| 1. |
- Jönsson, Anders, et al.
(författare)
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Microwave Ablation in Mitral Valve Surgery for Atrial Fibrillation (MAMA)
- 2012
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Ingår i: Journal of Atrial Fibrillation. - : Cardiofront. - 1941-6911. ; 5:2, s. 13-22
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy.Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone.Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22).Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.
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| 2. |
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| 3. |
- Allan, Julie, et al.
(författare)
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Etiska perspektiv på specialpedagogers yrkesroll och värdepedagogiska praktik
- 2022
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Yrkesetik handlar om att hantera motstridiga värden på ett professionellt sätt. Olika dilemman är ständigt närvarande i skolans vardag och kan handla om att minimera risken för att elever ska exkluderas eller om att säkerställa att elever får möjlighet att visa sina kunskaper på rätt sätt. I sin yrkesroll ställs specialpedagogen inför mångfacetterade arbetsuppgifter som omfattar att stödja barn och elever i svårigheter, vara en kvalificerad samtalspartner i pedagogiska frågor och samverka med andra yrkesgrupper för att utveckla skolans verksamhet. Arbetet innebär val mellan olika handlingsalternativ som kräver både kunskap och förmåga att urskilja och värdera etiska aspekter i komplexa sammanhang. I boken diskuteras både dilemman och möjligheter där etiska perspektiv spelar en viktig roll. Kapitlen tar upp frågor med praktiknära innehåll som lämpar sig för såväl individuell reflektion som kollegiala samtal med syftet att skapa ett gemensamt yrkesetiskt språk. Boken vänder sig till blivande och praktiserande specialpedagoger samt andra yrkeskategorier med arbetsuppgifter inom det specialpedagogiska området.
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| 4. |
- Haissaguerre, Michel, et al.
(författare)
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Localized sources maintaining atrial fibrillation organized by prior ablation
- 2006
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 113, s. 616-625
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Tidskriftsartikel (refereegranskat)abstract
- Background— Endocardial mapping of localized sources drivingatrial fibrillation (AF) in humans has not been reported.Methods and Results— Fifty patients with AF organizedby prior pulmonary vein and linear ablation were studied. AFwas considered organized if mapping during AF showed irregularbut discrete atrial complexes exhibiting consistent activationsequences for >75% of the time using a 20-pole catheter with5 radiating spines covering 3.5-cm diameter or sequential conventionalmapping. A site or region centrifugally activating the remainingatrial tissue defined a source. During AF with a cycle lengthof 211±32 ms, activation mapping identified 1 to 3 sourcesat the origin of atrial wavefronts in 38 patients (76%) predominantlyin the left atrium, including the coronary sinus region. Electrogramsat the earliest area varied from discrete centrifugal activationto an activity spanning 75% to 100% of the cycle length in 42%of cases, the latter indicating complex local conduction ora reentrant circuit. A gradient of cycle length (>20 ms)to the surrounding atrium was observed in 28%. Local radiofrequencyablation prolonged AF cycle length by 28±22 ms and eitherterminated AF or changed activation sequence to another organizedrhythm. In 4 patients, the driving source was isolated, surroundedby the atrium in sinus rhythm, and still firing at high frequency(228±31 ms) either permanently or in bursts.Conclusions— AF associated with consistent atrial activationsequences after prior ablation emanates mostly from localizedsources that can be mapped and ablated. Some sources harborelectrograms suggesting the presence of localized reentry.
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| 5. |
- Häggström, Margaretha, 1962, et al.
(författare)
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Att undervisa i hållbar utveckling - Relationellt perspektiv
- 2022
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Hur kan lärare arbeta med hållbar utveckling i en tid då globala kriser och klimatförändringar väcker både rädsla och oro? Och hur kan elever samtidigt känna hopp inför sin framtid och sitt vuxna liv? Dessa frågor är utgångspunkt för det utvecklings- och forskningsprojekt som utgör basen i denna bok. Du får följa med i berättelser som lärare och elever skapat tillsammans för att utveckla kunskap om social, ekologisk och ekonomisk hållbarhet. Boken redogör för de pedagogiska utgångspunkterna, men ger också rikligt med praktiska exempel på metoder och former för undervisning i och genom demokratiska och relationella förhållningssätt. Du får konkreta tips på hur du kan integrera hållbar utveckling i undervisningen. Såväl kritiska aspekter som lärdomar och möjligheter lyfts fram. I centrum står eleven och läraren utifrån det relationspedagogiska perspektivet. Att undervisa i hållbar utveckling: Relationellt perspektiv vänder sig till lärarstudenter och verksamma lärare i årskurs F-6. Bokens syfte är att inspirera, stödja och utgöra diskussionsunderlag i skolans arbete med miljöperspektivet och hållbar utveckling.
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| 6. |
- Jais, Pierre, et al.
(författare)
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Stepwise catheter ablation of chronic atrial fibrillation : Importance of descrete anatomic sites for termination
- 2006
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Ingår i: Journal of Cardiovascular Electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 17:Suppl 3, s. 28-36
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic atrial fibrillation (CAF) can be acutely terminated using a combination of approaches targeting thoracic veins, left atrial areas showing rapid/heterogeneous electrical activity, and by linear ablation. This observational study emphasizes the crucial role for conventional endocardial mapping to identify discrete anatomical sites, ablation of which is indispensable for the achievement of atrial fibrillation (AF) termination. Methods: Eighty consecutive patients with CAF underwent catheter ablation using the stepwise approach. Pulmonary vein isolation and roof-line ablation were performed as the initial two steps in all patients. In the presence of locally rapid or heterogeneous activity, ablation was then performed at all sites within the left atrium and coronary sinus (CS) region with the endpoint of local organization or slowing. If AF persisted, the mitral isthmus was targeted. Patients in whom AF terminated during one of these five ablation steps were differentiated from those in whom AF was terminated by radiofrequency ablation at a single discrete anatomic site within 1 minute. Electrograms at discrete anatomic sites of termination were classified according to morphology. Results: Termination of AF was achieved in 69 (86%) patients by ablation alone. In 50 patients (72%), this occurred while following the predetermined ablation schema. In the remaining 19 patients (28%), ablation targeting a discrete site (preferentially located at the CS, the base of left atrial appendage, and the interatrial septum) terminated AF. Such sites were identified by (1) continuous electrical activity and fractionation and (2) bursts of short cycle activity (130–160 msec), centrifugal activation or local activation gradients, indicating sources perpetuating AF. Conclusion: In 28% of patients with termination of CAF, the final successful ablation site is anatomically discrete and displays electrophysiological characteristics that can be effectively identified by point and activation mapping. Failure to identify these sites may significantly reduce the likelihood of termination of CAF by catheter ablation.
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| 8. |
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| 9. |
- 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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| 10. |
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| 11. |
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| 12. |
- Rostock, Thomas, et al.
(författare)
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Fibrillating areas isolated within the left atrium after radiofrequency linear catheter ablation
- 2006
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Ingår i: Cardiovascular Electrophysiology. - : Wiley. - 1045-3873 .- 1540-8167. ; 17, s. 807-812
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Nonpulmonary vein sources have been implicated as potential drivers of atrial fibrillation (AF). This observational study describes regions of fibrillating atrial tissue isolated inadvertently from the left atrium (LA) following linear catheter ablation for AF. METHODS AND RESULTS: We report four patients with persistent/permanent AF who underwent pulmonary vein isolation with additional linear lesions and who presented with recurrent AF (mean AF cycle length [AFCL] 175-270 ms). Further catheter ablation resulted in the inadvertent electrical isolation of significant areas of the LA in which AF persisted at the same AFCL as was measured prior to disconnection, despite the restoration of sinus rhythm (SR) in all other left and right atrial areas, strongly suggesting that these islands were driving the remaining atria into fibrillation. The disconnected areas were located in the lateral LA, including the left atrial appendage (LAA) in three patients (limited to the LAA in one) and in the posterior LA in one patient. These isolated fibrillating regions represented 15-24% of the global LA surface, as estimated by electroanatomic mapping. CONCLUSION: Fibrillation can be maintained within electrically isolated regions of the LA following catheter ablation of AF, demonstrating the importance of atrial drivers in the maintenance of AF. Further mapping of these drivers is needed to characterize their mechanism and thereby allow for a more specific ablation strategy.
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| 13. |
- Sanders, Prashanthan, et al.
(författare)
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Frequency mapping of the pulmonary veins in paroxysmal versus permanent atrial fibrillation
- 2006
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Ingår i: Journal of Cardiovascular Electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 17, s. 965-972
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The pulmonary veins (PVs) are a dominant source of triggers initiating atrial fibrillation (AF). While recent evidence implicates these structures in the maintenance of paroxysmal AF, their role in permanent AF is not known. The current study aims to compare the contribution of PV activity to the maintenance of paroxysmal and permanent AF. METHODS AND RESULTS: Thirty-four patients with paroxysmal AF (n = 20) or permanent AF (n = 14) undergoing ablation were studied. Prior to ablation, 32 seconds of electrograms were acquired from each PV and the coronary sinus (CS). The frequency of activity of each PV and CS was defined as the highest amplitude frequency on spectral analysis. The effects of ablation on the AF cycle length (AFCL) and frequency and on AF termination were determined. Significant differences were observed between paroxysmal and permanent AF. Paroxysmal AF demonstrates higher frequency PV activity (11.0 +/- 3.1 vs 8.8 +/- 3.0 Hz; P = 0.0003) but lower CS frequency (5.8 +/- 1.2 vs 6.9 +/- 1.4 Hz; P = 0.01) and longer AFCL (182 +/- 17 vs 158 +/- 21 msec; P = 0.002), resulting in greater PV to atrial frequency gradient (7.2 +/- 2.2 vs 4.2 +/- 2.9 Hz; P = 0.006). PV isolation in paroxysmal AF resulted in a greater decrease in atrial frequency (1.0 +/- 0.7 vs -0.05 +/- 0.4 Hz; P < 0.0001), greater prolongation of the AFCL (49 +/- 35 vs 5 +/- 6 msec; P < 0.0001), and more frequent AF termination (11/20 vs 0/14; P = 0.0007) compared to permanent AF. CONCLUSION: Paroxysmal AF is associated with higher frequency PV activity and lesser CS frequency compared to permanent AF. Isolation of the PVs had a greater impact on the fibrillatory process in paroxysmal AF compared to permanent AF, suggesting that while the PVs have a role in maintaining paroxysmal AF, these structures independently contribute less to the maintenance of permanent AF
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| 15. |
- Takahashi, Yoshihide, et al.
(författare)
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Sites of focal atrial activity characterized by endocardial mapping during atrial fibrillation
- 2006
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Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 47:10, s. 2005-2012
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe aim of the present study was to assess the feasibility of identifying sites of focal atrial activity by localized high-density endocardial mapping during atrial fibrillation (AF).BackgroundSites of focal activity in the left atrium have been demonstrated by epicardial mapping during AF.MethodsTwenty-four patients (15 with paroxysmal, 3 with persistent, and 6 with permanent AF) underwent endocardial mapping during AF. A 20-pole catheter with five radiating spines was used to map both atria for 30 s in each of 10 pre-determined segments. A focal activity was defined as ≥3 atrial cycles with activation spreading from center to periphery of the mapping catheter. Catheter ablation was performed independent of the mapping results.ResultsSpontaneous focal activities were observed in 13 sites in the left atrium (9%; anterior 1, roof 2, posterior 6, inferior 4) in 12 patients (9 paroxysmal, 3 persistent). Focal activity was observed continuously (two sites) or intermittently (11 sites, median 5 episodes), and associated with shortening of the cycle length (from 183 ± 33 ms to 172 ± 29 ms; p < 0.05). The mean duration of an intermittent episode was 1.5 s (range 0.4 to 7.1 s). Atrial fibrillation terminated without ablation at the foci in all of 12 patients, but in 2 of them, re-initiated arrhythmia was successfully ablated at these foci. Nine of these 12 patients (75%) were arrhythmia-free without antiarrhythmic drugs during a follow-up period of 7.0 ± 3.1 months.ConclusionsTermination of AF without ablation at the sites of atrial focal activity suggests that this activity may be triggered by impulses originating from other regions, such as the pulmonary veins.
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| 16. |
- Öhman, Anna, 1962-
(författare)
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Cykler och loopar i Salongen : En studie av återkoppling i frisörklassrummet
- 2015
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The interest in this empirical study aims at assessment, more precisely feedback as part of ordinary activities within hairdressing education. The study investigates feedback practices related to assessment of knowing during production, with focus on communication between student and teacher. Communication is regarded as interactively constructed and is investigated through a multimodal social semiotic perspective which implies studying verbal as well as nonverbal resources in meaning making. Speech and body movements are not subordinate to each other and are studied as contributing in communication on their own terms.Video observations were used to investigate feedback practices in the hairdressing classroom, during a couple of lessons when last year’s students received customers for various treatments. From one hour recording, a selection was made showing communication between student and teacher with joint focus of attention during production. The selection is based on the assumption of feedback as interactively constructed and represented in a multimodal way.The analysis of the feedback practice shows a multifaceted result, since each interaction between a student and a teacher is unique. Nevertheless, a recurrent pattern of feedback construction could be discerned. Three important functions of feedback were distinguished, that of control, instruction and evaluation. Furthermore, these functions interact in temporal processes of cycles and loops. The core of feedback practice is found within the loop, where questions and wonders from the student are brought into a joint investigation.
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