Background and Objectives: Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. Methods: Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). Results: Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. Conclusions Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

Treatment of ventricular arrhythmias (VA) usually involves managing the underlying cardiac conditions that cause the arrhythmia. However, managing the underlying disease is often challenging, and catheter ablation, or treatment targeting the VA itself might be required in a few patients. In this article, we explored evidence and recommendations regarding the treatment of VA in patients with structural heart disease focusing on the utilization of catheter ablation in these patients. The administration of optimal medical therapy, insertion of an implantable cardioverter-defibrillator, or resynchronization therapy improves survival in patients with left ventricular dysfunction. The role of catheter ablation in preventing sudden cardiac death remains uncertain in this population. In patients with coronary artery disease, reversing myocardial ischemia via revascularization is important in managing VA. Catheter ablation is recommended in patients with recurrent ventricular tachycardia in a setting of ischemic heart disease. In patients with non-ischemic cardiomyopathies such as dilated cardiomyopathy or hypertrophic cardiomyopathy, catheter ablation may be considered for those presenting with drug-refractory ventricular tachycardia.
Arrhythmias, Cardiac ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Catheter Ablation ; Catheters ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Heart Diseases ; Humans ; Myocardial Ischemia ; Tachycardia, Ventricular ; Ventricular Dysfunction, Left

The recommendations outlined constitute the first clinical practice guidelines of the Korean Heart Rhythm Society regarding catheter ablation of ventricular arrhythmias (VA). This is a guideline PART 2, which includes VA in the structurally normal heart, inherited primary arrhythmia syndromes, VA related to congenital heart disease, as well as VA and sudden cardiac death observed in specific populations. In the structurally normal heart, treatment is guided by the occurrence of symptoms or the frequency of arrhythmias that cause ventricular dysfunction over time. Catheter ablation can be recommended in patients in whom anti-arrhythmic medications are ineffective. The sites of origin of arrhythmic activity are known to be the outflow tract, fascicles, papillary muscle, or the annulus. Specific cardiac channelopathies include congenital long QT and Brugada syndrome. This guideline discusses the diagnostic criteria, risk stratification, and treatment of these syndromes. We have included recommendations for adult congenital heart disease. Moreover, we have discussed the management of VA occurring in specific populations such as in patients with psychiatric and neurological disorders, pregnant patients, those with obstructive sleep apnea or drug-related pro-arrhythmias, athletes, and elderly patients.
Adult ; Aged ; Arrhythmias, Cardiac ; Athletes ; Brugada Syndrome ; Catheter Ablation ; Catheters ; Channelopathies ; Death, Sudden, Cardiac ; Heart ; Heart Defects, Congenital ; Humans ; Nervous System Diseases ; Papillary Muscles ; Sleep Apnea, Obstructive ; Ventricular Dysfunction

Ventricular arrhythmias (VA) are a major cause of sudden cardiac death (SCD) in patients with known heart disease. Risk assessment and effective prevention of SCD are key issues in these patients. Implantable cardioverter defibrillator (ICD) insertion effectively treats sustained VA and reduces mortality in patients at high risk of SCD. Appropriate anti-arrhythmic drugs and catheter ablation reduce the VA burden and the occurrence of ICD shocks. In this guideline, authors have described the general examination and medical treatment of patients with VA. Medications and catheter ablation are also used as acute phase therapy for sustained VA.
Arrhythmias, Cardiac ; Catheter Ablation ; Catheters ; Death, Sudden, Cardiac ; Defibrillators ; Heart Diseases ; Humans ; Mortality ; Risk Assessment ; Shock

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction* ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke ; Stroke Volume

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

BACKGROUND: An inflammatory mechanism has been suggested to contribute to the progression of diabetic nephropathy. Although retinoid, a known anti-inflammatory agent, has been reported to be beneficial in some experimental renal diseases, it has not been shown whether it prevents disease progression in diabetic nephropathy. Therefore, we investigated whether all-trans retinoic acid inhibits inflammatory changes and improves renal function during the early stages of diabetic nephropathy in streptozotocin-induced diabetic rats. METHODS: We evaluated anti-inflammatory effect of retinoid on streptozotocin-induced diabetic nephropathy. Anti-inflammatory effect was determined by the expression of monocyte chemoattractant peptide-1 (MCP-1). RESULTS: Urinary protein excretion was significantly higher in diabetic rats at four weeks after the induction of diabetes mellitus compared with controls, and proteinuria in the group with retinoic acid treatment was decreased (1.25+/-0.69 vs. 0.78+/-0.72 mg/mg Cr, p=0.056). Urinary excretion of MCP-1 was rapidly increased at two days after induction of diabetes mellitus in diabetic rats, and further increased until four weeks of age compared with control rats. Retinoic acid treatment suppressed to 30% reduction of the urinary level of MCP-1 compared with vehicle treated diabetic rats (119.3+/-74.2 vs. 78.1+/-62.7 pg/mg Cr, p=0.078). Immunohistochemistry revealed a significant increase in staining for MCP-1 protein in the diabetic kidney, and retinoic acid treatment significantly suppressed intrarenal MCP-1 protein synthesis. CONCLUSION: Retinoic acid suppressed proteinuria and inflammatory changes in diabetic rats. These results suggest that retinoic acid may have an anti- inflammatory effect in diabetic nephropathy.
Animals ; Diabetes Mellitus ; Diabetic Nephropathies* ; Disease Progression ; Immunohistochemistry ; Inflammation ; Kidney ; Monocytes ; Proteinuria ; Rats ; Tretinoin

BACKGROUND: Pityrosporum yeast is a normal resident flora of the skin. Its hyphal form can be found on the lesions of pityriasis versicolor. Our previous studies showed that pathogenic pityrosporal hyphae coulc be found on a clinically normal scalp. We called it pityriasis versicolor of the scalp. This species may be involved in the pathogenesis of seborrheic dermatitis. OBJECTIVE: We investigated the incidence of pityrosporal hyphae on the scalp of patients with seborrheic dermatitis and normal persons, and compared the results between the two groups. METHODS: 202 patients with seborrheic dermatitis, 350 normal persons were studied. Scalp scrapings were stained with 20% Parker ink-KOH(P-KOH) solution. The number of pityrosporal hyphae per high power field(x 400) were counted according to a grading method(1+ to 3+). RESULTS: The incidence of pityriasis versicolor of the scalp was 28.7% in patients with seborrheic dermatitis, and 21.7% in normal persons. However the incidence of pityriasis versicolor of the scalp in seborrheic dermatitis in the age group of the second and sixth decades was two fold higher, 43.3%, 40.9%, respectively than in the normal control groups, from 9.5% to 25.0%. In the case of sex distribution, the incidence of pityriasis versicolor of the scalp in female patients of seborrheic dermatitis was two fold higher, 34.8%, than in the normal control, 18.8%. According to seasonal variation, the incidence was higher in spring(21.7%) and summer(34.3%) in the control group, and higher in spring, fall and summer, 31.2, 31.4 and 39.2%, respectively, in people with seborrheic dermatitis. CONCLUSION: The results of this study showed that the incidence of pityriasis versicolor of the scalp in patients with seborrheic dermatitis and normal person is similar, There were, however some differences between them according to age, sex and season.
Dermatitis, Seborrheic* ; Female ; Humans ; Hyphae ; Incidence* ; Malassezia ; Pityriasis* ; Scalp* ; Seasons ; Sex Distribution ; Skin ; Tinea Versicolor* ; Yeasts

BACKGROUND: Pityrosporum yeast is a normal resident flora of the skin. Its hyphal form can be found on the lesions of pityriasis versicolor. Our previous studies showed that pathogenic pityrosporal hyphae coulc be found on a clinically normal scalp. We called it pityriasis versicolor of the scalp. This species may be involved in the pathogenesis of seborrheic dermatitis. OBJECTIVE: We investigated the incidence of pityrosporal hyphae on the scalp of patients with seborrheic dermatitis and normal persons, and compared the results between the two groups. METHODS: 202 patients with seborrheic dermatitis, 350 normal persons were studied. Scalp scrapings were stained with 20% Parker ink-KOH(P-KOH) solution. The number of pityrosporal hyphae per high power field(x 400) were counted according to a grading method(1+ to 3+). RESULTS: The incidence of pityriasis versicolor of the scalp was 28.7% in patients with seborrheic dermatitis, and 21.7% in normal persons. However the incidence of pityriasis versicolor of the scalp in seborrheic dermatitis in the age group of the second and sixth decades was two fold higher, 43.3%, 40.9%, respectively than in the normal control groups, from 9.5% to 25.0%. In the case of sex distribution, the incidence of pityriasis versicolor of the scalp in female patients of seborrheic dermatitis was two fold higher, 34.8%, than in the normal control, 18.8%. According to seasonal variation, the incidence was higher in spring(21.7%) and summer(34.3%) in the control group, and higher in spring, fall and summer, 31.2, 31.4 and 39.2%, respectively, in people with seborrheic dermatitis. CONCLUSION: The results of this study showed that the incidence of pityriasis versicolor of the scalp in patients with seborrheic dermatitis and normal person is similar, There were, however some differences between them according to age, sex and season.
Dermatitis, Seborrheic* ; Female ; Humans ; Hyphae ; Incidence* ; Malassezia ; Pityriasis* ; Scalp* ; Seasons ; Sex Distribution ; Skin ; Tinea Versicolor* ; Yeasts

We report a case of Mycobacterium(M.) fortuitum infection in a 65-year-old female who presented with erythematous to purplish colored tender nodules and plaques with curst and purulent discharge on both upper and lower extremities along the sites of acupuncture. The culture of surgically excised specimen in 3% Ogawa media yielded slightly yellowish colored colonies within 2 days. Several tests for identification of the species were performed and growth on 5% NaCl, negative niacin test, positive results in nitrate reduction, catalase, urease and iron uptake tests were noted. Excision of the lesions followed by administration of minocycline and ciprofloxacin showed no sign of relapse to data a year after treatment.
Acupuncture* ; Aged ; Catalase ; Ciprofloxacin ; Female ; Humans ; Iron ; Lower Extremity ; Minocycline ; Mycobacterium fortuitum* ; Mycobacterium* ; Niacin ; Recurrence ; Urease