Authorship：Corresponding author   Language：Japanese   Publisher：Journal of Cardiology  

Background: The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD). This study aimed to investigate the incidence and predictors of iASD in catheter ablation, assessed by transthoracic echocardiography (TTE), a relatively non-invasive technique frequently employed in follow-up. Methods: This retrospective study included 639 patients (489 male; 60.2 ± 10.7 years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients underwent preprocedural transesophageal echocardiography (pre-TEE), preprocedural TTE (pre-TTE), and TTE one day after the procedure (post-TTE). iASD incidence after 6 months (6M), preprocedural characteristics, and procedure methods were evaluated. Results: Patent foramen ovale (PFO) was diagnosed in 42 patients (6.6 %) using pre-TEE and in 11 patients using pre-TTE (26.2 % of the patients with PFO in pre-TEE). Among the 597 patients without PFO, 497 underwent 6M-TTE. iASD was observed in 59.6 % of patients using post-TTE and 4.6 % using 6M-TTE. In the univariate logistic regression analysis, the total diameter of the sheath through the septum (odds ratio 1.15, p < 0.001) or two sheaths through a single puncture (odds ratio 4.17, p = 0.001) were independent risk factors on iASD incidence in 6M-TTE. iASD was also more likely to occur via cryoballoon ablation using a larger sheath than radiofrequency catheter ablation. Conclusions: iASD was not a rare complication. A larger sheath diameter or two sheaths through a single puncture were associated with the incidence of iASD.

DOI： 10.1016/j.jjcc.2024.06.007

Scopus

PubMed

Language：Japanese   Publisher：体液・代謝管理研究会  

症例は60歳代男性で、商業施設内のトイレで倒れているところを店員に発見され、当院へ救急搬送となった。救急隊接触時、意識レベルJCS III-200、心拍数156回/分、血圧146/135mmHg、呼吸数30回/分、SpO2 70%とショックバイタルで、便失禁があった。顔には黒褐色の嘔吐物が付着していた。酸素投与が開始され、来院時は意識レベルJCS II-10まで回復していたが、末梢冷感著明、眼瞼結膜は蒼白であった。動脈血ガス分析で代謝性アシドーシスと高度貧血を認め、ベッドサイドエコーでは肝周囲、左腎周囲、膀胱周囲、腸管周囲に腹水を認めた。大量輸液、炭酸ナトリウム投与、緊急輸血依頼を行い、ショック状態が持続していたため気管挿管し、人工呼吸器管理とした。胃前庭部からの持続的な出血と消化管狭窄を原因とした通過障害に伴う食事摂取量減少による循環血液量減少性ショックと判断し、意識レベルの改善後、Refeeding症候群の可能性を考慮して、栄養は200kcal/日の極少量から開始した。その後、経静脈的にリン、マグネシウム、カリウムの補正を開始したが、QT延長からTorsade de Pointes(TdP)が出現し電気的除細動を要した。一時ペーシングでTdPの抑制を行いつつ、電解質補正は継続し、その後不整脈の再発はなかった。意識レベル改善後に本人に聴取した結果、6年前から車中泊で生活しており、3ヵ月前から胃部不快感が強く食事摂取が困難となり、ほとんど水分のみで生活していたとのことであった。

Language：English   Publisher：International Heart Journal Association  

<p>Arterial stiffness has been reported to cause left atrial (LA) remodeling due to increased left ventricular filling pressure, resulting in atrial fibrillation (AF). This study aimed to evaluate the association between LA reverse remodeling (LARR) after AF ablation and cardio-ankle vascular index (CAVI), an indicator of arterial stiffness.</p><p>This study included 333 patients with AF (171 with paroxysmal AF and 162 with nonparoxysmal AF) and LA enlargement (LA volume index ≥ 34 mL/m²) who underwent AF ablation between December 2008 and July 2021. CAVI was evaluated preoperatively during AF (<i>n</i> = 155, 46.5%) or sinus rhythm (<i>n</i> = 178, 53.5%). Participants were divided into groups with LARR (<i>n</i> = 133, 39.9%) and without LARR (<i>n</i> = 200, 60.1%) according to whether the degree of decrease in LA volume index on transthoracic echocardiography 6 months after ablation was ≥ 15% or < 15%, respectively.</p><p>Sinus rhythm was maintained in 168 (50.5%) patients within 3-6 months after the index procedure. Univariate analysis revealed that preoperative CAVI (7.80 ± 1.22 versus 8.57 ± 1.09, <i>P</i> < 0.001) was significantly lower, and the maintenance of sinus rhythm (61.6% versus 43.0%, <i>P</i> = 0.0011) was higher in the group with LARR. Multivariate logistic regression analysis revealed that preoperative CAVI was independently associated with LARR (odds ratio, 0.60, 95% confidence interval, 0.46-0.78, <i>P</i> < 0.001).</p><p>In patients with AF and LA enlargement, CAVI is independently associated with LA reverse remodeling after catheter ablation.</p>

DOI： 10.1536/ihj.23-072

Scopus

PubMed

CiNii Research

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

カテーテルアブレーションを施行した左房拡大を示す心房細動(AF)患者を対象に、術前の心臓足首血管指数(CAVI)がアブレーション後の左房リバースリモデリング(LARR)と関連するかどうか検討した。対象は左房容積係数が34mL/m2以上のAF患者333例で、171例が発作性AF、162例が非発作性AFであった。アブレーション施行から6ヵ月後に経胸壁心エコー検査を実施し、左房容積係数が15%以上減少した症例をLARRと定義した。患者をLARR陽性群133例(男性74.4%、平均60.1±9.3歳)と陰性群200例(男性71.0%、平均64.6±8.8歳)の2群に分類した。術前のCAVIはLARR陽性群(7.80±1.22)の方が陰性群(8.57±1.09)より有意に低かった(P<0.001)。洞調律を維持した患者は陽性群(61.6%)の方が陰性群(43.0%)より有意に多かった(P<0.001)。重回帰ロジスティック分析で術前のCAVIはアブレーション後のLARRを予測する独立因子であった(OR 0.60、95%CI 0.46～0.78、P<0.001)。

Authorship：Lead author   Language：Japanese   Publisher：Journal of Interventional Cardiac Electrophysiology  

Background: The safety and efficacy of periprocedural use of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) remain unclear. We compared the incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium following AF ablation among patients receiving edoxaban, rivaroxaban, and warfarin and between normal- and low-dose use of edoxaban and rivaroxaban. Methods: This prospective randomized study included 170 consecutive AF patients. Patients taking DOACs upon admission to our hospital were randomly assigned to an edoxaban group or to a rivaroxaban group. Warfarin was continued in patients receiving warfarin at admission. All patients underwent AF ablation, and cerebral MRI was performed to evaluate asymptomatic cerebral micro-thromboembolism the day after the procedure. Results: Sixty-one patients were assigned to edoxaban and 63 to rivaroxaban. Warfarin was continued in 46 patients. Although asymptomatic cerebral micro-thromboembolism was detected in 25 patients (16.3%), there were no significant differences among the groups. Hemopericardium occurred in 2 patients (one each in the rivaroxaban and warfarin groups). The incidence of asymptomatic cerebral micro-thromboembolism was higher in the low-dose group (9 patients, 25.7%) than in the normal-dose group (8 patients, 10.0%) for patients prescribed either edoxaban or rivaroxaban (p < 0.05). The proportion of males (88.0%, 69.5%, p < 0.05), history of prior AF ablation (64.0%, 42.2%, p < 0.05), and hypertension (68.0%, 46.1%, p < 0.05) were significantly higher in patients with cerebral thromboembolism. Conclusions: The incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium in AF ablation was similar among patients using edoxaban, rivaroxaban, and warfarin. However, low doses of DOACs may increase the risk of asymptomatic stroke.

DOI： 10.1007/s10840-020-00732-y

Scopus

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3143/geriatrics.53.419

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.joa.2014.04.006

PubMed

Authorship：Lead author   Language：English   Publishing type：Doctoral thesis  

DOI： 10.1016/j.jjcc.2011.07.006

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jccase.2009.12.005

PubMed

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

DOI： 10.1111/j.1540-8159.2009.02478.x

PubMed

Event date： 2017.9

Language：English   Presentation type：Oral presentation (general)  

Venue：Yokohama, Japan  

Event date： 2015.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：神奈川  

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