1
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes Júnior AADP, Schaan BD, Silva CGDSE, Castilho FMD, Cesena FHY, Soares GP, Xavier Junior GF, Barreto Filho JAS, Passaglia LG, Pinto Filho MM, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Villela PB, Teixeira RA, Stein R, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2023. Arq Bras Cardiol 2024; 121:e20240079. [PMID: 38896747 PMCID: PMC11185831 DOI: 10.36660/abc.20240079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Luisa Campos Caldeira Brant
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | - Carisi Anne Polanczyk
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Bruno Ramos Nascimento
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital Madre Teresa, Belo Horizonte, MG - Brasil
| | | | - Andrea Rocha De Lorenzo
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | | | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Christina Grüne de Souza E Silva
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Fábio Morato de Castilho
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | | | - Gabriel Porto Soares
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Curso de Medicina da Universidade de Vassouras, Vassouras, RJ - Brasil
| | | | | | - Luiz Guilherme Passaglia
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | - Marcelo Martins Pinto Filho
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
| | | | | | - Octavio M Pontes Neto
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Paolo Blanco Villela
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Roney Orismar Sampaio
- Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brasil
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Thomaz A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston - EUA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston - EUA
| | - Pablo Perel
- World Heart Federation, Geneva - Suíça
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, Londres - Inglaterra
| | - Gregory A Roth
- Division of Cardiology, Department of Medicine, University of Washington, Washington - EUA
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
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2
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Menezes Junior AS, Rivera A, Ayumi Miyawaki I, Gewehr DM, Nascimento B. Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Cardiol Rep 2023; 25:1415-1424. [PMID: 37751037 DOI: 10.1007/s11886-023-01963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. RECENT FINDINGS We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR = 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.22; I2 = 0%), stroke (RR = 0.90; 95% CI, 0.43-1.91; p = 0.79; I2 = 23%), hospitalizations for cardiovascular and/or device-related adverse events (RR = 0.95; 95% CI, 0.75-1.21; p = 0.70; I2 = 0%), and quality of life (SMD = - 0.06; 95% CI, - 0.22 to 0.10; p = 0.473; I2 = 0%). RM was associated with fewer IO visits/patient/year (MD = 0.98; 95% CI, - 1.64 to - 0.33; p = 0.08; I2 = 98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR = 1.22; 95% CI, 1.01-1.48; p = 0.04; I2 = 0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.
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Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil
| | | | - Douglas Mesadri Gewehr
- Curitiba Heart Institute, Curitiba, Brazil
- Science, and Technology, Denton Cooley Institute of Research, Curitiba, Brazil
| | - Bárbara Nascimento
- Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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3
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Reinhardt A, Ventura R. Remote Monitoring of Cardiac Implantable Electronic Devices: What is the Evidence? Curr Heart Fail Rep 2023; 20:12-23. [PMID: 36701019 PMCID: PMC9877501 DOI: 10.1007/s11897-023-00586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review offers an overview of the evidence in diagnostic and therapeutic applications of remote monitoring implantable devices. RECENT FINDINGS Remote monitoring of cardiac implantable devices has become more and more popular in recent years as healthcare is moving towards a more patient centralized system. For heart failure patients with an ICD or pacemaker, there is controversial evidence regarding improvements in the clinical outcome, e.g., reduction of hospitalization rates or overall mortality. New developments as hemodynamic remote monitoring via measurement of the pulmonary artery pressure are promising technical achievements showing encouraging results. In cardiac remote monitoring of syncope and arrhythmias, implantable loop recorder plays an important role in diagnostic algorithms. Although there is controversial evidence according to remote monitoring of implantable devices, its use is rapidly expanding, giving healthcare providers the opportunity to react promptly to worsening of their patients. Adequate evaluation of the data created by remote monitoring systems remains an unsolved challenge of contemporary healthcare services.
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Affiliation(s)
- Adrian Reinhardt
- Electrophysiology Center Bremen, Heart Center Bremen, Senator-Wessling-Strasse 1, 28277 Bremen, Germany
| | - Rodolfo Ventura
- Electrophysiology Center Bremen, Heart Center Bremen, Senator-Wessling-Strasse 1, 28277 Bremen, Germany
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4
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Rocha MEQA, Lima NDA, Pinho LGB, Gondim DSP, Miná CPC, Rocha EAQA, Rocha MCT, Nobre JS, Pereira FTM, Prakash P, Maia FPA, Rocha EA. Remote monitoring of pacemakers and defibrillators: Effective and safe in Brazil? Heart Rhythm O2 2022; 3:736-742. [PMID: 36589013 PMCID: PMC9795284 DOI: 10.1016/j.hroo.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has become a common method of in-home monitoring and follow-up in high-income countries given its effectiveness, safety, convenience, and the possibility of early intervention. However, in Brazil, RM is still underutilized. Objectives This observational study aims to demonstrate our experience of using RM in Brazil and the predictive factors of RM of CIED follow-up in Brazil. Methods This was a prospective cohort study of patients with a CIED. Event rates are reported and clinical responses to those findings and outcomes based on the detection of RM. A logistic regression model was performed to identify predictors of more events, with P < .05 for statistical significance. Results This study evaluated consecutive 119 patients: 30.2% with pacemakers, 42.8% with implantable cardioverter-defibrillator, 22.7% with cardiac resynchronization therapy (CRT) with defibrillator, and 3.3% with CRT with pacemaker. Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up. The outcomes found were that 44.5% needed elective evaluation in medical treatment and 23.5% needed immediate evaluation in therapy. Logistic regression analysis showed that the groups with CRT or CRT with defibrillator (75.0%), reduced ejection fraction (76.5%), and New York Heart Association functional class ≥II (75.0%) had the highest RM event rates. Conclusions RM proved to be effective and safe in the follow-up of patients with CIEDs in Brazil, allowing early interventions and facilitating therapeutic management.
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Affiliation(s)
| | - Neiberg de Alcantara Lima
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan,Address reprint requests and correspondence: Dr Neiberg de Alcantara Lima, Division of Cardiology, Department of Internal Medicine, Wayne State University, 3990 John R. Street, 4 Hudson, Detroit, MI 48021.
| | | | | | | | | | | | - Juvêncio Santos Nobre
- Department of Statistics and Applied Mathematics, Federal University of Ceara, Fortaleza, Brazil
| | | | - Preeya Prakash
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | | | - Eduardo Arrais Rocha
- Postgraduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Brazil
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5
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Proietti M, Romiti GF, Vitolo M, Borgi M, Rocco AD, Farcomeni A, Miyazawa K, Healey JS, Lane DA, Boriani G, Basili S, Lip GYH. Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: A systematic review and meta-regression. Eur J Intern Med 2022; 103:84-94. [PMID: 35817660 DOI: 10.1016/j.ejim.2022.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. We aim to perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs. METHODS PubMed and EMBASE were searched for all studies documenting the prevalence of AHREs in patients (n=100 or more, <50% with history of AF) with CIEDs from inception to 20th August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994. RESULTS Among the 2614 results initially retrieved, 54 studies were included, with a total of 72,784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1% (95%CI: 24.3-32.1%), with high heterogeneity between studies (I2=98%). A multivariable meta-regression was able to explain significant proportion of heterogeneity (R2=61.9%, p<0.001), with age and follow-up time non-linearly, directly and independently associated with occurrence of SCAF. Older age, higher CHA2DS2-VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence. CONCLUSIONS In this systematic review and meta-regression analysis, SCAF was frequent among CIED recipients and was non-linearly associated with age and follow-up time. Older age, higher thromboembolic risk, and several cardiovascular comorbidities were associated with presence of SCAF.
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Affiliation(s)
- Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Borgi
- Department of Clinical and Experimental Medicine, Policlinic "G Martino," University of Messina, Messina, Italy
| | - Arianna Di Rocco
- Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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6
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Vio R, Giordani AS, Alturki A, Čulić V, Vitale R, China P, Themistoclakis S, Vanoli E, Proietti R. Prevalence of asymptomatic atrial fibrillation among multimorbid elderly patients: diagnostic implications. Minerva Cardiol Angiol 2022; 70:583-593. [PMID: 35212509 DOI: 10.23736/s2724-5683.22.05894-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advancing age of the global population is one of the main reasons for the uprising trend in atrial fibrillation (AF) prevalence worldwide leading to a proper "AF epidemic". Strictly related to the increasing prevalence of AF in the elderly is the relevant burden of cardiac end extra-cardiac comorbidities that these patients show. Patients with AF are frequently asymptomatic (i.e., asymptomatic or silent AF) and thus the arrhythmia is generally underdiagnosed. Detainment of proper treatment in elderly and comorbid patients may potentially result in significant morbidity and mortality. Therefore, in recent years, several screening strategies (systematic vs opportunistic screening) for asymptomatic AF have been developed and early diagnosis of AF is an important treatment goal that can improve prognosis. This review will focus on the prevalence of asymptomatic AF in the elderly, frequently associated comorbidities, screening strategies, and implications for a correct AF diagnosis.
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Affiliation(s)
- Riccardo Vio
- Unit of Cardiology, Department of Cardiothoracic, Vascular Medicine & Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy -
| | - Andrea S Giordani
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padova, Italy
| | - Ahmed Alturki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Viktor Čulić
- University of Split School of Medicine, Split, Croatia.,Department of Cardiology and Angiology, University Hospital Centre Split, Split, Croatia
| | - Raffaele Vitale
- Unit of Cardiology, Department of Cardiothoracic, Vascular Medicine & Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Paolo China
- Unit of Cardiology, Department of Cardiothoracic, Vascular Medicine & Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Sakis Themistoclakis
- Unit of Cardiology, Department of Cardiothoracic, Vascular Medicine & Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Emilio Vanoli
- Sacra Famiglia Fatebenefratelli Hospital, Erba, Como, Italy
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7
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Oliveira GMMD, Brant LCC, Polanczyk CA, Malta DC, Biolo A, Nascimento BR, Souza MDFMD, Lorenzo ARD, Fagundes AADP, Schaan BD, Castilho FMD, Cesena FHY, Soares GP, Xavier GF, Barreto JAS, Passaglia LG, Pinto MM, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Villela PB, Teixeira RA, Sampaio RO, Gaziano TA, Perel P, Roth GA, Ribeiro ALP. Estatística Cardiovascular – Brasil 2021. Arq Bras Cardiol 2022; 118:115-373. [PMID: 35195219 PMCID: PMC8959063 DOI: 10.36660/abc.20211012] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
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8
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Jang JP, Lin HT, Chen YJ, Hsieh MH, Huang YC. Role of Remote Monitoring in Detection of Atrial Arrhythmia, Stroke Reduction, and Use of Anticoagulation Therapy - A Systematic Review and Meta-Analysis. Circ J 2020; 84:1922-1930. [PMID: 33012748 DOI: 10.1253/circj.cj-20-0633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable cardiac devices.Methods and Results:We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio [RR], 1.363; 95% confidence interval [CI], 1.147-1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301-0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408-6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265-0.996). CONCLUSIONS RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.
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Affiliation(s)
- Jia-Pei Jang
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Hui-Ting Lin
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Yu-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University.,Institute of Public Health, National Yang-Ming University
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University
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9
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de Oliveira GMM, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, de Souza MDFM, Soares GP, Xavier GF, Machline-Carrion MJ, Bittencourt MS, Pontes OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115:308-439. [PMID: 33027364 PMCID: PMC9363085 DOI: 10.36660/abc.20200812] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson SaadUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Instituto do Coração Edson Saad
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Disciplina de Cardiologia,
Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
| | - Luisa Campos Caldeira Brant
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Carisi Anne Polanczyk
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Faculdade de Medicina
da
Universidade Federal do Rio Grande do Sul
(UFRS),
Porto Alegre
,
RS
–
Brasil
- Serviço de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Cardiologia
do
Hospital Moinhos de Vento
,
Porto Alegre
,
RS
–
Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre
(HCPA),
Porto Alegre
,
RS
–
Brasil
| | - Andreia Biolo
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Faculdade de Medicina
da
Universidade Federal do Rio Grande do Sul
(UFRS),
Porto Alegre
,
RS
–
Brasil
- Serviço de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Cardiologia
do
Hospital Moinhos de Vento
,
Porto Alegre
,
RS
–
Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Hospital de Clínicas de Porto Alegre
(HCPA),
Porto Alegre
,
RS
–
Brasil
| | - Bruno Ramos Nascimento
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Maria de Fatima Marinho de Souza
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Organização Vital StrategiesNova YorkEUA Organização Vital Strategies
,
Nova York
–
EUA
| | - Gabriel Porto Soares
- Instituto do Coração Edson SaadUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Instituto do Coração Edson Saad
da
Universidade Federal do Rio de Janeiro
(UFRJ),
Rio de Janeiro
,
RJ
–
Brasil
- Universidade de VassourasVassourasRJBrasil Curso de Medicina da
Universidade de Vassouras
,
Vassouras
,
RJ
–
Brasil
| | - Gesner Francisco Xavier
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Biblioteca da
Faculdade de Medicina
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - M. Julia Machline-Carrion
- ePHealth Primary Care SolutionsSanto Antônio SCBrasil ePHealth Primary Care Solutions
,
Santo Antônio
,
SC
–
Brasil
| | - Marcio Sommer Bittencourt
- Divisão de Clínica MédicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Divisão de Clínica Médica
do
Hospital Universitário
da
Universidade de São Paulo
,
São Paulo
,
SP
–
Brasil
- Faculdade Israelita de Ciências da Saúde Albert Einstein São PauloSPBrasil Faculdade Israelita de Ciências da Saúde Albert Einstein
,
São Paulo
,
SP
–
Brasil
| | - Octavio M. Pontes
- Departamento de Neurociências e Ciências do Comportamento Faculdade de Medicina de Ribeirão PretoUniversidade de São PauloSão PauloSPBrasil Serviço de Neurologia Vascular e Emergências Neurológicas, Divisão de Neurologia,
Departamento de Neurociências e Ciências do Comportamento
,
Faculdade de Medicina de Ribeirão Preto
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
| | - Odilson Marcos Silvestre
- Universidade Federal do AcreRio BrancoACBrasil Universidade Federal do Acre
(UFAC),
Rio Branco
,
AC
–
Brasil
| | - Renato Azeredo Teixeira
- Programa de Pós-Graduação em Saúde PúblicaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Programa de Pós-Graduação em Saúde Pública
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
| | - Roney Orismar Sampaio
- Departamento de CardiopneumologiaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Cardiopneumologia
da
Faculdade de Medicina
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
- Programa de Pós-GraduaçãoFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Programa de Pós-Graduação
da
Faculdade de Medicina
da
Universidade de São Paulo
(USP),
São Paulo
,
SP
–
Brasil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade Clínica de Cardiopatias Valvares do Instituto do Coração (Incor) do
Hospital das Clínicas
da
Faculdade de Medicina
da
Universidade de São Paulo
(HCFMUSP),
São Paulo
,
SP
–
Brasil
| | - Thomaz A. Gaziano
- Brigham and Women’s HospitalBostonEUA Brigham and Women’s Hospital
,
Boston
–
EUA
- Department of MedicineHarvard Medical SchoolBostonEUA Department of Medicine
, Cardiovascular,
Harvard Medical School
,
Boston
–
EUA
| | - Gregory A. Roth
- Global Health and Health Metrics SciencesInstitute for Health Metrics and EvaluationWashingtonEUA Global Health and Health Metrics Sciences
at the
Institute for Health Metrics and Evaluation
(IHME),
Washington
–
EUA
- Division of CardiologyUniversity of WashingtonSchool of MedicineWashingtonEUA Division of Cardiology
at the
University of Washington
School of Medicine
,
Washington
–
EUA
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica
da
Faculdade de Medicina
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
- Centro de TelessaúdeHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Serviço de Cardiologia e Cirurgia Cardiovascular e
Centro de Telessaúde
do
Hospital das Clínicas
da
Universidade Federal de Minas Gerais
(UFMG),
Belo Horizonte
,
MG
–
Brasil
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10
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López-Liria R, López-Villegas A, Leal-Costa C, Peiró S, Robles-Musso E, Bautista-Mesa R, Rocamora-Pérez P, Lappegård KT, Catalán-Matamoros D. Effectiveness and Safety in Remote Monitoring of Patients with Pacemakers Five Years after an Implant: The Poniente Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041431. [PMID: 32102208 PMCID: PMC7068341 DOI: 10.3390/ijerph17041431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 12/30/2022]
Abstract
Health-related quality of life (HRQoL) and functional capacity values immediately after pacemaker (PM) implantation have been well established; however, not much has been known about its long-term effects. The present study compared the long-term effectiveness and safety of remote monitoring plus a clinic visit versus clinic visits alone during follow-up of adults implanted with PMs. This study was a single-centre, controlled, non-randomised, non-blinded clinical trial. Data were collected pre-implantation and after 60 months. The patients in the PONIENTE study were assigned to two different groups: remote monitoring (RM) and conventional monitoring (CM). The EuroQol-5D (EQ-5D) questionnaire was used to assess HRQoL and Duke Activity Status Index was used for the functional capacity. After five years, 55 patients completed the study (RM = 21; CM = 34). EuroQol-5D and functional capacity values were improved; however, significant differences were observed only in the EQ5D visual analogue scale (p < 0.001). Remote monitoring was equally feasible, reliable, safe, and clinically useful as CM. The frequencies of rehospitalisations and emergency visits did not differ between the groups. RM was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Improved HRQoL was described not only immediately after PM implantation but also extended over a long time.
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Affiliation(s)
- Remedios López-Liria
- Department of Nursing Science, Physiotherapy and Medicine, Hum-498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain;
| | - Antonio López-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Team, Hospital de Poniente, 04700 Almeria, Spain
- Institute of Clinical Medicine. Faculty of Health Sciences, University of Tromsø, 9019 Tromsø. Norway;
- Correspondence: (A.L.-V.); (P.R.-P.); Tel.: +34-950-022-935
| | | | - Salvador Peiró
- Health Services Research Unit, FISABIO-PUBLIC HEALTH, 04700 Valencia, Spain;
| | | | | | - Patricia Rocamora-Pérez
- Department of Nursing Science, Physiotherapy and Medicine, Hum-498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain;
- Correspondence: (A.L.-V.); (P.R.-P.); Tel.: +34-950-022-935
| | - Knut Tore Lappegård
- Institute of Clinical Medicine. Faculty of Health Sciences, University of Tromsø, 9019 Tromsø. Norway;
- Division of Medicine, Nordland Hospital, N-8092 Bodø, Norway
| | - Daniel Catalán-Matamoros
- Department of Communication Studies, Universidad Carlos III de Madrid, 28903 Madrid, Spain;
- Health Sciences CTS-451 Research Group, Health Research Centre, University of Almería, 04120 Almería, Spain
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11
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Noseworthy PA, Kaufman ES, Chen LY, Chung MK, Elkind MSV, Joglar JA, Leal MA, McCabe PJ, Pokorney SD, Yao X. Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e944-e963. [PMID: 31694402 DOI: 10.1161/cir.0000000000000740] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.
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12
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Remote Monitoring of Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy and Permanent Pacemakers: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2018; 18:1-199. [PMID: 30443279 PMCID: PMC6235077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Under usual care, people with an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy with or without a defibrillator (CRT-D and CRT-P, respectively), or a permanent pacemaker have follow-up in-person clinic visits. Remote monitoring of these devices allows the transfer of the information stored in the device so that it can be accessed by the clinic personnel via a secured website. METHODS We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for remote monitoring of ICDs, CRTs, and permanent pacemakers plus clinic visits compared with clinic visits alone. This is an update of a 2012 health technology assessment. In addition to the eligible randomized controlled trials (RCTs) from the 2012 publication, we included RCTs identified through a systematic literature search on June 1, 2017. We assessed the risk of bias of each study using the Cochrane risk of bias tool and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We conducted an economic evaluation to determine the cost-effectiveness of remote monitoring blended with in-clinic follow-up compared to in-clinic follow-up alone in patients with an ICD, a CRT-D, or a pacemaker. We determined the budget impact of blended remote monitoring in patients implanted with ICD, CRT-D, CRT-P, or pacemaker devices from the perspective of the Ontario Ministry of Health and Long-Term Care. To understand patient experiences with remote monitoring, we interviewed 16 patients and family members. RESULTS Based on 15 RCTs in patients with implanted ICDs or CRT-Ds, remote monitoring plus clinic visits resulted in fewer patients with inappropriate ICD shocks within 12 to 37 months of follow-up (moderate quality evidence; absolute risk difference -0.04 [95% confidence interval -0.07 to -0.01]), fewer total clinic visits (moderate quality evidence), and a shorter time to detection and treatment of events (moderate quality evidence) compared with clinic visits alone. There was a similar risk of major adverse events (moderate quality evidence).Based on 6 RCTs in patients with pacemakers, remote monitoring plus clinic visits reduced the arrhythmia burden (high quality evidence), the time to detection and treatment of arrhythmias (high quality evidence), and the number of clinic visits (moderate quality evidence]) compared with clinic visits alone. Here again, there was a similar risk of major adverse events (high quality evidence).Results from the economic evaluation showed that among ICD and CRT-D recipients, blended remote monitoring (remote monitoring plus in-clinic follow ups) was more costly (incremental value of $4,354 per person) and more effective, providing higher quality-adjusted life years (incremental value of 0.19), compared to in-clinic follow-up alone. Among pacemaker recipients, blended remote monitoring was less costly (with an incremental saving of $2,370 per person) and more effective (with an incremental value of 0.12 quality-adjusted life years) than with in-clinic follow-up alone. We estimated that publicly funding remote monitoring could result in cost savings of $14 million over the first five years.Participants using remote monitoring reported that these devices provide important medical and safety benefits in managing their heart condition. Remote cardiac monitoring provides patients and their family members with an increased freedom. Their belief that the device will help with earlier detection of technical or clinical problems reduces the amount of stress and distraction their condition causes in their lives. CONCLUSIONS Remote monitoring of ICDs, CRT-Ds, and pacemakers plus clinic visits resulted in improved outcomes without increasing the risk of major adverse events compared with clinic visits alone. Remote monitoring is a cost-effective option for patients implanted with cardiac electronic devices. Patients reported positive experiences using remote monitoring, and perceived that the device provided important medical and safety benefits.
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13
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Ziacchi M, Palmisano P, Biffi M, Ricci RP, Landolina M, Zoni-Berisso M, Occhetta E, Maglia G, Botto G, Padeletti L, Boriani G. Clinically oriented device programming in bradycardia patients. J Cardiovasc Med (Hagerstown) 2018; 19:161-169. [DOI: 10.2459/jcm.0000000000000630] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Belkin MN, Soria CE, Waldo AL, Borleffs CJW, Hayes DL, Tung R, Singh JP, Upadhyay GA. Incidence and Clinical Significance of New-Onset Device-Detected Atrial Tachyarrhythmia. Circ Arrhythm Electrophysiol 2018. [DOI: 10.1161/circep.117.005393] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Mark N. Belkin
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - Cesar E. Soria
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - Albert L. Waldo
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - C. Jan Willem Borleffs
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - David L. Hayes
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - Roderick Tung
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - Jagmeet P. Singh
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
| | - Gaurav A. Upadhyay
- From the Center for Arrhythmia Care, University of Chicago Medicine, IL (M.N.B., C.E.S., R.T., G.A.U.); University Hospitals Cleveland Medical Center, OH (A.L.W.); Leiden University Medical Center, The Netherlands (C.J.W.B.); The Mayo Clinic, Rochester, MN (D.L.H.); and Massachusetts General Hospital, Boston (J.P.S.)
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15
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Karaca M, Aytekin D. Predicting Intermittent Atrial Fibrillation in Outpatient Clinics. Korean Circ J 2017; 47:361-365. [PMID: 28567086 PMCID: PMC5449530 DOI: 10.4070/kcj.2016.0340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/20/2016] [Accepted: 01/18/2017] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives Palpitations are the most common complaint in cardiology outpatient clinics. These palpitations may be derived from paroxysmal atrial fibrillation (AF) and can be easily overlooked. It is unclear whether inter-atrial conduction time (ICT) may predict the paroxysmal AF in out-patients that present with palpitations. We evaluated the ability of the ICT to predict paroxysmal AF in these patients. Subjects and Methods The study group consisted of 199 patients (110 female). All patients underwent 24-hour Holter electrocardiogram (ECG) monitoring (total of 327 Holter ECG monitorings, mean: 1.64 times per patient). Brief episodes of AF were documented in 35 patients (20 female, Group 1). The remaining patients without AF were designated as Group 2 (90 female). All patients underwent routine transthoracic echocardiographic examination. ICT was also measured by echocardiography. Results The mean age in Group 1 was greater than in Group 2 (63.02±14 vs. 51.27±16 years, p<0.001). The left atrium was larger in Group 1 than in Group 2 (39.7±3.4 vs. 37.29±4.3 mm, p<0.001). The other echocardiographic variables were comparable between the two groups. The mean ICT was significantly higher in Group 1 than in Group 2 (138±14 vs. 114±12 msn, p<0.001). The ICT of 127 ms was predictive for AF with a sensitivity of 86% and specificity of 87% (p<0.001). Conclusion Our findings show that ICT was prolonged in patients with palpitations who developed a brief episode of AF in Holter ECG monitoring. ICT prolongation may be used to identify patients with palpitation that are at risk of an AF episode. Holter ECG monitoring should be repeated to detect AF episodes in patients with prolonged ICT.
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Affiliation(s)
- Mustafa Karaca
- Department of Cardiology, Katip Celebi University IAEH, Izmir, Turkey
| | - Deniz Aytekin
- Department of Cardiology, Medikalp Heart Disease Clinic, Izmir, Turkey
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16
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Methods, accuracy and clinical implications of atrial fibrillation detection by cardiac implantable electronic devices. Int J Cardiol 2017; 236:262-269. [DOI: 10.1016/j.ijcard.2016.12.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
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17
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Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol 2017; 40:413-418. [PMID: 28273368 DOI: 10.1002/clc.22667] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/23/2016] [Indexed: 11/05/2022] Open
Abstract
Silent or subclinical asymptomatic atrial fibrillation (SAF) has currently gained wide interest in the epidemiologic, neurologic, and cardiovascular communities. It is well known that the electrophysiological and mechanical effects of symptomatic and silent atrial fibrillation (AF) are the same. It is probable that because "AF begets AF," progression from paroxysmal to persistent or permanent AF might be more rapid in patients with long-term unrecognized and untreated SAF, because no treatment is sought by or provided to such patients. Moreover, SAF is common and has significant clinical implications. The clinical consequences of SAF, which include emboli (silent or symptomatic), heart failure, and early mortality, are of paramount importance. Consequently, SAF should be considered in estimating the prevalence of the disease and its impact on morbidity, mortality, and quality of life. Several diagnostic methods of arrhythmia detection utilizing the surface electrocardiogram (ECG), subcutaneous ECG, or intracardiac devices have been utilized to seek meaningful arrhythmic markers of SAF. Whereas a wide range of clinical risk factors of SAF have been validated in the literature, there is an ongoing search for those arrhythmic risk factors that precisely identify and prognosticate outcome events in diverse populations at risk of SAF. Modern diagnostic modalities for the identification of SAF exist, but should be further explored, validated, and tailored to each patient needs. The scientific community should undertake the clinical challenge of identifying and treating SAF.
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Affiliation(s)
| | - Harold L Kennedy
- Department of Medicine & Cardiovascular Diseases, University of Missouri, Columbia, Missouri.,The Cardiovascular Research Foundation, St. Louis, Missouri
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18
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Witkowski M, Bissinger A, Grycewicz T, Lubinski A. Asymptomatic atrial fibrillation in patients with atrial fibrillation and implanted pacemaker. Int J Cardiol 2016; 227:583-588. [PMID: 27836293 DOI: 10.1016/j.ijcard.2016.10.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial fibrillation is the most common chronic arrhythmia. Due to diagnostic difficulties, the exact prevalence of silent atrial fibrillation is not precisely defined. AIM The main aim of the present study was to assess the prevalence of asymptomatic atrial fibrillation and the relation between clinical status and presence of symptoms of atrial fibrillation. MATERIAL AND METHODS Fifty patients with implanted pacemaker with atrial fibrillation recording function and diagnosed paroxysmal atrial fibrillation were enrolled to the study in order to detect episodes of atrial fibrillation. Episodes lasting >1min were included into analysis. Patients were evaluated for presence of atrial fibrillation symptoms. RESULTS A total of 870 atrial fibrillation episodes were registered, the majority (93%) were asymptomatic. Episodes occurred more often during the day than during the night (p<0.001). Asymptomatic episodes occurred 13 times more frequently than symptomatic (p<0.001). Majority of episodes lasting up to 5min were asymptomatic, while episodes lasting over 24h were usually symptomatic (p<0.001). Furthermore, there were association between silent atrial fibrillation and lower HR (p=0.003), higher percentage of atrial (p=0.01) and ventricular pacing (p<0.001), male gender (p<0.001), presence of atrioventricular block (p<0.003), lower NYHA class (p<0.002), and calcium channel blockers (p=0.033) and diuretics intake (p<0.001). CONCLUSION In patients with bradycardia permanent pacemakers and paroxysmal atrial fibrillation, the proportion of asymptomatic episodes is very high. It was observed that shorter duration of the episodes, male gender, lower heart rate, presence of atrioventricular block, lower NYHA class, higher percentage of atrial and ventricular pacing, Ca2+ blockers, and diuretics intake predisposed to silent atrial fibrillation.
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Affiliation(s)
- Michal Witkowski
- Department of Invasive Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland.
| | - Andrzej Bissinger
- Department of Invasive Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Tomasz Grycewicz
- Department of Invasive Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Andrzej Lubinski
- Department of Invasive Cardiology and Arrhythmias, Medical University of Lodz, Lodz, Poland
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19
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Karaca M, Aytekin D, Kırıs T, Koskderelioglu A, Gedizlioglu M. Cryptogenic ischemic stroke and silent atrial fibrillation: What is the relationship? SPRINGERPLUS 2016; 5:130. [PMID: 26933629 PMCID: PMC4760955 DOI: 10.1186/s40064-016-1756-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes and associated with silent cerebral infarctions and transient ischemic attacks. Any method that predicts the stroke or unmasks the silent PAF would contribute to the treatment of ischemic stroke. Intraatrial conduction time (ICT) has been shown to be associated with intermittent AF. In this study, we evaluated the value of ICT detected by transthoracic echocardiography in normal population and in patients with cryptogenic stroke (CS) as a risk factor for stroke. The patients with CS and with normal left ventricular function without valvular disease are included in group 1. Patients with atypical symptoms admitted to cardiology clinics without any risk factor for cardiac disease and found to be normal constituted group 2. Age, gender, weight, height, echocardiographic parameters and ICT were compared between groups. 63 and 64 subjects were included in group 1 and 2, respectively. Two groups were similar according to age and gender. Among the parameters studied, left atrial diameter and height of the patients were significantly higher in group 1 (40 ± 2 vs 37 ± 4 mm, p < 0.001 and 167 ± 9 vs 163 ± 9 cm p = 0.027, respectively). ICT was significantly higher in group 1 (131 ± 15 vs 118 ± 13 ms, respectively, p < 0.000). According to ROC analysis, a cut point of 124 ms for ICT with a sensitivity of 74 % and specificity of 73 % in patients with CS (p < 0.001). This study show us, the measurements the ICT determined by means of echocardiography is longer in patients with CS. This simple and noninvasive technique can be applied widely and lead the clinicians to adopt the use of diagnostic and the treatment procedures.
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Affiliation(s)
- Mustafa Karaca
- Atatürk Eğitim Araştırma Hastanesi Kardiyoloji Bölümü, Basın Sitesi 35150 Karabağlar, Izmir, Turkey
| | - D Aytekin
- Medikalp Heart Disease Clinic Cardiology Department, Izmir, Turkey
| | - T Kırıs
- Atatürk Eğitim Araştırma Hastanesi Kardiyoloji Bölümü, Basın Sitesi 35150 Karabağlar, Izmir, Turkey
| | - A Koskderelioglu
- Izmir Bozyaka State and Research Hospital Neurology Department, Izmir, Turkey
| | - M Gedizlioglu
- Izmir Bozyaka State and Research Hospital Neurology Department, Izmir, Turkey
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20
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Meschia JF. Pacemakers as Atrial Fibrillation Detectors: Finding Racial Differences and Opportunities for Preventing Stroke. J Am Heart Assoc 2016; 5:e003090. [PMID: 26873690 PMCID: PMC4802437 DOI: 10.1161/jaha.115.003090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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21
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Jawad-Ul-Qamar M, Kirchhof P. Almanac 2015: atrial fibrillation research in Heart. Heart 2016; 102:573-80. [PMID: 26791994 PMCID: PMC4819630 DOI: 10.1136/heartjnl-2015-307809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 01/21/2023] Open
Abstract
Atrial fibrillation continues to attract interest in the cardiovascular community and in Heart. Over 60 original research and review papers published in Heart in 2014–2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published in Heart in 2014–2015, highlighting new developments, emerging concepts and novel approaches to treatment.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK UHB NHS Trust, Birmingham, UK Atrial Fibrillation NETwork (AFNET), Münster, Germany Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
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