Publications by authors named "Seiji Fukamizu"

96 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 Mar 30. Epub 2021 Mar 30.

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
March 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

Safety and effectiveness of intracardiac echocardiography in ventricular tachycardia ablation: a nationwide observational study.

Heart Vessels 2021 Jan 21. Epub 2021 Jan 21.

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

Intracardiac echocardiography (ICE) utilized in conjunction with three-dimensional (3-D) mapping systems could enhance ventricular tachycardia (VT) ablation procedures. ICE has been increasingly used in VT ablation; however, the safety and effectiveness of VT ablation under the combined use of ICE remains unclear. The present study aimed to analyze the safety and short-term effects of VT ablation with or without ICE. We retrospectively enrolled patients who underwent initial VT ablation with a combination of ICE and a 3-D mapping system within 3 days of hospitalization and discharged from April 2011 to March 2017 using a nationwide Japanese inpatient database. Following enrollment, we conducted a propensity score-matching analysis to compare safety (in-hospital complications) and effectiveness (readmission within 30 days after discharge due to cardiovascular disease and readmissions within 30 days for repeat VT ablations) between patients who underwent VT ablation with (ICE group) and without ICE (non-ICE group). 3-D mapping systems were applied to both groups. We identified 5,804 eligible patients (1,272 and 4,532 patients in the ICE and non-ICE groups, respectively). One-to-one propensity score matching created a total of 1,147 pairs between the ICE and non-ICE groups. The ICE group showed a significantly lower prevalence of cardiac tamponade than the non-ICE group. There were no significant differences observed between the two groups regarding other outcomes concerning safety and effectiveness. Ventricular tachycardia ablation with ICE used in combination with a 3-D mapping system may reduce cardiac tamponade; however, no additional clinical advantages were noted in terms of safety and effectiveness.
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http://dx.doi.org/10.1007/s00380-020-01766-yDOI Listing
January 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

Statement for electrophysiological procedures under the COVID-19 pandemic from the Japanese heart rhythm society task force.

J Arrhythm 2020 Dec 7;36(6):1117-1121. Epub 2020 Sep 7.

Department of Cardiology Faculty of Medicine University of Tsukuba Tsukuba Japan.

COVID-19 is a global catastrophe with markedly reduced health and economy of human civilization. Heart rhythm disorder has also been impacted by this disease. This statement is the universal criteria for EP procedures in the new era, which we will face during COVID-19 pandemic. We described the methods of triage based on the severity of disease, the regional state of pandemic and supply of medical resources. This guidance will be the universal criteria for EP procedures in the new era, which we will face during and after the COVID-19 pandemic.
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http://dx.doi.org/10.1002/joa3.12419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733557PMC
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

Patient characteristics, procedure details including catheter devices, and complications of catheter ablation for ventricular tachycardia: a nationwide observational study.

J Arrhythm 2020 Jun 5;36(3):464-470. Epub 2020 May 5.

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

Background: Nationwide data are insufficient with respect to the characteristics of patients undergoing ventricular tachycardia (VT) ablation, complications of VT ablation, and procedure details including catheter devices used during VT ablation. The present study was performed to describe the patient characteristics, procedure details including catheter devices, and in-hospital complications of catheter ablation for VT using a national inpatient database.

Methods: We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent VT ablation from July 2010 to March 2017. We examined patients' age, gender, baseline diseases, comorbid conditions, admission status, catheter devices and drugs used, and in-hospital complications of VT ablation.

Results: We identified 10 641 patients (median age, 61 years) who underwent VT ablation. The most frequently observed background heart disease among patients with structural heart disease was ischemic cardiomyopathy. An irrigated ablation catheter was used in 73% of patients, a force-sensing ablation catheter was used in 22%, and intracardiac echocardiography was used in 25%. The frequency of using these procedures continuously increased over time. Overall, the prevalence of in-hospital complications was 3.5% (cardiac tamponade, 0.8%; stroke, 0.6%; critical bleeding, 1.9%; mechanical circulatory support, 0.9%; and in-hospital death, 0.8%).

Conclusions: The results of this study show the clinical features of VT ablation in a real-world clinical setting. The use of irrigated catheters, force-sensing catheters, and intracardiac echocardiography increased over time. The prevalence of in-hospital complications was 3.5%.
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http://dx.doi.org/10.1002/joa3.12356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279962PMC
June 2020

Permanent pacemaker implantation and its predictors in patients admitted for complete atrioventricular block: a report from the Tokyo Cardiovascular Care Unit Network multi-center registry.

Heart Vessels 2020 Nov 4;35(11):1573-1582. Epub 2020 Jun 4.

Tokyo CCU Network Scientific Committee, Tokyo, Japan.

Little is known about the permanent pacemaker implantation rate and predictors of permanent pacemaker implantation in patients admitted for complete atrioventricular block (cAVB). The present study was a retrospective analysis based on a multicenter cohort of 797 patients with cAVB (mean age: 79.6 ± 10.7 years; males: 48.4%) registered with the Tokyo Cardiovascular Care Unit Network multicenter registry between 2013 and 2016. Secondary cAVB due to acute coronary syndrome was excluded. The permanent pacemaker implantation rate was 82.9%. Multivariable logistic regression analysis revealed that systolic blood pressure (SBP) > 140 mmHg [odds ratio (OR) 2.10; 95% confidence interval (CI) 1.38-3.22; P < 0.001], male gender (OR 1.63; 95% CI 1.07-2.49; P = 0.023), and left ventricular ejection fraction (LVEF) ≥ 50% (OR 2.19; 95% CI 1.16-2.06; P = 0.016) were predictors of permanent pacemaker implantation while pre-admission β-blocker use (OR 0.28; 95% CI 0.17-0.47; P < 0.001) was associated with a lower risk of permanent pacemaker implantation. Reversible cAVB was not rare in patients admitted for cAVB. Data on SBP on admission, gender, LVEF, and pre-admission β-blocker use may be important for assessing the requirement for permanent pacemaker implantation in the emergency care setting.
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http://dx.doi.org/10.1007/s00380-020-01642-9DOI Listing
November 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

Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin.

Heart Rhythm 2020 09 28;17(9):1500-1507. Epub 2020 Apr 28.

Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.

Background: Successful bipolar radiofrequency catheter ablation (RFCA) of refractory ventricular arrhythmias (VAs) has been reported. However, the efficacy, safety, and long-term outcomes of bipolar RFCA of VAs are not fully determined.

Objective: The purpose of this study was to evaluate the effectiveness and safety of bipolar RFCA in treating refractory VAs during long-term follow-up.

Methods: Eighteen patients who underwent bipolar RFCA for ventricular tachycardia (VT) at 7 institutions were retrospectively investigated. Underlying heart diseases included remote myocardial infarction (n = 3 [17%]) and nonischemic cardiomyopathy (n = 15 [83%]). Although unipolar RFCA was performed in all patients, either it failed to suppress VT or VT recurred. The interventricular septum, left ventricular free wall, and left ventricular summit were targeted for bipolar RFCA.

Results: Acute success (VT termination and/or noninducibility) was achieved with bipolar RFCA in 16 patients (89%). Complications during the procedure included complete atrioventricular block (n = 2) and coronary artery stenosis (n = 1). One patient underwent chemical ablation after bipolar RFCA failure. At 12-month follow-up, VT reoccurred in 8 patients (44%). However, in patients with recurrence, VT burden had decreased: only 4 patients underwent re-RFCA, and only 1 of the 4 required chemical ablation. In the remaining 4 patients, re-RFCA was not required, as VT was controlled by medication or an implantable cardioverter-defibrillator.

Conclusion: Bipolar RFCA is useful for acute suppression of refractory VT. Although VT recurrence rates during long-term follow-up were relatively high, we observed a significant reduction in VT burden.
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http://dx.doi.org/10.1016/j.hrthm.2020.04.028DOI Listing
September 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

Response to letter to the editor.

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

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

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

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

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

Tokyo Medical and Dental University Tokyo Japan.

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

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

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

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

Conduction slowing area during sinus rhythm harbors ventricular tachycardia isthmus.

J Cardiovasc Electrophysiol 2020 02 20;31(2):440-449. Epub 2020 Jan 20.

Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan.

Introduction: The voltage map during sinus rhythm (SR) is a cornerstone of substrate mapping (SM) in scar-related ventricular tachycardia (VT) and frequently used with pace mapping (PM). Where to conduct PM is unclear in cases of an extensive or unidentified substrate. Conduction properties are another aspect incorporated by SM, and conduction slowing has gained interest as being related to successful ablation, although its mechanism has not been elucidated. We aimed to investigate the relationship between SR conduction properties and VT isthmuses.

Methods: Nineteen patients (mean age, 62 years) who underwent VT ablation with voltage mapping and PM were reviewed. Isochronal late activation maps (ILAMs) with eight zones were reconstructed and sequentially named from one to eight according to the SR propagation. Good PM sites were superimposed on ILAMs, and the isthmus was defined using different pacing latencies. ILAM properties harboring isthmuses were investigated.

Results: Twenty-eight ILAMs (13 epicardium, 1 right ventricular [RV], and 14 left ventricular [LV] endocardium) were reviewed. Eighteen isthmuses of 24 target VTs were identified, in which the proximal ends were in a later zone than the distal ends (zone 6 vs 4; P < .001), suggesting a reverse isthmus vector to the SR. The conduction velocity of the zone involving the distal isthmus was significantly lower than that of the SR preceding zone (0.40 vs 1.30 m/s; P < .001). SR conduction velocity decelerated by 69.5% (range 59.7%-74.5%) before propagating into the isthmus area.

Conclusion: Conduction slowing area during SR were related with the exit portion of the VT isthmuses.
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http://dx.doi.org/10.1111/jce.14339DOI Listing
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

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

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

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

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

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

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 Cardiovascular Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, 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

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

Catheter Ablation of Refractory Ventricular Fibrillation Storm After Myocardial Infarction.

Circulation 2019 05;139(20):2315-2325

Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.A., M.I.).

Background: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population.

Methods: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and long-term mortalities, respectively.

Results: One hundred ten patients were enrolled (age, 65±11years; 92 men; left ventricular ejection fraction, 31±10%). VF storm occurred at the acute phase of MI (4.5±2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (>1 week) in 48 (44%), and the remote phase (>6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [95% CI, 1.03-1.20]; P=0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction <30% (hazard ratio, 2.54 [95% CI, 1.21-5.32]; P=0.014), New York Heart Association class ≥III (hazard ratio, 2.68 [95% CI, 1.16-6.19]; P=0.021), a history of atrial fibrillation (hazard ratio, 3.89 [95% CI, 1.42-10.67]; P=0.008), and chronic kidney disease (hazard ratio, 2.74 [95% CI, 1.15-6.49]; P=0.023).

Conclusions: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short- and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.037997DOI Listing
May 2019