| 1. |
- Jensen-Urstad, K, et al.
(författare)
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Heart rate variability in healthy subjects is related to age and gender.
- 1997
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Ingår i: Acta Physiologica Scandinavica. - 0001-6772 .- 1365-201X. ; 160:3, s. 235-41
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Tidskriftsartikel (refereegranskat)abstract
- The effects of age and gender on heart rate variability as measured by spectral and time domain analysis of 24 h ECG recordings were evaluated in 101 healthy subjects, 49 men and 52 women (20-69 years of age). In the frequency domain, total power, very low-frequency power, low-frequency power and high-frequency power were negatively correlated to age (P < 0.001 for all variables). Total power decreased by 30% between 20-29 and 60-69 years of age. In the time domain, SDNN-index, the mean of the standard deviations of all normal R-R intervals for all 5 min segments of a 24 h ECG recording, was negatively correlated to age (P < 0.001). Total power, very low-frequency power, low-frequency power and the low-frequency/high-frequency ratio were lower in women (P < 0.05, P < 0.05, P < 0.01 and P < 0.01), although the absolute differences were much smaller than for age. There was a pronounced circadian variation; at night total power increased in all age groups (P < 0.01). The results show that age, and to a lesser degree gender, are important determinants of heart rate variability in healthy subjects. Heart rate variability is a valuable tool for risk stratification in cardiovascular disease, but the physiological effects of ageing, with diminishing heart rate variability in older age groups, must also be taken into account.
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| 2. |
- Jensen-Urstad, K, et al.
(författare)
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Pronounced resting bradycardia in male elite runners is associated with high heart rate variability.
- 1997
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 7:5, s. 274-8
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Tidskriftsartikel (refereegranskat)abstract
- Forty-eight hour Holter monitoring was undertaken of 16 male elite middle- and long-distance runners, age 25 +/- 3 years, with peak oxygen uptake 4.83 +/- 0.43 1 O2/min or 73.0 +/- 3.9 ml O2/kg/min. The athletes had pronounced bradycardia during the night-time, with heart rate calculated from four RR intervals < 30 beats/min in five runners. Twelve of 16 runners had RR intervals > 2 s. Of those, 10 runners had sinus pauses exceeding 2 s, the longest being 3.06 s. Three runners had AV block II, two with Mobitz type 1, and one with both Mobitz type 1 and 2. Autonomic function was estimated by time domain and power spectral analysis of heart rate variability. The runners were compared with a control group of 13 sedentary or moderately active subjects. The runners had a mean of 14 b.p.m. lower heart rate at night than the controls. The runners had higher heart rate variability in all spectral bands. In the time domain pNN50 and rMSSD, which are considered to reflect strongly vagal tone, were markedly higher in the runners than the controls. The findings suggest that an increased parasympathetic tone might at least partly explain the pronounced resting sinus bradycardias found in endurance-trained runners.
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| 3. |
- Jensen-Urstad, M, et al.
(författare)
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Heart rate variability is related to leucocyte count in men and to blood lipoproteins in women in a healthy population of 35-year-old subjects.
- 1998
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Ingår i: Journal of Internal Medicine. - 0954-6820 .- 1365-2796. ; 243:1, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate if, in a healthy randomly-selected population of 35-year-old men and women, there already is a relation between decreased heart rate variability and conventional risk factors for cardiovascular disease. BACKGROUND: Analysis of heart rate variability (HRV) has been used for estimating tonic autonomic activity. HRV is reduced in patients with various cardiovascular diseases. If a decreased HRV is a late phenomenon in the progression of cardiovascular disease, or if it parallels or even precedes manifest disease is unknown. DESIGN: Spectral analysis of HRV was made from 24-hour ambulatory electrocardiograms in a randomised population of healthy 35-year-old men (n = 63) and women (n = 70). The different spectral indices of HRV were analysed against gender, leucocyte count (previously described as an independent risk factor for cardiovascular disease), blood lipoproteins, smoking, heredity, body mass index (BMI) and systolic blood pressure. SETTING: A research centre of general medicine and a university hospital. RESULTS: Mean heart rate was lower, total power (TP), very low frequency power (VLF) and low frequency power (LF) were higher in men than in women. In women TP, VLF and LF were negatively correlated to BMI, smoking, triglycerides and positively correlated to HDL cholesterol. TP and VLF were also negatively correlated to risk factor score. High frequency power (HF), a marker of parasympathetic activity, was positively related to HDL cholesterol. In men, at daytime, TP, VLF, LF and HF were negatively correlated to leucocyte count. TP, VLF and LF were also negatively correlated to triglycerides and VLF also to risk factor score. CONCLUSIONS: There are correlations between HRV and known risk factors for cardiovascular disease already in a healthy 35-year-old population. A novel observation is the relationship in men between leucocyte count and heart rate variability.
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| 4. |
- Reichard, P, et al.
(författare)
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Autonomic neuropathy--a complication less pronounced in patients with Type 1 diabetes mellitus who have lower blood glucose levels.
- 2000
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 17:12, s. 860-6
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Autonomic neuropathy is a serious diabetic complication, probably contributing to the death of many young people with Type 1 diabetes mellitus. It is often not diagnosed. METHODS: Patients with Type 1 diabetes from the Stockholm Diabetes Intervention Study were investigated with power spectral analysis (n = 88), heart rate and blood pressure reactions to tilting (n = 66), and heart rate variability during deep breathing (n = 70) a mean of 11.4 years after randomization to intensified conventional treatment (ICT) or standard treatment (ST), the treatment groups similar with regard to age, duration of diabetes and metabolic control at baseline (HbA1c 9.4 (1.3)%, mean (SD)). Blood glucose levels (mean of 29 HbA1c values) during the 10 years were lower in the patients from the ICT group (7.2 (0.6) vs. 8.3 (1.0)%, P = 0.001). RESULTS: Heart rate variability (HRV) in the high frequency range (P = 0.034), the expiration-inspiration ratio (P = 0.020), and the brake index during tilt (P = 0.044) were lower in the ST group, indicating more pronounced parasympathetic insufficiency. Systolic blood pressure fell by 10 (16) mmHg in the ST group, and by 2.5 (15) mmHg in the ICT group 8 min after rising from the supine to a 70 degrees upright position (P = 0.034). A decreased autonomic function was associated with age and higher HbA1c. CONCLUSION: Better autonomic nerve function is associated with lower HbA1c and lower age which were both the same in the intensively and the conventionally treatment groups at baseline. After a mean of 11.4 years autonomic function was better in the intensively treated group.
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| 5. |
- Braunschweig, Frieder, et al.
(författare)
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Paroxysmal regular supraventricular tachycardia: the diagnostic accuracy of the transesophageal ventriculo-atrial interval.
- 2011
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Ingår i: Annals of Noninvasive Electrocardiology. - 1542-474X. ; 16:4, s. 327-335
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To establish the diagnostic accuracy of the transesophageal ventriculo-atrial (VA) interval in patients with paroxysmal supraventricular tachycardia (PSVT) and normal baseline electrocardiogram (ECG). Methods: The transesophageal VA interval during tachycardia was recorded in 318 patients (age 45 ± 17 years, 58% female) with PSVT and a normal surface ECG between attacks. Subsequently, all patients underwent an ablation procedure establishing the correct tachycardia diagnosis. Results: AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia through a concealed accessory pathway (AVRT), and ectopic atrial tachycardia (EAT) were found in 213, 95, and 10 cases, respectively. Receiver operating characteristic curve analysis identified an optimal cutoff for a binary categorization of AVNRT versus AVRT/EAT at ≤80 ms (area under the curve 0.891). Owing to a biphasic distribution, AVNRT was very likely at VA intervals ≤90 ms with a sensitivity, specificity, and positive predictive value (PPV) of 87%, 91%, and 95%. In the range 91–160 ms the corresponding values for AVRT were 88%, 95%, and 88% (90%, 99%, and 98% in male patients). In the small group with VA intervals >160 ms (n = 29), the diagnosis was less clear (PPV of 67% for AVNRT). Conclusions: In patients with sudden onset regular tachycardia and a normal ECG during sinus rhythm, a transesophageal VA interval of ≤80 ms has the highest diagnostic accuracy to diagnose AVNRT versus AVRT/EAT. Overall, the biphasic distribution of VA intervals suggests considering AVNRT at 90 ms and below and AVRT between 91 and 160 ms (in particular in male patients) while the diagnosis is vague at VA intervals above 160 ms.
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| 6. |
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| 7. |
- Kesek, Milos, et al.
(författare)
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Entrapment of circular mapping catheter in the mitral valve
- 2007
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Ingår i: Heart rhythm : the official journal of the Heart Rhythm Society. - New York, NY : Elsevier. - 1547-5271. ; 4:1, s. 17-19
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ablation procedures in the left atrium for treatment of atrial fibrillation are becoming increasingly common. The procedure often involves placing one or two circular mapping catheters in the left atrium. Entrapment of an ablation catheter in the mitral valve during ablations of left-sided accessory pathways by the retrograde approach has been described in two earlier published reports. More recently, several reports describe similar entrapment of a mapping catheter. In a recently published review, however, only one case of unspecified valve damage was registered among 8745 atrial fibrillation procedures. OBJECTIVE: The purpose of this study was to evaluate patients with entrapment. METHODS: Retrospective analysis of electrophysiological results. RESULTS: We describe three patients with entrapment during ablations for atrial fibrillation. The entrapments occurred with three different operators at three different electrophysiological laboratories within 2 years. The complication described here may be more common than is widely appreciated. CONCLUSIONS: From our figures, we estimate the incidence of the complication to 0.9% (95% confidence interval, 0.2-2.5%).
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| 8. |
- Akerstrom, Finn, et al.
(författare)
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Association between catheter ablation of atrial fibrillation and mortality or stroke
- 2024
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Ingår i: Heart. - : BMJ PUBLISHING GROUP. - 1355-6037 .- 1468-201X. ; 110, s. 163-169
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Tidskriftsartikel (refereegranskat)abstract
- Objective Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. Methods We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. Results Patients who underwent catheter ablation were healthier (mean CHA(2)DS(2)-VASc score 1.4 +/- 1.4 vs 1.6 +/- 1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5 +/- 2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). Conclusions Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.
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| 9. |
- Carnlöf, Carina, et al.
(författare)
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Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment
- 2010
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 9:1, s. 45-49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF.Aims: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation.Methods: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used.Results: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered.Conclusion: HRQOL is improved in AF patients with severe symptoms after PVI intervention.
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| 10. |
- Drca, Nikola, et al.
(författare)
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Atrial fibrillation is associated with different levels of physical activity levels at different ages in men
- 2014
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Ingår i: Heart. - : BMJ PUBLISHING GROUP. - 1355-6037 .- 1468-201X. ; 100:13, s. 1037-1042
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study examines the influence of physical activity at different ages and of different types, on the risk of developing atrial fibrillation (AF) in a large cohort of Swedish men. Methods Information about physical activity was obtained from 44 410 AF-free men, aged 45-79 years (mean age=60), who had completed a self-administered questionnaire at baseline in 1997. Participants reported retrospectively their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at 15, 30 and 50 years of age, and at baseline (mean age=60)). Participants were followed-up in the Swedish National Inpatient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CIs, adjusted for potential confounders. Results During a median follow-up of 12 years, 4568 cases of AF were diagnosed. We observed a RR of 1.19 (95% CI 1.05 to 1.36) of developing AF in men who at the age of 30 years had exercised for >5 h/week compared with <1 h/week. The risk was even higher (RR 1.49, 95% CI 1.14 to 1.95) among the men who exercised >5 h/week at age 30 and quit exercising later in life (<1 h/week at baseline). Walking/bicycling at baseline was inversely associated with risk of AF (RR 0.87, 95% CI 0.77 to 0.97 for >1 h/day vs almost never) and the association was similar after excluding men with previous coronary heart disease or heart failure at baseline (corresponding RR 0.88, 95% CI 0.77 to 0.998). Conclusions Leisure-time exercise at younger age is associated with an increased risk of AF, whereas walking/bicycling at older age is associated with a decreased risk.
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