Publications by authors named "Harumizu Sakurada"

97 Publications

Cardiac Tamponade during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis and Anti-DNA Antibody Positivity.

Intern Med 2021 Mar 29. Epub 2021 Mar 29.

Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Japan.

Drug-induced lupus (DIL) is a drug-mediated immune reaction with the same symptoms as that of lupus erythematosus. We herein report the first case of tocilizumab-induced lupus syndrome presenting with cardiac tamponade. A 65-year-old man presented with cough, exertional dyspnea, and chest pain after 2 months of tocilizumab therapy for rheumatoid arthritis. Echocardiography revealed marked pericardial effusion. Antinuclear antibodies and anti-double-stranded deoxyribonucleic acid antibodies were positive. The diagnosis of cardiac tamponade due to tocilizumab-induced lupus syndrome was made. He had no recurrence of pericardial effusion after tocilizumab discontinuation. Clinicians should be alert for lupus syndrome in patients receiving tocilizumab.
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http://dx.doi.org/10.2169/internalmedicine.7166-21DOI Listing
March 2021

The coronary artery calcium score correlates with left atrial low-voltage area: Sex differences.

J Cardiovasc Electrophysiol 2021 01 29;32(1):41-48. Epub 2020 Nov 29.

Tokyo Medical and Dental University, Tokyo, Japan.

Introduction: In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS.

Methods: This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low-voltage area (LA-LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA-LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non-LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups.

Results: LA volume, age, CHA DS VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non-LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p = .001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA-LVA (<0.5 mV) greater than 5%. The areas under the receiver operating characteristic curves for predicting LA-LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women.

Conclusion: Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men.
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http://dx.doi.org/10.1111/jce.14822DOI Listing
January 2021

Quality of life improvements by durable pulmonary vein isolation in patients with atrial fibrillation.

J Cardiovasc Electrophysiol 2020 08 4;31(8):2013-2021. Epub 2020 Jun 4.

Department of Cardiovascular Disease, Tokyo Medical and Dental University, Tokyo, Japan.

Introduction: Successful pulmonary vein isolation (PVI) can improve the quality of life (QOL) of patients with atrial fibrillation (AF). However, the role of durable PVI for such QOL improvement is not known. The aim of this study was to clarify the effectiveness of durable PVI in improving the QOL of patients with AF.

Methods And Results: We assessed 119 patients who underwent PVI (age 66.4 ± 9.6 years, 104 paroxysmal AF). A scheduled electrophysiological study was performed 6 months after the first PVI session-regardless of recurrence of AF-to assess the durability of PVI and to identify and re-isolate reconnected pulmonary veins. QOL scores were evaluated by an AF-specific QOL questionnaire and checked at baseline, 6  months, and 1 year after the first session. In patients without AF recurrence (nonrecurrence group, n = 93), the scores at 6 months improved compared with those at baseline; conversely, the scores did not improve in patients with AF recurrence (n = 26). Nevertheless, the scores at 1 year improved compared with those at 6 months in both groups. Within the nonrecurrence group, the score difference between 6 months and baseline was higher in the durable PVI group (n = 58) than that in the nondurable PVI group (n = 35).

Conclusions: The QOL of AF patients improved by the resumption of sinus rhythm following PVI. Patients with durable PVI had increased QOL scores compared with those with nondurable PVI. The durability of PVI may achieve further improvements in the QOL of patients with AF.
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http://dx.doi.org/10.1111/jce.14592DOI Listing
August 2020

Comparison of touch-up ablation rate and pulmonary vein isolation durability between hot balloon and cryoballoon.

J Cardiovasc Electrophysiol 2020 06 20;31(6):1298-1306. Epub 2020 Apr 20.

Tokyo Medical and Dental University, Tokyo, Japan.

Introduction: This study aimed to compare touch-up ablation (TUA) rates and pulmonary vein isolation (PVI) durability of hot balloon ablation (HBA) and cryoballoon ablation (CBA) in paroxysmal atrial fibrillation (PAF) patients.

Methods: In total, 137 PAF patients were enrolled in the study. Among them, 59 underwent two HBA procedures at 6-month intervals and 78 patients underwent two CBA sessions, both regardless of atrial fibrillation recurrence. Propensity score matching was performed to estimate similar patient characteristics between the HBA and CBA groups.

Results: Each group comprised of 46 matched patients for comparison. The TUA rate at the first session was higher for HBA (49 of 184 PVs) than for CBA (20 PVs) (P = .01), with the highest incidence at the left superior pulmonary vein (LSPV). The rates of PVI durability at the second session performed 7 months later were similar between HBA (168 of 184 PVs) and CBA (162 PVs) groups. The PVI durability rate at the TUA sites of the first session was higher for HBA than for CBA (41 of 49 PVs vs 10 PVs, respectively; P = .01). Fifty percent of the patients underwent HBA at 73°C for the LSPV. HBA performed at 73°C yielded a lower TUA rate than that at 70°C (16 of 23 PVs vs 7 of 23 PVs; P = .008).

Conclusions: While PVI durability was similar between HBA and CBA, the TUA rate was higher for HBA than for CBA, especially on the LSPV. For LSPV, HBA at a balloon temperature of 73°C may reduce the TUA rate.
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http://dx.doi.org/10.1111/jce.14485DOI Listing
June 2020

Response to letter to the editor.

J Cardiovasc Electrophysiol 2020 04 15;31(4):994. Epub 2020 Mar 15.

Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Ohkubo Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1111/jce.14437DOI Listing
April 2020

Recurrent ischemic stroke in patients with atrial fibrillation ablation and prior stroke: A study based on etiological classification.

J Arrhythm 2020 Feb 3;36(1):95-104. Epub 2019 Dec 3.

Tokyo Medical and Dental University Tokyo Japan.

Background: Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. This study investigated the incidence and mode of stroke recurrence in patients with a history of stroke who underwent atrial fibrillation (AF) ablation.

Methods: Of 825 patients who underwent AF ablation from 2006 to 2016, 77 patients (9.3%, median age 69 years) with a prior ischemic stroke were identified. Patients were classified as those with prior cardioembolic (CE) stroke (n = 55) and those with prior non-CE stroke (n = 22). The incidence and pattern of stroke recurrence were investigated.

Results: The incidence of asymptomatic AF (54.5% vs 22.7%;  = .011) and left atrial volume (135.8 mL vs 109.3 mL;  = .024) was greater in the CE group than in the non-CE group. Anticoagulation treatment was discontinued at an average of 28.1 months following the initial ablation in 34 (44.2%) patients. None of the patients developed CE stroke during a median 4.1-year follow-up. In the non-CE group, 2 patients experienced recurrent non-CE stroke (lacunar infarction in 1 and atherosclerotic stroke in 1); however, AF was not observed at the onset of recurrent ischemic stroke.

Conclusions: In patients with a history of stroke who underwent catheter ablation for AF, the incidence of recurrent stroke was 0.54/100 patient-years. The previous stroke in these patients may not have been due to AF in some cases; therefore, a large-scale prospective study is warranted to identify the appro priate antithrombotic therapy for the prevention of potentially recurrent stroke.
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http://dx.doi.org/10.1002/joa3.12285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011801PMC
February 2020

Fasciculoventricular pathway connecting to the left posterior fascicle area throughout the slow pathway with longitudinal dissociation in the His bundle.

J Cardiovasc Electrophysiol 2020 01 3;31(1):259-262. Epub 2019 Dec 3.

Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Ohkubo Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1111/jce.14301DOI Listing
January 2020

Catheter ablation for monomorphic ventricular tachycardia in Brugada syndrome patients: detailed characteristics and long-term follow-up.

J Interv Card Electrophysiol 2020 Jan 12;57(1):97-103. Epub 2019 Oct 12.

Department of Cardiology, Tokyo Medical Dental University, Tokyo, Japan.

Purpose: Brugada syndrome (BrS) is a risk of sudden cardiac death due to polymorphic ventricular tachycardia and ventricular fibrillation with unusual monomorphic ventricular tachycardia (MVT). Detailed characteristics of MVT and long-term outcome of catheter ablation are still unknown. This study is aimed to identify the detailed characteristics and long-term follow-up of catheter ablation in BrS patients.

Methods: We evaluated 188 patients who were diagnosed with BrS from March 1999 to March 2018. Of those, patients who developed MVT and underwent catheter ablation were included. We identified eight MVTs in seven BrS patients.

Results: Three of them already had implantable cardioverter-defibrillator, and MVTs were terminated by cardioversion or anti-tachycardia pacing. Four patients presented with MVT originating from the right ventricular outflow tract, one patient had MVT arising from the LV septum, one patient had MVT arising from the tricuspid annulus, and one patient had bundle branch reentry ventricular tachycardia. All MVTs were successfully treated by catheter ablation in the acute phase, and seven of eight (87.5%) were free from ventricular tachyarrhythmia during the long-term follow-up (median, 7.2 years).

Conclusions: All MVT cases were successfully treated by catheter ablation. We observed high ventricular arrhythmia free rate following catheter ablation during the long-term follow-up period. BrS patients who developed MVT should consider catheter ablation.
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http://dx.doi.org/10.1007/s10840-019-00620-0DOI Listing
January 2020

Characteristics of Marshall bundle-related atrial tachycardias using an ultrahigh-resolution mapping system.

J Interv Card Electrophysiol 2019 Aug 23;55(2):161-169. Epub 2019 Apr 23.

Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: Marshall bundle (MB)-related atrial tachycardias (ATs) have already been described; however, their characteristics using an ultrahigh-resolution mapping system are not yet well known. The purpose of this study was to clarify the characteristics of MB-related ATs with ultrahigh-resolution mapping.

Methods: In 28 patients who underwent an electrophysiological study for ATs using an ultrahigh-resolution mapping system, precise circuits of 37 ATs were detected. Among those ATs, five were diagnosed as MB-related ATs that had epicardial connections among the reentrant circuits (mean age 76.6 ± 3.7 years, one male patient). We analyzed the characteristics of those MB-related ATs with ultrahigh-resolution mapping.

Results: The mean cycle length was 260 ± 60 ms, and the total acquired electrograms were 12,962 ± 2616 points. Two ATs were perimitral ATs, two rotated around the left pulmonary vein (PV), and one rotated around the left inferior PV. All ATs had a centrifugal activation pattern: 5 o'clock on the mitral annulus in four ATs and the upper ridge in one. Tiny potentials, which indicated epicardial potentials covering the cycle length, were detected in four of five ATs. The local activation times covered over 95% of the tachycardia cycle length on the endocardial side only in all ATs. All ATs were terminated during a radiofrequency ablation from the endocardial side of the Marshall bundle.

Conclusions: The ultrahigh-resolution mapping system demonstrated an activation map of MB-related ATs with a centrifugal pattern. Macroreentrant tachycardias with a centrifugal activation pattern should be considered as possible MB-related ATs.
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http://dx.doi.org/10.1007/s10840-019-00544-9DOI Listing
August 2019

Characteristics of ventricular intracardiac electrograms of ventricular tachycardias originating from the epicardia in patients with an implantable cardioverter defibrillator.

J Cardiovasc Electrophysiol 2019 04 2;30(4):575-581. Epub 2019 Feb 2.

Department of Cardiology, Tokyo Medical and Dental, University, Tokyo, Japan.

Introduction: While characteristic waveforms of 12-lead electrocardiograms have been reported to predict the epicardial origin of ventricular tachycardia (VT), it has not been fully examined whether ventricular intracardiac electrograms (VEGMs) recorded from the implantable cardioverter defibrillator (ICD) via telemetry can determine the origin of VT or not. The aim of this study was to investigate the VEGM characteristics of VT originating from the epicardia.

Method And Results: Intracardiac VEGMs of the induced VTs, with detected sites of origin during the VT study, were recorded in 15 (23 VTs) of the 46 patients. The characteristics of the 23 VTs were evaluated using far-field and near-field VEGMs recorded via telemetry. Five of 23 VTs were found to be focused on the epicardial site (epi group) and 18 VTs were focused on the endocardium (endo group). VTs of the epi group had longer VEGM duration in far-field EGM than those of the endo group (epi group: 240 ± 49 ms vs endo group: 153 ± 45 ms; P = 0.002) and the duration from the onset to the peak of VEGM was also longer than that of the endo group (epi group: 153 ± 53 ms vs endo group: 63 ± 28 ms; P < 0.001). There was no difference in the V wave duration in tip-ring EGM between both groups (epi group: 122 ± 52 ms vs endo group: 98 ± 6 ms; P = 0.377).

Conclusion: Evaluation of intracardiac VEGM before VT ablation may be helpful to predict the epicardial origin of VT in patients with an ICD.
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http://dx.doi.org/10.1111/jce.13854DOI Listing
April 2019

Adenosine-sensitive atrial tachycardia originating from the anterior mitral annulus.

HeartRhythm Case Rep 2018 Nov 14;4(11):542-544. Epub 2018 Aug 14.

Department of Cardiovascular Diseases, Tokyo Medical and Dental University, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.hrcr.2018.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241165PMC
November 2018

The relationship between obstructive sleep apnea and recurrence of atrial fibrillation after pulmonary vein isolation using a contact force-sensing catheter.

J Interv Card Electrophysiol 2019 Apr 20;54(3):209-215. Epub 2018 Nov 20.

Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: Our aim was to elucidate the relationship between obstructive sleep apnea (OSA) and atrial fibrillation (AF) recurrence after repeated pulmonary vein isolation (PVI).

Methods: We conducted a non-randomized observational study, with the data prospectively collected. One hundred patients (paroxysmal AF, n = 89) underwent PVI using a contact force-sensing catheter. All patients underwent an electrophysiological study and additional ablation for left atrium-pulmonary vein (PV) reconnection and non-PV foci, 6 months after the first treatment session, regardless of AF recurrence. Those with an apnea-hypopnea index ≥ 15 were diagnosed with OSA. Continuous positive air pressure (CPAP) therapy was initiated after the second treatment session, based on results of a sleep study. For analysis, patients were classified into the non-OSA (n = 66), treated OSA (OSA patients undergoing CPAP; n = 11), and untreated OSA (n = 23) groups, and between-group differences evaluated.

Results: After the first session, AF recurrence was observed in 18.2% (12/66) and 14.7% (5/34) of patients without and with OSA, respectively (P = 0.678). After the second procedure, the rate of AF recurrence was 12.1% (8/66) in the non-OSA group, 9.1% (1/11) in the treated OSA group, and 8.7% (2/23) in the untreated OSA group (log-rank P = 0.944).

Conclusions: The rate of AF recurrence might not be greater in patients with untreated OSA than in those without OSA and those with treated OSA after repeated PVI, using a contact force-sensing catheter, for patients with paroxysmal or short-term persistent AF.
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http://dx.doi.org/10.1007/s10840-018-0489-xDOI Listing
April 2019

Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism.

Intern Med 2018 Dec 10;57(23):3389-3392. Epub 2018 Aug 10.

Tokyo Medical and Dental University, Japan.

Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year.
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http://dx.doi.org/10.2169/internalmedicine.1104-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306529PMC
December 2018

Development of Nonpulmonary Vein Foci Increases Risk of Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.

JACC Clin Electrophysiol 2017 06 1;3(6):547-555. Epub 2017 Feb 1.

Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: The aim of this paper was to clarify the impact of nonpulmonary vein foci (NPVF) on atrial fibrillation (AF) recurrence after pulmonary vein (PV) isolation.

Background: NPVF are considered contributing factors for the recurrence of AF after PV isolation, but their exact role remains unclear.

Methods: We retrospectively reviewed 216 patients (paroxysmal AF, n = 172; persistent AF, n = 44) who underwent a second electrophysiological study 6 months after the original PV isolation. Patients with AF recurrence underwent additional ablation procedures for reconnected PV and NPVF. NPVF were detected in the control group and with drug infusion (isoproterenol or isoproterenol with adenosine triphosphate) during the first and second procedure. NPVF detected for the first time in the second session were defined as newly developed, and their effect on AF recurrence after the second procedure was investigated, along with the predictive factors for NPVF development.

Results: Patients with AF recurrence after the first session had a significantly higher reconnected PV (91.5% vs. 68.2% in patients without recurrence). NPVF were detected in 20 and 54 patients in the first and second sessions, respectively. Patients with newly developed NPVF had a significantly higher AF recurrence (24.1% vs. 7.4% in patients without newly developed NPVF). Newly developed NPVF and AF recurrence after the first session were independent predictors for AF recurrence after the second procedure, whereas AF history and NPVF in the first session were independent predictors for newly developed NPVF.

Conclusions: NPVF detection and ablation may represent important therapeutic options to prevent AF recurrence, especially in patients who require repeated procedures.
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http://dx.doi.org/10.1016/j.jacep.2016.12.008DOI Listing
June 2017

Ventricular tachycardia storm originating from interventricular septum successfully treated with surgical cryoablation with electroanatomic and electrophysiological mapping before dual valve replacement.

J Arrhythm 2018 Feb 21;34(1):71-73. Epub 2017 Dec 21.

Tokyo Medical and Dental, University Tokyo Japan.

A 58-year-old man with dilated cardiomyopathy was admitted with heart failure. He had a history of two catheter ablation procedures for ventricular tachycardia (VT) originating from the intraventricular septum (IVS). Before dual valve replacement (DVR), he suffered a VT storm. An electrophysiological study revealed an extended low-voltage area at the IVS with the exit of the induced VT at the anterior side. Radiofrequency application was performed at the VT exit as a landmark for surgical cryoablation (SA). During the DVR, SA was performed at the IVS using this landmark. After SA, the patient had no ventricular tachyarrhythmia.
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http://dx.doi.org/10.1002/joa3.12020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828278PMC
February 2018

Successful catheter ablation of ventricular premature complexes from the right atrial side of the atrioventricular septum with good contact force.

J Arrhythm 2018 04 12;34(2):201-203. Epub 2018 Mar 12.

Department of Cardiovascular Diseases Tokyo Medical and Dental University Bunkyō Tokyo Japan.

The acquisition of good contact force for radiofrequency catheter ablation of ventricular premature complexes (VPCs) originating from the basal septum of the left ventricle (LV) is often difficult. We describe a case of VPCs originating from the basal septum of the LV, which were successfully eliminated by applying radiofrequency at the right atrium (RA) side of the atrioventricular septum (AVS) without causing any significant impairment of atrioventricular conduction because the ablation catheter could obtain better contact force through the RA approach. Moreover, intracardiac echocardiography (ICE) and RA angiography effectively demonstrated the AVS.
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http://dx.doi.org/10.1002/joa3.12038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891414PMC
April 2018

Usefulness of epicardial impedance evaluation for epicardial mapping and determination of epicardial ablation site for ventricular tachycardia: A pilot study.

J Cardiovasc Electrophysiol 2018 01 1;29(1):138-145. Epub 2017 Nov 1.

Toride Kitasoma Medical Center Hospital, Ibaraki, Japan.

Background: During epicardial mapping, determination of appropriate ablation sites in low voltage areas (LVA) is challenging because of large epicardial areas covered by adipose tissue.

Objective: To evaluate the impedance difference between epicardial fat and the epicardial LVA using multiple detector computed tomography (MDCT).

Methods: We enrolled patients who underwent ventricular tachycardia (VT) ablation via the epicardial approach after endocardial ablation failure. After the procedure, MDCT-derived images of epicardial fat were loaded to the mapping system. Then, all points acquired during sinus rhythm were retrospectively superimposed and analyzed.

Results: This study included data from 7 patients (62.5 ± 3.9 years old) who underwent eight epicardial VT ablation procedures. After the procedure, MDCT-derived images of epicardial fat were registered in eight procedures. Retrospective analysis of 1,595 mapping and 236 ablation points was performed. Of the 1,595 mapping points on the merged electroanatomical and epicardial fat maps, normal voltage area (NVA) and low voltage area (LVA) without fat had lower impedance than those with fat (NVA without fat 182 ± 46 Ω vs. NVA with fat 321 ± 164.0 Ω, P  =  0.001, LVA without fat 164 ± 69 Ω vs. LVA with fat 248 ± 89 Ω, P  =  0.002). Of the 236 ablation points, initial impedance before ablation was higher on epicardial fat than on epicardial LVA without fat (134 ± 16 Ω vs. 156 ± 28 Ω, P  =  0.01).

Conclusions: Real time epicardial impedance evaluation may be useful to determine effective epicardial ablation sites and avoid adipose tissue. However, the number of patients in the present study is limited. Further investigation with a large number of patients is needed to confirm our result.
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http://dx.doi.org/10.1111/jce.13361DOI Listing
January 2018

Genotype-Phenotype Correlation of Mutation for the Clinical and Electrocardiographic Characteristics of Probands With Brugada Syndrome: A Japanese Multicenter Registry.

Circulation 2017 Jun 24;135(23):2255-2270. Epub 2017 Mar 24.

From Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.Y., T.A., K.K., S.K. S.Y., H.O., W.S.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (M.H., S. Ohno); Department of Cardiovascular Medicine, University of Tokyo, Japan (K.Y.); Department of Cardiopulmonary Medicine, Keio University, Tokyo, Japan (S. Ogawa, K.F.); Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Japan (Y.A., H.W.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan (T.O., H.M.); Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Ishikawa, Japan (M.Y., K.H.); Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Japan (N.M.); Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Japan (H.S.); Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan (T.T.); Division of Cardiology, Yamaguchi University Graduate School of Medicine, Japan (A.S.); Department of Cardiology, Tokyo Women's Medical University, Japan (N.H.); Department of Cardiology, St Marianna University of Medicine, Kanagawa, Japan (R.K.); Department of Cardiovascular Medicine, Hiroshima University, Japan (Y.N.); Department of Cardiovascular Medicine, Osaka City University, Japan (M.T.); Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T.M.); Laboratory of Molecular Genetics, National Cerebral and Cardiovascular Center, Osaka, Japan (Y.M.); Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (J.D.K., M.J.A.); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).

Background: The genotype-phenotype correlation of mutations as a predictor of cardiac events in Brugada syndrome remains controversial. We aimed to establish a registry limited to probands, with a long follow-up period, so that the genotype-phenotype correlation of mutations in Brugada syndrome can be examined without patient selection bias.

Methods: This multicenter registry enrolled 415 probands (n=403; men, 97%; age, 46±14 years) diagnosed with Brugada syndrome whose gene was analyzed for mutations.

Results: During a mean follow-up period of 72 months, the overall cardiac event rate was 2.5%/y. In comparison with probands without mutations ( (-), n=355), probands with mutations ( (+), n=60) experienced their first cardiac event at a younger age (34 versus 42 years, =0.013), had a higher positive rate of late potentials (89% versus 73%, =0.016), exhibited longer P-wave, PQ, and QRS durations, and had a higher rate of cardiac events (=0.017 by log-rank). Multivariate analysis indicated that only mutation and history of aborted cardiac arrest were significant predictors of cardiac events ( (+) versus (-): hazard ratio, 2.0 and =0.045; history of aborted cardiac arrest versus no such history: hazard ratio, 6.5 and <0.001).

Conclusions: Brugada syndrome patients with mutations exhibit more conduction abnormalities on ECG and have higher risk for cardiac events.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.117.027983DOI Listing
June 2017

Outcomes of Brugada Syndrome Patients with Coronary Artery Vasospasm.

Intern Med 2017 15;56(2):129-135. Epub 2017 Jan 15.

Department of Cardiology, Yokohama General Hospital, Japan.

Objective To evaluate the outcomes of patients with concomitant Brugada syndrome and coronary artery vasospasm. Methods Patients diagnosed with Brugada syndrome with an implantable cardiac defibrillator were retrospectively investigated, and the coexistence of vasospasm was evaluated. The clinical features and outcomes were evaluated, especially in patients with coexistent vasospasm. A provocation test using acetylcholine was performed in patients confirmed to have no organic stenosis on percutaneous coronary angiography to confirm the presence of vasospasm. Implantable cardiac defibrillator shock status was checked every three months. Statistical comparisons of the groups with and without vasospasm were performed. A univariate analysis was also performed, and the odds ratio for the risk of implantable cardiac defibrillator shock was calculated. Patients Thirty-five patients with Brugada syndrome, of whom six had coexistent vasospasm. Results There were no significant differences in the laboratory data, echocardiogram findings, disease, or the history of taking any drugs between patients with and without vasospasm. There were significant differences in the clinical features of Brugada syndrome, i.e. cardiac events such as resuscitation from ventricular fibrillation or appropriate implantable cardiac defibrillator shock. Four patients with vasospasm had cardiac events such as resuscitation from ventricular fibrillation and/or appropriate defibrillator shock; three of them had no cardiac events with calcium channel blocker therapy to prevent vasospasm. The coexistence of vasospasm was a potential risk factor for an appropriate implantable cardiac defibrillator shock (odds ratio: 13.5, confidence interval: 1.572-115.940, p value: 0.035) on a univariate analysis. Conclusion Coronary artery vasospasm could be a risk factor for cardiac events in patients with Brugada syndrome.
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http://dx.doi.org/10.2169/internalmedicine.56.7307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337455PMC
March 2017

Life-Threatening Ventricular Arrhythmia and Brugada-Type ST-Segment Elevation Associated With Acute Ischemia of the Right Ventricular Outflow Tract.

Circ J 2017 Feb 11;81(3):322-329. Epub 2017 Jan 11.

Department of Cardiology, Yokohama Minami Kyosai Hospital.

Background: Brugada-type ECG (Br-ECG) is occasionally observed during acute myocardial ischemia of the right ventricular outflow tract (RVOT). No studies have explored, however, the association of ventricular tachyarrhythmia and development of Br-ECG due to acute ischemia of the RVOT.Methods and Results:The study included 13 consecutive patients with acute ischemia of the RVOT during coronary catheterization. Patients were divided into 2 groups: those with Br-ECG (group B) and those without (group N). The proportion of male patients was higher in group B than in group N (100% vs. 25%, P<0.01), and VT/VF developed in only patients with Br-ECG (group B). In group B, VT/VF was observed in patients without pre-existing organic change in the conus/right ventricular (RV) branch of the right coronary artery and no VT/VF was seen in patients with organic coronary stenosis despite Br-ECG.

Conclusions: Acute myocardial ischemia of the RVOT caused Br-ECG predominantly in male patients and subsequent development of VT/VF in some patients. VT/VF was seen in patients without any obstructive lesion but arrhythmic events were not observed in RVOT ischemia in the case of pre-existing coronary occlusion or stenosis of the conus or RV branch, suggesting the effects of precondition.
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http://dx.doi.org/10.1253/circj.CJ-16-1112DOI Listing
February 2017

Clinical Characteristics and Long-Term Prognosis of Senior Patients With Brugada Syndrome.

JACC Clin Electrophysiol 2017 01 1;3(1):57-67. Epub 2016 Jun 1.

Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan.

Objectives: This study investigated clinical characteristics and prognosis of Brugada syndrome (BrS) in patients older than 60 years of age during a long-term follow-up period.

Background: Clinical characteristics and prognosis of senior patients with BrS have not been clearly elucidated.

Methods: A total of 181 patients with BrS were divided into 2 groups by age at the time of diagnosis: the younger group was <60 years of age (n = 123), and the senior group was ≥60 years of age (n = 58).

Results: Mean ages were 42.7 ± 11 years and 68.6 ± 7.1 years, respectively. Prevalence of spontaneous type 1 electrocardiogram (ECG) was lower in the senior group (22 of 58; 37.9%) than in the younger group (64 of 123; 51.9%) (p = 0.027). Among various ECG parameters, the senior group had a lower incidence of prolonged r-J intervals in V ≥90 ms than the younger group (34 of 58; 58.6% vs. 90 of 123; 73.1%, p = 0.049) and day-to-day variation of Brugada ECG patterns (3 of 58; 5.2% vs. 23 of 123; 18.7%, p = 0.032). During a mean follow-up period of 7.6 ± 5.8 years, no senior patients experienced documented fatal ventricular arrhythmias, but 11 younger patients did. Kaplan-Meier analysis revealed a better prognosis in the senior group than in the younger group (log-rank, p = 0.011).

Conclusions: Senior BrS patients, ≥60 years of age, had a better prognosis than those <60 years of age. Implantable cardioverter-defibrillator insertion for senior patients with BrS needs careful consideration.
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http://dx.doi.org/10.1016/j.jacep.2016.04.004DOI Listing
January 2017

Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization.

Circ J 2017 Jan 22;81(2):235-240. Epub 2016 Dec 22.

Department of Cardiology, Tokyo Metropolitan Hiroo Hospital.

Background: Sodium bicarbonate and ascorbic acid have been proposed to prevent contrast-induced nephropathy (CIN). The present study evaluated the effect of their combined use on CIN incidence.Methods and Results:We prospectively enrolled 429 patients with chronic kidney disease (CKD: baseline estimated glomerular filtration rate <60 mL/min/1.73 m) prior to elective coronary catheterization. CIN was defined as absolute (≥0.5 mg/dL) or relative (≥25%) increase in serum creatinine within 72 h. In the saline hydration (n=218) and combined sodium bicarbonate+ascorbic acid (n=211) groups, a total of 1,500-2,500 mL 0.9% saline was given before and after the procedure. In addition, the combination group received 20 mEq sodium bicarbonate and 3 g ascorbic acid i.v. before the procedure, followed by 2 g ascorbic acid after the procedure and a further 2 g after 12 h. There were no significant differences between the basic characteristics and contrast volume in the 2 groups. CIN occurred in 19 patients (8.7%) in the saline group, and in 6 patients (2.8%) in the combined treatment group (P=0.008).

Conclusions: Combined sodium bicarbonate and ascorbic acid could prevent CIN following catheterization in CKD patients.
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http://dx.doi.org/10.1253/circj.CJ-16-0921DOI Listing
January 2017

Combination of drug-coated balloon angioplasty and excimer laser coronary angioplasty ablation for coronary restenosis of Kawasaki disease: A case report.

J Cardiol Cases 2017 Jan 6;15(1):18-21. Epub 2016 Oct 6.

Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.

Coronary aneurysm is a well-known sequela of Kawasaki disease. Although ischemic heart disease often becomes problematic due to coronary aneurysm and severe calcification, there is no consensus on how to treat ischemic lesions in those with Kawasaki disease. We describe a case of successful percutaneous coronary intervention of the restenosis lesion within a coronary artery aneurysm accompanied by Kawasaki disease by using an excimer laser coronary angioplasty ablation technique followed by drug-coated balloon angioplasty. < Patients with coronary aneurysms after Kawasaki disease have a high rate of coronary artery stenoses. As children with Kawasaki disease mature, cardiologists are likely to see increasing numbers of these patients with cardiovascular complications, including intrastent restenosis. A combination of drug-coated balloon angioplasty and excimer laser coronary angioplasty ablation may be an effective strategy for intrastent restenosis lesions near the coronary aneurysm.>.
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http://dx.doi.org/10.1016/j.jccase.2016.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262106PMC
January 2017

Middle fascicle as a common retrograde limb in two left upper septal interfascicular reentrant ventricular tachycardias: a case report.

J Interv Card Electrophysiol 2016 Dec 5;47(3):311-312. Epub 2016 Aug 5.

Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1007/s10840-016-0169-7DOI Listing
December 2016

Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter-Defibrillators.

Clin Cardiol 2016 May 6;39(5):263-8. Epub 2016 May 6.

Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients.

Hypothesis: Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients.

Methods: A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records.

Results: The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045).

Conclusions: This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.
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http://dx.doi.org/10.1002/clc.22521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490793PMC
May 2016

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator.

J Arrhythm 2016 Apr 19;32(2):102-7. Epub 2015 Nov 19.

Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan.

Background: Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias.

Methods: A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD).

Results: Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8.

Conclusions: In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.
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http://dx.doi.org/10.1016/j.joa.2015.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823574PMC
April 2016

Long-term efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with Brugada syndrome and an implantable cardioverter-defibrillator to prevent inappropriate shock therapy.

Heart Rhythm 2016 07 4;13(7):1455-9. Epub 2016 Mar 4.

Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.

Background: In patients with an implantable cardioverter-defibrillator (ICD) and Brugada syndrome (BrS), the long-term efficacy of catheter ablation for preventing inappropriate shock therapy due to paroxysmal atrial fibrillation (PAF) has not been elucidated.

Objective: To evaluate the efficacy of atrial fibrillation (AF) ablation for PAF for prevention of inappropriate ICD therapy over a longer follow-up period.

Methods: We enrolled 76 men with BrS and an ICD, with a mean age of 46.2 ± 16.5 years. Twenty-one patients had AF (19 had PAF, 1 had persistent AF, and 1 had longstanding persistent AF). Fourteen patients with PAF underwent pulmonary vein isolation (PVI) and received follow-up electrophysiological study (EPS) 6 months after the first PVI. If necessary, ablation was performed.

Results: Over a mean follow-up period of 3.3 ± 1.4 years after the repeat session, 13 of the 14 patients (92.9%) had no recurrence of AF. Six patients with PAF without inappropriate ICD therapy before PVI had no recurrence of AF and no inappropriate therapy during follow-up. Among the 8 patients who had inappropriate therapy because of PAF before PVI, 1 patient who had recurrent AF underwent another ablation session. After this final session, there were no recurrences of AF and no inappropriate therapy (mean follow-up period 3.1± 1.2 years).

Conclusion: Catheter ablation is effective in patients with BrS and an ICD, and prevents inappropriate ICD therapy owing to PAF; thus, catheter ablation is an appropriate first-line therapy for PAF among such patients.
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http://dx.doi.org/10.1016/j.hrthm.2016.03.006DOI Listing
July 2016