79 research outputs found
Mobile health applications for managing atrial fibrillation for healthcare professionals and patients: A systematic review
No full textAims: A plethora of mobile health applications (m-health apps) to support healthcare are available for both patients and healthcare professionals (HCPs) but content and quality vary considerably and few have undergone formal assessment. The aim is to systematically review the literature on m-health apps for managing atrial fibrillation (AF) that examine the impact on knowledge of AF, patient and HCP behaviour, patients' quality-of-life, and user engagement. Methods and results: MEDLINE, EMBASE, CINAHL, and PsychInfo were searched from 1 January 2005 to 5 September 2019, with hand-searching of clinical trial registers and grey literature. Studies were eligible for inclusion if they reported changes in any of the following: (i) knowledge of AF; (ii) provider behaviour (e.g. guideline adherence); (iii) patient behaviour (e.g. medication adherence); (iv) patient quality-of-life; and (v) user engagement. Two reviewers independently assessed articles for eligibility. A narrative review was undertaken as included studies varied widely in their design, interventions, comparators, and outcomes. Seven studies were included; six m-health apps aimed at patients and one at HCPs. Mobile health apps ranged widely in design, features, and method of delivery. Four studies reported patient knowledge of AF; three demonstrated significant knowledge improvement post-intervention or compared to usual care. One study reported greater HCP adherence to oral anticoagulation guidelines after m-health app implementation. Two studies reported on patient medication adherence and quality-of-life; both showed improved quality-of-life post-intervention but only one observed increased adherence. Regarding user engagement, five studies reported patient perspectives on usability, three on acceptability, and one on feasibility; overall all m-health apps were rated positively. Conclusion: Mobile health apps demonstrate improvements in patient knowledge, behaviour, and quality of life. Studies formally evaluating the impact of m-health on HCP behaviour are scarce and larger-scale studies with representative patient cohorts, appropriate comparators, and longer-Term assessment of the impact of m-health apps are warranted
Length of hospital stay for elective electrophysiological procedures: a survey from the European Heart Rhythm Association
No full textAIMS: Electrophysiological (EP) operations that have traditionally involved long hospital lengths of stay (LOS) are now being undertaken as day case procedures. The coronavirus disease-19 pandemic served as an impetus for many centres to shorten LOS for EP procedures. This survey explores LOS for elective EP procedures in the modern era. METHODS AND RESULTS: An online survey consisting of 27 multiple-choice questions was completed by 245 respondents from 35 countries. With respect to de novo cardiac implantable electronic device (CIED) implantations, day case procedures were reported for 79.5% of implantable loop recorders, 13.3% of pacemakers (PMs), 10.4% of implantable cardioverter defibrillators (ICDs), and 10.2% of cardiac resynchronization therapy (CRT) devices. With respect to CIED generator replacements, day case procedures were reported for 61.7% of PMs, 49.2% of ICDs, and 48.2% of CRT devices. With regard to ablations, day case procedures were reported for 5.7% of atrial fibrillation (AF) ablations, 10.7% of left-sided ablations, and 17.5% of right-sided ablations. A LOS ≥ 2 days for CIED implantation was reported for 47.7% of PM, 54.5% of ICDs, and 56.9% of CRT devices and for 54.5% of AF ablations, 42.2% of right-sided ablations, and 46.1% of left-sided ablations. Reimbursement (43-56%) and bed availability (20-47%) were reported to have no consistent impact on the organization of elective procedures. CONCLUSION: There is a wide variation in the LOS for elective EP procedures. The LOS for some procedures appears disproportionate to their complexity. Neither reimbursement nor bed availability consistently influenced LOS
Antithrombotic treatment management in low stroke risk patients undergoing cardioversion of atrial fibrillation <48 h duration: results of an EHRA survey
No full textData supporting the safety of cardioversion (CV) of atrial fibrillation (AF) without anticoagulation in patients with AF duration <48 h are scarce. Observational studies suggest that the risk of stroke in these patients is very low when the definite duration of the AF episode is of <48 h and the clinical risk profile as estimated through the CHA2DS2VASc score is low (a score of 0 for men and 1 for women). As the recent 2020 European Society of Cardiology (ESC) guidelines indication for this clinical scenario is based mainly on consensus, we sent out a survey to assess the current clinical practice on anticoagulation prior to and post-CV in patients with AF <24-48 h duration and low stroke risk across centres in Europe. Of the 136 respondents, half were affiliated to university hospitals (68/136; 50%). Non-university hospitals (50/136; 36%) and private hospitals (2/136; 1.4%) accounted over a third of respondents. The main findings of our survey were (i) heterogeneity in the anticoagulation management both before and post-CV in low stroke-risk patients with AF <48 h, (ii) higher utilization of periprocedural low-molecular-weight heparin than of non-vitamin K antagonist oral anticoagulant, (iii) higher utilization of pre-CV transoesophageal echocardiography for electrical CV than for pharmacological CV regardless of the duration of AF, (iv) high adherence to a 4-week post-CV oral anticoagulant (OAC) therapy, mainly for electrical CV, and finally, (v) perceived higher acceptance of lack of post-CV OAC therapy in patients with <24 h than 24-48 h episode duration. The results obtained in this survey highlight the need for more research providing definitive clarification on the safety of CV without anticoagulation in patients with short duration AF
Multimorbidity management in atrial fibrillation: The Polish perspective in the EHRA-PATHS study
No full textBackground: Atrial fibrillation (AF) is the most common arrhythmia which places a significant bur-den on individuals as well as the healthcare system. AF management requires a multidisciplinary approach in which tackling comorbidities is an important aspect.
Aims: This study aimed to evaluate how multimorbidity is currently assessed and managed and to determine if interdisciplinary care is undertaken.
Methods: A 21-item online survey was undertaken over four weeks as part of the EHRA-PATHS study examining comorbidities in AF and distributed to European Heart Rhythm Association members in Europe.
Results: A total of 341 eligible responses were received, of which 35 (10%) were from Polish physi-cians. Compared to other European locations, the rates of specialist services and referrals varied but were not significantly different. However, there were higher numbers of specialized services reported in Poland compared to the rest of Europe for hypertension (57% vs. 37%; P = 0.02) and palpita-tions/arrhythmias (63% vs. 41%; P = 0.01), whereas rates of sleep apnea services and comprehensive geriatric care tended to be lower (20% vs. 34%; P = 0.10 and 14% vs. 36%; P = 0.01, respectively). The only statistical difference in reasons for referral rates between Poland and the rest of Europe was the barrier relating to insurance and financial reasons (31% vs. 11%; P <0.01, respectively).
Conclusions: There is a clear need for an integrated approach to patients with AF and associated comorbidities. Preparedness of Polish physicians to deliver such care seems to be similar to other European countries but may be hampered by financial obstacles
Long‐term risk of cardiovascular implantable electronic device–related infection after catheter ablation of arrhythmia
No full textEvery percent matters: pitfalls in the mapping and ablation of arrhythmogenic foci arising from the right coronary cusp or right ventricular outflow tract
No full textPorównanie efektywności klinicznej leków antyarytmicznych i ablacji prądem o wysokiej częstotliwości w leczeniu pacjentów z napadowym migotaniem przedsionków - randomizowane badanie kliniczne
No full textGeneral practitioners’ perceptions on opportunistic single-time point screening for atrial fibrillation: A European quantitative survey
No full textBackground: There is no clear guidance on how to implement opportunistic atrial fibrillation (AF) screening in daily clinical practice. Objectives: This study evaluated the perception of general practitioners (GPs) about value and practicalities of implementing screening for AF, focusing on opportunistic single-time point screening with a single-lead electrocardiogram (ECG) device. Methods: A descriptive cross-sectional study was conducted with a survey developed to assess overall perception concerning AF screening, feasibility of opportunistic single-lead ECG screening and implementation requirements and barriers. Results: A total of 659 responses were collected (36.1% Eastern, 33.4% Western, 12.1% Southern, 10.0% Northern Europe, 8.3% United Kingdom & Ireland). The perceived need for standardized AF screening was rated as 82.7 on a scale from 0 to 100. The vast majority (88.0%) indicated no AF screening program is established in their region. Three out of four GPs (72.1%, lowest in Eastern and Southern Europe) were equipped with a 12-lead ECG, while a single-lead ECG was less common (10.8%, highest in United Kingdom & Ireland). Three in five GPs (59.3%) feel confident ruling out AF on a single-lead ECG strip. Assistance through more education (28.7%) and a tele-healthcare service offering advice on ambiguous tracings (25.2%) would be helpful. Preferred strategies to overcome barriers like insufficient (qualified) staff, included integrating AF screening with other healthcare programs (24.9%) and algorithms to identify patients most suitable for AF screening (24.3%). Conclusion: GPs perceive a strong need for a standardized AF screening approach. Additional resources may be required to have it widely adopted into clinical practice
Utility of a novel 3F coronary sinus catheter during simultaneous ablation of the left anterolateral accessory pathway and left ventricular summit premature ventricular contractions
No full text“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report
No full textBackground: Some electrophysiological techniques, such as balloon cryoablation, involve the use of steerable sheaths of large diameter (outer diameter 15 Fr or more). Their introduction to the femoral vein may be difficult, especially in patients who have had numerous venipunctures in this area.
Aim: The authors describe a modification of typical venous access with the use of a “buddy wire” technique, facilitating the insertion of the cryoablation sheaths to the femoral vein.
Methods: A case-control study. The study involved a retrospective analysis of 27 consecutive procedures of balloon cryoablation of pulmonary veins performed in 2015 by the first author, compared to 23 consecutive procedures of balloon cryoablation performed in 2014 without a “buddy wire” technique. The study and control groups did not vary significantly. There were 11 women in both groups. The average age of the patients was 55.9 years. The “buddy wire” technique was the only difference in procedure performance between the control and study groups. In the study group a short introducer was inserted through a puncture of the right femoral vein, and then two wires were introduced through it. One of them was secured, so that it could not move, while the other served as a typical trans-septal puncture monitored with the use of X-ray. The standard trans-septal sheet was replaced with a 15 Fr steerable sheath, inserted through the same puncture site next to the secured “buddy wire”. The short wire was then removed from the femoral vein. Typical balloon cryoablation of pulmonary veins was performed. After the end of the procedure, the puncture site was secured with a haemostatic suture for 12–18 h.
Results: Femoral access with a 15 Fr steerable sheath and cryoablation were safely performed in all patients in the study group and in 22 out of 23 in the control group (100% vs. 95.6%, p = NS). Pulmonary vein isolation in one patient was performed using another technique. No damage to steerable sheaths was observed. There were no vascular complications requiring extended hospitalisation, blood transfusion, or surgical interventions in either group. The “door-to-door” time of the procedures ranged from 2 h 32 min on average in the study group to 2 h 43 min on average in the control group (p = NS). There was significant reduction in fluoroscopy time: 7 min 15 s on average from 11 min 25 s (p = 0.0009).
Conclusions: The use of the “buddy wire” technique may lead to significant reduction in fluoroscopy time during cryoablation of pulmonary veins by facilitating the insertion of the steerable sheaths to the femoral vein.Wstęp: Niektóre z technik elektrofizjologicznych, np. do krioablacji balonowej, wykorzystują naczyniowe koszulki sterowalne o dużej średnicy. Wprowadzenie ich do żyły udowej, zwłaszcza u pacjenta po wielokrotnych nakłuciach naczyń w tej okolicy, może sprawiać istotne trudności.
Cel: Celem pracy było opisanie modyfikacji typowego dojścia żylnego z wykorzystaniem techniki „wspierającego prowadnika” dla ułatwienia wprowadzania koszulek do krioablacji do żyły udowej.
Metody: Badanie miało charakter kliniczno-kontrolny. Przeprowadzono retrospektywną analizę kolejnych 27 zabiegów krioablacji balonowej żył płucnych wykonanych w 2015 r. przez pierwszego autora. Grupę kontrolną stanowiły 23 zabiegi wykonane w 2014 r. przez ten sam zespół, podczas których nie wykorzystywano techniki „wspierającego prowadnika”. Grupa badana i kontrolna nie różniły się istotnie pod względem cech demograficznych. Pacjenci byli w wieku średnio 55,4 roku w grupie badanej i 56,4 roku w grupie kontrolnej. Wykonanie zabiegu w grupie badanej i kontrolnej różniło się jedynie wykorzystaniem „wspierającego prowadnika”. W grupie badanej poprzez nakłucie prawej żyły udowej wprowadzano krótki introduktor, a poprzez niego dwa prowadniki. Krótki prowadnik pozostawiano w pachwinie i zabezpieczano przed przesunięciem, natomiast z wykorzystaniem długiego prowadnika wykonywano typowe nakłucie transseptalne pod kontrolą skopii rentgenowskiej. Następnie wymieniano standardową koszulkę transseptalną na koszulkę sterowalną 15 F, przeprowadzając ją przez jedno miejsce wkłucia obok pozostawionego w pachwinie prowadnika. Następnie usuwano krótki prowadnik z żyły udowej. Wykonywano typową krioablację balonową żył płucnych. Po zakończeniu zabiegu miejsce wkłucia zabezpieczano szwem hemostatycznym na okres 12–18 h po zabiegu.
Wyniki: Koszulki transseptalne o dużej średnicy wprowadzono bez powikłań u wszystkich pacjentów z grupy badanej i u 22 osób z grupy kontrolnej (100 vs. 95,6%, p = NS). U 1 chorego przeprowadzono ablację żył płucnych inną techniką. Nie zaobserwowano uszkodzeń koszulek sterowalnych. U żadnego z pacjentów nie stwierdzono powikłań naczyniowych wymagających przedłużonej hospitalizacji, przetoczeń krwi czy interwencji chirurgicznej. Czas trwania zabiegu „door-to-door” wynosił średnio 2 h 32 min w grupie badanej i 2 h 43 min w grupie kontrolnej i nie różnił się istotnie między grupami. Wykazano skrócenie czasu fluoroskopii z 11 min 25 s w grupie kontrolnej do 7 min 15 s z 11 min 25 s w grupie badanej (p = 0,0009).
Wnioski: Wykorzystanie techniki „wspierającego prowadnika” sprzyja skróceniu czasu fluoroskopii w takcie zabiegów krioablacji balonowej żył płucnych poprzez ułatwienie wprowadzania koszulek sterowalnych do żyły udowej
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