研究者詳細 - 森田　宏

論文 - 森田　宏

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心臓突然死のrisk stratification 非虚血性心筋症患者の生命予後と心室頻拍に対する治療戦略について

西井伸洋, 江森哲郎, 永瀬聡, 森田宏, 斉藤博則, 草野研吾, 大江透

不整脈 20 ( 2 ) 184 - 184 2004年4月

Epoprostenol therapy decreases elevated circulating levels of monocyte chemoattractant protein-1 in patients with primary pulmonary hypertension.

Hashimoto Katsushi, Nakamura Kazufumi, Fujio Hideki, Miyaji Katsumasa, Morita Hiroshi, Kusano Kengo, Date Hiroshi, Shimizu Nobuyoshi, Emori Tetsuro, Matsubara Hiromi, Ohe Tohru

Circulation journal : official journal of the Japanese Circulation Society 68 ( 3 ) 227 - 31 2004年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Primary pulmonary hypertension (PPH) is a rare disease characterized by progressively increased resistance of the pulmonary arteries associated with vascular remodeling. Infiltration of inflammatory cells in affected vessels is a common pathological finding. Monocyte chemoattractant protein-1 (MCP-1) is recognized as a potent chemotactic and activating factor for monocytes and leukocytes, but its significance in PPH is unclear. METHODS AND RESULTS: Serum MCP-1 concentrations were measured in 16 PPH patients and the results were compared with those in 16 normal controls. MCP-1 concentrations in PPH patients (265.6+/-29.5 pg/ml) were significantly elevated compared with those in normal controls (119.6+/-6.9 pg/ml, p<0.0001). In 9 patients (3 men, 6 women; mean age, 29+/-3 years), repeated MCP-1 and hemodynamic measurements were performed prior to and during intravenous epoprostenol therapy. During a mean follow-up period of 7+/-1 months, MCP-1 concentrations were significantly reduced (288.8+/-122.8 to 185.9+/-117.5 pg/ml, p<0.01). CONCLUSIONS: Circulating MCP-1 concentrations are increased in PPH patients, but can alleviated by chronic intravenous epoprostenol therapy. The increase in MCP-1 might be one of the important factors responsible for the disease development in patients with PPH.

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Usefulness of body surface mapping to differentiate patients with Brugada syndrome from patients with asymptomatic Brugada syndrome.

Kenichi Hisamatsu, Kengo Fukushima Kusano, Hiroshi Morita, Shiho Takenaka, Satoshi Nagase, Kazufumi Nakamura, Tetsuro Emori, Hiromi Matsubara, Tohru Ohe

Acta medica Okayama 58 ( 1 ) 29 - 35 2004年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

We attempted to determine the usefulness of body surface mapping (BSM) for differentiating patients with Brugada syndrome (BS) from patients with asymptomatic Brugada syndrome (ABS). Electrocardiograms (ECG) and BSM were recorded in 7 patients with BS and 35 patients with ABS. Following the administration of Ic antiarrhythmic drugs, BSM was recorded in 5 patients with BS and 16 patients with ABS. The maximum amplitudes at J0, J20, J40 and J60 were compared between the 2 groups, as were 3-dimensional maps. The maximum amplitudes at J0, J20 and J60 under control conditions were larger in patients with BS than in patients with ABS (P < 0.05). A three-dimensional map of the ST segments under control conditions in patients with BS showed a higher peak of ST elevation in the median precordium compared to that for patients with ABS. Increases in ST elevation at J20, J40 and J60 following drug administration were greater in patients with BS than in patients with ABS (P < 0.05). Evaluation of the change in amplitude of the ST segment at E5 caused by Ic drug administration was also useful for differentiating between the 2 groups. In conclusion, BSM was useful for differentiating patients with BS from those with ABS.

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Evaluation of the usefulness of recording the ECG in the 3rd intercostal space and prevalence of Brugada-type ECG in accordance with recently established electrocardiographic criteria.

Kenichi Hisamatsu, Hiroshi Morita, Kengo Fukushima Kusano, Shiho Takenaka, Satoshi Nagase, Kazufumi Nakamura, Tetsuro Emori, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 68 ( 2 ) 135 - 8 2004年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: It has been reported that recording electrocardiograms (ECGs) in the 3rd intercostal space (ICS) is one method that can be used for detecting Brugada syndrome; however, the prevalence of Brugada-type ECGs recorded in the 3rd ICS and the usefulness of recording the ECG in the 3rd ICS in accordance with recently established electrocardiographic criteria is unknown. METHODS AND RESULTS: ECGs were recorded in both the 4th and 3rd ICS in 17 Brugada-type ECG patients (group A) and in 206 consecutive male subjects (group B). Brugada-type ECGs were divided into 3 types. In group A, the prevalence of type 1 ECG, which is a coved-type ECG with ST-segment elevation of >/=2 mm, increased from 23.5% to 64.7% when ECG was recorded in the 3rd ICS. The conversion to type 1 ECG was found to be related to induction of ventricular arrhythmia. In group B, the prevalence of Brugada-type ECG increased from 1.5% to 5.8% when the ECG was recorded in the 3rd ICS. CONCLUSIONS: Recording the ECG in the 3rd ICS is useful for identifying high-risk patients with Brugada-type ECG and for detecting concealed Brugada-type ECG.

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特発性心室細動と考えられた2症例―Short coupled variant of torsades de pointesとの比較検討―

渡辺敦之, 森田宏, 伴場主一, 西井伸洋, 永瀬聡, 中村一文, 斎藤博則, 草野研吾, 江森哲郎, 大江透

心電図 24 ( Suppl4 ) 61 - 67 2004年

出版者・発行元：一般社団法人日本不整脈心電学会

既往歴, 家族歴を認めない若年男性で睡眠中に突然, 心室細動 (VF) を認めた特発性心室細動と考えられた2症例を経験した.当院で経験したShort-coupled variant of Tdp (SCTDP) と考えられた2症例との比較検討を行い, 文献的考察を加えて報告する, 症例1は26歳男性.早朝, VFを認め心肺蘇生後に当科入院.症例2は29歳男性.早朝, うめき声にて家族が発見.VFを認め, 救急隊員による心肺蘇生後に入院.いずれの症例も安静時心電図にてQT延長, Brugada型心電図は認めず, ピルジカイニド負荷にてもST上昇は認めなかった.入院後は心室性期外収縮 (PVC) , 心室頻拍 (VT) を認めず, 冠動脈造影, 心筋生検でも有意な所見は認められなかった.その他の器質的心疾患の存在は否定的であった.電気生理検査では異常電位は認めず, 多形性心室頻拍 (PVT) , VFは誘発されなかった, 症例2に対してはICD植込みを施行した.現在のところ, ICDの作動は認めていない.

DOI： 10.5105/jse.24.suppl4_61

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Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome. 国際誌

Hiroshi Morita, Shiho Takenaka Morita, Satoshi Nagase, Kimikazu Banba, Nobuhiro Nishii, Yoshinori Tani, Atsuyuki Watanabe, Kazufumi Nakamura, Kengo Fukushima Kusano, Tetsuro Emori, Hiromi Matsubara, Kazumasa Hina, Toshimasa Kita, Tohru Ohe

Journal of the American College of Cardiology 42 ( 9 ) 1624 - 31 2003年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND: Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge test in BS patients, but the significance of the induced VA and TWA is not known. METHODS: Pilsicainide was administered to 65 patients with BS (10 symptomatic and 55 asymptomatic patients), and the occurrence of VA, TWA, and change of electrocardiogram were evaluated. Electrophysiologic study was performed in 57 patients, and the induction of VA by programmed electrical stimulation (PES) was evaluated. RESULTS: Ventricular arrhythmia was not induced by administration of pilsicainide in 55 patients (no-VA group). Administration of pilsicainide-induced VA in 10 patients (Pil-VA group) and polymorphic ventricular tachycardia in four patients. Pilsicainide-induced VA in 60% of the symptomatic patients but in only 7% of asymptomatic patients (p < 0.01). ST level, QTc, and indexes of cardiac conduction in the Pil-VA group were not different from those in the no-VA group. Ventricular fibrillation was induced by PES in 67% of the patients in the Pil-VA group and in 33% of the patients in the no-VA group. In six cases, macroscopic TWA occurred in association with pilsicainide-induced VA, but TWA occurred in only one patient without pilsicainide-induced arrhythmia. CONCLUSIONS: Administration of a sodium channel blocker results in induction of not only ST-elevation but also VA and TWA in patients with BS.

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β遮断薬の酸化ストレス

中村一文, 草野研吾, 森田宏, 斎藤博則, 江森哲郎, 松原広己, 大江透

心電図 23 ( 5 ) 427 - 427 2003年8月

Site-specific arrhythmogenesis in patients with Brugada syndrome. 国際誌

Hiroshi Morita, Kengo Fukushima-Kusano, Satoshi Nagase, Shiho Takenaka-Morita, Nobuhiro Nishii, Mikio Kakishita, Kazufumi Nakamura, Tetsuro Emori, Hiromi Matsubara, Tohru Ohe

Journal of cardiovascular electrophysiology 14 ( 4 ) 373 - 9 2003年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: It has been believed that electrophysiologic abnormality of the epicardial region of the right ventricular free wall may play an important role in arrhythmogenesis of phase 2 reentry in Brugada syndrome, but clinical evidence of the occurrence of ventricular arrhythmias at the right ventricular free wall has not been evaluated. In this study, we evaluated the site-specific inducibility of ventricular fibrillation (VF) and the origin of spontaneous premature ventricular contractions (PVCs) in patients with Brugada syndrome. METHODS AND RESULTS: Forty-five patients with Brugada-type ECG were enrolled in this study. Spontaneous PVCs were recorded in 9 patients. Programmed electrical stimulation (PES) was performed at the right ventricular apex (RVA), the free wall and septal region of the right ventricular outflow tract (RVOT), and the left ventricle (LV). The inducibility of PVT/VF was evaluated at each ventricular site, and the origin of PVC was determined by pace mapping. Sustained VF was induced in 17 patients. VF was induced in all 17 patients by PES at RVOT. Although PES at the septal region of the RVOT induced VF in only 5 patients (29%), PES at the free-wall region of the RVOT induced PVT/VF in 13 patients (76%). PES at RVA induced VF in only 2 patients (12%), and PES at LV failed to induce any arrhythmic events. Ventricular pace mapping showed that 64% of PVCs occurred at the free-wall region of the RVOT, 18% at the septal region of the RVOT, 9% at RVA, and 9% at LV. CONCLUSION: VF in patients with Brugada syndrome frequently is induced at the free-wall region of the RVOT area. The origin of PVC appears to be related to the site of PVT/VF induction by PES.

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Risk stratification for asymptomatic patients with Brugada syndrome.

Hiroshi Morita, Shiho Takenaka-Morita, Kengo Fukushima-Kusano, Makoto Kobayashi, Satoshi Nagase, Mikio Kakishita, Kazufumi Nakamura, Tetsuro Emori, Hiromi Matsubara, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 67 ( 4 ) 312 - 6 2003年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Ventricular fibrillation (VF) is induced in some asymptomatic patients with Brugada syndrome (BS), but the prognostic value of programmed electrical stimulation (PES) in such patients is controversial. The clinical characteristics of 41 asymptomatic BS patients, divided into 2 groups according to whether VF was induced by PES (inducible VF group: n=13, non-inducible VF group: n=28) were evaluated. ST levels in the right precordial leads were measured before and after administration of pilsicainide and the abnormal late potential (LP) was evaluated on the signal-averaged electrogram. The ST level at V(2) at baseline in the inducible VF group was significantly higher than that in the non-inducible VF group (p<0.05). Pilsicainide induced significant ST segment elevation in both groups and the ST level after pilsicainide in the inducible VF group was higher than that in the non-inducible VF group (p<0.01). LP was more frequent in the inducible VF group than in the non-inducible VF group. The criterion of ST level >0.15 mV at baseline with pilsicainide-induced additional ST elevation >0.10 mV and positive LP showed high sensitivity (92%) and specificity (89%) for detection of PES-induced VF in asymptomatic BS patients.

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Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. 国際誌

Hiroshi Morita, Kengo Kusano-Fukushima, Satoshi Nagase, Yoshihisa Fujimoto, Kenichi Hisamatsu, Hideki Fujio, Kayo Haraoka, Makoto Kobayashi, Shiho Takenaka Morita, Kazufumi Nakamura, Tetsuro Emori, Hiromi Matsubara, Kazumasa Hina, Toshimasa Kita, Masahiko Fukatani, Tohru Ohe

Journal of the American College of Cardiology 40 ( 8 ) 1437 - 44 2002年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: We sought to study atrial vulnerability in patients with Brugada syndrome. BACKGROUND: Atrial fibrillation (AF) often occurs in patients with Brugada syndrome, but atrial vulnerability in Brugada syndrome has not been evaluated. METHODS: The patient group consisted of 18 patients with Brugada syndrome. The control group consisted of 12 age- and gender-matched subjects who had neither organic heart disease nor AF episodes. The incidence and clinical characteristics of AF were evaluated in all 18 patients with Brugada syndrome, and an electrophysiologic study was performed in all 12 control subjects and in 14 of the 18 patients with Brugada syndrome. The atrial effective refractory period of the right atrium (RA-ERP), intra-atrial conduction time (conduction time from the stimulus at the right atrium to atrial deflection at the distal portion of the coronary sinus), duration of local atrial potential, and repetitive atrial firing (occurrence of two or more premature atrial complexes after atrial stimulation) were studied. RESULTS: Spontaneous AF occurred in 7 of the 18 patients with Brugada syndrome but in none of the control subjects. The RA-ERP was not different between the two groups. The intra-atrial conduction time was increased in the Brugada syndrome group versus the control group (168.4 +/- 17.5 vs. 131.8 +/- 13.0 ms, p < 0.001). The duration of atrial potential at the RA-ERP was prolonged in the Brugada syndrome group versus the control group (80.3 +/- 18.0 vs. 59.3 +/- 9.2 ms, p < 0.001). Repetitive atrial firing was induced in nine patients with Brugada syndrome and in six control subjects. Atrial fibrillation was induced in eight patients with Brugada syndrome but in none of the control subjects. In patients with Brugada syndrome without spontaneous AF, the intra-atrial conduction time and duration of atrial potential were also increased. CONCLUSIONS: Atrial vulnerability is increased in patients with Brugada syndrome. Abnormal atrial conduction may be an electrophysiologic basis for induction of AF in patients with Brugada syndrome.

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冠動脈及び全身性血管病変を呈した若年者の一例

大田恵子, 垣下幹夫, 小川愛子, 中村一文, 森田宏, 草野研吾, 江森哲郎, 松原広己, 大江透

血栓と循環 10 ( 3 ) 405 - 405 2002年9月

Spontaneous T wave alternans and premature ventricular contractions during febrile illness in a patient with Brugada syndrome. 国際誌

Hiroshi Morita, Satoshi Nagase, Kengo Kusano, Tohru Ohe

Journal of cardiovascular electrophysiology 13 ( 8 ) 816 - 8 2002年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 69-year-old man who had experienced syncope and ventricular fibrillation was referred to our hospital. ECG showed a right bundle branch block pattern with ST segment elevation in the right precordial leads. When the patient presented to the hospital with febrile illness, spontaneous T wave alternans and premature ventricular contractions were observed. When the patient became afebrile, ST segment elevation improved, and T wave alternans and premature ventricular contractions disappeared.

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発熱にともないT波交代現象と心室性期外収縮の頻発をきたしたBrugada症候群の一例

原岡佳代, 森田宏, 草野研吾, 永瀬聡, 藤尾英起, 江森哲郎, 大江透

心電図 22 ( 5 ) 482 - 482 2002年8月

[Advanced endocardial mapping systems].

Hiroshi Morita, Yasuyuki Kouno, Tohru Ohe

Nihon rinsho. Japanese journal of clinical medicine 60 ( 7 ) 1334 - 40 2002年7月

記述言語：日本語掲載種別：研究論文（学術雑誌）

The technique of endocardial mapping was developed by the advancement of radiofrequency catheter ablation techniques. Because the catheter ablation has been performed various complex arrhythmias, simple-catheter based mapping methods was limited and multiple electrodes catheter mapping and computed mapping system were developed. The basket catheter has 64-unipolar electrodes and can records endocardial potential during arrhythmia for a moment. The electro-anatomical mapping system, CARTO system, can records entire circuit of arrhythmia and point the critical area, but it will expend more time for mapping and can not indicate for unstable arrhythmias. The new mapping systems, include noncontact mapping system and LocaLisa system, will be able to use in the near future in Japan.

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Epicardial electrogram of the right ventricular outflow tract in patients with the Brugada syndrome: using the epicardial lead. 国際誌

Satoshi Nagase, Kengo Fukushima Kusano, Hiroshi Morita, Yoshihisa Fujimoto, Mikio Kakishita, Kazufumi Nakamura, Tetsuro Emori, Hiromi Matsubara, Tohru Ohe

Journal of the American College of Cardiology 39 ( 12 ) 1992 - 5 2002年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: We tried to record an epicardial electrogram directly, and we examined local electrograms before and after administration of a class IC anti-arrhythmic drug in patients with the Brugada syndrome. BACKGROUND: Electrical heterogeneity of the epicardium in the right ventricular outflow tract (RVOT) has been thought to be related to the Brugada syndrome. However, an epicardial abnormality has not been demonstrated in patients with the Brugada syndrome. METHODS: In five patients with a Brugada-type electrocardiogram (ECG), local unipolar electrograms were recorded at the epicardium and endocardium of the RVOT. To record the epicardial electrogram directly, we introduced an electrical guidewire into the conus branch (CB) of the right coronary artery. The duration of the local electrogram after termination of the QRS complex (DP) was measured before and after class IC anti-arrhythmic drug administration. The signal-averaged electrocardiogram (SAECG) was also obtained in all patients. RESULTS: A definite DP was observed at the epicardium, but not at the endocardium. After administration of a class IC anti-arrhythmic drug, the DP at the epicardium was prolonged from 38 +/- 10 ms to 67 +/- 24 ms. The late potential corresponding to the DP at the epicardium was observed in all patients on the SAECG. CONCLUSIONS: An epicardial electrogram can be recorded from the CB. Recording from the CB enables identification of an epicardial abnormality in patients with the Brugada syndrome. These abnormal electrograms may be related to a myocardial abnormality in the epicardium of patients with the Brugada syndrome.

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Brugada症候群における心房細動と心房受攻性

森田宏, 永瀬聡, 垣下幹夫, 河野康之, 草野研吾[福島], 江森哲郎, 松原広己, 大江透

不整脈 18 ( 2 ) 241 - 241 2002年4月