News & Announcements
Title Surpassing the 5,000 Mark in Catheter Ablation for Atrial Fibrillation for the First Time in Korea
The Arrhythmia Clinic of Korea University Anam Hospital did not start as the best clinic in the area. On the contrary, it was harshly blamed by other hospitals while the Health Insurance Review and Assessment Service asked if such a procedure is really necessary.
Two decades later, however, the clinic is recommended in unison as the best in Korea as well as the “quaternary” clinic for arrhythmia patients. The atmosphere in the medical community has changed completely.
Now, the clinic has reached a 5,000 mark in catheter ablation for atrial fibrillation. It took 23 years from the year 1998 when it introduced the medical procedure. The figure 5,000 over 23 years may sound like no big deal, but it is quite an achievement when considering that KUAH has not been one of the biggest four or five hospitals in Korea.
To celebrate the remarkable work of the hospital, the Whosaeng Shinmun met with Professor Jong-il Choi, the clinic’s leader. After explaining how his clinic achieved such a feat, he talked about how he felt and what his next goal was. Below is an excerpt of the interview.
Q. Korea University Anam Hospital is called the “quaternary” hospital in arrhythmia. And the Arrhythmia Clinic has performed catheter ablation on 5,000 patients with atrial fibrillation. How do you feel?
Professor Choi Jong-il: Arrhythmia was the condition that you had to live with before we introduced catheter ablation. As a pioneer, we were blamed by those who doubted its necessity. We were even visited by an inspection team of the Health Insurance Review and Assessment Service. Overcoming these difficulties, my dedicated staff members have reached the 5,000 mark. You may think it's not a big deal, but KUAH is not one of the biggest five Korean hospitals. I am very proud of this achievement.
I am not only talking about the figure 5,000. AFib is a progressive disease, thereby each patient has a different treatment success rate. My clinic has successfully treated over 90 percent of people with paroxysmal AFib while 75 to 80 percent of those with chronic persistent AFib. (For AFib, success indicates living without medication for a year)
Meanwhile, the focus of today is on early detection rather than the recurrence rate. The earlier the procedure is performed, the higher the success rate. Undergoing the procedure right after early detection grants most patients lives without drugs, while any delay lowers the possibility of success.
Q: I suspect that there have been many changes in the system over the years.
Professor Choi: Let me be honest. Improving the records and writing papers were the priority at first. However, we began to build a system of doctors, nurses, and technicians working together in steps with advancements including standardized ablation and three-dimensional virtual mapping. Now we treat almost all patients safely without complications.
Above all things, we have experience and skills that really do shine when treating tricky cases failed at other hospitals. We have reduced the time of the procedure. Also, 30 percent of our patients are recurrent cases. I think all these combined contributed to our nickname, the “quaternary” hospital in arrhythmia.
Our arrhythmia center accounts for 10-15% of all arrhythmia procedures in Korea. However, it is the 1st or 2nd hospital that performs the most procedures. This also means that atrial fibrillation electrode catheter ablation has been standardized. However, in the case of difficult surgery such as recurrence, we pride ourselves on being the best in the country.
Q: There must have been a dramatic moment during the treatment process.
Professor. Choi: The mortality rate from cerebral infarction during and after the procedure is high. In some cases, the esophagus is unavoidably affected. Side effects of fistula in the atrial procedure close to the esophagus may occur. It is important to proceed with the procedure while taking good care of it so that it does not occur. If necessary, endoscopy is performed and medications are prescribed.
The dramatic case I experienced was a case where the heart was torn, but I did it properly and ended up with no problems. Failure to do so could result in losing the patient. The most important thing is not to have any problems, but even if there is a problem, it needs to be dealt with quickly and, in particular, to quickly determine whether collaboration with a surgeon is necessary and to take action. It wasn't initially, but now there are few complications. This is what sets us apart from other hospitals.
Q: I know that many medical staff at domestic arrhythmia centers received training at Korea University Anam Hospital.
Professor Choi: Our center is doing about 500 cases a year. We can't all do it. We can only support it through education and research. In particular, almost 20 medical staffs in hospitals nationwide received the training from our hospital. Internationally, around 30 medical staff have been trained by our hospital and they are from Japan, China, and the Asia-Pacific region, for as little as 1 year and as long as 3 years. More than 150 SCI-level research papers have been published so far.
Q; What is the most important thing in the treatment of arrhythmias?
Professor Choi: It is an early detection, early treatment. Early detection and treatment results in good results. For this reason, early diagnosis and treatment are an issue these days. Nevertheless, there are many cases of late arrivals through medical examinations or after outpatient visits to oriental medicine clinics.
Electrocardiography in a stable state is basic, and it is important to find a patient by all means.
For the diagnosis of atrial fibrillation, it is good for everyone, but it is good to do an electrocardiogram for people over 65 years old. It is recommended that people over 75 years of age monitor twice a week at intervals of 2 weeks.
In this regard, it is hoped that the medical system will change in the arrhythmia field as long-term monitoring is possible with the wearable electrocardiogram device, Holter, and ICT is also prepared.
In addition, I am grateful that the government is paying more attention to the insurance fee of arrhythmias compared to other fields. If there is a disappointment, there are cases where the standard is not met by just testing, and the defibrillator is reduced. I hope that the clinical judgment of the doctor will be respected.
Q: What are the future goals of the Arrhythmia Center?
Professor Choi: 5,000 cases have been performed in 20 years. There is a saying that if you do something 10,000 hours, anything could be achieved. I can confidently say that the procedures on arrhythmia can be performed as safe and effective as I can. It is to fulfill the role of the 4th hospital for arrhythmia, and I am fully experienced and confident.
In addition, it has been doing well in the past and is doing well now, and in the future, we plan to further improve the atrial fibrillation procedure through clinical practices.
It is also very important to train junior medical staff. I was lucky (laughs) to be trained under a good teacher (Professor Kim Young-hoon), and I want to work with people who share the same vision. There's too much works to be done. We will create and share good programs. Personally, my philosophy in treating patients is twofold: compassion and the saying ‘put yourself in someone else’s shoes’. I may not be satisfied because I know a little more than other people, but I want to solve problems. In addition, I’m eager to listen to the story of the first-time patients even if that exceed so called, ‘the 3-minute consultation, by setting up the specialized clinic for arrhythmia.