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. 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)
  2. 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)
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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.
  33. 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.
  34. 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.
  35. 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.
  36. 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.
  37. 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.
  38. 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.
  39. 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.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. 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.
  45. 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.
  46. 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.
  47. 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.
  48. 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.
  49. 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.

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