• Journal of Chest Surgery
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• v.24 no.11
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• pp.1081-1089
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• 1991

Atrial fibrillation is characterized by beat to beat irregularity of shape, size, conduction time and polarity. The mechanism of atrial fibrillation can be explained by so called "Multiple wavelet theory". The adverse effect of atrial fibrillation is the decrease of cardiac output by absence of atrial kick[10 ~ 15%] and the possibility of thrombosis in the left atrium which is dangerous to develop the thromboembolism is increased. The present study was designed to assess the effect of overdrive pacing on the suppression of recurring of atrial fibrillation after open heart surgery and the results were summarized as follows: 1. There were no significant differences of factors between converting patients and non-converting patients to normal sinus rhythm by electric cardioversion after open heart surgery. 2. Among converting patients to normal sinus rhythm, there were no significant differences of factors between study group and control group. 3. Cardiothoracic Ratio on the preoperative chest film was significantly larger in the patients of recurring atrial fibrillation within 72hrs than in the patients of maintaining normal sinus rhythm. [61.7$\pm$ 1.4% vs 67.7$\pm$2.4%, p=0.03] 4. There was a significant difference of suppressive effects between overdrive pacing group and control group among recurred cases until 24, 48, and 72hours [Fisher`s exact test ; p=0.037, p=0.076, p=0.53, respectively] 5. There was a difference of the delay of recurring of atrial fibrillation between study group and control group among recurred cases within 72 hours.[53.4$\pm$6.9hr vs. 19.3$\pm$3.8 hr, p<0.01] We think that the overdrive pacing may suppress the natural pacemaker and the converted normal sinus rhythm is maintained longer than control group during critical immediate postoperative period.ve period.

• Korean Journal of Adult Nursing
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• v.21 no.1
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• pp.86-94
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• 2009

Purpose: The purpose of this study was to determine correlates of depression and perceived health status in patients with atrial fibrillation. Methods: The study utilized a descriptive correlational survey design. A convenience sample of 115 subjects were recruited from 3 tertiary medical centers. The data were analyzed by descriptive statistics, hierarchical multiple regression. Results: 1) Study subjects perceived the low frequency of symptoms, relatively high social support, low depression, moderately low physical health, and mental health. 2) The 38% of variance in depression was significantly explained by symptom(${\beta}$ = .49), social support(${\beta}$ = -.21), and education(${\beta}$ = -.17). 3) The 40% of variance in physical health was significantly explained by symptom(${\beta}$ = -.55), social support(${\beta}$ = .16), and education(${\beta}$ = .20). 4) the 12% of variance in mental health was significantly explained by symptom(${\beta}$ = -.26), and social support(${\beta}$ = .24). Conclusion: Most health care providers assume atrial fibrillation patients have very few symptoms. However, symptom related to atrial fibrillation was found to be the most important factors in explaining depression and perceived health status. Additionally, higher social support had great influences on the lower depression and higher perceived health status. Based on the findings of this study, directions for nursing practice and further nursing research for patients with atrial fibrillation are suggested.

• Proceedings of the KIEE Conference
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• 2005.10b
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• pp.29-31
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• 2005

Detection methods for atrial tachycardia and fibrillation on the time axis have the advantages of light operational load and are easy to apply to various applications. Despite these advantages, arrhythmia detection algorithm on the time axis cannot stand much noise such as motion artifacts, moreover the peak detection algorithm has high complexity. In this paper, we use a spectrum analysis method for the detection of atrial tachycardia and fibrillation. By applying spectrum analysis and digital filtering on obtained electrogram signals, we can diagnose heart arrhythmia without using peak detection algorithm.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.679-691
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• 1985

Ninety patients underwent mitral valvular heart surgery associated with or without aortic valve surgery and subjected to a clinical study in relation to their control of postoperative atrial fibrillation. There were 26 males and 64 females ranged in age from 16 to 56 years with a mean of 35.2 years. Systemic arterial embolizations were observed in 11 patients [12.2%]. Four patients of them were in normal sinus rhythm and 7 in atrial fibrillation. Out of these, left atrial thrombi were found only in 2 at the operation. Intraoperatively confirmed left atrial thrombi were in 16 patients [17.7%] of all 90 patients: Eleven patients occurred at the age of more than 40 years, 14 were in atrial fibrillation and 2 only had previous episodes of systemic arterial embolization. Sixty three patients underwent isolated mitral valve surgery [OMC 28, MVR 35] and 27 patients associated with aortic valve surgery along with mitral valve [OMC+AVR 13, MVR+AVR 14]. Preoperatively, 44 patients [48.9%] were in normal sinus rhythm. Of them, 35 patients [79.5%] revealed normal sinus rhythm thoroughly after operation without any aid of digitalis or quinidine and 5 patients [11.4%] restored normal sinus rhythm with digitalization alone. Other 3 patients converted to normal sinus rhythm with the addition of quinidine, however, in 1 patient who was resistant to quinidine therapy, electrocardioversion was carried out on the postoperative third week showing normal sinus rhythm. Thus, the most atrial fibrillations that occurred for the first time in the postoperative period, were able to reverted to normal sinus rhythm responding well to antiarrhythmic therapy. Preoperatively, 46 patients [51.1%] were in atrial fibrillation. Of them, only 5 patients returned to sinus rhythm after operation without any aid of digitalis or quinidine and other 5 restored normal sinus rhythm with digitalization: namely 2 restored within early postoperative period and 3 after more than 3 months. Eight patients well responded to quinidine therapy showing normal Sinus rhythm. So far, 25 patients have remained in persistent atrial fibrillation on 6 to 36 months follow-up. In view of these, 17 patients [68%] were over 40 years of age, 22[80%] had long duration of symptom over 5 years and 10[40%] have had atrial thrombi before operation. Left atrial dimension were still more than 40mm in 21 patients on follow up M-mode echocardiogram. One month after operation, 87 hospital survivors were improved by at least one functional NYHA class. There were 3 operative deaths [3.3%, bleeding 1, LCOS 2] and 4 late deaths [LCOS 1, valve thrombosis 1, late bleeding 1, fulminant hepatitis 1] during follow-up period. According to our limited experience, we may conclude that better results will be expected with the addition of quinidine therapy judiciously in the cases of postoperative persistent atrial fibrillation who were aged or had longer history of symptom and left atrial thrombi.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.249-254
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• 1993

Atrial fibrillation is commonly associated with organic mitral valve disease including rheumatic valvular heart diasease or mitral valve prolapse and so forth. Although spontaneous sinus reversion may occur in some patients after mitral valve operation, recurrence of atrial fibrillation is the rule in most of these patients. We have tried to maintain sinus rhythm after mital valve operation with oral quinidine therapy, and we will show the efficacy of this therapy in this report. From January 1986 to August 1992, 60 patients of mitral valvular heart disease, who had had atrial fibrillation preoperatively and gained sinus rhythm postoperatively, were selected for this study. These patients were divided into 2 groups: Control group [n=30] and Quinidine trial group [n=30]. The age,sex, duration of symptoms,left atrial size and other risk factors of the reversion to atrial fibrillation were adjusted to be similar between the two groups. The maintenance rate of sinus rhythm was calculated by Kaplan-Meier method, and the rate was significantly higher in quinidine trial group than in control group [ p=0.0001 ]. Univariate analysis was performed on the risk factors of reversion to atrial fibrillation, and the difference of maintenance rate between the two groups were corrected with this result: the difference was still statistically significant [ p=0.0205 ]. The quinidine levels were measured in postoperative days, and there were no difference of serum quinidine level between the quinidine success group and quinidine failure group. In conslusion, oral quinidine therapy was effective for the maintenance of sinus rhythm after mitral valve operation compared to control group, and there was no correlation between the serum quinidine level and clinical efficacy of quinidine therpy.

• Journal of Chest Surgery
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• v.44 no.1
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• pp.18-24
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• 2011

Background: We evaluated the efficacy of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in chronic atrial fibrillation associated with valvular heart disease. Material and Methods: From November 2005 to June 2009, ninety four patients have undergone valvular heart surgery with Cox-maze IV procedure. Preoperative duration of atrial fibrillation was $7.6{\pm}6.5$ years and follow-up duration was $22.7{\pm}12.3$ months. Results: There were two (2.1%) postoperative deaths not related to maze procedure. Two cerebrovascular accidents, five low cardiac output syndromes and two permanent pacemaker implantations have occurred after surgery. Preoperative ejection fraction on echocardiography was $55.3{\pm}8.1%$ and ejection fraction of postoperative six month was $54.7{\pm}6.5%$. Left atrial size of preoperative and postoperative were $61.5{\pm}11.6\;mm$ and $53.1{\pm}8.4\;mm$ at each. Freedom from atrial fibrillation rate at postoperative six-month was 80.7% and the cases of recurrence of atrial fibrillation after six months were three (3.3%). Risk factors for failure or recurrence of maze procedure were old age (p=.010) and preoperative moderate or severe tricuspid regurgitation (p=.033). Conclusion: The Cox-maze IV procedure using RFBP2 and cryothermy is quite safe and freedom from atrial fibrillation at postoperative 6 month was 82.5%. Risk factors for failure or recurrence of atrial fibrillation after Cox-maze IV were old age and preoperative over moderate tricuspid regurgitation.

• Korean Journal of Adult Nursing
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• v.17 no.2
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• pp.230-238
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• 2005

Purpose: The purposes of this study were to explore the concept of uncertainty and to examine the relationships among uncertainty, appraisal of uncertainty, depression, anxiety, and perceived health status in patients with atrial fibrillation. Method: The study utilized a descriptive correlational survey design using a face to face interview method. A convenience sample of 49 subjects were recruited from K university hospital over 8 months. The data were analyzed by t-test, ANOVA, Pearson correlation and partial correlation analysis. Results: 1) Subjects perceived with moderately high uncertainty(M=65.98); moderate physical health(M=39.80), mental health(M=47.38), and general health(M=2.94); moderate anxiety(M= 44.78); and slightly low depression(M=15.33). 2) There were significant differences in uncertainty by gender and education. 3) Uncertainty and danger appraisal were significantly correlated(r=.32, p=.03) while the uncertainty was not associated with opportunity appraisal. 4) Uncertainty was significantly correlated with mental health(r=-.31, p=.04), anxiety(r=.38, p=.01), and depression(r=.37, p=.01). Conclusion: This study was the first trial to explore uncertainty and to examine the relationships among its associated factors in Korean patients with atrial fibrillation. Thus, based on the findings of this study, directions for nursing practice and further nursing research for patients with atrial fibrillation were suggested.

• Korean Journal of Adult Nursing
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• v.25 no.1
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• pp.13-23
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• 2013

Purpose: The purpose of this study was to investigate the factors that influence health-related quality of life in patients with atrial fibrillation. Methods: The subjects were 150 outpatients with atrial fibrillation who visited the cardiology clinic of a university hospital in U city. The instruments used for this study were Mhel Uncertainty in Illness Scale (MUIS), Center for Epidemiologic Studies-Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), and the Short-Form-36 Health Survey (SF-36) Korean version II. The date were analyzed by ANOVA, Pearson-correlation coefficient, and hierachial multiple regression using SPSS/WIN 18.0. Results: The mean score of physical health-related quality of life (PCS) was $38.92{\pm}6.22$ and mental health-related quality of life (MCS) was $41.49{\pm}5.71$. Physical and Mental health-related quality of life had the significant correlations with uncertainty, anxiety and depression. In multiple regression analysis, physical health-related quality of life was significantly influenced by duration of disease, NYHA class, uncertainty. Mental health-related quality of life was significantly influenced by family income, NYHA class, anxiety and depression. Conclusion: These results suggest that these influencing factors should be consider in developing the nursing interventions to improve the healthrelated quality of life in patients with atrial fibrillation.

• The Journal of the Society of Stroke on Korean Medicine
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• v.18 no.1
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• pp.55-65
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• 2017

■ Objectives Atrial fibrillation is the most common cause of cardioembolic stroke. Of the 44 ischemic stroke patients with atrial fibrillation who were hospitalized in hospital of Korean Medicine from July 1, 2014 to June 30, 2017, we selected 39 patients who have had Magnetic Resonance Angiography. We divided them into Atrial Fibrillation group with no stenosis or less than 50% stenosis in the ipsilateral artery of the lesion and Artery to Artery Embolism group with more than 50% stenosis or occlusion in the ipsilateral artery of the lesion. ■ Methods Clinical characteristics, examination and evaluation tools were collected from the patient's electronic medical records. CHADS2, Initial National Institutes of Health Stroke Scale, 8-item Stroke Scale and Improved 8-item Stroke Scale Number were checked. ■ Results & Atrial Fibrillation group showed differences in age, brain lesion location, vascular lesion, Conclusion initial National Institutes of Health Stroke Scale, initial 8-item Stroke Scale and progress compared to Artery to Artery Embolism group.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.499-503
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• 2014

Atrial fibrillation (AF) is the most common type of arrhythmia and has a large global burden. In general, treatment of AF is based on medication and consists of rate and rhythm control together with anticoagulation. However, surgical treatment may be required in patients with AF combined with organic valvular heart diseases or who experience recurrence despite medication. In addition, surgical treatment plays a role in the treatment of lone AF. This article reviews the various surgical treatment options for AF.