Abstract Background Hypertension, type 2 diabetes and other cardiovascular diseases, all risk factors for atrial fibrillation, are associated with birth weight. It remains unclear, however, whether ...risk of atrial fibrillation is also associated with birth weight. We investigated the associations of birth weight and preterm birth (i.e., born more than one month before term) with risk of atrial fibrillation (AF). Methods The study population comprised 29 551 men and 23 454 women who were free from AF at baseline. Information on birth weight, preterm birth, and risk factors for AF was obtained from a questionnaire. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. Results During 12 years of follow-up, AF developed in 2711 men and 1491 women. High birth weight (≥ 5000 g) was associated with an increased risk of AF after adjustment for age and other risk factors for AF, but the association did not persist after further adjustment for adult height. In men but not in women, low birth weight was associated with an increased risk of AF. Compared with men weighing 2500–3999 g at birth, the multivariable RR was 1.86 (95% CI, 1.15 to 3.00) for those weighing < 1500 g. This association was stronger in men who were born full-term (RR 2.53; 95% CI, 1.35 to 4.73). Conclusions Both high birth weight and low birth weight (in men), in particular in men born full-term, were associated with an increased risk of AF. The association with high birth weight appeared to be mediated through adult height.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed ...with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases.
This study analysed 4690 consecutive TP performed between 2000 and 2015: 3408 (72.6%) were ablation of AF, left-sided atrial flutter, or left-sided atrial tachycardia (non-AP group); 1153 (24.6%) were ablation of left-sided accessory pathway, AP group; and 129 (2.8%) were ablation of ventricular tachycardia. Transseptal puncture was done under fluoroscopy, pressure monitoring, and commonly using contrast media injection. In 27 procedures, ICE or TEE was used to guide the TP. We found 34 tamponades (Tx) that required pericardial drainage of which 28 (0.59%) could possibly be TP related and six could not. The total complication rate for all Tx was 0.72%. A higher rate of tamponades was observed in the AF (non-AP) group than in the AP group (0.88 vs. 0.17%, P < 0.02). The highest rate of tamponades was registered during the operators 51-100 cases, 1.3%, and decreased to 0.4% in cases 101-200, P = 0.04.
TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate.
Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk ...of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up.
Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint - death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure - occurred in significantly more patients in the tamponade than in the control group 12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15-5.58); P = 0.021. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group HR 3.75 (95% CI 1.01-13.97); P = 0.049. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group HR 36.0 (95% CI 4.68-276.86); P = 0.001.
Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.
The Symptom Checklist: Frequency and Severity Scale (SCL) is a symptom-specific questionnaire that measures the patient’s perception of the frequency and severity of arrhythmia-related symptoms. ...Worldwide, the SCL is one of the most used symptom-specific questionnaires for this purpose. Until now, there has not been a valid Swedish translation of the SCL. This study aimed to translate the SCL into Swedish and test the face, content and construct validity of the translated version. The questionnaire was translated using the WHO’s recommendations for translation. Using the ‘think aloud method’, we gathered data from 12 patients regarding the intelligibility of the questions. Using exploratory factor analysis (EFA), we evaluated the face validity, construct validity and internal consistency properties of the questionnaire. The study included 646 patients with different types of supraventricular tachycardia, atrial fibrillation (AF) atrial flutter (AFL), atrioventricular reentrant tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), and ectopic atrial tachycardia (EAT). Translation and face validity were found to be acceptable. Construct validity evaluated using EFA and principal component analysis with varimax rotation identified four factors with eigenvalues greater than 1 and factor loading equal to or greater than 0.364, accounting for 58% and 53% of the variance in the frequency scale and the severity scale, respectively. Reliability evaluation revealed high internal consistency. For both the frequency and severity scale, the Cronbach’s alpha coefficient was 0.88. Our results show evidence that the Swedish version of the SCL has good psychometric properties according to face and construct validity and internal consistency for patients with AF, AFL, AVRT, AVNRT and EAT, and is reproducible and valid.
Why do arms extract less oxygen than legs during exercise? Calbet, J. A. L; Holmberg, H.-C; Rosdahl, H ...
American journal of physiology. Regulatory, integrative and comparative physiology,
11/2005, Volume:
289, Issue:
5
Journal Article
Peer reviewed
Open access
1 Department of Physical Education, University of Las Palmas de Gran Canaria, Canary Islands, Spain; 2 The Copenhagen Muscle Research Center, Rigshospitalet, Copenhagen, Denmark; Departments of 3 ...Physiology-Pharmacology and 4 Cardiology, Karolinska Institute, Stockholm; and 5 Department of Sport and Health Sciences, University College of Physical Education and Sports, Stockholm, Sweden
Submitted 6 December 2004
; accepted in final form 13 May 2005
To determine whether conditions for O 2 utilization and O 2 off-loading from the hemoglobin are different in exercising arms and legs, six cross-country skiers participated in this study. Femoral and subclavian vein blood flow and gases were determined during skiing on a treadmill at 76% maximal O 2 uptake ( O 2 max ) and at O 2 max with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise), and leg skiing (predominantly leg exercise). The percentage of O 2 extraction was always higher for the legs than for the arms. At maximal exercise (diagonal stride), the corresponding mean values were 93 and 85% ( n = 3; P < 0.05). During exercise, mean arm O 2 extraction correlated with the P O 2 value that causes hemoglobin to be 50% saturated (P 50 : r = 0.93, P < 0.05), but for a given value of P 50 , O 2 extraction was always higher in the legs than in the arms. Mean capillary muscle O 2 conductance of the arm during double poling was 14.5 (SD 2.6) ml·min 1 ·mmHg 1 , and mean capillary P O 2 was 47.7 (SD 2.6) mmHg. Corresponding values for the legs during maximal exercise were 48.3 (SD 13.0) ml·min 1 ·mmHg 1 and 33.8 (SD 2.6) mmHg, respectively. Because conditions for O 2 off-loading from the hemoglobin are similar in leg and arm muscles, the observed differences in maximal arm and leg O 2 extraction should be attributed to other factors, such as a higher heterogeneity in blood flow distribution, shorter mean transit time, smaller diffusing area, and larger diffusing distance, in arms than in legs.
diffusing capacity; fatigue; oxygen extraction; performance; training
Address for reprint requests and other correspondence: J. A. L. Calbet, Departamento de Educación Física, Campus Universitario de Tafira, 35017 Las Palmas de Gran Canaria, Canary Islands, Spain (e-mail: lopezcalbet{at}terra.es )
Purpose
Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with ...atrial fibrillation undergoing pulmonary vein isolation (PVI).
Methods
Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up.
Results
In the total study cohort, the mean resting sinus heart rate at PRE mean 57.9 bpm (95% CI 57.1–58.7 bpm) increased by over 10 bpm to POST mean 69.4 bpm (95% CI 68.5–70.3 bpm);
p
< 0.001 followed by a slight decrease at 3 M mean 67.3 bpm (95% CI 66.4–68.2 bpm) but still remaining higher compared to PRE (
p
< 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both
p
< 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (
p
= 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32–2.49),
p
< 0.001 and HR 1.64 (95% CI 1.20–2.25),
p
= 0.002, respectively).
Conclusion
Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A pulmonary vein isolation procedure in a patient with an atrial septal defect (ASD) closure device was complicated by entrapment of a mapping catheter in the device. The procedure was converted to ...open heart surgery, the device with the trapped catheter was explanted, the ASD was covered with a bovine patch, and a cryomaze procedure was performed. (
).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: Most studies concerning exercise electrocardiography (ECG) testing after acute myocardial infarction (AMI) were carried out in the prethrombolytic era. ST‐segment elevation in the ...infarction area during exercise has usually been interpreted as indicating the presence of dyskinesia as a result of extensive left ventricle damage.
Hypothesis: This study was undertaken to evaluate the contributions of exercise‐induced ST‐segment elevation and T‐wave pseudonormalization to the assessment of myocardial viability in patients with thrombolyzed myocardial infarction (MI), compared with low‐dose dobutamine echocardiography.
Methods: The study comprised 52 consecutive patients with AMI treated with thrombolysis. All patients underwent low‐dose dobutamine echocardiography and symptom‐limited exercise testing before discharge.
Nineteen patients showed ST‐segment elevation (Group 1), 9 showed isolated T‐wave pseudonormalization (Group 2), and 24 patients did not exhibit either of these ST‐T segment changes (Group 3). Low‐dose dobutamine echocardiography revealed evidence of viability in 16 patients (84%) in Group 1 (p=0.01), 5 (56%) in Group 2 (p=NS), and 11 patients (46%) in Group 3 (p = NS).
Conclusion: Exercise‐induced ST‐segment elevation may contribute to the evaluation of myocardial viability in patients with AMI treated with thrombolysis. However, in the absence of exercise‐induced ST‐segment elevation, further noninvasive studies might be indicated to assess myocardial viability.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
That muscular blood flow may reach 2.5 l kg â1 min â1 in the quadriceps muscle has led to the suggestion that muscular vascular conductance must be restrained during whole body
exercise to avoid ...hypotension. The main aim of this study was to determine the maximal arm and leg muscle vascular conductances
(VC) during leg and arm exercise, to find out if the maximal muscular vasodilatory response is restrained during maximal combined
arm and leg exercise. Six Swedish elite cross-country skiers, age (mean ± s.e.m. ) 24 ± 2 years, height 180 ± 2 cm, weight 74 ± 2 kg, and maximal oxygen uptake 5.1 ± 0.1 l min â1 participated in the study. Femoral and subclavian vein blood flows, intra-arterial blood pressure, cardiac output, as well
as blood gases in the femoral and subclavian vein, right atrium and femoral artery were determined during skiing (roller skis)
at â¼76% of and at with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise) and
leg skiing (predominantly leg exercise). During submaximal exercise cardiac output (26â27 l min â1 ), mean blood pressure (MAP) (â¼87 mmHg), systemic VC, systemic oxygen delivery and pulmonary (â¼4 l min â1 ) attained similar values regardless of exercise mode. The distribution of cardiac output was modified depending on the musculature
engaged in the exercise. There was a close relationship between VC and in arms ( r = 0.99, P < 0.001) and legs ( r = 0.98, P < 0.05). Peak arm VC (63.7 ± 5.6 ml min â1 mmHg â1 ) was attained during double poling, while peak leg VC was reached at maximal exercise with the diagonal technique (109.8
± 11.5 ml min â1 mmHg â1 ) when arm VC was 38.8 ± 5.7 ml min â1 mmHg â1 . If during maximal exercise arms and legs had been vasodilated to the observed maximal levels then mean arterial pressure
would have dropped at least to 75â77 mmHg in our experimental conditions. It is concluded that skeletal muscle vascular conductance
is restrained during whole body exercise in the upright position to avoid hypotension.
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The authors stopped a case of left atrial appendage occlusion because of miscolored brownish devices. The investigation demonstrated that devices may show a range of colors from a typical blue to a ...brownish hue, depending on oxide layer thickness, and this does not appear to have any impact on the performance of the device. (
Level of Difficulty: Intermediate.
)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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