Tag Archives: atrial fibrillation

Temporary pacing lead insertion in Lanarkshire hospitals between 2005 – 2007 Dear Sirs, The retrospective study recently reported by Yassin et al. (Br J Cardiol 2010;17:34-5) has some potential confounding factors not reported by the authors. In addition, there is a complete absence of data from their questionnaires, with any appropriate analysis. The study looks at procedures performed between 2005 and 2007. During this timeframe the numbers of doctors in training were being reduced and doctors in more junior grades did not always possess the same procedural experience as would have been previously expected, related to the impact of f

It may be that these figures are actually very good compared with data from other centres, given that this service was designed specifically to reduce the delay in receiving DCCV. It would be interesting, therefore, to have more data on the types of patients receiving cardioversion, and whether there are any factors that may predict both initial and long-term success. It is clear, for example, from other data that the current National Institute for Health and Clinical Excellence (NICE) recommendations to utilise cardioversion for patients with heart failure need revising.1 Patient selection If we look at the results in some detail it is clear

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We audited management of AF at the Royal Surrey County Hospital against standards derived from the NICE guidelines. Fifty-nine of the 663 patients (8.9%) presenting to the acute medical take during the month of May 2008 had a documented diagnosis of AF, 10% of whom presented with a new diagnosis of AF and 90% of whom had a pre-existing diagnosis. The case notes of these 59 patients were reviewed. All patients with a new diagnosis of AF were managed consistently with the NICE guidelines. Compliance for patients with pre-existing AF was much lower. Eighteen out of 31 patients (58%) with pre-existing AF were found to be on digoxin monotherapy on

Coffee consumption shows CHD benefits in women A meta-analysis of a number of cohorts studies published in the International Journal of Cardiology (2009;137:216-25) demonstrates that habitual coffee consumption may be associated with a lower risk of coronary heart disease (CHD) in women. Analysis of data from 21 cohort studies showed that moderate coffee consumption (of up to four cups of coffee per day) were associated with a 18% reduction in risk of CHD in women.  The investigators note that such an effect was unlikely to be caused by chance. Further benefits have been shown from a meta-analysis published in the Archives of Internal Medici

Reporting their findings (Circulation 2009;120:1768-74), a team led by Dr Kristen Patton (University of Washington, Seattle, US) conclude that: “Our results indicate a compelling, graded association between NT-proBNP levels and AF in a large, diverse cohort with extensive follow-up. The fact that elevated baseline NT-proBNP levels predict a diagnosis of AF even 16 years later suggests that peptide elevations precede the onset of arrhythmia,” they add. BNP, a neurohormone produced by the heart, regulates cardiac function and is widely used as a marker of heart failure. The precursor protein pro-B-type natriuretic peptide is cleaved to form

Figure 1. Electrocardiogram (ECG) showing new-onset atrial fibrillation Figure 3. Cardiac magnetic resonance image (MRI) consistent with a lymphoma tumour Figure 2. Echocardiography showing large intra-atrial mass One year previously he had been treated with six cycles of chemotherapy for aplastic large cell lymphoma. He had a pyrexia (38.5oC), elevated C-reactive protein (14.6 mg/L) and low haemoglobin (10.8 g/dL). As part of a screen for infection, echocardiography was performed to exclude endocarditis (figure 2), but revealed a large intra-atrial mass. Cardiac magnetic resonance imaging (MRI) (figure 3) appearance was consistent with a lym

The evidence The utility of cardioversion was originally explored in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study,2 which recruited over 4,000 patients aged 65 and over with atrial fibrillation and one additional risk factor for stroke. Patients were randomised to either rhythm control, using electrical cardioversion and medication as necessary, or to rate control using drugs, such as beta blockers or digoxin. To the surprise of the investigators the primary outcome, mortality, was worse in the rhythm control group, as were secondary outcomes such as hospitalisation and serious arrhythmias. Importantly,

A recent German study has shown the high diagnostic accuracy for a patient-activated, single-lead Omron Heart Scan (HCG-801-E). In the study carried out in four university hospitals in Germany, 508 consecutively enrolled patients with a clinical indication for an ECG, were asked to record a short-term ECG directly after their standard 12-lead procedure. The ECGs were analysed by a single, double-blinded observer for rhythm, intervals, amplitudes and conduction disturbances. The patient-activated system was able to detect over 90% of abnormalities in the 12-lead ECG, including ST-T wave changes and bundle branch block. Patients found the syste

1. Diagnose AF Many patients with AF remain asymptomatic and undetected, and AF is usually suspected when a patient is found to have an irregular pulse. At fast or slow rates the irregularity can be hard to detect. Confirmation of a diagnosis of AF must be obtained by undertaking an electrocardiogram (ECG).2 Automatic reporting software is not very effective at diagnosing AF and can over diagnose when the baseline is indistinct or, alternatively, may miss cases. The characteristic ECG findings are irregularly irregular QRS complexes and the absence of consistent P waves. Practice nurses and GPs should take advantage of scenarios for opportun