1.Delayed Sealing of WATCHMAN Device Shunt.
Young Ah PARK ; Jung Sun KIM ; Hui Nam PAK
International Journal of Arrhythmia 2017;18(1):62-65
Although left atrial appendage closure is an alternative to warfarin use in atrial fibrillation patients with a high bleeding risk, long-term outcome data in real-world practice are still limited. We describe a delayed shunt on the WATCHMAN fabric membrane and associated stroke at 7 months after the procedure. This shunt on the device surface disappeared at 15 months on the follow-up transesophageal echocardiogram.
Anticoagulants
;
Atrial Appendage
;
Atrial Fibrillation
;
Follow-Up Studies
;
Hemorrhage
;
Humans
;
Membranes
;
Stroke
;
Warfarin
2.Where We Can Find Bypass Tract in Ebstein's Anomaly?; a Case of Successful Ablation of Bypass Tract in Ebstein's Anomaly.
International Journal of Arrhythmia 2017;18(1):57-61
In patients with Ebstein's anomaly, the localization of accessory pathways may be impeded by abnormal local electrograms recorded along the atrialized right ventricle and by the presence of multiple accessory pathways. We report a case of 50-year-old man diagnosed with Ebstein's anomaly with Wolff-Parkinson-White syndrome who presented with recurrent palpitations. He was referred to our institution for radiofrequency catheter ablation of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed the tricuspid valve displaced into the right ventricle, consistent with Ebstein's anomaly. The electrophysiology study showed a right posterolateral accessory pathway. The optimal ablation site was located not in the atrioventricular line of the atrialized ventricular portion, but in the original atrioventricular line.
Accessory Atrioventricular Bundle
;
Catheter Ablation
;
Ebstein Anomaly*
;
Echocardiography
;
Electrophysiology
;
Heart Ventricles
;
Humans
;
Middle Aged
;
Tachycardia, Supraventricular
;
Tricuspid Valve
;
Wolff-Parkinson-White Syndrome
3.Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure.
International Journal of Arrhythmia 2017;18(1):54-56
No abstract available.
Defibrillators*
;
Heart Failure, Systolic*
;
Humans
4.Supraventricular Tachycardia in Special Population.
International Journal of Arrhythmia 2017;18(1):48-53
Medical and catheter-based ablation therapies have been successfully applied in treating supraventricular tachycardia, supported by abundant evidences from clinical trials. However, Special populations such as pediatric populations, pregnant patients, or patients with congenital heart diseases are easily excluded from clinical trials; thus, caution is needed when adopting results from clinical trials conducted in the usual adult population.
Adult
;
Heart Defects, Congenital
;
Heart Diseases
;
Humans
;
Pediatrics
;
Pregnancy
;
Tachycardia, Supraventricular*
5.Ondansetron Inhibits Voltage-Gated K⁺ Current of Ventricular Myocytes from Pregnant Mouse.
Shanyu CUI ; Hyewon PARK ; Hyelim PARK ; Dasom MUN ; Hyo Eun KIM ; Nuri YUN ; Boyoung JOUNG
International Journal of Arrhythmia 2017;18(2):77-84
BACKGROUND: The Htr3a antagonist, ondansetron, has been reported to prolong the QT interval and induce Torsades de pointes in the treatment of postoperative nausea and vomiting. To explore the mechanisms underlying these findings, we examined the effects of ondansetron on the mouse cardiac voltage-gated K⁺ (Kv) channel. METHODS AND RESULTS: Ondansetron increased QT intervals in late pregnant (LP) mice. We measured the Kv channels in freshly isolated left ventricular (LV) myocytes from non-pregnant (NP) and late pregnant (LP) mice, using patch-clamp electrophysiology. Ondansetron blocked Kv current at a dose of 50 µM, and reduced the amplitude of peak current densities in a dose-dependent manner (0, 1, 5, 50 µM), in LP but not in NP mice. In contrast, serotonin and the Htr3 agonist, m-CPBG, increased Kv current densities in NP, but not in LP mice. Interestingly, during pregnancy, serum serotonin levels were markedly increased, suggesting the saturation of the effect of serotonin. Immunostaning data showed that Kv4.3 protein and Htr3a co-localize at the membrane and t-tubule of cardiomyocytes. Moreover, Kv4.3 membrane trafficking was enhanced in response to Htr3a-mediated serotonin stimulation in NP, but not in LP mice. Membrane analysis showed that serotonin enhances Kv4.3 membrane trafficking in NP, but not LP mice. CONCLUSION: Ondansetron reduced Kv current densities, and reduced the Kv4.3 membrane trafficking in LP mouse ventricular cardiomyocytes. This data suggests that QT prolongation by ondansetron is mediated by the reduction of Kv current densities and Kv4.3 membrane trafficking.
Animals
;
Electrophysiology
;
Membranes
;
Mice*
;
Muscle Cells*
;
Myocytes, Cardiac
;
Ondansetron*
;
Postoperative Nausea and Vomiting
;
Pregnancy
;
Serotonin
;
Torsades de Pointes
6.Treatment of Tachycardia and Bradycardia in a Persistent Left Superior Vena Cava Patient Who Underwent Warden's Procedure and Tricuspid Annuloplasty.
International Journal of Arrhythmia 2016;17(1):69-73
53-year-old female was admitted to our institution with alternating atrial flutter and junctional bradycardia. The patient had undergone the Warden procedure to correct sinus venosus type atrial septal defect combined with partial anomalous pulmonary venous return, and ring tricuspid annuloplasty for severe tricuspid regurgitation. She also had persistent left superior vena cava (PLSVC). With the assistance of a 3D electroanatomic mapping system, catheter ablation therapy was used successfully to treat atrial flutter associated with a channel in the right atrial scar, and a pacemaker was implanted through the PLSVC because of resulting symptomatic bradycardia.
Atrial Flutter
;
Bradycardia*
;
Cardiac Surgical Procedures
;
Catheter Ablation
;
Cicatrix
;
Female
;
Heart Defects, Congenital
;
Heart Septal Defects, Atrial
;
Humans
;
Middle Aged
;
Pacemaker, Artificial
;
Scimitar Syndrome
;
Tachycardia*
;
Tricuspid Valve Insufficiency
;
Vena Cava, Superior*
7.Pitfalls of Atrial Advancement Using a Ventricular Extra-stimulus During Supraventricular Tachycardia.
Jeong Wook PARK ; Sung Hwan KIM ; Yong Seog OH ; Chun HWANG
International Journal of Arrhythmia 2016;17(1):64-68
The delivery of single His-refractory ventricular extra-stimulus during supraventricular tachycardia is useful to identify the mechanism of the tachycardia. We present the different responses based on the ventricular extra-stimulus site. Our findings demonstrate that the atrial activation via an accessory pathway was not advanced based on the ventricular pacing site. Therefore, atrioventricular tachycardia could masquerade as atrioventricular nodal reentrant tachycardia.
Tachycardia
;
Tachycardia, Atrioventricular Nodal Reentry
;
Tachycardia, Supraventricular*
8.Management of Aborted Sudden Cardiac Arrest with J Wave Syndrome.
International Journal of Arrhythmia 2016;17(1):60-63
We report the case of a 19-year-old male who successfully recovered from sudden cardiac arrest. Careful evaluation did not reveal any electrical or structural abnormalities. He underwent implantable cardioverter defibrillator (ICD) implantation, with a diagnosis of idiopathic ventricular fibrillation (VF). Three months later, VF recurred and was successfully terminated by ICD shock. Electrocardiogram (ECG) revealed a slurred type J point elevation at the inferolateral leads with a horizontal/descending ST segment change, which was not present during the initial hospitalization. Cilostazol was prescribed to prevent further lethal ventricular arrhythmias. Subsequently, no arrhythmic events were reported, and the J wave disappeared at the follow-up ECG. However, recurrent VF episodes with an interval of 1–2 weeks occurred 1 year later, and were terminated by ICD shock. Simultaneous ECG revealed a J point elevation at the inferolateral leads. Cilostazol was replaced by quinidine. Subsequently, no arrhythmic event recurred for over 12 months. Serial follow-up ECG is needed to identify masked inherited primary arrhythmic syndromes in sudden cardiac arrest survivors diagnosed with idiopathic VF. Cilostazol and quinidine might be good therapeutic options to prevent further lethal events in cases where the J wave syndrome is present with recurrent ventricular arrhythmias.
Anti-Arrhythmia Agents
;
Arrhythmias, Cardiac
;
Death, Sudden, Cardiac*
;
Defibrillators
;
Diagnosis
;
Electrocardiography
;
Follow-Up Studies
;
Heart Arrest
;
Hospitalization
;
Humans
;
Male
;
Masks
;
Quinidine
;
Shock
;
Survivors
;
Ventricular Fibrillation
;
Young Adult
9.Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation.
International Journal of Arrhythmia 2016;17(1):56-59
No abstract available.
Atrial Fibrillation*
;
Humans
10.Peri-procedural Management of Anticoagulation Therapy (cataract eye surgery, dental procedure and gastrointestinal endoscopy).
International Journal of Arrhythmia 2016;17(1):51-55
Anticoagulation therapy is widely used to prevent thromboembolism in patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves. The temporary interruption of anticoagulants is common to reduce the bleeding risk during peri-procedures. Traditionally, warfarin was held for several days before procedures with heparin bridging therapy. However, recent data showed that stopping warfarin was not necessary before procedures with a low bleeding risk, such as a gastrointestinal endoscopy, cataract eye surgery, and dental procedures when the thromboembolic risk of the patient is moderate-to-high. This review article outlines the estimation of the thromboembolic and bleeding risk before procedures, and determines the timing of anticoagulant interruption.
Anticoagulants
;
Atrial Fibrillation
;
Cataract
;
Endoscopy
;
Endoscopy, Gastrointestinal
;
Heart Valves
;
Hemorrhage
;
Heparin
;
Humans
;
Thromboembolism
;
Tooth Extraction
;
Venous Thromboembolism
;
Warfarin