• Korean Circulation Journal
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• 제52권10호
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• pp.755-767
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• 2022

Background and Objectives: Cryoballoon catheter ablation for the treatment of patients with symptomatic atrial fibrillation (AF) has been adopted globally, but there are limited multicenter reports of 12-month outcomes in the Korean patient population. This analysis evaluated the clinical performance and safety of cryoballoon ablation (CBA) according to standard-of-care practices in Korea. Methods: This evaluation of Korean patients with AF was conducted within the larger Cryo Global Registry, which is a prospective, multicenter, post-market registry. Freedom from a ≥30-second recurrence of atrial arrhythmias (after a 90-day blanking period until 12 months) and procedural safety were examined in subjects treated with CBA at 3 Korean centers. Results: Overall, 299 patients with AF (60±11 years old, 24.7% female, 50.5% paroxysmal AF) underwent CBA using the Arctic Front Advance cryoballoon. Of those, 298 were followed-up for at least 12 months. Mean procedure-, left atrial dwell- and fluoroscopy time was 76±21 minutes, 56±23 minutes, and 27±23 minutes, respectively. Freedom from AF recurrence at 12 months was 83.9% (95% confidence interval [CI], 76.9-88.9%) in the paroxysmal and 61.6% (95% CI, 53.1-69.0%) in the persistent AF cohort. Rhythm monitoring was performed on average 4.7±1.4 times during the follow-up period. Serious device- or procedure-related adverse events occurred in 2 patients (0.7%). The 12-month Kaplan-Meier estimate of freedom from repeat ablation and cardiovascular-related hospitalization was 93.8% (95% CI, 90.4-96.1%) and 89.7% (95% CI, 85.6-92.7%), respectively. Conclusions: CBA is an efficient, effective, and safe procedure for the treatment of AF patients when used according to real-world practices in Korea.

• Journal of Chest Surgery
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• 제52권2호
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• pp.61-69
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• 2019

Background: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement. Methods: From 2001 and 2014, 146 consecutive patients ($69.3{\pm}9.4years$, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes. Results: During 49.1 months of follow-up (interquartile range, 22.5-96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was $79.2%{\pm}3.5%$. The freedom from AF recurrence rate at 5 years was $59.8%{\pm}4.9%$. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02-1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22-7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00-1.05; p=0.045) were significantly associated with AF recurrence. Conclusion: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.

• Korean Circulation Journal
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• 제54권3호
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• pp.113-123
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• 2024

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 CHA₂DS₂-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.

• Journal of Chest Surgery
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• 제6권1호
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• pp.69-88
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• 1973

Twenty-one cases of open mitral commissurotomy were done between October 1963 and March 1973. 1] Preoperative embolism consists of 7 cerebral and 2 peripheral cases. Two operative cerebral embolism cases were noted. 2] There were two cases of restenosis, one associated valvular disease, three mitral insufficiency cases, and six cases of pulmonary hypertension. 3] Out of 21 cases, 13 cases of atrial fibrillation were found and two cases of atrial fibrillation were found postoperatively among 8 cases of preoperatively normal sinus rhythm. 4] During operation 10 cases of valvular calcification and 6 cases of left atrial thrombus were noted. 5] Complete blood count, electrolyte and acid base balance showed normal range of data. 6] Four helix reservoir whole blood total body perfusion and 17 cases of .hemodilution perfusion utilizing Rygg-Kyvsgaard bag oxygenator with sigma motor were performed. 7] EACA 125 mg/kg intravenous administration before cardiopulmonary bypass resulted in markedly diminished postoperative bleeding. 8] Post-perfusion urine amount was in satisfactory range. 9] There were 2 operative mortality due to coronary embolism and three cases of hospital death, 2 due to severe hepatic failure and one due to cerebral embolism. 10] Sixteen survival cases showed marked clinical improvements and almost all of them returned to their occupation satisfactorily after operation.

• 한국항행학회논문지
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• 제25권1호
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• pp.96-101
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• 2021

본 논문은 빅데이터를 이용하여 심방세동 환자의 뇌졸중 발병을 예측하는 기계 학습 모델을 제시한다. 학습 데이터로는 국민 건강 보험공단에서 제공하는 대한민국 전수에 해당하는 심방세동 환자의 정보를 수집하였다. 수집된 정보는 인구사회학, 과거 병력, 건강검진을 포함한 68개 독립변수로 구성된다. 본 연구의 목표는 기존 심방세동 환자의 뇌졸중 위험도 예측에 사용되던 통계적 모델 (CHADS2, CHA2DS2-VASc)의 성능을 검증하고 기계 학습 모델을 적용하여 기존 모델보다 높은 정확도를 가지는 모델을 제시하는 것이다. 제안하는 모델의 정확도, AUROC (area under the receiver operating characteristic)를 검증한 결과 제안하는 기계 학습 기반의 모형이 심방세동 환자의 뇌졸중 위험도를 사용한 모델이 기존의 통계적 모델보다 높은 정확도, 민감도, 특이도를 가지는 것을 확인할 수 있었다.

• Journal of Chest Surgery
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• 제41권6호
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• pp.710-717
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• 2008

배경: 심방 세동은 뇌혈관 사고, 말초 동맥 색전증 같은 합병증과 많은 연관이 되어 있고 무엇보다도 만성적으로 이 부정맥을 가지고 있는 환자들은 가슴 두근거림과 깜짝 놀램 증상 등이 있어서 환자의 삶의 질을 많이 떨어뜨린다. 이 논문의 목적은 본 교실에서 시행해 온 변형된 Maze술 식의 중장기 결과를 내고 이에 영향을 주는 요인들을 조사하는데 있다. 대상 및 방법: 2001년 6월부터 2007년 2월까지 88명을 대상으로 조사를 하였고 모두 본 교실에서 냉동절제(cryoabation)을 이용한 변형된 Maze술 식을 받았다. 냉동절제로 폐정맥 부분을 분리하는 방법에 따라 두 그룹으로 나누었고, 첫 번째 그룹은 58명(group 1, Lee-Maze, n=58)으로 우측 폐정맥은 절개 및 봉합으로 좌측 폐정맥은 냉동절제로 분리하였고, 두 번째 그룹은 30명(group 2, Cryo-Maze, n=30)으로 좌측 및 우측 폐정맥 부분 모두를 냉동 절제로만 시행하였다. 술 후 퇴원 시 동율동 전환 여부와 추적 관찰에서의 동율동 유지 및 심방 세동의 재발, 그리고 마지막 추적 관찰시의 심장리듬을 알아보았다. 결과: 모든 환자의 추적 관찰 기간은 평균 $44.3{\pm}19.2$개월이었고, 퇴윈 시 리듬은 group 1 (Lee-Maze)에서는 동율동이 72.4%에서 나타났고 group 2 (Cryo-Maze)에서는 66.7%가 관찰되었다. 마지막 추적 관찰 시 리듬은 group 1에서 81%, group 2에서는 60%에서 심방 세동이 재발하지 않았다. 그리고 Kaplan-Meier방법으로 분석을 해 보았을 때 심방 세동 재발로부터의 자유률(% Free from AF)은 group 1에서 1년 86.5%, 5년 80%였고, group 2에서는 1년 70%, 5년 51%였다. 결론: 냉동 절제를 이용한 변형된 Maze술은 단순하고 효과적인 수술이지만, 표준적 MazeIII 술 보다는 다소 낮은 성공률을 보이고 있다. 냉동 절제를 이용한 변형된 방법은 수술 시간이 단축될 수 있으나 성공률을 높이기 위해서는 더욱 많은 연구와 노력이 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제26권2호
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• pp.102-107
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• 1993

Human atria play an important role in extracellular homeostasis through release of atrial natriuretic peptide. To evaluate the relationship between plasma level of atrial natriuretic peptide (ANP) and many changes which can develop during extracorporeal circulation, we studied 16 patients undergoing, 12 cardiac operation and 4 thoracic operation. Plasma level of ANP in cardiac patients group was significantly higher and more changeable than thoracic patients group. After aortic cross clamp release, blood was filled at right atrium and right atrial pressure was rapidly increased. At the same time, plasma level of ANP was rised suddenly. Increase of ANP level was correlated (p<0.05) with the increase of total bypass time, but was not correlated statistical with aortic cross clamp time. ANP level did not fall rapidly after aortic cross clamp while both atria were completely empty. This result was explained by intraoperative hypothermia at that time, which can inactivate plasmal endopeptidase and catalytic receptors of ANP. The ANP level of atrial fibrillation group in cardiac patients were generally higher than normal sinus group, but there was no statistical correlation.

• 한국임상약학회지
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• 제26권3호
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• pp.207-212
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• 2016

Objective: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). Methods: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). Results: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ${\geq}3$ (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. Conclusion: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

• Korean Circulation Journal
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• 제52권3호
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• pp.220-230
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• 2022

Background and Objectives: Previous observational studies presented a positive association between alcohol and atrial fibrillation (AF). However, previous studies using genetic polymorphisms on the causal relationship between alcohol consumption and AF have reported conflicting results. This study aimed to evaluate the causality between alcohol consumption and AF using the aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism, which is the genetic variant with the most potent effect on drinking behavior. Methods: A total of 8,964 participants from the Dong-gu Study were included in the present study. The causal association between alcohol consumption and AF was evaluated through a Mendelian randomization (MR) analysis using the ALDH2 rs671 polymorphism as an instrumental variable. Results: No significant relationship between alcohol consumption and AF was found in the observational analysis. However, the genetic analysis using the ALDH2 polymorphism showed a significant association in men. In the MR analysis, genetically predicted daily alcohol consumption was positively related to AF. Conclusions: MR analysis revealed a significant association between the amount of alcohol consumption and AF, which suggests that the association may be causal.

• Korean Circulation Journal
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• 제54권1호
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• pp.13-27
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• 2024

Background and Objectives: Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs. Methods: This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated. Results: During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively). Conclusions: A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.