Korean Circulation Journal最新文献

{"title":"Atrial Cardiomyopathy and Atrial Fibrillation: Insight From Histopathological Analysis of Atrial Biopsies.","authors":"Takanori Yamaguchi, Kana Nakashima","doi":"10.4070/kcj.2025.0421","DOIUrl":"10.4070/kcj.2025.0421","url":null,"abstract":"<p><p>Atrial cardiomyopathy is a progressive condition that promotes atrial fibrillation (AF) persistence and adverse outcomes. Although fibrosis has long been considered its hallmark, the histopathological basis in non-valvular AF remains incompletely defined due to limited tissue availability outside surgery or autopsy. To overcome this, we established an integrated approach combining intracardiac echocardiography-guided right atrial biopsy with high-density electroanatomic mapping in AF ablation patients. Our studies revealed that atrial voltage reduction reflects not only fibrosis but also intercellular space expansion, myofibrillar loss, reduced nuclear density, and compensatory cardiomyocyte hypertrophy. Notably, atrial biopsy detected atrial amyloidosis in ~7% of patients, often at an early stage, highlighting its potential for earlier diagnosis and intervention. Sex-based analysis revealed that women consistently had lower atrial voltage, attributable to smaller myocardial mass rather than more severe remodeling. These findings demonstrate that atrial biopsy enables patient-specific histopathological assessment, deepening mechanistic understanding of atrial cardiomyopathy and informing future strategies for AF management.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"439-465"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Idealism and Reality: Cryoballoon Ablation Across Anesthetic Approaches in Real-World Practice.","authors":"Shonosuke Watanabe, Satoshi Higuchi","doi":"10.4070/kcj.2026.0003","DOIUrl":"10.4070/kcj.2026.0003","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"478-480"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Volume of Targeted Temperature Management and Neurological Outcomes in Comatose Out-of-Hospital Cardiac Arrest Survivors: Nationwide Population-Based Study.","authors":"Dongju Kim, Hanna Park, Hyojeong Kwon, Sang-Min Kim, June-Sung Kim, Youn-Jung Kim, Won Young Kim","doi":"10.4070/kcj.2025.0205","DOIUrl":"10.4070/kcj.2025.0205","url":null,"abstract":"<p><strong>Background and objectives: </strong>Case volume and improved survival have been reported in several critical illnesses; however, the impact of case volume of targeted temperature management (TTM) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients remains unclear. This study aimed to determine whether TTM case volume is associated with neurologically intact survival in comatose OHCA patients.</p><p><strong>Methods: </strong>This observational study included consecutive adult (≥18 years) OHCA survivors with TTM using data from the Nationwide OHCA Registry in South Korea between 2016 and 2021. TTM case volume was evaluated in 2 ways. First, TTM volume was included as a continuous variable in a restricted cubic spline analysis. Second, TTM case volume was categorized into tertiles (high: ≥17.0 cases/year, medium: 12.0-16.9, and low-volume: <12.0 cases/year), and multivariable logistic regression analysis using generalized estimating equations was performed on good neurologic outcomes (cerebral performance category 1-2) based on the low-volume center.</p><p><strong>Results: </strong>Overall, 4,018 OHCA survivors treated with TTM were included. In spline analyses, the overall association was significant; non-linearity was not detected in the primary 3-knot model but was observed in sensitivity models with alternative knot placements (4-knot: p=0.005; p for non-linearity=0.045). Although coronary angiography was lower in the high-volume center, multivariable analysis showed that a high-volume TTM center was associated with a good neurological outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.16-1.81; p=0.001).</p><p><strong>Conclusions: </strong>Higher TTM case volume was associated with better neurological outcome in comatose OHCA survivors and may reflect greater overall post-arrest care capability.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"495-506"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Reply to Stability or Latent Risk? Interpreting MRA Withdrawal in Recovered Heart Failure.","authors":"Junho Hyun, Sang Eun Lee","doi":"10.4070/kcj.2026.0831","DOIUrl":"10.4070/kcj.2026.0831","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"527-529"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of Primary Neonatal Tetralogy of Fallot Repair and Risk Factor Analysis of Right Ventricular Outflow Tract and Pulmonary Artery Reintervention.","authors":"Jae Hong Lim, Chang-Ha Lee, Sang Hun Cho, Eung Re Kim, Yong Jin Kim","doi":"10.4070/kcj.2025.0401","DOIUrl":"https://doi.org/10.4070/kcj.2025.0401","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neonates with symptomatic tetralogy of Fallot (TOF) often require surgery within the first month of life, but the optimal strategy remains uncertain. This study assessed outcomes and risk factors for right ventricular outflow tract (RVOT) and pulmonary artery (PA) reintervention after neonatal primary repair.</p><p><strong>Methods: </strong>Between 2004 and 2021, 42 neonates underwent primary TOF repair and were retrospectively analyzed. Mean follow-up was 12.2±5.7 years. Twenty-seven patients (64.3%) had TOF with pulmonary atresia, and 15 (35.7%) had TOF with pulmonary stenosis.</p><p><strong>Results: </strong>Overall survival at 15 years was 92.9%, with one hospital and two late deaths. Reintervention for RVOT and/or PA lesions was required in 35 patients (83.3%). Surgical reintervention occurred in 26 patients (61.9%), catheter-based reintervention in 29 (69.0%), and both in 20 (47.6%). Freedom from reintervention at 10 years was only 14.3%. Median time to first reintervention was 7.3 months (interquartile range, 4.3-17.8). On multivariable analysis, pulmonary atresia and smaller left pulmonary artery (LPA) size predicted reintervention. Specifically, the pulmonary atresia group had a higher reintervention burden than the pulmonary stenosis group (p=0.005), and each unit increase in LPA z-score reduced the risk of reintervention (p=0.022). An LPA z-score <-2.27 was associated with an increased risk of reintervention.</p><p><strong>Conclusions: </strong>Neonatal TOF repair provides excellent long-term survival but is associated with frequent RVOT and PA reinterventions. Careful preoperative evaluation, particularly of LPA dimensions, may help identify patients at higher risk for reintervention and optimize postoperative management.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume in Targeted Temperature Management Reflects System-Level Quality Rather Than Treatment Effect.","authors":"Jeong Hoon Yang","doi":"10.4070/kcj.2026.0177","DOIUrl":"10.4070/kcj.2026.0177","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":"56 6","pages":"507-508"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality Exercise Alleviates Postprandial Vascular and Metabolic Impairment in Adolescents With Congenital Heart Disease: A Randomized Controlled Crossover Trial.","authors":"Hyun Jeong Kim, Tae Gu Choi, Ho Jeong Min, Kanokwan Bunsawat, Ja-Kyoung Yoon, Woo Hyung Lee, Gi Beom Kim, Jae Gun Kwak, Woong-Han Kim, Sae Young Jae","doi":"10.4070/kcj.2025.0365","DOIUrl":"10.4070/kcj.2025.0365","url":null,"abstract":"<p><strong>Background and objectives: </strong>Adolescents with congenital heart disease (CHD) are at increased cardiovascular risk, exacerbated by high-fat meals (HFMs) and sedentary behavior. While exercise is recommended to mitigate this risk, adherence can be challenging. Virtual reality (VR) exergaming has emerged as a potentially motivating alternative. This study examined whether a single session of VR exergaming could attenuate vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD.</p><p><strong>Methods: </strong>In a randomized crossover design, 10 adolescents with CHD (mean age, 12.6±3.3 years) completed 2 trials after an HFM with 4 hours of sitting: (1) 30 minutes of VR cycling, and (2) uninterrupted sitting. Vascular and metabolic markers were assessed at baseline and 4 hours, including flow-mediated dilation (FMD), augmentation index (AIx), carotid-femoral pulse wave velocity, blood pressure (BP), glucose, lipids, and triglyceride-glucose index (TyG).</p><p><strong>Results: </strong>FMD was preserved in the VR trial and decreased in the sitting trial, with a significant interaction (p=0.008). Systolic BP showed a significant interaction (p=0.022), with reductions observed only after VR exercise. AIx was significantly lower in the VR trial compared with sitting (p=0.002), but no interaction was observed. The postprandial increase in TyG index was attenuated in the VR trial (interaction p=0.040).</p><p><strong>Conclusions: </strong>A single session of VR exergaming attenuated vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD. These findings suggest that VR exergaming may serve as an alternative to traditional exercise for vascular health in CHD.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"481-491"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146226509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of 1-Year Left Ventricular Mass Regression After Aortic Valve Surgery in Severe Aortic Regurgitation.","authors":"Sunghee Park, So-Min Lim, Sahmin Lee, Byung-Joo Sun, Ho Jin Kim, Jong-Min Song, Dae-Hee Kim","doi":"10.4070/kcj.2025.0211","DOIUrl":"10.4070/kcj.2025.0211","url":null,"abstract":"<p><strong>Background and objectives: </strong>Left ventricular reverse remodeling (LVRR) following aortic valve surgery has been associated with improved outcomes in chronic aortic regurgitation (AR), yet its definition remains controversial. This study evaluated the prognostic impact of LVRR using the degree of left ventricular mass index (LVMi) reduction.</p><p><strong>Methods: </strong>We retrospectively analyzed patients undergoing surgery for severe AR at Asan Medical Center between January 2006 and December 2020. LVRR was determined by the degree of LVMi regression at 1 year postoperatively. Patients were categorized into greater (n=315) or lesser (n=248) regression groups based on time-dependent receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality and rehospitalization due to heart failure (HF).</p><p><strong>Results: </strong>Over a median follow-up of 7.58 years, 29 patients (9.2%) in the greater regression group and 51 (20.6%) in the lesser regression group experienced the primary endpoint. Multivariate Cox regression analysis revealed that the greater regression group had a lower risk of mortality or HF rehospitalization (hazard ratio, 0.44; 95% confidence interval, 0.27-0.72). Further analyses identified hypertension as the only clinical predictor of reduced LVRR, while smaller left atrial diameter, larger baseline LVMi, and higher left ventricular ejection fraction were independent echocardiographic predictors of greater LVRR.</p><p><strong>Conclusions: </strong>Greater 1-year postoperative LVMi regression was associated with improved outcomes in chronic AR, particularly by reducing HF-related hospitalizations. While hypertension negatively affected remodeling, favorable baseline echocardiographic profiles, including higher LVMi, preserved left ventricular ejection fraction, and a smaller left atrium, were connected to more significant postoperative LVRR.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"509-522"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Deep Sedation Versus General Anesthesia in Cryoablation for Atrial Fibrillation: Insights From the Korean Heart Rhythm Society Cryoablation Registry.","authors":"Joong Min Lee, Myung-Jin Cha, Chang Hee Kwon, Min Soo Cho, Gi-Byoung Nam, Il-Young Oh, So-Ryoung Lee, Ju Youn Kim, Sung Ho Lee, Junbeom Park, Ki-Hun Kim, Pil-Sung Yang, Jun Hyung Kim, Jaemin Shim, Hong Euy Lim","doi":"10.4070/kcj.2025.0352","DOIUrl":"10.4070/kcj.2025.0352","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal sedation strategy for cryoablation in atrial fibrillation (AF) remains uncertain. We aimed to compare the safety and efficacy outcomes between deep sedation (DS) and general anesthesia (GA) in patients undergoing cryoablation.</p><p><strong>Methods: </strong>We analyzed 2,068 patients from the Korean Heart Rhythm Society Cryoablation Registry who underwent cryoablation for AF between 2018 and 2022. Patients were grouped based on anesthesia method: DS (n=1,390) and GA (n=678). Propensity score matching (1:1) was performed to adjust for baseline differences. The primary outcomes included any recurrence of atrial tachyarrhythmias (ATs) after a 3 month blanking period and procedure-related major complications.</p><p><strong>Results: </strong>The study included 2,068 patients (average age: 61.7±9.7 years; 76.3% male; 57.9% with persistent AF). In the matched cohort, AT recurrence rates were comparable between DS and GA groups (47.1% [n=220] vs. 53.1% [n=225]; p=0.99) during a mean follow-up of 1.2 years. The incidence of major complications was also similar between groups both before (2.8% [n=39] vs. 2.4% [n=16]; p=0.66) and after matching (2.3% [n=15] vs. 2.1% [n=14]; p=1.00). Subgroup analysis based on body mass index (≥30 vs. <30) revealed no significant differences in efficacy and safety outcomes between the DS and GA groups.</p><p><strong>Conclusions: </strong>DS provides a comparable safety and efficacy profile to GA for cryoablation in patients with AF. These findings support the use of DS as a feasible and practical alternative to GA in routine clinical practice.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"466-477"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation/Flutter After Transcatheter Device vs. Surgical Closure of Atrial Septal Defect in a Korean Nationwide Cohort.","authors":"Joong Min Lee, Ye-Jee Kim, Hwa Jung Kim, Young-Sun Park, Min Soo Cho, Myung-Jin Cha, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim","doi":"10.4070/kcj.2025.0487","DOIUrl":"https://doi.org/10.4070/kcj.2025.0487","url":null,"abstract":"<p><strong>Background and objectives: </strong>Atrial fibrillation/flutter (AF/AFL) is a common long-term complication after atrial septal defect (ASD) closure. We compared the incidence of new-onset AF/AFL and clinical outcomes between surgical and device closure.</p><p><strong>Methods: </strong>Using the Korean National Health Insurance Service database (2009-2021), we identified adults undergoing ASD closure without prior atrial arrhythmias. The primary outcome was new-onset AF/AFL. Secondary outcomes included all-cause mortality, ischemic stroke, and catheter ablation. Propensity score (PS) matching was performed to minimize confounding.</p><p><strong>Results: </strong>Among 11,133 patients (3,747 surgical; 7,386 device), 6,310 were included in the PS-matched cohort. During a median follow-up of 5.5 years, the device closure group showed a significantly lower risk of AF/AFL (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.59-0.91) and all-cause mortality (HR, 0.65; 95% CI, 0.52-0.81) compared to the surgical group in the matched cohort. Conversely, the device group was associated with a higher risk of ischemic stroke (HR, 1.50; 95% CI, 1.13-1.98). Catheter ablation for AFL was performed significantly more frequently in the surgical group (12.0% vs. 3.5%, p=0.048). Surgical closure, male sex, heart failure and older age at closure were associated with higher risk of AF/AFL after ASD closure.</p><p><strong>Conclusions: </strong>Among ASD patients without prior AF/AFL, device closure was associated with lower long-term AF/AFL, whereas AFL ablation was performed more frequently after surgical closure.</p><p><strong>Trial registration: </strong>Clinical Research Information Service Identifier: KCT0010486.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}