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1.
BMJ Case Rep ; 14(9)2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521742

RESUMO

We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease-cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.


Assuntos
Fibrilação Atrial , Doenças dos Nervos Cranianos , Hiponatremia , Síndrome de Secreção Inadequada de HAD , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Humanos , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/diagnóstico , Masculino
2.
Sensors (Basel) ; 21(16)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34450743

RESUMO

Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia and is often associated with other cardiovascular and cerebrovascular diseases, such as ischemic heart disease, chronic heart failure, and stroke. Automatic detection of AF by analyzing electrocardiogram (ECG) signals has an important application value. Using the contaminated and actual ECG signals, it is not enough to only analyze the atrial activity of disappeared P wave and appeared F wave in the TQ segment. Moreover, the best analysis method is to combine nonlinear features analyzing ventricular activity based on the detection of R peak. In this paper, to utilize the information of the P-QRS-T waveform generated by atrial and ventricular activity, frequency slice wavelet transform (FSWT) is adopted to conduct time-frequency analysis on short-term ECG segments from the MIT-BIH Atrial Fibrillation Database. The two-dimensional time-frequency matrices are obtained. Furthermore, an average sliding window is used to convert the two-dimensional time-frequency matrices to the one-dimensional feature vectors, which are classified using five machine learning (ML) techniques. The experimental results show that the classification performance of the Gaussian-kernel support vector machine (GKSVM) based on the Bayesian optimizer is better. The accuracy of the training set and validation set are 100% and 93.4%. The accuracy, sensitivity, and specificity of the test set without training are 98.15%, 96.43%, and 100%, respectively. Compared with previous research results, our proposed FSWT-GKSVM model shows stability and robustness, and it could achieve the purpose of automatic detection of AF.


Assuntos
Fibrilação Atrial , Análise de Ondaletas , Algoritmos , Fibrilação Atrial/diagnóstico , Teorema de Bayes , Eletrocardiografia , Humanos , Aprendizado de Máquina
3.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 38(4): 686-694, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34459168

RESUMO

Atrial fibrillation (AF) is a common arrhythmia, which can lead to thrombosis and increase the risk of a stroke or even death. In order to meet the need for a low false-negative rate (FNR) of the screening test in clinical application, a convolutional neural network with a low false-negative rate (LFNR-CNN) was proposed. Regularization coefficients were added to the cross-entropy loss function which could make the cost of positive and negative samples different, and the penalty for false negatives could be increased during network training. The inter-patient clinical database of 21 077 patients (CD-21077) collected from the large general hospital was used to verify the effectiveness of the proposed method. For the convolutional neural network (CNN) with the same structure, the improved loss function could reduce the FNR from 2.22% to 0.97% compared with the traditional cross-entropy loss function. The selected regularization coefficient could increase the sensitivity (SE) from 97.78% to 98.35%, and the accuracy (ACC) was 96.62%, which was an increase from 96.49%. The proposed algorithm can reduce the FNR without losing ACC, and reduce the possibility of missed diagnosis to avoid missing the best treatment period. Meanwhile, it provides a universal loss function for the clinical auxiliary diagnosis of other diseases.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos , Redes Neurais de Computação
4.
Rev Port Cardiol (Engl Ed) ; 40(8): 595-605, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392904

RESUMO

Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure. The authors review AF epidemiologic data, the importance of new tools for early AF detection, the current role of catheter ablation for rhythm control in AF, the state-of-the-art in periprocedural OAC, the optimal management of major bleeding, the causes of residual premature death and future strategies for improvements in AF prognosis.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Adulto , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Humanos , Portugal/epidemiologia , Prognóstico
5.
Cardiovasc Diabetol ; 20(1): 162, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348706

RESUMO

In a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Hipertensão , Isquemia Miocárdica , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco
6.
JAMA Netw Open ; 4(8): e2121867, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34448866

RESUMO

Importance: Postoperative atrial fibrillation (POAF) occurring after cardiac surgery is associated with adverse outcomes. Whether POAF persists beyond discharge is not well defined. Objective: To determine whether continuous cardiac rhythm monitoring enhances detection of POAF among cardiac surgical patients during the first 30 days after hospital discharge compared with usual care. Design, Setting, and Participants: This study is an investigator-initiated, open-label, multicenter, randomized clinical trial conducted at 10 Canadian centers. Enrollment spanned from March 2017 to March 2020, with follow-up through September 11, 2020. As a result of the COVID-19 pandemic, enrollment stopped on July 17, 2020, at which point 85% of the proposed sample size was enrolled. Cardiac surgical patients with CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex) score greater than or equal to 4 or greater than or equal to 2 with risk factors for POAF, no history of preoperative AF, and POAF lasting less than 24 hours during hospitalization were enrolled. Interventions: The intervention group underwent continuous cardiac rhythm monitoring with wearable, patch-based monitors for 30 days after randomization. Monitoring was not mandated in the usual care group within 30 days after randomization. Main Outcomes and Measures: The primary outcome was cumulative AF and/or atrial flutter lasting 6 minutes or longer detected by continuous cardiac rhythm monitoring or by a 12-lead electrocardiogram within 30 days of randomization. Prespecified secondary outcomes included cumulative AF lasting 6 hours or longer and 24 hours or longer within 30 days of randomization, death, myocardial infarction, ischemic stroke, non-central nervous system thromboembolism, major bleeding, and oral anticoagulation prescription. Results: Of the 336 patients randomized (163 patients in the intervention group and 173 patients in the usual care group; mean [SD] age, 67.4 [8.1] years; 73 women [21.7%]; median [interquartile range] CHA2DS2-VASc score, 4.0 [3.0-4.0] points), 307 (91.4%) completed the trial. In the intent-to-treat analysis, the primary end point occurred in 32 patients (19.6%) in the intervention group vs 3 patients (1.7%) in the usual care group (absolute difference, 17.9%; 95% CI, 11.5%-24.3%; P < .001). AF lasting 6 hours or longer was detected in 14 patients (8.6%) in the intervention group vs 0 patients in the usual care group (absolute difference, 8.6%; 95% CI, 4.3%-12.9%; P < .001). Conclusions and Relevance: In post-cardiac surgical patients at high risk of stroke, no preoperative AF history, and AF lasting less than 24 hours during hospitalization, continuous monitoring revealed a significant increase in the rate of POAF after discharge that would otherwise not be detected by usual care. Studies are needed to examine whether these patients will benefit from oral anticoagulation therapy. Trial Registration: ClinicalTrials.gov Identifier: NCT02793895.


Assuntos
Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Eletrocardiografia Ambulatorial/métodos , Programas de Rastreamento/métodos , Alta do Paciente , Complicações Pós-Operatórias/diagnóstico , Idoso , Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , COVID-19 , Canadá , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/cirurgia , Eletrocardiografia , Feminino , Hemorragia , Hospitalização , Humanos , Análise de Intenção de Tratamento , Ataque Isquêmico Transitório , Masculino , Pandemias , Fatores de Risco , Acidente Vascular Cerebral , Tromboembolia
8.
Cardiol J ; 28(5): 758-766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34382204

RESUMO

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases - especially ones as common as atrial fibrillation (AF) - and the possible interactions between patients' chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.


Assuntos
Fibrilação Atrial , COVID-19 , Acidente Vascular Cerebral , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Vacinas contra COVID-19 , Heparina , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pandemias , SARS-CoV-2 , Vitamina K
9.
Trials ; 22(1): 576, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454591

RESUMO

BACKGROUND: Although catheter ablation is an effective therapy for atrial fibrillation (AF), the most common cardiac arrhythmia encountered in clinical practice, AF ablation generates inflammation and oxidative stress in the early postoperative period predisposing to recurrence of AF. Isolevuglandins (IsoLGs) are reactive lipid mediators of oxidative stress injury that rapidly react with endogenous biomolecules to compromise their function. 2-Hydroxybenzylamine (2-HOBA), a potent small molecule scavenger of IsoLGs, sequesters the reactive species as inert adducts. This mechanism, coupled with reported safety in humans, supports the investigation of 2-HOBA as a novel therapeutic to reduce AF caused by oxidative stress, such as that which occurs after catheter ablation. Accordingly, we seek to test the hypothesis that treatment with 2-HOBA will decrease early recurrence of AF and other atrial arrhythmias following AF ablation by decreasing IsoLG adducts with native biomolecules. METHODS: The proposed trial will randomly assign 162 participants undergoing cryo- or radiofrequency catheter ablation for AF to 2-HOBA (N = 81) or placebo (N = 81). Individuals will begin the study drug 3 days prior to ablation and continue for 28 days. Participants will be given a wearable smartwatch capable of detecting and recording atrial arrhythmias. They will be instructed to record ECGs daily with additional ECGs if they experience symptoms of AF or when alerted by the smartwatch AF detection alarm. The primary clinical endpoint will be an episode of AF, atrial tachycardia, or atrial flutter lasting 30 s or more within 28 days post-AF ablation. Secondary measures will be the change in IsoLG adduct levels from blood samples collected immediately pre-ablation and post-ablation and reduction in AF burden as calculated from the smartwatch. DISCUSSION: The proposed trial will test the hypothesis that 2-HOBA reduces post-ablation atrial arrhythmias through sequestration of reactive IsoLG species. The results of this study may improve the understanding of the role of IsoLGs and oxidative stress in AF pathogenesis and provide evidence to advance 2-HOBA and related compounds as a new therapeutic strategy to treat AF. TRIAL REGISTRATION: ClinicalTrials.gov NCT04433091 . Registered on June 3, 2020.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Preparações Farmacêuticas , Dispositivos Eletrônicos Vestíveis , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/prevenção & controle , Fibrilação Atrial/cirurgia , Benzilaminas , Ablação por Cateter/efeitos adversos , Humanos , Recidiva Local de Neoplasia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Kardiologiia ; 61(7): 44-54, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397341

RESUMO

Aim    To study the role of blood concentration of growth differentiation factor 15 (GDF-15) as a predictor of left atrial/left atrial appendage (LA/LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF).Material and methods    538 patients with nonvalvular AF were admitted to the Tyumen Cardiology Research Center in 2019-2020 for radiofrequency ablation and elective cardioversion. According to findings of transesophageal echocardiography (EcoCG), 42 (7.8%) of these patients had LA/LAA thrombosis and 79 (14.7%) of them had the effect of spontaneous echo contrast (SEC). This comparative, cross-sectional, cohort study included at the initial stage 158 successively hospitalized patients with nonvalvular AF: group 1 (with LA/LAA thrombosis, n=42) and group 2 (without LA/LAA thrombosis and without SEC, n=116). To eliminate significant differences in age between the groups, an additional inclusion criterium was introduced, age from 45 to 75 years. Finally, 144 patients were included into the study: group 1 (with LA/LAA thrombosis, n=42, mean age 60.9±7.2 years) and group 2 (without LA/LAA thrombosis and without SEC, n=116, mean age 59.5±6.0 years). 93 (91%) patients in group 1 and 40 (95%) patients in group 2 had arterial hypertension (p=0.4168); 53 (52%) and 29 (^(%), respectively, had ischemic heart disease (p=0.0611). The groups did not differ in sex, profile of major cardiovascular diseases, or frequency and range of oral anticoagulant treatment. General clinical evaluation, EchoCG, and laboratory tests, including measurements of blood concentrations of GDF-15 and NT-proBNP, were performed.Results    In the group with LA/LAA thrombosis, 1) persistent AF prevailed whereas paroxysmal AF was more frequently observed in patients without thrombosis; 2) a tendency toward more pronounced chronic heart failure was observed; 3) tendencies toward a high median CHA2DS2­VASc score and toward a greater proportion of patients with scores ≥3 were observed. According to EchoCG findings, group 1 had higher values of sizes and volumes of both atria and the right ventricle, left ventricular (LV) end-systolic volume and size, pulmonary artery systolic blood pressure, and LV myocardial mass index. LV ejection fraction (EF) was in the normal range in both groups but it was significantly lower for patients with LA/LAA thrombosis, 59.1±5.1 and 64.0±7.3, respectively (p=0.00006). Concentrations of GDF-15 (p=0.00025) and NT-proBNP were significantly higher in group 1 than in group 2 (p=0.000001). After determining the threshold values for both biomarkers using the ROC analysis, two independent predictors of LA/LAA thrombosis were obtained by the stepwise multiple regression analysis: GDF-15 >935.0 pg/ml (OR=4.132, 95 % CI 1.305-13.084) and LV EF (OR=0.859, 95 % CI 0.776-0.951). The ROC analysis assessed the model quality as good: AUC=0.776 (p<0.001), sensitivity 78.3 %, specificity 78.3 %.Conclusion    For patients with nonvalvular AF, both increased GDF-15 (>935.0 pg/ml) and LV EF are independent predictors for LA/LAA thrombosis.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Fator 15 de Diferenciação de Crescimento/sangue , Trombose , Idoso , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/patologia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Estudos de Coortes , Estudos Transversais , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Trombose/diagnóstico , Trombose/etiologia
11.
Trials ; 22(1): 531, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380542

RESUMO

BACKGROUND: Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) was a pragmatic, cluster randomized trial assessing the effectiveness of a clinical decision support (CDS) tool in primary care, Nova Scotia, Canada. We evaluated if CDS software versus Usual Care could help primary care providers (PCPs) deliver individualized guideline-based AF patient care. METHODS: Key study challenges including CDS development and implementation, recruitment, and data integration documented over the trial duration are presented as lessons learned. RESULTS: Adequate resources must be allocated for software development, updates and feasibility testing. Development took longer than projected. End-user feedback suggested network access and broadband speeds impeded uptake; they felt further that the CDS was not sufficiently user-friendly or efficient in supporting AF care (i.e., repetitive alerts). Integration across e-platforms is crucial. Intellectual property and other issues prohibited CDS integration within electronic medical records and provincial e-health platforms. Double login and data entry were impediments to participation or reasons for provider withdrawal. Data integration challenges prevented easy and timely data access, analysis, and reporting. Primary care study recruitment is resource intensive. Altogether, 203 PCPs and 1145 of their patients participated, representing 25% of eligible providers and 12% of AF patients in Nova Scotia, respectively. The most effective provider recruitment strategy was in-office, small group lunch-and-learns. PCPs with past research experience or who led patient consent were top recruiters. The study office played a pivotal role in achieving patient recruitment targets. CONCLUSIONS: A rapid growth in healthcare data is leading to widespread development of CDS. Our experience found practical issues to address for such applications to succeed. Feasibility testing to assess the utility of any healthcare CDS prior to implementation is recommended. Adequate resources are necessary to support successful recruitment for future pragmatic trials. CDS tools that integrate multiple co-morbid guidelines across eHealth platforms should be pursued. TRIAL REGISTRATION: ClinicalTrials.gov NCT01927367. Registered on August 22, 2013.


Assuntos
Fibrilação Atrial , Sistemas de Apoio a Decisões Clínicas , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Registros Eletrônicos de Saúde , Humanos , Seleção de Pacientes , Atenção Primária à Saúde
12.
Sensors (Basel) ; 21(15)2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34372459

RESUMO

Atrial fibrillation (AF) is the most common cardiovascular disease (CVD), and most existing algorithms are usually designed for the diagnosis (i.e., feature classification) or prediction of AF. Artificial intelligence (AI) algorithms integrate the diagnosis of AF electrocardiogram (ECG) and predict the possibility that AF will occur in the future. In this paper, we utilized the MIT-BIH AF Database (AFDB), which is composed of data from normal people and patients with AF and onset characteristics, and the AFPDB database (i.e., PAF Prediction Challenge Database), which consists of data from patients with Paroxysmal AF (PAF; the records contain the ECG preceding an episode of PAF), and subjects who do not have documented AF. We extracted the respective characteristics of the databases and used them in modeling diagnosis and prediction. In the aspect of model construction, we regarded diagnosis and prediction as two classification problems, adopted the traditional support vector machine (SVM) algorithm, and combined them. The improved quantum particle swarm optimization support vector machine (IQPSO-SVM) algorithm was used to speed the training time. During the verification process, the clinical FZU-FPH database created by Fuzhou University and Fujian Provincial Hospital was used for hybrid model testing. The data were obtained from the Holter monitor of the hospital and encrypted. We proposed an algorithm for transforming the PDF ECG waveform images of hospital examination reports into digital data. For the diagnosis model and prediction model trained using the training set of the AFDB and AFPDB databases, the sensitivity, specificity, and accuracy measures were 99.2% and 99.2%, 99.2% and 93.3%, and 91.7% and 92.5% for the test set of the AFDB and AFPDB databases, respectively. Moreover, the sensitivity, specificity, and accuracy were 94.2%, 79.7%, and 87.0%, respectively, when tested using the FZU-FPH database with 138 samples of the ECG composed of two labels. The composite classification and prediction model using a new water-fall ensemble method had a total accuracy of approximately 91% for the test set of the FZU-FPH database with 80 samples with 120 segments of ECG with three labels.


Assuntos
Fibrilação Atrial , Máquina de Vetores de Suporte , Algoritmos , Inteligência Artificial , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos
13.
Trials ; 22(1): 525, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372905

RESUMO

BACKGROUND: Atrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation. METHODS/DESIGN: This cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study. We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation. DISCUSSION: Smartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines. TRIAL REGISTRATION: ClinicalTrials.gov NCT04545723 . Registered on September 10, 2020.


Assuntos
Fibrilação Atrial , Aplicativos Móveis , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Prog Cardiovasc Dis ; 66: 80-85, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332663

RESUMO

Atrial Fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF) frequently coexist, resulting in significant morbidity and mortality. Therapeutic options for patients with AF and HFrEF are limited due to few antiarrhythmic drug (AAD) choices and historically equivocal effects of procedural interventions on mortality. However, recent randomized trials examining catheter ablation (CA) in AF patients with HFrEF have shown a beneficial effect on arrhythmic burden and HF symptoms, as well as an improvement in mortality. This review focuses on the role of CA for AF patients with HFrEF.


Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter , Insuficiência Cardíaca/fisiopatologia , Potenciais de Ação , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Frequência Cardíaca , Humanos , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
15.
Prog Cardiovasc Dis ; 66: 86-91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332664

RESUMO

This article reviews and compares the rationale and evidence supporting high-power, short-duration radiofrequency (RF) ablation with those of conventional-power, conventional-duration RF ablation for atrial fibrillation (AF). The pros and cons of each approach, biophysics of ablation, pre-clinical studies informing clinical utilization, and the accumulated clinical evidence are presented. Both conventional-power, conventional-duration RF ablation and high-power, short-duration ablation are similarly safe, and effective approaches for AF ablation. Theoretical advantages of high-power, short-duration ablation, including greater procedure efficiency and limited conductive heating of collateral structures, must be weighed against the narrower safety margin related to rapid energy delivery during high power ablation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Veias Pulmonares/cirurgia , Potenciais de Ação , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Tomada de Decisão Clínica , Frequência Cardíaca , Humanos , Veias Pulmonares/fisiopatologia , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Prog Cardiovasc Dis ; 66: 92-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332665

RESUMO

Stroke is a major driver of increased morbidity and mortality in patients with non-valvular atrial fibrillation (NVAF). While systemic oral anticoagulation (OAC) continues to be the mainstay for stroke reduction therapy in patients with NVAF, several barriers prevent the sustained long-term use of OAC, including increased risk of bleeding, non-compliance, cost, drug-drug interactions, and the need for ongoing laboratory testing. Given the need for continued stroke reduction therapies in patients who are intolerant of or non-compliant with OAC, percutaneous left atrial appendage (LAA) occlusion (LAAO) has emerged as a nonpharmacologic alternative to OAC. The development of percutaneous LAAO techniques is based on data suggesting that more than 90% of thrombi in patients with NVAF originate in the LAA. Two percutaneous LAAO devices are currently in widespread clinical use: Watchman (United States and Europe) and the Amplatzer type of devices (Europe); randomized trial data exist only for the Watchman device. Multiple randomized and nonrandomized trials and registries have demonstrated the safety and effectiveness of LAAO in patients who are suitable for short-term anticoagulation using a variety of post-procedural antithrombotic strategies. Ongoing randomized clinical trials on LAAO are focused on OAC-ineligible patients to compare efficacy of LAAO devices against a multitude of antithrombotic options. This review aims to discuss the rationale and evidence for LAAO and post procedural antithrombotic strategies and opportunities for research examination. In addition, we discuss the need for continued investigation of LAAO in populations not well represented in clinical trials or registries, including women, older patients, and underrepresented racial and ethnic groups.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cateterismo Cardíaco/instrumentação , Fibrinolíticos/uso terapêutico , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Tomada de Decisão Clínica , Fibrinolíticos/efeitos adversos , Humanos , Seleção de Pacientes , Desenho de Prótese , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
18.
Ther Umsch ; 78(6): 313-319, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291659

RESUMO

Atrial fibrillation and ischaemic stroke: current treatment and personalized risk prediction of intracerebral haemorrhage Abstract. Atrial fibrillation is a major cause of stroke. Management of patients with atrial fibrillation and stroke is challenging. In this review article, based on the most recent scientific literature, the following questions are discussed: 1) When is the optimal point in time to start anticoagulation after a recent stroke? 2) How to treat patients with atrial fibrillation that have a stroke despite anticoagulant therapy? 3) What is the added value of MRI for personalized risk-prediction of intracerebral hemorrhage? 4) How to treat patients with atrial fibrillation after intracerebral hemorrhage? We provide recommendations for daily clinical management.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/diagnóstico , Hemorragia Cerebral , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle
19.
BMC Med Inform Decis Mak ; 21(1): 216, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261486

RESUMO

BACKGROUND: Generalization model capacity of deep learning (DL) approach for atrial fibrillation (AF) detection remains lacking. It can be seen from previous researches, the DL model formation used only a single frequency sampling of the specific device. Besides, each electrocardiogram (ECG) acquisition dataset produces a different length and sampling frequency to ensure sufficient precision of the R-R intervals to determine the heart rate variability (HRV). An accurate HRV is the gold standard for predicting the AF condition; therefore, a current challenge is to determine whether a DL approach can be used to analyze raw ECG data in a broad range of devices. This paper demonstrates powerful results for end-to-end implementation of AF detection based on a convolutional neural network (AFibNet). The method used a single learning system without considering the variety of signal lengths and frequency samplings. For implementation, the AFibNet is processed with a computational cloud-based DL approach. This study utilized a one-dimension convolutional neural networks (1D-CNNs) model for 11,842 subjects. It was trained and validated with 8232 records based on three datasets and tested with 3610 records based on eight datasets. The predicted results, when compared with the diagnosis results indicated by human practitioners, showed a 99.80% accuracy, sensitivity, and specificity. RESULT: Meanwhile, when tested using unseen data, the AF detection reaches 98.94% accuracy, 98.97% sensitivity, and 98.97% specificity at a sample period of 0.02 seconds using the DL Cloud System. To improve the confidence of the AFibNet model, it also validated with 18 arrhythmias condition defined as Non-AF-class. Thus, the data is increased from 11,842 to 26,349 instances for three-class, i.e., Normal sinus (N), AF and Non-AF. The result found 96.36% accuracy, 93.65% sensitivity, and 96.92% specificity. CONCLUSION: These findings demonstrate that the proposed approach can use unknown data to derive feature maps and reliably detect the AF periods. We have found that our cloud-DL system is suitable for practical deployment.


Assuntos
Fibrilação Atrial , Algoritmos , Fibrilação Atrial/diagnóstico , Terapia Comportamental , Eletrocardiografia , Frequência Cardíaca , Humanos , Redes Neurais de Computação
20.
J Stroke Cerebrovasc Dis ; 30(9): 105998, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303963

RESUMO

OBJECTIVES: Embolic strokes of unknown source (ESUS) are common and often suspected to be caused by unrecognized paroxysmal atrial fibrillation (AF). An AI-enabled ECG (AI-ECG) during sinus rhythm has been shown to identify patients with unrecognized AF. We pursued this study to determine if the AI-ECG model differentiates between patients with ESUS and those with known causes of stroke, and to evaluate whether the AF prediction by AI-ECG among patients with ESUS was associated with the results of prolonged ambulatory cardiac rhythm monitoring. MATERIALS AND METHODS: We reviewed consecutive patients admitted with acute ischemic stroke to a comprehensive stroke center between January 2018 and August 2019 and employed the TOAST classification to categorize the mechanisms of ischemia. Use and results of ambulatory cardiac rhythm monitoring after discharge were gathered. We ran the AI-ECG model to obtain AF probabilities from all ECGs acquired during the hospitalization and compared those probabilities in patients with ESUS versus those with known stroke causes (apart from AF), and between patients with and without AF detected by ambulatory cardiac rhythm monitoring. RESULTS: The study cohort had 930 patients, including 263 patients (28.3%) with known AF or AF diagnosed during the index hospitalization and 265 cases (28.5%) categorized as ESUS. Ambulatory cardiac rhythm monitoring was performed in 226 (85.3%) patients with ESUS. AF probability by AI-ECG was not associated with ESUS. However, among patients with ESUS, the probability of AF by AI-ECG was associated with a higher likelihood of AF detection by ambulatory monitoring (P = 0.004). A probability of AF by AI-ECG greater than 0.20 was associated with AF detection by ambulatory cardiac rhythm monitoring with an OR of 5.47 (95% CI 1.51-22.51). CONCLUSIONS: AI-ECG may help guide the use of prolonged ambulatory cardiac rhythm monitoring in patients with ESUS to identify those who might benefit from anticoagulation.


Assuntos
Inteligência Artificial , Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial , AVC Embólico/etiologia , Processamento de Sinais Assistido por Computador , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , AVC Embólico/diagnóstico por imagem , Feminino , Frequência Cardíaca , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo
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