잡견에서 Rapid Atrial Pacing에 의한 심방의 전기적 재현성과 이의 회복

남기병,김동운,차성일,이석재,홍종면,임승운,나기정,조명찬 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.6

Exercise, Heart and Health

남기병 대한심장학회 2011 Korean Circulation Journal Vol.41 No.3

Regular physical activity provides a variety of health benefits, including improvement in cardiopulmonary or metabolic status, reduction of the risk of coronary artery disease or stroke, prevention of cancer, and decrease in total mortality. Exercise-related cardiac events are occasionally reported during highly competitive sports activity or vigorous exercises. However, the risk of sudden death is extremely low during vigorous exercise, and habitual vigorous exercise actually decreases the risk of sudden death during exercise. The cause of sudden death is ischemic in older subjects (≥35 years old), while cardiomyopathies or genetic ion channel diseases are important underlying pathology in younger (<35 years old) victims. The subgroup of patients who are particularly at higher risk of exercise-related sudden death may be identified in different ways, such as pre-participation history taking, physical examination and/or supplementary cardiac evaluation. Limitations exist because current diagnostic tools are not sufficient to predict a coronary artery plaque with potential risk of disruption and/or an acute thrombotic occlusion. Proper and cost-effective methods for identification of younger subjects with cardiac structural problems or genetic ion channel diseases are still controversial.

부정맥의 약물요법

남기병 대한의사협회 2013 대한의사협회지 Vol.56 No.5

Management of cardiac arrhythmias involves antiarrhythmic drugs (AADs), catheter ablation,pacemakers, and implantable defibrillators. The effects of AADs are mediated by blocking various cardiac ion channels, mostly the cardiac sodium, calcium, or potassium channels. A simple classification of AADs based upon the target sites of drug action is useful for clinical application of AADs for common cardiac arrhythmias. Atrioventricular nodal blocking agents are useful for management of tachycardias with the atrioventricular node as a part of the reentrant circuit. Membrane active AADs are used for tachycardias occurring within the atrium or ventricle. Recent large randomized clinical trials have failed to show any beneficial effects of AADs for reducing cardiac mortality in patients with heart failure and at risk of sudden cardiac death or in patients with atrial fibrillation. In spite of these limitations, AAD medication remains an important initial or adjunctive therapy in the management of cardiac arrhythmias.

Two Components of Voltage Dependent Outward K+ Current in Isolated Human Atrial Myocytes

남기병,호원경 대한심장학회 2004 Korean Circulation Journal Vol.34 No.1

Background: The cardiac electrophysiological characteristics differ significantly among mammalian species oramong various disease processes. However, difficulties in the procedures for harvesting and isolating tissue haveprecluded studies using human cardiac specimens. Methods: The outward K+-currents were recorded in humanatrial myocytes isolated from patients undergoing open heart surgery. The electrophysiological characteristics ofthe voltage-dependent outward currents were investigated using a whole-cell patchclamp technique. Results:Using depolarizing step pulses, the transient outward currents were activated within 10 msec, which slowlyinactivated thereafter. After inactivation, the sustained components of the outward currents remained for up to 5.0seconds of depolarizing step pulses. While the inactivating component was almost completely inactivated atpotentials >+30 mV, the non-inactivating component showed only 10-15% inactivation. The non-inactivatingcomponent was highly sensitive to 4-AP and was inhibited by >80% at a concentration of 0.2 mM, while theinactivating component was inhibited by only 25%. The delayed rectifier potassium currents were not recorded.The ratios of the amplitudes of the inactivating and non-inactivating components varied. Conclusions: Twocomponents of the voltage dependent outward K+ currents in human cardiac tissue were identified, which couldbe separated according to their kinetic and pharmacologic properties. (Korean Circulation J 2004;34 (1):92-99)

Electrophysiological Characteristics of Arterially-PerfusedCanine Pulmonary Veins: Role of the DelayedAfterdepolarization-Induced Triggered Activity

남기병,최기준,박덕우,김준,이경석,김유호 대한심장학회 2005 Korean Circulation Journal Vol.35 No.9

Background and Objectives:The mechanism responsible for the generation of ectopic beats in pulmonary veins(PVs) remains to be well defined. The present study examines the electrophysiological characteristics of the PVsand other regions of the canine left atrium (LA) under low dose (300 μM) caffeine condition. Materials andMethods:Transmembrane action potentials were recorded from the left superior PVs, PV-LA junctions (PLJ,atrium <5 mm from the PV ostium), LA appendage (LAA) or Bachmann’s bundle (BB) in arterially perfusedcanine LA-PV preparations, using floating glass microelectrodes. Rapid atrial pacing (cycle lengths 140-300 ms,10 sec) was used to induce delayed afterdepolarizations (DAD) at the baseline and under low dose (300 μM) caffeineconditions. Results:Spontaneous diastolic depolarization or triggered activity (TA) was not observed in any ofthe recording area under the baseline condition. DAD and TA were induced by caffeine in 4/8 PVs and in 3/8PLJs, but in no LAA (0/6) or BB (0/5). These TA and DAD were also observed after termination of pacing-inducedatrial tachyarrhythmia. DAD was abolished by pretreatment of the atria with verapamil or propranolol (1.0μM). Conclusion:Spontaneous diastolic depolarization was not present in perfused canine left atria or proximalPV. Pulmonary veins and adjacent areas displayed an increased susceptibility to develop DAD-induced TAunder low dose caffeine condition. This distinctive electrophysiological property of the PV and PLJ area may contributeto the arrhythmogenic substrate responsible for the ectopic activity that initiates atrial fibrillation.

Gender Issues in Medical Decisions: Implicit Stereotyping and Unconscious Bias

남기병 대한심장학회 2018 Korean Circulation Journal Vol.48 No.6

특발성 지속성 좌심실빈맥의 임상적 및 전기생리학적 특성

남기병,박선수,한경일,류오열,김준수,김철호,이명묵,박영배,최윤식 대한순환기학회 1991 Korean Circulation Journal Vol.21 No.5

구연 : 순환기 ; 한국인에서 발생한 부루가다 증후군의 임상적 특징

박덕우,남기병,이경석,한기훈,최기준,김유호 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

한국인에서 발생한 부루가다 증후군의 임상적 특징

박덕우,남기병,이경석,한기훈,최기준,김유호 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

비후성 심근증으로 제세동기를 삽입한 환자의 임상관찰

김정욱,남기병,강병욱,홍윤기,장은영,김미영,조재철,김형용,박경민,최기준,김유호 대한심장학회 2007 Korean Circulation Journal Vol.37 No.11

Background and Objectives: Hypertrophic cardiomyopathy (HCM) is one of the most common heritable cardiac diseases. Patients with HCM are prone to ventricular tachyarrhythmias, and implantable cardioverter-defibrillator (ICD) implantation is recommended in high-risk patients to prevent sudden death. Clinical and tachycardial characteristics in patients with HCM have not been studied systematically. Subjects and Methods: Between April 1996 and February 2006, 23 patients with HCM underwent implantation of an ICD. ICDs were indicated for primary prevention in 9 patients and for secondary prevention in 14 patients. Clinical features, follow-up events and intracardiac electrograms were reviewed. Results: During a median follow-up period of 561 days (range 16 to 2,694 days), a total of 51 episodes of ventricular tachycardia (VT) occurred in 6 patients, while only one episode of ventricular fibrillation (VF) was recorded. There were 45 (64.2%) appropriate shocks (30 defibrillation shocks in 5 patients and 15 antitachycardia pacings (ATP) in 2 patients) in 6 patients, and 25 (35.7%) inappropriate shocks in 7 patients. The coupling intervals and VT cycle lengths were highly variable within individual patients. Over episode of ventricular fibrillation (VF) was recorded. There were 45 (64.2%) appropriate shocks (30 defibrillation drive acceleration in response to ATP was observed in 1 patient. Conclusion: As ventricular tachycardia is the main ventricular tachyarrhythmia in patients with HCM, an empirical ATP setting for VTs appears to be mandatory even in patients without previously documented VT. Based on the analyses of the intracardiac electrograms (presence of overdrive acceleration, variations in coupling intervals and cycle lengths), triggered activity may have an important role in the mechanism of a ventricular tachycardia. 배경 및 목적 비후성 심근증은 50명 중 1명의 비교적 높은 유병률을 가진 유전성 질환이다. 비후성 심근증이 있는 경우 심실 부정맥이 잘 발생하는 것으로 알려져 있고, 고위험 환자들에게는 제세동기 삽입이 심장 급사를 줄일 수 있는 것으로 밝혀져 있다. 본 연구에서는 비후성 심근증으로 제세동기 삽입술을 시행 받은 환자들에서 장기간 추적관찰 시 나타나는 부정맥과 이 부정맥의 특성을 고찰하고자 하였다. 방 법 196년 4월에서 206년 2월까지 23명의 비후성 심근증을 가진 환자들을 대상으로 제세동기를 삽입하였다. 제세동기는 9명에서 일차 예방의 목적으로 삽입되었고, 14명에서 이차 예방의 목적으로 삽입되었으며, 이들의 임상 양상 및 추적 관찰 기간 중에 발생한 부정맥의 심장내 전기도를 분석하였다. 결 과 561일간의 중앙 추적 관찰 기간 동안 (범위 16~2,694) 총 51회의 심실 빈맥이 6명의 환자에게서 발생하였다. 반면 심 실 세동은 1회 발생하였다. 적절 쇼크는 6명에서 45회 (64.2%) 발생하였고, 부적절 쇼크는 7명에서 25회 (35.7%) 발생하였다. 적절 쇼크 중 제세동 쇼크는 5명에서 30회 있었고, 항빈맥 조 율은 2명에서 15회 있었다. 심실빈맥의 발생은 제세동기 삽입 전 심실 빈맥이 진단된 경우뿐만 아니라 심실빈맥이 기록되 지 않은 경우에도 높은 빈도로 나타났다. 제세동기의 전기도 분석에서 연결 간격 및 심실 빈맥 박동 주기는 각각의 환자 들 내에서 변이가 심하였으며, 1명의 환자에서는 초과 박동성 가속이 관찰되었다. 결 론 임상 양상에 관계 없이, 비후성 심근증 환자들에서 심실 빈맥이 심실 세동보다 더 높은 빈도로 발생하였으며, 이는 제세 동기 삽입 전 심실빈맥의 유무와 관계없이 발생하였다. 심실 빈맥이 주된 심실 부정맥이었으므로, 이전에 심실 빈맥의 과 거력이 없던 환자에서도 항빈맥 조율 설정이 중요할 것으로 생각된다. 심장 내 전기도의 분석 결과 (연결 간격 및 빈맥 주 기의 변화, 조율 치료에 대한 반응) 방아쇠성 활동이 비후성 심근증에서 심실 빈맥 발생의 주된 발생기전으로 추정된다.