Supraventricular tachycardia and catheter ablation: Anxiety levels and patient perceptions

Aim: To investigate anxiety levels and patient perception associated with supraventricular tachycardia (SVT); investigate anxiety levels and patient perception pre- and post- radiofrequency catheter ablation (RFCA); and explore any association between anxiety and patient perception with patient age and gender.Design: Follow-up quantitative and qualitative cohort study. 141 patients in a tertiary centre in Scotland who underwent an electrophysiological study and RFCA for atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia or atrial tachycardia between 2009 and 2012 were enrolled. 59 (41.8%) were male; mean age at follow-up was 50 years.Interventions: Follow-up by structured phone questionnaire; mean follow-up period was 14 months. Main outcome measures: Anxiety level and patient perception during index episode, and anxiety level before and after RFCA.Results: During index episode, median patient anxiety, on a scale of 0–10, was 8. Anxiety was not associated with gender (p = 0.07). Patients in the lowest and highest anxiety groups tended to be older (mean 54.5 and 44.4 years respectively) compared with those in the middle 2 groups (mean 34.1 and 35.6 years). There was an association between anxiety and age (p = 0.039). 45 (32.0%) participants thought they were having a heart attack or dying. Before RFCA, median anxiety level was 7. 55 (39.0%) patients were afraid of complications, 21 (14.9%) patients feared being awake during RFCA. After RFCA, median anxiety was 2.5.Conclusions: Anxiety is a common accompaniment to SVT that may lead to greater pre-procedural anxiety. Exploring this link may allow reduction of anxiety via better psychopharmacological intervention, education, and preprocedural counselling

The Grizzly, September 28, 1989

Berman Art Center Ready to Roll • New Forum Frontier to be Forged • Letter: Granite Windows Grosses Grad • Stern Happy at Ursinus • Bear Pack Run: Join Us! • Bush Wacked at Drug Dialog • Security New Park Patrol • Wellness Days! • Crutcher Leads Lady Bears to Win • Ursinus Nipped by WMC • Soccer: So-So • V-ball: Optimistic View • Athletes of the Week • Hallinger Competes on Wheels • Calliope Blast from Pasthttps://digitalcommons.ursinus.edu/grizzlynews/1242/thumbnail.jp

Structural brain abnormalities in postural tachycardia syndrome: A VBM-DARTEL study

Postural tachycardia syndrome (PoTS), a form of dysautonomia, is characterized by orthostatic intolerance, and is frequently accompanied by a range of symptoms including palpitations, lightheadedness, clouding of thought, blurred vision, fatigue, anxiety, and depression. Although the estimated prevalence of PoTS is approximately 5–10 times as common as the better-known condition orthostatic hypotension, the neural substrates of the syndrome are poorly characterized. In the present study, we used magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) applying the diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL) procedure to examine variation in regional brain structure associated with PoTS. We recruited 11 patients with established PoTS and 23 age-matched normal controls. Group comparison of gray matter volume revealed diminished gray matter volume within the left anterior insula, right middle frontal gyrus and right cingulate gyrus in the PoTS group. We also observed lower white matter volume beneath the precentral gyrus and paracentral lobule, right pre- and post-central gyrus, paracentral lobule and superior frontal gyrus in PoTS patients. Subsequent ROI analyses revealed significant negative correlations between left insula volume and trait anxiety and depression scores. Together, these findings of structural differences, particularly within insular and cingulate components of the salience network, suggest a link between dysregulated physiological reactions arising from compromised central autonomic control (and interoceptive representation) and increased vulnerability to psychiatric symptoms in PoTS patients

Multicentre open label randomised controlled trial of immediate enhanced ambulatory ECG monitoring versus standard monitoring in acute unexplained syncope patients:the ASPIRED study

Introduction Diagnosing underlying arrhythmia in emergency department (ED) syncope patients is difficult. There is a evidence that diagnostic yield for detecting underlying arrhythmia is highest when cardiac monitoring devices are applied early, ideally at the index visit. This strategy has the potential to change current syncope management from low diagnostic yield Holter to higher yield ambulatory monitoring, reduce episodes of syncope, reduce risk of recurrence and its potential serious consequences, reduce hospital admissions, reduce overall health costs and increase quality of life by allowing earlier diagnosis, treatment and exclusion of clinically important arrhythmias. Methods and analyses This is a UK open prospective parallel group multicentre randomised controlled trial of an immediate 14-day ambulatory patch heart monitor vs standard care in 2234 patients presenting acutely with unexplained syncope. Our patient focused primary endpoint will be number of episodes of syncope at 1 year. Health economic evaluation will estimate the incremental cost per syncope episode avoided and quality-adjusted life year gained. Ethics and dissemination Informed consent for participation will be sought. The ASPIRED trial received a favourable ethical opinion from South East Scotland Research Ethics Committee 01 (21/SS/0073). Results will be disseminated via scientific publication, lay summary and visual abstract

The Grizzly, September 22, 1989

Kane Claiming Greeks Shall Survive • Olin Noise Annoys All • Letters: Boot Booze Begs Senior; Rovers Rotten • DiFeliciantonio: A Mouthful • McNulty Directs Residents • Surprise, surprise! UC Stomps Swarthmore • Ursinus Closes Gap with F&M Diplomats • Commentary; Why Bush War Can\u27t be Won; HPER Lab a Strong Addition • Intramurals: Full Steam Ahead! • One Giant Step • Sports Summary • Pledging: End of an Era? • BWC Causes Electrical Overloadhttps://digitalcommons.ursinus.edu/grizzlynews/1241/thumbnail.jp

Blueprint for change in AF: the Scottish national inquiry

Background: Understanding Atrial Fibrillation (AF) management in Scotland was identified as a key priority at the Cross Party Group (CPG) for Heart Disease and Stroke which meets regularly at the Scottish Parliament. Therefore, a national inquiry was launched to provide clear recommendations to government to improve health for people living with AF. Methods: An advisory panel was convened comprising major third sector representatives, academics, clinicians, Members of Scottish Parliament (MSPs), and people living with AF. Two questionnaires, one for clinicians; one for people living with AF were circulated through multiple channels and four roundtable events were held. Results: In total there were 262 responses to the questionnaires (n=203 clinician; n=59 people living with AF) and roundtables were attended by 35 people, including members of the advisory panel, MSPs, clinicians, academics and people living with AF. Ten key recommendations emerged relating to Detection and diagnosis of atrial fibrillation; Initial treatment and subsequent management of atrial fibrillation; The use of data to improve detection, diagnosis and treatment of atrial fibrillation in Scotland; and patient information and public awareness. Conclusions: It is hoped that the results of this inquiry will provide the blueprint for change that will improve AF management across Scotlan

Marked variation in newborn resuscitation practice: a national survey in the UK

Abstract Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications

Brain natriuretic peptide and high-sensitivity Troponin at 3 hours post emergency department attendance with unexplained syncope predict 90 day outcome

To investigate if Brain Natriuretic Peptide (BNP) and highsensitivity troponin I predict significant arrhythmia, symptomatic significant arrhythmia and 90-day death and/or Major Adverse Cardiac Event in Emergency Department (ED) unexplained syncope patients investigated with a 14-day ambulatory electrocardiogram (ECG) recorder. Single-centre, prospective, cohort study. Patients 16 years or over presenting within 6 hours of an episode of unexplained syncope were fitted with an ambulatory ECG recorder (Zio® XT monitor) and had high-sensitivity troponin I and BNP measured on ED admission and 3 hours later. Between 17/11/2015 and 13/06/2017, 86 patients were recruited. 24 had significant arrhythmia, 9 symptomatic significant arrhythmia and 26 patients had death and/or Major adverse cardiac events by 90 days. BNP at admission, three hours and change in BNP and high-sensitivity troponin I at three hours were associated with significant arrhythmia and serious outcome. BNP>20pg/mL and/or high-sensitivity troponin I above the 99% sex specific centile (M>34ng/L, F>16ng/L) at 3 hours had a sensitivity of 100% (21/21; 95% CI 81%-100%) and specificity of 43% (16/37; 28%-60%) for significant arrhythmia and a sensitivity of 100% (22/22; 95% CI 82%- 100%) and specificity of 44% (16/36; 28%-62%) for serious outcome both at 90 days. The combination of BNP and high-sensitivity troponin I at 3 hours shows promise as a potential predictive marker for serious arrhythmia and serious outcome at 90 days and deserves further exploration as a rule out test to enable safe discharge of patients from the ED who are at low risk of having cardiac syncope and subsequent adverse events