2018 심방세동 카테터 절제술 대한민국 진료지침: Part II

유희태,정동섭,박희남,박형섭,김주연,김준,이정명,김기훈,윤남식,노승영,오용석,조영진,심재민 대한부정맥학회 2018 International Journal of Arrhythmia Vol.19 No.3

In this part the writing group will cover strategies, techniques, and endpoints of atrial fibrillation (AF) ablation. Prior to all, electrical isolation of the pulmonary veins is recommended during all AF ablation procedures. In addition, techniques to be used for ablation of persistent and long-standing persistent AF, adjunctive ablation strategies, nonablative strategies to improve outcomes of AF ablation, and endpoints for ablation of paroxysmal, persistent, and long-standing persistent AF will be reviewed. Currently many technologies and tools are employed for AF ablation procedures. Radiofrequency energy, cryoablation, and other energy sources and tools are in various stages of development and/or clinical investigation. Finally, anticoagulation strategies pre-, during, and postcatheter ablation of AF and technical aspects of ablation to maximize safety are discussed in this section.

Transient Right Ventricular Dysfunction After Pericardiectomy in Patients With Constrictive Pericarditis

유희태,하종원,이삭,심지영,문정근,조인정,강민경,양우인,최동훈,정남식 대한심장학회 2011 Korean Circulation Journal Vol.41 No.5

Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart fail-ure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.

Endurance Ablation Facilitates Long-lasting Circumferential Pulmonary Vein Isolation and Better Clinical Outcomes in Patients with Paroxysmal Atrial Fibrillation

유희태,박준범,김태훈,엄재선,김종윤,정보영,이문형,박희남 대한부정맥학회 2017 International Journal of Arrhythmia Vol.18 No.3

Background Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation was found to be related to the reconnection of circumferential pulmonary vein isolation (CPVI). We hypothesized that endurance ablation with moderately increased radiofrequency (RF) power would facilitate long-lasting CPVI and better clinical outcomes. Methods We included 508 patients with paroxysmal AF (76.0% men; mean age, 56.2±9.5 years) who underwent CPVI alone. We compared endurance ablation group (ENDU-abl; n=254, 30 s ablation at each point with 35 W on anterior pulmonary veins (PVs) antrum and 25–30 W on posterior left atrium [LA]) with age-, sex-, and follow-up duration-matched conventional ablation group (CONV-abl; n=254, elimination of PV potential [PVP] with 25 W). Results 1. Total procedure time (p<0.001) and ablation time (p<0.001) were significantly longer, and major complication rate was comparable (p=0.088) between ENDU-abl and CONV-abl groups; 2. At 3-month follow-up, heart rate variability, high-frequency (HF) domain (p=0.008) and low-frequency (LF)/HF ratio (p<0.001) were significantly lower, while LA reverse remodeling was more significant at 1-year follow-up echocardiogram (p=0.013) in ENDU-abl group; 3. During 37.2±17.5 months of follow-up, the clinical recurrence of AF was significantly lower in ENDU-abl group (19.3% vs. 35.4%, log-rank p<0.001); 4. Among 38 patients who underwent redo-ablation at 15.1±12.1 months, reconnected PVPs were found in 4/11 patients (36.4%) from ENDU-abl group and in 26/27 patients (96.3%) from CONV-abl group (p<0.001). Conclusion Despite longer procedure time and relatively higher complication risk, endurance ablation with moderately increased RF power facilitates long-lasting CPVI, more significant autonomic neural remodeling and LA reverse remodeling, and better clinical outcome than conventional ablation in patients with paroxysmal AF.

常虛의 農村革命思想과 그 現在的 意義

유희태 건국대학교 1990 常虛思想 Vol.1 No.-

Gender Difference in Catheter Ablation: Atrial Fibrillations from Mars and Venus?

유희태,박희남 대한심장학회 2018 Korean Circulation Journal Vol.48 No.7

Social Inequalities of Oral Anticoagulation after the Introduction of Non-Vitamin K Antagonists in Patients with Atrial Fibrillation

유희태,Pil-Sung Yang,Jinseub Hwang,Soorack Ryu,Eunsun Jang,김태훈,엄재선,김종윤,박희남,이문형,Gregory Y.H. Lip,정보영 대한심장학회 2020 Korean Circulation Journal Vol.50 No.3

Background and Objectives: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea. Methods: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated. Results: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers. Conclusions: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.

Unilateral versus Bilateral Groin Puncture for Atrial Fibrillation Ablation: Multi-Center Prospective Randomized Study

유희태,신동금,심재민,남기병,유원우,이지현,김태훈,엄재선,정보영,이문형,김영훈,박희남 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.4

Purpose: Catheter ablation for atrial fibrillation (AF) requires heavy anticoagulation and uncomfortable post-procedural hemostasis. We compared patient satisfaction with and the safety of unilateral groin (UG) puncture-single trans-septal (ST) ablationwith conventional bilateral groin (BG) puncture-double trans-septal (DT) ablation in paroxysmal AF patients. Materials and Methods: We enrolled 222 patients with paroxysmal AF (59.4±10.7 years old) who were randomized in a 2:1 mannerinto UG-ST ablation (n=148) and BG-DT ablation (n=74) groups. If circumferential pulmonary vein isolation could not be achievedafter three attempts of touch-up ablation in the UG-ST group, the patient was crossed over to BG-DT by performing a left groinpuncture. Results: Ten patients in the UG-ST group (6.8%) required crossover to the BG-DT approach. There were no significant differencesin procedure time (p=0.144) and major complications rate (p>0.999) between the UG-ST and BG-DT groups. Access site pain(p=0.014), back pain (p=0.023), and total pain (p=0.015) scores were significantly lower for the UG-ST than BG-DT group as assessedby the Visual Analog Scale. Over 20.2±8.7 months of follow up, there was no difference in AF recurrence free-survival ratesbetween the two groups (Log rank, p=0.984). Conclusion: UG-ST AF ablation is feasible and safe, and was found to significantly reduce post-procedural hemostasis-related discomfort,compared to the conventional DT approach, in patients with paroxysmal AF.

대장균에 의한 흉쇄관절의 화농성 관절염

유희태 ( Hee Tae Yu ),하유정 ( You Jung Ha ),정상윤 ( Sang Youn Jung ),이광훈 ( Kwang Hoon Lee ),김현민 ( Hyun Min Kim ),이수곤 ( Soo Kon Lee ),박용범 ( Yong Beom Park ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2

Septic arthritis of the sternoclavicular joint is a rare condition. The predisposing risk factors include intravenous drug abuse, subclavian vein catheter placement, diabetes mellitus and trauma. Delayed or inadequate management can lead to irreversible joint damage with subsequent disability, even death. We report a 48-year-old female patient who presented with right sternoclavicular joint swelling and right shoulder pain. Magnetic resonance imaging of the sternum showed swelling of the right sternoclavicular joint with gadolinium enhancement. Synovial fluid and bone tissue culture revealed Escherichia coli (E.coli), and confirmed the diagnosis of sternoclavicular septic arthritis. She was successfully treated with surgical debridement and ciprofloxacin without recurrence. This is the first case report of E.coli sternoclavicular septic arthritis in Korea.

지중 관망 매설 시 지하공동 억제를 위한 물리 및 화학적 보강기법 연구

유희태(Yoo, Heetae),오정호(Oh, Jeongho) 한국방재학회 2017 한국방재학회논문집 Vol.17 No.3

최근 도심지역에서 지하공동의 발생 빈도가 급증함에 따라 사회적 불안이 야기되고 인적 재해도 발생되고 있는 실정이다. 도심지를 관통하는 철도 노선의 경우, 노선 하부 주변에 지하공동의 주 발생원인인 지중매설관 많이 분포해 있으며 도심지의 지하 공간 개발 또는 지하매설관의 파손 및 노후화에 의한 피해 발생 가능성이 있을 것으로 판단되며 이에 대한 검토가 필요한 실정이다. 이에 본 연구에서는 철도 노선 주위에 상하수도 관로 매설 시 관로 파손 및 노후화에 따른 지하공동 발생을 억제하기 위한 물리적 화학적 보강기법을 연구하고자 실내실험 및 수치해석을 실시하였다. 실험결과, 관 매설 시 토목섬유와 CLSM을 적용한 경우 관 파손에 의한 지하공동 전이를 억제하는 것을 지표면 침하량 및 파이프 거동을 통해 확인하였고 이를 제한적인 수치해석을 통해 검증하였다. The deterioration of water and sewage pipes in urban areas has been regarded as the primary cause of underground cavities, which have frequently been occurring in urban areas. It is noted that railways in service through the urban areas travel over the underground utilities, so it is imperative to establish a methodology to mitigate such damages. In this study, we carried out the laboratory test and numerical analysis in order to evaluate the effectiveness of physical and chemical treatments to mitigate underground cavitation caused by pipe breakage and deterioration. The test results had shown that the application of geosynthetic material and controlled low strength material (CLSM) seems to play a significant role in preventing the development of underground cavities from the deteriorated pipe by yielding less ground surface settlement and pipe responses due to repeated loading. A limited numerical analysis confirmed the test results as well.

A case of a leadless pacemaker implantation in patients early after tricuspid valve surgery

박한진,유희태 대한내과학회 2021 대한내과학회 추계학술대회 Vol.2021 No.1