Mode of Onset of Paroxysmal Atrial Fibrillation during 24 hour Holter Monitoring

BACKGROUND: Paroxysmal atrial fibrillation (PAF) causes not only severe symptoms and hemodynamic changes, but may progress to chronic atrial fibrillation. Autonomic nervous system or atrial premature beat (APB) has been suggested to contribute to the spontaneous initiation of PAF, but the exact mechanism has been largely unknown. METHODS: One hundred and twenty nine episodes of PAF lasting longer than 5 sec were analyzed in 18 patients (M:F=11:?). Two minutes of normal sinus rhythm before the onset of PAF, and the initial one minute of PAF were printed and analyzed. RESULTS: Most of PAFs were initiated by APBs (38%) or rapid atrial tachycardias (AT, 59%). The frequency of APBs tended to increase immediately before PAF onset (p=0.08). The coupling intervals and coupling indices were not significantly different between PAF-producing APBs and benign APBs. More than half of PAF episodes were initiated by rapid ATs (rate, 357+/-50 bpm). After the onset, they accelerated over several seconds and then degenerated into AF. In some cases, transition from AF to atrial flutter and vice versa were observed. Heart rate, measured at 60-second intervals during 2 minutes before PAF onset, did not change significantly (p=0.44). CONCLUSION: Most of PAFs were initiated by APBs or rapid ATs. Heart rate did not change significantly but the frequency of APBs tended to increase immediately before PAF onset. Rapid ATs frequently accelerated and degenerated into AF. In this regard, Holter monitoring could be useful in identifying patients with PAF triggered by rapid ATs.

A Case of Adult Intussusception of the Colon Caused by Leiomyoma / 대한소화기내시경학회지

Adult intussusception represents 1% of patients with bowel obstruction and 5% of all intussusception. It presents with a variety of acute, intermittent and chronic symptoms, thus making its preoperative diagnosis is difficult. Overall, colonic intussusception in adults is most often related to a primary carcinoma and benign smooth muscle tumors of the gastrointestinal tract are uncommon. We experienced a case of adult intussusception of the colon caused by leiomyoma. The 18-year old man was suffered from intermittent, colicky left lower quadrant pain and bloody diarrhea. Physical examination revealed a mass in the left lower abdomen. An abdominal CT scan revealed a "target mass" in the distal colon. The patient was treated with segmental resection of the descending colon and anastomosis. Pathology revealed a benign leiomyoma of the distal colon as the leading point of the colo-colic intussusception. His postoperative course was uneventful and did well.