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| 7. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - Hoboken, USA : Wiley-Blackwell Publishing Inc.. - 0147-8389 .- 1540-8159. ; 39:9, s. 914-925
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.
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| 8. |
- Blomström-Lundqvist, C, et al.
(författare)
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Incessant ventricular tachycardia with a right bundle-branch block pattern and left axis deviation abolished by catheter manipulation
- 1990
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 13:1, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- A 22-year-old man underwent electrophysiological evaluation for incessant wide QRS complex tachycardia with a pattern of right bundle-branch block and left axis deviation. The right and left ventricles were enlarged and hypokinetic consistent with dilated cardiomyopathy. Ventricular tachycardia was diagnosed by demonstrating capture and fusion beats, atrioventricular dissociation, and His potential activation that began after the onset of each QRS complex. Atrial extrastimuli and rapid atrial pacing failed to terminate the tachycardia and, although ventricular stimulation was successful, the tachycardia spontaneously restarted after one or two sinus beats. The tachycardia was unexpectedly abolished during catheter manipulation in the left ventricle and has not recurred during three-years of follow-up. The picture of a cardiomyopathy resolved. The ease with which the tachycardia was abolished by catheter manipulation implicate a therapeutic potential for catheter ablation of this type of tachycardia.
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| 9. |
- Blomström-Lundqvist, Carina
(författare)
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The safety of reusing ablation catheters with temperature control and the need for a validation protocol and guidelines for reprocessing
- 1998
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 21:12, s. 2563-2570
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the safety of reusing ablation catheters with temperature control, which has not previously been reported. A review of previously conducted studies on the feasibility of reusing electrode catheters is also presented. From September 1994 to December 1997, 74 deflectable ablation catheters with temperature control (Cordis-Websters and Osypkas) were used during mean 7.6 +/- 8.0 ablation sessions. The catheter tests included visual inspection for surface defects using a magnification glass, impedance measurements, evaluation of the catheter deflection capability, and the integrity of the thermistor and thermocouple. The catheters were sterilized by Sterrad after each use. A total of 41 catheters were rejected after an average 9.1 +/- 8.8 uses (range 1-31). The main reasons for rejection were inaccurate temperature measurements by the thermistor or thermocouple (19%), breakage of or defect in the internal pulling wire (12%), loss or disturbance of electrogram (9%), and loss of deflection capability (8%). The reuse of the catheters has not resulted in any major catheter failures or any major adverse clinical complications. There were no local or systemic infections. It can be concluded that these types of ablation catheters will sustain repeated uses and resterilizations without untoward harm to the patient provided that a thorough validation protocol and guidelines for quality control and rejection of catheters are used. There seems to be no rational for setting a limit for the number of reuses, since most failures occurred at any time of reuse.
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| 10. |
- Blomström-Lundqvist, C, et al.
(författare)
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Transesophageal versus intracardiac atrial stimulation in assessing electrophysiologic parameters of the sinus and AV nodes and of the atrial myocardium
- 1987
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 10:5, s. 1081-1095
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Tidskriftsartikel (refereegranskat)abstract
- Electrophysiological porameters of the sinus and AV nodes and of the atrial myocardium were assessed with both transesophageal atrial stimulation (TAS) and intracardiac atrial stimulation (ICS) in the same patient during the same study. The study group was comprised of nine men and seven women, aged 45 to 79 years, referred for the evaluation of syncope of possible arrhythmogenic origin. Twelve patients were included for analysis. Autonomic inhibition (AI) was obtained in five patients. The most striking result was the significantly longer AERP with TAS (mean 286 ± 9 ms) than with ICS (mean 244 ± 12 ms; p < 0.02). After AI, the AERP was even more prolonged with TAS (mean 332 ± 20 ms) than with ICS (mean 237 ± 8 ms; p < 0.01). Intraatrial and AV nodal conduction times assessed at multiple paced cycle lengths were significantly shorter with TAS than with ICS. There was no difference between TAS and ICS with regard to AVERP, Wenckebach periodicity and H-V intervals. Although a tendency towards shorter sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) was observed with TAS, the difference was not statistically significant. Possible mechanisms of the differences are discussed. It seemed clear that the site of origin of an atrial impulse can have definite effects upon excitability and conduction properties of atrial and AV nodal fibers. Enhanced sympathetic activity during TAS was also suggested. The electrophysiological properties inherent in the TAS technique warrant further elucidation.
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| 11. |
- Candinas, R, et al.
(författare)
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Impact of fusion avoidance on performance of the automatic threshold tracking feature in dual chamber pacemakers: A multicenter prospective randomized study
- 2002
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 25:11, s. 1540-1545
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Tidskriftsartikel (refereegranskat)abstract
- The Autocapture algorithm enables automatic capture verification on a beat-by-beat basis by recognizing the evoked response signal following each pacemaker stimulus. The algorithm intends to increase patient safety while decreasing energy consumption. However, the occurrence of fusion beats, particularly during dual chamber pacing, may limit the energy saving effect of Autocapture. The aim of this multicenter, prospective, randomized study was to evaluate the impact of the Fusion Avoidance (FA) algorithm on the incidence of fusion beats. Thirty-eight patients (mean age 69 +/- 13 years) with intrinsic AV conduction who were implanted with an Affinity DR were studied. After programming a PV/AV delay of 120/190 ms, patients were randomized to FA On or Off. Each group was further randomized with respect to activation of the AutoIntrinsic Conduction Search (AICS) algorithm. The total number of beats, ventricular paced beats, fusion beats, backup pulses, and threshold searches were analyzed from 24-hour Holter recordings. The number of total beats was comparable in both FA groups. The number of total ventricular paced beats, fusion beats, backup pulses, and threshold searches were significantly reduced in the FA On group (% reduction: 68% P < 0.001, 75% P < 0.01, 95% P < 0.01, and 94% P < 0.05, respectively). The number of ventricular paced beats with full capture was significantly reduced when AICS was activated (P < 0.05). In conclusion, the FA algorithm substantially reduces the amount of ventricular paced beats, fusion beats, unnecessary backup pulses and threshold searches, and therefore, provides added benefits in energy saving obtained by Autocapture.
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| 12. |
- Emilsson, Kent, 1963-, et al.
(författare)
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An unusual cause of high threshold values at pacemaker implantation
- 1997
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Ingår i: Pacing and Clinical Electrophysiology. - : John Wiley & Sons. - 0147-8389 .- 1540-8159. ; 20:Part: 1, s. 366-7
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Tidskriftsartikel (refereegranskat)abstract
- An 81-year old man with third-degree AV block and weakness underwent an unsuccessful attempt to DDD pacemaker implant caused by hypothyroidism. Administration of thyroxin until he was euthyroid permitted implantation with normal stimulation thresholds.
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| 15. |
- 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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| 16. |
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| 17. |
- Gottfridsson, Christer, 1958, et al.
(författare)
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Acute evaluation of transthoracic impedance vectors using ICD leads.
- 2009
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Ingår i: Pacing and clinical electrophysiology : PACE. - : Wiley. - 1540-8159 .- 0147-8389. ; 32:6, s. 762-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Minute ventilation (MV) has been proven to be very useful in rate responsive pacing. The aim of this study was to evaluate the feasibility of using implantable cardioverter-defibrillator (ICD) leads as part of the MV detection system. METHODS: At implant in 10 patients, the transthoracic impedance was measured from tripolar ICD, tetrapolar ICD, and atrial lead vectors during normal, deep, and shallow voluntary respiration. MV and respiration rate (RespR) were simultaneously measured through a facemask with a pneumotachometer (Korr), and the correlations with impedance-based measurements were calculated. Air sensitivity was the change in impedance per change in respiratory tidal volume, ohms (Omega)/liter (L), and the signal-to-noise ratio (SNR) was the ratio of the respiratory and cardiac contraction components. RESULTS: The air sensitivity and SNR in tripolar ICD vector were 2.70 +/- 2.73 ohm/L and 2.19 +/- 1.31, respectively, and were not different from tetrapolar. The difference in RespR between tripolar ICD and Korr was 0.2 +/- 1.91 breaths/minute. The regressed correlation coefficient between impedance MV and Korr MV was 0.86 +/- 0.07 in tripolar ICD. CONCLUSIONS: The air sensitivity and SNR in tripolar and tetrapolar ICD lead vectors did not differ significantly and were in the range of the values in pacemaker leads currently used as MV sensors. The good correlations between impedance-based and Korr-based RespR and MV measurements imply that ICD leads may be used in MV sensor systems.
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| 19. |
- Holmqvist, Fredrik, et al.
(författare)
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Indices of electrical and contractile remodeling during atrial fibrillation in man
- 2006
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 29:5, s. 512-519
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Tidskriftsartikel (refereegranskat)abstract
- Atrial electrical and contractile remodeling have been demonstrated to coincide during atrial fibrillation (AF) in experimental studies. We explored whether electrical and contractile remodeling correlate in man and explored its clinical implications. METHODS: Forty-nine patients with persistent AF were studied. Electrical remodeling was assessed noninvasively using spectral analysis to estimate the average fibrillatory rate (AFR). Atrial contractility was assessed by transesophageal echocardiography (TEE) measurement of left atrial appendage outflow velocity (LAAOV). RESULTS: The AFR was 403+/-43 fibrillations per minute (fpm) and the LAAOV was 0.27+/-0.14 m/s. A significant correlation was found between AFR and LAAOV (r=-0.47, P=0.001). In patients with a LAAOV>or=0.25 m/s, the AFR was 387+/-48 fpm compared to 419+/-31 fpm among patients with LAAOV<0.25 m/s (P<0.01). CONCLUSIONS: This study demonstrates that indices of electrical and contractile remodeling are strongly correlated in persistent AF in man. The interindividual overlap, however, is too large to allow predictions of LAAOV based on fibrillatory frequency alone.
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| 20. |
- Holmqvist, Fredrik, et al.
(författare)
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Noninvasive evidence of shortened atrial refractoriness during sinus rhythm in patients with paroxysmal atrial fibrillation.
- 2009
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 32:3, s. 302-307
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Shortening of the atrial refractory period is the key feature of atrial electrical remodeling during atrial fibrillation (AF). During sinus rhythm (SR), assessment of the atrial refractoriness is hampered by the fact that the atrial repolarization wave (Ta wave) is largely obscured by the following QRST complex. The purpose of this study was to study the Ta wave in subjects with paroxysmal AF during SR with third-degree atrioventricular (AV) block, and in matched controls. METHODS: Fifteen patients (mean age 70 +/- 10 years, five males) with paroxysmal AF undergoing AV-nodal ablation were studied. Fifteen age- and gender-matched subjects (mean age 71 +/- 9 years, five males) with third-degree AV block, without a history of heart disease, were used as controls. Standard 12-lead electrocardiograms (ECGs) were recorded and transformed to orthogonal leads and studied using P-wave signal averaging technique. RESULTS: The P to Ta interval was shorter (408 +/- 47 ms vs 451 +/- 53 ms, P = 0.017) and in Lead Y the Ta peak location was earlier (156 +/- 31 ms vs 187 +/- 34 ms, P = 0.002) in subjects with paroxysmal AF than in the controls. The P-wave duration (126 +/- 15 ms vs 129 +/- 17 ms, P = 0.59) and morphology was similar in AF patients and controls. CONCLUSIONS: In this study, the ECG signs of shorter atrial refractoriness associated with a history of AF are visualized for the first time during SR. The finding of the earlier location of the PTa peak in AF subjects implies that a possible indicator of increased arrhythmia susceptibility may be visible already in the unprocessed ECG.
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| 22. |
- Husser, D, et al.
(författare)
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Determinants and prognostic significance of immediate atrial fibrillation recurrence following cardioversion in patients undergoing pulmonary vein isolation
- 2005
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 28:2, s. 119-125
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immediate recurrence of atrial fibrillation (IRAF) occurs frequently after electrical cardioversion, its electrophysiological determinants and prognostic significance hove, however, not been studied in detail. This Study aimed to explore (1) the association of IRAF with clinical characteristics, pulmonary vein (PV) arrhythmogenicity as well as atrial electrophysiologic properties and (2) the prognostic significance of IRAF for outcome of PV isolation for atrial fibrillation (AF). Methods and Results: The subjects of this study were 41 consecutive patients (30 males, 11 females) who underwent PV isolation for drug-refroctory AF. Following successful initial cordioversion, 19 patients (46%) had IRAF within 2 minutes. Coupling intervals of AF reinitiating beats arising from PVs were shorter (386 +/- 39 vs 490 +/- 136 ms, P=0.008) and prematurity indices (0.38 +/- 0.06 vs 0.51 +/- 0.12, P=0.01) smaller than those of premature beats not initiating AF Patients with IRAF had more frequently AF duration <1 month, a longer P-wave duration, and a longer mid coronary sinus AF cycle length. Multivariate regression analysis revealed coronary sinus AF cycle length ( beta = 0.186, P=0.049), which was closely correlated with conduction time along the coronary sinus (R = 0.716, P = 0.003) to be independently associated with IRAF While early AF recurrence rate (within the first 5 days) following the procedure was higher in the IRAF group (53 vs 18%, P = 0.02), outcome was not different between the two groups thereafter. Conclusions: (1) IRAF is common in patients undergoing PV isolotion for AF, (2) is initiated by premature atrial beats with short coupling intervals, and (3) seems to be associated with conduction disturbances along the coronary sinus. It reflects susceptibility of arrhythmia recurrence within the first 5 days after the procedure, but not thereafter.
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| 23. |
- Höijer, Carl Johan, et al.
(författare)
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Single chamber atrial pacing: A realistic option in sinus node disease: A long-term follow-up study of 213 patients
- 2007
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 30:6, s. 740-747
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite several decades of experience with atrial pacing, many centers do not apply this mode to any greater extent, mainly because of concerns for the development of future atrioventricular (AV) block or atrial fibrillation. Recent studies have emphasized possible negative effects of right ventricular stimulation, even when AV-synchrony is preserved, and have thus given rise to renewed interest in single chamber atrial pacing for sinus node disease. Methods: This study presents the results of up to 19 years' follow-up of 213 patients with sinus node disease treated with atrial pacing with respect to survival and causes of death, development of atrial fibrillation and AV block, and total mode survival. Patients were divided into two groups: with or without associated atrial tachyarrhythmias at the time of implant. Results are given for all patients and for the two groups separately. Results: The mean follow-up time was 10.1 years. The survival of the entire group was lower after 10 years than that of an age and gender-matched general Swedish population. This was caused by patients with the brady-tachy syndrome (BT) having a significantly higher mortality rate than controls, whereas those with bradycardia only (B) had survival comparable to the general population. Permanent atrial fibrillation (AF) developed in 20% of patients and was significantly more common in patients with BT. The majority of patients with AF (78%) no longer needed any pacing, i.e., did not require ventricular stimulation due to slow ventricular rate. The annual incidence of high grade AV block was 1.8%. If patients with preexisting bundle branch block were excluded, the incidence was 1.6%. No fatal episode of AV block was seen. The overall mode survival at the end of follow-up was 75%, with 155 patients still with atrial pacemakers. Conclusion: Atrial pacing is a safe and reliable mode of pacing in patients with sinus node disease, even in the very long-term.
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| 26. |
- Jensen, Steen, et al.
(författare)
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Syncope and wide QRS tachycardia.
- 2005
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Ingår i: Pacing Clin Electrophysiol. - : Wiley. - 0147-8389. ; 28:7, s. 708-9
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Tidskriftsartikel (refereegranskat)
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| 27. |
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| 28. |
- Johansson, Birgitta, 1960, et al.
(författare)
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Low Mortality and Low Rate of Perceived and Documented Arrhythmias after Cox Maze III Surgery for Atrial Fibrillation.
- 2014
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Ingår i: Pacing and clinical electrophysiology : PACE. - : Wiley. - 1540-8159 .- 0147-8389. ; 37:2, s. 147-156
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Tidskriftsartikel (refereegranskat)abstract
- Background: To report a long-term single-site experience of the cut-and-sew Cox maze III procedure for atrial fibrillation (AF). Methods: A total of 232 consecutive patients underwent the Cox maze III procedure for symptomatic therapy-refractory AF, with concomitant surgery in 34 patients. Follow-up data were obtained from electrocardiograms, patient visits, questionnaires, and medical files. Results: There were 103 patients (44%) with paroxysmal AF during 8.8 ± 6.5 years and 129 patients (56%) with nonparoxysmal AF for 7.3 ± 6.7 years. The preoperative New York Heart Association class was better in patients with paroxysmal AF (P < 0.0001); the left ventricular ejection fraction was 59 ± 7% versus 56 ± 8%, P = 0.003, and the left atrial area 24 ± 6 versus 27 ± 6cm 2 ,P = 0.01. Early and late postoperative adverse events occurred at similar rates. Four patients from each group died of reasons unrelated to surgery. The mean follow-up was 66 ± 42 (5–155) months. In total, 184/229 (80%) patients were free of documented AF/atrial flutter/atrial tachycardia (AF/AFl/AT) off antiarrhythmic drugs (AA) and 189/229 (83%) on or off AA. The hazard ratio (HR) for paroxysmal versus nonparoxysmal AF patients regarding documented AF/AFl/AT was 0.8 (95% confidence interval [CI] 0.4–1.4; P = 0.40). For patients without versus with concomitant surgery, the corresponding HR was 0.4 (95% CI 0.2–0.8; P = 0.008). Of 197 patients (89%) responding to the questionnaire, 41 had sought care for symptoms of arrhythmia, 29 of whom had documented AF/AFl/AT, whereas another six had other arrhythmias. Conclusion: Cut-and-sew Cox maze III surgery provided long-lasting high efficacy, also in patients with nonparoxysmal AF of long duration and/or concomitant surgery, and was associated with low rates of subsequent adverse events. (PACE 2014; 37:147–156)
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| 31. |
- Kesek, Milos, et al.
(författare)
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Two Cases of LQT Syndrome with Malignant Syncope after Switch from Propranolol to Bisoprolol
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 39:3, s. 305-306
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Tidskriftsartikel (refereegranskat)abstract
- Propranolol in slow-release form has been the first-line treatment in long QT (LQT) until it was withdrawn from the market. We describe two cases where a switch to bisoprolol resulted in worsening of arrhythmia control: A man with LQT2, asymptomatic on propranolol, experienced syncope after switching to bisoprolol 5 mg daily. He switched back to propranolol and has remained asymptomatic during subsequent 12 months. A man with classical Jervell Lange-Nielsen syndrome, previous gangliectomy, and ICD implantation, switched to bisoprolol 5 mg daily. Four months later he experienced a tachycardia storm. He switched back to propranolol and has remained free from arrhythmias during subsequent 12 months.
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| 32. |
- Kesek, Milos, et al.
(författare)
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U22, a protocol to quantify symptoms associated with supraventricular tachycardia.
- 2009
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 32:S1, s. S105-S108
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main indication for ablation of supraventricular tachyarrhythmias (SVTA) is symptomatic relief. Specific paroxysmal symptoms cannot be quantified with general measures of quality of life, such as with the SF-36 questionnaire. U22 is a new protocol which measures the effects of arrhythmia on well-being, the intensity of discomfort during an episode, the type and temporal characteristics of dominant symptoms, and the duration and frequency of episodes. Discrete 0-10 scales are used. Unlike SF-36, U22 can be used in individual patients. METHODS: U22 and SF-36 protocols were used in the symptomatic evaluation of 88 patients (mean age = 49.6 +/- 16.4 years; 43 men), who underwent catheter ablation of SVTA. Results: The U22 scores (SD) for (a) well-being (10 being best), (b) effects of arrhythmia on well-being (10 being worst), and (c) discomfort during arrhythmia (10 being worst) were 5.6 (2.7), 7.5 (2.8), and 8.0 (2.4), respectively. For comparison, the physical and mental component summaries of SF-36 were 45.3 (11.0) and 45.2 (12.1), respectively, slightly lower than the expected normal of 50. The intensity of dominant symptom scored by U22 was 9.7 (1.2), 10 being worst. In 29% of patients > or =4 symptoms were equally dominant. Multiple dominant symptoms in U22 were associated with a low general well-being in SF-36. CONCLUSION: We found U22 useful to quantify symptoms associated with SVTA.
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| 33. |
- Kommata, Varvara, et al.
(författare)
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QRS dispersion detected in ARVC patients and healthy gene carriers using 252-leads body surface mapping : an explorative study of a potential diagnostic tool for arrhythmogenic right ventricular cardiomyopathy
- 2021
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 44:8, s. 1355-1364
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The diagnosis of ARVC remains complex requiring both imaging and electrocardiographic (ECG) techniques. The purpose was therefore to investigate whether QRS dispersion assessed by body surface mapping (BSM) could be used to detect early signs of ARVC, particularly in gene carriers.METHODS: ARVC patients, gene carriers without a history of arrhythmias or structural cardiac changes and healthy controls underwent 12-lead resting ECG, signal-averaged ECG, echocardiographic examination, 24-hours Holter monitoring, and BSM with electrocardiographic imaging. All 252-leads BSM recordings and 12-leads ECG recordings were manually analyzed for QRS durations and QRS dispersion.RESULTS: Eight controls, 12 ARVC patients with definite ARVC and 20 healthy gene carriers were included. The ECG-QRS dispersion was significantly greater in ARVC patients (42 vs. 25 ms, p < .05), but failed to fully differentiate them from controls. The BSM-derived QRS dispersion was also significantly greater in ARVC patients versus controls (65 vs. 29 ms, p < .05) and distinguished 11/12 cases from controls using the cut-off 40msec. The BSM derived QRS dispersion was abnormal (> 40 ms) in 4/20 healthy gene carriers without signs of ARVC, which may indicate early depolarization changes.CONCLUSIONS: QRS dispersion, when assessed by BSM versus 12-lead ECG, seem to better distinguish ARVC patients from controls, and could potentially be used to detect early ARVC in gene carriers. Further studies are required to confirm the value of BSM-QRS dispersion in this respect.
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| 34. |
- Kommata, Varvara, et al.
(författare)
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Repolarisation abnormalities unmasked with a 252-lead BSM system in patients with ARVC and healthy Gene Carriers
- 2022
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Ingår i: Pacing and Clinical Electrophysiology. - : John Wiley & Sons. - 0147-8389 .- 1540-8159. ; 45:4, s. 509-518
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) at an early stage can be challenging even after ECG recording and a combination of several imaging techniques. The purpose of this study was to explore if a Body Surface Mapping (BSM) system with 252-leads could identify repolarization abnormalities and thereby diagnose early stages of ARVC.METHODS: ARVC patients, gene carriers without signs of ARVC and controls underwent a 12 lead resting ECG, signal-averaged ECG, echocardiography, 24-hours Holter monitoring and BSM with electrocardiographic imaging (ECGI). All 252-leads, divided into four quadrants of the vest, were analyzed regarding concordances between T wave polarity and QRS main vector.RESULTS: Of 40 patients included there were 12 ARVC patients, 20 gene carriers and 8 controls. The ARVC patients had two different repolarization patterns, one with more pronounced negative T waves at the lower left panel and another with mixed changes that clearly differed from the controls, all of whom had a normal 12 lead ECGs and consistent repolarization patterns on their BSM recordings. The patterns observed in ARVC patients were also present in 5/20 (25%) gene carriers, three of whom had normal resting ECG. A novel repolarization index successfully detected all ARVC patients and 88% of gene carriers with pathologic repolarization pattern.CONCLUSIONS: The finding that abnormal repolarization patterns could be unmasked by BSM in 25% of healthy gene carriers, suggests that it may potentially be a useful tool for identifying early manifestations of ARVC. Further and larger studies are warranted to assess its diagnostic accuracy.
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| 35. |
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| 36. |
- Lensvelt, L. M. H., et al.
(författare)
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Mechanical extraction of cardiac implantable electronic devices leads with long dwell time: Efficacy and safety of the step up approach
- 2021
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Ingår i: Pacing and Clinical Electrophysiology: PACE. - : Wiley. - 0147-8389 .- 1540-8159. ; 44:1, s. 120-128
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the efficacy and safety of the stepwise mechanical transvenous lead extraction approach in a patient population with chronically implanted transvenous leads with a long dwell time. From January 2014 till December 2018, all lead extractions with lead dwell time >= 5 years performed at our tertiary centre were retrospectively analysed. A total of 173 leads, from 78 patients (median age 68 years; 81% male) with a median dwell time of 9 years (interquartile range [IQR] 5) were extracted, with three or more leads in 42% of the patients. Right atrial leads: 41%; right ventricular pacing leads: 16%; implantable cardioverter-defibrillator (ICD) leads: 31% (72% dual coil); coronary sinus leads: 12%. The majority (75%) of the leads had an active fixation. Most frequent indication for extraction was pocket infection/erosion (76%). Overall clinical success was 97%, and complete procedural success was 93%. Venous patency, assessed with venous angiography, was well preserved in 93% of the cases. The overall procedural complication rate was 3.8% (2.6% major and 1.3% minor). Despite the complexity of the population and a very long dwell time (median 9 years), a clinical success rate of 97% was achieved with the stepwise mechanical approach. Analysis of impeding progression of pectoral extraction suggests that dense fibrosis and sharp lead curvature in the transvenous trajectory pose a challenge. Complication rate was low, and acute venous patency was generally well preserved.
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| 40. |
- LINDE, C, et al.
(författare)
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Pacing in dilated cardiomyopathy
- 1995
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Ingår i: Pacing and clinical electrophysiology : PACE. - : Wiley. - 0147-8389 .- 1540-8159. ; 18:7, s. 1341-1345
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 41. |
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| 42. |
- Linde, C
(författare)
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Women and arrhythmias
- 2000
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Ingår i: Pacing and clinical electrophysiology : PACE. - : Wiley. - 0147-8389 .- 1540-8159. ; 23:1010 Pt 1, s. 1550-1560
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Tidskriftsartikel (refereegranskat)
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| 43. |
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| 45. |
- Magnusson, Peter, et al.
(författare)
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Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 39:3, s. 291-301
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Tidskriftsartikel (refereegranskat)abstract
- Background: Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.Aim: To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.Methods: Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).Results: Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow-up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) <50% (HR 2.63; P < 0.001) was associated with appropriate ICD therapy. In primary prevention, patients with established risk markers experienced appropriate therapy; atrial fibrillation (AF; HR 2.54; P = 0.010), EF < 50% (HR 2.78; P = 0.004), and nonsustained ventricular tachycardia (HR 1.80; P = 0.109) had the highest HR, and wall thickness 30 mm, syncope, exercise blood pressure response, or family history of SCD had weaker associations.Conclusion: ICD therapy successfully terminates ventricular arrhythmias in HCM. In addition to conventional risk markers, a history of AF or EF < 50% may be considered in risk stratification.
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| 46. |
- Mattsson, Gustav, et al.
(författare)
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Long-term follow-up of implantable cardioverter defibrillator patients with regard to appropriate therapy, complications, and mortality
- 2020
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 43:2, s. 245-253
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAn implantable cardioverter defibrillator (ICD) is recommended for patients with symptomatic heart failure with ejection fraction ≤35% despite optimal medical therapy. More recently, the benefits of ICDs have been questioned in nonischemic cardiomyopathy (CM).AimTo examine the incidence of appropriate therapy, complications, mortality, and cause of death among ICD patients in an unselected validated cohort. In primary prevention, appropriate therapy in ischemic versus nonischemic CM will be evaluated.MethodsA retrospective observational study of patients in Region Gävleborg, Sweden, who underwent ICD implantation or replacement between 2007 and 2017.ResultsIn total, 438 patients (mean age at implant: 65.9 ± 11.2 years, 82.0% males, mean follow‐up: 5.2 ± 4.0 years) were included. There were 108 (24.7%) deaths (49.1% due to heart failure) and 94.9% survived the first year. Cumulative incidence of appropriate therapy at 5‐year was 31.6%. Cumulative incidence of inappropriate shock at 5‐year was 9.1%. A total of 98 complications requiring surgical intervention occurred (annual rate: 4.3%). In total, 236 patients with primary prevention due to ischemic (61.9%) or nonischemic (38.1%) CM were included. During a mean follow‐up of 3.9 ± 2.5 years, for appropriate therapy, there was no significant difference (P = .985) between ischemic (cumulative incidence at 1, 3, and 5 years: 6.4%, 17.1%, and 19.6%) and nonischemic CM (cumulative incidence at 1, 3, and 5 years: 5.6%, 13.6%, and 24.4%).ConclusionIschemic and nonischemic CM confer similar risk of ventricular arrhythmia. This supports current guidelines regarding primary‐prevention ICD. Short‐term survival is excellent but complications remain a problem.
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| 47. |
- Michaëlsson, Magnus, et al.
(författare)
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Natural history of congenital complete atrioventricular block
- 1997
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley. - 0147-8389 .- 1540-8159. ; 20:8 Pt 2, s. 2098-2101
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Tidskriftsartikel (refereegranskat)abstract
- An update of studies on the natural history of congenital complete AV block is presented. A risk for heart failure, syncope, and sudden death is present at any age including fetal life. Unfavorable prognostic signs in utero are low and decreasing ventricular rate (VR), hydrops, AV valve regurgitation, and low aortic flow velocity. Indications for pacing in infancy are congestive heart failure, ventricular rate < 55 beats/min in isolated block and < 65 beats/min with associated disease, prolonged OTc, syncope attacks, frequent ventricular ectopic beats, and alternating ventricular pacemakers. Indications for immediate pacing in childhood and adult life are syncope, presyncope, VR rates lower than median for age, periods of junctional exit block, prolongation of QTc and mitral regurgitation, and change of ventricular pacemaker. Pacing is recommended to all patients older than 15 years.
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| 48. |
- Milasinovic, G, et al.
(författare)
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Reduction of RV pacing by continuous optimization of the AV interval
- 2006
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 29:4, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- Background: In patients requiring permanent pacing, preservation of intrinsic ventricular activation is preferred whenever possible. The Search AV+ (SAV+) algorithm in Medtronic EnPulse(TM) dual-chamber pacemakers can increase atrioventricular (AV) intervals to 320 ms in patients with intact or intermittent AV conduction. This prospective, multicenter study compared the percentage of ventricular pacing with and without AV interval extension. Methods: Among 197 patients enrolled in the study, the percentage of ventricular-paced beats was evaluated via device diagnostics at the 1-month follow-up. Patient cohorts were defined by clinician assessment of conduction via a 1:1 AV conduction test at the 2-week follow-up. The observed percentage of ventricular pacing with SAV + ON and the predicted percentage of ventricular pacing with SAV + OFF were determined from the SAV + histogram data for the period between the 2-week and 1-month follow-up visits. Results: Of 197 patients, 110 (55.8%) had intact 1:1 AV conduction, of which 109 had 1-month data. SAV + remained ON in 991109 patients; 10 patients had intrinsic A-V conduction intervals beyond SAV + nominal and therefore SAV + disabled. The mean percentage of ventricular pacing in the 109 patients was SAV+ ON = 23.1% (median 3.7%) versus SAV + OFF = 97.2% (median 99.7%). In 87 patients without 1:1 AV conduction, SAV + was programmed OFF in 6, automatically disabled in 52, and remained ON in 29. In 8 of these patients, 80-100% reduction in ventricular pacing was observed with SAV + ON. Conclusion: The Search AV+ algorithm in the EnPulse pacemaker effectively promotes intrinsic ventricular activation and substantially reduces unnecessary ventricular pacing.
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| 49. |
- Miller, Jennifer L, et al.
(författare)
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Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients.
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - : Wiley-Blackwell. - 0147-8389 .- 1540-8159. ; 39:2, s. 149-159
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Most patients cope well with an implantable cardioverter defibrillator (ICD), but psychological distress and ICD-related concerns have been reported in about 20% of ICD recipients. Many previous studies have not distinguished between genders.METHODS: In this nationwide study we compared quality of life, anxiety, and depression symptoms between the genders in ICD recipients, and determined predictors of each of these variables in men and women. All adult Swedish ICD recipients were invited by mail to participate and 2,771 patients (66 ± 12 years) completed standardized measures of quality of life, symptoms of anxiety, and depression. Time since implantation ranged from 1 year to 23 years with a mean of 4.7 ± 3.9.RESULTS: Women reported worse quality of life (mean index 0.790 vs 0.825) and higher prevalence of anxiety (20.5% vs 14.7%) than did men (P < 0.001 for both comparisons), while there were no differences in symptoms of depression (8.8% vs 8.2%).CONCLUSIONS: Most ICD recipients report a good quality of life, without emotional distress, but among the minority with distress, women fare worse than men.
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