Earticle

본 연구는 2010년 1월 1일부터 2011년 12월 31일까지 119구급대를 통해 병원으로 이송된 제세동 가능한 심실세동, 무맥성 심실빈맥 심전도 리듬을 보이는 심정지 환자 222명을 병원 도착 전 자발순환회복에 미치는 영향을 분석하였으며 그 결과는 다음과 같다. 심정지 환자의 대상은 남성이 162명(73.0%), 여성이 60명(27.0%)으로 주로 남성이 많았다. 연령별로는 50~59세 환자가 54건(24.3%)으로 가장 많았으며, 29세 이하 환자는 4건(1.8%)으로 가장 낮은 빈도를 보였다. 병원 전 자발순환회복에 미치는 영향에는 119구급대의 신고에서부터 출동반응시간, 현장도착시간이 짧을수록 자발순환회복에 영향을 주었으며, 119구급대가 현장에 3분 이내 도착한 경우에 4분 이후 도착한 경우보다 자발순환회복에 유의한 차이를 보였다. 119구급대를 통해 실시된 응급처치 중 전문소생술의 빈도는 낮았으나, 그 중 정맥로 확보가 자발순환회복에 유의한 차이를 보였다. 본 연구를 통하여 119구급대로 이송된 제세동 가능한 심정지 환자의 병원 도착 전 자발순환회복율을 높이기 위해서는 현장에서 목격자의 심폐소생술이 시행되어야 하며 119구급대는 신고에서 출동반응시간, 현장도착시간을 단축시켜 빠른 제세동이 적용되어야한다.

This research analyzed the effects on Recovery of Spontaneous Circulation of 222 cardiac arrest patients transported to hospital that can be defibrillated from January 1st 2010 to December 31st 2011. The results are as followed. Males accounted for majority, numbering 162 (73.0%) and females accounted for 60 (27.0%) out of cardiac arrest patients. As for the age, patients of age between 50~59 were the highest with 54 cases (24.3%). Patients below 29 had lowest frequency with 4 cases (1.8%). The effect on spontaneous circulation recovery before hospitalizing showed more significant difference the shorter the response time and site arrival time were from the 119 emergency call, and there also was significant difference on spontaneous circulation recovery when the 119 emergency team arrived the site within 3 minutes than 4 minutes. Among the first-aids performed by the 119 emergency team, frequency of advanced cardiac life support was low and out of this, securing vein showed significant difference in spontaneous circulation recovery. Through this study, in order to raise the spontaneous circulation recovery of cardiac arrest patients before hospitalizing who can be defibrillated, witness’ resuscitation should be performed on site and rapid defibrillation should be applied be shortening response time and site arrival time of 119 emergency team.

연구 목적 : 한국에서 일반인의 의한 AED의 사용 사례를 극히 드물다. 병원 전 심정지 상황에서 특히 제세동이 필요한 환자의 소생률을 높이기 위해서는 일반인에 의한 AED 사용이 요구된다. 본 연구의 목적은 AED사용에 영 향을 미치는 요인을 분석하는 것이며, 한일 비교를 통해 사회적 특성이 있는지를 확인하는 것이다. 연구 방법 : 2013년 2월 25일부터 3월 4일까지 설문 조사를 실시했다. 한국에서 517명, 일본에서 520명의 데이터 를 회수했다. 설문지를 통해 파악한 사회인구학적 요인과 AED에 관한 지식 요인이 AED사용의도에 영향을 미치는 지를 알기 위해 로지스틱 회귀분석을 실시했다. 연구 결과 : 한국의 517 명의 응답자 중 220명, 42.6%만이, 그리고 일본의 520명의 응답자 중 387 명, 74.4%가 AED를 사용해 환자를 도우려는 의사를 가지고 있었다. 한국과 일본 모두 성별은 유의한 요인이었다(한국 odd ratio[OR] = 0.419, 일본 OR = 0.582). 양국 모두에서 여성은 남성에 비해 AED를 사용해 환자를 도우려고 하지 않았다. AED에 관한 지식은 양국 모두에서 가장 큰 영향을 끼치는 요인이었다. 국가 간의 차가 있었던 요인은 우 선 연령이었다. 연령 요인이 한국에서는 유의하지 않았지만 일본에서는 젊을수록 AED 사용의사가 높았다(OR = 0.968). 또한 일본에서는 심장병력이 유의한 요인(OR=2.099)이었다. 결 론: 본 연구는 AED사용의도에 가장 큰 영향을 끼치는 요인이 AED에 관한 지식임을 밝혔다. 따라서, 병원 전 심정지 상황에서 제세동을 장려하기 위해서는 AED 설치와 함께 사회적 요인을 반영한 교육 프로그램이 필요하다.

Purpose : The purpose of the study is to investigate the factors influencing using AED use in South Korea and Japan. Methods : I conducted a questionnaire survey from February 25 to March 4, 2013, receiving responses from 517 people in Korea and 520 people in Japan. The questionnaire included sociodemographic factors, history of heart disease, AED knowledge, and other variables. A logistic regression analysis was conducted. Results : Among the 517 Korean respondents, 220 (42.6%) intended to use AEDs. Among the 520 Japanese respondents, 384 (74.4%) had similar intentions. Multiple logistic regression analysis found the following significant predictors of intent to use AEDs: gender (odds ratio [OR]=0.419), household income (OR=0.991), and AED knowledge (OR=2.833) in Korea; and gender (OR=0.582), age (OR= 0.968), cardiac disease history (OR=2.099), and AED knowledge (OR=2.984) in Japan. Conclusion : It would be helpful to teach AED use to encourage performing public access defibrillation. In addition, it is necessary to design AED education programs based on country-specific factors.

Purpose: The purpose of this study was to investigate the installation, management, and usability of automated external defibrillators (AED) installed in the apartments with over 500 households in Chungnam. Methods: The survey included 52 apartments with over 500 households having AED in Chungnam from July 1 to August 20, 2017. The information of AED was taken from the Chungnam Provincial Office. Results: The access and use of AED was closely affected by AED installation location, locking devices, lack of publicity, and AED use education for the residents. Conclusion: Efficient education on the use and management of AED for residents of the apartments is necessary.

Ventricular fibrillation (VF) and ventricular tachycardia (VT) are life-threatening signals. Automated external defibrillators can decrease the fatality rate if the VF/VT detection is stable and quick. This thesis proposes improved VF/VT detection. For our experiments, we use the complete Creighton University Ventricular Tachyarrhythmia Database. Samples are analyzed under the same conditions in intervals of 7 s. Based on this data, we propose a time-delay transform. Then, we extract six shockable features, three known and three new, which are used to construct our Neural Network with Weight Fuzzy Membership Functions model (NEWFM). The result is better than the phase space reconstruction algorithm.

Purpose: Our study aims to analyze prognosis after implantable cardioverter-defibrillator (ICD) implantation in Korean patients with Brugada syndrome (BrS). Materials and Methods: This was a retrospective study of BrS patients implanted with an ICD at one of four centers in Korea between January 1998 and April 2012. Sixty-nine patients (68 males, 1 female) were implanted with an ICD based on aborted cardiac arrest (n=38, 55%), history of syncope (n=17, 25%), or induced ventricular tachyarrhythmia on electrophysiologic study in asymptomatic patients (n=14, 20%). A family history of sudden cardiac death and a spontaneous type 1 electrocardiography (ECG) were noted in 13 patients (19%) and 44 patients (64%), respectively. Results: During a mean follow-up of 59±46 months, 4.6±5.5 appropriate shocks were delivered in 19 patients (28%). Fourteen patients (20%) experienced 5.2±8.0 inappropriate shocks caused by supraventricular arrhythmia, lead failure, or abnormal sensing. Six patients were admitted for cardiac causes during follow-up, but no cardiac deaths occurred. An episode of aborted cardiac arrest was a significant predictor of appropriate shock, and the composite of cardiac events in the Cox proportional hazard model [hazard ratio (95% confidence interval) was 11.34 (1.31-97.94) and 4.78 (1.41-16.22), respectively]. However, a spontaneous type 1 ECG was not a predictor of cardiac events. Conclusion: Appropriate shock (28%) and inappropriate shock (20%) were noted during a mean follow-up of 59±46 months in Korean BrS patients implanted with an ICD. An episode of aborted cardiac arrest was the most powerful predictor of cardiac events.

Purpose: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemiccardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantationrates and factors associated with appropriate PP ICD implants for ICM. Materials and Methods: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who wereeligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital andclinical factors, were investigated. Results: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0?78.0) years], only 76 (5.2%) patients underwentICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and totalhospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospitalsystem score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10?1.50] was an independent factor for predicting ICD implantation,along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97?17.87) andyounger age (<70 years: OR, 2.14; 95% CI, 1.30?3.53). Conclusion: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICDimplantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantationrate (Clinical trial registration No. NCT03590925).

Background/Aims: Despite the U.S. Food and Drug Adminstration approving a magnetic resonance imaging (MRI)-conditional pacemaker system in 2011, many physicians remain reluctant to perform MRI scanning in patients with cardiac implantable electronic devices. Herein, we aimed to evaluate the real-world safety of MRI in these patients. Methods: This single-center retrospective study examined the interrogation data and outcomes of patients with pacemakers or implantable cardioverter defibrillators who underwent MRI. MRI interrogation data were collected pre- and post-MRI and after 1 month of follow-up; these included the lead impedance, measured P- and R-wave amplitudes, and capture threshold. We compared these results between the magnetic resonance (MR)-conditional and conventional groups. Results: From September 2013 to December 2015, 35 patients with cardiac implantable electronic devices underwent 43 MRI scans, with a mean follow-up of 5 months. Among these 35 patients, 14 (40%) had MR-conditional devices and 21 (60%) had conventional devices. Seven patients had high voltage devices, which were all the conventional type. There were no adverse events associated with MRI during the follow-up period, and there were no significant differences in the interrogation data changes between the conventional and MR-conditional groups. Conclusions: This single-center retrospective study found that MRI can be performed safely in patients with pacemakers or implantable cardioverter defibrillators, regardless of the MRI support, as long as appropriate precautions are taken.

삽입형 제세동기(implantable cardioverter-defibrillator, ICD)는 심실세동 등에 의한 심정지 환자나 구조적 심장질환이 있는 심실빈맥 환자에서 이차 예방을 위해 삽입하여 이후 나타나는 돌연사를 줄이는 목적으로 사용되었다[1]. 하지만 2000년 초반부터는 비록 심실세동이나 심정지 등을 경험하지 않았더라도 심기능이 심하게 저하되어 있는 환자군에서 삽입형 제세동기를 삽입하는 것이 시작되어 현재는 그 빈도가 점차 증가하고 있으며 이를 ICD 삽입을 통한 돌연사의 일차적 예방이라고 이야기한다. 여기에서는 이러한 일차적 예방을 위한 ICD 삽입의 치료의 임상결과들을 통해 그 근거와 효과를 알아보고자 한다.

Implantable cardioverter-defibrillators (ICDs) are an effective treatment strategy for patients with aborted sudden cardiac death (SCD) and ventricular tachyarrhythmias. rimary prevention of SCD is a strategy involving the use of ICDs in patients who are at high risk for, but have not had, any previous events of ventricular arrhythmias or cardiac arrest. Several randomized clinical trials have demonstrated the efficacy of ICDs in the primary prevention of SCD. Therefore, ICD implantation is recommended as a standard of care by the guidelines in patients who have ischemic or nonischemic cardiomyopathy and a low left ventricular ejection fraction. However, the rates of ICD implantation as a primary prevention in Korea is quite low compared to western countries. In this review, we will summarize the results and efficacy of ICDs in the clinical trials about primary prevention of SCD, the current treatment guidelines, and the reimbursement policy of Korean health insurance. We hope that this review will help broaden the recognition of importance of ICD implantation for the primary prevention of SCD.

본 조사 연구는 일개 도내의 자동심장충격기 의무설치 기관의 자동심장충격기 설치현황 및 관리 점검 실태를 파악하기 위한 조사연구이다. 2017년 11월 20일부터 2017년 12월 20일까지 진행되었으며 총 169대의 자동심장충격기를 대상으로 조사하였다. 수집된 자료의 분석은 SPSS/WIN 20.0 프로그램을 이용하여 빈도분석과 백분율로 파악하였다. AED는 168대(99.41%)가 기관 실내에 설치되어 있는 것으로 조사되었으며, 24시간 항시 자동심장충격기가 운영되고 있는 경우는 47대(27.80%), 기관 운영시간 외에 자동심장충격기를 사용할 수 있는 경우는 44대(26.00%)으로 파악되었다. 책임관리자가 구조 및 응급처치 교육을 받은 경우가 87명(51.43%)이었으며, 자동심장충격기의 관리현황은 배터리 충전상태의 문제가 있는 경우는 2대(1.20%), 환자 부착용 AED패드의 유효기간이 지난 경우로 7대(4.10%)로 조사되었다. 향후 자동심장충격기 관리책임자를 위한 관리체계를 마련하고, 체계적 유지관리에 대한 정기적인 교육 프로그램을 개발하여 적용해야 한다. 또한 자동심장충격기 설치 관리에 대한 법률 강화 및 제도적 정비를 통한 지속적인 관리실태의 필요성에 대한 인식을 제고할 필요가 있다.

This study was conducted to investigate the status of the installation, maintenance and management of automatic external defibrillators (AEDs) in all mandatory institutions and buildings of the providence to be equipped with AEDs. The study was conducted from November 20, 2017 to December 20, 2017, during which time 169 AED units were surveyed. The collected data was analyzed by frequency analysis and the percentage was determined using the SPSS/WIN 20.0 program. A total of 168 units (99.41%) of AEDs were installed inside. Additionally, 47 units (27.80%) were available 24 hours a day, and 44 units (26.00%) were available outside business hours of the institution. Moreover, 87 units (51.43%) of the responsible managers received rescue and first aid training. Evaluation of the management status of the AEDs revealed two (1.20%) that had problems with their battery state of charge battery charge and seven (4.10%) for which the AED pads were past the expiration date. A management system for the manager of AEDs should be established and a regular training program for their systematic maintenance should be developed and applied. It is also suggested that awareness of the necessity of continuous management be raised through reinforcement of laws and legal system reorganization.

In this study, we evaluated the effects of static magnetic fields of earphones and headphones on pacemakers and implantable cardioverter defibrillators(ICDs). Five pacemakers and three ICDs were subjected to in-vitro test with three headphones which were an in-ear earphone, clip-on headphone, and closed-back headphone. Each implantable device was placed in close proximity(within 3 mm) to the ear-pad of each of the earphone and headphones for 3 min. As a result, no effects were observed on the pacemakers for the earphone and headphones during the test, but an effect was observed on one ICD for the clip-on and closed-back headphone during the test. When the ICD was placed in close proximity to the headphones, the ICD temporarily suspended functions of tachyarrhythmia detection and therapy. The effect was not observed in this study when the headphones were at least 2 cm from the ICD. Based on these findings, patients with ICDs should be advised to keep earphones and headphones at least 2 cm apart from their ICDs.