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D.D.D. 형 인공심박동기 시술 환자에서 심방심실 연속자극간격 변화가 수축기와 이완기에 미치는 영향
이만영(Man Young Lee),승기배(Ki Bae Seung),전승석(Seung Sok Chun),채장성(Jang Seong Chae),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1992 대한내과학회지 Vol.43 No.2
Background: Although the duration of the atrioventricular delay is known to affect ventricular diastolic filling time, the hemodynamic effects have been controversial. Several recent studies attempted to clarify the issue of optimal AV delay and have come to different conclusions. So we performed this study to evaluate the hemodynamic effects of varying A-V delays in A-V sequential pacing by echocardiography. Methods: 9 patients of this study had D,D.D. pace- makers because of complete atrioventricular block or sick sinus syndrome. The mean age of 5 male and 4 female patients was 49±22 years. Using the programming device, the pacing rate was set at 70/min, and at 5 different A-V delays (100, 125, 150, 175, 200, 250 ms), we measured the changes of various time intervals during systolic and diastolic phase by recording the M-mode echocardiogram of aortic and mitral valve, ECG, and phonocardiogram simultaneously. Results: In systolic phase, preejection periods were significantly shortened at A-V delay 200ms, 250 ms comparing to those of A-V delays below l75 ms. Left ventricular ejection times showed no statistically significant changes between various A-V delays. Systolic time intervals showed significant decrements at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. Changing the A-V delay from 100 ms to 250 ms, isovolumic contraction times were significantly pro- longed and isovolumic contraction time/preejection period ratios were significantly increased. And in diastolic phase, mitral valve opening times were significantly shortened at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. A spike-Mc intervals were significantly prolonged as changing the A-V delay from 100 ms to 250 ms. Conclusion: These data suggest that the change of A-V delay in D.D.D. pacemakers had variable effects on various time intervals of systolic and diastolic phase. Considering the close relationship between the systolic time interval and cardiac function, relatively long A-V delay such as 200 ms or 250 ms was thought to be more desirable in patients of this study. And measurement of systolic time interval by echocardiography could be used as an useful, noninvasive guideline for determining the optimal A-V delay in individual patient.
이만영(Man Young Lee),승기배(Ki Bae Seung),김종진(Jong Jim Kim),노태호(Tae Ho Rho),채장성(Jang Seong Chae),김종상(Jong Sang Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Chol) 대한내과학회 1990 대한내과학회지 Vol.39 No.6
N/A To evaluate the clinical differences between Q wave myocardial infarction and non-Q wave myocardial infarction, the records of 336 patients with first myocardial infarction were reviewed. According to the presence or absence of Q waves on electrocardiogram, the patients were divided into two groups: a Q wave myocardial infarction group and a non-Q wave myocardial infarction group. The results were as follows: 1) According to standard electrocardiographic criteria, among 336 patients 271 patients (80.6%) had Q wave myocardial infarctions, and 65 patients (19.4%) had non-Q wave myocaridal infarctions. 2) The average age and male-to-female ratio were similar in the two groups. There were no significant differencres between the two groups in serum cholesterol levels and in incidences of a history of hypertension and diabetes mellitus. 3) Peak cardiac enzyme levels of CPK and LDH were significantly higher in the Q wave myocardial infarction group than in the non-Q-wave myocardial infarctions group. 4) When the complications of arrythmia, congestive heart failure and hospital mortality were compaired, incidences of AV block and congestive heart failure were significantly higher in the Q wave myocardial infarction group, but there was no difference in hospital mortality between the two groups. 5) Incidences of recurrent angina, congestive heart failure, reinfarction, death, and cause of death were not different statistically between the two groups, even though there was a tendency to have more recurrent angina and reinfarction in the non-Q wave myocardial infarction group and more congestive heart failure in the Q wave myocardial infarction group.