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1.
Orv Hetil ; 161(46): 1953-1958, 2020 11 15.
Artigo em Húngaro | MEDLINE | ID: mdl-33190126

RESUMO

Összefoglaló. Bevezetés: Az inadekvát, aránytalan sinuscsomó-tachycardia a szív nomotop ingerképzési zavarával járó, nem ritka klinikai szindróma. A szívritmuszavar-entitást a nem paroxysmalis, magas nyugalmi sinusfrekvencia, a fizikai/pszichés stresszre adott aránytalan sinustachycardia, valamint foként palpitációs panaszok jellemzik. Célkituzés: Az aránytalan sinuscsomó-tachycardiás betegeink gyógyszeres kezelésével szerzett tapasztalataink ismertetése. Módszerek: 2008 és 2018 között 104 beteget (92 no, 12 férfi; átlagéletkor 31 ± 10 év) kezeltünk ezzel a szívritmuszavarral. A betegek kivizsgálásuk után 12 elvezetéses EKG-, terheléses EKG-, valamint 24 órás Holter-monitoros EKG-megfigyeléseken vettek részt a gyógyszeres kezelés elott és után (bizoprolol: 2 × 5 mg/nap; ivabradin: 2 × 5 mg/nap). Az életminoség változását a European Heart Rhythm Association (EHRA) tüneti skálája szerint állapítottuk meg. Eredmények: Mindkét gyógyszer jelentosen csökkentette a nyugalmi sinusfrekvenciát (kontroll: 102 ± 10/min; bizoprolol: 78 ± 6/min; ivabradin: 74 ± 8/min, mindketto: p<0,0001). A gyógyszeres kezelés nélküli, 24 órás Holter-monitoros EKG-felvételek során mért szívfrekvenciák (minimum-maximum [átlag] sinusfrekvencia/min) a kontrollértékekrol (58 ± 8-159 ± 14 [94 ± 6]/min) mindkét gyógyszerre egyaránt szignifikánsan csökkentek (bizoprolol: 53 ± 7-132 ± 13 [77 ± 9]/min [mindhárom: p<0,0001]; ivabradin 51 ± 6-134 ± 18 [77 ± 8]/min [mindhárom: p<0,0001]). A terheléses EKG-vizsgálatok elott (kontroll: 99 ± 13/min; bizoprolol 81 ± 11/min [p<0,0001]; ivabradin: 84 ± 10/min [p<0,0001]) és a terhelés csúcspontján mért sinusfrekvenciák (kontroll: 164 ± 15/min; bizoprolol: 140 ± 16/min [p<0,0001]; ivabradin: 142 ± 14/min [p<0,0001]) is jelentosen mérséklodtek. Az azonos dózisban adott két gyógyszer szívfrekvencia-csökkento hatásai között számottevo különbséget nem tapasztaltunk. Az életminoséget tükrözo EHRA tüneti skálán (kontroll: 2,3 ± 0,7) mind a bizoprolol (1,4 ± 1,4; p<0,0001), mind az ivabradin (1,1 ± 0,2; p<0,0001) egyformán csökkentette a betegek tüneteit, panaszait. Számottevo cardiovascularis mellékhatás egyik betegcsoportban sem jelentkezett. Következtetések: Vizsgálati eredményeink alapján megállapítható, hogy az aránytalan sinuscsomó-tachycardiás betegek gyógyszeres kezelésére: (1) a kardiospecifikus adrenerg béta-blokkoló bizoprolol és az If-csatorna-gátló ivabradin egyaránt hatékonynak és biztonságosnak bizonyult; (2) az azonos adagban adott két gyógyszer hatékonysága között számottevo különbség nem volt; (3) a gyógyszeres kezelés nemcsak a sinusfrekvenciát csökkentette, hanem a betegek panaszait, tüneteit is mérsékelte. Orv Hetil. 2020; 161(46): 1953-1958. INTRODUCTION: The inadequate, inappropriate sinus-node tachycardia is not a rare clinical syndrome, defined as a disturbance of the nomotopic impulse formation of the heart. This cardiac arrhythmic entity is characterized by a non-paroxismal, increased sinus rate at rest, and/or inadequate response to physical and/or emotional stress and palpitations. OBJECTIVE: The aim of this study was to describe our experiences with pharmacological therapy of patients with inappropriate sinus tachycardia syndrome. METHODS: Between 2008 and 2018, 104 patients (92 women, 12 men, mean age: 31 ± 10 years) were treated with this cardiac arrhythmia entity. All patients underwent 12-lead ECG, 24-hour Holter-ECG monitoring and standard bicycle dynamic exercise tests before and after drug treatment (bisoprolol: 5 mg bid; ivabradine: 5 mg bid). Changes in the quality of life were estimated by using the European Heart Rhythm Association (EHRA) score. RESULTS: Both drugs decreased significantly the resting heart rate (control: 102 ± 10/min; bisoprolol 78 ± 6/min (p<0.0001), ivabradine: 74 ± 8/min (p<0.0001). The results of the parameters of the 24-hour Holter ECG recordings (expressed as minimal-maximal [average] heart rate/min) with drug therapy showed a significant decrease from control values in all three parameters: control 58 ± 8-159 ± 14 (94 ± 6)/min; bisoprolol 53 ± 7-132 ±13 (77 ± 9)/min (all three: p<0.0001); ivabradine: 51 ± 6-134 ± 18 (77 ± 8)/min (all three: p<0.0001). The sinus rate reduced significantly both before the bicycle dynamic exercise tests (control: 99 ± 13/min; bisoprolol: 81 ± 11/min [p<0.0001]; ivabradine: 84 ± 10/min [p<0.0001]) and at the peaks of the exercise test (control: 164 ± 15/min; bisoprolol: 140 ± 16/min [p<0.0001]; ivabradine 142 ± 14/min [p<0.0001]). The heart rate reducing effects of the two drugs did not differ significantly. The EHRA quality of life score was equally improved by the two drugs (control: 2.3 ± 0.7; bisoprolol: 1.4 ± 1.4 [p<0.0001]; ivabradine: 1.1 ± 0.2 [p<0.0001]). No cardiovascular side effects were observed while taking bisoprolol or ivabradine. CONCLUSIONS: Based on our clinical results, it can be pointed out that in the drug therapy of patients with inappropriate sinus node tachycardia: (1) bisoprolol (5 mg bid) and ivabradine (5 mg bid) proved to be equally effective and safe; (2) the heart rate reducing effect of the two drugs - given in the same dosage - did not differ considerably; (3) the pharmacological therapy significantly decreased not only the sinus frequency, but also reduced the symptoms of the patients. Orv Hetil. 2020; 161(46): 1953-1958.


Assuntos
Qualidade de Vida , Taquicardia Sinusal , Adulto , Arritmias Cardíacas/tratamento farmacológico , Eletrocardiografia , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca , Humanos , Masculino , Taquicardia Sinusal/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
2.
Am J Vet Res ; 81(9): 720-731, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112172

RESUMO

OBJECTIVE: To characterize the patterns associated with Lorenz plots (LPs) or Poincaré plots derived from the Holter recordings of dogs with various cardiac rhythms. ANIMALS: 77 dogs with 24-hour Holter recordings. PROCEDURES: A 1-hour period from the Holter recordings from each of 20 dogs without arrhythmias and from each of 57 dogs with arrhythmias (10 each with supraventricular premature complexes, complex supraventricular ectopy, ventricular premature complexes, complex ventricular ectopy, and atrial fibrillation, and 7 with high-grade second-degree atrioventricular block) were used to generate the LPs. Patterns depicted in the LPs were described. RESULTS: Arrhythmia-free Holter recordings yielded LPs with a Y-shaped pattern and variable silent zones. Recordings with single premature complexes yielded LPs with double side and triple side lobes. Complex ectopy was denoted by dots clustered in the lower left corner of the LPs. The LPs of recordings with atrial fibrillation had fan patterns consistent with a nonlinear relationship between atrial electrical impulses and atrioventricular nodal conduction. The recordings with atrioventricular block yielded LPs with island patterns consistent with variable atrioventricular nodal conduction. CONCLUSIONS AND CLINICAL RELEVANCE: Distinct LP patterns were identified for common cardiac rhythms of dogs, supportive of nonrandom mechanisms as the cause of most rhythms. Visual interpretation of an LP generated from a Holter recording may aid in determining the arrhythmia type and understanding the arrhythmia's mechanism in dogs and other species.


Assuntos
Doenças do Cão , Eletrocardiografia Ambulatorial , Animais , Arritmias Cardíacas/veterinária , Cães , Eletrocardiografia Ambulatorial/veterinária
3.
Cardiovasc Ther ; 2020: 4354759, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33042223

RESUMO

To investigate whether specific time series patterns for blood pressure (BP), heart rate (HR), and sympathetic tone are associated with metabolic factors and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). A total of 989 patients who underwent simultaneous 24-hour ambulatory BP and Holter electrocardiogram monitoring were enrolled. The patients were categorized into sixteen groups according to their circadian patterns using the consensus clustering analysis method. Metabolic factors, including cholesterol profiles and apolipoprotein, were compared. The 10-year ASCVD risk was estimated based on the Framingham risk model. Overall, 16 significant associations were found between the clinical variables and cluster groups. Age was commonly associated with all clusters in systolic BP (SBP), diastolic BP (DBP), HR, and sympathetic tone. Metabolic indicators, including diabetes, body mass index, total cholesterol, high-density lipoprotein, and apolipoprotein, were associated with the four sympathetic tone clusters. In the crude analysis, the ASCVD risk increased incrementally from clusters 1 to 4 across SBP, DBP, HR, and sympathetic tone. After adjustment for multiple variables, however, only sympathetic tone clusters 3 and 4 showed a significantly high proportion of patients at high risk (≥7.5%) of 10-year ASCVD (odds ratio (OR) = 5.90, 95% confidential interval (CI) = 1.27-27.46, and P value = 0.024 and OR = 15.28, 95% CI = 3.59-65.11, and P value < 0.001, respectively). Time series patterns of BP, HR, and sympathetic tone can serve as an indicator of aging. Circadian variations in sympathetic tone can provide prognostic information about patient metabolic profiles and indicate future ASCVD risk.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/inervação , Ritmo Circadiano , Frequência Cardíaca , Adulto , Idoso , Biomarcadores/sangue , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Análise por Conglomerados , Eletrocardiografia Ambulatorial , Metabolismo Energético , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Seul/epidemiologia , Fatores de Tempo
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4429-4432, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018977

RESUMO

We present an open-source, low-cost, portable, 128-channel bioamplifier module designed specifically for ambulatory, long-term (≥24 hr) monitoring of gastrointestinal (GI) electrical activity. The electronics hardware integrates stateof-the-art, commercial-off-the-shelf components on a custom PCB. Features include on-board data logging, wireless data streaming, subject motion monitoring, and stable operation up to the maximum 2 kHz/channel sampling rate tested. The new device operates for ≈ 30 hr continuously powered by a single 3.7 V, 2500 mAh LiPo battery. The 3D-printed ABS mechanical enclosure is robust and small (13.1 × 8.8 × 2.5 cm), so that the device can be carried in a standard Holter monitor pouch. Results from initial 128-channel, high spatial resolution body surface colon mapping experiments demonstrate the utility of this new device for GI applications. The new bioamplifier module could also be used for multichannel recording experiments in a variety of biomedical domains to study electrical activity patterns of the neuromuscular system (EMG), uterus (EHG), heart (ECG), and brain (EEG).


Assuntos
Tecnologia sem Fio , Eletrocardiografia Ambulatorial , Eletrônica , Desenho de Equipamento , Monitorização Ambulatorial
5.
Yonsei Med J ; 61(11): 965-969, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107240

RESUMO

In cryptogenic stroke patients, early detection of new-onset atrial fibrillation (AF) and recurrent stroke is required to prevent poor clinical outcomes. Therefore, we investigated the predictors of new-onset AF and recurrent stroke in cryptogenic stroke patients without previously diagnosed AF. In total, 390 patients who were diagnosed with stroke and non-sustained atrial tachycardia (NSAT) on 24-hour Holter monitoring were followed up to assess new-onset AF and recurrent stroke. The 5-year event-free survival as well as the predictors of recurrent stroke or new-onset AF were investigated. Based on receiver operating characteristic analysis, frequent premature atrial contractions (PACs) were defined as PACs >44 beats/day. The median follow-up period was 35 months. The composite event rate was 11.5%. In Kaplan-Meier analysis, the 5-year cumulative incidence of composite events was higher in cryptogenic stroke patients with frequent PACs than in those without frequent PACs. Multivariate analysis revealed that current smoking, increased left atrial volume index, and frequent PACs were poor prognostic predictors of composite event, and frequent PACs were an independent poor prognostic factor of new-onset AF in cryptogenic stroke patients. Therefore, frequent PACs might be associated with poor clinical outcomes (new-onset AF and recurrent stroke) in cryptogenic stroke patients with concomitant NSAT.


Assuntos
Fibrilação Atrial/diagnóstico , Complexos Atriais Prematuros/complicações , Infarto Cerebral/complicações , Frequência Cardíaca/fisiologia , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Complexos Atriais Prematuros/diagnóstico , Infarto Cerebral/epidemiologia , Infarto Cerebral/prevenção & controle , Eletrocardiografia Ambulatorial/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , República da Coreia/epidemiologia , Acidente Vascular Cerebral/etiologia , Taquicardia
6.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 5-9, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016670

RESUMO

OBJECTIVE: The timely diagnosis of atrial fibrillation (AF) in patients with cardiac embolism with implantable loop recorders (ILR). MATERIAL AND METHODS: Twenty-nine patients, hospitalized within 6 months after stroke (n=19) or transient ischemic attack (n=10), were included in the study. ILR were implanted in all cases. The mean time of follow-up was one year. RESULTS: Five hundred and thirteen transmissions were detected during the whole follow-up period. Symptomatic episodes were recorded in 165 cases. Such episodes as bradycardia, asystole, AF, atrial tachycardia and ventricular tachycardia were recorded in 98 cases out of 348 planned transmissions. All transmissions were analyzed by an operator. However, 70 cases were false-positive because of ILR over-sensing. In total, arrhythmias were detected in 5 patients, including sick sinus syndrome (1), supraventricular tachycardia (1), ventricular tachycardia (1) and atrial fibrillation (3). Anticoagulant therapy was started immediately after the diagnosis of AF. CONCLUSION: Loop recording monitoring is an effective strategy in patients with cardiac embolism for timely diagnosis and further treatment of arrhythmia.


Assuntos
Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Anticoagulantes , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia Ambulatorial , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
7.
J Stroke Cerebrovasc Dis ; 29(10): 105118, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912526

RESUMO

BACKGROUND: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation, stroke, and mortality. However, the cut-off value for PAC counts that could identify patients with different stroke features is unclear, and the association of PACs to outcome is not determined. METHODS: The study retrospectively included patients with acute ischemic stroke who had underwent both a 24 h Holter recording and a brain MRI in Taipei Veterans General Hospital from January 2015 to May 2016. Patients were categorized into four groups according to their PAC frequencies on 24 h Holter recording. We compared the clinical severity, neuroimage features, stroke subtypes, and functional outcome among the four groups of patients. RESULTS: Among the 278 patients, the lower, middle, and upper quartiles of the PAC counts were 23, 74, and 459.5, respectively. In contrast to the 1st quartile of patients, the 3rd (PAC 75-459/24 h) and the 4th (PAC ≥460/24 h) quartiles of patients had higher NIH Stroke Scale (NIHSS) at admission (p = 0.014 and p = 0.002, respectively). The frequencies of cryptogenic stroke were not different among the 4 quartiles of the patients, but cryptogenic stroke patients with ≥ 75PACs/24hours had higher stroke severity compared to those with PACs < 75counts/24 h (NIHSS 9.1 vs. 5.2, p = 0.043). There was an increased trend in infarcts of multiple vascular territories and in mortality at 1 year among the four groups of patients with increased PAC frequency (p = 0.045 and p = 0.002, respectively). The 4th PAC quartile was associated with poor functional outcome (modified Rankin Scale ≥ 4) at 3 months in univariate analysis (OR: 5.66, CI: 2.69-11.91, p < 0.001), but was not an independent predictor after controlling for initial stroke severity. CONCLUSIONS: PACs ≥ 75 counts/24 h was associated with higher clinical severity in patients with acute ischemic stroke.


Assuntos
Complexos Atriais Prematuros/complicações , Isquemia Encefálica/etiologia , Frequência Cardíaca , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Complexos Atriais Prematuros/diagnóstico , Complexos Atriais Prematuros/mortalidade , Complexos Atriais Prematuros/fisiopatologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Avaliação da Deficiência , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Taiwan , Fatores de Tempo
9.
Am J Cardiol ; 133: 71-76, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32811653

RESUMO

This study aimed to evaluate the predictors of very late recurrence of atrial fibrillation (VLRAF) after an initial AF catheter ablation (CA) by analyzing the follow-up Holter electrocardiogram. We retrospectively studied patients (n = 253, mean age: 66 years, woman: 30%, paroxysmal AF: 73%) without recurrence of AF within 12 months and the use of antiarrhythmic drugs. In the Holter electrocardiogram analysis, the atrial premature complexes (APCs) burden, the profile of the APCs run and prematurity index of the APCs were evaluated. Fifty-one patients (20%) had VLRAF during the follow-up period (mean follow up: 46 months). Patients with VLRAF had a significantly greater APCs burden (0.318% [0.084 to 1.405] vs 0.132% [0.051 to 0.461], p = 0.022), longer number of APCs run (5 [3 to 11] vs 4 [0 to 7], p = 0.019), and shorter minimum prematurity index of the APCs (47 ± 7 vs 51 ± 6, p = 0.001) than those without VLRAF. The optimal cutoff value for the APCs burden, maximum number of APCs run, and minimum prematurity index of the APCs to predict VLRAF was 0.159%, 10, and 48%, respectively. The minimum prematurity index of the APCs (≤48%) was significantly associated with VLRAF in the multivariate analysis. In conclusion, the minimum prematurity index of the APCs (≤48%) at 12 months after CA was shown to be an independent predictor of VLRAF in patients without antiarrhythmic drugs. Although the index is a very simple parameter automatically calculated by analysis software, it can be an important index for following patients after CA over the long-term.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Complexos Atriais Prematuros/diagnóstico , Ablação por Cateter , Idoso , Fibrilação Atrial/etiologia , Complexos Atriais Prematuros/etiologia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Herzschrittmacherther Elektrophysiol ; 31(3): 288-291, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32780284

RESUMO

In order to document arrhythmias, indicated due to symptoms or for prognostic purposes, both invasive and noninvasive possibilities for ECG monitoring are available. The choice of the device for monitoring depends mainly on the frequency of arrhythmias. If they occur less than once a month, long-term monitoring becomes necessary which either continuously monitors the rhythm by an implantable device (implantables) or by wearable systems (wearables) which usually register the ECG discontinuously. Because wearables, e.g. smartphones, are basically ubiquitously available, they may be used for ECG monitoring. This paper comments on the use of implantables and wearables for the detection of atrial fibrillation and the documentation of symptomatic arrhythmias in syncope or palpitations.


Assuntos
Próteses e Implantes , Dispositivos Eletrônicos Vestíveis , Fibrilação Atrial , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Síncope
12.
PLoS One ; 15(8): e0238139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845894

RESUMO

Inappropriate sinus tachycardia (IST) is a common disease of the autonomic nervous system in children and adults. Diagnosis and treatment of IST in adolescents is not well defined. In this retrospective study, we tested our hypothesis regarding autonomic dysfunction in childhood by analyzing 24-h heart rate variability (HRV) in 479 children, with a mean age of 13.7 ± 2.1 years, who were referred to the outpatient clinic in the Pediatrics Department within the last 15 years. Seventy-four adolescents with a mean 24-h heart rate ≥ 95 bpm (our cut-off for an IST based upon 66 healthy controls) were deemed to have IST. We found the risk of IST to be high in adolescents with attention deficit disorder (OR = 3.5,p<0.001), pre-hypertension (OR = 2.5, p = 0.043) and hypertension (OR = 2.1,p = 0.02); insignificantly enhanced in children with short stature (OR = 1.9,p = 0.19), surgically-treated congenital heart disease (OR = 1.4,p = 0.51) and obesity without hypertension (OR = 1.4;p = 0.25); and negligible in adolescents with anorexia nervosa (OR = 0.3, p = 0.26) and constitutional thinness (OR = 0.9,p = 0.89). IST was associated with a significant decrease in global HRV and elevated blood pressures, indicating an enhanced cardiovascular risk. Methylphenidate did not increase 24-h heart rates, whereas omega-3 fatty acid supplementation significantly decreased elevated heart rates and increased HRV in adolescents with IST. In this retrospective analysis, 15.4% of adolescents suffered from IST with a 24-h heart rate ≥ 95 bpm, predominately due to attention deficit disorder and hypertension.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Hipertensão/complicações , Obesidade/complicações , Taquicardia Sinusal/diagnóstico , Taquicardia Sinusal/fisiopatologia , Adolescente , Eletrocardiografia Ambulatorial , Ácidos Graxos Ômega-3/uso terapêutico , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Metilfenidato/uso terapêutico , Estudos Retrospectivos , Taquicardia Sinusal/terapia
13.
J Stroke Cerebrovasc Dis ; 29(9): 105032, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807444

RESUMO

BACKGROUND AND PURPOSE: Paroxysmal atrial fibrillation (PAF) has been suggested as a major cause of embolic stroke of undetermined source (ESUS). Transient atrial mechanical dysfunction (stunning) frequently occurs after conversion of atrial fibrillation to sinus rhythm. The study aim was to determine if reversible atrial mechanical dysfunction in ESUS could help elucidate the mechanism of stroke. METHODS: Eighty-five consecutive patients with acute ischemic stroke were enrolled according to the following inclusion criteria: [1] ≥55 years old; [2] normal sinus rhythm upon admission; [3] no apparent embolic source; and [4] transthoracic echocardiographic evaluation had been performed in both the early phase (<72 h) and late phase (>7 days) after stroke onset. There were 27 patients in the lacunar or atherothrombotic infarction group (controls), 22 in the PAF group, and 36 in the ESUS group. To determine atrial stunning, transmitral flow velocity profiles (Doppler peak E- [early diastolic] and A- [atrial systolic] waves) were obtained. RESULTS: In the early phase, an E/A velocity ratio ≥ 1.0 was less common in the control group (1 patient, 3.7%) than in the PAF group (19 patients, 86.4%; p < 0.001) and ESUS group (10 patients, 27.8%; p < 0.05). In the late phase, the E/A ratio decreased to less than 1.0 in six patients (31.6%) who had PAF and in eight patients (80.0%) who had ESUS. CONCLUSION: Transient atrial mechanical dysfunction could be a helpful finding for elucidating the stroke mechanism in patients with ESUS, and early echocardiographic assessment could improve its detection.


Assuntos
Fibrilação Atrial/complicações , Função do Átrio Esquerdo , Frequência Cardíaca , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Diagnóstico Precoce , Ecocardiografia Doppler , Eletrocardiografia Ambulatorial , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
14.
J Stroke Cerebrovasc Dis ; 29(9): 105046, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807456

RESUMO

BACKGROUND AND PURPOSE: Ischemic strokes (IS) occur also in young adults and despite an extensive work-up the cause of IS remains very often cryptogenic. Thus, effectiveness of secondary prevention may be unclear. We aimed to analyze a relationship among vascular risk factors (VRF), clinical and laboratory parameters, outcomes and recurrent IS (RIS) in young cryptogenic IS (CIS) patients. SUBJECTS AND METHODS: The study set consisted of young acute IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). All analyzed patients underwent transesophageal echocardiography, 24-h and 3-week ECG-Holter to assess cause of IS according to the ASCOD classification. Recurrent IS (RIS) was recorded during a follow-up (FUP). RESULTS: Out of 294 young enrolled patients, 208 (70.7%, 113 males, mean age 41.6 ± 7.2 years) were identified as cryptogenic. Hyperlipidemia (43.3%), smoking (40.6%) and arterial hypertension (37.0%) were the most frequent VRF. RIS occurred in 7 (3.4%) patients during a mean time of FUP 19 ± 23 months. One-year risk of RIS was 3.4% (95%CI: 1.4-6.8%). Patients with RIS were older (47.4 vs. 41.1 years, p = 0.007) and more often obese (71.4 vs. 19.7%, p = 0.006), and did not differ in any of other analyzed parameters and VRF. Multivariate logistic regression analysis showed obesity (OR: 9.527; 95%CI: 1.777-51.1) and the previous use of antiplatelets (OR: 15.68; 95%CI: 2.430-101.2) as predictors of recurrent IS. CONCLUSION: Despite a higher presence of VRF in young CIS patients, the risk of RIS was very low. Obesity and previous use of antiplatelet therapy were found the only predictors of RIS.


Assuntos
Isquemia Encefálica/diagnóstico , Ecocardiografia Transesofagiana , Eletrocardiografia Ambulatorial , Acidente Vascular Cerebral/diagnóstico , Adulto , Idade de Início , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo
15.
Am J Cardiol ; 129: 25-29, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32600783

RESUMO

Occult atrial fibrillation (AF) can be the underlying cause for cryptogenic stroke (CS). Implantable loop recorders (ILRs) have become an important tool for long-term arrhythmia monitoring in CS patients. Office-based ILR implantation by nonelectrophysiologist physicians is increasingly common. To report the real world diagnostic yield and accuracy of remote ILR monitoring in high risk CS patients, we retrospectively analyzed 145 consecutive patients with CS who underwent ILR implantation between October 2014 and October 2018 at New York University Langone Health. A certified device technician and an electrophysiologist adjudicated all transmissions. The yield and accuracy of Reveal LINQ Intra Cardiac Monitor (ICM), a fourth generation device, was compared to that of TruRhythm Detection algorithm (fifth generation device). AF was diagnosed in 17 patients (12%) over a mean follow-up of 28 ± 12 months. The median time to diagnosis was 7.4 ± 21.3 months. A total of 1,637 remote transmissions (scheduled- and auto-triggered alerts: 756; patient-triggered: 881) were adjudicated. The positive predictive value for AF episodes in the scheduled interrogations increased from 4% in the Reveal LINQ ICM to 16% in the TruRhythm LINQ. Of 881 patient-triggered transmissions, none were found to be true positive. In the Reveal LINQ ICM, for scheduled transmissions, primary causes of false positive (FP) were atrial ventricular premature complexes (80%). In the TruRhythm LINQ, for scheduled transmissions, primary cause of FP were T-wave over-sensing (87%). In conclusion, the real world diagnostic yield of ILR for patients with CS remains suboptimal, with at least 84% of AF alerts being FP. Patient-riggered events did not correlate with arrhythmia and the necessity of patient triggering in this population should be questioned. Expert interpretation of recordings is critical to assure accurate diagnosis.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Próteses e Implantes , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 99(28): e21190, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664162

RESUMO

The effects of thyrotropin (TSH) suppressive therapy on autonomic regulation and ventricular repolarization in patients with differentiated thyroid cancer (DTC) have not been elucidated. The aim of present study was to evaluate variation in heart rate variability (HRV) and QT dispersion after TSH suppressive therapy in patients with DTC.Cases, defined as 271 patients with DTC within 1 year of exogenous levothyroxine, and all patients underwent a full history, physical examination, including standard 12 lead electrocardiogram (ECG), and 24 h ambulatory ECG monitoring (Holter) with normal free thyroxine (FT4) and free triiodothyronine (FT3) with levothyroxine. To evaluate effects of TSH suppressive therapy on HRV and QT dispersion, patients were divided into three groups according to different levels of TSH: TSH < 0.1 mIU/L group and 0.1 ≤ TSH < 0.5 mIU/L group were as TSH suppression groups, and 0.5 ≤ TSH < 2.0 mIU/L group was as TSH replacement group.Comparing with 0.5 ≤ TSH < 2.0 mIU/L group, significant changes in both time and frequency domain of HRV and QT dispersion were observed in TSH < 0.1 mIU/L group (P < .001: SDNN, SDANN, HF, LF/HF, QTd, and QTcd; P < .05: rMSSD) and 0.1 ≤ TSH < 0.5 mIU/L group (P < .001: SDNN, HF, LF/HF, QTd, and QTcd), and especially were more pronounced in TSH < 0.1 mIU/L group. Moreover, we found that TSH level was proportional to SDNN (ß = 15.829, P < .001), but inversely proportional to LF/HF (ß = -0.671, P < .001), QTd (ß = -16.674, P < .001) and QTcd (ß = -18.314, P < .001) in DTC patients with exogenous levothyroxine.Compared with euthyroid state, patients with suppressed serum TSH have increased sympathetic activity in the presence of diminished vagal tone, ultimately showed sympathovagal imbalance and with an increased inhomogeneity of ventricular recovery times. These findings revealed that TSH suppression therapy had a significant impact on cardiovascular system and had certain guiding role in the treatment and management of patients with DTC.


Assuntos
Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Neoplasias da Glândula Tireoide/fisiopatologia , Tiroxina/efeitos adversos , Adulto , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tireotropina/sangue
17.
Medicine (Baltimore) ; 99(29): e21098, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702857

RESUMO

INTRODUCTION: Ventricular ectopic beats (VEBs) are very common and often occur in hypertensive or obese individuals, as well as in patients presenting with either sleep apnea or structural cardiac disease. Sympathetic overactivity plays a crucial role in the development, continuation, and exacerbation of ventricular arrhythmias. Recent studies have reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal denervation (RDN) in reducing the arrhythmic burden. PATIENT CONCERNS: We describe a 38-year-old female symptomatic patient that at the time of presentation was complaining of fatigue in response to minor and medium efforts and not tolerating any physical activity, and episodes of tachycardia associated with dyspnoea, pre-syncope, and syncope. DIAGNOSIS: She had a high incidence of polymorphic VEBs on 24-hour-Holter monitoring who also presented with left ventricular (LV) hypertrophy for which she was treated with bisoprolol 10 mg/d. The 24-hour-Holter on bisoprolol at baseline showed sinus rhythm with an average heart rate of 92 bpm. There were 44,743 isolated VEBs. A total of 2538 nonsustained ventricular tachycardia events were registered. Her cardiac magnetic resonance imaging showed an increase in LV diastolic diameter and impairment of the right ventricle. INTERVENTIONS: The patient underwent endocardial ablation of the right ventricular outflow tract and the LV free lateral wall, and concomitantly underwent bilateral RDN. OUTCOMES: Three months post-procedure, her 24-hour-Holter off medication demonstrated an average heart rate 72 bpm and a substantially reduced number of 2823 isolated monomorphic VEBs. Thus far, 18-months follow-up, she has been asymptomatic and doing physical exercises. CONCLUSION: In our current patient, we used RDN as a synergistic method to attenuate the sympathetic overactivity, which is narrowly linked to VEBs appearance. Our case report highlighted that RDN may become a potential adjuvant treatment for VEBs in the future.


Assuntos
Denervação/normas , Rim/fisiopatologia , Complexos Ventriculares Prematuros/terapia , Adulto , Denervação/métodos , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos
18.
Herzschrittmacherther Elektrophysiol ; 31(3): 254-259, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32725276

RESUMO

Implantable loop recorders are a diagnostic tool for detecting cardiac arrhythmias and are independent of the patient's compliance. Automatic algorithms lead to a preselection of arrhythmic events that are transferred by telemonitoring to the cardiac specialists. This article describes the available loop recorders on the market, the respective implantation techniques, the indication, and reimbursement.


Assuntos
Eletrocardiografia Ambulatorial , Síncope , Arritmias Cardíacas , Eletrocardiografia , Humanos , Próteses e Implantes
20.
Diving Hyperb Med ; 50(2): 157-163, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32557418

RESUMO

INTRODUCTION: Scuba diving likely has an impact on the autonomic nervous system (ANS). In the course of conducting trials of underwater ECG recording for measurement of heart rate variability, there was an unexpected stressful event; one participant's regulator iced and began to free-flow. METHODS: A custom-made, water- and pressure-tight aluminum housing was used to protect a portable Holter monitor. ECGs were recorded in three experienced divers who witnessed an unplanned moderately stressful incident during diving. The ECG signals were analysed for measures of heart rate variability (HRV). RESULTS: Analysis for different short-term HRV measures provided consistent results if periods of interest were appropriately time-aligned. There was improvement in sympatho-vagal balance. One diver unexpectedly exhibited an increase in both sympathetic and vagal activity shortly after the incident. CONCLUSIONS: A conventional open-water dive affected the ANS of experienced recreational divers as measured by HRV which provides a global evaluation of the ANS and alterations in its two branches. The heart rate variability data gathered from several participating divers around the time of this event illustrate the potential utility of this variable in quantifying stress during diving. HRV data may be useful in addressing relevant diving related questions such as effects of cold, exercise or different breathing gases on ANS function.


Assuntos
Mergulho , Frequência Cardíaca , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos
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