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. 2021 Jun 2;37(4):709-870.
doi: 10.1002/joa3.12491. eCollection 2021 Aug.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias

Akihiko Nogami  1 , Takashi Kurita  2 , Haruhiko Abe  3 , Kenji Ando  4 , Toshiyuki Ishikawa  5 , Katsuhiko Imai  6 , Akihiko Usui  7 , Kaoru Okishige  8 , Kengo Kusano  9 , Koichiro Kumagai  10 , Masahiko Goya  11 , Yoshinori Kobayashi  12 , Akihiko Shimizu  13 , Wataru Shimizu  14 , Morio Shoda  15 , Naokata Sumitomo  16 , Yoshihiro Seo  2 , Atsushi Takahashi  17 , Hiroshi Tada  18 , Shigeto Naito  19 , Yuji Nakazato  20 , Takashi Nishimura  21 , Takashi Nitta  22 , Shinichi Niwano  23 , Nobuhisa Hagiwara  15 , Yuji Murakawa  24 , Teiichi Yamane  25 , Takeshi Aiba  9 , Koichi Inoue  26 , Yuki Iwasaki  14 , Yasuya Inden  27 , Kikuya Uno  28 , Michio Ogano  29 , Masaomi Kimura  30 , Shun-Ichiro Sakamoto  22 , Shingo Sasaki  31 , Kazuhiro Satomi  32 , Tsuyoshi Shiga  15 , Tsugutoshi Suzuki  33 , Yukio Sekiguchi  2 , Kyoko Soejima  34 , Masahiko Takagi  35 , Masaomi Chinushi  36 , Nobuhiro Nishi  37 , Takashi Noda  9 , Hitoshi Hachiya  38 , Masataka Mitsuno  39 , Takeshi Mitsuhashi  40 , Yasushi Miyauchi  41 , Aya Miyazaki  42 , Tomoshige Morimoto  43 , Hiro Yamasaki  2 , Yoshifusa Aizawa  44 , Tohru Ohe  45 , Takeshi Kimura  46 , Kazuo Tanemoto  47 , Hiroyuki Tsutsui  48 , Hideo Mitamura  49 ; JCS/JHRS Joint Working Group
Affiliations

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias

Akihiko Nogami et al. J Arrhythm. .
No abstract available

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Figures

FIGURE 1
FIGURE 1
History of non‐pharmacotherapy of cardiac arrhythmia
FIGURE 2
FIGURE 2
Transition in the number of implanted cardioverter‐defibrillators (ICD) and cardiac resynchronization therapies (CRT‐P/CRT‐D) in Japan
FIGURE 3
FIGURE 3
Distribution of underlying heart disease in ICD primary and secondary prevention cases in Japan. (From Shimizu et al, 2012 with permission.) ARVC, arrhythmogenic right ventricular cardiomyopathy; Brugada, Brugada syndrome; CHD, congenital heart disease; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; HHD, hypertensive heart disease; IHD, ischemic heart disease; IVF, idiopathic ventricular fibrillation; LQT, long QT syndrome; Misc., miscellaneous 2ndCM, secondary cardiomyopathy; VHD, valvular heart disease
FIGURE 4
FIGURE 4
ICD indications for coronary artery disease. AMI, acute myocardial infarction; BP, blood pressure; CA, catheter ablation; EPS, electrophysiological study; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association class; OHA, out‐of‐hospital cardiac arrest; Sust‐VT, sustained VT; VF, ventricular fibrillation; VT, ventricular tachycardia [Correction added on 22 June, after first online publication: Under ‘Primary prevention’, ≥48 days after onset of AMI or ...' has been replaced with ≥40 days after onset of AMI or ...]
FIGURE 5
FIGURE 5
ICD indications for non‐ischemic cardiomyopathy with left ventricular dysfunction. BP, blood pressure; CA, catheter ablation; EPS, electrophysiological study; LVEF, left ventricular ejection fraction; NYHA, NYHA functional class; OHA, out‐of‐hospital cardiac arrest; Sust‐VT, sustained VT; VF, ventricular fibrillation; VT, ventricular tachycardia [Correction added on 29 June, after first online publication: '(1) LVEF ≤35%' has been removed and renumbered in the box at the bottom‐left.]
FIGURE 6
FIGURE 6
ICD indication for patients with uncertain diagnosis of syncope. LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; VF, ventricular fibrillation; VT, ventricular tachycardia [Correction added on 29 June, after first online publication: '(1) NYHA class I or IV' has been amended to '(1) NYHA class I‐IV' in the box above 'Class IIa'.]
FIGURE 7
FIGURE 7
ICD indication for patients with Brugada syndrome. *1Arrhythmic syncope: In comparison with non‐arrhythmic syncope, there is a great frequency among middle‐aged men. Incontinence is frequently observed. Syncope is not driven by a crowded environment, pain, mental stress, and orthostatic body position. *2Close follow‐up is recommended in patients with Brugada ECG pattern induced by sodium channel blocker. ICD, implantable cardioverter‐defibrillator; VF, ventricular fibrillation; VT, ventricular tachycardia
FIGURE 8
FIGURE 8
ICD indication for patients with early repolarization (ER) pattern on ECG. * High‐risk ER electrocardiographic patterns: extensive J‐point elevation at inferior and/or lateral ECG leads, J‐p[oint elevation (≥0.2 mV), J‐point elevation with horizontal/descending ST‐segment, and dynamic circadian and/or day‐by‐day variations in J‐point elevation. ER, early repolarization; VF, ventricular fibrillation
FIGURE 9
FIGURE 9
ICD indication for patients with short QT syndrome (SQTS). *: short‐QT syndrome (SQTS) or sudden death under 40‐year‐old within the second‐degree relatives. ICD, implantable cardioverter‐defibrillator; SCD, sudden cardiac death; SQTS, short QT syndrome; VF, ventricular fibrillation
FIGURE 10
FIGURE 10
Deterministic and stochastic radiation risks. (From Japanese Circulation Society Joint Working Group, 2011 with permission.)
FIGURE 11
FIGURE 11
Pulmonary vein isolation using the TactiCath™ Quartz ablation catheter. The location of the catheter and the contact force measurement value are visualized. During PVI, the site of the catheter in contact with the tissue, the contact area, and the contact pressure are presented in a bullseye map format (Center)
FIGURE 12
FIGURE 12
RHYTHMIA™ mapping clearly demonstrating the atrial reentrant tachycardia related to 2 left atrial–pulmonary vein gaps. A total of 52,319 points can be acquired in 10 min, and clear gap‐to‐gap reentrant data are depicted
FIGURE 13
FIGURE 13
MediGuide™ system. The real‐time position of the ablation catheter is displayed, and sites of interest can be tagged on the looped cineangiogram
FIGURE 14
FIGURE 14
Slow pathway ablation using the anatomical approach. AVN, atrioventricular node; CS, coronary sinus; HB, His bundle; RA, right atrium; RV, right ventricle; TT, tendon of Todaro
FIGURE 15
FIGURE 15
Proposed algorithm for predicting atrial tachycardia origin on the basis of the P‐wave configuration from 12‐lead ECG recordings (From Tang et al, 1995 with permission.)
FIGURE 16
FIGURE 16
Indications for catheter ablation of symptomatic atrial fibrillation (AF). AAD, antiarrhythmic drug
FIGURE 17
FIGURE 17
Importance of general judgments for the indication of AF catheter ablation. It is essential to consider 3 factors (age, degree of symptom, and advancement), not individually but in total
FIGURE 18
FIGURE 18
Techniques of pulmonary vein isolation (PVI)
FIGURE 19
FIGURE 19
Cryoballoon ablation. (A) Schematic representation of pulmonary vein isolation procedure with the use of a cryoballoon catheter. (From Kuck et al, 2016 with permission.) (B) Fluoroscopic view during pulmonary vein occlusion with a cryoballoon, with the contrast medium retained in the distal portion of the left superior pulmonary vein
FIGURE 20
FIGURE 20
Radiofrequency hot‐balloon ablation. (A) Appearance of the SATAKE Hot‐Balloon. (B) Selective pulmonary vein angiograms using a hot balloon catheter. AP, anteroposterior; LAO, left anterior oblique; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein
FIGURE 21
FIGURE 21
Visually guided laser balloon ablation system. (A) Inflated shape of the Heart‐LightⓇ laser balloon. (B) Endoscopic view of the antrum of the right superior pulmonary vein (RSPV) during laser energy application (green light)
FIGURE 22
FIGURE 22
Localization of the ganglioplexus (GP) outside the atrium. LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein
FIGURE 23
FIGURE 23
Voltage map of the left atrium before and after ethanol injection into the vein of Marshall. After ethanol injection (Lower panel), a low‐voltage zone (<0.5 mV) is observable at the mitral isthmus area
FIGURE 24
FIGURE 24
Schematic of factors leading to arrhythmias in (A) pre‐ and (B) postoperative congenital heart disease. AV, atrioventricular; IART, intra‐atrial reentrant tachycardia; VT, ventricular tachycardia. (From Escudero et al, 2013 with permission.)
FIGURE 25
FIGURE 25
Schematic illustration of scar‐related macroreentrant VT. Bys, bystander; CP, common pathway.(From Stevenson et al, 1997 with permission.)
FIGURE 26
FIGURE 26
Flowchart of the entrainment mapping scheme. EG, electrogram; PPI, postpacing interval; S, stimulus; VT, ventricular tachycardia; VTCL, ventricular tachycardia cycle length. (From Stevenson et al, 1997 with permission.)
FIGURE 27
FIGURE 27
Ablation methods with substrate mapping. LAVA, local abnormal ventricular activity; LP, late potential; VT, ventricular tachycardia
FIGURE 28
FIGURE 28
Schematic illustrations of reentrant circuits for bundle branch reentry and interfascicular reentry tachycardias. AVN, atrioventricular node; HB, His bundle; LAF, left anterior fascicle; LPF, left posterior fascicle; RB, right bundle. (From Nogami et al, 2011 with permission.)
FIGURE 29
FIGURE 29
Conduction system in atrioventricular discordance. Ant., anterior; Ao, aorta; Lavc, left atrioventricular canal; LBB, left bundle branch; MLvent, morphological left ventricle; PA, pulmonary artery; Post., posterior; RA, right atrium; Ravc, right atrioventricular canal; RAA, right atrial appendage; RBB, right bundle branch; VSD, ventricular septal defect. (Modified from Anderson et al, 1973 with permission.)
FIGURE 30
FIGURE 30
Atrial situs solitus: morphological right atrium on the right and morphological left atrium on the left. Atrial situs inversus: morphological left atrium on the right and morphological right atrium on the left. Right atrial isomerism: bilateral morphological right atria. Left atrial isomerism: bilateral morphological left atria. LAA, left atrial appendage; RAA, right atrial appendage. (From Anderson, 2010 with permission.)
FIGURE 31
FIGURE 31
WATCHMAN™ device. Schema of implantation: delivery (A), deployment (B), and release (C). (D) Close‐up view of the WATCHMAN device. (E) Transesophageal echocardiographic image of an occluded LAA following deployment of a WATCHMANTM device. LA, left atrium, LAA, left atrial appendage. (From De Backer et al, 2014 with permission.)
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