39,911 research outputs found
Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation (GISSI-AF) trial
No full textBackground - Atrial fibrillation (AF) is a common arrhythmia that frequently recurs after restoration of sinus rhythm (SR). Identifying risk factors for recurrence may help define the best strategy for secondary prevention. Methods - The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks. Patients were randomized to valsartan or placebo; all other treatments for AF or underlying heart diseases were allowed. Primary end points were time to first recurrence of AF and proportion of patients with >1 AF episode during 1-year follow-up. We evaluated clinical and electrocardiographic baseline characteristics of all patients to identify independent predictors for AF recurrence using a Cox multivariable model. Results - Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months, independent of the modality of SR restoration, spontaneous (HR 1.42, 95% CI 1.14-1.77, P = .002), or by cardioversion (HR 1.19, 95% CI 1.01-1.40, P = .038), and a lower heart rate during SR (HR 0.99, 95% CI 0.99-1.00, P = .052). The risk factors were the same for > 1 AF recurrence. Patients treated with amiodarone had a lower risk for both end points (P < .0001 and P = .017), whereas those on diuretics had a greater risk (P = .009 and P = .003). Conclusions - In the GISSI-AF study population, AF history had significant prognostic value independent of the modality of SR restoration. Amiodarone and diuretic treatment affected the rate of AF recurrence
Karta öfver norra Qvarken med närliggande del af Finska skären
No full text0-meridiaanit: Ferrö ja GreenwichGraverad af C. G. LundgrenLit.
The environmental epidemiology of primary dystonia
No full textBackground: Dystonia is a movement disorder characterized by involuntary muscle contractions that cause twisting movements and abnormal postures. Primary dystonia is the most common form and is thought to be a multifactorial condition in which one or more genes combine with environmental factors to reach disease.
Methods: We reviewed controlled studies on possible environmental risk factors for primary early‐ and late‐onset dystonia.
Results: Environmental factors associated with primary early‐onset dystonia are poorly understood. Early childhood illnesses have been reported to be more frequent in patients with DYT1 dystonia than in subjects carrying the DYT1 mutation that did not manifest dystonia, thus raising the possibility that such exposures precipitate dystonia among DYT1 carriers. Conversely, several environmental factors have been associated with primary adult‐onset focal dystonias compared to control subjects. Namely, eye diseases, sore throat, idiopathic scoliosis, and repetitive upper limb motor action seem to be associated with blepharospasm (BSP), laryngeal dystonia (LD), cervical dystonia (CD), and upper limb dystonia, respectively. In addition, an inverse association between coffee drinking and BSP has been observed in both case‐unrelated control and family‐based case‐control studies. Additional evidence supporting a causal link with different forms of primary late‐onset dystonia is only available for diseases of the anterior segment of the eye, writing activity, and coffee intake.
Conclusion: There is reasonable epidemiological evidence that some environmental factors are risk‐modifying factors for specific forms of primary adult‐onset focal dystonia
Sex små berättelser af Aina och Eva
No full textEtt köpmanshus : novell ; Arftagerskan : novell ; Margarethe : berättelse / af Aina . En qvinna af folket : pennteckning ; Clara ; Vid sexton år / af Eva
Bone mineral content in girls with precocious puberty treated with gonadotropin-releasing hormone analog.
No full textGeographiske chartor öfwer Swerige med hans maj. konung Gustaf IV Adolphs allernådigste tillstånd utgifne af friherre S. G. Hermelin.
No full text[1:750000].0-meridiaani: Ferro. - Koordinaattiasteikko: E40°-49°, N67°10'-63°25'.Graverad af Fr. Akrel.Janamittakaava: Svenska mil.Lehti teoksesta: Geographiske chartor öfwer Swerige med hans maj. konung Gustaf IV Adolphs allernådigste tillstånd utgifne af friherre S. G. Hermelin. Andra Afdelningen, Storfurstendömet Finland. Stockholm, 1799
Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry
No full textBackground: An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.
Purpose: We aimed to investigate the importance of timing of ablation in preventing AF recurrences.
Methods: 153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.
Results: Of the 153 pts enrolled (69.9% male, 59±10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034±1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p=0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366±130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p=0.042) and the time to AT/AF recurrence was longer in the ET group (HR=0.2876, 95%CI: 0.1029 to 0.8038; p=0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR=4.66, 95%CI: 1.5 to 14.48, p=0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).
Conclusion: A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences
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