457 results on '"Pak HN"'
Search Results
2. Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation
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Yang, PS, primary, Kim, DH, additional, Jang, E, additional, Yu, HT, additional, Kim, TH, additional, Pak, HN, additional, Lee, MH, additional, Sung, JH, additional, and Joung, B, additional
- Published
- 2022
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3. Poster session 6: Saturday 6 December 2014, 08: 30–12: 30Location: Poster area
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Chung, H, Kim, JY, Joung, B, Uhm, JS, Pak, HN, Lee, MH, and Lee, KY
- Published
- 2014
4. Antiarrhythmic drug responders among patients with recurrent atrial fibrillation after catheter ablation
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Park, Y, primary, Yu, H, additional, Kim, TH, additional, Uhm, JS, additional, Joung, B, additional, Lee, MH, additional, and Pak, HN, additional
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- 2021
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5. Artificial intelligence-predicted poor responders to catheter ablation for atrial fibrillation
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Park, JW, primary, Kwon, OS, additional, Shim, JM, additional, Yu, HT, additional, Kim, TH, additional, Uhm, JS, additional, Kim, JY, additional, Choi, JI, additional, Joung, BY, additional, Lee, MH, additional, Kim, YH, additional, and Pak, HN, additional
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- 2021
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6. The reduction of body mass index and risk of incidence of cardiovascular events in the elderly population
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Park, JW, primary, Yang, PS, additional, Yu, HT, additional, Kim, TH, additional, Jang, ES, additional, Pak, HN, additional, Lee, MH, additional, and Joung, BY, additional
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- 2021
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7. Left atrial wall stress and the outcome of catheter ablation for atrial fibrillation: artificial intelligence-based prediction of clinical outcome
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Lee, J, primary, Kwon, OS, additional, Lee, JS, additional, Yu, HT, additional, Kim, TH, additional, Uhm, JS, additional, Joung, BY, additional, Lee, MH, additional, and Pak, HN, additional
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- 2021
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8. Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation
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Pak, HN, primary, Park, JW, additional, Yang, SY, additional, Kim, M, additional, Yu, HT, additional, Kim, TH, additional, Uhm, JS, additional, Joung, BY, additional, and Lee, MH, additional
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- 2021
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9. Malnutrition and risk of procedural complication in patients with atrial fibrillation undergoing catheter ablation
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Kim, D, primary, Yu, HT, additional, Kim, TH, additional, Uhm, JS, additional, Joung, B, additional, Lee, MH, additional, and Pak, HN, additional
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- 2021
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10. Efficacy and safety of 50-60 Watt high-power short-duration radiofrequency catheter ablation of atrial fibrillation: A propensity score matching study
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Pak, HN, primary, Yang, SY, additional, Kim, M, additional, Yu, HT, additional, Kim, TH, additional, Uhm, JS, additional, Joung, BY, additional, Lee, MH, additional, and Park, JW, additional
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- 2021
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11. P1379Atrial fibrillation, bone marrow density and the risk of fracture in patients with osteoporosis
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Yang, PS., primary, Kim, TH., additional, Uhm, JS., additional, Kim, JY., additional, Pak, HN., additional, Jung, B., additional, and Lee, MH., additional
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- 2017
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12. 1365Which patients develop recurrent atrial tachycardia but not atrial fibrillation after catheter ablation for atrial fibrillation?
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Park, YA., primary, Kim, TH., additional, Joung, B., additional, Lee, MH., additional, and Pak, HN., additional
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- 2017
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13. P279Outcomes of rate-control treatment in patients with atrial fibrillation and heart failure: a nationwide cohort study
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Yu, HT., primary, Lee, H., additional, You, SC., additional, Yang, PS., additional, Kim, TH., additional, Uhm, JS., additional, Kim, JY., additional, Pak, HN., additional, Lee, MH., additional, and Joung, B., additional
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- 2017
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14. P273Comparison of risk factors for new-onset atrial fibrillation in the young versus elderly age: a nationwide cohort study in korea
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Shin, DG., primary, Yang, PS., additional, Kim, TH., additional, Uhm, JS., additional, Pak, HN., additional, Lee, MH., additional, Kim, JY., additional, and Joung, B., additional
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- 2017
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15. P323Prognostic value of inferior shift of P-wave axis after catheter ablation for longstanding persistent atrial fibrillation including anterior line
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Shin, DG., primary, Kim, TH., additional, Jeong, H., additional, Kim, A., additional, Uhm, JS., additional, Joung, B., additional, Lee, MH., additional, and Pak, HN., additional
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- 2017
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16. P1745The impact of regular exercise in cardiovascular mortality and sudden cardiac arrest: a nationwide cohort study
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Park, YA., primary, Yang, PS., additional, Kim, TH., additional, Uhm, JS., additional, Kim, JY., additional, Pak, HN., additional, Lee, MH., additional, and Joung, B., additional
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- 2017
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17. P887Pulmonary vein isolation vs. additional linear ablation for patients with persistent atrial fibrillation those changed to paroxysmal type with antiarrhythmic therapy: a multi-center randomized study
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Yu, HT., primary, Shim, J., additional, Park, J., additional, Kim, IS., additional, Kim, TH., additional, Uhm, JS., additional, Joung, B., additional, Lee, MH., additional, Kim, YH., additional, and Pak, HN., additional
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- 2017
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18. P1378Cardioembolic and non-cardioembolic risk factors for ischemic stroke in patients with non-valvlular atrial fibrillation
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Yang, PS., primary, Kim, TH., additional, Uhm, JS., additional, Jung, B., additional, Lee, MH., additional, and Pak, HN., additional
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- 2017
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19. P1581Genetic polymorphism of Ryanodine receptor 2 and left atrial voltage in patients with atrial fibrillation
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Yang, PS., primary, Kim, TH., additional, Uhm, JS., additional, Jung, B., additional, Lee, MH., additional, and Pak, HN., additional
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- 2017
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20. P1697Consistently stable body mass index and atrial fibrillation: national health insurance service-health screening cohort study in Korea
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Lim, YM., primary, Yang, PS., additional, Kim, TH., additional, Uhm, JS., additional, Sung, JH., additional, Kim, JY., additional, Pak, HN., additional, Lee, MH., additional, and Joung, BY., additional
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- 2017
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21. Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study.
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Mun HS, Joung B, Shim J, Hwang HJ, Kim JY, Lee MH, Pak HN, Mun, Hee-Sun, Joung, Boyoung, Shim, Jaemin, Hwang, Hye Jin, Kim, Jong Youn, Lee, Moon-Hyoung, and Pak, Hui-Nam
- Abstract
Objective: Circumferential pulmonary vein isolation (CPVI) has been considered the cornerstone of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether linear ablation in addition to CPVI improves clinical outcome.Design: Prospective randomised study to compare the efficacy of CPVI and CPVI with additional linear ablation in patients with paroxysmal AF (PAF).Setting: University hospital.Patients: This study enrolled 156 patients (male 76.3%, 55.8±11.5 years old (mean±SD)) who underwent RFCA for PAF.Interventions: CPVI (n=52), CPVI+roof line (CPVI+RL; n=52) and CPVI+RL+posterior inferior line (CPVI+PostBox; n=52).Main Outcome Measures: Procedure time, ablation time and clinical outcome.Results: (1) The CPVI group showed shorter total procedure time (180.4±39.5 min vs 189.6±29.0 min and 201.7±51.7 min, respectively (mean±SD); p=0.035) and ablation time (4085.5±1384.1 s vs 5253.5±1010.9 s and 5495.0±1316.0 s, respectively; p<0.001) than the CPVI+RL and CPVI+PostBox groups. (2) During 15.6±5.0 months of follow-up, the recurrence rates 3 months after RFCA were 11.5% in CPVI, 21.2% in CPVI+RL and 19.2% in CPVI+PostBox (p=0.440). (3) The achievement rate of CPVI was 100.0%, and bidirectional block rate was 80.8% in CPVI+RL and 59.6% in CPVI+PostBox. The clinical recurrence rates with or without achieving bidirectional block were not significantly different from each other (p=0.386).Conclusion: In patients with PAF, linear ablation in addition to CPVI did not improve clinical outcome, regardless of bidirectional block achievement, while it prolonged the total procedure and ablation time. [ABSTRACT FROM AUTHOR]- Published
- 2012
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22. Unusual complications of percutaneous epicardial access and epicardial mapping and ablation of cardiac arrhythmias.
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Koruth JS, Aryana A, Dukkipati SR, Pak HN, Kim YH, Sosa EA, Scanavacca M, Mahapatra S, Ailawadi G, Reddy VY, and d'Avila A
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- 2011
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23. Non-ischaemic titrated cardiac injury caused by radiofrequency catheter ablation of atrial fibrillation mobilizes CD34-positive mononuclear cells by non-stromal cell-derived factor-1alpha mechanism.
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Kim SK, Pak HN, Park JH, Choi JI, Nam MH, Jo Y, and Kim YH
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- 2009
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24. Poster session 6: Saturday 6 December 2014, 08:30-12:30 * Location: Poster area
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Goirigolzarri Artaza, J, Gallego Delgado, M, Jaimes Castellanos, CP, Cavero Gibanel, MA, Pastrana Ledesma, MA, Alonso Pulpon, LA, Gonzalez Mirelis, J, Al Ansi, R Z, Sokolovic, S, Cerin, G, Szychta, W, Popa, B A, Botezatu, D, Benea, D, Manganiello, S, Corlan, A, Jabour, A, Igual Munoz, B, Osaca Asensi, JOA, Andres La Huerta, AALH, Maceira Gonzalez, AMG, Estornell Erill, JEE, Cano Perez, OCP, Sancho-Tello, MJSTDC, Alonso Fernandez, PAF, Sepulveda Sanchez, PSS, Montero Argudo, AMA, Palombo, C, Morizzo, C, Baluci, M, Kozakova, M, Panajotu, A, Karady, J, Szeplaki, G, Horvath, T, Tarnoki, DL, Jermendy, AL, Geller, L, Merkely, B, Maurovich-Horvat, P, Group, MTA-SE "Lendület" Cardiovascular Imaging Research, Moustafa, S, Mookadam, F, Youssef, M, Zuhairy, H, Connelly, M, Prieur, T, Alvarez, N, Ashikhmin, Y, Drapkina, O, Boutsikou, M, Demerouti, E, Leontiadis, E, Petrou, E, Karatasakis, G, Kozakova, M, Morizzo, C, Bianchi, V, Marchi, B, Federico, G, Palombo, C, Chatzistamatiou, E, Moustakas, G, Memo, G, Konstantinidis, D, Mpampatzeva Vagena, I, Manakos, K, Traxanas, K, Vergi, N, Feretou, A, Kallikazaros, I, Goto, M, Uejima, T, Itatani, K, Pedrizzetti, G, Mada, RO, Daraban, AM, Duchenne, J, Voigt, JU, Chiu, D Y Y, Green, D, Johnstone, L, Sinha, S, Kalra, PA, Abidin, N, Group, Salford Vascular Research, Sikora-Frac, M, Zaborska, B, Maciejewski, P, Bednarz, B, Budaj, A, Nemes, A, Sasi, V, Gavaller, H, Kalapos, A, Domsik, P, Katona, A, Szucsborus, T, Ungi, T, Forster, T, Ungi, I, Pluchinotta, FR, Arcidiacono, C, Saracino, A, Carminati, M, Bussadori, C, Dahlslett, T, Karlsen, S, Grenne, B, Sjoli, B, Bendz, B, Skulstad, H, Smiseth, OA, Edvardsen, T, Brunvand, H, Vereckei, A, Szelenyi, ZS, Szenasi, G, Santoro, C, Galderisi, M, Niglio, T, Santoro, M, Stabile, E, Rapacciuolo, A, Spinelli, L, De Simone, G, Esposito, G, Trimarco, B, Hubert, S, Jacquier, A, Fromonot, J, Resseguier, C, Tessier, A, Guieu, R, Renard, S, Haentjiens, J, Lavoute, C, Habib, G, Menting, M E, Koopman, LP, Mcghie, JS, Rebel, B, Gnanam, D, Helbing, WA, Van Den Bosch, AE, Roos-Hesselink, JW, Shiino, K, Yamada, A, Sugimoto, K, Takada, K, Takakuwa, Y, Miyagi, M, Iwase, M, Ozaki, Y, Placido, R, Ramalho, A, Nobre E Menezes, M, Cortez-Dias, N, Goncalves, S, Guimaraes, T, Robalo Martins, S, Francisco, AR, Almeida, AG, Nunes Diogo, A, Hayashi, T, Itatani, K, Inuzuka, R, Shindo, T, Hirata, Y, Shimizu, N, Miyaji, K, Henri, C, Dulgheru, R, Magne, J, Kou, S, Davin, L, Nchimi, A, Oury, C, Pierard, L, Lancellotti, P, Kovalyova, O, Honchar, O, Tengku, WINDA, Ketaren, ANDRE, Mingo Santos, S, Monivas Palomero, V, Restrepo Cordoba, A, Rodriguez Gonzalez, E, Goirigolzarri Artaza, J, Sayago Silva, I, Garcia Lunar, I, Mitroi, C, Cavero Gibanel, M, Segovia Cubero, J, Ryu, SK, Park, JY, Kim, SH, Choi, JW, Goh, CW, Byun, YS, Choi, JH, Westholm, C, Johnson, J, Jernberg, T, Winter, R, Rio, P, Moura Branco, L, Galrinho, A, Pinto Teixeira, P, Viveiros Monteiro, A, Portugal, G, Pereira-Da-Silva, T, Afonso Nogueira, M, Abreu, J, Cruz Ferreira, R, Mazzone, A, Botto, N, Paradossi, U, Chabane, A, Francini, M, Cerone, E, Baroni, M, Maffei, S, Berti, S, Tatu-Chitoiu, G P, Deleanu, D, Macarie, C, Chioncel, O, Dorobantu, M, Udroiu, C, Calmac, L, Diaconeasa, A, Vintila, V, Vinereanu, D, investigators, RO-STEMI, Ghattas, A, Shantsila, E, Griffiths, H, Lip, GY, Galli, E, Guirette, Y, Daudin, M, Auffret, V, Mabo, P, Donal, E, Fabiani, I, Conte, L, Scatena, C, Barletta, V, Pratali, S, De Martino, A, Bortolotti, U, Naccarato, AG, Di Bello, V, Falanga, G, Alati, E, Di Giannuario, G, Zito, C, Cusma' Piccione, M, Carerj, S, Oreto, G, Dattilo, G, Alfieri, O, La Canna, G, Generati, G, Bandera, F, Pellegrino, M, Alfonzetti, E, Labate, V, Guazzi, M, Cho, EJ, Park, S-J, Lim, HJ, Yoon, HR, Chang, S-A, Lee, S-C, Park, SW, Cengiz, B, Sahin, S T, Yurdakul, S, Kahraman, S, Bozkurt, A, Aytekin, S, Borges, I P, Peixoto, ECS, Peixoto, RTS, Peixoto, RTS, Marcolla, VF, Venkateshvaran, A, Sola, S, Dash, P K, Thapa, P, Manouras, A, Winter, R, Brodin, LA, Govind, S C, Mizariene, V, Verseckaite, R, Bieseviciene, M, Karaliute, R, Jonkaitiene, R, Vaskelyte, J, Arzanauskiene, R, Janenaite, J, Jurkevicius, R, Rosner, S, Orban, M, Nadjiri, J, Lesevic, H, Hadamitzky, M, Sonne, C, Manganaro, R, Carerj, S, Cusma-Piccione, MC, Caprino, A, Boretti, I, Todaro, MC, Falanga, G, Oreto, L, D'angelo, MC, Zito, C, Le Tourneau, T, Cueff, C, Richardson, M, Hossein-Foucher, C, Fayad, G, Roussel, JC, Trochu, JN, Vincentelli, A, Obase, K, Weinert, L, Lang, R, Cavalli, G, Muraru, D, Miglioranza, MH, Addetia, K, Veronesi, F, Cucchini, U, Mihaila, S, Tadic, M, Lang, RM, Badano, L, Polizzi, V, Pino, PG, Luzi, G, Bellavia, D, Fiorilli, R, Chialastri, C, Madeo, A, Malouf, J, Buffa, V, Musumeci, F, Gripari, P, Tamborini, G, Bottari, V, Maffessanti, F, Carminati, C, Muratori, M, Vignati, C, Bartorelli, A, Alamanni, F, Pepi, M, Polymeros, S, Dimopoulos, A, Spargias, K, Karatasakis, G, Athanasopoulos, G, Pavlides, G, Dagres, N, Vavouranakis, E, Stefanadis, C, Cokkinos, DV, Pradel, S, Mohty, D, Magne, J, Darodes, N, Lavergne, D, Damy, T, Beaufort, C, Aboyans, V, Jaccard, A, Mzoughi, K, Zairi, I, Jabeur, M, Ben Moussa, F, Ben Chaabene, A, Kamoun, S, Mrabet, K, Fennira, S, Zargouni, A, Kraiem, S, Jovanova, S, Arnaudova-Dezjulovic, F, Correia, C E, Cruz, I, Marques, N, Fernandes, M, Bento, D, Moreira, D, Lopes, L, Azevedo, O, GROUP, SUNSHINE, Keramida, K, Kouris, N, Kostopoulos, V, Psarrou, G, Giannaris, V, Olympios, CD, Marketou, M, Parthenakis, F, Kalyva, N, Pontikoglou, CH, Maragkoudakis, S, Zacharis, E, Patrianakos, A, Roufas, K, Papadaki, H, Vardas, P, Dominguez Rodriguez, F, Monivas Palomero, V, Mingo Santos, S, Arribas Rivero, B, Cuenca Parra, S, Zegri Reiriz, I, Vazquez Lopez-Ibor, J, Garcia-Pavia, P, Szulik, M, Streb, W, Wozniak, A, Lenarczyk, R, Sliwinska, A, Kalarus, Z, Kukulski, T, Nemes, A, Domsik, P, Kalapos, A, Forster, T, Serra, W, Lumetti, FL, Mozzani, FM, Del Sante, GDS, Ariani, AA, Corros, C, Colunga, S, Garcia-Campos, A, Diaz, E, Martin, M, Rodriguez-Suarez, ML, Leon, V, Fidalgo, A, Moris, C, De La Hera, JM, Kylmala, M M, Rosengard-Barlund, M, Groop, P H, Lommi, J, Bruin De- Bon, HACM, Bilt Van Der, IA, Wilde, AA, Brink Van Den, RBA, Teske, AJ, Rinkel, GJ, Bouma, BJ, Teixeira, R, Monteiro, R, Garcia, J, Silva, A, Graca, M, Baptista, R, Ribeiro, M, Cardim, N, Goncalves, L, Duszanska, A, Skoczylas, I, Kukulski, T, Polonski, L, Kalarus, Z, Choi, J-H, Park, JS, Ahn, JH, Lee, JW, Ryu, SK, Ahn, J, Kim, DH, Lee, HO, Przewlocka-Kosmala, M, Mlynarczyk, J, Rojek, A, Mysiak, A, Kosmala, W, Pellissier, A, Larochelle, E, Krsticevic, L, Baron, E, Le, V, Roy, A, Deragon, A, Cote, M, Garcia, D, Tournoux, F, Yiangou, K, Azina, C, Yiangou, A, Zitti, M, Ioannides, M, Ricci, F, Dipace, G, Aquilani, R, Radico, F, Cicchitti, V, Bianco, F, Miniero, E, Petrini, F, De Caterina, R, Gallina, S, Jardim Prista Monteiro, R, Teixeira, R, Garcia, J, Baptista, R, Ribeiro, M, Cardim, N, Goncalves, L, Chung, H, Kim, JY, Joung, B, Uhm, JS, Pak, HN, Lee, MH, Lee, KY, Ragab, AM, Abdelwahab, AMIR, Yazeed, YASER, El Naggar, WAEL, Spahiu, K, Spahiu, E, Doko, A, Liesting, C, Brugts, JJ, Kofflard, MJM, Kitzen, JJEM, Boersma, E, Levin, M-D, Coppola, C, Piscopo, G, Rea, D, Maurea, C, Caronna, A, Capasso, I, Maurea, N, Azevedo, O, Tadeu, I, Lourenco, M, Portugues, J, Pereira, V, Lourenco, A, Nesukay, E, Kovalenko, V, Cherniuk, S, Danylenko, O, Muhammedov, MB, Ahmedova, DM, Hojakuliyev, BG, Atayeva, D, Nemes, A, Domsik, P, Kalapos, A, Lengyel, C, Varkonyi, TT, Orosz, A, Forster, T, Castro, M, Abecasis, J, Dores, H, Madeira, S, Horta, E, Ribeiras, R, Canada, M, Andrade, MJ, Mendes, M, Morosin, M, Piazza, R, Leonelli, V, Leiballi, E, Pecoraro, R, Cinello, M, Dell' Angela, L, Cassin, M, Sinagra, G, Nicolosi, GL, Wierzbowska-Drabik, K, Hamala, P, Kasprzak, JD, O'driscoll, J, Rossato, C, Gargallo-Fernandez, P, Araco, M, Sharma, S, Sharma, R, Jakus, N, Baricevic, Z, Ljubas Macek, J, Skoric, B, Skorak, I, Velagic, V, Separovic Hanzevacki, J, Milicic, D, Cikes, M, Deljanin Ilic, M, Ilic, S, Kocic, G, Pavlovic, R, Stoickov, V, Ilic, V, Nikolic, LJ, Generati, G, Bandera, F, Pellegrino, M, Alfonzetti, E, Labate, V, Guazzi, M, Labate, V, Bandera, F, Generati, G, Pellegrino, M, Donghi, V, Alfonzetti, E, Guazzi, M, Zakarkaite, D, Kramena, R, Aidietiene, S, Janusauskas, V, Rucinskas, K, Samalavicius, R, Norkiene, I, Speciali, G, Aidietis, A, Kemaloglu Oz, T, Ozpamuk Karadeniz, F, Akyuz, S, Unal Dayi, S, Esen Zencirci, A, Atasoy, I, Osken, A, Eren, M, Fazendas, P R, Caldeira, D, Stuart, B, Cruz, I, Rocha Lopes, L, Almeida, A R, Sousa, P, Joao, I, Cotrim, C, Pereira, H, Fazendas, P R, Caldeira, D, Stuart, B, Cruz, I, Rocha Lopes, L, Almeida, A R, Joao, I, Cotrim, C, Pereira, H, Sinem Cakal, SC, Elif Eroglu, EE, Baydar, O, Beytullah Cakal, BC, Mehmet Vefik Yazicioglu, MVY, Mustafa Bulut, MB, Cihan Dundar, CD, Kursat Tigen, KT, Birol Ozkan, BO, Ali Metin Esen, A, Yagasaki, H, Kawasaki, M, Tanaka, R, Minatoguchi, S, Houle, H, Warita, S, Ono, K, Noda, T, Watanabe, S, Minatoguchi, S, Cho, E J, Park, S J, Lim, H J, Chang, S A, Lee, S C, Park, S W, Cho, E J, Park, S J, Lim, H J, Chang, S A, Lee, S C, Park, S W, Mornos, C, Cozma, D, Ionac, A, Mornos, A, Popescu, I, Ionescu, G, Pescariu, S, Melzer, L, Faeh-Gunz, A, Seifert, B, Attenhofer Jost, C H, Storve, S, Haugen, BO, Dalen, H, Grue, JF, Samstad, S, Torp, H, Ferrarotti, L, Maggi, E, Piccinino, C, Sola, D, Pastore, F, Marino, PN, Ranjbar, S, Karvandi, M, Hassantash, SA, Karvandi, M, Ranjbar, S, Tierens, S, Remory, I, Bala, G, Gillis, K, Hernot, S, Droogmans, S, Cosyns, B, Lahoutte, T, Tran, N, Poelaert, J, Al-Mallah, M, Alsaileek, A, Nour, K, Celeng, CS, Horvath, T, Kolossvary, M, Karolyi, M, Panajotu, A, Kitslaar, P, Merkely, B, Maurovich Horvat, P, Group, MTA-SE "Lendület" Cardiovascular Imaging Research, Aguiar Rosa, S, Ramos, R, Marques, H, Portugal, G, Pereira Da Silva, T, Rio, P, Afonso Nogueira, M, Viveiros Monteiro, A, Figueiredo, L, and Cruz Ferreira, R
- Abstract
Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predictor. Despite that echochardiography is more often used, cardiac MRI is considered more accurate. Our objetives are to validate "fast" LAV measures by MRI vs the considered gold standard (GS) and to compare Echo and MRI in a wide spectrum of patients. Methods: In a non-selected popullation with MRI study previously realized, we measured LAV by biplane method (BPMR) and by area-length in 4 chamber view (ALMR) and compared them with biplane (BPe) and discs method (MDDe) in 4 chamber view in echo. To validate MRI measurements, we measured LAV in short axis slices (Simpson Method, SM) in a group of patients and considered it the GS. Results: 186 patients were included (mean age 51 ± 17 age; 123 male; 14 in AF) with clinical indication of cardiac MRI (Philips 1,5 T). In 24 patients SM was calculated. 29% of cardiac MRI were considered normal. Mean underlying pathologies were myocardiopathy (27%), Ischemic myocardiopathy (17%), myopericarditis (10%), prior to AF ablation (4%), valvular disease (6%) and miscellaneous (7%). Excellent correlation was obtained between "fast" MRI measurements and SM in MRI (SM vs BPMR interclass correlation coefficient ICC=0.965 and SM vs ALMR, ICC=0.958; P<0.05) with low interobserver variability (ICC=0.983 for SM; ICC=0.949 for BPMR; ICC=0.931 for ALMR). "Fast" measurements by MRI showed stadistical correlation between them (CCI=0.910) (Figure). Correlation between Echo and MRI measures was only moderate. (BPRM vs BPe CCI=0,469 mean difference -30 ml; ALMR vs MDDe ICC=0,456 mean difference -24 mL). Conclusions: ‘fast’ LAV measures by MRI are comparable with the MRI GS and also between them. Echo values seem to underestimate compared to MRI, so its use may not be suitable.
- Published
- 2014
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25. Antiarrhythmic potential of mesenchymal stem cell is modulated by hypoxic environment.
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Hwang HJ, Chang W, Song BW, Song H, Cha MJ, Kim IK, Lim S, Choi EJ, Ham O, Lee SY, Shim J, Joung B, Pak HN, Kim SS, Choi BR, Jang Y, Lee MH, Hwang KC, Hwang, Hye Jin, and Chang, Woochul
- Abstract
Objectives: The purpose of this study was to evaluate the antiarrhythmic potential of mesenchymal stem cells (MSC) under a different environment.Background: Little is known about how environmental status affects antiarrhythmic potential of MSCs.Methods: To investigate the effect of paracrine factors secreted from MSCs under different circumstances on arrhythmogenicity in rats with myocardial infarction, we injected paracrine media (PM) secreted under hypoxic, normoxic conditions (hypoxic PM and normoxic PM), and MSC into the border zone of infarcted myocardium in rats.Results: We found that the injection of hypoxic PM, but not normoxic PM, markedly restored conduction velocities, suppressed focal activity, and prevented sudden arrhythmic deaths in rats. Underlying this electrophysiological alteration was a decrease in fibrosis, restoration of connexin 43, alleviation of Ca(2+) overload, and recovery of Ca(2+)-regulatory ion channels and proteins, all of which is supported by proteomic data showing that several paracrine factors including basic fibroblast growth factor, insulinlike growth factor 1, hepatocyte growth factor, and EF-hand domain-containing 2 are potential mediators. When compared with PM, MSC injection did not reduce or prevent arrhythmogenicity, suggesting that the antiarrhythmic or proarrhythmic potential of MSC is mainly dependent on paracrine factors.Conclusions: A hypoxic or normoxic environment surrounding MSC affects the type and properties of the growth factors or cytokines, and these secreted molecules determine the characteristics of the electro-anatomical substrate of the surrounding myocardium. [ABSTRACT FROM AUTHOR]- Published
- 2012
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26. Bleeding risk and major adverse events in patients with previous ulcer on oral anticoagulation therapy.
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Lee SJ, Shin DH, Hwang HJ, Kim JY, Pak HN, Lee MH, and Joung B
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- 2012
27. Differentiating Left Atrial Pressure Responses in Paroxysmal and Persistent Atrial Fibrillation: Implications for Diagnosing Heart Failure With Preserved Ejection Fraction and Managing Atrial Fibrillation.
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Park JS, Cho I, Kim D, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, and Pak HN
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- Humans, Female, Male, Middle Aged, Aged, Prospective Studies, Heart Rate physiology, Catheter Ablation, Echocardiography, Cardiac Pacing, Artificial, Atrial Function, Left physiology, Ventricular Function, Left physiology, Isoproterenol administration & dosage, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Atrial Fibrillation surgery, Heart Failure physiopathology, Heart Failure diagnosis, Heart Failure therapy, Stroke Volume physiology, Atrial Pressure physiology
- Abstract
Background: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF., Methods and Results: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H
2 FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2 FPEF score subgroup (all P <0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P <0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P =0.056) because the LAP-peak significantly increased with heart rate in the group with PAF., Conclusions: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2 FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control., Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.- Published
- 2024
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28. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, and Wan EY
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- Humans, Europe, Latin America, Asia, Atrial Fibrillation surgery, Atrial Fibrillation physiopathology, Catheter Ablation methods, Societies, Medical, Consensus
- Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society., Competing Interests: Data availability No new data were generated or analyzed in support of this research., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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29. Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects.
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GYH, and Joung B
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- Humans, Male, Middle Aged, Female, Republic of Korea epidemiology, United Kingdom epidemiology, Incidence, Adult, Risk Factors, Aged, White People, Hemorrhage ethnology, Hemorrhage epidemiology, Asian People
- Abstract
Background: This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the United Kingdom., Methods: We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems., Results: During the follow-up, primary outcome events occurred in 2,110 East Asians and in 6,515 Caucasians. East Asians had a 38% lower 5-year incidence rate compared with Caucasians (3.88 vs. 6.29 per 1,000 person-years; incidence rate ratio [IRR]: 0.62, 95% confidence interval [CI]: 0.59-0.65). East Asians showed a lower incidence of major bleeding (IRR: 0.86, 95% CI: 0.81-0.91), bleeding from the gastrointestinal (IRR: 0.53, 95% CI: 0.49-0.56), and genitourinary systems (IRR: 0.49, 95% CI: 0.44-0.53) compared with Caucasians. The incidence rates of ICH (IRR: 3.20, 95% CI: 2.67-3.84) and bleeding from the respiratory system (IRR: 1.28, 95% CI: 1.11-1.47) were higher in East Asians. Notably, East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR: 1.12, 95% CI: 1.01-1.25)., Conclusion: This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race., Competing Interests: B.J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and received research funds from Medtronic and Abbott. No fees have been received directly or personally. G.Y.H.L. has been a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos. No fees are received personally. He is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 Research and Innovation Program under grant agreement number 899871. The remaining authors have nothing to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
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- 2024
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30. Racial Differences in Ischemic and Hemorrhagic Stroke: An Ecological Epidemiological Study.
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GYH, and Joung B
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- Humans, Male, Middle Aged, Female, Incidence, Republic of Korea epidemiology, Risk Factors, Aged, Asian People, Adult, Health Status Disparities, Epidemiologic Studies, Ischemic Stroke epidemiology, Ischemic Stroke ethnology, White People statistics & numerical data, Hemorrhagic Stroke epidemiology, Hemorrhagic Stroke ethnology
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Background: This study aimed to evaluate racial differences in the incidence of stroke by conducting an ecological epidemiological study using UK Biobank and Korean nationwide data., Methods: This study used individual data from the Korean National Health Insurance Service-Health Screening and UK Biobank, which included participants who underwent health examinations between 2006 and 2010. We included 112,750 East Asians (50.7% men, mean age: 52.6 years) and 210,995 Caucasians (44.7% men, mean age: 55.0 years) who were not diagnosed with atrial fibrillation, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease, or cancer. The primary outcome was defined as a composite of ischemic and hemorrhagic stroke., Results: East Asians tended to have a lower body mass index (23.7 vs. 26.4 kg/m
2 , p < 0.001) and a higher proportion of participants who did not engage in moderate-to-vigorous physical activity (49.6% vs. 10.7%, p < 0.001) than Caucasians. During the follow-up, East Asians had higher 5-year incidence rates (presented as per 1,000 person-years) for primary outcome (1.73 vs. 0.50; IR ratio [IRR]: 3.48, 95% confidence interval [CI]: 3.13-3.88), ischemic stroke (1.23 vs. 0.33; IRR: 3.70, 95% CI: 3.25-4.21), hemorrhagic stroke (0.56 vs. 0.18; IRR: 3.20, 95% CI: 2.67-3.84), and atrial fibrillation-related stroke (0.19 vs. 0.09; IRR: 2.04, 95% CI: 1.55-2.68)., Conclusion: Based on this ecological epidemiological study, racial differences in stroke incidence were robust to a variety of statistical analyses, regardless of the subtype. This suggests the need for region-specific approaches to stroke prevention., Competing Interests: B.J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and received research funds from Medtronic and Abbott. No fees have been received directly or personally. G.Y.H.L. has been a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthem. No fees are received personally. He is a co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 899871. The remaining authors have nothing to declare., (Thieme. All rights reserved.)- Published
- 2024
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31. Atrial Cardiomyopathy Revisited - Evolution of a Concept. A Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Association (APHRS), and the Latin American Heart Rhythm Society (LAHRS).
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Goette A, Corradi D, Dobrev D, Aguinaga L, Cabrera JA, Chugh SS, de Groot JR, Soulat-Dufour L, Fenelon G, Hatem SN, Jalife J, Lin YJ, Lip GYH, Marcus GM, Murray KT, Pak HN, Schotten U, Takahashi N, Yamaguchi T, Zoghbi WA, and Nattel S
- Abstract
Developed in partnership with the European Heart Rhythm Association (EHRA), (a registered branch of the European Society of Cardiology (ESC)) the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin America Heart Rhythm Society (LAHRS)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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32. Effects of antiarrhythmic drug responsiveness and diagnosis-to-ablation time on outcomes after catheter ablation for persistent atrial fibrillation.
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Kim HJ, Kim D, Kim K, Choi SH, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, and Pak HN
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Background: The impact of delaying atrial fibrillation catheter ablation (AFCA) for antiarrhythmic drug (AAD) management on the disease course remains unclear. This study investigated AFCA rhythm outcomes based on the diagnosis-to-ablation time (DAT) and AAD responsiveness in participants with persistent AF (PeAF)., Methods: We included data from 1038 AAD-resistant PeAF participants, all of whom had a clear time point for AF diagnosis, especially PeAF at diagnosis time, and had undergone an AFCA for the first time. Participants who experienced recurrences of paroxysmal type on AAD therapy were analyzed as a cohort of AAD-partial responders; those maintaining PeAF on AAD were AAD-non-responders. We determined the DAT cutoff for best discriminating long-term rhythm outcomes using a maximum log-likelihood estimation method based on the Cox proportional hazard regression model., Results: Of the participants (79.8% male; median age 61), 806 (77.6%) were AAD-non-responders. AAD-non-responders had a higher body mass index and a larger left atrial diameter than AAD-partial-responders. They also had a higher incidence of AF recurrence after AFCA (adjusted hazard ratio 1.75, 95% confidence interval 1.33-2.30; log-rank p < .001) compared to AAD-partial-responders. The maximum log-likelihood estimation showed bimodal cutoffs at 22 and 40 months. The optimal DAT cutoff rhythm outcome was 22 months, which discriminated better in the AAD-partial-responders than in the AAD-non-responders., Conclusions: Both DAT and AAD responsiveness influenced AFCA rhythm outcomes. Delaying AFCA to a DAT of longer than 22 months was inadvisable, particularly in the participants in whom PeAF was changed to paroxysmal AF during AAD therapy., Competing Interests: Authors declare no conflict of interests for this article., (© 2024 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)
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- 2024
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33. The associations of leukocyte telomere length and intermediary cardiovascular phenotype with adverse cardiovascular outcomes in the white population.
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Chung HG, Yang PS, Cho S, Jang E, Kim D, Yu HT, Kim TH, Uhm JS, Sung JH, Pak HN, Lee MH, and Joung B
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- Humans, Male, Female, Middle Aged, Cross-Sectional Studies, Aged, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac pathology, Heart Failure genetics, Heart Failure pathology, White People genetics, Telomere Homeostasis, Electrocardiography, Risk Factors, United Kingdom epidemiology, Cardiovascular Diseases genetics, Leukocytes metabolism, Telomere genetics, Phenotype
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The evidence about the associations of leukocyte telomere length (LTL) and intermediary cardiovascular phenotypes with adverse cardiovascular outcomes is inconclusive. This study assessed these relationships with cardiovascular imaging, electrocardiography, and the risks of sudden cardiac death (SCD), coronary events, and heart failure (HF) admission. We conducted a cross-sectional analysis of UK Biobank participants enrolled between 2006 and 2010. LTL was measured using quantitative polymerase chain reactions. Electronic health records were used to determine the incidence of SCD, coronary events, and HF admission. Cardiovascular measurements were made using cardiovascular magnetic resonance imaging and machine learning. The associations of LTL with SCD, coronary events, and HF admission and cardiac magnetic resonance imaging, electrocardiogram parameters of 33,043 and 19,554 participants were evaluated by multivariate regression. The median (interquartile range) follow-up period was 11.9 (11.2-12.6) years. Data was analyzed from January to May 2023. Among the 403,382 white participants without coronary artery disease or HF, 181,637 (45.0%) were male with a mean age of 57.1 years old. LTL was independently negatively associated with a risk of SCD (LTL third quartile vs first quartile: hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.72-0.92), coronary events (LTL third quartile vs first quartile: HR: 0.88, 95% CI: 0.84-0.92), and HF admission (LTL fourth quartile vs first quartile: HR: 0.84, 95% CI: 0.74-0.95). LTL was also independently positively associated with cardiac remodeling, specifically left ventricular mass index, left-ventricular-end systolic and diastolic volumes, mean left ventricular myocardial wall thickness, left ventricular stroke volume, and with electrocardiogram changes along the negative degree of T-axis. Cross-sectional study results showed that LTL was positively associated with heart size and cardiac function in middle age, but electrocardiography results did not show these associations, which could explain the negative association between LTL and risk of SCD, coronary events, and HF admission in UK Biobank participants., (© 2024. The Author(s).)
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- 2024
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34. Clinical and pathophysiologic determinants of catheter ablation outcome in hypertrophic cardiomyopathy with atrial fibrillation.
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Lee JH, Cho I, Choi SH, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Hong GR, Hwang C, and Pak HN
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Background: Hypertrophic cardiomyopathy (HCM) is frequently associated with atrial fibrillation (AF). We compared clinical, echocardiographic, and electrophysiological parameters between HCM subtypes and those without HCM at AF catheter ablation (AFCA) and analyzed post-AFCA reverse remodeling and AF recurrence based on HCM presence and subtype., Methods: Among 5161 consecutive patients who underwent de novo AFCA, we included HCM patients and control patients who were age-, gender-, and AF type-matched. Between AF-HCM patients and controls, we compared baseline values for left atrium (LA) wall thickness (LAWT), reverse remodeling at 1-year follow-up, and procedural outcomes over the course of follow-up between two groups., Results: A total of 122 AF-HCM patients and 318 control patients were included. AF-HCM patients had more frequent heart failure and higher LA diameter, E/Em, and LA pressure (all, p < .001). However, LAWT did not differ from control group. A year after AFCA, degree of LA reverse remodeling was significantly lower in AF-HCM than in control group (ΔLA dimension, p = .025). Nonapical HCM (HR 1.71; 95% CI 1.05-2.80), persistent AF (HR 1.46; 95% CI 1.05-2.04), and LA dimension (HR 1.04; 95% CI 1.01-1.06) were independent risk factors for AF recurrence. During 78.0 months of follow-up, nonapical HCM patients showed higher AF recurrence rate than both apical HCM (log-rank p = .005) and control patients (log-rank p = .002)., Conclusions: The presence of HCM, particularly nonapical HCM, displayed increased LA hemodynamic loading with diastolic dysfunction and had poorer rhythm outcomes after AFCA compared to both apical HCM and control group., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)
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- 2024
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35. Modifiable lifestyle factors and lifetime risk of atrial fibrillation: longitudinal data from the Korea NHIS-HealS and UK Biobank cohorts.
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Park H, Kim D, Jang E, Yu HT, Kim TH, Kim DM, Sung JH, Pak HN, Lee MH, Lip GYH, Yang PS, and Joung B
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Biological Specimen Banks, Cohort Studies, Longitudinal Studies, Republic of Korea epidemiology, Risk Factors, UK Biobank, United Kingdom epidemiology, White People, East Asian People, Atrial Fibrillation epidemiology, Life Style
- Abstract
Background: The reason for higher incidence of atrial fibrillation (AF) in Europe compared with East Asia is unclear. We aimed to investigate the association between modifiable lifestyle factors and lifetime risk of AF in Europe and East Asia, along with race/ethnic similarities and disparities., Methods: 1:1 propensity score matched pairs of 242,763 East Asians and 242,763 White Europeans without AF were analyzed. Modifiable lifestyle factors considered were blood pressure, body mass index, cigarette smoking, diabetes, alcohol consumption, and physical activity, categorized as non-adverse or adverse levels. Lifetime risk of AF was estimated from the index age of 45 years to the attained age of 85 years, accounting for the competing risk of death., Results: The overall lifetime risk of AF was higher in White Europeans than East Asians (20.9% vs 15.4%, p < 0.001). The lifetime risk of AF was similar between the two races in individuals with non-adverse lifestyle factor profiles (13.4% vs 12.9%, p = 0.575), whereas it was higher in White Europeans with adverse lifestyle factor profiles (22.1% vs 15.8%, p < 0.001). The difference in the lifetime risk of AF between the two races increased as the burden of adverse lifestyle factors worsened (1 adverse lifestyle factor; 4.3% to ≥ 3 adverse lifestyle factors; 11.2%). Compared with East Asians, the relative risk of AF in White Europeans was 23% and 62% higher for one (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.16-1.29) and ≥ 3 adverse lifestyle factors (HR 1.62, 95% CI 1.51-1.75), respectively., Conclusions: The overall higher lifetime risk of AF in White Europeans compared with East Asians might be attributable to adverse lifestyle factors. Adherence to healthy lifestyle factors was associated with the lifetime risk of AF of about 1 in 8 regardless of race/ethnicity., (© 2024. The Author(s).)
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- 2024
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36. Clinical Implications of Polypharmacy for Patients with New-Onset Atrial Fibrillation Based on Real-World Data: Observations from the Korea National Health Insurance Service Data.
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Kim HJ, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, and Joung B
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Background: Polypharmacy is commonly observed in atrial fibrillation (AF) and is associated with poorer clinical outcomes. Our study aimed to elucidate the polypharmacy prevalence, its associated risk factors, and its relationship with adverse clinical outcomes using a 'real-world' database., Methods: This study included 451,368 subjects without prior history of AF (median age, 54 [interquartile range, 48.0-63.0] years; 207,748 [46.0%] female) from the Korea National Health Insurance Service-Health Screening (NHIS-HealS) database between 2002 and 2013. All concomitant medications prescribed were collected, and the intake of five or more concomitant drugs was defined as polypharmacy. During the follow-up, all-cause death, major bleeding events, transient ischemic attack (TIA) or ischemic stroke, and admission due to worsened heart failure were recorded., Results: Based on up to 7.7 (6.8-8.3) years of follow-up and 768,306 person-years, there were 12,241 cases of new-onset AF identified. Among patients with new-onset AF (40.0% females, median age 63.0 [54.0-70.0] years), the polypharmacy prevalence was 30.9% (3784). For newly diagnosed AF, factors, such as advanced age (with each increase of 10 years, odds ratios (OR) 1.32, 95% confidence interval (CI) 1.26-1.40), hypertension (OR 4.00, 95% CI 3.62-4.43), diabetes mellitus (OR 3.25, 95% CI 2.86-3.70), chronic obstructive pulmonary disease (COPD) (OR 3.00, 95% CI 2.51-3.57), TIA/ischemic stroke (OR 2.36, 95% CI 2.03-2.73), dementia history (OR 2.30, 95% CI 1.06-4.98), end-stage renal disease (ESRD) or chronic kidney disease (CKD) (OR 1.97, 95% CI 1.38-2.82), and heart failure (OR 1.95, 95% CI 1.69-2.26), were found to be independently correlated with the incidence of polypharmacy. Polypharmacy significantly increased the incidence and risk of major bleeding (adjusted hazard ratio (aHR) 1.26, 95% CI 1.12-1.41). The study observed a statistically significant increase in the incidence of all-cause mortality, however, the risk for all-cause mortality elevated but did not show significance (aHR 1.11, 95% CI 0.99-1.24). The risk of stroke and admission for heart failure did not change with polypharmacy., Conclusions: In our investigation using data from a nationwide database, polypharmacy was widespread in new-onset AF population and was related to major bleeding events. However, polypharmacy does not serve as an independent risk factor for adverse outcomes, with exception of major bleeding event. For AF patients, ensuring tailored medication for comorbidities as well as reducing polypharmacy are essential considerations., Competing Interests: The authors declare no conflict of interest. Boyoung Joung is serving as one of the Editorial Board members of this journal. We declare that Boyoung Joung had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Vladimir M. Pokrovskii and Buddhadeb Dawn. BYJ has been a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and has received research funds from Medtronic and Abbott. No fees were received, either directly or personally. The remaining authors have no other relationships or activities that could appear to have influenced the submitted work., (Copyright: © 2024 The Author(s). Published by IMR Press.)
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- 2024
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37. European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events.
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Park H, Kim D, You SC, Jang E, Yu HT, Kim TH, Kim DM, Sung JH, Pak HN, Lee MH, Yang PS, and Joung B
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- Humans, Male, Female, Middle Aged, Risk Assessment, United States epidemiology, Aged, Primary Prevention methods, Europe epidemiology, Eligibility Determination, United Kingdom epidemiology, Risk Factors, Genetic Predisposition to Disease, Multifactorial Inheritance, Patient Selection, Adult, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Coronary Artery Disease genetics, Coronary Artery Disease epidemiology, Coronary Artery Disease prevention & control, Practice Guidelines as Topic
- Abstract
Background: A study was designed to investigate whether the coronary artery disease polygenic risk score (CAD-PRS) may guide lipid-lowering treatment initiation as well as deferral in primary prevention beyond established clinical risk scores., Methods and Results: Participants were 311 799 individuals from the UK Biobank free of atherosclerotic cardiovascular disease, diabetes, chronic kidney disease, and lipid-lowering treatment at baseline. Participants were categorized as statin indicated, statin indication unclear, or statin not indicated as defined by the European and US guidelines on statin use. For a median of 11.9 (11.2-12.6) years, 8196 major coronary events developed. CAD-PRS added to European-Systematic Coronary Risk Evaluation 2 (European-SCORE2) and US-Pooled Cohort Equation (US-PCE) identified 18% and 12% of statin-indication-unclear individuals whose risk of major coronary events were the same as or higher than the average risk of statin-indicated individuals and 16% and 12% of statin-indicated individuals whose major coronary event risks were the same as or lower than the average risk of statin-indication-unclear individuals. For major coronary and atherosclerotic cardiovascular disease events, CAD-PRS improved C-statistics greater among statin-indicated or statin-indication-unclear than statin-not-indicated individuals. For atherosclerotic cardiovascular disease events, CAD-PRS added to the European evaluation and US equation resulted in a net reclassification improvement of 13.6% (95% CI, 11.8-15.5) and 14.7% (95% CI, 13.1-16.3) among statin-indicated, 10.8% (95% CI, 9.6-12.0) and 15.3% (95% CI, 13.2-17.5) among statin-indication-unclear, and 0.9% (95% CI, 0.6-1.3) and 3.6% (95% CI, 3.0-4.2) among statin-not-indicated individuals., Conclusions: CAD-PRS may guide statin initiation as well as deferral among statin-indication-unclear or statin-indicated individuals as defined by the European and US guidelines. CAD-PRS had little clinical utility among statin-not-indicated individuals.
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- 2024
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38. Optimal antithrombotic strategy in patients with atrial fibrillation beyond 1 year after drug-eluting stent implantation: Design and rationale of the randomized ADAPT AF-DES trial.
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Lee SH, Lee SJ, Heo JH, Ahn SG, Doh JH, Shin S, Shim J, Her AY, Kim BG, Lim SW, Kwon TG, Lee KH, Kim D, Lee YJ, Yu HT, Kim TH, Shin DH, Pak HN, and Kim JS
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- Female, Humans, Male, Drug Therapy, Combination, Hemorrhage chemically induced, Prospective Studies, Stroke prevention & control, Stroke etiology, Time Factors, Randomized Controlled Trials as Topic, Multicenter Studies as Topic, Anticoagulants administration & dosage, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation therapy, Clopidogrel administration & dosage, Clopidogrel therapeutic use, Drug-Eluting Stents, Percutaneous Coronary Intervention methods, Platelet Aggregation Inhibitors therapeutic use, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Background: Both anticoagulation and antiplatelet therapies are recommended after percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). Although contemporary guidelines recommend discontinuation of antiplatelet therapy 1 year after drug-eluting stent (DES) implantation due to excessive bleeding risk, supporting randomized trials are still lacking., Methods: The ADAPT AF-DES trial is a multicenter, prospective, open-label, randomized, non-inferiority trial, enrolling 960 patients with AF with a CHA
2 DS2 -VASc score > 1, who underwent PCI with DES implantation at least 12 months before enrollment. Eligible patients are randomly assigned to receive either non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy or NOAC plus clopidogrel combination therapy. The primary outcome is net adverse clinical event (NACE) at 1 year after randomization, defined as a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism, and major or clinically relevant non-major bleeding, as defined by the International Society on Thrombosis and Hemostasis criteria. We hypothesize that NOAC monotherapy would be non-inferior to NOAC plus clopidogrel combination therapy for NACE in patients with AF beyond 12 months after DES implantation., Conclusions: The ADAPT AF-DES trial will evaluate the efficacy and safety of NOAC monotherapy versus NOAC plus clopidogrel combination therapy in patients with AF beyond 12 months after PCI with DES implantation. The ADAPT AF-DES trial will provide robust evidence for an optimal antithrombotic strategy in patients with AF after DES implantation., Clinical Trial Registration: https://www., Clinicaltrials: gov. Unique identifier: NCT04250116., Competing Interests: Disclosure J-SK reported receiving grants from Samjin Pharmaceutical and speaker's fees from Abbott Vascular., (Copyright © 2024 Elsevier Inc. All rights reserved.)- Published
- 2024
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39. Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins.
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Jin Z, Hwang T, Kim D, Lim B, Kwon OS, Kim S, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, and Pak HN
- Abstract
Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695., (© 2024. The Author(s).)
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- 2024
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40. Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: UTMOST AF.
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Hwang T, Kwon OS, Yu HT, Yang SY, Kim D, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, and Pak HN
- Abstract
Background: High-power short-duration (HPSD) ablation creates wide, shallow lesions using radiofrequency (RF) heating. It is uncertain if adjusting RF energy based on atrial wall thickness provides extra benefits. We studied the safety and effectiveness of tailored HPSD energy based on left atrial (LA) wall thickness (LAWT) for circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF)., Methods: We enrolled 212 patients (68.4% male, mean age: 59.5 ± 11.0 years) and randomly assigned them to two groups: LAWT-guided CPVI (WT, n = 108) and conventional CPVI (control, n = 104). Both groups used an open irrigated-tip deflectable catheter to apply 50 W for 10 s to the posterior LA, while controls used 60 W for 15 s on other LA regions. RF delivery time in WT was titrated (15 s at LAWT > 2.1 mm, 13 s at 1.4-2.1 mm, and 11 s at <1.4 mm) according to the computed tomogram-myocardial thickness color map., Results: After a mean follow-up of 13.4 ± 7.0 months, the WT and control groups showed no significant difference regarding clinical recurrence rate (13.9% vs. 5.8%, respectively; p = .061) and major complication rate (4.6% vs. 3.8%, respectively; p > .999). The total procedure time, cardioversion rate, and post-procedural AAD prescription rates did not significantly differ between the groups., Conclusions: The LAWT-guided energy titration strategy did not result in improved procedural safety and efficacy compared to the conventional 50-60 W-HPSD CPVI in patients with PAF., Competing Interests: We previously developed automated customized software (AMBER, LaonMed, Korea) to measure myocardial thickness from cardiac CT. We registered the patent for the above technology on June 2, 2022, and had the patent number (10‐2022‐0067621). The authors declare no conflict of interest, except for the patent related to wall thickness measurement software., (© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)
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- 2024
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41. Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index.
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Jung M, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, and Joung B
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- Humans, Multimorbidity, Risk Factors, Comorbidity, Anticoagulants therapeutic use, Hemorrhage chemically induced, Hemorrhage diagnosis, Hemorrhage epidemiology, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Stroke diagnosis, Stroke epidemiology, Stroke prevention & control
- Abstract
Background: Predicting survival in atrial fibrillation (AF) patients with comorbidities is challenging. This study aimed to assess multimorbidity in AF patients using the Charlson Comorbidity Index (CCI) and its clinical implications., Methods: We analyzed 451,368 participants from the Korea National Health Insurance Service-Health Screening cohort (2002-2013) without prior AF diagnoses. Patients were categorized into new-onset AF and non-AF groups, with a high CCI defined as ≥4 points. Antithrombotic treatment and outcomes (all-cause death, stroke, major bleeding, and heart failure [HF] hospitalization) were evaluated over 9 years., Results: In total, 9.5% of the enrolled patients had high CCI. During follow-up, 12,241 patients developed new-onset AF. Among AF patients, antiplatelet drug use increased significantly in those with high CCI (adjusted odds ratio [OR] 1.05, 95%confidence interval [CI] 1.02-1.08, P < .001). However, anticoagulants were significantly less prescribed in patients with high CCI (OR 0.97, 95%CI 0.95-0.99, P = .012). Incidence of adverse events (all-cause death, stroke, major bleeding, HF hospitalization) progressively increased in this order: low CCI without AF, high CCI without AF, low CCI with AF, and high CCI with AF (all P < .001). Furthermore, high CCI with AF had a significantly higher risk compared to low CCI without AF (all-cause death, adjusted hazard ratio [aHR] 2.52, 95% CI 2.37-2.68, P < .001; stroke, aHR 1.43, 95% CI 1.29-1.58, P < .001; major bleeding, aHR 1.14, 95% CI 1.04-1.26, P = .007; HF hospitalization, aHR 4.75, 95% CI 4.03-5.59, P < .001)., Conclusions: High CCI predicted increased antiplatelet use and reduced oral anticoagulant prescription. AF was associated with higher risks of all-cause death, stroke, major bleeding, and HF hospitalization compared to high CCI., Competing Interests: Declaration of Competing Interest BJ has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and received research funds from Medtronic and Abbott. No fees were received directly or personally. The remaining authors have no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2024
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42. Association of extra-pulmonary vein triggers with low-voltage area and clinical recurrence in patients with atrial fibrillation undergoing catheter ablation.
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Park IJ, Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, and Pak HN
- Abstract
Background and Objectives: Although extra-pulmonary vein (PV) triggers (ExPVTs) play a role in atrial fibrillation (AF) recurrence after catheter ablation (AFCA), the mechanism is unknown. We explored whether the locations of ExPVTs were associated with low-voltage scar areas (LVAs)., Methods: Among 2255 consecutive patients who underwent a de novo AFCA, 1696 (male 72.1%, median 60 years old, paroxysmal 64.7%) were included who underwent isoproterenol provocation and voltage mapping of the left atrium (LA) during their procedures. We investigated the associations between ExPVTs and their mean LA voltage and colocalization of ExPVTs within LVAs (<0.2 mV)., Results: We observed ExPVTs in 181 (10.7%) patients (60 in the LA, 99 in the right atrium [RA], 16 biatrial, and 6 unmappable). A lower mean LA voltage was independently associated with the existence of ExPVTs (OR 0.77 per 1 SD mV increase, 95% CI 0.60-0.99, p = .039). Among 76 patients who had ExPVTs
[LA] , 43 (56.6%) had ExPVTs within LVAs. During a median of a 42-month follow-up, patients with ExPVTs had a higher AF recurrence than those without (HR 1.87, 95% CI 1.48-2.37, Log-rank p < .001), but colocalization of ExPVTs and LVAs (Log-rank p = .544) and the anatomical location of ExPVTs (Log-rank p = .084) did not affect the rhythm outcome., Conclusions: The presence of ExPVTs was associated with low LA voltage and poor rhythm outcome post-AFCA, but the colocalization of ExPVTs and LVA in LA did not affect rhythm outcome., Competing Interests: Authors declare no conflict of interests for this article., (© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)- Published
- 2024
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43. Clinical Characteristics and Rhythm Outcomes in Patients With Atrial Myopathy After Successful Catheter Ablation of Atrial Fibrillation.
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Kim MH, Kim TH, Hwang I, Park JW, Yu HT, Uhm JS, Joung B, Lee MH, Hwang C, and Pak HN
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- Humans, Aged, Treatment Outcome, Heart Atria, Echocardiography methods, Recurrence, Atrial Fibrillation, Catheter Ablation adverse effects, Catheter Ablation methods, Atrial Remodeling
- Abstract
Background: Although successful atrial fibrillation (AF) ablation can maintain sinus rhythm and reduce the left atrial (LA) dimension, blunted LA reverse remodeling can be observed in patients with atrial myopathy. We explored the potential mechanisms and long-term outcomes in patients with blunted LA reverse remodeling after successful AF catheter ablation., Methods and Results: We included 1685 patients who underwent baseline and 1-year follow-up echocardiograms, had a baseline LA dimension ≥40 mm, and did not have a recurrence of AF within a year. The patients were divided into tertile groups according to the delta value of the change in LA dimension on the preprocedure and 1-year postprocedure echocardiography. After propensity score matching for age, sex, AF type, and LA dimension, 1272 patients were finally included in the analyses (424 in each group; the least/blunted, moderate, and the most reverse remodeling group). The patients in the T1 group (blunted LA reverse remodeling) were independently associated with higher left ventricular mass index (odds ratio [OR], 1.014 [95% CI, 1.005-1.022], P =0.001), change in ΔH
2 FPEF score (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder, filling pressure) score (OR, 1.445 [95% CI, 1.121-1.861], P =0.004), ventricular epicardial adipose tissue volume (OR, 1.010 [95% CI, 1.003-1.017], P =0.003), thinner LA wall thickness (OR, 0.461 [95% CI, 0.271-0.785], P =0.004), lower LA voltage (OR, 0.670 [95% CI, 0.499-0.899], P =0.008), and showed higher long-term AF recurrence (log-rank P <0.001) than other groups., Conclusions: Blunted LA reverse remodeling after AF catheter ablation, which is suggestive of atrial myopathy, was independently associated with a larger ventricular epicardial adipose tissue volume and worsening of H2 FPEF score. Blunted LA reverse remodeling after AF catheter ablation was also an independent predictor for higher recurrences of AF post-1-year AF catheter ablation.- Published
- 2024
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44. All-Cause Death and Major Adverse Events in Atrial Fibrillation with Frailty: Observations from the Korea National Health Insurance Service Data.
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Park JS, Yang PS, Kim D, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, and Joung B
- Abstract
Background: Atrial fibrillation (AF) is an indicator of frailty in old patients. This study aimed to investigate the effect of frailty on the use of oral anticoagulants (OAC) and clinical outcomes in a nationwide cohort of patients with new-onset AF., Methods: This study included 451,368 participants without AF from the Korea National Health Insurance Service-Health Screening cohort between 2002 and 2009. The Hospital Frailty Risk Score was retrospectively calculated for each patient using all available International Classification of Disease 10th revision diagnostic codes. According to the aggregate score, patients were divided into two groups: the participants without frailty ( < 5 points) and the participants with frailty ( ≥ 5 points). The primary outcome was death from any cause, and the secondary outcomes were cardiovascular death, ischemic stroke, major bleeding, and heart failure admission., Results: With up to 7.2 ± 1.5 years of follow-up, 11,953 participants (median age, 67 [interquartile range, 59.5-74.5] years; 7200 [60.2%] males) developed new-onset AF. Among the patients with AF, 3224 (26.9%) had frailty. Frailty was significantly associated with old age, female sex, polypharmacy, and other comorbidities. In patients with AF, frailty was negatively associated with OAC prescription after new-onset AF ( p < 0.001). Compared to patients without frailty, patients with frailty had a significantly higher incidence and risk of all-cause death (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.65-3.14), cardiovascular death (HR 2.42, 95% CI 2.10-2.80), ischemic stroke (HR 2.25, 95% CI 2.02-2.51), major bleeding (HR 2.44, 95% CI 2.17-2.73), and heart failure admission (HR 1.29, 95% CI 1.09-1.52). In subgroup analysis, when compared to the non-OAC group, the risks associated with frailty were significantly lower in the OAC group for all-cause death, cardiovascular death, ischemic stroke, and heart failure admission., Conclusions: Frailty was negatively associated with the use of OAC and was a predictor of poor prognosis owing to the association of frailty with death, thromboembolic events, bleeding, and heart failure admission. However, OAC use was associated with lower risks related to frailty for all-cause death and major adverse cardiovascular events in patients with AF., Competing Interests: BJ has provided speaking engagements for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo. Furthermore, BJ has received research funding from both Medtronic and Abbott. No personal or direct payments were received for these engagements or grants. The other authors have declared no competing relationships or activities that may have influenced the submitted work. Boyoung Joung is serving as one of the Editorial Board members of this journal. We declare that Boyoung Joung had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Juhani Airaksinen., (Copyright: © 2024 The Author(s). Published by IMR Press.)
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- 2024
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45. Recurrent ventricular fibrillation treated with scar homogenization in a patient with arrhythmogenic cardiomyopathy.
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Uhm JS, Oh SK, Park JW, Joung B, Pak HN, and Lee MH
- Abstract
Competing Interests: All of the authors declare no conflict of interest.
- Published
- 2024
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46. Association between Obesity and Heart Failure and Related Atrial Fibrillation: Patient-Level Data Comparisons of Two Cohort Studies.
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Lee YS, Yang PS, Jang E, Kim D, Yu HT, Kim TH, Uhm JS, Sung JH, Pak HN, Lee MH, and Joung B
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- Adult, Humans, Risk Factors, Obesity complications, Obesity epidemiology, Cohort Studies, Atrial Fibrillation complications, Heart Failure epidemiology, Heart Failure complications
- Abstract
Purpose: Heart failure (HF) and atrial fibrillation (AF) frequently coexist, with over 50% patients with HF having AF, while one-third of those with AF develop HF. Differences in obesity-mediated association between HF and HF-related AF among Asians and Europeans were evaluated., Materials and Methods: Using the Korean National Health Insurance Service-Health Screening (K-NHIS-HealS) cohort and the UK Biobank, we included 394801 Korean and 476883 UK adults, respectively aged 40-70 years. The incidence and risk of HF were evaluated based on body mass index (BMI)., Results: The proportion of obese individuals was significantly higher in the UK Biobank cohort than in the K-NHIS-HealS cohort (24.2% vs. 2.7%, p <0.001). The incidence of HF and HF-related AF was higher among the obese in the UK than in Korea. The risk of HF was higher among the British than in Koreans, with adjusted hazard ratios of 1.82 [95% confidence interval (CI), 1.30-2.55] in K-NHIS-HealS and 2.00 (95% CI, 1.69-2.37) in UK Biobank in obese participants ( p for interaction <0.001). A 5-unit increase in BMI was associated with a 44% greater risk of HF-related AF in the UK Biobank cohort ( p <0.001) but not in the K-NHIS-HealS cohort ( p =0.277)., Conclusion: Obesity was associated with an increased risk of HF and HF-related AF in both Korean and UK populations. The higher incidence in the UK population was likely due to the higher proportion of obese individuals., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2024.)
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- 2024
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47. Identification of concealed cardiomyopathy using next-generation sequencing-based genetic testing in Korean patients initially diagnosed with idiopathic ventricular fibrillation.
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Jeong JH, Kim YG, Oh SK, Lee HS, Choi YY, Min K, Shim J, Park YM, Kim JH, Oh YS, Kim NH, Pak HN, On YK, Park HW, Hwang GS, Kim DK, Park YA, Park HS, Cho Y, Oh S, Choi JI, and Kim YH
- Subjects
- Male, Humans, Adult, Middle Aged, Female, Ventricular Fibrillation diagnosis, Ventricular Fibrillation genetics, Genetic Testing methods, High-Throughput Nucleotide Sequencing methods, Cardiomyopathies diagnosis, Cardiomyopathies genetics, Cardiomyopathy, Hypertrophic genetics
- Abstract
Aims: Idiopathic ventricular fibrillation (IVF) is a disease in which the cause of ventricular fibrillation cannot be identified despite comprehensive clinical evaluation. This study aimed to investigate the clinical yield and implications of genetic testing for IVF., Methods and Results: This study was based on the multi-centre inherited arrhythmia syndrome registry in South Korea from 2014 to 2017. Next-generation sequencing-based genetic testing was performed that included 174 genes previously linked to cardiovascular disease. A total of 96 patients were clinically diagnosed with IVF. The mean age of the onset was 41.2 ± 12.7 years, and 79 patients were males (82.3%). Of these, 74 underwent genetic testing and four (5.4%) of the IVF probands had pathogenic or likely pathogenic variants (each having one of MYBPC3, MYH7, DSP, and TNNI3). All pathogenic or likely pathogenic variants were located in genes with definite evidence of a cardiomyopathy phenotype, either hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy., Conclusion: Next-generation sequencing-based genetic testing identified pathogenic or likely pathogenic variants in 5.4% of patients initially diagnosed with IVF, suggesting that genetic testing with definite evidence genes of cardiomyopathy may enable molecular diagnosis in a minority of patients with IVF. Further clinical evaluation and follow-up of patients with IVF with positive genotypes are needed to unveil concealed phenotypes, such as the pre-clinical phase of cardiomyopathy., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
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48. Comparison of pulmonary vein isolation using cryoballoon, high-power short-duration, and conventional radiofrequency ablation for atrial fibrillation: a propensity score-weighted study.
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Park H, Park JW, Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, and Pak HN
- Abstract
Background: The comparative efficacy, saftey, and heart rate variability (HRV) parameters after pulmonary vein isolation using cryoballoon (Cryo-PVI), high-power short-duration (HPSD-PVI), and conventional radiofrequency ablation (conventional-PVI) for atrial fibrillation (AF) is unclear., Materials and Methods: In this propensity score-weighted, retrospective analysis of a single-center cohort, we analyzed 3,395 patients (26.2% female, 74.5% paroxysmal AF) who underwent AF catheter ablation without an empirical left atrial ablation. Procedural factors, recurrence rates, complication rates, and the post-procedural HRV parameters were compared across the Cryo-PVI ( n = 625), HPSD-PVI ( n = 748), and conventional-PVI ( n = 2,022) groups., Results: Despite the shortest procedural time in the Cryo-PVI group (74 min for Cryo-PVI vs. 104 min for HPSD-PVI vs. 153 min for conventional-PVI, p < 0.001), the major complication ( p = 0.906) and clinical recurrence rates were similar across the three ablation groups (weighted log-rank, p = 0.824). However, the Cryo-PVI group was associated with a significantly lower risk of recurrent AF in patients with paroxysmal AF [weighted hazard ratio (WHR) 0.57, 95% confidence interval (CI) 0.37-0.86], whereas it was associated with a higher risk of recurrent AF in patients with persistent AF (WHR 1.41, 95% CI 1.06-1.89, p for interaction of <0.001) compared with the conventional-PVI group. In the subgroup analysis for the HRV, the Cryo-PVI group had the highest low-frequency-to-high-frequency ratio at 1-year post-procedure, whereas the HPSD-PVI group had the lowest low-frequency-to-high-frequency ratio at 1-year post-procedure ( p < 0.001)., Conclusions: The Cryo-PVI group had better rhythm outcomes in patients with paroxysmal AF but worse rhythm outcomes in patients with persistent AF and a higher long-term post-procedural sympathetic nervous activity and sympatho-vagal balance compared with the conventional-PVI group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Park, Park, Kim, Yu, Kim, Uhm, Joung, Lee, Hwang and Pak.)
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- 2023
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49. Revisiting symptomatic pulmonary vein stenosis after high-power short-duration radiofrequency ablation in patients with atrial fibrillation.
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Kim J, Kim D, Yu HT, Kim TH, Joung B, Lee MH, and Pak HN
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- Humans, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Stenosis, Pulmonary Vein diagnostic imaging, Stenosis, Pulmonary Vein etiology, Stenosis, Pulmonary Vein surgery, Radiofrequency Ablation adverse effects, Catheter Ablation adverse effects, Pulmonary Veins surgery
- Abstract
Competing Interests: Conflict of interest: B.J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi Sankyo and received research funds from Medtronic and Abbott. No fees have been received directly or personally. All remaining authors have declared no conflicts of interest.
- Published
- 2023
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50. The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology.
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Ahn HJ, Cha MJ, Lee E, Lee SR, Choi EK, Han S, Nam GB, Choi JI, Pak HN, Oh IY, Shin DG, On YK, Park SW, Kim YH, and Oh S
- Subjects
- Humans, Adult, Middle Aged, Prospective Studies, Heart Atria surgery, Recurrence, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
Background: Young atrial fibrillation (AF) patients have been underrepresented in studies of radiofrequency catheter ablation (RFCA) and the outcome of RFCA has not been widely addressed. We investigated age-related differences in clinical features, the recurrence of atrial tachyarrhythmia, and its predictors of patients who underwent RFCA for AF., Methods: This is a multicenter prospective study of 2799 patients who underwent RFCA for AF in 2017-2020. The patients were divided into two groups - group A (age < 60 years, n = 1269) and group B (age ≥ 60 years, n = 1530) - and a recurrence of any atrial tachyarrhythmia 1 year after RFCA following a 90-day blanking period was compared., Results: The mean age was 51.6 ± 6.7 and 66.8 ± 5.2 years for groups A and B, respectively. Higher body mass index, smaller left atrium, and more prevalent cardiomyopathy and obstructive sleep apnea were observed in group A. Overall, 1-year atrial tachyarrhythmia-free survival was 85.6% and lower in young patients (83.1% in group A vs. 87.7% in group B, log-rank p < 0.01): adjusted hazard ratio (aHR) of recurrence (95% confidence interval (CI)), 1.45 (1.13-1.86) for group A compared to group B (p < 0.01). The association between younger age and higher recurrence was continuously observed in patients under 60 years. Any non-PV ablation was associated with a lower recurrence of atrial tachyarrhythmia in group B (aHR 0.68 (0.47-0.96), p < 0.05), but not in group A., Conclusions: AF patients younger than 60 years had a higher 1-year AF recurrence after RFCA. Young AF patients might have distinctive pathophysiology of AF requiring more integrated management., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
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