the first-pass PVI and acute PV reconnections are unclear. Methods An extensive encircling PVI was performed with the QDOT MICRO catheter with a vHPSD (90 W-4 s) in 30 patients with AF (19 men, 64 ± 10 years). The association of the PV gap sites (first-pass PVI failure, acute PV reconnections [spontaneous reconnections or dormant conduction provoked by adenosine triphosphate] or both) with the left atrial (LA) wall thickness and LA bipolar voltage on the PVI line and ablation-related parameters were assessed. Results PV gaps were observed in 29 (6%) of 480 segments (16 segments per patient) in 17 patients (56%). The PV gaps were associated with the LA wall thickness, bipolar voltage, and the number of RF points (LA wall thickness, 2.5 ± 0.5 vs. 1.9 ± 0.4 mm, p < .001; bipolar voltage, 2.59 ± 1.62 vs. 1.34 ± 1.14 mV, p < .001; RF points, 6 ± 2 vs. 4 ± 2, p = .008) but were not with the other ablation-related parameters. Receiver operating characteristic curves yielded that an LA wall thickness ≥2.3 mm and bipolar voltage ≥2.40 mV were determinants of PV gaps with an area under the curve of 0.82 and 0.73, respectively. Conclusions The LA voltage and wall thickness on the PV-encircling ablation line were highly associated with PV gaps using the 90 W/4 s-vHPSD ablation.
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Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Nagashima K. One-Shot Diagnosis for Atrial Tachycardia: The Utility of a Single Atrial Extrastimulus. JACC Clin Electrophysiol 2024:S2405-500X(24)00176-2. [PMID: 38703166 DOI: 10.1016/j.jacep.2024.02.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
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Maeda S, Nagashima K, Yasuda N, Tsurumi N, Kato T, Awaji Y. Coexistence of a Classical Nodoventricular Accessory Pathway With a Left-Sided Mahaim Accessory Pathway. JACC Case Rep 2024; 29:102220. [PMID: 38464805 PMCID: PMC10920106 DOI: 10.1016/j.jaccas.2024.102220] [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: 08/04/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 03/12/2024]
Abstract
The coexistence of 2 Mahaim pathways represents a diagnostic challenge. We present a case in which the SH/HA intervals were useful for identifying concealed nodoventricular or His-ventricular pathways.
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Affiliation(s)
- Soichiro Maeda
- Division of Cardiology, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yasuda
- Division of Clinical Engineering, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Naoki Tsurumi
- Division of Cardiology, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Toshiaki Kato
- Division of Cardiology, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Yoshifumi Awaji
- Division of Cardiology, Nagoya Ekisaikai Hospital, Aichi, Japan
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Hirata S, Nagashima K, Watanabe R, Wakamatsu Y, Okumura Y. Pseudo-slow-fast atrioventricular nodal reentrant tachycardia: Is the fast pathway a criminal or innocent bystander? J Arrhythm 2024; 40:143-145. [PMID: 38333396 PMCID: PMC10848596 DOI: 10.1002/joa3.12955] [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] [Received: 10/12/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 02/10/2024] Open
Abstract
The intracardiac electrograms are shown during scanned single premature ventricular extrastimuli with a decreasing coupling interval in a very short RP tachycardia. What is the diagnosis and is the fast pathway essential for sustaining the tachycardia?
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Affiliation(s)
- Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Nagashima K, Maruyama M, Kaneko Y, Sakai S, Sekihara T, Kawaji T, Iwakawa H, Egami Y, Ota C, Nagase S, Yagi T, Suzuki K, Fukaya H, Nakamura H, Mori H, Ueda A, Soejima K, Watanabe R, Wakamatsu Y, Hirata S, Hirata M, Okumura Y. Systematic observation-based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway. J Arrhythm 2024; 40:131-142. [PMID: 38333409 PMCID: PMC10848616 DOI: 10.1002/joa3.12976] [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] [Received: 10/18/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024] Open
Abstract
Background This study aimed to establish a systematic method for diagnosing atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed nodoventricular pathway (cNVP). Methods We analyzed 13 cases of AVNRT with a bystander cNVP, 11 connected to the slow pathway (cNVP-SP) and two to the fast pathway (cNVP-FP), along with two cases of cNVP-related orthodromic reciprocating tachycardia (ORT). Results The diagnostic process was summarized in three steps. Step 1 was identification of the presence of an accessory pathway by resetting the tachycardia with delay (n = 9) and termination without atrial capture (n = 4) immediately after delivery of a His-refractory premature ventricular contraction (PVC). Step 2 was exclusion of ORT by atrio-His block during the tachycardia (n = 4), disappearance of the reset phenomenon after the early PVC (n = 7), or dissociation of His from the tachycardia during ventricular overdrive pacing (n = 1). Moreover, tachycardia reset/termination without the atrial capture (n = 2/2) 1 cycle after the His-refractory PVC was specifically diagnostic. Exceptionally, the disappearance of the reset phenomenon was also observed in the two cNVP-ORTs. Step 3 was verification of the AVN as the cNVP insertion site, evidenced by an atrial reset/block preceding the His reset/block in fast-slow AVNRT with a cNVP-SP and slow-fast AVNRT with a cNVP-FP or His reset preceding the atrial reset in slow-fast AVNRT with a cNVP-SP. Conclusion AVNRT with a bystander cNVP can be diagnosed in the three steps with few exceptions. Notably, tachycardia reset/termination without atrial capture one cycle after delivery of a His-refractory PVC is specifically diagnostic.
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Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Mitsunori Maruyama
- Department of Cardiovascular MedicineNippon Medical School Musashikosugi HospitalKanagawaJapan
| | - Yoshiaki Kaneko
- Department of Cardiovascular MedicineGunma University Graduate School of MedicineGunmaJapan
| | - Satoshi Sakai
- Department of CardiologyNara Prefecture General Medical CenterNaraJapan
| | - Takayuki Sekihara
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Tetsuma Kawaji
- Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
| | - Hidehiro Iwakawa
- Department of Cardiovascular MedicineAkita University Graduate School of MedicineAkitaJapan
| | | | - Chisato Ota
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Satoshi Nagase
- Department of Advanced Arrhythmia and Translational Medical ScienceNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Tetsuo Yagi
- Department of CardiologySendai City HospitalMiyagiJapan
| | | | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineKanagawaJapan
| | - Hironori Nakamura
- Department of Cardiovascular MedicineKitasato University School of MedicineKanagawaJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akiko Ueda
- Division of Advance Arrhythmia ManagementKyorin University HospitalTokyoJapan
| | - Kyoko Soejima
- Department of Cardiovascular MedicineKyorin University HospitalTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Sawada M, Otsuka N, Nagashima K, Watanabe R, Wakamatsu Y, Hayashida S, Hirata S, Hirata M, Kurokawa S, Okumura Y. Clinical implication of the patient's disease awareness and adherence to medications in patients undergoing atrial fibrillation ablation. J Arrhythm 2024; 40:57-66. [PMID: 38333379 PMCID: PMC10848582 DOI: 10.1002/joa3.12965] [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] [Received: 08/09/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024] Open
Abstract
Background The effects of the patient's disease awareness on the management of postablation of atrial fibrillation (AF) are unknown. Methods One hundred thirty-three AF patients undergoing an initial ablation were given a disease awareness questionnaire with a score of 16 points (8 points about AF in general and 8 points about oral anticoagulants) for the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) before and 1-year-after ablation. We divided them into the poor disease awareness group and good disease awareness group according to the median value (75%) of the total JAKQ score about AF in general, and compared the baseline patient characteristics and the 1-year changes in the JAKQ score, medication adherence, blood pressure, laboratory data, echocardiographic parameters, and AF/atrial tachycardia (AT) recurrence rate between the two groups. Results Forty-two (31.6%) patients were classified as having poor disease awareness (<75% of the total JAKQ score), which was closely associated with poor medication adherence, hypertension, diabetes, dyslipidemia, and greater left atrial volume (LAV). These trends in the poor disease awareness group remained unchanged 1 year after the ablation. During the 25.3-month follow-up, the AF/AT recurrence rate was significantly higher in the poor disease awareness than the good disease awareness group (23.8% vs. 7.7%; p = .003 by the log-rank test). Conclusions Poor disease awareness was linked to poor medication adherence, lifestyle-related diseases, and greater LAV before and even 1 year after the ablation, making it a potential surrogate marker for AF/AT recurrence. These findings highlight the clinical significance of disease awareness in AF management.
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Affiliation(s)
- Masanaru Sawada
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Satoshi Hayashida
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Takahashi R, Taniguchi Y. Characteristics of tissue temperature during ablation with THERMOCOOL SMARTTOUCH SF versus TactiCath versus QDOT MICRO catheters (Qmode and Qmode+): An in vivo porcine study. J Cardiovasc Electrophysiol 2024; 35:7-15. [PMID: 37794818 DOI: 10.1111/jce.16092] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION High-power short-duration (HPSD) ablation at 50 W, guided by ablation index (AI) or lesion size index (LSI), and a 90 W/4 s very HSPD (vHPSD) setting are available for atrial fibrillation (AF) treatment. Yet, tissue temperatures during ablation with different catheters around venoatrial junction and collateral tissues remain unclear. METHODS In this porcine study, we surgically implanted thermocouples on the epicardium near the superior vena cava (SVC), right pulmonary vein, and esophagus close to the inferior vena cava. We then compared tissue temperatures during 50W-HPSD guided by AI 400 or LSI 5.0, and 90 W/4 s-vHPSD ablation using THERMOCOOL SMARTTOUCH SF (STSF), TactiCath ablation catheter, sensor enabled (TacthCath), and QDOT MICRO (Qmode and Qmode+ settings) catheters. RESULTS STSF produced the highest maximum tissue temperature (Tmax ), followed by TactiCath, and QDOT MICRO in Qmode and Qmode+ (62.7 ± 12.5°C, 58.0 ± 10.1°C, 50.0 ± 12.1°C, and 49.2 ± 8.4°C, respectively; p = .005), achieving effective transmural lesions. Time to lethal tissue temperature ≥50°C (t-T ≥ 50°C) was fastest in Qmode+, followed by TacthCath, STSF, and Qmode (4.3 ± 2.5, 6.4 ± 1.9, 7.1 ± 2.8, and 7.7 ± 3.1 s, respectively; p < .001). The catheter tip-to-thermocouple distance for lethal temperature (indicating lesion depth) from receiver operating characteristic curve analysis was deepest in STSF at 5.2 mm, followed by Qmode at 4.3 mm, Qmode+ at 3.1 mm, and TactiCath at 2.8 mm. Ablation at the SVC near the phrenic nerve led to sudden injury at t-T ≥ 50°C in all four settings. The esophageal adventitia injury was least deep with Qmode+ ablation (0.4 ± 0.1 vs. 0.8 ± 0.4 mm for Qmode, 0.9 ± 0.3 mm for TactiCath, and 1.1 ± 0.5 mm for STSF, respectively; p = .005), correlating with Tmax . CONCLUSION This study revealed distinct tissue temperature patterns during HSPD and vHPSD ablations with the three catheters, affecting lesion effectiveness and collateral damage based on Tmax and/or t-T ≥ 50°C. These findings provide key insights into the safety and efficacy of AF ablation with these four settings.
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Affiliation(s)
- Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Medical Research Support Center, Institute of Medical Science, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Medical Research Support Center, Institute of Medical Science, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
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Wakamatsu Y, Nagashima K, Watanabe R, Hirata S, Okumura Y. Termination of slow-fast atrioventricular reentrant tachycardia by a single cryoablation of the slow pathway guided by a fractionation map. J Arrhythm 2023; 39:969-972. [PMID: 38045462 PMCID: PMC10692848 DOI: 10.1002/joa3.12932] [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: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/05/2023] Open
Abstract
This is a slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) case wherein the fractionation map-guided cryoablation of the slow pathway (SP) successfully terminated the tachycardia. In this case, the Advisor™ HD Grid catheter and fractionation map in the EnSite™ X EP system with relatively high-sensitive settings were useful for detecting the target SP area. Direct AVNRT termination by cryomapping at the fractionated potential area might be a quick and safe ablation strategy, which may provide a new workflow for SP ablation.
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Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Yamauchi T, Okumura Y, Nagashima K, Watanabe R, Saito Y, Yokoyama K, Matsumoto N, Miyauchi K, Miyazaki S, Hayashi H, Matsue Y, Nishizaki Y, Nojiri S, Minamino T, Daida H. External Validation of the HELT-E 2S 2 Score in Japanese Patients With Nonvalvular Atrial Fibrillation - A Pooled Analysis of the RAFFINE and SAKURA Registries. Circ J 2023; 87:1777-1787. [PMID: 37558457 DOI: 10.1253/circj.cj-23-0318] [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: 08/11/2023]
Abstract
BACKGROUND The HELT-E2S2score, which assigns 1 point to Hypertension, Elderly aged 75-84 years, Low body mass index <18.5 kg/m2, and Type of atrial fibrillation (AF: persistent/permanent), and 2 points to Extreme Elderly aged ≥85 years and previous Stroke, has been proposed as a new risk stratification for strokes in Japanese AF patients, but has not yet undergone external validation.Methods and Results: We evaluated the prognostic performance of the HELT-E2S2score for stroke risk stratification using 2 large-scale registries in Japanese AF patients (n=7,020). During 23,241 person-years of follow-up (mean follow-up 1,208±450 days), 287 ischemic stroke events occurred. The C-statistic using the HELT-E2S2score was 0.661 (95% confidence interval [CI], 0.629-0.692), which was numerically higher than with the CHADS2score (0.644, 95% CI 0.613-0.675; P=0.15 vs. HELT-E2S2) or CHA2DS2-VASc score (0.650, 95% CI, 0.619-0.680; P=0.37 vs. HELT-E2S2). In the SAKURA AF Registry, the C-statistic of the HELT-E2S2score was consistently higher than the CHADS2and CHA2DS2-VASc scores across all 3 types of facilities comprising university hospitals, general hospitals, and clinics. However, in the RAFFINE Study, its superiority was only observed in general hospitals. CONCLUSIONS The HELT-E2S2score demonstrated potential value for risk stratification, particularly in a super-aged society such as Japan. However, its superiority over the CHADS2or CHA2DS2-VASc scores may vary across different hospital settings.
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Affiliation(s)
| | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | - Ryuta Watanabe
- Division of Cardiology, Nihon University Itabashi Hospital
| | - Yuki Saito
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | | | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Yuji Nishizaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
- Medical Technology Innovation Center, Juntendo University
- Division of Medical Education, Juntendo University School of Medicine
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
- Faculty of Health Science, Juntendo University
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11
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Saito Y, Omae Y, Nagashima K, Miyauchi K, Nishizaki Y, Miyazaki S, Hayashi H, Nojiri S, Daida H, Minamino T, Okumura Y. Phenotyping of atrial fibrillation with cluster analysis and external validation. Heart 2023; 109:1751-1758. [PMID: 37263768 DOI: 10.1136/heartjnl-2023-322447] [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: 01/24/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Atrial fibrillation (AF) is a heterogeneous condition. We performed a cluster analysis in a cohort of patients with AF and assessed the prognostic implication of the identified cluster phenotypes. METHODS We used two multicentre, prospective, observational registries of AF: the SAKURA AF registry (Real World Survey of Atrial Fibrillation Patients Treated with Warfarin and Non-vitamin K Antagonist Oral Anticoagulants) (n=3055, derivation cohort) and the RAFFINE registry (Registry of Japanese Patients with Atrial Fibrillation Focused on anticoagulant therapy in New Era) (n=3852, validation cohort). Cluster analysis was performed by the K-prototype method with 14 clinical variables. The endpoints were all-cause mortality and composite cardiovascular events. RESULTS The analysis subclassified derivation cohort patients into five clusters. Cluster 1 (n=414, 13.6%) was characterised by younger men with a low prevalence of comorbidities; cluster 2 (n=1003, 32.8%) by a high prevalence of hypertension; cluster 3 (n=517, 16.9%) by older patients without hypertension; cluster 4 (n=652, 21.3%) by the oldest patients, who were mainly female and with a high prevalence of heart failure history; and cluster 5 (n=469, 15.3%) by older patients with high prevalence of diabetes and ischaemic heart disease. During follow-up, the risk of all-cause mortality and composite cardiovascular events increased across clusters (log-rank p<0.001, p<0.001). Similar results were found in the external validation cohort. CONCLUSIONS Machine learning-based cluster analysis identified five different phenotypes of AF with unique clinical characteristics and different clinical outcomes. The use of these phenotypes may help identify high-risk patients with AF.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuto Omae
- Department of Industrial Engineering and Management, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Ishii K, Matsue Y, Miyauchi K, Miyazaki S, Hayashi H, Nishizaki Y, Nojiri S, Saito Y, Nagashima K, Okumura Y, Daida H, Minamino T. Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score. Eur Heart J Qual Care Clin Outcomes 2023; 9:716-723. [PMID: 36542406 DOI: 10.1093/ehjqcco/qcac085] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 11/08/2023]
Abstract
AIM Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF). We sought to develop and externally validate a risk model for new-onset HF admission in patients with AF and those without a history of HF. METHODS AND RESULTS Using two multicentre, prospective, observational AF registries, RAFFINE (2857 patients, derivation cohort) and SAKURA (2516 patients without a history of HF, validation cohort), we developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression with the derivation cohort. External validity testing was used for the validation cohort. Overall, 148 (5.2%) and 104 (4.1%) patients in the derivation and validation cohorts, respectively, developed HF during median follow-ups of 1396 (interquartile range [IQR]: 1078-1820) and 1168 (IQR: 844-1309) days, respectively. In the derivation cohort, age, haemoglobin, serum creatinine, and log-transformed brain natriuretic peptide were identified as potential risk factors for HF development. The risk model showed good discrimination and calibration in both derivations (area under the curve [AUC]: 0.80 [95% confidence interval (CI) 0.76-0.84]; Hosmer-Lemeshow, P = 0.257) and validation cohorts (AUC: 0.78 [95%CI 0.74-0.83]; Hosmer-Lemeshow, P = 0.475). CONCLUSION The novel risk model with four readily available clinical characteristics and biomarkers performed well in predicting new-onset HF admission in patients with AF.
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Affiliation(s)
- Kai Ishii
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuji Nishizaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Division of Medical Education, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
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13
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Matsumoto K, Mori H, Nagashima K, Kaneko Y, Kato R. Fast-slow atrioventricular nodal re-entrant tachycardia incorporating superior and inferolateral left atrial slow pathways. J Cardiovasc Electrophysiol 2023; 34:2002-2005. [PMID: 37526239 DOI: 10.1111/jce.16030] [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: 06/12/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A 70-year-old man revealed a rare type of atrioventricular nodal re-entrant tachycardia (AVNRT) involving distinct retrograde pathways, superior slow pathway, and inferolateral left atrial slow pathway. RESULT Radiofrequency ablation was successfully performed on the noncoronary cusp and in the left atrium, respectively, to eliminate the tachycardias. DISCUSSION AND CONCLUSION Due to the anomalous electrical conduction patterns, careful diagnosis and ablation strategies were necessary to avoid the risk of atrioventricular block. These findings underscore the diversity and complexity of AVNRT and highlight the importance of tailored therapeutic approaches.
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Affiliation(s)
- Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Bunkyo City, Tokyo, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
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14
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Honma T, Hirata S, Nagashima K, Okumura Y. One electrogram tracing tells all: What is the mechanism of this tachycardia and where is the catheter positioned? J Cardiovasc Electrophysiol 2023; 34:1488-1490. [PMID: 37232447 DOI: 10.1111/jce.15957] [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: 05/07/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Taiga Honma
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shu Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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15
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Sawada M, Kurokawa S, Okumura Y. Trends over the recent 6 years in ablation modalities and strategies, post-ablation medication, and clinical outcomes of atrial fibrillation ablation. J Arrhythm 2023; 39:366-375. [PMID: 37324765 PMCID: PMC10264728 DOI: 10.1002/joa3.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post-ablation medication and clinical outcomes remains to be fully investigated. Methods We divided 682 patients who had undergone AF ablation in 2014-2019 (420 paroxysmal AFs [PAF], 262 persistent AFs [PerAF]) into three groups according to the period, that is, the 2014-2015 (n = 139), 2016-2017 (n = 244), and 2018-2019 groups (n = 299), respectively. Results Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra-pulmonary vein (PV)-LA ablation was more frequently performed in the 2014-2015 group than in the 2016-2017 and 2018-2019 groups (41.1% vs. 9.1% and 8.1%; p < .001). The 2-year freedom rate from AF/atrial tachycardias for PAF was similar among the three groups (84.0% vs. 83.1% vs. 86.7%; p = .98) but lowest in the 2014-2015 group for PerAF (63.9% vs. 82.7% and 86.3%; p = .025) despite the highest post-ablation antiarrhythmic drug use. Cardiac tamponade was significantly decreased in the 2018-2019 group (3.6% vs. 2.0% vs. 0.33%; p = 0.021). There was no difference in the 2-year clinically relevant events among the three groups. Conclusion Although ablation was performed in a more diseased LA and extra-PV-LA ablation was less frequent in recent years, the complication rate decreased, and AF recurrences for PAF remained unchanged, but that for PerAF decreased. Clinically relevant events remained unchanged over the recent 6 years, suggesting that the impact of the recent ablation modalities and strategies on remote clinically relevant events may be small during this study period.
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Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Satoshi Hayashida
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Masanaru Sawada
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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16
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Mano H, Nakai T, Ikeya Y, Kogawa R, Saito Y, Kurokawa S, Nagashima K, Okumura Y. When Is Cardiac Resynchronization Therapy with a Defibrillator Indicated in Patients with Heart Failure, Especially Elderly Patients? Int Heart J 2023:22-418. [PMID: 37197920 DOI: 10.1536/ihj.22-418] [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] [Indexed: 05/19/2023]
Abstract
One benefit of an implantable cardioverter-defibrillator is the prevention of sudden cardiac death (SCD). It is recommended for patients with a low left ventricular ejection fraction (LVEF). However, the choice of cardiac resynchronization therapy (CRT) with or without a defibrillator (CRT-D and CRT-P) in elderly patients is controversial. To understand the current situation for proper device selection, we investigated the impact of defibrillators on mortality in elderly patients with heart failure.Consecutive patients who underwent CRT implantation were retrospectively recruited. Baseline characteristics, all-cause mortality, cardiac death, and defibrillator implantation rates were investigated in patients aged > 75 or ≤ 75 years.A total of 285 patients (79 patients aged > 75 years) were analyzed. Elderly patients had more comorbidities, but a lower proportion had ventricular arrhythmia. During the mean follow-up of 47 months, 109 patients died (67 due to cardiac death). Kaplan-Meier analysis showed higher mortality in elderly patients (P = 0.0428) but no significant difference in cardiac death by age group (P = 0.7472). There were no significant differences in mortality between patients with CRT-D versus CRT-P (P = 0.3386).SCD was rare. A defibrillator had no significant impact on mortality. In elderly patients, comorbidities are common and related to mortality. The selection of CRT-D versus CRT-P should take those factors into account.
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Affiliation(s)
- Hiroaki Mano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Watanabe R, Okumura Y, Nagashima K, Wakamatsu Y, Yamada A, Kurokawa S. Chronic Ablation Lesions after Cryoballoon and Hot Balloon Ablation of Atrial Fibrillation. J NIPPON MED SCH 2023; 90:69-78. [PMID: 36436916 DOI: 10.1272/jnms.jnms.2023_90-112] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronological changes in ablation lesions after cryoballoon ablation (CBA) and hot balloon ablation (HBA) of atrial fibrillation (AF) remain unclear. METHODS Of 90 patients who underwent initial balloon-based catheter ablation of AF and cardiac magnetic resonance imaging (cMRI) 3 months after ablation, data from 48 propensity score-matched patients (24 per group; 34 males; age 62±10 years) were analyzed. High-density pulmonary vein-left antrum (PV-LA) voltage mapping was performed after PV isolation, and low voltage areas around the PV ostia were defined as the total acute ablation lesion area (cm2). cMRI-derived dense fibrotic tissue localized around PVs was defined as the total chronic ablation lesion area (cm2). The percentage of total ablation lesion areas to total PV-LA surface area (%ablation lesion) was calculated during each phase, and %acute ablation lesion and %chronic ablation lesion areas were compared in patients who had undergone CBA and HBA. RESULTS The %acute ablation lesion area was larger for the CBA group than for the HBA group (30.8±5.8% vs. 23.0±5.5%, p < 0.001). There was no difference in %chronic cMRI-derived ablation lesion area (24.8±10.8% vs. 21.1±11.6%, p = 0.26) between groups. The rates of chronic AF recurrence were 12.5% and 8.3%, respectively (p = 0.45; log-rank test). LA volume and LA surface area were strongly associated with AF recurrence, but %chronic ablation lesion area was not (27±8% vs. 23±12%, p = 0.39). CONCLUSION Large acute ablation lesions after CBA were smaller during the chronic phase. The size of chronic ablation lesions and the rate of AF recurrence were both similar for CBA and HBA.
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Affiliation(s)
- Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Akimasa Yamada
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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18
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Wakamatsu Y, Nagashima K, Kaneko Y, Mori H, Tsutsui K, Maegaki M, Sonoda K, Otsuka N, Hirata S, Hirata M, Kato R, Sumitomo N, Okumura Y. Novel Ablation Strategy Targeting the Slow Pathway Visualized by Ultrahigh-Resolution Mapping in Typical Slow-Fast Atrioventricular Nodal Reentrant Tachycardia. Circ Arrhythm Electrophysiol 2023; 16:e011497. [PMID: 36799216 DOI: 10.1161/circep.122.011497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan (Y.K.)
| | - Hitoshi Mori
- Department of Cardiology (H.M., K.T., R.K.), Saitama Medical University International Medical Center, Saitama, Japan
- Department of Pediatric Cardiology (H.M., N.S.), Saitama Medical University International Medical Center, Saitama, Japan
| | - Kenta Tsutsui
- Department of Cardiology (H.M., K.T., R.K.), Saitama Medical University International Medical Center, Saitama, Japan
| | - Masaharu Maegaki
- Department of Cardiology, Ayase Heart Hospital, Tokyo, Japan (M.M.)
| | | | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
| | - Shu Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
| | - Moyuru Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
| | - Ritsushi Kato
- Department of Cardiology (H.M., K.T., R.K.), Saitama Medical University International Medical Center, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology (H.M., N.S.), Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (Y.W., K.N., N.O., S.H., M.H., Y.O.)
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Okumura Y, Nagashima K, Watanabe R, Yokoyama K, Kato T, Fukaya H, Hayashi H, Nakahara S, Shimizu W, Iwasaki YK, Fujimoto Y, Mukai Y, Ejima K, Otsuka T, Suzuki S, Murakami M, Kimura M, Harada M, Koyama J, Okamatsu H, Yamane T, Yamashita S, Tokuda M, Narui R, Takami M, Shoda M, Harada T, Nakajima I, Fujiu K, Hiroshima K, Tanimoto K, Fujino T, Nakamura K, Kumagai K, Okada A, Kobayashi H, Hayashi T, Watari Y, Hatsuno M, Tachibana E, Iso K, Sonoda K, Aizawa Y, Chikata A, Sakagami S, Inoue M, Minamiguchi H, Makino N, Satomi K, Yazaki Y, Aoyagi H, Ichikawa M, Haruta H, Hiro T, Okubo K, Arima K, Tojo T, Kihara H, Miyanaga S, Fukuda Y, Oiwa K, Fujiishi T, Akabane M, Ishikawa N, Kusano K, Miyamoto K, Tabuchi H, Shiozawa T, Miyamoto K, Mase H, Murotani K. Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes after Catheter Ablation of Atrial Fibrillation in the Very Elderly (REHEALTH AF) study: rationale and design of a prospective, multicentre, observational, comparative study. BMJ Open 2023; 13:e068894. [PMID: 36792334 PMCID: PMC9933749 DOI: 10.1136/bmjopen-2022-068894] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Data are lacking on the extent to which patients with non-valvular atrial fibrillation (AF) who are aged ≥80 years benefit from ablation treatment. The question pertains especially to patients' postablation quality of life (QoL) and long-term clinical outcomes. METHODS AND ANALYSIS We are initiating a prospective, registry-based, multicentre observational study that will include patients aged ≥80 years with non-valvular AF who choose to undergo treatment by catheter ablation and, for comparison, such patients who do not choose to undergo ablation (either according to their physician's advice or their own preference). Study subjects are to be enrolled from 52 participant hospitals and three clinics located throughout Japan from 1 June 2022 to 31 December 2023, and each will be followed up for 1 year. The planned sample size is 660, comprising 220 ablation group patients and 440 non-ablation group patients. The primary endpoint will be the composite incidence of stroke/transient ischaemic attack (TIA) or systemic embolism (SE), another cardiovascular event, major bleeding and/or death from any cause. Other clinical events such as postablation AF recurrence, a fall or bone fracture will be recorded. We will collect standard clinical background information plus each patient's Clinical Frailty Scale score, AF-related symptoms, QoL (Five-Level Version of EQ-5D) scores, Mini-Mental State Examination (optional) score and laboratory test results, including measures of nutritional status, on entry into the study and 1 year later, and serial changes in symptoms and QoL will also be secondary endpoints. Propensity score matching will be performed to account for covariates that could affect study results. ETHICS AND DISSEMINATION The study conforms to the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies issued by the Ministry of Health, Labour and Welfare, Japan. Results of the study will be published in one or more peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000047023.
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Affiliation(s)
- Yasuo Okumura
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Koichi Nagashima
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Ryuta Watanabe
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Katsuaki Yokoyama
- Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Takeshi Kato
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate Schoool of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Japanese Red Cross Fukuoka Hospital, Fukuoka City, Fukuoka, Japan
| | - Koichiro Ejima
- Department of Cardiology, Minamino Cardiovascular Hospital, Hachioji, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Minato-ku, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Minato-ku, Tokyo, Japan
| | - Masato Murakami
- Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Masaomi Kimura
- Divison of Cardiology, Pulmonary Medicine and Nephrology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Junjiroh Koyama
- Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Hideharu Okamatsu
- Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Ryohsuke Narui
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Tomoo Harada
- Department of Cardiology, St.Marianna University School of Medicine Hospital, Kawasaki, Kanagawa, Japan
| | - Ikutaro Nakajima
- Department of Cardiology, St.Marianna University School of Medicine Hospital, Kawasaki, Kanagawa, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Kojiro Tanimoto
- Deparatment of Cardiology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan
| | - Koji Kumagai
- Department of Cardiovascular Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Tatsuya Hayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Yuji Watari
- Department of Cardiology, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Mina Hatsuno
- Department of Cardiology, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Eizo Tachibana
- Division of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Kazuki Iso
- Division of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Kazumasa Sonoda
- Division of Cardiology, Department of Medicine, Tokyo Rinkai Hospital, Edogawa-ku, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama City, Toyama, Japan
| | - Satoru Sakagami
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Masaru Inoue
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | | | - Nobuhiko Makino
- Department of Cardiology, Osaka Police Hospital, Osaka City, Osaka, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshinao Yazaki
- Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hideshi Aoyagi
- Department of Cardiovascular Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Makoto Ichikawa
- Department of Cardiology, Sekishin Clinic, Kawagoe, Saitama, Japan
| | - Hironori Haruta
- Department of Cardiology, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Takafumi Hiro
- Circulatory medicine, Akabane Central General Hospital, Kita-ku, Tokyo, Japan
| | - Kimie Okubo
- Department of Cardiology, Itabashi Medical Association Hospital, Itabashi-ku, Tokyo, Japan
| | - Ken Arima
- Department of Cardiology, Kasukabe Medical Center, Kasukabe, Saitama, Japan
| | - Taiki Tojo
- Department of Cardiovascular medicine, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
| | - Hajime Kihara
- Department of Internal Medicine, Kihara Cardiovascular Clinic, Asahikawa, Hokkaido, Japan
| | - Satoru Miyanaga
- Division of Cardiology, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan
| | - Yoshiaki Fukuda
- Department of Cardiology, Higashi Saitama General Hospital, Satte, Saitama, Japan
| | - Koji Oiwa
- Cardiology, Japan Community Health are Organization, Yokohama Chuo Hospital, Yokohama, Kanagawa, Japan
| | - Tamami Fujiishi
- Department of Cardiology, JCHO Sagamino Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Akabane
- Department of Cardiology, Akabane Clinic, Outawara, Tochigi, Japan
| | - Norikazu Ishikawa
- Department of Cardiology, Zengyodanchi Ishikawa Clinic, Fujisawa, Kanagawa, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Haruna Tabuchi
- Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Tomoyuki Shiozawa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Kenjiro Miyamoto
- Department of Cardiology, Sapporo Shiroishi Memorial Hospital, Hokkaido, Sapporo, Japan
| | - Hiroshi Mase
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Hayashida S, Nagashima K, Scheinman MM, Higuchi S, Okumura Y. Is the mechanism of these supraventricular tachycardias simply explained by reverse rotation? J Arrhythm 2023; 39:217-220. [PMID: 37021035 PMCID: PMC10068918 DOI: 10.1002/joa3.12824] [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: 09/30/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Satoshi Hayashida
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Melvin M. Scheinman
- Division of Cardiology, Section of Cardiac Electrophysiology University of California San Francisco San Francisco California USA
| | - Satoshi Higuchi
- Division of Cardiology, Section of Cardiac Electrophysiology University of California San Francisco San Francisco California USA
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
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Nagashima K, Maruyama M, Kaneko Y, Nogami A, Mori H, Sumitomo N, Tanimoto K, Hayashida S, Wakamatsu Y, Hirata S, Hirata M, Okumura Y. Response to Para-Hisian Pacing in the Setting of Presence of a Concealed Nodoventricular/Nodofascicular Pathway. JACC Clin Electrophysiol 2023; 9:283-296. [PMID: 36858703 DOI: 10.1016/j.jacep.2022.10.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Mori
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, Tokyo Medical Center, Tokyo, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shu Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Moyuru Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y. In vivo tissue temperatures during 90 W/4 sec-very high power-short-duration (vHPSD) ablation versus ablation index-guided 50 W-HPSD ablation: A porcine study. J Cardiovasc Electrophysiol 2023; 34:369-378. [PMID: 36527433 PMCID: PMC10107763 DOI: 10.1111/jce.15782] [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: 09/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neither the actual in vivo tissue temperatures reached with 90 W/4 s-very high-power short-duration (vHPSD) ablation for atrial fibrillation nor the safety and efficacy profile have been fully elucidated. METHODS We conducted a porcine study (n = 15) in which, after right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We compared tissue temperatures close to a QDOT MICRO catheter, between during 90 W/4 s-vHPSD ablation during ablation index (AI: target 400)-guided 50 W-HPSD ablation, both targeting a contact force of 8-15 g. RESULTS Maximum tissue temperature reached during 90 W/4 s-vHPSD ablation did not differ significantly from that during 50 W-HPSD ablation (49.2 ± 8.4°C vs. 50.0 ± 12.1°C; p = .69) and correlated inversely with distance between the catheter tip and the thermocouple, regardless of the power settings (r = -0.52 and r = -0.37). Lethal temperature (≥50°C) was best predicted at a catheter tip-to-thermocouple distance cut-point of 3.13 and 4.27 mm, respectively. All lesions produced by 90 W/4 s-vHPSD or 50 W-HPSD ablation were transmural. Although there was no difference in the esophageal injury rate (50% vs. 66%, p = .80), the thermal lesion was significantly shallower with 90 W/4 s-vHPSD ablation than with 50W-HPSD ablation (381.3 ± 127.3 vs. 820.0 ± 426.1 μm from the esophageal adventitia; p = .039). CONCLUSION Actual tissue temperatures reached with 90 W/4 s-vHPSD ablation appear similar to those with AI-guided 50 W-HPSD ablation, with the distance between the catheter tip and target tissue being shorter for the former. Although both ablation settings may create transmural lesions in thin atrial tissues, any resulting esophageal thermal lesions appear shallower with 90 W/4 s-vHPSD ablation.
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Affiliation(s)
- Naoto Otsuka
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Department of Pathology and Microbiology Nihon University School of Medicine, Division of Human Pathology, Tokyo, Japan
| | - Rie Takahashi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
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Kurokawa S, Kashimoto M, Hagikura K, Shimodai-Yamada S, Otsuka N, Wakamatsu Y, Nagashima K, Matsumoto T, Hao H, Okumura Y. Intravenous Semaphorin 3A Administration Maintains Cardiac Contractility and Improves Electrical Remodeling in a Mouse Model of Isoproterenol-Induced Heart Failure. Int Heart J 2023; 64:453-461. [PMID: 37258121 DOI: 10.1536/ihj.22-705] [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] [Indexed: 06/02/2023]
Abstract
The effects of recombinant semaphorin 3A (Sema3A) on myocardial contractility and electrical remodeling in mice with isoproterenol (ISP) -induced heart failure were investigated.C57BL/6J mice intraperitoneally received ISP (480 mg/kg/day, ISP group; n = 24) or saline (control group; n = 31) for 14 days. Twenty-one ISP-treated mice received 0.5 mg/kg Sema3A intravenously on days 7 and 11 (ISP+Sema3A group). The sympathetic nervous system was activated upon ISP treatment, but was reduced upon Sema3A administration. Greater myocardial tissue fibrosis was observed in the ISP group than in the control group. However, fibrosis was not significantly different between the ISP+Sema3A and control groups. Fractional shortening of the left ventricle was lower in the ISP group than in the control group and was restored in the ISP+Sema3A group (control, 53 ± 8%; ISP, 37 ± 7%; ISP+Sema3A, 48 ± 3%; P < 0.05). Monophasic action potential duration at 20% repolarization (MAPD20) was prolonged in the ISP group (compared to control group), but this was reversed upon Sema3A administration (control, 29 ± 3 ms; ISP, 35 ± 6 ms; ISP+Sema3A, 29 ± 3 ms; P < 0.05). qPCR revealed Kv4.3, KChIP2, and SERCA2 downregulation in the ISP group and upregulation in the ISP+Sema3A group; however, Western blotting revealed similar changes only for Kv4.3 (P < 0.05).Intravenous Sema3A may maintain myocardial contractility by suppressing the sympathetic innervation of the myocardium and reducing myocardial tissue damage, in addition to restoring MAPD via Kv4.3 upregulation.
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Affiliation(s)
- Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Miwa Kashimoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kazuhiro Hagikura
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine
| | - Sayaka Shimodai-Yamada
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Taro Matsumoto
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y. In vivo tissue temperature during lesion size index-guided 50W ablation versus 30W ablation: A porcine study. J Cardiovasc Electrophysiol 2023; 34:108-116. [PMID: 36300696 DOI: 10.1111/jce.15722] [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: 06/28/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Neither the actual in vivo tissue temperatures reached with lesion size index (LSI)-guided high-power short-duration (HPSD) ablation for atrial fibrillation nor the safety profile has been elucidated. METHODS We conducted a porcine study (n = 7) in which, after right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We compared tissue temperatures reached during 50 W-HPSD ablation with those reached during standard (30 W) ablation, both targeting an LSI of 5.0 (5-15 g contact force). RESULTS Tmax (maximum tissue temperature when the thermocouple was located ≤5 mm from the catheter tip) reached during HPSD ablation was modestly higher than that reached during standard ablation (58.0 ± 10.1°C vs. 53.6 ± 9.2°C; p = .14) and peak tissue temperature correlated inversely with the distance between the catheter tip and the thermocouple, regardless of the power settings (HPSD: r = -0.63; standard: r = -0.66). Lethal temperature (≥50°C) reached 6.3 ± 1.8 s and 16.9 ± 16.1 s after the start of HPSD and standard ablation, respectively (p = .002), and it was best predicted at a catheter tip-to-thermocouple distance cut point of 2.8 and 5.3 mm, respectively. All lesions produced by HPSD ablation and by standard ablation were transmural. There was no difference between HPSD ablation and standard ablation in the esophageal injury rate (70% vs. 75%, p = .81), but the maximum distance from the esophageal adventitia to the injury site tended to be shorter (0.94 ± 0.29 mm vs. 1.40 ± 0.57 mm, respectively; p = .09). CONCLUSIONS Actual tissue temperatures reached with LSI-guided HPSD ablation appear to be modestly higher, with a shorter distance between the catheter tip and thermocouple achieving lethal temperature, than those reached with standard ablation. HPSD ablation lasting <6 s may help minimize lethal thermal injury to the esophagus lying at a close distance.
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Affiliation(s)
- Naoto Otsuka
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Department of Pathology and Microbiology, Division of Human Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Section of Laboratory for Animal Experiments, Institute of Medical Science, Medical Research Support Center, Nihon University School of Medicine, Tokyo, Japan
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Tsuda T, Kato T, Usuda K, Kusayama T, Usui S, Sakata K, Hayashi K, Kawashiri MA, Yamagishi M, Takamura M, Otsuka T, Suzuki S, Hirata A, Murakami M, Takami M, Kimura M, Fukaya H, Nakahara S, Shimizu W, Iwasaki YK, Hayashi H, Harada T, Nakajima I, Okumura K, Koyama J, Tokuda M, Yamane T, Momiyama Y, Tanimoto K, Soejima K, Nonoguchi N, Ejima K, Hagiwara N, Harada M, Sonoda K, Inoue M, Kumagai K, Hayashi H, Satomi K, Yazaki Y, Watari Y, Arai M, Watanabe R, Yokoyama K, Matsumoto N, Nagashima K, Okumura Y. Effect of Catheter Ablation for Atrial Fibrillation in Heart Failure With Mid-Range or Preserved Ejection Fraction ― Pooled Analysis of the AF Frontier Ablation Registry and Hokuriku-Plus AF Registry ―. Circ J 2022. [DOI: 10.1253/circj.cj-22-0461] [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: 12/03/2022]
Affiliation(s)
- Toyonobu Tsuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | - Shinya Suzuki
- Department of Cardiology, The Cardiovascular Institute
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | | | - Masaomi Kimura
- Division of Cardiology, Pulmonary Medicine and Nephrology, Hirosaki University School of Medicine
| | | | | | | | | | | | - Tomoo Harada
- St. Marianna University School of Medicine Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Masaru Arai
- Division of Cardiology, Nihon University Itabashi Hospital
| | - Ryuta Watanabe
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | | | | | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
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Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Sawada M, Kurokawa S, Okumura Y. Novel “red‐bull sign” during cavotricuspid isthmus ablation: Indication of an ablation catheter stuck in the subeustachian pouch. J Arrhythm 2022; 38:1028-1034. [DOI: 10.1002/joa3.12793] [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: 07/21/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Moyuru Hirata
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Shu Hirata
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Masanaru Sawada
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan
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Wong CX, Higuchi S, Nagashima K, Kaneko Y, Gerstenfeld EP, Scheinman MM. Ventriculoatrial Block and His-His Changes During Supraventricular Tachycardia: Diagnostic and Mechanistic Implications. JACC Case Rep 2022; 6:101593. [PMID: 36704060 PMCID: PMC9871070 DOI: 10.1016/j.jaccas.2022.08.010] [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: 05/11/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
Supraventricular tachycardia (SVT) with ventriculoatrial (VA) block can represent a diagnostic challenge. We present a case of SVT where His-His interval shortening was repeatedly observed during episodes of VA block. This novel observation is more diagnostically suggestive of atrioventricular nodal re-entrant tachycardia, as opposed to orthodromic re-entry using a nodofascicular or nodoventricular pathway where a constant His-His is recorded during episodes of VA block. (Level of Difficulty: Intermediate.).
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Key Words
- AH, atrio-His
- AV, atrioventricular
- AVNRT
- AVNRT, atrioventricular nodal re-entrant tachycardia
- HA, His-atrial
- HH, His-His
- HV, His-ventricular
- His
- LBBB, left bundle branch block
- NF, nodofascicular
- NV, nodoventricular
- ORT, orthodromic re-entry
- RBBB, right bundle branch block
- SVT, supraventricular tachycardia
- VA, ventriculoatrial
- nodoventricular or nodofascicular
- supraventricular tachycardia
- ventriculoatrial block
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Affiliation(s)
- Christopher X. Wong
- Division of Electrophysiology, Department of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Satoshi Higuchi
- Division of Electrophysiology, Department of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Edward P. Gerstenfeld
- Division of Electrophysiology, Department of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Melvin M. Scheinman
- Division of Electrophysiology, Department of Cardiology, University of California-San Francisco, San Francisco, California, USA,Address for correspondence: Dr Melvin M. Scheinman, Division of Electrophysiology, Department of Cardiology, University of California-San Francisco, 500 Parnassus Avenue, San Francisco, California 94143, USA. @MelScheinman
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28
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Ishii K, Matsue Y, Miyauchi K, Miyazaki S, Hidemori H, Nishizaki Y, Nojiri S, Saito Y, Nagashima K, Okumura Y, Daida H, Minamino T. Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF), and HF development as a complication of AF is associated with a decline in the quality of life and poor prognosis. However, unlike thrombotic events, incidence of HF in patients with AF has not changed for decades, and a preventive strategy has yet to be developed.
Purpose
We sought to develop a risk model for new-onset HF admission in patients with AF and without a history of HF. Additionally, we attempted to externally validate the developed risk model.
Methods
We utilized two multicenter, prospective, observational registries of AF and analyzed the patients without a history of AF. One of which is defined as a derivation cohort, which included 2,857 patients, and the other is defined as a validation cohort, which included 2,516 patients. We developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression analysis with the derivation cohort. The external validity was tested in the validation cohort.
Results
During the follow-up period, 148 patients (5.2%) in the derivation cohort and 104 patients (4.1%) in the validation cohort developed HF during the median follow-up period of 1,396 (interquartile range [IQR]: 1,078–1,820) days and 1,168 (IQR: 844–1,309) days, respectively. In the derivation cohort, four predictors (age, hemoglobin, serum creatinine, and log-transformed brain natriuretic peptide) were identified as potential risk factors for HF development. The developed risk model showed good discrimination and calibration in both the derivation (area under the curve [AUC], 0.77 [95% confidence interval (CI) 0.73–0.81]; Hosmer-Lemeshow test, P=0.257) and validation cohorts (AUC: 0.76 [95% CI 0.72–0.81]; Hosmer-Lemeshow test, P=0.475). Considering death not due to HF as a competing risk, the cumulative incidence curves for HF admission stratified by the risk score were generated, which showed higher HF hospitalization rate for the higher risk score categories.
Conclusion
The newly developed risk model with four readily available clinical characteristics and biomarkers performed well in the prediction of new-onset HF admission of patients with AF in both derivation and validation cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Ishii
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - Y Matsue
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - S Miyazaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - H Hidemori
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - Y Nishizaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - S Nojiri
- Juntendo University School of Medicine, Medical Technology Innovation Center , Tokyo , Japan
| | - Y Saito
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - K Nagashima
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - Y Okumura
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - H Daida
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
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Saito Y, Omae Y, Fukamachi D, Nagashima K, Toyotani J, Okumura Y. Quantitative estimation of pulmonary artery wedge pressure from chest radiographs by a regression convolutional neural network. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent studies reported that a convolutional neural network (CNN; a deep learning model) can detect elevated pulmonary artery wedge pressure (PAWP) from chest radiographs, the diagnostic images most commonly used for assessing pulmonary congestion in heart failure. However, no method has been published for quantitatively estimating PAWP from such radiographs. We hypothesized that a regression CNN, an alternative type of deep learning, could be a useful tool for quantitatively estimating PAWP from chest radiographs in cardiovascular diseases.
Methods
We retrospectively enrolled 936 patients with cardiovascular diseases who had undergone right heart catheterization (RHC) and chest radiography and estimated PAWP by constructing a regression CNN based on the VGG16 model. We randomly categorized 80% of the data as training data (training group, n=748) and 20% as test data (test group, n=188). Moreover, we tuned the learning rate–one of the model parameters–by 5-hold cross-validation of the training group. Correlations between PAWP measured by RHC (ground truth [GT] PAWP) and PAWP derived from the regression CNN (estimated PAWP) were tested. To visualize how the regression CNN assessed the images, we created a regression activation map (RAM), a visualization technique for regression CNN.
Results
Estimated PAWP correlated significantly with GT PAWP in both the training (r=0.76, P<0.001) and test group (r=0.62, P<0.001). Bland-Altman plots found a mean (SEM) difference between GT and estimated PAWP of −0.23 (0.16) mm Hg in the training and −0.05 (0.41) mm Hg in the test group. The RAM showed that our regression CNN model estimated high PAWP by focusing on the cardiomegaly and pulmonary congestion. In the test group, the area under the curve (AUC) for detecting elevated PAWP (≥18 mm Hg) produced by the regression CNN model was similar to the AUC of an experienced cardiologist (0.86 vs 0.83, respectively; P=0.24).
Conclusion
This proof-of-concept study shows that regression CNN can quantitatively estimate PAWP from standard chest radiographs in cardiovascular diseases.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The Bayer Academic Support
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Affiliation(s)
- Y Saito
- Nihon University , Tokyo , Japan
| | - Y Omae
- College of Industrial Technology, Nihon University, Department of Industrial Engineering and Management , Chiba , Japan
| | | | | | - J Toyotani
- College of Industrial Technology, Nihon University, Department of Industrial Engineering and Management , Chiba , Japan
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Shoji H, Boku N, Kudo-Saito C, Nagashima K, Tsugaru K, Takahashi N, Kawakami T, Amanuma Y, Wakatsuki T, Okano N, Narita Y, Yamamoto Y, Kizawa R, Imazeki H, Aoki K, Muro K. 1217P Profiling of myeloid cells associated with prognosis in nivolumab monotherapy for advanced gastric cancer (WJOG10417GTR study). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1335] [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] Open
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31
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Sawada M, Nagashima K, Wakamatsu Y, Otsuka N, Hayashida S, Hirata S, Hirata M, Kurokawa S, Okumura Y. Successful bailout of complications during hot balloon ablation. HeartRhythm Case Rep 2022; 8:748-751. [PMID: 36618594 PMCID: PMC9811017 DOI: 10.1016/j.hrcr.2022.08.004] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Koichi Nagashima
- Address reprint requests and correspondence: Dr Koichi Nagashima, Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan.
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Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [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: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Hayashida S, Nagashima K, Iso K, Okumura Y, Scheinman MM. A troubling tachycardia. Heart Rhythm 2022; 19:1031-1032. [DOI: 10.1016/j.hrthm.2021.09.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
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Sakai S, Nagashima K, Kaneko Y, Maruyama M. A narrow QRS complex tachycardia: What is the mechanism? Heart Rhythm 2022; 19:1557-1558. [PMID: 35595019 DOI: 10.1016/j.hrthm.2022.05.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Satoshi Sakai
- Department of Cardiology, Nara Prefecture General Medical Center, Shichijo Nishimachi, Nara, Japan.
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi-Kosugi Hospital, Tokyo, Japan
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Wakamatsu Y, Nagashima K, Mori H, Tsutsui K, Masaharu M, Sonoda K, Ikeda Y, Kato R, Sumitomo N, Okumura Y. PO-651-08 NOVEL SLOW PATHWAY ABLATION STRATEGY TARGETING THE FRACTIONAL POTENTIALS HIGHLIGHTED BY THE LUMIPOINT MODULE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Sasa Y, Nakai T, Ikeya Y, Kogawa R, Otsuka N, Kurokawa S, Nagashima K, Iida K, Okumura Y, Kunimoto S. Bradyarrhythmia Suspected to be Associated with Sleep Apnea Syndrome. Int Heart J 2022; 63:393-397. [PMID: 35296616 DOI: 10.1536/ihj.21-517] [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] [Indexed: 11/18/2022]
Abstract
Sleep apnea syndrome (SAS) is a condition in which apnea and hypoventilation at night cause hypoxemia and impaired wakefulness during the day, resulting in a general malaise and dozing. Sleep apnea has been implicated in the development of hypertension, ischemic heart disease, arrhythmia, heart failure, and cerebrovascular disease.1) Approximately 50% of patients with sleep-disordered breathing have an arrhythmia. In severe cases with an apnea-hypopnea index (AHI) of 30 or more, the frequency of arrhythmias during sleep is two to four times that of individuals without SAS. Bradyarrhythmias such as sinus bradycardia, sinus arrest, and atrioventricular block occurs at night in about 5%-10% of patients with sleep-disordered breathing.2)During nocturnal sleep, vagal excitation causes excessive muscle relaxation of the upper airway, leading to periodic airway diameter reduction, which increases snoring and obstructive apnea. As a result, hypoxemia is likely, further increasing vagal tone and leading to bradycardia. An increase in ventilation rate and volume quickly compensates for the decrease in arterial partial pressure of oxygen during apnea, which leads to new bradycardia due to a decrease in the partial pressure of oxygen in arterial blood, which suppresses vagal tone and respiration.3)We experienced a case of a 44-year-old patient with bradyarrhythmia that might be associated with SAS. After continuous positive airway pressure treatment, AHI decreased, and very long cardiac arrests resolved.
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Affiliation(s)
- Yusuke Sasa
- Department of Cardiology, Kawaguchi Municipal Medical Center
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Korehito Iida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Saito Y, Omae Y, Fukamachi D, Nagashima K, Mizobuchi S, Kakimoto Y, Toyotani J, Okumura Y. Quantitative estimation of pulmonary artery wedge pressure from chest radiographs by a regression convolutional neural network. Heart Vessels 2022; 37:1387-1394. [PMID: 35220466 PMCID: PMC9239946 DOI: 10.1007/s00380-022-02043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/28/2021] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
AbstractRecent studies reported that a convolutional neural network (CNN; a deep learning model) can detect elevated pulmonary artery wedge pressure (PAWP) from chest radiographs, the diagnostic images most commonly used for assessing pulmonary congestion in heart failure. However, no method has been published for quantitatively estimating PAWP from such radiographs. We hypothesized that a regression CNN, an alternative type of deep learning, could be a useful tool for quantitatively estimating PAWP in cardiovascular diseases. We retrospectively enrolled 936 patients with cardiovascular diseases who had undergone right heart catheterization (RHC) and chest radiography and estimated PAWP by constructing a regression CNN based on the VGG16 model. We randomly categorized 80% of the data as training data (training group, n = 748) and 20% as test data (test group, n = 188). Moreover, we tuned the learning rate—one of the model parameters—by 5-hold cross-validation of the training group. Correlations between PAWP measured by RHC [ground truth (GT) PAWP] and PAWP derived from the regression CNN (estimated PAWP) were tested. To visualize how the regression CNN assessed the images, we created a regression activation map (RAM), a visualization technique for regression CNN. Estimated PAWP correlated significantly with GT PAWP in both the training (r = 0.76, P < 0.001) and test group (r = 0.62, P < 0.001). Bland–Altman plots found a mean (SEM) difference between GT and estimated PAWP of − 0.23 (0.16) mm Hg in the training and − 0.05 (0.41) mm Hg in the test group. The RAM showed that our regression CNN model estimated high PAWP by focusing on the cardiomegaly and pulmonary congestion. In the test group, the area under the curve (AUC) for detecting elevated PAWP (≥ 18 mm Hg) produced by the regression CNN model was similar to the AUC of an experienced cardiologist (0.86 vs 0.83, respectively; P = 0.24). This proof-of-concept study shows that regression CNN can quantitatively estimate PAWP from standard chest radiographs in cardiovascular diseases.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yuto Omae
- Department of Industrial Engineering and Management, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Saki Mizobuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yohei Kakimoto
- Department of Industrial Engineering and Management, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Jun Toyotani
- Department of Industrial Engineering and Management, College of Industrial Technology, Nihon University, Chiba, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Acharya U, Aidala C, Akiba Y, Alfred M, Andrieux V, Apadula N, Asano H, Azmoun B, Babintsev V, Bandara N, Barish K, Bathe S, Bazilevsky A, Beaumier M, Belmont R, Berdnikov A, Berdnikov Y, Bichon L, Blankenship B, Blau D, Bok J, Borisov V, Brooks M, Bryslawskyj J, Bumazhnov V, Campbell S, Canoa Roman V, Cervantes R, Chiu M, Chi C, Choi I, Choi J, Citron Z, Connors M, Corliss R, Cronin N, Csörgő T, Csanád M, Danley T, Daugherity M, David G, DeBlasio K, Dehmelt K, Denisov A, Deshpande A, Desmond E, Dion A, Dixit D, Do J, Drees A, Drees K, Durham J, Durum A, En’yo H, Enokizono A, Esha R, Esumi S, Fadem B, Fan W, Feege N, Fields D, Finger M, Finger M, Fitzgerald D, Fokin S, Frantz J, Franz A, Frawley A, Fukuda Y, Gallus P, Gal C, Garg P, Ge H, Giles M, Giordano F, Goto Y, Grau N, Greene S, Grosse Perdekamp M, Gunji T, Guragain H, Hachiya T, Haggerty J, Hahn K, Hamagaki H, Hamilton H, Hanks J, Han S, Harvey M, Hasegawa S, Haseler T, Hemmick T, He X, Hill J, Hill K, Hodges A, Hollis R, Homma K, Hong B, Hoshino T, Hotvedt N, Huang J, Imai K, Inaba M, Iordanova A, Isenhower D, Ivanishchev D, Jacak B, Jezghani M, Jiang X, Ji Z, Johnson B, Jouan D, Jumper D, Kang J, Kapukchyan D, Karthas S, Kawall D, Kazantsev A, Khachatryan V, Khanzadeev A, Khatiwada A, Kim C, Kim EJ, Kim M, Kim T, Kincses D, Kingan A, Kistenev E, Klatsky J, Kline P, Koblesky T, Kotov D, Kovacs L, Kudo S, Kurita K, Kwon Y, Lajoie J, Larionova D, Lebedev A, Lee S, Lee S, Leitch M, Leung Y, Lewis N, Lim S, Liu M, Li X, Loggins VR, Loomis D, Lovasz K, Lynch D, Lökös S, Majoros T, Makdisi Y, Makek M, Manko V, Mannel E, McCumber M, McGaughey P, McGlinchey D, McKinney C, Mendoza M, Mignerey A, Milov A, Mishra D, Mitchell J, Mitrankova M, Mitrankov I, Mitrankov I, Mitsuka G, Miyasaka S, Mizuno S, Mondal M, Montuenga P, Moon T, Morrison D, Mulilo B, Murakami T, Murata J, Nagai K, Nagashima K, Nagashima T, Nagle J, Nagy M, Nakagawa I, Nakano K, Nattrass C, Nelson S, Niida T, Nouicer R, Novák T, Novitzky N, Nukazuka G, Nyanin A, O’Brien E, Ogilvie C, Orjuela Koop J, Osborn J, Oskarsson A, Ottino G, Ozawa K, Pantuev V, Papavassiliou V, Park J, Park S, Patel M, Pate S, Peng W, Perepelitsa D, Perera G, Peressounko D, PerezLara C, Perry J, Petti R, Phipps M, Pinkenburg C, Pisani R, Potekhin M, Pun A, Purschke M, Radzevich P, Ramasubramanian N, Read K, Reynolds D, Riabov V, Riabov Y, Richford D, Rinn T, Rolnick S, Rosati M, Rowan Z, Runchey J, Safonov A, Sakaguchi T, Sako H, Samsonov V, Sarsour M, Sato S, Schaefer B, Schmoll B, Sedgwick K, Seidl R, Sen A, Seto R, Sexton A, Sharma D, Shein I, Shibata TA, Shigaki K, Shimomura M, Shioya T, Shukla P, Sickles A, Silva C, Silvermyr D, Singh B, Singh C, Singh V, Slunečka M, Smith K, Snowball M, Soltz R, Sondheim W, Sorensen S, Sourikova I, Stankus P, Stoll S, Sugitate T, Sukhanov A, Sumita T, Sun J, Sun Z, Sziklai J, Tanida K, Tannenbaum M, Tarafdar S, Taranenko A, Tarnai G, Tieulent R, Timilsina A, Todoroki T, Tomášek M, Towell C, Towell R, Tserruya I, Ueda Y, Ujvari B, van Hecke H, Velkovska J, Virius M, Vrba V, Vukman N, Wang X, Watanabe Y, Wong C, Woody C, Xue L, Xu C, Xu Q, Yalcin S, Yamaguchi Y, Yamamoto H, Yanovich A, Yoon I, Yoo J, Yushmanov I, Yu H, Zajc W, Zelenski A, Zharko S, Zou L. Transverse-single-spin asymmetries of charged pions at midrapidity in transversely polarized
p+p
collisions at
s=200 GeV. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.105.032003] [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: 11/07/2022]
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Aizawa Y, Nakai T, Ikeya Y, Kogawa R, Saito Y, Toyama K, Yumikura T, Otsuka N, Nagashima K, Okumura Y. AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? Heart Vessels 2022; 37:1411-1417. [PMID: 35133499 PMCID: PMC9239935 DOI: 10.1007/s00380-022-02037-8] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
Some patients with pacemakers present with first-degree atrioventricular (AV) block. To avoid right ventricular (RV) pacing, preserving intrinsic AV conduction as much as possible is recommended. However, there is no clear cutoff AV interval to determine whether intrinsic AV conduction should be preserved or RV pacing should be delivered. This study aimed to compare a pacing mode-preserving, intrinsic AV conduction with the DDD mode delivering RV pacing in terms of echocardiographic parameters in patients with first-degree AV block and to investigate whether RV pacing induces heart failure (HF). Stroke volume (SV) was measured to determine the optimal AV delay with the intrinsic AV conduction rhythm and the DDD pacing delivering RV pacing. Echocardiographic evaluation was performed for 6-month follow-up period. Seventeen patients were studied. At baseline, mean intrinsic PQ interval was 250 ± 40 ms. SV was greater with RV pacing with optimal AV delay of 160 ms than with intrinsic AV conduction rhythm in all patients. Therefore, pacemakers were set to the DDD to deliver RV pacing. During follow-up, seven patients developed HF. Mean baseline E/E′ ratio in patients who developed HF (HF group) during RV pacing was higher than in patients without HF (non = HF group; 17.9 ± 8 versus 11.5 ± 2, P = 0.018) Even within HF group patients without a high baseline E/E′ ratio, it increased with RV pacing (22.2 ± 6 versus 11.6 ± 2; P < 0.001). In patients with pacemaker and first-degree AV block, RV pacing with the optimal AV delay of 160 ms increased SV. However, the risk of HF may be increased with RV pacing if the E/Eʹ ratio is > 15 during intrinsic AV conduction or RV pacing. RV pacing should be avoided in patients with high E/Eʹ ratio under intrinsic AV conduction or RV pacing.
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Affiliation(s)
- Yoshihiro Aizawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yukitoshi Ikeya
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Rikitake Kogawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuki Saito
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuto Toyama
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tetsuro Yumikura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoto Otsuka
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Yamazaki R, Matsukiyo S, Morita T, Tanaka SJ, Umeda T, Aihara K, Edamoto M, Egashira S, Hatsuyama R, Higuchi T, Hihara T, Horie Y, Hoshino M, Ishii A, Ishizaka N, Itadani Y, Izumi T, Kambayashi S, Kakuchi S, Katsuki N, Kawamura R, Kawamura Y, Kisaka S, Kojima T, Konuma A, Kumar R, Minami T, Miyata I, Moritaka T, Murakami Y, Nagashima K, Nakagawa Y, Nishimoto T, Nishioka Y, Ohira Y, Ohnishi N, Ota M, Ozaki N, Sano T, Sakai K, Sei S, Shiota J, Shoji Y, Sugiyama K, Suzuki D, Takagi M, Toda H, Tomita S, Tomiya S, Yoneda H, Takezaki T, Tomita K, Kuramitsu Y, Sakawa Y. High-power laser experiment forming a supercritical collisionless shock in a magnetized uniform plasma at rest. Phys Rev E 2022; 105:025203. [PMID: 35291161 DOI: 10.1103/physreve.105.025203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
We present an experimental method to generate quasiperpendicular supercritical magnetized collisionless shocks. In our experiment, ambient nitrogen (N) plasma is at rest and well magnetized, and it has uniform mass density. The plasma is pushed by laser-driven ablation aluminum (Al) plasma. Streaked optical pyrometry and spatially resolved laser collective Thomson scattering clarify structures of plasma density and temperatures, which are compared with one-dimensional particle-in-cell simulations. It is indicated that just after the laser irradiation, the Al plasma is magnetized by a self-generated Biermann battery field, and the plasma slaps the incident N plasma. The compressed external field in the N plasma reflects N ions, leading to counterstreaming magnetized N flows. Namely, we identify the edge of the reflected N ions. Such interacting plasmas form a magnetized collisionless shock.
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Affiliation(s)
- R Yamazaki
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - T Morita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - S J Tanaka
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - T Umeda
- Institute for Space-Earth Environmental Research, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan
| | - K Aihara
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - M Edamoto
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - S Egashira
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - R Hatsuyama
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Higuchi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Hihara
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Horie
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - M Hoshino
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - A Ishii
- Max Planck Institute for Gravitational Physics (Albert Einstein Institute), Am Mühlenberg 1, Potsdam-Golm 14476, Germany
| | - N Ishizaka
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Itadani
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Izumi
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - S Kambayashi
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kakuchi
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - N Katsuki
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - R Kawamura
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Kawamura
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kisaka
- Department of Physical Science, Hiroshima University, Higashi-Hiroshima 739-8526, Japan
| | - T Kojima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - A Konuma
- Institute for Laser Science, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - R Kumar
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - I Miyata
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - T Moritaka
- Fundamental Physics Simulation Research Division, National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - Y Murakami
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - K Nagashima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - Y Nakagawa
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Nishimoto
- School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Nishioka
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - Y Ohira
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - N Ohnishi
- Department of Aerospace Engineering, Tohoku University, 6-6 Aramaki Aza Aoba, Aoba, Sendai, Miyagi 980-8579, Japan
| | - M Ota
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Sano
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Sakai
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Sei
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - J Shiota
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Shoji
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - K Sugiyama
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - D Suzuki
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - M Takagi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - H Toda
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Tomita
- Astronomical Institute, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai, Miyagi 980-8578, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - S Tomiya
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - H Yoneda
- Institute for Laser Science, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - T Takezaki
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminamiku, Kitakyushu, Fukuoka 802-0985, Japan
- Faculty of Engineering, University of Toyama, 3190, Gofuku, Toyama 930-8555, Japan
| | - K Tomita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- Division of Quantum Science and Engineering, Hokkaido University, Sapporo 060-8628, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
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Saito Y, Nakai T, Ikeya Y, Kogawa R, Otsuka N, Wakamatsu Y, Kurokawa S, Ohkubo K, Nagashima K, Okumura Y. Prognostic value of the MELD-XI score in patients undergoing cardiac resynchronization therapy. ESC Heart Fail 2022; 9:1080-1089. [PMID: 34983080 PMCID: PMC8934924 DOI: 10.1002/ehf2.13776] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Multi‐organ dysfunction was recently reported to be a common condition in patients with heart failure (HF). The Model for End‐stage Liver Disease eXcluding International normalized ratio (MELD‐XI) score reflects liver and kidney function. The prognostic relevance of this score has been reported in patients with a variety of cardiovascular diseases who are undergoing interventional therapies. However, the relationship between the severity of hepatorenal dysfunction assessed by the MELD‐XI score and the long‐term clinical outcomes of HF patients receiving cardiac resynchronization therapy (CRT) has not been evaluated. Methods and results Clinical records of 283 patients who underwent CRT implantation between March 2003 and October 2020 were retrospectively evaluated (mean age 67 ± 12, 22.6% female). Blood samples were collected before CRT implantation. Patients were divided into three groups based on tertiles of the MELD‐XI score: first tertile (MELD‐XI = 9.44, n = 95), second tertile (9.44 < MELD‐XI < 13.4, n = 94), and third tertile (MELD‐XI ≥ 13.4, n = 94). The primary endpoint was all‐cause mortality. Compared with the other groups, the third tertile group exhibited significantly older age, higher prevalence of diabetes mellitus and hypertension, lower haemoglobin level, and higher N‐terminal pro‐brain natriuretic peptide level (all P < 0.05). The functional CRT response rate was also significantly lower in the third tertile group (P = 0.011). During a median follow‐up of 30 months (inter‐quartile range, 9–67), 105 patients (37.1%) died. Kaplan–Meier analysis revealed that patients with a higher MELD‐XI score had a greater risk of all‐cause mortality (log‐rank test: P < 0.001). Even after adjustment for clinically relevant factors and a conventional risk score, the MELD‐XI score was still associated with mortality (adjusted hazard ratio: 1.04, 95% confidence interval: 1.00–1.07, P = 0.014, and adjusted hazard ratio: 1.04, 95% confidence interval: 1.01–1.09, P = 0.005, respectively). A higher MELD‐XI score was associated with a greater risk of all‐cause mortality than a lower MELD‐XI score regardless of whether a pacemaker or defibrillator was implanted (log‐rank test: P = 0.010 and P < 0.001, respectively). Conclusions Impaired hepatorenal function assessed by the MELD‐XI score was associated with older age, higher prevalence of multiple co‐morbidities, severity of HF, lower CRT response rates, and subsequent all‐cause mortality in HF patients undergoing CRT implantation. These results suggest that the MELD‐XI score can provide additional prognostic information and may be useful for improving risk stratification in this population.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Ikeya Y, Saito Y, Nakai T, Kogawa R, Otsuka N, Wakamatsu Y, Kurokawa S, Ohkubo K, Nagashima K, Okumura Y. Prognostic importance of the Controlling Nutritional Status (CONUT) score in patients undergoing cardiac resynchronisation therapy. Open Heart 2021; 8:openhrt-2021-001740. [PMID: 34711651 PMCID: PMC8557277 DOI: 10.1136/openhrt-2021-001740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/30/2021] [Accepted: 10/14/2021] [Indexed: 01/01/2023] Open
Abstract
Aims Malnutrition is common and associated with worse clinical outcomes in patients with heart failure (HF). The Controlling Nutritional Status (CONUT) score is an integrated index for evaluating diverse aspects of the complex mechanism of malnutrition. However, the relationship between the severity of malnutrition assessed by the CONUT score and clinical outcomes of HF patients receiving cardiac resynchronisation therapy (CRT) has not been fully clarified. Methods Clinical records of 263 patients who underwent pacemaker or defibrillator implantation for CRT between March 2003 and October 2020 were retrospectively evaluated. The CONUT score was calculated from laboratory data obtained before CRT device implantation. Patients were divided into three groups: normal nutrition (CONUT scores 0–1, n=58), mild malnutrition (CONUT scores 2–4, n=132) and moderate or severe malnutrition (CONUT scores 5–12, n=73). The primary endpoint was all-cause mortality. Results The moderate or severe malnutrition group had a lower body mass index, more advanced New York Heart Association functional class, higher Clinical Frailty Scale score, lower levels of haemoglobin and higher levels of N-terminal probrain natriuretic peptide (all p<0.05). In the moderate or severe malnutrition group, the CRT response rate was significantly lower than for the other two groups (p=0.001). During a median follow-up period of 31 (10–67) months, 103 (39.1%) patients died. Kaplan-Meier analysis revealed that the moderate or severe malnutrition group had a significantly higher mortality rate (log-rank p<0.001). A higher CONUT score and CONUT score ≥5 remained significantly associated with all-cause mortality after adjusting for previously reported clinically relevant factors and the conventional risk score (VALID-CRT risk score) (all p<0.05). Conclusions A higher CONUT score before CRT device implantation was strongly associated with HF severity, frailty, lower CRT response rate and subsequent long-term all-cause mortality.
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Affiliation(s)
- Yukitoshi Ikeya
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yuki Saito
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Toshiko Nakai
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Rikitake Kogawa
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Naoto Otsuka
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Sayaka Kurokawa
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Kimie Ohkubo
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Koichi Nagashima
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
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Otsuka N, Okumura Y, Kuorkawa S, Nagashima K, Wakamatsu Y, Hayashida S, Ohkubo K, Nakai T, Hao H, Takahashi R, Taniguchi Y. Actual tissue temperature during ablation index-guided high-power short-duration ablation versus standard ablation: Implications in terms of the efficacy and safety of atrial fibrillation ablation. J Cardiovasc Electrophysiol 2021; 33:55-63. [PMID: 34713525 DOI: 10.1111/jce.15282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Actual in vivo tissue temperatures and the safety profile during high-power short-duration (HPSD) ablation of atrial fibrillation have not been clarified. METHODS We conducted an animal study in which, after a right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We recorded tissue temperatures during a 50 W-HPSD ablation and 30 W-standard ablation targeting an ablation index (AI) of 400 (5-15 g contact force). RESULTS Maximum tissue temperatures reached with HSPD ablation were significantly higher than that reached with standard ablation (62.7 ± 12.5 vs. 52.7 ± 11.4°C, p = 0.033) and correlated inversely with the distance between the catheter tip and thermocouple, regardless of the power settings (HPSD: r = -0.71; standard: r = -0.64). Achievement of lethal temperatures (≥50°C) was within 7.6 ± 3.6 and 12.1 ± 4.1 s after HPSD and standard ablation, respectively (p = 0.003), and was best predicted at cutoff points of 5.2 and 4.4 mm, respectively. All HPSD ablation lesions were transmural, but 19.2% of the standard ablation lesions were not (p = 0.011). There was no difference between HPSD and standard ablation regarding the esophageal injury rate (30% vs. 33.3%, p > 0.99), with the injury appearing to be related to the short distance from the catheter tip. CONCLUSIONS Actual tissue temperatures reached with AI-guided HPSD ablation appeared to be higher with a greater distance between the catheter tip and target tissue than those with standard ablation. HPSD ablation for <7 s may help prevent collateral tissue injury when ablating within a close distance.
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Affiliation(s)
- Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kuorkawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Takahashi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Taniguchi
- Institute of Medical Science, Medical Research Support Center, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan
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Hayashida S, Nagashima K, Kurokawa S, Arai M, Watanabe R, Wakamatsu Y, Otsuka N, Yagyu S, Iso K, Okumura Y. Modified ablation index: a novel determinant of a successful first-pass left atrial posterior wall isolation. Heart Vessels 2021; 37:802-811. [PMID: 34709460 DOI: 10.1007/s00380-021-01971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
Although a left atrial posterior wall isolation (LAPWI) in addition to a pulmonary vein isolation is a well-accepted option for persistent atrial fibrillation (AF), a complete isolation can be challenging. This study aimed to evaluate the performance of a modified ablation index (AI) (AI/bipolar voltage along the ablation line) for predicting a durable LAPWI. The study included 55 consecutive patients, aged 65 ± 11 years, who underwent an electroanatomic mapping-guided LAPWI of AF. The association between the gaps (first-pass LAPWI failure and/or acute LAPW reconnections), voltage amplitude along the roof and floor lines, and thickness of the LAPW was investigated. Gaps occurred in 22 patients (40%) and in 26 (8%) of the 330 line segments. Gaps were associated with a relatively high bipolar voltage (3.38 ± 1.83 vs. 1.70 ± 1.12 mV, P < 0.0001) and thick LA wall (2.52 ± 1.15 vs. 1.42 ± 0.44 mm, P < 0.0001). A modified AI ≤ 199 AU/mV, bipolar voltage ≥ 2.64 mV, wall thickness ≥ 2.04 mm, and roof ablation line ≥ 43.4 mm well predicted gaps (AUCs: 0.783, 0.787, 0.858, and 0.752, respectively). A high-voltage zone, thick LAPW, and long roof ablation line appeared to be determinants of gaps, and a modified AI ≥ 199 AU/mV along the ablation lines appeared to predict an acute durable LAPWI.
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Affiliation(s)
- Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Division of Cardiology, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Seina Yagyu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuki Iso
- Division of Cardiology, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Acharya UA, Aidala C, Akiba Y, Alfred M, Andrieux V, Apadula N, Asano H, Azmoun B, Babintsev V, Bandara NS, Barish KN, Bathe S, Bazilevsky A, Beaumier M, Belmont R, Berdnikov A, Berdnikov Y, Bichon L, Blankenship B, Blau DS, Bok JS, Brooks ML, Bryslawskyj J, Bumazhnov V, Campbell S, Canoa Roman V, Cervantes R, Chi CY, Chiu M, Choi IJ, Choi JB, Citron Z, Connors M, Corliss R, Corrales Morales Y, Cronin N, Csanád M, Csörgő T, Danley TW, Daugherity MS, David G, DeBlasio K, Dehmelt K, Denisov A, Deshpande A, Desmond EJ, Dion A, Dixit D, Do JH, Drees A, Drees KA, Durham JM, Durum A, Enokizono A, En'yo H, Esha R, Esumi S, Fadem B, Fan W, Feege N, Fields DE, Finger M, Finger M, Fitzgerald D, Fokin SL, Frantz JE, Franz A, Frawley AD, Fukuda Y, Gal C, Gallus P, Garg P, Ge H, Giles M, Giordano F, Goto Y, Grau N, Greene SV, Grosse Perdekamp M, Gunji T, Guragain H, Hachiya T, Haggerty JS, Hahn KI, Hamagaki H, Hamilton HF, Han SY, Hanks J, Harvey M, Hasegawa S, Haseler TOS, He X, Hemmick TK, Hill JC, Hill K, Hodges A, Hollis RS, Homma K, Hong B, Hoshino T, Hotvedt N, Huang J, Huang S, Imai K, Inaba M, Iordanova A, Isenhower D, Ivanishchev D, Jacak BV, Jezghani M, Ji Z, Jiang X, Johnson BM, Jouan D, Jumper DS, Kang JH, Kapukchyan D, Karthas S, Kawall D, Kazantsev AV, Khachatryan V, Khanzadeev A, Khatiwada A, Kim C, Kim EJ, Kim M, Kincses D, Kingan A, Kistenev E, Klatsky J, Kline P, Koblesky T, Kotov D, Kudo S, Kurgyis B, Kurita K, Kwon Y, Lajoie JG, Larionova D, Lebedev A, Lee S, Lee SH, Leitch MJ, Leung YH, Lewis NA, Li X, Lim SH, Liu MX, Loggins VR, Lökös S, Loomis DA, Lovasz K, Lynch D, Majoros T, Makdisi YI, Makek M, Manko VI, Mannel E, McCumber M, McGaughey PL, McGlinchey D, McKinney C, Mendoza M, Mignerey AC, Milov A, Mishra DK, Mitchell JT, Mitrankov I, Mitrankova M, Mitsuka G, Miyasaka S, Mizuno S, Mondal MM, Montuenga P, Moon T, Morrison DP, Mulilo B, Murakami T, Murata J, Nagai K, Nagashima K, Nagashima T, Nagle JL, Nagy MI, Nakagawa I, Nakano K, Nattrass C, Nelson S, Niida T, Nouicer R, Novák T, Novitzky N, Nukazuka G, Nyanin AS, O'Brien E, Ogilvie CA, Orjuela Koop JD, Osborn JD, Oskarsson A, Ottino GJ, Ozawa K, Pantuev V, Papavassiliou V, Park JS, Park S, Pate SF, Patel M, Peng W, Perepelitsa DV, Perera GDN, Peressounko DY, PerezLara CE, Perry J, Petti R, Phipps M, Pinkenburg C, Pisani RP, Potekhin M, Pun A, Purschke ML, Radzevich PV, Ramasubramanian N, Read KF, Reynolds D, Riabov V, Riabov Y, Richford D, Rinn T, Rolnick SD, Rosati M, Rowan Z, Runchey J, Safonov AS, Sakaguchi T, Sako H, Samsonov V, Sarsour M, Sato S, Schaefer B, Schmoll BK, Sedgwick K, Seidl R, Sen A, Seto R, Sexton A, Sharma D, Sharma D, Shein I, Shibata TA, Shigaki K, Shimomura M, Shioya T, Shukla P, Sickles A, Silva CL, Silvermyr D, Singh BK, Singh CP, Singh V, Slunečka M, Smith KL, Snowball M, Soltz RA, Sondheim WE, Sorensen SP, Sourikova IV, Stankus PW, Stoll SP, Sugitate T, Sukhanov A, Sumita T, Sun J, Sun Z, Sziklai J, Tanida K, Tannenbaum MJ, Tarafdar S, Taranenko A, Tarnai G, Tieulent R, Timilsina A, Todoroki T, Tomášek M, Towell CL, Towell RS, Tserruya I, Ueda Y, Ujvari B, van Hecke HW, Velkovska J, Virius M, Vrba V, Vukman N, Wang XR, Watanabe YS, Wong CP, Woody CL, Xu C, Xu Q, Xue L, Yalcin S, Yamaguchi YL, Yamamoto H, Yanovich A, Yoo JH, Yoon I, Yu H, Yushmanov IE, Zajc WA, Zelenski A, Zharko S, Zou L. Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p^{↑}+p Collisions at sqrt[s]=200 GeV. Phys Rev Lett 2021; 127:162001. [PMID: 34723614 DOI: 10.1103/physrevlett.127.162001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200 GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.
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Affiliation(s)
- U A Acharya
- Georgia State University, Atlanta, Georgia 30303, USA
| | - C Aidala
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - Y Akiba
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M Alfred
- Department of Physics and Astronomy, Howard University, Washington, D.C. 20059, USA
| | - V Andrieux
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - N Apadula
- Iowa State University, Ames, Iowa 50011, USA
| | - H Asano
- Kyoto University, Kyoto 606-8502, Japan
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - B Azmoun
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - V Babintsev
- IHEP Protvino, State Research Center of Russian Federation, Institute for High Energy Physics, Protvino 142281, Russia
| | - N S Bandara
- Department of Physics, University of Massachusetts, Amherst, Massachusetts 01003-9337, USA
| | - K N Barish
- University of California-Riverside, Riverside, California 92521, USA
| | - S Bathe
- Baruch College, City University of New York, New York, New York 10010, USA
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - A Bazilevsky
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M Beaumier
- University of California-Riverside, Riverside, California 92521, USA
| | - R Belmont
- University of Colorado, Boulder, Colorado 80309, USA
- Physics and Astronomy Department, University of North Carolina at Greensboro, Greensboro, North Carolina 27412, USA
| | - A Berdnikov
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - Y Berdnikov
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - L Bichon
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | - B Blankenship
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | - D S Blau
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
- National Research Nuclear University, MEPhI, Moscow Engineering Physics Institute, Moscow 115409, Russia
| | - J S Bok
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - M L Brooks
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Bryslawskyj
- Baruch College, City University of New York, New York, New York 10010, USA
- University of California-Riverside, Riverside, California 92521, USA
| | - V Bumazhnov
- IHEP Protvino, State Research Center of Russian Federation, Institute for High Energy Physics, Protvino 142281, Russia
| | - S Campbell
- Columbia University, New York, New York 10027 and Nevis Laboratories, Irvington, New York 10533, USA
| | - V Canoa Roman
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - R Cervantes
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - C Y Chi
- Columbia University, New York, New York 10027 and Nevis Laboratories, Irvington, New York 10533, USA
| | - M Chiu
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - I J Choi
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - J B Choi
- Jeonbuk National University, Jeonju 54896, Korea
| | - Z Citron
- Weizmann Institute, Rehovot 76100, Israel
| | - M Connors
- Georgia State University, Atlanta, Georgia 30303, USA
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - R Corliss
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | | | - N Cronin
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - M Csanád
- ELTE, Eötvös Loránd University, H-1117 Budapest, Pázmány P. s. 1/A, Hungary
| | - T Csörgő
- Eszterházy Károly University, Károly Róbert Campus, H-3200 Gyöngyös, Mátrai út 36, Hungary
- Institute for Particle and Nuclear Physics, Wigner Research Centre for Physics, Hungarian Academy of Sciences (Wigner RCP, RMKI) H-1525 Budapest 114, P.O. Box 49, Budapest, Hungary
| | - T W Danley
- Department of Physics and Astronomy, Ohio University, Athens, Ohio 45701, USA
| | | | - G David
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - K DeBlasio
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - K Dehmelt
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - A Denisov
- IHEP Protvino, State Research Center of Russian Federation, Institute for High Energy Physics, Protvino 142281, Russia
| | - A Deshpande
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - E J Desmond
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - A Dion
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - D Dixit
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - J H Do
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - A Drees
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - K A Drees
- Collider-Accelerator Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - J M Durham
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Durum
- IHEP Protvino, State Research Center of Russian Federation, Institute for High Energy Physics, Protvino 142281, Russia
| | - A Enokizono
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Physics Department, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima, Tokyo 171-8501, Japan
| | - H En'yo
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - R Esha
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - S Esumi
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - B Fadem
- Muhlenberg College, Allentown, Pennsylvania 18104-5586, USA
| | - W Fan
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - N Feege
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - D E Fields
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - M Finger
- Charles University, Ovocný trh 5, Praha 1, 116 36 Prague, Czech Republic
| | - M Finger
- Charles University, Ovocný trh 5, Praha 1, 116 36 Prague, Czech Republic
| | - D Fitzgerald
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - S L Fokin
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
| | - J E Frantz
- Department of Physics and Astronomy, Ohio University, Athens, Ohio 45701, USA
| | - A Franz
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - A D Frawley
- Florida State University, Tallahassee, Florida 32306, USA
| | - Y Fukuda
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - C Gal
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - P Gallus
- Czech Technical University, Zikova 4, 166 36 Prague 6, Czech Republic
| | - P Garg
- Department of Physics, Banaras Hindu University, Varanasi 221005, India
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - H Ge
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - M Giles
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - F Giordano
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Y Goto
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - N Grau
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - S V Greene
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | | | - T Gunji
- Center for Nuclear Study, Graduate School of Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - H Guragain
- Georgia State University, Atlanta, Georgia 30303, USA
| | - T Hachiya
- Nara Women's University, Kita-uoya Nishi-machi Nara 630-8506, Japan
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - J S Haggerty
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - K I Hahn
- Ewha Womans University, Seoul 120-750, Korea
| | - H Hamagaki
- Center for Nuclear Study, Graduate School of Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - H F Hamilton
- Abilene Christian University, Abilene, Texas 79699, USA
| | - S Y Han
- Ewha Womans University, Seoul 120-750, Korea
- Korea University, Seoul 02841, Korea
| | - J Hanks
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - M Harvey
- Texas Southern University, Houston, Texas 77004, USA
| | - S Hasegawa
- Advanced Science Research Center, Japan Atomic Energy Agency, 2-4 Shirakata Shirane, Tokai-mura, Naka-gun, Ibaraki-ken 319-1195, Japan
| | - T O S Haseler
- Georgia State University, Atlanta, Georgia 30303, USA
| | - X He
- Georgia State University, Atlanta, Georgia 30303, USA
| | - T K Hemmick
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - J C Hill
- Iowa State University, Ames, Iowa 50011, USA
| | - K Hill
- University of Colorado, Boulder, Colorado 80309, USA
| | - A Hodges
- Georgia State University, Atlanta, Georgia 30303, USA
| | - R S Hollis
- University of California-Riverside, Riverside, California 92521, USA
| | - K Homma
- Hiroshima University, Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - B Hong
- Korea University, Seoul 02841, Korea
| | - T Hoshino
- Hiroshima University, Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - N Hotvedt
- Iowa State University, Ames, Iowa 50011, USA
| | - J Huang
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - S Huang
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | - K Imai
- Advanced Science Research Center, Japan Atomic Energy Agency, 2-4 Shirakata Shirane, Tokai-mura, Naka-gun, Ibaraki-ken 319-1195, Japan
| | - M Inaba
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - A Iordanova
- University of California-Riverside, Riverside, California 92521, USA
| | - D Isenhower
- Abilene Christian University, Abilene, Texas 79699, USA
| | - D Ivanishchev
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
| | - B V Jacak
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - M Jezghani
- Georgia State University, Atlanta, Georgia 30303, USA
| | - Z Ji
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - X Jiang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B M Johnson
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- Georgia State University, Atlanta, Georgia 30303, USA
| | - D Jouan
- IPN-Orsay, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, BP1, F-91406 Orsay, France
| | - D S Jumper
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - J H Kang
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - D Kapukchyan
- University of California-Riverside, Riverside, California 92521, USA
| | - S Karthas
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - D Kawall
- Department of Physics, University of Massachusetts, Amherst, Massachusetts 01003-9337, USA
| | - A V Kazantsev
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
| | - V Khachatryan
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - A Khanzadeev
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
| | - A Khatiwada
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Kim
- University of California-Riverside, Riverside, California 92521, USA
- Korea University, Seoul 02841, Korea
| | - E-J Kim
- Jeonbuk National University, Jeonju 54896, Korea
| | - M Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Korea
| | - D Kincses
- ELTE, Eötvös Loránd University, H-1117 Budapest, Pázmány P. s. 1/A, Hungary
| | - A Kingan
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - E Kistenev
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - J Klatsky
- Florida State University, Tallahassee, Florida 32306, USA
| | - P Kline
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - T Koblesky
- University of Colorado, Boulder, Colorado 80309, USA
| | - D Kotov
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - S Kudo
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - B Kurgyis
- ELTE, Eötvös Loránd University, H-1117 Budapest, Pázmány P. s. 1/A, Hungary
| | - K Kurita
- Physics Department, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima, Tokyo 171-8501, Japan
| | - Y Kwon
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - J G Lajoie
- Iowa State University, Ames, Iowa 50011, USA
| | - D Larionova
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - A Lebedev
- Iowa State University, Ames, Iowa 50011, USA
| | - S Lee
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - S H Lee
- Iowa State University, Ames, Iowa 50011, USA
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - M J Leitch
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Y H Leung
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - N A Lewis
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - X Li
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S H Lim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Pusan National University, Pusan 46241, Korea
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - M X Liu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - V-R Loggins
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Lökös
- ELTE, Eötvös Loránd University, H-1117 Budapest, Pázmány P. s. 1/A, Hungary
| | - D A Loomis
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
| | - K Lovasz
- Debrecen University, H-4010 Debrecen, Egyetem tér 1, Hungary
| | - D Lynch
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - T Majoros
- Debrecen University, H-4010 Debrecen, Egyetem tér 1, Hungary
| | - Y I Makdisi
- Collider-Accelerator Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M Makek
- Department of Physics, Faculty of Science, University of Zagreb, Bijenička c. 32 HR-10002 Zagreb, Croatia
| | - V I Manko
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
| | - E Mannel
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M McCumber
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - P L McGaughey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D McGlinchey
- University of Colorado, Boulder, Colorado 80309, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C McKinney
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - M Mendoza
- University of California-Riverside, Riverside, California 92521, USA
| | - A C Mignerey
- University of Maryland, College Park, Maryland 20742, USA
| | - A Milov
- Weizmann Institute, Rehovot 76100, Israel
| | - D K Mishra
- Bhabha Atomic Research Centre, Bombay 400 085, India
| | - J T Mitchell
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - Iu Mitrankov
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - M Mitrankova
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - G Mitsuka
- KEK, High Energy Accelerator Research Organization, Tsukuba, Ibaraki 305-0801, Japan
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| | - S Miyasaka
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- Department of Physics, Tokyo Institute of Technology, Oh-okayama, Meguro, Tokyo 152-8551, Japan
| | - S Mizuno
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - M M Mondal
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - P Montuenga
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - T Moon
- Korea University, Seoul 02841, Korea
- Yonsei University, IPAP, Seoul 120-749, Korea
| | - D P Morrison
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - B Mulilo
- Korea University, Seoul 02841, Korea
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - T Murakami
- Kyoto University, Kyoto 606-8502, Japan
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - J Murata
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Physics Department, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima, Tokyo 171-8501, Japan
| | - K Nagai
- Department of Physics, Tokyo Institute of Technology, Oh-okayama, Meguro, Tokyo 152-8551, Japan
| | - K Nagashima
- Hiroshima University, Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - T Nagashima
- Physics Department, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima, Tokyo 171-8501, Japan
| | - J L Nagle
- University of Colorado, Boulder, Colorado 80309, USA
| | - M I Nagy
- ELTE, Eötvös Loránd University, H-1117 Budapest, Pázmány P. s. 1/A, Hungary
| | - I Nakagawa
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - K Nakano
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Department of Physics, Tokyo Institute of Technology, Oh-okayama, Meguro, Tokyo 152-8551, Japan
| | - C Nattrass
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Nelson
- Florida A&M University, Tallahassee, Florida 32307, USA
| | - T Niida
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - R Nouicer
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - T Novák
- Eszterházy Károly University, Károly Róbert Campus, H-3200 Gyöngyös, Mátrai út 36, Hungary
- Institute for Particle and Nuclear Physics, Wigner Research Centre for Physics, Hungarian Academy of Sciences (Wigner RCP, RMKI) H-1525 Budapest 114, P.O. Box 49, Budapest, Hungary
| | - N Novitzky
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - G Nukazuka
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - A S Nyanin
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
| | - E O'Brien
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - C A Ogilvie
- Iowa State University, Ames, Iowa 50011, USA
| | | | - J D Osborn
- Department of Physics, University of Michigan, Ann Arbor, Michigan 48109-1040, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Oskarsson
- Department of Physics, Lund University, Box 118, SE-221 00 Lund, Sweden
| | - G J Ottino
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - K Ozawa
- KEK, High Energy Accelerator Research Organization, Tsukuba, Ibaraki 305-0801, Japan
- Tomonaga Center for the History of the Universe, University of Tsukuba, Tsukuba, Ibaraki 305, Japan
| | - V Pantuev
- Institute for Nuclear Research of the Russian Academy of Sciences, prospekt 60-letiya Oktyabrya 7a, Moscow 117312, Russia
| | - V Papavassiliou
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - J S Park
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Korea
| | - S Park
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Korea
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - S F Pate
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| | - M Patel
- Iowa State University, Ames, Iowa 50011, USA
| | - W Peng
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | - D V Perepelitsa
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- University of Colorado, Boulder, Colorado 80309, USA
| | - G D N Perera
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - D Yu Peressounko
- National Research Center "Kurchatov Institute," Moscow, 123098 Russia
| | - C E PerezLara
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - J Perry
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| | - R Petti
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M Phipps
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - C Pinkenburg
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - R P Pisani
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - M Potekhin
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - A Pun
- Department of Physics and Astronomy, Ohio University, Athens, Ohio 45701, USA
| | - M L Purschke
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - P V Radzevich
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - N Ramasubramanian
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794-3800, USA
| | - K F Read
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D Reynolds
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| | - V Riabov
- National Research Nuclear University, MEPhI, Moscow Engineering Physics Institute, Moscow 115409, Russia
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
| | - Y Riabov
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
| | - D Richford
- Baruch College, City University of New York, New York, New York 10010, USA
| | - T Rinn
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Iowa State University, Ames, Iowa 50011, USA
| | - S D Rolnick
- University of California-Riverside, Riverside, California 92521, USA
| | - M Rosati
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| | - Z Rowan
- Baruch College, City University of New York, New York, New York 10010, USA
| | - J Runchey
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| | - A S Safonov
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| | - T Sakaguchi
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - H Sako
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| | - V Samsonov
- National Research Nuclear University, MEPhI, Moscow Engineering Physics Institute, Moscow 115409, Russia
- PNPI, Petersburg Nuclear Physics Institute, Gatchina, Leningrad region 188300, Russia
| | - M Sarsour
- Georgia State University, Atlanta, Georgia 30303, USA
| | - S Sato
- Advanced Science Research Center, Japan Atomic Energy Agency, 2-4 Shirakata Shirane, Tokai-mura, Naka-gun, Ibaraki-ken 319-1195, Japan
| | - B Schaefer
- Vanderbilt University, Nashville, Tennessee 37235, USA
| | - B K Schmoll
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K Sedgwick
- University of California-Riverside, Riverside, California 92521, USA
| | - R Seidl
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
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| | - A Sen
- Iowa State University, Ames, Iowa 50011, USA
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| | - I Shein
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- Department of Physics, Tokyo Institute of Technology, Oh-okayama, Meguro, Tokyo 152-8551, Japan
| | - K Shigaki
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| | - P Shukla
- Bhabha Atomic Research Centre, Bombay 400 085, India
| | - A Sickles
- University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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| | - M Slunečka
- Charles University, Ovocný trh 5, Praha 1, 116 36 Prague, Czech Republic
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| | - Z Sun
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| | - M Tomášek
- Czech Technical University, Zikova 4, 166 36 Prague 6, Czech Republic
| | - C L Towell
- Abilene Christian University, Abilene, Texas 79699, USA
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| | - H Yamamoto
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| | - A Yanovich
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| | - H Yu
- New Mexico State University, Las Cruces, New Mexico 88003, USA
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- Saint Petersburg State Polytechnic University, St. Petersburg 195251, Russia
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- University of California-Riverside, Riverside, California 92521, USA
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Nagashima K. Fast-slow atrioventricular nodal reentrant tachycardia phenotype mimicking the slow-slow type. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Abstract
Abstract
Background
Fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (AVNRT) is characterized by a short atrio-His (AH) interval and the earliest site of atrial activation (EAA) in the proximal coronary sinus (EAA-CS), while slow-slow (S/S-) AVNRT presents a long AH interval and EAA-CS. Those intracardiac appearances are initial indicators for making a diagnosis.
Purpose
To identify an unknown phenotype of F/S-AVNRT.
Methods
Among 46 consecutive patients with F/S-AVNRT, 6 patients (1 man, age 59±9) had an apparent but not typical (pseudo-) S/S-AVNRT during an electrophysiologic study. In 2 patients, pseudo-S/S-AVNRT was clinically documented.
Results
In all 6 patients, the diagnosis of F/S-AVNRT was made by an exclusion of atrial tachycardia with findings of 1) a V-A-V response following ventricular entrainment or 2) termination without atrial capture by ventricular pacing, and an exclusion of AV reentrant tachycardia with a ventriculoatrial dissociation during an initial (so-called QRS transition) zone of ventricular entrainment. An initial A-A-V activation sequence on atrial induction of F/S-AVNRT observed in 1 patient and Wenckebach-type AV block during ongoing F/S-AVNRT developing in 3 patients suggested the presence of the lower common pathway (LCP). Like the typical S/S-AVNRT, pseudo-S/S-AVNRT was induced with atrial stimulation after a jump in the AH interval or double ventricular response. However, in all patients, the pseudo-S/S-AVNRT transited to F/S-AVNRT following AV block in a single cycle and/or pseudo-S/S-AVNRT transited from spontaneously or triggered by atrial contractions. Importantly, on these transitions, the atrial cycle length (CL) and EAA-CS remained unchanged, that is, the atrial CL of S/S-AVNRT was almost identical to that of F/S-AVNRT, suggesting that the essential circuit of both tachycardias was identical. Actually, both tachycardias were cured by ablation at a single site in the traditional slow pathway (SP). Collectively, the pseudo-S/S-AVNRT was diagnosed as another phenotype of F/S-AVNRT accompanied by sustained antegrade conduction via another bystander (likely the left-sided or superior) SP breaking through the His bundle owing to the repetitive antegrade block at the LCP occurring by linking phenomenon, thus representing a long AH interval during the ongoing F/S-AVNRT. When the antegrade conduction is blocked at the bystander SP during the pseudo-S/S-AVNRT, releasing the linking phenomenon, the subsequent antegrade conduction reach the His-bundle via the fast pathway, thus returning to F/S-AVNRT.
Conclusions
An unknown, but not rare F/S-AVNRT phenotype exists that apparently mimics the typical S/S-AVNRT and is also an unknown subtype of apparent S/S-AVNRT. The presence of this pseudo-S/S-AVNRT suggests the limitation of classifying types of AVNRT based on AH and HA intervals during tachycardia. Understandings of this phenotype can advance a diagnosis of atypical AVNRT with multiple phenotypes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Kaneko
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - T Nakajima
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - S Tamura
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - H Hasegawa
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - T Kobari
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - K Nagashima
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo, Japan
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Nakahara S, Wakamatsu Y, Fukuda R, Hori Y, Nishiyama N, Sato H, Nagashima K, Mizutani Y, Ishikawa T, Kobayashi S, Taguchi I, Okumura Y. Utility of hot-balloon-based pulmonary vein isolation under balloon surface temperature monitoring: First clinical experience. J Cardiovasc Electrophysiol 2021; 32:2625-2635. [PMID: 34350665 DOI: 10.1111/jce.15196] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/06/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A new hot balloon system that registers balloon surface temperature (BST) during energy delivery is now available for clinical use in Japan. This study sought to investigate the utility of BST measurement for achievement of pulmonary vein isolation (PVI) by a single-shot energy delivery strategy during hot balloon ablation (HBA). METHODS We applied and tested the system in 30 consecutive patients undergoing HBA for paroxysmal or early-persistent atrial fibrillation (AF). We also performed real-time PV potential monitoring using a circular catheter. RESULTS Acute PVI was achieved with single hot balloon shots in 88% (106/120) of the PVs. Real-time BSTs and PV potentials were recorded in all cases. Mean BST at documentation of PVI was 49.4°C, and acute reconnections were observed in most cases (86%, 12/14) in which the single-shot technique was ineffective. Time-to-isolation (TTI) (23.1 ± 8.7 s vs. 36.3 ± 9.3 s, p < .01) and median BST (59.9 ± 2.6°C vs. 55.7 ± 1.9°C, p < .01) differed significantly between cases in which PVI was achieved (vs. those in which PVI was not achieved). Multivariable analysis revealed strong association between both TTI and median BST and acute PVI. The best median BST cutoff value for achieving PVI with a single shot was >58.7°C (sensitivity 67.0%, specificity 100%). CONCLUSION Our data suggest that real-time BST monitoring during energy applications is useful for predicting achievement of acute PVI by a single shot during HBA.
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Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuji Wakamatsu
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hirotsugu Sato
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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48
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Wakamatsu Y, Nagashima K, Otsuka N, Hayashida S, Hirata S, Hirata M, Kurokawa S, Nakai T, Okumura Y. B-PO05-109 IS ACHIEVING OPTIMAL CATHETER CONTACT STABILITY FOR VERY HIGH-POWER SHORT-DURATION ABLATION OF ATRIAL FIBRILLATION EASY? Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Watanabe R, Nagashima K, Wakamatsu Y, Otsuka N, Hirata S, Yagyu S, Kurokawa S, Ikeda A, Yokoyama K, Nakai T, Okumura Y. B-PO04-087 EFFECT OF OBESITY ON LEFT ATRIAL WALL SUBSTRATE IN PATIENTS WITH ATRIAL FIBRILLATION: INSIGHT INTO EPICARDIAL ADIPOSE TISSUE AND FATTY INFILTRATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.782] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Otsuka N, Okumura Y, Nagashima K, Wakamatsu Y, Hirata S, Kurokawa S, Ohkubo K, Nakai T. B-PO02-033 MECHANISM TISSUE HEATING DURING HIGH-POWER SHORT-DURATION ABLATION VS. 30W-SETTING ABLATION: IN VIVO ACTUAL TISSUE TEMPERATURE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.289] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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