2024/10/07 更新

写真a

チヌシ マサオミ
池主 雅臣
CHINUSHI Masaomi
所属
教育研究院 医歯学系 保健学系列 教授
医学部 保健学科 検査技術科学専攻 教授
職名
教授
外部リンク

学位

  • 医学博士 ( 1993年3月   新潟大学 )

研究キーワード

  • 心臓植込みデバイス

  • 抗不整脈薬

  • 心臓電気生理

  • カテーテルアブレーション

  • 不整脈

研究分野

  • ライフサイエンス / 循環器内科学

経歴

  • 新潟大学   医学部 保健学科 検査技術科学専攻   教授

    2014年4月 - 現在

  • 新潟大学   医学部 保健学科   准教授

    2004年4月 - 2014年3月

  • 新潟大学   保健学研究科 保健学専攻   准教授

    2004年4月 - 2014年3月

  • 新潟大学   保健学研究科 保健学専攻   准教授

    2004年4月 - 2014年3月

  • 新潟大学   医学部   講師

    1999年11月 - 2000年5月

  • 新潟大学   医学部附属病院   助手

    1998年6月 - 1999年1月

▶ 全件表示

所属学協会

 

論文

  • Impedance decrement indexes for avoiding steam‐pop during bipolar radiofrequency ablation: An experimental study using a dual‐bath preparation 国際誌

    Osamu Saitoh, Ayaka Oikawa, Ayari Sugai, Masaomi Chinushi

    Journal of Cardiovascular Electrophysiology   31 ( 12 )   3302 - 3310   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    INTRODUCTION: This experimental study was conducted to explore impedance monitoring for safely performing bipolar (BIP) radiofrequency (RF) ablation targeted to arrhythmia focus. METHODS AND RESULTS: Using a newly designed dual-bath experimental model, contact-force-controlled (20-g) BIP ablation (50 W, 60 s) was attempted for porcine left ventricle (17.0 ± 2.7 mm thickness). BIP ablation was successfully accomplished for 60 s in 75 of the 89 RF applications (84.3%), whereas audible steam-pop occurred in the other 14 RF applications (15.7%). Receiver operating characteristic analysis demonstrated the optimal predictive values regarding the occurrence of steam-pop as follows; thinner myocardial wall (≤14.8 mm), low minimum impedance (≤89 ohm), greater total impedance decrement (TID) (≤ -25 ohm) and %TID (≤ -22.5%). Greater impedance decrement was not observed immediately preceding the occurrence of steam-pop but appeared around 15 s before. Four steam-pops happened before reaching the optimal predictive values of minimum impedance, whereas all 14 steam-pops developed 11.5 ± 9.2 and 8.1 ± 8.1 s after reaching the optimal predictive values of TID and %TID, respectively. Total lesion depth (endocardial plus epicardial) was 10.7 ± 1.2 mm on average, and was well correlated with TID and %TID. Transmural lesion through the myocardial wall was created in 22 RF applications. CONCLUSION: Relatively thinner areas of the myocardium are likely to be at greater risk for steam-pop during BIP RF ablation. Lowering the RF application energy to reduce the impedance decrement may help to lessen this risk.

    DOI: 10.1111/jce.14764

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  • Patient-by-patient basis anti-tachycardia pacing for fast ventricular tachycardia with structural heart diseases. 査読 国際誌

    Masaomi Chinushi, Hiroshi Furushima, Osamu Saitoh, Takashi Noda, Takashi Nitta, Yoshifusa Aizawa, Tohru Ohe, Takashi Kurita

    Pacing and clinical electrophysiology : PACE   43 ( 9 )   983 - 991   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    BACKGROUND: Anti-tachycardia pacing (ATP) delivered from an implantable device is an important tool to terminate ventricular tachycardia (VT). But its real-world efficacy for fast VT has not been fully studied. METHODS: Using the database of Nippon-storm study, effect of patient-by-patient basis ATP programming for fast VT (≥ 188 bpm) was assessed for the patients with structural heart diseases. Fast VTs were divided into three groups depending on HR; Group-A was 188-209 bpm, and Group-B and Group-C were 210-239 bpm and ≥ 240 bpm, respectively. RESULTS: During a median follow-up of 28 months, 202 fast VT episodes (209±19 bpm) were demonstrated in the 85 patients. ATP terminated 151 of the 202 episodes (74.8%) in total. The success rate of the ATP was not different among the three groups; 73.3% in Group-A, 80.6% in Group-B and 66.7% in Group-C. ATP success rate of more than 50% and more than 70% was 77.6% and 64.7% of the patients, respectively. LVEF was significantly higher in the patients with rather than without successful ATP therapy, and ROC analysis revealed that LVEF of 23% was the optimal cut-off value. ATP was less effective in patients taking amiodarone, but etiology of the structural heart diseases, indication of the device implantation and all ECG parameters were not useful predictors for successful ATP therapy. CONCLUSIONS: ATP highly terminated fast VT with wide HR-ranges in patients with structural heart diseases, and should be considered as the first line therapy for fast VT except for patients with very low LVEF. This article is protected by copyright. All rights reserved.

    DOI: 10.1111/pace.13980

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  • Bepridil Inhibits Premature Ventricular Complexes Induced by Cardio-Sympathetic Nerve Stimulation in a Canine Experimental Model. 査読

    Osamu Saitoh, Junya Watanabe, Ayari Sugai, Ayaka Oikawa, Mika Sugai, Masaomi Chinushi

    International heart journal   61 ( 2 )   338 - 346   2020年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Sympathetic nerve activity has arrhythmogenic potential for ventricular arrhythmias associated with structural heart diseases. However, a sufficient amount of beta-blockers occasionally cannot be prescribed in some patients.An experimental study was performed to clarify the therapeutic effects of bepridil, a multiple ionic current inhibitor that does not affect beta-adrenergic receptors, for premature beats occurring during enhanced sympathetic nerve activity. Cardio-sympathetic nerve activity was augmented via stellate-ganglion (SG) stimulation in a canine model (n = 8), and the arrhythmogenic potential and anti-arrhythmic effects of bepridil (2 and 4 mg/kg intravenously) were assessed. For safe use, vagal-stimulation-induced slow HR and programmed electrical stimulation were applied to evaluate possible pro-arrhythmic effects of the drug. Heart rate variability (HRV) indexes were used to estimate cardio-autonomic nerve activity.Either side of the SG-stimulation increased BP and HR. Premature beats were induced in 10/16 SG-stimulations and it was more frequent in left (8/8) rather than right stimulation (2/8). Following 2 mg/kg drug administration, premature beats were still inducible in 8/16 stimulations (7/8 in left and 1/8 in right), but burden of the premature beats decreased from 87.1 ± 46.8 to 62.1 ± 42.6 beats. After 4 mg/kg administration, premature beats were inducible in one SG-stimulation. Proarrhythmic effects were not observed in all experiments. Steady-state HRV indexes and percent increases in SG-stimulation-induced BP-elevation and HR-acceleration were similar among the 3 periods (before, 2 and 4 mg/kg of the drug).Bepridil may be an option for ventricular arrhythmias developed during enhanced cardio-sympathetic nerve activity with minimal effect on autonomic nerve responses.

    DOI: 10.1536/ihj.19-494

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  • Therapy-Resistant Ventricular Arrhythmias Developed More Often in Advanced Than in Therapeutic Mild Hypothermic Condition. 査読

    Saitoh O, Watanabe J, Oikawa A, Sugai A, Furushima H, Chinushi M

    International heart journal   60 ( 5 )   1161 - 1167   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1536/ihj.18-711

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  • Enhanced arrhythmogenic potential induced by renal autonomic nerve stimulation: Role of renal artery catheter ablation 査読 国際誌

    Masaomi Chinushi, Osamu Saitoh, Ayari Sugai, Ayaka Oikawa, Junya Watanabe, Hiroshi Furushima

    Heart Rhythm   17 ( 1 )   133 - 141   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier {BV}  

    DOI: 10.1016/j.hrthm.2019.07.029

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  • Electrode Contact Force-Controlled Bipolar Radiofrequency Ablation: Different Effects on Lesion Size between Dual- and Single-Bath Preparations 査読

    Masaomi Chinushi, Osamu Saitoh, Junya Watanabe, Ayari Sugai, Katsuya Suzuki, Yukio Hosaka, Hiroshi Furushima

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   40 ( 3 )   223 - 231   2017年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    Background: During bipolar (BIP) radiofrequency (RF) ablation using two catheters in humans, each catheter is placed in separate cardiac chambers or spaces. We developed a contact force-controlled experimental preparation, and compared measurements made with two catheters placed in a single bath (SB), versus each catheter placed in separate baths, in order to assess the preparation-dependent differences in the results of BIP-RF ablation.
    Methods: In the SB experiments, a porcine heart was placed in the center of the bath, while in the dual-bath (DB) experiments, it was placed between two half baths communicating through windows.
    Results: The initial impedance was greatest (110.5 +/- 7.2 Omega) with the BIP-DB, followed by the BIP-SB (92.0 +/- 5.6 Omega) and the unipolar (UNIP) DB (84.9 +/- 4.7 Omega) configurations. During 50-W ablation for 60 seconds at a 20-g contact force, the root mean square voltage was 75.7 +/- 2.5 V in the BIP-DB, 68.0 +/- 2.1 V in the BIP-SB, and 66.8 +/- 2.0 V in the UNIP-DB. The mean surface lesion diameters were similar among the three configurations. However, the endocardial lesion depth was 5.60 +/- 0.56 mm with the BIP-DB, 4.71 +/- 0.64 mm with the BIP-SB, and 4.24 +/- 0.58 mm with the UNIP-DB configuration. On average, the endocardial lesions were significantly deeper than the epicardial ones.
    Conclusions: BIP ablation created much deeper lesions as compared to UNIP ablation. Lesion depth could be different depending on experimental preparation, and contact force-controlled DB preparation may be a much more appropriate model for studying the effects of BIP ablation. (PACE 2017; 40: 223-231)

    DOI: 10.1111/pace.12993

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  • Electrical stimulation-based evaluation for functional modification of renal autonomic nerve activities induced by catheter ablation 査読

    Masaomi Chinushi, Katsuya Suzuki, Osamu Saitoh, Hiroshi Furushima, Kenichi Iijima, Daisuke Izumi, Akinori Sato, Mika Sugai, Mitsuya Iwafuchi

    HEART RHYTHM   13 ( 8 )   1707 - 1715   2016年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    BACKGROUND Catheter ablation of the renal artery can be performed without apparent angiographic stenosis. This suggests that renal nerve function can be attenuated with minor structural damage to the renal artery.
    OBJECTIVE To clarify this hypothesis, we examined the relationship between electrical nerve stimulation (ENS)-induced blood pressure (BP) response and severity of histological injury of the renal artery using an acute canine model of renal artery ablation.
    METHODS An irrigation catheter was inserted into the renal arteries of 8 dogs, and radiofrequency current was delivered at 15, 20, or 25 W. ENS was applied to each artery before and after ablation.
    RESULTS Before ablation, ENS increased the BP and heart rate from 145 15/86 13 to 189 21/111 19 mm Hg and from 116 9 to 130 6 beats/min, respectively. Heart rate variability indices and serum catecholamine levels were elevated concomitantly. After ablation, the ENS -induced increase in BP and heart rate were markedly attenuated after 15 W ablation and those were nearly completely inhibited after 20 or 25 W ablation. An increase in heart rate variability indices and serum catecholamine levels became insignificant regardless of the applied energy. Renal artery angiograms revealed stenotic lesions only after 25 W ablation procedures. Histological studies showed mild to moderate injury of the arterial wall and autonomic nerves caused by 20 and 25 W ablation procedures, whereas only minor changes caused by 15 W ablation.
    CONCLUSION Functional renal autonomic nerve ablation is potentially performable with the guidance of ENS.

    DOI: 10.1016/j.hrthm.2016.04.021

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  • Blood pressure and autonomic responses to electrical stimulation of the renal arterial nerves before and after ablation of the renal artery 査読

    Masaomi Chinushi, Daisuke Izumi, Kenichi Iijima, Katsuya Suzuki, Hiroshi Furushima, Osamu Saitoh, Yui Furuta, Yoshifusa Aizawa, Mitsuya Iwafuchi

    Hypertension   61 ( 2 )   450 - 456   2013年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Radiofrequency (RF) catheter ablation of the renal artery is therapeutic in patients with drug-refractory essential hypertension. This study was designed to examine the role of the renal autonomic nerves and of RF application from inside the renal artery in the regulation of blood pressure (BP). An open irrigation catheter was inserted into either the left or right renal artery in 8 dogs. RF current (17±2 watts) was delivered to one renal artery. Electrical autonomic nerve stimulation was applied to each renal artery before and after RF ablation. BP, heart rate, indices of heart rate variability, and serum catecholamines were analyzed. Before RF ablation, electrical autonomic nerve stimulation of either renal artery increased BP from 150±16/ 92±15 to 173±21/105±16 mm Hg. After RF ablation, BP increased similarly when the nonablated renal artery was electrically stimulated, although the rise in BP was attenuated when the ablated renal artery was stimulated. Serum catecholamines and sympathetic nerve indices of heart rate variability increased when electrical autonomic nerve stimulation was applied before RF ablation and to the nonablated renal artery after RF ablation, although it changed minimally when the ablated renal artery was stimulated, suggesting interconnectivity between afferent renal nerve stimulation and systemic sympathetic activity. Renal artery angiogram showed no apparent injury after RF ablation. In conclusion, electrical stimulation of the renal arterial autonomic nerves increases BP via an increase in central sympathetic nervous activity. This response might be used to determine the target ablation site and end point of renal artery RF ablation. © 2012 American Heart Association, Inc.

    DOI: 10.1161/HYPERTENSIONAHA.111.00095

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  • The peak-to-end of the T wave in the limb ECG leads reflects total spatial rather than transmural dispersion of ventricular repolarization in an anthopleurin-A model of prolonged QT interval 査読

    Daisuke Izumi, Masaomi Chinushi, Kenichi Iijima, Hiroshi Furushima, Yukio Hosaka, Kanae Hasegawa, Yoshifusa Aizawa

    HEART RHYTHM   9 ( 5 )   796 - 803   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    BACKGROUND Previous studies have showed that the interval between the peak and the end of the T wave (Tp-e) is a marker of transmural dispersion of ventricular repolarization.
    OBJECTIVE We studied the relationship between (a) the Tp-e on local pseudo transmural electrograms (pseudo transmural Tp-e) or limb leads of body surface electrocardiogram (surface Tp-e) and (b) the intracardiac left ventricular (LV) repolarization during a drug-induced QT-interval prolongation.
    METHODS Using open-chested canine intact hearts treated by anthopleurin-A, transmural LV electrograms were recorded via needle electrodes placed in the basoanterior, midanterior, apicoanterior, basolateral, midlateral, and apicolateral LV wall. Recovery time (RT) was calculated as an index of local repolarization at each transmural unipolar electrode.
    RESULTS This model showed slower heart rate-dependent heterogeneous distribution of ventricular repolarization both along the basal to apical axis and along the transmural axis. RT was longer at the LV apex than at the base and longer in the lateral than in the anterior wall during the slower heart rate. A high correlation was found between surface Tp-e and total LV dispersion. In contrast, pseudo transmural Tp-e correlated with transmural RT dispersion. The shortest RT in the heart roughly corresponded to the peak, as did the longest RT with the end of the T wave on the surface electrocardiogram.
    CONCLUSION During drug-induced QT-interval prolongation with a large apicobasal and anterolateral dispersion of ventricular repolarization, the Tp-e in the limb leads expresses spatial (total) distribution of repolarization in the whole left ventricle.

    DOI: 10.1016/j.hrthm.2011.11.046

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  • Is the coexistence of sustained ST-segment elevation and abnormal Q waves a risk factor for electrical storm in implanted cardioverter defibrillator patients with structural heart diseases? 査読

    Hiroshi Furushima, Masaomi Chinushi, Kenichi Iijima, Kanae Hasegawa, Akinori Sato, Daisuke Izumi, Hiroshi Watanabe, Yoshifusa Aizawa

    EUROPACE   14 ( 5 )   675 - 681   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    The aim of this study was to determine whether or not the coexistence of sustained ST-segment elevation and abnormal Q waves (STe-Q) could be a risk factor for electrical storm (ES) in implanted cardioverter defibrillator (ICD) patients with structural heart diseases.
    In all, 156 consecutive patients received ICD therapy for secondary prevention of sudden cardiac death and/or sustained ventricular tachyarrhythmias were included. Electrical storm was defined as epsilon 3 separate episodes of ventricular tachycardia (VT) and/or ventricular fibrillation (VF) terminated by ICD therapies within 24 h. During a mean follow-up of 1825 1188 days, 42 (26.9) patients experienced ES, of whom 12 had coronary artery disease, 15 had idiopathic dilated cardiomyopathy, 6 had hypertrophic cardiomyopathy, 4 had arrhythmogenic right ventricular cardiomyopathy, 4 had cardiac sarcoidosis, and 1 had valvular heart disease. Sustained ST-segment elevation and abnormal Q waves in epsilon 2 leads on the 12-lead electrocardiography was observed in 33 (21) patients. On the KaplanMeier analysis, patients with STe-Q had a markedly higher risk of ES than those without STe-Q (P 0.0001). The multivariate Cox proportional hazards regression model indicated that STe-Q and left ventricular ejection fraction (LVEF) (30) were independent risk factors associated with the recurrence of VT/VF (STe-Q: HR 1.962, 95 CI 1.243.12, P 0.004; LVEF: HR 1.860, 95 CI 1.202.89, P 0.006), and STe-Q was an independent risk factor associated with ES (HR 4.955, 95 CI 2.699.13, P 0.0001).
    Sustained ST-segment elevation and abnormal Q waves could be a risk factor of not only recurrent VT/VF but also ES in patients with structural heart diseases.

    DOI: 10.1093/europace/eur386

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    researchmap

  • Triggers of ventricular tachyarrhythmias and therapeutic effects of nicorandil in canine models of LQT2 and LQT3 syndromes 査読

    M Chinushi, H Kasai, M Tagawa, T Washizuka, Y Hosaka, Y Chinushi, Y Aizawa

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   40 ( 3 )   555 - 562   2002年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    OBJECTIVES We sought to identify the triggers of ventricular tachyarrhythmia (VTA) in experimental models of long QT type 2 (LQT2) and long QT type 3 (LQT3) syndromes.
    BACKGROUND Most adverse cardiac events occurring in the long QT type 1 syndrome are related to sympathetic nerve activity. In contrast, various factors may trigger VTA in patients with LQT2 and LQT3.
    METHODS The mode of onset of VTA and therapeutic effects of the potassium-adenosine triphosphate channel opener nicorandil were compared in canine models of LQT2 and LQT3, using three induction protocols: 1) bradycardia produced by atrioventricular block (BRADY); 2) programmed ventricular stimulation; and 3) electrical stimulation of the left stellate ganglion (left stellate stimulation [LSS]). Transmural unipolar electrograms were recorded, and the activation-recovery interval (ARI) was measured.
    RESULTS Ventricular tachyarrhythmias developed during BRADY in all six experiments in the LQT3 model, but in none of the six experiments in LQT2. Programmed ventricular stimulation induced VTA in two experiments of the LQT2 model, but in none of the LQT3 experiments. Stimulation of the left stellate ganglion induced VTA in three experiments in LQT2 and in two experiments in LQT3. Nicorandil caused greater shortening of ARI and greater attenuation of transmural ARI dispersion in the LQT2 model than in the LQT3 model. After treatment with nicorandil, a single VTA was induced in the LQT2 model by LSS, whereas in the LQT3 model, VTA remained inducible by BRADY in four experiments and LSS in one experiment.
    CONCLUSIONS An abrupt increase in sympathetic activity appeared arrhythmogenic in both models. Nicorandil attenuated the heterogeneity of ventricular repolarization and suppressed the induction of VTA in the LQT2 model, but had a limited therapeutic effiect in the LQT3 model. (C) 2002 by the American College of Cardiology Foundation.

    DOI: 10.1016/S0735-1097(02)01975-7

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  • Differences in coagulation responses to vascular injury between uninterrupted dabigatran and apixaban: A clinical prospective randomized study. 国際誌

    Yasuhiro Ikami, Daisuke Izumi, Shinya Fujiki, Hirotaka Sugiura, Sou Otsuki, Naomasa Suzuki, Yuta Sakaguchi, Takahiro Hakamata, Yuki Hasegawa, Nobue Yagihara, Kenichi Iijima, Takahiro Tanaka, Masahiro Ishizawa, Masaomi Chinushi, Tohru Minamino, Takayuki Inomata

    Heart rhythm   2024年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The coagulation response during vascular injury with uninterrupted administration of direct oral anticoagulants has not been elucidated. OBJECTIVE: Our aim was to evaluate differences in coagulation responses after vascular injury between uninterrupted direct thrombin inhibitor and direct factor Xa inhibitor recipients. METHODS: Patients scheduled for catheter ablation for atrial fibrillation were randomly assigned to receive dabigatran or apixaban in this prospective, randomized, comparative, parallel-group study. Venous blood was collected 3 times: 180 minutes after taking the anticoagulant on the day before the procedure, before vascular punctures of the ablation procedure, and 10-15 minutes after the start of vascular punctures. RESULTS: Forty-two patients were enrolled. The prothrombin fragment 1+2 level, the primary end point, was much larger after vascular puncture in the uninterrupted dabigatran recipients (median, 83 pmol/L; interquartile range, 56-133 pmol/L) than in the uninterrupted apixaban recipients (median, 1 pmol/L; interquartile range, -3 to 19 pmol/L; P < .001). Antithrombin levels decreased after vascular puncture in dabigatran recipients, and both protein C and antithrombin levels decreased after vascular puncture in apixaban recipients. CONCLUSION: Unlike uninterrupted apixaban, uninterrupted dabigatran does not inhibit thrombin generation in response to vascular injury.

    DOI: 10.1016/j.hrthm.2024.07.017

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  • Correlation between Time Course of Ventricular Tachyarrhythmias and Improvement of LVEF after Induction of Steroid Therapy in Cardiac Sarcoidosis(タイトル和訳中)

    鈴木 尚真, 大槻 総, 和田 理澄, 赤川 理恵, 井神 康宏, 長谷川 祐紀, 池主 雅臣, 猪又 孝元

    日本循環器学会学術集会抄録集   88回   PJ085 - 4   2024年3月

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    記述言語:英語   出版者・発行元:(一社)日本循環器学会  

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  • Clinical Impact of Intraoperative Target Branch Changes in Left-Ventricular Lead Placement for Cardiac Resynchronization Therapy(タイトル和訳中)

    井神 康宏, 赤川 理恵, 鈴木 尚真, 長谷川 祐紀, 大槻 総, 池主 雅臣, 猪又 孝元

    日本循環器学会学術集会抄録集   88回   PJ052 - 3   2024年3月

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    記述言語:英語   出版者・発行元:(一社)日本循環器学会  

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  • Myocardium with Unstable Excitability under Durable Lesion: Difference in Conductive Heating Effect between Short and Moderate RF Application Time(タイトル和訳中)

    齋藤 修, 笠井 琢充, 及川 綾花, 古嶋 博司, 井神 康宏, 鈴木 尚真, 長谷川 祐紀, 大槻 総, 池主 雅臣

    日本循環器学会学術集会抄録集   88回   PJ045 - 3   2024年3月

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    記述言語:英語   出版者・発行元:(一社)日本循環器学会  

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  • Symmetrical recovery time course between impedance and intramyocardial temperature after bipolar radiofrequency ablation; Role of impedance monitoring to estimate temperature rise. 国際誌

    Takumi Kasai, Osamu Saitoh, Kyogo Fuse, Ayaka Oikawa, Hiroshi Furushima, Masaomi Chinushi

    Indian pacing and electrophysiology journal   2023年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: During radiofrequency (RF) ablation, impedance monitoring has been used to avoid steam-pop caused by excessive intramyocardial temperature (IMT) rise. However, it is uncertain why the impedance decline is related to steam-pop and whether the impedance decline is correlated to IMT. METHODS: Twenty-one bipolar ablations (40 W, 30-g contact, 120 s) were attempted for seven perfused porcine myocardium. Immediately after ablation, a temperature electrode was inserted into the mid-myocardial portion, and the recovery process of impedance and its correlation to IMT were assessed. RESULTS: Transmural lesion was created in all 21 applications but steam-pop occurred in 5/21 applications with large impedance decline. In the 16 applications without steam-pop, impedance and IMT soon after ablation were 97.2 ± 4.0 Ω and 66.1 ± 4.8 °C, respectively. Reasonably high linear correlation was demonstrated between the maximum IMT after ablation and impedance differences before and after ablation. Recovery processes of the decreased impedance and the elevated IMT fit well to each equation of the single exponential decay function and showed symmetric shapes with no statistical difference of time constant (100.1 ± 34.5 s in impedance vs. 108.7 ± 27.3 s in IMT) and half-time of recovery (144.5 ± 49.8 s in impedance vs. 156.9 ± 39.4 s in IMT). Recovered impedance after ablation (104.8 ± 3.9 Ω) was 5.1 ± 2.0 Ω smaller than that before ablation (109.9 ± 2.7 Ω), suggesting several factors other than IMT rise participate in impedance decline in RF ablation. CONCLUSIONS: Recovery of impedance and IMT after ablation well correlated, which supports the usefulness of impedance monitoring for safe RF ablation.

    DOI: 10.1016/j.ipej.2023.12.001

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  • Distribution of excitation recoverable myocardium after radiofrequency ablation and its relation to energy application time and irrigation. 国際誌

    Osamu Saitoh, Takumi Kasai, Kyogo Fuse, Masaomi Chinushi

    Journal of cardiovascular electrophysiology   34 ( 4 )   928 - 941   2023年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Radiofrequency (RF) catheter ablation induces excitation recoverable myocardium around durable core lesions, and its distribution may be different depending on energy delivery methods. METHODS AND RESULTS: In coronary perfusing porcine hearts, pacing threshold through the ventricle was measured using eight-pole (1-mm distance) needle electrodes vertically inserted into myocardium before, within 3 min after and 40 min after 40 W ablation with 10-g catheter contact (Group 1: irrigation catheter for 15 s, Group 2: irrigation catheter for 40 s, Group 3: nonirrigation catheter for 15 s, Group 4: nonirrigation catheter for 40 s). Ablation was accomplished in all 12 ablations in Groups 1-3 whereas in 8/12 ablations in Group 4 because of high-temperature rise. Within 3 min after ablation, 10.0 V pacing uncaptured electrodes were distributed from the surface to inside the myocardium, and its depth was deeper in 40 s than in 15 s ablation. 40 min after ablation, excitation recovery at one or more electrodes below the durable lesion was observed in all Groups. Excitation recovery electrodes were also observed on the surface in Group 1 but not the other Groups. Accordingly, the number of excitation-recovered electrodes were larger in Group 1 than the other Groups. CONCLUSIONS: Regardless of the ablation methods, excitation recoverable myocardium was present around 1.0 mm below the durable lesions. Lesions created by short application time using an irrigation catheter may have included large excitation recoverable myocardium soon after ablation because of the presence of reversible myocardium on well-irrigated myocardial surfaces.

    DOI: 10.1111/jce.15873

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  • 心房細動のTriggerおよびDriverと考えられる上大静脈(SVC)の細動様電気活動の焼灼部位決定にCARTOでのCFAE mappingが有用であった1例

    坂口 裕太, 和泉 大輔, 鈴木 尚真, 袴田 崇裕, 井神 康宏, 大槻 総, 飯嶋 賢一, 八木原 伸江, 池主 雅臣, 猪又 孝元

    心臓   54 ( Suppl.1 )   20 - 20   2022年11月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

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  • Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators. 国際誌

    Takahiro Hakamata, Sou Otsuki, Daisuke Izumi, Yuta Sakaguchi, Naomasa Suzuki, Yasuhiro Ikami, Yuki Hasegawa, Nobue Yagihara, Kenichi Iijima, Masaomi Chinushi, Koichi Fuse, Takayuki Inomata

    Heart rhythm   19 ( 10 )   1704 - 1711   2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Inappropriate shocks delivered by subcutaneous implantable cardioverter-defibrillators (S-ICDs) are most frequently caused by cardiac oversensing. However, the predictors for oversensing of S-ICD remain unclear. OBJECTIVE: We aimed to investigate the predictors for oversensing of S-ICD, especially clinical impact of an electrocardiographic (ECG) change. METHODS: We retrospectively enrolled 99 consecutive patients who underwent S-ICD implantation between 2013 and 2021. Oversensing events were defined as inappropriate charge of the capacitors induced by cardiac or noncardiac signals other than tachycardia. RESULTS: During a median follow-up period of 34 months (interquartile range 20-50 months), 11 of 99 patients (11%) experienced 34 oversensing events and 4 patients (4%) received inappropriate shocks during their events. Six patients exhibited ECG changes (bundle branch block, 3; ventricular pacing, 1; inverted T wave, 1; poor R-wave progression, 1) during the follow-up period. Oversensing events were observed in 4 of 6 patients with ECG change (67%), and 3 patients underwent S-ICD removal because of inevitable shock. Contrastingly, of the remaining patients without ECG change, all 7 patients who experienced oversensing events could continue using S-ICD with the reprogramming sensing vector and/or restriction of excessive exercise. Logistic regression analysis showed that lower voltage of Sokolow-Lyon ECG (V1S + V5R) was the predictor of oversensing in patients without ECG change. When the cutoff value was 2.1 mV, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 62.7%, 15.7%, and 98.1%, respectively. CONCLUSION: Unavoidable oversensing resulting in S-ICD removal is caused by ECG change. Oversensing in patients without ECG change can be managed.

    DOI: 10.1016/j.hrthm.2022.05.037

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  • Impedance‐decline‐guide power control long application time bipolar radiofrequency catheter ablation 査読

    Osamu Saitoh, Takumi Kasai, Kyogo Fuse, Ayaka Oikawa, Hiroshi Furushima, Masaomi Chinushi

    Journal of Cardiovascular Electrophysiology   2022年9月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/jce.15684

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  • Clinical impact of nocturnal ventricular tachyarrythmias in electrical storm. 国際誌

    Naomasa Suzuki, Sou Otsuki, Daisuke Izumi, Rie Akagawa, Yuta Sakaguchi, Takahiro Hakamata, Yasuhiro Ikami, Yuki Hasegawa, Nobue Yagihara, Kenichi Iijima, Masaomi Chinushi, Takayuki Inomata

    Pacing and clinical electrophysiology : PACE   45 ( 11 )   1330 - 1337   2022年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The incidence of electrical storm (ES) is significantly higher during the daytime. However, the association between nocturnal ventricular tachyarrythmias during ES and prognosis remains unclear. Therefore, this study aimed to investigate the clinical characteristics and outcomes of ES with midnight ventricular tachyarrythmias. METHODS: We included 48 consecutive patients who had an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator implanted between 2010 and 2020 and those who had experienced the onset of an out-of-hospital ES episode. According to the midnight (0:00 a.m.-6:00 a.m.) occurrence of ventricular arrythmia events consisting of ventricular tachycardia (VT) and ventricular fibrillation (VF), we divided them into two groups (with-midnight group: n = 27, without-midnight group: n = 21). The clinical characteristics and outcomes of the two groups were compared. RESULTS: The patients in the with-midnight group were mostly males, had longer QRS duration, and longer corrected QT-interval than those in the without-midnight group (p < .05). The incidence of all-cause death, especially heart failure death, was higher in the with-midnight group than in the without-midnight group (p < .01). Multivariate analysis showed that the presence of midnight VT/VF during ES was the only independent risk factors for heart failure death (HR = 18.9, 95%CI = 1.98-181, p = .011). CONCLUSIONS: The presence of midnight VT/VF during ES might be associated with the poor prognosis. The loss of a sympathetic circadian pattern of VT/VF distribution during ES might suggest advanced stages of the cardiac disease.

    DOI: 10.1111/pace.14592

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  • Excitation Recovery on the Surface Myocardium After Shorter but Not Nominal Time Radiofrequency Application Using an Open Irrigation Catheter

    Masaomi Chinushi, Osamu Saitoh

    Circulation. Arrhythmia and electrophysiology   15 ( 1 )   e010392   2022年1月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1161/CIRCEP.121.010392

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  • The Risk of Ventricular Tachyarrhythmias in Patients with Antimitochondrial Antibodies-Related Noncardiac Diseases.

    Yasuhiro Ikami, Daisuke Izumi, Yuki Hasegawa, Naomasa Suzuki, Yuta Sakaguchi, Takahiro Hakamata, Sou Otsuki, Nobue Yagihara, Kenichi Iijima, Takeshi Kashimura, Masaomi Chinushi, Tohru Minamino, Takayuki Inomata

    International heart journal   63 ( 3 )   476 - 485   2022年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Antimitochondrial antibodies (AMA) are serum autoantibodies specific to primary biliary cholangitis and are linked to myopathy and myocardial damage; however, the presence of AMA as a risk factor for ventricular tachyarrhythmias (VTs) has remained unknown. This study aimed to elucidate whether the presence of AMA-related noncardiac diseases indicates VTs risk.This cohort study enrolled 1,613 patients (883 females) who underwent AMA testing to assess noncardiac diseases. The incidence of VTs and supraventricular tachyarrhythmias (SVTs) from a year before the AMA testing to the last visit of the follow-up were retrospectively investigated as primary and secondary objectives. Using propensity score matching, we extracted AMA-negative patients whose covariates were matched to those of 152 AMA-positive patients. In this propensity score-matched cohort, the incidence of VTs and SVTs in the AMA-positive patients were compared with that in AMA-negative patients.The AMA-positive patients had higher estimated cumulative incidence (log-rank, P = 0.013) and prevalence (5.9% versus 0.7%, P = 0.020) of VTs than the AMA-negative patients. The presence of AMA was an independent risk factor for VTs (hazard ratio, 4.02; 95% CI, 1.44-20.01; P = 0.005). Meanwhile, AMA were associated with atrial flutter and atrial tachycardia development. In AMA-positive patients, VTs were associated with male sex, underlying myopathy, high creatine kinase levels, presence of chronic heart failure or ischemic heart disease, left ventricular dysfunction, presence of SVTs, and the electrocardiographic parameters indicating atrial disorders.The presence of AMA-related noncardiac diseases is an independent risk factor for VTs.

    DOI: 10.1536/ihj.22-075

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  • 脂肪沈着領域にリエントリー回路が同定された陳旧性心筋梗塞の1例

    大槻 総, 和泉 大輔, 井神 康宏, 長谷川 祐紀, 八木原 伸江, 飯嶋 賢一, 池主 雅臣, 南野 徹

    心臓   53 ( Suppl.1 )   25 - 25   2021年11月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

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  • Efficacy of antitachycardia pacing alert by remote monitoring of implantable cardioverter-defibrillators for out-of-hospital electrical storm. 国際誌

    Sou Otsuki, Daisuke Izumi, Yuta Sakaguchi, Naomasa Suzuki, Takahiro Hakamata, Yasuhiro Ikami, Yuki Hasegawa, Nobue Yagihara, Kenichi Iijima, Masaomi Chinushi, Tohru Minamino, Inomata Takayuki

    Pacing and clinical electrophysiology : PACE   44 ( 10 )   1675 - 1682   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Remote monitoring (RM) has been shown to reduce all-cause mortality in patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators (ICD/CRT-D). Not all devices transmit an alert for antitachycardia pacing (ATP) therapy, and it is unknown whether differences of RM alert affect the outcomes of electrical storm (ES). METHODS: We enrolled 42 patients with ICD/CRT-D whose out-of-hospital ES were detected by RM between 2013 and 2020. We divided their 54 episodes into two groups (ATP-alert-on; 22, ATP-alert-off; 32), and clinical outcomes were compared between the two groups. RESULTS: In 35 of 54 episodes of ES, ventricular tachycardia (VT) could be terminated within 24 h of ES onset just by ATP (ATP-alert-on: 14, ATP-alert-off: 21); however, many patients subsequently received shock delivery for VT. Among the 35 episodes, only in ATP-alert-on group, seven patients were prompted to visit our hospital without ICD shock through confirmation of ES by ATP-alert. Episodes that led to shock delivery 24 h or longer after the ES onset were significantly less common in the ATP-alert-on group (ATP-alert-on: 1/14, ATP-alert-off: 9/21, p = .03). Although there were no significant differences in the number of shock deliveries between episodes in the two groups, the number of ATP deliveries were significantly fewer in the ATP-alert-on group (12[7-26] vs. 29[16-53] in ATP-alert-off group, p = .03). Multivariate logistic regression analyses showed that the only ATP-alert significantly reduced ATP deliveries (HR = 0.14, 95%CI = 0.04-0.57, p = .003). CONCLUSION: Remote monitoring with an ATP-alert function during electrical storm may reduce appropriate ICD therapy through prompting early review.

    DOI: 10.1111/pace.14334

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  • Anti‐tachycardia pacing for non‐fast and fast ventricular tachycardias in individual Japanese patients: From Nippon‐storm study

    Masaomi Chinushi, Osamu Saitoh, Hiroshi Furushima, Yoshifusa Aizawa, Takashi Noda, Takashi Nitta, Tohru Ohe, Takashi Kurita

    Journal of Arrhythmia   37 ( 4 )   1038 - 1045   2021年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    BACKGROUND: Anti-tachycardia pacing (ATP) delivered from an implantable device is a useful tool to terminate ventricular tachycardia (VT). But its real-world efficacy for those patients having multiple VTs with varying VT rates has not been fully studied. METHODS: Using the Nippon-storm study database, efficacy of patient-by-patient basis ATP programing for Japanese patients having both non-fast (120-187 bpm) and fast VT (≥188 bpm) was assessed. According to the useful criteria of ≥50% success termination by ATP, patients were divided into three subgroups; success ≥50% for both non-fast and fast VT (both useful), ≥50% only for non-fast VT (non-fast VT useful), or ≥50% for neither non-fast nor fast VT (neither useful). RESULTS: During a median follow-up of 28 months, ATP terminated 184 of the 203 non-fast VT episodes (91%) and 86 of the 113 fast VT episodes (76%) in all 41 patients. In the patient-by-patient analysis, efficacy of ATP was not different between non-fast and fast VT in most of the patients (36/41 = 88%); 32 patients were in the both useful and four other patients in the neither useful. Neither ischemic nor non-ischemic structural heart disease was associated with the ATP efficacy, whereas LVEF more than 37.0% and non-prescribed amiodarone were characteristics of the patients classified into the both useful. CONCLUSIONS: ATP well terminated both non-fast and fast VT occurring in individual Japanese patients with various structural heart diseases in the real-world device treatment and this finding further supports ATP programing for all device tachycardia detection zones in most patients with multiple VTs.

    DOI: 10.1002/joa3.12572

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  • JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

    Akihiko Nogami, Takashi Kurita, Haruhiko Abe, Kenji Ando, Toshiyuki Ishikawa, Katsuhiko Imai, Akihiko Usui, Kaoru Okishige, Kengo Kusano, Koichiro Kumagai, Masahiko Goya, Yoshinori Kobayashi, Akihiko Shimizu, Wataru Shimizu, Morio Shoda, Naokata Sumitomo, Yoshihiro Seo, Atsushi Takahashi, Hiroshi Tada, Shigeto Naito, Yuji Nakazato, Takashi Nishimura, Takashi Nitta, Shinichi Niwano, Nobuhisa Hagiwara, Yuji Murakawa, Teiichi Yamane, Takeshi Aiba, Koichi Inoue, Yuki Iwasaki, Yasuya Inden, Kikuya Uno, Michio Ogano, Masaomi Kimura, Shun-Ichiro Sakamoto, Shingo Sasaki, Kazuhiro Satomi, Tsuyoshi Shiga, Tsugutoshi Suzuki, Yukio Sekiguchi, Kyoko Soejima, Masahiko Takagi, Masaomi Chinushi, Nobuhiro Nishi, Takashi Noda, Hitoshi Hachiya, Masataka Mitsuno, Takeshi Mitsuhashi, Yasushi Miyauchi, Aya Miyazaki, Tomoshige Morimoto, Hiro Yamasaki, Yoshifusa Aizawa, Tohru Ohe, Takeshi Kimura, Kazuo Tanemoto, Hiroyuki Tsutsui, Hideo Mitamura

    Journal of arrhythmia   37 ( 4 )   709 - 870   2021年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1002/joa3.12491

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  • Progressive increase in activation delay during premature stimulation is related to ventricular fibrillation in Brugada syndrome 国際誌

    Yuki Hasegawa, Daisuke Izumi, Yasuhiro Ikami, Sou Otsuki, Nobue Yagihara, Kenichi Iijima, Masaomi Chinushi, Tohru Minamino

    Journal of Cardiovascular Electrophysiology   32 ( 7 )   1939 - 1946   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    INTRODUCTION: The local conduction delay has been deemed to play an important role in the perpetuation of ventricular fibrillation (VF) in Brugada syndrome (BrS). We evaluated the relationship between the activation delay during programmed stimulation and cardiac events in BrS patients. METHODS: This study included 47 consecutive BrS patients who underwent an electrophysiological study and received implantable cardiac defibrillator therapy. We divided the patients into two groups based on whether they had developed VF (11 patients) or not (36 patients) during the follow-up period of 89 ± 53 months. The activation delay was assessed using the interval between the stimulus and the QRS onset during programmed stimulation. The mean increase in delay (MID) was used to characterize the conduction curves. RESULTS: The MID at the right ventricular outflow tract (RVOT) was significantly greater in patients with VF (4.5 ± 1.2 ms) than in those without VF (2.2 ± 0.9 ms) (p < .001). A receiver operating characteristics curve analysis indicated that the optimal cut-off point for discriminating VF occurrence was 3.3 with 88.9% sensitivity and 91.3% specificity. Furthermore, patients with an MID at the RVOT ≥ 3.3 ms showed significantly higher rates of VF recurrence than those with an MID at the RVOT < 3.3 ms (p < .001). The clinical characteristics, including the signal-averaged electrocardiogram measurement and VF inducibility were similar between the two groups. CONCLUSION: A prolonged MID at the RVOT was associated with VF and maybe an additional electrophysiological risk factor for VF in BrS patients.

    DOI: 10.1111/jce.15065

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  • Novel electrocardiographic criteria for short QT syndrome in children and adolescents. 国際誌

    Hiroshi Suzuki, Minoru Horie, Junichi Ozawa, Naokata Sumitomo, Seiko Ohno, Kenji Hoshino, Eiji Ehara, Kazuhiro Takahashi, Yoshichika Maeda, Masao Yoshinaga, Shigeru Tateno, Junichi Takagi, Shozaburo Doi, Satoshi Hoshina, Isamu Sato, Taisuke Ishikawa, Naomasa Makita, Masaomi Chinushi, Kohei Akazawa, Masami Nagashima

    Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology   23 ( 12 )   2029 - 2038   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIMS: Although shortening of the corrected QT interval (QTc) is a key finding in the diagnosis of short QT syndrome (SQTS), there may be overlap of the QTc between SQTS patients and normal subjects in childhood and adolescence. We aimed to investigate electrocardiographic findings for differentiation of SQTS patients. METHODS AND RESULTS: The SQTS group comprised 34 SQTS patients <20 years old, including 9 from our institutions and 25 from previous reports. The control group comprised 61 apparently healthy subjects with an QTc of <360 ms who were selected from 13 314 participants in a school-based screening programme. We compared electrocardiographic findings, including QT and Jpoint-Tpeak intervals (QT and J-Tpeak, respectively), those corrected by using the Bazett's and Fridericia's formulae (cB and cF, respectively) and early repolarization (ER) between the groups. QT, QTc by using Bazett's formula (QTcB), QTc by using Fridericia's formula (QTcF), J-Tpeak, J-Tpeak cB, and J-Tpeak cF were significantly shorter in the SQTS group than in the control group. On receiver operating characteristic curve analysis, the area under the curve (AUC) was largest for QTcB (0.888) among QT, QTcB, and QTcF, with a cut-off value of 316 ms (sensitivity: 79.4% and specificity: 96.7%). The AUC was largest for J-Tpeak cB (0.848) among J-Tpeak, J-Tpeak cB, and J-Tpeak cF, with a cut-off value of 181 ms (sensitivity: 80.8% and specificity: 91.8%). Early repolarization was found more frequently in the SQTS group than in the control group (67% vs. 23%, P = 0.001). CONCLUSION: A QTcB <316 ms, J-Tpeak cB < 181 ms, and the presence of ER may indicate SQTS patients in childhood and adolescence.

    DOI: 10.1093/europace/euab097

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  • JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias.

    Akihiko Nogami, Takashi Kurita, Haruhiko Abe, Kenji Ando, Toshiyuki Ishikawa, Katsuhiko Imai, Akihiko Usui, Kaoru Okishige, Kengo Kusano, Koichiro Kumagai, Masahiko Goya, Yoshinori Kobayashi, Akihiko Shimizu, Wataru Shimizu, Morio Shoda, Naokata Sumitomo, Yoshihiro Seo, Atsushi Takahashi, Hiroshi Tada, Shigeto Naito, Yuji Nakazato, Takashi Nishimura, Takashi Nitta, Shinichi Niwano, Nobuhisa Hagiwara, Yuji Murakawa, Teiichi Yamane, Takeshi Aiba, Koichi Inoue, Yuki Iwasaki, Yasuya Inden, Kikuya Uno, Michio Ogano, Masaomi Kimura, Shun-Ichiro Sakamoto, Shingo Sasaki, Kazuhiro Satomi, Tsuyoshi Shiga, Tsugutoshi Suzuki, Yukio Sekiguchi, Kyoko Soejima, Masahiko Takagi, Masaomi Chinushi, Nobuhiro Nishi, Takashi Noda, Hitoshi Hachiya, Masataka Mitsuno, Takeshi Mitsuhashi, Yasushi Miyauchi, Aya Miyazaki, Tomoshige Morimoto, Hiro Yamasaki, Yoshifusa Aizawa, Tohru Ohe, Takeshi Kimura, Kazuo Tanemoto, Hiroyuki Tsutsui, Hideo Mitamura

    Circulation journal : official journal of the Japanese Circulation Society   85 ( 7 )   1104 - 1244   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1253/circj.CJ-20-0637

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  • 抗ミトコンドリア抗体陽性ミオパチーおよび原発性胆汁性胆管炎患者における心室頻拍の臨床的特徴(The Clinical Features of Ventricular Tachyarrhythmias in Patient with Anti-Mitochondrial Antibody-Associated Myopathy and/or Primary Biliary Cholangitis)

    井神 康宏, 和泉 大輔, 鈴木 尚真, 坂口 裕太, 袴田 崇裕, 長谷川 祐紀, 大槻 総, 飯嶋 賢一, 八木原 伸江, 池主 雅臣, 南野 徹

    日本循環器学会学術集会抄録集   85回   OJ91 - 5   2021年3月

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    記述言語:英語   出版者・発行元:(一社)日本循環器学会  

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  • CORRIGENDUM: JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias.

    Akihiko Nogami, Takashi Kurita, Haruhiko Abe, Kenji Ando, Toshiyuki Ishikawa, Katsuhiko Imai, Akihiko Usui, Kaoru Okishige, Kengo Kusano, Koichiro Kumagai, Masahiko Goya, Yoshinori Kobayashi, Akihiko Shimizu, Wataru Shimizu, Morio Shoda, Naokata Sumitomo, Yoshihiro Seo, Atsushi Takahashi, Hiroshi Tada, Shigeto Naito, Yuji Nakazato, Takashi Nishimura, Takashi Nitta, Shinichi Niwano, Nobuhisa Hagiwara, Yuji Murakawa, Teiichi Yamane, Takeshi Aiba, Koichi Inoue, Yuki Iwasaki, Yasuya Inden, Kikuya Uno, Michio Ogano, Masaomi Kimura, Shun-Ichiro Sakamoto, Shingo Sasaki, Kazuhiro Satomi, Tsuyoshi Shiga, Tsugutoshi Suzuki, Yukio Sekiguchi, Kyoko Soejima, Masahiko Takagi, Masaomi Chinushi, Nobuhiro Nishi, Takashi Noda, Hitoshi Hachiya, Masataka Mitsuno, Takeshi Mitsuhashi, Yasushi Miyauchi, Aya Miyazaki, Tomoshige Morimoto, Hiro Yamasaki, Yoshifusa Aizawa, Tohru Ohe, Takeshi Kimura, Kazuo Tanemoto, Hiroyuki Tsutsui, Hideo Mitamura

    Circulation journal : official journal of the Japanese Circulation Society   85 ( 9 )   1692 - 1700   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1253/circj.CJ-66-0196

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  • Usefulness of the intravenous flecainide challenge test before oral flecainide treatment in a patient with Andersen-Tawil syndrome. 査読 国際誌

    Sato A, Takano T, Chinushi M, Minamino T

    BMJ case reports   12 ( 7 )   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1136/bcr-2019-229628

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  • Asymptomatic Coronary Artery Disease in Japanese Patients With the Acute Ischemic Stroke

    Minoru Tagawa, Shigekazu Takeuchi, Yuichi Nakamura, Makihiko Saeki, Yoshinori Taniguchi, Tsukasa Ohno, Hiroyuki Watanabe, Yukie Ochiai, Kiminori Kato, Masaomi Chinushi, Yoshifusa Aizawa

    Journal of Stroke and Cerebrovascular Diseases   28 ( 3 )   612 - 618   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W.B. Saunders  

    Objective: To investigate the prevalence and outcomes of asymptomatic coronary artery disease (CAD) in patients with the first episode of ischemic stroke. Methods: Patients admitted to our hospital between November 2001 and January 2009 for the episode of an acute ischemic stroke/transient ischemic attack were included. Stress-Tl-201 scintigraphy was performed and followed by coronary angiography (CAG). The prevalence and risks for asymptomatic CAD, and long-term outcomes were studied. Results: Of 1309 patients, only 15 (1.1%) patients presented with a history of CAD. Excluding 406 patients because of severity, systemic infection, early transfer to another hospital, or a refusal to participate, myocardial scintigraphy was performed in 903 patients (mean age, 72 ± 10 years, male 63.9%), and myocardial ischemia was diagnosed in 214 patients (23.7%). Of these patients, 76 patients underwent CAG, and showed significant stenosis (&gt
    75%) of a coronary artery in 61 (80.3%) patients. The risk factors for positive scintigraphy findings and CAG were high-grade premature complexes via Holter monitoring (P &lt
    .0001), enlarged left ventricle (P =.0051) and wall motion abnormalities (P =.0014) observed on echocardiography, and carotid artery stenosis observed in magnetic resonance angiography imaging (P &lt
    .0001). During the follow-up periods of 83 ± 47 months and of 91 ± 47 months, 17.2% of scintigraphy-positive and 2.8% of scintigraphy-negative patients developed episodes of myocardial ischemia, respectively (P &lt
    .001). Conclusions: Symptomatic CAD was rare in Japanese patients with the first episode of ischemic stroke, but asymptomatic CAD was identified by stress Tl-201 myocardial scintigraphy in one-quarter of the patients. Positive scintigraphy was associated with asymptomatic CAD and future cardiac events.

    DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.035

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  • Effects of Direct Oral Anticoagulants at the Peak Phase, Trough Phase, and After Vascular Injury. 査読 国際誌

    Sou Otuki, Daisuke Izumi, Masayoshi Suda, Akinori Sato, Yuki Hasegawa, Nobue Yagihara, Kenichi Iijima, Masaomi Chinushi, Ichiro Fuse, Tohru Minamino

    Journal of the American College of Cardiology   71 ( 1 )   102 - 104   2018年1月

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  • Incorrect Holter-ECG analysis caused by the pacemaker delivering small high-frequency currents for thoracic impedance measurement 査読

    Masaomi Chinushi, Hitoshi Tachikawa, Yuko Chinushi, Toshio Yamaguchi, Osamu Saitoh, Takashi Tsuda

    Journal of Cardiology Cases   16 ( 6 )   219 - 222   2017年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier Ltd  

    In an 86-year-old woman who had been treated for sick sinus syndrome, the small high-frequency current delivered by pacemaker in order to measure the minutes ventilation for utilizing the rate-response mode was transiently over-sensed on the Holter electrocardiogram. Although her pacing system was working appropriately, the numbers of the paced beats on the automatic Holter analysis were undercounted (from &gt
    60% to &lt
    5%) during the over-sensing periods because these currents were recognized as multiple pacing spikes. Physicians need to pay attention to such multiple pacing spike markers, because these can be a cause of unreliable results of the Holter analysis. &lt
    Learning objective: Paying attention to multiple pacing spike markers on Holter electrocardiogram is clinically important in patients treated by a rate-response pacemaker. This is because (1) this does not imply the malfunction of the pacemaker system, and (2) results from automatic Holter analysis would not be reliable during the period when these multiple pacing markers were recorded.&gt

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  • The effects of pure potassium channel blocker nifekalant and sodium channel blocker mexiletine on malignant ventricular tachyarrhythmias 査読

    Sou Otuki, Kanae Hasegawa, Hiroshi Watanabe, Goro Katsuumi, Nobue Yagihara, Kenichi Iijima, Akinori Sato, Daisuke Izumi, Hiroshi Furushima, Masaomi Chinushi, Yoshifusa Aizawa, Tohru Minamino

    JOURNAL OF ELECTROCARDIOLOGY   50 ( 3 )   277 - 281   2017年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    Background: Patients with repetitive ventricular tachyarrhythmias so-called electrical storm frequently require antiarrhythmic drugs. Amiodarone is widely used for the treatment of electrical storm but is ineffective in some patients. Therefore, we investigated the efficacy of stepwise administration of nifekalant, a pure potassium channel blocker, and mexiletine for electrical storm.
    Methods: This study included 44 patients with repetitive ventricular tachyarrhythmias who received stepwise therapy with nifekalant and mexiletine for electrical storm. Nifekalant was initially administered, and mexiletine was subsequently added if nifekalant failed to control ventricular tachyarrhythmias.
    Results: Nifekalant completely suppressed recurrences of ventricular arrhythmias in 28 patients (64%), including 6 patients in whom oral amiodarone failed to control arrhythmias. In 9 of 16 patients in whom nifekalant was partially effective but failed to suppress ventricular arrhythmias, mexiletine was added. The addition of mexiletine prevented recurrences of ventricular tachyarrhythmias in 5 of these 9 patients (56%). There was no death associated with electrical storm. In total, the stepwise treatment with nifekalant and mexiletine was effective in preventing ventricular tachyarrhythmias in 33 of 44 patients (75%). There was no difference in cycle length of the ventricular tachycardia, QRS interval, QT interval, or left ventricular ejection fraction between patients who responded to antiarrhythmic drugs and those who did not. During follow-up, 8 patients had repetitive ventricular tachyarrhythmia recurrences, and the stepwise treatment was effective in 6 of these 8 patients (75%).
    Conclusions: The stepwise treatment with nifekalant and mexiletine was highly effective in the suppression of electrical storm. (C) 2016 Published by Elsevier Inc.

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  • Malignant Form of Idiopathic Ventricular Arrhythmia Originating from the Right Ventricular Outflow Tract 査読

    Keiko Sonoda, Hiroshi Watanabe, Masaomi Chinushi, Kanae Hasegawa, Nobue Yagihara, Kenichi Iijima, Akinori Sato, Daisuke Izumi, Hiroshi Furushima, Yoshifusa Aizawa

    journal of arrhythmia   27 ( 4 )   316   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Idiopathic ventricular fibrillation (VF) and/or polymorphic VT are occasionally initiated by VT or premature ventricular contraction (PVC) originating from the RVOT. Methods: Among 56 patients without structural heart disease in whom EPS was conducted for idiopathic VT arising from the RVOT, we examined the clinical characteristics in 5 patients with VF or polymorphic VT initiated by PVC originating from RVOT. Results: Episodes of VF were documented in 1 patient and polymorphic VT in 4 patients including one with a family history of aborted sudden death. In holter recording, there was no PVC/VT with short coupling interval in any patients. In Treadmill test, there were no patient with VT/VF inducted by exercise. 2 patients had J waves. The morphologies of PVC triggering polymorphic VT or VF were various:QS pattern was seen in the lead? in 3 patients, RS pattern was seen in the remaining. Conclusion: In this study, we found that the lack of inducibility by exercise and the absence of family history of cardiac disease were not always benign factor in the RVOT-VT/PVC. There were not any special feature in the form of PVC triggering VT/VF. Our findings may be useful to treat the patients with history of syncope and episodes of RVOT VT/VPC. © 2011, Japanese Heart Rhythm Society. All rights reserved.

    DOI: 10.4020/jhrs.27.PJ2_085

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  • Sustained ventricular tachycardia developed following successful ablation of target idiopathic left ventricular premature complexes 査読

    Minoru Tagawa, Yukie Ochiai, Yuichi Nakamura, Hiroshi Furushima, Masaomi Chinushi

    INTERNATIONAL JOURNAL OF CARDIOLOGY   222   686 - 688   2016年11月

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    記述言語:英語   出版者・発行元:ELSEVIER IRELAND LTD  

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  • Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks 査読

    Minoru Tagawa, Sachie Ochiai, Yuichi Nakamura, Akinori Sato, Masaomi Chinushi

    HEART AND VESSELS   31 ( 7 )   1200 - 1205   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    A 73-year-old woman first visited our emergency room with multiple syncopal attacks. Before admission, she had received an antibiotic (Garenoxacin) for 3 days from a local clinic. First electrocardiogram (ECG) showed no ST-segment deviation but mild QT interval prolongation with a positive U wave. Second ECG recording 3 h later showed slightly slower heart rate and revealed marked QTU interval prolongation suggesting the cause of her syncopal attacks. After cessation of Garenoxacin, the QTU interval prolongation shortened. However, both epinephrine infusion and treadmill exercise test reproduced similar QTU interval prolongation and T wave deformities. Later, genetic analysis demonstrated that this patient had a mutation in KCNH2 gene, and she was diagnosed as a type-2 long-QT syndrome which was accentuated by use of garenoxacin. At the emergency out-patient clinic, repetitive ECG recordings can be useful and should be considered in order to identify the cause of syncopal attacks in patients who were prescribed antibiotics and had mild QT interval abnormalities.

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  • Regional Differences in Frequency of Warfarin Therapy and Thromboembolism in Japanese Patients With Non-Valvular Atrial Fibrillation - Analysis of the J-RHYTHM Registry 査読

    Hiroshi Inoue, Hirotsugu Atarashi, Eitaro Kodani, Ken Okumura, Takeshi Yamashita, Hideki Origasa, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani, Tetsunori Saikawa, Akiko Chishaki

    CIRCULATION JOURNAL   80 ( 7 )   1548 - 1555   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background: The proportion of patients with atrial fibrillation (AF) treated with anticoagulation varies from country to country. In Japan, little is known about regional differences in frequency of warfarin use or prognosis among patients with non-valvular AF (NVAF).
    Methods and Results: In J-RHYTHM Registry, the number of patients recruited from each of 10 geographic regions of Japan was based on region population density. A total of 7,406 NVAF patients were followed up prospectively for 2 years. At baseline, significant differences in various clinical characteristics including age, sex, type of AF, comorbidity, and CHADS(2) score, were detected among the regions. The highest mean CHADS(2) score was recorded in Shikoku. Frequency of warfarin use differed between the regions (P&lt;0.001), with lower frequencies observed in Hokkaido and Shikoku. Baseline prothrombin time international normalized ratio differed slightly but significantly between the regions (P&lt;0.05). On univariate analysis, frequency of thromboembolic events differed among the regions (P&lt;0.001), with the highest rate seen in Shikoku. An inverse correlation was detected between frequency of thromboembolic and of major hemorrhagic events (P=0.062). On multivariate analysis, region emerged as an independent risk for thromboembolism.
    Conclusions: Thromboembolic risk, frequency of warfarin use, and intensity and quality of warfarin treatment differed significantly between geographic regions of Japan. Region was found to be an independent predictor of thromboembolic events.

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  • 血圧調整における左右腎交感神経興奮の役割 (実験モデルの神経電気刺激と高周波アブレーション)

    池主 雅臣, 鈴木 克弥, 齋藤 修, 大矢 佳奈, 飯嶋 賢一, 佐藤 光希, 和泉 大輔, 須貝 美佳, 古嶋 博司

    心臓   48 ( 6 )   608 - 616   2016年6月

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    記述言語:日本語   出版者・発行元:公益財団法人 日本心臓財団  

    腎動脈アブレーションでは両側腎動脈に高周波通電が行われているが, その根拠は明らかにされていない. 高周波通電が両側腎動脈に行われる理由を検証するため動物実験を行った. ビーグル犬を用いて血圧調整における左右腎交感神経興奮の効果を, 腎動脈高周波アブレーション前後の神経電気刺激の昇圧反応から検討した. 腎動脈にイリゲーションカテーテルを挿入して高周波通電を片側腎動脈に行い, 先端電極からの神経電気刺激をアブレーション前後で施行した. アブレーション前の神経電気刺激で昇圧速脈反応が左右腎動脈で同程度に誘発され, 心拍変動解析の交感神経指標と血中カテコラミン値も上昇した. アブレーションを施行した腎動脈では神経電気刺激による昇圧速脈反応は観察されなくなったが, アブレーションをしなかった腎動脈の神経電気刺激では, アブレーション前と同等の昇圧速脈反応が再度誘発された. 腎交感神経刺激による全身交感神経緊張は左右腎動脈で同等に生じ, 一側腎動脈アブレーションは, 対側腎動脈刺激の昇圧速脈誘発に影響を与えなかった. 腎動脈アブレーションで成果を得るには, 両側腎動脈通電が望まれることを支持する所見と思われる.&lt;/p&gt;

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  • 器質的心疾患症例の心室不整脈と自律神経興奮

    池主 雅臣, 齋藤 修, 奥田 明子, 古嶋 博司

    心電図   36 ( 1 )   31 - 37   2016年

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    記述言語:日本語   出版者・発行元:一般社団法人 日本不整脈心電学会  

    交感神経興奮は器質的心疾患症例の心室不整脈に対する催不整脈効果を有し,迷走神経興奮は抗不整脈作用を示すと考えられる.自律神経興奮はその強度のみならず,交感神経興奮と迷走神経興奮のバランス,変動のダイナミクスも不整脈発症に影響を及ぼす.日常診療では,器質的心疾患を有する心室不整脈に,心機能と不整脈の両面からβ遮断薬が用いられるとともに,β遮断薬作用を併せもつIII群抗不整脈薬が処方されている.繰り返し生じる心室頻拍によりelectrical stormに陥った場合,自律神経は重要な治療介入ポイントとなる.初期治療では鎮痛・鎮静・麻酔とともにβ遮断薬が用いられるが,重症例では短期作用型β遮断薬静注,さらには心臓交感神経のブロック・切除,腎動脈カテーテルアブレーション,硬膜外ブロックなどの非薬物治療が用いられる場合があり,交感神経興奮抑制を介した一定の治療効果が期待できる.

    DOI: 10.5105/jse.36.31

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    その他リンク: http://search.jamas.or.jp/link/ui/2016172097

  • Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry 査読

    Akiko Chishaki, Naoko Kumagai, Naohiko Takahashi, Tetsunori Saikawa, Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, Hideki Origasa, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani

    THROMBOSIS RESEARCH   136 ( 2 )   267 - 273   2015年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:PERGAMON-ELSEVIER SCIENCE LTD  

    Introduction: Recently, direct-acting oral anticoagulants (DOACs) have been introduced, with increasing use in patientswith non-valvular atrial fibrillation (NVAF). However, warfarin continues to be widely used and the benefits and risks of warfarin in NVAF patients warrant closer inspection.
    Materials and Methods: Thromboembolism, major hemorrhage, and total and cardiovascular mortalities were analyzed in 7,406 NVAF patients in the J-RHYTHM Registry from January to July 2009, prior to DOAC introduction. Propensity score matching analysis was performed to reduce the differences in clinical characteristics between non-anticoagulant (n = 1002) and warfarin (n = 6404) cohorts to reassess warfarin outcomes over 2 years.
    Results: The incidence of thromboembolism was significantly greater in the non-anticoagulant cohort (3.0%) than in the warfarin cohort (1.5%, P &lt; 0.001) with less frequent major hemorrhage in the non-anticoagulant cohort (0.8%) than in the warfarin cohort (2.1%, P = 0.009). Using propensity score matching, new subsets (n = 896 each) were obtained, with matching of the clinical characteristics between warfarin and non-anticoagulant subsets. The warfarin subset had lower risk factors compared with the total warfarin cohort. The incidence of thromboembolism was higher in the non-anticoagulant subset (2.9%) than in the warfarin subset (0.7%, P &lt; 0.001). However, major hemorrhage was not significantly different between the two subsets.
    Conclusions: Although warfarin was associated with a significantly higher incidence of hemorrhage in the unmatched cohorts, propensity score matching revealed that warfarin reduced thromboembolism without a significant increase in hemorrhage in the matched subsets with lower risks. Propensity score matching reduced selection bias and provided rational comparisons although it had indwelling limitations. (C) 2015 Elsevier Ltd. All rights reserved.

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  • Effects of combination therapy with nifekalant and mexiletine on electrical storm 査読

    S. Otuki, K. Hasegawa, H. Watanabe, N. Yagihara, K. Iijima, A. Sato, D. Izumi, H. Furushima, M. Chinushi, T. Minamino

    EUROPEAN HEART JOURNAL   36   1068 - 1068   2015年8月

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    記述言語:英語   出版者・発行元:OXFORD UNIV PRESS  

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  • Frequency Characteristics and Associations with the Defibrillation Threshold of Ventricular Fibrillation in Patients with Implantable Cardioverter Defibrillators 査読

    Kenichi Iijima, Masaomi Chinushi, Osamu Saitoh, Kanae Hasegawa, Keiko Sonoda, Nobue Yagihara, Akinori Sato, Daisuke Izumi, Hiroshi Watanabe, Hiroshi Furushima, Yoshifusa Aizawa, Tohru Minamino

    INTERNAL MEDICINE   54 ( 10 )   1175 - 1182   2015年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Objective The dominant frequency (DF) in frequency analyses is considered to represent the objective cycle length and complexity of activation under conditions of ventricular fibrillation (VF). However, knowledge regarding the mechanisms determining the DF in human VF is limited. We studied the characteristics of the DF of human VF and relationship between DF and the defibrillation threshold.
    Methods Seventy-two implantable cardioverter-defibrillator patients and 211 VF were studied. Using defibrillation tests, we performed a frequency analysis with fast Fourier transformation. The correlations between DF and clinical characteristics, including the defibrillation threshold, were assessed.
    Results The mean DF of all induced VFs was 5.2 +/- 0.8 Hz. The patients were divided into two groups according to DF: the low-DF (DF &lt;5.2 Hz, n=32) and high-DF (DF &gt;= 5.2 Hz, n=40) groups. The frequency of structural heart disease was significantly higher in the low-DF group. In addition, the QRS duration, QT interval and effective refractory period of the right ventricle (RV-ERP) were significantly longer in the low-DF group. A multivariate analysis showed RV-ERP to be the only independent predictor of DF. Excluding patients receiving group III anti-arrhythmic drugs, which are known to have potent defibrillation threshold effects, the defibrillation threshold was significantly lower in the low-DF group (p=0.026).
    Conclusion We found that the DF of human VF is associated with underlying heart disease, the cardiac function, cardiac conduction, ventricular refractoriness and defibrillation threshold. Our findings may be useful for identifying and managing patients with a high defibrillation threshold.

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  • Circadian pattern of fibrillatory events in non-Brugada-type idiopathic ventricular fibrillation with a focus on J waves 査読

    Yoshiyasu Aizawa, Masahito Sato, Seiko Ohno, Minoru Hone, Seiji Takatsuki, Keiichi Fukuda, Masaomi Chinushi, Tatsuya Usui, Kazutaka Aonuma, Yukio Hosaka, Michel Haissaguerre, Yoshifusa Aizawa

    HEART RHYTHM   11 ( 12 )   2261 - 2266   2014年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    BACKGROUND The circadian pattern of ventricular fibrillation (VF) episodes in patients with idiopathic ventricular fibrillation (IVF) is poorly understood. OBJECTIVE The purpose of this study was to assess the circadian pattern of VF occurrence in patients with IVF.
    METHODS Excluding Brugada syndrome and other primary electrical diseases, the circadian pattern of VF occurrence was determined in 64 patients with IVF. The clinical and electrocardiographic characteristics were compared among patients with nocturnal (midnight to 6:00 AM) VF and nonnocturnal VF in relation to 3 waves. A 3 wave was defined as either notching or a slur at the QRS terminal &gt;0.1 mV above the isoelectric line in contiguous leads.
    RESULTS The overall distribution pattern of VF occurrence showed 2 peaks at approximately 6:00 AM and around 8:00 PM, Nocturnal VF was observed in 20 patients (31.3%), and J waves were present in 14 of these 20 individuals (70.0%), whereas 3 waves were less frequent in the 44 nonnocturnal patients with VF: 16 (36.4%) (P = .0117). Among patients with J waves, nocturnal VF was observed in 46.7% with a peak at approximately 4:00 AM. Nocturnal VF was Less common in patients without 3 waves, occurring in only 17.6% (P = .0124). Both the type and Location of J waves and the pattern of the ST segment were similar between the nocturnal and nonnocturnal VF groups. 3 waves were associated with a VF storm and Long-term arrhythmia recurrence.
    CONCLUSION In IVF, the presence of J waves may characterize a higher nocturnal incidence of VF and a higher acute and chronic risk of recurrence.

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  • 心拍変動に伴うQT間隔のダイナミクス トレッドミル運動負荷試験を用いた検討

    鈴木 克弥, 齋藤 修, 阪井 絵理伽, 渡邊 美友貴, 道村 玲香, 阿部 望, 奈良 佳輝, 田中 勇気, 末永 有香, 飯沼 裕美, 神林 真弓, 大井 恵子, 大矢 佳奈, 加藤 公則, 津田 隆志, 池主 雅臣

    新潟県臨床検査技師会誌   54 ( 4 )   212 - 216   2014年10月

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    記述言語:日本語   出版者・発行元:(一社)新潟県臨床検査技師会  

    トレッドミル運動負荷試験中のQT間隔の変動がBazett補正式で適正に補正されるか検討した。対象は健常者226名とし、運動によるQT/QTc間隔のダイナミクスを回帰曲線式で分析した。結果、安静臥位から立位への体位変化または運動中の心拍数増加に伴ってBazett補正によるQTc間隔が適正範囲を逸脱した者が23%存在した。

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  • 時系列コンピュータ解析によるJ波高の定量的評価 日内変動における自律神経興奮の関わり

    齋藤 修, 鈴木 克弥, 大矢 佳奈, 杉浦 広隆, 大塚 英明, 池主 雅臣

    新潟県臨床検査技師会誌   54 ( 3 )   150 - 154   2014年7月

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    記述言語:日本語   出版者・発行元:(一社)新潟県臨床検査技師会  

    心電図でJ波を認めた正常洞調律の27例(男19例、女8例、平均36歳)を対象に、時系列コンピュータ解析によりJ波高の定量的評価を行った。24時間心電図で期外収縮等を除外した正常心拍を毎分加算平均し、QRS波の開始直前の基線を基準点としてR波頂点の8ms後から72ms後までの区間の電位高を8ms間隔ごとに計測した。この結果とマニュアル計測したJ波高とは、幅広いレンジでほぼ一致した。J波高には日内変動がみられ、夜間上昇型が22例(A群)、非夜間上昇型が5例(B群)で、患者背景やJ波高の変動幅は両群間で有意差がなかった。心拍変動解析では、高周波成分(HF)パワーは両群とも夜間に上昇し、低周波成分/HFは夜間に低下する傾向で、日中のHFパワーに有意差はなかったが、夜間はA群で有意に高値であった。A群の最大J波高はHFパワー値と正の相関を示し、夜間のJ波増高に迷走神経興奮の関与が示唆された。

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  • Efficacy of bepridil to prevent ventricular fibrillation in severe form of early repolarization syndrome 査読

    Goro Katsuumi, Wataru Shimizu, Hiroshi Watanabe, Takashi Noda, Akihiko Nogami, Kimie Ohkubo, Takeru Makiyama, Naofumi Takehara, Yuichiro Kawamura, Yukio Hosaka, Masahito Sato, Satoki Fukae, Masaomi Chinushi, Hirotaka Oda, Masaaki Okabe, Akinori Kimura, Koji Maemura, Ichiro Watanabe, Shiro Kamakura, Minoru Horie, Yoshifusa Aizawa, Naomasa Makita, Tohru Minamino

    INTERNATIONAL JOURNAL OF CARDIOLOGY   172 ( 2 )   519 - 522   2014年3月

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    記述言語:英語   出版者・発行元:ELSEVIER IRELAND LTD  

    DOI: 10.1016/j.ijcard.2014.01.036

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  • Augmentation of the J wave by rapid pacing in a patient with vasospastic angina 査読

    Akinori Sato, Hiroshi Watanabe, Keiko Sonoda, Masaomi Chinushi, Takashi Tsuda, Daisuke Izumi, Hiroshi Furushima, Tohru Minamino

    INTERNATIONAL JOURNAL OF CARDIOLOGY   172 ( 1 )   E111 - E113   2014年3月

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    記述言語:英語   出版者・発行元:ELSEVIER IRELAND LTD  

    DOI: 10.1016/j.ijcard.2013.12.121

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  • Impact of Gender on the Prognosis of Patients With Nonvalvular Atrial Fibrillation 査読

    Hiroshi Inoue, Hirotsugu Atarashi, Ken Okumura, Takeshi Yamashita, Hideki Origasa, Naoko Kumagai, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani, Tetsunori Saikawa, Akiko Chishaki

    AMERICAN JOURNAL OF CARDIOLOGY   113 ( 6 )   957 - 962   2014年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

    Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70 years) who were followed-up prospectively for 2 years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n = 5,241), female subjects (n = 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and coronary artery disease. Male and female patients had mean CHADS(2) (Congestive heart failure, Hypertension, Age of 75 years or more, Diabetes mellitus and prior Stroke or transient ischetnic attack) scores of 1.6 and 1.8, respectively (p &lt;0.001); Warfarin was given to 87% of male patients and 86% of female patients (p = 0.760), and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline (1.91 vs 1.90, respectively, p = 0.756). Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging (odds ratio 1.59,95% confidence interval 1.05 to 2.40, p = 0.027) and all-cause mortality (odds ratio 1.78, 95% confidence interval 1.25 to 2.55, p &lt;0.002) but not for thromboembolic events (odds ratio 1.24, 95% confidence interval 0.83 to 1.86, p = 0.297) or cardiovascular mortality (odds ratio 0.96,95% confidence interval 0.56 to 1.66, p = 0.893). In conclusion, female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin. However, male gender is a risk factor for major hemorrhaging and all-cause mortality. (c) 2014 Elsevier Inc. All rights reserved.

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  • Efficacy of Bepridil to Prevent Ventricular Fibrillation in Early Repolarization Syndrome 査読

    Katsuumi Goro, Shimizu Wataru, Watanabe Hiroshi, Noda Takashi, Nogami Akihiko, Ohkubo Kimie, Takehara Naofumi, Kawamura Yuichiro, Hosaka Yukio, Makiyama Takeru, Sato Masahito, Fukae Satoki, Chinushi Masaomi, Oda Hirotaka, Okabe Masaaki, Kimura Akinori, Maemura Koji, Watanabe Ichiro, Kamakura Shiro, Horie Minoru, Aizawa Yoshifusa, Makita Naomasa, Minamino Tohru

    CIRCULATION   128 ( 22 )   2013年11月

  • Target International Normalized Ratio Values for Preventing Thromboembolic and Hemorrhagic Events in Japanese Patients With Non-Valvular Atrial Fibrillation - Results of the J-RHYTHM Registry (vol 77, pg 2264, 2013) 査読

    Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, Hideki Origasa, Naoko Kumagai, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okayama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani, Tetsunori Saikawa, Akiko Chishaki

    CIRCULATION JOURNAL   77 ( 11 )   2848 - 2848   2013年11月

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    記述言語:英語   出版者・発行元:JAPANESE CIRCULATION SOC  

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  • Electrical storm in idiopathic ventricular fibrillation is associated with early repolarization 査読

    Yoshifusa Aizawa, Masaomi Chinushi, Kanae Hasegawa, Nobu Naiki, Minoru Horie, Yoshiaki Kaneko, Masahiko Kurabayashi, Shogo Ito, Tsutomu Imaizumi, Yoshiyasu Aizawa, Seiji Takatsuki, Kunitake Joo, Masahito Sato, Katsuya Ebe, Yukio Hosaka, Michel Haissaguerre, Keiichi Fukuda

    Journal of the American College of Cardiology   62 ( 11 )   1015 - 1019   2013年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objectives This study sought to characterize patients with idiopathic ventricular fibrillation (IVF) who develop electrical storms. Background Some IVF patients develop ventricular fibrillation (VF) storms, but the characteristics of these patients are poorly known. Methods Ninety-one IVF patients (86% male) were selected after the exclusion of structural heart diseases, primary electrical diseases, and coronary spasm. Electrocardiogram features were compared between the patients with and without electrical storms. A VF storm was defined as VF occurring ≥3 times in 24 h and J waves &gt
    0.1 mV above the isoelectric line in contiguous leads. Results Fourteen (15.4%) patients had VF storms occurring out-of-hospital at night or in the early morning. J waves were more closely associated with VF storms compared to patients without VF storms: 92.9% versus 36.4% (p &lt
    0.0001). VF storms were controlled by intravenous isoproterenol, which attenuated the J-wave amplitude. After the subsidence of VF storms, the J waves decreased to the nondiagnostic level during the entire follow-up period. Implantable cardioverter-defibrillator therapy was administered to all patients during follow-up. Quinidine therapy was limited, but the patients on disopyramide (n = 3), bepridil (n = 1), or isoprenaline (n = 1) were free from VF recurrence, while VF recurred in 5 of the 9 patients who were not given antiarrhythmic drugs. Conclusions The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves, which diminished to below the diagnostic level during follow-up. VF recurred in patients followed up without antiarrhythmic agents. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.

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  • Ventricular fibrillation associated with complete right bundle branch block 査読

    Yoshiyasu Aizawa, Seiji Takatsuki, Takehiro Kimura, Nobuhiro Nishiyama, Kotaro Fukumoto, Yoko Tanimoto, Kojiro Tanimoto, Shunichiro Miyoshi, Makoto Suzuki, Yasuhiro Yokoyama, Masaomi Chinushi, Ichiro Watanabe, Satoshi Ogawa, Yoshifusa Aizawa, Charles Antzelevitch, Keiichi Fukuda

    HEART RHYTHM   10 ( 7 )   1028 - 1035   2013年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    BACKGROUND A substantial number of patients with idiopathic ventricular fibrillation (IVF) present with no specific electrocardiographic (ECG) findings.
    OBJECTIVE To evaluate complete right bundle branch block (RBBB) in patients with IVF.
    METHODS Patients with IVF showing complete RBBB were included in the present study. Structural and primary electrical diseases were excluded, and provocation tests were performed to exclude the presence of spastic angina or Brugada syndrome (BrS). The prevalence of complete RBBB and the clinical and ECG parameters were compared either in patients with IVF who did not show RBBB or in the general population and age and sex comparable controls with RBBB.
    RESULTS Of 96 patients with IVF, 9 patients were excluded for the presence of BrS. Of 87 patients studied, 10 (11.5%) patients showed complete RBBB. None had structural heart diseases, BrS, or coronary spasms. The mean age was 44 +/- 15 years, and 8 of 10 patients were men. Among the ECG parameters, only the QRS duration was different from that of the other patients with IVF who did not show complete RBBB. Ventricular fibrillation recurred in 3:2 in the form of storms, which were well suppressed by isoproterenol. Complete RBBB was found less often in control subjects (1.37%; P &lt;.0001), and the QRS duration was more prolonged in patients with IVF: 139 +/- 10 ms vs 150 +/- 14 ms (P = .0061).
    CONCLUSIONS Complete RBBB exists more often in patients with IVF than in controls. A prolonged (IRS complex suggests a conduction abnormality. Our findings warrant further investigation of the role of RBBB in the development of arrhythmias in patients with IVF.

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  • Short-coupling premature ventricular complexes from the left ventricle triggered isoproterenol-resistant electrical storm in a patient with Brugada syndrome 査読

    Masaomi Chinushi, Kenichi Iijima, Akinori Sato, Hiroshi Furushima

    HEART RHYTHM   10 ( 6 )   916 - 920   2013年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

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  • Suppression of Storms of Ventricular Tachycardia by Epicardial Ablation of Isolated Delayed Potential in Noncompaction Cardiomyopathy 査読

    Masaomi Chinushi, Kenichi Iijima, Hiroshi Furushima, Daisuke Izumi, Akinori Sato, Nobue Yagihara, Kanae Hasegawa, Hiroshi Watanabe, Kyoko Soejima, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   36 ( 4 )   e115 - e119   2013年4月

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    記述言語:英語   出版者・発行元:WILEY-BLACKWELL  

    A 65-year-old recipient of an implantable cardioverter defibrillator suffering from ventricular noncompaction developed storms of ventricular tachycardia (VT). Epicardial voltage mapping revealed the presence of a large low-voltage area in the left ventricular apical and inferoposterior wall, and isolated delayed potential was recorded over 1.5 cm in the posterior border between low and normal myocardial voltage. Pacemapping at the delayed potential recording site produced two different QRS depending on pacing output strength, and these two QRS morphologies were similar to clinically documented VTs. During one of the VTs, a mid-diastolic potential was recorded from the site with the delayed potential, and rapid pacing produced concealed entrainment. After epicardial radiofrequency ablation of the isolated delayed potential, VTs were noninducible and the VT storm was suppressed. (PACE 2013; 36:e115-e119)

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  • [Arrhythmia and genetic background]. 査読

    Chinushi M, Sato A

    Rinsho byori. The Japanese journal of clinical pathology   61 ( 2 )   150 - 158   2013年2月

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  • Guidelines for Clinical Cardiac Electrophysiologic Studies (JCS 2011) - Digest Version - JCS Joint Working Group 査読

    Satoshi Ogawa, Yoshifusa Aizawa, Kazutaka Aonuma, Makoto Hirai, Yoshito Iesaka, Hiroshi Inoue, Toshiyuki Ishikawa, Shiro Kamakura, Takao Kato, Youichi Kobayashi, Yoshio Kosakai, Koichiro Kumagai, Takashi Kurita, Yuji Nakazato, Ken Okumura, Morio Shoda, Kaoru Sugi, Naokata Sumitomo, Seiji Takatsuki, Kan Takayanagi, Ichiro Watanabe, Masaomi Chinushi, Akira Fujiki, Atsushi Iwasa, Yoshinori Kobayashi, Keisuke Kuga, Satoshi Nagase, Satoshi Ohnishi, Kazuhiro Satomi, Kaoru Tanno, Masayuki Yasuda, Hiroyuki Daida, Kazumasa Hiejima, Hiroshi Kasanuki, Takuro Misaki, Tohru Ohe

    CIRCULATION JOURNAL   77 ( 2 )   497 - 518   2013年2月

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    記述言語:英語   出版者・発行元:JAPANESE CIRCULATION SOC  

    DOI: 10.1253/circj.CJ-66-0055

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  • Ventricular repolarization gradient and electrocardiogram characteristics of Tako-Tsubo cardiomyopathy 査読

    Masaomi Chinushi

    HEART RHYTHM   10 ( 1 )   78 - 79   2013年1月

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    記述言語:英語   出版者・発行元:ELSEVIER SCIENCE INC  

    DOI: 10.1016/j.hrthm.2012.09.013

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  • Amiodarone-related sinoatrial node dysfunction and its implications in the treatment of atrial fibrillation 査読

    Masaomi Chinushi

    Circulation Journal   77 ( 9 )   2240 - 2241   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1253/circj.CJ-13-0878

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  • Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation: results of the J-RHYTHM Registry. 査読

    Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, Hideki Origasa, Naoko Kumagai, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani, Tetsunori Saikawa, Akiko Chishaki

    Circulation journal : official journal of the Japanese Circulation Society   77 ( 9 )   2264 - 70   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. METHODS AND RESULTS: Of 7,527 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Patients were followed-up prospectively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboembolic events occurred in 3.0% of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8%/2 years for INR values of ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1% for INR values ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8%/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. CONCLUSIONS: An INR of 1.6-2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6-2.99 is also effective, but associated with a slightly increased risk in major hemorrhage. (UMIN Clinical Trials Registry UMIN000001569)

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  • Malfunction of cardiac resynchronization therapy due to subsequent fracture of the ring and tip conductors of a co-radial left ventricular bipolar lead 査読

    Akinori Sato, Masaomi Chinushi, Daisuke Izumi, Hiroshi Furushima, Tohru Minamino

    Internal Medicine   52 ( 11 )   1189 - 1193   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    In two patients treated with cardiac resynchronization therapy (CRT), left ventricular (LV) pacing failure occurred due to ring conductor fractures of the bipolar LV lead (co-radial model). CRT was resumed by pacing between the tip conductor of the LV lead and the coil conductor of the right ventricular lead. However, shortly thereafter, subsequent fracture of the tip conductor developed, and implantation of a new LV lead was required. When one of the bipolar conductors of a co-radial designed LV lead fractures, reimplantation of a new LV lead is a better therapeutic option (than changing the LV pacing mode) in order to reliably continue CRT treatment. © 2013 The Japanese Society of Internal Medicine.

    DOI: 10.2169/internalmedicine.52.8988

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  • Incessant ventricular tachyarrhythmia in the emergency room 査読

    Masaomi Chinushi, Akinori Sato

    Journal of Cardiology Cases   6 ( 6 )   e185 - e186   2012年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.jccase.2012.09.001

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  • Novel KCNQ1 Missense Mutation Associated with Juvenile-Onset Atrial Fibrillation 査読

    Kanae Hasegawa, Seiko Ohno, Hideki Itoh, Tetuhisa Hattori, Takeru Makiyama, Futoshi Toyoda, Wei-Guang Ding, Masaomi Chinushi, Hiroshi Matsuura, Minoru Horie

    CIRCULATION   126 ( 21 )   2012年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Radiofrequency Catheter Ablation to Ventricular Tachycardia with Tetoralogy of Fallot Usefulness of Ablation to Narrow Channel of Macroreentrant Circuit Around Ventricular Septal Patch 査読

    Hiroshi Furushima, Masaomi Chinushi, Hiroshi Watanabe, Daisuke Izumi, Akinori Sato, Kenichi Iijima

    CIRCULATION   126 ( 21 )   2012年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Correlation between Defibrillation Threshold and Dominant Frequency of Ventricular Fibrillation 査読

    Kenichi Iijima, Akinori Sato, Daisuke Izumi, Hiroshi Watanabe, Hiroshi Furushima, Masaomi Chinushi

    CIRCULATION   126 ( 21 )   2012年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Hemodynamic Responses and Histological Effects of Radiofrequency Catheter Ablation to Renal Artery Sympathetic Nerve 査読

    Masaomi Chinushi, Daisuke Izumi, Kenichi Iijima, Katuya Suzuki, Hiroshi Furushima, Yoshifusa Aizawa, Mitsuya Iwafuchi

    CIRCULATION   126 ( 21 )   2012年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Clinical characteristics and risk of arrhythmia recurrences in patients with idiopathic ventricular fibrillation associated with early repolarization 査読

    Hiroshi Watanabe, Akihiko Nogami, Kimie Ohkubo, Hiro Kawata, Yuka Hayashi, Taisuke Ishikawa, Takeru Makiyama, Satomi Nagao, Nobue Yagihara, Naofumi Takehara, Yuichiro Kawamura, Akinori Sato, Kazuki Okamura, Yukio Hosaka, Masahito Sato, Satoki Fukae, Masaomi Chinushi, Hirotaka Oda, Masaaki Okabe, Akinori Kimura, Koji Maemura, Ichiro Watanabe, Shiro Kamakura, Minoru Horie, Yoshifusa Aizawa, Wataru Shimizu, Naomasa Makita

    INTERNATIONAL JOURNAL OF CARDIOLOGY   159 ( 3 )   238 - 240   2012年9月

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    記述言語:英語   出版者・発行元:ELSEVIER IRELAND LTD  

    DOI: 10.1016/j.ijcard.2012.05.091

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  • Nifekalant Enlarged the Transmural Activation-Recovery Interval Difference as Well as the Peak-to-End Interval on Surface ECG in a Patient with Short-QT Syndrome 査読

    Masaomi Chinushi, Akinori Sato, Daisuke Izumi, Hiroshi Furushima

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   23 ( 8 )   877 - 880   2012年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Transmural ARI Dispersion in SQTS. A 38-year-old woman with type 1 short-QT syndrome (SQTS) was referred to our hospital. Her ECG showed short QT/QTc interval and peaked T wave. Activationrecovery intervals (ARIs) were calculated from the intracardiac endocardial and epicardial electrode catheters placed in the left ventricle (LV). Intravenous administration of nifekalant prolonged effective refractory period at multiple ventricular sites as well as the QT/QTc interval (from 260/300 to 364/419 ms) on the surface ECG. Nifekalant also enlarged the transmural ARI dispersion of the ventricular repolarization, which was measured by the difference between the longest endocardial ARI and the shortest epicardial ARI during atrial pacing at 90 bpm, from 73 to 103105 ms. These values corresponded to the intervals between the peak and end of the T wave on the surface ECG. Nifekalant-induced QT interval prolongation on the surface ECG may not indicate attenuation of the arrhythmogenic potential in the heart of SQTS patients. (J Cardiovasc Electrophysiol, Vol. 23, pp. 877-880, August 2012)

    DOI: 10.1111/j.1540-8167.2012.02292.x

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  • Early Repolarization and Its Modification by Preexcitation in Two Patients with Intermittent Wolff-Parkinson-White Syndrome 査読

    Kanae Hasegawa, Akinori Sato, Hiroshi Watanabe, Hiroshi Furushima, Masaomi Chinushi, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   35 ( 8 )   e231 - e233   2012年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    We report two cases of intermittent Wolff-Parkinson-White (WPW) syndrome. In one patient, early repolarization (ER) was masked during preexcitation whereas in the other, J wave-like notches were observed in the right precordial leads only during preexcitation. The clinical significance of ER is not apparent in WPW syndrome but some possible mechanisms are discussed. (PACE 2012; 35:e231e233)

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  • Exercise-Related QT Interval Shortening with a Peaked T Wave in a Healthy Boy with a Family History of Sudden Cardiac Death 査読

    Masaomi Chinushi, Akinori Sato, Kenichi Iijima, Katuya Suzuki, Furushima Hiroshi, Daisuke Izumi, Hiroshi Watanabe, Hasegawa Kanae, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   35 ( 8 )   e239 - e242   2012年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    An asymptomatic 15-year-old boy, who had a family history of sudden cardiac death, was referred for screening for cardiac disease. The 12-lead electrocardiogram at rest showed a short QT/QTc(Bazett)/QTc(Fredericia) interval of 320/388/364 ms, but the intervals were further shortened to 200/339/284 ms after the treadmill test concomitant with appearance of a peaked T wave. Other conventional cardiac examinations were normal, but effective refractory period was less than 180 ms in both ventricles, and double ventricular extrastimulation reproducibly induced nonsustained polymorphic ventricular tachycardia. Intravenous administration of epinephrine also induced a short QT interval and a peaked T wave, and a hump was manifested on the T wave of the first postpacing beat with a longer preceding RR interval. Furthermore, a couple of premature ventricular complexes originated from a similar timing as the hump. Genetic analysis did not show the mutation in KCNQ1, KCNH2, KCNE1, KCNE2, KCNJ2, SCN5A genes but revealed single nucleotide polymorphism (C5457T) in SCN5A gene. (PACE 2012; 35:e239e242)

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  • Characteristics of J Wave-Associated Idiopathic Ventricular Fibrillation: Role of Drugs 査読

    Masaomi Chinushi, Kanae Hasegawa, Kenichi Iijima, Hiroshi Furushima, Daisuke Izumi, Akinori Sato, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   35 ( 8 )   e226 - e230   2012年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    A storm of J wave-associated idiopathic ventricular fibrillation (VF) was observed in a 49-year-old man. Multiform premature ventricular complexes initiated the episodes of VF. Intravenous isoproterenol attenuated the J wave and suppressed the VF storm. After the implantation of a cardioverter defibrillator, VF was induced by programmed electrical stimulation at baseline, and it was terminated by a 25-J shock after an unsuccessful 15-J shock. During oral treatment with quinidine sulfate, 600 mg daily, the J wave was attenuated and VF became noninducible by programmed electrical stimulation. VF induced by a shock delivered on the T wave was terminated by a single 10-J shock. Mean F-F interval and dominant frequency of the VF were 162 ms and 6.8 Hz at baseline, and 210 ms and 5.0 Hz during the quinidine sulfate treatment. (PACE 2012; 35:e226e230)

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  • Recurrence of ventricular fibrillation in a patient with non-type 1 Brugada electrocardiographic morphology. 査読

    Tagawa M, Chinushi M, Nakamura Y, Ochiai Y, Sato A, Iijima K, Uchiyama H, Furushima H, Aizawa Y

    Journal of cardiology cases   6 ( 1 )   e17 - e19   2012年7月

  • Epicardial and endocardial mapping determine most successful site of ablation for ventricular tachyarrhythmias originating from left ventricular summit 査読

    Kenichi Iijima, Masaomi Chinushi, Hiroshi Furushima, Yoshifusa Aizawa

    EUROPACE   14 ( 6 )   911 - 912   2012年6月

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    記述言語:英語   出版者・発行元:OXFORD UNIV PRESS  

    A 34-year-old woman presented with idiopathic premature ventricular complex (PVC) and ventricular tachycardia (VT) originating from the area called the left ventricular summit. Radiofrequency (RF) application both through the coronary sinus and to the epicardial surface transiently suppressed the VT/PVC. Radiofrequency with sufficient energy was only applicable from the endocardial site, and the VT/PVC was successfully eliminated.

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  • KCNQ1複合ヘテロ接合体のJervell and Lange-Nielsen症候群(JLNS)の女児例

    羽二生 尚訓, 渡辺 健一, 沼野 藤人, 鈴木 博, 佐藤 光希, 池主 雅臣, 渡辺 マヤ, 白石 修一, 高橋 昌

    日本小児循環器学会雑誌   28 ( Suppl. )   s304 - s304   2012年6月

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    記述言語:日本語   出版者・発行元:(NPO)日本小児循環器学会  

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  • Dynamicity of the J-Wave in Idiopathic Ventricular Fibrillation With a Special Reference to Pause-Dependent Augmentation of the J-Wave 査読

    Yoshifusa Aizawa, Akinori Sato, Hiroshi Watanabe, Masaomi Chinushi, Hiroshi Furushima, Minoru Horie, Yoshiaki Kaneko, Tsutomu Imaizumi, Kimie Okubo, Ichiro Watanabe, Tsuyoshi Shinozaki, Yoshiyasu Aizawa, Keiichi Fukuda, Kunitake Joo, Michel Haissaguerre

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   59 ( 22 )   1948 - 1953   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    Objectives This study evaluated the pause-dependency of the J-wave to characterize this phenomenon in idiopathic ventricular fibrillation (VF).
    Background The J-wave can be found in apparently healthy subjects and in patients at risk for sudden cardiac death, and risk stratification is therefore needed.
    Methods Forty patients with J-wave-associated idiopathic VF were studied for J waves with special reference concerning pause-dependent augmentation. J waves were defined as those &gt;= 0.1 mV above the isoelectric line and were compared with 76 non-VF patients of comparable age and sex.
    Results The J-wave was larger in patients with idiopathic VF than in the controls: 0.360 +/- 0.181 mV versus 0.192 +/- 0.064 mV (p = 0.0011). J waves were augmented during storms of VF (n +/- 9 [22.5%]), which was controlled by isoproterenol; they disappeared within weeks in 5 patients. In addition, sudden prolongation of the R-R interval was observed in 27 patients induced by benign arrhythmia, and 15 patients (55.6%) demonstrated pausedependent augmentation (from 0.391 +/- 0.126 mV to 0.549 +/- 0.220 mV; p +/- 0.0001). In the other 12 experimental subjects and in the 76 control subjects, J waves remained unchanged. Pause-dependent augmentation of J waves was detected in 55.6% (sensitivity) but was specific (100%) in the patients with idiopathic VF with high positive (100%) and negative (86.4%) predictive values.
    Conclusions Pause-dependent augmentation of J waves was confirmed in about one-half of the patients with idiopathic VF after sudden R-R prolongation. Such dynamicity of J waves was specific to idiopathic VF and may be used for risk stratification. (J Am Coll Cardiol 2012; 59: 1948-53) c 2012 by the American College of Cardiology Foundation

    DOI: 10.1016/j.jacc.2012.02.028

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  • Analysis of J waves during myocardial ischaemia 査読

    Akinori Sato, Yasuhiko Tanabe, Masaomi Chinushi, Yuka Hayashi, Tsuyoshi Yoshida, Eiichi Ito, Daisuke Izumi, Kenichi Iijima, Nobue Yagihara, Hiroshi Watanabe, Hiroshi Furushima, Yoshifusa Aizawa

    EUROPACE   14 ( 5 )   715 - 723   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    The aim of this study was to investigate the relationship between J-wave dynamics and arrhythmias during myocardial ischaemia in patients with vasospastic angina (VSA).
    Sixty-seven consecutive patients diagnosed with VSA by a provocation test for coronary spasm were grouped according to whether they had a J wave in the baseline electrocardiograms or not (VSA-JW group, n 14; VSA-non-JW group: n 53). We retrospectively studied the associations between J-wave and ST-segment dynamics and induced ventricular fibrillations (VFs) during coronary spasm. In the VSA-JW group, 7 of the 14 patients showed changes in J-wave morphology and/or gains in J-wave voltage, followed by VF in 4 patients. Compared with patients without VF, the four patients with VF showed similar maximal voltage in the baseline J waves but a higher voltage during induced coronary spasms (0.57 0.49 vs. 0.30 0.11 mV; P 0.011). In three patients with VF, J waves progressively increased and were accompanied by the characteristic coved-type or lambda-shaped ST-segment elevations. In the VSA-non-JW group, only four patients showed new appearances of J waves during coronary spasms and another patient without a distinct J wave developed VF. Ventricular fibrillations were induced more frequently in the VSA-JW group than in the VSA-non-JW group [4/14 (29) vs. 1/53 (2); P 0.012].
    J-wave augmentations were caused by myocardial ischaemia during coronary spasms. The presence and augmentation of J waves, especially prominent J waves with the characteristic ST-elevation patterns, were associated with VF.

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  • Characteristics of electrocardiographic repolarization in acute myocardial infarction complicated by ventricular fibrillation 査読

    Yoshifusa Aizawa, Marek Jastrzebski, Takuya Ozawa, Kalina Kawecka-Jaszcz, Piotr Kukla, Wataru Mitsuma, Masaomi Chinushi, Toru Ida, Yoshiyasu Aizawa, Kenji Ojima, Minoru Tagawa, Satoru Fujita, Masaaki Okabe, Keiichi Tsuchida, Yasushi Miyakita, Hiroshi Shimizu, Shogo Ito, Tsutomu Imaizumi, Ken Toba

    JOURNAL OF ELECTROCARDIOLOGY   45 ( 3 )   252 - 259   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    Background and Purpose: Some de- and re-polarization patterns can reflect an increased risk of ventricular tachyarrhythmias. We studied whether some electrocardiographic (ECG) patterns are able to predict the development of ventricular fibrillation (VF) during acute myocardial infarction (MI).
    Methods: We compared the patterns of ST-T segment of 78 patients who developed VF during acute MI (patient with VF) vs 170 comparable patients with acute MI but with no VF complications.
    Results: Of the VF group, 47 developed out-of-hospital VF and 31 developed VF after their admission to the hospital. A steep downsloping ST segment toward a negative T wave with or without a short, flat, or rising portion at the initial portion was observed in 69.2% of the 78 patients: 61.3% in patients with pre-VF and 74.5% in patients with post-VF, vs 9.4% of patients who did not develop VF (P &lt; .0001). In 90.6% of the latter, a typical upward-concave or convex "ischemic" pattern of the ST segment was observed. Thus, the characteristic ST-T patterns were highly associated with VF with a specificity greater than 90%.
    Conclusions: A steep downsloping ST segment may characterize the ECGs of patients who develop VF during acute MI. (c) 2012 Elsevier Inc. All rights reserved.

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  • Epicardial Scar in a Patient with no Apparent Heart Disease 査読

    Masaomi Chinushi, Daisuke Izumi, Hiroshi Furushima, Akinori Sato, Kenichi Iijima, Kanae Hasegawa, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   35 ( 5 )   e136 - e139   2012年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    A 35-year-old man, who had an episode of aborted sudden cardiac death due to ventricular fibrillation, suffered from multiple storms of ventricular tachycardia (VT). Conventional cardiac examinations did not reveal any structural heart diseases, and he had been treated by an implantable cardioverter defibrillator since 2007. At the latest admission, epicardial but not endocardial voltage mapping revealed a small area of low voltage at the left ventricular (LV) postero-lateral wall where a delayed potential was recorded during sinus rhythm. Excellent pacemapping with a prolonged stimulus to QRS interval was obtained from the area, and a mid-diastolic potential was recorded during the VT. Radiofrequency application terminated the VT and any VT became noninducible after the ablation. In some patients diagnosed as LV-VT with no apparent heart disease, arrhythmogenic substrate may exist on the epicardial surface of the ventricle. (PACE 2012; 35:e136e139)

    DOI: 10.1111/j.1540-8159.2011.03142.x

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  • Significance and usefulness of heart rate variability in patients with multiple system atrophy 査読

    Hiroshi Furushima, Takayoshi Shimohata, Hideaki Nakayama, Tetsutaro Ozawa, Masaomi Chinushi, Yoshifusa Aizawa, Masatoyo Nishizawa

    MOVEMENT DISORDERS   27 ( 4 )   570 - 574   2012年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    Background: The purpose of this study was to investigate whether heart rate variability parameters can be useful for evaluating cardiac autonomic dysfunction in multiple system atrophy patients. Methods: Both the time and frequency domains of heart rate variability were investigated among 17 multiple system atrophy patients and 27 normal control subjects. Results: All time-and frequency-domain measures, except the low-to high-frequency ratio, were significantly lower in multiple system atrophy patients than in controls. In multiple system atrophy patients, there were significant inverse correlations between heart rate variability parameters and disease duration, as well as disease severity, but heart rate variability parameters were not affected by other autonomic dysfunctions. Conclusions: The cardiac autonomic state of multiple system atrophy was characterized by decreases in both sympathetic and parasympathetic tones. Because heart rate variability parameters were not affected by other autonomic dysfunctions, this may be a useful method for evaluating cardiac autonomic dysfunction in multiple system atrophy. (C) 2012 Movement Disorder Society

    DOI: 10.1002/mds.24929

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  • Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization Response 査読

    Hiroshi Watanabe, Akihiko Nogami, Kimie Ohkubo, Hiro Kawata, Yuka Hayashi, Taisuke Ishikawa, Takeru Makiyama, Satomi Nagao, Nobue Yagihara, Naofumi Takehara, Yuichiro Kawamura, Akinori Sato, Kazuki Okamura, Yukio Hosaka, Masahito Sato, Satoki Fukae, Masaomi Chinushi, Hirotaka Oda, Masaaki Okabe, Akinori Kimura, Koji Maemura, Ichiro Watanabe, Shiro Kamakura, Minoru Horie, Yoshifusa Aizawa, Wataru Shimizu, Naomasa Makita

    CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY   5 ( 2 )   E60 - E61   2012年4月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1161/CIRCEP.112.971507

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  • Relationship between electroanatomical voltage mapping characteristics and breakout site of ventricular activation in idiopathic ventricular tachyarrhythmia originating from the right ventricular outflow tract septum 査読

    Hiroshi Furushima, Masaomi Chinushi, Kenichi Iijima, Daisuke Izumi, Yukio Hosaka, Yoshifusa Aizawa

    JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY   33 ( 2 )   135 - 141   2012年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    Objective To assess the electrophysiological characteristics of the breakout site of ventricular activation using electroanatomical voltage mapping (EVM) and its relation to the optimal ablation site in idiopathic ventricular tachyarrhythmias originating from the outflow tract of the (RVOT) septum.
    Methods Twenty-eight patients with symptomatic drug-refractory premature ventricular complexes (PVCs) and/or ventricular tachycardia (VT) originating from the RVOT septum and 5 control subjects with WPW syndrome were included. Low-voltage areas (LVAs) were defined as signal amplitudes between 0.1 and 1.5 mV. The borderline between the normal area and the LVA was defined as "border," and the distance from the LVA to the border (length of LVA) was measured.
    Results In all 28 patients and control subjects, there was an LVA below the pulmonary valve. There was no significant difference in length of LVA between patients with idiopathic ventricular arrhythmias and control subjects (2.0+/-0.6 vs. 1.9+/-0.1 cm). In 19 of the 28 patients, the optimal ablation site was identical to the border area. In all 11 patients who had pre-potentials at the successful ablation site, there were two cases with polymorphic VT and/or ventricular fibrillation associated with PVCs. In these two cases, length of LVA was longer than in other patients (4.0 and 3.9 cm vs. 1.8+/-0.5 cm (n=26)), and the optimal ablation site was located at the border area.
    Conclusion The border area, including the LVA, tends to be the breakout site and/or origin of ventricular arrhythmias in idiopathic ventricular tachyarrhythmia originating from the RVOT septum.

    DOI: 10.1007/s10840-011-9623-8

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  • Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version 査読

    Yoshifusa Aizawa, Minoru Horie, Hirosh Inoue, Shiro Kamakura, Takao Katoh, Masunori Matsuzaki, Takuro Misaki, Hideo Mitamura, Yuji Murakawa, Takashi Nitta, Satoshi Ogawa, Ken Okumura, Naokata Sumitomo, Masao Yoshinaga, Masaomi Chinushi, Akira Fujiki, Hiroshi Furushima, Takanori Ikeda, Makoto Ito, Keisuke Kuga, Kengo Kusano, Shinich Niwano, Ryuji Nohara, Shingo Sasaki, Akihiko Shimizu, Wataru Shimizu, Morio Shoda, Masatsugu Hori, Makoto Nakazawa, Tsuneaki Sugimoto, Tetsu Yamaguchi

    CIRCULATION JOURNAL   76 ( 2 )   489 - 507   2012年2月

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    記述言語:英語   出版者・発行元:JAPANESE CIRCULATION SOC  

    DOI: 10.1253/circj.CJ-88-0022

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  • Intramural inflammation as a cause of transient ST-segment elevation in a patient of cardiac sarcoidosis 査読

    Kenichi Iijima, Masaomi Chinushi, Hiroshi Furushima, Yoshifusa Aizawa

    EUROPACE   14 ( 2 )   300 - 302   2012年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    DOI: 10.1093/europace/eur279

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  • The prevalence of early repolarization in Wolff-Parkinson-White syndrome with a special reference to J waves and the effects of catheter ablation 査読

    Nobue Yagihara, Akinori Sato, Kenichi Iijima, Daisuke Izumi, Hiroshi Furushima, Hiroshi Watanabe, Tadanobu Irie, Yoshiaki Kaneko, Masahiko Kurabayashi, Masaomi Chinushi, Masahito Satou, Yoshifusa Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   45 ( 1 )   36 - 42   2012年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    We determined the prevalence of J waves in the electrocardiograms (ECG) of 120 patients with Wolff-Parkinson-White syndrome in comparison with J-wave prevalence in a control group of 1936 men and women with comparable demographic and ECG characteristics and with normal atrioventricular conduction. J waves were present only during manifest preexcitation in 22 of 120 patients (18.3%), disappearing after catheter ablation and suggesting that J waves were associated with the presence of preexcitation. J waves were present in 19 (15.8%) of 120 patients only after ablation, apparently having been masked by early depolarization of the preexcited myocardial region, and in 22 patients (18.3%), J waves were not altered significantly by preexcitation. Thus, the overall J-wave prevalence was 52.5% (63/120) and, excluding those apparently due to preexcitation, 34.8% (41/120), both substantially higher than the prevalence (11.5%) in the control group (P &lt; .001 for both). The patients with J waves appearing only during preexcitation were younger, predominantly females. The presence of J waves after ablation was associated with a history of atrial fibrillation and shorter ventricular effective refractory period. It is concluded that the prevalence of J waves is high in patients with Wolff-Parkinson-White syndrome and is influenced by manifest preexcitation. (C) 2012 Elsevier Inc. All rights reserved.

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  • Benign Premature Ventricular Complexes from the Right Ventricular Outflow Tract Triggered Polymorphic Ventricular Tachycardia in a Latent Type 2 LQTS Patient 査読

    Akinori Sato, Masaomi Chinushi, Keiko Sonoda, Akira Abe, Daisuke Izumi, Hiroshi Furushima

    INTERNAL MEDICINE   51 ( 23 )   3261 - 3265   2012年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A 57-year-old woman showed frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT), and some of the PVCs triggered polymorphic ventricular tachycardia (PVT). Structural heart diseases were ruled out by conventional cardiac examinations. Radiofrequency catheter ablation was successful in eliminating the PVCs and subsequent PVT. However, epinephrine infusion unmasked her prolonged QT interval, and a genetic analysis revealed a KCNH2 mutation (R694H) as the cause of latent type-2 long QT syndrome (LQTS). This case suggests that latent LQTS may work as an arrhythmogenic substrate of PVT triggered by a benign form of RVOT-PVCs in patients with a structurally normal heart.

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  • Post-exercise Cardiac Asystole in a Young Competitive Athlete 査読

    Masahiro Ito, Kanae Hasegawa, Masaaki Arakawa, Masaomi Chinushi

    INTERNAL MEDICINE   51 ( 8 )   979 - 979   2012年

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    記述言語:英語   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    DOI: 10.2169/internalmedicine.51.7100

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  • Insulation Defects in Riata Implantable Cardioverter-defibrillator Leads 査読

    Akinori Sato, Masaomi Chinushi, Kenichi Iijima, Daisuke Izumi, Hiroshi Furushima

    INTERNAL MEDICINE   51 ( 19 )   2689 - 2694   2012年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Background The structures composing implantable cardioverter-defibrillator (ICD) leads have become more complicated and thinner with technological advances. Silicon insulation defects with and without clinically manifested electrical abnormalities have been reported in Riata leads (St. Jude Medical).
    Objective The aim of this study was to assess the incidence and clinical implications of insulation defects in Riata leads implanted at our hospital.
    Methods The subjects included 10 consecutive patients who received 8-French Riata ICD leads with dual-coil conductors (model 1580 or 1581) between 2006 and 2010 at our hospital. Operative records, chest X-rays and interrogation data were reviewed.
    Results In all cases, Atlas+ (St. Jude Medical) was used as an ICD generator and the Riata leads were implanted transvenously and fixed to the right ventricular apex. During a mean follow-up period of 52 +/- 9 (36-70) months, chest X-rays revealed insulation defects in Riata leads and conductor wires projecting from the bodies of the Riata leads in two of 10 (20%) patients. One of the patients received inappropriate ICD therapies due to T-wave oversensing based on attenuation of R waves and augmentation of T waves 41 months after implantation. In the other patient, an insulation defect without any clinically manifested electrical troubles was detected 50 months after implantation.
    Conclusion Riata leads have a high incidence of insulation defects, which may be occasionally accompanied by inappropriate ICD discharges. For patients with Riata leads, careful observation of any changes in the lead-electrical measurements and a routine chest X-ray follow-up are necessary.

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  • Long QT Syndrome with Nocturnal Cardiac Events Caused by a KCNH2 Missense Mutation (G604S) 査読

    Akinori Sato, Masaomi Chinushi, Hiroshi Suzuki, Fujito Numano, Takanori Hanyu, Kenichi Iijima, Hiroshi Watanabe, Hiroshi Furushima

    INTERNAL MEDICINE   51 ( 14 )   1857 - 1860   2012年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    An 8-year-old boy suffered from an unconsciousness attack and torsade de pointes arrhythmia during sleep or at rest. His electrocardiogram showed prolonged QT intervals, but the T wave morphology was atypical for type 1, 2 or 3 congenital long-QT syndrome (LQTS). Intravenous epinephrine slightly prolonged the QT interval whereas mexiletine infusion shortened the QT interval. Although these clinical characteristics might suggest type 3 LQTS, a genetic analysis identified the G604S-KCNH2 mutation (type 2 LQTS). Because mismatches between the genotype and phenotype of LQTS are possible, genetic analysis of LQTS is important to identify the most appropriate therapeutic option and risk stratification.

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  • カルシウム拮抗薬と硝酸薬の内服下で,心停止にいたる虚血発作を繰り返した冠攣縮性狭

    高山 亜美, 池主 雅臣, 有田 匡孝, 園田 桂子, 飯嶋 賢一, 佐藤 光希, 柏村 健, 和泉 大輔, 渡部 裕, 古嶋 博司, 小玉 誠, 相澤 義房

    心臓   44 ( 2 )   S2_87 - S2_91   2012年

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    記述言語:日本語   出版者・発行元:Japan Heart Foundation  

    症例はエルゴノビン負荷試験にて冠攣縮性狭心症(VSA)と診断された72歳,男性.カルシウム拮抗薬と硝酸薬の内服治療を受けていた.内服治療開始から20年後,夜間に突然の心肺停止をきたした.救急隊により自動体外式除細動器(AED)治療が試みられたが作動が保留され,記録では無脈性電気活動(PEA)を認めた.救急外来に搬送され心肺蘇生にて心拍は再開した.入院後,再び徐脈性心房細動からPEAとなった.心肺蘇生後の12誘導心電図ではII,III,aV<sub>F</sub>誘導にてST上昇を認めたが,冠動脈造影では狭窄はなく,薬剤抵抗性冠攣縮性狭心症(VSA)としてカルシウム拮抗薬を増量し,本人・家族の同意のうえで植込み型除細動器(ICD)による治療を行った.心室細動ではなくPEAをきたすVSAは稀であり,ICD治療についての議論も含めて貴重な症例と思われ,若干の考察を加え報告する.

    DOI: 10.11281/shinzo.44.S2_87

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  • Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization 査読

    Hiroshi Watanabe, Akihiko Nogami, Kimie Ohkubo, Hiro Kawata, Yuka Hayashi, Taisuke Ishikawa, Takeru Makiyama, Satomi Nagao, Nobue Yagihara, Naofumi Takehara, Yuichiro Kawamura, Akinori Sato, Kazuki Okamura, Yukio Hosaka, Masahito Sato, Satoki Fukae, Masaomi Chinushi, Hirotaka Oda, Masaaki Okabe, Akinori Kimura, Koji Maemura, Ichiro Watanabe, Shiro Kamakura, Minoru Horie, Yoshifusa Aizawa, Wataru Shimizu, Naomasa Makita

    CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY   4 ( 6 )   874 - 881   2011年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Background-Recently, we and others reported that early repolarization (J wave) is associated with idiopathic ventricular fibrillation. However, its clinical and genetic characteristics are unclear.
    Methods and Results-This study included 50 patients (44 men; age, 45 +/- 17 years) with idiopathic ventricular fibrillation associated with early repolarization, and 250 age-and sex-matched healthy controls. All of the patients had experienced arrhythmia events, and 8 (16%) had a family history of sudden death. Ventricular fibrillation was inducible by programmed electric stimulation in 15 of 29 patients (52%). The heart rate was slower and the PR interval and QRS duration were longer in patients with idiopathic ventricular fibrillation than in controls. We identified nonsynonymous variants in SCN5A (resulting in A226D, L846R, and R367H) in 3 unrelated patients. These variants occur at residues that are highly conserved across mammals. His-ventricular interval was prolonged in all of the patients carrying an SCN5A mutation. Sodium channel blocker challenge resulted in an augmentation of early repolarization or development of ventricular fibrillation in all of 3 patients, but none was diagnosed with Brugada syndrome. In heterologous expression studies, all of the mutant channels failed to generate any currents. Immunostaining revealed a trafficking defect in A226D channels and normal trafficking in R367H and L846R channels.
    Conclusions-We found reductions in heart rate and cardiac conduction and loss-of-function mutations in SCN5A in patients with idiopathic ventricular fibrillation associated with early repolarization. These findings support the hypothesis that decreased sodium current enhances ventricular fibrillation susceptibility. (Circ Arrhythm Electrophysiol. 2011;4:874-881.)

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  • A Novel Mutation in a Lamin A/C Gene Associated with Dilated Cardiomyopathy, Degeneration of Cardiac Conduction System, and Altered Gene Expression 査読

    Nobue Yagihara, Keiko Sonoda, Hiroshi Watanabe, Hiroaki Obata, Akinori Sato, Masaomi Chinushi, Haruo Hanawa, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Makoto Kodama

    CIRCULATION   124 ( 21 )   2011年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Brugada-Type ST-Segment Elevation Influenced by Postesophageal Reconstruction 査読

    Masaomi Chinushi, Yukako Ohno, Akiko Sanada, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   22 ( 11 )   1292 - 1293   2011年11月

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    記述言語:英語   出版者・発行元:WILEY-BLACKWELL  

    DOI: 10.1111/j.1540-8167.2011.02046.x

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  • Ventricular Tachycardia Due to Intramyocardial Fibroma 査読

    Kenichi Iijima, Masaomi Chinushi, Daisuke Izumi, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   22 ( 7 )   825 - 826   2011年7月

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    記述言語:英語   出版者・発行元:WILEY-BLACKWELL  

    DOI: 10.1111/j.1540-8167.2010.01974.x

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  • Role of mineralocorticoid receptor on atrial structural remodeling and inducibility of atrial fibrillation in hypertensive rats 査読

    Shinpei Kimura, Masahiro Ito, Makoto Tomita, Makoto Hoyano, Hiroaki Obata, Limin Ding, Masaomi Chinushi, Haruo Hanawa, Makoto Kodama, Yoshifusa Aizawa

    HYPERTENSION RESEARCH   34 ( 5 )   584 - 591   2011年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:NATURE PUBLISHING GROUP  

    Hypertension is well known to increase atrial fibrillation (AF) and the development of AF is associated with atrial chamber remodeling. Although mineralocorticoid receptor (MR) inhibition provides cardiovascular protection, the role of MR on atrial structural remodeling and inducibility of AF in hypertension remains unclear. Here, we investigated roles of the MR on atrial structural remodeling and inducibility of AF in hypertensive rats by using MR antagonist eplerenone (EPL). Dahl salt-sensitive (DS) rats were fed a normal-salt or a high-salt (HS) diet from 7 weeks, and a non-antihypertensive dose of EPL or vehicle was administrated from 13 weeks, at which time myocytes hypertrophy, interstitial fibrosis in the atrium and AF inducibility had increased, until 20 weeks. There was no significant difference in systolic blood pressure between DS+HS (186 +/- 4mmHg) and DS+HS+EPL (184 +/- 5mmHg) at 20 weeks. Burst atrial pacing demonstrated decreased AF inducibility in DS+HS+EPL (0 of 10) compared with DS+HS (7 of 10). Fibrosis and myocytes hypertrophy in the atrium were decreased in DS+HS+EPL with the reduction of atrial inflammatory cytokines. These beneficial effects of EPL were associated with less atrial oxidative stress, as assessed by 4-hydroxy-2-nonenal staining, and reduced activation of the Rho GTPase Rac1 in the atrium. Thus, MR has important roles in atrial structural remodeling and AF inducibility in Dahl rats. The effects of MR are associated, at least in part, with activation of Rac1-oxidative stress/inflammatory axis. Hypertension Research (2011) 34, 584-591; doi:10.1038/hr.2010.277; published online 20 January 2011

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  • Preexcitation unmasks J waves: 2 cases 査読

    Satomi Nagao, Yuka Hayashi, Nobue Yagihara, Akinori Sato, Hiroshi Watanabe, Hiroshi Furushima, Masaomi Chinushi, Yoshifusa Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   44 ( 3 )   359 - 362   2011年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    It is not known if J waves of early repolarization can be affected by depolarization or not. We report 2 cases in whom J waves were unmasked by preexcitation. A 59-year-old woman with Wolff-Parkinson-White syndrome who had frequent episodes of tachycardia underwent radiofrequency catheter ablation. The 12-lead electrocardiogram on admission showed delta waves and a notch in leads II, III, and a VF (J waves), which disappeared after the elimination of preexcitation. A 56-year-old man with Wolff-Parkinson-White syndrome was admitted for catheter ablation for supraventricular tachycardia. His electrocardiogram showed delta waves in I, II, aVL, V(2) to V(6), and J waves in the inferior leads and V(3) through V(6) with ST elevation and ST elevation in V(2). After ablation, J waves disappeared and were replaced by S waves. However, ST elevation remained in the precordial leads. The 2 cases suggest that J waves may be affected by the depolarization process: preexcitation. (c) 2011 Published by Elsevier Inc.

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  • Catheter Ablation of Ventricular Tachycardias Due to Forward and Reverse Propagation Across a Reentrant Circuit Inside a Nonischemic Biventricular Aneurysm 査読

    Masaomi Chinushi, Daisuke Izumi, Hiroshi Furushima, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   22 ( 4 )   467 - 471   2011年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Ablation of Bidirectional VT. A 64-year-old recipient of implantable cardioverter defibrillator presenting with a 4.7 x 3.3 cm nonischemic, biventricular aneurysm developed multiple electrical storms due to ventricular tachycardia (VT) with 2 distinct QRS morphologies. Endocardial electroanatomical mapping revealed the presence of a low-voltage area corresponding to the aneurysm, where multiple delayed potentials were recorded. Activation mapping and entrainment pacing of both VT revealed the, respectively, forward and reverse propagation of the wavefront across a single reentrant circuit inside the ventricular aneurysm. Delivery of 3 applications of radiofrequency energy to a critical segment of the reentrant pathway eliminated both VT and the electrical storms. (J Cardiovasc Electrophysiol, Vol. 22, pp. 467-467).

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  • Rate Control Is a Better Initial Treatment for Patients With Atrial Fibrillation and Heart Failure - Rhythm Control vs. Rate Control: Which Is Better in the Management of Atrial Fibrillation? (Rate-Side) 査読

    Masaomi Chinushi, Kenichi Iijima

    CIRCULATION JOURNAL   75 ( 4 )   970 - 978   2011年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Congestive heart failure (CHF) and atrial fibrillation (AF) often coexist, and each increase the morbidity and mortality associated with the other. Until now, many studies have reported that a strategy of rate control, in combination with anticoagulation in patients at risk of thromboembolic events, appears to be at least equivalent to a strategy of maintaining sinus rhythm with currently available pharmacological therapeutic options. As compared to rhythm control therapy, rate control treatment is simple and relatively easy. Therefore, pharmacological rate control should be considered initially in patients with AF associated with CHF. However, cardiac symptoms associated with AF may continue after achieving reasonable ventricular rate control. Either pharmacological or non-pharmacological rhythm control needs to be considered at that time. Amiodarone is the only recommended antiarrhythmic drug in the recent therapeutic guidelines for CHF, and can be used for both rhythm and rate control of AF. However, there is no question that some patients require early non-pharmacological rhythm control instead of long-lasting rate control. Catheter ablation (CA) can be applicable even in AF associated with CHF, but the results of CA are closely associated with the clinical and electrophysiological characteristics in each patient, as well as with the experience with this procedure in each institution. Indications for and the appropriate period of CA need to be carefully examined in each individual. (Circ J 2011; 75: 970-978)

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  • Ventricular Fibrillation and Ventricular Tachycardia Triggered by Late-Coupled Ventricular Extrasystoles in a Brugada Syndrome Patient 査読

    Masaomi Chinushi, Hiroshi Furushima, Yukio Hosaka, Daisuke Izumi, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   34 ( 1 )   e1 - e5   2011年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC  

    Premature ventricular complexes (PVC) falling after the end of the T wave triggered ventricular fibrillation (VF) at night and monomorphic ventricular tachycardia (MVT) during daytime, in a recipient of implantable cardioverter defibrillator with Brugada syndrome. Treatment with bepridil (1) decreased the height of ST segment elevation in leads V1-V3, (2) completely eliminated VF, and (3) markedly decreased the incidence of PVC and MVT. Albeit rare, VF can be triggered by late-coupled PVC, due to a mechanism other than phase 2 reentry in some patients with Brugada syndrome. (PACE 2011; e1-e5).

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  • An Appropriate Defibrillation Threshold Obtained by the Combined Connection Between Two Shock Leads and ICD Generator 査読

    Akinori Sato, Masaomi Chinushi, Kenichi Iijima, Hiroshi Watanabe, Daisuke Izumi, Hiroshi Furushima, Keiko Sonoda, Kanae Hasegawa, Nobue Yagihara, Yoshifusa Aizawa

    INTERNAL MEDICINE   50 ( 22 )   2815 - 2818   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A 60-year-old man with arrhythmogenic right ventricular cardiomyopathy was readmitted for the battery exchange of his implantable cardioverter-defibrillator (ICD). Since (i) he had been treated with a dual-coil shock lead (Sprint Fidelis, Medtronic) and (ii) pre-operative venography showed mild collateral flow to the left subclavian vein, a single-coil lead was additionally implanted. However, the single-coil defibrillation system was unable to terminate the induced ventricular fibrillation (VF), thus dual defibrillation shock pathways were created using the connection to the superior vena cava coil of the Fidelis lead. The combined connections of the two shock leads provided an appropriate margin of the defibrillation threshold.

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  • Endocardial Arrhythmogenic Mechanisms of Torsades de Pointes in Patients with the Congenital Long QT Syndrome 査読

    Masaomi Chinushi, Hiroshi Furushima, Yukio Hosaka, Satoru Komura, Akinori Sato, Kenichi Iijima, Yoshifusa Aizawa

    INTERNAL MEDICINE   50 ( 16 )   1695 - 1702   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    We injected acetylcholine (Ach) into the coronary artery to ascertain whether coronary vasospasm contributed to the syncopal events or chest oppression suffered by 3 patients with long QT syndrome (LQTS). During the test, a quadripolar electrode catheter was placed in the right ventricle and the activation-recovery interval was reanalyzed from the stored data. Intracoronary Ach transiently prolonged the QT intervals in all 3 patients without inducing coronary vasospasm. The Ach-induced QT prolongation was associated with enhanced spatial and temporal dispersion of intra-ventricular repolarization. The electrophysiological abnormalities were consistent with the putative arrhythmogenic mechanisms identified in experimental studies of LQTS.

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  • Inappropriate Pacing Inhibition Triggered by QT Prolongation due to T Wave Oversensing in an ICD Recipient Presenting with Long QT Syndrome 査読

    Kenichi Iijima, Masaomi Chinushi, Kanae Hasegawa, Daisuke Izumi, Yukio Hosaka, Hiroshi Furushima, Yoshifusa Aizawa

    INTERNAL MEDICINE   50 ( 9 )   1021 - 1024   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Inappropriate inhibition of atrial pacing due to T-wave oversensing (TWOS) was observed in a patient presenting with congenital long QT syndrome, treated with an implantable cardioverter defibrillator (ICD) and beta-adrenergic blocker. Development of TWOS was associated with further QT interval prolongation in the absence of amplitude changes in the intracardiac T and R waves. Replacement of the ICD generator with a sensing filter designed to attenuate the intracardiac T wave suppressed TWOS and normalized the pacing functions.

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  • Characteristics of Ventricular Tachycardia in Drug-Refractory Electrical Storm in ICD Patients with Structural Heart Disease 査読

    Hiroshi Furushima, Masaomi Chinushi, Keiko Sonoda, Kanae Hasegawa, Nobue Yagihara, Kenichi Iijima, Akinori Sato, Daisuke Izumi, Hiroshi Watanabe, Yoshifusa Aizawa

    journal of arrhythmia   27   194   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objective: The aim of the present study was to assess characteristics of ventricular tachycardia (VT) of electrical storm (ES) in ICD patients with structural heart disease. Methods: We included 156 consecutive patients who implanted ICD due to secondary prevention. ES was defined as the occurrence of at least 3 episodes of VT/VF within 24-hours. Basic treatment for ES was as follows
    sedation, β-blockers, and class I and/or III antiarrhythmic drugs. We defined that elimination of ES for 2 weeks after basic treatment was drug effective (DE), if not, drug refractory (DR). Results: During a mean follow-up period of 54 ± 37 months, ES occurred in 42 patients (OMI in 12, DCM in 15, HCM in 6, ARVC in 5, cardiac sarcoidosis in 4). Patients with DE and DR were 30 and 12 patients, respectively. There were no significant differences in age, sex, and LVEF. However, cycle length of VT (VTCL) was significantly longer in patients with DR than with DE (384 ± 16 vs. 305 ± 10 ms, p&lt
    0.05). All 12 patients with DE required for Catheter ablation. Conclusion: Longer VTCL in ES was related to drug refractoriness, which might be caused by stability of reentry circuit in spite of antiarrhythmic therapy. © 2011, Japanese Heart Rhythm Society. All rights reserved.

    DOI: 10.4020/jhrs.27.OP06_3

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  • Incidence and Management for Trouble-Shooting Associated with the Sprint-Fidelis ICD Lead 査読

    Kenichi Iijima, Masaomi Chinushi, Akinori Sato, Yukio Hosaka, Daisuke Izumi, Hiroshi Furushima, Hiroshi Watanabe, Masahito Sato, Katsuya Ebe, Hiroshi Shimizu, Kazuyoshi Takahashi, Yoshifusa Aizawa

    Journal of Arrhythmia   27   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Method: We investigated the outcomes of 136 patients with Sprint-Fidelis in 5 centers in Niigata Prefecture. Results. Incidence: Lead troubles occurred in 9 patients (6.6%). The mean period before the trouble was 31 months (16-57 months). Implantation: Among these 9 patients, the lead was implanted using a cut-down technique in 4, an extra-thoracic approach in 4 and a subclavian approach in 1. Discovery: The lead troubles in 5 were discovered at regular clinics. The other 4 patients emergently visited because of the lead integrity alert (LIA) or inappropriate ICD discharges. In the 9 patients, the average sensing integrity counter was 338/day and mean F-F interval, of which was recognized as NST, was less than 200ms. The LIA: The LIA had been programmed in 7, and 5 of the patients visited before inappropriate ICD discharges. However, the other 2 elderly patients couldn't notice the alert sound. Extraction: Lead extraction was attempted in 6 and 5 leads were removable without any complications. Conclusions: The incidence of troubles with Sprint-Fidelis is high, and it occurs in the relatively late phase. The LIA is useful to detect the lead problems but its efficacy may be limited in elderly patients. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • Association of J-Wave with Atrial Fibrillation in Wolff-Parkinson-White Syndrome 査読

    Nobue Yagihara, Masaomi Chinushi, Hiroshi Furushima, Hiroshi Watanabe, Daisuke Izumi, Akinori Sato, Kenichi Iijima, Tadanori Irie, Yoshiaki Kaneko, Masahiko Kurabayashi, Masahito Sato, Yoshifusa Aizawal

    Journal of Arrhythmia   27   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: J-waves are considered to reflect early repolarization. We have previously reported the disappearance of J waves after catheter ablation of an accessory pathway in patients with Wolff-Parkinson-White syndrome. Here, we further studied the association of an accessory pathway on J-waves with Wolff-Parkinson-White syndrome. Methods: We included 124 patients with Wolff-Parkinson-White syndrome who underwent catheter ablation, and 1936 controls without structural heart disease or ECG abnormalities. Results: The prevalence of J-waves was higher in patients with Wolff-Parkinson-White syndrome (n=69, 56%) than the controls (n=222, 11.5%). After successful ablation of the Wolff-Parkinson-White patients, J-waves disappeared in 22 patients, while J-waves were still apparent or after ablation in 21 patients. The prevalence of atrial fibrillation was higher in patients with J-waves (n=31, 45%) after ablation than those without (n=15, 33%). The ventricular and atrial refractory period tended to be shorter in patients with J-waves, after ablation than those without such waves. Conclusion: J-waves were frequently observed and were affected by ablation of an accessory pathway in patients with Wolff-Parkinson-White syndrome although the exact nature of this association is still undetermined. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • Impact of Mid-Niigata Prefecture Earthquake on Cardiovascular Diseases 査読

    Masaomi Chinushi, Hiroshi Watanabe, Masahito Sato, Yuichi Nakamura, Tsuneo Nagai, Masaaki Okabe, Naohito Tanabe, Makoto Kodama, Hiroshi Furushima, Yoshifusa Aizawa

    journal of arrhythmia   27 ( 4 )   399   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Acute physical and psychological stress caused by earthquake can provoke cardiovascular events. We retrospectively investigated the incidence of acute cardiovascular events from September 25, 2004, to November 19, 2004, in 8 hospitals that treated most patients with such disorders in the area affected by the mid-Niigata prefecture earthquake. The number of cardiovascular events markedly increased in the week following the earthquake, with a daily median (range) of 6 (0-21) compared with 2 (0 4) in the prior 4 weeks. The number of cases of sudden death increased in the week after the earthquake, with a daily median of 3 (0-6) compared with 1 (0-3) in the prior 4 weeks. Of the 14 cases of acute coronary syndrome presenting during the week after the earthquake, 4 of the 14 cases occurred on the day of the earthquake. Pulmonary embolism increased to 9 cases in the 4 weeks after the earthquake, compared to only 1 case reported in the 4 weeks before the earthquake. Takotsubo cardiomyopathy increased in the 4 weeks after the earthquake to 25 cases compared with only 1 case reported in the 4 weeks before the earthquake. Although 10 patients (40%) with Takotsubo cardiomyopathy developed life-threatening heart failure, all recovered within several weeks following the improvement of apical dysfunction. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • The Effectiveness of Nifekalant Hydrocholoride for Treatment of Refractory Ventricular Arrhythmia 査読

    Minoru Tagawa, Masaomi Chinushi, Yukie Ochiai, Yuichi Nakamura, Yoshifusa Aizawa

    journal of arrhythmia   27   189   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Methods: A total of 24 consecutive patients suffered sustained ventricular tachycardia (VT) (group A: n=13), ventricular fibrillation (VF) (group B: n=7) or repeated non-sustained ventricular tachycardia (NSVT) (group C: n=4). ventriucular arrhythmia (VA) was complicated with ischemic heart disease (IHD) in 11 patients (group I) and with other diseases in another 13 patients (group non-I). Nifekalant hyddrochloride (NIF) was administrated during cardiopulmonary resuscitation (CPR) in 13 patients. Results: NIF administration was effective in terminating VA in 19 of 24 patients (79.2%). NIF administration directly terminated VT in 6 patients, and VT was successfully cardioverted using additional direct-current (DC) shock after NIF administration in another 4 patients in group A with DC shock-resistant VT. Refractory VF was also successfully cardioverted by additional DC shock after NIF administration in 4 patients in group B. Repeated NSVT was not undertaken after NIF administration in all patients in group C. NIF was effective in terminating VA in all patients in group I as well as in 8 patients in group non-I. In 11 of 17 patients, continuous intravenous NIF infusion prevented the recurrence of VA. VA was successfully controlled by continuous intravenous infusion of NIF in 6 of 10 patients in group I. Conclusion: Nifekalant was effective in terminating refractory ventricular arrhythmia. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • Magnesium Treatment for Drug-Induced QT Prolongation 査読

    Daisuke Izumi, Masaomi Chinushi, Kenichi Lijima, Kanae Hasegawa, Akinori Sato, Hiroshi Furushima, Yoshifusa Aizawa

    journal of arrhythmia   27 ( 4 )   297   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Effects of magnesium administration (0.2ml/kg, iv) on the QT interval and transmural ventricular repolarization were compared among the 4 models of QT interval prolongation: (20 experiments) bepridil (BEP), amiodarone (AMD), E-4031 (E) or anthopleurin-A (AP-A). Using plunge needle electrodes, transmural electrograms were obtained from the left ventricle, and the activation-recovery interval (ARI) and transmural ARI-dispersion were analyzed. Results: (1) After administration of each drug, ARIs at all LV layers were prolonged, and transmural ARI-dispersions were enlarged in the AP-A and E models. BEP (4 mg/kg) homogeneously prolonged ARIs, and it produced a relatively small transmural ARI-dispersion (32±10 ms) similar to the AMD model (1.5 mg/kg/hr) (32±7 ms). (2) Magnesium injection (0.2 mEq/kg, iv) shortened ARIs and suppressed Torsades de Pointes in the AP-A model. (3) Magnesium did not shorten nor homogenize ARI distribution in the other 3 models. Magnesium slightly prolonged the ARIs in the E model. Conclusions: Magnesium did not reduce the transmural dispersion of repolarization except in AP-A model. Inhibition of the triggered premature beats seems to be another therapeutic effect of magnesium treatment for QT interval prolongation. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • ST-T Abnormalities on ECG in Relation to Cardiovascular Risk Factors 査読

    Yuko Chinushi, Hiroshi Watanabe, Masaomi Chinushi, Yoshifusa Aizawa, Aizawa

    Journal of Arrhythmia   27 ( 3 )   202 - 207   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Significance of an ST-T abnormality in subjects with no apparent heart diseases is to be determined. Subjects and methods: The study involved 44,990 adults (16,368 males and 28,622 females) aged 40-85 years who underwent an annual health examination. Cardiovascular risks (CVRs) were considered positive if 1) body mass index was ≥25 Kg/m2, 2) systolic blood pressure (BP) ≥ 130 mmHg and/or diastolic BP ≥ 85 mmHg, 3) triglyceride ≥ 150 mg/dl, 4) HDL-C level ≤40 mg/dl for men and ≤50 mg/dl for women, or 5) fasting blood glucose ≥110 mg/dl. The relation between CVRs and ST-T abnormalities were evaluated. Results: ST-T abnormalities were found in 6.49% in males, and more frequently in females: 8.45%. Each CVR and the number of combined CVRs were risk factors for ST-T abnormalities on ECG (P &lt
    0.0001 for a trend). On the other hand, ECG-based LVH was found in 5.7% but showed no relation with CVRs or their combinations. ST-T abnormalities may represent preclinical cardiac involvement of CVRs more sensitively than LVH on ECG and ECG findings may be used in mass examinations. Conclusions: ST-T abnormalities without apparent heart diseas may be considered to be nonspecific but this cross-sectional study showed that they are related to CVRs and may be used as an early marker of preclinical cardiac damage by CVRs. © 2011, Japanese Heart Rhythm Society. All rights reserved.

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  • An Appropriate Defibrillation Threshold Obtained by the Combined Connection between Two Shock Leads and ICD Generator

    Sato Akinori, Chinushi Masaomi, Iijima Kenichi, Watanabe Hiroshi, Izumi Daisuke, Furushima Hiroshi, Hasegawa Kanae, Yagihara Nobue, Aizawa Yoshifusa

    Journal of Arrhythmia   27   PJ2_070   2011年

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    記述言語:英語   出版者・発行元:Japanese Heart Rhythm Society  

    A 60-year-old man with arrhythmogenic right ventricular cardiomyopathy was readmitted to exchange the battery of his implantable cardioverter-defibrillator (ICD). When a dual-chamber ICD was implanted 6 years ago, induced ventricular fibrillation (VF) was terminated successfully by a 20-joule shock. Since (1) he had been treated with a dual-coil shock lead (Sprint Fidelis) and (2) preoperative venography showed mild collateral flow to the left subclavian vein, a single-coil lead (Sprint Quattro) was also implanted. However, the single-coil defibrillation system was unable to terminate the induced VF with a 25-joule shock, and a maximum shock of 35 joules was required to resume sinus rhythm. Therefore, dual defibrillation shock pathways were created using the additional connection of the superior vena cava coil of the Fidelis lead to the ICD. As a result, induced VF was terminated successfully by 15∼25 joules, and the shock impedance was decreased from 63 to 39 ohms. Using a combined connection between two implanted leads and an ICD generator is uncommon, but it can help some patients, as in our case.

    DOI: 10.4020/jhrs.27.PJ2_070

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  • 致死的不整脈の予知

    池主 雅臣, 相澤 義房

    心臓   43 ( 10 )   1297 - 1302   2011年

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    記述言語:日本語   出版者・発行元:Japan Heart Foundation  

    DOI: 10.11281/shinzo.43.1297

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    その他リンク: http://search.jamas.or.jp/link/ui/2012011517

  • Fetal Atrioventricular Block and Postpartum Augmentative QT Prolongation in a Patient With Long-QT Syndrome With KCNQ1 Mutation 査読

    Hiroshi Furushima, Masaomi Chinushi, Akinori Sato, Yoshifusa Aizawa, Akira Kikuchi, Koichi Takakuwa, Kenichi Tanaka

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   21 ( 10 )   1170 - 1173   2010年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    2:1 AV Block in KCNQ1. The case of a 32-year-old pregnant woman, who had had several syncopal episodes during swimming and running at 9 and 10 years of age and whose fetus had 2:1 AV block, is presented. The mother and baby had the same heterozygous single nucleotide substitution in KCNQ1 at T587M. After 27 weeks of gestation, the fetal 2:1 AV block disappeared, and 1:1 AV conduction resumed, with a fetal heart rate of 110-120 beats/min. The maternal electrocardiogram revealed a normal QTc interval (433 ms) without ST-T abnormalities at gestational week 23, but the QTc was 490 and 531 ms at 1 and 2 months postpartum, with biphasic T waves in leads V2 and V3. This case is the first report of fetal 2:1 AV block with KCNQ1 mutation (T587M) and unmasked maternal QT prolongation in the postpartum period. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1170-1173).

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  • Role of mineralocorticoid receptor-Rac1 axis on atrial structural remodeling and inducibility of atrial fibrillation in hypertensive rats 査読

    M. Ito, S. Kimura, M. Tomita, M. Chinushi, M. Kodama, Y. Aizawa

    EUROPEAN HEART JOURNAL   31   1018 - 1018   2010年9月

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    記述言語:英語   出版者・発行元:OXFORD UNIV PRESS  

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  • Inducibility of atrial fibrillation depends not on inflammation but on atrial structural remodeling in rat experimental autoimmune myocarditis 査読

    Makoto Hoyano, Masahiro Ito, Shinpei Kimura, Komei Tanaka, Kazuki Okamura, Satoru Komura, Wataru Mitsuma, Satoru Hirono, Masaomi Chinushi, Makoto Kodama, Yoshifusa Aizawa

    Cardiovascular Pathology   19 ( 5 )   e149 - e157   2010年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Introduction: There is increasing evidence to support a link between inflammation and atrial fibrillation (AF). However, the role of inflammation on new-onset AF is still to be elucidated. Methods: Rats underwent induction of experimental autoimmune myocarditis (EAM). Atrial structural change was evaluated by echocardiography and histological analysis. Electrophysiological data and the in vivo atrial response to burst atrial pacing were evaluated in the acute (2 weeks after EAM induction) and chronic phases (8 weeks after induction). In addition, atrial pacing after 2, 4, and 6 h after lipopolysaccharide (LPS) infusion, when the expression of gap junctions was modified, were challenged with young healthy rats. Results: AF was induced in 11 of 15 chronic phase EAM rats but not in either acute phase EAM rats or LPS infusion rats (P&lt
    .01). Echocardiography showed dilatation of both atrium and ventricle and a decrease in the ejection fraction in the chronic phase. Histology revealed severe inflammatory lesions only in the acute phase. Interstitial atrial fibrosis as well as the area of atrial myocyte increased in the chronic phase but not in the acute phase. Conclusions: AF could be induced in the chronic phase of myocarditis rats, but not in the acute phase of myocarditis rats or in rats with LPS infusion. Acute inflammation per se did not increase the occurrence of AF induction. Atrial structural remodeling caused by inflammation and hemodynamic effects is necessary to induce AF. © 2010 Elsevier Inc. All rights reserved.

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  • Ventricular Tachyarrhythmia Associated with Hypertrophic Cardiomyopathy: Incidence, Prognosis, and Relation to Type of Hypertrophy 査読

    Hiroshi Furushima, Masaomi Chinushi, Kenichi Iijima, Akiko Sanada, Daisuke Izumi, Yukio Hosaka, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   21 ( 9 )   991 - 999   2010年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    Patients: The study consisted of 66 consecutive patients with HCM who were admitted to Niigata University Hospital between 1992 and 2005. Their clinical characteristics and ECG morphology were investigated according to the type of HCM.
    Results: The type of HCM was asymmetric hypertrophy (ASH) in 34 patients (51%), obstructive HCM (HOCM) in 9 (14%), apical HCM (ApHCM) in 14 (21%), and midventricular obstruction (MVO) in 9 (14%). The cause of admission was ventricular tachyarrhythmia in 25 patients (38%), unexplained syncope in 11 (17%), and heart failure in 30 (45%). Sustained monomorphic ventricular tachycardia (SMVT) occurred in 19 patients and ventricular fibrillation in 6. In the 19 patients with SMVT, 12 had MVO and 3 of these had previous apHCM. Six of the 19 patients with SMVT had ASH, and 3 had abnormal apical wall motion. In 14 patients, the SMVT appeared to originate from the apical aneurysm based on the morphology of the tachycardia. Ventricular tachyarrhythmia recurred in 14 of the 25 patients (56%), and 4 of the 18 patients with an ICD had electrical storm. ASH with abnormal wall motion of the LV apex or MVO was recognized in the 4 patients with electrical storm; they commonly had abnormal Q waves and ST elevation in leads V4-V6.
    Conclusion: Ventricular tachyarrhythmia was responsible for 38% of hospitalizations in HCM, and SMVT occurred in patients with MVO and/or with abnormal wall motion of the LV apex. Electrical storm was more common in patients with ST elevation in precordial leads V4-V6. (J Cardiovasc Electrophysiol, Vol. 21, pp. 991-999, September 2010).

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  • Effects of Bepridil Versus E-4031 on Transmural Ventricular Repolarization and Inducibility of Ventricular Tachyarrhythmias in the Dog 査読

    Daisuke Izumi, Masaomi Chinushi, Kenichi Iijima, Shizue Ahara, Satoru Komura, Hiroshi Furushima, Yukio Hosaka, Akiko Sanada, Nobue Yagihara, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   33 ( 8 )   950 - 959   2010年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Methods: We used plunge needle electrode to record transmural left ventricular (LV) repolarization and activation-recovery interval (ARI) to estimate local repolarization. The correlation between paced cycle length and ARI was separately examined in the LV endocardium, mid-myocardium (Mid), and epicardium. Attempts to induce VTA were made during bradycardia and sympathetic stimulation.
    Results: Bepridil and E-4031 prolonged QT interval and ARI in all LV layers, though the magnitude of prolongation was greatest in Mid, increasing the transmural ARI dispersion, particularly during bradycardia. Compared with E-4031, bepridil caused mild, reverse use-dependent changes in ventricular repolarization, and less ARI dispersion than E-4031 during slow ventricular pacing. Both drugs increased ARI(max) and cycle length at 50% of ARI(max), though the changes were smaller after bepridil than after E-4031 administration. Bradycardia after the administration of each drug induced no VTA; however, sympathetic stimulation induced sustained polymorphic VTA in two of five dogs treated with E-4031 versus no dog treated with bepridil.
    Conclusions: Unlike the pure I(kr) blocker, E-4031, bepridil exhibited weak properties of reverse use-dependency and protected against sympathetic stimulation-induced VTA. It may be an effective supplemental treatment for recipients of implantable cardioverter defibrillator. (PACE 2010; 950-959).

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  • Efficacy of Procainamide and Lidocaine in Terminating Sustained Monomorphic Ventricular Tachycardia - Retrospective Case Series 査読

    Satoru Komura, Masaomi Chinushi, Hiroshi Furushima, Yukio Hosaka, Daisuke Izumi, Kenichi Iijima, Hiroshi Watanabe, Nobue Yagihara, Yoshifusa Aizawa

    CIRCULATION JOURNAL   74 ( 5 )   864 - 869   2010年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background: The efficacy of antiarrhythmic drugs in terminating sustained monomorphic ventricular tachycardia (SMVT) was assessed in a retrospective manner to provide a basis for recommending their use.
    Methods and Results: The 90 patients were included in this study to evaluate the efficacy to terminate SMVT using procainamide or lidocaine. All patients were alert and responsive. The mean systolic blood pressure was 91 +/- 25 mmHg (range, 40-150 mmHg). SMVT was diagnosed from ECG recordings and later in an electrophysiologic study. VTs with a cycle length of 329 +/- 55 and 324 +/- 61 ms were treated with the mean doses of 358 +/- 50 mg and 81 +/- 30 mg of procainamide and lidocaine and were terminated in 53/70 (75.7%) and in 7/20 (35.0%) respectively. The drugs were discontinued if there was no rise in blood pressure after slowing of the tachycardia rate or if there were signs of impending deterioration in consciousness. Though procainamide was effective, blood pressure was often low and DC shock should be available at all times during administration of the drug.
    Conclusions: Procainamide, the relatively older drug, was more effective than lidocaine in terminating SMVT associated with structural heart diseases. This is a retrospective analysis but can form the basis for formulating guidelines for initial management of SMVT. (Circ J 2010; 74: 864-869)

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  • Effect of Bepridil in Atrial Fibrillation Inducibility Facilitated by Vagal Nerve Stimulation - Prevention of Vagal Nerve Activation-Induced Shortening of the Atrial Action Potential Duration 査読

    Kenichi Iijima, Masaomi Chinushi, Daisuke Izumi, Shizue Ahara, Hiroshi Furushima, Satoru Komura, Yukio Hosaka, Akiko Sanada, Akinori Sato, Yoshifusa Aizawa

    CIRCULATION JOURNAL   74 ( 5 )   895 - 902   2010年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background: Because bepridil blocks multiple myocardial ionic channels, including the muscarinic acetylcholine receptor-operated potassium current (I(KAch)), bepridil is expected to suppress atrial fibrillation (AF) mediated by vagal nerve stimulation (VNS).
    Methods and Results: The therapeutic effects of bepridil were studied with a special focus on heart rate variability (HRV) in a canine model of AF. During VNS, AF was induced in 9 of 9 experiments before, vs 3 of 9 experiments after administration of bepridil (P&lt;0.01). During 350 ms atrial pacing, VNS shortened the right and left atrial monophasic action potentials at 90% repolarization (MAP90) by -31 +/- 8% and -22 +/- 12%, respectively, vs -10 +/- 13% and -6 +/- 8%, respectively, after bepridil (P&lt;0.01, N=9). Bepridil prolonged the sinus cycle length, although it had no significant effect on the conduction time measured at 300 ms pacing. Statistically insignificant change was observed in the VNS-induced slowing of the sinus cycle length and in the VNS-induced increase in high frequency amplitude of HRV before (1.2 +/- 0.7 to 5.3 +/- 4.0 ms) vs after (1.7 +/- 0.8 to 5.4 +/- 2.3 ms) bepridil administration.
    Conclusions: Bepridil prevented the VNS-induced shortening of atrial MAP90 and suppressed the inducibility of AF during VNS in two-thirds of the experiments. As far as this study shows, it may be possible that inhibition of I(KAch) played a part in this antifibrillatory effect. (Circ J 2010; 74: 895-902)

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  • Efficacy of Procainamide and Lidocaine in Terminating Sustained Monomorphic Ventricular Tachycardia - Retrospective Case Series 査読

    Satoru Komura, Masaomi Chinushi, Hiroshi Furushima, Yukio Hosaka, Daisuke Izumi, Kenichi Iijima, Hiroshi Watanabe, Nobue Yagihara, Yoshifusa Aizawa

    CIRCULATION JOURNAL   74 ( 5 )   864 - 869   2010年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background: The efficacy of antiarrhythmic drugs in terminating sustained monomorphic ventricular tachycardia (SMVT) was assessed in a retrospective manner to provide a basis for recommending their use.
    Methods and Results: The 90 patients were included in this study to evaluate the efficacy to terminate SMVT using procainamide or lidocaine. All patients were alert and responsive. The mean systolic blood pressure was 91 +/- 25 mmHg (range, 40-150 mmHg). SMVT was diagnosed from ECG recordings and later in an electrophysiologic study. VTs with a cycle length of 329 +/- 55 and 324 +/- 61 ms were treated with the mean doses of 358 +/- 50 mg and 81 +/- 30 mg of procainamide and lidocaine and were terminated in 53/70 (75.7%) and in 7/20 (35.0%) respectively. The drugs were discontinued if there was no rise in blood pressure after slowing of the tachycardia rate or if there were signs of impending deterioration in consciousness. Though procainamide was effective, blood pressure was often low and DC shock should be available at all times during administration of the drug.
    Conclusions: Procainamide, the relatively older drug, was more effective than lidocaine in terminating SMVT associated with structural heart diseases. This is a retrospective analysis but can form the basis for formulating guidelines for initial management of SMVT. (Circ J 2010; 74: 864-869)

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  • HIGH FREQUENCY OF ELECTROCARDIOGRAPHIC ABNORMALITIES AT EARLY REPOLARIZATION PHASE IN IDIOPATHIC VENTRICULAR FIBRILLATION 査読

    Yuka Hayashi, Hiroshi Watanabe, Kazuki Okamura, Masahito Sato, Yukio Hosaka, Hiroshi Furushima, Masaomi Chinushi, Hirotaka Oda, Masaaki Okabe, Yoshifusa Aizawa

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   55 ( 10 )   2010年3月

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    記述言語:英語   出版者・発行元:ELSEVIER SCIENCE INC  

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  • Delayed Pericardial Effusion Due to Perforation of the Right Ventricular Outflow Tract by an ICD Lead 査読

    Masaomi Chinushi, Yukio Hosaka, Shinsuke Okada, Kenichi Iijima, Hiroshi Furushima, Yoshifusa Aizawa

    INTERNAL MEDICINE   49 ( 5 )   389 - 392   2010年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A delayed pericardial effusion developed in a recipient of a cardioverter defibrillator (ICD). After an uneventful implant procedure and postoperative recovery, the patient suffered loss of appetite and fatigue, and was re-admitted to the hospital 48 days later. Her vital signs were stable and cardiac silhouette on chest roentgenogram was normal. However, blood cell counts and chemistry revealed the presence of anemia and liver dysfunction, an echocardiogram showed a diffuse pericardial effusion, and computed tomography suggested that the ICD lead, screwed in the right ventricular outflow tract, had perforated the wall. In order to make a prompt diagnosis and initiate timely corrective treatment, the physician in charge of long-term follow-up should remember that a pericardial effusion can be delayed and accumulate in the absence of typical signs of cardiac tamponade after ICD lead implantation.

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  • Ischemia-Induced Prominent J Waves in a Patient with Brugada Syndrome 査読

    Nobue Yagihara, Akinori Sato, Hiroshi Furushima, Masaomi Chinushi, Takashi Hirono, Yoshifusa Aizawa

    INTERNAL MEDICINE   49 ( 18 )   1979 - 1982   2010年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A 75-year-old man was admitted to our hospital in January 2010 for evaluation of syncope and abnormal ECG. ECG showed type 1 ST elevation in lead V-1 and he was diagnosed as Brugada syndrome. During cardiac catheterization, baseline coronary angiography was normal, but intracoronary ergonovine maleate induced spasms of the right and left coronary arteries concomitant with chest pain and ST elevation on ECG. J waves were accentuated or newly developed. Soon after an intracoronary injection of nitroglycerin, chest pain was relieved and ischemia-induced J wave disappeared and the ST segment returned to the same morphology as baseline. Extrastimuli induced ventricular fibrillation. He received an implantable cardioverter-defibrillator. He was also treated with Ca antagonist and isosorbide dinitrate and has had an uneventful course for 5 months.

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  • Coronary vasospasm triggered ventricular fibrillation delayed after radiofrequency ablation of the right accessory pathway 査読

    Yukio Hosaka, Masaomi Chinushi, Kazuyoshi Takahashi, Kazuyuki Ozaki, Takao Yanagawa, Tsutomu Miida, Hirotaka Oda, Yoshifusa Aizawa

    EUROPACE   11 ( 11 )   1554 - 1556   2009年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    Ventricular fibrillation associated with coronary vasospasm developed 8 h after successful radiofrequency (RF) ablation of the right accessory pathway in an 81-year-old male. A segment of the coronary vasospasm was located close to the accessory pathway, where seven RF ablations had been applied. Although rare, physicians should carefully consider the risk of such events when an RF current is applied near a coronary artery.

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  • Significance of Early Onset and Progressive Increase of Activation Delay During Premature Stimulation in Brugada Syndrome 査読

    Hiroshi Furushima, Masaomi Chinushi, Kenichi Iijima, Daisuke Izumi, Yukio Hosaka, Yoshifusa Aizawa

    CIRCULATION JOURNAL   73 ( 8 )   1408 - 1415   2009年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background: The relationship between the activation delay during programmed stimulation and the inducibility of ventricular fibrillation (VF) and filtered QRS duration on signal-averaged ECG (SAECG) were assessed in patients with Brugada syndrome (BS).
    Methods and Results: The activation delay was assessed using the interval between the stimulus and the QRS complex during programmed stimulation in 25 patients with BS and 10 with idiopathic ventricular tachycardia (controls). The mean increase of delay (MID) was used to characterize the conduction curves. The filtered QRS duration (fQRSd) in leads V(2) (RfQRSd) and V(5) (LfQRSd) were also evaluated using SAECG. Both MIDs at the right ventricular outflow tract (RVOT) were significantly greater in symptomatic and asymptomatic BS patients than in the control group (symptomatic, 7.1 +/- 2.7 ms vs control, 2.5 +/- 1.2 ms, P&lt;0.001, asymptomatic, 7.3 +/- 3.3 ms vs control, P&lt;0.001, respectively). The MID correlated with the His-ventricular interval; however, there were no significant correlations between the MID and RfQRSd or RfQRSd-LfQRSd.
    Conclusions: The MID, which indicates an increase of the St-QRS during premature stimulation, was much greater in patients with BS (regardless of clinical symptoms) than in the control group, especially in the RVOT, which might be related to the easy inducibility of VF from the RVOT. (Circ J 2009; 73: 1408-1415)

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  • Effects of verapamil on anterior ST segment and ventricular fibrillation cycle length in patients with Brugada syndrome 査読

    Masaomi Chinushi, Kenichi Iijima, Minoru Tagawa, Satoru Komura, Hiroshi Furushima, Yoshifusa Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   42 ( 4 )   367 - 373   2009年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    Purpose: This Study examined the effects of verapamil (5-10 mg intravenous) on the cardiac electrical activity of 10 Brugada syndrome (BS) patients having vasospastic angina, atrial fibrillation, and/or hypertension.
    Results: Verapamil showed no significant change ill the ST-segment elevation. Likewise, there was no significant change in the lengths of QRS complex, HV and corrected QT intervals, or effective refractory period at the right ventricle, The conduction time between right ventricular apex and Outflow tract, measured at 400-millisecond pacing, was mildly prolonged by verapamil. At baseline, induced ventricular fibrillation (VF) was terminated by a 200-J shock in all patients. After verapamil, VF was reinduced in 7, was noninducible in 2, and self-terminated in 1 patient. Mean F-F interval was shorter after than before verapamil, and a 360-J shock was required in 2 of the 7 patients.
    Conclusion: In some BS patients, calcium channel blockade may modify the electrical characteristics of VF. (c) 2009 Elsevier Inc. All rights reserved.

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  • Pilsicainide-Induced ST Segment Elevation and ST Segment Depression in Two Patients with Variant Forms of Brugada-Type Electrocardiographic Abnormalities 査読

    Masaomi Chinushi, Minoru Tagawa, Daisuke Izumi, Hiroshi Furushima, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   32 ( 6 )   811 - 815   2009年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC  

    In two patients with variant forms of Brugada electrocardiographic abnormalities, ST segment elevation, and reciprocal ST segment depression developed during intravenous administration of pilsicainide. In one patient, pilsicainide accentuated the ST segment elevation in leads I, aV(L), and V(1)-V(3) and caused ST segment depression in leads II, III, and aV(F). Coronary angiograms at the time of ST segment elevation were normal. In the other patient, pilsicainide accentuated the coved-type ST segment elevation in leads II, III, and aV(F) and caused ST segment depression in leads I, aV(L), and V(2)-V(5). Frequent premature ventricular complexes (PVCs) with two different left bundle branch block patterns developed during ST segment elevation. Intravenous isoproterenol returned the ST segment to baseline in both patients and suppressed the PVCs in the second patient. We hypothesize that a wide area of epicardial myocardium with large I(to) current might explain the reciprocal ST segment depression observed at the time of accentuated ST segment elevation.
    (PACE 2009; 32:811-815).

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  • Focal atrial tachycardia refractory to radiofrequency catheter ablation originating from right atrial appendage 査読

    Hiroshi Furushima, Masaomi Chinushi, Yukio Hosaka, Yoshifusa Aizawa

    EUROPACE   11 ( 4 )   521 - 522   2009年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    A 44-year-old female presented with incessant, drug-refractory atrial tachycardia (AT). An electrophysiological study suggested focal abnormal automaticity, and localized the AT origin to the apex of the right atrial appendage (RAA). Repeated radiofrequency catheter ablation to the site of the earliest endocardial activation during AT failed. At surgery, right atrial appendectomy terminated the AT. On macroscopic findings, the cavity of the RAA became a dead-end before the apex. In patients with drug and radiofrequency catheter ablation, refractory focal AT arising from the RAA, especially the apex of the RAA, in our opinion surgical treatment could be considered in the lack of efficacy of ablation.

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  • Metabolic Syndrome and Catheter Ablation in Atrial Fibrillation 査読

    Masaomi Chinushi, Masahiro Ito

    CIRCULATION JOURNAL   73 ( 3 )   428 - 429   2009年3月

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    記述言語:英語   出版者・発行元:JAPANESE CIRCULATION SOC  

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  • Ventricular Fibrillation Triggered during and after Radiofrequency Energy Delivery to the Site of Origin of Idiopathic Right Ventricular Outflow Tract Arrhythmia 査読

    Kenichi Iijima, Masaomi Chinushi, Hiroshi Furushima, Yukio Hosaka, Daisuke Izumi, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   32 ( 3 )   406 - 409   2009年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC  

    We observed a case of idiopathic ventricular arrhythmias originating from the right ventricular outflow tract (RVOT). The origin of target premature ventricular contraction (PVC) and nonsustained ventricular tachycardia (VT) was within a wide low-voltage area around the RVOT. During radiofrequency (RF) application to the site of arrhythmia origin, polymorphic VT and ventricular fibrillation were repeatedly triggered by new PVC that had developed near the site of ablation. This electrical storm persisted &gt; 30 minutes after cessation of RF current delivery, and was suppressed by additional RF applications to the site of origin of the new PVC.
    (PACE 2009; 32:406-409).

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  • Evaluation of channel function after alteration of amino acid residues at the pore center of KCNQ1 channel 査読

    Taruna Ikrar, Haruo Hanawa, Hiroshi Watanabe, Yoshiyasu Aizawa, Mahmoud M. Ramadan, Masaomi Chinushi, Minoru Horie, Yoshifusa Aizawa

    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   378 ( 3 )   589 - 594   2009年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE  

    The effect of the electrical charge or the size of tile amino acid residue at the pore center of a slowly activation component of the delayed rectifier potassium channel: KCNQ1 was studied. K+ currents were measured after transfection of one of four KCNQ1 mutants: substituting Isoleucine with Lysine, Glutamate, Valine or Glycine and then transfected in COS-7 cells. Both the negatively- and positive charged residue 1313 K and 1313 E showed a loss of function when expressed alone and a dominant negative suppression when co-expressed with wild type KCNQ1. When the Site Was Substituted with the smallest neutral amino acid residue: 1313G, there was a small reduction of current when transfected alone and a gain of function when co-transfected with the wild type. 1313V showed no difference from the wild type. Changes of amino acid residue at the pore center of KCNQ1 may alter the channel function but this depends on tile electrical charge or the size of amino acid residue. (C) 2008 Elsevier Inc. All rights reserved.

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  • Correlation between Surface and Intracardiac Electrocardiogram in a Patient with Inappropriate Defibrillation Shocks Due to Hyperkalemia 査読

    Yukio Hosaka, Masaomi Chinushi, Kenichi Iijima, Akiko Sanada, Hiroshi Furushima, Yoshifusa Aizawa

    INTERNAL MEDICINE   48 ( 13 )   1153 - 1156   2009年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A 39-year-old man received implantable cardioverter defibrillator (ICD) shocks during sinus rhythm, triggered by an increase in amplitude and oversensing of intracardiac T waves, caused by hyperkalemia. After treatment of hyperkalemia, the T wave morphology normalized, and oversensing and inappropriate ICD shocks were eliminated. Alteration of the intracardiac electrogram was well correlated to the surface electrocardiogram (ECG) changes. Intracardiac T waves can be altered by hyperkalemia and it seems that this alteration can be estimated by surface ECG analysis.

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  • Segmental Conduction Block in a Low-Voltage Area Suppressed Macro-Reentrant Ventricular Tachycardia after Surgical Repair of Tetralogy of Fallot 査読

    Masaomi Chinushi, Satoru Komura, Hiroshi Furushima, Yoshifusa Aizawa

    INTERNAL MEDICINE   48 ( 12 )   1021 - 1023   2009年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Macro-reentrant ventricular tachycardia (VT) developed in a 20-year-old man, 17 years after surgical repair of tetralogy of Fallot. Activation mapping of the VT revealed its counterclockwise propagation around the right ventricle, and through a critical pathway between a transannular patch and the tricuspid annulus. This critical pathway was 6 cm long and contained myocardium with a normal amplitude, while the area of low voltage was limited adjacent to the transannular patch. A linear lesion was created by radiofrequency energy delivered only to the low voltage area. After ablation, the activation wavefront through the low voltage area was blocked, and VT became non-inducible.

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  • Comparative Effects of Olmesartan and Azelnidipine on Atrial Structural Remodeling in Spontaneously Hypertensive Rats 査読

    Kazuki Okamura, Masahiro Ito, Komei Tanaka, Masaomi Chinushi, Takeshi Adachi, Wataru Mitsuma, Satoru Hirono, Mikio Nakazawa, Makoto Kodama, Yoshifusa Aizawa

    PHARMACOLOGY   83 ( 6 )   360 - 366   2009年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    The differential effects between olmesartan (OM), an angiotensin 2 type 1 receptor blocker (ARB), and azelnidipine (AZ), a calcium channel blocker (CCB), on atrial structural remodeling were studied in spontaneously hypertensive rats (SHR). Eight weeks after treatment, both OM and AZ decreased systolic blood pressure to similar levels. Histological analysis revealed that both OM and AZ had decreased the size of the atrial myocytes and interstitial fibrosis in the atrium, and that the effects of OM were greater than those of AZ. These beneficial effects of OM were associated with less atrial oxidative stress, as assessed by 3-nitrotyrosine staining, and less activation of Rac1, a regulatory component in NADPH oxidase. These results suggest that the ARB was more effective than the CCB in ameliorating atrial structural remodeling due to the suppression of oxidative stress. Copyright (C) 2009 S. Karger AG, Basel

    DOI: 10.1159/000218103

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  • Preservation of Renal Function in Response to Cardiac Resynchronization Therapy 査読

    Shinpei Kimura, Masahiro Ito, Masaomi Chinushi, Komei Tanaka, Yasutaka Tanabe, Yukio Hosaka, Satoru Komura, Shinsuke Okada, Kenichi Iijima, Hiroshi Furushima, Koichi Fuse, Masahito Sato, Yoshifusa Aizawa

    CIRCULATION JOURNAL   72 ( 11 )   1794 - 1799   2008年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOC  

    Background Cardiac resynchronization therapy (CRT) has recently been introduced as a new option for patients with severe heart failure, but its effect on renal function remains unclear.
    Methods and Results Twenty-three patients receiving CRT were studied. Responders were those who showed &gt; 0% increase in left ventricular ejection fraction after CRT by echocardiography. Clinical parameters, echocardiographic measurement, renal function, and prescriptions were examined before and 3 months after CRT, and the relationship between the response to CRT and renal function was examined. The responders had a better prognosis than the non-responders (p &lt; 0.05). There was a significant difference in the change in the estimated glomerular filtration rate between the responders and non-responders (p &lt; 0.05), even in patients with renal dysfunction before CRT (p &lt; 0.01). Prescriptions of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) were 100% in the CRT responders and 60% in the non-responders (p &lt; 0.05). Up-titration of blockers could be significantly achieved in the CRT responders compared with the non-responders (p &lt; 0.05).
    Conclusions Preservation of renal function was observed in the responders to CRT, even in patients with renal dysfunction. Prescription of ACEI/ARB and up-titration of beta-blockers increased in the CRT responders. These results may contribute to the beneficial effects of CRT. (Circ J 2008; 72: 1794-1799)

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  • Ventricular repolarization gradients in a patient with takotsubo cardiomyopathy 査読

    Hiroshi Furushima, Masaomi Chinushi, Akiko Sanada, Yoshifusa Aizawa

    EUROPACE   10 ( 9 )   1112 - 1115   2008年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

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  • Automatic R-wave and impedance testing with the modern patient alert system to reduce inappropriate implantable cardioverter defibrillator shocks due to lead fracture 査読

    Masaomi Chinushi, Yukio Hosaka, Noboru Ikarashi, Kenichi Iijima, Hiroshi Furushima, Yoshifusa Aizawa

    EUROPACE   10 ( 6 )   738 - 740   2008年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

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  • A double-point mutation in the selectivity filter site of the KCNQ1 potassium channel results in a severe phenotype, LQT1, of long QT syndrome 査読

    Taruna Ikrar, Haruo Hanawa, Hiroshi Watanabe, Shinsuke Okada, Yoshiyasu Aizawa, Mahmoud M. Ramadan, Satoru Komura, Fumio Yamashita, Masaomi Chinushi, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   19 ( 5 )   541 - 549   2008年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Mutation in the Selectivity Filter of the KCNQ1.
    Introduction: Slowly activating delayed-rectifier potassium currents in the heart are produced by a complex protein with alpha and beta subunits composed of the potassium voltage-gated channel KQT-like subfamily, member 1 (KCNQ1) and the potassium voltage-gated channel Isk-related family, member 1 (KCNE1), respectively. Mutations in KCNQ1 underlie the most common type of hereditary long QT syndrome (LQTS). Like other potassium channels, KCNQ1 has six transmembrane domains and a highly conserved potassium selectivity filter in the pore helix called "the signature sequence." We aimed to investigate the functional consequences of a newly identified mutation within the signature sequence.
    Methods and Results: Potassium channel genomic DNA from a family with clinical evidence of LQTS was amplified by polymerase chain reaction (PCR), and the resulting products were then sequenced. Three family members had a double-point mutation in KCNQ1 at nucleotides 938 (T-to-A) and 939 (C-to-A), resulting in an isoleucine-to-lysine change at amino acid position 313. These patients displayed prolonged QTc intervals (629, 508, and 500 ms(1/2,) respectively) and repetitive episodes of syncope, but no deafness. Three-dimensional structure modeling of KCNQ1 revealed that this mutation is located at the center of the channel pore. COS-7 cells displayed a lack of current when transfected with a plasmid expressing the mutant. In addition, the mutant displayed a dominant negative effect on current but appeared normal with respect to plasma membrane integration.
    Conclusion: An I313K mutation within the selectivity filter of KCNQ1 results in a dominant-negative loss of channel function, leading to a long QT interval and subsequent syncope.

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  • A post-QRS potential in Brugada syndrome its relation to electrocardiographic pattern and possible genesis 査読

    Yoshifusa Aizawa, Masaomi Chinushi, Minoru Tagawa, Hiroshi Furushima, Shinsuke Okada, Kenichi Iijima, Daisuke Izumi, Hiroshi Watanabe, Satoru Komura

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   51 ( 17 )   1720 - 1721   2008年4月

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    記述言語:英語   出版者・発行元:ELSEVIER SCIENCE INC  

    DOI: 10.1016/j.jacc.2008.01.031

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  • KCNQ1の複合ヘテロ接合体変異はQT延長症候群と関連する(A Compound Heterozygous Mutation in KCNQ1 Associated with Long QT Syndrome)

    Sato Akinori, Arimura Takuro, Aizawa Yoshiyasu, Ushinohama Hiroya, Ishikawa Shiro, Chinushi Masaomi, Aizawa Yoshifusa, Kimura Akinori

    Circulation Journal   72 ( Suppl.I )   561 - 561   2008年3月

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    記述言語:英語   出版者・発行元:(一社)日本循環器学会  

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  • Antiarrhythmic vs. pro-arrhythmic effects depending on the intensity of adrenergic stimulation in a canine anthopleurin-A model of type-3 long QT syndrome 査読

    Masaomi Chinushi, Daisuke Izumi, Kenichi Iijima, Shizue Ahara, Satoru Komura, Hiroshi Furushima, Yukio Hosaka, Yoshifusa Aizawa

    EUROPACE   10 ( 2 )   249 - 255   2008年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    Aims The effects of adrenergic activity and beta-blockade were studied in a canine experimental model of type-3 tong QT syndrome (LQT3) induced by application of anthopleurin-A.
    Methods and results Boluses of epinephrine at 0.5 and/or 1.0 mu g/kg were administered before and after propranolol, 0.3 mg/kg, and the distribution of the ventricular repolarization and the development of polymorphic ventricular tachyarrhythmia (VA) were assessed. Using needle electrodes, transmural unipolar electrograms were recorded across the left ventricle (W) and right ventricle (RV). Activation-recovery interval (ARI) was measured in each electrogram to estimate local repolarization during RV pacing at the cycle length of 750 ms after the creation of complete atrioventricular block. Before propranolol, epinephrine, 0.5 mu g/kg, did not induce VA in any experiment. However, a dose of 1.0 mu g/kg induced polymorphic VA following multiple premature ventricular complex (PVC) in four of six experiments. Epinephrine, 0.5 mu g/kg, shortened ARI at all sites and lessened LV transmural ARI dispersion. Neither ARI nor its dispersion could be determined after 1.0 mu g/kg of epinephrine because of the induction of PVC, polymorphic VA, or both. Propranolol (i) prevented epinephrine-induced PVC and polymorphic VA in all experiments, (ii) slightly prolonged ARI at all sites, along with a decrease in IV transmural. ARI dispersion, and (iii) reversed the epinephrine-induced shortening of ARI.
    Conclusion In this LQT3 model, an increase in adrenergic activity by epinephrine had dose-dependent, opposite effects on ventricular electrical stability. Since beta-adrenergic blockade suppressed epinephrine-induced PVC and polymorphic VA, it might be considered for supplemental therapy to suppress VA in patients presenting with LQT3.

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  • Clinical characteristics, treatment; and outcome of tachycardia induced cardiomyopathy 査読

    Hiroshi Watanabe, Kazuki Okamura, Masaorni Chinushi, Hiroshi Furushima, Yasutaka Tanabe, Makoto Kodama, Yoshifusa Aizawa

    INTERNATIONAL HEART JOURNAL   49 ( 1 )   39 - 47   2008年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    Tachycardia-induced cardiomyopathy is characterized by ventricular systolic dysfunction and congestive heart failure resulting from persistent or highly frequent tachyarrhythmias with uncontrolled heart rate. While reversible and often considered benign, few studies have examined the outcome of the disorder.
    The clinical characteristics, treatment, and long-term outcomes of 12 consecutive patients with tachycardia-induced cardiomyopathy (9 men, age, 51.9 +/- 17.6 years) were studied. The mean period between the occurrence of tachyarrbythmias and the development of congestive heart failure was 26.0 +/- 34.3 days. The mean heart rate on admission was 156.3 +/- 28.7 beats/min. All patients had severe heart failure with a NYHA functional class of 2.3 +/- 0.5, left ventricular ejection fraction of 0.32 +/- 0.10, and brain natriuretic peptide level of 505.7 +/- 449.1 pg/mL. In all patients, cardiac dysfunction recovered after 53.5 +/- 61.3 days. During the follow-up of 53 +/- 24 months, 2 patients had a recurrence of heart failure with uncontrolled tachyarrhythmia and 1 patient died suddenly.
    In tachycardia-induced cardiomyopathy, recurrent heart failure with uncontrollable tachyarrhythmia and sudden death were observed after recovery from cardiac dysfunction. A substrate for heart failure and/or life-threatening arrhythmia might persist, and careful, long-term follow-up seems required.

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  • Comparison of conduction delay in the right ventricular outflow tract between Brugada syndrome and right ventricular cardiomyopathy: investigation of signal average ECG in the precordial leads 査読

    Hiroshi Furushima, Masaomi Chinushi, Kazuki Okamura, Kenichi Iijima, Satoru Komura, Yasutaka Tanabe, Shinsuke Okada, Daisuke Izumi, Yoshifusa Aizawa

    EUROPACE   9 ( 10 )   951 - 956   2007年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    Background In both Brugada syndrome (BS) and arrhythmogenic right ventricular cardiomyopathy (ARVC), electrical abnormalities in the right ventricular outflow tract (RVOT) are important for arrhythmogenesis.
    Objectives The aim of this study was to compare conduction delay in the right ventricular in BS with that in ARVC using the signal-averaged electrocardiogram.
    Methods Twenty patients with BS (18 men and 2 women; 55 +/- 12 years old; 9 symptomatic and 11 asymptomatic) and eight patients with ARVC (six men and two women; 53 +/- 16 years old) were included. We assessed the presence of late potentials (LPs) and the filtered QRS duration (fQRSd) in V-2 and V-5 using a high-pass filter of 40 Hz (fQRSd:40) and 100 Hz (fQRSd:100).
    Results In ARVC, there was no significant difference in fQRSd:40 between V2 and V5 (158 +/- 19 vs. 145 +/- 17 ms, respectively): however, in BS, fQRSd:40 in V2 was significantly longer than fQRSd:40 in V5 (147 +/- 15 vs. 125 +/- 10 ms, P &lt; 0.001). In ARVC, there was no significant difference between fQRSdA0 and fQRSd:100 in V-2 and V-5 (158 +/- 19 vs. 142 +/- 23 ms and 145 +/- 17 vs. 132 +/- 9 ms, respectively). In contrast, in BS, fQRSd:100 was significantly shorter than fQRSd:40 in V2 (110 +/- 8 ms vs. 147 +/- 15, P &lt; 0.001). The relative decrease in fQRSd: 100 compared with fQRSd:40 in V2 was significantly greater in BS than in ARVC.
    Conclusion The dominant prolongation of the fQRSd in the right precordial. lead in BS was different from the characteristics of ARVC, which may be caused by the conduction delay due to fibro-fatty replacement in RV.

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  • Evaluating patients with acute ischemic stroke with special reference to newly developed atrial fibrillation in cerebral embolism 査読

    Minoru Tagawa, Shigekazu Takeuchi, Masaomi Chinushi, Makihiko Saeki, Yoshinori Taniguchi, Yuichi Nakamura, Hideko Ohno, Keiko Kitazawa, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   30 ( 9 )   1121 - 1128   2007年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    Background: Cardioembolic strokes are extensive and have a poor prognosis. To identify the cardiovascular risk factors of cardioembolic stroke, we evaluated the cardiovascular status with special reference to persistent atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF) combined with the type of acute ischemic stroke.
    Methods: We divided 315 consecutive patients admitted to our Department of Neurosurgery with an acute ischemic stroke into four types of brain infarction using clinical history, onset pattern of stroke, and brain imaging: cardioembolic (group E, n = 105), lacunar (group L, n = 92), atherothrombotic (group T, n = 111), and unclassified (n = 7). All patients underwent standard electrocardiography (ECG), a 24-hour ECG recording (Holter ECG) and transthoracic echocardiography (UCG).
    Results: Persistent AF or PAF was detected in 97 patients (31.5%) using Holter ECG: more frequently in group E (67.6%) than in groups L (15.2%) or T (9.2%). Persistent AF or PAF was first diagnosed on admission using a standard ECG in 16 patients (5.2%) with no previous history and 14 of these patients belonged to group E (13.3%). PAF was newly detected on Holter ECG in another 26 patients (8.4%) and 13 of these patients (12.4%) belonged to group E. Concerning UCG, left atrial enlargement and mitral regurgitation were more frequent in group E than in group L or T.
    Conclusion: Holter ECG in addition to ECG on admission is important for detecting persistent AF or PAF in patients with ischemic stroke, especially with cardioembolism as diagnosed by neuroimaging.

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  • Effect of dl-sotalol on mortality and recurrence of ventricular Tachyarrhythmias: Ischemic compared to nonischemic cardiomyopathy 査読

    Hiroshi Furushima, Masaomi Chinushi, Kazuki Okamura, Satoru Komura, Yasutaka Tanabe, Akinori Sato, Daisuke Izumi, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   30 ( 9 )   1136 - 1141   2007年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    Objective: We compared the effectiveness of sotalol on mortality and the recurrence of ventricular tachyarrhythmia (VTA) between idiopathic dilated cardiomyopathy (IDCM) and coronary artery disease (CAD).
    Patients: Forty patients with spontaneous VTA and induced VTA associated with CAD (n = 23) and IDCM (n = 17) were studied. In all patients, sotalol was prescribed and an electrophysiologic study (EPS) was performed to evaluate its effect on the induction of VTA. There were no significant differences in left ventricular ejection fraction (LVEF) between CAD and IDCM (35% +/- 10% vs. 35% +/- 12%).
    Results: After sotalol, there were no significant differences in the QTc interval on electrocardiogram (ECG) or in the effective refractory period in the apex of the right ventricle between the two groups, but sotalol was more effective in preventing the induction of VTA in CAD than in IDCM (65% vs. 29%; P &lt; 0.05). During a mean follow-up period of 47 +/- 27 months, the overall VTA recurrence rate was significantly lower in CAD than in IDCM (P &lt; 0.01). The all-cause mortality rate tended to be lower in CAD than in IDCM, but the difference was not significant (P = 0.07). Electrical storm (ES) occurred more frequently in IDCM than in CAD, (41% vs. 13%; P &lt; 0.05), and all patients with ES (n = 10) failed to respond to sotalol as assessed by EPS.
    Conclusion: Sotalol reduced the overall VTA recurrence rate and all-cause mortality more in CAD than in IDCM.

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  • Incidence and initial characteristics of pilsicainide-induced ventricular arrhythmias in patients with Brugada syndrome 査読

    Masaomi Chinushi, Satoru Komura, Daisuke Izumi, Hiroshi Furushima, Yasutaka Tanabe, Takashi Washizuka, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   30 ( 5 )   662 - 671   2007年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    Background: In patients with Brugada syndrome, class I antiarrhythmic drugs can trigger ventricular arrhythmias (VA). The incidence and initial characteristics of VA that developed after pilsicainide was examined in 28 patients with Brugada-type electrocardiographic (ECG) abnormalities and with a positive response in the pilsicainide test. The clinical outcome was also compared between patients with and without pilsicainide-induced VA.
    Methods and Results: In all patients, pilsicainide increased ST segment elevation and accentuated type 1 ECG changes. Ventricular tachycardia (VT) developed in 3 patients and premature ventricular complexes (PVC) in 2 other patients. These 5 patients (group I) had higher ST segment elevation in lead V2 on the ECG at baseline and after pilsicainide and showed a longer QTc interval after pilsicainide than the other 23 patients (group II). However, there was no difference between the 2 groups regarding incidence of prior cardiac events, results of signal-averaged ECG, HV interval, inducibility of ventricular fibrillation by programmed electrical stimulation, or QRS duration. In 1 patient, PVC originated from 3 sites, 2 of which triggered polymorphic VT. The right ventricular (RV) outflow tract was the origin of 2 types of PVC, and other RV sites of 5 other types. During a 45 +/- 37 months follow-up, polymorphic VT recurred in 2 patients in group II.
    Conclusions: Pilsicainide induced VA in some patients with Brugada syndrome, but this result may not be used as a parameter of the risk stratification of Brugada syndrome. Multiple PVC induced by pilsicainide and triggering polymorphic VT originated from several RV sites is an important factor when considering patients for treatment with catheter ablation.

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  • Human cardiac ryanodine receptor mutations in ion channel disorders in Japan 査読

    Yoshiyasu Aizawa, Wataru Mitsuma, Taruna Ikrar, Satoru Komura, Haruo Hanawa, Seiichi Miyajima, Fumito Miyoshi, Youichi Kobayashi, Masaomi Chinushi, Akinori Kimura, Masayasu Hiraoka, Yoshifusa Aizawa

    INTERNATIONAL JOURNAL OF CARDIOLOGY   116 ( 2 )   263 - 265   2007年3月

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    記述言語:英語   出版者・発行元:ELSEVIER IRELAND LTD  

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is characterized by adrenergic induced bidirectional or polymorphic ventricular tachycardias. Some of CPVT families were reported to be associated with cardiac ryanodine receptor gene (RyR2) mutations. However, association between RyR2 and other arrhythmogenic disorders is not clarified. In this study, we analyzed 83 Japanese patients including patients with long-QT syndrome, Brugada syndrome, idiopathic ventricular fibrillation, arrhythmogenic right ventricular caridiomyopalby and CPVT. Genetic screening of RyR2 revealed 3 distinct mutations among 4 families with CPVT (75% of incidence). However, no mutation was found in other groups. This is the first report to demonstrate prevalence of RyR2 mutations in various arrhythmogenic disorders in Japan. RyR2 mutations were detected frequently in CPVT but not in other diseases. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

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  • 心室性不整脈に対する効果

    池主 雅臣, 和泉 大輔, 古嶋 博司, 相澤 義房

    心電図 = Electrocardiology   27 ( 1 )   53 - 60   2007年1月

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    記述言語:日本語   出版者・発行元:The Japanese Society of Electrocardiology  

    心室性不整脈に対するベプリジルの薬効を臨床例と実験モデルで検討した, 【臨床例の検討】複数の抗不整脈薬に難治性の持続性心室頻拍例に対するベプリジルの効果を検討した.対象は器質的心疾患に伴う持続性心室頻拍の16症例 (57±13歳, LVEF=40±16%) で, ベプリジルの内服量は156±40mg/日であった.以下に主な結果を示す. (1) ベプリジル内服後に, QT (QTc) 間隔は延長したがQRS幅に有意な変化はみられなかった. (2) ベプリジル治療後に6例で心室頻拍が抑制され, 発作回数の減少が3例で認められた.全体での有効率は56%であった.ベプリジル使用に関連した有害事象はみられなかった. (3) ベプリジルが有効であった症例は無効であった症例に比べて, NYHA心機能分類が良好で, 心室頻拍の波形が少なく, QT間隔の延長程度が大きかった.電気生理検査による薬効判定の結果はべプリジルの臨床的有用性と相関した, 【実験モデルでの検討】ベプリジルは徐脈依存性に心室再分極時間を延長したが, 心室貫壁性の不応期分布の不均一性の増大は軽度であった.ベプリジルは交感神経刺激によって誘発される心室性不整脈に対して抑制効果を示した.

    DOI: 10.5105/jse.27.53

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  • Non-pharmacological management of ventricular tachycardia 査読

    Masaomi Chinushi, Yoshifusa Aizawa

    Circulation Journal   71   A-97 - A-105   2007年

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    記述言語:英語  

    Ventricular tachyarrhythmias (VTA), a major cause of sudden cardiac death, require meticulous management in order to prevent recurrent episodes. Recently, non-pharmacological interventions, including radiofrequency catheter ablation and implantable cardioverter defibrillators (ICD), have become important treatments of VTA. Catheter ablation is curative in a relatively high percentage of patients presenting with idiopathic monomorphic ventricular tachycardia (VT). For VT associated with structural heart disease, however, the efficacy of catheter ablation remains limited, and ICD is the first-line therapy. In a subset of patients presenting with recurrent episodes of ventricular fibrillation (VF), catheter ablation is a therapeutic option when the VF is triggered by specific premature ventricular complexes. In Japan, unlike in the United States and Europe, ICD have not yet been accepted as first-line prevention of sudden cardiac death caused by VTA. The efficacy of ICD is occasionally limited by intolerable complications, such as electrical storm, inappropriate shock delivery and infection. Catheter ablation and ICD therapy might need to be combined for problematic cases.

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  • Bepridil for drug-refractory ventricular tachyarrhythmias 査読

    Daisuke Izumi, Masaomi Chinushi, Hiroshi Watanabe, Takashi Washizuka, Kazuki Okamura, Satoru Komura, Yasutaka Tanabe, Hiroshi Furushima, Yoshifusa Aizawa

    INTERNAL MEDICINE   46 ( 3 )   119 - 124   2007年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Aims To avoid frequent discharges of implantable cardioverter defibrillators, antiarrhythmic drugs may be needed in some patients with ventricular tachyarrhythmias. For ventricular tachyarrhythmias refractory to conventional antiarrhythmic drugs, we evaluated the efficacy of bepridil, a multiple ion-channel blocker.
    Methods and results Sixteen patients with structural heart disease and ventricular tachyarrhythmias refractory to multiple antiarrhythmic drugs (4.1 +/- 1.6 drugs including class III drugs) were enrolled. Bepridil was prescribed at a mean dose of 156 +/- 40 mg/day. Bepridil prolonged the QT/QTc interval without affecting heart rate or the QRS duration. During a mean follow-up of 52 +/- 44 months, bepridil completely suppressed ventricular tachyarrhythmias in 6 of the 16 patients (38%) and the drug decreased the frequency of ventricular tachyarrhythmia recurrences by&gt; 75% in 3 of the other 10 patients. The markers of complete suppression of ventricular tachyarrhythmias during bepridil treatment included a smaller number of VT morphologies, a better NYHA functional class, and a greater drug-induced prolongation of the QT/QTc interval. The result of electrophysiologic study-guided evaluation of bepridil was closely associated with the clinical efficacy of bepridil in 7 of 8 patients.
    Conclusion Bepridil appears to be useful to suppress drug-refractory ventricular tachyarrhythmia recurrence.

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  • Multiple premature beats triggered ventricular arrhythmias during pilsicainide infusion in a patient with inferior ST-segment elevation 査読

    Masaomi Chinushi, Daisuke Izumi, Hiroshi Furushima, Hiroshi Watanabe, Yoshifusa Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   29 ( 12 )   1445 - 1448   2006年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    A 17-year-old man was referred to our hospital for treatment of common paroxysmal atrial flutter. His electrocardiogram at rest showed subtle ST-segment elevation in leads II, III, and aV(F). Intravenous pilsicainide caused further ST-segment elevation in the inferior leads, new ST-segment depression in leads V2-V6, two distinct forms of premature ventricular complexes (PVCs) triggering short runs of polymorphic ventricular tachycardia (VT). An infusion of isoproterenol suppressed these arrhythmias and normalized the ST-segment. Pilsicainide may induce PVCs and polymorphic VT in atypical Brugada syndrome.

    DOI: 10.1111/j.1540-8159.2006.00562.x

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  • Angiotensin 2 type 1 receptor blocker attenuates atrial structural remodeling in spontaneously hypertensive rats: Role of the suppression of atrial oxidative stress 査読

    Kazuki Okamura, Masahiro Ito, Masaomi Chinushi, Makoto Kodama, Yoshifusa Aizawa

    JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY   41 ( 6 )   1053 - 1054   2006年12月

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    記述言語:英語   出版者・発行元:ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD  

    DOI: 10.1016/j.yjmcc.2006.08.057

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  • Transient left ventricular apical ballooning developing after the Central Niigata Prefecture Earthquake: two case reports. 査読

    Tagawa M, Nakamura Y, Ishiguro M, Satoh K, Chinushi M, Kodama M, Aizawa Y

    Journal of cardiology   48 ( 3 )   153 - 158   2006年9月

  • Role of autonomic nervous activity in the antiarrhythmic effects of magnesium sulfate in a canine model of polymorphic ventricular Tachyarrhythmia associated with prolonged QT interval 査読

    Masaomi Chinushi, Daisuke Izumi, Satoru Komura, Shizue Ahara, Akinori Satoh, Hiroshi Furushima, Takashi Washizuka, Yoshifusa Aizawa

    JOURNAL OF CARDIOVASCULAR PHARMACOLOGY   48 ( 3 )   121 - 127   2006年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    This study was performed to examine the role played by the autonomic nervous system in the antiarrhythmic effects of magnesium sulfate (Mg++) in a canine model of polymorphic ventricular tachyarrhythmia facilitated by anthopleurin-A and a slower heart rate induced QT interval prolongation. In 6 experiments, complete atrioventricular block was created to control the heart rate and bradycardia at 800- to 1500-ms cycle lengths was applied for 60 see before and after drug-induced autonomic block. Transmural unipolar electrograms were recorded from multipolar needle electrodes, and activation-recovery intervals (ARI) were measured. Before drug-induced autonomic block, polymorphic ventricular tachyarrhythmia developed in all 6 experiments during bradycardia before but not after the administration of Mg++ (0.2 ml/kg intravenous bolus). During drug-induced autonomic block, triggered premature activity decreased without significant changes in underlying dispersion of repolarization and polymorphic ventricular tachyarrhythmia developed during bradycardia in I experiment. Administration of Mg++ during drug-induced autonomic block eliminated premature activity and polymorphic ventricular tachyarrhythmia during bradycardia. The distribution of left ventricular (IV) and right ventricular repolarization and dispersion of transmural repolarization were analyzed before and 60 see after Mg+ administration during ventricular pacing at 80 bpm. Mg++ caused a modest shortening of ARI at all sites before and after drug-induced autonomic block. Since ARI shortening was greater at the mid-myocardial sites than at other IV sites, Mg++ decreased transmural ARI dispersion from 77 +/- 16 to 46 +/- 21 ms before drug-induced autonomic block and from 79 +/- 7 to 51 +/- 16 ms after drug-induced autonomic block. The antiarrhythmic effects of Mg++ in this model of long QT syndrome were attributable to its direct pharmacological properties and not to changes in ambient autonomic nervous activity. The blockade of sympathetic activity decreased the incidence of premature events and partially suppressed polymorphic ventricular tachyarrhythmia in this model.

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  • Amiodarone therapy in patients implanted with cardioverter-defibrillator for life-threatening ventricular arrhythmias 査読

    Kazuhiro Satomi, Takashi Kurita, Seiji Takatsuki, Yasuhiro Yokoyama, Masaomi Chinushi, Naoya Tsuboi, Takashi Nitta, Morio Shoda, Hideo Mitamura

    CIRCULATION JOURNAL   70 ( 8 )   977 - 984   2006年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOCIETY  

    Background Whether amiodarone can improve the patient's clinical outcome by reducing implantable cardioverter-defibrillator (ICD) therapy deliveries for ventricular tachycardia or fibrillation (VT/VF) has not been clearly evaluated.
    Methods and Results A total of 507 patients with VT/VF due to organic heart disease who had ICDs implanted were enrolled in this study. The patients were divided into 3 groups: Arniodarone (n=247), Class I antiarrhythmic drug (n=103) and Control (n=157) groups, and the total cause mortality and arrhythmic event free survival rates were evaluated between the groups. The mean follow-up period was 38 +/- 27 months. The left ventricular ejection fraction was significantly decreased in the Arniodarone group (Amiodarone: 37 +/- 15%; Class I: 39 +/- 16%; Control: 44 +/- 17%). The mortality and arrhythmic events were significantly higher in the Class I group than the Amiodarone group (p &lt; 0.05), but there was no significant difference between the Arniodarone and Control groups (arrhythmic event free rate at 5 years: Amiodarone: 53%; Class I: 35%; Control: 48%; 5 year survival: 86%, 74% and 77%, respectively). Side effects from amiodarone were found in 12% of the patients, but no fatal events were observed.
    Conclusions The present study could not demonstrate the benefit of amiodarone in ICD patients, probably due to a significant clinical bias exerted in selecting this drug.

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  • Shortening of the ventricular fibrillatory intervals after administration of verapamil in a patient with Brugada syndrome and vasospastic angina 査読

    M Chinushi, M Tagawa, Y Nakamura, Y Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   39 ( 3 )   331 - 335   2006年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    A 43-year-old man presented with electrocardiographic findings consistent with Brugada syndrome. Though the baseline coronary angiogram was normal, intracoronary infusion of ergonovine maleate caused complete occlusion of the left anterior descending and a 99% occlusion of the proximal right coronary artery, each relieved by intracoronary isosorbide dinitrate. Double extrastimuli delivered at the right ventricular outflow tract induced ventricular fibrillation terminated by a 200-J shock. Verapamil, 10 mg IV, increased ST-segment elevation and programmed stimulation repeated after the drug induced ventricular fibrillation with shorter F-F intervals and lower amplitude signals, which was not terminated by 200 J and required an additional 360-J shock. Ca2+ antagonism may have been adverse in this patient with Brugada syndrome because the drug has the potential to increase the voltage gradient through the right ventricle and to slow intraventricular conduction at very fast heart rates. (c) 2006 Elsevier Inc. All rights reserved.

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  • Over-expression of Kv1.5 in rat cardiomyocytes extremely shortens the duration of the action potential and causes rapid excitation 査読

    Yasutaka Tanabe, Katsuharu Hatada, Naoki Naito, Yoshiyasu Aizawa, Masaomi Chinushi, Hiroyuki Nawa, Yoshifusa Aizawa

    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   345 ( 3 )   1116 - 1121   2006年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE  

    Background: Genetically abnormal action potential duration (APD) can be a cause of arrhythmias that include long and short QT interval syndrome.
    Purpose: The aim of this study was to evaluate the arrhythmogenic effect of short QT syndrome induced by the over-expression of Kv1.5 in rat.
    Methods: From Sprague-Dawley rats on fetal days 18-19, cardiomyocytes were excised and cultured with and without transfection with the Kv-1.5 gene using an adenovirus vector. The expression of Kv1.5 was proven by immunohistochemistry and Western blot analysis. In the culture dish and in the whole cells, the electrical activities were recorded using the whole-cell patch-clamp technique and the effects of 4-AP and verapamil were tested.,
    Results: After transfection with Kvl.5 for 12 h, immunohistochemical staining and Western blot analysis were positive for Kvl.5 while they were negative in the control transfected with only Lac-Z. In the culture dish, the myocytes showed spontaneous beating at 115 beats/min (bpm) just prior to the transfection with Kvl.5 and increased to 367 bpm at 24 h. The control myocytes showed stable beating rates during culturing. 4-AP at 200 mu M slowed down the rate and verapamil abolished the beating. In the whole cells, the maximal resting membrane potential was slightly depolarized and APD was extremely abbreviated both at 50% and 90% of repolarization compared with those of the control. Rapid spontaneous activities were found in a single myocyte with Kv1.5 transfection and 4-AP slowed down the frequency of the activities with a reversal of the shortened APD.
    Conclusion: The over-expression of Kv1.5 induced short APD and triggered activities in rat cardiomyocytes. This model can be used to study the arrhythmogenic substrate of short QT syndrome. (c) 2006 Elsevier Inc. All rights reserved.

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  • Decrease in amplitude of intracardiac ventricular electrogram and inappropriate therapy in patients with an implantable cardioverter defibrillator 査読

    Hiroshi Watanabe, Masaomi Chinushi, Daisuke Izumi, Akinori Sato, Shinsuke Okada, Kazuki Okamura, Satoru Komura, Yukio Hosaka, Hiroshi Furushima, Takashi Washizuka, Yoshifusa Aizawa

    INTERNATIONAL HEART JOURNAL   47 ( 3 )   363 - 370   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:INTERNATIONAL HEART JOURNAL ASSOCIATION  

    Intracardiac electrograms are important for discrimination of tachyarrhythmia by implantable cardioverter defibrillators (ICD). A low R-wave can cause not only undersensing of ventricular tachyarrhythmia but also inappropriate discharges due to oversensing of unexpected signals because of its characteristic sensing algorithm. Therefore, this study aimed to investigate adverse events associated with R-wave amplitude. We included 115 consecutive patients followed-up over one year after implantation of a transvenous ICD system. The status of the ICD was checked every 3 months and intracardiac ventricular electrograms were analyzed. The decrease in R-wave amplitude was high in arrhythmogenic hypertrophy cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC), and sarcoidosis. Low R-waves (&lt; 5.0 mV) were observed in 13 patients at a follow-up of 15 +/- 16 months after implantation, and the mean R-wave was 3.0 +/- 0.8 mV. The frequency of low R-waves was high in ARVC (38%), sarcoidosis (33%), and dilated cardiomyopathy (17%). All of the dilated cardiomyopathy patients with low R-waves had severe left ventricular dysfunction. Inappropriate ICD therapy resulting from T-wave oversensing occurred in 7 patients and the R-wave was &lt; 5.0 mV in 6 of the patients. The frequency of inappropriate therapy was high in patients with sarcoidosis. In 3 patients, inappropriate therapy caused ventricular tachyarrhythmia. In conclusion, decreases in R-wave amplitude occurred in some progressive cardiac disorders and caused inappropriate ICD discharges having arrhythmogenicity. Physicians should attempt to obtain a high R-wave amplitude during ICD implantation and careful follow-up is required, especially in patients with ARVC or sarcoidosis.

    DOI: 10.1536/ihj.47.363

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  • Distinct U wave changes in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) 査読

    Yoshiyasu Aizawa, Satoru Komura, Shinsuke Okada, Masaomi Chinushi, Yoshifusa Aizawa, Hiroshi Morita, Tohru Ohe

    INTERNATIONAL HEART JOURNAL   47 ( 3 )   381 - 389   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:INTERNATIONAL HEART JOURNAL ASSOCIATION  

    Although catecholaminergic polymorphic ventricular tachycardia (CPVT) is associated with fatal ventricular arrhythmias and sudden death, the ECG findings are not fully understood. In this paper, we report on alterations in the U-wave.
    Seven patients from 6 families with CPVT in which bidirectional tachycardia and polymorphic VT were induced by exercise or isoproterenol infusion visited our hospitals. VT was not inducible by programmed electrical stimulation. A novel gene mutation of the ryanodine receptor 2 (RyR2) was confirmed in 2 families.
    In one of these patients, U-wave alternans was observed following ventricular pacing at 160 beats/min. In the other patient, U-wave alternans was observed during the recovery phase after the exercise stress test, which was terminated because of polymorphic VT. In both cases, leads V-3-V-5 were the leads showing alternans most clearly. In the third patient, a negative U-wave became positive following a pause from sinus arrest and a change in T-wave was also noted.
    Since such findings were not found in the other subjects who underwent electrophysiologic study, isoproterenot infusion or exercise stress testing, the phenomenon seems to be relevant to the underlying pathogenesis of CPVT. The genesis and significance of U-wave alteration need to be determined.

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  • Comparison of efficacy of sotalol and nifekalant for ventricular tachyarrhythmias 査読

    H Watanabe, M Chinushi, T Washizuka, H Sugiura, T Hirono, Y Aizawa, S Komura, Y Hosaka, Y Tanabe, H Furushima, Y Aizawa

    CIRCULATION JOURNAL   70 ( 5 )   583 - 587   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOCIETY  

    Background Suppression of implantable defibrillator discharges associated with ventricular tachyarrhythmia (VTA) has been reported for sotalol. This study aimed to investigate the efficacy of intravenous nifekalant hydrochloride in predicting the effects of oral sotalol.
    Methods and Results The present study included 14 patients who had sustained VTA associated with structural heart disease. All patients also had inducible VTA. To compare the effects of nifekalant and sotalol, programmed electrical stimulation was performed, in the basal state, after nifekalant administration, and after sotalol administration. Nifekalant and sotalol similarly prolonged the corrected QT interval and ventricular effective refractory periods, but the heart rate was slowed by sotalol only. In 4 of 5 patients whose VTA became non-inducible by nifekalant, subsequent treatment with sotalol also suppressed the inducible VTA. In all of the 9 patients non-responding to nifekalant, VTA remained inducible during sotalol treatment. Nifekalant accurately predicted the response to sotalol during electrophysiologic study in 13 of 14 patients. Of 11 patients who remained on sotalol, VTA recurred in 3 non-responders during a follow-up of 46 +/- 11 months.
    Conclusions Nifekalant and sotalol had similar effects on inducible VTA. The response of inducible VTA to nifekalant may predict the clinical efficacy of sotalol.

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  • Tumor necrosis factor-alpha inhibits the cardiac delayed rectifier K current via the asphingomyelin pathway 査読

    K Hatada, T Washizuka, M Horie, H Watanabe, F Yamashita, M Chinushi, Y Aizawa

    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   344 ( 1 )   189 - 193   2006年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE  

    Tumor necrosis factor-alpha (TNF-alpha) affects contractility and ionic currents in the heart. However, the electrophysiological effects, especially on delayed rectifier K currents (IK), have not yet been fully elucidated. We examined the effects of TNF-alpha on IK. Using a voltage-clamp method, IK was measured in guinea pig ventricular myocytes in the basal state and after pharmacological intervention. To specify the site of the action of TNF-alpha, the myocytes were incubated with pertLISSiS toxin or Al-olcoylethanolarnine, it cerarnidase inhibitor, and IK was measured. TNF-alpha suppressed IK when it was enhanced by isoproterenol, histamine or forskolin but not in the basal state or when IK was augmented by an internal application of cyclic AMP. Both pre-itICUbation with pertUSSiS toxin and N-olcoylethanolamine abolished the inhibitory action of TNF-alpha on isoproterenol-augmented IK. TNF-alpha inhibits IK, mainly IKs, when it is augmented by PKA as a result of the generation of sphingosine. (c) 2006 Elsevier Inc. All rights reserved.

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  • Ventricular tachycardia late after repair of congenital heart disease: efficacy of combination therapy with radiofrequency catheter ablation and class III antiarrhythmic agents and long-term outcome 査読

    H Furushima, M Chinushi, H Sugiura, S Komura, Y Tanabe, H Watanabe, T Washizuka, Y Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   39 ( 2 )   219 - 224   2006年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    Objective: This study investigated the treatment of ventricular tachycardia (VT) after repair of tetralogy of Fallot or double outlet of the right ventricle.
    Background: The ideal antiarrhythmic therapy for VT in patients after repair of congenital heart disease, especially without left ventricular dysfunction, has not yet been established.
    Methods: Seven consecutive patients (2 women and 5 men) with stable monomorphic sustained VT were investigated. The mean age was 25 +/- 7 years (range, 16-35 years). Four patients had undergone surgical repair of tetralogy of Fallot, and 3 had surgical correction of double outlet of the right ventricle at the mean age of 18 +/- 7 years (range, 9-27 years) before documentation of the arrhythinia.
    Results: The mean ejection fraction of the left ventricle was 60% +/- 8% (range, 50-72). Fourteen sustained monomorphic VTs were induced in 7 patients using programed electrical stimulation. The mean cycle length of tachycardia was 346 +/- 77 milliseconds (range, 260-480 seconds). The site of the surgical correction of the right ventricle was associated with the origin of VT in all patients. Radiofrequency catheter ablation was attempted in 8 VTs in 7 patients: 7 clinical and 1 nonclinical VTs. In 6 patients, class III antarrhythinic agents were added because VT remained inducible after ablation. During a follow-up of 61 +/- 29 months (range, 15-110 months), there were no recurrences of VT.
    Conclusion: In patients with drug-refractory VT originating from the right ventricle late after congenital heart disease, and when their left ventricular function do not deteriorate, combined therapy for radiofrequency catheter ablation with class III antiarrhythmic agents might effective and should be considered as a therapeutic option. (c) 2006 Elsevier Inc. All rights reserved.

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  • Japanese randomized trial for investigation of a combined therapy of amiodarone and implantable cardioverter defibrillator in patients with ventricular tachycardia and fibrillation - The Nippon ICD plus Pharmacologic Option Necessity (NIPPON) study design 査読

    T Kurita, H Mitamura, Y Aizawa, T Nitta, K Aonuma, N Tsuboi, M Chinushi, Y Kobayashis, K Soejima, K Satomi, H Furushima, T Ohe, S Ogawa, Kodama, I, H Ohtsu, T Yamazaki

    CIRCULATION JOURNAL   70 ( 3 )   316 - 320   2006年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOCIETY  

    Background Implantable cardioverter-defibrillators (ICDs) are the most effective therapy in reducing the mortality of patients with life-threatening ventricular tachyarrhythmias. However, the ICD cannot prevent the recurrence of tachycarida attacks and that limits the clinical usefulness of them. The Nippon ICD Plus Pharmachologic Option Necessity (NIPPON) trial was designed as the first prospective randomized study to test the hypothesis whether amiodarone could improve the patient's clinical outcome by reducing the amount of ICD therapy in the Japanese patient Population.
    Methods and Results Approximately 400 patients with organic heart disease and spontaneous episode(s) of sustained ventricular tachycardia/fibrillation (VT/VF) will be randomly assigned to one of 2 groups; the amiodarone group and non-amiodarone group. Both groups of patients will be followed at least for 24 months. The end-point committee will adjudicate events in a blinded fashion. The primary end-points of this Study are determination of the appropriate therapy from the ICD and alteration of the assigned treatment because of its harmful effects and/or frequent ICD therapies.
    Conclusion The NIPPON study is expected to confirm our understanding of the prognostic and therapeutic usefulness of adjuvant amiodarone therapy for patients with an ICD and with a history of sustained VT/VF.

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  • Japanese randomized trial for investigation of a combined therapy of amiodarone and implantable cardioverter defibrillator in patients with ventricular tachycardia and fibrillation - The Nippon ICD plus Pharmacologic Option Necessity (NIPPON) study design 査読

    T Kurita, H Mitamura, Y Aizawa, T Nitta, K Aonuma, N Tsuboi, M Chinushi, Y Kobayashis, K Soejima, K Satomi, H Furushima, T Ohe, S Ogawa, Kodama, I, H Ohtsu, T Yamazaki

    CIRCULATION JOURNAL   70 ( 3 )   316 - 320   2006年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOCIETY  

    Background Implantable cardioverter-defibrillators (ICDs) are the most effective therapy in reducing the mortality of patients with life-threatening ventricular tachyarrhythmias. However, the ICD cannot prevent the recurrence of tachycarida attacks and that limits the clinical usefulness of them. The Nippon ICD Plus Pharmachologic Option Necessity (NIPPON) trial was designed as the first prospective randomized study to test the hypothesis whether amiodarone could improve the patient's clinical outcome by reducing the amount of ICD therapy in the Japanese patient Population.
    Methods and Results Approximately 400 patients with organic heart disease and spontaneous episode(s) of sustained ventricular tachycardia/fibrillation (VT/VF) will be randomly assigned to one of 2 groups; the amiodarone group and non-amiodarone group. Both groups of patients will be followed at least for 24 months. The end-point committee will adjudicate events in a blinded fashion. The primary end-points of this Study are determination of the appropriate therapy from the ICD and alteration of the assigned treatment because of its harmful effects and/or frequent ICD therapies.
    Conclusion The NIPPON study is expected to confirm our understanding of the prognostic and therapeutic usefulness of adjuvant amiodarone therapy for patients with an ICD and with a history of sustained VT/VF.

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  • Elimination of late potentials by quinidine in a patient with Brugada syndrome 査読

    H Watanabe, M Chinushi, A Osaki, K Okamura, D Izumi, S Komura, Y Hosaka, Y Tanabe, H Furushima, T Washizuka, Y Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   39 ( 1 )   63 - 66   2006年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    The beneficial effects of quinidine on ST-segment elevation, inducible ventricular tachyarrhythmias, and episodes of ventricular tachyarrhythmia have been reported in Brugada syndrome. This is the first report describing quinidine-induced elimination of the late potential, which is considered one of the parameters for an arrhythmic event, in a patient with Brugada syndrome. (c) 2006 Elsevier Inc. All rights reserved.

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  • Relationship between dominant prolongation of the filtered QRS duration in the right precordial leads and clinical characteristics in Brugada syndrome 査読

    H Furushima, M Chinushi, T Hirono, H Sugiura, H Watanabe, S Komura, T Washizuka, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   16 ( 12 )   1311 - 1317   2005年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    SAECG and EPS in Brugada Syndrome. Background: Electrical abnormalities in the RVOT may be involved in Brugada syndrome.
    Objectives: We investigated the relationship between the signal-averaged ECG (SAECG) and electrophysiologic study (EPS), especially focusing on conduction delay in the outflow tract of the right ventricle (RVOT) and its contribution to clinical characteristics.
    Methods: Twenty-four patients with Brugada syndrome (23 men and 1 woman; 61 +/- 16 years old) were studied. We assessed the presence of late potential (LP) in SAECG and the filtered QRS duration in the right precordial leads (V-1 or V-2; RfQRS) and in the left precordial leads (V-5 or V-6; LfQRS) and the difference between them. In 18 patients, SAECG was evaluated for an LP on three separate occasions.
    Results: SAECG was positive for LP in 15 patients at least once; and in 7 patients, SAECG was positive for an LP on multiple occasions, and 6 of 7 patients (86%) had a history of cardiac arrest. The difference between RfQRS and LfQRS was significantly greater in patients with cardiac arrest than in patients with syncope or in asymptomatic patients; 29 +/- 10, 14 +/- 11 (P &lt; 0.01), and 7 +/- 5 msec (P &lt; 0.001), respectively. All patients were alive and one patient with cardiac arrest had an appropriate VF therapy delivered by the ICD.
    Conclusions: The dominant prolongation of the filtered QRS duration in the right precordial leads may be related to the risk of arrhythmic event in Brugada syndrome.

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  • Nifekalant hydrochloride suppresses severe electrical storm in patients with malignant ventricular tachyarrhythmias 査読

    T Washizuka, M Chinushi, H Watanabe, Y Hosaka, S Komura, H Sugiura, T Hirono, H Furushima, Y Tanabe, Y Aizawa

    CIRCULATION JOURNAL   69 ( 12 )   1508 - 1513   2005年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPANESE CIRCULATION SOCIETY  

    Background Some patients with an implantable cardioverter-defibrillator (ICD) suffer from burst of inappropriate multiple discharges (severe electrical storm), and because the current therapeutic options are limited, the effect of nifekalant hydrochloride, a new class III drug, on severe electrical storm was investigated in the present study.
    Methods and Results Ninety-one consecutive patients treated with ICD were included in the study (M 70; mean age 58 years; left ventricular ejection fraction 45 +/- 15%). Severe electrical storm was defined as more than 10 ICD discharges within 1 h. During a mean follow-up period of 30 +/- 13 months, 41/91 (45%) patients had appropriate ICD therapy for arrhythmias and severe electrical storm occurred in 11 of them (12%) at 20 +/- 18 months after ICD implantation. The mean number of ICD discharges/h during severe electrical storm was 18 +/- 12. In 4 of 10 patients, severe electrical storm was successfully suppressed by a combination of deep sedation and beta-blocking agent; 6 other patients were refractory to this treatment, but severe electrical storm was successfully suppressed by intravenous administration of nifekalant hydrochloride with no adverse effects.
    Conclusions Nifekalant hydrochloride is an effective and safe treatment for severe electrical storm.

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  • Heart rate variability is a useful parameter for evaluation of anticholinergic effect associated with inducibility of atrial fibrillation 査読

    H Sugiura, M Chinushi, S Komura, T Hirono, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   28 ( 11 )   1208 - 1214   2005年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    Background: Disopyramide is thought to have an advantageous effect for atria] fibrillation (AF) associated with vagal activity because of its anticholinergic effect.
    Method: We used a canine vagal nerve stimulation (VNS) model. The monophosic action potential (MAP) duration at 90% repolarization (MAP(90)). the intraatrial conduction time. the induciblity of AF by electrical stimulation, and the amplitude of high-frequency component (HF-amp) of the heart rate variability (HRV) were evaluated before and after the administration of disopyramide (I mg/kg) (group D, n = 8) or pilsicainide (1 mg/kg) (group P n = 5).
    Results: In group D, HF-amp decreased in the baseline condition from 1.1 +/- 0.6 to 0.6 +/- 0.4 ins and the degree of VNS-induced augmentation of HF-amp was attenuated from +492% to +127%. VNS-induced shortening of MAP(90) was also attenuated in the right atrium (from -30 +/- 15% to -10 +/- 6%) and in the left atrium (from -15 +/- 9% to -6 +/- 6%). In group P, little (effect was shown in these parameters, The vagotonic AF became noninducible in all eight experiments in group D, while in only one of five in group R
    Conclusion: The beneficial effect of disopyramide for vagotonic AF is based on the decrease of basal vagal tone and attenuation of the effect of vagal stimulation in the atrial myocardium. 111711 is a useful parameter for evaluation of the effect of antiarrhythmic drugs on the autonomic nerve system, and the evaluation of variability maybe useful for testing drug efficacy for arrhythimas.

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  • Transient giant negative T waves associated with cardiac involvement of diffuse large B-cell lymphoma 査読

    M Ito, J Tsuchiyama, M Chinushi, M Kodama, Y Aizawa

    CIRCULATION   112 ( 20 )   E322 - E323   2005年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1161/CIRCULATIONAHA.104.530568

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  • Human cardiac ryanodine receptor mutations in ion channel disorders in Japan 査読

    Y Aizawa, W Mitsuma, S Komura, K Ueda, M Chinushi, Y Aizawa, M Hiraoka, C Antzelevitch

    CIRCULATION   112 ( 17 )   U150 - U150   2005年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Similarities between Brugada syndrome and ischemia-induced ST-segment elevation. Clinical correlation and synergy 査読

    M Chinushi, H Furushima, Y Tanabe, T Washizuka, Y Aizawaz

    JOURNAL OF ELECTROCARDIOLOGY   38 ( 4 )   18 - 21   2005年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    Vasospastic angina (VSA) and Brugada syndrome (BS) are classified into different categories of cardiac disease, but both can be causes of sudden cardiac death from ventricular fibrillation (VF). The coexistence of VSA and BS in the same patient is possible, and this raises several questions: (1) what is the incidence of the coexistence of BS and VSA in the same patient? (2) is susceptibility to VF enhanced by the coexistence of the 2 diseases? and (3) is there any possibility of Ca-antagonists being used for the treatment of VSA-aggravated BS? In our institution, VSA coexisted in 5 of the 3 8 patients with BS (13.1%). Anginal episodes were confirmed clinically in 4 of the 5 patients, and syncope attack occurred after the symptom of chest pain in 2 patients. However, VF did not develop during the coronary vasospasm in any of the patients. Treatment with Ca-antagonist was effective for VSA, and neither aggravation of Brugada-type electrocardiographic abnormality nor an increase in the incidence of syncope attack was observed. Although the coexistence of BS and VSA in the same patient is not rare, neither enhanced susceptibility to VF nor the proarrhythmic effect of Ca-antagonist has been confirmed in our experience. However, careful attention is required in such patients because the influence of myocardial ischemia and/or the effect of Ca-antagonist may be different in each patient with BS. (c) 2005 Elsevier Inc. All rights reserved.

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  • Inappropriate discharges of intravenous implantable cardioverter defibrillators owing to lead failure 査読

    T Washizuka, M Chinushi, R Kazama, T Hirono, H Watanabe, S Komura, H Sugiura, Y Tanabe, H Furushima, S Fujita, Y Okura, Y Aizawa

    INTERNATIONAL HEART JOURNAL   46 ( 5 )   909 - 913   2005年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:INTERNATIONAL HEART JOURNAL ASSOCIATION  

    We describe here the case of a 58-year-old female patient who experienced inappropriate shocks from her implantable cardioverter-defibrillator (ICD). Stored electrograms from her ICD showed hi.-h frequency noise preceding the shock. Although the pacing threshold was normal and lead fracture was not found in chest X-rays, pacing lead impedance decreased to 480 Omega. Moreover, such high frequency noise was observed by electrogram telemetry, but not by routine evaluation every 3 months. ICD lead dysfunction was Suspected, so we elected to replace the ICD lead system. At the time of the operation. lead impedance was 410 Omega and pacing threshold was the same as it was at the time of the ICD implantation, and no lead insulation disturbances were observed in the generator pocket. However. manipulation of the lead system produced high frequency noise reproducibly. Since some of the ICD lead dysfunction initially was clinically silent at rest. dysfunction was difficult to detect before serious problems occurred. Therefore, more careful evaluation of the ICD lead system is needed during long-term follow-up of ICD implants.

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  • Effects of intravenous magnesium in a prolonged QT interval model of polymorphic ventricular tachycardia focus on transmural ventricular repolarization 査読

    M Chinushi, H Sugiura, S Komura, T Hirono, D Izumi, M Tagawa, H Furushima, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   28 ( 8 )   844 - 850   2005年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING  

    Background: This study was performed to clarify the antiarrhythmic effects of magnesium sulfate (Mg++) in a prolonged QT interval canine model of polymorphic ventricular tachyarrhythmia (VTA).
    Methods: In six experiments in a canine model of prolonged QT by anthopleurin-A, Mg++ was administered in boluses of 0.2 mL/kg during repetitive episodes of self-terminating polymorphic VTA or frequent premature ventricular complexes (PVCs). The distribution of ventricular repolarization across the left ventricular(LV) wall and dispersion of transmural repolarization were analyzed before, and 30 and 120 seconds after Mg++ administration, during ventricular pacing at 100 bpm. Transmural unipolar electrograms were recorded from multipolar needle electrodes, and local activation-recovery intervals (ARI) were measured.
    Results: Mg++ rapidly eliminated self-terminating polymorphic VTA and all isolated PVCs. During ventricular pacing at 100 bpm, Mg++ caused modest shortening of ARI at all recording sites. Since the magnitude of ARI shortening was greater at mid-myocardial sites than at other ventricular sites, mean transmural ARI dispersion decreased from 80 +/- 22 to 45 +/- 18 ms within 30 seconds after Mg++ injection. However, this effect was transient, and, at 120 seconds after Mg++ administration, ARI had increased all sites and transmural ARI dispersion lengthened to 65 18 ms. Besides suppression of triggered premature activity, homogenization of transmural ventricular repolarization was associated with the antiarrhythmic effects of intravenous Mg++ in this model.
    Conclusion: Since these effects were transient, a continuous intravenous infusion of Mg++ is preferred to prevent recurrences of VTA.

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  • Impact of earthquakes on Takotsubo cardiomyopathy 査読

    H Watanabe, M Kodama, Y Okura, Y Aizawa, N Tanabe, M Chinushi, Y Nakamura, T Nagai, M Sato, M Okabe

    JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION   294 ( 3 )   305 - 307   2005年7月

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    記述言語:英語   出版者・発行元:AMER MEDICAL ASSOC  

    DOI: 10.1001/jama.294.3.305

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  • Variable electrocardiographic effects of short-term quinidine sulfate administration in Brugada syndrome 査読

    H Watanabe, M Chinushi, T Washizuka, H Sugiura, T Hirono, S Komura, Y Hosaka, M Yamaura, Y Tanabe, H Furushima, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   28 ( 5 )   372 - 377   2005年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL FUTURA PUBLISHING, INC  

    Quinidine, a class I antiarrhythmic agent with blocking property of transient outward current, is a possible candidate for the suppression of ventricular fibrillation in patients with Brugada syndrome; although there is a concern that its ability to these effects may be proarrhythmic. Therefore, we evaluated the effect of quinidine sulfate on ST-segment elevation in Brugada syndrome. In 8 patients with Brugada syndrome, the magnitude of ST-elevation at the I-point (STJ), and the ST-segment configuration in leads V1-V3, were compared before and on day 2 after the initiation of quinidine administration. In 3 patients, quinidine attenuated STJ by &gt;= 0.1 mV Of these 3 patients, ST-segment elevation was normalized in 2 patients, while the ST-segment configuration was unchanged in another. In another 3 patients, quinidine augmented STJ by &gt;= 0.1 mV without any change of ST-segment configuration, and the augmentation was returned to baseline after the discontinuation of quinidine. Quinidine exhibited no effect on the ST-segment in the remaining 2 patients. The favorable effects of quinidine on the ST-segment tended to be more pronounced in patients with prominent ST-elevution at baseline. In 1 patient, quinidine was effective in eliminating both ST-segment elevation and repetitive tachyarrhythmia episodes. In conclusion, the effects of quinidine on ST-segment elevation were variable. Quinidine may potentially augment the ST-segment elevation in some patients with Brugada syndrome.

    DOI: 10.1111/j.1540-8159.2005.09494.x

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  • Electrophysiologic study-guided therapy with sotalol for life-threatening ventricular tachyarrhythmias 査読

    H Watanabe, M Chinushi, T Washizuka, H Sugiura, T Hirono, S Komura, Y Hosaka, Y Tanabe, H Furushima, S Fujita, K Kato, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   28 ( 4 )   285 - 290   2005年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL FUTURA PUBLISHING, INC  

    The aim of this study was to investigate the long-term efficacy and safety of electrophysiologic study (EPS)-guided sotalol administration combined with implantable cardioverter defibrillators (ICD) for ventricular tachyarrhythmias (VTA). This study enrolled 92 patients with both structural heart disease and sustained VTA. Sotalol was administered to 57 patients, and its efficacy was assessed by EPS. Long-term treatment was continued in combination with ICD in 31 patients (57%) whose VTA was no longer inducible (responder group) and in 16 patients whose VTA remained inducible (non-responder group). The long-term outcomes were compared among the responder group, the nonresponder group, and 35 ICD recipients untreated with antiarrhythmic drugs (ICD-only group). During a mean follow-up of 44 +/- 33 months, the recurrence of VTA was not significantly different between all patients treated with sotalol (30%) and patients in the ICD-only group (46%). However, the recurrence of VTA was significantly lower in the responder (13%) than in the nonresponder (63%) or the ICD-only groups (46%). There was no significant difference in VTA recurrence between the nonresponder and the ICD-only groups. One patient each in the responder and the ICD-only groups died suddenly, and all-cause mortality was similar in the three groups. The incidence of inappropriate ICD discharges was less in the sotalol than in the ICD-only groups. No patient had to discontinue long-term sotalol treatment because of the adverse effects. In conclusion, sotalol reduced VTA recurrence in the responding patients and inappropriate ICD discharge. EPS may predict the efficacy of sotalol for VTA recurrence.

    DOI: 10.1111/j.1540-8159.2005.09413.x

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  • Unsuccessful internal defibrillation in Brugada syndrome: Focus on refractoriness and ventricular fibrillation cycle length 査読

    H Watanabe, M Chinushi, H Sugiura, T Washizuka, S Komura, Y Hosaka, H Furushima, H Watanabe, J Hayashi, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   16 ( 3 )   262 - 266   2005年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Introduction: In patients with Brugada syndrome, implantable cardioverter defibrillator (ICD) is the only reliable treatment to prevent sudden death though, in some cases, internal defibrillation may be unsuccessful. The aim of this study was to examine the determinants of defibrillation failure, with a focus on electrophysiologic characteristics.
    Methods: The study included 51 patients treated with ICD: 22 with Brugada syndrome and 29 with structural heart disease (SHD). The prevalence of defibrillation energy requirement precluding the programming of a 10-J safety margin, the mean right ventricular effective refractory period (ERP), and mean induced ventricular fibrillation cycle length (VFCL) from the stored ICD electrograms, were compared between the two patient groups.
    Results: High defibrillation requirements were observed in 18% of patients with Brugada syndrome versus 0% of patients with SHD. However, the patients with SHD had larger heart size than those with Brugada syndrome. Mean VFCL and mean ERP were both significantly shorter in patients with Brugada syndrome than in patients with SHD, and ERP and VFCL were significantly correlated.
    Conclusion: Patients with Brugada syndrome have a high prevalence of high defibrillation energy requirement, and short ventricular ERP and VFCL.

    DOI: 10.1046/j.1540-8167.2005.40579.x

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  • A novel mutation in FKBP12.6 binding region of the human cardiac ryanodine receptor gene (R2401H) in a Japanese patient with catecholaminergic polymorphic ventricular tachycardia 査読

    Y Aizawa, K Ueda, S Komura, T Washizuka, M Chinushi, N Inagaki, Y Matsumoto, T Hayashi, M Takahashi, N Nakano, M Yasunami, A Kimura, M Hiraoka, Y Aizawa

    INTERNATIONAL JOURNAL OF CARDIOLOGY   99 ( 2 )   343 - 345   2005年3月

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    記述言語:英語   出版者・発行元:ELSEVIER SCI IRELAND LTD  

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an autosomal dominant inherited disorder characterized by adrenergic induced polymorphic ventricular tachycardias and associated with sudden cardiac death. The human cardiac ryanodine receptor gene (RyR2) was linked to CPVT. A 20-year-old male was referred to our hospital because of recurrent syncope after physical and emotional stress. Routine cardiac examinations including catheterization revealed no structural abnormality. Exercise on treadmill induced premature ventricular contraction in bigeminy and bidirectional ventricular tachycardia was induced during isoproterenol infusion. beta-Blocking drug was effective in suppressing the arrhythmias. We performed genetic screening by PCR-SSCP method followed by DNA sequencing, and a novel missense mutation R2401H in RyR2 located in FKBP12.6 binding region was identified. This mutation was not detected in 190 healthy controls. Since FKBP12.6 plays a critical role in Ca channel gating, the R2401H mutation can be expected to alter Ca-induced Ca release and E-C coupling resulting in CPVT. This is the first report of RyR2 mutation in CPVT patient from Asia including Japan. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

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  • Genomic and non-genomic regulation of L-type calcium channels in rat ventricle by thyroid hormone 査読

    H Watanabe, T Washizuka, S Komura, T Yoshida, Y Hosaka, K Hatada, Y Aizawa, M Chinushi, T Yamamoto

    ENDOCRINE RESEARCH   31 ( 1 )   59 - 70   2005年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:TAYLOR & FRANCIS INC  

    Hyperthyroidism is associated with low exercise tolerance despite high cardiac output and sometimes with the development of heart failure. L-type calcium channels may play a role in the mechanism, but this has not been fully understood. We examined the effects of thyroid hormone on gene expression and function of L-type calcium channels in rat ventricles by the ribonuclease protection assay and whole-cell patch-clamp technique, respectively. The effects of bisoprolol, betablocking agent, on the regulation of calcium channel by thyroid hormone was also studied. In hyperthyroid animals, the mRNA of the calcium channel alpha I c subunit was reduced on day 4, compared with that in euthyroid animals, and remained low on day 8. Bisoprolol did not affect the thyroid hormone mediated decrease in alpha] c subunit mRNA. While L-type calcium current was greater in hyperthyroid than euthyroid myocytes on day 4, it was smaller, on day 8. In addition, the isoproterenol-induced increase in calcium current in euthyroid rats was attenuated in hyperthyroid rats. Acetylcholine decreased calcium current in hyperthyroid myocytes, but not in euthyroid myocytes. In conclusion, L-type calcium current was increased by thyroid hormone in rat ventricular myocytes by the activation of the adenylate cyclase cascade, despite a decreased calcium channel gene expression. These genomic and non-genomic modifications may play an important role in the association of high cardiac output with low exercise tolerance, and in the development of heart failure in hyperthyroidism.

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  • Potential candidates for cardiac resynchronization therapy in Japanese patients with idiopathic dilated cardiomyopathy - A niigata multicenter study of DCM 査読

    S Komura, M Chinushi, M Kudo, T Saikawa, Y Tanabe, H Furushima, T Washizuka, M Kodama, H Oda, S Miyajima, F Masani, Y Igarashi, M Murata, Y Aizawa

    CIRCULATION JOURNAL   68 ( 12 )   1104 - 1109   2004年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING ASIA  

    Background The purpose of this study was to assess the candidates suitable for cardiac resynchronization therapy (CRT) and to examine the significance of the QRS duration in Japanese patients with idiopathic dilated cardiomyopathy (DCM).
    Methods and Results The study population consisted of 357 patients. The selection criteria for candidates suitable for CRT were QRS duration = 130 ms, left ventricular ejection fraction (LVEF) = 35% and New York Heart Association (NYHA) functional class III or IV by ACC/AHA/NASPE 2002 guidelines. We divided the study population into 2 groups: group A with a QRS duration &lt; 130 ms, and group B with a QRS duration = 130 ms. In 25 of the 375 patients (7.0%), all the criteria were fulfilled. Group B had a significantly larger left ventricular diameter end-diastole and end-systole than group A (P &lt; 0.0001). Group B had a lower LVEF (P &lt; 0.0001). There was a fair inverse correlation (r = -0.58, P &lt; 0.0001) between the length of the QRS duration and LVEF.
    Conclusion Approximately 7% of the Japanese patients with DCM are CRT candidates. In the present study, we found that prolonged QRS duration was associated with poor systolic function.

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  • Postprandial variations in ST-segment in a patient with Brugada syndrome and partial gastrectomy 査読

    H Watanabe, M Chinushi, K Hao, H Sugiura, T Hirono, S Komura, Y Hosaka, Y Tanabe, H Furushima, S Fujita, T Washizuka, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   27 ( 11 )   1560 - 1562   2004年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL FUTURA PUBLISHING, INC  

    A 74-year-old man with a history of partial gastrectomy presented with an electrocardiogram consistent with Brugada syndrome and marked meal related fluctuations in the ST segment. ST-segment elevation was prominently attenuated at 30 minutes and increased at 120 minutes after meals. Analysis of heart rate variability revealed a relationship between postprandial heightened parasympathetic activity and increase in Brugada-type ECG abnormality. A rapid postprandial increase in blood glucose may initially stimulate sympathetic nervous activity and secondarily increase parasympathetic tone. Food intake can be associated with fluctuations in ST-segment elevation in patients with the Brugada syndrome.

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  • Radiofrequency catheter ablation for incessant atrioventricular nodal reentrant tachycardia normalized H-V block associated with tachycardia-induced cardiomyopathy 査読

    H Furushima, M Chinushi, H Sugiura, Y Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   37 ( 4 )   315 - 319   2004年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    A 30-year-old man was admitted for treatment of tachycardia-induced cardiomyopathy caused by incessant atrioventricular nodal reentrant tachycardia (AVNRT). An echocardiogram revealed dilatation of all cardiac chambers with severe globally depressed biventricular systolic function. During an electrophysiologic study, HV interval was prolonged to 118 ms by atrial extrastimulus and 2:1 HV block was documented during AVNRT. Four weeks after catheter ablation for AVNRT, an echocardiogram demonstrated regression of the wall motion abnormality of both ventricles and of their dimensions. in the electrophysiologic study, the HV conduction disturbance disappeared. So far, this is the first case in which tachycardia-induced cardiomyopathy was accompanied by transient His-Purkinje conduction abnormality.

    DOI: 10.1016/j.jelectrocard.2004.07.009

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  • Indications for an implantable cardioverter defibrillator (ICD) 査読

    Y Aizawa, M Chinushi, T Washizuka

    INTERNAL MEDICINE   43 ( 5 )   360 - 367   2004年5月

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    記述言語:英語   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Since the first clinical use of implantable defibrillator in human, the technology and the function of implantable cardioverter-defibrillator (ICD) have been much improved and now, ICD can be implanted within the chest wall. ICD is the most reliable therapy to prevent sudden cardiac death (SCD) in patients with documented VT/NF and the efficacy is most clear in patients with depressed heart function. It is now extended as a tool of the primary prevention of SCD in high risk patients after myocardial infarction. However, such beneficial effect is not applicable to DCM though patients might have depressed heart function. ICD is not free from procedure- or device-related problems which need to be resolved. From unknown causes, VTNF might recur in an incessant form and an emergency admission is needed. Therefore, even during ICD therapy, patients often require antiarrhythmic drugs or catheter ablation.

    DOI: 10.2169/internalmedicine.43.360

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  • Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcome 査読

    H Furushima, M Chinushi, H Sugiura, H Kasai, T Washizuka, Y Aizawa

    CLINICAL CARDIOLOGY   27 ( 4 )   217 - 222   2004年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CLINICAL CARDIOLOGY PUBL CO  

    Background: Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established.
    Hypothesis: This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis.
    Methods: The study included eight consecutive patients (five men, three women, aged 54 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital.
    Results: The average ejection fraction was 43 +/- 11%. Twenty-two VTs were observed in these patients, and mean heart rate during VT was 192 +/- 29 beats/min (range 144-259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study.
    Conclusions: In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., coil icosteroids, antiarrhythinic agents, and catheter ablation) difficult. The implantable cardioverter-defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis.

    DOI: 10.1002/clc.4960270409

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  • Intramyocardial hemorrhage caused by myocardial contusion 査読

    Y Hosaka, M Kodama, M Chinushi, T Washizuka, H Sugiura, K Satou, Y Aizawa

    CIRCULATION   109 ( 2 )   277 - 277   2004年1月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1161/01.CIR.0000109525.74497.6F

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  • Thyroid hormone regulates mRNA expression and currents of ion channels in rat atrium 査読

    H Watanabe, ML Ma, T Washizuka, S Komura, T Yoshida, Y Hosaka, K Hatada, M Chinushi, T Yamamoto, K Watanabe, Y Aizawa

    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   308 ( 3 )   439 - 444   2003年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE  

    Atrial fibrillation is one of the common arrhythmias associated with hyperthyroidism. This study examined the effects of thyroid hormone (T3) on mRNA expression and currents of major ionic channels determining the action potential duration (APD) in the rat atrium using the RNase protection assay and the whole-cell patch-clamp technique, respectively. T3 increased the Kv1.5 mRNA expression and decreased the L-type calcium channel mRNA expression, while the Kv4.2 mRNA expression did not change. APD was shorter in hyperthyroid than in euthyroid myocytes. The ultrarapid delayed rectifier potassium currents were remarkably increased in hyperthyroid than in euthyroid myocytes, whereas the transient outward potassium currents were unchanged. L-type calcium currents were decreased in hyperthyroid than in euthyroid myocytes. T3 shifted the current-voltage relationship for calcium currents negatively. In conclusion, T3 increased the outward currents and decreased the inward currents. The resultant changes of ionic currents shortened APD, providing a substrate for atrial fibrillation. (C) 2003 Elsevier Inc. All rights reserved.

    DOI: 10.1016/S0006-291X(03)01420-7

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  • Mechanism of discordant T wave alternans in the in vivo heart 査読

    M Chinushi, D Kozhevnikov, EB Caref, M Restivo, N El-Sherif

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   14 ( 6 )   632 - 638   2003年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL FUTURA PUBLISHING, INC  

    Introduction: Compared to concordant T wave alternans (CA), discordant T wave alternans (DA) may be associated with an increased dispersion of repolarization (DR) and a greater propensity to develop reentrant ventricular tachyarrhythmias. The electrophysiologic mechanisms of DA in the in vivo heart are not well understood.
    Methods and Results: The mechanisms of DA were investigated in the canine anthopleurin-A surrogate model of long QT3 syndrome using tridimensional analysis of activation and repolarization patterns from 256 to 384 unipolar electrograms. Cardiac repolarization was evaluated as the activation-recovery interval (ARI) of local electrograms. Two mechanisms for the development of DA were observed. (1) Stepwise shortening of cycle length (CL) superimposed on preexisting DR resulted in different diastolic intervals (DI) at midmyocardial sites compared to epicardial and endocardial sites. The dispersion of DI coupled with different restitution kinetics at those sites induced DA. (2) The dependence of conduction velocity on DI as the CL is abruptly shortened could result in differential conduction delays at mid sites. This enhanced the dispersion of DI between sites and, coupled with the different restitution kinetics, induced DA. The critical step for the development of DA in both mechanisms was the occurrence of short ARI in two consecutive beats either at epicardial sites in the first mechanism or at mid sites in the second mechanism. Sites with DA had significantly more DR compared to sites with concordant T wave alternans, and ventricular tachyarrhythmias developed mainly in the presence of DA.
    Conclusion: In the in vivo heart, DA developed due to critical interaction between dispersion of DI and differences in restitution kinetics at different myocardial sites. The dispersion of DI could result from preexisting DR or differential conduction delay at a critical short CL. DA is critically linked to the development of malignant tachyarrhythmias.

    DOI: 10.1046/j.1540-8167.2003.03028.x

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  • Function, subcellular localization and assembly of a novel mutation of KCNJ2 in Andersen's syndrome 査読

    Y Hosaka, H Hanawa, T Washizuka, M Chinushi, F Yamashita, T Yoshida, S Komura, H Watanabe, Y Aizawa

    JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY   35 ( 4 )   409 - 415   2003年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD  

    Andersen's syndrome (AS) (which is characterized by periodic paralysis, cardiac arrhythmias and dysmorphic features), a hereditary disease, and missense mutations of KCNJ2 (which encodes an inward rectifying potassium channel) have been reported recently. We performed clinical and molecular analyses of a patient with AS, and found a novel mutation (G215D) of KCNJ2. Twelve-lead electrocardiography revealed a long QT interval and frequent premature ventricular contractions, and polymorphic ventricular tachycardia was induced by programmed electrical stimulation. Use of a conventional whole-cell patch-clamp system with COS7 cells demonstrated that the G215D mutant was non-functional, and that co-expression of wild type (WT)- and mutant-KCNJ2 shows a dominant negative effect on both inward and outward currents. We performed confocal laser scanning microscopy to assess the cellular trafficking of WT- and mutant-KCNJ2 subunits tagged with yellow fluorescent protein (YFP) and cyan fluorescent protein (CFP), respectively. Tagging with the YFP did not affect the channel function of WT-KCNJ2 and both proteins showed similar plasma membrane fluorescence patterns. Furthermore, the result of fluorescence resonance energy transfer (FRET) studies at the plasma membrane region suggested that both YFP-tagged WT- and CFP-tagged mutant-KCNJ2 combine to construct a hetero-multimer of the potassium channel. In conclusion, the G215D mutant of KCNJ2 is distributed normally in the plasma membrane, but exhibits a dominant-negative effect and reduces the Kir2.1 current, presumably due to hetero-multimer construction. (C) 2003 Elsevier Science Ltd. All rights reserved.

    DOI: 10.1016/S0022-2828(03)00046-4

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  • Micro dislodgment of ventricular pacing lead undetectable during rapid pacing one year after implantation 査読

    Y Chinushi, M Chinushi, H Furushima, Y Tanabe, T Washizuka, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   26 ( 3 )   787 - 788   2003年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    A 71-year-old woman had undergone valvular heart surgery in 1981, and implantation of a permanent ventricular pacemaker for ventricular pauses during atria] fibrillation in 2001. One year after pacemaker implantation, she complained of faintness. When pacing at 100 beats/min the pacemaker functioned properly. However, pacing and sensing failure was detected at a pacing rate of 60 beats/min. At rapid pacing rates, the lead tip was in closer contact with the endocardium, and its microdislodgment was undetectable. The symptoms have resolved since the lead was repositioned.

    DOI: 10.1046/j.1460-9592.2003.00138.x

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  • Ventricular tachyarrhythmias in a canine model of LQT3 - Arrhythmogenic effects of sympathetic activity and therapeutic effects of mexiletine 査読

    M Chinushi, M Tagawa, H Sugiura, S Komura, Y Hosaka, T Washizuka, Y Aizawa

    CIRCULATION JOURNAL   67 ( 3 )   263 - 268   2003年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL PUBLISHING ASIA  

    The ventricular tachyarrhythmias associated with the LQT3 syndrome are typically bradycardia-dependent. However, some episodes can be associated with exercise or emotional stress, suggesting a different arrhythmogenic mechanism when sympathetic activity predominates. This study examined the potential arrhythmogenic mechanisms during periods of autonomically mediated transient heart rate acceleration in a canine anthopleurin-A model of LQT3 syndrome. Using plunge needle electrodes, transmural unipolar electrograms of the left ventricle were recorded from endocardial (Endo), mid-myocardial (Mid) and epicardial (Epi) sites. The activation-recovery interval (ARI) was measured to estimate local refractoriness. The cardiac cycle length was gradually shortened by cessation of vagal stimulation (vagal stimulation protocol (VSP)), and intramural electrograms and onset mode of ventricular tachyarrhythmias were analyzed in 7 experiments. The VSP was performed 8 times before and 5 times after administration of mexiletine in each experiment. Before mexiletine, vagal stimulation slowed the heart rate and created large transmural ARI dispersion because of a greater ARI prolongation at Mid rather than Epi/Endo sites. After cessation of vagal stimulation, unipolar electrograms started to show ARI alternans and ventricular premature beats developed sporadically. Sustained ventricular tachyarrhythmias were induced in 12 of the 56 trials of the VSP. Initiation of ventricular tachyarrhythmias was,associated with delayed conduction at Mid/Endo sites. Mexiletine attenuated transmural ARI dispersion, and neither ARI alternans nor ventricular tachyarrhythmias was observed during all 35 trials of the VSP after mexiletine administration. Heart rate acceleration induced by an abrupt shift to a state of predominant sympathetic activity enhances arrhythmias in this LQT3 model. Mexiletine homogenizes ventricular repolarization, suppresses premature complexes and was antiarrhythmic during ventricular tachyarrhythmias induced by the VSP.

    DOI: 10.1253/circj.67.263

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  • Suppression of electrical storm by biventricular pacing in a patient with idiopathic dilated cardiomyopathy and ventricular tachycardia 査読

    Y Tanabe, M Chinushi, T Washizuka, S Minagawa, H Furushima, H Watanabe, Y Hosaka, S Komura, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   26 ( 1 )   101 - 102   2003年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    This study presents a patient with idiopathic dilated cardiomyopathy who had suffered from multiple ICD shocks. Amiodarone and a,B-blocker failed to suppress ventricular tachycardia. His ECG showed a very wide QRS complex with an intraventricular conduction delay, so biventricular (BV) pacing was attempted. The BV pacing successfully prevented the multiple ICD shocks accompanied with an improvement in left ventricular systolic function and physical activity.

    DOI: 10.1046/j.1460-9592.2003.00156.x

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  • Characteristics of a novel mutation of KCNJ2 in Andersen's syndrome 査読

    Y Hosaka, H Hanawa, T Washizuka, M Chinushi, F Yamashita, T Yoshida, A Abe, S Komura, H Watanabe, Y Aizawa

    CIRCULATION   106 ( 19 )   47 - 47   2002年11月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Induction of ventricular fibrillation in Brugada syndrome by site-specific right ventricular premature depolarization 査読

    M Chinushi, T Washizuka, Y Chinushi, K Higuchi, T Toida, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   25 ( 11 )   1649 - 1651   2002年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    This patient was a 50-year-old man. Oral pilsicainide unmasked a Brugada-type ECG abnormality and self-terminating polymorphic VT was repetitively induced. The polymorphic VT always developed following a specific ventricular premature complex showing a left bundle branch block pattern suggesting a limited origin in the right ventricle.

    DOI: 10.1046/j.1460-9592.2002.01649.x

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  • Activation-recovery interval as a parameter to assess the intracardiac ventricular repolarization in patients with congenital long QT syndrome 査読

    M Chinushi, T Washizuka, Y Hosaka, H Furushima, Y Tanabe, Y Chinushi, Y Aizawa

    AMERICAN JOURNAL OF CARDIOLOGY   90 ( 4 )   432 - +   2002年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EXCERPTA MEDICA INC  

    Activation recovery interval (ARI) calculated from intracardiac electrograms in patients with long QT syndrome (LQTS) was correlated with local effective refractory period (ERP). Epinephrine induced ARI prolongation and increased ARI dispersion, whereas mexiletine diminished heterogeneity of ventricular repolarization.

    DOI: 10.1016/S0002-9149(02)02506-7

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  • Arrhythmogenesis of T wave alternans associated with surface QRS complex alternans and the role of ventricular prematurity: Observations from a canine model of LQT3 syndrome 査読

    M Chinushi, Y Hosaka, T Washizuka, H Furushima, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   13 ( 6 )   599 - 604   2002年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Introduction: T wave alternans (TWA) is characterized by cycle-to-cycle changes in the QT interval and/or T wave morphology. It is believed to amplify the underlying dispersion of ventricular repolarization. The aim of this study was to examine the mechanisms and arrhythmogenesis of TWA accompanied by QRS complex and/or blood pressure (BP) waveform alternans, using transmural ventricular electrogram recordings in an anthopleurin-A model of long QT syndrome.
    Methods and Results: The cardiac cycle length was gradually shortened by interruption of vagal stimulation, and TWA was induced in six canine hearts. Transmural unipolar electrograms were recorded with plunge needle electrodes from endocardial (Endo), mid-myocardial (Mid), and epicardial (Epi) sites, along with the surface ECG and BP. The activation-recovery interval (ARI) was measured to estimate local refractoriness. During TWA, ARI alternans was greater at the Mid than the Epi/Endo sites, and it was associated with the development of marked spatial dispersion of ventricular repolarization. As TWA increased, ventricular activation of the cycles associated with shorter QT intervals displayed delayed conduction at the Mid sites as a result of a critically longer ARI of the preceding cycle and longer QT interval, while normal conduction was preserved at the Epi site. Delayed conduction at the Mid sites manifested as surface ECG QRS and BP waveform alternans, and spontaneous ventricular tachyarrhythmias developed in absence of ventricular prematurity. In other instances, in absence of delayed conduction during TWA, ventricular premature complexes infringed on a prominent spatial dispersion of ventricular repolarization of cycles with long QT intervals and initiated ventricular tachyarrhythmia. \ Conclusion: TWA accompanied by QRS alternans may signal a greater ventricular electrical instability, since it is associated with intramural delayed conduction, which can initiate ventricular tachyarrhythmia without ventricular premature complexes.

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  • Correlation between the effective refractory period and activation-recovery interval calculated from the intracardiac unipolar electrogram of humans with and without dl-Sotalol treatment - Reply 査読

    M Chinushi

    CIRCULATION JOURNAL   66 ( 3 )   308 - 309   2002年3月

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    記述言語:英語   出版者・発行元:BLACKWELL PUBLISHING ASIA  

    DOI: 10.1253/circj.66.308

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  • Class I antiarrhythmic drug and coronary vasospasm-induced T wave alternans and ventricular tachyarrhythmia in a patient with Brugada syndrome and vasospastic angina 査読

    Y Chinushi, M Chinushi, T Toida, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   13 ( 2 )   191 - 194   2002年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    A 50-year-old man presented with a history of transient chest pain and palpitations. The 12-lead ECG at rest showed normal sinus rhythm. A slight ST segment elevation was observed in leads V-1 to V-3. During hospitalization, atrial fibrillation developed, and oral pilsicainide was administered. Thirty minutes after the drug was given, the ECG showed marked ST segment elevation in leads V-1 to V-3, and T wave alternans became visible in leads V-2 and V-3. Self-terminating ventricular tachycardia was initiated following frequent ventricular premature complexes, which showed a left bundle branch block pattern. The coronary angiogram was normal, but in the provocation test of vasospastic angina, acetylcholine administration into the left coronary artery resulted in complete occlusion of the left anterior descending and circumflex arteries. Marked ST segment elevation developed in leads I, aVL, and V-3 to V-6 concomitant with visible QT/T alternans in leads V-4 and V., and ventricular tachyarrhythmia was initiated. Brugada syndrome and vasospastic angina coexisted in this patient, and T wave alternans can be used as a predictor of ventricalar tachyarrhythmias in such patients.

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  • 塩酸ニフェカラントの心室頻拍リエントリー回路への作用

    鷲塚 隆, 池主 雅臣, 杉浦 広隆, 小村 悟, 渡部 裕, 保坂 幸男, 田辺 靖貴, 山浦 正幸, 古嶋 博司, 阿部 晃, 相澤 義房

    不整脈 = Journal of arrhythmia   18 ( 1 )   25 - 32   2002年1月

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    記述言語:日本語   出版者・発行元:Elsevier B.V.  

    DNA nanotechnology-based nanosystems and macrosystems have attracted much attention in the biomedical research field. The nature of DNA endows these systems with biodegradable, biocompatible, and immunomodulatory properties. Here, we present an injectable hydrogel system that consists only of chemically synthesized short DNA strands, water, and salts. Several preparations of polypod-like structured DNA, or polypodna, were designed, including tri-, tetra-, penta- and hexapodna, as the building blocks of self-gelling DNA hydrogel. Under physiological conditions, properly designed polypodna preparations formed a hydrogel. The analysis of the modulus data of the hydrogel consisting of two sets of hexapodna preparations showed that this injectable hydrogel was reorganized at a time scale of 0.25s. Then, DNA hydrogel containing unmethylated cytosine-phosphate-guanine (CpG) dinucleotides was used to stimulate innate immunity through Toll-like receptor 9, the receptor for CpG DNA. Gel formation significantly increased the activity of immunostimulatory CpG DNA, retarded the clearance after intradermal injection into mice, and increased the immune responses to ovalbumin (OVA) incorporated into the hydrogel as a model antigen. OVA/CpG DNA hydrogel induced much less local or systemic adverse reactions than OVA injected with complete Freund's adjuvant or alum. GpC DNA hydrogel containing no CpG sequences was less effective, indicating the importance of immunomodulation by CpG DNA hydrogel. Thus, we have created an efficient system for sustained delivery of antigens or other bioactive compounds.

    DOI: 10.1016/j.jconrel.2014.02.001

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    その他リンク: http://search.jamas.or.jp/link/ui/2003145617

  • [Possibility of gene-specific treatment for hereditary arrhythmic diseases]. 査読

    Chinushi M, Washizuka T

    Nihon rinsho. Japanese journal of clinical medicine   60 ( 1 )   143 - 148   2002年1月

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  • Inappropriate discharges by fourth generation implantable cardioverter defibrillators in patients with ventricular arrhythmias 査読

    T Washizuka, M Chinushi, M Tagawa, H Kasai, H Watanabe, Y Hosaka, F Yamashita, H Furushima, A Abe, H Watanabe, J Hayashi, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   65 ( 11 )   927 - 930   2001年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    The study prospectively investigated the incidence, cause and efficient management of inappropriate discharge by the fourth generation implantable cardioverter-defibrillator (ICD) system in 45 patients (mean age, 57 +/- 16 years). During the follow-up period of 27 +/- 17 months, 18 patients (40%) experienced one or more inappropriate therapies: sinus and supraventricular tachycardia (15 patients) and T wave oversensing (3 patients). In the 15 patients, re-programming of the tachycardia detection interval and/or additional treatment with beta -blocking agents were effective. In the 3 patients with T wave oversensing, the arrythmia was associated with an increase in T wave amplitude, change in T wave morphology and decreased R wave amplitude, and re-programming of the sensitivity of the local electrogram or changing the number of intervals to detect ventricular tachycardia decreased the number of inappropriate discharges in all 3 patients. In conclusion, inappropriate therapies are common problems in patients treated with the fourth generation ICD system, but most of them can be resolved using the dual-chamber ICD system. However, in patients with T-wave oversensing, it is difficult to avoid inappropriate discharge completely, even if the dual-chamber ICD system is implanted.

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  • Absence of morning peak in ventricular tachycardia and fibrillation events in nonischemic heartr disease: analysis of therapies by implantable cardioverter defibrillators. 査読

    Keiichi, Tanaka, Yoshihusa, Aizawa, Takashi, Washizuka, Masaomi, Chinushi, Ken, Okumura, Satoshi, Ogawa, Hiroshi, Kasanuki, Keisuke, Kuga, Takashi, Kurita, Shiro, Kamakura, et, al on behalf of, the, Japanese ICD, Study Group

    Pacing and Clinical Electrophysiology   24 ( 11 )   1602 - 1606   2001年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Futura  

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  • QT interval prolongation and torsades de pointes unmasked by intracoronary acetylcholine administration 査読

    M Chinushi, Nakagawa, I, T Hori, F Yamashita, T Washizuka, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   24 ( 10 )   1561 - 1562   2001年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Intracoronary acetylcholine administration, which was performed to exclude vasospasms, unmasked an abnormal QT interval prolongation and initiated torsades de pointes in a patient with normal QT interval at rest.

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  • Arrythmogenicity of intramural T wave alternans under operation of autonomic activity and its correlation to the results of surface ECG 査読

    M Chinushi, H Furushima, T Washizuka, M Tagawa, Y Hosaka

    CIRCULATION   104 ( 17 )   111 - 111   2001年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Myocardium extending from the left atrium onto the pulmonary veins: A comparison between subjects with and without atrial fibrillation 査読

    M Tagawa, K Higuchi, M Chinushi, T Washizuka, T Ushiki, N Ishihara, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   24 ( 10 )   1459 - 1463   2001年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Rapid discharges from the myocardium extending from the left atrium onto the pulmonary vein (PV) have been shown to initiate AF, and AF may be eradicated by the catheter ablation within the PV. However, if there is any difference in the distribution patterns of the myocardial sleeve onto the PV between the subjects with and without AF is to be determined. Twenty-one autopsied hearts were examined. Eleven patients previously had AF before death and another 10 patients had normal sinus rhythm as confirmed from the medical records including ECGs before death. After exposing the heart, the distance to the peripheral end of the myocardium was measured from the PV-atrial junction in each PV. Then, the PVs were sectioned and stained and the distal end of myocardium and the distribution pattern were studied. The anteroposterior diameter of the left atrium was also measured. In 74 of 84 PVs, the myocardium extended beyond the PV-atrial junction. The myocardium was localized surrounding the vascular smooth muscle layer forming a myocardial sleeve. The peripheral end of the myocardial sleeve was irregular and the maximal and minimal distances were measured in each PV, The myocardium extended most distally in the superior PVs compared to the inferior ones and the maximal distance to the peripheral end was similar between the AF and non-AF subjects (8.4 +/- 2.8 vs 8.7 +/- 4.4 mm for the left superior and 6.5 +/- 3.5 vs 5.1 +/- 3.9 mm for the right superior PV, respectively). A significant difference was found in the maximal distance in the inferior PVs: 7.3 +/- 4.6 vs 3.3 +/- 2.8 mm for the left (P &lt; 0.05) and 5.7 +/- 2.4 vs 1.7 +/- 1.9 mm for the right inferior PV (P &lt; 0.001) in the subjects with and without AF, respectively. The diameter of left atrium was slightly dilated in AF patients but insignificantly (4.1 +/- 0.1 vs 3.6 +/- 0.1 cm, P &gt; 0.07). The myocytes on the PV were less uniform and surrounded by more fibrosis in patients with AF compared to those without AF. In conclusion, the myocardium extended beyond the atrium-vein junction onto the PVs. The distribution patterns of the myocardium was almost similar between subjects with and without AF, but the histology suggested variable myocytes in size and fibrosis in patients with AF.

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  • Correlation between the effective refractory period and activation-recovery interval calculated from the intracardiac unipolar electrogram of humans with and without dl-sotalol treatment 査読

    M Chinushi, M Tagawa, H Kasai, T Washizuka, A Abe, H Furushima, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   65 ( 8 )   702 - 706   2001年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    In experimental studies and/or human body surface mapping, the activation -recovery interval (ARI) is used as a parameter to estimate local repolarization. However, it has not been clarified whether the ARI calculated from the intracardiac unipolar electrogram of humans reasonably represents the local effective refractory period (ERP). Measurement of ARIs at multiple ventricular sites can be helpful in assessing the dispersion of ventricular refractoriness of humans, so we examined the relationship between ERP and ARI in the control state and under treatment with dl-sotalol during clinical electrophysiologic studies (EPS). Of 19 patients, an EPS was performed in the control state in 12 and during treatment with dl-sotalol in the other 7. Quadripolar electrode catheters with an interelectrode distance of 5 mm were placed at the right atrium and in the right ventricle. Using atrial pacing, the heart rate was increased incrementally by 10 beats/min, and ERP and ARI were measured for each pacing rate. The ER-P at the right ventricle was measured by single extrastimulation between the first and third distal electrodes of the catheter in the right ventricle, and the ARI was calculated from the second distal unipolar electrode of the same catheter as the interval between the minimum derivative of the intrinsic deflection and the maximum derivative of the T wave. In all patients, the unipolar electrogram was stable during the entire EPS, and 83 data points in the control group and 50 in the dl-sotalol group were analyzed. At each pacing rate, the beat-to-beat difference of ARI was less than 10 ms. As the atrial pacing rate increased, the ERP and ARI were progressively shortened, and linear regression analysis revealed an excellent correlation between ERP and ARI. At the same pacing rate, the ERP and ARI in the dl-sotalol group were longer than those in the control group, but no difference was observed in the slope (close to 1.0) and in the intercept of the regression lines between ERP and ARI. In the human ventricle, the ARI calculated from the intracardiac unipolar electrogram represents the local ERP both in the control state and under treatment with dl-sotalol. The ARI can be used as a parameter of local refractoriness and used to study the distribution of refractoriness in the human ventricle.

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  • Discrepancy between inducibility of ventricular tachycardia and activity of cardiac sarcoidosis - Requirement of defibrillator implantation for the inactive stage of cardiac sarcoidosis 査読

    T Mezaki, M Chinushi, T Washizuka, H Furushima, Y Chinushi, K Ebe, H Okumura, Y Aizawa

    INTERNAL MEDICINE   40 ( 8 )   731 - 735   2001年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Monomorphic ventricular tachycardia (VT) developed in two patients with cardiac sarcoidosis. Before treatment with prednisolone, technetium or gallium scintigram revealed abnormal accumulation in the heart and bilateral hilar lymph nodes, but programmed electrical stimulation failed to induce VT in either case. Prednisolone was administered and the abnormal accumulation of the scintigra ms disappeared. However, VT became reproducibly inducible, and in one of the patients, transient entrainment was demonstrated in clinical VT morphology. Defibrillators were implanted in both patients. Some VTs associated with cardiac sarcoidosis are due to reentry, and inducibility of VT is not associated with the activity of cardiac sarcoidosis. Even though steroid therapy suppresses the activity of cardiac sarcoidosis, defibrillator implantation is necessary to prevent a possible arrhythmic event during the followup.

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  • Cycle length-associated modulation of the regional dispersion of ventricular repolarization in a canine model of long QT syndrome 査読

    M Chinushi, EB Caref, M Restivo, G Noll, Y Aizawa, N El-Sherif

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   24 ( 8 )   1247 - 1257   2001年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Previous tridimensional activation mapping showed that the development of functional conduction block at the onset of torsades de pointes was regionally heterogeneous; conduction block was frequently observed in the LV and the interventricular septum (IVS) but not in the RV, in the canine anthopleurin-A (AP-A) model of long QT syndrome (LQTS). This may be related to the distribution of myocytes with M celllike electrophysiological characteristics. To better understand the regional difference of arrhythmogenicity in LQTS, the authors investigated cycle length related modulation of ventricular repolarization among three different layers: the endocardium (End), mid-myocardium (Mid), and epicardium (Epi) of the LV and RV and at two different areas: the Epi and septum (Sep) in the IVS. The LQT3 model was produced by AP-A in dogs. Using constant pacing and single premature stimulation (S1S2), the ventricular repolarization pattern was analyzed from 256 unipolar electrograms. Activation-recovery intervals (ARIs) were used to estimate local repolarization. In seven experiments, AP-A increased regional ARI dispersion to 88.1 +/- 36.0 ms in the LV, to 72.9 +/- 35.7 ms in the IVS, and to 23.0 +/-8.7 ms in the RV at the pacing cycle length (CL) of 1,000 ms. Development of the large ARI dispersion was due to greater ARI prolongation at the Mid site in the LV and at Sep site in the IVS. As the S1S2 interval was shortened, regional ARI dispersion decreased gradually, and finally, ARI dispersion showed a reversal gradient of repolarization between the Mid and Epi sites in the LV and between the Sep and Epi sites in the IVS. Two factors contributed to create the reversal gradient of repolarization: (1) a difference in restitution kinetics at the Mid site in the LV and at the Sep site in the IVS, characterized by a larger Delta ARI and slower time constant (tau), and (2) a difference in diastolic intervals at each site resulting in different input to restitution at the same CL. However, the RV showed small alteration in the transmural dispersion of repolarization in the S1S2 protocol. S-2 created heterogeneous functional conduction block in the LV and IVS but not in the RV. In the LQT3 model, the arrhythmogenicity of torsades de pointes is primarily due to dispersion of repolarization in the LV and IVS because of prominent distribution of M cells. The RV seems to participate passively in reentrant excitation during torsades de pointes.

    DOI: 10.1046/j.1460-9592.2001.01247.x

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  • Inappropriate discharges from an intravenous implantable cardioverter defibrillator due to T-wave oversensing 査読

    T Washizuka, M Chinushi, H Kasai, H Watanabe, M Tagawa, Y Hosaka, A Abe, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   65 ( 7 )   685 - 687   2001年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    This report describes the clinical management of 2 patients with ventricular fibrillation (VF) who received inappropriate shocks from an implantable cardioverter defibrillator (ICD) due to T-wave oversensing. Cardiac sarcoidosis was confirmed as the underlying heart disease in 1 patient and idiopathic dilated cardiomyopathy in the other. Within 2 months after ICD implantation, both patients received several inappropriate shocks during sinus rhythm. Stored electrograms showed decreased R-wave amplitudes and increased T-wave amplitudes. The ICD sensed both R- and T-waves as ventricular activation, which met the rate criteria for VF treatment. Reprogramming the sensing threshold in association with administration of a drug to slow the heart rate decreased the incidence of the inappropriate shocks in both patients, but these palliative measures did not completely suppress the inappropriate shocks. To avoid T-wave oversensing, the repositioning or adding of a sensing lead is required. The potential risk of T-wave oversensing in ICD patients who have small R-wave amplitudes should be recognized.

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  • Role of alpha 1-blockade in congenital long QT syndrome - Investigation by exercise stress test 査読

    H Furushima, M Chinushi, T Washizuka, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   65 ( 7 )   654 - 658   2001年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    Beta-blockade is widely reported to reduce the incidence of syncope in 75-80% of patients with congenital long QT syndrome (LQTS). However, despite full-dose beta -blockade, 20-25% of patients continue to have syncopal episodes and remain at high risk for sudden cardiac death. In some patients refractory to beta -blockade, the recurrence of arrhythmias is successfully prevented by left stellate ganglionectomy, and also by labetalol, a nonselective beta -blockade with alpha1-blocking action. These observations suggest that not only beta -adrenoceptors, but also alpha1-adrenoceptors, play an important pathogenic role, especially under sympathetic stimulation, in LQTS. The clinical effects of alpha1-blockade in congenital LQTS were investigated in 8 patients with familial or sporadic LQTS. Two measurements of the QT interval were taken, from the QRS onset to the T wave offset (QT) and from the QRS onset to the peak of the T wave (QTp). Using the Bruce protocol, an exercise test was performed after administration of beta -blockade alone and again after administration of alpha1-blockade. The following were compared: (1) Bazzet-corrected QT (QTc) and QTp (QTpc) intervals in the supine and standing position before exercise and in the early recovery phase after exercise; and (2) the slopes (reflecting the dynamic change in the QT interval during exercise) of the QT interval to heart rate were obtained from the linear regression during the exercise test. In the supine position before exercise, there was no change in the QTc before or after the addition of alpha1-blockade (498 +/- 23 vs 486 +/- 23 ms [NS]). However, in the upright position before exercise and in the early recovery phase after exercise, QTc was significantly shortened from 523 +/- 21 to 483 +/- 22 ms (p&lt;0.01), and from 521&lt;plus/minus&gt;30 to 490 +/- 39 ms (p&lt;0.01), respectively, by &lt;alpha&gt;1-blockade. The QTpc was unchanged in any situation. Consequently, QTc-QTpc was significantly shortened by alpha1-blockade in the upright position before exercise and in the early recovery phase after exercise (131 +/- 36 to 105 +/- 37 ms (p&lt;0.05), and 132&lt;plus/minus&gt;29 to 102 +/- 31 ms (p&lt;0.01), respectively). The slopes of the QT interval-heart rate relation by linear regression became significantly steeper from -2.23&lt;plus/minus&gt;0.38 to -2.93 +/-0.76 (p&lt;0.01) with the addition of &lt;alpha&gt;1-blockade. The findings suggest that the addition of alpha1-blockade attenuated the exercise-induced prolongation of the QT interval and that the rate adaptation of the QT interval to heart rate during exercise was improved. This indicates that additional treatment with alpha1-blockade may be beneficial to prevent cardiac events in LQTS patients in whom ventricular arrhythmia is resistant to beta -blockade.

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  • 心電図V_1-V_3誘導で軽度のST-T変動を示し,除細動器治療を要した特発性心室細動の1例

    林 学, 池主 雅臣, 福永 博, 保坂 幸男, 奥村 弘史, 笠井 英裕, 田川 実, 阿部 晃, 鷲塚 隆, 相澤 義房

    心電図 = Electrocardiology   21 ( 3 )   336 - 342   2001年5月

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    記述言語:日本語   出版者・発行元:The Japanese Society of Electrocardiology  

    症例は22歳男性, 1999年3月, 朝食後に―過性の意識消失発作が生じたため入院した.虚血性心疾患と脳神経疾患は否定されたが, 入院時心電図のV<SUB>1</SUB>-V<SUB>3</SUB>誘導で軽度のST部分の上昇が認められた.フレカイニド負荷試験を行つたが心電図異常の顕性化は認められなかった.電気生理学的検査では3連発心室早期刺激で非持続性の多形性心室頻拍が誘発されたが再現性は乏しく, dl-ソタロール内服後に頻拍は誘発されなくなった, dl-ソタロール内服下で外来経過観察を行っていたが, 再度同様の意識消失発作が生じた.3回目の電気生理学的検査では心室細動が誘発されたが, フレカイニド負荷試験での心電図変化の増強はこの時も認められなかった.本例は経過中, 軽度のQRSとST-T変化がV1-V3誘導で認められた.繰り返す意識消失発作に対し除細動器を植え込んだが, 前胸部誘導での軽度のST-T変化の意義について今後検討を要する.

    DOI: 10.5105/jse.21.336

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    その他リンク: http://search.jamas.or.jp/link/ui/2001270495

  • Intravenous administration of class I antiarrhythmic drugs induced T wave alternans in a patient with Brugada syndrome 査読

    M Chinushi, T Washizuka, H Okumura, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   12 ( 4 )   493 - 495   2001年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    A 71-year-old man who experienced aborted sudden death was referred to our hospital, Coronary artery disease and cerebral accident were ruled out by conventional tests. The 12-lead ECG obtained at rest showed a right bundle branch block pattern and ST segment elevation in leads V-1 to V-3, Double ventricular extrastimuli at coupling intervals &gt;180 msec induced ventricular fibrillation (VF) twice during electrophysiologic study. Intravenous administration of procainamide accentuated ST segment elevation in leads V-1 to V-3, and visible T wave alternans was induced in leads V-2 and V-3 at a dose of 450 mg, Initiation of T wave alternans was not associated with changes of the cardiac cycle or development of premature beats. When procainamide infusion was discontinued, T wave alternans disappeared before the elevated ST segment returned to the control level. Pilsicainide also accentuated ST segment elevation and induced similar T wave alternans in leads V-2 and V-3, Class I antiarrhythmic drug-related T wave alternans has been reported rarely in Brugada syndrome, but it may represent enhanced arrhythmogenicity of VF, We need to monitor closely and study the clinical implications of T wave alternans in Brugada syndrome.

    DOI: 10.1046/j.1540-8167.2001.00493.x

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  • Mechanism and arrhythmogenicity of discordant QT/T alternans 査読

    M Chinushi, DO Kozhevnikov, EB Caref, M Restivo, N El-Sherif

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   37 ( 2 )   91A - 92A   2001年2月

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    記述言語:英語   出版者・発行元:ELSEVIER SCIENCE INC  

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  • Abrupt loss of constant fusion during entrainment of ventricular tachycardia at a critical paced cycle length 査読

    M Yamaura, Y Aizawa, M Chinushi, T Washizuka, H Uchiyama, H Kitazawa

    JAPANESE HEART JOURNAL   42 ( 1 )   67 - 78   2001年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    Sustained monomorphic ventricular tachycardia (VT) can be frequently entrained and interrupted with rapid pacing and the mechanism of the pacing-induced interruption is considered to be due to orthodromic block.
    This study focused on the incidence of VT which was interrupted at a critical cycle length and was characterized by an abrupt loss of constant fusion in the surface electrocardiogram (ECG), and the role of orthodromic block as the cause of such characteristic change and interruption of VT M as analyzed.
    Among 45 consecutive patients with symptomatic VT, rapid pacing was performed in 43 VTs of 39 patients. The exit was mapped as the earliest site of the activation during VT and an electrode catheter was located at the site. Rapid pacing was performed at progressively shorter cycle lengths in steps of 10 msec until VT was interrupted and the timing of the orthodromic and direct capture was compared at the exit.
    Abrupt loss of constant fusion was observed in 25 of 39 patients (64.1%). and the loss was invariably associated with interruption of VT. When the timings of the activation of the exit were compared, which were measured from the preceding (n-1) stimulus as the time reference, the direct capture was relatively delayed compared to that of the orthodromic capture. This finding suggests that orthodromic
    In the remaining 13 patients (35.9%), the surface ECG showed a gradual transition into the fully paced QRS morphology. The direct capture M as confirmed in the non-fused beats, but it was not necessarily associated with interruption of VT. The interval from the stimulus to the entrained electrogram at the exit showed a gradual prolongation until the exit was finally captured directly from the pacing site.
    The confirmation of constant fusion followed by abrupt loss in ECG can be a reliable hallmark of orthodromic block as the cause of the interruption of VT during transient entrainment at a critical paced cycle length.

    DOI: 10.1536/jhj.42.67

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  • Vasospastic angina accompanied by Brugada-type electrocardiographic abnormalities 査読

    M Chinushi, Y Kuroe, E Ito, M Tagawa, Y Aizawa

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY   12 ( 1 )   108 - 111   2001年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Brugada Syndrome and Vasospastic Angina. We present two patients with vasospastic angina and Brugada-type ECG abnormalities. The first patient complained of chest pain, and transient ST segment elevation was confirmed on EGG. Coronary angiogram showed no organic stenosis. The second patient had syncopal episodes following anginal chest pain, and the same symptoms were reproduced by intracoronary acetylcholine injection that Induced vasospasm. In both patients, ECG at rest showed ST segment elevation in leads V-1 and V-2 and a right bundle branch block pattern that were accentuated by a Class I antiarrhythmic drug. Ventricular fibrillation also was induced by programmed electrical stimulation. Susceptibility to ventricular fibrillation can be modulated by the interaction of coronary vasospasm with Brugada syndrome or vice versa; therefore, it is important to study the clinical implications of the coexistence of the two diseases in such patients.

    DOI: 10.1046/j.1540-8167.2001.00108.x

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  • Demonstration of transient entrainment in monomorphic sustained ventricular tachycardia associated with cardiac sarcoidosis 査読

    M Chinushi, T Mezaki, Y Aoki, Nakagawa, I, T Washizuka, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   64 ( 8 )   635 - 637   2000年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    A 49-year-old man was referred fur further treatment of sustained monomorphic ventricular tachycardia (VT) associated with cardiac sarcoidosis. During an electrophysiologic study (EP), dl-sotalol suppressed the spontaneous VT and prevented induction of VT. However, when predonisolone treatment was started, monomorphic VT recurred frequently. To terminate the VT, a temporal pacing lead was placed at the apex of the right ventricle, and programmed electrical stimulation was attempted from the lead. During the EP study, 2 different monomorphic VTs were repetitively induced and both types were able to be terminated by rapid ventricular pacing; in one of the VT morphologies, constant and progressive fusion was obvious during the ventricular pacing. Some monomorphic VTs associated with cardiac sarcoidosis are due to reentry with an excitable gap, but the clinical efficacy of EP-guided antiarrhythmic drug treatment seems to be less certain during steroid therapy. In the present case, a defibrillator device was implanted to prevent a possible arrhythmic event.

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  • Antitachycardia burst pacing for pleomorphic reentrant ventricular tachycardias associated with non-coronary artery diseases - A morphology specific programming for ventricular tachycardias 査読

    M Chinushi, M Tagawa, H Kasai, A Abe, K Taneda, T Washizuka, Y Aizawa

    JAPANESE HEART JOURNAL   41 ( 3 )   313 - 324   2000年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    To study the role of antitachycardia burst pacing in patients with reentrant pleomorphic ventricular tachycardia (VT) associated with non-coronary artery diseases, the efficacy of antitachycardia pacing and appropriate antitachycardia pacing cycle length were evaluated in each pleomorphic VT morphology of seven patients.
    Seven patients were included in this study, Clinically documented pleomorphic VTs were reproduced in an electrophysiologic study. For each VT, rapid ventricular pacing was attempted from the apex of the right ventricle at a cycle length which was 20 ms shorter than that of VT and repeated after a decrement of the cycle length in steps of 10 ms until the VT was terminated or accelerated.
    All 16 VTs could be entrained by the rapid pacing, and 13 of the 16 VTs (81 %) were terminated, whereas pacing-induced acceleration was observed in the other 3 VTs of the 3 patients. VT cycle length (VTCL), block cycle length (BCL) which was defined as the longest VT interrupting paced cycle length, %BCL/VTCL and entrainment zone which was defined as VTCL minus BCL, varied in each VT morphology of each patient. In two patients, antitachycardia pacing was effective in all VT morphologies and the maximum difference of the %BCL/VTCL among the pleomorphic VTs was less than 10 %. Thus, antitachycardia pacing seemed to be beneficial for these patients. In the other 5 patients, a difference of more than 10 % in %BCL/VTCL was observed among the pleomorphic VT morphologies and/or at least one VT morphology showed pacing-induced acceleration. Compared to the 13 terminated VTs, three accelerated VTs had a wide entrainment zone [160 +/- 34 vs 90 +/- 48 ms, p &lt; 0.04] and small %BCL/VTCL [61 +/- 6 vs 77 +/- 11 %, p &lt; 0.03].
    In pleomorphic VTs associated with non-coronary artery diseases, responses to rapid pacing was not uniform, VT might be terminable or accelerated even in the same patient. We need to pay close attention when programming antitachycardia pacing in patients with pleomorphic VT.

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  • Structure of the reentrant circuit of idiopathic left ventricular tachycardia: New insights into the role of the Purkinje network 査読

    T Washizuka, M Chinushi, S Niwano, Y Aizawa

    JOURNAL OF ELECTROCARDIOLOGY   33 ( 2 )   195 - 198   2000年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    In idiopathic left ventricular tachycardia (ILVT), the reentrant circuit is considered to involve the Purkinje system, and the Purkinje potential (P-potential) appears to be a marker for successful ablation. However, the characteristics of the reentrant circuit in ILVT have not yet been defined. In 2 cases of ILVT, we performed detailed mapping along the left ventricular septum during VT and sinus rhythm. ILVTs were successfully ablated at the posteroapical area of the left ventricular septum where the high frequency P-potential was recorded and this portion was considered to be the exit site of the reentrant circuit. A small P-potential was also recorded at the portion proximal to the exit site, and it preceded the P-potential at the exit site. However, the local ventricular electrogram at the exit site preceded that at the proximal site during VT. Moreover, the small P-potential was orthodromically entrained by ventricular pacing from the proximal site. These findings suggest that the reentry circuit of ILVT appeared to have considerable size.

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  • Development of ventricular fibrillations with different characteristics in the local electrocardiogram - Large and small amplitude of activation, and its implication for implantable cardioverter defibrillator treatment 査読

    M Chinushi, T Washizuka, H Kasai, K Ohhira, M Satoh, Y Aizawa

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   63 ( 12 )   1007 - 1010   1999年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BLACKWELL SCIENCE ASIA  

    An implantable cardioverter defibrillator (ICD) was implanted in 2 patients with ventricular tachyarrhythmia related to old myocardial infarction, and defibrillation tests were attempted at the time of ICD implantation and at 2 or 4 weeks after the operation. Ventricular fibrillation (VF) was induced by T-wave shocks, but the amplitude of the ventricular electrogram was different in each VF. In most of the VFs with large ventricular electrograms, the local activity was appropriately detected. However, many undersensed beats were observed in other VFs that had fine ventricular electrograms and a longer time was needed before delivering the shock. The amplitude of the ventricular electrogram might be small in some cases of VF and this might result in undersensing and/or unsuccessful defibrillation. Close attention must be paid to the amplitude of ventricular activation in each VF to avoid possible difficulty in ICD therapy.

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  • Recovery of the right atrial effective refractory period after cardioversion of chronic atrial fibrillation 査読

    Y Tanabe, M Chinushi, K Taneda, S Fujita, H Kasai, M Yamaura, S Imai, Y Aizawa

    AMERICAN JOURNAL OF CARDIOLOGY   84 ( 10 )   1261 - +   1999年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EXCERPTA MEDICA INC  

    The effective refractory period was shorter in patients with than without chronic atrial fibrillation (AF). The effective refractory period was prolonged, and at 12 and 24 hours after cardioversion of AF it was the same as the subjects without AF.

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  • Both low and high energy cardioversion induced accelerated ventricular tachycardia in a patient treated with an implantable cardioverter defibrillator 査読

    T Washizuka, M Chinushi, K Hatada, H Kasai, K Ohhira, H Furushima, Y Aizawa

    JAPANESE HEART JOURNAL   40 ( 5 )   665 - 669   1999年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    A 72-year old male with an old myocardial infarction who had drug-refractory ventricular tachyarrhythmias received an implantable cardioverter-defibrillator (ICD). The patient did not take his prescribed beta-blocking agent for two days, following which he experienced six discrete shocks for spontaneous VT while riding his bicycle. Both 5J and 30J cardioversions were ineffective at terminating the VT and accelerated VT developed following the shocks. After admission, an electrophysiological study was performed while he was taking the P-blocking agent, both low and high energy cardioversions reproducibly terminated the clinical VT without showing any accelerated rhythm. These findings suggest that the increase in sympathetic discharge may enhance the proarrhythmic potential of ICDs.

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  • Beneficial effect of amiodarone on pacing induced terminability of reentrant ventricular tachycardia 査読

    M Chinushi, H Uchiyama, Nakagawa, I, T Washizuka, Y Aizawa

    JAPANESE HEART JOURNAL   40 ( 4 )   471 - 475   1999年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    A 33 year-old woman was referred to our hospital for further treatment of ventricular tachycardia (VT). During treatment with amiodarone (200 mg/day), clinical VT at the cycle length of 510 ms was induced. During the VT, rapid ventricular pacing was repeated at progressively shorter cycle lengths after a decrement of 10 ms steps. The VT was entrained by the rapid pacing and reproducibly terminated at a. paced cycle length of 380 ms. Four weeks after reducing the amiodarone to 100 mg/day, programmed stimulation was repeated. The VT with the same morphology but with a slightly shorter cycle length of 480 ms was again induced. However, at this time, rapid pacing from the same site could not terminate VT and transient acceleration developed at a shorter paced cycle length of 260 ms. The QT (QTc) interval, effective refractory period at the pacing site and width of the paced QRS complex were similar before and after changing the amiodarone treatment. The most characteristic change of VT in the second study was a widening of the entrainment zone, which was calculated as the difference between VT cycle length and the longest pacing cycle length which interrupts VT during the entrainment (from 130 to &gt; 220 ms), and it may be explained by the preferential shortening of the action potential duration and/or facilitation of the depressed cell to cell conduction within the reentry circuit. Amiodarone must exert a preferential action in the reentry circuit and modulate the conduction property as well as the effective refractory period. We should pay close attention to the efficacy of antitachycardia pacing during the modification of amiodarone treatment.

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  • Mechanism of arrhythmogenicity of the short-long cardiac sequence that precedes ventricular tachyarrhythmias in the long QT syndrome 査読

    N El-Sherif, EB Caref, M Chinushi, M Restivo

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   33 ( 5 )   1415 - 1423   1999年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    OBJECTIVES The purpose of this study was to investigate the electrophysiologic mechanism(s) that underlie the transition of one or more short-long (S-L) cardiac, sequences to ventricular tachyarrhythmias (VTs) in the long QT syndrome.
    BACKGROUND One or more S-L cardiac cycles, usually the result of a ventricular bigeminal rhythm, frequently precedes the onset of VT in patients with either normal or prolonged QT interval. Electrophysiologic mechanisms that underlie this relationship have not been fully explained.
    METHODS We investigated electrophysiologic changes associated with the transition of a S-L cardiac sequence to VT in the canine anthopleurin-A model, a surrogate of LQT3. Experiments were performed on 12 mongrel puppies after administration of anthopleurin-A. Correlation of tridimensional activation and repolarization patterns was obtained from up to 384 electrograms. Activation-recovery intervals were measured from unipolar electrograms and were considered to represent local repolarization.
    RESULTS We analyzed 24 different episodes of a S-L sequence that preceded VT obtained from 12 experiments. The VT followed one S-L sequence (five episodes), two to five S-L sequences (12 episodes) and more than five S-L sequences (seven episodes). The single premature ventricular beats coupled to the basic beats were consistently due to a subendocardial focal activity (SFA). There were two basic mechanisms for the development of VT after one or more S-L sequences: 1) in 10 examples of a S-L sequence due to a stable unifocal bigeminal rhythm, the occurrence of a second SFA, which arose consistently from a different site, infringed on the pattern of dispersion of repolarization (DR) of the first SFA to initiate reentrant excitation; 2) in the remaining 14 episodes of a S-L sequence, a slight lengthening (50 to 150 ms) in one or more preceding cycle lengths (CLs) resulted in alterations of the spatial pattern of DR at key sites to promote reentry. The lengthening of the preceding CL produced differentially a greater degree of prolongation of repolarization at midmyocardial and endocardial sites compared with epicardial sites with consequent increase of DR. The increased DR at key adjacent sites resulted in the development of de novo zones of functional conduction block and/or slowed conduction to create the necessary prerequisites for successful reentry.
    CONCLUSIONS The occurrence of VT after one or more S-L cardiac sequences was due to well defined electrophysiologic changes with predictable consequences that promoted reentrant excitation. (C) 1999 by the American College of Cardiology.

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  • Effect of atropine on QT prolongation and torsade de pointes induced by intracoronary acetylcholine in the long QT syndrome 査読

    H Furushima, S Niwano, M Chinushi, M Yamaura, K Taneda, T Washizuka, Y Aizawa

    AMERICAN JOURNAL OF CARDIOLOGY   83 ( 5 )   714 - 718   1999年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EXCERPTA MEDICA INC  

    We recently reported a marked QT prolongation and torsade de pointes (TDP) induced by an intracoronary acetylcholine (ACh) administration in patients with long QT syndrome, but the mechanism was not determined. In the present study, the effect of atropine on the ACh-induced QT prolongation and TDP was studied in long QT syndrome. Nine patients with congenital long QT syndrome were studied. ACh at doses of 20, 50, and 100 mu g were injected in a stepwise manner into the left main coronary artery, and the changes in the QT interval were measured. In 4 of the 9 patients, ACh administration at a dose of 100 mu g was repeated after an intravenous atropine administration at a dose of 0.5 mg. The QT intervals were measured using 12-lead electrocardiograms, and the data were compared before and after atropine administration. The coronary angiograms were normal and coronary spasm was not induced by ACh in all patients. The intracoronary administration of ACh at a dose of 100 mu g significantly prolonged the corrected QT interval (QT(c)), from 511 +/- 26 to 629 +/- 40 ms (p &lt;0.05). In 5 of the 9 patients, TDP was induced and was spontaneously terminated within 10 seconds (n = 4) or required direct-current shock (n = 1). After atropine administration, intracoronary ACh at the same dose resulted in no QT prolongation, and the QT(c) interval remained unchanged (525 +/- 29 vs 520 +/- 21 ms before and after atropine), and no TDP was induced. These findings indicate that the muscarinic receptor is involved in ACh-induced QT prolongation and TDP, both of which were prevented by the atropine administration. (C)1999 by Excerpta Medica, Inc.

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  • Ventricular fibrillation with small amplitude of activation and its implications for implantable cardioverter defibrillator treatment 査読

    M Chinushi, H Kasai, M Tagawa, T Washizuka, Y Aizawa

    JAPANESE HEART JOURNAL   40 ( 1 )   87 - 90   1999年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    An implantable cardioverter defibrillator (ICD) was implanted in a patient with ventricular fibrillation (VF) related to old myocardial infarction. During VF, amplitude of ventricular activation was small, and the ventricular sensitivity at 1.2 mV failed to detect several small ventricular activations. When the sensitivity was changed to 0.3 mV, both under- and oversensed beats occurred during VF, and at the ventricular sensitivity of 0.15 mV, the undersensed beats disappeared while oversensed beats markedly increased. Defibrillation test was repeated one and four weeks after the implantation, and these inappropriate beats were minimized at the ventricular sensitivity of 0.3 mV. We should pay attention to the amplitude of ventricular activation to avoid possible trouble in ICD therapy.

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  • Autonomic nerve activity and long QT interval syndrome - A role of acetylcholine and alpha-adrenoceptor 査読

    Y Aizawa, H Furushima, M Chinushi, T Washizuka

    JOURNAL OF ELECTROCARDIOLOGY   32   173 - 176   1999年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    DOI: 10.1016/S0022-0736(99)90076-6

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  • Role of alpha 1-adrenoceptor long QT syndrome 査読

    H Furushima, S Niwano, M Chinushi, M Yamaura, T Washizuka, Y Aizawa

    CIRCULATION   98 ( 17 )   776 - 776   1998年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • QT/T alternans and arrhythmias in the long QT syndrome 査読

    M Chinushi, EB Caref, M Restivo, N El-Sherif

    CIRCULATION   98 ( 17 )   10 - 10   1998年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Electrophysiological basis of arrhythmogenicity of QT/T alternans in the long-QT syndrome - Tridimensional analysis of the kinetics of cardiac repolarization 査読

    M Chinushi, M Restivo, EB Caref, N El-Sherif

    CIRCULATION RESEARCH   83 ( 6 )   614 - 628   1998年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Tachycardia-dependent QT/T alternans occurs in patients with the congenital or idiopathic form of long-QT syndrome (LQTS) and may presage the onset of polymorphic ventricular tachyarrhythmias. To examine the electrophysiological basis of arrhythmogenicity of QT/T alternans in LQTS, the tridimensional repolarization pattern of QT/T alternans was studied in the anthopleurin-A model of LQTS, a surrogate for LQT3. In 11 anesthetized mongreal puppies, tridimensional repolarization and activation patterns were analyzed from 256 to 384 unipolar electrograms. Cardiac repolarization was evaluated as the activation-recovery interval (ARI) of local electrograms. To induce QT/T alternans, the pacing cycle length (CL) was abruptly shortened in steps of 50 ms from a basic drive of 1000 ms, ARIs were calculated at epicardial (Epi), midmyocardial (Mid), and endocardial (End) sites. ARI restitution at each site was assessed by using a single premature stimulation delivered after the basic drive. ARI alternans occurred at longer CLs at Mid sites compared with End and Epi sites, and the magnitude of alternans at Mid sites was greater. Two factors contributed to the modulation of ART during QT/T alternans: (1) differences in restitution kinetics at Mid sites, characterized by larger Delta ARI and a slower time constant ( tau), and (2) differences in diastolic intervals resulting in different input to restitution at the same constant CL, These 2 factors could explain not only the onset of alternans at Mid sites at longer CLs but also the critical observation that ARI dispersion between Epi and Mid sites during alternans was greater than during the slower basic CL. Marked ARI alternans could be present in local electrograms without manifest alternation of the QT/T segment in the surface EGG. The latter was seen at critically short CLs associated with reversal of the gradient of ARI between Epi and Mid sites, with a consequent reversal of polarity of the intramyocardial QT wave in alternate cycles. The arrhythmogenicity of QT/T alternans was primarily due to the greater degree of spatial dispersion of repolarization during alternans than during slower rates not associated with alternans. This could result in functional conduction block and reentrant ventricular tachyarrhythmias during the fixed drive associated with alternans.

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  • The use of the block cycle length as a safe and efficient means of interrupting sustained ventricular tachycardia and its pharmacological modification 査読

    K Ohira, S Niwano, H Furushima, K Taneda, M Chinushi, Y Aizawa

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   21 ( 9 )   1686 - 1692   1998年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    In nine patients who had inducible monomorphic sustained ventricular tachycardia (VT), rapid pacing was performed in 11 episodes of morphologically distinct VT at progressively shorter cycle lengths and VT was interrupted at a critical cycle length. The VT interrupting critical cycle length was defined as the block cycle length (BCL) and the effect of Class I antiarrhythmic drugs were examined. Both the VT cycle length (VTCL) and the BCL were prolonged after administration of either drug. The overall mean ratio of the BCL to the VTCL was unchanged after procainamide administration, but increased after the use of mexiletine. The ratio, however, varied in individual VTs and the BCL after treatment with Class I antiarrhythmic drugs could not be predicted from the ratio baseline value, although the ratio was always &gt; 60% and the hazard of VT acceleration might be avoided if the BCL is used.

    DOI: 10.1111/j.1540-8159.1998.tb00265.x

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  • Successful slow pathway ablation in a patient with atrioventricular nodal reentrant tachycardia having a proximal common pathway 査読

    M Chinushi, Y Aizawa, Y Ogawa, S Fujita, Y Kusano, S Miyajima, A Shibata

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   21 ( 6 )   1316 - 1318   1998年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Radiofrequency catheter ablation was attempted in a patient with atrioventricular nodal reentrant tachycardia (AVNRT). AVNRT tl as easily inducible but an intermittent loss of the atrial activation was observed during AVNRT suggesting the presence of a proximal common pathway. During sinus rhythm, a relatively delayed activation that was compatible with a slow potential, was recorded anterior to the ostium of coronary sinus, and radiofrequency catheter ablation application (20 watts) to the site induced junction tachycardia. After an additional radiofrequency catheter ablation application to close the site, AVNRT became noninducible without deterioration of atrioventricular conduction through a fast pathway. This is the first case in which radiofrequency catheter ablation application to the slow potential recording site has been successful, even in AVNRT having a proximal common pathway.

    DOI: 10.1111/j.1540-8159.1998.tb00195.x

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  • Repetitive ventricular responses induced by radiofrequency ablation for idiopathic ventricular tachycardia originating from the outflow tract of the right ventricle 査読

    M Chinushi, Y Aizawa, K Ohhira, S Fujita, M Shiba, S Niwano, H Furushima

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   21 ( 4 )   669 - 678   1998年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    In 23 consecutive patients, radiofrequency (RF) ablation was used as treatment for idiopathic ventricular tachycardia (VT) originating from the outflow tract of the right ventricle. In this study, rye focused on the repetitive ventricular response (&gt; 5 consecutive QRS beats during RF application). The incidence and clinical implications of the repetitive ventricular response were examined through the results of endocardial mapping and RF ablation. VT origin was mapped as the earliest activation site during VT, and it was determined within 0.5 X 0.5 cm (narrow site) in 13 patients and wider than 0.5 x 0.5 cm (wide origin) in the other 10 patients. The repetitive ventricular response was induced during application of RF current in 14 of 23 patients (61%), and it was more frequently observed in VT from a wide origin (100%) than in the VT from a narrow site (31%). The QRS morphology of the repetitive ventricular response was identical to that of clinical VT. As RF application was continued and/or repeated, the RR interval of the repetitive ventricular response was gradually prolonged, the number of consecutive QRS complexes was decreased, and clinical VT was finally eliminated. The overall success rate of RF ablation was 96% (22/23 patients), and no complications were observed. In conclusion, a repetitive ventricular response was frequently/observed in idiopathic right VT. The changing pattern of repetitive ventricular response, slowing, and/or disappearing was consistent with successful RF ablation.

    DOI: 10.1111/j.1540-8159.1998.tb00122.x

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  • Bifid T waves induced by isoprenaline in a patient with Brugada syndrome 査読

    T Washizuka, M Chinushi, S Niwano, Y Aizawa

    HEART   79 ( 3 )   305 - 307   1998年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    A 41 year old man with incomplete right bundle branch block and persistent coved-type ST elevation in the right precordial leads during sinus rhythm had an episode of syncope while driving. He had never had syncope before and there was no family history of sudden cardiac death. Ventricular fibrillation was induced during electrophysiological study (EPS) by double extrastimuli applied to the right ventricle. Disopyramide was effective in preventing ventricular fibrillation during EPS. beta Adrenoceptor stimulation manifested bifid T waves and reduced ST segment elevation in right precordial leads. Simultaneously recorded monophasic action potential (MAP) duration at 90% repolarisation did not change in the right ventricular outflow tract, while it shortened in the left ventricular septum. These findings suggest that right precordial bifid T waves might result from relatively early repolarisation of the left ventricles. Moreover the gradient of action potential duration might explain the mechanism of ST segment abnormalities in a patient with Brugada syndrome.

    DOI: 10.1136/hrt.79.3.305

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  • Intracoronary acetylcholine-induced prolongation of monophasic action potential in long QT syndrome 査読

    H Furushima, S Niwano, M Chinushi, M Shiba, S Fujita, A Abe, K Ohhira, K Taneda, Y Aizawa

    JAPANESE HEART JOURNAL   39 ( 2 )   225 - 233   1998年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    Two patients with long QT syndrome, who bad episodes of syncope, underwent recordings of the monophasic action potential (MAP) from the right ventricle. Intracoronary administration of acetylcholine (ACh) induced prolongation of MAP duration and caused Torsade de Pointes (Tdp) in both patients. In one patient, intravenous atropine administration did not induce any change in MAP duration. In the other patient, ACh was administered after atropine. According to the results of the present study, abnormal regulation of the muscarinic receptor-mediated K-channel may be involved in the mechanism causing prolongation of MAP duration caused by ACh administration.

    DOI: 10.1536/ihj.39.225

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  • Relation between bradycardia dependent long QT syndrome and QT prolongation by disopyramide in humans 査読

    H Furushima, S Niwano, M Chinushi, K Ohhira, A Abe, Y Aizawa

    HEART   79 ( 1 )   56 - 58   1998年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    Background-Recent molecular biological investigations have identified abnormal genes in familial forms of long QT syndrome, but in bradycardia dependent acquired long QT syndrome, no such genetic abnormality has yet been identified.
    Objective-To investigate the relation between the responses of QT interval to pacing change and to disopyramide.
    Methods-This study included 13 patients with bradyarrhythmia who had undergone pacemaker implantation. The patients were divided into two groups: group I (n = 8), patients with QT prolongation (QT interval greater than or equal to 500 ms) during bradycardia; group II (n = 5), patients without QT prolongation (QT interval &lt; 500 ms) during bradycardia. The responses of QT interval caused by the change of pacing rate were determined and compared with the changes of the QT interval after disopyramide administration.
    Results-The QT interval in group I was significantly longer than that in group II when the pacing rate was decreased from 110 to 50 beats/min: mean (SD) 451 (16) v 416 (17) ms at 90 beats/min (p = 0.0033), and 490 (19) v 432 (18) ms at 70 beats/min (p = 0.0002), respectively. The QT interval was prolonged significantly by disopyramide in both groups, but the change was more pronounced in group I than in group II: 78 (33) v 35 (10) ms (p &lt; 0.05).
    Conclusions-This study suggests that the patients showing bradycardia dependent QT prolongation are also more markedly affected by disopyramide and that abnormal potassium channel may be the underlying mechanism.

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  • Frequency dependent shortening of conduction time through the reentrant pathway during transient entrainment of ventricular tachycardia 査読

    Y Aizawa, E Itoh, M Chinushi, M Shiba, H Uchiyama, A Shibata

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   21 ( 1 )   126 - 129   1998年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    In a patient with nonischemic ventricular tachycardia (VT), VT was entrained and the conduction time from the pacing site to the entrained local electrogram showed a rate dependent shortening and its degree affected by the pacing site, The QRS complex, which was entrained by the last pacing stimulus, was constant and identical to that of VT and no rate dependent facilitated conduction was observed when the heart was paced at similar paced cycle lengths during sinus rhythm. As the mechanism of the-shortening of the conduction time through the reentrant circuit, a shift of-the entrance seems most likely.

    DOI: 10.1111/j.1540-8159.1998.tb01071.x

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  • Effects of the ATP-sensitive K channel opener nicorandil on the QT interval and the effective refractory period in patients with congenital long QT syndrome 査読

    Yoshifusa Aizawa, Hirohide Uchiyama, Masayuki Yamaura, Toshio Nakayama, Makoto Arita, H. Inoue, S. Ogawa, H. Kasanuki, S. Kamakura, M. Chinushi

    Journal of Electrocardiology   31 ( 2 )   117 - 123   1998年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Churchill Livingstone Inc.  

    Congenital or idiopathic long QT syndrome is characterized by a frequently lethal ventricular arrhythmia called torsades de pointes (TdP) as well as a prolonged QT interval. The long QT interval related to an abnormal gene of the Na+ channel has been shown to be shortened by mexiletine. However, the action of K+ channel openers on the QT interval associated with abnormal genes of the K channel has yet to be studied. Seven patients of five families with long QT syndrome were included in this study, of whom six had syncope and six had documented TdP. Either long QT interval or sudden cardiac death had been observed in family members of all seven patients. At 1 to 3 weeks after admission, when TdP or frequent ventricular arrhythmia had subsided, nicorandil, an ATP-sensitive K channel opener, was administered orally at a dose of 15 mg/day in five patients and at 30 mg/day in the remaining two patients, and the effects were assessed on the third day after drug administration. In four patients, the effective refractory period was measured in the right ventricle before and after administration of K channel opener administration. The QT interval (QTc) prior to administration of the K channel opener was 0.60 ± 0.09 ms (mean ± SD) (0.61 ± 0.10 second(1/2)), which was shortened to 0.54 ± 0.05 ms (0.55 ± 0.06 second(1/2)) on the third day of drug administration (P &lt
    .05 for both): 10.4 ± 8.0% (8.6 ± 5.5%). The QT interval at varying preceding R-R intervals on Holter electrocardiograms showed a shift toward the right as a result of the drug administration. The effective refractory period showed a significant prolongation, 256 ± 26 ms versus 280 ± 22 ms before and after drug administration, respectively (P &lt
    .05). Intravenous administration of nicorandil resulted in no significant change in heart rate or blood pressure, while QTc showed a tendency to shorten, but nonsignificantly (P = .08). However, a hump on the monophasic action potential was abolished, especially at the long preceding R-R interval induced by premature stimulation of the ventricle. It is concluded that nicorandil shortens the QT interval slightly when administered orally, whereas the effective refractory period shows a slight prolongation. The physiologic and clinical significance of these effects needs to be studied further.

    DOI: 10.1016/S0022-0736(98)90042-5

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  • Electrophysiological mechanism of the characteristic electrocardiographic morphology of torsade de pointes tachyarrhythmias in the long-QT syndrome - Detailed analysis of ventricular tridimensional activation patterns 査読

    N ElSherif, M Chinushi, EB Caref, M Restivo

    CIRCULATION   96 ( 12 )   4392 - 4399   1997年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AMER HEART ASSOC  

    Background The long-QT syndrome (LQTS) is an electrophysiological (EP) entity characterized by prolongation of cardiac repolarization and the occurrence of polymorphic ventricular tachyarrhythmias (VTs), sometimes with a twisting QRS morphology, better known as torsade de pointes (TdP). In the present study, detailed analysis of ventricular tridimensional activation patterns during nonsustained TdP V-T was performed to provide an EP mechanism of the periodic transition in QRS axis.
    Methods and Results The studies were conducted with the anthopleurin-A canine model of LQTS. Tridimensional isochronal maps of ventricular activation were constructed from 256 bipolar electrograms obtained from the use of 64 plunge needle electrodes. In 26 episodes of nonsustained TdP VT, detailed activation maps could be accurately constructed during QRS-axis transitions in surface ECGs. The initial bed of all VTs consistently arose as a subendocardial focal activity, whereas subsequent beats were due to reentrant excitation in the form of rotating scrolls. The VT ended when reentrant excitation was terminated. In 22 of 26 episodes, the transition in QRS axis coincided with the transient bifurcation of a predominantly single rotating scroll into two simultaneous scrolls involving both the right ventricle and left ventricle separately. The common mechanism for initiation or termination of bifurcation was the development of functional conduction block between the anterior or posterior right ventricle free wall and the ventricular septum. In 4 of 26 episodes, a fast polymorphic VT, with an apparent shift in QRS axis, was due to a predominantly single localized circuit that varied its location and orientation from beat to beat, with the majority of ventricular myocardium being activated in a centrifugal pattern.
    Conclusions The study provides for the first time an EP mechanism for the characteristic periodic transition of the QRS axis during TdP VT in the LQTS.

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  • Electrophysiologic mechanism of the characteristic electrocardiographic morphology of Torsade de Pointes tachyarrhythmias in the long QT syndrome 査読

    N ElSherif, M Chinushi, EB Caref, M Restivo

    CIRCULATION   96 ( 8 )   3103 - 3103   1997年10月

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    記述言語:英語   出版者・発行元:AMER HEART ASSOC  

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  • Relation of surface QT/T-wave alternans to repolarization in the long QT syndrome (LOTS): Role of left ventricular M-cells 査読

    M Chinushi, M Restivo, EB Caref, G Nollo, Stoyanovsky, V, N ElSherif

    CIRCULATION   96 ( 8 )   1815 - 1815   1997年10月

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    記述言語:英語   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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  • Radiofrequency catheter ablation for idiopathic right ventricular tachycardia with special reference to morphological variation and long term outcome 査読

    M Chinushi, Y Aizawa, K Takahashi, H Kitazawa, A Shibata

    HEART   78 ( 3 )   255 - 261   1997年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    Objective-To assess the long term outcome of radiofrequency (RF) catheter ablation for idiopathic ventricular tachycardia (VT) originating from the outflow tract of the right ventricle, with special reference to the morphological variation in the VT-QRS complexes.
    Patients-13 patients whose ventricular tachycardia was treated with RF ablation were followed up more than 18 months after RF ablation.
    Results-Endocardial mapping revealed the various extensions of ventricular tachycardia origin (from 0.5 x 0.5 cm to 2.0 x 2.0 cm) in which the earliest local electrogram was recorded during ventricular tachycardia. In all five tachycardias from a relatively wider origin (more than 0.5 x 0.5 cm) and in four of eight from a narrow origin (&lt;0.5 x 0.5 cm), subtle morphological variation in the VT-QRS complexes was observed. In tachycardias with morphological variation, the local electrogram at the tachycardia origin also showed concomitant variation in morphology and activation sequence. Ventricular tachycardia from a narrow site was eliminated by RF ablation to the confined site, but a larger number of RF applications was required in tachycardias from a wider origin. All 13 tachycardias were successfully ablated by RF current, and during the follow up period of 28.2 (SD 7.2) months, recurrence was observed in only one patient who had a wider origin.
    Conclusions-Long term efficacy of RF ablation was excellent in idiopathic ventricular tachycardia originating from the outflow tract of the right ventricle. Subtle morphological variations were frequently observed in this type of ventricular tachycardia, and about half of them represented a relatively wider arrhythmogenic area.

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  • Clockwise and counter-clockwise circulation of wavefronts around an anatomical obstacle as one mechanism of two morphologies of sustained ventricular tachycardia in patients after a corrective operation of tetralogy of Fallot 査読

    M Chinushi, Y Aizawa, H Kitazawa, K Takahashi, T Washizuka, A Shibata

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   20 ( 9 )   2279 - 2281   1997年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    Two different monomorphic VTs were observed in two patients after a corrective operation for tetralogy of Fallot. The activation pattern of the wavefronts of the two VTs were different: in a counter-clockwise direction around the anatomical obstacle due to a ventriculotomy of the right ventricle in one VT; and in a clockwise direction around the same obstacle in the other VT. The different revolutions of the wavefronts could be the mechanism for the different morphologies of VT.

    DOI: 10.1111/j.1540-8159.1997.tb04250.x

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  • Fusion with postpaced return cycle identical to tachycardia cycle length during transient entrainment of ventricular tachycardia and its implications 査読

    H Kitazawa, T Washizuka, H Uchiyama, M Chinushi, S Niwano

    JAPANESE HEART JOURNAL   38 ( 3 )   369 - 378   1997年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    In reentrant ventricular tachycardia CVT), the postpaced return cycle (RC) during transient entrainment at a pacing site far from the central common pathway is longer than the VT cycle length (VTCL), when VT is represented by a figure-eight model. However, the reentrant circuit has not been fully elucidated.
    The purpose of this study was to present VT in which the postpaced RC became identical to VTCL during transient entrainment while fusion is evident in the surface electrocardiogram (ECG).
    Among 38 patients with inducible reentrant VTs who underwent electrophysiologic study (EPS), 10 VTs of six patients were selected. All patients had underlying heart diseases: dilated cardiomyopathy (n=2), coronary artery disease (n=1), postoperative tetralogy of Fallot (TOF; n=2), and arrhythmogenic right ventricular dysplasia (n=1). Catheter mapping was performed to demonstrate that the site of origin was distant from the pacing site.
    The cycle length of induced VT (n=19 VTs) was 380 +/- 41 msec. Five patients (83%) had two morphological VTs; one a left bundle branch block (LBBB) and the other a right bundle branch block (RBBB) pattern. During rapid pacing, constant fusion was observed in all VTs, but the postpaced RC was identical to VTCL. In 2 patients (4 VTs), the revolution of wavefronts around an anatomical obstacle (scar of myotomy in TOF, and infarction) was demonstrated.
    The fact that the postpaced RC was identical to VTCL but showed fusion in the surface ECG can be explained by macro-reentry. The pacing site must be located at the preferential route of the macroreentrant circuit.

    DOI: 10.1536/ihj.38.369

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  • Ventricular tachycardia initiated by high energy cardioversion in a patient with an implantable cardioverter defibrillator 査読

    M Chinushi, Y Aizawa, K Higuchi

    HEART   77 ( 4 )   373 - 374   1997年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    A transvenous implantable cardioverter defibrillator (ICD) was implanted into a 58 year old woman with idiopathic dilated cardiomyopathy who had drug refractory monomorphic ventricular tachycardia (VT). Antitachycardia pacing failed to terminate the VT; termination was attempted at 24 J, which was above the defibrillation threshold. When cardioversion at 24 J was delivered, VT with a different morphology and slower rate was reproducibly initiated. At 3 J, however, the original VT was successfully terminated without initiation of the slower VT. A new VT may be induced by high energy cardioversion. This may be a manifestation of the proarrhythmic potential of ICDs.

    DOI: 10.1136/hrt.77.4.373

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  • Discrepant drug action of disopyramide on ECG abnormalities and induction of ventricular arrhythmias in a patient with Brugada syndrome 査読

    M Chinushi, Y Aizawa, Y Ogawa, M Shiba, K Takahashi

    JOURNAL OF ELECTROCARDIOLOGY   30 ( 2 )   133 - 136   1997年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

    An electrophysiologic study was attempted in a patient who experienced cardiac arrest. Programmed electrical stimulation from the right ventricle, without the use of any drugs, induced ventricular fibrillation (VF) twice. Disopyramide prevented the induction of ventricular arrhythmia by rendering VF to a nonsustained polymorphic ventricular tachycardia when administered at 300 mg/day, and noninducible at 400 mg/day. However, ST segment elevation and the rSr' pattern in leads V1-3 characteristic of Brugada syndrome became exaggerated by disopyramide. Disopyramide exerted discrepant action on the electrocardiographic (ECG) abnormalities and induction of VF in this patient, suggesting the efficacy of antiarrhythmic drugs assessed by an electrophysiologic study may be unrelated to ECG abnormalities in cases of Brugada syndrome.

    DOI: 10.1016/S0022-0736(97)80021-0

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  • Adaptation of repolarization across the ventricular wall in the long QT Syndrome 査読

    EB Caref, M Restivo, M Chinushi, Stoyanovsky, V, S John, M Chaudry, N ElSherif

    BIOPHYSICAL JOURNAL   72 ( 2 )   MP124 - MP124   1997年2月

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    記述言語:英語   出版者・発行元:CELL PRESS  

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  • Morphological variation of nonreentrant idiopathic ventricular tachycardia originating from the right ventricular outflow tract and effect of radiofrequency lesion 査読

    M Chinushi, Y Aizawa, K Takahashi, O Kouji, H Kitazawa, T Washizuka, A Abe, A Shibata

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   20 ( 2 )   325 - 336   1997年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    RF catheter ablation was performed in 16 patients with nonreentrant idiopathic VT originating from the RVOT. All documented VT was monomorphic, but subtle morphological variation in the VT-QRS complex was observed in 10 (63%) of 16 patients. Through endocardial mapping, VT Origin was determined within a narrow site (&lt; 0.5 X 0.5 cm) in 4 of the 10 patients with the morphological variation. In the other 6 of 10 patients, the origin extended to an area of &gt; 0.5 X 0.5 cm. In VT with morphological variation, the local electrogram at the site of VT origin also showed variation in morphology and activation sequence. For VT of narrow origin, RF application to the site eliminated the TIT. However, in VT from a wide arrhythmogenic area, RF current had to be delivered to 3-7 distinct sites to cover the possible origin, and specific QRS configuration of VT and/or PVC was ablated at each of the earliest activation site. All but one VT were successfully ablated by RF current. Subtle morphological variation was frequent in this type of VT, and about half were associated with a wide arrhythmogenic area. Precise mapping and analysis of the efficacy of each RF application might be helpful to better understand the relationship between subtle changes of VT-QRS morphology and their origins.

    DOI: 10.1111/j.1540-8159.1997.tb06177.x

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  • Preferential action of mexiletine on central common pathway of reentrant ventricular tachycardia 査読

    Y Aizawa, A Abe, K Ohira, H Furushima, M Chinushi, S Fujita

    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   28 ( 7 )   1759 - 1764   1996年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCIENCE INC  

    Objectives. The action of mexiletine on diseased myocardium was assessed in reentrant ventricular tachycardia (VT).
    Background. Whether class Ib antiarrhythmic agents exert a preferential action on the central common pathway of reentrant ventricular tachycardia has not yet been studied in humans.
    Methods. In 10 consecutive patients (7 with a previous myocardial infarction, 3 with nonischemic disease), VT was induced and entrained with rapid pacing. The orthodromic conduction time was measured from stimulus to the entrained electrogram at the exit from the presumed central common pathway (i.e., the earliest site of activation). Mexiletine at 125 to 250 mg was administered intravenously, and when VI with the same configuration was induced, the study was repeated. The action of mexiletine on the central common pathway was assessed from the changes in VT cycle length and orthodromic conduction time. The effects on QRS complex duration, local conduction time between the exit and the pacing site and duration of the local electrogram were compared between normal and diseased myocardium.
    Results. Mexiletine prolonged the VT cycle length in all patients, from (mean +/- SD) 316 +/- 30 to 360 +/- 64 ms (mean change 20 +/- 7%, p &lt; 0.001); during entrainment of VT, the orthodromic conduction time was prolonged, from 306 +/- 58 to 367 +/- 89 ms (mean change 18 +/- 9%, p &lt; 0.001). These changes were highly correlated (r = 0.95, p &lt; 0.001). QRS duration changed little (4 +/- 3%), and local conduction time showed no change. The duration of the fragmented electrogram width was prolonged by mexiletine: from 146 +/- 50 to 176 +/- 56 ms (mean change 23 +/- 8%, during VT, p &lt; 0.001). Only a slight change occurred in the effective refractory period, both at the pacing site and at the exit.
    Conclusions. Mexiletine caused little change in conduction time in normal myocardium but prolonged VT cycle length, orthodromic conduction time and duration of the local electrogram at the earliest site of activation of VT. From these findings, a preferential action of mexiletine on diseased myocardium was suggested but seemed to occur only at higher frequencies during tachycardia. (C) 1996 by the American College of Cardiology

    DOI: 10.1016/S0735-1097(96)00375-0

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  • Action of antiarrhythmic agents on the area of slow conduction in ventricular tachycardia 査読

    Y Aizawa, M Chinushi, A Abe, K Ohhira, M Shiba, S Fujita

    JAPANESE HEART JOURNAL   37 ( 5 )   773 - 784   1996年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    The most common mechanism of monomorphic sustained ventricular tachycardia (VT) is reentry with an excitable gap, but the electrophysiological properties and response to antiarrhythmic agents in the area of slow conduction are not yet fully known.
    The conduction time through the area of slow conduction may show a frequency-dependent delay in some VT but in others, constant conduction time was observed as the paced cycle length was decreased while VT was entrained. VT with a so-called decremental property could be terminated more often with rapid pacing with less risk of acceleration of the VT rate.
    When the excitable gap was estimated by the width of the zone of entrainment: defined as the difference between the cycle length of VT and the longest VT-interrupting paced cycle length during transient entrainment, there was no difference in the width of the zone of entrainment between the responders (VT induction was prevented with drugs) and the non-responders (VT remained inducible). The cycle length of VT was not a predictor of drug-efficacy. However, when the drug-effect was assessed at the intermediate doses, VT of those with a significantly narrowed width of the zone of entrainment were subsequently suppressed when the same drug was added.
    In conclusion, the electrophysiological properties of the area is diverse and it might affect pacing-induced terminability.
    Whether an antiarrhythmic agent is able to prevent VT-induction or not can not be predicted from the basal electrophysiologic parameters, but a significant narrowing of the width of the zone of entrainment, and hence the excitable gap, can be a hallmark for drug-efficacy.

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  • Acetylcholine-induced prolongation of the QT interval in idiopathic long QT syndrome 査読

    Y Aizawa, T Washizuka, Y Igarashi, H Kitazawa, M Chinushi, A Abe, A Shibata

    AMERICAN JOURNAL OF CARDIOLOGY   77 ( 10 )   879 - &   1996年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EXCERPTA MEDICA INC  

    Intracoronary acetycholine prolonged the QT interval in 5 patients with congenital long QT syndrome but not in subjects with normal QT intervals. Prolongation was not due to bradycardia or adrenergic drive, and atropine was suggested to attenuate the response.

    DOI: 10.1016/S0002-9149(97)89189-8

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  • Suppression of fluid accumulation following pericardial inflammation in a patient with primary chylopericardium 査読

    M Chinushi, Y Watanabe, Y Aizawa, H Hanawa, M Yamazoe, Y Osman, A Shibata, M Shinonaga

    JAPANESE HEART JOURNAL   37 ( 2 )   271 - 274   1996年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    The patient was a 50-year-old woman with primary chylopericardium. Triglyceride rich chyloid fluid was continuously drained from the pericardial space through an indwelling catheter. A surgical procedure was scheduled since a medium chain triglyceride diet was insufficient to control the fluid accumulation. Before the operation, inflammatory signs were apparent around the indwelling catheter and the catheter was removed immediately. The inflammation was easily treated with antibiotics, and the pericardial effusion no longer accumulated during a follow-up period of 10 months.
    The inflammatory process may have caused fibrin production and tissue adhesion in the pericardial cavity, and these might have prevented an accumulation of chyloid fluid and occluded the connection between the thoracic duct and the pericardial cavity.

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  • Discrepant effects of mexiletine on cycle length of ventricular tachycardia and on the effective refractory period in the area of slow conduction 査読

    Y Aizawa, M Chinushi, H Kitazawa, T Washizuka, A Abe, A Shibata, Kodama, I

    HEART   75 ( 3 )   281 - 286   1996年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    Objective-Monomorphic sustained ventricular tachycardia (VT) can often be entrained and interrupted at a critical paced cycle length. The aim was to evaluate a possible determinant of this phenomenon by observing the action of mexiletine on the critical paced cycle length and other variables.
    Methods-Nine consecutive patients with symptomatic VT were studied. After induction of VT, the area of slow conduction was mapped as the earliest site of the activation or the site with mid-diastolic potential during the tachycardia. Rapid pacing was performed at a site distant from the tachycardia circuit to entrain the tachycardia, starting at a cycle length 10-20 ms shorter than the VT cycle length, and repeated after a decrement of the cycle length in steps of 10 ms to obtain the longest paced cycle length that interrupted the tachycardia: the block cycle length. The effective refractory period (ERP) was measured at the pacing site at which the myocardium was presumed to be normal and also in the area of slow conduction. The effects of mexiletine on the cycle length of VT, the block cycle length, and the ERP at two sites were obtained before and after mexiletine administration. The relation between the cycle length of VT and block cycle length and their changes were also analysed.
    Results-11 VTs with the same morphology were induced before and after mexiletine administration. The VT cycle length was prolonged by mexiletine from 309 (SD 53) to 361 (47) ms, and it was interrupted at block cycle lengths of 247 (37) and 307 (41) ms, respectively, the changes being 18 (12)% and 23 (8)% (both P &lt; 0.001). All VTs were entrained, and during pacing at the block cycle length there was abrupt loss of fusion and change in the presystolic electrogram, always associated with interruption of VT on cessation of rapid pacing. A good correlation was observed between the VT cycle length and the block cycle length (r = 0.77 to 0.80). The ERP at the pacing site (normal myocardium) and in the area of slow conduction showed no significant change: 241 (21) v 240 (22) ms and 262 (9) v 252 (9) ms, respectively. The block cycle length was longer than the ERP after mexiletine administration: 362 (55) v 252 (9) ms (P &lt; 0.02).
    Conclusions-Mexiletine prolonged the cycle length of VT and the VT-interrupting critical cycle length but not the ERP. The prolongation of the VT cycle length and the block cycle length by mexiletine seemed to be unrelated to the action potential duration, but related to depressed intercellular conduction.

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  • Long-term results of radiofrequency catheter ablation in non-ischemic sustained ventricular tachycardia with underlying heart disease - Nonuniform arrhythmogenic substrate and mode of ablation 査読

    M Chinushi, Y Aizawa, K Ohhira, A Abe, A Shibata

    JAPANESE HEART JOURNAL   37 ( 2 )   183 - 194   1996年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    This study examined 12 VTs in 8 patients who underwent radiofrequency (RF) catheter ablation for ventricular tachycardia (VT) associated with non-ischemic underlying heart diseases, and who were followed-up for more than 24 months after ablation. The site of VT origin was determined to be within a narrow site (within 1.0 x 1.0 cm) in 5 VTs (4 patients), but VT originated from a wide origin (more than 1.0 x 1.0 cm) in the other 5 VTs (3 patients). The remaining patient had two macroreentrant VTs revolving around an anatomical obstacle in both the clockwise and counterclockwise directions. Two of 5 VTs originating from a narrow site were successfully ablated by 2-3 RF applications. In VT associated with a wide origin, two perpendicular linear RF lesions with 6.0 +/- 1.8 RF applications were required to ablate the VT. Eight of the 12 VTs (66.7%) were finally ablated by RF current (30-50 watts), and they did not recur during the follow-up period of 31.2 +/- 6.5 months.
    An excellent long-term outcome is expected, even in VT associated with non-ischemic underlying heart disease, if VT is successfully treated by RF ablation.

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  • Drug-induced narrowing of the width of the zone of entrainment as a predictor of the subsequent non-inducibility of reentrant ventricular tachycardia after an additional dose of an antiarrhythmic drug 査読

    Y Aizawa, M Chinushi, N Naitoh, A Shibata

    HEART   75 ( 2 )   165 - 170   1996年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    Background-The efficacy of drugs used to treat inducible monomorphic sustained ventricular tachycardia (VT) has been assessed by investigating their ability to suppress inducibility, but the mechanism of the drug action remains to be determined.
    Objectives-To determine electrophysiological variables that predict inducibility, divided doses of class I antiarrhythmic drugs were given and their effects were analysed, particularly the ability of the final dose to suppress inducibility.
    Methods-The excitable gap was estimated by the zone of entrainment, which was defined as the difference between the cycle length of VT and the longest paced cycle length that interrupted VT during entrainment of VT with rapid pacing at paced cycle lengths in decrements of 10 ms. The cycle length of VT, the block cycle length, and the zone of entrainment were measured in the drug free state and after intermediate and final doses of procainamide, disopyramide, cibenzoline, and mexiletine.
    Results-Sustained monomorphic VT with a mean (SD) cycle length of 285 (43) ms was induced in 8 patients. It was entrained and interrupted at the block cycle length of 231 (31) ms. The width of the zone of entrainment was 54 (23) ms. In 8 studies VT was not inducible at final doses of procainamide in 4, cibenzoline in 1, and mexiletine in 3. In another 10 studies (procainamide in 4, disopyramide in 1, cibenzoline in 2, and mexiletine in 3), VT remained inducible at the intermediate dose and at the final dose. The cycle length of VT was prolonged to a similar degree in studies of effective and ineffective drugs, but the cycle length that blocked VT was longer at the intermediate dose of the effective drugs. Consequently, the width of the zone of entrainment was significantly narrowed at the intermediate dose of effective drugs and the width of the zone of entrainment was narrower than when ineffective drugs were given (22 (13) ms upsilon 76 (18) or 75 (37) ms at the intermediate and final doses respectively (P &lt; 0.02).
    Conclusion-Drugs that narrowed the zone of entrainment were associated with non-inducibility of VT after the final dose of the drug was given. The baseline variables did not predict the responses to class I antiarrhythmic drugs.

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  • Limited success of pharmacological therapy and indications for catheter ablation in ventricular tachycardia 査読

    Y Aizawa, M Chinushi, T Washizuka, K Takahashi

    RECENT PROGRESS IN ELECTROPHARMACOLOGY OF THE HEART   203 - 211   1996年

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    記述言語:英語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:CRC PRESS INC  

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  • RADIOFREQUENCY CURRENT CAUSED SLOWING OF NONREENTRANT IDIOPATHIC RIGHT-VENTRICULAR TACHYCARDIA ORIGINATING FROM A WIDE ARRHYTHMOGENIC AREA 査読

    M CHINUSHI, Y AIZAWA, A SHIBATA

    BRITISH HEART JOURNAL   74 ( 6 )   698 - 699   1995年12月

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    記述言語:英語   出版者・発行元:BRITISH MED JOURNAL PUBL GROUP  

    Radiofrequency catheter ablation was attempted in a patient with non-reentrant idiopathic right ventricular tachycardia (VT). Endocardial mapping indicated that the VT originated in the outflow tract of the right ventricle; however, an electrogram with an almost the identical activation time was recorded from an area extending to 1.0 x 2.0 cm. Each application of radiofrequency current within the area terminated VT, but a progressively slower VT with the same QRS configuration was induced until the area was covered by separate radiofrequency lesions. A progressive prolongation of VT cycle length might be related to a residual arrhythmogenic myocardium. Termination and slowing of the VT rate can be a hallmark of efficacy of each radiofrequency lesion.

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  • SUCCESSFUL RADIOFREQUENCY CATHETER ABLATION FOR MACROREENTRANT VENTRICULAR TACHYCARDIAS IN A PATIENT WITH TETRALOGY OF FALLOT AFTER CORRECTIVE SURGERY 査読

    M CHINUSHI, Y AIZAWA, H KITAZAWA, Y KUSANO, T WASHIZUKA, A SHIBATA

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   18 ( 9 )   1713 - 1716   1995年9月

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    記述言語:英語   出版者・発行元:FUTURA PUBL CO  

    Radiofrequency (RF) catheter ablation was applied to two macroreentrant ventricular tachycardias (VTs) documented after corrective operation for tetralogy of Fallot. The activation wavefront of VT with a right bundle branch block pattern was found to revolve in a clockwise manner around a presumed myotomy scar in the right ventricle, and VT with a left bundle branch block pattern revolved around the same anatomical obstacle in a counterclockwise manner. In both VTs, the biggest conduction delay was confirmed at the right ventricular outflow tract. RF applications to the slow conduction area terminated each VT within a few seconds but were insufficient to cure the VTs. RF lesions were then applied to the slow conduction area in a line to intersect the macroreentrant circuit, and both VTs became noninducible.

    DOI: 10.1111/j.1540-8159.1995.tb06994.x

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  • CATHETER ABLATION OF VENTRICULAR-TACHYCARDIA WITH RADIOFREQUENCY CURRENTS, WITH SPECIAL REFERENCE TO THE TERMINATION AND MINOR MORPHOLOGIC CHANGE OF REINDUCED VENTRICULAR-TACHYCARDIA 査読

    Y AIZAWA, M CHINUSHI, N NAITOH, H KITAZAWA, T WASHIZUKA, H UCHIYAMA, A SHIBATA

    AMERICAN JOURNAL OF CARDIOLOGY   76 ( 8 )   574 - 579   1995年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CAHNERS PUBL CO  

    During catheter ablation with radiofrequency (RF) currents, the incidence of the termination of reentrant ventricular tachycardia (VT) during application of RF energy and the morphologic change of the reinduced VT were analyzed. Twenty-five patients (20 men and 5 women, aged 44 +/- 17 years) were studied. After induction of monomorphic sustained VT, the ablation site was determined by endocardial activation mapping, identification of isolated mid-diastolic potential, and pacing during tachycardia. Thirty-six monomorphic VTs were induced in 25 patients and terminated with programmed stimulation. The cycle length was 323 +/- 55 ms and all VTs were entrained with rapid ventricular pacing. The target site was the earliest site of activation of VT in 26 VTs in 16 patients, and the area of slow conduction in 10 VTs in 9 patients. VT was terminated soon after the application of RF currents in 33 VTs in 22 patients at 6.0 +/- 3.1 seconds, and VT was induced immediately after the cessation of RF currents in 11 patients. Of these, 4 patients with idiopathic left ventricular VT had an alternation in the QRS configuration before catheter ablation and required repeat ablation of the other VT morphology. In the other 7 patients, such morphology was not observed before ablation, but was observed in VT induced when the original VT was terminated. Repeated attempts of catheter ablation 2 to 9 times at the remapped site was, however, successful in 7 of 8 VTs. In the remaining 3 patients, ablation was attempted within the area of slow conduction, but VT was not terminated during RF and only minor morphologic change was observed in 1 patient. With the inclusion of these 3 patients, catheter ablation was unsuccessful only during 4 VTs in 4 patients.

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  • SPATIAL ORIENTATION AT THE REENTRANT CIRCUIT AT IDIOPATHIC LEFT-VENTRICULAR TACHYCARDIA 査読

    Y AIZAWA, M CHINUSHI, H KITAZAWA, T WASHIZUKA, K TAKAHASHI, M SHIBA, K OHHIRA, A ABE, A SHIBATA

    AMERICAN JOURNAL OF CARDIOLOGY   76 ( 4 )   316 - 319   1995年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CAHNERS PUBL CO  

    In 6 patients with idiopathic left ventricular tachycardia, the spatial orientation of the reentrant circuit was estimated from the results of transient entrainment of ventricular tachycardia with rapid pacing at different sites. The entrance to the area of slow conduction was located toward the outflow tract, while the exit was located at the apicoposterior area of the left interventricular septum.

    DOI: 10.1016/S0002-9149(99)80092-7

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  • SPATIAL ORIENTATION AT THE REENTRANT CIRCUIT AT IDIOPATHIC LEFT-VENTRICULAR TACHYCARDIA 査読

    Y AIZAWA, M CHINUSHI, H KITAZAWA, T WASHIZUKA, K TAKAHASHI, M SHIBA, K OHHIRA, A ABE, A SHIBATA

    AMERICAN JOURNAL OF CARDIOLOGY   76 ( 4 )   316 - 319   1995年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:CAHNERS PUBL CO  

    In 6 patients with idiopathic left ventricular tachycardia, the spatial orientation of the reentrant circuit was estimated from the results of transient entrainment of ventricular tachycardia with rapid pacing at different sites. The entrance to the area of slow conduction was located toward the outflow tract, while the exit was located at the apicoposterior area of the left interventricular septum.

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  • NICORANDIL SUPPRESSES A HUMP ON THE MONOPHASIC ACTION-POTENTIAL AND TORSADE-DE-POINTES IN A PATIENT WITH IDIOPATHIC LONG QT SYNDROME 査読

    M CHINUSHI, Y AIZAWA, H FURUSHIMA, H INUZUKA, K OJIMA, A SHIBATA

    JAPANESE HEART JOURNAL   36 ( 4 )   477 - 481   1995年7月

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    記述言語:英語   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    The patient was a 71-year-old female with Torsade de Pointes (TdP) associated with idiopathic long QT syndrome. TdP and polymorphic nonsustained VT were frequently observed at bedside and an electrophysiologic study was performed. The QT (and QTU) interval was abnormally prolonged, and alternation of the QT interval was also recorded on the electrocardiogram. Monophasic action potential (MAP) from the right ventricle showed a hump on the falling limb of the MAP following a long RR interval of more than 1.0 sec. Intravenous administration of nicorandil (2 mg) resulted in disappearance of the hump, and ventricular arrhythmia was no longer observed. The QT interval at a PP interval of 720 msec was slightly shortened. She was treated with a DDD-pacemaker and given nicorandil. No recurrence of TdP was observed during the follow-up period of 8 months. This drug might be effective in patients with idiopathic long QT syndrome.

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  • ALTERNATION OF QRS MORPHOLOGY AND EFFECT OF RADIOFREQUENCY ABLATION IN IDIOPATHIC VENTRICULAR-TACHYCARDIA 査読

    T WASHIZUKA, Y AIZAWA, M CHINUSHI, N NAITOH, T MIYAJIMA, Y KUSANO, H KITAZAWA, H UCHIYAMA, K TAKAHASHI, A SHIBATA, S MIYAJIMA, M SATOU

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   18 ( 1 )   18 - 27   1995年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    We performed electrophysiological studies in 13 patients with idiopathic VT and attempted radiofrequency (RF) catheter ablation in 4 of them. Results: VT was induced by programmed stimulation in all patients and the mean cycle length was 363 +/- 58 msec. In 8 of 13 patients (62%), alternation of either the cycle length and/or morphology of VT was observed. Transient entrainment was achieved in all patients by rapid pacing from the right ventricular outflow tract so reentry was considered the underlying mechanism of VT. The site of earliest activation (EAS) during VT was located at the apicoposterior portion of the left ventricular septum amd used as the target site for RF catheter ablation. Spikelike presystolic activity was detected 20-40 msec prior to the large deflection of the local electrogram in four patients. VT was terminated by a few seconds of RF current in all four patients, but subsequently new VTs with a slightly different morphology were induced in three of them and re-mapping showed a shift of the EAS. After additional RF ablation at the new EAS, VT was no longer induced. No complication was noted and VT did not recur during a follow-up period for a mean of 9.3 +/- 5.2 months. Conclusion: RF catheter ablation seems useful and safe for idiopathic VT. The alternation of QRS morphology and the findings at the time of catheter ablation suggest that an alternative pathway or multiple exits may be present in some patients with idiopathic VT, because the change in VT morphology was associated with a shift of the EAS.

    DOI: 10.1111/j.1540-8159.1995.tb02471.x

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  • Radiofrequency current caused slowing of nonreentrant idiopathic right ventricular tachycardia originating from a wide arrhythmogenic area 査読

    Masaomi Chinushi, Yoshifusa Aizawa, Akira Shibata

    Heart   74 ( 6 )   698 - 699   1995年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BMJ Publishing Group  

    Radiofrequency catheter ablation was attempted in a patient with non-reentrant idiopathic right ventricular tachycardia (VT). Endocardial mapping indicated that the VT originated in the outflow tract ofthe right ventricle
    however, an electrogram with an almost the identical activation time was recorded from an area extending to 1.0 ×2.0 cm. Each application of radiofrequency current within the area terminated VT, but a progressively slower VT with the same QRS configuration was induced until the area was covered by separate radiofrequency lesions. A progressive prolongation of VT cycle length might be related to a residual arrhythmogenic myocardium. Termination and slowing of the VT rate can be a hallmark of efficacy of each radiofrequency lesion.

    DOI: 10.1136/hrt.74.6.698

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  • Administration of combination therapy with class Ic and class II antiarrhythmic drugs for a patient with WPW syndrome

    M. Chinushi, H. Yamaguchi, K. Tanabe, H. Furushima, Y. Ogawa, H. Inuzuka, K. Ojima, Y. Kusano, Y. Aizawa, A. Shibata

    Respiration and Circulation   43 ( 3 )   283 - 287   1995年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Combination therapy with class Ic and class II antiarrhythmic drugs was applied to a patient with atrioventricular reciprocating tachycardia (AVRT) associated with WPW syndrome. Single pilsicainide treatment (150 mg/day) suppressed the atrioventricular conduction via the accessory pathway, but AVRT persisted and the cycle length of the tachycardia was slightly prolonged as compared with the drug free state. During this single drug treatment, anterograde concealed conduction to the accessory pathway was confirmed. Therefore, it was our hypothesis that the interruption through the accessory pathway occurred below the accessory pathway or within the pathway itself. Additional treatment of atenolol (50 mg/day) suppressed the spontaneous AVRT attack completely. During the combination treatment, markedly deteriorated retrograde accessory pathway conduction was confirmed by electrophysiologic study. AVRT could not be induced by electrical stimulations. After administration of isoproteronol, retrograde conduction via the accessory pathway was improved and AVRT became inducible.

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  • RADIOFREQUENCY CURRENT CATHETER ABLATION FOR VENTRICULAR-TACHYCARDIA 査読

    M CHINUSHI, Y AIZAWA, Y KUSANO, T WASHIZUKA, T MIYAJIMA, N NAITHO, K TAKAHASHI, A SHIBATA

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   58 ( 5 )   315 - 325   1994年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN CIRCULATION SOC  

    Radiofrequency current catheter ablation was attempted for 17 morphologies of ventricular tachycardia (VT) in 14 patients. Five patients had underlying heart disease. The site of VT origin was determined as the earliest site of ventricular activation, or by pacing within the area of slow conduction. In 15 VTs, ablation was performed during VT, and 12 VTs (80%) were terminated within an average of 5.4+/-4.2 seconds. After ablation, 14 VTs (14/17=82%) of 11 patients (11/14=79%) could not be induced by electrical stimulation. Radiofrequency ablation appeared to be more effective in VTs without underlying heart disease (91%), and in VTs originating from the right ventricle (100%). Successful ablation sites usually showed a normal local electrograms during VT. Ablation in the slow conduction area was attempted in 3 VTs, and 2 VTs became noninducible. The mean number of applications of radiofrequency current for each VT origin was 7.7+/-6.4 at 20 - 50 Watts. In 4 patients, application of radiofrequency current was required 10 or more times because of a possible large arrhythmogenic area, or because of reinduction of VT, even though VT was terminated by radiofrequency current. No major complication was observed except for complete right bundle branch block in 1 patient. In conclusion: (1) Radiofrequency catheter ablation was considered to be effective and safe, especially for VT without underlying heart disease or VT originating from the right ventricle. (2) Ablation during VT was considered to be useful for identifying the proper ablation site and to avoid creating an unnecessary lesion.

    DOI: 10.1253/jcj.58.315

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  • CONDUCTIVE PROPERTY OF THE ZONE OF SLOW CONDUCTION OF REENTRANT VENTRICULAR-TACHYCARDIA AND ITS RELATION TO PACING-INDUCED TERMINABILITY 査読

    M AIZAWA, Y AIZAWA, M CHINUSHI, K TAKAHASHI, A SHIBATA

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   17 ( 1 )   46 - 55   1994年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    In order to assess the functional characteristics of the zone of slow conduction of reentrant VT, rapid pacing was performed to entrain VT. The orthodromic conduction time was measured as the interval between the stimulus and the orthodromically captured electrogram recorded distal to the zone of slow conduction, but not precisely at the exit point, and its response to rapid pacing was evaluated. In 32 of 33 consecutive patients, rapid pacing was performed to entrain VT. Of these, rapid pacing was repeated in 28 patients at 3-10 cycle lengths in steps of 10 msec before VT was terminated or rapid pacing produced an acceleration of the rate. A pacing induced prolongation of the orthodromic conduction time (slowed conduction) was observed in 16 (57.1%) patients and in another 12 (42.9%) patients, the conduction time was constant. The pacing induced termination was observed in 93.8% of VT with slowed conduction and in 50% of VT with constant conduction, and the difference was significant (P &lt; 0.05). There was no difference in the cycle length of VT or the shortest paced cycle length between VT with and without slowed conduction. The zone of slow conduction in human VT showed different conductive properties and VT with slowed conduction was associated with an easier and safer terminability with rapid pacing. The fact might be useful in selecting patients for antitachycardia pacing.

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  • EVIDENCE FOR SLOW CONDUCTION AREAS DURING PACING IN PATIENTS WITH SINUS RHYTHM, AND THEIR RELATION TO THE SITE OF VT ORIGIN 査読

    M CHINUSHI, Y AIZAWA, Y KUSANO, T WASHIZUKA, A SHIBATA

    JAPANESE HEART JOURNAL   35 ( 1 )   1 - 13   1994年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    In 52 patients with reentrant monomorphic sustained ventricular tachycardia (VT), the site of VT origin was determined by endocardial mapping and the interval from stimulus artifact to the onset of QRS complex (St - QRS) was measured during pace-mapping. Eleven patients had remote myocardial infarction (group 1), 25 patients had other underlying heart diseases (group 2), and 16 had idiopathic VT (group 3). A St - QRS interval of 40 msec or longer was defined as abnormal. (1) Long St - QRS interval: Thirteen sites with long St - QRS intervals were detected in 13 (25.0%) of 52 patients: 5 patients in group 1 (45.5%), 7 (28.0%) patients in group 2 and one (6.3%) in group 3. (2) Local electrogram: The local electrogram at sites with a long St - QRS interval was wide and 113 +/- 38 msec in duration during sinus rhythm which increased to 159 +/- 64 msec during VT (p&lt;0.05). In sinus rhythm, an abnormally prolonged local electrogram was observed in 11 of 13 sites with a long St - QRS interval, and mid-diastolic potential or continuous activity was observed in 3 sites during VT. (3) Relation to VT origin: At sites with a long St - QRS interval, concealed entrainment was observed in 3 patients, and the earliest activated local electrogram during VT in 5 patients. Conclusion: Sites with a long ST - QRS interval were observed in 25% of the patients with VT, and their incidence tended to be higher in patients with ischemic heart disease. Such sites were associated with abnormal local electrograms and some of the sites were considered to be the active limb of the reentry circuit.

    DOI: 10.1536/ihj.35.1

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  • Critical cycle length of rapid pacing to interrupt ventricular tachycardia depends on sodium channel availability within the reentry circuit

    Y. Kusano, Y. Aizawa, M. Chinushi, T. Miyajima, A. Shibata, I. Kodama

    Japanese Heart Journal   35 ( 1 )   415 - 416   1994年

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    記述言語:英語   掲載種別:研究論文(国際会議プロシーディングス)  

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  • Radiofrequency catheter ablation for ventricular tachycardia

    M. Chinushi, Y. Aizawa, Y. Kusano, H. Kitazawa, A. Shibata

    Japanese Heart Journal   35 ( 1 )   291 - 292   1994年

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    記述言語:英語   掲載種別:研究論文(国際会議プロシーディングス)  

    (1) VT either originates from a small circumscribed area (72%) or from an extended area of slow conduction (28%). (2) VT from the outflow tract of right ventricle is a good candidate for RF ablation. (3) Efficacy of RF ablation is similar between VT from a small area and VT from an extended area of slow conduction. But the number of RF lesions is greater in VT from an extended area. (4) VT from an extended area can be ablated by the systematic lesions made in two crossing lines at the center of the wide VT origin.

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  • IDIOPATHIC VENTRICULAR-FIBRILLATION AND BRADYCARDIA-DEPENDENT INTRAVENTRICULAR BLOCK 査読

    Y AIZAWA, M TAMURA, M CHINUSHI, N NAITOH, H UCHIYAMA, Y KUSANO, H HOSONO, A SHIBATA

    AMERICAN HEART JOURNAL   126 ( 6 )   1473 - 1474   1993年12月

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    記述言語:英語   出版者・発行元:MOSBY-YEAR BOOK INC  

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  • CATHETER ABLATION WITH RADIOFREQUENCY CURRENT OF VENTRICULAR-TACHYCARDIA ORIGINATING FROM THE RIGHT VENTRICLE 査読

    Y AIZAWA, M CHINUSHI, N NAITOH, Y KUSANO, H KITAZAWA, K TAKAHASHI, H UCHIYAMA, A SHIBATA

    AMERICAN HEART JOURNAL   125 ( 5 )   1269 - 1275   1993年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:MOSBY-YEAR BOOK INC  

    Catheter ablation of ventricular tachycardia (VT) with radiofrequency current would be safer than the conventional ablation with direct current shocks. Seven patients who had eight morphologically distinct symptomatic monomorphic VTs underwent catheter ablation with radiofrequency current. The mean age +/- SD was 52 +/- 16 years, and the mean cycle length of the clinical VT was 298 +/- 36 milliseconds. Sustained VT was induced by programmed stimulation with or without isoproterenol in four patients and developed during the infusion of isoproterenol alone in two patients. Of these, four VTs were entrained with rapid pacing. The ablation was attempted at the site of earliest activation through the distal electrode and the external patch electrode on the back during VT in seven episodes in six patients. In the other patient it was applied during sinus rhythm. Energy was 40 to 50 W in the first case and 30 to 40 W in the others, and was given for 30 seconds. All VTs were terminated within 6 seconds, 3.6 +/- 0.8 seconds after the application of the radiofrequency current. Additional current was given to one to four predetermined sites by mapping. The mean number of applications was 4.0 +/- 1.3 sites. Except in the first patient, VT was eliminated successfully and VT was not induced by programmed stimulation, by the administration of isoproterenol, or by treadmill exercise testing. VT did not recur during the follow-up period of 6.8 +/- 1.1 months.

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  • PLEOMORPHIC VENTRICULAR-TACHYCARDIA ARISING FROM A NEW SITE DURING ANTIARRHYTHMIC DRUG-THERAPY 査読

    M CHINUSHI, Y AIZAWA, N NAITOH, H KITAZAWA, Y KUSANO, M TAMURA, A SHIBATA

    JAPANESE HEART JOURNAL   34 ( 3 )   255 - 268   1993年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    We analyzed the site of VT origin and the induction mode of VT in 9 patients who showed new VT morphologies with different bundle branch block patterns after administering antiarrhythmic drug(s). In all patients, VT exhibiting the clinical morphology was induced in the drug free state. (1) VT origin: In 6 patients, VTs showing LBBB pattern had a site of origin at the right ventricular free wall, and VTs with RBBB pattern originated from the left ventricular free wall. VT from the intraventricular septum of the right ventricle showed RBBB pattern in two patients and VT with LBBB pattern arose from the posteroseptum of the left ventricle in one patient. (2) VTs with new morphologies: After administering drug(s), VTs with new morphologies were induced in 18 studies and the mean cycle length of these VTs was not different from that in the control study. Among them, the induction mode was less aggressive in 4 of 7 drug studies and more aggressive in 1 study. (3) VTs with the same morphology: VTs with morphologies identical to those of the clinical VTs were induced in 15 studies. However, the drugs' effect was evident. The mean cycle length of these VTs was significantly prolonged, and VTs were induced by less aggressive modes or at longer coupling intervals. In conclusion: (1) After administering drug(s), different electrophysiologic characteristics were observed between the VTs with new morphologies and the VTs with the same morphology. (2) If a new VT was induced by less aggressive modes after administering drug(s), the drug(s) might act to facilitate inducibility: proarrhythmic effect.

    DOI: 10.1536/ihj.34.255

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  • ALTERNATION IN THE FUSION COMPLEX DURING CONSTANT PACING OF SUSTAINED VENTRICULAR-TACHYCARDIA 査読

    M CHINUSHI, Y AIZAWA, Y KUSANO, H KITAZAWA, T MIYAJIMA, A SHIBATA

    JAPANESE HEART JOURNAL   34 ( 2 )   227 - 234   1993年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    In a patient with sustained ventricular tachycardia (VT), we observed two different conduction times through the reentry circuit at the critical paced cycle length. The cycle length of the VT was 420 msec and overdrive pacing initially performed at a paced cycle length of 400 msec and repeated at decrements of 10 msec until the VT was interrupted at a paced cycle length of 320 msec. During rapid pacing, constant fusion and progressive fusion were confirmed. The first post-pacing return cycle was identical to each paced cycle length. The conduction time between the stimulus artifact and the orthodromically captured electrogram at the left ventricle was constant at 350 msec in each paced cycle length. However, only at a pacing cycle length of 360 msec two conduction times were alternatively observed, one of 350 msec and the other of 365 msec. When the conduction time changed from 350 msec to 365 msec, morphological alternation both in the surface QRS complex and in the orthodromically captured electrogram was evident. Dual slow pathways or a single slow pathway with plural exits from the reentry circuit is a likely mechanism of the alternation.

    DOI: 10.1536/ihj.34.227

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  • CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA - FROM DC TO RF ABLATION 査読

    Y AIZAWA, M CHINUSHI, N NAITOH, Y KUSANO, A SHIBATA

    CARDIAC PACING AND ELECTROPHYSIOLOGY TODAY   363 - 365   1993年

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    記述言語:英語   掲載種別:研究論文(国際会議プロシーディングス)   出版者・発行元:SIMUL INTERNATIONAL INC  

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  • SUCCESSFUL RADIOFREQUENCY CURRENT CATHETER ABLATION OF SUSTAINED VENTRICULAR-TACHYCARDIA 査読

    M CHINUSHI, Y AIZAWA, H KUWANO, H HOSONO, H KITAZAWA, Y KUSANO, N NAITHO, M TAMURA, A SHIBATA

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   15 ( 10 )   1460 - 1466   1992年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    We performed radiofrequency current catheter ablation in two patients with nonischemic sustained ventricular tachycardia (VT). In one patient, two morphologically distinct VTs were induced by electrical stimulation. One showed right bundle branch block pattern and the other left bundle branch block pattern. The earliest site of activation during each VT was determined at the septum of the right ventricle. However, these two sites were close to the His-bundle electrogram recording area. In the other patient, a VT with a left bundle branch block pattern occurred spontaneously after the administration of isoproterenol. The earliest site of activation during VT was determined at the outflow tract of the right ventricle. During tachycardia, radiofrequency current ablation (40 W x 30 sec) was delivered to the earliest site of activation. A few seconds after fulguration, each VT was terminated and additional radiofrequency currents were given near these sites. After the ablation, VT could not be induced by the electrical stimulations, nor did it recur. No side effects were observed and the atrioventricular conduction remained intact. We feel that nonischemic VTs could possibly be treated by using radiofrequency current catheter ablation.

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  • POSSIBLE INTRAMURAL SITE OF REENTRANT CIRCUIT IN VENTRICULAR-TACHYCARDIA OF NONISCHEMIC CAUSE - PREOPERATIVE AND INTRAOPERATIVE MAPPING STUDIES 査読

    M CHINUSHI, Y AIZAWA, F MASANI, A OBATA, A SHIBATA

    JAPANESE HEART JOURNAL   33 ( 4 )   505 - 512   1992年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    A patient with a drug-refractory sustained ventricular tachycardia (VT) of nonischemic cause was mapped for the site of VT origin. The intraoperative mapping showed the earliest site of activation of VT on the epicardial surface at which the initial deflection of the local electrogram preceded the onset of the QRS complex of VT by 45 msec. The endocardial mapping could not indicate the site at which the electrogram was found prior to the onset of the QRS complex of VT. However, at the earliest site of the endocardial mapping, VT was entrained without change in the configuration of the QRS complex. After cessation of the rapid pacing, VT resumed at the intrinsic rate and the first post-paced return cycle was identical to each paced cycle length. The interval from the stimulus to the orthodromically captured local electrogram at the pacing site was identical to the cycle length of VT. Catheter ablation from the endocardial side and a cryoablative procedure from the epicardial side failed to eradicate the VT. These findings suggest an intramural site of VT origin and reentrant circuit of which the exit and the entrance face the epicardial and the endocardial surfaces, respectively.

    DOI: 10.1536/ihj.33.505

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  • FREQUENCY AND OUTPUT-DEPENDENT CHANGE IN CONDUCTION OVER SLOW PATHWAYS IN A PATIENT WITH SUSTAINED VENTRICULAR-TACHYCARDIA UNRELATED TO CORONARY-ARTERY DISEASE 査読

    M CHINUSHI, Y AIZAWA, T FUNAZAKI, M TAMURA, A SHIBATA

    PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY   15 ( 5 )   756 - 761   1992年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:FUTURA PUBL CO  

    In a patient with sustained ventricular tachycardia, we obtained two different paced QRS morphologies from a single pacing site. In one QRS morphology the stimulus to the QRS complex was long, 150 msec, and in the other it was 100 msec. At the paced cycle length of 600 msec and the stimulus output of 4 V, one QRS morphology with the stimulus to the onset of QRS activation (St-QRS) interval of 150 msec was observed. At the paced cycle length of 400 msec, the other QRS morphology with a St-QRS interval of 100 msec was observed alternately with the former. At the paced cycle length of 353 msec or 316 msec, the latter with a shorter St-QRS interval was exclusively observed. When the stimulus output was increased from 4 to 10 V, keeping with the paced cycle length at 400 msec, the St-QRS interval was shortened from 100 to 80 msec. For the two QRS morphologies with two St-QRS intervals, two slowly conducting pathways would be responsible. The site of the block in the faster pathway must be located at the proximity of the pacing site and the conduction at a shorter paced cycle length would be explained by "supernormal conduction."

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  • INCIDENCE AND MECHANISM OF INTERRUPTION OF REENTRANT VENTRICULAR-TACHYCARDIA WITH RAPID VENTRICULAR PACING 査読

    Y AIZAWA, S NIWANO, M CHINUSHI, M TAMURA, Y KUSANO, T MIYAJIMA, H KITAZAWA, A SHIBATA

    CIRCULATION   85 ( 2 )   589 - 595   1992年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AMER HEART ASSOC  

    Background. Information concerning the electrophysiological characteristics of the reentrant circuit is still limited. To understand the incidence and mechanism of pacing-induced interruption of ventricular tachycardia (VT), rapid pacing was performed to entrain VT, and the local electrogram at the VT origin and the surface electrocardiogram were analyzed.
    Methods and Results. Among 25 patients, evidence of transient entrainment was confirmed in 20 patients, but the critical paced cycle length at which VT was interrupted was obtained in 13 patients when the paced cycle length was decreased in steps of 10 msec. During pacing at the critical cycle length (defined as block cycle length), changes in the local electrogram at VT origin were confirmed in all of the 13 patients; that is, 1) a change in morphology and 2) a change in the timing of activation: a sudden shortening in the stimulus to local electrogram time (third entrainment criterion by Waldo). The two changes mean that the exit is activated from a different direction (retrograde capture) because of an orthodromic block in the slow conduction zone. The QRS complex in the surface electrocardiogram showed a change in configuration from the fusion complex to the fully paced one at the same time when the exit was captured antidromically.
    Conclusions. Based on our observations in these patients, ventricular tachycardia interruption is very often associated with orthodromic block in the reentrant circuit at a critical cycle length of rapid pacing.

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  • AN ATTEMPT AT ELECTRICAL CATHETER ABLATION OF THE ARRHYTHMOGENIC AREA IN IDIOPATHIC VENTRICULAR-FIBRILLATION 査読

    Y AIZAWA, M TAMURA, M CHINUSHI, S NIWANO, Y KUSANO, N NAITOH, A SHIBATA, T TOHJOH, Y UEDA, K JOHO

    AMERICAN HEART JOURNAL   123 ( 1 )   257 - 260   1992年1月

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    記述言語:英語   出版者・発行元:MOSBY-YEAR BOOK INC  

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  • ACTIONS OF ANTIARRHYTHMIC DRUG ON THE REENTRANT CIRCUIT OF SUSTAINED VENTRICULAR-TACHYCARDIA 査読

    Y AIZAWA, M CHINUSHI

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   56   1470 - 1473   1992年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN CIRCULATION SOC  

    DOI: 10.1253/jcj.56.SupplementV_1470

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  • LOW-ENERGY CATHETER ELECTRICAL ABLATION FOR SUSTAINED VENTRICULAR-TACHYCARDIA 査読

    S NIWANO, Y AIZAWA, M SATOH, M CHINUSHI, A SHIBATA

    AMERICAN HEART JOURNAL   122 ( 1 )   81 - 88   1991年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:MOSBY-YEAR BOOK INC  

    Catheter electrical ablation using a relatively low level of energy - 40 to 100 joules - was attempted in 12 consecutive patients with drug-refractory sustained ventricular tachycardia (VT). They had 19 monomorphic VTs, and ischemic heart disease was found as the underlying heart disease in one, nonischemic heart disease was found in nine, and no structural heart disease was seen in two patients. Electrical discharge was delivered at the site of the earliest endocardial activation in 17 VTs, and at the slow conduction area in two VTs. Among 19 VTs in 12 patients, 12 VTs (63%) in seven patients (58%) were successfully ablated and became noninducible during electrophysiologic study. There were no major complications, but transient atrioventricular block occurred in one patient and transient friction rub occurred in another. Delivered electrical energy and the time interval between the local electrogram and the surface QRS did not correlate with the clinical outcome of the procedure. However, "excellent" pace-mapped QRS morphology was obtained from the site of earliest activation or from the slow conduction area in 9 of 12 VTs in the successful cases but in only one of seven VTs in the unsuccessful cases. Low-energy catheter electrical ablation seems to be a satisfactory therapeutic procedure compared with the conventional method that uses an energy level of 200 joules or higher.

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  • AORTITIS SYNDROME, CORONARY-ARTERY ECTASIA, AND MID-VENTRICULAR OBSTRUCTION 査読

    M CHINUSHI, M YAMAZOE, Y TAMURA, T FUNAZAKI, Y IGARASHI, T MATSUBARA, Y TANABE, A SHIBATA

    JAPANESE HEART JOURNAL   32 ( 2 )   281 - 286   1991年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    A 46-year-old Japanese woman, who had been diagnosed as having aortitis syndrome 4 years earlier, was admitted to our hospital in May 1989. The diagnosis of aortitis syndrome was confirmed by intravenous digital subtraction angiography which showed stenotic lesions in each subclavian artery, the left common carotid artery, and the descending aorta. Coronary arteriography revealed diffuse and prominent dilatation of entire coronary artery segments. Moreover, a left ventriculogram showed complete obstruction of the mid-ventricle during systole. Thus, we diagnosed this case as aortitis syndrome complicated by coronary artery ectasia and mid-ventricular obstruction. The causal relations of these findings are discussed.

    DOI: 10.1536/ihj.32.281

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  • PROARRHYTHMIC EFFECTS OF ANTIARRHYTHMIC DRUGS ASSESSED BY ELECTROPHYSIOLOGIC STUDY IN RECURRENT SUSTAINED VENTRICULAR-TACHYCARDIA 査読

    M CHINUSHI, Y AIZAWA, S MIYAJIMA, T FUNAZAKI, M TAMURA, A SHIBATA

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   55 ( 2 )   133 - 141   1991年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN CIRCULATION SOC  

    Proarrhythmic responses were evaluated in repeated electrophsiologic studies (EPS) in 27 patients with inducible ventricular tachycardia (VT). Class Ia drugs were administered to 23, Ib to 6, Ic to 4, III to 5 and IV to 9 patients. The mean age was 53 years, and 18 patients had structural heart diseases. Pleomorphism was observed in 11 patients. In 4 patients (15%), the VT cycle length (CL) shortened by 50 ms or more in EPS during the administration of antiarrhythmic drugs. VT was inducible by a less aggressive induction mode than the control study in 9 patients (33%). In 4 patients (15%), the induced VT changed to the incessant form, and the other 2 patients (7%) required DC shocks due to hemodynamic deterioration. Patients with pleomorphic VT and/or structural heart diseases seemed to develop proarrhythmia more frequently. In total, some proarrhythmic response was observed in 13 (48%) of the 27 patients. Therefore, it should be kept in mind that proarrhythmic effects are frequently observed during antiarrhythmic therapy in patients with sustained VT. The action of the drugs on the slow conduction zone may vary, which may provide a basis for the development of proarrhythmia.

    DOI: 10.1253/jcj.55.133

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  • Abnormal local ventricular electrogram and its relation to induction of ventricular tachycardia in patients with hypertrophic cardiomyopathy 査読

    S. Miyajima, Y. Aizawa, M. Satoh, K. Suzuki, T. Funazaki, K. Ebe, S. Niwano, M. Tamura, M. Chinushi, A. Shibata

    Journal of Cardiology   20 ( 3 )   649 - 656   1991年

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  • CLINICAL CHARACTERISTICS AND POSSIBLE ROLE OF CORONARY-ARTERY SPASM IN SYNCOPE AND OR ABORTED SUDDEN-DEATH 査読

    Y IGARASHI, M YAMAZOE, Y TAMURA, T MATSUBARA, Y TANABE, M CHINUSHI, T YAMAGUCHI, M SAEKI, Y AIZAWA, A SHIBATA

    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION   54 ( 12 )   1477 - 1485   1990年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN CIRCULATION SOC  

    We investigated the clinical and pathophysiologic characteristics in patients with vasospastic angina who developed syncope and/or experienced aborted sudden death (SD). Vasospastic angina was diagnosed using the methylergonovine test. Syncope was found in 32 (10.4%) patients among 309 who were admitted to our institute in a one-year period. The most frequent cause of syncope was ventricular tachycardia which was found in 10 (31.2%) of the 32 patients. The next important cause of syncope was vasospastic angina which was found in 7 patients (21.8%). Among the 7 patients with vasospastic angina who experienced one or more syncopal episodes, there were 3 patients with aborted SD, 3 with syncope and one with shock. Cardiovascular collapse was observed in 4. Interior wall ischemia was found in 5 and anterior wall ischemia in 2 during the methylergonovine test. None of the 7 patients had significant coronary stenosis. Two patients had no prodromal symptom such as chest pain. Our results suggest that coronary artery spasm may be one of the most frequent cardiovascular diseases that causes syncope which is not always accompanied by a prodromal symptom. Therefore, coronary spasm should be distinguished in patients with unexplained syncope or aborted SD.

    DOI: 10.1253/jcj.54.12_1477

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  • THE OCCURRENCE OF LEUKEMIA IN A PATIENT WITH PULMONARY ASBESTOSIS 査読

    M CHINUSHI, S KOYAMA, M TAKAHASHI, A SHIBATA, EMURA, I

    JAPANESE JOURNAL OF MEDICINE   29 ( 6 )   607 - 610   1990年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A 77-year-old man, who had been a subway construction worker, was admitted to our hospital for surgical treatment of left check carcinoma and an examination for pancytopenia on November 17, 1986. Bone marrow aspiration revealed that 10% of the nucleated cells were blasts with morphological atypism. Bone marrow biopsy showed hypocellular marrow and a diffuse increase of argyrophil fibers with the presence of aebestos fibers was observed by microscope. A chest X-ray showed the findings of old tuberculosis and pulmonary asbestosis, and asbestos fibers were demonstrated in the broncho-pulmonary lavage fluid. He was diagnosed to have pulmonary asbestosis complicated with hypoplastic low percentage leukemia.

    DOI: 10.2169/internalmedicine1962.29.607

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  • Association of sustained ventricular tachycardia and a mid-systolic click: A case report 査読

    K. Suzuki, Y. Aizawa, M. Tamura, T. Funazaki, S. Miyajima, S. Niwano, M. Chinushi, M. Sato, K. Ebe, A. Shibata

    Journal of Cardiology   19 ( 21 )   119 - 127   1989年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

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  • AV NODAL REENTRANT TACHYCARDIA WITH A BYSTANDER MAHAIM FIBER 査読

    Y AIZAWA, K SUZUKI, M CHINUSHI, A SHIBATA

    JAPANESE HEART JOURNAL   29 ( 6 )   891 - 896   1988年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

    DOI: 10.1536/ihj.29.891

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書籍等出版物

  • 日本臨床領域別症候群シリーズ 心室内伝導障害,心室内変行伝導

    池主雅臣, 齋藤修( 担当: 分担執筆)

    日本臨床社  2019年11月 

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  • 日本臨床領域別症候群シリーズ 2 束ブロック,3 束ブロック

    池主雅臣, 齋藤修( 担当: 分担執筆)

    日本臨床社  2019年11月 

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  • EPS概論改訂第2版 陳旧性心筋梗塞の持続性心室頻拍・心室細動

    池主雅臣, 保坂幸男( 担当: 分担執筆)

    南江堂  2019年3月 

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  • 循環器内科専門医バイブル。不整脈(識る・診る・治す)

    池主雅臣, 齋藤修, 保坂幸男( 担当: 分担執筆)

    中山書店  2018年2月 

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  • ICD・CRTの考えかた、使い方

    池主 雅臣( 担当: 分担執筆)

    中外医学社  2018年2月 

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  • 不整脈を科学する

    池主 雅臣( 担当: 分担執筆)

    医歯薬出版  2017年1月 

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  • 心室頻拍のすべて

    池主 雅臣( 担当: 分担執筆)

    南江堂  2016年11月 

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  • 超・EPS・入門

    池主 雅臣( 担当: 分担執筆)

    南江堂  2016年6月 

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  • 不整脈診療。クリニカルクエスチョン200

    池主 雅臣( 担当: 分担執筆)

    診断と治療社  2015年4月 

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MISC

  • 重症の混合型神経調節性失神に合併した発作性心房細動に対する自律神経叢への高周波アブレーションにより失神の改善を認めた1例

    赤川理恵, 長谷川祐紀, 鈴木尚真, 井神康宏, 大槻総, 池主雅臣, 猪又孝元

    失神研究会プログラム・抄録集(Web)   13th   2023年

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  • ICD,CRTD植込み例におけるCT撮影時の電磁干渉に関する検討

    土田良樹, 石田尚子, 種村俊彦, 松澤春香, 松田萌々香, 岡田隆, 長谷川進, 西塔毅, 和泉大輔, 赤川理恵, 鈴木尚真, 袴田崇裕, 坂口裕太, 長谷川祐紀, 大槻総, 八木原伸江, 池主雅臣, 猪又孝元

    植込みデバイス関連冬季大会プログラム・抄録集(Web)   15th   2023年

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  • ICD/CRT-D植込み後における追加リード挿入の危険因子

    和田理澄, 大槻総, 赤川理恵, 鈴木尚真, 坂口裕太, 長谷川祐紀, 八木原伸江, 池主雅臣, 猪又孝元

    植込みデバイス関連冬季大会プログラム・抄録集(Web)   15th   2023年

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  • Baffle leakと下大静脈三尖弁輪間峡部を心腔内エコーで詳細に観察しえた完全大血管転位症Senning術後の心房粗動の1例

    鈴木尚真, 大槻総, 和田理澄, 赤川理恵, 井神康弘, 長谷川裕紀, 池主雅臣, 猪又孝元

    日本不整脈心電学会カテーテルアブレーション関連大会(Web)   2023   2023年

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  • Marshall静脈を介した左上肺静脈への心外膜側伝導によりCryo balloonアブレーションに加え肺静脈内への高周波焼灼を要した1例

    加藤淳, 井神康宏, 大槻総, 赤川理恵, 鈴木尚真, 長谷川祐紀, 池主雅臣, 猪又孝元

    日本不整脈心電学会カテーテルアブレーション関連大会(Web)   2023   2023年

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  • Electrical stormの発症時間と予後の関連性

    鈴木尚真, 大槻総, 和泉大輔, 袴田崇裕, 坂口裕太, 井神康宏, 八木原伸江, 飯嶋賢一, 池主雅臣, 猪又孝元

    植込みデバイス関連冬季大会プログラム・抄録集(Web)   14th   2022年

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  • 植込み型除細動器(ICD,CRT-D)の現行機種で見られる早期電池消耗の臨床的特徴

    飯嶋賢一, 和泉大輔, 鈴木尚真, 坂口裕太, 袴田崇裕, 井神康宏, 大槻総, 八木原伸江, 池主雅臣, 猪又孝元

    植込みデバイス関連冬季大会プログラム・抄録集(Web)   14th   2022年

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  • 日本人におけるCRT-D植込み後の長期生存を予測する因子の検討

    坂口裕太, 和泉大輔, 鈴木尚真, 袴田崇裕, 井神康宏, 大槻総, 八木原伸江, 飯嶋賢一, 池主雅臣, 猪又孝元

    植込みデバイス関連冬季大会プログラム・抄録集(Web)   14th   2022年

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  • Activation mappingが困難な全低電位左房に対しescape mappingによりmitral isthmus lineを作成しえた拡張相肥大型心筋症合併心房頻拍の1例

    井神康宏, 和泉大輔, 大槻総, 赤川理恵, 鈴木尚真, 坂口裕太, 袴田崇裕, 長谷川祐紀, 八木原伸江, 池主雅臣, 猪又孝元

    日本不整脈心電学会カテーテルアブレーション関連大会(Web)   2022   2022年

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  • CRT植込み患者に対する持続性心房細動への肺静脈隔離術の有効性の検討

    鈴木尚真, 大槻総, 和泉大輔, 赤川理恵, 坂口裕太, 長谷川裕紀, 八木原伸江, 池主雅臣, 猪又孝元

    日本不整脈心電学会カテーテルアブレーション関連大会(Web)   2022   2022年

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  • 心房細動アブレーションに対する多点pacingによる3D mapping法(Escape mapping)の有用性の検討

    井神康宏, 和泉大輔, 鈴木尚真, 坂口裕太, 袴田崇裕, 長谷川祐紀, 大槻総, 飯嶋賢一, 八木原伸江, 池主雅臣, 猪又孝元

    日本不整脈心電学会カテーテルアブレーション委員会公開研究会プログラム・抄録集   2021   2021年

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  • 分枝を含む緩徐伝導路領域の線状通電で治療した三尖弁輪旋回型マクロリエントリー心室頻拍 査読

    保坂幸男, 高橋和義, 袴田崇裕, 土田圭一, 田中孔明, 石塚光夫, 赤川理恵, 小柳宜人, 中野賢治, 小田弘隆, 池主雅臣

    臨床心臓電気生理   43   257 - 265   2020年

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  • 右室流出路transannularパッチ修復術・心室中隔欠損パッチ閉鎖術後にDouble-loopマクロリエントリー心室頻拍を発症したファロー四徴症症例

    保坂幸男, 高橋和義, 須藤洸司, 土田圭一, 田中孔明, 西田耕太, 袴田崇裕, 秋山琢洋, 小田弘隆, 池主雅臣

    臨床電気生理研究会雑誌   42   73 - 80   2019年

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  • 各種抗凝固療法における血管損傷時の凝固系の反応の検討

    大槻 総, 和泉 大輔, 須田 将吉, 佐藤 光希, 長谷川 祐紀, 八木原 伸江, 飯嶋 賢一, 池主 雅臣, 南野 徹

    日本内科学会雑誌   107 ( Suppl. )   163 - 163   2018年2月

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    記述言語:日本語   出版者・発行元:(一社)日本内科学会  

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  • テストステロン減少が病態の顕性化に寄与したと考えられた高齢発症のQT延長症候群の1例

    長谷川 祐紀, 坂口 裕太, 大槻 総, 飯嶋 賢一, 八木原 伸江, 佐藤 光希, 和泉 大輔, 池主 雅臣, 南野 徹

    心臓   49 ( Suppl.1 )   43 - 49   2017年8月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    27歳時に片側睾丸摘出の既往がある61歳男性。母親とその姉妹2人が20歳頃に突然死している。失神や多形性心室頻拍(TdP)の既往はなかったが、50歳頃より検診でQT延長を指摘されていた。今回、運転中に初めて失神し搬送された。この際、著明なQT延長(QTc=666ms)とTdP頻発を認めた。器質的心疾患は認めず、家族歴から先天性QT延長症候群と考えられたが、本例では60歳代での心原性失神の初発であった。検診心電図では、QT延長は段階的に顕性化していた。本例では数日前からエフェドリン含む感冒薬の内服歴がありTdP発症の要因となったと考えられた。さらに本例では明らかなテストステロン低値を認めており、QT延長症候群の高齢での顕性化に寄与したと考えられた。QT延長例や潜在的素因を持つ例に内分泌的異常や薬剤など幅広い修飾因子が加わることで、高齢で初回発作をきたす例があり注意を要する。(著者抄録)

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  • 断線によるCRT左室リード留置部位の変更で異なる臨床経過を呈した3例

    長谷川 祐紀, 和泉 大輔, 大槻 総, 飯嶋 賢一, 八木原 伸江, 佐藤 光希, 池主 雅臣, 南野 徹

    心臓   48 ( Suppl.2 )   179 - 186   2016年12月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    CRT-D植込み後、左室リード断線による心不全悪化をきたし、冠静脈狭窄のため異なる部位への再留置を余儀なくされた3症例を経験した。3例とも左室リードは単純牽引で用手的抜去可能であった。症例1:68歳女性。拡張型心筋症(DCM、EF=37%、QRS=132ms、NYHAIII)、徐脈性心房細動、心室頻拍のためCRT-Dを植込み、NYHAIIに改善した。植込み8年2月後に左室リード断線をきたした。後側壁側から側壁側への再留置となり、その後初回留置後より利尿剤の減量が可能となった。症例2:71歳男性。DCM(EF=32%、QRS=180ms、NYHAIII)のためCRT-Dを植込み、NYHAIIに改善した。2年3ヵ月後に左室リード断線をきたした。心室刺激閾値高値や横隔神経捕捉のため目標領域への留置が困難であり、中心静脈経由で後側壁側に再留置したが、心不全は改善せず術後54日目に死亡した。症例3:57歳女性。DCM(EF=17%、QRS=190ms、NYHAIII)のためCRT-Dを植込みNYHAIIに改善した。4年7ヵ月後に左室リード断線をきたした。前側壁側から前壁側への再留置となり、その後心不全が悪化した(NYHAIII)。結語:左室リードの再留置時には、同部位への留置が困難となる可能性、他部位への留置によりCRTの効果が異なる可能性を考慮する必要がある。(著者抄録)

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  • クラリスロマイシン内服中に徐脈を契機に多形性心室頻拍をきたした高齢者QT延長症候群の1例

    長谷川 祐紀, 和泉 大輔, 大槻 総, 八木原 伸江, 飯嶋 賢一, 佐藤 光希, 池主 雅臣, 南野 徹

    心臓   48 ( Suppl.1 )   155 - 155   2016年8月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

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  • 出力を変えた洞調律時ペースマッピングと頻拍中エントレインメントペーシングで、2つの心室頻拍の近接必須緩徐伝導部位を同定した陳旧性心筋梗塞例

    保坂 幸男, 高橋 和義, 柏 麻美, 尾崎 和幸, 土田 圭一, 真田 明子, 藤原 裕季, 中村 則人, 廣木 次郎, 小田 弘隆, 池主 雅臣

    臨床心臓電気生理   39   205 - 214   2016年5月

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    記述言語:日本語   出版者・発行元:臨床心臓電気生理研究会  

    陳旧性心筋梗塞の82歳、男性。2種類の心室頻拍(VT-1とVT-2)によるelectrical stormのためカテーテルアブレーションを行った。Voltage mappingで左室中隔に低電位領域を認めた。同部位から洞調律時に出力を変えてペーシングを行うと5VでVT-2、10VではVT-1の波形が長い刺激-QRS間隔(VT-1:70msec、VT-2:130msec)を介して再現された。さらに同部位ではVT-1中とVT-2中にmid-diastolic potential(MDP)とsystolic potential(SP)の2つの電位(aとb)が記録され、その出現順序はVT-1とVT-2で逆転していた。VT-1とVT-2中に5Vでペーシングを行うと、刺激はそれぞれのVTのMDPを捕捉してconcealed entrainmentを呈した。VT-2中に10Vでペーシングを行うと、MDPとSPの両者を捕捉してQRS波形はVT-1に変化し、刺激中止後はVT-2に復し、post-pacing intervalはVT-2に近似していた。VT-1とVT-2の必須緩徐伝導路は近接しており、MDPはそれぞれのVT維持に必須な電位で、SPはもう一方のVT回路の緩徐伝導路の興奮を反映していると解された。(著者抄録)

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  • 不整脈原性右室心筋症に伴う心停止発作 (第1土曜特集 不整脈を科学する) -- (突然死を識る・治す)

    池主 雅臣

    医学のあゆみ   256 ( 6 )   697 - 704   2016年2月

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    記述言語:日本語   出版者・発行元:医歯薬出版  

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    その他リンク: http://search.jamas.or.jp/link/ui/2016090412

  • 心筋中層・心外膜側・心内膜側にそれぞれの主起源を有する3種類の心室頻拍にカテーテル治療を行った催不整脈性右室心筋症の1例

    保坂 幸男, 池主 雅臣, 高橋 和義, 真田 明子, 柏 麻美, 廣木 次郎, 尾崎 和幸, 土田 圭一, 藤原 裕季, 中村 則人, 小田 弘隆

    心臓   47 ( Suppl.2 )   176 - 183   2015年12月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    症例は心室頻拍(VT)のための緊急入院歴が2回ある催不整脈性右室心筋症の男性。初回入院の契機となったVT1は流出路の中隔起源で、洞調律時の電位高は右室側・左室側ともに正常であった。VT1と同波形の心室性期外収縮(PVC)の先行度は右室側32ms、左室側25msであり、PVCは右室側および左室側からの高周波通電で時間を要して(30〜50秒後)消失したが効果は一過性であった。中隔起源と考えて両心室から中隔に対して高周波通電を追加して治療に成功した。2回目入院では、三尖弁輪10時方向を起源とするVT2を認めた。VT2(PVC)に20ms先行する心内膜側の最早期興奮部位から通電を行うと、通電20〜30秒後にVT(PVC)は抑制されたが容易に再発した。対側の心外膜側には低電位領域が同定され、低電位領域内で140ms先行する局所電位に高周波通電を行ったところVT2は直ちに停止し、その後の誘発は不能となった。効果判定のプログラム刺激で右室下壁の低電位領域を起源とするVT3が繰り返し誘発された。VT3は血行動態が不安定であったため、洞調律時の心内膜側に顕著であった遅延電位部位に心内膜と心外膜側から通電を行い治療に成功した。これまでに、いずれのVTの再発も認めていない。催不整脈性右室心筋症のVTは多様な部位(心内膜側・心筋中層・心外膜側)から生じるが、三次元マッピングシステムを駆使した詳細なマッピングで治療できる可能性がある。(著者抄録)

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  • 高血圧性心肥大で経過観察中に持続性心室頻拍を発症し蘇生された1例

    長谷川 祐紀, 和泉 大輔, 大槻 総, 八木原 伸江, 佐藤 光希, 小澤 拓也, 渡部 裕, 池主 雅臣, 南野 徹

    心臓   47 ( Suppl.1 )   38 - 43   2015年8月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    症例は49歳男性。高血圧、糖尿病のためカルシウム拮抗薬、インスリン治療を受けていた。心電図では肥大性ST変化を認め、心エコーでは壁厚15mmの対称性左室肥大を認められていたが、左室収縮能は保持されていた。トラック運転中に意識消失し追突事故を起こした。救急隊が250bpmの脈をふれない単形性心室頻拍(VT)を確認し、心肺蘇生中にVTは停止し回復した。緊急搬送後の心臓精査にて冠動脈病変はなく、心臓MRIで心室中隔中層の遅延造影所見を認めた。電気生理学的検査では血行動態が破綻するRBBB型とLBBB型の複数波形の単形性VTが誘発された。一部のVTでは、エントレインメント所見を認めリエントリー機序が想定され、心室中隔に拡張期電位を認めたことから同領域が不整脈基盤となっている可能性が示唆された。左室肥大例において心臓MRIで遅延造影所見を認める場合、不整脈リスクを考慮すべきと考えられ、文献的考察を交えて報告する。(著者抄録)

    DOI: 10.11281/shinzo.47.S1_38

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  • CKD合併心房細動例における抗凝固療法 (MAIN CONTENTS エビデンスにもとづいた抗凝固薬の使い分け)

    池主 雅臣, 齋藤 修, 奥田 明子

    Cardio-coagulation = カーディオコアギュレーション : 循環器における抗凝固療法   1 ( 4 )   249 - 256   2014年12月

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    記述言語:日本語   出版者・発行元:メディカルレビュー社  

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    その他リンク: http://search.jamas.or.jp/link/ui/2015060704

  • 虚血と不整脈 J波と虚血性心室細動の関係 冠攣縮狭心症における検討

    佐藤 光希, 渡部 裕, 池主 雅臣, 和泉 大輔, 小澤 拓也, 伊藤 英一, 田辺 恭彦, 相澤 義房, 南野 徹

    心電図   34 ( 2 )   118 - 126   2014年10月

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    記述言語:日本語   出版者・発行元:(一社)日本不整脈心電学会  

    近年、心室細動(VF)に関連する疾患として、J波症候群という新しい疾患群が提唱された。虚血性心疾患においてもJ波の存在やその変化は、心筋虚血とVF発生との関係を解析するうえで非常に重要である。われわれは、心筋虚血による超急性期のJ波の変化とVF発生の関係を明らかにするため、冠攣縮誘発試験施行例のうち虚血が誘発された67例において、J波とVF発生の関係を検討した。その結果、67例中14例において安静時心電図にJ波が存在していた。冠攣縮誘発による虚血に伴って、安静時心電図のJ波は14例中7例で増悪を示し、そのうち4例でVFに至った。一方で、安静時心電図でJ波が見られなかった53例のうち、4例で虚血に伴って新たなJ波が出現したが、VFは生じなかった。J波に変化がみられなかった49例のうち1例でのみ、VFを生じた。冠攣縮誘発試験前のJ波の存在は、冠攣縮誘発時のVF発生に関係した(OR 20.8、p=0.006)。また、冠攣縮誘発時のJ波の増悪・出現もVF発生に関与した(OR 31.4、p=0.002)。このことから、J波は冠攣縮誘発時の心筋虚血の超急性期において、VFに関係していることが示された。心筋虚血の超急性期におけるJ波を含めた特異な心電図変化を解析することは、虚血性VFや虚血性心疾患の突然死のリスク階層化にも有用と考えられる。さらに研究を進めていくことで、虚血性VFの機序や病態が解明し、治療に貢献していくことが期待される。(著者抄録)

    DOI: 10.5105/jse.34.118

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  • 左室基部後壁起源の心室性期外収縮により心室細動を繰り返した特発性心室細動の1例

    勝海 悟郎, 古嶋 博司, 和泉 大輔, 大槻 総, 長尾 智美, 飯嶋 賢一, 佐藤 光希, 小田 雅人, 渡部 裕, 池主 雅臣, 南野 徹

    心臓   46 ( Suppl.2 )   56 - 61   2014年8月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    生来健康の27歳男性。父親が57歳時に突然死している。深夜飲酒中に心室細動をきたし当院に搬送された。心肺蘇生、低体温療法を施行し、後遺症なく回復した。心エコー、心臓MRI、冠動脈CTで器質的心疾患は認めなかった。Type 3 Brugada型心電図を認めたが、ICD植え込み後に施行したピルシカイニド負荷試験ではtype 1様波形変化が1誘導のみであり、特発性心室細動と診断した。また、同検査中に右脚ブロック、左軸偏位型の心室性期外収縮を認めた。運動負荷試験後の夜間から早朝にこの心室性期外収縮より心室細動が惹起され、ショック作動を繰り返した。心臓電気生理検査では左室基部後壁心外膜側に心室性期外収縮の起源を認め、心内膜側から焼灼を試みたが、完全には抑制されなかった。その後、ベプリジル内服により心室性期外収縮、心室細動は抑制され、以後9ヵ月間再発なく経過している。心室細動を惹起する心室性期外収縮の起源が同定され、bepridilが奏功した特発性心室細動症例を経験したので文献的考察を加えて報告する。(著者抄録)

    DOI: 10.11281/shinzo.46.S2_56

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  • ブルガダ型心電図診断に対する取り組みについて

    加藤 公則, 松田 和博, 池主 雅臣, 南野 徹, 小林 隆司, 佐藤 幸示, 北川 寛, 笹川 力, 上村 伯人, 曽根 博仁

    人間ドック   29 ( 2 )   356 - 356   2014年7月

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    記述言語:日本語   出版者・発行元:(公社)日本人間ドック学会  

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  • QRS幅,波高を規定する要因と臨床的意義 (特集 心電図攻略法 : 診断能力向上のための虎の巻)

    池主 雅臣, 齋藤 修

    レジデント   7 ( 3 )   22 - 30   2014年3月

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    記述言語:日本語   出版者・発行元:医学出版  

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    その他リンク: http://search.jamas.or.jp/link/ui/2014124469

  • Radiofrequency catheter ablation of macroreentrant ventricular tachycardia after corrective surgery for tetralogy of Fallot

    Masaomi Chinushi, Osamu Saitou, Hiroshi Furushima

    Journal of Arrhythmia   30 ( 4 )   222 - 229   2014年

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    記述言語:英語   掲載種別:書評論文,書評,文献紹介等   出版者・発行元:Elsevier  

    Ventricular tachycardia (VT) may occur in patients after corrective surgery for tetralogy of Fallot (ToF), and this can be a cause of sudden cardiac death. Macroreentrant VT is a unique mechanism in these patients, although other mechanisms are involved in VT development. Owing to advances in electrophysiological knowledge and medical technology, macroreentrant VT after corrective surgery for ToF can be treated by catheter ablation. In the macroreentrant circuit of VT, several critical isthmuses (types 1-4) could be included, and these are supported by anatomical obstacles and operative interventions in the right ventricle. Linear radiofrequency (RF) application through the critical isthmus can terminate and prevent the recurrence of macroreentrant VT. Among the critical isthmuses, the type 1 isthmus (between the right ventricular outflow scar and tricuspid annulus) is the most common, but compared with the other types of isthmuses, it is longer so and has a thicker myocardium. Therefore, higher-energy RF application using irrigation and/or large-tip ablation catheters is usually required to complete the linear conduction block. Since other isthmuses may simultaneously work as critical components of the macroreentrant circuit, detailed mapping is encouraged before starting RF application in the type 1 isthmus. Since long-term evidence of the effectiveness of catheter ablation for VT in patients after ToF repair is limited, hybrid treatment with implantable cardioverter defibrillators (ICDs) would be a reasonable strategy for secondary prevention of cardiac events, such as that in patients with other underlying heart diseases. Indications of electrophysiological study, catheter ablation, and/or ICD therapy for primary prevention of sudden cardiac death should be further examined in high-risk patients after ToF repair.

    DOI: 10.1016/j.joa.2014.02.007

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  • 右室流出路起源の期外収縮をトリガーとする多形性心室頻拍が見られた潜在性type2-QT延長症候群の1例

    佐藤 光希, 園田 桂子, 飯嶋 賢一, 八木原 伸江, 和泉 大輔, 渡部 裕, 古嶋 博司, 南野 徹, 阿部 晃, 池主 雅臣

    心臓   45 ( Suppl.3 )   135 - 135   2013年12月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    DOI: 10.11281/shinzo.45.S3_135

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  • 虚血と不整脈 J波と虚血性心室細動の関係 冠攣性狭心症における検討

    佐藤 光希, 渡部 裕, 池主 雅臣, 和泉 大輔, 小澤 拓也, 伊藤 英一, 田辺 恭彦, 相澤 義房, 南野 徹

    心電図   33 ( Suppl.4 )   S - 4   2013年9月

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    記述言語:日本語   出版者・発行元:(一社)日本不整脈心電学会  

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  • 神経電気刺激と高周波通電による腎動脈自律神経興奮への介入

    池主 雅臣, 鈴木 克弥, 斉藤 修, 飯嶋 賢一, 和泉 大輔, 佐藤 光希, 古嶋 博司, 南野 徹, 岩渕 三哉

    心電図   33 ( Suppl.4 )   S - 4   2013年9月

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    記述言語:日本語   出版者・発行元:(一社)日本不整脈心電学会  

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  • 急性期および慢性期の心室性不整脈の治療に苦慮した劇症型心筋炎の1例

    風間 絵理菜, 田川 実, 中村 裕一, 大倉 裕二, 浅井 泰博, 南場 一美, 落合 幸江, 池主 雅臣, 南野 徹

    心電図   33 ( Suppl.4 )   S - 4   2013年9月

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    記述言語:日本語   出版者・発行元:(一社)日本不整脈心電学会  

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  • 多形性心室頻拍の契機となるLV summit領域の心室性期外収縮にカテーテルアブレーションが奏功した1例

    勝海 悟郎, 池主 雅臣, 飯嶋 賢一, 佐藤 光希, 和泉 大輔, 渡部 裕, 古嶋 博司, 南野 徹

    心臓   45 ( Suppl.2 )   19 - 19   2013年8月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    DOI: 10.11281/shinzo.45.S2_19

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  • 症例問題で腕試し! 心電図トレーニング (特集 波形がみえる! 好きになる! 心電図の読み方トレーニング) -- (実践! 現場で出会う心電図)

    池主 雅臣, 斉藤 修

    レジデントノート   15 ( 1 )   95 - 106   2013年4月

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    記述言語:日本語   出版者・発行元:羊土社  

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    その他リンク: http://search.jamas.or.jp/link/ui/2013181427

  • 4 失神にて救急搬送され, 左室下壁誘導に「J波」を認めた, 冠攣縮性狭心症の1例(I.一般演題, 第271回新潟循環器談話会)

    津田 隆志, 山口 利夫, 太刀川 仁, 池主 雅臣

    新潟医学会雑誌   127 ( 1 )   56 - 57   2013年1月

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  • 6 先天性QT延長症候群の家族歴のあり, 胎児期より管理した症例の検討(I.一般演題, 第271回新潟循環器談話会)

    鈴木 博, 羽二生 尚訓, 渡辺 健一, 星名 哲, 齋藤 昭彦, 佐藤 光希, 古嶋 博司, 池主 雅臣

    新潟医学会雑誌   127 ( 1 )   58 - 58   2013年1月

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  • Concomitant abnormalities in Brugada syndrome

    Hiroshi Furushima, Masaomi Chinushi, Yoshifusa Aizawa, Tohru Minamino

    Journal of Arrhythmia   29 ( 2 )   83 - 87   2013年

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    記述言語:英語   掲載種別:書評論文,書評,文献紹介等   出版者・発行元:Elsevier B.V.  

    Brugada syndrome (BS) is characterized by ST-segment elevation in the right precordial leads and is associated with sudden cardiac death secondary to polymorphic ventricular tachycardia (PVT)/ ventricular fibrillation (VF) in the absence of structural heart disease. Vasospastic angina (VSA) and neurally mediated syncope (NMS) are observed occasionally in BS patients, although their associations with BS remain controversial. The incidence of concomitant VSA and BS is 11-13%, and there might be an increased risk of VF when BS and VSA coexist, as reported in several previous studies. Whether the manifestation or augmentation of a coved-type electrocardiography (ECG) pattern is associated with coronary artery vasospasm is unclear. The significance of increased coved-type ST-segment elevation and its relation to arrhythmogenesis in BS is an important issue that needs to be resolved in future studies of concomitant BS and VSA. The coexistence of BS and VSA should always be taken into account in the management of both conditions, particularly when calcium antagonists are used. Previous reports suggest a high incidence of NMS in BS patients, and it is often difficult to differentiate between NMS and high-risk syncopal episodes due to ventricular tachyarrhythmias. Therefore, the identification of a therapeutic strategy to treat syncope in BS patients is often problematic. The autonomic nervous system is involved in arrhythmogenesis and may precipitate cardiac events in BS patients. To investigate BS, it may be useful to consider VSA and NMS as concomitant abnormalities. Future studies are needed to understand the relationship between BS and the autonomic nervous system. © 2012 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.

    DOI: 10.1016/j.joa.2012.12.007

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  • 5 通常型房室結節リエントリー性頻拍とアデノシン感受性左心房頻拍を合併した1例(I.一般演題, 第270回新潟循環器談話会)

    飯嶋 賢一, 池主 雅臣, 有田 匡孝, 長谷川 奏恵, 園田 桂子, 八木原 伸江, 佐藤 光希, 和泉 大輔, 渡部 裕, 古嶋 博司, 相澤 義房

    新潟医学会雑誌   126 ( 8 )   439 - 439   2012年8月

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  • 9 経静脈リードを皮下に用いて植え込み型除細動器(ICD)を植え込んだJervell and Lange-Nielsen症候群(J-LNS)の女児例(I.一般演題, 第270回新潟循環器談話会)

    羽二生 尚訓, 渡辺 健一, 沼野 藤人, 鈴木 博, 齋藤 昭彦, 佐藤 光希, 古嶋 博司, 池主 雅臣, 渡邉 マヤ, 白石 修一, 高橋 昌

    新潟医学会雑誌   126 ( 8 )   441 - 441   2012年8月

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  • 救命できたaborted sudden deathの集計

    林 由香, 藤木 伸也, 萱森 裕美, 渡辺 達, 園田 桂子, 飯嶋 賢一, 小田 雅人, 佐藤 光希, 小幡 裕明, 和泉 大輔, 小澤 拓也, 渡部 裕, 柏村 健, 伊藤 正洋, 古嶋 博司, 廣野 暁, 池主 雅臣, 塙 晴雄, 小玉 誠, 柳川 貴央, 本多 忠幸, 遠藤 裕

    新潟医学会雑誌   126 ( 5 )   269 - 269   2012年5月

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  • 完全右脚ブロックを呈する特発性心室細動症例の臨床的および心電図学的特徴の検討

    相澤 義泰, 高月 誠司, 木村 雄弘, 西山 信大, 福本 耕太郎, 谷本 陽子, 谷本 耕司郎, 三好 俊一郎, 福田 恵一, 鈴木 誠, 横山 泰廣, 池主 雅臣, 相澤 義房

    Journal of Arrhythmia   28 ( Suppl. )   167 - 167   2012年5月

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  • 心電図同期下CTによる疣贅描出が診断に有用であったリード感染症の1例

    園田 桂子, 伊藤 正洋, 小幡 裕明, 和泉 大輔, 池主 雅臣, 池田 洋平, 堀 祐郎, 吉村 宣彦

    Journal of Arrhythmia   28 ( Suppl. )   391 - 391   2012年5月

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  • 2 心臓カリウムチャネルの遺伝子変異を認めたQT短縮症候群の1家系(一般演題,第52回下越内科集談会)

    貴船 夏子, 池主 雅臣, 佐藤 光希, 鈴木 博, 長谷川 聡, 沼野 藤人, 羽二生 尚訓, 渡辺 健一, 園田 桂子, 長谷川 奏恵, 八木原 伸江, 飯嶋 賢一, 和泉 大輔, 渡部 裕, 古鴫 博司, 相澤 義房

    新潟医学会雑誌   126 ( 5 )   275 - 275   2012年5月

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  • 3 構造と電位情報の3D画像を用いた不整脈のカテーテルアブレーション(II.テーマ演題,第266回新潟循環器談話会)

    池主 雅臣, 古嶋 博司, 和泉 大輔, 佐藤 光希, 飯嶋 賢一, 渡部 裕, 八木原 伸江, 長谷川 奏恵, 岡田 桂子, 相澤 義房

    新潟医学会雑誌   125 ( 10 )   578 - 579   2011年10月

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  • 1 洞不全症候群と拡張型心筋症を呈したlamin遺伝子変異の1例(I.テーマ演題,第265回新潟循環器談話会)

    園田 桂子, 渡部 裕, 富川 千絵, 小田 雅人, 池主 雅臣, 塙 晴雄, 小玉 誠, 相澤 義房

    新潟医学会雑誌   125 ( 6 )   345 - 345   2011年6月

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  • 4 家族性不整脈疾患に対する遺伝子解析 : 新潟大学医歯学総合病院 第一内科における検討(I.テーマ演題,第265回新潟循環器談話会)

    佐藤 光希, 池主 雅臣, 長谷川 奏恵, 八木原 伸江, 飯嶋 賢一, 和泉 大輔, 渡部 裕, 古嶋 博司, 鈴木 博, 塙 晴雄, 小玉 誠, 相澤 義房

    新潟医学会雑誌   125 ( 6 )   346 - 346   2011年6月

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  • 神経調節性失神 器質的心疾患を有さない若年アスリート運動直後失神の1例

    長谷川 奏恵, 伊藤 正洋, 小田 雅人, 小幡 裕明, 保坂 幸男, 池主 雅臣, 小玉 誠, 荒川 正昭, 相澤 義房

    心電図   31 ( Suppl.2 )   S - 2   2011年5月

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  • 当院における冠動脈バイパス術後心房細動の発症危険因子/予防因子についての検討

    八木原 伸江, 池主 雅臣, 古嶋 博司, 長谷川 奏恵, 真田 明子, 飯嶋 賢一, 和泉 大輔, 保坂 幸男, 渡部 裕, 伊藤 正洋, 廣野 暁, 菊地 千鶴男, 竹久保 賢, 林 純一, 相澤 義房

    新潟医学会雑誌   125 ( 1 )   49 - 49   2011年1月

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  • 不整脈の急性増悪 (特集 慢性疾患の急性増悪--病態の理解と治療の実際)

    池主 雅臣, 古田 由衣, 長谷川 奏恵

    救急医学   35 ( 1 )   15 - 20   2011年1月

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    記述言語:日本語   出版者・発行元:へるす出版  

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  • ダール高血圧ラットの心房リモデリングにおけるミネラルコルチコイド受容体の役割

    富田 任, 伊藤 正洋, 木村 新平, 池主 雅臣, 小幡 裕明, 小玉 誠, 相澤 義房

    日本高血圧学会総会プログラム・抄録集   33回   317 - 317   2010年10月

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  • 免疫と不整脈 自己免疫性心筋炎 リモデリングと心房細動

    伊藤 正洋, 保屋野 真, 木村 新平, 池主 雅臣, 塙 晴雄, 小玉 誠, 相澤 義房

    心電図   30 ( Suppl.3 )   S - 3   2010年7月

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  • ホルター心電図記録中の突然死例の検討

    池主 雅臣, 木村 新平, 相澤 義房

    心電図 = Electrocardiology   30   "S - 1-71"-"S-1-73"   2010年5月

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  • 心房細動の治療戦略 ミネラルコルチコイド受容体拮抗薬はラットの器質的心房リモデリングに対しリバースリモデリング作用を有し心房細動易誘発性を改善する

    伊藤 正洋, 保屋野 真, 木村 新平, 田中 孔明, 岡村 和気, 小幡 裕明, 三間 渉, 廣野 暁, 池主 雅臣, 小玉 誠, 相澤 義房

    日本心臓病学会誌   4 ( Suppl.I )   137 - 137   2009年8月

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  • グラフ 心電図で診るBrugada症候群

    池主 雅臣, 長尾 智美, 和泉 大輔

    日本医事新報   ( 4446 )   69 - 72   2009年7月

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  • PJ-089 Characteristics of the Subsequent Recurrence of Ventricular Tachyarrhythmia in Patients under ICD Therapy, Concern of Driving(PJ015,ICD (M),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

    Hosaka Yukio, Chinushi Masaomi, Furushima Hiroshi, Izumi Daisuke, Satoh Akinori, Iijima Kenichi, Sanada Akiko, Yagihara Nobue, Aizawa Yoshifusa

    Circulation journal : official journal of the Japanese Circulation Society   73   568 - 568   2009年3月

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  • PE-167 Role of Mineralcorticoid Receptor Antagonist on Atrial Structural Remodeling in Hypertensive Rats(PE028,Heart Failure, Basic (M),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

    Kimura Shinpei, Itoh Masahiro, Hoyano Makoto, Hirono Satoru, Chinushi Masaomi, Kodama Makoto, Aizawa Yoshifusa

    Circulation journal : official journal of the Japanese Circulation Society   73   441 - 441   2009年3月

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  • PJ-688 The Abnormality of QT/RR Relationship in Brugada Syndrome and Idiopathic Ventricular Fibrillation without Prominent J-wave(PJ116,Ventricular Arrhythmia (Clinical/Pathophysiology) (A),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

    Izumi Daisuke, Chinushi Masaomi, Furushima Hiroshi, Hosaka Yukio, Satoh Akinori, Iijima Kenichi, Sanada Akiko, Yagihara Nobue, Aizawa Yoshifusa

    Circulation journal : official journal of the Japanese Circulation Society   73   719 - 719   2009年3月

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  • PJ-692 Role of Faster Pacing and Magnesium (Mg) for the Treatment of Torsade de pointes (Tdp) Associated with Intravenous Amiodarone Administration(PJ116,Ventricular Arrhythmia (Clinical/Pathophysiology) (A),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

    Chinushi Masaomi, Iijima Kenichi, Furushima Hiroshi, Izumi Daisuke, Hosaka Yukio, Sanada Akiko, Satoh Akinori, Ahara Shizue, Aizawa Yoshifusa

    Circulation journal : official journal of the Japanese Circulation Society   73   720 - 720   2009年3月

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  • PE-105 Exercise-induced QT Interval Prolongation and Its Relation to the Cardiac Events in Long QT Syndrome (LQTS) Carrying KCNQ1-Mutations(PE018,Arrhythmia, Others (Clinical/Pathophysiology) (A),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

    Sato Akinori, Chinushi Masaomi, Sanada Akiko, Iijima Kennichi, Yagihara Nobue, Izumi Daisuke, Hosaka Yukio, Furushima Hiroshi, Aizawa Yoshifusa

    Circulation journal : official journal of the Japanese Circulation Society   73