Background and Objectives: Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA. Methods: A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA. Results: In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHA 2 DS 2 -VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group. Conclusions ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, large-scale vaccinations have been performed worldwide without sufficient verification of safety profiles. So far, little is known about skin manifestations following COVID-19 vaccination in Korean patients. Objective: We investigated the epidemiological and clinical characteristics of patients who had skin manifestations following COVID-19 vaccination in Korea. Methods: We retrospectively reviewed the data of 123 patients that presented with skin manifestations within 1 month after COVID-19 vaccination from two tertiary referral hospitals in Korea. The types of COVID-19 vaccinations administered to the patients, demographics, comorbidities, and clinical course of the patients were obtained from the data. Statistical analyses of the extracted data were performed using Microsoft Excel. Results: Skin manifestations following COVID-19 vaccination were mostly observed in patients in their 40s (23.6%), according to our data. Urticarial eruption was the most common manifestation, followed by macular rash (17.1%) and papulosquamous eruption (17.1%). Notably, 70% of the patients showed delayed reactions. More than half of the patients showed a good prognosis, and their symptoms were relieved with conservative treatment, including corticosteroids and antihistamines, even after additional vaccination. Conclusion We statistically analyzed the prevalence and characteristics of skin manifestations after COVID-19 vaccination. Urticarial eruptions are the most common skin manifestations associated with the COVID-19 vaccination. We believe that this real-world retrospective study will provide valuable information for doctors who treat patients with skin manifestations after COVID-19 vaccination by providing real-world experience in Korea.

Fixed drug eruption (FDE) is a drug-induced disorder that may appear as patches or bullae. It recurs at the same sites as those involved in exposure to the same drug (causative drug). We encountered two cases of generalized FDE, and both patients had a history of diclofenac exposure before the onset of skin lesions. In the first case, an 82-year-old female patient presented with multiple erythematous patches on the trunk and lower extremities. In the second case, a 71-year-old male patient developed multiple bullae on violaceous patches on the trunk and extremities. The findings of histopathologic examinations were indicative of the diagnosis of FDEs. Although diclofenac is commonly used as a non-steroidal inflammatory drug, diclofenac-induced generalized FDE occurs rarely and has not been reported in Korea. With reuse of causative drugs, the size and number of lesions tend to increase. Therefore, early diagnosis of FDE is important, and avoidance of repeated exposure to drugs should be educated.

Although non-vitamin K-antagonist oral anticoagulants (NOACs) reduce major bleeding events in patients with atrial fibrillation more effectively than does warfarin, a significant bleeding risk remains. Patients exhibiting current bleeding and those who are expected to bleed require appropriate management, because NOAC discontinuation may increase the thromboembolic risk. This article details general management principles for patients experiencing current bleeding and those undergoing invasive surgery while on NOACs.

No abstract available.

Although non-vitamin K-antagonist oral anticoagulants (NOACs) reduce major bleeding events in patients with atrial fibrillation more effectively than does warfarin, a significant bleeding risk remains. Patients exhibiting current bleeding and those who are expected to bleed require appropriate management, because NOAC discontinuation may increase the thromboembolic risk. This article details general management principles for patients experiencing current bleeding and those undergoing invasive surgery while on NOACs.
Anticoagulants ; Atrial Fibrillation ; Heart ; Hemorrhage ; Humans ; Perioperative Care ; Warfarin

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.
American Heart Association ; Anticoagulants ; Arrhythmias, Cardiac ; Asia ; Atrial Fibrillation ; Cardiology ; Consensus ; Heart ; Humans ; Mass Screening ; Risk Factors ; Stroke

BACKGROUND: Various Q-switched (QS) lasers, such as ruby, alexandrite or neodymium:YAG (Nd:YAG) lasers, are used to remove tattoos and permanent makeup. To our knowledge, there has been no indication or guideline published for the optimal time for laser-mediated tattoo removal. OBJECTIVE: To set a guideline for the optimal irradiation time for tattoo and permanent makeup removal via 1064 nm QS Nd:YAG (QSND) laser, we compared the degree of tattoo removal and skin histologic changes when the irradiation was employed at different time points. METHODS: Rat skin was marked with 54 artificial permanent makeup marks with black ink using a permanent makeup machine. The marks were irradiated with a 1064 nm QSND laser on the application day, and 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Pigmentation changes were checked over time using a Mexameter(R) and skin biopsy. RESULTS: There was no significant difference in the degree of pigment removal as examined by Mexameter(R) on the day of makeup application compared to 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Histopathologically, the permanent makeup pigments seemed to move from epidermis to superficial and mid dermis with time. The pigments were relatively well removed throughout the epidermis and dermis when the laser was employed 7 days after tattoo application, compared to laser irradiation on the day of application, as viewed histologically. CONCLUSION: Laser removal of permanent makeup is effective on the day of application, as determined by testing pigment levels. However, based on histopathology, it is recommended to use lasers to remove permanent makeup about a week after application, since the wound repair process is almost complete at that time.
Animals ; Biopsy ; Dermis ; Epidermis ; Ink ; Pigmentation ; Rats ; Skin* ; Tattooing ; Wounds and Injuries