20 results on '"Shintaro Yamagami"'
Search Results
2. Impact of catheter ablation for atrial fibrillation on cardiac disorders in patients with coexisting heart failure
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Tetsuma Kawaji, Satoshi Shizuta, Takanori Aizawa, Shintaro Yamagami, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, and Takeshi Kimura
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Atrial fibrillation ,Catheter ablation ,Heart failure ,Systolic dysfunction ,Diastolic dysfunction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims We sought to investigate the time course of cardiac disorders after catheter ablation for atrial fibrillation (AF) in patients with coexisting heart failure (HF) during long‐term follow‐up. Methods and results We analysed consecutive 280 patients undergoing first‐time catheter ablation for AF who had coexisting HF, which was defined as prior HF hospitalization, estimated right ventricular systolic pressure ≥45 mmHg, or B‐type natriuretic peptide (BNP) ≥200 pg/dL before the procedure. The primary endpoints were improvements in left ventricular ejection fraction (LVEF), E/e′, BNP, left atrial dimension (LAD), and mitral regurgitation (MR) at 1 year. The secondary endpoints were serial changes of LVEF, E/e′, BNP, LAD, and MR at 6 months, 1 year, and 5 years and cumulative incidence of HF hospitalization. During the mean follow‐up of 5.1 ± 3.0 years, 70.7% of patients were free from recurrent AF. Among patients with LVEF
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- 2021
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3. Prognostic impact of catheter ablation in patients with asymptomatic atrial fibrillation
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Tetsuma Kawaji, Satoshi Shizuta, Munekazu Tanaka, Shushi Nishiwaki, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Takashi Yoshizawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, and Takeshi Kimura
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Medicine ,Science - Abstract
Background Catheter ablation for asymptomatic atrial fibrillation (AF) remains controversial. The aim of the present study was to explore the prognostic impact of catheter ablation in asymptomatic AF patients. Methods We performed a post-hoc analysis of 537 risk-matched pairs of AF patients receiving first-time catheter ablation or conservative management. The primary outcome measure was a composite of cardiovascular death, heart failure (HF) hospitalization, ischemic stroke, or major bleeding. The study patients were divided into asymptomatic and symptomatic patients, and were further divided according to the presence or absence of previous AF-related complications (ischemic stroke or HF hospitalization). Results Most baseline characteristics were well balanced between the catheter ablation versus conservative management groups. The median follow-up period was 5.3 years. Catheter ablation as compared to conservative management was associated with significantly lower incidence of the primary outcome measure in the asymptomatic AF patients (14.7% versus 25.4% at 8-year, log-rank P = 0.008). However, the advantage of catheter ablation was significant only in the high-risk subset of patients with the previous AF-related complications (19.2% versus 55.6% at 8-year, log-rank P = 0.006), but not in those without (13.9% and 17.3%, P = 0.08). On the other hand, among the symptomatic AF patients, catheter ablation was associated with significantly lower incidence of the primary outcome measure regardless of the previous AF-related complications. Conclusions In the post-hoc analysis of the matched AF cohort, catheter ablation as compared with conservative management was associated with better long-term clinical outcomes among asymptomatic AF patients only when the previous AF-related complications were present.
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- 2022
4. Renal function and outcomes in atrial fibrillation patients after catheter ablation.
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Tetsuma Kawaji, Satoshi Shizuta, Takanori Aizawa, Shintaro Yamagami, Yasuaki Takeji, Yusuke Yoshikawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, and Takeshi Kimura
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Medicine ,Science - Abstract
BackgroundAtrial fibrillation (AF) and renal failure coexist and interact. However, scarce data about association between renal function and clinical outcomes in patients undergoing catheter ablation for AF are available. We sought to evaluate long-term renal function and clinical outcomes after AF ablation.MethodsWe enrolled 791 non-dialysis patients undergoing catheter ablation for AF, and evaluated the incidence of worsening renal function (WRF) after the procedure, defined as >30% decline in estimate glomerular filtration rate.ResultsMean follow-up duration was 5.1±2.5 years. Five hundreds and twenty-six patients (66.5%) were free from recurrent atrial arrhythmias without any antiarrhythmic drugs at the time of final follow-up. Cumulative incidence of WRF was 13.2% at 5-year after procedure, which was significantly higher in patients with recurrent AF compared to those without (21.6% versus 8.7%, PConclusionsIn AF patients undergoing catheter ablation for AF, arrhythmia recurrence was associated with WRF during follow-up, which was a strong predictor of adverse clinical outcomes.
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- 2020
- Full Text
- View/download PDF
5. A case of systemic sclerosis with worsened subclinical left ventricular systolic dysfunction after pacemaker implantation
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Seita Yamasaki, Makoto Miyake, Jiro Sakamoto, Akinori Tamura, Shintaro Yamagami, Suguru Nisiuchi, Keiichiro Yamane, Yodo Tamaki, Soichiro Enomoto, Hirokazu Kondo, and Toshihiro Tamura
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Cardiology and Cardiovascular Medicine - Published
- 2022
6. Matched comparison of catheter ablation versus conservative management for atrial fibrillation
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Tetsuma Kawaji, Satoshi Shizuta, Kyohei Yamaji, Munekazu Tanaka, Kazuki Kitano, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Takashi Yoshizawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, Takeshi Morimoto, and Takeshi Kimura
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Heart Failure ,Stroke ,Treatment Outcome ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Conservative Treatment ,Cardiology and Cardiovascular Medicine - Abstract
It is still controversial whether catheter ablation for atrial fibrillation (AF) could improve clinical outcomes in general AF population. Among 4398 patients with diagnosis of AF in the outpatient department of Kyoto University Hospital between January 2005 and March 2015, we identified 537 pairs of patients who received first-time catheter ablation (ablation group) or conservative management (conservative group), matched for age, gender, AF duration, AF type, AF symptoms, and previous heart failure (HF). The primary outcome measure was a composite of cardiovascular death, HF hospitalization, ischemic stroke, or major bleeding. Most baseline characteristics were well balanced between the 2 groups, except for the higher prevalence of low body weight, history of malignancy, and severe chronic kidney disease in the conservative group. Median follow-up duration was 5.3 years. The cumulative 5-year incidence of the primary outcome measure was significantly lower in the ablation group than in the conservative group (5.2% versus 15.6%, log-rank P 0.001). Even after adjusting for the imbalances in the baseline characteristics, the lower risk of the ablation group relative to the conservative group for the primary outcome measure remained highly significant (HR 0.32, 95% CI 0.21-0.47, P 0.001). Ablation compared with conservative management was also associated with significantly lower risks for the individual components of the primary outcome. In this matched analysis in AF patients, ablation as compared with conservative management was associated with better long-term clinical outcomes, although we could not deny the possibility of selection bias and unmeasured confounding.
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- 2022
7. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation
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Shushi Nishiwaki, Shin Watanabe, Fumiya Yoneda, Munekazu Tanaka, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Tetsuma Kawaji, Takashi Yoshizawa, Hirohiko Kohjitani, Takeshi Morimoto, Takeshi Kimura, and Satoshi Shizuta
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated.We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6-18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up.Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0-7.6] cmTR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.
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- 2022
8. The usefulness of cardiac electrophysiological study by the median cubital vein approach
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Masaya Akiyama, Suguru Nishiuchi, Sosuke Sugimura, Yuta Nakano, Kazushige Shimizu, Sadanori Shimizu, Shintaro Yamagami, Hirokazu Kondo, and Toshihiro Tamura
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- 2022
9. Impact of catheter ablation for atrial fibrillation on cardiac disorders in patients with coexisting heart failure
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Koh Ono, Takeshi Kimura, Masashi Kato, Satoshi Shizuta, Shintaro Yamagami, Tetsuma Kawaji, Takafumi Yokomatsu, Shinji Miki, and Takanori Aizawa
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Systolic dysfunction ,medicine.drug_class ,medicine.medical_treatment ,Diastole ,Heart failure ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Internal medicine ,Natriuretic peptide ,medicine ,Humans ,Cumulative incidence ,Original Research Article ,cardiovascular diseases ,030212 general & internal medicine ,Ejection fraction ,business.industry ,Stroke Volume ,Atrial fibrillation ,medicine.disease ,Treatment Outcome ,lcsh:RC666-701 ,cardiovascular system ,Cardiology ,Ventricular pressure ,Diastolic dysfunction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims We sought to investigate the time course of cardiac disorders after catheter ablation for atrial fibrillation (AF) in patients with coexisting heart failure (HF) during long‐term follow‐up. Methods and results We analysed consecutive 280 patients undergoing first‐time catheter ablation for AF who had coexisting HF, which was defined as prior HF hospitalization, estimated right ventricular systolic pressure ≥45 mmHg, or B‐type natriuretic peptide (BNP) ≥200 pg/dL before the procedure. The primary endpoints were improvements in left ventricular ejection fraction (LVEF), E/e′, BNP, left atrial dimension (LAD), and mitral regurgitation (MR) at 1 year. The secondary endpoints were serial changes of LVEF, E/e′, BNP, LAD, and MR at 6 months, 1 year, and 5 years and cumulative incidence of HF hospitalization. During the mean follow‐up of 5.1 ± 3.0 years, 70.7% of patients were free from recurrent AF. Among patients with LVEF
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- 2020
10. Abstract 11526: Nardilysin is a Potential Biomarker for the Early Diagnosis of Non-St-Segment Elevation Acute Coronary Syndrome, A Multicenter Prospective Cohort Study, Nardi-ACS Study
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Mikiko Ohno, hiroki shiomi, Mariko Yano, Takanori Aizawa, Yukiko Nakano, Shintaro Yamagami, Masashi Kato, Masanobu Ohya, Po-Min Chen, Kazuya Nagao, Kenji Ando, Kazushige Kadota, Takafumi Yokomatsu, Inada Tsukasa, masato kurokawa, Takeshi Morimoto, Takeshi Kimura, and Eiichiro Nishi
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Rapid and accurate diagnosis of acute coronary syndrome (ACS) is critical to prevent the fatal complication accompanied with the delay of the treatment. However, the diagnosis of non-ST-segment elevation ACS (NSTE-ACS), especially shortly after the onset, is not straightforward because even high-sensitivity cardiac troponin (hs-cTn) is sometimes not elevated at that phase. We previously reported in a retrospective study that serum nardilysin is a potential biomarker for the early detection of NSTE-ACS. Here, we present the results of the Nardi-ACS study, a multicenter prospective study conducted at six centers in Japan to clarify the significance of nardilysin for the early detection of ACS. Methods and Results: We analyzed serum nardilysin and hs-cTnI (Architect; Abbott) in the sequential 2 independent cohorts; phase I primary cohort (435 patients with chest pain who consecutively visited to the emergency room (ER)) and phase II validation cohort (486 patients with a strong suspicion of ACS who underwent coronary angiography). The frequency of non-ACS, STEMI and NSTE-ACS was 64.4, 22.5, and 13.1 (%) in the phase I, and 14.0, 60.0, and 25.9 (%) in the phase II cohort, respectively. The cutoff value of serum nardilysin was set at 1350.9 pg/ml (mean +2SD) obtained in 246 healthy volunteers, while the cutoff of hs-cTnI was set at 52 pg/ml. The initial blood test in the phase I cohort revealed that nardilysin was significantly elevated in ACS patients, compared to non-ACS patients (p Conclusion: Nardilysin could be a potential biomarker for the early diagnosis of troponin-negative NSTE-ACS.
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- 2021
11. Correction: Matched comparison of catheter ablation versus conservative management for atrial fibrillation
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Tetsuma Kawaji, Satoshi Shizuta, Kyohei Yamaji, Munekazu Tanaka, Kazuki Kitano, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Takashi Yoshizawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, Takeshi Morimoto, and Takeshi Kimura
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Cardiology and Cardiovascular Medicine - Published
- 2022
12. Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time
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Satoshi Shizuta, Takashi Yoshizawa, Takanori Aizawa, Shintaro Yamagami, Shinji Miki, Masashi Kato, Tetsuma Kawaji, Koh Ono, Takafumi Yokomatsu, Akihiro Komasa, and Takeshi Kimura
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Management of atrial fibrillation ,Atrial fibrillation ,Catheter ablation ,030204 cardiovascular system & hematology ,medicine.disease ,Ablation ,03 medical and health sciences ,0302 clinical medicine ,Radiofrequency catheter ablation ,Internal medicine ,Heart failure ,Cardiology ,Medicine ,Population study ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The impact of delays in the treatment with radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been well evaluated. The aim of this study was to investigate the impact of diagnosis-to-ablation time (DAT) on the long-term clinical outcomes after AF-RFCA. Methods We enrolled 1206 consecutive patients undergoing first-time RFCA for AF. The study population was divided into 2 groups based on DAT: short ( 3 years) (N = 531) DAT groups. Results Mean follow-up duration was 5.0 ± 2.5 years. The 5-year event-free rates from recurrent atrial tachyarrhythmias after the first and second RFCAs were significantly higher in short DAT group than in long DAT group (60.2% versus 48.3%, log-rank P Conclusions In the management of AF, early RFCA was associated with significantly lower arrhythmia recurrence compared with delayed RFCA, leading to reduced cardiovascular hospitalization, especially in heart failure patients.
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- 2019
13. Impact of Pre-Existing Bradycardia on Subsequent Need for Pacemaker Implantation After Radiofrequency Catheter Ablation for Atrial Fibrillation
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Koh Ono, Shinji Miki, Takanori Aizawa, Takeshi Kimura, Takafumi Yokomatsu, Satoshi Shizuta, Masashi Kato, Shintaro Yamagami, Tetsuma Kawaji, and Takashi Yoshizawa
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Male ,Bradycardia ,Pacemaker, Artificial ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Pacemaker implantation ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Heart Rate ,Internal medicine ,Atrial Fibrillation ,Female patient ,Heart rate ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Sick Sinus Syndrome ,business.industry ,Incidence ,Age Factors ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Radiofrequency catheter ablation ,Slow ventricular response ,Catheter Ablation ,Cardiology ,Female ,Permanent pacemaker ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The incidence of subsequent need for permanent pacemaker implantation (PMI) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in real world patients with and without pre-existing bradycardia has not yet been fully evaluated. Methods and Results: A total of 1,131 consecutive patients undergoing first-time RFCA for AF who had no previous or planned device implantation, were enrolled in the present study. Of 799 paroxysmal AF (PAF) patients, 121 (15.1%) had sinus node dysfunction (SND). Of 332 non-PAF patients, 73 (22.0%) had slow ventricular response (VR), defined as heart rate80 beats/min at rest without any rate-control drugs. The 5-year cumulative incidence of PMI after RFCA in PAF patients with and without SND was 14.8% and 1.7%, respectively (P0.001). The 5-year cumulative incidence of PMI after RFCA in non-PAF patients with and without slow VR was 14.8% and 4.7%, respectively (P0.001). SND and female gender in PAF patients, as well as slow VR and age ≥75 years in non-PAF patients, were independent and additive predictors of PMI. The 5-year cumulative incidence of PMI was 26.3% in female PAF patients with SND and 33.3% in elderly non-PAF patients with slow VR.PMI was avoided in85% of patients undergoing RFCA for PAF with pre-existing SND, although care should be taken for female patients. Decision-making regarding RFCA for non-PAF patients with slow VR, especially in the elderly, should be cautious.
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- 2018
14. P985The long-term impact of maintaining sinus rhythm on the risk for death or heart failure after catheter ablation for atrial fibrillation in a real world clinical practice
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Takanori Aizawa, M Tanaka, Satoshi Shizuta, Hiroki Shiomi, T Kimura, Shintaro Yamagami, Akihiro Komasa, and Takashi Yoshizawa
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac arrhythmia ,Atrial fibrillation ,Catheter ablation ,Cardiac Ablation ,Ablation ,medicine.disease ,Internal medicine ,Heart failure ,Cardiology ,Medicine ,Sinus rhythm ,Lost to follow-up ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated. Purpose To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization. Methods The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation. Results Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P Risks for a Composite of Death or HF Hazard Ratio (95% CI) Crude HR P value Adjusted HR P value AF recurrence 2.59 (1.43–4.43) 0.002 2.05 (1.11–3.58) 0.02 Age>75 years old 2.55 (1.56–4.10) 50% 0.27 (0.16–0.48) Figure 1 Conclusions Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.
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- 2019
15. Renal function and outcomes in atrial fibrillation patients after catheter ablation
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Koh Ono, Satoshi Shizuta, Takafumi Yokomatsu, Takanori Aizawa, Yasuaki Takeji, Shintaro Yamagami, Tetsuma Kawaji, Masashi Kato, Yusuke Yoshikawa, Shinji Miki, and Takeshi Kimura
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Male ,Epidemiology ,medicine.medical_treatment ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,Kidney ,Vascular Medicine ,Medical Conditions ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Atrial Fibrillation ,Chronic Kidney Disease ,Medicine and Health Sciences ,Medicine ,Cumulative incidence ,030212 general & internal medicine ,Cause of death ,Multidisciplinary ,Incidence ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,Treatment Outcome ,Nephrology ,Cardiovascular Diseases ,Catheter Ablation ,Cardiology ,Engineering and Technology ,Female ,Anatomy ,Arrhythmia ,Glomerular Filtration Rate ,Research Article ,Biotechnology ,medicine.medical_specialty ,Catheters ,Science ,Renal function ,Bioengineering ,Hemorrhage ,Catheter ablation ,03 medical and health sciences ,Signs and Symptoms ,Internal medicine ,Renal Diseases ,Humans ,Renal Insufficiency, Chronic ,Heart Failure ,business.industry ,Proportional hazards model ,Biology and Life Sciences ,Renal System ,Cardiovascular Disease Risk ,medicine.disease ,Medical Risk Factors ,Heart failure ,Medical Devices and Equipment ,Clinical Medicine ,business ,Follow-Up Studies - Abstract
BackgroundAtrial fibrillation (AF) and renal failure coexist and interact. However, scarce data about association between renal function and clinical outcomes in patients undergoing catheter ablation for AF are available. We sought to evaluate long-term renal function and clinical outcomes after AF ablation.MethodsWe enrolled 791 non-dialysis patients undergoing catheter ablation for AF, and evaluated the incidence of worsening renal function (WRF) after the procedure, defined as >30% decline in estimate glomerular filtration rate.ResultsMean follow-up duration was 5.1±2.5 years. Five hundreds and twenty-six patients (66.5%) were free from recurrent atrial arrhythmias without any antiarrhythmic drugs at the time of final follow-up. Cumulative incidence of WRF was 13.2% at 5-year after procedure, which was significantly higher in patients with recurrent AF compared to those without (21.6% versus 8.7%, P2at baseline. Patients with WRF had significantly higher 5-year incidences of all-cause death, cardiovascular death, heart failure hospitalization, ischemic stroke, and major bleeding compared to those without WRF. After adjustment of baseline differences in the multivariate Cox model, the excessive risks of WRF for all-cause death and heart failure hospitalization remained significant (adjusted HR 3.46, P = 0.002; adjusted HR 3.67, PConclusionsIn AF patients undergoing catheter ablation for AF, arrhythmia recurrence was associated with WRF during follow-up, which was a strong predictor of adverse clinical outcomes.
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- 2020
16. Real-time surveillance of left atrial appendage thrombus during contrast computed tomography imaging for catheter ablation: THe Reliability of cOMputed tomography Beyond UltraSound in THROMBUS detection (THROMBUS) study
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Koh Ono, Hitomi Numamoto, Takaaki Kitamura, Koji Koizumi, Ryu Mabuchi, Shinji Miki, Kaori Togashi, Takeshi Kimura, Masashi Kato, Takafumi Yokomatsu, Shintaro Yamagami, Shotaro Kanao, Tetsuma Kawaji, Naomi Enoki, and Satoshi Shizuta
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Male ,medicine.medical_specialty ,Supine position ,media_common.quotation_subject ,medicine.medical_treatment ,Contrast Media ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Contrast (vision) ,Humans ,Atrial Appendage ,030212 general & internal medicine ,Thrombus ,media_common ,Aged ,business.industry ,Ultrasound ,Atrial fibrillation ,Thrombosis ,Hematology ,Middle Aged ,medicine.disease ,Ablation ,Prone position ,Catheter Ablation ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Echocardiography, Transesophageal - Abstract
Left atrial contrast computed tomography (LA-CT) as well as transesophageal echocardiography (TEE) can exclude left atrial appendage (LAA) thrombus, but is sometimes unable to evaluate LAA due to incomplete LAA filling. The aim of the current study was to validate the utility of real-time approach of LA-CT with real-time surveillance of LAA-filling defect (FD). We enrolled consecutive 894 patients with LA-CT studies acquired for catheter ablation and compared the diagnostic accuracy in demonstrating LAA-FD between conventional protocol (N = 474) and novel protocol with real-time surveillance of LAA-FD immediately after the initial scanning and, when necessary, adding delayed scanning in the supine or prone position (N = 420). Primary endpoint was severity of LAA-FD classified into the 3 groups: “Grade-0” for complete filling of contrast, “Grade-1” for incomplete filling of contrast, and “Grade-2” for complete FD of contrast. The prevalence of Grade-1 and Grade-2 FD was 17.3% and 11.2% in conventional protocol, whereas there was no patient with Grade-2 FD, and only 1 patient with Grade-1 FD after the additional scanning in novel protocol. In 5 patients with suspected LAA thrombus both by TEE and Grade-2 FD in LA-CT by the conventional protocol, ablation procedure was canceled due to diagnosis of LAA thrombus. Conversely, 4 patients with suspected LAA thrombus by TEE in novel protocol group was proved to have intact LAA by LA-CT with and without additional scanning. This novel approach with real-time surveillance improved the diagnostic accuracy of LA-CT in detecting LAA-FD, suggesting potential superiority of LA-CT over TEE in excluding LAA thrombus.
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- 2018
17. Clinical Utility of Intravenous Nifekalant Injection during Radiofrequency catheter Ablation for Persistent Atrial Fibrillation
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Masashi Kato, Akihiro Komasa, Koh Ono, Takafumi Yokomatsu, Satoshi Shizuta, Takashi Yoshizawa, Takanori Aizawa, Shinji Miki, Shintaro Yamagami, Tetsuma Kawaji, and Takeshi Kimura
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Atrial fibrillation ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,Nifekalant ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Radiofrequency catheter ablation ,Internal medicine ,Clinical endpoint ,medicine ,Cardiology ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial tachycardia ,Original Research ,medicine.drug - Abstract
Background Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and results We retrospectively enrolled 157 consecutive persistentAF patientsundergoing first RFCA procedure withcomplex fractionated atrial electrogram (CFAE)ablation after pulmonary veins isolation and compared outcomes between patientswith (NFK group: N=79) and without (No-NFK group: N=78)additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF terminationwas significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P
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- 2018
18. Malignant disease as a comorbidity in patients with severe aortic stenosis: clinical presentation, outcomes, and management
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Yoshihiro Kato, Makoto Miyake, Naritatsu Saito, Ryusuke Nishikawa, Current As Registry Investigators, Kenji Nakatsuma, Akihiro Komasa, Keiichiro Yamane, Chisato Izumi, Yasuyo Takeuchi, Yuichi Kawase, Katsuhisa Ishii, Kenji Minatoya, Shintaro Yamagami, Yugo Yamashita, Yutaka Hirano, Takao Kato, Takeshi Kimura, Norio Kanamori, Yuki Kimura, Tsukasa Inada, Takeshi Morimoto, Shinichi Shirai, Kazuya Nagao, Takeshi Kitai, Tomohiko Taniguchi, Eri Minamino-Muta, Moriaki Inoko, Kanae Su, Kensuke Takabayashi, Koichiro Murata, Tomoki Sasa, and Hirokazu Mitsuoka
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Male ,medicine.medical_specialty ,Comorbidity ,030204 cardiovascular system & hematology ,Malignancy ,Severity of Illness Index ,Asymptomatic ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Risk Factors ,Cause of Death ,Neoplasms ,Preoperative complications ,Internal medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Cancer ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic stenosis ,Health Policy ,Hazard ratio ,Absolute risk reduction ,Aortic Valve Stenosis ,Prognosis ,medicine.disease ,Confidence interval ,Stenosis ,Echocardiography ,Aortic Valve ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
[Aim]To investigate the effect of malignancy on the outcomes of patients with severe aortic stenosis (AS) and the management strategy for AS with malignancy. [Methods and results]Using data of 3815 patients with severe AS in a retrospective multicentre registry [CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry], we compared 3-year clinical outcomes among three groups based on malignancy status: with malignancy currently under treatment including best supportive care (malignancy group), with a history of malignancy without any current treatment (past history group), or without history of malignancy (no malignancy group). Patients in the malignancy group (n = 124) were more often men and had higher prevalence of low body mass index, recurrence of malignancy, anaemia, and asymptomatic status, despite comparable surgical risks and echocardiographic parameters. The malignancy group or the past history group (n = 389) had significantly higher risk for all-cause death [hazard ratio (HR) 2.49, 95% CI (95% confidence interval) 1.98–3.14; HR 1.23, 95% CI 1.04–1.46] and for malignancy-related death (HR 16.2, 95% CI 10.64–24.54; HR 3.66, 95% CI 2.43–5.52) than that of the no malignancy group (n = 3302). The excess risk for aortic valve-related death was not observed in the malignancy group (HR 0.79, 95% CI 0.48–1.29) and was lower in the past history group (HR 0.72, 95% CI 0.53–0.96). In the malignancy group, the treatment strategy (surgery: n = 16, conservative management: n = 108) was determined based on the clinical status of AS or life expectancy. [Conclusions]Malignancy had marked effect on all-cause death and malignancy-related death in patients with severe AS. History of malignancy also had a smaller but significant effect on mortality.
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- 2018
19. Very long-term clinical outcomes after radiofrequency catheter ablation for atrial fibrillation: A large single-center experience
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Chihiro Ota, Satoshi Shizuta, Shintaro Yamagami, Takeshi Kimura, Takeshi Morimoto, Takanori Aizawa, Kentaro Nakai, Takahiro Doi, Koh Ono, Koji Hanazawa, Tetsuma Kawaji, Tetsushi Nakao, Takashi Yoshizawa, Naoaki Onishi, Koji Goto, Yasuhiro Sasaki, Mitsuhiko Yahata, and Mamoru Hayano
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Male ,medicine.medical_specialty ,Time Factors ,Adverse outcomes ,030204 cardiovascular system & hematology ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,030212 general & internal medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Outcome measures ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Discontinuation ,Surgery ,Survival Rate ,Treatment Outcome ,Radiofrequency catheter ablation ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Aims Radiofrequency catheter ablation (RFCA) has become widely used for drug-refractory atrial fibrillation (AF). However, there is a paucity of data on the long-term clinical outcomes after RFCA for AF. The aim of the present study was to investigate the very long-term outcomes after RFCA for AF in a large number of consecutive patients. Methods and results In this retrospective single-center study, we evaluated very long-term follow-up results in 1206 consecutive patients undergoing first RFCA for AF. The primary outcomes were adverse outcomes at 30-day as a safety outcome measure and event-free rates from recurrent atrial tachyarrhythmias as efficacy outcome measures. Final follow-up rate reached 99.3% with a mean follow-up duration of 5.0±2.5years. The incidence of overall 30-day adverse outcomes was 3.6% without death. The 10-year event-free rates from recurrent atrial tachyarrhythmias after the initial and last procedures were 46.9% and 76.4%, respectively. Arrhythmia recurrence occurred most commonly during the first year and decreased beyond 3-year, although it continued to occur at an annual rate of 2.0% and 1.3%, respectively, throughout the 10-year follow-up period. The cumulative 10-year incidences of stroke and major bleeding were 4.2% and 3.5%, respectively, with annual rates of 0.3%. Discontinuation rate of oral anticoagulation at 1-, 3-, and 10-year was 34.6%, 53.4%, 58.0% and 61.9%. Conclusions RFCA for AF provided favorable very long-term arrhythmia-free survival without much safety concerns. The 10-year rates of stroke and major bleeding were low even with discontinuation of oral anticoagulation in a large proportion of patients.
- Published
- 2017
20. Clinical Utility of Intravenous Nifekalant Injection During Radiofrequency Catheter Ablation for Persistent Atrial Fibrillation.
- Author
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Tetsuma Kawaji, Satoshi Shizuta, Shintaro Yamagami, Takanori Aizawa, Akihiro Komasa, Takashi Yoshizawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, and Takeshi Kimura
- Subjects
- *
CATHETER ablation , *ATRIAL fibrillation , *POTASSIUM antagonists - Abstract
Background: Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and Results: We retrospectively enrolled 157 consecutive persistent AF patients undergoing first RFCA procedure with complex fractionated atrial electrogram (CFAE) ablation after pulmonary veins isolation and compared outcomes between patients with (NFK group: N=79) and without (No-NFK group: N=78) additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF termination was significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P<0.001). Arrhythmia-free survival, however, was not significantly different between 2 groups (61.5% versus 54.1%, P=0.63).There was no significant difference between 2 groups in the prevalence of recurrent atrial tachycardia (25.0% versus 23.5%, P=0.89). Arrhythmia-free survivalin patients with AF termination during procedure was significantly higher than those without (73.0% versus 41.0%, P=0.002; adjusted hazard ratio 0.48, 95% confidence interval 0.17-0.84, P=0.02) among NFK group,but not among No-NFK group (66.7% versus 53.2%, P=0.53). Conclusions: Intravenous nifekalant injection during additional CFAE ablation did not improve sinus maintenance rate after RFCA procedure for AF, but AF termination by nifekalant injection could be a clinical predictor of better success rates after procedure. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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