The most severe forms of prognostic symptom in cerebral infarction is that of cardiogenic cerebral embolism caused by atrial fibrillation. This type of arrhythmia increases with age, and expects to affect over 1 million people in Japan by 2030. The aims of treatment are to (1) control complications, (2) prevent cerebral infarction through anti-coagulant treatment (medication to prevent blood from coagulating), and (3) prevent Afib from becoming chronic by maintaining regular pulse. <\/span><\/p>\n Though there are anti-arrhythmia medications to treat arrhythmia, they might not work for some patients, and some patients cannot take them because of the side effects. Non-pharmaceutic treatment would then involves catheter ablation. In recent years, innovative technology along with 3D mapping have become mainstream, making treatment more effective and safe. The latest report shows that catheter ablation is effective toward reducing chronic Afib by 10%. For that matter, many medical facilities are performing catheter ablation for Afib before it becomes chronic.<\/span><\/p>\n There was no effective method to prevent Afib from becoming chronic in the past. However, it is now possible to prevent chronic Afib and maintain normal pulse with one single or multiple procedures.<\/span><\/p>\n <\/p>\n\n\n In Afib cases, blood flow is staggered inside the heart cavity, causing blood clots to form inside the left atrial appendage. If this blood clot breaks off within the heart chamber, it will pass through blood vessels and travel to the brain. If this blood clot clogs up a brain vessel, cerebral embolism occurs, resulting in cerebral infarction that could leave damaging after affects. <\/span>Regardless of whether the Afib is symptomatic, paroxysmal, or persistent, it can cause cerebral infarction. To prevent blood clot from forming, it is necessary to be on appropriate anti-coagulant drugs. However, in some patients, even with the use of anti-coagulants, blood clots still form. For these patients, as well as high risk patients such as seniors, diabetic patients, patients with past history of cerebral infarction and valvular disease patients, performing Transesophageal echocardiography (TEE) to assess blood clot is absolutely necessary.<\/span><\/p>\n Makiminato Chuo Hospital introduced the use of cryo-balloon in 2016 and endoscopic laser balloon catheterization in 2018 for treatment of Afib. Catheter used in cryo-balloon ablation has a diameter of 28mm. The treatment involves pressing the balloon at the entrance of the pulmonary vein to freeze the left atrial myocardium at -50 degrees, thus isolating the electrical current of the pulmonary vein. Compared to traditional high frequency ablation which takes 5 to 10 minutes to work on one pulmonary vein, cryo-ablation takes only 3 minutes to complete. Another merit of cryo-ablation is lower risk of blood clot formation. One of the disadvantages of cryo-ablation is that it is limited to pulmonary veins. Since 10 to 30% of Afib occurs outside of pulmonary veins, for these cases, high frequency ablation must also be included during treatment. Another disadvantage of cryo-ablation is there is approximately 10% of the cases who developed phrenic nerve palsy.<\/span><\/p>\n\n\n In laser-balloon, the treatment involves pressing the balloon at the entrance of the pulmonary vein, and under the guidance of an endoscope applies laser in a circle to isolate the electrical current of the pulmonary vein. Compared to traditional high frequency ablation, this method allows continuous and consistent cauterizing. Unlike cryo-balloon, laser-balloon is size-adjustable, giving it the freedom to target different formations of pulmonary veins. Since 10 to 30% of Afib occurs outside of pulmonary veins, for these cases, high frequency ablation must also be included during treatment. <\/span><\/p>\n\n\n Merits of cryo- and laser-balloon procedures <\/span><\/p>\n\n\n Image to the right shows isolation to both right and left pulmonary veins. Pulmonary veins (blood vessels that carry blood from the lungs to the heart) are the main locations where Afib occurs. Circular ablations creating a cauterizing line to each of the left and right pulmonary veins isolate the electrical path to the left atrium. <\/span><\/p>\n\n\n However, for chronic Afib, isolating the pulmonary veins alone usually is not effective. For these patients, we use the tailor-made approach to catheter ablation. The above case shows the abrupt termination of chronic Afib to normal heartbeat. Merits of tailor-made approach <\/span><\/p>\n\n\n Below is a case who came to our arrhythmia outpatient clinic with cerebral ischemic symptoms such as non-vertigo and feeling of blacking out. ECG was ordered and revealed frequent ventricular tachycardia (VT). The patient underwent catheter ablation using high density 3D mapping system. VT disappeared with one treatment and the patient was able to maintain normal heartbeat without needs of medication.<\/span><\/p>\n\n\n Merits of high density 3D mapping for definitive treatment of refractory tachycardia<\/span><\/p>\n\n\n\n There are four valves inside the heart, and mitral valve is one of them. Prognostic loss of mobility to the valve from inflammation results in progressive stenosis, obstructing blood passage and causing patient to feel tired and out of breath during exertion. In severe stenosis cases, open heart surgery is necessary to replace the stenotic valve with a biological or mechanical valve. In mild cases, however, a dumbbell-shaped balloon (Inoue balloon catheter technique) is used to effectively expand (dehisce) the narrowed commissure. This procedure is called percutaneous transseptal mitral commissurotomy (PTMC). Patients undergoing PTMC can be discharged in 1 to 2 days after the procedure. The procedure can be repeated if one treatment is not sufficiently effective.<\/span><\/p>\n\n\n Merits of PTMC <\/span><\/p>\n\n\n Syncope (blackout) is a temporary loss of consciousness with many different causes. As some syncope cases have been documented to lead to sudden cardiac death, our arrhythmia outpatient clinic sees also patients who have had experienced syncope. Our doctor will speak with you in details about your medical history, order 24-hour ECG (Holter) monitor, and if necessary have you admitted for a detailed examination called electrophysiology study (EPS). Furthermore, to find out the cause of syncope, a loop recorder is implanted below the surface of the skin for 3 years to automatically record any abnormal ECG waves, and to also allow the patient to actively record any symptoms. <\/span><\/p>\n\n\n Ventricular fibrillation (Vf) is the most dangerously fatal type of arrhythmia that can lead to death in a short time. In recent years, the remarkable accessibility of AED (automated external defibrillator) has saved many lives. For patients who have been saved by external defibrillator, it is the more important for them to find out the cause of Vf and get treated to prevent sudden death. Patients with Vf coming to our arrhythmia outpatient clinic will receive thorough interview of their medical history, as well as receiving an electrophysiology study (EPS). If necessary, catheter ablation treatment or implantation of ICD or CRTD will also be carried out. <\/span><\/p>\n\n\n In cardiac resynchronization therapy (CRT), three leads are placed inside the heart. In the right atrium is a standard pacemaker lead, in the right ventricle is a defibrillation shock lead, and in the left ventricle a special pacemaker lead. The pacemaker device itself is placed below the surface of the skin to your left chest. The pacemaker leads send electrical signals at optimal timing, which help to improve ventricular dyssynchrony. More importantly, in addition to improving heart failure, this treatment gives life-saving shock when fatal arrhythmia occurs.\u3000<\/span><\/p>\n\n\n \n<\/p> The image to the right show pre- and post-treatment ECGs. The top ECG shows elongated QRS length (blue box) before treatment in comparison to the post-CRT treatment in the bottom ECG, indicating shortened length and improved dyssynchrony. Also, the frequent arrhythmia (\uff0a<\/span>) before treatment was improved with catheter ablation.<\/p>\n <\/p>\n\n\n Merits of Cardiac Resynchronization Therapy for severe cardiac hypofunction <\/span><\/p>\n\n\n Device treatments include pacemaker, ICD (Implantable Cardioverter Defibrillator), CRT (Cardiac Resynchronization Therapy), and CRTD (Cardiac Resynchronization Defibrillator). After your device implantation, you will return periodically to have your device checked. Our device treatment outpatient clinic is every Monday, Wednesday and Friday mornings. Even if you had your device implanted somewhere else and would like to have it interrogated by us on a regular basis, please do not hesitate to contact us for appointment. <\/span><\/p>\n\n\n Record on the device can also be accessed remotely. <\/span><\/p>\n We are the first on Okinawa to introducing home-monitoring system for ICD patients living in offshore islands. Today, this system is available to everyone with device implantation. Patients receive a home monitoring device which notifies the service center of any arrhythmia events or sends data on a regular basis to the service center. The hospital then have access to these data to respond timely. This home-monitoring system is also usable in nursing homes or other long-term care facilities.<\/span><\/p>\n\n\n Merits of home-monitoring system <\/span><\/p>\n\n\n APHRS is one of the world renown arrhythmia associations; our Arrhythmia and Heart Failure Department appeared on its January 16, 2016 newsletter. <\/span><\/p>\n\n\n <\/p>\n<\/div>\n\n\n\n <\/p>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n \u25cf <\/span><\/strong> Assessing Left Atrial Thrombosis (Transesophageal Echocardiography) <\/span> <\/h5>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/hp1-01-01-300x224.jpg\")
\n
\u25cf <\/span><\/strong> Balloon Treatments for Afib<\/span><\/h5>\n\n\n\n
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/medtronic_arctic_front.png\")
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/cryo.jpg\")
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/laser-balloon.jpg\")
\n
\u25cf <\/span><\/strong> Tailor-made Treatment for Afib via 3D Mapping<\/span><\/h5>\n\n\n\n
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/jyunkanki1.jpg\")
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/hp1-02-1_2.jpg\")
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/hp1-03-1_2.jpg\")
<\/figure><\/div>\n\n\n
To control atrial fibrillation and maintain a normal heartbeat over an extended period of time, multiple catheter ablation may be required. The case to the right received a second catheter ablation and was able to maintain normal heartbeat for more than 11 years.<\/span><\/p>\n\n\n\n
Refractory Tachycardia<\/span><\/h4>\n\n\n\n
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/02\/hp2-02-1.jpg\")
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/VT-300x140.jpg\")
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/VT-after-300x126.jpg\")
\n
Mitral Valve Stenosis<\/span><\/h4>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/PTMC-3.jpg\")
\n
Syncope<\/span><\/h4>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/loop-recorder_ENG_final.jpg\")
<\/figure><\/div>\n\n\nPost-CPR<\/span><\/h4>\n\n\n
Heart Failure<\/span><\/h4>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/CRT_ENG_final.jpg\")
<\/figure><\/div>\n\n\n![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/ventsyn_ENG_final.jpg\")
<\/figure><\/div>\n\n\n\n
\u25cf <\/span><\/strong> Device Treatment<\/span><\/h5>\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/home-monitor_ENG_final.jpg\")
<\/figure><\/div>\n\n\n\n
<\/h2>\n\n\n\n
Merits and Achievements of Arrhythmia Department<\/h4>\n\n\n\n
\u25cf <\/span><\/strong> Asia-Pacific Heart Rhythm Society (APHRS)<\/span><\/h5>\n\n\n
![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/10\/revisedmapversion1MakiminatoCentralHospital-SATOSHIHIGAMD_01-724x1024.jpg\")
<\/figure>\n\n\n\n![\"\"](\"http:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2020\/10\/revisedmapversion1MakiminatoCentralHospital-SATOSHIHIGAMD_02-724x1024.jpg\")
<\/figure>\n<\/div>\n<\/div>\n\n\n\n\u25cf <\/span><\/strong> Taiwan Heart Rhythm Society AF Ablation 20th Anniversary Forum<\/span><\/h5>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/20171216002808-edited.jpg\")
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/shinbosaidoabl20th_friendshipforever-edited.jpg\")
\u25cf <\/span><\/strong> Distinguished Service Awards<\/span><\/h5>\n\n\n\n
![\"\"](\"https:\/\/haku-ai.or.jp\/en\/wp-content\/uploads\/2022\/04\/awards.jpg\")
\u25cf <\/span><\/strong> Invited Lectures<\/span><\/h5>\n\n\n
\n