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Screening for Atrial Fibrillation Using a Single Lead ECG Monitoring Device
고점석,정형기 전남대학교 의과학연구소 2021 전남의대학술지 Vol.57 No.3
Atrial fibrillation (AF) is the most common arrhythmia which needs management for stroke prevention. Therefore, it has emphasized the importance of screening for general population to detect AF earlier. We conducted screening for AF in the Chonbuk region in South Korea. Participants who were older than 50 years were enrolled. The screening test used a single lead electrocardiography (ECG) (KardiaBand, AliveCor, CA, USA). Diagnosis of AF was confirmed by electrophysiologists, if the single lead ECG demonstrated AF of more than 30 seconds. We analyzed the prevalence of AF and the characteristics of newly detected AF patients. A total of 2728 participants, 145 (5.3%) participants had already been diagnosed with AF before. The number of screening positive was 55. Among them, 40 participants were confirmed for AF. Male gender and age older than 70 years were the independent risk factors for AF among the screening positive participants. Most of newly detected AF patients were at high risk for stroke which had more than 2 points on the CHA2DS2-VASc score. We followed up with those patients and encouraged them to visit the hospital. As a result, 31 (77.5%) patients started to manage AF. The additional 1.2% of AF was detected by a screening test with a single lead ECG monitor device. Considering most participants of newly detected AF by screening were at high risk for stroke, it was thought that AF was still undertreated. Therefore, screening tests with simple mobile device might be useful for early detection of AF.
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급성 심근경색증 환자에서 QT분산의 심근손상 및 관상동맥 병변 예측가능성
고점석,주소영,정명호,홍영준,배은희,이민구,윤남식,김주한,김원,안영근,조정관,서순팔,박종춘,안병희,김상형,강정채 대한심장학회 2004 Korean Circulation Journal Vol.34 No.12
Background and Objectives:Increased QT dispersion (QTD) in patients with acute myocardial infarction (AMI) may be related with such adverse events as sudden cardiac death and ischemic heart failure. Subjects and Methods:Two hundred eight patients (age:62±10.4 years, 158 males), underwent diagnostic coronary angiography under the diagnosis of AMI between January and December 2001 at the Heart Center of Chonnam National University Hospital, and these patients were enrolled to evaluate the relationship between the QTD and myocardial injury and the complex coronary arterial lesion. Results:A QTD of over 80 ms was observed in 89 patients (42.7%). There were in 61 patients with ST elevation myocardial infarction (STEMI, 68.5%) and 28 patients with non-ST elevation myocardial infarction (NSTEMI, 31.5%). There was no correlation between the QTD and such risk factors as hypertension, diabetes, gender, smoking, hyperlipidemia and family history. The level of CK-MB on admission was correlated with the QTD (112.5±98.1 U/L in the group with a QTD over 80 ms and 72.6±73.4 U/L in the group with a QTD under 80 ms, p<0.05). The ejection fraction measured by two dimensional echocardiography on admission showed correlation with the QTD (50.9±11.4% in the group with a QTD over 80 ms and 54.7±11.2% U/L in the group with a QTD under 80 ms, p<0.05). For the coronary angiographic findings, the lesion type, according to American College of Cardiology/American Heart Association classification, correlated with the QT dispersion (type B2 or C:64.1% in the group with a QTD over 80 ms, 49.6% in the group with a QTD under 80 ms, p<0.05) Conclusion:There was significant correlation between the prolonged QTD and the severity of myocardial injury at admission, and the complex coronary arterial lesion in patients with AMI. 배경 및 목적: 급성 심근경색증 환자에서 QT분산의 증가는 심인성 급사 및 심부전증의 발생과 같은 단기 및 장기 예후와 연관이 있는것으로 알려져 있다. 이는 심근손상의 정도와 관련이 있을 것으로 생각되며, 심근손상의 범위는 심근효소의 증가정도로 추정할 수 있다. 본 연구에서는 급성 심근경색증에서 QT분산의 증가가 심근효소의 상승 및 복합병변과 연관이 있는지 알아보았다. 방 법: 2001년 1월부터 2001년 12월까지 전남대학교병원 순환기내과에 급성 심근경색증으로 입원하여 관상동맥 조영술을 시행한 환자 중 208예(62.2±10.4세, 남 158예, 여 50예)를 대상으로 하여, 진단 당시 심전도에서 QT 분산을 구하고 심근효소를 측정하고 관상동맥 조영술 소견 등과 비교하였다. 결 과: 대상 환자 중에서 89명(42.7%)에서 QT분산이 80 ms 이상 증가되었으며 이중에서 ST 분절 상승 심근경색증은 61명(68.5%), ST 분절 비상승 심근경색증은 28명(31.5%)로서, QT분산의 증가와 ST절의 상승은 유의한 관계를 보이지 않았다. QT분산이 증가한 군과 그렇지 않은 군 사이에 나이, 성별 및 고혈압, 흡연, 고지혈증, 당뇨 등 관상동맥질환의 위험인자의 빈도는 의의 있는 차이를 보이지 않았다. 내원 당시 CK-MB수치는 QT분산이 80 ms 이상인 군에서 112.5±98.1 U/L, 미만인 군 72.6±73.4 U/L로서 QT분산이 증가한 군에서 유의하게 높았으며(p<0.01), CK-MB수치와 QT분산 수치사이에도 유의한 양의 상관관계를 보였다(p<0.05). 내원 시 시행한 이면성 심초음파도 검사에서 QT분산이 80 ms 이상인 군에서 50.9±11.4%, 미만인 군 54.7±11.2 U/L로서 좌심실 구혈률과 QT분산의 증가 사이에는 유의한 상관관계가 있었으나(p<0.05), 좌심실 부전증 발생과는 관계가 없었다. 관상동맥 조영술에서 재관류 이전 TIMI flow 및 협착이 있는 혈관의 수, 좌전행지 병변 여부와는 관련이 없었으나, QT분산이 증가한 군에서 ACC/AHA분류에서 복잡병변(B2 및 C형)의 빈도가 64.1%로서 증가하지 않은 군 49.6%에 비해 유의하게 높았다(p<0.05). 결 론: 급성 심근경색증 환자에서 QT분산의 증가는 내원 시 심근손상 및 관상동맥의 복잡병변과 유의한 관계가 있음을 알 수 있었다.
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불안정형 협심증 및 급성 비ST절 상승 심근경색증 환자에서 심부전 발생 예측 인자
고점석,주소영,정명호,홍영준,박옥영,박우석,김주한,김원,안영근,조정관,서순팔,박종춘,안병희,김상형,강정채 대한심장학회 2004 Korean Circulation Journal Vol.34 No.5
Background and Objectives :Besides the acute coronary syndrome (ACS), the left ventricular failure (LVF) is the next important determinant of morbidity and mortality after acute coronary syndrome (ACS). The (UA) or acute non -ST elevation myocardial infarction (NSTEMI). Subjects and Methods :179 patients (60.4 ±11.6 years, 121 male) who underwent diagnostic coronary angiography under the diagnosis of UA/NSTEMI between January and December, 2000, in the Chonam National University Hospital Heart Center were en -features, initial electrocardiogram, laboratory findings and coronary angiographic findings. Results:Unstable angina was clinically diagnosed in 124 patients, and NSTEMI in 55 patients. During a 12-month folow -up period, les than 40% of the left ventricular ejection fraction (EF), a low amount, was observed in 28 patients (15.7%). In diabetic patients, the incidence of LVF was significantly higher than in non -Patients with elevated C -reactive protein (CRP) or positive troponin I had LVF more frequently (p<0.05). On the initial electrocardiogram, the total summation of ST segment change inversely correlated with EF (p<0.05). Patients whose QT dispersion was longer than 80 ms had a higher incidence of LVF (p<0.05). Coronary angio -graphic findings of total occlusion corelated with the development of LVF (p<0.05), but not with other charac -teristics. On multiple logistic regression analysis, high CRP level (p=0.024), summation of ST change (p=0.02 1), Conclusion :Elevated CRP, sumation of ST change and total coronary artery occlusion are important predictive factors for LVF in UA/NSTEMI. 배경 및 목적: 내원 당시에 정상적인 좌심실 기능을 보였던 급성 관상동맥 증후군 환자인 UA 혹은 NSTEMI 환자에서 좌Korean Circulation J 2004;34(5):459-467 466 심실 부전을 예측할 수 있는 다양한 임상적 및 검사 소견 인자에 대해 알아보고자 하였다. 방 법: 2000년 1월부터 12 월까지 전남대학교병원 심장센터에 UA 혹은 NSTEMI로 입원하였던 환자 중 정상적인 좌심실 기능을 보였고 관상동맥 조영술을 시행한 환자 중 179예(60.4 ± 1.6세, 남 121예, 여 58예)를 대상으로 하여 12개월간 장기적인 임상 관찰을 통하여 좌심실부전 발생 여부에 관한 임상적 특징, 기저 심전도 소견, 검사실 소견 및 관상동맥 조영술상 병변의 등의 예측인자들을 비교하였다. 결 과: 대상 환자 중에서 164예(91.6%)가 관상동맥 조영술 에서 유의한 협착을 보였다. 좌심실 부전이 발생한 환자 는 28예(15.7%)이었으며, 좌심실 구혈률은 정상 범위 에 있으나, 국소 심실벽 운동이상을 보이는 경우는 47 예(26.4%)였다. 당뇨병 환자에서 좌심실 부전의 발생 이 유의하게 많았고(p<0.05) troponin I 혹은 troponin T가 양성이고 CRP가 증가한 환자에서 심부전이 발생 할 확률이 높았으며(p<0.05), 심부전이 있는 군에서 troponin I 수치가 유의하게 높았다(p<0.05). 기저 심전도 에서 ST분절의 상승과 하강이 동시에 있는 경우에 좌 심실 부전이 발생할 확률이 가장 높았으며 ST분절의 상승-하강 폭의 총합은 좌심실 부전 및 좌심실 구혈률 과 유의한 관계를 보였다(p<0.05). 또한 QT 분산(가장 큰 QT값과 가장 작은 QT값의 차)이 80 ms이상인 군 에서 심부전 발생 가능성이 높아짐을 알 수 있었다. 관 상동맥 조영술에서 재관류 이전 관상동맥 완전 폐쇄 여 부와 심부전의 발생은 유의한 관계를 보였으나(p<0.05), 협착이 있는 혈관의 수, ACC/AHA 병변의 분류, 좌전 행지 포함여부와는 관련이 없었다. 좌심실 부전과 관계 가 있는 것으로 나타난 여러 인자에 대한 다변량 분석 에서 CRP수치, ST절의 변화폭의 총합, 당뇨병 유병여 부가 좌심실 부전을 예측할 수 있는 독립변인임을 알 수 있었다. 결 론: 급성 관상동맥 증후군환자 중 UA 혹은 NSTEMI 환 자에서 좌심실 부전을 예측할 수 있는 인자는 증가된 CRP수치, ST절의 변화폭의 총합, 당뇨병 등이었다.
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Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
고점석 대한부정맥학회 2017 International Journal of Arrhythmia Vol.18 No.1
Atrioventricular nodal reentrant tachycardia is the most common type of supraventricular tachycardia. The initiation and maintenance of tachycardia is caused by the characteristic anatomic and electrophysiologic properties of the atrioverntricular node. Acute management for the termination of tachycardia includes pharmacologic and non-pharmacologic management. There are several options for preventing recurrence of tachycardia, and radiofrequency ablation for modulation of tachycardia circuit can be considered as a primary strategy. A thorough understanding of the unique electrophysiologic features is very essential for optimal management and best possible outcome in cases of invasive management.
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고점석,정명호,이민구,이신은,강원유,김수현,박근호,심두선,윤남식,윤현주,홍영준,박형욱,김주한,안영근,조정관,박종춘,강정채 대한심장학회 2009 Korean Circulation Journal Vol.39 No.6
Background and Objectives: Left ventricular (LV) remodeling (LVR) after an acute myocardial infarction (AMI) has important clinical implications. We have investigated the prognostic relevance of ventricular systolic dyssnchrony as an indicator of LVR after an AMI. Subjects and Methods: We enrolled 92 patients (males, 72.8%; mean age, 61.0±13.0 years) with an AMI who underwent successful percutaneous coronary intervention. We analyzed the baseline characteristics, the laboratory and echocardiographic findings, and we performed follow-up echocardiography 6 months after the AMI. The patients were divided into two groups: 1) the presence of LVR, which was defined as an increment of LV end systolic volume (LVESV) >20% compared with the baseline examination; and 2) the absence of LVR. Results: Twenty-seven patients (29.3%) developed LVR after a 6 month follow-up. There was no statistically significant difference in the clinical and angiographic findings between the two groups. With respect to the laboratory findings, the LVR group had a higher peak creatine kinase MB (CK-MB) (149.9±155.0 vs. 74.6±69.7 U/L, p=0.001) and troponin-I (70.2±73.3 vs. 43.2±39.5 ng/mL, p=0.024) level than the group without LVR. With respect to echocardiographic findings, the baseline LV ejection fraction (EF) and LVESV were not significantly different (LVESV, 73.0±37.3 vs. 91.3±52.0 mL, p=0.013; and EF, 58.3±13.3 vs. 55.6± 11.8%, p=0.329) between the groups with and without LVR, respectively. The degree of LV dyssynchrony, which was assessed by tissue Doppler imaging, was significantly higher in the LVR group than the group without LVR (75.2±43.4 vs. 38.3±32.5 ms), and the degree of LV dyssynchrony was an independent predictor for LVR based on multivariate analysis {hazard ratio (HR)=0.097, p<0.001}. In receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) was 0.754 and a cutoff value of 45.9 predicted the development of LVR with 74.1% sensitivity and 72.3% specificity. Conclusion: The presence of LV dyssynchroncy immediately after a myocardial infarction is an important predictive factor for development LVR. Background and Objectives: Left ventricular (LV) remodeling (LVR) after an acute myocardial infarction (AMI) has important clinical implications. We have investigated the prognostic relevance of ventricular systolic dyssnchrony as an indicator of LVR after an AMI. Subjects and Methods: We enrolled 92 patients (males, 72.8%; mean age, 61.0±13.0 years) with an AMI who underwent successful percutaneous coronary intervention. We analyzed the baseline characteristics, the laboratory and echocardiographic findings, and we performed follow-up echocardiography 6 months after the AMI. The patients were divided into two groups: 1) the presence of LVR, which was defined as an increment of LV end systolic volume (LVESV) >20% compared with the baseline examination; and 2) the absence of LVR. Results: Twenty-seven patients (29.3%) developed LVR after a 6 month follow-up. There was no statistically significant difference in the clinical and angiographic findings between the two groups. With respect to the laboratory findings, the LVR group had a higher peak creatine kinase MB (CK-MB) (149.9±155.0 vs. 74.6±69.7 U/L, p=0.001) and troponin-I (70.2±73.3 vs. 43.2±39.5 ng/mL, p=0.024) level than the group without LVR. With respect to echocardiographic findings, the baseline LV ejection fraction (EF) and LVESV were not significantly different (LVESV, 73.0±37.3 vs. 91.3±52.0 mL, p=0.013; and EF, 58.3±13.3 vs. 55.6± 11.8%, p=0.329) between the groups with and without LVR, respectively. The degree of LV dyssynchrony, which was assessed by tissue Doppler imaging, was significantly higher in the LVR group than the group without LVR (75.2±43.4 vs. 38.3±32.5 ms), and the degree of LV dyssynchrony was an independent predictor for LVR based on multivariate analysis {hazard ratio (HR)=0.097, p<0.001}. In receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) was 0.754 and a cutoff value of 45.9 predicted the development of LVR with 74.1% sensitivity and 72.3% specificity. Conclusion: The presence of LV dyssynchroncy immediately after a myocardial infarction is an important predictive factor for development LVR.
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