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| 12. |
- Siotis, Alexander, et al.
(författare)
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LONG-TERM ADHERENCE TO FLECAINIDE AS A RHYTHM CONTROL THERAPY IN RECURRENT ATRIAL FIBRILLATION - A RETROSPECTIVE COHORT STUDY
- 2022
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1556-3871 .- 1547-5271. ; 19:5, s. 315-316
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Konferensbidrag (refereegranskat)abstract
- Background: The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied. Objective: To assess clinical characteristics associated with flecainide treatment success in patients with recurrent AF. Methods: Using hospital medical records, 135 consecutive adult AF patients who were referred for in-hospital initiation of flecainide were included (median age 62 (IQR 53-70) years, 35% females, 28% persistent AF, median CHA2DS2-VASc score 1, median follow up time 14.5 (IQR 3.3-32.7) months). Patient characteristics at admission, including left atrial enlargement (LAE) assessed as LA volume index >34 ml/m2, were retrieved from medical records. Kaplan Meier curve and Cox regression analysis were used to analyse the association between the clinical characteristics and the likelihood of the drug discontinuation due to failed rhythm control efficacy (primary endpoint) or discontinuation for any reason (secondary endpoint). Results: By the end of follow up 88 patients (65.0%) had continued flecainide therapy. Reasons for discontinuation were failed efficacy (16.0%), side effects (7.0%) or safety issues (16.0 %) such as proarrhythmia (6.7%), heart failure (2.2%), coronary heart disease (1.5%), QRS widening (1.5%), QTc ≥500 ms (0.7%) or AV block II (0.7%). Age ≥60 years, male gender, height and LAE were significant predictors of therapy discontinuation in the univariate analysis, however only LAE (HR=3.9 95% CI 1.1-13.5 for the primary (Figure A) and HR=2.5 95%CI 1.3-4.9 for the secondary endpoints) and age ≥60 years (HR=3.9 95% CI 1.1-11.9 for the primary and HR=2.2 95%CI 1.1-4.3 for the secondary endpoint) remained independent predictors of therapy discontinuation in the multivariate analysis. The outcome did not differ between paroxysmal and persistent AF (Figure B). [Formula presented] [Formula presented] Conclusion: LAE and age ≥60 years were associated with flecainide rhythm control failure in patients with recurrent AF. The vast majority of all treatment failures occured within 6 months from the treatment start. AF type did not significantly predict treatment efficacy.
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| 13. |
- Demidova, Marina M., et al.
(författare)
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Early repolarization pattern on ECG recorded before the acute coronary event does not predict ventricular fibrillation during ST-elevation myocardial infarction
- 2020
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 17:4, s. 629-636
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Tidskriftsartikel (refereegranskat)abstract
- Background: Generally considered benign, electrocardiographic (ECG) early repolarization (ER) pattern was claimed to be an indicator of increased susceptibility to ventricular arrhythmias during acute ischemia. Objective: The purpose of this study was to assess in a nonselected population whether ER pattern documented before ST-elevation myocardial infarction (STEMI) is associated with risk of hemodynamically unstable ventricular tachycardia (VT) or ventricular fibrillation (VF) during acute STEMI. Methods: For STEMI patients admitted for primary percutaneous coronary intervention from 2007–2010, the latest ECGs recorded before STEMI were exported in digital format. After excluding ECGs with paced rhythm and QRS duration ≥120 ms, the remaining ECGs were processed using the Glasgow algorithm allowing automatic ER detection. The association between ER pattern and VT/VF during the first 48 hours of STEMI was tested using logistic regression. Results: ECGs recorded before STEMI were available for 1584 patients. Of these patients, 124 did not meet inclusion criteria, leaving 1460 patients available for analysis (age 68 ± 12 years; 67% male). ER pattern was present in 272 patients (18.6%; ER+ group). ER+ and ER– groups did not differ with regard to clinical characteristics. VT/VF during the first 48 hours of STEMI occurred in 19 ER+ (7.0%) and 105 ER– patients (8.8%; P =.398). ER was not associated with any VT/VF (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.47–1.29; P =.324); VT/VF before reperfusion (OR 0.48; 95% CI 0.23–1.001; P =.051); or reperfusion-related VT/VF (OR 1.28; 95% CI 0.55–3.01; P =.569). Conclusion: In a nonselected population of STEMI patients, the ER pattern on ECG recorded before the acute coronary event was not associated with VT/VF during the first 48 hours of STEMI.
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| 17. |
- Mittal, S., et al.
(författare)
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The World-wide Randomized Antibiotic Envelope Infection Prevention (WRAP-IT) trial: Long-term follow-up
- 2020
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 17:7, s. 1115-1122
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Tidskriftsartikel (refereegranskat)abstract
- Background: The World-wide Randomized Antibiotic Envelope Infection Prevention trial reported a 40% reduction in major cardiac implantable electronic device (CIED) infections within 12 months of the procedure with the use of an antibacterial-eluting envelope (TYRX Absorbable Antibacterial Envelope, Medtronic, Mounds View, MN). Objective: The purpose of this report was to describe the longer-term (>12 months) envelope effects on infection reduction and complications. Methods: All trial patients who underwent CIED replacement, upgrade, revision, or initial cardiac resynchronization therapy – defibrillator implantation received standard-of-care infection prophylaxis and were randomized in a 1:1 ratio to receive the envelope or not. CIED infection incidence and procedure and system-related complications were characterized through all follow-up (36 months) by using Cox proportional hazards regression modeling. Results: In total, 6800 patients received their intended randomized treatment (3371 envelope; 3429 control; mean follow-up period 21.0 ± 8.3 months). Major CIED-related infections occurred in 32 envelope patients and 51 control patients (Kaplan-Meier [KM] estimate 1.3% vs 1.9%; hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.41–0.99; P = .046). Any CIED-related infection occurred in 57 envelope patients and 84 control patients (KM estimate 2.1% vs 2.8%; HR 0.69; 95% CI 0.49–0.97; P = .030). System- or procedure-related complications occurred in 235 envelope patients and 252 control patients (KM estimate 8.0% vs 8.2%; HR 0.95; 95% CI 0.79–1.13; P < .001 for noninferiority); the most common were lead dislodgment (1.1%), device lead damage (0.5%), and implant site hematoma (0.4%). Implant site pain occurred less frequently in the envelope group (0.1% vs 0.4%; P = .067). There were no (0.0%) reports of allergic reactions to the components of the envelope (mesh, polymer, or antibiotics). Conclusion: The effects of the TYRX envelope on the reduction of the risk of CIED infection are sustained beyond the first year postprocedure, without an increased risk of complications. © 2020 The Authors
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| 18. |
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| 19. |
- Sutton, Richard, et al.
(författare)
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Pacing in vasovagal syncope : physiology, pacemaker sensors and recent clinical trials. Precise patient selection and measurable benefit
- 2020
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 17:5A, s. 821-828
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Tidskriftsartikel (refereegranskat)abstract
- The role of pacing in vasovagal syncope (VVS) is considered from a physiological basis. Most VVS patients lose consciousness due to hypotension before severe bradycardia/asystole occurs. Patients that benefit from dual-chamber pacing are typically older with highly symptomatic, late-onset, frequent and severe syncope with short/no prodrome and documented severe cardioinhibition. Tilt-testing is of value in patients with recurrent unexplained syncope to identify important hypotensive susceptibility stemming from reduced venous return and stroke volume. A negative tilt-test in vasovagal patients with spontaneous asystole documented by implantable/insertable loop-recorder is associated with lower syncope recurrence rates after pacemaker implantation. Pacing may be more effective if triggered by sensor detection of a parameter changing earlier in the reflex than bradycardia when stroke volume may still be relatively preserved. In this regard, detection of right ventricular impedance offers promise. In conclusion, conservatism is recommended limiting pacing in VVS to a small subset of symptomatic older patients with clearly documented cardioinhibition paying particular attention to the timing of loss of consciousness in relation to asystole/bradycardia. Understanding VVS physiology permits application of well-timed and appropriate pacing that yields benefit for highly symptomatic patients.
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| 20. |
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