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1.
Clin Case Rep ; 12(5): e8718, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38681029

RESUMO

Key Clinical Message: This case highlights the pitfalls and provides tips for the extraction of deeply implanted lumenless leads, and encourages careful lead selection in the current era of widespread left bundle branch area pacing. Abstract: The extraction of cardiovascular implantable electronic device leads is sometimes complicated. We describe a case with difficult but successful extraction of SelectSecure, a lumenless permanent pacemaker lead, implanted deep in the ventricular septum, highlighting its pitfalls and tips in the current era of left bundle branch area pacing.

2.
Circ J ; 88(7): 1081-1088, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38281763

RESUMO

BACKGROUND: The impact of sleep apnea (SA) on heart rate variability (HRV) in atrial fibrillation (AF) patients has not been investigated.Methods and Results: Of 94 patients who underwent AF ablation between January 2021 and September 2022, 76 patients who had a nocturnal Holter electrocardiography and polysomnography conducted simultaneously were included in the analysis. A 15-min duration of HRV, as determined by an electrocardiogram during apnea and non-apnea time, were compared between patients with and without AF recurrence at 12 months' postoperatively. Patients had a mean age of 63.4±11.6 years, 14 were female, and 20 had AF recurrence at 12 months' follow-up. The root mean square of the difference between consecutive normal-to-normal intervals (RMSSD, ms) an indicator of a parasympathetic nervous system, was more highly increased in patients with AF recurrence than those without, during both apnea and non-apnea time (apnea time: 16.7±4.5 vs. 13.5±3.3, P=0.03; non-apnea time: 20.9±9.5 vs. 15.5±5.9, P<0.01). However, RMSSD during an apneic state was decreased more than that in a non-apneic state in both groups of patients with and without AF recurrence (AF recurrence group: 16.7±4.5 vs. 20.9±9.5, P<0.01; non-AF recurrence group; 13.5±3.3 vs. 15.5±5.9, P=0.03). Consequently, the effect of AF recurrence on parasympathetic activity was offset by SA. Similar trends were observed for other parasympathetic activity indices; high frequency (HF), logarithm of HF (lnHF) and the percentage of normal-to-normal intervals >50 ms (pNN50). CONCLUSIONS: Without considering the influence of SA, the results of nocturnal HRV analysis might be misinterpreted. Caution should be taken when using nocturnal HRV as a predictor of AF recurrence.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Eletrocardiografia Ambulatorial , Frequência Cardíaca , Sistema Nervoso Parassimpático , Síndromes da Apneia do Sono , Humanos , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Pessoa de Meia-Idade , Feminino , Masculino , Idoso , Síndromes da Apneia do Sono/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Recidiva , Polissonografia
3.
Int J Cardiol Heart Vasc ; 47: 101245, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37521520

RESUMO

Background: Several factors that predict new-onset atrial fibrillation (AF) have been investigated using the 24-hour Holter electrocardiogram (ECG) and 12-lead ECG; however, these have been based on each test independently. The aim of this study was to combine findings from the two tests to create a comprehensive, easy-to-use score and to examine its validity. Methods and Results: A total of 502 patients underwent 24-hour Holter ECG and 12-lead ECG were followed up for 6.2 ± 3.5 years, and 66 patients developed new-onset AF. Multivariate Cox regression analyses revealed that total number of supraventricular extrasystoles (SVEs) ≥ 100 beats/day and SVE's longest run ≥ 3 beats on 24-hour Holter ECG and PR interval ≥ 185 ms, amplitude ratio of P wave (aVR/V1) < 1.0 and amplitude of RV5 + SV1 ≥ 2.2 mV on 12-lead ECG were significant independent predictors for developing AF (all p < 0.01). Using these cut-off points, the PAAFS (acronym for risk factors) score was constructed by adding one point for each parameter if the patient met each of the criteria. The area under the curve (AUC) of the PAAFS score was 0.80, compared to the AUCs of 24-hour Holter ECG-only factors (0.73) and 12-lead ECG-only factors (0.72), indicating an improvement in score. The annual incidence of AF for each PAAFS score were 0.0%, 0.2%, 0.7%, 1.9%, 5.6%, and 11.1%/year for scores 0 to 5, respectively. Conclusion: The PAAFS score, which combines findings from 24-hour Holter ECG and 12-lead ECG, was superior to 24-hour Holter ECG and 12-lead ECG alone in predictive accuracy for new-onset AF.

4.
Int Heart J ; 64(3): 496-501, 2023 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-37197915

RESUMO

Tako-tsubo syndrome (TTS) can be triggered by emotional or physical stress and is characterized by transient left ventricular dysfunction with apical ballooning. Some neurologic disorders and pheochromocytoma serve as triggers for TTS, however, its association with primary aldosteronism (PA) is not well known. Pulmonary vein isolation (PVI) with catheter ablation for atrial fibrillation (AF) has been performed worldwide, and TTS following PVI has been reported as a rare complication. Sympathetic stimulation can play an important role in TTS development, however, its mechanism and risk factors are not yet understood.We describe a 72-year-old woman with PA who developed TTS after PVI with radiofrequency catheter ablation (RFCA) for symptomatic paroxysmal AF. Complete isolation of the pulmonary vein was carried out without any complications, however, she complained of epigastric discomfort 7 hours after the procedure. An electrocardiogram showed recurrent AF with a new negative-T wave and prolonged QT interval. Transthoracic echocardiography revealed apical ballooning and basal hypercontraction, characteristic of TTS, and coronary angiography showed no significant stenosis. She was diagnosed with TTS following RFCA for AF and managed well with conservative therapy.The present case suggests that TTS should be recognized as a complication associated with AF ablation. Moreover, PA may be involved in TTS development by increasing sympathetic activity. Further studies on the mechanism and characteristics of TTS are required.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Hiperaldosteronismo , Veias Pulmonares , Cardiomiopatia de Takotsubo , Feminino , Humanos , Idoso , Fibrilação Atrial/complicações , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/complicações , Veias Pulmonares/diagnóstico por imagem , Ecocardiografia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/cirurgia , Resultado do Tratamento , Recidiva
5.
Percept Mot Skills ; 121(2): 548-67, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26474441

RESUMO

This research assessed whether public space users will adopt a least-effort approach and choose a less suitable seat nearby or seek the most suitable seat, even if it is farther away from them when the decision is made. How distance assessment affects seat choice was investigated through an observational survey, which allowed the identification of behavioral patterns. Those behavioral patterns were then tested in a paired comparison experiment with 40 participants. The results showed that the effect of distance on seat choice is related to the difference in distance between the options and that a sufficient difference can cause trade-offs between distance and seat properties. The necessary difference in distance is conditioned by the activity and the seat properties.


Assuntos
Comportamento de Escolha , Percepção de Distância , Julgamento , Orientação , Espaço Pessoal , Meio Social , Comportamento Espacial , Simulação por Computador , Planejamento Ambiental , Humanos , Individualidade , Estudos Observacionais como Assunto , Comportamento Social
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