133 results on '"Kenichiro Yamagata"'
Search Results
2. Explainable localization of premature ventricular contraction using deep learning‐based semantic segmentation of 12‐lead electrocardiogram
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Kota Kujime, Hiroshi Seno, Kenzaburo Nakajima, Masatoshi Yamazaki, Ichiro Sakuma, Kenichiro Yamagata, Kengo Kusano, and Naoki Tomii
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automatic ECG diagnosis ,deep neural network ,premature ventricular contraction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Predicting the origin of premature ventricular contraction (PVC) from the preoperative electrocardiogram (ECG) is important for catheter ablation therapies. We propose an explainable method that localizes PVC origin based on the semantic segmentation result of a 12‐lead ECG using a deep neural network, considering suitable diagnosis support for clinical application. Methods The deep learning‐based semantic segmentation model was trained using 265 12‐lead ECG recordings from 84 patients with frequent PVCs. The model classified each ECG sampling time into four categories: background (BG), sinus rhythm (SR), PVC originating from the left ventricular outflow tract (PVC‐L), and PVC originating from the right ventricular outflow tract (PVC‐R). Based on the ECG segmentation results, a rule‐based algorithm classified ECG recordings into three categories: PVC‐L, PVC‐R, as well as Neutral, which is a group for the recordings requiring the physician's careful assessment before separating them into PVC‐L and PVC‐R. The proposed method was evaluated with a public dataset which was used in previous research. Results The evaluation of the proposed method achieved neutral rate, accuracy, sensitivity, specificity, F1‐score, and area under the curve of 0.098, 0.932, 0.963, 0.882, 0.945, and 0.852 on a private dataset, and 0.284, 0.916, 0.912, 0.930, 0.943, and 0.848 on a public dataset, respectively. These quantitative results indicated that the proposed method outperformed almost all previous studies, although a significant number of recordings resulted in requiring the physician's assessment. Conclusions The feasibility of explainable localization of premature ventricular contraction was demonstrated using deep learning‐based semantic segmentation of 12‐lead ECG. Clinical trial registration: M26‐148‐8.
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- 2024
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3. Syncope Due to Iatrogenic Cava Vein Obstruction
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Keiko Shimamoto, MD, PhD, Kenichiro Yamagata, MD, PhD, Hiroki Horinouchi, MD, PhD, and Kengo Kusano, MD, PhD
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calcification ,collateral circulation ,dialysis ,pacemaker ,superior vena cava obstruction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 77-year-old female patient with multiple pacemaker leads experienced hypotension and syncope during right heart catheterization. Imaging studies revealed a stenotic inferior vena cava with superior vena cava obstruction and well-developed retrograde collateral vessels, suggesting that balloon obstruction of the sole venous return site caused low cardiac output leading to syncope.
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- 2024
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4. Interference of cardiac implantable electronic devices and computed tomography imaging in the current era with a phantom model
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Akihito Ideishi, Kenichiro Yamagata, Tatsuya Nishii, Hideto Miyanooi, Yuichiro Miyazaki, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Kenzaburo Nakajima, Mitsuru Wada, Tsukasa Kamakura, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Takashi Noda, Satoshi Nagase, Takeshi Aiba, and Kengo Kusano
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cardiac implantable electronic device ,computed tomography ,oversensing ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Introduction Cardiac implantable electronic devices are used in patients with cardiac rhythm disorders. Computed tomography irradiation is not prohibited for patients with cardiac implantable electronic devices, despite adverse events being reported. Hence, appropriate preparation and knowledge are required before computed tomography irradiation can be carried out in these patients. Since there is limited knowledge or literature about the influence of computed tomography irradiation in cases with recent cardiac implantable electronic devices, we aimed to evaluate the adverse events and elucidate the necessary and sufficient safety measures associated with this therapy. Methods and Results We placed cardiac implantable electronic devices on an anthropomorphic phantom model and observed their electrical activity in electrograms, while various protocols of computed tomography irradiation were implemented and adverse events evaluated. Oversensing with pauses of up to 3.2 s was observed in standard computed tomography protocols, but ventricular tachyarrhythmia or other clinically significant events could not be confirmed. Oversensing with pauses of up to 8.0 s was observed and ventricular tachyarrhythmia was detected in the maximum‐dose protocols. However, treatments such as antitachycardia pacing or shock therapy for ventricular tachyarrhythmia were not observed because of their absence. Conclusion Computed tomography irradiation for patients using cardiac implantable electronic devices is highly unlikely to cause clinically significant adverse events with the device settings and computed tomography protocols currently being used. Changing or monitoring the device settings routinely before computed tomography irradiation is not necessarily required for most patients.
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- 2023
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5. Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope
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Reina Tonegawa-Kuji, MD, PhD, Yuko Y. Inoue, MD, PhD, Michikazu Nakai, PhD, Koshiro Kanaoka, MD, PhD, Yoko Sumita, Yuichiro Miyazaki, MD, Akinori Wakamiya, MD, PhD, Keiko Shimamoto, MD, PhD, Nobuhiko Ueda, MD, PhD, Kenzaburo Nakajima, MD, PhD, Naoya Kataoka, MD, PhD, Mitsuru Wada, MD, Kenichiro Yamagata, MD, PhD, Kohei Ishibashi, MD, PhD, Koji Miyamoto, MD, PhD, Satoshi Nagase, MD, PhD, Takeshi Aiba, MD, PhD, Yoshihiro Miyamoto, MD, PhD, Yoshitaka Iwanaga, MD, PhD, and Kengo Kusano, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Implantable cardiac monitors (ICMs) help investigate the cause of unexplained syncope, but the probability and predictors of needing a pacing device thereafter remain unclear. Methods: We retrospectively analyzed the data of patients who received ICM insertion for unexplained syncope with suspected arrhythmic etiology. The data were obtained from a nationwide database obtained between April 1, 2012 and March 31, 2020. Multivariable mixed-effects survival analysis was performed to identify predictors of pacing device implantation (PDI), and a risk score model was developed accordingly. Results: In total, 2905 patients (age: 72 years [range: 60-78]) implanted with ICMs to investigate the cause of syncope were analyzed. During the median follow-up period of 128 days (range: 68–209) days, 473 patients (16%) underwent PDI. Older age, history of atrial fibrillation, bundle branch block (BBB), and diabetes were independent predictors of PDI in multivariable analysis. A risk score model was developed with scores ranging from 0 to 32 points. When patients with the lowest quartile score (0–13 points) were used as a reference, those with higher quartiles had a higher risk of PDI (second quartile: 14–15 points, hazard ratio [HR]: 3.86, 95% confidence interval [CI]: 2.62–5.68; third quartile: 16–18 points, HR: 4.67, 95% CI: 3.14–6.94; fourth quartile: 19–32 points, HR: 6.59, 95% CI: 4.47–9.71). Conclusions: The 4 identified predictors are easily assessed during the initial evaluation of patients with syncope. They may help identify patients with a higher risk of requiring permanent PDI. Résumé: Contexte: Les moniteurs cardiaques implantables (MCI) aident à déterminer la cause d’une syncope inexpliquée, mais la probabilité et les facteurs prédictifs du besoin d’un dispositif de stimulation cardiaque par la suite demeurent incertains. Méthodologie: Nous avons analysé de façon rétrospective les données de patients s’étant fait implanter un MCI après une syncope inexpliquée et chez lesquels une étiologie d’arythmie était soupçonnée. Les données proviennent d’une base de données nationale et s’étendent du 1er avril 2012 au 31 mars 2020. Une analyse de survie multivariable à effets mixtes a été effectuée pour cibler les facteurs prédictifs de l’implantation d’un dispositif de stimulation cardiaque (IDSC), et un modèle de score de risque a été conçu en conséquence. Résultats: Au total, les cas de 2905 patients (âge : 72 ans [écart interquartile (ÉI) : 60-78]) ayant reçu un MCI pour déterminer la cause de la syncope ont été analysés. Durant la période de suivi médiane de 128 jours (ÉI : 68-209), 473 patients (16 %) ont subi une IDSC. L’âge avancé, les antécédents de fibrillation auriculaire, le bloc de branche et le diabète étaient des facteurs prédictifs indépendants de l’IDSC dans l’analyse multivariable. Un modèle de score de risque a été conçu, les scores allant de 0 à 32 points. Lorsque les patients ayant un score dans le quartile inférieur (0 à 13 points) étaient utilisés à titre de référence, ceux ayant un score dans les quartiles supérieurs avaient un risque plus élevé d’IDSC (deuxième quartile : 14-15 points, rapport des risques instantanés [RRI] : 3,86, intervalle de confiance [IC] à 95 % de 2,62 à 5,68; troisième quartile : 16-18 points, RRI : 4,67, IC à 95 % de 3,14 à 6,94; quatrième quartile : 19-32 points, RRI : 6,59, IC à 95 % de 4,47 à 9,71). Conclusions: Les quatre facteurs prédictifs ciblés sont faciles à évaluer durant l’évaluation initiale des patients ayant subi une syncope. Ils peuvent aider à repérer les patients présentant un risque plus élevé d’avoir besoin d’un dispositif de stimulation cardiaque permanent.
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- 2023
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6. N-terminal pro atrial natriuretic peptide as a prognostic marker of cardiac resynchronization therapy recipients
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Nobuhiko Ueda, Naoya Kataoka, Yuichiro Miyazaki, Keiko Shimamoto, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Kenichiro Yamagata, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Koichiro Kinugawa, Naoto Minamino, and Kengo Kusano
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Although the dynamic changes of atrial natriuretic peptide (ANP) expressions in a failing heart are well-documented, the clinical implications of detailed measurements of each ANP molecular form processed from proANP remain unclear. Methods: Patients screening was conducted on patients who were eligible for cardiac resynchronization therapy (CRT) between 2014 and 2019 in our institution. Blood samples and echocardiographic parameters were collected on the day before and six months after implantation. Total ANP, proANP, and N-terminal fragment of proANP (NT-proANP) were examined as predictive biomarkers for cardiac death, left ventricular assist device implantation, and heart failure hospitalization following CRT implantation. Results: A total of 86 subjects (mean age 70 years, 64 males) who underwent successful CRT implantation were enrolled. Plasma levels of total ANP, proANP, and NT-proANP were not normally distributed [25.8 pM (interquartile range: 11.1–53.1), 2.2 pM (1.0–5.4), and 4.1 nM (2.4–7.1), respectively]. Over a median follow-up of 2.7 years, 31 patients (2 deaths and 29 heart failure hospitalizations) reached the endpoints. Among the different ANP forms, only NT-proANP emerged as an independent predictor of the composite outcome (adjusted odds ratio of 2.542 in those with levels above vs. below the median, 95 % confidence interval 1.151–5.615, p = 0.021). NT-proANP levels were associated with left atrial volume and left diastolic functional parameters and decreased in response to echocardiographic improvements at six months post-implantation (16 ± 44 % decrease in responders vs 18 ± 60 % increase in non-responders, p = 0.005). Conclusion: Pre-implantation NT-proANP levels could serve as a predictive factor for clinical outcomes in recipients of CRT.
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- 2023
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7. Differences in patient characteristics, clinical practice and outcomes of cardiac implantable electric device therapy between Japan and the USA: a cross-sectional study using data from nationally representative administrative databases
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Takeshi Aiba, Kengo Kusano, Michikazu Nakai, Kohei Ishibashi, Tsukasa Kamakura, Mitsuru Wada, Koji Miyamoto, Satoshi Nagase, Koshiro Kanaoka, Yoshihiro Miyamoto, Keiko Shimamoto, Kenichiro Yamagata, Yoshitaka Iwanaga, Reina Tonegawa-Kuji, Yoko Sumita, Yuko Y Inoue, Yuichiro Miyazaki, Akinori Wakamiya, Nobuhiko Ueda, and Kenzaburo Nakajima
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Medicine - Abstract
Objectives To identify differences in patient characteristics, clinical practice and outcomes of cardiac implantable electronic device (CIED) therapy between Japan and the USA.Design A cross-sectional study.Setting Nationally representative administrative databases from Japan and the USA containing hospitalisations with first-time implantations of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac-resynchronisation therapy with or without defibrillators (CRTP/CRTD).Participants Patients hospitalised with first-time implantations of CIEDs.Outcome measures In-hospital mortality, in-hospital complication and 30-day readmission rates.Results Overall, 107 339 (median age 78 (71–84), 48 415 women) and 295 584 (age 76 (67–83), 127 349 women) records with CIED implantations were included from Japan and the USA, respectively. Proportion of women in defibrillator recipients was lower in Japan than in the USA (ICD, 21% vs 28%, p
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- 2023
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8. Long term prognosis in patients with pulmonary hypertension undergoing catheter ablation for supraventricular tachycardia
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Hiroyuki Kamada, Junji Kaneyama, Yuko Y. Inoue, Takashi Noda, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Kenichiro Yamagata, Koji Miyamoto, Tatsuo Aoki, Takeshi Ogo, Satoshi Nagase, Takeshi Aiba, Kazuhiro Satomi, and Kengo Kusano
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Medicine ,Science - Abstract
Abstract Various forms of supraventricular tachycardia (SVT) occur in patients with severe pulmonary hypertension (PH). Despite the high efficacy of radiofrequency catheter ablation (RFCA) for SVT, insufficient data exist regarding patients with PH. Thirty SVTs in 23 PH patients (age 47 [35–60] years; mean pulmonary artery pressure 44 [32–50] mmHg) were analyzed. Procedural success rate, short- and long-term clinical outcomes, were evaluated during a median follow-up of 5.1 years. Single-procedure success rate was 83%; 94% (17/18) in typical atrial flutter, 73% (8/11) in atrial tachycardia (AT), and 100% (1/1) in atrioventricular nodal reentrant tachycardia. Antiarrhythmic drugs, serum brain natriuretic peptide levels and number of hospitalizations significantly decreased after RFCA than that before (p = 0.002, 0.04, and 0.002, respectively). Four patients had several procedures. After last RFCA, 12 patients had SVT and 8 patients died. Kaplan–Meier curves showed that patients with SVT after the last RFCA had a lower survival rate compared to those without (p = 0.0297). Multivariate analysis identified any SVT after the last RFCA as significant risk factor of mortality (hazard ratio: 9.31; p = 0.016). RFCA for SVT in patients with PH is feasible and effective in the short-term, but SVT is common during long-term follow-up and associated with lower survival.
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- 2021
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9. Complications Associated With Catheter Ablation in Patients With Atrial Fibrillation: A Report From the JROAD‐DPC Study
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Yasuhiro Yokoyama, Koji Miyamoto, Michikazu Nakai, Yoko Sumita, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Yoshihiro Miyamoto, Satoshi Yasuda, and Kengo Kusano
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atrial fibrillation ,catheter ablation ,complications ,older ,Japanese Registry of All Cardiac and Vascular Diseases ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Aging is one of the major concerns and determinants of the indications for catheter ablation (CA) for atrial fibrillation. This study aimed to assess the safety of CA in older patients with atrial fibrillation undergoing CA. Methods and Results The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases‐Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 6 632 484 records found between April 2012 and March 2018 from 1058 hospitals, 135 299 patients with atrial fibrillation (aged 65±10 years, 38 952 women) who underwent CA in 456 hospitals were studied and divided into the following age groups:
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- 2021
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10. Comparing the catheter delivery system and the stylet delivery system for ventricular lead placement in pacemaker implantation—The CATS delivery system randomized controlled trial
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Kenichiro Yamagata, Kohei Ishibashi, Kenzaburo Nakajima, Naoya Kataoka, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Satoshi Yasuda, and Kengo Kusano
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catheter delivery system ,pacemaker implantation ,randomized trial ,stylet delivery system ,trainee ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Right ventricular lead placement is one of the fundamental procedures during pacemaker implantation through the subclavian vein. Currently, there are two techniques to deliver the lead to the right ventricle: the catheter and stylet delivery systems. Surgeons, especially trainees in the early stage of training, are known to face difficulty while delivering the lead to the right ventricle. The objective of this study is to investigate and compare the two techniques of lead delivery by trainees in patients who are scheduled to undergo pacemaker implantation. Methods This is a prospective, single‐center, randomized controlled clinical trial. One‐hundred patients who were scheduled to undergo pacemaker implantation with a right ventricular lead will be randomized such that the pacemaker can be implanted via either the catheter delivery system or the stylet delivery system at a 1:1 ratio. The primary endpoint is the total number of attempts needed to place the lead in the ideal position. Secondary endpoints are the efficacy and safety of the implantation procedure. All implantation procedures will be performed by trainees under the supervision of expert cardiologists. Results The results of this study are currently under investigation. Conclusion This will be the first clinical trial to compare the efficacy and safety of the catheter delivery system and the stylet delivery system during the implantation of the ventricular lead in pacemaker implantation. Our findings are expected to improve the lead implantation procedure by providing information about which delivery system to choose in which situation.
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- 2019
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11. Feasibility of late gadolinium enhancement magnetic resonance imaging to detect ablation lesion gaps in patients undergoing cryoballoon ablation of paroxysmal atrial fibrillation
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Tsuyoshi Mishima, Koji Miyamoto, Yoshiaki Morita, Tsukasa Kamakura, Kenzaburo Nakajima, Kenichiro Yamagata, Mitsuru Wada, Kouhei Ishibashi, Yuko Inoue, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Satoshi Yasuda, and Kengo Kusano
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ablation ,atrial fibrillation ,cryothermal balloon ,late gadolinium enhancement magnetic resonance imaging ,lesion gaps ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Although late gadolinium enhancement magnetic resonance imaging (LGE‐MRI) allows the identification of lesions and gaps after a cryothermal balloon (CB) ablation of paroxysmal atrial fibrillation (PAF), the accuracy has not yet been well established. Methods The subjects consisted of 10 consecutive patients who underwent a second ablation procedure among our cohort of 80 patients who underwent LGE‐MRI after the CB ablation of PAF. LGE‐MRI scar regions were compared with electroanatomical mapping during the second procedure. In the analysis, the unilateral pulmonary vein (PV) antrum was divided into 7 regions. Results The gap characterization analysis was performed in 140 regions around 40 PVs in total. There were 16 LGE‐MRI gaps around 11 PVs (mean 1.6 ± 1.4 gaps/patient) in 7 patients and 14 electrical gaps around 10 PVs in 8 patients (mean 1.4 ± 1.1 gaps/patient). The locations of 13 electrical gaps were well matched to that on the LGE‐MRI, whereas the remaining 1 electrical gap had not been predicted on the LGE‐MRI. Compared to the electrical gaps in the second procedure, the sensitivity and specificity of the LGE‐MRI gaps were 93% (13 LGE‐MRI gaps of 14 electrical gaps) and 98% (123 LGE‐MRI scars out of 126 electrical scars), respectively. Conclusion LGE‐MRI can accurately localize the lesion gaps after CB ablation of PAF.
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- 2019
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12. Successful elimination of recurrent ventricular tachycardia by epicardial ablation over coronary artery supplying postinfarction aneurysm
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Kenichiro Yamagata, MD, PhD, Petr Peichl, MD, PhD, and Josef Kautzner, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2018
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13. Low‐Voltage Type 1 ECG Is Associated With Fatal Ventricular Tachyarrhythmia in Brugada Syndrome
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Satoshi Nagase, Tsukasa Kamakura, Naoya Kataoka, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Y. Inoue, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Satoshi Yasuda, Wataru Shimizu, Shiro Kamakura, and Kengo Kusano
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Brugada syndrome ,electrocardiography ,sudden cardiac death ,ventricular fibrillation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Epicardial mapping can reveal low‐voltage areas on the right ventricular outflow tract in patients with Brugada syndrome with several ventricular fibrillation (VF) episodes. A type 1 ECG is associated with an abnormal electrogram on right ventricular outflow tract epicardium. This study investigated the clinical significance of the amplitude of type 1 ECGs in patients with Brugada syndrome. Methods and Results In 209 patients with Brugada syndrome with a spontaneous type 1 ECG (26 resuscitated from VF, 54 with syncope, and 129 asymptomatic), the amplitude of the ECG in leads exhibiting type 1 was measured among V1 to V3 leads positioned in the standard and upper 1 and 2 intercostal spaces. The number of ECG leads exhibiting type 1 did not differ among groups. The averaged amplitude of type 1 ECG was, however, significantly smaller in the group resuscitated from VF than in the asymptomatic group (P
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- 2018
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14. Three Dimensional Electroanatomical Mapping of Lower Loop Reentry in Patients with Intracardiac Operation
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Hiro Kawata, MD, Kazuhiro Suyama, MD, PhD, Miki Yokoawa, MD, Kenichiro Yamagata, MD, Teruki Yokoyama, MD, Hisaki Makimoto, MD, Atsushi Doi, MD, PhD, Yuko Yamada, MD, PhD, Hideo Okamura, MD, Takashi Noda, MD, PhD, Kazuhiro Satomi, MD, PhD, Wataru Shimizu, MD, PhD, Naohiko Aihara, MD, and Shiro Kamakura, MD, PhD
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Lower loop reentry ,Atrial flutter ,Body surface electrocardiogram ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: The aim of this study was to clarify the characteristics of lower loop reentry (LLR. in patients who underwent cardiac surgery. Methods: Of 194 patients from 2000 to 2007 with negative flutter waves in the inferior leads (II, III, and aVf), 4 patients had LLR and reentrant circuits identified by a 3D activation sequence mapping system. We studied the characteristics of the surface electrocardiogram (ECG. patterns of those LLRs. Results: All 4 patients had a history of an intracardiac operation. The 3D activation sequence mapping system during the LLR exhibited a clockwise (CW. wavefront around the inferior vena cava (IVC. from the caudal view. During the LLR, the right atrium (RA. free wall was activated in a caudal-cranial sequence and a collision of two activation wavefronts from the lower RA and upper RA occurred at the RA free wall. Conclusions: The 3D activation mapping during the AT revealed an activation wavefront propagating around the IVC and the diagnosis of LLR. Detailed 3D electroanatomical mapping and pacing study are needed to identify the reentrant circuit of LLR in patients with previous intracardiac surgery.
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- 2011
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15. Adding interactive face-to-face lectures to passive lectures effectively reduces radiation exposure during atrial fibrillation ablation
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Yuichiro Miyazaki, Kenichiro Yamagata, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, and Kengo Kusano
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Cardiology and Cardiovascular Medicine - Published
- 2023
16. Structural characteristics of patients with superior vena cava foci initiating atrial fibrillation: Analysis with electrocardiogram‐triggered computed tomography
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Satoshi Oka, Kenichiro Yamagata, Tatsuya Nishii, Reina Tonegawa‐Kuji, Keiko Shimamoto, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, and Kengo Kusano
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
17. Left ventricular endomyocardial biopsy guided by intracardiac echocardiography via a trans-septal approach
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Kengo Kusano, Kenichiro Yamagata, Hideaki Kanzaki, and Yasuhiro Yokoyama
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medicine.medical_specialty ,Intracardiac echocardiography ,business.industry ,medicine.medical_treatment ,Biopsy ,Heart Ventricles ,Catheter ablation ,Atrial fibrillation ,General Medicine ,medicine.disease ,Endomyocardial biopsy ,Echocardiography ,Internal medicine ,Heart failure ,Cardiology ,Suspected diagnosis ,Medicine ,Humans ,business - Abstract
A 29-year-old woman was referred to our hospital for catheter ablation (CA) due to symptomatic atrial fibrillation (AF), after two failed CA attempts at another hospital. She had presented with left ventricular dysfunction at the age of 1 year, with a suspected diagnosis of endocardial
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- 2023
18. A new biomarker of cardiac resynchronization therapy response: cGMP to mature BNP ratio
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Yasuhiro Yokoyama, Naoya Kataoka, Michikazu Nakai, Ayaka Matsuo, Akihiro Fujiwara, Akinori Wakamiya, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Hiroyuki Takahama, Chisato Izumi, Koichiro Kinugawa, Naoto Minamino, and Kengo Kusano
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Cardiac Resynchronization Therapy ,Heart Failure ,Natriuretic Peptide, Brain ,Humans ,Stroke Volume ,Cardiology and Cardiovascular Medicine ,Biomarkers ,Peptide Fragments ,Ventricular Function, Left - Abstract
Biomarkers that can predict cardiac resynchronization therapy (CRT) response have not yet been identified. The purpose of this study was to assess whether individual measurements of four brain/B-type natriuretic peptide (BNP) forms, coupled with cyclic guanosine monophosphate (cGMP) might contribute to the prediction of echocardiographic CRT responders.A BNP precursor (proBNP) and total BNP (= proBNP + mature BNP) were measured with newly developed kits, while an N-terminal fragment of proBNP (NT-proBNP) and cGMP were measured with commercial kits on the day before CRT implantation. Estimated mature BNP (emBNP = total BNP-proBNP), and the ratio of cGMP to each BNP form, as well as the concentrations of three other BNP forms, were prospectively investigated for their capability in predicting a response to CRT. A CRT responder was defined as an improvement in left ventricular ejection fraction10% and/or a reduction in left ventricular end-systolic volume15% at 6-month follow-up.Out of 77 patients, 46 (60%) were categorized as CRT responders. Among the measurement parameters, only the highest quartile of the cGMP to emBNP ratio was an independent predictor of CRT responders (odds ratio 4.87, 95% confidence interval 1.25-18.89, p = 0.02). The cGMP to emBNP ratio was associated with the cumulative events of heart failure hospitalization within one year following CRT implantation (log-rank p = 0.029).The cGMP to emBNP ratio could be utilized as a predictive biomarker of CRT responders. (Clinical Study on Responder Prediction in Cardiac Resynchronization Therapy Using Individual Molecular Measurement of Natriuretic Peptide: UMIN R000038927).
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- 2022
19. Current clinical practice of subcutaneous implantable cardioverter-defibrillator: Analysis using the JROAD-DPC database
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Reina Tonegawa-Kuji, Yuko Y. Inoue, Michikazu Nakai, Koshiro Kanaoka, Yoko Sumita, Yuichiro Miyazaki, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Yoshitaka Iwanaga, Yoshihiro Miyamoto, and Kengo Kusano
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Male ,Death, Sudden, Cardiac ,Treatment Outcome ,Physiology (medical) ,Tachycardia, Ventricular ,Humans ,Arrhythmias, Cardiac ,Cardiology and Cardiovascular Medicine ,Aged ,Brugada Syndrome ,Defibrillators, Implantable ,Retrospective Studies - Abstract
Current evidence describing the characteristics of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy, its trend, and perioperative outcomes compared with transvenous implantable cardioverter-defibrillator (TV-ICD) based on a real-world, large-scale database is scarce.The purpose of this study was to identify the characteristics of current S-ICD therapy using a nationwide database.A retrospective analysis of ICD implantation was performed using a nationwide database obtained between 2016 and 2020. A total of 8690 patients implanted with ICD (median age 65 [52-72] year; 6902 men; 2021 S-ICD recipients) were analyzed.Younger patients were more prone to have S-ICD (P.001). A history of ventricular fibrillation (VF) (odds ratio [OR] 2.45; 95% confidence interval [CI] 2.04-2.93), nonsustained ventricular tachycardia (VT) (OR 1.73; 95% CI 1.36-2.21), Brugada syndrome (BrS) (OR 3.14; 95% CI 2.48-4.00), and dialysis treatment (OR 2.02; 95% CI 1.44-2.82) were independent predictors of S-ICD selection on mixed-model logistic analysis. The proportion of S-ICD implantations has been increasing (P.001), especially in patients with BrS (P.001) and dialysis (P = .04). The proportion of combined complications after S-ICD implantation was low (1.3%) in the unmatched cohort and was comparable to TV-ICD in the 1:1 propensity-matched cohort of 3354 patients (1.5% vs 2.3%; OR 0.65; 95% CI 0.38-1.10).S-ICD was more likely to be implanted in younger patients and those with a history of VF, nonsustained VT, BrS, and dialysis treatment. The proportion of S-ICD implantation increased, especially in patients with BrS. The incidence of in-hospital complications was low in S-ICD recipients.
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- 2022
20. Clinical Impacts and Insights Into Mechanisms of Paced Fragmented QRS in Cardiac Resynchronization Therapy Patients
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Nobuhiko Ueda, Takashi Noda, Akihito Ideishi, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Yasuda, and Kengo Kusano
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Cardiac Resynchronization Therapy ,Heart Failure ,Electrocardiography ,Humans - Published
- 2022
21. Impact of atrial septal pacing in left ventricular–only pacing in patients with a first-degree atrioventricular block: A case series
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Yu Murata, Kohei Ishibashi, Kenichiro Yamagata, Chisato Izumi, Teruo Noguchi, and Kengo Kusano
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Cardiology and Cardiovascular Medicine - Published
- 2022
22. Impact of cascade screening for catecholaminergic polymorphic ventricular tachycardia type 1
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Keiko Shimamoto, Seiko Ohno, Koichi Kato, Koichiro Takayama, Keiko Sonoda, Megumi Fukuyama, Takeru Makiyama, Satomi Okamura, Koko Asakura, Noriaki Imanishi, Yoshiaki Kato, Heima Sakaguchi, Tsukasa Kamakura, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Kengo Kusano, Minoru Horie, and Takeshi Aiba
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Male ,Death, Sudden, Cardiac ,Child, Preschool ,Mutation ,Tachycardia, Ventricular ,Humans ,Ryanodine Receptor Calcium Release Channel ,Child ,Cardiology and Cardiovascular Medicine - Abstract
ObjectiveHuman cardiacryanodine receptor 2(RYR2) shows autosomal-dominant inheritance in catecholaminergic polymorphic ventricular tachycardia type 1 (CPVT1); however,de novovariants have been observed in sporadic cases. Here, we investigated CPVT1-relatedRYR2variant inheritance and its clinical significance between familial andde novocases.MethodsWe enrolled 82 independent CPVT1 probands (median age: 10.0 (7.0–13.0) years; 45 male) carrying theRYR2variants and whose biological origin could be confirmed by parental genetic analysis: assured familial inheritance (familial group: n=24) andde novovariants (de novogroup: n=58). We examined the clinical characteristics of the probands and their family members carrying theRYR2variants.ResultsIn thede novogroup, theRYR2variants were more likely located in the C-terminus domain and less likely in the N-terminus domain than those in the familial group. The cumulative incidence of the first cardiac events (syncope and cardiac arrest (CA) or CA only) of the probands at the age of 5 and 10 years was higher in thede novogroup than in the familial group. Nearly half of the probands in both groups experienced CA events before diagnosis. Only 37.5% of their genotype-positive parents had symptoms; however, at least 66.7% of the genotype-positive siblings were symptomatic.ConclusionsCPVT1 probands harbouringde novo RYR2variants showed an earlier onset of symptoms than those with assured familial inheritance. Cascade screening may enable early diagnosis, risk stratification and prophylactic therapeutic intervention to prevent sudden cardiac death of probands and potential genotype-positive family members.
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- 2022
23. Retrograde penetration pacing into the conduction system as an alternative approach of his-bundle pacing
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Kohei Ishibashi, Kenzaburo Nakajima, Takeshi Aiba, Takashi Noda, Koji Miyamoto, Mitsuru Wada, Satoshi Nagase, Keisuke Kiso, Yoshifumi Nouno, Yuko Inoue, Kenichiro Yamagata, Tsukasa Kamakura, Nobuhiko Ueda, and Kengo Kusano
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Bradycardia ,Cardiac function curve ,medicine.medical_specialty ,business.industry ,Atrial fibrillation ,medicine.disease ,QRS complex ,Narrow qrs ,Late phase ,Baseline characteristics ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,medicine.symptom ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background : The optimal right ventricular (RV) pacing site during pacemaker implantation is still unclear due to left ventricular (LV) dyssynchrony by traditional RV pacing. His-bundle (HIS) pacing has achieved narrow QRS and maintained LV synchrony but high failure rate. RV septal pacing occasionally has QRS waveform with wide and narrow component in the early and late phase, respectively, and maintains LV synchrony, reflecting the normal conduction system. We aimed to define this QRS waveform as retrograde penetration pacing into the conduction system (RPP-CS) and compared its effect on LV synchrony as an alternative approach of HIS pacing. Methods and Results : We enrolled 42 patients with atrio ventricular block (AVB) or bradycardia atrial fibrillation (AF) requiring pacemaker implantation (RPP-CS, n = 27; no RPP-CS, n = 15). Baseline characteristics were similar between the groups. RPP-CS was observed in 96% and 26% of the RV septum and apex area, respectively. RPP-CS had a significantly shorter QRS width (p Conclusions : RPP-CS, especially with short QRS intervals (≤132 ms), had a high frequency of LV synchrony, maintained postoperative cardiac function, and may be an adequate first-line RV pacing site strategy for AVB or bradycardia AF as an alternative approach of HIS pacing.
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- 2022
24. Impact of nocturnal hypoxemia on the recurrence of atrial tachyarrhythmia after catheter ablation of atrial fibrillation
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Satoshi Nagase, Takeshi Aiba, Mitsuru Wada, Yuko Inoue, Akinori Wakamiya, Nobuhiko Ueda, Takashi Noda, Koji Miyamoto, Kohei Ishibashi, Kenzaburo Nakajima, Kenichiro Yamagata, Tsukasa Kamakura, Kengo Kusano, Tomoyuki Yambe, and Keisuke Suzuki
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Hypoxemia ,Recurrence ,Risk Factors ,Interquartile range ,Tachycardia ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,Sleep study ,Continuous positive airway pressure ,Hypoxia ,business.industry ,Sleep apnea ,Atrial fibrillation ,medicine.disease ,Obstructive sleep apnea ,Treatment Outcome ,Catheter Ablation ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Factors causing atrial tachyarrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF) remain undetermined. This study aimed to investigate the effect of nocturnal hypoxemia on the recurrence of atrial tachyarrhythmia after CA of AF. Among 594 patients with AF who underwent an ambulatory sleep study at the National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (2014–2019), 365 underwent CA of AF; 290 patients who underwent CA were followed up for > 3 months. Multivariate Cox regression analysis was used to calculate hazard ratios (HRs) using clinical variables, to identify the independent predictors of atrial tachyarrhythmia recurrence after the final CA. Atrial tachyarrhythmia recurred in 45 of 290 (15.5%) patients during the median follow-up period of 479 days (interquartile range 225–1002). On the performing multivariate analysis of the data of patients who did not receive continuous positive airway pressure (CPAP), severe nocturnal hypoxemia [defined as the percentage of sleep time spent with SaO2 of
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- 2021
25. Prevalence and characteristics of the Brugada electrocardiogram pattern in patients with arrhythmogenic right ventricular cardiomyopathy
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Teruo Noguchi, Kenzaburo Nakajima, Tsukasa Kamakura, Kenichiro Yamagata, Seiko Ohno, Nobuhiko Ueda, Koji Miyamoto, Chisato Izumi, Kengo Kusano, Kohei Ishibashi, Takeshi Aiba, Naoya Kataoka, Yuko Inoue, Satoshi Nagase, Mitsuru Wada, and Takashi Noda
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,depolarization abnormality ,heart failure ,Right ventricular cardiomyopathy ,QRS complex ,Interquartile range ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,In patient ,Brugada syndrome ,cardiovascular diseases ,PR interval ,cardiac death ,arrhythmogenic right ventricular cardiomyopathy ,business.industry ,Original Articles ,medicine.disease ,Heart failure ,Brugada ECG Pattern ,RC666-701 ,Cardiology ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Despite distinct pathophysiology, arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome (BrS) exhibit overlapping phenotypes. We investigated the prevalence and characteristics of the Brugada electrocardiogram (ECG) pattern in ARVC patients. Methods A total of 114 ARVC patients fulfilling the revised Task Force Criteria were enrolled. The Brugada ECG pattern was evaluated according to the consensus report on right precordial leads, and 1141 ECGs (median, 1; interquartile range, 1‐16 ECGs/patient) were analyzed. Results Five patients (4%) showed a Brugada ECG pattern, which disappeared in four patients with ECGs recorded more than 2 years afterward. ARVC patients with the Brugada ECG pattern had a longer PQ interval (220 ± 62 ms vs 180 ± 35 ms, P = .02) and longer QRS duration (138 ± 25 ms vs 102 ± 23 ms, P, Despite distinct pathophysiology, several reports have suggested overlapping phenotypes between arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome. A Brugada ECG pattern was transiently recorded at least once in 5 out of 114 ARVC patients (4%). A transient Brugada ECG pattern (*) was associated with cardiac death in patients with ARVC.
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- 2021
26. Impact of Pre-Ablation Direct Current Cardioversion for Persistent Atrial Fibrillation to Predict Recurrence of Atrial Fibrillation after Catheter Ablation
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Hiroyuki Kamada, Kazuki Mori, Nobuhiko Ueda, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Kenichiro Yamagata, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takashi Noda, Chisato Izumi, Teruo Noguchi, Kengo Kusano, and Takeshi Aiba
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Male ,Treatment Outcome ,Recurrence ,Atrial Fibrillation ,Catheter Ablation ,Electric Countershock ,Humans ,General Medicine ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
The efficacy of direct current (DC) cardioversion before catheter ablation (CA) for persistent atrial fibrillation (PerAF) patients remains controversial. We hypothesized that maintenance of sinus rhythm (SR) by pre-ablation DC cardioversion may predict the outcome of CA in patients with PerAF. A total of 383 PerAF patients with no or mild symptoms (EHRA I/II) who had undergone DC cardioversion before CA (301 males, 65 ± 10 years old, mean atrial fibrillation (AF) duration: 25 ± 47 months) were retrospectively enrolled. Whether or not SR was maintained at least 24 hour after DC cardioversion, patients were divided into two groups, namely, the DC-SR group and DC-AF group, and then all were followed until AF recurrence after CA. After DC cardioversion, 281 (73%) patients were categorized into the DC-SR group, and 102 (27%) were categorized into the DC-AF group. A total of 195 patients underwent CA at an average of 83 (54-145) days after DC cardioversion, including 161 (83%) in the DC-SR group and 34 (17%) in the DC-AF group. During follow-up (median: 15 [10-25] months), the number of patients who were free from AF was significantly higher in the DC-SR group compared with the DC-AF group (61.5% versus 38.3%, P0.0001). Multivariate analysis revealed that the DC-SR group (hazard ratio [HR]: 0.45, 95% confidence interval [CI]: 0.21-0.99, P = 0.047) and age at first AF diagnosis (HR: 0.95, 95% CI: 0.91-1.00, P = 0.039) were the independent predictors for being AF-free after CA. In conclusion, the 24-hour rhythm outcome of pre-ablation DC cardioversion and age at first AF diagnosis may predict the recurrence of AF after CA in patients with PerAF.
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- 2022
27. Pulmonary Vein Isolation and Pacemaker Implantation in a Patient with Dextrocardia Situs Inversus
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Kenzaburo Nakajima, Chisato Izumi, Nobuhiko Ueda, Tsukasa Kamakura, Takeshi Aiba, Satoshi Nagase, Kohei Ishibashi, Yuko Inoue, Mitsuru Wada, Hideaki Kanzaki, Takashi Noda, Kenichiro Yamagata, Yasuhiro Yokoyama, Koji Miyamoto, and Kengo Kusano
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Bradycardia ,Pacemaker, Artificial ,medicine.medical_specialty ,Isolation (health care) ,medicine.medical_treatment ,Catheter ablation ,Dextrocardia ,Pulmonary vein ,Jugular vein ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,Aged ,Sick Sinus Syndrome ,business.industry ,Atrial fibrillation ,General Medicine ,Situs Inversus ,medicine.disease ,Surgery ,Situs inversus ,Catheter Ablation ,cardiovascular system ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 70-year-old female with dextrocardia with situs inversus (DSI) totalis and inferior vena cava occlusion underwent radiofrequency catheter ablation because she had symptomatic paroxysmal atrial fibrillation (AF). Careful preoperative examination made successful pulmonary vein isolation through the left jugular vein approach. One-year later, however, AF recurred, and symptomatic sinus bradycardia or junctional bradycardia often occurred. Then, the pacemaker was implanted. We here reported a rare case of congenital abnormality, DSI with inferior vena cava occlusion who had undergone successful pulmonary vein isolation and pacemaker implantation without any complications.
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- 2021
28. Incessant non-sustained ventricular tachycardia immediately after MitraClip placement: a case report
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Sayaka Funabashi, Makoto Amaki, Kenichiro Yamagata, and Chisato Izumi
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Cardiology and Cardiovascular Medicine - Abstract
Background MitraClip therapy has become an alternative therapy for primary and secondary mitral regurgitation (MR) in patients at high surgical risk. However, this procedure is associated with several complications. Case summary The patient was a 93-year-old male with severe MR caused by prolapse of the mid-posterior mitral leaflet (P2) and atrial enlargement. His heart failure (HF) continued to worsen, requiring hospitalization. Considering his high surgical risk, the heart team chose MitraClip treatment. After one clip was placed in the centre of the mitral valve (P2 lateral side), MR severity was reduced from severe to trivial. However, immediately after grasping, incessant non-sustained ventricular tachycardia (VT) with a heart rate of 150 beats/min occurred. Since there were no significant ST-T changes on electrocardiogram and no left ventricular (LV) wall motion abnormalities on echocardiography, ischaemic heart disease was ruled out, and pacing with a temporary pacemaker, potassium level correction, and intravenous amiodarone administration were performed. The frequency of VT decreased but it did not disappear. Diuretics were administered for HF, and VT disappeared within a few hours, with no recurrence, probably due to a decrease in the LV chamber size after diuresis. Discussion The VT waveform showed a right bundle branch block pattern with a superior axis. Furthermore, a negative lead I and a transition zone with an abrupt change from V4 to V5 indicated that PVC/VT arose from the posterior papillary muscle area. The probable cause was mechanical extension of the posterior medial papillary muscle as a result of leaflet grasping, with resolution following appropriate volume management.
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- 2022
29. Successful recovery from refractory hypoxia due to right-to-left shunting associated with iatrogenic atrial septal defect after catheter ablation in a patient with a left-ventricular assist device: a case report
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Shotaro Komeyama, Takuya Watanabe, Kenichiro Yamagata, and Norihide Fukushima
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Cardiology and Cardiovascular Medicine - Abstract
Background Catheter ablation (CA) has been reported to be an effective therapeutic option for ventricular arrhythmias, even in patients with a left-ventricular assist device (LVAD). However, the issues of right-to-left shunting due to iatrogenic atrial septal defect (iASD) associated with procedures for CA have not been well documented. We describe a rare case of refractory hypoxia associated with right-to-left shunting via iASD after CA through the transseptal approach in an LVAD patient. Case summary A 52-year-old Asian man with a continuous-flow implantable LVAD and progressive right ventricular (RV) dysfunction was admitted because of refractory ventricular tachycardia (VT) and subsequent right heart failure. Since VT could not be controlled by intravenous administration of multiple antiarrhythmic drugs, VT ablation via the transseptal approach was performed. Ventricular tachycardia was terminated to the sinus rhythm after VT ablation; however, hypoxia associated with significant right-to-left shunting across the iASD was detected. Intensive medical management, such as an adjusted mechanical ventilator to increase pulmonary vascular compliance and adjustment of LVAD pump speed, as well as the use of intravenous inotropes to support impaired RV function successfully stabilized the haemodynamic and improved hypoxia for the disappearance of right-to-left shunting. Echocardiography at 7 months after CA showed that the significant iASD and right-to-left shunting had disappeared. Discussion The evaluation of RV function prior to VT ablation via the transseptal approach is important in the postoperative management of patients with LVAD, because RV dysfunction may cause refractory hypoxia due to iASD.
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- 2022
30. Functionally validated SCN5A variants allow interpretation of pathogenicity and prediction of lethal events in Brugada syndrome
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Tadashi Nakajima, Soshiro Ogata, Naomasa Makita, Shiro Kamakura, Minoru Horie, Jean-Jacques Schott, Takeshi Aiba, Kengo Kusano, Satoshi Nagase, Masahiko Takagi, Hiroyuki Mishima, Koh-ichiro Yoshiura, Kenichiro Yamagata, Hiroshi Morita, Matilde Karakachoff, Taisuke Ishikawa, Nobuyuki Murakoshi, Kimie Ohkubo, Kunihiro Nishimura, Yoshiyasu Aizawa, Christian Dina, Yukiko Nakano, Wataru Shimizu, Seiko Ohno, Shinya Kowase, Kenshi Hayashi, Hiroki Kimoto, Shimpei Morimoto, and Akihiko Nogami
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0301 basic medicine ,Genetics ,Proband ,congenital, hereditary, and neonatal diseases and abnormalities ,Mutation ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease_cause ,medicine.disease ,Sudden death ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,cardiovascular system ,medicine ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Gene ,Survival analysis ,Exome sequencing ,Genetic association ,Brugada syndrome - Abstract
Aims The prognostic value of genetic variants for predicting lethal arrhythmic events (LAEs) in Brugada syndrome (BrS) remains controversial. We investigated whether the functional curation of SCN5A variations improves prognostic predictability. Methods and results Using a heterologous expression system and whole-cell patch clamping, we functionally characterized 22 variants of unknown significance (VUSs) among 55 SCN5A mutations previously curated using in silico prediction algorithms in the Japanese BrS registry (n = 415). According to the loss-of-function (LOF) properties, SCN5A mutation carriers (n = 60) were divided into two groups: LOF-SCN5A mutations and non-LOF SCN5A variations. Functionally proven LOF-SCN5A mutation carriers (n = 45) showed significantly severer electrocardiographic conduction abnormalities and worse prognosis associated with earlier manifestations of LAEs (7.9%/year) than in silico algorithm-predicted SCN5A carriers (5.1%/year) or all BrS probands (2.5%/year). Notably, non-LOF SCN5A variation carriers (n = 15) exhibited no LAEs during the follow-up period. Multivariate analysis demonstrated that only LOF-SCN5A mutations and a history of aborted cardiac arrest were significant predictors of LAEs. Gene-based association studies using whole-exome sequencing data on another independent SCN5A mutation-negative BrS cohort (n = 288) showed no significant enrichment of rare variants in 16 985 genes including 22 non-SCN5A BrS-associated genes as compared with controls (n = 372). Furthermore, rare variations of non-SCN5A BrS-associated genes did not affect LAE-free survival curves. Conclusion In vitro functional validation is key to classifying the pathogenicity of SCN5A VUSs and for risk stratification of genetic predictors of LAEs. Functionally proven LOF-SCN5A mutations are genetic burdens of sudden death in BrS, but evidence for other BrS-associated genes is elusive.
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- 2021
31. Superior vena cava obstruction induced by pacemaker leads resulting in downhill esophageal varices
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Kazuya Mori, Kenichiro Yamagata, Hiroki Horinouchi, and Kengo Kusano
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Pacemaker, Artificial ,Superior Vena Cava Syndrome ,Vena Cava, Superior ,Humans ,Vascular Diseases ,Cardiology and Cardiovascular Medicine ,Esophageal and Gastric Varices - Published
- 2022
32. Author's reply
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Yuichiro Miyazaki, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, and Kengo Kusano
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Cardiology and Cardiovascular Medicine - Published
- 2022
33. An anatomical approach to determine the location of the sinoatrial node during catheter ablation
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Tsukasa Kamakura, Kenichiro Yamagata, Keiko Shimamoto, Kengo Kusano, Koji Miyamoto, Satoshi Nagase, Yuko Inoue, Kenzaburo Nakajima, Mitsuru Wada, and Takashi Noda
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Vena Cava, Superior ,Intracardiac echocardiography ,medicine.medical_treatment ,Catheter ablation ,Right superior pulmonary vein ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Superior vena cava ,Interquartile range ,Physiology (medical) ,Atrial Fibrillation ,Heart rate ,medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Sinoatrial Node ,Sinoatrial node ,business.industry ,medicine.anatomical_structure ,Pulmonary Veins ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Crista terminalis - Abstract
INTRODUCTION The sinoatrial node (SAN) should be identified before superior vena cava (SVC) isolation to avoid SAN injury. However, its location cannot be identified without restoring sinus rhythm. This study evaluated the usefulness of the anatomically defined SAN by comparing it with the electrically confirmed SAN (e-SAN) to predict the top-most position of e-SAN and thus establish a safe and more efficient anatomical reference for SVC isolation than the previously reported reference of the right superior pulmonary vein (RSPV) roof. METHODS AND RESULTS The e-SAN was identified as the earliest activation site in the electroanatomical map obtained during sinus rhythm. The anatomically defined SAN, the cranial edge of the crista terminalis (CT) visualized with intracardiac echocardiography (CT top), and the RSPV roof, which was obtained from the overlaid electroanatomical image of SVC and RSPV, were tagged on one map. The distance from the e-SAN to each reference was measured. Among 77 patients, the height of the e-SAN from the CT top was a median (interquartile range) of -2.0 (-8.0 to 4.0) mm. The e-SAN existed from 10 mm above the CT top or lower in 74 (96%) patients and from the RSPV roof or below in 73 (95%) patients. The reference of 10 mm above the CT top is more proximal to the right atrium than the RSPV roof and can provide longer isolatable SVC sleeves (30.0 [20.0-35.0] vs. 24.0 [18.0-30.0] mm, p
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- 2021
34. Relationship between electrical gaps after Maze procedure and atrial tachyarrhythmias and ablation outcomes after cardiac surgery and concomitant Maze procedure
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Satoshi Nagase, Tsukasa Kamakura, Naoki Tadokoro, Kenzaburo Nakajima, Koji Miyamoto, Mitsuru Wada, Nobuhiko Ueda, Takeshi Aiba, Takashi Noda, Satsuki Fukushima, Yuko Inoue, Kenichiro Yamagata, Takashi Kakuta, Kohei Ishibashi, Tomoyuki Fujita, Tomoyuki Yambe, Keisuke Suzuki, and Kengo Kusano
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Male ,medicine.medical_specialty ,Cox maze procedure ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Atrial tachycardia ,Aged ,Retrospective Studies ,business.industry ,Atrial fibrillation ,Ablation ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter ,Follow-Up Studies - Abstract
Atrial tachycardia (AT) and atrial fibrillation (AF) commonly occur after cardiac surgeries (CSs). This study investigated the mechanisms and long-term outcomes of AT and AF ablation after various Maze procedures, particularly whether atrial tachyarrhythmias after the Maze procedure occur due to gaps in the Maze lines. We analyzed 37 consecutive cases with atrial tachyarrhythmias after the Maze procedures and concomitant CSs between 2007 and 2019. Fifty-nine atrial tachyarrhythmias were induced in 37 consecutive cases, and 49 of those atrial tachyarrhythmias were mappable ATs. Forty ATs were related to the Maze procedures in the 49 mappable ATs (81.6%). All 37 consecutive cases had residual electrical conductions (gaps) in the Maze lines (88 gaps; 2.4 ± 1.2 gaps/patient). Forty of 88 gaps (45.5%) were associated with gap-related ATs. The common ATs in this study were 1. peri-mitral atrial flutter due to gaps at pulmonary vein isolation (PVI) line to mitral valve annulus (MVA) (20 cases), and 2. peri-tricuspid atrial flutter due to gaps at right atrial incision to the tricuspid valve annulus (TVA) (10 cases). Forty-seven of 49 ATs (95.9%) were successfully ablated at the first session, and there were no complications. The mean follow-up period after ablation was 3.6 ± 3.2 (median, 2.1; interquartile range, 0.89-6.84) years. The Kaplan-Meier analysis of freedom from recurrent atrial tachyarrhythmias after Maze procedure was 82.7% at 1-year follow-up and 75.5% at 4-year follow-up after a single procedure. Reentry was the main mechanism of ATs after Maze procedures and concomitant CSs, and ATs were largely related to the gaps on the Maze lines between the PVI line and the MVA or those on the lines between right atrial incision to the TVA. Long-term follow-up data suggest that catheter ablation of atrial tachyarrhythmias after various Maze procedures is effective and safe.
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- 2021
35. Unusual Overlapping Cardiac Sarcoidosis and Long-QT Type 3 Induced Ventricular Fibrillation
- Author
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Kengo Kusano, Keisuke Kiso, Tsukasa Kamakura, Mitsuru Wada, Yuko Yamada-Inoue, Takeshi Aiba, Takashi Noda, Nobuhiko Ueda, Satoshi Nagase, Emi Tateishi, Kenichiro Yamagata, Koji Miyamoto, Kohei Ishibashi, Yoshihiko Ikeda, Kenzaburo Nakajima, Hatsue Ishibashi-Ueda, and Tatsuya Nishikawa
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medicine.medical_specialty ,Sarcoidosis ,Long QT syndrome ,Case Report ,030204 cardiovascular system & hematology ,QT interval ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,Internal Medicine ,medicine ,Missense mutation ,Humans ,cardiovascular diseases ,Pathological ,SCN5A ,medicine.diagnostic_test ,business.industry ,Arrhythmias, Cardiac ,General Medicine ,Middle Aged ,medicine.disease ,ventricular fibrillation ,long-QT syndrome ,Long QT Syndrome ,Positron emission tomography ,Ventricular fibrillation ,Cardiology ,cardiovascular system ,030211 gastroenterology & hepatology ,Female ,business ,Tomography, X-Ray Computed - Abstract
A 54-year-old woman had been resuscitated after ventricular fibrillation and her electrocardiogram showed a QT prolongation (QTc=510 ms), and genetic screening revealed a missense variant, R1644C, in the SCN5A gene. She was therefore diagnosed with congenital long-QT syndrome (LQTS) type 3. However, the patient had left ventricular dysfunction, and based on the findings of cardiac magnetic resonance imaging, positron emission tomography and pathological examinations, she was diagnosed with cardiac sarcoidosis. Although both are rare diseases, their overlapping presence in this case may have led to an increased cardiovascular risk compared with either alone. Thus, not only genetic but comprehensive clinical examinations are important for making a correct diagnosis.
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- 2021
36. Differences in patient characteristics, clinical practice and outcomes of cardiac implantable electric device therapy between Japan and the USA: a cross-sectional study using data from nationally representative administrative databases
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Reina Tonegawa-Kuji, Yuko Y Inoue, Michikazu Nakai, Koshiro Kanaoka, Yoko Sumita, Yuichiro Miyazaki, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Kenzaburo Nakajima, Mitsuru Wada, Tsukasa Kamakura, Kenichiro Yamagata, Kohei Ishibashi, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Yoshihiro Miyamoto, Yoshitaka Iwanaga, and Kengo Kusano
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General Medicine - Abstract
ObjectivesTo identify differences in patient characteristics, clinical practice and outcomes of cardiac implantable electronic device (CIED) therapy between Japan and the USA.DesignA cross-sectional study.SettingNationally representative administrative databases from Japan and the USA containing hospitalisations with first-time implantations of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac-resynchronisation therapy with or without defibrillators (CRTP/CRTD).ParticipantsPatients hospitalised with first-time implantations of CIEDs.Outcome measuresIn-hospital mortality, in-hospital complication and 30-day readmission rates.ResultsOverall, 107 339 (median age 78 (71–84), 48 415 women) and 295 584 (age 76 (67–83), 127 349 women) records with CIED implantations were included from Japan and the USA, respectively. Proportion of women in defibrillator recipients was lower in Japan than in the USA (ICD, 21% vs 28%, pConclusionsInternational variations in patient characteristics, practice and outcomes were observed. In-hospital mortality after CIED implantation was similar between Japan and the USA, except in cases of leadless pacemaker recipients.
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- 2023
37. Novel Non-Invasive Index for Prediction of Responders in Cardiac Resynchronization Therapy Using High-Resolution Magnetocardiography
- Author
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Kenzaburo Nakajima, Shogo Oishi, Chisato Izumi, Hideaki Kanzaki, Satoshi Nagase, Takeshi Aiba, Mitsuru Wada, Masaru Sugimachi, Kohei Ishibashi, Takashi Noda, Kenichiro Yamagata, Takahiro Nakashima, Shiro Kamakura, Shunsuke Usami, Tsukasa Kamakura, Soshiro Ogata, Kengo Kusano, Yoshitaka Kimura, Satoshi Yasuda, Nobuhiko Ueda, Hiroshi Takaki, Shoji Kawakami, Koji Miyamoto, and Yuko Yamada-Inoue
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Retrospective Studies ,Heart Failure ,Magnetocardiography ,Ejection fraction ,Left bundle branch block ,business.industry ,Stroke Volume ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Treatment Outcome ,Heart failure ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
BACKGROUND Approximately one-third of patients with advanced heart failure (HF) do not respond to cardiac resynchronization therapy (CRT). We investigated whether the left ventricular (LV) conduction pattern on magnetocardiography (MCG) can predict CRT responders.Methods and Results:This retrospective study enrolled 56 patients with advanced HF (mean [±SD] LV ejection fraction [LVEF] 23±8%; QRS duration 145±19 ms) and MCG recorded before CRT. MCG-QRS current arrow maps were classified as multidirectional (MDC; n=28) or unidirectional (UDC; n=28) conduction based on a change of either ≥35° or
- Published
- 2020
38. Improved Risk Stratification of Patients With Brugada Syndrome by the New Japanese Circulation Society Guideline ― A Multicenter Validation Study ―
- Author
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Mitsuru Wada, Yuko Inoue, Satoshi Nagase, Takashi Noda, Satoshi Yasuda, Nobuyuki Murakoshi, Tetsuji Shinohara, Kenzaburo Nakajima, Kohei Ishibashi, Takeshi Aiba, Tsukasa Kamakura, Naohiko Takahashi, Akinori Wakamiya, Minoru Horie, Hiroshi Morita, Wataru Shimizu, Masaki Ieda, Koji Miyamoto, Kenji Yodogawa, Kengo Kusano, Akihiko Nogami, Naoya Kataoka, Kenichiro Yamagata, and Yasuya Inden
- Subjects
Adult ,Male ,medicine.medical_specialty ,Validation study ,030204 cardiovascular system & hematology ,Risk Assessment ,Asymptomatic ,Syncope ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Brugada Syndrome ,Retrospective Studies ,Brugada syndrome ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,General Medicine ,Guideline ,Middle Aged ,medicine.disease ,Defibrillators, Implantable ,Practice Guidelines as Topic ,Ventricular Fibrillation ,Ventricular fibrillation ,Risk stratification ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The new guideline (NG) published by the Japanese Circulation Society (JCS) places emphasis on previous arrhythmic syncope and inducibility of ventricular fibrillation (VF) by ≤2 extrastimuli during programmed electrical stimulation (PES) for deciding the indication of an implantable cardioverter-defibrillator in patients with Brugada syndrome (BrS). This study evaluated the usefulness of the NG and compared it with the former guideline (FG) for risk stratification of patients with BrS.Methods and Results:This was a multicenter (7 Japanese hospitals) retrospective study involving 234 patients with BrS who underwent PES at baseline (226 males; mean age at diagnosis: 44.9±13.4 years). At diagnosis, 46 patients (20%) had previous VF, 100 patients (43%) had previous syncope, and 88 patients (37%) were asymptomatic. We evaluated the difference in the incidence of VF in each indication according to the new and FGs. During the follow-up period (mean: 6.9±5.2 years), the incidence of VF was higher in patients with Class IIa indication according to the NG (NG: 16/45 patients [35.6%] vs. FG: 16/104 patients [15.4%]), while the incidence of VF in patients with other than class I or IIa indication was similarly low in both guidelines (NG: 2/143 patients [1.4%] vs. FG: 2/84 patients [2.4%]). Conclusions This study validated the usefulness of the NG for risk stratification of BrS patients.
- Published
- 2020
39. A case of macroreentrant atrial tachycardia between a persistent left superior vena cava and the left atrium with a decremental property
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Satoshi Nagase, Kenichiro Yamagata, Kengo Kusano, Tomoyuki Yambe, Takashi Noda, and Keisuke Suzuki
- Subjects
Bidirectional atrial tachycardia ,Persistent left superior vena cava ,medicine.medical_specialty ,business.industry ,Decremental property ,medicine.medical_treatment ,Left atrium ,Macroreentrant atrial tachycardia ,Case Report ,Catheter ablation ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial tachycardia - Published
- 2020
40. Clinical Significance of Atrial Tachyarrhythmia Duration for Ventricular Arrhythmia in Patients with Cardiac Resynchronization Therapy
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nobuhiko ueda, Takashi Noda, Koshiro Kanaoka, Yuichiro Miyazaki, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Hideaki Kanzaki, Chisato Izumi, Teruo Noguchi, Satoshi Yasuda, and Kengo Kusano
- Subjects
History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
41. Mechanical coronary artery stenosis induced by active fixation left ventricular lead: a case of acute complication after cardiac resynchronization therapy device implantation
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Satoshi Oka, Hiroyuki Endo, Kensuke Takagi, and Kenichiro Yamagata
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Cardiac Resynchronization Therapy ,Heart Failure ,Treatment Outcome ,Heart Ventricles ,Coronary Stenosis ,Humans ,Cardiac Resynchronization Therapy Devices ,Cardiology and Cardiovascular Medicine - Published
- 2022
42. Efficacy and safety of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients implanted with cardiac resynchronization therapy devices
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Kenzaburo Nakajima, Chisato Izumi, Satoshi Nagase, Kengo Kusano, Naoya Kataoka, Satoshi Yasuda, Teruo Noguchi, Yuko Inoue, Tsukasa Kamakura, Takeshi Aiba, Kohei Ishibashi, Nobuhiko Ueda, Koji Miyamoto, Mitsuru Wada, Kenichiro Yamagata, and Takashi Noda
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Tachycardia ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Cardiac Resynchronization Therapy Devices ,Heart Atria ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,Heart failure ,Antitachycardia Pacing ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Atrial tachyarrhythmias (ATAs) have a significant negative impact on the prognosis of patients implanted with cardiac resynchronization therapy (CRT) devices. New-generation atrial antitachycardia pacing (Reactive ATP, Medtronic Inc., Minneapolis, MN, USA) is effective in managing ATAs in patients implanted with pacemakers. The purpose of this study was to evaluate the efficacy and safety of Reactive ATP in patients implanted with CRT devices. Methods This was a single-center retrospective study involving 72 CRT patients with a history of ATAs [44 patients with a device capable of Reactive ATP (ATP group) and 28 patients with a device without ATP function (Control group)]. The atrial fibrillation (AF) burden, the biventricular pacing rate, and clinical outcomes were compared between the two groups. Results At baseline, there was no significant difference in the AF burden and biventricular pacing rate between the ATP and Control groups. During the 832 ± 489 days of the follow-up period, 23 of the 44 patients (52%) received a total of 2862 ATP deliveries and the median ATP success rate was 23.6% (interquartile range: 12.5–50.0%) in the ATP group. The AF burden was significantly decreased only in the ATP group 6 months after ATP was programmed (from 6.1 ± 18.2% to 2.0 ± 5.4%, p = 0.0083) and maintained low throughout the follow-up period. Moreover, there were no Reactive ATP-related complications observed. Patients in the ATP group showed a significantly lower incidence of heart failure (HF) hospitalization (log-rank, p = 0.041) and ventricular arrhythmias (log-rank, p = 0.039) than those reported in the Control group. Conclusions Reactive ATP successfully and safely reduced AF burden, and was associated with a lower incidence of HF hospitalization in patients implanted with CRT devices.
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- 2020
43. Zero-fluoroscopy ablation in patients with cardiac electronic implantable devices
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Keiko Shimamoto, Kenichiro Yamagata, Akinori Wakamiya, Nobuhiko Ueda, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue‐Yamada, Koji Miyamoto, Satoshi Nagase, and Kengo F. Kusano
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Male ,Treatment Outcome ,Physiology (medical) ,Fluoroscopy ,Atrial Fibrillation ,Catheter Ablation ,Tachycardia, Supraventricular ,Humans ,Female ,Electronics ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Introduction: Utilizing a 3-dimensional (3-D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans-septal approach and catheter manipulation technique in patients with CIED leads. Methods and Results: This study comprised 68 consecutive patients (45 [66.2%] males, median [interquartile range] 73 [68–77] years old) with CIED who underwent catheter ablation for supraventricular tachycardia, 16 without fluoroscopy (zero-fluoro group) and 52 with fluoroscopy (conventional-fluoro group), between July 2019 and April 2021. All procedures were performed under a 3-D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were mainly atrial fibrillation (73.6%) and atrial tachycardia. The median time from venipuncture to trans-septal procedure (zero-fluoro vs. conventional-fluoro group: 27.0 min vs. 23.5 min, P=0.71) and total procedure time (215 min vs. 172 min, P=0.55) were not different between the two groups. The acute procedural success rate (100% vs. 98.1%, P=1.00) and reduction of atrial high-rate episodes at 6 months (3.2 [0.3–93.9]% vs. 1.0 [0.0–14.9]%, P=0.33) did not differ between the two groups. No patient showed lead-related complications in both groups. Conclusions: Zero-fluoro ablation for supraventricular arrhythmia using 3-D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation.
- Published
- 2021
44. Abstract 12189: The Ratio of Cyclic Guanosine Monophosphate to Brain Natriuretic Peptide (cGMP/BNP) Stratifies The Risk of Heart Failure Hospitalization in Cardiac Resynchronization Therapy (CRT) Patients
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Akihito Ideishi, Nobuhiko Ueda, Yasuhiro Yokoyama, Naoya Kataoka, Yuichiro Miyazaki, Akinori Wakamiya, Tsukasa Kamakura, Mitsuru Wada, kohei ishibashi, Kenichiro Yamagata, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Naoto Minamino, and Kengo Kusano
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Cardiac Resynchronization Therapy (CRT) is established treatment for patients with heart failure, however, there are various predictors of prognosis. Although CRT responder is reported to have a better prognosis than CRT non-responder, some cases have poor clinical outcomes even among CRT responders. Meanwhile, brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) are associated with the severity of heart failure. Little is known about the efficacy of prognostic value of BNP and cGMP in CRT patients especially among CRT responders. Methods: Among 246 consecutive CRT patients, we retrospectively analyzed 86 patients whose biomarkers were measured at the time of implantation. The patients were divided into two groups by the median value of cGMP/BNP (0.26). The endpoint was heart failure hospitalization, and the CRT responder was defined as an improvement of end-systolic volume (ESV) ≥ 15% or ejection fraction (EF) ≥ 10% at 6 months after CRT implantation. Results: The patients were 65.4 ± 13.6 years old, 64 (74%) patients were male, 17 (20%) patients were ischemic cardiomyopathy, and 47 (55%) patients were CRT responders. During a median follow-up period of 830 (interquartile range: 482-1246) days, 27 patients (31%) had heart failure hospitalization (high cGMP/BNP group: 8 vs low cGMP/BNP group 19, p = 0.016). Kaplan-Meier analysis revealed the risk of heart failure hospitalization was higher in high cGMP/BNP group than in low group (log-rank p = 0.0025), and the same result was observed even among CRT responders (log-rank p=0.018). cGMP/BNP increased in responders (p = 0.0045) but not in non-responders (p = 0.23) at 6 months after CRT implantation in Wilcoxon signed-rank test. Univariate analysis showed that BMI, chronic kidney disease, diabetes mellitus, hemoglobin, CRT responder, and cGMP/BNP were predictors of heart failure hospitalization. Conclusion: cGMP/BNP is useful for the heart failure risk stratification in CRT patients.
- Published
- 2021
45. Paroxysmal atrial fibrillation as a predictor of pacemaker implantation in patients with unexplained syncope
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Yuichiro Miyazaki, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, and Kengo Kusano
- Subjects
Adult ,Aged, 80 and over ,Male ,Pacemaker, Artificial ,Atrial Fibrillation ,Bradycardia ,Electrocardiography, Ambulatory ,Humans ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Syncope ,Aged ,Retrospective Studies - Abstract
Recent studies using an implantable loop recorder (ILR) have reported on clinical predictors of pacemaker implantation in patients with unexplained syncope. However, atrial fibrillation (AF) was not included as a risk factor; this may be because the precise mechanism of AF (persistent or paroxysmal) has not been explicitly investigated. Thus, this study aimed to investigate the relationship between paroxysmal AF and cardiac syncope recurrence requiring pacemaker implantation in patients with an ILR owing to unexplained syncope.We included consecutive patients who underwent ILR implantation for unexplained syncope between September 2010 and July 2020. ILR implantation was indicated for syncope that could not be explained even after comprehensive evaluation.Overall, 128 patients (72 men; mean age, 62.5 ± 21.1 years) underwent ILR evaluation. Paroxysmal AF was diagnosed before ILR implantation in 32 patients. Bradyarrhythmia with an indication for pacemaker implantation was detected in 33 patients. The number of syncopal episodes (≥ 3) in the previous 2 years, history of paroxysmal AF/asymptomatic sinus arrest, and bundle branch block were independent predictors of pacemaker implantation. Among patients with a history of paroxysmal AF, the PR interval was longer in those who required pacemaker implantation than in those who did not (194.8 vs 168.8 ms; p = 0.0356).Paroxysmal AF is a significant predictor of recurrent syncope, leading to pacemaker implantation in patients with unexplained syncope. Careful history taking of paroxysmal AF is essential, and aggressive use of ILR is recommended to detect bradycardic events.
- Published
- 2021
46. Comparison Between Septal Pacing With the Catheter Delivery System and Apical Pacing With the Stylet Delivery System for Ventricular Lead Placement: A Randomized Controlled Trial
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Takeshi Aiba, Kohei Ishibashi, Akinori Wakamiya, Kenichiro Yamagata, Koji Miyamoto, Keiko Shimamoto, Yuko Inoue, Mitsuru Wada, Nobuhiko Ueda, Takashi Noda, Tsukasa Kamakura, Satoshi Nagase, and Kengo Kusano
- Subjects
medicine.medical_specialty ,Ventricular lead ,medicine.diagnostic_test ,business.industry ,law.invention ,Stylet ,Catheter ,Randomized controlled trial ,law ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Delivery system ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Published
- 2021
47. Prompt recognition and successful aspiration of a left atrial thrombus under intracardiac echocardiography guidance during radiofrequency catheter ablation for atrial tachycardia
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Sho Suzuki, Kenichiro Yamagata, Reina Tonegawa-Kuji, Yuichiro Miyazaki, Kengo Kusano, and Nobuhiko Ueda
- Subjects
medicine.medical_specialty ,Intracardiac echocardiography ,business.industry ,Left atrium ,Thrombosis ,medicine.disease ,medicine.anatomical_structure ,Radiofrequency catheter ablation ,Echocardiography ,Physiology (medical) ,Internal medicine ,Cardiology ,Catheter Ablation ,Tachycardia, Supraventricular ,Medicine ,Humans ,Heart Atria ,Thrombus ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Left atrial thrombus ,Atrial tachycardia - Published
- 2021
48. Long term prognosis in patients with pulmonary hypertension undergoing catheter ablation for supraventricular tachycardia
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Yuko Y. Inoue, Satoshi Nagase, Tsukasa Kamakura, Takeshi Aiba, Takeshi Ogo, Mitsuru Wada, Kohei Ishibashi, Junji Kaneyama, Nobuhiko Ueda, Takashi Noda, Kengo Kusano, Koji Miyamoto, Kenichiro Yamagata, Hiroyuki Kamada, Kazuhiro Satomi, Tatsuo Aoki, and Kenzaburo Nakajima
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Hypertension, Pulmonary ,Science ,medicine.medical_treatment ,Cardiology ,Catheter ablation ,Article ,Medical research ,Internal medicine ,medicine.artery ,Tachycardia, Supraventricular ,Humans ,Medicine ,Survival rate ,Atrial tachycardia ,Retrospective Studies ,Multidisciplinary ,business.industry ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Pulmonary hypertension ,Survival Rate ,Pulmonary artery ,Catheter Ablation ,Female ,Supraventricular tachycardia ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Various forms of supraventricular tachycardia (SVT) occur in patients with severe pulmonary hypertension (PH). Despite the high efficacy of radiofrequency catheter ablation (RFCA) for SVT, insufficient data exist regarding patients with PH. Thirty SVTs in 23 PH patients (age 47 [35–60] years; mean pulmonary artery pressure 44 [32–50] mmHg) were analyzed. Procedural success rate, short- and long-term clinical outcomes, were evaluated during a median follow-up of 5.1 years. Single-procedure success rate was 83%; 94% (17/18) in typical atrial flutter, 73% (8/11) in atrial tachycardia (AT), and 100% (1/1) in atrioventricular nodal reentrant tachycardia. Antiarrhythmic drugs, serum brain natriuretic peptide levels and number of hospitalizations significantly decreased after RFCA than that before (p = 0.002, 0.04, and 0.002, respectively). Four patients had several procedures. After last RFCA, 12 patients had SVT and 8 patients died. Kaplan–Meier curves showed that patients with SVT after the last RFCA had a lower survival rate compared to those without (p = 0.0297). Multivariate analysis identified any SVT after the last RFCA as significant risk factor of mortality (hazard ratio: 9.31; p = 0.016). RFCA for SVT in patients with PH is feasible and effective in the short-term, but SVT is common during long-term follow-up and associated with lower survival.
- Published
- 2021
49. Complications Associated With Catheter Ablation in Patients With Atrial Fibrillation: A Report From the JROAD‐DPC Study
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Kenzaburo Nakajima, Kohei Ishibashi, Satoshi Nagase, Kengo Kusano, Yoko Sumita, Takeshi Aiba, Koji Miyamoto, Satoshi Yasuda, Yasuhiro Yokoyama, Michikazu Nakai, Kenichiro Yamagata, Yoshihiro Miyamoto, Nobuhiko Ueda, Tsukasa Kamakura, Yuko Inoue, Mitsuru Wada, and Takashi Noda
- Subjects
Male ,medicine.medical_specialty ,complications ,medicine.medical_treatment ,Catheter ablation ,Japanese Registry of All Cardiac and Vascular Diseases ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Japan ,Older patients ,Risk Factors ,Internal medicine ,catheter ablation ,Atrial Fibrillation ,older ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Arrhythmia and Electrophysiology ,In patient ,Hospital Mortality ,Registries ,030212 general & internal medicine ,Original Research ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Survival Rate ,Cross-Sectional Studies ,ROC Curve ,RC666-701 ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Catheter Ablation and Implantable Cardioverter-Defibrillator ,Follow-Up Studies - Abstract
Background Aging is one of the major concerns and determinants of the indications for catheter ablation (CA) for atrial fibrillation. This study aimed to assess the safety of CA in older patients with atrial fibrillation undergoing CA. Methods and Results The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases‐Diagnosis Procedure Combination) is a nationwide claims database using data from the Japanese Diagnosis Procedure Combination/Per Diem Payment System. Among 6 632 484 records found between April 2012 and March 2018 from 1058 hospitals, 135 299 patients with atrial fibrillation (aged 65±10 years, 38 952 women) who underwent CA in 456 hospitals were studied and divided into the following age groups: Conclusions The nationwide JROAD‐DPC database demonstrated that the frequency of complications following CA in patients with atrial fibrillation increased according to age.
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- 2021
50. Retrograde penetration pacing into the conduction system as an alternative approach of his-bundle pacing: Retrograde penetration pacing into the conduction system
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Kohei, Ishibashi, Kenichiro, Yamagata, Keisuke, Kiso, Yoshifumi, Nouno, Nobuhiko, Ueda, Kenzaburo, Nakajima, Tsukasa, Kamakura, Mitsuru, Wada, Yuko, Inoue, Koji, Miyamoto, Satoshi, Nagase, Takashi, Noda, Takeshi, Aiba, and Kengo, Kusano
- Subjects
Electrocardiography ,Pacemaker, Artificial ,Heart Conduction System ,Cardiac Pacing, Artificial ,Humans ,Ventricular Function, Left - Abstract
The optimal right ventricular (RV) pacing site during pacemaker implantation is still unclear due to left ventricular (LV) dyssynchrony by traditional RV pacing. His-bundle (HIS) pacing has achieved narrow QRS and maintained LV synchrony but high failure rate. RV septal pacing occasionally has QRS waveform with wide and narrow component in the early and late phase, respectively, and maintains LV synchrony, reflecting the normal conduction system. We aimed to define this QRS waveform as retrograde penetration pacing into the conduction system (RPP-CS) and compared its effect on LV synchrony as an alternative approach of HIS pacing.We enrolled 42 patients with atrio ventricular block (AVB) or bradycardia atrial fibrillation (AF) requiring pacemaker implantation (RPP-CS, n = 27; no RPP-CS, n = 15). Baseline characteristics were similar between the groups. RPP-CS was observed in 96% and 26% of the RV septum and apex area, respectively. RPP-CS had a significantly shorter QRS width (p 0.001). The frequency of maintaining LV synchrony was significantly higher in RPP-CS (67% vs. 20%, p = 0.003). The QRS interval's optimal cut-off value during RPP-CS was 132 ms for prediction of LV synchrony (sensitivity 83%, specificity 89%, positive predictive value 94%, and negative predictive value 73%). During RPP-CS, shorter QRS intervals (QRS ≤ 132 ms) had better postoperative LV ejection fraction than longer intervals (p 0.001).RPP-CS, especially with short QRS intervals (≤132 ms), had a high frequency of LV synchrony, maintained postoperative cardiac function, and may be an adequate first-line RV pacing site strategy for AVB or bradycardia AF as an alternative approach of HIS pacing.
- Published
- 2021
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