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Implantable Cardioverter-Defibrillator of Korean Patients in a Single Center Registry.

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

International Journal of Arrhythmia.2017;18(4):155-167. doi:10.18501/arrhythmia.2017.026

BACKGROUND AND OBJECTIVES: The safety and efficacy of implantable cardioverter-defibrillator (ICD) for Korean is unclear. We investigated the clinical characteristics and outcomes of Korean patients undergoing ICD for primary or secondary prevention. MATERIALS AND METHODS: From October 1999 to December 2016, 396 cases (365 patients) of ICD implantation were performed: Baseline characteristics, procedural findings, and clinical outcome data were collected retrospectively from our ICD registry. The primary outcome was composite of cardiac death, appropriate shock or antitachycardia pacing. RESULTS: Among 365 patients, 91 patients (25.9%) had ICD for primary prevention and 274 patients (75.1%) were for secondary prevention (51.2±17.10 years, male was 80.8%). The median follow-up period was 3.1 years (interquartile range: 1.6–6.0 days). The most prevalent etiology was dilated cardiomyopathy (46.2%) in the primary prevention and idiopathic ventricular tachycardia or fibrillation (24.4%) in the secondary prevention. The primary outcome was noted in 28.6% of the primary prevention and 33.2% of the secondary prevention (P=0.44). The rate of cardiac death was 2.2% in the primary prevention and 1.8% in the secondary prevention (P=1.00). The hospitalization due to heart failure was higher in the primary prevention compared with the secondary prevention (23.1% versus 13.5%, P=0.03). ICD therapy occurred in 134 patients (36.7%). Among them, 60 patients (44.8% of ICD therapy) experienced inappropriate shock. The most common cause of inappropriate shock was atrial fibrillation of flutter (AF/AFL). CONCLUSION: The clinical efficacy and safety of ICD in Korean is consistent with the data from Western countries.
Atrial Fibrillation ; Cardiomyopathy, Dilated ; Death ; Defibrillators, Implantable* ; Follow-Up Studies ; Heart Failure ; Hospitalization ; Humans ; Male ; Primary Prevention ; Retrospective Studies ; Secondary Prevention ; Shock ; Tachycardia, Ventricular ; Treatment Outcome

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Two Cases of Transhepatic Implantation of Cardiac Implantable Electronic Device: All Roads lead to Rome.

Myung Jin CHA ; Jae Sun UHM ; Tae Hoon KIM ; Eue Keun CHOI ; Boyoung JOUNG ; Hui Nam PAK ; Seil OH ; Moon Hyoung LEE

International Journal of Arrhythmia.2017;18(4):209-214. doi:10.18501/arrhythmia.2017.032

Lead insertion for cardiac implantable electronic devices requires venous access into the right side of the heart. The access route commonly used is from the axillary vein, through the subclavian vein and the superior vena cava. However, in patients with congenital heart malformations or those with vascular stenosis, and/or those who have undergone previous cardiac surgery, the passage of leads might be difficult, and the implantation procedure would show restricted scope. In such cases, insertion of leads through the hepatic vein is known to be a safe procedure. We report 2 cases of patients with limited vascular access who underwent lead implantation using the transhepatic approach—1 patient who underwent placement of an implantable cardioverter defibrillator and the other who underwent placement of a permanent pacemaker.
Axillary Vein ; Constriction, Pathologic ; Defibrillators ; Defibrillators, Implantable ; Heart ; Hepatic Veins ; Humans ; Subclavian Vein ; Thoracic Surgery ; Vena Cava, Superior

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Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation with Myotonic Dystrophy and Achalasia-like Esophageal Dilatation.

Bong Joon KIM ; Tae Joon CHA

International Journal of Arrhythmia.2017;18(4):205-208. doi:10.18501/arrhythmia.2017.031

Myotonic dystrophy, a multi-systemic disease with cardiac involvement, is the most common inherited neuromuscular disease. Here, we report the results of radiofrequency catheter ablation of persistent atrial fibrillation in a patient with myotonic dystrophy and achalasia-like esophageal dilatation.
Atrial Fibrillation* ; Catheter Ablation* ; Dilatation* ; Humans ; Myotonic Dystrophy* ; Neuromuscular Diseases

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Prevalence of Atrial Fibrillation in Korean Population.

So Ryoung LEE ; Eue Keun CHOI

International Journal of Arrhythmia.2017;18(4):195-204. doi:10.18501/arrhythmia.2017.030

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and has been a major public health problem. The prevalence of AF globally has been reported to range from 0.4% to 2% in the adult population; however, the prevalence widely varies depending on the study population. Although AF prevalence in Asian population is about 1% lower than that in European and North American population, the number of AF patients in Asia is rapidly increasing concomitant with the increased aging of the population. However, previous studies that reported AF epidemiology in the Korean population are limited. According to a recent report based on the national health claims database, prevalence of AF in 2015 was 0.7% in the entire Korean adult population and showed a continuous increase with population aging. Additionally, among patients with AF, mean CHA2DS2-VASc score was significantly increased and the number of high thromboembolic risk patients has increased over time. Although oral anticoagulation (OAC) prescription in AF patients increased from 35% to 51%, especially after introduction of non-vitamin K antagonist anticoagulants, a substantial proportion of Korean patients with AF still remain undertreated. In this review, we aimed to summarize temporal changes in the prevalence and incidence of AF and to evaluate the thromboembolic risk in patients with AF. In addition, we also discussed the utilization of OAC therapy in patients with AF in Korean population.
Adult ; Aging ; Anticoagulants ; Arrhythmias, Cardiac ; Asia ; Asian Continental Ancestry Group ; Atrial Fibrillation* ; Epidemiology ; Humans ; Incidence ; Prescriptions ; Prevalence* ; Public Health ; Stroke

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Transvenous Lead Extraction.

Boyoung JOUNG

International Journal of Arrhythmia.2017;18(4):185-194. doi:10.18501/arrhythmia.2017.029

Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide for the management of not only bradycardia but also arrhythmia and heart failure. This increase in the frequency of device therapy is paralleled with an increase in the requirement for systemic extraction. Safe lead extraction is central to the management of several complications related to pacemakers. The most common indication for lead extraction is systemic infection. Adhesions in chronically implanted leads can become major obstacles to safe lead extraction, leading to life-threatening bleeding and cardiac perforations. Currently, several extraction tools enable safe and successful transvenous lead extraction (TLE) of pacemaker and implantable cardioverter–defibrillator leads. This article provides a comprehensive review of the indications, tools, techniques, and outcomes for TLE. Operator experience is vital in determining success, as familiarity with a wide array of techniques will increase the likelihood of uncomplicated extraction. Lead extraction should, therefore, ideally be performed in high-volume centers with experienced staff and on-site support from a cardiothoracic surgical team that is able to deal with bleeding complications from cardiovascular perforation.
Arrhythmias, Cardiac ; Bradycardia ; Heart Failure ; Hemorrhage ; Recognition (Psychology)

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Chronic Obstructive Pulmonary Disease Increases the Risk of New-onset Atrial Fibrillation and Mortality of Patients with Atrial Fibrillation.

Shinjeong SONG ; Pil Sung YANG ; Tae Hoon KIM ; Jae Sun UHM ; Hui Nam PAK ; Moon Hyoung LEE ; Boyoung JOUNG

International Journal of Arrhythmia.2017;18(4):176-184. doi:10.18501/arrhythmia.2017.028

BACKGROUND: Although a few previous studies have analyzed the role of reduced lung function in predicting atrial fibrillation (AF), the relationship between the incidence of AF and comorbid chronic obstructive pulmonary disease (COPD) is unclear. We hypothesized that COPD is associated with the occurrence of new-onset AF and clinical outcomes in AF patients. METHODS: We analyzed the development of new-onset AF in 501,668 patients without AF and clinical outcomes in 4,541 patients with AF using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). RESULTS: Comorbid COPD was found in 4.8% (11,442 of 501,668) of non-AF patients and 18.6% (820 of 4,541) of AF patients. The incidence of AF in COPD patients was significantly higher compared to non-COPD patients (2.6% vs. 0.6%, p < 0.001) over the follow-up period (45.5±14.9 months). In a multivariate Cox regression analysis, COPD predicted higher risk of AF independently from other risk factors (HR: 1.41, 95% CI: 1.25-1.60, p < 0.001). The allcause mortality of AF patients with COPD was significantly higher in patients who used b-blockers (20.6% vs 13.1% during follow-up, p < 0.008). Multivariate Cox regression analysis showed that COPD is still an independent risk factor for all-cause mortality (HR: 1.25, 95% CI: 1.03–1.51, p=0.022), and stroke (HR: 1.19, 95% CI: 1.00–1.41, p=0.039). CONCLUSION: The presence of COPD is an independent risk factor for new-onset AF. COPD is independently associated with all-cause mortality and stroke in AF patients.
Atrial Fibrillation* ; Cohort Studies ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Mortality* ; National Health Programs ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors ; Stroke

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Detailed Electrode Catheter Positioning is Important for the Ablation of Outflow Tract Origin Ventricular Arrhythmias.

In Geol SONG ; Sung Hwan KIM ; Ju Youn KIM ; Jeong Ho KIM ; Yoo Ri KIM ; Tae Seok KIM ; Ji Hoon KIM ; Sung Won JANG ; Man Young LEE ; Tai Ho RHO ; Yong Seog OH

International Journal of Arrhythmia.2017;18(4):168-175. doi:10.18501/arrhythmia.2017.027

BACKGROUND AND OBJECTIVES: Electroanatomical mapping using a three-dimensional (3D) system has high accuracy and improves the results of the ablation of outflow tract (OT) premature ventricular contraction (PVC) or ventricular tachycardia (VT) but imposes a considerable economic burden. Here, we compared detailed diagnostic catheterization and 3D mapping system for the ablation of OT PVC/VT. MATERIALS AND METHODS: Between June 2012 and February 2017, patients with symptomatic OT PVC/VT underwent radiofrequency ablation. Group 1 underwent detailed diagnostic catheterization (using circular and linear multielectrodes) without a 3D mapping system, while group 2 underwent diagnostic catheterization using a conventional 3D mapping system. Procedural success of PVC reduction, remaining symptoms, need for post-operative medications, and procedural time were evaluated. RESULTS: Ninety-eight OT PVC/VT cases were consecutively enrolled. The mean follow-up period was 17.7±14.5 months. Neither acute success rate (95% vs. 82%, p=0.06) nor a PVC reduction > 80% (84% vs. 87%, p=0.74) differed significantly between the two groups. The recurrence rates of PVC-related symptoms were similar (12% vs. 7%, p=0.06) between the groups, but the medication requirement for symptomatic PVC differed (12% vs. 29%, p < 0.01). The total procedure time of group 1 was shorter than that of group 2 (132±42 min vs. 157±47 min, p=0.01) and fluoroscopy time (24±15 min vs. 38±22 min, p < 0.01) and ablation time (528±538 sec vs. 899±598 sec, p < 0.01) were also significantly shortened. CONCLUSION: Detailed electrode catheter positioning is a safe and cost-effective method for the ablation of OT PVC/VT.
Arrhythmias, Cardiac* ; Catheter Ablation ; Catheterization ; Catheters* ; Electrodes* ; Fluoroscopy ; Follow-Up Studies ; Humans ; Methods ; Recurrence ; Tachycardia, Ventricular ; Ventricular Premature Complexes

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Preexcitation Syndrome with a Mahaim-type Accessory Pathway.

Kwang No LEE ; Young Hoon KIM

International Journal of Arrhythmia.2017;18(3):151-154. doi:10.18501/arrhythmia.2017.025

Wide QRS complex tachycardia with a left bundle branch block pattern can be caused by supraventricular tachycardia with aberrant conduction, preexcitation syndrome mediated through a right-sided accessory pathway, and/or ventricular tachycardia. The use of atrial pacing maneuvers can be beneficial for unmasking minimal preexcitation to differentiate between these conditions. Here, we report a case of successful radiofrequency catheter ablation of a Mahaim fiber in a patient with wide QRS complex tachycardia.
Bundle-Branch Block ; Catheter Ablation ; Humans ; Pre-Excitation Syndromes* ; Tachycardia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

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Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation.

Jun KIM

International Journal of Arrhythmia.2017;18(3):148-150. doi:10.18501/arrhythmia.2017.024

No abstract available.
Atrial Fibrillation* ; Dabigatran* ; Warfarin*

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Non-medication Treatment of Atrial Fibrillation.

Junbeom PARK

International Journal of Arrhythmia.2017;18(3):143-147. doi:10.18501/arrhythmia.2017.023

Atrial fibrillation accounts for 20–30% of all causes of ischemic cerebral infarction. Patients with chronic atrial fibrillation tend to be overlooked because their symptoms diminish as the baseline heart rate decreases. However, some recent reports that warn against the risk of ischemic stroke and heart failure due to atrial fibrillation have been published, and various medical treatments and safe and effective procedures have been introduced.
Atrial Fibrillation* ; Catheter Ablation ; Cerebral Infarction ; Heart Failure ; Heart Rate ; Humans ; Stroke

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