발작성 심실상성빈맥의 심전기 생리학적 기전에 대한 임상적 연구

류제영(Jay Young Rhew),배열(Youl Bae),김준우(Jun Yoo Kim),김성희(Sung Hee Kim),김주한(Ju Han Kim),김광채(Gwang Chae Gill),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee 대한내과학회 1997 대한내과학회지 Vol.52 No.2

N/A Objectives: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. Methods: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. Results: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9±17.3 years in AVNRT, 25.5±13.3 years in WPW and 26.3±15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6±23.9 per minute and AVRT was 186.7±38.0 per minute, which were faster than that of AVNRT(161.7±28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. Conclusion: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.

급성 심근경색증 환자에서 장기 임상경과에 대한 C - Reactive Protein 의 역할

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),박형욱(Hyung Wook Park),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),염주협(Ju Hyup Yum),김원(Weon Kim),김주한(Ju Han Kim),류제영(Jay Young Rhew),안영근(Young Keun A 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. Methods: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9±9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43±0.14 mg/dL) on admission and Group II (n=122, 59.1±10.4 years, male 83.6%) with elevated CRP ( ≥1.0 mg/dL, mean value=3.50±0.93 mg/dL) on admission. Results: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4±10.5 to 52.0±9.0%, 1.52±1.13 to 2.77±0.55, p<0.001 vs Group II; 50.1±11.2 to 52.7±9.7, 1.55±1.11 to 2.76±0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). Conclusion: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.(Korean J Med 61:606-615, 2001)

관상동맥 중재술을 시술받은 불안정형 협심증 환자에서 저분자량 헤파린의 장기 효과

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),서순팔(Soon Pa 대한내과학회 2002 대한내과학회지 Vol.63 No.2

배경: 급성 관동맥 증후군 환자에서 저분자량 헤파린은 기존의 미분획 헤파린에 비해 aPTT monitoring이 필요 없으며 피하주사로 쉽게 투여할 수 있다는 장점과 함께 주요 심장사고를 감소시키는 것으로 알려져 있다. 목적: 불안정형 협심증으로 내원하여 관상동맥 중재술을 시행한 환자 중 Dalteparin (Fragmin)을 사용했던 군과 미분획 헤파린을 사용했던 군 사이에 사망, 급성 심근경색증, 표적 병변 재개통술, 재협착률 등의 주요 심장사고 및 합병증에 대해 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법: 1999년 1월부터 2001년 6월까지 전남대학교병원 심장센터에 입원하여 관상동맥 중재술을 시행 받고 6개월 이후에 추적 관상동맥 조영술을 시행한 불안정형 협심증 환자 180예를 대상으로 Dalteparin (Fragmin)을 사용했던 90예의 환자군을 I군(61.8±8.9세, 남:61, 여:29)으로, 미분획 헤파린을 사용했던 90예의 환자군을 II군(62.6±9.7세, 남:63, 여:27)으로 각각 분류하고 양군 사이에 임상적 및 관상동맥 조영술 특성과 주요 심장사고, 합병증에 대해 비교하였다. 결과: 1) I군에서 당뇨병 환자가 많았던 것 이외에(I군; 38/90명, 42.2% vs II군; 27/90명, 30.0%, p=0.021) 양 군 사이에 임상 양상에 있어서 유의한 차이는 없었다. 2) 병변 혈관의 수, 경색관련 혈관의 분포, TIMI flow, ACC/AHA 형태, 혈전 내재 병변, 스텐트 사용 여부, 병변 길이 등 관상동맥 조영술상 양군간에 유의한 차이는 없었다. 3) 재원 기간 중 급성 심근경색증, 표적 혈관 재개통술, 사망 등 주요 심장 사고에 있어서 양군간에 차이는 없었다. 4) 6개월 추적 관상동맥 조영술상 I군에 비해 II군에서 최소 혈관 내경의 유의한 감소 및 내경 협착률에 있어서 유의한 증가를 보였다(1.81±0.49 mm vs 1.64±0.44 mm, 32.2±14.5% vs 37.4±18.8%, 각각 p=0.035, 0.041). 5) 6개월 이후 추적 관상동맥 조영술상 재협착률은 I군에서 유의하게 낮았고(I군 26/90명, 28.8% vs II군 32/90명, 35.6%, p=0.041), 표적 혈관 재개통술에 있어서 I군에서 유의하게 낮았으나(I군 21/90명, 23.3% vs II군 27/90명, 30.0%, p=0.039), 사망률에 있어서 양군 사이에 유의한 차이는 없었다. 6) 합병증에 있어서 심각한 출혈성, 경미한 출혈성 부작용 및 허혈성 뇌졸중, 혈소판 감소증에 있어서 양군 사이에 유의한 차이는 없었다. 7) 관상동맥 중재술 후 재협착에 관여하는 인자는 스텐트 사용 여부, 병변 길이, 관상동맥 중재술 후 최소 혈관 내경, 내원 당시 CRP 수치, 당뇨병 동반 여부, 사용하였던 헤파린의 종류였다(p=0.032, 0.001, 0.001, 0.011, 0.022, 표 6). 결론: 불안정형 협심증 환자에서 저분자량 헤파린인 Dalteparin (Fragmin)을 사용했던 환자군에서 미분획 헤파린을 사용했던 환자군에 비해서 재협착률 및 관상동맥 재개통술이 유의하게 낮았다. Background: Antithrombotic therapy with heparin reduces the rate of ischemic events in patients with acute coronary syndrome. Low-molecular-weight heparin (LMWH), given subcutaneously twice daily, has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer and does not require monitoring. Methods: We prospectively analyzed 180 patients with unstable angina who underwent percutaneous coronary intervention (PCI) between 1999 and 2001 at Chonnam National University Hospital to receive either 120 U/kg of Dalteparin (Fragmin), administered subcutaneously twice daily (group I; n=90, 61.8±8.9 years, male 67.8%), or continuous intravenous unfractionated heparin (group II; n=90, 62.6±9.7 years, male 70.0%). During hospitalization and at 6 month after PCI, major adverse cardiac events such as acute myocardial infarction, target vessel revascularization, death, or restenosis were examined. Results: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death were not different between two groups. At follow-up coronary angiography at 6 month after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 26/90, 28.8% vs. Group II; 32/90, 35.6%, p=0.041) and the incidence of target vessel revascularization was lower in group I than in group II (Group I; 21/90, 23.3% vs Group II; 27/90, 30.0%, p=0.039). There was no difference in the rate of major and minor hemorrhage, ischemic stroke and thrombocytopenia between two groups. In the multivariate analysis, factors relating to restenosis were lesion length, postprocedural minimal luminal diameter, CRP on admission, diabetes mellitus, type of hepairn, stent use. Conclusion: Dalteparin, a LMWH, is superior to standard unfractionated heparin for reducing restenosis rate and target vessel revascularization without increasing bleeding complications. (Korean J Med 63:158-168, 2002)

장기적인 우심실 첨부 조율 시 좌심실 기능부전의 발생에 관여하는 인자

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Ch 대한내과학회 2002 대한내과학회지 Vol.63 No.2

배경: 12유도 심전도상 QRS파 폭(QRSd)의 연장은 좌심실 수축기 기능의 감소와 관계가 있고, 확장형 심근증에서 QRS파 폭은 좌심실 기능 이상 정도 및 예후와 밀접한 관계가 있다고 알려져 있다. 우심실 첨부를 조율하는 영구형 심박조율기 시술 후 QRSd의 과도한 연장이 관찰되는데 심박조율기 시술 환자에서 QRSd 연장의 의미는 아직까지 명확하게 밝혀져 있지 않다. 본 연구는 우심실 첨부를 조율하는 영구형 심박조율기 시술 후 QRSd 증가의 의미를 규명하고 좌심실 기능부전에 관여하는 인자를 알아보기 위하여 시행되었다. 방법: 전남대학교병원 순환기내과에서 영구형 심박조율기(DDD형 15, VDD형 18, VVI형 31)를 시술 받은 후 1년 이상 경과된 환자 64명(남:녀=27:37, 시술 시 나이=57.6±15.4세)을 대상으로 하였다. 시술 전 기저질환을 평가하고, 시술 전, 시술 직후 및 최종 추적 시(추적기간 68.2±44.0개월) 심전도와 심초음파도를 시행하여 QRSd와 좌심실 구혈률(LVEF)과의 관계를 분석하고, 최종 추적 시 좌심실 기능부전(LVEF-FU<50%)에 관여하는 인자를 분석하였다. 결과: 심박조율기 시술 전 LVEF는 64.9±10.1%이었고, 최종 추적 시 LVEF (LVEF-FU)은 59.3±11.5%로 유의하게 감소하였고(p<0.001), 11명(17.2%)에서는 LVEF- FU가 50% 미만으로 감소하였다. LVEF-FU<50%는 시술 전 당뇨병의 존재 및 최종 추적 시 QRSd와 관련이 있었다(R2=0.302, p<0.001). 심박조율기 시술 전 및 직후 QRSd와 LVEF-FU은 유의한 상관관계가 없었으나, 최종 추적 시 QRSd는 LVEF-FU와 유의한 음의 상관관계가 있었고(r=-0.451, p<0.01), 추적 기간 동안 QRSd의 변화량과 LVEF의 변화량 사이에 유의한 음의 상관관계가 있었다(r=-0.419, p<0.01). LVEF-FU는 QRSd가 180 ms 이상일 때 180 ms 이하일 때에 비해 유의하게 낮았다(44.4±12.0% vs. 61.7±9.5%, p<0.001). QRSd 180 ms로 좌심실 기능부전을 예측할 때 예민도는 60.0%, 특이도는 88.7%, 양성 예측도는 50.0%, 음성 예측도 99.2%이었다. 시술 직후 QRSd는 최종 추적 시 QRSd과 유의한 양의 상관관계가 있었다(r=0.542, p<0.01). 결론: 우심실 첨부를 조율하는 심박조율기 시술 후 좌심실 기능부전이 17.4%에서 발생하였고 좌심실 기능부전은 추적 심전도에서 QRSd가 180 ms 이상 연장되는 것으로 예측할 수 있었다. 심실 심박조율기 시술 후 발생할 수 있는 좌심실 기능부전을 예방하기 위해서 심박조율기 시술 후 QRSd의 변화를 극소화할 수 있는 기술에 대한 연구가 필요할 것으로 생각되었다. Background It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. Methods We studied sixty-four patients (male:female=27:37, mean age=57.6±15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2±44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. Results Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3±11.5% vs. 64.9±10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd ≥180 ms than in patients without (44.4±12.0% vs. 61.7±9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). Conclusion LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd ≥180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing. (Korean J Med 63:169-176, 2002)

급성 심근경색증 환자에서 내원 시 단핵구 증가증과 예후

홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),이승현 ( Seung Hyun Lee ),박옥영 ( Ok Young Park ),박우석 ( Woo Seok Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),류제영 ( Jay Young Rhew ),양승호 ( Seung Ho Yang ),안영근 ( 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : The inflammation is an important feature of atherosclerotic lesions, and peripheral monocytosis is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). The aim of this study was to determine the significance in clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI) and major adverse cardiac events and event-free survival rate after PCI according to the value of peripheral monocyte on admission. Methods : A total of 127 patients with AMI who underwent PCI between June 2000 and June 2001 at Chonnam National University Hospital were divided into two groups: Group I (n=63, 61.7±10.9 years, male 71.4%) with normal monocyte count (<900/mm3, mean value=536±202/mm3) on admission and Group II (n=64, 61.7±13.4 years, male 78.1%) with elevated monocyte count (≥900/mm3, mean value=1,140±260/mm3) on admission. Results : Baseline ejection fraction was lower in Group II than in Group I (Group I; 53.3±13.0% vs Group II; 45.0±11.7%, p=0.014). The value of C-reactive protein, troponin-T and troponin-I was higher in Group II than in Group I (Group I; 2.8±1.9 mg/dL, 1.98±1.53 ng/mL, 18.3±17.7 ng/mL vs Group II; 5.3±5.0 mg/dL, 3.34±2.54 ng/mL, 43.1±24.0 ng/mL, p=0.034, 0.020, 0.006, respectively). The incidence of target lesion revascularization was higher in Group II than in Group I during hospitalization and during 6-month clinical follow-up after PCI (1.6% vs 12.5%, 19.0% vs 31.3%, p=0.012, 0.015, respectively). The event-free survival rates were lower in Group II than in Group I during hospitalization and during 6-month follow-up after PCI (96.8% vs 84.4%, 71.4% vs 53.1%, p=0.006, 0.008, respectively). Conclusion : Peripheral monocytosis is associated with LV dysfunction and higher incidence of target lesion revascularization and worse mid-term event-free survival during hospitalization and at 6 months after PCI in patients with AMI.(Korean J Med 63:521-531, 2002) Key Words : Coronary Diseases, Myocardial Infarction, Angioplasty, Inflammation

증예(症例) : 혈액투석 도관 거치시 발생한 유도도선 (guide wire)의 대퇴정맥 내 삽입

최혜은 ( Hye Eun Choi ),류제영 ( Jay Young Rhew ),선인호 ( In O Sun ),이신은 ( Shin Eun Lee ),이영재 ( Young Jae Lee ),최진화 ( Jin Hwa Choi ),이은영 ( Eun Young Lee ),김정화 ( Jung Wha Kim ),이광영 ( Kwang Young Lee ) 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.1

When a hemodialysis catheter is placed a guide wire is inserted into a central vein first. The dialysis catheter is advanced over the guide wire. After the insertion of the catheter, the guide wire is removed. We experienced a case of accidental insertion of the entire guide wire, which was not removed by mistake soon after the placement of a temporary hemodialysis catheter into the right femoral vein. After 4 months chest X-ray revealed the guide wire in the right femoral through internal jugular veins. It was removed successfully via nonsurgical percutaneous retrieval with a loop snare with internal jugular approach.

원인 불명 실신에서 기립경사검사 결과의 예측

정은아(Eun A Chung),이승현(Seung Hyun Lee),홍영준(Young Joon Hong),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),이상현(Sang Hyun Lee),강경태(Kyung Tae Kang),류제영(Jay Young Rhew),박종철(Jong Cheol Park),안영근(Yo 대한내과학회 2001 대한내과학회지 Vol.61 No.2

N/A Background : Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. Methods : Eighty five patients (mean age, 43±18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 μg/min and 5 μg/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure ≤80 mm Hg) and/or symptomatic bradycardia (≤45/min for ≥10 seconds) or asystole ≥3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. Results : Group I patients had more episodes of syncope than Group II (3.1±2.5/year vs. 2.0±2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5±17.5 mm Hg vs. 118.1±18.2 mm Hg, p<0.05). However, HR after tilt was significantly faster in Group I than Group II (81.1±15.1/min vs. 74.2±14.9/min, p<0.05 at 2 minutes after tilt; 83.7±14.4/min vs. 74.6±14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9±12.6/min vs. 12.8±10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minutes of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. Conclusion : In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.(Korean J Med 61:133-140, 2001)

발작성 심실상성빈맥의 12 유도 심전도를 이용한 감별진단과 ST - T 파 분석의 의의

이승욱(Seung Uk Lee),조정관(Jeong Gwan Cho),류제영(Jay young Rhew),김계훈(Kye Hoon Kim),김원(won Kim),김성희(Seong Hee Kim),김준우(Jun Woo Kim),조장현(Jang Hyun Cho),안영근(Young Keun Ahn),김원영(Won Young Kim),조상기(Sang Ki Cho),정 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objects: Accurate differential diagnosis of paroxysmal supraventricular tachycardia (PSVT) has become more important after introduction of curative catheter ablation technique into clinical practice. It has been reported that ST-T changes during supraventricular tachycardia are frequent, but its association is different according to the type of PSVT and the location of the AV bypass tracts. Therefore, this study was performed to evaluate the significance of ST-T changes in addition to classic ECG parameters in differentiating AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT), and predicting the location of the AV bypass tracts. Methods: One hundred thirty patients presenting with narrow-QRS complex (<120 msec) regular tachycardia in whom the mechanism of the tachycardia was later confirmed as AVNRT or AVRT by electrophysiologic study (EPS) with successful catheter ablation were included in this study. Tachycardia cycle length, visible P wave, pseudo r` wave in Vl, pseudo s wave in the inferior leads, QRS altemation, ST segments depression, and T wave inversion were evaluated in the ECGs recorded during spontaneous episodes of the PSVT and compared between patients with AVNRT (n=54) and AVRT (n=76). Results: Tachycardia cycle lengths were not different between AVNRT and AVRT (355.8 ± 50.6 msec vs. 341.9 ± 51.4 msec). P wave during the tachycardia was significantly more frequently seen in AVRT than AVNRT, (72,4% vs, 9.3%, p<0.0001). However, pseudo r` wave and pseudo s wave were significantly more frequent in AVNRT than AVBT (59.3% vs. 7.9%, 33.3% vs. 1.3%, respectively, p<0,0001). QRS alternation was significantly more frequent in AVRT than AVNRT (342% vs. 11.1%, p<0.05). ST segment depression ≥1 mm was observed in 27.8% of AVNBT and 79.9% of AVBT (p<0.001). T wave inversion was more frequent in AVRT than AVNRT (30.3% vs. 7.4%, p<0.01). ST depression ≥2mm was observed in 76.9% of the left posterior pathways, 28.1% of the left anterolateral pathways, 66.7% of the right posterior pathways, and 1.1% of the right anterior pathways. Sensitivity, specificity, and positive predictive value in differentiating AVRT from AVNRT with visible p wave were 72%, 91%, and 92%, respectively : 78%, 72%, and 80%, respectively with ST segment depression ≥1 mm, and 30%, 93%, and 85%, respectively with T wave inversion. In differentiating AVNRT from AVRT, Sensitivity, Specificity, and positive predictive value of pseudo r' wave and pseudo s wave were 59%, 92%, 84%, respectively and 33%, 99%, 94%, respectively. Sensitivity, specificity, and positive predictive value in distinguishing posterior location from anterior location of the pathways were 74%, 76%, and 72%, respectively with ST segment depression (≥2mm) and 46%, 83%, and 70%, respectively with T wave inversion. Conculsions : ST Segment depression during PSVT can be used complementally to the classic ECG parameters in the differential diagnosis of PSVT and predicting the location of the AV bypass tracts.

방실결절회귀성 빈맥의 유발에 관여하는 심전기생리학적 인자에 관한 연구

조정관(Jeong Gwan Cho),신순철(Soon Chul Shin),류제영(Jay Young Rhew),배열(Youl Bae),김준우(Jun Woo Kim),김성희(Sung Hee Kim),김주한(Ju Han Kim),서정평(Jeong Pyeong Seo),박종철(Jong Chul Park),차광수(Gwang Su Cha),박주형,정명호(Myung Ho 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: Although a subtle balance between conduction time of the antgrade slow pathway and refractory period of the retrograde fast pathway is known to play the most critical role in the induction of AV nodal reentrant tachycardia(AVNRT), other electrophysiologic factors such as concealed conduction in to the fast pathway have been suggested to be responsible. The present study was performed to determine the electrophysiologic factors responsible for the induction of AVNRT. Methods: Total 34 subjects undergoing electrophysiologic study(EPS) including 9 normal subjects(SAVNP), 7 subjects with dual AV nodal pathways(DAVNP) but no inducible AVNBT, and 18 inducible AVNRT patients were included in this study. EPS was performed using the conventional technique. To evaluate the presence of concealed conduction into the fast AV nodal pathway(FP) and its effects on the effective refractory period(ERP) of the FP (FP-ERP) to a subsequent impulse, single(A2) and double atrial extrastimuli(A2A3) were given. FP-ERP of conducted A2 [FP-ERP-A2(+)] was measured with a second atrial extrastimulus(A3) following a first atrial extrastimulus(A2), which was delivered at a coupling interval 20-30ms longer than FP-ERP. ERPs of non-conducted A2 [FP-ERP-A(-)] was measured with A3 following A2 at coupling intervals 20 ms shorter than FP-ERP. Concealed conduction was considered to be present when A1A3 interval of A3 blocked at the FP with a longest A2A3 interval was longer than FP-ERP. Concealment index(CI)-1 and CI-2 were calculated by dividing FP-ERP-A2(-) by FP-ERP-A2(+) and FP-ERP, respectively. In addition, relationship between antegrade slow pathway conduction time(A2H2) and retrograde fast pathway conduction time(HA), retrograde AV conduction system block cycle length(VA-BCL), and retrograde AV conduction system EBP(VA-ERP) was evaluated by a regression analysis. Results: Concealed conduction was present in all the subjects. CI-1 was 0.63±0.04 and CI-2, 0.79±0.04 in SAVNP and 0.67±0.11, 0.68±0.07 respectively, in AVNRT patients in whom the antegrade slow pathway(SP) was ablated with catheter ablation, showing no significant difference in CI between 2 groups. At the time of induction of AVNRT with A2, A2H2. was significantly correlated with FP-ERP and FP-CT(r=OA43, p=0.04; r=0.507, p=0,02, respectively). By multivariate regression analysis, it was derived that A2H2 should be greater than 0.79 FP-ERP+1.57 FP-CT-0.44 HA-190(ms) (r=0.71, p< 0.05). Conclusion: Induction of typical AVNRT with A2 is determined by conduction time of the slow pathway, refractory period and conduction velocity of the fast pathway, and concealed conduction into the fast pathway.

혈소판 당단백 2b / 3a 수용체 차단제 부착 스텐트의 돼지 관상동맥 스텐트 재협착 억제 효과

강경태(Kyung Tae Kang),정명호(Myung Ho Jeong),김남호(Nam Ho Kim),류제영(Jay Young Rhew),이상현(Sang Hyun Lee),박종철(Jong Cheol Park),이승욱(Seung Uk Lee),김건형(Kun Hyung Kim),최명자(Myung Ja Choi),안영근(Young Keun Ahn),조정관(Jeon 대한내과학회 2001 대한내과학회지 Vol.60 No.4

N/A Background: The problems of coronary stent thrombosis and restenosis still remain to be solved. The glycoprotein Iib/IIIa receptor blocker, Abciximab (ReoPro), plays import ant roles in the treatment of high-risk patient with acute platelet-rich thrombus and in the inhibition of smooth muscle cell proliferation. The aim of this study was to determine whether the use of ReoPro-coated stents could reduce the neointimal formation in a porcine coronary stent restenosis model. Methods: ReoPro was coated on the surface of stent by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13), and ReoPro-coated stents (Group II, n=14). Follow-up quantitative coronary angiogram was performed at 4 weeks after stenting and histopathologic assessment were compared in both groups. Results: The diameter stenosis by QCA between two groups was significantly higher in Group I (23±5 % vs. 15±7 %, p=0.003). On histopathologic examination, no in-stent thrombus was observed. The percent area stenosis was significantly higher in Group I than in Group II (48±17 % vs. 30±16 %, p=0.01). The area of neoinima was larger in Group I than in Group II (3.2±1.2 mm vs. 2.0±1.0 mm, p =0.01). By immunocytochemistry, proliferation cell nuclear antigen indices were higher in Group I (4.2±2.1 %, vs 2.4±1.8 % p =0.03). Conclusion: The ReoPro-coated stent is safe and effective in the prevention of in-stent thrombus and restenosis, which may be related with the inhibition of platelet thrombus and neointimal cell proliferation.(Korean J Med 60:314-323, 2001)