RESUMO
BACKGROUND: In this study, the prognostic value of AF-related quality of life (AFEQT) at baseline on Major Adverse Cardiovascular Events (MACE) and improvement of perceived symptoms (EHRA) was assessed. Furthermore, the relationship between QoL and AF-related hospitalizations was assessed. METHODS: A cohort of AF-patients diagnosed between November 2014 and October 2019 in four hospitals embedded within the Netherlands Heart Network were prospectively followed for 12 months. MACE was defined as stroke, myocardial infarction, heart failure and/or mortality. Subsequently, MACE, EHRA score improvement and AF-related hospitalizations between baseline and 12 months of follow-up were recorded. RESULTS: In total, 970 AF-patients were available for analysis. In analyses with patients with complete information on the confounder subset 36/687 (5.2%) AF-patients developed MACE, 190/432 (44.0%) improved in EHRA score and 189/510(37.1%) were hospitalized during 12 months of follow-up. Patients with a low AFEQT score at baseline more often developed MACE (OR(95%CI): 2.42(1.16-5.06)), more often improved in EHRA score (OR(95%CI): 4.55(2.45-8.44) and were more often hospitalized (OR(95%CI): 4.04(2.22-7.01)) during 12 months post diagnosis, compared to patients with a high AFEQT score at baseline. CONCLUSIONS: AF-patients with a lower quality of life at diagnosis more often develop MACE, more often improve on their symptoms and also were more often hospitalized, compared to AF-patients with a higher quality of life. This study highlights that the integration of patient-reported outcomes, such as quality of life, has the potential to be used as a prognostic indicator of the expected disease course for AF.
Assuntos
Fibrilação Atrial , Humanos , Qualidade de Vida , Prognóstico , Pacientes , Progressão da DoençaRESUMO
BACKGROUND: Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. METHODS: In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow-up data were collected for patients who developed persistent PNP. RESULTS: Overall, the mean age was 62 ± 10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203 (113-351) and 184 (82-359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery. CONCLUSION: After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Paralisia/etiologia , Nervo Frênico , Veias Pulmonares/cirurgia , Resultado do TratamentoRESUMO
AIMS: This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation. METHODS AND RESULTS: We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality. CONCLUSION: Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.
Assuntos
Desfibriladores Implantáveis , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Estudos de Coortes , Morte Súbita Cardíaca/prevenção & controle , Humanos , Prevenção Primária , Fatores de RiscoRESUMO
UNLABELLED: The Web-based distress management program for patients with an implantable cardioverter-defibrillator (ICD; WEBCARE) was developed to mitigate distress and enhance health-related quality of life in ICD patients. This study investigated the treatment effectiveness at 3-month follow-up for generic and disease-specific outcome measures. METHODS: Consecutive patients implanted with a first-time ICD from six hospitals in the Netherlands were randomized to either the "WEBCARE" or the "usual care" group. Patients in the WEBCARE group received a 12-week fixed, six-lesson behavioral treatment based on the problem-solving principles of cognitive behavioral therapy. RESULTS: Two hundred eighty-nine patients (85% response rate) were randomized. The prevalence of anxiety and depression ranged between 11% and 30% and 13% and 21%, respectively. No significant intervention effects were observed for anxiety (ß = 0.35; p = .32), depression (ß = -0.01; p = .98) or health-related quality of life (Mental Component Scale: ß = 0.19; p = .86; Physical Component Scale: ß = 0.58; p = .60) at 3 months, with effect sizes (Cohen d) being small (range, 0.06-0.13). There were also no significant group differences as measured with the disease-specific measures device acceptance (ß = -0.37; p = .82), shock anxiety (ß = 0.21; p = .70), and ICD-related concerns (ß = -0.08; p = .90). No differences between treatment completers and noncompleters were observed on any of the measures. CONCLUSIONS: In this Web-based intervention trial, no significant intervention effects on anxiety, depression, health-related quality of life, device acceptance, shock anxiety, or ICD-related concerns were observed. A more patient tailored approach targeting the needs of different subsets of ICD patients may be warranted. TRIAL REGISTRATION: clinicaltrials.gov. Identifier: NCT00895700.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Desfibriladores Implantáveis/psicologia , Estresse Psicológico/prevenção & controle , Telemedicina/métodos , Ansiedade/epidemiologia , Ansiedade/terapia , Depressão/epidemiologia , Depressão/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Little is known about the course of emotional and physical distress in patients with an implantable cardioverter defibrillator (ICD). PURPOSE: We examined (1) trajectories of emotional and physical distress in the first 18 months postimplantation and (2) predictors of these trajectories, including demographical, clinical, and personality factors. METHODS: Dutch patients with an ICD (N = 645) completed measures on anxiety, depression, somatic symptoms, and perceived disability at the time of implantation, and 2, 12, and 18 months postimplantation. Measures on Type D personality (tendency to inhibit the expression of negative emotions) and anxiety sensitivity (tendency to fear anxiety-related sensations) were also completed at baseline. RESULTS: Latent class analysis (LatentGOLD) identified six to seven distinct trajectories, varying largely in overall levels of distress, and remaining relatively stable after a small initial decline. Multinomial regression showed that Type D personality and anxiety sensitivity were the most prominent predictors, particularly of trajectories that reflected higher distress levels. Cardiac resynchronization therapy and coronary artery disease also increased the risk for distress, whereas ICD indication and shocks did not. CONCLUSIONS: The course of emotional and physical distress may be relatively stable after ICD implantation. In clinical practice, identification of patients with high risk of higher levels of emotional and physical distress may be warranted; as such, patients with high levels of anxiety sensitivity or a Type D personality should be identified and offered behavioral support.
Assuntos
Ansiedade/psicologia , Doença das Coronárias/psicologia , Desfibriladores Implantáveis/psicologia , Depressão/psicologia , Estresse Fisiológico/fisiologia , Estresse Psicológico/psicologia , Idoso , Ansiedade/diagnóstico , Doença das Coronárias/terapia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Percepção , Implantação de Prótese/psicologia , Fatores de Risco , Personalidade Tipo DRESUMO
OBJECTIVE: A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation. METHODS: A total of 1012 patients completed the state version of the State-Trait Anxiety Inventory at baseline. The end points were ventricular arrhythmias and mortality the first year after ICD implantation. RESULTS: Within the first year after ICD implantation, 19% of patients experienced a ventricular arrhythmia, and 4% died. Anxiety was associated with an increased risk of ventricular arrhythmias (hazard ratio [HR] = 1.017; 95% confidence interval [CI] = 1.005-1.028; p = .005) and mortality (HR = 1.038; 95% CI = 1.014-1.063; p = .002) in adjusted analysis. Patients with anxiety (highest tertile) had a 1.9 increased risk for ventricular arrhythmias (95% CI = 1.329-2.753; p =.001) and a 2.9 increased risk for mortality (95% CI = 1.269-6.677; p = .01) compared with patients with low anxiety (lowest tertile). Among 257 patients with cardiac resynchronization therapy, anxiety was associated with mortality (HR = 5.381; 95% CI = 1.254-23.092; p = .02) after adjusting for demographic and clinical covariates. CONCLUSIONS: Anxiety was associated with an increased risk of ventricular arrhythmias and mortality 1 year after ICD implantation, independent of demographic and clinical covariates. Monitoring and treatment of anxiety may be warranted in a selected subgroup of high-risk patients with an ICD.
Assuntos
Ansiedade/mortalidade , Desfibriladores Implantáveis/psicologia , Taquicardia Ventricular/mortalidade , Fibrilação Ventricular/mortalidade , Idoso , Ansiedade/psicologia , Terapia de Ressincronização Cardíaca/mortalidade , Terapia de Ressincronização Cardíaca/psicologia , Causas de Morte , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Personalidade , Modelos de Riscos Proporcionais , Índice de Gravidade de Doença , Taquicardia Ventricular/psicologia , Fibrilação Ventricular/psicologiaRESUMO
BACKGROUND: In this study, the relationship between AF-related quality of life (AFEQT) at baseline in AF-patients and the improvement on perceived symptoms and general state of health (EHRA, European Heart Rhythm Association score) at 12 months was assessed across predefined age categories. METHODS: Between November 2014 and October 2019 patients diagnosed with AF de novo in four hospitals embedded within the Netherlands Heart Network were prospectively followed for 12 months. These AF-patients were categorized into quartiles based on their AFEQT score at diagnosis and EHRA score was measured at diagnosis and 12 months of follow-up. Stratified analyses were performed using age categories (<65 vs. ≥65 years; <75 vs. ≥75 years). RESULTS: In total, 203/483 (42.0%) AF-patients improved in EHRA score after 12 months of follow-up. AF-patients in the lowest AFEQT quartile were more likely to improve, compared to patients in the highest AFEQT quartile (OR [95%CI]:4.73 [2.63-8.50]). Furthermore, patients ≥65 years and patients <75 years at diagnosis with lower AFEQT scores at baseline were most likely to improve in EHRA score after 12 months, compared to similarly aged patients with higher AFEQT scores at baseline. CONCLUSION: The present study indicates that AF-patients with a lower quality of life at diagnosis were most likely to improve their EHRA score after 12 months. This effect was most prominent in patients ≥65 years of age and patients <75 years of age, compared to patients >65 and ≥75 years, respectively. Future research should focus on further defining characteristics of these age groups to enable the implementation of age-tailored treatment.
RESUMO
AIMS: A paucity of studies in implantable cardioverter-defibrillator (ICD) patients has examined gender disparities in patient-reported outcomes, such as anxiety and quality of life (QoL). We investigated (i) gender disparities in anxiety and QoL and (ii) the magnitude of the effect of gender vs. New York Heart Association (NYHA) functional class (III/IV), ICD shock, and Type D personality on these outcomes. METHODS AND RESULTS: Implantable cardioverter-defibrillator patients (n = 718; 81% men) completed the State-Trait Anxiety Inventory (STAI) and the Short-Form Health Survey 36 (SF-36) at baseline and 12 months post-implantation. The magnitude of the effect was indicated using Cohen's effect size index. Multivariate analysis of covariance for repeated measures showed no differences between men and women on mean scores of anxiety (F((1,696)) = 2.67, P = 0.10). Differences in QoL were observed for only two of the eight subscales of the SF-36, with women reporting poorer physical functioning (F((1,696)) = 7.14, P = 0.008) and vitality (F((1,696)) = 4.88, P = 0.028) than men. With respect to anxiety, effect sizes at baseline and 12 months for gender, NYHA class, and ICD shocks were small. A large effect size for Type D personality was found at both time points. For QoL, at baseline and 12 months, the effect sizes for gender were small, while the influence of NYHA class and Type D personality was moderate to large. CONCLUSIONS: Men and women did not differ on mean anxiety or QoL scores, except for women reporting poorer QoL on two domains. The relative influence of gender on anxiety and QoL was less than that of NYHA functional class and Type D personality.
Assuntos
Ansiedade/psicologia , Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Qualidade de Vida/psicologia , Caracteres Sexuais , Idoso , Ansiedade/epidemiologia , Arritmias Cardíacas/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Personalidade/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter-defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter-defibrillator. During a follow-up of 2.2 years (interquartile range, 2.0-2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead-related (n=47) and pocket-related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter-defibrillator-related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
Assuntos
Morte Súbita Cardíaca , Desfibriladores Implantáveis , Cardioversão Elétrica , Complicações Pós-Operatórias , Implantação de Prótese/efeitos adversos , Idoso , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/classificação , Desfibriladores Implantáveis/estatística & dados numéricos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Análise de Falha de Equipamento/métodos , Análise de Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Avaliação das Necessidades , Países Baixos/epidemiologia , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Medição de Risco , Fatores de RiscoRESUMO
INTRODUCTION: Three-dimensional (3D) navigation systems are widely used for pulmonary vein antrum isolation (PVAI). To circumvent left atrial (LA) mapping, 3D CT reconstructions of the LA can be superimposed directly (CT overlay) on the fluoroscopy image to guide ablation catheters and to mark ablation sites. METHODS AND RESULTS: Sixty-eight patients (pts) with symptomatic AF refractory to medical therapy were randomly assigned to CT overlay (group 1, n = 38) or CartoMerge (group 2, n = 30). In group 1 registration of the CT image was performed with contrast injections in 2 orthogonal projections. In group 2, visualization of all pulmonary vein (PV) ostia was done by PV angiography, followed by merging of the CT image and the Carto shell. We compared procedural success, procedure time, fluoroscopy time and radiation burden, measured as dose area product (DAP). Baseline characteristics were comparable in both groups. Procedural success, defined as disappearance of PV potentials in all PVs, was achieved in 37/38 (97%) of group 1 patients and 27/30 (90%) patients in group 2 (P = NS). Total procedure time was significantly shorter in group 1 compared to group 2 (129 +/- 34 vs 181 +/- 30 min, P < 0.0001). Although fluoroscopy time tended to be longer in the CT overlay group (47 +/- 16 vs 40 +/- 13 min, P = 0.06), proper use of diaphragmation resulted in comparable radiation values for both groups (DAP 53 +/- 27 vs 56 +/- 35 Gy cm(2), P = 0.76). CONCLUSIONS: CT overlay for PV isolation is feasible and may, in comparison to conventional LA navigation systems, shorten procedural time without increases in radiation burden.
Assuntos
Ablação por Cateter/métodos , Processamento de Imagem Assistida por Computador/métodos , Veias Pulmonares/diagnóstico por imagem , Idoso , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Determinação de Ponto Final , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia , Doses de Radiação , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To compare clinical outcomes of clamping devices and linear nonclamping devices for isolation of the posterior left atrium (box) in thoracoscopic ablation of long-standing persistent atrial fibrillation. METHODS: Eighty patients who underwent thoracoscopic pulmonary vein and box isolation using a bipolar clamping device (42 patients) or bipolar nonclamping device (38 patients) to create the roof/inferior lesions for box isolation were included from 2 centers. Follow-up consisted of 24-hour Holter at regular intervals. Freedom from AF during 1-year follow-up and catheter repeat interventions were compared between groups. RESULTS: Acute intraoperative electrical isolation of the box compartment was significantly higher in the clamping group than in the nonclamping group (100% and 79%, respectively, P < .01). At 1-year follow-up, 91% of the clamping group and 79% of the nonclamping group were in sinus rhythm. During 1-year follow-up, recurrence rates did not significantly differ between the 2 groups (P = .08). Repeat catheter interventions were required in 10% of the clamping group and 21% of the nonclamping group (P = .15). Conduction gaps in the roof or inferior lesions were found in 1 patient (2%) in the clamping group versus 4 patients (11%) in the nonclamping group (P = .13). CONCLUSIONS: Thoracoscopic pulmonary vein and box isolation are highly effective in restoring sinus rhythm in long-standing persistent atrial fibrillation on short-term follow-up. Comparison of clamping and nonclamping devices revealed lower rates of intraoperative exit block of the box in the nonclamping group. However, this did not translate into a significant difference in atrial fibrillation freedom at short-term (1-year) follow-up.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Átrios do Coração/cirurgia , Veias Pulmonares/cirurgia , Toracoscopia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Constrição , Feminino , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Toracoscopia/efeitos adversos , Fatores de TempoRESUMO
BACKGROUND: Studies have examined the relationship between shocks and anxiety, but little is known about the role of personality. Our aim was to examine the determinants of self-reported and interviewer-rated anxiety following implantable cardioverter defibrillator (ICD) implantation. METHODS: At baseline, that is, 0-3 weeks following ICD implantation, 308 ICD patients (82% men, mean age = 62.6 years) completed the DS14 (Type D personality) and ASI (anxiety sensitivity). The STAI (self-reported symptoms of state-anxiety) was assessed at baseline and follow-up, which was 2 months following ICD implantation. At this follow-up, the HAM-A interview (interviewer-rated anxiety) was assessed in a subsample (57%); the occurrence of ICD shocks was deduced from medical records. RESULTS: Analysis of covariance (ANCOVA) for repeated measures showed a significant interaction effect between time and shocks (F = 9.27, P = 0.003) with patients who had experienced a shock experiencing higher levels of self-reported anxiety at follow-up. The main effects of Type D personality (F = 33.42, P < 0.0001) and anxiety sensitivity (F = 66.31, P < 0.0001) were significant, indicating that these patients scored higher on self-reported anxiety across time points. Multivariable linear regression analyses yielded Type D personality (beta= 0.18, P = 0.021) and anxiety sensitivity (beta= 0.19, P = 0.016), but not shocks, as independent predictors of interviewer-rated anxiety. Covariates included gender, marital status, education, age, ICD indication, cardiac history, and comorbidity. CONCLUSIONS: Type D personality and anxiety sensitivity were independent predictors of both self-reported and interviewer-rated anxiety outcomes while ICD shocks were related to an increase in levels of self-reported anxiety only. Identification and support of ICD patients with Type D personality, increased anxiety sensitivity, or shocks is important.
Assuntos
Ansiedade/epidemiologia , Ansiedade/psicologia , Desfibriladores Implantáveis/psicologia , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrochoque/psicologia , Eletrochoque/estatística & dados numéricos , Determinação da Personalidade/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores de RiscoRESUMO
Isovolumic times (IVTs) comprise a determinant of exercise capacity in cardiomyopathy. We postulated that an increase in exercise capacity after cardiac resynchronization therapy (CRT) might be related to a more efficient cardiac cycle due to decreasing IVTs and increased filling times. According to standard selection criteria, a CRT device was implanted in 52 patients (37 men; 69 +/- 8 years) with a QRS duration of 174 +/- 30 ms. The etiology was ischemic in 22 and idiopathic in 30 patients. A 6-minute walking test (MWT) and echocardiographic Doppler were performed before and 3 and 6 months after CRT. Timing cycles were obtained with echocardiographic Doppler. An improvement in MWT by >15% (responders) after 6 months of CRT was observed in 46% of patients. The MWT was moderately correlated with baseline time intervals (IVT r = -0.44, filling time r = 0.52), but not to baseline left ventricular ejection fraction (r = -0.06). However, change in the MWT after 3 and 6 months was best related to changes in IVT (r = -0.66 and -0.68, respectively). Receiver-operating characteristic curve analysis of baseline IVT showed that an IVT >29% predicted exercise response with a positive predictive value of 89% and a negative predictive value of 77%. In conclusion, improvement in exercise tolerance after CRT is associated with a decrease in prolonged IVT. Baseline IVT might be used as an adjunctive parameter for selecting symptomatic responders to CRT.
Assuntos
Estimulação Cardíaca Artificial , Cardiomiopatias/terapia , Tolerância ao Exercício , Volume Sistólico , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Sistema de Condução Cardíaco , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The distressed (type D) personality is an emerging risk factor in coronary artery disease that has been associated with adverse prognosis, impaired health status, and emotional distress. Little is known about factors that may influence the impact of type-D personality on health outcomes. Therefore, the aim of this study was to determine the combined effect of type-D and not having a partner on symptoms of anxiety and depression. METHODS: Patients (n=554) hospitalized for acute myocardial infarction or implantable cardioverter defibrillator implantation completed the 14-item type-D Scale (DS14) during hospitalization and the State-Trait Anxiety Inventory and Beck Depression Inventory at 2 months follow-up. RESULTS: Stratifying by personality and partner status showed that type-D patients without a partner had a higher risk of both anxiety [odds ratio (OR)=8.27; 95% confidence interval (CI)=2.50-27.32] and depressive symptoms (OR=6.74; 95% CI=2.19-20.76) followed by type-D patients with a partner (OR=3.73; 95% CI=2.16-6.45 and OR=3.81; 95% CI=2.08-6.99, respectively) and non-type-D patients without a partner (OR=2.04; 95% CI=1.05-3.96 and OR=3.03; 95% CI=1.46-6.31, respectively) compared to non-type-D patients with a partner, adjusting for demographic and clinical baseline characteristics, indicating a dose-response relationship. CONCLUSION: Lack of a partner further exacerbated the risk of symptoms of anxiety and depression in the already distressed type-D patients. In clinical practice, it is important to identify type-D patients without a partner and carefully monitor them, as they may be less likely to alter health-related behaviors due to their increased levels of distress.
Assuntos
Ansiedade/psicologia , Desfibriladores Implantáveis/psicologia , Depressão/psicologia , Infarto do Miocárdio/psicologia , Inventário de Personalidade , Pessoa Solteira/psicologia , Temperamento , Idoso , Ansiedade/diagnóstico , Comorbidade , Depressão/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Fatores de Risco , Papel do DoenteRESUMO
OBJECTIVE: Sudden cardiac arrest caused by cardiac arrhythmias is 1 of the leading causes of death worldwide. Implantable cardioverter defibrillators (ICDs) are considered as standard care for patients with increased risk of arrhythmias. However, 1 in 4 ICD patients experiences psychological distress post-ICD implantation. The WEB-based distress management program for ICD patients (WEBCARE) was developed to mitigate anxiety and depression and enhance health-related quality of life in ICD patients. This study investigates the 6- and 12-months outcomes. METHOD: A total of 289 consecutive ICD patients from 6 referral hospitals in the Netherlands were randomized to either the WEBCARE (n = 146) or usual care (n = 143) group. Patients in the WEBCARE group received an online, 12-weeks fixed, 6 lesson behavioral treatment based on problem solving therapy. Patients in the usual care group receive care as usual. RESULTS: Current findings show no significant difference on anxiety, depression or quality of life between the WEBCARE and Usual Care group at 6- and 12-months postimplantation. CONCLUSIONS: In this clinical trial of a Web-based behavioral intervention for ICD patients, the Web-based treatment was not superior to usual care on the long-term regarding patient reported outcomes. Future studies are warranted to examine the applicability of blended-care models and focus on further personalizing the program in order to increase adherence and improve outcomes. (PsycINFO Database Record
Assuntos
Ansiedade/prevenção & controle , Desfibriladores Implantáveis/psicologia , Depressão/prevenção & controle , Internet , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Idoso , Arritmias Cardíacas/terapia , Terapia Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países BaixosRESUMO
This study investigated the optimal echocardiographic indexes to determine the most hemodynamically appropriate atrioventricular (AV) delay in cardiac resynchronization therapy (CRT) for heart failure. Doppler echocardiographic optimization of AV delay in CRT has not been correlated with invasive hemodynamic indexes. In 30 patients who underwent CRT, invasive left ventricular (LV) pressure measurements with a sensor-tipped pressure guidewire and Doppler echocardiographic examination were performed <24 hours after pacemaker implantation. Invasively, the optimal sensed AV delay was determined by LV dP/dt(max). The Doppler echocardiographic methods evaluated were the velocity-time integral (VTI) of the transmitral flow (EA VTI), diastolic filling time (EA duration), the VTI of the LV outflow tract or aorta (LV VTI), and Ritter's formula. Biventricular pacing with optimized interventricular and AV delay increased LV dP/dt(max) from 777 +/- 149 to 1,010 +/- 163 dynes/s (p<0.0001). The optimal AV delay with the EA VTI method was concordant with LV dP/dt(max) in 29 of 30 patients (r = 0.96), with EA duration in 20 of 30 patients (r= 0.83), with LV VTI in 13 patients (r = 0.54), and with Ritter's formula in none of the patients (r = 0.35). In conclusion, to obtain the optimal acute hemodynamic benefit of CRT, Doppler echocardiography is a reliable tool to optimize the AV delay compared with the invasive LV dP/dt(max). The measurement of the maximal VTI of mitral inflow is the most accurate method.
Assuntos
Nó Atrioventricular/fisiopatologia , Cardiomiopatia Dilatada/complicações , Ecocardiografia Doppler/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Hemodinâmica , Marca-Passo Artificial , Idoso , Feminino , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , MasculinoRESUMO
A recent publication compared catheter ablation and antiarrhythmic drugs as initial therapy for paroxysmal atrial fibrillation. No difference was seen in the primary endpoint of the cumulative AF burden over two years. The burden of AF was documented objectively by a series of 7-day continuous ECG recordings; a method that will evolve as a gold standard for measuring the AF burden. The major shortcoming of the study was an obsolete ablation endpoint, lacking verification of pulmonary vein isolation. Other drawbacks were the fact that ablations were not exclusively carried out in high-volume centres and a high cross-over rate in the drug group. Also, although the primary endpoint was not significantly different, several secondary outcomes obviously favoured ablation. Outcomes in both the ablation and drug groups were relatively good, and this study will not change the current practice for the majority of paroxysmal AF patients, although catheter ablation could be performed as the initial therapy.
Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Eletrocardiografia Ambulatorial , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. METHODS: The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y, m = 59.1) and 134 older (>70 y, m = 74.3) ICD patients. End points were all-cause mortality and cardiac death after a median follow-up of 3.2 years. RESULTS: Older patients had more advanced heart failure and a higher mortality rate (n = 34/25%) than younger patients (n = 60/13%), P = 0.001. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09-3.34) and 2.26 (95% CI 1.16-4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. CONCLUSION: Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk.
Assuntos
Envelhecimento/psicologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/psicologia , Estresse Psicológico/mortalidade , Estresse Psicológico/psicologia , Personalidade Tipo D , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto JovemRESUMO
BACKGROUND: Clinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice. METHODS: This prospective follow-up study included 589 patients with an ICD (mean age=62.6 ± 10.1 years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers. RESULTS: After a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p=0.52) or cardiac (p=0.99) death. However, appropriate shocks (HR=2.60, 95% CI 1.47-5.58, p=0.001) and Type D personality (HR=1.85, 95% CI 1.12-3.05, p=0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes. CONCLUSION: Vulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.