医学部 内科学講座 循環器内科学部門

小森 孝洋

コモリ タカヒロ  (Takahiro Komori)

基本情報

所属
自治医科大学 附属病院冠動脈集中治療部 講師

J-GLOBAL ID
201401078347173247
researchmap会員ID
B000238141

外部リンク

経歴

 1

論文

 54
  • Tomonori Watanabe, Hitoshi Hachiya, Hiroaki Watanabe, Kazunori Anno, Takafumi Okuyama, Tomohiko Harunari, Ayako Yokota, Masashi Kamioka, Takahiro Komori, Yuko Torigoe-Kurosu, Hisaki Makimoto, Tomoyuki Kabutoya, Yoshifumi Kimura, Yasushi Imai, Kazuomi Kario
    Journal of arrhythmia 40(2) 363-373 2024年4月  
    BACKGROUND: The precise details of atrial activation around the triangle of Koch (ToK) remain unknown. We evaluated the relationship between the atrial-activation pattern around the ToK and success sites for slow-pathway (SP) modification ablation in slow-fast atrioventricular reentrant tachycardia (AVNRT). METHODS: Thirty patients with slow-fast AVNRT who underwent successful ablation were enrolled. Atrial activation around the ToK during sinus rhythm was investigated using ultra-high-density mapping pre-ablation. The relationships among features of atrial-activation pattern and success sites were examined. RESULTS: Of 30 patients (22 cryoablation; 8 radiofrequency ablation), 26 patients had a collision site of two wavefronts of delayed atrial activation within ToK, indicating a success site. The activation-search function of Lumipoint software, which highlights only atrial activation with a spatiotemporal consistency, showed non-highlighted area on the tricuspid-annulus side of ToK. In 23 of the patients, a spiky potential was recorded at that collision site outside the Lumipoint-highlighted area. Fifteen cryoablation patients with a success site coincident with a collision site outside the Lumipoint-highlighted area had significantly more frequent disappearances of SP after initial cryoablation (46.7% vs. 0%, p = .029), fewer cryoablations (3.7 ± 1.8 vs. 5.3 ± 1.3, p = .045), and shorter procedure times (170 ± 57 vs. 228 ± 91 min, p = .082) compared to the seven cryoablation patients without such sites. Four patients had transient AV block by ablation inside the Lumipoint-highlighted area with fractionated signals, but no patient developed permanent AV block or recurrence post-procedure (median follow-up: 375 days). CONCLUSIONS: SP modification ablation at the collision site of atrial activation of the tricuspid-annulus side along with a spiky potential could provide a better outcome.
  • Tomonori Watanabe, Satoshi Hoshide, Hitoshi Hachiya, Yoshiyuki Yumita, Masafumi Sato, Tadayuki Mitama, Takafumi Okuyama, Hiroaki Watanabe, Ayako Yokota, Masashi Kamioka, Takahiro Komori, Hisaki Makimoto, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
    Hypertension research : official journal of the Japanese Society of Hypertension 2024年3月26日  
    Lack of the typical nocturnal blood pressure (BP) fall, i.e non-dipper, has been known as a cardiovascular risk. However, the influence of non-dipper on atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been unclear. We investigated the clinical impact of non-dipping as evaluated by 24-hour ambulatory BP monitoring on the long-term outcome of AF recurrence post-PVI in 76 AF patients with a history of increased BP. The PVI procedure was successful in all 76 patients (mean age, 66±9years; antihypertensive medication, 89%; non-paroxysmal AF, 24%). Twenty patients had AF recurrence during a median follow-up of 1138 days. There was no difference in BP levels between the AF recurrence and non-recurrence groups (average 24 h systolic BP:126 ± 17 vs.125 ± 14 mmHg; P = 0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs.15.0%; P = 0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF and average 24-hr systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI:1.05-7.34], P = 0.039). Non-dipper patients had a larger left atrial (LA) volume index than the dipper patients (45.9 ± 17.3 vs.38.3 ± 10.2 ml/m2, P = 0.037). Among the 58 patients who underwent high-density voltage mapping in LA, 11 patients had a low-voltage area (LVA) defined as an area with a bipolar voltage < 0.5 mV. However, there was no association of LVA with non-dipper or dipper (22.2% vs.16.1%, P = 0.555). Non-dipper is an independent predictor of AF recurrence post-PVI. Management of abnormal diurnal BP variation post-PVI may be important.
  • 横田 彩子, 甲谷 友幸, 三玉 唯由季, 奥山 貴文, 渡邉 裕昭, 上岡 正志, 小森 孝洋, 渡部 智紀, 牧元 久樹, 今井 靖, 苅尾 七臣
    日本循環器学会学術集会抄録集 88回 PJ019-3 2024年3月  
  • 渡邉 裕昭, 牧元 久樹, 興梠 貴英, 菅沼 雅徳, 岡谷 貴之, 奥山 貴文, 横田 彩子, 上岡 正志, 小森 孝洋, 渡部 智紀, 甲谷 友幸, 今井 靖, 苅尾 七臣
    日本循環器学会学術集会抄録集 88回 PJ047-4 2024年3月  
  • 上岡 正志, 渡部 智紀, 渡邉 裕昭, 牧元 久樹, 奥山 貴文, 横田 彩子, 小森 孝洋, 甲谷 友幸, 今井 靖, 苅尾 七臣
    日本循環器学会学術集会抄録集 88回 PJ071-5 2024年3月  

MISC

 32

共同研究・競争的資金等の研究課題

 6