No abstract available.
Age Factors ; Aged ; Atrial Appendage/diagnostic imaging/*drug effects ; Atrial Fibrillation/complications/diagnostic imaging/*drug therapy ; Echocardiography, Doppler, Color ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Factor Xa Inhibitors/*therapeutic use ; Female ; Humans ; Pyrazoles/*therapeutic use ; Pyridones/*therapeutic use ; Thrombosis/diagnostic imaging/etiology/*prevention & control ; Treatment Outcome

Treatment of cardiac disease via the epicardium fell under the domain of cardiac surgery due to the need for an open thoracotomy. Since an open thoracotomy is invasive in nature and has the potential for complications, a minimally invasive and percutaneous approach would be more attractive for suitable patients. The recent success of epicardial ablation of refractory arrhythmia via the percutaneous pericardial approach has increased the potential for delivery of epicardial therapies. Epicardial ablation has increased the success and safety since anti-coagulation and transseptal catheterization for left atrial arrhythmias is not required. The pericardial space has also been used to deliver therapy for several cardiac diseases. There are reports on successful delivery of drugs and their efficacy. Even though there was a wide range of efficacies reported in those studies, the reported complication rates are strikingly low, which suggests that direct delivery of drugs to the epicardium via the pericardial space is safe. Furthermore, recent animal studies have supported the feasibility of epicardial delivery of biological agents, including genes, cells, and even genetically engineered tissue for therapeutic purposes. In conclusion, percutaneous pericardial cannulation of closed pericardial space can play a significant role in providing non-surgical therapy for cardiovascular diseases. However, it requires skills and operator experiences. Therefore, there is need to further develop new tools, safer techniques, and effective procedure environment before generalizing this procedure.
Animals ; Arrhythmias, Cardiac ; Biological Agents ; Cardiovascular Diseases ; Catheterization ; Catheters ; Drug Administration Routes ; Heart Diseases ; Humans ; Pericardium ; Thoracic Surgery ; Thoracotomy

Implantable cardioverter-defibrillators (ICDs) are an effective treatment strategy for patients with aborted sudden cardiac death (SCD) and ventricular tachyarrhythmias. rimary prevention of SCD is a strategy involving the use of ICDs in patients who are at high risk for, but have not had, any previous events of ventricular arrhythmias or cardiac arrest. Several randomized clinical trials have demonstrated the efficacy of ICDs in the primary prevention of SCD. Therefore, ICD implantation is recommended as a standard of care by the guidelines in patients who have ischemic or nonischemic cardiomyopathy and a low left ventricular ejection fraction. However, the rates of ICD implantation as a primary prevention in Korea is quite low compared to western countries. In this review, we will summarize the results and efficacy of ICDs in the clinical trials about primary prevention of SCD, the current treatment guidelines, and the reimbursement policy of Korean health insurance. We hope that this review will help broaden the recognition of importance of ICD implantation for the primary prevention of SCD.
Arrhythmias, Cardiac ; Cardiomyopathies ; Death, Sudden, Cardiac* ; Defibrillators, Implantable* ; Heart Arrest ; Hope ; Humans ; Insurance, Health ; Korea ; Primary Prevention* ; Standard of Care ; Stroke Volume ; Tachycardia

The efficacy and safety of catheter ablation for the management of atrial fibrillation (AF) has been improved in recent years. Radiofrequency (RF) catheter ablation for maintaining sinus rhythm is superior to the current antiarrhythmic drug therapy in selected patients. Pulmonary vein isolation (PVI) is the cornerstone of various catheter ablation strategies. It is well recognized that pulmonary vein (PV) antrum contributes to the AF initiation and/or perpetuation. Since PV stenosis is a complication of ablation within a PV, the ablation site for PVI has shifted to the junction between the left atrium and the PV rather than the ostium of the PV. However, PV reconnection after ablation is the major cause of recurrence of AF. The recovery of PV conduction could be caused by anatomical variations such as the failure to produce complete transmural lesion or gaps at the ablation line due to the transient electrophysiologic effects from the RF ablation. In this review, we discussed several factors to be considered for the achievement of the best PVI, including clinical aspects and technical aspects.
Atrial Fibrillation ; Catheter Ablation ; Constriction, Pathologic ; Drug Therapy ; Heart Atria ; Humans ; Pulmonary Veins* ; Recurrence

A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia. We report on a middle-aged, female patient presented with wide QRS tachycardia. The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system. We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.
Bundle of His ; Bundle-Branch Block* ; Female ; Humans ; Purkinje Fibers ; Tachycardia ; Tachycardia, Supraventricular* ; Tachycardia, Ventricular

No abstract available.
Atrial Fibrillation* ; Humans ; Korea*

PURPOSE: To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. METHODS: Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. RESULTS: A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). CONCLUSIONS: Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.
Adolescent ; Adult ; Eye Movements/*physiology ; *Facial Expression ; Female ; Humans ; Male ; Oculomotor Muscles/*physiopathology/surgery ; Ophthalmologic Surgical Procedures ; Retrospective Studies ; *Self Concept ; Strabismus/physiopathology/*psychology/surgery

The peri-stent vascular changes after 2nd generation drug-eluting stent (2G DES) implantation have not been fully investigated compare to 1st generation DES (1G DES). From March 2003 to October 2010, patients receiving percutaneous coronary intervention (PCI) with either 1G or 2G DES were retrospectively included. All patients underwent intravascular ultrasound (IVUS) at post-procedure and 8-12 months after PCI. A total of 281 patients (1G DES: 201 patients with 217 lesions and 2G DES: 80 patients with 88 lesions) were enrolled. The incidence of positive peri-stent vascular remodeling (PPVR) and late-acquired incomplete stent apposition (LAISA) were investigated by IVUS images. Major adverse cardiac events (MACE) up to 3 years were also evaluated. The lesion and the stent length were shorter, and the stent size was larger in the 2G DES group. The incidences of PPVR and LAISA were lower in the 2G DES group before and after propensity score matching. However, the incidence of 3-year MACE were not different between the two groups. Independent predictors for PPVR or LAISA were stent length and 1G DES implantation. These results suggested that biocompatible stent system in 2G DES might have reduced peri-stent vascular changes.
Drug-Eluting Stents* ; Humans ; Incidence ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Propensity Score ; Retrospective Studies ; Stents* ; Ultrasonography*

No abstract available.
Defibrillators ; Defibrillators, Implantable* ; Jugular Veins*

Background: The muscular discontinuities or lack of myocardial extensions around the pulmonary veins (PVs) antrum were previously reported. The objective of our study was to compare the efficacy of a partial antral ablation for PV iso‑ lation (PVI) using ultra-high density (UHD) mapping with a conventional wide antral circumferential ablation (WACA) in atrial fibrillation (AF) patients. Methods: A total of 119 patients medical records who received catheter ablation for AF in our hospital were ana‑ lyzed. In one group of patients, detailed activation mapping of each PV was performed using a UHD mapping system.Each PV antral segment’s activation pattern was classified into “directly-activated from the LA” or “passively-activated from an adjacent PV segment” patterns. The ablation applications were performed at the directly-activated PV antral segment only for the PVI when the PV had “passively-activated segments” (partial antral ablation; PA-UHD group).Another patient group received a conventional WACA for the PVI (WACA group). Results: Sixty patients received partial antral ablation (PA-UHD), and age/sex-matched 59 patients received WACA.In the PA-UHD group, passively-activated segments were observed in 58.3% of all PV segments. The success rate of a partial antral ablation for the PVI in PVs with passively-activated segments was 85%. The 1-year atrial tachyarrhyth‑ mia recurrence did not differ between the PA-UHD and WACA groups. Conclusions Our study revealed the presence of passively-activated PV segments, which could potentially indicate muscular discontinuity at the PV-LA junction. In most PVs with passively-activated segments, PVI was successfully achieved by ablation with only directly-activated segments. The 1-year recurrence rate of atrial tachyarrhythmia in PAUHD group was comparable to that observed in the WACA group.