Atrial fibrillation (AF) is the disordered activation of the atrial myocardium, which is a major cause of stroke. Currently, the most effective, minimally traumatic treatment for AF is percutaneous catheter ablation to isolate arrhythmogenic areas from the rest of the atrium. The standard in vitro evaluation of ablation catheters through lesion studies is a resource intensive effort due to tissue variability and visual measurement methods, necessitating large sample sizes and multiple prototype builds. A computational test bed for ablation catheter evaluation was built in SolidWorks® using the morphology and dimensions of the left atrium adjacent structures. From this geometry, the physical model was built in COMSOL Multiphysics®, where a combination of the laminar fluid flow, electrical currents, and bioheat transfer was used to simulate radiofrequency (RF) tissue ablation. Simulations in simplified 3D geometries led to lesions sizes within the reported ranges from an in-vivo ablation study. However, though the ellipsoid lesion morphologies in the full atrial model were consistent with past lesion studies, perpendicularly oriented catheter tips were associated with decreases of -91.3% and -70.0% in lesion depth and maximum diameter. On the other hand, tangentially oriented catheter tips produced lesions that were only off by -28.4% and +7.9% for max depth and max diameter. Preliminary investigation into the causes of the discrepancy were performed for fluid velocities, contact area, and other factors. Finally, suggestions for further investigation are provided to aid in determining the root cause of the discrepancy, such that the test bed may be used for other ablation catheter evaluations.

Bakgrund: Förmaksflimmer är ur ett globalt perspektiv den mest förekommande arytmisjukdomen och prevalensen ökar i och med en åldrande befolkning. Sjukdomen kan påverka patienten fysiskt, psykiskt och socialt, vilket kan orsaka en sämre livskvalité. Genom livsstilsförändringar kan symtombördan minskas. Det leder till att patienter med förmaksflimmer är i behov av en personcentrerad omvårdnad utifrån ett helhetsperspektiv. Sjuksköterskans ansvarsområde är omvårdnad och den ska inkludera ett deltagande av patienten i planeringen och i utförandet för att främja hälsa. Syfte: Syftet var att belysa patientens upplevelser av omvårdnaden vid förmaksflimmer inom hälso- och sjukvården. Metod: En allmänlitteraturstudie. Resultat: Litteraturstudien resulterade i tre huvudkategorier: bristande information och utbildning, betydelsen av kontakt med sjuksköterskan och behov av stöd. Konklusion: Sjuksköterskan har en betydelsefull roll för patienter med förmaksflimmer och ansvarar för omvårdnaden. Omvårdnaden bör inkludera information och patientutbildning, samt stöd och hantering i patientens egenvård. Digitala alternativ för omvårdnad kan öka stödet och vara ett alternativ för att utöka omvårdnaden. / Background: From a global perspective, atrial fibrillation is the most common arrhythmia disease, and the prevalence is increasing with an aging population. The disease affects the patient physically, psychologically and socially, which can cause a poorer quality of life. Through lifestyle changes, the burden of symptoms can be reduced. That leads to patients with atrial fibrillation are in need of person-centered care based on a holistic perspective. The nurse's area of responsibility is nursing, that includes participation of the patient in the planning and in the execution and to promote health. Purpose: The aim was to illustrate the patients’ experiences of nursing care for atrial fibrillation within healthcare. Method: A general literature review. Results: The literature reviews results are presented in three categories: lack of information and education, importance of contact with the nurse and need for support. Conclusion: The nurse has an important role for patients with atrial fibrillation and is responsible for nursing care. Nursing care should include information and patient education, as well as support and management in the patient's self-care. Digital care can increase support and could be an option to extend nursing care.

Moderne Herzschrittmacher sind mit zahlreichen Algorithmen ausgestattet, die sie zu bemerkenswerten therapeutischen und diagnostischen Werkzeugen machen. Die zunehmende Komplexität bringt jedoch unbeabsichtigt neue Herausforderungen mit sich. In dieser Arbeit beschreiben wir eine neue Herzschrittmacher-Induzierte Arrhythmie die oft zum Vorhofflimmern führt.:1. Introduction................................................................................................ 3 1.1. A flashback to the beginning of cardiac pacemakers ............................. 3 1.2. Early pacemakers and significant advances .......................................... 5 1.3. Fast-forward to modern pacemakers ...................................................... 6 1.4. Current challenges .................................................................................. 8 1.5. Identification of a new pacemaker induced arrhythmia .......................... 10 1.6. Methods and results ............................................................................... 11 1.7. Patient characteristics ............................................................................ 13

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Untersuchung von MPO sowie anti-inflammatorischer HDL Funktionalität bei Patienten mit Vorhofflimmern

Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke (n=86) had a larger overall oriented bounding box (OBB) volume (p=0.003) and a higher number of brain lesion components (p=0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p<0.001), age (OR 2.13, 95%CI 1.52–3.06, p<0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p=0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.

The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients (n = 454) undergoing CV. Cox regression models were performed to estimate AF recurrence comparing patients with and without statins. In addition, we performed a propensity score matched analysis with a 1:1 ratio. Statins were prescribed to 183 (40.3%) patients. After a median follow-up period of 373 (207–805) days, recurrence of AF was present in 150 (33.0%) patients. Patients receiving statins had a significantly lower rate of AF recurrence (log-rank p < 0.001). In univariate analysis, statin therapy was associated with a significantly reduced rate of AF recurrence (HR 0.333 (95% CI 0.225–0.493), p = 0.001), which remained significant after adjustment (HR 0.238 (95% CI 0.151–0.375), p < 0.001). After propensity score matching treatment with statins resulted in an absolute risk reduction of 27.5% for recurrent AF (21 (18.1%) vs. 53 (45.7%); p < 0.001). Statin therapy was associated with a reduced risk of long-term AF recurrence after successful cardioversion.

Atrial fibrillation (AF) is our society's most common cardiac arrhythmic disease, leading to increased morbidity and mortality. Predicting AF episodes during sinus rhythm based on electrocardiograms (ECGs) allows timely interventions. It is known, that changes in selected ECG morphology features are a predictor for the onset of AF, but no systematic investigation of different ECG features' temporal changes has been performed so far. We split sinus rhythm episodes of 60 minutes preceding AF from the MIT-BIH AF database into segments of 5 minutes with 50% overlap (n=644) and calculated 155 features of different domains per segment. Logistic regression analyses between the segments preceding AF and others revealed the most significant effects for segments ending 5 minutes before AF onset, with PQ interval slope (p < 0.01), PQ interval correlation (p < 0.05), and median RR time (p < 0.05) being the most relevant features. A decision tree ensemble, trained with all features, achieved an accuracy of 0.87 when distinguishing 8 segment clusters. Our results confirm expected changes in ECG features (e.g., PQ interval) before AF episodes, indicating impaired atrial excitation, and show that the combination of interpretable features is sufficient to discriminate at different points in time before AF onset. For advanced analyses, more extensive databases should be included.

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No description available.