Updated on 2025/02/14

写真a

 
Arai Toshiki
 
Affiliation
Chibahokusoh Hospital, Department of Cardiovascular Medicine, Assistant Professor
Title
Assistant Professor
External link

Papers

  • Efficacy and safety of atrial fibrillation ablation in patients with aged 80 years or older. Letter to the editor (response to Kataoka N, et al.).

    Kenji Yodogawa, Yu-Ki Iwasaki, Nobuaki Ito, Toshiki Arai, Masato Hachisuka, Yuhi Fujimoto, Kanako Hagiwara, Hiroshige Murata, Yoshiyasu Aizawa, Wataru Shimizu, Kuniya Asai

    Heart and vessels   2025.1

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  • Efficacy and safety of atrial fibrillation ablation in patients with aged 80 years or older.

    Kenji Yodogawa, Yu-Ki Iwasaki, Nobuaki Ito, Toshiki Arai, Masato Hachisuka, Yuhi Fujimoto, Kanako Hagiwara, Hiroshige Murata, Yoshiyasu Aizawa, Wataru Shimizu, Kuniya Asai

    Heart and vessels   2024.9

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    Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the elderly. Its prevalence rises with age, particularly in individuals over 80 years old. While catheter ablation has emerged as a first line therapy for the patients with symptomatic AF, evidence on its application in elderly patients remains controversial. This study aimed to assess safety and efficacy outcomes of AF ablation in patients aged ≥ 80 years. Consecutive 1327 patients who underwent a first pulmonary vein isolation (PVI) for AF were retrospectively analyzed. Patients aged ≥ 80 years (elderly group, n = 107) were compared with patients aged < 80 years (younger group, n = 1220). At 1-year follow-up, there was no significant difference in AF free rate between the elderly and the younger group (72.0% vs. 73.9%, P = 0.786). Regarding major complications, the elderly patients had a greater incidence of periprocedural stroke (1.9% vs. 0.1%, P = 0.018). The rates of cardiac tamponade, phrenic palsy, and vascular complications were not significantly different between the 2 groups. PVI for AF is effective in patients aged ≥ 80 years with a similar success rate, but periprocedural stoke risk was higher compared to the younger population.

    DOI: 10.1007/s00380-024-02458-7

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  • Enlarged right atrium predicts pacemaker implantation after atrial fibrillation ablation in patients with tachycardia-bradycardia syndrome. International journal

    Toshiki Arai, Yu-Ki Iwasaki, Hiroshi Hayashi, Nobuaki Ito, Masato Hachisuka, Serina Kobayashi, Yuhi Fujimoto, Kanako Hagiwara, Hiroshige Murata, Kenji Yodogawa, Wataru Shimizu, Kuniya Asai

    International journal of cardiology. Heart & vasculature   49   101297 - 101297   2023.12

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    INTRODUCTION: Although catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. METHODS: From 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). RESULTS: When comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). CONCLUSION: Right atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.

    DOI: 10.1016/j.ijcha.2023.101297

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  • Efficacy of electrical isolation of the left atrial posterior wall depends on the existence of left atrial low-voltage zone in patients with persistent atrial fibrillation.

    Shunsuke Uetake, Mitsunori Maruyama, Noriyuki Kobayashi, Toshiki Arai, Yasushi Miyauchi

    Heart and vessels   37 ( 10 )   1757 - 1768   2022.10

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    BACKGROUND: Modification of the low-voltage zone in the left atrium (LA-LVZ) in addition to pulmonary vein isolation (PVI) has not shown sufficient improvement in arrhythmia-free survival in patients with persistent atrial fibrillation (PerAF). Further, the effect of electrical posterior wall isolation (PWI) is controversial. We investigated the impact of existence of LA-LVZ on the outcome of patients undergoing additional PWI for PerAF. METHODS: A total of 347 patients with PerAF who underwent primary catheter ablation with LA-LVZ based strategy were retrospectively analyzed. Voltage mapping in the left atrium (LA) was performed during sinus rhythm. Additional LVZ ablation was performed in patients with LA-LVZ. The operators decided whether additional PWIs were to be performed. RESULTS: Of 347 patients, 108 had LA-LVZ. In the LVZ group, patients with additional PWI (N = 70) had higher rates of freedom from tachyarrhythmia recurrence than those without (77.1% vs. 42.1%, p < 0.001). Furthermore, even when patients were limited to those with LA-LVZ in areas other than the posterior wall (N = 85), PWI had higher success rates (80.9% vs. 42.1%, p < 0.001). In contrast, in patients without LVZ (N = 239), there was no significant difference in the rate of successful outcome between those with and without PWI (81.3% vs. 88.1%, p = 0.112). On the other hand, the patients with PWI had greater atrial tachycardia (AT) recurrence rate than those without PWI (10.0% vs. 2.5%, p = 0.003). CONCLUSIONS: PWI, in addition to PVI and LVZ modification, may improve single procedural outcomes in patients with PerAF who have LVZ, regardless of the distribution in the LA. A combination of voltage-guided ablation and PWI may be a simple, tailored, and effective ablation strategy.

    DOI: 10.1007/s00380-022-02069-0

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  • Improvement in Quality of Life via Catheter Ablation for Atrial Fibrillation in Patients Undergoing Hemodialysis Therapy. International journal

    Masato Hachisuka, Hiroshi Hayashi, Yu-Ki Iwasaki, Nobuaki Ito, Toshiki Arai, Serina Kobayashi, Rei Mimuro, Yuhi Fujimoto, Eiichiro Oka, Kanako Hagiwara, Ippei Tsuboi, Hiroshige Murata, Teppei Yamamoto, Michio Ogano, Kenji Yodogawa, Meiso Hayashi, Wataru Shimizu

    CJC open   4 ( 9 )   748 - 755   2022.9

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    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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  • Hemodynamic Collapse Caused by Cardiac Dysfunction and Abdominal Compartment Syndrome in a Patient with Mitochondrial Disease.

    Reiko Shiomura, Shuhei Tara, Nobuaki Ito, Makoto Watanabe, Toshiki Arai, Noriyuki Kobayashi, Masaki Wakita, Yuhi Fujimoto, Junya Matsuda, Jun Nakata, Takeshi Yamamoto, Wataru Shimizu

    Internal medicine (Tokyo, Japan)   61 ( 4 )   489 - 493   2022.2

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    We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.

    DOI: 10.2169/internalmedicine.7729-21

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  • An uncommon mechanism of a short RP narrow QRS tachycardia? International journal

    Shunsuke Uetake, Noriyuki Kobayashi, Toshiki Arai, Nobuaki Ito, Yasushi Miyauchi

    Journal of cardiovascular electrophysiology   32 ( 12 )   3211 - 3213   2021.12

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    DOI: 10.1111/jce.15256

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  • Prognostic impact of newly detected atrial fibrillation in patients with hypertrophic cardiomyopathy following cardiac implantable electronic device implantation.

    Hiroshi Hayashi, Yu-Ki Iwasaki, Toshiki Arai, Rei Mimuro, Masato Hachisuka, Yujin Maru, Yuhi Fujimoto, Eiichiro Oka, Kanako Hagiwara, Yoichi Imori, Teppei Yamamoto, Hiroshige Murata, Kenji Yodogawa, Hitoshi Takano, Wataru Shimizu

    Heart and vessels   36 ( 5 )   667 - 674   2021.5

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    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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Misc.

  • Implantable Cardioverter Defibrillator Generator Replacement in the Octogenarian(タイトル和訳中)

    林 洋史, 土井田 祐子, 岡島 周平, 伊藤 紳晃, 新井 俊貴, 小林 芹奈, 蜂須賀 誠人, 藤本 雄飛, 萩原 かな子, 岡 英一郎, 村田 広茂, 相澤 義泰, 淀川 顕司, 岩崎 雄樹, 丸山 光紀, 清水 渉, 浅井 邦也

    日本循環器学会学術集会抄録集   88回   OJ02 - 9   2024.3

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  • Optimizing Ablation Sites in Recurrent Atrial Fibrillation Cases using Emphasize Settings(タイトル和訳中)

    岡島 周平, 藤本 雄飛, 岩崎 雄樹, 土井田 祐子, 伊藤 紳晃, 新井 俊貴, 蜂須賀 誠人, 萩原 かな子, 村田 広茂, 相澤 義泰, 淀川 顕司, 清水 渉, 浅井 邦也

    日本循環器学会学術集会抄録集   88回   PJ006 - 2   2024.3

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  • Electrocardiographic Features in the Early Differential Diagnosis of Cardiac Amyloidosis from Cardiac Sarcoidosis(タイトル和訳中)

    蜂須賀 誠人, 村田 広茂, 淀川 顕司, 土井田 祐子, 岡島 周平, 伊藤 紳晃, 新井 俊貴, 小林 芹奈, 藤本 雄飛, 萩原 かな子, 林 洋史, 相澤 義泰, 清水 渉, 浅井 邦也, 岩崎 雄樹

    日本循環器学会学術集会抄録集   88回   PJ053 - 1   2024.3

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