研究者詳細 - 中川　晃志

論文 - 中川　晃志

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Prevalence, Characteristics, and Arrhythmogenic Substrate of Mitral Annular Disjunction Assessed by Cardiac Magnetic Resonance Imaging in Patients With Apparently Idiopathic Ventricular Arrhythmia.

Saori Asada, Hiroshi Morita, Norihisa Toh, Takuro Masuda, Akira Ueoka, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Shinsuke Yuasa

Journal of arrhythmia 41 ( 4 ) e70172 2025年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Mitral annular disjunction (MAD) is linked to an increased risk of sudden cardiac death, but its association with ventricular arrhythmias (VAs) in Japanese patients is unclear. METHODS: We retrospectively analyzed 129 Japanese patients with VAs and no overt structural heart disease who underwent echocardiography and cardiac MRI. RESULTS: MAD was diagnosed in 7.0%, and in 14% of patients with VAs originating from the mitral valve apparatus. MAD was significantly associated with multifocal VAs, late gadolinium enhancement in the papillary muscles, and greater mitral regurgitation. CONCLUSION: MAD may be an important arrhythmogenic substrate in apparently idiopathic VAs among Japanese patients.

DOI： 10.1002/joa3.70172

Pathophysiology and management of adults with complex congenital heart disease after biventricular repair. 国際誌

Mitsutaka Nakashima, Norihisa Toh, Takashi Miki, Yoichi Takaya, Koji Nakagawa, Kazuhiro Omori, Toru Miyoshi, Kazufumi Nakamura, Hiroshi Morita, Teiji Akagi, Shinsuke Yuasa

Journal of cardiology 86 ( 1 ) 12 - 19 2025年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Surgical management of congenital heart disease encompasses a spectrum of procedures, ranging from biventricular repair to univentricular palliation, each tailored to the specific anatomical and hemodynamic features of individual cases. Among these, biventricular repair, which preserves a functional ventricle to sustain pulmonary circulation, is prioritized whenever feasible. Advances in approaches have significantly improved outcomes, enabling many patients with congenital heart disease to reach adulthood, including the majority who have undergone biventricular repair. Despite these advancements, long-term complications-such as valvular disease, arrhythmias, heart failure, outflow tract obstruction, and dysfunction of extracardiac conduits-pose persistent challenges in the lifelong care of these patients. This review examines the distinct challenges and management strategies associated with adult patients who have undergone biventricular repair for complex congenital heart disease. The discussion focuses on key conditions, including repaired tetralogy of Fallot, transposition of the great arteries following atrial or arterial switch procedures, surgically managed or untreated congenitally corrected transposition of the great arteries with significant tricuspid regurgitation necessitating intervention, pulmonary atresia with intact ventricular septum, and Ebstein's anomaly. By addressing the long-term complications and therapeutic considerations unique to this patient population, this review aims to provide a comprehensive framework for optimizing care as these individuals transition into adulthood.

DOI： 10.1016/j.jjcc.2025.03.014

Hemodynamic Changes After Wire Frame Occluders vs. Metal Mesh Devices for Atrial Septal Defect.

Mitsutaka Nakashima, Yoichi Takaya, Kentaro Ejiri, Takashi Miki, Rie Nakayama, Koji Nakagawa, Teiji Akagi, Kazufumi Nakamura, Shinsuke Yuasa

Circulation journal : official journal of the Japanese Circulation Society 89 ( 7 ) 930 - 938 2025年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Transcatheter atrial septal defect (ASD) closure is the first treatment option for secundum ASD, but parameters for optimal device selection have not been established. We compared outcomes between occluders with a wire frame and metal mesh devices. METHODS AND RESULTS: This study included secundum ASD patients implanted with a wire frame occluder (GORE®CARDIOFORM ASD occluder [GCA]; W.L. Gore & Associates) or metal mesh devices (Amplatzer septal occluder device [Abbott] and Occlutech Figulla Flex II device [Occlutech]). The presence of residual shunt and B-type natriuretic peptide (BNP) levels after implantation were compared. Of the 970 patients with either GCA (n=48) or a metal mesh device (n=922; control), 42 patients from each group were analyzed after propensity score matching. The prevalence of residual shunt was significantly lower in the GCA group 1 day and 1 month after implantation (P<0.001 and P=0.017, respectively), whereas there was no significant difference between the 2 groups 6 months later (P=0.088). BNP levels at 1 month were significantly higher in the GCA group (ratio of change 1.36; 95% confidence interval [CI] 1.01-1.83), but did not differ significantly between the 2 groups at 6 months (ratio of change 1.04; 95% CI 0.65-1.65). CONCLUSIONS: Patients implanted with a wire frame occluder had a lower prevalence of residual shunt and a greater increase in BNP levels in the early period after implantation.

DOI： 10.1253/circj.CJ-24-0966

Iatrogenic laceration of the atrial septum during catheter ablation for atrial fibrillation in a patient with multiple atrial septal defects.

Koji Nakagawa, Yoichi Takaya, Teiji Akagi, Takashi Miki, Hiroshi Morita, Shinsuke Yuasa

Cardiovascular intervention and therapeutics 2025年6月

Virtual endoscopic imaging of the heart using photon-counting detector computed tomography for electrophysiologists. 国際誌

Hiroshi Morita, Saori Asada, Masakazu Miyamoto, Koji Nakagawa, Satoshi Nagase, Yoshimasa Morimoto, Satoshi Kawada, Tadashi Wada, Takuro Masuda, Akira Ueoka, Norihisa Toh, Toru Miyoshi, Nobuhiro Nishii, Shinsuke Yuasa

Heart rhythm 2025年6月

Efficacy of transcatheter patent foramen ovale closure for drug-resistant migraine: initial experience in Japan and long-term outcome.

Teiji Akagi, Yoichi Takaya, Takashi Miki, Rie Nakayama, Koji Nakagawa, Mitsuki Nakashima, Yoshiaki Takahashi, Nozomi Hishikawa, Shinsuke Yuasa

Cardiovascular intervention and therapeutics 2025年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

This study evaluates the efficacy and safety of transcatheter patent foramen ovale (PFO) closure for the treatment of drug-resistant migraine in Japan. Previous studies have suggested a potential benefit for migraine with aura, although large-scale trials in the United States and Europe have failed to confirm efficacy as a primary endpoint. The study included 27 patients (mean age 36.4 years, 15 female, 21 with aura) who had more than two migraine attacks per month despite medication. All had PFO confirmed by transesophageal echocardiography and underwent transcatheter closure with the Amplatzer PFO Occluder. Patients were followed up to 12 months with migraine severity monitored by headache specialist. The procedure was successful and without complications in all cases. One patient required a larger occluder (35 mm) due to the size of PFO. At 12 months, 22 of 27 (81%) patients reported either complete resolution or improvement of migraine. Specifically, 10 of 21 (48%) patients with aura experienced complete resolution of migraine at one year. Patients without aura had a lower response rate, with only one case of complete resolution. Despite limitations such as the lack of a control group and potential patient selection bias, the study demonstrated that PFO closure may provide significant relief for patients with drug-resistant migraine, particularly those with aura. These findings support further investigation to better define its clinical indications and potential benefits.

DOI： 10.1007/s12928-025-01135-4

Early Corticosteroid Therapy and Its Effect on Ventricular Tachyarrhythmia Recurrence in Cardiac Sarcoidosis: A 10-Year Longitudinal Multicenter Study. 国際誌

Akiko Ueda, Koji Nakagawa, Koji Miyamoto, Reina Tonegawa-Kuji, Miyako Igarashi, Kenji Okubo, Akihiko Nogami, Kengo Kusano, Kyoko Soejima

Journal of cardiovascular electrophysiology 36 ( 6 ) 1386 - 1394 2025年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: The role of corticosteroids in the management of ventricular tachyarrhythmia (VA) in cardiac sarcoidosis (CS) remains controversial. This study assessed the effect of early steroid initiation on VA recurrence rates in patients with CS and evaluated VA frequency before and after steroid therapy. METHODS: From a registry of 137 patients with CS with arrhythmias, those with VA and more than 60 days of follow-up were included. Patients were categorized into three groups: previous-on-steroid, those using corticosteroids at the time of the first VA (n = 15); early-steroid, those with steroid initiation within 60 days (n = 21); and no-or-delayed-steroid, those without steroid use at 60 days from the first VA (n = 35). The VA recurrence and timing were analyzed. RESULTS: The median age at the first VA was 60 years. Over a median follow-up period of 81 (range: 4-345) months, 43 patients experienced VA recurrence. The median time to recurrence was 101, 33, and 17 months in the early-steroid, no-or-delayed steroid, and previous-on-steroid groups, respectively. Corticosteroid use at 60 days was an independent predictor of VA recurrence at 120 months (hazard ratio: 2.257; p = 0.045 in the no-or-delayed steroid group and hazard ratio: 3.155; p = 0.021 in the previous-on-steroid group vs. the early-steroid group). Low left ventricular ejection fraction (LVEF) was associated with frequent VA episodes. Corticosteroid initiation did not increase early VA episodes. CONCLUSION: Early corticosteroid initiation after VA onset reduced the long-term recurrence without increasing early episodes. Cases of repetitive VA were common in those with low LVEF.

DOI： 10.1111/jce.16685

Acute effect of multipoint pacing and fused AV delay in patients receiving cardiac resynchronization therapy.

Masakazu Miyamoto, Nobuhiro Nishii, Tomofumi Mizuno, Akira Ueoka, Takuro Masuda, Saori Asada, Kentaro Ejiri, Satoshi Kawada, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Shinsuke Yuasa

Journal of arrhythmia 41 ( 3 ) e70085 2025年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure with dyssynchrony. However, one-third of patients do not respond positively to it. Recently, multipoint pacing (MPP), which involves pacing from two sites on the left ventricle, has been found to improve symptoms and hemodynamics compared to conventional CRT. An automatic fused atrioventricular (AV) delay that performs fused pacing for intrinsic conduction has also been introduced. However, the combined effect of MPP and fused AV delay on acute hemodynamics is unknown. OBJECTIVE: To evaluate the acute hemodynamic effects of MPP and fused AV delay in patients undergoing CRT. METHODS: A pressure wire was delivered to the left ventricle, and dp/dt was compared with single atrial stimulation pacing in 52 patients with various pacing configurations. RESULTS: Delta dp/dt was greater in MPP than in conventional CRT (10.5 ± 1.0% vs. 8.2 ± 1.0%, p < 0.001) and in fused AV delay than in short AV delay (10.4 ± 0.8% vs. 8.3 ± 1.1, p < 0.001). Hemodynamic parameters significantly most improved with the combination of MPP and fused AV delay. Delta dp/dt was greater in LV pacing than in biventricular (BiV) pacing with MPP and fused AV delay; however, the delta QRS duration was shorter in LV pacing than in BiV pacing. Delta dp/dt and delta QRS duration were negatively correlated. The super-responder rate was 66%. CONCLUSION: Combining MPP and fused AV delay has an additional effect. Shortening the QRS duration can increase the dp/dt, but the estimated line differs between LV and BiV pacing.

DOI： 10.1002/joa3.70085

Aging of the tricuspid valve annulus detected by photon-counting detector computed tomography: Importance of aortic root compression on occurrence of arrhythmias. 国際誌

Hiroshi Morita, Koji Nakagawa, Satoshi Nagase, Yoshihisa Morimoto, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Norihisa Toh, Toru Miyoshi, Nobuhiro Nishii, Shinsuke Yuasa

Heart rhythm 2025年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The aortic root compresses the heart in elderly patients, potentially influencing the conduction system and causing atrial tachyarrhythmias. However, actual anatomic alterations in the right side of the heart because of aortic root compression have not yet been fully evaluated. OBJECTIVE: This study aimed to elucidate the alterations in the tricuspid valve annulus (TVA) caused by aortic root compression using a 3-dimensional endoscopic view of the heart constructed by photon-counting detector computed tomography, an emerging medical technology. METHODS: We analyzed 147 consecutive patients who underwent photon-counting detector computed tomography at our institute after excluding those with diseases that directly influenced the right side of the heart. RESULTS: Aortic root compression caused significant TVA deformation. We defined severe TVA compression as the length of the TVA compressed by the aortic root ≥80% of the major axis of the TVA. Severe compression was more prevalent in elderly patients (age ≥75 years [44%]; P < .01). The distance between the membranous septum and ostium of the coronary sinus was shortened, whereas the cavotricuspid isthmus was elongated in older patients. The regression analysis identified aging as a significant contributor to TVA compression. The short minor and long major axes of the TVA, incidence of atrial tachyarrhythmias (74% vs 45%; P < .01), and atrioventricular conduction disturbances (35% vs 15%; P < .01) were more frequently observed in patients with severe compression. CONCLUSION: Aortic root compression deforms the TVA and alters the anatomic relationship between the atrioventricular conduction system and the cavotricuspid isthmus. Therefore, aortic root compression may contribute to the occurrence of atrial tachyarrhythmias and conduction disturbances in older patients.

DOI： 10.1016/j.hrthm.2025.03.2002

Impact of High-Sensitivity Cardiac Troponin T on Clinical Outcomes in Patients With Cardiac Sarcoidosis.

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

Circulation journal : official journal of the Japanese Circulation Society 89 ( 4 ) 442 - 449 2025年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The prognostic utility of high-sensitivity cardiac troponin T (hs-cTnT) on clinical outcomes in cardiac sarcoidosis (CS) remains unknown, so we evaluated hs-cTnT in the chronic phase of CS. METHODS AND RESULTS: We enrolled 92 consecutive patients with CS in the chronic phase after medical therapies. Patients were divided into 2 groups according to hs-cTnT level: 0.014 ng/mL: high hs-cTnT (n=37); normal hs-cTnT (n=55). The primary endpoint was cardiac death and the secondary endpoint was cardiac death, ventricular tachyarrhythmias, or hospitalization for heart failure. The mean age of patients was 63±11 years, and 75 received steroid treatment. During a median follow-up of 63 months, there were 9 cardiac deaths: 7 (19%) patients with high hs-cTnT and 2 (4%) patients with normal hs-cTnT. The rate of cardiac death was higher in patients with high hs-cTnT than in those with normal hs-cTnT (log-rank, P<0.01). Cox proportional hazard analysis showed that hs-cTnT was an independent predictor of cardiac death. The events rate was higher in patients with high hs-cTnT than in those with normal hs-cTnT (log-rank, P<0.01): cardiac death, ventricular tachyarrhythmias or hospitalization for heart failure occurred in 24 (65%) patients with high hs-cTnT and 11 (20%) patients with normal hs-cTnT. CONCLUSIONS: Elevated hs-cTnT was linked with adverse outcomes in CS patients, suggesting it is an effective prognostic biomarker.

DOI： 10.1253/circj.CJ-24-0801

Electrocardiographic correlates of ventricular arrhythmias in repaired congenital heart disease. 国際誌

Satoshi Kawada, Hiroshi Morita, Koji Nakagawa, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Norihisa Toh, Nobuhiro Nishii, Shingo Kasahara, Shinsuke Yuasa

Heart rhythm O2 6 ( 1 ) 39 - 47 2025年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Sudden cardiac death (SCD) is a major cause of mortality in congenital heart disease (CHD). Ventricular arrhythmias (VAs) are responsible for 80% of SCD. However, the clinical characteristics of patients with CHD and VAs are not fully understood. OBJECTIVE: This study was undertaken to evaluate clinical and electrocardiographic characteristics of patients with CHD based on the presence or absence of VAs. METHODS: We identified 28 patients with CHD with VAs (men, n = 15; 35.9 ± 16.5 years). Two patients with channelopathies were excluded from the analysis. RESULTS: The most common diagnoses in patients with VAs were a transposition of the great arteries (n = 8, 30.8%), followed by tetralogy of Fallot (n = 7, 26.9%). Compared with patients without VA (n = 43), those with VAs had a longer QRS (160.6 ± 52.9 ms vs 133.4 ± 29.3 ms; P = .004), a higher prevalence of fragmented QRS (65.4% vs 37.2%; P = .022) and more epsilon wave (23.1% vs 2.3%; P = .005). Multivariable analysis showed that QRS > 180 ms (odds ratio [OR], 22.23; 95% confidence interval [CI], 2.40-206.53) and epsilon wave (OR, 14.33; 95% CI, 1.47-139.58) were significantly associated with VAs. During a median follow-up duration of 5.4 years, 5 patients (19.2%) received appropriate ICD therapy, and 3 patients (11.5%) died of heart failure. CONCLUSION: The assessment of QRS duration and the presence of fQRS and epsilon waves in patients with CHD could improve risk prediction for the development of VAs. These electrocardiogram (ECG) features could assist in clinical decision-making and might consequently reduce mortality.

DOI： 10.1016/j.hroo.2024.10.006

Intracardiac Echocardiography-Guided Biopsy for a Giant Cardiac Angiosarcoma with Extensive Invasion.

Yoshitake Fukuda, Kazufumi Nakamura, Koji Nakagawa, Hironobu Toda, Yuki Otsuka, Yohei Masuda, Yoshiaki Soejima, Masahiro Tabata, Yoshiyuki Ayada, Gentaro Kato, Shingo Kasahara, Fumio Otsuka, Shinsuke Yuasa

International heart journal 66 ( 4 ) 706 - 711 2025年

記述言語：英語掲載種別：研究論文（学術雑誌）

Cardiac angiosarcoma is a rare malignant tumor with a poor prognosis. Because of its aggressive nature, early pathological diagnosis is essential. Previous studies have reported the efficacy of intracardiac echocardiography (ICE) -guided biopsy for unknown cardiac masses; however, its application is unclear. Herein, we describe a case of a giant cardiac angiosarcoma with extensive invasion, successfully diagnosed using ICE-guided biopsy. A 52-year-old man with palpitations and facial edema was admitted to our hospital. Contrast-enhanced computed tomography (CT) revealed a giant hypervascular tumor in the right atrium, extending into nearby structures, including the interatrial septum and left atrial roof. The tumor was initially suspected to be either a mediastinal tumor with cardiac invasion or a primary cardiac tumor. Given the high bleeding risk associated with percutaneous CT-guided or thoracoscopic biopsies, an ICE-guided biopsy of the right atrial mass was performed using a steerable sheath, without complications. The patient was diagnosed with angiosarcoma and underwent surgical resection. Intra-operative evaluation revealed that the tumor was confined to the pericardium with no mediastinal invasion, confirming the diagnosis of primary cardiac angiosarcoma. The patient underwent postoperative chemotherapy and radiotherapy, and is alive 7 months after surgery, demonstrating that ICE-guided biopsy using a steerable sheath is a safe and effective diagnostic tool for cardiac masses, particularly those with malignant characteristics and extensive invasion.

DOI： 10.1536/ihj.25-105

Life-Threatening Ventricular Tachyarrhythmia in Isolated Cardiac Sarcoidosis Compared With Cardiac Sarcoidosis With Extracardiac Involvement 国際誌

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

The American Journal of Cardiology 238 65 - 69 2024年12月

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

Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the risk of life-threatening ventricular tachyarrhythmia. We aimed to evaluate the incidence of ventricular tachyarrhythmia in patients with isolated CS. A total of 94 patients with CS were enrolled. Isolated CS was diagnosed by histologic or clinical confirmation in the heart alone. The end points were sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or implantable cardioverter-defibrillator therapy for ventricular fibrillation or sustained ventricular tachycardia. A total of 25 patients were diagnosed with isolated CS, and 69 were diagnosed with CS with extracardiac involvement. As the initial cardiac manifestation leading to the CS diagnosis, 10 patients (40%) with isolated CS had ventricular tachyarrhythmia. Over the median follow-up of 48 months after the CS diagnosis, sudden cardiac death occurred in 2 patients (8%) with isolated CS. Ventricular fibrillation or sustained ventricular tachycardia, including implantable cardioverter-defibrillator therapy, occurred in 15 patients (60%) with isolated CS and 13 (19%) with CS with extracardiac involvement. The rate of ventricular tachyarrhythmia was higher in patients with isolated CS than in those with CS with extracardiac involvement (log-rank, p <0.01). Cox proportional hazard analysis showed that isolated CS was independently associated with ventricular tachyarrhythmia. A total of 2 or more ventricular tachyarrhythmias more frequently occurred in patients with isolated CS (52% vs 13%, p <0.01). Electric storm more frequently occurred in patients with isolated CS (24% vs 6%, p = 0.01). In conclusion, patients with isolated CS have ventricular tachyarrhythmia at a higher rate than those with CS with extracardiac involvement.

DOI： 10.1016/j.amjcard.2024.12.002

Crescent-Shaped Atrial Septal Defect: A New Clinical Entity of an Acquired Defect for Transcatheter Closure. 国際誌

Mitsutaka Nakashima, Teiji Akagi, Yoichi Takaya, Takashi Miki, Rie Nakayama, Koji Nakagawa, Norihisa Toh, Kazufumi Nakamura, Shinsuke Yuasa

JACC. Asia 4 ( 12 ) 1013 - 1016 2024年12月

Efficacy of Ivabradine in Preventing Inappropriate Shock due to Sinus Tachycardia in a Patient with Cardiac Sarcoidosis

Takuro Masuda, Kazufumi Nakamura, Nobuhiro Nishii, Saori Asada, Akira Ueoka, Masakazu Miyamoto, Koji Nakagawa, Yoichi Takaya, Hironobu Toda, Hiroshi Morita, Shinsuke Yuasa

International Heart Journal 65 ( 6 ) 1167 - 1171 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Heart Journal (Japanese Heart Journal)

We herein report a case of left ventricular dysfunction due to cardiac sarcoidosis following cardiac resynchronization therapy defibrillator (CRT-D) in an 87-year-old man. He presented to our hospital after receiving shock therapy while conscious. Device interrogation revealed that inappropriate shock occurred due to sinus tachycardia. Due to the setting of a low ventricular tachycardia (VT) detection rate because of a history of slow VT, increasing the VT detection rate was not feasible. After initiation of treatment with ivabradine, the sinus rate decreased and there was no recurrence of inappropriate shock during a 3-year follow-up period. Ivabradine was effective for preventing inappropriate shock due to sinus tachycardia.

DOI： 10.1536/ihj.24-323

Differences in clinical significance of atrial tachyarrhythmias in idiopathic ventricular fibrillation vs Brugada syndrome: A multicenter study 国際誌

Tomofumi Mizuno, Nobuhiro Nishii, Hiroshi Morita, Takuro Masuda, Akira Ueoka, Saori Asada, Yoshimasa Morimoto, Masakazu Miyamoto, Satoshi Kawada, Tadashi Wada, Shigeki Hiramatsu, Keisuke Okawa, Motoki Kubo, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Shinsuke Yuasa

Heart Rhythm O2 5 ( 11 ) 796 - 804 2024年11月

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

BACKGROUND: Atrial tachyarrhythmias (ATAs) are the primary cause of inappropriate implantable cardioverter-defibrillator (ICD) therapy in patients with idiopathic ventricular fibrillation (IVF) and are associated with decreased quality of life and increased mortality. Nonetheless, the incidence of ATAs in IVF cases has not been clarified. OBJECTIVE: The study sought to determine the incidence and clinical significance of ATAs in patients with IVF compared with those with Brugada syndrome (BrS). METHODS: Patients diagnosed with IVF or BrS and receiving ICDs in 6 hospitals were enrolled between February 1997 and July 2020 to compute data regarding the incidence of ATAs, appropriate/inappropriate ICD therapy frequency, and independent predictors of ATAs. RESULTS: Overall, 137 patients (51 in the IVF group and 86 in the BrS group) were enrolled. ATAs were detected in 22 (43.1%) patients in the IVF group and 17 (19.8%) in the BrS group (P = .006). Inappropriate ICD therapies due to ATAs were more frequently observed in the IVF group than in the BrS group (12 [23.5%] vs 7 [8.1%]; P = .020). Conversely, there was no significant difference in appropriate ICD therapies between the IVF and BrS groups (14 [27.5%] vs 23 [27.1%]; P = 1.000). Cox regression analysis revealed no predictive factors for the development of ATAs in the IVF group. CONCLUSION: ATA events were observed more frequently in patients with IVF than in those with BrS, and ATAs led to inappropriate ICD therapy in patients with IVF. Clinicians need to consider the recurrence of not only ventricular arrhythmias, but also the development of atrial arrhythmias for better management of IVF cases.

DOI： 10.1016/j.hroo.2024.09.001

Fenestrated GORE® CARDIOFORM ASD occluder for transcatheter atrial septal defect closure in a geriatric patient.

Mitsutaka Nakashima, Teiji Akagi, Takashi Miki, Rie Nakayama, Yoichi Takaya, Koji Nakagawa, Satoshi Akagi, Norihisa Toh, Kazufumi Nakamura

Journal of cardiology cases 30 ( 2 ) 31 - 34 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

UNLABELLED: An 82-year-old man with a secundum atrial septal defect (ASD) underwent transcatheter closure. The patient had a wide area of aortic and superior rim deficiency, with left ventricular diastolic dysfunction and moderate mitral regurgitation. These findings suggested the risk of both cardiac erosion and increased left atrial pressure after closure. To avoid cardiac erosion, a GORE® CARDIOFORM ASD (GCA) occluder (W.L. Gore & Associates, Flagstaff, AZ, USA) was considered an appropriate device in this patient. However, the possibility of excessively high left atrial pressure due to complete defect closure was a concern. Thus, we created a 4.5-mm fenestration using a surgical punch in the fabric membrane of a 44-mm GCA. The device was deployed in an appropriate position, and no significant elevation of pulmonary capillary wedge pressure was observed. One month after the closure, marked improvement in clinical symptoms and continuous flow through the fenestration were observed. This novel fenestration technique may contribute to expansion of the indications for transcatheter ASD closure in patients who require a GCA owing to an anatomically high risk of erosion accompanied by left ventricular diastolic dysfunction. LEARNING OBJECTIVE: In elderly patients with left ventricular diastolic dysfunction, transcatheter atrial septal defect (ASD) closure is difficult because rapid resolution of an ASD shunt can cause an increase in left atrial pressure. Previous reports described the creation of a fenestration in the closure device. The use of a GORE® CARDIOFORM ASD (GCA) occluder can reduce the erosion risk; however, creating a stable fenestration is difficult. We developed a novel technique to create a stable fenestration in a GCA.

DOI： 10.1016/j.jccase.2024.04.001

卵円孔開存症の解剖学的特徴と卵円孔開存症閉鎖術後の残存シャントとの関係国際誌

中山理絵, 高谷陽一, 赤木禎治, 中島充貴, 三木崇史, 武本梨佳, 中川晃志, 杜徳尚, 中村一文

日本循環器学会学術集会(Web) 104 ( 3 ) 633 - 634 2024年7月

Impact of extracardiac sarcoidosis on clinical outcomes in patients with cardiac sarcoidosis: Importance of continued screening for cardiac involvement. 国際誌

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

International journal of cardiology 413 132368 - 132368 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The prognostic impact of extracardiac sarcoidosis remains unknown in cardiac sarcoidosis (CS). We aimed to evaluate the influence of extracardiac sarcoidosis on clinical outcomes and the effect of continued outpatient visits for screening of cardiac involvement. METHODS: Ninety-nine patients with CS were divided into two groups: patients with systemic CS who had prior extracardiac sarcoidosis, patients with isolated CS who had no prior extracardiac sarcoidosis. Patients with systemic CS were divided according to the continuation of outpatient visits. The endpoint was cardiac death, fatal ventricular arrhythmia, or hospitalization for heart failure. RESULTS: At the time of diagnosing CS, patients with isolated CS had a higher prevalence of high-grade atrioventricular block or fatal ventricular arrhythmia, and left ventricular contractile dysfunction than those with systemic CS. Over a median follow-up of 42 months, cardiac events occurred in 19 (37%) of 52 patients with systemic CS and in 27 (57%) of 47 patients with isolated CS. The event-free survival rate was worse in patients with isolated CS than in those with systemic CS. Cox proportional hazard analysis showed that the absence of prior extracardiac sarcoidosis was an independent predictor of adverse outcomes. Patients with systemic CS who ceased outpatient visits had a lower left ventricular ejection fraction with severe heart failure symptoms and a worse event-free survival rate than those who continued outpatient visits. CONCLUSIONS: The presence of extracardiac sarcoidosis is associated with clinical outcomes. The cessation of screening for cardiac involvement after diagnosing extracardiac sarcoidosis is associated with adverse outcomes.

DOI： 10.1016/j.ijcard.2024.132368

Late gadolinium enhancement in early repolarization syndrome 国際誌

Hiroshi Morita, Saori Asada, Satoshi Nagase, Akira Ueoka, Takuro Masuda, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii, Shinsuke Yuasa

Heart Rhythm 2024年7月

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

BACKGROUND: In patients with Brugada syndrome, myocardial fibrosis can be identified through epicardial biopsy or cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). However, the myocardial alterations in patients with early repolarization syndrome (ERS) remain poorly elucidated. OBJECTIVE: The objective of this study was to investigate the presence of myocardial fibrosis in patients with ERS by LGE in CMR. METHODS: We retrospectively evaluated 20 patients with ERS, all of whom exhibited J waves in the contiguous 2 leads. The location of J waves was classified as in the septum (V1-V2), anterior (V3-V4), lateral (I, aVL, V5-V6), inferior (II, III, aVF), or posterior (V7-V9) regions. To compare the distribution of LGE on CMR imaging with J waves, sections on short-axis view of the left ventricle (LV) were categorized as located in the septum, anterior, lateral, inferior, and posterior regions. RESULTS: Overall, 85% of ERS patients displayed LGE, which was more prevalent in the septum and posterior regions, followed by the inferior and lateral regions. The presence or absence of J waves and LGE coincided in 61% of LV areas, whereas discordance between the distributions of J waves and LGE was observed in 38%. LGE was most frequent in the septum (75%), where its reflection in J waves may be less robust. The appearance of LGE was not associated with symptoms, electrical storm, or ventricular fibrillation occurrence during follow-up. CONCLUSION: LGE is common in patients with ERS, and the distribution of J waves and LGE coincides in approximately 60% of LV areas.

DOI： 10.1016/j.hrthm.2024.07.116

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