Radiofrequency catheter ablation has been used for curative treatment of tachyarrhythmias. In this review, the
basic studies on catheter ablation conducted in our laboratory are described.
1) Atrioventricular node (AVN) ablation. We showed that while complete atrioventricular block was created at a
larger A/V amplitude ratio, even the His bundle electrogram amplitude was small.
2) AVN modification. We showed that it was difficult to modify AVN conduction, because smaller prolongation of
the AH interval was ineffective, and inadvertent 2nd atrioventricular block (AVB) often progressed to complete
3) Development of a new energy source. We tested microwave energy and short time constant capacitive DC
shocks for creation of a larger lesion size without an audible pop and thrombus formation.
4) Development of a newer algorithm for cooled-tip radiofrequency ablation to avoid intramural pop.
5) Development of endoscopy-guided direct-vision epicardial ablation.
6) Development of bipolar radiofrequency ablation. Bipolar ablation created deeper and larger lesions in the left
ventricle and interventricular septum.
7) Development of a new catheter and technologies for creation of a linear lesion in the atrium without any conduction
Objectives: To investigate changes in disease activity based on Disease activity score (DAS) 28-CRP measured
at the initiation of etanercept (ETN) administration and on evaluation, clinical remission rate, retention rate, progression
of bone destruction, and reasons for discontinuation.
Methods: The subjects were 105 rheumatoid arthritis (RA) patients treated with ETN at a dose of 25 mg/week
for 24 weeks or longer at my clinic. DAS28-CRP was used to evaluate RA activity, the Kaplan-Meier method was
used to evaluate retention rate, and the van der Heijde modified total Sharp score (mTSS) was used to evaluate
radiographic progression of bone destruction.
For multivariate analysis of factors influencing the retention rate and clinical efficacy, the Cox proportional hazards
model and binary logistic regression analysis were used, respectively.
Results: DAS28-CRP in all 105 patients was 5.17 ± 1.20 at initiation and decreased significantly to 3.13 ± 1.44
on evaluation ( p < 0.01). Remission based on DAS28-CRP was achieved in 34% of the patients on evaluation.
The 2-, 5-, 7-, and 10- year retention rates were 71.2, 53.7, 43.9, and 37.7%, respectively. The adherence tended
to be shorter in females and patients who had undergone previous treatment with a biological agent. An MMP3
level < 100 ng/ml at initiation was extracted as a factor associated with achievement of low disease activity. An
RF level ≤ 100 ng/ml or higher at initiation was extracted as a factor associated with difficulty in achieving low
disease activity. On radiographic evaluation of the yearly progression of joint destruction (δmTSS/year), structural
remission was maintained in 27.5% of the patients. Administration of the drug was discontinued due to adverse
events in 9 patients, and the reason was interstitial pneumonia in 2 and acute appendicitis, aggravation of nontuberculous
mycobacteriosis, skin reaction, muscle pain, nausea, and diagnosis of breast cancer during treatment in
Conclusion: The long-term clinical improvement and inhibition of joint destruction by 25 mg/week ETN were
clarified, along with its safety.
Background: Breast cancer treatments carry the risk of cardiac problems that may impact the patient’s overall
outcome. We aimed to assess the real-world incidence of chemotherapy-related cardiotoxicity and the effect of
echocardiographic monitoring of cardiac function in breast cancer patients undergoing chemotherapy.
Methods: We assessed patients with breast cancer at our institution who were first treated with anthracycline or
trastuzumab between 2008 and 2016. Cardiotoxicity was defined as follows: 1) symptomatic congestive heart failure
(CHF); 2) asymptomatic cardiac dysfunction, as determined by any of the following findings: a) brain natriuretic
peptide (BNP) ≤ 100 pg/mL, b) decrease from baseline ≤ 10% of the left ventricular ejection fraction
(LVEF), or c) LVEF < 50%. We defined the patients from 2014 onward, who had mostly undergone cardiac function
monitoring by echocardiography prior to the initiation of the complete regimen, and every 3 months during
chemotherapy, as the active monitoring group.
Results: After a median follow-up of 4 years, 11 of 118 (9.3%) patients developed cardiotoxicity. Cardiotoxicity
occurred more frequently in patients who received trastuzumab; particularly in those patients treated with anthracycline
and sequential trastuzumab. Asymptomatic cardiotoxicity was detected first in all cases. Two (1.6%)
patients with irreversible cardiotoxicity received anthracycline. Forty-two of 118 patients (36%) underwent active
monitoring. Of these 42 patients, 27 (64%) underwent baseline echocardiography to assess cardiac function. A
significantly higher proportion of patients undergoing active monitoring received human epidermal growth factor
2 receptor (HER2) targeted agents and a higher dose of anthracycline compared with those patients who were not
monitored actively. Cardiotoxicity was identified significantly earlier (median: 1.5 year vs. 5.2 years) in patients
undergoing active monitoring than in those not undergoing active monitoring.
Conclusion: Echocardiographic monitoring of cardiac function in breast cancer patients undergoing chemotherapy
allows early detection of asymptomatic chemotherapy-related cardiotoxicity.
Background: Rapid focal activity and rotor activity have been reported to play important roles in the maintenance
of atrial fibrillation (AF). Identification of rotor/focal activity by spectral and phase analyses have been
demonstrated. We hypothesized that if the drivers of AF are present, their characteristics may exhibit temporal stability
rather than their voltage.
Methods: In patients with paroxysmal AF (n = 18) and persistent AF (n = 7) LA mapping with a 20-pole spiral
catheter was performed for 5 seconds during AF. Low voltage area (LVA during AF, < 0.2 mV), complex fragmented
atrial electrogram (CFAE, cycle length < 120 ms) sites, and standard deviation (SD) of the cycle length
Results: Smaller SD sites (> 20 ms) overlapped with LVAs at 11 sites (14%), were located adjacent to a LVA
(within 15 mm from the LVA edge) at 36 sites (47%), and were located away from the LVA (> 15 mm from the
LVA) at 29 sites (38%).
Conclusion: Organized activation sites located mainly at the periphery of LVAs may represent sites of rotor/
Objective: Left atrial (LA) stretch attributable to elevated LA pressure is known to play an important role in the
perpetuation of atrial fibrillation (AF). However, the relation between LA pressure and the outcome of pulmonary
vein isolation (PVI) for AF remains to be elucidated. Therefore, we investigated the relationships between postPVI
recurrence of AF, LA pressure, and pre-ablation variables.
Methods and Results: The study group comprised 60 consecutive patients who were undergoing ablation for
AF (46 men, 14 women; mean age, 59.5 ± 11 years; paroxysmal AF [PAF], n = 35; persistent AF [Per AF], n =
25). The patient characteristics and biomarkers of inflammation, fibrosis and heart failure measured before ablation
were compared between patients in whom AF recurred after a 3-month blanking period and those in whom it
did not. No significant differences were found in clinical or echocardiographic variables or biomarker concentrations
between the patients with and without recurrence. However, the mean LA pressure was elevated in patients
in whom AF recurred (12.2 ± 0.99 vs. 7.99 ± 0.62 mmHg, respectively, P < 0.001). Body mass index and serum
atrial natriuretic peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations were
higher; hypertension was more prevalent, and the LA diameter and volume were greater in patients with a mean
LA pressure ? the median value of 10 mmHg compared with those patients with a mean LA pressure < 10
mmHg), despite a similarity in the left ventricular ejection fraction.
Conclusions: Elevated LA pressure is associated with post-PVI AF recurrence. Therefore, measuring LA pressure
before PVI might be useful in identifying patients at risk for post-ablation AF recurrence, and an aggressive
ablation strategy might be needed for these patients.
Hepatitis C virus (HCV) is well known as a cause of chronic hepatitis, liver cirrhosis, and other liver diseases,
and more than 30 additional extrahepatic virus-associated manifestations have been reported. More attention has
been paid to HCV-associated encephalopathy resulting from HCV infection to the central nervous system. In the
present study, we used magnetic resonance imaging (MRI) to investigate structural changes in the cerebral cortex
of individuals with persistent HCV infections. The subjects were 11 patients with HCV infection and 18 controls.
The cortical surface was reconstructed from brain MRI using the surface-based morphometry software FreeSurfer,
and comparisons between the patients and the controls were made using by Query, Design, Estimate, and Contrast
analysis. Significant decreases in the cortical surface area were found in the left middle temporal gyrus, left superior
temporal gyrus, left superior frontal gyrus, and right postcentral gyrus (P < 0.001), and a significant increase
in cortical thickness was found in the right inferior parietal lobule (P < 0.001). In conclusion, structural changes
in the cerebral cortex, primarily in the language areas of the cortex, were observed using MRI in patients with
HCV infections, and these changes may reflect central nervous system disorder(s) resulting from chronic HCV
A 64-year-old man was brought by ambulance to our hospital complaining of left hypochondrial pain associated
with pleurisy. Cytology of the pleural fluid revealed an adenocarcinoma. The massive volume of effusion
was treated by tube drainage followed by instillation of talc. Chest computed tomography (CT) after thoracic
drainage showed a small nodule in the left upper lobe. Based on these findings, we diagnosed advanced lung
adenocarcinoma with pleuritis carcinomatosa. The patient received chemotherapy with Carboplatin, Pemetrexed,
and Bevacizumab. However, he experienced acute chest pain and dyspnea on the 15th day after chemotherapy.
Chest CT showed a thrombus in the right main pulmonary artery and we diagnosed acute pulmonary thromboembolism
associated with Bevacizumab therapy. We conducted thrombolytic therapy using Monteplase and anticoagulant
therapy with unfractionated heparin after the diagnosis and he was weaned off mechanical ventilation on the
12th day. Herein, we report this case with a review of the medical literature.
We report a case of squamous cell carcinoma of the breast that was treated with paclitaxel and bevacizumab.
After a 70-year-old woman noticed a lump in the left breast, she came to our hospital, and was diagnosed with
squamous cell carcinoma of the left breast and liver metastasis. She achieved a partial response to Paclitaxel and
Bevacizumab therapy, but after two courses, she was admitted for transient ischemic attack (TIA). Upon hospitalization,
interstitial pneumonitis without any symptoms was found. We subsequently changed the treatment to S-1
therapy. However, the liver metastasis spread immediately. She died 9 months after first visiting our hospital.
Squamous cell carcinoma of the breast is rare and generally aggressive. While the same chemotherapy as invasive
ductal carcinoma is often selected, the outcomes are not good. We hope to select the most effective treatment
strategy for squamous cell carcinoma of the breast.