詳細

栗田　隆志 （クリタ　タカシ）

  • 近畿大学病院　臨床教授
Last Updated :2024/04/25

コミュニケーション情報 byコメンテータガイド

  • コメント

    国立循環器病センター不整脈部門に約25年間勤務しておりました。そこで培った不整脈治療のノウハウ、最新のテクノロジーを近畿大学病院で展開し、多くの患者の皆様から高い評価を頂いています。

  • 報道関連出演・掲載一覧

    ＜報道関連出演・掲載一覧＞ ●2021/2/2 　朝日放送「キャスト」 　清原翔さんが脳内出血を発症されていたことについて ●2020/10/20 　読売テレビ「情報ライブミヤネ屋」 　心不全の診断指標であるBNPについて ●2017/10/18 　朝日新聞 　植え込み型除細動器について

研究者情報

学位

  • 医学博士（2000年09月 福岡大学）

ホームページURL

J-Global ID

現在の研究分野（キーワード）

    国立循環器病センター不整脈部門に約25年間勤務しておりました。そこで培った不整脈治療のノウハウ、最新のテクノロジーを近畿大学病院で展開し、多くの患者の皆様から高い評価を頂いています。

研究分野

  • ライフサイエンス / 循環器内科学

研究活動情報

論文

  • Takashi Kurita
    Journal of cardiovascular electrophysiology 34 6 1367 - 1369 2023年06月
  • Nobuhiko Ueda; Takashi Noda; Kengo Kusano; Satoshi Yasuda; Takashi Kurita; Wataru Shimizu
    JACC. Asia 3 3 335 - 345 2023年06月 
    The effectiveness of primary prevention implantable cardioverter-defibrillators (ICDs) is well established. However, there are several unsolved problems related to ICD use for primary prevention in Asia, including ICD underuse, population differences in underlying heart disease, and the rate of appropriate ICD therapy compared with Western countries. Although the prevalence of ischemic cardiomyopathy in Asia is lower than in Europe and the United States, the mortality rate of Asian patients with ischemic heart disease has been increasing recently. As for the use of ICDs for primary prevention, there have been no randomized clinical trials, and limited data are available in Asia. This review focuses on the unmet needs related to ICD use for primary prevention in Asia.
  • Laurence D Sterns; Angelo Auricchio; Edward J Schloss; Dan Lexcen; Luke Jacobsen; Paul DeGroot; Amy Molan; Takashi Kurita
    Heart rhythm 20 3 479 - 480 2023年03月
  • Laurence D Sterns; Angelo Auricchio; Edward J Schloss; Dan Lexcen; Luke Jacobsen; Paul DeGroot; Amy Molan; Takashi Kurita
    Heart rhythm 20 2 190 - 197 2023年02月 
    BACKGROUND: Antitachycardia pacing (ATP) is an established implantable cardioverter-defibrillator (ICD) therapy that terminates ventricular tachycardias (VTs) without painful ICD shocks. However, factors influencing ATP success are not well understood. OBJECTIVE: The purpose of this study was to examine ATP success rates by patient, device, and programming characteristics. METHODS: This retrospective analysis of the PainFree SmartShock Technology study included spontaneous ATP-treated monomorphic VT episodes. ATP success rates were calculated for various factors. Also, the relationship of ATP programming on shock burden and syncope were investigated. RESULTS: Of the 2770 enrolled patients (2200 [79%] male; mean age 65 years), 1699 (61%) received an ICD and 1071 (39%) a cardiac resynchronization therapy - defibrillator. ATP had >80% rate of success for terminating VTs overall, with similar rates observed between ICD and cardiac resynchronization therapy - defibrillator devices (82.2% vs 80.3%, respectively; P = .81) as well as between primary and secondary prevention patients with ICDs (77.2% vs 83.9% respectively; P = .25). Arrhythmias with a median cycle length of ≥320 ms had a significantly higher ATP success rate (88.0%; 95% confidence interval 84.8%-90.6%). The cumulative percentage of ATP success increased from 71% at 1 ATP sequence delivered to 87% at ≥8 sequences delivered. Programming more ATP sequences was associated with lower shock burden (P = .0005). There was no evidence that more sequences were associated with higher rates of syncope (P = .16). CONCLUSION: Delivering more ATP sequences resulted in a higher overall success of terminating VTs, while programming more ATP was associated with decreased shock burden and no evidence of increased syncope or acceleration. This suggests that more ATP sequences should be programmed when possible, but confirmation in prospective studies will be necessary.
  • Akihiko Nogami; Kyoko Soejima; Itsuro Morishima; Kenichi Hiroshima; Ritsushi Kato; Satoru Sakagami; Fumiharu Miura; Keisuke Okawa; Tetsuya Kimura; Takashi Inoue; Atsushi Takita; Kikuya Uno; Koichiro Kumagai; Takashi Kurita; Masahiko Gosho; Kazutaka Aonuma
    Circulation journal : official journal of the Japanese Circulation Society 87 1 50 - 62 2022年12月 
    BACKGROUND: Optimal periprocedural oral anticoagulant (OAC) therapy before catheter ablation (CA) for atrial fibrillation (AF) and the safety profile of OAC discontinuation during the remote period (from 31 days and up to 1 year after CA) have not been well defined.Methods and Results: The RYOUMA registry is a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017-2018. Of the 3,072 patients, 82.3% received minimally interrupted direct-acting OACs (DOACs) and 10.2% received uninterrupted DOACs. Both uninterrupted and minimally interrupted DOACs were associated with an extremely low thromboembolic event rate. Female, long-standing persistent AF, low creatinine clearance, hepatic disorder, and high intraprocedural heparin dose were independent factors associated with periprocedural major bleeding. At 1 year after CA, DOAC was continued in 55.9% of patients and warfarin in 56.4%. The incidence of thromboembolic and major bleeding events for 1 year was 0.3% and 1.2%, respectively. Age ≥73 years, dementia, and AF recurrence were independently associated with major bleeding events. Univariate analyses revealed that warfarin continuation and off-label overdose of DOACs were risk factors for major bleeding after CA. CONCLUSIONS: High intraprocedural dose of heparin was associated with periprocedural major bleeding events. At 1 year after CA, over half of the patients had continued OAC therapy. Thromboembolic events were extremely low; however, major bleeding occurred in 1.2%. Age ≥73 years, dementia, and AF recurrence were independently associated with major bleeding after CA.
  • Shingo Sasaki; Takashi Noda; Ken Okumura; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    Circulation journal : official journal of the Japanese Circulation Society 87 1 92 - 100 2022年12月 
    BACKGROUND: The prospective observational Nippon Storm Study aggregated clinical data from Japanese patients receiving implantable cardioverter-defibrillator (ICD) therapy. This study investigated the usefulness of prophylactic ICD therapy in patients with non-ischemic heart failure (NIHF) enrolled in the study.Methods and Results: We analyzed 540 NIHF patients with systolic dysfunction (left ventricular ejection fraction <50%). Propensity score matching was used to select patient subgroups for comparison; 126 patients were analyzed in each of the primary (PP) and secondary (SP) prophylaxis groups. The incidence of appropriate ICD therapy during follow-up in the PP and SP groups was 21.4% and 31.7%, respectively (P=0.044). The incidence of electrical storm (ES) was higher in SP than PP patients (P=0.024). Cox proportional hazard analysis revealed that increased serum creatinine in SP patients (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.02-1.33; P=0.013) and anemia in PP patients (HR 0.92; 95% CI 0.86-0.98; P=0.008) increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation in PP patients (HR, 0.64 [95% CI, 0.45-0.91], P=0.013) decreased that likelihood. CONCLUSIONS: In propensity score-matched Japanese NIHF patients, the incidence of appropriate ICD therapy and ES was significantly higher in SP than PP patients. Impaired renal function in SP patients and anemia in PP patients increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation reduced that likelihood in PP patients.
  • Masaomi Kimura; Atsushi Kobori; Junichi Nitta; Kenzo Hirao; Satoshi Shizuta; Takashi Kurita; Kaoru Okishige; Koichiro Kumagai; Junjiro Koyama; Kenichi Hiroshima; Osamu Inaba; Masahiko Goya; Yasuteru Yamauchi; Fred J Kueffer; Daniel Becker; Ken Okumura
    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 64 3 695 - 703 2022年09月 
    PURPOSE: Catheter ablation is a recommended rhythm control therapy after failed or intolerant antiarrhythmic drug (AAD) treatment for patients with atrial fibrillation (AF). This study evaluates clinical performance and safety of pulmonary vein isolation (PVI) using the cryoballoon (Arctic Front Advance) in Japan. METHODS: Cryo AF Global Registry is a prospective, multi-center registry. Patients with paroxysmal AF (PAF) were treated at 10 Japanese hospitals. Efficacy was evaluated by freedom from a ≥ 30-s recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT), AF-related symptoms, and quality of life using the EQ-5D-3L questionnaire. The safety endpoint was serious device- and procedure-related adverse events. RESULTS: The study included 352 patients with PAF (65 ± 10 years of age, 36% female, 36% without prior failure of AAD). Mean duration since first diagnosis of AF was 3.0 ± 5.5 years. Serious device- and procedure-related adverse event rate was 2.6% (95% CI: 1.2-4.8%). Freedom from AF/AFL/AT was 88.5% (95% CI: 84.7-91.4%) at 12 months and 86.7% (95% CI: 81.1-90.8%) at 24 months. The number of patients with ≥ 1 AF symptom was significantly decreased from 88% at enrollment to 22% (p < 0.01) at 12-month follow-up. General quality of life using EQ-5D did not improve significantly after 12 months in the summary score. However, in the visual analog scale score, there was improvement (5.8 ± 18.4; p < 0.01). CONCLUSIONS: This study demonstrates that cryoablation used for PVI is a safe and effective treatment in real-world use for patients with PAF in Japan.
  • Akihiko Nogami; Takashi Kurita; Kengo Kusano; Masahiko Goya; Morio Shoda; Hiroshi Tada; Shigeto Naito; Teiichi Yamane; Masaomi Kimura; Tsuyoshi Shiga; Kyoko Soejima; Takashi Noda; Hiro Yamasaki; Yoshifusa Aizawa; Tohru Ohe; Takeshi Kimura; Shun Kohsaka; Hideo Mitamura
    JOURNAL OF ARRHYTHMIA 38 1 1 - 30 2022年02月
  • Akihiko Nogami; Takashi Kurita; Kengo Kusano; Masahiko Goya; Morio Shoda; Hiroshi Tada; Shigeto Naito; Teiichi Yamane; Masaomi Kimura; Tsuyoshi Shiga; Kyoko Soejima; Takashi Noda; Hiro Yamasaki; Yoshifusa Aizawa; Tohru Ohe; Takeshi Kimura; Shun Kohsaka; Hideo Mitamura
    CIRCULATION JOURNAL 86 2 337 - 363 2022年02月
  • Tomoya Nagano; Ryobun Yasuoka; Motohide Tanaka; Masahiro Maruyama; Gaku Nakazawa; Takashi Kurita
    Journal of cardiology 79 2 283 - 290 2022年02月 
    BACKGROUND: Direct oral anticoagulants (DOACs) have been used to prevent cardiogenic embolism in patients with atrial fibrillation (AF). No evidence has been established for the follow-up renal function evaluation intervals. We hypothesized that a proposed follow-up interval of renal function can be estimated by patient's baseline characteristics including creatinine clearance (CCr). METHODS: We conducted a single-center retrospective study at Kindai University Hospital from May 2011 to December 2017. Patients were screened and they were enrolled if baseline CCr of ≥50 mL/min. To provide a periodical synchronization for measurements of CCr in all patients, these were evaluated at four different time points (approximately at 3, 6, 9, and 12 months). Primary endpoint was defined as a CCr value of <50 mL/min during the follow-up period. We analyzed associations between the cumulative risk for renal endpoint and baseline characteristics by the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: Renal endpoint was associated with age (95% CI: 0.07 to 0.21, p<0.01), body weight (95% CI: -0.09 to -0.01, p<0.01), CCr (95% CI: -0.18 to -0.07, p<0.01), and CHA2DS2-VASc score (95% CI: 0.14 to 0.63, p<0.01). Combining baseline CCr of <60 mL/min and other risk factors, acceptable intervals for 5% risk levels were 78 days (age ≥75 years old), 100 days (CHA2DS2-VASc score of> 4 points), and 90 days (body weight <60kg), respectively. Under conditions of baseline CCr of <60 mL/min, age ≥75 years old, CHA2DS2-VASc score of> 4 points, or body weight <60 kg, an increased risk of renal endpoints is 4.85, 3.29, 1.24, 2.44 fold, respectively. CONCLUSIONS: We propose a risk-stratified follow-up interval for renal evaluation in patients with AF and DOACs therapy according to a combination of baseline CCr and other risk factors.
  • Masaya Watanabe; Hisashi Yokoshiki; Takashi Noda; Isao Yokota; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    International heart journal 62 6 1249 - 1256 2021年11月 
    Electrical storm (ES), defined by 3 or more occurrences of ventricular arrhythmias within 24 hours, has been shown to be associated with an increased risk of mortality; however, detailed information remains lacking. We aimed to examine the incidence and determinants of ES and its impact on mortality in patients enrolled in the nationwide implantable cardioverter-defibrillator (ICD) registry.We studied 1,256 patients (age 65 ± 12 years) who had structural heart disease with an ICD. The patients were classified into reduced ejection fraction (EF < 35%; 657 (52%) patients) and preserved or moderately reduced EF (EF ≥ 35%; 599 (48%) patients).ES occurred in 49 (7%) and 36 (6%) patients in the EF < 35% and EF ≥ 35% groups (log-rank P = 0.297) during the median follow-up of 2.3 years. ICD with resynchronization therapy was associated with a lower incidence of ES in patients with EF < 35%. Non-ischemic heart disease and diuretics were associated with ES in patients with EF ≥ 35%. During the follow-up, 10/49 (20%) patients with ES and 80/608 patients (13%) without ES died in patients with EF < 35%, while 7/36 (19%) patients with ES and 38/563 patients (7%) without ES died in those with EF ≥ 35%. We have created 4 Cox multivariate models. All models showed approximately 2-fold higher hazard ratios in patients with EF ≥ 35% compared to EF < 35%.Our study showed that the determinants of ES differed between EF < 35% and EF ≥ 35%. The impact of ES for mortality was numerically higher in EF ≥ 35% than in EF < 35%, although a significant interaction was not detected.
  • Motohide Tanaka; Ryobun Yasuoka; Tomoya Nagano; Yasuhito Kotake; Masahiro Maruyama; Hiromi Yamamoto; Yoshitaka Iwanaga; Yutaka Hirano; Gaku Nakazawa; Takashi Kurita
    International journal of cardiology. Heart & vasculature 36 100866 - 100866 2021年10月 
    Background: Transesophageal echocardiography (TEE) is currently the gold standard technique for diagnosing left atrial appendage (LAA) thrombi. Cardiac computed tomography (CT) has been expected to become an alternative method to TEE; however, a reliable quantitative evaluation method has not been established. Methods and results: We enrolled 177 patients with persistent atrial fibrillation who underwent both cardiac CT and TEE before catheter ablation. The patients were classified into two groups according to the TEE results: the thrombus group (13 patients) and non-thrombus group (164 patients). The Hounsfield unit (HU) density at the proximal LAA (LAAp) and distal LAA (LAAd) was measured on cardiac CT images. The LAAd/LAAp HU ratio and standard deviation of HU density (HU-SD) at the LAAd were evaluated. We created an algorithm by decision tree analysis to predict LAA thrombus formation using the HU ratio and HU-SD. Definite absence of LAA thrombus (Category-I) was diagnosed for 139 patients by combining the first and second branching of the decision tree (Category-Ia: HU ratio of ≥0.26, Category-Ib: HU ratio of <0.26, HD-SD of ≥26.94). Definite presence of LAA thrombus (Category-Ⅱ) was diagnosed for 3 patients using the third branching of the decision tree (Category-Ⅱ: HU ratio of <0.26 and HU-SD of <13.85). Highly possibility of LAA thrombus (Category-III), but not definite, was diagnosed for the remaining 35 patients; therefore, these patients required diagnostic TEE. The diagnostic accuracy of this algorithm was 0.95. Conclusion: We have proposed a reliable algorithm to diagnose LAA thrombus formation using the HU ratio and HU-SD.
  • Masahiro Maruyama; Ryobun Yasuoka; Tomoya Nagano; Gaku Nakazawa; Takashi Noda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    Journal of cardiology 78 3 244 - 249 2021年09月 
    BACKGROUND: Implantable cardioverter-defibrillator and cardiac resynchronization therapy using a defibrillator (ICD/CRT-D) are established means of reducing mortality due to ventricular arrhythmia. Although atrial fibrillation/flutter (AF) is the most common cardiac arrhythmia in patients with heart disease, the impact of AF on the prognosis of patients with ICD/CRT-D remains controversial. METHODS AND RESULTS: We analyzed data from the Nippon Storm Study, a prospective observational study of 1570 patients that was conducted at 48 Japanese ICD centers. We allocated 1549 participants to AF and non-AF groups, compared their clinical data at the time of enrollment, and monitored the incidences of mortality, hospitalization, and appropriate and inappropriate ICD/CRT-D therapy during a median 28 months. When the AF (n = 257, 16.6%) and non-AF-(n = 1292, 83.4%) groups were compared, the AF group was older (67.7 vs. 61.4 years; p<0.0001), and had lower left ventricular ejection fraction (38.0 ± 17.0% vs. 43.5 ± 18.9%; p<0.0001). During follow up, mortality was significantly higher in the AF than the non-AF group (p<0.0001). In multivariate analysis, AF was significantly associated with all-cause mortality [p = 0.013; hazard ratio (HR)=1.62]. Inappropriate ICD/CRT-D therapy occurred in 40/257 patients (15.6%) and AF was associated with a higher prevalence of inappropriate ICD/CRT-D therapy (p<0.0001; HR=2.25). CONCLUSION: The presence of AF at ICD/CRT-D implantation carries subsequent independent risks of 1.62-fold for death and 2.25-fold for inappropriate therapy.
  • Masaomi Chinushi; Osamu Saitoh; Hiroshi Furushima; Yoshifusa Aizawa; Takashi Noda; Takashi Nitta; Tohru Ohe; Takashi Kurita
    Journal of Arrhythmia 37 4 1038 - 1045 2021年08月 
    BACKGROUND: Anti-tachycardia pacing (ATP) delivered from an implantable device is a useful tool to terminate ventricular tachycardia (VT). But its real-world efficacy for those patients having multiple VTs with varying VT rates has not been fully studied. METHODS: Using the Nippon-storm study database, efficacy of patient-by-patient basis ATP programing for Japanese patients having both non-fast (120-187 bpm) and fast VT (≥188 bpm) was assessed. According to the useful criteria of ≥50% success termination by ATP, patients were divided into three subgroups; success ≥50% for both non-fast and fast VT (both useful), ≥50% only for non-fast VT (non-fast VT useful), or ≥50% for neither non-fast nor fast VT (neither useful). RESULTS: During a median follow-up of 28 months, ATP terminated 184 of the 203 non-fast VT episodes (91%) and 86 of the 113 fast VT episodes (76%) in all 41 patients. In the patient-by-patient analysis, efficacy of ATP was not different between non-fast and fast VT in most of the patients (36/41 = 88%); 32 patients were in the both useful and four other patients in the neither useful. Neither ischemic nor non-ischemic structural heart disease was associated with the ATP efficacy, whereas LVEF more than 37.0% and non-prescribed amiodarone were characteristics of the patients classified into the both useful. CONCLUSIONS: ATP well terminated both non-fast and fast VT occurring in individual Japanese patients with various structural heart diseases in the real-world device treatment and this finding further supports ATP programing for all device tachycardia detection zones in most patients with multiple VTs.
  • Akihiko Nogami; Takashi Kurita; Haruhiko Abe; Kenji Ando; Toshiyuki Ishikawa; Katsuhiko Imai; Akihiko Usui; Kaoru Okishige; Kengo Kusano; Koichiro Kumagai; Masahiko Goya; Yoshinori Kobayashi; Akihiko Shimizu; Wataru Shimizu; Morio Shoda; Naokata Sumitomo; Yoshihiro Seo; Atsushi Takahashi; Hiroshi Tada; Shigeto Naito; Yuji Nakazato; Takashi Nishimura; Takashi Nitta; Shinichi Niwano; Nobuhisa Hagiwara; Yuji Murakawa; Teiichi Yamane; Takeshi Aiba; Koichi Inoue; Yuki Iwasaki; Yasuya Inden; Kikuya Uno; Michio Ogano; Masaomi Kimura; Shun-ichiro Sakamoto; Shingo Sasaki; Kazuhiro Satomi; Tsuyoshi Shiga; Tsugutoshi Suzuki; Yukio Sekiguchi; Kyoko Soejima; Masahiko Takagi; Masaomi Chinushi; Nobuhiro Nishi; Takashi Noda; Hitoshi Hachiya; Masataka Mitsuno; Takeshi Mitsuhashi; Yasushi Miyauchi; Aya Miyazaki; Tomoshige Morimoto; Hiro Yamasaki; Yoshifusa Aizawa; Tohru Ohe; Takeshi Kimura; Kazuo Tanemoto; Hiroyuki Tsutsui; Hideo Mitamura
    JOURNAL OF ARRHYTHMIA 37 4 709 - 870 2021年08月
  • Yoshiaki Kubota; Wan Ting Tay; Tiew-Hwa Katherine Teng; Kuniya Asai; Takashi Noda; Kengo Kusano; Atsushi Suzuki; Nobuhisa Hagiwara; Shinji Hisatake; Takanori Ikeda; Ryobun Yasuoka; Takashi Kurita; Wataru Shimizu
    ESC heart failure 8 5 3791 - 3799 2021年06月 
    AIMS: The number of patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) is increasing in Asia, and these conditions often coexist. We previously revealed a tendency of beta-blocker underuse among patients with HF with reduced ejection fraction (HFrEF) and COPD in Asian countries other than Japan. Here, we evaluated the impact of cardio-selective beta-blocker use on the long-term outcomes of patients with HF and COPD. METHODS AND RESULTS: Among the 5232 patients with HFrEF (left ventricular ejection fraction of <40%) prospectively enrolled from 11 Asian regions in the ASIAN-HF registry, 412 (7.9%) had a history of COPD. We compared the clinical characteristics and long-term outcomes of the patients with HF and COPD according to the use and type of beta-blockers used: cardio-selective beta-blockers (n = 149) vs. non-cardio-selective beta-blockers (n = 124) vs. no beta-blockers (n = 139). The heart rate was higher, and the outcome was poorer in the no beta-blocker group than in the beta-blocker groups. The 2 year all-cause mortality was significantly lower in the non-cardio-selective beta-blocker group than in the no beta-blocker group. Further, the cardiovascular mortality significantly decreased in the non-cardio-selective beta-blocker group before (hazard ratio: 0.36; 95% confidence interval: 0.18-0.73; P = 0.004) and after adjustments (hazard ratio: 0.37; 95% confidence interval: 0.19-0.73; P = 0.005), but not in the cardio-selective beta-blocker group. CONCLUSIONS: Beta-blockers reduced the all-cause mortality of patients with HFrEF and COPD after adjusting for age and heart rate, although the possibility of selection bias could not be completely excluded due to multinational prospective registry.
  • Takashi Nakamura; Mana Okune; Masakazu Yasuda; Heitaro Watanabe; Masafumi Ueno; Kenji Yamaji; Kazuki Mizutani; Takashi Kurita; Gaku Nakazawa
    BMC cardiovascular disorders 21 1 272 - 272 2021年06月 
    BACKGROUND: We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). METHODS: This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups. RESULTS: All patients were diagnosed as having exudative PE by Light's criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light's criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4-26.0] vs 17.4 [IQR, 13.7-26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012). CONCLUSIONS: Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.
  • Nobuhiro Nishii; Takashi Noda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    International journal of cardiology. Heart & vasculature 34 100779 - 100779 2021年06月 
    Introduction: Various risk factors for the first inappropriate implantable cardioverter-defibrillator (ICD) therapy event have been reported, including a history of atrial fibrillation/atrial flutter (AF/AFL), younger age, and multiple zones. Nonetheless, which factors are concordant with real-world data has not been clarified, and risk factors for the second inappropriate ICD therapy event have not been well examined. This study aimed to clarify the risk factors for the first and second inappropriate ICD therapy events. Methods: We conducted a post-hoc secondary analysis of data from a multicenter, prospective observational study (the Nippon Storm Study) designed to clarify the risk factors for electrical storm. Results: The analysis included data from 1549 patients who received ICD or cardiac resynchronization therapy with defibrillator (CRT-D). Over a median follow-up of 28 months, 293 inappropriate ICD therapy events occurred in 153 (10.0%) patients. On multivariate Cox regression analysis, the risk factors for the first inappropriate ICD therapy event were younger age (hazard ratio [HR], 0.986; p = 0.028), AF/AFL (HR, 2.324; p = 0.002), ICD without CRT implantation (HR, 2.377; p = 0.004), and multiple zones (HR, 1.852; p = 0.010). "No-intervention" after the first inappropriate ICD therapy event was the sole risk factor for the second inappropriate ICD therapy event. Conclusions: Risk factors for the first inappropriate ICD therapy event were similar to those previously reported. Immediate intervention after the first inappropriate ICD therapy event could reduce the risk of the second inappropriate event.
  • Hiroshi Hayashi; Wataru Shimizu; Yuki Iwasaki; Kenji Yodogawa; Takashi Noda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    Journal of cardiovascular electrophysiology 32 3 823 - 831 2021年03月 
    INTRODUCTION: Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all-cause mortality have not been fully elucidated. METHODS AND RESULTS: From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all-cause mortality were evaluated. During a median follow-up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00-1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01-1.06; p < .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all-cause mortality compared to those that required shocks during the ES (log-rank p = .10). CONCLUSIONS: ATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.
  • Takashi Kurita
    Circulation journal : official journal of the Japanese Circulation Society 85 3 272 - 274 2021年02月
  • Yasuhito Kotake; Ryobun Yasuoka; Motohide Tanaka; Takashi Noda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Gaku Nakazawa; Takashi Kurita
    International journal of cardiology. Heart & vasculature 32 100704 - 100704 2021年02月 
    Background: Patients with implantable cardioverter defibrillator (ICD) use for primary prevention (primary prevention patients) of sudden cardiac death have lower incidence of appropriate ICD therapy (app-Tx) compared with those with ICD use for secondary prevention (secondary prevention patients). However, detail analysis of a second app-Tx after a first app-Tx is still lacking. Objective: This study aimed to compare the incidence of a second app-Tx in primary vs secondary prevention patients. Methods: We conducted sub-analysis of the Nippon Storm Study, which was a prospective, observational study involving 985 patients with structural heart disease (left ventricular ejection fraction ≤ 50%). Of these, we selected 251 patients (62 ± 14 years old, 82% men) who experienced at least one appropriate ICD therapy, and compared occurrence of a second app-Tx between primary (n = 116) and secondary (n = 135) prevention patients. Results: There was no significant difference in the incidence of a second app-Tx between primary and secondary prevention patients (the cumulative incidence for a second app-Tx was 59% at 1 year and 79% at 3 years in primary prevention patients vs the cumulative incidence for the second app-Tx was 59% at 1 year and 75% at 3 years in secondary prevention patients).Additionally, we evaluated the incidence of a second app-Tx according to basal structural disease (ischemic and non-ischemic cardiomyopathy) and found no significant difference between primary and secondary prevention patients. Conclusion: Once app-Tx occurs, primary prevention patients acquire the high risk of subsequent ventricular arrhythmias because there is a comparable incidence of a second app-Tx in secondary prevention patients.
  • Shinichi Niwano; Haruhiko Abe; Masahiko Takagi; Yukio Sekiguchi; Yu-Ki Iwasaki; Ritsushi Kato; Yusuke Kondo; Takashi Kurita; Takashi Nitta; Akihiko Nogami
    Journal of arrhythmia 37 1 226 - 230 2021年02月 
    Although implantable cardioverter defibrillators (ICDs) are a powerful preventive therapy for cardiac sudden death, there are some populations in whom ICDs cannot be applied because of a lack of a definitive indication (grey-zone patients), such as in patients during the acute phase of cardiac injury with a susceptible risk for lethal arrhythmias. In such patients, wearable cardioverter defibrillators (WCDs) provide safer bridging period during the acute phase until the final decision-making for the ICD use and it may eliminate any inappropriate overuse of ICDs in the subacute phase. The JCS/JHRS practical guidelines provide the criteria for WCD use in Japan. Nevertheless, the evidence for that is totally limited in Japan and is dependent on the accumulation of actual real-world data from other countries in order to be able to discuss the appropriate criteria for WCD use. This study will be conducted retrospectively and/or prospectively, and is an observational and multicenter study among Japanese institutions (J-WCDR, Japan WCD Registry). This will provide evidence for WCD use in our own country and contribute to upcoming updates for the future guideline revisions.
  • Yusuke Kondo; Takashi Noda; Yasunori Sato; Marehiko Ueda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    Heart rhythm O2 2 1 5 - 11 2021年02月 
    Background: The Nippon Storm Study was a prospective observational study designed to gather clinical data on implantable cardioverter-defibrillator (ICD) therapy in Japanese patients. Objective: The purpose of this subanalysis was to compare the incidence of ICD therapy in patients with left ventricular dysfunction owing to coronary artery disease (CAD) for primary and secondary prophylaxis of sudden cardiac death. Methods: We analyzed data of 493 patients with CAD and ICDs (men, 87%; age, 68 ± 10 years; left ventricular ejection fraction, 36% ± 13%; primary prophylaxis, 36%). All patients were followed up for at least 2 years. Propensity score matching was used to select patient subgroups for comparison: 133 patients with ICD for primary prophylaxis and 133 with ICD for secondary indications. Results: There were no significant differences between primary and secondary prophylaxis groups with respect to the incidence of appropriate ICD therapy within 2 years (0.153 vs 0.239; hazard ratio, 1.565 [95% confidence interval (CI), 0.898-2.727]; P = .114). Two-year electrical storm risks were 3.3% and 9.6% with HR = 3.236 (95% CI, 1.058-9.896; P = .039) in patients with primary and secondary prophylaxis, respectively. Conclusion: The incidence of ICD therapy received by patients with CAD for primary and secondary prophylaxis was not significantly different based on our propensity score-matched analysis. However, secondary-prophylaxis ICD therapy seems to be associated with a significantly higher risk for electrical storm than primary-prophylaxis ICD therapy.
  • Mana Okune; Masakazu Yasuda; Naoko Soejima; Kazuyoshi Kakehi; Takayuki Kawamura; Takashi Kurita; Gaku Nakazawa; Yoshitaka Iwanaga
    Frontiers in cardiovascular medicine 8 781125 - 781125 2021年 
    Aims: The clinical impact of the type of atrial fibrillation (AF) has not been completely elucidated in non-ischemic cardiomyopathy (NICM). Although the structure and function of the left atrium (LA) provide prognostic information in patients with heart failure, the relationship of the AF type with LA structure and function in NICM is unclear. Methods: Consecutive patients with NICM who underwent cardiac magnetic resonance were evaluated and followed. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for major adverse cardiovascular events (MACE) related to the AF type, such as paroxysmal AF, chronic AF, and new-onset AF (NOAF). Results: Among 625 patients with NICM (mean age, 64.4 ± 14.2 years; women, 39.7%), 133 had a history of AF at baseline; of these, 60 had paroxysmal AF. Each baseline AF type was associated with higher LA volume and lower LA emptying fraction but not with an increased incidence of MACE (p = 0.245). New-onset AF developed in 5.9% of patients with sinus rhythm over a median follow-up period of 609 days, and maximum LA volume was a strong and independent predictor [p < 0.001, area under the ROC curve (AUC): 0.795]. Maximum LA volume was superior to LA emptying fraction and B-type natriuretic peptide (AUC: 0.683 and 0.680, respectively). The use of β-blocker and the age of the patient were associated with the incidence of NOAF (HR: 0.37, 95% CI: 0.16-0.84 and HR: 1.05, 95% CI: 1.01-1.09, respectively). Kaplan-Meier analysis showed that patients with NOAF had a higher incidence of MACE than those with sinus rhythm or baseline AF (p = 0.002). NOAF and LA emptying fraction were independent predictors of MACE (HR: 2.28, 95% CI: 1.20-3.97 and HR: 0.98, 95% CI: 0.96-0.99, respectively) after adjusting for age, sex, body mass index, and diagnosis. Conclusions: Paroxysmal and chronic AF in patients with NICM were not associated with an increased incidence of MACE despite their association with LA volume and function. NOAF was independently associated with poor prognosis. Higher maximum LA volume predicted the onset and lower LA emptying fraction was independently associated with poor prognosis.
  • Akihiko Nogami; Takashi Kurita; Haruhiko Abe; Kenji Ando; Toshiyuki Ishikawa; Katsuhiko Imai; Akihiko Usui; Kaoru Okishige; Kengo Kusano; Koichiro Kumagai; Masahiko Goya; Yoshinori Kobayashi; Akihiko Shimizu; Wataru Shimizu; Morio Shoda; Naokata Sumitomo; Yoshihiro Seo; Atsushi Takahashi; Hiroshi Tada; Shigeto Naito; Yuji Nakazato; Takashi Nishimura; Takashi Nitta; Shinichi Niwano; Nobuhisa Hagiwara; Yuji Murakawa; Teiichi Yamane; Takeshi Aiba; Koichi Inoue; Yuki Iwasaki; Yasuya Inden; Kikuya Uno; Michio Ogano; Masaomi Kimura; Shun-Ichiro Sakamoto; Shingo Sasaki; Kazuhiro Satomi; Tsuyoshi Shiga; Tsugutoshi Suzuki; Yukio Sekiguchi; Kyoko Soejima; Masahiko Takagi; Masaomi Chinushi; Nobuhiro Nishi; Takashi Noda; Hitoshi Hachiya; Masataka Mitsuno; Takeshi Mitsuhashi; Yasushi Miyauchi; Aya Miyazaki; Tomoshige Morimoto; Hiro Yamasaki; Yoshifusa Aizawa; Tohru Ohe; Takeshi Kimura; Kazuo Tanemoto; Hiroyuki Tsutsui; Hideo Mitamura
    Circulation journal : official journal of the Japanese Circulation Society 85 9 1692 - 1700 2021年
  • 慢性閉塞性肺疾患を合併したうっ血性心不全患者の長期転帰にβ遮断薬が及ぼす影響 ASIAN HF Registry(Impact of Β-blocker on Long-term Outcomes in Congestive Heart Failure Patients with Chronic Obstructive Pulmonary Disease: ASIAN HF Registry)
    久保田 芳明; Wan Ting Tay; 浅井 邦也; 野田 崇; 草野 研吾; 鈴木 敦; 萩原 誠久; 久武 真二; 池田 隆徳; 安岡 良文; 栗田 隆志; Tiew-Hwa Katherine Teng; Inder Anand; Lam Carolyn S.P.; 清水 渉
    日本循環器学会学術集会抄録集 84回 OJ24 - 2 2020年07月
  • 心尖部肥大型心筋症が臨床転帰へ及ぼす影響 心臓MRI所見からの洞察(Impact of Apical Hypertrophic Cardiomyopathy on Clinical Outcomes: Insights from Cardiac Magnetic Resonance Imaging)
    中村 貴; 岩永 善高; 奥根 真楠; 筧 和剛; 河村 尚幸; 栗田 隆志
    日本循環器学会学術集会抄録集 84回 OJ2 - 4 2020年07月
  • 心臓MRI/18F-FDG PETの融合画像による心臓サルコイドーシスの活動性評価(Fusion Imaging of Cardiac Magnetic Resonance/18F-fluorodeoxyglcose Positron Emission Tomography for Assessing Active Cardiac Sarcoidosis)
    副島 奈央子; 安田 昌和; 鍵岡 賛典; 奥根 真楠; 筧 和剛; 河村 尚幸; 栗田 隆志; 岩永 善高
    日本循環器学会学術集会抄録集 84回 PJ14 - 4 2020年07月
  • 慢性閉塞性肺疾患を合併したうっ血性心不全患者の長期転帰にβ遮断薬が及ぼす影響 ASIAN HF Registry(Impact of Β-blocker on Long-term Outcomes in Congestive Heart Failure Patients with Chronic Obstructive Pulmonary Disease: ASIAN HF Registry)
    久保田 芳明; Wan Ting Tay; 浅井 邦也; 野田 崇; 草野 研吾; 鈴木 敦; 萩原 誠久; 久武 真二; 池田 隆徳; 安岡 良文; 栗田 隆志; Tiew-Hwa Katherine Teng; Inder Anand; Lam Carolyn S.P.; 清水 渉
    日本循環器学会学術集会抄録集 84回 OJ24 - 2 2020年07月
  • Masaomi Chinushi; Hiroshi Furushima; Osamu Saitoh; Takashi Noda; Takashi Nitta; Yoshifusa Aizawa; Tohru Ohe; Takashi Kurita
    Pacing and clinical electrophysiology : PACE 43 9 983 - 991 2020年06月 [査読有り]
     
    BACKGROUND: Anti-tachycardia pacing (ATP) delivered from an implantable device is an important tool to terminate ventricular tachycardia (VT). But its real-world efficacy for fast VT has not been fully studied. METHODS: Using the database of Nippon-storm study, effect of patient-by-patient basis ATP programming for fast VT (≥ 188 bpm) was assessed for the patients with structural heart diseases. Fast VTs were divided into three groups depending on HR; Group-A was 188-209 bpm, and Group-B and Group-C were 210-239 bpm and ≥ 240 bpm, respectively. RESULTS: During a median follow-up of 28 months, 202 fast VT episodes (209±19 bpm) were demonstrated in the 85 patients. ATP terminated 151 of the 202 episodes (74.8%) in total. The success rate of the ATP was not different among the three groups; 73.3% in Group-A, 80.6% in Group-B and 66.7% in Group-C. ATP success rate of more than 50% and more than 70% was 77.6% and 64.7% of the patients, respectively. LVEF was significantly higher in the patients with rather than without successful ATP therapy, and ROC analysis revealed that LVEF of 23% was the optimal cut-off value. ATP was less effective in patients taking amiodarone, but etiology of the structural heart diseases, indication of the device implantation and all ECG parameters were not useful predictors for successful ATP therapy. CONCLUSIONS: ATP highly terminated fast VT with wide HR-ranges in patients with structural heart diseases, and should be considered as the first line therapy for fast VT except for patients with very low LVEF. This article is protected by copyright. All rights reserved.
  • Kenji Yamaji; Kazuhiro Kobuke; Takero Matsuura; Masakazu Yasuda; Masafumi Ueno; Takashi Kurita; Yoshitaka Iwanaga
    Journal of Cardiology Cases 2020年06月 [査読有り]
  • Can a New Algorithm of Cardiac Resynchronization Therapy (Adaptive CRT) Expand Its Utility?
    栗田 隆志
    Ciruculation Journal 84 11 - 12 2020年01月 [査読有り]
  • 心房頻拍に対して経大動脈アプローチのカテーテルアブレーション中に急性心筋梗塞を発症した1例
    筧 和剛; 上野 雅史; 山田 信広; 船内 陽平; 永野 兼也; 河村 尚幸; 丸山 将広; 安田 昌和; 山治 憲司; 岩永 善高; 栗田 隆志
    日本冠疾患学会誌 Suppl.2019 171 - 171 (NPO)日本冠疾患学会 2019年12月
  • 重症急性心筋梗塞に挑む 急性心筋梗塞症の治療の現状と今後の課題 当院での症例から考える
    上野 雅史; 岩永 善高; 栗田 隆志
    日本心臓病学会学術集会抄録 67回 S - 3 (一社)日本心臓病学会 2019年09月
  • 台風21号による関西国際空港閉鎖、連絡橋タンカー船衝突事故時に発症した急性肺血栓塞栓症の一例
    船内 陽平; 山治 憲司; 河村 尚幸; 渡邉 平太郎; 高瀬 徹; 上野 雅史; 平野 豊; 岩永 善高; 栗田 隆志
    日本心臓病学会学術集会抄録 67回 P - 083 (一社)日本心臓病学会 2019年09月
  • TAVI後にNOACとAspiring投与下で弁血栓に伴う脳梗塞をきたした一例
    安田 昌和; 上野 雅史; 藤井 公輔; 山本 裕美; 岩永 善高; 坂口 元一; 栗田 隆志
    日本心血管インターベンション治療学会抄録集 28回 [MP38 - 005] 2019年09月
  • Kawamura T; Iwanaga Y; Nakamura T; Yasuda M; Kurita T; Miyazaki S
    Internal medicine (Tokyo, Japan) 58 14 2041 - 2044 2019年07月 [査読有り]
     
    An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.
  • ASIAN HF Registryからの高齢者における左室駆出率が低下した心不全(Heart Failure with Reduced Ejection Fraction in the Elderly from ASIAN HF Registry)
    久保田 芳明; 浅井 邦也; Tay Wan Ting; 中島 育太郎; 野田 崇; 草野 研吾; 萩原 誠久; 池田 隆徳; 栗田 隆志; Teng Tiew-Hwa Katherine; Anand Inder; Lam Carolyn S.P.; 清水 渉
    日本循環器学会学術集会抄録集 83回 PJ097 - 2 2019年03月
  • 植込み型除細動器使用患者において心房細動が死亡に及ぼす影響 NIPPON Storm試験からのサブ解析(Impact of Atrial Fibrillation on Mortality in Patients with Implantable Cardioverter Defibrillators: Sub-analysis from the NIPPON Storm Study)
    丸山 将広; 安岡 良文; 栗田 隆志; 野田 崇; 新田 隆; 相澤 義房; 大江 透
    日本循環器学会学術集会抄録集 83回 OJ35 - 6 2019年03月
  • 電気的ストームを呈する患者における抗頻脈ペーシングの有効性 NIPPON STORM STUDY(The Effectiveness of Antitachycardia Pacing in Patients with Electrical Storm: The NIPPON STORM STUDY)
    Hayashi Hiroshi; Hachisuka Masato; Mimuro Rei; Maru Yujin; Fujimoto Yuhi; Oka Eiichiro; Hagiwara Kanako; Yamamoto Teppei; Yodogawa Kenji; Iwasaki Yuki; Shimizu Wataru; Noda Takashi; Nitta Takashi; Aizawa Yoshifusa; Ohe Tohru; Kurita Takashi
    日本循環器学会学術集会抄録集 83回 FRS10 - 2 2019年03月
  • 不整脈非薬物治療ガイドライン
    栗田 隆志
    Ciruculation Journal 2019年03月 [査読有り]
  • Maruyama M; Kurita T; Kotake Y; Hashiguchi N; Yasuoka R; Ueno M; Iwanaga Y; Miyazaki S
    Journal of cardiology cases 19 2 66 - 69 2019年02月 [査読有り]
     
    Catheter ablation (CA) targeting premature ventricular contraction (PVC) from Purkinje fibers can be an effective therapy for refractory ventricular fibrillation (VF) after myocardial infarction (MI). We experienced two cases in which catheter ablation targeting PVC initiating VF after percutaneous coronary intervention (PCI) in post-MI patients was effective despite transient early recurrences of VF. The first patient (a 68-year-old woman with MI) developed drug-refractory VF 3 days after PCI to the left anterior descending artery (LAD) and left circumflex artery. CA targeting Purkinje potential preceding PVC at the infarcted area eliminated both the PVCs and VF. Three days after the procedure, the VF attacks relapsed by a different type of PVC. However, the VF responded to conventional treatments and disappeared thereafter. In the second patient (an 83-year-old woman with old MI), refractory VF attacks occurred after PCI to the LAD. CA targeting Purkinje potential preceding two distinct types of PVC successfully suppressed the VF. Although the VF relapsed 2 days after CA, it was suppressed by conventional treatment and disappeared the next day. .
  • Kurita T; Ando K; Ueda M; Shizuta S; Okamura H; Matsumoto N; Gerritse B; Fagan DH; Schloss EJ; Meijer A; Auricchio A; Sterns LD; Okumura K
    Pacing Clin Electrophysiol. 21 2018年06月 [査読有り]
  • Samuel F. Sears; Lindsey Rosman; Shingo Sasaki; Yusuke Kondo; Laurence D. Sterns; Edward J. Schloss; Takashi Kurita; Albert Meijer; Judith Raijmakers; Bart Gerritse; Angelo Auricchio
    Heart Rhythm 15 5 734 - 740 2018年05月 [査読有り]
     
    Background: The effect of implantable cardioverter-defibrillator (ICD) shock on device-measured activity and patient-reported outcomes is unknown. Objective: The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data (ie, device-based physical activity) and subjective patient-reported outcomes (eg, quality of life and shock anxiety). Methods: The PainFree Smart Shock Technology (SST) clinical trial included 2770 patients with a single- or dual-chamber ICD or cardiac resynchronization therapy – defibrillator device who were followed for 22 ± 9 months. Participants completed measures of quality of life (EuroQol-5D [EQ-5D] questionnaire) and shock anxiety (Florida Shock Anxiety Scale) at baseline, biannual visits, and monthly for 6 months after an ICD shock. Daily physical activity data were obtained from a built-in device accelerometer. Results: The average daily activity was 185.3 ± 119.4 min/d. Activity was significantly reduced after an ICD shock (P < .0001) and recovered to a normal level after ∼90 days. An ICD shock was also associated with decreased quality of life (EQ5-D health score) and increased EQ-5D anxiety scores, but it did not affect mobility, self-care, activity, or pain. Similarly, shock anxiety (Florida Shock Anxiety Scale) increased in shocked patients and remained significantly elevated at 24 months, regardless of appropriate or inappropriate shock delivery. Conclusion: ICD shocks have a long-lasting adverse effect on both objective, device-measured physical activity and subjective patient-reported outcomes of quality of life and shock anxiety. Successful management of patients with an ICD requires attention to clinically relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living.
  • Noda T; Kurita T; Nitta T; Chiba Y; Furushima H; Matsumoto N; Toyoshima T; Shimizu A; Mitamura H; Okumura K; Ohe T; Aizawa Y
    Int J Cardiol 2018年05月 [査読有り]
  • Kubota Y; Tay WT; Asai K; Murai K; Nakajima I; Hagiwara N; Ikeda T; Kurita T; Teng TK; Anand I; Lam CSP; Shimizu W; ASIA-HF Study investigators
    ESC heart failure 5 2 297 - 305 2018年04月 [査読有り]
     
    AIMS: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are increasingly frequent in Asia and commonly coexist in patients. However, the prevalence of COPD among Asian patients with HF and its impact on HF treatment are unclear. METHODS AND RESULTS: We compared clinical characteristics and treatment approaches between patients with or without a history of COPD, before and after 1:2 propensity matching (for age, sex, geographical region, income level, and ethnic group) in 5232 prospectively recruited patients with HF and reduced ejection fraction (HFrEF, <40%) from 11 Asian regions (Northeast Asia: South Korea, Japan, Taiwan, Hong Kong, and China; South Asia: India; Southeast Asia: Thailand, Malaysia, Philippines, Indonesia, and Singapore). Among the 5232 patients with HFrEF, a history of COPD was present in 8.3% (n = 434), with significant variation in geography (11.0% in Northeast Asia vs. 4.7% in South Asia), regional income level (9.7% in high income vs. 5.8% in low income), and ethnicity (17.0% in Filipinos vs. 5.2% in Indians) (all P < 0.05). Use of mineralocorticoid receptor antagonists and diuretics was similar between groups, while usage of all β-blockers was lower in the COPD group than in the non-COPD group in the overall (66.3% vs. 79.9%) and propensity-matched cohorts (66.3% vs. 81.7%) (all P < 0.05). A striking exception was the Japanese cohort in which β-blocker use was high in COPD and non-COPD patients (95.2% vs. 91.2%). CONCLUSIONS: The prevalence of COPD in HFrEF varied across Asia and was related to underuse of β-blockers, except in Japan.
  • Takashi Kurita; Ryobun Yasuoka
    Catheter Ablation: A Current Approach on Cardiac Arrhythmias 269 - 281 2018年01月 [査読有り]
  • Shinichi Niwano; Yukio Sekiguchi; Yosuke Ishii; Yuki Iwasaki; Ritsushi Kato; Hideo Okamura; Masahiko Takagi; Takashi Kurita; Takashi Nitta
    Circulation Journal 82 6 1481 - 1486 2018年 [査読有り]
     
    Prevention of sudden cardiac death (SCD) has become an important issue in today’s cardiovascular field, together with various developments in secondary prevention of basic cardiac diseases. The importance of the implantable cardioverter defibrillator (ICD) is now widely accepted because it has exhibited significant improvement in patients’ prognoses in ischemic and non-ischemic cardiovascular diseases. However, there is an unignorable gap between the ICD indication in the guidelines and real-world high-risk patients for SCD, especially in the acute recovery phase of cardiac injury. Although various studies have demonstrated a clinical benefit of defibrillation devices, the studies of immediate ICD use in the acute recovery phase have failed to exhibit a benefit in patients from the point of the view of a decrease in total deaths. To bridge this gap, the wearable cardioverter defibrillator (WCD) provides a safer observation period in the acute phase and eliminates inappropriate overuse of ICD in the subacute phase. Here, we discuss the usefulness of the WCD and current understanding of its indications based on various clinical data. In conclusion, WCD is a feasible bridge to therapy and/or safe observation for patients at high risk of SCD, especially in the acute recovery phase of cardiac diseases.
  • Angelo Auricchio; J. Harrison Hudnall; Edward J. Schloss; Laurence D. Sterns; Takashi Kurita; Albert Meijer; Dedra H. Fagan; Tyson Rogers
    EUROPACE 19 12 1973 - 1980 2017年12月 [査読有り]
     
    Aims Single-chamber (VR-ICD) and subcutaneous (S-ICD) implantable cardioverter-defibrillators are effective to protect patients against sudden death but expose them to higher risk of inappropriate shock (IS). We sought to quantify the annual rate and influencing factors of ISs in VR- and S-ICDs from the literature. Methods and results PubMed, Embase, and Cochrane Library were searched for full text articles with IS rates. Poisson distribution estimated proportion of patients with ISs; rates were annualized based on follow-up duration. Random effects meta-analysis accounted for study-to-study variation. Out of 3264 articles, 16 qualified for the meta-analysis. Across studies, 6.4% [95% confidence interval (CI) 5.1-7.9%] of patients received an IS per year. Meta-regression analyses demonstrated that IS rates were lower in more recent studies [rate ratio (RR) per year: 0.93, 95% CI: 0.87-0.98; P = 0.01] and trended lower in studies with longer follow-up (RR per year: 0.78, 95% CI: 0.60-1.01; P = 0.06). Use of S-ICDs (RR: 1.81, 95% CI: 0.86-3.81; P = 0.12) and ventricular tachycardia zone programmed on (RR: 1.13, 95% CI: 0.65-1.97; P = 0.66) were not associated with a significantly increased change in risk. The IS rate observed in one of the more recent studies was significantly lower than predicted after accounting for covariates (RR: 0.29, 95% CI: 0.14-0.60; P<0.001). Conclusions A comprehensive review of the literature shows that 6.4% of patients with ICDs experienced their first IS annually. One of the 16 studies was better than predicted with the lowest reported rate (1.9%) and could not be explained by timing of the study or other covariates.
  • Eiichi Watanabe; Katsunori Okajima; Akira Shimane; Tomoya Ozawa; Tetsuyuki Manaka; Itsuro Morishima; Toru Asai; Masahiko Takagi; Toshihiro Honda; Atsunobu Kasai; Eitaro Fujii; Kohei Yamashiro; Ritsuko Kohno; Haruhiko Abe; Takashi Noda; Takashi Kurita; Shigeyuki Watanabe; Hiroya Ohmori; Takashi Nitta; Yoshifusa Aizawa; Ken Kiyono; Ken Okumura
    JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 49 3 271 - 280 2017年09月 [査読有り]
     
    Purpose Patients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions. Methods Inappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold. Results Of the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 +/- 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 +/- 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively. Conclusions We found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits.
  • Takashi Kurita
    Early Repolarization Syndrome: Etiology and Therapeutics 85 - 96 2017年08月 [査読有り]
     
    The role of an implantable cardioverter-defibrillator (ICD) in patients with ERS still needs to be considered, since there have been no prospective, randomized studies that have examined the effect of ICDs compared with antiarrhythmic drugs in patients with ERS and ventricular fibrillation (VF). However, theoretically, ICDs must be the first-line strategy for patients with ERS because ICDs are effective in patients with a high risk of sudden cardiac death, regardless of underlying heart disease. An essential problem of ICDs is that they cannot prevent the occurrence of tachycardia attacks, and this limits their clinical usefulness. Especially during an electrical storm, it induces multiple shocks to terminate VF and may deteriorate the patients' outcome. Another unresolved problem of ICDs is inappropriate therapy which demonstrated a 10-20% incidence in the previous large clinical trials. To program relatively high tachycardia detection rate and long detection rate are possible strategy to reduce risks of inappropriate and unnecessary ICD shocks. Another attractive capability of ICD is that it stores electrograms during the episode of VF. Analyzing the mode of onset or electrocardiographic manifestations at the episodes of ventricular arrhythmia is an effective strategy to clarify the underlying mechanism of ER and VF.
  • Ryobun Yasuoka; Takashi Kurita; Yasuhito Kotake; Yuzuru Akaiwa; Naotaka Hashiguchi; Koichiro Motoki; Hiromi Yamamoto; Kazuhiro Kobuke; Yoshitaka Iwanaga; Yutaka Hirano; Shunichi Miyazaki
    HEART AND VESSELS 32 7 893 - 901 2017年07月 [査読有り]
     
    Low blood flow velocity in the left atrial appendage (LAA) indicates a high risk of thromboembolism. Although transesophageal echocardiography (TEE) has been the standard method with which to evaluate the LAA blood flow velocity, a clinically noninvasive method is desired. We hypothesized that the ratio of the Hounsfield unit (HU) density at two distinct points within the LAA represents the blood flow velocity in the LAA. We retrospectively investigated 60 consecutive patients with atrial fibrillation (paroxysmal type, n = 29) who underwent enhanced computed tomography (CT) and TEE. The peak emptying flow velocity in the LAA (LAAPV) was evaluated using TEE. HU density was measured at proximal and distal sites of the LAA (LAAp and LAAd) on CT images. The LAAd/LAAp ratio was correlated with the LAAPV (P < 0.01, r = 0.69). Among several indices, the HU ratio was the most significant parameter associated with the LAAPV (beta = 0.469, CI 28.602-68.286, P < 0.001). Receiver-operating characteristic analysis (area under the curve, 0.91) demonstrated that an HU density ratio cutoff of 0.32 discriminated a low LAAPV (< 25 cm/s) with sensitivity of 90% and specificity of 84%. Flow velocity of the LAA can be estimated by the HU density ratio at distal and proximal sites within the LAA. Our method might be a feasible substitution for TEE to discriminate patients with a reduced LAAPV.
  • Ryobun Yasuoka; Takashi Kurita; Yasuhito Kotake; Naotaka Hashiguchi; Koichiro Motoki; Kazuhiro Kobuke; Yoshitaka Iwanaga; Shunichi Miyazaki
    CIRCULATION JOURNAL 81 5 668 - 674 2017年05月 [査読有り]
     
    Background: The CRYO-Japan PMS study indicated that cryoballoon ablation (Cryo-Abl) has a lower acute success rate of pulmonary vein isolation (PVI) for the right and left inferior PVs (RIPV and LIPV, respectively) than for the superior PVs. This study aimed to determine if the orientation and position of the inferior PVs are related to the difficulty of acute success of PVI. Methods and Results: We investigated 30 consecutive patients who underwent Cryo-Abl. A "difficult PV" was defined as the requirement for >2 cooling applications and/or touch-up ablation to achieve PVI. We measured the ventral angle between the vertical line and the direction of each PV trunk (PV angle) on the transverse plane of enhanced CT images. PV position was defined as the difference in the levels between the bottom of the RIPVs and the non-coronary cusp of the aorta. PV angle <105 and PV position <1.250 mm were independent factors of difficult RIPV isolation (PV angle: odds ratio (OR)=23.80, confidence interval (Cl) 3.15528 to -0.53622, P=0.002; PV position: OR=12.14, Cl -2.77301 to -0.23160, P=0.014). PV position <16.875mm was also related to the difficulty of LIPV isolation (OR=5.78, CI -1.77095 to -0.09474, P=0.027). Conclusions: RIPV with ventral orientation may require difficult maneuvers to advance an ablation system towards it. Low take-off of the inferior PVs may cause non-coaxial configuration of balloon catheters towards the direction of these veins.
  • Naotaka Hashiguchi; Takashi Kurita; Shunichi Miyazaki
    EUROPACE 19 5 733  2017年05月 [査読有り]
  • ペースメーカー植込み患者における心臓機能障害グレードの再評価 前向き多施設共同JHRSレジストリの中間解析(Reassessment of Grade of Cardiac Disability in Patients with Implanted Pacemakers: Interim Analysis of the Prospective, Multicenter JHRS Registry)
    安部 治彦; 奥村 謙; 清水 昭彦; 栗田 隆志; 中里 祐二; 草野 研吾; 新田 隆; 平尾 見三
    日本循環器学会学術集会抄録集 81回 OJ - 130 2017年03月
  • 心サルコイドーシスの脚ブロックおよびQRS分裂がもつ臨床的重要性(Clinical Significance of Bundle Branch Block and Fragmented QRS in Cardiac Sarcoidosis)
    丸山 将広; 岩永 善高; 鍵岡 賛典; 藤田 晃輔; 河村 尚幸; 中村 貴; 安田 昌和; 栗田 隆志; 宮崎 俊一
    日本循環器学会学術集会抄録集 81回 PJ - 158 2017年03月
  • 橋口 直貴; 小竹 康仁; 赤岩 譲; 安岡 良文; 元木 康一郎; 栗田 隆志; 宮崎 俊一
    心臓 48 Suppl.2 64 - 64 (公財)日本心臓財団 2016年12月
  • Ryobun Yasuoka; Takashi Kurita; Yasuhito Kotake; Naotaka Hashiguchi; Koichiro Motoki; Shunichi Miyazaki
    Journal of Cardiology Cases 14 5 133 - 135 2016年11月 [査読有り]
     
    Cardiac memory is an electrocardiographic manifestation of transient T wave abnormalities, which is observed after abrupt interruption of abnormal ventricular activation. We report a case with preexisting complete left bundle branch block in whom cardiac memory was induced. This cardiac memory was induced by normalization of QRS morphology after development of complete atrioventricular block due to acute inferior myocardial infarction. < Learning objective: Although T wave inversion can often be seen in acute coronary syndrome, cardiac memory might create unusual changes of T wave morphologies in the case with preexisting left bundle branch block. Premature beats arising from upstream of abnormal conduction site produced equalization of bi-ventricular activation in a case of preexisting complete left bundle branch block. This may cause normalization of the QRS complex and cardiac memory (T wave inversion).>
  • Sousuke Sugimura; Takashi Kurita; Kazuaki Kaitani; Ryobun Yasuoka; Shunichi Miyazaki
    HEART AND VESSELS 31 9 1562 - 1569 2016年09月 [査読有り]
     
    Episodes of atrial fibrillation (AF) are mainly initiated by triggers from pulmonary veins (PVs). The superior vena cava (SVC) has been identified as a second major substrate of non-PV foci, but the electrophysiologic features of the SVC have not been fully investigated. We hypothesized that SVC ectopies are suppressed by predominant features of PV ectopies and tend to appear after PV isolation (PVI). We evaluated the electrophysiological characteristics and clinical implications of SVC ectopies in patients with AF during catheter ablation using high-dose isoproterenol and the atrial overdrive pacing maneuver. The manifestation patterns and modes of onset (coupling interval and appearance interval) of ectopies from both the PVs and SVC were investigated. 205 patients were enrolled [153 males and 52 females; mean age 64 +/- A 10 years; paroxysmal in 143 patients (69.8 %), persistent in 40 (19.5 %), and long-standing persistent in 22 patients (10.7 %)]. Before PVI, PV ectopies were detected in 182/205 patients (89 %). SVC ectopies were rarely observed before PVI but were significantly more frequent after the completion of PVI (3/205 vs. 14/205 patients, p = 0.011). The coupling interval (CI) and % CI (CI/preceding the A-A interval x 100) of PV ectopies were significantly shorter than those of SVC ectopies (211 +/- A 78 vs. 282 +/- A 106 ms, p = 0.021, and 34 +/- A 9 vs. 51 +/- A 17 %, p < 0.001, respectively). The appearance intervals of the PV ectopies were shorter than those of the SVC ectopies (6.3 +/- A 4.0 vs. 10.7 +/- A 6.7 s, p = 0.030). During repeat procedures, PVs with reconnection to the left atrium were less frequently observed in patients with SVC firing than in patients without SVC firing (1.7 +/- A 1.5 vs. 2.9 +/- A 1.1 PVs, p = 0.029). We demonstrated that PVI tends to manifest SVC ectopies with less spontaneous activity and that an elimination of predominant ectopies from the PVs may affect appearance of SVC ectopy.
  • 橋口 直貴; 栗田 隆志
    成人病と生活習慣病 46 8 1041 - 1045 (株)東京医学社 2016年08月 
    植込み型除細動器(ICD)の有効性は多くの大規模臨床試験で証明されているが、皮下植込み型除細動器(S-ICD)や着用型除細動器(WCD)といった新しいデバイスも使用可能となり、除細動治療の選択肢が増えてきた。ショック作動を減らすためのデバイス治療設定や頻拍鑑別プログラムも進歩してきている。遠隔モニタリングによるフォローアップや条件付きMRI対応デバイスも普及してきた。両心室ペーシングにおけるnon-responderを減らすためにペーシング設定のoptimizationが重要であるが、4極リードの使用、多点ペーシング、デバイス独自のoptimization法などを用いることで、より効率的な両心室ペーシングが施行できる可能性がある。(著者抄録)
  • Takashi Kurita
    Journal of Arrhythmia 32 4 245 - 246 2016年08月 [査読有り]
  • Laurence D. Sterns; Mathias Meine; Takashi Kurita; Albert Meijer; Angelo Auricchio; Kenji Ando; Charles T. Leng; Ken Okumura; John L. Sapp; Mark L. Brown; Daniel R. Lexcen; Bart Gerritse; Edward J. Schloss
    HEART RHYTHM 13 7 1489 - 1496 2016年07月 [査読有り]
     
    BACKGROUND Prolonged ventricular fibrillation (VF) detection has been shown to reduce implantable cardioverter-defibrillator (ICD) therapies and improve prognosis in primary prevention ICD patients. Data in secondary prevention patients are limited. OBJECTIVE The PainFree SST secondary prevention study is the largest trial of secondary prevention patients randomized between standard and prolonged detection to assess the safety of this strategy in these patients. METHODS A total of 705 secondary prevention patients implanted with an ICD in the Pain Free SST trial were enrolled in this substudy; 353 patients were randomized to VF detection of 18/24 intervals and 352 patients to 30/40. All other VF parameters were standardized by protocol. RESULTS The 1-year arrhythmic syncope-free rates in the standard and prolonged groups were 97.7% vs 96.9%, respectively, (P = .0034 for noninferiority). Freedom from all-cause syncope was 96% in both arms (P = .0013 for noninferiority). There was no difference in the time to first appropriate or inappropriate VF therapy. However, the rates of treated VF episodes were lower in the prolonged arm (1.48 per patient per year vs 0.44 per patient per year, P = .0001). A trend toward lower mortality in the prolonged group was not statistically different (5.6% 1 year, 12% 2 years vs 3.8% 1 year, 7.7% 2 years, adjusted hazard ratio = 0.60, P = .061). CONCLUSION This large prospective randomized study shows that prolonged detection can safely be programmed in secondary prevention ICD patients with new or existing devices. This programming strategy decreases the rate of treated events and is not associated with an increased risk of syncope or mortality.
  • Masakazu Yasuda; Yoshitaka Iwanaga; Takao Kato; Toshiaki Izumi; Yasutaka Inuzuka; Takashi Nakamura; Yuki Miyaji; Takayuki Kawamura; Shigeru Ikeguchi; Moriaki Inoko; Takashi Kurita; Shunichi Miyazaki
    Open Heart 3 2 2016年07月 [査読有り]
     
    Background The presence of myocardial fibrosis by cardiac MRI has prognostic value in cardiac sarcoidosis, and localisation may be equally relevant to clinical outcomes. Objective We aimed to analyse cardiac damage and function in detail and explore the relationship with clinical outcomes in patients with cardiac sarcoidosis using cardiac MRI. Methods We included 81 consecutive patients with cardiac sarcoidosis undergoing cardiac MR. Left ventricular mass and fibrosis mass were calculated, and localisation was analysed using a 17-segment model. Participants underwent follow-up through 2015, and the development of major adverse cardiac events including ventricular tachyarrhythmias was recorded. Results Increased left ventricular fibrosis mass was associated with increased prevalence of ventricular tachyarrhythmias (p< 0.001). When localisation was defined as the sum of late gadolinium enhancement in the left ventricular basal anterior and basal anteroseptal areas, or the right ventricular area, it was associated with ventricular tachyarrhythmias (p< 0.001). Kaplan-Meier analysis during a median follow-up of 22.1â €..months showed that both the mass and localisation groupings for fibrosis were significantly associated with major adverse cardiac events or ventricular tachyarrhythmias and that when combined, the risk stratification was better than for each variable alone (p< 0.001, respectively). By Cox-proportional hazard risk analysis, the localisation grouping was an independent predictor for the both. Conclusions In patients with cardiac sarcoidosis, both fibrosis mass and its localisation to the basal anterior/anteroseptal left ventricle, or right ventricle was associated with the development of major adverse cardiac events or ventricular tachyarrhythmias. Cardiac MR with late gadolinium enhancement may be useful for improving risk stratification in patients with cardiac sarcoidosis.
  • Yoshiyasu Aizawa; Seiji Takatsuki; Yoshiaki Kaneko; Takashi Noda; Yoshinori Katsumata; Takahiko Nishiyama; Takehiro Kimura; Nobuhiro Nishiyama; Kotaro Fukumoto; Shinichi Niwano; Takashi Kurita; Takeshi Mitsuhashi; Shiro Kamakura; Akihiko Shimizu; Minoru Horie; Yoshifusa Aizawa; Keiichi Fukuda
    International journal of cardiology. Heart & vasculature 11 104 - 110 2016年06月 [査読有り]
     
    In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.
  • 橋口 直貴; 栗田 隆志
    Heart View 20 5 468 - 476 (株)メジカルビュー社 2016年05月
  • 非虚血性心筋症におけるICD留置後予後の差異
    河村 尚幸; 岩永 善高; 宮地 佑希; 安田 昌和; 中村 貴; 安岡 良文; 元木 康一郎; 栗田 隆志; 宮崎 俊一
    日本内科学会雑誌 105 臨増 159 - 159 (一社)日本内科学会 2016年02月
  • 栗田 隆志
    心臓 48 9 1002 - 1006 公益財団法人 日本心臓財団 2016年
  • Keisuke Shioji; Takashi Kurita; Takafumi Kawai; Takashi Uegaito; Koichiro Motoki; Mitsuo Matsuda; Shunichi Miyazaki
    INTERNAL MEDICINE 55 9 1121 - 1124 2016年 [査読有り]
     
    We herein describe an adult case of double-chambered right ventricle (DCRV) with symptomatic drug-intolerant paroxysmal atrial fibrillation (PAf). The woman was referred to undergo radiofrequency ablation (RFA), and mapping of the pulmonary veins (PVs) demonstrated that a spontaneous spike potential originating from the left inferior PV (LIPV) induced sustained Af in the second procedure. Accordingly, the LIPV was regarded as the arrhythmogenic PV. Since complete isolation of the PVs, the sinus rhythm has been maintained for at least two years. This is the first report to describe that RFA for drug-intolerant PAf was useful in a patient with DCRV.
  • Masaki Fuyuta; Shinichi Nakao; Atsuhiro Kitaura; Tatsushige Iwamoto; Shinichi Hamasaki; Shouhei Iwasaki; Takashi Kurita
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 29 6 1533 - 1536 2015年12月 [査読有り]
     
    Objective: To evaluate the preoperative prevalence of each type of J-wave syndrome electrocardiographic pattern and its association with perioperative cardiac events. Design: Retrospective study. Setting: Single hospital university study. Participants: The study evaluated 930 patients who underwent gynecologic, abdominal, neurosurgical, orthopedic, and urologic surgeries. Interventions: Preoperative standard 12-lead electrocardiogram (ECG) monitoring was performed, and each type of J-wave syndrome ECG pattern types 1, 2, and 3 and Brugada syndrome-type was evaluated. Incidence of perioperative cardiac events was investigated up to 1 year postoperatively using an electronic medical record system. Measurements and Main Results: Data from 789 patients were included in the final study. Of these, 16 patients (2.0%) had J-wave syndrome: 7 patients (0.9%) had type-1 patterns; 5 patients (0.6%) had type-2 patterns; 2 patients (0.3%) had type-3 patterns; and 2 patients (0.3%) had Brugada syndrome-type ECG patterns. A J-point elevation >= 0.2 mV, which is considered to be more dangerous, was found in only 2 patients with Brugada syndrome-type ECG patterns, both of whom suffered perioperative lethal arrhythmias. Conclusion: Patients with J-wave syndrome ECG patterns, even dangerous patterns, are not necessarily associated with a higher risk of perioperative cardiac events. However, Brugada syndrome type ECG patterns should be carefully monitored. (C) 2015 Elsevier Inc. All rights reserved.
  • Yasuhito Kotake; Takashi Kurita; Yuzuru Akaiwa; Ryobun Yasuoka; Koichiro Motoki; Kazuhiro Kobuke; Yoshitaka Lwanaga; Shunichi Miyazaki
    JOURNAL OF CARDIOLOGY 66 1-2 161 - 167 2015年07月 [査読有り]
     
    Background: The most critical adverse effects of class Ill drugs are marked QT prolongation and torsade de pointes. Even though intravenous amiodarone (iv-Amio) is a representative class Ill drug, it peculiarly inhibits both clinical ventricular tachycardia/fibrillation (VT/VF) and proarrhythmic effects. To test the hypothesis that iv-Amio homogeneously prolongs repolarization, we evaluated electrocardiographic changes before and during short-term amiodarone therapy, focusing closely on the ventricular dispersion of repolarization. Methods: Twenty-seven consecutive patients treated with iv-Amio for VT/VF as a first-line antiarrhythmic therapy were enrolled in this study. Twelve-lead electrocardiography was recorded before and during amiodarone therapy to evaluate the following electrocardiographic intervals: R-R, QRS, QT, QRS to T-peak (QTp), and T-peak to T-end (Tp-e; as an index of dispersion of repolarization). Repolarization indices were corrected to the heart rate by Bazett's method (QTc, c-QTp, c-Tp-e). Results: Amiodarone suppressed VT/VF in 19/27 (70%) patients without conferring any proarrhythmic effect. The QTc, c-QTp, and R-R interval were significantly prolonged during amiodarone (476 +/- 45 ms vs 511 +/- 45 ms, p < 0.05; 338 +/- 40 ms vs 364 35 ms, p < 0.05; 762 +/- 272 ms vs 870 189 ms, p < 0.05; respectively), whereas the c-Tp-e and QRS durations did not change significantly (139 33 ms vs 145 +/- 41 ms, p = 0.25; 96 +/- 20 ms vs 97 +/- 21 ms, p = 0.33; respectively). Conclusions: Iv-Amio homogeneously prolongs repolarization and properly inhibits original VT/VF recurrence without inducing torsade de pointes. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Angelo Auricchio; Edward J. Schloss; Takashi Kurita; Albert Meijer; Bart Gerritse; Steven Zweibel; Faisal M. AlSmadi; Charles T. Leng; Laurence D. Sterns
    HEART RHYTHM 12 5 926 - 936 2015年05月 [査読有り]
     
    BACKGROUND The benefits of implantable cardioverterdefibrillators (ICDs) have been well demonstrated in many clinical trials, and ICD shocks for ventricular tachyarrhythmias save Lives. However, inappropriate and unnecessary shock delivery remains a significant clinical issue with considerable consequences for patients and the healthcare system. OBJECTIVE The purpose of the PainFree SmartShock Technology (SST) study was to investigate new-generation ICDs to reduce inappropriate and unnecessary shocks through novel discrimination algorithms with modern programming strategies. METHODS This prospective, multicenter clinical trial enrolled 2790 patients with approved indication for ICD implantation (79% male, mean age 65 years; 69 /a primary prevention indication, 27% singlechamber ICD, 33% replacement or upgrade). Patients were followed for a minimum of 12 months, and mean follow-up was 22 months. The primary end-point of the study was the percentage of patients remaining free of inappropriate shocks at 1 year postimplant, analyzed separately for dual/triple-chamber ICDs (N = 2019) and single-chamber ICDs (N = 751). RESULTS The inappropriate shock rate at 1 year was 1.5% for patients with dual/triple-chamber ICDs and 2.5% for patients with single-chamber devices. Two years postimplant, the inappropriate shock rate was 2.8% for patients with dual-/triple chamber ICDs and 3.7% for those with single-chamber ICDs. The most common cause of an inappropriate shock in both groups was atrial fibrillation or flutter. CONCLUSION In a large patient cohort receiving ICDs for primary or secondary prevention, the adoption of novel enhanced detection algorithms in conjunction with routine implementation of modern programming strategies Led to a very Low inappropriate shock rate.
  • Akihiko Shimizu; Takeshi Mitsuhashi; Takashi Nitta; Hideo Mitamura; Takashi Kurita; Haruhiko Abe; Yuji Nakazato; Naokata Sumitomo; Kazushige Kadota; Kazuo Kimura; Ken Okumura
    Journal of Arrhythmia 31 2 83 - 87 2015年04月 [査読有り]
     
    Background There is little information regarding appropriate therapies for coronary artery disease (CAD) patients with implantable devices - such as implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy devices (CRT-Ds) and cardiac resynchronization therapy pacemaker (CRT-P) devices - in Japan. To address this lack of information, we have launched the Japan Implantable Devices in Coronary Artery Disease (JID-CAD) study. Methods This study has been designed as a prospective, multicenter, non-randomized and observational investigation. All patients will be followed up every six months over a two-year period. The primary endpoint will be the administration of appropriate device therapy. Secondary endpoints include administration of inappropriate therapy, death, hospitalization, or cardiovascular events. Conclusion In this report, we discuss the current clinical situation of appropriate therapy, and how it is influenced by catheter ablation and revascularization therapy in patients with CAD.
  • 栗田 隆志; 野田 崇
    心電図 35 3 219 - 226 一般社団法人 日本不整脈心電学会 2015年 
    【目的】NIPPON Storm Studyはショックデバイス機器植込み症例に生じる特異的な病態，electrical storm（E-storm）を明らかにすべく企画された登録試験であり，2014年6月にフォローアップが終了した．【結果】1,570例が登録され，平均年齢は62±14歳，男性が78％，一次予防目的が47％，二次予防目的が53％，ICDが68％，CRT-Dが32％であった．基礎心疾患は虚血性心疾患が31％，非虚血性拡張型心筋症が23％，肥大型心筋症が13％，Brugada症候群が9％で，平均左室駆出率は43±19％であった．追跡可能であった1,549例において（平均806日追跡），適切作動が351例（22.7％）に，E-stormが97例（6.3％）に認められた．適切作動，E-stormともに一次予防患者に比して，二次予防において有意に高かった（143/731 vs. 208/818 ; p=0.0023, 29/731 vs. 68/818 ; p=0.0004）．作動の発生率は虚血性心疾患に比べて，拡張型心筋症で有意に高かったが（90/486 vs. 94/347 ; p=0.0056），E-stormの発生率は虚血性心疾患と拡張型心筋症，ICDとCRT-D間で差は認められなかった（24/486 vs. 19/347 ; p=0.78，63/1,048 vs. 34/501 ; p=0.49）．E-stormの有無で2群に分けた検討では，E-storm群は非E-storm群に比して，有意に二次予防適応が多く（68/97 vs. 750/1,452, p＜0.002），左室駆出率が低く（38±16 vs. 43±17, p＜0.005），QRS幅が広かった（136±40 vs. 126±31, p＜0.03）．【結語】NIPPON Storm Studyでは，100例を超えるE-stormの症例が収集され，今後の詳細な解析により，その病態が明らかにされる．
  • Yoshiaki Kaneko; Minoru Horie; Shinichi Niwano; Kengo F. Kusano; Seiji Takatsuki; Takashi Kurita; Takeshi Mitsuhashi; Tadashi Nakajima; Tadanobu Irie; Kanae Hasegawa; Takashi Noda; Shiro Kamakura; Yoshiyasu Aizawa; Ryobun Yasuoka; Katsumi Torigoe; Hiroshi Suzuki; Toru Ohe; Akihiko Shimizu; Keiichi Fukuda; Masahiko Kurabayashi; Yoshifusa Aizawa
    CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY 7 6 1122 - 1128 2014年12月 [査読有り]
     
    Background-Electrical storms (ESs) in patients with Brugada syndrome (BrS) are rare though potentially lethal. Methods and Results-We studied 22 men with BrS and ES, defined as >= 3 episodes/d of ventricular fibrillation (VF) and compared their characteristics with those of 110 age-matched, control men with BrS without ES. BrS was diagnosed by a spontaneous or drug-induced type 1 pattern on the ECG in the absence of structural heart disease. Early repolarization (ER) was diagnosed by J waves, ie, >0.1 mV notches or slurs of the terminal portion of the QRS complex. The BrS ECG pattern was provoked with pilsicainide. A spontaneous type I ECG pattern, J waves, and horizontal/descending ST elevation were found, respectively, in 77%, 36%, and 88% of patients with ES, versus 28% (P<0.0001), 9% (P=0.003), and 60% (P=0.06) of controls. The J-wave amplitude was significantly higher in patients with than without ES (P=0.03). VF occurred during undisturbed sinus rhythm in 14 of 19 patients (74%), and ES were controlled by isoproterenol administration. All patients with ES received an implantable cardioverter defibrillator and over a 6.0 +/- 5.4 years follow-up, the prognosis of patients with ES was significantly worse than that of patients without ES. Bepridil was effective in preventing VF in 6 patients. Conclusions-A high prevalence of ER was found in a subgroup of patients with BrS associated with ES. ES appeared to be suppressed by isoproterenol or quinidine, whereas bepridil and quinidine were effective in the long-term prevention of VF in the highest-risk patients.
  • Takashi Noda; Takashi Kurita; Takashi Nitta; Haruhiko Abe; Shigeyuki Watanabe; Hiroshi Furushima; Naoki Matsumoto; Takeshi Toyoshima; Akihiko Shimizu; Hideo Mitamura; Tohru Ohe; Yoshifusa Aizawa
    CIRCULATION JOURNAL 78 8 1989 - + 2014年08月 [査読有り]
     
    Background: Little is known regarding the appropriate duration for driving restrictions after inappropriate implantable cardiac shock device (ICSD) therapy. Methods and Results: We evaluated the Nippon Storm Study data, and found that inappropriate ICSD therapy occurred in 114 (7.6%) patients during a median follow-up of 464 days. Among those patients, 25 experienced further inappropriate ICSD therapy during a subsequent median follow-up of 380 days. Time-dependent recurrence of inappropriate ICSD therapy occurred in 19 (76%) patients within 180 days. Conclusions: The interval for driving restrictions after inappropriate ICSD therapy can be reduced.
  • Asamura S; Kurita T; Motoki K; Yasuoka R; Hashimoto T; Isogai N
    Eplasty 14 e40  2014年 [査読有り]
     
    BACKGROUND: A common complication associated with implantable cardiac electrical device implantation compromises skin lesions caused by overstretching just above a buried device that is relatively large in size. Apart from affecting the cosmetic appearance in some patients, a compromised blood supply to the skin may also lead to ischemic necrosis, which is an important complication. We describe a novel procedure for the implantation of implantable cardiac electrical devices generators under the pectoralis major muscle to avoid such skin-related complications. METHODS: Twenty-one patients were referred to plastic surgeon for surgical support for the secondary replacement of implantable cardiac electrical devices. In all cases, the leads and devices had been implanted under the skin. We decided to perform device implantation under the pectoralis major muscle, which was highly recommended in all these patients. RESULTS: In Japan, leanness is determined on the basis of body mass index less than 18.5, and 11 patients out of 21 (52%) were considered to be lean. The surgeon's participation in the procedure for implantable cardiac electrical device implantation did not exceed 5 minutes in total. CONCLUSIONS: We consider that the novel method of sub-pectoralis major muscle device implantation described here minimizes the risk of the skin breakdown and improves the patient's quality of life.
  • Masaki Fuyuta; Shinichi Nakao; Noriko Takai; Mayuka Shiba; Yuko Tanaka; Tatsushige Iwamoto; Takashi Kurita
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 27 6 1334 - 1336 2013年12月 [査読有り]
  • Electrical stormにどう対応するか
    栗田 隆志
    Circulation Up-to-Date Circulation Up-to-Date 8 4 62 - 69 メディカ出版 2013年08月 
    医局論文番号534
  • Takigawa M; Kiso K; Noda T; Kurita T; Yamada Y; Okamura H; Satomi K; Suyama K; Aihara N; Nanasato M; Hirayama H; Kamakura S; Shimizu W; Ishida Y
    Annals of nuclear medicine 27 5 407 - 415 2013年06月 [査読有り]
     
    BACKGROUND: Although several predictors of an electrical storm (ES) are indicated in patients with idiopathic dilated cardiomyopathy (IDCM), whether the severity of the myocardial tissue damage (SMTD) evaluated by myocardial perfusion SPECT (MPS) has an association with an ES remains unclear. The purpose of this study was to elucidate the clinical significance of SMTD for the prediction of ES in IDCM patients with an ICD. METHODS: Thirty-seven (27 men, mean age 58 ± 15 years) IDCM patients receiving ICD implantations for secondary prevention with preoperative MPS were enrolled in this study. The medical history, physical and laboratory findings, electrocardiograms, echocardiograms and MPS findings were evaluated. The SMTD was assessed by the summed scores of 17 segments using a 4-point system (0, normal ~3, severe defect). RESULTS: During a mean follow-up of 43.9 ± 30.7 months, an ES developed in 12/37 (32.4 %) patients. The SMTD score predicted an ES with a 92 % sensitivity and 56 % specificity, at a cut-off score of 10. In addition, a multivariate analysis showed that the SMTD score remained an independent predictor of an ES (HR 1.09/score 1 increase, 95 % CI 1.01-1.19, p = 0.02). The SMTD score was significantly associated with three indices of late potentials on the signal-averaged electrocardiograms, and was significantly higher in patients with positive late potentials (p = 0.0006). CONCLUSION: SMTD score assessed by MPS has a strong correlation to the late potentials and higher SMTD score may increase the risk of ES among patients with IDCM and an ICD.
  • 不整脈から心不全へ，よくなる新機能：心臓ペースメーカと心臓再同期療法
    安岡 良文; 栗田 隆志
    レジデントノート 15 1 74 - 83 羊土社 2013年04月 
    医局論文番号526
  • 期外収縮
    栗田 隆志; 宮崎 俊一
    医学と薬学 69 4 575 - 579 自然科学社 2013年04月 
    医局登録番号 529
  • 症例検討：陳旧性心筋梗塞患者に合併した重症心室頻拍ストームに対して緊急アブレーションが奏功した１例
    藤田 晃輔; 赤岩 譲; 栗田 隆志; 小竹 康仁; 磯野 員理; 安田 昌和; 野並 有紗; 安岡 良文; 小林 直也; 生田 新一郎; 元木 康一郎; 谷口 貢; 宮崎 俊一
    Osaka Heart Club Osaka Heart Club 36 9 6 - 12 大阪ハートクラブ 2013年03月 
    医局論文番号524
  • デバイス関連不整脈
    栗田 隆志
    不整脈概論 専門医になるためのエッセンシャルブック 406 - 413 メジカルビュー社 2013年02月 
    医局論文番号523
  • Yoshifusa Aizawa; 栗田 隆志; Kazutaka Aonuma; Makoto Hirai; Yoshito Iesaka; Hiroshi Inoue; Toshiyuki Ishikawa; Shiro Kamakura; Takao Kato; Youichi Kobayashi; Yoshio Kosakai; Koichiro Kumagai; Yuji Nakazato; Ken Okumura; Morio Shoda; Kaoru Sugi; Naokata Sumitomo; Seiji Takatsuki; Ken Takayanagi; Ichiro Watanabe
    Circulation Journal 77 2 497 - 518 日本循環器学会 2013年02月 
    医局登録番号 535
  • 栗田 隆志
    日本心電学会誌 心電図 32 4 400 - 409 日本心電学会 2012年12月 
    医局論文番号522
  • 安岡 良文; 栗田 隆志; 小竹 康仁; 赤岩 譲; 野並 有紗; 元木 康一郎; 宮崎 俊一
    心臓 44 (*)3 69 - 73 西村書店 2012年12月 
    医局登録番号 512

    第44巻（SUPPL.3）号69-73頁
  • Sudden Cardiac Arrest During General Anesthesia in an Undiagnosed Burugada Patient
    Masaaki Furuta; 栗田 隆志; Shinichi Nakao; Noriko Takai; Mayuka Shiba; Yuko Tanaka; Tatsushige Iwamoto
    Journal of Cardiothoracic and Vascular Anesthesia 26 5 ELSEVIER 2012年10月 
    医局登録番号 513
  • 栗田 隆志
    呼吸と循環：2012：60(5):525-531 60 5 525 - 531 医学書院 2012年05月 
    医局登録番号 495
  • 慢性心不全例におけるICD,CRT-Dの１次予防効果
    栗田 隆志
    月刊 循環器 CIRCULATION 2 4 94 - 103 医学出版 2012年04月 
    医局登録番号 490
  • Koichiro Motoki; Takashi Kurita; Ryobun Yasuoka; Shunichi Miyazaki
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 23 4 436 - 439 2012年04月 [査読有り]
     
    Double Chamber Tachycardias Originating from the Aortic Sinus of Valsalva. Monomorphic ventricular tachycardia is basically a benign phenomenon in patients without structural heart disease. The focal source of the tachycardia is usually located in the right ventricular outflow tract and more rarely in the left ventricular outflow tract. Aortic sinus of Valsalva (ASV) is a well-known source of atrial and ventricular tachycardias. We report a case with simultaneous existence of sustained atrial and ventricular tachycardias originating from ASV, which was successfully treated with radiofrequency catheter ablation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 436-439, April 2012)
  • 栗田 隆志
    近畿大学医学雑誌 37 1,2 81 - 85 近畿大学医学会 2012年03月 
    医局登録番号 493
  • Takashi Kurita
    CIRCULATION JOURNAL 76 3 582 - 583 2012年03月 [査読有り]
  • 栗田 隆志
    臨床雑誌「内科」 109 1 83 - 88 南江堂 2012年01月 
    医局登録番号 484
  • Akihiko Shimizu; Takashi Nitta; Takashi Kurita; Katsuhiko Imai; Yoshinori Kobayashi; Kyouko Soejima; Shinnichi Niwano; Shigeyuki Watanabe; Harushiko Abe; Yoshifusa Aizawa; Ken Okumura
    Journal of Arrhythmia 28 5 263 - 272 2012年 [査読有り]
     
    Purpose: The aim of this study was to describe the recent conditions associated with implantable defibrillation therapy for individual underlying heart diseases. Methods: Ten thousand six hundred and five patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds) that were implanted from 2006 to 2010 were selected from the Japan Cardiac Device Therapy Registry database. They were divided into 12 disease categories and further divided into either primary or secondary prevention of sudden cardiac death. Results: The major underlying diseases of the patients in this cohort were ischemic heart disease (IHD, 35%), dilated cardiomyopathy (DCM, 25%), hypertrophic cardiomyopathy (HCM, 8%), and Brugada syndrome (Brugada, 8%). There were no structural heart diseases in this cohort the incidence of IHD was relatively lower than that of western countries, while the incidence of cardiomyopathy was higher. The percentage of primary prevention (% primary) among the individual diseases varied. IHD was the most prevalent underlying condition in the patient cohort however, the % primary was 33%, which was relatively lower than that of the other structural heart diseases. The % primary was relatively higher in patients with DCM (57%) and Brugada (47%). Over 5 years, the % primary gradually increased in patients with DCM, IHD, and HCM, with a particularly dramatic increase in those with DCM. A decrease in the % primary among patients with Brugada began in 2008. Conclusions: In patients that underwent implantable defibrillation therapy, there was a relatively lower % primary in the IHD group, and a substantial increase in the % primary in patients with DCM. © 2012 Japanese Heart Rhythm Society.
  • Takashi Kurita; Takashi Noda; Takashi Nitta; Hiroshi Furushima; Akihiko Shimizu; Tohru Ohe; Yoshifusa Aizawa; Yasutaka Chiba
    Journal of Arrhythmia 28 5 277 - 279 2012年 [査読有り]
     
    An understanding of the clinical aspects of electrical storm (E-storms) in patients with implantable cardiac shock devices (ICSDs: ICDs or cardiac resynchronization therapy with defibrillator [CRT-D]) may provide important information for clinical management of patients with ICSDs. The Nippon Storm Study was organized by the Japanese Heart Rhythm Society (JHRS) and Japanese Society of Electrocardiology and was designed to prospectively collect a variety of data from patients with ICSDs, with a focus on the incidence of E-storms and clinical conditions for the occurrence of an E-storm. Forty main ICSD centers in Japan are participating in the present study. From 2002, the JHRS began to collect ICSD patient data using website registration (termed Japanese cardiac defibrillator therapy registration, or JCDTR). This investigation aims to collect data on and investigate the general parameters of patients with ICSDs, such as clinical backgrounds of the patients, purposes of implantation, complications during the implantation procedure, and incidence of appropriate and inappropriate therapies from the ICSD. The Nippon Storm Study was planned as a sub-study of the JCDTR with focus on E-storms. We aim to achieve registration of more than 1000 ICSD patients and complete follow-up data collection, with the assumption of a 5-10% incidence of E-storms during the 2-year follow-up. © 2012 Japanese Heart Rhythm Society.
  • 虚血性心筋症に対するICDの現状と展望
    栗田 隆志
    日本臨牀 69 9 462 - 487 日本臨牀社 2011年11月 
    医局登録番号474
  • 不整脈の非薬物治療：その適応と限界を知る
    安岡 良文; 栗田 隆志
    Heart View Heart View 15 12 192 - 195 メジカルビュー社 2011年11月 
    医局登録番号 473
  • 不整脈の非薬物治療：その適応と限界を知る
    安岡 良文; 栗田 隆志
    Heart View Heart View 15 12 192 - 195 メジカルビュー社 2011年11月 
    医局登録番号 473
  • Takashi Kurita; Takashi Noda; Takeshi Aiba; Ikutaro Nakajima; Wataru Shimizu; Koichiro Motoki; Ryobun Yasuoka; Shunichi Miyazaki; Shiro Kamakura
    JOURNAL OF ELECTROCARDIOLOGY 44 6 736 - 741 2011年11月 [査読有り]
     
    Various clinical data demonstrate that cardiac resynchronization therapy (CRT) provides a favorable structural as well as electrical remodeling. The CArdiac Resynchronization-Heart Failure study, which tested the pure effect of CRT (using CRT devices without the capability of defibrillation) clearly showed a significant reduction in the total mortality by partly preventing sudden cardiac death. The antiarrhythmic effects of CRT are explained, at least in part, by ionic and genetic modulation of ventricular myocytes. It has been revealed in animal experiments to mimic disorganized ventricular contraction that CRT reverses down-regulation of certain K(+) channels and abnormal Ca(2+) homeostasis in the failing heart. However, CRT can be proarrhythmic in some particular cases especially in the early phase of this therapy. According to our study, proarrhythmic effects after CRT can be observed in approximately 10% of patients. The relatively high incidence of the proarrhythmic effects of CRT may promote a trend toward selecting CRT-D rather than CRT-P. (C) 2011 Elsevier Inc. All rights reserved.
  • Toru Kinugawa; Takashi Kurita; Ryuji Nohara; Michael L. Smith
    INTERNATIONAL HEART JOURNAL 52 6 398 - 400 2011年11月 [査読有り]
     
    A 33-year-old Japanese man with atrial tachycardia visited our clinic. He regularly consumed daily alcohol with cola, one cup of regular coffee, and a candy containing 0.7 mg of caffeine per tablet. After stopping his caffeine intake, his arrhythmia ameliorated. Since caffeine might be associated with his arrhythmia, a caffeine load test (equivalent to his daily intake of caffeine) was performed for 4 days. Atrial tachycardia time from a Holter recording was 44.2 minute/day before the caffeine load, compared with 215.2 minute/day during the caffeine load. Plasma caffeine concentration before and during caffeine loading was 3.1 mg/dL and 5.4 mg/dL, respectively. Caffeine use seemed to be an important factor for his atrial tachycardia, since his arrhythmia became worse during caffeine load testing and was ameliorated after the cessation of caffeine. (Int Heart J 2011; 52: 398-400)
  • Kurita T
    Nihon rinsho. Japanese journal of clinical medicine 69 Suppl 9 462 - 467 2011年11月 [査読有り]
  • 栗田 隆志
    心臓 43 10 1303 - 1309 日本心臓財団 2011年10月 
    医局登録番号 472
  • Angelo Auricchio; Albert Meijer; Takashi Kurita; Edward Schloss; Karin Brinkman; Marieke Claessens-van Ooijen; Laurence Sterns
    EUROPACE 13 10 1484 - 1493 2011年10月 [査読有り]
     
    Introduction Implantable cardioverter defibrillator (ICD) shock therapy improves survival of patients at risk for sudden cardiac death. The high sensitivity of ICDs to detect tachycardia events is accompanied by reduced specificity resulting in inappropriate and unnecessary shocks. Up to 30% of ICD patients may experience inappropriate shocks, which are most commonly caused by lead noise, oversensing of T-waves, and supraventricular tachycardias. The new Protecta ICD and cardiac resynchronization therapy devices have been designed to minimize inappropriate and unnecessary shocks through novel SmartShock (TM) technology algorithms targeting these causes. Methods The PainFree SST study is a prospective, multicentre clinical trial, which will be conducted in two consecutive phases. Phase I will assess safety and any delay that may arise in ventricular fibrillation (VF) arrhythmia detection time using new algorithms. Phase II will evaluate reduction of inappropriate and unnecessary shocks at 1 year of follow-up. Additional objectives will include Quality of Life, healthcare utilization, safety of extending the ventricular tachyarrhythmia/VF interval detection duration (18 out of 24 vs. 30 out of 40 intervals), and reasons for inappropriate shock. Up to 2000 subjects in 150 centres worldwide will be enrolled with a follow-up of at least 1 year. Subjects enrolled in Phase I will continue in Phase II of the study and data from all enrolled subjects will contribute to the analysis of Phase II objectives. Conclusion Inappropriate and unnecessary shock delivery remains a significant clinical issue for patients receiving device therapies, which has considerable consequences for patients and the healthcare system. The PainFree SST study will investigate the ability of new algorithms to reduce inappropriate shocks. Results from this study are expected in mid-2013.
  • 心不全におけるデバイス治療の現状と展望
    栗田 隆志
    循環器内科 70 1 45 - 52 科学評論社 2011年07月 
    医局登録番号 455
  • 心不全と突然死：CRT-Dの意義
    栗田 隆志
    別冊・医学のあゆみ ここまで進んだ不整脈研究の最新動向 109 - 114 2011年07月 
    医局登録番号 454
  • 鎌倉 史郎; 伊藤 誠; 草野 研吾; 栗田 隆志; 藤井 謙司
    Pharma Medica 29 6 121 - 126 (株)メディカルレビュー社 2011年06月
  • Takashi Kurita; Koichiro Motoki; Ryobun Yasuoka; Takayoshi Hirota; Yuzuru Akaiwa; Yasuhito Kotake; Shunichi Miyazaki
    CIRCULATION JOURNAL 75 4 979 - 985 2011年04月 [査読有り]
     
    The incidence of atrial fibrillation (AF) increases with advancing NHYA cardiac functional class, and it significantly affects the cardiac function of a failing heart. In such situations, clinicians should aim to maintain sinus rhythm in these patients with heart failure (HF) in order to improve their prognosis. However, according to various randomized clinical studies demonstrating the non-superiority of rhythm control over rate control, many clinicians seem to prefer to take the line of least resistance (ie, rate control). Curative catheter ablation mainly based on isolation procedure of the pulmonary veins in patients with AF and HF has demonstrated a significant improvement in left ventricular function, even in the presence of adequate ventricular rate control before the ablation. On the other hand, ablation and biventricular pacing therapy, which is an extreme rate control strategy, has not shown any beneficial effects for these patients. Therefore, a regular RR interval with an appropriate cycle length only is not sufficient to improve cardiac performance, and maintenance of sinus rhythm, which restores atrial contraction and the atrioventricular synchrony, is thought to be essential for an improvement in HF. Thoughtful clinicians should do their best to find a way to keep HF patients in sinus rhythm. (Circ J 2011; 75: 979-985)
  • 植込み型除細動器ICDはどの患者に必要か、どの患者に有益か
    栗田 隆志
    日本医師会雑誌 139 11 2339 - 2343 日本医師会 2011年02月 
    医局論文番号434
  • 不整脈薬物療法を行ううえで知っておくべきエビデンス心室性不整脈
    栗田 隆志
    Heart View Heart View 15 2 32 - 37 メジカルビュー社 2011年02月 
    医局論文番号439
  • 栗田 隆志
    心電図 31 2 208 - 210 The Japanese Society of Electrocardiology 2011年 
    心房細動（AF）を合併した心不全患者に対する心臓再同期療法（CRT）の有効性は，十分な房室伝導の抑制により改善すると考えられる．したがって，薬物治療あるいはアブレーションによる房室結節の抑制を積極的に行う必要がある．CRTによる心不全の改善は心房に生じたリモデリングを回復させ，AFの発生を抑制する可能性がある．また，自験例を対象とした検討から，AFは拡張型心筋症におけるelectrical storm（ES）発生のリスク因子であり，これに併せて加算平均心電図の陽性所見の有無を確認することで，ESの発生を正確に予測可能であることが示唆された．
  • 栗田 隆志
    心電図 31 4 376 - 386 The Japanese Society of Electrocardiology 2011年 
    心不全患者における心臓突然死は心不全死と並ぶ最大の死因であり，生命予後の改善を図るうえでその発生を未然に防ぐことはきわめて重要といえる．植込み型除細動器（ICD）の1次予防効果を確認した大規模臨床試験はすべて欧米で行われたもので，これらの結果をそのまま我が国に外挿することには問題がある．特に心筋梗塞患者の予後は欧米に比べて良好といわれ，適切なリスク評価が望まれる．また，心臓再同期療法（cardiac resynchronization therapy : CRT）は心臓の非同期的収縮と左心機能低下を有する患者において，QOLのみならず生命予後も改善させることが証明された．CRTにICDの機能を搭載したCRT-Dは心不全死と心臓突然死を抑制し，より一層生命予後の改善に貢献することが期待されている．最近の大規模臨床試験は，より軽症な心不全患者にもCRT-Dが有効であることを証明しており，同治療法の適応拡大は今後の潮流といえる．CRT-Dを用いることの最大の問題は，不適切あるいは不必要なショックの送出である．今後はショックを可能な限り抑制するアルゴリズム，設定の工夫が要求されるであろう．
  • Akihiko Shimizu; Takashi Nitta; Takashi Kurita; Katsuhiko Imai; Yoshinori Kobayashi; Shinnichi Niwano; Harushiko Abe; Yoshifusa Aizawa
    journal of arrhythmia 27 4 204  2011年 [査読有り]
     
    MADIT-CRT trial and REVERSE trial recommended the implantation of CRT-D in patients with a relatively early phase of heart failure (HF) and electrocardiac disturbance (ED). The primary prevention by CRT-D has already increased for recent days in Japan. However, it is little known what caused an increase of implantation of CRT-D. Methods: We investigated 3267 patients (66±11 years old) with newly implanted CRT-D in data-base of JCDTR. The clinical characteristics were compared between primary and secondary prevention. Further, we investigated the transition of percentage of primary prevention, LVEF, QRS duration and NYHA functional class at the implantation for the latest 5 years. Results: Subjects were divided into two group, primary (n=2073 63%) and secondary prevention(n=1194 37%). The clinical characteristics of primary prevention were relatively elder, lower LVEF, higher NYHA functional class and higher degree of LV dyssynchrony. However, there was no significant difference in QRS duration. The percentage of primary prevention of CRT-D has significantly increased from 50% to 69%. But, the percentages of NYHA I/II, LVEF> 35% and QRS duration < 130 msec did not significantly change for 5 years in the primary prevention group. Conclusion: Though the primary prevention of CRT-D has increased for 5 years, this did not result from the increase of patients with a relatively early phase of HF and ED. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Teruki Yokoyama; Takashi Noda; Hideo Okamura; Futoshi Yamanaka; Yuko Yamada; Koji Miyamoto; Kazuhiro Satomi; Takeshi Aiba; Wataru Shimizu; Takashi Kurita; Naohiko Aihara; Shiro Kamakura
    journal of arrhythmia 27 4 228  2011年 [査読有り]
     
    Background: Permanent AF is occasionally observed in patients receiving ICDs. However, in some cases, AF could be terminated at DFTs. Benefit of dual chamber ICDs over single chamber ICDs in such patients is unclear. Methods: The study subjects consisted of 50 VT/VF patients with perm-AF (41males/9females, 61 ±12 y.o.) including 16 ischemic heart disease, 19 cardiomyopathy. In all patients, single chamber ICDs were selected and DFTs were performed. We assessed the frequency of SR restoration and maintenance of SR during follow-up. Results: Perm-AF was terminated in 15 (30%) patients at DFT. Longevity of AF, usage of amiodarone, LVEF were not significantly different between patients with and without termination of AF. Univariate regression analysis revealed smaller LAD (47 ±3 v.s. 54±2mm, p=0.03) and larger fibrillatory-wave in V1 (0.13 v.s. 0.08mV, p=0.02) could be predictors for SR restoration. During follow-up, sustained AF recurred in 13/15 at one month and in 14/15 at one year. Conclusion: In patients with smaller LAD and larger fibrillatory-wave in V1, perm-AF were possibly terminated at DFTs. However, because maintenance of SR was almost impossible, atrial leads are unnecessary. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Ryobun Yasuoka; Takashi Kurita; Yuzuru Akaiwa; Koichro Motoki; Hiromi Yamamoto; Yositaka Iwanaga; Yutaka Hirano; Shunichi Miyazaki
    Journal of Arrhythmia 27 2011年 [査読有り]
     
    Trans-esophageal echocardiography < TEE> has been recognized as a standard procedure to exclude left atrial appendage thrombus < LAA-T> but it may cause discomfort in some patients. Multi-detector computed tomography < MDCT> may be performed to understand PV and LA anatomy as well as to detect LAA-T in patients with atrial fibrillation < AF> The purpose of this study is to determine whether TEE can be skipped before pulmonary vein isolation < PVI> by using MDCT.We enrolled 100 consecutive AF patients < paroxysmal AF in 73, persistent or long lasting AF in 27 > who underwent PVI. LAA-T was defined as well-contoured echogenic mass in LAA using TEE. To assess LAA by MDCT, the Hounsfield unit < HU> density was measured at LAA proximal < LAAp > and distal < LAAd> .The cutoff value of LAAp/LAAd to provide 100% probability of LAA-T absence was calculated using receiver operating characteristic curves R< OC-C> .LAA-T was detected in 7 patients < 7/27 patients with persistent or long lasting AF> . ROC-C indicates that LAAp/LAAd> 0.43 demonstrates 100% specificity. Using this cutoff value, 76% patients can be diagnosed as absence of LAA-T solely by MDCT In conclusion,LAA-T was observed only in persistent or long lasting AF patients.LAA-T can be excluded in 76% patients without using TEE. TEE could be unnecessary for PVI in PAF patients below the cutoff value of HU density. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Hisaki Makimoto; Eiichiro Nakagawa; Hiroshi Takaki; Yuko Yamada; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Naohiko Aihara; Takashi Kurita; Shiro Kamakura; Wataru Shimizu
    journal of arrhythmia 27 186  2011年 [査読有り]
     
    Objectives: The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing. Background: During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS). Methods: Treadmill exercise testing was conducted for 93 patients (91 men), 46 ± 14 years of age, with BrS (22 documented ventricular fibrillation, 35 syncope alone, and 36 asymptomatic) and for 102 healthy control subjects (97 men), 46 ± 17 years of age. Patients were routinely followed up. The clinical end point was defined as the occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia. Results: Augmentation of ST-segment elevation β0.05 mV in V(1) to V(3) leads compared with baseline was observed at early recovery (1 to 4 min at recovery) in 34 BrS patients (37% [group 1]), but was not observed in the remaining 59 BrS patients (63% [group 2]) or in the 102 control subjects. During 76 ± 38 months of follow-up, ventricular fibrillation occurred more frequently in group 1 (15 of 34, 44%) than in group 2 (10 of 59, 17% p = 0.004). Multivariate Cox regression analysis showed that in addition to previous episodes of ventricular fibrillation (p = 0.005), augmentation of ST-segment elevation at early recovery was a significant and independent predictor for cardiac events (p = 0.007), especially among patients with history of syncope alone (6 of 12 [50%] in group 1 vs. 3 of 23 [13%] in group 2) and among asymptomatic patients (3 of 15 [20%] in group 1 vs. 0 of 21 [0%] in group 2). Conclusions: Augmentation of ST-segment elevation during recovery from exercise testing was specific in patients with BrS, and can be a predictor of poor prognosis, especially for patients with syncope alone and for asymptomatic patients. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Koichiro Motoki; Takashi Kurita; Yasuhito Kotake; Yuzuru Akaiwa; Ryobun Yasuoka; Shunichi Miyazaki
    Journal of Arrhythmia 27 384  2011年 [査読有り]
     
    Background: Little is known about clinical predictors for the recurrence after extensive pulmonary vein isolation (EPVI) in patients with atrial fibrillation (AF) Objectives The purpose of this study was to investigate clinical parameters which predict complete cure of AF after EPVI. Methods and Results: A total of 152 consecutive patients with paroxysmal AF (PAF) who underwent successful EPVI were examined. We divided them into two groups, 1: Complete cure group 103 patients who were free from PAF without any antiarrhythmic drugs and 2: recurrence group the remaining 49 patients with recurrence of PAF. Between the two groups, we compared several clinical parameters before EPVI as follows clinical backgrounds (presence of structural heart disease and CHADS2 score), parameters in transthoracic and transesophageal echocardiogram [left atrium (LA) dimension, systolic and diastolic LA appendage (LAA) flow velocity], LA volume assessed by multiditector CT, additional creation of cava-tricuspid isthmus block line, serum brain natriuretic peptide (BNP) level. Using multi-variate analysis, filling velocity of the LAA and BNP before EPVI were identified as the independent predictors of complete cure of PAF (p< 0.001, p< 0.05, respectively). Conclusion: Low BNP levels and better filling velocity of the LAA are the negative predictors for the recurrence after EPVI in patients with AF. These may relate to preserved LA function and to restricted AF substrates within PVs. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Hideo Okamura; Takashi Kurita; Yuko Yamada; Takashi Noda; Kazuhiro Satomi; Takeshi Aiba; Wataru Shimizu; Naohiko Aihara; Jian Cao; Jeffery M. Gillberg; Hideshiro Saito-Benz; Shiro Kamakura
    Journal of Arrhythmia 27 378  2011年 [査読有り]
     
    Introduction: Inappropriate shock due to T-wave oversensing (TWOS) is an unsolved issue in implantable cardioverter defibrillator (ICD) therapy. New algorithm launched by Medtronic utilizes electrogram (EGM) sense-pattern and morphology to distinguish TWOS from ventricular arrhythmias. We have evaluated this algorithm using human data. Methods: Stored EGMs of TWOS from 3 Japanese patients were fed into ICD bench system equipped with the new algorithm. We used original detection parameters to reproduce TWOS from recorded episodes. Then we re-analyzed the same episode using the new algorithm to test whether it could properly reject the TWOS and avoid shocks. Results: Case1: Brugada patient who recieved inappropriate shock due to TWOS in VF zone. Amplitude of R-wave and T-wave was 2mV and 3mV, respectively. Successful TWOS rejection was observed. Case2: Idiopathic VF patient who experienced inappropriate shock in VF zone. R-wave was variable (1.5-7.5mV) and T-wave was 2mV. Appropriate TWOS rejection was achieved. Case3: Hypertrophic cardiomyopathy patient who recieved 11 shocks due to TWOS in VT zone. R-wave was 14mV and T wave was 4mV. The algorithm rejected this episode properly. Conclusion: The new algorithm rejected TWOS and avoided the inappropriate shocks successfully in all these cases in the bench test. © 2011, Japanese Heart Rhythm Society. All rights reserved.
  • Hisaki Makimoto; Takashi Noda; Takashi Kurita; Ikutaro Nakajima; Teruki Yokoyama; Atsushi Doi; Yuko Yamada; Hideo Okamura; Kazuhiro Satomi; Takeshi Aiba; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura
    INTERNAL MEDICINE 50 21 2591 - 2595 2011年 [査読有り]
     
    This case report describes incessant monomorphic ventricular tachycardia (VT), not Torsade de Pointes, induced by intravenous amiodarone in a 48-year-old woman with dilated cardiomyopathy. VT was reproducibly triggered by short coupled premature ventricular complex (PVC) with different morphology from VT. After amiodarone infusion, the coupling interval of initiating PVC was prolonged, and moreover, the morphology of initiating PVC became the same as that of VT. Though amiodarone has become the first line drug to treat ventricular tachyarrhythmias in patients with cardiac dysfunction, it is important to be aware of its proarrhythmic effect, which may lead to an electrical storm of monomorphic VT.
  • Hiro Kawata; Takashi Noda; Takashi Kurita; Kenichiro Yamagata; Yuko Yamada; Hideo Okamura; Kazuhiro Satomi; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Mitsuaki Isobe; Shiro Kamakura
    CIRCULATION JOURNAL 74 11 2301 - 2307 2010年11月 [査読有り]
     
    Background: The intervals of the driving restrictions after an implantable cardioverter defibrillator (ICD) replacement vary across the different countries around the world. However, little is known regarding the appropriate duration for driving restrictions after an ICD replacement. The aim of this study was to investigate the clinical effect of ICD replacements and to elucidate when to resume driving an automobile after an ICD replacement. Methods and Results: The study reviewed 139 consecutive patients with an ICD replacement in order to evaluate the incidence of ICD therapies before and after ICD replacements, and to assess the time-dependence of the ICD therapies after the ICD replacement. There was no significant difference in the incidence of ICD therapies delivered during durations of 3 months and 6 months before and after the ICD replacement (P=0.28, and 1.0, respectively). ICD therapies after the replacements were observed in 8.6% of the patients who were legally eligible to drive according to the Japanese guidelines at 1 year, and that was associated with a relatively low annual risk of death or injury to others. Conclusions: Implantable cardioverter defibrillator replacements did not affect the future ICD therapies under similar algorithms. The appropriate interval for driving restrictions after an ICD replacement is recommended to be a week or so, with a system integrity check performed before resumption of driving. (Circ J 2010; 74: 2301-2307)
  • Hisaki Makimoto; Eiichiro Nakagawa; Hiroshi Takaki; Yuko Yamada; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Naohiko Aihara; Takashi Kurita; Shiro Kamakura; Wataru Shimizu
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 56 19 1576 - 1584 2010年11月 [査読有り]
     
    Objectives The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing. Background During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS). Methods Treadmill exercise testing was conducted for 93 patients (91 men), 46 +/- 14 years of age, with BrS (22 documented ventricular fibrillation, 35 syncope alone, and 36 asymptomatic); and for 102 healthy control subjects (97 men), 46 +/- 17 years of age. Patients were routinely followed up. The clinical end point was defined as the occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia. Results Augmentation of ST-segment elevation >= 0.05 mV in V(1) to V(3) leads compared with baseline was observed at early recovery (1 to 4 min at recovery) in 34 BrS patients (37% [group 1]), but was not observed in the remaining 59 BrS patients (63% [group 2]) or in the 102 control subjects. During 76 +/- 38 months of follow-up, ventricular fibrillation occurred more frequently in group 1 (15 of 34, 44%) than in group 2 (10 of 59, 17%; p = 0.004). Multivariate Cox regression analysis showed that in addition to previous episodes of ventricular fibrillation (p = 0.005), augmentation of ST-segment elevation at early recovery was a significant and independent predictor for cardiac events (p = 0.007), especially among patients with history of syncope alone (6 of 12 [50%] in group 1 vs. 3 of 23 [13%] in group 2) and among asymptomatic patients (3 of 15 [20%] in group 1 vs. 0 of 21 [0%] in group 2). Conclusions Augmentation of ST-segment elevation during recovery from exercise testing was specific in patients with BrS, and can be a predictor of poor prognosis, especially for patients with syncope alone and for asymptomatic patients. (J Am Coll Cardiol 2010;56:1576-84) (C) 2010 by the American College of Cardiology Foundation
  • Masateru Takigawa; Takashi Noda; Takashi Kurita; Naohiko Aihara; Yuko Yamada; Hideo Okamura; Kazuhiro Satomi; Kazuhiro Suyama; Wataru Shimizu; Shiro Kamakura
    CIRCULATION JOURNAL 74 9 1822 - 1829 2010年09月 [査読有り]
     
    Background: Electrical storm (ES) is a serious problem in patients with an implantable cardioverter defibrillator (ICD). However, insufficient reports have indicated the predictors of ES in ICD patients with idiopathic dilated cardiomyopathy (DCM) The purpose of this study was to clarify the predictors of ES for risk stratification in DCM patients with an ICD Methods and Results: Of 446 ICD patients, 53 DCM patients were included in this study During a mean follow-up of 55 +/- 36 months. ES (>= 3 times appropriate ICD therapy within 24h) occurred in 18/53 (34%) patients According to multivariate Cox proportional hazard regression analysis, a duratidn of the terminal low amplitude signals of <40 mu V (LAS40) (HR 1 4/10 ms increase, 95% confidence interval (CI) 1 1-2 1, P=0 0049) or root mean square voltage of the last 40 ms of the QRS complex (RMS40) (HR 088/1 mu V, 95%CI 0 77-0 96, P=0 001) on the signal averaged electrocardiogram, and a history of atrial fibrillation (AF) before ICD implantation (HR 2 3, 95%CI 1 2-5.0, P=0 013) were independently associated with an increased risk of ES Conclusions: Our data indicated that a longer LAS40, lower RMS40 and history of AF before ICD implantation could strongly predict ES. and the combination of those parameters could effectively stratify the risk of ES in DCM patients (Circ J 2010, 74: 1822-1829)
  • Miki Yokokawa; Kazuhiro Suyama; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Takashi Kurita; Wataru Shimizu; Naohiko Aihara
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 33 7 E62 - E64 2010年07月 [査読有り]
     
    A 76-year-old man with a history of atrial septal defect repair underwent radiofrequency (RF) ablation of typical atrial flutter. During electrophysiological study, incessant sharp potentials were recorded, originating from the ostium of the inferior vena cava (IVC), and dissociated from atrial activity. During sinus rhythm, these potentials propagated to the atria and caused premature complexes when falling beyond the atrial refractory period. Electro-anatomical mapping revealed the presence of the earliest potential in the postero-lateral ostium of the IVC, propagating to the septal region. After RF isolation of the IVC, the patient has remained arrhythmia-free over a 5-year follow-up. (PACE 2010; e62-e64).
  • Takayuki Nagai; Kazuhiro Satomi; Takashi Noda; Hideo Okamura; Yuko Yamada; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura; Takashi Kurita
    CIRCULATION JOURNAL 74 7 1302 - 1307 2010年07月 [査読有り]
     
    Background: This study evaluated the efficacy of amiodarone for avoiding inappropriate therapies by implantable cardioverter defibrillators (ICDs). Methods and Results: A total of 232 patients with structural heart disease (58 13 years; 78% males) who underwent an initial ICD implantation were retrospectively investigated to compare baseline characteristics and event rates of inappropriate ICD therapy delivery between patients with oral amiodarone therapy (amiodarone group, n=116) and those without (non-amiodarone group, n=116). During a mean follow-up of 29+/-21 months, inappropriate therapies occurred less frequently in the amiodarone group than in the non-amiodarone group (12% vs 27%, P=0.0068). As a cause of inappropriate ICD therapy, only atrial fibrillation (AF) significantly differed between the groups (3% vs 12%, P=0.01). The results of multivariate logistic regression analysis showed that amiodarone therapy (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.19-0.77, P=0.0073) and no history of spontaneous AF (OR 0.27, 95%CI 0.13-0.57, P=0.0007) were independent predictors of a lower risk of inappropriate ICD therapy. Conclusions: In the present group of ICD patients with structural heart disease, inappropriate therapy delivery occurred predominantly in those with spontaneous AF and/or without amiodarone. (Circ J 2010; 74: 1302-1307)
  • Aya Miyazaki; Heima Sakaguchi; Takamichi Uchiyama; Takashi Kurita; Hideo Ohuchi; Osamu Yamada
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 33 5 637 - 640 2010年05月 [査読有り]
     
    The atrioventricular (AV) conduction system in AV discordance remains unclear, especially in cases with complex cardiac anomaly. We report a case of accessory pathway reciprocating tachycardia in atrioventricular discordance (AVD) and mitral atresia with twin AV nodes. In this case, the anterior AV node was located along the atretic mitral valve. The anterior AV node was involved in tachycardia and the posterior AV node acted as a bystander during tachycardia. The anterior AV node in AVD can be located along the atretic mitral valve, and one of twin AV nodes might act as a bystander during AV reciprocating tachycardia. (PACE 2010; 637-640).
  • 清水 渉; 相庭 武司; 山田 優子; 岡村 英夫; 野田 崇; 里見 和浩; 須山 和弘; 相原 直彦; 栗田 隆志; 鎌倉 史郎
    心電図 = Electrocardiology 30 1 55 - 62 The Japanese Society of Electrocardiology 2010年03月 
    先天性QT延長症候群（LQTS）の薬物治療としては，β遮断薬のほかに，内向き電流を減少させるIb群Na＋チャネル遮断薬やCa拮抗薬，外向き電流を増加させるK＋チャネル開口薬などが考えられる．Ca拮抗薬のベラパミルは，単相性活動電位（monophasic action potential ; MAP）記録を用いた臨床研究や，動脈灌流心室筋切片標本を用いた実験的LQTSモデルによる検討からその有効性が報告されている．当院では主にβ遮断薬治療による外来経過観察中に遺伝子型が同定された先天性LQTS患者193例中11例（5.7%）で，torsade de pointes（TdP）の反復によるelectrical storm（ES）を認めた．ESのリスク因子としては，女性，発端者，LQT2型，失神・心停止・TdPの既往，Schwartzスコアー≧6，安静時QT時間≧ 500msecが，直接的な誘因としては，低K血症や低Mg血症があげられた．ES急性期の治療として，Ca拮抗薬のベラパミルの静注と持続点滴が有効であった．
  • Miki Yokokawa; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura; Wataru Shimizu
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 21 2 186 - 192 2010年02月 [査読有り]
     
    Neurally Mediated Syncope in Brugada Syndrome. Introduction: Patients with type 1 Brugada electrocardiogram (ECG) and an episode of syncope are diagnosed as symptomatic Brugada syndrome; however, all episodes of syncope may not be due to ventricular tachyarrhythmia. Methods and Results: Forty-six patients with type 1 Brugada ECG (all males, 51 +/- 13 years, 29 spontaneous, 17 Ic-drug induced), 20 healthy control subjects (all males, 35 +/- 11 years), and 15 patients with suspected neurally mediated syncope (NMS; 9 males, 54 +/- 22 years) underwent the head-up tilt (HUT) test. During the HUT test, 12-lead ECGs were recorded in all patients, and the heart rate variability was investigated in some patients. Sixteen (35%) of 46 patients with Brugada ECG, 2 (10%) of 20 control subjects, and 10 (67%) of 15 patients with suspected NMS showed positive responses to the HUT test. Although no significant differences were observed in HUT-positive rate among Brugada patients with documented VT (7/14; 50%), syncope (5/19; 26%) and asymptomatic patients (4/13; 31%), the HUT-positive rate was significantly higher in patients with documented VT (50%) and those with VT or no symptoms (11/27, 41%) compared to that in control subjects (10%) (P<0.05). Augmentation of ST-segment amplitude (>= 0.05 mV) in leads V1-V3was observed in 11 (69%) of 16 HUT-positive patients with Brugada ECG during vasovagal responses, and was associated with augmentation of parasympathetic tone following sympathetic withdrawal. Conclusion: Thirty-five percent of patients with Brugada ECG showed vasovagal responses during the HUT test, suggesting that some Brugada patients have impaired balance of autonomic nervous system, which may relate to their syncopal episodes. (J Cardiovasc Electrophysiol, Vol. 21, pp. 186-192, February 2010)
  • 栗田 隆志
    心臓 42 6 771 - 771 Japan Heart Foundation 2010年
  • 横川 美樹; 清水 渉; 野田 崇; 岡村 英夫; 里見 和浩; 須山 和弘; 栗田 隆志; 相原 直彦; 神崎 秀明; 庭屋 和夫; 小林 順二郎; 鎌倉 史郎
    心電図 29 5 342 - 349 (一社)日本不整脈心電学会 2009年12月 
    心電図上のQRS波形は、心臓の興奮伝播様式を反映するとされている。本研究では、心臓再同期療法(CRT)施行前後でのQRS波形の変化を87点体表面心電図(体表面電位図)を用いて評価し、CRTの有効性の指標を検討した。慢性心不全を伴う拡張型心筋症患者35例(男性28例、58±16歳、左室駆出率20±8%)を対象に、CRT施行前(18±17日前)、CRT施行後(1日後、1ヵ月後、3ヵ月後)の87点体表面心電図(体表面電位図)を記録した。87誘導のうち、正常興奮伝播での最終興奮部位に相当する流出路領域(OT:D-F/5-6、高位前胸部領域)と左室心外膜ペーシング部位に相当する後側壁領域(PL:J-L/3-4、低位左側背部領域)におけるQRS波形を評価した。各領域における6誘導のうち、R波形を呈する誘導(R誘導)数とQS波形を呈する誘導(QS誘導)数を、有効群21例と無効群14例で比較した。CRT施行前の各領域におけるR誘導数とQS誘導数に、両群で差はなかった。CRT施行後、有効群でOT領域でのR誘導数が有意に増加したが、無効例では不変であった。また、有効群でPL領域でのQS誘導数が有意に増加したが、無効例では不変であった。CRT施行後の各領域におけるR誘導数、QS誘導数は、両群ともに経過観察期間を通じて不変であった。CRT施行後の流出路領域のR誘導数の増加と後側壁領域のQS誘導数の増加は、CRTの有効性の予測因子となることが示唆された。(著者抄録)
  • Takashi Kurita; Shigeyuki Ueda; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Wataru Shimizu; Naohiko Aihara; Shunichi Miyazaki; Shiro Kamakura
    INTERNATIONAL HEART JOURNAL 50 6 823 - 827 2009年11月 [査読有り]
     
    A 74-year-old female with a diagnosis of idiopathic dilated cardiomyopathy and ventricular tachycardia died suddenly 9 years after an implantation of an implantable cardioverter-defibrillator (ICD). The destructive removal of an ICD generator and the leads by an uninformed coroner resulted in the loss of the fragile electrograms during the terminal episodes of VT/VF and caused severe charring on the surface of the ICD generator. In order to observe the conditions in which the shock deliveries occurred during the noise detection, we programmed the ICD to deliver the maximum shock energy via a programmer while keeping continuous contact between the device surface and shock lead. The maximum shock energy of 31 Joules produced significant sparks from the surface of the ICD. To avoid the loss of data from an ICD and injury to the patient, widespread notification and education through appropriate scientific societies about the functions of ICDs are highly recommended. (Int Heart J 2009; 50: 823-827)
  • Shiro Kamakura; Tohru Ohe; Kiyoshi Nakazawa; Yoshifusa Aizawa; Akihiko Shimizu; Minoru Horie; Satoshi Ogawa; Ken Okumura; Kazufumi Tsuchihashi; Kaoru Sugi; Naomasa Makita; Nobuhisa Hagiwara; Hiroshi Inoue; Hirotsugu Atarashi; Naohiko Aihara; Wataru Shimizu; Takashi Kurita; Kazuhiro Suyama; Takashi Noda; Kazuhiro Satomi; Hideo Okamura; Hitonobu Tomoike
    CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY 2 5 495 - 503 2009年10月 [査読有り]
     
    Background-The prognosis of patients with saddleback or noncoved type (non-type 1) ST-elevation in Brugada syndrome is unknown. The purpose of this study was to clarify the long-term prognosis of probands with non-type 1 ECG and those with coved (type 1) Brugada-pattern ECG. Methods and Results-A total of 330 (123 symptomatic, 207 asymptomatic) probands with a coved or saddleback ST-elevation >= 1 mm in leads V-1-V-3 were divided into 2 ECG groups-type 1 (245 probands) and non-type 1 (85 probands)-and were prospectively followed for 48.7 +/- 15.0 months. The absence of type 1 ECG was confirmed by drug provocation test and multiple recordings. The ratio of individuals with a family history of sudden cardiac death (14%) was lower than previous studies. Clinical profiles and outcomes were not notably different between the 2 groups (annual arrhythmic event rate of probands with ventricular fibrillation; type 1: 10.2%, non-type 1: 10.6%, probands with syncope; type 1: 0.6%, non-type 1: 1.2%, and asymptomatic probands; type 1: 0.5%, non-type 1: 0%). Family history of sudden cardiac death at age <45 years and coexistence of inferolateral early repolarization with Brugada-pattern ECG were independent predictors of fatal arrhythmic events (hazard ratio, 3.28; 95% confidence interval, 1.42 to 7.60; P = 0.005; hazard ratio, 2.66; 95% confidence interval, 1.06 to 6.71; P = 0.03, respectively, by multivariate analysis), although spontaneous type 1 ECG and ventricular fibrillation inducibility by electrophysiological study were not reliable parameters. Conclusions-The long-term prognosis of probands in non-type 1 group was similar to that of type 1 group. Family history of sudden cardiac death and the presence of early repolarization were predictors of poor outcome in this study, which included only probands with Brugada-pattern ST-elevation. (Circ Arrhythmia Electrophysiol. 2009; 2: 495-503.)
  • 強心薬依存性終末期心不全患者における心臓再同期療法の有用性
    中島 育太郎; 野田 崇; 神崎 秀明; 河田 宏; 山形 研一郎; 山田 優子; 岡村 英夫; 里見 和浩; 須山 和弘; 清水 渉; 相原 直彦; 鎌倉 史郎; 栗田 隆志
    心電図 29 Suppl.3 S - 318 (一社)日本不整脈心電学会 2009年06月
  • Taka-aki Matsuyama; Takashi Kurita; Kazuhiro Suyama; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Wataru Shimizu; Naohiko Aihara; Yoshihiko Ikeda; Shin Inoue; Shiro Kamakura; Hatsue Ishibashi-Ueda
    EUROPACE 11 6 827 - 830 2009年06月 [査読有り]
     
    A 68-year-old woman with idiopathic dilated cardiomyopathy suffered from drug-resistant monomorphic ventricular tachycardia (VT). Electrophysiological study revealed a re-entrant VT circuit located just beneath the inferior mitral valve annulus. The VT was considered to be related to the mitral valve isthmus and was abolished by radiofrequency ablation. The patient died 2 years after the ablation due to worsening of heart failure and an autopsy was performed. Pathological examination revealed ablation scar tissue on the localized myocardial bundle running parallel to the mitral valve annulus. Therefore, this bundle appeared to comprise the slow conduction area of the re-entrant VT in this case.
  • Takayuki Nagai; Takashi Kurita; Kazuhiro Satomi; Takashi Noda; Hideo Okamura; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Junjiro Kobayashi; Shiro Kamakura
    CIRCULATION JOURNAL 73 6 1028 - 1032 2009年06月 [査読有り]
     
    Background: Although high defibrillation threshold (DFT) is a major and unavoidable clinical problem after implantation of an implantable cardioverter defibrillator (ICD), little is known about the cause and management of a high DFT in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to assess the predictors of a high DFT in patients with HCM. Methods and Results: Twenty-three patients with non-dilated HCM who underwent ICD implantation were included. The DFT at the time of the device implantation was measured in all patients. The patients were divided into 2 groups, a high DFT group (DFT >= 15J, n=13) and a low DFT group (DFT <15J, n=10); and their baseline characteristics were compared. The QRS duration was longer in the high than in the low DFT group (128 +/- 31 vs 103 +/- 12 ms, respectively; P=0.02). QRS duration, left ventricular (LV) end-systolic diameter, and LV ejection fraction were significant predictors of DFT in univariate analysis. However, in multivariate analysis, the only factor significantly associated with DFT was QRS duration (P=0.002). Conclusions: QRS duration is the most consistent predictor of a high DFT in HCM patients undergoing ICD implantation. (Circ J 2009; 73: 1028-1032)
  • Aya Miyazaki; Koji Kagisaki; Takashi Kurita; Osamu Yamada
    PEDIATRIC CARDIOLOGY 30 4 516 - 519 2009年05月 [査読有り]
     
    The atrioventricular (AV) conduction system in corrected transposition of the great arteries (cTGA) involving situs inversus remains unclear. A case of cTGA involving situs inversus, mild pulmonary stenosis, and ventricular septal defect (VSD) is reported. An electrophysiologic study using the CARTO system and angiography was performed to identify the AV conduction system before a double-switch operation with VSD enlargement. The His bundle was located at the anteroseptum of the left-sided RA. It descended along the posteroinferior margin of the VSD with cTGA involving situs inversus and a normal-sized pulmonary trunk. No AV block occurred after surgery. The combination of the CARTO system and angiography could be useful for identifying the conduction system.
  • 植込み型徐細動器・心臓再同期療法と電気生理検査
    栗田 隆志
    Heart View 2009 :13（3）：99-104 Heart View 2009 :13（3）：99-104 13 3 99 - 104 MEDICAL VIEWメジカルビュー社 2009年03月 
    医局登録番号 321
  • 舛方 葉子; 清水 渉; 山田 優子; 宮本 康二; 岡村 英夫; 野田 崇; 里見 和浩; 須山 和弘; 栗田 隆志; 相原 直彦; 鎌倉 史郎
    Progress in Medicine 29 Suppl.1 637 - 640 (株)ライフ・サイエンス 2009年03月 
    アミオダロン静注薬の臨床的な使用状況とその有効性、経口薬への切り替えについて検討した。薬剤抵抗性不整脈に対してアミオダロン静注薬を使用した18例を対象とした。18例中12例は平均5.5日の静注期間を経て経口薬へ移行した。最高血中濃度は有効域であった。アミオダロン静注薬の投与前後で著明なQT延長やtorsades de pointesの出現は認めなかった。18例中15例、心室性不整脈のみに限れば15例中12例で急性効果を認めた。急性期無効例でも、増量や他剤併用により効果を認めた。アミオダロン静注開始の翌日より内服を開始した症例では、5日目に静注薬を中止したところ、アミオダロン血中濃度の急激な低下を認めた。静注薬投与が長期に及んだ症例では、静注薬中止と同時に経口薬を維持量で開始したが、静注薬中止による血中濃度の低下は軽度で、有効血中濃度は保たれた。
  • Takeshi Aiba; Wataru Shimizu; Takashi Noda; Hideo Okamura; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura
    CIRCULATION JOURNAL 73 3 451 - 460 2009年03月 [査読有り]
     
    Background: Intra-atrial reentrant tachyarrhythmia (IART) after Surgical repair for congenital heart diseases (CHD) has not been noninvasively characterized. Methods and Results: The 28 patients after surgery for CHD and 14 patients without surgery were investigated by 87-lead body surface mapping (BSM), 12-lead electrocardiogram (ECG), 20-lead signal averaged ECG (SAECG) and endocardial electroanatomical mapping (CARTO) during clockwise (CW: n=9) or counterclockwise (CCW: n=5) incisional atrial tachycardia (Incision-AT), CCW (n=23) or CW (n=4) cavotricuspid isthmus-dependent atrial flutter (CTI-AFL), and double-loop reentry (n=4). On the BSM, the isopotential map pattern and its locus of the minimum potential could differentiate the reentrant circuits, and the activation map revealed the reentrant circuits, which were highly coincident with those obtained from CARTO. On the 12-lead ECG, negative-positive polarity in the inferior leads or a discordant pattern in the precordial leads was observed in all cases of CTI-AFL, but 3/14 Incision-AT, positive polarity in lead Vi was observed in all cases of CCW, but none of CW CTI-AFL, positive polarity in lead I was observed in all cases of CW, but none of CCW Incision-AT. Conclusions: Flutter-wave isopotential map and its activation sequence from the BSM predict reentrant circuits of IART after surgery for CHD. Flutter-wave polarity on the 12-lead ECG could differentiate these reentrant patterns. (Circ J 2009; 73: 451-460)
  • 栗田 隆志; 野田 崇; 岡村 英夫; 里見 和浩; 清水 渉; 須山 和弘; 相原 直彦; 鎌倉 史郎; 安田 聡
    心電図 = Electrocardiology 29 1 10 - 17 The Japanese Society of Electrocardiology 2009年02月 
    ニフェカラント静注薬は我が国で開発された唯一の純粋なIKrチャネル遮断薬であり，重症心室不整脈に対する高い抑制効果が示されている．特に急性冠症候群など冠動脈疾患に合併した難治性の心室頻拍・心室細動（VT/VF）に対しては，8割を超える患者において有効性が示された．また，拡張型心筋症など慢性的な病変によるVT/VFに対する効果は若干劣るものの，6割を超える効果が確認された．ニフェカラントに残された最大の問題は，過剰なQT延長によるtorsade de pointesの誘発であろう．この合併症を避けるためには推奨されているよりも少ない量（loadingは0.15～0.2mg/kg，維持量は0.2mg/kg/時）から投与を開始し，モニター心電図による継続した監視と12誘導心電図でのQT時間の観察が必須である．同薬剤の中止または減量の目安はQTc時間が550msecを超えた場合と考えられる．また，アミオダロン静注薬との使い分けや，経口薬への移行などについては今後に残された課題である．
  • Takashi Kurita
    Journal of Arrhythmia 23 4 264 - 268 2009年 [査読有り]
     
    Recently several randomized trials have demonstrated the excellent role of the implantable cardioverter-defibrillator (ICD) in improving the mortality rate in patients with a high risk of sudden cardiac death regardless of its purpose or the underlying heart disease. However, because such large clinical trials have only been carried out in Western countries, those results may not be fully applicable to Japanese or other Asian patient populations. According to a Japanese study, the total mortality in the patients was approximately 20% during 5 years of follow up, which was comparable to, or slightly better than that in the MADIT-II patients with ICDs. In such a patient population with an excellent prognosis, the MADIT-II criteria can not easily be applied. Therefore, we should strengthen the criteria, i.e. from an EF≤5% to 25% or adopt the usage of additional examinations (e.g. signal averaging ECG, micro-volt T wave alternance or EPS). © 2007, Japanese Heart Rhythm Society. All rights reserved.
  • 松山 高明; 井上 紳; 池田 善彦; 岡村 英夫; 野田 崇; 里見 和浩; 須山 和弘; 栗田 隆志; 清水 渉; 相原 直彦; 鎌倉 史郎; 太田 秀一; 植田 初江
    心電図 28 6 567 - 573 (一社)日本不整脈心電学会 2008年12月 [査読有り]
     
    カテーテルアブレーションの適応となる頻脈性不整脈のうち、右房心内膜からのアプローチで効果が得られない一部の症例に対し、経大動脈アプローチにより大動脈弁尖周囲に通電することがある。しかし、同部位の組織学的構築は複雑で、詳細な解剖学的検討は少ない。剖検心9例(平均64.0歳、平均心重量349.4g、平均大動脈径24.2mm)を用いて各弁尖周囲の組織学的特徴を観察した。右冠尖と左冠尖には右室流出路中隔部と左室流出路心筋が接していた。それに対して無冠尖周囲は心室筋を認めず、上方に両心耳とBachmann束、同レベルに房室弁輪組織、下方は膜性中隔を介してHis束が位置していた。カテーテルアブレーション施行時にはこれらの解剖学的特徴の認識が必要であると考えられた。(著者抄録)
  • Masateru Takigawa; Takashi Noda; Wataru Shimizu; Koji Miyamoto; Hideo Okamura; Kazuhiro Satomi; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura; Takashi Kurita
    HEART RHYTHM 5 11 1523 - 1527 2008年11月 [査読有り]
     
    BACKGROUND It is well-known that the incidence of ventricular tachyarrhythmias is the highest in winter and during the daytime in patients with structural heart disease. However, little is known about the seasonal and circadian distributions of ventricular fibrillation (VF) in patients with Brugada syndrome. OBJECTIVE The aim of this study was to investigate seasonal and circadian distributions of VF in patients with Brugada syndrome. METHODS We analyzed the data of appropriate shock episodes for VF recorded by an implantable cardioverter-defibrillator (ICD) in patients with Brugada syndrome. RESULTS Among 62 consecutive Brugada syndrome patients with an ICD (48 +/- 14 years, 58 males), 19 patients had at least one episode of an appropriate ICD shock due to VF during a mean follow-up of 70 +/- 36 months, and 98 episodes were evaluated as isolated VF. There was a significant peak between March and June (P = .03). As for the circadian variation, significantly more VF occurred from midnight to 6:00 (P < .0001). Electrical storms of VF occurred in seven patients. The seasonal and circadian variations of electrical storms were similar to those of the isolated VF episodes. CONCLUSIONS In patients with Brugada syndrome, there was a significant seasonal peak from spring to early summer and a significant circadian peak from midnight to early morning in terms of the occurrences of VF.
  • 横山 光樹; 野田 崇; 栗田 隆志; 河田 宏; 山形 研一郎; 岡村 英夫; 里見 和浩; 須山 和弘; 清水 渉; 相原 直彦; 鎌倉 史郎
    心電図 28 5 491 - 491 (一社)日本不整脈心電学会 2008年10月 [査読有り]
  • Takashi Kurita; Takeshi Aiba; Yoko Masukata; Kenichiro Yamagata; Wataru Shimizu; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura
    Journal of Cardiac Failure 14 7 2008年09月
  • 西平 守和; 野田 崇; 栗田 隆志; 神崎 秀明; 宮本 康二; 岡村 英夫; 里見 和浩; 須山 和弘; 清水 渉; 相原 直彦; 鎌倉 史郎
    Journal of Arrhythmia 24 Suppl. 244 - 244 (一社)日本不整脈心電学会 2008年04月
  • 中島 育太郎; 野田 崇; 栗田 隆志; 神崎 秀明; 石橋 耕平; 宮本 康二; 岡村 英夫; 里見 和浩; 須山 和弘; 清水 渉; 相原 直彦; 鎌倉 史郎
    Journal of Arrhythmia 24 Suppl. 285 - 285 (一社)日本不整脈心電学会 2008年04月
  • 舛方 葉子; 清水 渉; 山田 優子; 宮本 康二; 岡村 英夫; 野田 崇; 里見 和浩; 須山 和弘; 栗田 隆志; 相原 直彦; 鎌倉 史郎
    Journal of Arrhythmia 24 Suppl. 186 - 186 (一社)日本不整脈心電学会 2008年04月
  • 清水 渉; 相庭 武司; 栗田 隆志; 里見 和浩; 横川 美樹; 岡村 英夫; 野田 崇; 須山 和弘; 相原 直彦; 鎌倉 史郎
    心電図 = Electrocardiology 28 2 147 - 157 The Japanese Society of Electrocardiology 2008年03月 
    Brugada症候群には一部の患者ではSCN5Aなどの遺伝子変異が同定され, 遺伝性不整脈疾患にもかかわらず, 若年発症はまれで40～50歳にかけて初発することや, 常染色体優性遺伝形式をとるにもかかわらず男性に圧倒的に頻度が高いという性差など, 未解決な点も多い.動脈灌流右室心筋切片に高感度光マツピング法を応用したBrugadaモデルにより, ST上昇や心室細動 (VF) 第1拍目の心室期外収縮には, 心外膜-心内膜細胞間の電位勾配と心外膜細胞間のphase 2 reentryが関与するが, VFが持続するためには, 軽度の伝導 (脱分極) 異常が必要であるとされている, SCN5A陽1生Brugada症候群患者ではSCN5A陰性患者に比べ, 心電図の脱分極指標 (PR, QRS時間) が長く, 平均10年間の経過観察でこれらの延長度も大きいことが報告され, 特にSCN5A陽性例で, 加齢による脱分極異常がVFの晩期発症に関与する可能性が示唆されている.男性優位の性差には, 右室心外膜細胞の第1相notchが雌に比べ雄で大きいことが関与していると動物実験で報告されている, また, Brugada症候群男性患者では, 年齢を一致させた対照男性に比べて, 外向き電流を増加させる男性ホルモン (テストステロン) レベルが有意に高く, 体脂肪率が低いことが報告されており, テストステロンの関与も示唆されている.
  • Kenichiro Yamagata; Wataru Shimizu; Hiro Kawata; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura
    Japanese Journal of Electrocardiology 28 Suppl4 69 - 72 2008年
  • Akihiko Shimizu; Takashi Nitta; Takashi Kurita; Katsuhiko Imai; Takeshi Kimura; Yoshinori Kobayashi; Kyoko Soejima; Shinichi Niwano; Shigeyuki Watanabe; Haruhiko Abe
    Journal of Arrhythmia 24 3 133 - 140 2008年 [査読有り]
     
    Background: The current status of the efficacy of implantable cardioverter-defibrillator (ICD) and cardiac-resynchronization therapy with implantable defibrillator (CRT-D) in patients with left ventricular dysfunction needs to be clarified. Methods and Results: From the Japanese Cardiac Device Treatment Registry database, a total of 1,584 patients who had an LVEF 40% and had an ICD or CRT-D were selected as subjects in this study. The difference in the clinical characteristics between the primary and secondary prevention groups and the transition of the indications for device implantation over time were examined. Primary prevention gradually increased up to about 50% in all patients. The implantations of ICD/CRT-D for primary prevention in ischemic hear disease was significantly lower than that in dilated cardiomyopathy (33% vs 51% p< 0.0001). The number of implantations for CRT-D for primary prevention increased dramatically over a one-year period. Conclusions: In Japan, the implantable defibrillat r devices for primary prevention was significantly lower in ischemic heart disease compared with dilated cardiomyopathy. Further, an extension of the indications for ICD/CRT-D implantations has recently been occurring, especially with CRT-D devices for primary prevention. © 2008, Japanese Heart Rhythm Society. All rights reserved.
  • Takigawa M; Noda T; Kurita T; Okamura H; Suyama K; Shimizu W; Aihara N; Nakajima H; Kobayashi J; Kamakura S
    Cardiology 110 4 226 - 229 2008年 [査読有り]
     
    This case report describes a patient with an intravascular infection of a pacemaker system with Stenotrophomonas maltophilia, which occurred 17 years after the implantation. The patient was treated with appropriate antibiotics and debridement of the infectious tissue in the pocket, and the entire pacemaker system was removed by open heart surgery. She was discharged from our center after a 6-week course of antibiotics and implantation of a new pacemaker.
  • Takeshi Aiba; Kenichiro Yamagata; Wataru Shimizu; Atsushi Taguchi; Kazuhiro Satomi; Takashi Noda; Hideo Okamura; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura; Takashi Kurita
    CIRCULATION JOURNAL 72 1 88 - 93 2008年01月 [査読有り]
     
    Background Although an electrophysiologic study (EPS) and Holter-monitoring are often helpful in evaluating the efficacy of antiarrhythmic drugs in patients with ventricular tachyarrhythmias (ventricular tachycardia/fibrillation (VT/VF)), the efficacy of EPS- or Holter-guided oral amiodarone therapy in Japanese patients is still unclear. Methods and Results EPS was performed I month after starting amiodarone, and Holter-monitoring was recorded before and I month after antiodarone in 188 patients with sustained VT/VF because of structural heart diseases. In spite of the judgment of EPS (n=89) or Holter (n=75), all patients continued arniodarone. Patients were followed up to 3 years and the primary endpoint was VT/VF recurrence and secondary endpoint was death by all cause. Kaplan-Meier estimated the risk of VT/VF recurrence was significantly smaller with EPS-guided arniodarone (p < 0.01) but not with Holter-guided amiodarone. Multivariate Cox hazard analysis revealed that EPS-guided arniodarone was an independent factor suppressing the recurrence of VT/VF (p < 0.05, 95% confidence interval =0.15 to 0.96). In the subgroup analysis, EPS-guided arniodarone was effective in patients with relatively well-preserved left ventricular ejection fraction (LVEF >= 0.30) but not in patients with lower LVEF (LVEF < 0.30). Conclusion EPS-guided arniodarone was useful for preventing recurrence of VT/VF in patients with a relatively well-preserved LVEF, but not always beneficial inpatients with a lower LVER.
  • 心臓再同期療法後の再分極指標の変化と心室性不整脈の発症
    横川 美樹; 清水 渉; 野田 崇; 岡村 英夫; 須山 和弘; 栗田 隆志; 相原 直彦; 神崎 秀明; 鎌倉 史郎
    心電図 27 5 478 - 478 (一社)日本不整脈心電学会 2007年09月
  • Kenichiro Yamagata; Takashi Noda; Takashi Kurita; Hideo Okamura; Wataru Shimizu; Kazuhiro Suyama; Naohiko Aihara; Kazuo Niwaya; Shirou Kamakura
    Journal of Cardiac Failure 13 6 2007年08月
  • Otomo K; Suyama K; Okamura H; Noda T; Satomi K; Shimizu W; Kurita T; Aihara N; Kamakura S
    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 19 2 109 - 119 2007年08月 [査読有り]
     
    OBJECTIVE: The effects of 2:1 AV block (AVB) on AV nodal reentrant tachycardia (AVNRT) remain to be elucidated. This study was performed to localize the site of 2:1 AVB and elucidate the effects of 2:1 AVB on typical AVNRT. METHODS: The His bundle (HB) electrograms during typical AVNRT with 2:1 AV block were reviewed in 24 patients. It was hypothesized that if 2:1 AVB at the HB or below changed tachycardia cycle length (TCL), the lower turnaround point of the reentrant circuit (RC) might be located within the HB and parts of the HB might be involved in the RC. RESULTS: A HB potential was absent in blocked beats during 2:1 AVB in four patients (supra-Hisian block), and the maximal amplitude of the HB potential in blocked beats was the same as that in conducted beats in four patients (infra-Hisian block), and was significantly smaller than that in conducted beats (0.1 +/- 0.1 versus 0.5 +/- 0.2 mV, P < 0.05) in 16 patients (intra-Hisian block). Eight patients (33%) with intra-Hisian block had a nearly identical prolongation of the H-A and A-A intervals in blocked beats (12 +/- 3 and 13 +/- 2 ms, respectively) with unchanged A-H intervals, while the remaining 16 patients (67%) exhibited invariable A-A and/or H-A intervals. CONCLUSION: The site of 2:1 AVB during typical AVNRT was estimated to be at the HB or below in 83% of the cases. Two-to-one intra-Hisian block transiently prolonged TCL, possibly indicating involvement of the proximal HB in the RC in one-third of typical the AVNRT cases with 2:1 AVB.
  • Miki Yokokawa; Takashi Noda; Hideo Okamura; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura; Wataru Shimizu
    AMERICAN JOURNAL OF CARDIOLOGY 100 4 649 - 655 2007年08月 [査読有り]
     
    To investigate changes of electrocardiographic parameters with aging and their relation to the presence of SCN5A mutation in probands with Brugada syndrome (BS), we measured several electrocardiographic parameters prospectively during long-term follow-up (10 +/- 5 years) in 8 BS probands with SCN5A mutation (SCN5A-positive group, all men; age 46 +/- 10 years) and 36 BS probands without SCN5A mutation (SCN5A-negative group, all men; age 46 +/- 13 years). Throughout the follow-up period, depolarization parameters, such as P-wave (lead II), QRS (leads II, V-2, V-5), S-wave durations (leads II, V-5), and PQ interval (leads II) were all significantly longer and S-wave amplitude (II, V-5) was significantly deeper in the SCN5A-positive group than in the SCN5A-negative group. The SCN5A-positive group showed a significantly longer corrected QT interval (lead V2) and higher ST amplitude (lead V-2) than those in the SCN5A-negative group. The depolarization parameters increased with aging during the follow-up period in both groups; however, the PQ interval (lead II) and QRS duration (lead V-2) were prolonged more prominently and the QRS axis deviated more to the left with aging in the SCN5A-positive group than in the SCN5A-negative group. In conclusion, conduction slowing was more marked and more progressively accentuated in Brugada probands with SCN5A mutation than in those without SCN5A mutation. (c) 2007 Elsevier Inc. All rights reserved.
  • Otomo K; Suyama K; Okamura H; Noda T; Satomi K; Shimizu W; Kurita T; Aihara N; Kamakura S
    Heart rhythm 4 6 703 - 710 2007年06月 [査読有り]
     
    BACKGROUND: The retrograde fast pathway in typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits marked variation in its electrophysiologic properties. OBJECTIVE: The purpose of this study was to characterize the retrograde fast pathway and localize the lower turnaround site of the reentrant circuit in typical AVNRT. METHODS: Seventy-four patients with typical AVNRT were divided into two groups according to the response of the retrograde fast pathway to intravenous administration of adenosine triphosphate (ATP) during ventricular pacing: ATP-S [n = 47 (63.5%)] with and ATP-R without [n = 27 (36.5%)] His-atrial (H-A) block. H-A intervals were measured from the most proximal His-bundle electrogram to the earliest atrial activation during the tachycardia (HAt) and entrainment pacing from the parahisian right ventricular region (HAe). It was postulated that the HAt was the difference in conduction time between the lower common pathway (x) and retrograde fast pathway (y) (HAt = y - x), whereas HAe was the sum of the two (HAe = y + x). Hence, x = (HAe-HAt)/2. x >0 suggested the presence of a lower common pathway, whereas x <0 suggested the absence of a lower common pathway and lower turnaround site within the His bundle. RESULTS: x was significantly smaller in ATP-R than ATP-S (-6 +/- 5 vs 4 +/- 4 ms, P <.05) and was <0 in 23 (85%) of 27 ATP-R patients. The maximal increment in H-A interval during ventricular pacing was significantly longer in ATP-S than ATP-R (35 +/- 33 vs 2 +/- 2 ms, P <.05). CONCLUSION: A concealed atriohisian tract totally bypassing the atrioventricular node constituted the retrograde fast pathway in one third of all typical AVNRT cases.
  • Takeshi Ohgo; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura; Tohru Ohe; Wataru Shimizu
    HEART RHYTHM 4 6 695 - 700 2007年06月 [査読有り]
     
    BACKGROUND Some patients with Brugada syndrome experience an electrical storm of ventricular fibrillation (VF). OBJECTIVE The purpose of this study was to investigate the clinical, laboratory, electrocardiographic, and electrophysiologic characteristics, acute and subsequent chronic treatment, and follow-up data of patients with Brugada syndrome associated with electrical storm of VF. METHODS Sixty-seven patients with Brugada syndrome (65 men and 2 women, age 46 14 years) were divided into three groups: 7 patients with a history of electrical storm of VF (group 1), 39 symptomatic patients with documented VF and/or syncope (group II), and 21 asymptomatic patients (group III). Electrical storm was defined as three or more episodes of VF per day recorded by the memory of an implantable cardioverter-defibrillator. RESULTS No significant differences were observed among the three groups with regard to clinical (age at diagnosis, familial history of sudden cardiac death), laboratory (SCN5A mutation and serum potassium Level), electrocardiographic and electrophysiologic characteristics, and follow-up duration after diagnosis. However, arrhythmic events during follow-up after diagnosis and number of arrhythmic events per patient were significantly higher in group I compared with groups II and III. Isoproterenol infusion (0.003 +/- 0.003 mu g/kg/min for 24 +/- 13 days) completely suppressed electrical storm of VF in all five patients treated and was successfully replaced with oral medications, including denopamine, quinidine, isoproterenol, cilostazol, and bepridil atone or in combination. CONCLUSION No specifically clinical, laboratory, etectrocardiographic, and electrophysiologic characteristics were recognized in patients with Brugada syndrome associated with electrical storm of VF. Isoproterenol infusion was effective as an acute treatment in suppressing electrical storm of VF and was successfully replaced with chronic oral medications.
  • 横川 美樹; 清水 渉; 野田 崇; 岡村 英夫; 北村 聡子; 須山 和弘; 栗田 隆志; 相原 直彦; 神崎 秀明; 鎌倉 史郎; 庭屋 和夫
    Journal of Arrhythmia 23 Suppl. 168 - 168 (一社)日本不整脈心電学会 2007年04月
  • Wataru Shimizu; Kiyotaka Matsuo; Yoshihiro Kokubo; Kazuhiro Satomi; Takashi Kurita; Takashi Noda; Noritoshi Nagaya; Kazuhiro Suyama; Naohiko Aihara; Shiro Kamakura; Nozomu Inamoto; Masazumi Akahoshi; Hitonobu Tomoike
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 18 4 415 - 421 2007年04月 [査読有り]
     
    Introduction: The clinical phenotype is 8 to 10 times more prevalent in males than in females in patients with Brugada syndrome. Brugada syndrome has been reported to be thinner than asymptomatic normal controls. We tested the hypothesis that higher testosterone level associated with lower visceral fat may relate to Brugada phenotype and male predominance. Methods and Results: We measured body-mass index (BMI), body fat percentage (BF%), and several hormonal levels, including testosterone, in 48 Brugada males and compared with those in 96 age-matched control males. Brugada males had significantly higher testosterone (631 +/- 176 vs 537 +/- 158 ng/dL; P = 0.002), serum sodium, potassium, and chloride levels than those in control males by univariate analysis, and even after adjusting for age, exercise, stress, smoking, and medication of hypertension, diabetes, and hyperlipidemia, whereas there were no significant differences in other sex and thyroid hormonal levels. Brugada males had significantly lower BMI (22.1 +/- 2.9 vs 24.6 +/- 2.6 kg/m(2); P < 0.001) and BF% (19.6 +/- 4.9 vs 23.1 +/- 4.7%; P < 0.001) than control males. Testosterone level was inversely correlated with BMI and BF% in both groups, even after adjusting for the confounding variables. Conditional logistic regression models analysis showed significant positive and inverse association between Brugada syndrome and hypertestosteronemia (OR:3.11, 95%CI:1.22-7.93, P = 0.017) and BMI (OR:0.72, 95%CI:0.61-0.85, P < 0.001), respectively. Conclusions: Higher testosterone level associated with lower visceral fat may have a significant role in the Brugada phenotype and male predominance in Brugada syndrome.
  • 栗田 隆志; 安田 正之; 中里 祐二; 高橋 直之; 山下 武志; 安田 聡; 清水 渉; 鎌倉 史郎
    心電図 = Electrocardiology 27 1 61 - 73 The Japanese Society of Electrocardiology 2007年01月 
    ベプリジルはCa2+チャネル抑制作用のみならず, ほとんどのK+チャネルの抑制効果を有している.特にlKsとlKrの双方を同時に抑制することは心室筋の再分極相を過剰に延長させ, QT延長に伴うtorsades de pointes (TdP) を招来する危険性がある.ベプリジルによるTdPの頻度は1%程度であると報告されており, Ia群薬によるTdPと同等か若干高いものと考えられる.ベプリジルを内服中にTdPを発生した患者の多くは200mg/日の量を内服し, 血中濃度は500ng/mLを超えていた.つまり, ベプリジルは血中濃度依存性にQTを延長させる可能性がある, 一方, この血中濃度を超えてもQTの延長が軽微な症例も多く, ベプリジルに過剰に反応する患者が存在することも示唆された.またTdPの発生を予見するQTcの上限値はIa群薬と同様に550msecと考えられた.lksとlkrの双方の抑制は心外膜側の活動電位を顕著に延長させ, T波の逆転を誘発することが動物実験により示されている.今回はこの結果を基に, ベプリジルによるTdPを発生した患者のT波形態を検討した.比較対照群として純粋なlkrチャネル抑制薬であるニフエカラントによるTdP症例を選択した.ベプリジルによるTdP患者では, ニフエカラントのそれと比較して, V5誘導におけるT波が有意に平定化または陰転化していた, ベプリジルは動物実験で示されたように心外膜側の活動電位を延長させ, 再分極相における電気ベクトルを外膜側から内膜側方向へ転じることによりT波極性の変化を招来するものと考えられた.
  • Koji Miyamoto; Miki Yokokawa; Koji Tanaka; Takayuki Nagai; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura; Wataru Shimizu
    AMERICAN JOURNAL OF CARDIOLOGY 99 1 53 - 57 2007年01月 [査読有り]
     
    To evaluate the diagnostic and prognostic value of an electrocardiogram (ECG) recorded at a higher (third or second) intercostal space, 98 men (17 to 76 years of age, mean +/- SD 47 13; with documented ventricular fibrillation [VF] in 22 and syncope in 32) were categorized into 3 groups; 68 men had a spontaneous type 1 ECG in standard leads V-1 and V-2 (S group), 19 had a spontaneous type 1 ECG only in the higher V-1 and V2 leads (H group), and 11 had a type 1 ECG only after receiving class Ic sodium channel blockers (Ic group). There were no significant differences in baseline clinical characteristics, including VF episodes, syncope, atrial fibrillation, family history, late potentials, and inducibility of VF during electrophysiologic study across the 3 groups. During prospective follow-up periods (779 +/- 525, 442 +/- 282, and 573 +/- 382 days, respectively), subsequent cardiac events occurred in 11 men (16%) within the S group, in 2 men (11%) in the H group, and in 0 men (0%) in the Ic group (p = NS, S vs H group). In men with previous episodes of VF, subsequent cardiac events occurred in 7 (44%) within the S group and in 2 (50%) in the H group (p = NS). In conclusion, men with a spontaneous type 1 Brugada ECG recorded only at higher leads V-1 and V-2 showed a prognosis similar to that of men with a type 1 ECG in using standard leads V-1 and V-2. (c) 2007 Elsevier Inc. All rights reserved.
  • Junko Ohashi; Satoshi Yasuda; Shunichi Miyazaki; Wataru Shimizu; Isao Morii; Takashi Kurita; Atsushi Kawamura; Shiro Kamakura; Hiroshi Nonogi
    JOURNAL OF CARDIOVASCULAR PHARMACOLOGY 48 6 274 - 279 2006年12月 [査読有り]
     
    Nifekalant hydrochloride (NIF) is a novel intravenous class-III antiarrhythmic agent with a pirimidinedione structure that purely blocks the K(+)channel without inhibiting P-adrenergic receptors. The authors investigated the efficacy of NIF for refractory ventricular tachycardia/fibrillation (VTNF). They studied 30 patients treated with an intravenous infusion of NIF [26 men, 4 women;, age: 63 +/- 17 (mean +/- SD) years] at a dose of 0.19 +/- 0. 14 mg/kg body weight per hour. Sixteen were patients with acute coronary syndrome (ACS), and 14 were patients with chronic structural heart disease (Chr-HD). Amiodarone and sotalol had already been administered to 9 patients with Chr-HD before the administration of NIF. The QT and T peak-end (Tp-e) intervals were measured and corrected by Bazett's method (QTc, cTp-e). The left ventricular ejection fraction was depressed (28 +/- 9%). NIF was effective for preventing VT/VF without proarrhythmia and hemodynamic deterioration in 21 patients (70%; 12 with ACS; 9 with Chr-HD), but ineffective in 4 patients (all with Chr-HD). The QTc prolongation in the responders was more pronounced than in the nonresponders (25% +/- 15% versus 5% +/- 7% increase; P < 0.05). Proarrhythmic torsade de pointes (TdP) developed transiently in the remaining 5 patients in whom the cTp-e was markedly increased compared with that in the responders (93% +/- 49% versus 37% +/- 41% increase; P < 0.05). In conclusion, these findings indicate that the intravenous administration of NIF is useful in the emergent treatment of inhibiting drug-refractory VT/VF, although proarrhythmic UP owing to an enhancement of transmural dispersion of repolarization needs to be taken into account.
  • Kiyoshi Otomo; Hideo Okamura; Takashi Noda; Kazuhiro Satomi; Wataru Shimizu; Kazuhiro Suyama; Takashi Kurita; Naohiko Aihara; Shiro Kamakura
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 17 11 1177 - 1183 2006年11月 [査読有り]
     
    Introduction: Recent anatomical and electrophysiological studies have demonstrated the presence of leftward posterior nodal extension (LPNE); however, its role in the genesis of atrioventricular nodal reentrant tachycardia (AVNRT) is poorly understood. This study was performed to characterize successful slow pathway (SP) ablation site and to elucidate the role of LPNE in genesis of atypical AVNRT with eccentric activation patterns within the coronary sinus (CS). Methods and Results: Among 45 patients with atypical AVNRT (slow-slow/fast-slow/both = 20/22/3 patients) with concentric (n = 37, 82%) or eccentric CS activation (n = 8, 18%), successful ablation site was evaluated. Among 35/37 patients (95%) with concentric CS activation, ablation at the conventional SP region outside CS eliminated both retrograde SP conduction and AVNRT inducibility. Among eight patients with eccentric CS activation, the earliest retrograde atrial activation was found at proximal CS 16 +/- 4 mm distal to the ostium during AVNRT. The earliest retrograde activation site was located at inferior to inferoseptal mitral annulus, consistent with the presumed location of LPNE. Ablation at the conventional SP region with electroanatomical approach only rendered AVNRT nonsustained without elimination of retrograde SP conduction in seven of eight patients (88%). Ablation targeted to the earliest retrograde atrial activation site within proximal CS (15 +/- 4 mm distal to the ostium); however, eliminated retrograde SP conduction and rendered AVNRT noninducible in six of eight patients (75%). Conclusion: In 75% of "left-variant" atypical AVNRT, ablation within proximal CS was required to eliminate eccentric retrograde SP conduction and render AVNRT noninducible, suggesting LPNE formed retrograde limb of reentrant circuit.
  • Miki Yokokawa; Hiroshi Takaki; Takashi Noda; Kazuhiro Satomi; Kazuhiro Suyama; Takashi Kurita; Shiro Kamakura; Wataru Shimizu
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 29 10 1112 - 1121 2006年10月 [査読有り]
     
    Background: Mutations in sodium channel gene, SCN5A, have been identified in Brugada syndrome, but it is still unclear as to how sodium channel dysfunction relates to arrhythmogenesis. We examined spatial distribution of both repolarization and depolarization abnormalities in patients with Brugada syndrome by using 87-leads body surface potential mapping (BSPM). Methods: BSPM was recorded under baseline condition and after pharmacological interventions in 28 patients with Brugada syndrome (27 males, 49 +/- 14 years). The ST-segment amplitude 20 ms after the end of QRS (ST20), QRS duration, and corrected recovery time (RTc) were measured in all 87-leads, and averaged among 6-leads (D-F, 5-6) reflecting right ventricular outflow tract (RVOT) potentials and the other 81 -leads. Results: The ST20 was elevated at baseline, normalized by isoproterenol, and augmented by pilsicainide in only the RVOT The RTc was longer at baseline and increased by pilsicainide in only the RVOT On the other hand, the QRS duration was slightly widened at baseline, further increased by pilsicainide, but not changed by isoproterenol in both leads. Conclusions: The ST-segment elevation and the RTc prolongation were localized and modulated by agents only in the RVOT region, while the slight QRS widening at baseline and further increase by pilsicainide were observed homogeneously. Our data suggest that depolarization abnormalities are distributed homogeneously, whereas repolarization abnormalities are localized in the RVOT.
  • Kazuhiro Satomi; Takashi Kurita; Seiji Takatsuki; Yasuhiro Yokoyama; Masaomi Chinushi; Naoya Tsuboi; Takashi Nitta; Morio Shoda; Hideo Mitamura
    CIRCULATION JOURNAL 70 8 977 - 984 2006年08月 [査読有り]
     
    Background Whether amiodarone can improve the patient's clinical outcome by reducing implantable cardioverter-defibrillator (ICD) therapy deliveries for ventricular tachycardia or fibrillation (VT/VF) has not been clearly evaluated. Methods and Results A total of 507 patients with VT/VF due to organic heart disease who had ICDs implanted were enrolled in this study. The patients were divided into 3 groups: Arniodarone (n=247), Class I antiarrhythmic drug (n=103) and Control (n=157) groups, and the total cause mortality and arrhythmic event free survival rates were evaluated between the groups. The mean follow-up period was 38 +/- 27 months. The left ventricular ejection fraction was significantly decreased in the Arniodarone group (Amiodarone: 37 +/- 15%; Class I: 39 +/- 16%; Control: 44 +/- 17%). The mortality and arrhythmic events were significantly higher in the Class I group than the Amiodarone group (p < 0.05), but there was no significant difference between the Arniodarone and Control groups (arrhythmic event free rate at 5 years: Amiodarone: 53%; Class I: 35%; Control: 48%; 5 year survival: 86%, 74% and 77%, respectively). Side effects from amiodarone were found in 12% of the patients, but no fatal events were observed. Conclusions The present study could not demonstrate the benefit of amiodarone in ICD patients, probably due to a significant clinical bias exerted in selecting this drug.
  • K Otomo; H Okamura; T Noda; K Satomi; W Shimizu; K Suyama; T Kurita; N Aihara; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 29 6 589 - 599 2006年06月 [査読有り]
     
    Background: Transversal conduction across crista terminalis (CT) is commonly observed during low-rate coronary sinus (CS) pacing after isthmus ablation and sometimes mimics incomplete clockwise isthmus block (IB). Site-specific influence of trans-cristal conduction gap on recognition of clockwise IB has been poorly understood. Methods: Forty-five patients with common-type atrial flutter underwent mapping of CT and free wall lateral to CT during CS pacing of 100 ppm using CARTO after verification of IB, while duodecapolar catheter was positioned along tricuspid annulus to map periannular activation. Results: A total of 43 gaps were demonstrated at upper (n = 15, 35%), middle (n = 17, 40%), and lower one-thirds of CT (n = 11, 25%) in 36 of 45 patients (80%). Gaps were single in 31 (69%) and multiple in 5 patients (11%). Activation patterns of free wall lateral to CT in CARTO maps were descending pattern without gaps (n = 9, 20%), collision pattern with a single gap (n = 31, 69%), and simultaneous pattern with multiple gaps (n = 5, 11%). Activation sequence of duodecapolar catheter was complete block pattern in 41 (91%) and incomplete block pattern in 4 patients (9%), masquerading as persistent clockwise isthmus conduction. The incomplete block pattern in duodecapolar catheter was exclusively associated with a gap at the lower CT (0/15, 0/17, and 4/11 gaps at upper, middle, and lower CT, respectively; P < 0.01) and was attributable to faster conduction across CT gaps than in complete block pattern. Conclusions: Trans-cristal conduction was commonly observed during low-rate CS pacing. Rapid transversal conduction exclusively across lower CT masqueraded as incomplete clockwise IB.
  • K Otomo; H Okamura; T Noda; K Satomi; W Shimizu; K Suyama; T Kurita; N Aihara; S Kamakura
    HEART RHYTHM 3 5 544 - 554 2006年05月 [査読有り]
     
    BACKGROUND The electrophysiologic mechanisms of different ventriculoatrial (VA) block patterns during atrioventricular nodal reentrant tachycardia (AVNRT) are poorly understood. OBJECTIVES The purpose of this study was to characterize AVNRTs with different VA block patterns and to assess the effects of slow pathway ablation. METHODS Electrophysiologic data from six AVNRT patients with different VA block patterns were reviewed. RESULTS All AVNRTs were induced after a sudden AH "jump-up" with the earliest retrograde atrial activation at the right superoparaseptum. Different VA block patterns comprised Wenckebach His-atrial (HA) block (n = 4), 2:1 HA block (n = 1), and variable HA conduction times during fixed AVNRT cycle length (CL) (n = 1). Wenckebach HA block during AVNRT was preceded by gradual HA interval prolongation with fixed His-His (HH) interval and unchanged atrial activation sequence. AVNRT with 2:1 HA block was induced after slow pathway ablation for slow-slow AVNRT with 1:1 HA conduction, and earliest atrial activation shifted from right inferoparaseptum to superoparaseptum without change in AVNRT CL. The presence of a lower common pathway was suggested by a longer HA interval during ventricular pacing at AVNRT CL than during AVNRT (n = 5) or Wenckebach HA block during ventricular pacing at AVNRT CL (n = 1). In four patients, HA interval during ventricular pacing at AVNRT CL was unusually long (188 +/- 30 ins). Ablations at the right inferoparaseptum tendered AVNRT noninducible in 5 (83%) of 6 patients. CONCLUSION Most AVNRTs with different VA block patterns were amenable to classic slow pathway ablation. The reentrant circuit could be contained within a functionally protected region around the AV node and posterior nodal extensions, and different VA block patterns resulted from variable conduction at tissues extrinsic to the reentrant circuit.
  • K Satomi; T Kurita; K Suyama; T Noda; H Okamura; K Otomo; W Shimizu; N Aihara; S Kamakura
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 17 5 469 - 476 2006年05月 [査読有り]
     
    Introduction: A reentrant circuit within an area of abnormal myocardium is suspected as the origin of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular dysplasia (ARVD). Objectives: To examine the relationship between the reentrant circuits of VT and the abnormal electrograms in ARVD, and to assess the feasibility of a block line formation in the reentrant circuit isthmus utilizing electroanatomical mapping system (CARTO) guidance. Methods and Results: An electrophysiological study and catheter ablation (CA) were performed in 17 ARVD patients (13 men, 47 +/- 17 year) using CARTO. Endocardial mapping during sinus rhythm demonstrated electrogram abnormalities extended from the tricuspid annulus (TA) or the right ventricular outflow tract in 16 of 17 patients. In 13 hemodynamically stable VTs, the reentrant circuits and critical slow conduction sites for the CA were investigated during VTs. The entire macro-reentrant pathway was identified in 6/13 stable VTs (figure-of-8 in 4, single loop in 2). In the remaining seven VTs, a focal activation pattern was found in four and an unidentifiable pattern in three. CA successfully abolished all the macro-reentrant and focal tachycardias, however, not effective in three unidentifiable VTs. In the 13 cases with unstable VT, the linear conduction block zone was produced between the sites with abnormal electrograms and the TA. Ultimately, 23/26 VTs (88%) became noninducible after the CA. During follow-up (26 +/- 15 months), 13/17 patients remained free from any VT episodes. Conclusions: CARTO is useful for characterizing the anatomical and electrophysiological substrates, and for identifying the optimal ablation sites for VT associated with ARVD.
  • T Nagai; K Suyama; W Shimizu; T Noda; K Satomi; T Kurita; N Aihara; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 29 5 549 - 552 2006年05月 [査読有り]
     
    A 20-year-old man was admitted to our hospital for treatment of verapamil sensitive idiopathic left ventricular tachycardia (ILVT). During the electrophysiologic study (EPS), no sustained ventricular tachycardia (VT) could be induced both at baseline and after infusion of isoproterenol. However, sustained clinical VT could be easily induced with single ventricular extrastimulation following intravenous administration of pilsicainide, a class Ic sodium channel blocker. The arrhythmia was ablated with radiofrequency catheter ablation.
  • 栗田 隆志; 里見 和浩; 北村 聡子; 野田 崇; 須山 和弘; 清水 渉; 相原 直彦; 鎌倉 史郎
    心電図 = Electrocardiology 26 2 144 - 152 The Japanese Society of Electrocardiology 2006年03月 
    欧米を中心としたいくつかの大規模試験によると植込み型除細動器 (ICD) は対象となる心疾患の種類や, 1次または2次予防としての使用目的を問わず, 心不全患者に対して予後の改善をもたらす最も有効な治療法の一つとされている.しかし, 高価なICDの乱用は医療経済を圧迫する新たな要因となりうるため, ICDの効果的な活用に向けた的確なリスク判断が求められる.本稿では基礎心疾患を有する患者の突然死予防について, 虚血性と非虚血性に分けてその治療戦略を考察する.我が国において, 虚血性心疾患患者の突然死発生率は小さいと考えられ, 治療の有効性を高めるため欧米のエビデンスに基づいたものよりも強化された診断基準が必要である.一方, 非虚血性心筋症においては突然死のリスクは海外と同等であり, 欧米で示されたリスク評価を外挿できる.
  • S Kitamura; K Satomi; T Kurita; W Shimizu; K Suyama; N Aihara; K Niwaya; J Kobayashi; S Kamakura
    CIRCULATION JOURNAL 70 3 273 - 277 2006年03月 [査読有り]
     
    Background As a result of longer follow-up after implantation of cardioverter defibrillators (ICD), fatigue of the leads has become a concern. The aim of this study was to determine the incidence and clinical presentation of ICD lead failures. Methods and Results The Study Population consisted of 241 patients with 249 ICD leads Who underwent implantation of an ICD with a transvenous lead system. After device implantation, the patients were routinely followed up every 4 months. Five lead failures (2.0%) Occurred as an oversensing of artifact during the follow-up period (2.6 +/- 2.1 years); 4 of those 5 patients received inappropriate shocks and I case of lead failure was identified in a patient with frequent episodes of non-sustained ventricular fibrillation. In particular, the right ventricular polyurethane transvenous lead in the Medtronic model 6936 failed in 4 (13%) of 31 cases. Percutaneous lead extraction was not available in all cases, so an additional ICD lead was inserted through the same site of the subclavian vein. Conclusions Lead failures may occur 5 years after ICD implantation and polyurethane leads have an especially high incidence of failure. However, there were no follow-up parameters observed that predicted lead failures.
  • T Kurita; H Mitamura; Y Aizawa; T Nitta; K Aonuma; N Tsuboi; M Chinushi; Y Kobayashis; K Soejima; K Satomi; H Furushima; T Ohe; S Ogawa; Kodama, I; H Ohtsu; T Yamazaki
    CIRCULATION JOURNAL 70 3 316 - 320 2006年03月 [査読有り]
     
    Background Implantable cardioverter-defibrillators (ICDs) are the most effective therapy in reducing the mortality of patients with life-threatening ventricular tachyarrhythmias. However, the ICD cannot prevent the recurrence of tachycarida attacks and that limits the clinical usefulness of them. The Nippon ICD Plus Pharmachologic Option Necessity (NIPPON) trial was designed as the first prospective randomized study to test the hypothesis whether amiodarone could improve the patient's clinical outcome by reducing the amount of ICD therapy in the Japanese patient Population. Methods and Results Approximately 400 patients with organic heart disease and spontaneous episode(s) of sustained ventricular tachycardia/fibrillation (VT/VF) will be randomly assigned to one of 2 groups; the amiodarone group and non-amiodarone group. Both groups of patients will be followed at least for 24 months. The end-point committee will adjudicate events in a blinded fashion. The primary end-points of this Study are determination of the appropriate therapy from the ICD and alteration of the assigned treatment because of its harmful effects and/or frequent ICD therapies. Conclusion The NIPPON study is expected to confirm our understanding of the prognostic and therapeutic usefulness of adjuvant amiodarone therapy for patients with an ICD and with a history of sustained VT/VF.
  • 清水 渉; 相庭 武司; 野田 崇; 里見 和浩; 須山 和弘; 栗田 隆志; 相原 直彦; 鎌倉 史郎
    心電図 = Electrocardiology 26 1 20 - 27 The Japanese Society of Electrocardiology 2006年01月 
    分子遺伝学的研究の進歩により, 一部の致死性不整脈疾患は心筋イオンチャネル機能に関係する遺伝子の変異によって発症することが判明し, 「イオンチャネル病」という概念が生まれた, これには先天性または後天性QT延長症候群 (LQTS) , Brugada症候群などが含まれる.先天性LQTSでは現在までに8つの遺伝子型が同定されているが, 動脈灌流左室心筋切片を用いたLQTSモデルや単相性活動電位記録を用いた臨床研究により, K+電流 (IKs, IKr) の機能低下によるLQT1とLQT2では, ATP感受性K+ (KATP) チャネル開口薬のニコランジルの有効性が主に静注薬で示唆されている.一方, Brugada症候群ではNa+チャネル遺伝子のSCN5Aの異常が報告されているが, その病態には一過性外向き電流 (Ito) に関係する右室心外膜細胞活動電位の第1相notchが関与する.このため, K+チャネル開口薬の使用や虚血時のATP感受性K+電流 (IK, ATP) 増強は, 表現型 (ST上昇や心室細動) を増悪させたり, これを顕性化させる可能性がある (後天性Brugada症候群) .
  • K Otomo; T Noda; E Nakagawa; K Satomi; W Shimizu; K Suyama; T Kurita; N Aihara; S Kamakura
    JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 14 3 183 - 192 2005年12月 [査読有り]
     
    Duodecapolar catheters (DPCs) have been widely used to diagnose isthmus block after ablation in patients with atrial flutters. The purpose of this study was to assess the ability of DPC to diagnose isthmus block utilizing electroanatomical mapping system (CARTO). Methods: Sixty-two patients with common atrial flutter underwent isthmus ablation during CS pacing while DPC was positioned at lateral wall of RA along tricuspid annulus (TA). When activation sequence of DPC recording changed exclusively counter-clockwise after ablation, or did not even after ablations targeting single potentials on ablation line (Ab-L), only lateral side of Ab-L was remapped using CARTO to assess whether complete block (CB) was established. Results: After ablation, DPC recording suggested CB and incomplete block (ICB) in 53 (85%) and 9 patients (15%), respectively. In 51/53 patients (96%) with CB suggested by DPC recordings, CARTO remap also demonstrated CB, however, in the remaining two patients (4%), demonstrated ICB with residual isthmus conduction that was slow enough to allow wavefront conducting around TA to arrive at distal dipole of DPC earlier, mimicking CB. In 4/9 patients (44%) with ICB suggested by DPC recordings, CARTO remap also demonstrated ICB, however, in the remaining five patients (56%), demonstrated CB with earlier arrival of wavefront traversing posterior wall at just lateral to Ab-L than that conducting around TA, mimicking ICB. Sensitivity, specificity, positive, and negative predictive values of DPC to diagnose CB were 91, 67, 96, and 44%, respectively. Conclusions: Mapping using DPC would not be sufficient for diagnosis of CB and ICB.
  • T Noda; W Shimizu; A Taguchi; T Aiba; K Satomi; K Suyama; T Kurita; N Aihara; S Kamakura
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 46 7 1288 - 1294 2005年10月 [査読有り]
     
    Objectives: The aim of this study was to assess the clinical characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for idiopathic ventricular fibrillation (V-F) and/or polymorphic ventricular tachycardia initiated by ventricular extrasystoles originating from the right ventricular outflow tract (RVOT). Background: Ventricular fibrillation and/or polymorphic ventricular tachycardia are occasionally initiated by ventricular extrasystoles originating from the RVOT in patients without structural heart disease. Methods: Among 101 patients without structural heart disease in whom RFCA was conducted for idiopathic ventricular tachyarrhythmias arising from the RVOT, we examined the clinical characteristics and the efficacy of RFCA in 16 patients with spontaneous VY and/or polymorphic ventricular tachycardia initiated by the ventricular extrasystoles originating from the RVOT. Results: Among 16 patients, spontaneous episodes of VF were documented in 5 patients, and 11 patients had prior episodes of syncope. Holter recordings showed frequent isolated ventricular extrasystoles with the same morphology as that of initiating ventricular extrasystoles, and non-sustained polymorphic ventricular tachycardia with short cycle length (mean of 245 +/- 28 ms) in all 16 patients. Radiofrequency catheter ablation by targeting the initiating ventricular extrasystoles eliminated episodes of syncope, VY, and cardiac arrest in all patients during follow-up periods of 54 +/- 39 months. Conclusions: Our data suggest that the malignant entity of idiopathic VF and/or polymorphic ventricular tachycardia was occasionally present in patients with idiopathic ventricular arrhythmias arising from the RVOT. Radiofrequency catheter ablation was effective as a treatment option for this entity.
  • T Noda; W Shimizu; K Suyama; T Tobiume; K Satomi; T Kurita; N Aihara; S Kamakura
    CIRCULATION JOURNAL 69 8 1003 - 1006 2005年08月 [査読有り]
     
    This case report describes a patient with the permanent form of junctional reciprocating tachycardia coexisting with atrial tachycardia. A detailed electrophysiological study established the diagnosis, and radiofrequency catheter ablation abolished both arrythmias.
  • S Yagi; E Tsuda; W Shimizu; T Kurita; O Seguchi; H Nonogi; S Kamakura
    CIRCULATION JOURNAL 69 7 870 - 874 2005年07月 [査読有り]
     
    There is an adult patient population in Japan with undiagnosed coronary artery lesions caused by Kawasaki disease (KD) occurring before 1967, the time at which KD was first described. Two adult patients presented with a low left ventricular (LV) ejection fraction and ventricular tachycardia (VT) caused by presumed KD. A 43-year-old man with rapid VT had a history of an acute febrile illness with desquamation of the fingertips at the age of 10 months. Coronary angiography (CAG) showed segmental stenosis of the right coronary artery (RCA) and occlusion of the left anterior descending artery with a giant aneurysm. The other patient was a 48-year-old man with a history of ischemic cardiomyopathy diagnosed after a previous myocardial infarction when he was 32 years old. He had segmental stenosis of the RCA on CAG. Non-sustained VT with transient unconsciousness was observed during 24-h Holier electrocardiography. Rapid VT with syncope was induced in both patients in the electrophysiologic studies and an implantable defibrillator was required to prevent sudden death. Physicians Must be aware that VT can occur in older patients with LV dysfunction many years after KD.
  • N Tahara; H Takaki; A Taguchi; K Suyama; T Kurita; W Shimizu; S Miyazaki; T Kawada; K Sunagawa
    AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY 288 3 H1179 - H1185 2005年03月 [査読有り]
     
    Potent cardioinhibitory vagal reflex resulting in bradycardia and hypotension has been observed under particular conditions of transmural inferior ischemia and its reperfusion, such as those observed with acute infarction. However, whether exercise-induced ischemia with ST depressions that is subendocardial and that might be recurrently experienced in daily activities can evoke this reflex remains unknown. In patients with exercise-induced ST depressions due to either inferior [ right coronary artery stenosis ( RCA), n = 52] or anterior ischemia [ left anterior descending artery stenosis ( LAD), n = 51], we evaluated postexercise vagal activity ( from 0 to 6 min) by the time constant of heart rate ( HR) decay and HR variability by 30-s averages of the absolute values of successive RR interval differences ( DeltaRR). Exercise parameters were similar between groups. The time constant was slightly but significantly shorter in RCA than LAD patients ( 79 +/- 24 vs. 93 +/- 29 s, P < 0.01). More significantly, DeltaRR early after exercise ( 0.5 - 2.5 min) was approximately twofold greater in RCA than LAD patients ( from + 76 to + 118%, P < 0.001), indicating pronounced vagal activity stimulated by inferior ischemia. Revascularization prolonged the time constant ( P < 0.05) and attenuated recovery DeltaRR in RCA patients ( P < 0.05, n = 10) but did not change both parameters in LAD patients ( n = 12). As well as acute inferior infarction, exercise-induced inferior subendocardial ischemia, which might recurrently occur in daily activities, activates the cardioinhibitory reflex. These new findings must be taken into account in interpreting vagal activity in patients with coronary artery disease.
  • K Satomi; W Shimizu; H Takaki; K Suyama; T Kurita; N Aihara; S Kamakura
    HEART RHYTHM 2 2 149 - 154 2005年02月 [査読有り]
     
    OBJECTIVES The purpose of this study was to test the hypothesis that the lability of beat-by-beat QT variability is prominent during sympathetic stimulation in LQT1 patients. We analyzed beat-by-beat QT variability using a newly developed program and applied cross-correlation methods in LQT1 patients before and after epinephrine infusion. BACKGROUND Studies suggest that cardiac events associated with sympathetic stimulation are more common in the LQT1 form than the LQT2 and LQT3 forms of congenital long QT syndrome (LQTS). Although beat-by-beat alternation of T-wave morphology is observed in LQTS, its objective estimation is difficult because of complicated T-wave morphology. METHODS Twelve-lead ECG was recorded under baseline conditions and during epinephrine infusion (0.1 mug/kg/min) in 14 LQT1 and five control patients. We measured beat-by-beat QT interval by a cross-coffelation technique. Mean of successive changes in RR (DeltaRR), QT (DeltaQT), standard deviation of DeltaRR (SD-DeltaRR), DeltaQT (SD-DeltaQT), and QT1 QT/ RR) before and after epinephrine were compared between the two groups. RESULTS No significant differences in any parameters were observed between the two groups under baseline conditions. DeltaQT, SD-DeltaQT, and QT1 were increased in LQT1 but not in control patients during epinephrine (LQT1: DeltaQT 2.3-4.2 ms, SD-DeltaQT 2.2-4.1, QTI 0.10-0.22, P <.005 vs baseline; Control: DeltaQT 2.5-2.4 ms, SD-DeltaQT 1.9-2.1, QTI 0.08-0.09: P = NS vs baseline). CONCLUSIONS Beat-by-beat QT variability analyzed by the cross-correlation method was greater in LQT1 patients during epinephrine infusion, suggesting sympathetic stimulation accentuates beat-by-beat alternation of repolarization in LQT1 patients.
  • 鎌倉 史郎; 里見 和浩; 須山 和弘; 清水 渉; 栗田 隆志; 相原 直彦
    心電図 = Electrocardiology 25 1 56 - 64 The Japanese Society of Electrocardiology 2005年01月 
    III群抗不整脈薬であるソタロールとアミオダロンが電気生理学検査 (EPS) や心機能に対していかなる影響を及ぼし, 再発予防効果または生命予後延長効果を有するかを, 頻脈性不整脈に対して長期投与を行った例で検討した.対象は不整脈または心不全のためにソタロールまたはアミオダロンを投与された429例中, 持続性心室頻拍 (SVT) /心室細動 (VF) に対してIII群抗不整脈薬を投与された219例 (ソタロール36例, アミオダロン183例) , 発作性心房細動 (PAF) に対して両薬を投与された61例 (ソタロール14例, アミオダロン47例) である.平均観察期間はSVTNF: ソタロール28カ月, アミオダロン39ヵ月, PAF=ソタロール14ヵ月, アミオダロン37カ月で, SVTNF例ではほぼ全例が器質的心疾患を有していた.致死性不整脈の再発率は, EPSで心室性不整脈が誘発されなかった例のほかに, アミオダロン投与下で多形性VT, VFが誘発された例で少なかった.III群抗不整脈薬投与例の生命予後は, 心機能良好例よりも低心機能例で悪かったが, ICD植込み群と非植込み群間では有意な差がなかった.致死性不整脈に対する2次予防効果は, ソタロールとアミオダロン間で差がなかったが, PAFの洞調律維持効果はアミオダロンが優れていた.本邦ではIII群抗不整脈薬投与例にEPSを施行する意義があると思われ, 低心機能例にはICDを植込まない治療法も選択できると考えられた.
  • 栗田 隆志
    心臓 37 1 4 - 13 公益財団法人 日本心臓財団 2005年
  • T Noda; W Shimizu; K Satomi; K Suyama; T Kurita; N Aihara; S Kamakura
    EUROPEAN HEART JOURNAL 25 23 2149 - 2154 2004年12月 [査読有り]
     
    Aims To examine the initiating mode of Torsade de Pointes (TdP) in patients congenital tong QT syndrome (LQTS). Methods and results We evaluated 111 episodes of TdP recorded on the electrocardiograms of 24 patients with congenital LQTS. and clarified the initiating mode, three consecutive preceding RR intervals defined as C-2, C-1, and C-0, the timing of imitiating premature ventricular contraction (PVC) and the cycle length (CL) of TdP. Three different initiating patterns were observed: (1) a "short-tong-short" (SLS) pattern (23 patients, 72 TdP, 65%) defined as one or more short-long cycles followed by an initiating short-coupled PVC (C-1 > C-2 and C-0), (2) an "increased sinus rate" (ISR) pattern (8 patients, 28 TdP,. 25%) defined as a gradual increase sinus rate with or without T-wave alternans (C-2 greater than or equal to C-1 greater than or equal to C-0), and (3) a "changed depolarization" (CD) pattern (5 patients, 11 TdP, 10%) defined as a sudden tong PVC or fusion beat followed by short-coupled PVC. The C-0 was shorter in ISR SLS and CD (mean C-0: 488 vs. 587 and 603 ms, respectively; P < 0.05). Therefore, the initiating PVC appeared near the T-wave peak of the last beat before onset ISR, while it occurred after the T-wave peak in SLS and CD. The CL of TdP was in ISR than in SLS (256 vs. 295 ms, P < 0.05). Conclusions Our data show the existence of three predominant initiating modes TdP in patients with congenital LQTS and suggests a differential mechanism of initiation of TdP for each mode. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All reserved.
  • S Sakuragi; H Takaki; A Taguchi; K Suyama; T Kurita; W Shimizu; T Kawada; Y Ishida; T Ohe; K Sunagawa
    CIRCULATION JOURNAL 68 10 915 - 922 2004年10月 [査読有り]
     
    Background Using the exercise ECG for diagnosing coronary artery disease (CAD) is hampered by the occurrence of false-positive (FP) ST-segment depression. Because it is known that the recovery ST-T time-course in CAD differs from that in FP subjects, the ST slope may help discriminate FP from true-positive (TP) results. Methods and Results Treadmill digitized ECG from patients with significant ST-segment depressions and normal resting ECG were analyzed in 134 patients with CAD on angiography (>50% narrowing) and reversible perfusion defects (TP group), and 64 subjects with normal perfusion (FP group) on exercise single photon emission computed tomography. The ST slope between the J-point and J80 was measured every minute up to 6-min postexercise. The ST slope was significantly higher in FP than in TP at peak exercise, and at postexercise 1-, 2- and 3-min (p<0.01, all). Thereafter, it gradually increased in TP, while monotonically decreasing in FP. Its decrease from 3- to 6-min could correctly diagnose 88% of FP subjects, whereas it was found in only 19% of TP patients (total accuracy 83%). Conclusions The ST slope change from early to late recovery is a simple yet reliable marker for discriminating FP from TP ST-segment responses in subjects with a normal resting ECG.
  • W Shimizu; T Noda; H Takaki; N Nagaya; K Satomi; T Kurita; K Suyama; N Aihara; K Sunagawa; S Echigo; Y Miyamoto; Y Yoshimasa; K Nakamura; T Ohe; JA Towbin; SG Priori; S Kamakura
    HEART RHYTHM 1 3 276 - 283 2004年09月 [査読有り]
     
    OBJECTIVES The aim of this study was to test the hypothesis that epinephrine test may have diagnostic value for genotyping LQT1, LQT2, and LQT3 forms of congenital long QT syndrome (LQTS). BACKGROUND A differential response of dynamic QT interval to epinephrine infusion between LQT1, LQT2, and LQT3 syndromes has been reported, indicating the potential diagnostic value of the epinephrine test for genotyping the three forms. METHODS The responses of 12-lead ECG parameters to epinephrine were retrospectively examined in 15 LQT1, 10 LQT2, 8 LQT3, and 10 healthy volunteers to select the best ECG criteria for separating the four groups. The epinephrine test then was prospectively conducted in 42 probands clinically affected with LQTS, their 67 family members, and 10 new volunteers. The best criteria were applied in a blinded fashion to prospectively separate a different group of 31 LQT1, 23 LQT2, 6 LQT3, and 30 Control patients (10 genotype-negative LQT1, 10 genotype-negative LQT2 family members, and 10 volunteers). RESULTS The sensitivity (penetrance) by ECG diagnostic criteria was lower in LQT1 (68%) than in LQT2 (83%) or LQT3 (83%) before epinephrine and was improved with steady-state epinephrine in LQT1 (87%) and LQT2 (91%) but not in LQT3 (83%), without the expense of specificity (100%). The sensitivity and specificity to differentiate LQT1 from LQT2 were 97% and 96%, those from LQT3 were 97% and 100%, and those from Control were 97% and 100%, respectively, when Delta mean corrected Q-Tend greater than or equal to35ms at steady state was used. The sensitivity and specificity to differentiate LQT2 from LQT3 or Control were 100% and 100%, respectively, when Delta mean corrected Q-Tend greater than or equal to80ms at peak was used. CONCLUSIONS Epinephrine infusion is a powerful test to predict the genotype of LQT1, LQT2, and LQT3 syndromes as well as to improve the clinical diagnosis of genotype-positive patients, especially those with LQT1 syndrome.
  • T Aiba; W Shimizu; M Inagaki; K Satomi; A Taguchi; T Kurita; K Suyama; N Aihara; K Sunagawa; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 27 7 901 - 909 2004年07月 [査読有り]
     
    Although chronic amiodarone has been proven to be effective to suppress ventricular tachycardia (VT) and ventricular fibrillation (VF), how we predict the recurrence of VT/VF after chronic amiodarone remains unknown. This study evaluated the predictive value of the QT interval, spatial, and transmural dispersions of repolarization (SDR and TDR)for further arrhythmic events after chronic amiodarone. Eighty-seven leads body surface ECGs were recorded before (pre) and one month after (post) chronic oral amiodarone in 50 patients with sustained monomorphic VT associated with organic heart disease. The Q-Tend (QTe), the Q-Tpeak (QTp), and the interval between Tpeak and Tend (Tp-e) as an index of TDR were measured automatically from 87-lead ECG, corrected Bazett's method (QTce, QTcp, Tcp-e), and averaged among all 87 leads. As an index of SDR, the maximum (max) minus minimum (min) QTce (max-min QTce) and standard deviation of QTce (SD-QTce) was obtained among 87 leads. All patients were prospectively followed (15 +/- 10 months) after starting amiodarone, and 20 patients had arrhythmic events. The univariate analysis revealed that post max QTce, post SD-QTce, post max-min QTce, and post mean Tcp-e from 87-lead but not from 12-lead ECG were the significant predictors for further arrhythmic events. ROC analysis indicated the post max-min QTce greater than or equal to106 ms as the best predictor of events (hazard ratio = 10.4, 95%, CI 2.7 to 40.5, P = 0.0008). Excessive QT prolongation associated with increased spatial and transmural dispersions of repolarization predict the recurrence of VT/VF after amiodarone treatment.
  • T Noda; K Suyama; W Shimizu; K Satomi; K Otomo; H Okamura; T Kurita; N Aihara; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 27 4 561 - 562 2004年04月 [査読有り]
     
    NODA, T., ET AL.: Ventricular Tachycardia with Figure Eight Pattern Originating From the Right Ventricle in A Patient with Cardiac Sarcoidosis. This case report describes VT with figure eight pattern originating from the right ventricle in a 33-year-old patient with cardiac sarcoidosis. Multiple radiofrequency linear ablation could abolish the VT, and this patient has been clinically free from symptoms of VT during a 6-month follow-up.
  • 致死性不整脈症例に対する植え込み型除細動器(ICD)の適応について 当施設での使用経験を含めて
    小澤 友哉; 伊藤 誠; 山路 正之; 宮本 証; 杉本 喜久; 八尾 武憲; 芦原 貴司; 堀江 稔; 浅井 徹; 大林 靖典; 小野 進; 山岡 修; 静田 聡; 栗田 隆志; 中村 隆志
    滋賀医学 26 92 - 92 (一社)滋賀県医師会 2004年03月
  • T Kurita; K Satomi; A Taguchi; W Shimizu; K Suyama; N Aihara; S Kamakura; K Niwaya; J Kobayashi
    CARDIAC ARRHYTHMIAS 2003 535 - 539 2004年 [査読有り]
  • T Noda; K Suyama; W Shimizu; K Satomi; K Otomo; E Nakagawa; T Kurita; N Aihara; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 26 10 2050 - 2051 2003年10月 [査読有り]
     
    This case report describes two distinct morphological ventricular tachycardias (VTs) associated with bidirectional reentrant circuit around the tricuspid annulus in a 32-year-old patient with arrhythmogenic right ventricular dysplasia. Multiple radiofrequency linear ablation could abolish both VTs, and this patient has been clinically free from symptoms of VTs at 1-year follow-up.
  • M Myoishi; S Yasuda; S Miyazaki; K Ueno; Morii, I; K Satomi; Y Otsuka; A Kawamura; T Kurita; S Kamakura; H Nonogi
    CIRCULATION JOURNAL 67 10 898 - 900 2003年10月 [査読有り]
     
    Excretion in the urine is an important pathway for the elimination of nifekalant hydrochloride (NIF), a novel class III antiarrhythmic agent. Three patients with renal failure were undergoing hemodialysis and receiving NIF for the prevention of ischemia-induced ventricular tachyarrhythmia. Because NIF is not dialyzed, dose adjustment at relatively low concentrations was required, with monitoring of the QT interval.
  • T Hanaoka; K Suyama; A Taguchi; W Shimizu; T Kurita; N Aihara; S Kamakura
    JAPANESE HEART JOURNAL 44 5 673 - 680 2003年09月 [査読有り]
     
    Intracardiac echocardiography (ICE) serves as an adjunct to fluoroscopy for electro-physiological procedures by identifying critical anatomic landmarks and confirming catheter-endocardial contact. In the present study, we investigated the usefulness of ICE for radiofrequency catheter ablation. ICE was utilized to guide transseptal puncture in 19 patients undergoing, radiofrequency catheter ablation. The fossa ovalis. which was one critical anatomic landmark. had an average vertical diameter of 18.5 +/- 6.9 min and an average horizontal diameter of 10.0 +/- 2.4 null, as measured by ICE and fluoroscopy. Although there was only a small shift of the puncture site in the horizontal direction, the puncture site shifted towards the upper edge of the fossa ovalis for 17 patients (89%). Furthermore, we could verify that the distance between the apex of the tent-shape formed by the pressure of the puncture needle in the fossa ovalis and the left atrial wall opposing it was Sufficient to carry out the procedure safely. Confirming the Puncture Site using ICE is useful in carrying out transseptal left heart catheterization safety.
  • T Aiba; T Kurita; K Suyama; K Satomi; A Taguchi; W Shimizu; N Aihara; S Kamakura
    JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 8 2 129 - 133 2003年04月 [査読有り]
     
    We report a case of left accessory atrioventricular pathway (AP) which antegrade conduction was manifest during pacing from the anterior site of the atrial insertion, but absent during pacing from the posterior site. Infusion of adenosine triphosphate during pacing from the posterior site induced a conduction block of atrioventricular node without affecting the persistent antegrade conduction block of the AP. These findings suggested that the different response of the AP according to the directional change of atrial conduction was not due to a 'linking' phenomenon, but may relate to the impedance mismatch because of an oblique fashion of the pathway.
  • M Takagi; N Aihara; S Kuribayashi; A Taguchi; T Kurita; K Suyama; S Kamakura; M Takamiya
    HEART 89 2 169 - 174 2003年02月 [査読有り]
     
    Objective: To investigate the relation between the wall motion abnormalities and sodium channel abnormalities in cases of the Brugoda syndrome. Design: Consecutive prospective case-control study in a single hospital. Setting: Tertiary referral centre. Patients: 13 consecutive patients with Brugado syndrome and 13 age and sex matched control subjects. Interventions: Each subject underwent electron beam computed tomography (EBT) and a 12 lead ECG before and after disopyramide injection. Main outcome measures: QRS width and the magnitude of ST segment elevation in the 12 lead ECG; wall motion by EBT. EBT revealed deterioration of focal wall motion abnormalities in the right Results: After disopyramide, ventricular outflow tract region in eight of the 13 patients (62%). Prolongation of the QRS width after disopyramide injection in lead V2, which usually reflects the electrical activity in right ventricular outflow tract region, was greater in these eight patients (p < 0.01) than in the other five patients, in whom wall motion did not change after disopyramide. The degree of augmentation of ST segment elevation did not differ significantly between the two groups Conclusions: The deterioration of wall motion abnormalities in the right ventricular outflow tract region after disopyramide suggests the presence of functional abnormalities of the sodium channel. Some patients with Brugada syndrome may have arrhythmogenic substrates with abnormal responses to sodium channel blockers.
  • W Shimizu; T Noda; H Takaki; T Kurita; N Nagaya; K Satomi; K Suyama; N Aihara; S Kamakura; K Sunagawa; S Echigo; K Nakamura; T Ohe; JA Towbin; C Napolitano; SG Priori
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 41 4 633 - 642 2003年02月 [査読有り]
     
    OBJECTIVES This study was designed to test the hypothesis that epinephrine infusion may be a provocative test able to unmask nonpenetrant KCNQ1 mutation carriers. BACKGROUND The LQT1 form of congenital long QT syndrome is associated with high vulnerability to sympathetic stimulation and appears with incomplete penetrance. METHODS The 12-lead electrocardiographic parameters before and after epinephrine infusion were compared among 19 mutation carriers with a baseline corrected QT interval (QTc) of greater than or equal to460 ms (Group I), 15 mutation carriers with a QTc of <460 ms (Group II), 12 nonmutation carriers (Group III), and 15 controls (Group IV). RESULTS The mean corrected Q-Tend QTce), Q-Tpeak (QTcp), and Tpeak-end (Tcp-e) intervals among 12-leads before epinephrine were significantly larger in Group I than in the other three groups. Epinephrine (0.1 mug/kg/min) increased significantly the mean QTce, QTcp, Tcp-e, and the dispersion of QTcp in Groups I and II, but not in Groups III and IV. The sensitivity and specificity of QTce measurements to identify mutation carriers were 59% (20/34) and 100% (27/27), respectively, before epinephrine, and the sensitivity was substantially improved to 91% (31/34) without the expense of specificity (100%, 27/27) after epinephrine. The mean QTce, QTcp, and Tcp-e before and after epinephrine were significantly larger in 15 symptomatic than in 19 asymptomatic mutation carriers in Groups I and II, and the prolongation of the mean QTce with epinephrine was significantly larger in symptomatic patients. CONCLUSIONS Epinephrine challenge is a powerful test to establish electrocardiographic diagnosis in silent LQT1 mutation carriers, thus allowing implementation of prophylactic measures aimed at reducing sudden cardiac death. (J Am Coll Cardiol 2003;41:633-42) (C) 2003 by the American College of Cardiology Foundation.
  • T Noda; W Shimizu; A Taguchi; K Satomi; K Suyama; T Kurita; N Aihara; S Kamakura
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 40 10 1841 - 1847 2002年11月 [査読有り]
     
    OBJECTIVES The study examined whether patients with Brugada syndrome are sensitive to vagal stimulation or ischemia. BACKGROUND Experimental studies have suggested that a prominent transient outward current (I-to)-mediated action potential notch and a subsequent loss of the action potential dome in the epicardium, but not in the endocardium, give rise to ST-segment elevation and subsequent ventricular fibrillation (VF). METHODS We evaluated the frequency of coronary spasm, augmentation (greater than or equal to0.1 mV) of ST-segment elevation in leads V-1 to V-3, and induction of VF by intracoronary injection of acetylcholine (ACh) and/or ergonovine maleate (EM) in 27 symptomatic patients with Brugada syndrome and 30 control subjects. RESULTS The coronary spasm was induced in 3 (11%) of the 27 patients with Brugada syndrome and in 13 (43%) of the 30 control subjects. ST-segment elevation was augmented by 11 (33%) of the 33 right coronary injections (ACh: 6/11 [55%]; EM: 5/22 [23%]), without coronary spasm, but not by any of the left coronary injections in patients with Brugada syndrome. Ventricular fibrillation was induced by 3 (9%) of the 33 right coronary injections (ACh: 2/11 [18%]; EM: 1/22 [5%]), but not by any of the left coronary injections. In contrast, neither ST-segment elevation nor VF was observed in any of the control subjects. CONCLUSIONS Our results support the hypothesis that mild ischemia and vagal influences act additively or synergistically with the substrate responsible for the Brugada syndrome to elevate the ST-segment and precipitate VF. These observations suggest that Brugada patients may be at a higher risk for ischemia-related sudden death. (C) 2002 by the American College of Cardiology Foundation.
  • T Kurita; W Shimizu; M Inagaki; K Suyama; A Taguchi; K Satomi; N Aihara; S Kamakura; J Kobayashi; Y Kosakai
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 40 2 330 - 334 2002年07月 [査読有り]
     
    Objectives We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome. Background Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial leads) and sudden cardiac death caused by ventricular fibrillation. Direct evidence in support of the EP mechanism underlying this intriguing syndrome has been lacking. Methods Monophasic action potentials (MAPs) were obtained from three patients with the coved-type ST-segment elevation (Brugada patients) and five control patients using the contact electrode method. Epicardial MAPs were recorded during open-chest surgery in all patients. Results A spike-and-dome configuration was documented from epicardial sites of the right ventricular (RV) outflow tract in all Brugada patients but not in control patients. Monophasic action potential recordings from the endocardium with special focus on the RV outflow tract could not demonstrate any morphological abnormalities in three Brugada patients. Conclusions The presence of a deeply notched action potential in the RV epicardium, but not in endocardium, would be expected to induce a transmural current that would contribute to elevation of the ST-segment in the right precordial leads. The spike-and-dome configuration may also prolong the epicardial action potential, thus contributing to a rapid reversal of the transmural gradients and inscription of an inverted T-wave.
  • H Nakajima; J Kobayashi; T Kurita; S Kitamura
    ANNALS OF THORACIC SURGERY 74 1 251 - 253 2002年07月 [査読有り]
     
    A 39-year-old man had cor triatriatum (Lucas-Schmidt type IA) with severe mitral regurgitation and atrial fibrillation. We performed resection of the anomalous septum between the accessory chamber and the left atrium, and conducted mitral valve repair and the maze procedure. The patient regained sinus rhythm and normal pulmonary venous drainage to the left ventricle without mitral regurgitation. Histological examination demonstrated fibrotic myocardial structures in the anomalous septum. The maze procedure and complete excision of the anomalous septum proved to be effective surgical treatment for atrial fibrillation with cor triatriatum.
  • Noda T; Takaki H; Kurita T; Suyama K; Nagaya N; Taguchi A; Aihara N; Kamakura S; Sunagawa K; Nakamura K; Ohe T; Horie M; Napolitano C; Towbin JA; Priori SG; Shimizu W
    European heart journal 23 12 975 - 983 2002年06月 [査読有り]
  • M Kanda; W Shimizu; K Matsuo; N Nagaya; A Taguchi; K Suyama; T Kurita; N Aihara; S Kamakura
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 39 11 1799 - 1805 2002年06月 [査読有り]
     
    OBJECTIVES The study examined the electrocardiographic and electrophysiologic characteristics in relation to programmed ventricular stimulation (PVS)-induced ventricular fibrillation (VF), as well as the implications of PVS-induced VF on the recurrence of cardiac events in Symptomatic Brugada syndrome. BACKGROUND Brugada syndrome is characterized by ST-segment elevation in the right precordial leads (V-1-V-3) and an episode of VF. METHODS Thirty-four symptomatic patients with Brugada syndrome (33 men and I woman; 44 +/- 12 years old) were classified into two groups according to the inducibility of VF with PVS: 22 patients with induced VF requiring direct cardioversion for termination (Induced VF group) and 12 patients without induced VF (Noninduced VF group). RESULTS The induced VF group showed a longer QRS duration, a higher incidence of right bundle branch block and late potentials detected on the signal-averaged electrocardiogram, longer His-ventricular intervals and a longer conduction time from the RVOT to the left ventricle at extrastimulation than those in the non-induced VF group. However, there was no significant difference in the recurrence of cardiac events (V-F documented by an implantable cardioverter-defibrillator and sudden cardiac death) between the two groups (8 [36%] of 22 patients vs. 7 [58%] of 12 patients) during long-term follow-up (range 1 to 149 months; mean 38). CONCLUSIONS Our data suggest that induction of VF by PVS depends on the severity of depolarization abnormalities but does not predict the recurrence of cardiac events in symptomatic Brugada syndrome, indicating that both depolarization and repolarization abnormalities are important in the development of VF. (C) 2002 by the American College of Cardiology Foundation.
  • W Shimizu; Y Tanabe; T Aiba; M Inagaki; T Kurita; K Suyama; N Nagaya; A Taguchi; N Aihara; K Sunagawa; K Nakamura; T Ohe; JA Towbin; SG Priori; S Kamakura
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 39 12 1984 - 1991 2002年06月 [査読有り]
     
    OBJECTIVES This Study compared the effects of beta-blockade on transmural and spatial dispersion of repolarization (TDR and SDR, respectively) between the LQT1 and LQT2 forms of congenital long QT syndrome (LQTS). BACKGROUND The LQT1 form is more sensitive to sympathetic stimulation and more responsive to beta-blockers than either the LQT2 or LQF3 forms. METHODS Eighty-seven-lead, body-surface electrocardiograms (ECGs) were recorded before and after epinephrine infusion (0.1 mug/kg body weight per min) in the absence and presence of oral propranolol (0.5-2.0 mg/kg per day) in 11 LQT1 patients and 11 LQT2 patients. The Q-T-end interval, the Q-T-peak interval and the interval between T-peak and T-end (Tp-e), representing TDR, were measured and averaged from 87-lead ECGs and corrected Bazett's method (corrected Q-T-end interval [cQT(e)], corrected Q-T-peak interval [cQT(p)], an corrected interval between T-peak and T-end [cT(p-e)]). The dispersion of cQT(e) (cQT(c)-D) was was defined as the interval between the maximum and obtained among 87 leads minimum values of cQT(c). RESULTS Propranolol in the absence of epinephrine significantly prolonged the mean cQT(p) value but not the mean cQT(c) value, thus decreasing the mean cT(p-e) value in both LQT1 and LQT2 patients; the differences with propranolol were significantly larger in LQT1 than in LQT2 (p < 0.05). The maximum cQT(e), minimum cQT(e) and cQT(e)-D were not changed with propranolol. Propranolol completely suppressed the influence of epinephrine in prolonging the mean cQT(c), maximum cQT(e) and minimum cQT(e) values, as well as increasing the mean cT(p-e) and cQT(e)-D values in both groups. CONCLUSIONS Beta-blockade under normal sympathetic tone produces a greater decrease in TDR in the LQT1 form than in the LQT2 form, explaining the superior effectiveness of beta-blockers in LQT1 versus LQT2. Beta-blockers also suppress the influence of sympathetic stimulation in increasing TDR and SDR equally in LQT1 and LQT2 syndrome.
  • T Aiba; T Kurita; A Taguchi; W Shimizu; K Suyama; N Aihara; S Kamakura
    CIRCULATION JOURNAL 66 4 367 - 371 2002年04月 [査読有り]
     
    The efficacy of empirical chronic oral amiodarone therapy in 129 patients with sustained ventricular tachyarrhythmia (VT/VF) and structural heart disease is evaluated. Twenty-nine patients were treated with class I drugs and monitored by electrophysiological study (EPS) and Holter electrocardiogram (ECG) (class 1). The remaining 100 non-responders to the class I drugs were treated with oral amiodarone, of whom 70 were tolerant (AMD(+)) and 30 were intolerant (AMD(-)). Patients were followed up to 36 months. The primary and secondary end-points were recurrence of VT/VF and hypothetical death, respectively; whereby, hypothetical death was defined as actual death and the event of rapid VT/VF (heart rate >240 beats/min) in patients with an implantable cardioverter defibrillator. Class I and AMD+ patients showed a better prognosis than AMD(-) patients. The VT/VF event free at 36 months in class 1 (64.8%) and AMD(+) (56.1%) patients were significantly higher than that in AMD- (27.2%) (p<0.01) patients. Hypothetical survival rates in class I (92.0%) and AMD+ (83.6%) patients were significantly higher than that in AMD- (57.0%) (p<0.001) patients, but there were no significant differences in the actual survival rate among the 3 patient groups. The independent clinical factors suppressing the recurrence of VT/VF (Cox hazard) were treatment with amiodarone (p=0.02, 95 % confidence interval (CI) =0.19-0.86) and EPS/Holter ECG-guided Class I drugs (p=0.04, 95% CI=0.14-0.94). The results demonstrate that empirical amiodarone has a substantial long-term benefit that is comparable to EPS/Holter ECG-guided class I drugs in the treatment of high-risk patients with VT/VF and structural heart disease.
  • 里見 和浩; 栗田 隆志; 田口 敦史; 清水 渉; 須山 和弘; 相原 直彦; 鎌倉 史郎
    心電図 = Electrocardiology 22 2 135 - 143 The Japanese Society of Electrocardiology 2002年03月 
    Brugada症候群9例, および心室細動 (VF) を合併した器質的心疾患患者5例において, 植え込み型除細動器に保存されたVF発症時の心内電位記録を比較検討し, この2群のVF発症と再分極過程の関連を検討した.Brugada症候群においては, 器質的心疾患患者におけるVFに比較し, VFを誘発する心室期外収縮 (PVC) の連結期は短く (Brugada群: 360±52msec, 器質的心疾患群: 446±91msec, p<0.01) またこの連結期とR-R間隔はより密接に関連していた.またBrugada症候群では, このR-R間隔で補正した連結期 (385±40msec) と安静時の補正QT時間 (420±30msec) との比較から, 比較的遅い時相で出現するPVCからVFに移行することが示された.Brugada症候群におけるVFはある特定のPVCから開始し, その発生の時相はT波後半成分に相当し, 再分極過程と密接に関連していると考えられた.
  • T Ohe; KF Kusano; H Morita; T Emori; K Suyama; A Shimizu; N Aihara; T Kurita; S Kamakura
    CATHETER ABLATION OF ARRHYTHMIAS, SECOND EDITION 345 - 374 2002年 [査読有り]
  • M Takagi; K Suyama; A Taguchi; W Shimizu; T Kurita; N Aihara; S Kamakura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 25 1 109 - 111 2002年01月 [査読有り]
     
    A 60-year-old woman who had previously undergone an atrial septal defect repair and had type I atrial flutter underwent electrophysiological study. After radiofrequency (RF) ablation to the isthmus between the inferior vena cava and the tricuspid annulus, type I atrial flutter was changed to atrial tachycardia following atriotomy without termination. This atrial tachycardia was eliminated by single-site RF ablation of a small lesion below the caudal end of the atriotomy scar, where continuous and fragmented potentials were recorded during tachycardia. We experienced a rare case in which RF energy changed tachycardia circuits.
  • Shimizu W; Aiba T; Kurita T; Kamakura S
    Journal of cardiovascular electrophysiology 12 12 1418 - 1421 2001年12月 [査読有り]
  • Absence of morning peak in ventricular tachycardia and fibrillation events in nonischemic heartr disease: analysis of therapies by implantable cardioverter defibrillators.
    Keiichi, Tanaka; Yoshihusa, Aizawa; Takashi, Washizuka; Masaomi, Chinushi; Ken, Okumura; Satoshi, Ogawa; Hiroshi, Kasanuki; Keisuke, Kuga; Takashi, Kurita; Shiro, Kamakura; et; al on behalf of; the; Japanese ICD; Study Group
    Pacing and Clinical Electrophysiology 24 11 1602 - 1606 Futura 2001年11月 [査読有り]
  • Ogawa M; Suyama K; Kurita T; Shimizu W; Matsuo K; Taguchi A; Aihara N; Kamakura S; Shimomura K
    Pacing and clinical electrophysiology : PACE 24 10 1470 - 1478 2001年10月 [査読有り]
  • 相原 直彦; 稲垣 正司; 高木 雅彦; 田口 敦史; 須山 和弘; 清水 渉; 栗田 隆志; 鎌倉 史郎
    心電図 = Electrocardiology 21 4 421 - 428 The Japanese Society of Electrocardiology 2001年07月 
    加算平均心電図法を用い, V1, V2, V5誘導にて, Naチャネル遮断薬投与時の心電図変化を検討した, Brugada症候群ではNaチャネル遮断薬投与によりSTは右側前胸部誘導に限局して上昇した、コントロール群では有意なSTの上昇は認められなかった.高周波領域心電図信号であるQRS幅は各誘導で延長したが, 特にV2誘導でのQRS幅の延長が大きかった.Brugada症候群のT波波高は, 低下するもの (coved: 入江型群) とそれ以外のもの (saddle-back: 鞍背型群) に分類された, Naチャネル遮断薬投与後のQRS幅, QRS幅の変化量は, coved型群, saddleback型, コントロール群の順に大で, T波波高減高とQRS幅の延長に関連が認められた.以上より, Brugada症候群では, 右側前胸部誘導に相当する部位に限局した脱分極障害と再分極障害の両者が存在し, その両者は互いに関連している可能性が考えられた.
  • Takagi M; Aihara N; Kuribayashi S; Taguchi A; Shimizu W; Kurita T; Suyama K; Kamakura S; Hamada S; Takamiya M
    European heart journal 22 12 1032 - 1041 2001年06月 [査読有り]
  • 鎌倉 史郎; 清水 渉; 田口 敦史; 須山 和弘; 栗田 隆志; 相原 直彦
    心電図 = Electrocardiology 21 3 251 - 257 The Japanese Society of Electrocardiology 2001年05月 
    心筋壊死が生じる心室分画と, 心電図変化としてそれが反映される体表面領域との対応関係を, カテーテルアブレーション (CA) で限局性壊死が作成された症例を用いて検討した, 対象は頻拍のために左室または右室にCAを施行した118例.全例でCA前と後10日以内に体表面電位図を洞調律時に記録し, QRS等電位図のSubtraction map (S-map) を1msecごとに作成した.左室を前壁, 側壁, 後壁, 前部中隔, 後部中隔のそれぞれ基部, 中央部と心尖部の計11ヵ所に, 右室を流出路部中隔, 流出路部自由壁, 中央部中隔, 中央部自由壁, 下壁基部および心尖部の計6ヵ所に分類し, 焼灼 (壊死) 分画とS-map上で電位低下の生じた体表面領域との関係を検討した.S-map上118例中96例で0.05mV以上の電位低下がCA後に認められた.その出現時相は局所が興奮する時相にほぼ一致していた.左室心尖部焼灼例では左前胸部中央やや下方で電位が低下し, 基部焼灼例ではそれを取り囲むような体表面領域 (後壁例: 背部下方, 側壁例: 背部上方, 前壁例: 左前胸部上方, 前部中隔例: そのやや右方, 後部中隔例: 右前胸部下方) で低下し, 中央部焼灼例では基部と心尖部の中間領域で電位が低下した, 一方, 右室流出路部中隔焼灼例では前胸部中央上方で, 流出路部自由壁例ではその右方, 中央部中隔と自由壁例では前胸部中央やや上方, 下壁基部例では右前胸部下方で電位が低下した, 本研究で得られた心室分画一体表面領域の対応関係に基づいて, 心筋梗塞部位や冠動脈病変部位を心電図から詳細に診断できると考えられた.
  • Aiba T; Shimizu W; Taguchi A; Suyama K; Kurita T; Aihara N; Kamakura S
    Journal of cardiovascular electrophysiology 12 5 511 - 517 2001年05月 [査読有り]
  • Aiba T; Suyama K; Aihara N; Taguchi A; Shimizu W; Kurita T; Kamakura S
    Pacing and clinical electrophysiology : PACE 24 3 333 - 344 2001年03月 [査読有り]
  • Tanabe Y; Inagaki M; Kurita T; Nagaya N; Taguchi A; Suyama K; Aihara N; Kamakura S; Sunagawa K; Nakamura K; Ohe T; Towbin JA; Priori SG; Shimizu W
    Journal of the American College of Cardiology 37 3 911 - 919 2001年03月 [査読有り]
  • Takenaka K; Yasuda S; Miyazaki S; Kurita T; Sutani Y; Morii I; Daikoku S; Kamakura S; Nonogi H
    Jpn Circ J 65 1 60 - 62 2001年 [査読有り]
  • Shimizu W; Antzelevitch C; Suyama K; Kurita T; Taguchi A; Aihara N; Takaki H; Sunagawa K; Kamakura S
    Journal of cardiovascular electrophysiology 11 12 1320 - 1329 2000年12月 [査読有り]
  • Kakishita M; Kurita T; Matsuo K; Taguchi A; Suyama K; Shimizu W; Aihara N; Kamakura S; Yamamoto F; Kobayashi J; Kosakai Y; Ohe T
    Journal of the American College of Cardiology 36 5 1646 - 1653 2000年11月 [査読有り]
  • 種田 宏司; 池主 雅臣; 相澤 義房; 福士 智久; 奥村 謙; 栗田 康生; 小川 聡; 田口 敦史; 栗田 隆志; 鎌倉 史郎; 福島 研吾; 大江 透; 清水 昭彦; 松崎 益徳; 武市 耕; 笠貫 宏; 田中 茂夫; 植え込み型除細動器発作状況研究会
    不整脈 16 4 464 - 469 (NPO)日本不整脈学会 2000年10月 
    心室頻拍/心室細動(VT/VF)に対する植込み型除細動器(ICD)を経験した53例(男性47例・女性4例,56±12歳)を対象にICDの内部メモリー記録の解析からVT/VF発症の日内変動を虚血性心疾患群と非虚血性心疾患群で検討した.虚血性心疾患群例のVT/VF発症には午前8〜10時の間にピークが認められたが非虚血性心疾患群例では明瞭な日内変動は認められなかった
  • Aiba T; Inagaki M; Shimizu W; Matsuo K; Taguchi A; Suyama K; Kurita T; Aihara N; Sunagawa K; Kamakura S
    Journal of cardiovascular electrophysiology 11 9 968 - 974 2000年09月 [査読有り]
  • Takagi M; Aihara N; Takaki H; Taguchi A; Shimizu W; Kurita T; Suyama K; Kamakura S
    Journal of cardiovascular electrophysiology 11 8 844 - 848 2000年08月 [査読有り]
  • Shimizu W; Matsuo K; Takagi M; Tanabe Y; Aiba T; Taguchi A; Suyama K; Kurita T; Aihara N; Kamakura S
    Journal of cardiovascular electrophysiology 11 4 396 - 404 2000年04月 [査読有り]
  • 種田 宏司; 池主 雅臣; 相澤 義房; 福士 智久; 奥村 謙; 栗田 康生; 小川 聡; 田口 敦史; 栗田 隆志; 鎌倉 史郎; 埋め込み型除細動器発作状況研究会
    新潟医学会雑誌 113 11〜12 538 - 538 新潟医学会 1999年12月
  • 田口 敦史; 鎌倉 史朗; 相原 直彦; 栗田 隆志; 須山 和弘; 清水 渉; 松尾 清隆
    心電図 = Electrocardiology 19 3 278 - 283 The Japanese Society of Electrocardiology 1999年05月 
    左脚ブロック+下方軸型特発性心室頻拍 (VT) 症例で, 左室側に最早期興奮部位を認める症例の臨床的特徴を検討した.対象は左脚ブロック+下方軸型の特発性心室頻拍59例.全例に心内膜マッピングを施行し, うち9例で最早期興奮部位を左室流出路側に同定できた.これらの症例 (LV群) の臨床的, ならびに電気生理学的諸指標を右室流出路に起源が同定できた症例 (RV群) と比較検討した.LV群は, 男性8名, 女性1名で, 有意に男性が多かった.またVT rateは有意に遅く, 臨床的に30秒以上の持続型VTが認められる症例が多かった.年齢・自覚症状はRV群と差異を認めなかった.心内膜側での頻拍時の最早期興奮部位はLV群9例中6例でLCC側, 3例ではRCC側に推定された.また3例では大心静脈内から心外膜マッピングを施行できた.うち2例で心外膜側が心内膜側よりも早期に興奮しており, 心外膜側に頻拍の起源が推定された.
  • Matsuo K; Kurita T; Inagaki M; Kakishita M; Aihara N; Shimizu W; Taguchi A; Suyama K; Kamakura S; Shimomura K
    European heart journal 20 6 465 - 470 1999年03月 [査読有り]
  • 田原 宣広; 高木 洋; 砂川 賢二; 田口 敦史; 松尾 清隆; 須山 和弘; 栗田 隆志
    心臓 31 2 20 - 22 公益財団法人 日本心臓財団 1999年
  • 田原 宣広; 高木 洋; 砂川 賢二; 田口 敦史; 松尾 清隆; 須山 和弘; 栗田 隆志
    心臓 31 2 76 - 78 公益財団法人 日本心臓財団 1999年
  • Toyofuku M; Takaki H; Sunagawa K; Kurita T; Shimizu W; Suyama K; Aihara N; Kamakura S
    Journal of electrocardiology 32 1 1 - 5 1999年01月 [査読有り]
  • Matsuo K; Nishikimi T; Yutani C; Kurita T; Shimizu W; Taguchi A; Suyama K; Aihara N; Kamakura S; Kangawa K; Takamiya M; Shimomura K
    Circulation 98 22 2433 - 2440 1998年12月 [査読有り]
  • Tada H; Kurita T; Ohe T; Shimizu W; Suyama K; Aihara N; Shimomura K; Kamakura S
    International journal of cardiology 67 1 27 - 38 1998年11月 [査読有り]
  • Kamakura S; Shimizu W; Matsuo K; Taguchi A; Suyama K; Kurita T; Aihara N; Ohe T; Shimomura K
    Circulation 98 15 1525 - 1533 1998年10月 [査読有り]
  • H Takaki; K Sunagawa; N Sugimachi; Y Hara; T Kawada; T Kurita; Y Goto
    EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 78 4 333 - 339 1998年09月 [査読有り]
     
    The transient response of oxygen uptake ((V) over dot O-2) to submaximal exercise, known to be abnormal in patients with cardiovascular disorders, can be useful in assessing the functional status of the cardiocirculatory system, however, a method for evaluating it accurately has not yet been established. As an alternative approach to the conventional test at constant exercise intensity, we applied a random stimulus technique that has been shown to provide relatively noise immune responses of system being investigated. In 27 patients with heart failure and 24 age-matched control subjects, we imposed cycle exercise at 50 W intermittently according to a pseudo-random binary (exercise-rest) sequence, while measuring breath-by-breath (V) over dot O-2. After determining the transfer function relating exercise intensity ((W)) over dot to (V) over dot O-2 and attenuating the high frequency ranges (> 6 exercise-rest cycles . min(-1)), we computed the high resolution band-limited (0-6 cycles . min(-1)) (V) over dot O-2 response (0-120 s) to a hypothetical step exercise. The (V) over dot O-2 response showed a longer time constant: in the patients than in the control subjects [47 (SD 37) and 31 (SD 8) s, respectively, P < 0.05]. Furthermore, the amplitude of the (V) over dot O-2 response after the initial response was shown to be significantly smaller in the patients than in the control subjects [176 (SD 50) and 267 (SD 54) ml . min(-1) at 120 s]. The average amplitude over 120 s correlated well with peak (V) over dot O-2 (r = 0.73) and Delta(V) over dot O-2/Delta(W) over dot (r = 0.70), both of which are well-established indexes of exercise tolerance. The data indicated that our band-limited (V) over dot O-2 step response using random exercise was more markedly attenuated and delayed in the patients with heart failure than in the normal controls and that it could be useful in quantifying the overall functional status of the cardiocirculatory system.
  • Suyama K; Kurita T; Shimizu W; Matsuo K; Taguchi A; Aihara N; Kamakura S; Shimomura K
    Pacing and clinical electrophysiology : PACE 21 9 1693 - 1699 1998年09月 [査読有り]
  • Aiba T; Suyama K; Matsuo K; Taguchi A; Shimizu W; Kurita T; Aihara N; Kamakura S
    Journal of cardiovascular electrophysiology 9 9 1004 - 1007 1998年09月 [査読有り]
  • Matsuo K; Shimizu W; Kurita T; Inagaki M; Aihara N; Kamakura S
    Journal of cardiovascular electrophysiology 9 5 508 - 512 1998年05月 [査読有り]
  • Shimizu W; Kurita T; Matsuo K; Suyama K; Aihara N; Kamakura S; Towbin JA; Shimomura K
    Circulation 97 16 1581 - 1588 1998年04月 [査読有り]
  • 田口 敦史; 鎌倉 史郎; 相原 直彦; 栗田 隆志; 須山 和弘; 松尾 清隆; 植田 初江
    心臓 30 12 748 - 752 公益財団法人 日本心臓財団 1998年 
    症例は54歳,女性.Fabry病の家系で,41歳頃から心肥大を指摘され,心エコー図検査では肥大型心筋症の所見が認められていた.数年おきに心エコー図検査を施行していたところ,46歳の心エコー図では認められなかった左室流出路の圧較差が,5年後の51歳時の心エコーで検出された.その後,労作・安静と関係のない胸痛が出現するため,精査の目目的で入院した.検査所見上は白血球α-galactosidase Aの活性低下を認め,カテーテル検査時に施行した心筋生検では心筋細胞の核周囲を中心に平行ないし同心円状を示すlamella構造の沈着を多数認め,Fabry病と診断された.左室流出路の圧較差は平均約80mmHgであったが,ジソピラミド50mgの静注で18mmHgに低下した.また,心エコーの記録時にもジソピラミド300mgの内服で圧較差の改善が認められ,同時に胸部症状も改善した.
    ヘテロ接合体の患者で多く認められる心Fabry病は,ほとんどの症例で肥大型心筋症類似の心筋肥大を認めるといわれる.しかし,左室流出路の圧較差を生じ,閉塞性肥大型心筋症の病像を示す症例の報告はまれである.貴重な症例と考え考察を加えて報告した.
  • Matsuo K; Shimizu W; Kurita T; Suyama K; Aihara N; Kamakura S; Shimomura K
    Journal of cardiovascular electrophysiology 9 1 74 - 83 1998年01月 [査読有り]
  • Shimizu W; Kosakai Y; Inagaki M; Kurita T; Suyama K; Aihara N; Kamakura S; Isobe F
    Japanese circulation journal 61 12 988 - 996 社団法人日本循環器学会 1997年12月 [査読有り]
     
    Although the Maze procedure is highly successful in restoring sinus rhythm in patients with atrial fibrillation (AF), the electrophysiologic changes that occur after the Maze procedure and its mechanism of action are still unclear. The aims of the present study were to examine the electrophysiologic changes that occur in the arrhythmogenic substrate after the Maze procedure and to evaluate the mechanism by which it prevents lone and paroxysmal AF. The modified Maze procedure was performed in 6 patients (6 men, mean age 47±7 years) with lone and paroxysmal AF. Electrophysiologic studies were performed before and 35±8 days after the Maze procedure. Atrial mapping during sinus rhythm revealed that atrial activation propagated smoothly in a concentric circle from the sinus node to other regions in the right atrium and into the coronary sinus before the Maze procedure. Following the Maze procedure, atrial activation propagated selectively through routes produced by incisions or cryoablations in all 6 patients. In addition, double and triple potentials were recorded in regions where conduction blocks were created by the Maze procedure. Neither sinus node function nor AV conduction was changed following the Maze procedure. The Maze procedure did not affect the atrial effective refractory period or the zone of fragmented atrial activity, although the conduction delay zone was increased significantly (p<0.05). AF was inducible in all 6 patients before the Maze procedure, whereas it was not inducible in any patients after the Maze procedure. The Maze procedure is effective in preventing AF without affecting sinus node function and AV conduction. Intra-atrial conduction block produced by incisions or cryoablations contributes to the prevention of AF. (Jpn Circ J 1997; 61: 988 - 996)
  • Fukushima K; Emori T; Shimizu W; Kurita T; Aihara N; Kosakai Y; Isobe F; Shimomura K; Kawashima Y; Ohe T
    Heart (British Cardiac Society) 78 5 499 - 504 1997年11月 [査読有り]
  • Shimizu W; Kamakura S; Kurita T; Suyama K; Aihara N; Shimomura K
    Journal of cardiovascular electrophysiology 8 10 1102 - 1114 1997年10月 [査読有り]
  • Y Nakayama; T Kurita; N Aihara; S Kamakura; K Shimomura
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 20 7 1881 - 1882 1997年07月 [査読有り]
     
    In a patient with WPW syndrome and idiopathic dilated cardiomyopathy, intractable atrioventricular reentrant tachycardia (AVRT) was iatrogenically induced. QRS without preexcitation, caused by junctional escape beats after verapamil or unidirectional antegrade block of accessory pathway after catheter ablation, established frequent AVRT attack.
  • Kurita T; Ohe T; Shimizu W; Suyama K; Aihara N; Takaki H; Kamakura S; Shimomura K
    Pacing and clinical electrophysiology : PACE 20 3 Pt 1 695 - 705 1997年03月 [査読有り]
  • 田口 敦史; 清水 渉; 鎌倉 史郎; 相原 直彦; 栗田 隆志; 須山 和弘; 稲垣 正司; 由谷 親夫; 下村 克朗
    心臓 29 12 939 - 944 公益財団法人 日本心臓財団 1997年 
    明らかな器質的心疾患を認めない右室流出路起源非持続型の心室頻拍(VT)症例74例中,5例に心室細動(Vf)を確認し(Vf群),その臨床的,病理学的および電気生理学的特微を無作為に選んだ非Vf群20例と比較検討した.
    VT rateはVf群282±25/分で非Vf群の187±46/分に比較して有意に強く(p<0.0005),Vf群5例では全例でVT中のQRS波形の変形を認めた.電気生理学的には右室心尖部,流出路の有効不応期と1:1応答に有意差は認めなかったが,非Vf群に比べVf群で不応期が短く,1:1応答が充進している傾向にあった.また,両群とも心室内に明らかな異常電位は認めなかったが,心内膜生検による病理所見ではVf群5例全例に軽度の線維化と3例に中等度の脂肪浸潤を認めた.一方,非Vf群では中等度以上の脂肪浸潤は心筋生検を行った12例中1例も認めなかった.
    Vf群は5例ともVT中の心拍数が速く,VT中にQRS波形の変形を認めており,このような所見のある右室流出路起源の非持続型VT症例では,Vfに移行する可能性があり,VTを管理していく上で注意が必要であると考えられた.
  • Tetsuro Emori; Tohru Ohe; Naohiko Aihara; Takashi Kurita; Wataru Shimizu; Shiro Kamakura; Katsuro Shimomura
    Annals of Noninvasive Electrocardiology 2 1 40 - 46 1997年 [査読有り]
     
    Objective: Patients with long QT syndrome (LQTS) have an abnormality in the dynamic relationship between the QT and RR intervals (QT/RR relation) assessed by 24-hour Holter ECG monitoring. The clinical efficacy of β- blocker therapy in LQTS patients has been established, but its antiarrhythmic mechanism has not been fully elucidated. In the present study, the influences of β-blocker therapy on the QT/RR relation were investigated in LQTS patients with no arrhythmic event during β-blocker therapy. Methods: Holter ECG recordings before and after the therapy were obtained from seven LQTS patients (all female, age range 10 45 years). The QT/RR relation was analyzed by our original computer algorithm with automatic measurement of the Q-aT interval (time interval from the QRS onset to the T wave apex. The correlation coefficient (r), and the slope of the best fit linear regression line between the Q-aT and RR intervals (Q-aT/RR slope) after β-blocker therapy were compared with those before the therapy. To determine whether the dose of β-blockers was sufficient for suppression of the sympathetic nervous activity, a frequency-domain analysis of the heart rate variability was performed (low frequency power [LF]: 0.04-0.15 Hz, high frequency power [HF]: 0.15 0.40 Hz). Results: The LF component of the heart rate variability decreased and the H F component increased during the daytime after β blocker therapy. However, the Q-aT/RR relation after β-blocker therapy was the same as that before the therapy (mean slope before - 0.20 ± 0.07, mean slope after = 0.19 ± 0.08 P = not significant mean r before = 0.82 ± 0.17 mean r after = 0.76 ± 0.15 P = not significant). Conclusion: β-Blocker therapy did not affect the unique Q-aT/RR relation, which reflects an intrinsic abnormality of the ventricular repolarization in LQTS patients.
  • Hirao H; Shimizu W; Kurita T; Suyama K; Aihara N; Kamakura S; Shimomura K
    Journal of the American College of Cardiology 28 5 1269 - 1277 1996年11月 [査読有り]
  • Tada H; Shimizu W; Ohe T; Hamada S; Kurita T; Aihara N; Kamakura S; Takamiya M; Shimomura K
    Circulation 94 3 437 - 444 1996年08月 [査読有り]
  • Shimizu W; Kurita T; Suyama K; Aihara N; Kamakura S; Shimomura K
    The American journal of cardiology 77 11 1004 - 1008 1996年05月 [査読有り]
  • T Kurita; T Ohe; K Maeda; F Isobe; S Kamakura; K Shimomura
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION 60 3 189 - 191 1996年03月 [査読有り]
     
    The present patient demonstrated torsade de pointes (TdP) after a pacemaker implantation without a decrease in heart rate or pacemaker malfunction. Marked QT prolongation and TdP were closely related to alteration of the depolarization pattern (appearance of junctional rhythm). Resetting the pacemaker to a rate that inhibited spontaneous rhythm was effective in preventing TdP.
  • Tada H; Ohe T; Yutani C; Shimizu W; Kurita T; Aihara N; Kamakura S; Shimomura K
    Japanese circulation journal 60 2 133 - 136 1996年02月 [査読有り]
  • 大江 透; 江森 哲郎; 丸山 隆久; 粟田 隆志; 清水 渉; 相原 直彦
    心臓 28 4 351 - 359 公益財団法人 日本心臓財団 1996年 
    QT間隔やTU波形は心拍数などの生理的作用および自律神経作働薬や抗不整脈薬などの薬理的作用で変化するが,QT延長症候群患者では,とくに著明に変化すると報告されている.ここでは,QT延長症候群患者を対象として種々の生理的作用または薬剤負荷に対する再分極過程の変化を以下の4項目について検討した.1)先天性QT延長症候群における心拍数変動に対する変化,2)先天性QT延長症候群における運動負荷,Isoprotereld負荷,および心房ペーシングに対する変化,3)後天性QT延長症候群における抗不整脈薬Ia群投与時の変化,4)後天性QT延長症候群における徐脈時の変化.結果:1)先天性QT延長症候群患者では,QT間隔の日内変動が異常で運動時とくにQT間隔延長やTU波の異常が顕著となった.2)先天性QT延長症候群患者では,心房ペーシングにより著明なQT延長は来たさずlsopreterenol負荷により著明な延長が生じた.3)後天性QT延長候群患者では,Ia群薬投与や徐脈時に著明なQT間隔の延長とTU波形の異常(U波の増大) が出現した. 以上, 先天性Q T 延長症候群患者におけるQT延長とTU波異常の増悪は交感神経の亢進が原因で,後天性QT延長症候群患者の場合はIa群抗不整脈薬や徐脈に対する過剰反応によると考えられた.
  • Katagiri-Kawade M; Ohe T; Arakaki Y; Kurita T; Shimizu W; Kamiya T; Orii T
    Pacing and clinical electrophysiology : PACE 18 12 Pt 1 2128 - 2134 1995年12月 [査読有り]
  • Shimizu W; Ohe T; Kurita T; Kawade M; Arakaki Y; Aihara N; Kamakura S; Kamiya T; Shimomura K
    Journal of the American College of Cardiology 26 5 1299 - 1309 1995年11月 [査読有り]
  • Emori T; Ohe T; Aihara N; Kurita T; Shimizu W; Kamakura S; Shimomura K
    Pacing and clinical electrophysiology : PACE 18 10 1909 - 1918 1995年10月 [査読有り]
  • Maruyama T; Ohe T; Kurita T; Aihara N; Shimizu W
    European heart journal 16 5 667 - 673 1995年05月 [査読有り]
  • Hiroshi Tada; Takashi Kurita; Tohru Ohe; Katsuro Shimomura; Tadashi Ishihara; Yoshiharu Yamada; Nakaaki Osawa
    American Heart Journal 130 4 911 - 912 1995年 [査読有り]
  • Ohe T; Aihara N; Kamakura S; Kurita T; Shimizu W; Shimomura K
    Journal of the American College of Cardiology 25 1 54 - 58 1995年01月 [査読有り]
  • Takaki H; Sunagawa K; Sugimachi M; Tamai J; Okano Y; Kurita T; Aihara N; Shimizu W; Suyama K; Kamakura S
    Heart and vessels 10 6 323 - 327 1995年 [査読有り]
  • Shimizu W; Kamakura S; Ohe T; Kurita T; Takaki H; Aihara N; Shimomura K
    The American journal of cardiology 74 8 780 - 785 1994年10月 [査読有り]
  • Shimizu W; Ohe T; Kurita T; Tokuda T; Shimomura K
    Journal of cardiovascular electrophysiology 5 5 438 - 444 1994年05月 [査読有り]
  • 大江 透; 栗田 隆志; 清水 渉
    心臓 26 8 895 - 910 公益財団法人 日本心臓財団 1994年 
    QT延長症候群の発作時の心電図の特徴は,1)著明なQT延長(TU波の異常),2)発作を誘発する心室期外収縮,3)torsades de pointes(TdP)である.一般的には,この3つの心電図上の特徴は同じ原因で起こり,またその機序も同一であると考えられている.しかし,原因は同一でも発生機序が異なっている可能性がある.この発表では,各々の発生機序を最近開発された電極カテーテル押しつけによるmonophasic action potential(MAP)記録法を用いて検討した.
    1)先天性QT延長患者群はisoproterenol投与前後,後天性QT延長群はdisopyramide投与前後で,MAP持続時間(MAP-d)を計測した.著明なQT延長(TU波異常)はMAP-d延長とearly afterdepolarization(EAD)発生とに密接に関連していた.
    2)TdP発生時のMAPの記録が可能であった5名において心室期外収縮とMAPで記録されるEADとの関連性を検討した.全例でEADが認められ,EADの電位の大きさと期外収縮出現とに密接な関連性が認められた.
    3)先天性QT延長愚者は著明なQT延長出現(isoproterenol 1μg/分)時,後天性QT延長患者はTdP発生時,MAP-dのバラツキを検討した.MAP-dのバラツキはTdP発生時に著明に増大していた.TdPの発生機序として撃発活動の他にreentryの可能性も考えられた.
  • Shimizu W; Ohe T; Kurita T; Takaki H; Aihara N; Kamakura S; Shimomura K
    Japanese circulation journal 58 Suppl 4 1148 - 1152 The Japanese Circulation Society 1994年 [査読有り]
  • K SHIMOMURA; S KAMAKURA; W SHIMIZU; T KURITA; H TAKAKI; N AIHARA; T OHE; Y KOSAKAI
    CARDIAC PACING AND ELECTROPHYSIOLOGY TODAY 324 - 327 1993年 [査読有り]
  • T OHE; T KURITA; W SHIMIZU; N AIHARA; S KAMAKURA; K SIMOMURA
    CARDIAC PACING AND ELECTROPHYSIOLOGY TODAY 315 - 317 1993年 [査読有り]
  • Kurita T; Ohe T; Shimizu W; Hotta D; Shimomura K
    Pacing and clinical electrophysiology : PACE 16 1 Pt 1 33 - 38 1993年01月 [査読有り]
  • O KINOSHITA; S KAMAKURA; T OHE; N AIHARA; H TAKAKI; T KURITA; C YUTANI; K SHIMOMURA
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 20 5 1230 - 1237 1992年11月 [査読有り]
     
    Objectives. The purpose of this study was to analyze the frequency content of signal-averaged electrocardiograms (ECGs) in patients with idiopathic ventricular tachycardia of right ventricular origin and in patients with arrhythmogenic right ventricular dysplasia. Background. The late potentials in the time domains are usually found in patients with arrhythmogenic right ventricular dysplasia. They are not usually found in patients with idiopathic ventricular tachycardia of right ventricular origin. Methods. Fast Fourier transform analysis of signal-averaged ECGs was performed with the use of a Blackman-Harris window in 43 subjects: 20 normal volunteers (group I), 12 patients with idiopathic ventricular tachycardia of right ventricular origin (group II) and 11 patients with arrhythmogenic right ventricular dysplasia (group III), and the frequency spectrum was displayed in a three-dimensional graph. Area ratio (ratio of the area under the spectral plot from 40 to 120 Hz to the area from 0 to 120 Hz) was calculated in all subjects. Results. Area ratio was significantly higher in group II than in group I (243 +/- 45 vs. 196 +/- 15, p < 0.01) and significantly higher in group III (3% +/- 51) than in group I or II (p < 0.001). The high frequency components in group II were confined within the QRS complex in the three-dimensional graph, whereas those in group III extended outside the QRS complex. Conclusions. Frequency analysis of the signal-averaged ECG with fast Fourier transform analysis can detect the high frequency components in patients with right ventricular tachycardia, including idiopathic ventricular tachycardia and arrhythmogenic right ventricular dysplasia.
  • K SUYAMA; T OHE; T KURITA; T MARUYAMA; H TAKAKI; N AIHARA; S KAMAKURA; W SHIMIZU; M MATSUHISA; K SHIMOMURA
    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 15 8 1114 - 1121 1992年08月 [査読有り]
     
    We examined entrainment by ventricular pacing in six patients during orthodromic atrioventricular reentrant tachycardia (AVRT) utilizing a left-sided lateral accessory pathway. Constant fusion and progressive fusion were demonstrated in all patients by left ventricular pacing during tachycardia, but in none of the patients by right ventricular pacing. When left ventricular pacing was performed during AVRT, the antidromic wave front from the pacing impulse (n) collided with the orthodromic wave front of the previous pacing beat (n - 1) within the ventricle, therefore, constant fusion and progressive fusion were demonstrated in the surface electrocardiographic QRS complexes. On the other hand, when right ventricular pacing was performed during orthodromic AVRT, the antidromic wave front from the pacing impulse (n) collided with the orthodromic wave front of the previous paced beat (n - 1) within the normal atrioventricular pathway, and constant fusion and progressive fusion were therefore not demonstrated. These phenomena were explained by the relationship of the ventricular pacing site and the reentrant circuit. This study demonstrates the importance of the pacing site in manifest entrainment of orthodromic AVRT during ventricular pacing.
  • O KINOSHITA; S KAMAKURA; T OHE; C YUTANI; M MATSUHISA; N AIHARA; H TAKAKI; T KURITA; K SHIMOMURA
    CIRCULATION 85 6 2054 - 2059 1992年06月 [査読有り]
     
    Background. The signal-averaged ECG has been used to detect late potentials, and it is considered a noninvasive marker for areas of slow conduction requisite for reentrant arrhythmia. Late potentials are not usually found in patients with idiopathic ventricular tachycardia (VT); nevertheless, fragmented electrograms are often recorded in those patients during endocardial mapping. The purpose of this study was to investigate the spectral content of the signal-averaged ECGs with use of fast Fourier transform analysis (FFT) in patients with idiopathic VT of left ventricular origin. Methods and Results. Signal-averaged ECGs were recorded in 12 patients with idiopathic VT originating from the left ventricle (group 1) and 25 age-matched normal volunteers (group 2). Frequency analysis with FFT was performed with a Blackman-Harris window in a segment length of 120 msec from 40 msec before the end of the QRS complex, and the frequency spectrum was displayed in a three-dimensional graph. Area ratio 1 (area of 20-50 Hz/area of 10-50 Hz) and area ratio 2 (area of 40-100 Hz/area of 0-40 Hz) were calculated in all subjects. Late potentials defined by the time domain were negative in all subjects. The area ratios of group 1 were significantly higher than those of group 2. High-frequency components in the three-dimensional graph were confined within the QRS complex. Conclusions. These results suggest that frequency analysis of signal-averaged ECGs with FFT is an available method for detecting the high-frequency component within the QRS complex in some patients with idiopathic VT of left ventricular origin.
  • W SHIMIZU; T OHE; T KURITA; H TAKAKI; N AIHARA; S KAMAKURA; M MATSUHISA; K SHIMOMURA
    EUROPEAN HEART JOURNAL 13 2 261 - 268 1992年02月 [査読有り]
  • T OHE; T KURITA; W SHIMIZU; T EMORI; K SHIMOMURA
    ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 644 178 - 186 1992年01月 [査読有り]
  • Shimizu W; Ohe T; Kurita T; Takaki H; Aihara N; Kamakura S; Matsuhisa M; Shimomura K
    Circulation 84 5 1915 - 1923 1991年11月 [査読有り]
  • Shimizu W; Ohe T; Kurita T; Shimomura K
    Pacing and clinical electrophysiology : PACE 14 11 Pt 2 1966 - 1970 1991年11月 [査読有り]
  • Thoru Ohe; Takashi Kurita; Naohiko Aihara; Shiro Kamakura; Mokuo Matsuhisa; Katsuro Shimomura; Tohru Ohe
    JAPANESE CIRCULATION JOURNAL 54 10 1323 - 1330 1990年 [査読有り]
     
    The study group consisted of 26 patients with a history of documented Torsade de Pointes (TdP) who were divides into 3 groups according to the causes of TdP. Group I consisted of 5 patients with congenital long QT syndrome. Group II consisted of 15 patients with TdP caused by antiarrhythmic drugs. Group III consisted of 6 patients with TdP caused by bradycardia resulting from third degree atrioventricular block. The QT interval was determined from a 12-lead electrocardiogram. Monophasic Action Potential (MAP) was recorded by a 6 F USCI electrode catheter. Isoproterenol infusion resulted in TU abnormality in all patients in Group I and induced a hump at phase 3 slope of MAP in all 3 patients tested. The QT interval change before and after IA administration was significantly larger in Group II patients compared to those without TdP (0.132+0.062 vs 0.029+0.31 sec, < 0.005). Injection of 100 mg. of disopyramide in 2 patients in Group II resulted a hump at phase 3 slope of the MAP in both of them. The QT prolongation associated with decreasing the pacing rate from 70 to 50/min was significantly larger in patients with Group III compared to patients with bradycardia but without TdP (0.02±0.04 vs 0.07 ±0.05 sec, p< 0.005). The results suggests: 1) different approaches are necessary for evaluation of TU abnormalities in patients with TdP according to the causes of TdP, 2) MAP might be a useful method for evaluating TU abnormality in patients with TdP. © 1990, The Japanese Circulation Society. All rights reserved.
  • T. Nishimura; T. Kurita; T. Ohe; K. Hayashida; T. Uehara; I. Mitani; H. Oka; M. Hayashi
    Kakuigaku 26 3 419 - 423 1989年 [査読有り]
     
    123I-MIBG and 201TlCl myocardial imaging were carried out in 69 years-old man who had anterior myocardial infarction with ventricular tachycardia. In planar and SPECT imaging, the defect size of 123I-MIBG was larger compared to that of 201TlCl. The zone of fractionated activity was corresponded with the defect of 123I-MIBG. Thus, the denervated but variable myocardium could be detected by 123I-MIBG and 201TlCl myocardial imaging. 123I-MIBG may give a useful clinical information, since denervation may play a role in causing ventricular arrhythmia after myocardial infarction.
  • 大江 透; 丸井 伸行; 栗田 隆志; 下村 克朗
    心臓 20 6 770 - 777 公益財団法人 日本心臓財団 1988年 
    TorsadesdePointes(TdP)発生に関与する諸因子を調べる目的で,以下の3項目について検討した.
    (1)TdPが認められた患者42名を原因別(徐脈,薬剤,虚血,先天性QT延長症候群,その他)に分類し,発作の特徴,誘因,治療について相互比較した.TdPは,QT延長の有無,慢性VS急性,治療法の違いにより,3つの異なる病態に分類された.
    (2)完全房室ブロック患者を,TdPを伴う患者(11人)と伴わない患者(14人)に分類し,徐脈におけるTdP発生を検討した.TdP発生は,徐脈の程度や補充収縮の発生部位とは関係なく,QT延長と密接な関係があった.また,この徐脈が原因のQT延長に年齢が関与している可能性が示唆された.
    (3)抗不整脈薬の投与によりTdPが誘発された患者のTdP発生前後の病態を比較して抗不整脈薬の投与によるTdPの発生について検討した.抗不整脈薬でTdPを起こした患者の薬剤血中濃度は治療域の場合が多く,中毒よりも患者の感受性の問題が重要と考えられた.また,TdP発生時の電解質の低下も重要な因子と考えられた.

書籍

  • もっと理解しよう！新版 知識整理のためのペースメーカ・ICD・CRT/CRT-D・ILRブック , 植込み型除細動器（ICD)に関する臨床試験
    小竹 康仁; 栗田 隆志 (担当:共著範囲:)メジカルビュー社 2013年06月 
    医局論文番号532
  • 循環器薬物治療実践シリーズⅥ ベプリジルの基礎と臨床（新版）ー上手に使うコツー, 催不整脈作用とその他の副作用について
    栗田 隆志; 安田正之; 中里祐二; 高橋尚彦; 山下武志; 安田 聡; 清水; 渉; 鎌倉史郎 (担当:共著範囲:)ライフメディコム 2013年03月 
    医局論文番号525
  • 今日の循環器疾患治療指針 第３版, 心室頻拍
    栗田 隆志 (担当:共著範囲:)2013年01月 
    医局論文番号519
  • 今日の循環器疾患治療指針 第３版, 植込み型除細動器の適応と管理
    栗田 隆志 (担当:共著範囲:)医学書院 2013年01月 
    医局論文番号521
  • 不整脈学, アミオダロンとICD
    栗田 隆志 (担当:共著範囲:)南江堂 2012年09月 
    医局登録番号 504
  • EBM循環器疾患の治療 2012-2013, 右脚ブロックやnarrowQRS症例の心不全に対するCRTは有効か？
    栗田 隆志 (担当:共著範囲:)中外医学社 2012年03月 
    医局登録番号 491
  • 救急・集中治療医学レビュー2012-'13ー最新主要文献と解説, 重症不整脈対策
    栗田 隆志 (担当:共著範囲:)総合医学社 2012年02月 
    医局登録番号 488
  • 重症心不全の予防と治療 , 重症心不全の心電図
    栗田 隆志 (担当:共著範囲:)中外医学社 2011年09月 
    医局登録番号 445
  • 救急・治療医学レビュー2011－最新主要文献と解説ー , 重症不整脈対策
    栗田 隆志 (担当:共著範囲:)総合医学社 2011年02月 
    医局論文番号440

講演・口頭発表等

  • ３つの独立した心房細動気質を確認出来た発作性心房細動の１例  [通常講演]
    小竹 康仁; 栗田 隆志; 赤岩 譲; 安岡 良文; 元木 康一郎; 宮崎 俊一
    第116回 日本循環器学会近畿地方会 2013年11月 大阪市 第116回 日本循環器学会近畿地方会
  • コメディカル特別教育セッション 誰にでもわかるアブレーションの基礎 CM-1  [通常講演]
    栗田 隆志
    第22回 日本心血管インターベンション治療学会学術集会 CVIT2013 2013年07月 神戸市 第22回 日本心血管インターベンション治療学会学術集会 CVIT2013
  • 交代性脚ブロックから完全房室ブロックへ進行した過程が詳細に記録された1症例  [通常講演]
    堀江 勝博; 栗田 隆志; 安岡 良文; 赤岩 譲; 小竹 康仁; 元木 康一郎; 宮崎 俊一
    第115回 日本循環器学会近畿地方会 2013年06月 京都市 第115回 日本循環器学会近畿地方会
  • 植込み型心電計にて失神原因が診断できた2例  [通常講演]
    御勢 久也; 安岡 良文; 小竹 康仁; 赤岩 譲; 元木 康一郎; 栗田 隆志; 宮崎 俊一
    第115回 日本循環器学会近畿地方会 2013年06月 京都市 第115回 日本循環器学会近畿地方会
  • 左房＿肺静脈のinteractionが心房細動成立に寄与していることが、ATP投与により証明された1例  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 宮崎 俊一
    第115回 日本循環器学会近畿地方会 2013年06月 京都市 第115回 日本循環器学会近畿地方会
  • How Can We Find a Way to Control Electrical Storm in Patients with the Implantable Cardiac Shock Devices?  [通常講演]
    栗田 隆志
    第77回 日本循環器学会学術集会 2013年03月 横浜市 第77回 日本循環器学会学術集会
  • 陳旧性心筋梗塞に伴う薬剤抵抗性持続性心室頻拍に対して緊急PCIを施行した心不全および呼吸不全の１例  [通常講演]
    植木 博之; 生田 新一郎; 上野 雅史; 山本 広之; 安田 昌和; 菅 竜也; 山治 憲司; 森本 啓介; 栗田 隆志; 宮崎 俊一
    第20回 CVIT日本心血管インターベンション治療学会近畿地方会 2013年02月 千里ライフサイエンスセンター （大阪市） 第20回 CVIT日本心血管インターベンション治療学会近畿地方会
  • 経皮的心外膜カテーテルアブレーションが無効であった致死性不整脈に対する外科的直達手術の有効性  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 宮崎 俊一; 西野 貴子; 佐賀 俊彦; 里見和浩
    第25回 臨床不整脈研究会 2013年01月 東京ステーションコンファレンス （東京都千代田区） 第25回 臨床不整脈研究会
  • Very long term evaluation in patients with atrio-ventricular nodal reentrant tachycardia undergoing radiofrequency catheter Ablation  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 高井 博之; 宮崎 俊一
    International Symposium on Progress in Clinical Pacing 2012 2012年12月 Rome, Italy International Symposium on Progress in Clinical Pacing 2012
  • Simultaneous ipsilatetal superior and inferior pulmonary vein Isolation does not predict the clinical outcome in patients with paroxysmal atrial fibrillation  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 高井 博之; 宮崎 俊一
    International Symposium on Progress in Clinical Pacing 2012 2012年12月 Rome, Italy International Symposium on Progress in Clinical Pacing 2012
  • Does Simultaneous Ipsilatetal Superior and Inferior Pulmonary Vein Isolation Improve the Clinical Outcome in Patients with Paroxysmal Atrial Fibrillation?  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 宮崎 俊一
    第5回 アジアパシフィックハートリズム学会 2012年10月 台湾 台北 第5回 アジアパシフィックハートリズム学会
  • 房室結節回帰性頻拍に対するカテーテルアブレーションの長期的有効性と安全性  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 野並 有紗; 安岡 良文; 宮崎 俊一; 高井 博之
    第27回 日本不整脈学会学術大会 2012年07月 横浜市 第27回 日本不整脈学会学術大会
  • 陳旧性心筋梗塞患者に合併した重症心室頻拍ストームに対して緊急アブレーションが奏功した１例  [通常講演]
    藤田 晃輔; 栗田 隆志; 安田 昌和; 赤岩 譲; 野並 有紗; 安岡 良文; 元木 康一郎; 宮崎 俊一
    第113回 日本循環器学会近畿地方会 2012年06月 大阪市 第113回 日本循環器学会近畿地方会
  • 完全左脚ブロック患者に生じた急性下壁心筋梗塞：補充調律時のQRS波とT波の興味ある心電図変化に関する考察  [通常講演]
    池田 智之; 谷口 貢; 安岡 良文; 安田 昌和; 中村 貴; 生田 新一郎; 岩永 善高; 栗田 隆志; 宮崎 俊一; 小林 直也
    第113回 日本循環器学会近畿地方会 2012年06月 大阪市 第113回 日本循環器学会近畿地方会
  • 下大静脈フィルター留置後のため、鎖骨下静脈と内頸静脈からのアプローチにてアブレーションを施行した発作性上室性頻拍の一例  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 野並 有紗; 安岡 良文; 宮崎 俊一
    第113回 日本循環器学会近畿地方会 2012年06月 大阪市 第113回 日本循環器学会近畿地方会
  • アブレーション終了直後にたこつぼ型心筋症を発症した通常型房室結節回帰性頻拍の一例  [通常講演]
    小竹 康仁; 元木 康一郎; 赤岩 譲; 安岡 良文; 栗田 隆志; 宮崎 俊一
    第111回 日本循環器学会近畿地方会 2011年11月 京都市 第111回 日本循環器学会近畿地方会
  • Cardiac resynchronization therapy to prevent life-threatening arrhythmias in patients with congestive heart failure  [通常講演]
    栗田 隆志; 元木 康一郎; 安岡 良文; 宮崎 俊一; Takashi Noda; Takeshi Aiba; Ikutaro Nakajima; Wataru Shimizu; Shiro Kamakura
    2011年11月 
    医局登録番号 478
  • 心室頻拍（VT)中のvery late systolic potentialを指標に通電し、根治に成功した不整脈原性右室心筋症（ARVC)の1例  [通常講演]
    安岡 良文; 栗田 隆志; 小竹 康仁; 赤岩 譲; 元木 康一郎; 宮崎 俊一; 堂上友紀; 永井
    第23回 カテーテル・アブレーション委員会公開研究会 2011年10月 横浜市 第23回 カテーテル・アブレーション委員会公開研究会
  • Flow Velocity in the Left Atrial Appendage Can Predict Complete Cure of Paroxysmal Atrial Fibrillation after Pulmonary Vein Isolation  [通常講演]
    元木 康一郎; 栗田 隆志; 赤岩 譲; 安岡 良文; 生田 新一郎; 山本 裕美; 宮崎 俊一
    Venice Arrhythmias 2011 2011年10月 Venice,Italy Venice Arrhythmias 2011
  • 植込み型除細動器を植込まれた低心機能患者のわが国最近５年間の実態  [通常講演]
    清水 昭彦; 栗田 隆志; 新田 隆; 安部; 治彦; 今井; 克彦; 小林; 義典; 副島; 京子; 庭野; 慎一; 渡辺; 重行; 相澤 義房
    第５９回 日本心臓病学会学術集会 2011年09月 神戸 第５９回 日本心臓病学会学術集会
  • Clinical Parameters Associated with Complete Cure of Atrial Fibrillation Undergoing Extensive Pulmonary Vein Isolation  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹 康仁; 赤岩 譲; 安岡 良文; 宮崎 俊一
    4th Asia Pacific Heart Rhythm Society Scientific Session 2011年09月 福岡市 4th Asia Pacific Heart Rhythm Society Scientific Session
  • Trans-esophageal Echocardiography Is Not Required in All Patients before Pulmonary Vein Isolation  [通常講演]
    安岡 良文; 栗田 隆志; 赤岩 譲; 元木 康一郎; 山本 裕美; 岩永 善高; 平野 豊; 宮崎 俊一
    4th Asia Pacific Heart Rhythm Society Scientific Session 2011年09月 福岡市 4th Asia Pacific Heart Rhythm Society Scientific Session
  • Is Trans-esophageal Echocardiography Required in All Patients with Atrial Fibrillation who Undergo Catheter Ablation Using Pulmonary Vein Isolation?  [通常講演]
    安岡 良文; 栗田 隆志; 赤岩 譲; 元木 康一郎; 山本 裕美; 小夫家 和宏; 岩永 善高; 平野 豊; 宮崎 俊一; 中内 祥文; 弘田 隆省
    第75回 日本循環器学会総会・学術集会 2011年08月 横浜市 第75回 日本循環器学会総会・学術集会
  • 初回アブレーション６年後に右下肺静脈の不整脈源性基質獲得により再発したと考えられた発作性心房細動の一例  [通常講演]
    元木 康一郎; 栗田 隆志; 小竹康仁; 赤岩譲; 安岡良文; 宮崎 俊一
    第14回 臨床難治性不整脈研究会 2011年06月 大阪市 第14回 臨床難治性不整脈研究会
  • JPN.J.E循環器フォーラム2010 －不整脈薬物治療フォーラムー心房細動を合併した心不全患者に対するデバイス治療（ICD,CRT治療）  [通常講演]
    栗田 隆志
    2011年05月 日本心電学会
     
    医局登録番号448
  • 一過性に両方向性伝導障害がみられた副伝導路症候群の一例  [通常講演]
    元木 康一郎; 栗田 隆志; 安岡 良文; 生駒興平; 谷口 貢; 木村 彰男; 宮崎 俊一
    第107回日本循環器学会近畿地方会 2009年06月 大阪 第107回日本循環器学会近畿地方会

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