4,882 research outputs found
Electrical cardioversion of atrial fibrillation and the risk of brady-arrhythmic events
No full textBackground: Electrical cardioversion (ECV) is a common procedure for terminating atrial fibrillation (AF). ECV is associated with brady-arrhythmic events, however, the age-specific risks of clinically significant brady-arrhythmic events are unknown. Methods: Using Danish nationwide registers, we identified patients with AF at their first non-emergent ECV between 2005 and 2018 and estimated their 30-day risk of brady-arrhythmic events. Moreover, factors associated with increased risks of brady-arrhythmias were identified. Absolute risks were estimated using logistic regression models fitted with natural splines as well as standardization (G-formula). Results: We identified 20,725 eligible patients with a median age of 66 years (IQR 60-72) and most males (73%). The 30-day risks of brady-arrhythmic events after ECV were highly dependent on age with estimated risks ranging from 0.5% (95% CI 0.2-1.7) and 1.2% (95% CI 0.99-1.5) to 2.7% (95% CI 2.1-3.3) and 5.1% (95% CI 2.6-9.7) in patients aged 40, 65, 80, and 90 years, respectively. Factors associated with brady-arrhythmias were generally related to cardiovascular disease (eg, ischemic heart disease, heart failure, valvular AF) or a history of syncope. We found no indications that pre-treatment with anti-arrhythmic drugs conferred increased risks of brady-arrhythmic events (standardized absolute risk difference -0.25% [95% CI -0.67 to 0.17]). Conclusions: ECV conferred clinically relevant 30-day risks of brady-arrhythmic events, especially in older patients. Anti-arrhythmic drug treatment was not found to increase the risk of brady-arrhythmias. Given the widespread use of ECV, these data should provide insights regarding the potential risks of brady-arrhythmic events.</p
Isrogrogidda Falka Af-soomaaliga: Aragti ku aadan Midaynta Qoraalkiisa
No full textQoraagu wuxuu diraasad ku sameeyey sidii loo midayn lahaa af Soomaaliga qoraaal ahaan loo adeegsada. Gaar ahaan wuxuu diiradda saarayaa sidii loo midayn lahaa qaababka isrogrogga falalka oo haatan loo adeegsado siyaabo aan midaysanayn.In questo articolo, l'autore analizza e avanza una proposta relativamente alla standardizzazione del somalo scritto, in particolar modo delle forme di coniugazione dei verbi somali che attualmente non sono scritte in modo omogenea.In this article, the author analyzes and provides a proposal about the standardization of written Somali, in particular relating to verb conjugation forms whose orthography still differs today.Cabdirashid M. Ismaaciil, Cabdalla C. Mansuur, Saynab A. Sharci (eds.
Coastal Research and its Economic Justification
No full textProper and thorough planning of coastal engineering projects is discussed and the economie justification of research work indicated. Examples are given concerning navigational problems, coastal protection problems, and harbor sediment problems.KWP-collectio
Midaynta iyo Horumarinta Af-soomaaliga
No full textQoraagu wuxuu maqaalkan ku falanqaynayaa arrimo ku saabsan midaynta af Soomaaliga qoran, oo dadka qaarkood ay ku doodaan in ay dhibaato ka taagantahay, iyagoo u aanaynaya kala duwanaanta lahjadaha Soomaaliyeed iyo farta af Soomaaliga oo aan xasillayn. Qoraha oo soo bandhigayaa in arrimahaasu aanu sax ahayn, wuxuuna muujinayaa caqabadaha dhabta ah ee hortaagan houmarinta af Soomaaliga: afku wuxuu la'yahay dawlad si rasmi ah u adeegsato, weerar ba'anna waxaa ku haya af Ingiriisiga, xagga ereyadana nabaadguur xooggan ayaa ku dhacaya, gaar ahaan ereyada la xiriira dhaqanka Soomaaliyeed.L'autore, in questo articolo, analizzando la questione della lingua somala scritta, cerca di illustrare che la situazione del somalo standard non è cosi problematica come a detta di alcuni somali, specialmente, nell'ortografia e nella differenza tra i dialetti, ma il problema somalo è bensì riscontrabile in altri fattori: la mancanza di un stato che continui ad adottare il somalo come lingua ufficiale, l'estinzione di tantissimi vocaboli in disuso, nonché la forte influenza dalla lingua inglese.The author in this article, in analysing the written somali language, wants to show the somali standard situation is not so bad, like some Somalis say, especially in orthography and in vernaculars difference. In spite of, the somali language problem is recognisable in some others factors: lack of state that usually chooses somali language as official language, extinction of many terms in disuse and also the strong influence of English.Cabdirashid M. Ismaaciil, Cabdalla C. Mansuur, Saynab A. Sharci (eds.
Om inloppet ifrån Östersjön : till SöderTelje eller Egelsta wiken
No full textAuthor: Nathanael Gerhard af Schultén.Dated: "Carlberg den 12 Januari 1806."Digital reproduction, The National Library of Finland, Centre for Preservation and Digitisation, MikkeliA description of the Baltic Sea.TravelEuropeanaSchultén, Nathanael Gerhard af (1750-1825
Dwing als gebiedsontwikkelaar een duidelijke opdracht af
No full textTerwijl de context waarin gebiedsontwikkelaars werken alleen maar complexer wordt, ziet Co Verdaas, hoogleraar gebiedsontwikkeling, een aanhoudende neiging om keuzes vooruit te schuiven of te verhullen. Hij geeft zes tips om gebiedsontwikkelaars in hun kracht te zetten. “Zonder escalatie geen resultaat zou het devies moeten zijn.”Practice Chair Urban Area Developmen
His Bundle Pacing Improves Left Ventricular Function in Patients with Bradyarrhythmia or Tachy-Brady Syndrome and Permanent Atrial Fibrillation: A Retrospective Analysis
No full textBackground: Permanent atrial fibrillation (AF) frequently coexists with heart failure (HF), leading to structural remodeling and progressive sinus node dysfunction. As the condition advances, bradyarrhythmia or tachy-brady syndrome may develop. Right ventricular pacing and cardiac resynchronization therapy may impair left ventricular function due to non-physiological ventricular activation. His bundle pacing (HBP) offers a more physiological alternative. This study evaluates HBP’s impact on left ventricular function in patients with bradyarrhythmia or tachy-brady syndrome and permanent AF. Methods: A retrospective analysis included 41 patients with HF who underwent HBP implantation due to bradyarrhythmia or tachy-brady syndrome in permanent AF. LVEF, LVEDD, and MR were assessed before and after implantation, alongside the impact of comorbidities (e.g., ischemic heart disease and chronic kidney disease) and pharmacotherapy (digoxin, metoprolol, and mineralocorticoid receptor antagonists). Statistical analyses included the Wilcoxon test (LVEF and MR), paired Student’s t-test (LVEDD), Spearman’s correlation, and linear regression. Significance was set at p < 0.05. Results: HBP significantly improved LVEF (median increase: 14.58%; p < 0.001) and reduced LVEDD (mean reduction: 5.41 ± 1.30 mm; p < 0.001). MR severity also decreased (p < 0.001). Patients with lower baseline LVEF showed greater improvement in this parameter after HBP (ρ = −0.671, p < 0.001). Only chronic kidney disease was associated with a lower likelihood of MR improvement (p = 0.0486). Conclusions: HBP improves left ventricular function and reduces MR severity in patients with permanent AF and bradyarrhythmia or tachy-brady syndrome. A low baseline LVEF was the strongest predictor of subsequent improvement. Further studies are needed to confirm long-term benefits
Effects of consistent atrial pacing and atrial rate stabilization - two pacing algorithms to suppress recurrent paroxysmal atrial fibrillation in brady-tachy syndrome
No full textBackground and method Recently, various dedicated atrial pacing algorithms have been proposed to prevent atrial fibrillation (AF). Consistent atrial pacing (CAP; an algorithm for automatic atrial overdrive) and atrial rate stabilization (ARS; an algorithm for preventing the 'short-long' sequences) were tested in 16 patients with brady-tachy syndrome and recurrent paroxysmal AF (greater than or equal to3 episodes per month). Results In the population as a whole, pacing with CAP was associated with a significant reduction in AF burden in comparison with DDDR pacing. With regard to the effects on AF burden, 11 patients (69%) were found to benefit significantly from CAP or ARS pacing algorithms (reduction > 50% in AF burden). In detail, seven patients were responders to both algorithms, two to CAP only and two to ARS only. Two patients exhibited a significant increase in AF burden with the ARS algorithm. With regard to the effects on number of mode switches per day, seven patients (44%) were found to benefit significantly from CAP or ARS pacing algorithms (reduction in mode switches per day > 50%). In detail, five patients were responders to both algorithms and two to ARS only. Two patients had a significant increase in the number of mode switches per day with both CAP and ARS algorithms. Conclusion The response to ARS and CAP algorithms is heterogeneous. In 31-69% of patients with brady-tachy syndrome a significant reduction in AF burden and/or mode switch episodes can be obtained with ARS and/or CAP algorithms; however, in a few patients an increase in AF episodes and/or AF burden may occur. (C) 2001 The European Society of Cardiology
Brady- and tachyarrhythmias detected by continuous rhythm monitoring in paroxysmal atrial fibrillation
No full textObjective Atrial fibrillation (AF) is associated with adverse events including conduction disturbances, ventricular arrhythmias and sudden death. The aim of this study was to examine brady-and tachyarrhythmias using continuous rhythm monitoring in patients with paroxysmal self- terminating AF (PAF).Methods In this multicentre observational substudy to the Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling and Vascular destabilisation in the progression of AF (RACE V), we included 392 patients with PAF and at least 2 years of continuous rhythm monitoring. All patients received an implantable loop recorder, and all detected episodes of tachycardia =182 beats per minute (BPM), bradycardia =30 BPM or pauses =5 s were adjudicated by three physicians.Results Over 1272 patient- years of continuous rhythm monitoring, we adjudicated 1940 episodes in 175 patients (45%): 106 (27%) patients experienced rapid AF or atrial flutter (AFL), pauses =5 s or bradycardias =30 BPM occurred in 47 (12%) patients and in 22 (6%) patients, we observed both episode types. No sustained ventricular tachycardias occurred. In the multivariable analysis, age >70 years (HR 2.3, 95% CI 1.4 to 3.9), longer PR interval (HR 1.9, 1.1-3.1), CHA2DS2- VASc score =2 (HR 2.2, 1.1-4.5) and treatment with verapamil or diltiazem (HR 0.4, 0.2-1.0) were significantly associated with bradyarrhythmia episodes. Age >70 years was associated with lower rates of tachyarrhythmias.Conclusions In a cohort exclusive to patients with PAF, almost half experienced severe bradyarrhythmias or AF/ AFL with rapid ventricular rates. Our data highlight a higher than anticipated bradyarrhythmia risk in PAF
Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium
No full textFull author list omitted for brevity. For the full list of authors, see article.BACKGROUND: Tools for the prediction of atrial fibrillation (AF) may identify high-risk individuals more likely to benefit from preventive interventions and serve as a benchmark to test novel putative risk factors. METHODS AND RESULTS: Individual-level data from 3 large cohorts in the United States (Atherosclerosis Risk in Communities [ARIC] study, the Cardiovascular Health Study [CHS], and the Framingham Heart Study [FHS]), including 18 556 men and women aged 46 to 94 years (19% African Americans, 81% whites) were pooled to derive predictive models for AF using clinical variables. Validation of the derived models was performed in 7672 participants from the Age, Gene and Environment-Reykjavik study (AGES) and the Rotterdam Study (RS). The analysis included 1186 incident AF cases in the derivation cohorts and 585 in the validation cohorts. A simple 5-year predictive model including the variables age, race, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, and history of myocardial infarction and heart failure had good discrimination (C-statistic, 0.765; 95% CI, 0.748 to 0.781). Addition of variables from the electrocardiogram did not improve the overall model discrimination (C-statistic, 0.767; 95% CI, 0.750 to 0.783; categorical net reclassification improvement, -0.0032; 95% CI, -0.0178 to 0.0113). In the validation cohorts, discrimination was acceptable (AGES C-statistic, 0.664; 95% CI, 0.632 to 0.697 and RS C-statistic, 0.705; 95% CI, 0.664 to 0.747) and calibration was adequate. CONCLUSION: A risk model including variables readily available in primary care settings adequately predicted AF in diverse populations from the United States and Europe
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