The mid-term results of patients who underwent radiofrequency atrial fibrillation ablation together with mitral valve surgery

Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74) underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90%) were in NYHA class III; 34 (85%) patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

Sinus Tachyarrhythmia

Sinus tachycardia is an accelerated rhythm in which the rate of impulses arising from the sinoatrial node is elevated. Uncontrolled sinus tachycardia may result in a poor prognosis, particularly in patients with cardiovascular disease, because of a hemodynamic disturbance arising from the tachycardia itself. When sinus tachycardia is specifically triggered by anemia, shock, or fever, it is referred to as physiological sinus tachycardia. Physiological sinus tachycardia should resolve with correction of the underlying cause. Inappropriate sinus tachycardia (IST) is unexplained by physiological demand. Palpitation is the most frequent symptom in IST patients. Even though treatment of IST has insufficient efficacy and a relatively high recurrence rate, several treatment strategies such as use of a β-blocker, ivabradine, and radiofrequency catheter ablation can be used for IST patients.

The change and its clinical significance of deceleration capacity of heart rate in elderly coronary artery disease / 中华老年医学杂志

Objective To investigate the change and its clinical significance of the deceleration capacity (DC) of heart rate in elderly patients with coronary heart disease (CHD).Methods A total of 105 elderly CHD patients and 86 elderly non-CHD patients were selected.All patients underwent 24 h ambulatory electrocardiographic recording.DC,heart rate variability (HRV) time domain index,heart rate turbulence (HRT) parameters including turbulence onset (TO) and turbulence slope (TS),and the occurrence of ventricular arrhythmias were off-line calculated.Results The values of DC,HRV and HRT were decreased in elderly patients with CHD.DC had positive correlations with standard deviation of normal-to-normal intervals (SDNN),the square root of the mean squared successive differences between normal-to-normal RR intervals (rMSSD) and percentage of adjacent normal-to-normal intervals that differed more than 50 ms (pNN50) (r=0.60,0.51,0.49,0.41,respectively,all P ＜0.05) and had a negative correlation with the occurrence of ventricular arrhythmias (r=-0.34,P＜0.05).The value of DC was much decreased in elderly CHD patients with type 2 diabetic or acute myocardial infarction.Conclusions The decreased DC value is correlated with heart rate variability,turbulence slope and the occurrence of ventricular arrhythmias in elderly CHD patients.The deceleration capacity of heart rate is a better noninvasive method for screening and predicting sudden death in high-risk elderly patients with CHD.

Comparação entre métodos de avaliação da modulação vagal cardíaca / Comparison of assessment methods of cardiac vagal modulation

FUNDAMENTO: Diversos métodos têm sido utilizados para avaliar a modulação vagal cardíaca; entretanto, há lacunas quanto a associação e acurácia desses métodos. OBJETIVO: Investigar a associação entre três métodos válidos, reprodutíveis e comumente utilizados para avaliação da modulação vagal cardíaca, e comparar as suas acurácias. MÉTODOS: Trinta homens saudáveis (23 ± 4 anos) e 15 homens com coronariopatia (61 ± 10 anos) foram avaliados em ordem contrabalanceada pela Variabilidade da Frequência Cardíaca (VFC; variáveis: domínio do tempo = pNN50, DPNN e RMSSD, domínio da frequência = AF ms² e AF u.n.), Arritmia Sinusal Respiratória (ASR) e Teste de Exercício de 4 segundos (T4s). RESULTADOS: Indivíduos saudáveis apresentaram maior modulação vagal nos três métodos (p < 0,05). No grupo saudável houve correlação (p < 0,05) entre os resultados da VFC (pNN50 e DPNN) e da ASR, mas não houve correlação entre o T4s e os outros dois métodos estudados. No grupo com coronariopatia houve correlação entre os resultados da VFC (pNN50, DPNN, RMSSD, AF ms² e AF u.n.) e da ASR. Em adição, houve correlação entre o T4s e a ASR. Por fim, os métodos ASR e T4s apresentaram tamanho do efeito mais preciso e melhor acurácia (p < 0,05) comparados à VFC. CONCLUSÃO: A VFC e a ASR geraram resultados parcialmente redundantes em indivíduos saudáveis e em pacientes com coronariopatia, enquanto o T4s gerou resultados complementares a VFC e ASR em indivíduos saudáveis. Além disso, os métodos ASR e T4s foram mais precisos para discriminar a modulação vagal cardíaca entre indivíduos saudáveis e pacientes com coronariopatia comparados à VFC.

BACKGROUND: Several methods have been used to assess cardiac vagal modulation, but there are gaps regarding the association and accuracy of these methods. OBJECTIVE: To investigate the association between three valid, reproducible and commonly methods used to assess cardiac vagal modulation and compare their accuracies. METHODS: Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced design by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms² and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced order by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms² and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). RESULTS: Healthy subjects had higher vagal modulation by the three methods (p <0.05). There was a correlation in the healthy group (p <0.05) between the results of HRV (SDNN and pNN50 and RSA, but there was no correlation between the T4s and the other two methods. In the group with coronary artery disease, there was a correlation between the results of HRV (pNN50, SDNN, RMSSD, HF ms² and HF n.u.) and RSA. In addition, there was a correlation between the RSA and T4s. Finally, the T4s and RSA methods presented more accurate effect size and better accuracy (p <0.05), when compared to the HRV. CONCLUSION: HRV and RSA generated partially redundant results in healthy subjects and in patients with coronary artery disease, while the T4s generated results that were complementary to HRV and RSA in healthy subjects. In addition, RSA and T4s methods were more accurate when discriminating cardiac vagal modulation between healthy subjects and patients with coronary artery disease, when compared to HRV.

Qualidade de vida em pacientes com cardioversor desfibrilador implantável: utilização do questionário SF-36 / Quality of life of patients with implantable cardioversor-defibrillator: the usage of SF-36 questionnaire

OBJETIVO: Verificar a qualidade de vida em pacientes portadores de cardioversor desfibrilador implantável (CDI) por meio do Questionário SF-36 MÉTODOS: Pesquisa descritiva com abordagem quantitativa realizada em um ambulatório de Cardiologia, por meio de entrevista e do Questionário SF-36 a 50 portadores de CDI durante a consulta médica de acompanhamento, no período de janeiro a dezembro de 2009 RESULTADOS: Dentre os indivíduos incluídos no estudo, 19 (38 por cento) eram do gênero feminino e 31 (62 por cento), do masculino. A idade média foi de 58,4 anos, variando de 21 a 75 anos. Verificaram-se apenas dois domínios abaixo do escore 50, relacionados às limitações por aspectos físicos e emocionais. O domínio aspectos sociais apresentou o maior escore, 80,5. A maioria dos pacientes relatou que sua saúde estava um pouco melhor em comparação ao ano anterior CONCLUSÃO: Os resultados evidenciaram prejuízo na qualidade de vida, demonstrando menores escores nos aspectos físicos e emocionais. Não houve correlação da qualidade de vida com as variáveis idade, gênero, estado civil e nível de escolaridade. Entretanto, os pacientes se sentem aliviados e seguros com os benefícios proporcionados pelo CDI na manutenção de suas vidas, protegendo-os da morte súbita.

OBJECTIVE: To observe the quality of life of patients with implantable cardioversor defibrillator (ICD). METHODS: Descriptive research with quantitative approach by means of an interview and the analysis of the Questionnaire SF-36 in a cardiovascular outpatient service. Fifty patients users of this device participated in this study during their medical follow-up in the period from January to December. RESULTS: Out of the subjects, 19 (38 percent) were female and 31 (62 percent) male. The average age was 58.4 years, ranging from 21 to 75 years. Two domains regarding limitations by physical and emotional aspects below score 50 were observed The social aspects domain presented the higher score; 80,5. Most of the users reported that their health is a little better compared with a year ago. CONCLUSION: The results showed that individuals' quality of life is impaired, with lower scores for physical and emotional aspects. There was not a correlation between quality of life and age, gender, marital status and educational level. However, they feel comfortable and safe with ICD benefits since it provides their maintenance in being alive protecting them of sudden death.

Sinus heart rate turbulence in patients with different subtypes of essential hypertension / 中国医师进修杂志

Objective To explore sinus heart rate turbulence (HRT) in patients with different subtypes of essential hypertension (EH), and analyze the relationship between HRT and autonomic nervous system function damage in these patients. Methods The study consisted of 107 patients with EH (EH group) and 46 controls (control group). Based on 24 hours dynamic electrocardiogram, all patients were divided into dipper,non-dipper,and anti-dipper blood pressure group. The indexes about HRT and heart rate variability (HRV) among these groups were calculated and compared,and the relationship between turbulence onset (TO),turbulence slope (TS) and 24 hours mean systolic blood pressure,diastolic blood pressure was analyzed. Results There were significant differences in TO,TS,SDNN between EH group and control group(P ＜ 0.05 ). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in control group( P ＜ 0.05 ), and TS was lower than that in control group(P ＜ 0.05 ). There was no significant difference in TO,TS between dipper blood pressure group and control group (P ＞ 0.05). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in dipper blood pressure group, but TS was lower than that in dipper blood pressure group (P ＜0.05). Correlation analysis showed that TO had positive relationship with average heart rate and age (rs = 0.265, P = 0.004;rs = 0.217, P = 0.018 ), but had negative correlation with SDNN and left ventricular ejection fraction (LVEF) (rx = -0.287,P = 0.002;rx =-0. 179, P = 0.049). Whereas, TS had negative correlation with average heart rate and age (r = -0.335, P =0.015 ;r = -0.238,P= 0.009), but had positive relationship with SDNN and LVEF(r = 0.540,P = 0.001 ;r =0.432,P = 0.001 ). Conclusions HRT of EH patients becomes significantly low. It suggests that the autonomic nerve function in EH patients be injured seriously.