Publications by authors named "Marina Arai"

8 Publications

  • Page 1 of 1

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/joa3.12285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011801PMC
February 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.13854DOI Listing
April 2019

A pseudo-sinus rhythm due to bigeminal ectopy with the focus in the right superior pulmonary vein.

HeartRhythm Case Rep 2018 Nov 4;4(11):553-555. Epub 2018 Aug 4.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrcr.2018.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241170PMC
November 2018

Pneumopericardium after epicardial catheter ablation detected with "bruit de moulin".

HeartRhythm Case Rep 2018 Oct 23;4(10):484-485. Epub 2018 Jul 23.

Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrcr.2018.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197557PMC
October 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/joa3.12038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891414PMC
April 2018

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1253/circj.CJ-16-0921DOI Listing
January 2017