No abstract available.
Electrocardiography, Ambulatory*

A 41-year-old male was presented with drug-resistant supraventricular tachycardia. Electrophysiological study confirmed that the supraventricular tachycardia was caused by dual atrioventricular nodal pathways and a left lateral accessory pathway (AP). The left lateral AP was resistant to traditional endocardial ablation, but was successfully eliminated by radiofrequency ablation via the intracoronary sinus approach.
Accessory Atrioventricular Bundle ; Catheter Ablation ; Humans ; Male ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular

Flecainide acetate is a potent class IC anti-arrhythmic drug with a major sodium channel blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse. It may also result in life-threatening arrhythmia, although cases of flecainide-induced torsades de pointes are rare. Furthermore, the electrical and hemodynamic deteriorations observed during flecainide toxicity may not respond to conventional treatments. In the present study, we report the case of a 20-year-old Korean man with flecainide poisoning, who presented with hypotension. The patient was successfully treated with sodium bicarbonate, amiodarone, MgSO₄, and lidocaine, with no recourse to extracorporeal therapy. Although there is no standard therapy for flecainide toxicity, this report demonstrates that intensive pharmacological treatment is beneficial in cases of flecainide overdose.
Amiodarone ; Arrhythmias, Cardiac ; Drug-Related Side Effects and Adverse Reactions ; Flecainide ; Hemodynamics ; Humans ; Hypotension ; Lidocaine ; Poisoning ; Shock ; Sodium Bicarbonate ; Sodium Channels ; Torsades de Pointes* ; Young Adult

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

No abstract available.
Ductus Arteriosus, Patent* ; Imaging, Three-Dimensional*

Wolff-Parkinson-White (WPW) syndrome is a relatively common electrical disorder showing paroxysmal supraventricular tachycardia. However, the familial form of WPW syndrome is rare, and is usually inherited as a Mendelian autosomal dominant trait. Here, we describe a family where a father and son both showed WPW syndrome. Their conditions were treated with radiofrequency ablation.
Catheter Ablation* ; Fathers* ; Humans ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality in coronary angiography. Although the mechanism is unclear, N-acetylcysteine (NAC) is known to protect against CIN. Preliminary studies with NAC have found conflicting results for the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC for the prevention of CIN in patients undergoing coronary angiography. SUBJECTS AND METHODS: 48 patients with chronic renal insufficiency (mean [+/-SD] serum creatinine concentration, 2.06+/-0.56 mg/dL), who were undergoing coronary angiography with a nonionic, low-osmolar contrast agent, were prospectively studied. Patients were randomly assigned to receive either the antioxidant, NAC (600 mg orally twice daily), and 0.45% saline intravenously (n=25), before and after administration of contrast agents, or saline only (n=23). The renal function parameters were assessed 48 hour before and after radiocontrast media administration. RESULTS: 14 of the 48 patients (29%) showed an increase in the 0.5 mg/dL serum creatinine concentration after 48 hours of contrast media administration: 4 of the 25 patients in the NAC group (16%) and 10 of the 23 in the control group (43%; p=0.036; relative risk, 0.37; 95% confidence interval, 1.04 to 7.79). In the NAC group, the mean serum creatinine concentration insignificantly increased (p=0.54), from 2.2+/-0.8 to 2.3+/-0.9 mg/dL, after 48 hours of contrast media administration; whereas, in the control group, the mean serum creatinine concentration significantly increased (p=0.011), from 1.9+/-0.4 to 2.2+/-0.8 mg/dL. The absolute change in serum creatinine concentration was significantly greater in the control than the NAC group (p=0.044). CONCLUSION: Prophylactic oral administration of the antioxidant NAC, along with hydration, prevents the decrease in the renal function induced by a nonionic, low-osmolality contrast agent in patients with chronic renal insufficiency.
Acetylcysteine* ; Administration, Oral ; Contrast Media ; Coronary Angiography* ; Creatinine ; Humans ; Mortality ; Prospective Studies ; Renal Insufficiency, Chronic

BACKGROUND/AIMS: Invasive coronary angiography remains the gold standard in the diagnosis of coronary artery disease. However, multidetector CT (MDCT) coronary angiography is an emerging technique that is available for the non-invasive detection of coronary artery stenoses. While the diagnostic accuracy of first generation MDCT is limited, recently released 64-slice MDCT has yielded promising results due to increased temporal and spatial resolution. The objective of this study was to investigate the diagnostic accuracy of non-invasive 64-slice MDCT for coronary artery disease. METHODS: One hundred one patients (63 males and 38 females; mean age, 63.7+/-10.5 years) undergoing conventional coronary angiography were included in this study. All coronary arteries, including the distal segments and side branches, were analyzed for the presence of significant stenosis (> or =50% diameter stenosis) and compared with of the quantitative coronary angiographic findings. RESULTS: Of the 1,440 coronary artery segments studied, 1,348 segments were assessed quantitatively by both MDCT and conventional coronary angiography (94%). Two hundred nine significant stenoses were detected by conventional coronary angiography. On a segment-based analysis, the senisitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. On a vessel-based analysis, the sensitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. The corresponding values obtained on a patient-based analysis were 100, 94, 97, and 100%, respectively. Coronary calcification was the major cause of false-positive findings. CONCLUSIONS: This study demonstrated that 64-slice MDCT coronary angiography is of similar accuracy as conventional coronary angiography for the detection of coronary artery disease. In selected groups of patients, 64-slice MDCT may replace the more invasive coronary angiography.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Male ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) is the leading cause of death in postmenopausal women, and exercise echocardiography was reported to be a useful noninvasive test for diagnosis of CAD and risk-stratification in the era of fundamental echocardiographic imaging. This study was performed to determine whether normal findings on exercise echocardiography using advanced imaging equipments such as harmonic imaging provide useful data on prognosis in postmenopausal women with chest pain. METHOD: The study population consisted of 102 patients with postmenopausal women who were proven to be normal on exercise echocardiography from August 1997 to January 1999. Patients were followed up for a mean duration of 3.5 years. These patients were classified into 3 groups on existence of risk factors; low-risk, moderate-risk, high-risk. End points during follow-up were all-cause mortality and cardiac events (cardiac death, nonfatal myocardial infarction and coronary revascularization). We studied the prognostic value of exercise echocardiography in 102 patients of postmenopausal women with chest pain (mean age 59+/-6 years). RESULT: Of these 102 patients, 1 patient (0.1%) among the high-risk group underwent coronary revascularization and 2 patients (1.9%) among low- and moderate-risk group died of non-cardiac reasons. No cardiac deaths or nonfatal myocardial infarction were reported. According to risk group classification, there was no difference in major adverse cardiac events between each risk groups. ST segment change on exercise electro-cardiography was observed in 7 patients (7%). CONCLUSION: Normal results on exercise echocardiography using harmonic imaging in postmenopausal women with chest pain is a good method of predicting long-term prognosis.
Cause of Death ; Chest Pain ; Classification ; Coronary Artery Disease ; Death ; Diagnosis ; Echocardiography* ; Female ; Follow-Up Studies ; Humans ; Mortality ; Myocardial Infarction ; Prognosis ; Risk Factors

BACKGROUND AND OBJECTIVES: Arterial stiffness and wave reflections increase with advancing age, and the systolic and pulse pressures are elevated. These changes in aortic stiffness and pulse wave velocity with aging may change the cardiac function. The diastolic function of the left ventricle declines with aging even in normal healthy subjects too. This investigation was designed to assess the correlations between the left ventricular diastolic function and arterial stiffness with using echocardiography including doppler tissue imaging (DTI) and an applanation tonometer. SUBJECTS AND METHODS: The subjects were 100 healthy volunteers who had normal left ventricular systolic function and no major cardiovascular risk factors such as hypertension, hypercholesterolemia, diabetes, obesity and smoking. The left ventricular diastolic function was assessed with the mitral inflow indexes and DTI, and the pulmonary venous return was measured by echocardiography. The central aorta blood pressure, the augmentation index (AIx) and the pulse wave velocity (PWV) were evaluated by using an applanation tonometer (SphygmoCoR system). RESULTS: With advancing age, the left mitral E/A ratio decreased (r=-.738, p<0.05) and the DTI early/late diastolic velocity (E'/A') ratio decreased (r=-.759, p<0.05), which showed a significant change of the left ventricular diastolic function. The Aix (r=.406, p<0.05) and PWV (r=.614, p<0.05) increased with aging. The PWV correlated significantly with the E/A ratio (r=-.593, p<0.05) and the E'/A' ratio (r=-.559, p<0.05). CONCLUSION: This study showed that increases of the large conduit vessel stiffness with aging are associated with a decline of the left ventricular diastolic function in healthy subjects.
Aging ; Aorta ; Atherosclerosis ; Blood Flow Velocity ; Blood Pressure ; Diastole ; Echocardiography ; Healthy Volunteers ; Heart Ventricles ; Humans ; Hypercholesterolemia ; Hypertension ; Obesity ; Pulse Wave Analysis ; Risk Factors ; Smoke ; Smoking ; Vascular Stiffness*