Analysis of clinical risk factors of failed electrical cardioversion in patients with persistent atrial fibrillation or atrial flutter

Background@#Although rhythm control could be the best for symptomatic atrial fibrillation (AF), some patients fail to achieve sinus rhythm (SR). This study aimed to identify clinical risk factors of failed electrical cardioversion (ECV). @*Methods@#A total of 248 patients who received ECV for persistent AF or atrial flutter (AFL) were retrospectivelyreviewed. Patients were divided into three groups: Group 1 maintained SR for > 1 year, group 2 maintained SR ≤ 1 yearafter ECV, and group 3 failed ECV. SR maintenance was assessed using regular electrocardiography or Holter monitoring. @*Results@#Patients were divided into group 1 (73, 29%), group 2 (146, 59%), and group 3 (29, 12%). The mean ageof patients was 60 ± 10 years, and 197 (79%) were male. Age, sex, and baseline characteristics were similar amonggroups. However, increased cardiac size, digoxin use, heart failure (HF), and decreased left ventricular ejection frac‑ tion (LVEF) were more common in group 3. Univariate analysis of clinical risk factors for failed ECV was increasedcardiac size [hazard ratio (HR) 2.14 (95% confidence interval [CI], 1.06–4.34, p = 0.030)], digoxin use [HR 2.66 (95% CI, 1.15–6.14), p = 0.027], HF [HR 2.60 (95% CI, 1.32–5.09), p = 0.005], LVEF < 40% [HR 3.45 (95% CI, 1.00–11.85), p = 0.038], and decreased LVEF [HR 2.49 (95% CI, 1.18–5.25), p = 0.012]. Among them, HF showed clinical significance only by multivariate analysis [HR 3.01 (95% CI, 1.13–7.99), p = 0.027]. @*Conclusions@#Increased cardiac size, digoxin use, HF, LVEF < 40%, and decreased LVEF were related to failed ECV for persistent AF or AFL. Among these, HF was the most important risk factor. Further multi-center studies including greater number of participants are planned.

Hypertrophic cardiomyopathy with paroxysmal atrial fibrillation misdiagnosed as WPW syndrome

Hypertrophic cardiomyopathy (HCM) is associated with an increased incidence of Wolff–Parkinson–White (WPW) syndrome and atrial fibrillation. However, a delta-like wide QRS can be observed in the hypertrophied myocardium. When considering the rarity of the paraseptal bypass tract (BT), the normal QRS axis suggests a higher possibility of HCM origin. Otherwise, there is no known electrocardiographic clue indicating a wide QRS differentiation between HCM and WPW syndrome. Moreover, the atriofascicular, nodofascicular/ventricular or fasciculoventricular BT should be differentiated. In this case, atrioventricular conduction system incidental injury revealed a wide QRS origin from the HCM, but this method should be avoided except in some selected cases.

Hypertrophic cardiomyopathy with paroxysmal atrial fibrillation misdiagnosed as WPW syndrome

Hypertrophic cardiomyopathy (HCM) is associated with an increased incidence of Wolff–Parkinson–White (WPW) syndrome and atrial fibrillation. However, a delta-like wide QRS can be observed in the hypertrophied myocardium. When considering the rarity of the paraseptal bypass tract (BT), the normal QRS axis suggests a higher possibility of HCM origin. Otherwise, there is no known electrocardiographic clue indicating a wide QRS differentiation between HCM and WPW syndrome. Moreover, the atriofascicular, nodofascicular/ventricular or fasciculoventricular BT should be differentiated. In this case, atrioventricular conduction system incidental injury revealed a wide QRS origin from the HCM, but this method should be avoided except in some selected cases.

Short-Long R-R Sequence Induced Implantable Cardioverter Defibrillator Shock by Dislodged Lead Even Having Normal Interrogation Parameter

Inappropriate shocks from an implantable cardioverter defibrillator (ICD) can cause potentially dangerous ventricular arrhythmias and impaired quality of life. We describe a case in which a dislodged lead caused inappropriate ICD shocks through simultaneous sensing of atrial and ventricular signals. Interestingly, repeated short-long R-R sequences were recorded, but ICD interrogation parameters were usually unchanged.

Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock

Aortocaval fistula (ACF) occurs in < 1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

Reviews of Literature on Dental Plaque Control and Oral Hygiene Education in Korea / 치위생과학회지

The purpose of this study was to understand the effectiveness of oral health education (OHE) or oral hygiene instruction (OHI) involving professional plaque control/removal, as compared to conventional plaque control/removal. By means of a systematic review of the literature, in the review of literature by using systematic method, Korean articles of plaque control including OHE or OHI, were studied in order to analyze and conclude the literature to enhance oral health. We found that self and professional plaque control/removal, in addition to tooth brushing instructions, decreased incidence and prevalence of loss of teeth. Taken together, professional mechanical plaque removals were most effective 4~5 visits every 1~2 weeks. Use of disclosing agent was more effective than oral education or model education. In line with oral hygiene education, professional brushing, oral prophylaxis, scaling and root planing, it was advisable to repeat the training according to the characteristics of the patient. Routine OHE or OHI would be help to increase to oral health. For a quality of life related oral health, reliability and validity of data are needed to develop and its data should be applied to dental health insurance policy.

Local Atrial/Ventricular Ratio as an Adjuvant Marker for Catheter Ablation of Atrioventricular Accessory Pathways

BACKGROUND AND OBJECTIVES: The earliest atrial (A)/ventricular (V) activation potential, or accessory pathway (AP) potential are commonly used as ablation targets for atrioventricular (AV) APs. However, these targets are sometimes ambiguous. SUBJECTS AND METHODS: We reviewed 119 catheter ablation cases in 112 patients diagnosed with orthodromic atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Local A/V amplitude potentials with the earliest activation or AP potential were measured shortly before achieving antegrade AP conduction block, ventriculoatrial block during right ventricle (RV) pacing, or AVRT termination with no AP conduction. RESULTS: APs were located in the left lateral (55.5%), left posterior (17.6%), left posteroseptal (10.1%), midseptal (1.7%), right posteroseptal (7.6%), right posterior (1.7%), and right lateral (5.9%) regions. The mean earliest activation time was 16.7±15.5 ms, mean A/V potential was 1.1±0.9/1.0±0.9 mV, and mean A/V ratio was 1.7±2.0. There was no statistically significant difference between the activation methods (antegrade vs. RV pacing vs. orthodromic AVRT) or AP locations (left vs. right atrium). However, when the local A/V ratio was divided into 3 groups (≤0.6, 1.0±0.3, and ≥1.4), the antegrade approach resulted in an A/V ratio greater than 1.0±0.3 (86.7%, p=0.007), and the orthodromic AVRT state resulted in a ratio of less than 1.0±0.3 (87.5%, p<0.001). CONCLUSION: The mean local A/V potential and ratio did not differ by activation method or AP location. However, a different A/V ratio based on activation method (≥1.0±0.3, antegrade approach; and ≤1.0±0.3, orthodromic AVRT state) could be a good adjuvant marker for targeting AV APs.

Change in plaque control ability by the professional oral health care program / 대한구강보건학회지

OBJECTIVES: This study aimed to examine the impact of a regular professional oral health care program and the accompanying oral health education. METHODS: We included 552 patients who visited the C dental hospital more than 5 times as part of a regular professional oral health care program from January 2009 to March 2014. This program comprised of an O'Leary plaque control record, tooth brushing instructions, professional tooth brushing, professional tooth cleaning, periodontal or operative treatment (optional), and education on auxiliary devices. The O'Leary plaque control record was evaluated at the fifth consecutive visit, from the first visit to the recent visit. RESULTS: The study data revealed that patient plaque control rate significantly increased with a lapse in care provided from the baseline. However, no intergroup differences were observed with respect to age and sex. The plaque controlling ability of a patient who was educated on the Watanabe's brushing method, which was a combination of the Watanabe's brushing method and rolling method, was significantly increased. Use of an interdental brush, attending the 5-time tooth brushing instruction program, and tooth polishing aided to enhance the plaque-control rate. Further, the plaque control rate of a patient with a pontic, fully covered tooth and implant was significantly higher than those without the same. The Watanabe's brushing method, number of fully covered teeth, and number of implants were significant variables that impacted the final plaque control rate, as ascertained using multiple linear regression analysis. Increased plaque control rate was maintained till the recent evaluation from the fifth visit. CONCLUSIONS: The ability of patients to reduce plaque formation was improved after the educational program, which comprised of tooth brushing instructions as part of a regular professional oral health care program.

Evaluation of the validity of Qraycam for tooth examination during epidemiological surveys / 대한구강보건학회지

OBJECTIVES: The aim of this study was to evaluate applicability of the Qraycam device for detecting caries and filling body during tooth examinations. METHODS: Fifty-two subjects aged 25 to 34 years were recruited for tooth examination. Two examiners (an epidemiologic expert and a non-expert) performed visual tooth examination using only dental operating light, dental mirror, and air-drying without a dental explorer. Pictures or videos of every tooth surface were obtained under visual ray and 405 nm blue ray, respectively, by using Qraycam. The two examiners then evaluated these videos or images more than 7 days after visual examination. RESULTS: The results of the visual, visible ray image, and 405 nm blue ray image examinations showed very good kappa agreement with the gold standard for both examiners. The 405 nm blue ray image examination showed higher kappa agreement than visible ray image examination, and was similar to visual examination. Accuracy of detecting caries was enhanced by using 405 nm blue ray images from Qraycam. Accuracy of detecting filling body on 405 nm blue ray image examination was almost same as that by visual examination. CONCLUSIONS: Tooth examination with Qraycam images revealed high agreement with the gold standard and showed accuracy for detecting caries and filling body. Therefore, Qraycam would enhance the quality of oral epidemiologic survey including tooth examination and save cost and time of survey.

Mechanical Extraction of a Massive Intracoronary Thrombus from the Super-Dominant Right Coronary Artery in Thrombogenic Lung Cancer Patient

The congenital absence of the left circumflex artery and a compensatory super-dominant right coronary artery (RCA) is a very rare benign coronary anomaly in the clinic. The presence of a massive thrombus in the super-dominant RCA can lead to fatal results in cases of acute myocardial infarction, unless the thrombus is mechanically removed. Aspiration of the thrombus using a 6 Fr right Judkins guide catheter is useful to extract a massive thrombus and is both safe and effective. We report a case of complete revascularization of the super-dominant RCA after thrombus aspiration using a 6 Fr Judkins right catheter in a patient with acute inferior and inferolateral wall myocardial infarction.

Association of oral health status and related factors with oral health impact profile (OHIP-14) among patients in a dental hospital in Gwangju, Korea / 대한구강보건학회지

OBJECTIVES: The aim of this study was to determine the association between oral health status and oral health impact profile (OHIP-14) among patients undergoing treatment in a dental hospital, in order to develop an oral health care method for improving oral health related quality of life (OHRQoL). METHODS: A total of 980 patients aged 7-89 years were selected from a dental hospital between May 2011 and March 2014. Questionnaires on oral health impact profile (OHIP-14K) were distributed to the patients, and their dental records were examined to find out their oral health status. RESULTS: OHIP-14 scores of patients with periodontal pockets over 4 mm and presence of chronic general disease were significantly higher than those without pockets and chronic disease (P<0.05). Factors such as age, gender, having prosthesis or dental implant, regular oral health care over a period of 1 year were not significantly associated with OHIP-14 scores. CONCLUSIONS: Periodontal health status and chronic general disease could be factors associated with OHRQoL. Thus, improving oral symptoms through professional oral care may help improve OHRQoL.

Multiple Papillary Fibroelastomas and Thrombus in the Left Heart

Cardiac papillary fibroelastomas (CPF) are benign cardiac tumors and usually discovered incidentally during echocardiography. This report describes the case of a 68-year-old man, referred to cardiology for multiple masses of the left ventricle and left atrium. The transthoracic echocardiography revealed multiple oscillating masses in the left ventricle and aortic valve, non-mobile mass in the left atrium with severe mitral stenosis and moderate aortic regurgitation. The patient underwent surgical resection of the masses with valve replacements. Histopathologic examination confirmed the diagnosis of CPF in the left ventricle and aortic valve, thrombus in the left atrium.

Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult

Atrial septal defect [ASD] is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography [TEE] is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine [DEX], which is a highly selective a-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation

Comparison between the National Oral Health Survey Systems of the United States and South Korea / 대한구강보건학회지

In Korea, two kinds of National oral health surveys have been conducted to develop various oral health indices during the past decade. The system still needs to be improved further in terms of quality control for the examination system, data management, personnel empowerment, etc. Therefore, this study compares the National Oral Health Survey system of the United States (US) with that of South Korea. The US national surveys related to oral health were set from the 1970s, whereas Korea's national surveys have been initiated only recently; consequently, the US system is well organized and systematically managed by the professional personnel in governmental institutes, such as the Division of Oral Health in Centers for Disease Control. Furthermore, this study examines the scope of the examiner training program, and the methods for developing and implementing a standardized examination environment, data quality control, a data input system with automatic error checking, and data back up in the US. Considering the various factors involved in conducting nationwide epidemiological surveys as mentioned above, the structure and implementation methods of oral surveys in Korea clearly need to be improved.

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.

Clinical outcomes between different stent designs with the same polymer and drug: comparison between the Taxus Express and Taxus Liberte stents

BACKGROUND/AIMS: The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. METHODS: Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. RESULTS: The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). CONCLUSIONS: In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.

Neutrophil to Lymphocyte Ratio Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. SUBJECTS AND METHODS: We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR6.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. RESULTS: The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). CONCLUSION: The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.

Prevalence of dentine hypersensitivity in a dental hospital / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to develop a dentine hypersensitivity (DH) manual for a dental hospital. METHODS: The records of all DH patients who presented between 2005 to 2010 were analyzed to determine their age group, awareness of DH, and DH distribution before and after dental treatment. RESULTS: Out of 953,272 patients, data of 4,646 were analyzed. The male to female ratio of DH patients was found to be 1:1:1. The prevalence of DH was highest in patients in the age group of 40-49 years. The DH awareness rate was high to time, temperature and after dental treatment factor in the middle-age group. CONCLUSIONS: Since DH is widely prevalent and common, systematic screening is essential to ensure good oral health.

Low Pressure Pulmonary Artery Aneurysm with Atrial Septal Defect

Pulmonary artery (PA) aneurysm is a rare finding in the thoracic cavity, accompanied by pulmonary hypertension. Clinical presentation of PA aneurysms is usually asymptomatic. The guideline for PA aneurysm treatment is unclear. We report an unusual case of low pressure PA aneurysm associated with atrial septal defect in a 69-year-old man.

Prevalence of demand for dentures in Korean elderly receiving governmental support funds / 대한구강보건학회지

OBJECTIVES: This study was conducted to investigate the status of elderly dentures wearers and to understand the relationship between elderly welfare recipients and general elderly Koreans. METHODS: A total of 3,810 subjects (3,458 general elderly and 352 elderly welfare recipients) over 65 years who participated in the Forth Korea National Health and Nutrition Examination Survey were examined. Oral examinations were conducted to ascertain those that were wearing dentures and those that needed dentures. A questionnaire measured chewing ability, concern about oral health, oral health behaviors, pronunciation ability and socio-demographic characteristics. The statistical analysis was done by using the SPSS 19.0 program. RESULTS: In the elderly welfare recipients, 28.2% was maxillary and 19.2% was mandible complete dentures and 36.0% had unmet denture treatment needs. In the general elderly, 21.7% was maxillary and 13.9% was mandible complete dentures and 24.3% had unmet denture treatment needs. The unmet denture treatment need in elderly welfare recipients was significantly higher than the general elderly after adjusting for other covariates. CONCLUSIONS: A denture service program is necessary for the elderly welfare recipients' oral health.