인공 장애물에 의한 심실세동의 동역학적 변화의 광학적 지도 분석

정보영 ( Bo Young Joung ),구본권 ( Bon Kwon Koo ),서정철 ( Zheng Zhe Xu ),김일권 ( Il Kwon Kim ),황기철 ( Ki Chul Hwang ),이문형 ( Moon Hyoung Lee ),김성순 ( Sung Soon Kim ) 한국조직공학과 재생의학회 2006 조직공학과 재생의학 Vol.3 No.3

The effects of artificial obstacles on the dynamics of ventricular fibrillation have been extensively investigated with an electrical mapping system. This study was performed to assess the influence of transmural obstacles on the dynamics of wavefronts and to determine whether obstacles can convert ventricular fibrillation to ventricular tachycardia by stabilizing wavefronts in fibrillating right ventricular tissues of pigs using an optical mapping system. The right ventricles of pigs(n=15) were excised and placed in a tissue perfusion system with the epicardium facing up. A hole of increasing size from 2 mm to 8 mm in diameter was created using a skin biopsy punch. Then, the other 8mm sized hole was made just beside the first hole. The changes of wavefront dynamics and the cycle length of optical action potential waves were investigated. In 14 among 20 obstacles of ten tissues, transient attachment of electrical activities along the rim of obstacles and transient rotation of wavefronts were observed. During baseline ventricular fibrillation, fibrillation cycle length was 118.5±24.7 msec and this was increased to 135.4±30.2 msec after 8mm hole, and to 159.4±47.7 msec after 2 holes(p=0.01). There was a positive correlation between the obstacle size and cycle length(r=0.43, p=0.007). In three tissues, conversion to ventricular tachycardia from ventricular fibrillation was observed after creation of two holes. Obstacles of proper size had anti-fibrillatory effects in tissues with ventricular fibrillation and this phenomenon was partly explained by the temporary attachment of wavefronts to the obstacles.

심방세동의 기전

정보영 ( Bo Young Joung ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4

Atrial fibrillation (AF) remains the most common adult rhythm disorder, and it associated with a substantial rate of morbidity and economic burden. AF involves a wide spectrum of arrhythmias from lone AF to paroxysmal to chronic AF. It is likely that AF comprises a spectrum of disease with no single mechanism adequate enough to comprehensively explain AF and its variability. Mechanism of fibrillation is explained by multiple wavelets and focal activation theories. Electrical, contractile and mechanical remodeling is involved in AF progression. Atrial remodeling may also increase in atrial fibrosis which can slow conduction velocity and can shorten the refractory period in atria with long-standing AF. Mechanical remodeling manifests as decreased atrial contractility and increased atrial compliance which leads to a stretch of the atrial myocardium. Abnormal intracellular calcium dynamics is observed in AF. Modulating factors such as genetic factors, age, obesity, sleep apnea, inflammation, autonomic factors and atrial and pulmonary vein stretch only partially account for the increase in AF. It is still unclear whether initiation of AF activates direct inflammatory effects or whether the presence of a pre-existing systemic inflammatory state promotes further persistence of AF. Although significant progress in understanding the mechanism of this arrhythmia has been accomplished, the pathophysiology of AF is complex and likely has many possible mechanisms which may be interrelated. (Korean J Med 2011;81:417-422)

심실 빈맥의 임상양상 및 예후

김진배 ( Jin Bae Kim ),정보영 ( Bo Young Joung ),김종윤 ( Jong Youn Kim ),김대혁 ( Dae Huyk Kim ),안신기 ( Shin Ki Ahn ),이문형 ( Moon Hyoung Lee ),김성순 ( Sung Soon Kim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.3

목적: 심실 빈맥의 원인 질환으로 허혈성 심질환이 가장 흔하다고 보고되고 있으나 우리나라의 경우 허혈성 심질환에 의한 심실 빈맥의 빈도나 임상양상 및 예후에 대하여 국내 보고가 미흡한 상태였다. 따라서 본 연구를 통해 우리나라에서 발생한 심실 빈맥의 임상적 특징과 예후에 대해 알아보고자 하였다. 방법: 1999년 1월부터 2002년 12월까지 본원에서 심실 빈맥으로 진단된 환자 136명을 대상으로 하였으며 내원 당시 ECG의 특징과 임상적 특징, 추적 결과을 분석하여 예후을 조사하였다. 결과: 남자는 100명(73.5%), 여자는 36명(26.5%)으로 남녀 비는 2.76:1였다. 환자의 발작 시 증상 중 가장 많이 호소하였던 것은 심계 항진(50.8%)이었으며 흉통(17.6%), 졸도가 15예(11.0%), 호흡곤란 7예(5.1%), 심장 돌연사 7예(5.1%)였으며 무증상인 경우가 2예(1.5%), 기타 다른 증상이 4예(2.9%)였다. 심실 빈맥의 발생에 특별한 유발 인자가 없었던 경우가 제일 많았으며(58.1%), 물리적인 활동(33.1%), 감정적인 스트레스(7.4%)가 유발인자로 관찰되었다. 심전도상의 특징을 살펴보면 기저 심박수는 74.8±17.5회, QRS폭은 101.1±18.5 ms였으며 전기축은 정상축이 가장 많았으며 V1 유도의 QRS 모양으로 분류해 보면 우각 차단형이 54예(39.7%), 좌각 차단형이 44예 (32.4%), 다형 심실 빈맥이 15예(11.0%)였으며 V1유도가 기록되지 않았던 경우가 23예(16.9%)있었다. 심실 빈맥의 원인 질환으로는 특발성 심실 빈맥이 74예(54.4%)로 가장 많았으며 허혈성 심질환이 29예(21.3%)로 그 다음이었다. 특발성 심근병증이 16예(11.8%)였으며 심판막증이 6예(4.4%)있었고, 그 밖에도 선천성 심질환(3예), Long QT 증후군(4예), Brugada 증후군(4예)있었다. 추적관찰되었던 119예 중에서 재발되었던 환자는 31예(22.8%)였으며 사망한 환자는 12예(10.1%)였다. 추적 관찰에서 재발 및 사망 여부가 확인되지 않은 환자는 17명(13.9%)였다. 재발하기까지의 기간이나 사망률로 환자의 예후를 판별하였는데, 여타 질환에 비해 특발성 심실 빈맥의 경우가 통계적으로 유의하게 좋은 예후를 보여 주었으며 허혈성 심질환인 경우가 가장 좋치 못한 결과를 보여 주었다(p<0.05). 특발성 심실 빈맥의 치료법 중 전극 도자 절제술가 가장 좋은 예후를 보여 주었으며 득발성 심실 빈맥의 경우 사망 환자는 없었다(p<0.05). 결론: 국내 심실 빈맥의 환자는 서구와는 달리 특발성인 경우가 가장 많았고 특발성 심실 빈맥의 경우가 다른 심실 빈맥에 비하여 예후가 가장 좋았으며 특발성 심실 빈맥의 치료 방법 중 전극 도자 절제술의 효과가 가장 좋았다. Background: Although the determination of etiology is crucial for the management of ventricular tachycardia (VT), there have been few studies on the epidemiology and clinical characteristics of patients with ventricular tachycardia in Korea. Previous studies on Western populations have shown that ischemic VT is the most common type arrhythmia; however, the incidence of ischemic heart disease in Korea is lower than in Western culture. The purpose of this study was to determine the clinical characteristics and prognosis of Korean patients with VT. Methods: From January 1999 to December 2002 patients who were diagnosed with VT by ECG or confirmed by electrophysiological studies were enrolled. Hospital records were reviewed for the clinical characteristics which included: demographic features, underlying disease, clinical presentation, ECG features and prognosis in 136 patients who visited our emergency room or out patient clinic. Results: There were 100 men and 36 women (mean age 51.517.6). The most common presenting symptom was palpitation (56.6%), which was followed by chest pain and syncope. The most common type of VT was idiopathic VT (54.4%); ischemic VT was found in 29 cases (21.3%) and dilated or hypertrophic cardiomyopathy in 16 cases (11.8%). For all types of VT, the idiopathic VT showed the best prognosis and cardiac function (p<0.05). RFCA (Radiofrequency catheter ablation) was the best treatment option for treatment of idiopathic VT (p<0.05). Conclusions: These findings suggest that idiopathic VT may be the most common type of VT in Korean patients; it usually originates form either the right ventricular outflow tract (RVOT) or the LV. The response to treatment and prognosis was poor in VT patients who had underlying heart disease; however, the prognosis was excellent for those with idiopathic VT.(Korean J Med 71:276-284, 2006)

남녀 및 나이에 따른 심자도 변수 차이 분석

임현균,정남식,이용호,권혁찬,정보영,박용기,Lim, Hyun-Kyoon,Chung, Nam-Sik,Lee, Yong-Ho,Kwon, Hyuk-Chan,Joung, Bo-Young,Park, Yong-Ki 대한의용생체공학회 2007 의공학회지 Vol.28 No.4

Magnetocardiography (MCG) is a device to measure the magnetic field from the heart. It is a noninvasive device and takes only few minutes to record magnetocardiogram from a subject. In this study, we compared the difference of MCG data recorded from 56 normal subjects in early twenties (28 males and 28 females, mean $age=21.0{\pm}1.6$ years) and 36 elderly subjects (20 males and 16 females, mean $age=61.9{\pm}6.9$ years) for the analysis of the age and gender difference. A total of 24 parameters used in the analysis were derived from QRS complex, R-wave, T-wave, and ST-T period. As a result, seven parameters including maximum current angle and map angle showed the significant difference (p<0.01 and p<0.05, respectively) between young males and young females. Significant difference (p<0.05) between elderly males and elderly females was found from a parameter, pole distance at T-wave peak. In the comparison of age difference, seven parameters regarding current moment, pole distance, and dynamics showed the significant difference between young and elderly males. Eight parameters also showed significant difference (p<0.05) between two younger and elderly female groups. Results showed that parameters regarding current moment, pole distance, and dynamics might be changed when people get older. In conclusion, gender and age difference should be considered when MCG data are analyzed for certain parameters.

증례 : 비장티푸스성 살모넬라균에 의한 심율동전환제세동기 삽입부 감염 1예

이동준 ( Dong Jun Lee ),이승현 ( Seung Hyun Lee ),한재현 ( Jea Hyun Han ),이승준 ( Seung Jun Lee ),박희남 ( Hui Nam Pak ),이문형 ( Moon Hyoung Lee ),정보영 ( Bo Young Joung ) 대한내과학회 2013 대한내과학회지 Vol.84 No.3