Gender Difference in Patients with Recurrent Neurally Mediated Syncope

박정왜,장신이,임혜란,온영근,허준,신대희,김준형,김준수 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.4

Purpose: The gender difference of neurally mediated syncope is not well defined in a large patient population. The aim of this study was to evaluate the gender difference of clinical manifestations in patients with neurally mediated syncope who underwent head-up tilt test. Materials and Methods: The medical records of 1,051 consecutive patients with two or more episodes of syncope, who were diagnosed as having neurally mediated syncope by head-up tilt test, were retrospectively reviewed. Results: Of 1,051 patients, 497 (47.3%) patients were male and 554 (52.7%) patients were female. Female patients were experiencing syncopal episodes for longer periods of their lives (8.2 ± 9.5 years vs. 6.8 ± 9.2years, p = 0.002) and more episodes of syncope prior to head-up tilt test (HUT)(7.2 ± 9.4 vs. 5.0 ± 6.4, p = 0.001) than male patients. Micturition syncope (20.0% vs. 5.2%, p < 0.001) was observed more frequently in male patients than in female patients. To the contrary, however, defecation syncope (16.3% vs. 9.3%, p < 0.001) was observed more frequently in female patients than in male patients. Conclusion: Female patients were experiencing syncopal episodes for longer periods of their lives and more episodes of syncope than male patients. Gender difference was also noted with regard to frequency of situational syncope.

원인 불명의 실신 환자에서 Implantable Loop Recorder의 임상 경험

신대희,김준수,박정왜,임혜란,김준형,이선미,김기선,이창희,정동채,온영근,김덕경,이상훈,홍경표,박정의 대한심장학회 2008 Korean Circulation Journal Vol.38 No.4

Background and Objectives: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope. Subjects and Methods: Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55±17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR. Results: During a follow-up period of 8.8±7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted. Conclusion: ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope. Background and Objectives: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope. Subjects and Methods: Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55±17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR. Results: During a follow-up period of 8.8±7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted. Conclusion: ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope.

시간경과에 따른 전극도자 임피던스의 변화:심방과 심실 전극도자의 차이

최유정,김준수,박정왜,유철웅,이일,박만기,조대경,김선운,이경진,이상훈,홍경표,박정의 대한심장학회 2005 Korean Circulation Journal Vol.35 No.6

Comparison of Recurrence Rate Based on the Frequency of Preceding Symptoms in Patients With Neurocardiogenic Syncope or Presyncope

이선미,오혜림,김준수,박정왜,임혜란,신대희,온영근,이상훈 대한심장학회 2011 Korean Circulation Journal Vol.41 No.8

Background and Objectives: In patients with neurocardiogenic syncope or presyncope, symptoms developed unpredictably and intermittently. The purpose of this study was to determine whether there was any significant difference in the recurrence rate of symptoms during the follow-up period between patients with many episodes of symptoms and those with fewer episodes of symptoms before diagnosis, as well as to assess the clinical significance of previous episodes of symptoms during treatment. Subjects and Methods: A total of 100 patients with neurocardiogenic syncope or presyncope were divided in two groups (high episode group, n=54; low episode group, n=46) according to the frequency of symptoms before the head-up tilt test. We retrospectively analyzed the recurrence of symptoms using telephone interviews and medical record reviews. Results: The clinical characteristics were not significantly different between the two groups. However, the recurrence rate was significantly lower in the high episode group than in the low episode group (5.6% vs. 19.6%, p=0.001). In the high episode group, patients treated with medication showed higher recurrence of symptoms than those without medication. In the lower episode group, a similar result was observed. Conclusion: The frequency of previous symptoms at the diagnosis of neurocardiogenic syncope or presyncope did not predict the occurrence of symptoms during the follow-up period. Therefore, to continue drug treatment based on the frequency of symptoms in patients with neurocardiogenic syncope or presyncope may not be the best option.

Electrical Storms in Patients with an Implantable Cardioverter Defibrillator

Pil Sang Song,June Soo Kim,신대희,박정왜,배기인,이창희,정동채,류동렬,온영근 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.1

Purpose: In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD. Materials and Methods: Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours. Results: Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 ± 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027). Conclusion: ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.

심장신경성 실신 환자에서 기립경사 훈련의 장기추적결과

김제상,김준수,김성해,백경기,이선미,박정왜,최진호,성지동,이상철,박승우,권현철,전은석,김덕경,이상훈,홍경표,박정의 대한심장학회 2004 Korean Circulation Journal Vol.34 No.8

Background and Objectives:Tilt training as a non pharmacological therapy was recently introduced to treat the patients with neurocardiogenic syncope. Tilt training has been known to prevent neurocardiogenic syncope by desensitizing abnormal autonomic reflex. Herein, the early effect of tilt training and the preventive effect on the relapse of syncope were studied during a long-term follow-up period. Subjects and Methods:Fifteen patients (11 males) who experienced recurrent syncope, despite drug treatment or were intolerant to drug treatment, among those diagnosed as neurocardiogenic syncope by the head-up tilt test at Samsung Medical Center between March 2000 and May 2003 were recruited. Each patient underwent tilt training after admission and was educated to continue self-tilt training after discharge. Data for recurrences after discharge were obtained via questionnaires on outpatient visits or by telephone interviews. Results:Eleven (73%) of the 15 who underwent tilt training on admission showed therapeutic effects. The mean follow-up period was 21±10 months (5-40 months). Only one patient was excluded due to follow-up loss. Ten of the above patients underwent training by themselves for an average of 4 months after discharge, and experience no relapse of syncope during the follow-up period. Conclusion:Tilt training maintained its therapeutic effect during long-term follow-up. This could be a new treatment for patients non responsive or intolerant to medical therapy. 배경 및 목적:기립경사 훈련은 심장신경성 실신 환자의 비약물적 치료방법으로 임상에 도입되었으며, 비정상적 자율신경반사를 억제하여 실신을 예방한다고 알려져 있다. 이에 저자들은 기립경사 훈련의 초기치료효과와 장기간 추적관찰시 재방지 효과를 알아보고자 본 연구를 수행하였다. 방 법:2000년 5월부터 2003년 3월까지 본원에서 약물치료에 반응하지 않거나 약물치료에 순응하지 못하는 환자 15명(남자 10명, 여자 5명)을 대상으로 하여 기립경사훈련을 시행하였다. 각각의 환자들은 입원시 시행한 것과 마찬가지로 퇴원 후에도 자가 훈련을 하도록 하였다. 자가훈련에 대한 평가는 외래 방문시에 확인하는 것 이외에 전화면담을 통해서 하였다. 결 과: 입원시 대상환자 15명 중 11명에서 치료효과를 나타내었으며, 추적관찰기간은 평균 21개월이었다. 1명의 환자가 추적관찰이 되지 않아 제외되었으며 10명의 환자는 퇴원 후 평균 4개월동안 스스로 기립경사훈련을 시행하였고 추적관찰기간 중에 실신의 재발을 경험한 환자는 없었다. 결 론: 기립경사훈련은 장기간 추적관찰 중 치료효과를 나타내며, 약물치료 등의 일반적인 치료를 대체할 수 있는 새로운 치료법이라고 생각된다.