Analysis of the mechanism and appropriate therapy of atrial tachycardia originating from atrioventricular annulus

• Project/Area Number: 16K09444
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Kumamoto University
• Principal Investigator: Yamabe Hiroshige 熊本大学, 医学部附属病院, 特任教授 (20419641)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2017: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2016: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
• Keywords: 心房頻拍 / Caチャネル / カテーテルアブレーション / ベラパミル / リエントリー / エントレインメント / 循環器

Outline of Final Research Achievements

We demonstrated the presence of slow potential at the entrance site of the slow conduction zone of the reentry circuit in verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus. We showed that the radiofrequency catheter ablation targeting the entrance of the slow conduction zone of the reentry circuit is effective and safe compared with the radiofrequency catheter ablation targeting the exit site of the slow conduction zone in the atrial tachycardia originating from the vicinity to the atrioventricular node. We showed that the radiofrequency energy delivery to the aortic non-coronary sinus is effective for the termination of atrial tachycardia originating from the vicinity to the atrioventricular node when the slow conduction zone of the reentry circuit was located just below the aortic non-coronary sinus.

Academic Significance and Societal Importance of the Research Achievements

房室弁輪部起源のカルシウムチャネル依存性組織を頻拍の回路内に含む心房性頻拍において、頻拍回路の詳細な解析ならびに有効な通電方について検討を行い、有益な研究結果が得られた。特に房室結節近傍起源の心房頻拍においては従来のリエントリー回路の出口を通電するよりも、入口部を同定し通電を行う新しい方法が安全でより有効性に優れていることを明らかにした。

Research Products

• [Journal Article] Slow Potential at the Entrance of the Slow Conduction Zone in the Reentry Circuit of a Verapamil-Sensitive Atrial Tachycardia Originating From the Atrioventricular Annulus (2018)
  • Author(s): 山部浩茂、金澤尚徳、伊藤美和、金子祥三、金丸侑右、木山 卓也、辻田賢一
  • Journal Title: J Am Heart Assoc Volume: 7 Issue: 14
  • DOI: 10.1161/jaha.118.009223
  • Peer Reviewed / Open Access
• [Journal Article] Study on the Effect of Irbesartan on Atrial Fibrillation Recurrence in Kumamoto: Atrial Fibrillation Suppression Trial (SILK study). (2018)
  • Author(s): Hiroshige Yamabe
  • Journal Title: Journal of cardiology Volume: 71 Issue: 2 Pages: 129-134
  • DOI: 10.1016/j.jjcc.2017.07.010
  • Peer Reviewed
• [Journal Article] Prevalence and mechanism of rotor activation identified during atrial fibrillation by noncontact mapping: Lack of evidence for a role in the maintenance of atrial fibrillation. (2016)
  • Author(s): Hiroshige Yamabe
  • Journal Title: Heart Rhythm Volume: 13 Issue: 12 Pages: 2323-2330
  • DOI: 10.1016/j.hrthm.2016.07.030
  • Peer Reviewed
• [Journal Article] Difference in the Maintenance Mechanism of Atrial Fibrillation Perpetuated after Pulmonary Vein Isolation between Paroxysmal and Persistent Atrial Fibrillation: Effects of Subsequent Stepwise Ablation. (2016)
  • Author(s): Hiroshige Yamabe
  • Journal Title: International Journal of Cardiology Volume: 210 Pages: 109-118
  • DOI: 10.1016/j.ijcard.2016.02.092
  • Peer Reviewed
• [Presentation] Comparison of Ablation Outcome between Patients Targeting Entrance and Exit of Circuit in Verapamil-sensitive Atrial Tachycardia Originating from Atrioventricular-Node Vicinity (2019)
  • Author(s): 山部浩茂、金澤尚徳、伊藤美和、金子祥三、金丸侑右、木山 卓也、辻田賢一
  • Organizer: 第83回日本循環器学会学術集会
• [Presentation] Catheter Ablation of Verapamil-Sensitive Atrial Tachycardia Originating From the Vicinity to the Atrioventricular Node: Comparison of Acute Procedural Outcome Between Patients Targeting the Entrance and Those Targeting the Exit Site of the Tachycardia Circuit (2018)
  • Author(s): 山部浩茂、金澤尚徳、伊藤美和、金子祥三、金丸侑右、木山 卓也、辻田賢一
  • Organizer: 91th American Heart Association Scientific Sessions
  • Int'l Joint Research
• [Presentation] Management of AT in the Vicinity of AV Node (2017)
  • Author(s): Hiroshige Yamabe
  • Organizer: The Asia Pacific Heart Rhythm Society 2017
  • Int'l Joint Research / Invited
• [Presentation] Which is the Optimal Ablation Target of AT Originating from Peri-AVN Region (2017)
  • Author(s): Hiroshige Yamabe
  • Organizer: The Asia Pacific Heart Rhythm Society 2017
  • Int'l Joint Research / Invited
• [Presentation] Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia:Analysis using the Entrainment Method (2017)
  • Author(s): Hiroshige Yamabe
  • Organizer: American Heart Association Scientific Sessions 2017
  • Int'l Joint Research
• [Presentation] Significance of Slow Potential Recorded at the Slow Conduction Zone in Verapamil-sensitive Atrial Reentrant Tachycardia Originating from the Atrioventricular Annulus (2016)
  • Author(s): Hiroshige Yamabe
  • Organizer: The 89th American Heart Association Scientific Sessions
  • Place of Presentation: New Orleans, Louisiana, USA
  • Year and Date: 2016-11-12
  • Int'l Joint Research
• [Presentation] Mapping and Ablation of Para-hisian SVTs (2016)
  • Author(s): Hiroshige Yamabe
  • Organizer: The Asia Pacific Heart Rhythm Society 2016
  • Place of Presentation: Seoul, Korea
  • Year and Date: 2016-10-12
  • Int'l Joint Research / Invited
• [Book] Heart View ATP感受性心房頻拍の頻拍回路に基づく新しいアブレーション方法 (2018)
  • Author(s): 山部浩茂
  • Total Pages: 6
  • Publisher: メジカルビュー社
• [Book] Catheter Ablation: A Modern Approach to Cardiac Arrhythmias (2017)
  • Author(s): Hiroshige Yamabe
  • Total Pages: 7
  • Publisher: Springer
• [Book] Beyond the textbook 心電図 実践診療で役立つコツ (2017)
  • Author(s): 山部浩茂
  • Total Pages: 7
  • Publisher: 診断と治療社