Web of Science

記述言語：英語   出版者・発行元：Heart Rhythm  

DOI： 10.1016/j.hrthm.2024.11.006

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記述言語：英語   出版者・発行元：Journal of Electrocardiology  

Background: Time-frequency analysis using continuous wavelet transform enables the detection of hidden frequency power within the QRS complex in electrocardiography. These frequency profiles may reflect myocardial damage and electrical dispersion. This study evaluated the frequency power profile in patients with a history of ventricular tachycardia (VT) using time-frequency analysis and assessed changes in the profile after catheter ablation. Methods: Thirteen patients with a history of VT and 15 without who underwent implantable cardioverter-defibrillator implantation for secondary and primary prevention, respectively, were included. The time-frequency powers were calculated from QRS onset to the beginning of the T-wave in lead V5 on 3-min electrocardiography pre-implantation using continuous wavelet transform analysis. The frequency power of each scale band (40, 80, 150, 200, and 250 Hz) was evaluated using the mean of three continuous beats. Results: The signal powers in high-frequency bands against that of 80 Hz were significantly higher in the VT group than in the non-VT group (250/80 Hz: 0.214 ± 0.060 vs. 0.146 ± 0.055, p = 0.004; 200/80 Hz: 0.282 ± 0.086 vs. 0.211 ± 0.082, p = 0.036; 150/80 Hz: 0.425 ± 0.118 vs. 0.341 ± 0.097, p = 0.049). Among 11 patients undergoing VT ablation in the secondary prevention group, the high-frequency component ratio significantly decreased post-ablation (250/80 Hz: 0.220 ± 0.062 to 0.183 ± 0.067, p = 0.015; 150/80 Hz: 0.424 ± 0.115 to 0.383 ± 0.108, p = 0.031). Peak signal powers of 250 Hz were detected within the QRS complex in all patients, with significant prolongation after ablation. Conclusion: The distribution shift of the powers in the high-frequency bands was relevant in patients with VT. The time-frequency analysis was useful for stratifying ventricular arrhythmia risk.

DOI： 10.1016/j.jelectrocard.2025.154027

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記述言語：英語   出版者・発行元：Esc Heart Failure  

Aims: Cardiac resynchronization therapy (CRT) improves the prognosis of patients with heart failure (HF) and wide QRS complex. However, patients with non-left bundle branch block (LBBB) show a poor response to CRT. This study evaluated myocardial work estimated by pressure–strain loops on echocardiography for predicting response to CRT in patients with non-LBBB. Methods and results: Of 267 patients who underwent CRT implantation, 54 patients with non-LBBB (mean age, 62 ± 12 years, 72% males, and 24% with ischemic cardiomyopathy) were retrospectively included. Two-dimensional speckle-tracking echocardiography was performed before and at 6-month follow-up in all patients. Myocardial work was estimated by pressure–strain loop analysis using speckle-tracking echocardiography and non-invasive blood pressure measurement. CRT response was defined as a ≥15% decrease in left ventricular end-systolic volume on echocardiography at the 6-month follow-up. The mean left ventricular ejection fraction (LVEF) before implantation was 27% ± 8% in total. Six months after implantation, 18 patients (33%) responded to CRT. The absolute LVEF improvement for responders and non-responders were 5.5% ± 6.9% and 1.3% ± 7.5%, respectively (P = 0.021). Baseline global work index (GWI), which is the average myocardial work based on the pressure–strain loop, was significantly higher in the responder group than in the non-responder group (590 ± 271 vs. 409 ± 216 mmHg%; P = 0.010). Multivariable analysis showed GWI to be an independent predictor of CRT response (odds ratio, 1.109; 95% confidence interval [CI], 1.013–1.213; P = 0.024). Receiver operating characteristic curve analysis determined the cut-off value of GWI for response as 456 mmHg% (AUC 0.700, 95% CI 0.553–0.840; P = 0.019). During the median 37-month follow-up, all-cause death occurred in 21 patients (39%). On multivariable analysis, GWI ≤ 456 mmHg% was independently associated with an increased risk of all-cause mortality (hazard ratio, 2.882; 95% CI, 1.157–7.176; P = 0.023). Conclusions: High GWI assessed by speckle-tracking echocardiography and a non-invasively estimated LV pressure curve was independently associated with a favourable response to CRT and improved outcomes in patients with non-LBBB. The use of this non-invasive approach for quantifying myocardial variability and residual contractility can be beneficial for assessing CRT candidates and allow for more accurate patient stratification. Further, large multicentre studies are required to validate these findings.

DOI： 10.1002/ehf2.15246

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記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.

DOI： 10.1536/ihj.24-646

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CiNii Research

記述言語：英語   出版者・発行元：JAMA Network Open  

IMPORTANCE There is no clear consensus regarding the discontinuation of oral anticoagulants (OACs) after catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVE To evaluate thromboembolic and major bleeding events and all-cause death following OAC discontinuation and characteristics associated with patient prognoses after successful CA. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients without AF recurrence or adverse events 12 months after CA among those undergoing their first CA between January 1, 2006, and December 31, 2021. The study population was divided into groups according to the continuation and discontinuation of OACs at the landmark period of 12 months after CA. Follow-up data were acquired until December 31, 2023, and the study analysis was conducted from January to April 2024. EXPOSURES OAC discontinuation. MAIN OUTCOMES AND MEASURES Primary outcomes were thromboembolic and major bleeding events and all-cause death after 12 months. Inverse probability of treatment weighting (IPTW) and propensity score–matched analyses were used to adjust baseline characteristics. RESULTS This study included 1821 patients (mean [SD] age, 63.6 [11.7] years; 1339 men [73.5%]). Overall, 922 patients (50.6%) continued OAC for 12 months, whereas 899 (49.4%) discontinued OAC. During a mean (SD) follow-up of 4.8 (4.0) years, thromboembolic events, major bleeding events, and death occurred in 43 (2.4%), 41 (2.3%), and 71 (3.9%) patients, respectively. After IPTW adjustment, the OAC discontinuation group demonstrated a significantly higher incidence of thromboembolism (incidence rate, 0.86 [95% CI, 0.45-1.35] vs 0.37 [95% CI, 0.22-0.54] per 100 person-years; log-rank P = .04) and a lower incidence of major bleeding (incidence rate, 0.10 [95% CI, 0.02-0.19] vs 0.65 [95% CI, 0.43-0.90] per 100 person-years; log-rank P < .001) than in the continuation group. In a subgroup analysis, OAC discontinuation was associated with a higher risk of thromboembolism in patients with asymptomatic AF, left ventricular ejection fraction of less than 60%, and left atrial diameter of 45 mm or greater. In contrast, OAC discontinuation was beneficial for reducing major bleeding risks in patients with a HAS-BLED score of 2 or greater. These outcomes were similar in the propensity score–matched analysis using 1100 paired matched patients, except for insignificant differences in thromboembolic events. Differences in mortality between the 2 groups were not statistically significant. CONCLUSIONS AND RELEVANCE In this retrospective cohort study, discontinuation of OACs after successful CA was associated with increased thromboembolic events and decreased bleeding events. The benefits of discontinuing OACs were stratified according to specific characteristics, pending a future prospective randomized study.

DOI： 10.1001/jamanetworkopen.2025.1320

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記述言語：英語   出版者・発行元：Journal of Interventional Cardiac Electrophysiology  

Background: Few studies have reported on the quantitative evaluation of autonomic nerve modification after balloon ablation. Therefore, this study aimed to evaluate the effects of cryoballoon and hotballoon ablations on the autonomic nervous system (ANS) and their relationship with prognosis. Methods: We included 234 patients who underwent cryoballoon ablation (n = 190) or hotballoon ablation (n = 44) for paroxysmal atrial fibrillation. Heart rate variability (HRV) analysis was performed on all patients using a 3-min electrocardiogram at baseline, 1, 3, 6, and 12 months after ablation. HRV parameters and prognoses were compared between the two balloon systems. Results: Ln low-frequency (LF), Ln high-frequency (HF), standard deviation of the R-R intervals (SDNN), and RR intervals significantly decreased after 1 month in both groups, but the changes were more pronounced in the cryoballoon group than in the hotballoon group. In contrast, HRV indices in the hotballoon ablation group decreased gradually and reached their lowest point 3-to-6 months after the procedure, which was later than in the cryoballoon ablation group. The recurrence rate did not differ between the two groups. HRV parameters changed similarly in the cryoballoon group, regardless of recurrence. However, patients with recurrence had significantly higher SDNN and Ln LF at 12 months than those without recurrence in the hotballoon group (41.2 ± 39.3 ms vs. 18.5 ± 12.6 ms, p = 0.006, and 2.2 ± 0.7 ms² vs. 1.5 ± 0.7 ms², p = 0.003, respectively). Conclusions: The time course of HRV changes differed between cryoballoon and hotballoon ablations. Hence, the two balloon systems may have distinct effects on the ANS and its role in prognosis.

DOI： 10.1007/s10840-023-01581-1

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記述言語：英語   出版者・発行元：Heartrhythm Case Reports  

DOI： 10.1016/j.hrcr.2024.12.006

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記述言語：日本語   出版者・発行元：公益社団法人 日本生体医工学会  

<p>心室細動（VF）が成立するには通常、心室性不整脈が発生し、それがVFへ移行・維持する段階を経るが、その成立機序は必ずしも明らかでなく、また、関与する分子基盤の知見も乏しい。我々は、VFの成立が促される分子を探索するために、液体クロマトグラフ質量分析計LC-MS/MSを用いて、VFストーム家兎モデル（3羽）と健常家兎（3羽）の心室筋組織での蛋白・リン酸化蛋白を網羅的に定量し、統合パスウェイ解析（IPA）によって主要シグナル経路が探索された。このモデル動物は、完全房室ブロック作成と植込み型除細動器埋込を組み合わせて作成される。両心室肥大とQT延長を示し、非持続性心室頻拍・VFエピソードが頻発する。3羽が経験したVFエピソード数は、各々139, 19, 86回であった。1,938個の蛋白が同定され、106個の蛋白に有意な発現変化（False Discovery Rate (FDR)<0.1）があった。IPAの結果、顕著な有意差をもって、「ミトコンドリア機能異常」が推測された。次いで、「TCAサイクルと呼吸電子伝達系・ATP生成」に加え、「ケトン体分解」「酸化的リン酸化」「脂肪酸β酸化」「蛋白のミトコンドリア輸送」など、ミトコンドリア関連経路の多くが不活性化されていた。リン酸化蛋白は614個同定され、その内82個で有意なリン酸化変化（FDR<0.1）があった。サルコメアのZ領域蛋白、アクチン、プロテインキナーゼAサブユニットが過リン酸化され、「横紋筋収縮亢進」「インテグリンシグナル活性化」が推測された。心不全の進展に関与する既知シグナル経路の活性化は特定されなかった。重篤なVFストームに陥っていた家兎に、ミトコンドリア内膜リン脂質カルジオリピン安定化薬elamipretideの持続投与を開始したところ、VFエピソードが漸減、抑制された。以上より、ミトコンドリア障害に伴うATP産生低下が、VFストームの進展に重要な役割を果たしていると考えられた。</p>

DOI： 10.11239/jsmbe.annual63.281_2

CiNii Research

記述言語：英語   出版者・発行元：Heart Rhythm  

Background: Cardiac resynchronization therapy (CRT) improves the prognosis of patients with heart failure and complete left bundle branch block; however, its efficacy in cardiac sarcoidosis (CS) remains unclear. Objective: This study evaluated the mechanisms of CRT response in patients with and without CS, focusing on myocardial work (MW) assessment. Methods: Twenty and 73 patients with CS and dilated cardiomyopathy (DCM) who underwent CRT implantation and had complete left bundle branch block and QRS width of ≥ 150 ms were assessed. Two-dimensional speckle-tracking echocardiography was performed before implantation and 1 week and 6 months after implantation. MW was estimated by pressure-strain analysis using echocardiography. Responders were defined as ≥ 15% decrease in left ventricular end-systolic volume after 6 months. The outcomes and changes in MW were compared between the groups. Results: The CS group exhibited a lower response rate (40% vs 84%, P < .001) and a higher incidence of death and left ventricular assist device implantation than the DCM group. The CS group had a higher MW of the septal wall and smaller MW differences in the lateral-septal wall before implantation than the DCM group. After implantation, the increase in the septal wall MW was significantly lower in the CS group, resulting in a smaller reduction in the lateral-septal wall MW difference. MW difference in lateral-septal wall and basal septum thinning were determinants for the left ventricular end-systolic volume reduction. Conclusion: Patients with CS had poor outcomes after CRT. Baseline MW differences in the lateral-septal wall and improvements in septal MW may play an essential role in improving cardiac function.

DOI： 10.1016/j.hrthm.2025.05.030

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記述言語：英語   出版者・発行元：Journal of Radiation Research  

Ventricular tachycardia (VT) is a severe arrhythmia commonly treated with implantable cardioverter defibrillators, antiarrhythmic drugs and catheter ablation (CA). Although CA is effective in reducing recurrent VT, its impact on survival remains uncertain, especially in patients with extensive scarring. Stereotactic arrhythmia radioablation (STAR) has emerged as a novel treatment for VT in patients unresponsive to CA, leveraging techniques from stereotactic body radiation therapy used in cancer treatments. Recent clinical trials and case series have demonstrated the short-term efficacy and safety of STAR, although long-term outcomes remain unclear. Imaging techniques, such as electroanatomical mapping, contrast-enhanced magnetic resonance imaging and nuclear imaging, play a crucial role in treatment planning by identifying VT substrates and guiding target delineation. However, challenges persist owing to the complex anatomy and variability in target volume definitions. Advances in imaging and artificial intelligence are expected to improve the precision and efficacy of STAR. The exact mechanisms underlying the antiarrhythmic effects of STAR, including potential fibrosis and improvement in cardiac conduction, are still being explored. Despite its potential, STAR should be cautiously applied in prospective clinical trials, with a focus on optimizing dose delivery and understanding long-term outcomes. Collaborative efforts are necessary to standardize treatment strategies and enhance the quality of life for patients with refractory VT.

DOI： 10.1093/jrr/rrae090

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記述言語：英語   出版者・発行元：Journal of Arrhythmia  

Background: Visualizing the specific regions where atrial fibrillation (AF) is maintained is crucial for effective treatment, but it remains challenging in clinical practice. We aimed to address this challenge by developing a mapping approach focused on the cycle length (CL) and its gradient (CL-gradient). Methods: In 105 patients undergoing initial ablation for persistent AF, pre-ablation CARTOFINDER data were utilized to create maps based on three indicators: (1) CL, the atrial frequency during AF calculated using CARTOFINDER; (2) Short CL, encompassing CLs within 5 ms of the minimum CL; and (3) CL-gradient, the CL range within a 6 mm radius. We evaluated the association between the AF termination through ablation and the measured values and patterns in each map. Results: AF termination occurred in 17 patients. The AF termination group exhibited the significant large maximum CL-gradient (48.8 ms [interquartile range, 38.6–66.3], p <.001) and the short distance between the minimum CL site and the maximum CL-gradient site (15.8 mm, [interquartile range, 6.0–23.2], p =.029). Of the 17 AF termination cases, 13 exhibited a CL distribution pattern characterized by a steep CL-gradient near the minimum CL site (SG-MCL), defined as the distance of less than 23.2 mm and the maximum CL-gradient greater than 33.1 ms. In these AF termination cases, SG-MCL was also correlated with the ablation area. Conclusions: The minimum CL area accompanied by significant CL gradients in the immediate vicinity may play a crucial role in sustaining AF.

DOI： 10.1002/joa3.13151

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記述言語：英語   出版者・発行元：Heart Rhythm  

Background: Venous vascular access complications are usually nonfatal but are the most common complications after transvenous catheter intervention. Vascular closure devices (VCDs) have recently become available for venous closure. Objective: This study aimed to evaluate the feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated VCDs in patients who underwent catheter ablation. Methods: This single-center observational study enrolled 226 consecutive patients who underwent elective catheter ablation with femoral venipuncture. For hemostasis, vessel closure by VCD was performed with real-time ultrasound guidance after 2022 (n = 123) and without ultrasound guidance in 2021 (n = 103). The occurrence of venous access site–related complications (major, minor, or other) was compared. Results: The rate of device failure was significantly lower in patients with ultrasound guidance than in those without (1.6% vs 6.3%; P = .048). The occurrence of all venous access site–related complications was significantly lower in patients with ultrasound guidance than in those without (4.9% vs 18.4%; P = .001). Time to ambulation was shorter in patients with ultrasound guidance than in those without (2.0 ± 0.1 hours vs 2.2 ± 0.6 hours; P < .001). Conclusion: Real-time ultrasound guidance can reduce device failure, access site–related complications, and time to ambulation in performing venous closure with a VCD.

DOI： 10.1016/j.hrthm.2024.04.041

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記述言語：英語   出版者・発行元：Annals of Noninvasive Electrocardiology  

Background: The fibrosis-5 (FIB-5) index is a noninvasive marker for assessing the progression of liver fibrosis and predictor in patients with heart failure (HF). This study investigated the association between the FIB-5 index and response to cardiac resynchronization therapy (CRT) and evaluated its predictive value for prognosis. Methods: In total, 203 patients who underwent CRT/CRT-defibrillator (CRT-D) implantation were retrospectively included. The FIB-5 index was calculated using blood samples obtained before and after CRT/CRT-D. Response to CRT was defined as a relative reduction in left ventricular end-systolic volume of ≥15% 6 months after CRT/CRT-D. We compared the prognosis after CRT/CRT-D between the groups according to the FIB-5 index. Results: One hundred and twenty-three patients (61%) responded to CRT. The responder group demonstrated a significantly higher FIB-5 index than the nonresponder group (−2.76 ± 3.85 vs. −4.67 ± 3.29, p < 0.001). Receiver-operating characteristic analysis demonstrated that the area under the curve of the FIB-5 index was 0.660 with a cutoff value of −4.00 for responders. In multivariate analysis, FIB-5 index ≥ −4.00 was an independent predictor for CRT response (odds ratio: 3.665, p = 0.003), in addition to QRS duration ≥ 150 ms and echocardiographic dysynchrony. The FIB-5 index increased significantly after 6 months in the responder group but not in the nonresponder group. The FIB-5 index ≥ −4.00 group showed a significantly better prognosis for cardiac death, HF hospitalization, and composite endpoint than the FIB-5 index < −4.00 group. Conclusion: The FIB-5 index in addition to classical predictors may be a useful marker for predicting response to CRT.

DOI： 10.1111/anec.70004

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記述言語：英語   出版者・発行元：Jacc Clinical Electrophysiology  

DOI： 10.1016/j.jacep.2024.02.013

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記述言語：英語   出版者・発行元：Journal of Cardiovascular Electrophysiology  

Introduction: Intrinsic antitachycardia pacing (iATP) is a novel automated antitachycardia pacing (ATP) that provides individual treatment to terminate ventricular tachycardia (VT). However, the clinical efficacy of iATP in comparison with conventional ATP is unknown. We aim to compare the termination rate of VT between iATP and conventional ATP in patients with implantable cardioverter-defibrillators using a unique setting of different sequential orders of both ATP algorisms. Methods: Patients with the iATP algorithm were assigned to iATP-first and conventional ATP-first groups sequentially. In the iATP-first group, a maximum of seven iATP sequences were delivered, followed by conventional burst and ramp pacing. In contrast, in the conventional ATP-first group, two bursts and ramp pacing were initially programmed, followed by iATP sequences. We compared the success rates of VT termination in the first and secondary programmed ATP zones between the two groups. Results: Fifty-eight and 56 patients were enrolled in the iATP-first and conventional ATP-first groups, and 67 and 44 VTs were analyzed in each group, respectively. At the first single ATP therapy, success rates were 64% and 70% in the iATP and conventional groups, respectively. At the end of the first iATP treatment zone, the success rate increased from 64% to 85%. Moreover, secondary iATP therapy following the failure of conventional ATPs increased the success rate from 80% to 93%. There was a significant benefit of alternative iATP for VT termination compared to secondary conventional ATP (100% vs. 33%, p =.028). Conclusions: iATP may be beneficial as a secondary therapy after failure of conventional ATP to terminate VT.

DOI： 10.1111/jce.16232

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記述言語：英語   出版者・発行元：Frontiers in Cardiovascular Medicine  

Torsades de Pointes (TdP) refers to a polymorphic ventricular tachycardia (VT) with undulating QRS axis that occurs in long QT syndrome (LQTS), although the term has been used to describe polymorphic ventricular tachyarrhythmias in which QT intervals are not prolonged, such as short-coupled variant of TdP currently known as short-coupled ventricular fibrillation (VF) and Brugada syndrome. Extensive works on LQTS-related TdP over more than 50 years since it was first recognized by Dessertennes who coined the French term meaning “twisting of the points”, have led to current understanding of the electrophysiological mechanism that TdP is initiated by triggered activity due to early afterdepolarization (EAD) and maintained by reentry within a substrate of inhomogeneous repolarization. While a recently emerging notion that steep voltage gradients rather than EADs are crucial to generate premature ventricular contractions provides additions to the initiation mode, the research to elucidate the maintenance mechanism hasn't made much progress. The reentrant activity that produces the specific form of VT is not well characterized. We have conducted optical mapping in a rabbit model of electrical storm by electrical remodeling (QT prolongation) due to chronic complete atrioventricular block and demonstrated that a tissue-island with prolonged refractoriness due to enhanced late Na⁺ current (I<inf>Na−L</inf>) contributes to the generation of drifting rotors in a unique manner, which may explain the ECG characteristic of TdP. Moreover, we have proposed that the neural Na⁺ channel Na<inf>V</inf>1.8-mediated I<inf>Na−L</inf> may be a new player to form the substrate for TdP. Here we discuss TdP mechanisms by comparing the findings in electrical storm rabbits with recently published studies by others in simulation models and human and animal models of LQTS.

DOI： 10.3389/fcvm.2024.1363848

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記述言語：英語   出版者・発行元：Journal of Interventional Cardiac Electrophysiology  

Background : Real-time phase mapping (ExTRa™) is useful in determining the strategy of catheter ablation for non-paroxysmal atrial fibrillation (AF). This study aimed to investigate the features of drivers of AF associated with its termination during ablation. Methods: Thirty-six patients who underwent catheter ablation for non-paroxysmal AF using online real-time phase mapping (ExTRa™) were enrolled. A significant AF driver was defined as an area with a non-passively activated ratio of ≥ 50% on mapping analysis in the left atrium (LA). All drivers were simultaneously evaluated using a low-voltage area, complex fractionated atrial electrogram (CFAE), and rotational activity by unipolar electrogram analysis. The electrical characteristics of drivers were compared between patients with and without AF termination during the procedure. Results: Twelve patients achieved AF termination during the procedure. The total number of drivers detected on the mapping was significantly lower (4.4 ± 1.6 vs. 7.4 ± 3.8, p = 0.007), and the drivers were more concentrated in limited LA regions (2.8 ± 0.9 vs. 3.9 ± 1.4, p = 0.009) in the termination group than in the non-termination group. The presence of drivers 2–6 with limited (≤ 3) LA regions showed a tenfold increase in the likelihood of AF termination, with 83% specificity and 67% sensitivity. Among 231 AF drivers, the drivers related to termination exhibited a greater overlap of CFAE (56.8 ± 34.1% vs. 39.5 ± 30.4%, p = 0.004) than the non-related drivers. The termination group showed a trend toward a lower recurrence rate after ablation (p = 0.163). Conclusions: Rotors responsible for AF maintenance may be characterized in cases with concentrated regions and fewer drivers on mapping.

DOI： 10.1007/s10840-023-01588-8

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記述言語：英語   出版者・発行元：Journal of Cardiovascular Electrophysiology  

Introduction: The clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy (CRT) remain unclear. We aimed to investigate the differences in outcomes and gain insight into the mechanisms of early and delayed responses to CRT. Methods: This retrospective study included 110 patients who underwent CRT implantation. Positive response to CRT was defined as ≥15% reduction of left ventricular (LV) end-systolic volume on echocardiography at 1 year (early phase) and 3 years (delayed phase) after implantation. The latest mechanical activation site (LMAS) of the LV was identified using two-dimensional speckle-tracking radial strain analysis. Results: Seventy-eight (71%) patients exhibited an early response 1 year after CRT implantation. Of 32 non-responders in the early phase, 12 (38%) demonstrated a delayed response, and 20 (62%) were classified as non-responders after 3 years. During the follow-up time of 10.3 ± 0.5 years, the delayed and early responders had a similar prognosis of mortality and heart failure (HF) hospitalization. In contrast, non-responders had a worse prognosis. Multivariate analysis revealed that a longer duration (months) between initial HF hospitalization and CRT (odds ratio [OR]: 1.126; 95% confidence interval [CI]: 1.036–1.222; p =.005), non-exact concordance of LV lead location with LMAS (OR: 32.744; 95% CI: 1.101–973.518; p =.044), and pre-QRS duration (OR: 0.901; 95% CI: 0.827–0.981; p =.016) were independent predictors of delayed response to CRT compared with early response. Conclusion: The prognoses were similar regardless of the response time after CRT. A longer history of HF, suboptimal LV lead position, and shorter pre-QRS duration were related to delayed response than early response.

DOI： 10.1111/jce.16125

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出版者・発行元：医歯薬出版(株)  

DOI： 10.32118/j01436.2024096747

CiNii Research

記述言語：英語   出版者・発行元：Jacc Clinical Electrophysiology  

DOI： 10.1016/j.jacep.2023.08.010

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記述言語：英語   出版者・発行元：PACE Pacing and Clinical Electrophysiology  

Deep septal ventricular pacing is a recently developed physiological pacing modality with good efficacy; however, it has a potential risk of unusual complications. Here, we report a patient with pacing failure and spontaneous, complete lead dislodgement after >2 years of deep septal pacing, possibly caused by systemic bacterial infection and specific lead behavior in the septal myocardium. This case report may implicate a hidden risk of unusual complications in deep septal pacing.

DOI： 10.1111/pace.14688

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PubMed

記述言語：英語   出版者・発行元：Journal of Cardiovascular Electrophysiology  

Introduction: Diagnosis of outflow tract ventricular arrhythmia (OTVA) localization by an electrocardiographic complex is key to successful catheter ablation for OTVA. However, diagnosing the origin of OTVA with a precordial transition in lead V3 (V3TZ) is challenging. This study aimed to create the best practical electrocardiogram algorithm to differentiate the left ventricular outflow tract (LVOT) from the right ventricular outflow tract (RVOT) of OTVA origin with V3TZ using machine learning. Methods: Of 498 consecutive patients undergoing catheter ablation for OTVA, we included 104 patients who underwent ablation for OTVA with V3TZ and identified the origin of LVOT (n = 62) and RVOT (n = 42) from the results. We analyzed the standard 12-lead electrocardiogram preoperatively and measured 128 elements in each case. The study population was randomly divided into training group (70%) and testing group (30%), and decision tree analysis was performed using the measured elements as features. The performance of the algorithm created in the training group was verified in the testing group. Results: Four measurements were identified as important features: the aVF/II R-wave ratio, the V2S/V3R index, the QRS amplitude in lead V3, and the R-wave deflection slope in lead V3. Among them, the aVF/II R-wave ratio and the V2S/V3R index had a particularly strong influence on the algorithm. The performance of this algorithm was extremely high, with an accuracy of 94.4%, precision of 91.5%, recall of 100%, and an F1-score of 0.96. Conclusions: The novel algorithm created using machine learning is useful in diagnosing the origin of OTVA with V3TZ.

DOI： 10.1111/jce.15823

Open Access

Web of Science

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PubMed

記述言語：英語   出版者・発行元：F1000research  

Background: Currently, the standard curative treatment for ventricular tachycardia (VT) and ventricular fibrillation (VF) is radiofrequency catheter ablation. However, when the VT circuit is deep in the myocardium, the catheter may not be delivered, and a new, minimally invasive treatment using different energies is desired. Methods: This is a protocol paper for a feasibility study designed to provide stereotactic radiotherapy for refractory VT not cured by catheter ablation after at least one catheter ablation. The primary end point is to evaluate the short-term safety of this treatment and the secondary endpoint is to evaluate its efficacy as assessed by the reduction in VT episode. Cyberknife M6 radiosurgery system will be used for treatment, and the prescribed dose to the target will be 25Gy in one fraction. The study will be conducted on three patients. Conclusion: Since catheter ablation is the only treatment option for VT that is covered by insurance in Japan, there is currently no other treatment for VT/VF that cannot be cured by catheter ablation. We hope that this feasibility study will provide hope for patients who are currently under the stress of ICD activation. Trial registration: The study has been registered in the Japan Registry of Clinical Trials (jRCTs042230030).

DOI： 10.12688/f1000research.138758.2

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Interventional Cardiac Electrophysiology  

Background: The adaptive cardiac resynchronization therapy (aCRT) algorithm automatically produces synchronized left ventricular pacing (sLVP) with intrinsic atrioventricular conduction to improve clinical outcomes. However, relationship between sLVP percentage and risk for ventricular tachyarrhythmia (VT/VF) remains unclear. This study aimed to evaluate the clinical impact of sLVP rate on VT/VF occurrence. Methods: In total, 1,419 device interrogation data from 42 consecutive patients who underwent new aCRT device implantation were retrospectively analyzed. The primary endpoint was the first time VT/VF episode after aCRT device implantation. Results: During a median follow-up of 34 months, 15 patients had VT/VF episodes. Patients were divided into a high sLVP (the average sLVP percentage of ≥ 51.5%, n = 27) or low sLVP group (< 51.5%, n = 15). The high sLVP group had a significantly lower VT/VF incidence (22% vs. 60%; p = 0.014) and an independent predictor for VT/VF occurrence on multivariate analysis (hazard ratio 0.21; p = 0.007). LV ejection fraction improvements after 6 months (12.3 ± 8.7% vs. 2.8 ± 10.3%; p = 0.004) and 12 months (13.8 ± 9.3% vs. 6.2 ± 11.1%; p = 0.030) were significantly greater in the high sLVP group than in the low sLVP group. Age, PR interval, and left atrial diameter were significantly associated with the sLVP rate after aCRT. Conclusions: Patients with high sLVP percentage after aCRT had lower long-term risk of VT/VF incidence with a favorable response to CRT. A synchronized pacing algorithm using intrinsic conduction may prevent malignant arrhythmias, as well as recover cardiac functions.

DOI： 10.1007/s10840-022-01284-z

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PubMed

記述言語：英語   出版者・発行元：Annals of Noninvasive Electrocardiology  

Background: The current study aimed to evaluate changes in electrical depolarization and repolarization parameters after His-bundle pacing (HBP) compared with right ventricular pacing (RVP) and its association with ventricular arrhythmia (VA). Methods: Forty-one patients (13 with HBP, 14 with RVP, and 14 controls [AAI mode]) were evaluated. After continuous pacing algorithm, QRS duration, QT interval, QTc, JT interval, T-peak to T-end (Tpe), and Tpe/QT ratio were measured on electrocardiography at baseline and 1 week, 1 month, and 6 months postoperatively. We investigated VA occurrence and adverse events after implantation. Results: At 6 months, QRS duration was significantly shorter in the HBP (121.6 ± 15.6 ms) than in the RVP (150.1 ± 14.9 ms) group. The QT intervals were lower in the HBP (424.0 ± 40.9 ms) and control (405.9 ± 23.0 ms) groups than in the RVP (453.0 ± 40.2 ms) group. The Tpe and Tpe/QT ratios at 6 months differed significantly between the HBP and RVP groups (Tpe, 69.8 ± 19.7 ms vs 87.4 ± 11.9 ms and Tpe/QT, 0.16 ± 0.03 vs 0.19 ± 0.02, respectively). The Tpe and Tpe/QT ratios were similarly shortened in the HBP and control groups. VA occurred less frequently in the HBP (15%) and control (7.1%) groups than in the RVP (50%) group (p = 0.020). The non-RVP group showed significantly lower rates of VA and major adverse events than the RVP group. Patients with VA demonstrated significantly longer QRS duration, QT interval, Tpe, and Tpe/QT at 6 months than those without VA. Conclusion: HBP showed better depolarization and repolarization stability than RVP.

DOI： 10.1111/anec.12991

Open Access

Web of Science

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PubMed

記述言語：英語   出版者・発行元：Journal of Cardiovascular Electrophysiology  

Introduction: Reactive atrial-based antitachycardia pacing (rATP) in patients with cardiac implantable electronic devices (CIEDs) suppresses the progression of atrial fibrillation (AF) to the persistent form. However, the clinical factors associated with successful reactive atrial-based antitachycardia pacing (rATP) treatment are unknown. This study aimed to examine the predictors of high rATP efficacy in patients with CIEDs. Methods: The data of 101,325 rATP-treated atrial tachyarrhythmia (AT/AF) episodes in 51 patients, obtained through remote monitoring and device interrogation, were analyzed. The study population was divided into the high and low efficacy groups based on the overall median success rate of rATP. Clinical characteristics were compared between the two groups. Results: During a follow-up period of 28.6 ± 8.6 months, the median success rate was 43.7% (31.5%–64.9%). The prevalence of a history of catheter ablation of AF was significantly higher in the high efficacy group than in the low efficacy group (73.0% vs. 44.0%, p =.048) and was the only independent predictor of high rATP efficacy (odds ratio, 3.45; p =.038). The rATP success rate in patients with (n = 30) and without (n = 21) a history of catheter ablation was 53.9% (40.0%–67.5%) and 36.4% (22.2%–47.7%), respectively (p =.012). The effect of rATP after ablation was more pronounced in patients with long cycle length episodes (≥75% of AT/AF sequences having a cycle length of 200–449 ms) (67.3% [46.0%–73.6%] vs. 30.6% [18.1%–60.3%], p =.027). The high efficacy group had a significantly lower incidence of AT/AF lasting ≥1, ≥7, and ≥30 days than the low efficacy group. Conclusion: rATP combined with catheter ablation therapy is effective in suppressing AT/AF.

DOI： 10.1111/jce.15551

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PubMed

記述言語：英語   出版者・発行元：Jacc Clinical Electrophysiology  

Background: Catheter ablation for ventricular tachycardia (VT) is associated with perioperative thromboembolic risk. However, the strategy for postprocedural management remains unknown. Objectives: The aim of this study was to evaluate the prothrombotic response after VT ablation in various coagulation biomarkers in patients with and without the administration of oral anticoagulation (OAC). Methods: Data from 112 patients (58 with uninterrupted OAC and 54 without) with structural heart disease who underwent endocardial VT ablation were retrospectively analyzed. We also included 41 patients who underwent ablation for premature ventricular contraction from the right ventricle and 13 patients who underwent electrophysiology study (the control group). Blood samples of coagulation markers were collected before and 3 days after the procedure in all patients. Results: The percentage of D-dimer levels ≤1.0 μg/mL at baseline was lower in the VT ablation groups (76% and 50% in the OAC and non-OAC groups, respectively) than in the other groups (100%). After 3 days, the percentage remained at 67% in the OAC group; however, the non-OAC VT group demonstrated a remarkable decrease of 20%. Similarly, fibrin monomer complex, thrombin antithrombin, and prothrombin fragment 1+2 levels were well suppressed in the control, premature ventricular contraction, and OAC groups. However, the non-OAC group demonstrated increased coagulation markers both before and after 3 days. Multivariate analysis demonstrated that OAC administration and normal coagulation markers at baseline were independent predictors of stable coagulation status after ablation. Conclusions: The coagulation cascade was significantly activated in patients undergoing VT ablation. Uninterrupted OAC administration suppressed the coagulation response, which might be associated with a reduction in perioperative prothrombotic risk.

DOI： 10.1016/j.jacep.2022.02.015

Open Access

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PubMed

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

We report the usefulness of novel automated anti-tachycardia pacing (ATP) for ventricular tachycardia (VT) termination evaluated in an electrophysiology study. This intrinsic, automated ATP with an implanted cardiac resynchronization therapy-defibrillator successfully terminated the sustained VT, which had not been suppressed by repetitive burst pacing from the electrode catheter. The reproduction of programed pacing of the automated ATP by a right ventricular electrode catheter was effective in terminating VT, and this termination was absolute and reproducible. Further detailed assessment in an electrophysiology study could highlight the algorithm of the automated ATP and its possible benefit in terminating the reentrant VT.

DOI： 10.1536/ihj.21-755

Open Access

Web of Science

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PubMed

CiNii Research

記述言語：英語   出版者・発行元：Heart and Vessels  

Focal activation is believed to be an atrial fibrillation (AF) driver; however, little is known about whether all focal activations are necessary for AF persistence. The purpose of this study was to assess the electrical nature of focal activation and identify high-priority focal activations using a novel mapping system (CARTOFINDER). Thirty-five patients with persistent AF who underwent catheter ablation were assessed. Cycle length (CL) and CL standard deviation (CLSD) on unipolar recordings and voltage amplitude and electrogram morphologies on bipolar recordings were evaluated at all points of interest. The most frequent CL at each mapping site was defined as the dominant CL. We identified dominant focal activations (DFAs) that had a shorter dominant CL on the integrated CARTOFINDER map. The effect of elimination of DFAs on AF maintenance was assessed by the composite endpoint (termination to sinus rhythm, organization of the rhythm to atrial tachycardia, and AF CL slowing). In all, 450 focal activations were identified among 10,868 points, and 50.4% of focal activations were DFAs. Focal activations showed relatively long CL and regularity with short CLSD. Most focal activations showed an isoelectric baseline and were located outside of the fractionated electrogram area. Both DFAs and non-DFAs were typically observed in the normal voltage range. Elimination of DFAs was achieved in 19 (54.3%) patients, with a remarkable impact on AF maintenance (68.4% vs. 25.0%, p = 0.018). In conclusion, DFAs may play an important role in AF maintenance and could be an attractive therapeutic target for AF.

DOI： 10.1007/s00380-021-01977-x

Web of Science

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PubMed