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Park H, Kim D, You SC, Jang E, Yu HT, Kim TH, Kim DM, Sung JH, Pak HN, Lee MH, Yang PS, Joung B. European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events. J Am Heart Assoc 2024; 13:e032831. [PMID: 38639378 DOI: 10.1161/jaha.123.032831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A study was designed to investigate whether the coronary artery disease polygenic risk score (CAD-PRS) may guide lipid-lowering treatment initiation as well as deferral in primary prevention beyond established clinical risk scores. METHODS AND RESULTS Participants were 311 799 individuals from the UK Biobank free of atherosclerotic cardiovascular disease, diabetes, chronic kidney disease, and lipid-lowering treatment at baseline. Participants were categorized as statin indicated, statin indication unclear, or statin not indicated as defined by the European and US guidelines on statin use. For a median of 11.9 (11.2-12.6) years, 8196 major coronary events developed. CAD-PRS added to European-Systematic Coronary Risk Evaluation 2 (European-SCORE2) and US-Pooled Cohort Equation (US-PCE) identified 18% and 12% of statin-indication-unclear individuals whose risk of major coronary events were the same as or higher than the average risk of statin-indicated individuals and 16% and 12% of statin-indicated individuals whose major coronary event risks were the same as or lower than the average risk of statin-indication-unclear individuals. For major coronary and atherosclerotic cardiovascular disease events, CAD-PRS improved C-statistics greater among statin-indicated or statin-indication-unclear than statin-not-indicated individuals. For atherosclerotic cardiovascular disease events, CAD-PRS added to the European evaluation and US equation resulted in a net reclassification improvement of 13.6% (95% CI, 11.8-15.5) and 14.7% (95% CI, 13.1-16.3) among statin-indicated, 10.8% (95% CI, 9.6-12.0) and 15.3% (95% CI, 13.2-17.5) among statin-indication-unclear, and 0.9% (95% CI, 0.6-1.3) and 3.6% (95% CI, 3.0-4.2) among statin-not-indicated individuals. CONCLUSIONS CAD-PRS may guide statin initiation as well as deferral among statin-indication-unclear or statin-indicated individuals as defined by the European and US guidelines. CAD-PRS had little clinical utility among statin-not-indicated individuals.
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Affiliation(s)
- Hanjin Park
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics Yonsei University College of Medicine Seoul Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Dong-Min Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine Dankook University Cheonan Republic of Korea
| | - Jung-Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center CHA University Seongnam Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center CHA University Seongnam Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
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Choi JI, Park YM, Oh YS, Kim JB, Han S, Park JS, On YK, Choi KJ, Hwang GS, Lee MH, Shin DG, Kim NH, Kim DK, Namgung J, Kim DH, Park HW, Park HC, Choi EK, Rhee KS, Shin SY, Kim YH. Efficacy and safety of once-daily carvedilol in patients with atrial fibrillation: A randomized, double-blind, placebo-controlled trial. Heart Rhythm 2024:S1547-5271(24)02384-1. [PMID: 38621497 DOI: 10.1016/j.hrthm.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Jong-Il Choi
- Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea.
| | - Yae Min Park
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yong-Seog Oh
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Bae Kim
- Kyunghee University Hospital, Seoul, Republic of Korea
| | - Seongwook Han
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | | | | | | | | | - Moon-Hyoung Lee
- Yonsei Medical Center, Severance Hospital, Seoul, Republic of Korea
| | - Dong-Gu Shin
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Nam-Ho Kim
- Wonkwang University Hospital, Iksan, Republic of Korea
| | - Dae-Kyeong Kim
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - June Namgung
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Dae-Hyeok Kim
- Inha University Hospital, Incheon, Republic of Korea
| | - Hyung-Wook Park
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | | | | | - Kyoung Suk Rhee
- Chonbuk National University Hospital, Cheongju, Republic of Korea
| | | | - Young-Hoon Kim
- Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. Racial Differences in Ischemic and Hemorrhagic Stroke: An Ecological Epidemiological Study. Thromb Haemost 2024. [PMID: 38423097 DOI: 10.1055/a-2278-8769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study aimed to evaluate racial differences in the incidence of stroke by conducting an ecological epidemiological study using UK Biobank and Korean nationwide data. METHODS This study used individual data from the Korean National Health Insurance Service-Health Screening and UK Biobank, which included participants who underwent health examinations between 2006 and 2010. We included 112,750 East Asians (50.7% men, mean age: 52.6 years) and 210,995 Caucasians (44.7% men, mean age: 55.0 years) who were not diagnosed with atrial fibrillation, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, or cancer. The primary outcome was defined as a composite of ischemic and hemorrhagic stroke. RESULTS East Asians tended to have a lower body mass index (23.7 vs. 26.4 kg/m2, p < 0.001) and a higher proportion of participants who did not engage in moderate-to-vigorous physical activity (49.6% vs. 10.7%, p < 0.001) than Caucasians. During the follow-up, East Asians had higher 5-year incidence rates (presented as per 1,000 person-years) for primary outcome (1.73 vs. 0.50; IR ratio [IRR]: 3.48, 95% confidence interval [CI]: 3.13-3.88), ischemic stroke (1.23 vs. 0.33; IRR: 3.70, 95% CI: 3.25-4.21), hemorrhagic stroke (0.56 vs. 0.18; IRR: 3.20, 95% CI: 2.67-3.84), and atrial fibrillation-related stroke (0.19 vs. 0.09; IRR: 2.04, 95% CI: 1.55-2.68). CONCLUSION Based on this ecological epidemiological study, racial differences in stroke incidence were robust to a variety of statistical analyses, regardless of the subtype. This suggests the need for region-specific approaches to stroke prevention.
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Affiliation(s)
- Dong-Seon Kang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim M, Uhm JS, Park JW, Bae S, Jung IH, Heo SJ, Kim D, Yu HT, Kim TH, Joung B, Lee MH. The Effects of Radiofrequency Catheter Ablation for Atrial Fibrillation on Right Ventricular Function. Korean Circ J 2024; 54:203-217. [PMID: 38654567 PMCID: PMC11040267 DOI: 10.4070/kcj.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The effects of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) on right ventricular (RV) function are not well known. METHODS Patients who underwent RFCA for AF and underwent pre- and post-procedural echocardiography were enrolled consecutively. Fractional area change (FAC), RV free-wall longitudinal strain (RVFWSL), and RV 4-chamber strain including the ventricular septum (RV4CSL) were measured. Changes in FAC, RVFWSL, and RV4CSL before and after RFCA were compared among paroxysmal AF (PAF), persistent AF (PeAF), and long-standing persistent AF (LSPeAF) groups. RESULTS A total of 164 participants (74 PAF, 47 PeAF, and 43 LSPeAF; age, 60.8 ± 9.8 years; men, 74.4%) was enrolled. The patients with PeAF and LSPeAF had worse RV4CSL (p<0.001) and RVFWSL (p<0.001) than those with PAF and reference values. Improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared with the PAF and LSPeAF groups (ΔRV4CSL, 8.4% [5.1, 11.6] in PeAF vs. 1.0% [-1.0, 4.1] in PAF, 1.9% [-0.2, 4.4] in LSPeAF, p<0.001; ΔRVFWSL, 9.0% [6.9, 11.5] in PeAF vs. 0.9% [-1.4, 4.9] in PAF, 1.0% [-1.0, 3.6] in LSPeAF, p<0.001). In patients without recurrence, improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared to the LSPeAF group. CONCLUSIONS RV systolic function is more impaired in patients with PeAF and LSPeAF than in those with PAF. RV systolic function is more improved after RFCA in patients with PeAF than in those with PAF or LSPeAF.
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Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Sakai K, Fuke H, Yoshimura K, Sasaki M, Abe K, Haino S, Hams T, Hasegawa M, Kim KC, Lee MH, Makida Y, Mitchell JW, Nishimura J, Nozaki M, Orito R, Ormes JF, Seo ES, Streitmatter RE, Thakur N, Yamamoto A, Yoshida T. Search for Antideuterons of Cosmic Origin Using the BESS-Polar II Magnetic-Rigidity Spectrometer. Phys Rev Lett 2024; 132:131001. [PMID: 38613296 DOI: 10.1103/physrevlett.132.131001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/21/2023] [Accepted: 01/10/2024] [Indexed: 04/14/2024]
Abstract
We searched for antideuterons (d[over ¯]'s) in the 4.7×10^{9} cosmic-ray events observed during the BESS-Polar II flight at solar minimum in 2007-2008 but found no candidates. The resulting 95% C.L. upper limit on the d[over ¯] flux is 6.7×10^{-5} (m^{2} s sr GeV/n)^{-1} in an energy range from 0.163 to 1.100 GeV/n. The result has improved by more than a factor of 14 from the upper limit of BESS97, which had a potential comparable to that of BESS-Polar II in the search for cosmic-origin d[over ¯]'s and was conducted during the former solar minimum. The upper limit of d[over ¯] flux from BESS-Polar II is the first result achieving the sensitivity to constrain the latest theoretical predictions.
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Affiliation(s)
- K Sakai
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - K Yoshimura
- Okayama University, Okayama, Okayama 700-8530, Japan
| | - M Sasaki
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - K Abe
- Kobe University, Kobe, Hyogo 657-8501, Japan
| | - S Haino
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - T Hams
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - M Hasegawa
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K C Kim
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - M H Lee
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - Y Makida
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - J W Mitchell
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
- The University of Tokyo, Bunkyo, Tokyo 113-0033, Japan
| | - M Nozaki
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - R Orito
- Kobe University, Kobe, Hyogo 657-8501, Japan
| | - J F Ormes
- University of Denver, Denver, Colorado 80208, USA
| | - E S Seo
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - R E Streitmatter
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - N Thakur
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - A Yamamoto
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - T Yoshida
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
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Jin Z, Hwang T, Kim D, Lim B, Kwon OS, Kim S, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins. NPJ Digit Med 2024; 7:81. [PMID: 38532181 DOI: 10.1038/s41746-024-01075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695.
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Affiliation(s)
- Ze Jin
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taehyun Hwang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sangbin Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects. Thromb Haemost 2024. [PMID: 38359877 DOI: 10.1055/a-2269-1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the United Kingdom. METHODS We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. RESULTS During the follow-up, primary outcome events occurred in 2,110 East Asians and in 6,515 Caucasians. East Asians had a 38% lower 5-year incidence rate compared with Caucasians (3.88 vs. 6.29 per 1,000 person-years; incidence rate ratio [IRR]: 0.62, 95% confidence interval [CI]: 0.59-0.65). East Asians showed a lower incidence of major bleeding (IRR: 0.86, 95% CI: 0.81-0.91), bleeding from the gastrointestinal (IRR: 0.53, 95% CI: 0.49-0.56), and genitourinary systems (IRR: 0.49, 95% CI: 0.44-0.53) compared with Caucasians. The incidence rates of ICH (IRR: 3.20, 95% CI: 2.67-3.84) and bleeding from the respiratory system (IRR: 1.28, 95% CI: 1.11-1.47) were higher in East Asians. Notably, East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR: 1.12, 95% CI: 1.01-1.25). CONCLUSION This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race.
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Affiliation(s)
- Dong-Seon Kang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jung M, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Joung B. Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index. Int J Cardiol 2024; 398:131605. [PMID: 38000669 DOI: 10.1016/j.ijcard.2023.131605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/05/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Predicting survival in atrial fibrillation (AF) patients with comorbidities is challenging. This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications. METHODS We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002-2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years. RESULTS In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02-1.08, P < .001). However, anticoagulants were significantly less prescribed in patients with high CCI (OR 0.97, 95%CI 0.95-0.99, P = .012). Incidence of adverse events (all-cause death, stroke, major bleeding, HF hospitalization) progressively increased in this order: low CCI without AF, high CCI without AF, low CCI with AF, and high CCI with AF (all P < .001). Furthermore, high CCI with AF had a significantly higher risk compared to low CCI without AF (all-cause death, adjusted hazard ratio [aHR] 2.52, 95% CI 2.37-2.68, P < .001; stroke, aHR 1.43, 95% CI 1.29-1.58, P < .001; major bleeding, aHR 1.14, 95% CI 1.04-1.26, P = .007; HF hospitalization, aHR 4.75, 95% CI 4.03-5.59, P < .001). CONCLUSIONS High CCI predicted increased antiplatelet use and reduced oral anticoagulant prescription. AF was associated with higher risks of all-cause death, stroke, major bleeding, and HF hospitalization compared to high CCI.
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Affiliation(s)
- Moonki Jung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Lee YS, Yang PS, Jang E, Kim D, Yu HT, Kim TH, Uhm JS, Sung JH, Pak HN, Lee MH, Joung B. Association between Obesity and Heart Failure and Related Atrial Fibrillation: Patient-Level Data Comparisons of Two Cohort Studies. Yonsei Med J 2024; 65:10-18. [PMID: 38154475 PMCID: PMC10774652 DOI: 10.3349/ymj.2023.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/27/2023] [Accepted: 10/03/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Heart failure (HF) and atrial fibrillation (AF) frequently coexist, with over 50% patients with HF having AF, while one-third of those with AF develop HF. Differences in obesity-mediated association between HF and HF-related AF among Asians and Europeans were evaluated. MATERIALS AND METHODS Using the Korean National Health Insurance Service-Health Screening (K-NHIS-HealS) cohort and the UK Biobank, we included 394801 Korean and 476883 UK adults, respectively aged 40-70 years. The incidence and risk of HF were evaluated based on body mass index (BMI). RESULTS The proportion of obese individuals was significantly higher in the UK Biobank cohort than in the K-NHIS-HealS cohort (24.2% vs. 2.7%, p<0.001). The incidence of HF and HF-related AF was higher among the obese in the UK than in Korea. The risk of HF was higher among the British than in Koreans, with adjusted hazard ratios of 1.82 [95% confidence interval (CI), 1.30-2.55] in K-NHIS-HealS and 2.00 (95% CI, 1.69-2.37) in UK Biobank in obese participants (p for interaction <0.001). A 5-unit increase in BMI was associated with a 44% greater risk of HF-related AF in the UK Biobank cohort (p<0.001) but not in the K-NHIS-HealS cohort (p=0.277). CONCLUSION Obesity was associated with an increased risk of HF and HF-related AF in both Korean and UK populations. The higher incidence in the UK population was likely due to the higher proportion of obese individuals.
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Affiliation(s)
- Young Shin Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Adhikari G, Carlin N, Choi JJ, Choi S, Ezeribe AC, França LE, Ha C, Hahn IS, Hollick SJ, Jeon EJ, Jo JH, Joo HW, Kang WG, Kauer M, Kim BH, Kim HJ, Kim J, Kim KW, Kim SH, Kim SK, Kim WK, Kim YD, Kim YH, Ko YJ, Lee DH, Lee EK, Lee H, Lee HS, Lee HY, Lee IS, Lee J, Lee JY, Lee MH, Lee SH, Lee SM, Lee YJ, Leonard DS, Luan NT, Manzato BB, Maruyama RH, Neal RJ, Nikkel JA, Olsen SL, Park BJ, Park HK, Park HS, Park KS, Park SD, Pitta RLC, Prihtiadi H, Ra SJ, Rott C, Shin KA, Cavalcante DFFS, Scarff A, Spooner NJC, Thompson WG, Yang L, Yu GH. Search for Boosted Dark Matter in COSINE-100. Phys Rev Lett 2023; 131:201802. [PMID: 38039466 DOI: 10.1103/physrevlett.131.201802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7 kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.
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Affiliation(s)
- G Adhikari
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - N Carlin
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - J J Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - A C Ezeribe
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - L E França
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - C Ha
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - I S Hahn
- Department of Science Education, Ewha Womans University, Seoul 03760, Republic of Korea
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S J Hollick
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - E J Jeon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J H Jo
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - H W Joo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - M Kauer
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H J Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - J Kim
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - K W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S K Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W K Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Department of Physics, Sejong University, Seoul 05006, Republic of Korea
| | - Y H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - Y J Ko
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D H Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H Y Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - I S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Y Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S M Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - Y J Lee
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - N T Luan
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - B B Manzato
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - R H Maruyama
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - R J Neal
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - J A Nikkel
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - S L Olsen
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - B J Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H K Park
- Department of Accelerator Science, Korea University, Sejong 30019, Republic of Korea
| | - H S Park
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - K S Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S D Park
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - R L C Pitta
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - H Prihtiadi
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S J Ra
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - C Rott
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
| | - K A Shin
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D F F S Cavalcante
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - A Scarff
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - N J C Spooner
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - W G Thompson
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - G H Yu
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
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Park H, Park JW, Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, Pak HN. Comparison of pulmonary vein isolation using cryoballoon, high-power short-duration, and conventional radiofrequency ablation for atrial fibrillation: a propensity score-weighted study. Front Cardiovasc Med 2023; 10:1238363. [PMID: 37876772 PMCID: PMC10590885 DOI: 10.3389/fcvm.2023.1238363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
Background The comparative efficacy, saftey, and heart rate variability (HRV) parameters after pulmonary vein isolation using cryoballoon (Cryo-PVI), high-power short-duration (HPSD-PVI), and conventional radiofrequency ablation (conventional-PVI) for atrial fibrillation (AF) is unclear. Materials and methods In this propensity score-weighted, retrospective analysis of a single-center cohort, we analyzed 3,395 patients (26.2% female, 74.5% paroxysmal AF) who underwent AF catheter ablation without an empirical left atrial ablation. Procedural factors, recurrence rates, complication rates, and the post-procedural HRV parameters were compared across the Cryo-PVI (n = 625), HPSD-PVI (n = 748), and conventional-PVI (n = 2,022) groups. Results Despite the shortest procedural time in the Cryo-PVI group (74 min for Cryo-PVI vs. 104 min for HPSD-PVI vs. 153 min for conventional-PVI, p < 0.001), the major complication (p = 0.906) and clinical recurrence rates were similar across the three ablation groups (weighted log-rank, p = 0.824). However, the Cryo-PVI group was associated with a significantly lower risk of recurrent AF in patients with paroxysmal AF [weighted hazard ratio (WHR) 0.57, 95% confidence interval (CI) 0.37-0.86], whereas it was associated with a higher risk of recurrent AF in patients with persistent AF (WHR 1.41, 95% CI 1.06-1.89, p for interaction of <0.001) compared with the conventional-PVI group. In the subgroup analysis for the HRV, the Cryo-PVI group had the highest low-frequency-to-high-frequency ratio at 1-year post-procedure, whereas the HPSD-PVI group had the lowest low-frequency-to-high-frequency ratio at 1-year post-procedure (p < 0.001). Conclusions The Cryo-PVI group had better rhythm outcomes in patients with paroxysmal AF but worse rhythm outcomes in patients with persistent AF and a higher long-term post-procedural sympathetic nervous activity and sympatho-vagal balance compared with the conventional-PVI group.
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Affiliation(s)
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
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12
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Kim J, Kim D, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Revisiting symptomatic pulmonary vein stenosis after high-power short-duration radiofrequency ablation in patients with atrial fibrillation. Europace 2023; 25:euad296. [PMID: 37757850 PMCID: PMC10558058 DOI: 10.1093/europace/euad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- Joongmin Kim
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Daehoon Kim
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hee Tae Yu
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Tae-Hoon Kim
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Boyoung Joung
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Moon-Hyoung Lee
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Park H, Yang PS, Sung JH, Jin MN, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Joung B. Association Between the Combined Effects of Physical Activity Intensity and Particulate Matter and All-Cause Mortality in Older Adults. Mayo Clin Proc 2023; 98:1153-1163. [PMID: 37422738 DOI: 10.1016/j.mayocp.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/18/2023] [Accepted: 04/12/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM10) and mortality in older adults. METHODS This nationwide cohort study included older adults without chronic heart or lung disease who engaged in regular PA. Physical activity was assessed by a standardized, self-reported questionnaire that asked the usual frequency of PA sessions with low (LPA), moderate (MPA), or vigorous intensity (VPA). Each participant's annual average cumulative PM10 was categorized as low to moderate and high PM10 on the basis of a cutoff value of 90th percentile. RESULTS A total of 81,326 participants (median follow-up, 45 months) were included. For participants engaged in MPA or VPA sessions, every 10% increase in the proportion of VPA to total PA sessions resulted in a 4.9% (95% CI, 1.0% to 9.0%; P=.014) increased and 2.8% (95% CI, -5.0% to -0.5%; P=.018) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, <.001). For participants engaged only in LPA or MPA sessions, every 10% increase in the proportion of MPA to total PA sessions resulted in a 4.8% (95% CI, -8.9% to -0.4%; P=.031) and 2.3% (95% CI, -4.2% to -0.3%; P=.023) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, .096). CONCLUSION We found that for the same level of total PA, MPA was associated with delayed mortality whereas VPA was associated with hastened mortality of older adults in high levels of PM10.
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Affiliation(s)
- Hanjin Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jung-Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Yoon M, Oh J, Chun KH, Yu HT, Lee CJ, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Clinical Implications of Device-Detected Atrial Fibrillation in Cardiac Resynchronization Therapy. Korean Circ J 2023; 53:483-496. [PMID: 37271751 PMCID: PMC10406527 DOI: 10.4070/kcj.2022.0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is associated with decreased cardiac resynchronization therapy (CRT) benefits compared to sinus rhythm (SR). Effective biventricular (BiV) pacing is a determinant of CRT success, but AF can interfere with adequate BiV pacing and affect clinical outcomes. We investigated the effect of device-detected AF on clinical outcomes and optimal BiV pacing in patients with heart failure (HF) treated with CRT. METHODS We retrospectively analyzed 174 patients who underwent CRT implantation between 2012 and 2019 at a tertiary center. The optimal BiV pacing percentage was defined as ≥98%. Device-detected AF was defined as an atrial high-rate episode ≥180 beats per minute lasting more than 6 minutes during the follow-up period. We stratified the patients without preexisting AF at pre-implantation into device-detected AF and no-AF groups. RESULTS A total of 120 patients did not show preexisting AF at pre-implantation, and 54 had AF. Among these 120 patients, 19 (15.8%) showed device-detected AF during a median follow-up of 25.1 months. The proportion of optimal BiV pacing was significantly lower in the device-detected AF group than in the no-AF group (42.1% vs. 75.2%, p=0.009). The device-detected AF group had a higher incidence of HF hospitalization, cardiovascular death, and all-cause death than the no-AF group. The device-detected AF and previous AF groups showed no significant differences regarding the percentage of BiV pacing and clinical outcomes. CONCLUSIONS For HF patients implanted with CRT, device-detected AF was associated with lower optimal BiV pacing and worse clinical outcomes than no-AF.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong-Hyeon Chun
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Corrigendum: Effect of epicardial fat volume on outcomes after left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Front Cardiovasc Med 2023; 10:1220717. [PMID: 37332573 PMCID: PMC10274134 DOI: 10.3389/fcvm.2023.1220717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.1005760.].
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Choi SH, Yu HT, Kim D, Park JW, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, Pak HN. Late recurrence of atrial fibrillation 5 years after catheter ablation: predictors and outcome. Europace 2023; 25:euad113. [PMID: 37099677 PMCID: PMC10228616 DOI: 10.1093/europace/euad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is a chronic progressive disease that continuously recurs even after successful AF catheter ablation (AFCA). We explored the mechanism of long-term recurrence by comparing patient characteristics and redo-ablation findings. METHODS AND RESULTS Among the 4248 patients who underwent a de novo AFCA and protocol-based rhythm follow-up at a single centre, we enrolled 1417 patients [71.7% male, aged 60.0 (52.0-67.0) years, 57.9% paroxysmal AF] who experienced clinical recurrences (CRs), and divided them according to the period of recurrence: within one year (n = 645), 1-2 years (n = 339), 2-5 years (n = 308), and after 5 years (CR>5 yr, n = 125). We also compared the redo-mapping and ablation outcomes of 198 patients. In patients with CR>5 yr, the proportion of paroxysmal AF was higher (P = 0.031); however, the left atrial (LA) volume (quantified by computed tomography, P = 0.003), LA voltage (P = 0.003), frequency of early recurrence (P < 0.001), and use of post-procedure anti-arrhythmic drugs (P < 0.001) were lower. A CR>5 yr was independently associated with a low LA volume [odds ratio (OR) 0.99 (0.98-1.00), P = 0.035], low LA voltage [OR 0.61 (0.38-0.94), P = 0.032], and lower early recurrence [OR 0.40 (0.23-0.67), P < 0.001]. Extra-pulmonary vein triggers during repeat procedures were significantly greater in patients with a CR>5 yr, despite no difference in the de novo protocol (P for trend 0.003). The rhythm outcomes of repeat ablation procedures did not differ according to the timing of the CR (log-rank P = 0.330). CONCLUSIONS Patients with a later CR exhibited a smaller LA volume, lower LA voltage, and higher extra-pulmonary vein triggers during the repeat procedure, suggesting AF progression.
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Affiliation(s)
- Sung Hwa Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Chun Hwang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Yu GI, Kim TH, Yu HT, Joung B, Pak HN, Lee MH. Learning Curve Analyses for Left Bundle Branch Area Pacing with Conventional Stylet-Driven Pacing Leads. J Interv Cardiol 2023; 2023:3632257. [PMID: 37251364 PMCID: PMC10212686 DOI: 10.1155/2023/3632257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Background Physiological conduction system pacing has attracted attention to overcome the dyssynchrony problems of conventional right ventricular pacing (RVP). Left bundle branch area pacing (LBBAP), which complements short combing of His bundle pacing (HBP), has emerged and has proven its efficiency and safety. In addition, initial experiences of LBBAP were mainly using lumen-less pacing lead, and the feasibility of stylet-driven pacing lead (SDL) was also established. The purpose of this study is to evaluate the learning curve for LBBAP using SDL. Methods The study enrolled 265 patients who underwent LBBAP or RVP performed by operators without previous LBBAP experience at Yonsei University Severance Hospital in Korea between December 2020 and October 2021. LBBAP was performed using SDL with an extendable helix. The learning curve was evaluated by analyzing fluoroscopy and procedure times. And, before and after reaching the learning curve, we evaluated how much the time required for the LBBAP differed from the time required for the RVP. Results LBBAP was successful in 50 of 50 (100.0%) patients left bundle branch pacing was successful in 49 of 50 (98.0%). In 50 patients who underwent LBBAP, mean fluoroscopy and procedural times were 15.1 ± 13.5 minutes and 59.9 ± 24.8 minutes, respectively. The plateau of fluoroscopy time reached in the 25th case and the plateau of procedure time reached in the 24th case. Conclusion During the initial experience with LBBAP, fluoroscopy and procedural times improved with increasing operator experience. For operators who were experienced in cardiac pacemaker implantation, the steepest part of the learning curve was over the first 24-25 cases. It is shorter than the previously reported learning curves of HBP.
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Affiliation(s)
- Ga-In Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, GyeongSang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Choi SH, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Lip GYH, Joung B. Association of obesity with incident atrial fibrillation in Korea and the United Kingdom. Sci Rep 2023; 13:5197. [PMID: 36997588 PMCID: PMC10063613 DOI: 10.1038/s41598-023-32229-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
Obesity has been linked to atrial fibrillation (AF) burden and severity, and epidemiological studies suggest that AF is more prevalent in whites than Asian. We aimed to investigate whether obesity mediates associations with AF in Europe and Asia using patient-level data comparisons of two cohort studies. Using Korean National Health Insurance Service's Health Screening (NHIS-HealS) and U.K. Biobank data, we included 401,206 Korean and 477,926 British aged 40-70 years without previous AF who received check-ups. The incidence and risk of AF were evaluated regarding different body mass index (BMI) values. The obese proportion (BMI ≥ 30.0 kg/m2, 2.8% vs. 24.3%, P < 0.001) was higher in the U.K. than the Korean. In the Korean and U.K. cohort, the age- and sex-adjusted incidence rates of AF were 4.97 and 6.54 per 1000 person-years among obese individuals. Compared to Koreans, the risk of AF was higher in the British population, with adjusted hazard ratios of 1.41 (Korea, 95% CI 1.26-1.58) and 1.68 (UK, 95% CI 1.54-1.82) in obese participants (P for interaction < 0.05). Obesity was associated with AF in both populations. British subjects had a greater incidence of AF related to the high proportion of obese individuals, especially participants in the obesity category, the risk of AF also increased.
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Affiliation(s)
- Sung Hwa Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Park YJ, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Sex difference in atrial fibrillation recurrence after catheter ablation and antiarrhythmic drugs. Heart 2023; 109:519-526. [PMID: 35332048 PMCID: PMC10086497 DOI: 10.1136/heartjnl-2021-320601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The risk of recurrence after atrial fibrillation (AF) catheter ablation (AFCA) is higher in women than in men. However, it is unknown whether a sex difference exists in antiarrhythmic drug (AAD) responsiveness among patients with recurrence. METHODS Among 2999 consecutive patients (26.5% women, 58.3±10.9 years old, 68.1% paroxysmal AF) who underwent de novo AFCA, we compared and evaluated the sex differences in rhythm outcome in 1094 patients with recurrence and in 788 patients who subsequently underwent rhythm control with AAD. RESULTS During a follow-up of 48.2±34.9 months, 1094 patients (36.5%) had AF recurrence after AFCA, and 508 of 788 patients (64.5%) had AF recurrence under AAD. Although the rhythm outcome of a de novo AFCA was worse (log-rank p=0.041, HR 1.28, 95% CI 1.02 to 1.59), p=0.031) in women, AAD response after postprocedural recurrences was better in women than in men (log-rank p=0.003, HR 0.75, 95% CI 0.59 to 0.95, p=0.022), especially in women older than 60 years old (log-rank p=0.003). In 249 patients who underwent repeat procedure after AAD use, the pulmonary vein (PV) reconnection rate (62.7% vs 76.8%, p=0.048) was lower in women than in men but not the existence of extra-PV trigger (37.8% vs 25.4%, p=0.169). CONCLUSIONS Although women showed worse rhythm outcomes than men after AFCA, the post-AFCA AAD response was better in elderly women than in men. TRIAL REGISTRATION NUMBER NCT02138695.
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Affiliation(s)
- Yoon Jung Park
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Je-Wook Park
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, Korea (the Republic of)
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Park SY, Hahn KI, Kang WG, Kazalov V, Kim GW, Kim YD, Lee EK, Lee MH, Leonard DS, Sala E, So JH, Yoon SC. Detection efficiency calibration for an array of fourteen HPGe detectors. Appl Radiat Isot 2023; 193:110654. [PMID: 36646029 DOI: 10.1016/j.apradiso.2023.110654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
The CUP array of germanium (CAGe) is an array of fourteen high-purity germanium (HPGe) detectors. The detection efficiency of full-energy-peak emitted from the various samples assayed on the CAGe was calculated using the Monte Carlo simulation toolkit GEANT4. If the dead layer on the surface of the crystal is treated in the simulation as a continuous part of the active crystal, then the detection efficiency will be overestimated. Thus, the detection efficiency of the CAGe was adjusted using multi-nuclide source data and Monte Carlo simulations. The gamma spectra of the known activity source were obtained for each HPGe detector of the CAGe. The detection efficiency measured by the multi-source data was smaller than that of simulation data if the simulation treated the whole volume of germanium crystals as active for gamma detection. By optimizing the dead layers' thicknesses in the simulation, the detection efficiency calculated by the simulation could be matched to that of multi-source data.
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Affiliation(s)
- S Y Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - K I Hahn
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - V Kazalov
- Baksan Neutrino Observatory, Institute for Nuclear Research of the Russian Academy of Science, Kabardino-Balkaria, 361609, Russia
| | - G W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea.
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; Department of Physics and Astronomy, Sejong University, Seoul, 05006, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - E Sala
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - J H So
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - S C Yoon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
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21
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Yu GI, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Lip GYH, Yang PS, Joung B. Impact of frailty on early rhythm control outcomes in older adults with atrial fibrillation: A nationwide cohort study. Front Cardiovasc Med 2023; 9:1050744. [PMID: 36684588 PMCID: PMC9853018 DOI: 10.3389/fcvm.2022.1050744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose Rhythm-control therapy administered early following the initial diagnosis of atrial fibrillation (AF) has superior cardiovascular outcomes compared to rate-control therapy. Frailty is a key factor in identifying older patients' potential for improvement after rhythm-control therapy. This study evaluated whether frailty affects the outcome of early rhythm-control therapy in older patients with AF. Methods From the Korean National Health Insurance Service database (2005-2015), we collected 20,611 populations aged ≥65 years undergoing rhythm- or rate-control therapy initiated within 1 year of AF diagnosis. Participants were emulated by the EAST-AFNET4 trial, and stratified into non-frail, moderately frail, and highly frail groups based on the hospital frailty risk score (HFRS). A composite outcome of cardiovascular-related mortality, myocardial infarction, hospitalization for heart failure, and ischemic stroke was compared between rhythm- and rate-control. Results Early rhythm-control strategy showed a 14% lower risk of the primary composite outcome in the non-frail group [weighted incidence 7.3 vs. 8.6 per 100 person-years; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.79-0.93, p < 0.001] than rate-control strategy. A consistent trend toward a lower risk of early rhythm-control was observed in the moderately frail (HR 0.91, 95% CI 0.81-1.02, p = 0.09) and highly frail (HR 0.93, 95% CI 0.75-1.17, p = 0.55) groups. Conclusion Although the degree attenuated with increasing frailty, the superiority of cardiovascular outcomes of early rhythm-control in AF treatment was maintained without increased risk for safety outcomes. An individualized approach is required on the benefits of early rhythm-control therapy in older patients with AF, regardless of their frailty status.
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Affiliation(s)
- Ga-In Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea,Pil-Sung Yang,
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,*Correspondence: Boyoung Joung,
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Song TJ, Shin JI, Yon DK, Lee SW, Hwang SY, Hwang J, Park SH, Lee SB, Lee MH, Kim MS, Koyanagi A, Tizaoui K, Kim JH, Smith L. Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review. Eur Rev Med Pharmacol Sci 2023; 27:404-410. [PMID: 36647889 DOI: 10.26355/eurrev_202301_30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.
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Affiliation(s)
- T-J Song
- Department of Neurology, Seoul Hospital, Ewha University College of Medicine, Seoul, Republic of Korea.
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23
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Uhm JS, Ko KY, Shim CY, Park JW, Kim M, Bae S, Jung IH, Kim IS, Kim JY, Choi EY, Son WJ, Roh YH, Yu HT, Kim TH, Hong GR, Joung B, Pak HN, Lee MH. Effects of radiofrequency catheter ablation for premature ventricular complexes originating from the right ventricular outflow tract on right ventricular function. J Cardiovasc Electrophysiol 2023; 34:189-196. [PMID: 36349711 DOI: 10.1111/jce.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/09/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This study aimed to elucidate the relationship between premature ventricular complexes (PVCs) and right ventricular (RV) dysfunction, and the effects of radiofrequency catheter ablation (RFCA) on RV function. METHODS A total of 110 patients (age, 50.8 ± 14.4 years; 30 men) without structural heart disease who had undergone RFCA for RV outflow tract (RVOT) PVCs were retrospectively included. RV function was assessed using fractional area change (FAC) and global longitudinal strain (GLS) before and after RFCA. Clinical data were compared between the RV dysfunction (n = 63) and preserved RV function (n = 47) groups. The relationship between PVC burden and RV function was analyzed. Change in RV function before and after RFCA was compared between patients with successful and failed RFCA. RESULTS PVC burden was significantly higher in the RV dysfunction group than in the preserved RV function group (p < .001). FAC and GLS were significantly worse in proportion to PVC burden (p < .001 and p < .001, respectively). The risk factor associated with RV dysfunction was PVC burden [odds ratio (95% confidence interval), 1.092 (1.052-1.134); p < .001]. Improvement in FAC (13.0 ± 8.7% and -2.5 ± 5.6%, respectively; p < .001) and GLS (-6.8 ± 5.7% and 2.1 ± 4.2%, respectively; p < .001) was significant in the patients with successful RFCA, compared to the patients in whom RFCA failed. CONCLUSIONS Frequent RVOT PVCs are associated with RV dysfunction. RV dysfunction is reversible by successful RFCA.
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Affiliation(s)
- Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - In-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jong Youn Kim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Eui-Young Choi
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Won Jeong Son
- Biostatistics Collaboration Unit, Department of Biomedical System Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical System Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
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Lee K, Lee SK, Lee J, Jeon BK, Kim TH, Yu HT, Lee JM, Park JK, Baek YS, Kim DH, Shim J, Joung B, Lee MH, Pak HN, Park J. Protocol of BEYOND trial: Clinical BEnefit of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in rhYthm cONtrol of atrial fibrillation in patients with diabetes mellitus. PLoS One 2023; 18:e0280359. [PMID: 36652465 PMCID: PMC9847966 DOI: 10.1371/journal.pone.0280359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
SGLT-2 inhibitor, traditionally used for glycemic control, has several beneficial effects that can help manage heart failure (HF). SGLT-2 inhibitors reduce the risk of cardiovascular mortality in patients with HF. As atrial fibrillation (AF) is closely associated with HF and diabetes mellitus (DM) is a risk factor for AF, we assume that SGLT-2 inhibitors will also show therapeutic benefits regarding AF, especially for rhythm control. This trial has a multicenter, prospective, open, blinded endpoint design. It is a 1:1 randomized and controlled study. A total of 716 patients who are newly diagnosed of AF and DM within 1 year will be enrolled from 7 tertiary medical centers. The trial is designed to compare the effects of SGLT-2 inhibitors and other oral hypoglycemic agents on atrial rhythm control in patients with AF and DM. The primary outcome is the recurrence of AF within a year (including post-antiarrhythmic drugs (AAD) or ablation). The secondary outcomes are the ablation rate within a year, change in AF burden, size of the left atrium, NT-proBNP, the AF symptom score, and the quality of life. This trial will prospectively evaluate the effect and safety of SGLT-2 inhibitors on AF rhythm control in patients with DM. It will provide an invaluable dataset on rhythm control in AF with DM for future studies and offer novel information to assist in clinical decisions. (BEYOND trial, ClinicalTrials.gov number: NCT05029115. https://clinicaltrials.gov/ct2/show/NCT05029115).
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Affiliation(s)
- Kyuhyun Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soo Kyoung Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Juyeon Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Bo Kyung Jeon
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jung Myung Lee
- Kyung Hee University, Medical Center, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Dong Hyeok Kim
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Jaemin Shim
- Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
- * E-mail:
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Hwang I, Kwon OS, Hong M, Yang SY, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Corrigendum: Association of ZFHX3 genetic polymorphisms and extrapulmonary vein triggers in patients with atrial fibrillation who underwent catheter ablation. Front Physiol 2022; 13:1100597. [PMID: 36531173 PMCID: PMC9756966 DOI: 10.3389/fphys.2022.1100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fphys.2021.807545.].
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Hwang I, Jin Z, Park JW, Kwon OS, Lim B, Hong M, Kim M, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Corrigendum: Computational modeling for antiarrhythmic drugs for atrial fibrillation according to genotype. Front Physiol 2022; 13:991997. [PMID: 36531166 PMCID: PMC9757488 DOI: 10.3389/fphys.2022.991997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fphys.2021.650449.].
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effect of epicardial fat volume on outcomes after left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Front Cardiovasc Med 2022; 9:1005760. [DOI: 10.3389/fcvm.2022.1005760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundGreater epicardial adipose tissue (EAT) is related to higher recurrences after atrial fibrillation catheter ablation (AFCA). We investigated the effects of posterior wall box isolation (POBI) in conjunction with circumferential pulmonary vein isolation (CPVI) on rhythm outcomes according to varying EAT volumes among patients with persistent atrial fibrillation (PeAF).Materials and methodsWe included 1,187 patients with PeAF undergoing a de novo AFCA including those receiving CPVI alone (n = 687) and those receiving additional POBI (n = 500). The rhythm outcomes at 2 years post-AFCA were compared in subgroups stratified by the EAT volume using propensity overlap weighting.ResultsA reduced EAT volume was linearly associated with more favorable rhythm outcomes for additional POBI than for CPVI alone (P for interaction = 0.002). Among the patients with smaller EAT volumes (≤116.23 mL, the median value, n = 594), additional POBI was associated with a reduced AF recurrence risk as compared to CPVI only [weighted HR (hazard ratio) 0.74, 95% CI (confidence interval) 0.56–0.99]. In contrast, among the remaining 593 patients with greater EAT volumes (>116.23 mL), No difference was observed in the recurrence risk between the additional POBI and CPVI alone groups (weighted HR 1.13, 95% CI 0.84–1.52). Among 205 patients with repeat ablations, the POBI reconnection rate was more frequent in the large EAT group (77.4%) than in the small EAT group (56.7%, P = 0.034).ConclusionWhile PeAF patients with a smaller EAT volume averted AF recurrence by additional POBI after CPVI, no benefit of the POBI was observed in those with a greater EAT volume.
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Kim SE, Chun KH, Oh J, Yu HT, Lee CJ, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Prediction of response to cardiac resynchronization therapy using cardiac magnetic resonance imaging in non-ischemic dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a well-established therapy for symptomatic heart failure with reduced ejection fraction, but the response is different for individuals. Although many modalities have been conducted to predict CRT response, cardiac magnetic resonance (CMR) to predict CRT response has still insufficient usefulness.
Purpose
We determine whether the parameters including late gadolinium enhancement (LGE) identified in CMR could act as predictors of CRT response.
Methods
We retrospectively investigated 124 patients with non-ischemic dilated cardiomyopathy who underwent CMR before CRT implantation between Jan 2010 and July 2021 in a single center. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) >15% on echocardiography after at least 3 months after CRT implantation.
Results
Among the study population (mean age 65.7±11.2 years, mean EF 25±6.5%, 50% of female), 85 (69%) patients were defined as CRT responder. The CRT responders had more left bundle branch block (LBBB) compared with non-responders [79 (92.9%) vs. 23 (59.0%), p<0.001], but there was a no difference of QRS duration (158.7 vs 165.0ms, p=0.054) between two groups. CMR analysis showed that there were no significant differences in the left ventricular (LV) chamber volume and LV ejection fraction between CRT-responder and non-responder. However, the right ventricular (RV) chamber volume was smaller (RV end-diastolic volume index, 86.3 vs 103.5 ml/m2, p=0.039; RV end-systolic volume index, 49.3 vs 68.5 ml/m2, p=0.013) and the RV ejection fraction (RVEF) was higher (46.9 vs 37.6%, p=0.002) in CRT-responders compared with non-responders. The LGE on CMR was more shown in non-responders than in CRT-responders [33 (84.6%) vs 45 (52.9%), p<0.001]. In CMR parameters, RV dysfunction (RVEF <45%) [Odds ratio (OR), 0.21 (0.05–0.93), p=0.045] and LGE [OR, 0.21 (0.05–0.58), p=0.01] were significantly associated with poor CRT response.
Conclusions
The presence of LGE and RV dysfunction on CMR were associated with poor CRT response in patients with non-ischemic dilated cardiomyopathy. Further investigation with CMR for pre-CRT patients is needed to support these results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S E Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - K H Chun
- NHIS Ilsan Hospital, Cardiology , Goyang , Korea (Republic of)
| | - J Oh
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - S M Kang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Kim MH, Hwang I, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA.
Methods
Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA>40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS).
Results
Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p<0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling.
Conclusions
Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
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Affiliation(s)
- M H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - I Hwang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J W Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Park Y, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effects of early recurrence and extra-PV triggers on long-term recurrence after catheter ablation for atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although early recurrence (ER) within 3 months after atrial fibrillation (AF) catheter ablation (AFCA) was recently reported to be a reliable predictor of late recurrence (LR), the mechanism is not clear.
Purpose
We explored the characteristics of patients with ER and compared the long-term late recurrence (LR) pattern depending on the existence of extra-pulmonary vein trigger (ExPV-trigger).
Methods
Among 3643 patients who underwent de novo AFCA, we included 1249 patients (59.2±11.0 years old, 31.3% persistent AF) who underwent isoproterenol provocation and regular follow-up over three years after AFCA. We evaluated the risk factors for ER and compared the patients with ER alone (10.1%), LR alone (16.6%), and ER+LR (15.9%), and the outcome of repeat procedure.
Results
Overall ER (ER alone and ER+LR) was independently associated with persistent AF (OR 1.58 [1.16–2.14], p=0.003), extra-PV triggers (OR 2.80 [1.90–4.13], p<0.001), and empirical extra-PV ablation (OR 1.54 [1.15–2.07], p=0.004). Overall LR (LR alone and ER+LR) risk was significantly higher in the ER with ExPV-trigger group than in ER without ExPV-trigger or no ER groups (Log-rank p<0.001). The rhythm outcome of the second procedure did not differ between ER+LR and LR alone groups (Log-rank p=0.160), but was worse in the ER+LR ExPV-trigger than in ER+LR without ExPV-trigger or LR alone groups (Log-rank p=0.005).
Conclusion
ER was independently associated with LR after de novo AFCA. ExPV-trigger played crucial roles in ER and LR after de novo AFCA and worse rhythm outcome after redo AFCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effect of the epicardial fat volume on the outcomes after a left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While the effect of a circumferential pulmonary vein isolation (CPVI) alone is unsatisfactory, that of an additional electrical posterior wall box isolation (POBI) is controversial in persistent atrial fibrillation (PeAF) patients. Increased epicardial adipose tissue (EAT) is associated with higher recurrence rates after AF catheter ablation (AFCA).
Purpose
We investigated the possible effects of a POBI on rhythm outcomes with varying EAT volumes.
Methods
We included 1,187 patients with PeAF undergoing a de novo AFCA (79.6% male, median age 60 years) into two groups including those receiving a CPVI alone (n=687) and those an additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the total EAT volume using propensity overlap weighting.
Results
A reduced total EAT volume was linearly associated with more favorable rhythm outcomes for an additional POBI treatment than for a CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (≤116.23 ml, the median value, n=594), an additional POBI was associated with a reduced AF recurrence risk as compared to a CPVI only (weighted hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56–0.99; weighted log-rank P=0.039). In contrast, among the remaining 593 patients with greater EAT volumes (>116.2 3mL), there was no difference in the AF recurrence risk between an additional POBI and CPVI alone (weighted HR 1.13, 95% CI 0.84–1.52; weighted log-rank P=0.410). Among 185 patients with a repeat ablation, the POBI reconnection rate tended to be higher in the large EAT group (75.0%) than small EAT group (55.4%, P=0.060).
Conclusion
While PeAF patients with a smaller EAT volume averted AF recurrence by an additional POBI after the CPVI, no benefit of the POBI was observed in those with a greater EAT volume. The EAT volume might identify AF patients likely to benefit from linear ablation in addition to the CPVI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Ministry of Science, ICT & Future Planning (MSIP)Korean Ministry of Health and Welfare
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - O S Kwon
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
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Kim D, Yang PS, You SC, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Lip GYH, Sung JH, Joung B. Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients : A Nationwide Propensity Score-Weighted Study. Ann Intern Med 2022; 175:1356-1365. [PMID: 36063552 DOI: 10.7326/m21-4798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rhythm control is associated with lower risk for adverse cardiovascular outcomes compared with usual care among patients recently diagnosed with atrial fibrillation (AF) with a CHA2DS2-VASc score of approximately 2 or greater in EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial). OBJECTIVE To investigate whether the results can be generalized to patients with low stroke risk. DESIGN Population-based cohort study. SETTING Nationwide claims database of the Korean National Health Insurance Service. PARTICIPANTS 54 216 patients with AF having early rhythm control (antiarrhythmic drugs or ablation) or rate control therapy that was initiated within 1 year of the AF diagnosis. MEASUREMENTS The effect of early rhythm control on the primary composite outcome of cardiovascular death, ischemic stroke, hospitalization for heart failure, or myocardial infarction was compared between eligible and ineligible patients for EAST-AFNET 4 (CHA2DS2-VASc score, approximately 0 to 1) using propensity overlap weighting. RESULTS In total, 37 557 study participants (69.3%) were eligible for the trial (median age, 70 years; median CHA2DS2-VASc score, 4), among whom early rhythm control was associated with lower risk for the primary composite outcome than rate control (hazard ratio, 0.86 [95% CI, 0.81 to 0.92]). Among the 16 659 low-risk patients (30.7%) who did not meet the inclusion criteria (median age, 54 years; median CHA2DS2-VASc score, 1), early rhythm control was consistently associated with lower risk for the primary outcome (hazard ratio, 0.81 [CI, 0.66 to 0.98]). No significant differences in safety outcomes were found between the rhythm and rate control strategies regardless of trial eligibility. LIMITATION Residual confounding. CONCLUSION In routine clinical practice, the beneficial association between early rhythm control and cardiovascular complications was consistent among low-risk patients regardless of trial eligibility. PRIMARY FUNDING SOURCE The Ministry of Health and Welfare and the Ministry of Food and Drug Safety, Republic of Korea.
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Affiliation(s)
- Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea (P.S.Y., J.H.S.)
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (S.C.Y.)
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.)
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea (P.S.Y., J.H.S.)
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (D.K., E.J., H.T.Y., T.H.K., H.N.P., M.H.L., B.J.)
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Samoutis A, Lee MH, Patel A, Jaiswal P. O099 Position and number of anchors in hip arthroscopy labrum repair: a systematic review. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
Hip labral tears are reported in 22–55% of patients with hip or groin pain. Operative treatment is necessary for most cases, via hip arthroscopy with the use of suture anchors. This systematic review aims to determine the optimal number and position of anchors in hip labral repair.
Methods
Pubmed, Ovid & Embase were searched, and 2 researchers independently screened the 1,304 results. Outcome measures such as procedures performed, number & (clockface) position of anchors, failure & articular involvement of anchors were extracted.
Results
5 studies were included in the analysis: 1 Cross-Sectional Study (1645 Hips, mean age (MA):33.7 years), 3 Retrospective case studies (491 hips, MA:31.0) and 1 Controlled Cadaveric study (32 cadaveric hips, MA:62.7). Chi-squared statistical analysis of 323 hips found a significant difference (X2 (2, N = 323) = 17.88, p < .001) in the risk of articular involvement with the position of anchors at 11°-12° o’clock, 1°-2° and 3°-4°. There is an absolute risk reduction (ARR) of 19% with anchors positioned at 11°-12° compared to anchors positioned at 3°-4° (X2 (1, N=178) =15.79, p < .001) and an ARR of 12% with anchors at 1°-2° compared to anchors positioned at 3°-4° (X2 (1, N = 237) = 15.79, p < .0109). Additionally, by assessing 1645 operations it was found that for tears spanning >2 hours, a minimum of 2 anchors was placed.
Conclusion
Placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and careful placement can be used to minimize articular injury. Preferable positions of anchors are 11°-12°, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
Take-home message
In Hip Arthroscopy labral repair, placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and 2 hours. flexible anchor instrumentation can be used to minimize articular injury, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Ablation and antiarrhythmic drug effects on PITX2+/− deficient atrial fibrillation: A computational modeling study. Front Cardiovasc Med 2022; 9:942998. [PMID: 35928934 PMCID: PMC9343754 DOI: 10.3389/fcvm.2022.942998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAtrial fibrillation (AF) is a heritable disease, and the paired-like homeodomain transcription factor 2 (PITX2) gene is highly associated with AF. We explored the differences in the circumferential pulmonary vein isolation (CPVI), which is the cornerstone procedure for AF catheter ablation, additional high dominant frequency (DF) site ablation, and antiarrhythmic drug (AAD) effects according to the patient genotype (wild-type and PITX2+/− deficient) using computational modeling.MethodsWe included 25 patients with AF (68% men, 59.8 ± 9.8 years of age, 32% paroxysmal AF) who underwent AF catheter ablation to develop a realistic computational AF model. The ion currents for baseline AF and the amiodarone, dronedarone, and flecainide AADs according to the patient genotype (wild type and PITX2+/− deficient) were defined by relevant publications. We tested the virtual CPVI (V-CPVI) with and without DF ablation (±DFA) and three virtual AADs (V-AADs, amiodarone, dronedarone, and flecainide) and evaluated the AF defragmentation rates (AF termination or changes to regular atrial tachycardia (AT), DF, and maximal slope of the action potential duration restitution curves (Smax), which indicates the vulnerability of wave-breaks.ResultsAt the baseline AF, mean DF (p = 0.003), and Smax (p < 0.001) were significantly lower in PITX2+/− deficient patients than wild-type patients. In the overall AF episodes, V-CPVI (±DFA) resulted in a higher AF defragmentation relative to V-AADs (65 vs. 42%, p < 0.001) without changing the DF or Smax. Although a PITX2+/− deficiency did not affect the AF defragmentation rate after the V-CPVI (±DFA), V-AADs had a higher AF defragmentation rate (p = 0.014), lower DF (p < 0.001), and lower Smax (p = 0.001) in PITX2+/− deficient AF than in wild-type patients. In the clinical setting, the PITX2+/− genetic risk score did not affect the AF ablation rhythm outcome (Log-rank p = 0.273).ConclusionConsistent with previous clinical studies, the V-CPVI had effective anti-AF effects regardless of the PITX2 genotype, whereas V-AADs exhibited more significant defragmentation or wave-dynamic change in the PITX2+/− deficient patients.
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Lee JH, Hwang I, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Lower pulmonary vein-to-left atrium volume ratio predicts poor rhythm outcome after atrial fibrillation catheter ablation. Front Cardiovasc Med 2022; 9:934168. [PMID: 35911561 PMCID: PMC9334901 DOI: 10.3389/fcvm.2022.934168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Although left atrial (LA) dimension (LAD) is one of the predictors of atrial fibrillation (AF) recurrence after catheter ablation, repetitive recurrences occur in patients without enlarged LAD. We explored the predictive value of pulmonary vein (PV) to LA volume percent ratio (PV/LA%vol) for rhythm outcomes after AF catheter ablation (AFCA). We included 2913 patients (73.5% male, 60.0 [52.0–67.0] years old, 60.6% paroxysmal AF) who underwent AFCA. We evaluated the association between PV/LA%vol and AF recurrence after AFCA and compared the predictive value for AF recurrences according to the LA size with LAD. We additionally investigated the association between PV/LA%vol and PITX2 gene using a genome-wide association study. LAD affected 1-year recurrence only in the highest tertile group (T3, p = 0.046), but PV/LA%vol determined 1-year recurrence in all LAD groups (T1, p = 0.044; T2, p = 0.021; and T3, p = 0.045). During 20.0 (8.0–45.0) months of follow-up, AF recurrence rate was significantly higher in patients with lower PV/LA%vol (Log-rank p = 0.004, HR 0.91 [0.84–1.00], p = 0.044). In the T1 and T2 LAD groups, predicting AF recurrences was better with PV/LA%vol than with LAD (AUC 0.63 vs. 0.51, p < 0.001 at T1; AUC 0.61 vs. 0.50, p = 0.007 at T2). We replicated PITX2-related rs12646447, which was independently associated with PV/LA%vol (β = 0.15 [0–0.30], p = 0.047). In conclusion, smaller PV volumes after LA volume adjustments have genetic background of PITX2 gene and predictive value for poorer rhythm outcomes after AFCA, especially in patients without LA enlargement.
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Affiliation(s)
- Jae-Hyuk Lee
- Department of Cardiology, Myongji Hospital, Hanyang University Medical Center, Gyeonggi-do, South Korea
| | - Inseok Hwang
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Division of Cardiology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- *Correspondence: Hui-Nam Pak,
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Kim M, Park YJ, Yu HT, Kim TH, Uhm JS, Joung B, Pak HN, Lee MH. Case Report: Delayed Ventricular Pseudoaneurysm After Radiofrequency Ablation of Left Posteromedial Papillary Muscle Ventricular Tachycardia. Front Cardiovasc Med 2022; 9:887190. [PMID: 35783824 PMCID: PMC9240706 DOI: 10.3389/fcvm.2022.887190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
A 74-year-old woman presented with incessant wide complex tachycardia that was refractory to cardioversions. Successful radiofrequency catheter ablation was performed on the left ventricular posteromedial papillary muscle. An inaudible steam pop has occurred during the procedure, but we confirmed that there were no complications during the procedure and short-term follow-up of echocardiography. Two months after the procedure, an asymptomatic pseudoaneurysm was identified at the ablation site that had not been observed in the short-term follow-up.
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Affiliation(s)
- Min Kim
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yoon Jung Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
- *Correspondence: Moon-Hyoung Lee,
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Jang YW, Yoon Y, Maharjan R, Yi H, Jeong M, Hong SY, Lee MH, Kim SW, Kim JI, Yang JW. First Report of Pseudomonas cichorii Causing Bacterial vein necrosis on Perilla plants [ Perilla frutescens (L.) Britton.] in South Korea. Plant Dis 2022; 107:549. [PMID: 35700520 DOI: 10.1094/pdis-01-22-0143-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Perilla (Perilla frutescens L.) is the second most important upland crop and the third largest edible oil crop in Korea (Shin and Kim 1994). During a disease survey in Busan, Korea in September 2021, symptoms of vein necrosis were observed in perilla plants, with incidences of approximately 30% and 50% in two fields. Symptoms of spots on the perilla appeared as leaf dryness and spots with water-soaked blotches largely concentrated on the mid-veins of leaves. The lesions were initiated with water-soaked spots on the leaf or stem and gradually turned black or brown. Necrosis was also observed in the stems. A bacterium was isolated on Luria-Bertani (LB) agar from diseased leaf tissues that were surface-disinfected with 70% ethyl alcohol for 3-5 min and then washed with sterile water three times. Three pieces of sterilized leaf tissue (size: 0.5 × 0.5 cm) were mixed with 500 µL sterile water for 30 min, and then the suspension was serially diluted and spread on LB agar. Subsequently, isolates were cultivated on LB agar and King's Medium B agar (KMB) (Schaad et al. 2001), and they were predominantly cream-colored and circular bacterial colonies with undulated margins. The bacterial colonies on KMB displayed fluorescence under 365 nm UV light. The isolates were analyzed with the GEN III MicroPlate (Biolog, Hayward, CA, USA), and all isolates were identified as Pseudomonas cichorii, a devastating plant bacterium that damages a wide range of host plants worldwide, including in South Korea (Hikichi et al. 2013; Ramkumar et al. 2015). To identify the species of the bacterial pathogen, genomic DNA of four isolates (BS4922, BS4167, BS4345, and BS4560) was extracted, and the 16S rRNA gene and hrcRST gene were amplified with universal primers, 27F/1492R and Hcr1/Hcr2, and sequencing was then done (Patel et al. 2019). In the BLAST analysis, the 16S rRNA sequences (GenBank OM060656, OM275434, OM275435, OM275436) showed a 100% and 99% similarity to P. cichorii strains MAFF 302698 (AB724286) and P. cichorii strain Pc-Gd-4 (KU923373), respectively. Further, hrcRST gene sequences (GenBank OM143596, OM268864, OM268865, and OM268866) showed high similarity (>99%) with P. cichorii strain P16-51 (MG518230). A pathogenicity test of the four isolates was performed on 3 - 4 weeks old perilla plants by creating wounds with a needle on the lower leaves and stems, and then the plants were inoculated by spraying inoculum (108 CFU/ml). The plants that served as the negative control were wounded and sprayed with unsterilized water. The inoculated perilla plants were placed in a greenhouse at 28 ± 2oC , 80-85% relative humidity, and a natural photoperiod. The inoculation site began to show symptoms of water-soaked brown lesions. Disease symptoms such as leaf dryness, water-soaked blotches on the mid-vein of leaves, and necrosis on plant stems were observed in the inoculated plants 7-10 days after inoculation, whereas the plants of the negative control group did not show any symptoms. The bacteria were re-isolated from the diseased tissues of the plants, and DNA sequence analysis identified them as P. cichorii. Additionally, all isolates induced hypersensitivity reactions in tobacco and tomato leaves within 24 h after inoculation. To our knowledge, this is the first report of P. cichorii infecting perilla in South Korea. The findings in this study will provide the basic information for the development of diagnostic tools and management measures against P. cichorii in perilla.
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Affiliation(s)
- Yun-Woo Jang
- National Institute of Crop Science, RDA, , Southern Area Crop Science, 20, jeompiljae-ro, miryang, Korea (the Republic of), 50424;
| | - Youngnam Yoon
- National Institute of Crop Science, RDA, Corp Productiong Technology Research Division, 20th, Jeompiljaero, Miryang, Korea (the Republic of), 50424;
| | - Rameswor Maharjan
- National Institute of Crop Science, RDA, Crop Production Technology Research Division, Miryang, Gyeongsangnam-do, Korea (the Republic of);
| | - Hwijong Yi
- National Institute of Crop Science, RDA, Crop Production Technology Research Division, Miryang, Gyeongsangnam-do, Korea (the Republic of);
| | - M Jeong
- National Institute of Crop Science, RDA, Corp Productiong Technology Research Division, Miryang, Korea (the Republic of);
| | - S Y Hong
- National Institute of Crop Science, RDA, Mirayang, Korea (the Republic of);
| | - M H Lee
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - S W Kim
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - J I Kim
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - Jung-Wook Yang
- National Institute of Crop Science Muan, Bioenergy crop research Institute, 199 Muanro Cheonggye, Muan, Jeonnam, Korea (the Republic of), 58545;
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Liu PY, Choi EK, Kim TS, Kuo JY, Lee JM, On YK, Park SW, Park HW, Shin DG, Wang L, Yen HW, Lee MH. XaMINA: A Real-World, Prospective, Observational Study of Treatment-Naïve Patients Treated with Rivaroxaban for Stroke Prevention in Atrial Fibrillation in Asia. Adv Ther 2022; 39:3316-3333. [PMID: 35616848 DOI: 10.1007/s12325-022-02102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The efficacy and safety of rivaroxaban for the prevention of stroke and systemic embolism have been demonstrated in Asian and non-Asian patients with non-valvular atrial fibrillation (NVAF) in multiple studies. However, limited published data exist on its use specifically in treatment-naïve patients from the Asia region. Patients in South Korea and Taiwan can now receive rivaroxaban as first-line therapy, allowing for data generation in this patient group. METHODS XaMINA was a prospective, real-world, multicenter, single-arm, observational cohort study of patients with NVAF in South Korea and Taiwan naïve to anticoagulation and initiating rivaroxaban. The primary outcome was major bleeding; secondary outcomes included all-cause mortality, symptomatic thromboembolic events, and treatment persistence. RESULTS In total, 1094 patients were included and the follow-up was 1 year. The baseline mean CHADS2 score was 1.63 ± 0.98, mean CHA2DS2-VASc score was 2.92 ± 1.42, and mean HAS-BLED score was 1.00 ± 0.75. The primary outcome occurred in 20 (1.8%) patients [incidence rate 2.1 events per 100 patient-years (95% CI 1.35-3.25)]. Thromboembolic events occurred in 9 (0.8%) patients, of whom 5 (0.5%) had stroke, 3 (0.3%) myocardial infarction, and 1 (0.1%) a transient ischemic attack. There were no cases of non-central nervous system systemic embolism, and 735 (67.2%) patients persisted with rivaroxaban treatment for 1 year. CONCLUSION XaMINA demonstrated low incidence rates of major bleeding events and thromboembolic events in patients with NVAF newly initiating rivaroxaban in South Korea and Taiwan, consistent with previous real-world studies reconfirming the results of the ROCKET AF study. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov (identifier NCT03284762) on 15 September 2017.
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Affiliation(s)
- Ping-Yen Liu
- Division of Cardiology, Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Seok Kim
- The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Jen-Yuan Kuo
- Division of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Jung Myung Lee
- Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Young Keun On
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Dong-Gu Shin
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Lili Wang
- Bayer (South East Asia) Pte Ltd, Singapore, Singapore
| | | | - Moon-Hyoung Lee
- Severance Hospital, Yonsei University, 50-1 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
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Kang DS, Sung JH, Kim D, Jin MN, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Lip G, Yang PS, Joung B. Association between exercise habit changes and mortality following a cardiovascular event. Heart 2022; 108:1945-1951. [PMID: 35589378 DOI: 10.1136/heartjnl-2022-320882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate the associations between exercise habit changes following an incident cardiovascular event and mortality in older adults. METHODS We analysed the relationship between exercise habit change and all-cause, cardiovascular and non-cardiovascular deaths in adults aged ≥60 years between 2003 and 2012 who underwent two consecutive health examinations within 2 years before and after diagnosis of cardiovascular disease (CVD). They were categorised into four groups according to exercise habit changes: persistent non-exercisers, exercise dropouts, new exercisers and exercise maintainers. Differences in baseline characteristics were adjusted using inverse probability of treatment weighting. RESULTS Of 6076 participants, the median age was 72 (IQR 69-76) years and men accounted for 50.6%. Compared with persistent non-exercisers (incidence rate (IR) 4.8 per 100 person-years), new exercisers (IR 3.5, HR 0.73, 95% CI 0.58 to 0.91) and exercise maintainers (IR 2.9, HR 0.53, 95% CI 0.38 to 0.73) were associated with reduced risk of all-cause death. The rate of non-cardiovascular death was significantly lower in new exercisers (IR 2.3, HR 0.73, 95% CI 0.56 to 0.95) and exercise maintainers (IR 2.3, HR 0.61, 95% CI 0.42 to 0.90) than in persistent non-exercisers (IR 3.2). Also, trends towards reduced cardiovascular death in new exercisers and exercise maintainers were observed (p value for trend <0.001). CONCLUSIONS More virtuous exercise trajectories in older adults with CVD are associated with lower mortality rates. Our results support public health recommendations for older adults with CVD to perform physical activity.
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Affiliation(s)
- Dong-Seon Kang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Inje University College of Medicine, Busan, Korea
| | - Eunsun Jang
- Cardiology, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Boyoung Joung
- Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
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Yang PS, Kim DH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Sung JH, Joung B. Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health & Welfare, Republic of Korea
Background
Rhythm control is associated with better cardiovascular outcomes than usual care among patients recently diagnosed with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the effects of early rhythm control compared to rate control on the primary composite outcome of cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF), or myocardial infarction.
Methods
We conducted a retrospective population-based cohort study including 22635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011-2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used.
Results
Among patients with early AF treatment (initiated within 1 year since diagnosis), compared with rate control, rhythm control was associated with a similar lower risk of the primary composite outcome both women (weighted incidence rate per 100 person-years: 8.68 in rhythm control vs. 10.3 in rate control; hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.69 to 0.90; P<0.001) and men (weighted incidence rate per 100 person-years: 6.33 in rhythm control vs. 8.32 in rate control; HR 0.77, 95% CI 0.67 to 0.88; P<0.001). However, the effective initiation time for rhythm control therapy was within 6 and 11 months after AF diagnosis in female and male patients, respectively. Moreover, the effective times for other outcomes were different between genders (hospitalization for HF; female within 2 months, male within 9 months/ ischemic stroke; female within 11 months, male immediately).
Conclusions
Early initiation of rhythm control was associated with a lower risk of primary outcome in both genders. However, the effective rhythm control treatment initiation time for primary outcome, stroke and HF-related admission was different in both genders. For rhythm control treatment to be effective, women should start treatment earlier than men.
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Affiliation(s)
- PS Yang
- CHA University, Seongnam, Korea (Republic of)
| | - DH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - JH Sung
- CHA University, Seongnam, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
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Yu G, Kim TH, Yu HT, Joung BY, Pak HN, Lee MH. Learning curve of left bundle branch area pacing with standard stylet-driven pacing leads: a single center prospective observational study in Korea. Europace 2022. [DOI: 10.1093/europace/euac053.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although cardiac pacing is an essential therapy for bradycardia, conventional right ventricular pacing (CRVP) can cause electrical-mechanical dyssynchrony. Left Bundle Branch Area Pacing (LBBAP) is a new conduction system pacing strategy that includes a normal conduction system and therefore maintains synchronous ventricular contraction. Most of the experience with LBBAP is done in a lumen-less lead with fixed helix design, and this device is not available in sometimes.
Purpose
This study aimed to evaluate the learning curve of LBBAP using standard stylet-driven lead with extendable helix design.
Methods
This study enrolled patients who underwent permanent cardiac pacemaker implantation at a University Hospital in South Korea from December 2020 to October 2021. LBBAP was performed with a 5.6Fr stylet-driven pacing lead with an extendable helix. The learning curve was assessed by analyzing fluoroscopy time and procedure time.
Results
In 65 patients who underwent LBBAP during the observation period, mean fluoroscopy time and procedural time were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively in this study. The learning curve for achieving LBBAP appears to plateau after around 24th case with a progressive reduction in procedure time. This is a significantly shorter period of time when compared to the previously reported learning curves of his bundle pacing (30-50cases), previously developed conduction system pacing strategy.
Conclusion
During initial experience with LBBAP, fluoroscopy and procedural time continue to improve with operator experience. For physicians who are experienced at cardiac pacemaker implantation, the steepest part of the learning curve of LBBAP appears to be over the first 20-25 cases.
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Affiliation(s)
- G Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University, Seoul, Korea (Republic of)
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Verdugo-Paiva F, Vergara C, Ávila C, Castro J, Cid J, Contreras V, Jara I, Jiménez V, Lee MH, Muñoz M, Rojas-Gómez AM, Rosón-Rodríguez P, Serrano-Arévalo K, Silva-Ruz I, Vásquez-Laval J, Zambrano-Achig P, Zavadzki G, Rada G. COVID-19 L·OVE repository is highly comprehensive and can be used as a single source for COVID-19 studies. J Clin Epidemiol 2022; 149:195-202. [PMID: 35597369 PMCID: PMC9116966 DOI: 10.1016/j.jclinepi.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022]
Abstract
Background and Objective The coronavirus disease 2019 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains more than 430,000 articles as of September 20, 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews. Methods Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that was available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search. Results We identified 83 eligible systematic reviews that included 2,132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2,125/2,132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2,057/2,132). Both the comprehensiveness and the currency were 100% for randomized trials (82/82). Conclusion The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes.
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Affiliation(s)
| | - C Vergara
- Epistemonikos Foundation, Santiago, Chile
| | - C Ávila
- Epistemonikos Foundation, Santiago, Chile
| | - J Castro
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Cid
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - I Jara
- Epistemonikos Foundation, Santiago, Chile
| | - V Jiménez
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M H Lee
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Muñoz
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A M Rojas-Gómez
- Epistemonikos Foundation, Santiago, Chile; Unidad de investigación en medicina estomatológica preventiva y social (UIMEPS), Universidad del Magdalena, Santa Marta, Colombia
| | | | | | - I Silva-Ruz
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - G Zavadzki
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - G Rada
- Epistemonikos Foundation, Santiago, Chile; UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile; Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Shin JI, Kim SE, Lee MH, Kim MS, Lee SW, Park S, Shin YH, Yang JW, Song JM, Moon SY, Kim SY, Park Y, Suh DI, Yang JM, Cho SH, Jin HY, Hong SH, Won HH, Kronbichler A, Koyanagi A, Jacob L, Hwang J, Tizaoui K, Lee KH, Kim JH, Yon DK, Smith L. COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:3760-3770. [PMID: 35647859 DOI: 10.26355/eurrev_202205_28873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use. MATERIALS AND METHODS We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). RESULTS Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19. CONCLUSIONS AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.
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Affiliation(s)
- J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Lee KH, Li H, Lee MH, Park SJ, Kim JS, Han YJ, Cho K, Ha B, Kim SJ, Jacob L, Koyanagi A, Shin JI, Kim JH, Smith L. Clinical characteristics and treatments of multi-system inflammatory syndrome in children: a systematic review. Eur Rev Med Pharmacol Sci 2022; 26:3342-3350. [PMID: 35587087 DOI: 10.26355/eurrev_202205_28754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multisystem inflammatory syndrome in children (MIS-C) can occur in association with coronavirus disease 2019 (COVID-19). It is not easy to differentiate MIS-C from severe COVID-19 or Kawasaki disease based on symptoms. The aim of this study was to describe the clinical and laboratory characteristics of MIS-C. PATIENTS AND METHODS We searched PubMed/Medline for case series and reports of MIS-C published until June 20, 2020. From a total of nine articles involving 45 cases, various clinical and laboratory data were extracted. Each target case was evaluated by using different diagnostic criteria. RESULTS The average age at onset of MIS-C was 8.6 years. In 80% of cases, the age of patients ranged from 5 to 15 years. Fever (100%) and shock (82%) were the most common presenting symptoms. Sixty percent of cases met the diagnostic criteria for typical or atypical Kawasaki disease. Biomarkers indicative of inflammation, coagulopathy, or cardiac injury were characteristically elevated as follows: ferritin (mean: 1,061 ng/mL), CRP (217 mg/L), ESR (69 mm/hr), IL-6 (214.8 pg/mL), TNFα (63.4 pg/mL), D-dimer (3,220 ng/mL), PT (15.5 s), troponin I (1,006 ng/L), and BNP (12,150 pg/mL). Intravenous immunoglobulin was administered in all target cases, and inotropic agents were commonly used as well. No case of death was observed. CONCLUSIONS This study demonstrated that MIS-C is a serious condition that presents with fever, rash, as well as cardiovascular and gastrointestinal symptoms. Although it is challenging to differentiate MIS-C from Kawasaki disease or severe COVID-19, initiation of appropriate treatments through early diagnosis is warranted.
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Affiliation(s)
- K H Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Electrical Posterior Box Isolation in Repeat Ablation for Atrial Fibrillation: A Prospective Randomized Clinical Study. JACC Clin Electrophysiol 2022; 8:582-592. [PMID: 35589170 DOI: 10.1016/j.jacep.2022.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 01/01/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study investigated whether additional electrical posterior box isolation (POBI) may improve the rhythm outcome of repeat ablation in atrial fibrillation (AF). BACKGROUND Although electrically reconnected pulmonary veins (PVs) are the main mechanism of AF recurrence, it is unclear whether linear ablation in addition to circumferential PV isolation (CPVI) improves rhythm outcomes after repeat ablation. METHODS The authors prospectively randomized 150 patients with PV reconnection undergoing redo procedures to either a CPVI-alone group (n = 75) or an additional POBI group (n = 75). The primary endpoint was AF recurrence after a single procedure, and the secondary endpoints were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs. RESULTS After a median follow-up of 17 months, the clinical recurrence rate did not significantly differ between the CPVI-alone and additional-POBI groups (30.7% vs 30.7%; log-rank P =0.828). Of the 46 patients with clinical recurrence, the recurrences as atrial tachycardia (8.7% vs 30.4%; P =0.137) and cardioversion rates (21.7% vs 47.8%; P =0.122) were not significantly different between the CPVI-alone and additional-POBI groups. Major complication rates did not differ between the 2 groups (1.3% vs 5.3%; P = 0.363), but the total ablation time was significantly longer in the additional-POBI group than in the CPVI-alone group (median: 1,084 [IQR: 704-1,664] vs 1,595 [IQR: 1,244-2,302] seconds; P < 0.001). CONCLUSIONS Among patients undergoing redo AF ablation with reconnected PVs, the addition of POBI to CPVI did not improve rhythm outcomes or influence overall safety, whereas leading to a longer ablation time than that with CPVI alone. (Comparison of Circumferential Pulmonary Vein Isolation and Complex Pulmonary Vein Isolation Additional Linear Ablation for Recurred Atrial Fibrillation After Previous Catheter Ablation: Prospective Randomized Trial [RILI Trial]; NCT02747498).
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Affiliation(s)
- Daehoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Yu GI, Yang PS, Kim MH, Jin MN, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Joung B. Association between Physical Activity and the Risk of Mortality and Hospitalization in Older Korean Adults with Heart Failure. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2305153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Badreddine J, Lee MH, Mishra K, Pope R, Kim JY, Hong SH, Gupta S, Song JM, Shin JI, Ghayda RA. Continuing perioperative estrogen therapy does not increase venous thromboembolic events in transgender patients: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:2511-2517. [PMID: 35442466 DOI: 10.26355/eurrev_202204_28488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study is to compare the risk of venous thromboembolic events (VTE) between patients suspending and continuing estrogen therapy perioperatively, in male to female gender-affirming surgery (vaginoplasty). MATERIALS AND METHODS The authors conducted a systematic review and meta-analysis of existing research on male to female gender-affirming study, which compared the risk of VTE among the usage of estrogen perioperatively. RESULTS A total of 209 studies were identified as potentially eligible among PubMed, Embase, and Cochrane library databases. Among the studies, 191 studies were excluded due to their abstract inappropriateness. Out of the remaining 18 studies, only 3 articles were eligible and were finally included. Meta-analysis was performed and showed odds ratio of 0.77 (95% CI: 0.04, 14.01). CONCLUSIONS Perioperative estrogen therapy does not increase VTE risk on male to female gender-affirming surgery. Therefore, estrogen therapy may be continued perioperatively in vaginoplasty. More prospective studies are needed.
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Affiliation(s)
- J Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Kim MH, Yu HT, Park YJ, Kim TH, Joung B, Lee MH, Pak HN. Diabetes Mellitus Is an Independent Risk Factor for a Stiff Left Atrial Physiology After Catheter Ablation for Atrial Fibrillation. Front Cardiovasc Med 2022; 9:828478. [PMID: 35419435 PMCID: PMC8995895 DOI: 10.3389/fcvm.2022.828478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Scar tissue formation after catheter ablation for atrial fibrillation (AF) may adversely affect the diastolic properties of the left atrium (LA), which can result in a stiff LA physiology in a small proportion of patients. In this study, we aimed to explore the relationship between diabetes mellitus and a stiff LA physiology after AF catheter ablation (AFCA). Methods A total of 1,326 patients who underwent de novo AFCA, and baseline and 1-year follow-up echocardiographies were enrolled. After 1:3 propensity score (PS) matching for age, sex, and AF type, we compared 211 patients with DM with 633 patients without DM. A stiff LA physiology was defined as estimated pulmonary arterial pressure increase of >10 mmHg and a right ventricular systolic pressure of >35 mmHg at 1-year follow-up echocardiography. Pulmonary vascular resistance (PVR) was estimated using echocardiographic parameters. Results Among the 844 PS-matched patients, a stiff LA physiology was observed in 32 patients (4.1%). The patients with DM showed a higher peak LA pressure (p < 0.001) and greater LA wall stress (p = 0.001) than did those without. A stiff LA physiology was independently associated with DM [Odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.02-5.59, p = 0.045], empirical extra-pulmonary vein LA ablation (OR = 3.14, 95% CI 1.07–9.3, p = 0.038) and the ΔPVR (OR = 1.78, 95% CI 1.37–2.31, p < 0.001). The ΔPVR was independently associated with DM (β = 0.37, 95% CI 0.06-0.67, p = 0.020) and a stiff LA physiology (β = 1.40, 95% CI 0.70–2.10, p < 0.001). During the 38.8 ± 29.3months follow-up, the incidence of the clinical recurrence of AF was significantly higher in the patients with a stiff LA physiology than in those without (log rank p = 0.032). Conclusion A stiff LA physiology was independently associated with DM because of the relatively small decrease in the PVR after AFCA in this population. The patients with a stiff LA physiology had worse rhythm outcomes after AFCA than those without.
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Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Impact of the COVID-19 Pandemic and Public Restrictions on Outcomes After Catheter Ablation of Atrial Fibrillation. Front Cardiovasc Med 2022; 9:836288. [PMID: 35402533 PMCID: PMC8987708 DOI: 10.3389/fcvm.2022.836288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Here we aimed to analyze changes in the outcomes of atrial fibrillation (AF) catheter ablation (AFCA) during the coronavirus disease 2019 (COVID-19) pandemic and examine the relationship between rhythm outcomes and the stringency of government social distancing measures. Methods We included 453 patients who underwent de novo AFCA between May 2018 and October 2019 (pre-COVID-19 era) and 601 between November 2019 and April 2021 (COVID-19 era). The primary outcome was late recurrence, defined as any episode of AF or atrial tachycardia documented after a 3-month blanking period. A multivariable Cox regression analysis was performed to estimate the relative hazards of AF recurrence in the two eras. Results In the study population (24.3% women; median age, 60 years), 660 (62.6%) patients had paroxysmal AF. Among those with paroxysmal AF, the late recurrence rate was significantly lower in the COVID-19 era than in the pre-COVID-19 era [9.4% vs. 17.0%, respectively, log-rank P = 0.004; adjusted hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.35–0.90] during a median follow-up of 11 months. In patients with persistent AF, the late recurrence rate did not significantly differ between the pre-COVID-19 and COVID-19 era groups (18.9% vs. 21.5%, respectively; log-rank P = 0.523; adjusted HR 0.84, 95% CI 0.47–1.53) during the median follow-up of 11 months. Conclusion A decrease in AF recurrence after catheter ablation was observed in patients with paroxysmal AF during the COVID-19 outbreak, whereas no change was observed in those with persistent AF.
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study. Front Physiol 2022; 13:846620. [PMID: 35370797 PMCID: PMC8968313 DOI: 10.3389/fphys.2022.846620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps). Methods We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps. Results Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010). Conclusion CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hui-Nam Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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