Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation

BACKGROUND AND OBJECTIVES: The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. MATERIALS AND METHODS: Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. RESULTS: Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. CONCLUSION: Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.

Effects of Assisted Kinesitherapy in Myocardial Infarction Patients during Convalescence / 日本農村医学会雑誌

As part of the rehabilitation program for myocardial infarction patients, assisted exercise under the eye of therapists is an effective rehabilitation therapy during the period from hospital discharge to the returning to work. Regrettably, however, this part of the program is not put into regular practice in rehabilitation centers yet.<BR>Under the circumstances, we have conducted this type of therapy for myocardial infartion convalescents, and assessed it significance and benefits by examining therapeutic effects and changes in the endurace test results as well as changes in the cardiac output during exercise.<BR>In this study, we used data obtained from 25 out of the 68 acute myocardial infarction patients treated in the coronary-care unit of our hospital between Nov. 1, 1990 and May 31, 1992.<BR>Exercises were performed three times a week for eight to 12 weeks, kinetic intensity correspond-ing to 70-80 % of the highest heart rate in stress tests. The heart rate, blood pressure and cardiac output were measured based on ECG recordings.<BR>As a result, it was found that the kinesitherapy helps (1) increase the tolerability to exercise, (2) lower the heart rate, blood pressure and double product and (3) elevate the stroke volume index during exercise.<BR>From these findings, it is safe to say that the kinesitherapy can be given to myocardial infarction victims without causing them anxiety and is very helpful for them to restore good health and normal cardiac function and to resume their place in society.