Patient-reported Symptomatic Events Do Not Adequately Reflect Atrial Arrhythmia.

BACKGROUND: Management of atrial fibrillation is frequently geared towards improving symptoms. Yet, the magnitude of symptom rhythm discordance is not well known in the setting of ambulatory electrocardiographic (AECG) monitoring. OBJECTIVE: We aimed to quantify the symptom rhythm correlation for atrial arrhythmia (AT/AF) events. METHODS: This was a retrospective cohort analysis of AECG data at a tertiary care center. All AECGs of >7 days with at least one AT/AF were included. Patient-triggered symptoms included shortness of breath, tiredness, palpitations, dizziness, or passing out with or without concurrent AT/AF. Symptom-rhythm correlation (SRC) was calculated for each patient. Additionally, AT/AF-Symptom association was evaluated at the event level using multivariable mixed effects logistic regression. RESULTS: We identified 742 patients with qualifying AECG data; mean age was 64 years, 50% were female, 22% had heart failure, and mean CHA2DS2-VASc score was 2.5. There were 6,289 symptomatic events and 6,900 ATAF episodes. Among symptomatic events 1013(16%) had shortness of breath, 839(13%) tiredness, 2640(42%) palpitations, 783(12%) dizziness, and 93(1%) with passing out. Overall SRC was 0.39(range 0-1.0), but presence of ATAF increased odds of symptoms by ∼8.3 times in adjusted analyses(p<0.01). In multivariable analysis, prior AF rhythm control treatment and lower heart rate were associated with worse SRC(p<0.01). CONCLUSION: While ATAF events increase the chances of symptoms, there is poor overall correlation between symptomatic events and documented ATAF. Patient factors and prior treatments influence symptom-rhythm correlation. An improved understanding of this relationship correlation is needed to optimize clinical outcomes and improve the rigor of AF research.

Pericardial Decompression Syndrome After Drainage of Chronic Pericardial Effusions.

Pericardial decompression syndrome (PDS) is a potentially fatal disorder of left ventricular function that sometimes occurs after drainage of a pericardial effusion for cardiac tamponade. Patients at risk for PDS are difficult to identify. Here, we report 2 cases where PDS developed after drainage of effusions that had been present for years, suggesting that patients with chronic effusions are at higher risk for PDS. (Level of Difficulty: Advanced.).

Ultra-Sensitive Ultrasound.

Lung ultrasound (LUS) is a dynamic, real-time, non-invasive bedside tool that offers increased sensitivity over standard imaging modalities in identifying pulmonary edema. This case highlights acute post-operative hypoxia secondary to pulmonary edema that was initially missed by chest radiography (CXR) and chest computed tomography (CT). The edema was diagnosed first on same day by bedside LUS, later seen on next day follow-up CXR and resolved with diuresis. LUS has demonstrated superior accuracy compared to CXR, but scant evidence compares it to CT. This case presentation serves to increase awareness of LUS as a highly sensitive and easy-to-use diagnostic tool for hospital providers in the evaluation of acute hypoxia.