A 52-year-old male with Brugada syndrome presented with repeated and appropriate shock from an implantable cardioverter defibrillator (ICD). Catheter ablation for substrate elimination targeting low-voltage, complex, and fractionated electrocardiograms and late potentials in the epicardial right ventricular outflow tract was successfully performed. Brugada phenotype in the right precordial leads from the third intercostal space disappeared in the early stage after catheter ablation and that from the standard fourth intercostal space disappeared later. He remained free from ventricular fibrillation over the next fourteen months. We suggest that this novel ablation strategy is effective in Brugada syndrome patients with ICD, and early response after catheter ablation can be predicted by high precordial leads.

The aim of the study is to compare the efficacy and safety of iv administration of vernakalant, a relatively new atrial selective antiarrhythmic agent, versus ibutilide, in cardioversion of recent onset atrial fibrillation.Methods: A total of 78 patients (56 men -22 women, mean age 63.7266.67 years) presenting with new-onset atrial fibrillation was studied.In 36 patients (Group A, Men 24 -12 Women, mean age 62.4467.24years) iv vernakalant was administered (3 mgr/Kgr over 10 min and if needed after 15 min, a second dose 2 mgr/Kgr in 10 min).In 42 patients (Group B, 32 Men 10 Women, mean age 64.81þ6 years) iv ibutilide was administered (1 mgr over 10 min and if needed after 10 min, a second dose 1 mgr at 10 min).Results: 52.78% of patients (n ¼ 19) of Group A were converted vs 52.38% of patients (n ¼ 22) of Group B (p ¼ 0.58), with an average time of converting 11.864.3min in patients of Group A vs 33.9620.25 min in patients of Group B (p <0.0001).The average length of hospital stay of patients in Group A was 17.64615.96hours versus 41.09617.6 hours of Group B (p <0.0001).In one patient in Group A the administration of vernakalant was discontinued due to hypotension while 2 other patients reported dysgeusia during hospitalization.In 3 patients of group B the administration of ibutilide was discontinued due to appearance of nonsustained ventricular tachycardia, which resolved with discontinuation of the drug.The cost of drugs was estimated at 488.226170.34 e for patients of group A versus 142.43654.45e for patients of group B (p <0.0001), however hospitalization costs were significantly lower in patients of Group A (258.586124.73 e over 414.436100.32 -p ¼ 0.002).Conclusion: There was no significant difference in the efficiency of converting recent onset AF between vernakalant and ibutilide.The vernakalant, although an expensive drug, had fewer side effects and more rapid restoration, which reduced the overall cost of hospitalization of patients.

A 79-year-old woman who underwent catheter ablation for paroxysmal atrial fibrillation presented with Torsades de Pointes (TdP). Aggravation of prolonged QT interval which is most likely due to neural modulation by catheter ablation, played major role in the initiation of TdP. The patient was successfully treated with isoproterenol during acute stage and discharged after stabilization without implantation of permanent pacemaker or implantable cardioverter defibrillator.

Aim: Ergonovine provocation test has shown high sensitivity and specificity for the detection of vasospastic angina (VSA). In real world clinical practice, VAS is assumed by coronary response to nitrate. In this study, we analyzed weather ergonovine provocation test can be replaced by coronary response to nitrate for the detection of VSA.

Introduction: The Cilotax stent®, cilostazol and paclitaxel dual-coating stent (CPD-stent), was created for synergy effect to increase the anti-proliferative effect of paclitaxel and the anti-throm...

Pitavastatin is a potent lipophilic statin and may play an important role in acute myocardial infarction (AMI) but there have been limited data on the safety and efficacy of pitavastatin in AMI. This study consisted of 1,039 consecutive patients with AMI (74.0% men, mean age 61.4 ± 12.6 years) who presented in 10 major percutaneous coronary intervention centers in Korea from February 2007 through September 2009. Pitavastatin 2 mg/day was routinely administered in patients with AMI from time of presentation. We investigated changes of lipid profiles, biochemical markers, adverse events, and clinical outcomes up to 12 months. During the study 318 events overall occurred in 220 patients (21.2%) who reported ≥1 treatment emergent adverse event, although 20 events in 14 patients (1.4%) were treatment-related adverse events. Low-density lipoprotein (LDL) cholesterol percent change was -25.6% and LDL cholesterol target attainment was 70.5% at 12-month follow-up. Levels of creatinine phosphokinase, serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and high-sensitivity C-reactive protein decreased significantly during the first 1 month of pitavastatin treatment and were sustained to 12-month follow-up. Major adverse cardiac events occurred in 66 patients (7.3%). All-cause deaths occurred in 32 patients (3.5%) including 19 (2.1%) cardiac deaths and recurrent MIs occurred in 14 (1.6%) and target lesion revascularizations in 42 (4.7%). In conclusion, administration of pitavastatin 2 mg/day in patients with AMI showed 70.5% LDL cholesterol target attainment with good tolerance and was associated with favorable clinical outcomes up to 12 months.

Introduction: The radial artery is currently regarded as a useful vascular access site for coronary procedures. But there is no known impact of transradial coronary intervention (TRI) regarding the change of radial artery diameter. There were no published data regarding the change of radial artery diameter by quantitative artery analysis after the TRI. Hypothesis: The radial artery will not show significant change after transradial coronary interventions. Methods: From June 2009 to September 2012, consecutive patients underwent TRI and follow-up coronary angiography (FUCA) after TRI were enrolled. Retrograde radial artery angiography was performed before TRI in all patients. We analyzed the radial images of initial angiography and FUCA. We divided radial artery from an elbow to sheath tip into 5 parts (D1, D2, D3, D4 and D5) and analyzed radial artery diameter and minimal luminal diameter (MLD). The primary endpoint was the changes of radial artery diameter after TRI Results: Among total 613 patients unde...

Although the technology of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is evolving that make it appealing for challenging anatomy, proximal aortic neck morphology, especially severe angulation, is still one of the most determinants for a successful procedure. We describe a patient of AAA with severely angulated proximal neck, in whom kinked stent graft limb occurred against severe angulation of proximal neck. Then, we suggested how to prevent this complication in the second patient. Our case demonstrated the stent graft limb could be kinked by severe aortic neck angulation, making it challenging. However, the kinked stent graft limb could be prevented by deploying stent graft limbs below the most severely angulated aortic neck intentionally.

The radial artery is currently regarded as a useful vascular access site for coronary procedures. But there is no known impact of transradial coronary intervention (TRI) regarding the change of radial artery diameter. There were no published data regarding the change of radial artery diameter by

BackgroundGenetic analysis from patients participated in the randomized trials reported that the increased risk of type 2 diabetes noted with statins is at least partially explained by HMG-coenzyme A reductase inhibition. We investigated vascular and metabolic phenotypes of different dosages of rosuvastatin in hypercholesterolemic patients.MethodsA randomized, single-blind, placebo-controlled, parallel study was conducted in 48 patients on placebo, and in 47, 48, and 47 patients given daily rosuvastatin 5, 10, and 20mg, respectively during a 2month treatment period.ResultsRosuvastatin 5, 10, and 20mg improved flow-mediated dilation (34, 40, and 46%) after 2months therapy when compared with baseline (P<0.001 by paired t-test) and when compared with placebo (P<0.001 by ANOVA). Rosuvastatin 5,10, and 20mg dose-dependently and significantly increased insulin (mean % changes; 19, 29, and 31%, respectively) and glycated hemoglobin levels (mean % changes; 2, 2, and 3%, respectively), and decreased adiponectin levels (mean % changes; 3, 9, and 14%, respectively) and insulin sensitivity (mean % changes; 2, 3, and 4%, respectively) after 2months therapy when compared with baseline (all P<0.05 by paired t-test). These effects with rosuvastatin 5, 10, and 20mg were significant when compared with placebo (P=0.006 for insulin, P=0.012 for glycated hemoglobin, P=0.007 for adiponectin, and P=0.002 for insulin sensitivity by ANOVA).ConclusionsDespite beneficial reductions in LDL cholesterol and improvement of flow-mediated dilation, rosuvastatin dose-dependently and significantly resulted in decreasing insulin sensitivity and increasing ambient glycemia by reducing adiponectin levels and increasing insulin levels in hypercholesterolemic patients.

Ascending aortic pseudoaneurysm is a rare complication after cardiothoracic surgery and the open surgical repair for this complication is challenging. We report on a patient who developed an ascending aortic pseudoaneurysm after aortic valve replacement (AVR), which was treated successfully with endovascular therapy. Our case showed that angulation of the ascending aorta is one of factors for consideration in application of endovascular therapy and endovascular therapy might be an option for management of ascending aortic pathology in patients with high surgical risk, particularly patients with a severely angulated proximal ascending aorta.

BACKGROUND:Effects of omega-3 fatty acids (n-3 FA) combined with fenofibrate are not yet investigated, compared with fenofibrate. METHODS:This was a randomized, single-blind, placebo-controlled, parallel study. Age, sex, and body mass index were matched among groups. All patients were recommended to maintain a low fat diet. Fifty patients with hypertriglyceridemia in each group were given placebo, n-3 FA 2g+fenofibrate 160mg (combination), or fenofibrate 160mg, respectively daily for 2months. RESULTS:Placebo, combination, and fenofibrate significantly decreased triglycerides by 7%, 41% and 30%, respectively and triglycerides/HDL cholesterol ratio by 11%, 45% and 32%, respectively relative to baseline measurements (all P<0.05 by paired t-test). When compared with placebo and fenofibrate, these with combination were significant (P<0.001 by ANOVA). When compared with placebo, both combination and fenofibrate significantly decreased apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen (all P<0.05 by ANOVA), however, there were no significant differences between combination and fenofibrate. When compared with placebo, both combination and fenofibrate significantly reduced insulin and glucose (both P<0.05 by ANOVA), and improved insulin sensitivity (P=0.005 by ANOVA). However, there were no significant differences between combination and fenofibrate. CONCLUSIONS:When compared with fenofibrate, combination significantly decreased triglycerides and triglycerides/HDL cholesterol ratio. Otherwise, combination and fenofibrate significantly reduced apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen to a similar extent. Also, combination and fenofibrate significantly improved insulin sensitivity to a similar extent by reducing insulin and glucose in patients with hypertriglyceridemia.

Endovascular aneurysm repair (EVAR) is a safe alternative to open surgical repair for an abdominal aortic aneurysm. However, unfavorable aortic anatomy of the aneurysm has restricted the widespread use of EVAR. Anatomic limitation is most often related to characteristics of the proximal neck anatomy. In this report, we described a patient with a severely angulated proximal neck who underwent EVAR, but required repeat intervention because of thrombotic occlusion of stent graft limbs.

While recent guidelines have suggested the potential for beta-blockers as first-line agents in chronic stable angina, few data regarding comparative anti-anginal and metabolic effects between beta-blockers with and without vasodilating properties have been reported, particularly in patients with angina pectoris.

Introduction: The Cilotax stent, cilostazol and paclitaxel dual-coating stent, was created for synergy effect to increase the anti-proliferative effect of paclitaxel and the anti-thrombotic effect of cilostazol. We evaluated safety and efficacy outcomes of the cilotax stents for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Hypothesis: The Cilotax stent will be safe and effect for treating myocardial infarction patients. Methods: A prospective, open-labeled, single-center cohort has been performed at Gil hospital Gachon university in Korea. All patients will be clinically followed-up for 12 months. The primary endpoint was major adverse cardiac event (MACE): the composite of cardiac death (CD), recurrent myocardial infarction (MI) and ischemia-driven target lesion revascularization (TLR) at 12 months. Stent thromboses (ST) by ARC definition were analyzed. Results: From Nov. 2011 to Feb. 2013, 109 patients with STEMI undergoing primary PCI and stent implantation were enrolled. 12-month MACE were three (2.8%), CD one (0.9%), recurrent MI two (1.9%). STs were three (2.8%), subacute ST two (1.9%), late ST one (0.9%). Conclusions: The use of cilotax stents, cilostazol and paclitaxel dual-coating stents, is relatively safe and effective in patients with evolving ST-segment elevation myocardial infarction who are undergoing primary PCI with stent implantation.

myocardial infarction, stent thrombosis, TVR). Results: The DES and BMS groups were well matched except that DES patients received dual antiplatelet therapy for a longer duration and had smaller final vessel diameter. In survival analysis, at a mean follow-up of 1333 ± 659 days after PCI, the DES group had similar incidence of death/myocardial infarction (24 vs 27%, log rank p=0.23) and stent thrombosis (4.0 vs 2.6%, p=0.18) as the BMS group. The DES patients had lower incidence of TVR (8.1 vs 17%, p=0.0018) but similar MACE (26 vs 37%, p=0.31). In multivariable analysis, DES vs BMS implantation showed no significant impact on death/myocardial infarction [adjusted hazards ratio (HR) 1.0, 95% confidence intervals (CI) 0.7-1.4], stent thrombosis (HR 1.7; CI 0.7-4.0), or MACE (HR 0.8; CI 0.6-1.1). However, TVR was lower in the DES group (HR 0.4; CI 0.3-0.7). Conclusion: In patients presenting with NSTEMI, DES implantation appears to be as safe as BMS implantation at long-term follow up.