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Miyauchi S, Ouhara K, Shintani T, Tokuyama T, Okubo Y, Okamura S, Miyamoto S, Oguri N, Uotani Y, Takemura T, Tari M, Hiyama T, Miyauchi M, Kajiya M, Mizuno N, Nakano Y. Periodontal Treatment During the Blanking Period Improves the Outcome of Atrial Fibrillation Ablation. J Am Heart Assoc 2024; 13:e033740. [PMID: 38597139 DOI: 10.1161/jaha.123.033740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Periodontitis has not been recognized as a modifiable risk factor for atrial fibrillation (AF). This prospective nonrandomized study investigated whether periodontal treatment improves the AF ablation outcome. METHODS AND RESULTS We prospectively enrolled 288 AF patients scheduled to undergo initial radiofrequency catheter ablation. Each patient underwent periodontal inflamed surface area (PISA; a quantitative index of periodontal inflammation) measurement. All eligible patients were recommended to receive periodontal treatment within the blanking period, and 97 consented. During the mean follow-up period of 507±256 days, 70 (24%) AF recurrences were documented. Patients who exhibited AF recurrences had a higher PISA than those who did not (456.8±403.5 versus 277.7±259.0 mm2, P=0.001). These patients were categorized into high-PISA (>615 mm2) and low-PISA (<615 mm2) groups according to the receiver operating characteristic analysis for AF recurrence (area under the curve, 0.611; sensitivity, 39%; specificity, 89%). A high PISA, as well as female sex, AF duration, and left atrial volume, were the statistically significant predicter for AF recurrence (hazard ratio [HR], 2.308 [95% CI, 1.234-4.315]; P=0.009). In patients with a high PISA, those who underwent periodontal treatment showed significantly fewer AF recurrences (P=0.01, log-rank test). The adjusted HR of periodontal treatment for AF recurrence was 0.393 (95% CI, 0.215-0.719; P=0.002). CONCLUSIONS Periodontitis may serve as a modifiable risk factor for AF. PISA is a hallmark of AF recurrence, and periodontal treatment improves the AF ablation outcome, especially for those with poor periodontal condition.
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Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
- Division of Medicine, Health Service Center Hiroshima University Higashihiroshima Japan
| | - Kazuhisa Ouhara
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Tomoaki Shintani
- Center for Oral Clinical Examination Hiroshima University Hospital Hiroshima Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Tasuku Takemura
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Misako Tari
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Toru Hiyama
- Division of Medicine, Health Service Center Hiroshima University Higashihiroshima Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Mikihito Kajiya
- Center for Oral Clinical Examination Hiroshima University Hospital Hiroshima Japan
| | - Noriyoshi Mizuno
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
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Uotani Y, Sasaki N, Nakashima M, Akiyama R, Oguri N, Miyamoto S, Miyauchi S, Okamura S, Okubo Y, Tokuyama T, Ohno H, Nakano Y. Clinical Features of Tachycardia-induced Cardiomyopathy in Patients with Atrial Fibrillation. Intern Med 2024:2466-23. [PMID: 38369360 DOI: 10.2169/internalmedicine.2466-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Objective Atrial fibrillation (AF) is the most common cause of tachycardia-induced cardiomyopathy (TIC). However, which patients with AF are prone to developing TIC remains unclear. In this study, we investigated the clinical features of AF patients with TIC. Methods This single-center study included 722 patients with AF (average age, 63.1±10.2 years old; 191 women) who underwent radiofrequency catheter ablation. We defined TIC as an initial left ventricular ejection fraction (LVEF) of <40% and a >20% recovery of the LVEF after successful AF ablation and compared the clinical characteristics between the TIC and control groups. Results The proportions of type 2 diabetes (30.5% vs. 14.7%), renal dysfunction (34.2% vs. 23.8%), hypertension (67.1% vs. 54.8%), and persistent AF (62.2% vs. 32.2%) were significantly higher in the TIC group (n=82) than in the control group (n=640). The atrioventricular nodal effective refractory period (AVNERP) (303±72 ms vs. 332±86 ms; p=0.017) was significantly shorter in the TIC group than in the control group. A multivariable analysis found that persistent AF [odds ratio (OR), 3.19; 95% confidence interval (CI), 1.94-5.24], renal dysfunction (OR, 1.87; 95% CI, 1.06-3.32), and type 2 diabetes (OR, 2.30; 95% CI, 1.31-4.05) were significantly associated with TIC. Conclusion Comorbid renal dysfunction and type 2 diabetes were clinical features of AF patients with TIC. Persistent AF, and short AVNERP may be involved in the development of TIC.
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Affiliation(s)
- Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, Japan
| | - Mika Nakashima
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Rie Akiyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Haruya Ohno
- Department of Molecular and Internal Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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Okubo Y, Oguri N, Sakai T, Uotani Y, Furutani M, Miyamoto S, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Conduction velocity mapping in atrial fibrillation using omnipolar technology. Pacing Clin Electrophysiol 2024; 47:19-27. [PMID: 38041418 DOI: 10.1111/pace.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Recent studies have shown that atrial slow conduction velocity (CV) is associated with the perpetuation of atrial fibrillation (AF). However, the criteria of CV measurement have not been standardized. The aim of this study was to evaluate the relationship between the slow CV area (SCVA) measured by novel omnipolar technology (OT) and AF recurrence. METHODS This study included 90 patients with AF who underwent initial pulmonary vein isolation (PVI). The segmented surface area of the SCVA was measured by left atrial (LA) electrophysiological mapping using OT before the PVI. The proportion of the SCVA at each cutoff value of CV (from < 0.6 to < 0.9 m/s) was compared between the patients with and without AF recurrence. RESULTS During a mean follow-up period of 516 ± 197 days, the recurrence of AF after the initial PVI was observed in 23 (25.5%) patients. In patients with AF recurrence, the proportion of the SCVA in the LA posterior, LA appendage (LAA), and LA anterior were significantly higher than those without AF recurrence. The multivariate analysis indicated that the proportion of the low voltage area and the SCVA in the LA anterior (local CV < 0.7 m/s) were independent predictors of AF recurrence (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01-1.14; p = 0.03; HR, 1.40; 95% CI, 1.07-1.83; p = 0.01, respectively). CONCLUSION By evaluating the local CV using OT, it was indicated that SCVA with CV < 0.7 m/s in the LA anterior is strongly associated with AF recurrence after PVI.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takumi Sakai
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Motoki Furutani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Okubo Y, Miyamoto S, Oguri N, Sakai T, Uotani Y, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Lead deformation of the stylet-driven lead in left bundle branch area pacing. Heart Rhythm 2023; 20:781-782. [PMID: 36796531 DOI: 10.1016/j.hrthm.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/27/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takumi Sakai
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Miyamoto S, Okubo Y, Uotani Y, Oguri N, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Initial experience of novel over the wire type decapolar catheter for ventricular arrhythmias originating from left ventricular summit. J Interv Card Electrophysiol 2023; 66:117-124. [PMID: 35960405 DOI: 10.1007/s10840-022-01340-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previously, direct monitoring of local activation at the communicating vein (CV) has been reported to be useful for the ablation of ventricular arrhythmias (VAs) originating from the left ventricular (LV) summit. In this study, we evaluated the performance of the novel over-the-wire (OTW)-type decapolar catheter for VAs originating from the LV summit. METHODS Overall, 17 patients who underwent catheter ablation for idiopathic VAs originating from the LV summit were included in this study. Of these, seven patients underwent mapping of the epicardial LV outflow tract with the novel 2.7 Fr OTW-type decapolar catheter (EPstar FIX AIV), and ten underwent mapping with the standard 2.0 Fr octopolar catheter (EPstar FIX 2F) procedure (AIV group = EPstar FIX AIV and control group = EPstar FIX 2F). RESULTS No significant differences in the baseline characteristics were observed between the two groups. In the AIV group, all patients achieved successful catheter positioning in the target CV, whereas in the control group, two patients failed to achieve the same. The novel catheter not only advanced to the target vessels using a 0.014-in guidewire but it was also used for contrast injection from the catheter lumen, which enabled accurate and safe positioning. As a result, the earliest activation time preceding QRS onset during the VA, recorded at the CV, was significantly earlier when compared with the control group (44.66 ± 11.23 ms vs. 32.16 ± 4.26 ms, P = 0.007). CONCLUSIONS Compared with the conventional electrode catheter, this novel multipolar electrode catheter is more effective for mapping local activation at the CV.
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Affiliation(s)
- Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Miyauchi S, Nishi H, Ouhara K, Tokuyama T, Okubo Y, Okamura S, Miyamoto S, Oguri N, Uotani Y, Takasaki T, Katayama K, Furusho H, Miyauchi M, Takahashi S, Hiyama T, Nakano Y. Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation: Histological Evaluation of Left Atrial Appendages. JACC Clin Electrophysiol 2023; 9:43-53. [PMID: 36697200 DOI: 10.1016/j.jacep.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Atrial fibrosis contributes to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis, a common infectious and inflammatory disease, aggravates some systemic diseases. However, the association of periodontitis with AF and with atrial fibrosis has remained unclarified. OBJECTIVES The authors aimed to elucidate the relationship between periodontitis and atrial fibrosis by studying resected left atrial appendages (LAAs). METHODS Seventy-six patients with AF (55 with nonparoxysmal AF, 25 with mitral valve regurgitation, 18 with LAA thrombus) who were scheduled to undergo LAA excision during cardiac surgery were prospectively enrolled. All patients underwent an oral examination, and the remaining number of teeth, bleeding on probing, periodontal probing depth, and periodontal inflamed surface area (PISA) were evaluated as parameters of periodontitis. The degree of fibrosis in each LAA was quantified by Azan-Mallory staining. RESULTS Bleeding on probing (R = 0.48; P < 0.0001), periodontal probing depth of ≥4 mm (R = 0.26; P = 0.02), and PISA (R = 0.46; P < 0.0001) were positively correlated with atrial fibrosis. Among patients with >10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis (R = 0.57; P < 0.0001). After adjustments for age, AF duration, BMI, mitral valve regurgitation, and CHADS₂ (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was significantly associated with atrial fibrosis (β = 0.016; P = 0.0002). CONCLUSIONS The authors histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is likely a risk factor for AF.
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Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Division of Medicine, Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhisa Ouhara
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taiichi Takasaki
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keijiro Katayama
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Hiyama
- Division of Medicine, Health Service Center, Hiroshima University, Higashihiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Okamura S, Ochi H, Onohara Y, Nakashima M, Akiyama R, Tokuyama T, Okubo Y, Ikeuchi Y, Miyauchi S, Miyamoto S, Oguri N, Uotani Y, Odake Y, Chayama K, Kihara Y, Nakano Y. GJA1 gene polymorphism is a genetic predictor of recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Heart Rhythm 2022; 19:2044-2050. [PMID: 36038005 DOI: 10.1016/j.hrthm.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/06/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and recurrence of AF after pulmonary vein isolation (PVI) have been linked to sinus node dysfunction. OBJECTIVE The purpose of this study was to investigate the association between the heart rate-associated single nucleotide polymorphisms (SNPs) identified in genome-wide association studies and recurrence of AF after PVI. METHODS In this study, patients with paroxysmal AF who underwent initial PVI, including 522 patients for screening and 172 patients for replication, were recruited and 21 heart rate-associated SNPs identified in genome-wide association studies were genotyped. The association between these SNPs and the recurrence of AF was investigated. RESULTS Throughout the follow-up period of 21 ± 12 months, 119 patients with paroxysmal AF (22.8%) exhibited AF recurrences in the screening set. The rate of AF recurrence was significantly associated with the minor allele C of the gap junction alpha-1 protein (GJA1) rs1015451 (additive model: odds ratio 2.07; P = 9.32 × 10-7), but not with other SNPs. This association was confirmed in the replication set (allelic model: odds ratio 1.81; P = 2.70 × 10-2). Multivariate analysis revealed that the recurrence of AF after AF ablation was independently related to the GJA1 SNP rs1015451 additive model, duration of AF >1 year, AF from non-pulmonary vein foci, and thicker interventricular septum. CONCLUSION The GJA1 SNP rs1015451, coding for a gap junction protein (connexin-43), may be considered a novel genetic marker for AF recurrence after PVI.
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Affiliation(s)
- Sho Okamura
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidenori Ochi
- Department of Health Management, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan; Department of Gastroenterology and Metabolism, Biomedical Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mika Nakashima
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rie Akiyama
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yodo Odake
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Biomedical Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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8
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Ikeuchi Y, Ochi H, Motoda C, Tokuyama T, Okubo Y, Okamura S, Miyauchi S, Miyamoto S, Uotani Y, Onohara Y, Nakashima M, Akiyama R, Tahara H, Chayama K, Kihara Y, Nakano Y. Plasma MicroRNAs as noninvasive diagnostic biomarkers in patients with Brugada syndrome. PLoS One 2022; 17:e0261390. [PMID: 35617207 PMCID: PMC9135283 DOI: 10.1371/journal.pone.0261390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) can be diagnosed by a type 1 BrS tracing in a 12-lead electrocardiogram (ECG). However, there are daily variations in the ECGs of BrS patients, which presents a challenge when diagnosing BrS. Although many susceptibility genes have been identified, the SCN5A gene is reportedly the main causative gene of BrS. However, most patients do not have an evidence of genetic predisposition to develop BrS. In addition, the diagnosis and risk stratification for ventricular fibrillation (VF) in patients with BrS presents some problems. Meanwhile, circulating micro RNAs (miRNAs) have drawn increased attention as potential biomarkers of various diseases. We hypothesize that circulating miRNAs may be potential diagnostic biomarkers for BrS. METHODS We enrolled 70 Japanese BrS patients and 34 controls for the screening cohort. A total of 2,555 miRNA sequences were detected using the 3D-Gene miRNAs labeling kit and 3D-Gene Human miRNAs Oligo Chip. We compared the expression of the miRNAs between the BrS patients and the controls. We validated whether the miRNA were significantly up- or downregulated in the screening cohort using RT-PCR. We also enrolled 72 Japanese BrS patients and 56 controls to replicate these miRNAs. RESULTS Eight miRNAs (hsa-miR-223-3p, hsa-miR-22-3p, hsa-miR-221-3p, hsa-miR-4485-5p, hsa-miR-550a-5p, hsa-miR-423-3p, hsa-miR-23a-3p, and hsa-miR-30d-5p) were downregulated, and one miRNA (hsa-miR-873-3p) was upregulated by more than 3-fold in BrS patients. The multivariate logistic regression analysis determined that hsa-miR-423-3p, hsa-miR-223-3p, and hsa-miR-23a-3p were independently associated with BrS (P < 0.0001). The AUC based on cross validation was 0.871 with a sensitivity and specificity of 83.5% and 81.1%, respectively. CONCLUSIONS The plasma miRNAs are potential noninvasive biomarkers of BrS, and the constructed logistic model was useful for discriminating BrS.
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Affiliation(s)
- Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidenori Ochi
- Department of Health Management, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Syunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mika Nakashima
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Rie Akiyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetoshi Tahara
- Department of Cellular and Molecular Biology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Uotani Y, Okubo Y, Komatsu Y, Nogami A, Aonuma K, Nakano Y. Isochronal late activation mapping of epicardial ventricular tachycardia in a patient with mid-ventricular obstructive hypertrophic cardiomyopathy. HeartRhythm Case Rep 2022; 8:374-377. [PMID: 35607347 PMCID: PMC9123325 DOI: 10.1016/j.hrcr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Okubo Y, Miyamoto S, Uotani Y, Ikeuchi Y, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Clinical impact of left bundle branch area pacing in heart failure with preserved ejection fraction and mid-range ejection fraction. Pacing Clin Electrophysiol 2022; 45:499-508. [PMID: 35179237 DOI: 10.1111/pace.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, conduction system pacing, including His bundle and left bundle branch area pacing (LBBAP), has emerged as an alternative pacing procedure for right ventricular (RV) pacing. The current study aimed to compare the clinical outcomes of LBBAP and conventional RV mid-septal pacing (RVMSP) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and HF with mid-range ejection (HFmrEF) requiring frequency RV pacing due to atrioventricular block (AVB). METHODS A total of 89 patients with HFpEF and HFmrEF requiring RV pacing due to symptomatic AVB were enrolled between September 2018 and April 2021, among whom 43 and 46 underwent LBBAP and RVMSP, respectively. RESULTS No significant differences in baseline characteristics were observed between the two groups. The LBBAP group had a significantly shorter paced-QRS duration and paced left ventricular activation time (LVAT) compared to the RVMSP group (123.4 ± 10.4 ms vs. 152.3 ± 12.3 ms, p < 0.001 and 68.3 ± 10.0 ms vs. 95.2 ± 12.3 ms, p < 0.001, respectively). The LBBAP group had significantly lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at the 6-month follow-up compared to the RVMSP group [459.6 pg/mL (240.4-678.7) vs. 972.7 pg/mL (629.5-1315.9), p = 0.01]. More patients in the LBBAP group exhibited a significant improvement in NT-proBNP, defined as a >50% decreased from baseline levels. CONCLUSION LBBAP maintains physiological ventricular activation and contributes to greater improvement in NT-proBNP value 6 months after implantation in patients with HFpEF and HFmrEF compared to RVMSP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Miyauchi S, Tokuyama T, Uotani Y, Miyamoto S, Ikeuchi Y, Okamura S, Okubo Y, Katayama K, Takasaki T, Nakatani N, Matsudaira Y, Furusho H, Miyauchi M, Takahashi S, Nakano Y. Association between Left Atrial Appendage Fibrosis and Thrombus Formation: A Histological Approach. J Cardiovasc Electrophysiol 2022; 33:677-687. [DOI: 10.1111/jce.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
- Health Service CenterHiroshima University1‐7‐1 KagamiyamaHigashihiroshimaJapan
| | - Takehito Tokuyama
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukimi Uotani
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shogo Miyamoto
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Sho Okamura
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yousaku Okubo
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Keijiro Katayama
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Taiichi Takasaki
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Nobuhiro Nakatani
- Medical Division, Technical CenterHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yorisato Matsudaira
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukiko Nakano
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
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Okubo Y, Uotani Y, Miyamoto S, Miyauchi S, Ikeuchi Y, Okamura S, Tokuyama T, Nakano Y. Use of a high-density mapping catheter for Purkinje-related ventricular tachycardia in a patient with a previous history of anterior myocardial infarction. HeartRhythm Case Rep 2021; 7:232-236. [PMID: 34026503 PMCID: PMC8129040 DOI: 10.1016/j.hrcr.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Makita T, Uotani Y, Izawa Y, Kawashima H, Hashimoto Y. Toxicologic studies of the hormonal form of vitamin D3: acute and subacute toxicity of 1alpha-hydroxycholecalciferol. Toxicol Appl Pharmacol 1976; 36:323-9. [PMID: 1273850 DOI: 10.1016/0041-008x(76)90011-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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