We report on a patient with Behcet's syndrome who had two pseudoaneurysms at the junction of a saphenous vein graft and the native common carotid artery. He had experienced graft interposition due to the aneurysm rupture, but the saphenous vein was interpositioned due to the graft reobstruction. We successfully repaired the pseudoaneurysms with stent-graft.
Aneurysm ; Aneurysm, False ; Behcet Syndrome* ; Carotid Artery Injuries* ; Carotid Artery, Common ; Humans ; Rupture ; Saphenous Vein ; Transplants

Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.
Bundle of His ; Catheter Ablation ; Tachycardia*

Torsades de Pointes is a life-threatening arrhythmia associated with a number of causes, but is very rare among endocrinologic disorders. We report a case of male pseudohermaphroditism with hyperaldosteronism due to a 17alpha-hydroxylase deficiency presented with sudden cardiac arrest.
46, XY Disorders of Sex Development/*diagnosis/drug therapy ; Adult ; Death, Sudden, Cardiac/*etiology/*pathology ; Female ; Humans

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the age-related differences in clinical features, coronary anatomy, risk factors, hospital courses, and long-term prognosis of acute myocardial infarction(AMI) in women. MATERIALS AND METHODS: Total 513 female patients with AMI were divided into 3 groups ; group 1(n=3, 50 years old or less), group 2(n=02, between 51 years and 70 years old), and group 3(n=68, older than 70 years). Clinical follow-up including cardiac events was performed for mean duration of 26 months(1~155 months). Cardiac events include cardiac death, reinfarction, CABG, PTCA, CHF, stroke, and recurrent angina. RESULTS: Minimal lesion(<50% stenosis) in infarct-related artery was more prevalent in group 1 than in group 3(p<0.05). In group 2, the number of low high density lipoprotein(HDL) was significantly more than in group 3(p<0.01). During hospitalization, death and shock were more prevalently observed in group 3 than group 1(p<0.005) and group 2(p<0.001). Group 3 had more heart failures than group 1(p<0.001) and group 2(p<0.001) and group 2 had more heart failures than group 1(p<0.05). The younger age group showed a significantly higher survial rate(7 years : group 1; 76.1%, group 2; 60.6%, group 3; 34.2%, p<0.0001, Log Rank Stat =49.4) and cardiac event-free survival rate(7 years : group 1; 48.4%, group 2; 32.3%, group 3; 16.0%, p<0.0001, Log Rank Stat =37.5) for each 3 comparisons. In Cox proportional harzard analysis, LV systolic function influenced the group 2 survival (odds ratio 3.8, 95% CI 1.7 to 8.3, p<0.005) and the group 3 survival (odds ratio 2.2, 95% CI 1.1 to 4.5, p<0.05). The cardiac event free survival was influenced by age(odds ratio 1.6, 95% CI 1.2 to 2.1, p<0.005) and LV systolic function(odds ratio 1.8, 95% CI 1.3 to 2.5, p<0.001). CONCLUSION: Younger female patients with AMI had a more favorable prognosis compared with older female patients. LV systolic fuction was important as a prognostic factor for long-term survival except younger female AMI patients.
Arteries ; Death ; Disease-Free Survival ; Female ; Follow-Up Studies ; Heart ; Hospitalization ; Humans ; Middle Aged ; Myocardial Infarction* ; Prognosis* ; Risk Factors ; Shock ; Stroke

BACKGROUND AND OBJECTIVES: Previous studies have demonstrated an association between several single nucleotide polymorphisms and atrial fibrillation (AF). We hypothesized that the phenotypes of AF patients were associated with common AF susceptibility alleles. SUBJECTS AND METHODS: A total of 659 patients (57±9 years, 76% male) with AF who underwent catheter ablation and 659 age, and sex-matched controls were genotyped for the common AF susceptibility alleles rs2200733 and rs6843082 at 4q25, rs2106261 at ZFHX3, and rs13376333 at KCNN3. The phenotypes of AF patients, including electroanatomical characteristics of the left atrium and recurrence after ablation, were compared. RESULTS: The rs2200733 variant allele carriers have larger left atrium volume (128.5±40.7 vs. 113.5±29.2 mL, p=0.020), longer PR interval (185.9±32.6 vs. 174.8±21.9 ms, p=0.018), and higher amplitude of negative P-wave terminal force in Lead V₁ (0.07±0.04 vs. 0.05±0.04 mV, p=0.015) on electrocardiography than those without the variant allele. When the patients were assigned to three groups according to the number of variant alleles (Group A: no variant, n=15; Group B: 1 variant, n=158; Group C: 2 variants, n=439), incremental prognostic value, according to the number of variant alleles, was demonstrated (Log Rank p=0.015). Multivariate Cox regression analysis showed that persistent AF (OR 1.677, 95% CI 1.176-2.381, p=0.004) and the number of variants (OR 1.552, 95% CI 1.099-2.222, p=0.015) were independent predictors for recurrence of AF. CONCLUSION: This study showed the common AF susceptibility alleles at 4q25 and ZFHX3 are associated with electroanatomical characteristics of the left atrium and the clinical outcomes of catheter ablation in Korean patients with AF.
Alleles ; Atrial Fibrillation* ; Catheter Ablation* ; Electrocardiography ; Heart Atria* ; Humans ; Phenotype ; Polymorphism, Single Nucleotide* ; Recurrence

Rhythm control therapy is the main strategy for restoring and maintaining sinus rhythm in patients with non-valvular atrial fibrillation (NVAF). Sinus rhythm is better restored and maintained with antiarrhythmic drugs than with placebo treatment. In addition, catheter ablation or combination therapy is more effective than antiarrhythmic drugs for treating NVAF. However, in most clinical trials to date, rhythm control therapy has resulted in neutral clinical outcomes compared with rate control therapy. The decision to undergo rhythm control therapy should be based on age, atrial fibrillation (AF)-related symptoms, type of AF, structural heart disease, and underlying comorbidities. For now, rhythm control therapy is indicated to improve symptoms in patients with NVAF who have refractory symptoms after adequate rate control therapy. The Korean Heart Rhythm Society organized the Korean AF Management Guideline Committee and analyzed all available data, including South Korean patients with NVAF. This review article provides general principles and detailed methodology for rhythm control therapy in South Korean patients with NVAF.
Anti-Arrhythmia Agents ; Atrial Fibrillation* ; Catheter Ablation ; Comorbidity ; Drug Therapy* ; Heart Diseases ; Heart* ; Humans

Rhythm control therapy is used in atrial fibrillation (AF) management to improve AF-related symptoms along with rate control. AF catheter ablation is effective in maintaining sinus rhythm and has an acceptable complication rate. Compared with antiarrhythmic drugs, AF catheter ablation is superior with respect to arrhythmia-free survival and improvement in the quality of life. Therefore, AF ablation is recommended for rhythm control after the failure of antiarrhythmic drugs and is sometimes considered a first-line therapy for AF patients. Radiofrequency and cryoballoon ablation show similar efficacy, with slightly different complication profiles. Surgery for AF is also an effective rhythm control therapy and should be considered in patients undergoing cardiac surgery or in those with failed catheter ablation. For patients undergoing AF catheter ablation, performing ablation under uninterrupted warfarin or non-vitamin K oral anticoagulant treatment is recommended for periprocedural stroke risk management. Here, we review existing data and discuss the general principles of AF catheter and surgical ablation in patients with AF.

PURPOSE: Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke, and 90% of thromboembolisms in these patients arise from the left atrial appendage (LAA). Recently, it has been documented that an LAA occlusion device (OD) is not inferior to warfarin therapy, and that it reduces mortality and risk of stroke in patients with AF. MATERIALS AND METHODS: We implanted LAA-ODs in 5 Korean patients (all male, 59.8+/-7.3 years old) with long-standing persistent AF or permanent AF via a percutaneous trans-septal approach. RESULTS: 1) The major reasons for LAA-OD implantation were high risk of recurrent stroke (80%), labile international neutralizing ratio with hemorrhage (60%), and 3/5 (60%) patients had a past history of failed cardioversion for rhythm control. 2) The mean LA size was 51.3+/-5.0 mm and LAA size was 25.1x30.1 mm. We implanted the LAA-OD (28.8+/-3.4 mm device) successfully in all 5 patients with no complications. 3) After eight weeks of anticoagulation, all patients switched from warfarin to anti-platelet agent after confirmation of successful LAA occlusion by trans-esophageal echocardiography. CONCLUSION: We report on our early experience with LAA-OD deployment in patients with 1) persistent or permanent AF who cannot tolerate anticoagulation despite significant risk of ischemic stroke, or 2) recurrent stroke in patients who are unable to maintain sinus rhythm.
Aged ; Anticoagulants/contraindications ; Atrial Appendage/*physiopathology ; Atrial Fibrillation/epidemiology/*physiopathology/*surgery ; Humans ; Male ; Middle Aged ; Risk Factors ; *Septal Occluder Device ; Stroke/epidemiology/*prevention & control ; Treatment Outcome ; Warfarin/contraindications

PURPOSE: The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction. MATERIALS AND METHODS: Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared. RESULTS: The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p = 0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R) than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02]. CONCLUSION: In patients with SND and intact AV conduction, AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction.
Aged ; Atrial Fibrillation/complications/physiopathology ; Atrioventricular Node/*physiopathology ; Cardiac Pacing, Artificial ; Cohort Studies ; Female ; Follow-Up Studies ; Heart Failure/complications ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Sick Sinus Syndrome/*physiopathology ; Treatment Outcome

PURPOSE: Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD. MATERIALS AND METHODS: Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography. RESULTS: ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57+/-13% vs. 62+/-13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001). CONCLUSION: ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.
Aged ; Arrhythmias, Cardiac/physiopathology ; Cicatrix/*physiopathology ; Coronary Artery Disease/*pathology/*physiopathology ; Death, Sudden, Cardiac/pathology ; Female ; Heart Conduction System/abnormalities/physiopathology ; Humans ; Male ; Middle Aged ; Myocardium/*pathology ; Prognosis