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髙見 充医学部附属病院 循環器内科講師
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■ 論文- AIMS: Several algorithms can differentiate inferior axis premature ventricular contractions (PVCs) originating from the right side and left side on 12-lead electrocardiograms (ECGs). However, it is unclear whether distinguishing the origin should rely solely on PVC or incorporate sinus rhythm (SR). We compared the dual-rhythm model (incorporating both SR and PVC) to the PVC model (using PVC alone) and quantified the contribution of each ECG lead in predicting the PVC origin for each cardiac rotation. METHODS AND RESULTS: This multicentre study enrolled 593 patients from 11 centres-493 from Japan and Germany, and 100 from Belgium, which were used as the external validation data set. Using a hybrid approach combining a Resnet50-based convolutional neural network and a transformer model, we developed two variants-the PVC and dual-rhythm models-to predict PVC origin. In the external validation data set, the dual-rhythm model outperformed the PVC model in accuracy (0.84 vs. 0.74, respectively; P < 0.01), precision (0.73 vs. 0.55, respectively; P < 0.01), specificity (0.87 vs. 0.68, respectively; P < 0.01), area under the receiver operating characteristic curve (0.91 vs. 0.86, respectively; P = 0.03), and F1-score (0.77 vs. 0.68, respectively; P = 0.03). The contributions to PVC origin prediction were 77.3% for PVC and 22.7% for the SR. However, in patients with counterclockwise rotation, SR had a greater contribution in predicting the origin of right-sided PVC. CONCLUSION: Our deep learning-based model, incorporating both PVC and SR morphologies, resulted in a higher prediction accuracy for PVC origin, considering SR is particularly important for predicting right-sided origin in patients with counterclockwise rotation.2024年10月, 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, 26(10) (10), 英語, 国際誌研究論文（学術雑誌）
- 2024年09月, CIRCULATION JOURNAL, 88(9) (9), 1502 - 1508, 英語研究論文（学術雑誌）
- 2024年09月, CIRCULATION JOURNAL, 88(9) (9), 1502 - 1508, 英語研究論文（学術雑誌）
- BACKGROUND: Despite the positive impact of implantable cardioverter defibrillators (ICDs) and wearable cardioverter defibrillators (WCDs) on prognosis, their implantation is often withheld especially in Japanese heart failure patients with reduced left ventricular ejection fraction (HFrEF) who have not experienced ventricular tachycardia (VT) or ventricular fibrillation (VF) for uncertain reasons. Recent advancements in heart failure (HF) medications have significantly improved the prognosis for HFrEF. Given this context, a critical reassessment of the treatment and prognosis of ICDs and WCDs is essential, as it has the potential to reshape awareness and treatment strategies for these patients. METHODS: We are initiating a prospective multicenter observational study for HFrEF patients eligible for ICD in primary and secondary prevention, and WCD, regardless of device use, including all consenting patients. Study subjects are to be enrolled from 31 participant hospitals located throughout Japan from April 1, 2023, to December 31, 2024, and each will be followed up for 1 year or more. The planned sample size is 651 cases. The primary endpoint is the rate of cardiac implantable electronic device implementation. Other endpoints include the incidence of VT/VF and sudden death, all-cause mortality, and HF hospitalization, other events. We will collect clinical background information plus each patient's symptoms, Clinical Frailty Scale score, laboratory test results, echocardiographic and electrocardiographic parameters, and serial changes will also be secondary endpoints. RESULTS: Not applicable. CONCLUSION: This study offers invaluable insights into understanding the role of ICD/WCD in Japanese HF patients in the new era of HF medication.2024年06月, Journal of arrhythmia, 40(3) (3), 423 - 433, 英語, 国内誌研究論文（学術雑誌）
- (一社)日本循環器学会, 2023年03月, 日本循環器学会学術集会抄録集, 87回, CP20 - 5, 日本語植込み型心臓電気デバイス(CIED)植込み患者の植込み6ヵ月後の活動・睡眠の実態と関連要因
- (一社)日本循環器学会, 2023年03月, 日本循環器学会学術集会抄録集, 87回, CP20 - 5, 日本語植込み型心臓電気デバイス(CIED)植込み患者の植込み6ヵ月後の活動・睡眠の実態と関連要因
- INTRODUCTION: Data are lacking on the extent to which patients with non-valvular atrial fibrillation (AF) who are aged ≥80 years benefit from ablation treatment. The question pertains especially to patients' postablation quality of life (QoL) and long-term clinical outcomes. METHODS AND ANALYSIS: We are initiating a prospective, registry-based, multicentre observational study that will include patients aged ≥80 years with non-valvular AF who choose to undergo treatment by catheter ablation and, for comparison, such patients who do not choose to undergo ablation (either according to their physician's advice or their own preference). Study subjects are to be enrolled from 52 participant hospitals and three clinics located throughout Japan from 1 June 2022 to 31 December 2023, and each will be followed up for 1 year. The planned sample size is 660, comprising 220 ablation group patients and 440 non-ablation group patients. The primary endpoint will be the composite incidence of stroke/transient ischaemic attack (TIA) or systemic embolism (SE), another cardiovascular event, major bleeding and/or death from any cause. Other clinical events such as postablation AF recurrence, a fall or bone fracture will be recorded. We will collect standard clinical background information plus each patient's Clinical Frailty Scale score, AF-related symptoms, QoL (Five-Level Version of EQ-5D) scores, Mini-Mental State Examination (optional) score and laboratory test results, including measures of nutritional status, on entry into the study and 1 year later, and serial changes in symptoms and QoL will also be secondary endpoints. Propensity score matching will be performed to account for covariates that could affect study results. ETHICS AND DISSEMINATION: The study conforms to the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies issued by the Ministry of Health, Labour and Welfare, Japan. Results of the study will be published in one or more peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000047023.2023年02月, BMJ open, 13(2) (2), e068894, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: A recent randomized trial demonstrated that catheter ablation for atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (EF) is associated with a reduction in death or heart failure. However, the effect of catheter ablation for AF in patients with heart failure with mid-range or preserved EF is unclear.Methods and Results: We screened 899 AF patients (72.4% male, mean age 68.4 years) with heart failure and left ventricular EF ≥40% from 2 Japanese multicenter AF registries: the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) as the ablation group (525 patients who underwent ablation) and the Hokuriku-Plus AF Registry as the medical therapy group (374 patients who did not undergo ablation). Propensity score matching was performed in these 2 registries to yield 106 matched patient pairs. The primary endpoint was a composite of cardiovascular death and hospitalization for heart failure. At 24.6 months, the ablation group had a significantly lower incidence of the primary endpoint (hazard ratio 0.32; 95% confidence interval 0.13-0.70; P=0.004) than the medical therapy group. CONCLUSIONS: Compared with medical therapy, catheter ablation for AF in patients with heart failure and mid-range or preserved EF was associated with a significantly lower incidence of cardiovascular death or hospitalization for heart failure.2022年12月, Circulation journal : official journal of the Japanese Circulation Society, 87(7) (7), 939 - 946, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Several algorithms have been proposed for differentiating the right and left outflow tracts (RVOT/LVOT) arrhythmia origins from 12-lead electrocardiograms (ECGs); however, the procedure is complicated. A deep learning (DL) model, a form of artificial intelligence, can directly use ECGs and depict the importance of the leads and waveforms. This study aimed to create a visualized DL model that could classify arrhythmia origins more accurately.Methods and Results: This study enrolled 80 patients who underwent catheter ablation. A convolutional neural network-based model that could classify arrhythmia origins with 12-lead ECGs and visualize the leads that contributed to the diagnosis using a gradient-weighted class activation mapping method was developed. The average prediction results of the origins by the DL model were 89.4% (88.2-90.6) for accuracy and 95.2% (94.3-96.2) for recall, which were significantly better than when a conventional algorithm is used. The ratio of the contribution to the prediction differed between RVOT and LVOT origins. Although leads V1 to V3 and the limb leads had a focused balance in the LVOT group, the contribution ratio of leads aVR, aVL, and aVF was higher in the RVOT group. CONCLUSIONS: This study diagnosed the arrhythmia origins more accurately than the conventional algorithm, and clarified which part of the 12-lead waveforms contributed to the diagnosis. The visualized DL model was convincing and may play a role in understanding the pathogenesis of arrhythmias.2022年07月, Circulation journal : official journal of the Japanese Circulation Society, 86(8) (8), 1273 - 1280, 英語, 国内誌研究論文（学術雑誌）
- Background: Some of atrial fibrillation (AF) drivers are found in normal/mild late-gadolinium enhancement (LGE) areas, as well as moderate ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in normal/mild LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping), mild LGE areas were defined as areas with a volume ratio of the enhancement voxel of 0% to <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI. Results: NPAs were found in 20 (18.0%) of 131 normal/mild LGE areas where AWT was significantly thicker than that in the passively activated areas (PAs) (2.5 ± 0.3 vs. 2.2 ± 0.3 mm, p < .001). However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where AWT was thinner than that of PAs (2.1 ± 0.2 mm vs. 2.23 ± 0.3 mm, p = .02). An ROC curve analysis yielded an optimal cutoff value of 2.2 mm for predicting the presence of an NPA in normal/mild LGE areas. Conclusion: The location of AF drivers in normal/mild LGE areas might be more accurately identified by evaluating AWT.2022年04月, Journal of arrhythmia, 38(2) (2), 221 - 231, 英語, 国内誌研究論文（学術雑誌）
- The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. We investigated 3326 consecutive patients (25.8% female, mean age 63.3 ± 10.3 years) who underwent catheter ablation for AF from the atrial fibrillation registry to follow the long-term outcomes and use of anti coagulants after ablation (AF frontier ablation registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 24.0 months, 2339 (70.3%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 144 (4.3%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.8 per 100 person-years) compared with the AF recurrence group (3.0 per 100 person-years, p = 0.003). The multivariate analysis revealed that freedom from AF (hazard ratio 0.61, 95% confidence interval 0.44-0.86, p = 0.005) was independently associated with the incidence of the composite event. In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.2021年09月, Heart and vessels, 37(2) (2), 327 - 336, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: A substantial number of patients with shock devices (implantable cardioverter defibrillators [ICDs] or ICDs with resynchronization [CRTDs]) experience psychological distress. OBJECTIVE: We investigated the device nurse telephone intervention's effect on improving the patient's adaptation to shock devices, quality of life (QOL), and anxiety in the remote monitoring era. METHODS: The patient's adaptation to the device, health-related QOL, and anxiety were investigated by the modified Implanted Devices Adjustment-Japan score (IDAS), Short Form-36, and State-Trait Anxiety Inventory (STAI) before and one-year after the device nurse telephone intervention, performed every 3 months. A total of 95 patients (median age 69-years-old and 25 females) participated. Sixty patients had ICDs and 35 CRTDs. Structural heart disease was observed in 72 patients, and idiopathic ventricular arrhythmias in the others. The mean left ventricular ejection fraction was 46±15%. The median duration since the device implantation was 5.2-years. RESULTS: The total IDAS score significantly improved from 28.42±7.11 at baseline to 26.77±7.68 (p = 0.0076) at one-year. Both the state and trait anxiety significantly improved (from 38.9±9.6 to 35.3±9.0 [<0.0001] and 38.8±10.3 to 36.2±9.8 [p = 0.0044], respectively). The prevalence of patients with a state and trait anxiety of more than 40 decreased from 44 (46%) and 38 (40%) patients before the study to 27 (28 %) and 32 (34 %) at one-year. The SF-36 mental component summary score significantly increased (50.8±8.3 at baseline to 53.1±7.7 at one-year, p = 0.0031). CONCLUSIONS: The device nurse intervention facilitated the patient's adaptation to the shock device, increased the health-related QOL, and reduced the patient's anxiety. This article is protected by copyright. All rights reserved.2021年08月, Pacing and clinical electrophysiology : PACE, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: It is unclear whether there are differences in the clinical factors between atrial fibrillation (AF) recurrence and adverse clinical events (AEs), including stroke/transient ischemic attack (TIA), major bleeding, and death, after AF ablation.Methods and Results:We examined the data from a retrospective multicenter Japanese registry conducted at 24 cardiovascular centers between 2011 and 2017. Of the 3,451 patients (74.1% men; 63.3±10.3 years) who underwent AF ablation, 1,046 (30.3%) had AF recurrence and 224 (6.5%) suffered AEs (51 strokes/TIAs, 71 major bleeding events, and 36 deaths) over a median follow-up of 20.7 months. After multivariate adjustment, female sex, persistent and long-lasting persistent AF (vs. paroxysmal AF), and stepwise increased left atrial diameter (LAd) quartiles were significantly associated with post-ablation recurrences. A multivariate analysis revealed that an age ≥75 years (vs. <65 years), body weight <50 kg, diabetes, vascular disease, left ventricular (LV) ejection fraction <40% (vs. ≥50%), Lad ≥44 mm (vs. <36 mm), and creatinine clearance <50 mL/min were independently associated with AE incidences, but not with recurrences. CONCLUSIONS: This study disclosed different determinants of post-ablation recurrence and AEs. Female sex, persistent AF, and enlarged LAd were determinants of post-ablation recurrence, whereas an old age, comorbidities, and LV and renal dysfunction rather than post-ablation recurrence were AEs determinants. These findings will help determine ablation indications and post-ablation management.2021年07月, Circulation journal : official journal of the Japanese Circulation Society, 86(2) (2), 233 - 242, 英語, 国内誌研究論文（学術雑誌）
- Atrial tachycardia (AT) in the right atrium often occurs following open-heart surgery. Catheter ablation for these AT is challenging and can lead to unintended conduction block. We performed late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) prior to catheter ablation and predicted wavefront propagation during SR as well as the slow conduction zone during tachycardia. LGE-MRI may assist predicting the conduction disturbance and reducing the risk of unexpected sinus exit block.2021年06月, Clinical case reports, 9(6) (6), e04198, 英語, 国際誌
- A 61-year-old female with 50 000 ventricular premature contractions and a reduced left ventricular ejection fraction of 35% was referred to our center. Although the origin was considered to originate from the junction between the left and right coronary cusp, a single radiofrequency application above the aortic sinus cusp could eliminate it. LGE-MRI was able to reveal the exact location of the single RF lesion.2021年06月, Clinical case reports, 9(6) (6), e04169, 英語, 国際誌
- (一社)日本循環器学会, 2021年04月, Circulation reports, 3(5) (5), 294 - 299, 英語, 国内誌
- Cardiac accessory pathways (APs) in Wolff-Parkinson-White (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.2021年04月, Scientific reports, 11(1) (1), 8045 - 8045, 英語, 国際誌研究論文（学術雑誌）
- Background Medium-dose (25 gray) x-ray radiation therapy has recently been performed on patients with refractory ventricular tachyarrhythmias. Unlike x-ray, carbon ion and proton beam radiation can deliver most of their energy to the target tissues. This study investigated the electrophysiological and pathological changes caused by medium-dose carbon ion and proton beam radiation in the left ventricle (LV). Methods and Results External beam radiation in the whole LV was performed in 32 rabbits. A total of 9 rabbits were not irradiated (control). At the 3-month or 6-month follow-up, the animals underwent an open-chest electrophysiological study and were euthanized for histological analyses. No acute death occurred. Significant LV dysfunction was not seen. The surface ECG revealed a significant reduction in the P and QRS wave voltages in the radiation groups. The electrophysiological study showed that the local conduction times in each LV site were significantly longer and that the local LV bipolar voltages were significantly lower in the radiation groups than in the control rabbits. Histologically, apoptosis, fibrotic changes, and a decrease in the expression of the connexin 43 protein were seen in the LV myocardium. These changes were obvious at 3 months, and the effects were sustained 6 months after radiation. No histological changes were seen in the coronary artery and esophagus, but partial radiation pneumonitis was observed. Conclusions Medium-dose carbon ion and proton beam radiation in the whole LV resulted in a significant electrophysiological disturbance and pathological changes in the myocardium. Radiation of the arrhythmogenic substrate would modify the electrical status and potentially induce the antiarrhythmic effect.2021年04月, Journal of the American Heart Association, 10(7) (7), e019687, 英語, 国際誌研究論文（学術雑誌）
- シュプリンガー・ジャパン(株), 2021年04月, Heart and vessels, 36(4) (4), 549 - 560, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. METHODS: A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden-matched pulmonary vein isolation (PVI) group. RESULTS: Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow-up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log-rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. CONCLUSIONS: FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1014 - 1023, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Inflammation, such as that associated with intermediate CD14++ CD16+ monocytes and atrial structural remodeling (SRM), may be important in the recurrence of atrial fibrillation (AF) after catheter ablation. However, the relationship between the intermediate CD14++ CD16+ monocytes, SRM, and AF recurrence is unclear. METHODS: Twenty-four patients with AF were enrolled. The proportion of intermediate monocytes (PIM) was assessed before ablation by flow cytometry. As a surrogate marker of SRM, the volume ratio (VR) of signal intensity greater than 1 standard deviation on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) was calculated. We investigated whether PIM correlated with SRM on LGE-MRI and determined the optimal cutoff value for predicting AF recurrence. RESULTS: Univariate analysis revealed positive correlations between PIM and BNP with SRM (PIM: r = .593, p = .002; BNP: r = .567, p = .004). Multivariable analysis revealed that PIM was independently associated with VR on LGE-MRI (β = .522; p = .033). The finding of an area under the receiver operating characteristic curve of 0.750 revealed that a VR ≥ 13.3% on LGE-MRI as the optimal cutoff value to predict AF recurrence with 80% sensitivity and 71% specificity, which was associated with PIM ≥ 10.0%. CONCLUSION: Intermediate monocytes were significantly positively correlated with SRM. PIM ≥ 10% was associated with a VR ≥ 13.3% on LGE-MRI, which predicted AF recurrence after catheter ablation.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1035 - 1043, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy late-gadolinium enhancement (LGE) areas and play an important role in AF drivers. However, this was not validated in humans. OBJECTIVE: The purpose of this study was to evaluate the LGE properties of AF rotors in patients with persistent AF. METHODS: A total of 287 segments in 15 patients with persistent AF (long-standing persistent AF in 9 patients) that underwent AF ablation were assessed. Non-passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real-time phase mapping (ExTRa Mapping). The properties of the LGE areas were assessed using the LGE heterogeneity and the density which was evaluated by the entropy (LGE-entropy) and the volume ratio of the enhancement voxel (LGE-volume ratio), respectively. RESULTS: NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7% and 10% for the LGE-entropy and LGE-volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE-entropy of >5.7 and LGE-volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments; p = .001). No NPAs were found at segments with an LGE-volume ratio of >50% regardless of the LGE-entropy. Of five patients with AF recurrence, NPAs outside the PV antrum were not ablated in three patients and the remaining NPAs were ablated, but their LGE-entropy and LGE-volume ratio were low. CONCLUSION: AF rotors are mostly distributed in relatively weak and much more heterogenous LGE areas.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1005 - 1013, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE132 - 5, 英語カテーテルアブレーション後の心房細動患者において血管疾患の合併は脳卒中および出血リスクを高める(Concomitance with Vascular Disease is Associated with Higher Stroke and Bleeding Risks in Patients with Atrial Fibrillation after Catheter Ablation)
- (一社)日本循環器学会, 2021年02月, Circulation journal : official journal of the Japanese Circulation Society, 85(3) (3), 264 - 271, 英語, 国内誌
- (一社)日本不整脈心電学会, 2021年02月, Journal of arrhythmia, 37(1) (1), 52 - 59, 英語, 国内誌研究論文（学術雑誌）
- OBJECTIVES: This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND: Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging. METHODS: We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference). RESULTS: More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT. CONCLUSIONS: Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.2020年12月, JACC. Clinical electrophysiology, 6(14) (14), 1797 - 1807, 英語, 国際誌研究論文（学術雑誌）
- Direct oral anticoagulants (DOACs) are sometimes prescribed at off-label under-doses for patients who have undergone ablation for atrial fibrillation (AF). This practice may be an attempt to balance the risk of bleeding against that of stroke or AF recurrence.We examined outcomes of 1163 patients who continued use of a DOAC after ablation. The patients were enrolled in a large (3530 patients) multicenter registry in Japan. The study patients were classified as 749 (64.4%) appropriate standard-dose DOAC users, 216 (18.6%) off-label under-dose DOAC users, and 198 (17.0%) appropriate low-dose DOAC users.Age and CHA2DS2-VASc scores differed significantly between DOAC dosing regimens, with patients given an appropriate standard-dose being significantly younger (63.3 ± 9.4 versus 64.8 ± 9.5 versus 73.2 ± 6.8 years, P < 0.0001) and lower (2.1 ± 1.5 versus 2.4 ± 1.6 versus 3.4 ± 1.4, P < 0.0001) than those given an off-label under-dose or an appropriate low-dose. During the median 19.0-month follow-up period, the AF recurrence rate was similar between the appropriate standard-dose and off-label under-dose groups but relatively low in the appropriate low-dose group (42.5% versus 41.2% versus 35.4%, P = 0.08). Annualized rates of thromboembolic events, major bleeding, and death from any cause were 0.47%, 0.70%, and 0.23% in the off-label under-dose group, while those rates were 0.74%, 0.73%, and 0.65% in the appropriate standard-dose, and 1.58%, 2.12%, and 1.57% in the appropriate low-dose groups.In conclusion, the clinical adverse event rates for patients on an off-label under-dose DOAC regimen after ablation, predicated on careful patient evaluations, was not high as seen with that of patients on a standard DOAC dosing regimen.2020年11月, International heart journal, 61(6) (6), 1165 - 1173, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are characterized as a wider and more continuous than that after conventional radiofrequency catheter ablation (RFCA) without the contact force (CF)-sensing technology. However, the impact on the lesion characteristics of ablation with a CF-sensing catheter has not been well discussed. We sought to assess the lesions using late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) and to compare the differences between the two groups (CB group vs. RF group). METHODS: A total of 30 consecutive patients who underwent PVI were enrolled (CB group, 18; RF group, 12). The RF applications were delivered with a target lesion size index (LSI) of 5. The PVI lesions were assessed by LGE-MRI 3 months after the PVI. The region around the PV was divided into eight segments: roof, anterior-superior, anterior carina, anterior inferior, bottom, posterior inferior, posterior carina, and posterior superior segment. The lesion width and visual gap of each segment were compared between the two groups. The visual gaps were defined as no-enhancement site of >4 mm. RESULTS: The mean LSI was 4.7 ± 0.7. The lesion width was significantly wider but the visual gaps were more frequently documented at the bottom segment of right PV in the CBA group (lesion width: 8.1 ± 2.2 vs. 6.3 ± 2.2 mm; p = .032; visual gap at the bottom segment or right PV: 39% vs. 0%; p = .016). CONCLUSIONS: The PVI lesion was wider after CBA, while the visual gaps were fewer after RFCA with a CF-sensing catheter.2020年10月, Journal of cardiovascular electrophysiology, 31(10) (10), 2572 - 2581, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE21 - 5, 英語アブレーション後の心房細動再発は本当にエンドポイントなのか AF Frontier Ablation Registryからの臨床的洞察(Is Atrial Fibrillation Recurrence after Ablation Really the Endpoint for the Patients?: Clinical Insights from the AF Frontier Ablation Registry)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE127 - 2, 英語非侵襲的な粒子線外部照射が動物心臓の電気生理学的、病理学的変化に及ぼす影響(Impact of Non-invasive External Particle Beam Radiation on the Electrophysiological and Pathological Changes in the Animal Heart)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OJ15 - 4, 英語心房細動患者における循環血中CD14++CD16+単球上のToll様受容体4のアップレギュレーションは低電位領域と相関している(Toll-like Receptor 4 Upregulation on Circulating CD14++CD16+monocytes Correlates with the Low-voltage Zones in Patients with Atrial Fibrillation)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OJ15 - 2, 英語B型ナトリウム利尿ペプチドによる心房細動カテーテルアブレーション後の脳卒中イベント予測 AF Frontier Ablation Registryからの洞察(B-Type Natriuretic Peptide Predicts Stroke Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OJ15 - 4, 英語Toll-like Receptor 4 Upregulation on Circulating CD14++CD16+monocytes Correlates with the Low-voltage Zones in Patients with Atrial Fibrillation(和訳中)
- Inflammation has been suggested to play a key role in the pathogenesis of atrial fibrillation (AF). Our hypothesis was that this inflammation, mediated by intermediate monocytes and toll-like receptor 4 (TLR4), causes the formation and expansion of low-voltage zones (LVZs). Prior to ablation, the monocyte subsets of 78 AF patients and TLR4 expression of 66 AF patients were analyzed via a flow cytometric analysis. Based on the CD14/CD16 expression, the monocytes were divided into three subsets: classical, intermediate, and non-classical. At the beginning of the ablation session, voltage mapping was performed. LVZs were defined as all bipolar electrogram amplitudes of < 0.5 mV. Correlations between the flow cytometric analysis results and presence of LVZs, as well as the total area of the LVZ, were examined. Patients with LVZs clearly had a higher proportion of intermediate monocytes (10.0 ± 3.6% vs. 7.2 ± 2.7%, p < 0.001) than those without LVZs. TLR4 was much more frequently expressed in the intermediate monocytes than other two monocyte subsets (p < 0.001). Moreover, the TLR4 expression level in intermediate monocytes correlated positively with the total area of the LVZs (r = 0.267, p = 0.030), especially in patients with paroxysmal AF (r = 0.365, p = 0.015). The intermediate monocytes and TLR4 expression positively correlated with LVZs in AF patients.2020年06月, Heart and vessels, 35(12) (12), 1717 - 1726, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- (一社)日本循環器学会, 2020年02月, Circulation reports, 1(3) (3), 149 - 152, 英語, 国内誌
- INTRODUCTION: The ablation index (AI) and lesion size index (LSI) are novel markers for predicting the ablation lesion quality, however, collateral damage is still a concern. This study aimed to compare the lesion characteristics and tissue temperature profiles between 20 W (20 Ws) and 40 W (40 Ws) ablation settings under the same AI and LSI. METHODS: An ex vivo model consisting of swine myocardium (5-6 mm thickness) in a circulating, warmed saline bath was used. Twenty-one tissue temperature electrodes were used. Radiofrequency applications with different power settings were performed with a 10 to 12 g contact force until the AI and LSI reached 350 and 4.5, respectively. RESULTS: A total of 120 radiofrequency (RF) applications and 2520 tissue temperature profiles were analyzed. The speed of the tissue temperature rise with 40 Ws was significantly faster than that with 20 Ws. However, the maximum tissue temperature did not significantly differ between 20 and 40 Ws with the same AI (44.6°C ± 3.9°C vs 45.1°C ± 6.4°C, P = .73), and was significantly lower for 40 Ws with the same LSI (42.8°C ± 3.4°C vs 40.0°C ± 3.4°C, P = .003). For both the AI and LSI, the number of electrodes exhibiting high temperatures (≥39°C) was significantly larger and the duration of high tissue temperatures was significantly longer with 20 Ws. The thermal latency with 40 Ws was greater. CONCLUSIONS: Although the targeted AI and LSI were the same for both 20 and 40 Ws, the tissue temperature profiles differed greatly depending on the RF power setting. A high power setting based on the AI and LSI may reduce the collateral thermal damage.2020年01月, Journal of cardiovascular electrophysiology, 31(1) (1), 196 - 204, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHA2DS2-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHA2DS2-VASc scores but not with OAC status. CONCLUSIONS: Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.2019年11月, Circulation journal : official journal of the Japanese Circulation Society, 83(12) (12), 2418 - 2427, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. CASE SUMMARY: A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. DISCUSSION: The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid.2019年09月, European heart journal. Case reports, 3(3) (3), 英語, 国際誌研究論文（学術雑誌）
- 2019年08月, J Cardiovasc Electrophysiol., 30(8) (8), 1339 - 1340, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- INTRODUCTION: Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are wide and continuous, however, the distribution can depend on the pulmonary vein (PV) size. We sought to assess the relationship between the lesion distribution and PV size after CBA and hotballoon ablation (HBA). METHODS AND RESULTS: A total of 80 consecutive patients who underwent PVI were enrolled (40 with CBA). The lesions were visualized by late-gadolinium enhancement magnetic resonance imaging. The lesion width, lesion gaps, and distance from the PV ostium (PVos) to distal lesion edge (DLE) were assessed. If the DLE extended inside the PV, the value was expressed as a negative value. Although the lesion width was significantly wider in the CB group (7.8 ± 2.0 vs 4.9 ± 1.0 mm, P < .001), the number of lesion gaps was significantly less in the HB group (2.9 ± 2.4 vs 1.3 ± 1.4 gaps, P = .001). The distance from the PVos to DLE was a negative value in both groups, but the impact was significantly greater (-1.5 ± 1.8 vs -0.2 ± 1.2 mm, P < .001) and negatively correlated with PV size in the CB group, but not in HB group (r = -0.27, P = .007). The AF recurrence 12 months after the procedure did not differ (5 [12.5%] of 40 in the CB group vs 4 [10%] of 40 in the HB group, P = .695). CONCLUSIONS: The PVI lesions after HBA were characterized by (a) narrower, but (b) more continuous, (c) smaller lesion inside the PV, and (d) irrespective of PV size as compared to that after CBA.2019年07月, J Cardiovasc Electrophysiol., 30(10) (10), 1830 - 1840, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVES: This study aimed to confirm the precise course of a pericardiocentesis with the anterior approach using post-procedural computed tomography (CT). BACKGROUND: Percutaneous epicardial ventricular tachycardia (VT) ablation has been increasingly performed. Although the inferior approach has been the common method, the feasibility of the anterior approach has subsequently been reported. However, the precise course of the anterior approach has not been presented. METHODS: An epicardial ablation with the anterior approach was performed in 15 patients. At the end of the procedure, the epicardial sheath was exchanged for a drainage tube to monitor bleeding. Of those patients, in 9 procedures in 8 patients a CT scan was performed just after the procedure to confirm the course of the drainage tube and to rule out any complications. Epicardial ablation was indicated for a failed endocardial VT ablation in 7 patients and epicardial substrate modification in 1 patient with Brugada syndrome. RESULTS: Volume-rendered images reconstructed from CT demonstrated each course of the drainage tubes and their relation to the surrounding organs. These images revealed that the tube had a curved trace, and did not penetrate the diaphragm or pass through the abdominal cavity. No injury to the surrounding organs was detected in any of the cases. CONCLUSIONS: The precise course of the drainage tube placed along the trajectory of the anterior approach was able to be confirmed using post-procedural CT images. These images support the safety and feasibility of the anterior approach from the anatomic standpoint with a low incidence of abdominal viscera injury.2019年06月, JACC Clin Electrophysiol., 5(6) (6), 730 - 741, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2019年05月, HeartRhythm case reports, 5(5) (5), 241 - 243, 英語, 国際誌
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, LBCS2 - 6, 英語日本における心房細動に対するカテーテルアブレーション治療後の抗凝血薬の中止および臨床的有害事象 AFアブレーションフロンティアレジストリ(Discontinuation of Anticoagulant Drugs and Clinical Adverse Events after Catheter Ablation of Atrial Fibrillation in Japan: AF Ablation Frontier Registry)
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, PJ113 - 7, 英語心房細動患者における血中intermediate CD14++CD16+monocyteと心房電気的リモデリングとの相関関係(The Correlation between Circulating Intermediate CD14++CD16+Monocytes and Atrial Electrical Remodeling in Atrial Fibrillation Patients)[査読有り]
- BACKGROUND: Air embolisms are serious complications during catheter ablation procedures. OBJECTIVES: The aims of the present study were to determine when air bubbles enter the left atrium (LA) during catheter ablation procedures and to identify techniques that reduce air bubble intrusion. METHODS: An ex vivo study was performed to monitor air bubbles using a silicone heart model and a high-resolution camera. In total, 280 radiofrequency catheter and cryoballoon ablation processes were tested. RESULTS: Small and large air bubbles were often observed during catheter ablation processes. Many small air bubbles arose during sheath flushing at fast speeds (15 mL/2 s) (median bubble number [quartiles]: 35 [20-53] for SL0, 35 [23-44] for Agilis, and 98 [91-100] for FlexCath) and during initial cryoballoon inflation/freezing/deflation (34 [22-47]). Large (≥1.5 mm) air bubbles were observed during Lasso catheter insertion (1 [0-1]), cryoballoon insertion (2 [1-2]), and initial inflation/freezing/deflation (1 [1-3]). Massive air bubbles were observed during Optima catheter insertion into the sheath using an inserter (10 [2-15]). Sheath flushing at slow speeds (15 mL/5 s) significantly reduced the number of air bubbles. Before cryoballoon insertion, temporary balloon inflation and air bubble removal from the inflated surface were most effective in reducing air bubble intrusions. Optima catheter insertion without an inserter significantly reduced large air bubble intrusion. CONCLUSION: Air bubbles entered the LA at specific times. Techniques such as sheath flushing at slow speeds, temporary cryoballoon inflation before insertion, inserting the Optima catheter without an inserter, and avoidance of negative pressure in the LA could reduce air bubble intrusion.2019年01月, Heart rhythm, 16(1) (1), 128 - 139, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本不整脈心電学会, 2019年, Journal of Arrhythmia., 35(5) (5), 733 - 736, 英語, 国内誌[査読有り]
- (一社)日本不整脈心電学会, 2019年, Journal of Arrhythmia., 35(5) (5), 697 - 708, 英語, 国内誌[査読有り]
- Noninvasive ablation of cardiac arrhythmia by scanned particle radiotherapy is highly promising, but especially challenging due to cardiac and respiratory motion. Irradiations for catheter-free ablation in intact pigs were carried out at the GSI Helmholtz Center in Darmstadt using scanned carbon ions. Here, we present real-time electrocardiogram (ECG) data to estimate time-resolved (4D) delivered dose. For 11 animals, surface ECGs and temporal structure of beam delivery were acquired during irradiation. R waves were automatically detected from surface ECGs. Pre-treatment ECG-triggered 4D-CT phases were synchronized to the R-R interval. 4D-dose calculation was performed using GSI's in-house 4D treatment planning system. Resulting dose distributions were assessed with respect to coverage (D95 and V95), heterogeneity (HI = D5-D95) and normal tissue exposure. Final results shown here were performed offline, but first calculations were started shortly after irradiation The D95 for TV and PTV was above 95% for 10 and 8 out of 11 animals, respectively. HI was reduced for PTV versus TV volumes, especially for some of the animals targeted at the atrioventricular junction, indicating residual interplay effects due to cardiac motion. Risk structure exposure was comparable to static and 4D treatment planning simulations. ECG-based 4D-dose reconstruction is technically feasible in a patient treatment-like setting. Further development of the presented approach, such as real-time dose calculation, may contribute to safe, successful treatments using scanned ion beams for cardiac arrhythmia ablation.2017年08月, Physics in medicine and biology, 62(17) (17), 6869 - 6883, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs. METHODS AND RESULTS: Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume. CONCLUSIONS: Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.2017年04月, Circulation. Arrhythmia and electrophysiology, 10(4) (4), 英語, 国際誌研究論文（学術雑誌）
- 2017年01月, HeartRhythm case reports, 3(1) (1), 87 - 89, 英語, 国際誌
- High-energy ion beams are successfully used in cancer therapy and precisely deliver high doses of ionizing radiation to small deep-seated target volumes. A similar noninvasive treatment modality for cardiac arrhythmias was tested here. This study used high-energy carbon ions for ablation of cardiac tissue in pigs. Doses of 25, 40, and 55 Gy were applied in forced-breath-hold to the atrioventricular junction, left atrial pulmonary vein junction, and freewall left ventricle of intact animals. Procedural success was tracked by (1.) in-beam positron-emission tomography (PET) imaging; (2.) intracardiac voltage mapping with visible lesion on ultrasound; (3.) lesion outcomes in pathohistolgy. High doses (40-55 Gy) caused slowing and interruption of cardiac impulse propagation. Target fibrosis was the main mediator of the ablation effect. In irradiated tissue, apoptosis was present after 3, but not 6 months. Our study shows feasibility to use high-energy ion beams for creation of cardiac lesions that chronically interrupt cardiac conduction.2016年12月, Scientific reports, 6, 38895 - 38895, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Formation of microemboli during catheter ablation has been suggested as a cause for asymptomatic cerebral emboli. However, it is unknown which part of the process and ablation setting/strategy is most strongly related to this occurrence. METHODS AND RESULTS: A total of 27 pigs were used. Catheter/sheath manipulations in left atrium were performed in 25 of 27 pigs outfitted with microemboli monitoring systems. Ablations using open-irrigated radiofrequency catheters were performed in 18 of 25 pigs. Two of 27 pigs did not undergo left atrial procedures and were injected with microembolic materials in the carotid artery to serve as positive controls. In total, 334 sheath/catheter manipulations (transseptal puncture, sheath flushing, catheter insertion, pulmonary vein venography, and sheath exchange) and 333 radiofrequency applications (power setting, 30/50 W; point-by-point/drag ablations) were analyzed. High microbubble volume in the extracorporeal circulation loop and a high number of microembolic signals in carotid artery were observed during sheath/catheter manipulations especially in saline/contrast injections at fast speed and ablations with steam pop. Fast sheath flushing produced significantly higher microbubble volume than slow sheath flushing (median, 12 200 versus 121 nL; P<0.0001). A total of 44 of 126 (35%) blood filters in the circulation loop showed microparticles (thrombus/coagulum and tissue). Most of them were seen after radiofrequency application especially in 50-W ablations, drag ablations, and steam pop. Brain magnetic resonance imaging showed positive-embolic lesions in control pigs. CONCLUSIONS: Formation of microbubbles was the greatest during fast saline/contrast injections and steam pops, whereas high-power radiofrequency applications, drag ablations, and steam pops produced most of the microparticles.2016年01月, Circulation. Arrhythmia and electrophysiology, 9(1) (1), e003226, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The differences in ablation characteristics of freezing time and balloon size using second generation cryoballoon are still unknown. METHODS AND RESULTS: Twenty-six dogs underwent pulmonary vein (PV) isolation. Balloon and tissue temperatures (left atrial-PV junction, phrenic nerve, and internal esophagus) were monitored. The ablation duration was randomized to either 3 or 4 minutes, which did not show significant differences in temperature profiles, PV isolation success rate, complications, or histological changes. Twenty dogs underwent cryoablation using 28-mm cryoballoon, 6 dogs were done using the 23-mm cryoballoon. Positioning of the 23-mm cryoballoon was more distal in the PV, which resulted in better PV occlusion. Temperature profiles showed lower temperatures in the 23-mm cryoballoon than in the 28-mm cryoballoon (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. CONCLUSIONS: The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.2015年08月, Circulation. Arrhythmia and electrophysiology, 8(4) (4), 836 - 45, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Particle therapy, with heavy ions such as carbon-12 ((12)C), delivered to arrhythmogenic locations of the heart could be a promising new means for catheter-free ablation. As a first investigation, we tested the feasibility of in vivo atrioventricular node ablation, in Langendorff-perfused porcine hearts, using a scanned 12C beam. METHODS AND RESULTS: Intact hearts were explanted from 4 (30-40 kg) pigs and were perfused in a Langendorff organ bath. Computed tomographic scans (1 mm voxel and slice spacing) were acquired and (12)C ion beam treatment planning (optimal accelerator energies, beam positions, and particle numbers) for atrioventricular node ablation was conducted. Orthogonal x-rays with matching of 4 implanted clips were used for positioning. Ten Gray treatment plans were repeatedly administered, using pencil beam scanning. After delivery, positron emission tomography-computed tomographic scans for detection of β(+) ((11)C) activity were obtained. A (12)C beam with a full width at half maximum of 10 mm was delivered to the atrioventricular node. Delivery of 130 Gy caused disturbance of atrioventricular conduction with transition into complete heart block after 160 Gy. Positron emission computed tomography demonstrated dose delivery into the intended area. Application did not induce arrhythmias. Macroscopic inspection did not reveal damage to myocardium. Immunostaining revealed strong γH2AX signals in the target region, whereas no γH2AX signals were detected in the unirradiated control heart. CONCLUSIONS: This is the first report of the application of a (12)C beam for ablation of cardiac tissue to treat arrhythmias. Catheter-free ablation using 12C beams is feasible and merits exploration in intact animal studies as an energy source for arrhythmia elimination.2015年04月, Circulation. Arrhythmia and electrophysiology, 8(2) (2), 429 - 38, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Thermodynamics in the left atrium-pulmonary vein (PV) junction, phrenic nerve, and esophagus during PV isolation (PVI) using the second-generation cryoballoon are not known. METHODS AND RESULTS: Twenty dogs underwent PVI using second-generation cryoballoon. Ablations were performed for ≤2 deliveries based on PVI without a bonus freeze. Inner balloon, balloon surface, and tissue temperatures were monitored during cryoablation. The tissue thermocouples were placed on the epicardial surface of the left atrium-PV junction, as well as on the phrenic nerve and within the esophagus. A total of 259 cryoballoon and 229 tissue tissue thermocouples profiles during 53 cryoablations of 40 PVs were analyzed. Acutely, PVI was achieved in 36 of 40 PVs (90%). Conductive tissue cooling spread radially from the balloon-left atrium-PV contact point. The lowest tissue temperatures were dependent on the distance of the tissue thermocouples to the balloon surface (r=0.85; P<0.001). In addition, blood flow leaks around the balloon had a warming effect on the balloon and tissue temperature profiles. Chronic isolation (mean, 48±16 days) was achieved in 27 of 36 PVs (75%). In 8 of 9 acutely isolated but with chronic reconnection PVs, the blood flow leak location was concordant with chronic reconnection gap. Although only 1 esophageal ulcerated lesion was observed, neither phrenic nerve palsy nor severe PV stenosis was seen in any dogs. CONCLUSIONS: Variance in tissue thermodynamics during cryothermal ablation depends on the distance from balloon and peri-balloon blood flow leaks. This information may be useful for successful PVI without severe complications.2015年02月, Circulation. Arrhythmia and electrophysiology, 8(1) (1), 186 - 92, 英語, 国際誌研究論文（学術雑誌）
- PURPOSE: Dabigatran is effective for both the prevention of stroke and bleeding in patients with atrial fibrillation (AF). However, the safety and efficacy of the use of dabigatran in the peri-procedural period for radiofrequency catheter ablation (RFCA) of AF is unknown. Therefore, the purpose of this study was to evaluate the safety and efficacy of dabigatran in the peri-procedural period for RFCA of AF and the duration of hospital stay. METHODS: Consecutive patients (n = 227) who underwent RFCA for AF were prospectively analyzed. Peri-procedural anticoagulant therapy with dabigatran (n = 101, D group) was compared with warfarin and heparin bridging (n = 126, W group). Dabigatran was discontinued 12-24 h before and restarted 3 h after the procedure. Warfarin was stopped 3 days before the procedure and unfractionated heparin was administered. RESULTS: Ischemic stroke occurred in one patient of the D group (0.8 %). There was no significant difference between the two groups in the incidence of major bleeding (three cases of cardiac tamponade in each group and one case of intracranial bleeding in the W group, p = 0.93) or minor bleeding (five cases in the D group vs. five in the W group, p = 0.54). The duration of hospital stay was significantly shorter in the D group than in the W group (7.2 vs. 10.3 days, p = 0.0001). CONCLUSIONS: Peri-procedural anticoagulation therapy with dabigatran for RFCA of AF was equally safe and effective compared with warfarin and heparin bridging. The use of dabigatran for RFCA of AF shortened the duration of hospital stay.2013年09月, J Interv Card Electrophysiol, 37(3) (3), 223 - 31, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- (一社)日本循環器学会, 2013年, Circ J, 77(10) (10), 2490 - 6, 英語, 国内誌Optimal strength and number of shocks at upper limit of vulnerability testing required to predict high defibrillation threshold without inducing ventricular fibrillation[査読有り]
- INTRODUCTION: Conduction block in the posterior right atrium (RA) plays an important role in perpetuating atrial flutter (AFL). Although conduction blocks have functional properties, it is not clear how the block line changes with the pacing rate, pacing site, and administration of antiarrhythmic drugs. METHODS AND RESULTS: Forty patients with typical AFL were enrolled. Pacing (110, 170, 230 ppm) from the coronary sinus ostium (CSo) and low lateral RA was performed. After 1 mg/kg pilsicainide (pure sodium channel blockade) administration, the pacing protocol was repeated. Conduction block was assessed based on a color-coded isopotential map and 20 points of virtual unipolar electrograms in the posterior RA using noncontact mapping. Block line proportion was defined as the percentage of length of the block line between the superior and inferior vena cava. The pacing rate-dependent extension of the block proportion was significant during pacing from both sides (pacing from the CSo: 59 ± 17% at 110 ppm, 69 ± 16% at 230 ppm, P < 0.05; pacing from the low lateral RA: 43 ± 19% at 110 ppm, 55 ± 22% at 230 ppm, P < 0.05). The block line was significantly longer during CSo pacing than during low lateral RA pacing at each rate (all P < 0.05). After pilsicainide administration, the block line extended further. CONCLUSION: In addition to pacing rate-dependent and site-dependent changes in the block line, pilsicainide further extended the block line length. This phenomenon explains the clinical observation that counterclockwise AFL occurs more frequently than clockwise AFL, and the mechanism of class IC AFL.2012年08月, Journal of cardiovascular electrophysiology, 23(8) (8), 827 - 34, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Noncontact mapping is useful for the diagnosis of various arrhythmias. Virtual unipolar electrogram morphologies (VUEM) of the conduction block and the turnaround points, however, are not well defined. We compared the VUEM characteristics of a transverse conduction block in the posterior right atrium (RA) with those of contact bipolar electrograms obtained during typical atrial flutter (AFL). METHODS: Contact bipolar electrograms were used to map the posterior RA during typical AFL in 16 patients. Twenty points of the VUEM recorded along the block line were analyzed and compared with contact bipolar electrograms. RESULTS: Seventeen AFLs were analyzed. Fifteen AFLs showed an incomplete transverse conduction block in the posterior RA by contact bipolar mapping. A double potential on the block line corresponded to the two components of the VUEM, in which the second component showed an Rs, RS, or rS pattern. At the turnaround point, a fused double potential of the contact bipolar electrograms corresponded to a change of the second component of the VUEM from an rS to a QS morphology. Two AFLs showed a complete block line in the posterior RA. The contact bipolar electrogram showed double potentials from the inferior vena cava to the superior vena cava, whereas the second component of the VUEM remained in an unchanged Rs, RS, or rS pattern. CONCLUSION: VUEM analysis was a reliable method for identifying the posterior block line during AFL. This method may also be applicable for detecting block lines and turnaround points of circuits in other unmappable arrhythmias.2011年11月, Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 32(2) (2), 111 - 9, 英語, 国際誌研究論文（学術雑誌）
- PURPOSE: Slow pathway (SP) ablation of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) can be complicated by unexpected AV block even at sites >10 mm inferior to the bundle of His (HB), and one cause is thought to be the inferior dislocation of an antegrade fast pathway (A-FP). We assessed locations of FPs guided by CARTO. METHODS: Sites of FPs were mapped guided by CARTO before SP ablation in 18 patients with slow-fast AVNRT. The A-FP was defined as the site with the minimum interval between the stimulus and HB potential when pace mapping in the right atrial septum. RESULTS: The A-FP was 7.9 ± 7.5 mm inferior and 2.9 ± 5.0 mm posterior to the HB. In 6 of 18 patients (33%), the A-FP was inferiorly dislocated >10 mm to the HB. SP ablation was successfully performed in all patients at sites >10 mm from both the HB and the A-FP without AV block. In the inferiorly dislocated A-FP group, A-FPs seemed to be positioned much more on atrial sites and sufficiently posterior to SP ablation sites. CONCLUSIONS: The A-FP inferiorly dislocated >10 mm to the HB in one third of patients with AVNRT and seemed to be positioned deep on atrial sites. It is again emphasized that SP ablation within the triangle of Koch should be performed at a very ventricular annulus site, particularly in the inferiorly dislocated A-FP group.2011年11月, Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 32(2) (2), 95 - 103, 英語, 国際誌研究論文（学術雑誌）
- Mitral isthmus (MI) ablation is challenging. Blood flow in the CS and circumflex artery (LCx) may act as a heat sink and reduce the efficacy of radiofrequency ablation. Ablation in the CS also has the risk of injury to the LCx. We have reported to be able to visualize the precise anatomical characteristics between CS and LCx on MI obtained by MDCT. The aim of this study was to evaluate usefulness of MDCT guided MI ablation. Methods: Twenty patients (14 males, 61±11 y) whose CS and LCx images could be obtained simultaneously by MDCT were included in this study. We performed MI ablation between LIPV and the mitral annulus. The strategy for MDCT guided MI ablation were 1. MI line was designed just below LAA, 2. In case of LCx below CS, MI line was designed proximal the crossing point of LCX and CS, and 3. If LCX is presence on MI, MI line designed more laterally on comparatively peripheral LCX. Irrigated-tip catheters were used during MI ablation with the following settings: endocardial surface (maximum power: 40 W); CS (maximum power: 20 W). Results: The MI was blocked in 94.5% (19/20) of patients with 594±293 seconds of radiofrequency application. The epicardial ablation inside the CS was required in 45% (9/20) patients. No complications occurred. Conclusion: The MDCT guided MI ablation resulted in a high success rate of MI block without complications.Japanese Heart Rhythm Society, 2011年, Journal of Arrhythmia, 27, OP55_4 - OP55_4, 英語
- 症例は濃厚な突然死家族歴を有する71歳男性．発熱ならびに植込み型除細動器（ICD）作動で緊急入院となった．中学生の頃から脚ブロックを指摘され，54歳時に失神歴あり，64歳時に心室細動（VF）から心肺停止となり蘇生された．安静時12誘導心電図では完全右脚ブロック（QRS幅170msec, V1, V2にノッチあり）を認め，加算平均心電図では遅延電位陽性であった．心エコー，心筋シンチグラフィー，心臓MRI，心筋生検では特記すべき異常を認めなかったが，ピルジカイニド負荷にてV2にcoved型の心電図変化を認め，Brugada症候群または不整脈源性右室心筋症初期の可能性を考えICD植込みを行った．その後6年間状態は安定していたが，平成21年9月頃より発熱を契機に肝酵素上昇，VF発作を認め緊急入院となった．肝酵素，炎症反応上昇認めるものの，各種検査でも熱源不明であり，高熱時にVF発作を認め不整脈コントロールに難渋した．VFの原因となった基礎心疾患の診断や，発熱時のVFへの対応なども含め興味深い1例と考えられたため報告する．The Japanese Society of Electrocardiology, 2011年, 心電図, 31(4) (4), 417 - 423, 日本語
- (一社)日本不整脈心電学会, 2010年09月, 心電図, 30(Suppl.4) (Suppl.4), S - 194, 日本語肺静脈隔離後のnoncontact mappingによるcomplex fractionated atrial electrogramsの評価
- (一社)日本不整脈心電学会, 2010年09月, 心電図, 30(Suppl.4) (Suppl.4), S - 202, 日本語器質的心疾患に伴う心室頻拍(VT)ablationにおけるensite array systemの有用性についての検討
- (一社)日本不整脈心電学会, 2010年09月, 心電図, 30(Suppl.4) (Suppl.4), S - 202, 日本語不明熱を契機に心室細動発作を繰り返した心臓伝導障害とBrugada症候群の合併と考えられた1例
- (一社)日本不整脈心電学会, 2010年09月, 心電図, 30(Suppl.4) (Suppl.4), S - 226, 日本語心臓再同期療法患者における心室性不整脈イベント発生時期についての検討
- (一社)日本不整脈心電学会, 2010年04月, Journal of Arrhythmia, 26(Suppl.) (Suppl.), 183 - 183, 日本語
- (一社)日本不整脈心電学会, 2010年04月, Journal of Arrhythmia, 26(Suppl.) (Suppl.), 225 - 225, 日本語
- (一社)日本不整脈心電学会, 2010年04月, Journal of Arrhythmia, 26(Suppl.) (Suppl.), 281 - 281, 日本語
- (一社)日本不整脈心電学会, 2010年04月, Journal of Arrhythmia, 26(Suppl.) (Suppl.), 284 - 284, 日本語
- Japan Heart Foundation, 2010年, 心臓, 42(1) (1), S1_3 - S1_3, 日本語
- 2009年08月, JOURNAL OF CARDIOLOGY, 54(1) (1), 139 - 143, 英語, 国際誌[査読有り]
- 日本補完代替医療学会, 2008年11月, 日本補完代替医療学会学術集会プログラム・抄録集, 11回, 80 - 80, 日本語植込み型除細動器(ICD)植込み患者の植込み後1年間における気分状態の推移
- 2008年09月, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 31(9) (9), 1160 - 1167, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Endocardial substrate mapping for monomorphic ventricular tachycardia ablation in ischemic and non-ischemic cardiomyopathy.We investigated the differences in the endocardial substrates between ischemic cardiomyopathy (ICM) and non-ICM (NICM) by using electro-anatomical mapping and pace-mapping. We studied 18 patients (ICM and NICM, 9 each) with monomorphic ventricular tachycardia (VT) documented by 12-leads ECG. Low voltage area was defined by signal amplitude <1.5 mV. A pace-map QRS morphology that matched VT in >10 of the 12-leads ECG was regarded as a pace-map match. And conduction delay during pace-mapping was defined as the stimulus to QRS interval >or=40 ms. Low voltage area was 53.8 +/- 21.5 and 20.8 +/- 16.7 cm2 in ICM and NICM patients, respectively (P = 0.002). Pace-mapping was assessed in 6 ICM and 9 NICM. Pace-map match with conduction delay were obtained in all the 6 ICM patients. But in NICM patients, pace-map match with conduction delay was obtained in 3 patients. Pace-map match sites where conduction delay was not observed were obtained in 5 patients. Pace-map match could not be obtained in 1 patient. We attempted ablation in 6 ICM and 7 NICM patients. Subsequently, VT recurrence was not observed in ICM but it was observed in 6 of 7 NICM patients (log-rank P = 0.0016). In NICM patients, the arrhythmogenic substrate that represented the abnormal electrogram and conduction delay was observed less within the endocardial surface when compared with that observed in ICM. VT recurrence rate subsequent to endocardial ablation was higher in NICM than in ICM patients.2008年07月, The Kobe journal of medical sciences, 54(2) (2), E122-35, 英語, 国内誌研究論文（学術雑誌）
- 2005年01月, Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine, 94(1) (1), 132 - 4, 日本語, 国内誌[Hypokalemic myopathy with long-term heavy Cola consumption].研究論文（学術雑誌）
- 2022年, 日本不整脈心電学会学術大会プログラム・抄録集(Web), 68th心房細動アブレーションを受けている高齢患者の臨床転帰に対する併存疾患の影響
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE022 - 7, 英語The Lesion Continuity after Pulmonary Vein Isolation with LSI of 5 vs 6: Late-gadolinium Enhancement Magnetic Resonance Imaging(LGE-MRI) Analysis(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE023 - 4, 英語Shortcut-Link between the Fast and Slow Pathways: Another Possible Explanation for AVNRT Sustained with Ventriculoatrial Block(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE032 - 2, 英語The Relationship between AF Rotor Detected by ExTRa Mapping and Tissue Property Assessed by LGE-MRI in Persistent Atrial Fibrillation Patients(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE045 - 1, 英語Acute Response and Rhythm Outcome of the Patchy Late-gadolinium Enhancement Sites Ablation in Patients with Atrial Fibrillation: LGE-MRI Analysis(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE075 - 1, 英語The Importance of the HCM Phenotype in the Management of Ventricular Arrhythmias and Implanted Cardioverter Defibrillators(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE075 - 4, 英語Clinical Outcomes Following Upgrade to Cardiac Resynchronization Therapy in Patients with Cardiac Sarcoidosis(和訳中)
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, OE135 - 3, 英語Net Clinical Benefit of Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation: The Hyogo AF Network(HAF-NET) Registry(和訳中)
- (一社)日本遠隔医療学会, 2021年02月, 日本遠隔医療学会学術大会プログラム・抄録集, 24回, 59 - 59, 英語心房細動患者への小型ワイヤレスECGモニタリング装置の郵送サービスの有用性(The utility of using the postal delivery service to deliver small wireless ECG monitoring devices to patients with atrial fibrillation)
- (一社)インターナショナルハートジャーナル刊行会, 2020年11月, International Heart Journal, 61(6) (6), 1165 - 1173, 英語
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OJ15 - 2, 英語B-Type Natriuretic Peptide Predicts Stroke Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry(和訳中)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE49 - 1, 英語心房細動のカテーテルアブレーション後に抗凝固療法を中止した患者における脳卒中イベント AF Frontier Ablation Registryのサブ解析(Stroke Events in Patients with Discontinuation of Anticoagulation after Catheter Ablation of Atrial Fibrillation: Subanalysis from AF Frontier Ablation Registry)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE66 - 1, 英語高度室房ブロックの発生にもかかわらず持続する上室性頻拍 NV/NF fiberによるSVTとAVNRTの多施設共同研究(Supraventricular Tachycardia Sustained despite Occurrence of Sudden Ventriculoatrial Block: A Multicenter Study of NV/NF Fiber-related SVT vs. AVNRT)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE76 - 2, 英語ラジオ波焼灼術が心房細動患者におけるpatchy遅延造影部位に及ぼす影響 LGE-MRIによる解析(The Impact of the Radiofrequency Application on the Patchy Late-gadolinium Enhancement Sites in Patients with Atrial Fibrillation: LGE-MRI Analysis)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE104 - 1, 英語心房細動患者におけるLGE-MRIで描出された線維化領域とExTRa Mappingで記録された非受動的興奮領域との関連(The Relationship between Fibrotic Areas Assessed by LGE-MRI and Non-Passively Activated Areas Detected by ExTRa Mapping in Atrial Fibrillation Patients)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE127 - 2, 英語非侵襲的な粒子線外部照射が動物心臓の電気生理学的、病理学的変化に及ぼす影響(Impact of Non-invasive External Particle Beam Radiation on the Electrophysiological and Pathological Changes in the Animal Heart)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, PE55 - 4, 英語植込み型心臓電気デバイス感染の微生物学的特徴と抗生物質の選択(Microbiological Characteristics and Selection of Antibiotics for Cardiac Implantable Electronic Device Infection in Our Hospital)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, PE58 - 7, 英語心房細動アブレーション後に直接経口抗凝固薬をunder-doseまたは中止した場合の臨床的有害事象 AF Frontier Ablation Registryのサブ解析(Clinical Adverse Events of Under-dose or Discontinue Direct Oral Anticoagulants after Atrial Fibrillation Ablation: Subanalysis from the AF Frontier Ablation Registry)
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, PL04 - 3, 英語LGE-MRI技術を用いた左心房線維性基質の画像化の実施可能性(Feasibility of Imaging Fibrotic Substrates in the Left Atrium Using LGE-MRI Technology)
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, OE01 - 5, 英語Cryoballoonアブレーション治療および接触力センシング型カテーテルによるラジオ波焼灼療法におけるLGE-MRIにより評価した損傷特性(Lesion Characteristics Assessed by LGE-MRI between Cryo-balloon Ablation and Radiofrequency Ablation with Contact-force Sensing Catheter)
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, OE36 - 4, 英語各種高周波出力設定が同じアブレーション条件下の組織温度プロファイルに及ぼす影響(Impact of Different Radiofrequency Power Settings on Tissue Temperature Profiles under the Same Ablation Index)
- (一社)日本循環器学会, 2017年03月, 日本循環器学会学術集会抄録集, 81回, FRS - 034, 英語クライオバルーンアブレーション術に伴う空気塞栓症リスクを軽減する手技(Techniques for Reducing the Risk of Air Embolism Associated with Cryoballoon Ablation Procedures)
- (一社)日本循環器学会, 2017年03月, 日本循環器学会学術集会抄録集, 81回, OE - 376, 英語凍結バルーンアブレーション中の左心房に入る気泡のタイミング(Timing Air Bubbles Entering the Left Atrium during Cryoballoon Ablation Procedures)
- (一社)日本循環器学会, 2015年03月, Circulation Journal, 79(Suppl.I) (Suppl.I), 737 - 737, 英語In vivoモデルにおいて組織熱力学が冷凍バルーンアブレーション技術を用いた肺静脈伝導に及ぼす影響(The Impact of Tissue Thermodynamics on Pulmonary Vein Conduction Using Cryoballoon Ablation Technology in an In Vivo Model)
- (一社)日本循環器学会, 2015年03月, Circulation Journal, 79(Suppl.I) (Suppl.I), 971 - 971, 英語凍結バルーン技術を用いた肺静脈隔離時においてさまざまな凍結アブレーション時間とバルーンサイズが熱力学および有効性に及ぼす影響(Effect of Different Cryoablation Time and Balloon Size on the Thermodynamics and Efficacy during Pulmonary Vein Isolation Using Cryoballoon Technology)
- (一社)日本不整脈心電学会, 2014年10月, Journal of Arrhythmia, 30(5) (5), 356 - 361, 英語
- (一社)日本循環器学会, 2013年03月, Circulation Journal, 77(Suppl.I) (Suppl.I), 112 - 112, 英語非発作性心房細動患者におけるganglionated plexi ablationの効果(The Effect of Ganglionated Plexi Ablation in Patients with Non-Paroxysmal Atrial Fibrillation)
- (一社)日本循環器学会, 2013年03月, Circulation Journal, 77(Suppl.I) (Suppl.I), 2 - 2, 英語発作性心房細動に対する単回ganglionated plexiアブレーション+肺静脈隔離後1年目の臨床転帰(One-year Clinical Outcome after a Single Ganglionated Plexi Ablation Plus Pulmonary Vein Isolation for Paroximal Atrial Fibrillation)
- (一社)日本循環器学会, 2013年03月, Circulation Journal, 77(Suppl.I) (Suppl.I), 32 - 33, 英語Ganglionated Plexiアブレーションが心房細動患者における2年間の追跡調査中の安静時洞調律に及ぼす影響(The Effect of the Ganglionated Plexi Ablation on the Resting Sinus Rate in Patients with Atrial Fibrillation during 2-Year Follow-Up)
- (一社)日本循環器学会, 2013年03月, Circulation Journal, 77(Suppl.I) (Suppl.I), 101 - 101, 英語心外膜カテーテルアブレーションに影響する右心室心外膜の解剖学的特徴(The Characteristics of Right Ventricular Epicardium Anatomy Affecting Epicardial Catheter Ablation)
- 2012年11月, CIRCULATION, 126(21) (21), 英語Visualization of the Antegrade Slow and Fast Pathway Input Using 3D Electro-Anatomical Mapping System in the Patients with Atrioventricular Nodal Reentrant Tachycardia研究発表ペーパー・要旨（国際会議）
- (一社)日本不整脈心電学会, 2012年04月, Journal of Arrhythmia, 28(2) (2), 96 - 99, 英語
- (一社)日本循環器学会, 2012年03月, Circulation Journal, 76(Suppl.I) (Suppl.I), 1033 - 1033, 英語単回心臓自律神経叢アブレーション+肺静脈隔離術(GPPVI)における心房細動の除去(Eliminating Atrial fibrillation in a Single Ganglionated Plexi Ablation Plus Pulmonary Vein Isolation (GPPVI))
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 259 - 259, 英語AF/AFL/AT 臨床研究 AFアブレーション患者において神経節のある神経叢のアブレーションは洞レートに影響するか?(AF/AFL/AT: Clinical Studies Does Ganglionated Plexi Ablation Affect Sinus Rate in Patients with AF Ablation?)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 259 - 259, 英語AF/AFL/AT 臨床研究 心房細動患者における非肺静脈病変の特徴(AF/AFL/AT: Clinical Studies Characteristics of Non-Pulmonary Vein Foci in Patients with Atrial Fibrillation)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 270 - 270, 英語AF/AFL/AT アブレーション 心臓神経叢のアブレーションによる心房細動の急速な停止と周期長との関係(AF/AFL/AT: Ablation The Relationship between Acute Termination by Ganglionated Plexi Ablation and Cycle Length of Atrial Fibrillation)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 335 - 335, 英語AF/AFL/AT アブレーション 心臓神経叢アブレーションによるAF消失部位における心電図の特徴(AF/AFL/AT: Ablation The Characteristics of the Electrograms at the Site of AF Termination by Ganglionated Plexi Ablation)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 408 - 408, 英語AF/AFL/AT アブレーション MDCTガイド下僧帽弁峡部アブレーションの有用性(AF/AFL/AT: Ablation Usefulness of MDCT Guided Mitral Isthmus Ablation)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 427 - 427, 英語心臓神経叢領域とコンプレックス細分化心房電位図との対比(The Contrast between the Area of the Ganglionated Plexi and Complex Fractionated Atrial Electrograms)
- (一社)日本不整脈心電学会, 2011年09月, 心電図, 31(Suppl.4) (Suppl.4), 438 - 438, 英語心房細動における右心房リモデリング 典型的右心房粗動の発生に関与するか?(Right Atrial Remodeling in Atril Fibrillation: Is It Particular to an Incidence of Typical Right Atrial Flutter?)
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 259 - 259, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 259 - 259, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 270 - 270, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 335 - 335, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 408 - 408, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 427 - 427, 英語
- (一社)日本不整脈心電学会, 2011年09月, Journal of Arrhythmia, 27(Suppl.) (Suppl.), 438 - 438, 英語
- (一社)日本循環器学会, 2011年03月, Circulation Journal, 75(Suppl.I) (Suppl.I), 2 - 3, 英語非虚血性心筋症患者において心臓再同期療法が冠血流および微小血管抵抗に及ぼす作用(Effect of Cardiac Resynchronization Therapy on Coronary Flow and Microvascular Resistance in Patients with Non-ischemic Cardiomyopathy)
- (一社)日本循環器学会, 2011年03月, Circulation Journal, 75(Suppl.I) (Suppl.I), 3 - 3, 英語心臓再同期療法開始から6ヵ月後における冠血流予備能と心エコー図上の反応との関連性(Relationship between Coronary Flow Reserve and Echocardiac Response after 6-month of Cardiac Resynchronization Therapy)
- (一社)日本循環器学会, 2011年03月, Circulation Journal, 75(Suppl.I) (Suppl.I), 10 - 10, 英語非虚血性心筋症患者において心臓再同期療法が冠動脈血流相パターンに及ぼす作用(Effect of Cardiac Resynchronization Therapy on Phasic Coronary Flow Pattern in Patients with Non-ischemic Cardiomyopathy)
- (一社)日本循環器学会, 2011年03月, Circulation Journal, 75(Suppl.I) (Suppl.I), 106 - 107, 英語Navxシステムを用いた心房細動のカテーテルアブレーションにおける二相性陽圧換気(BiPAP)の有用性(Usefulness of Bi-level Positive Airway Pressure (BiPAP) in Catheter Ablation of Atrial Fibrillation Using the Navx System)
- (一社)日本循環器学会, 2010年03月, Circulation Journal, 74(Suppl.I) (Suppl.I), 261 - 261, 英語心臓再同期療法中の患者における心室再分極の時間依存性変化(Time-dependent Change of Ventricular Repolarization in Patients with Cardiac Resynchronization Therapy: Using Beat-to-Beat QT Dispersion)
- (一社)日本循環器学会, 2010年03月, Circulation Journal, 74(Suppl.I) (Suppl.I), 276 - 277, 英語植込み型除細動器を装着した患者における抗頻拍ペーシングの効果に対する心室頻拍周期長の有意な影響(Significant Influence of Ventricular Tachycardia Cycle Length on Efficacy of Anti-tachycardia Pacing in Implantable Cardioverter-defibrillator Patients)
- (一社)日本循環器学会, 2010年03月, Circulation Journal, 74(Suppl.I) (Suppl.I), 330 - 330, 英語心臓再同期療法を施行中の患者の死亡率 ペースメーカーと植込み型除細動器との比較(Mortality of Patients with Cardiac Resynchronization Therapy: Pacemaker versus Implantable Cardioverter Defibrillator)
- (一社)日本循環器学会, 2010年03月, Circulation Journal, 74(Suppl.I) (Suppl.I), 330 - 331, 英語抗凝固療法およびデバイス植込みを受けた患者において周術期のヘパリンブリッジングは出血性合併症リスクを高める(Peri-operatieve Heparin Bridging Increase the Risk of Bleeding Complication in Patients with Anti-coagulation Therapy and Device Implantation)
- 社団法人日本循環器学会, 2009年03月01日, Circulation journal : official journal of the Japanese Circulation Society, 73, 547 - 547, 英語PJ-007 Three-Dimensional Electro-anatomical Mapping of Antegrade and Retrograde Fast Pathway(PJ001,Arrhythmia, Others (Clinical/Pathophysiology) 1 (A),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- 社団法人日本循環器学会, 2009年03月01日, Circulation journal : official journal of the Japanese Circulation Society, 73, 689 - 689, 英語PJ-568 Rate- and Direction-dependent Conduction Block at the Sinus Venosa Region Evaluated by Non-contact Mapping in Patients with Typical Atrial Flutter(PJ095,Arrhythmia, Others (Basic) 2 (A),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- (一社)日本循環器学会, 2009年03月, Circulation Journal, 73(Suppl.I) (Suppl.I), 685 - 685, 英語
- (一社)日本循環器学会, 2009年03月, Circulation Journal, 73(Suppl.I) (Suppl.I), 689 - 689, 英語通常型心房粗動患者における非接触型マッピングにより評価した静脈洞領域での心拍及び方向依存性の伝導ブロック(Rate- and Direction-dependent Conduction Block at the Sinus Venosa Region Evaluated by Non-contact Mapping in Patients with Typical Atrial Flutter)
- 社団法人日本循環器学会, 2008年10月20日, Circulation journal : official journal of the Japanese Circulation Society, 72, 1097 - 1097, 日本語56) 意識消失で来院し多種類の心房性頻拍を認めた一例(第105回日本循環器学会近畿地方会)
- 社団法人日本循環器学会, 2008年03月01日, Circulation journal : official journal of the Japanese Circulation Society, 72, 480 - 481, 英語PE-481 The Upper Turnover Portion of the Reentry Circuit of Typical Atrial Flutter(Arrhythmia, diagnosis/Pathophysiology/EPS(09)(A),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- 社団法人日本循環器学会, 2008年03月01日, Circulation journal : official journal of the Japanese Circulation Society, 72, 515 - 515, 英語PJ-021 Changes of Spatial Atrial Fibrillatory Cycle Length during Atrial Fibrillation before and after Pulmonary Vein Isolation(Arrhythmia, diagnosis/Pathophysiology/EPS(12)(A),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- 社団法人日本循環器学会, 2008年03月01日, Circulation journal : official journal of the Japanese Circulation Society, 72, 708 - 708, 英語PJ-780 Influence of Cardiac Resynchronization Therapy on Temporal and Spatial Ventricular Repolarization in Patients with Congestive Heart Failure(Arrhythmia, diagnosis / Pathophysiology / EPS(16)(A),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- (一社)日本循環器学会, 2008年03月, Circulation Journal, 72(Suppl.I) (Suppl.I), 708 - 708, 英語
- 第83回日本循環器学会学術集会, 2019年03月, 英語, 日本循環器学会, 横浜, 国内会議The lesion distribution after pulmonary vein isolation using balloon catheter : LGE-MRI analysis口頭発表（一般）
- 第83回日本循環器学会学術集会, 2019年03月, 日本語, 日本循環器学会, 横浜, 国内会議The Correlation between Circulating Intermediate CD14++CD16+Monocytes and Atrial Electrical Remodeling in Atrial Fibrillation Patientsポスター発表
- 第83回日本循環器学会学術集会, 2019年03月, 日本語, 日本循環器学会, 横浜, 国内会議The Characteristics of Onset Timing of the Coronary Artery Spasm during an Atrial Fibrillation Ablation Procedure口頭発表（一般）
- 第83回日本循環器学会学術集会, 2019年03月, 英語, 日本循環器学会, 横浜, 国内会議Lesion characteristics assessed by LGE-MRI between cryo-balloon ablation and radiofrequency ablation with contact-force sensing catheter口頭発表（一般）
- 第83回日本循環器学会学術集会, 2019年03月, 英語, 日本循環器学会, 横浜, 国内会議Impact of Different Radiofrequency Power Settings on Tissue Temperature Profiles Under the Same Ablation Index口頭発表（一般）
- 第83回日本循環器学会学術集会, 2019年03月, 日本語, 日本循環器学会, 横浜, 国内会議Impact of Anisotropic Conduction Property in the Left Atrium following Pulmonary Vein Isolation on the Inducibility of Atrial Tachycardia口頭発表（一般）
- 第83回日本循環器学会学術集会, 2019年03月, 英語, 日本循環器学会, 横浜, 国内会議Feasibility of Imaging Fibrotic Substrates in the Left Atrium using LGE-MRI Technologyシンポジウム・ワークショップパネル（公募）
- 第83回日本循環器学会学術集会, 2019年03月, 英語, 日本循環器学会, 横浜, 国内会議A Novel Unshielded Magnetocardiography System: The 1st Performance Test in 25 Healthy Male Volunteers口頭発表（一般）
- カテーテルアブレーション関連秋季大会2018, 2018年11月, 日本語, 日本不整脈心電学会, 沖縄, 国内会議不顕性副伝導路を介するPseudo VTの一例口頭発表（一般）
- 第126回日本循環器学会 近畿地方会, 2018年11月, 日本語, 大阪, 国内会議僧帽弁機械弁置換術，Maze 術後の僧帽弁輪を旋回する心房頻拍に冠静脈洞内での通電が有効であった一例口頭発表（一般）
- カテーテルアブレーション関連秋季大会2018, 2018年11月, 日本語, 日本不整脈心電学会, 沖縄, 国内会議下大静脈-三尖弁輪峡部通電により右冠動脈の血腫圧排，閉塞をきたした1 例 ～血管内超音波と3次元CTからの考察～口頭発表（一般）
- カテーテルアブレーション関連秋季大会2018, 2018年11月, 日本語, 日本不整脈心電学会, 沖縄, 国内会議ICD適切作動を伴うVF発作に対しカテーテルアブレーションが奏功したBrugada症候群の1例ポスター発表
- カテーテルアブレーション関連秋季大会2018, 2018年11月, 日本語, 日本不整脈心電学会, 沖縄, 国内会議7年の経過で心内膜面不整脈基質の著名な悪化を認めた拡張相肥大型心筋症の1例ポスター発表
- 第65回日本不整脈心電学会学術大会, 2018年07月, 英語, 日本不整脈心電学会, 東京, 国内会議The correlation between circulating intermediate CD14++CD16+monocytes and atrial electrical remodeling in AF patientsポスター発表
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2022年04月01日 - 2026年03月31日デジタルヘルス技術を活用した新たな循環器遠隔診療体制の構築
- 日本学術振興会, 科学研究費助成事業 若手研究, 若手研究, 神戸大学, 2019年04月01日 - 2021年03月31日心臓への粒子線照射後の組織学的、電気生理学的変化の解析と不整脈治療への展開本年度はウサギに鎮静を行い心エコー図検査、心電図検査を施行。 合計32羽のウサギを兵庫県立粒子線医療センターに搬送しウサギの心臓へ非侵襲的に粒子線の照射を行った。これらのウサギを再度神戸大学動物実験施設に搬送し、心電図、心エコー図検査などを定期的に行い経過観察を行った後に全身麻酔下で開胸にて心外膜側の電気生理検査を行い、その後安楽死を行った。心臓、周辺組織の組織学的評価を行った。現在組織学的評価、電気生理学的検査の評価を行っているが、粒子線照射群においては、まず皮膚（前胸部）に照射による皮膚変化を認め、心エコー図検査では1-3カ月後に心嚢水貯留などの所見を認め、体表心電図では電位の低下を認めた。開胸下での電気生理検査では照射群において伝導時間の延長、伝導速度の低下、電位波高の減高を認め粒子線照射により電気生理学的変化を確認できた。粒子線照射による明らかな電気生理学的変化、組織学的変化を認めている。また周辺臓器への影響も明らかとなった。これらの結果は今後カテーテルを使用しない放射線照射による非侵襲的な不整脈治療への応用につながる非常に重要な知見であると考えられる。これらの結果は本年の日本循環器学会総会、日本不整脈心電学会総会、また米国不整脈学会総会などで発表を予定している。同時にこれらの結果は来年度を目安に論文として学術雑誌に投稿を予定している。
- 日本学術振興会, 学術研究助成基金助成金／若手研究(B), 若手研究(B), 神戸大学, 2017年04月 - 2019年03月ウサギを兵庫県立粒子線医療センターに搬送し、心臓に粒子線照射を行った後にその後経過観察を行った。照射群のウサギは心電図、心エコー図検査を行い3－6カ月後に全身麻酔下での開胸下で電気生理検査を行った。その後安楽死を行い、心臓の組織学的変化を検討した。照射群においては、まず皮膚（前胸部）に照射による皮膚変化を認め、心エコー図検査では1-3カ月後に心嚢水貯留などの所見を認め、体表心電図では電位の低下を認めた。開胸下での電気生理検査では照射群において伝導時間の延長、伝導速度の低下、電位波高の減高を認め粒子線照射により電気生理学的変化を確認できた。将来的に不整脈治療への応用が期待される結果が示された。競争的資金