研究テーマ
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1. 有効で安全性の高いアブレーション方法の開発
2. 植え込み型デバイスによる心臓病の管理法の確立
3. 非侵襲的な手法による不整脈発生機序の解明 |
より安全なカテーテルアブレーションを目指して
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心房細動に対するカテーテルアブレーションにおいて、高出力・短時間焼灼法が導入されています。従来の低出力・長時間焼灼に比較し、焼灼時間の短縮により伝導熱傷害を低減し、周辺臓器傷害を回避しうることが示されています。しかし、実臨床での高出力・短時間焼灼による食道への熱傷害(ETI:食道粘膜障害および食道神経叢傷害による胃蠕動運動低下)の特徴は明らかではなく、自験例での検討を行っています。
心房細動に対して、従来の低出力・長時間焼灼(Conventional群)でカテーテルアブレーションを施行した170例、および高出力・短時間焼灼(HP-SD群)で施行した101例を対象に、ETIの発生頻度と特徴を比較検討しました。
Conventional群ではETI出現頻度38例(22%)に対し、HP-SD群では37例(37%)と有意に高値でしたが、より深い熱傷害である食道粘膜傷害はConventional群とHP-SD群では差はありませんでした(8%
vs. 7%, P=0.827)。(図1) しかし、HP-SD群では浅いびらんにとどまる一方、Conventional群ではより傷害の強い潰瘍性病変を呈しており(図2)、HP-SD群でのETIは、食道浅層への熱傷害にとどまる可能性が示されました。
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図1
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図2 |
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HP-SD群での食道粘膜傷害は浅いびらんであるのに対し(A)、Conventional群では深い潰瘍性病変を呈していました(B)。
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Circulation: Arrhythmia and Electrophysiology 13 (10), e008602, 2020
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上述のごとく、高出力・短時間焼灼の食道熱傷害に対する安全性が示されました。しかし、焼灼指標のうち、どの指標がETI発症に最も寄与するかは明らかになっていません。
心房細動に対して高出力・短時間焼灼で施行した163例を対象に、ETIの発生頻度と食道に重複する焼灼部位の焼灼指標を比較・検討しました。(図3)全例で術2日後に上部消化管内視鏡を施行し、44例(23%)でETIを認めました。ETIを認めた群では、食道重複部位における焼灼指標のうち、カテーテル先端の平均接触強度(コンタクトフォース:
CF)が有意に高く(14.8 g vs. 11.6 g, P < 0.001)、平均CF < 10 gであった症例は有意に少なく(11%
vs. 32%, P = 0.008)、> 20gであった症例は有意に多い結果でした。(25% vs. 5%, P < 0.001)。(表1)
高出力・短時間焼灼によるETIの発症には、焼灼指標のうちCFが最も影響があることが明らかとなりました。 |
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図3
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表1 |
Circulation: Arrhythmia and Electrophysiology 14 (6), e009897, 2021
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これらの結果を参考に当科では、なるべく低いCFで高出力・短時間焼灼を行うことにより、安全な心房細動アブレーションを目指しております。
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植え込み型デバイスによる心臓病の管理法の確立
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心臓再同期療法(CRT)に関して、治療反応性の良否の予測をテーマに研究を行い臨床応用につなげています。心不全では他臓器障害を有することが多く、『心肝連関』に着目し肝予備能評価法であるalbumin-bilirubin(ALBI)スコア*のCRT植え込み後の予後予測における有用性について検討しました(図4)。
*ALBIスコア: (log10 total bilirubin [μmol/L] × 0.66) + (albumin [g/L] × -0.085)にて算出します。
Grade 1:2:3 = ≦-2.60:>-2.60 ~ ≦-1.39:> -1.39
Gradeが低いほど肝予備能は良好とされます。
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J Clin Oncol. 2015; 33: 550-558.
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図4 |
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CRT植え込み後に心不全イベントの発生を経時的に追ったデータです。
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J Clin Med. 2021;10: 5378. doi: 10.3390
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CRT植え込み6か月後にALBIスコア高値(肝予備能低下)を呈した群では心不全イベントの発生が多く、他臓器連関の重要性が示されました。
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非侵襲的な手法による致死性不整脈発生の予測
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心室頻拍の発生予測に心臓MRIの遅延造影が有用であることが示されています。しかし、心疾患患者では腎障害を有することが多く遅延造影による評価が困難な症例が多数存在します。そこで心不全患者において、慢性腎臓病と123I-MIBGシンチグラフィーにて評価した心臓交感神経障害の併存の有無と致死性不整脈出現との関連性について検討しました(図5)。 |
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図5 |
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致死性不整脈の発生を経時的に追ったデータです。
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Ann Noninvasive Electrocardiol. 2021 (in press)
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慢性腎臓病と心臓交感神経障害を併存する患者群にて、致死性不整脈の発生が高率であることが示されました。123I-MIBGシンチグラフィーは、腎障害を有する患者においても安全に行うことができる検査のため、臨床応用が期待されます。
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これまでの主な業績
- Masashi Kamioka, Hisaki Makimoto, Tomonori Watanabe, Hiroaki Watanabe,
Takafumi Okuyama, Takashi Kaneshiro, Naoko Hijioka, Ayako Yokota, Takahiro
Komori, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario. Unipolar-voltage-based
evaluation of left atrial tissue properties and ablation outcome in patients
with atrial fibrillation. EP Europace (in press)
- Shinya Yamada, Takashi Kaneshiro, Minoru Nodera, Kazuaki Amami, Takeshi
Nehashi, Yukiko Horikoshi, Yukio Yamadera, Yasuchika Takeishi. Utility
of short-time electrocardiogram to assess risk for atrial arrhythmia recurrence:
Impact of atrial premature beat occurrence 1 day after pulmonary vein isolation
for atrial fibrillation. Journal of Cardiovascular Electrophysiology (in
press)
- Shinya Yamada, Takashi Kaneshiro, Minoru Nodera, Kazuaki Amami, Takeshi
Nehashi, Yasuchika Takeishi. Left atrial epicardial adipose tissue exacerbates
electrical conduction disturbance in normal-weight patients undergoing
pulmonary vein isolation for atrial fibrillation. Journal of Cardiovascular
Electrophysiology 34(3), 565-574, 2023
- Kazuaki Amami, Akiomi Yoshihisa, Yuko Horikoshi, Shinya Yamada, Takeshi
Nehashi, Naoko Hijioka, Minoru Nodera, Takashi Kaneshiro, Tetsuro Yokokawa,
Tomofumi Misaka, Yasuchika Takeishi. Utility of a novel wearable electrode
embedded in an undershirt for electrocardiogram monitoring and detection
of arrhythmias. PLoS One 17 (8), e0273541, 2022
- Naoko Hijioka, Takashi Kaneshiro, Takeshi Nehashi, Kazuaki Amami, Minoru
Nodera, Shinya Yamada, Tetsuro Yokokawa, Tomofumi Misaka, Yasuchika Takeishi.
Influence of power setting on superior vena cava potential during right
pulmonary vein isolation. Journal of Interventional Cardiac Electrophysiology
65 (1), 25-31, 2022
- Shinya Yamada, Takashi Kaneshiro, Naoko Hijioka, Kazuaki Amami, Yukiko
Horikoshi, Yukio Yamadera, Takuto Hikichi, Akiomi Yoshihisa, Yasuchika
Takeishi. Autonomic cardiogastric neural interaction after pulmonary vein
isolation in patients with atrial fibrillation. Journal of Interventional
Cardiac Electrophysiology 65 (2), 357–364, 2022
- Masashi Kamioka, Naoko Hijioka, Minoru Nodera, Shinya Yamada, Takashi Kaneshiro,
Yasuchika Takeishi. Electrophysiological properties and involvement of
anatomical factors for the prediction of intramural origin in patients
with ventricular tachyarrhythmia arising from the left ventricular outflow
tract. Journal of Interventional Cardiac Electrophysiology 63 (1), 115-123,
2022
- Naoko Hijioka, Takashi Kaneshiro, Takeshi Nehashi, Kazuaki Amami, Minoru
Nodera, Shinya Yamada, Masashi Kamioka, Takafumi Ishida, Yasuchika Takeishi.
Procedural characteristics of pulmonary vein isolation with high-power
short-duration setting ablation compared to conventional setting. BMC cardiovascular
disorders 22 (1), 14, 2022
- Kazuaki Amami, Shinya Yamada, Akiomi Yoshihisa, Takashi Kaneshiro, Naoko
Hijioka, Minoru Nodera, Takeshi Nehashi, Yasuchika Takeishi. Predictive
impacts of chronic kidney disease and cardiac sympathetic nervous activity
on lethal arrhythmic events in chronic heart failure. Annals of Noninvasive
Electrocardiology 27 (1), e12900, 2022
- Shinya Yamada, Takashi Kaneshiro, Akiomi Yoshihisa, Minoru Nodera, Kazuaki
Amami, Takeshi Nehashi, Yasuchika Takeishi. Albumin-bilirubin score for
prediction of outcomes in heart failure patients treated with cardiac resynchronization
therapy. Journal of Clinical Medicine 10 (22), 5378, 2021
- Yusuke Tomita, Shinya Yamada, Takashi Kaneshiro, Naoko Hijioka, Takeshi
Shimizu, Yasuchika Takeishi. A sudden rise in pacing threshold of left
ventricular lead associated with myocardial ischemia. Journal of Arrhythmia
37 (3), 693-695, 2021
- Takashi Kaneshiro, Kazuaki Amami, Naoko Hijioka, Minoru Nodera, Shinya
Yamada, Tetsuro Yokokawa, Tomofumi Misaka, Takuto Hikichi, Akiomi Yoshihisa,
Yasuchika Takeishi. Significance of contact force on esophageal thermal
injury during relative high-power short-duration ablation of atrial fibrillation.
Circulation: Arrhythmia and Electrophysiology 14 (6), e009897, 2021
- Masashi Kamioka, Takashi Kaneshiro, Naoko Hijioka, Kazuaki Amami, Minoru
Nodera, Shinya Yamada, Yasuchika Takeishi. Visit-to-visit blood pressure
variability predicts atrial fibrillation recurrence after pulmonary vein
isolation in patients with hypertension and atrial fibrillation. Circulation
Reports 3 (4), 187-193, 2021
- Shinya Yamada, Akiomi Yoshihisa, Naoko Hijioka, Kazuaki Amami, Takashi
Kaneshiro, Takafumi Ishida, Yasuchika Takeishi. Associations of the prognostic
nutritional index with the cardiac function and survival after cardiac
resynchronization therapy. Internal Medicine 60 (7), 985-991, 2021
- Shinya Yamada, Akiomi Yoshihisa, Takashi Kaneshiro, Kazuaki Amami, Naoko
Hijioka, Tomofumi Misaka, Tetsuro Yokokawa, Yasuchika Takeishi. Clinical
impact of long PR-interval and presence of late gadolinium enhancement
on hospitalized patients with non-ischemic heart failure. Annals of Noninvasive
Electrocardiology 26 (2), e12818, 2021
- Shinya Yamada, Akiomi Yoshihisa, Takashi Kaneshiro, Kazuaki Amami, Naoko
Hijioka, Masayoshi Oikawa, Yasuchika Takeishi. The relationship between
red cell distribution width and cardiac autonomic function in heart failure.
Journal of Arrhythmia 36 (6), 1076-1082, 2020
- Takashi Kaneshiro, Naoko Hijioka, Yoshiyuki Matsumoto, Minoru Nodera, Shinya
Yamada, Masashi Kamioka, Yasuchika Takeishi. Temperature drop in thawing
phase reflects sufficient ice formation and better outcome of pulmonary
vein isolation using 2nd-generation cryoballoon. Journal of Interventional
Cardiac Electrophysiology 59 (2), 357-364, 2020
- Masashi Kamioka, Akiomi Yoshihisa, Naoko Hijioka, Minoru Nodera, Shinya
Yamada, Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Hiroyuki
Kunii, Yasuchika Takeishi. The efficacy of combination of transcatheter
atrial septal defects closure and radiofrequency catheter ablation for
the prevention of atrial fibrillation recurrence through bi-atrial reverse
remodeling. Journal of Interventional Cardiac Electrophysiology 59 (2),
365-372, 2020
- Takashi Kaneshiro, Masashi Kamioka, Naoko Hijioka, Shinya Yamada, Tetsuro
Yokokawa, Tomofumi Misaka, Takuto Hikichi, Akiomi Yoshihisa, Yasuchika
Takeishi. Characteristics of esophageal injury in ablation of atrial fibrillation
using a high-power short-duration setting. Circulation: Arrhythmia and
Electrophysiology 13 (10), e008602, 2020
- Masashi Kamioka, Akiomi Yoshihisa, Minoru Nodera, Tomofumi Misaka, Tetsuro
Yokokawa, Takashi Kaneshiro, Kazuhiko Nakazato, Takafumi Ishida, Yasuchika
Takeishi. The clinical implication of new‐onset in‐hospital atrial fibrillation
in patients with acute decompensated heart failure. Journal of Arrhythmia
36 (5), 874-882, 2020
- Shinya Yamada, Akiomi Yoshihisa, Naoko Hijioka, Masashi Kamioka, Takashi
Kaneshiro, Tetsuro Yokokawa, Tomofumi Misaka, Takafumi Ishida, Yasuchika
Takeishi. Autonomic dysfunction in cardiac amyloidosis assessed by heart
rate variability and heart rate turbulence. Annals of Noninvasive Electrocardiology
25 (4), e12749, 2020
- Shinya Yamada, Akiomi Yoshihis, Takamasa Sato, Masashi Kamioka, Takashi
Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Takafumi Ishida, Yasuchika
Takeishi. Prognostic significance of premature ventricular complex burden
on hospitalized patients with heart failure. Journal of Arrhythmia. 2019;36:134-142
- Shinya Yamada, Takashi Kaneshiro, Masashi Kamioka, Hidetomo Onuma, Yukio
Yamadera, Yasuchika Takeishi. Clinical impact of speckle tracking echocardiography
for detecting the origin of posterior papillary muscle ventricular arrhythmia.
Europace. 2019;21:917
- Naoko Hijioka, Masashi Kamioka, Yoshiyuki Matsumoto, Minoru Nodera, Shinya
Yamada, Takashi Kaneshiro, Akiomi Yoshihisa, Takafumi Ishida, Yasuchika
Takeishi. Clinical impact of insulin resistance on pulmonary vein isolation
outcome in patients with paroxysmal atrial fibrillation. Journal of Cardiovascular
Electrophysiology. 2019;30:479-486
- Yoshiyuki Matsumoto, Takashi Kaneshiro, Naoko Hijioka, Minoru Nodera, Shinya
Yamada, Masashi Kamioka, Akiomi Yoshihisa, Hiroshi Ohkawara, Takuto Hikichi,
Hitoshi Suzuki, Yasuchika Takeishi. Predicting factors of transmural thermal
injury after cryoballoon pulmonary vein isolation. Journal of Interventional
Cardiac Electrophysiology. 2019;54:101-108
- Takashi Kaneshiro, Yoshiyuki Matsumoto, Naoko Hijioka, Minoru Nodera, Shinya
Yamada, Masashi Kamioka, Akiomi Yoshihisa, Hiroshi Ohkawara, Hitoshi Suzuki,
Yasuchika Takeishi. Distinct forms of esophageal lesions after radiofrequency
and cryoballoon pulmonary vein isolation. JACC:Clinical Electrophysiology.
2018;4:1642-3
- Shinya Yamada, Akiomi Yoshihisa, Yu Sato, Takamasa Sato, Masashi Kamioka,
Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Hitoshi Suzuki,
Takafumi Ishida, Yasuchika Takeishi. Utility of heart rate turbulence and
T-wave alternans to assess risk for readmission and cardiac death in hospitalized
heart failure patients. Journal of Cardiovascular Electrophysiology. 2018;29:1257-1264
- Minoru Nodera, Hitoshi Suzuki, Yoshiyuki Matsumoto, Masashi Kamioka, Takashi
Kaneshiro, Akiomi Yoshihisa, tetsuya Ohira, Yasuchika Takeishi. Association
between serum uric acid level and ventricular tachyarrhythmia in heart
failure patients with implantable cardioverter-defibrillator. Cardiology.
2018;140:47-51
- Masashi Kamioka, Naoko Hijioka, Yoshiyuki Matsumoto, Minoru Nodera, Takashi
Kaneshiro, Hitoshi Suzuki, Yasuchika Takeishi. Uncontrolled blood pressure
affects atrial remodeling and adverse clinical outcome in paroxysmal atrial
fibrillation. Pacing and Clinical Electrophysiology. 2018;41:402-410
- Takashi Kaneshiro, Yoshiyuki Matsumoto, Minoru Nodera, Masashi Kamioka,
Yoshiyuki Kamiyama, Akiomi Yoshihisa, Hiroshi Ohkawara, Hitoshi Suzuki,
Yasuchika Takeishi. Anatomical Predisposing Factors of Transmural Thermal
Injury after Pulmonary Vein Isolation. Europace. 2018;20:1122-1128
- Hitoshi Suzuki, Minoru Nodera, Masashi, Kamioka, Takashi Kaneshiro, Yoshiyuki
Kamiyama, Yasuchika Takeishi. Intracardiac impedance after cardiac resynchronization
therapy is a novel predictor for worsening of heart failure. Heart and
Vessels. 2017;32:926-931
- Takashi Kaneshiro, Yoshiyuki Matsumoto, Minoru Nodera, Masashi Kamioka,
Hitoshi Suzuki, Yasuchika Takeishi. Spastic occlusion of coronary artery
during cryoballoon pulmonary vein isolation. HeartRhythm Case Reports.
2017;3: 509-512.
- Takashi Kaneshiro, Kentaro Yoshida, Yukio Sekiguchi, Hiroshi Tada, Kenji
Kuroki, Keisuke Kuga, Yoshiyuki Kamiyama, Hitoshi Suzuki, Yasuchika Takeishi,
Kazutaka Aonuma. Crucial role of pulmonary vein firing as an initiator
of typical atrial flutter: Evidence of a close relationship between atrial
fibrillation and typical atrial flutter. Journal of Arrhythmia. 2017;33:86-91.
- Takashi Kaneshiro, Hitoshi Suzuki, Minoru Nodera, Masashi Kamioka, Yoshiyuki
Kamiyama, Yasuchika Takeishi. Fibrillatory excitation in the pulmonary
vein is associated with the presence of dissociated pulmonary vein activity
after isolation. Journal of Interventional Cardiac Electrophysiology. 2016;47:231-236.
- Naoko Hijioka, Masashi Kamioka, Hitoshi Suzuki, Yasuchika Takeishi. A case
of atrial tachycardia circulating around a left atrial roof scar with diabetes
mellitus and renal failure on hemodialysis. Case Reports in Medicine. 2016;6485939.
- Takashi Kaneshiro, Hitoshi Suzuki, Minoru Nodera, Shinya Yamada, Masashi
Kamioka, Yoshiyuki Kamiyama, Yasuchika Takeishi. Mapping strategy associated
with QRS morphology for catheter ablation in patients with idiopathic ventricular
outflow tract tachyarrhythmia. Pacing and Clinical Electrophysiology. 2016;39:338-344.
- Masashi Kamioka, Minoru Nodera, Hitoshi Suzuki, Yasuchika Takeishi. The
utility of shock coil and left ventricular tip right ventricular coil impedance
as a predictor of pneumothorax in cardiac resynchronization therapy implantation.
Journal of Cardiology Cases. 2016;13:193-195.
- Minoru Nodera, Hitoshi Suzuki, Shinya Yamada, Masashi Kamioka, Takashi
Kaneshiro, Yoshiyuki Kamiyama, Yasuchika Takeishi. Association of serum
n-3/n-6 polyunsaturated fatty acid ratio with T-wave alternans in patients
with ischemic heart disease. International Heart Journal. 2015;56:613-617.
- Yoshiyuki Kamiyama, Hitoshi Suzuki, Shinya Yamada, Takashi Kaneshiro, Yasuchika
Takeishi. Serum phosphate levels reflect responses to cardiac resynchronization
therapy in chronic heart failure patients. Journal of Arrhythmia. 2015;31:38-42.
- Hitoshi Suzuki, Tetsuya Ohira, Yasuchika Takeishi, Mitsuaki Hosoya, Seiji
Yasumura, Hiroaki Satoh, Yukihiko Kawasaki, Atsushi Takahashi, Akira Sakai,
Akira Ohtsuru, Gen Kobashi, Kotaro Ozasa, Shunichi Yamashita, Kenji Kamiya,
Masafumi Abe, for the Fukushima Health Management Survey Group. Increased
prevalence of atrial fibrillation after the Great East Japan Earthquake:
Results from the Fukushima Health Management Survey. International Journal
of Cardiology. 2015;198:102-105.
- Shinya Yamada, Hitoshi Suzuki, Takashi Kaneshiro, Yoshiyuki Kamiyama, Shu-ichi
Saitoh, Yasuchika Takeishi. Prognostic value of T-wave alternans in survivors
of ventricular fibrillation or hemodynamically unstable ventricular tachycardia.
Journal of Arrhythmia. 2014;30:485-490.
- Shinya Yamada, Hitoshi Suzuki, Yoshiyuki Kamiyama, Shu-ichi Saitoh, Yasuchika
Takeishi. Predictive impact of the decreasing rate of intrathoracic impedance
in worsening chronic heart failure. Journal of Interventional Cardiac Electrophysiology.
2014;40:87-91.
- Hitoshi Suzuki, Shinya Yamada, Yoshiyuki Kamiyama, Yasuchika Takeishi.
Efficacy of intrathoracic impedance and remote monitoring in patients with
an implantable device after the 2011 Great East Japan Earthquake. International
Heart Journal. 2014;55:53-57.
- Shinya Yamada, Hitoshi Suzuki, Masashi Kamioka, Satoshi Suzuki, Yoshiyuki
Kamiyama, Akiomi Yoshihisa, Shu-ichi Saitoh, Yasuchika Takeishi. Sleep-disordered
breathing increases risk for fatal ventricular arrhythmias in patients
with chronic heart failure. Circulation Journal. 2013;77:1466-1473.
- Yuichi Nakamura, Hitoshi Suzuki, Hiroto Takeda, Yasuchika Takeishi. DDTA
mode pacing in the treatment of complete conduction block from the right
atrium to the ventricles and interatrial electrical dissociation after
surgical procedures. Journal of Arrhythmia. 2013;29:235-237.
- Shinya Yamada, Hitoshi Suzuki, Masashi Kamioka, Yoshiyuki Kamiyama, Shu-ichi
Saitoh, Yasuchika Takeishi. Uric acid increases the incidence of ventricular
arrhythmia in patients with left ventricular hypertrophy. Fukushima Journal
of Medical Science. 2012;58:101-106.
- Takashi Kaneshiro, Hitoshi Suzuki, Shinya Yamada, Yoshiyuki Kamiyama, Shu-ichi
Saitoh, Yasuchika Takeishi. Intrathoracic impedance changes reflect reverse
left ventricular remodeling in response to cardiac resynchronization therapy
in chronic heart failure patients. International Heart Journal. 2012;53:249-252.
- Masashi Kamioka, Hitoshi Suzuki, Shinya Yamada, Yoshiyuki Kamiyama, Shu-ichi
Saitoh, Yasuchika Takeishi. High sensitivity C-reactive protein predicts
nonresponders and cardiac deaths in severe heart failure patients after
CRT implantation. International Heart Journal. 2012;53:306-312.
- Hitoshi Suzuki, Yasuchika Takeishi. Inducibility of atrial fibrillation
caused by acute increase of atrial pressure in rat diseased heart with
chronic atrial dilation. International Heart Journal. 2012;53:257-260.
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