体表面十二誘導心電図による心房粗動回路の推定法の開発

2014 Fiscal Year Research-status Report

• Project/Area Number: 25461043
• Research Institution: Gunma University
• Principal Investigator: 金古 善明 群馬大学, 医学(系)研究科(研究院), 准教授 (60302478)
• Co-Investigator(Kenkyū-buntansha): 中島 忠 群馬大学, 医学部附属病院, 講師 (40510574)
• Project Period (FY): 2013-04-01 – 2016-03-31
• Keywords: 心房粗動 / 十二誘導心電図 / リエントリー回路 / 電気生理検査 / カテーテルアブレーション

Outline of Annual Research Achievements

心房に頻拍回路を有するリエントリー性頻拍である心房粗動において、その回路の起源を非侵襲的に推定できれば、カテーテルアブレーションによる成否の予測、標的心房の決定や心房中隔穿刺の必要性をはじめとする治療ストラテジーの決定、患者へのインフォームド・コンセントを得るにあたり極めて有用と考えられる。本研究では、体表面十二誘導心電図における粗動波には誘導間で時相の違いがあることに注目し、心房粗動の回旋回路が存在する心房を非侵襲的に高い診断精度で推定する新たな心電図指標を開発することを目的とした。当該年度には電気生理検査及びカテーテルアブレーションを施行し粗動回路が同定された42症例の46心房粗動を後ろ向きに調査した。時計回旋性通常型心房粗動以外の右房起源心房粗動（A群、27例）、時計回旋性通常型心房粗動（B群、9例）、さらに左房起源心房粗動（C群、10例）の3群に分類した。心房粗動中の体表面12誘導心電図記録から、我々が考案したII誘導とV1誘導の粗動波の時相の違いを定量化したリード間粗動波形相違指数（Interlead difference:　ILD）を算出し、また粗動波高を計測した。A、B及びC群のiLDは、それぞれ0.21±0.13（0.02～0.89）、0.56±0.22（0.24～0.94）、0.91±0.05（0.80～0.96）であり、各群間に有意差を認めた。一方、A群（0.24±0.09 mV）及びB群の波高値（0.22±0.08 mV）は、C群（0.11±0.06）に比し高値であったが、A群とB群の間に差はなかった。ILDはA群とB群、B群とC群をそれぞれ、AUC0.943、0.941と高い診断精度で識別した。iLD0.26未満はA群を正診率92.5％で診断し、0.76以上はC群を正診率96.0％と高い精度で診断した。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

研究計画どおり当該年度では後ろ向き研究から前向き研究に移行し、研究は順調に推移した。

Strategy for Future Research Activity

後ろ向き研究にて算出されたIDLのcut off値に基づいて粗動回路の局在する心房を推定し、実際に電気生理検査及びカテーテルアブレーションにより同定された粗動回路を予知しえたか引き続き前向きに検証する。

Causes of Carryover

当該年度では後ろ向き研究も平行して行っていたためである。

Expenditure Plan for Carryover Budget

来年度以降は前向き研究を主に施行する予定であり、請求した助成金を使用する予定である。

Research Products

• [Journal Article] Measurement of the ventriculoatrial interval from the coronary sinus during para-Hisian pacing may fail to distinguish ventriculoatrial nodal conduction from conduction over a septal accessory pathway. (2015)
  • Author(s): Iijima T, Kaneko Y, Nakajima T, Irie T, Ota M, Saito A, Kurabayashi M
  • Journal Title: J Arrhythmia Volume: 31 Pages: 33-37
  • Peer Reviewed / Open Access
• [Journal Article] Idiopathic ventricular fibrillation triggered by premature atrial contractions. (2015)
  • Author(s): Iizuka T, Kaneko Y, Nakajima T, Kurabayashi M
  • Journal Title: J Cardiovasc Electrophysiol Volume: 26 Pages: 98-100
  • DOI: 10.1111/jce.12545.
  • Peer Reviewed / Open Access
• [Journal Article] V-A-A-V activation sequence at the onset of a long RP tachycardia: what is the mechanism? (2015)
  • Author(s): Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Kurabayashi M
  • Journal Title: J Cardiovasc Electrophysiol Volume: 26 Pages: 101-103
  • DOI: 10.1111/jce.12534.
  • Peer Reviewed / Open Access
• [Journal Article] The morphology of unipolar potentials predicts the depth of activation foci. (2014)
  • Author(s): Kaneko Y, Nakajima T, Kurabayashi M
  • Journal Title: J Arrhythmia Volume: 30 Pages: 292-299
  • Peer Reviewed / Open Access
• [Journal Article] A novel KCNQ1 splicing mutation in patients with forme fruste LQT1 aggravated by hypokalemia. (2014)
  • Author(s): Imai M, Nakajima T, Kaneko Y, Niwamae N, Irie T, Ota M, Iijima T, Tange S, Kurabayashi M
  • Journal Title: J Cardiol Volume: 64 Pages: 121-126
  • DOI: 10.1016/j.jjcc.2013.11.014.
  • Peer Reviewed / Open Access
• [Journal Article] Electro-anatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia. (2014)
  • Author(s): Irie T, Kaneko Y, Nakajima T, Ota M, Iijima T, Tamura M, Iizuka T, Tamura S, Saito A, Kurabayashi M
  • Journal Title: Heart Vessels Volume: 29 Pages: 817-824
  • DOI: 10.1007/s00380-013-0424-0.
  • Peer Reviewed / Open Access
• [Journal Article] Electrical Storm in Patients with Brugada syndrome is Associated with Early Repolarization. (2014)
  • Author(s): Kaneko Y, Horie M, Niwano S, Kusano KF, Takatsuki S, Kurita T, Mitsuhashi T, Nakajima T, Irie T, Hasegawa K, Noda T, Kamakura S, Aizawa Y, Yasuoka R, Torigoe K, Suzuki H, Ohe T, Shimizu A, Fukuda K, Kurabayashi M, Aizawa Y
  • Journal Title: Circ Arrhythmia Electrophysiol Volume: 7 Pages: 1122-1128
  • DOI: 10.1161/CIRCEP.114.001806.
  • Peer Reviewed / Open Access
• [Journal Article] Pseudo-postpacing interval of diastolic potential after entrainment pacing of remote bystander pathway in reentrant ventricular tachycardia. (2014)
  • Author(s): Kaneko Y Nakajima T, Irie T, Igawa O, Iijima T, Ota M, Tamura M, Iizuka T, Tamura S, Saito A, Kurabayashi M
  • Journal Title: Heart Vessels Volume: 29 Pages: 703-8
  • DOI: 10.1007/s00380-013-0411-5
  • Peer Reviewed / Open Access
• [Journal Article] Pathology of a lesion ablated from inside the coronary sinus. (2014)
  • Author(s): Kaneko Y, Nakajima T, Irie T, Kurabayashi M
  • Journal Title: J Cardiovasc Electrophysiol Volume: 25 Pages: 1135-1136
  • DOI: 10.1111/jce.12487.
  • Peer Reviewed / Open Access
• [Journal Article] Eccentric activation of the coronary sinus during typical atrial flutter: what is the mechanism? (2014)
  • Author(s): Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Tamura M, Iizuka T, Tamura S, Kurabayashi M
  • Journal Title: J Arrhythmia Volume: 30 Pages: 529-532
  • Peer Reviewed / Open Access
• [Presentation] A case of idiopathic ventricular fibrillation triggered by premature atrial contractions. (2014)
  • Author(s): Iizuka T, Kaneko Y, Nakajima T, Ota M, Iijima T, Tamura M, Tamura S, Kurabayashi M
  • Organizer: The joint meeting of the 29th annual meeting of the Japanese Heart Rhythm Society and the 31the annual scientific meeting of the Japanese Society of Electrocardiology
  • Place of Presentation: 東京、ザ・プリンス・タワーパーク・東京
  • Year and Date: 2014-07-25 – 2014-07-25
• [Presentation] The etiology of J wave in healed myocardial infarction: the association with J wave before the onset. (2014)
  • Author(s): Tamura S, Kaneko Y, Nakajima T, Iijima T, Tamura M, Iizuka T, Saito A, Tange S, Iwasaki T, Sekiguchi M, Kaneko K, Kurabayashi M
  • Organizer: The joint meeting of the 29th annual meeting of the Japanese Heart Rhythm Society and the 31the annual scientific meeting of the Japanese Society of Electrocardiology
  • Place of Presentation: 東京、ザ・プリンス・タワーパーク・東京
  • Year and Date: 2014-07-25 – 2014-07-25
• [Presentation] Anterior type fast-slow atrioventricular nodal reentrant tachycardia: proposal of a distinct tachycardia entity. (2014)
  • Author(s): Kaneko Y, Okishige K, Naito S, Morishima I, Tobiume T, Nakajima T, Irie T, Kato R, Matsumoto K, Kurabayashi M, Suzuki F
  • Organizer: The joint meeting of the 29th annual meeting of the Japanese Heart Rhythm Society and the 31the annual scientific meeting of the Japanese Society of Electrocardiology
  • Place of Presentation: 東京、ザ・プリンス・タワーパーク・東京
  • Year and Date: 2014-07-24 – 2014-07-24
• [Presentation] Do antiarrhythmic drugs promote a development of perimitral atrial flutter after extensive encircling pulmonary vein isolation? (2014)
  • Author(s): Iijima T, Kaneko Y, Nakajima T, Irie T, Ota M, Tamura M, Iizuka T, Tamura S, Saito A, Kurabayashi M
  • Organizer: The joint meeting of the 29th annual meeting of the Japanese Heart Rhythm Society and the 31the annual scientific meeting of the Japanese Society of Electrocardiology
  • Place of Presentation: 東京、ザ・プリンス・タワーパーク・東京
  • Year and Date: 2014-07-23 – 2014-07-23
• [Presentation] A pitfall of entrainment mapping: far-field sensing and far-field capture are mechanisms behind paradoxical shortening of the post-pacing interval. (2014)
  • Author(s): Kaneko Y, Nakajima T, Irie T, Kurabayashi M
  • Organizer: The joint meeting of the 29th annual meeting of the Japanese Heart Rhythm Society and the 31the annual scientific meeting of the Japanese Society of Electrocardiology
  • Place of Presentation: 東京、ザ・プリンス・タワーパーク・東京
  • Year and Date: 2014-07-23 – 2014-07-23
• [Presentation] Pathology of left free wall Epicardial accessory pathway successfully ablated inside coronary sinus. (2014)
  • Author(s): Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Tamura M, Iizuka T, Tamura S, Kobayashi K, Saito A, Kurabayashi M
  • Organizer: Heart Rhythm 2014
  • Place of Presentation: San Francisco
  • Year and Date: 2014-05-08 – 2014-05-08