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정병천,김남호,남기병,박형욱,온영근,이영수,임홍의,정보영,차태준,황교승,오세일,김준수 대한심장학회 2015 Korean Circulation Journal Vol.45 No.1
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke varies considerably according to individual clinical status. TheCHA2DS2-VASc score is better than the CHADS2 score for identifying truly lower risk patients with AF. With the advent of novel oral anticoagulants(NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety andconvenience compared with warfarin. Furthermore, new aspects of antithrombotic therapy and risk assessment of stroke have been revealed:the efficacy of stroke prevention with aspirin is weak, while the risk of major bleeding is not significantly different from that oforal anticoagulant (OAC) therapy, especially in the elderly. Reflecting these pivotal aspects, previous guidelines have been updated in recentyears by overseas societies and associations. The Korean Heart Rhythm Society has summarized the new evidence and updated recommendationsfor stroke prevention of patients with nonvalvular AF. First of all, antithrombotic therapy must be considered carefully andincorporate the clinical characteristics and circumstances of each individual patient, especially with regards to balancing the benefits ofstroke prevention with the risk of bleeding, recommending the CHA2DS2-VASc score rather than the CHADS2 score for assessing the riskof stroke, and employing the HAS-BLED score to validate bleeding risk. In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0),no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2–3) or NOACs, isrecommended for patients with a CHA2DS2-VASc score ≥2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapyshould be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy couldbe permitted.
정병천,이상희,조용근,박형섭,김윤년,이영수,신동구,조윤경 대한의학회 2011 Journal of Korean medical science Vol.26 No.12
Under conditions of Na^+ channel hyperactivation with aconitine, the changes in action potential duration (APD) and the restitution characteristics have not been well defined in the context of aconitine-induced arrhythmogenesis. Optical mapping of voltage using RH237 was performed with eight extracted rabbit hearts that were perfused using the Langendorff system. The characteristics of APD restitution were assessed using the steadystate pacing protocol at baseline and 0.1 μM aconitine concentration. In addition, pseudo-ECG was analyzed at baseline, and with 0.1 and 1.0 μM of aconitine infusion respectively. Triggered activity was not shown in dose of 0.1 μM aconitine but overtly presented in 1.0μM of aconitine. The slopes of the dynamic APD restitution curves were significantly steeper with 0.1 μM of aconitine than at baseline. With aconitine administration, the cycle length of initiation of APD alternans was significantly longer than at baseline (287.5 ± 9.6vs 247.5 ± 15.0 msec, P = 0.016). The functional reentry following regional conduction block appears with the progression of APD alternans. Ventricular fibrillation is induced reproducibly at pacing cycle length showing a 2:1 conduction block. Low-dose aconitine produces arrhythmogenesis at an increasing restitution slope with APD alternans as well as regional conduction block that proceeds to functional reentry.