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Delayed Sealing of WATCHMAN Device Shunt.

Young Ah PARK ; Jung Sun KIM ; Hui Nam PAK

International Journal of Arrhythmia.2017;18(1):62-65. doi:10.18501/arrhythmia.2017.010

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

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Where We Can Find Bypass Tract in Ebstein's Anomaly?; a Case of Successful Ablation of Bypass Tract in Ebstein's Anomaly.

June NAMGUNG ; Jae Jin KWAK

International Journal of Arrhythmia.2017;18(1):57-61. doi:10.18501/arrhythmia.2017.009

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

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Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure.

Young Keun ON

International Journal of Arrhythmia.2017;18(1):54-56. doi:10.18501/arrhythmia.2017.008

No abstract available.
Defibrillators* ; Heart Failure, Systolic* ; Humans

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Supraventricular Tachycardia in Special Population.

Youngjin CHO

International Journal of Arrhythmia.2017;18(1):48-53. doi:10.18501/arrhythmia.2017.007

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*

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Treatment of Tachycardia and Bradycardia in a Persistent Left Superior Vena Cava Patient Who Underwent Warden's Procedure and Tricuspid Annuloplasty.

Youngjin CHO

International Journal of Arrhythmia.2016;17(1):69-73. doi:10.18501/arrhythmia.2016.012

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*

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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. doi:10.18501/arrhythmia.2016.011

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*

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Management of Aborted Sudden Cardiac Arrest with J Wave Syndrome.

Ki Hong LEE ; Hyung Wook PARK

International Journal of Arrhythmia.2016;17(1):60-63. doi:10.18501/arrhythmia.2016.010

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

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Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation.

Sang Jin HAN

International Journal of Arrhythmia.2016;17(1):56-59. doi:10.18501/arrhythmia.2016.009

No abstract available.
Atrial Fibrillation* ; Humans

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Peri-procedural Management of Anticoagulation Therapy (cataract eye surgery, dental procedure and gastrointestinal endoscopy).

Joong Wha CHUNG

International Journal of Arrhythmia.2016;17(1):51-55. doi:10.18501/arrhythmia.2016.008

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

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Use of NOAC in Cardioversion.

Jin Bae KIM

International Journal of Arrhythmia.2016;17(1):46-50. doi:10.18501/arrhythmia.2016.007

Cardioversion increases the risk for stroke or systemic embolic events, and patients scheduled for cardioversions need several weeks of anticoagulant treatment to prevent these adverse events. Anticoagulant therapy should be considered as a balancing act between the risk of stroke and the risk of life-threatening bleeding. The efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) was found to be equal to, or even superior, to warfarin for the prevention of stroke, systemic embolism, and other outcomes in patients with atrial fibrillation, when all risk factors were considered. There have been few studies independently looking at the efficacy and safety profile of NOACs in cardioversion. The efficacy of both rivaroxaban and dabigatran in preventing stroke or major systemic embolic events post-cardioversion was found to be similar to that of warfarin. The efficacy of apixaban could not be compared based on the available data because of the limited number of procedures performed. However, all three NOACs were found to be safe for use in cardioversion when compared to warfarin.
Anticoagulants ; Atrial Fibrillation ; Dabigatran ; Electric Countershock* ; Embolism ; Hemorrhage ; Humans ; Risk Factors ; Rivaroxaban ; Stroke ; Warfarin

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