• Korean Circulation Journal
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• v.53 no.5
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• pp.273-293
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• 2023

Pulsed field ablation (PFA) was recently rediscovered as an emerging treatment modality for the ablation of cardiac arrhythmias. Ultra-short high voltage pulses are leading to irreversible electroporation of cardiac cells subsequently resulting in cell death. Current literature of PFA for pulmonary vein isolation (PVI) consistently reported excellent acute and long-term efficacy along with a very low adverse event rate. The undeniable benefit of the novel ablation technique is that cardiac cells are more susceptible to electrical fields whereas surrounding structures such as the pulmonary veins, the phrenic nerve or the esophagus are not, or if at all, minimally affected, which results in a favorable safety profile that is expected to be superior to the current standard of care without compromising efficacy. Nevertheless, the exact mechanisms of electroporation are not yet entirely understood on a cellular basis and pulsed electrical field protocols of different manufactures are not comparable among one another and require their own validation for each indication. Importantly, randomized controlled trials and comparative data to current standard of care modalities, such as radiofrequency- or cryoballoon ablation, are still missing. This review focuses on the "pearls" and "pitfalls" of PFA, a technology that has the potential to become the future leading energy source for PVI and beyond.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.313-319
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• 2008

Background: The Cox maze-III procedure is considered as the most effective surgical treatment for atrial fibrillation. Because this procedure takes a long time and it complicates the concomitant cardiac surgery, some surgeons perform a left atrial maze procedure or pulmonary vein isolation only to reduce the operation time. This study was performed to evaluate how the modified procedures, with using cut-and-sew techniques, can influence the treatment of atrial fibrillation. Material and Method: Between Feb 1999 and June 2005, 40 patients (17 males and 23 females) with organic heart disease and atrial fibrillation underwent the Cox maze-III procedure (23), the left atrial maze procedure (10) or pulmonary vein isolation (7). The cut-an-sew technique was used to ablate the atrial wall, but cryoablation was used instead of the cut-and-sew technique for the coronary sinus and the inferior wall between the pulmonary vein and the mitral annulus. Result: After a mean follow-up period of $50.0{\pm}21.6$ months, all (100%) of the 23 patients who underwent the Cox maze-III procedure had regular sinus or atrial rhythm conversion, and 7(70%) of 10 with a left atrial maze procedure and 4(57.1%) of 7 with pulmonary vein isolation had regular sinus or atrial rhythm conversion (p=0.002). Conclusion: To obtain a high conversion rate from atrial fibrillation to a regular sinus rhythm or a regular atrial rhythm, the standard Cox maze-III procedure should be performed in both atria. The limited modified procedures like the left atrial maze procedure or pulmonary vein isolation may reduce the cure rate of atrial fibrillation.

• International Journal of Arrhythmia
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• 제18권2호
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• pp.66-76
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• 2017

Background and Objectives: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. Subjects and Methods: We studied 304 L-PeAF patients (77% male, $60{\pm}10yrs$), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. Results: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (${\ss}=10.4$, 95% confidence interval [CI] 2.79-17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97-0.99, p=0.001), during $45.6{\pm}16.7$ months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). Conclusion: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.

• Journal of Korean Academy of Nursing
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• v.5 no.1
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• pp.70-78
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• 1975

The investigators conducted this survey to find out prevalence of diseases and symptoms of the 812 nurses who were working at the 12 Seoul city and University's hospital in Seoul by retrospective study The results of survey were summarized as follows: 1. Distribution of Prevalence Rate of Diseases and Symptoms. 1) An average prevalence rate of diseases and Symptoms of the nurses/100 persons was 64.3 cases at Present October I.1972 2) The total number of diseases and Symptoms was 522 cases at present Oct, I 1972 for the survey nurses. The prevalence rate of following diseases/100 persons were as, foot sore-11, 3. myopia-9.7, neuralgia-9.6, anemia-9.1, insomnia-8.6 cases and the corrected number percent of prevalence rate of diseases and symptoms of the above diseases into 100 denominator were as follows : foot sore-17.6% , myopia-15.4%, neuralgia-14.9%, anemia-14.2% insomnia-13.2%. 3) The prevalence rate of diseases and symptoms/100 person for the age group of 45 and over was 140.0 cases and the age of 35-39 years was 27.3 cases. 4) The prevalence rate of diseases and symptoms/100 persons by the rotation system of nurses'duty/day were as follows: two shift system rotation-86.7 cases, three shift system rotation-67.9 cases and day duty only was 56.2 cases, 5) The prevalence rate of diseases and symptoms/100 person by the basic nursing education background seemed to be lower occurrence against to the higher education and it was 94.4 cases at the Technical Nursing High School graduates. 6) The prevalence rate of diseases and symptoms/100 persons by the marital status of the nurses were as follows; single-64.8 cases, married-48, 7 cases, and widowed-28.6 cases. II. Relationship Between working Experience and prevalence of the Disease and symptoms. 1) There were no relationship by statistical test between prevalence of eye disease and experience at the eye ward(p〉0.05), skin disease and experience at the dermatology ward (p〉0.05), foot sore and experience at the operating room (p〉0.05), varicose vein and experience at the operating room (p〉0.05), sore finger and experience at the central supply room (p〉0.05), infectious disease and experience at the isolation ward(p〉0.05). 2) There was significant relationship by statistical test between pulmonary tuberculosis and experience at the tuberculosis ward (p〉0.05) prevalence of pulmonary tuberculosis was five times in experienced group than non experienced group.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.32-37
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• 2000

Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.345-350
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• 2001

배경: 항부정맥 술식으로서의 메이스 술식은 우수한 동율동 전환율을 보고 있으나, 술식의 복잡성과 상대적으로 긴 수술 시간 등으로 모든 환자들에게 적용할 수는 없기에, 일부 환자군에서 보다 간단한 항부정맥술인 폐정맥 분리술을 시행 받은 환자들을 대상으로 동율동 전환율 등의 수술 성적과 위험 인자 등에 대해 알아보고자한다. 대상 및 방법: 1995년 10월부터 1999년 2월까지, 폐정맥 분리술을 시행받은 96명의 환자들을 대상으로 후향적 연구를 시행하였다. 남자가 37명(38.5%), 여자가 59명(61.5%) 이었고, 평균 연령은 46.9$\pm$11.6세 이었다. 승모판 협착 환자가 50명(52.1%), 폐쇄 부전이 24명(25%), 협착과 폐쇄부전이 같이 있었던 경우가 22명(22.9%)이었다. 판막 술식과 폐정맥 분리술을 시행하고 좌심방이 제거술을 시행하였다. 모든 환자들은 술 후 6개월 내지 1년 이내에 외래에서 심전도와 심초음파를 시행받았다. 평균 추적 관찰 기간은 25.9$\pm$11.5개월 이었다. 술 후 최근 추적일까지 동율동으로 전환된 군과 안된 군으로 나누어 분석을 하였다. 결과: 조기 성적으로는 사망이 3명(3.1%), 술 후 6개월 이내의 추적관찰 유실이 2명(2.1%) 이었다. 조기 합병증으로 재수술이 필요 했던 출혈이 4례, 심폐바이패스 이탈 실패오 심실보조장치 등의 삽입이필요했던 경우가 1례, 뇌혈관질환 1례, 심근경색이 1례 등이 있었다. 만기 합병증으로는 동기능 부전 증후군으로 영구 심박동기를 삽입한 경우가 1례, 일시적인 뇌경색 1례 있었고 다른 판막과 연관된 합병증은 없었다. 동율동 전환 환자 수는 75명(82%)이었다. 동율동으로의 전환이 어려운 위험인자로 50세로 이상의 연령(p=0.03), 65mm 이상의 좌심방 크기(p=0.03), 동반 우심 술식 시행(p=0.02)등이 있었다 결론: 승모판 질환을 동반한 심방 세동 환자에서 폐정맥 분리술을 시행하여 만족할 만한 동율동 전환율을 얻을 수 있었다.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.811-816
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• 2007

Background: We analyzed our experience of arrhythmia surgery in patients with congenital heart disease. Material and Method: A retrospective review was performed on 43 consecutive patients with congenital heart disease, who underwent arrhythmia surgery between June 1998 and June 2006. Result: The median age at surgery was 52 years ($4{\sim}75$ years). The most frequent cardiac anomaly was an atrial septal defect (23/43, 53.5%). The types of arrhythmias were atrial flutter-fibrillation, intermittent non-sustainable ventricular tachycardia and others in 37, 2 and 4, respectively. Arrhythmia surgery consisted of a bi-atrial maze operation in 18 patients (modified cox maze III procedure in 5 patients, and a right side maze plus pulmonary vein cryo-isolation in 13), right side maze operation in 18 patients, cavo-tricuspid isthmus cryoablation for benign atrial flutter in 4 patients, right ventricular endocardial cryoablation in 2 patients and extranodal cryoablation for atrioventricular node re-entry tachycardia in 1 patient. The median follow-up was 23.8 months ($1{\sim}95.2$ months). There was no early mortality, and one late non-cardiac related death. The overall rates of restored sinus rhythm before discharge and $3{\sim}6$ months after surgery were 79% and 81%, respectively (bi-atrial maze group: 72% and 83%, right-side maze group: 77%, 77%). Conclusion: Arrhythmias associated with congenital heart disease can be safely treated surgically with an excellent intermediate-term outcome.