研究者詳細 - 中川　晃志

論文 - 中川　晃志

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Risk stratification for the occurrence of ventricular fibrillation in patients with early repolarization syndrome 国際誌

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

Heart Rhythm 21 ( 10 ) 1787 - 1794 2024年5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: Several signs of malignant early repolarizations have been proposed in patients with early repolarization syndrome (ERS). However, reports have challenged the efficacy of these signs in predicting future ventricular fibrillation (VF) in patients with ERS. OBJECTIVE: This study aimed to assess the predictive value of various electrocardiogram (ECG) markers for future VF events in patients with ERS. METHODS: We retrospectively evaluated the clinical characteristics of 44 patients with ERS to identify risk factors for VF during follow-up. RESULTS: After the initial event, 16 patients experienced VF (VF group), whereas 28 did not (non-VF group). The VF group had a longer QRS interval, more fragmented QRS (fQRS), and a higher T/R voltage ratio than the non-VF group. Wide J waves were more prevalent in the VF group; however, other J-wave markers did not differ between the groups. Positive late potentials recorded on signal-averaged ECGs were more frequent in the VF group. Whereas none of the patients showed spontaneous Brugada syndrome on ECG, the VF group frequently exhibited pilsicainide-induced ST-segment elevation. These ECG markers were significantly associated with the occurrence of VF during follow-up. Patients with multiple ECG factors, including QRS abnormalities (wide QRS or fQRS), wide J waves, and a high T/R ratio, had a worse prognosis than patients without multiple factors, effectively stratifying patient risk. CONCLUSION: The occurrence of VF in patients with ERS may be associated with conduction abnormalities such as QRS widening, fQRS, high T/R ratio, positive late potentials, and pilsicainide test results. Therefore, ECG factors could be useful in identifying high-risk patients.

DOI： 10.1016/j.hrthm.2024.04.101

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Clinical characteristics of electrical storm in patients with early repolarization syndrome 国際誌

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

Heart Rhythm 21 ( 5 ) 562 - 570 2024年5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: Early repolarization syndrome (ERS) is an idiopathic ventricular fibrillation (VF) associated with inferolateral J waves. While electrical storm (ES) in ERS is not rare, their characteristics and risk factors are not fully understood. OBJECTIVE: This study aimed to clarify the significance of ES in ERS. METHODS: We evaluated 44 patients with ERS who experienced VF/sudden cardiac death or arrhythmic syncope. We assessed clinical characteristics to identify the risk factors for ES. RESULTS: In total, 13 patients (30%) experienced ES (ES group). Of these, 11 patients (85%) experienced ES during the acute phase of initial VF episodes and 2 patients (2%) experienced ES during follow-up. VF associated with ES occurred during therapeutic hypothermia in 6 of 13 patients (46%). The J-wave voltage during therapeutic hypothermia was higher in the ES group than that in the patients without ES. Isoproterenol was used in 5 patients (38%), which decreased J-wave voltage and relieved ES. Among the clinical markers, shorter QT and QTp intervals (the interval from QRS onset to the peak of T wave), pilsicainide-induced ST elevation, and high scores on the Shanghai Score System were associated with ES. Although pilsicainide induced ST elevation in 6 of 34 patients (18%), spontaneous Brugada electrocardiographic patterns did not appear to be associated with VF. Therapeutic hypothermia was also a risk factor for acute phase ES. CONCLUSION: Patients with ERS in the ES group frequently had short QT and QTp intervals, pilsicainide-induced ST elevations, and high Shanghai Score System scores. Therapeutic hypothermia was also associated with acute phase ES.

DOI： 10.1016/j.hrthm.2024.01.016

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Idiopathic ventricular tachycardia detected after coronavirus disease 2019.

Koichiro Yamamoto, Koji Nakagawa, Fumio Otsuka

Journal of general and family medicine 25 ( 3 ) 164 - 165 2024年5月

Artificial intelligence to detect noise events in remote monitoring data

Nobuhiro Nishii, Kensuke Baba, Ken'ichi Morooka, Haruto Shirae, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Kentaro Ejiri, Satoshi Kawada, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Shinsuke Yuasa

Journal of Arrhythmia 40 ( 3 ) 560 - 577 2024年4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：Wiley

Abstract

Background

Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) can detect various events early. However, the diagnostic ability of CIEDs has not been sufficient, especially for lead failure. The first notification of lead failure was almost noise events, which were detected as arrhythmia by the CIED. A human must analyze the intracardiac electrogram to accurately detect lead failure. However, the number of arrhythmic events is too large for human analysis. Artificial intelligence (AI) seems to be helpful in the early and accurate detection of lead failure before human analysis.

Objective

To test whether a neural network can be trained to precisely identify noise events in the intracardiac electrogram of RM data.

Methods

We analyzed 21 918 RM data consisting of 12 925 and 1884 Medtronic and Boston Scientific data, respectively. Among these, 153 and 52 Medtronic and Boston Scientific data, respectively, were diagnosed as noise events by human analysis. In Medtronic, 306 events, including 153 noise events and randomly selected 153 out of 12 692 nonnoise events, were analyzed in a five‐fold cross‐validation with a convolutional neural network. The Boston Scientific data were analyzed similarly.

Results

The precision rate, recall rate, F1 score, accuracy rate, and the area under the curve were 85.8 ± 4.0%, 91.6 ± 6.7%, 88.4 ± 2.0%, 88.0 ± 2.0%, and 0.958 ± 0.021 in Medtronic and 88.4 ± 12.8%, 81.0 ± 9.3%, 84.1 ± 8.3%, 84.2 ± 8.3% and 0.928 ± 0.041 in Boston Scientific. Five‐fold cross‐validation with a weighted loss function could increase the recall rate.

Conclusions

AI can accurately detect noise events. AI analysis may be helpful for detecting lead failure events early and accurately.

DOI： 10.1002/joa3.13037

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卵円孔開存閉鎖後の卵円孔開存の解剖学的特徴と残存シャントの関係【JST機械翻訳】|||

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) 39 ( 2 ) 200 - 206 2024年4月

Feasibility of Treat and Repair Strategy in Congenital Heart Defects With Pulmonary Arterial Hypertension. 国際誌

Satoshi Akagi, Shingo Kasahara, Teiji Akagi, Kentaro Ejiri, Toshiharu Mitsuhashi, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Ito

JACC. Advances 3 ( 4 ) 100887 - 100887 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: A treatment strategy for congenital heart defects with moderate to severe pulmonary arterial hypertension (PAH) has not been established. OBJECTIVES: The purpose of this study was to identify patients in whom a treat and repair strategy was considered and to examine pretreatment variables associated with successful defect repair. METHODS: Patients with atrial or ventricular septal defect and PAH (pulmonary vascular resistance [PVR] ≥ 5 Wood units) eligible for the treat and repair strategy were included. Hemodynamics among pretreatment, pre-repair, and post-defect repair were compared. Clinical outcomes in patients with or without defect repair were also compared. Clinical outcomes included all-cause death, hospitalization for worsening pulmonary hypertension, and lung transplantation. RESULTS: Among 25 eligible for the treat and repair strategy, 20 underwent successful repair (repaired group) and 5 did not have a repair (unrepaired group). In the repaired group, PVR significantly decreased from 9.6 ± 2.6 WU at pretreatment to 5.0 ± 3.4 pre-repair (ß coefficient -4.6 [95% CI: -5.9 to -3.3]). The pulmonary to systemic blood flow ratio (Qp/Qs) increased from 1.5 ± 0.6 at pretreatment to 2.4 ± 1.3 pre-repair (ß coefficient 0.9 [95% CI: 0.4-1.38]). In the unrepaired group, pretreatment PVR decreased with treatment; however, PVR remained elevated. Qp/Qs did not change between pretreatment and post-treatment. The repaired group had a better prognosis than the unrepaired group (HR 0.092 [95% CI: 0.009-0.905]). Pretreatment mean pulmonary artery pressure, PVR, Qp/Qs, and arterial oxygen saturations were associated with undergoing defect repair. CONCLUSIONS: In this small cohort, a treat and repair strategy was successfully used in a significant proportion of the patients with congenital heart defects with moderate to severe PAH.

DOI： 10.1016/j.jacadv.2024.100887

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成人Fontan患者における鉄欠乏の有病率と運動能力との関連【JST機械翻訳】|||

中島充貴, 杜徳尚, 赤木禎治, 中山理絵, 三木崇史, 高谷陽一, 赤木達, 中川晃志, 西井伸洋, 中村一文

日本循環器学会学術集会(Web) 88回 PJ027 - 2 2024年3月

成人期PDA閉鎖術の至適デバイス選択に対する心臓CTの有用性

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

日本成人先天性心疾患学会雑誌 13 ( 1 ) 124 - 124 2024年1月

出産を契機に肺高血圧症と診断されTreat & Repair療法に成功したASD症例

古田めぐみ, 中島充貴, 赤木禎治, 三木崇史, 中山理絵, 高谷陽一, 中川晃志, 赤木達, 杜徳尚, 西井伸洋, 中村一文, 松原広己

日本成人先天性心疾患学会雑誌 13 ( 1 ) 143 - 143 2024年1月

Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm. 国際誌

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

Journal of cardiovascular electrophysiology 35 ( 2 ) 307 - 316 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Electrical storm (ES) of ventricular tachyarrhythmias (VTAs) is an important cause of sudden death in patients with cardiac sarcoidosis (CS). VTAs in CS are associated with myocardial scarring and inflammation. However, little is known about the risk factors of ES in patients with CS and VTAs. The objective of this study is to clarify the characteristics and risk factors for the development of ES in patients with CS. METHODS: The study population included consecutive 52 patients with CS and sustained VTA. Twenty-five out of 52 patients experienced ES. We evaluated clinical characteristics, imaging modalities, and electrocardiogram (ECG) parameters to determine the risk factors associated with ES. RESULTS: Half of the patients experienced VTAs as the initial symptom of sarcoidosis, and eight patients had ES as the initial VTA episode. There were no differences in cardiac imaging abnormalities between patients with and without ES. Among ECG markers, significant QRS fragmentation (odds ratio [OR]: 7.9, p = .01) and epsilon waves (OR: 12.24, p = .02) were associated with ES. Among the ventricular tachycardia (VT) characteristics, multiple morphologies of monomorphic VTs (OR: 10.9, p < .01), short VT cycle lengths (OR: 12.5, p < .01), and polymorphic VT (OR: 13.5, p < .01) were associated with ES. Bidirectional VTs were detected in 10 patients with ES and one patient without ES. Immunosuppressive therapy relieved ES in some patients. CONCLUSIONS: ES was common in patients with CS and VTAs. Significant depolarization abnormalities that appeared as QRS fragmentation, epsilon waves, and specific VT characteristics were associated with ES.

DOI： 10.1111/jce.16156

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A variability of the QRS morphology during wide QRS tachycardia. 国際誌

Saori Asada, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura

Pacing and clinical electrophysiology : PACE 46 ( 12 ) 1568 - 1571 2023年12月

Management of sensing issues with a subcutaneous implantable cardioverter-defibrillator in a patient with Brugada syndrome: A case report. 国際誌

Satoshi Kawada, Nobuhiro Nishii, Tomofumi Mizuno, Masakazu Miyamoto, Koji Nakagawa, Hiroshi Morita

HeartRhythm case reports 9 ( 12 ) 878 - 882 2023年12月

Initial results of transcatheter modification of left atrial appendage by obliteration with device in patients with nonvalvular atrial fibrillation: Real-world data from the TERMINATOR registry. 国際誌

Hidehiko Hara, Shunsuke Kubo, Yoshifumi Nakajima, Takashi Matsumoto, Yusuke Kondo, Hiroki Sugane, Kenji Okubo, Koji Nakagawa, Daisuke Nagatomo, Daisuke Hachinohe, Shigeki Kusa, Masahiko Goya, Mamoru Nanasato, Takeshi Arita, Hiro Yamasaki, Kensuke Kuwabara, Tomotaka Yoshiyama, Nobuaki Tanaka, Masaharu Masuda, Tomohiro Sakamoto, Masaki Nakashima, Yohei Ohno, Shigeru Saito, Masato Fukunaga

Journal of cardiology 83 ( 5 ) 298 - 305 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Percutaneous left atrial appendage closure (LAAC) has increased for those who need alternative to long-term anticoagulation with non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: From September 2019, after initiating WATCHMAN (Boston Scientific, Maple Grove, MN, USA) device implantation, we established Transcatheter Modification of Left Atrial Appendage by Obliteration with Device in Patients from the NVAF (TERMINATOR) registry. Utilizing 729 patients' data until January 2022, we analyzed percutaneous LAAC data regarding this real-world multicenter prospective registry. A total of 729 patients were enrolled. Average age was 74.9 years and 28.5 % were female. Paroxysmal AF was 37.9 % with average CHADS2 3.2, CHA2DS2-VASc 4.7, and HAS-BLED score of 3.4. WATCHMAN implantation was successful in 99.0 %. All-cause deaths were 3.2 %, and 1.2 % cardiovascular or unexplained deaths occurred during follow-up [median 222, interquartile range (IQR: 93-464) days]. Stroke occurred in 2.2 %, and the composite endpoint which included cardiovascular or unexplained death, stroke, and systemic embolism were counted as 3.4 % [median 221, (IQR: 93-464) days]. Major bleeding defined as BARC type 3 or 5 was seen in 3.7 %, and there was 8.6 % of all bleeding events in total [median 219, (IQR: 93-464) days]. CONCLUSIONS: These preliminary data demonstrated percutaneous LAAC with WATCHMAN device might have a potential to reduce stroke and bleeding events for patients with NVAF. Further investigation is mandatory to confirm the long-term results of this strategy using this transcatheter local therapy instead of life-long systemic anticoagulation.

DOI： 10.1016/j.jjcc.2023.09.010

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Syncope and loss of consciousness after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: Prevalence and characteristics in long-term follow-up. 国際誌

Saori Asada, Hiroshi Morita, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii

Heart rhythm O2 4 ( 10 ) 641 - 649 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Syncope is a significant prognostic factor in patients with Brugada syndrome (BrS). However, the risk of ventricular arrhythmia in patients with nonarrhythmic loss of consciousness (LOC) is similar to that in asymptomatic patients. LOC events after implantable cardioverter-defibrillator (ICD) implantation may provide insights into underlying causes of the initial LOC episode. OBJECTIVE: The purpose of this study was to examine LOC characteristics following ICD implantation. METHODS: We retrospectively analyzed 112 patients with BrS (mean age 47 years; 111 men) who were treated with an ICD. The patients were classified into 3 groups based on symptoms at implantation: asymptomatic (35 patients); LOC (46 patients); and ventricular tachyarrhythmia (VTA) (31 patients). We evaluated the incidence and cause of LOC during long-term follow-up after ICD implantation. RESULTS: During mean follow-up of 12.2 years, 41 patients (37%) experienced LOC after ICD implantation. Arrhythmic LOC occurred in 5 asymptomatic patients, 14 LOC patients, and 16 patients with VTA. Nonarrhythmic LOC, similar to the initial episode, occurred after ICD implantation in 6 patients with prior LOC (2 with neurally mediated syncope and 4 with epilepsy). Most epileptic patients experienced LOC during rest or sleeping, and did not show an abnormal encephalogram during initial evaluation of the LOC episodes. CONCLUSION: After ICD implantation, 13% of patients had nonarrhythmic LOC similar to the initial episode. Accurate classification of LOC based on a detailed medical history is important for risk stratification, although distinguishing arrhythmic LOC from epilepsy-related LOC episodes can be challenging depending on the circumstances and characteristics of the LOC event.

DOI： 10.1016/j.hroo.2023.09.007

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Ventricular arrhythmias induced by phase 2 reentry in a patient with J-wave syndrome. 国際誌

Satoshi Kawada, Hiroshi Morita, Masakazu Miyamoto, Saori Asada, Koji Nakagawa, Nobuhiro Nishii

HeartRhythm case reports 9 ( 9 ) 629 - 633 2023年9月

GORE CARDIOFORM Septal Occluderを用いた経皮的卵円孔開存閉鎖術の国内初期成績

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

日本心臓病学会学術集会抄録 71回 O - 1 2023年9月

Significance of left posterior extension of early repolarization in patients with J-wave syndrome. 国際誌

Masakazu Miyamoto, Hiroshi Morita, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii

Heart rhythm 20 ( 12 ) 1729 - 1736 2023年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: J waves in the inferior or lateral leads are characteristic electrocardiographic (ECG) changes in patients with early repolarization syndrome (ERS). However, the presence of J waves in the left posterior region has not yet been evaluated. OBJECTIVE: The purpose of this study was to clarify the significance of J waves in the posterior left ventricle using leads V7-V9 and a body surface mapping (BSM) system. METHODS: Forty patients diagnosed with ERS were included. All patients exhibited J waves in either the contiguous inferior, lateral, or posterior leads. We evaluated the incidence of J waves in the inferolateral and posterior leads using a 15-lead ECG with synthesized V7-V9 and an 87-lead BSM. Additionally, we assessed the arrhythmogenicity of the posterior regions based on the morphology of the premature ventricular complexes (PVCs) associated with ventricular fibrillation (VF). RESULTS: J waves were observed in the lateral, inferior, and posterior leads of 26 (65%), 31 (78%), and 39 (97%) patients, respectively. J waves were found only in the posterior leads of 5 patients. BSM was evaluated in 9 patients, all of whom exhibited a positive area on the posterior region. PVCs associated with VF were recorded in 5 patients. Among patients with inferolateral and posterior J waves, all except 1 patient who displayed left bundle branch block morphology showed PVCs originating from the posterior left ventricular region. CONCLUSION: Posterior J waves are common in ERS patients. This abnormality can be detected using leads V7-V9 and the BSM system and may be associated with arrhythmogenesis.

DOI： 10.1016/j.hrthm.2023.08.032

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奇異性脳塞栓症を起こした卵円孔開存は心臓CTでどのように見えるのか?

三木崇史, 中川晃志, 辻真弘, 中島充貴, 西原大裕, 中山理絵, 高谷陽一, 三好亨, 赤木禎治, 伊藤浩

日本心血管インターベンション治療学会抄録集 31回 MO66 - 5 2023年8月

Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis. 査読

Masakazu Miyamoto, Kazufumi Nakamura, Koji Nakagawa, Nobuhiro Nishii, Satoshi Kawada, Akira Ueoka, Saori Asada, Atsuyuki Watanabe, Hiroshi Morita, Hiroshi Ito

Circulation reports 5 ( 7 ) 298 - 305 2023年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background: Various types of arrhythmia are observed in patients with cardiac amyloidosis, but the prevalence of arrhythmia has not been fully investigated. This study investigated the prevalence and treatment of arrhythmias in patients with cardiac amyloidosis before the introduction of new agents for amyloidosis, such as tafamidis. Methods and Results: Of 53 patients who were histologically diagnosed with cardiac amyloidosis at 10 centers in western Japan between 2009 and 2021, 43 who were diagnosed on the basis of immunohistochemical staining were evaluated in this study. Of these 43 patients, 13 had immunoglobulin light-chain (AL) amyloidosis and 30 had transthyretin (ATTR) amyloidosis; further, 27 had atrial tachyarrhythmia, 13 had ventricular tachyarrhythmia, and 17 had bradyarrhythmia. Atrial fibrillation (AF) was the most common arrhythmia in patients with cardiac amyloidosis (n=24; 55.8%), especially among those with ATTR amyloidosis (70.0% of ATTR vs. 23.1% of AL). Eleven (25.6%) patients were treated with a cardiac implantable device. All 3 patients with pacemakers were alive at the last follow-up (median 76.7 months; interquartile range [IQR] 4.8-146.4 months). Of the 8 patients who underwent AF ablation, there was no recurrence in 6 (75%) after a median of 39.3 months (IQR 19.8-59.3 months). Conclusions: The prevalence of various arrhythmias was high in patients with cardiac amyloidosis. AF occurred most frequently in patients with cardiac amyloidosis, especially among patients with ATTR.

DOI： 10.1253/circrep.CR-23-0022

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Significant Delayed Activation on the Right Ventricular Outflow Tract Represents Complete Right Bundle-Branch Block Pattern in Brugada Syndrome. 国際誌

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

Journal of the American Heart Association 12 ( 10 ) e028706 2023年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background The appearance of complete right bundle-branch block (CRBBB) in Brugada syndrome (BrS) is associated with an increased risk of ventricular fibrillation. The pathophysiological mechanism of CRBBB in patients with BrS has not been well established. We aimed to clarify the significance of a conduction delay zone associated with arrhythmias on CRBBB using body surface mapping in patients with BrS. Methods and Results Body surface mapping was recorded in 11 patients with BrS and 8 control patients both with CRBBB. CRBBB in control patients was transiently exhibited by unintentional catheter manipulation (proximal RBBB). Ventricular activation time maps were constructed for both of the groups. We divided the anterior chest into 4 areas (inferolateral right ventricle [RV], RV outflow tract [RVOT], intraventricular septum, and left ventricle) and compared activation patterns between the 2 groups. Excitation propagated to the RV from the left ventricle through the intraventricular septum with activation delay in the entire RV in the control group (proximal RBBB pattern). In 7 patients with BrS, excitation propagated from the inferolateral RV to the RVOT with significant regional activation delay. The remaining 4 patients with BrS showed a proximal RBBB pattern with the RVOT activation delay. The ventricular activation time in the inferolateral RV was significantly shorter in patients with BrS without a proximal RBBB pattern than in control patients. Conclusions The CRBBB morphology in patients with BrS consisted of 2 mechanisms: (1) significantly delayed conduction in the RVOT and (2) proximal RBBB with RVOT conduction delay. Significant RVOT conduction delay without proximal RBBB resulted in CRBBB morphology in patients with BrS.

DOI： 10.1161/JAHA.122.028706

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