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방실결절회귀성 빈맥의 성공적인 전극도자 절제의 예측인자
강정채(Jung Chaee Kang),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),이상현(Sang Hyun Lee),김준우(Jun Woo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5
Catheter ablation of the AV nodal slow pathway using radiofrequency (RF) energy has been established as the first-line curative therapeutic modality of recurrent symptomatic AV nodal reentrant tachycardia (AVNRT). In contrast to catheter ablation of the AV bypass tract, there was no useful marker to localize succesful site of the pathway. This study was performed to determine predictors of successful catheter ablation of the AV nodal slow pathway in patients with AVNRT. Methods : Forty patients (18 men, 22 women; 47.9±13.3 years) with AVNRT undergoing successful catheter ablation of the AV nodal slow pathway were included in this study, in which 217 attempts were tried to ablate the AV nodal slow pathway. Characteristics of local atrial electrogram, anatomical site at each attempt, junctional rhythm during RF delivery were analyzed (40 successful, 177 failed). Maximum difference and duration of atrial electrograms were measured and local atrial electrograms were classified into 5 types (A1, A2, B1, B2 and C type) according to the type and the degree of fragmentation. Finally, the occurrence of junctional rhythm during RF discharge and its onset time were compared between successful and failed attempts. Results : There was no significant difference in the maximum difference of amplitude and duration of atrial electrograms between successful and failed attempts. The success rate in each type of atrial electrogram was significantly different. And, the success rate in non-C type atrial electrograms (A1, A2, B1, and B2) was significantly higher than that in type C atrial electrograms (25.0% vs 10.3%, p<0.01). No significant difference was noted in success rates according to attempted sites. Junctional rhythms during radiofrequency application occured significantly more frequent in successful attempts than in failed attempts (87.5% vs 47.5%, p<0.001). The time to onset of junctional rhythm was not different between successful and failed attempts (5.2±4.9 sec vs 6.1±5.5 sec). Conclusion : Fragmented local atrial electrogram and junctional rhythm during RF energy delivery may be used to predict successful catheter ablation of AVNRT. It is recommended that RF energy should be applied to the site where fragmented atrial electrogram is recorded and terminated if junctional rhythm does not develop within 15 seconds after starting RF energy delivery. (Korean. J. Med 57:867-874, 1999)
헤파린 부착 관상동맥 스텐트의 스텐트 재협착 예방에 대한 효과
강정채(Jung Chaee Kang),박창수(Chang Soo Park),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),정상우(Sang Woo Juhng),김준 대한내과학회 1999 대한내과학회지 Vol.57 No.1
The coronary stent reduces acute coronary arterial occlusion and late restenosis during and after coronary intervention. However, stent thrombosis and restenosis are still major limitations in widespread use of coronary stent. Local drug delivery with use of heparin-coated stent will be a new approach reducing the incidence of stent thrombosis and restenosis. In order to evaluate the effects of heparin-coated stent on stent restenosis, heparin-coated stents were compared with control stents in a porcine coronary stent restenosis model. Methods : Stent overdilation injury (stent:artery= 1.3:1.0) was performed with bare Wiktor (Group I, n=10) and heparin-coated Wiktor (Group II, n=20) stents (HEPAMEDTM, Medtronics, U.S.A.) in porcine coronary arteries. Follow-up quantitative coronary angiography (QCA) was performed at 4 weeks after stenting and histopathologic assessments of stented porcine coronary arteries were compared in both groups. Results : 1) On QCA, percent diameter stenosis was significantly higher in Group I than in Group II (16.3±6.62% vs. 9.6±5.06%, p<0.05). 2) Injury score of stented porcine coronary artery was not different in both groups (1.26±0.23 vs. 1.20±0.22). 3) Pathologic area stenosis of stented artery was higher in Group I than in Group II (41.6±12.5% vs. 27.1±9.9%, p<0.005). 4) Neointimal area was higher in Group I than in Group II (4.58±1.41 mm2 vs. 2.57±1.07 mm2, p<0.05). 5) By immunohistochemistry, proliferating cell nuclear antigen (PCNA) index was higher in Group I compared with in Group II (11.2±6.75% vs. 6.3±4.14%, p<0.05). Conclusions : Heparin-coated stent is effective in the prevention of late coronary stent restenosis in a porcine coronary stent restenosis model, which may be related with the inhibition of neointimal cell proliferation.