Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Inotropes play a significant role in the treatment of cardiogenic shock (CS). Phosphodiesterase 3 inhibitors (PDE3i) are being used with increasing frequency, despite limited supporting evidence.</p><p><b><i>Methods and Results:</i></b> We performed a systematic review to assess the clinical importance of PDE3i in CS. The search included studies that compared the effect of ‘PDE3i with or without inotropes’ with ‘No PDE3i with or without inotropes’ in patients with cardiogenic shock. Early death, cardiac arrest, and initiation of renal replacement therapy were assessed as outcomes. We identified 2 randomized controlled trials (RCT) with a total of 224 patients who met the eligibility requirements from the PubMed, Web of Science, and CENTRAL databases, up until October 31, 2024. One RCT compared milrinone with dobutamine (DOB), and another compared enoximone with levosimendan. Meta-analysis revealed that PDE3i were neither superior nor inferior for the outcomes in the total cohort (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.35–6.26 for early deaths; OR 1.14, 95% CI 0.42–3.14 for cardiac arrest; OR 1.53, 95% CI 0.80–2.92 for the initiation of renal replacement therapy).</p><p><b><i>Conclusions:</i></b> The present systematic review revealed no difference in outcomes, early deaths, cardiac arrest and initiation of renal replacement therapy when using PDE3i in patients with CS treated with or without other inotropes.</p>

DOI： 10.1253/circrep.cr-25-0152

PubMed

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p>Intravenous magnesium is commonly used in clinical practice for treating Torsade de Pointes (TdP), although supporting evidence remains limited. This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines. Four online databases were searched for relevant studies published as of November 27, 2024, but only 4 observational studies met the inclusion criteria. TdP resolved in a substantial proportion of patients treated with intravenous magnesium (78.3% [N=36/46]), although most studies lacked a control group. No serious adverse events related to magnesium were reported (0% [N=0/46]). Despite several limitations that preclude firm conclusions, intravenous magnesium appears to be a relatively safe and effective treatment for TdP. However, TdP progressed to ventricular fibrillation (VF) in 21.7% (N=10/46) of patients, underscoring the need for readiness to perform immediate electrical defibrillation during treatment. Further high-quality studies are warranted to validate these findings.</p>

DOI： 10.1253/circrep.cr-25-0175

PubMed

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> The optimal device for mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains unknown. Therefore, in this study we aimed to analyze which MCS (intra-aortic balloon pumping (IABP) or IMPELLA) is associated with better outcomes in patients with AMI-related CS.</p><p><b><i>Methods and Results:</i></b> This systematic review and meta-analysis used a random-effects model to account for potential heterogeneity. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for the dichotomous outcomes. The PubMed, Web of Science, and CENTRAL databases were searched up to April 30, 2023. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Two randomized controlled trials were included in the meta-analysis. For the primary outcome of 30-day survival, IMPELLA probably improves the outcome by a small amount compared with IABP (RR0.94 [95% CI 0.5–1.53], 29 fewer per 1,000 [95% CI from 204 fewer to 258 more], low certainty of evidence).</p><p><b><i>Conclusions:</i></b> We could not show a survival benefit of IMPELLA compared with IABP in patients with AMI complicated by CS. Further investigation is required to resolve this issue.</p>

DOI： 10.1253/circrep.cr-25-0161

PubMed

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Several antiarrhythmic agents, including amiodarone (AMD) and nifekalant (NIF), are used in the management of life-threatening arrhythmias such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Although a few studies have compared the antiarrhythmic effect of NIF and AMD, most have focused on termination or defibrillation of VF/VT. In this meta-analysis, we aimed to assess the current evidence on the preventive effects of NIF and AMD on recurrent VF and electrical storm (ES).</p><p><b><i>Methods and Results:</i></b> The protocol was registered in PROSPERO (CRD42024578486). PubMed (MEDLINE and PMC), Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, and Igaku Chuo Zasshi were searched for observational studies and randomized controlled trials evaluating patients with cardiac arrest due to recurrent VF and ES treated with AMD or NIF, published before 28 August 2024. The primary endpoint was the recurrence of VF/VT. Secondary outcomes included short-term death and incidence of torsades de pointes (TdP). 5 eligible studies comprising 222 participants were included. Evidence regarding differences between NIF and AMD in the recurrence of VF/VT, short-term death, and incidence of TdP was of very low certainty and remains highly uncertain.</p><p><b><i>Conclusions:</i></b> NIF and AMD may have little to no difference in preventing the recurrence of VF/VT, short-term death, or incidence of TdP; however, the certainty of the evidence is very low.</p>

DOI： 10.1253/circrep.cr-25-0138

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CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p>Intravenous atropine is widely recommended as the first-line treatment for symptomatic bradycardia, but because the optimal initial dose remains uncertain, the aim of this scoping review was to examine the existing literature on the efficacy and safety of intravenous atropine at specific doses in adult patients with symptomatic bradycardia and to identify gaps in evidence. A systematic search of 4 databases (PubMed, CENTRAL, Web of Science, and Ichushi-Web) was conducted from inception to December 16, 2024. Studies were included if they reported administration of a specified dose of atropine in adult patients, regardless of study design. No randomized controlled trials directly comparing 0.5 mg vs. 1.0 mg were found. A total of 19 studies were included and categorized into groups based on initial atropine dose: low (<0.5 mg), moderate (0.5 mg ≤ dose <1.0 mg), high (≥1.0 mg), and those spanning multiple categories. No consistent relationship was found between atropine dose and clinical outcomes, such as heart rate response or adverse effects. None of the moderate-dose studies reported worsening bradycardia. Moderate-dose atropine could be safe, and the current practice of using 0.5 mg as an initial dose in Japan, where 0.5 mg/mL prefilled syringes are commercially available, appears clinically reasonable. However, in the absence of high-quality comparative data, future research should apply rigorous study designs to determine the optimal atropine dose in emergency care settings.</p>

DOI： 10.1253/circrep.cr-25-0169

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CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Cardiogenic shock, cardiac tamponade, and pulmonary embolism are critical conditions in cardiovascular emergencies, characterized by high mortality rates. Early diagnosis and treatment are essential to improve outcomes. Point-of-care ultrasound (POCUS) has emerged as a noninvasive tool for evaluating shock. However, further assessment through the latest meta-analyses is necessary to comprehensively evaluate its diagnostic accuracy in cardiogenic emergencies. Therefore, in this study, we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of POCUS in patients with cardiogenic and obstructive shock.</p><p><b><i>Methods and Results:</i></b> Up to December 31, 2023, we systematically reviewed 9 studies reporting all 4 values (true positive, false positive, false negative, and true negative) published in the PubMed, Web of Science, and CENTRAL databases: 8 studies assessed cardiac shock, and 8 assessed obstructive shock separately. For cardiac shock, the pooled sensitivity was 86.1% (95% confidence interval [CI]: 71.5–93.9%), and specificity was 95.8% (95% CI: 94.0–97.2%). For obstructive shock, the pooled sensitivity was 77.5% (95% CI: 62.5–87.6%) and specificity was 97.6% (95% CI: 93.9–99.1%). The area under the curve was 0.96 (95% CI: 0.95–0.98) for cardiogenic shock and 0.94 (95% CI: 0.88–0.98) for obstructive shock.</p><p><b><i>Conclusions:</i></b> This meta-analysis suggested that POCUS has reasonable diagnostic accuracy for cardiogenic and obstructive shock, particularly with high pooled specificity.</p>

DOI： 10.1253/circrep.cr-25-0105

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CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Cardiogenic shock, a life-threatening condition frequently encountered in emergency departments, requires rapid diagnosis and management. Point-of-care ultrasound (POCUS) is widely used as a bedside tool; however, its impact on prognosis in patients with suspected cardiogenic shock remains unclear. This systematic review aimed to evaluate whether POCUS improves the clinical outcomes in these patients.</p><p><b><i>Methods and Results:</i></b> We searched PubMed, Web of Science, and Cochrane Library up to December 31, 2023, for studies evaluating the prognostic impact of POCUS in adults with undifferentiated shock, including cardiogenic shock. From 3,759 identified records, 2 studies (1 randomized controlled trial [RCT] and 1 observational study) involving 5,711 patients with shock were included. The RCT showed no significant differences in in-hospital mortality between the POCUS and non-POCUS groups (relative risk [RR] 0.99 [95% confidence interval (CI) 0.64–1.51]). The observational study reported higher mortality in patients receiving POCUS before intervention (RR 1.25 [95% CI 1.12–1.39]). Overall, POCUS did not significantly reduce mortality in patients with suspected cardiogenic shock. Given the limited number and quality of available studies, the certainty of evidence was low (RCT) and very low (observational study).</p><p><b><i>Conclusions:</i></b> Although POCUS plays an essential role in diagnosis and clinical decision-making, our review suggests that it may not significantly improve prognosis in patients with suspected cardiogenic shock. Further studies are required to determine its prognostic value.</p>

DOI： 10.1253/circrep.cr-25-0108

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Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) has impacted on cardiovascular disease. However, it remains unclear whether the COVID-19 pandemic has impacted on disease severity and patients’ prognosis of acute myocardial infarction (AMI) in Japan.</p><p><b><i>Methods and Results:</i></b> We retrospectively accumulated data from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination (JROAD-DPC) study (April 2019 to March 2021). Patients were divided into a before COVID-19 pandemic group or a during COVID-19 pandemic group. The proportion of patients who presented with cardiogenic shock (Killip class IV) was compared between groups, in association with 30-day mortality as the primary outcome. Killip class IV AMI significantly increased in the during COVID-19 pandemic group (15.7% vs. 14.5% in the before pandemic group, P<0.0001). The 30-day mortality was higher in the during COVID-19 pandemic group (9.6% vs. 9.2% in the before COVID-19 pandemic group, P=0.049). However, there was no significant difference in the adjusted 30-day mortality in each Killip class between the before and during COVID-19 pandemic groups.</p><p><b><i>Conclusions:</i></b> During the early stage of the COVID-19 pandemic in Japan, 30-day mortality of AMI increased, mainly because of the increase of Killip class IV AMI patients. However, irrespective of the COVID-19 pandemic, the adjusted 30-day mortality of each Killip classification group was unchanged.</p>

DOI： 10.1253/circrep.cr-24-0011

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Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Cardiovascular Electrophysiology  

Introduction: Right ventricular (RV) pacing sometimes causes left ventricular (LV) systolic dysfunction, also known as pacing-induced cardiomyopathy (PICM). However, the association between specifically paced QRS morphology and PICM development has not been elucidated. This study aimed to investigate the association between paced QRS mimicking a complete left bundle branch block (CLBBB) and PICM development. Methods: We retrospectively screened 2009 patients who underwent pacemaker implantation from 2010 to 2020 in seven institutions. Patients who received pacemakers for an advanced atrioventricular block or bradycardia with atrial fibrillation, baseline LV ejection fraction (LVEF) ≥ 50%, and echocardiogram recorded at least 6 months postimplantation were included. The paced QRS recorded immediately after implantation was analyzed. A CLBBB-like paced QRS was defined as meeting the CLBBB criteria of the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society in 2009. PICM was defined as a ≥10% LVEF decrease, resulting in an LVEF of <50%. Results: Among the 270 patients analyzed, PICM was observed in 38. Baseline LVEF was lower in patients with PICM, and CLBBB-like paced QRS was frequently observed in PICM. Multivariate analysis revealed that low baseline LVEF (odds ratio [OR]: 0.93 per 1% increase, 95% confidence interval [CI]: 0.89–0.98, p = 0.006) and CLBBB-like paced QRS (OR: 2.69, 95% CI: 1.25–5.76, p = 0.011) were significantly associated with PICM development. Conclusion: CLBBB-like paced QRS may be a novel risk factor for PICM. RV pacing, which causes CLBBB-like QRS morphology, may need to be avoided, and patients with CLBBB-like paced QRS should be followed-up carefully.

DOI： 10.1111/jce.16229

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Language：English   Publisher：The Japanese Circulation Society  

<p>The 87^thAnnual Meeting of the Japanese Circulation Society (JCS2023) was held in March 2023 in Fukuoka, Japan, marking the first in-person gathering after the COVID-19 pandemic. With the theme of “New Challenge With Next Generation” the conference emphasized the development of future cardiovascular leaders and technologies such as artificial intelligence (AI). Notable sessions included the Mikamo Lecture on heart failure and the Mashimo Lecture on AI in medicine. Various hands-on sessions and participatory events were well received, promoting learning and networking. Post-event surveys showed high satisfaction among participants, with positive feedback on face-to-face interactions and the overall experience. JCS2023, attended by 17,852 participants, concluded successfully, marking a significant milestone in post-pandemic meetings, and advancing cardiovascular medicine.</p>

DOI： 10.1253/circj.cj-24-0127

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：PACE - Pacing and Clinical Electrophysiology  

Background: Precise mapping of the Purkinje fiber network is essential in catheter ablation of Purkinje-related ventricular arrhythmias (PrVAs). We sought to evaluate the mapping ability of a multi-spline duodecapolar catheter (PentaRay) for PrVAs. Methods: Mappings of Purkinje fibers by PentaRay catheters were compared with those by conventional mapping catheters in consecutive patients undergoing catheter ablation of PrVAs from 2015 to 2022. Results: Sixteen PrVAs (7 premature ventricular contractions or non-reentrant fascicular tachycardias [PVCs/NRFTs] and 9 fascicular ventricular tachycardias [FVTs]) were retrospectively studied. In PVCs/NRFTs, earliest preceding Purkinje potentials (PPs) could be recorded by the PentaRay catheters but not by the mapping and ablation catheters in 5 cases. At the earliest PP sites, the precedence from the QRS onset was greater, and the amplitude of the preceding potentials was higher in the PentaRay catheter compared with those in the mapping and ablation catheter (−62.0 ± 42.8 vs. −29.4 ± 34.2 ms, P = 0.02; 0.45 ± 0.43 vs. 0.09 ± 0.08 mV, P = 0.02). In FVTs, late diastolic potentials (P1) were recorded by the PentaRay catheters but not by the mapping and ablation catheters or the linear duodecapolar catheter in 2 cases. The amplitude of P1 was higher in the PentaRay catheter compared with that in the linear duodecapolar catheter and the mapping and ablation catheters (0.72 ± 0.49 vs. 0.17 ± 0.18 vs. 0.27 ± 0.21 mV, P = 0.0006, P = 0.002). The localized critical PPs, defined as the earliest preceding potentials in PVCs/NRFTs and P1 in FVTs, could be recorded in all the patients by the PentaRay catheter. The mapping ability of critical PPs of PrVAs was better with the PentaRay catheter than with the conventional mapping catheters (16/16 vs. 9/16, P = 0.004 by McNemar exact test). Conclusions: The PentaRay catheter has clinical advantages in mapping of the Purkinje fiber network to reveal critical PPs as ablation targets of PrVAs.

DOI： 10.1111/pace.14906

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Language：English   Publisher：HeartRhythm Case Reports  

DOI： 10.1016/j.hrcr.2023.10.023

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Language：Japanese   Publisher：Japanese Society of Sonographers  

DOI： 10.11272/jssabst.49.0_s143

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：JACC: Clinical Electrophysiology  

Background: Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of patients with heart failure (HF) and AF. However, its optimal timing remains to be fully elucidated. Objectives: The aim of this study was to investigate the prognostic impact of early CA in patients with HF and AF hospitalized for worsening HF. Methods: From JROADHF (Japanese Registry of Acute Decompensated Heart Failure) (n = 13,238), patients with HF and AF who underwent CA within 90 days after admission for HF (early CA; n = 103) and those who did not (control; n = 2,683) were identified. Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n = 83 in each group). Results: In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray’ test: P < 0.001 and P = 0.005; subdistribution HR: 0.28 [95% CI: 0.13-0.63] and HR: 0.31 [95% CI: 0.13-0.75]; matched: Gray's test: P = 0.006 and P = 0.017; subdistribution HR: 0.24 [95% CI: 0.08-0.70] and HR: 0.28 [95% CI: 0.09-0.84], respectively). Conclusions: In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in patients with HF and AF.

DOI： 10.1016/j.jacep.2023.05.038

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Heart and Vessels  

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for critically ill patients all over the world; however, comprehensive survey regarding the relationship between VA-ECMO duration and prognosis is limited. We conducted a survey of VA-ECMO patients in the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC), which was a health insurance claim database study among cardiovascular centers associated with the Japan Circulation Society, between April 2012 and March 2016. Out of 13,542 VA-ECMO patients, we analyzed 5766 cardiovascular patients treated with VA-ECMO. 68% patients used VA-ECMO only for 1 day and 93% had VA-ECMO terminated within 1 week. In multivariate analysis, the hazard ratio of 1-day support was significantly high at 1.72 (95% confidence intervals; 95% CI 1.53–1.95) (p < 0.001), while that of 2-day [0.60 (95% CI 0.49–0.73)], 3-day [0.75 (95% CI 0.60–0.94)], 4-day [0.43 (95% CI 0.31–0.60)] and 5-day support [0.62 (95% CI 0.44–0.86)] was significantly low. Comprehensive database analysis of JROAD-DPC revealed that cardiovascular patients who were supported with VA-ECMO for 2–5 days showed lower mortality. The optimal VA-ECMO support window should be investigated in further studies.

DOI： 10.1007/s00380-022-02158-0

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

循環器疾患診療実態調査に基づくJROAD-DPCデータを用いて、静脈脱血-動脈送血による膜型人工肺(VA-ECMO)の装着期間が予後に及ぼす影響について検討した。対象は入院当日にVA-ECMOを導入した20歳以上の心血管疾患患者5766例で、急性呼吸窮迫症候群または補助人工心臓の植込み前にECMOを導入した症例は除外した。疾患別では冠動脈疾患が2561例(44.4%)で最も多く、次いで肺血栓塞栓症が333例(5.1%)、心筋炎が293例(5.1%)であった。患者を院内転帰に応じて死亡群3629例(男性76.1%、平均62.8±14.3歳)と生存群2137例(男性72.2%、平均59.4±15.2歳)の2群に分類した。VA-ECMOの使用期間は死亡群(平均2.12±2.20日)の方が生存群(平均1.90±1.82日)より有意に長かった(P<0.001)。多変量解析でECMO期間は生存率と有意に関連し、年齢および疾患別に交絡因子を調整した後も、ハザード比は1日のECMO装着(1.72)の方が2日(0.60)、3日(0.75)、4日(0.43)より有意に高かった(P<0.001)。

Language：English   Publisher：Circulation: Arrhythmia and Electrophysiology  

DOI： 10.1161/CIRCEP.122.011579

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Language：English   Publisher：Journal of Arrhythmia  

Background: Focal Purkinje ventricular arrhythmias (VAs) might originate from the vicinity of the proximal portion of the cardiac conducting system. This study aimed to clarify the features associated with focal Purkinje VAs originating from the proximal conduction system. Methods: A total of 18 patients with focal Purkinje VAs undergoing radiofrequency catheter ablation (RFCA) were retrospectively examined and divided into the proximal type or the non-proximal type. The proximal type was defined as having the origin at the proximal half of the interventricular septum, or the proximal half and the septal side of the anterior wall. The 12-lead electrocardiogram and electrophysiological findings were investigated. Results: Seven patients met criteria for proximal type of focal Purkinje VA. Out of the 7, 4 patients with proximal VAs had multiple QRS morphologies of VAs clinically, whereas out of 11 patients with non-proximal VAs, only 1 had multiple morphologies (p =.047). VA QRS duration was shorter in the proximal type than in the non-proximal type (111.2 ± 19.8 ms vs. 135.7 ± 17.7 ms; p =.003). The absolute axis difference between sinus rhythm and VA was smaller in the proximal type (80.4 ± 46.1°vs. 138.8 ± 59.6°; p =.014). The absolute axis difference ≤134° was useful in distinguishing the two types. Recurrence of VA was recorded in 3 proximal type patients and 3 non-proximal type patients. No procedure-related conduction block was observed. Conclusion: A VA of absolute axis difference ≤134°, and multiple QRS morphologies of clinical VAs indicate a proximal origin. Focal Purkinje VAs from proximal origins can be suppressed by RFCA without severe conduction disturbance.

DOI： 10.1002/joa3.12787

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Language：English   Publisher：(一社)日本不整脈心電学会  

伝導系の近位部から発する巣状プルキンエ心室不整脈(FPVA)に関連してみられる所見を明らかにした。2008～2020年に5病院でFPVAと診断され高周波カテーテルアブレーション(RFCA)が行われた患者18名(男性11名、年齢18～75歳)を後方視的に検討した。そのFPVAの起源が心臓伝導系の近位部にあると判定された近位群は7名存在した。臨床的に心室不整脈(VA)と考えられた時の心電図で複数のQRS形態が観察されたのは、近位群の7名中4名、非近位群の11名中では1名のみであった(p=0.047)。VA時のQRS幅は非近位群に比べ近位群で有意に短縮していた。洞調律時とVA時で電気軸角度にみられた差の絶対値は、近位群で80.4±46.1度、非近位群では138.8±59.6度となり(p=0.003)、この絶対差が134度以下という基準を定めると両群を識別するのに有用であった。VAの再発は両群で3名ずつに発生した。RFCA処置に関連した伝導ブロックの例は観察されなかった。以上のように、臨床的VAで多様なQRS形態が観察されること、およびVA時に変化した電気軸角度の絶対差が134度以下であることは、FPVAの起源が伝導系近位部にあることを指し示していた。RFCAを行うことで、重度の伝導障害を起こすことなく近位部起源のFPVAを抑制できると結論された。

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Several algorithms have been proposed for differentiating the right and left outflow tracts (RVOT/LVOT) arrhythmia origins from 12-lead electrocardiograms (ECGs); however, the procedure is complicated. A deep learning (DL) model, a form of artificial intelligence, can directly use ECGs and depict the importance of the leads and waveforms. This study aimed to create a visualized DL model that could classify arrhythmia origins more accurately.</p><p><b><i>Methods and Results:</i></b> This study enrolled 80 patients who underwent catheter ablation. A convolutional neural network-based model that could classify arrhythmia origins with 12-lead ECGs and visualize the leads that contributed to the diagnosis using a gradient-weighted class activation mapping method was developed. The average prediction results of the origins by the DL model were 89.4% (88.2–90.6) for accuracy and 95.2% (94.3–96.2) for recall, which were significantly better than when a conventional algorithm is used. The ratio of the contribution to the prediction differed between RVOT and LVOT origins. Although leads V1 to V3 and the limb leads had a focused balance in the LVOT group, the contribution ratio of leads aVR, aVL, and aVF was higher in the RVOT group.</p><p><b><i>Conclusions:</i></b> This study diagnosed the arrhythmia origins more accurately than the conventional algorithm, and clarified which part of the 12-lead waveforms contributed to the diagnosis. The visualized DL model was convincing and may play a role in understanding the pathogenesis of arrhythmias.</p>

DOI： 10.1253/circj.cj-22-0229

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Cardiovascular Electrophysiology  

Introduction: Ectopic beats originating from the pulmonary vein (PV) trigger atrial fibrillation (AF). The purpose of this study was to clarify the electrophysiological determinant of AF initiation from the PVs. Methods: Pacing studies were performed with a single extra stimulus mimicking an ectopic beat in the left superior PVs (LSPVs) in 62 patients undergoing AF ablation. Inducibility of AF, effective refractory period (ERP), and conduction properties within the PVs were analyzed. Results: A single extra stimulus in LSPV induced AF in 20 patients (32% of all patients) at the mean coupling interval (CI) of 172 ms. A CI-dependent anisotropic conduction at the AF onset was visualized in a three-dimensional mapping. Onset of AF was site-specific with reproducibility in each individual. Mean ERP in LSPV in the AF-inducible group was shorter than that in the AF-noninducible group (182 ± 55 vs. 254 ± 51 ms, p <.0001). LSPV ERP dispersion was greater in the AF-inducible group than in the AF-noninducible group (45 ± 28 vs. 27 ± 19 ms, p <.01). Circumferential intra-PV conduction time (IPVCT) exhibited decremental properties in response to shortening of CI and the prolongation of IPVCT in the AF-inducible site was greater than that in the AF-noninducible site (p <.05) in each individual. Conclusions: Location and CI of an ectopic excitation ultimately determine the initiation of AF from the PVs. ERP dispersion and circumferential conduction delay may lead to anisotropic conduction and reentry within the PVs that initiate AF.

DOI： 10.1111/jce.15371

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Responsible for pages：p100-104.   Language：Japanese   Book type：Scholarly book

Event date： 2025.3

Event date： 2025.3

Event date： 2025.2

Event date： 2024.5

Language：Japanese  

Country：Japan  

Event date： 2024.5

Language：Japanese  

Country：Japan  

Event date： 2023.5

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Country：Japan  

Event date： 2023.5

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Country：Japan  

Event date： 2023.5

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Country：Japan  

Event date： 2022.6

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Event date： 2022.6

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2022.6

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Country：Japan  

Event date： 2021.4

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2020.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2020.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京   Country：Japan  

Event date： 2020.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜   Country：Japan  

Event date： 2020.6

Language：English   Presentation type：Oral presentation (general)  

Venue：Bangkok   Country：Japan  

Event date： 2019.6

Language：Japanese  

Country：Japan  

Event date： 2019.6

Language：Japanese  

Country：Japan  

Event date： 2019.6

Language：Japanese  

Country：Japan  

Event date： 2019.6

Language：Japanese  

Country：Japan  

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