Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.
Atrial Fibrillation ; Atrial Flutter* ; Female ; Humans ; Male

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

A 50 year old female presented unusual electrocardiographic changes including AV block, accelerated idioventricular rhythm, ventricular premature systole with severe fluctuation of blood pressure and clinical features of angina pectoris. Deep ST segment depression was demonstrated in spite of the normal coronary arteriogram and the negative coronary artery spasm study. Urinary excretion of catecholamines and their metabolites were elevated and a huge pheochromocytoma was found in the left adrenal glandd. After removal of the pheochromocytoma, the electrocardiographic abnormalities and the blood pressure were normalized and teh aptient became asymptomatic.
Accelerated Idioventricular Rhythm ; Angina Pectoris* ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Catecholamines ; Coronary Vessels ; Depression ; Electrocardiography* ; Female ; Humans ; Middle Aged ; Pheochromocytoma* ; Spasm ; Systole

Primary tumors of the heart are rare and the most are benign. Malignant tumors constitute less than 25% of primary cardiac tumors and angiosarcomas are the most commonly reported histologic type. At least 160 cases have been reported in the world, but no previous report in Korea. We reported a case of primary cardiac angiosarcoma located in right atrium.
Heart ; Heart Atria ; Heart Neoplasms ; Hemangiosarcoma* ; Korea

Dextrocardia with situs inversus is a rare congenital anomaly of development involving a left-handed malrotation of the visceral organs which affects approximately 1:10,000 patients. It is known that the prevalence of coronary atherosclerosis in patients with dextrocardia is similar to that of the general population. Successful coronary angiography and coronary angioplasty have previously been reported in patients with dextrocardia, but to our knowledge no report exist of a successful coronary angioplasty in a patient with dextrocardia with situs inversus in Korea. We performed a successful percutaneous transluminal coronary angioplasty of an infarct-related vessel in a acute myocardial infarction patient with dextrocardia with situs inversus.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease ; Dextrocardia* ; Humans ; Korea ; Myocardial Infarction ; Prevalence ; Situs Inversus*

BACKGROUND/AIMS: The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. METHODS: Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. RESULTS: The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). CONCLUSIONS: In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.
Aged ; Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Cardiovascular Agents/administration & dosage ; Chi-Square Distribution ; Coronary Angiography ; Coronary Artery Disease/mortality/radiography/*therapy ; Coronary Restenosis/etiology/mortality ; Coronary Thrombosis/etiology/mortality ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology/mortality ; Paclitaxel/*administration & dosage ; Propensity Score ; Prosthesis Design ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stainless Steel ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM. METHODS: We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value > or = 240. RESULTS: The mean PRU values were 233.5 +/- 83.2 and 190.3 +/- 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 +/- 82.4 vs. 210.8 +/- 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 +/- 82.5 vs. 247.9 +/- 81.1, p = 0.044). CONCLUSIONS: A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.
Aged ; Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Aspirin/administration & dosage ; Chi-Square Distribution ; Coronary Disease/blood/*therapy ; Diabetes Mellitus, Type 2/*blood ; Drug Therapy, Combination ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Platelet Activation/*drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; *Platelet Function Tests ; *Point-of-Care Systems ; Predictive Value of Tests ; Purinergic P2Y Receptor Antagonists/*administration & dosage/adverse effects ; Registries ; Republic of Korea ; Risk Assessment ; Risk Factors ; *Stents ; Tetrazoles/*administration & dosage/adverse effects ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives ; Treatment Outcome

Limited data are available on the long-term clinical efficacy of drug-eluting stent (DES) in diffuse long lesions. From May 2006 to May 2007, a total of 335 consecutive patients (374 lesions) were underwent percutaneous coronary intervention with implantation of long DES (> or = 30 mm) in real world practice. Eight-month angiographic outcomes and 2-yr clinical outcomes were compared between SES (n = 218) and PES (n = 117). Study endpoints were major adverse cardiac events including cardiac death, myocardial infarction, target-lesion revascularization, target-vessel revascularization and stent thrombosis. Baseline characteristics were similar in the two groups as were mean stent length (44.9 +/- 15.2 mm in SES and 47.4 +/- 15.9 in PES, P = 0.121). Late loss at 8 months follow-up was significantly lower in SES than in PES group (0.4 +/- 0.6 mm in SES vs 0.7 +/- 0.8 mm in PES, P = 0.007). Mean follow-up duration was 849 +/- 256 days, and 2-yr cumulative major adverse cardiac events were significantly lower in the SES than in the PES group (5.5% in SES vs 15.4% in PES, P = 0.003). In conclusion, long-term DES use in diffuse long coronary lesions is associated with favorable results, with SES being more effective and safer than PES in this real-world clinical experience.
Aged ; Aged, 80 and over ; Coronary Angiography ; Coronary Artery Disease/*therapy ; *Drug-Eluting Stents/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel/*administration & dosage/adverse effects ; Sirolimus/*administration & dosage/adverse effects ; Treatment Outcome