記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The Kumamoto criteria have been proposed as a non-invasive screen for transthyretin amyloid cardiomyopathy. This study assessed the validity of the Kumamoto criteria externally. Methods and Results: The study included 138 patients (median age 73 years; 65% male) who underwent 99 mTc-pyrophosphate (PYP) scintigraphy. Patients were divided into 4 groups according to total scores on the Kumamoto criteria (i.e., 0-3) for the following 3 factors: high-sensitivity cardiac troponin T ≥0.0308 ng/mL, wide (≥120 ms) QRS, and left ventricular posterior wall thickness ≥13.6 mm. The diagnostic performance and positive predictive value (PPV) of the Kumamoto criteria for positive 99 mTc-PYP scintigraphy were validated. Eighteen (13%) patients were positive on 99 mTc-PYP scintigraphy. The Kumamoto criteria had a favorable diagnostic performance (area under the curve 0.808). The PPV for groups with scores of 0, 1, 2, and 3 was 0% (n=0/42), 11% (n=6/57), 21% (n=7/33), and 83% (n=5/6), respectively, which is lower, particularly for those with a score of 2, than in the original Kumamoto cohort. However, the PPV increased after combining the Kumamoto criteria with a history of orthopedic diseases (spinal canal stenosis and/or carpal tunnel syndrome). Conclusions: This study suggests that the Kumamoto criteria have a favorable diagnostic performance; however, the PPV may decrease depending on the study population. Combining the Kumamoto criteria with the presence of orthopedic disease may improve the PPV.

DOI： 10.1253/circrep.CR-22-0110

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing hemodialysis (HD); AF lowers quality of life (QoL) and increases the risk of dialysis-related complications. The present study aimed to evaluate the effectiveness of AF ablation on the QoL in patients undergoing HD. Methods: Nineteen patients undergoing HD (14 men, age 68 ± 8 years; 15 with paroxysmal AF) who underwent catheter ablation (CA) of AF were enrolled in the study. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was assessed to evaluate the QoL of the HD patients at baseline and 6 months after the ablation. Ablation outcomes and procedural complications were evaluated and compared to those of 1053 consecutive non-HD patients who underwent AF ablation. Results: The KDQOL-SF of the HD patients 6 months after the ablation showed an improvement in physical functioning (54 ± 23 to 68 ± 28, P < 0.01), general health perceptions (38 ± 17 to 48 ± 15, P < 0.01), and symptoms/problems (75 ± 21 to 84 ± 13, P = 0.02), compared to baseline. For intradialytic symptoms, dyspnea during HD significantly improved after the CA in the HD patients without AF recurrence (43% to 7%, P = 0.04), whereas the atrial tachyarrhythmias and hypotension during HD remained unchanged. During the follow-up period of 17 ± 13 months after the last procedure, the incidence of being arrhythmia-free was similar (HD patients, 79% vs non-HD patients, 86%, log-rank P = 0.82). No life-threatening complications occurred in any of the patients. Conclusions: CA of AF improves QoL in patients undergoing chronic HD therapy.

DOI： 10.1016/j.cjco.2022.05.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ijcha.2022.101074

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記述言語：英語  

DOI： 10.1007/s00380-022-02138-4

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記述言語：英語  

DOI： 10.1007/s00380-022-02137-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Atrioventricular Block (AVB) is one of the common manifestations in cardiac sarcoidosis (CS). Although pacemaker implantation is generally recommended in patients with CS complicated by symptomatic AVB, some case reports have shown that they can be managed by steroid therapy without pacemaker implantation. The aim of this study was to evaluate the feasibility and effectiveness of steroid therapy without pacemaker implantation in patients with CS complicated by symptomatic AVB. We performed medical record review of consecutive ten CS patients who admitted Nippon Medical School Hospital for symptomatic second or third degree AVB between April 2015 and March 2021. Of the studied population, steroid therapy before pacemaker implantation was feasible in three patients with second degree AVB. Two of them showed subsequent recovery of atrioventricular conduction to 1:1, and they were managed by steroid therapy without pacemaker. The remaining one patient showed no improvement of atrioventricular conduction and required pacemaker implantation. Seven patients with third degree AVB required device implantation (pacemaker; n = 7, cardiac resynchronization therapy defibrillator; n = 1) before steroid therapy mainly because of hemodynamic instability. Steroid therapy without pacemaker implantation might be feasible, and possibly be effective in patients with CS presenting second degree AVB. However, the feasibility is limited in patients with third degree AVB.

DOI： 10.1007/s00380-022-02092-1

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記述言語：英語  

A 42-year-old man was admitted for recurrent atrioventricular reciprocating tachycardia. We performed a total activation mapping, which included a range from the ventricular to atrial waves during right ventricular pacing. The mapping revealed a delayed ventriculoatrial conduction on the left lateral wall. We performed ablation within the coronary sinus, and the ventriculoatrial conduction was lost. By widening the range, we could easily visualize the ventriculoatrial conduction through the accessory pathway. This mapping showed that the conduction in the area of the accessory pathway was delayed, and it was easy to estimate that the conduction pathway included the coronary sinus.

DOI： 10.1111/anec.12961

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Atrial flutter (AFL) is a large reentrant circuit located in the right atrium. Anti-arrhythmic drugs (AADs) can provoke AFL with 1:1 atrioventricular conduction (AVC) to cause hemodynamic collapse. We elucidated the characteristics of patients with AFL exhibiting spontaneous 1:1 AVC. Fifteen patients (1:1 AFL group; 11 males, 52.4 ± 13.7 years old) who documented AFL with 1:1 AVC were enrolled and compared to 153 patients without 1:1 AVC (Control group; 137 males, 68.9 ± 11.2 years old). AFL cycle length during maximum AVC was significantly longer in the 1:1 AFL group than in the control group (274.7 ± 37.0 vs. 216.2 ± 25.6 ms, p < 0.001). Among 1:1 AVC group, 9 patients had AADs, and AFL cycle length was significantly longer during 1:1 AVC as compared with 2:1 AVC documented the other day (284.4 ± 41.3 vs. 233.3 ± 26.0 ms, p < 0.001), suggesting enhancement effect of the AADs during 1:1 AVC. Remaining 6 patients who did not take AADs, 2 patients showed enlargement of the tricuspid annulus and 3 patients developed 1:1 AVC during exercise. Multivariate analysis revealed that younger age and the use of AADs was independent risk factors for the development of 1:1 AFL group. Prolonged AFL cycle length associated with the class Ia/Ic AAD use, slower heart rate during sinus rhythm and younger age were important risk factors for the development of 1:1 AVC during AFL.

DOI： 10.1007/s00380-021-01968-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound-guided apical approach in patients with chronic pericardial effusion. METHODS: Among 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis. RESULTS: A subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group. CONCLUSION: The subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.

DOI： 10.1002/clc.23810

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-20-1212

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語  

DOI： 10.1007/s10840-022-01161-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Sustained ventricular tachycardia (sVT), leading to sudden cardiac death, is one of the common manifestations in cardiac sarcoidosis (CS). Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been reported to be associated with sVT, the relationships of its localization to sVT have not been fully evaluated.To evaluate the localization of LGE and its relationships to sVT in patients with CS, we reviewed medical record of consecutive 31 patients with CS who underwent CMR. The localization of LGE was divided into four categories: Left ventricular (LV) septum, LV free wall, right ventricular (RV) septum, and RV free wall. We investigated the association of sVT with localization of LGE and other parameters including serum biomarkers LV ejection fraction on echocardiography and Fluorine-18-fluorodeoxyglucose (FDG) accumulation on positron emission tomography (PET) -CT.Of the studied population, 8 patients (25.8%) were known to present with sVT among 31 CS patients. LGE was observed in the RV free wall in 6 patients with sVT, whereas it was in 5 patients without sVT (75.0% versus 21.7%, P = 0.022). Univariate analysis showed that only LGE in the RV free wall was associated with sVT (odds ratio [OR]: 10.80; 95% confidence interval [CI]: 1.64-70.93, P = 0.013).LGE in the RV free wall was associated with sVT in patients with CS.

DOI： 10.1536/ihj.21-635

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD-SHD). METHODS: We prospectively analyzed 183 CKD-SHD patients (median age, 69 years [interquartile range, 61-77 years]) who underwent 24-h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory-based late potentials (w-LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes. RESULTS: Thirteen patients reached the primary endpoint during a follow-up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w-LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4-22.3, p = .007) and NSVT [HR = 8.72, 95% CI: 2.8-26.5: p < .001] was significantly associated with the primary endpoint. Kaplan-Meier analysis demonstrated that the combination of w-LPs and NSVT resulted in a lower event-free survival rate than did other NIEMs (p < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint. CONCLUSION: The combination of w-LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD-SHD patients.

DOI： 10.1111/anec.12923

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Attempting to minimize radiation exposure during catheter ablation of atrial fibrillation (AF) for patients, operators and medical staffs should be performed. This study aimed to investigate the feasibility and safety of a metal interference alert guided septal approach using 3 intracardiac echocardiography viewing positions for near-zero fluoroscopy AF ablation procedures. Methods/results: A total of 668 procedures among 608 consecutive patients with AF (67.2 ± 7.3 years, 408 males) who underwent catheter ablation were retrospectively evaluated and divided into 2 groups, near-zero group (n = 42) and conventional group (n = 595). In the near-zero group, a metal interference alert guided septal approach with 3 different catheter intracardiac echocardiography positions to minimize the fluoroscopy time was applied, and a left atrial access with 2 long sheaths from a single septal puncture without fluoroscopy was successfully achieved in 41 out of 42 cases. The total fluoroscopy time was significantly shorter in the near-zero group than that in the conventional group (0.5 ± 2.0 vs. 21.4 ± 12.9 min p < 0.0001). The total procedure time and time to the septal puncture were both significantly longer in the near-zero group than those in the conventional group (131.4 ± 40.2 vs. 116.6 ± 46.4p = 0.0453, 31.6 ± 9.2 vs. 19.9 ± 10.2 min, p < 0.0001), The ablation time did not differ between the 2 groups (Near-zero: 99.8 ± 41.0 vs. Conventional: 96.8 ± 44.3 min, p = 0.6663). There were no significant differences in the complication rate between the 2 groups (Near-zero: 0 vs. Conventional 14 case, p = 0.6151). Conclusion: A metal interference alert guided septal approach using 3 intracardiac echocardiography viewing positions was feasible and safe for a near-zero fluoroscopy catheter ablation of AF.

DOI： 10.1016/j.ijcha.2021.100896

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). Although coronary artery spasms (CAS) during or after ablation procedures have been described as a rare complication in some case reports, the incidence and characteristics of this complication have not been fully elucidated. The present observational study aimed to clarify the CAS in a large number of patients experiencing AF ablation. METHODS: A total of 2913 consecutive patients (male: 78%, mean 66 ± 10 years) who underwent catheter ablation of AF were enrolled. RESULTS: Nine patients (0.31%, mean 66 ± 10 years, 7 males) had transient ST-T elevation (STE). Eight out of the 9 patients had STE in the inferior leads. STE occurred after the transseptal puncture in 7 patients, after the sheath was pulled out of the left atrium in 1, and 2 h after the ablation procedure in 1. Six patients had definite angiographic CAS without any sign of an air embolization on the emergent coronary angiography. In the3 other patients, the STE improved either directly after an infusion of nitroglycerin or spontaneously before the CAG. The patients with CAS had a higher frequency of a smoking habit (89% vs. 53%; P = .04), smaller left atrial diameter (36 ± 6 vs. 40 ± 7; P = .07), and lower CHADS2 score (0.6 ± 0.5 vs. 1.3 ± 1.1; P = .004) than those without. CONCLUSIONS: Although the incidence was rare (0.31%), CAS should be kept in mind as a potentially life-threatening complication throughout an AF ablation procedure especially performed under conscious sedation.

DOI： 10.1007/s10840-021-01089-6

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Although the reno-protective effects of sodium-glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The prospective, multicentre, randomized, double-blind, placebo-controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2-12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub-analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety-six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2 , P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2 , the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (-6.61 vs. +0.22 mL/min/1.73 m2 , P = 0.008 and +0.063 vs. -0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = -0.675, P < 0.001, respectively) but not in the empagliflozin group. CONCLUSIONS: Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2 . Early administration of sodium-glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection.

DOI： 10.1002/ehf2.13509

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The clinical course and therapeutic strategies in the congenital long QT syndrome (LQTS) are genotype-specific. However, accurate estimation of LQTS genotype is often difficult from the standard 12-lead ECG. OBJECTIVES: This study aims to evaluate the utility of QT/RR slope analysis by the 24-hour Holter monitoring for differential diagnosis of LQTS genotype between LQT1 and LQT2. METHODS: This cross-sectional study enrolled 54 genetically identified LQTS patients (29 LQT1 and 25 LQT2) recruited from three medical institutions. The QT-apex (QTa) interval and the QT-end (QTe) interval at each 15-second were plotted against the RR intervals, and the linear regression (QTa/RR and QTe/RR slopes, respectively) was calculated from the entire 24-hour and separately during the day or night-time periods of the Holter recordings. RESULTS: The QTe/RR and QTa/RR slopes at the entire 24-hour were significantly steeper in LQT2 compared to those in LQT1 patients (0.262 ± 0.063 vs. 0.204 ± 0.055, p = .0007; 0.233 ± 0.052 vs. 0.181 ± 0.040, p = .0002, respectively). The QTe interval was significantly longer, and QTe/RR and QTa/RR slopes at daytime were significantly steeper in LQT2 than in LQT1 patients. The receiver operating curve analysis revealed that the QTa/RR slope of 0.211 at the entire 24-hour Holter was the best cutoff value for differential diagnosis between LQT1 and LQT2 (sensitivity: 80.0%, specificity: 75.0%, and area under curve: 0.804 [95%CI = 0.68-0.93]). CONCLUSION: The continuous 24-hour QT/RR analysis using the Holter monitoring may be useful to predict the genotype of congenital LQTS, particularly for LQT1 and LQT2.

DOI： 10.1111/anec.12878

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The development of heart failure is associated with fluid balance, including that of extracellular water (ECW) and intracellular water (ICW). This study determined whether sodium-glucose cotransporter 2 inhibitors affect fluid balance and improve heart failure in patients after acute myocardial infarction. METHODS AND RESULTS: EMBODY was a prospective, randomized, double-blinded, placebo-controlled trial of Japanese patients with acute myocardial infarction and type 2 diabetes. Overall, 55 patients who underwent bioelectrical impedance analysis were randomized to receive once daily 10 mg empagliflozin or placebo 2 weeks after acute myocardial infarction onset. We investigated the time course of body fluid balance measured using the bioelectrical impedance analysis device, InBody. The primary end points were changes in body fluid balance from weeks 0 to 24. Changes between baseline and week 24 in the empagliflozin and placebo groups were -0.21 L (P = .127) and +0.40 L (P = .001) in ECW (P = .001) and -0.23 L (P = .264) and +0.74 L (P < .001) in ICW (P < .001), respectively. In a stratified analysis, the rise in ECW and ICW was significantly attenuated in the empagliflozin group in contrast to the placebo group in participants with a body mass index of 25 or higher but not in those with a body mass index of less than 25. CONCLUSIONS: Early sodium-glucose cotransporter 2 inhibitor administration may attenuate changes in ECW and ICW.

DOI： 10.1016/j.cardfail.2021.07.022

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Plasma volume status (PVS), a parameter of the discrepancy between actual plasma volume (PV) and ideal PV, has been recently evaluated as a prognostic marker in patients with heart failure. This subgroup analysis of the EMBODY trial was designed to determine whether a sodium-glucose cotransporter 2 (SGLT2) inhibitor affects the alleviation of heart failure and improvement of PVS in patients after acute myocardial infarction (AMI) with congestive heart failure (CHF). METHODS: The EMBODY trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial to identify the effect of an SGLT2 inhibitor on cardiac sympathetic hyperactivity in patients with AMI and type 2 diabetes mellitus (T2DM) in Japan. In total, 105 patients were randomized (1:1) to receive 10 mg empagliflozin or a placebo (once daily), 2 weeks after the onset of AMI. In this subanalysis, we investigated the time-course of PVS at baseline and weeks 4, 12, and 24. RESULTS: Overall, 96 patients were included in the subgroup analysis set (age 64.3 ± 10.9 years, 80.2% men; 46 in the empagliflozin group and 50 in the placebo group). Body weight and PVS decreased in the empagliflozin group compared with the placebo group at 24 weeks (- 2.2 vs. + 0.1 kg, P < 0.001, and - 5.1 vs. - 0.3%, P < 0.001, respectively). Decreased PVS, defined as a change in PVS of < - 4.5%, was associated with the administration of empagliflozin (odds ratio 2.61, 95% confidence interval 1.11-6.15, P = 0.028). N-terminal pro b-type natriuretic peptide levels decreased in both the empagliflozin and placebo groups (1028.7-370.3 pg/mL, P < 0.001, and 1270.6-673.7 pg/mL, P < 0.01, respectively). CONCLUSION: Empagliflozin reduced the body weight and PVS. Early SGLT2 inhibitor administration in patients with AMI, CHF, and T2DM can therefore be effective in reducing the body weight and PVS. TRIAL REGISTRATION: UMIN 000030158.

DOI： 10.1007/s13300-021-01103-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to investigate the incidence and prognostic impact of newly detected AF after cardiac implantable electronic device (CIED) implantation with HCM patients. Fifty-six patients (33 men, age 57 ± 17 years) with HCM who underwent CIED implantations with no previous history of AF at the time of implantation (ICD n = 46, Pacemaker n = 10) were retrospectively enrolled. During 5.7 ± 3.6 years of follow-up, AF was newly detected in 20 (36%) of 56 patients after the CIED implantation (AF group) and the rest of the patients had no newly detected AF (non-AF group). The presence of mitral regurgitation (HR 8.49; 95% CI 2.29-30.6 P < 0.01) and concomitant NYHA II-IV (HR 3.37; 95% CI 1.30-8.86 P = 0.01) were the independent predictors of newly detected AF. During the follow-up, all patients in the AF group started anticoagulation mean 21 days after detection of AF, and none had a stroke during the follow-up period. The rate of appropriate ICD therapy (log-rank P = 0.95), inappropriate ICD therapy (log-rank P = 0.78), and all-cause death (log-rank P = 0.23) were similar between the two groups. However, the incidence of hospitalizations due to heart failure was higher in the AF group (55% vs. 6% log-rank P < 0.01). In conclusion, the incidence of newly detected AF after CIED implantations in HCM patients was high. The newly detected AF was associated with worsening heart failure and careful follow-up is recommended.

DOI： 10.1007/s00380-020-01728-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Respiratory management during catheter ablation of atrial fibrillation (AF) is important for the efficacy and safety of the procedure. Obstructive apnea due to an upper airway obstruction might cause serious complications including air embolisms and cardiac tamponade. However, real time monitoring of upper airway obstructions during catheter ablation has not been established. The purpose of the present study was to evaluate esophageal pressure monitoring for respiratory management during catheter ablation of AF. Methods and Results: Twenty-four consecutive patients (20 men and 4 women; mean age, 61 ± 13 years) with AF who underwent esophageal pressure monitoring during catheter ablation of AF were retrospectively analyzed. The patients were divided into 2 groups. One was the obstructive apnea (OA) group (n = 17), which required airway management tools including nasal airways and/or non-invasive positive airway pressure (NPPV) and the other was the control group (n = 7), which did not require airway management. Esophageal pressure measurements were obtained in all patients, and the OA group exhibited a substantial negative esophageal pressure as compared to the control group (-41.48 ± 19.58 vs. -12.42 ± 5.77 mmHg, p < 0.001). Airway management in the OA group immediately improved the negative esophageal pressure and returned to a normal range (-41.48 ± 19.58 vs. -16 ± 8.1 mmHg, 0 < 0.001) along with a recovery from desaturation. Conclusions: Esophageal pressure monitoring was a simple and effective method for the evaluation and management of obstructive apnea during AF catheter ablation.

DOI： 10.1016/j.ijcha.2021.100771

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although epicardial structures around the atrium such as adipose tissue possess arrhythmogenicity, little is known about atrial tachycardias (ATs) originating from epicardial sites (Epi-ATs). This study aimed to elucidate the prevalence, characteristics, and outcome after radiofrequency catheter ablation (RFCA) of Epi-ATs and to reveal the association between Epi-ATs and the epicardial structures. METHODS: The electrocardiographic, electrophysiologic, and anatomical properties and results of RFCA were analyzed in 42 patients with a total of 49 ectopic ATs. RESULTS: Six Epi-ATs (12%) were observed in six patients (14%). Four of six were respiratory cycle-dependent ATs and one was a swallowing-induced AT. The Epi-AT origins were adjacent to a pulmonary vein (five cases) and vein of Marshall (one case). A Valsalva maneuver or atropine infusion to define the arrhythmia mechanism affected the appearance of the Epi-ATs. The congruity rate between epicardial adipose tissue and the AT origin was significantly higher (100% vs. 44%, p = .045), and the epicardial adipose tissue volume of the atrium was significantly larger (104.1 vs. 64.6 ml, p = .04) in the Epi-AT group. Endocardial RFCA targeting the AT foci resulted in acute success in five of five cases. However, electrical isolation including of the AT foci resulted in acute failures (two of three cases) or a recurrence (one of one case). CONCLUSIONS: Six Epi-ATs were associated with thoracic veins and epicardial arrhythmogenic structures. The main cause provoking the Epi-ATs was associated with autonomic nerve activity.

DOI： 10.1002/clc.23577

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Early detection of cardiac involvement in patients with sarcoidosis is important but currently unresolved. The aim of this study was to elucidate the utility of frequency domain microvolt T-wave alternans (TWA), signal-averaged ECG (SAECG), and heart rate turbulence (HRT) using 24-hour Holter ECG for detecting cardiac involvement in patients with pulmonary sarcoidosis. Methods: This study consisted of consecutive 40 pulmonary sarcoidosis patients (11 males, 62 ± 13 years) who underwent 24-hour Holter monitoring with and without cardiac involvement. All patients underwent frequency domain TWA, SAECG, and HRT using 24-hour Holter monitoring. Patients with atrial fibrillation pacing or wide QRS electrocardiogram were excluded. Results: After 14 patients were excluded, a total of 26 patients (six males, 59 ± 14 years) were evaluated. Seven patients had cardiac involvement (cardiac sarcoidosis [CS] group). On the Holter SAECG, duration of low-amplitude signals <40 μV in the terminal filtered QRS complex (LAS40) was significantly higher, and root mean square voltage of the terminal 40 ms of the filtered QRS complex (RMS40) was significantly lower in the CS group compared with the non-CS group (LAS40: 61.4 ± 35.9 vs 37.6 ± 9.2 ms; P = .018, RMS40: 11.4 ± 10.3 vs 23.6 ± 13.2 ms; P = .023). Prevalence of positive late potential (LP) was also significantly higher in the CS group than that in the non-CS group (85.7% vs 31.5%; P = .026). The sensitivity, specificity, positive, and negative predictive values of LP for identifying patients with cardiac involvement were 85.7%, 68.4%, 50.0%, and 92.8%, respectively. Conclusion: Holter SAECG may be useful for detecting cardiac involvement in patients with pulmonary sarcoidosis.

DOI： 10.1002/joa3.12501

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Amyloid light-chain (AL) cardiac amyloidosis is known to result in restrictive cardiomyopathy, which has a poor prognosis. Although electrocardiography (ECG) is useful for its diagnosis and management, there are few reports on the long-term follow-up of electrocardiographic changes. The patient in the present case was a 62-year-old woman who visited our hospital due to palpitation and lower leg edema. A chest radiograph showed cardiac enlargement, and ECG revealed sinus rhythm, first-degree atrioventricular block, low QRS voltage in the limb leads and a pseudomyocardial infarction pattern in the precordial leads. Echocardiography revealed left ventricular hypertrophy with systolic and diastolic dysfunction. Immunoelectrophoresis demonstrated M-protein (IgGλ), and bone marrow biopsy implied IgGλ-type plasmacytoma. Myocardial biopsy findings were compatible with cardiac amyloidosis. Based on these findings, we diagnosed the patient with AL cardiac amyloidosis. Melphalan-prednisolone (MP) therapy was performed in conjunction with treatment for non-sustained ventricular tachycardia and congestive heart failure. Two years and four months later, the sinus rhythm converted to atrial tachycardia. At a follow-up examination at four years and eight months, right branch block appeared. Then degree of intraventricular conduction was worsened, and the low voltage of the limb leads was not observed. Seven years after the diagnosis, she was eventually hospitalized for the treatment of pneumonia and heart failure with tachycardia. On the seventh day of hospitalization, heart rhythm was changed to atrial stand-still with escaped ventricular rhythm and died of cardiac arrest. These ECG changes may provide valuable information regarding the pathophysiological changes that occur in AL cardiac amyloidosis.

DOI： 10.1272/jnms.JNMS.2022_89-111

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all-cause mortality have not been fully elucidated. METHODS AND RESULTS: From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all-cause mortality were evaluated. During a median follow-up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00-1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01-1.06; p < .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all-cause mortality compared to those that required shocks during the ES (log-rank p = .10). CONCLUSIONS: ATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.

DOI： 10.1111/jce.14891

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The new guideline (NG) published by the Japanese Circulation Society (JCS) places emphasis on previous arrhythmic syncope and inducibility of ventricular fibrillation (VF) by ≤2 extrastimuli during programmed electrical stimulation (PES) for deciding the indication of an implantable cardioverter-defibrillator in patients with Brugada syndrome (BrS). This study evaluated the usefulness of the NG and compared it with the former guideline (FG) for risk stratification of patients with BrS.Methods and Results:This was a multicenter (7 Japanese hospitals) retrospective study involving 234 patients with BrS who underwent PES at baseline (226 males; mean age at diagnosis: 44.9±13.4 years). At diagnosis, 46 patients (20%) had previous VF, 100 patients (43%) had previous syncope, and 88 patients (37%) were asymptomatic. We evaluated the difference in the incidence of VF in each indication according to the new and FGs. During the follow-up period (mean: 6.9±5.2 years), the incidence of VF was higher in patients with Class IIa indication according to the NG (NG: 16/45 patients [35.6%] vs. FG: 16/104 patients [15.4%]), while the incidence of VF in patients with other than class I or IIa indication was similarly low in both guidelines (NG: 2/143 patients [1.4%] vs. FG: 2/84 patients [2.4%]). CONCLUSIONS: This study validated the usefulness of the NG for risk stratification of BrS patients.

DOI： 10.1253/circj.CJ-19-0910

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Protection from lethal ventricular arrhythmias leading to sudden cardiac death (SCD) is a crucial challenge after acute myocardial infarction (AMI). Cardiac sympathetic and parasympathetic activity can be noninvasively assessed using heart rate variability (HRV) and heart rate turbulence (HRT). The EMBODY trial was designed to determine whether the Sodium-glucose cotransporter 2 (SGLT2) inhibitor improves cardiac nerve activity. METHODS: This prospective, multicenter, randomized, double-blind, placebo-controlled trial included patients with AMI and type 2 diabetes mellitus (T2DM) in Japan; 105 patients were randomized (1:1) to receive once-daily 10-mg empagliflozin or placebo. The primary endpoints were changes in HRV, e.g., the standard deviation of all 5-min mean normal RR intervals (SDANN) and the low-frequency-to-high-frequency (LF/HF) ratio from baseline to 24 weeks. Secondary endpoints were changes in other sudden cardiac death (SCD) surrogate markers such as HRT. RESULTS: Overall, 96 patients were included (46, empagliflozin group; 50, placebo group). The changes in SDANN were + 11.6 and + 9.1 ms in the empagliflozin (P = 0.02) and placebo groups (P = 0.06), respectively. Change in LF/HF ratio was - 0.57 and - 0.17 in the empagliflozin (P = 0.01) and placebo groups (P = 0.43), respectively. Significant improvement was noted in HRT only in the empagliflozin group (P = 0.01). Whereas intergroup comparison on HRV and HRT showed no significant difference between the empagliflozin and placebo groups. Compared with the placebo group, the empagliflozin group showed significant decreases in body weight, systolic blood pressure, and uric acid. In the empagliflozin group, no adverse events were observed. CONCLUSIONS: This is the first randomized clinical data to evaluate the effect of empagliflozin on cardiac sympathetic and parasympathetic activity in patients with T2DM and AMI. Early SGLT2 inhibitor administration in AMI patients with T2DM might be effective in improving cardiac nerve activity without any adverse events. TRIAL REGISTRATION: The EMBODY trial was registered by the UMIN in November 2017 (ID: 000030158). UMIN000030158; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034442 .

DOI： 10.1186/s12933-020-01127-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are 2 separate entities that coexist in a significant proportion of patients. In patients with CTI ablation of AFL, the decision to hold anticoagulation often becomes an issue. OBJECTIVES: This study aimed to describe the incidence of the development of AF after CTI ablation in patients without a history of AF and to identify the risk predictors of the occurrence of AF. METHODS: The present study included 120 consecutive patients (106 men; mean age 68 ± 12 years) who underwent radiofrequency catheter ablation (RFCA) of typical AFL since 2010. Patients with a history of AF before RFCA were excluded. The P-wave and QRS morphology, characteristics, and duration were evaluated by 12-lead electrocardiography the day after ablation. RESULTS: During 3.6 ± 2.6 years of follow-up after RFCA, 49 patients (41%) developed new-onset AF. A univariate analysis revealed that the presence of fragmented QRS (fQRS) complexes (hazard ratio [HR], 4.63; 95% confidence interval [CI] 2.31-9.29; P < .001) and advanced interatrial block (IAB), defined as P-wave duration > 120 ms and biphasic morphology in the inferior leads (HR 4.44; 95% CI 2.45-8.01; P < .001), were predictors of new-onset AF. A multivariate analysis revealed that fQRS complexes (HR 3.35; 95% CI 1.58-7.10; P = .002) and advanced IAB (HR 2.64; 95% CI 1.38-5.07; P < .004) were independent predictors. CONCLUSION: The present study indicated that new-onset AF developed in a significant proportion of patients undergoing AFL ablation. The presence of fQRS complexes and advanced IAB were predictors of new-onset AF.

DOI： 10.1016/j.hrthm.2020.04.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There is increasing evidence that a proportion of patients with cardiac sarcoidosis (CS) have atrial arrhythmias (AA). Although 18F-fluorodeoxy-glucose (FDG) uptake in the ventricle on positron emission tomography/computed tomography (PET/CT) is well studied, FDG uptake in the atrium has not been elucidated in detail. OBJECTIVES: To evaluate FDG uptake in the atrium and its relationship with AA in patients with CS. METHODS: We retrospectively investigated 62 CS patients. All patients underwent echocardiography and PET/CT. Serum angiotensin converting enzyme (ACE) and soluble IL-2 receptor (sIL-2R) levels, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were also evaluated. ECG, Holter monitoring and device interrogations were used to detect AA. RESULTS: Of the studied population, 25 patients (40.3%) had AA, of which 2 patients had atrial tachycardia (AT) and 23 patients had atrial fibrillation (AF). Eighteen patients with AA had atrial FDG uptake on PET/CT, whereas 14 patients without AA had atrial FDG uptake (72.0% vs 37.8%, P = 0.017). Multivariate analysis revealed a significant association between AA and age (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.01-1.31, P = 0.040), atrial FDG uptake (odds ratio [OR]: 7.23; 95% confidence interval [CI]: 1.91-27.36, P = 0.004), and left atrial diameter (OR: 1.08; 95% CI: 1.01-1.16, P = 0.027). Meanwhile, gender, serum ACE and BNP levels, and left ventricular ejection fraction were not associated with AA. CONCLUSIONS: Atrial FDG uptake was common in patients with CS and strongly associated with AA.

DOI： 10.1016/j.ijcard.2020.04.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Signal-averaged electrocardiography (SAECG) has been known to be useful for prediction of lethal ventricular arrhythmias (VA). However, this technique has limitations in patients with intraventricular conduction disturbance (IVCD), which is common in cardiac sarcoidosis (CS). Meanwhile, wavelet-transformed ECG (WTECG) has been reported to be useful for detecting arrhythmogenic substrate hidden within QRS complex. The objective of this study was to assess the utility of WTECG for detecting arrhythmogenic substrate in patients with CS. Forty-four CS patients including 18 patients with VA were retrospectively investigated. The parameters on the signal-averaged electrocardiography (SAECG) and the power of frequency components on WTECG were compared between VA group and non-VA group. Eighteen patients have VA (VT: n = 17, VF: n = 1). LP were detected in 17 in VA group and 24 in non-VA group. WTECG showed that high-frequency components (HFC; 80-150 Hz) were developed in VA group. Peak power value at 150 Hz (P150) was significantly higher in VA group than that in non-VA group (442.9 ± 160.2 vs 316.7 ± 100.8, p = 0.006). The receiver operating characteristic (ROC) curve analysis showed an optimal cutoff point of 336 of P150 for detecting patients with VA, with 82.4% sensitivity, 61.5% specificity, and area under the curve of 0.74 (95% confidence interval [CI] 0.59-0.89). WTECG may be useful for detecting CS patients who are prone to VA.

DOI： 10.1007/s00380-020-01584-2

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Limited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF). METHODS: This was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated. RESULTS: During the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence. CONCLUSIONS: This multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS.

DOI： 10.1136/heartjnl-2019-315007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). METHODS: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. RESULTS: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95% confidence interval (CI): 1.16-5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95% CI: 1.16-4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. CONCLUSION: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.

DOI： 10.1016/j.jjcc.2019.07.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A highly conductive textile was woven from nano-fibers coated with the PEDOT-PSS polymer. The aim of this study was to assess the usefulness of textile electrodes for ECG recording as a smart garment. Electrode textile pads and lead wires were sewn to the lining of sportswear and their tolerability to repeated washings were tested up to 150 times. The electrical conductivity of the textile electrode remained functional for up to 50 machine washes. To assess the level of motion artifacts or noise during the daily monitoring of ECG, a single lead ECG with conventional or textile electrodes was recorded during supine rest, seated rest, upright trunk rotation (i.e., twisting), and stepping movement in 66 healthy adults. A Holter system was used for data storage and analysis. ECG patterns of P, QRS, and T waves were comparable between the conventional and textile electrodes. However, the signal-to-artifact-and/or-noise ratio (SAR) during twisting was larger in the textile electrodes than in the conventional electrodes. No skin irritation was seen in the textile electrodes. The single lead textile electrodes embedded in an inner garment were usable for continuous and/or repeated ECG monitoring in daily life except during vigorous trunk movement.

DOI： 10.1007/s00380-019-01347-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-19-0133

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A persistent left superior vena cava (PLSVC) is a congenital venous abnormality and is usually asymptomatic and does not cause hemodynamic disturbances. Therefore, it is difficult to identify it by routine examinations in clinical practice. This study aimed to elucidate the electrocardiographic characteristics for the prediction of a PLSVC. Twelve patients (9 males, 56.2 ± 18.3 years) who were diagnosed with a PLSVC were enrolled. The electrocardiographic parameters, including the P-wave duration, axis, and morphology of the P waves, were automatically measured and compared to 150 controls (77 males, 57.3 ± 14.6 years). There were no significant differences in the P-wave duration. Negative or positive/negative P waves in lead III predicted a PLSVC with a sensitivity of 100% and specificity of 81%. The P-wave axis in PLSVC exhibited a significant leftward deviation as compared to the controls (14.8 ± 21.1 vs. 54.0 ± 17.4°, p < 0.001). A receiver operating characteristic curve analysis of the P-wave axis for predicting a PLSVC exhibited an area under curve of 0.93 [CI 95% (0.87-0.98), p < 0.001), and identified a P-wave axis of less than 37.5° to have a 92% sensitivity and 83% specificity in predicting a PLSVC. A negative or positive/negative P-wave morphology in lead III was a useful finding for suggesting the presence of a PLSVC.

DOI： 10.1007/s00380-018-1278-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Landiolol, an ultra-short acting β1-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients. CONCLUSIONS: Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.

DOI： 10.1253/circj.CJ-18-1131

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An early repolarization electrocardiographic (ER-ECG) pattern is caused by various pathophysiological conditions and is reported to be a predictor of life-threatening ventricular tachyarrhythmias. However, little evidence has been reported on the prevalence and significance of the ER-ECG pattern in acute myocarditis. This study aimed to investigate the prevalence and significance of the ER-ECG pattern and its mechanistic insight based on the cardiac magnetic resonance findings in patients with acute myocarditis. METHODS: Thirty patients (23 men; 39.2±19.1 years) with a diagnosis of acute myocarditis by a clinical presentation between March 2011 and April 2018 were retrospectively evaluated. The patients were divided into 2 groups depending on the presence of an ER-ECG pattern on admission. RESULTS: Nine cases had an ER-ECG pattern, which was defined as terminal QRS notching or slurring with an amplitude of >0.1 mV in at least 2 inferior or lateral leads (early repolarization [ER] group), whereas the remaining 21 cases had broad ST-segment elevation or pathological Q waves (non-ER group). The cardiac troponin T level was significantly higher in the non-ER group than ER group (3.2±4.3 versus 0.9±1.2 ng/mL; P=0.036). The ECG changes returned to baseline along with the normalization of the cardiac biomarkers. Nine of the 21 non-ER group patients, but none of the 9 ER group patients, developed a fulminant course and lethal ventricular tachyarrhythmias. T2-weighted cardiac magnetic resonance showed high-intensity signals over the entire transmural left ventricle in the non-ER group, whereas they were localized to the left ventricular epicardium in the ER group. CONCLUSIONS: The ER-ECG pattern in acute myocarditis was transient and reversible and was not associated with a worse prognosis. Inflammation/swelling localized to the left ventricular epicardium because of acute myocarditis might provide a mechanistic insight into the ER-ECG pattern.

DOI： 10.1161/CIRCEP.118.006969

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jacep.2018.11.005

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early recurrence of atrial fibrillation (AF) is common following a successful electrical cardioversion (ECV). The purpose of this study was to investigate the hypothesis that AF recurrence is related to atrial electrical inhomogeneity, which may influence the P wave characteristics. METHODS: Two hundred ninety-one consecutive persistent AF patients who underwent ECV were enrolled, and evaluated for AF recurrences one month after the ECV. Patients with open-heart surgery, a history of catheter ablation, and an unsuccessful ECV were excluded. The P wave duration, dispersion and P wave morphology were evaluated by 12‑lead ECGs 30 min after the ECV. RESULTS: In total, 141 patients were investigated. One month after the ECV, 60 (43%) patients maintained sinus rhythm. The advanced interatrial block (aIAB; P wave duration >120 ms and biphasic P waves in the inferior leads) (Hazard ratio [HR], 4.51; 95% confidence interval [CI] 1.45-14.01, P = 0.009), P wave dispersion (HR, 1.06; 95%CI 1.02-1.09, P = 0.001), and duration of AF per month (HR, 1.03; 95%CI 1.01-1.04, P = 0.004) were independent predictors of AF recurrence. An aIAB was not associated with structural parameters such as the left atrial volume index or right atrial area. There were no differences in the serum BNP level and frequency of administering anti-arrhythmic drugs between the patients with and without recurrence. CONCLUSIONS: The risk of AF recurrence after the ECV can be predicted by the P wave characteristics. A longer P wave dispersion and the duration of AF also had a tendency for recurrence.

DOI： 10.1016/j.ijcard.2018.07.135

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Protection from lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important problems after myocardial infarction. Cardiac sympathetic hyperactivity is related to poor prognosis and fatal arrhythmias and can be non-invasively assessed with heart rate variability, heart rate turbulence, T-wave alternans, late potentials, and 123I-meta-iodobenzylguanide (123I-MIBG) scintigraphy. Sodium glucose cotransporter 2 (SGLT2) inhibitors potentially reduce sympathetic nervous system activity that is augmented in part due to the stimulatory effect of hyperglycemia. The EMBODY trial is designed to determine whether the suppression of cardiac sympathetic activity induced by the SGLT2 inhibitor is accompanied by protection against adverse cardiovascular outcomes. METHODS: The EMBODY trial is a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with acute MI and type 2 diabetes in Japan. A total of 98 patients will be randomized (1:1) to receive once-daily placebo or empagliflozin, an SGLT2 inhibitor, 10 mg. The primary end point is the change from baseline to 24 weeks in heart rate variability. Secondary end points include the change from baseline for other sudden cardiac death surrogate-markers such as heart rate turbulence, T-wave alternans, late potentials, and 123I-MIBG scintigraphy imaging. Adverse effects will be evaluated throughout the trial period. PLANNED OUTCOMES: The EMBODY trial will evaluate the potential cardioprotective effect of empagliflozin and will provide additional important new data regarding its preventative effects on sudden cardiac death. TRIAL REGISTRATION: Unique Trial Number, UMIN000030158 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000034442 ). FUNDING: Nippon Boehringer Ingelheim and Eli Lilly and Company.

DOI： 10.1007/s13300-018-0480-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier B.V.  

BACKGROUND: Early detection of cardiac involvement in sarcoidosis is difficult but essential to achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect subtle cardiac electrical abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement. OBJECTIVE: This study aims to investigate the prognostic significance of LP in patients with pulmonary sarcoidosis. METHODS: We prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic peptide levels were also evaluated. We followed these patients for the evaluation of incidence of cardiac events including cardiac death, arrhythmias, and heart failure requiring hospital admission. RESULTS: Of the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up period of 9.8 years, 8 patients with LPs had cardiovascular events, including development of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event (heart failure). Multivariate analyses revealed that LPs were associated with an increased risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20-78.01; P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring, and echocardiographic parameters were not associated with subsequent cardiac events. CONCLUSION: SAECG might possibly be useful for the early detection of cardiac sarcoidosis and, if independently validated, could eventually be considered as a screening test for further risk stratification.

DOI： 10.1016/j.hrthm.2018.03.013

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Atrial fibrillation (AF) itself creates structural and electrophysiological changes such as atrial enlargement, shortening of refractory period and decrease in conduction velocity, called "atrial remodeling", promoting its persistence. Although the remodeling process is considered to be reversible, it has not been elucidated in detail. The aim of this study was to assess the feasibility of P wave dispersion in the assessment of reverse atrial remodeling following catheter ablation of AF. Consecutive 126 patients (88 males, age 63.0 ± 10.4 years) who underwent catheter ablation for paroxysmal AF were investigated. P wave dispersion was calculated from the 12 lead ECG before, 1 day, 1 month, 3 months and 6 months after the procedure. Left atrial diameter (LAD), left atrial volume index (LAVI), left ventricular ejection fraction (LVEF), transmitral flow velocity waveform (E/A), and tissue Doppler (E/e') on echocardiography, plasma B-type natriuretic peptide (BNP) concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were also measured. Of all patients, 103 subjects remained free of AF for 1 year follow-up. In these patients, P wave dispersion was not changed 1 day and 1 month after the procedure. However, it was significantly decreased at 3 and 6 months (50.1 ± 14.8 to 45.4 ± 14.4 ms, p < 0.05, 45.2 ± 9.9 ms, p < 0.05, respectively). Plasma BNP concentrations, LAD and LAVI were decreased (81.1 ± 103.8 to 44.8 ± 38.3 pg/mL, p < 0.05, 38.2 ± 5.7 to 35.9 ± 5.6 mm, p < 0.05, 33.3 ± 14.2 to 29.3 ± 12.3 mL/m2, p < 0.05) at 6 months after the procedure. There were no significant changes in LVEF, E/A, E/e', serum creatinine, and eGFR during the follow up period. P wave dispersion was decreased at 3 and 6 months after catheter ablation in patients without recurrence of AF. P wave dispersion is useful for assessment of reverse remodeling after catheter ablation of AF.

DOI： 10.1007/s00380-017-1008-1

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

INTRODUCTION: The concept of a 3-month blanking period is widely accepted after the first radiofrequency catheter ablation (RFCA) session for atrial fibrillation (AF). We sought to investigate whether this phenomenon was also observed after a 2nd session, and which factors were related to it. METHODS AND RESULTS: We conducted a prospective observational study including all AF patients who underwent RFCA since 2010. The patients who underwent a second RFCA were followed without any antiarrhythmic drugs. Their clinical background, laboratory data, echocardiographic parameters, ablation procedures, and arrhythmia recurrences were analyzed. Recurrences were classified into early period recurrences (EPRs) and late period recurrences (LPRs) recorded within and after the first 3 months postablation, respectively. Among 925 patients who underwent an initial AF ablation, 2nd sessions were performed in 250 patients, and EPRs and LPRs occurred in 53 (21.2%) and 54 (21.6%) patients, respectively. Although EPRs were an independent predictor of LPRs (hazard ratio [HR], 8.01; 95% confidence interval [CI] 4.03-15.93, P < 0.001), 20 of the patients with EPRs (37.7%) did not experience LPRs, supporting the concept of a blanking period. Among 53 patients with EPRs, the E/E' ratio on echocardiography (HR, 1.156; 95% CI 1.00-1.33, P = 0.04) was an independent predictor of LPRs, while other parameters including the maximum serum C-reactive protein level after the session and the ablation procedure details were not. CONCLUSION: A 3-month blanking period was also applicable after the 2nd AF ablation session. This phenomenon was related to a lower left atrial pressure demonstrated by the E/E' ratio.

DOI： 10.1111/jce.13129

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Atrial fibrillation (AF) is one of the major risk factor for ischemic stroke, and oral anticoagulation is generally indicated for prevention of stroke. However, the utility of oral anticoagulation for AF in dialysis patients remains controversial. In this single-center, retrospective, observational study, data from 1120 patients on maintenance hemodialysis were analyzed. Baseline medical data were collected from dialysis records including age, gender, the cause of end-stage renal disease, dialysis vintage, and comorbidities. We evaluated outcomes including stroke, major hemorrhage, and death. A total of 106 (11.4 %) patients had AF. After exclusion criteria were applied, 84 patients had analyzable data. Warfarin was prescribed in 30 (35.7 %) of these patients. The remaining 54 patients were classified as the non-warfarin group. CHADS2 score was not significantly different between the warfarin and non-warfarin group. During the mean 47 months of follow up, 7 strokes occurred. However, warfarin use was not associated with the risk for stroke [hazard ratio (HR) 1.07; 95 % confidence interval (CI) 0.20-5.74]. Kaplan-Meier analysis showed no statistically significant difference in the overall survival, stroke-free survival or bleeding-free survival between the warfarin and non-warfarin group. AF is common in Japanese dialysis patients. Despite a certain prevalence of oral anticoagulation, the present study demonstrated neither beneficial nor detrimental effects. A large randomized controlled trial should be considered.

DOI： 10.1007/s00380-015-0777-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND Atrial tachycardia (AT) may develop after biatrial surgical ablation of atrial fibrillation. However, the mechanism has not been determined in detail.
OBJECTIVE We aimed to determine the mechanism and treatment of postoperative AT following biatrial surgical ablation in relation to the design and durability of the surgical lesion sets.
METHODS An electrophysiologic study and radiofrequency ablation were performed in 34 consecutive patients (23 male, mean age of 63 +/- 9.4 years) who were referred for AT that developed late after biatrial surgical ablation.
RESULTS The mechanism of a total of 53 ATs was macroreentry in 30, a focal mechanism in 20, and localized reentry in 1, and could not be determined in 2. The cause of the macroreentrant AT was residual conduction across a surgical lesion, most of which was located at the annular end of the mitral (n = 18) or tricuspid isthmus incision (n = 7), where cryoablation was applied during the surgery. We did not find any gaps across the cut-and-sew lesions. Radiofrequency (RF) applications to the gap, or an alternative site to transect the circuit, or the earliest activation site of the focus was effective for 48 ATs (91%). After a total of 1.3 +/- 0.6 RF sessions, 27 patients (79%) were free of AT (n = 2) or AF (n = 5) during a follow-up period of 50 49 months.
CONCLUSIONS Macroreentry due to a gap in a surgical lesion and focal AT were the major mechanisms of AT in patients after biatrial surgical ablation. Radiofrequency ablation of those ATs is feasible.

DOI： 10.1016/j.hrthm.2015.12.033

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated. METHODS: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were life-threatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups. RESULTS: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84±3 vs. 82±2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P<0.001) and lower left ventricular ejection fraction (45%±15% vs. 68%±10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO2 narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38). CONCLUSION: Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis.

DOI： 10.1272/jnms.83.62

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

A 46-year-old man was admitted to our hospital for near syncope and palpitations. An electrocardiogram showed a common type of atrial flutter (AFL) with 1:1 atrioventricular conduction. Transthoracic echocardiography revealed a massive right atrial (RA) thrombus with a huge RA and right ventricle. The patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy. It was difficult to control the heart rate with beta-blockers during AFL, which resulted in the deterioration of right-sided heart failure. The effect of anticoagulation therapy for the RA thrombus was also limited. Restoration to sinus rhythm by catheter ablation effectively improved the right-sided heart failure, and the massive RA thrombus eventually disappeared.

DOI： 10.2169/internalmedicine.55.5520

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Few reports are available on the characteristics of electrical storms of ventricular tachycardia (VT storm) refractory to intravenous (IV) amiodarone.
Methods and Results: IV-amiodarone was administered to 60 patients with ventricular tachyarrhythmia between 2007 and 2012. VT storms, defined as 3 or more episodes of VT within 24 h, occurred in 30 patients (68 +/- 12 years, 7 female), with 12 having ischemic and 18 non-ischemic heart disease. We compared the clinical and electrocardiographic characteristics of the patients with VT storms suppressed by IV-amiodarone (Effective group) to those of patients not affected by the treatment (Refractory group). IV-amiodarone could not control recurrence of VT in 9 patients (30%). The Refractory group comprised 5 patients with acute myocardial infarctions. Although there was no difference in the VT cycle length, the QRS duration of both the VT and premature ventricular contractions (PVCs) followed by VT was narrower in the Refractory group than in the Effective group (140 +/- 30 vs. 178 +/- 25 ms, P&lt;0.01; 121 +/- 14 vs. 179 +/- 22 ms, P&lt;0.01). In the Refractory group, additional administration of IV-mexiletine and/or Purkinje potential-guided catheter ablation was effective.
Conclusions: IV-amiodarone-refractory VT exhibited a relatively narrow QRS tachycardia. The narrow triggering PVCs, suggesting a Purkinje fiber origin, may be treated by additional IV-mexiletine and endocardial catheter ablation.

DOI： 10.1253/circj.CJ-15-0213

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R-V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH.
Patients and Methods: The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) &gt;35 mmHg, were compared to those in 30 age- and gender-matched normal subjects.
Results: The R wave amplitude and R/S ratio in the Syn-ECGs were significantly (P&lt;0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513-0.596, P&lt;0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P&lt;0.001) and R/S ratio (AUC 0.823, P&lt;0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R&gt;0.12 mV, and 2) R/S ratio in V5R&gt;0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10-0.43, specificity 0.90-1.00).
Conclusion: The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH.

DOI： 10.1272/jnms.82.136

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス/肉芽腫性疾患学会  

背景:心臓サルコイドーシスは、診断がつき次第ステロイド治療 の適応となる。ステロイド投与後にしばしば糖尿病を発症する(ス テロイド糖尿病)が、その頻度やリスク因子については検討され ていない。 目的:心臓サルコイドーシス患者におけるステロイド導入後に糖 尿病を発症する頻度・およびリスク因子について検討。 方法:1996 年から 2015 年の間に日本医科大学付属病院・付属千 葉北総病院でステロイドを導入した心臓サルコイドーシス患者 51 例。ステロイドは初期投与 Prednisolone 30mg / 日、1 か月間 施行し以降漸減し維持量(5-10mg)とした。導入前に糖尿病と診 断されていた 5 例を除外し 46 例(男性 13 例、平均年齢 58+/­14 歳)で後ろ向きに検討。 結果:18 例(39.1%)でステロイド導入後に糖尿病を発症した。 多変量解析の結果、年齢のみが独立した糖尿病発症の危険因子(オ ッズ比 1.08、95%信頼区間 1.01-1.16、p=0.03)でああった。 結論:心臓サルコイドーシスに対するステロイド導入後に糖尿病 を発症する頻度は高く、特に高齢者では注意が必要である。

DOI： 10.7878/jjsogd.35.Suppl1_58-2

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

Atrial tachyarrhythmias (AT) commonly recur within the first 3 months after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), and the influence of antiarrhythmic drugs (AADs) on the recurrences has not been fully elucidated. We sought to evaluate the efficacy of a 3-month lower-dose flecainide regime on early and late recurrences of ATs.
We randomly assigned 126 patients, who underwent RFCA for AF, to the flecainide group (150 or 100 mg/day according to their body weight) or to the control group receiving no AADs. The primary endpoint was any AT lasting for a parts per thousand yen30 s during the first 3 months and the secondary endpoint was a composite of ATs lasting for a parts per thousand yen24 h or requiring cardioversion or hospitalization during the same period. All AADs were stopped after the first 3 months and the late arrhythmia recurrences were also evaluated. The primary endpoint rates were 37 and 41% in the flecainide (143 +/- 19 mg/day) and control groups, respectively (log-rank P = 0.76), and those of the secondary endpoint were 10 and 14%, respectively (log-rank P = 0.45). The estimated rates of maintaining sinus rhythm at 12 months after the first 3 months were 78 and 72%, in the flecainide and control groups, respectively (log-rank P = 0.68), and the rates were 51 and 90% in those with and without the primary endpoint, respectively (log-rank P &lt; 0.001).
The 3-month lower-dose flecainide therapy after AF ablation did not reduce the early and late arrhythmia recurrences. The clinically significant ATs were also not prevented.

DOI： 10.1093/europace/euu041

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: The periesophageal vagus nerve plexus controls the kinetics of the stomach, digestive tract, and gallbladder, and catheter ablation of atrial fibrillation (AF) can cause vagus nerve injury (VNI). We sought to clarify the incidence, clinical course, and anatomical factors related to periesophageal VNI.
Methods: The present study included 257 consecutive patients with AF (mean age, 62 11 years) who underwent catheter-based pulmonary vein isolation. With 64-slice computed tomographic images, the left atrium (LA)-esophageal contact length, LA diameter, and distances between each mediastinal structure were compared between patients with VNI and those without VNI.
Results: VNI occurred in 5 patients (1.9%), gastric hypomotility in 3 patients, and acalculous cholecystitis in 2 patients, within 3 days after ablation, and all patients recovered completely within 2 weeks. Compared with patients without VNI, those with VNI more frequently underwent ablation at the mitral isthmus (p=0.03) and inside the coronary sinus (p=0.03). On computed tomographic images, the esophagus was closer to the aorta than to the spine in 67% of patients and was defined as an aorta-sided esophagus. In patients with VNI, the distance from the LA to the spine or the descending aorta (in patients with an aorta-sided esophagus) was shorter (p=0.03), and the transverse LA-esophageal contact length was longer (p=0.01).
Conclusion: Acalculous cholecystitis, as well as gastric hypomotility, can develop as a result of periesophageal VNI in patients undergoing AF ablation. The anatomical relationships among the LA, esophagus, spine, and descending aorta may influence the occurrence of VNI.

DOI： 10.1272/jnms.81.248

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Purpose Catheter ablation of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is still challenging, and it is unclear whether the difficulty is caused by the hypertrophy of left atrial (LA) myocardial wall thickness. The objective of the study was to compare the LA wall thickness and AF ablation outcomes between patients with HCM and those without structural heart disease.
Methods The present study enrolled 17 consecutive HCM patients (63+/-12 years) with drug-refractory AF and 34 control patients without any detectable heart disease, whose age, gender, type of AF, and LA dimension were matched to the HCM patients. The myocardial wall thickness of 11 distinct LA locations, measured using 64-slice computed tomography images, and AF ablation outcomes were compared between the two groups.
Results The LA wall thickness did not differ at 9 of the 11 locations and was significantly thinner in the HCM patients than in the control patients at the mid-posterior wall (1.44+/-0.17 vs. 1.58+/-0.22, p=0.04) and infero-posterior wall (1.62+/-0.16 vs. 1.74+/-0.18, p=0.03). Although antiarrhythmic drugs were used more frequently in the HCM patients (p=0.008), the rate of maintaining sinus rhythm during the follow-up did not differ between the HCM and control patients (53 vs. 56 % after the initial ablation [log-rank p=0.78] and 82 and 88 % after the repeat procedure [log-rank p=0.35]).
Conclusions The LA wall in the HCM patients with AF was not thicker than that of the matched patients without structural heart disease. Catheter ablation of AF showed favorable outcomes in both patient groups.

DOI： 10.1007/s10840-014-9894-y

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記述言語：英語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Background Measuring postpacing intervals (PPIs) is the standard maneuver for localizing reentrant tachycardia circuits. However, changes or termination of the tachycardia during entrainment pacing, or difficulties in defining the correct local activity, limit the use of PPIs.
Methods and Results We hypothesized that the number of pacing stimuli needed to entrain (NNE) was useful for mapping intra-atrial reentrant tachycardias. First, 10 patients with typical atrial flutter were studied to characterize the NNE. Next, 317 entrainment attempts in 30 patients with 76 intra-atrial reentrant tachycardias were analyzed to determine the efficacy of the NNE. The NNE was small at sites within the reentrant circuit (median 2) and large at remote sites during typical atrial flutter. The NNE depended on the pacing cycle length and coupling interval of the initial paced beat, where the NNE became smaller at shorter pacing cycle lengths and coupling intervals. The NNE highly correlated with the difference between the PPI and tachycardia cycle length (r = 0.906; P&lt;0.001). When the pacing cycle length and coupling interval were 16 to 30 ms below the tachycardia cycle length, a NNE 2 and &gt;3 predicted a PPI-tachycardia cycle length 20 and &gt;20 ms, respectively, with 100% accuracy. Thirty-six (11%) entrainment attempts changed or terminated intra-atrial reentrant tachycardia. Importantly, the NNE remained valid in those cases. Furthermore, the NNE provided additional information in cases with some difficulties with PPI measurements.
Conclusions The NNE is a simple and reliable criterion, which facilitates mapping intra-atrial reentrant tachycardia.
Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT001747.

DOI： 10.1161/CIRCEP.113.001416

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記述言語：英語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Circadian variations in the QT interval (QT) and QT dispersion are decreased in patients with type 2 diabetes because of cardioneuropathy. Insulin resistance has been recently identified as an independent determinant of QT prolongation in normoglycemic women. However, the relationship between QT prolongation and the degree of insulin resistance as well as circadian variation remains unclear in diabetic patients. This study was designed to assess the relationship between insulin resistance and the circadian variation in QT measurements in patients with type 2 diabetes. In 14 patients with diabetes, QT, corrected QT (QTc), QT dispersion, QTc dispersion, and RR interval (RR) were analyzed using 12-lead Holter monitoring and commercial software. The degree of diurnal variation in each measurement was defined as the amplitude between the maximum and mean values on curves fitted using the mean cosinor method (A_QT, A_QTc, A_QT dispersion, A_QTc dispersion, and A_RR). The cosine curve was fitted to all measured values in each QT measurement and RR for 24 h. Insulin resistance (glucose infusion rate (GIR)) was measured using the euglycemic hyperinsulinemic glucose clamp method. The maximum QT, QTc, QT dispersion, and QTc dispersion were &gt; 450 ms. GIR was significantly correlated with A_QT only (r = 0.59, P &lt; 0.05). GIR was not correlated with other variables, and was dependent only on the circadian variation in QT.

DOI： 10.1007/s00380-013-0356-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/europace/eut207

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background: Atrioventricular (AV) block is one of the main clinical manifestations in patients with cardiac sarcoidosis (CS). Although steroid therapy is considered to be effective for AV block, the efficacy has not been demonstrated in detail.
Methods and results: Fifteen CS patients presenting with advanced or complete AV block were retrospectively investigated. All patients were treated with 30 mg/day of prednisone after device implantation, which was tapered to a maintenance dosage of 5-10 mg/day. During a mean follow-up of 7.1 years, AV block resolved to normal conduction or first-degree AV block in 7 patients (recovery group). The improvement was driven within the first week of steroid therapy in 4 patients, while 3 patients showed late recovery of AV conduction. The remaining 8 patients were classified as the non-recovery group. The recovery group showed a higher left ventricular ejection fraction (69.4 8.9% versus 44.1 19.3%, p = 0.029) and higher prevalence of advanced AV block (87.5% versus 28.6%, p = 0.040) compared with those of the non-recovery group. In patients with the recovery group, there was no late recurrence of AV block during the follow-up period.
Conclusions: Early initiation of steroid therapy may be effective for AV block, and steroid therapy before device implantation is a possible therapeutic strategy for some selected patients. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2013.07.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background: Atrial fibrillation (AF) is highly prevalent in patients with ischemic stroke, but the diagnosis is often difficult.
Methods: This study consisted of 68 stroke patients in sinus rhythm without history of AF. All patients underwent P-wave signal-averaged electrocardiography (P-SAECG), echocardiography, 24-h Holter monitoring, and measurement of plasma B-type natriuretic peptide (BNP) concentrations at admission.
Results: An abnormal P-SAECG was found in 34 of 68 stroke patients. In the follow-up period of 11 +/- 4 months, AF developed in 17 patients (AF group). The remaining 51 patients were classified as the non-AF group. The prevalence of atrial late potentials (ALP) on P-SAECG, and the number of premature atrial contractions (PACs) were significantly higher in the AF group than those in the non-AF group (88.2% vs 37.3%; p &lt; 0.001, 149 +/- 120 vs 79 +/- 69; p = 0.030, respectively). However, there were no significant differences in age, left atrial dimension, or BNP concentrations between both groups. Cox proportional hazards analysis revealed that the presence of ALP (risk ratio 11.15; p = 0.002) and frequent PACs (more than 100/24 h) (risk ratio 4.53; p = 0.007) had significant correlation to the occurrence of AF.
Conclusions: ALP may be a novel predictor of AF in stroke patients. P-SAECG should be considered in stroke of undetermined etiology. (c) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2012.08.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The heart failure guideline in Japan has stated the necessity of investigating the role of oral inotropic agents in patients with chronic heart failure (CHF), which are clinically available only in Japan. A total of 1,846 consecutive patients with heart failure (mean: 69.5 years old, 1,279 males) treated at our institute from November 2009 to August 2010 were investigated retrospectively. Thirty-one patients (1.84%) who had taken oral inotropic agents (pimobendan 27, docarpamine 6, and denopamine 4) were extracted for this study, and the efficacy and limitations of the treatments were analyzed. Following the oral inotropic treatment, the NYHA functional class (P = 0.017), cardiothoracic ratio (P = 0.002) and B-type natriuretic peptide levels (P = 0.011) were significantly improved, and the number of emergency room (ER) visits (P &lt
0.001) and hospitalizations (P &lt
0.001) were significantly reduced. The nonsurviving patients (n = 7/31, 22.6%) were significantly older (P = 0.02) and tended to have a larger cardiothoracic ratio (P = 0.084) compared with the survivors. An absence of concomitant beta-blocker therapy was significantly associated with a worse prognosis (oneyear mortality 2/21 versus 5/10, log rank, P = 0.011). Oral inotropic agents brought about improvements in the clinical parameters of CHF and a reduction in ER visits and hospitalizations. However, concomitant beta-blocker therapy should be considered for patients receiving oral inotropic treatment.

DOI： 10.1536/ihj.54.75

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

A 56-year-old man was admitted because of palpitations and dyspnea. A 12-lead electrocardiogram showed irregular wide QRS complex tachycardia with a slur at the initial portion of the QRS complex. He had preexisting long-standing persistent atrial fibrillation, but early excitation syndrome had never been noted. Chest X-ray showed heart enlargement and pulmonary congestion. He was diagnosed with late onset of Wolff-Parkinson-White syndrome, and congestive heart failure was probably caused by rapid ventricular response of atrial fibrillation through the accessory pathway. Emergency catheter ablation for the accessory pathway was undertaken, and heart failure was dramatically improved.

DOI： 10.2169/internalmedicine.51.6044

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT HEART JOURNAL ASSOC  

Ventricular tachycardia (VT) and ventricular fibrillation (VF) leading to sudden cardiac death remains responsible for significant mortality in patients with prior myocardial infarction (MI). The study population consisted of 50 normal controls and 50 patients with prior MI. The MI subjects were divided into 3 groups: VT/VF (-) group; 25 patients without ventricular tachyarrhythmia, VT group; 13 patients with sustained VT, and VF group; 12 patients with resuscitated VF. The parameters on the signal-averaged ECG and the frequency components recorded from the wavelet-transformed ECG were compared. The high-frequency components (HFC; 80-150 Hz) were developed in the MI group to a greater extent than those in the control group. Among the MI patients, the RFC were more developed in the VT and VF groups than in the VT/VF (-) group. In the VF group, the positive rate of LP was 50%. Meanwhile, when the peak power value at 150 Hz &gt; 300 was defined as abnormal, the HFC was detected in 13 (100%) patients in the VT group and 12 (91.7%) in the VF group. The sensitivity of the abnormal HFC in identifying patients with VT/VF was higher than that of SAECG (96% versus 72%), although the specificity remained similar (68.5% versus 64.3%). Abnormal HFC recorded from the wavelet-transformed ECG may be a novel factor in detecting patients who are prone to VT/VF. (Int Heart J 2011; 52: 286-289)

DOI： 10.1536/ihj.52.286

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Background: Right ventricular outflow tract ventricular tachycardia (RVOT-VT), arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/ARVD), and Brugada syndrome (BrS) were characterized by arrhythmias originating in the right ventricle, and the pathophysiologic mechanism underlying these arrhythmias has not been fully understood.
Methods: This study consisted of 40 subjects, including 20 patients with RVOT-VT, 10 patients with BrS, and 10 ARVD patients. The parameters on the signal-averaged electrocardiography (ECG) and the frequency components recorded from the wavelet-transformed ECG were compared between the three groups. Late potentials were positive in none of the patients with RVOT-VT, seven of the patients with BrS, and all of ARVD patients.
Results: In Brugada and ARVD patients, the power of high-frequency components (80-150 Hz) was developed to a greater extent than in RVOT-VT patients. In the power analysis of the high-frequency components between BrS and ARVD, the frequency showing the greatest power was significantly higher in ARVD patients than that in BrS patients (145.4 +/- 27.9 Hz vs 81.7 +/- 19.9 Hz, P &lt; 0.01).
Conclusions: High-frequency components were developed in ARVD and BrS, but not in RVOT-VT. The frequency levels showing high power by wavelet analysis obviously differ between ARVD and BrS. Wavelet analysis may provide new insight into unsolved mechanisms in arrhythmogenic right heart disease.

DOI： 10.1111/j.1542-474X.2011.00441.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Methods: Thirty-one CS patients presenting premature ventricular contractions (PVCs, &gt;= 300/day) were investigated. Fourteen patients had nonsustained ventricular tachycardia (NSVT). All of patients were treated with corticosteroid, and the initial dosage is 30 mg/day of prednisone, which was tapered over a period of 6 months to a maintenance dosage of 10 mg/day. Twenty-four hour Holter monitoring, signal averaged electrocardiography (SAECG), echocardiography, gallium-67 scintigraphy, serum angiotensin converting enzyme (ACE) and plasma B-type natriuretic peptide (BNP) concentrations were assessed before and after corticosteroid therapy.
Results: As a whole, there were no significant differences in the number of PVCs and in the prevalence of NSVT before and after steroid therapy. However, the less advanced LV dysfunction patients (EF &gt;= 35%, n = 17) showed significant reduction in the number of PVCs (from 1820 +/- 2969 to 742 +/- 1425, P = 0.048) and in the prevalence of NSVT (from 41 to 6%, p = 0.039). Late potentials on SAECG were abolished in 3 patients. The less advanced LV dysfunction group showed a significantly higher prevalence of gallium-67 uptake compared with the advanced LV dysfunction group (EF &lt; 35 %, n = 14). In the advanced LV dysfunction patients, there were no significant differences in these parameters.
Conclusions: Corticosteroid therapy may be effective for ventricular arrhythmias in the early stage, but less effective in the late stage.
Ann Noninvasive Electrocardiol 2011;16(2):140-147.

DOI： 10.1111/j.1542-474X.2011.00418.x

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記述言語：英語   出版者・発行元：Japanese Heart Rhythm Society  

Background: Paroxysmal atrial fibrillation (AF) is highly prevalent in patients with ischemic stroke, but the diagnosis is often difficult. Methods: This study consisted of 61 stroke patients in sinus rhythm without a history of paroxysmal AF. All patients underwent P-wave signal-averaged electrocardiography (P-SAECG), echocardiography, 24-hour Holter monitoring, and measurement of plasma B-type natriuretic peptide (BNP) concentrations at admission. Results: An abnormal P-SAECG was found in 33 of 61 stroke patients. In the follow-up period of 11±3 months, paroxysmal AF developed in 19 patients (AF group). The remaining 42 patients were divided into non-AF group. An abnormal P-SAECG and frequent premature atrial contractions (PACs, 100 or more/24 hour) were detected more frequently in patients with AF group than non-AF group (89.5% vs 35.7%; p<0.001, 84.2% vs 26.2%; p<0.001, respectively). However, there were no significant differences in age, left atrial dimension, BNP concentrations between both groups. Cox proportional hazards analysis revealed that an abnormal P-SAECG (hazard ratio 21.3; p=0.003) and frequent PACs (hazard ratio 4.6; p=0.046) had significant correlation to the development of paroxysmal AF. Conclusions: An abnormal P-SAECG and frequent PACs may be novel predictors of paroxysmal AF in stroke patients. P-SAECG should be considered in stroke of undetermined etiology.

DOI： 10.4020/jhrs.27.PE4_066

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.42.509

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

The use of automated external defibrillators (AEDs) has increased the number of survivors of out-of-hospital cardiac arrest. The AED has a high specificity and moderately high sensitivity in detecting rhythms appropriately treated by defibrillation. However, a few shockable rhythms are misdiagnosed by the AED. Two cases of inappropriate analyses by AEDs in patients with in-hospital ventricular fibrillation are presented. In the first case, the AED failed to recognize ventricular fibrillation because of the presence of pacemaker spikes. In the second case, the fine ventricular fibrillation and the presence of artifacts were suspected as the causes of inappropriate analysis by the AED. Both patients were resuscitated by advanced cardiovascular life support with a manual defibrillator. Trained healthcare providers should be aware of the limitations of AED in specific situations.

DOI： 10.1253/circj.72.679

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The clinical and electrophysiological characteristic of ventricular premature contractions (VPCs) which trigger the incessant form of polymorphic ventricular tachycardia (VT), so-called “electrical storm” associated with ischemic heart disease, remains unclarified. The aim of this study was to evaluate those matters and the possible role of the Purkinje network in the emergence of an electrical storm. Methods and results: We experienced 5 patients (68 ±5 years, mean LVEF: 29%) with electrical storms which occurred during the acute phase of an infarction in 3 patients and the remote phase in 2. The triggering VPCs were multifocal in 3 patients and monofocal in the remaining 2. Radiofrequency (RF) catheter ablation was performed for a goal of eliminating the triggering VPCs. A total of 9 different kinds of VPCs differentiated by their morphology were successfully eliminated by the RF deliveries targeting the VPCs— foci. At the successful ablation sites, Purkinje potentials preceded the QRS onset of the VPC by 67 ±23 ms, suggesting the VPCs originated in the surviving Purkinje fibers. Moreover, the extensive RF deliveries applied at the surviving Purkinje network rendered the polymorphic VT unable to be induced by programmed stimulation which reproducibly induced it before the ablation in 2 patients. Conclusion: A surviving Purkinje network might contribute not only to the initiation of the repetitive form of lethal ventricular arrhythmias, but also to the perpetuation of the arrhythmias in patients with ischemic heart disease. © 2008, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.24.200

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

It has been reported that green tea consumption reduces the risk of coronary artery disease and cardiac events. Catechin is a major constituent of Japanese green tea and an antioxidant. Lipids and oxidization of low-density lipoprotein cholesterol (LDL-C) play important roles in atherosclerosis. Therefore, we evaluated the effect of catechin intake on the lipid profile and plasma oxidized LDL. The study population consisted of 40 healthy adult volunteers (10 men, 30 women). Catechin was extracted from green tea leaves. The subjects were randomly divided into two groups, a catechin group (n = 29) and a control group (n = 11). In the catechin group, catechin (500 mg: equivalent to 6 or 7 cups of green tea) was administered orally. Venous blood samples were obtained before eating a meal at the start and after 4 weeks without any lifestyle modification. Plasma oxidized LDL assay was performed with a sandwich-type enzyme immunoassay using anti-oxidized phosphatidylcholine monoclonal antibody. The baseline lipid profiles and tea consumptions were similar between the two groups. Plasma oxidized LDL was significantly decreased after catechin administration (from 9.56 +/- 9.2 to 7.76 +/- 7.7 U/mL, P = 0.005), while plasma LDL-C, triglyceride, and HDL-C concentrations did not change. Catechin decreased the plasma oxidized LDL concentration without significant change in plasma LDL concentration. The mechanism of the beneficial effects of green tea on coronary artery disease might result from a decrease in plasma oxidized LDL.

DOI： 10.1536/ihj.48.725

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Background: Nifekalant is a class III antiarrhythmic drug, which is usually used for suppression of ventricular tachycardia (VT) and fibrillation. We studied the efficacy of nifekalant for acute conversion of atrial flutter (AFL) in a prospective, open label study in the intensive care unit (ICU) of cardiovascular medicine.
Methods: This study consisted of 31 patients. Twenty-six patients (84%) suffered from structural heart diseases. AFL was developed in 15 patients (48%) while on antiarrhythmic therapy with class IA or IC drugs (I-AFL group) for suppressing atrial fibrillation (AF) and in the remaining patients without such drugs (S-AFL group). Patients with prolonged QT interval, hypokalemia were excluded. All patients received one dose of 0.3 mg/kg of nifekalant over 10 minutes under continuous ambulatory monitoring. Four patients with common AFL in each group received nifekalant during electrophysiologic (EP) study.
Results: Nifekalant had an overall AFL conversion efficacy of 77.4% within 60 minutes. Eleven patients in S-AFL group (68.8%) and 13 patients in I-AFL group (86.7%) could be converted with mean conversion times of 10.8 +/- 6.2 and 15.0 +/- 8.0 minutes, respectively (n.s.). Conversion rate was significantly higher in patients with a short duration of arrhythmia. The two modes of AFL termination were mainly demonstrated and the preferential mode significantly differed between the two groups. One patient in each group with excessive QT prolongation (6.5%) developed torsade de pointes (TdP), requiring electrical shock in one patient (3.3%).
Conclusions: Nifekalant can be used for conversion of AFL with a potent efficacy even in patients with structural heart diseases. However, caution should be required for developing TdP.

DOI： 10.1111/j.1540-8159.2007.00846.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOCIETY  

Background The therapeutic strategy for non-sustained ventricular tachycardia (NSVT), considered as a risk-stratifier for sudden cardiac death (SCD), still remains undetermined.
Methods and Results In the present study 222 of 4,079 patients (5.4%) hospitalized with NSVT during 2002 to 2004 were prospectively evaluated using an algorithm for risk-stratification according to each type of structural heart disease. The algorithm comprises the left ventricular ejection fraction, signal-averaged electrocardiography, programmed ventricular stimulation and the family history of SCD. Of the 222 patients, 151 (68.0%) were successfully risk-stratified and 32 patients consequently received an implantable cardioverter defibrillator (ICD) (21.2%; algorithm-ICD group). The remaining 119 patients without an ICD (algorithm-observation group) were observed. During 27.7 +/- 11.4 months of follow-up, the patients in the algorithm-ICD group had a significantly higher prevalence of tachyarrhythmic events than did those in the algorithm-observation group (9/32 vs 1/119; p &lt; 0.05). In the algorithm-ICD group, 2, 1 and 6 patients experienced an SCD, aborted SCD and appropriate ICD intervention, respectively, while there was only 1 SCD in the algorithm-observation group.
Conclusions The proposed algorithm for risk-stratification of patients with NSVT may be feasible for appropriate selection of high-risk patients and candidates for prophylactic ICD implantation.

DOI： 10.1253/circj.71.1107

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOCIETY  

Background Electrocardiographic conduction abnormalities including development of atrioventricular block, bundle branch block or ventricular arrhythmias are characteristic manifestations of cardiac sarcoidosis (CS). The present study seeks to show the minute conduction abnormality by detection of late potentials (LP) on signal averaged electrocardiogram (SAECG).
Methods and Results Ten patients with CS, 52 patients with pulmonary sarcoidosis (PS) but no obvious cardiac manifestations and 52 normal controls were studied. All participants underwent SAECG to detect LP. In patients with CS (the CS group), LP were detected in 8 patients (80%). In 52 patients with PS, LP were detected in 25 patients (46:2%, PS-LP(+) group), comparing only 3 (5.8%) of normal controls (p &lt; 0.0001). The remaining 27 patients with PS with negative LP were classified in the PS-LP(-) group. In the CS group, premature ventricular contraction frequency on Holter's monitoring and plasma B-type natriuretic peptide concentrations were significantly higher than those in the PS group. However, no significant difference in these parameters between PS-LP(+) and PS-LP(-) groups were found.
Conclusions In the PS patients without obvious cardiac manifestations, LP were detected as high as 46.2%, suggesting latent minute conduction abnormality. The higher incidence of LP in PS might be considered as an expression of latent myocardial fibrosis. Close follow-up is needed in these patients.

DOI： 10.1253/circj.71.540

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Infective endocarditis, a serious infection most commonly affecting rheumatic or prosthetic valves, generally occurs after bacteremia. Atopic dermatitis, a very common disease, carries a high prevalence of skin infections, particularly with Staphylococcus aureus. While cutaneous colonization by S. aureus represents an important source of bacteremia, few cases of infective endocarditis arising from the skin lesions of atopic dermatitis have been reported. We describe a patient with recurrent S. aureus prosthetic valve endocarditis developing in this manner.

DOI： 10.2169/internalmedicine.46.6207

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND A reliable alternative method for detecting Brugada syndrome is desirable because the diagnosis of Brugada syndrome using 12-lead ECG is not optimal.
OBJECTIVES The purpose of this study was to assess the usefulness of the wavelet-transformed ECG in detecting Brugada syndrome.
METHODS The study consisted of 15 patients with Brugada syndrome and 15 healthy subjects (control group). The parameters on the signal-averaged ECG and the frequency components recorded from the wavelet-transformed ECG were compared between the two groups. Measurements were repeated after pilsicainide infusion in the two groups of patients, after an isoproterenol infusion following pilsicainide injection, and after administration of citostazol in the group of patients with Brugada syndrome.
RESULTS The positive rate of late potentials was 80% in the Brugada syndrome group and 0% in the control group (P &lt;.01). The high-frequency components (80-150 Hz) were developed in the Brugada syndrome group to a greater extent than in the control group, but the Low-frequency components (10-50 Hz) did not differ (mean peak power at 80 Hz; 713 +/- 36 vs 488 +/- 60, P &lt;.001). After pilsicainide injection, high-frequency components significantly increased in both groups. However, after isoproterenol and cilostazol administration, high-frequency components significantly decreased but remained higher than in the control group (80 Hz; 655 +/- 40 vs 488 +/- 60, P &lt;.001). The sensitivity of the development of high-frequency components in detecting Brugada syndrome was higher than that of signal-averaged ECG (100% vs 80%), but specificity remained high and similar (100% for both methods).
CONCLUSION Abnormally high-frequency components recorded from the wavelet-transformed ECG might be a novel factor in detecting Brugada syndrome.

DOI： 10.1016/j.hrthm.2006.08.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOCIETY  

Background Hypertrophic cardiomyopathy (HCM) is thought to have a microvolt-level electrical disarrangement in the myocardium that leads to ventricular tachyarrhythmias and sudden cardiac death. Although signal-averaged electrocardiography (ECG) has been used to detect late potential as a parameter of electrical instability, its predictability is not high. The focus of the present study was the ability of high-resolution wavelet transform from beat-to-beat analysis to detect arrhythmogenic substrates and to evaluate its relationship to the severity of ventricular tachycardia.
Methods and Results The study group comprised 50 healthy subjects and 50 patients with HCM. The filtered-QRS duration from the signal-averaged ECG, the high-power duration (HPD) and number of disarrangement points (NDP) from the wavelet-transform ECG were measured. When HPD was defined &gt;114 ms and/or NDP &gt;9 points as abnormal, the sensitivity and specificity for ventricular tachycardia was 93.8% and 79.4%, respectively. When a meant standard deviation of the HPD in normal subjects was defined as normal, 93.8% of patients with a positive late potential were out of the normal range.
Conclusions The newly developed color-display 3-dimensional wavelet transform system showed good time-frequency resolution in analyzing every single beat without signal-averaging. The analysis could be used to detect arrhythmogenic substrates inpatients with HCM.

DOI： 10.1253/circj.70.69

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Percutaneous aortic valvuloplasty is reportedly a useful tool for the management of critical and severe aortic stenosis with cardiogenic shock 1. However, early percutaneous coronary intervention for cardiogenic shock is beneficial for elderly patients with acute myocardial infarction 2,3. We describe a patient with critical aortic stenosis who presented with severe coronary stenosis of the left main trunk and the ostium of the right coronary artery. We performed percutaneous coronary intervention and percutaneous aortic valvuloplasty under intra-aortic balloon pump and percutaneous cardiopulmonary support. After these procedures, the cardiogenic shock was reversed, and the patient could be weaned from both intra-aortic balloon pump support and percutaneous cardiopulmonary support.

DOI： 10.1272/jnms.73.158

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

The differential diagnosis of wide QRS Premature contractions is often inaccurate in most ECG machines with automatic computer-assisted diagnosis. The purpose of the present study was to improve the accuracy of the automated differential diagnosis between premature ventricular contractions (PVC) and supraventricular contractions with aberrant conduction (A-PSC). The study investigated 180 consecutive electrocardiograms (ECGs) with wide QRS premature contractions picked up from 3,723 in the ECG database. A new algorithm, Detection of Wide QRS Complex --&gt; Second Derivative --&gt; Absolute Value --&gt; Smoothing --&gt; T Wave Subtraction --&gt; F Detection, was compared with a conventional QRS morphology algorithm and F algorithm without T wave subtraction. The rate of false positives was reduced step by step (22.3% in the conventional algorithm, 7.8% in the F without T subtraction algorithm and 3.0% in the F with T subtraction algorithm), resulting in a marked increase in diagnostic accuracy for A-PSC from 77.2% to 90.6% and 95.0%, respectively. In a general population with external samples, the newest algorithm showed 77.8% sensitivity, 99% specificity, and 98.9% accuracy for diagnosis of A-PSC. The new algorithm for differential diagnosis of wide QRS complexes is simple, reliable, and easy to apply to most 12-lead ECG machines with computer-assisted automatic diagnosis.

DOI： 10.1253/circj.67.1036

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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PubMed

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

背景<BR>心サルコイドーシス(心サ症)では心電図異常が現れることが多いが,心合併症のない眼,肺サルコイドーシス(眼,肺サ症)の一部にも潜在性の心筋病変が存在している可能性がある.そこで眼,肺サ症の心電図QRS波を周波数解析し,正常例と比較検討.<BR>対象と方法<BR>心血管合併症をもたないQRS幅正常の眼,肺サ症(S)10例,対照として健常人(N)10例.各症例で加算平均心電図を記録,f-QRS,RMS、。を計測,比較.<BR>同時に心電図X誘導の洞調律1心拍をウェーブレット変換し,各周波数ごとにパワー値の推移を検討.伝導遅延の指標として周波数50Hzにおける高パワー持続時間(High Power Duration;HPD),QRS内部電位の不均一性の指標として不連続点の数(Number of Discontinous Points;NDP)を計測,比較した.<BR>結果<BR>f-QRS(108.0±5.7vs106.5±7.4),HP(105.0±Zlvs113.1±17.6)は2群間で有意差は認めなかったが,サルコイドーシス群でRMS40は有意に低下(10.7±4.2vs8.1±0.7),NDPは増加(3.0±0.0vs4.8±L5).<BR>考察<BR>眼,肺サ症においても一部には潜在性心筋病変が存在し,それをQRS内部電位の微細な変化として捉えうる可能性が示唆された.

DOI： 10.11281/shinzo1969.35.Supplement1_20

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その他リンク： http://search.jamas.or.jp/link/ui/2003221655

記述言語：日本語   出版者・発行元：The Japanese Society of Clinical Pharmacology and Therapeutics  

DOI： 10.3999/jscpt.33.2_343S

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2002220372

記述言語：英語   出版者・発行元：The Japanese Society of Hypertension  

In a patient who was taking an angiotensin-converting-enzyme inhibitor, low-density lipoprotein (LDL) apheresis with dextran-sulfate cellulose provoked hypotension accompanied by lacrimation and blurred vision. Hypotension was eliminated by changing the anticoagulant from heparin to a protease inhibitor, nafamostat mesilate. A study was undertaken to clarify whether an antagonist of angiotensin type 1-receptor, losartan, could be safely used in the same patient during LDL apheresis treatment. Blood pressure and humoral factors were compared between the apheresis sessions with losartan and those without. Although angiotensin II and bradykinin plasma levels during LDL apheresis were significantly greater with losartan than without, blood pressure reduction by losartan was mild and unpleasant symptoms were not induced. Losartan was thus safely used for this patient during treatment by LDL apheresis. The greater rise in bradykinin levels during apheresis with losartan might be ascribable to angiotensin type 2-receptor stimulation.(Hypertens Res 2001;24: 595-598)

DOI： 10.1291/hypres.24.595

PubMed

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・透析患者・重度慢性腎臓病患者は出血リスクが高く,抗血栓薬投与に当たっては注意が必要である.・心房細動を合併した維持透析患者に対する経口抗凝固療法は現時点では原則不要であるが,症例ごとに検討する必要がある.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J06863&link_issn=&doc_id=20200930280021&doc_link_id=10.11477%2Fmf.1438200431&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1438200431&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

心サルコイドーシスは脚ブロックや房室ブロックなどの伝導障害で発症することが多く、伝導異常を鋭敏に反映する加算平均心電図がその早期診断に有用である可能性がある。われわれは心電図正常の肺サルコイドーシス患者74例で加算平均心電図を記録分析し、その後の心イベントとの関連性を解析した。結果、29名(39.2%)が加算平均心電図においてLP陽性であった。平均9.8年のフォローアップ期間でLP陽性例のうち8例が心イベントを発症した(完全房室ブロック4例、心室頻拍2例、心不全2例)。一方、心室遅延電位陰性群では1例のみ(心不全)であった。多変量解析の結果、LPのみが独立した危険因子であった(ハザード比9.66、95%信頼区間1.20-78.01、p=0.033)。Kaplan-Meier法を用いた解析では、LP陽性患者は陰性患者に比し有意に心イベントを起こしやすい(log-lank、p=0.004)ことが判明した。以上の結果から、肺サルコイドーシスにおける心室遅延電位は、心イベントの早期予測に有用である可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

心サルコイドーシスは脚ブロックや房室ブロックなどの伝導障害で発症することが多く、伝導異常を鋭敏に反映する加算平均心電図がその早期診断に有用である可能性がある。われわれは心電図正常の肺サルコイドーシス患者74例で加算平均心電図を記録分析し、その後の心イベントとの関連性を解析した。結果、29名(39.2%)が加算平均心電図においてLP陽性であった。平均9.8年のフォローアップ期間でLP陽性例のうち8例が心イベントを発症した(完全房室ブロック4例、心室頻拍2例、心不全2例)。一方、心室遅延電位陰性群では1例のみ(心不全)であった。多変量解析の結果、LPのみが独立した危険因子であった(ハザード比9.66、95%信頼区間1.20-78.01、p=0.033)。Kaplan-Meier法を用いた解析では、LP陽性患者は陰性患者に比し有意に心イベントを起こしやすい(log-lank、p=0.004)ことが判明した。以上の結果から、肺サルコイドーシスにおける心室遅延電位は、心イベントの早期予測に有用である可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00681&link_issn=&doc_id=20200818280001&doc_link_id=%2Fdn4eleca%2F2020%2F004002%2F002%2F0069-0074%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdn4eleca%2F2020%2F004002%2F002%2F0069-0074%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00679&link_issn=&doc_id=20200323220008&doc_link_id=20200323220006&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20200323220006&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(株)日本医事新報社  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は16歳女性。心電図で心室早期興奮を認め、右房刺激では僧帽弁輪5時付近の冠静脈洞(CS)3-4電極で心房心室波が融合し、ATP 20mg急速静注により、AH間隔の延長と心室早期興奮が強まった後に房室ブロックを呈した。心室刺激での逆行性心房最早期興奮部位は、CS遠位端(1-2電極)で減衰伝導特性を示した。心房期外刺激で順行性副伝導路の不応期の後にAH間隔のjump up現象を認め、心房最早期興奮部位をCS入口部とする頻拍周期430msecのnarrow QRS頻拍が誘発されslow/slow型房室結節リエントリー性頻拍(AVNRT)と診断。頻拍が持続したまま逆行性心房興奮部位が心室刺激と同一の僧帽弁輪5時に変化し頻拍周期は450msecに延長した。心室刺激中に僧帽弁輪5時に留置したアブレーションカテーテルの電極で心室心房波融合電位が得られ、高周波通電1秒で副伝導路が離断され遅伝導路を介する室房伝導に移行した。その後slow/slow型AVNRTが誘発され、遅伝導路への通電で頻拍は誘発不能となった。僧帽弁輪5時に見られた副伝導路はATP感受性かつ減衰伝導特性を示し、解剖学的位置より房室結節心室間副伝導路と考えられた。(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本臨床工学技士会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は、強皮症に伴う間質性肺炎で在宅酸素療法を導入中の76歳女性。有症候性の持続性心房細動に対してカテーテルアブレーション施行目的で入院。%肺活量が65%と拘束性肺障害あり、局所麻酔と低用量プレセデックスを用いた浅鎮静で手技を行った。心筋焼灼に伴う疼痛を訴えたため、プレセデックス増量とミダゾラムを投与したところ、喀痰排出が困難となり酸素飽和度の低下をきたした。フルマゼニルで拮抗し、呼吸状態を改善させたのちペンタゾシンとヒドロキシジンを使用し拡大両側肺静脈隔離術を施行した。術後経過良好であったが、術翌日に心電図上前胸部誘導でT波の陰転化を認め、その後呼吸困難が出現し、心エコー検査では心尖部の壁運動低下がみられた。CPKは43U/Lであったが、NT-proBNPは4457pg/mLと増加しており、胸部X線では肺うっ血像を示した。心不全加療後に施行した冠動脈造影検査では有意狭窄は認めず、左室造影所見では心尖部の無収縮は改善していた。術後にアブレーション焼灼時の疼痛を我慢していたことが判明し、カテーテルアブレーションを誘因とするたこつぼ心筋症と診断した。心房細動に対するカテーテルアブレーションを契機にたこつぼ心筋症を発症した1例を経験した。(著者抄録)

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

J-GLOBAL

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は49歳、男性。下壁誘導でP&#039;-/+を示すshort RP&#039;頻拍1は、心房単一期外刺激で順行伝導jump upの後、逆行心房エコー波のjump up様所見と共に誘発され、心房最早期興奮部(AEP)は高位心房中隔であった。ATP 20mgでHA時間は不変でAH延長後にブロックで停止、心室刺激中の投与はVAブロックを呈した。順行性遅伝導路を標的としたKoch三角での通電は無効で、冠静脈洞(CS)入口部天井通電でHA時間短縮を伴う頻拍周期延長を来した。逆行伝導の興奮順序は同様で、下部共通路への入力がより心房端でかつ伝導特性がより遅い順行遅伝導路(SP)に乗り換え、下部共通路伝導距離延長で生じた現象と考えた。この付近の通電で右房-CS間伝導障害により左房内興奮順序が変化し頻拍周期が延長、SP左側偏位が示唆された。本頻拍は両心房、CS内で根治せず、バルサルバ洞内の頻拍中AEPへの通電で停止し、SP上方偏位が考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

症例1は38歳男性で、突然右半身不全麻痺が出現し、脳梗塞の診断で他院に緊急入院し、高度の徐脈を指摘され当院に転院搬送となった。電気生理学的検査では右房は中隔の一部を除き広範な無電位領域を示し、部分的心房静止と診断した。開胸下に左房後壁に心房リードを留置し、心房-心室順次ペーシングを施行したところ、心原性脳塞栓と診断され、抗凝固療法を導入し、現在も外来経過観察中である。症例2は65歳男性で、感染性心内膜炎に対し僧帽弁形成術を施行した。その後外来にて経過をみていたところ、頻脈性心房粗細動を認めた。心臓超音波検査における僧帽弁左室流入波形ではA波は認めず、臨床的に心房静止と診断し、ペースメーカ植込みを行った。その際、右房は広範囲に無電位領域を認めたが、一部電位が残存し、ペーシング可能な部位を認めたため心房リードを留置し、心房-心室順次ペーシングを施行した。

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2017201299

記述言語：日本語   出版者・発行元：(公社)日本臨床工学技士会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

うっ血性心不全を合併して入院し、経過中に頻脈性心房細動(AF)を新規に発症し、アミオダロン静注薬を投与した75例(男性40名、女性35名、平均76歳)を対象とした。心疾患内訳は、虚血性心疾患40例、急性心筋梗塞13例、拡張型心筋症6例であった。洞調律復帰は42例であった。アミオダロン投与1時間以内に心拍数が低下した。洞調律復帰群とAF持続群の患者背景を比較すると、性別(男性)、虚血性心疾患、左房径、機械補助換気で有意差を認め、多変量解析の結果、機械補助換気、性別、左房径の順にアミオダロン抵抗性を示した。洞調律復帰した42例中39例が洞調律を維持したまま退院した。退院後は経口アミオダロン12例、他の抗不整脈薬4例、抗不整脈薬非内服23例であった。AF持続群33例中18例で電気的除細動を施行し、16例は洞調律に復帰した。最終的に64例が洞調律に復帰して退院した。死亡例は14例であった。10例に有害事象を認め、洞性徐脈3例、接合部調律3例、低血圧3例、洞停止1例、静脈炎1例で、いずれも軽症で、投与中断には至っていない。

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016320493

記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は72歳、男性。拡張型心筋症に対してCRTD植え込み3年後に右脚ブロック+右軸偏位型の単形性持続性VT(周期480〜520msec)を繰り返した。左室心内膜マッピングでは低電位領域を認めず、CRTDの左室リードペーシング中に心外膜マッピングを施行。左室後壁基部に2×3cmの低電位領域(LVZ)を認め、内部の複数箇所で遅延電位が記録された。ペーシングから260msecのdelayをもってVTと同一波形のQRS波形となる部位を同定、ペーシングや当部位を起源とするectopyにより容易にVTが誘発され、VT中は拡張期電位となった。焼灼中にVT停止し、焼灼を継続すると局所のectopyが進出ブロックによりQRSを捕捉しなくなり、QRSと解離した局所興奮も認め、以後VTは誘発不能となった。緩徐伝導路起源のectopyの進出ブロックにより必須伝導路内のブロックが確認された稀有な症例を経験したので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

頻脈性心房細動・心房頻拍に対するアミオダロン静注薬の有効性と安全性について検討した。急性冠症候群(ACS)または急性心不全(CHF)で入院し、経過中に頻脈性心房細動・心房粗動に対してアミオダロン静注薬を使用した44例(男性22名、女性22名、平均77歳)を対象とした。急速飽和中に13例、持続静注中に10例が洞調律に復帰し、洞調律復帰までの時間は平均15時間であった。洞調律復帰群の平均心拍数は129→99bpmに低下し、心房細動持続群で123→108bpmに低下した。洞調律に復帰せず、心房組動が持続した21例のうち9例で電気的除細動を行った。12例は効果不十分のため、心拍数コントロールを追加した。アミオダロンによると推測される有害事象が3例(静脈炎1例、血圧低下2例)で発生した。投与後脳梗塞を1例が発症した。

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は、72歳男性。肥大型心筋症、発作性心房細動のため近医通院していたが、動悸を自覚しホルター心電図で症状に一致してLong R-P&#039;頻拍が認められ、カテーテルアブレーション目的に当院へ紹介となった。心臓電気生理学的検査で、心房単発期外刺激によるjump up現象は認めず、右室刺激中の心房最早期興奮部位をHis束領域に有する弱い逆行伝導を認めた。心房頻回刺激で頻拍周期460msecのLong R-P&#039;頻拍が誘発され、頻拍中の心房最早期興奮部位は冠動脈洞入口部より約2cm遠位であった。頻拍中に左心房内をmappingしたところ、左房内僧帽弁輪6時方向からの巣状興奮パターンを呈し、最早期興奮部位では冠静脈洞内で得られる電位よりも26msec先行する分裂電位が記録された。心房内各所からのエントレインメントペーシングは、最早期興奮部位でのみ刺激後の復元周期が頻拍周期に一致した。同部位で頻拍中に通電を行い頻拍は約8秒で停止したが、イソプロテレノール負荷で再発し、左房心内膜側からの追加通電を行ったが再発を繰り返した。左房心内膜側の最早期興奮部位の対側の冠静脈洞側でより早期性のある電位が記録され同部位への通電を行い、約1秒で頻拍は停止し以降誘発不能となった。心内膜側、心外膜側の両者からの焼灼が有効であった僧帽弁輪を起源とする巣状心房頻拍の1例を経験した。(著者抄録)

DOI： 10.11281/shinzo.47.S2_85

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記述言語：日本語   出版者・発行元：(株)日本医事新報社  

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記述言語：日本語   出版者・発行元：(株)日本医事新報社  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo.47.1028

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

Web of Science

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は29歳男性。左室後側壁血管腫に関連する複数個の心室頻拍(VT)を認め、心内膜・心外膜アプローチによるアブレーションが無効であったため開胸下に心内膜・心外膜側から腫瘍辺縁を冷凍凝固した。術後に右脚ブロック・右軸偏位型(VT1)および左脚ブロック・左軸偏位型(VT2)で同一頻拍周期(300 msec)の2種類のVTを認めた。腫瘍-僧帽弁輪間を峡部(mitral isthmus、MI)とし、VT1は僧帽弁輪を反時計方向回転、VT2は時計方向に旋回した。MIの興奮を冠静脈洞内の多極カテーテルにて記録、洞調律中は両方向から興奮の進入する遅延電位として記録され、VT1中は中隔から側壁方向、VT2中はその逆方向へ伝播する拡張期電位となった。洞調律中にMIの側壁出口付近を焼灼したところMI側壁部の興奮が遅延し、焼灼部遠位(前側壁基部)からの刺激で焼灼部のブロックが確認され、VT1、VT2ともに誘発不能となった。冠静脈洞の多極カテーテルでVT中の拡張期電位の興奮伝播および焼灼の効果を評価しえたMI-VTを経験したので報告する。(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

経口アミオダロン不耐症例に合併したelectrical stormに対する静注アミオダロンの安全性および有効性について検討した。静注アミオダロンで治療した致死性不整脈患者60例中、経口アミオダロンを減量または中止中に発症したelectrical storm 6例を対象とした。6例の減量・中止の原因として、甲状腺機能異常は甲状腺機能亢進症、破壊性甲状腺炎(バセドー病)2例、間質性肺炎またはKL-6上昇例2例、肝機能障害増悪2例であった。カテコラミン内服薬は半数に投与され、植込み型除細動器は全例に植え込まれていた。発作時の平均血中K濃度は若干低値であった。6例中4例で静注アミオダロンが有効で、残り2例が無効であった。この2例に関してもカテーテルアブレーションを追加することにより、その後不整脈の抑制が得られた。6例に有害事象は認められなかったが、1例に徐脈、1例に甲状線刺激ホルモンの上昇を認められた。

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は15歳、男性。Gorlin症候群(基底細胞癌、心臓腫瘍)に合併した心室頻拍(VT)の頻回発作を認め、アミオダロン内服、アブレーション施行するも抑制できず、手術目的に当院転院した。術前心内膜マッピングでは、左室後壁に腫瘍浸潤に一致する18cm2の広範囲の低電位領域を認め、その辺縁では全周性に遅延電位が記録された。プログラム刺激により誘発されたVTは2種類。VT#1(RBBB、左軸偏位、CL300ms)は、低電位領域の後中隔側で、VT#2(RBBB、右軸偏位、CL300ms)は後側壁側でpace mapが近似した。開胸下心外膜マッピングでも低電位領域辺縁を最早期とする多種類のVTが誘発され、腫瘍切除が困難であったため腫瘍を隔離するように凍結凝固し頻拍を抑制しえた。低電位領域辺縁の病理では線維腫の浸潤と心筋の錯綜配列様構造異常を認め、これが本頻拍の不整脈基質である可能性が示唆された。(著者抄録)

DOI： 10.11281/shinzo.46.S3_258

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

DOI： 10.7878/jjsogd.34.57-1

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その他リンク： http://search.jamas.or.jp/link/ui/2015040268

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

心筋梗塞の急性期から亜急性期には、薬物療法抵抗性の多形性心室頻拍および心室細動が生じ、いわゆるelectrical storm(ES)の状態となることがある。日本医科大学でカテーテル心筋焼灼術を必要としたES症例では、全例で梗塞境界領域のPurkinje線維から発生する期外収縮がトリガーとなっていた。そのうち2例では、Purkinje線維がリエントリーにも関与することが示され、その広範な焼灼によりトリガーのみならずプログラム刺激による誘発が不能となり、基質の修飾法としての有用性が示唆された。また、心筋梗塞に伴う心室頻拍(VT)のなかで、特発性左室頻拍(ILVT)に類似した束枝内Purkinje VTにおいては、前収縮期Purkinje電位と拡張期Purkinje電位が頻拍中に記録される部位での焼灼が有効であり、ILVTと同様のアプローチが有用であった。(著者抄録)

DOI： 10.5105/jse.34.127

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は57歳、男性。持続性心房細動に対してアブレーションを施行。両側肺静脈隔離と後壁隔離後も心房細動が持続し、左房内から僧帽弁輪部を冠静脈洞(CS)に沿って焼灼を行った。焼灼中心房細動は頻拍周期(TCL)270msecの反時計方向回転perimitral ATに移行した。AT中、CS近位部では左房電位の110msec後にCS電位を認め、焼灼によるLA-CS間伝導遅延が示唆された。僧帽弁輪峡部(MI)焼灼中に左房電位が著明に遅延しTCLが延長したものの頻拍は持続した。VOM直下の左房焼灼を行うと頻拍は停止、しかしdifferential pacingで伝導の残存が示された。VOM付着部のCSが最早期であったことからVOMを介する伝導の残存と考え、焼灼線上のVOM付近をさらに焼灼したところブロックが完成した。MI焼灼においてVOMが心内膜側の伝導ブロックを架橋していたものと考えられ報告する。(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：英語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：Elsevier  

Prediction of lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important and challenging problems after myocardial infarction (MI). Identification of MI patients who are prone to ventricular tachyarrhythmias allows for an indication of implantable cardioverter- defibrillator placement. To date, noninvasive techniques such as microvolt T-wave alternans (MTWA), signal-averaged electrocardiography (SAECG), heart rate variability (HRV), and heart rate turbulence (HRT) have been developed for this purpose. MTWA is an indicator of repolarization abnormality and is currently the most promising risk-stratification tool for predicting malignant ventricular arrhythmias. Similarly, late potentials detected by SAECG are indices of depolarization abnormality and are useful in risk stratification. However, the role of SAECG is limited because of its low predictive accuracy. Abnormal HRV and HRT patterns reflect autonomic disturbances, which may increase the risk of lethal ventricular arrhythmias, but the existing evidence is insufficient. Further studies of noninvasive assessment may provide a new insight into risk stratification in post-MI patients. © 2014 Japanese Heart Rhythm Society.

DOI： 10.1016/j.joa.2014.02.013

Scopus

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は15歳、男性。動悸発作を伴うA型WPW症候群の電気生理学的検査を行った。左側後壁に副伝導路を認め、心室期外刺激で房室結節遅伝導路を逆行し、副伝導路を順行する逆方向性房室回帰性頻拍が容易に誘発された。また、心室連続刺激では、頻拍周期380msec時のみ副伝導路を逆行し、房室結節遅伝導路を順行する正方向性房室回帰性頻拍が誘発された。副伝導路の焼灼後、心室期外刺激でfast-slow 1 echoを認めた。また、isoproterenol投与後に速伝導路の逆行性伝導が出現し、slow-fast型房室結節リエントリー性頻拍が誘発され、遅伝導路の焼灼を行った。遅伝導路が関与する4種の頻拍を呈したWPW症候群を経験したので報告する。(著者抄録)

DOI： 10.11281/shinzo.45.S3_112

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

Web of Science

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

72歳、男性。発作性心房細動のカテーテルアブレーションのため紹介。術前3D-CTにて、左房中隔と後壁を結ぶ長さ39mm、径3mmの索状構造物を認めた。心内エコーガイド下に、索状構造物の長軸方向に沿って10極カテーテルを留置。洞調律中は左房後壁端と中隔端の両方向から興奮が進入し、中間でcollisionした。三次元マップでも同様であった。中隔ペーシングでは中隔端から左房後壁方向へ、左房天蓋刺激では左房後壁端から中隔端への伝導を示し、刺激周期を徐々に短縮しても伝導時間は延長せず、緩徐伝導特性は認めなかった。心房細動中はpassiveに興奮、またアデノシン三リン酸(ATP)やisoproterenol投与で期外収縮は誘発されず不整脈源性はなかった。心房細動に対し拡大肺静脈隔離とroof line焼灼を施行。Roof line作成後はその前方からの刺激で中隔端から後壁端方向のみへの伝導となり、また索状構造物を用いたdifferential pacingも行い、roof lineのブロックが確認できた。左房索状構造物は極めて稀であり、その電気生理学的特性を調べ得たことは貴重と考え報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo.45.S1_16

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は69歳、男性。心房細動に対し2回目のセッションを行った。肺静脈再隔離と後壁隔離を行い、mitral isthmusのblock lineを作成した後にCL 370msecのATが誘発された。Activation mapは左肺静脈carina前側のridgeが最早期興奮部位(EAS)で、そこからmitral isthmus焼灼線上の一方には直接、対側には僧帽弁輪を旋回して到達する興奮伝導パターンであった。Total activation timeは280msecと頻拍周期を満たさなかったが、EAS周囲およびmitral isthmus焼灼線の対側で頻拍周期に近く、マクロリエントリーと考えられた。EASと冠静脈(CS)内を広範囲に焼灼したが頻拍は停止しなかった。そこでCSからカテーテル先端をvein of Marshall(VOM)にwedgeさせたところ、左房内の最早期と最遅期興奮の間に棘波上の電位を認め、同部位でのPPIが頻拍周期に一致し、焼灼中にATが停止した。イリゲーションカテーテルから造影したところ成功部位からblock lineを通過し左房ridgeへと続くVOMが造影された。当頻拍はVOMが心内膜側やCS内通電での焼灼線をブリッジする心外膜側の伝導路となっていたと考えられ、mitral isthmus焼灼難渋例の一部にこのような症例が存在すると思われるので報告する。(著者抄録)

DOI： 10.11281/shinzo.44.S3_123

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

[背景・目的] Brugada症候群と不整脈源性右室心筋症（ARVD）はともに加算平均心電図における心室遅延電位（LP）が高率に検出されるが，そのLPの形態に着目すると，ARVDでは高周波成分で形成されるのに対し，Brugada症候群では比較的低周波成分で形成されることが多い．そこで，われわれは，QRS波の周波数解析を行うことにより両者の周波数特性を検討した．<BR>[対象と方法] 特発性右室流出路起源心室頻拍（RVOT-VT）20例，Brugada症候群10例，ARVD 10例．全例で心電図Z誘導QRS波をガボール関数を用いてウェーブレット変換し，各周波数帯でのピークのパワー値，および総パワー値を比較．<BR>[結果] Brugada症候群では80Hzを中心に，ARVDでは150Hzを中心にQRS内部に高周波成分が発達していた．高周波帯の中で最大パワーを有する周波数はBrugada症候群に比し，ARVDで有意に高かった（81.7± 19.9Hz vs 145.4± 27.9 Hz，p<0.01）．<BR>[結論] 心電図QRS波の周波数解析において，周波数特性は，Brugada症候群とARVDで明らかに異なる．

DOI： 10.11281/shinzo.44.S1_19

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その他リンク： http://search.jamas.or.jp/link/ui/2012165334

記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

DOI： 10.11281/shinzo.43.S1_27

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

[背景] Brugada型心電図のリスク層別化には, 有効な方法がない. 近年, 心電図の時間周波数解析の有用性が報告されており, Brugada症候群検出における有用性を評価した.<BR>[方法] 対象はBrugada型心電図と診断された18例(女性: 1, 45±20歳). 高分解能心電計(sampling, 10kHz)を用いて, V₁, V₂誘導の通常肋間と上位肋間(第2, 3肋間)の計6誘導を同時記録. Wavelet変換(Gabor関数)を用いて, QRS波後方の周波数成分(40-200Hz)を評価した.<BR>[結果] 検査時にTypeを示した3例を含め6例(すべて男性)がBrugada症候群と診断され(BS群), 残り12例(女性: 1, Type II=8, Type III=4)はBrugada症候群の診断基準を満たさなかった(非BS群). BS群では, 非BS群に比べ高周波数成分(80Hz以上)のパワー値が増高する傾向にあり, 高周波数成分の増高が認められる誘導数(6誘導中)が有意に多かった(4±1.4 vs 1.33±1.2, p<0.05).<BR>[結語] 異常高周波数成分を検出することで, Brugada型心電図のリスク層別化に有用である可能性が示唆された.

DOI： 10.11281/shinzo.43.S1_3

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

31歳、女性。39.2℃の発熱があり、その2ヵ月後より眼前暗黒感を伴う眩暈を主訴に近医を受診。両側橈骨動脈が触知不能のため高安動脈炎が疑われ紹介。精査目的で入院するも妊娠6週1日目であることが判明し、造影剤を使用した検査は中止。WBC10,540/μL、CRP0.73mg/dL、血沈69mm/1時と炎症反応が亢進し、頸動脈エコーでは両側の総頸動脈内中膜肥厚、および胸部MRAで大動脈弓3分枝の狭窄が認められた。症状、血液生化学検査、および画像診断より高安動脈炎I型と診断した。プレドニゾロン30mg/日の内服開始に伴い、眩暈の改善および橈骨動脈の触知を認め外来加療とした。CRPと血沈を指標に外来でプレドニゾロンを漸減し、継続加療を行った。妊娠経過中に胎児の発達に問題なく、妊娠も正常に経過した。本症例の高安動脈炎病期はgroup I、新生児予後スコアーは0点であることより自然経腟分娩とし、妊娠39週3日に体重3,010gの男児を無事出産した。高安動脈炎は全国に約5,000人の罹患患者がいるが、妊娠症例の報告は比較的少なく、本疾患妊娠症例の診断・治療、妊娠分娩時の管理などにつき考察を加える。(著者抄録)

DOI： 10.11281/shinzo.42.1323

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その他リンク： http://search.jamas.or.jp/link/ui/2011031673

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo.42.S1_10

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo.42.S1_29

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

67歳女。めまいを主訴に近医を受診し、完全房室ブロックを認めた。4日後、自然に洞調律へ復帰したが、心エコー上左室前壁中隔〜側壁に壁運動異常を認め左室駆出率は35%と低下した。冠動脈造影では有意狭窄を認めなかったもののタリウム心筋シンチグラムで冠動脈支配に一致しない欠損像を認めた。原因として心サルコイドーシスやアミロイドーシスが疑われたが他臓器病変なく、確定診断には至らなかった。全身性疾患鑑別のため胃生検を施行し、心サルコイドーシスと診断した。その後、房室ブロックに対しペースメーカ植え込み術を施行し、ステロイド治療を開始した。

DOI： 10.1272/manms.6.30

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo.41.S1_28

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

DOI： 10.11281/shinzo1969.40.Supplement1_4

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

症例は60歳、男性。心筋梗塞に合併した心室頻拍(VT)に対して40歳時に心内膜切除術を施行した。今回、右脚ブロック上方軸偏位型のVT(370msec)が頻発し心臓電気生理検査を施行。VT中の左室マッピングでは、瘤下壁端と健常心筋との境界を最早期とする巣状興奮パターンを示し、最早期部位(s-QRS:330msec)から瘤前壁(s-QRS:100msec)にかけてpost pacing間隔が頻拍周期に一致したconcealed entrainmentを認めるisolated potentialを追えた。最早期部位と瘤前壁との間では、最早期から順行する興奮と最遅延部位から最早期に向かう電位のdouble potentialが記録された。後者は刺激で捕捉されず心外膜側の興奮を反映、最早期部位は心外膜から心内膜側へのbreakthroughと考えられた。瘤前壁のisolated potential記録部位での高周波通電でVTは根治できた。【総括】心外膜側残存心筋と瘤瘢痕内残存心筋を含むマクロリエントリーであった心内膜切除術後心室頻拍の1例を報告した。(著者抄録)

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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