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1.
Xu Gao Avirup Guha Benjamin Buck Dilesh Patel Melissa J. Snider Michael Boyd Muhammad Afzal Auroa Badin Hemant Godara Zhenguo Liu Jaret Tyler Raul Weiss Steven Kalbfleisch John Hummel Ralph Augostini Mahmoud Houmsse Emile G. Daoud 《Indian pacing and electrophysiology journal》2018,18(2):68-72
Background
Expert opinion recommends performing exercise testing with initiation of Class Ic antiarrhythmic medication.Objective
To evaluate the rate and reason for discontinuation of Ic agent within the first year of follow up, with particular attention to rate of proarrhythmia and the value of routine treadmill testing.Methods
This is a single center retrospective cohort study including consecutive patients with atrial arrhythmias who were initiated on a Class Ic agent from 2011 to 2016. Data was collated from chart review and pharmacy database.Results
The study population included 300 patients (55% male, mean age 61; mean ejection fraction, 56%) started on flecainide (n = 153; 51%) and propafenone (n = 147; 49%). Drug initiation was completed while hospitalized on telemetry and the staff electrophysiologists directed dosing. There was one proarrhythmic event during initiation (0.3%). The primary reason for not being discharged on Ic agent was due to detection of proarrhythmia (n = 15) or ischemia (n = 1) with treadmill testing (5.3%). Exercise testing was the single significant variable to affect the decision to discontinue Ic drug, p < 0.0001 (95% CI: 1.89–6.08%). During follow up, the primary reason for discontinuation of Ic agent was lack of efficacy, 32%.Conclusions
With proper screening, initiation of Class Ic agent is associated with very low rate of proarrhythmia. Treadmill testing is of incremental value and should be completed in all patients after loading Class Ic antiarrhythmic. 相似文献2.
Antonio Scarà Luigi Sciarra Ermenegildo De Ruvo Alessio Borrelli Domenico Grieco Zefferino Palamà Paolo Golia Lucia De Luca Marco Rebecchi Leonardo Calò 《Indian pacing and electrophysiology journal》2018,18(2):61-67
Background
The Amigo® Remote Catheter System is a relatively new robotic system for catheter navigation. This study compared feasibility and safety using Amigo (RCM) versus manual catheter manipulation (MCM) to treat paroxysmal atrial fibrillation (PAF). Contact force (CF) and force-time integral (FTI) values obtained during pulmonary vein isolation (PVI) ablation were compared.Methods
Forty patients were randomly selected for either RCM (20) or MCM (20). All were studied with the Thermocool® SmartTouch® force-sensing catheter (STc). Contact Force (CF), Force Time Integral (FTI) and procedure-related data, were measured/stored in the CARTO®3.Results
All cases achieved complete PVI without major complications. Mean CF was significantly higher in the RCM group (13.3 ± 7.7 g in RCM vs. 12.04 ± 7.42 g in MCM p < 0.001), as was overall mean FTI (425.6 gs ± 199.6 gs with RCM and 407.5 gs ± 288.0 gs in MCM (p = 0.007) and was more likely to fall into the optimal FTI range (400-1000) using RCM (66.1% versus 49.1%, p < 0.001). FTI was significantly more likely to fall within the optimal range in each PV, as was CF within its optimal range in the right PVs, but trended higher in the left PVs. Freedom from atrial tachyarrhythmia was 90.0% for the RCM and 70.0% for the MCM group (p = 0,12) at 540 days follow-up.Conclusions
This pilot study suggests that use of the Amigo RCM system, with STc catheter, seems to be safe and effective for PVI ablation in paroxysmal AF patients. A not statistically significant favorable trend was observed for RCM in term of AF-free survival. 相似文献3.
Huimei Huang Qinyun Ruan Meiyan Lin Lei Yan Chunyan Huang Liyun Fu 《Cardiovascular ultrasound》2017,15(1):14
Background
This study is aimed at investigating myocardial multi-directional systolic deformation in hypertensive with different left ventricular ejection fraction (LVEF), and exploring its contribution to LVEF.Methods
One hundred and twenty-three patients with primary hypertension (HT) were divided into group A (LVEF ≥ 55%), group B (45% ≤ LVEF < 50%, or 50% ≤ LVEF < 55% + LVEDVI ≥ 97 ml/m2), and group C (LVEF < 45%). Two-dimensional strain echocardiography (2DSE) including LV longitudinal strain (SL), radial strain (SR) and circumferential strain (SC) were measured.Results
SL decreased gradually from group A, B to C (all p < 0.05) while SR and SC were reduced only in group B and C (all p < 0.05). All strain measurements correlated to LVEF, with the strongest correlation in SC (r = ?0.82, p < 0.01) and the second in SL (r = ?0.76). The diastolic E/e increased from group A, B to C.Conclusions
Left ventricular multi-directional deformation correlated well to LVEF in hypertension and particularly SC, indicating that it was SC, not SL or SR, that makes the prominent contribution to left ventricular pump function.4.
Iskra H. Bayraktarova Milko K. Stoyanov Boyan T. Kunev Tchavdar N. Shalganov 《Indian pacing and electrophysiology journal》2018,18(2):49-53
Purpose
To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology.Methods
Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value <0.05.Results
The population was aged 48.5 ± 15.7 (12-85) years; males were 38.5%. AH jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation – in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% – only by burst pacing; in 14.8% – only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = –0.204, Р<0.001.Conclusion
Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients. 相似文献5.
Shilu Zhao Mingfang Li Weizhu Ju Lingyun Gu Fengxiang Zhang Hongwu Chen Kai Gu Bing Yang Minglong Chen 《Indian pacing and electrophysiology journal》2018,18(3):95-99
Background
Atrial tissue fibrosis can cause electrical or structural remodeling in patients with atrial fibrillation. Transforming growth factor beta 1(TGF-β1) signaling acts as a central role in fibroblast activation. In this report, we aimed to investigate the relationship between serum level of TGF-β1 and mean left atrial voltage in patients with chronic atrial fibrillation (CAF).Methods
A total of 16 consecutive adult patients with CAF who underwent catheter ablation were enrolled. Blood samples for measurement of TGF-β1 were collected from periphery veins and coronary sinus before pulmonary vein isolation. The measurement was performed with a commercially available ELISA kit. Cardiac indices were measured using echocardiography. The left atrial electroanatomic mapping was performed after pulmonary vein isolation.Results
Serum level of TGF-β1 in peripheral blood was higher than that in coronary sinus (p < 0.001). TGF-β1 serum level in coronary sinus negatively correlated with mean left atrial voltage (r = -0.650, p = 0.012), While periphery TGF-β1 level tended to be negatively correlated with mean left atrial voltage(r = -0.492, p = 0.053). Patients who treated with angiotensin II receptor antagonists had lower coronary sinus TGF-β1 serum level than those who did not treated with angiotensin II receptor antagonists (p = 0.046).Conclusion
Level of TGF-β1 in peripheral serum is higher than that in coronary sinus, and serum level of TGF-β1 in coronary sinus is negatively associated with mean left atrial voltage in patients with CAF, angiotensin II receptor antagonists could affect TGF-β1 serum level. 相似文献6.
Amirfarjam Fazelifar Fatemeh Jorfi Majid Haghjoo 《Indian pacing and electrophysiology journal》2018,18(1):13-19
Background
With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing.Purpose
This study was sought to determine different ECG patterns in patients with BiV pacing.Methods
Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62.0 ± 13.5 years) with advanced heart failure and baseline left bundle branch block pattern after at least 6-month of uncomplicated CRT.Results
During BiV pacing, 65% of the patients showed a dominant R wave in V1. There was a right axis deviation in 57% in frontal plane. However, a left superior axis emerged in 34% and normal frontal plane axis in 9%. Sequential BiV pacing (73% vs. 58%, P = 0.04) and pacing from posterolateral coronary vein (80% vs. 60%, p = 0.045) were more likely to present with a dominant R wave in V1. In sequential pacing, AV interval was significantly longer in patients with negative complex in V1 than in those with positive complex (124 ± 21 vs. 116 ± 8.0, p = 0.005). A Q/q wave was detected in 85% of patients in lead I and 78% in lead aVL.Conclusions
BiV pacing from lateral coronary venous branches and right ventricular apex characteristically presented with dominant R wave in V1, Q/q wave in leads I and aVL, and right or left superior axis. However, a negative complex in V1, QRS axis in other quadrants, and lack of Q/q wave in leads I and aVL did not necessarily indicate a problem. 相似文献7.
Jorge I. Ramírez Sepúlveda Marika Kvarnström Per Eriksson Thomas Mandl Katrine Brække Norheim Svein Joar Johnsen Daniel Hammenfors Malin V. Jonsson Kathrine Skarstein Johan G. Brun the DISSECT consortium Lars Rönnblom Helena Forsblad-d’Elia Sara Magnusson Bucher Eva Baecklund Elke Theander Roald Omdal Roland Jonsson Gunnel Nordmark Marie Wahren-Herlenius 《Biology of sex differences》2017,8(1):25
Background
Despite men being less prone to develop autoimmune diseases, male sex has been associated with a more severe disease course in several systemic autoimmune diseases. In the present study, we aimed to investigate differences in the clinical presentation of primary Sjögren’s syndrome (pSS) between the sexes and establish whether male sex is associated with a more severe form of long-term pSS.Methods
Our study population included 967 patients with pSS (899 females and 68 males) from Scandinavian clinical centers. The mean follow-up time (years) was 8.8 ± 7.6 for women and 8.5 ± 6.2 for men (ns). Clinical data including serological and hematological parameters and glandular and extraglandular manifestations were compared between men and women.Results
Male patient serology was characterized by more frequent positivity for anti-Ro/SSA and anti-La/SSB (p = 0.02), and ANA (p = 0.02). Further, men with pSS were more frequently diagnosed with interstitial lung disease (p = 0.008), lymphadenopathy (p = 0.04) and lymphoma (p = 0.007). Conversely, concomitant hypothyroidism was more common among female patients (p = 0.009).Conclusions
We observe enhanced serological responses and higher frequencies of lymphoma-related extraglandular manifestations in men with pSS. Notably, lymphoma itself was also significantly more common in men. These observations may reflect an aggravated immune activation and a more severe pathophysiological state in male patients with pSS and indicate a personalized managing of the disease due to the influence of the sex of patients with pSS.8.
U. Boles E.E. Gul L. Fitzgerald F. Sadiq Ali C. Nolan K. Aldworth-Gaumond D.R. Redfearn A. Baranchuk B. Glover C. Simpson H. Abdollah K.A. Michael 《Indian pacing and electrophysiology journal》2018,18(2):56-60
Background
Current algorithms and device morphology templates have been proposed in current Implantable Cardioverter-Defibrillators (ICDs) to minimize inappropriate therapies (ITS), but this has not been completely successful.Aim
Assess the impact of a deliberate strategy of using an atrial lead implant with standardized parameters; based on all current ICD discriminators and technologies, on the burden of ITS.Method
A retrospective single-centre analysis of 250 patients with either dual chamber (DR) ICDs or biventricular ICDs (CRTDs) over a (41.9 ± 27.3) month period was performed. The incidence of ITS on all ICD and CRTD patients was chronicled after the implementation of standardized programming.Results
39 events of anti-tachycardial pacing (ATP) and/or shocks were identified in 20 patients (8% incidence rate among patients). The total number of individual therapies was 120, of which 34% were inappropriate ATP, and 36% were inappropriate shocks. 11 patients of the 250 patients received ITS (4.4%). Of the 20 patients, four had ICDs for primary prevention and 16 for a secondary prevention. All the episodes in the primary indication group were inappropriate, while seven patients (43%) of the secondary indication group experienced inappropriate therapies.Conclusions
The burden of ITS in the population of patients receiving ICDs was 4.4% in the presence of atrial leads. The proposed rationalized programming criteria seems an effective strategy to minimize the burden of inappropriate therapies and will require further validation. 相似文献9.
A. W. den Hartog R. Franken M. P. van den Berg A. H. Zwinderman J. Timmermans A. J. Scholte V. de Waard A. M. Spijkerboer G. Pals B. J. M. Mulder M. Groenink 《Netherlands heart journal》2016,24(11):675-681
Background
Mild biventricular dysfunction is often present in patients with Marfan syndrome. Losartan has been shown to reduce aortic dilatation in patients with Marfan syndrome. This study assesses the effect of losartan on ventricular volume and function in genetically classified subgroups of asymptomatic Marfan patients without significant valvular regurgitation.Methods
In this predefined substudy of the COMPARE study, Marfan patients were classified based on the effect of their FBN1 mutation on fibrillin-1 protein, categorised as haploinsufficient or dominant negative. Patients were randomised to a daily dose of losartan 100 mg or no additional treatment. Ventricular volumes and function were measured by magnetic resonance imaging at baseline and after 3 years of follow-up.Results
Changes in biventricular dimensions were assessed in 163 Marfan patients (48?% female; mean age 38 ± 13 years). In patients with a haploinsufficient FBN1 mutation (n = 43), losartan therapy (n = 19) increased both biventricular end diastolic volume (EDV) and stroke volume (SV) when compared with no additional losartan (n = 24): left ventricular EDV: 9 ± 26 ml vs. ?8 ± 24 ml, p = 0.035 and right ventricular EDV 12 ± 23 ml vs. ?18 ± 24 ml; p < 0.001 and for left ventricle SV: 6 ± 16 ml vs. ?8 ± 17 ml; p = 0.009 and right ventricle SV: 8 ± 16 ml vs. ?7 ± 19 ml; p = 0.009, respectively. No effect was observed in patients with a dominant negative FBN1 mutation (n = 92), or without an FBN1 mutation (n = 28).Conclusion
Losartan therapy in haploinsufficient Marfan patients increases biventricular end diastolic volume and stroke volume, furthermore, losartan also appears to ameliorate biventricular filling properties.10.
Background
Sudden cardiac death (SCD) risk stratification is the most important preventive action in patients with hypertrophic cardiomyopathy (HCM). The identification of the ischemia biomarker high sensitive troponin I (hs-TnI) role for this arrhythmic disease may provide additional information for SCD risk stratification. The aim of the study was to compare echocardiographic parameters (prognostic for risk stratification of SCD in HCM) among two subgroups of HCM patients: with elevated hs-TnI versus non-elevated hs-TnI level.Methods
In 51 HCM patients (mean age 39 ± 8 years, 31 males and 20 females) an echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, was performed. The hs-TnI was measured 24 h later.Results
By comparing two subgroups of patients, 26 members with hs-TnI positive versus 25 with hs-TnI negative, the study showed that the values of all three parameters were greater: provocable left ventricular outflow tract gradient (LVOTG) – 49.1 ± 45.9 vs 25.5 ± 24.8 mmHg, p = 0.019; left atrial diameter – 50.1 ± 9.6 vs 43.9 ± 9.8 mmHg, p = 0.041; maximal LV thickness – 22.1 ± 5.3 vs 19.9 ± 34 mm, p = 0.029.Conclusion
The increased value of all three echocardiographic parameters used as risk factors for SCD (ESC Guidelines) is related to the elevated level of hs-TnI in HCM. Due to the high LVOTG – great hs-TnI relationship, exercise stress, both diagnostic and even rehabilitation/training, should be monitored by biomarker control.11.
M. O. Versteylen M. Manca I. A. Joosen D. E. Schmidt M. Das L. Hofstra H. J. Crijns E. A. Biessen B. L. Kietselaer 《Netherlands heart journal》2016,24(12):722-729
Background
CC chemokine ligands (CCLs) are elevated during acute coronary syndrome (ACS) and correlate with secondary events. Their involvement in plaque inflammation led us to investigate whether CCL3-5-18 are linked to the extent of coronary artery disease (CAD) and prognostic for primary events during follow-up.Methods
We measured CCL3-5-18 serum concentrations in 712 patients with chest discomfort referred for cardiac CT angiography. Obstructive CAD was defined as ≥50?% stenosis. The extent of CAD was measured by calcium score and segment involvement score (number of coronary segments with any CAD, range 0–16). Patients were followed up for all-cause mortality, ACS and revascularisation, for a mean 26 ± 7 months.Results
Patients with obstructive CAD had significantly higher CCL5 (p = 0.02), and borderline significantly elevated CCL18 plasma levels as compared with patients with <50?% stenosis (p = 0.06). CCL18 levels were associated with coronary calcification (p = 0.002) and segment involvement score (p = 0.007). Corrected for traditional risk factors, only CCL5 provided independent predictive value for obstructive CAD: odds ratio (OR) 1.27 (1.02–1.59), p = 0.04. CCL5 provided independent predictive value for primary events during follow-up: OR 1.62 (1.03–2.57), p = 0.04.Conclusions
While CCL18 serum levels correlated with extent of CAD, CCL5 demonstrated an independent association with the presence of obstructive CAD, and occurrence of primary cardiac events.12.
J. Slikkerveer K. de Boer L. F. H. J. Robbers A. C. van Rossum O. Kamp 《Netherlands heart journal》2016,24(5):319-325
Aims
There is a continuing search for new treatment options in patients who suffer from refractory angina pectoris to improve quality of life. Several studies have recently demonstrated promising results by stimulating angiogenesis using extracorporeal shockwave therapy in these patients. The purpose of this study is to quantitatively analyse the effect of extracorporeal shockwave therapy on myocardial perfusion in patients with refractory angina pectoris.Methods
We included 15 patients with NYHA class 3–4 of whom 8 patients underwent baseline and follow-up cardiac magnetic resonance imaging (CMR). All patients received 9 shockwave treatments of their ischaemic zone over a period of 3 months.Results
Quantitative analysis of myocardial perfusion using CMR revealed no significant improvement of myocardial perfusion after treatment (0.80 ± 0.22 vs 0.76 ± 0.31; p = 0.42). However, the total group of 15 patients did experience a significant improvement in NYHA class (p = 0.034) and reduction of nitroglycerin use (p = 0.012).Conclusion
Although treatment with extracorporeal shockwave was associated with an improvement in NYHA class, we could not observe an improvement in myocardial ischaemic zone and perfusion with CMR. To unravel the exact mechanisms of shockwave treatment, more in vitro and animal studies as well as larger (placebo-controlled) studies are required.13.
M. Verdoia A. Schaffer L. Barbieri G. Di Giovine G. Bellomo P. Marino H. Suryapranata G. De Luca 《Netherlands heart journal》2016,24(7-8):462-474
Background
Pro-thrombotic conditions importantly influence myocardial perfusion and procedural results after percutaneous coronary intervention (PCI). The neutrophil-to-lymphocyte ratio (NLR) has emerged as a predictor of cardiovascular events and of long-term prognosis, especially in ST-elevation myocardial infarction patients undergoing primary PCI. The aim of our study was to evaluate the role of NLR on periprocedural myocardial infarction (MI) in patients undergoing non-urgent PCI.Methods
In a consecutive cohort of 1542 patients undergoing PCI, myonecrosis biomarkers were determined at 6, 12, 24 and 48 hours post-procedure. Patients were divided into quintiles according to NLR values. Periprocedural myonecrosis was defined as a troponin I increase of 3 times the upper limit of normal or as 50?% of an elevated baseline value, whereas periprocedural MI was defined as a CK-MB increase of 3 times the upper limit of normal or 50?% of baseline.Results
Higher NLR was related to age, established risk factors and cardiovascular history. NLR was associated with severe coronary artery disease (p = 0.009), tighter stenosis (p < 0.001), coronary calcifications (p = 0.005), intracoronary thrombus or thrombectomy use (p < 0.001), TIMI flow pre- and post-PCI (p < 0.001), and inversely to restenosis (p = 0.04) and use of a drug-eluting stent (p = 0.001). NLR did not influence the occurrence of myonecrosis (p = 0.75; adjusted OR (95?% CI) = 0.99 (0.63–1.54), p = 0.96), but was associated with a higher occurrence of periprocedural MI, even after correction for baseline differences (p = 0.03; adjusted OR (95?% CI) = 1.33 (1.02–2.3), p = 0.02), with NLR ≥ 3 best predicting the risk of periprocedural MI at the receiver operating characteristic curve analysis.Conclusion
In patients undergoing non-urgent PCI, a higher NLR increases the risk of periprocedural MI, especially for values ≥ 3.14.
M. Zalewska-Adamiec H. Bachorzewska-Gajewska A. Tomaszuk-Kazberuk K. Nowak P. Drozdowski J. Bychowski R. Krynicki W. J. Musial S. Dobrzycki 《Netherlands heart journal》2016,24(9):511-519
Background
Takotsubo cardiomyopathy (TTC) is characterised by transient contractility disturbances of the apex of the left ventricle.Methods
We enrolled 101 patients from the northern-eastern part of Poland in the years 2008–2012 who were hospitalised for TCC. The control group consisted of female patients diagnosed with anterior myocardial infarction with ST-segment elevation (anterior STEMI) (n = 101).Results
89?% of the study group were women. Patients with TTC had diabetes (12.6?% vs 29.7?%; p = 0.002) and hyperlipidaemia (36.8?% vs 64.4?%; p = 0.0001) significantly less frequently, and better kidney function assessed by estimated glomerular filtration rate versus patients with anterior STEMI (74.52?% vs 64.30?%; p = 0.004). In the TTC group there were more patients with chronic obstructive pulmonary disease (11.6?% vs 1.0?%; p = 0.002) and thyroid disturbances, especially hyperthyroidism (23.4?% vs 11.0?%; p = 0.021). In patients with TTC sudden cardiac arrest, pulmonary oedema and cardiogenic shock were observed less frequently than in the control group (14.7?% vs 30.7?%; p = 0.0078). Hospitalisations in TTC patients were less frequently complicated by pneumonia (20.0?% vs 35.6?%; p = 0.0148) and urinary infection (4.2?% vs 21.8?%; p = 0.0003). Cardiac rupture occurred in 3 patients with TTC and in 1 with anterior STEMI. In-hospital mortality was significantly lower in the group with TTC. Also, mortality at 30 days, 3 months, 1 year and 2.5 years was significantly lower in patients with TTC than in patients with MI (p = 0.035; p = 0.0226; p = 0.0075; p = 0.009).Conclusions
Previously considered to be a benign syndrome, TTC should be reconsidered as a clinical condition at risk for serious complications such as cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death and causing substantial early hazard. The prognosis in TTC is significantly better than in patients with anterior STEMI.15.
Muhammad Umer Nisar Muhammad Bilal Munir Michael S. Sharbaugh Floyd W. Thoma Andrew D. Althouse Samir Saba 《Indian pacing and electrophysiology journal》2018,18(1):6-12
Aims
Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Patients presenting with AF are often admitted to hospital for rhythm or rate control, symptom management, and/or anticoagulation. We investigated temporal trends in AF hospitalizations in United States from 1996 to 2010.Methods
Data were obtained from the National Hospital Discharge Survey (NHDS), a national probability sample survey of discharges conducted annually by National Center for Health Statistics. Because of the survey design, sampling weights were applied to the raw NHDS data to produce national estimates. Hospitalizations with a primary diagnosis of AF were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 427.31. Weighted least squares regression was used to test for linear trends in the number of AF admissions, length of stay, and inpatient mortality. We further stratified AF admissions based on patients' age, gender, and race.Results
Admissions for a primary diagnosis of AF increased from approximately 286,000 in 1996 to about 410,000 in 2010 with a significant linear trend (β = 9470 additional admissions per year, p < 0.001). The trend of increased AF admissions was uniform across patient sub-groups. Overall, mean length of stay for AF admissions was 3.75 days, and this remained relatively stable over time (β = 0.002 days, p = 0.884). Inpatient mortality was 0.96% and also remained stable over time (β = 0.031%, p = 0.181).Conclusion
Our data demonstrate an increase in the number of AF admissions but constant length of stay and mortality over time. 相似文献16.
Anunay Gupta Neeraj Parakh Raghav Bansal Sunil K. Verma Ambuj Roy Gautam Sharma Rakesh Yadav Nitish Naik Rajnish Juenja Vinay K. Bahl 《Indian pacing and electrophysiology journal》2018,18(6):210-216
Background
Pacing from RV mid septum and outflow tract septum has been proposed as a more physiological site of pacing and narrower paced QRS complex duration. The paced QRS morphology and duration in different RV pacing sites is under continued discussion. Hence, this study was designed to address the correlation of pacing sites in right ventricle with paced QRS complex duration.Methods
Two hundred fifty-two consecutive patients who underwent pacemaker implantation were enrolled. Baseline clinical characteristics were recorded for each patient. All patient underwent fluoroscopy, electrocardiogram and echocardiography post pacemaker implantation. Paced QRS duration was calculated from the leads with maximum QRS duration.Results
Mean paced QRS (pQRS) duration was significantly higher in apical septum group with a mean of 148.9?±?14.8?m?s compared to mid septum (139.6?±?19.9?m?s; p-value 0.003) and RVOT septum (139.6?±?14.8?m?s; p-value 0.002) groups, respectively. There was no significant difference between mid-septal and RVOT septal pQRS duration. On multivariate analysis, female gender, baseline QRS duration and RVOT septal pacing were the only predictors for narrow pQRS duration (<150?msec).Conclusion
RV mid-septal and RVOT septal pacing were associated with significantly lower pQRS duration as compared with apical pacing. Based on multivariate analysis RVOT septal pacing appears to be preferred and more physiological pacing site. 相似文献17.
18.
Jamie L. Kuck Julie A. Bastarache Ciara M. Shaver Joshua P. Fessel Sergey I. Dikalov James M. May Lorraine B. Ware 《Biochemical and biophysical research communications》2018,495(1):433-437
Background
Increased endothelial permeability is central to shock and organ dysfunction in sepsis but therapeutics targeted to known mediators of increased endothelial permeability have been unsuccessful in patient studies. We previously reported that cell-free hemoglobin (CFH) is elevated in the majority of patients with sepsis and is associated with organ dysfunction, poor clinical outcomes and elevated markers of oxidant injury. Others have shown that Vitamin C (ascorbate) may have endothelial protective effects in sepsis. In this study, we tested the hypothesis that high levels of CFH, as seen in the circulation of patients with sepsis, disrupt endothelial barrier integrity.Methods
Human umbilical vein endothelial cells (HUVEC) were grown to confluence and treated with CFH with or without ascorbate. Monolayer permeability was measured by Electric Cell-substrate Impedance Sensing (ECIS) or transfer of 14C-inulin. Viability was measured by trypan blue exclusion. Intracellular ascorbate was measured by HPLC.Results
CFH increased permeability in a dose- and time-dependent manner with 1 mg/ml of CFH increasing inulin transfer by 50% without affecting cell viability. CFH (1 mg/ml) also caused a dramatic reduction in intracellular ascorbate in the same time frame (1.4 mM without CFH, 0.23 mM 18 h after 1 mg/ml CFH, p < 0.05). Pre-treatment of HUVECs with ascorbate attenuated CFH induced permeability.Conclusions
CFH increases endothelial permeability in part through depletion of intracellular ascorbate. Supplementation of ascorbate can attenuate increases in permeability mediated by CFH suggesting a possible therapeutic approach in sepsis. 相似文献19.
Jem D. Lane Sarah Whittaker-Axon Richard J. Schilling Martin D. Lowe 《Indian pacing and electrophysiology journal》2019,19(2):49-54
Background
Implantable cardioverter-defibrillator (ICD) lead parameters may deteriorate due to right ventricular (RV) disease such as arrhythmogenic right ventricular cardiomyopathy (ARVC), with implications for safe delivery of therapies. We compared ICD and CRT-D (cardiac resynchronisation therapy-defibrillator) lead parameters in patients with ARVC and dilated cardiomyopathy (DCM).Methods
RV lead sensing (R wave amplitude) and pacing (threshold and amplitude-pulse width product (APWP)), left ventricular (LV) pacing (APWP), and imaging parameter trends were assessed in 18 patients with ARVC and 18 with DCM.Results
R wave amplitude did not change significantly over time in either group (over 5 years, ARVC -0.4 mV, 95% CI -3.8–3.0 mV; DCM -1.8 mV, 95% CI -5.0–1.3 mV). Within ARVC group, divergent trends were seen according to lead position. DCM patients experienced an increase in RV lead threshold (+1.1 V over 5 years, 95% CI + 0.5 to +1.7 V) and RV APWP (+0.48 Vms over 5 years, 95% CI + 0.24 to +0.71 Vms); ARVC patients had no change. ARVC patients had a higher LVEF at baseline than DCM patients (52 vs 20%, p < 0.001), though LVEF decreased over time for the former, while increasing for the latter. TAPSE did not change over time for ARVC patients.Conclusions
Lead parameters in ARVC patients were stable over medium-term follow up. In DCM patients, RV lead threshold and RV and LV APWP increased over time. These differential responses for DCM and ARVC were not explained by imaging indices, and may reflect distinct patterns of disease progression. 相似文献20.
Ankavipar Saprungruang Apichai Khongphatthanayothin John Mauleekoonphairoj Pharawee Wandee Supaluck Kanjanauthai Zahurul A. Bhuiyan Arthur A.M. Wilde Yong Poovorawan 《Indian pacing and electrophysiology journal》2018,18(5):165-171