• Journal of Chest Surgery
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• v.9 no.2
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• pp.265-270
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• 1976

Implantation of a permanent pacemaker is a widely accepted procedure for the patient with complete heart block.As a result of these device, the prognosis for patients with Adams-Stokes syndrome caused by complete A-V block and other cardiac arrhythmia have become much more optimistic. Permanent pacemaker implantation by means of a transvenous approach has made the operative risk much less and the procedure simpler. However, a number of complications have been reported in the literature regarding transvenous endocardial pacemaker implantation during the last a decade. The patient presented in this paper is a 26-year old girl who was implanted with a permanent pacemaker at 14 years of age because of a congenital A-V block. Following first exchange of pulse generator, the electrode (lead) was fractured, so that by the pulse generator, a change to the transvenous technique of implantation was made, After this, there were episodes of recurrent wound infection on three occasions, even though the site of pulse generator implantation was exchanged to the contralateral side of chest wall, massive doses of antibiotics were administered and sensitivity tests for coagulase positive staphylococcal infection were performed. Though there was no definite evidence of blood stream infection by blood culture, we decided not to use the transvenous technique and not to implant the pulse generator in the chest wall because the venous system and the entire anterior chest wall appeared to be diseased or contaminated by virulent pyogenic organisms. Finally this intractable systemic and local wound infection was successfully controlled by myocardial lead implantation via a subxiphoid approach and implantation of the pulse generator far down in the abdominal wall. The causes and routes of recurrent wound infection and possible blood born infection in this particular patient are still obscure. We strongly believe that myocardial pacemaker implantation is much safer than transvenous endocardial pacemaker implantation & myocardial pacemaker implantation is a definite method for controlling such an intractable wound infection. following transvenous pacemaker implantation.

• The Korean Journal of Pain
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• v.23 no.3
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• pp.215-218
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• 2010

Glossopharyneal neuralgia (GPN) is generally considered to be a pain disease. However, it can be also be a life-threatening cardiac cause of syncope. Neuralgia in the throat and neck can trigger severe bradycardia up to the point of asystole, which can progress to cardiac syncope with or without seizures. A 65 year-old male patient diagnosed with glossopharyngeal neuralgia complained of severe paroxysmal pain in his right chin and ear followed by bradycardia, aystole and syncope. We report a case successfully treated with a permanent pacemaker and carbamazepine in a patient with GPN who had syncopal attacks preceded by paroxysms of pain.

• Journal of Biomedical Engineering Research
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• v.23 no.6
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• pp.477-484
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• 2002

A pacemaker autosense algorithm with dual thresholds. one for noise or tachyarrhythmia detection (noise threshold, NT) and the other for intrinsic beat detection (sensing threshold. ST), was developed to improve the sensing performance in single pass VDD electrograms. unipolar electrograms, or atrial fibrillation detection. When a deflection in an electrogram exceeds the NT (defined as 50% of 57), the autosense algorithm with dual thresholds checks if the deflection also exceeds the ST. If it does, the autosense algorithm calculates the signal to noise ratio (SNR) of the deflection to the highest deflection detected by NT but lower than ST during the last cardiac cycle. If the SNR 2, the autosense algorithm declares an intrinsic beat detection and calculates the next ST based on the three most recent intrinsic peaks. If the SNR $\geq$2, the autosense algorithm checks the number of deflections detected by NT during the last cardiac cycle in order to determine if it is a noise detection or tachyarrhythmia detection. Usually the autosense algorithm tries to set the 57 at 37.5% of the average of the three intrinsic beats, although it changes the percentage according to event classifications. The autosense algorithm was tested through computer simulation of atrial electrograms from 5 patients obtained during EP study, to simulate a worst sensing situation. The result showed that the ST levels for autosense algorithm tracked the electrogram amplitudes properly, providing more noise immunity whenever necessary. Also, the autosense algorithm with dual thresholds achieved sensing performance as good as the conventional fixed sensitivity method that was optimized retrospectively.

• Journal of the Institute of Electronics Engineers of Korea SD
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• v.46 no.1
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• pp.45-51
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• 2009

A low-voltage, low-power analog CMOS front-end for a cardiac pacemaker is proposed. The circuits include a 4th order switched-capacitor (SC) filter with a passband of 80-120 Hz and a SC variable gain amplifier whose control range is from 0 to 24-dB with 0.094 dB step. An inverter-based switched-capacitor circuit technique is used for low-voltage operation and ultra-low power consumption, and correlated double sampling technique is used for reducing the finite gain effect of an inverter. The proposed circuit has been designed in a $0.35-{\mu}m$ CMOS process, and it achieves 80-dB SFDR at 5-kHz sampling frequency. The power consumption is only 330 nW at 1-V power supply.

• Journal of the Institute of Electronics Engineers of Korea SD
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• v.46 no.1
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• pp.52-58
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• 2009

A low voltage, low power delta-sigma modulator is proposed for cardiac pacemaker applications. A cascade of delta-sigma modulator stages that employ a feedforward topology has been used to implement a high-resolution oversampling ADC under the low supply. An inverter-based switched-capacitor circuit technique is used for low-voltage operation and ultra-low power consumption. An experimental prototype of the proposed circuit has been implemented in a $0.35-{\mu}m$ CMOS process, and it achieves 61-dB SNDR, 63-dB SNR, and 65-dB DR for a 120-Hz signal bandwidth at 7.6-kHz sampling frequency. The power consumption is only 280 nW at 1-V power supply.

• Journal of Veterinary Clinics
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• v.27 no.5
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• pp.569-572
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• 2010

A 4-year-old neutered female Pekingese dog (weighing 3.6 kg) was referred with the primary complaint of exercise intolerance with occasional syncope. Physical examination revealed irregularly irregular heart rhythm with persistent pulse deficits. The 12-lead surface ECG showed a marked sinus arrest with occasional junctional escape beats, indicating a sick sinus syndrome. Permanent transvenous cardiac pacing with a rate-responsive bipolar implantable pacemaker (VVIR type) was performed in the right ventricle. After pacemaker implantation, the clinical signs were remarkably improved. No further syncopal episodes have yet been occurred after implantation.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.113-116
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• 2014

A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

• Journal of Biomedical Engineering Research
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• v.22 no.3
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• pp.269-273
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• 2001

Proper determination of pacing threshold is important for patient safety and pacemaker longevity. In general, cardiac muscle contractions caused by pacing pulses are verified by observing the morphology of surface ECG displayed on a monitor. In this study, a method of automatic pacing threshold determination based on morphological difference between intrinsic and paced ECGs was developed. First, characteristics of intrinsic ECG and paced ECG were analyzed in time and frequency domain and a proper discrimination parameter was extracted. Then, the automatic capture verification method based on the parameter was developed and applied to 23 pacemaker patients. The selected parameter was the area of ventricular depolarization wave during 80ms after pacing stimulus. It was found that the method was reliable and effective in identifying paced ECG and, thereby, determing a proper pacing threshold.

• Proceedings of the Korean Biophysical Society Conference
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• 2002.06b
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• pp.20-21
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• 2002

The inflow of Ca$\^$2＋/ through voltage-activated T-type calcium channels (T-channels) regulates a variety of cellular functions including neuronal excitability, cardiac pacemaker activity, hormone secretion, smooth muscle contraction, and fertilization. Not only are T-channels enormously important for the normal operation of cells, they also playa critical role in pathophysiological conditions such as cardiac hypertrophy and absence epilepsy.(omitted)

• The Korean Journal of Physiology
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• v.16 no.2
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• pp.119-128
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• 1982

The frog truncus arterious were studied with conventional glass microelectrode technique in order to elucidate the underlying mechanism of spontaneous pacemaker activity. The analyses were focussed on the ionic nature of pacemaker current by changing the concentrations of extracellular $K^+$ and, $Na^+$, or by using blockers of K- and Ca-current and chronotropic transmitters. 1) The action potential of the spontaneously active truncus arteriosus has some characteristic feature of maximal distolic potential ranged from -65 to -75 mV, resting potential from -45 to -50 mV and overshoot voltage about +30 mV, respectively. Duration of the action potential taken from rapid upstroke to maximal diastolic potential was about 600 msec. Usual discharge rate was $25{\sim}30/min$ at room temperature $(18{\sim}20^{\circ}C)$. 2) The sensitivity of the resting membrane potential to change extracellular potassium concentrations $(0{\sim}12\;mM)$ was relatively low. Transient hyperpolarization was appeared in the 12 mM K Ringer after 10 min exposure to 0 mM K and it could be related to Na-pump reactivation by high potassium. 3) Reduction of extracellular sodium concetrations diminished the amplitude and frequency of the action potential. In Ringer solution containing 30% Na (substituted by equimolar Tris), spontaneous activity stopped but reappeared as very slow and small action potential. There was no spotaneous activity in zero Na Ringer solution. 4) Caesium(10 mM), K-current blocker decreased the frequency of the action potential and also pacemaker depolarization. Manganese (2 mM) known to be Ca-current antagonist, blocked spontaneous activity completely. 5) Adrenaline and acetylcholine had no chronotropic effect. But adrenaline increased the duration of plateau phase and the magnitude of the action potential in the follower cell. It is concluded that K-, Na-and Ca-current components are involved in the genesis of spontaneous activity of the frog truncus arteriosus like cardiac pacemaker tissues. But the insensitivity of truncus arteriosus to adrenaline and acetylcholine indicates that there are some different control mechanisms of spontaneous rhythm in two tissues.