• 대한의용생체공학회:의공학회지
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• 제39권2호
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• pp.69-79
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• 2018

The present study proposes an algorithm that can discriminate between normal subjects and paroxysmal atrial fibrillation (PAF) patients, which is conducted using electrocardiogram (ECG) without PAF events. For this, time-domain features and random forest classifier are used. Time-domain features are obtained from Poincare plot, Lorenz plot of ${\delta}RR$ interval, and morphology analysis. Afterward, three features are selected in total through feature selection. PAF patients and normal subjects are classified using random forest. The classification result showed that sensitivity and specificity were 81.82% and 95.24% respectively, the positive predictive value and negative predictive value were 96.43% and 76.92% respectively, and accuracy was 87.04%. The proposed algorithm had an advantage in terms of the computation requirement compared to existing algorithm, so it has suggested applicability in the more efficient prediction of PAF.

• 대한의용생체공학회:의공학회지
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• 제23권1호
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• pp.1-8
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• 2002

심방세동은 가장 많이 나타나는 부정맥으로. 뇌졸중 등 심각한 합병증을 초래하는 질환이다 심방세동이 발작성으로 발생하는 경우 단시간내 불규칙적으로 발생하기 때문에 그 진단이 어렵다 본 연구에서는 발작성 심방세동 환자의 조기진단을 위하여 심실세동 등의 진단에 이용되는 신호평균 심전도를 이용한 분석방법을 사용하였다 심방세동의 징후가 있는 환자는 초기에 심방에서 심근의 전기전도가 지연된다는 이론을 근거로 심전도 P파의 길이를 진단의 기준으로 하였다. p파 길이를 정확히 측정하기 위하여 다양한 종류의 필터와 차단주파수에 대하여 분석하였으며. p파의 시작과 끝점을 판단하는 여러 방법을 시도하였다. 분석 방법의 신뢰성을 높이기 위하여 자동으로 P파 길이를 측정하는 알고리즘을 구현하였다. 구현된 알고리즘의 검증을 위해서 발작성 심방세동 이외의 병력이 없는 환자 38명과 정상인 32명을 대상으로 임상 데이터를 수집하였다. 분석 결과 30 Hz 차주파수를 가지는 LMS 필터를 사용하고. 절대치 8.75 $\mu N$를 기준으로 P파의 시작과 끝점을 측정하여 P파 길이를 계산할 때가 가장 높은 발작성 심방세동의 예측도를 가졌다. 또한 발작성 심방세동의 진단을 위한 가장 적합한 판별 값을 구하기 위하여 수신 동작 특성 곡선을 이용한 결과. 의사결정의 판별 값을 112 ms로 하는 경우 진단의 민감도 88 %. 특이도 64.4 %의 결과를 얻을 수 있었다

• Journal of Chest Surgery
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• 제47권4호
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• pp.358-366
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• 2014

Background: To improve sinus rhythm conversion, the Cox maze III procedure with narrow mazes (width: ${\leq}3.0cm$) was performed in combination with left atrial volume reduction. Methods: From October 2007 to April 2013, 87 patients with atrial fibrillation (paroxysmal in 3, persistent in 14, and permanent in 70) underwent the Cox maze procedure concomitant with another cardiac procedure. They were followed-up with serial electrocardiographic and echocardiographic studies. We used 24-hour Holter monitoring tests to evaluate postoperatively symptomatic patients. Results: At the mean follow-up time of 36.4 months, 81 patients (94.2%) had sinus rhythm and two were on anti-arrhythmic medication (one on a beta-blocker and the other on amiodarone). Five patients (5.8%) with postoperative recurrent and persistent atrial fibrillation never experienced sinus rhythm conversion; however, they did not require any medication for rate control. On postoperative echocardiography, the left atrial A waves were more frequently observed after concomitant mitral valve repair than after concomitant mitral valve replacement (82.4% vs. 40.4%, respectively; p<0.001). Conclusion: For the Cox maze procedure, narrow mazes and atrial volume reduction resulted in excellent sinus rhythm conversion without the preventive use of anti-arrhythmic drugs, and they did not affect the presence of the left atrial A waves on echocardiography.

• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.242-246
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• 2017

Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

• 한국생물물리학회:학술대회논문집
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• 한국생물물리학회 2001년도 학술 발표회 진행표 및 논문초록
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• pp.58-58
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• 2001

Even though atrial fibrillation is the most prevalent arrhythmia, the mechanism of development is not yet clear. Recently, there has been several reports that the most frequent source of paroxysmal atrial fibrillation is located inside pulmonary vein. Recently we successfully isolated single cardiac myocytes which were inside of pulmonary vein and reported the spontaneous action potential was generated from these cells.(omitted)

• 전자공학회논문지SC
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• 제49권3호
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• pp.38-46
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• 2012

심방세동은 발작성 심방세동 단계에서부터 검출 및 분석하여 적절한 치료를 실시하여야 하며, 홀터 심전계를 통해서만 측정할 수 있다. 현재 12채널 심전계를 통해서는 심방세동 신호를 추출할 수 있는 효과적인 방법들이 개발되어 있으나, 홀터 심전계를 위한 방법으로는 심실활동 템플릿을 단순 제거하는 ABS(averaged beat subtraction)방법이 사용되고 있다. 최근 단일 채널 심전도로부터 심방세동 신호를 추출하기 위한 PCA(principal component analysis) 또는 SVD(singular value decomposition) 기반의 알고리즘이 제안되기도 하였으나, 구현이 복잡하고 전문가의 개입이 필요한 한계가 있다. 본 논문에서는 주 입력인 심방세동 심전도에서 심실활동을 이벤트로서 검출한 뒤 이를 기준 입력으로 하는 이벤트 동기 적응필터(ESAF, event-synchronous adaptive filter)를 제안하고, 심방세동 신호 추출 성능을 평가해 보았다. 그 결과 기존 ABS 방법에 비해 우수할 뿐만 아니라, 전문가의 개입 없이도 PCA 또는 SVD 기반의 알고리즘과도 대등한 성능을 보였다. 나아가 이형성 심실활동이 있는 경우에도 효과적으로 대응할 수 있는 확장 ESAF 방법을 제안하였으며, 단형성 심실활동이 있는 경우와 유사한 수준의 성능을 확인하였다. 제안된 알고리즘을 홀터 심전계에 적용하면 발작성 심방세동 심전도의 분석뿐만 아니라 항부정맥 약물의 치료효과를 실시간으로 보다 정확하게 평가할 수 있을 것으로 기대된다.

• Journal of Chest Surgery
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• 제53권5호
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• pp.270-276
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• 2020

Background: We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). Methods: Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. Results: All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. Conclusion: Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.

• Journal of Yeungnam Medical Science
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• 제18권2호
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• pp.267-276
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• 2001

특발성 발작성 심방세동 환자에서 P파 간격 분산은 대조군에 비해 유의하게 증가해 있었으며, 동율동으로 전환 후 약물로 예방 치료를 받은 경우 12개월 후 추적 검사했을 때 최대 P파 간격과 P파 간격분산이 통계적으로 의미있게 감소한다는 것을 알 수 있었다. 이는 아마도 발작성 특발성 심방세동 환자에서 정상인보다 심방내의 전기적 불안정성과 불균질성의 증가에 기인한다고 보여지며, 약물 치료를 했을 때 이러한 전기적 불안정성이 감소한다는 것을 알 수 있었다. 따라서 P파 간격분산은 향후 발작성 심방세동 환자의 선별 검사로서, 또한 치료 후 재발을 예측할 수 았는 예후 인자로서 유용하게 사용될 수 있으리라는 예측을 해보며, 이를 규명하기 위해 추후 더 많은 표본들에 대한 전향적인 시도가 이루어져야 될 것으로 사료된다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.181-182
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• 1998

In previous study for correlation between P-wave Signal Averaged Electrocardiography (SAECG) and Paroxysmal Atrial Fibrillation (PAF) subjects, we showed that the duration of P-wave in subjects is longer than in controls. In this respect, the P-wave SAECG is a new method proving to be an accurate and independent noninvasive marker for the risk of PAF. To prove this suggestion, accurate detection and alignment of P-wave are indispensible. In previous study, we measured P-wave duration by manual. So it was not accurate and consistent. To measure the P-wave duration accurately and automatically, we have developed an automatic algorithm for P-wave duration measurement. We showed that the duration of P- wave in the subjects is longer than in controls with this algorithm.

• International Journal of Arrhythmia
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• 제19권3호
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• pp.235-284
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• 2018

In this part the writing group will cover strategies, techniques, and endpoints of atrial fibrillation (AF) ablation. Prior to all, electrical isolation of the pulmonary veins is recommended during all AF ablation procedures. In addition, techniques to be used for ablation of persistent and long-standing persistent AF, adjunctive ablation strategies, nonablative strategies to improve outcomes of AF ablation, and endpoints for ablation of paroxysmal, persistent, and long-standing persistent AF will be reviewed. Currently many technologies and tools are employed for AF ablation procedures. Radiofrequency energy, cryoablation, and other energy sources and tools are in various stages of development and/or clinical investigation. Finally, anticoagulation strategies pre-, during, and postcatheter ablation of AF and technical aspects of ablation to maximize safety are discussed in this section.