Risk prediction for sudden cardiac death by quantitative analysis of fragmented QRS and J wave using differentiation of signal addition

2017 Fiscal Year Annual Research Report

• Project/Area Number: 15K09082
• Research Institution: Okayama University
• Principal Investigator: 森田 宏 岡山大学, 医歯薬学総合研究科, 教授 (50322227)
• Co-Investigator(Kenkyū-buntansha): 杉山 洋樹 岡山大学, 医学部, 客員研究員 (20726137) [Withdrawn]
• Project Period (FY): 2015-04-01 – 2018-03-31
• Keywords: fragmented QRS / J波 / 心室細動 / 突然死

Outline of Annual Research Achievements

QRS波形加算微分解析システム及び12誘導心電図を使用し、分裂性QRS(fQRS)およびJ波の意義を、心疾患で検討した。心室筋興奮伝播が障害心筋・線維化により様々な方向に変化した場合、QRS波形の多棘波を形成し、fQRSの成因となり、その存在は不整脈発生の基質や心機能障害と関連すると考えられる。Ｊ波は再分極早期の電気的異常を示しており、再分極相の不安定性から，致死的不整脈発生に結び付く。J波及びfQRS波形がさまざまな心室頻拍・細動発生にどのように関わるかを、臨床データベースを構築し、予後との関連を検討してきた。これまでにBrugada症候群で527例(心室細動例 50例)、特発性心室細動49例、QT延長症候群 150例を登録し，経過観察を行っている。致死的不整脈イベント発生例では、発症を予測するリスク因子について検討を行った。Brugada症候群ではfQRS検出部位の広がりについて検討し、右室流出路のみならず、下壁・側壁誘導などの他の誘導で広く見られる例では、経過中の心室細動の発生と関連すること報告した（Circulation Arrhythm Electrophysiol 2017）。Brugada症候群において、無症候性の心室細動発生予測因子としてfQRS及びT波頂点から終末部までの時間(Tpeak-Tend間隔, Tpe)が挙げられ、これらの因子は失神・心室細動例でも再発予測因子であった。下側壁誘導のJ波は失神・心室細動例での再発予測因子であったが、無症候例での心室細動発生とは関連せず、初回心室細動発作のリスク因子と再発のリスク因子が異なることが示された（J Cadiovasc Electrophysiol 2018）。遺伝性不整脈に関するfQRS及びJ波の意義は日本循環器学会の遺伝性不整脈の診療に関するガイドライン(2017年改訂版)で協力員として分担執筆を行った。

Research Products

• [Journal Article] Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome. (2018)
  • Author(s): Morita H, Watanabe A, Kawada S, Miyamoto M, Morimoto Y, Nakagawa K, Nishii N, Nakamura K, Ito H.
  • Journal Title: J Cardiovasc Electrophysiol Volume: 29 Pages: 107-114
  • DOI: 10.1111/jce.13349
  • Peer Reviewed
• [Journal Article] Different responses to exercise between Andersen-Tawil syndrome and catecholaminergic polymorphic ventricular tachycardia. (2018)
  • Author(s): Inoue Y, Aiba T, Kawata H, Sakaguchi T, Mitsuma W, Morita H, Noda T, Takaki H, Toyohara K, Kanaya Y, Itoi T, Mitsuhashi T, Sumitomo N, Cho Y, Yasuda S, Kamakura S, Kusano K, Miyamoto Y, Horie M, Shimizu W.
  • Journal Title: Europace Volume: in press Pages: in press
  • DOI: 10.1093/europace/eux351
  • Peer Reviewed
• [Journal Article] Impact of premature activation of the right ventricle with programmed stimulation in Brugada syndrome. (2018)
  • Author(s): Nakagawa K, Nagase S, Morita H, Wada T, Tanaka M, Murakami M, Watanabe A, Nishii N, Nakamura K, Kusano KF, Ito H, Ohe T.
  • Journal Title: J Cardiovasc Electrophysiol Volume: 29 Pages: 71-78
  • DOI: 10.1111/jce.13336
  • Peer Reviewed
• [Journal Article] Analysis of Arrhythmic Events is Useful to Detect Lead Failure Earlier in Patients Followed by Remote Monitoring (2018)
  • Author(s): Nishii N, Miyoshi A, Kubo M, Miyamoto M, Morimoto M, Kawada S, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H.
  • Journal Title: J Cardiovasc Electrophysiol Volume: 29 Pages: 463-470
  • DOI: 10.1111/jce.13399
  • Peer Reviewed
• [Journal Article] Genotype-Phenotype Correlation of SCN5A Mutation for the Clinical and Electrocardiographic Characteristics of Probands with Brugada Syndrome: A Japanese Multicenter Registry. (2017)
  • Author(s): Yamagata K, Horie M, Aiba T, Ogawa S, Aizawa Y, Ohe T, Yamagishi M, Makita N, Sakurada S, Tanaka T, Shimizu A, Hagiwara N, Kishi R, Nakano Y, Takagi M, Makiyama T, Ohno S, Fukuda K, Watanabe H, Morita H, Hayashi K, Kusano K, Kamakura S, Yasuda S, Ogawa H, Miyamoto Y, Kapplinger JD, Ackerman MJ, Shimizu W.
  • Journal Title: Circulation Volume: 135 Pages: 2255-2270
  • DOI: 10.1161/CIRCULATIONAHA.117.027983.
  • Peer Reviewed
• [Journal Article] Distribution and Prognostic Significance of Fragmented QRS in Patients with Brugada Syndrome (2017)
  • Author(s): Morita H, Watanabe A, Morimoto Y, Kawada S, Tachibana M, Nakagawa K, Nishii N, Ito H.
  • Journal Title: Circ Arrhythm Electrophysiol. Volume: 10 Pages: E004765-E004765
  • DOI: 10.1161/CIRCEP.116.004765.
  • Peer Reviewed
• [Journal Article] Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome. (2017)
  • Author(s): Tachibana M, Nishii N, Morita H, Nakagawa K, Watanabe A, Nakamura K, Ito H
  • Journal Title: J Cardiovasc Electrophysiol Volume: 28 Pages: 1454-1459
  • DOI: 10.1111/jce.13315
  • Peer Reviewed
• [Journal Article] Comparison of longevity and clinical outcomes of implantable cardioverter-defibrillator leads among manufacturers. (2017)
  • Author(s): Kawada S, Nishii N, Morimoto Y, Miyoshi A, Tachibana M, Sugiyama H, Nakagawa K, Watanabe A, Morita H, Ito H.
  • Journal Title: Heart Rhythm Volume: 14 Pages: 1469-1503
  • DOI: 10.1016/j.hrthm.2017.05.020.
  • Peer Reviewed
• [Journal Article] Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern. (2017)
  • Author(s): Nagase S, Tanaka M, Morita H, Nakagawa K, Wada T, Murakami M, Nishii N, Nakamura K, Ito H, Ohe T, Kusano KF.
  • Journal Title: Front Physiol Volume: 8 Pages: 14-14
  • DOI: 10.3389/fphys.2017.00014. eCollection 2017
  • Peer Reviewed
• [Presentation] Significance of the distribution of fragmented QRS in Patients with Brugada Syndrome. (2017)
  • Author(s): Morita H, Watanabe A, Ueoka A, Tachibana M, Tsushima S, Nakagawa K, Nishii N, Ito H.
  • Organizer: Heart Rhythm 2017
  • Int'l Joint Research / Invited
• [Presentation] Risk Stratification in Brugada Syndrome (Invited Symposium 5) (2017)
  • Author(s): Morita H
  • Organizer: Asian Pasific Heart Rhythm Society 2017
  • Int'l Joint Research / Invited
• [Presentation] Depolarization Abnormality in High Risk Patients with Brugada Syndrome (Invited Symposium) (2017)
  • Author(s): Morita H
  • Organizer: Asian Pacific Heart Rhythm Society 2017
  • Int'l Joint Research / Invited
• [Book] Early Repolarization Syndrome (2017)
  • Author(s): Watanabe A, Morita H.
  • Total Pages: 107(55-70)
  • Publisher: Springer
  • ISBN: 978-981-10-3379-7