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講演形態	タイトル	発表言語
一般演題 General Presentation		英語 日本語
シンポジウム	CRTレスポンダーの同定	英語
	Identification of CRT Responder
シンポジウム	CRT-PかCRT-Dか、あるいはICDか	英語
	Controversy for Device Selection: CRT-P Versus CRT-D Versus ICD
シンポジウム	皮下植え込み型除細動器の有用性と限界	英語
	The Usefulness and the Limitation of Subcutaneous ICD
シンポジウム	着用型自動除細動器(WCD)の心臓突然死予防における役割	英語
	Wearable Cardioverter Defibrillator: Role in Prevention of Sudden Cardiac Death
シンポジウム	心室細動に対するアブレーション（ブルガダ症候群以外）	英語
	Ablation of Ventricular Fibrillation (except Brugada Syndrome)
シンポジウム	VTアブレーションにおける最新マッピング	英語
	New Mapping Technique for VT Ablation
シンポジウム	左側特発性心室頻拍（ILVT）のマッピングとアブレーション	英語
	Mapping and Ablation of Idiopathic Left Ventricular Tachycardia
シンポジウム	先天性心疾患に対する最新のカテーテルアブレーション治療	英語
	Current Management of Tachyarrhythmia by Catheter Ablation in Congenital Heart Disease
シンポジウム	ブルガダ症候群に対するアブレーション：トリガーかサブストレートか	英語
	Catheter Ablation for Brugada Syndrome: Should We Target the Trigger or the Substrate of Ventricular Fibrillation?
シンポジウム	心房細動アブレーション：トリガーかサブストレートか	英語
	Approaches to Catheter Ablation for Atrial Fibrillation: Triggers or Substrate Modification
シンポジウム	VTアブレーションのための最新画像診断法	英語
	Latest Modalities of Image Integration for VT Ablation
シンポジウム	不整脈原性右室心筋症	英語
	Arrhythmogenic Right Ventricular Cardiomyopathy
シンポジウム	透視軽減	英語
	Reduction of Radiation Exposure
シンポジウム	心不全患者における不整脈治療の進歩と展望	英語
	Recent Progress and Future Prospects for Treating Cardiac Arrhythmias in Heart Failure
シンポジウム	心房細動患者における周術期の抗凝固療法	日本語
	Periprocedural Management of Atrial Fibrillation Patients Taking Oral Anti-Coagulant
シンポジウム	無症候性心房細動の診断・治療と予後	英語
	Silent Atrial Fibrillation: Diagnosis, Therapy and Prognosis
シンポジウム	心房細動の管理：リズムコントロール vs. レートコントロール	英語
	Management of Atrial Fibrillation: Rhythm Versus Rate Control Therapy
シンポジウム	デバイス感染の治療の現状と問題点	日本語
	The Treatment of Device Infection : The Current Status and Problems
シンポジウム	抗不整脈薬の新展開	英語
	State of the Art: Antiarrhythmic Management of Atrial Fibrillation
シンポジウム	ブルガダ症候群のメカニズム	英語
	Mechanisms Underlying Brugada Syndrome
シンポジウム	遺伝子から考える心房細動治療	英語
	Treatment of Atrial Fibrillation and Genetic Background

CRTレスポンダーの同定

Identification of CRT responders

座長：	栗田　隆志 （近畿大学医学部附属病院心臓血管センター）

Chairperson：Takashi Kurita

(Kinki University)




　Cardiac resynchronization therapy (CRT) has been established as the essential strategy to improve the mortality and QOL of patients with an impaired left ventricular function and wide QRS. The frontiers of CRT have been expected to expand the indication of this therapy for patients with mild heart failure (NHHA class I or II) or a narrow QRS. Recent large clinical trials (MADIT-RIT and RAFT) showed the positive results of an early indication of CRT for mild heart failure patients, and suggested that the electrocardiographic indices (QRS width >150 ms and left bundle branch block) are appropriate parameters to detect responders of CRT. On the contrary, EchoCRT study provided the negative impact of the echocardiographic evaluation of dyssynchrony for predicting responders of CRT in patients with a narrow QRS.

　Even using various evaluation methods, a certain amount of non-responders after CRT can be seen, and the proper identification of responders before the therapy is still a big concern for effectively using this expensive device. On the other hand, new developments in device capabilities, such as the “Quadripolar LV lead”, “Adoptive CRT” and “Multisite Pacing”, can be alternative approaches to reduce non-responders to CRT.

In this symposium, we will discuss the appropriate methods for speculating who will be responders to CRT, including the possibility echocardiograms provide, the role of advanced technologies in reducing non-responders, the next possible strategies when we encounter non-responders to CRT after the operation, and what is the highest percentage of responders we can expect to reach.

先天性心疾患に対する最新のカテーテルアブレーション治療

Current Management of Tachyarrhythmia by Catheter Ablation in Congenital Heart Disease

座長：	住友　直方 （埼玉医科大学国際医療センター小児心臓科）

Chairperson：Naokata Sumitomo

(Saitama Medical University International Medical Center)




Recent advances in catheter ablation techniques have enable various types of atrial and ventricular arrhythmias to be cured for structural heart disease even in post operative congenital heart disease. The improvement of success rate of catheter ablation is largely depends upon the development of newer technologies of 3D mapping system, such as CARTO system. The 3D mapping system can visualize the isthmus of the arrhythmia circuit, with a detailed information of the anatomical structure and the prior surgical procedures of the underlining congenital heart disease. The arrhythmia circuit is mostly around anatomic obstacle, surgical incisions, and surgical patch or baffle of the previous surgery. To know the 3D information is one of the key points to success the catheter ablation of the tachyarrhythmia in congenital heart disease. However, catheter could not reach the optimal target point, because of the prior surgery, such as Fontan operation.
This symposium is aimed to introduce the current advanced management of tachyarrhythmia by catheter ablation in congenital heart disease.
KEYNOTE LECTURE     George F. Van Hare St Louis Children's Hospital, Washington University School of Medicine in St. Louis, St Louis Children's Hospital




演題名：Arrhythmias following repair of congenital heart disease

演者     Katja Zeppennfeld       Leiden University Medical Center 




演題名：Anatomical substrate and ablation of VT in Congenital heart disease

演者     Sabine Ernst    Royal Brompton Hospital       




演題名：Advanced ablation strategies for arrhythmia management in complex adult congenital heart disease

心房細動患者における周術期の抗凝固療法

Periprocedural Management of Atrial Fibrillation Patients Taking Oral Anti-coagulant

座長：	井上　耕一 （桜橋渡辺病院 心臓血管センター）

Chairperson：Koichi Inoue

(Sakurabashi Watanabe Hospi)




梗塞リスクを伴う非弁膜症性心房細動患者に対して、心原性脳梗塞・全身性塞栓症の予防のための抗凝固療法は必須である。経口抗凝固療薬がワルファリンしかなかった時代から、非ビタミンK依存型抗凝固薬（NOAC）が使える時代になり数年がたつ。ガイドラインでもワルファリンよりもNOACが望ましいと位置づけられ、リアルワールドにおけるNOACの使用経験も蓄積され、さらに、よりハイリスクでチャレンジングな状況でのNOAC使用に関する知見も徐々に深まってきている。本シンポジウムでは、「観血的処置の周術期」という「抗凝固療法のリスクとベネフィットのバランスをとるのが難しい状況における抗凝固療法はどうあるべきか」をテーマとした。ワルファリンとNOACのどちらが有用か、NOAC間で差異はあるのか、投与のプロトコルはどうするべきか、アブレーションの場合はどうか、ハイリスク患者やハイリスク手術ではどうするべきか、ヘパリンブリッジは有用か、などこのテーマで解決すべき課題は未だ多い。これらについて本邦の患者におけるデータをもとにして議論し，より有効かつ安全な抗凝固療法を見出す一助としたい。

CRT-PかCRT-Dか、あるいはICDか

Controversy for Device Selection: CRT-P Versus CRT-D Versus ICD

座長：	安部　治彦
	（順天堂大学浦安病院循環器内科）
Chairperson：	Haruhiko Abe
	(University of Occupational and Environmental Health)

In Japan, prevalence of sudden cardiac death patients, as well as heart failure patients, have been gradually increasing every year up to more than 70,000 persons/year, reported by Ministry of Health, Labour and Welfare (MHLW) in Japan. Several evidences have shown that mortality and morbidity in heart failure patients were improved with therapies of ICD and CRT devices. However, only less than 9,000 patients per year are received with these therapies, currently in Japan.
　The selection of devices for heart failure patients is the most important clinical issue for electrophysiologists, especially in proposed high risk patients for sudden cardiac death. Indeed, several guidelines have shown the indication for use of each device. However, several clinical issues for device selection are still remained in real world. For example, which devices should be selected in moderate heart failure patients (previously implanted RV paced patients with reduced ejection fraction 35-50%)? In patients with remained moderate lower ejection fraction after implanted CRT-P, how should we do, up-grade to CRT-D or not?
　In this symposium, Professor Chu-Pak Lau will be reviewed first concerning to current indications and topics for these devices with guidelines, and then discuss by all presenters and audience in this special and/or controversial topics in clinical studies and related issues for the device selection, CRT-P, ICD and CRT-D.

皮下植え込み型除細動器の有用性と限界

The Usefulness and the Limitation of Subcutaneous ICD

座長：	小林　洋一
	（昭和大学医学部循環器内科学部門）
Chairperson：	Youichi Kobayashi
	(Showa University School of Medicine)

Subcutaneous ICD (S-ICD) will be available in Japan soon. As there is no lead, epoch-making use can be considered, but on the other hand, there is also a limit.　As advantages, the case under the situation where a lead cannot be put in as infection of lead and the case it is expected to be that ICD becomes unnecessary in the future are considered to be good indications. Furthermore, S-ICD may be useful for a child case who will have a lead failure when growing up. However, of course the case who needs pacing S-ICD is unsuitable and the case who do not have the suitable QRS sensing will not be implantable. In this symposium we would like to discuss the usefulness and limitation in order to promote suitability in developing S-ICD.

着用型自動除細動器(WCD)の心臓突然死予防における役割

Wearable Cardioverter Defibrillator: Role in Prevention of Sudden Cardiac Death

座長：	清水　昭彦
	（山口大学大学院医学系研究科保健学専攻）
Chairperson：	Akihiko Shimizu
	(Yamaguchi Graduate School of Medicine)

It has been more than 2 years since wearable cardioverter defibrillator (WCD) became available in Japan. The indication of WCD are as follows. 1) Patients who have a high risk of sudden cardiac death (SCD) due to VF or VT, but the indication for ICD implantation has not been determined yet, because of potential change of the risk of SCD over the time. 2) Patients who are indicated for ICD implantation, but are not appropriate to be implanted at that time, such as in infection. The WCD may reduce the risk of SCD until the indication for ICD implantation is determined or the conditions of the patient are met.

Although the experience of WCD in Japanese population is limited, as compared to the data in the US, fewer patients with primary prevention of SCD have been treated with WCD, suggesting that many patients with acute myocardial infarction with low ejection fraction have been followed without a WCD. The indication and other issues in WCD therapy will be discussed in this symposium.

不整脈原性右室心筋症

Arrhythmogenic Right Ventricular Cardiomyopathy

座長：	合屋　雅彦
	（東京医科歯科大学医学部附属病院循環器内科）
Chairperson：	Masahiko Goya
	(Tokyo Medical and Dental University)

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is progressive disease and an inherited desmosomal cardiomyopathy characterized by a high burden of ventricular arrhythmias and increased risk for sudden cardiac death (SCD). Fibro fatty replacement of the right ventricle (RV) within the so-called triangle of dysplasia which encompasses the RV inflow, outflow, and apex is thought to result in regions of slow conduction, which form the substrate for scar-related macroreentrant ventricular tachycardia (VT). The pathological lesions are believed to progress over time from the epicardium to the endocardium and with diffuse involvement of the RV and the left ventricle (LV) in half of the cases.

Restriction of the exercise and the titration of Beta-blockers up to the maximally tolerated dose are recommended as the first-line therapy. Patients with a history of aborted SCD, poorly tolerated VT and syncope have the highest risk of SCD and ICD therapy is required.

Catheter ablation should be considered in patients with frequent symptomatic PVC or VT unresponsive to medical therapy. In early 2000’s even though electroanatomic and voltage mapping systems provided significant improvement concerning the result of catheter ablation targeting ARVC-VT, it was not considered curative because of high recurrence rate. Recently several reports were published as for the importance of an endo-epicardial– based ablation strategy, catecholamine challenge and PVC mapping, and substrate of the left ventricle.

In this session, we will expect to have the most advanced concept, methodology, and technology for the better understanding the mechanisms and the innovative therapeutic techniques of this complex arrhythmias.

遺伝子から考える心房細動治療

Treatment of Atrial Fibrillation and Genetic Background

座長：	中谷　晴昭
	（千葉大学　理事）
Chairperson：	Haruaki Nakatani
	(Chiba University)

Atrial fibrillation (AF) is a widely prevalent arrhythmia associated with increased morbidity, mortality and socioeconomic burden. For decades, treatment of AF has been discussed in the aspect of pharmacological or non-pharmacological modification of electrical property of the myocardium and propagation of excitation in the atria. It is almost 20 years since the concept structural remodeling of the atrial tissue by AF was experimentally confirmed. Recent reports have suggested that certain genetic backgrounds, such as variants in genes encoding gap junction proteins and ion channels, increase the risk of AF. Genome-wide association studies have disclosed that even common single-nucleotide polymorphisms　(SNPs) increase the vulnerability to the development of AF. Also, AF susceptibility SNPs seem to be related with recurrence of arrhythmia after catheter ablation for AF. AF occurs as a phenomenon of combination of genetic abnormalities or variations, acquired organic myocardial abnormalities, and/or autonomic modulation of myocardial electrical stability. Thus, most efficient management of this arrhythmia should be focused on a primary cause of AF in each patient. In this symposium, to obtain an insight into the future of AF management, the potential role of gene-oriented treatment of AF will be discussed.

心不全患者における不整脈治療の進歩と展望

Recent Progress and Future Prospects for Treating Cardiac Arrhythmias in Heart Failure

座長：	萩原 誠久
	（東京女子医科大学循環器内科）
Chairperson：	Nobuhisa Hagiwara
	（Department of Cardiology Tokyo Women's Medical University）

Cardiac arrhythmias can be a potential complication of heart failure (HF). Both atrial and ventricular arrhythmias are common in patients with HF and contribute significantly to mortality and morbidity. Atrial fibrillation occurs with increasing frequency as the severity of HF increases.
Anticoagulation and rate control are important. Attempted maintenance of sinus rhythm with class III antiarrhythmic drugs or the catheter ablation are reasonable considerations for selected patients with HF. Implantable cardioverter defibrillators (ICD) are first-line therapy for high-risk patients who have been resuscitated from sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Also, a number of randomized clinical trials have now demonstrated that primary prophylaxis of ICD can improve mortality in selected patients with HF. Therefore, the risk stratification and the prevention of VT/VF are the key common issues in the treatment of these patients. Furthermore, there has been much progress with the catheter ablation technique, ICD, and cardiac resynchronization therapy (CRT) devices, which are now useful in patients with arrhythmias and HF. In this symposium, we would like to discuss the pathogenesis of cardiac arrhythmias, recent progress and future prospects for treating cardiac arrhythmias in patients with HF.

VTアブレーションのための最新画像診断法

Latest Modalities of Image Integration for VT Ablation

座長：	平尾　見三
	（東京医科歯科大学 不整脈センター）
Chairperson：	Kenzo Hirao
	（Tokyo Medical and Dental University）

Recent advances in the field of modalities of cardiac image integration enable electrophysiologists to perform ventricular tachycardia (VT) ablation more effectively and safely. Intraprocedural imaging is an important consideration in VT ablation, where it is needed for defining substrate, tagging ablation targets, tracking lesion location, and monitoring for complications.
The progress of 3-dimensional (3D) electroanatomic mapping has a significant impact on such advances in VT ablation. This mapping visualizes scar regions as low voltage area on substrate map, the site of origin of focal VTs and reentrant VT circuits on activation map as well as the geometry of the heart.
With mappable VTs, ascertainment of VT circuit components assessed by conventional activation and entrainment mapping occurs during tachycardia. In unmappable VTs, electroanatomical mapping system is effective in mapping the anatomical substrate and electrophysiological substrate identified by scar-related ventricular electrograms (e.g. late potentials , fractionated potentials) during non-VT rhythm.
Preprocedural assessment by various imaging modalities provides us helpful information for VT ablation regarding anatomy, cardiac function and VT substrate. Current gold standard for scar imaging is LGE (late gadolinium enhancement) on cardiac magnetic resonance imaging (MRI). This imaging modality can provide a detailed assessment of scar architecture and can be used for image integration with the 3D electroanatomic mapping system.
Patients who cannot undergo MRI scanning may have scar imaging performed with positron emission tomography (PET) and/or computed tomography (CT) to obtain a high-resolution metabolic scar map, which can also be used for image integration.
Besides fluoroscopy and electroanatomic mapping, intracardiac echocardiogramphy (ICE) has been used as an additional modality during VT ablation. It allows for real-time scar imaging, visualization of cardiac structures, catheter contact and lesion formation.
These challenges in VT ablation based on the different imaging modalities may eventually improve the outcome of VT ablation. In this symposium, 5 experts in this field will provide us lectures focusing on the latest modalities of image integration for VT ablation.

デバイス感染の治療の現状と問題点

The Treatment of Device Infection : The Current Status and Problems

座長：	末田　泰二郎（広島大学大学院医歯薬保健学研究院 外科学）
	光野　正孝（兵庫医科大学 心臓血管外科）

　デバイス感染はデバイス植え込み後の最も重大な合併症のひとつであり、本学会等でも毎年のようにテーマに取り上げられている。昨今ではエキシマレーザーシースによるデバイス抜去等が徐々に普及し、エキスパートをもってすれば技術的には抜去がほぼ可能となってきた。
　一方で、デバイス植え込みは元来ハイリスク患者がその対象となっている場合が多く、感染デバイス抜去に成功しても、結局は感染や心不全等で救命できない症例も少なからず存在する。その治療成績に大きく影響を与えるものとして、例えば一時ペーシングの可否やペーシング部位（特に敗血症を呈しデバイス抜去を必要とするが心機能が悪く抜去直後からCRTを必要とするような症例）、デバイス抜去後の再植え込みの時期（同様に敗血症を呈する症例）、リスクは高くても外科の介入が必要な症例（心筋電極の使用も含む）等の問題があるが、未だ一定の見解は得られていない。
　本シンポジウムでは、「デバイス感染の治療の現状と問題点」として、技術的にリード抜去困難な症例に対する対策とともに、上記のような問題点についても検討し、最終的に患者を救命するにはどのように対策を構ずればよいかを考えたい。

左側特発性心室頻拍（ILVT）のマッピングとアブレーション

Mapping and Ablation of Idiopathic Left Ventricular Tachycardia

小林　義典	東海大学医学部付属八王子病院循環器内科
横式　尚司	北海道大学病院循環器内科

The advance in the clinical electrophysiology has identified several types of idiopathic left ventricular tachycardia (ILVT). These include tachycardia originating from the outflow tract, the aortic sinus cusp, the superior portion of the epicardial LV (LV summit), the mitral annulus, the postero-septal region of LV (cardiac crux), the papillary muscles, and the Purkinje-fascicular network (such as verapamil-sensitive VT).
Our understanding of the mechanisms, anatomical location and characteristic intracardiac electrograms at the critical sites of those ILVTs is prerequisite for successful catheter ablation. In addition to endocardial mapping, some form of ILVTs requires the mapping in the coronary venous system and/or on the epicardial surface. Information regarding the morphology of QRS complex during tachycardia is also important for the mapping, and subtle differences in the QRS complex lead us to determine the distinct approach to the critical target for catheter ablation. The accumulating evidences using new electrophysiological and imaging technology have been helpful for further elucidating the mechanisms and origins of ILVTs.
This symposium aims to focus on the novel findings related to ILVTs and to share the important tips and pitfalls on the mapping and ablation of ILVTs.

心房細動アブレーション：トリガーかサブストレートか

Approaches to Catheter Ablation for Atrial Fibrillation:Triggers or Substrate Modification

熊谷　浩一郎	福岡山王病院ハートリズムセンター

Trigger elimination by pulmonary vein isolation (PVI) represents the cornerstone of ablation strategies. However, some patients with paroxysmal atrial fibrillation (AF) may be undertreated with PVI alone. Further modification of atrial substrate maintaining AF seems necessary in some patients. Patient selection for additional atrial substrate modification is usually based on their clinical presentation although the correlation between AF type and the extent of atrial structural disease remains unclear. The two most common techniques for substrate modification are the creation of linear lesions in the left atrium (LA) and ablation at sites with complex fractionated atrial electrograms (CFAEs) during AF considered critical for AF perpetuation. However, a recent clinical study found no reduction in the rate of recurrent AF when either linear ablation or ablation of CFAEs was performed in addition to PVI. Perhaps neither CFAEs nor lines may be the additional targets for ablation. More selective targets may be needed to better characterize an individual patient’s specific arrhythmic substrate. Previous studies have shown the correlation of low-voltage areas with atrial fibrosis and scarring. A novel individualized approach for AF ablation based on low-voltage areas in the LA has been provided. However, the necessity of additional ablation of low-voltage areas to PVI for paroxysmal AF is less clear, and long-term data after ablation of low-voltage areas are limited. The additional ablation could increase risk. Consequently, extended AF ablation may lead to overtreatment in the sense of increased procedure and fluoroscopy time, complication rate, and proarrhythmia. We discuss the approaches to AF ablation targeting triggers or substrate modification.

心室中隔頻拍: マッピング，アブレーションの近年の進歩

Septal VTs: Diagnosis and recent evolution of mapping and ablation.

夛田　浩	福井大学医学部 病態制御医学講座 循環器内科学

The ventricular septum is a major origin of ventricular tachycardia (VT): Among idiopathic VTs, most outflow tract VTs and some mitral and tricuspid annular VTs occur from the septum.  A rare and distinct type of verapamil-sensitive, left fascicular VT also could be ablated at the left upper septum (left upper septal VT).  In structural heart disease, especially in cardiac sarcoidosis and hypertrophic cardiomyopathy, the critical substrate of reentrant VTs is often found within the septum. 
In some VTs arising from the septum, because the VT origin and reentry substrate exist beyond the reach of ablation with the use of standard techniques, an open surgical approach is required for a cure.   However, recently emerged ablation techniques and instruments, such as bipolar radiofrequency ablation and intramyocardial infusion-needle catheter ablation may cure these kinds of septal VTs that have been refractory to the conventional catheter ablation therapy. 
In this symposium, eminent physicians in this field will present these issues and discuss how to diagnose and ablate septal VTs safely. 

透視軽減

Reduction of Radiation Exposure

副島　京子	杏林大学医学部　循環器内科

WHO has launched the “Global Initiative on Radiation Safety in Health Care Settings” to mobilize the health sector in the safe use of radiation in medicine. In the interventional cardiology, the major concern regarding the brain cancer development has been raised. Previous data showed that the typical dose for atrial fibrillation catheter ablation is 15 mSv and 64-slice CT prior is 15mSv. Total of 30mSv is compatible with the average dose of evacuees from Chernobyl plant! In the EP field, non-fluoroscopic mapping systems contributed to the reduction of radiation exposure. Awareness of the radiation cannot be emphasized enough.

心房細動の管理：リズムコントロール vs. レートコントロール

Management of Atrial Fibrillation: Rhythm versus Rate Control Therapy

池田　隆徳	東邦大学医学部内科学講座 循環器内科学分野

There has been considerable debate for over a decade regarding the management of patients with atrial fibrillation (AF). It is about whether physicians should attempt to restore and maintain sinus rhythm using cardioversion, antiarrhythmic drugs, and/or catheter ablation, so-called “rhythm-control” therapy, or whether patients with AF should be treated with drugs such as beta-blockers, calcium-channel blockers, or digoxin, to control the rapid ventricular heart rate responsible for the majority of symptoms, the so-called “rate-control” therapy. Restoration and maintenance of sinus rhythm would intuitively seem to be the ideal approach for both stroke prevention and symptom alleviation. However, some studies demonstrated that long-term maintenance of sinus rhythm has proven difficult to achieve using antiarrhythmic drugs in AF patients. Moreover, adverse drug effects, ranging from proarrhythmic effects to organ toxicity, are a common concern when antiarrhythmic drugs were used. Conversely, rate control therapy is generally considered a safe and inexpensive therapeutic strategy mainly for persistent AF, although it may not be an effective treatment option in patients who are highly symptomatic. Recent several clinical trials revealed that rhythm control therapy offers no clinical benefit over rate control therapy. However, we should recognize that these studies primarily enrolled older patients with persistent AF, who were mildly symptomatic. Therefore, the results cannot be extrapolated to other patient populations, particularly patients with highly symptomatic younger than 65 years with paroxysmal and/or lone AF. In this symposium, we will widely discuss about which therapy is better regarding the management of AF in various clinical settings.

VTアブレーションにおける最新マッピング

New mapping technique for VT ablation

座長：	関口　幸夫 (筑波大学医学医療系　循環器内科学)

Chairperson: Yukio Sekiguchi

(Cardiovascular Division, Faculty of Medicine, University of Tsukuba)




In these days, the therapies for ventricular tachycardia (VT) have been advanced by the progress of invasive strategies such as implantable cardioverter defibrillator (ICD) or radiofrequency catheter ablation (RFCA), in addition to conventional drug therapy.
Especially, RFCA has become a useful treatment of drug-refractory VTs in the patients with structural heart disease. Several studies clarified that radiofrequency lesions delivered on the basis of substrate mapping by electroanatomical mapping system have been effective in unmappable or multiple VTs. Besides, the technique of percutaneous pericardial puncture to perform epicardial mapping and ablation has gained wide acceptance for the treatment of epicardial VT. However, long-term success rates remain unsatisfactory and are limited by lack of defined ablation endpoint.
Recently, several new mapping or ablation techniques have been reported in order to eliminate such VTs and were able to achieve adequate outcome.
In this session, we would like to discuss the topics regarding the utility of new mapping strategy for VT ablation in the patients with structural heart disease.

ブルガダ症候群に対するアブレーション：トリガーかサブストレートか

Catheter Ablation for Brugada Syndrome: Should We Target the Trigger or the Substrate of Ventricular Fibrillation?




因田　恭也（名古屋大学医学部　循環器内科）

Chairperson： Yasuya Inden

(Department of Cardiology, Nagoya University Graduate School of Medicine)




Ventricular fibrillation (VF) in patients with Brugada syndrome is life-threating and repeated arrhythmia. Ablation for Brugada syndrome has been reported recently and the targets of ablation were the trigger ventricular premature beat (VPB) and/or the substrate of the right ventricular outflow. The goal of the Brugada ablation is the decrease of the attack frequency or the disappearance of VF attack. We can detect the origin of VPB easily in the patients with frequent VPBs, but it will be difficult to eliminate the triggers in the patients with few VPB. The substrate of Brugada syndrome has been reported to be located over the epicedial surface of the right ventricular outflow. The epicardial ablation targeting the abnormal electrograms is performed in this area. In contrast, the radiofrequency energy was delivered by the endocardial approach in some cases. But the endpoints of these procedures aren’t established well.
And the indication of Brugada ablation depends on the patient’s condition such as the attack frequency, but the ECG criteria for ablation isn’t clear. The short and long term effects of these ablation were not fully investigated. We discuss the Brugada ablation targeting the trigger or the substrate of VF.

無症候性心房細動の診断・治療と予後

Silent Atrial Fibrillation: Diagnosis, Prognosis and Therapy




山根　禎一　東京慈恵会医科大学　循環器内科

Chairperson： Teiichi Yamane (Jikei University School of Medicine)




Silent or asymptomatic atrial fibrillation (AF) currently has gained wide interest not only in cardiovascular but also in neurologic field, which is reported to be responsible for the 25~40% of cryptogenic stroke. Furthermore, silent AF has been focused to be associated with the progression of dementia through the accumulation of micro-ischemic strokes.

In contrast to the manifest or symptomatic AF, there remained multiple unknown/debatable issues around the silent AF as follows; 1) Its epidemiology and populations, 2) How to diagnose and define the silent AF (standard Holter, external loop recorder, or implantable devices), 3) the proximity of silent AF episodes to thromboembolic events, 4) How to manage silent AF (including the necessity of anticoagulation therapy), 5) indication of curative ablation strategy for silent AF, etc.

Following the establishment of the management for the manifest AF, now we need to face the new disease entity of silent AF. In this symposium, we are planning to discuss the above non-resolved issues of silent AF among specialists of various medical fields (cardiology, neurology, etc).

抗不整脈薬の新展開

State of the art: Antiarrhythmic Management of Atrial Fibrillation

座長：	新　博次 (日本医科大学附属多摩永山病院)

Chairperson： Hirotsugu Atarashi (Nippon Medical School Tama Nagayama Hospital)




Goals of use antiarrhythmic medications for AF patients are including reduction in the frequency and duration of episodes of arrhythmia without increasing mortality and morbidity. Since the CAST study, noticed that suppression of arrhythmias using antiarrhythmic drugs may induce proarrhythmic events especially in patients with ischemic heart disease or heart failure. The majority of available antiarrhhthmic drugs exert predominant effects on cardiac sodium or potassium channels. How to select an appropriate drug for each patient, down regulation or up regulation of these ion channels depend on patient’s pathophysiology should be considered, therefore selection of drugs should be considered advancement of electrical remodeling. To maintain sinus rhythm, to date, non-pharmacological managements, pulmonary vein isolation is one of the effective approaches but adding antiarrhyhthmic drugs is not rare. In such cases what is the most effective pharmacological approach would be presented. Hopefully, what should we expect from next generation of antiarrhythmic drugs will be considered.

ブルガダ症候群のメカニズム

Mechanisms Underlying Brugada Syndrome

座長：	清水　渉　日本医科大学　内科学(循環器内科学)

Chairperson：Wataru Shimizu

(Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School)




Brugada syndrome (BrS) is characterized by a coved-type ST-segment elevation in the right precordial leads (V1 and V2) known as type-1 Brugada ECG and associated with a high risk of sudden cardiac death due to ventricular fibrillation (VF). The cellular mechanisms underlying BrS have long been a matter of debate. Two principal hypotheses have been advanced 1) The repolarization hypothesis asserts that an outward shift in the balance of currents in right ventricular epicardium can lead to repolarization abnormalities resulting in the development of phase 2 reentry, which generates closely-coupled premature beats capable of precipitating VT/VF; 2) The depolarization hypothesis suggests that slow conduction in the RVOT leading to discontinuities in conduction, plays a primary role in the development of the electrocardiographic and arrhythmic manifestations of the syndrome. The repolarization and depolarization hypotheses are not necessarily mutually exclusive and may indeed be synergistic. In this symposium, we will discuss on the potential mechanism underlying BrS from the viewpoint of electrocardiographic, electrophysiologic characteristics, genetics, and response to pharmacological agents or epicardial catheter ablation.

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