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2018 대한부정맥학회 심실빈맥 전극도자 절제술 가이드라인 Part 1
노승영,김성환,김윤년,김주연,김준,김태훈,남기병,박경민,박형섭,박희남,배은정,오세일,윤남식,이만영,조영진,조용근,진은선,차태준,최종일,Yoo Ri Kim 대한부정맥학회 2018 International Journal of Arrhythmia Vol.19 No.2
Ventricular arrhythmias (VA) are a major cause of sudden cardiac death (SCD) in patients with known heart disease. Risk assessment and effective prevention of SCD are key issues in these patients. Implantable cardioverter defibrillator (ICD) insertion effectively treats sustained VA and reduces mortality in patients at high risk of SCD. Appropriate anti-arrhythmic drugs and catheter ablation reduce the VA burden and the occurrence of ICD shocks. In this guideline, authors have described the general examination and medical treatment of patients with VA. Medications and catheter ablation are also used as acute phase therapy for sustained VA.
노승영,심재민,이광노,안진희,김동혁,이대인,최종일,김영훈 대한심장학회 2018 Korean Circulation Journal Vol.48 No.7
Background and Objectives Previous studies provided controversial result about gender differences in the clinical outcome after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We assessed pure difference after adjustment of referral bias. Methods The clinical outcomes including freedom from AF/atrial tachycardia (AT) recurrence after RFCA were compared between women and men in 1:1 confounding factor matching with age, AF type, periods since diagnosis (±12 months), and procedure era (±12 months). Subgroup analysis was performed in categories defined by AF type and age of 55 (mean menopausal age of Asian women). Results Total 1,875 patients with AF underwent 2,307 RFCA between January 1998 and May 2014 in a single center. Total 367 women (19.6%, 59±10 years) who had undergone first ablation were included. Women had larger left atrial diameter index (26±4 vs. 23±4 mm/m2; p<0.001) and higher peri-procedural complications (9.2% vs. 4.9%; p=0.030) compared to men. The freedom from AF/AT recurrence after RFCA was not different between both groups (71% vs. 76%; log-rank p=0.131, mean follow-up of 55 months). Women with non-paroxysmal AF (PAF) had significantly worse outcome (54% vs. 69%; p=0.014), especially in subgroup with age ≤55 (48% vs. 71%; p=0.010). In multivariate analysis, female gender was an independent predictor of recurrence in subgroup with non-PAF and age ≤55 (hazard ratio [HR], 2.539; 95% confidence interval [CI], 1.112–5.801; p=0.027). Conclusions The clinical outcome after RFCA was not different between both genders regardless of referral bias. However, the gender difference became evident in patients under 55 years with non-PAF.
증례 : 순환기 ; 영구적 심장 박동 조율기 이식 후의 재발성 리드(lead) 파손(fracture)과 완전 이탈 1예
노승영 ( Seung Eung Roh ),박희남 ( Hui Nam Park ),김지박 ( Ji Bak Kim ),문재영 ( Jae Young Moon ),이광노 ( Kwnag No Lee ),김영훈 ( Young Hoon Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6
우리는 완전 방실 차단 환자에서 반복적으로 발생한 유도절단과 이탈을 확인하였으며, 그 이유로 환자가 버스 운전을 하면서 과도하게 팔을 움직인 것과 삽입시 접근 방법을 생각해 볼 수 있었다. 새로운 유도를 겨드랑이 정맥 접근법으로 삽입하고 직업을 교체함으로써 문제는 해결되었다. With the increased use of implantable cardiac devices, the incidence of hardware problems has also increased. Some of the hardware problems might be induced by patient factors. We experienced recurrent pacemaker lead fracture and dislocation after permanent pacemaker implantation. The patient was a bus driver who used his left arm vigorously when he turned the steering wheel. After a new lead was inserted via an axillary vein approach and the patient changed his occupation, no more lead problems have occurred. When a recurrent hardware problem with an implantable pacemaker or defibrillator occurs, patient factors related to anatomy or behavior must be considered. (Korean J Med 78:747-750, 2010)