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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, Kim YH. Identification of concealed cardiomyopathy using next-generation sequencing-based genetic testing in Korean patients initially diagnosed with idiopathic ventricular fibrillation. Europace 2023; 25:euad313. [PMID: 37949661 PMCID: PMC10639093 DOI: 10.1093/europace/euad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
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.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Incheon Sejong General Hospital, Incheon, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yae Min Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong-Seog Oh
- Department of Internal Medicine, Seoul St.Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Keun On
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Dae-Kyeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Ah Park
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Shimizu W, Kusumoto FM, Agbayani MJF, Apiyasawat S, Chen M, Ching CK, Choi JI, Dan Do VB, Hanafy DA, Hurwitz JL, Johar S, Kalman JM, Khan AHH, Khmao P, Krahn AD, Ngarmukos T, Binh Nguyen ST, Nwe N, Oh S, Soejima K, Stiles MK, Tsao HM, Tseveendee S. Statement from the Asia Summit: Current state of arrhythmia care in Asia. Heart Rhythm O2 2023; 4:741-755. [PMID: 38034890 PMCID: PMC10685152 DOI: 10.1016/j.hroo.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 12/02/2023] Open
Abstract
On May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit-22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life-threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region due to differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present.
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Affiliation(s)
| | - Fred M. Kusumoto
- Mayo Clinic Jacksonville, EP and Pacing Services, Jacksonville, Florida
| | | | | | | | | | - Jong-Il Choi
- Korea University Medical Center, Seoul, Republic of Korea
| | - Van Buu Dan Do
- Tam Duc Cardiology Hospital Joint Stock Company, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | | - Andrew D. Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Nwe Nwe
- Yangon General Hospital, Yangon, Myanmar
| | - Seil Oh
- Seoul National University Hospital, Seoul, Republic of Korea
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Jeong JH, Oh SK, Kim YG, Choi YY, Lee HS, 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, Kim YH. Clinical and Genetic Features of Korean Inherited Arrhythmia Probands. Korean Circ J 2023; 53:693-707. [PMID: 37653714 PMCID: PMC10625850 DOI: 10.4070/kcj.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Inherited arrhythmia (IA) is a more common cause of sudden cardiac death in Asian population, but little is known about the genetic background of Asian IA probands. We aimed to investigate the clinical characteristics and analyze the genetic underpinnings of IA in a Korean cohort. METHODS This study was conducted in a multicenter cohort of the Korean IA Registry from 2014 to 2017. Genetic testing was performed using a next-generation sequencing panel including 174 causative genes of cardiovascular disease. RESULTS Among the 265 IA probands, idiopathic ventricular fibrillation (IVF) and Brugada Syndrome (BrS) was the most prevalent diseases (96 and 95 cases respectively), followed by long QT syndrome (LQTS, n=54). Two-hundred-sixteen probands underwent genetic testing, and 69 probands (31.9%) were detected with genetic variant, with yield of pathogenic or likely pathogenic variant as 6.4%. Left ventricular ejection fraction was significantly lower in genotype positive probands (54.7±11.3 vs. 59.3±9.2%, p=0.005). IVF probands showed highest yield of positive genotype (54.0%), followed by LQTS (23.8%), and BrS (19.5%). CONCLUSIONS There were significant differences in clinical characteristics and genetic yields among BrS, LQTS, and IVF. Genetic testing did not provide better yield for BrS and LQTS. On the other hand, in IVF, genetic testing using multiple gene panel might enable the molecular diagnosis of concealed genotype, which may alter future clinical diagnosis and management strategies.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Yun Young Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Yae Min Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong-Seog Oh
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Keun On
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Dae-Kyeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Ah Park
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
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Choi Y, Lee KY, Kim SH, Kim KA, Hwang BH, Choo EH, Lim S, Kim CJ, Kim JJ, Byeon J, Oh GC, Jeon DS, Yoo KD, Park HW, Kim MC, Ahn Y, Ho Jeong M, Hwang Y, Chang K. Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction. Front Med (Lausanne) 2023; 10:1165400. [PMID: 37396907 PMCID: PMC10310993 DOI: 10.3389/fmed.2023.1165400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The use of a cardioverter defibrillator for the primary prevention of sudden cardiac death is not recommended within 40 days after acute myocardial infarction (AMI). We investigated the predictors for early cardiac death among patients who were admitted for AMI and successfully discharged. Methods Consecutive patients with AMI were enrolled in a multicenter prospective registry. Among 10,719 patients with AMI, 554 patients with in-hospital death and 62 patients with early non-cardiac death were excluded. Early cardiac death was defined as a cardiac death within 90 days after index AMI. Results Early cardiac death after discharge occurred in 168/10,103 (1.7%) patients. A defibrillator was not implanted in all patients with early cardiac death. Killip class ≥3, chronic kidney disease stage ≥4, severe anemia, cardiopulmonary support usage, no dual antiplatelet therapy at discharge, and left ventricular ejection fraction (LVEF) ≤35% were independent predictors for early cardiac death. The incidence of early cardiac death according to the number of factors added to LVEF criteria in each patient was 3.03% for 0 factor, 8.11% for 1 factor, and 9.16% for ≥2 factors. Each model that sequentially added the factors in the presence of LVEF criteria showed a significant gradual increase in predictive accuracy and an improvement in reclassification capability. A model with all factors showed C-index 0.742 [95% CI 0.702-0.781], p < 0.001; IDI 0.024 [95% CI 0.015-0.033], p < 0.001; and NRI 0.644 [95% CI 0.492-0.795], p < 0.001. Conclusion We identified six predictors for early cardiac death after discharge from AMI. These predictors would help to discriminate high-risk patients over current LVEF criteria and to provide an individualized therapeutic approach in the subacute stage of AMI.
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Affiliation(s)
- Young Choi
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung An Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Chan Jun Kim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Jin-Jin Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeho Byeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Gyu Chul Oh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Ki Dong Yoo
- Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Ha-Wook Park
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngdeok Hwang
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York, New York, NY, United States
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Hypertension and diabetes including their earlier stage are associated with increased risk of sudden cardiac arrest. Sci Rep 2022; 12:12307. [PMID: 35854061 PMCID: PMC9296606 DOI: 10.1038/s41598-022-16543-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Sudden cardiac arrest (SCA) is a medical disaster for both the victim and the society. Despite intrinsic limitations in the management of SCA, primary prevention has been overlooked and risk factors for SCA are not fully understood. We aimed to evaluate whether hypertension and diabetes mellitus (DM), including pre-hypertension and impaired fasting glucose (IFG), are associated with increased risk of SCA. We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 were enrolled. The risk of SCA was evaluated in people with hypertension and DM with a clinical follow-up through December 2018. A total of 4,056,423 people with 33,345,378 person-years of follow-up and 16,352 SCA events were examined. People with hypertension had 65.4% increased risk of SCA (adjusted hazard ratio [HR] = 1.654 [1.572–1.739]; p < 0.001). Pre-hypertension was also associated with 21.3% increased risk of SCA (adjusted HR = 1.213 [1.158–1.272]; p < 0.001). People who had IFG and DM showed 7.5% (adjusted HR = 1.075 [1.035–1.117]; p < 0.001) and 80.1% (adjusted HR = 1.801 [1.731–1.875]; p < 0.001) increased risk of SCA, respectively. People with DM who took anti-diabetic medication showed significantly lower risk of SCA compared with uncontrolled DM patients (fasting glucose ≥ 200 mg/dL) (adjusted HR = 0.625 [0.533–0.733]; p < 0.001). Coexistence of hypertension and DM was associated with an even higher risk of SCA (adjusted HR = 3.078 [2.877–3.293]; p < 0.001). In conclusion, the risk of SCA is significantly higher in people with hypertension and DM, including pre-hypertension and IFG. Adequate control of blood pressure and serum glucose can have a profound impact for the primary prevention of SCA in the general population.
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Roh SY, Choi JI, Park SH, Kim YG, Shim J, Kim JS, Han KD, Kim YH. The 10-Year Trend of Out-of-hospital Cardiac Arrests: a Korean Nationwide Population-Based Study. Korean Circ J 2021; 51:866-874. [PMID: 34595855 PMCID: PMC8484994 DOI: 10.4070/kcj.2021.0127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 01/31/2023] Open
Abstract
We aimed to evaluate the epidemiologic features and outcomes of non-traumatic out-of-hospital cardiac arrest (OHCA) on the basis of nationwide population-based data from Korean National Health Insurance System. This study showed the incidence of OHCA in Korea had increased during the last decade (48.2 per 100,000 person-years in 2008 to 66.7 in 2017). Coronary artery disease was the main cause (59.8%). The 1-year mortality rate tended to decline steadily. Despite the advances in medical care system, the incidence of OHCA has increased and mortality rate was still high. Background and Objectives It is crucial to understand the exact public health burden of out-of-hospital cardiac arrest (OHCA) cases; this is presently unknown since sufficient episodes are not reported in registry studies. We aimed to evaluate the epidemiologic features and outcomes of non-traumatic OHCA. Methods During January 2008 to December 2017, we enrolled 387,665 patients who had been assigned a code for sudden cardiac arrest or had undergone cardiopulmonary resuscitation in the emergency room using the Korean National Health Insurance Service database. Those whose arrest was of non-cardiac origin were excluded. Results The incidence of OHCA per 100,000 patients increased steadily from 48.2 in 2008 to, 53.8 in 2011, 60.1 in 2014, and 66.7 in 2017, with a 1-year survival rate of 8.2%. Age and sex-adjusted mortality rates showed a decreasing trend. The hazard ratio was 1.0015 in 2009, 0.9865 in 2012, 0.9769 in 2015, and 0.9629 in 2017 (p for trend <0.0001), with coronary artery disease-related OHCA accounting for 59.8% of the total. Subgroups with coronary artery disease-related OHCA were more likely to be older and have a higher prevalence of all related comorbidities, excluding malignancy, than those with non-coronary artery disease-related OHCA. Conclusions This nationwide population-based study showed that the incidence of OHCA in Korea had increased during the last decade. The post OHCA 1-year mortality rate showed a poor outcome but improved gradually.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
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Kim YG, Oh SK, Choi HY, Choi JI. Inherited arrhythmia syndrome predisposing to sudden cardiac death. Korean J Intern Med 2021; 36:527-538. [PMID: 33092314 PMCID: PMC8137412 DOI: 10.3904/kjim.2020.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Inherited arrhythmia (IA) is one of the main causes of sudden cardiac death (SCD) in young people, and is reported to be a more prevalent cause of SCD in Asia than in Western countries. IAs are a group of genetic disorders caused by mutations in genes encoding cardiac ion channels, leading to electrophysiological characteristics that often occur in the absence of structural abnormalities. Channelopathies, such as long QT syndrome and Brugada syndrome, carry a potential risk of life-threatening ventricular tachyarrhythmias that predispose to SCD, although early prediction and prevention of the risk remain challenging. Recent advances in genetic testing have facilitated risk stratification as well as a precise diagnosis for IA, despite ongoing debates about the implications. Herein, we provide epidemiological data, a pathophysiological overview, and the current clinical approach to IAs related to SCD. In addition, we review the general issues arising from genetic testing for IAs.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ha Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Cho Y, Cho SY, Oh IY, Lee JH, Park JJ, Lee HY, Kim KH, Yoo BS, Kang SM, Baek SH, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Choi DJ. Implantable Cardioverter-defibrillator Utilization and Its Outcomes in Korea: Data from Korean Acute Heart Failure Registry. J Korean Med Sci 2020; 35:e397. [PMID: 33258331 PMCID: PMC7707927 DOI: 10.3346/jkms.2020.35.e397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are sparse data on the utilization rate of implantable cardioverter-defibrillator (ICD) and its beneficial effects in Korean patients with heart failure with reduced left ventricular ejection fraction (LVEF). METHODS Among 5,625 acute heart failure (AHF) patients from 10 tertiary university hospitals across Korea, 485 patients with reassessed LVEF ≤ 35% at least 3 months after the index admission were enrolled in this study. The ICD implantation during the follow-up was evaluated. Mortality was compared between patients with ICDs and age-, sex-, and follow-up duration matched control patients. RESULTS Among 485 patients potentially indicated for an ICD for primary prevention, only 56 patients (11.5%) underwent ICD implantation during the follow-up. Patients with ICD showed a significantly lower all-cause mortality compared with their matched control population: adjusted hazard ratio (HR) (95% confidence interval [CI]) = 0.39 (0.16-0.92), P = 0.032. The mortality rate was still lower in the ICD group after excluding patients with cardiac resynchronization therapy (adjusted HR [95% CI] = 0.09 [0.01-0.63], P = 0.015). According to the subgroup analysis for ischemic heart failure, there was a significantly lower all-cause mortality in the ICD group than in the no-ICD group (HR [95% CI] = 0.20 [0.06-0.72], P = 0.013), with a borderline statistical significance (interaction P = 0.069). CONCLUSION Follow-up data of this large, multicenter registry suggests a significant under-utilization of ICD in Korean heart failure patients with reduced LVEF. Survival analysis implies that previously proven survival benefit of ICD in clinical trials could be extrapolated to Korean patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01389843.
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Affiliation(s)
- Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Yeong Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kye Hun Kim
- Department of Internal Medicine, Heart Research Center, Chonnam National University, Gwangju, Korea
| | - Byung Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hong Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Seok Jeon
- Department of Internal Medicine, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Jae Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Hee Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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9
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Roh SY, Choi JI, Kim MS, Cho EY, Kim YG, Lee KN, Shim J, Kim JS, Kim YH. Incidence and etiology of sudden cardiac arrest in Koreans: A cohort from the national health insurance service database. PLoS One 2020; 15:e0242799. [PMID: 33237971 PMCID: PMC7688167 DOI: 10.1371/journal.pone.0242799] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
The incidence of sudden cardiac arrest (SCA) in Asians is lower than that seen in Western populations, but there are few available data on the incidence and associated cardiac etiology of SCA in Asians. From 2002 to 2013, patients with SCA were analyzed using a cohort from the South Korean National Health Insurance Service (NHIS) coded database. Sudden unexplained death syndrome (SUDS) was defined as cryptogenic arrest, excluding that of non-cardiac origin, coronary artery disease (CAD), cardiomyopathy (CM), and valvular heart disease. During the 12-year study period, 5,973 patients (0.53%) from the total cohort of 1,125,691 had a cardiac arrest code. The overall incidence of arrest was 48.7 per 100,000 person-years (95% CI 16.6-18.0). The incidence of primary SCA excluding those of non-cardiac origin was 16.1 per 100,000 person-years (95% CI 15.4-16.8). It was higher in males than in females (18.1 vs. 14.1 per 100,000 person-years). CAD was the most common cause of SCA (59.4%), and followed by CM (13.9%). SUDS accounted for 14.7% of SCA events. The risk of SCA had increased gradually from over 25 years old. Heart failure, atrial fibrillation and hypertension are major factors associated with SCA incidence. Our findings outline epidemiologic data for SCA and the proportion of associated cardiac etiology leads SCA in a large population.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
- * E-mail:
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Cho
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Jin Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
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10
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Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124257. [PMID: 32549238 PMCID: PMC7345790 DOI: 10.3390/ijerph17124257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 12/02/2022]
Abstract
Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives have rarely been explored. Thus, this study aimed to provide an initial investigation of ICD recipients’ perceived susceptibility and barriers/benefits regarding ACP and/or advance directives (ADs), and associations of these modifiable factors with preferences for end-of-life life-sustaining treatments (LSTs) (cardiopulmonary resuscitation (CPR), ventilator support, hemodialysis, and hospice care). Using a descriptive correlational design, 48 ICD recipients (age, 50.1 years; male, 85.4%) completed survey questionnaires. “No burden on family” was the most highly valued (59.1%), followed by “comfortable death” (20.4%), and both (11.4%). LST preference was 43.8% for ventilator support, 45.8% for both hemodialysis and hospice care, and 54.2% for CPR. Perceived susceptibility to having unexpected end-of-life experiences increased the likelihood of preference for aggressive LSTs, with preferences increasing by 15% for CPR, 17% for ventilator support, and 23% for hemodialysis. A non-modifiable factor, older age, was the only predictor of increased preference for hospice care (odds ratio = 1.09, p = 0.016). Among the modifiable factors, a higher perceived susceptibility increased the likelihood of aggressive LST preferences. The findings imply that to facilitate informed decisions for LSTs, early ACP discussion could be helpful and enhance these modifiable factors.
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11
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Kim J, Choi J, Shin MS, Park JK, An M, Kim SH, Choi N, Lee MO, Heo S. Effect of physical and psychocognitive function and perceived health status on 12-month adverse cardiac events among implantable cardioverter-defibrillator recipients. Heart Lung 2020; 49:530-536. [PMID: 32434703 DOI: 10.1016/j.hrtlng.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-implant recovery in patients with implantable cardioverter-defibrillators (ICDs) is often compromised because of reduced physical and psycho-cognitive function and poor health perception, leading to short event-free survival. OBJECTIVES To examine the effects of psychocognitive function, health perception, and ICD-related factors on 12-month cardiac events among ICD patients. METHODS Using a prospective study design, ICD patients underwent baseline assessment and were followed for 12 months to assess cardiac events. RESULTS Cardiac events occurred in 14 patients (18.9%) (N = 74: age, 58 years; primary ICDs, 45.9%). Time after ICD implant (odds ratio [OR] = 1.002; p = .028) and executive function (OR = 1.021; p = .027) were significant predictors of 12-month cardiac events, while other physical and psychological indices were not. CONCLUSIONS Reduced executive function and longer time after implant predicted the events. Healthcare professionals need to assess executive function and provide treatment and support to improve executive function.
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Affiliation(s)
- JinShil Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, College of Medicine, Incheon, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Minjeong An
- Chonnam National University, College of Nursing, Gwangju, South Korea
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, Seoul, South Korea.
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Mee Ok Lee
- Gachon University Gil Medical Center, Incheon, South Korea
| | - Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, Atlanta, USA
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12
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Kim SS, Park HW, Jeong HK, Lee KH, Yoon NS, Cho JG. Defibrillation threshold testing during implantable cardioverter defibrillator implantation: 5-year follow-up. J Interv Card Electrophysiol 2020; 60:485-491. [PMID: 32399866 DOI: 10.1007/s10840-020-00733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Defibrillation threshold (DFT) testing is a routine practice in some Asian countries for patients receiving an implantable cardioverter defibrillator (ICD). However, there are few long-term data about the necessity of intraoperative DFT testing in an Asian population. We investigated the safety of DFT testing and the long-term clinical outcomes in Asian patients undergoing ICD implantation. METHODS All patients undergoing de novo transvenous ICD implantation were randomized to undergo periprocedural DFT testing. The study included 67 patients (50 males; 51.5 ± 16.9 years) who underwent ICD implantation with (n = 33) or without (n = 34) intraoperative DFT testing between March 2012 and February 2014. We compared first-shock success, composite safety end points (the sum of complications recorded at 30 days), arrhythmic death, and all-cause mortality. RESULTS The baseline clinical characteristics and the procedural-related adverse event rate (3.0% with DFT vs. 0% with non-DFT, p = 0.214) did not differ between groups. The programmed output of the first shock was lower in the DFT testing group (22.9 ± 4.4 J vs. 25.3 ± 5.4 J, p = 0.007). However, there were no significant differences between groups for all-cause mortality (12.1% vs. 17.6%, p = 0.526) or first-shock success rate for ventricular arrhythmia (100% vs. 88.2%, p = 0.471). CONCLUSIONS There were no between-group differences in periprocedural safety, complications, and long-term clinical outcomes. Our results suggest that DFT testing in Asian patients allows reduction of the programmed output of the first shock, but does not affect long-term clinical outcomes.
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Affiliation(s)
- Sung Soo Kim
- Cardiovascular Division, Chosun University Hospital, 365, Pilmun daero, Dong-gu, Gwangju, South Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.
| | - Hyung Ki Jeong
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
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