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Where is the Lead? Inappropriate Implantable Cardioverter-Defibrillator Shock Caused by Extreme Twiddling.

International Journal of Arrhythmia.2016;17(4):227-230. doi:10.18501/arrhythmia.2016.039

A 43-year-old man who had received mitral and aortic valve replacement surgery underwent the implantation of an implantable cardioverter defibrillator (ICD) for sustained ventricular tachycardia. The patient presented with a sudden jolting sensation in his left upper chest area one year after the device implantation. He had a history of vigorous upper body exercise during the several months of the follow-up period. Device interrogation revealed complete sensing and capture failure. The ventricular lead impedance was in the normal range, but the high voltage impedance had dropped to less than 10 Ω. Four inappropriate shocks for ventricular fibrillation had been delivered due to over-sensing of the atrial signal on the ventricular lead. Chest radiography showed ventricular lead displacement with extreme rotation and flipping-over of the generator. In the lead revision operation, the old ventricular lead was extracted and replaced, and the generator was fixed more deeply in the pocket with a non-absorbable ligature.
Adult ; Aortic Valve ; Defibrillators ; Defibrillators, Implantable* ; Electric Impedance ; Follow-Up Studies ; Humans ; Ligation ; Radiography ; Reference Values ; Sensation ; Shock* ; Tachycardia, Ventricular ; Thorax ; Ventricular Fibrillation

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Radiofrequency Ablation of Recurrent Ventricular Premature Complex Originating from near Left Ventricular Summit Guided by Intracardiac Echocardiography.

Hye Bin GWAG ; Kyoung Min PARK

International Journal of Arrhythmia.2016;17(4):223-226. doi:10.18501/arrhythmia.2016.038

A 40-year-old man presented with frequent ventricular premature complexes (VPCs) and left ventricular systolic dysfunction. He underwent radiofrequency (RF) ablation using a 3-dimensional mapping system; the ablation was performed from both the right and left outflow tract septa. Improvement in symptoms and left ventricular systolic function was noted, but VPCs recurred one month after the procedure, and 24-hour Holter monitoring revealed a VPC burden of 26%. Direct visualization of the anatomical details, catheter contact, and transmural lesion formation by intracardiac echocardiography allowed for successful performance of a redo RF ablation with higher power and longer duration at the previous ablation sites.
Adult ; Catheter Ablation* ; Catheters ; Echocardiography* ; Electrocardiography, Ambulatory ; Humans ; Ventricular Premature Complexes*

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Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation.

Gi Byoung NAM

International Journal of Arrhythmia.2016;17(4):220-222. doi:10.18501/arrhythmia.2016.037

No abstract available.
Atrial Fibrillation* ; Catheter Ablation*

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Management of Atrial Flutter.

Chan Hee LEE

International Journal of Arrhythmia.2016;17(4):214-219. doi:10.18501/arrhythmia.2016.036

Atrial flutter is a macro-reentrant atrial arrhythmia characterized by regular atrial rate and constant P-wave morphology. The atrial flutter is divided into typical and atypical types, according to whether reentrant circuit involves the cavotricuspid isthmus. This review summarizes the management of atrial flutter based on 2015 ACC/AHA/HRS guideline.
Arrhythmias, Cardiac ; Atrial Flutter* ; Catheter Ablation

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Non Sinus Focal Atrial Tachycardia.

Yong Giun KIM

International Journal of Arrhythmia.2016;17(4):210-213. doi:10.18501/arrhythmia.2016.035

Non sinus focal atrial tachycardia (AT) is an uncommon arrhythmia. Electrocardiograms (ECGs) can be used to diagnose the condition. ECGs can also be used to pinpoint the origin of the focal AT; however, the precise location is ultimately confirmed by electrophysiology. Automaticity, triggered activity, and micro-reentry are possible underlying mechanisms for focal AT. Pharmacological therapy is recommended for symptomatic patients. Radiofrequency catheter ablation is a viable alternative, especially in patients intolerant to drugs, or patients with drug-refractory focal AT. This review describes the epidemiology, clinical features, diagnosis, and mechanisms of focal AT, as well as possible therapeutic approaches for this condition.
Arrhythmias, Cardiac ; Catheter Ablation ; Diagnosis ; Electrocardiography ; Electrophysiology ; Epidemiology ; Humans ; Tachycardia* ; Tachycardia, Ectopic Atrial

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Sinus Tachyarrhythmia.

Gu Hyun KANG

International Journal of Arrhythmia.2016;17(4):206-209. doi:10.18501/arrhythmia.2016.034

Sinus tachycardia is an accelerated rhythm in which the rate of impulses arising from the sinoatrial node is elevated. Uncontrolled sinus tachycardia may result in a poor prognosis, particularly in patients with cardiovascular disease, because of a hemodynamic disturbance arising from the tachycardia itself. When sinus tachycardia is specifically triggered by anemia, shock, or fever, it is referred to as physiological sinus tachycardia. Physiological sinus tachycardia should resolve with correction of the underlying cause. Inappropriate sinus tachycardia (IST) is unexplained by physiological demand. Palpitation is the most frequent symptom in IST patients. Even though treatment of IST has insufficient efficacy and a relatively high recurrence rate, several treatment strategies such as use of a β-blocker, ivabradine, and radiofrequency catheter ablation can be used for IST patients.
Anemia ; Arrhythmia, Sinus ; Cardiovascular Diseases ; Catheter Ablation ; Fever ; Hemodynamics ; Humans ; Prognosis ; Recurrence ; Shock ; Sinoatrial Node ; Tachycardia* ; Tachycardia, Sinus

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Paroxysmal Supraventricular Tachycardia: the General Principle.

Yoo Ri KIM

International Journal of Arrhythmia.2016;17(4):200-205. doi:10.18501/arrhythmia.2016.033

The best available evidence indicates that the prevalence of supraventricular tachycardia (SVT) in the general population is 2.29 per 1,000 persons. Women have twice the risk of developing paroxysmal supraventricular tachycardia (PSVT) compared to men. Individuals aged >65 years have >5 times the risk of developing PSVT compared to younger persons. Twelve-lead electrocardiograms (ECGs) obtained during both tachycardia and sinus rhythm may reveal the etiology and help diagnose SVT. It is important to conduct a 12-lead ECG to differentiate tachycardia mechanisms according to whether the atrioventricular (AV) node is an obligate component. Invasive electrophysiologic (EP) study and catheter ablation have become a standard treatment for SVT, in addition to being an acute medical treatment. Diagnostic EP study complications are rare, but can be life threatening.
Catheter Ablation ; Electrocardiography ; Female ; Humans ; Male ; Prevalence ; Tachycardia ; Tachycardia, Supraventricular*

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The Persistence of Non-Vitamin K Antagonist Oral Anticoagulants in Korean Patients with Non-Valvular Atrial Fibrillation.

Choong Sil SEONG ; Hye Bin GWAG ; Jin Kyung HWANG ; Seung Jung PARK ; Kyoung Min PARK ; June Soo KIM ; Young Keun ON

International Journal of Arrhythmia.2016;17(4):190-199. doi:10.18501/arrhythmia.2016.032

BACKGROUND AND OBJECTIVES: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), showing better efficacy and safety than warfarin. However, the rates or reasons for discontinuation of NOACs in clinical practice have not been clarified. The aim of this study was to compare 3 NOACs (apixaban, rivaroxaban, and dabigatran) with warfarin in terms of medication persistence. SUBJECTS AND METHODS: We retrospectively evaluated 1,527 patients with NVAF who had recently started taking NOACs between January 2012 and September 2015 (294 apixaban, 748 rivaroxaban, and 485 dabigatran) and compared them with 363 patients with NVAF who started taking warfarin between January 2012 and December 2013 at the Samsung Medical Center. RESULTS: The mean follow-up duration was 532 days. The discontinuation rates were higher in the 3 NOAC groups than in the warfarin group within the first year. The major causes of discontinuation were maintenance of sinus rhythm; adverse events, including all bleeding and gastrointestinal symptoms; and patients demand. The adverse event rate was lower in the warfarin group than in the 3 NOAC groups. No significant differences in thromboembolic and major bleeding events were found between the 3 NOAC groups and the warfarin group. CONCLUSION: In a single-center study, NOACs showed lower medication persistence and higher adverse event rates than warfarin during the first year.
Anticoagulants* ; Atrial Fibrillation* ; Follow-Up Studies ; Hemorrhage ; Humans ; Medication Adherence ; Retrospective Studies ; Rivaroxaban ; Stroke ; Treatment Outcome ; Warfarin

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Design of Korean Noninvasive Risk Evaluation Study for Sudden Cardiac Death from Infarction or Heart Failure: Heart failure study of K-REDEFINE registry.

Seung Jung PARK ; Gyo Seung HWANG ; Gi Byoung NAM ; Hyung Wook PARK ; Joong Wha CHUNG ; Seung Yong SHIN ; Sang Min KIM ; Jun Hyung KIM ; Young Soo LEE ; Yae Min PARK ; Jong Youn KIM ; Dae Hyeok KIM ; Dae kyeong KIM ; June NAMGUNG ; Dae Hee SHIN ; Joon Hyouk CHOI ; Hyoung Seob PARK ; Jong Il CHOI ; Jin Seok KIM ; Tae Joon CHA ; Sang Weon PARK ; Jae Sun UHM ; Nam Ho KIM ; Minsoo AHN ; Dong Gu SHIN ; Nuri JANG ; Meemo PARK ; June Soo KIM

International Journal of Arrhythmia.2016;17(4):181-189. doi:10.18501/arrhythmia.2016.031

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is one of the most common causes of death in patients with heart failure (HF). However, there are no available data on SCD in previous Korean HF registries. Additionally, although widely used, the utility of left ventricular (LV) ejection fraction (EF) in risk stratification for SCD is limited. SUBJECTS AND METHODS: The Korean non-invasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (KREDEFINE) is the first Korean prospective, nationwide multicenter registry, primarily focused on SCD. The registry consists of 2 groups of patients presenting with (1) acute HF or (2) acute myocardial infarction (MI) at 25 tertiary referral cardiovascular centers. Using the HF-group data of the K-REDEFINE registry, the incidence and risk factors of SCD in patients with HF will be assessed. In particular, the efficacy of Holter-based ECG variables, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/ variability (maker of autonomic function), in risk stratification for SCD will be evaluated. Other cardiovascular outcomes will also be analyzed, including atrioventricular arrhythmias, HF-related admission, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will pave the way for better management of patients with HF at high risk of SCD by elucidating the burden and risk factors of SCD and the clinical utility of various non-invasive ambulatory ECG-based parameters in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Cause of Death ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke

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Time Variance of Electrocardiographic Transmural Dispersion in Acute Myocardial Infarction.

Jin Sun PARK ; Gyo Seung HWANG ; Sun Mi KIM ; Kyoung Woo SEO ; Byoung Joo CHOI ; So Yeon CHOI ; Myeong Ho YOON ; Joon Han SHIN ; Seung Jea TAHK

International Journal of Arrhythmia.2016;17(4):174-180. doi:10.18501/arrhythmia.2016.030

BACKGROUND AND OBJECTIVES: The mechanism responsible for lethal ventricular arrhythmia (LVA) after acute myocardial infarction (AMI) remains unclear. SUBJECTS AND METHODS: The corrected QT interval (QTc) and interval from the peak to the end of the T wave (TpTe) were measured, which indicated myocardial transmural dispersion of repolarization (TDR) in 72 patients with AMI. TpTe was also expressed as a corrected value, [TpTe/QTe]x100% and TpTe/√RR. These parameters were obtained from all the 12-leads of electrocardiography after arrival at the hospital, just before and after percutaneous coronary intervention (PCI), and at 4, 24, and 48 hours and 5 days after PCI. RESULTS: Analyzing with repeated measures analysis of variance, the TpTe, [TpTe/QTe]x100% and TpTe/√RR after AMI showed significant changes in time variance. The patients were divided into LVA (17 patients, 24%) and non-LVA group (55 patients, 76%). The [TpTe/ QTe]×100% (V₂: 25±7% vs. 22±5%, p=0.036) and TpTe/√RR (V₂: 109 ± 42 ms vs. 88 ± 22 ms, p=0.05, V₃: 108±39 ms vs. 91±27 ms, p=0.048) in V₂ and V₃ leads were prolonged in the LVA group after PCI. The [TpTe/QTe]×100% (28±9 % vs. 22±5%, p=0.025) and TpTe/√RR (129±53 ms vs. 99±41 ms, p=0.05) in V₃ lead were prolonged in the LVA group 24 hours after PCI. CONCLUSION: The mechanisms responsible for LVA after AMI may be associated with increased TDR, and PCI may have an important role in reducing LVA.
Arrhythmias, Cardiac ; Electrocardiography* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

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