不整脈分野
研究テーマ
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
　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。
図1
図２
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）。
Circulation: Arrhythmia and Electrophysiology 13 (10), e008602, 2020
　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。
図3



表１
Circulation: Arrhythmia and Electrophysiology 14 (6), e009897, 2021
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。
植え込み型デバイスによる心臓病の管理法の確立
　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。
J Clin Oncol. 2015; 33: 550-558.
図４
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。
J Clin Med. 2021;10: 5378. doi: 10.3390
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。
非侵襲的な手法による致死性不整脈発生の予測
　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）。
図５
致死性不整脈の発生を経時的に追ったデータです。
Ann Noninvasive Electrocardiol. 2021 (in press)
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。


これまでの主な業績
  1. Kaneshiro T, Murota S, Nodera M, Yamada S, Oikawa M, Takeishi Y. Feasibility of a 90-watt, 3-second radiofrequency application for superior vena cava isolation during atrial fibrillation ablation. Europace 27, euaf056, 2025
  2. Kaneshiro T, Murota S, Nehashi T, Nodera M, Yamada S, Ikeda M, Takeishi Y. Achieving reduced radiation exposure with maintained fluoroscopy effectiveness using ultralow-dose settings in cryoballoon ablation. J Arrhythm 40, 1400-1407, 2024
  3. Yamada S, Kaneshiro T, Nodera M, Amami K, Nehashi T, Oikawa M, Yamaki T, Nakazato K, Ishida T, Takeishi Y. Associations of the fibrosis-4 index with left atrial low-voltage areas and arrhythmia recurrence after catheter ablation: Cardio-hepatic interaction in patients with atrial fibrillation. J Arrhythm 40, 585-593, 2024
  4. Yamada S, Kaneshiro T, Nodera M, Murota S, Takeishi Y. Critical ablation targets of ventricular tachycardia revealed by activation mapping with both last deflection and peak frequency annotations in a patient of cardiac sarcoidosis. J Arrhythm 40, 1510-1513, 2024
  5. Nehashi T, Kaneshiro T, Nodera M, Yamada S, Takeishi Y. Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation. J Arrhythm 39, 884-893, 2023
  6. Kamioka M, Makimoto H, Watanabe T, Watanabe H, Okuyama T, Kaneshiro T, Hijioka N, Yokota A, Komori T, Kabutoya T, Imai Y, Kario K. Unipolar-voltage-based evaluation of left atrial tissue properties and ablation outcome in patients with atrial fibrillation. Europace 25, euad240, 2023
  7. Yamada S, Kaneshiro T, Nodera M, Amami K, Nehashi T, Horikoshi Y, Yamadera Y, Takeishi Y. 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. J Cardiovasc Electrphysiol 34, 1969-1978, 2023
  8. Yamada S, Kaneshiro T, Nodera M, Amami K, Nehashi T, Takeishi Y. Left atrial epicardial adipose tissue exacerbates electrical conduction disturbance in normal-weight patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrphysiol 34, 565-574, 2023
  9. Amami K, Yoshihisa A, Horikoshi Y, Yamada S, Nehashi T, Hijioka N, Nodera M, Kaneshiro T, Yokokawa T, Misaka T, Takeishi Y. Utility of a novel wearable electrode embedded in an undershirt for electrocardiogram monitoring and detection of arrhythmias. PLoS One 17, e0273541, 2022
  10. Hijioka N, Kaneshiro T, Nehashi T, Amami K, Nodera M, Yamada S, Yokokawa T, Misaka T, Takeishi Y. Influence of power setting on superior vena cava potential during right pulmonary vein isolation. J Interv Card Electrophysiol 65, 25-31, 2022
  11. Yamada S, Kaneshiro T, Hijioka N, Amami K, Horikoshi Y, Yamadera Y, Hikichi T, Yoshihisa A, Takeishi Y. Autonomic cardiogastric neural interaction after pulmonary vein isolation in patients with atrial fibrillation. J Interv Card Electrophysiol 65, 357-364, 2022
  12. Kamioka M, Hijioka N, Nodera M, Yamada S, Kaneshiro T, Takeishi Y. 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. J Interv Card Electrophysiol 63, 115-123, 2022
  13. Hijioka N, Kaneshiro T, Nehashi T, Amami K, Nodera M, Yamada S, Kamioka M, Ishida T, Takeishi Y. Procedural characteristics of pulmonary vein isolation with high-power short-duration setting ablation compared to conventional setting. BMC Cardiovasc Disord 22, 14, 2022
  14. Amami K, Yamada S, Yoshihisa A, Kaneshiro T, Hijioka N, Nodera M, Nehashi T, Takeishi Y. Predictive impacts of chronic kidney disease and cardiac sympathetic nervous activity on lethal arrhythmic events in chronic heart failure. Ann Noninvas Electro 27, e12900, 2022
  15. Yamada S, Kaneshiro T, Yoshihisa A, Nodera M, Amami K, Nehashi T, Takeishi Y. Albumin-bilirubin score for prediction of outcomes in heart failure patients treated with cardiac resynchronization therapy. J Clin Med 10, 5378, 2021
  16. Tomita Y, Yamada S, Kaneshiro T, Hijioka N, Shimizu T, Takeishi Y. A sudden rise in pacing threshold of left ventricular lead associated with myocardial ischemia. J Arrhythm 37, 693-695, 2021
  17. Kaneshiro T, Amami K, Hijioka N, Nodera M, Yamada S, Yokokawa T, Misaka T, Hikichi T, Yoshihisa A, Takeishi Y. Significance of contact force on esophageal thermal injury during relative high-power short-duration ablation of atrial fibrillation. Circ Arrhythm Electrophysiol 14, e009897, 2021
  18. Kamioka M, Kaneshiro T, Hijioka N, Amami K, Nodera M, Yamada S, Takeishi Y. Visit-to-visit blood pressure variability predicts atrial fibrillation recurrence after pulmonary vein isolation in patients with hypertension and atrial fibrillation. Circ Rep 3, 187-193, 2021
  19. Yamada S, Yoshihisa A, Hijioka N, Amami K, Kaneshiro T, Ishida T, Takeishi Y. Associations of the prognostic nutritional index with the cardiac function and survival after cardiac resynchronization therapy. Intern Med 60, 985-991, 2021
  20. Yamada S, Yoshihisa A, Kaneshiro T, Amami K, Hijioka N, Misaka T, Yokokawa T, Takeishi Y. Clinical impact of long PR-interval and presence of late gadolinium enhancement on hospitalized patients with non-ischemic heart failure. Ann Noninvas Electro 26, e12818, 2021
  21. Yamada S, Yoshihisa A, Kaneshiro T, Amami K, Hijioka N, Oikawa M, Takeishi Y. The relationship between red cell distribution width and cardiac autonomic function in heart failure. J Arrhythm 36, 1076-1082, 2020
  22. Kaneshiro T, Hijioka N, Matsumoto Y, Nodera M, Yamada S, Kamioka M, Takeishi Y. Temperature drop in thawing phase reflects sufficient ice formation and better outcome of pulmonary vein isolation using second-generation cryoballoon. J Interv Card Electrophysiol 59, 357-364, 2020
  23. Kamioka M, Yoshihisa A, Hijioka N, Nodera M, Yamada S, Kaneshiro T, Oikawa M, Kobayashi A, Kunii H, Takeishi Y. 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. J Interv Card Electrophysiol 59, 365-372, 2020
  24. Kaneshiro T, Kamioka M, Hijioka N, Yamada S, Yokokawa T, Misaka T, Hikichi T, Yoshihisa A, Takeishi Y. Characteristics of esophageal injury in ablation of atrial fibrillation using a high-power short-duration setting. Circ Arrhythm Electrophysiol 13, e008602, 2020
  25. Kamioka M, Yoshihisa A, Nodera M, Misaka T, Yokokawa T, Kaneshiro T, Nakazato K, Ishida T, Takeishi Y. The clinical implication of new-onset in‐hospital atrial fibrillation in patients with acute decompensated heart failure. J Arrhythm 36, 874-882, 2020
  26. Yamada S, Yoshihisa A, Hijioka N, Kamioka M, Kaneshiro T, Yokokawa T, Misaka T, Ishida T, Takeishi Y. Autonomic dysfunction in cardiac amyloidosis assessed by heart rate variability and heart rate turbulence. Ann Noninvas Electro 25, e12749, 2020
  27. Yamada S, Yoshihisa A, Sato T, Kamioka M, Kaneshiro T, Oikawa M, Kobayashi A, Ishida T, Takeishi Y. Prognostic significance of premature ventricular complex burden on hospitalized patients with heart failure. J Arrhythm 36, 134-142, 2019
  28. Yamada S, Kaneshiro T, Kamioka M, Onuma H, Yamadera Y, Takeishi Y. Clinical impact of speckle tracking echocardiography for detecting the origin of posterior papillary muscle ventricular arrhythmia. Europace 21, 917, 2019
  29. Hijioka N, Kamioka M, Matsumoto Y, Nodera M, Yamada S, Kaneshiro T, Yoshihisa A, Ishida T, Takeishi Y. Clinical impact of insulin resistance on pulmonary vein isolation outcome in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrphysiol 30, 479-486, 2019
  30. Matsumoto Y, Kaneshiro T, Hijioka N, Nodera M, Yamada S, Kamioka M, Yoshihisa A, Ohkawara H, Hikichi T, Suzuki H, Takeishi Y. Predicting factors of transmural thermal injury after cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol 54, 101-108, 2019
  31. Kaneshiro T, Matsumoto Y, Hijioka N, Nodera M, Yamada S, Kamioka M, Yoshihisa A, Ohkawara H, Suzuki H, Takeishi Y. Distinct forms of esophageal lesions after radiofrequency and cryoballoon pulmonary vein isolation. JACC Clin Electrophysiol 4, 1642-1643, 2018
  32. Yamada S, Yoshihisa A, Sato Y, Sato T, Kamioka M, Kaneshiro T, Oikawa M, Kobayashi A, Suzuki H, Ishida T, Takeishi Y. Utility of heart rate turbulence and T-wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients. J Cardiovasc Electrphysiol 29, 1257-1264, 2018
  33. Nodera M, Suzuki H, Matsumoto Y, Kamioka M, Kaneshiro T, Yoshihisa A, Ohira T, Takeishi Y. Association between serum uric acid level and ventricular tachyarrhythmia in heart failure patients with implantable cardioverter-defibrillator. Cardiology 140, 47-51, 2018
  34. Kamioka M, Hijioka N, Matsumoto Y, Nodera M, Kaneshiro T, Suzuki H, Takeishi Y. Uncontrolled blood pressure affects atrial remodeling and adverse clinical outcome in paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 41, 402-410, 2018
  35. Kaneshiro T, Matsumoto Y, Nodera M, Kamioka M, Kamiyama Y, Yoshihisa A, Ohkawara H, Suzuki H, Takeishi Y. Anatomical predisposing factors of transmural thermal injury after pulmonary vein isolation. Europace 20, 1122-1128, 2018
  36. Suzuki H, Nodera M, Kamioka M, Kaneshiro T, Kamiyama Y, Takeishi Y. Intracardiac impedance after cardiac resynchronization therapy is a novel predictor for worsening of heart failure. Heart Vessels 32, 926-931, 2017
  37. Kaneshiro T, Matsumoto Y, Nodera M, Kamioka M, Suzuki H, Takeishi Y. Spastic occlusion of coronary artery during cryoballoon pulmonary vein isolation. HeartRhythm Case Rep 3, 509-512, 2017
  38. Kaneshiro T, Yoshida K, Sekiguchi Y, Tada H, Kuroki K, Kuga K, Kamiyama Y, Suzuki H, Takeishi Y, Aonuma K. 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. J Arrhythm 33, 86-91, 2017
  39. Kaneshiro T, Suzuki H, Nodera M, Kamioka M, Kamiyama Y, Takeishi Y. Fibrillatory excitation in the pulmonary vein is associated with the presence of dissociated pulmonary vein activity after isolation. J Interv Card Electrophysiol 47, 231-236, 2016
  40. Hijioka N, Kamioka M, Suzuki H, Takeishi Y. A case of atrial tachycardia circulating around a left atrial roof scar with diabetes mellitus and renal failure on hemodialysis. Case Rep Med 2016, 6485939, 2016
  41. Kaneshiro T, Suzuki H, Nodera M, Yamada S, Kamioka M, Kamiyama Y, Takeishi Y. Mapping strategy associated with QRS morphology for catheter ablation in patients with idiopathic ventricular outflow tract tachyarrhythmia. Pacing Clin Electrophysiol 39, 338-344, 2016
  42. Kamioka M, Nodera M, Suzuki H, Takeishi Y. The utility of shock coil and left ventricular tip–right ventricular coil impedance as a predictor of pneumothorax in cardiac resynchronization therapy implantation. J Cardiol Cases 13, 193-195, 2016
  43. Nodera M, Suzuki H, Yamada S, Kamioka M, Kaneshiro T, Kamiyama Y, Takeishi Y. Association of serum n-3/n-6 polyunsaturated fatty acid ratio with T-wave alternans in patients with ischemic heart disease. Int Heart J 56, 613-617, 2015
  44. Kamiyama Y, Suzuki H, Yamada S, Kaneshiro T, Takeishi Y. Serum phosphate levels reflect responses to cardiac resynchronization therapy in chronic heart failure patients. J Arrhythm 31, 38-42, 2015
  45. Suzuki H, Ohira T, Takeishi Y, Hosoya M, Yasumura S, Satoh H, Kawasaki Y, Takahashi A, Sakai A, Ohtsuru A, Kobashi G, Ozasa K, Yamashita S, Kamiya K, Abe M, 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. Int J Cardiol 198, 102-105, 2015
  46. Yamada S, Suzuki H, Kaneshiro T, Kamiyama Y, Saitoh S, Takeishi Y. Prognostic value of T-wave alternans in survivors of ventricular fibrillation or hemodynamically unstable ventricular tachycardia. J Arrhythm 30, 485-490, 2014
  47. Yamada S, Suzuki H, Kamiyama Y, Saitoh S, Takeishi Y. Predictive impact of the decreasing rate of intrathoracic impedance in worsening chronic heart failure. J Interv Card Electrophysiol 40, 87-91, 2014
  48. Suzuki H, Yamada S, Kamiyama Y, Takeishi Y. Efficacy of intrathoracic impedance and remote monitoring in patients with an implantable device after the 2011 Great East Japan Earthquake. Int Heart J 55, 53-57, 2014
  49. Yamada S, Suzuki H, Kamioka M, Suzuki S, Kamiyama Y, Yoshihisa A, Saitoh S, Takeishi Y. Sleep-disordered breathing increases risk for fatal ventricular arrhythmias in patients with chronic heart failure. Circ J 77, 1466-1473, 2013
  50. Nakamura Y, Suzuki H, Takeda H, Takeishi Y. DDTA mode pacing in the treatment of complete conduction block from the right atrium to the ventricles and interatrial electrical dissociation after surgical procedures. J Arrhythm 29, 235-237, 2013
  51. Yamada S, Suzuki H, Kamioka M, Kamiyama Y, Saitoh S, Takeishi Y. Uric acid increases the incidence of ventricular arrhythmia in patients with left ventricular hypertrophy. Fukushima J Med Sci 58, 101-106, 2012
  52. Kaneshiro T, Suzuki H, Yamada S, Kamiyama Y, Saitoh S, Takeishi Y. Intrathoracic impedance changes reflect reverse left ventricular remodeling in response to cardiac resynchronization therapy in chronic heart failure patients. Int Heart J 53, 249-252, 2012
  53. Kamioka M, Suzuki H, Yamada S, Kamiyama Y, Saitoh S, Takeishi Y. High sensitivity C-reactive protein predicts nonresponders and cardiac deaths in severe heart failure patients after CRT implantation. Int Heart J 53, 306-312, 2012
  54. Suzuki H, Takeishi Y. Inducibility of atrial fibrillation caused by acute increase of atrial pressure in rat diseased heart with chronic atrial dilation. Int Heart J 53, 257-260, 2012

文責:山田慎哉、金城貴士



教室紹介
スタッフ紹介
診療部門紹介
研究部門紹介
　基礎研究
　　心不全
　　血管生物医学
　　肺高血圧症
　　冠循環
　臨床研究
　　不整脈
　　心不全
　　心臓核医学
　　虚血性心疾患
受賞
業績