Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.712
Filtrar
1.
Kardiologiia ; 60(8): 90-97, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155964

RESUMO

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40-49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Cardioversão Elétrica , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/cirurgia , Fibrilação Atrial/terapia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
2.
Rev Med Liege ; 75(11): 706-710, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155443

RESUMO

The 2020 recommendations of the European Society of Cardiology have been enriched on the basis of numerous data published over the past 4 years. They emphasize the importance of a comprehensive management of the arrhythmia and give an increasingly prominent place to treatment by ablation. In this article, we summarize all the new recommendations.


Assuntos
Fibrilação Atrial , Cardiologia , Fibrilação Atrial/terapia , Humanos
3.
Ther Umsch ; 77(8): 385-389, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054647

RESUMO

Arrhythmia as an Incidental Finding Abstract. An arrhythmic pulse can be determined using clinical or technical examinations such as palpitation and ECG. Due to the rapid spread of wearables, more and more people have the opportunity to derive pulse curves or even ECGs themselves before seeking professional medical care, which increases the number of randomly detected arrhythmic pulse. Incidental findings naturally lead to relevant diagnoses in some of the people affected, but on the other hand they are also psychologically stressful for some individuals. Therefore, it is important to differentiate frequently found common benign causes from the causes with therapeutic consequence and to adequately inform patients about their rhythm. In particular bradyarrhythmias often have no therapeutic consequence as long as the patient remains asymptomatic. Pacemakers are usually only indicated for symptomatic bradycardia. Atrial fibrillation deserves special attention due to its frequency and the fact that, if undetected, this is associated with significantly increased morbidity and mortality. Supraventricular and ventricular extrasystoles increase with age. They are often "idiopathic", but they also can be an expression of still subclinical heart disease.


Assuntos
Fibrilação Atrial , Achados Incidentais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Eletrocardiografia , Humanos
4.
JAMA ; 324(16): 1620-1628, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33107945

RESUMO

Importance: Catheter ablation of persistent atrial fibrillation (AF) has limited success. Procedural strategies beyond pulmonary vein isolation have failed to consistently improve results. The vein of Marshall contains innervation and AF triggers that can be ablated by retrograde ethanol infusion. Objective: To determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation. Design, Setting, and Participants: The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an investigator-initiated, National Institutes of Health-funded, randomized, single-blinded trial conducted in 12 centers in the United States. Patients (N = 350) with persistent AF referred for first ablation were enrolled from October 2013 through June 2018. Follow-up concluded in June 2019. Interventions: Patients were randomly assigned to catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures. Main Outcomes and Measures: The primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was blinded to randomization treatment. There were 12 secondary outcomes, including AF burden, freedom from AF after multiple procedures, perimitral block, and others. Results: Of the 343 randomized patients (mean [SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial. Vein of Marshall ethanol was successfully delivered in 155 of 185 patients. At 6 and 12 months, the proportion of patients with freedom from AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the catheter ablation combined with vein of Marshall ethanol infusion group compared with 38% (60/158) in the catheter ablation alone group (difference, 11.2% [95% CI, 0.8%-21.7%]; P = .04). Of the 12 secondary outcomes, 9 were not significantly different, but AF burden (zero burden in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P = .01), freedom from AF after multiple procedures (65.2% vs 53.8%; difference, 11.4% [95% CI, 0.6%-22.2%]; P = .04), and success achieving perimitral block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P < .001) were significantly improved in vein of Marshall-treated patients. Adverse events were similar between groups. Conclusions and Relevance: Among patients with persistent AF, addition of vein of Marshall ethanol infusion to catheter ablation, compared with catheter ablation alone, increased the likelihood of remaining free of AF or atrial tachycardia at 6 and 12 months. Further research is needed to assess longer-term efficacy. Trial Registration: ClinicalTrials.gov Identifier: NCT01898221.


Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Etanol/administração & dosagem , Veia Cava Superior , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/métodos , Estimativa de Kaplan-Meier , Masculino , Método Simples-Cego , Taquicardia/terapia , Resultado do Tratamento , Veia Cava Superior/embriologia , Veia Cava Superior/inervação
7.
Medicine (Baltimore) ; 99(33): e21097, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871980

RESUMO

INTRODUCTION: Substantial advances in cardiac pacing technology have been developed in the past decades. However, efforts to improve pacing technology to achieve physiological electrical activity, such as with cardiac resynchronization therapy, are underway. Permanent His bundle pacing, which directly stimulates the His-Purkinje network and electrically activates both ventricles, simulates physiological electric activity in the heart, and has been considered an ideal pacing strategy to treat arrhythmias. For patients with atrial fibrillation complicated by third-degree atrioventricular block (AVB), permanent His bundle pacing is a better option than conventional right ventricular apical or septal pacing, the latter of which may be associated with risks, such as heart failure. However, His bundle pacing exhibits some shortcomings, including elevated pacing threshold, dislocation, and abnormal sensing. CASE PRESENTATION: A 69-year-old female patient who had atrial fibrillation (AF) complicated by third-degree AVB and who was treated with permanent His bundle pacing combined with left bundle branch pacing. DIAGNOSIS: AF complicated by third-degree AVB. INTERVENTIONS: We used the left bundle branch as a backup pacing site to overcome any shortcomings related to permanent His bundle pacing. OUTCOMES: The patient recovered well without any events. CONCLUSION: We selected His bundle pacing as the primary pacing, but also used left bundle branch pacing as a backup approach. If His bundle pacing results in an increased sensing threshold, pacing threshold changes, or dislocations, left bundle branch pacing can compensate for dysfunction of permanent deficiencies in His bundle pacing, preserving physiological pacing.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Terapia de Ressincronização Cardíaca/métodos , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Feminino , Humanos
11.
Am J Cardiol ; 131: 27-32, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32753268

RESUMO

It is unclear if patients with paroxysmal atrial fibrillation (AF) and persistent AF have different outcomes following electrical cardioversion (ECV). ENSURE-AF-a multicenter, prospective, randomized, open-label, blinded-endpoint evaluation trial-compared once-daily edoxaban 60 mg with enoxaparin-warfarin in 2,199 subjects undergoing ECV of nonvalvular AF (NCT02072434). Patients received ≥3 weeks of proper anticoagulation or transesophageal echocardiogram before ECV paroxysmal AF was defined as AF with spontaneous conversion of duration of <7 days; persistent AF was defined as AF lasting ≥7 days without spontaneous conversion. Clinical characteristics and outcomes were compared between subjects based on type of AF present at baseline. In total, 415 subjects had paroxysmal AF; 1,777 had persistent AF. Patients with paroxysmal AF were older (65.8 ± 10.3 vs 63.9 ± 10.5, p = 0.001) with more hypertension (82.7% vs 77.2%, p = 0.01) versus persistent AF patients. Congestive heart failure was more common in persistent AF (46.7%) versus paroxysmal AF (31.3%, p <0.0001). CHA2DS2-VASc (score >2: 52.0% vs 49.5%, p = 0.4375) and prior myocardial infarction (6.5% vs 6.8%, p = 0.91) did not significantly differ between groups. After ECV, primary endpoint events were numerically higher in paroxysmal AF versus persistent AF (1.5% vs 0.6%, p = 0.0571), approaching statistical significance. Of note, myocardial infarction was observed in paroxysmal AF (n = 4 vs 0), whereas persistent AF was accompanied by stroke (n = 0 vs 5; p <0.05). In conclusion, patients with paroxysmal AF had more frequent major cardiovascular events than patients with persistent AF. Composite event rates were driven mainly by myocardial infarction in patients with paroxysmal AF and by stroke in those with persistent AF. Overall, the absolute number of events was low after ECV under anticoagulation.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Cardioversão Elétrica , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
12.
J Stroke Cerebrovasc Dis ; 29(9): 105014, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807429

RESUMO

INTRODUCTION: Early detection of atrial fibrillation (AF) after stroke is essential to achieve timely initiation of appropriate prophylactic treatment. We aimed to assess the diagnostic value of using prehospital continuous ECG (cECG) for AF detection after acute stroke. PATIENTS AND METHODS: In this retrospective cohort study, we included AF naïve ischemic stroke patients of 50 years or older. Medical records and corresponding digital prehospital cECGs were systematically reviewed. The proportion of AF detectable by prehospital cECG, in-hospital 12-lead ECG, telemetry and outpatient cECG was determined. McNemar's chi-squared test was used to compare probability of AF on prehospital cECG vs. in-hospital 12-lead ECG. RESULTS: In 500 included patients, a new onset AF was detectable by prehospital cECG in 27 patients (5.4% [95% CI 3.6-7.8]). In-hospital 12-lead ECG detected AF in 28 of 458 patients (6.1% [95% CI 4.1-8.7). Sixty-two (12.4% [95% CI 9.6-15.6]) were diagnosed with new onset AF by either prehospital cECG, in-hospital 12-lead ECG, in-hospital telemetry or outpatient cECG. Thus, 43.5% of all AF cases were detectable during prehospital transport. The probability of AF did not differ between prehospital cECG and in-hospital 12-lead ECG. Nevertheless, a lack in overlapping diagnoses meant number needed to screening with prehospital cECG was 16 for diagnosing one AF case not detected by in-hospital 12-lead ECG. CONCLUSION: Using prehospital cECG as an addition to very early AF evaluation after acute stroke had diagnostic value and could represent a low cost and easily accessible opportunity for very early AF detection. This may improve post-stroke care and save resources for further unnecessary AF screening. Conducting routine prehospital cECG after acute stroke and ensuring this is available to clinicians is encouraged.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Serviços Médicos de Emergência , Frequência Cardíaca , Acidente Vascular Cerebral/etiologia , Telemetria , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo
13.
Am J Emerg Med ; 38(9): 1807-1815, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32738474

RESUMO

INTRODUCTION AND METHODS: Early and accurate risk stratification of patients with atrial fibrillation (AF) in the emergency department (ED) could aid the physician in determining a timely treatment strategy appropriate to the severity of disease. We conducted a retrospective review of 243 adult patients who presented to a tertiary ED with AF in 2017. Primary outcome studied was 30-day adverse event (a composite outcome of repeat visit to the ED, cardiovascular complications, and all-cause mortality). Secondary outcome studied was 90-day all-cause mortality. We compared the performance of the RED-AF, AFTER and CHA2DS2-VASc score by plotting receiver operating characteristic (ROC) curves and estimating the areas under curves (AUC), and assessed the potential to further improve the tools with their incorporation of new variables. RESULTS: Existing scoring tools had poor predictive value for 30-day adverse events, with the RED-AF score performing comparatively better, followed by the AFTER and CHA2DS2-VASc score. All scores performed collectively better to predict 90-day mortality, with the AFTER score performing the best, followed by the RED-AF and CHA2DS2-VASc score. By incorporating heart rate at initial presentation to the ED as a variable into the AFTER Score, we generated a Modified AFTER Score with superior predictive performance above existing scores for 90-day mortality. CONCLUSION: Existing scores collectively performed poorly to predict 30-day adverse outcomes, but the AFTER and Modified AFTER score showed good predictive value for 90-day mortality. Further studies should be done to validate their use in guiding clinician's disposition of patients with AF in the ED.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Serviço Hospitalar de Emergência , Medição de Risco/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
14.
Am J Cardiol ; 128: 12-15, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650904

RESUMO

Although atrial fibrillation (AF) is strongly associated with stroke, previous studies have shown suboptimal use of anticoagulation (AC). In particular, there is a lack of data on the long-term use of AC after AF catheter ablation. We followed up patients 1 to 5 years out from catheter ablation at the Johns Hopkins Hospital (JHH) to assess their long-term use of AC. We sent a survey to patients from the JHH AF database who underwent an AF catheter ablation between 01/01/2014 and 03/31/2018. Patients were asked whether they were still on AC, if they thought the ablation was successful in controlling AF symptoms and whether they had follow-up rhythm monitoring. Replies were compared with risk scores and demographic data from the electronic medical record. We sent the survey to 628 patients in the database meeting our inclusion criteria, and we received 289 responses. The average age of patients was 67 ± 10 with a median CHA2DS2-VASc of 2 and a median follow-up of 3.6 years. Overall, 81.6% of patients with a CHA2DS2-VASc >2 reported taking AC. Use of AC was positively correlated with a higher CHA2DS2-VASc score (p = 0.012) and older age (p = 0.028), but negatively correlated with a successful ablation (p = 0.040). The most common reason (50.0%) for not being on AC was that doctors were recommending stopping it after a successful ablation. In general, higher risk patients (older, higher CHA2DS2-VASC score) were more likely to remain on AC. However, patients who self-reported a successful ablation were less likely to remain on AC. There may be many patients who can tolerate AC, but are recommended to stop due to a successful ablation. It is still debated how successful AF ablation affects stroke risk. In conclusion, there is considerable variation in the long-term management of AC after an ablation, but for the present, it seems prudent to continue AC based on stroke risk scores until more definite data are available.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Desprescrições , Acidente Vascular Cerebral/prevenção & controle , Idoso , Fibrilação Atrial/complicações , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
15.
Am J Cardiol ; 128: 84-91, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650929

RESUMO

Valvular atrial fibrillation (AF) is defined as AF in the presence of mitral stenosis or mechanical valve prosthesis. However, there are patients with AF who have significant native valvular heart disease (VHD) others than mitral stenosis that are classified as nonvalvular AF. The characteristics and prognostic implications of these entities have not been extensively studied. Of 1,885 AF patients referred for electrical cardioversion (64 ± 13years, 71% male), 171 (9.1%) had valvular AF (any grade of mitral stenosis or mechanical/biological valve prostheses) and 1,714 patients were identified as nonvalvular AF, of whom 329 (17.5%) had significant left-sided VHD. Patients with nonvalvular AF but with significant left-sided VHD were older, more frequently women and had more co-morbidities compared with the other groups. Furthermore, nonvalvular AF patients with significant left-sided VHD showed the worst left ventricular systolic function and largest left atrial volumes. During a median follow-up of 64 months (interquartile range: 33 to 96 months), 488 patients presented with the combined endpoint of all-cause mortality, heart failure hospitalization, and ischemic stroke. Patients with nonvalvular AF and with significant left-sided VHD had more events of heart failure whereas patients with valvular AF had higher all-cause mortality events. There were no differences in ischemic stroke events. Type of AF was not associated with outcomes after correcting for echocardiographic variables. In conclusion, the frequency of AF patients with significant VHD is relatively high. The consequences of VHD and AF on cardiac structure and function are more important determinants of adverse outcome than the type of AF.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Fibrilação Atrial/epidemiologia , Insuficiência da Valva Mitral/epidemiologia , Distribuição por Idade , Idoso , Anticoagulantes/uso terapêutico , Insuficiência da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Isquemia Encefálica/epidemiologia , Anuloplastia da Valva Cardíaca/estatística & dados numéricos , Causas de Morte , Ecocardiografia , Cardioversão Elétrica , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Mortalidade , Prognóstico , Encaminhamento e Consulta , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
16.
PLoS Med ; 17(7): e1003146, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32673305

RESUMO

BACKGROUND: Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. METHODS AND FINDINGS: We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. CONCLUSIONS: We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/epidemiologia , China/epidemiologia , Centros Comunitários de Saúde , Estudos Transversais , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Varfarina/administração & dosagem , Varfarina/uso terapêutico
17.
Am Heart J ; 226: 152-160, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32580074

RESUMO

It is assumed that electrical cardioversion (ECV) improves the quality of life (QoL) of patients with atrial fibrillation (AF) by restoring sinus rhythm (SR). OBJECTIVE: We examined the effect of ECV and rhythm status on QoL of patients with symptomatic persistent AF in a randomized controlled trial. METHOD: The elective cardioversion for prevention of symptomatic atrial fibrillation trial examined the efficacy of dronedarone around the time of ECV in maintaining SR. Quality of life was measured with the University of Toronto Atrial Fibrillation Severity Scale. The primary outcome was the change in AF symptom severity (∆AFSS) score over 6 months (0-35 points, with higher scores reflecting worse QoL and a minimal clinically important difference defined as ∆AFSS ≥3 points). Multivariable linear regression was performed to identify factors associated with changes in QoL. RESULTS: We included 148 patients with complete AFSS scores at baseline and 6 months. Over 6 months, QoL improved irrespective of rhythm status (ΔAFSS scores for patients who (i) maintained SR; (ii) had AF relapse after successful ECV; and (iii) had unsuccessful ECV were -6.8 ±â€¯6.4 points, -4.1 ±â€¯6.2 points, and -4.0 ±â€¯5.8 points respectively, P < .01 for all subgroups). After adjustment of baseline covariates, maintenance of SR was associated with QoL improvement (ΔAFSS: -3.8 points, 95% CI: -6.0 to -1.6 points, P < .01). CONCLUSIONS: Maintenance of SR was associated with clinically relevant improvement in patients' QoL at 6 months. Patients with AF recurrence had a small but still relevant improvement in their QoL, potentially due to factors other than sinus rhythm.


Assuntos
Fibrilação Atrial/terapia , Cardioversão Elétrica , Qualidade de Vida , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Fatores de Tempo , Resultado do Tratamento
19.
Circ Arrhythm Electrophysiol ; 13(7): e007588, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32538131

RESUMO

BACKGROUND: Scientific research on atrial fibrosis in atrial fibrillation (AF) has mainly focused on quantitative or molecular features. The purpose of this study was to perform a clinicoarchitectural/structural investigation of fibrosis to provide one key to understanding the electrophysiological/clinical aspects of AF. METHODS: We characterized the fibrosis (amount, architecture, cellular components, and ultrastructure) in left atrial biopsies from 121 patients with persistent/long-lasting persistent AF (group 1; 59 males; 60±11 years; 91 mitral disease-related AF, 30 nonmitral disease-related AF) and from 39 patients in sinus rhythm with mitral valve regurgitation (group 2; 32 males; 59±12 years). Ten autopsy hearts served as controls. RESULTS: Qualitatively, the fibrosis exhibited the same characteristics in all cases and displayed particular architectural scenarios (which we arbitrarily subdivided into 4 stages) ranging from isolated foci to confluent sclerotic areas. The percentage of fibrosis was larger and at a more advanced stage in group 1 versus group 2 and, within group 1, in patients with rheumatic disease versus nonrheumatic cases. In patients with AF with mitral disease and no rheumatic disease, the percentage of fibrosis and the fibrosis stages correlated with both left atrial volume index and AF duration. The fibrotic areas mainly consisted of type I collagen with only a minor cellular component (especially fibroblasts/myofibroblasts; average value range 69-150 cells/mm2, depending on the areas in AF biopsies). A few fibrocytes-circulating and bone marrow-derived mesenchymal cells-were also detectable. The fibrosis-entrapped cardiomyocytes showed sarcolemmal damage and connexin 43 redistribution/internalization. CONCLUSIONS: Atrial fibrosis is an evolving and inhomogeneous histological/architectural change that progresses through different stages ranging from isolated foci to confluent sclerotic zones which-seemingly-constrain impulse conduction across restricted regions of electrotonically coupled cardiomyocytes. The fibrotic areas mainly consist of type I collagen extracellular matrix and, only to a lesser extent, mesenchymal cells.


Assuntos
Fibrilação Atrial/patologia , Átrios do Coração/patologia , Doenças das Valvas Cardíacas/patologia , Miocárdio/patologia , Cardiopatia Reumática/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/metabolismo , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Função do Átrio Esquerdo , Remodelamento Atrial , Biópsia , Colágeno Tipo I/análise , Conexina 43/análise , Feminino , Fibrose , Átrios do Coração/química , Átrios do Coração/fisiopatologia , Doenças das Valvas Cardíacas/metabolismo , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/química , Estudos Retrospectivos , Cardiopatia Reumática/metabolismo , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/terapia
20.
J Am Heart Assoc ; 9(14): e017529, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32515253

RESUMO

Atrial fibrillation is a common clinical manifestation in hospitalized patients with coronavirus disease 2019 (COVID-19). Medications used to treat atrial fibrillation, such as antiarrhythmic drugs and anticoagulants, may have significant drug interactions with emerging COVID-19 treatments. Common unintended nontherapeutic target effects of COVID-19 treatment include potassium channel blockade, cytochrome P 450 isoenzyme inhibition or activation, and P-glycoprotein inhibition. Drug-drug interactions with antiarrhythmic drugs and anticoagulants in these patients may lead to significant bradycardia, ventricular arrhythmias, or severe bleeding. It is important for clinicians to be aware of these interactions, drug metabolism changes, and clinical consequences when choosing antiarrhythmic drugs and anticoagulants for COVID-19 patients with atrial fibrillation. The objective of this review is to provide a practical guide for clinicians who are managing COVID-19 patients with concomitant atrial fibrillation.


Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Fibrilação Atrial/terapia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Antiarrítmicos/efeitos adversos , Antiarrítmicos/farmacocinética , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacocinética , Antivirais/efeitos adversos , Antivirais/farmacocinética , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Interações Medicamentosas , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA