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2.
JMIR Mhealth Uhealth ; 10(1): e30807, 2022 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-34894626

RESUMO

BACKGROUND: Poor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited. OBJECTIVE: The purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF. METHODS: Patient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. RESULTS: A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82%) patients underwent follow-up at 1 month, 107 (79%) at 3 months, and 96 (71%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93%) and 10 (7%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group. CONCLUSIONS: The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful.


Assuntos
Fibrilação Atrial , Aplicativos Móveis , Acidente Vascular Cerebral , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade
3.
J Arrhythm ; 37(2): 445-447, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33850587

RESUMO

A 51-year-old man, who had a history of open heart surgery for corrected transposition of great arteries, presented with palpitation due to atrial tachycardia. A propagation map using three-dimensional electroanatomical mapping (CARTO3) showed atrial flutter and underwent linear ablation successfully. This case highlights the difficulty of diagnosis before mapping following a complicated cardiac operation and the usefulness of three-dimensional mapping.

4.
J Cardiol Cases ; 23(2): 80-82, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33520029

RESUMO

A 74-year-old man who had a history of paroxysmal atrial fibrillation, visited the emergency department because of syncope. An electrocardiogram showed atrial fibrillation with slow ventricular response and long pauses. A permanent pacemaker was implanted under oral anticoagulation. Two screw-in leads were positioned at the right atrial appendage and the right ventricular apex. Seven hours after the implantation, he collapsed with hypotension due to cardiac tamponade. Vital signs improved after urgent pericardial drainage, but blood was continuously drained from the pericardial catheter. Due to uncontrollable cardiac tamponade, surgical repair was indicated. We found neither of the leads perforated the myocardium, but there was intermittent bleeding from a pin hole injury in the atrial wall site of the right coronary artery. Redness was observed in the right atrial appendage, but there was no bleeding point. We supposed that the screw tip of the atrial lead might have perforated the atrial appendage, but was retracted spontaneously afterwards. The pin hole was closed with a patch and the postoperative course was uneventful. This is a rare case of cardiac tamponade due to the injury of the coronary artery by a screw-in lead positioned at the right atrial appendage. .

5.
Int J Cardiovasc Imaging ; 37(3): 903-912, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33047179

RESUMO

To clarify the impact on left ventricular (LV) function of percutaneous atrial septal defect (ASD) closure in adult patients. Echocardiograms of 46 patients (52 ± 18 years) who underwent ASD closure with a significant left-to-right shunt obtained before and 1 month after the procedure were retrospectively analyzed. Functional parameters were obtained by 2-dimensional speckle-tracking imaging. Global longitudinal strain and strain rate at early diastole (SRe) was calculated from the three standard apical views, while circumferential and radial parameters were calculated from basal, middle, and apical LV short-axis views. Along with a diminished right ventricular (RV) volume, the LV volume and ejection fraction increased (end-diastolic volume: 61 ± 12 to 76 ± 15 mL, p < 0.001; and 63% ± 4 to 64% ± 4% p = 0.03; respectively). Both global strain and SRe was augmented only in the circumferential direction (- 16.2% ± 2.9% to - 19.8% ± 2.8%; and 1.07 ± 0.29 to 1.34 ± 0.28 s-1, both p < 0.001). Augmentation of circumferential SRe correlated with both the changes in and the pre-procedural value of diastolic LV eccentricity index (r = - 0.57, p < 0.001; and r = 0.37, p = 0.01; respectively), a morphological parameter of RV volume overload. Following ASD closure in adults, both LV systolic and diastolic function could favorably change in the circumferential direction, and the degree of diastolic functional change is associated with RV volume overload, i.e., severity of ventricular interdependence.


Assuntos
Cateterismo Cardíaco , Ecocardiografia Doppler , Ecocardiografia Tridimensional , Comunicação Interatrial/terapia , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
J Cardiol Cases ; 22(6): 257-259, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33304416

RESUMO

Congenital long QT syndrome (LQTS) is associated with ventricular arrhythmia and an increased risk of sudden cardiac death in young people. However, it is extremely rare for an elderly man to experience ventricular fibrillation (VF) due to congenital LQTS as a first episode. We describe the case of an 84-year-old man who experienced syncope after urination. He had a medical history of hypertension and asthma, but no history of syncope. Electrocardiographic findings in 2017 showed QT prolongation (corrected QT = 505 ms). No medication that could induce QT prolongation was administered. Blood test results on admission showed no electrolyte abnormalities, and there were no abnormal findings on echocardiography. The second episode of loss of consciousness occurred during hospitalization, and electrocardiography revealed incessant torsade de pointes, caused by R-on-T with short-long-short (SLS) sequences due to bradyarrhythmia. Coronary angiography did not detect myocardial ischemia, and an implantable cardioverter-defibrillator was implanted for secondary prevention. Genetic testing revealed a mutation of the KCNH2 gene, indicating LQTS type 2. In summary, we report a rare case of prolonged QT interval with SLS sequences due to sick sinus syndrome triggering VF as the first attack in an elderly patient with LQTS type 2. .

7.
Prog Rehabil Med ; 5: 20200028, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33210015

RESUMO

BACKGROUND: Recent reports on catheter ablation for premature ventricular complex (PVC) or ventricular tachycardia in the context of cardiomyopathy suggest that ablation can improve cardiac function and decrease the number of PVCs. However, reports on exercise tolerance after catheter ablation for PVC are few. CASE: A 56-year-old woman consulted her primary care doctor presenting with palpitations and fatigue on exertion. Her left ventricular systolic function had been normalized with medications after a diagnosis of dilated cardiomyopathy 5 years previously. Electrocardiography showed sinus rhythm and ventricular bigeminy. Holter electrocardiography revealed a total of 34,867 PVCs. The highest number of consecutive PVCs recorded was three. In the cardiopulmonary exercise test, the peak oxygen consumption (VO2) was markedly reduced to 14 ml/kg/min. The patient was referred to our hospital for catheter ablation because pharmacotherapy was ineffective. PVCs originated from the left ventricular outflow tract and were successfully eliminated by ablation at the non-coronary cusp of the aortic valve using three-dimensional activation mapping with a CARTO system. The patient's symptoms on exertion improved immediately after ablation. Postoperative Holter electrocardiography revealed that the number of PVCs had decreased to one per day. Peak VO2 had markedly improved to 22 ml/kg/min 2 months after catheter ablation therapy. DISCUSSION: The elimination of frequent PVCs contributed to improved exercise tolerance.

8.
J Electrocardiol ; 60: 209-211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32446110

RESUMO

A 58-year-old woman with a history of multi-origin atrial tachycardia and limb-girdle muscular dystrophy was treated for presyncope caused by pauses in atrial rhythm. A dual-chamber pacemaker was implanted. The low-voltage area extended broadly, but 10-V pacing could not capture the large right atrium, including the right atrial appendage, except the coronary sinus ostium. The atrial lead was screwed in using a steerable stylet. A ventricular lead was placed in the right ventricular apex. Atrial pacing at the coronary sinus was required to treat the pauses in the atrial rhythm.


Assuntos
Fibrilação Atrial , Distrofia Muscular do Cíngulo dos Membros , Marca-Passo Artificial , Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia , Feminino , Átrios do Coração , Humanos , Pessoa de Meia-Idade
9.
J Arrhythm ; 36(1): 186-188, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32071641

RESUMO

A 63-year-old man was referred to our hospital for his palpitation due to atrial fibrillation. He was admitted for catheter ablation. Cryoablation was applied to the left superior pulmonary vein for 180 seconds, and its potential disappeared in 22 seconds. The lowest temperature was -45°C. Suddenly, sinus arrest was observed 1 minute after the completion of freezing. The right ventricle was paced but no atrial potential was observed for 5 minutes until normal sinus rhythm resumed. We report a case of severe sinus arrest after cryoablation to the left pulmonary vein.

10.
Circ J ; 84(2): 269-276, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31902829

RESUMO

BACKGROUND: Cardiac conduction disturbance (CD) is the most frequent complication following transcatheter aortic valve replacement (TAVR). This study examined whether the anatomy of the membranous septum (MS) could provide useful information about the risk of CD following TAVR with a balloon-expandable valve (BEV).Methods and Results:Among 132 consecutive patients, 106 (mean age, 85.6±5.1 years; 75 females) were included in the study. Using preoperative CT and angiography, MS length and implantation depth (ID) were assessed. The MS length minus the prosthesis ID was calculated (∆MSID). Correlation between CD, defined as new-onset left-bundle branch block (LBBB) or the need for permanent pacemaker (PPM) within 1 week after the procedure, and MS length were evaluated. A total of 19 patients (18%) developed CD following TAVR. MS length was significantly shorter in these patients than in those without CD (5.3±1.3 vs. 6.6±1.4; P<0.001), and was the important predictor of CD (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.27-0.69, P<0.001). When considering the pre- and postprocedural parameters, the ∆MSID was smaller in patients with CD (-1.7±1.5 vs. 0.8±1.9, P<0.001), and emerged as the important predictor of CD (OR: 0.47, 95% CI: 0.33-0.69, P<0.001). CONCLUSIONS: Short MS is associated with an increased risk of CD after TAVR with BEV.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Bloqueio de Ramo/etiologia , Angiografia por Tomografia Computadorizada , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Septo Interventricular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Septo Interventricular/fisiopatologia
11.
JACC Case Rep ; 2(4): 572-576, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34317296

RESUMO

A 50-year-old man presented with general fatigue on exertion. Investigations revealed tachycardia-induced cardiomyopathy induced by Wolff-Parkinson-White syndrome and atrial fibrillation. He was successfully treated with catheter ablation. Cardiac magnetic resonance imaging revealed that delayed enhancement throughout the left ventricle disappeared within 2 months after ablation. (Level of Difficulty: Beginner.).

12.
Circ Rep ; 2(7): 345-350, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-33693251

RESUMO

Background: Hypertension in patients with atrial fibrillation (AF) is a known independent risk factor for stroke. The Complete blood pressure (BP) monitor (Omron Healthcare, Kyoto, Japan) was developed as the first BP monitor with electrocardiogram (ECG) capability in a single device to simultaneously monitor ECG and BP readings. This study investigated whether the Complete can accurately differentiate sinus rhythm (SR) from AF during BP measurement. Methods and Results: Fifty-six consecutive patients with persistent AF admitted for catheter ablation were enrolled in the study (mean age 65.8 years; 83.9% male). In all patients, 12-lead ECGs and simultaneous Complete recordings were acquired before and after ablation. The Complete interpretations were compared with physician-reviewed ECGs, whereas Complete recordings were reviewed by cardiologists in a blinded manner and compared with ECG interpretations. Sensitivity, specificity, and κ coefficient were also determined. In all, 164 Complete and ECG recordings were simultaneously acquired from the 56 patients. After excluding unclassified recordings, the Complete automated algorithm performed well, with 100% sensitivity, 86% specificity, and a κ coefficient of 0.87 compared with physician-interpreted ECGs. Physician-interpreted Complete recordings performed well, with 99% sensitivity, 85% specificity, and a κ coefficient of 0.85 compared with physician-interpreted ECGs. Conclusions: The Complete, which combines BP and ECG monitoring, can accurately differentiate SR from AF during BP measurement.

13.
Int Heart J ; 58(6): 1008-1011, 2017 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-29151483

RESUMO

A 54-year-old woman with a history of multiple cardiac surgeries suffered from hypoxemia caused by a right-to-left intra-cardiac shunt due to coronary sinus (CS) anomaly with persistent left superior vena cava (PLSVC). Both the contrast echocardiography and enhanced computed tomography (CT) provided conclusive diagnosis of this rare congenital anomaly, which was overlooked for a long time. However, an important diagnostic clue was left-arm injection of the contrast media. In the present case, previously performed enhanced CT with its routine manner, i.e., contrast through the right arm, missed this anomaly. It is crucial to note that the unusual type of unroofed CS with PLSVC, presenting with an entirely right-to-left intra-cardiac shunt, cannot be delineated on an enhanced routine chest CT if the contrast media is injected through the right arm.


Assuntos
Meios de Contraste/administração & dosagem , Seio Coronário/anormalidades , Átrios do Coração/anormalidades , Cardiopatias Congênitas/diagnóstico por imagem , Hipóxia/etiologia , Seio Coronário/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipóxia/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores
14.
Echocardiography ; 33(5): 756-63, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26661528

RESUMO

BACKGROUND: Previous studies indicated that the three-dimensional features of the mitral valve (MV) have a significant impact on MV disease. However, quantification of MV with manual tracing software was too time-consuming for routine clinical practice. This study was performed to investigate the efficacy and accuracy of MV quantification with a novel highly automated commercially available software package developed for this purpose. METHODS: Using the manual tracing and automated package, two expert sonographers and one cardiologist individually analyzed three-dimensional datasets acquired with transesophageal echocardiography from 74 patients (15 with functional mitral regurgitation, 32 with MV prolapse, and 27 normal subjects) retrospectively. Time for analysis and inter-observer agreement were compared between the two methods, and agreement of measurements was analyzed using Cronbach's α. RESULTS: Time for analysis using the automated package was significantly shorter than manual tracing (whole cohort, 260 ± 65 vs. 381 ± 68 seconds, P < 0.001; functional mitral regurgitation, 234 ± 42 vs. 378 ± 64 seconds, P < 0.001; MV prolapse, 293 ± 69 vs. 407 ± 67 seconds, P < 0.001; normal controls, 235 ± 52 vs. 351 ± 60 seconds, P < 0.001). There was good agreement among all three observers using both methods, and measurements with the automated package agreed well with the manual tracing values. CONCLUSIONS: The novel automated software package reduced time for quantification of MV with similar accuracy compared to the manual method. Automated quantification is useful and may be a key to widespread adoption of three-dimensional quantification in clinical practice.


Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Reconhecimento Automatizado de Padrão/métodos , Idoso , Algoritmos , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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