Clinical and Research Activities

Division of Cardiology

Interventional Cardiology section

10-3Interventional Cardiology section performs more than 200 percutaneous coronary interventions (PCI) in a year including Stent POBA, and rotablator. We usually use pressure-wire to measure FFR and assess the functional severity of stenosis. Emergent PCI for acute coronary syndrome can be performed in 24/7 manner.

Cardiology EP-section

Electrophysiology is the medical subspecialty that focuses on understanding, diagnosing, and treating heart rhythm problems or arrhythmias by studying the heart’s electrical activity and pathways. The Cardiac Electrophysiology (EP) and Arrhythmia Service at Gunma University Hospital provides a full range of cardiac diagnostic and evaluation techniques and EP procedures. Equipped with the latest technology for electrophysiologic diagnosis and care, this sophisticated equipment enables us to offer the full range of non-invasive evaluation and therapeutic services to patients with arrhythmias including atrial fibrillation, tachycardia, atrial flutter, and congenital heart rhythm problems. These diagnostic services address an array of cardiac conditions including:
•Ventricular arrhythmias, including ventricular tachycardia, survivors of sudden cardiac arrest (SCA) or at risk for SCA
•Supraventricular arrhythmias, including atrial fibrillation, Wolfe-Parkinson-White (WPW) syndrome
•Syncope hereditary disorders with risk of SCA, including Long QT, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy (HCM)
•Patients needing cardiac implantable electronic devices, including pacemakers, implantable defibrillators, biventricular pacemakers/ defibrillators and implantable loop recorders
•Patients with congenital heart disease and arrhythmias
•Outpatient monitoring of cardiac implantable electronic devices with a dedicated device clinic and remote monitoring of device capabilities

1. Clinical Activities
不整脈部門紹介の最初の写真Our team offers the following:
Electrophysiology Procedures (EP)
•Diagnostic EP studies for patients including adults with congenital heart disease
•Catheter ablation of arrhythmias: atrial fibrillation, atrial flutter, atrial tachycardias, other supraventricular tachycardias and WPW
The atrial fibrillation program treats patients with both paroxysmal and persistent atrial fibrillation utilizing state-of-the-art techniques for pulmonary vein isolation and linear ablation. Other therapies, including novel drugs for atrial fibrillation, are also available at our section. Our section routinely sees patients with recurrent ventricular tachycardia associated with heart disease, and performs complex ablation procedures for these patients. We also treat patients with ventricular tachycardia who have normal heart structure and function. The ablation procedure in this population is done with both traditional (endocardial) and new (epicardial) approaches.
•Cardiac implantable electronic devices, including pacemakers, implantable defibrillators, biventricular (cardiac resynchronization) pacemakers and defibrillators and implantable cardiac monitors, including implantable loop recorders
When indicated for the heart failure patient, cardiac resynchronization therapy utilizing implantation of a bi-ventricular pacemaker/defibrillator can be performed. We specialize in difficult or failed implants and offer left ventricular epicardial and endocardial leads for failed bi-ventricular implants.
•Tilt table testing

2. Research Activities
11-3We has carried on in-depth studies of the electro-anatomical substrate of organized tachyarrhythmias, and made prominent contributions to the understanding of the electrophysiological diagnosis and mechanisms of tachyarrhythmias. Our research interests have consistently involved virtually all aspects of the practice of clinical electrophysiology, including device therapy. A notable characteristic of our research is its originality and high relevance to the needs of clinical cardiology. More specifically, our long-term and meticulous recordings of coronary sinus double potentials have contributed new insights into the localization of atrioventricular accessory pathways, major interatrial connections and electrophysiological mechanisms of uncommon atrial tachyarrhythmias. We have also described the presence of previously unidentified potentials on the left ventricular endocardial surface, which clarified the pathogenesis of idiopathic left ventricular tachycardia. In an editorial, Dr. Peng-Sheng Chen commented that this discovery, if confirmed by histopathologic studies, might open a new chapter in clinical cardiac electrophysiology.  We have gained international visibility by publishing approximately 70 articles in reputable, peer-reviewed journals in the field of clinical electrophysiology. We has also regularly contributed abstracts to scientific congresses, including the annual meetings of the American Heart Association and North American Heart Rhythm Society. 

Heart Failure section

Our aim is treating patients with heart failure using medical agents and several devices. Especially, adaptive servo ventilation (ASV) is main device to treat severe heart failure, regardless of sleep disordered breathing. We are focusing on the clinical research to utilize ASV as a treatment tool for “chronic” heart failure.
In addition, cardiac rehabilitation is another promising therapy to improve patient’s clinical symptom and outcome. Cardiopulmonary exercise test with expiration gas analyzer can quantify exercise capacity in patients with chronic heart failure. We actively apply cardiac rehabilitation in patients with myocardial infarction, dilated cardiomyopathy and hypertensive heart disease etc. to improve skeletal muscle and vascular function.
We have many abstract presentations in scientific meeting including American Heart Association and American College of Cardiology every year. These researches have been published in peer-reviewed scientific journals.

Echocardiography section

aOur echocardiography team performs ~ 3,700 echocardiograms and ~180 trans-esophagial echocardiograms in a year. Various stress echocardiographies such as dobutamine-stress echo and exercise stress echo are actively performed.
We are strong for the all kinds of assessments in diseased heart, including valvular heart disease, dyssynchronic heart, dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy, congenital heart disease, and heart failure with preserved ejection fraction.
We have many abstract presentations in scientific meetings including American Heart Association and American College of Cardiology every year. These researches have been published in peer-reviewed scientific journals.

Overview for the Cardiac imaging (CT/RI) section

14-1It is very important to evaluate myocardial ischemia and viability.  So, we perform stress myocardial perfusion imaging.  Isotopes for myocardial perfusion imaging are 99mTc MIBI, 99mTc-tetorofosmin and 201Tl. The formers have good quality to evaluate cardiac function using QGS software. Moreover, we perform 123I-BMIPP imaging to evaluate myocardial fatty acid metabolism and 123I-MIBG imaging to evaluate cardiac sympathetic nerve function. The former is valuable for the evaluation of myocardial ischemic memory imaging and cardiac sarcoidosis. The latter is used for the evaluation of chronic heart failure in DCM and other CHF patients. 18F-FDG-PET is very useful to evaluate myocardial viability on glucose loading image and the inflammation of cardiac sarcoidosis on fasting image.
Cardiac CT was improved mainly to assess coronary morphologies. By using high end machine, we can acquire cardiac morphologies in 0.28sec at fast (as of 2012). And now, Cardiac CT is also improving and try to get more accurate cardiac images and functions.

2. Clinical Activities
Scintigraphies including stress myocardial perfusion imaging, rest myocardial perfusion imaging, 123I-BMIPP imaging to evaluate myocardial fatty acid metabolism and 123I-MIBG imaging to evaluate cardiac sympathetic nerve function, are performed. It is possible to perform rest imagings including 123I-BMIPP imaging and 123I-MIBG imaging in the other day. On the other hand, 18F-FDG-PET is performed to evaluate myocardial glucose metabolism.
Also, Cardiac CT is mainly performed to acquire coronary morphologies.
From April 2012 to March 2013, 99Tc-Stress perfusion SPECT:139 cases, Rest perfusion: 33 cases, 123I-BMIPP: 28 cases, 123I-MIBG: 2 cases, 18F-FDG-PET: 71 cases and Cardiac CT: 212 cases were performed.

3. Research Activities
We performed some studies, for example 1) Prediction of functional recovery after revascularization in coronary artery disease using 18F-FDG and 123I-BMIPP SPECT, 2) Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. 3) Prediction of functional improvement of ischemic myocardium with 123I-BMIPP SPECT and 99mTc-tetrofosmin SPECT imaging. 4) Usefulness of biventricular pacing to improve cardiac symptoms, exercise capacity and sympathetic nerve activity in patients with moderate to severe chronic heart failure.5) Usefulness of 123I-MIBG imaging to evaluate microvascular disturbance caused by embolization by microdebris after rotational atherectomy.6) Practical assessment of myocardial viability with a positron coincidence gamma camera using 18F-FDG in AMI patients. 7) Prediction of functional outcome in stunned myocardium after myocardial infarction using 123I-BMIPP and 99mTc-tetrofosmin imaging. 8) Relation Between Connective Tissue Growth Factor and Cardiac Sympathetic Nerve Activity In Heart Failure of DCM Patients. 9) Estimation of the left ventricular diastolic function with cardiac MDCT and 10) Quantitative Iodine image analysis provides the accurate information on myocardial ischemia: Comparison with 99mTc-Stress perfusion SPECT-

Division of Respiratory Medicine

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