100 research outputs found
Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
Cost-effectiveness and screening performance of ECG handheld machine in a population screening programme: The Belgian Heart Rhythm Week screening programme
Aims Overall, 40% of patients with atrial fibrillation are asymptomatic. The usefulness and cost-effectiveness of atrial fibrillation screening programmes are debated. We evaluated whether an atrial fibrillation screening programme with a handheld electrocardiogram (ECG) machine in a population-wide cohort has a high screening yield and is cost-effective. Methods We used a Markov-model based modelling analysis on 1000 hypothetical individuals who matched the Belgian Heart Rhythm Week screening programme. Subgroup analyses of subjects >= 65 and >= 75 years old were performed. Screening was performed with one-lead ECG handheld machine Omron (R) HeartScan HCG-801. Results In both overall population and subgroups, the use of the screening procedure diagnosed a consistently higher number of diagnosed atrial fibrillation than not screening. In the base-case scenario, the screening procedure resulted in 106.6 more atrial fibrillation patient-years, resulting in three fewer strokes, 10 more life years and five more quality-adjusted life years (QALYs). The number needed-to-screen (NNS) to avoid one stroke was 361. In subjects >= 65 years old, we found 80.8 more atrial fibrillation patient-years, resulting in three fewer strokes, four more life-years and five more QALYs. The NNS to avoid one stroke was 354. Similar results were obtained in subjects >= 75 years old, with a NNS to avoid one stroke of 371. In the overall population, the incremental cost-effectiveness ratio for any gained QALY showed that the screening procedure was cost-effective in all groups. Conclusions In a population-wide screening cohort, the use of a handheld ECG machine to identify subjects with newly diagnosed atrial fibrillation was cost-effective in the general population, as well as in subjects >= 65 and subjects >= 75 years old
Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters
Objectives: To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters. Methods: Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and the analgesics were recorded. Patients were followed for at least 3 months. Results: The acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144±48 min for RF, vs 158±49 min for cryo). More applications were given with RF than with cryo (26±17 vs. 18±10, p<0.05). Fluoroscopy time was longer with RF (29±15 vs. 19±12 min, p<0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly less analgesia (p<0.01), and no use of long sheaths (p<0.005). The isthmus tended to be longer in the failed procedures (p=0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success. Concl
Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF
M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe
Rappels des principes fondamentaux en électrocardiographie
Cet article décrit les principes de base de l’électrocardiogramme (ECG). Il s’adresse aux personnes curieuses d’en connaître un peu plus sur cet examen cardiologique de base et incontournable qui permet de dépister nombre de maladies cardiaques
Fibrillation Auriculaire : les montres connectées pour la détecter, les guidelines pour la traiter
Les derniers Guidelines de la fibrillation atriale (FA) ont été publiés fin août 2020, coïncidant avec le Congrès Européen de Cardiologie (ESC)1. Cet épais document de 126 pages insiste sur de nombreux points dont la prise en charge qui devient non seulement spécialisée mais surtout pluridisciplinaire. [Revivre le WEBINAIRE du Louvain Médical du 27 mai 2021
INNOVATIONS EN CARDIOLOGIE QUE RETENIR DE 2016 ?
Cette année a vu l’apparition en Belgique de 2 nouvelles molécules dans le domaine de la rythmologie, le Praxbind© et le Brivaness©, leur utilisation sera présentée. En 2016, la Société Européenne de Cardiologie a publié de nouvelles recommandations concernant la prise en charge des dyslipidémies, de la fibrillation auriculaire, de l’insuffisance cardiaque et de la prévention cardiovasculaire. Cet article revoit brièvement les points essentiel
Bloc auriculo-ventriculaire complet de cause exceptionnelle
L’apparition de troubles de conduction auriculo-ventriculaire nécessite des examens complémentaires afin de préciser l’étiologie. Le diagnostic différentiel comprend des pathologies infectieuses, infiltratives et néoplasiques. Parmi celles-ci, le lymphome cardiaque primitif est une entité rare dont le diagnostic est souvent tardif. Avec un traitement adéquat, une réponse tumorale complète avec résolution des troubles de conduction peut être obtenue. Que savons-nous à ce propos ? Le lymphome primitif cardiaque est une pathologie rare, représentant 1% des tumeurs cardiaques primitives. Il entreprend souvent le cœur droit et préférentiellement les oreillettes aux ventricules. Exceptionnellement il peut se compliquer d'un bloc auriculo-ventriculaire. Que nous apporte cet article ? Cet article illustre l’importance de rechercher un diagnostic étiologique en présence d’un bloc auriculo-ventriculaire. Le lymphome cardiaque primitif est une pathologie rare avec une mortalité importante sans traitement. Avec un diagnostic précoce et un traitement adéquat, la réponse thérapeutique peut être spectaculaire et permettre de normaliser les troubles de conduction
- …