デジタル心電データを用いた不整脈ストーム化の予測と心臓突然死予防

2023 Fiscal Year Annual Research Report

• Project/Area Number: 21K08028
• Research Institution: Okayama University
• Principal Investigator: 森田 宏 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• Co-Investigator(Kenkyū-buntansha): 川田 哲史 岡山大学, 大学病院, 助教 (40897576) [Withdrawn]
• Project Period (FY): 2021-04-01 – 2024-03-31
• Keywords: 心臓突然死 / 心室頻拍 / 心室細動 / 心臓サルコイドーシス / Brugada症候群 / 早期再分極症候群 / 不整脈ストーム

Outline of Annual Research Achievements

今回の研究では、不整脈症候群として、心臓サルコイドーシス、Brugada症候群、早期再分極症候群を中心に解析を行った。
①心臓サルコイドーシスでは、QRS棘波の程度、心室内での広がり、ε波の存在が不整脈ストームと関連が見られた。いずれも著明な興奮伝導障害を示す所見であり、結果として、心拍数の早い心室頻拍（VT）、多形性VT、複数種類の持続性VTが不整脈ストーム時に発生した。
② 1) Brugada症候群では完全右脚ブロックの成因を解析し、右脚本幹の障害以外に、約60％の例で右脚末梢から右室心筋にかけての伝導障害により右脚ブロック型波形を示すことが判明した。右室前壁から流出路にかけての興奮伝播遅延が著明で、心室細動（VF）発生が頻回となることと関連があった。2) 植込み型除細動器移植後の失神発作を検討し、不整脈発作と癲癇の鑑別の困難さを指摘した。3）欧米の専門家と共同でBrugada症候群の総論を執筆した。
③ 1) 早期再分極症候群（ERS）では、下側壁誘導のＪ波が診断に重要であるが、後壁誘導での頻度の検討を行った。下側壁誘導にＪ波がを有するERSの35例中、34例で後壁誘導にＪ波がみられ、下側壁誘導にＪ波を認めない特発性心室細動でも30例中5例（20%）に後壁誘導Ｊ波がみられた。2) ERSの心室細動ストーム発生例では、QTおよびQTp間隔の短縮、上海スコアシステム高値、低体温療法が関連していた。3) 経過中の心室細動発生は、QRS幅延長、QRS棘波の存在、J幅延長、T/R電位比高値が関連していた。4) ERSの不整脈基質として、心臓MRIによる心筋線維化が80％の例で認められ、投稿後、現在論文修正中である。5) 心室細動発生時の特徴について国際共同研究を行った。
様々な不整脈症候群においてストーム化、致死的不整脈発生には、心筋伝導障害が重要であることが、示唆された。

Research Products

• [Int'l Joint Research] University of Amsterdam/University de Montreal(オランダ)
  • Country Name: NETHERLANDS
  • Counterpart Institution: University of Amsterdam/University de Montreal
• [Int'l Joint Research] Tel-Aviv University/Universita della Svizzera italiana/University Hospital Munster(イスラエル)
  • Country Name: ISRAEL
  • Counterpart Institution: Tel-Aviv University/Universita della Svizzera italiana/University Hospital Munster
  • # of Other Institutions: 49
• [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 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 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 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 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 Pages: -
  • 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 Pages: -
  • 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 Pages: -
  • 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 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 Pages: -
  • DOI: 10.1016/j.jacep.2024.05.012
  • 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 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 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 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 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 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 Pages: 1729-1736
  • DOI: 10.1016/j.hrthm.2023.08.032
  • Peer Reviewed
• [Journal Article] Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis. (2023)
  • Author(s): Miyamoto M, Nakamura K, Nakagawa K, Nishii N, Kawada S, Ueoka A, Asada S, Watanabe A, Morita H, Ito H.
  • Journal Title: Circ Rep. Volume: 5 Pages: 298-305
  • DOI: 10.1253/circrep.CR-23-0022
  • 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, et al.
  • Journal Title: J Am Heart Assoc Volume: 12 Pages: -
  • 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 Pages: 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 Pages: 2427-2439
  • DOI: 10.1093/eurheartj/ehad295
  • Peer Reviewed / Open Access / 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
• [Remarks] Amsterdam UMC
  • URL: https://researchinformation.amsterdamumc.org/en/persons/arthur-am-wilde/publications/?type=%2Fdk%2Fatira%2Fpure%2Fresearchoutput%2Fresearchoutputtypes%2Fcontributiontojournal%2Fsystematicreview