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우측 방실우회로의 전극도자 절제에 효과적인 접근방법에 대한 연구
조정관(Jeong Gwan Cho),박우석(Woo Suck Park),배열(Youl Bae),안영근(Young Keun Ahn),류제영(Jay Young Rhew),김남호(Nam Ho Kim),이상현(Sang Hyun Lee),박형욱(Hyung Wook Park),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),박종춘(Jong Chu 대한내과학회 1998 대한내과학회지 Vol.55 No.3
N/A Background: Although radiofrequency catheter ablation (CA) of the accessory pathway (AP) is very effective and safe, it has been reported that CA is more difficult in the right-side AP than the left-side AP, requiring the refinement of the conventional CA technique for the right-side AP. This study was, therefore, aimed to develop an effective technique for CA of the right-side AP. Methods: Fifty right-side APs in 45 patients which underwent CA were included in this study. The locations of APs were divided into 8 regions (anteroseptal, mid septal, posteroseptal, posterior, posterolateral, lateral, anterolateral, and anterior). After localizing APs, CA of the APs was attempted via the inferior vena cava (1VC) in all patients. If CA attempt via the IVC for more than 1 hour was failed, then CA was tried via the superior vena cava (SVC). Successful CA was defined as permanent loss of AP conduction even during infusion of isoproterenol (1-4 ㎍/min). The ways of approaching the ablation catheter to the successful target sites were classified into over-the-tricuspid valve approach (OV) via the IVC (IVC-OV), OV via the SVC (SVC-OV), under-the-tricuspid valve (UV) approach via the IVC (IVC-UV), and UV via the SVC (SVC-UV) and evaluated according to the AP locations. Results - The locations of the APs were anteroseptal in 5 APs, mid septal in 6, posteroseptal in 12, posterior in 3, posterolateral in 5, right lateral in 11, anterolateral in 4, and anterior in 4. Forty-eight (96.0%) of 50 APs were successfully ablated; 35 (70.0%) with primary 1VC approaches and 13 (26.0%) with secondat7 SVC approaches. As a successful approach, IVC-OV was 26 (54.2%); IVC UV, 9 (18.8%); SVC OV, 4 (8.3%), and SVC UV, 9 (18.8%). Secondary SVC approaches were required 7 (70.0%) in the lateral APs, 2 (50.0%) in the anterolateral Aps, 1 (25.0%) of the posterolateral APs, 1 (25.0%) in the anterior APs, 1 (20.0%) of the anteroseptal APs, and 1 (8.3%) in the posteroseptal APs but none in the midseptal and posterior APs. SVC-UV approach was used in 9 (69.2%) in 13 APs which were ablated with SVC approach. Conclusions: The ways of approach to successful target site in CA of the right-side APs are different according to the location and SVC approaches are frequently required in ablation of the lateral or anterolateral APs. Therefore, SVC approaches should be considered in these locations if the initial 1VC approaches are not successful.
경피적 관동맥 성형술시 반복적인 혈류차단 - 재관류에 따른 관동맥내 심전도의 변화
김주한(Ju Han Kim),김준우(Joon Woo Kim),김성희(Sung Hee Kim),김남호(Nam Ho Kim),박우석(Woo Suck Park),박주형(Joo Hyung Park),길광채(Gwang Chae Gill),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Cha 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective : Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). Methods: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. Results: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2±13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1±12.6 seconds and 63.3±14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2±13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2±41.7 seconds and 38.5±29.6 seconds for the first inflation and the second, respectively(P<0.05). Conclusion: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.