ABSTRACT
BACKGROUND: Recent studies of patients with pacemakers and implantable cardioverter/defibrillators have shown that subclinical atrial fibrillation (AF) is common and is associated with thromboembolic risk. We sought to evaluate the frequency, characteristics, and impact of new AF diagnosed by ambulatory 30-day rhythm monitoring. METHODS: The 30-day rhythm monitoring data from January 2010 to August 2015 at our institution were reviewed. Medical record review was performed on patients that had a new or preexisting diagnosis of AF. RESULTS: Of 2,326 patients without a previous diagnosis of AF, 78 had a new diagnosis of AF (3.4%) during 30-day monitoring. Patients with a new diagnosis of AF (mean age of 68.5 years, 56% female) had a mean CHA2DS2-VASc score of 3.2 (±1.8). The median time to diagnosis was 6 days, and 86% were diagnosed within 14 days. In 31 patients (40%), AF was exclusively detected automatically by the monitor. Of 46 patients that had manually activated the monitor, 34 also had automatically detected AF. Each patient had a median of 7 episodes, with the median duration of the longest episode being approximately 2 hours. Following the diagnosis of AF, 37 (47%) were started on anticoagulation and 9 (12%) were prescribed aspirin. CONCLUSIONS: A total of 3.4% of patients who underwent 30-day rhythm monitoring for any indication were found to have a new diagnosis of AF (402 per 1000 patient-years). Most of these episodes were detected automatically, corresponding to device-detected subclinical AF. The most common intervention following diagnosis of AF was initiation of oral anticoagulation.
Subject(s)
Atrial Fibrillation/diagnosis , Electrocardiography, Ambulatory/methods , Heart Rate/physiology , Administration, Oral , Aged , Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Female , Follow-Up Studies , Humans , Male , Prognosis , Retrospective Studies , Risk Factors , Thromboembolism/etiology , Thromboembolism/prevention & control , Time FactorsABSTRACT
Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form.
Subject(s)
Aortic Valve/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Hypereosinophilic Syndrome/diagnostic imaging , Adult , Anticoagulants/therapeutic use , Aortic Valve/physiopathology , Echocardiography/methods , Echocardiography, Transesophageal/methods , Female , Humans , Hypereosinophilic Syndrome/drug therapy , Hypereosinophilic Syndrome/physiopathologyABSTRACT
A 54year old man with hypertrophic cardiomyopathy was evaluated for alcohol septal ablation. However there were no sizeable septal branches from the left anterior descending artery supplying the basal septum. He was found to have a rare variant, the descending septal branch from ostial right coronary artery and underwent ablation through the same. We describe our case and the relevant literature available for use of this anatomical variant in alcohol septal ablation.