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KIYOTAKE ISHIKAWA M.D,
TAKUMI YAMADA M.D, YUKIHIKO YOSHIDA M.D,
MASATERU TAKIGAWA M.D,
YUTAKA AOYAMA M.D,
NATSUO INOUE M.D,
YASUSHI TATEMATSU M.D,
MAMORU NANASATO M.D,
KAZUO KATO M.D,
NAOYA TSUBOI M.D, [......],
TAKUMI YAMADA,
YUKIHIKO YOSHIDA,
MASATERU TAKIGAWA,
YUTAKA AOYAMA,
NATSUO INOUE,
YASUSHI TATEMATSU,
MAMORU NANASATO,
KAZUO KATO,
NAOYA TSUBOI,
HARUO HIRAYAMA
[show abstract]
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ABSTRACT: Introduction:An additional approach may be essential to reduce recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We examined the efficacy of renin-angiotensin system blockers (RAS-B) in suppressing AF recurrences after PVI.Methods and Results:We retrospectively studied 264 consecutive patients (195 male, median age: 63 years) who underwent successful PVI of paroxysmal (n = 94) or persistent AF (n = 170). RAS-B treatment was performed in 145 patients (angiotensin-converting enzyme inhibitors; n = 13, angiotensin receptor blockers; n = 129, both; n = 3). Echocardiography was performed before and 3 months after the ablation to examine the occurrence of left atrial structural reverse remodeling (LA-RR). After a median follow-up of 195 (interquartile range: 95–316) days, AF recurred in 51 (19.3%) patients. A Cox regression analysis revealed that AF recurrence was significantly lower in the patients with RAS-B than in those without (hazard ratio [HR] = 0.41 [95% confidence interval (CI): 0.23–0.71], P = 0.002). After a multivariate adjustment for potential confounders, the use of RAS-B (HR = 0.39 [95% CI: 0.19–0.77], P = 0.007) and type of AF (HR = 0.30 [95% CI: 0.13–0.66], P = 0.003) were the independent predictors for AF recurrence during the entire follow-up. Although effect of RAS-B was not significant during the early follow-up (<3 month), it was the only independent predictor during the late follow-up (>3 months) (HR = 0.21 [95% CI: 0.08–0.53], P = 0.001). There were no significant differences in LA-RR occurrence regarding RAS-B medication. The use of RAS-B was an independent predictor of late AF recurrences irrespective of an early LA-RR occurrence.Conclusions:Treatment with RAS-B significantly reduced the AF recurrence after PVI. This benefit became more prominent 3 months after the PVI. (PACE 2011; 34:296–303)
Pacing and Clinical Electrophysiology 02/2011; 34(3):296 - 303. · 1.35 Impact Factor
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Ph.D. TAKUMI YAMADA M.D,
HARISH DOPPALAPUDI M.D,
HUGH T. McELDERRY M.D,
TARO OKADA M.D,
YOSHIMASA MURAKAMI M.D,
YASUYA INDEN Ph.D, YUKIHIKO YOSHIDA M.D,
SHINJI KANEKO Ph.D,
NAOKI YOSHIDA M.D,
TOYOAKI MUROHARA Ph.D,
ANDREW E. EPSTEIN M.D,
VANCE J. PLUMB M.D,
G. NEAL KAY M.D
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ABSTRACT: Idiopathic VAs Originating from the LV Papillary Muscles. Introduction: Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PAMs). This study investigated the prevalence, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of these VAs, and compared them with other LV VAs.Methods and Results: We studied 71 patients with VAs originating from the LV anterolateral and posteroseptal regions among 159 patients undergoing successful catheter ablation of idiopathic LV VAs. PAM VAs were uncommon, rare in a sustained form, and more common from the posterior papillary muscle (PPM) than anterior papillary muscle (APM). A younger age was a good predictor for differentiating left posterior fascicular VAs from PPM VAs. There were several electrocardiographic features that accurately differentiated PAM and LV fascicular VAs from mitral annular VAs. However, an R/S ratio ≤1 in lead V6 in the LV anterolateral region and a QRS duration >160 ms in the LV posteroseptal region were the only reliable predictors for differentiating PAM VAs from LV fascicular VAs. A sharp ventricular prepotential was recorded at the successful ablation site during 42% of the PAM VAs. Radiofrequency current with an irrigated or conventional 8-mm tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins whereas that with a nonirrigated 4-mm tip ablation catheter produced excellent results in LV fascicular and mitral annular VAs.Conclusions: There are differences in the electrocardiographic and electrophysiological features among VAs originating from these regions that are helpful for their diagnosis and effective catheter ablation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 62–69, January 2010)
Journal of Cardiovascular Electrophysiology 09/2009; 21(1):62 - 69. · 3.06 Impact Factor
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Yasuya Inden M.D,
Makoto Tsuda M.D,
Hiroshi Mayashi M.D,
Hiroto Takezawa M.D,
Shigeo Iino M.D,
Takahisa Kondo M.D, Yukihiko Yoshida M.D,
Makoto Akahoshi M.D,
Masayuki Terasawa M.D,
Teruo Itoh M.D,
Hdehiko Saito M.D,
Makoto Hirai M.D
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ABSTRACT: Background: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time.Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria.Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime).Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased.There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3.Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.
Clinical Cardiology 02/2009; 21(11):801 - 806. · 2.15 Impact Factor
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TAKUMI YAMADA M.D,
YOSHIMASA MURAKAMI M.D,
TARO OKADA M.D,
NAOKI YOSHIDA M.D,
YUICHI NINOMIYA M.D,
JUNJI TOYAMA M.D, YUKIHIKO YOSHIDA M.D,
NAOYA TSUBOI M.D,
YASUYA INDEN M.D,
MAKOTO HIRAI M.D, [......],
JUNJI TOYAMA,
YUKIHIKO YOSHIDA,
NAOYA TSUBOI,
YASUYA INDEN,
MAKOTO HIRAI,
TOYOAKI MUROHARA,
HUGH T. McELDERRY,
ANDREW E. EPSTEIN,
VANCE J. PLUMB,
G. NEAL KAY
[show abstract]
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ABSTRACT: Background:Pulmonary vein (PV) isolation (PVI) has been demonstrated to be an effective technique for curing atrial fibrillation (AF). AF foci that cannot be isolated by PVI (non-PV foci) can become the cause of AF recurrence. The purpose of this study was to investigate the characteristics of non-PV AF foci.Methods and Results:Two hundred consecutive patients with symptomatic AF underwent electrophysiologic studies. In all patients, successful ostial or antral PVI was achieved with a multielectrode basket catheter (MBC). In 45 patients, spontaneous AF was induced even after PVI. In 23 of those patients, 30 AF foci were found in the left atrium (LA) (12 in the PV antrum, and 18 in the LA wall). Twenty-six of those foci were eliminated by focal ablation guided by an MBC. Five of those foci (four in the PV antrum and one in the LA posterior wall) were speculated to be located epicardially because a small potential preceding the LA potential was recorded from the MBC electrodes during AF initiation at the successful ablation site where single large potentials were recorded during sinus rhythm and a longer duration of radiofrequency energy delivery was needed to eliminate them.Conclusions:MBC mapping with induction of spontaneous AF may be useful for identifying non-PV AF foci in the LA after PVI. In some of those non-PV foci, mainly around the PVI lesions, a few electrophysiologic findings suggesting an epicardial location were observed. This may be a rationale for the efficacy of extensive PV ablation
Pacing and Clinical Electrophysiology 10/2007; 30(11):1323 - 1330. · 1.35 Impact Factor
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TAKUMI YAMADA M.D,
YOSHIMASA MURAKAMI M.D,
MASAHIRO MUTO M.D,
TARO OKADA M.D,
MITSUHIRO OKAMOTO M.D,
JUNJI TOYAMA M.D, YUKIHIKO YOSHIDA M.D,
NAOYA TSUBOI M.D,
TERUO ITO M.D,
TAKAHISA KONDO M.D,
YASUYA INDEN M.D,
MAKOTO HIRAI M.D,
TOYOAKI MUROHARA M.D
[show abstract]
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ABSTRACT: Introduction: The right pulmonary veins (RPVs) and posterior wall of the right atrium (PRA) are anatomically located adjacent to each other. The aim of this study was to demonstrate the electrophysiologic characteristics of atrial tachycardia (AT) originating from the PRA or RPVs.Methods and Results: A total of 26 consecutive patients with AT originating from the RPVs or PRA underwent detailed atrial endocardial mapping and successful radiofrequency catheter ablation. Eight foci were found in the PRA and 18 foci in the RPVs. Analysis of P wave configuration showed that lead V1 was the most helpful in distinguishing the AT foci between these two sites. In all cases, double potential (DP) configurations were recorded from several electrodes of a multielectrode catheter placed in the PRA, and the first DP component (FP) was the earliest potential recorded from the right atrium during the tachycardia. The amplitude of the FP was higher than that of the second DP component (SP) for AT foci originating in the PRA, whereas the reverse occurred for those in the RPV. The activation sequence of the FP was from superior to inferior for the AT foci in the superior RPV, whereas the reverse occurred for the AT foci in the inferior RPV.Conclusion: P wave configuration in lead V1 is helpful in distinguishing AT foci between those originating in the PRA and RPVs. The DPs obtained from the PRA can be useful in predicting whether AT foci originate from the PRA or RPVs. (J Cardiovasc Electrophysiol, Vol. 15, pp. 745-751, July 2004)
Journal of Cardiovascular Electrophysiology 07/2004; 15(7):745 - 751. · 3.06 Impact Factor
