失神とてんかんの鑑別診断を容易にする新しい失神診断ツールの作成

2015 Fiscal Year Annual Research Report

• Project/Area Number: 25461081
• Research Institution: University of Occupational and Environmental Health, Japan
• Principal Investigator: 安部 治彦 産業医科大学, 医学部, 教授 (70231967)
• Co-Investigator(Kenkyū-buntansha): 河野 律子 産業医科大学, 医学部, 講師 (20449945)
• Project Period (FY): 2013-04-01 – 2016-03-31
• Keywords: 失神 / てんかん / けいれん発作 / 心電図

Outline of Annual Research Achievements

目的：一過性意識消失患者には、失神とてんかん発作が含まれるが、臨床症状の類似性からその臨床的鑑別には困難を伴う。診断ツールの作成のための臨床指標の抽出が目的である。対象と方法：平成２５年～２６年にかけて、産業医科大学病院で診断および治療、外来フォローされているてんかん患者３２０名（平均　３１＋／―１２歳）と性・年齢をマッチさせた健常者１５０名の心電図所見を比較した。側頭用てんかん患者の意識消失時のけいれん発作の頻度、心電図所見（J波の有無、QT dispersion）を健常対照群と比較検討した。また、失神患者１２５名の内、失神時の心電図所見が得られている植込み型心電計（ILR）患者７２名の臨床症状と発作時の心電図所見も併せて解析した。結果：１）てんかん患者では、心電図上有意にJ波の発生頻度が高い（26% vs. 13%, P<0.001）。てんかん患者のQT dispersionは有意に大きかった（P<0.001）。ILRを植込んだ意識消失患者において、意識消失時のけいれん発作の発生頻度は、心原性失神と反射性失神、てんかん患者の３群間で有意差を認めなかった。
結論：意識消失時のけいれん発作の有無は、失神とてんかん発作の鑑別診断の指標とはならないことが判明した。また、てんかん患者では、健常者に比し有意に心電図異常（J波の出現やQT dispersionの増大）を認めることも明らかとなった。意識消失で受診する患者において、けいれんの有無は失神と転換の鑑別に有用ではない。心電図以上の特徴も含めてかん別する必要がある。

Research Products

• [Journal Article] Effects of right ventricular pacing sites on blood pressure variation in upright posture: a comparison of septal versus apical pacing sites. (2016)
  • Author(s): Kohno R, Abe H, Nakajima H, Hayashi K, Oginosawa Y, Benditt DG:
  • Journal Title: Europace Volume: 印刷中 Pages: 印刷中
• [Journal Article] Japan implantable devices in coronary artery disease (JID-CAD): study design (2015)
  • Author(s): Shimizu A, Mitsuhashi T, Nitta T, Mitamura H, Kurita T, Abe H, Nakazato Y, Sumitomo N, Kadota K, Kimura K, Okumura K:
  • Journal Title: Journal of Arrhythmia Volume: 31 Pages: 631-635
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Genotype-dependent differences in age of manifestation and arrhythmia complications observed in short QT syndrome. (2015)
  • Author(s): Harrell DT, Ashihara T, Ishikawa T, Tominaga I, Mazzanti A, Komiya N, Takahashi K, Oginosawa Y, Abe H, Maemura K, Sumitomo N, Uno K, Takano M, Priori AG, Makita N:
  • Journal Title: Int J Cardiol Volume: 190 Pages: 393-402
• [Journal Article] Syncope Unit: rationale and requirement-the European Heart Rhythm Association position statement endorsed by Heart Rhythm Society. (2015)
  • Author(s): Kenny RA, Brignole M, Dan GA, Deharo JC, van Dijk JG, Doherty C, Hamdam M, Moya A, Parry SW, Sutton R, Ungar A, Wieling W, Asgari M, Baron-Esquivias G, Blanc JJ,Casagranda I, Cunnigham C, Fedorowski A, Furlan R, Gall N, De Lange FJ, Mcmahon G, Mitro P, Pietrucha A, Podoleanu C, Rabiele A, Abe H, Savelieva I:
  • Journal Title: Europace Volume: 17(9) Pages: 1325-40
• [Journal Article] 黒住論文に対するEditorial Comment (2015)
  • Author(s): 安部治彦：
  • Journal Title: 心臓 Volume: 47(7) Pages: 809-809
• [Journal Article] 心臓突然死と一過性意識消失・失神発作 (2015)
  • Author(s): 安部治彦：
  • Journal Title: 感染防止 Volume: 25(6) Pages: 1-5
• [Journal Article] 突然死予防の最新デバイス (2015)
  • Author(s): 河野律子、荻ノ沢泰司、林 克英、大江学治、高椅正雄、安部治彦：
  • Journal Title: 心電図 Volume: 35(3) Pages: 227-237
• [Presentation] 多臓器不全を主体に来院し持続性心室頻拍を合併した動脈硬化性血管疾患の１例 (2015)
  • Author(s): 塀壮史、荻ノ沢泰司、高椅正雄、林克英、大江学治、河野律子、安部治彦、尾辻豊：
  • Organizer: 第１１９回日本循環器学会九州地方会
  • Place of Presentation: アクロス福岡（福岡県福岡市）
  • Year and Date: 2015-12-05 – 2015-12-05
• [Presentation] ストレスと失神 (2015)
  • Author(s): 安部治彦：
  • Organizer: 第７２回日本循環器心身医学会総会、スイーツセミナー
  • Place of Presentation: 全労災ソレイユ（大分県大分市）
  • Year and Date: 2015-11-14 – 2015-11-15
• [Presentation] Right ventricular pacing and newly occurrence of atrial fibrillation in patients paced with atrioventricular block. (2015)
  • Author(s): Hayashi K, Abe H, Fukunami M, Takahashi M, Watabe T, Phe H, Kohno R, Oginosawa Y, Otsuji Y:
  • Organizer: ESC 2015
  • Place of Presentation: London, United Kingtom
  • Year and Date: 2015-08-29 – 2015-09-02
• [Presentation] Driving restriction by revision of Japan Road and Traffic Law in patients with cardiac arrhythmias. (2015)
  • Author(s): Abe H:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE. Educational Session 8
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] Is a HUT necessary for the prediction of sudden cardiac death? Pro (2015)
  • Author(s): Abe H:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE. Debate Session 7
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] The current situation of diagnostic pathways in unexplained syncope. To implant? Or not to implant? (2015)
  • Author(s): Kohno R, Abe H:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE. Suits Seminar 3
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] Device settings for detecting true atrial tachyarrhythmias and algorithms for preventing atrial tachyarrhythmias. (2015)
  • Author(s): Kohno R, Abe H:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE. How to apply AF detecting function of implanting devices for the patient management.,
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] Impact of right ventricular septum pacing for left ventricular function on paced patient with atrioventricular block. (2015)
  • Author(s): Hayashi K, Abe H, Kohno R, Takahashi M, Watabe T, Phe H, Oginosawa Y, Otsuji Y:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE.
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] Meta-analysis of short QT syndrome discloses genotype-dependent clinical characteristics in age of manifestation and arrhythmia complication. (2015)
  • Author(s): Harrell DT, Ashihara T, Ishikawa T, Mazzanti A, Takahashi K, Oginosawa Y, Abe H, Maemura K, Sumitomo N, Uno K, Takano M, Priori SG, Makita N:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE.
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] Paroxysmal AV block detected by implantable loop recorder in syncope patients. (2015)
  • Author(s): Kohno R, Hayashi K, Takahashi M, Watabe T, Ohe H, Oginosawa Y, Otsuji Y, Abe H:
  • Organizer: The 30th Annual Meeting of the JHRS/ the 32th Annual Scientific Meeting of the JSE.
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-28 – 2015-07-31
• [Presentation] 社会的問題 (2015)
  • Author(s): 安部治彦：
  • Organizer: 第３０回日本不整脈学術大会／第３２回日本心電学会学術集会合同学術大会、ICD/CRT合同研修セミナー、教育講演
  • Place of Presentation: 国立京都国際会館他（京都府京都市）
  • Year and Date: 2015-07-27 – 2015-07-31
• [Presentation] ペースメーカ心電図のピットホール (2015)
  • Author(s): 安部治彦：
  • Organizer: 日本不整脈学会・EPサマーセミナー
  • Place of Presentation: 御茶ノ水ｿﾗｼﾃｨｶﾝﾌｧﾚﾝｽｾﾝﾀｰ（東京都千代田区）
  • Year and Date: 2015-06-27 – 2015-06-28
• [Presentation] Syncope and sudden cardiac death prevention (2015)
  • Author(s): Abe H:
  • Organizer: Europace/Cardiostim 2015
  • Place of Presentation: Milan, Italy
  • Year and Date: 2015-06-20 – 2015-06-24
• [Presentation] A higher prevalence of early repolarization and its characteristics on electrocardiogram in patients with epilepsy. (2015)
  • Author(s): Hayashi K, Kohno R, Akamatsu N, Oginosawa Y, Otsuji Y, Abe H:
  • Organizer: Europace/Cardiostim 2015
  • Place of Presentation: Milan, Italy
  • Year and Date: 2015-06-20 – 2015-06-24
• [Presentation] Distinct clinical characteristics in short QT syndrome associated with mutations in KCNH2 or KCNQ1 (2015)
  • Author(s): Harrell DT, Ishikawa T, Komiya N, Takahashi K, Oginosawa Y, Abe H, Maemura K, Sumitomo N, Uno K, Makita N:
  • Organizer: 79th Annual Scientific Meeting of the Japanese Circulation Society.
  • Place of Presentation: 大阪国際会議場他（大阪府大阪市）
  • Year and Date: 2015-04-24 – 2015-04-26
• [Presentation] Pacing and sensing interference by air bubles surrounding non-extended helix of active fixation leads: in vivo observations and in vitro experiments. (2015)
  • Author(s): Oginosawa Y, Abe H, Kohno R, Watabe T, Hayashi K, Takahashi M, Otsuji Y:
  • Organizer: 79th Annual Scientific Meeting of the Japanese Circulation Society.
  • Place of Presentation: 大阪国際会議場他（大阪府大阪市）
  • Year and Date: 2015-04-24 – 2015-04-26
• [Presentation] Correlation beyween right ventricular pacing and newly occurrence of atrial fibrillation in pacemaker patients with atrioventricular block: insight into mechanism. (2015)
  • Author(s): Hayashi K, Abe H, Fukunami M, Takahashi M, Watabe T, Ohe H, Kohno R, Oginosawa Y, Otsuji Y:
  • Organizer: 79th Annual Scientific Meeting of the Japanese Circulation Society.
  • Place of Presentation: 大阪国際会議場他（大阪府大阪市）
  • Year and Date: 2015-04-24 – 2015-04-26
• [Presentation] Diagnosis of syncope (2015)
  • Author(s): Kohno R, Abe H:
  • Organizer: 79th Annual Scientific Meeting of the Japanese Circulation Society.
  • Place of Presentation: 大阪国際会議場他（大阪府大阪市）
  • Year and Date: 2015-04-24 – 2015-04-26
• [Book] 「徹底解説！心電図-基礎から臨床までー」 (2015)
  • Author(s): 安部治彦
  • Total Pages: 260
  • Publisher: 医学書院
• [Book] 「徹底解説！心電図-基礎から臨床までー」 (2015)
  • Author(s): 河野律子
  • Total Pages: 260
  • Publisher: 医学書院
• [Book] 「不整脈診療の極意」 (2015)
  • Author(s): 河野律子、安部治彦
  • Total Pages: 179
  • Publisher: 南山堂
• [Book] 「EBM循環器疾患の治療2015-2016」 (2015)
  • Author(s): 高橋正雄、河野律子、安部治彦
  • Total Pages: 468
  • Publisher: 中外医学社
• [Book] 「Medical Topics Series不整脈２０１５」 (2015)
  • Author(s): 河野律子、安部治彦
  • Total Pages: 216
  • Publisher: メデイカルレビュー社