Publications by authors named "Naokata Sumitomo"

99 Publications

Diagnostic value of P-waves in children with idiopathic restrictive cardiomyopathy.

Heart Vessels 2021 Jan 26. Epub 2021 Jan 26.

Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan.

Restrictive cardiomyopathy (RCM) is a rare myocardial disease with an impaired diastolic function and poor prognosis. Almost all RCM patients are reported to have abnormal P-waves due to atrial overloading. This study aimed to reveal the characteristics of the P-waves in RCM patients and to suggest the diagnostic index of RCM in children with a 12-lead electrocardiogram (ECG). We retrospectively investigated 17 ECGs of children with idiopathic RCM during the initial visit at 15 institutes in Japan between 1979 and 2013. The RCM group was divided into four groups based on the age (elementary school [ES] and junior high school [JHS] students) and inception of the diagnosis (abnormal ECG on school-heart-screening [e-RCM] and some cardiovascular symptoms [s-RCM]), the ES/e-RCM (n = 5), ES/s-RCM (n = 4), JHS/e-RCM (n = 4), and JHS/s-RCM (n = 4) groups. As an aged-match control group, school-heart-screening ECGs of 1st-grade ES students (16,770 students) and 1st-grade JHS students (18,126 students) from Kagoshima in 2016 were adopted. For a comparison between the groups, we used the effect size "Hedge's g" by calculating the mean and standard deviation of the two groups. An effect size of 0.8 (or above) had an overlap of 53% (or less). The effect sizes of the sum of the absolute values of the forward and backward amplitudes in lead V1 (P1 + P2 V1) was the largest, and the ES/e-RCM, ES/s-RCM, JHS/e-RCM, and JHS/s-RCM were 15.8, 22.1, 9.4, and 10.3, respectively. A P1 + P2 V1 > 200 μV was able to rule in all RCM patients, thus, we proposed 200 µV as the cutoff value for screening purposes. In conclusion, the P1 + P2 V1 in the school-heart-screening may be useful for detecting asymptomatic or early-stage RCM in school-age children.
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http://dx.doi.org/10.1007/s00380-021-01784-4DOI Listing
January 2021

COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis.

Pediatr Pulmonol 2021 Jan 11. Epub 2021 Jan 11.

Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA.

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 has been increasingly recognized. However, the clinical features of MIS-C and the differences from Kawasaki disease remain unknown. The study aims to investigate the epidemiology and clinical course of MIS-C.

Methods: PubMed and EMBASE were searched through August 30, 2020. Observational studies describing MIS-C were included. Data regarding demographic features, clinical symptoms, laboratory, echocardiography and radiology findings, treatments, and outcomes were extracted. Study-specific estimates were combined using one-group meta-analysis in a random-effects model.

Results: A total of 27 studies were identified including 917 MIS-C patients. The mean age was 9.3 (95% confidence interval [CI], 8.4-10.1). The pooled proportions of Hispanic and Black cases were 34.6% (95% CI, 28.3-40.9) and 31.5% (95% CI, 24.8-38.1), respectively. The common manifestations were gastrointestinal symptoms (87.3%; 95% CI, 82.9-91.6) and cardiovascular involvement such as myocardial dysfunction (55.3%; 95% CI, 42.4-68.2), coronary artery aneurysms (21.7%; 95% CI, 12.8-30.1) and shock (65.8%; 95% CI, 51.1-80.4), with marked elevated inflammatory and cardiac markers. The majority of patients received intravenous immunoglobulin (81.0%; 95% CI, 75.0-86.9), aspirin (67.3%; 95% CI, 48.8-85.7), and corticosteroids (63.6%; 95% CI, 53.4-73.8) with a variety of anti-inflammatory agents. Although myocardial dysfunction improved in 55.1% (95% CI, 33.4-76.8) at discharge, the rate of extracorporeal membrane oxygenation use was 6.3% (95% CI, 2.8-9.8) and the mortality was 1.9% (95% CI, 1.0-2.8).

Conclusion: Our findings suggest that MIS-C leads to multiple organ failure, including gastrointestinal manifestations, myocardial dysfunction and coronary abnormalities, and has distinct features from Kawasaki disease.
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http://dx.doi.org/10.1002/ppul.25245DOI Listing
January 2021

Transvenous lead performance of implantable cardioverter-defibrillators and pacemakers.

Pacing Clin Electrophysiol 2021 Mar 18;44(3):481-489. Epub 2021 Jan 18.

Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.

Background: After the reports of recalled leads, several technological improvements have been introduced and the durability of implantable cardioverter defibrillator (ICD) leads has improved. The incidence of lead failures is now less than in the previous studies. However, there are few reports that have shown the long-term durability of ICD leads as compared to pacemaker (PM) leads. This study analyzed the medium to long-term performance of transvenous ICD leads as compared to PM leads.

Methods: We retrospectively studied 1227 cases from April 2007 to December 2017 who underwent an initial transvenous ICD or PM implantation. The number of lead failures and patient background characteristics were analyzed.

Results: During a median 3-3.5 years follow up period, 1 (0.3%) ICD lead and 18 (2.4%) PM leads failed. The incidence of lead failures was significantly higher in the PM group than ICD group (p = .019). Males were associated with a higher incidence of lead failures in the PM group.

Conclusion: Since the era of recalled ICD leads, the durability of ICD leads has remarkably improved and the incidence of lead failures with non-recalled ICD leads has been less than that for PM leads.
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http://dx.doi.org/10.1111/pace.14154DOI Listing
March 2021

Efficacy and safety of tolvaptan after pediatric congenital heart disease surgery.

Heart Vessels 2021 Jan 3. Epub 2021 Jan 3.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.

It is not clear whether tolvaptan is safe and effective irrespective of various underlying clinical conditions including the functional ventricle morphology, chromosomal abnormalities, and renal function after complex pediatric congenital heart disease surgery. Also, the appropriate dose of tolvaptan in these patients has not been previously identified. We retrospectively assessed the urine volume, body weight, patient clinical characteristics, laboratory data, and vital signs before and on days 1 and 7 of the tolvaptan administration after congenital heart disease surgery. Also, we assessed the relationship between the tolvaptan dose and its effects. A total of 86 patients were included the study. The mean time from the surgery to the tolvaptan administration was 23.5 ± 3.7 days. After administering tolvaptan, the urine volume significantly increased and body weight significantly decreased from baseline by days 1 and 7 (p < 0.0001). The urine volume significantly increased more in the survivors than the deceased. Of the 22 patients who had low serum sodium concentrations at baseline, 20 had an increased serum sodium concentration on day 7. The clinical effect of tolvaptan was not affected by the functional ventricle morphology, chromosomal abnormalities, or renal function. There was a positive correlation between the tolvaptan dose and change in the urine volume until a tolvaptan dose of up to 0.3 mg/kg/day but not at more than 0.3 mg/kg/day. Tolvaptan administration is safe and effective after congenital heart disease surgery irrespective of various underlying clinical conditions. Though the urine volume tends to increase until a tolvaptan dose of up to 0.3 mg/kg/day in pediatric congenital heart disease patients, there was no further benefit with more than 0.3 mg/kg/day.
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http://dx.doi.org/10.1007/s00380-020-01743-5DOI Listing
January 2021

Late recovery of the cardiopulmonary exercise capacity after transcatheter amplatzer device closures for atrial septal defects in adults.

Heart Vessels 2021 Jan 2. Epub 2021 Jan 2.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.

Transcatheter atrial septal defect (ASD) closures using an Amplatzer Septal Occluder (ASO) have been widely performed. Compared to children, we sometimes experience late recovery of exercise performance in adult patients. Our study aimed to evaluate the change in the cardiopulmonary exercise capacity in asymptomatic or mildly symptomatic adult patients after a transcatheter ASD closure using an ASO. The subjects consisted of 29 patients (age 39.5 ± 13.6 years) that underwent cardiopulmonary exercise testing (CPX) before, 3, 6, and 12 months after a transcatheter secundum ASD closure using an ASO. The peak oxygen consumption (peak VO), anaerobic threshold (AT), and slope of the correlation between the ventilation and carbon dioxide production (VE/VCO slope) were evaluated. We also evaluated the left-ventricular end-diastolic diameter (LVEDD), right-ventricular end-diastolic dimension (RVEDD) by echocardiography, and hemodynamic values by cardiac catheterization before the ASO procedure. The peak VO did not show any improvement 3 months after the ASO procedure; however, a significant improvement was displayed 6 and 12 months (baseline: 23.4 ± 6.3, 3 months: 23.6 ± 6.4, 6 months: 25.1 ± 5.6, 12 months: 26.4 ± 5.3 mL/kg/min; p < 0.001) after the ASO. The LVEDD (before: 38.1 ± 3.6, 3 months: 43.4 ± 3.4 mm; p < 0.001) and RVEDD (before: 33.6 ± 5.3, 3 months: 26.3 ± 2.6 mm; p < 0.001) on echocardiography quickly improved 3 months after the ASO. Although the LVEDD and RVEDD normalized 3 months after the ASO, the peak VO still decreased; however, the peak VO improved to almost a normal range 6 months after the ASO.
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http://dx.doi.org/10.1007/s00380-020-01741-7DOI Listing
January 2021

Novel Diagnostic Observations of Nodoventricular/Nodofascicular Pathway-Related Orthodromic Reciprocating Tachycardia Differentiating From Atrioventricular Nodal Re-Entrant Tachycardia.

JACC Clin Electrophysiol 2020 Dec 30;6(14):1797-1807. Epub 2020 Sep 30.

Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ibaraki, Tokyo, Japan.

Objectives: This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT).

Background: Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging.

Methods: We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference).

Results: More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT.

Conclusions: Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.
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http://dx.doi.org/10.1016/j.jacep.2020.07.007DOI Listing
December 2020

The impact of high-density atrioventricular dual-chamber mapping in a patient with a left epicardial accessory pathway.

HeartRhythm Case Rep 2020 Nov 11;6(11):888-890. Epub 2020 Sep 11.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan.

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http://dx.doi.org/10.1016/j.hrcr.2020.08.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653477PMC
November 2020

Hepatocyte growth factor predicts failure of Fontan circulation.

ESC Heart Fail 2020 Sep 10. Epub 2020 Sep 10.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.

Aims: This study aimed to assess the value of the hepatocyte growth factor (HGF) as an independent predictor of a Fontan circulation failure.

Methods And Results: This retrospective case-control study included 34 consecutive patients (19 men and 15 women) who underwent a post-operative cardiac catheterization after a Fontan operation at the Saitama Medical University International Medical Center between April 2017 and December 2019. We divided the patients into two groups according to the HGF level: HGF < 0.4 ng/mL (n = 20, normal HGF group) and HGF ≥ 0.4 ng/mL (n = 14, elevated HGF group). The age at the time of the cardiac catheterization was 59.3 ± 7.9 months. The range of the duration between the Fontan operation and the cardiac catheterization was 37.5 ± 7.9 months. The age (P = 0.417), gender (P = 0.08), morphology of the functional ventricle (P = 0.99), presence or closure of the Fontan fenestration (P = 0.704), and rate of medication use (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers) (P = 0.99) were equivalent between the two groups. Laboratory parameters including the brain natriuretic peptide level (P = 0.085), serum creatinine level (P = 0.27), and aspartate aminotransferase level (P = 0.235) were similar between the two groups. The elevated HGF group had a higher C-reactive protein level than the normal HGF group (0.42 ± 0.14 and 0.05 ± 0.01 mg/dL, P = 0.005). The elevated HGF group had a higher central venous pressure (CVP) level than the normal HGF group (13.4 ± 0.7 and 9.7 ± 0.4 mmHg, P < 0.0001), and the HGF was positively correlated with the CVP (P = 0.0004, r  = 0.33). The SvO level was significantly lower in the elevated HGF group than in the normal HGF group (61.9 ± 2.3% and 75.0 ± 1.2%, P < 0.0001), and the HGF was negatively correlated with the SvO (P < 0.0001, r  = 0.65). Of the 34 patients, six underwent catheter interventions. Patients who underwent catheter interventions had a higher HGF level than those who did not (0.44 ± 0.03 and 0.37 ± 0.01 ng/mL, P = 0.032). The receiver operating characteristic curve created for the discrimination of a catheter intervention revealed that an HGF value of >0.405 ng/mL could detect the need for a catheter intervention with 75.0% sensitivity and 83.3% specificity. A multivariable regression analysis showed that an elevated HGF was an independent predictor of an elevated CVP (β-coefficient 21.2, SE 5.5, P = 0.0005) and decreased SvO (β-coefficient -92.9, SE 12.4, P < 0.0001).

Conclusions: The HGF is an independent predictor of a failure of a Fontan circulation. The HGF is an indicator for an additional catheter intervention after a Fontan operation.
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http://dx.doi.org/10.1002/ehf2.12943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754719PMC
September 2020

Impact of the T-wave characteristics on distinguishing arrhythmogenic right ventricular cardiomyopathy from healthy children.

Int J Cardiol 2021 Jan 30;323:168-174. Epub 2020 Aug 30.

Department of Pediatrics, Kagoshima Medical Center, Kagoshima, Japan.

Background: T-wave inversion (TWI) is not considered useful for diagnosing pediatric arrhythmogenic right ventricular cardiomyopathy (ARVC), because right precordial TWI in ARVC resembles a normal juvenile pattern.

Objectives: The aims of this study were to clarify the electrocardiographic (ECG) characteristics of pediatric ARVC to distinguish those patients from healthy children.

Methods: Between 1979 and 2017, 11 ARVC patients under 18 years old were registered and compared with school screening ECGs from 48,401 healthy children.

Results: The mean age at the first arrhythmic event or diagnosis was 13.3 ± 4.7 years. Nine patients were asymptomatic initially and were found by ECG screening, but 6 developed severe symptoms during the follow-up. Healthy children had a normal juvenile pattern, while ARVC children, especially symptomatic patients, had a significant tendency to have inferior and anterior TWI. The phenomenon of T-wave discontinuity (TWD) in which the TWI became deeper from V1 to V3 and suddenly turned positive in V5 was significantly more frequent in ARVC (60%) than healthy children (0.55%). Anterior TWI and TWD were also significantly more frequent in those who developed severe symptoms. The sensitivity and specificity of TWD were 60% (95% CI, 31-83%), and 99% (95% CI, 99-99%) to distinguish ARVC from healthy children, as well as 100% (95% CI, 71-100%) and 80% (95% CI, 51-80%), respectively, to predict severe symptoms in the future.

Conclusions: The ECG is useful to distinguish ARVC children, even in the early phase. Anterior TWI and TWD could detect ARVC children and to predict the possible serious conditions.
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http://dx.doi.org/10.1016/j.ijcard.2020.08.088DOI Listing
January 2021

Clinical characteristics of COVID-19 in children: A systematic review.

Pediatr Pulmonol 2020 10 4;55(10):2565-2575. Epub 2020 Aug 4.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.

Background: Limited pediatric cases with coronavirus disease 2019 (COVID-19) have been reported and the clinical profiles regarding COVID-19 in children remain obscure. Our aim was to investigate the clinical characteristics of COVID-19 in children.

Methods: PUBMED and EMBASE were searched through 20 June 2020, for case reports and case series reporting pediatric COVID-19 cases. Epidemiological, clinical, laboratory, and radiological data were collected and analyzed to compare by age.

Results: Our search identified 46 eligible case reports and case series. A total of 114 pediatric cases with COVID-19 were included. The main clinical features were mild symptoms including fever (64%), cough (35%), and rhinorrhea (16%), or no symptoms (15%). Ground-like opacities were common radiological findings (54%). The main laboratory findings were lymphopenia (33%) and elevated D-dimer (52%) and C-reactive protein (40%) levels. We identified 17 patients (15%) with multisystem inflammatory syndrome in children (MIS-C) manifesting with symptoms overlapping with, but distinct from, Kawasaki disease, including gastrointestinal symptoms, left ventricular systolic dysfunction, shock, and marked elevated inflammatory biomarkers. Twelve percent of the patients including 65% of the MIS-C cases required intensive care because of hypotension. No deaths were reported.

Conclusion: This systematic review found that children with COVID-19 are generally less severe or asymptomatic. However, infants might be seriously ill and older children might develop MIS-C with severe illness. Early detection of children with mild symptoms or an asymptomatic state and early diagnosis of MIS-C are mandatory for the management of COVID-19 and the prevention of transmission and a severe inflammatory state.
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http://dx.doi.org/10.1002/ppul.24991DOI Listing
October 2020

Comparison of transcatheter patent ductus arteriosus closure between children and adults.

Heart Vessels 2020 Nov 3;35(11):1605-1613. Epub 2020 Jun 3.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.

The data comparing the characteristics and effect of transcatheter patent ductus arteriosus (PDA) closure between children and adults is scarce. We analyzed 54 consecutive patients who underwent transcatheter PDA closures. We divided the patients into 2 groups of < 18 years and ≥ 18 years and compared the hemodynamic changes before and after the PDA closure. Adults had a higher incidence of heart failure on admission, diagnoses by heart failure and incidental echocardiography, PDA calcifications, and procedural complications than children (all P < 0.05). The left ventricular end-diastolic volume index (LVEDVI), left atrial diameter index (LADI), and LV mass index (LVMI) decreased after the PDA closure in children but not in adults. The LV ejection fraction (LVEF) significantly decreased 1 day after the PDA closure in both groups but remained low at 6 months after the procedure in only adults. The percent change in the LVEDVI, LADI, LVMI, and LVEF from baseline to 6 months after the procedure was significantly lesser in adults than children (LVEDVI: - 5.2 ± 29.1% vs. - 34.9 ± 18.9%, LADI: - 7.0 ± 13.2% vs. - 22.1 ± 18.9%, LVMI: - 11.0 ± 16.5% vs. - 34.1 ± 15.7%, LVEF: - 5.9 ± 7.6% vs. 6.1 ± 9.1%, all P < 0.05). Transcatheter PDA closure was not associated with a reduction in the LV and LA volume as well as an improvement in the LV hypertrophy and LV function in adults as compared to children. We suggested that an early diagnosis and transcatheter PDA closure during childhood might provide clinical benefit before progressive LV remodeling and heart failure.
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http://dx.doi.org/10.1007/s00380-020-01639-4DOI Listing
November 2020

A significance of school screening electrocardiogram in the patients with ventricular noncompaction.

Heart Vessels 2020 Jul 11;35(7):985-995. Epub 2020 Mar 11.

International University of Health and Welfare, Tokyo, Japan.

Left ventricular noncompaction (LVNC) is a hereditary cardiomyopathy and is associated with high morbidity and mortality. However, the role and significance of school screening for LVNC have not been fully elucidated. In this multicenter, retrospective cohort study, a total of 105 children with LVNC were included from 2000 to 2017. At the initial presentation, 44 patients (41.9%) were diagnosed by school screening. One (1.0%) patient underwent heart transplantation and four (3.8%) patients died during the study. Electrocardiogram data showed a high prevalence of fragmented QRS (33.4%) and J wave (15.7%). Treatments were needed in eight (18.2%) patients who were detected by school screening. The multivariable proportional hazards model showed T-wave abnormality on electrocardiogram in first graders was independent risk factors for major adverse cardiac events (odds ratio 4.94, p value = 0.0007). Moreover, dilation of the left atrium on chest X-ray and low ejection fraction on echocardiogram at the initial treatment were independent risk factors for treatment (odds ratio 1.7 × 10 and 22.3, p = 0.0362 and 0.0028, respectively). This study is the first report focusing on school screening in a large pediatric cohort with LVNC. With the use of abnormalities in electrocardiogram, school screening may be a good detector of and predictor for LVNC.
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http://dx.doi.org/10.1007/s00380-020-01571-7DOI Listing
July 2020

Desmin-related myopathy characterized by non-compaction cardiomyopathy, cardiac conduction defect, and coronary artery dissection.

ESC Heart Fail 2020 06 6;7(3):1338-1343. Epub 2020 Mar 6.

Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.

Desmin-related myopathy (DRM) is a rare heritable cardiac and skeletal muscle disease caused by mutations in the desmin gene (DES). DRM is generally characterized by skeletal muscle weakness, conduction disturbance, and dilated cardiomyopathy. However, the clinical cardiac phenotypes of DRM are not yet fully understood. Herein, we report the first case of DRM with the de novo missense DES mutation, R454W, that is characterized by left ventricular non-compaction cardiomyopathy, progressive cardiac conduction defect, spontaneous coronary artery dissection, and no skeletal muscle weakness. Our case findings suggest that clinicians should genetically test patients who have cardiomyopathy, progressive cardiac conduction defect, and coronary artery dissection, even if the patient has neither family history of DRM nor skeletal muscle symptoms.
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http://dx.doi.org/10.1002/ehf2.12667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261580PMC
June 2020

Percutaneous Simple Lead Traction Is a Feasible and Effective Method for Right Ventricular Lead Perforations.

Int Heart J 2020 Jan 17;61(1):54-59. Epub 2020 Jan 17.

Department of Cardiology, Saitama Medical University International Medical Center.

Right ventricular (RV) lead perforations are relatively rare but a potentially life-threatening complication of surgical implantations of cardiac implantable electronic devices (CIEDs). The result of percutaneous simple lead traction after lead perforations in the Japanese population has not been well clarified.We retrospectively studied 1359 patients (pacemakers [PMs], 973 patients; implantable cardioverter defibrillators [ICD], 386 patients) from April 2007 to December 2018 who underwent initial CIED implantation. Fifteen patients (1.1%) were diagnosed with RV lead perforations. The clinical data were evaluated in those patients, and the baseline characteristics and echocardiographic data were compared between the lead perforation group and the non-perforation group. The success and complication rates of the simple traction and repositioning of the RV lead were also assessed.The number of perforated RV leads was seven ICD leads (1.8%) and eight PM leads (0.82%). They were diagnosed on a median seven days (5.5-36.0) after the CIED implantation. Twelve patients were asymptomatic but were detected by an increased capture threshold. Three patients had pericarditis and stimulation of the diaphragm. Only one patient in the ICD lead group who took anticoagulants had a cardiac tamponade and needed an urgent pericardiocentesis (0.07%). No one required a thoracotomy or other devices related to complications after repositioning the RV lead. There was no significant difference in the baseline characteristics and echocardiographic parameters between the groups.RV lead perforations were relatively rare complications of CIED implantations. Percutaneous simple lead traction and repositioning the perforated lead was feasible and effective if the patients did not receive anticoagulants.
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http://dx.doi.org/10.1536/ihj.19-326DOI Listing
January 2020

Successful Ablation of Atrial Tachycardia Originating from Inside the Single Atrium and Conduit After a Fontan Operation.

Int Heart J 2020 Jan 17;61(1):174-177. Epub 2020 Jan 17.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center.

An 18-year-old male who had a past medical history of an intracardiac total cavopulmonary connection (TCPC) operation was referred to our hospital for radiofrequency catheter ablation (RFCA) of supraventricular tachycardia (SVT). Two types of SVTs were induced, and 3-dimensional (3D) maps were created using an ultra-high-density 3-dimensional mapping system (Rhythmia). The earliest atrial activation site (EAAS) of SVT1 was at the superior part of the conduit, and the EAAS of SVT2 was at the inferior part of the single atrium (SA). The SVTs were terminated by energy deliveries to the EAAS from the conduit in SVT1 and from inside the single atrium in SVT2. Detailed maps of the SVTs were important to understand the mechanisms of the SVTs. The Rhythmia system was useful for the detailed mapping of complex arrhythmias. The use of Rhythmia in patients after a TCPC is difficult, because puncturing the TCPC conduit and proceeding and manipulating the Orion catheter via a narrow puncture hole are difficult. We were the first to succeed in ablating two atrial tachycardias (ATs) originating from the inside and outside of the conduit after a TCPC operation by using an ultra-high-density 3-dimensional mapping system.
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http://dx.doi.org/10.1536/ihj.19-236DOI Listing
January 2020

Ultra-high density mapping of intra-atrial reentrant tachycardia in a patient after a lateral tunnel total cavopulmonary connection.

J Arrhythm 2019 Dec 16;35(6):848-850. Epub 2019 Sep 16.

Department of Cardiology Saitama Medical University International Medical Center Saitama Japan.

We report a case of an 18-year-old male with a postsurgical lateral tunnel (LT) total cavopulmonary connection (TCPC) and supraventricular tachycardia (SVT). Patients after an LT TCPC have complicated suture lines and a considerable area of damaged myocardium in the LT, which could become a complex arrhythmogenic substrate of tachycardias. Detailed three-dimensional (3D) mapping of the LT and atrium is important for a successful ablation. In this patient, successful catheter ablation of two types of complex tachycardias was accomplished using an ultra-high density 3D mapping system inside the LT.
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http://dx.doi.org/10.1002/joa3.12238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898537PMC
December 2019

Predictors of Early Postoperative Supraventricular Tachyarrhythmias in Children After the Fontan Procedure.

Int Heart J 2019 Nov 15;60(6):1358-1365. Epub 2019 Nov 15.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center.

Postoperative arrhythmias are a frequent and fatal complication after the Fontan operation. However, clinical evidence demonstrating early postoperative arrhythmias in children undergoing the Fontan operation is limited. This study aimed to evaluate the prevalence of arrhythmias and identify the predictors of early postoperative supraventricular tachyarrhythmias (SVTs) after the Fontan procedure.Data were analyzed from 80 pediatric patients who underwent Fontan procedures between April 2000 and December 2017 in a single-center retrospective study. Early postoperative SVTs were defined as arrhythmias within 30 days after the Fontan procedure. We divided the patients into two groups, with or without early postoperative arrhythmias, and the predictors of early postoperative arrhythmias were analyzed. A multivariate logistic regression analysis was performed to determine independent predictors of early postoperative SVTs after the Fontan procedure.Early postoperative SVTs were observed in 21 patients (26.3%). The most common arrhythmia was junctional ectopic tachycardia. After an adjustment, an atrioventricular valve regurgitation (AVVR) grade of ≥2 (odds ratio 10.54, 95% confidence interval 2.52 to 44.17, P = 0.001) and preoperative arrhythmias (odds ratio 26.49, 95% confidence interval 1.64 to 428.62, P = 0.021) were significant predictors of early postoperative SVTs after the Fontan operation.An AVVR grade ≥2 and preoperative arrhythmia were significant predictors associated with early postoperative SVTs. Intervention for AVVR may provide clinical benefit for preventing early postoperative arrhythmias after the Fontan operation.
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http://dx.doi.org/10.1536/ihj.19-099DOI Listing
November 2019

Multivariate analysis of TU wave complex on electrocardiogram in Andersen-Tawil syndrome with KCNJ2 mutations.

Ann Noninvasive Electrocardiol 2020 05 14;25(3):e12721. Epub 2019 Nov 14.

Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.

Background: The exact differences between the TU wave complex of ATS1 and that of healthy individuals remain to be investigated. We sought to characterize the TU wave complex of Andersen-Tawil syndrome type 1 (ATS1) using high frequency electrocardiogram (ECG) data.

Methods: Electrocardiograms were recorded as time series data with a 2 kHz frequency ECG amplifier in 13 patients with ATS1 (positive for KCNJ2 mutation, ATS1 group) and age-matched healthy individuals (control group). Conventional ECG parameters were measured, and principal component analysis (PCA) and independent component analysis (ICA) were applied to the TU wave complex.

Results: Time from T peak (Tp) to U peak (Up), time from bottom (B) to Up, and time from B to U end (BUe, U duration) (0.232 ± 0.018 vs. 0.165 ± 0.017, p < .0001), where B is the lowest point between T and U waves, were all longer in the ATS1 group than the control group. Multivariate logistic regression analysis revealed that BUe could completely differentiate the two groups. PCA ratios in the ATS1 group were significantly larger than the control group (26.5 ± 12.3 vs. 10.4 ± 6.2, p = .0005). ICA revealed 1 or 2 U-wave-specific independent components (ICs) that exclusively comprise the U wave in ATS1, whereas U waves in the control group were composed of some ICs that also comprised T waves.

Conclusions: U-wave-related temporal parameters, particularly BUe, and the existence of U-wave-specific ICs, extracted in the ICA, are useful for differentiation of U waves in ATS1 from those in healthy individuals.
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http://dx.doi.org/10.1111/anec.12721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358888PMC
May 2020

Early assessment of cardiac troponin I predicts the postoperative cardiac status and clinical course after congenital heart disease surgery.

Heart Vessels 2020 Mar 14;35(3):417-421. Epub 2019 Sep 14.

Division of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Saitama, Japan.

Cardiac troponin I (cTnI) is a regulatory protein with a high sensitivity and specificity for cardiac injury. Preoperative and postoperative elevations of cTnI are usually considered predictors of the mortality and morbidity. However, little is known about the relationship between the cTnI and postoperative course after the congenital heart disease (CHD) operation. Sixty-five consecutive patients who underwent cardiac surgery for CHD at our institution between March 2016 and January 2017 were included. The cTnI was measured after the operation. Also, the association between the cTnI and duration of the catecholamine use, ICU stay, aortic cross clamp time, and other clinical parameters were assessed. The cTnI level on postoperative day 1 was positively correlated with the duration of the catecholamine use (p < 0.001) and ICU stay (p < 0.001). Also, a higher cTnI level was associated with a lower urine volume and higher lactate level 24 h after the ICU admission. In the multivariable regression analysis, the cTnI was a significant independent predictor of the catecholamine use (p = 0.002) and ICU stay (p = 0.003). The cTnI level on postoperative day 1 was a predictor of the duration of the catecholamine use and ICU stay.
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http://dx.doi.org/10.1007/s00380-019-01497-9DOI Listing
March 2020

Improvement in Dyssynchrony with Pharmacological Ablation of Right-Sided Accessory Pathway-Induced Cardiomyopathy in Infants.

Int Heart J 2019 Sep 4;60(5):1201-1205. Epub 2019 Sep 4.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center.

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.
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http://dx.doi.org/10.1536/ihj.18-723DOI Listing
September 2019

Relationship between the ablation index, lesion formation, and incidence of steam pops.

J Arrhythm 2019 Aug 1;35(4):636-644. Epub 2019 Jun 1.

Department of Cardiology Saitama Medical University International Medical Center Saitama Japan.

Background: The ablation index (AI) is reported to be useful for a durable pulmonary vein isolation (PVI). However, there have been no studies investigating the relationship between the power, contact force (CF), AI, and steam pops.

Methods: Using an in vitro model, ablation energy was delivered until a steam pop occurred and the time to the steam pop and AI when the steam pop occurred were measured. The experiment was performed with a combination of various powers (20, 30, 40, and 50 W) and contact forces (CFs) (10, 30, and 50 g) 20 times for each setting. The analysis consisted of two protocols. The first protocol was a comparison between the ablation power and several parameters under the same CF (10, 30, and 50 g). The second protocol was a comparison between the CF and several parameters under the same power (20, 30, 40, and 50 W). The correlation between the lesion formation and ablation parameters was evaluated.

Results: The AI value when steam pops occurred varied depending on the ablation settings. All AI median values were <500 under an ablation power of 50 W. On other hand, the median ablation time up to the steam pop was more than 46 seconds, but all median values of the AI were more than 550 under an ablation with 20 W.

Conclusions: The AI cannot predict steam pops. A low power and long duration ablation could obtain a high AI value. However, high-power ablation could not obtain a high AI value because of an early occurrence of steam pops.
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http://dx.doi.org/10.1002/joa3.12195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686293PMC
August 2019

Anomalous origin of the coronary artery coursing between the great vessels presenting with a cardiovascular event (J-CONOMALY Registry).

Eur Heart J Cardiovasc Imaging 2020 02;21(2):222-230

Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

Aims: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA.

Methods And Results: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period.

Conclusions: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted.
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http://dx.doi.org/10.1093/ehjci/jez076DOI Listing
February 2020

Usefulness of Red Blood Cell Distribution Width in the Assessment of Hemodynamics After Tetralogy of Fallot Repair.

Circ J 2019 03 23;83(4):818-823. Epub 2019 Feb 23.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center.

Background: There are no reports on the effect of red blood cell distribution width (RDW) in surgical repair of tetralogy of Fallot (ToF). Methods and Results: A total of 50 patients who underwent cardiac catheterization after surgical repair of ToF were retrospectively assessed. RDW was positively correlated with the ratio of right ventricular pressure to left ventricular pressure (RVP/LVP; P<0.0001, r=0.57). Patients with elevated RDW had a higher RVP/LVP than those with a normal RDW (P<0.0001). Also, elevated RDW was related to elevated central venous pressure (P<0.0001), decreased mixed venous oxygen saturation (P<0.0001), greater pulmonary stenosis (P=0.003) and severe pulmonary regurgitation on echocardiography (P<0.0001), a higher rate of residual ventricular septal defect leak (P=0.004) and higher reoperation rate (P=0.009). Of the 7 patients who underwent reoperation, 6 had decrease in RDW after reoperation (P=0.012). On multivariable regression analysis, RDW was the strongest indicator of higher RVP/LVP.

Conclusions: For the first time, RDW has been shown to be a strong indicator for assessing the hemodynamics and risk of later reoperation after surgical repair of ToF.
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http://dx.doi.org/10.1253/circj.CJ-18-1016DOI Listing
March 2019

Successful radiofrequency catheter ablation of life-threatening atrial tachycardia in an infant with asplenia syndrome.

J Cardiol Cases 2019 Jan 14;19(1):1-4. Epub 2018 Sep 14.

Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.

A 1-year-old infant with asplenia syndrome and congenital heart disease consisting of common atrium, common inlet left ventricle with a common atrio-ventricular (AV) valve, pulmonary atresia, and total anomalous pulmonary venous connection was admitted to our hospital for radiofrequency catheter ablation (RFCA) of supraventricular tachycardia (SVT) before total cavo-pulmonary connection. After antiarrhythmic medications were discontinued for RFCA, she suffered from SVT that resulted in the rapid deterioration of hemodynamic status. Antiarrhythmic medications and cardioversion were not effective in terminating SVT. The baseline electrocardiogram confirmed the existence of twin AV nodes; however, this SVT was revealed to be focal atrial tachycardia (AT) with enhanced automaticity. The origin of AT was not related to surgical scar. Emergent RFCA for AT was successful in our case of asplenia syndrome. AT is a life-threatening complication in a single ventricle and delayed treatment can be fatal. It is important to perform RFCA promptly when drug treatment is not effective. We suggest that the AV node is not always the target site for ablation in patients with asplenia syndrome and twin AV nodes. < In the case of supraventricular tachycardia with asplenia and twin atrio-ventricular (AV) nodes, atrial tachycardia (AT) as well as AV reentrant tachycardia could occur. AT is a life-threatening complication in infants with single ventricle. If drug therapy is not effective, emergent catheter ablation should be performed. AV node is not always the target site for ablation in patients with asplenia and twin AV nodes.>.
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http://dx.doi.org/10.1016/j.jccase.2018.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342611PMC
January 2019

The necessity of implantable cardioverter defibrillators in patients with Kearns-Sayre syndrome - systematic review of the articles.

Int J Cardiol 2019 Mar 27;279:105-111. Epub 2018 Dec 27.

Department of Pathophysiology, Oita University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

The most common cardiac feature of Kearns-Sayre syndrome (KSS) is atrioventricular block (AVB), and pacemaker implantations (PMIs) are recommended for KSS patients with advanced AVB. However, some KSS patients develop fatal arrhythmias such as polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) and die suddenly even after PMIs. We report a patient with KSS who developed PMVT, VF, and QT prolongation, and was treated with mexiletine and successfully managed with an implantable cardioverter defibrillator (ICD). We reviewed the literature on arrhythmias in KSS published from 1975 to 2018. There were 112 patients with arrhythmia-associated KSS, 10 died, and 6 died suddenly after the PMI. The first manifestation of an arrhythmia was bundle branch block, then it progressed to AVB, and developed into complete AVB (CAVB) in about half the KSS patients. Ventricular arrhythmias were documented in 12 patients, and 8 were implanted with defibrillators afterwards. One patient after the implantation of a cardiac resynchronization therapy defibrillator (CRT-D) was treated for VF by an appropriate shock. This fact suggested that VF occurred even under proper pacing, and that defibrillators were effective. Pacemakers may suppress early afterdepolarizations (EADs) associated with a QT prolongation due to bradycardia. Similarly, mexiletine may suppress EADs by blocking the late sodium and Ca currents. Ventricular arrhythmias observed under suppression of EADs may be caused by delayed afterdepolarization (DADs) via an increasing intracellular Ca concentration due to mitochondrial dysfunction. Therefore, a PMI alone may not be sufficient to prevent sudden death, and an ICD implantation should be necessary.
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http://dx.doi.org/10.1016/j.ijcard.2018.12.064DOI Listing
March 2019

Successful demonstration of the detailed connection between the twin atrioventricular nodes and sling in a patient with asplenia syndrome.

HeartRhythm Case Rep 2018 Oct 17;4(10):480-483. Epub 2018 Jul 17.

Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1016/j.hrcr.2018.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197405PMC
October 2018

Congenital multiple pulmonary vein atresia and stenosis in an infant.

Pediatr Int 2018 Oct;60(10):976-978

Department of Pathology, Nihon University School of Medicine, Tokyo, Japan.

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http://dx.doi.org/10.1111/ped.13664DOI Listing
October 2018

Safety and accuracy of the Rhythmia mapping system in pediatric patients.

Heart Rhythm 2019 03 9;16(3):388-394. Epub 2018 Oct 9.

Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.

Background: A new mapping system (Rhythmia) using a 64 mini-electrode small basket array (Orion) was developed that enables rapid high-density mapping in a short time. However, there are few reports about the usefulness of this system in pediatric cases.

Objective: The purpose of this study was to investigate the safety and accuracy of the Rhythmia system and Orion catheter in children.

Methods: Catheter ablation was performed using the Rhythmia system and Orion catheter in 23 patients younger than 20 years (body weight >20 kg) without a past medical history of cardiac disease. Mapping time, number of mapping beats, and number of mapping electrodes were compared for left atrium, right atrium and right ventricular outflow tract.

Results: Twenty-three maps of the right atrium were acquired in 12.6 minutes (range 8.9-15.1), consisting of 709 beats (range 492-1163) and 7132 electrograms (range 4618-10,533). Twelve maps of the left atrium were acquired in 12.1 minutes (range 9.8-14.6), consisting of 565 beats (range 446-881) and 6412 electrograms (range 4912-11,402). There were no significant difference in mapping time, accepted beats, and electrograms between the 2 chambers. Manual annotation was needed in 53 of 293,185 electrograms (0.01%) due to far-field ventricular electrogram sensing and artifact. No adverse events occurred in any of the cases.

Conclusion: The Orion catheter and Rhythmia mapping system were safe and accurate for mapping various arrhythmias in pediatric patients. Detailed geometry and high-resolution activation mapping were acquired without the need for manual reannotation.
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http://dx.doi.org/10.1016/j.hrthm.2018.10.002DOI Listing
March 2019