Updated risk assessments for sudden cardiac death in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator

박예민 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.1

Hypertrophic cardiomyopathy (HCM) is a genetic disease associated with a risk of malignant ventricular tachyarrhythmias and sudden cardiac death (SCD). Assessment of the SCD risk is crucial for its clinical management, and there has been considerable interest in developing risk stratification strategies. An implantable cardioverter-defibrillator (ICD) is a life-saving treatment for patients with HCM who are at a high-risk of ventricular tachyarrhythmias and SCD. However, a substantial number of ICD recipients experience adverse effects arising from inappropriate device therapy and implant-related complications. This has led to numerous investigations of the risk of SCD and the indications for ICD implantation. American guidelines were recently updated to include new risk markers, including left ventricular systolic dysfunction, apical aneurysm, and extensive late gadolinium enhancement, while European guidelines recommend individualized estimated 5-year SCD risk assessment models. Studies evaluating other risk factors for SCD in patients with HCM have also been published. Drawing on recent guidelines and publications on clinical risk factors, we focus this review on updated risk assessments for SCD with ICD therapy in patients with HCM.

Inadvertently Developed Ventricular Fibrillation during Electrophysiologic Study and Catheter Ablation: Incidence, Cause, and Prognosis

박예민,최인석,최종일,Ra Seung Lim,Jong-Il Choi,임홍의,Sang Weon Park,YOUNGHOON KIM,이현수 대한심장학회 2013 Korean Circulation Journal Vol.43 No.7

Background and Objectives: Ventricular fibrillation (VF) can inadvertently occur during electrophysiologic study (EPS) or catheter abla -tion. We investigated the incidence, cause, and progress of inadvertently developed VF during EPS and catheter ablation. Subjects and Methods: We reviewed patients who had developed inadvertent VF during EPS or catheter ablation. Patients who devel-oped VF during programmed ventricular stimulation to induce ventricular tachycardia or VF were excluded. Results: Inadvertent VF developed in 11 patients (46.7±9.3 years old) among 2624 patients (0.42%); during catheter ablation for atrial fi-brillation (AF) in nine patients, frequent ventricular premature beats (VPBs) in one, and Wolff-Parkinson-White (WPW) syndrome were observed in one. VF was induced after internal cardioversion in six AF patients due to incorrect R-wave synchronization of a direct cur-rent shock. Two AF patients showed spontaneous VF induction during isoproterenol infusion while looking for AF triggering foci. The re-maining AF patient developed VF after rapid atrial pacing to induce AF, but the catheter was accidentally moved to the right ventricular (RV) apex. A patient with VPB ablation spontaneously developed VF during isoproterenol infusion. The focus of VPB was in the RV outflow tract and successfully ablated. A patient with WPW syndrome developed VF after rapid RV pacing with a cycle length of 240 ms. Single high energy (biphasic 150-200 J) external defibrillation was successful in all patients, except in two, who spontaneously terminated VF. The procedure was uneventfully completed in all patients. At a mean follow-up period of 17.4±15.5 months, no patient presented with ventricular arrhythmia. Conclusion: Although rare, inadvertent VF can develop during EPS or catheter ablation. Special caution is required to avoid incidental VF during internal cardioversion, especially under isoproterenol infusion.

Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-ventricular Block and Ventricular Tachycardia

박예민,신재욱,김민수,강웅철,문정근,정욱진,성연미 대한심장학회 2016 Korean Circulation Journal Vol.46 No.2

We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully

A Comparison of Two Brands of Clopidogrel in Patients With Drug-Eluting Stent Implantation

박예민,안태훈,이경훈,Kwen-Chul Shin,정을식,Dong Su Shin,Myeong Gun Kim,강웅철,한승환,최인석,신익균 대한심장학회 2012 Korean Circulation Journal Vol.42 No.7

Background and Objectives: Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopi-dogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. Subjects and Methods: Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and com-pleted >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment for-mulation, Platless® (test formulation, n=211) or Plavix® (reference formulation, n=217). The incidence of 1-year major adverse cardiovas-cular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. Results: The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The in -cidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless® group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix® group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless® group vs. 0% in Plavix® group (p=0.49). Conclusion: In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective random-ized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopi-dogrel.

Repeated Aborted Sudden Cardiac Death with Long QT Syndrome in a Patient with Anomalous Origin of the Right Coronary Artery from the Left Coronary Cusp

박예민,김수지,박철현,강웅철,신미승,고광곤,최인석 대한심장학회 2013 Korean Circulation Journal Vol.43 No.12

A 15-year-old female with a prior history of aborted cardiac death and surgical correction of anomalous origin of the right coronary artery (RCA) presented with polymorphic ventricular tachycardia. Her electrocardiogram after defibrillation was suggestive of congenital long QT syndrome (LQTS). The patient was treated with a β-blocker and remained free from ventricular arrhythmia during the follow-up of more than 6 months. Here, we present the case of a young female with repeated aborted cardiac death accompanied by anomalous origin of the RCA and congenital LQTS for the first time.

뇌농양으로 나타난 중추신경계 방선균증 1예

박예민,원인식,김주일,조현정,서종구,김진용,김은영,박상희,박윤수,서일혜,조용균 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

뇌농양으로 나타난 중추신경계 방선균증 1예

박예민,김은영,박상희,서일혜,조용균,박윤수,원인식,김주일,조현정,서종구,김진용 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.4

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

Efficacy of Inhaled Iloprost in Cor Pulmonale and Severe Pulmonary Hypertension Associated with Tuberculous Destroyed Lung

박예민,정욱진,이상표,최덕영,백한주,정성환,최인석,신익균 한국심초음파학회 2014 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.22 No.2

Chronic obstructive pulmonary disease (COPD) is one of the causes of cor pulmonale. Cor pulmonale patients with pulmonaryhypertension have a significant lower survival rate than patients without. However, there is no conclusive treatment options incor pulmonale and pulmonary hypertension associated with COPD until now. We report a patient with cor pulmonale andpulmonary hypertension associated with severe form of COPD and tuberculous destroyed lung who achieved marked clinical,functional and echocardiographic hemodynamic improvements with inhaled iloprost for six months.

The Effects of Single Nucleotide Polymorphisms in Korean Patients with Early-onset Atrial Fibrillation after Catheter Ablation

박예민,노승영,이대인,심재민,최종일,박상원,김영훈 대한의학회 2020 Journal of Korean medical science Vol.35 No.49

Background: This study evaluated the status of single nucleotide polymorphisms (SNPs) in Korean patients with early-onset (< 40 years old) atrial fibrillation (AF) and their effects on the outcome after catheter ablation. Methods: A total of 89 patients (35.7 ± 3.7 years, 81 males) with drug-refractory AF (paroxysmal 64.0%) who underwent catheter ablation were included in this study. Sixteen SNPs, including rs13376333, rs10465885, rs10033464, rs2200733, rs17042171, rs6843082, rs7193343, rs2106261, rs17570669, rs853445, rs11708996, rs6800541, rs251253, rs3807989, rs11047543, and rs3825214, were genotyped. Serial 48-hour Holter monitoring was conducted to detect AF recurrences during long-term follow up. Results: Wild-type genotypes of rs11047543 (GG; 26/69 [37.7%] vs. GA; 13/18 [72.2%] vs. AA; 0/0 [0%], P = 0.009) and rs7193343 (CC; 0/7 [0%] vs. CT; 22/40 [55.0%] vs. TT; 18/41 [43.9%], P = 0.025) and the homozygous variant of rs3825214 (AA; 16/31 [51.6%] vs. AG; 22/43 [51.2%] vs. GG; 2/13 [15.4%], P = 0.056) were significantly associated with a lower rate of late recurrence. When the patients were assigned to four groups according to the number of risk alleles (n = 0–3), there were significant differences in recurrence rate (n = 0; 0/3 vs. n = 1; 2/13 [15.4%] vs. n = 2; 24/52 [46.2%] vs. n = 3; 13/17 [76.5%], P = 0.003). When correcting for multiple variables, rs11047543 (hazard ratio [HR], 2.723; 95% confidence interval [CI], 1.358–5.461; P = 0.005) and the number of risk alleles (HR, 2.901; 95% CI, 1.612–5.219; P < 0.001) were significantly associated with recurrence of AF after catheter ablation. Conclusion: Polymorphisms on rs7193343 closest to ZFHX3 (16q22), rs3825214 near to TBX5 (12q24), and rs11047543 near to SOX5 (12p12) modulate the risk for AF recurrence after catheter ablation. The number of risk alleles of these 3 SNPs was an independent predictor of recurrence during long-term follow up in Korean patients with early-onset AF.

Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation

박예민,최종일,김우현,이손기,임홍의,박상원,김영훈,국형돈 대한심장학회 2013 Korean Circulation Journal Vol.43 No.1

Background and Objectives: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during cathe-ter ablation of atrial fibrillation (AF). Subjects and Methods: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and elec-trocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. Results: Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in in-ferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applica-tions, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications. Conclusion: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be help-ful in guiding effective focal ablation.