Initial Experience of Percutaneous Extraction of Infected Cardiac Implantable Electric Devices Using Excimer Laser

Article信州医学雑誌 63(2):103-108 (2015)journal articl

National survey of catheter ablation for atrial fibrillation: The Japanese catheter ablation registry of atrial fibrillation (J-CARAF)

AbstractTo assess the current status of atrial fibrillation (AF) ablation in Japan, the Japanese Heart Rhythm Society (JHRS) instituted a national registry, the Japanese Catheter Ablation Registry of AF (J-CARAF).MethodsUsing an online questionnaire, the JHRS invited electrophysiology centers in Japan to voluntarily and retrospectively register data regarding the AF ablation procedures performed in September, 2011.ResultsA total of 128 centers submitted data regarding AF ablation procedures in 932 patients (age 62.1±10.4 years; male 76.8%; paroxysmal AF 65.7%, CHADS2 score 1.0±1.0). The majority received oral anticoagulant therapy during and following the procedure (68.9% and 97.5%, respectively). Pulmonary vein isolation (PVI) was performed in 97.5% of the patients; ipsilateral encircling PVI was the preferred technique (79.7%). Three-dimensional (3D) mapping systems and irrigated-tip catheters were used in 94.8% and 87.7% of the procedures, respectively. Ablation methods other than PVI were performed in 78.8% of all the patients and 73.5% of the patients with paroxysmal AF. Acute complications were reported in 6.2% of the patients, but no early deaths were recorded.ConclusionsIpsilateral encircling PVI, using 3D mapping and irrigated-tip catheters, is the standard AF ablation method in Japan. However, adjunctive ablations were performed frequently, even in patients with paroxysmal AF

Association between Inter-atrial Septum Motion and Persistent Atrial Fibrillation Recurrence after Catheter Ablation

Article信州医学雑誌 69(4) : 189-201(2021)departmental bulletin pape

冠動脈内圧測定により得られる病変重症度の新しい生理学的指標Epicardial Resistance Indexの基礎理論

冠動脈狭窄性病変の機能的重症度を評価するため,我利よ独自に,病変に特異的な新たな指標であるepicardial resistance index(ERI)を考案した.本論文ではERIの概念および理論的基礎を論説する.ERIは,薬物による最大充血状態(hyperemia)下において,心外膜に存在する冠動脈の狭窄性病変の血管抵抗と狭窄以下の末梢心筋部の抵抗の比で表される指標である.ERIは先端に圧センサーチップを有する圧測定ワイヤーを用いて,狭窄病変前後の冠動脈内圧を測定することで得られる病変部の圧較差を,末梢部血管内圧-中心静脈圧(末梢部心筋での圧較差)で除することにより計算される.測定を最大充血状態で行うのは,冠動脈内圧の自己調整機構の影響を排除するためである.冠動脈内圧の測定による狭窄病変の評価としては,従来fractional flow reserve(FFR)が指標として用いられていたが,同一冠動脈内に複数の病変を有する場合,個々の病変の重症度を個別に評価することは不可能であった.今回我々が考案した新たな指標であるERIは,個々の病変の抵抗を表す指標であるため,病変特異的に重症度評価を行うことが可能となった.単一病変において,虚血が生じえる病変の重症度の閾値は,FFRではcut-off値0.33であることを証明した.さらにFFRと異なり,同一血管に複数の病変がある場合もこのERI値が個々に計算可能で,重症度評価の指標となることを明らかにした.実臨床90病変において,PCI前後で病変のERI測定および定量的冠動脈造影を比較した結果,ERIと血管造影上の狭窄度はr=0.67と良好な正相関を示した.我々の考案したERIは,実際の臨床上問題となる複数の病変を有する複雑病変の治療に際し,どの病変を治療すれば虚血を解除することが可能か事前に判別することができ,不要な治療を避け,必要な病変のみ選択治療を施行できるという点で,特にカテーテルによる冠動脈治療上大きな意義があると考えられる.To assess functional severity of the coronary stenotic lesion, we introduce a novel lesion-specific parameter, the epicardial resistance index (ERI), and describe its concept and theoretical basis. The ERI is defined as the ratio of the resistance of an epicardial coronary stenosis to that of downstream myocardium under hyperemic condition. The ERI is calculated as the trans-lesional pressure gradient divided by (Pd-Pv) at maximum hyperemia, where Pd represents the mean distal coronary pressure in the absence of any stenosis and Pv represents the central venous pressure. Based on theoretical conversion of fractional flow reserve (FFR) to ERI, the reported FFR cut-off value of 0.75 for inducible ischemia corresponds to an ERI of 0.33. This new parameter allows the resistance of the each coronary stenosis to be assessed separately even in the presence of multiple lesions in a coronary artery tree. Using the 170 measurements performed in the 90 lesions, the correlation of ERI with the anatomical parameters obtained from QCA was analyzed. By polynomial regression analysis, the ERI showed a significant positive correlation with the QCA-derived %DS (r=0.67, p<0.001). ERI may have wide application in routine clinical practice especially in the setting of complex catheter-based coronary intervention

冠動脈内圧測定により得られる病変重症度の新しい生理学的指標Epicardial Resistance Indexの基礎理論

冠動脈狭窄性病変の機能的重症度を評価するため,我利よ独自に,病変に特異的な新たな指標であるepicardial resistance index(ERI)を考案した.本論文ではERIの概念および理論的基礎を論説する.ERIは,薬物による最大充血状態(hyperemia)下において,心外膜に存在する冠動脈の狭窄性病変の血管抵抗と狭窄以下の末梢心筋部の抵抗の比で表される指標である.ERIは先端に圧センサーチップを有する圧測定ワイヤーを用いて,狭窄病変前後の冠動脈内圧を測定することで得られる病変部の圧較差を,末梢部血管内圧-中心静脈圧(末梢部心筋での圧較差)で除することにより計算される.測定を最大充血状態で行うのは,冠動脈内圧の自己調整機構の影響を排除するためである.冠動脈内圧の測定による狭窄病変の評価としては,従来fractional flow reserve(FFR)が指標として用いられていたが,同一冠動脈内に複数の病変を有する場合,個々の病変の重症度を個別に評価することは不可能であった.今回我々が考案した新たな指標であるERIは,個々の病変の抵抗を表す指標であるため,病変特異的に重症度評価を行うことが可能となった.単一病変において,虚血が生じえる病変の重症度の閾値は,FFRではcut-off値<0.75と報告されている.我々は,数学的変換によりこの虚血閾値がERIでは,ERI値>0.33であることを証明した.さらにFFRと異なり,同一血管に複数の病変がある場合もこのERI値が個々に計算可能で,重症度評価の指標となることを明らかにした.実臨床90病変において,PCI前後で病変のERI測定および定量的冠動脈造影を比較した結果,ERIと血管造影上の狭窄度はr=0.67と良好な正相関を示した.我々の考案したERIは,実際の臨床上問題となる複数の病変を有する複雑病変の治療に際し,どの病変を治療すれば虚血を解除することが可能か事前に判別することができ,不要な治療を避け,必要な病変のみ選択治療を施行できるという点で,特にカテーテルによる冠動脈治療上大きな意義があると考えられる.To assess functional severity of the coronary stenotic lesion, we introduce a novel lesion-specific parameter, the epicardial resistance index (ERI), and describe its concept and theoretical basis. The ERI is defined as the ratio of the resistance of an epicardial coronary stenosis to that of downstream myocardium under hyperemic condition. The ERI is calculated as the trans-lesional pressure gradient divided by (Pd-Pv) at maximum hyperemia, where Pd represents the mean distal coronary pressure in the absence of any stenosis and Pv represents the central venous pressure. Based on theoretical conversion of fractional flow reserve (FFR) to ERI, the reported FFR cut-off value of 0.75 for inducible ischemia corresponds to an ERI of 0.33. This new parameter allows the resistance of the each coronary stenosis to be assessed separately even in the presence of multiple lesions in a coronary artery tree. Using the 170 measurements performed in the 90 lesions, the correlation of ERI with the anatomical parameters obtained from QCA was analyzed. By polynomial regression analysis, the ERI showed a significant positive correlation with the QCA-derived %DS (r=0.67, p<0.001). ERI may have wide application in routine clinical practice especially in the setting of complex catheter-based coronary intervention

Spatial distribution of ventricular late potentials assessed by the newly developed signal-averaged vector-projected 187-channel electrocardiogram in patients with old myocardial infarction

Risk stratification of lethal arrhythmias is important for the management of ischemic heart disease. Recently, we developed a novel 187-channel signal-averaged vector-projected high-resolution electrocardiograph (187-ch SAVP-ECG) with a Mason–Likar lead system with 10 electrodes. The purpose of this study was to examine the feasibility of a noninvasive evaluation of the spatial distribution of high-frequency late potentials (HFLPs) in patients with myocardial infarction (MI) by using the 187-ch SAVP-ECG. Sixty-four MI patients (7 women and 57 men), between the age of 39 and 84 years (mean 67.7±9.7 years), with positive ventricular late potentials defined by an X, Y, Z-lead ECG were studied. The integrated ventricular 187-ch SAVP-ECG could identify the area of HFLPs that was projected virtually by mathematically calculated 187 electrograms on the body surface in all patients, and differentiate the locations of MI. The 187-ch SAVP-ECG can be a practical and noninvasive examination tool for identifying the location of infarction areas and possible arrhythmogenic substrates with slow conduction properties in patients with MI