Faculty Profiles - MORITA Hiroshi

Papers - MORITA Hiroshi

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Activation Pattern of the Polymorphic Ventricular Tachycardia and Ventricular Fibrillation on Body Surface Mapping in Patients With Brugada Syndrome.

Akira Ueoka, Hiroshi Morita, Atsuyuki Watanabe, Koji Nakagawa, Nobuhiro Nishii, Satoshi Nagase, Tohru Ohe, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 80 ( 8 ) 1734 - 43 2016.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract (RVOT) in patients with Brugada syndrome (BrS). To evaluate the importance of the RVOT, we evaluated the activation pattern of induced ventricular tachyarrhythmias using body surface mapping (BSM) in patients with BrS. METHODS AND RESULTS: We examined 14 patients with BrS in whom ventricular tachyarrhythmias were induced by programmed electrical stimulation. The 87-lead BSM was recorded during induced ventricular tachyarrhythmias, and an activation map and an isopotential map of QRS complexes every 5 ms were constructed to evaluate the activation pattern of ventricular tachyarrhythmias. BSM during 20 episodes of ventricular tachyarrhythmias induced at the RVOT showed that repetitive excitation was generated at the RVOT and propagated to the inferior RV and left ventricle, and then returned to the RVOT. Polymorphic QRS change during ventricular tachyarrhythmias was associated with migration of the earliest activation site and rotor. BSM during 4 episodes of ventricular fibrillation (VF) showed that the excitation front moved randomly with formation of multiple wavefronts. CONCLUSIONS: Programmed stimulation initiated repetitive firing from the RVOT. Migration and competition of the earliest activation site and rotor and local conduction delay changed the QRS morphology. Degeneration of the reentrant circuit into multiple wavefronts resulted in VF. (Circ J 2016; 80: 1734-1743).

DOI： 10.1253/circj.CJ-16-0124

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Prognostic significance of fever-induced Brugada syndrome. International journal

Yuka Mizusawa, Hiroshi Morita, Arnon Adler, Ofer Havakuk, Aurélie Thollet, Philippe Maury, Dao W Wang, Kui Hong, Estelle Gandjbakhch, Frédéric Sacher, Dan Hu, Ahmad S Amin, Najim Lahrouchi, Hanno L Tan, Charles Antzelevitch, Vincent Probst, Sami Viskin, Arthur A M Wilde

Heart rhythm 13 ( 7 ) 1515 - 20 2016.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In Brugada syndrome (BrS), spontaneous type 1 electrocardiogram (ECG) is an established risk marker for fatal arrhythmias whereas drug-induced type 1 ECG shows a relatively benign prognosis. No study has analyzed the prognosis of fever-induced type 1 ECG (F-type1) in a large BrS cohort. OBJECTIVES: The objectives of this study were to assess the prognosis of F-type1 in asymptomatic BrS and to compare the effects of fever and drugs on ECG parameters. METHODS: One hundred twelve patients with BrS who developed F-type1 were retrospectively enrolled. Prognosis was evaluated in 88 asymptomatic patients. In a subgroup (n = 52), ECG parameters of multiple ECGs (at baseline, during fever, and after drug challenge) were analyzed. RESULTS: Eighty-eight asymptomatic patients had a mean age of 45.8 ± 18.7 years, and 71.6% (67 of 88) were men. Twenty-one percent (18 of 88) had a family history of sudden cardiac death, and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. Drug challenge was positive in 29 of 36 patients tested (80.6%). The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y (3 of 88; 43.6 ± 37.4 months). ST-segment elevation in lead V2 during fever and after drug challenge was not significantly different (0.41 ± 0.21 ms during fever and 0.40 ± 0.30 ms after drug challenge; P > .05). Fever shortened the PR interval compared to baseline, whereas drug challenge resulted in prolonged PR interval and QRS duration (PR interval: 169 ± 29 ms at baseline, 148 ± 45 ms during fever, and 202 ± 35 ms after drug challenge; QRS duration: 97 ± 18 ms at baseline, 92 ± 28 ms during fever, and 117 ± 21 ms after drug challenge). CONCLUSION: Patients with BrS who develop F-type1 are at risk of arrhythmic events. F-type1 appears to develop through a more complex mechanism as compared with drug-induced type 1 ECG.

DOI： 10.1016/j.hrthm.2016.03.044

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チアノーゼ型心疾患術後に生じた肺動静脈瘻のAmplatzer Vascular Plug IIによる塞栓術

三木崇史, 赤木禎治, 高谷陽一, 麻植浩樹, 中川晃志, 中村一文, 森田宏, 伊藤浩

日本成人先天性心疾患学会雑誌 5 ( 1 ) 114 - 114 2016.1

Fallot四徴症術後遠隔期にカテコラミン誘発性多形性心室頻拍が疑われICD植込みを行った1例

上岡亮, 森田宏, 西井伸洋, 橘元見, 津島翔, 中川晃志, 渡邊敦之, 中村一文, 永徳隆裕, 馬場健児, 大月審一, 笠原真吾, 佐野俊二, 永瀬聡, 伊藤浩

心臓 48 ( 1 ) S1_163 - S1_163 2016

Language：Japanese Publisher：公益財団法人日本心臓財団

症例は3歳の男児. 生後6カ月でFallot四徴症 (TOF) に対し修復術施行, 術後高度肺動脈弁逆流 (PR) が残存し加療中であった. 三輪車に乗っている際に心肺停止状態となり, 救急搬送された. 初期波形は心室細動であり, 電気的除細動器により停止するも, 啼泣および興奮時に繰り返し二方向性の心室頻拍 (VT) をきたした. β遮断薬・Ⅰ群薬での治療を試みたが発作抑制されず, 徐脈も著明となり増量困難であった. 心臓電気生理検査では瘢痕は見られず, プログラム刺激でVTは誘発されず, カテコラミン負荷で多源性VTが誘発された. VTは手術切開線と関連無く, 交感神経亢進時に誘発される二方向性VTで, カテコラミン誘発性多形性心室頻拍 (CPVT) と診断. 薬物治療は限界で高度PRもあり, 開胸下で右室流出路再建術, ICD心外膜リード植込みを行った. 心房ペーシング下でのβ遮断薬内服で, VTの再発は見られていない. TOFにCPVTが合併した稀有な症例を経験したので報告する.

DOI： 10.11281/shinzo.48.S1_163

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Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block.

Tadashi Wada, Satoshi Nagase, Hiroshi Morita, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Kunihisa Kohno, Hiroshi Ito, Kengo F Kusano, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 79 ( 12 ) 2568 - 75 2015

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Brugada syndrome (BrS)-type electrocardiogram (ECG) is concealed by complete right bundle-branch block (CRBBB) in some cases of BrS. Clinical significance of BrS masked by CRBBB is not well known. METHODS AND RESULTS: We reviewed an ECG database of 326 BrS patients who had type 1 ECG with or without pilsicainide. "BrS masked by CRBBB" was defined on ECG as <2-mm elevation of the J point at the time of CRBBB in the right precordial leads, and BrS-type J-point elevation ≥2 mm at the time of normalized QRS complex on relieved CRBBB. We identified 25 BrS patients (7.7%) with persistent (n=12) or intermittent CRBBB (n=13). Relief of CRBBB by pacing was performed in patients with persistent CRBBB. The prevalence of BrS masked by CRBBB was 3.1% (10/326 patients). Three patients had type 1 ECG, and 7 patients had type 2 or 3 ECG on relief of CRBBB. Two of these 10 patients had lethal arrhythmic events during the follow-up period (mean, 86.4±57.2 months). There was no prognostic difference between BrS masked by CRBBB and other BrS. CONCLUSIONS: In a small BrS population, CRBBB can completely mask typical BrS-type ECG. BrS masked by CRBBB is associated with the same risk of fatal ventricular tachyarrhythmia as other BrS.

DOI： 10.1253/circj.CJ-15-0618

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Risk stratification in patients with Brugada syndrome without previous cardiac arrest – prognostic value of combined risk factors.

Hideo Okamura, Tsukasa Kamakura, Hiroshi Morita, Koji Tokioka, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Nobuhiro Nishii, Satoshi Nagase, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Hiroshi Ito, Tohru Ohe, Kengo F Kusano

Circulation journal : official journal of the Japanese Circulation Society 79 ( 2 ) 310 - 7 2015

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear. METHODS AND RESULTS: A total of 218 consecutive patients (211 male; aged 46 ± 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001). CONCLUSIONS: Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.

DOI： 10.1253/circj.CJ-14-1059

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成人先天性心疾患に伴う不整脈の特徴と最新の治療心房中隔欠損と心房細動の治療の最前線

中川晃志, 永瀬聡, 赤木禎治, 木島康文, 高谷陽一, 西井伸洋, 河野晋久, 中村一文, 森田宏, 伊藤浩

日本心臓病学会学術集会抄録 62回 JS3 - 3 2014.9

Electrocardiographic parameters and fatal arrhythmic events in patients with Brugada syndrome: combination of depolarization and repolarization abnormalities. International journal

Koji Tokioka, Kengo F Kusano, Hiroshi Morita, Daiji Miura, Nobuhiro Nishii, Satoshi Nagase, Kazufumi Nakamura, Kunihisa Kohno, Hiroshi Ito, Tohru Ohe

Journal of the American College of Cardiology 63 ( 20 ) 2131 - 2138 2014.5

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study aimed to determine the usefulness of the combination of several electrocardiographic markers on risk assessment of ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). BACKGROUND: Detection of high-/low-risk BrS patients using a noninvasive method is an important issue in the clinical setting. Several electrocardiographic markers related to depolarization and repolarization abnormalities have been reported, but the relationship and usefulness of these parameters in VF events are unclear. METHODS: Baseline characteristics of 246 consecutive patients (236 men; mean age, 47.6 ± 13.6 years) with a Brugada-type electrocardiogram, including 13 patients with a history of VF and 40 patients with a history of syncope episodes, were retrospectively analyzed. During the mean follow-up period of 45.1 months, VF in 23 patients and sudden cardiac death (SCD) in 1 patient were observed. Clinical/genetic and electrocardiographic parameters were compared with VF/SCD events. RESULTS: On univariate analysis, a history of VF and syncope episodes, paroxysmal atrial fibrillation, spontaneous type 1 pattern in the precordial leads, and electrocardiographic markers of depolarization abnormalities (QRS duration ≥120 ms, and fragmented QRS [f-QRS]) and those of repolarization abnormalities (inferolateral early repolarization [ER] pattern and QT prolongation) were associated with later cardiac events. On multivariable analysis, a history of VF and syncope episodes, inferolateral ER pattern, and f-QRS were independent predictors of documented VF and SCD (odds ratios: 19.61, 28.57, 2.87, and 5.21, respectively; p < 0.05). Kaplan-Meier curves showed that the presence/absence of inferolateral ER and f-QRS predicted a worse/better prognosis (log-rank test, p < 0.01). CONCLUSIONS: The combination of depolarization and repolarization abnormalities in BrS is associated with later VF events. The combination of these abnormalities is useful for detecting high- and low-risk BrS patients.

DOI： 10.1016/j.jacc.2014.01.072

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左室側壁心外膜側に不整脈基質が存在すると考えられたJ波症候群の1例

中川晃志, 永瀬聡, 和田匡史, 田中正道, 西井伸洋, 寒川睦子, 河野晋久, 中村一文, 森田宏, 草野研吾, 伊藤浩, 湯本晃久, 向原直木, 大江透

臨床心臓電気生理 37 127 - 135 2014.5

Language：Japanese Publisher：臨床心臓電気生理研究会

症例は52歳、男性。以前より心電図にて早期再分極が認められていた。心室細動自然発作を来たしたため、当院入院。心電図ではI、II、aVl、aVf、V4-6にJ波を認めた。心臓電気生理学的検査において、多極カテーテルにて経冠静脈的に左室側壁心外膜側の電位を記録すると、単極および双極誘導において体表面心電図のJ波に相当する成分が記録され、この成分は心房頻回刺激およびisoproterenolにて減高し、pilsicainideにて増強を示した。一方、前室間静脈、中心静脈、左室側壁心内膜側からの記録ではJ波に相当する成分は記録されず、また心室プログラム刺激にて心室細動は右室心尖部、右室流出路、左室心内膜側からは誘発されず、左室側壁心外膜側からのみ誘発された。Pilsicainide投与後は左室心外膜側起源と思われる期外収縮が散発し、Brugada型波形は出現しなかった。本例はJ波症候群Type 1+2と考えられ、左室側壁心外膜側の電気的異常が病態の成因に関与することが示唆された興味深い1例と考えられたので報告する。(著者抄録)

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心臓突然死予知への挑戦サルコイドーシスにおけるlateral領域のfragmented QRSは心室頻拍の予測因子となる

武寛, 森田宏, 伴場主一, 廣畑敦, 中村一文, 草野研吾, 山本桂三, 大江透, 伊藤浩

心電図 34 ( Suppl.2 ) S - 35 2014.3

Left ventricular epicardial electrogram recordings in idiopathic ventricular fibrillation with inferior and lateral early repolarization. International journal

Koji Nakagawa, Satoshi Nagase, Hiroshi Morita, Hiroshi Ito

Heart rhythm 11 ( 2 ) 314 - 7 2014.2

A successful epicardial ablation from the middle cardiac vein for ventricular tachycardia with prior inferior myocardial infarction

Wada Tadashi, Nagase Satoshi, Tanaka Masamichi, Nakagawa Koji, Nishii Hironobu, Kohno Yoshihisa, Nakamura Kazufumi, Morita Hiroshi, Ito Hiroshi

Shinzo 46 ( 3 ) S3_203 - S3_211 2014

右室単発早期刺激により明瞭なcoved型そしてsaddleback型心電図が得られたBrugada症候群の1例

中川晃志, 永瀬聡, 和田匡史, 田中正道, 西井伸洋, 渡邊敦之, 中村一文, 森田宏, 河野晋久, 草野研吾, 大江透, 伊藤浩

心臓 45 ( Suppl.3 ) 143 - 148 2013.12

Language：Japanese Publisher：(公財)日本心臓財団

症例は62歳、男性。早朝の苦悶様呼吸に続く呼吸停止疑いのため近医受診し、Brugada症候群疑いにて当院紹介入院。心電図では完全右脚ブロックを合併することもありBrugada型心電図との診断が容易ではなかった。電気生理学的検査時、ピルジカイニド1mg/kgを投与したが、やはり明瞭なBrugada型波形が得られないため、完全右脚ブロックの状態を是正する目的で右室心尖部より単発早期刺激を加えた。すると刺激間隔の短縮に伴いcoved型そしてsaddleback型の比較的明瞭なBrugada型心電図を得ることができた。完全右脚ブロックを伴いBrugada型心電図の診断が困難であったが右室心尖部単発早期断激によりBrugada型心電図が明瞭化され、また、相対的な右室伝導遅延の改善に伴いcoved型からsaddleback型に心電図が変化したBrugada症候群の1例を経験したので報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00679&link_issn=&doc_id=20131216220028&doc_link_id=10.11281%2Fshinzo.45.S3_143&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.45.S3_143&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

LQT1において血清カリウム値がQT間隔および不整脈イベントに及ぼす影響

杉山洋樹, 中村一文, 森田宏, 三浦大志, 永瀬聡, 河野晋久, 草野研吾, 大江透, 伊藤浩

心電図 33 ( Suppl.4 ) S - 194 2013.9

CPAを発症したLQTS症例の臨床像の特徴

寒川睦子, 森田宏, 河野晋久, 永瀬聡, 西井伸洋, 中村一文, 草野研吾, 伊藤浩, 大江透, 氏家良人

心電図 33 ( Suppl.4 ) S - 172 2013.9

QT延長症候群の診断に苦慮した1例

高谷陽一, 森田宏, 麻植浩樹, 杜徳尚, 吉田賢司, 谷山真規子, 三好亨, 西井伸洋, 永瀬聡, 中村一文, 河野普久, 草野研吾, 伊藤浩

心電図 33 ( Suppl.4 ) S - 154 2013.9

治療に苦慮した先天性QT延長症候群(LQT3)の1例

野田陽子, 森田宏, 三浦大志, 高谷陽一, 和田匡史, 中川晃志, 西井伸洋, 永瀬聡, 伊藤浩

心電図 33 ( Suppl.4 ) S - 153 2013.9

Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: a novel risk factor for Brugada syndrome with ventricular fibrillation. International journal

Hiro Kawata, Hiroshi Morita, Yuko Yamada, Takashi Noda, Kazuhiro Satomi, Takeshi Aiba, Mitsuaki Isobe, Satoshi Nagase, Kazufumi Nakamura, Kengo Fukushima Kusano, Hiroshi Ito, Shiro Kamakura, Wataru Shimizu

Heart rhythm 10 ( 8 ) 1161 - 8 2013.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF). OBJECTIVE: To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF. METHODS: We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.1 mV in inferior (II, III, aVF) or lateral leads (I, aVL, V₄-V₆), in 49 individuals (46 men; age 46 ± 13 years) with a type 1 ECG of BrS and previous history of VF. RESULTS: ER was observed persistently (in all ECGs) in 15 patients (31%; P group), intermittently (in at least one but not in all ECGs) in 16 patients (33%; I group), and not observed in 18 patients (37%; N group), yielding an overall ER incidence of 63% (31/49). During the follow-up period (7.7 years), recurrence of VF was documented in all 15 patients (100%) in the P group, and less in 12 patients (75%) in the I group and in 8 patients (44%) in the N group. The P group showed a worse prognosis than N group (P = .0001) by Kaplan-Meier analysis. Either persistent or intermittent ER in an inferolateral lead was an independent predictor of fatal arrhythmic events (hazard ratio 4.88, 95% confidence interval 2.02-12.7, P = .0004; and hazard ratio 2.50, 95% confidence interval 1.03-6.43, P = .043, respectively). CONCLUSION: The prevalence of ER in inferolateral leads was high and an especially persistent form of ER was associated with a worse outcome in BrS patients with documented VF.

DOI： 10.1016/j.hrthm.2013.04.009

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BAL所見が診断に有用であった持続性心室頻拍を伴う心室瘤の1例

和田匡史, 草野研吾, 西井伸洋, 永瀬聡, 森田宏, 中村一文, 河野晋久, 伊藤浩

心臓 45 ( Suppl.2 ) 91 - 91 2013.8

サルコイドーシスにおける心室頻拍の予測因子

武寛, 森田宏, 伴場主一, 大原美奈子, 廣瀬英軌, 廣畑敦, 草野研吾, 山本桂三, 大江透, 伊藤浩

心臓病センター榊原病院雑誌 17 14 - 18 2013.8

Language：Japanese Publisher：心臓病センター榊原病院

サルコイドーシスにおける心室頻拍の予後予測因子として、fragmented QRS(fQRS)が関連するか検討した。心臓サルコイドーシス50例(心サ)、全身性サルコイドーシス71例(全サ)であった。心サ群では、房室ブロックを66%に認め、心機能も有意に低値であった。心サ群50例のうち、初診時に心室頻拍を認めたのは19例であった。fQRSの存在は、心サ群と全サ群とも有意差を認めなかったが、局在性をみると、前壁(52%対30%)、側壁(54%対14%)で有意差を認めた。下壁のfQRSは、全サ群にも多く認め、前壁、側壁のfQRSが心サ群に関連している可能性が考えられた。心サ群の11例が再発、無症候性31例のうち6例に心室頻拍の新規発症を認めた。全サ群からの心室頻拍発症は認めなかった。前壁(68%対31%)、側壁(60%対23%)のfQRSはVT群で有意に高値であった。

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Papers - MORITA Hiroshi