In general, most clinical studies have long recruitment periods. Signing the informed consent is particularly time-consuming when the participant must meet physically with the researchers. Therefore, ...introducing fully web-based techniques with the use of eAuthentication (BankID) and new digital electrocardiogram (ECG) monitoring could speed up inclusion time, increase adherence, and also reach out to more remote regions.
The objectives of this study were to explore whether inclusion of a large number of participants could be realized quickly by using a total digital approach both for information and signing of informed consent, along with ECG monitoring and instant feedback on a mobile device. We also explored whether this approach can increase adherence in registration of ECG recordings and answering questionnaires, and if it would result in a more geographically uniform distribution of participants covering a wide age span.
Women with palpitations were intensively studied over 2 months by means of a handheld ECG monitoring device (Coala Heart Monitor). The device connects to a smartphone or tablet, which allows the participants to obtain the results immediately. Recruitment, study information, and signing the informed consent form with the help of BankID were performed in a completely digital manner.
Between March and May 2018, 2424 women indicated their interest in participating in the study. On June 19, 2018, presumptive participants were invited to log in and register. After 25 days, 1082 women were included in the study; among these, 1020 women fulfilled the inclusion criteria, 913 of whom completed all phases of the study: recording ECG using the handheld device, completion of the prestudy questionnaires, and completion of the poststudy questionnaires 2 months after the ECG recordings. The dropout rate was 9%. In total, 101,804 ECG recordings were made. The mean age was 56 (SD 11) years (range 21-88 years) and 35 participants were 75 years or older. The participants were evenly distributed between living in the countryside and in cities.
Total digital inclusion recruitment of 1082 participants was achieved in only 25 days, and resulted in a good geographical distribution, excellent adherence, and ability to reach a vast age span, including elderly women. Studies using a total digital design would be particularly appealing during a pandemic since physical contact should be avoided as much as possible.
ISRCTN Registry ISRCTN22495299; http://www.isrctn.com/ISRCTN22495299.
NOWINSKI, K., et al.: Transient Proarrhythmic State Following Atrioventricular Junctional Radiofre‐quency Ablation. This study was designed to prospectively assess ventricular de‐ and repolarization ...by the QRS, QT, and JT intervals, and their dispersion in the 12‐lead ECG during right ventricular pacing at 60, 70, and 80 beats/min during the first month after AV junctional RF ablation. Previous reports have found early polymorphic ventricular arrhythmia after RF AV junctional ablation. Our hypothesis was that there is a proarrhythmic state following this procedure, which depends on the paced rate and time after ablation. The analysis of the immediate changes was based on 17 patients (10 men) with a mean age of 64 years (SD 14) (range 38–82 years). A 12‐lead ECG was recorded during right ventricular pacing at 60, 70, and 80 beats/min within 24 hours (day 1), between 24 and 48 hours (day 2), and 1 week after ablation (day 7). For analysis of changes beyond 1 week, 13 additional patients with a mean age of 73 years (SD 8) (range 62–90 years) were analyzed on days 1, 7, and 30. All intervals were measured with a digitizing table. The mean QRS duration shortened by 2.4% at 60 beats/min (P < 0.01), and the mean QT and JT intervals shortened by 5–7% between days 1 and 7 (P < 0.001). The mean QT was 9% shorter and the mean JT interval was 13% shorter at 80 compared to 60 beats/min on day 1 (P < 0.001). QT dispersion was reduced by 13% when the stimulation rate was increased from 60 to 80 beats/min on day 1 (P < 0.05). There were no significant changes beyond the first week. The study results point to the induction of a proarrhythmic state immediately after AV junctional RF ablation resolving during the first week. Repolarization shortened gradually between 80 and 60 beats/min to an extent that is suggestive of a clinically important antiarrhythmic effect at the higher rate, which was supported also by clinical experience.
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BFBNIB, FSPLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Objectives. To explore sex differences regarding indication for atrio-ventricular junction ablation (AVJ), choice of pacing system, complications to pacemaker treatment, long-term outcome, and cause ...of death after AVJ ablation. Design. 700 patients who had undergone AVJ ablation between January 1990 and December 2010 were included. Data were retrieved from the patients´ medical records and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator Registry. Information about admission to hospital and cause of death was retrieved from the National Board of Health and Welfare. Results. Mean follow-up was 90 ± 64 months. Indication for AVJ ablation, choice of pacing system, and outcome after AVJ ablation differed between the sexes. The men had more often permanent atrial fibrillation, p = .0001, and a VVIR pacemaker or cardiac resynchronization therapy (CRT) implanted prior to ablation, p = .0001. Heart failure was present in 44% of the men vs. 28% of the women, p = .0001. LVEF decreased slightly in the whole cohort after the AVJ ablation. There were no sex differences in complication rates due to the pacemaker/ICD treatment, p = .3 or mortality due to AVJ ablation. Conclusion. In this long-term follow-up in patients with atrial fibrillation treated with AVJ ablation and pacing, indication, choice of pacing system, and morbidity differed but there were no sex differences regarding survival or primary cause of death found. The main factor influencing survival was age at the time of ablation. Women less often received treatment with ICD and/or CRT when indication was present compared with men.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Psychosocial factors influence the risk of developing hypertension. Personality traits have a modulating effect against the harmful influences of psychosocial factors.
Through a longitudinal clinical ...study consisting of men and women aged 35 and 55 at the baseline in Estonia and Sweden, to assess the influence of psychosocial factors and personality traits resulting in arterial hypertension.
Data analysis based on the cross-sectional study with 2 assessments over 13 years of a sample comprising 158 individuals from Estonia and 213 individuals from Sweden. The Pearlin Mastery Scale, Rosenberg Self-esteem Scale, Depression Model and Gothenburg Quality of Life Instrument were used.
Throughout the follow-up period, a higher depressive mood and lower self-assessed quality of life score prevailed among the 35-year-old and 55-year-old Estonians compared with the Swedish study participants (p < 0.001). Among the 55-year-old Estonian study participants with diagnosed hypertension, but not among the Swedish, negative stressful life events had a significantly stronger effect (p < 0.001) on the risk of developing hypertension. In addition, lower mastery (p < 0.05) dominated among study participants diagnosed with hypertension.
The combined effects of psychosocial factors and personality traits are important variables in predicting the risk of developing arterial hypertension. The study results are relevant to clinical practice and provide suggestions for employing successful preventive measures.
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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
Radiofrequency (RF) ablation is effective for ablation of atrial arrhythmias. However, RF ablation in the vicinity of the atrioventricular (AV) node is associated with a risk of inadvertent, ...irreversible high-grade AV block, depending on the type of substrate. Cryoablation is an alternative method. The objective was to investigate the acute and long-term risks of AV block during cryoablation.
We studied 1303 consecutive cryoablations of substrates in the vicinity of the AV node in 1201 patients (median age 51 years, range 6-89 years) on acute and long-term impairment to the AV nodal conduction system. The arrhythmias treated were AV nodal reentrant tachycardias (n=1116), paraseptal and superoparaseptal accessory pathways (n=100), and focal atrial tachycardias (n=87). In 158 (12%) procedures, cryomapping (38 cases) or cryoablation (120 cases) were stopped due to transient AV block (first-degree AV block 74 cases, second-degree AV block 67 cases, and third-degree AV block 17 cases) after which another site was tested. Transient AV block occurred within seconds of mapping up to 3 min of ablation. The incidence of AV block was similar for different substrates. In most cases, AV nodal conduction was restored within seconds but in two cases transient AV block lasted 21 and 45 min, respectively. There were no cases of acute permanent AV blocks. No late AV blocks occurred during follow-up (mean 24 months, range 6-96 months).
Cryoablation adjacent to the AV node carries a negligible risk of permanent AV block. Transient AV block during ablation is a benign finding.
Purpose
Cardiac enzyme elevation after radiofrequency (RF) catheter ablation of atrial flutter (AFL) is common. Some studies found that cryoablation (CRYO) of AFL, compared to RF, is associated with ...higher levels of troponin, a finding that may indicate CRYO causes a greater amount of myocardial injury than RF. However, other investigations found no significant differences between troponin levels after CRYO versus RF. We have in a randomized study compared the post-procedural troponin I levels in RF and CRYO and the possible relation to procedural outcome and complications.
Methods
We randomized 153 patients with cavotricuspid isthmus (CTI)-dependent AFL to CRYO or RF (78 CRYO; 75 RF). RF was performed with a 3.5-mm open-irrigated-tip catheter, and CRYO was performed with an 8-mm-tip catheter. Troponin I levels were measured before and 6 h after ablation.
Results
Acute procedural success was achieved in 71/75 patients in the RF and in 72/78 patients in the CRYO. Troponin I levels were significantly elevated in both groups (baseline 0.012, 6th hour 0.35 ng/ml;
p
< 0.001). Troponin I levels were similar for RF and CRYO. Troponin I levels were higher in patients with acute failure compared to patients with acute success (0.48 ± 0.4 and 0.34 ± 0.16 ng/ml,
p
= 0.029); however, there was no difference between patients with or without late recurrence. There were no major complications in any group.
Conclusion
RF and CRYO for CTI-dependent AFL resulted in similar amounts of procedural myocardial injury. Troponin I levels had no prognostic value for late recurrence of AFL and there were no complications related to high troponin I levels.
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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
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