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：日本語   出版者・発行元：(一社)日本感染症学会  

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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)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

都心部総合病院救急外来を受診した外国人患者の臨床的特徴を調査し、外国人診療における課題を検討した。2017年4月から9月にかけて、日本医科大学付属病院救急・総合診療センターを受診した初診外国人患者158例を対象に、年齢、来院方法、緊急度トリアージ、疾患分類、出身国、在留方法、保険の有無を後方視的に調査した。平均年齢38±16歳、来院方法ではwalk-in 131例(83%)、救急搬送27例(17%)であり、トリアージでは緊急4%、準緊急23%、低緊急50%、非緊急23%であった。疾患分類では感染症22%、消化器疾患11%、外傷8%、精神疾患5%の順であった。出身国では中国41%、韓国13%、ネパール8%、フィリピン8%、アメリカ6%の順であり、在日外国人は83%、健康保険加入率は75%であった。患者は旅行者よりも、在日外国人が多く、健康保険の加入率も高かった。東京オリンピック・パラリンピックに向けて、外国人旅行者の急増が予想される中、医療通訳をはじめ、医療環境整備に取り組んでいく必要がある。(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=2019&ichushi_jid=J05937&link_issn=&doc_id=20190214290010&doc_link_id=%2Ffg3byoin%2F2019%2F001501%2F010%2F0038-0042%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg3byoin%2F2019%2F001501%2F010%2F0038-0042%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.JNMS.2019_86-204

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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：MEDICAL ASSOC NIPPON MEDICAL SCH  

DOI： 10.1272/jnms.83.182

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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  

Objective: Current data indicate that the rate of trauma in children during gymnastic formation is increasing, especially while creating a structure with a certain height, such as the human pyramid. The goal of the present study was to clarify the clinical characteristics of these injuries. Methods: In this single-institution review, all children treated for a gymnastic formation-related injury at Nippon Medical School Hospital from 2013 through 2015 were identified through the institution's registry. The injury mechanism was classified, and injury severity, interventions, and outcome were examined.
Results: Eight children were treated for a gymnastic formation-related injury. They were 7 boys and 1 girl aged 10 to 15 years (mean age, 13.1 +/- 1.8 years). Neurotrauma ranging from concussion to spinal cord injury without radiographic abnormality occurred in 6 patients (75%). No intracranial hemorrhagic lesions were detected. The Glasgow Coma Scale score on arrival was 15 in all 8 patients, and neurological deficits were present in 1 patient. No patient required surgical intervention. All patients made a full recovery after discharge from the hospital. No patients died. The average follow-up period was 2.1 +/- 0.9 weeks.
Conclusions: Neurotrauma is a frequent result of gymnastic formation accidents in children. Healthcare workers and teachers should recognize this type of injury, and public education that targets parents should be introduced.

DOI： 10.1272/jnms.82.295

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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 < 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）   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 > 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 < 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, >= 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 >= 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 < 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   掲載種別：研究論文（学術雑誌）  

Background: Wavelet-transform is a novel time-frequency analysis on surface electrocardiogram (ECG) in detection of high-frequency components (HFCs) intra-QRS complex, suggesting abnormal myocardial conductions. We evaluated usefulness of Wavelet-transformed ECG in detection of ventricular tachyarrhythmia (VTA) in hypertrophic obstructive cardiomyopathy (HOCM). Methods: We studied 30 patients, including VTA group (N=7) and Non-VTA group (N=23). 12-lead ECG (sampling=10kHz) was recorded and the representative QRS complex (300ms) was transformed using Gabor function to the power curve along a time course. Percentages of peak power values at each frequency (120, 150, and 200Hz) in the corresponding power values at 40Hz (P120/40, P150/40, and P200/40, respectively) were calculated. “The percentage &gt
50% ” was defined as an abnormal-HFC and the number of leads in which an abnormal-HFC was detected of 12 leads (NL-AHFC) was counted. Results: P120/40, P150/40, and P200/40 in VTA group were significantly higher than those in Non- VTA group (45.0±25.2vs27.2±7.5, P&lt
0.05
41.4±23.2vs25.2±7.4, P=0.05
45.1± 20.9vs22.3±8.2, P=0.05, respectively). NL-AHFC (P120/40) in VTA group increased more than those in Non-VTA group (4.1 ±1.2 vs 1.1 ±2.1, P&lt
0.05). When “NL-AHFC (P120/40) &gt
3” was defined as abnormal, the sensitivity, specificity, positive and negative predictive values for detection of VTA were 86, 92, 75, 96%, respectively. Conclusion: Wavelet-transform might be a novel method to detect arrhythmogenic substrates in HOCM. Keywords: wavelet transform, hypertrophic obstructive cardiomyopathy, ventricular tachyarrhythmia. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.OP36_6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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&gt
0.001, 84.2% vs 26.2%
p&gt
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. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.PE4_066

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: It is important to follow up patients surviving acute myocardial infarction (MI), to detect the presence of any life-threatening arrhythmias. Various non-invasive examinations, such as signal-averaged ECG (SAECG), have been reported to predict the fatal ventricular tachycardia (VT)
however, these conventional methods have limitations in detecting VT occurring in patients with complete right bundle branch block (CRBBB) QRS. Wavelet tsansform has been increasingly reported as a superior time-frequency analysis on the surface ECG in detecting abnormal high-frequency components (HFCs), thus suggesting abnormal myocardial conductions
however, it remains unclear whether wavelet-transformed ECG (WTECG) is useful in patients with CRBBB. Objective: The purpose of this study is to assess the predictive value of WTECG for detecting arrhythmogenic substrates in MI patients with CRBBB. Methods: Both the WTECG and SAECG were evaluated in 22 subjects with CRBBB, including 10 subjects without cardiovascular diseases (control group), 7 prior MI patients without VT (Non-VT group), and 5 prior MI patients with sustained VT (VT group). A 12-lead ECG (10 kHz sampling) was recorded and the representative QRS complex (300 ms) was transformed at a frequency range of 40-280 Hz using the Gabor function as the analyzing wavelet. In the power curve along a time course, the percentages of the peak power values at each frequency (60, 80, 120, 150, and 200 Hz) in the corresponding power values at 40 Hz (P60/40, P80/40, P120/40, P150/40, and P200/40, respectively) were calculated. 'The power percentages (P120/40, P150/40, or P200/40) ≥50%′ was defined as an abnormal HFC (AHFC), and the number of the leads in which an AHFC was detected (NL-AHFC) of 8 leads (I, aV F, V1-V6) was counted for comparison of the two MI groups. Results: There was no significant difference among the three groups in the SAECG recording. The power percentages of HFCs (P120/40, P150/40, and P200/40) in Non-VT group were significantly higher than those in control group (48.2 ± 36.5 vs. 30.6 ± 7.7, P&lt
0.001
47.8 ± 35.5 vs. 26.9 ± 7.1, P&lt
0.001
47.3 ± 39.4 vs. 24.9 ± 7.6, P&lt
0.001
respectively). NL-AHFC (P150/40) in VT group significantly increased more than in Non-VT group (3.2 ± 0.4 vs. 1.4 ± 0.8, P=0.001). When 'NL-AHFC (P150/40) ≥3′ was defined as abnormal, the sensitivity, specificity, positive and negative predictive values for detection of VT in Ml patients with CRBBB was 100, 85.7, 83.3, and 100%, respectively. Conclusion: WTECG might be a novel non-invasive method to detect arrhythmogenic substrates in MI patients with CRBBB.

DOI： 10.1272/jnms.76.291

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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  

Most paroxysmal atrial fibrillation (PAF) ultimately becomes chronic atrial fibrillation (CAF), even in the presence of antiarrhythmic drugs. Upstream therapies such as calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI), or strains have attracted attention for treating AF patients. We have previously reported that ACEI inhibited the progression of PAF to CAF. CCB and statins were also reported to inhibit the development of AF, but the follow-up periods in several of the papers appeared to be too short to allow a clear verdict on the antiarrhythmic effects. We therefore conducted a retrospective analysis of the relationship between long-term treatment (over 5 years) with an ACEI, CCB, or statin and outcome in patients with PAF (n = 125).
The follow-up period was 7.7 +/- 3.1 years. Class I antiarrhythmic drugs were prescribed for 76.6% of the patients. ACEI tor 36.0%, CCB for 47.2%. and statins for 20.0%. We assessed the cardiac rhythm from the medical records of electrocardiograms and determined the time from the first visit to the development of CAF. Kaplan-Meier analysis showed that file use of an ACEI significantly decreased the cumulative probability of CAF. while Class I antiarrhythmics, CCB, and statins did not inhibit progression to CAF. Multiratio analysis showed that only ACEI was related to a reduced progression to CAF (odds ratio, 0.112; 95% confidence interval, 0.034 to 0.374, P = 0.001). Class I antiarrhythmic drugs, CCBs, and statins showed no such association.
ACEI thus appear to be superior to CCB or statins with respect to upstream therapy. (Int Heart J 2009; 50: 141-151)

DOI： 10.1536/ihj.50.141

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Disopyramide (DP), mexiletine (MX), and flecainide (FL) are class I antiarrhythmic drugs. However, these drugs exert different effects on the electrocardiogram (ECG) based on their unique actions on cardiac myocytes. The electrocardiographic changes during combination therapy with these drugs are not well understood. The purpose of the present study was to evaluate acute morphologic changes in the ECG based on signal-averaged high resolution ECG (SAECG) after administration of the drugs in relation to their antiarrhythmic efficacy and safety. Twenty-one patients with frequent and stable premature ventricular contractions (PVC) were studied. Changes in the filtered QRS duration (f-QRS) and the root mean square voltage of the last 40 msec of the QRS complex (RMS40) were evaluated. Suppression of PVCs was achieved soon after intravenous administration of the drugs (63% for DP, 43% for MX, 86% for FL and 100% for DP+MX). Although DP and FL significantly prolonged f-QRS, MX had little effect on f-QRS. DP+MX also prolonged f-QRS, but the degree of prolongation was moderate. RMS40 was significantly decreased by DP and FL, but not by MX. DP+MX also decreased RMS40, but the decrease was less than for DP alone. Late potentials were observed after administration in 56% of patients with DP, 0% with MX, 67% with FL and 0% with DP+MX. No adverse events were reported during the study. In summary, the class I antiarrhythmic drugs exerted different acute effects on SAECG parameters. The combination of DP and MX increased the efficacy on suppressing PVC without excess additive changes on SAECG parameters. We conclude that combination therapy with DP and MX is efficacious and safe in patients with PVC and the analysis of SAECG during antiarrhythmic therapy is clinically important. © 2006, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.22.155

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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 < 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：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 <.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 <.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 <.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 A multicenter investigational survey (Japanese Guideline for Arrhythmia Management By Individual Therapy) was conducted to evaluate the validity of using CD-ROM guidelines vs physician choice for the selection of antiarrhythmic drugs.
Methods and Results Patients with paroxysmal atrial fibrillation (PAF, n=274) or premature ventricular contractions (PVC, n=216) were enrolled. The rate of concordance for drug selection between the treating physician and the CD-ROM was 216 of 274 patients (78.8%) with PAF. Of these, 168 (61.3%) were concordant for first-line agents and the remaining 48 (17.5%) were concordant for second-line agents. The concordance for the treatment of PVC was 154/216 cases (71.3%). Of these, 106 (49.1%) were concordant for first-line agents and the remaining 48 (22.2%) were concordant for second-line agents. Nonconcordance for PAF therapy was more likely to occur for patients with underlying heart disease (p<0.05), depressed cardiac function (p<0.001), and with more frequent ECG abnormalities and renal dysfunction. These differences were not seen in patients with PVC.
Conclusion The CD-ROM guidelines appear to be valid in the selection of antiarrhythmic drugs for both PAF and PVC, but their usefulness is influenced by the patient's clinical characteristics.

DOI： 10.1253/circj.69.1357

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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：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

To test the hypothesis that the reverse mode of the Na+/Ca2+ exchange augmented by a rapid heart rate has an antiarrhythmic effect by shortening the action potential duration, we examined the effects of KB-R7943 (2-[2-[4-(4-nitrobenzyloxy)phenyl]ethyl] isothiourea methanesulfonate), a selective inhibitor of the reverse mode of the Na+/Ca2+ exchange, to attenuate this effect. We recorded the electrocardiogram, monophasic action potential (MAP), and left ventricular pressure in canine beating hearts. In comparison to the control, KB-R7943 significantly increased the QTc value and MAP duration. MAP alternans and left ventricular pressure alternans were observed after changing the cycle length to 300 milliseconds in the control studies. KB-R7943 magnified both types or alternans and produced spatially discordant alternans between tight and left ventricles. Early after-depolarizations and nonsustained ventricular tachycardia occurred in the presence or KB-R7943. Our data suggest that the reverse mode of the Na+/Ca2+ exchange may contribute to suppression of arrhythmias by abbreviating action potential duration under pathophysiological conditions. This conclusion is based on further confirmation by future studies of the specificity of KB-R7943 for block of the reverse mode of the Na+/Ca2+ exchange. (c) 2005 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jelectrocard.2004.12.001

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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 Atrial fibrillation, is a progressive disease, which in the paroxysmal form (PAF) becomes more frequent and finally becomes chronic (CAF). A retrospective analysis of patients with PAF was conducted to examine the hypothesis that angiotensin-converting enzyme inhibitors (ACEI) will prevent the progression to CAF.
Methods and Results On the basis of their treatment, 95 patients with PAF were divided into 2 groups: 42 patients treated with ACEI for hypertension throughout the period of treatment and follow-up (ACEI group) and 53 patients not given ACEI (non-ACEI group). Cardiac rhythms were assessed either from the medical records or the electrocardiograms recorded every 2-4 weeks at follow-up visits. The mean follow-up time was 8.3 +/- 3.5 years. There was no significant difference in the use of antiarrhythmic drugs, left atrial diameter or left ventricular ejection fraction between the 2 groups. The Kaplan-Meier curve for the time to occurrence of CAF showed a lower incidence of CAF in the ACEI group and demonstrated that the 5-year probability for persistence of PAF without progression to CAF was 88.3%, but 47.5% in the non-ACEI group.
Conclusions These results indicate that ACEI will prevent progression from PAF to CAF.

DOI： 10.1253/circj.69.671

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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：AMER PHYSIOLOGICAL SOC  

We hypothesized that partial cellular uncoupling produced by low concentrations of heptanol increases the vulnerability to inducible atrial fibrillation (AF). The epicardial surface of 12 isolated-perfused canine left atria was optically mapped before and after 1-50 muM heptanol infusion. At baseline, no sustained (>30 s) AF could be induced in any of the 12 tissues. However, after 2 muM heptanol infusion, sustained AF was induced in 9 of 12 tissues (P<0.001). Heptanol >5 muM caused loss of 1: 1 capture during rapid pacing, causing no AF to be induced. AF was initiated by conduction block across the fiber leading to reentry, which broke up after one to two rotations into two to four independent wavelets that sustained the AF. Heptanol at 2 muM had no effect on the cellular action potential duration restitution or on the maximal velocity rate over time of the upstroke. The effects of heptanol were reversible. We conclude that partial cellular uncoupling by heptanol without changing atrial active membrane properties promotes wavebreak, reentry, and AF during rapid pacing.

DOI： 10.1152/ajpheart.00927.2001

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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：FUTURA PUBL CO  

Aging and Atrial Fibrillation.
Introduction: Aging is associated with atrial interstitial fibrosis and increased incidence of atrial fibrillation (AF). We hypothesized that aged rats are suitable for study of aging-related AF and that partial atrial cellular uncoupling induced with heptanol in young rats mimics aging-related AF.
Methods and Results: Interatrial conduction time and atrial response to burst atrial pacing were evaluated in 11 young (2-3 months) and 12 old (22-24 months) male rats (Fisher 344) in the Langendorff-perfused setting. At baseline, sustained (>30 sec) atrial tachycardia (AT) and AF were induced in 10 of 12 and in 7 of 12 old rats, respectively. No such arrhythmias could be induced in the young rats. Old rats had significantly (P < 0.01) longer interatrial conduction time and P wave durations than the young rats. Burst pacing failed to induce AT and AF in all, 11 young rats studied. The effects of heptanol 2 to 10 muM were studied in both groups. Heptanol 2 to 5 muM promoted inducible AT in all 5 young rats studied; however, when its concentration was raised to 10 muM, AT could no longer be induced in any of the 5 young rats. No AF could be induced in any of the 5 young rats at heptanol concentrations of 2 to 10 muM. In the old rats, AF could still be induced during perfusion of 2 muM heptanol. However, when its concentration was raised to 5 and 10 muM, AF could not be induced in any of the 6 old rats studied. Optical mapping using a potentiometric dye showed a periodic single wavefront of activation during AT in both groups and 2 to 4 independent wavefronts propagating indifferent directions during AF in the old rats. Histology revealed a significant increase in interstitial atrial fibrosis (P < 0.01), atrial cell size (P < 0.05), and heart weight in old versus young rats. Fibrosis in the old rats was highly heterogeneous.
Conclusion: The rat model is suitable for study of aging-related AF. Uniform partial atrial cellular uncoupling with heptanol perfusion in the young rats, although promoting inducible AT, does not mimic aging-related AF. The results suggest that heterogeneous atrial interstitial fibrosis and atrial cell hypertrophy might contribute to the aging-related increase in atrial conduction slowing, conduction block, and inducible AF in the old rat model.

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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：AMER PHYSIOLOGICAL SOC  

We tested the hypothesis that sildenafil, singly or in combination with nitric oxide (NO) donors, promotes ventricular tachycardia (VT) and ventricular fibrillation (VF). Vulnerability to VT/VF was tested by rapid pacing in eight isolated normal swine right ventricles (RV). The endocardial activation was optically mapped, and the dynamic action potential duration (APD) restitution curves were constructed with metal microelectrodes. At baseline, no VT/VF could be induced. Sildenafil (0.2 mug/ml) or NO donor singly or in combination did not alter VT/VF vulnerability. However, when 2 mug/ml sildenafil was combined with NO donors, the incidence of VT and VF rose significantly (P<0.01). VT with a single periodic wavefront was induced in five of eight RVs, and VF with multiple wavefronts was induced in all eight RVs. The sildenafil-NO donor pro-VT/VF combination significantly increased the maximum slope of the APD restitution curve and the amplitude of the APD alternans. The pro-VT/VF effects of sildenafil were reversible after drug-free Tyrode solution perfusion. We conclude that a sildenafil (2 μg/ml) and NO donor combination increases VT/VF vulnerability in the normal RV by a mechanism compatible with the restitution hypothesis.

DOI： 10.1152/ajpheart.00607.2001

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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：AMER PHYSIOLOGICAL SOC  

First published January The focal source hypothesis of ventricular fibrillation (VF) posits that rapid activation from a focal source, rather than action potential duration (APD) restitution properties, is responsible for the maintenance of VF. We injected aconitine (100 mug) into normal isolated perfused swine right ventricles (RVs) stained with 4-{beta-[2-(di-n-butylamino)-6-naphthyl] vinyl} pyridinium (di-4-ANEPPS) for optical mapping studies. Within 97+/-163 s, aconitine induced ventricular tachycardia (VT) with a mean cycle length 268+/-37 ms, which accelerated before converting to VF. Drugs that flatten the APD restitution slope, including diacetyl monoxime (10-20 mM, n=6), bretylium (10-20 mug/ml, n=3), and verapamil (2-4 mug/ml, n=3), reversibly converted VF to VT in all cases. In two RVs, VF persisted despite of the excision of the aconitine site. Simulations in two-dimensional cardiac tissue showed that once VF was initiated, it remained sustained even after the "aconitine" site was eliminated. In this model of focal source VF, the VT-to-VF transition occurred due to a wave break outside the aconitine site, and drugs that flattened the APD restitution slope converted VF to VT despite continuous activation from aconitine site.

DOI： 10.1152/ajpheart.00867.2001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/107424840200700205

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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：AMER COLL CHEST PHYSICIANS  

Study objective: To clarify the clinical significance of pleural effusion in the clinical course of acute aortic dissection (AAD).
Design: Retrospective clinical series.
Setting: A university hospital.
Patients: Fifty-five patients strongly, suspected of having AAD because of severe chest or back pain. Patients with obvious ischemic heart disease, lung disease, and pleural disease were excluded.
Interventions: An additional diagnosis of pleural effusion was made when evident by, CT.
Measurements and results: Pleural effusion was detected in 42 of 48 patients (88%) with AAD (mean +/-SD age, 65 +/- 12 years; 35 men and 13 women), but in only, I of 7 patients (14%) who proved not to have AAD (mean age, 74 +/- 10 years; 6 men and I woman). Effusion appeared at a mean of 4.5 days after onset of dissection. Thoracentesis performed in six patients showed a bloody effusion in three patients and an exudative effusion in three patients. In the six AAD patients without pleural effusion, four patients underwent surgery within 3 days after onset of dissection. In patients with AAD, effusion was demonstrated on the first CT after hospital admission in IS patients, and was bilateral in 32 patients. WBC count in blood, serum C-reactive protein concentration, and body, temperature were higher in patients with effusion (13,400 +/- 3,600/muL, 18.4 +/- 11.5 mg/dL, and 38.2 +/- 0.7degreesC) than in: those without effusion (10,300 +/- 2,900/muL, 4.5 +/- 4.2 mg/dL, and 37.0 +/- 1.0degreesC, respectively).
Conclusions: Pleural effusion occurs frequently in patients with AAD, often in association with inflammatory reactions.

DOI： 10.1378/chest.121.3.825

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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  

Objective The aim of this study was to clarify the prognosis of economy class syndrome (pulmonary thromboemholism following long distance flight) patients discharged from the intensive care unit.
Method Medications, daily activities, recurrence of pulmonary thromboembolism, and quality of life were investigated for an average of 471 days following discharge from the intensive care unit. The information from the patients was obtained by means of a mailed questionnaire or telephone interview.
Patients Ten patients with economy class syndrome were enrolled in this study. Nine were female and one was male (61+/-9 years).
Results In addition to appropriate acute care, additional management was given including the placement of an inferior vena cava filter in 3 patients and a course of oral anticoagulation therapy in 7 patients. None of them died or had recurrence of pulmonary thromboembolism. Four patients took subsequent air flights. No thromboembolic episodes were seen during the follow-up: period.
Conclusion The long-term prognosis in these patients can be favorable with appropriate management of the acute episode in conjunction with adequate preventive measures.

DOI： 10.2169/internalmedicine.41.91

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DOI： 10.1177/107424840200700i107

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DOI： 10.1177/107424840200700i106

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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：FUTURA PUBL CO  

Introduction: We previously reported that there is a high incidence of sudden cardiac death (SCD) in dogs with myocardial infarction (MI), complete AV block (CAVB), and nerve growth factor (NGF) infusion to the left stellate ganglion (LSG). Whether or not QT interval prolongation underlines the mechanism of SCD was unclear.
Methods and Results: We analyzed QT intervals in three groups of dogs. All dogs had CAVB and MI. The LSG group (n=9) and right stellate ganglion (RSG) group (n=6) received NGF infusion via the osmotic pumps over a 5-week period to LSG and RSG, respectively. The control group (n=6) received no NGF. The dogs either died suddenly or were sacrificed within 2 to 3 months after MI. Heart rhythm and QT and RR intervals were monitored using implantable cardioverter defibrillator ECG recordings. There was a time-dependent increase of QTc intervals in the LSG group and a time-dependent decrease of QTc intervals in the RSG group. At the end of NGF infusion, QTc intervals in the LSG group (408 +/- 41 msec) were significantly longer than those in the control (350 +/- 41 msec; P<0.05) and RSG groups (294<plus/minus>23 msec; P<0.01). In the LSG group, 4 of 9 dogs died of SCD. There was no SCD in either the RSG or control group. Immunocytochemical staining showed NGF infusion to LSG and RSG resulted in left and right ventricular sympathetic nerve sprouting and hyperinnervation, respectively.
Conclusion: NGF infusion to the LSG in dogs with MI and CAVB resulted in increased QT interval and incidence of ventricular tachycardia, ventricular fibrillation, and SCD, whereas NGF infusion to the RSG shortened QT interval and reduced the incidence of ventricular tachycardia. These findings indicate that QT interval prolongation is causally related to the occurrence of ventricular arrhythmia in dogs with nerve sprouting, MI, and CAVB.

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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-Investigators who studied ventricular defibrillation by use of optical mapping techniques failed to observe an initial defibrillation event (isoelectric window or quiescent period) shown by electrode mapping studies. This discrepancy has important implications for the mechanisms of defibrillation, The purpose of the present study was to demonstrate an optical equivalent of an isoelectric window after a near-threshold defibrillation shock.
Methods and Results-We studied 10 isolated, perfused swine right ventricles. Upper limit of vulnerability was determined by shocks on T waves. A 50% probability of successful defibrillation (DFT50) was determined with an up-down algorithm. Immediately after unsuccessful defibrillation shock, new wavefronts were generated. When the shock strength was low, immediate reinitiation of reentry and ventricular fibrillation might occur without a postshock isoelectric window. However, if the shock strength was within 50 V of DFT50 (near-threshold), a synchronized activation occurred, followed by organized repolarization that ended 64 +/- 18 ms after shock. After a period of quiescence (18 +/- 24 ms), activation recurred 83 +/- 33 ms after shock and reinitiated ventricular fibrillation. Similar patterns of activation, including a quiescent period, were observed after shock was applied on the T wave of the paced beat that induced ventricular fibrillation, Upper limit of vulnerability correlated well with DFT50,
Conclusions-In isolated swine right ventricles, an optical equivalent of an isoelectric window exists after near-threshold defibrillation shocks. These findings support the idea that a near-threshold defibrillation shock terminates all activation wavefronts but fails to halt ventricular fibrillation because the same shock reinitiates ventricular fibrillation after an isoelectric window.

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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：AMER PHYSIOLOGICAL SOC  

Several different patterns of wave break have been described by mapping of the tissue surface during fibrillation. However, it is not clear whether these surface patterns are caused by multiple distinct mechanisms or by a single mechanism. To determine the mechanism by which wave breaks are generated during ventricular fibrillation, we conducted optical mapping studies and single cell transmembrane potential recording in six isolated swine right ventricles (RV). Among 763 episodes of wave break (0.75 times.s(-1).cm(-2)), optical maps showed three patterns: 80% due to a wave front encountering the refractory wave back of another wave, 11.5% due to wave fronts passing perpendicular to each other, and 8.5% due to a new (target) wave arising just beyond the refractory tail of a previous wave. Computer simulations of scroll waves in three-dimensional tissue showed that these surface patterns could be attributed to two fundamental mechanisms: head-tail interactions and filament break. We conclude that during sustained ventricular fibrillation in swine RV, surface patterns of wave break are produced by two fundamental mechanisms: head-tail interaction between waves and filament break.

DOI： 10.1152/ajpheart.2001.281.1.H253

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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：AMER PHYSIOLOGICAL SOC  

Whether or not the excitation-contraction (E-C) uncoupler diacetyl monoxime (DAM) and cytochalacin D (Cyto D) alter the ventricular fibrillation (VF) activation patterns is unclear. We recorded single cell action potentials and performed optical mapping in isolated perfused swine right ventricles (RV) at different concentrations of DAM and Cyto D. Increasing the concentration of DAM results in progressively shortened action potential duration (APD) measured to 90% repolarization, reduced the slope of the APD restitition curve, decreased Kolmogorov-Sinai entropy, and reduced the number of VF wave fronts. In all RVs, 15-20 mmol/l DAM converted VF to ventricular tachycardia (VT). The VF could be reinduced after the DAM was washed out. In comparison, Cyto D (10-40 mu mol/l) has no effects on APD restitution curve or the dynamics of VF. The effects of DAM on VF are associated with a reduced number of wave fronts and dynamic complexities in VF. These results are compatible with the restitution hypothesis of VF and suggest that DAM may be unsuitable as an E-C uncoupler for optical mapping studies of VF in the swine RVs.

DOI： 10.1152/ajpheart.2001.280.6.H2689

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Electrophysiological findings suggest that concealed anterograde conduction through accessory pathways may exist even during sinus rhythm in patients with so-called concealed Wolff-Parkinson-White (WPW) syndrome. To evaluate the pre-excitation characteristics in various types of WPW syndrome, high-resolution electrocardiograms were analyzed in 81 consecutive WPW syndrome patients and 50 age-matched normal subjects. The WPW group consisted of 30 cases of concealed WPW diagnosed by electrophysiological study, 38 cases of manifest WPW in which apparent delta waves were constant, and 13 cases of intermittent WPW in which the delta waves appeared periodically. The duration of the low-amplitude, high-frequency components of the signalaveraged filtered QRS complex that preceded the earliest upstroke of the surface QRS, including any delta waves (preceding potential duration, PPD), and the duration of low amplitude signals less than 10μV (I-LAS10) or 20μV (I-LAS20) were measured as parameters of pre-excitation. The PPDs in concealed and intermittent WPW were both significantly longer than in manifest WPW or in control subjects (6.8±2.7 ms, 7.9±3.5 ms vs 2.3±3.2 ms, 1.0±1.6ms, both p&lt
0.0001). Abnormally prolonged PPDs (&gt
4ms) were observed in 90% of concealed WPW cases and 76.9% of intermittent WPW, but in only 4% of normal subjects and 31.6% of manifest WPW. Both I-LAS10 and I-LAS20 in the 3 types of WPW syndrome were significantly longer than in normal subjects. The initial portion of the filtered QRS in concealed WPW closely resembled that of intermittent WPW. These results strongly suggest that in concealed WPW anterograde conduction through accessory pathways does occur and produces small amounts of pre-excitation even during sinus rhythm. The study concluded that, despite its name, concealed WPW is not completely concealed, and that non-invasive diagnosis during sinus rhythm is possible by using high-resolution electrocardiography to detect the concealed anterograde pre-excitation.

DOI： 10.1253/jcj.65.367

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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  

The intramural dynamics of ventricular fibrillation (VF) remain poorly understood. Recent investigations have suggested that stable intramural reentry may underlie the mechanisms of VF. We performed optical mapping studies of VF in isolated swine right ventricles (RVs) and left ventricles (LVs). Nine RV walls were cut obliquely in their distal edge exposing the transmural surface, Six LV wedge preparations were also studied. Results showed that intramural reentry was present. In RV, 28 of 44 VF episodes showed reentry; 15% of the activation pathways were reentrant. Except for 4 episodes, reentry was transmural, involving subendocardial structures as the papillary muscle (PM) or trabeculae. Tn LV, reentry was observed in 27 of 27 VF episodes: 23% of the activations were part of reentrant pathways (P<0.05 compared with RV). All LV reentrant pathways were truly intramural (confined to the wall) and were frequently located at the PM insertion, In both ventricles, reentry was spatially and temporally unstable. Histological studies showed abrupt changes in fiber orientation at sites of reentry and wave splitting. Connexin 40 immunostaining demonstrated intramyocardial Purkinje fibers at sites of reentry in the PM root and around endocardial trabeculae. Our results confirm that reentry is frequent-but unstable-in the myocardial wall during VF. In RV, reentry is mostly transmural and requires participation of subendocardial structures. The LV has a greater incidence of reentry and is intramural, Anisotropic anatomic structures played key roles in the generation of wave splitting and in the maintenance of reentry.

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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-The action potential duration (APD) restitution hypothesis of wave break during Ventricular fibrillation (VF) in the epicardial border zone (EBZ) of hearts with chronic myocardial infarction is unknown.
Methods and Results-VF was induced by rapid pacing, and the EBZ with the two adjoining sites (right ventricle and lateral left ventricle) were sequentially mapped in random order in 7 open-chest anesthetized dogs 6 to 8 weeks after left anterior descending artery occlusion and in 4 control dogs. At each site, 3 seconds of VF was mapped with 477 bipolar electrodes 1.6 mm apart. The number of wave fronts and approximate entropy were significantly (P<0.01) higher in the EBZ than all other sites in both groups independent of the rate of invasion of new wave fronts and epicardial breakthroughs, The higher wavelet density in the EBZ was caused by increased (P<0.01) incidence of spontaneous wave breaks. There was no difference between the two groups in either reentry period (80 episodes) or VF cycle length. Reentry in the EBZ had a smaller core perimeter, slower rotational speed, and a small or no excitable gap (P<0.01), often causing termination after one rotation. The dynamic monophasic action potential duration restitution curve in the EBZ had longer (P<0.01) diastolic intervals, over which the slope was >1. Connexin43-positive staining was significantly (P<0.01) and selectively reduced in the EBZ.
Conclusions-A selective increase in wave break and alteration of reentry occur in the EBZ during VF in hearts with healed myocardial infarction. Increased wave break in the EBZ is compatible with the action potential duration restitution hypothesis.

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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-Long-term rapid atrial pacing may result in atrial fibrillation (AF) in dogs. Whether there is histological evidence for neural remodeling is unclear.
Method and Results-We performed rapid right atrial pacing in 6 dogs for 111+/-76 days to induce sustained AF. Tissues from 6 healthy dogs were used as controls. Immunocytochemical staining of cardiac nerves was performed using anti-growth-associated protein 43 (GAP43) and anti-tyrosine hydroxylase (TH) antibodies. In dogs with AF, the density of GAP43-positive and TH-positive nerves in the right atrium was 470+/-406 and 231+/-126 per mm(2), respectively, which was significantly (P<0.001) higher than the nerve density in control tissues (25+/-32 and 88+/-40 per mm(2), respectively). The density of GAP43-positive and TH-positive nerves in the atrial septum was 317+/-36 and 155+/-85 per mm(2), respectively, and was significantly (P<0.001) higher than the nerve density in control tissues (9+/-13 and 30+/-7 per mm(2), respectively). Similarly, the density of GAP43-positive and TH-positive nerves in the left atrium of dogs with AF was 119+/-61 and 91+/-40 per mm(2), respectively, which was significantly (P<0.001) higher than the nerve density in control tissues (10+/-15 and 38+/-39 per mm(2), respectively). Furthermore, in dogs with AF, the right atrium had a significantly higher nerve density than the left atrium. Microscopic examinations revealed an inhomogeneous distribution of cardiac nerves within each sampling site.
Conclusions-Significant nerve sprouting and sympathetic hyperinnervation are present in a canine model of sustained AF produced by prolonged right atrial pacing. magnitude of nerve sprouting and hyperinnervation was higher in the right atrium than in the left atrium.

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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：AMER PHYSIOLOGICAL SOC  

Machine-pulled high-impedance glass capillary microelectrode is standard for transmembrane potential (TMP) recordings. However, it is fragile and difficult to impale, especially in beating myocardial tissues. We hypothesize that a high-impedance pure iridium metal electrode can be used as an alternative to the glass microelectrode for TMP recording. The TMPs were simultaneously recorded from isolated perfused swine right ventricles with a metal microelectrode and a standard glass microelectrode during pacing and during ventricular fibrillation. The basic morphology of TMP recorded with these electrodes was comparable. The action potential duration (APD) at 90% repolarization was 241 +/- 29 ms for the metal microelectrode and 236 +/- 31 ms for the glass microelectrode with a good correlation (r = 0.99, P< 0.0001). The maximum slope value of the APD restitution curves during pacing was also significantly correlated. One metal microelectrode and >20 glass microelectrodes were needed per study. We conclude that, in isolated perfused swine right ventricles, the TMP recorded by the metal microelectrode is comparable with that recorded by the glass microelectrode. Because the metal microelectrode is more durable than the glass microelectrode, it can serve as an alternative for APD recording and for restitution analyses.

DOI： 10.1152/ajpheart.2000.279.6.H3113

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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-The mechanisms by which 60-Hz alternating current (AC) can induce ventricular fibrillation (VF) are unknown.
Methods and Results-We studied 7 isolated perfused swine right ventricles in vitro. The action potential duration restitution curve was determined. Optical mapping techniques were used to determine the patterns of activation on the epicardium during 5-second 60-Hz AC stimulation (10 to 999 mu A). AC captured the right ventricles at 100 +/- 65 mu A, which is significantly lower than the direct current pacing threshold (0.77 +/- 0.45 mA, P<0.05). AC induced ventricular tachycardia or VF at 477 +/- 266 mu A, when the stimulated responses to AC had (1) short activation CLs (128 +/- 14 ms) (2) short diastolic intervals (16 +/- 9 ms), and (3) short diastolic intervals associated with a steep action potential duration restitution curve. Optical mapping studies showed that during rapid ventricular stimulation by AC, a wave front might encounter the refractory tail of an earlier wave front, resulting in the formation of a wave break and VF. Computer simulations reproduced these results.
Conclusions-AC at strengths less than the regular pacing threshold can capture the ventricle at fast rates. Accidental AC leak to the ventricles could precipitate VF and sudden death if AC results in a fast ventricular rate coupled with a steep restitution curve and a nonuniform recovery of excitability of the myocardium.

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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：AMER PHYSIOLOGICAL SOC  

The vulnerability of the infarcted hearts to ventricular fibrillation (VF) was tested in in situ canine hearts during nicotine infusion. The activation pattern was mapped with 477 bipolar electrodes in open-chest anesthetized dogs (n = 8) 5-6 wk after permanent occlusion of the left anterior descending coronary artery. Nicotine (129 +/- 76 ng/ml) lengthened (P< 0.01) the pacing cycle length at which VF was induced from 171 +/- 8.9 to 210 +/- 14.7 ms. Nicotine selectively amplified the magnitude of conduction time and monophasic action potential (MAP) amplitude and duration (MAPA and MAPD, respectively) alternans in the epicardial border zone (EBZ) but not in the normal zone. With critical reduction of the MAPA and MAPD in the EBZ, conduction block occurred across the long axis of the EBZ cells. Block led immediately to reentry formation in the EBZ with a mean period of 105 +/- 10 ms, which, after one to two rotations, degenerated to VF. Nicotine widened the range of diastolic intervals over which the dynamic MAPD restitution curve had a slope >1. We conclude that nicotine facilitates conduction block, reentry, and VF in hearts with healed myocardial infarction by increasing the magnitude of depolarization and repolarization alternans consistent with the restitution hypothesis of vulnerability to VF.

DOI： 10.1152/ajpheart.2000.278.6.H2124

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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  

The factors that contribute to the occurrence of sudden cardiac death (SCD) in patients with chronic myocardial infarction (MI) are not entirely clear. The present study tests the hypothesis that augmented sympathetic nerve regeneration (nerve sprouting) increases the probability of ventricular tachycardia (VT), ventricular fibrillation (VF), and SCD in chronic MI. In dogs with MI and complete atrioventricular (AV) block, we induced cardiac sympathetic nerve sprouting by infusing nerve growth factor (NGF) to the left stellate ganglion (experimental group, n=9). Another 6 dogs with MI and complete AV block but without NGF infusion served as controls (n=6). Immunocytochemical staining revealed a greater magnitude of sympathetic nerve sprouting in the experimental group than in the control group. After MI, all dogs showed spontaneous VT that persisted for 5.8+/-2.0 days (phase 1 VT). Spontaneous VT reappeared 13.1+/-6.0 days after surgery (phase 2 VT). The frequency of phase 2 VT was 10-fold higher in the experimental group (2.0+/-2.0/d) than in the control group (0.2+/-0.2/d, P<0.05). Four dogs in the experimental group but none in the control group died suddenly of spontaneous VF. We conclude that MI results in sympathetic nerve sprouting. NGF infusion to the left stellate ganglion in dogs with chronic MI and AV block augments sympathetic nerve sprouting and creates a high-yield model of spontaneous VT, VF, and SCD. The magnitude of sympathetic nerve sprouting may be an important determinant of SCD in chronic MI.

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PubMed

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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-The role of papillary muscle (PM) in the generation and maintenance of reentry is unclear.
Methods and Results-Computerized mapping (477 bipolar electrodes, 1.6-mm resolution) was performed in fibrillating right ventricles (RVs) of swine in vitro. During ventricular fibrillation (VF), reentrant wave fronts often transiently anchored to the PM. Tissue mass reduction was then performed in 10 RVs until VF converted to ventricular tachycardia (VT), In an additional 6 RVs, procainamide infusion converted VF to VT. Maps showed that 77% (34 of 44) of all VT episodes were associated with a single reentrant wave front anchored to the PM. Purkinje fiber potentials preceded the local myocardial activation, and these potentials were recorded mostly around the PM. When PM was trimmed to the level of endocardium (n = 4), sustained VT was no longer inducible, Transmembrane potential recordings (n = 5) at the PM revealed full action potential during pacing, without evidence of ischemia, Computer simulation studies confirmed the role of PM as a spiral wave anchoring site that stabilized wave conduction.
Conclusions-We conclude that PM is important in the generation and maintenance of reentry during VT and VF.

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PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/107424849900400207

PubMed

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記述言語：日本語  

CiNii Books

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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.25.17

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総ページ数：243  

ASIN

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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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：日本救急医学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

都心部総合病院救急外来を受診した外国人患者の臨床的特徴を調査し、外国人診療における課題を検討した。2017年4月から9月にかけて、日本医科大学付属病院救急・総合診療センターを受診した初診外国人患者158例を対象に、年齢、来院方法、緊急度トリアージ、疾患分類、出身国、在留方法、保険の有無を後方視的に調査した。平均年齢38±16歳、来院方法ではwalk-in 131例(83%)、救急搬送27例(17%)であり、トリアージでは緊急4%、準緊急23%、低緊急50%、非緊急23%であった。疾患分類では感染症22%、消化器疾患11%、外傷8%、精神疾患5%の順であった。出身国では中国41%、韓国13%、ネパール8%、フィリピン8%、アメリカ6%の順であり、在日外国人は83%、健康保険加入率は75%であった。患者は旅行者よりも、在日外国人が多く、健康保険の加入率も高かった。東京オリンピック・パラリンピックに向けて、外国人旅行者の急増が予想される中、医療通訳をはじめ、医療環境整備に取り組んでいく必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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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  

J-GLOBAL

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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  

J-GLOBAL

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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)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

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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)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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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  

Web of Science

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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：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：日本歯内療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

【背景】日本医科大学付属病院総合診療センターは、外傷を含む1・2次救急患者や診療科の特定できない初診患者の診療を主に行っており、2010年度から初期臨床研修医による救急・総合診療研修が必修化された。【目的】研修医教育の取り組みに関するアンケート調査をもとに臨床教育の問題点、課題について検討した。【方法】2011年4月から2014年3月にかけて、当センターをローテイトした1年次初期臨床研修医を対象に研修・教育に関するアンケート調査を行った。【結果・考察】研修内容・教育の総合評価では、満足度は5点満点中平均4.2±0.8点であり、研修前後における救急・総合診療に対する関心度は、研修前3.7±0.8点から研修後4.1±0.5点と有意に増加した(p<0.01)。短期間に幅広い疾患を経験できたことや充実した指導体制が高評価の主因と考えられた。研修医の質を高め、診療レベルの向上を図るために、引き続き効果的な教育方法を導入し、客観的な教育評価を継続する必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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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：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)日本病院総合診療医学会  

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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)日本感染症学会  

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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：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

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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：SPRINGER  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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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：(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)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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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：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)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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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.45.S1_16

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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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77歳女性で、左大腿骨頸部骨折で人工骨頭置換術を受け、退院7日後に呼吸困難および胸痛が出現した。胸部造影CTで両側肺動脈主幹部、下肢静脈エコーで左大腿静脈に血栓が認められた。心エコーでは右房内に索状の巨大浮遊血栓(42mm×35mm)を認め、推定収縮期肺動脈圧は58.1mmHgと肺高血圧を示した。右房内血栓を伴っていたが亜広範型の急性肺塞栓症であり、出血リスクは低いと考え血栓溶解療法を選択した。肺塞栓および循環不全に備えて経皮的心肺補助装置導入用のシースを右大腿動静脈に挿入後、モンテプラーゼ160万単位を全身投与した。投与2時間後の心エコーで右房内血栓に変化はなく、右心負荷所見の改善が認められた。軽度の穿刺部出血で輸血を要したが、未分画ヘパリン静注による抗凝固療法は継続した。第5病日の造影CTで両側肺動脈内の血栓は残存していたが末梢では縮小を認め、右房内血栓は第9病日に消失した。その後、順調に経過し第35病日に退院した。

DOI： 10.11281/shinzo.44.937

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00679&link_issn=&doc_id=20120723250062&doc_link_id=%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.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)日本糖尿病学会  

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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  

単形性心室頻拍によるelectrical storm(VT storm)に対するアミオダロン静注薬の有効性を評価し、アミオダロン不応性VT stormについて検討した。心室性不整脈に対してアミオダロン静注薬が使用された45例中、VT stormを発症した19例を対象とした。虚血性心疾患では、経皮的冠動脈インターベンション(PCI)直後に1例、3日後に2例、13日後に1例でVT stormを発症した。副作用のため経口アミオダロンを中止、もしくは減量していたのは3例で、1例に低カリウム血症を認めた。VT波形を確認できた12例中9例で右脚ブロック型を呈し、残りの3例は左脚ブロック型であった。19例中14例でアミオダロンが有効であった。また、アミオダロン投与による副作用は、徐脈、QT延長をそれぞれ1例ずつに認めた。無効例に対する根治治療のために1例はPCIが、残り4例にカテーテルアブレーションを要した。

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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：(一社)日本内科学会  

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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52歳、男性。繰り返す動悸を自覚し、携帯心電計で周期240msのnarrow QRS頻拍と心房細動を認めたため、アブレーションを行った。両側肺静脈を隔離後、冠静脈洞近位部からのburst pacingでWenckebach型房室ブロックを伴う周期240msの心房頻拍(AT)が誘発され、このATはATP 5mg静注で停止した。AT中のelectroanatomicalマッピングでは、右房はHis束領域が最早期であったが、局所の単極電位にR波を認めた。左房は前壁中隔が最早期であったが同部位での焼灼は無効であった。そこで大動脈弁無冠尖(NCC)にカテーテルを留置したところ、His束領域よりも20msec先行し、単極電位ではQSパターンとなる最早期興奮部位を認めた。ここでの通電中にATから周期350msの非通常型房室結節リエントリー頻拍(AVNRT)へと移行。その後、通常型AVNRTも誘発され遅伝導路領域を焼灼し、これらの頻拍はすべて誘発不能となった。NCC起源ATを認め、その焼灼中にAVNRTへの移行が見られた症例を報告する。(著者抄録)

DOI： 10.11281/shinzo.43.S3_34

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記述言語：日本語   出版者・発行元：日本臨床検査医学会  

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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)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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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：(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62歳、女性。7年前に気管支喘息と皮疹、筋力低下からChurg-Strauss症候群(CSS)と診断された。今回突然の動悸と呼吸困難で受診。頻拍周期280msecの右脚ブロック+左軸偏位型心室頻拍(VT)を認め、直流通電で停止した。超音波検査上左室駆出率21%であり、心筋生検では心内膜の線維化を認めたが、冠動脈に有意狭窄はなかった。電気生理検査を行い左室後中隔に20極電極を留置したところ洞調律中連続的にPurkinje電位(PP)が記録され、PP-QRSは88msecと延長していた。心房および心室ペーシングで非持続性Clinical VTが誘発され、VT中PPはQRSに先行して遠位から近位へ逆行した。三次元マッピングでは中隔および後壁に広くPPが記録され、fragmentしたPPが頻拍中QRSに62msec先行する部位でpacemapが近似し同部位で焼灼を行った。CSSは心内膜心筋炎を合併するが、調べ得るかぎりこれまでにPurkinje線維起源VTの報告はない。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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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] 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：(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  

左室特発性心室頻拍(ILVT)は、verapamilに感受性のある緩徐伝導路を有するマクロリエントリーであり、緩徐伝導路は仮性腱索や乳頭筋に存在することが想定されているが詳細に検討されていない。症例は器質的心疾患のない53歳、男性。Verapamilで停止する右脚ブロック・北西軸型VTのため入院。VT中にCARTOを用いて左室マッピングし、3D-CTとmergeしたところ、拡張期電位(P1)は後中隔、下壁と前側壁に広く分布した。後中隔のP1は、後乳頭筋尖部側より後乳頭筋基部側へとゆっくりと伝導し、乳頭筋基部上で前収縮期電位(P2)へと連続した。P2は左脚後枝領域のみで記録され、左脚後枝を逆行性に早く伝導する一方、後乳頭筋上を基部より尖部へと伝導した。後乳頭筋尖部より後中隔を介し基部へと回帰するリエントリー回路を想定し、乳頭筋尖部で通電したところVTは停止した。後乳頭筋が回路の一部と考えられた。(著者抄録)

DOI： 10.11281/shinzo.42.S4_129

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記述言語：日本語   出版者・発行元：同愛記念病院学術雑誌部  

糖尿病患者227例(男性139例、女性88例、平均63.5歳)を、BMI25以上のO群(85例)、23〜24.9以下のNH群(58例)、22.9以下のNL群(84例)に分け、インスリン抵抗性指標HOMA-R2.5以上の抵抗性あるR群、1.7〜2.4の抵抗性不明のI群、1.6以下の抵抗性のないN群として検討した。平均年齢はO群で若く、HbA1cはNH群で低く、HOMA-RはO群で高値、NL群で低値であった。O群ではR群:47例、I群:13例、N群:25例とR群が半数以上を占め、平均年齢はN群で高く、HbA1c・BMI・糸球体濾過値(eGFR)はN群で低値であった。NH群ではR群:14例、I群:14例、N群:30例とN群が半数を占め、平均年齢・HbA1cはR群で低く、BMI・eGFRは3群同等であった。NL群ではR群:12例、I群:19例、N群:53例とN群が半数以上を占め、平均年齢・HbA1cはR群で高く、BMIはI群で高値、eGFRはR群で低値であった。

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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：(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)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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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：日本歯内療法学会  

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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：日本歯内療法学会  

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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)日本糖尿病学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

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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)日本内科学会  

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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：(公財)日本心臓財団  

症例は76歳、女性。閉塞性肥大型心筋症に対する経皮的中隔心筋焼灼術(PTSMA)施行5年後にVTが出現、MRIでは左室基部〜中部中隔に辺縁不整の瘢痕を認めた。EPSでは心室刺激による誘発と停止が可能な2種類のVTを認めた。VT#1(RBBB+RAD)は左室中隔基部のPTSMAによると思われる低電位領域の前縁に関連する限局した範囲内のマクロリエントリーであり、収縮期電位の最早期部位での通電で誘発不能となった。VT#2(RBBB+LAD)は瘢痕後縁の僧帽弁輪後中隔が最早期のfocal VTパターンを示し、心内膜、CS内通電が無効。僧帽弁形成術中開胸下に心外膜マッピングを施行したところ、心内膜側と同様に後壁僧帽弁輪が最早期のfocal VTパターンを示し、最早期部位の凍結アブレーション中に停止した。術中にVT#1は誘発されず。以後、両VTは誘発不能となった。PTSMA瘢痕に関連するVTをマッピングし根治し得た症例を経験したので報告する。(著者抄録)

DOI： 10.11281/shinzo.41.S4_173

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記述言語：日本語   出版者・発行元：日本臨床検査医学会  

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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：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：(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：(NPO)日本顎咬合学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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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  

DOI： 10.1272/manms.5.74

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その他リンク： http://search.jamas.or.jp/link/ui/2009199043

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  

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：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)日本内科学会  

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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：(公財)日本心臓財団  

症例は合併奇形のない修正大血管転位の36歳、女性。動悸発作のため電気生理学的検査を施行。解剖学的左室刺激で減衰伝導特性を有し冠状静脈洞(CS)入口部が最早期の室房伝導を認めた。順行伝導は2重伝導特性を認めなかった。イソプロテレノール投与下、右室2連期外刺激で周期340msecのlong R-P&#039;頻拍が誘発。頻拍中の心房興奮順序は心室ペーシング時と変化なくヒス束不応期中の心室早期刺激によりリセットされないことより非通常型房室結節リエントリー性頻拍と診断。解剖学的左室刺激中の心房最早期興奮部位であるCS入口部付近の通電で心房興奮順序が変化し頻拍は誘発されなくなった。残存した弱い逆行伝導は右心耳の入口部付近が最早期興奮部位であった。修正大血管転位では前房室結節伝導路(anterior node)と後房室結節伝導路(posterior node)があり通常後者は機能しない。本症例の房室結節リエントリー性頻拍はposterior nodeが関与し、anterior nodeを介する逆行伝導が残存したと考えられる。非通常型房室結節リエントリー性頻拍を合併した修正大血管転位の報告例はなく、考察を加え報告する。(著者抄録)

DOI： 10.11281/shinzo1969.40.Supplement4_5

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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：日本臨床検査医学会  

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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：(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   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  

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71歳、男性。心筋梗塞(後下壁)に対するCABG後、多形性VTとVFを繰り返したためCARTOシステムを用いて左室マッピングを施行。下・後壁〜中隔低の広範囲でQRSに先行するPurkinje電位(PP)が記録され、VT・VFのトリガーとなる3種類のVPCはすべてPurkinje起源であった。PPを選択的に捕捉する2〜3連期外刺激を行うとVTは容易に誘発された。周期270msecのPP捕捉3連刺激中のQRS波形は、1拍目がVPC#3,2拍目がVPC#1に類似し、3拍目はVPC#2波形となりVTが誘発された。また、VPC連発でもVTは開始され、連発中PPはQRSに先行、QRS波形が変化しながらVTに移行した。一方、PP非記録部位の刺激ではVT誘発は困難であった。PP記録部位を広範囲に焼灼したところVPCは消失し、VT誘発性も低下した。VPC連発や連続刺激中のPurkinje網内での伝導時間・伝導方向の変化がVT開始機序として重要であることが示唆された。(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  

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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   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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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：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：英語  

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：(株)ミノファーゲン製薬  

アミオダロンによる重症例、及び軽症例の肝障害を報告した。症例1(重症例)は88歳女性で、アミオダロン投与開始約3年後より肝機能障害が出現した。非代償性肝硬変と診断し、アミオダロンが原因と考え、投与を中止した。アミノレバン点滴静注により意識障害は改善し、肝機能も改善傾向にあった。しかし、その後、腎機能が急激に悪化し、死亡した。アミオダロン積算服用量は66gであった。症例2(軽症例)は61歳女性で、アミオダロン投与開始約2年後より肝機能障害が出現した。グルタミン酸オキザロ酢酸トランスアミナーゼ:200IU/L、グルタミン酸ピルビン酸トランスアミナーゼ:36IU/Lであった。アミオダロンの投与を中止したところ、アミオダロンの血中濃度は徐々に低下した。また、トランスアミナーゼ値は低下傾向を示し、肝機能は、5ヵ月後にはほぼ正常化した。アミオダロン積算服用量は360gであった。アミオダロンの長期投与は重篤な肝障害に陥ることがあり、1〜3ヵ月ごとにトランスアミナーゼ値を測定し、早期に発見することが重要だと考えられた。

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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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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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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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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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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)南江堂  

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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/shinzo1969.39.Supplement1_51

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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74歳、女性。難治性の閉塞性肥大型心筋症に対し経皮的中隔心筋焼灼術を施行。術後一過性に完全房室ブロックとなったが、その後もPR時間延長を伴う右脚ブロックが見られたため電気生理学検査を行った。検査時、洞周期は一定だったが、著明なHV時間の一心拍ごとの交互変化が見られた(90⇔190msec)。心房頻回刺激では刺激周期の短縮に伴いHV時間が正常化し、刺激周期350msecでAHブロックが起きるまで1対1房室伝導を示した。洞調律中に心房期外刺激を加えるとH1H2 900msec以上ではH1H2延長に伴いH2V2が延長し、H1H2 550〜900msecではH2V2は54msecで一定だったが、H1H2 540msec以下ではH1H2短縮に伴いH2V2は再び進行性に延長した。Overdrive suppressionにより一過性に洞周期を延長させるとHVブロックが出現した。propranolol 2mgを静注したところHV時間は正常化し、またH1H2時間に伴う変化も抑制された。本症例の所見から、ヒトの病的刺激伝導系における第4相ブロックの機序につき考察した。(著者抄録)

DOI： 10.11281/shinzo1969.38.Supplement4_95

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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：(株)ヒョーロン・パブリッシャーズ  

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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)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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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  

拡張型心筋症22例をアミオダロン投与群(7例)と非投与群に分け,単球のケモカイン(MPC-1,IL-8)産生量を比較した.投与群でのみMPC-1,IL-8が有意に減少し,心機能が有意に改善された.さらに投与群では心不全の一指標とされるTNF-αの有意な減少が認められた

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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)日本循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本顎咬合学会  

DOI： 10.14399/jacd1999.26.156

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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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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：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/shinzo1969.38.supplement1_10

CiNii Research

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記述言語：日本語   出版者・発行元：(公財)鈴木謙三記念医科学応用研究財団  

Wavelet変換心電図を用いることにより,従来十分な解析が不可能であった様々な基礎疾患(心サルコイドーシス,Brugada症候群,肥大型心筋症,陳旧性心筋梗塞)を持つ致死性不整脈患者において,心電図QRS内部の高周波成分が有する特性を詳細に解析することが可能となった.さらにWavelet変換心電図マッピングを併用することにより,不整脈気質の局在性をより明らかにすることが可能になり,本検査は致死性不整脈の発生源の同定など不整脈治療を行う上での重要な指標になると考えられた

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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  

DOI： 10.11281/shinzo1969.36.Supplement1_8

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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：日本語   出版者・発行元：(公財)日本心臓財団  

74歳女.70歳時に僧帽弁置換術と慢性心房細動に対するradial手術を施行されたが,術後2ヵ月より周期220msの心房頻拍(AT)が持続したため心臓電気生理学的検査(EPS)目的で入院となった.EPSではAT中,冠静脈洞(CS)の興奮順序は遠位から近位であり,CS内広範囲でpost-pacing interval(PPI)が頻拍周期とほぼ一致するconcealed entrainment(CE)を認めたことから僧帽弁輪を回旋するATと考えられた.左房後壁切開線に接合する僧帽弁輪部直下のCS内部に波高の高い電位が記録され,PPIが頻拍周期に一致するCEを認め,同部位への高周波通電開始4秒後に頻拍は停止し以後誘発不能となった.本症例ではradial手術において凍結凝固が完全に行われなかったCS筋層を介する伝導が頻拍発生の原因になったと考えられた

DOI： 10.11281/shinzo1969.37.Supplement4_115

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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：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：(株)ライフ・サイエンス  

アミオダロンを投与した拡張型心筋症7例(男6例・女1例,平均63歳:A群)と非投与の15例(男12例・女3例,平均65歳:B群)を対象に,末梢血より単核球を抽出し,ELISA法により上清液中の炎症性サイトカイン濃度を測定した.その結果,A群では投与開始4週間後のBNP値が投与前に比較して有意に低下していた.単球が産生するTNF-α,IL-6についても,アミオダロン投与前後で有意な減少を認めた.B群ではこれらの有意な変化は認めなかった.また,左室駆出率はA群では有意な改善を認めたが,B群では認めなかった

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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  

64歳男.動悸発作の出現を契機に心電図にてlong RP型頻拍を認め,ATP投与で頻拍は停止した.心房期外刺激で誘発される頻拍であり,最早期興奮はHis束領域であった.また,洞調律時に心室期外刺激により特定の連結期に過剰伝導を認め,逆行性fast pathway伝導も認めた.His束近傍に分裂電位を認め,同部位の通電で頻拍は停止した

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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  

26歳男.動悸発作を契機に先行周期およびQRS波形が微妙に異なる2種類の右脚ブロック・右軸偏位型のQRS波形が交互に出現する頻拍を認めた.VerapamilでQRS波形の変化なしに頻拍周期の差が増大し頻拍が停止した.2つの不整脈は右室頻回刺激で誘発された.電気生理学的に左室前壁に異常放電部位の存在が確認され,同部に通電を行ったところ,頻拍は停止し,以後は誘発されなくなった

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記述言語：日本語   出版者・発行元：(NPO)日本不整脈学会  

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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：(NPO)日本不整脈学会  

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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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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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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：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/shinzo1969.37.Supplement1_33

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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：(公財)日本心臓財団  

66歳女.心電図上II,III,aVfで陰性P波を示すlong RP頻拍を認め心臓電気生理学的検査を施行した.洞調律中の右心室連続刺激および早期刺激でも房室伝導を認めず,冠状静脈洞(Cs)内,開口部から18mmの部位に最早期心房興奮部位を有する周期410msの頻拍が,右心房刺激で容易に誘発された.頻拍中の右心室連続刺激で房室解離を認めたことから,心房頻拍と診断した.この頻拍はATPの5mg急速静注によりAV間隔不変のまま房室ブロックになる前に停止し,最早期興奮部位における高周波通電を施行した.その結果,頻拍は停止するもののその後も誘発され,その度ごとに最早期興奮部位が隣接する位置に移動し,頻拍周期が徐々に延長した.Cs内部および僧帽弁輪下壁側で計18回の通電後には最早期興奮部位はヒス束電位記録部位に至った.最早期の通電を避け,slow pathway領域における高周波通電としたところ通電開始1.5秒で頻拍は停止,接合部調律が出現して,以後誘発不能となった

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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：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：(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：(NPO)日本不整脈学会  

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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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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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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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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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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：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  

Grugada症候群に有効とされる4種類の薬剤(pilsicainide,isoproterenol,quinidine,cilostazole)を5名の患者に投与し,加算平均心電図の変化を調べた.pilsicainideの投与によりf-QRSとLAS40が増加し,RMS40は減少した.isoproterenolの投与によりf-QRSとLAS40は減少傾向,RMS40は増加傾向を示した.cilostazoleでも同様の傾向が認められた.quinidineでは明らかな変化は認められなかった

DOI： 10.11281/shinzo1969.36.Supplement1_8

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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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：(公財)日本心臓財団  

58歳男.僧帽弁形成術施行後の心房粗動(AF)に対しカテーテルアブレーション(RF)を施行した.AFは粗動周期247msec,F波は心電図上II,III,aVFで陰性,V1誘導で陽性であった.AF中の心内マッピングでは心房興奮は三尖弁周囲反時計方向に旋回し,右房解剖学的峡部からの高頻度刺激でconcealed entrainmentが得られ通常型AFと考えられた.三尖弁-下大静脈間の線状焼灼中に頻拍周期は突然延長し,心電図上P波の波形は変化した.冠動脈洞(CS)からヒス束(HBE)の興奮伝播はHBEからCSへ移行したため,isthmusブロックにより非通常型AFに移行したものと考えられた.右房切開線に沿って留置した20極カテーテルにてAF中にdouble potential(DP)が記録され,DPの初期成分は後壁を下降し,後半成分は前壁を上行する興奮伝播様式を呈し,切開線前後及び下方でconcealed entrainmentが得られた.切開線周囲を旋回する頻拍と考え,切開線下端から下大静脈へRFを施行しAFは停止し,アブレーションに成功した

DOI： 10.11281/shinzo1969.35.Supplement4_52

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その他リンク： http://search.jamas.or.jp/link/ui/2004127903

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：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：(NPO)日本不整脈学会  

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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：(NPO)日本不整脈学会  

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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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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：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：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：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：(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：クインテッセンス出版(株)  

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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：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：(NPO)日本不整脈学会  

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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：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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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：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：医学図書出版(株)  

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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：(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：ELSEVIER SCIENCE INC  

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：ELSEVIER SCIENCE INC  

Web of Science

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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  

健常人50名,心室期外収縮患者100名(心室遅延電位(LP)陽性50名,陰性50名)の体表心電図から任意の正常洞調律1心拍を選んでQRS波をウェーブレット変換し,時間周波数解析結果を周波数・時間・パワーの三次元で色別表示した.更に周波数50Hzおよび100Hzにおける高パワー領域持続時間(WD50,WD100)を測定し,加算平均心電図より求めたf-QRSとの相関を調べた.その結果,連続する3心拍の誤差率,ノイズはわずかで,200回加算平均データの解析結果と相似しており,本解析の再現性が示された.WD50はf-QRSと有意な正相関を認め,LP陽性例では内部の波形が不均一でWD50が有意に延長していた.又,WD50異常延長は持続性心室頻拍発生に対して高い感度・特異度・予測精度を示し,本法は心電図微小成分のダイナミックな変化の解析に応用可能であると考えられた

DOI： 10.5105/jse.21.31

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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：日本語   出版者・発行元：(公財)日本心臓財団  

心室性不整脈を有する発症から10日以内のAMI7例を対象とした.塩酸ニフェカラントは,心室性期外収縮に対し7例中4例で有効であった.QT時間は持続投与開始1時間後11.0%延長した.しかしRR間隔,PR時間,QRS幅には変化がなかった.血中未変化体濃度は投与直後1595±715ng/ml,2時間後549±91ng/mlであった.血行動態(Swan-Ganz法)には有意な変化は認めず,むしろPCWPとCIは改善傾向にあった.心原性ショックにリドカイン抵抗性の心室頻拍を伴う一例では,単回静注直後より心室頻拍は消失,持続点滴静注で抑制された.投与後血圧は上昇,RAPは低下し血行動態は改善した

DOI： 10.11281/shinzo1969.32.Supplement5_124

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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：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：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：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：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：FEDERATION AMER SOC EXP BIOL  

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