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1.
Pacing Clin Electrophysiol ; 46(2): 108-113, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36333921

RESUMEN

BACKGROUND: Atrial fibrillation and flutter are often treated with external electrical cardioversion (ECV) in patients with potentially electrically sensitive cardiovascular implantable electronic devices (CIED). Long-term follow-up data on contemporary CIED undergoing ECV is sparse. The aim is to investigate shock-related complications and impact on CIEDs. METHODS: All ECV procedures from 2010 to 2020 in patients with CIED performed at a tertiary university hospital were identified in the Danish National Patient Registry. Changes in device measurements after ECV were retrospectively studied and procedure-related complications were identified by review of medical records. RESULTS: We analyzed 763 ECV procedures in 372 patients, median device implant time 1.9 years. The mean age of patients was 69.9 ± 9.9 years of which 73.4% were men. We identified two cases of device programming changes and four cases of premature battery depletion (≤3 years after device implant). Minor changes in device measurements were found for impedances, sensing, and pacing thresholds. No patients died due to ECV-related device dysfunctions within the first 12 months after cardioversions. CONCLUSION: External cardioversion in patients with contemporary pacemakers and implantable cardioverter-defibrillators seems safe in the majority of patients. Clinically important changes in device function following cardioversion were rarely observed but may be critical for device function. In an observational study, causality between cardioversion and device dysfunction cannot be established. For patient safety, we suggest that routine device interrogation after cardioversion still should be part of standard care.


Asunto(s)
Fibrilación Atrial , Desfibriladores Implantables , Marcapaso Artificial , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Fibrilación Atrial/terapia , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/métodos , Estudios Retrospectivos
2.
Eur J Clin Invest ; 52(1): e13649, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34233016

RESUMEN

BACKGROUND: The aim of the present study was to examine the relation between adipose tissue content of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the risk of incident atrial fibrillation (AF). METHODS: In this case-cohort study based on data from the Danish Diet, Cancer and Health cohort, a total of 5255 incident cases of AF was identified during 16.9 years of follow-up. Adipose tissue biopsies collected at baseline from all cases and from a randomly drawn subcohort of 3440 participants were determined by gas chromatography. Data were analysed using weighted Cox regression. RESULTS: Data were available for 4741 incident cases of AF (2920 men and 1821 women). Participants in the highest vs. the lowest quintile of EPA experienced a 45% lower risk of AF (men HR 0.55 (95% CI 0.41-0.69); women HR 0.55 (0.41-0.72)). For DHA, no clear association was found in men, whereas in women, participants in the highest quintile of DHA in adipose tissue had a 30% lower risk of incident AF (HR 0.70 (0.54-0.91)) compared to participants in the lowest quintile. CONCLUSIONS: A monotonous inverse association was found for the content of EPA in adipose tissue and risk of AF in both men and women. The content of DHA was inversely associated with the risk of AF in women, whereas no clear association was found for men.


Asunto(s)
Tejido Adiposo/química , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Ácidos Docosahexaenoicos/análisis , Ácidos Docosahexaenoicos/fisiología , Ácido Eicosapentaenoico/análisis , Ácido Eicosapentaenoico/fisiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo
3.
BMC Med ; 15(1): 203, 2017 11 17.
Artículo en Inglés | MEDLINE | ID: mdl-29145892

RESUMEN

BACKGROUND: Accumulating evidence suggests that individual circulating saturated fatty acids (SFAs) are heterogeneous in their associations with cardio-metabolic diseases, but evidence about associations of SFAs with metabolic markers of different pathogenic pathways is limited. We aimed to examine the associations between plasma phospholipid SFAs and the metabolic markers of lipid, hepatic, glycaemic and inflammation pathways. METHODS: We measured nine individual plasma phospholipid SFAs and derived three SFA groups (odd-chain: C15:0 + C17:0, even-chain: C14:0 + C16:0 + C18:0, and very-long-chain: C20:0 + C22:0 + C23:0 + C24:0) in individuals from the subcohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study across eight European countries. Using linear regression in 15,919 subcohort members, adjusted for potential confounders and corrected for multiple testing, we examined cross-sectional associations of SFAs with 13 metabolic markers. Multiplicative interactions of the three SFA groups with pre-specified factors, including body mass index (BMI) and alcohol consumption, were tested. RESULTS: Higher levels of odd-chain SFA group were associated with lower levels of major lipids (total cholesterol (TC), triglycerides, apolipoprotein A-1 (ApoA1), apolipoprotein B (ApoB)) and hepatic markers (alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT)). Higher even-chain SFA group levels were associated with higher levels of low-density lipoprotein cholesterol (LDL-C), TC/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, ApoB, ApoB/A1 ratio, ALT, AST, GGT and CRP, and lower levels of HDL-C and ApoA1. Very-long-chain SFA group levels showed inverse associations with triglycerides, ApoA1 and GGT, and positive associations with TC, LDL-C, TC/HDL-C, ApoB and ApoB/A1. Associations were generally stronger at higher levels of BMI or alcohol consumption. CONCLUSIONS: Subtypes of SFAs are associated in a differential way with metabolic markers of lipid metabolism, liver function and chronic inflammation, suggesting that odd-chain SFAs are associated with lower metabolic risk and even-chain SFAs with adverse metabolic risk, whereas mixed findings were obtained for very-long-chain SFAs. The clinical and biochemical implications of these findings may vary by adiposity and alcohol intake.


Asunto(s)
Biomarcadores/sangre , Glucemia/metabolismo , Ácidos Grasos/sangre , Inflamación/sangre , Lípidos/sangre , Adulto , Anciano , Índice de Masa Corporal , HDL-Colesterol , LDL-Colesterol/sangre , Estudios Transversales , Grasas de la Dieta/metabolismo , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Triglicéridos/sangre , Adulto Joven
4.
Eur J Clin Invest ; 47(12)2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28906545

RESUMEN

OBJECTIVES: The aim of this study was to investigate the association between adipose tissue content of total saturated fatty acids including myristic (C14:0), palmitic (C16:0) and stearic (C18:0) acid, as a measure of exposure to saturated fatty acids and the risk of incident atrial fibrillation. MATERIALS AND METHODS: A total of 57 053 Danish men and women aged 50-64 years participating in the Diet, Cancer and Health cohort had an adipose tissue biopsy taken at baseline, and this was analysed for saturated fatty acids content by gas chromatography. Follow-up was registry based and in this case-cohort study we used all cases and a randomly drawn subcohort of 3500 participants representative for the entire cohort. RESULTS: Data were analysed using weighted Cox proportional hazards regression. During a median follow-up of 14.6 years, a total of 4722 cases of incident atrial fibrillation were diagnosed. For both men and women, no association between adipose tissue content of total saturated fatty acids and the risk of atrial fibrillation could be demonstrated. CONCLUSION: We did not find an association between adipose tissue content of total saturated fatty acids and the risk of incident atrial fibrillation.


Asunto(s)
Tejido Adiposo/metabolismo , Fibrilación Atrial/epidemiología , Ácidos Grasos/metabolismo , Sistema de Registros , Anciano , Estudios de Casos y Controles , Cromatografía de Gases , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo
5.
Ugeskr Laeger ; 186(11)2024 03 11.
Artículo en Danés | MEDLINE | ID: mdl-38533864

RESUMEN

Spontaneous epidural haematoma (SEDH) is a rare complication of sickle cell disease (SCD). To our knowledge, 38 cases of patients with SEDH associated with SCD have been reported in the literature. In this case report we describe the first Danish paediatric case with SCD and SEDH. The pathophysiology of this association is not fully understood, but skull bone infarction, haemopoietic marrow expansion or compromised blood flow due to hyper viscosity might contribute to this rare complication. In patients with SCD presenting with relevant symptoms, early imaging could be considered.


Asunto(s)
Anemia de Células Falciformes , Hematoma Epidural Craneal , Humanos , Niño , Hematoma Epidural Craneal/complicaciones , Hematoma Epidural Craneal/diagnóstico , Anemia de Células Falciformes/complicaciones , Cabeza
6.
Heart Rhythm ; 20(9): 1227-1235, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-36965653

RESUMEN

BACKGROUND: External cardioversion (ECV) is an essential part of rhythm control of atrial fibrillation and flutter in patients with and without cardiovascular implantable electronic devices (CIEDs). Long-term follow-up data on ECV-related CIED dysfunctions are limited. OBJECTIVE: The purpose of this study was to investigate the risk of CIED reintervention following ECV in a nationwide cohort. METHODS: We identified CIED implants and surgical reinterventions from 2005 to 2021 in the Danish Pacemaker and ICD Register. We included CIED patients undergoing ECV from 2010 to 2019 from the Danish National Patient Registry. For each ECV-exposed generator, 5 matched generators without ECV were identified, and for each ECV-exposed lead, 3 matched leads were identified. The primary endpoints were generator replacement and lead reintervention. RESULTS: We compared 2582 ECV-exposed patients with 12,910 matched patients with a pacemaker (47%), implantable cardioverter-defibrillator (ICD) (29%), cardiac resynchronization therapy-pacemaker (6%), or cardiac resynchronization therapy-defibrillator (18%). During 2 years of follow-up, 210 ECV-exposed generators (8.1%) vs 670 matched generators (5.2%) underwent replacements, and 247 ECV-exposed leads (5.6%) vs 306 matched leads (2.3%) underwent reintervention. Unadjusted hazard ratios were 1.61 (95% confidence interval [CI] 1.37-1.91; P <.001) for generator replacement and 2.39 (95% CI 2.01-2.85; P <.001) for lead reintervention. One-year relative risks were 1.73 (95% CI 1.41-2.12; P <.001) for generator replacement and 2.85 (95% CI 2.32-3.51; P <.001) for lead reintervention, and 2-year relative risks were 1.39 (95% CI 1.19-1.63; P <.001) and 2.18 (95% CI 1.84-2.57; P <.001), respectively. CONCLUSION: ECV in patients with a CIED is associated with a higher risk of generator replacement and lead reintervention. The risks of reinterventions were more pronounced within the first year after cardioversion.


Asunto(s)
Fibrilación Atrial , Desfibriladores Implantables , Marcapaso Artificial , Humanos , Cardioversión Eléctrica/efectos adversos , Fibrilación Atrial/terapia , Estudios de Cohortes , Desfibriladores Implantables/efectos adversos , Marcapaso Artificial/efectos adversos , Estudios Retrospectivos
7.
J Rehabil Med ; 51(6): 442-450, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-30931484

RESUMEN

OBJECTIVE: To examine the effect of a rehabilitation programme on quality of life and physical capacity in patients with atrial fibrillation. METHODS: Patients with paroxysmal or persistent atrial fibrillation were randomized to either a 12-week rehabilitation programme with education and physical training (intervention group) or standard care (control group). At baseline, after 3, 6 and 12 months participants completed 5 different quality of life questionnaires (Quality of Life in patients with Atrial Fibrillation (AF-QoL-18), Atrial Fibrillation Effect on QualiTy of Life (AFEQT), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7) and EuroQol 5D (EQ-5D)), and physical exercise tests. Differences in mean] scores between groups were analysed by repeated measures analysis of variance (ANOVA). RESULTS: Fifty-eight patients (age range 43-78 years, 31% female) were included. In the intervention group the AF-QoL-18 score increased from baseline (48.4 (standard deviation (SD) 22.8)) to 6 months (68.0 (SD 15.2)) compared with the control group (baseline 51.6 (SD 22.3), 6 months 59.2 (SD 27.3)). After 12 months, there was no difference. Similar patterns were found for the other questionnaires. Maximum exercise capacity improved in the intervention group from baseline (176 W (SD 48)) to 6 months (190 W (SD 55)). There was no change in the control group. CONCLUSION: Education and physical training may have a short-term (but no long-term) beneficial effect on quality of life and physical exercise capacity in patients with atrial fibrillation.


Asunto(s)
Fibrilación Atrial/terapia , Terapia por Ejercicio/métodos , Educación del Paciente como Asunto/métodos , Calidad de Vida , Adulto , Anciano , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/psicología , Tolerancia al Ejercicio/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Resultado del Tratamiento
9.
PLoS One ; 13(12): e0208833, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30533060

RESUMEN

Fatty acids in adipose tissue share dietary sources and metabolic pathways and therefore occur in patterns. The aim of the present study was to investigate the association between adipose tissue fatty acid patterns identified by the data-driven dimension-reducing method treelet transform and the risk of atrial fibrillation. A total of 57,053 Danish men and women aged 50-64 years participating in the Diet, Cancer and Health cohort had an adipose tissue biopsy taken at baseline. During a median follow-up of 14.6 years, a total of 4,710 participants developed atrial fibrillation or atrial flutter. Adipose tissue biopsies were analysed for fatty acid content by gas chromatography for all cases of atrial fibrillation and for a randomly drawn subcohort (n = 3,500) representative for the entire cohort. Hazard ratios with 95% confidence intervals for atrial fibrillation according to quintiles of factor scores were determined by weighted Cox proportional hazards regression analyses for men and women separately. From the 32 fatty acids measured, 7 major factors/patterns of fatty acids were identified using treelet transform. We found that a pattern consisting of n-6 polyunsaturated fatty acids (PUFA) (except linoleic acid) was associated with a lower hazard of atrial fibrillation. Patterns consisting of marine n-3 PUFA and containing n-9 fatty acids were associated with a lower hazard of atrial fibrillation in women. In conclusion, patterns of fatty acids in adipose tissue identified by treelet transform may be differentially associated with the risk of atrial fibrillation.


Asunto(s)
Tejido Adiposo/metabolismo , Fibrilación Atrial/epidemiología , Aleteo Atrial/epidemiología , Ácidos Grasos/metabolismo , Fibrilación Atrial/metabolismo , Aleteo Atrial/metabolismo , Dinamarca , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo
10.
Am J Cardiol ; 120(7): 1129-1132, 2017 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-28803653

RESUMEN

The aim of the present study was to explore substitution of intake of saturated fatty acids (FAs) with monounsaturated and polyunsaturated FAs and incident atrial fibrillation (AF) in men and women. A total of 57,053 Danish participants aged 50 to 64 years were enrolled in the Diet, Cancer and Health cohort study in 1993 to 1997 and completed a semiquantitative food frequency questionnaire at baseline. Follow-up was registry-based and data were analyzed using Cox proportional hazards regression. The statistical model was formulated in such a way that 1 g/day of saturated FAs was replaced with 1 g/day of monounsaturated or polyunsaturated FAs while keeping total fat intake, total energy intake, and energy intake from protein and carbohydrates constant. During a median follow-up of 17 years, 5,175 incident cases of AF occurred. In men, there was a higher hazard of AF when total n-3 polyunsaturated FAs replaced dietary saturated FAs-hazard ratio per 1-g substitution of FAs of 1.08 (95% confidence interval 1.02 to 1.14) in a model adjusted for lifestyle factors. For other substitutions of FAs (monounsaturated, total or n-6 polyunsaturated FAs), no consistent nor statistically significant associations were found. In conclusion, we found a moderately higher risk of AF in men, but not in women, when total n-3 polyunsaturated FAs replaced dietary saturated FAs. Substitution of saturated FAs with monounsaturated, total or n-6 polyunsaturated FAs was not associated with the risk of AF.


Asunto(s)
Fibrilación Atrial/prevención & control , Ácidos Grasos Monoinsaturados/farmacología , Ácidos Grasos Insaturados/farmacología , Sistema de Registros , Medición de Riesgo , Fibrilación Atrial/dietoterapia , Fibrilación Atrial/epidemiología , Dinamarca/epidemiología , Ingestión de Energía , Ácidos Grasos/farmacología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios
11.
Artículo en Inglés | MEDLINE | ID: mdl-25614825

RESUMEN

UNLABELLED: A patient of Cushing's disease (CD) characterized by a large tumor and only subtle symptoms of hormonal hypersecretion was examined. The patient had a germline variant in the aryl hydrocarbon receptor-interacting protein (AIP) gene. A 50-year-old male presenting with headache was diagnosed with a large pituitary tumor by magnetic resonance imaging (MRI). His visual fields were intact and he exhibited no features of CD. Owing to an exuberant response to synacthen, an overnight dexamethasone suppression test was performed revealing inadequate suppression of plasma cortisol (419 nmol/l). Owing to tumor growth and visual field impairment, he underwent transsphenoidal surgery and developed hypocortisolemia. The pathology specimen revealed a sparsely granulated corticotrope adenoma. Postoperative MRI showed a large tumor remnant. The patient developed skin hyperpigmentation and a synacthen test demonstrated high basal and stimulated cortisol levels; an overnight dexamethasone suppression test showed no suppression (791 nmol/l) and elevated plasma ACTH levels (135 ng/l). A transcranial operation was performed followed by radiotherapy. Two months after radiotherapy, he developed secondary adrenocortical failure. Genetic testing revealed an AIP variant of unknown significance (p.R16H) without loss of the normal AIP allele in the tumor. A literature review showed ten CD patients with AIP gene variants, of whom five (including our case) were p.R16H. CD is occasionally dominated by pituitary tumor growth rather than symptoms of hypersecretion. The particular AIP gene variant identified in our patient is shared by four other reported cases of CD. Future studies are needed to assess whether the reported AIP gene variant is more than just coincidental. LEARNING POINTS: CD is occasionally dominated by pituitary tumor growth rather than symptoms of hypersecretion.Resolution of both tumor remnant and hormonal hypersecretion may occur within 2 months after postoperative radiotherapy.The particular AIP gene variant identified in our patient is shared by four other reported cases of CD.

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