Atrial fibrillation (AF) guidelines recommend that symptom relief be a primary goal in management. However, patient perception of their prevailing rhythm is often inaccurate, complicating ...symptom-targeted treatment.
The purpose of this study was to evaluate the accuracy of patient perception of their prevailing rhythm and identify factors that predict inaccuracies.
Demographic and health status data were captured by questionnaires for 458 outpatients with documented AF. AF burden (%) was captured by 1-week continuous heart monitors. Patients estimated the length and frequency of their AF episodes by completing the AF Symptom Severity questionnaire. Patient reports were compared to AF burden, and outliers were identified and broken into 2 groups: patients with AF burden <10% who indicated near-continuous AF (overestimators) and patients with AF burden >90% who estimated little to no AF (underestimators). Multinomial logistic regression was used to identify predictors of inaccuracies (over- or underestimators).
By continuous monitor, 15% of patients were found to be over- or underestimators. Persistent AF, female sex, older age, anxiety, and depression were predictive of inaccurate patient perception. Persistent AF, female sex, and older age were predictive of underestimating, while mood disorders (anxiety and depression) were predictive of overestimating. The prevalence of underestimators was nearly twice that of overestimators.
Sex, age, and mood disorders are among factors that lead to inaccurate patient perception of their prevailing rhythm in patients with AF. Such modulating factors should be considered when evaluating treatment strategies. Consideration should be given to more liberal use of heart monitors in these patient populations to better target therapy.
Abstract Importance Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of handheld smartphone electrocardiogram (ECG) monitors could represent a ...helpful tool connecting the athletic trainer to the cardiologist. Observations Six college athletes presented to their athletic trainers complaining of palpitations during exercise. A single lead ECG was performed using the AliveCor Heart Monitor and sent wirelessly to the Team Cardiologist who confirmed an absence of dangerous arrhythmia. Conclusions and relevance AliveCor monitoring has the potential to enhance evaluation of symptomatic athletes by allowing trainers and team physicians to make diagnosis in real-time and facilitate faster return to play.
Abstract Brugada syndrome is responsible for up to 4% of all sudden cardiac deaths worldwide and up to 20% of sudden cardiac deaths in patients with structurally normal hearts. Heterogeneity of ...repolarization and depolarization, particularly over the right ventricle and the outflow tract, is responsible for the arrhythmogenic substrate. The coved Type I ECG pattern is considered diagnostic of the syndrome but its prevalence is very low. Distinguishing between a saddle back Type 2 Brugada pattern and one of many “Brugada-like” patterns presents challenges especially in athletes. A number of criteria have been proposed to assess Brugada ECG patterns. Proper precordial ECG lead placement is paramount. This paper reviews Brugada syndrome, Brugada ECG patterns, and recently proposed criteria. Recommendations for evaluating a Brugada ECG pattern are provided.
Background Brugada syndrome (BrS) is an autosomal dominant inherited arrhythmic disease associated with the SCN5A mutation. Included studies were published prospective or retrospective cohort and ...case control studies that compared MAE (sustained ventricular tachycardia, sudden cardiac arrest, or sudden cardiac death) in BrS with and without SCN5A mutation.
Implantation of implantable cardioverter defibrillator for prevention of sudden cardiac death is deferred for 90 days after coronary revascularization, but mortality may be highest early after ...cardiac procedures in patients with ventricular dysfunction. We determined mortality risk in postrevascularization patients with left ventricular ejection fraction ≤35% and compared survival with those discharged with a wearable cardioverter defibrillator (WCD).
Hospital survivors after surgical (coronary artery bypass graft surgery) or percutaneous (percutaneous coronary intervention PCI) revascularization with left ventricular ejection fraction ≤35% were included from Cleveland Clinic and national WCD registries. Kaplan-Meier, Cox proportional hazards, propensity score-matched survival, and hazard function analyses were performed. Early mortality hazard was higher among 4149 patients discharged without a defibrillator compared with 809 with WCDs (90-day mortality post-coronary artery bypass graft surgery 7% versus 3%, P=0.03; post-PCI 10% versus 2%, P<0.0001). WCD use was associated with adjusted lower risks of long-term mortality in the total cohort (39%, P<0.0001) and both post-coronary artery bypass graft surgery (38%, P=0.048) and post-PCI (57%, P<0.0001) cohorts (mean follow-up, 3.2 years). In propensity-matched analyses, WCD use remained associated with lower mortality (58% post-coronary artery bypass graft surgery, P=0.002; 67% post-PCI, P<0.0001). Mortality differences were not attributable solely to therapies for ventricular arrhythmia. Only 1.3% of the WCD group had a documented appropriate therapy.
Patients with left ventricular ejection fraction ≤35% have higher early compared to late mortality after coronary revascularization, particularly after PCI. As early hazard seemed less marked in WCD users, prospective studies in this high-risk population are indicated to confirm whether WCD use as a bridge to left ventricular ejection fraction improvement or implantable cardioverter defibrillator implantation can improve outcomes after coronary revascularization.
Although mammals of different species have different sleep patterns, brief sleep-wake transitions commonly are observed across species and appear to occur randomly throughout the sleeping period. The ...dynamical patterns and functions of these brief awakenings from sleep are not well understood, and they often are viewed as disruptions (random or pathologic) of the sleep process. In this article, we hypothesize that brief awakenings from sleep may reflect aspects of the endogenous sleep control mechanism and thus may exhibit certain robust dynamical patterns across species. We analyze sleep recordings from mice, rats, cats, and humans, and we compare the distributions of sleep and wake episode durations. For all four species, we find that durations of brief wake episodes during the sleep period exhibit a scale-free power-law behavior with an exponent α that remains the same for all species (α ≈ 2.2). In contrast, sleep episode durations for all four species follow exponential distributions with characteristic time scales, which change across species in relation to body mass and metabolic rate. Our findings suggest common dynamical features of brief awakenings and sleep durations across species and may provide insights into the dynamics of the neural circuits controlling sleep.
Frequent premature atrial complexes (PACs) are associated with higher morbidity and mortality. Recent studies suggest that frequent PACs are associated with new onset atrial fibrillation (AF). ...However, a systematic review and meta-analysis of the literature has not been done. We assessed the association between frequent PACs and new onset AF by a systematic review and a meta-analysis.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) that compared new onset AF among patients with and without frequent PACs documented by Holter monitoring or 12-lead electrocardiogram. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.
Twelve studies from 2009 to 2017 were included in this meta-analysis involving 109,689 subjects (9217frequent and 100,472 non-frequent PACs). Frequent PACs were associated with increased risk of new onset AF (pooled risk ratio = 2.76, 95% confidence interval: 2.05–3.73, p < 0.000, I2 = 90.6%).
Frequent PACs are associated with up to three-fold increased risk of new onset AF. Our study suggests that frequent PACs in general population is an independent predictor of new onset AF.
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