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1.
Med Clin North Am ; 103(5): 945-956, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378336

RESUMO

Cardiac defects are the most common congenital defects, accounting for approximately 9 per 1000 births. Patients with structural heart disease related to congenital diseases are prone to develop intrinsic rhythm abnormalities as a result of altered physiology. In addition, they are at an increased risk of developing acquired arrhythmias secondary to the nature of surgical interventions done to improve physiologic function in the setting of these defects. Arrhythmia management and risk stratification pose particularly complex challenges to clinicians managing this population.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Cardiopatias Congênitas/epidemiologia , Fibrilação Atrial/etiologia , Ablação por Cateter , Gerenciamento Clínico , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Marca-Passo Artificial
2.
High Blood Press Cardiovasc Prev ; 26(4): 339-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385256

RESUMO

INTRODUCTION: Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. AIM: To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. METHODS: In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. RESULTS: The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). CONCLUSIONS: Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.


Assuntos
Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/instrumentação , Serviços Comunitários de Farmácia , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
3.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(4): 521-530, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31441251

RESUMO

Atrial fibrillation (AF) is one of the most common arrhythmias, which does great harm to patients. Effective methods were urgently required to prevent the recurrence of AF. Four methods were used to analyze RR sequence in this paper, and differences between Pre-AF (preceding an episode of AF) and Normal period (far away from episodes of AF) were analyzed to find discriminative criterion. These methods are: power spectral analysis, approximate entropy (ApEn) and sample entropy (SpEn) analysis, recurrence analysis and time series symbolization. The RR sequence data used in this research were downloaded from the Paroxysmal Atrial Fibrillation Prediction Database. Supporting vector machine (SVM) classification was used to evaluate the methods by calculating sensitivity, specificity and accuracy rate. The results showed that the comprehensive utilization of recurrence analysis parameters reached the highest accuracy rate (95%); power spectrum analysis took second place (90%); while the results of entropy analyses and time sequence symbolization were not satisfactory, whose accuracy were both only 70%. In conclusion, the recurrence analysis and power spectrum could be adopted to evaluate the atrial chaotic state effectively, thus having certain reference value for prediction of AF recurrence.


Assuntos
Fibrilação Atrial/diagnóstico , Entropia , Átrios do Coração/fisiopatologia , Humanos , Recidiva , Sensibilidade e Especificidade , Máquina de Vetores de Suporte
5.
Angiology ; 70(10): 921-928, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31387358

RESUMO

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out "high risk" AMI population for more meticulous heart rate monitoring for NOAF.


Assuntos
Fibrilação Atrial/diagnóstico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Fatores de Risco
6.
Ther Adv Cardiovasc Dis ; 13: 1753944719860676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319783

RESUMO

BACKGROUND: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. METHODS: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). RESULTS: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1-2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03-76). At a median of 8.2 months (range 0-61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1-1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. CONCLUSION: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/etiologia , Técnicas de Apoio para a Decisão , Neoplasias/complicações , Acidente Vascular Cerebral/etiologia , Tromboembolia Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Ohio , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade
7.
J Stroke Cerebrovasc Dis ; 28(9): 2448-2452, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307898

RESUMO

BACKGROUND AND AIMS: Increasingly, insertable cardiac monitors (ICM) have been used to detect Atrial Fibrillation (AF) in patients with cryptogenic stroke or embolic strokes of undetermined source (ESUS). We aim to examine the characteristics of these patients who were subsequently found to have AF. METHODS: We studied 83 consecutive patients who were comprehensively evaluated using neuroimaging and vessel imaging (computed tomography angiography, magnetic resonance angiography, or transcranial and extracranial Doppler sonography) to have met the previously established ESUS criteria. All 83 patients had ICM implanted between 2015 and 2017. All patients were followed up for at least 1 year, with a median follow-up period of 1.5 ± .5 years. We compared the baseline clinical, laboratory, echocardiographic, neuro-imaging profiles, and clinical outcomes in terms of functional recovery, recurrent stroke, and mortality in patients with and without detected AF. RESULTS: AF detection rate in this ESUS cohort was 12% over the study period. Patients with detected AF were associated with bilateral infarcts pattern at presentation (30% versus 5.5%, P = .035). Infarcts involving multiple vascular territories was not significantly associated with the detection of AF. There were no significant differences in the other clinical characteristics and outcomes between the AF group compared to the group without detected AF. Echocardiographic parameters including left ventricular ejection fraction and left atrial diameter were also not shown to be significantly different. CONCLUSION: Our study found that a neuroimaging profile of bilateral infarcts was associated with AF detection using insertable cardiac monitor in ESUS patients. Larger prospective studies are needed to validate our findings.


Assuntos
Fibrilação Atrial/diagnóstico , Infarto Encefálico/epidemiologia , Frequência Cardíaca , Embolia Intracraniana/epidemiologia , Monitorização Ambulatorial/instrumentação , Telemetria/instrumentação , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/mortalidade , Infarto Encefálico/terapia , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/mortalidade , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Singapura/epidemiologia , Fatores de Tempo , Resultado do Tratamento
8.
High Blood Press Cardiovasc Prev ; 26(4): 331-337, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31309456

RESUMO

INTRODUCTION: We aimed to find new predictive parameters for atrial fibrillation (AF) onset in hypertensive patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA). METHODS: One hundred and eight patients with essential hypertension (HTN) were prospectively enrolled, from which 67 patients had no other important comorbidities (HTN group), while 41 patients had a recent AF episode, but were in sinus rhythm at the moment of enrollment (HTN and AF group). LA diameters and maximal volume, LV mass, LV ejection fraction and diastolic function were assessed through 2D conventional echocardiography. Moreover, peak longitudinal and contractile strain of LA walls (PALS and PACS, respectively) were analyzed by speckle tracking technique. Patients were followed up for 1 year and recurrent 24-h rhythm monitoring was done, in order to identify atrial fibrillation. RESULTS: Age and time from diagnosis of HTN were higher in HTN and AF group than in HTN group (68.02 ± 19 years versus 57.2 ± 1.52 years, p = 0.001 and 62.2 ± 9.2 months versus 40.4 ± 6.4 months, p = 0.04). All LA diameters and LA maximal volume were significantly larger in HTN and AF group (for LA antero-posterior diameter p = 0.02, for all the rest p < 0.0001). LV ejection fraction was preserved in both groups, being significantly lower in HTN and AF patients (58.44 ± 0.79 versus 60.75 ± 0.57, p = 0.02). LV mass was higher in HTN and AF group and these patients had also a more severe diastolic dysfunction, (E/A ratio 1.8 ± 0.51 versus 0.9 ± 0.02, p = 0.04) and lower septal and lateral A' velocities (p < 0.0001 and p = 0.002). The peak LA longitudinal and contractile strain values were also significantly lower in HTN and AF group versus HTN group (for all p < 0.0001). Among the echocardiographic parameters, we identified PALS and PACS as predictors for AF, with a good discriminating capacity (AUC = 0.88 for PALS and AUC = 0.86 for PACS). CONCLUSIONS: Compared to patients with isolated hypertension, patients with hypertension and AF display several echocardiographic differences. Among them, LA strain parameters could be useful predictors of AF occurrence in hypertensive patients.


Assuntos
Fibrilação Atrial/etiologia , Função do Átrio Esquerdo , Ecocardiografia Doppler de Pulso , Hipertensão Essencial/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fenômenos Biomecânicos , Eletrocardiografia Ambulatorial , Hipertensão Essencial/complicações , Hipertensão Essencial/fisiopatologia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
Int Heart J ; 60(4): 788-795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353344

RESUMO

Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Cardiomiopatias/complicações , Átrios do Coração/fisiopatologia , Sarcoidose/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter , Ecocardiografia , Eletrocardiografia Ambulatorial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia
10.
J Stroke Cerebrovasc Dis ; 28(9): 2363-2375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31281110

RESUMO

The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly. Consequently, VKAs have been underused in the elderly. Alternative anticoagulants may offer a safer choice, particularly in patients who have experienced previous stroke. The aim of this narrative review is to examine available evidence for the effective treatment of patients with AF and previous cerebral vascular events with non-VKA oral anticoagulants, including the most appropriate time to start or reinitiate treatment after a stroke, systemic embolism, or clinically relevant bleed. For patients with AF treated with oral anticoagulants it is important to balance increased protection against future stroke/systemic embolism and reduced risk of major bleeding events. For patients with AF who have previously experienced a cerebrovascular event, the use of oral anticoagulants alone also appears more effective than low-molecular weight heparin (LMWH) alone or LMWH followed by oral anticoagulants. Available data suggest that significant reduction in stroke, symptomatic cerebral bleeding, and major extracranial bleeding within 90 days from acute stroke can be achieved if oral anticoagulation is initiated at 4-14 days from stroke onset.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Prevenção Secundária/métodos , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Esquema de Medicação , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
11.
Ideggyogy Sz ; 72(5-6): 195-197, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31241264

RESUMO

Background and purpose: Population-based screening is an option to identify persons at high risk for stroke. However it is associated with rather high expenses, necessitating the selection of effective methods that take local characteristics into account. The 12th district of Budapest has a long tradition of population-based screening for frequent and preventable diseases. The Szent János Hospital hosts an annual stroke screening day. In the present study, previously published data from the 2011 screening were compared with those obtained in 2016, looking for changes and tendencies throughout the examined period. Methods: The screening day was conducted in a generally similar way in 2011 and 2016. Similarly to the previous event, the program was organized on a Saturday, the call for the event was spread by the local newspaper. The crew composition was the same. As regards the components of the screening (currently including general history taking, risk status assessment, blood pressure measurement, BMI assessment, cholesterol and blood glucose tests, carotid duplex ultrasonography, and ophthalmological examination), the only difference was the absence of cardiologic examination (it was conducted on an independent day). The anonymous data sheet was the same. Results: The number of participants in the 2016 event was 33, to provide more comfortable conditions. The female predominance was slightly less pronounced but was still present in 2016 (60.6% vs. 72.9%). The mean age became substantially higher (71.2 y vs. 62.9 y). The ratios of participants with higher level of education (97% vs. 94%) and those who are married were still remarkable. The most frequent risk factors were the same; however the ratio of participants with hypertension, 'other heart disease', and diabetes increased, whereas that of with hyperlipidemia and obesity decreased. The incidence of atrial fibrillation was unaltered. None of the participants in 2016 admitted smoking (previously this ratio was 20.8%) or drinking heavily. The findings of the carotid ultrasonography revealed a more favorable vascular status. Ophthalmological assessments (predominantly hypertensive alterations on fundoscopy) revealed that the pathological vs. physiological ratio switched to 1:2 from 2:1. The final evaluation of the screening program likewise demonstrated an improved overall state of health of the population. Conclusion: We observed a more favorable stroke risk status of the population in 2016. Whether it is indeed a tendency unknown at present. The role of the local media in calling for screening is still decisive, and the cohesive power of the family is important.


Assuntos
Fibrilação Atrial/diagnóstico , Estenose das Carótidas/diagnóstico , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/epidemiologia , Pressão Sanguínea , Feminino , Humanos , Hungria/epidemiologia , Hipertensão/epidemiologia , Programas de Rastreamento/economia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
12.
Clin Interv Aging ; 14: 879-887, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190774

RESUMO

Purpose: Atrial fibrillation (AF) is an increasingly common rhythm disorder and an important risk factor of ischemic stroke, heart failure, hospitalization, and cardiovascular mortality. Its diagnosis, however, is often delayed because of silent character of the arrhythmia. The aim of the study was to identify independent determinants of AF in patients of the geriatric ward, so as to be able to propose a strategy for screening of this arrhythmia. Methods: Cross-sectional cohort study of patients admitted to the department of geriatrics was conducted. The prevalence of AF and its health correlates (including AF recognized risk factors) was assessed. Relative risks were calculated and multivariable logistic regression analysis model was built. The predictive performance was evaluated using receiver-operating characteristic (ROC) curve analysis. Results: There were 416 patients hospitalized in the study period and 98 (23.6%) presented with AF. The independent predictors with top 3 strongest association with AF were congestive heart failure (OR 5.43; 95%CI 3.14-9.39; P<0.001), age of 75+years (OR 4.0; 95% CI 1.43-11.2; P=0.008), and previous history of stroke or transient ischemic attack (OR 2.1; 95% CI 1.06-4.13; P=0.03). ROC analysis showed CHA2DS2-VASc scale significance as a screening tool for AF (ROC-AUC 0.75; 0.7-0.8; P<0.001), with the value of 4 or more as the best cut-off point. Conclusions: Based on CHA2DS2-VASc score the intensity of surveillance for AF at a primary prevention population level could be probably guided, but it requires further research.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Avaliação Geriátrica/métodos , Fatores Etários , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Ataque Isquêmico Transitório/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
13.
Stud Health Technol Inform ; 261: 266-273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156128

RESUMO

PROBLEM: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia. It constitutes one of the leading cardiovascular health problems, affecting 33.5 million people of the world's population. AF detection is commonly made by an Electrocardiogram (EEG). Nevertheless, with the advances in biomedical sensors, innovative approaches have emerged on detecting AF based on the analysis of signals acquired by photoplethysmography (PPG) sensors. OBJECTIVE: This paper aims to provide a systematic review to determine the features that have been used to detect Atrial Fibrillation in PPG signals. METHODS: A systematic review of six databases (Pubmed, Science Direct, Scopus, IEEE Xplore, Engineering Village y Mendeley) was carried out following the PRISMA-DTA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses on Diagnostic Test Accuracy). RESULTS: This article provides an analysis of the features extracted for the detection of Atrial Fibrillation in photoplethysmography signals from 16 studies. It was found 44 features: 29 were extracted from the signal analyzed in the time domain, 12 from the signal analyzed in the frequency domain, and 3 from the signal analyzed in the time-frequency domain. CONCLUSIONS: The systematic review allowed obtaining the features reported in the literature with higher performance in the detection of AF in terms of sensitivity, specificity, and accuracy. It was possible to observe a clear tendency to analyze the PPG signal in the time domain, although some studies have obtained better performance in the classification of AF when analyzing features in the frequency and time-frequency domains.


Assuntos
Fibrilação Atrial , Fotopletismografia , Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos , Sensibilidade e Especificidade
14.
J Stroke Cerebrovasc Dis ; 28(9): 2569-2573, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31230824

RESUMO

BACKGROUND: Detection and treatment of atrial fibrillation (AF) is a major goal in preventing secondary stroke. Insertable cardiac monitors (ICMs) are available for diagnosis of arrhythmia monitoring in patients with cryptogenic stroke. Magnetic resonance imaging (MRI)-based diagnostic evaluation for acute ischemic stroke subtype classification is common in Japan and can be useful for specific diagnosis of cryptogenic stroke. PURPOSE: We aimed to investigate the detection rate of AF with an ICM in patients with cryptogenic stroke who were diagnosed by MRI. METHODS: We performed a retrospective, multicenter, observational study. AF monitoring data of an ICM (Reveal LINQ) in patients with cryptogenic stroke were registered from 5 stroke centers in Japan between October 2016 and March 2018. ICM candidates in cryptogenic stroke were diagnosed by MRI-based evaluation and selected according to the criteria proposed by the Japan Stroke Society. Detection of AF was defined as AF for longer than 120 seconds. RESULTS: Eighty-four consecutive patients (64 men; aged 38-90 years) underwent ICM implantation after diagnosis of cryptogenic stroke. AF was detected in 22 of 84 (26.2%) patients with an ICM during a median follow-up of 221.5 days (range: 93-365 days). The detection rate of AF within 3 months after ICM implantation was 21.4%. CONCLUSIONS: The AF detection rate with an ICM is approximately one fifth within 3 months in patients with cryptogenic stroke as diagnosed by MRI. Our data suggest that the Japanese criteria based on MRI may be useful for selecting adequate candidates for ICM implantation.


Assuntos
Fibrilação Atrial/diagnóstico , Frequência Cardíaca , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Telemetria/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Tomada de Decisão Clínica , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo
15.
Angiology ; 70(10): 916-920, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220924

RESUMO

We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group (P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.


Assuntos
Fibrilação Atrial/complicações , Embolia/prevenção & controle , Ataque Isquêmico Transitório/prevenção & controle , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
17.
Pediatr Cardiol ; 40(5): 1009-1016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31062060

RESUMO

Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Ablação por Cateter/efeitos adversos , Tetralogia de Fallot/mortalidade , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
18.
J Stroke Cerebrovasc Dis ; 28(8): 2159-2167, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103554

RESUMO

BACKGROUND: Patients with cerebral microbleeds have increased risk of intracranial hemorrhage and ischemic stroke. No trial specifically informs antithrombotic therapy for patients with cerebral microbleeds and atrial fibrillation. We investigated the safety of anticoagulation versus no anticoagulation with regard to cerebrovascular outcomes and mortality. METHODS: All consecutive atrial fibrillation patients from 2015 to 2018 with MRI evidence of ≥1 cerebral microbleed at time of imaging were reviewed. Patients were treated with warfarin, direct oral anticoagulants, or neither. Primary outcome was all-cause mortality informed by National Death Registry and the composite of ischemic and hemorrhagic stroke. All statistical tests were 2-sided and significant at P < .05. RESULTS: The median interval from patient identification until the end of electronic health record surveillance was 9.93 months (interquartile range, 2.83-19.17 months). We identified 308 atrial fibrillation patients with cerebral microbleeds; 128(41.6%) were on warfarin, 88(28.6%) on direct oral anticoagulants, and 92(29.9%) on neither. Over the surveillance interval, 87 deaths, 51 ischemic strokes, and 14 hemorrhagic strokes occurred. The estimated likelihoods of the composite stroke outcome and ischemic stroke only did not differ significantly among the 3 groups. However, patients taking direct oral anticoagulants had a significantly smaller likelihood of all-cause mortality than patients who were not anticoagulated (adjusted hazard ratio: .44[.23, .83], P=.012). CONCLUSIONS: In patients with coprevalent atrial fibrillation and cerebral microbleeds, we did not detect differences in subsequent ischemic stroke, hemorrhagic stroke, or both, comparing warfarin, direct oral anticoagulants, or neither. Patients treated with direct oral anticoagulants had better survival than nonanticoagulated patients.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/prevenção & controle , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Tomada de Decisão Clínica , Registros Eletrônicos de Saúde , Feminino , Florida/epidemiologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
19.
Aust N Z J Public Health ; 43(4): 313-318, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31141280

RESUMO

OBJECTIVE: Examine the feasibility and acceptability of an electrocardiogram (ECG) attached to a mobile phone (iECG) screening device for atrial fibrillation (AF) in Aboriginal Controlled Community Health Services (ACCHS) and other community settings. METHODS: Semi-structured interviews were conducted with ACCHS staff in urban, rural and remote communities in three Australian states/territories. Quantitative and qualitative questions identified the enabling factors and barriers for staff and Aboriginal patients' receptiveness to the device. Mean quantitative scores and their standard deviation were calculated in Microsoft Excel and qualitative questions were thematically analysed. RESULTS: Eighteen interviews were conducted with 23 staff across 11 ACCHS. Quantitative data found staff were confident in providing iECG screening and managing the referral pathway, and thought the process was beneficial for patients. Qualitative data highlighted the usefulness of the device to undertake opportunistic screening and acceptability in routine practice, and provided opportunities to engage patients in education around AF. CONCLUSION: The iECG device was well accepted within ACCHSs and was feasible to use to screen for AF among Aboriginal patients. Implications for public health: The device can be used in clinical and community settings to screen Aboriginal people for atrial fibrillation to help reduce rates of stroke and other cardiovascular diseases.


Assuntos
Fibrilação Atrial/diagnóstico , Telefone Celular , Eletrocardiografia/instrumentação , Programas de Rastreamento/métodos , Aplicativos Móveis , Grupo com Ancestrais Oceânicos , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Austrália , Eletrocardiografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Atenção Primária à Saúde , Pesquisa Qualitativa , Saúde da População Rural , População Rural , População Urbana
20.
Expert Rev Med Devices ; 16(6): 503-514, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31095424

RESUMO

Background: This study was conducted to verify if automated oscillometric blood pressure monitors (AOBPMs) have sufficiently high predictive validity to screen patients with atrial fibrillation (AF). Methods: Electronic searches were performed to identify all studies published between 1946 and 14 July 2018, from indexed in Ovid-Medline, Embase, the Cochrane Library, and CINAHL by using the following keywords: 'atrial fibrillation,' 'atrial flutter,' 'blood pressure monitor,' and 'sphygmomanometer.' Results: Thirteen diagnostic accuracy studies, including a total of 9,380 elderly, were included in our meta-analysis. The meta-analysis showed that the pooled sensitivity was 0.91 (95% CI, 0.89 to 0.93), and the heterogeneity between studies was as high as 88.4% (X2 = 120.55, p < 0.001). The pooled specificity was 0.96 (95% CI, 0.96 to 0.97), and the heterogeneity between studies was 95.3% (X2 = 299.26, p < .001). The area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was 0.98 (SE = 0.005), and the Q-value was 0.94 (SE = 0.010). Conclusion: The AOBPM is an appropriate screening tool that may be applied to elderly to verify the presence of AF conveniently. The AOBPM has high applicability in practice, since it may prevent potentially fatal complications such as stroke.


Assuntos
Fibrilação Atrial/diagnóstico , Monitores de Pressão Arterial , Programas de Rastreamento , Oscilometria , Automação , Humanos , Viés de Publicação
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