Abstract Background Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality, posing a considerable burden on healthcare systems. In Republic of Korea, the prevalence and incidence of AF have increased in recent years. There have also been significant changes in the trends of antiarrhythmic drug (AAD) use and procedural treatments for AF. Objectives This study aims to review the trends in AF treatment strategies in Republic of Korea, particularly focusing on the utilization of antiarrhythmic drugs and catheter ablation. Methods The Korean National Health Insurance Service (K-NHIS) data were used to identify AF patients from 2013 to 2022. AAD usage and catheter ablation procedures were analyzed annually. AADs were classified into Class IC and III drugs. Trends in beta-blockers, calcium channel blockers, and digoxin prescriptions were also examined. The primary endpoint was the trend of AAD use and AF catheter ablation (AFCA) over 10 years. Results In 2022, 940,063 patients had a prior diagnosis of AF. From 2013 to 2022, the use of AADs increased from 12.1 to 16.4% among prevalent AF patients. Beta-blockers were the most commonly prescribed rate control medication, while the use of calcium channel blockers and digoxin declined. The frequency of AFCA procedures also increased, from 0.5% of prevalent AF patients in 2013 to 0.7% in 2022. Younger patients, males, and those with lower CHA 2 DS 2 -VASc scores were more likely to receive AFCA. Regional variations in treatment patterns were observed, with Seoul exhibiting higher rates of procedural treatments and AAD prescriptions. Conclusions Over the past decade, there has been a significant increase in the use of AADs and AFCA procedures in Republic of Korea. These trends reflect recent advancements in AF management advocating a refined rhythm control strategy.
Abstract Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. However, applying HBP to daily clinical practices is still challenging without easy access to the average HBP. Therefore, we developed a simple method to make a binary decision for the control of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings ( K = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5, 10, 15, 20). A high BP was defined as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was defined as a mean HBP ≥ 135/85 mmHg. Validation for the decision method was conducted using actual HBP data. The C-statistics and the accuracy of the high BP counts for the uncontrolled HBP were generally high (> 0.85) for all combinations of K s and SDs but decreased as SDs increased but remained steady as K s increased. In the validation, the C-statistic of the high BP count-to-total BP reading (C-T) ratio was 0.985, and a C-T ratio ≥ 0.5 showed a sensitivity of 0.957, a specificity of 0.907 and an accuracy of 0.927. The count-based decision method can provide an accurate quick assessment of the controlledness of HBP.
In patients with atrial fibrillation (AF), females taking vitamin K antagonist are at higher risk of stroke or systemic embolism (SSE), bleeding and all-cause death than males. This study investigated the relationship between sex and adverse clinical events in a contemporary AF patient cohort taking anticoagulation.This prospective multicenter AF registry study comprised 6,067 patients with AF (mean age, 70±9 years; men, 59%) with intermediate to high risk of stroke (CHA2DS2-VAscore ≥1) and receiving oral anticoagulation therapy. Adverse clinical outcomes, including SSE, bleeding, death were evaluated in patients stratified by sex and anticoagulation patterns.Women were older and used more direct oral anticoagulants (85% vs. 78%, p<0.001) than men. During a median (25th and 75th percentiles) follow-up of 30 (24, 38) months, the incidence rate and risk of SSE (0.7 in women vs. 0.7 in men per 100 person-years) and major bleeding (0.1 in women vs. 0.1 in men per 100 person-years) were not different between the sexes. However, women had a lower all-cause death rate (0.4 in women vs. 0.6 in men per 100 person-years, hazard ratio: 0.48, 95% confidence interval: 0.25-0.91, p=0.025) than men.In contemporary anticoagulation for AF, SSE and major bleeding risks did not differ between sexes. However, women showed a lower risk of all-cause death rate than men, indicating that the use of oral anticoagulants for treating AF in females does not appear to be a risk factor for adverse clinical events.ClinicalTrials.gov Identifier: NCT02786095.
SUPPLEMENTARY MATERIALRhythm control and cardiovascular or cerebrovascular outcomes in patients with atrial fibrillation: A study of the CODE-AF registry Ho Gi Chung, MD; Junbeom Park; Jin-Kyu Park; Ki-Woon Kang; Jaemin Shim; Jin-Bae Kim; Jun Kim; Eue-Keun Choi; Hyung Wook Park; Young Soo Lee; Boyoung Joung Supplementary Table 1. Subgroup analysis of primary outcome in rate- and rhythm-control group before overlap weighting. Supplementary Figure 1. Cumulative incidence of primary outcome in rhythm and rate control treatment groups before overlap weighting. Supplementary Figure 2. Cumulative incidence of secondary outcomes in rhythm and rate control treatment groups before overlap weighting.
Introduction: The cause of sudden cardiac arrest (SCA) in a considerable number of patients remains unknown. The present study was performed for elucidating the associations between the morphology of the papillary muscles and SCA. Hypothesis: The morphology of the papillary muscles should be associated with SCA. Methods: We retrospectively included 190 patients with SCA. History, laboratory data, ECG, echocardiography, coronary angiography, and cardiac CT/MRI were analyzed for elucidation of causes of SCA. We compared incidence of the accessory papillary muscles between the patients with SCA of unknown cause (including idiopathic ventricular fibrillation) and the patients with SCA of known causes. We also compared incidence of the accessory papillary muscles between the patients with SCA of unknown cause and age- and sex-matched 2-fold patients without SCA. The accessory papillary muscles were defined as the papillary muscles with origins separated from the anterolateral and posteromedial papillary muscle...
Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first.Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR).We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR.The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure.Follow-up chest Radiography showed complete resolution of the UPE.This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Abstract Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. However, applying HBP to daily clinical practices is still challenging without easy access to the average HBP. Therefore, we developed a simple method to make a quick decision regarding the controlledness of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings ( K = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5, 10, 15, 20). A high BP was defined as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was defined as a mean HBP ≥ 135/85 mmHg. Validation for the decision method was conducted using actual HBP data. The C-statistics and the accuracy of the high BP counts for the uncontrolled HBP were generally high (> 0.85) for all combinations of K s and SDs and decreased as SDs increased but remained steady as K s increased. In validation, the C-statistic of the high BP count-to-total BP reading (C/T) ratio was 0.985, and the C/T ratio ≥ 0.5 showed a sensitivity of 0.957, a specificity of 0.907, and an accuracy of 0.927. The count-based decision method can provide an accurate quick assessment of the controlledness of HBP.
Bee venom-loaded poly(lactic-co-glycolic acid) (PLGA) particles were prepared by double emulsion-solvent evaporation, and characterized for a sustained-release system. Factors such as the type of organic solvent, the amount of bee venom and PLGA, the type of PLGA, the type of polyvinyl alcohol, and the emulsification method were considered. Physicochemical properties, including the encapsulation efficiency, drug loading, particle size, zeta-potential and surface morphology were examined by Fourier transform infrared (FT-IR) spectroscopy, differential scanning calorimetry (DSC), and X-ray diffraction (XRD). The size of the bee venom-loaded PLGA particles was 500 nm (measured using sonication). Zeta-potentials of the bee venom-loaded PLGA particles were negative owing to the PLGA. FT-IR results demonstrated that the bee venom was completely encapsulated in the PLGA particles, indicated by the disappearance of the amine and amide peaks. In addition, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis indicated that the bee venom in the bee venom-loaded PLGA particles was intact. In vitro release of the bee venom from the bee venom-loaded PLGA particles showed a sustained-release profile over 1 month. Bee venom-loaded PLGA particles can help improve patients' quality of life by reducing the number of injections required.
BACKGROUND This study sought to evaluate whether a poor increase in inferior P-wave amplitude during sympathetic stimulation might be a helpful diagnostic tool for sick sinus syndrome (SSS). METHODS AND RESULTS Three-dimensional electroanatomic mapping of the right atrium, inferior P-wave amplitude and conventional corrected sinus node recovery time (CSNRT) were compared in 112 consecutive atrial fibrillation (AF) patients with (n=21) and without SSS (n=91). The significant cranial shift of earliest activation site (EAS) (the distance from the superior vena cava to the EAS: 11.1 vs. 5.9 mm, P 550 ms showed a sensitivity of 50% and specificity of 84% for diagnosing SSS, poor increases of P-waves amplitude in lead aVF ( 550 ms and poor increase of P-waves amplitude in lead aVF showed more improved diagnostic accuracy (sensitivity 89%, specificity 75%). CONCLUSIONS A combined algorithm using inferior P-wave amplitude showed improved performance for the diagnosis of SSS compared with CSNRT >550 ms alone.
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