| 1. |
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| 2. |
- Bianchi, Stefano, et al.
(författare)
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Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation : Chronic Clinical Atrioventricular-Nodal Stimulation Download Study
- 2015
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Ingår i: Circulation. - 1941-3149 .- 1941-3084. ; 8:3, s. 562-568
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: -Patients with a high ventricular rate during atrial fibrillation (AF) are at increased risk of receiving inappropriate implantable cardioverter defibrillator (ICD) shocks. The objective was to demonstrate the feasibility of high frequency atrioventricular-nodal stimulation (AVNS) to reduce the ventricular rate during AF to prevent inappropriate ICD shocks.METHODS AND RESULTS: -Patients with a new atrial lead placement as part of a CRT-D implant and a history of paroxysmal or persistent AF were eligible. If proper atrial lead position was confirmed, AVNS software was uploaded to the CRT device, tested and optimized. AVNS was delivered via a right atrial pacing lead positioned in the posterior right atrium. Software allowed initiation of high frequency bursts triggered on rapidly conducted AF. Importantly, the efficacy was evaluated during spontaneous AF episodes between 1 and 6 months after implant. Forty-four patients were enrolled in 4 centers. Successful atrial lead placement occurred in 74%. Median implant time of the AVNS lead was 37 minutes. In 26 (81%) patients, manual AVNS tests increased the ventricular interval by > 25%. Between 1 and 6 months, automatic AVNS activations occurred in 4 patients with rapidly conducted AF, and in 3 patients, AVNS slowed the ventricular rate out of the ICD shock zone. No adverse events were associated with the AVNS software.CONCLUSIONS: -The present study demonstrated the feasibility of implementation of AVNS in a CRT-D system. AVNS increased ventricular interval > 25% in 81% of patients. AVNS did not influence the safety profile of the CRT-D system.
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| 3. |
- Blomström-Lundqvist, Carina, et al.
(författare)
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Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation : The CAPTAF Randomized Clinical Trial
- 2019
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - Chicago : American Medical Association (AMA). - 1067-5027 .- 1527-974X .- 0098-7484 .- 1538-3598. ; 321:11, s. 1059-1068
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication. OBJECTIVE To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or beta-blocker, with 4-year follow-up. Study dateswere July 2008-September 2017. Major exclusionswere ejection fraction <35%, left atrial diameter > 60 mm, ventricular pacing dependency, and previous ablation. INTERVENTIONS Pulmonary vein isolation ablation (n= 79) or previously untested antiarrhythmic drugs (n= 76). MAIN OUTCOMES AND MEASURES Primary outcomewas the General Health subscale score (Medical Outcomes Study 36-Item Short-Form Health Survey) at baseline and 12 months, assessed unblinded (range, 0 [worst] to 100 [best]). There were 26 secondary outcomes, including atrial fibrillation burden (% of time) from baseline to 12 months, measured by implantable cardiac monitors. The first 3 months were excluded from rhythm analysis. RESULTS Among 155 randomized patients (mean age, 56.1 years; 22.6% women), 97% completed the trial. Of 79 patients randomized to receive ablation, 75 underwent ablation, including 2 who crossed over to medication and 14 who underwent repeated ablation procedures. Of 76 patients randomized to receive antiarrhythmic medication, 74 received it, including 8 who crossed over to ablation and 43 for whom the first drug used failed. General Health score increased from 61.8 to 73.9 points in the ablation group vs 62.7 to 65.4 points in the medication group (between-group difference, 8.9 points; 95% CI, 3.1-14.7; P=.003). Of 26 secondary end points, 5 were analyzed; 2 were null and 2 were statistically significant, including decrease in atrial fibrillation burden (from 24.9% to 5.5% in the ablation group vs 23.3% to 11.5% in the medication group; difference -6.8%[95% CI, -12.9% to -0.7%]; P=.03). Of the Health Survey subscales, 5 of 7 improved significantly. Most common adverse events were urosepsis (5.1%) in the ablation group and atrial tachycardia (3.9%) in the medication group. CONCLUSIONS AND RELEVANCE Among patients with symptomatic atrial fibrillation despite use of antiarrhythmic medication, the improvement in quality of life at 12 months was greater for those treated with catheter ablation compared with antiarrhythmic medication. Although the study was limited by absence of blinding, catheter ablation may offer an advantage for quality of life.
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| 4. |
- Calén, H., et al.
(författare)
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Detector setup for a storage ring with an internal target
- 1996
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Ingår i: Nuclear Instruments and Methods in Physics Research Section A. - : Elsevier BV. - 0168-9002 .- 1872-9576. ; 379:1, s. 57-75
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Tidskriftsartikel (refereegranskat)abstract
- A detector setup for the cooler storage ring CELSIUS is described. The setup detects particles produced in interactions between the internal beam and a cluster-jet target. Particles emitted in the forward direction are measured by means of arrays of plastic scintillators and proportional counters. Particles, particularly photons, emitted more isotropically are measured by means of two calorimeters containing CsI(Na) crystals. The performance of the setup is given for neutral meson production in proton-proton and proton-deuteron interactions in the energy range 290-1360 MeV.
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| 5. |
- Chaudhry, Uzma, et al.
(författare)
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Efficacy of the antibacterial envelope to prevent cardiac implantable electronic device infection in a high-risk population
- 2022
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Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 24:12, s. 1973-1980
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Tidskriftsartikel (refereegranskat)abstract
- AimsInfection is a serious complication of cardiac implantable electronic device (CIED) therapy. An antibiotic-eluting absorbable envelope has been developed to reduce the infection rate, but studies investigating the efficacy and a reasonable number needed to treat in high-risk populations for infections are limited.Methods and resultsOne hundred and forty-four patients undergoing CIED implantation who received the antibacterial envelope were compared with a matched cohort of 382 CIED patients from our institution. The primary outcome was the occurrence of local infection, and secondary outcomes were any CIED-related local or systemic infections, including endocarditis, and all-cause mortality. The results were stratified by a risk score for CIED infection, PADIT. The envelope group had a higher PADIT score, 5.9 ± 3.1 vs. 3.9 ± 3.0 (P < 0.0001). For the primary endpoint, no local infections occurred in the envelope group, compared with 2.6% in the control group (P = 0.04), with a more pronounced difference in the stratum with a high (>7 points) PADIT score, 0 vs. 9.9% (P = 0.01). The total CIED-related infections were similar between groups, 6.3% compared with 5.0% (P = 0.567). Mortality after 1600 days of follow-up did not differ between groups, 22.9 vs. 26.4%, P = 0.475.ConclusionOur study confirms the clinical efficacy of an antibacterial envelope in the prevention of local CIED infection in patients with a higher risk according to the PADIT score. In an effort to improve cost–benefit ratios, ration of use guided by the PADIT score is advocated. Further prospective randomized studies in high-risk populations are called for.
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| 6. |
- Farouq, Maiwand, et al.
(författare)
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Age-stratified comparison of prognosis in cardiac resynchronization therapy with or without prophylactic defibrillator for non-ischemic cardiomyopathy – a nationwide cohort study
- 2023
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Ingår i: Europace. - 1532-2092. ; 25:7
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimsPrior studies have suggested that the benefit from primary preventive defibrillator treatment for patients with non-ischemic cardiomyopathy primarily, treated with cardiac resynchronization therapy, may be age-dependent. We aimed to compare age-stratified mortality rates and mode of death in patients with non-ischemic cardiomyopathy who are treated with either primary preventive Cardiac Resynchronization Therapy-defibrillator (CRT-D) or CRT-pacemaker (CRT-P).MethodsAll patients with non-ischemic cardiomyopathy and CRT-P or primary preventive CRT-D who were implanted in Sweden during the period 2005-2020 were included. Propensity scoring was used to create a matched cohort. Primary outcome was all-cause mortality within five years.Results4027 patients were included, 2334 with CRT-P and 1693 with CRT-D. Crude 5-year mortality was 635 (27%) vs. 246 (15%), p ConclusionIn this nationwide registry-based study, patients with CRT-D have better five-year survival compared to patients with CRT-P. The interaction between age and mortality reduction not consistent, but patients with CRT-D aged
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| 7. |
- Farouq, Maiwand, et al.
(författare)
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Successful percutaneous extraction of malpositioned pacemaker lead in the left ventricle after proper dabigatran treatment
- 2022
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Ingår i: PACE - Pacing and Clinical Electrophysiology. - : Wiley. - 1540-8159 .- 0147-8389. ; 45:9, s. 1101-1105
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Tidskriftsartikel (refereegranskat)abstract
- Malpositioned pacemaker lead in the left ventricle (LV) is a rare procedural complication, which causes a special risk of thromboembolic events. Hence, prompt identification and early management of misplaced leads inside the LV is critical. Herein, we present a case of malpositioned pacemaker lead with transient ischemic attacks after the pacemaker implantation. The misplaced ventricular lead was discovered during regular echocardiography. Both leads were extracted percutaneously after dabigatran treatment. To our knowledge, this is the first report of uncomplicated percutaneous extraction of an inadvertently placed LV lead after dabigatran treatment. No neurologic events during a follow-up of 4 years.
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| 8. |
- Högås, Marcus, 1991-
(författare)
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Was Einstein Wrong? : Theoretical and observational constraints on massive gravity
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- For more than a century, Einstein's theory of general relativity has described gravitational phenomena with astonishing precision. However, for the theory to fit observations we need to add two elusive substances: dark energy and dark matter. Together they add up to 95% of the energy budget of the Universe. Yet, we do not know what these substances are. Another question mark is the expansion rate of the Universe; two incompatible values are obtained depending on the measuring method. These problems (dark energy, dark matter, and the expansion rate) belong to the big questions within gravity today and they may be interpreted as signs that general relativity is not the final theory for gravity. As an alternative, in this thesis we analyze an extended theory of gravity called bimetric gravity. In general relativity (GR), gravity is massless which means that gravitational waves propagate at the speed of light. Hence, a natural extension is to consider theories where gravity has a mass. This is precisely what bimetric gravity achieves. The theoretical consistency of this theory is firmly established but it is also crucial to test if the theory agrees with observations. In fact, in this theory there are two types of gravitational waves/fields, one massless as in GR but also one massive. When observing gravitational phenomena, we observe a mix of the two. Depending on the mixing and on the mass of the massive field, observational signatures appear for example on cosmological scales, in gravitational wave events or on solar-system scales. Until recently the phenomenology of the full theory was still uncharted, and an important question was if all observational tests could be satisfied at the same time. To address this, we devised a unified framework that enables straightforward comparison between constraints from different probes, without being restricted to a particular region of the parameter space. The result is that bimetric gravity is compatible with observations and even fit data slightly better than GR. Together with the fact that the dark energy can be explained by the interaction between the two gravitational fields, we have shown that the theory is a viable dark energy candidate. At the same time, the observational data provides a substantial restriction on the parameter space that excludes many of the popular models in the literature – an important result in and of itself.A longstanding issue within this theory has been to predict the growth of structure while avoiding exponential instabilities. Here, we propose a simple model which solves the full, nonlinear equations of motion, which can be used to calculate the growth of structure, without any instabilities. We also describe our work towards a framework for calculating the process of gravitational collapse in this theory where we manage to solve the equations numerically for a short time interval. The results indicate that the gravitational collapse proceeds as in general relativity, assuming that the initial conditions are similar.Future work is needed to decide whether bimetric gravity can solve any of the other big questions within gravity today, such as the discrepant expansion rate of the Universe. In this thesis, we show that it is an observationally viable dark energy candidate that exhibits novel gravitational features. In short, gravity can be massive.
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| 9. |
- Jekell, Andreas, et al.
(författare)
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Markers of inflammation, endothelial activation, and arterial stiffness in hypertensive heart disease and the effects of treatment : results from the SILVHIA study
- 2013
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Ingår i: Journal of Cardiovascular Pharmacology. - 0160-2446 .- 1533-4023. ; 62:6, s. 559-566
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Tidskriftsartikel (refereegranskat)abstract
- We assessed the contribution of blood pressure (BP), inflammation, and endothelial activation to the development of structural vascular and cardiac changes in hypertension. Furthermore, the effects of antihypertensive therapy were studied. We studied 114 patients with hypertension and left ventricular hypertrophy and 38 matched hypertensive subjects without cardiac hypertrophy and 38 normotensive subjects. The group with hypertension and cardiac hypertrophy were randomized to treatment with an angiotensin receptor blocker (irbesartan) or a beta-adrenergic receptor blocker (atenolol) for 48 weeks. Markers of inflammation (high-sensitive C-reactive protein, interleukin-6, leukocyte counts), vascular function (ambulatory aortic stiffness index, arterial compliance, and pulse pressure), and endothelial activation (E-selectin, intracellular adhesion molecule-1, vascular adhesion molecule-1) were assessed. Markers of inflammation and arterial stiffness were lowest in the normotensive group and highest in patients with hypertensive heart disease; endothelial markers were similar between groups. Inflammation was independently related to BP. Markers of arterial stiffness were independently related to BP and to a lesser extent to left ventricular mass. Antihypertensive treatment improved arterial compliance; inflammatory and endothelial markers remained unchanged. In conclusion, markers of inflammation and arterial stiffness are independently related to BP. Antihypertensive therapy seems to improve arterial stiffness, but effects on markers of inflammation and endothelial activation are small.
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| 10. |
- Kessler, Richard, et al.
(författare)
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First-Year Sloan Digital Sky Survey-II Supernova Results : Hubble Diagram and Cosmological Parameters
- 2009
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Ingår i: Astrophysical Journal Supplement Series. - : American Astronomical Society. - 0067-0049 .- 1538-4365. ; 185:1, s. 32-84
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Tidskriftsartikel (refereegranskat)abstract
- We present measurements of the Hubble diagram for 103 Type Ia supernovae (SNe) with redshifts 0.04 < z < 0.42, discovered during the first season (Fall 2005) of the Sloan Digital Sky Survey-II (SDSS-II) Supernova Survey. These data fill in the redshift "desert" between low- and high-redshift SN Ia surveys. Within the framework of the MLCS2K2 light-curve fitting method, we use the SDSS-II SN sample to infer the mean reddening parameter for host galaxies, RV = 2.18 ± 0.14stat ± 0.48syst, and find that the intrinsic distribution of host-galaxy extinction is well fitted by an exponential function, P(AV ) = exp(-AV /τV), with τV = 0.334 ± 0.088 mag. We combine the SDSS-II measurements with new distance estimates for published SN data from the ESSENCE survey, the Supernova Legacy Survey (SNLS), the Hubble Space Telescope (HST), and a compilation of Nearby SN Ia measurements. A new feature in our analysis is the use of detailed Monte Carlo simulations of all surveys to account for selection biases, including those from spectroscopic targeting. Combining the SN Hubble diagram with measurements of baryon acoustic oscillations from the SDSS Luminous Red Galaxy sample and with cosmic microwave background temperature anisotropy measurements from the Wilkinson Microwave Anisotropy Probe, we estimate the cosmological parameters w and ΩM, assuming a spatially flat cosmological model (FwCDM) with constant dark energy equation of state parameter, w. We also consider constraints upon ΩM and ΩΛ for a cosmological constant model (ΛCDM) with w = -1 and non-zero spatial curvature. For the FwCDM model and the combined sample of 288 SNe Ia, we find w = -0.76 ± 0.07(stat) ± 0.11(syst), ΩM = 0.307 ± 0.019(stat) ± 0.023(syst) using MLCS2K2 and w = -0.96 ± 0.06(stat) ± 0.12(syst), ΩM = 0.265 ± 0.016(stat) ± 0.025(syst) using the SALT-II fitter. We trace the discrepancy between these results to a difference in the rest-frame UV model combined with a different luminosity correction from color variations; these differences mostly affect the distance estimates for the SNLS and HST SNe. We present detailed discussions of systematic errors for both light-curve methods and find that they both show data-model discrepancies in rest-frame U band. For the SALT-II approach, we also see strong evidence for redshift-dependence of the color-luminosity parameter (β). Restricting the analysis to the 136 SNe Ia in the Nearby+SDSS-II samples, we find much better agreement between the two analysis methods but with larger uncertainties: w = -0.92 ± 0.13(stat)+0.10 -0.33(syst) for MLCS2K2 and w = -0.92 ± 0.11(stat)+0.07 -0.15 (syst) for SALT-II.
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| 11. |
- Ljungström, Erik, et al.
(författare)
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Combination of a leadless pacemaker and subcutaneous defibrillator with nine effective shock treatments during follow-up of 18 months
- 2019
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 56, s. 1-3
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Tidskriftsartikel (refereegranskat)abstract
- We present a case of combination of a leadless pacemaker (Micra) and a subcutaneous implantable cardioverter-defibrillator (S-ICD). The patient had a total of nine adequate shock treatments of ventricular fibrillation during 18 months of follow-up after the implantation. The shock treatments did not lead to any alteration in the Micra. All three sensing vectors of the S-ICD worked well. After 18 months, the functioning of both Micra and S-ICD continues to be uneventful. This case demonstrates that S-ICD combined with Micra may be a safe and feasible approach to provide pacing and ICD treatment without intracardiac leads.
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| 12. |
- Mörtsell, David, et al.
(författare)
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Acute and long-term efficacy and safety with a single cryoballoon application as compared with the standard dual application strategy : a prospective randomized study using the second-generation cryoballoon for pulmonary vein isolation in patients with symptomatic atrial fibrillation
- 2018
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 20:10, s. 1598-1605
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Tidskriftsartikel (refereegranskat)abstract
- AimsA single cryoballoon (CB) application per vein for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) could save time and was therefore compared to the standard approach of two consecutive CB applications for acute and long-term efficacy and safety.Methods and resultsPatients with symptomatic AF were randomized to a single CB application per vein guided by an Achieve® catheter (Single cryo-arm) or to two CB applications using a standard guidewire (Routine cryo-arm). The primary endpoint was the rate of acute complete PVI. Secondary endpoints were freedom from AF evaluated by electrocardiogram and 7 days Holter at 6 and 12 months, symptoms by Symptom Severity Questionnaires and EHRA score and quality of life (QoL) by EQ5D-5L at 12 months. Among 140 patients included, PVI was achieved in 271 (100%) veins in the Single cryo-arm and in 269/271 (99.3%) veins in the Routine cryo-arm, P = 0.25. The procedure time was shorter in the Single cryo-arm, mean ± standard deviation 99.4 ± 33.3 min vs. 118.4 ± 34.3 min, P = 0.0015. Freedom from AF after one procedure at 12 months did not differ; 73.9.0% (Single cryo) vs. 71.4% (Routine), P = 0.74. Symptoms and QoL did also not differ between the two groups. There was a lower complication rate in the Single cryo-group, 2.9% vs. 12.9%, P = 0.03.ConclusionA single CB application shortens the procedure time without affecting acute or long-term efficacy, as compared to the routine two-application strategy, which with the lower complication rates has important implications when defining standards for PVI.
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| 13. |
- Mörtsell, David, et al.
(författare)
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Clinical outcome of the 2nd generation cryoballoon for pulmonary vein isolation in patients with persistent atrial fibrillation — A sub-study of the randomized trial evaluating single versus dual cryoballoon applications
- 2019
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 278, s. 120-125
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To assess the efficacy of the 2nd generation Cryoballoon for pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (PersAF), and to compare it to patients with paroxysmal atrial fibrillation (PAF).Methods: The outcome (arrhythmia recurrence at 12 months) was prospectively assessed in patients with PersAF(n = 77) and compared to that in patients with PAF(n = 62), who underwent PVI within a randomized trial evaluating single versus dual applications with the 2nd generation cryoballoon. Other endpoints included symptoms of AF, quality of life, procedure related characteristics, redo ablation rates and adverse events. Variables predicting recurrences were studied including all patients.Results: Freedom from arrhythmia recurrence was 64.9% after a single ablation and 68.8% after one or more procedures, which was significantly lower compared to PAF patients; 82.2% (p = 0.029) and 83.9% (p = 0.048) respectively, at 12 months. The improvements in EHRA score (−1.3 ± 0.8, p < 0.0001), symptom severity score (SSQ) (−5.0 ± 4.2, p < 0.0001) and EQ5D-5 L global score (+10.4 ± 20.3, p = 0.0002) after ablation was significant compared to baseline. The re-ablation rate was 7/77 (9.1%) which did not differ from that in PAF patients, 9/62 (14.5%), p = 0.42. Procedure duration, 104.8 ± 37.4 versus 113 ± 31.2 min (p = 0.129), application time, 1605 ± 659 versus 1521 ± 557 s (p = 0.103) and total adverse events after 12 months, 8/77 (10.4%) versus 5/62 (8.1%) (p = 0.77) did not differ in PersAF versus PAF patients.Conclusion: Both symptoms and QoL improved significantly in patients with PersAF after ablation. Freedom from AF was clinically significant but lower than in PAF patients. The cryoballoon seems an effective technique also in patients with persistent AF.
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| 14. |
- Mörtsell, David, et al.
(författare)
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Cryoballoon vs. radiofrequency ablation for atrial fibrillation : a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry
- 2019
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 21:4, s. 581-589
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use. The aim was to compare the second-generation cryoballoon and the irrigated RF energy regarding outcomes and safety.Methods and results: Of 4657 patients undergoing their first AF ablation, 982 with CRYO and 3675 with RF energy were included from the Swedish catheter ablation registry and the Atrial Fibrillation Ablation Long-Term registry of the European Heart Rhythm Association of the European Society of Cardiology. The primary endpoint was repeat AF ablation. The major secondary endpoints included procedural duration, tachyarrhythmia recurrence, and complication rate. The re-ablation rate after 12 months was significantly lower in the CRYO vs. the RF group, 7.8% vs. 11%, P=0.005, while freedom from arrhythmia recurrence (30 s duration) did not differ between the groups, 70.2 % vs. 68.2%, P=0.44. The result was not influenced by AF type and lesion sets applied. In the Cox regression analysis, paroxysmal AF had significantly lower risk for re-ablation with CRYO, hazard ratio 0.56 (P=0.041). Procedural duration was significantly shorter with CRYO than RF, (meanSD) 133.6 +/- 45.2 min vs. 174.6 +/- 58.2 min, P<0.001. Complication rates were similar; 53/982 (5.4%) vs. 191/3675 (5.2%), CRYO vs. RF, P=0.806.Conclusion: The lower re-ablation rates and shorter procedure times observed with the cryoballoon as compared to RF ablation may have important clinical implications when choosing AF ablation technique despite recognized limitations with registries.
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| 15. |
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| 16. |
- Mörtsell, David, et al.
(författare)
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Irbesartan reduces common carotid artery intima-media thickness in hypertensive patients when compared with atenolol : the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) study
- 2007
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 261:5, s. 472-479
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose. Angiotensin II promotes cell growth and has been implicated in the development and maintenance of left ventricular (LV) hypertrophy and of structural vascular changes. We wished to examine whether an angiotensin receptor blocker (ARB) would influence structural vascular changes beyond the effects of blood pressure reduction.Methods. Hypertensive patients with LV hypertrophy (age 55 ± 9 years, blood pressure 162 ± 19/104 ± 8 mmHg, LV mass index 148 ± 31 g m−2; mean ± SD) were randomized double-blind to the ARB irbesartan (n = 52) or the beta1 receptor blocker atenolol (n = 56) for 48 weeks. Ultrasonography of the left and right common carotid artery (CCA) and echocardiography were performed at week 0 and 48.Results. With similar reductions in blood pressure, CCA intima-media thickness (IMT) was reduced by irbesartan (from 0.92 ± 0.14 by 0.01 ± 0.10 mm, NS), whereas it was increased by atenolol (from 0.94 ± 0.21 by 0.03 ± 0.12 mm, P = 0.018; P = 0.002 between groups). CCA lumen diameter was less reduced by irbesartan than by atenolol. Thus, CCA intima-media area was reduced by irbesartan (from 21.3 ± 5.0 by 0.90 ± 2.45 mm2, P = 0.034) but not by atenolol (from 21.3 ± 6.1 by 0.18 ± 2.71 mm2, NS; P = 0.037 between groups). Changes in CCA IMT or area did not relate to changes in LV mass.Conclusions. The favourable effects by irbesartan on CCA IMT with an outward vascular remodelling suggest that angiotensin II mediates structural vascular changes, beyond the effects of blood pressure. This may be important in the prevention of cerebrovascular events.
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| 17. |
- Mörtsell, David, 1973-
(författare)
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Outcomes and safety of new techniques for pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation : A study based on randomised trials and registries
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is a common disease with a high prevalence in the adult population. Treatment of AF encompasses antiarrhythmic drugs and catheter ablation to reduce symptoms. The aim of this thesis was to study how to best alleviate symptoms of AF in a safe and efficient way comparing pharmacological treatment and the two dominating catheter ablation techniques, cryoballoon (CRYO) ablation and point-by-point radiofrequency (RF) ablation.Quality of life improved more for those AF patients randomised to treatment with catheter ablation compared to those treated with antiarrhythmic medication after 12 months of follow up (n=155).We evaluated a proposed optimised CRYO ablation protocol and randomised 140 patients to a single cryoballoon application per vein guided by a mapping catheter (Single cryo) or two cryoballoon applications (Routine). Acute pulmonary vein isolation rate did not differ. Procedure time decreased by 19 minutes with a lower complication rate in the Single cryo-arm. Freedom from AF after one procedure at 12 months did not differ; 73.9.0% (Single cryo) versus 71.4% (Routine).CRYO ablation was also assessed in persistent AF and paroxysmal AF. Freedom from arrhythmia recurrence was lower after a single ablation in persistent AF (64.9%) compared with paroxysmal AF (82.2%) after 12 months. However, the reduction of AF symptoms and quality of life was excellent in both groups and did not differ after 12 months.Patients undergoing their first AF ablation with CRYO or RF were included in a registry study. After 12 months, freedom from AF was equal irrespective of AF type, but there was a lower re-ablation rate and need for continued antiarrhythmic drug treatment after CRYO ablation. Procedure duration was reduced by 40 minutes with CRYO and complication rates did not differ,In conclusion, catheter ablation reduces AF symptoms more than antiarrhythmic drugs and cryoballoon ablation can be further optimised with reduced procedure times and improved safety. Cryoballoon ablation is as efficacious as RF ablation as a first-line therapy in both paroxysmal and persistent AF and the lower re-ablation rates and shorter procedure times may have important clinical implications when choosing AF ablation technique.
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| 18. |
- Mörtsell, David
(författare)
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Stöd för köldballong vid flimmer
- 2018
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Ingår i: Dagens Medicin. - 1104-7488.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Presenterar resultaten från en av mina studier i Dagens Medicin.
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| 19. |
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| 20. |
- Nof, Eyal, et al.
(författare)
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Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal : an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry
- 2019
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 21:12, s. 1876-1889
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved.METHODS AND RESULTS: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046].CONCLUSION: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
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| 21. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Multidisciplinärt endokarditteam på plats i Skåne - Första årets erfarenhet visar riktningen framåt
- 2019
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Ingår i: Läkartidningen. - 0023-7205. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- International guidelines recommend that the treatment of patients with infective endocarditis (IE) should be directed by a multidisciplinary endocarditis team. The aim of this study was to describe the first-year experience of multidisciplinary rounds by the endocarditis team in Scania, Sweden. This was a retrospective study on all possible and definitive IE episodes that were assessed by the endocarditis team from January 1st to December 31st, 2017. Descriptive statistics were used. A total of 145 multidisciplinary rounds were held and addressed 100 episodes in 97 patients. The median age was 71 years and 66% were males. The most common causative pathogens were alpha-hemolytic streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and enterococci. The endocarditis team recommended surgery in 40 % of episodes. The transfer of patients between different hospitals was facilitated by the team. The IE team evaluated a large proportion of patients with IE in the region and provided a rapid expert opinion on the optimal management of complicated cases of IE.
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| 22. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Pacemaker implantation following tricuspid valve annuloplasty.
- 2023
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Ingår i: JTCVS open. - 2666-2736. ; 16, s. 276-289
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Tidskriftsartikel (refereegranskat)abstract
- Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases.By using data from multiple Swedish mandatory national registries, all patients (n=1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression.The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8±10.3years vs 67.5±12.4years, P=.012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03).This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.
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