Publications by authors named "Rintaro Hojo"

56 Publications

Cardiac perforation due to a fracture of a recalled Accufix bipolar active fixation pacing lead 29 years after implantation: A case report.

J Cardiovasc Electrophysiol 2021 May 8;32(5):1461-1463. Epub 2021 Apr 8.

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

The Accufix bipolar active fixation atrial pacing lead (Model 330-801; Telectronics) can have mechanical complications due to a fracture of its J retention wire. An 80-year-old man had the Accufix atrial pacing lead implanted 29 years prior, and surgical removal was required because a part of the lead was perforating the apex of the right ventricle. Regular follow-up examinations are recommended to eliminate the possibility of protrusion and detachment of the J retention wire, even if the clinical course after implantation is stable for a prolonged period.
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http://dx.doi.org/10.1111/jce.15024DOI Listing
May 2021

The effect of posterior wall isolation for persistent atrial fibrillation on recurrent arrhythmia.

J Cardiovasc Electrophysiol 2021 Mar 2;32(3):597-604. Epub 2021 Feb 2.

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

Introduction: It is important to consider recurrent arrhythmia after catheter ablation for persistent atrial fibrillation (AF) for planning an ablation strategy. However, the studies are limited to pulmonary vein isolation (PVI) plus posterior wall isolation (PWI), which were reported to improve procedural outcomes. The objective of this study is to evaluate the effect of PWI on recurrent arrhythmia.

Methods: This is an observational study on patients with persistent AF comparing PVI plus PWI and PVI only strategies. In PVI plus PWI group, linear ablation of the left atrium roofline and bottom line were performed to achieve PWI after PVI. Some patients with AF recurrence underwent the second procedure. The presence of recurrent arrhythmia and results of the second procedures were evaluated.

Results: A total of 181 patients (mean age, 66.9 ± 10.2 years; male, 76.8%) were included. PVI plus PWI group and PVI only group consisted of 90 and 91 patients, respectively. AF recurrence was observed in 28 of 90 (31.1%) patients with PVI plus PWI and in 43 of 91 (47.3%) with PVI only, and log-rank test did not show any significant difference (p = .35). The occurrence of recurrent persistent AF was significantly lower in PVI plus PWI group than in PVI only group (5/90; 5.6% vs. 18/91; 20.9%, p = .002). There was no significant difference between the two groups in recurrent paroxysmal AF and atrial tachycardia (AT).

Conclusion: PWI, in addition to PVI, for persistent AF was significantly related to fewer episodes of recurrent persistent AF, and it did not increase recurrent AT.
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http://dx.doi.org/10.1111/jce.14906DOI Listing
March 2021

A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report.

Eur Heart J Case Rep 2020 Oct 9;4(5):1-4. Epub 2020 Sep 9.

Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.

Background: Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this procedure. Therefore, in cases where the right atrium (RA)-SVC conduction site is near the PN, tremendous care is required to prevent PN injury.

Case Summary: Repeated SVC isolation was performed due to the recurrence of SVC-triggered AF. The RA-SVC activation map revealed that the partial conduction block line was detected, and the propagation broke through the gap at the course of the PN site from the RA to the SVC. Since the course of the PN identified at high-output pacing was wide, the SVC was isolated by making longitudinal lines on both sides of the PN in a cranial direction, except for where low-output pacing captured, confirming compound muscle action potential to detect PN injury. Eventually, the SVC was successfully isolated without PN injury, and the sinus rhythm was maintained without antiarrhythmic drugs during a 14-month follow-up period.

Conclusion: Superior vena cava isolation was difficult depending on the course of the PN, and some methods to avoid PN injury were reported. However, this method can facilitate safe and effective SVC isolation with the conventional system, including the cases with AF foci located on the course of the PN.
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http://dx.doi.org/10.1093/ehjcr/ytaa312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780490PMC
October 2020

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

JACC Clin Electrophysiol 2020 12 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 coronary artery calcium score correlates with left atrial low-voltage area: Sex differences.

J Cardiovasc Electrophysiol 2021 Jan 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

One-point posterior ablation for complete isolation of the posterior left atrium.

HeartRhythm Case Rep 2020 Oct 14;6(10):738-740. Epub 2020 Jul 14.

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

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http://dx.doi.org/10.1016/j.hrcr.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573377PMC
October 2020

Novel mapping algorithm during catheter ablation for ventricular parasystole originating from left anterior fascicle.

J Arrhythm 2020 Aug 6;36(4):777-779. Epub 2020 Jul 6.

Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.

A 17-year-old woman presented with frequent palpitations and shortness of breath and was diagnosed with drug-refractory ventricular parasystole. We predicted that the parasystole originated from the left anterior fascicle (LAF). Detailed activation maps of both conduction systems, including the LAF, during sinus rhythm and ventricular parasystole were obtained using a parallel mapping system. We confirmed the earliest fascicular potential of the parasystole and performed catheter ablation with no complications. This novel mapping algorithm for simultaneous acquisition of multiple maps aided effective treatment of ventricular parasystole originating from the LAF.
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http://dx.doi.org/10.1002/joa3.12400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411214PMC
August 2020

Delayed bleeding complication due to internal mammary artery injury after ultrasound-guided percutaneous catheter drainage for liver cyst infection.

Acute Med Surg 2020 Jan-Dec;7(1):e512. Epub 2020 Jun 9.

Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.

Background: Ultrasound-guided percutaneous catheter drainage (PCD) is widely accepted as a primary treatment for pyogenic liver abscess. Severe PCD-related complications have been reported; however, delayed bleeding complications due to internal mammary artery injury are unknown.

Case Presentation: An 84-year-old man undergoing hemodialysis owing to chronic kidney disease due to focal segmental glomerulosclerosis was admitted to our hospital for liver cyst infection. Ultrasound-guided PCD was carried out through the normal liver at the upper abdominal midline at the level of the sixth intercostal space. Two days later, an abdominal hematoma occurred at the puncture site. Contrast-enhanced computed tomography revealed extravasation of the distal right internal mammary artery, which was successfully treated with percutaneous coil embolization.

Conclusion: Internal mammary artery injury should be considered as a differential diagnosis when a progressing hematoma develops after PCD.
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http://dx.doi.org/10.1002/ams2.512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283991PMC
June 2020

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

Bipolar radiofrequency catheter ablation between the left ventricular endocardium and great cardiac vein for refractory ventricular premature complexes originating from the left ventricular summit.

J Arrhythm 2020 Apr 14;36(2):363-366. Epub 2020 Feb 14.

Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.

Ablation for ventricular arrhythmias originating from the left ventricular (LV) summit is sometimes challenging. Bipolar radiofrequency catheter ablation (RFCA) is effective for refractory arrhythmias; little is known about bipolar RFCA from the coronary venous system and the appropriate settings. We experienced three cases of ventricular premature complexes (VPCs) originating from the LV summit successfully treated by bipolar RFCA between the LV endocardium (irrigated catheters as active electrodes) and coronary venous system (8-mm-tip catheters as return electrodes). These cases showed that bipolar RFCA was effective for the VPCs originating from the LV summit; 8-mm-tip catheters were useful as return electrodes.
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http://dx.doi.org/10.1002/joa3.12312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132175PMC
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

Patient characteristics and in-hospital complications of subcutaneous implantable cardioverter-defibrillator for Brugada syndrome in Japan.

J Arrhythm 2019 Dec 16;35(6):842-847. Epub 2019 Sep 16.

Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan.

Background: Clinical features and complications of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation for Brugada syndrome have not been well studied.

Methods: We used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in-hospital complications of patients with Brugada syndrome implanted with S-ICD or transvenous (TV)-ICD.

Results: We extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 ± 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S-ICD and 142 (51%) received TV-ICD. TV-ICD recipients had a history of atrial fibrillation more frequently compared with S-ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S-ICD and TV-ICD (13 days [10-20.5] vs 12 days [10-18], respectively). The prevalence of in-hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group.

Conclusions: Short-term safety of S-ICD implantation may be identical to that of TV-ICD. Large prospective studies are warranted to compare the effects and long-term safety of S-ICD compared with TV-ICD.
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http://dx.doi.org/10.1002/joa3.12234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898525PMC
December 2019

Elongated xiphoid process misleading the pericardiocentesis site.

Europace 2020 04;22(4):583

Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2 - 34 -10 Ebisu, Shibuya-ku, Tokyo, Japan.

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http://dx.doi.org/10.1093/europace/euz279DOI Listing
April 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

Multiple peritricuspidal reentry tachycardias after cardiac infiltration by leukaemia: a case report.

Eur Heart J Case Rep 2019 Jun;3(2)

Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.

Background: Cardiac involvement by malignant lymphocytic neoplasms is a rare phenomenon. Little is known concerning cardiotoxicity in the chronic phase after completion of treatment.

Case Summary: A 50-year-old woman with a past history of cardiac involvement of acute lymphoblastic leukaemia (ALL) underwent electrophysiologic study and catheter ablation for symptomatic atrial tachycardia (AT). She was diagnosed with ALL when she was 8 years old and treated with systematic chemotherapy with prednisolone and vincristine. After complete remission, she suffered from repeated palpitations beginning at the age of 16 years. Electrophysiologic study using high-density (HD) mapping showed two types of peritricuspid AT in addition to low voltage in the right atrium with conduction delay.

Discussion: Cardiac involvement by malignant lymphocytic neoplasms is a rare phenomenon, and cardiac infiltration often disappears after remission of ALL. Thus, little is known about cardiac electrophysiological characteristics in the chronic phase of complete remission of ALL. We describe a rare case of a patient with multiple peritricuspidal reentry tachycardias after cardiac infiltration by leukaemia using a HD mapping system.
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http://dx.doi.org/10.1093/ehjcr/ytz046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601183PMC
June 2019

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

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.

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

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

Sex-Dependent Phenotypic Variability of an SCN5A Mutation: Brugada Syndrome and Sick Sinus Syndrome.

J Am Heart Assoc 2018 09;7(18):e009387

1 Keio University Hospital Tokyo Japan.

Background Brugada syndrome ( BS ) is known to be 9 times more prevalent in males than females. However, little is known about the development of sick sinus syndrome in female members with familial BS . Methods and Results Familial BS patients and family members, both from our institutions and collaborating sites that specialize in clinical care of BS , participated in this study. We collected information on their clinical and genetic background, along with the inheritance patterns of BS . Detailed information on each case with familial BS is described. A total of 7 families, including 25 BS patients (12 females and 13 males), were included. Seven were probands and 18 were family members. Ten out of the 12 female patients and none of the 13 male patients developed sick sinus syndrome. Sudden death or spontaneous ventricular fibrillation occurred in 7 out of 13 male patients and 2 out of 12 female patients. Conclusions Familial BS existed in which female patients developed sick sinus syndrome but male patients did not. Some of those female patients with sick sinus syndrome had unrecognized BS . Information should be collected not only regarding a family history of sudden death or BS , but also whether a pacemaker was implanted in female members.
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http://dx.doi.org/10.1161/JAHA.118.009387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222934PMC
September 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.

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http://dx.doi.org/10.1016/j.hrcr.2018.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197557PMC
October 2018

Macroreentrant atrial tachycardia detouring the epicardium at the anterior wall of the left atrium.

J Cardiovasc Electrophysiol 2019 02 2;30(2):263-264. Epub 2018 Nov 2.

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

A 79-year-old woman with a history of pulmonary vein isolation for persistent atrial fibrillation was admitted for recurrence of atrial tachycardia, with a tachycardia cycle length of 236 milliseconds. The ultra-high-resolution mapping system revealed that tachycardia circuit detouring the epicardium at the anterior wall scar and breaking through to the endocardium below the left atrial appendage. Radiofrequency energy was applied to this site, which successfully terminated the tachycardia. This case suggests that epicardial conduction could occur even at the left atrial anterior wall and identifies a variation in epicardial conduction around the left atrium, which could be a tachycardia circuit.
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http://dx.doi.org/10.1111/jce.13766DOI Listing
February 2019

High-resolution 3D mapping of epicardial conduction during Marshall bundle-related atrial tachycardia.

J Arrhythm 2018 Jun 30;34(3):298-301. Epub 2018 Apr 30.

Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.

A 73-year-old woman was admitted for atrial tachycardia (AT) ablation. The activation map and pacing study indicated that the AT propagated around the left pulmonary vein and that the Marshall bundle (MB) bypassed the scar area of the left pulmonary vein ridge and mitral isthmus. The Rhythmia Mapping System revealed double potentials propagated along the assumed position of the MB. The mapping system includes a confidence mask that can be used to visually identify low-confidence areas of the map based upon extremely low-voltage signals. Given the low-voltage area in the endocardial side, the epicardial conduction was emphasized.
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http://dx.doi.org/10.1002/joa3.12067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009767PMC
June 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