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Sökning: L773:1532 2092 OR L773:1099 5129 > (2005-2009)

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1.
  • Liuba, Ioan, et al. (författare)
  • Corrigendum for: Focal atrial tachycardia : increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 1357
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 10:11, s. 1357-1357
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • P values of P < 0.0001 should have been given in the abstractfor the increase within the region activated during the first15 ms of both the incidence of bipolar electrograms with multiplenegative deflections and of the incidence of unipolar electrogramswith multiple negative deflections.In the section ‘Characteristics of electrograms in theregion surrounding the earliest activation site and in the remainingatrium’ the P value for bipolar voltage should be P <0.0001, not P < 0001. In the same section the P value forthe decrease of unipolar and bipolar peak-to-peak voltage shouldbe P < 0.0001, not P < 0001.
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4.
  • Bollmann, Andreas, et al. (författare)
  • Analysis of surface electrocardiograms in atrial fibrillation: techniques, research, and clinical applications
  • 2006
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 8:11, s. 911-926
  • Forskningsöversikt (refereegranskat)abstract
    • Atrial. fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Neither the natural history of AF nor its response to therapy is sufficiently predictable by clinical and echocardiographic parameters. The purpose of this article is to describe technical aspects of novel electrocardiogram (ECG) analysis techniques and to present research and clinical applications of these methods for characterization of both the fibrillatory process and the ventricular response during AF Atrial fibrillatory frequency (or rate) can reliably be assessed from the surface ECG using digital signal processing (extraction of atrial, signals and spectral analysis). This measurement shows large inter-individual variability and correlates well with intra-atriat cycle length, a parameter which appears to have primary importance in AF maintenance and response to therapy. AF with a tow fibrillatory rate is more likely to terminate spontaneously and responds better to antiarrhythmic drugs or cardioversion, whereas high-rate AF is more often persistent and refractory to therapy. Ventricular responses during AF can be characterized by a variety of methods, which include analysis of heart rate variability, RR-interval histograms, Lorenz plots, and non-linear dynamics. These methods have all shown a certain degree of usefulness, either in scientific explorations of atrioventricular (AV) nodal function or in selected clinical questions such as predicting response to drugs, cardioversion, or AV nodal modification. The role of the autonomic nervous system for AF sustenance and termination, as well as for ventricular rate responses, can be explored by different ECG analysis methods. In conclusion, non-invasive characterization of atrial fibrillatory activity and ventricular response can be performed from the surface ECG in AF patients. Different signal processing techniques have been suggested for identification of underlying AF pathomechanisms and prediction of therapy efficacy.
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5.
  • Bollmann, Andreas, et al. (författare)
  • Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation.
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 9:8, s. 6-621
  • Tidskriftsartikel (refereegranskat)abstract
    • ims In atrial fibrillation (AF), a relation between electrocardiogram (ECG) fibrillatory wave amplitude and thrombus formation has been sought for long with conflicting results. In contrast, the possible relation between atrial fibrillatory rate obtained from the surface ECG and left atrial thrombus formation in patients with AF is unknown and was consequently evaluated in this study. Methods and results One-hundred and twenty-five patients (mean age 64 ± 12 years, 72% male) with persistent non-valvular AF (mean duration 28 ± 80 days) undergoing transesophageal echocardiography were studied. In all patients, standard 12-lead ECG recordings were acquired before the examination. Atrial fibrillatory rate was determined using spatiotemporal QRST cancellation and time–frequency analysis of lead V1. Atrial fibrillatory rate measured 401 ± 63 fibrillations per minute (fpm, range 235–566 fpm) and was related with age (R = −0.326, P < 0.001), ventricular rate (R = −0.202, P = 0.024), gender (407 ± 62 in males vs. 387 ± 64 fpm in females, P = 0.038) but not AF duration (R = 0.088, P = 0.374), presence of lone AF (408 ± 66 vs. 394 ± 58 fpm, P = 0.228), or beta-blocker or calcium channel blocker treatment (398 ± 63 vs. 405 ± 62 fpm, P = 0.556). Age was the only independent predictor of fibrillatory rate (B = −1.714, P < 0.001). In patients with left atrial thrombus (n = 10), spontaneous echo contrast (SEC) was more frequently present (70 vs. 29 %, p = 0.007) and left atrial appendage (LAA) outflow velocity was lower (26 ± 20 vs. 37 ± 15 cm/s, P = 0.012) than in patients without thrombus (n = 115). In contrast, mean fibrillatory rate, which showed a weak inverse correlation with LAA velocity (R = −0.118, P = 0.048) was not different between both groups (380 ± 56 vs. 403 ± 63 fpm, P = 0.226). Similarly, presence of thrombus and SEC combined was not related with fibrillatory rate. Conclusion Atrial fibrillatory rate obtained from surface ECG lead V1 is not a risk marker for left atrial thrombus formation in AF.
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6.
  • Bollmann, Andreas, et al. (författare)
  • Atrial fibrillatory rate and risk of stroke in atrial fibrillation.
  • 2009
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 11, s. 582-586
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims In atrial fibrillation (AF), a relation between electrocardiogram (ECG) parameters such as fibrillatory wave amplitude and stroke has been sought with conflicting results. In this study, we tested the hypothesis that the atrial fibrillatory rate of surface ECG lead V1 is related to stroke risk and may consequently be helpful for identifying high-risk patients. Methods and results Atrial fibrillatory rate of 79 consecutive patients with AF and embolic stroke (age 83 +/- 7 years, 41% male) was compared with those of a matched AF population without stroke (n = 79). Atrial fibrillatory rate was determined from the surface ECG using spatiotemporal QRST cancellation and time-frequency analysis of lead V1. There was no significant difference in any clinical or echocardiographic variable in patients with stroke compared with AF controls without stroke. Atrial fibrillatory rate measured 373 +/- 55 fibrillations per minute (fpm; range 235-505 fpm) in the entire population. There was no fibrillatory rate difference between stroke patients (369 +/- 54 fpm, range 256-505 fpm) and AF controls without stroke (378 +/- 56 fpm, range 235-488 fpm). There was an inverse correlation between fibrillatory rate and age (R = -0.219, P = 0.006). Individuals aged >/=85 years had a significantly lower fibrillatory rate (356 +/- 44 fpm) than individuals aged 65-74 years (384 +/- 56 fpm, P = 0.033) and individuals aged 75-84 years (384 +/- 60 fpm, P = 0.016). In those subgroups, fibrillatory rates were, however, also similar in stroke patients and AF controls. Conclusion Atrial fibrillatory rate obtained from surface ECG lead V1 is not a risk marker for stroke in AF.
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7.
  • Bollmann, Andreas, et al. (författare)
  • Fibrillatory rate response to candesartan in persistent atrial fibrillation.
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 10, s. 1138-1144
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Angiotensin-receptor blockers may exert favourable anti-arrhythmic effects in atrial fibrillation (AF), but their mechanisms are not fully understood. In this study, we tested the hypotheses that (i) candesartan reduces atrial fibrillatory rate and (ii) fibrillatory rate and its response to candesartan are related with the outcome of cardioversion. For this purpose, a post hoc subanalysis of the randomized, placebo-controlled CAPRAF (Candesartan in the Prevention of Relapsing Atrial Fibrillation) trial was performed. Methods and results Patients with AF undergoing electrical cardioversion were randomized to receive candesartan 8 mg once daily (n = 58) or matching placebo (n = 66) and no additional class I or III anti-arrhythmic drugs. Fibrillatory rate was determined from ECG lead V1 at baseline and at the day of cardioversion using spatiotemporal QRST cancellation and time-frequency analysis. The median time on treatment was 29 days. Candesartan reduced fibrillatory rate [399 +/- 48 vs. 388 +/- 49 fibrillations/min (fpm), P = 0.04], but not placebo (402 +/- 58 vs. 402 +/- 61 fpm, P = 0.986). Candesartan effects were only observed if the baseline fibrillatory rate was high [>420 fpm: 445 +/- 21 vs. 415 +/- 49 fpm, P = 0.006 vs. intermediate (360-420 fpm): 397 +/- 19 vs. 391 +/- 37 fpm, P = 0.351 vs. low (<360 fpm): 326 +/- 26 vs. 338 +/- 29 fpm, P = 0.179]. Cardioversion success was 100% in patients with an on-treatment rate <360 fpm vs. 83% in patients with higher rates (P = 0.02). Risk for AF recurrence was similar in patients with low (64%), intermediate (75%), or high on-treatment rates (63%, P = 0.446) and was also independent of candesartan effects on the fibrillatory rate. Conclusion In patients with persistent AF, candesartan decreases the fibrillatory rate, but this effect is restricted to patients with high baseline fibrillatory rates and is not associated with improved cardioversion outcome. Fibrillatory rates <360 fpm are associated with successful cardioversion, but not with AF recurrence.
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8.
  • Brignole, M, et al. (författare)
  • Indications for the use of diagnostic implantable and external ECG loop recorders
  • 2009
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 11:5, s. 671-687
  • Tidskriftsartikel (refereegranskat)
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9.
  • Camm, A J, et al. (författare)
  • Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study.
  • 2007
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 9:12, s. 1110-8
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: This investigation was conducted to determine the effectiveness of several conventional overdrive pacing modalities (single rate and rate responsive pacing at various lower rates) and of four dedicated preventive pacing algorithms in the suppression of paroxysmal atrial fibrillation (AF). METHOD AND RESULTS: In this multi-centre, randomized trial, 372 patients with drug-refractory paroxysmal AF were enrolled. Patients received a dual-chamber pacing device capable of delivering conventional pacing therapy as well as dedicated AF prevention pacing therapies and to record detailed AF-related diagnostics. The primary endpoint was AF burden, whereas secondary endpoints were time to first AF episode and averaged sinus rhythm duration. During a conventional pacing phase, patients were randomized to single rate or rate-responsive pacing with lower rates of either 70 or 85 min(-1) or to a control group with single rate pacing at 40 min(-1). In the subsequent preventive pacing phase, patients underwent pacing at a lower rate of 70 min(-1) with or without concomitant application of four preventive pacing algorithms. A substantial amount of data was excluded from the analysis because of atrial-sensing artefacts, identified in the device-captured diagnostics. In the conventional pacing phase, no significant differences were found between various lower rates and the control group receiving single rate pacing at 40 min(-1) or between single rate and rate-responsive pacing. Patients receiving preventive pacing with all four therapies enabled had a similar AF burden compared with patients treated with conventional pacing at 70 min(-1) (P = 0.47). CONCLUSIONS: The results do not demonstrate a significant effect of conventional atrial overdrive pacing or preventive pacing therapies. However, the observations provided important information for further consideration with respect to the design and conduct of future studies on the effect of atrial pacing therapies for the reduction of AF.
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  • Carlson, Jonas, et al. (författare)
  • Can Orthogonal Lead Indicators of Propensity to Atrial Fibrillation be Accurately Assessed from the 12-Lead ECG?
  • 2005
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 7:Suppl 2, s. 39-48
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: When analyzing P-wave morphology, the vectorcardiogram(VCG) has been shown useful to identify indicators of propensity to atrial fibrillation (AF). Since VCG is rarely used in the clinical routine, we wanted to investigate if these indicators could be accurately determined in VCG derived from standard 12-lead ECG (dVCG).Methods: ECG and VCG recordings from 21 healthy subjects and 20 patients with a history of AF were studied. dVCG was calculated from ECG using the inverse Dower transform. Following signal averaging of P-waves, comparisons were madebetween VCG and dVCG, where three parameters characterizing signal shape and 15 parameters describing the P-wave morphology were used to assess the compatibility of the two recording techniques. The latter parameters were alsoused to compare the healthy and the AF groups.Results: After transformation, P-wave shape was convincingly preserved. P-wave morphology parameters were consistent within the respective groups when comparing VCG and dVCG, with better preservation observed in the healthy group.Conclusion VCG derived from routine 12-lead ECG may be a useful alternate method for studying orthogonal P-wave morphology.
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13.
  • Darpo, B (författare)
  • Detection and reporting of drug-induced proarrhythmias: room for improvement
  • 2007
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1099-5129. ; 99 Suppl 4, s. 23-36
  • Tidskriftsartikel (refereegranskat)
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14.
  • Fored, CM, et al. (författare)
  • Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study
  • 2008
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 10:7, s. 825-831
  • Tidskriftsartikel (refereegranskat)
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16.
  • Gizurarson, Sigfus, et al. (författare)
  • Effects of complete heart block on myocardial function, morphology, and energy metabolism in the rat.
  • 2007
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1099-5129. ; 9:6, s. 411-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Severe sustained bradycardia may cause acute and possibly chronic congestive heart failure (CHF). The aim of this study was to investigate acute and chronic effects of complete heart block (CHB) on cardiac function, morphology, and creatine (Cr) metabolism.
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  • Hertervig, Eva, et al. (författare)
  • Pulmonary vein potentials in patients with and without atrial fibrillation.
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 10, s. 692-697
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Pulmonary vein (PV) potentials are invariably recordable at the PV ostia in patients with atrial fibrillation (AF) and delayed conduction around the PV ostia may play a role in the initiation and maintenance of AF. Aims To investigate the presence and extent of PV potentials in patients with and without AF. Methods and results Circumferential catheter recordings at the PV ostia were obtained from 10 patients with paroxysmal AF and 9 with concealed Wolff-Parkinson-White (WPW) syndrome without history of AF. Typical PV potential was defined as either rapid deflections that separated from atrial deflection with a time delay in-between, or multiphasic, continuous or fractionated potentials. The presence of PV potentials was verified during sinus rhythm and during atrial pacing at the distal coronary sinus for the left PVs or at the right atrial appendage for the right PVs. To quantify the extent in which the PV potentials were recordable, the number of PVs with typical PV potentials recordable was counted. The time interval from the onset to the end of the electrograms recordable at the PV ostium (A-PV interval) was measured, and the maximal and mean of this interval were obtained. Typical PV potentials were recorded in 31 of 34 PVs (91%) in patients with AF, but in 4 of 36 PVs (11%) in patients with concealed WPW. A narrow, biphsic or triphasic, potential was recorded in 3 of 34 PVs (9%) in patients with AF, but in 29 of 36 (81%) PVs in patients with concealed WPW. The maximal and mean A-PV intervals were significantly longer in patients with AF (71 +/- 24 and 49 +/- 13 ms) than in patients with concealed WPW syndrome (33 +/- 14 and 25 +/- 6 ms). Conclusion In patients with AF, typical PV potentials with marked conduction time delay were almost invariably recordable at the PV ostium, but in patients without a history of AF, merely simple, narrow potentials were found. These findings support the involvement of conduction delay and re-entrant activities around the PV ostia in the genesis and/or perpetuation of AF.
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18.
  • Holmqvist, Fredrik, et al. (författare)
  • Atrial fibrillation signal organization predicts sinus rhythm maintenance in patients undergoing cardioversion of atrial fibrillation.
  • 2006
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 8:8, s. 559-565
  • Tidskriftsartikel (refereegranskat)abstract
    • Electrical remodelling is believed to influence the outcome following cardioversion of patients with persistent atrial fibrillation (AF). However, the results in clinical studies are conflicting. We assessed the hypothesis that non-invasively obtained atrial fibrillatory organization can be used as a predictor of sinus rhythm (SR) maintenance. METHODS AND RESULTS: Fifty-four patients (37 men, age 67+/-11) with persistent AF (median duration 3 months, 1 day to 18 months), without anti-arrhythmic drug treatment, referred for cardioversion were studied. Assessment of the atrial harmonic decay was made by time-frequency analysis of the ECG. At 1-month follow-up, 30 patients had relapsed into AF. The mean harmonic decay at inclusion of those relapsing into AF was 1.5+/-0.3 compared with 1.1+/-0.3 among those maintaining SR (P=0.0004). Using a cut-off value of harmonic decay
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19.
  • Husser, Daniela, et al. (författare)
  • Electrocardiographic characteristics of fibrillatory waves in new-onset atrial fibrillation
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 9:8, s. 638-642
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims In atrial. fibrillation (AF), fibrillatory waves of surface electrocardiograms (ECG) vary among patients with respect to waveform and repetition rate. The purpose of this study was to (i) explore clinical determinants of new-onset AF and (ii) determine prognostic significance to predict initial treatment outcome of electrocardiographic fibrillatory wave characteristics in new-onset AF Methods and results Twenty-five patients (15 mate, mean age 69 +/- 16 years) with new-onset AF (median AF duration 8 days) were studied. Fibrillatory rate and exponential decay defined as decay of the curve that connects power maxima of dominant and harmonic frequency components were obtained by spatiotemporal. QRST cancellation and time-frequency analysis of the index ECG (before treatment initiation). Baseline AF rate was 380 +/- 50 fibrillations per minute (fpm) (range 222-494); patients' age (beta = - 1.747, P = 0.003) and AF duration (beta = 0.726, P = 0.036) were independently related with fibrillatory rate. AF terminated within 24 h in seven patients, while it was persistent in the other 18 patients. Terminating AF had lower atrial. rate (333 +/- 66 vs. 398 +/- 40 fpm, P = 0.005) and exponential decay (1.03 +/- 0.36 vs. 1.40 +/- 0.37, P = 0.041) than persisting AF Multivariate analysis revealed fibrillatory rate to be the only independent predictor of AF termination or persistence (p = 0.031, P = 0.031). Sensitivity and specificity for predicting AF termination were strongly related to fibrillatory rate (area under the curve = 0.817). Sensitivity and specificity were 89% and 71% for a fibrillatory rate of 355 fpm. Conclusions Fibrillatory rates vary substantially among patients to new-onset AF and are related to patients' age and AF duration. Lower fibrillatory rates indicate higher chances of spontaneous AF termination within 24 h.
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20.
  • Husser, Oliver, et al. (författare)
  • Exercise testing for non-invasive assessment of atrial electrophysiological properties in patients with persistent atrial fibrillation
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 9:8, s. 627-632
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims Experimental studies suggest that the autonomic nervous system modulates atrial refractoriness and conduction velocity in atrial. fibrillation (AF). These modulatory effects are, however, difficult to assess in the clinical setting. This study sought to non-invasively characterize in patients with persistent AF, the influence of autonomic modulation induced by exercise on atrial fibrillatory rate as marker of atrial refractoriness and to identify clinical and electrocardiographic predictors of atrial rate response. Methods and results In 24 patients (16 mates, mean age 60 +/- 13 years) with persistent AF (16 +/- 25 months), continuous ECGs were recorded during bicycle exercise testing. Fibrillatory rate (in fibrillations per minute, fpm) was assessed at baseline and immediately after termination of exercise with spatiotemporal QRST cancellation and time-frequency analysis. Ventricular response was characterized by time-domain HRV indices. Exercise had no influence on mean fibrillatory rate (409 +/- 42 vs. 414 +/- 43 fpm, P = NS). Seven patients responded to exercise with an increase in fibrillatory rate (26 10 fpm, P < 0.001 and three with a decrease (-21 +/- 8 fpm, P < 0.001), while the remaining 14 patients did not show a response. Responders' HRV indices changed in response to exercise similarly to that of non-responders. Their baseline fibrillatory rate was, however, lower than that of non-responders (387 +/- 18 vs. 425 +/- 48 fpm, P = 0.028). No other clinical or echocardiographic variable was associated with fibrillatory rate response. Twelve weeks after cardioverson, responders were more likely to remain in sinus rhythm than non-responders (88 vs. 46 %, P = 0.04). Conclusions Exercise-induced autonomic activation produces changes in atrial. etectrophysiological properties that can be detected by time-frequency analysis. Higher baseline fibrillatory rates are associated with an impaired atrial response to exercise that suggests advanced electrical remodelling and reduced sensitivity to autonomic stimuli.
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23.
  • Johansson, B. I., et al. (författare)
  • ST segment elevation and chest pain during cryoablation of atrial flutter
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129. ; 9:6, s. 407-10
  • Tidskriftsartikel (refereegranskat)abstract
    • A 61-year-old male was treated with cryoablation for typical atrial flutter. Cryoablation was performed percutaneously with an 8-mm tip catheter to achieve a bidirectional conduction block of the cavo-tricuspid isthmus. When freezing at the point where bidirectional isthmus block occurred, the patient experienced chest pain and ECG showed ST segment elevations corresponding to the right coronary artery. Cryoablation may be painless per se, but patients should be told to report chest discomfort and surface ECG must be followed carefully during ablation.
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24.
  • Johansson, Birgitta, 1960, et al. (författare)
  • Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation.
  • 2008
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 10:5, s. 610-7
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: Our aim was to compare the long-term effects on rhythm and quality of life (QoL) after left atrial epicardial radiofrequency (RF) ablation vs. no ablation in patients undergoing cardiac surgery. METHODS AND RESULTS: Thirty-nine patients with ECG documented atrial fibrillation (AF) scheduled for coronary artery bypass grafting (CABG) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation. Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls. The follow-up after ablation was 32 +/- 11 months. The percentage of patients in sinus rhythm (SR) at long-term follow-up was 62 vs. 33% (P = 0.03) after ablation and no ablation, respectively. SR at 3 months was highly predictive of that at 32 months (sensitivity 95%, positive predictive value 86%). Long-term SR was associated with better QoL, fewer symptoms, higher ejection fraction, and smaller left and right atria than AF. CONCLUSION: SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF. AF at 3 months did not preclude a later stabilization to SR.
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25.
  • Jons, Christian, et al. (författare)
  • The Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial : clinical rationale, study design, and implementation
  • 2009
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 11:7, s. 917-923
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: No large randomized multicentre trial has evaluated the efficacy of radiofrequency ablation (RFA) vs. anti-arrhythmic drug (AAD) therapy as a first-line treatment of paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation (MANTRA-PAF) trial is a randomized, controlled, parallel group, multicentre study designed to test whether catheter-based RFA is superior to optimized AAD therapy in suppressing relapse within 24 months of symptomatic and/or asymptomatic AF in patients with paroxysmal AF without prior AAD therapy. The primary endpoint is cumulative AF burden on repeated 7 days Holter monitoring. Secondary endpoints are: thromboembolic events, hospitalization due to arrhythmia, pro-arrhythmic events, procedure/treatment-related side effects, health economics, quality of life, and change in left ventricular function. Ten centres in Scandinavia and Germany are participating in the study. Enrolment was started in 2005 and as of November 2008, 260 patients have been enrolled into the study. It is expected that enrolment will end by March 2009, when 300 patients have been included. CONCLUSION: The MANTRA-PAF trial will determine whether catheter-based RFA is superior to optimized AAD therapy as a first-line treatment in suppressing long-term relapse of symptomatic and/or asymptomatic AF.
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26.
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27.
  • Kennergren, Charles, 1948, et al. (författare)
  • A single-centre experience of over one thousand lead extractions.
  • 2009
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 11:5, s. 612-7
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: The aim of the study was to present a single-centre experience of pacemaker and implantable cardioverter defibrillator (ICD) lead extraction using different methods, mainly laser-assisted extraction. METHODS AND RESULTS: Data from 1032 leads and 647 procedures were gathered. A step-by-step approach using different techniques while performing an ongoing risk-benefit analysis was used. The most common indications were local infection, systemic infection, non-functional lead, elective lead replacement, and J-wire fracture. Mean implantation time for all leads was 69 months and for laser-extracted leads 91 months. Laser technique was used to extract 60% of the leads, 29% were manually extracted, 6% extracted with mechanical tools, 4% were surgically removed, and 0.6% extracted by a femoral approach. Failure rate was 0.7%, and major complication rate was 0.9%. No extraction-related mortality occurred. Median time for laser extraction was 2 min. Long implantation time was not a risk factor for failure or for complication. CONCLUSION: Pacing and ICD leads can safely, successfully, and effectively be extracted. Leads can often be extracted by a superior transvenous approach; however, open-chest and femoral extractions are still required. Laser-assisted lead extraction proved to be a useful technique to extract leads that could not be removed by manual traction. The results indicate that the paradigm of abandoning redundant leads, instead of removing them, may have to be reconsidered.
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28.
  • Kennergren, Charles, 1948 (författare)
  • Cardiac implantable electronic device treatment: taking care of complications.
  • 2009
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 11:11, s. 1419-20
  • Tidskriftsartikel (refereegranskat)
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29.
  • Kennergren, Charles, 1948, et al. (författare)
  • Laser-assisted lead extraction: the European experience.
  • 2007
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1099-5129. ; 9:8, s. 651-6
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction in Europe. The final European multi-centre study experience is presented. METHOD AND RESULTS: The Excimer is a cool cutting laser (50 degrees C) with a wavelength of 308 nm. The energy is emitted from the tip of a flexible sheath and is absorbed by proteins and lipids, 64% of the energy is absorbed at a tissue depth of 0.06 mm. The sheath is positioned over the lead, and the fibrosis surrounding the lead is vaporized while advancing the sheath without damaging other leads. From August 1996 to March 2001, 383 leads (170 atrial, 213 ventricular) in 292 patients (mean age 61.6 years, range 13-96) were extracted at 14 European centres. Mean implantation time was 74 months (3-358). Most frequent indications were pocket infection (26%), non-functional leads (21%), patient morbidity (21%), septicaemia or endocarditis (14%), erosion (5%), and lead interference (8%). Median extraction time was 15 min (1-300). Complete extraction was achieved in 90.9% of the leads and partial extraction in 3.4%. Extraction failed in 5.7% of the leads. Major complications = perforations caused 10/22 (3.4/5.7%) of the failures. Most partially extracted patients were considered clinically successful, as only minor lead parts without clinical significance were left. Femoral non-laser technique was used to remove 8/12 of the non-complication failures. The total complication rate, including five minor complications (1.7%), was 5.1%. No in-hospital mortality occurred. CONCLUSION: Pacing and implantable cardioverter-defibrillator leads can safely, effectively, and predictably be extracted. Open-heart extractions can be limited to special cases. The results indicate that the traditional policy of abandoning redundant leads, instead of removing them, may be obsolete in many patients.
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30.
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31.
  • Kesek, Milos, et al. (författare)
  • Reduction of fluoroscopy duration in radiofrequency ablation obtained by the use of a non-fluoroscopic catheter navigation system.
  • 2006
  • Ingår i: Europace. - : Oxford University Press (OUP). ; 8:12, s. 1027-30
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: Radiofrequency (RF) ablation requires placement of several catheters at critical positions. The catheters are positioned with fluoroscopy, resulting in a significant radiation exposure. We have investigated to what degree an intracardiac navigation system reduces the fluoroscopy duration in different groups of routine RF ablations. METHODS AND RESULTS: The fluoroscopy time was evaluated in 365 consecutive routine RF ablations, performed between 2002 and 2005. An intracardiac navigation system (LocaLisa, Medtronic) was used from 2003. The data were prospectively entered into a database and subsequently retrieved, and the procedures classified as being performed with fluoroscopy only or with the aid of the LocaLisa system. After introduction of the LocaLisa system, the median fluoroscopy time decreased from 24 to 10 min in the 141 atrioventricular nodal re-entry tachycardia (AVNRT) ablations and from 43 to 28 min in the 71 atrial flutter (AFl) ablations (P<0.005 for both). In the 145 Wolff-Parkinson-White (WPW) ablations, a decrease from 27 to 23 min was observed (P=0.03). The decrease in AVNRT and AFl, but not in WPW was associated with the introduction of the LocaLisa system. CONCLUSION: The use of the LocaLisa system during RF ablations significantly reduced the fluoroscopy time in AVNRT and AFl ablations, by a median of 58% and 46%, respectively.
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32.
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33.
  • Kirchhof, Paulus, et al. (författare)
  • Outcome parameters for trials in atrial fibrillation - Recommendations from a consensus conference organized by the German atrial fibrillation competence NETwork and the European Heart Rhythm Association
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 9:11, s. 1006-1023
  • Forskningsöversikt (refereegranskat)abstract
    • Atrial fibrillation (AF), the most common atria[ arrhythmia, has a complex aetiology and causes relevant morbidity and mortality due to different mechanisms, including but not limited to stroke, heart failure, and tachy- or bradyarrhythmia. Current therapeutic options (rate control, rhythm control, antithrombotic therapy, 'upstream therapy') only prevent a part of this burden of disease. New treatment modalities are therefore currently under evaluation in clinical trials. Given the multifold clinical consequences of AF, controlled trials in AF patients should assess the effect of therapy in each of the main outcome domains. This paper describes an expert consensus of required outcome parameters in seven relevant outcome domains, namely death, stroke, symptoms and quality of life, rhythm, left ventricular function, cost, and emerging outcome parameters. In addition to these 'requirements' for outcome assessment in AF trials, further outcome parameters are described in each outcome domain. In addition to a careful selection of a relevant primary outcome parameter, coverage of outcomes in all major domains of AF-related morbidity and mortality is desirable for any clinical trial in AF.
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34.
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35.
  • Linde, C (författare)
  • Cardiac resynchronization therapy in mild heart failure
  • 2009
  • Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 1111 Suppl 5, s. 72-76
  • Tidskriftsartikel (refereegranskat)
  •  
36.
  • Liuba, Ioan, et al. (författare)
  • Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site.
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 10:10, s. 1195-1204
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Fractionated electrograms are often noted during mapping of focal atrial tachycardia (FAT). This finding suggests poor cell-to-cell coupling, which is thought to be an important prerequisite in the process of ectopic impulse initiation and propagation. The purpose of the present study was to assess the electrogram fractionation in the vicinity of the earliest activation site and in the remaining atrium in these patients. Methods and results: Thirteen patients with FAT (age 48 ± 17 years) who underwent catheter ablation were investigated. Mapping was performed with the CARTO system. Electrogram fractionation was assessed on the basis of the number of negative deflections, both in the region surrounding the earliest activation site and in the remaining atrium. Unipolar and bipolar peak-to-peak voltage and bipolar electrogram duration were also studied. All patients underwent successful radiofrequency ablation. A higher degree of electrogram fractionation existed in the region surrounding the earliest activation site and activated within the first 15 ms when compared with the remaining atrium (incidence of bipolar electrograms with multiple negative deflections: 88 vs. 79%, P < 0.0001; incidence of unipolar electrograms with multiple negative deflections: 56 vs. 43%, P = 0.0001). The peak-to-peak voltage in the region activated within the first 15 ms was less than that in the remaining atrium (bipolar voltage: 1.33 ± 0.99 vs. 1.61 ± 1.11 mV, P < 0.001; unipolar voltage: 1.75 ± 0.92 vs. 1.95 ± 1.11 mV, P = 0.0188). There were no significant differences in bipolar electrogram duration. Within the region activated during the first 15 ms, from the periphery to the earliest activation site, there was a gradual increase in electrogram fractionation (incidence of bipolar electrograms with multiple negative deflections gradually increasing from 82 to 100% and incidence of unipolar electrograms with multiple negative deflections increasing from 56 to 90%), as well as a gradual decrease in peak-to-peak voltage (bipolar voltage gradually decreasing from 1.47 ± 1.06 to 0.89 ± 0.54 mV, P < 0.0001; unipolar voltage gradually decreasing from 1.89 ± 0.94 to 1.30 ± 0.63 mV, P < 0.0001). Irregular, closely spaced isochrones were also noted in the region activated during the first 15 ms. The area of this region was 4.88 ± 3.59 cm2. Conclusion: Increased electrogram fractionation exists within a relatively wide region around the tachycardia origin when compared with the remaining atrium. Moreover, this region is electrically heterogeneous, as suggested by the fact that the degree of electrogram fractionation increases gradually whereas the electrogram voltage decreases gradually towards the earliest activation site. These findings suggest that a non-discrete atrial region with gradually changing electrophysiological properties may underlie the substrate of FAT.
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37.
  • Liuba, Ioan, et al. (författare)
  • Source of inflammatory markers in patients with atrial fibrillation
  • 2008
  • Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 10, s. 848-853
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims Elevated levels of C-reactive protein and other inflammatory markers have been reported in some patients with atrial fibrillation (AF). Whether this finding is related to AF per se or to other conditions remains unclear. In addition, the source of inflammatory markers is unknown. Therefore, in the present study, we sought to assess the extent and the source of inflammation in patients with AF and no other concomitant heart or inflammatory conditions. Methods and results The study group consisted of 29 patients referred for radiofrequency catheter ablation: 10 patients with paroxysmal AF, 8 patients with permanent AF, and 10 control patients with Wolf-Parkinson-White (WPW) syndrome and no evidence of AF (mean age 54±11 vs. 57±13 vs. 43±16). No patient had structural heart diseases or inflammatory conditions. High-sensitive C-reactive protein, interleukin-6 (IL-6), and interleukin-8 (IL-8) were assessed in blood samples from the femoral vein, right atrium, coronary sinus, and the left and right upper pulmonary veins. All samples were collected before ablation. Compared with controls and patients with paroxysmal AF, patients with permanent AF had higher plasma levels of IL-8 in the samples from the femoral vein, right atrium, and coronary sinus, but not in the samples from the pulmonary veins (median values in the femoral vein: 2.58 vs. 2.97 vs. 4.66 pg/mL, P = 0.003; right atrium: 2.30 vs. 3.06 vs. 3.93 pg/mL, P = 0.013; coronary sinus: 2.85 vs. 3.15 vs. 4.07, P = 0.016). A high-degree correlation existed between the IL-8 levels in these samples (correlation coefficient between 0.929 and 0.976, P< 0.05). No differences in the C-reactive protein and IL-6 levels were noted between the three groups of patients. Conclusion The normal levels of C-reactive protein and IL-6, alongwith the elevated levels of IL-8 in patients with permanent AF but not in those with paroxysmal AF, suggest a link between a low-grade inflammatory reaction and long-lasting AF. The elevated IL-8 levels in the peripheral blood, right atrium, and coronary sinus but not in the pulmonary veins suggest a possible source of inflammation in the systemic circulation.
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38.
  • Malmborg, Helena, et al. (författare)
  • Acute and clinical effects of cryoballoon pulmonary vein isolation in patients with symptomatic paroxysmal and persistent atrial fibrillation
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 10:11, s. 1277-1280
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To assess the acute effects, safety, and clinical outcome of atrial fibrillation (AF) ablation using a cryoballoon catheter. METHODS AND RESULTS: Forty patients with paroxysmal or persistent AF underwent pulmonary vein (PV) isolation with a cryoballoon catheter (Arctic Front, CryoCath). Electrocardiograms were recorded in case of symptomatic AF recurrences, and a 24 h Holter recording was performed at last follow-up. Complete PV isolation was achieved in 39 (91%) of the 43 procedures (56% with the cryoballoon catheter alone, 44% with an additional conventional ryocatheter). The number of balloon applications per procedure was 9.6 +/- 1.6. The PV isolation rate was significantly higher (83.9%) if total vessel occlusions were obtained than if intermediate (63.6%, P = 0.01) or poor occlusions were achieved (38.1%, P = 0.0002). The mean procedure time was 239 +/- 48 min. At follow-up (mean 8.9 +/- 4.6 months), 52.5% of patients were free from arrhythmia-related symptoms and another 17.5% had reduction of arrhythmia-related symptoms. Two cases each of phrenic nerve paralysis and dysphagia occurred. CONCLUSIONS: Cryoballoon PV isolation is a feasible technique with a high acute success rate and comparable clinical outcome to radiofrequency ablation. Although complications were rare, the need for an additional conventional cryocatheter warrants further development of the technique.
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39.
  • Milasinovic, Goran, et al. (författare)
  • Percent ventricular pacing with managed ventricular pacing mode in standard pacemaker population
  • 2008
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 10:2, s. 151-155
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims Unnecessary right ventricular pacing has deleterious effects and becomes more significant when cumulative percent ventricular pacing (Cum%VP) exceeds 40% of time. The Managed Ventricular Pacing (MVP) mode has been shown to significantly reduce the percent ventricular pacing compared to the DDD/R mode. This study assessed the percent of ventricular pacing in a standard pacemaker population programmed to MVP and for which patients it is possible to achieve a Cum%VP <= 40%. Methods and results Unselected, consecutive patients were implanted with a dual chamber pacemaker with a mean follow-up period of 76 days. The Cum%VP was calculated from device diagnostics between pre-hospital discharge (PHD) and the 1-month post implant visit. The median Cum%VP of 107 patients (age 67.2 +/- 14 years; 53% mate) who were programmed to MVP was 3.9%. The median Cum%VP was 1.4% in patients with sinus node disease (SND) and 28.8% in patients with AV block (AVB). Cum%VP <= 40% was observed in 72% of all. patients, in 50% of AVB patients, and in 86% of SND patients. Conclusion The MVP mode is capable of achieving a tow percent of ventricular pacing in a standard pacemaker population with SND and AVB. In addition, 72% of patients in MVP mode demonstrated Cum%VP <= 40%.
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40.
  • Mitrofanova, L, et al. (författare)
  • Anatomy of the inferior interatrial route in humans
  • 2005
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092. ; 7, s. 49-55
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims To explore the morphology of the proximal coronary sinus (CS) and the surrounding tissues in order to identify possible routes for interatrial conduction. Method Specimens containing interatrial septum and proximal CS were taken from 21 necropsied hearts and sliced into 10-mu m thick parallel histological sections in 1-mm steps starting from the valve plane, up to the atrial. roof (40-80 sections per heart). The sections were stained with van Gieson's stain. Results Media in the proximal CS consists of smooth muscle cells that do not form a continuous layer. CS was not surrounded by striated atrial myocardium in 10 specimens in which posterior CS wall was covered by epicardial fat only. In seven specimens, striated muscle bundles of up to 2-mm width connected the myocardium surrounding the CS with the left atrium. Regardless of their presence, variable posterior and/or anterior interatrial muscular connections were identified in all specimens. Conclusion Variability of the striated atrial. myocardium surrounding proximal CS may affect interatrial conduction. Striated muscular fascicles connecting the proximal CS with the left atrium are not obligatory cardiac structures and may be considered as supplementary to the larger interatrial connections outside the CS. (c) 2005 The European Society of Cardiology.
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41.
  • Nilsson, Göran, et al. (författare)
  • QTc interval and survival in 75-year-old men and women from the general population
  • 2006
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 8:4, s. 233-240
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: The study concerns the relationship of the corrected QT (QTc) interval to 6.4 years of survival and to measures of cardiac function, such as echocardiographic variables and plasma levels of brain natriuretic peptide (BNP), in 75-year-old people. Methods and results: QTc was measured in a 12-lead electrocardiogram (ECG) in 210 men and 223 women, comprising a randomly selected sample from the general population (70% participation rate). The Sicard 440/740 computer-analysis program, with Hodges' formula for heart rate-based QT correction, was used. The optimal cut-off point for predicting survival according to the receiver operating characteristic curve was found between 429 and 430 ms. Individuals with a QTc interval of ≥430 ms (n = 115) had decreased survival when compared with those with shorter QTc interval (n = 318); the relative risk was 2.4 (95% confidence interval 1.5-3.7). The predictive ability of QTc reflects an association between QTc and the following variables: BNP, left ventricular mass, and left ventricular ejection fraction (but not diastolic filling patterns). Both Hodges' and Bazett's formulae for heart rate correction of the QT interval were useful for predicting survival. The median QTc was 415 ms using Hodges' formula and 430 ms with Bazett's formula. The QRS component of QTc predicted survival better than the rest of the QTc interval and was approximately as useful as the QTc interval itself. Conclusion: The computer-derived QTc obtained from the ordinary 12-lead ECG identifies high-risk individuals among elderly people from the general population.
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42.
  • Platonov, Pyotr (författare)
  • Interatrial conduction in the mechanisms of atrial fibrillation: from anatomy to cardiac signals and new treatment modalities.
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 9:Suppl. 6, s. 10-16
  • Tidskriftsartikel (refereegranskat)abstract
    • Areas of slow conduction and conduction block are important prerequisites for re-entry known to underlie atrial fibrillation (AF). Experimental and clinical data show that AF is associated with global lowering of atrial propagation velocity and the presence of defects in the interatrial conduction routes. The increasing data from anatomical studies demonstrate the possible prerequisites for conduction disturbances that could be primarily because of anatomical variability in interatrial connections or because of age-related development of fibrotic changes in the atrial musculature. More detailed descriptions of the structure and function of the interatrial connections other than Bachmann's bundle have become available and, as a result, the role of these connections in the mechanisms of AF is increasingly appreciated. Interatrial pacing studies show promising results, but further studies on larger amounts of materials are required in order to identify the population of patients who would benefit more effectively from this treatment as well as the optimal pacing technique. Therefore, more extensive documentation is required before therapeutic modalities aimed at improving interatrial conduction will become a part of the clinical routine in the management of AF patients.
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43.
  • Puererfellner, Helmut, et al. (författare)
  • Reduction of atrial fibrillation burden by atrial overdrive pacing: experience with an improved algorithm to reduce early recurrences of atrial fibrillation
  • 2009
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 11:1, s. 62-69
  • Tidskriftsartikel (refereegranskat)abstract
    • Two independent studies have revealed a potential limitation of post-mode switch overdrive pacing (PMOP), which is its delayed start. We conducted a prospective, randomized, single blind, crossover design study (the post-long pause overdrive pacing study) to test the efficacy of an improved version of PMOP (PMOPenhanced). A total of 45 patients were enrolled, of whom 41 were analysed. The median number of atrial tachycardia/atrial fibrillation (AT/AF) episodes per day (1.38 vs. 1.19), the median number of early recurrences of atrial fibrillation (ERAF) per day (0.56 vs. 0.51), and the median AT/AF burden (time per day spent in AT/AF) (2.47 vs. 2.51 h) were not significantly different during the control and active study periods. Based on the median number of episodes per week recorded 90 days prior to enrolment, the patients were stratified by the median and then split into two groups, Group A (lower 2-Quartiles) and Group B (upper 2-Quartiles). The median AT/AF burden was significantly lower in Group B during the active study period (3.71 vs. 1.71 h, P = 0.02).The median number of AT/AF episodes per day and the median number of ERAF per day in Group B showed a trend towards reduction when the algorithm was turned on (3.79 vs. 2.44 and 2.77 vs. 1.86, respectively). In contrast, in Group A we did not demonstrate any difference in AT/AF frequency, ERAF frequency, or burden. The main finding of this study is that temporary overdrive pacing at 90 bpm for 10 min starting just prior to device-classified AT/AF termination does not show a positive effect on the overall study population. However, when enabled in patients who suffer from a high percentage of ERAF, a significant reduction in the AT/AF burden could be demonstrated. Based on these findings, further prospective studies on a more targeted patient population are needed to confirm our results.
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44.
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45.
  • Sciaraffia, Elena, et al. (författare)
  • Right ventricular contractility as a measure of optimal interventricular pacing setting in cardiac resynchronization therapy
  • 2009
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 11:11, s. 1496-1500
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: The aim of the present study was to assess whether right ventricular (RV) contractility can be used for optimization of the interventricular (VV) interval and to study the acute hemodynamic effect of different VV intervals on right and left ventricular (LV) contractility in patients referred for cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Intracardiac LV and RV dP/dt were measured with a 0.014-in. sensor-tipped pressure guidewire during pacing at nine different VV intervals ranging from +80 ms (LV pre-excitation) to -80 ms (RV pre-excitation) in 26 patients who received a biventricular pacemaker. No correlation was found between the optimal VV intervals identified by maximum LV dP/dt and RV dP/dt, which were identical in only seven cases (27%). Only when testing slightly broader intervals (+/-20 ms) was there a statistically significant correlation (P= 0.037) between the optimized VV intervals. In the majority of patients (58%) either LV or RV pre-excitation was superior to simultaneous pacing according to LV dP/dt(max) measurements. CONCLUSION: RV dP/dt(max) failed to identify the optimal VV interval when compared with LV dP/dt(max) and can therefore not be recommended for VV optimization in CRT patients.
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46.
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47.
  • Thilén, Ulf, et al. (författare)
  • Prolonged P wave duration in adults with secundum atrial septal defect: a marker of delayed conduction rather than increased atrial size?
  • 2007
  • Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 9:Suppl 6, s. 105-108
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: Although atrial fibrillation is a frequent complication of an atrial septal defect (ASD) of the secundum type, the underlying mechanisms are poorly understood. Atrial conduction disturbances, manifested as a prolonged P-wave duration, have been suggested as a substrate for arrhythmia. Prolongation of the P-wave in unrepaired ASD has been demonstrated by means of the conventional ECG, but not by more sophisticated methods. The aim of the study was to analyse P-wave duration and morphology by high-resolution P-wave signal-averaged ECG (PSA-ECG) and to investigate potential atrial mechano-electrical interactions in adults with an unrepaired ASD. METHODS AND RESULTS: P-wave signal-averaged-ECG was obtained in 35 adult patients (age 53 +/- 15 years) with ASD and compared with an equal number of sex- and age-matched healthy controls. Right and left atrial sizes were assessed by echocardiography in the ASD group. P wave duration was significantly longer in the ASD group than in control subjects (148 +/- 16 vs. 128 +/- 15 ms, P < 0.0001). P-wave morphology did not differ significantly between patients and controls. There was no clear relation between P-wave duration and atrial size. CONCLUSION: Atrial septal defect in the adult is characterized by a prolonged P-wave duration, indicating delayed atrial conduction, which is not related to the enlargement of the atria but rather to conduction delay. The nature and potential reversibility of this warrant further investigation.
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