記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.hrcr.2022.11.014

PubMed

researchmap

記述言語：英語  

A 69-year-old woman was referred for upgrading implantable cardioverter defibrillator (ICD) to cardiac resynchronization therapy defibrillator (CRT-D) because of symptomatic heart failure due to dilated cardiomyopathy. Her electrocardiogram showed left bundle branch block and echocardiography showed severe left ventricular dysfunction. Venography confirmed the presence of persistent left superior vena cava (PLSVC), and occlusion of innominate vein and the coronary sinus (CS) ostium. We tried to insert the left ventricular (LV) lead through the PLSVC. Because the PLSVC was narrow, there was concern that insertion of the guiding catheter through the PLSVC might cause vascular damage. Therefore, we planned to implant the LV lead without a guiding catheter. Although the LV lead did not advance to the CS due to the acute angle, using a second wire (buddy wire system), the tip of the first wire was trapped by an inflated balloon delivered by a second wire (anchor balloon technique). This technique allowed us to reinforce the support of the other wire. The LV lead was easily advanced along with the fixed first wire and was delivered to the lateral vein of the CS. Thus, we successfully performed minimally invasive implantation of an LV lead through a PLSVC approach. <Learning objective: The double wire (buddy wire) technique and anchor balloon technique are effective options for implantation of a left ventricular lead through a persistent left superior vena cava in cardiac resynchronization therapy.>.

DOI： 10.1016/j.jccase.2021.11.009

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to evaluate the characteristics and prognosis of patients with vasospastic angina (VSA) diagnosed by a provocation test with a secondary prevention implantable cardioverter defibrillator (ICD), compared with patients with organic coronary stenosis. We retrospectively evaluated 309 consecutive patients who received an ICD implantation between January 2010 and March 2018 in our institutions. Of these patients, 206 were implanted with an ICD for secondary prevention. In these 206 patients, 40 with VSA and 72 with organic coronary stenosis were evaluated. Patients with VSA were characterized by younger age (56.1 ± 13.1 versus 69.2 ± 9.5 years, respectively), and a lower prevalence of diabetes (15.0% versus 40.3%, respectively) and heart failure (2.5% versus 26.4%, respectively) than patients with organic coronary stenosis (P < 0.001). Using the Kaplan-Meier analysis, with the VSA group as the reference, the incidence of appropriate ICD shock was similar between the two groups (hazard ratio, 0.85; 95% confidence interval, 0.341-2.109; P = 0.722). The incidence of ventricular fibrillation was significantly higher in the VSA group (hazard ratio, 0.22; 95% confidence interval, 0.057-0.814; P = 0.024), whereas the incidence of major adverse cardiac events, including cardiac death, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, and heart failure, was significantly higher in the organic coronary stenosis group (hazard ratio, 13.1; 95% confidence interval, 1.756-98.17; P = 0.012). In conclusion, patients with VSA with an ICD implanted for secondary prevention have a higher risk of ventricular fibrillation and lower risk of major adverse cardiac events than patients with organic coronary stenosis.

DOI： 10.1536/ihj.20-360

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary: An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion: When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

DOI： 10.1093/ehjcr/ytaa562

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The incidence of ventricular arrhythmia in patients with an implanted pacemaker is not yet known. The aim of this study was to analyze non-sustained ventricular tachycardia (NSVT) episodes based on stored electrograms (EGM) and determine the occurrence rate and risk factors for NSVT in a pacemaker population.This study included 302 consecutive patients with a dual-chamber pacemaker. A total of 1024 EGMs stored in pacemakers as ventricular high-rate episodes were analyzed. The definition of NSVT was ≥ 5 consecutive ventricular beats at ≥ 150 bpm lasting < 30 seconds.In baseline, most patients (94.8%) had ≥ 60% left ventricular ejection fraction. Of 1024 EGMs, 420 (41.0%) showed appropriate NSVT episodes, as well as premature atrial contractions, atrial tachyarrhythmia, or atrial fibrillation with a rapid ventricular response, whereas other EGMs did not show an actual ventricular arrhythmia. On EGM analysis, during a mean follow-up period of 46.1 months, NSVT occurred one or more times in 82 patients (33.1%). On multivariate analysis, ≥ 50% right ventricular pacing was an independent risk factor for NSVT (odds ratios, 4.519; P < 0.001), but NSVT was not associated with increased all-cause mortality.Moreover, in the pacemaker population, ≥ 50% right ventricular pacing is an independent risk factor for NSVT; however, NSVT was not associated with increased all-cause mortality because of the preserved left ventricular function.

DOI： 10.1536/ihj.20-141

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent pacemakers with transthoracic impedance sensors have a specific algorithm identifying sleep apnea (SA). Our aim was to evaluate the algorithm in Japanese patients. METHODS: Consecutive patients implanted with a pacemaker with sleep apnea monitoring algorithm at our hospital were enrolled prospectively. After implantation, patients underwent polysomnography (PSG). The respiratory disturbance index measured by pacemaker (RDI-PM) was extracted in the morning after PSG. RESULTS: Forty-five patients were recruited; 78% of patients underwent overnight PSG completely, and among them RDI-PM was invalid for one patient. Then the analysis was performed in 34 patients. Moderate/severe SA (apnea hypopnea index, AHI≥15events/h) and severe SA (AHI≥30events/h) by PSG were diagnosed in 65% and 41% of patients. The mean AHI-PSG and RDI-PM were 30.4±22.6 and 21.7±14.2events/h, respectively. There was a significant positive correlation between AHI-PSG and RDI-PM (r=0.543; p=0.001). The correlation was stronger in the severe SA group (r=0.664; p=0.010), in a group whose apnea index was higher than hypopnea index (r=0.822; p=0.002), and in a group whose central sleep apnea (CSA) index was higher than obstructive sleep apnea index (r=0.977; p<0.001). RDI-PM cut-off value for identifying severe SA was 22 (area under the curve, 0.682; sensitivity, 64%; specificity, 75%). CONCLUSIONS: The pacemaker-based algorithm is a useful screening tool for SA in Japanese individuals, especially in the severe SA group, apnea-dominant group, and CSA-dominant group.

DOI： 10.1016/j.jjcc.2018.10.007

PubMed

researchmap

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 Association  

A 17-year-old woman was resuscitated from cardiac arrest due to ventricular fibrillation and was diagnosed with concealed long QT syndrome. She underwent subcutaneous implantable cardiac defibrillator (S-ICD) implantation at our hospital. The device electrogram immediately after implantation was normal. Four days after implantation, she received an inappropriate shock. The device interrogation revealed a continuous baseline shift and frequent oversensing for low amplitude signals, followed by a shock. A chest radiograph in the orthogonal view showed entrapped subcutaneous air surrounding the distal electrode. Entrapped subcutaneous air can cause inappropriate shocks in the early period after S-ICD implantation.

DOI： 10.1536/ihj.17-117

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

researchmap

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 SCIENCE BV  

Background: Research on the correlation of serum bilirubin level with cardiac function as well as outcomes in heart failure patients with cardiac resynchronization therapy (CRT) has not yet been reported. The aim of this study was to analyze the relationship between change in serum bilirubin level and left ventricular reverse remodeling, and also to clarify the impact of bilirubin change on clinical outcomes in CRT patients.
Methods: We evaluated 105 consecutive patients who underwent CRT. Patients who had no serum total-bilirubin data at both baseline and 3-9 months' follow-up or had died less than 3 months after CRT implantation were excluded. Accordingly, a total of 69 patients were included in the present analysis. The patients were divided into two groups: decreased bilirubin group (serum total-bilirubin level at follow-up &lt;= that at baseline; n = 48) and increased bilirubin group (serum total-bilirubin level at follow-up &gt; that at baseline; n = 21).
Results: Mean follow-up period was 39.3 months. In the decreased bilirubin group, mean left ventricular end-systolic diameter decreased from 54.5 mm to 50.2 mm (p = 0.001) and mean left ventricular ejection fraction increased significantly from 29.8% to 37.0% (p = 0.001). In the increased bilirubin group, there was no significant change in echocardiographic parameters from baseline to follow-up. In Kaplan-Meyer analysis, cardiac mortality combined with heart failure hospitalization in the increased bilirubin group was significantly higher than that in the decreased bilirubin group (log-rank p = 0.018). Multivariate Cox regression analysis revealed that increased bilirubin was an independent predictor of cardiac mortality combined with heart failure hospitalization (OR = 2.66, p = 0.023).
Conclusions: The change in serum bilirubin is useful for assessment of left ventricular reverse remodeling and prediction of outcomes in heart failure patients with CRT. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2017.04.001

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: The characteristics and prognosis of implanted pacemaker-identified new-onset atrial fibrillation (AF) in Japanese people has not been well evaluated.
Methods and Results: A total of 395 consecutive patients with newly implanted pacemakers were retrospectively analyzed between January 2010 and December 2015 at Yokohama City University Hospital. Patients with a prior history of AF, VVI mode pacemaker, congenital heart disease, severe valvular heart disease, and cardiovascular surgery before pacemaker implantation were excluded. Among the remaining patients, 44 (21.3%) developed new AF during follow-up (mean follow-up, 1,115 +/- 651 days; range, 9-2,176 days). Patients with new-onset AF had a significantly higher CHADS(2) score (2.09 +/- 1.27 vs. 1.31 +/- 1.08, P&lt;0.001) and CHA(2)DS(2)-VASc score (3.00 +/- 1.39 vs. 2.26 +/- 1.19, P&lt; 0.001) compared with those without new-onset AF. On Cox regression analysis only age at implantation was significantly correlated with new-onset AF. Interestingly, the incidence of hospitalization due to heart failure was significantly higher in the new-onset AF than in the without new-onset AF group.
Conclusions: A total of 21.3% of pacemaker-implanted patients with high CHADS(2) and CHA(2)DS(2)-VASc scores developed new-onset AF during a mean follow-up of 3.1 years; and pacemaker-identified AF was associated with an increased risk of worsening heart failure.

DOI： 10.1253/circj.CJ-16-1018

Web of Science

PubMed

researchmap

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 Ltd  

Patients with corrected transposition of great arteries (c-TGA) are generally known to develop atrioventricular block, systemic right ventricular dysfunction, and tricuspid regurgitation over time, which are associated with tachyarrhythmia and progressive heart failure. A 76-year-old man had been diagnosed with c-TGA. He developed a cardiopulmonary arrest while playing tennis, and an automated external defibrillator detected ventricular fibrillation (VF). Immediate cardiopulmonary resuscitation and intensive treatment were performed. He fully recovered without neurological sequelae. QRS duration was 172 ms. Echocardiography showed marked dysfunction and dyssynchrony of the systemic right ventricle (systemic right ventricular end-diastolic diameter/end-systolic diameter = 73/60 mm, systemic right ventricular ejection fraction = 34%). For secondary prevention and treatment of progressive heart failure, cardiac resynchronization therapy with defibrillator (CRT-D) implantation was recommended. Venography via the left cubital superficial vein revealed a persistent left superior vena cava (PLSVC) and giant coronary sinus that did not connect with the right superior vena cava (SVC). Because of the acute angle between the PLSVC and great cardiac vein, we selected a right-sided approach via the right SVC. We were finally able to deliver a coronary sinus lead to the lateral vein. CRT-D implantation can be achieved even in patients with c-TGA and PLSVC. &lt
Learning objective: CRT-D implantation can be achieved even in a patient with c-TGA and PLSVC.&gt

DOI： 10.1016/j.jccase.2016.11.008

Scopus

PubMed

researchmap

DOI： 10.4022/jafib.1381

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: The incidence of atrioventricular block (AVB) in pacemaker patients with sick sinus syndrome (SSS) is not yet known. The aim of this study was to analyze AVB episodes in SafeR mode based on stored electrograms (EGM), and determine the occurrence rate and risk factors for advanced AVB in a pacemaker population with SSS.
Methods and Results: The study included 50 consecutive patients with SSS without a history of advanced AVB who had a dual-chamber pacemaker programmed in SafeR mode. A total of 377 EGM stored in the pacemakers as AVB episodes fulfilling the second-or third-degree criterion were analyzed. Of 377 EGM, 73 EGM (19.4%) were appropriate episodes, whereas the other EGM did not show actual AVB, and showed atrial tachyarrhythmia, ventricular event in the blanking period, or premature atrial contractions with block. On EGM analysis, advanced AVB occurred in 9 patients (18%), and the occurrence rate was 11.7% per year. Moreover, on multivariate analysis beta-blocker use was an independent risk factor for advanced AVB (OR, 9.10; P=0.004).
Conclusions: The occurrence rate of advanced AVB in patients with SSS is much higher than previously reported, and beta-blocker use is an independent risk factor for advanced AVB. SafeR is useful to detect latent AVB. Stored EGM, however, sometimes include inaccurately classified events.

DOI： 10.1253/circj.CJ-14-1255

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Obstruction of the access vein is a well-known complication after cardiovascular implantable electronic device (CIED) implantation. In that case, well-developed collateral superficial veins are frequently observed on the skin surface around the CIED. The aim of this study was to clarify the relationship between venous obstruction and development of a superficial vein across the clavicle.
Methods and Results: A total of 107 patients scheduled for generator replacement, device upgrade, or lead extraction were enrolled. The skin surface around the device was photographed. A 20-ml bolus of contrast medium was injected into a peripheral arm vein on the side of CIED implantation, and contrast venography was performed. Venous obstruction was defined as luminal diameter narrowing &gt;75%. Venography showed venous obstruction in 27 patients (25.2%). There were no statistically significant differences in patient characteristics between the venous obstruction and no venous obstruction group. Of 107 patients, 44 (41.1%) had a superficial vein across the clavicle on the side of CIED implantation. The sensitivity of the presence of a superficial vein across the clavicle in the diagnosis of venous obstruction was 96.3% and specificity was 77.5% (P&lt;0.001).
Conclusions: The presence of a superficial vein across the clavicle is useful for the prediction of venous obstruction in patients with CIED.

DOI： 10.1253/circj.CJ-14-0104

Web of Science

Scopus

PubMed

researchmap

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 B.V.  

Background: The effect of cardiac pacing on sleep-disordered breathing is controversial. We investigated the long-term effect of cardiac pacing on sleep disordered breathing in patients with conventional indications for permanent pacemakers Methods: Subjects comprised 40 patients (29 men
mean age 69 ± 9 years, mean left ventricle ejection fraction 69 ± 8%, and body mass index 23.6 ± 3.5 kg/m2) who were diagnosed with indications for permanent pacemakers (sick sinus syndrome in 23 patients, atrioventricular block in 15, and brady atrial fibrillation in 2). All patients received polysomnographic evaluations before implantation of permanent pacemakers. After implantation of permanent pacemakers, all patients received polysomnographic evaluations during use of the pacemaker settings (AAI/DDD/VVI at 70 beats per minute). Results: The mean follow-up period was 35 ± 13 months. Before implantation, the distribution of sleep-disordered breathing was as follows: 93% had apnea hypopnea index &gt
5, 58% had apnea hypopnea index &gt
15, and 20% had apnea hypopnea index &gt
30. The mean apnea hypopnea index for all patients was 20 ± 15, for those with obstructive type apnea was 4.9 ± 5.3, and for those with central type apnea was 3.0 ± 4.5. The mean Epworth Sleepiness Score was 5.9 ± 4.0. No patient received continuous positive airway pressure therapy or any other therapy for sleep-disordered breathing during the follow up period. The mean apnea hypopnea index at 1 week after implantation of permanent pacemakers was 21 ± 14 (P=0.8) and the mean apnea hypopnea index at end of follow-up was 11 ± 7(P&gt
0.0001). Conclusion: Long term cardiac pacing significantly reduces the number of episodes of sleep apnea in patients with conventional permanent pacemaker indications. © 2014 Japanese Heart Rhythm Society.

DOI： 10.1016/j.joa.2014.02.003

Scopus

researchmap

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 IRELAND LTD  

Background: Renal insufficiency is recognized as a predictor of mortality and adverse outcome in heart failure (HF) patients. However, the long-term clinical outcome of cardiac resynchronization therapy (CRT) in Japanese HF patients with renal insufficiency remains uncertain.
Methods: We evaluated 67 consecutive patients who underwent CRT at our hospital. The patients were divided into two groups according to a baseline estimated glomerular filtration rate (e-GFR) cut-off value of 50 ml/min, which is defined as the time at which patients should be referred to a nephrologist, by the Japanese Society of Nephrology. Follow-up echocardiographic findings and renal function were examined at 3-6 months after CRT. Then, we compared long-term clinical outcomes between the two groups, and analyzed the effect of CRT on renal function, echocardiographic parameters and cardiac survival.
Results: During a mean follow-up period of 30.3 months, patients with advanced renal insufficiency (e-GFR &lt; 50 ml/min) had significant higher all-cause mortality (log-rank p = 0.033) and higher cardiac mortality combined with HF hospitalization (log-rank p = 0.017) than patients with e-GFR &gt;= 50 ml/min. Multivariate analysis revealed that advanced renal insufficiency was an independent predictor of cardiac mortality combined with HF hospitalization (odds ratio = 3.01, p = 0.008). Subgroup analysis in the baseline advanced renal insufficiency group revealed that patients with preserved renal function by CRT (&lt;10% reduction in e-GFR) had a higher rate of decrease of left ventricular end-systolic diameter (-14.0% vs. -0.8%, p = 0.023) and lower cardiac mortality combined with HF hospitalization (log-rank p = 0.029) compared with patients with deterioration of renal function (&gt;= 10% reduction in e-GFR).
Conclusions: The present study suggests that advanced renal insufficiency is quite useful for the prediction of worsening clinical outcomes in HF patients treated by CRT. Preservation of renal function by CRT brings about better cardiac survival through prevention of adverse cardiac events, even in HF patients with advanced renal insufficiency. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2012.06.001

Web of Science

PubMed

researchmap

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 Association  

Ventricular desynchronization imposed by ventricular pacing causes regional disturbances of adrenergic innervation in the left ventricular myocardium and increases the risk of heart failure and atrial fibrillation (AF) in patients with sinus node disease (SND). As a result, decreased iodine-123 metaiodobenzylguanidine (I-123 MIBG) uptake occurs in patients with an implanted permanent pacemaker. Fourteen SND patients with an implanted pacemaker equipped with an algorithm for reducing unnecessary right ventricular pacing (RURVP) were enrolled. Pacemakers were programmed to RURVP mode for the first 12 weeks, and then reprogrammed to DDD for the last 12 weeks. At the end of each mode, data on cumulative percent ventricular pacing (%Vp), atrial high rate episodes (%AHR), I-123 MIBG myocardial scintigraphy, brain natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and myocardial damage indices typified by troponin T and C-reactive protein (CRP) were collected. %Vp was lower in RURVP than in DDD (0.2% versus 95.7%, P = 0.00098). BNP, hANP, troponin T, and CRP did not differ significantly between the pacing modes. However, I-123 MIBG findings of patients with full ventricular pacing in DDD improved in RURVP. In contrast, among patients without full ventricular pacing in DDD, their I-123 MIBG findings did not differ significantly between the pacing modes. In SND patients with normal cardiac function and intact atrioventricular conduction, the reduction of %Vp in RURVP was due to the reduction of ineffective pacing and fusion pacing in DDD. Therefore, these 2 types of pacing do not affect cardiac pump function.

DOI： 10.1536/ihj.53.353

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) was implanted dual-chamber ICD for the purpose of both the left ventricular outflow tract (LVOT) gradient reduction by ventricular pacing and the primary prevention of ventricular tachyarrhythmia. Because the LVOT gradient reduction and improvement of symptoms by pacing were insufficient, however, a new pacing lead was inserted in the right ventricular apex at a different position 1.5 cm away from the site of the defibrillation lead, and the LVOT gradient greatly declined from 108 to 30 mmHg. This DDD pacing was continued over seven years. On this occasion, he was referred to our hospital because of battery depletion, and a cardiac catheterization study was performed after ICD replacement. The LVOT gradient was 10 mmHg in sinus rhythm. After administration of isoproterenol (0.02γ), the gradient was increased to 92 mmHg in sinus rhythm. DDD pacing using a newly placed ventricular pacing lead significantly decreased the gradient to 36 mmHg. This case study indicated that DDD pacing from a suitable location in the right ventricular apex caused a marked early reduction in the LVOT gradient, and at long-term follow up a further significant effect was obtained, also in sinus rhythm. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.226

Scopus

researchmap

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

72歳女性。永続性心房細動と左室心尖部心室瘤を伴う肥大型心筋症の症例。心室頻拍(VT)でICD頻回作動のためカテーテルアブレーションの方針とした。右室ペーシング下でisochronal late activation map(ILAM)とvoltage mapを作成した。心尖部心室瘤内に広範の低電位領域を認め,瘤内の中隔後壁と前壁にdeceleration zone(DZ)を,側壁にさらに遅れたsharpなdelayed potentialを認めた。DZ2ヶ所に多極マッピングカテーテルを配置すると,右室ペーシング時はsplit delayed potential,VT時はmid diastolic～pre systolic potentialを認めた。VT中のactivation mapでは2ヶ所のDZを通過するcritical isthmusが確認された。前壁DZでは,concealed entrainmentが得られpost pacing interval(PPI)はVT cycle length(VTCL)に一致し,S-QRS/VTCL=31%でcentral isthmusと判断した。Delayed potentialを認めた側壁でもVT中にmid diastolic potentialを認め,同部位でconcealed entrainment,PPI=VTCL,S-QRS/VTCL=35%となり前壁DZ部位よりentrance側のcentral isthumsと判断した。側壁delayed potential部位の通電にて5秒で頻拍停止し,その後誘発されなくなった。2ヶ所のDZを必須緩徐伝導路に含むことがILAM,entrainment,VT activation mapにて証明できた1例として報告する。(著者抄録)

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

緒言:近年、小児における皮下植込み型除細動器(S-ICD)植込みの熊告が散見される。35kg以下の小児例での植込み報告は少なく、安全に施行し得た2症例を経験したため報告する。症例:(1)11歳男児。体重32.8kg。生来健康。X年4月に心肺停止となり心室細動に対して除細動を行い前医へ搬送。第6病日に当院に転院。精査の結果QT延長症候群あるいは特発性心室細動となった。第24病日にS-ICD植込み術を施行。経過良好で第34病日に退院した。(2)7歳男児。体重27.3kg。NAA10遺伝子異常を伴う肥大型心筋症のため前医通院中、Y年5月に心肺停止となり心室細動に対して除細動を行い前医へ搬送。精査の結果QT延長症候群と診断し心室細動の原因と考えられた。第22病日に当院に転院し第29病日にS-ICD植込み術を施行。経過良好で第38病日に退院した。結語:35kg以下の小児に対して安全にS-ICD植込みができた症例を経験した。植込み後の長期的なデータが乏しいため、今後も創部・リードトラブルや不適切作動について十分な経過観察が必要と考えられる。(著者抄録)

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00679&link_issn=&doc_id=20220617260021&doc_link_id=%2Fah2sinzd%2F2022%2F005406%2F025%2F0729-0733%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2022%2F005406%2F025%2F0729-0733%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：臨床心臓電気生理研究会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：南山堂  

CiNii Books

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(株)南山堂  

CiNii Books

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2011235682

記述言語：日本語   出版者・発行元：Japan Heart Foundation  

症例は76歳, 女性. 1989年に洞不全症候群(II型)にてDDDペースメーカー植え込みを施行した. 2001年にペースメーカー感染を発症したため, 保存的治療を行い, 以降, 良好に経過していた. 2008年6月に電池消耗のため, ペースメーカー交換を施行した. その18日後にポケット部の皮膚に瘻孔が形成され, 膿の漏出が認められ, ペースメーカー感染の診断で入院となった. ペースメーカー本体を除去し, ポケット内デブリードマンを行った. リード線は用手法では容易には抜去できず, 可視範囲内で2本ともリードのコネクト部を切断した. 血液とポケット内の培養より緑膿菌が検出されたため, 6週間抗生物質投与を行った. しかし, 2009年3月に39℃の発熱にて入院となった. 血液培養より緑膿菌が検出され, 残存リード線の感染と診断した. 2009年3月中旬に心臓外科医および体外循環装置の待機下, 心室リード(フィン型)に対して, 右大腿静脈アプローチでリード抜去術を行った. 8Frブライトチップシースを右大腿静脈に挿入した. ピッグテイルカテーテルをリードにかけ, アンプラッツグーズネックスネアでガイドワイヤーを捕捉し, ループを作成した. リードの中の鎖骨下静脈断端に近い部位に固定し引いたところ, 同側のリード断端が遊離された. 次にその断端をスネアで捕捉し, シースとともに引いたところ, リード全体を抜去することができた. ペースメーカーリード感染に対し, 経大腿静脈アプローチにて留置後20年のペーシングリードを抜去し得た症例について報告する.

DOI： 10.11281/shinzo.43.505

J-GLOBAL

researchmap

記述言語：日本語  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(株)南山堂  

researchmap

記述言語：日本語   出版者・発行元：南山堂  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(株)南山堂  

CiNii Books

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2009214749

記述言語：日本語   出版者・発行元：(株)南山堂  

CiNii Books

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2009173485

記述言語：英語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：Japan Heart Foundation  

症例は81歳, 男性. 陳旧性肺結核·慢性肺気腫·閉塞性肥大型心筋症(hypertrophic obstructive cardiomyopathy; HOCM)に対して経過観察されていた. 2007年9月急性肺炎で入院中に急性心筋梗塞を合併し緊急心臓カテーテル検査を施行. 大動脈内バルーンパンピング(intraaortic balloon pumping; IABP)挿入後に左前下行枝segment 7の閉塞病変に対して血栓吸引療法を施行し再疎通に成功. 第7病日に心不全が改善せずHOCMと僧帽弁閉鎖不全(mitral regurgitation; MR)の悪化による低拍出量症候群が考えられ一時ペーシング(DDD)を開始. HOCMとMRの改善により心不全は軽快しIABPが離脱できた. 第14病日に永久ペースメーカー(DDD)植え込み術を施行し, 呼吸不全は気管切開後に持続的陽圧呼吸(continuous positive airway pressure; CPAP)まで改善したが, 第39病日に陳旧性肺結核による喀血で慢性呼吸不全が悪化し第49病日に多臓器不全で死亡. HOCMに合併した急性心筋梗塞によって血行動態が悪化しペースメーカー治療が有効であった稀な症例について報告する.

DOI： 10.11281/shinzo.41.567

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(株)南山堂  

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

DOI： 10.11477/mf.1541101121

CiNii Books

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2008136752

記述言語：日本語   出版者・発行元：ライフサイエンス出版(株)  

researchmap

記述言語：日本語   出版者・発行元：神奈川県医師会  

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：英語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

researchmap

記述言語：日本語  

researchmap

記述言語：日本語  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

researchmap

記述言語：英語  

researchmap

記述言語：日本語  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

researchmap

記述言語：英語  

researchmap

記述言語：英語  

researchmap

記述言語：日本語  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

researchmap

researchmap

researchmap

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語  

researchmap

記述言語：英語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap