Background: Left bundle branch area pacing (LBBAP) provides physiologic ventricular activation but requires deep lead penetration into the interventricular septum, which can rarely cause various complications.Case presentation: A 57-year-old woman with high-degree atrioventricular block underwent dual-chamber pacemaker implantation with stylet-driven LBBAP via the left axillary vein. Within hours, she developed nausea, vomiting, and frequent ventricular premature contractions with non-sustained ventricular tachycardia, while remaining hemodynamically stable. Transthoracic echocardiography revealed a well-circumscribed echo lucent mass in the mid interventricular septum (15.6 × 24.7 mm) consistent with hematoma, without pericardial effusion or left ventricular outflow tract obstruction. In the absence of clinical deterioration, a conservative strategy with close rhythm monitoring and serial echocardiography was chosen. The hematoma regressed progressively with near-complete resolution at two weeks, and the patient remained asymptomatic with stable lead function at 6-month follow-up. Conclusions Interventricular septal hematoma is a rare complication of LBBAP that may present predominantly with ventricular arrhythmia. In hemodynamically stable patients without mechanical compromise, careful surveillance can allow successful conservative management without surgical intervention.

Natural killer (NK) cells are pivotal innate immune system components that exhibit spontaneous cytolytic activity against abnormal cells, such as infected and tumor cells. NK cells have shown significant promise in adoptive cell therapy because of their favorable safety profiles and minimal toxicity in clinical settings. Despite their advantages, the therapeutic application of unmodified NK cells faces challenges, including limited in vivo persistence, particularly in the immunosuppressive tumor microenvironment. Recent advances in genetic engineering have enhanced the therapeutic potential of NK cells by addressing these limitations and improving their therapeutic efficacy. In this review, we have described various methodologies for the genetic modification of NK cells, including viral vectors, electroporation, and nanoparticle-based approaches. The ongoing research on nanomaterialbased approaches highlights their potential to overcome current limitations in NK cell therapy, paving the way for advanced cancer therapy and improved clinical outcomes. In this review, we also emphasize the potential of engineered NK cells in cancer immunotherapy and other clinical applications, highlighting the expanding scope of NK cell-based treatments and the critical role of innovative genetic engineering techniques.

Background and Objectives: Direct head-to-head comparisons between the PolarX and the Arctic Front Advance Pro (AFA-Pro) system remain limited. This study aimed to assess whether the PolarX offers better clinical outcome compared to the AFA-Pro, particularly in patients with persistent AF. Methods: We performed a retrospective study of 306 patients undergoing cryoballoon ablation from March 2023 to August 2024. This population was divided into two groups based on the duration of AF episode: the paroxysmal AF group (n = 206) and the persistent AF group (n = 100). Among those with persistent AF, there were 47 in the AFA-Pro group and 53 in the PolarX group. The primary outcome was freedom from AF/atrial tachycardia (AT). Results: In patients with paroxysmal and persistent AF, the mean follow-up durations were 347.1 ± 156.0 days (median, 350.5 days; interquartile range [IQR], 201.8 to 482.5) and 345.5 ± 166.5 days (median, 331.0; IQR, 184.3 to 495.5), respectively. In patients with paroxysmal AF, the PolarX did not improve freedom from AF/AT compared to the AFA-Pro (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.63 to 2.42; P = 0.546). However, in patients with persistent AF, the PolarX showed a difference in freedom from AF/AT compared to the AFAPro (HR, 0.45; 95% CI, 0.24 to 0.99; P = 0.022). Conclusions The use of the PolarX showed a difference in freedom from AF/AT recurrence in patients with persistent AF, which reached statistical significance.

Background: In the Rivaroxaban Once-daily oral direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial, rivaroxaban 20 mg was the on-label dose, and the dose-reduction criterion for rivaroxaban was a creatinine clearance of < 50 mL/min. Some Asian countries are using reduced doses label according to the J-ROCKET AF trial. The aim of this study was to assess the safety and efficacy of a high-dose rivaroxaban regimen (HDRR, 20/15 mg) and low-dose rivaroxaban regimen (LDRR, 15/10 mg) among elderly East Asian patients with atrial fibrillation (AF) in real-world practice. Methods: This study was a multicenter, prospective, non-interventional observational study designed to evaluate the efficacy and safety of rivaroxaban in AF patients > 65 years of age with or without renal impairment. Results: A total of 1,093 patients (mean age, 72.8 ± 5.8 years; 686 [62.9%] men) were included in the analysis, with 493 patients allocated to the HDRR group and 598 patients allocated to the LDRR group. A total of 765 patients received 15 mg of rivaroxaban (203 in the HDRR group and 562 in the LDRR group). There were no significant differences in the incidence rates of major bleeding (adjusted hazard ratio [HR], 0.64; 95% confidential interval [CI], 0.21–1.93), stroke (adjusted HR, 3.21; 95% CI, 0.54–19.03), and composite outcomes (adjusted HR, 1.13;95% CI, 0.47–2.69) between the HDRR and LDRR groups. Conclusion This study revealed the safety and effectiveness of either dose regimen of rivaroxaban in an Asian population for stroke prevention of AF. Considerable numbers of patients are receiving LDRR therapy in real-world practice in Asia. Both regimens were safe and effective for these patients.

Background and Objectives: Optimal anticoagulation in very elderly patients is challenging due to the high risk of anticoagulant-induced bleeding. The aim of this study was to assess outcomes of on-label reduced-dose edoxaban (30 mg) in very elderly patients who had additional risk factors for bleeding. Methods: This was a multi-center, prospective, non-interventional observational study to evaluate the efficacy and safety of on-label reduced-dose edoxaban in atrial fibrillation (AF) patients 80 years of age or older and who had more than 1 risk factor for bleeding. Results: A total of 2448 patients (mean age 75.0±8.3 years, 801 [32.7%] males) was included in the present study, and 586 (23.9%) were 80 years of age or older with additional risk factors for bleeding. Major bleeding events occurred frequently among very elderly AF patients who had additional bleeding risk factors compared to other patients (unadjusted hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.16–4.02); however, there were no significant differences in stroke incidence (HR, 1.86; 95% CI, 0.98–3.55). There were no significant differences for either factor after adjusting for age and sex (adjusted HR, 1.65; 95% CI, 0.75–3.62 for major bleeding; adjusted HR, 1.13; 95% CI, 0.51–2.50 for stroke). Conclusions In very elderly AF patients with comorbidities associated with greater risk of bleeding, the incidence of major bleeding events was significantly increased. In addition, risk of stroke showed tendency to increase in same population. Effective anticoagulation therapy might be important in these high-risk population, and close observation of bleeding events might also be required.

Background: The relationship between sinus node dysfunction and atrial fibrillation (AF) has been well known. The reversibility of sinus node dysfunction is indeed a critical factor in determining the treatment strategy in patients with tachycardia–bradycardia syndrome (TBS). We aimed to assess the clinical outcome of choosing catheter abla‑ tion as the initial treatment in tachycardia–bradycardia syndrome and predictive factors leading to the implantation of a permanent pacemaker (PPM) in these patients. Methods: Patients with TBS who had been taken AF catheter ablation from 2012 to 2021 were reviewed, and 113 patients were enrolled. Patients were divided into two groups based on whether a “sinus pause episode of more than 3 s unrelated to tachyarrhythmia” coexists (Group I, n = 20) or not (Group II, n = 93). Results: Compared to Group II, baseline characteristics showed that Group I was comprised of more female gender (p = 0.043), with hypertension (p = 0.033), and with enlarged left atrium (p = 0.003). An average three-year follow-up found that eight patients (8/113, 7%) were implanted PPM (5/20, 25% in Group I vs. 3/93, 3.2% in Group II, p = 0.001).Using a multivariate model, a “sinus pause episode unrelated to tachyarrhythmia” was strongly associated with PPM implantation after catheter ablation in patients with TBS (HR 6.765, 95% CI 1.355–33.763, p = 0.020). Only four out of 113 patients (3.5%) progressed to persistent or permanent AF. Conclusions After catheter ablation as the initial treatment in TBS, only 7% underwent PPM implantation, and an iso‑ lated sinus pause was a predictive factor for requiring PPM implantation. In addition, even in patients who undergo catheter ablation with subsequent PPM implantation, we can expect to improve the clinical outcome associated with a reduced AF burden.

The global burden of mental illness has increased significantly since the COVID-19 pandemic. In South Korea, despite this rising burden, the utilization of mental health services remains critically low compared to other countries. This study evaluated successful integrated treatment centers from various countries, including the United States, the United Kingdom, and Australia, to identify the best practices that can be applied to South Korean society. These international examples informed the development of Mind the SHIM (SNUH Health in Mind) center, an integrated treatment model designed to address the gaps in non-pharmacological mental health services in South Korea. Mind the SHIM center focuses on developing and validating programs tailored to local needs, emphasizing professional education, systematic program delivery, and community collaboration. The biopsychosocial approach of the center is expected to enhance the overall quality of life of the patients and increase the utilization of mental health services, reducing the broader economic and social burden of mental illness in South Korea.

Background: The relationship between sinus node dysfunction and atrial fibrillation (AF) has been well known. The reversibility of sinus node dysfunction is indeed a critical factor in determining the treatment strategy in patients with tachycardia–bradycardia syndrome (TBS). We aimed to assess the clinical outcome of choosing catheter abla‑ tion as the initial treatment in tachycardia–bradycardia syndrome and predictive factors leading to the implantation of a permanent pacemaker (PPM) in these patients. Methods: Patients with TBS who had been taken AF catheter ablation from 2012 to 2021 were reviewed, and 113 patients were enrolled. Patients were divided into two groups based on whether a “sinus pause episode of more than 3 s unrelated to tachyarrhythmia” coexists (Group I, n = 20) or not (Group II, n = 93). Results: Compared to Group II, baseline characteristics showed that Group I was comprised of more female gender (p = 0.043), with hypertension (p = 0.033), and with enlarged left atrium (p = 0.003). An average three-year follow-up found that eight patients (8/113, 7%) were implanted PPM (5/20, 25% in Group I vs. 3/93, 3.2% in Group II, p = 0.001).Using a multivariate model, a “sinus pause episode unrelated to tachyarrhythmia” was strongly associated with PPM implantation after catheter ablation in patients with TBS (HR 6.765, 95% CI 1.355–33.763, p = 0.020). Only four out of 113 patients (3.5%) progressed to persistent or permanent AF. Conclusions After catheter ablation as the initial treatment in TBS, only 7% underwent PPM implantation, and an iso‑ lated sinus pause was a predictive factor for requiring PPM implantation. In addition, even in patients who undergo catheter ablation with subsequent PPM implantation, we can expect to improve the clinical outcome associated with a reduced AF burden.

Background: The relationship between sinus node dysfunction and atrial fibrillation (AF) has been well known. The reversibility of sinus node dysfunction is indeed a critical factor in determining the treatment strategy in patients with tachycardia–bradycardia syndrome (TBS). We aimed to assess the clinical outcome of choosing catheter abla‑ tion as the initial treatment in tachycardia–bradycardia syndrome and predictive factors leading to the implantation of a permanent pacemaker (PPM) in these patients. Methods: Patients with TBS who had been taken AF catheter ablation from 2012 to 2021 were reviewed, and 113 patients were enrolled. Patients were divided into two groups based on whether a “sinus pause episode of more than 3 s unrelated to tachyarrhythmia” coexists (Group I, n = 20) or not (Group II, n = 93). Results: Compared to Group II, baseline characteristics showed that Group I was comprised of more female gender (p = 0.043), with hypertension (p = 0.033), and with enlarged left atrium (p = 0.003). An average three-year follow-up found that eight patients (8/113, 7%) were implanted PPM (5/20, 25% in Group I vs. 3/93, 3.2% in Group II, p = 0.001).Using a multivariate model, a “sinus pause episode unrelated to tachyarrhythmia” was strongly associated with PPM implantation after catheter ablation in patients with TBS (HR 6.765, 95% CI 1.355–33.763, p = 0.020). Only four out of 113 patients (3.5%) progressed to persistent or permanent AF. Conclusions After catheter ablation as the initial treatment in TBS, only 7% underwent PPM implantation, and an iso‑ lated sinus pause was a predictive factor for requiring PPM implantation. In addition, even in patients who undergo catheter ablation with subsequent PPM implantation, we can expect to improve the clinical outcome associated with a reduced AF burden.

The global burden of mental illness has increased significantly since the COVID-19 pandemic. In South Korea, despite this rising burden, the utilization of mental health services remains critically low compared to other countries. This study evaluated successful integrated treatment centers from various countries, including the United States, the United Kingdom, and Australia, to identify the best practices that can be applied to South Korean society. These international examples informed the development of Mind the SHIM (SNUH Health in Mind) center, an integrated treatment model designed to address the gaps in non-pharmacological mental health services in South Korea. Mind the SHIM center focuses on developing and validating programs tailored to local needs, emphasizing professional education, systematic program delivery, and community collaboration. The biopsychosocial approach of the center is expected to enhance the overall quality of life of the patients and increase the utilization of mental health services, reducing the broader economic and social burden of mental illness in South Korea.