Prediction of the arrhythmic storm using digital electrocardiographic data and prevention of sudden cardiac death.

• Project/Area Number: 21K08028
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 53020:Cardiology-related
• Research Institution: Okayama University
• Principal Investigator: Morita Hiroshi 岡山大学, 医歯薬学域, 教授 (50322227)
• Co-Investigator(Kenkyū-buntansha): 川田 哲史 岡山大学, 大学病院, 助教 (40897576)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Project Status: Completed (Fiscal Year 2023)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2023: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2022: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2021: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 心臓突然死 / 不整脈ストーム / デジタル心電図 / 心室頻拍 / 心室細動 / 重症化予測 / 伝導障害 / 心臓サルコイドーシス / Brugada症候群 / 早期再分極症候群 / 特発性心室細動 / QT延長症候群 / 重症心室性不整脈 / デジタル心電情報 / 分裂性QRS電位

Outline of Research at the Start

心臓突然死は心室頻拍、心室細動といった重症心室性不整脈が主要な原因を占める。不整脈発生リスクを評価し、適切な治療を行っていても、高リスク例では不整脈ストームが発生し、短時間に頻回の心室頻拍・細動をくり返し、治療抵抗性で極めて予後不良となる。我々はデジタル心電情報における新しいリスク指標であるQRS波形の分裂電位やJ波、T波細分析などに注目し、心疾患における致死的不整脈や心不全の発生リスクを検討し、予測因子としてその有用性を報告してきた。心室ストーム化の基盤として障害心筋やイオンチャネル機能異常があり、これらの基質は、デジタル心電情報に反映されると考えられる。

Outline of Final Research Achievements

We analyzed the characteristics of lethal arrhythmic syndromes. In cases with cardiac sarcoidosis, the distribution and severity of the fragmented QRS, and epsilon wave were associated with electrical storm (ES). Both electrocardiographic signs represent significant conduction abnormality. Sixty percent of patients with Brugada syndrome and compete right bundle branch block had remarkable conduction delay at the terminal of the right bundle branch and myocardium, and it was associated with frequent occurrence of ventricular fibrillation (VF). ES of the early repolarization syndrome was associated with short QT and QTp intervals, high points of the Shanghai Score System, and therapeutic hypothermia. The conduction abnormality was a common arrhythmogenic substrate promoting ES in various arrhythmic syndromes.

Academic Significance and Societal Importance of the Research Achievements

不整脈疾患における最重症形態である、心室頻拍・心室細動の電気的ストームと関連する心電図所見を報告した。主に解析したものが、遺伝性不整脈及び二次性心筋症疾患であるが、伝導障害が重症不整脈発生と関連することが共通しており、他の疾患においても、同様な指標が重症化予測に有用である可能性が考えられる。これらの指標を判定することで、各種不整脈疾患における重症化を予測し、その発生予防が可能となる。これにより、突然死の予防、疾患の重症化を防ぎ、入院や死亡による社会的損失や医療費の削減にもつながると考えられる。

Research Products

• [Int'l Joint Research] University of Amsterdam/University de Montreal(オランダ)
• [Int'l Joint Research] Tel-Aviv University/Universita della Svizzera italiana/University Hospital Munster(イスラエル)
• [Journal Article] Successful use of lidocaine hydrochloride in the management of ventricular arrhythmias in a case of pilsicainide intoxication. (2024)
  • Author(s): Kawada S, Tanimoto M, Onishi N, Takaishi A, Morita H.
  • Journal Title: HeartRhythm Case Rep Volume: 10 Issue: 2 Pages: 119-123
  • DOI: 10.1016/j.hrcr.2023.10.034
  • Peer Reviewed / Open Access
• [Journal Article] Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome. (2024)
  • Author(s): Komatsu Y, Nogami A, Hocini M, Morita H, Sato N, Marijon E, Arentz T, Yli-Mayry S, Onishi Y, Kowase S, et al.
  • Journal Title: JACC Clin Electrophysiol. Volume: 10 Issue: 1 Pages: 1-12
  • DOI: 10.1016/j.jacep.2023.09.013
  • Peer Reviewed
• [Journal Article] Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm. (2024)
  • Author(s): Morita H, Nakagawa K, Ueoka A, Mizuno T, Masuda T, Asada S, Miyamoto M, Kawada S, Nishii N, Nakamura K.
  • Journal Title: J Cardiovasc Electrophysiol. Volume: 35 Issue: 2 Pages: 307-316
  • DOI: 10.1111/jce.16156
  • Peer Reviewed
• [Journal Article] Clinical characteristics of electrical storm in patients with early repolarization syndrome. (2024)
  • Author(s): Morita H, Ueoka A, Mizuno T, Masuda T, Asada S, Ejiri K, Miyamoto M, Kawada S, Nakagawa K, Nishii N, et al.
  • Journal Title: Heart Rhythm. Volume: 21 Issue: 5 Pages: 562-570
  • DOI: 10.1016/j.hrthm.2024.01.016
  • Peer Reviewed
• [Journal Article] Risk Stratification for the Occurrence of Ventricular Fibrillation in Patients with Early Repolarization Syndrome. (2024)
  • Author(s): Morita H, Asada S, Ueoka A, Mizuno T, Masuda T, Miyamoto M, Kawada S, Nakagawa K, Nishii N, Yuasa S.
  • Journal Title: Heart Rhythm. Volume: 21 Issue: 10 Pages: 1787-1794
  • DOI: 10.1016/j.hrthm.2024.04.101
  • Peer Reviewed
• [Journal Article] Local dispersion of repolarization in the occurrence of ventricular fibrillation in Brugada syndrome: Possibility of phase 2 reentry? (2024)
  • Author(s): Nagase S, Oka S, Kamakura T, Aiba T, Morita H, Kusano K.
  • Journal Title: Pacing Clin Electrophysiol. Volume: 47 Issue: 8 Pages: 1049-1053
  • DOI: 10.1111/pace.14917
  • Peer Reviewed
• [Journal Article] MODE AND CHARACTERISTICS OF ARRHYTHMIA INITIATION IN IDIOPATHIC VENTRICULAR FIBRILLATION. A THESIS SUBSTUDY. (2024)
  • Author(s): Belhassen B, Conte G, Steinberg C, Whitaker J, Khan H, Laredo M, Doldi F, Ho R, Tadros R, Dinov B , Chorin E, Hansom S, Waintraub X, Eckardt L, Jankelson L, Peichl P, Mellor G, Sy R, Rattanawong P, Stojkovic S, Garber L, Suna G, et al.
  • Journal Title: JACC Clinical Electrophysiol Volume: 10
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Expert consensus document on automated diagnosis of the electrocardiogram: The task force on automated diagnosis of the electrocardiogram in Japan part 3: Inappropriate internal processing in the automatic diagnosis of electrocardiograms and its problems (2024)
  • Author(s): Kato T, Yashima M, Takahashi N, Watanabe E, Ikeda T, Kasamaki Y, Sumitomo N, Ueda N, Morita H, Hiraoka M
  • Journal Title: J Arrhythmia Volume: 40 Issue: 1 Pages: 17-25
  • DOI: 10.1002/joa3.12962
  • Peer Reviewed
• [Journal Article] Demonstration of Arrhythmia Substrate-associated Dispersion of Repolarization by Epicardial Unipolar Mapping in Brugada Syndrom (2024)
  • Author(s): Nagase Satoshi、Kataoka Naoya、Morita Hiroshi、Kamakura Tsukasa、Ueoka Akira、Nakamura Toshihiro、Oka Satoshi、Miyazaki Yuichiro、Wakamiya Akinori、Nakajima Kenzaburo、Ueda Nobuhiko、Wada Mitsuru、Ishibashi Kohei、Inoue Yuko、Miyamoto Koji、Aiba Takeshi、Kusano Kengo
  • Journal Title: JACC: Clinical Electrophysiology Volume: 10 Issue: 7 Pages: 1576-1588
  • DOI: 10.1016/j.jacep.2024.05.012
  • Peer Reviewed
• [Journal Article] Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis (2023)
  • Author(s): Miyamoto Masakazu、Nakamura Kazufumi、Nakagawa Koji、Nishii Nobuhiro、Kawada Satoshi、Ueoka Akira、Asada Saori、Watanabe Atsuyuki、Morita Hiroshi、Ito Hiroshi
  • Journal Title: Circulation Reports Volume: 5 Issue: 7 Pages: 298-305
  • DOI: 10.1253/circrep.CR-23-0022
  • ISSN: 2434-0790
  • Year and Date: 2023-07-10
  • Peer Reviewed
• [Journal Article] Syncope and loss of consciousness after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: Prevalence and characteristics in long-term follow-up. (2023)
  • Author(s): Asada S, Morita H, Mizuno T, Masuda T, Ueoka A, Miyamoto M, Kawada S, Nakagawa K, Nishii N.
  • Journal Title: Heart Rhythm O2 Volume: 4 Issue: 10 Pages: 641-649
  • DOI: 10.1016/j.hroo.2023.09.007
  • Peer Reviewed / Open Access
• [Journal Article] A variability of the QRS morphology during wide QRS tachycardia. (2023)
  • Author(s): Asada S, Nakagawa K, Nishii N, Morita H, Nakamura K.
  • Journal Title: Pacing Clin Electrophysiol. Volume: 46 Issue: 12 Pages: 1568-1571
  • DOI: 10.1111/pace.14871
  • Peer Reviewed
• [Journal Article] A rare case of tetralogy of Fallot with catecholaminergic polymorphic ventricular tachycardia. (2023)
  • Author(s): Eitoku T, Nishii N, Morita H, Kasahara S.
  • Journal Title: HeartRhythm Case Rep. Volume: 9 Issue: 3 Pages: 152-155
  • DOI: 10.1016/j.hrcr.2022.12.005
  • Peer Reviewed / Open Access
• [Journal Article] Ventricular arrhythmias induced by phase 2 reentry in a patient with J-wave syndrome (2023)
  • Author(s): Kawada S, Morita H, Miyamoto M, Asada S, Nakagawa K, Nishii N.
  • Journal Title: HeartRhythm Case Rep Volume: 9 Issue: 9 Pages: 629-633
  • DOI: 10.1016/j.hrcr.2023.06.008
  • Peer Reviewed / Open Access
• [Journal Article] Management of sensing issues with a subcutaneous implantable cardioverter-defibrillator in a patient with Brugada syndrome: A case report (2023)
  • Author(s): Kawada S, Nishii N, Mizuno T, Miyamoto M, Nakagawa K, Morita H.
  • Journal Title: HeartRhythm Case Rep Volume: 9 Issue: 12 Pages: 878-882
  • DOI: 10.1016/j.hrcr.2023.09.009
  • Peer Reviewed / Open Access
• [Journal Article] Significance of left posterior extension of early repolarization in patients with J-wave syndrome. (2023)
  • Author(s): Miyamoto M, Morita H, Mizuno T, Masuda T, Ueoka A, Asada S, Kawada S, Nakagawa K, Nishii N.
  • Journal Title: Heart Rhythm. Volume: 20 Issue: 12 Pages: 1729-1736
  • DOI: 10.1016/j.hrthm.2023.08.032
  • Peer Reviewed
• [Journal Article] Significant Delayed Activation on the Right Ventricular Outflow Tract Represents Complete Right Bundle Branch Block Pattern in Brugada Syndrome. (2023)
  • Author(s): Morimoto Y, Morita H, Ejiri K, Mizuno T, Masuda T, Ueoka A, Asada S, Miyamoto M, Kawada S, Nakagawa K, Nishii N, Nakamura K Ito H
  • Journal Title: Journal of American Heart Association Volume: - Issue: 10
  • DOI: 10.1161/jaha.122.028706
  • Peer Reviewed / Open Access
• [Journal Article] The Mechanism of Brugada Syndrome: Is it Induced Only by Conduction Disturbance? (2023)
  • Author(s): Morita H, Nagase S.
  • Journal Title: JACC Clin Electrophysiol. Volume: 9 Issue: 11 Pages: 2356-2356
  • DOI: 10.1016/j.jacep.2023.08.038
  • Peer Reviewed
• [Journal Article] Use, misuse, and pitfalls of the drug challenge test in the diagnosis of the Brugada syndrome. (2023)
  • Author(s): Wilde AAM, Amin AS, Morita H, Tadros R.
  • Journal Title: Eur Heart J. Volume: 44 Issue: 27 Pages: 2427-2439
  • DOI: 10.1093/eurheartj/ehad295
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure (2023)
  • Author(s): Nakagawa Koji、Akagi Teiji、Takaya Yoichi、Miki Takashi、Kijima Yasufumi、Nakayama Rie、Toh Norihisa、Nishii Nobuhiro、Nakamura Kazufumi、Morita Hiroshi、Ito Hiroshi
  • Journal Title: Catheterization and Cardiovascular Interventions Volume: 101 Issue: 2 Pages: 390-395
  • DOI: 10.1002/ccd.30556
  • Peer Reviewed
• [Journal Article] Use, misuse, and pitfalls of the drug challenge test in the diagnosis of the Brugada syndrome. (2023)
  • Author(s): Wilde AAM, Amin AS, Morita H, Tadros R
  • Journal Title: European Heart Journal Volume: -
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Impact of direct oral anticoagulant use on mortality in very old patients with non-valvular atrial fibrillation (2022)
  • Author(s): Takahashi Masahiko、Okawa Keisuke、Morimoto Takeshi、Tsushima Ryu、Sudo Yuya、Sakamoto Ai、Sogo Masahiro、Ozaki Masatomo、Doi Masayuki、Morita Hiroshi、Okumura Ken、Ito Hiroshi
  • Journal Title: Age and Ageing Volume: 51 Issue: 7
  • DOI: 10.1093/ageing/afac146
  • Peer Reviewed
• [Journal Article] Enhancement of pacing function by HCN4 overexpression in human pluripotent stem cell-derived cardiomyocytes (2022)
  • Author(s): Saito Yukihiro、Nakamura Kazufumi、Yoshida Masashi、Sugiyama Hiroki、Akagi Satoshi、Miyoshi Toru、Morita Hiroshi、Ito Hiroshi
  • Journal Title: Stem Cell Research & Therapy Volume: 13 Issue: 1
  • DOI: 10.1186/s13287-022-02818-y
  • Peer Reviewed
• [Journal Article] Targeted deep sequencing analyses of long QT syndrome in a Japanese population (2022)
  • Author(s): NagataY、WatanabeR、EichhornC、OhnoS、AibaT、IshikawaT、NakanoY、AizawaY、HayashiKi、MurakoshiN、NakajimaT、YagiharaN、MishimaH、SudoT、HiguchiC、TakahashiA、SekineA、MakiyamaT、TanakaY、WatanabeA、TachibanaM、MoritaH、YoshiuraK-i、TsunodaT、WatanabeH、KurabayashiM、NogamiA、KiharaY、HorieM、ShimizuW、MakitaN、TanakaT
  • Journal Title: PLOS ONE Volume: 17 Issue: 12 Pages: e0277242-e0277242
  • DOI: 10.1371/journal.pone.0277242
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Fragmented QRS as a predictor of cardiac events in patients with cardiac sarcoidosis (2022)
  • Author(s): Ogura S, Nakamura K, Morita H, Nakagawa K, Nishii N, Akagi S, Toh N, Takaya Y, Yoshida M, Miyoshi T, Watanabe A and Ito H
  • Journal Title: J Cardiol Volume: 79 Issue: 3 Pages: 446-452
  • DOI: 10.1016/j.jjcc.2021.10.022
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Functionally validated SCN5A variants allow interpretation of pathogenicity and prediction of lethal events in Brugada syndrome. (2021)
  • Author(s): Ishikawa T, Kimoto H, Mishima H, Yamagata K, Ogata S, Aizawa Y, Hayashi K, Morita H, Nakajima T, Nakano Y, Nagase S, Murakoshi N, Kowase S, Ohkubo K, Aiba T, Morimoto S, Ohno S, Kamakura S, Nogami A, Takagi M, Karakachoff M, Dina C, Schott JJ, Yoshiura KI, Horie M, Shimizu W, Nishimura K, Kusano K, Makita N.
  • Journal Title: Eur Heart J. Volume: 42(29) Issue: 29 Pages: 2854-2863
  • DOI: 10.1093/eurheartj/ehab254
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prognosis of patients with severe left ventricular dysfunction after transvenous lead extraction and the need for additional hemodynamic support in the perioperative period. (2021)
  • Author(s): Nishii N, Nishimoto T, Mizuno T, Masuda T, Asada S, Miyamoto M, Kawada S, Nakagawa K, Nakamura K, Morita H, Morimatsu H, Kasahara S and Ito H.
  • Journal Title: Heart Rhythm Volume: 18 Issue: 6 Pages: 962-969
  • DOI: 10.1016/j.hrthm.2021.01.026
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Effect of preprocedural pharmacologic cardioversion on pulmonary vein isolation in patients with persistent atrial fibrillation. (2021)
  • Author(s): Okawa K, Hara S, Morimoto T, Tsushima R, Sudo Y, Sogo M, Ozaki M, Takahashi M, Doi M, Morita H and Ito H.
  • Journal Title: Heart Rhythm Volume: 18 Issue: 9 Pages: 1473-1479
  • DOI: 10.1016/j.hrthm.2021.04.027
  • Peer Reviewed / Int'l Joint Research
• [Presentation] Risk stratification and management of J wave syndromes (2024)
  • Author(s): Hiroshi Morita
  • Organizer: Heart Rhythm 2024
  • Int'l Joint Research / Invited
• [Presentation] チャネル病と不整脈デバイス治療．Brugada症候群. (2023)
  • Author(s): 森田 宏
  • Organizer: 日本不整脈心電学会 第15回植込みデバイス関連冬期大会
  • Invited
• [Presentation] Brugada症候群の心電図を極める (2023)
  • Author(s): 森田 宏
  • Organizer: 日本不整脈心電学会 心電学関連春季大会
  • Invited
• [Presentation] Panel Discussion 6. Risk stratification of Brugada syndrome in Okayama University Hospital. (2023)
  • Author(s): Hiroshi Morita, Saori Asada, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Satoshi Kawada, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii.
  • Organizer: 第69回日本不整脈心電学会学術大会
• [Presentation] ICE-APHRS Joint Session: Arrhythmic risk management in inherited arrhythmia syndromes. “ECG risk stratification in Brugada syndrome patients”. (2023)
  • Author(s): Hiroshi Morita
  • Organizer: 第69回日本不整脈心電学会学術大会
  • Invited
• [Presentation] 遺伝性不整脈のデバイス治療（Brugada症候群） (2023)
  • Author(s): 森田 宏
  • Organizer: 不整脈心電学会 冬期植込みデバイス大会
  • Invited
• [Presentation] J波症候群（Brugada症候群、早期再分極症候群）の機序と臨床電気生理学的特徴 (2022)
  • Author(s): 森田 宏
  • Organizer: 第55回河口湖心臓討論会
  • Invited
• [Presentation] J wave syndromes -up to date- (2022)
  • Author(s): 森田 宏
  • Organizer: 特発性心室細動研究会
  • Invited
• [Presentation] Can we provide appropriate risk stratification in early repolarization syndrome? (2022)
  • Author(s): Hiroshi Morita
  • Organizer: Japanese Heart Rhythm Society 2022
  • Int'l Joint Research / Invited
• [Presentation] J wave syndromes up to date (2022)
  • Author(s): 森田 宏
  • Organizer: 特発性心室細動研究会
  • Invited
• [Book] 循環器疾患最新の治療2022-2023 (2022)
  • Author(s): 伊藤 浩、山下武志
  • Total Pages: 520
  • Publisher: 南江堂
  • ISBN: 9784524229956
• [Book] 今さら聞けない心電図 (2022)
  • Author(s): 池田 隆徳
  • Total Pages: 312
  • Publisher: メジカルビュー社
  • ISBN: 9784758319782
• [Book] 令和の心不全治療ガイド (2022)
  • Author(s): 伊藤 浩
  • Total Pages: 314
  • Publisher: 文光堂
  • ISBN: 9784830619694
• [Book] 循環器疾患最新の治療 2022-2023 (2022)
  • Author(s): 森田 宏
  • Total Pages: 502
  • Publisher: 南江堂
  • ISBN: 9784524229956
• [Book] 今さら聞けない心電図 改訂第2版 (2022)
  • Author(s): 森田 宏
  • Total Pages: 299
  • Publisher: MEDICAL VIEW
  • ISBN: 9784758319782
• [Book] 臨床循環器学 (2021)
  • Author(s): 森田 宏
  • Total Pages: 829
  • Publisher: 文光堂
  • ISBN: 9784830619670
• [Remarks] Amsterdam UMC
  • URL: https://researchinformation.amsterdamumc.org/en/persons/arthur-am-wilde/publications/?type=%2Fdk%2Fatira%2Fpure%2Fresearchoutput%2Fresearchoutputtypes%2Fcontributiontojournal%2Fsystematicreview