Publications by authors named "Jongmin Hwang"

35 Publications

Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea.

Korean Circ J 2021 Oct;51(10):851-862

Division of Cardiology, Daegu Catholic University College of Medicine, Daegu, Korea.

Background And Objectives: As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients.

Methods: Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]).

Results: Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746-42.306).

Conclusions: COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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http://dx.doi.org/10.4070/kcj.2021.0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484995PMC
October 2021

High density mapping guided partial antral ablation for a pulmonary vein isolation.

Sci Rep 2021 08 16;11(1):16563. Epub 2021 Aug 16.

Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.

The muscular discontinuities at the pulmonary vein (PV)-left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment's activation pattern was classified into a "directly-activated from the LA" or "passively-activated from an adjacent PV segment" pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had "passively-activated segments". If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A "successful partial antral ablation" was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a "failed partial antral ablation" was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.
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http://dx.doi.org/10.1038/s41598-021-96004-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367962PMC
August 2021

Ablation of persistent atrial fibrillation based on high density voltage mapping and complex fractionated atrial electrograms: A randomized controlled trial.

Medicine (Baltimore) 2021 Aug;100(31):e26702

Department of Thoracic and Cardiovascular surgery, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.

Introduction: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI.

Methods: We randomized 50 patients (mean age 58.4 ± 9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs.

Results: The mean persistent AF duration was 24.0 ± 23.1 months and mean left atrial dimension 4.9 ± 0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329).

Conclusion: Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%.
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http://dx.doi.org/10.1097/MD.0000000000026702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341227PMC
August 2021

Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease.

J Hum Hypertens 2021 11 6;35(11):994-1002. Epub 2021 Jan 6.

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.

Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP-CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ -8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.
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http://dx.doi.org/10.1038/s41371-020-00472-6DOI Listing
November 2021

Stimulated four-wave mixing in the cascade-type atomic system of a warm Cs atomic ensemble.

Opt Express 2020 Nov;28(24):35927-35936

We investigate stimulated four-wave mixing (FWM) in the 6S-6P-8S open transition of a warm Cs atomic ensemble. Despite the absence of the two-photon cycling transition, we measure high-contrast FWM signals in the 6P-8S transition between the upper excited states according to the frequency detuning and powers of the coupling and driving lasers. The FWM light generation in the upper excited states is interpreted as the FWM phenomena induced by the driving laser of the 6S-6P transition from the cascade-type two-photon coherent atomic ensemble with the coupling and pump lasers. We believe that this work can contribute to the development of hybrid photonic quantum networks between photonic quantum states generated from different atomic systems.
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http://dx.doi.org/10.1364/OE.410142DOI Listing
November 2020

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019.

J Korean Med Sci 2020 Oct 12;35(39):e349. Epub 2020 Oct 12.

Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.

Backgrounds: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes.

Methods: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed.

Results: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, = 0.026), and were more male (59.1% vs. 18.8%, = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis ( = 0.008).

Conclusion: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.
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http://dx.doi.org/10.3346/jkms.2020.35.e349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550234PMC
October 2020

Influence of Anatomical and Clinical Characteristics on Long-Term Prognosis of FFR-Guided Deferred Coronary Lesions.

JACC Cardiovasc Interv 2020 08;13(16):1907-1916

Department of Cariology, Keimyung University Dongsan Hospital, Daegu, Korea. Electronic address:

Objectives: The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)-guided deferred lesions, verified by intravascular ultrasound (IVUS).

Background: Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known.

Methods: The study included 459 patients with 552 intermediate lesions who had deferred revascularization on the basis of a nonischemic FFR (>0.80). Grayscale IVUS was examined simultaneously. The primary endpoint was patient-oriented composite outcome (POCO) (a composite of all-cause death, myocardial infarction, and any revascularization) during 5-year follow-up.

Results: The rate of 5-year POCO was 9.8%. Diabetes mellitus (hazard ratio: 3.50; 95% confidence interval [CI]: 1.86 to 6.57; p < 0.001), left ventricular ejection fraction ≤40% (hazard ratio: 4.80; 95% CI: 1.57 to 14.63; p = 0.006), and positive remodeling (hazard ratio: 2.04; 95% CI: 1.03 to 4.03; p = 0.041) were independent predictors for POCO. When the lesions were classified according to the presence of the adverse clinical characteristics (diabetes, left ventricular ejection fraction ≤40%) or adverse plaque characteristics (positive remodeling, plaque burden ≥70%), the risk of POCO was incrementally increased (4.3%, 13.6%, and 21.3%, respectively; p < 0.001).

Conclusions: In patients with FFR-guided deferred lesions, 5-year clinical outcomes were excellent. Lesion-related anatomical factors from intravascular imaging as well as patient-related clinical factors could provide incremental information about future clinical risks.
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http://dx.doi.org/10.1016/j.jcin.2020.05.040DOI Listing
August 2020

Adherence to dabigatran and the influence of dabigatran-induced gastrointestinal discomfort in the real-world practice.

Int J Cardiol 2021 01 14;323:77-82. Epub 2020 Aug 14.

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea. Electronic address:

Background: Dabigatran-induced gastrointestinal discomfort (DGID) is an important factor influencing the adherence to dabigatran. We investigated the incidence and risk factors of DGID and its impact on the adherence and persistence to dabigatran.

Methods: We prospectively enrolled the patients prescribed with dabigatran in 10 tertiary hospitals of the South Korea. The adherence was assessed using the percentage of the prescribed doses of the medication presumably taken by the patient (PDT by pill count). We evaluated the relationship between DGID and the baseline GI symptoms or the previous GI disease history using a questionnaire.

Results: A total of 474 patients (mean age 67.8 ± 9.3 years, male 68.6%, and mean CHADS-VASc score 2.2 ± 1.2) were enrolled. The adherence assessed by the PDT was 93.5 ± 5.5% at 1-month and 96.4 ± 8.4% at 6-months among the persistent patients. During the 6-month follow-up, 82 (18.1%) patients discontinued dabigatran, and the most common reason for dabigatran discontinuation was DGID (49, 59.8%). Sixty-eight (14.3%) patients experienced DGID, and there was no difference in the clinical factors between those with or without DGID. Among the patients who experienced DGID, 42 discontinued dabigatran (61.8%). In a multivariate analysis, DGID was the only predictor of dabigatran discontinuation and a low adherence.

Conclusion: Overall adherence of dabigatran was excellent, but those with DGID showed low adherence and persistence. Furthermore, it was challenging to predict DGID by clinical parameters. Therefore, it is recommended to follow the patients closely to check for DGID when prescribing dabigatran.
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http://dx.doi.org/10.1016/j.ijcard.2020.08.032DOI Listing
January 2021

Long Term Clinical Outcomes in Patients with Moderate Aortic Stenosis.

Heart Surg Forum 2020 May 28;23(3):E358-E365. Epub 2020 May 28.

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.

Background: While the surgical correction of moderate aortic stenosis (AS) can be deferred with a watchful waiting according to the present guideline, the clinical outcomes for moderate AS with comorbidity have not extensively been studied. We aimed to explore the factors that would contribute to the outcomes of moderate AS with at least five years of follow-up duration.

Methods: Medical records review identified patients with moderate aortic valve (AV) stenosis from January 2008 and December 2012. Echocardiographic data were gathered, and the final 5-year clinical outcomes, defined as the composite of cardiovascular (CV) death, admission for heart failure (HF) aggravation, and AV replacement, were evaluated.

Results: Among 148 patients (mean age, 69.3 years; mean AV area, 1.24 cm2), 79 had adverse outcomes (16 CV deaths, 32 AV replacements, and 31 HF cases), during a mean follow-up of 5.6 years. The event group showed worse dyspnea of NYHA III-IV and a higher frequency of diabetes mellitus (DM). They had a higher frequency of moderate or moderate-to-severe functional mitral regurgitation (MR) and smaller AV area. In the multivariate analysis, DM (HR 2.29, 95% CI 1.03-5.10), moderate or moderate-to-severe MR (HR 4.84, 95% CI 1.66-10.07), and NYHA III-IV (HR 3.84, 95% CI 1.72-8.56) independently were associated with adverse outcomes.

Conclusions: The symptomatic patients with moderate AS had higher events than expected, and early intervention should be considered in case of concomitant MR and DM.
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http://dx.doi.org/10.1532/hsf.2971DOI Listing
May 2020

Clinical impact of diabetes mellitus on 2-year clinical outcomes following PCI with second-generation drug-eluting stents; Landmark analysis findings from patient registry: Pooled analysis of the Korean multicenter drug-eluting stent registry.

PLoS One 2020 10;15(6):e0234362. Epub 2020 Jun 10.

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.

Background: Patients with diabetes mellitus are at an increased risk for adverse clinical events following percutaneous coronary interventions (PCI). However, the clinical impact of diabetes mellitus (DM) on second-generation drug-eluting stent (DES) implantation is not well-known. The aim of the current analysis was to examine the clinical impact of DM on clinical outcomes and the time sequence of associated risks in patients treated with second-generation DES.

Methods: Using patient-level data from two stent-specific, all-comer, prospective DES registries, we evaluated 1,913 patients who underwent PCI with second-generation DES between Feb 2009 and Dec 2013. The primary outcomes assessed were two-year major cardiac adverse events (MACE), composite endpoints of death from any cause, myocardial infarction (MI), and any repeat revascularization. We classified 0-1 year as the early period and 1-2 years as the late period. Landmark analyses were performed according to diabetes mellitus status.

Results: There were 1,913 patients with 2,614 lesions included in the pooled dataset. The median duration of clinical follow-up in the overall population was 2.0 years (interquartile range 1.9-2.1). Patients with DM had more cardiovascular risk factors than patients without DM. In multivariate analyses, the presence of DM and renal failure were strong predictors of MACE and target-vessel revascularization (TVR). After inverse probability of treatment weighting (IPTW) analyses, patients with DM had significantly increased rates of 2-year MACE (HR 2.07, 95% CI; 1.50-2.86; P <0.001). In landmark analyses, patients with DM had significantly higher rates of MACE in the early period (0-1 year) (HR 3.04, 95% CI; 1.97-4.68; P < 0.001) after IPTW adjustment, but these findings or trends were not observed in the late period (1-2 year) (HR 1.24, 95% CI; 0.74-2.07; P = 0.41).

Conclusions: In the second-generation DES era, the clinical impact of DM significantly increased the 2-year event rate of MACE, mainly caused by clinical events in the early period (0-1 year). Careful observation of patients with DM is advised in the early period following PCI with second-generation DES.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234362PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286514PMC
August 2020

Clinical Impact of Implantable Cardioverter-Defibrillator Therapy and Mortality Prediction Model for Effective Primary Prevention in Korean Patients.

J Korean Med Sci 2020 Mar 9;35(9):e49. Epub 2020 Mar 9.

Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

Background: Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.

Methods: Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).

Results: During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) ( < 0.001).

Conclusion: In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.
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http://dx.doi.org/10.3346/jkms.2020.35.e49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061144PMC
March 2020

The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: study using three-dimensional echocardiography.

J Interv Card Electrophysiol 2020 Jan 30;57(1):87-95. Epub 2019 Dec 30.

Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea.

Purpose: The exact correlation between the baseline left atrial (LA) volume (LAV) and atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) outcomes and changes to the LA after AF RFCA has not yet been fully understood. We sought to evaluate the serial changes in the LAV and LA function after RFCA using 3D echocardiography.

Methods: Consecutive patients who received RFCA of paroxysmal (PAF) or persistent AF (PeAF) at our center between January 2013 and March 2016 were included. Real-time 3D apical full-volume images were acquired, and a 3D volumetric assessment was performed using an automated three-beat averaging method. The LAV index (LAVI) was calculated and the LA ejection fraction (LAEF) was calculated as [LAVmax - LAVmin]/LAVmax.

Results: Ninety-nine total patients were enrolled, and the mean age was 58.0 ± 8.2 years and 75 (74.7%) were male. There were 59 (59.6%) PAF patients and the remaining 40 (40.4%) had PeAF. AF recurred in 5 of 59 (8.5%) PAF and in 10 of 40 (25%) PeAF patients. The LAVImax increased on 1 day, decreased at 3 months, and then increased again at 1 year but was lower than that at baseline. The LAEF changes were similar to the volume changes but were more prominent in PeAF than PAF patients. The baseline 3D LAVImax was an independent predictor of AF recurrence after RFCA and the cut-off value was 44.13 ml/m.

Conclusion: In our study, even after 3 months of scar formation due to ablation, structural remodeling of the LA continued. The changes were more prominent in the non-recurrent, PeAF patients.
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http://dx.doi.org/10.1007/s10840-019-00696-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036070PMC
January 2020

Hyperfine-state dependence of highly efficient amplification from diode-pumped cesium vapor.

Opt Express 2019 Dec;27(25):36231-36240

We report optical amplification with an optical-to-optical conversion efficiency of 70 ± 1% from a diode-pumped Cs vapor cell. When pump (852 nm; D-line) and signal (895 nm; D-line) lasers with a narrow spectral width of ∼2 MHz are resonant on the hyperfine states (F = 3 or 4) of the 6S state, we observe that the amplification factors are significantly changed according to the hyperfine-state combination of the pump and signal lasers. We find that the optical frequencies of the pumping and signal lasers need to be controlled near the hyperfine state of 6S (F = 4) to obtain an efficient diode-pumped alkali amplifier (DPAA). To realize highly efficient optical gain conditions, both the spatial modes of the pump and signal lasers are made to overlap in the Cs vapor cell with the use of a single-mode optical fiber. An amplification factor of 430 ± 15 is achieved under the following conditions: cell temperature of 90 °C, signal power of 0.1 mW, and pump power of 200 mW. We believe that our results can aid in the development of highly efficient diode-pumped alkali-vapor lasers and amplifiers.
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http://dx.doi.org/10.1364/OE.27.036231DOI Listing
December 2019

NOAC Adherence of Patients with Atrial Fibrillation in the Real World: Dosing Frequency Matters?

Thromb Haemost 2020 Feb 28;120(2):306-313. Epub 2019 Oct 28.

Division of Cardiology, Department of Internal Medicine, SM Christianity Hospital, Pohang, South Korea.

Background And Objectives:  Nonvitamin K antagonist oral anticoagulants (NOACs) require stricter medication adherence. We investigated the NOACs adherence in real-world practice.

Methods:  We screened all patients in our cardiology department the day before their outpatient appointment, over a 5-month period. We enrolled 719 consecutive patients who were taking NOACs for atrial fibrillation. The patients were contacted by phone or text to bring the remnant pills with them without any information why. Adherence was measured by the percentage of prescribed doses taken (PDT) (number of doses taken/number of doses expected to be taken from the last prescription × 100 [%]) and the Morisky Medication Adherence Scale (MMAS)-8.

Results:  All 4 NOACs (apixaban 47.8%, dabigatran 21.2%, rivaroxaban 18.4%, and edoxaban 12.6%) were prescribed. The mean duration that the patients had been taking NOACs was 7.2 ± 5.7 months. The PDT was 95.4 ± 9.1% in the once-daily dosing group and 93.4 ± 12.7% in the twice-daily group, and the difference was statistically significant ( = 0.017). The mean MMAS was 2.6 ± 0.8. The proportion of patients with a PDT < 80% was 7.8%. They had a significantly higher MMAS than the PDT ≥ 80% group (3.4 vs. 2.5;  = 0.000).

Conclusion:  Most patients who were taking NOACs had excellent adherence regardless of the dosing frequency. An MMAS ≥ 3 could be used as a simple screening tool for a poor NOAC adherence.
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http://dx.doi.org/10.1055/s-0039-1697954DOI Listing
February 2020

5-Year Outcomes According to FFR of Left Circumflex Coronary Artery After Left Main Crossover Stenting.

JACC Cardiovasc Interv 2019 05;12(9):847-855

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea. Electronic address:

Objectives: The aim of the current study was to evaluate the long-term clinical impact of fractional flow reserve (FFR) in jailed left circumflex coronary artery (LCx) after left main coronary artery (LM) simple crossover stenting.

Background: Although the provisional side-branch intervention with FFR guidance has been validated for non-LM bifurcation lesions, the outcome of such a strategy in LM bifurcation disease is not well-known.

Methods: Patients who underwent LM-to-left anterior descending coronary artery simple crossover stenting and who had FFR measurements in the LCx thereafter were enrolled. A low FFR was defined as ≤0.80. The clinical outcomes were assessed by the 5-year rate of target lesion failure (TLF) (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization).

Results: In 83 patients, the mean FFR of the LCx after LM stenting was 0.87 ± 0.08, and 14 patients (16.9%) had a low FFR. There was no correlation between the FFR and angiographic % diameter stenosis in jailed LCx (R = 0.039; p = 0.071) and there was no difference in the angiographic % diameter stenosis in the high and low FFR groups. At 5 years, the low FFR group had a significantly higher rate of TLF than the high FFR group (33.4% vs. 10.7%; hazard ratio: 4.09, 95% confidence interval: 1.15 to 14.52; p = 0.029). However, there was no difference in the clinical outcomes according to the angiographic % diameter stenosis. In a multivariate analysis, a low FFR was an independent predictor of the risk for a 5-year TLF (hazard ratio: 6.49; 95% confidence interval: 1.37 to 30.73; p = 0.018).

Conclusions: The patients with a high FFR in jailed LCx had better 5-year outcomes than those with a low FFR. The FFR measurement in jailed LCx can be helpful in selecting an adequate treatment strategy and may reduce unnecessary complex procedures.
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http://dx.doi.org/10.1016/j.jcin.2019.02.037DOI Listing
May 2019

Assessing Accuracy of Wrist-Worn Wearable Devices in Measurement of Paroxysmal Supraventricular Tachycardia Heart Rate.

Korean Circ J 2019 May 11;49(5):437-445. Epub 2019 Feb 11.

Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background And Objectives: Wrist-worn wearable devices provide heart rate (HR) monitoring function via photoplethysmography technology. Recently, these devices have been used by patients to measure the HR when palpitation occurs, but few validation studies of these instruments have been conducted. We assessed the accuracy of these devices for measuring a HR.

Methods: This study enrolled 51 consecutive patients with a history of paroxysmal supraventricular tachyarrhythmia (SVT) or paroxysmal palpitations who were scheduled to undergo an electrophysiological study (EPS). Three devices were assessed: Apple Watch Series 2 (Apple), Samsung Galaxy Gear S3 (Galaxy), and Fitbit Charge 2 (Fitbit). Patients were randomly assigned to wear 2 different devices. The HR at baseline and induced SVT were measured during the EPS. After successful ablation of SVT, HR measurements was also done during atrial and ventricular pacing study.

Results: The mean patient age was 44.4±16.6 years and 27 patients were male (53%). The accuracy (within ±5 beats per minute [bpm] of an electrocardiogram [ECG] measurement) of the baseline HR measurements was 100%, 100%, and 94%, for Apple, Galaxy, and Fitbit, respectively. The HR during induced SVT ranged from 108 bpm to 228 bpm and the accuracy (within ±10 bpm of an ECG) was 100%, 90%, and 87% for the Apple, Galaxy, and Fitbit, respectively. During pacing study, accuracy of these devices was also acceptable but tended to decrease as the HR increased, and showed differences between the devices.

Conclusions: Wrist-worn wearable devices accurately measure baseline and induced SVT HR.

Trial Registration: Clinical Research Information Service Identifier: KCT0002282.
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http://dx.doi.org/10.4070/kcj.2018.0323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511533PMC
May 2019

Novel method for the prediction of para-Hisian premature ventricular complexes from the electrocardiogram.

J Arrhythm 2019 Feb 21;35(1):92-98. Epub 2018 Nov 21.

Cardiology Revere Health Provo Utah.

Background: Catheter ablation of para-Hisian (PH) premature ventricular complexes (PVCs) has a high risk of heart block. This study aimed to find the electrocardiographic (ECG) predictors of PH-PVCs.

Methods: We enrolled 47 patients who underwent an electrophysiologic study for catheter ablation of PVCs and analyzed the ECG characteristics, retrospectively.

Results: The PVC locations were the PH in 14, right ventricular (RV) outflow tract (OT) in 11, left ventricular (LV) OT in 16, LV septum in 5, and LV summit in 1. The QRS width of the PH-PVCs was significantly narrower than that of the rest of PVCs (140.9 ± 17.1 ms vs. 158.9 ± 19.4 ms,  = 0.004). Precordial transition of the PH-PVCs related to sinus rhythm was not helpful in predicting the location. Lead I had monophasic R waves in 100% and lead aVR QS waves in 100%. In aVL, 13 of 14 patients had monophasic R waves, and 1 had biphasic (rS) waves with an initial positive polarity. Among the study cohort, 15 patients had a QS in aVR and R in aVL, including 13 PH-PVCs and 2 PVCs coming from the RVOT septum and LVOT septum, respectively. The QS in aVR and monophasic R in aVL had a sensitivity of 92.8%, specificity of 93.9%, positive predictive value of 86.7%, and negative predictive value of 96.9% for localizing PH-PVCs.

Conclusions: A PVC morphology with a QS in aVR and monophasic R in aVL and QRS width <143 msec, could be used as a reliable parameter for predicting the PH location.
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http://dx.doi.org/10.1002/joa3.12139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373644PMC
February 2019

The incidence of left atrial appendage thrombi on transesophageal echocardiography after pretreatment with apixaban for cardioversion in the real-world practice.

PLoS One 2018 7;13(12):e0208734. Epub 2018 Dec 7.

Department of internal medicine, Division of Cardiology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.

The risk of thromboembolisms during the post-cardioversion period is high. For patients with persistent atrial fibrillation (AF), anticoagulation with warfarin (INR 2.0~3.0) is recommended for at least three weeks prior and four weeks after cardioversion. We aimed to evaluate the efficacy of apixaban in preventing thromboembolic events during post-cardioversion. We enrolled 127 consecutive persistent AF patients (83 persistent, 44 longstanding persistent AF), scheduled to undergo cardioversion and were pretreated with apixaban. All patients underwent transesophageal echocardiography (TEE) to rule out thrombi in the left atrium (LA) or LA appendage (LAA) after anticoagulation with apixaban. The median duration of anticoagulation before the TEE was 37 (interquartile range [IQR] 34, 50) days. There were 7 patients (5.5%) with visible thrombi in the LAA. A spontaneous echo contrast was noted in 24 (18.9%) patients. Cardioversion was attempted in 117 patients, and they were prescribed amiodarone before the elective DC cardioversion. Sinus rhythm was achieved in 37 patients (31.6%) by amiodarone itself. DC cardioversion was attempted in 80 patients and was successful in 73 (91.3%). None of the cardioverted patients had any thromboembolic events within one month. Transient ischemic attacks were observed in one patient during a median follow up period of 202 days (IQR 143, 294). In conclusion, apixaban could be used as an anticoagulant for patients scheduled for cardioversion. However, the incidence of thrombi was not negligible. TEE or other imaging modalities should be considered before cardioversion or other invasive procedures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208734PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6285970PMC
May 2019

Alternative strategies to improve success rate of mitral isthmus block.

Medicine (Baltimore) 2018 Nov;97(48):e13060

Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul.

Achieving bidirectional conduction block (BDB) across the mitral isthmus (MI) is technically challenging. We describe our experience using different ablation strategies for achieving successful MI block.We reviewed the records of patients who had undergone MI ablation for peri-mitral (PM) flutter at our institution from January 2010 to May 2015. We investigated ablation strategies for achieving MI block and their long-term outcomes in terms of recurrence of atrial tachyarrhythmia.Single endocardial MI ablation with or without distal coronary sinus (CS) ablation achieved MI block in 129 out of 236 (54.7%) patients. After failure of MI block, a new MI line ablation, ablation targeting the vein of Marshall (VOM), or anterior line ablation was performed in selected patients. The MI block was achieved in 13 (52.0%) out of 25 patients with new MI line ablation and in 13 (68.4%) out of 19 patients with VOM ablation. Anterior line ablation was tried in 23 patients and the line of block was achieved in 12 (52.2%) patients. Finally, overall PM BDB (PMB, MI block or anterior line block) was achieved in 167 (70.8%) of 236 patients. The incidence atrial tachyarrhythmia was similar between the patients with successful PMB and those with failed PMB (32.9% vs 42.0%, P = .18). In multivariable Cox regression analysis, the PMB was not associated with recurrence of atrial tachyarrhythmia (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.43-1.12).In conclusion, single endocardial MI line with or without distal CS ablation showed limited success for achieving MI block. Additional substrate modifications such as a new MI line ablation, anterior line ablation, or ablation targeting the VOM may improve the success rate of PMB block. However, the benefits of PMB were not clear in this study.
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http://dx.doi.org/10.1097/MD.0000000000013060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283218PMC
November 2018

Implication of ultrasound contrast-enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes.

J Clin Ultrasound 2018 Sep;46(7):461-466

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.

Purpose: Ultrasonographic contrast enhancement of carotid plaque (CECP) has been used to detect neovascularization of vasa vasorum and plaque. However, it is uncertain whether CECP can provide risk stratification of coronary artery disease (CAD). This study aimed to evaluate the relationship between CECP and manifestations of acute coronary syndrome (ACS) in established CAD patients and to explore the prognostic implication of CECP for cardiovascular (CV) clinical outcomes.

Methods: A medical record review revealed that contrast-enhanced ultrasonography was performed to evaluate carotid atherosclerosis in 209 coronary artery-stented and 105 non-stented patients. The rate of ACS manifestations was compared depending on contrast uptake patterns: grade 0, absent; grade 1, dot; and grade 2, diffuse pattern. CV primary outcomes were assessed during a mean 7.6 months of follow-up.

Results: Male sex, smoking, history of old myocardial infarction, intensive medications, and a favorable lipid profile were common in the stented versus non-stented group. Patients with grade 2 CECP had a higher rate of ACS, greater plaque thickness, and class I-II of Gray-Weale plaque echogenicity. During follow-up, 10 coronary revascularizations (nine ACSs), six strokes, and four heart failures occurred. Grade 2 CECP was more closely related with CV primary outcomes and showed a tendency toward more acute CV outcomes.

Conclusion: ACS manifestations were proportionate to CECP grade. Diffuse CECP uptake could be a risk factor for acute CV outcomes.
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http://dx.doi.org/10.1002/jcu.22638DOI Listing
September 2018

Radiation reduction during percutaneous coronary intervention: A new protocol with a low frame rate and selective fluoroscopic image storage.

Medicine (Baltimore) 2017 Jul;96(30):e7517

Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.

The percutaneous coronary intervention (PCI) procedure is associated with potentially high levels of radiation exposure and therefore increased risk of adverse radiation-induced outcomes, ranging from cataract to malignancy. Frame rate reduction and selective fluoroscopy storage may help reduce radiation exposure. In this study, we evaluated the efficacy of a radiation reduction protocol that uses a lower frame rate and selective storage of fluoroscopic images in terms of its effect on reducing the radiation dose during PCI.The new protocol incorporated a lower frame rate as compared with the conventional protocol, and used selective storage of fluoroscopic images. We reviewed the medical records of patients who underwent PCI under the conventional protocol from January 2013 to December 2013, and compared them with those who underwent PCI with the new protocol from January 2015 to December 2015. The primary endpoint was radiation dose reduction expressed as cumulative air kerma and dose-area product (DAP). The image quality was assessed by 3 independent well-trained cardiologists.One hundred fifty-five patients were enrolled in the conventional protocol group, and 152 were enrolled in the radiation reduction protocol group (total, n = 307). There was no statistical significance in terms of the baseline characteristics, including body mass index. Overall, the radiation reduction protocol group showed a significant reduction in both cumulative air kerma (1634.39 ± 717.95 vs 2074.75 ± 1003.72 mGy, P < .001) and DAP (12344.86 ± 5371.75 vs 15312.19 ± 7136.58 μGy m, P < .001). Image quality was acceptable in both groups.The radiation reduction protocol, which uses a lower frame rate and selective storage of fluoroscopic images, may be an alternative approach to reducing PCI radiation dose.
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http://dx.doi.org/10.1097/MD.0000000000007517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627824PMC
July 2017

Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis.

J Thorac Cardiovasc Surg 2017 11 15;154(5):1556-1565.e1. Epub 2017 Jun 15.

Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: Conduction disturbances are common in patients with aortic stenosis. We investigated the incidence, reversibility, and prognosis of conduction disorders requiring permanent pacemaker implantation in patients with degenerative aortic stenosis after isolated aortic valve replacement.

Methods: This was a retrospective study conducted at a tertiary care center. We evaluated the incidence of conduction disturbances in patients who underwent isolated surgical aortic valve replacement for aortic stenosis between January 2005 and May 2015. Relevant clinical information was obtained from the patients' medical records.

Results: We reviewed results of 663 patients with pathologically proven degenerative aortic stenosis (bicuspid aortic valve, n = 285 [43.0%]) who underwent isolated aortic valve replacement (mechanical valve, n = 310 [46.8%]). Patients' mean age was 67.1 ± 8.1 years, and 362 were male (54.6%). Immediate postoperative intraventricular conduction disorders occurred in 56 patients (8.4%), and atrioventricular block occurred in 68 patients (10.3%). Ten patients with symptomatic second-degree or third-degree atrioventricular block underwent permanent pacemaker implantation within 30 days of aortic valve replacement. During the mean follow-up period of 1288 ± 1122 days, 64 patients (9.7%) developed irreversible conduction disorders (bundle branch block n = 24 and first-degree atrioventricular block n = 42). Of the 10 patients requiring permanent pacemakers, 4 remained depend on the permanent pacemaker during follow-up. Beyond 30 days after aortic valve replacement, 1 patient underwent permanent pacemaker implantation for de novo conduction disturbance 44 months postoperatively.

Conclusions: After isolated aortic valve replacement, permanent pacemaker implantation for conduction disturbance is rare (n = 10/663, 1.5%). Isolated aortic valve replacement for degenerative aortic stenosis has a low risk of conduction disturbances during long-term follow-up.
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http://dx.doi.org/10.1016/j.jtcvs.2017.05.101DOI Listing
November 2017

Supraventricular tachyarrhythmias in patients with a persistent left superior vena cava.

Europace 2018 07;20(7):1168-1174

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56, Dalseong-ro, Jung-gu, Daegu, Korea.

Aims: A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. This venous anomaly can impact the evaluation and treatment of supraventricular tachyarrhythmia (SVA). The aim of this study was to assess the proportion and characteristics of PLSVC in adult SVA patients.

Methods And Results: From July 2002 to July 2012, clinical and procedural data from databases of 10 cardiac electrophysiology laboratories in the Yeungnam region of the Republic of Korea were reviewed. Of 6662 adult SVA patients who underwent an EP study or catheter ablation of SVA during the 10-year study period, 18 patients had PLSVC (mean age 47.6 ± 14.8 years, 10 men). The proportion of PLSVC in adult SVA patients was 0.27% (18/6662). SVA type and procedural outcomes of radiofrequency (RF) catheter ablation in these patients were investigated and the results were as follows: successful slow pathway modification in six of seven patients with atrioventricular nodal reentrant tachycardia (AVNRT), successful ablation of accessory pathway in three of four patients with atrioventricular reentrant tachycardia, and successful ablation of atrial tachycardia (cavotricuspid isthmus-dependent in two, septal macroreentry in one, focal from the PLSVC in one) in three of four patients. In one patient with junctional tachycardia, catheter ablation failed. In two patients with atrial fibrillation, catheter ablation was successful.

Conclusion: Among adult SVA patients who underwent an EP study or RF catheter ablation during the 10-year study period, 0.27% had PLSVC. The most common type of SVA was AVNRT. The success rate of catheter ablation was 82% in SVA patients with PLSVC. There were no procedure-related complications.
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http://dx.doi.org/10.1093/europace/eux164DOI Listing
July 2018

Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation: A comparison of 2 versus 4 frame rate.

Medicine (Baltimore) 2017 Jun;96(24):e7200

Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups.The 4-FPS group showed higher median DAP (599.9 cGy cm; interquartile range [IR], 371.4-1337.5 cGy cm vs. 392.0 cGy cm; IR, 289.7-591.4 cGy cm; P < .01), longer median fluoroscopic time (24.4 min; IR, 17.5-34.9 min vs. 15.1 min; IR, 10.7-20.1 min; P < .01), and higher median ED (1.1 mSv; IR, 0.7-2.5 mSv vs. 0.7 mSv; IR, 0.6-1.1 mSv; P < .01) compared with the 2-FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan-Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25).In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional fluoroscopy setting.
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http://dx.doi.org/10.1097/MD.0000000000007200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478349PMC
June 2017

Frequency and clinical impact of retained implantable cardioverter defibrillator lead materials in heart transplant recipients.

PLoS One 2017 2;12(5):e0176925. Epub 2017 May 2.

Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176925PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413001PMC
September 2017

Rapidly Growing Right Ventricular Outflow Tract Mass in Patient with Sarcomatoid Renal Cell Carcinoma.

J Cardiovasc Ultrasound 2016 Dec 28;24(4):329-333. Epub 2016 Dec 28.

Department of Internal Medicine, Cardiovascular Center, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

Cardiac metastasis from renal cell carcinoma (RCC) without inferior vena cava (IVC) involvements is extremely rare with few reported cases. Sarcomatoid RCC with rhabdoid feature is a rare pathologic type of RCC having aggressive behavior due to great metastatic potential. Here, we report a case of rapidly growing cardiac metastasis of RCC which brought on right ventricular outflow tract (RVOT) obstruction without IVC and right atrial involvement in a 61-year-old woman. Cardiac arrest occurred during radical nephrectomy and echocardiography revealed mass nearly obstructing the RVOT which was not recognized by preoperative echocardiography 1 month ago. Postoperative immunohistochemical evaluation of renal mass revealed sarcomatoid RCC with rhabdoid feature.
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http://dx.doi.org/10.4250/jcu.2016.24.4.329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234337PMC
December 2016

Radiofrequency Catheter Ablation Targeting the Vein of Marshall in Difficult Mitral Isthmus Ablation or Pulmonary Vein Isolation.

J Cardiovasc Electrophysiol 2017 Apr 31;28(4):386-393. Epub 2017 Jan 31.

Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Introduction: The ligament of Marshall may hinder the creation of mitral isthmus (MI) block or pulmonary vein (PV) isolation (PVI) in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). We aimed to assess the benefit of RF ablation targeting the vein of Marshall (VOM) in failed cases of MI block or PVI.

Methods And Results: We reviewed the medical records of patients who underwent RF ablation targeting the VOM after failed MI ablation or left PVI using the conventional method, which included circumferential point-by-point ablation around the PV antrum and carina for PVI, and endocardial MI and epicardial distal coronary sinus (CS) ablation for MI block. The VOM was identified by using selective VOM venography with an external irrigation RF ablation catheter. RF ablation targeting the VOM was performed with RF application at the ostium of the VOM inside the CS or at the endocardial region facing the VOM course. During the set period, CS venography was performed in 42 patients after failure of left PVI (n = 5) or MI block (n = 37). Under CS venography, the VOM was visualized in 22 of 42 patients (MI = 19 and PVI = 3). During selective venography of the VOM, no procedure-related complication was observed. RF application targeting the VOM successfully achieved MI block in 13 patients (68.4%) and PVI in 2 patients (66.7%).

Conclusion: Selective VOM venography using an irrigated ablation catheter is feasible and safe. RF ablation targeting the VOM may provide additional benefit in failed cases of MI block or PVI.
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http://dx.doi.org/10.1111/jce.13161DOI Listing
April 2017

Extraction of a Fully Deployed Coronary Stent during Retrieval of Another Dislodged Stent.

Korean Circ J 2016 Nov 1;46(6):862-865. Epub 2016 Nov 1.

Cardiovascular Center, Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.

Coronary stent dislodgement is a rare and serious complication of percutaneous coronary intervention and is associated with major adverse cardiac events. Successful retrieval of the stent is recommended in this situation because it is important for the prognosis. Recently, a patient was referred to our hospital with a dislodged coronary stent. When attempting to percutaneously extract the dislodged stent, a challenging situation was encountered, as the stent was entrapped and tightly entangled with another fully deployed coronary stent. Extraction of a fully deployed stent is generally prohibited as it may result in severe complications. Nevertheless, we extracted both the dislodged stent and the fully deployed stent, as a last resort. Herein, we report about this case. Our case highlights if the operator had a thorough understanding of the surrounding circumstances regarding the fully deployed coronary stent, successful extraction of the fully deployed coronary stent without any complications could be possible.
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http://dx.doi.org/10.4070/kcj.2016.46.6.862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099344PMC
November 2016

Erratum: Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients.

Korean Circ J 2016 Jul 21;46(4):590. Epub 2016 Jul 21.

Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

[This corrects the article on p. 207 in vol. 46, PMID: 27014351.].
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http://dx.doi.org/10.4070/kcj.2016.46.4.590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965443PMC
July 2016
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