Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation

<p>Abstract</p> <p>Background</p> <p>Symptoms related to atrial fibrillation and their impact on health-related quality of life (HRQoL) are often evaluated in clinical trials. However, there remains a need for a properly validated instrument. We aimed to develop and validate a short symptoms scale for patients with AF.</p> <p>Methods</p> <p>One hundred and eleven patients with a variety of symptoms related to AF were scheduled for DC cardioversion. The mean age was 67.1 ± 12.1 years, and 80% were men. The patients completed the new symptoms scale, the Toronto Symptoms Check List (SCL) and the generic Short Form 36 (SF-36) the day before the planned DC cardioversion. Compliance was excellent, with only 1 of 666 answers missing.</p> <p>Results</p> <p>One item, 'limitations in working capability', was deleted because of a low numerical response rate, as many of the patients were retired. The internal consistency reliability of the remaining six items was 0.81 (Cronbach's α). Patients scored highest in the items of 'dyspnoea on exertion', 'limitations in daily life due to AF' and 'fatigue due to AF', with scores of 4.5, 3.3 and 4.5, respectively. There was a good correlation to all relevant SF-36 domains and to the relevant questions of the SCL. The Rasch analyses showed that the items are unidimensional and that they are clearly separated and cover an adequate range. Test-retest reliability was performed in patients who failed DC and was adequate for three of six items, >0.70.</p> <p>Conclusion</p> <p>The psychometric characteristics of the new short symptoms scale were found to have satisfactory reliability and validity.</p

New Insights Into the Initiation of Atrial Fibrillation

Background— This study investigated onset scenarios of atrial fibrillation (AF), the first phase of the Atrial Fibrillation Therapy (AFT) trial, to determine potential arrhythmogenic triggers as targets for atrial pacing algorithms that have been proposed for prevention of AF. Methods and Results— Ninety-eight patients (58 men; age 65±11 years) with recurrent, symptomatic, drug-refractory AF and a conventional pacemaker indication in 31 of 98 received a dual-chamber pacemaker. Using novel diagnostic pacemaker features AF onset scenarios were prospectively evaluated in 612 AF episodes during a 2-month monitoring period, with atrial pacing limited to 40 bpm. The most common onset scenario was premature atrial complexes (PACs) before AF (48% onsets per patient), followed by bradycardia (33%), sudden onset (17%), and tachycardia (0%). Combinations of onset scenarios were frequent (median 2 different scenarios per patient). A main study finding was the significance of repetitive AF, with 33% of onsets per patient being initiated within 5 minutes of a previous AF episode. Sudden onsets were more frequent among patients with than without repetitive AF (24% versus 0% onsets per patient, P =0.011), whereas the proportion of PACs before AF was not statistically different (50% versus 37%, P =0.52); however, patients with repetitive AF had more PACs per hour (72 versus 29, P =0.023) and a higher number of AF episodes per day (17 versus 0, P =0.001) and were more likely to have at least 1 PAC-related onset (90% versus 53%, P <0.0001). Conclusions— Novel diagnostic pacemaker features allowed a detailed individual analysis of rate and rhythm changes before AF and thus uncovered a substantial intraindividual and interindividual variability of AF onset scenarios

Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing

Background: Atrial fibrillation (AF) is characterized by electrical and structural remodeling. Irregular and/or fast atrio-ventricular (AV) conduction during AF can result in AV dyssynchrony, tachymyopathy, pressure and volume overload with subsequent dilatation, valve regurgitation, and ventricular dysfunction with progression to heart failure. Objective: To gain further insight into the myocardial pathophysiological changes induced by right atrial tachypacing (A-TP) in a large animal model. Methods: A total of 28 Landrace pigs were randomized as 14 into AF-induced A-TP group and 14 pigs to control group. AF pigs were tachypaced for 43 +/- 4 days until in sustained AF. Functional remodeling was investigated by echocardiography (after cardioversion to sinus rhythm). Structural remodeling was quantified by histological preparations with picrosirius red and immunohistochemical stainings. Results: A-TP resulted in decreased left ventricular ejection fraction (LVEF) accompanied by increased end-diastolic and end-systolic left atrium (LA) volume and area. In addition, A-TP was associated with mitral valve (MV) regurgitation, diastolic dysfunction and increased atrial and ventricular fibrotic extracellular matrix (ECM). Conclusions: A-TP induced AF with concomitant LV systolic and diastolic dysfunction, increased LA volume and area, and atrial and ventricular fibrosis

Stellar Diameters and Temperatures II. Main Sequence K & M Stars

We present interferometric diameter measurements of 21 K- and M- dwarfs made with the CHARA Array. This sample is enhanced by literature radii measurements to form a data set of 33 K-M dwarfs with diameters measured to better than 5%. For all 33 stars, we compute absolute luminosities, linear radii, and effective temperatures (Teff). We develop empirical relations for \simK0 to M4 main- sequence stars between the stellar Teff, radius, and luminosity to broad-band color indices and metallicity. These relations are valid for metallicities between [Fe/H] = -0.5 and +0.1 dex, and are accurate to ~2%, ~5%, and ~4% for Teff, radius, and luminosity, respectively. Our results show that it is necessary to use metallicity dependent transformations to convert colors into stellar Teffs, radii, and luminosities. We find no sensitivity to metallicity on relations between global stellar properties, e.g., Teff-radius and Teff-luminosity. Robust examinations of single star Teffs and radii compared to evolutionary model predictions on the luminosity-Teff and luminosity-radius planes reveals that models overestimate the Teffs of stars with Teff < 5000 K by ~3%, and underestimate the radii of stars with radii < 0.7 R\odot by ~5%. These conclusions additionally suggest that the models overestimate the effects that the stellar metallicity may have on the astrophysical properties of an object. By comparing the interferometrically measured radii for single stars to those of eclipsing binaries, we find that single and binary star radii are consistent. However, the literature Teffs for binary stars are systematically lower compared to Teffs of single stars by ~ 200 to 300 K. Lastly, we present a empirically determined HR diagram for a total of 74 nearby, main-sequence, A- to M-type stars, and define regions of habitability for the potential existence of sub-stellar mass companions in each system. [abridged]Comment: 73 pages, 12 Tables, 18 Figures. Accepted for publication in The Astrophysical Journa