RESUMO
PURPOSE: Pulmonary vein isolation (PVI) by catheter ablation has reduced efficacy for the treatment of persistent atrial fibrillation (persAF), as compared to paroxysmal atrial fibrillation (paroxAF). We investigated whether the selection of persAF patients for PVI who "step back" to the paroxysmal stage on amiodarone offers a success rate comparable to that of patients with paroxAF. METHODS: Sixty-two consecutive persAF patients and 62 matched control patients with paroxAF were included. Persistent patients were started on amiodarone and cardioverted to sinus rhythm (SR). PVI was performed after 3 months in those who "stepped back" and had sustained SR and in all paroxAF patients. RESULTS: Five of the 62 (8%) study patients returned to persAF after cardioversion; despite amiodarone, they did not undergo PVI. The rest received PVI and was followed for a mean of 31 ± 14 months. Redo procedures were performed in 44% and 29% in the persAF and paroxAF group (p = 0.093), respectively. The recurrence rate after multiple procedures without antiarrhythmic drugs was similar among the persAF and paroxAF patients (11% and 7%) at 6 months (p = 0.510), but increased in the persAF group at 1 year (21% and 9%, p = 0.065) and exceeded that of the paroxAF group at the end of the follow-up (26% and 12%, p = 0.046). Kaplan-Meier survival analysis showed shorter time to recurrence in the persAF group (p = 0.045). CONCLUSION: PersAF patients who "step back" to the paroxysmal stage on amiodarone can expect long-term success of a PVI-only strategy in more than 70% of the time. However, late recurrences are more common compared to paroxAF.
Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/cirurgia , Veias Pulmonares/cirurgia , Estudos de Casos e Controles , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , ReoperaçãoRESUMO
Tumour-related peer support groups (PSGs) show long-term development in quality of life and coping, and decrease distress in cancer care. To clarify channels of social support in oncologic rehabilitation by combined exercise and psychosocial therapy, individual semi-structured interviews were conducted after 1 year additional belly dance rehabilitation in a closed PSG among 51 patients with malignant tumour diagnosis in Budapest, Hungary. Interview data were transcribed and analysed using qualitative content analysis (ATLAS.ti 6 Win). Results suggest that group experience provides emotional-, practical- and informational support. We could point out specific social effects of "role model" function and extend the coping model. The group dispose all the features of effective suggestion and may be effectively applied as additional therapy for patients with malignancies. The extended coping model and the introduction of "role model" function could be useful for PSGs' efficacy assessment.
Assuntos
Dança , Neoplasias/reabilitação , Grupo Associado , Grupos de Autoajuda , Apoio Social , Adaptação Psicológica , Adulto , Idoso , Emoções , Feminino , Humanos , Hungria , Pessoa de Meia-Idade , Neoplasias/psicologia , Pesquisa Qualitativa , Qualidade de VidaRESUMO
BACKGROUND: Because depressive illness is recurrent, recurrence prevention should be a mainstay for reducing its burden on society. One way to reach this goal is to identify malleable risk factors. The ability to attenuate sadness/dysphoria (mood repair) and parasympathetic nervous system functioning, indexed as respiratory sinus arrhythmia (RSA), are impaired during depression and after it has remitted. The present study therefore tested the hypothesis that these two constructs also may mirror risk factors for a recurrent major depressive episode (MDE). METHOD: At time 1 (T1), 178 adolescents, whose last MDE had remitted, and their parents, reported on depression and mood repair; youths' RSA at rest and in response to sad mood induction also were assessed. MDE recurrence was monitored until time 2 (T2) up to 2 years later. Mood repair at T1 (modeled as a latent construct), and resting RSA and RSA response to sadness induction (RSA profile), served to predict onset of first recurrent MDE by T2. RESULTS: Consistent with expectations, maladaptive mood repair predicted recurrent MDE, above and beyond T1 depression symptoms. Further, atypical RSA profiles at T1 were associated with high levels of maladaptive mood repair, which, in turn, predicted increased risk of recurrent MDE. Thus, maladaptive mood repair mediated the effects of atypical RSA on risk of MDE recurrence. CONCLUSIONS: This study documented that a combination of behavioral and physiological risk factors predicted MDE recurrence in a previously clinically referred sample of adolescents with depression histories. Because mood repair and RSA are malleable, both could be targeted for modification to reduce the risk of recurrent depression in youths.
Assuntos
Adaptação Psicológica/fisiologia , Sintomas Afetivos/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Arritmia Sinusal Respiratória/fisiologia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Recidiva , RiscoRESUMO
The connection between certain arrhythmias and the autonomic nervous system is well known. Authors report a patient, whose paroxysmal atrial fibrillation was induced by increased vagal tone.
Assuntos
Fibrilação Atrial/etiologia , Taquicardia Paroxística/etiologia , Manobra de Valsalva , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Paroxística/diagnósticoRESUMO
A 4-year-old boy with skin symptoms resembling verruca plana juvenile was observed. The light- and electron-microscopic picture showed the typical features of histiocytosis X (Letterer-Siwe syndrome). Beside the skin manifestations some less dense areas in the skull bones were found by X-ray examination. Vinblastine and prednisolone treatment for one year resulted in complete remission.