1,720,966 research outputs found
Acute heart failure. What doctors in clinical practice need to know
No full textHeart failure is a highly prevalent disease in the adult population. Patients suffering from decompensated heart failure are often acutely admitted to hospital where this potentially life-threatening situation requires immediate therapy. The clinical picture of heart failure can be unspecific, especially as the major symptom, respiratory insufficiency (dyspnea) is also seen in patients suffering from various lung disorders. Therefore, it is essential to assess the patient's acute problems in form of a careful physical examination and also by a detailed medical history. During medical examination a careful auscultation of the lungs as well as the assessment of potential peripheral edema is recommended. Importantly, signs of cardiogenic shock must not be overlooked. A standard 12-lead electrocardiogram (ECG) and an echocardiographic assessment of cardiac function represent two essential technical investigations. Heart rhythm, frequency and potential abnormalities of the ECG may be informative with respect to the specific disease entity. Similarly, cardiac performance, dimensions and more specific aspects, such as valve function can be evaluated using echocardiography and can help to initiate an appropriate therapy. These specific cardiac investigations should be combined with X-ray imaging of the lungs and specific blood parameters. Acute heart failure is a very common and acutely life-threatening clinical picture. Every physician working in emergency medicine or in an intensive care unit should be able to recognize it as soon as possible and to treat the patient accordingly
First experience with a new tool for automatic mapping of fragmented signals in a case report of cardioneuroablation
No full textComparison between contrast-guided and pressure-guided ablation using the novel pressure visualization tool for cryoballoon pulmonary vein isolation
No full textAbstract During cryoballon pulmonary vein isolation (PVI) complete occlusion of the pulmonary vein ostia during the freeze cycles is mandatory. Typically, PV occlusion is assessed by contrast injection under fluoroscopy. Using an update for the Cryo Console it is possible to directly visualize occlusion pressure as an indicator of complete PV occlusion during cryoballoon procedures. In this study, we compared PV pressure monitoring during cryoballoon PVI to a conventional approach regarding procedural outcomes. We retrospectively analysed the procedural data of 50 patients (25 patients with pressure-guided PVI and 25 patients with contrast-guided PVI) treated with cryoballoon PVI in our centre. Complete PV occlusion in the pressure-guided group was defined as an abrupt change in the pressure waveform with a loss of the a-wave after advancing the cryoballoon to the PV ostium. We observed comparable results regarding procedural time, left atrial dwell time or fluoroscopy time when comparing the pressure guided to our conventional approach. Moreover, there were no differences regarding acute procedural effectivity or freeze cycle characteristics. As expected, a significant reduction of contrast use was achieved in the pressure measurement group (10.4 vs. 25.5 ml, p < 0.0001). Monitoring complete PV occlusion by visualizing the occlusion pressure is feasible. Acute procedural outcome was comparable to our standard approach using contrast injection to verify complete PV occlusion. Most importantly, a significant reduction in contrast use could be achieved which has to be confirmed in larger patient cohorts
Evaluation of a novel portable capacitive ECG system in the clinical practice for a fast and simple ECG assessment in patients presenting with chest pain: FIDET (Fast Infarction Diagnosis ECG Trial)
Full text linkElectrocardiogram (ECG) assessment plays a crucial role in patients presenting with chest pain and suspected acute coronary syndrome (ACS). In a pilot study, we previously evaluated a capacitive ECG system (cECG) as a novel ECG technique for a fast and simple ECG assessment in patients with ST-elevation myocardial infarction (STEMI). In a next step, the sensitivity and specificity of this novel ECG technique have to be assessed in patients with ACS. The Fast Infarction Diagnosis ECG Trial (FIDET) is a prospective, bi-center, observer-blinded noninferiority study to evaluate the cECG compared to the conventional ECG (kECG) in the clinical practice for ECG assessment in consecutive patients presenting with suspected ACS. In 250 patients who were admitted to the hospital, because of an ACS [including STEMI and non-ST-elevation acute coronary syndrome (NSTE-ACS)], both a kECG and a cECG recording were performed within a time lag of less than 10 min. The primary end point will be sensitivity and specificity of the cECG compared to the kECG in diagnosing a STEMI with a margin of noninferiority of 7.5 %. Secondary end points include sensitivity and specificity of the cECG compared to the kECG in diagnosing an NSTE-ACS, safety of the cECG system (adverse event, serious adverse event and suspected unexpected serious adverse reaction), parameters of the ECG measurement (PQ-interval, QT-interval, ST-amplitude and heart rate) and measurement duration of the two methods. FIDET is designed as a noninferiority study to show that a novel cECG system is suitable for the diagnosis of myocardial infarction in the clinical context and might even have benefits, for example by offering a faster and easier ECG assessment
Contact force sensing manual catheter versus remote magnetic navigation ablation of atrial fibrillation: a single-center comparison
No full textAbstract
Background
Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation in combination with contact force sensing (MCN-CF) ablation of atrial fibrillation (AF) is lacking. The primary aim of the present retrospective comparative study was to compare the outcome of RMN versus (vs.) MCN-CF ablation of AF with regards to AF recurrence. Secondary aim was to analyze periprocedural risk, ablation characteristics and repeat procedures.
Methods
We retrospectively analyzed 452 patients undergoing a total of 605 ablations of AF: 180 patients were ablated using RMN, 272 using MCN-CF.
Results
Except body mass index there was no significant difference between groups at baseline. After a mean 1.6 ± 1.6 years of follow-up and 1.3 ± 0.4 procedures, 81% of the patients in the MCN-CF group remained free of AF recurrence compared to 53% in the RMN group (
P
< 0.001). After analysis of 153 repeat ablations (83 MCN-RF vs. 70 RMN;
P
= 0.18), there was a significantly higher reconnection rate of pulmonary veins after RMN ablation (
P
< 0.001). In multivariable Cox-regression analysis, RMN ablation (
P
< 0.001) and left atrial diameter (
P
= 0.013) was an independent risk factor for AF recurrence. Procedure time, radiofrequency application time and total fluoroscopy time and fluoroscopy dose were higher in the RMN group without difference in total number of ablation points. Complication rates did not differ significantly between groups (
P
= 0.722).
Conclusions
In our retrospective comparative study, the AF recurrence rate and pulmonary vein reconnection rate is significantly lower with more favorable procedural characteristics and similar complication rate utilizing MCN-CF compared to RMN
Next-generation atrial fibrillation ablation: clinical performance of pulsed-field ablation and very high-power short-duration radiofrequency
No full textAbstract Introduction Pulsed-field energy (PFA) and very high-power short-duration radiofrequency (vHPSD-RF) are two novel ablation methods for pulmonary vein isolation (PVI). Both PFA and vHPSD-RF show promise for improving efficacy, safety, and reducing procedure durations. However, direct comparisons between these two techniques are scarce. Methods and results Retrospective analysis of 82 patients with symptomatic AF. Of these, 52 patients received PFA and 30 received vHPSD-RF (90 W, 4 s) as index procedure. At the 6-month follow-up, AF recurrence occurred in 4 patients following PFA and 5 patients following vHPSD-RF ( p -value = 0.138). Significant improvements in the EHRA and NYHA stages were evident in both PFA ( p < 0.001 and p = 0.047, respectively) and vHPSD-RF groups ( p = 0.007 and p = 0.012, respectively). The total procedure duration and the left atrial dwell time were significantly shorter in the PFA group (64 ± 19 min vs. 99 ± 32 min, p < 0.001 and 41 ± 12 min vs. 62 ± 29 min, p < 0.001, respectively). The fluoroscopy time and dose area product were significantly higher in PFA (14 ± 6 vs. 9 ± 5 min, p < 0.001 and 14 ± 9 vs. 11 ± 9 Gy cm 2 , p = 0.046, respectively). One patient in the vHPSD-RF group suffered a stroke, not directly linked to the procedure (0 vs. 1 major complication, p = 0.366). Conclusion Based on this retrospective single-center study, PFA and vHPSD-RF were associated with similar effectiveness and safety profiles. PFA was linked to shorter procedure times and higher radiation exposure compared to vHPSD-RF. Graphical Abstrac
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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