Makoto Hirai

Nagoya University, Nagoya, Aichi, Japan

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Publications (123)520.23 Total impact

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    ABSTRACT: Background: Elevated red blood cell distribution width (RDW) predicts poor prognosis in patients with cardiovascular diseases. However, little is known about the association between RDW and outcomes after catheter ablation of atrial fibrillation (AF).Methods and Results:A total of 757 patients who underwent radiofrequency catheter ablation of AF were divided into heart failure (HF, n=79) and non-HF (n=678) groups; RDW was assessed as a predictor after catheter ablation in each. During a 22.3-month follow-up period, the baseline RDW in the HF group was greater in the recurrence group than in the non-recurrence group (14.5±2.0% vs. 13.5±0.9%, P=0.013). In contrast, no significant difference in RDW at baseline was found in the non-HF group between the recurrence and non-recurrence groups (13.3±0.8% vs. 13.2±0.8%, P=0.332, respectively). Multivariate analysis demonstrated that RDW (hazard ratio 1.20, 95% confidence interval 1.01-1.40, P=0.034) was an independent predictor of AF recurrence in the HF group. The cut-off values of RDW for the recurrence of AF and major adverse events in the HF group were 13.9% and 14.8%, respectively. Conclusions: High RDW is an independent predictor for the recurrence of AF and major adverse events in patients with HF after catheter ablation. RDW is a potential noninvasive marker in AF patients complicated with HF.
    Preview · Article · Jan 2016 · Circulation Journal
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    ABSTRACT: Background: Little is known about the association between B-type natriuretic peptide (BNP) levels and catheter ablation of atrial fibrillation (AF) in patients with heart failure. This study aimed to examine the impact of elimination of AF by catheter ablation on BNP levels in patients with left ventricular systolic dysfunction. Methods: Fifty-four AF patients with left ventricular ejection fraction (LVEF) ≤ 50%, who underwent radiofrequency catheter ablation therapy of AF, were included. BNP sampling was performed at baseline, 3 days, and 1 month after ablation. Results: After a follow-up period of 6 months, the BNP levels decreased significantly in the non-recurrence group (n = 35) (median 126.3 [interquartile 57.2-206.5] pg/mL, 63.5 [23.9-180.2] pg/mL, and 45.9 [21.9-160.3] pg/mL, p < 0.001, respectively), but not in the recurrence group (n = 19) (144.7 [87.1-217.3] pg/mL, 88.8 [12.9-213.2] pg/mL, and 118.5 [51.6-298.2] pg/mL, p = 0.368, respectively). The patients in the non-recurrence group had a higher percentage relative reduction in BNP levels from baseline to 1 month after ablation than those in the recurrence group (56.5 [-9.0-77.4]% vs, -2.4 [-47.1-60.9]%, p = 0.027). Additionally, a relative reduction in BNP levels significantly correlated with an increase in LVEF after ablation (r = 0.486, p < 0.001). Conclusions: Plasma BNP levels decreased significantly with successful catheter ablation of AF in patients with impaired LVEF. The decrease in BNP levels might be associated with early recovery of cardiac function and subsequent maintenance of sinus rhythm at follow-up. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · Pacing and Clinical Electrophysiology
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    ABSTRACT: The relationship between body mass index (BMI) and the prognosis of elderly patients with atrial fibrillation (AF) is unknown. We aimed to examine the association of body weight with the clinical outcomes among Japanese elderly patients with a history of documented AF. This observational study of AF patients from an outpatients clinic in Nagoya University Hospital included 413 patients ≥70 years old (99 obese: BMI ≥25 kg/m(2); 256 normal weight: BMI 18.5-24.9 kg/m(2); and 58 underweight patients: BMI <18.5 kg/m(2)). The mean age was 77.5 ± 5.6 years. During a mean follow-up of 19.0 months, all-cause death occurred in 23 patients (obese 1 %, normal weight 5.1 %, and underweight 16 %). The major adverse events including all-cause death, stroke or transient ischemic attack, heart failure requiring admission, and acute coronary syndrome were observed in 53 patients (obese 5.1 %, normal weight 13 %, and underweight 26 %). After adjusting for confounding factors, the underweight group had a significantly greater risk for all-cause death [hazard ratio (HR) 2.91, 95 % confidence interval (CI) 1.12-7.60, p = 0.029], and major adverse events (HR 2.45, 95 % CI 1.25-4.78, p = 0.009) than the normal weight group. In contrast, the obese group had a better prognosis in major adverse events compared with the normal weight group (HR 0.34, 95 % CI 0.13-0.89, p = 0.029). In conclusion, lower BMI was independently associated with poor outcomes among older AF patients. The association between obesity and better prognosis in elderly AF patients was also found.
    No preview · Article · Oct 2015 · Heart and Vessels
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    ABSTRACT: This study aimed to examine the association between body mass index (BMI) and prognosis in heart failure patients after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. We retrospectively investigated 125 patients (33 overweight [BMI ≥25 kg/m(2)], 75 normal weight [BMI 18.5-24.9 kg/m(2)], and 17 underweight patients [BMI <18.5 kg/m(2)]) who underwent CRT-D implantation. The clinical outcome endpoints were all-cause death and appropriate shock therapy. During the follow-up period (mean 3.1 ± 1.8 years), 23 patients died (1 [3.0 %] overweight, 17 [22.7 %] normal weight, and 5 [29.4 %] underweight patients), and appropriate shock events were observed in 14 patients (2 [6.1 %] overweight, 10 [13.3 %] normal weight, and 2 [11.8 %] underweight patients). All patients survived shock therapy. After adjusting for confounding factors, overweight patients had significantly fewer outcomes relating to all-cause death and appropriate shock events (hazard ratio 0.27, 95 % confidence interval 0.08-0.91, p = 0.034) than normal weight patients. However, the prognostic difference between overweight and normal weight patients could be diminished as a result of the successful shock therapies (p = 0.067). Additionally, prognosis did not differ between overweight and normal weight patients among the responders, but did differ among the non-responders. The underweight patients had a poorer prognosis after CRT-D implantation compared with the other groups. Although high BMI was associated with better outcomes among heart failure patients with CRT-D implantations, the difference in the prognosis between overweight and normal weight patients was reduced because of defibrillator therapy and the improvement in cardiac function provided by CRT-D implantation.
    No preview · Article · May 2015 · Journal of Interventional Cardiac Electrophysiology
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    ABSTRACT: Objective: Uninterrupted oral warfarin strategy has become the standard protocol to prevent complications during catheter ablation (CA) for the treatment of atrial fibrillation (AF). However, little is known about the safety and efficacy of uninterrupted dabigatran therapy in patients undergoing CA for AF. Therefore, this study investigated the safety and efficacy of uninterrupted dabigatran therapy and compared the findings with those for uninterrupted warfarin therapy. Methods: Bleeding and thromboembolic events during the periprocedural period were evaluated in 363 consecutive patients who underwent CA for AF at Nagoya University Hospital, and received uninterrupted dabigatran (n=173) or uninterrupted warfarin (n=190) for periprocedural anticoagulation. Results: A total of 27 (7%) patients experienced either bleeding or thromboembolic complications. Major bleeding complications occurred in 2 (1%) patients in the dabigatran group (DG) and 2 (1%) patients in the warfarin group (WG). Eight (5%) patients in the DG and 9 (5%) patients in the WG experienced groin hematoma, a type of minor bleeding complication. Meanwhile, no patient in the DG and 1 (1%) in the WG developed cerebral ischemic stroke. Overall, there was no significant difference between the groups for any category. The activated partial thromboplastin time (APTT) independently predicted periprocedural complications in the DG. Conclusion: Uninterrupted dabigatran therapy in CA for AF thus may be a safe and effective anticoagulant therapy, and appears to be closely similar to continuous warfarin; however, it is essential to pay close attention to the APTT values when using dabigatran during CA.
    Preview · Article · May 2015 · Internal Medicine
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    ABSTRACT: Close monitoring of intraoperative activated clotting time (ACT) is crucial to prevent complications during the periprocedural period of atrial fibrillation (AF) ablation. However, little is known about the ACT in the patients receiving new oral anticoagulants (NOACs). To evaluate change in the ACT among anticoagulants used during the periprocedural period of AF ablation. We examined 869 consecutive patients who underwent AF ablation between April 2012 and August 2014 and received NOACs (n = 499) including dabigatran, rivaroxaban and apixaban, or warfarin (n = 370) for uninterrupted periprocedural anticoagulation. The changes in intraprocedural ACT were investigated among the anticoagulants. Furthermore, the incidence of periprocedural events was estimated. The average time in minutes required for achieving the target ACT >300 s was significantly longer in the dabigatran group (DG) and apixaban group (AG) than in the warfarin group (WG) and rivaroxaban group (RG) (60min, 70min vs. 8min, 9min, P < 0.001). In addition, the proportion of patients who achieved the target ACT after initial heparin bolus was significantly lower in the DG and AG than in the WG and RG (36%, 26% vs. 84%, 78%, P < 0.001). Furthermore, the incidence of periprocedural complications was equivalent among the groups. The average time required for reaching the target ACT was longer in the DG and AG than in the WG and RG. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Apr 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Dipeptidyl peptidase-4 (DPP-4) inhibitors were recently reported to have cardioprotective effects via amelioration of ventricular function. However, the role of DPP-4 inhibition in atrial remodeling, especially of the arrhythmogenic substrate, remains unclear. We investigated the effects of a DPP-4 inhibitor, alogliptin, on atrial fibrillation (AF) in a rabbit model of heart failure caused by ventricular tachypacing (VTP). Rabbits subjected to VTP at 380 bpm for 1 or 3 weeks, with or without alogliptin treatment, were assessed using echocardiography, electrophysiology, histology, and immunoblotting, and compared with non-paced animals. VTP rabbits exhibited increased duration of atrial burst pacing-induced AF, while administration of alogliptin shortened this duration by 73%. The extent of atrial fibrosis following VTP reduced by 39% in the alogliptin-treated group. VTP rabbits treated with alogliptin displayed a 1.6-fold increase in left atrial myocardial capillary density, compared to non-treated rabbits. A 2-fold increase in endothelial nitric oxide synthase (eNOS) phosphorylation was observed in the left atrium of alogliptin-treated rabbits, compared to non-treated rabbits. Moreover, a NOS inhibitor (N(ω)-nitro-l-arginine methyl ester) blocked the beneficial effects of alogliptin on AF duration, fibrosis, and capillary density. Alogliptin shortened the duration of AF caused by VTP-induced fibrotic atrial tissue by augmenting atrial angiogenesis and activating eNOS. Our findings suggest that DPP-4 inhibitors may be useful in the prevention of heart failure-induced AF. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Mar 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Apixaban, a factor Xa (FXa) inhibitor, is a new oral anticoagulant for stroke prevention in atrial fibrillation (AF). However, little is known about its efficacy and safety as a periprocedural anticoagulant therapy for patients who had undergone catheter ablation (CA) for AF. We evaluated 342 consecutive patients who underwent CA for AF between April 2013 and March 2014 and received apixaban (n = 105) and warfarin (n = 237) for uninterrupted periprocedural anticoagulation. We retrospectively investigated the occurrence of bleeding and thromboembolic complications during the procedural period and compared them between the apixaban group (AG) and warfarin group (WG). Thromboembolic complications occurred in one (0.4%) patient in the WG. Major and minor bleeding complications occurred in one (1%) and four (4%) patients in the AG, and three (1%) and 12 (5%) patients in the WG. No significant difference in complications was observed between the AG and WG. Of importance, adverse event rates did not differ between the two groups after adjusting by a propensity score analysis. In preoperative tests of blood coagulation, there were significant differences in the prothrombin time, activated partial thromboplastin time, FXa activity, and prothrombin fragment 1 + 2 (F1+2) levels between the AG and WG. The use of apixaban during the periprocedural period of AF ablation seemed as efficacious and safe as warfarin. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Dec 2014 · Pacing and Clinical Electrophysiology
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    ABSTRACT: Background Patients with greater improvement of cardiac function after cardiac resynchronization therapy (CRT) implantation are identified as super-responders. However, it remains unclear which kind of preimplant assessments could accurately predict outcomes after CRT. Thus, we aimed to examine the essential predicting factors for super-response to CRT, and to construct an accurate predictable model. Methods We retrospectively analyzed the CRT patients who underwent implantation at Nagoya University Hospital. Super-responders are defined as those who show a relative reduction in left ventricular end-systolic volume 30% after 6 months of CRT. ResultsEighty patients (mean age, 67.8 10.2 years) were included. Twenty-two patients received upgrading procedure to CRT implantation. Six months after the implantation, 29 patients (36%) were super-responders. Multiple logistic regression analysis shows that consistent right ventricular pacing with a previous device (odds ratio [OR] 7.28, 95% confidence interval [CI] 1.52-34.9; P = 0.013), lack of prior history of ventricular arrhythmia (OR 5.32, 95% CI 1.52-18.6; P = 0.009), and smaller left atrial diameter (LAD) (OR 0.92, 95% CI 0.86-0.98; P = 0.014) are independent predictors for CRT super-responders. The use of a combination of these predictive factors could increase the certainty with which a greater response to CRT is predicted and the presence of such a combination could improve prognosis. Conclusion Greater response to biventricular pacing occurs more frequently in patients with consistent right ventricular pacing, lack of prior history of ventricular arrhythmia, and smaller LAD. An association between patient background characteristics and a super-response to CRT was also identified.
    No preview · Article · Sep 2014 · Pacing and Clinical Electrophysiology
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    ABSTRACT: Background: In recent years, there has been a series of recalls of popular implantable cardioverter defibrillators leads, and several reports have demonstrated an increasing rate of failure of such leads over time in Caucasian patients. However, little is known about the performance of these leads in Asian patients. The aim of this study was to investigate the rate of failure of the recalled leads and the characteristics as compared with non-recalled leads in Japanese patients. Methods and Results: A retrospective chart review was conducted in 214 patients (75 Sprint Fidelis, 8 Riata, and 131 Sprint Quattro leads) who underwent implantation and follow-up at Nagoya University Hospital. During the follow-up period, 14 Sprint Fidelis leads (19%) and 1 Riata lead (13%) failed, but no abnormality was found in the Sprint Quattro, non-recalled leads. Five patients (4 Sprint Fidelis and 1 Riata, 33% of lead failure patients) received inappropriate shocks. The 3-, 4-, and 5-year lead survival rates in Sprint Fidelis leads were 95.1% (95% confidence interval [Cl]: 89.6%-100%), 89.8% (95% Cl: 82.1%-97.6%), and 88.0% (95% Cl: 79.6%-96.4%), respectively. A previous device implantation before Sprint Fidelis lead was the only significant predictor for lead fracture (hazard ratio, 5.33; 95% Cl: 1.55-18.4; P=0.008). Conclusions: The rate of Sprint Fidelis lead failure continues to increase over time in Japanese patients.
    No preview · Article · Feb 2014 · Circulation Journal
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    ABSTRACT: Background Several algorithms for localizing accessory pathways (APs) are based on the delta wave morphology, R/S ratio, and QRS polarity. However, they are somewhat complicated, and an accurate determination of the delta wave morphology is occasionally difficult. The aims of this study were to develop a simple algorithm for localizing APs using only the R/S ratio, and to test the accuracy of the algorithm prospectively. Methods We studied 142 patients with a single anterogradely conducting AP on a 12-lead ECG. R/S ratios were analyzed in leads V1, V2, and aVF (R/S-V1, R/S-V2, and R/S-aVF). AP locations were divided into five regions based on fluoroscopic anatomy. Results A new algorithm was developed by correlating R/S-V1, R/S-V2, and R/S-aVF with successful ablation sites in 88 initial consecutive patients. All 55 patients with left free wall APs showed R/S-V1 ≥0.5, and 47 (98%) of 48 patients with left anterior or lateral APs showed R/S-aVF ≥1. In contrast, all seven patients with left posterolateral or posterior APs showed R/S-aVF <1. All nine patients with right-and-left midseptal or posteroseptal APs showed R/S-V1 <0.5 and R/S-V2 ≥0.5. Of 12 patients with right anterior, lateral or anteroseptal APs, 10 (83%) showed R/S-V1 <0.5, R/S-V2 <0.5 and R/S-aVF ≥1. Finally, nine (75%) of 12 patients with right posterolateral or posterior APs showed R/S-V1 <0.5, R/S-V2 <0.5, and R/S-aVF <1. Then this algorithm was tested prospectively in 54 patients. Overall, the sensitivity was 94%, and the specificity was 98%. Conclusions This ECG algorithm provides a simple and accurate way to identify the AP localization.
    Preview · Article · Dec 2013 · Journal of Arrhythmia
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    ABSTRACT: Background: In recent years, there has been a series of recalls of popular implantable cardioverter defibrillators leads, and several reports have demonstrated an increasing rate of failure of such leads over time in Caucasian patients. However, little is known about the performance of these leads in Asian patients. The aim of this study was to investigate the rate of failure of the recalled leads and the characteristics as compared with non-recalled leads in Japanese patients. Methods and results: A retrospective chart review was conducted in 214 patients (75 Sprint Fidelis, 8 Riata, and 131 Sprint Quattro leads) who underwent implantation and follow-up at Nagoya University Hospital. During the follow-up period, 14 Sprint Fidelis leads (19%) and 1 Riata lead (13%) failed, but no abnormality was found in the Sprint Quattro, non-recalled leads. Five patients (4 Sprint Fidelis and 1 Riata, 33% of lead failure patients) received inappropriate shocks. The 3-, 4-, and 5-year lead survival rates in Sprint Fidelis leads were 95.1% (95% confidence interval [CI]: 89.6%-100%), 89.8% (95% CI: 82.1%-97.6%), and 88.0% (95% CI: 79.6%-96.4%), respectively. A previous device implantation before Sprint Fidelis lead was the only significant predictor for lead fracture (hazard ratio, 5.33; 95% CI: 1.55-18.4; P=0.008). Conclusions: The rate of Sprint Fidelis lead failure continues to increase over time in Japanese patients.
    No preview · Article · Nov 2013 · Circulation Journal
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    ABSTRACT: Background: Cardiac resynchronization therapy (CRT) has been reported to improve symptoms and cardiac performance in patients with severe heart failure (HF), but CRT recipients with advanced HF do not always experience improved mortality rates. Cystatin C has recently been involved in HF, but the association of serum cystatin C level with adverse events and long-term prognosis after CRT is unknown. This study investigated whether cystatin C level can predict mortality and cardiovascular events after CRT. Methods and results: A total of 117 consecutive patients receiving a CRT device for the treatment of advanced HF were assessed according to cystatin C level and long-term outcome after implantation of the device. Over a median follow-up of 3.2 years, 34 patients (29.1%) died and 59 patients (50.4%) developed cardiovascular events. Kaplan-Meier survival analysis indicated that elevated cystatin C level was significantly associated with higher all-cause mortality and prevalence of cardiovascular events, including hospitalization for progressive HF. After multivariate Cox regression analysis, serum cystatin C level and QRS duration, but not conventional echocardiographic parameters, were found to independently predict all-cause death or cardiovascular events. Of importance, only cystatin C level was an independent predictor of all-cause mortality after CRT. Conclusions: Cystatin C level independently predicts cardiac mortality or morbidity in patients receiving CRT. The assessment of cystatin C level could provide valuable information about long-term prognosis after CRT.
    No preview · Article · Aug 2013 · Circulation Journal
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    ABSTRACT: To differentiate acute from chronic damage to the myocardium in patients with myocardial infarction (MI) using DE and T2w MR. Short-axis T2w and DE MR images were acquired twice after the onset of MI in 36 patients who successfully underwent emergency coronary revascularisation. The areas of infarct and oedema were measured. The oedema-infarct ratio (O/I) of the left ventricular area was calculated by dividing the oedema by the infarct area. The oedema size on T2w MR was significantly larger than the infarct size on DE MR in the acute phase. Both the oedema size on T2w MR and the infarct size on DE MR in the acute phase were significantly larger than those in the chronic phase. The O/I was significantly greater in the acute phase compared with that in the chronic phase (P < 0.05). An analysis of relative cumulative frequency distributions revealed an O/I of 1.4 as a cut-off value for differentiating acute from chronic myocardial damage with the sensitivity, specificity, and accuracy of 85.1%, 82.7% and 83.9%, respectively. The oedema-infarct ratio may be a useful index in differentiating acute from chronic myocardial damage in patients with MI. MR can differentiate reversible from irreversible myocardial damage after myocardial infarction. MR is a useful modality to noninvasively differentiate the infarct stages. The O/I is an important index to decide therapeutic strategies.
    Full-text · Article · Dec 2011 · European Radiology

  • No preview · Article · Dec 2011 · Heart Rhythm
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    ABSTRACT: Although the circadian variation of catecholamine has been reported, that of the pulse wave velocity (PWV) has not. Brachial ankle (ba) PWV is associated with well-established indices of central stiffness. It is not known whether arterial stiffness is associated with catecholamine. The aim of the present study was to evaluate the changes in baPWV and those on the plasma epinephrine and norepinephrine levels in the morning and evening in hypertensive patients (HPs) and normotensive subjects (NSs). The baPWV and blood pressure (BP) were measured in 14 NSs (14 males, 39 ± 5 years) and 10 HPs (9 males and 1 female, 55 ± 13 years) at 06:00 h, noon, 18:00 h, and midnight, respectively. The plasma epinephrine and norepinephrine levels were measured in 14 NSs and 5 HPs at 06:00 h and 18:00 h, respectively. There was no significant difference in BPs at 06:00 h, noon, 18:00 h, and midnight in either NSs or HPs. The baPWV at 06:00 h was significantly lower than that at noon, 18:00 h, and midnight in NSs (P = 0.01, 0.04, and 0.0008, respectively). The plasma epinephrine and norepinephrine levels at 06:00 h were markedly lower than those at 18:00 h in NSs (P = 0.002 and 0.003, respectively). There were no significant changes in the baPWV of HPs at 06:00 h, noon, 18:00 h, or midnight. The plasma epinephrine and norepinephrine levels at 06:00 h were notably lower than those at 18:00 h in HPs (P = 0.004 and 0.01, respectively). Only NSs showed a significant reduction in the baPWV with a decrease in the plasma catecholamine levels in the morning, suggesting that the baPWV of NSs may be correlated with the variation of the plasma catecholamine levels.
    Full-text · Article · Oct 2011 · Heart and Vessels

  • No preview · Article · Oct 2011 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Background: Although many experimental data support the suppressive effect of RASIs on the occurrence of AF, recent clinical trials revealed no benefit of RASIs to prevent AF. However, if appropriate patients were selected, RASIs could work more effectively. In this study, we hypothesized that RASIs was effective in patients with normal LA. Methods: We retrospectively studied 178 consecutive patients (mean age=60±12 yrs, 76% males) with normal LA (LA<40 mm) who underwent successful PVI for AF. Multivariate analysis was performed to clarify the predictors of AF recurrence. The effect of RASI on AF recurrence was also assessed. Results: AF recurred in 40 patients (22.6%) during the follow-up period (mean 498±377 days). Multivariate Cox proportional analysis revealed that treatment with RASIs (HR 0.32, 95%CI 0.14–0.71, P=0.005), duration of AF (HR 1.08/year, 95%CI 1.00–1.15, P=0.04), history of hypertension (HR 3.05, 95%CI 1.29–7.24, P=0.01), and ejection fraction (HR 0.54/10%, 95%CI 0.34–0.87, P=0.01) were associated with AF recurrence in patients with normal LA. Conclusion: Several factors could be the predictors of AF recurrence. RASIs could suppress AF recurrence in patients with normal LA after PVI.
    No preview · Article · Jan 2011 · Journal of Arrhythmia
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    ABSTRACT: Background: Renal dysfunction was shown to influence the mortality and morbidity in patients with severe heart failure. However the assessment of cardiac resynchronization therapy with defibrillator (CRT-D) implantation for patients with chronic kidney disease (CKD) has not been firmly established. The purpose of this study was to assess whether CKD stages before CRT-D could predict the clinical response to CRT-D. Methods: We studied consecutive 73 advanced HF patients who underwent CRT-D in our hospital (67±10 years, New York Heart Association (NYHA) class 3.3±0.7, left ventricular ejection fraction (LVEF) 28.2±8.4%, QRS duration 164±29 ms, 49 males). The end point was all-cause mortality or HF-related hospitalization. Results: During a mean follow-up of 1452±156 days, 19 deaths (26%) and 24 HF hospitalization (32%) were observed. Baseline CKD stages were not related to NYHA class and LVEF, but related to the higher risk of reaching the composite the end point. Cox multivariated analysis showed higher CKD stage was an independent positive predictor of the end point (HR: 1.59, 95%CI: 1.037–2.439, P=0.033). Conclusions: Baseline CKD stages independently predicted long-term mortality and HF hospitalization. Renal dysfunction may be one of the risk factors for nonresponse to CRT-D.
    No preview · Article · Jan 2011 · Journal of Arrhythmia
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    ABSTRACT: Although several ECG algorithms have been proposed for differentiating the origins of outflow tract ventricular arrhythmia (OT-VA), their accuracy still is limited in cases with cardiac rotation. The purpose of this study was to assess whether a novel "cardiac rotation-corrected" transitional zone (TZ) index would be a useful marker for differentiating right ventricular outflow tract (RVOT) origin from aortic sinus cusp (ASC) origin. Surface ECGs of OT-VAs with left bundle branch block morphology and inferior axis in 112 patients who were successfully ablated in the RVOT (n = 87) or the ASC (n = 25) were analyzed. The TZ index was defined according to the site of R-wave transition of sinus beats and OT-VAs. The TZ index was significantly lower in the ASC origin than in the RVOT origin (-1.2 ± 0.9 vs 0.3 ± 0.7, P <.0001). A cutoff value of the TZ index <0 predicted the ASC origin with 88% sensitivity and 82% specificity. The previously reported R-wave duration index ≥ 50% had a high specificity of 85% but a low sensitivity of 44%, and R/S-wave amplitude index ≥ 30% had 68% sensitivity and 79% specificity. The area under the curve by receiver operating characteristic curve analysis was 0.90 for the TZ index, which was significantly higher than the R-wave duration index and R/S-wave amplitude index of 0.74 and 0.76, respectively. This novel TZ index can be a more useful marker for differentiating RVOT origin from ASC origin.
    No preview · Article · Nov 2010 · Heart rhythm: the official journal of the Heart Rhythm Society

Publication Stats

1k Citations
520.23 Total Impact Points

Institutions

  • 1991-2015
    • Nagoya University
      • • Division of Cardiology
      • • Department of Nursing
      • • Division of of Internal Medicine
      Nagoya, Aichi, Japan
  • 2014
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 1996-2006
    • Nagoya Second Red Cross Hospital
      Nagoya, Aichi, Japan
  • 2002
    • Peptide Institute, Inc.
      Ibaragi, Ōsaka, Japan
    • Mitsubishi Nagoya Hospital
      Nagoya, Aichi, Japan