| 1. |
- Arvanitis, Panagiotis, et al.
(författare)
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Recent-onset atrial fibrillation : a study exploring the elements of Virchow's triad after cardioversion
- 2022
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 64:1, s. 49-58
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Tidskriftsartikel (refereegranskat)abstract
- PurposeAtrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF.MethodsPatients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels.ResultsForty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without.ConclusionAlthough LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients.
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| 2. |
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| 3. |
- Boehmer, John P, et al.
(författare)
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Adjudication of mortality events in a heart failure-arrhythmia trial by a multiparameter descriptive method: comparison with methods used in heart failure trials and methods used in arrhythmia trials.
- 2008
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1383-875X. ; 23:2, s. 101-10
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Mortality events in studies of cardiovascular disease are currently adjudicated using different methodologies depending on the investigators' preferences. Traditionally, deaths have been categorized by a single term, such as sudden, ischemic, or pump failure, a method that can be referred to as "categorical". In contrast, deaths may be categorized using several specific pieces of information about the event, a method that can be referred to as "multiparameter descriptive." Herein, we describe an adaptation of this descriptive method in a trial of patients with heart failure and arrhythmias. METHODS AND RESULTS: Case examples were selected from two clinical trials of an investigational implantable cardioverter-defibrillator (ICD)-biventricular pacing system in patients with symptomatic heart failure and a class I indication for ICD implantation, and the complete results for one of the trials are given. Deaths were classified according to the new descriptive method, and also according to published categorical methods for heart failure and arrhythmia trials. The descriptive method preserved traditional arrhythmia and heart failure trial single category classifications of death. Furthermore, there was agreement between the arrhythmia and heart failure category classifications in 126 of the 148 of the mortality events adjudicated (85%). CONCLUSION: A descriptive method for the classification of death retains more data and allows for comparison among trials using different classification schemes. This may allow greater mechanistic insight into study populations that have diverse and frequently multiple etiologies of death.
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| 4. |
- Borgquist, Rasmus, et al.
(författare)
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Maximizing QRS duration reduction in contemporary cardiac resynchronization therapy is feasible and shorter QRS duration is associated with better clinical outcome
- 2023
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1572-8595. ; 66:8, s. 1799-1806
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWe aimed to evaluate if optimization by maximizing QRS duration (QRSd) reduction is feasible in an all-comer cardiac resynchronization therapy (CRT) population, and if reduced, QRSd is associated with a better clinical outcome.MethodsPatients with LBBB receiving CRT implants during the period 2015–2020 were retrospectively evaluated. Implants from 2015–2017 were designated as controls. Starting from 2018, an active 12-lead electrogram-based optimization of QRSd reduction was implemented (intervention group). QRSd reduction was evaluated in a structured way at various device AV and VV settings, aiming to maximize the reduction. The primary endpoint was a composite of heart failure hospitalization or death from any cause.ResultsA total of 254 patients were followed for up to 6 years (median 2.9 [1.8–4.1]), during which 82 patients (32%) reached the primary endpoint; 53 deaths (21%) and 58 (23%) heart failure hospitalizations. Median QRS duration pre-implant was 162 ms [150–174] and post-implant 146ms [132–160]. Mean reduction in QRS duration was progressively larger for each year during the intervention period, ranging from − 9.5ms in the control group to − 24 in the year 2020 (p = 0.005). QRS reduction > 14 ms (median value) was associated with a lower risk of death or heart failure hospitalization (adjusted HR 0.54 [0.29–0.98] (p = 0.04).ConclusionsImplementing a general strategy of CRT device optimization by aiming for shorter QRS duration is feasible in a structured clinical setting and results in larger reductions in QRS duration post-implant. In patients with a larger QRS reduction, compared to those with a smaller QRS reduction, there is an association with a better clinical outcome.
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| 5. |
- Hill, JA, et al.
(författare)
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Medical misinformation: vet the message!
- 2019
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1572-8595. ; 55:1, s. 1-3
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Härdén, Marie, et al.
(författare)
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Responsiveness of AF6, a new, short, validated, atrial fibrillation-specific questionnaire--symptomatic benefit of direct current cardioversion.
- 2010
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1572-8595. ; 28:3, s. 185-191
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To measure the effects on symptoms of electrical cardioversion (DC) in patients with atrial fibrillation (AF) by means of a new, short, validated, AF-specific questionnaire, the AF6. Methods One hundred eleven patients (67 ± 12 years, 89 men) were screened before and 12 ± 3 days after DC using AF6, covering ‘breathing difficulties at rest’, ‘breathing difficulties on exertion’, ‘limitations in day-to-day life due to atrial fibrillation’, ‘feeling of discomfort due to atrial fibrillation’, ‘tiredness due to atrial fibrillation’, and ‘worry/anxiety due to atrial fibrillation’. A single global score was calculated. The Toronto AF Symptoms and Severity Check List (AFSS) and the generic SF-36 were also administered. Patients in sinus rhythm at 12 ± 3 days (n = 56) were defined as responders and patients in AF (n = 55) as non-responders. Results The mean single global score decreased in all patients (18 ± 12.4 to 13 ± 11.6, p < 0.0001) and in responders (22 ± 14 vs. 12 ± 12, p < 0.01) but not in non-responders (14 ± 9 vs. 14 ± 11, N.S). The AFSS frequency scores decreased from 14.5 ± 7.7 to 9.5 ± 7.8 in responders, p = 0.001, but not in non-responders. There was a strong correlation between changes in the AF6 and the SF-36 regarding four of the six items. Effect sizes of AF6 ranged from 0 to 0.52 in all patients, in responders from 0.10 to 0.85 and in non-responders from −0.23 to 0.34, the highest figures consistently referring to ‘tiredness due to atrial fibrillation’. Conclusions The symptom scores measured by AF6 decreased significantly, especially in responders. AF6 demonstrated adequate responsiveness to change, and effect sizes were mostly moderate, in responders moderate to high.
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| 7. |
- Jemtrén, Anette, et al.
(författare)
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Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation.
- 2022
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1572-8595. ; 65:1, s. 193-199
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Tidskriftsartikel (refereegranskat)abstract
- Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation.This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36±17years with a range of 3-89years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization.A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤250ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P=0.40) as was the mean APERP (303±68ms vs. 307±75) (P=0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P<0.001).The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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| 8. |
- Johansson, Birgitta, et al.
(författare)
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Atrial function after left atrial epicardial cryoablation for atrial fibrillation in patients undergoing mitral valve surgery
- 2012
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science+Business Media B.V.. - 1383-875X .- 1572-8595. ; 33:1, s. 85-91
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore the effects on atrial and ventricular function of restoring sinus rhythm (SR) after epicardial cryoablation and closure of the left atrial appendage (LAA) in patients with mitral valve disease and atrial fibrillation (AF) undergoing surgery.METHODS: Sixty-five patients with permanent AF were randomized to mitral valve surgery combined with left atrial epicardial cryoablation and LAA closure (ABL group, n = 30) or to mitral valve surgery alone (control group, n = 35). Two-dimensional and Doppler echocardiography were performed before and 6 months after surgery.RESULTS: At 6 months, 73% of the patients in the ABL group and 46% of the controls were in SR. Patients in SR at 6 months had a reduction in their left ventricular diastolic diameter while the left ventricular ejection fraction was unchanged. In patients remaining in AF, the left ventricular ejection fraction was lower than at baseline. The left atrial diastolic volume was reduced after surgery, more in patients with SR than AF. In patients in SR, the peak velocity during the atrial contraction and the reservoir function were lower in the ABL group than in the control group.CONCLUSIONS: In patients in SR, signs of atrial dysfunction were observed in the ABL but not the control group. Atrial dysfunction may have existed before surgery, but the difference between the groups implies that the cryoablation procedure and/or closure of the LAA might have contributed.
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| 9. |
- Källner, Nils, et al.
(författare)
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Predictors of rate-adaptive pacing in patients implanted with implantable cardioverter-defibrillator and subsequent differential clinical outcomes
- 2019
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : SPRINGER. - 1383-875X .- 1572-8595. ; 55:1, s. 83-91
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Tidskriftsartikel (refereegranskat)abstract
- PurposePatients with severe cardiomyopathy often have chronotropic incompetence, which is predominantly managed by activating rate-adaptive pacing in patients implanted with an implantable cardioverter-defibrillator (ICD) capable of atrial pacing. The purpose of this study was to determine predictors of rate-adaptive pacing activation, the cumulative incidence of activation, and the association of rate-adaptive pacing activation with subsequent clinical outcomes in an ICD population.MethodsThe authors evaluated 228 patients implanted with an ICD between 2011 and 2015. Multivariable logistic regression was used to evaluate predictors of rate-adaptive pacing activation. Cox proportional-hazards regression was used to examine associations of rate-adaptive pacing activation and clinical outcomes.ResultsRate-adaptive pacing was turned on in 38.5% (n=88) of patients during follow-up. Several statistically significant predictors of rate-adaptive pacing activation were found, particularly previous atrial fibrillation (odds ratio [OR]=8.27, 95% confidence interval [CI]=2.96-23.06, pamp;lt;0.001), previous myocardial infarction (OR=4.17, 95% CI=1.38-12.58, p=0.01), and non-ischemic cardiomyopathy (OR=3.83, 95% CI=1.22-12.00, p=0.02). In multivariable adjusted analyses, rate-adaptive pacing activation within 30days of implantation was not associated with the risk of device therapy for tachyarrhythmias (hazard ratio [HR]=1.52, 95% CI=0.71-3.28, p=0.29), atrial fibrillation (HR=1.42, 95% CI=0.71-2.87, p=0.32), HF re-admission (HR=1.39, 95% CI=0.80-2.43, p=0.25), nor all-cause mortality (HR=2.34, 95% CI=0.80-6.84, p=0.12).ConclusionsDuring follow-up, more than one in three HF patients implanted with an ICD developed the need for rate-adaptive pacing. Atrial fibrillation, prior myocardial infarction, and non-ischemic cardiomyopathy were statistically significant baseline clinical predictors of rate-adaptive pacing activation. Rate-adaptive pacing activation was not associated with subsequent adverse clinical outcomes.
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| 10. |
- Labori, Frida, et al.
(författare)
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Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment-a systematic review and meta-analysis
- 2021
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 61:2, s. 215-225
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The recommended stroke prevention for patients with atrial fibrillation (AF) and increased risk of ischemic stroke is oral anticoagulation (OAC). Parts of the patient population are not eligible due to contraindication, and percutaneous left atrial occlusion (LAAO) can then be a preventive treatment option. The aim of this systematic review and meta-analysis is to estimate the long-term clinical effectiveness of LAAO as stroke prevention in patients with AF, increased risk of ischemic stroke, and contraindication to OAC. Methods We performed a systematic review and meta-analysis, using Poisson random effect models, to estimate the incidence rate (events per 100 patient-years) of ischemic stroke, transient ischemic attack, major bleeding, and all-cause death after LAAO treatment. We also calculated the risk reduction of ischemic stroke with LAAO compared with no stroke prevention estimated through a predicted risk in an untreated population (5.5 per 100 patient-years). Results We included 29 observational studies in our meta-analysis, including 7 951 individuals and 12 211 patient-years. The mean CHA(2)DS(2)-VASc score among the patients in the included studies is 4.32. The pooled incidence rate of ischemic stroke is 1.38 per 100 patient-years (95% CI 1.08; 1.77). According to a meta-regression model, the estimated incidence rate of ischemic stroke at CHA(2)DS(2)-VASc 4 is 1.39 per 100 patient-years. This implies a risk reduction of 74.7% with LAAO compared to predicated risk with no stroke prevention. Conclusions Our results suggest that LAAO is effective as stroke prevention for patients with AF, increased risk of stroke, and contraindication to oral anticoagulation.
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| 11. |
- Liuba, Ioan, et al.
(författare)
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Activation mapping of focal atrial tachycardia : the impact of the method for estimating activation time
- 2009
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer. - 1383-875X .- 1572-8595. ; 26:3, s. 169-180
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Tidskriftsartikel (refereegranskat)abstract
- PurposeDifferent methods can be used to estimate activation time during the mapping of focal atrial tachycardia. The present study aimed to compare activation maps generated by three widely used methods of determining activation time.MethodsFourteen patients (mean age 48 ± 17 years) with focal atrial tachycardia were investigated. Mapping was performed with the CARTO system. All patients underwent successful ablation. Local activation time was successively defined as the peak amplitude (Bi-peak), the steepest downslope (Bi-dslope), and the onset (Bi-on) of the bipolar electrograms.ResultsThe three methods of activation time determination were highly correlated with one another but generated foci with different locations. The distances between the foci generated by the different methods were 4.36 ± 4.91 mm (Bi-peak–Bi-dslope), 7.21 ± 5.11 mm (Bi-peak–Bi-on), and 7.21 ± 5.87 mm (Bi-dslope–Bi-on) (p = 0.26). Also, the three methods generated foci with different diameters: 3.13 ± 2.17 mm for Bi-peak, 2.81 ± 0.78 for Bi-dslope, and 2.54 ± 0.14 mm for Bi-on (p = 0.60). However, the foci tended to cluster within relatively wide regions of low-amplitude fractionated electrograms. The surface of these regions was 3.81 ± 2.34 cm2 (Bi-peak), 3.38 ± 2.12 cm2 (Bi-dslope), and 4.76 ± 3.01 cm2 (Bi-on) (p = 0.34).ConclusionThe three methods of activation time determination, although highly correlated with one another, may generate foci of different sizes and in different locations. However, the foci tend to cluster within relatively large areas of low-amplitude fractionated electrograms. These findings suggest a sizeable atrial region with particular electrophysiological proprieties and raise the possibility of an anatomical substrate of the tachycardia. During mapping, this region can be roughly delineated by all three methods of activation time estimation. However, details concerning the activation pattern within the region and the location of the focus vary among the methods.
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| 12. |
- Malmborg, Helena, et al.
(författare)
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A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter
- 2009
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 24:2, s. 127-31
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Although radiofrequency (RF) energy is routinely used for tricuspid isthmus (TI) ablation, it is often associated with discomfort. The paucity of studies comparing the feasibility and efficacy of cryo- versus RF energy for TI-ablation urged us to conduct a prospective, randomised trial. METHODS: Forty patients with atrial flutter (AFl) were randomised to RF- or cryoenergy for TI-ablation. Perceived pain was scored from 1 to 10 on a Visual Analogue Scale. RESULTS: Significantly lower pain scores were recorded for cryoablation versus RF ablation (0.96 +/- 0.73 versus 4.2 +/- 2.4, p = 0.00004). Cryoablation was associated with significantly longer procedure duration and ablation time (137 +/- 35 versus 111 +/- 29 min, p = 0.016 and 81 +/- 40 versus 48 +/- 30 min, p = 0.007) and lower acute success rate (56% versus 100%, p = 0.001) than RF ablation. The recurrence of AFl was 20% (cryo) versus 15% (RF; p = 0.45) after a mean of 15.1 months follow-up. CONCLUSION: Cryoablation results in significantly less pain and discomfort compared to RF ablation of AFl, which is offset by the significantly lower acute success rate.
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| 13. |
- Nault, Isabelle, et al.
(författare)
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Clinical value of fibrillatory wave amplitude on surface ECG in patients with persistent atrial fibrillation
- 2009
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1572-8595 .- 1383-875X. ; 26:1, s. 11-19
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Tidskriftsartikel (refereegranskat)abstract
- We postulated that amplitude of fibrillatory (F)-wave in patients with persistent AF would correlate with clinical characteristics and outcome in patients undergoing catheter ablation for AF. Maximal and mean amplitude of F-waves were measured in V1 and lead II in 90 patients prior to ablation for persistent AF. F-wave amplitudes were correlated to clinical, echocardiographic variables, and outcome. F-wave a parts per thousand yenaEuro parts per thousand 0.1 mV in lead II and V1was correlated with younger age and shorter AF history, and in lead II only was correlated with a smaller left atrium. Higher F-wave amplitude at baseline predicted AF termination during ablation. Maximal amplitude of a parts per thousand yenaEuro parts per thousand 0.07 mV predicted AF termination by ablation with 82%/79% sensitivity and 68%/73% specificity in V1/lead II respectively. An association between F-wave amplitude and AF recurrence was observed. Forty-three percent of patients with mean f wave amplitude < 0.05 in lead V1 had AF recurrence compared to 12% of those with F-wave a parts per thousand yenaEuro parts per thousand 0.05 (p = 0.004). Longer AF duration, older age and larger LA size are associated with fine AF amplitude. High F-wave amplitude predicts procedural termination of arrhyhmia in patients with persistent AF and freedom from AF upon follow-up.
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| 14. |
- ONeill, Mark D, et al.
(författare)
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The stepwise ablation approach for chronic atrial fibrillation - evidence for a cumulative effect
- 2006
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 16, s. 153-167
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Tidskriftsartikel (refereegranskat)abstract
- Treatment options for atrial fibrillation (AF) have evolved from simple, fluoroscopy-guided pulmonary vein isolation for those patients with paroxysmal AF to complex, multi-modality procedures targeting not only anatomic structures but also electrophysiologic phenomena including complex fractionated electrograms, sites of dominant frequency and local non-venous drivers in patients with persistent and permanent AF. The stepwise ablation approach is a novel technique whereby structures contributing to initiation and maintenance of AF are sequentially targeted by radiofrequency ablation. Broadly divided into pulmonary veins, left atrial (LA) roof, left atrium (incorporating all anatomic regions of the chamber), mitral isthmus and non-LA structures, each region is targeted in sequence and the impact of ablation upon the global fibrillatory process assessed by measurement of AF cycle length (AFCL) at a site remote from the ablation target. In addition to pulmonary vein electrical disconnection and demonstrable complete conduction block across the roof and mitral isthmus lines (when performed), ablation is performed at those sites displaying continuous electrical and complex fractionated activity, with the endpoint of local organization, as well as at sites displaying electrograms consistent with focal sources driving AF. Ablation is accompanied by a cumulative increase in the AFCL prior to termination of AF by conversion either directly to sinus rhythm or to an atrial tachycardia which is then mapped conventionally and ablated. There is a ceiling of ablation within the LA beyond which further ablation is unlikely to result in a clinical benefit and should prompt evaluation of the contribution of the right atrium to maintenance of AF. The stepwise approach benefits from the integration of anatomic and electrophysiologic information to achieve a high level of success in termination of chronic AF by catheter ablation.
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| 15. |
- Ostrowska, Bozena, et al.
(författare)
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A novel variant in plakophilin-2 gene detected in a family with arrhythmogenic right ventricular cardiomyopathy
- 2012
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 34:1, s. 11-18
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement of muscular fibers predominantly in the right ventricle and with ventricular arrhythmias as the main clinical manifestation. Mutations in several components of the desmosome genes have been identified and mutations of the plakophilin-2 (PKP-2) gene are a common cause of ARVC. The aim of this study is to investigate the correlation between genotype and phenotype in a family with a novel PKP-2 variant.METHODS AND RESULTS: This study describes the clinical findings and genetic analysis in a family with ARVC. A part of the family has been followed clinically long term for up to 27 years. Two not previously reported PKP-2 variants (L506P and T526A) have been identified in this family. Even though all members of this family share the novel variant L506P, the clinical features, i.e., their phenotypes are different. The L506P variant is located in exon 7 and affects a highly conserved residue. The same amino acid, leucine, is present in all species evaluated, indicating a functional importance and the variant is predicted to be damaging. The novel L506P variant in the PKP-2 gene is thus a possible pathogenic alteration in the described family with ARVC. In contrast, the T526A variant is weakly conserved and predicted to be tolerated.CONCLUSION: While many of the reported ARVC mutations are truncating mutations, the possibly damaging variant found in this family, is a missense alteration affecting a highly conserved residue 506 located in exon 7.
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| 16. |
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| 17. |
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| 18. |
- Sciaraffia, Elena, 1977-, et al.
(författare)
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The reliability of cardiogenic impedance and correlation with echocardiographic and plethysmographic parameters for predicting CRT time intervals post implantation
- 2013
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 37:2, s. 155-162
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Tidskriftsartikel (refereegranskat)abstract
- AimsEncouraging data have been reported on the use of cardiogenic impedance (CI) in cardiac reshynchronization therapy (CRT) optimization. The purpose of this study was to: evaluate the stability of certain CI vectors 24 hours post implantation, study the correlation between these CI signals and selected echocardiographic parameters, examine the possibility of non-invasive calibration of patient-specific impedance-based prediction models.Methods and resultsThirteen patients received a CRT-D device with monitor capability of the dynamic impedance between several electrodes. At implantations patient-specific impedance-based prediction models were created for identification of optimal atrioventricular (AV) and interventricular (VV) delays and calibrated on invasive measurements of left ventricular contractility (LV dP/dtmax). Simultaneously non-invasive measurements of LV dP/dtmax and stroke volume (SV) were obtained using a finger plethysmograph. Patients were re-evaluated with echocardiography and new CI measurements the day after implantation.The haemodynamic benefit achieved by optimal VV setting according to the patient-specific impedance-based prediction models at follow-up was not as large as the one obtained at implantation. In a multivariate partial least square regression analysis a correlation was found between aortic VTI and a generic linear combination of CI features (P<0,005). No correlation was found between the patient-specific impedance-based prediction models and the non-invasive measurements of LV dP/dtmax and SV.ConclusionsCardiogenic impedance signals can be used to optimize CRT settings but seems less feasible as an ambulatory tool since calibration is required. The positive correlation between aortic-VTI and CI measurements seems promising; although a larger cohort is required to create an echocardiography-based patient-specific model.
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| 19. |
- Sciaraffia, Elena, et al.
(författare)
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The use of impedance cardiography for optimizing the interventricular stimulation interval in cardiac resynchronization therapy-a comparison with left ventricular contractility
- 2009
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 25:3, s. 223-228
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Tidskriftsartikel (refereegranskat)abstract
- The present study aimed to assess whether impedance cardiography (IC) can correctly identify the optimal interventricular (VV) pacing interval in cardiac resynchronization therapy (CRT). Twenty four patients received a biventricular pacemaker and underwent IC for cardiac output (CO) measurements to identify the optimal VV interval. Invasive measurements of left ventricular (LV) dP/dt(max) were used as a reference. During optimization the VV interval was changed with 20 ms steps from +80 (LV pre-excitation) to-80 ms (RV pre-excitation). The optimal VV interval was defined as the one that resulted in the highest LV dP/dt(max) value and the highest CO obtained by IC, respectively. During simultaneous biventricular pacing both LV dP/dt(max) and CO increased (mean 16.6% and 16.2%, respectively) as compared to baseline. Biventricular pacing with optimized VV intervals resulted in a further absolute increase of LV dP/dt (max) and CO (5.6% and 41.3%, respectively). The average decrease in LV dP/dt(max) was 79.6 +/- 51.6 mmHg/s when the optimal VV interval was programmed according to the IC measurements. Cross spectral analysis showed no correlation between the optimal VV intervals identified by the two methods (p > 0.05) and identical optimal VV intervals were identified in only six of the 24 patients. When broader VV time intervals were compared the correlation between the two methods was statistically significant (p = 0,0166). In conclusion, the use of IC for VV interval optimization is questionable since these optimized time intervals do not seem to correlate well with those obtained by measuring LV dP/dt.
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| 20. |
- Tapanainen, Jari M., et al.
(författare)
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Interatrial right-to-left conduction in patients with paroxysmal atrial fibrillation
- 2009
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1572-8595 .- 1383-875X. ; 25:2, s. 117-122
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Tidskriftsartikel (refereegranskat)abstract
- We wanted to illustrate the right-to-left impulse propagation routes during sinus in patients with paroxysmal atrial fibrillation (PAF), as alterations in conduction patterns have been linked to the pathogenesis of PAF, and as no large patient materials have been published. Patients underwent 3-D electroanatomical contact mapping prior to catheter ablation. The site of the earliest left atrial (LA) activation was determined. Three different interatrial routes were identified, either as solitary pathways (36/50 patients, 72%) or in their combinations (14/50). Bachmann's bundle (BB) was involved in the majority of the cases with solitary routes (25/36). More seldom, impulse propagation occurred near the oval fossa (FO) (7/36) or the coronary sinus ostium (4/36). In patients with combined routes, both the BB (10/14) and FO routes (11/14) were included in most cases. In PAF patients, LA can be activated during sinus rhythm through three distinct connections, either encompassing a single route or via any combination of these connections. In one third, the earliest LA activation occurs outside BB. The knowledge of the propagation patterns may give insight into the pathophysiology of PAF and into refining ablation therapy.
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| 21. |
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| 22. |
- van Rosmalen, Frank, et al.
(författare)
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Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry.
- 2021
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1383-875X .- 1572-8595. ; 60, s. 395-406
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety.METHODS: The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared.RESULTS: Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991).CONCLUSIONS: The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
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- Venkateswaran, Ramkumar V, et al.
(författare)
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Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization therapy.
- 2015
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science and Business Media LLC. - 1572-8595 .- 1383-875X. ; 44:3, s. 297-304
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Tidskriftsartikel (refereegranskat)abstract
- Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT.
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