Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea.

STUDY OBJECTIVES: Obstructive sleep apnea is common among patients with atrial fibrillation, but the prevalence and risk factors for atrial fibrillation among patients who are being investigated on suspicion of sleep apnea are not well known. The aim of the study was to estimate the prevalence of atrial fibrillation among patients investigated for suspected obstructive sleep apnea and to identify risk factors for atrial fibrillation among them. METHODS: The prevalence of atrial fibrillation was investigated among 201 patients referred for suspected obstructive sleep apnea. Patients without known atrial fibrillation were investigated with a standard 12-lead ECG at hospital and short intermittent handheld ECG recordings at home, during 14 days. RESULTS: Atrial fibrillation occurred in 13 of 201 subjects (6.5%), and in 12 of 61 men aged 60 years and older (20%). The prevalence of atrial fibrillation increased with sleep apnea severity (p = 0.038). All patients with atrial fibrillation were men and all had sleep apnea. Age 60 or older, the occurrence of central sleep apnea and diabetes mellitus were independent risk factors for atrial fibrillation after adjustments for body mass index, gender, sleep apnea and cardiovascular disease. CONCLUSIONS: Atrial fibrillation is common among subjects referred for sleep apnea investigation and the prevalence of atrial fibrillation increases with sleep apnea severity. Independent risk factors for atrial fibrillation among patients investigated for suspected obstructive sleep apnea include the occurrence of coexisting central sleep apnea, age 60 years or older and diabetes mellitus.

[Identification of paroxysmal, transient arrhythmias: Intermittent registration more efficient than the 24-hour Holter monitoring]. / Identifiering av paroxysmala, kortvariga arytmier: - Intermittent registrering mer effektiv än 24-timmars Holter-EKG.

Many patients suffer from palpitations or dizziness/presyncope. These patients are often referred for Holter ECG (24 hour), although the sensitivity for detecting arrhythmias is low. A new method, short intermittent regular and symptomatic ECG registrations at home, might be a convenient and more sensitive alternative also suitable for primary health care. In this case report we present a patient who had contacted health care several times during a seven year period for paroxysmal palpitations. Routine examination with 24 hour Holter ECG and event recorder did not result in a diagnosis. Using intermittent handheld ECG registration at home, a paroxysmal supraventricular arrhythmia was diagnosed. Further investigation revealed that the patient had a concealed Wolff-Parkinson-White (WPW) syndrome.

Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias.

BACKGROUND: Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope. DESIGN: prospective, observational, cross-sectional study. SETTING: Clinical Physiology, University Hospital. PATIENTS: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope. INTERVENTIONS: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days. MAIN OUTCOME MEASURES: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT). RESULTS: 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes. CONCLUSIONS: Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population.

BACKGROUND: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke. DESIGN: Cross-sectional study. SETTING: Eight family practice centres and two hospital-based out-patient clinics in Sweden. SUBJECTS: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). INTERVENTIONS: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. MAIN OUTCOME MEASURES: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds. RESULTS: 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7-5.2). These 35 patients had a mean age of 70.7 years (SD ± 7.7; range 53-85) and a median CHADS2 of 2 (range 1-4). CONCLUSIONS: Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.

Sense of coherence in three cross-sectional studies in Northern Sweden 1994, 1999 and 2004 -- patterns among men and women.

AIMS: To explore changes in sense of coherence (SOC) over a 10-year period in the general population in northern Sweden. METHODS: Three cross-sectional surveys from 1994 (n=1802), 1999 (n=1698) and 2004 (n=1777), conducted within the northern Sweden MONICA Project, were compared. Participants answered questions about gender, age, experience of disease, perceived health, psychosocial factors and Antonovsky's SOC scale with 13 items. RESULTS: A small, but significant, decrease in SOC medians and a shift of cumulative distributions towards slightly lower SOC values were seen both in the total study population and in its male and female subgroups between 1994 and 1999. No changes were seen between 1999 and 2004, with the exception of women between 25 and 44 years of age, who showed a continuous decrease. CONCLUSIONS: The present study shows that SOC at a population level in northern Sweden, within a 10-year span, is relatively stable, not withstanding minor changes. These small changes might be attributed to societal changes in Sweden during the 1990s and an increase in "minor'' psychiatric complaints in the Swedish population as a whole during the same period.