ABSTRACT
Rhythm control therapy is used in atrial fibrillation (AF) management to improve AF-related symptoms along with rate control. AF catheter ablation is effective in maintaining sinus rhythm and has an acceptable complication rate. Compared with antiarrhythmic drugs, AF catheter ablation is superior with respect to arrhythmia-free survival and improvement in the quality of life. Therefore, AF ablation is recommended for rhythm control after the failure of antiarrhythmic drugs and is sometimes considered a first-line therapy for AF patients. Radiofrequency and cryoballoon ablation show similar efficacy, with slightly different complication profiles. Surgery for AF is also an effective rhythm control therapy and should be considered in patients undergoing cardiac surgery or in those with failed catheter ablation. For patients undergoing AF catheter ablation, performing ablation under uninterrupted warfarin or non-vitamin K oral anticoagulant treatment is recommended for periprocedural stroke risk management. Here, we review existing data and discuss the general principles of AF catheter and surgical ablation in patients with AF.
ABSTRACT
Objective@#With the recent development of various MRI-conditional cardiac implantable electronic devices (CIEDs), the accurate identification and characterization of CIEDs have become critical when performing MRI in patients with CIEDs. We aimed to develop and evaluate a deep learning-based algorithm (DLA) that performs the detection and characterization of parameters, including MRI safety, of CIEDs on chest radiograph (CR) in a single step and compare its performance with other related algorithms that were recently developed. @*Materials and Methods@#We developed a DLA (X-ray CIED identification [XCID]) using 9912 CRs of 958 patients with 968 CIEDs comprising 26 model groups from 4 manufacturers obtained between 2014 and 2019 from one hospital. The performance of XCID was tested with an external dataset consisting of 2122 CRs obtained from a different hospital and compared with the performance of two other related algorithms recently reported, including PacemakerID (PID) and Pacemaker identification with neural networks (PPMnn). @*Results@#The overall accuracies of XCID for the manufacturer classification, model group identification, and MRI safety characterization using the internal test dataset were 99.7% (992/995), 97.2% (967/995), and 98.9% (984/995), respectively. These were 95.8% (2033/2122), 85.4% (1813/2122), and 92.2% (1956/2122), respectively, with the external test dataset. In the comparative study, the accuracy for the manufacturer classification was 95.0% (152/160) for XCID and 91.3% for PPMnn (146/160), which was significantly higher than that for PID (80.0%,128/160; p < 0.001 for both). XCID demonstrated a higher accuracy (88.1%; 141/160) than PPMnn (80.0%; 128/160) in identifying model groups (p < 0.001). @*Conclusion@#The remarkable and consistent performance of XCID suggests its applicability for detection, manufacturer and model identification, as well as MRI safety characterization of CIED on CRs. Further studies are warranted to guarantee the safe use of XCID in clinical practice.
ABSTRACT
The choice of an adequate antithrombotic regimen for atrial fibrillation patients undergoing emergent or elective percutaneous coronary intervention (PCI) should be based on the ischemic event and on the risk of bleeding. Recent randomized controlled trials have consistently demonstrated that dual antithrombotic therapeutic regimens, using non-vitamin K anticoagulants and clopidogrel, are superior to triple or dual therapy with warfarin and aspirin. This report incorporates findings of recent notable studies to provide concrete, clinically useful details and recommendations for bleeding risk assessment and optimal antithrombotic therapeutic strategies after PCI. In addition, we introduce guidelines for antithrombotic management after structural heart disease intervention.
Subject(s)
Humans , Anticoagulants , Aspirin , Atrial Fibrillation , Heart Diseases , Heart , Hemorrhage , Percutaneous Coronary Intervention , Risk Assessment , WarfarinABSTRACT
Although non-vitamin K-antagonist oral anticoagulants (NOACs) reduce major bleeding events in patients with atrial fibrillation more effectively than does warfarin, a significant bleeding risk remains. Patients exhibiting current bleeding and those who are expected to bleed require appropriate management, because NOAC discontinuation may increase the thromboembolic risk. This article details general management principles for patients experiencing current bleeding and those undergoing invasive surgery while on NOACs.
Subject(s)
Humans , Anticoagulants , Atrial Fibrillation , Heart , Hemorrhage , Perioperative Care , WarfarinABSTRACT
BACKGROUND/AIMS@#Although brachial-ankle pulse wave velocity (baPWV) has been validated as a novel method to predict the cardiovascular risk in general population, the relevance of baPWV to the traditional risk scores has not been clearly revealed. This study investigated the relationship between baPWV and four different cardiovascular risk-predicting scores in men and women.@*METHODS@#A total of 539 subjects (58.1 ± 12.2 years, 50.1% men) without cardiovascular disease (CVD) who underwent health examinations including baPWV measurement were retrospectively analyzed. Four cardiovascular risk scores (Framingham risk score [FRS; 1998], Adult Treatment Panel [ATP] III revised FRS [2002], generalized FRS [2008], and American College of Cardiology/American Heart Association [ACC/AHA] CVD risk [2013]) were calculated in each subject.@*RESULTS@#In a total population, baPWV was moderately correlated with four cardiovascular risk scores (r = 0.577 for FRS; r = 0.594 for ATP III revised FRS; r = 0.589 for generalized FRS; r = 0.571 for ACC/AHA CVD risk; p < 0.001 for each). These correlations were stronger in women than in men (r = 0.649 vs. 0.451 for FRS; r = 0.719 vs. 0.411 for ATP III revised FRS; r = 0.735 vs. 0.540 for generalized FRS; r = 0.699 vs. 0.552 for ACC/AHA CVD risk; p for gender difference ≤ 0.005 for each).@*CONCLUSIONS@#In middle-aged and elderly Koreans without CVD, baPWV was identified as having a moderately positive correlation with four different risk scores. The correlation was stronger in women than in men, implying the better performance of baPWV in women for predicting cardiovascular risk of healthy population.
ABSTRACT
Although non-vitamin K-antagonist oral anticoagulants (NOACs) reduce major bleeding events in patients with atrial fibrillation more effectively than does warfarin, a significant bleeding risk remains. Patients exhibiting current bleeding and those who are expected to bleed require appropriate management, because NOAC discontinuation may increase the thromboembolic risk. This article details general management principles for patients experiencing current bleeding and those undergoing invasive surgery while on NOACs.
ABSTRACT
The choice of an adequate antithrombotic regimen for atrial fibrillation patients undergoing emergent or elective percutaneous coronary intervention (PCI) should be based on the ischemic event and on the risk of bleeding. Recent randomized controlled trials have consistently demonstrated that dual antithrombotic therapeutic regimens, using non-vitamin K anticoagulants and clopidogrel, are superior to triple or dual therapy with warfarin and aspirin. This report incorporates findings of recent notable studies to provide concrete, clinically useful details and recommendations for bleeding risk assessment and optimal antithrombotic therapeutic strategies after PCI. In addition, we introduce guidelines for antithrombotic management after structural heart disease intervention.
ABSTRACT
BACKGROUND: Although coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA), there has been no convinced data on the necessity of routine invasive coronary angiography (ICA) in OHCA. We investigated clinical factors associated with obstructive CAD in OHCA. METHODS: Data from 516 OHCA patients (mean age 58 years, 83% men) who underwent ICA after resuscitation was obtained from a nation-wide OHCA registry. Obstructive CAD was defined as the lesions with diameter stenosis ≥ 50% on ICA. Independent clinical predictors for obstructive CAD were evaluated using multiple logistic regression analysis, and their prediction performance was compared using area under the receiver operating characteristic curve with 10,000 repeated random permutations. RESULTS: Among study patients, 254 (49%) had obstructive CAD. Those with obstructive CAD were older (61 vs. 55 years, P < 0.001) and had higher prevalence of hypertension (54% vs. 36%, P < 0.001), diabetes mellitus (29% vs. 21%, P = 0.032), positive cardiac enzyme (84% vs. 74%, P = 0.010) and initial shockable rhythm (70% vs. 61%, P = 0.033). In multiple logistic regression analysis, old age (≥ 60 years) (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36–3.00; P = 0.001), hypertension (OR, 1.74; 95% CI, 1.18–2.57; P = 0.005), positive cardiac enzyme (OR, 1.72; 95% CI, 1.09–2.70; P = 0.019), and initial shockable rhythm (OR, 1.71; 95% CI, 1.16–2.54; P = 0.007) were associated with obstructive CAD. Prediction ability for obstructive CAD increased proportionally when these 4 factors were sequentially combined (P < 0.001). CONCLUSION: In patients with OHCA, those with old age, hypertension, positive cardiac enzyme and initial shockable rhythm were associated with obstructive CAD. Early ICA should be considered in these patients.
Subject(s)
Humans , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Diabetes Mellitus , Heart Arrest , Hypertension , Logistic Models , Out-of-Hospital Cardiac Arrest , Prevalence , Resuscitation , Risk Factors , ROC CurveABSTRACT
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.
Subject(s)
Humans , American Heart Association , Anticoagulants , Arrhythmias, Cardiac , Asia , Atrial Fibrillation , Cardiology , Consensus , Heart , Mass Screening , Risk Factors , StrokeABSTRACT
OBJECTIVE: Unrecognized left main coronary artery disease (LMCD) is often fatal; however, accuracy of non-invasive tests for diagnosing LMCD is still unsatisfactory. This study was performed to elucidate single-photon emission computed tomography (SPECT) detection of LMCD using quantitative coronary angiography (QCA) data. MATERIALS AND METHODS: Fifty-five patients (39 men; mean age, 68.1 ± 10.9 years) diagnosed with significant left main (LM) stenosis (≥ 50%) by invasive coronary angiography (ICA) were retrospectively reviewed. All study patients underwent SPECT with pharmacologic stress within 30 days of ICA. All coronary lesions were quantified via QCA, and SPECT findings were compared with QCA results. RESULTS: Only four patients (7.3%) had isolated LMCD; all others had combined significant stenosis (≥ 70%) of one or more other epicardial coronary arteries. Patients with more severe coronary artery disease tended to have higher values for summed difference scores in a greater number of regions, but the specific pattern was not clearly defined. Summed stress score of SPECT did not differ according to LM stenosis severity. Only three patients (5.4%) had a typical LM pattern of reversible perfusion defect on SPECT. A significant negative linear correlation between stenosis severity and stress perfusion percent was found in the left anterior descending artery region (r = −0.455, p < 0.001) but not in the left circumflex artery. CONCLUSION: Single-photon emission computed tomography findings were heterogeneous, not specific and poorly correlated to QCA data in patients with significant LMCD. This may be due to highly prevalent significant stenosis of other epicardial coronary arteries.
Subject(s)
Humans , Male , Arteries , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Myocardial Ischemia , Perfusion , Retrospective Studies , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-PhotonABSTRACT
This erratum is being published to correct the printing error on Table 5 of the article.
ABSTRACT
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. This guideline is based on recent data of the Korean population and the recent guidelines of the European Society of Cardiology, European Association for Cardio-Thoracic Surgery, American Heart Association, and Asia Pacific Heart Rhythm Society. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF. This guideline deals with optimal stroke prevention, screening, rate and rhythm control, risk factor management, and integrated management of AF.
ABSTRACT
Atrial fibrillation (AF) is the most common cardiac abnormality associated with ischemic stroke. Anticoagulant therapy plays an important role in the prevention of stroke associated with AF. Risk stratification and selection of oral anticoagulants in patients with AF are usually performed according to international guidelines from Europe or the United States of America. However, pivotal trials enrolled only a small number of Asian subjects, limiting the application of international guidelines to Korean patients with AF. The Korean Heart Rhythm Society organized a Korean AF Management Guideline Committee and analyzed all available studies regarding the management of AF, including studies on Korean patients. Expert consensus or guidelines for the optimal management of Korean patients with AF were achieved after a systematic review with intensive discussion. This article provides general principles for appropriate risk stratification and selection of anticoagulation therapy in Korean patients with AF.
Subject(s)
Humans , Americas , Anticoagulants , Asian People , Atrial Fibrillation , Consensus , Embolism and Thrombosis , Europe , Heart , Stroke , United StatesABSTRACT
Atrial fibrillation (AF) is characterized by irregular and relatively rapid heart rate, which occasionally causes symptoms such as palpitations, dyspnea, or reduced exercise capacity. Controlling the ventricular rate is a mainstay for the symptom management of patients with AF. Rate control can be achieved with beta-blockers, non-dihydropyridine calcium channel blockers, digoxin, or combination therapy. Rhythm control is an option for patients in whom appropriate rate control cannot be achieved or who have persistent symptoms despite rate control. The choices of drug and target heart rate are usually specified by international guidelines for AF management. However, pivotal trials included in those guidelines enrolled only a small number of Asian subjects, which limit application of those guidelines to a Korean population. The Korean Heart Rhythm Society organized the Korean AF Management Guideline Committee and analyzed all available studies regarding management of AF including studies with Korean patients. Then, expert consensus or guidelines for optimal management in Korean patients with AF were achieved after systematic review with intensive discussion. This article provides general principles for rate control therapy in Korean patients with AF.
Subject(s)
Humans , Asian People , Atrial Fibrillation , Calcium Channel Blockers , Consensus , Digoxin , Dyspnea , Heart Rate , HeartABSTRACT
BACKGROUND: Herpes zoster (HZ) is a chronic inflammatory disease that could result in autonomic dysfunction, often leading to atrial fibrillation (AF). METHODS: From the Korean National Health Insurance Service database of 738,559 subjects, patients newly diagnosed with HZ (n = 30,685) between 2004 and 2011, with no history of HZ or AF were identified. For the non-HZ control group, 122,740 age- and sex-matched subjects were selected. AF development in the first two-years following HZ diagnosis, and during the overall follow-up period were compared among severe (requiring hospitalization, n = 2,213), mild (n = 28,472), and non-HZ (n = 122,740) groups. RESULTS: There were 2,204 (1.4%) patients diagnosed with AF during follow-up, and 825 (0.5%) were diagnosed within the first two years after HZ. The severe HZ group showed higher rates of AF development (6.4 per 1,000 patient-years [PTPY]) compared to mild-HZ group (2.9 PTPY) and non-HZ group (2.7 PTPY). The risk of developing AF was higher in the first two-years after HZ diagnosis in the severe HZ group (10.6 PTPY vs. 2.7 PTPY in mild-HZ group and 2.6 PTPY in non-HZ group). CONCLUSION: Severe HZ that requires hospitalization shows an increased risk of incident AF, and the risk is higher in the first two-years following HZ diagnosis.
Subject(s)
Humans , Atrial Fibrillation , Case-Control Studies , Diagnosis , Follow-Up Studies , Herpes Zoster , Hospitalization , Inflammation , National Health ProgramsABSTRACT
Double right coronary arteries (RCA) are very rare congenital anomalies of coronary artery. We report a case of double RCA with total occlusion, incidentally found by collateral flows. A 71-year-old patient underwent percutaneous coronary intervention of left coronary arteries for angina, and the presence of double RCA was missed at initial coronary angiography (CAG). About 20 months later, second CAG was performed due to recurrent angina, and the CAG showed newly developed collateral flow suggesting the presence of the other missed RCA. There was a total occlusion at missed RCA and the lesion was successfully revascularized with drug eluting stent. If there was no collateral flow, the other RCA could not be found and its critical lesion could not be managed properly. Our case suggests that collateral flow can be a useful clue in detecting coronary anomaly. Besides, it is important to fully understand coronary anatomy, not to miss uncommon coronary lesion.
Subject(s)
Aged , Humans , Acute Coronary Syndrome , Coronary Angiography , Coronary Vessels , Heart Defects, Congenital , Percutaneous Coronary Intervention , StentsABSTRACT
Stent migration and loss are rare but can be devastating complications during percutaneous coronary intervention (PCI) for coronary artery disease. We report a unique case of wandering stent from the right coronary artery to the femoral artery via the axillary artery. Initially, the stent was stripped from the delivery catheter and embolized to axillary artery during emergent PCI. An intra-aortic balloon pump might have forced retrograde movement of the stent to axillary artery which have subsequently remobilized to the femoral artery. After stabilization, the stent was successfully removed by a percutaneous approach using a snare. Immediate retrieval of wandering stent is recommended for the prevention of secondary embolization.
Subject(s)
Axillary Artery , Catheters , Coronary Artery Disease , Coronary Vessels , Drug-Eluting Stents , Embolism , Femoral Artery , Percutaneous Coronary Intervention , SNARE Proteins , StentsABSTRACT
A 68-year-old woman visited the emergency department twice with symptoms of acute heart failure including shortness of breath, general weakness, and abdominal distension. Laboratory findings showed extremely low level of serum hemoglobin at 1.4 g/dL. Echocardiographic examination demonstrated dilated left ventricular cavity with systolic dysfunction and moderate amount of pericardial effusion. In this patient, acute heart failure due to severe iron deficiency anemia was caused by inappropriate habitual bloodletting.
Subject(s)
Aged , Female , Humans , Anemia , Anemia, Iron-Deficiency , Bloodletting , Dyspnea , Echocardiography , Emergency Service, Hospital , Heart Failure , Heart , Iron , Pericardial EffusionABSTRACT
Along with the development of innovative stent designs, preclinical trials in animal models are essential. Many animal models have been used and appear to yield comparable results to clinical trials despite substantial criticisms about their validity. Among the animal models, porcine coronary artery models have been the standard models for the preclinical evaluation of endovascular devices. However, rapid growth rate, high body weight potential, and the propensity to develop granulomatous inflammatory reactions are major limitations of the porcine coronary artery model. Compared with porcine coronary artery models, the comparative rabbit iliac artery model has the advantages of being small and easy to handle and relatively inexpensive. Furthermore, the rabbit model has been known to reliably reflect human restenosis histopathologically and have major advantages such as pairwise comparison, which makes each animal serve as its own control subject, therefore, maximizing its statistical power for comparative testing. However, despite the widespread use of this model, a systematic description of the procedure and harvest protocols has never been published. This article describes the surgical procedure, stent implantation procedure, method for tissue harvesting, and how measurements are performed. Although the results of animal models may not perfectly extrapolate to humans, the comparative rabbit iliac artery model may be a useful tool for assessing and comparing the efficacy of new coronary stents with conventional stent systems. This thorough description of the techniques required for vascular access, stent implantation, tissue preparation, and measurement, should aid investigators wishing to begin using the comparative rabbit iliac artery model.
Subject(s)
Animals , Humans , Rabbits , Body Weight , Coronary Vessels , Iliac Artery , Models, Animal , Research Personnel , Stents , Tissue and Organ HarvestingABSTRACT
OBJECTIVE: To evaluate the relationship between the cross sectional area (CSA) and isokinetic strength of the back muscles in patients with chronic low back pain. METHOD: Data of twenty-eight middle-aged patients with chronic back pain were analyzed retrospectively. CSAs of both paraspinal muscles and the disc at the L4-L5 level were measured in MRI axial images and the relative CSAs (rCSA: CSA ratio of muscle and disc) were calculated. The degree of paraspinal muscle atrophy was rated qualitatively. Isokinetic strengths (peak torque, peak torque per body weight) of back flexor and extensor were measured with the isokinetic testing machine. Multiple regression analysis with backward elimination was used to evaluate relations between isokinetic strength and various factors, such as CSA or rCSA and clinical characteristics in all patients. The same analysis was repeated in the female patients. RESULTS: In analysis with CSA and clinical characteristics, body mass index (BMI) and CSA were significant influencing factors in the peak torque of the back flexor muscles. CSA was a significant influencing factor in the peak torque of total back muscles. In analysis with rCSA and clinical characteristics, BMI was significant in influencing the peak torque of the back flexors. In female patients, rCSA was a significant influencing factor in the peak torque per body weight of the back flexors, and age and BMI were influencing factors in the peak torque of back flexors and total back muscles. CONCLUSION: In middle-aged patients with chronic low back pain, CSA and rCSA were influencing factors in the strength of total back muscles and back flexors. Also, gender and BMI were influencing factors.