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Clinical characteristics and provocation factors of paroxysmal atrial fibrillation in Korea;
Korean Atrial Fibrillation Registry
원광대학교병원 내과학교실
*김용철, 윤경호, 오석규, 김남호, 정진원, KORAF Investigators
Background and Objective: Paroxysmal atrial fibrillation (AF) is a common form of AF. Despite making up more than 40% of the cases of AF, its prevalence and provocation factors are unknown, especially in Korea. The purpose of this study are to evaluate the characteristics and provocation factors of paroxysmal AF in Korea. Methods: AF registration and observational study was done in Korea. We analyzed the KORAF data, which was included the prospective study registered electrocardiographically confirmed AF patients who firstly diagnosed at each institute since 2006 and followed up for 1 years. This study enrolled 3, 108 patients from 27 hospitals in 13 cities of South Korea. Results:
Paroxysmal AF was 38% of AF. Mean age was 62±13 years and male was 64%. Major risk factors or associated diseases of paroxysmal AF were hypertension (42.0%), sleep disorder (19.2%), smoking (14.3%), dyslipidemia (13.9%), and DM (12.9%). Provocating conditions or factors were unknown in 60.3% and 3 major known precipitating factors were emotional stress (11.3%), exercise (9.0%), and alcohol (7.8%).
The thromboembolic complications associated with paroxysmal AF were found in 107 (9.4%). Cerebral embolic infarction (80%) was the most common. Bleeding complications were occurred in 10 (0.9%). Conclusion: Clinical characteristics of paroxysmal AF in Korea were similar compared with Western country. This study helps further the understanding of paroxysmal AF in Korea.
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Long-term follow up of implantable defibrillator implantation according to the underlying heart disease
고려대학교 안암병원 순환기 내과
*장진근, 박희남, 박재석, 곽재진, 김용현, 최종일, 김영훈
Background: The implantable cardioverter defibrillator (ICD) has been classified as ACC/AHA class IIb indication in patients with both Brugada electrocardiograph (ECG) of type 2 or 3 and positive provocation test. We followed up on the patients with ICD and examined the clinical relevance of ICD based on underlying heart diseases. Methods and Results: Among 70 patients with ICD (53.8±14.7 years old, male 77.1%, 4 CRT-D), 26 patients were diagnosed with genetic ventricular arrhythmic disease (GVD, 11 Brugada syndrome, 6 LQTs, 8 HCM, and 1 ARVD), 13 were diagnosed with idiopathic VF, 12 with ischemic cardiomyopathy, and 17 with non-ischemic cardiomyopathy. Only 3 patients with Brugada syndrome underwent ICD implantation for primary prevention purpose, and the rest were for secondary prevention.
We analyzed the incidence and types of ICD therapy, rate of ventricular tachycardia (VT)/ fibrillation(VF) based on the underlying diseases.
Results: 1.During 34.7±21.4 months of follow up, 28.6% (20/70) of patients were given appropriate ICD therapy {30.8% (8/26) in GVD, 15.4% (2/13) idiopathic VF, 25% (3/12) ischemic VT, and 29.4% (5/17) non-ischemic VT}. The mean number of ICD shock and anti-tachycardia pacing were 1.08±3.15 times and 1.47±7.03 times, respectively. 2.10 % (7/70) patients experienced inappropriate ICD therapy {15.4% (4/26) in genetic disease, 7.7% (1/13) idiopathic VF, 8.3% (1/12) ischemic VT, 5.9% (1/17) non-ischemic VT}, and the most common cause was atrial fibrillation (42.6%, n=3). 3.None of 3 patients with Brugada ECG for primary prevention and none of 10 patients with idiopathic VF with normal ECG and syncope were experienced ICD therapies during 37.8±20.8 months follow up. 4.2.8% (2/70) patient experienced admission for the device related complications. Conclusion The appropriate therapy rate for VT/VF set by the current guideline for ICD implantation was within a reasonable range. For the substantial device related complication or inappropriate ICD shock, ICD implantation should be considered prudentially for patients with Brugada ECG for the primary prevention as well as those with inducible idiopathic VF with a history of syncope and completely normal ECG.
