Omega 3 poly unsaturated fatty acids (n-3 PUFA) have been shown to protect against sudden cardiac death following myocardial infarction and reduce the risk of ventricular arrhythmias in patients with heart failure. At the inception of this study, there was one clinical study that reported n-3 PUFA supplementation reduced the risk of atrial fibrillation (AF) following CABG. As AF is a very common arrhythmia and as there are no safe and effective means of preventing AF, we designed this study to further validate the findings of the previous study in a more robust study design. In addition, this study also aimed to evaluate the cellular changes that underpin the beneficial anti-arrhythmic effect of n-3 PUFA.The outcome of this study shows that n-3 PUFA does not reduce the risk of AF following CABG. However, short term supplementation with n-3 PUFA reliably increases the membrane incorporation in phospholipids and results in alteration in the expression levels of cardiac calcium handling proteins phospholamban and ryanodine receptors. In addition, such incorporation in animal (rat) ventricular myocytes leads to changes in the rate of decay of the systolic calcium transient and an increase in the amplitude of the caffeine induced calcium transient thereby indicating a greater activity of SERCA. These findings needs further evaluation but is clearly interesting as the clinical situations where n-3 PUFA have been shown to be anti-arrhythmic are situations where cellular calcium overload is the main mechanism of arrhythmogenesis.

Introdução: a fibrilação atrial (FA) é a arritmia mais frequente na prática clínica estando associada à elevada taxa de morbidade e mortalidade. O risco de acidente vascular cerebral (AVC) apresenta-se aumentado em pacientes com FA e há evidência de aumento progressivo do risco com o avançar da idade. A detecção precoce da FA pode permitir a antecipação terapêutica e consequente redução de morbimortalidade. Vários recursos diagnósticos têm sidos utilizados com essa finalidade incluindo o marca-passo cardíaco definitivo (MPD) que permite armazenar registros de elevada frequência no canal atrial. Sistemas atuais de monitoramento remoto contínuo (MRC) do portador de MPD permitem a identificação e o envio diário à distância destes eventos armazenados pelo dispositivo. Objetivo: definir o papel do MRC na detecção e no manejo da FA em idosos portadores de MPD. Método: foi um estudo prospectivo e randomizado com seleção consecutiva de 300 idosos (60 anos ou mais) entre março/2007 e janeiro/2010, em ritmo sinusal e com indicação para implante ou troca de MPD. Os pacientes (P) foram randomizados para grupo de intervenção (GI) em monitoramento remoto contínuo (n=150) e grupo controle (GC) em seguimento convencional (n=150) com consultas agendadas para 30, 90, 180 dias e posteriormente a cada seis meses até dois anos de seguimento. No GI foram realizadas consultas extras motivadas por alertas automáticos de FA com duração mínima de 2,5 horas enviados pelo sistema de MRC. Resultados: o tempo de seguimento médio foi de 435 dias. Não houve diferença entre os grupos (GI x GC) em relação à idade (75,5 x 74,3 anos, p=0,44), sexo (feminino 54,7% x 57,4%, p=0,46), indicação do MPD (BAV 89,7% x 88,7%; p=0,84) e eventos clínicos (incidência de FA 25,3% x 19,3%, p=0,42; AVC 1,4% x 0%, p=0,44 e óbitos 8,6% x 5,3%, p=0,16). Houve mais documentação eletrocardiográfica da FA no GI (10%) em comparação ao GC (4%), p=0,027 e o MPD detectou corretamente a FA em 95,2% desses casos. O tempo para a primeira recorrência da FA foi de 79 x 128 dias; p=0,005. O número de dias em FA foi menor no GI (16 dias; IConf 95%: 8,89 a 23,18) em relação ao GC (51,9 dias; IConf 95%: 21,89 a 81,93), p=0,028. Baseados no escore CHADS2 houve mais pacientes com indicação para terapia antitrombótica no GI (p=0,008). Foram realizadas 55 consultas extras motivadas pelo sistema de MRC com necessidade de mudança terapêutica em 81% dos casos (36% antitrombóticos, 20% antiarrítmicos, 13% reprogramação MPD e 12% cardioversão). Conclusões: o MRC proporcionou menor tempo para a detecção da FA reduzindo o número de dias em arritmia devido à antecipação da terapêutica. Houve mais pacientes com documentação eletrocardiográfica da FA e submetidos à terapia antitrombótica no GI. Os alertas automáticos do sistema de MRC apresentaram importância clínica na maioria das consultas extras havendo necessidade de modificações na terapia antiarrítmica e antitrombótica, assim como na reprogramação do MPD. Os resultados deste estudo destacam o MRC como ferramenta auxiliar no manejo da FA em idosos portadores de MPD / Introduction: atrial fibrillation (AF) is the most common arrhythmia in clinical practice and it is related to high prevalence of morbidity and mortality. The annual risk of stroke is increased in AF patients especially with advancing age. Early AF detection should anticipate the management of AF which can reduces morbidity and mortality. Atrial high rate episodes device detected is a good diagnostic tool in PM carriers and these events can be sent daily to the doctor by continuous remote monitoring (CRM) systems. The aim of this study was to determine the role of CRM to detect and in the management of AF in elderly pacemaker patients. Method: It was a randomized and prospective study. Between March/2007 and January/2010 we selected 300 consecutive patients with an indication to atrioventricular pacemaker implantation or generator change. There were included patients in sinus rhythm with 60 years old or more. They were randomized in remote group (RG=150) and control (CG=150). Follow-up (FU) was scheduled in 30, 90 and 180 days and after, 6/6 months until two years. Patients in RG had extra appointment if automatic AF alerts (minimum AF burden of 2.5 hours) were sent by CRM. Results: FU mean time was 435 days. There were no difference between studied groups (RG vs. CG) in age (75.5 vs. 74.3 years, P=0.44); gender (female 54.7% vs. 57.4%, P=0.46); pacemaker indication due to sick sinus syndrome 10.3% vs. 11.3% and AV block 89.7% vs. 88.7%, P=0.84; AF incidence 25.3% vs. 19.3%, P=0.42; stroke 1.4% vs. 0%, P=0.44 and death 8.6% vs. 5.3%, P=0.16. AF was documented by electrocardiogram in 21 patients (RG=10% vs. CG=4%, P=0.027) and the pacemakers detected AF correctly in 95,2%. Median time to first AF recurrence was 79 vs. 128 days, P=0.005. The mean AF days was 16.0 (IC95%; 8.89 to 23.18) vs. 51.91 (IC95%; 21.89 to 81.93); P=0.028. According CHADS2 score, there were more patients with an antithrombotic therapy indication in RG (P=0.008). In 55 extra appointments, there was a therapy change in 81% of them (36% antithrombotic therapy, 20% arrhythmic therapy, 13% pacemaker programming and 12% electrical cardioversion). Conclusion: CRM allowed earlier AF detection which reduced AF days by anticipated therapy. In RG, the time to detection of first AF recurrence was lower than in the conventional approach. There were more AF documented by EKG and more patients with an indication to antithrombotic therapy in RG. Most of extra appointment needed a therapy change with regard to antithrombotic or antiarrhythmic therapy and device programming. The results of this study point out the CRM like a good auxiliary tool in the management of AF in elderly pacemaker patients

O objetivo deste estudo foi avaliar retrospectivamente, em longo-prazo, os preditores de recorrência de fibrilação atrial paroxística (FA) em 139 pacientes submetidos à ablação por radiofreqüência, através das técnicas ostial ou extraostial de abordagem do átrio esquerdo, associadas ou não à ablação do istmo cavo-tricuspídeo (ICT). Variáveis pré, intra e pós-ablação foram avaliadas por análise uni e multivariada, para determinar os preditores de recorrência da FA após um procedimento. Observou-se que maior tempo de história de FA, uso de mais antiarrítmicos e recorrência de FA dentro de 60 dias pós-procedimento, aumentaram o risco de recorrência de FA a longo-prazo. Por outro lado, a associação de flutter atrial e a ablação concomitante do ICT, reduziram o risco de recorrência ao final de 33 ±12 meses. / The objective of this study was to evaluate in retrospect, in long-term, the predictors of late recurrence of atrial fibrillation (AF) in 139 patients submitted to the ablation by radiofrequency, through the techniques ostial or extra-ostial of approach of the atrium left, associated or not to the ablation of the cavotricuspid isthmus(ICT). Variables pre, intra and post-ablation were appraised for analysis uni and multivariated, to determine the predictors of recurrence of AF after one procedure. It was observed that larger time of history of AF, use of more drugs and recurrence of AF within 60 days after procedure; they increased the risk of recurrence of AF in long-term. On the other hand, the association of atrial flutter and the concomitant ablation of ICT, they reduced the recurrence risk at the end of 33 ±12 months.

eHealth is a recently emerging practice at the intersection between the ICT and healthcare fields where computing and communication technology is used to improve the traditional healthcare processes or create new opportunities to provide better health services, and eHealth can be considered under the umbrella of the Internet of Things. A common practice in eHealth is the use of machine learning for a computer-aided diagnosis, where an algorithm would be fed some biomedical signal to provide a diagnosis, in the same way a trained radiologist would do. This work considers the task of Atrial Fibrillation detection and proposes a novel range of algorithms to achieve energy-efficiency. Based on our working hypothesis, that computationally simple operations and low-precision data types are key for energy-efficiency, we evaluate various algorithms in the context of resource-restrained health-monitoring wearable devices. Finally, we assess the sustainability dimension of the proposed solution.

Förmaksflimmer är den vanligaste arytmin. Symtomen och diagnosen i sig har visats kunna orsaka upplevelser av oro, rädsla, osäkerhet och nedsatt livskvalité. Även om upplevelserna har visats kunna lindras med information, är det inte klargjort vilka behov personerna har av hjälp och stöd från vården. Syftet med arbetet var därför att undersöka det upplevda behovet av eftervård hos personer med förmaksflimmer. Metoden som har använts är av deskriptiv design med nio stycken kvalitativa semistrukturerade intervjuer efterföljt av manifest innehållsanalys. I resultatet presenteras tre kategorier besvarande av syftet. I kategorin Kunskapsbehov beskrivs informanternas upplevelse av behov att få ställa frågor och att få svar, bland annat på vilken behandling som var aktuell. Kategorin beskriver även behovet av information, som varierade, samt hur information bäst inhämtas. I kategorin Ansvar för uppföljning och eftervård framkom det olika upplevelser om var ansvaret för eftervård ligger. Vissa personer ansåg att det var deras ansvar att kontakta vården, medan andra personer ansåg att ansvaret låg hos vården. Kontinuerlig uppföljning är ett behov som många upplever, men som kan styras av det aktuella måendet och medicineringen. Den tredje kategorin är Vård och egenvård, behov av stöd. Den kännetecknas av behovet av en hantering av förmaksflimmer, som delvis kunde upplevas vara botemedel för sjukdomen. Behovet av vägledning från vården, i form av fysioterapeut, kurator och praktiska hjälpmedel påtalades. Kategorin beskriver även behovet av stöd från vården och samtalsgrupp var ett förslag som framkom för att tillgodose behovet av stöd. Slutsatsen är att det upplevda behovet av eftervård vid förmaksflimmer varierar. Behovet av uppföljning utmärker sig, även om alla inte upplever det behovet. För att tillgodose personernas individuella behov ställs det krav på sjuksköterskan och dennes roll i informatik, hälso-informatik samt personcentrerad vård. Eftervården måste anpassas efter den individuella personens behov. / Atrial fibrillation is the most common arrhythmia. The symptoms and diagnosis has shown to cause experiences of worry, fear, uncertainty and reduced quality of life. Even though these experiences can be relieved by information, it is not clear what need of help and support from healthcare the persons has. That is why the aim of this study was too investigate the perceived need for aftercare in persons with atrial fibrillation. The method that have been used is a descriptive design with nine qualitative semi-structured interviews, follow by a manifest content analysis. In the result three categories that described the aim is presented. The category The need for knowledge showed that the persons experience a need to ask questions and get them answered, among other things answers about current treatment. The category also describes the need for information, which varied, as well as how information is best collected. In the category Responsibility for follow-up and aftercare different experiences of where the responsibility for aftercare lays arose. Some persons felt that it was their responsibility to contact the healthcare, while other persons felt that the responsibilities laid with the healthcare. Continuous follow-up is a need that many people experience, but the need can be controlled by the current mood and medication. The third category is Care and self-care, the need for support. It was characterized by the need for management of atrial fibrillation, which in part could be perceived as a cure for the disease. The need for guidance from the healthcare, in form of a physical therapist, curators and practical aids was pointed out. The category also describes the need for support from healthcare and conversation therapy group was a proposal that came up to meet the need for support. The conclusion is that the perceived need for aftercare with atrial fibrillation varies. The need for follow-up stands out, even though not all experience that need. In order to accommodate the persons individual needs the nurse play a pivotal role in informatics, health informatics and person-centered care. The aftercare must accommodate the individual persons need.

Die hier vorliegende Studie stellt die Früh- und Langzeitergebnisse der chirurgischen Vorhofablation zur Behandlung des ischämischen Vorhofflimmerns (VHF) in Kombination mit einer aortokoronaren Bypass-Anlage vor. Dabei wurden die epikardiale Pulmonalvenenisolation mittels Radiofrequenzenergie (RF) und die endokardiale Kryoablation inklusive einer Box-Läsion und Mitralisthmuslinie miteinander verglichen. Im Zeitraum von 2002 bis 2009 wurden die prä- und postoperativen Daten von 262 Patienten mit paroxysmalem oder lang-persistierendem VHF prospektiv erhoben und anschließend eine Nachbeobachtung von durchschnittlich 2,30 Jahren durchgeführt. Die Kryoablation war im Vergleich zur RF-Ablation mit einer signifikant höheren perioperativen Invasivität und Morbidität verbunden. Die Operations- und Ischämiezeit sowie die postoperative intensivmedizinische Betreuung waren nach der Kryoablation signifikant länger. Die Rate an Schrittmacherimplantationen (4,8 % vs. 0,0 %), kardialen bzw. zerebralen Komplikationen (22,9 % vs. 12,3 %) und die Krankenhausmortalität (8,4 % vs. 2,2 %) lagen ebenfalls signifikant höher. Hingegen waren die Langzeitergebnisse ohne signifikante Unterschiede zwischen den Ablationsmethoden. Sowohl das Überleben (81,9 % vs. 86,0 %) als auch die Konversionsrate in den Sinusrhythmus (55,6 % vs. 61,5 %), die Lebensqualität der Patienten und die Komplikations- und Reinterventionsraten zeigten im Langzeitverlauf vergleichbare Ergebnisse. Auf der Basis der oben erhobenen Befunde kann die endokardiale Kryoablation nicht als Standardverfahren zur Therapie des paroxysmalen und lang-persistierenden ischämischen VHFs begleitend zu einer aortokoronaren Bypass-Anlage empfohlen werden. Die epikardiale RF-Ablation ist hier aufgrund der geringeren operativen Invasivität bei vergleichbaren Früh- und Langzeitergebnissen der endokardialen Ablation vorzuziehen. :BIBLIOGRAFISCHE ZUSAMMENFASSUNG ABKÜRZUNGSVERZEICHNIS TABELLENVERZEICHNIS ABBILDUNGSVERZEICHNIS 1 EINLEITUNG 1.1 Grundlagen zum Vorhofflimmern 1.1.1 Definition 1.1.2 Epidemiologie 1.1.3 Ätiologie 1.1.4 Klassifikation 1.1.5 Pathophysiologie 1.1.6 Klinik und Komplikationen 1.1.7 Therapieansätze 1.2 Chirurgische Vorhofablation 1.2.1 Entwicklung der VHF-Chirurgie 1.2.2 Indikation 1.2.3 Chirurgische Ablationskonzepte 1.2.4 RF-Ablation 1.2.5 Kryoablation 1.2.6 Alternative Energiequellen 1.3 KHK und operative Revaskularisation bei VHF-Patienten 1.4 Ziele der Arbeit und Fragestellung´ 2 MATERIAL UND METHODEN 2.1 Patientenkollektiv 2.2 Erfassung der Patientenvariablen 2.3 Definition der Endpunkte 2.4 Operations- und Ablationstechnik 2.5 Postoperatives Management 2.6 Follow-Up 2.7 Statistische Auswertung 3 ERGEBNISSE 3.1 Patienten mit paroxysmalem VHF 3.1.1 Patientencharakteristik 3.1.2 Operative Ergebnisse 3.1.3 Postoperative Ergebnisse und Komplikationen 3.1.4 Zustand bei Krankenhausentlassung 3.1.5 Ergebnisse der Langzeitbeobachtung 3.2 Patienten mit lang-persistierendem VHF 3.2.1 Patientencharakteristik 3.2.2 Operative Ergebnisse 3.2.3 Postoperative Ergebnisse und Komplikationen 3.2.4 Zustand bei Krankenhausentlassung 3.2.5 Ergebnisse der Langzeitbeobachtung 3.3 Ausgewählte Vergleiche von Patienten mit paroxysmalem und mit lang-persistierendem VHF 3.3.1 Patientencharakteristik 3.3.2 Operative Ergebnisse 3.3.3 Zustand bei Krankenhausentlassung 3.3.4 Ergebnisse der Langzeitbeobachtung 3.4 Ausgewählte Vergleiche von Patienten mit RF- und Kryoablation 3.4.1 Patientencharakteristik 3.4.2 Operative Ergebnisse 3.4.3 Postoperative Ergebnisse und Komplikationen 3.4.4 Zustand bei Krankenhausentlassung 3.4.5 Ergebnisse der Langzeitbeobachtung 4 DISKUSSION 4.1 Bezug zur Fragestellung 4.2 Einfluss des ischämischen VHFs 4.3 Einfluss des Ablationskonzepts 4.4 Einfluss der Ablationsenergie 4.4.1 Herzspezifische Laborparameter 4.4.2 Postoperative Verlaufsparameter 4.4.3 Ergebnisse der Langzeitbeobachtung 4.5 Schlussfolgerung und Ausblick 4.6 Limitationen 6 ZUSAMMENFASSUNG DER ARBEIT 7 LITERATURVERZEICHNIS 8 ANLAGEN SELBSTÄNDIGKEITSERKLÄRUNG PUBLIKATIONEN DANKSAGUNG

Background: The ideal treatment strategy for patients with cryptogenic stroke and patent foramen ovale (PFO) is not yet clear. Previous randomized controlled trials (RCTs) comparing transcatheter PFO closure with medical therapy in patients with cryptogenic stroke to prevent recurrent ischemic stroke showed mixed results. This meta-analysis aims to compare rates of recurrent stroke, transient ischemic attack (TIA) and all-cause mortality with PFO closure and medical therapy vs. medical therapy alone. Methods: PubMed and the Cochrane Center Register of Controlled Trials were searched for studies published through June 2018, comparing PFO closure plus medical therapy versus medical therapy alone. Six RCTs (n = 3750) comparing PFO closure with medical therapy were included in the analysis. End points were recurrent stroke, TIA and all-cause mortality. The odds ratios (OR) with 95% confidence interval (CI) were computed and p < 0.05 was considered as a level of significance. Results: A total of 1889 patients were assigned to PFO closure plus medical therapy and 1861 patients were assigned to medical therapy only. Risk of recurrent stroke was significantly lower in the PFO closure plus medical therapy group compared to medical therapy alone. (OR 0.47, 95% CI 0.33–0.67, p < 0.0001). Rate of TIA was similar between the two groups (OR 0.76, 95% CI 0.52–1.14), p = 0.18). There was no difference in all-cause mortality between two groups (OR 0.73, CI 0.33–1.58, p = 0.42). Patients undergoing PFO closure were more likely to develop transient atrial fibrillation than medical therapy alone (OR: 5.85; CI: 3.06–11.18, p ≤0.0001) whereas the risk of bleeding was similar between the groups (OR: 0.93; CI: 0.55–1.57, p = 0.78). Conclusions: The results of this meta-analysis suggest that transcatheter closure of PFO plus medical therapy is superior to medical therapy alone for the prevention of recurrent cryptogenic stroke. However, PFO closure in these patients has not been shown to reduce the risk of recurrent TIA or all-cause mortality. There is a higher rate of transient atrial fibrillation post PFO closure device placement, the long-term effects of which have yet to be studied.

Bedingt durch die zunehmende Prävalenz der Rhythmusstörung Vorhofflimmern mit den assoziierten Morbiditäts- und Mortalitätsrisiken ist die Entwicklung und Etablierung kurativer Therapieverfahren von klinischem und wissenschaftlichem Interesse. Entsprechend dem pathophysiologischen Verständnis der Arrhythmie-induzierenden Triggeraktivität und des Arrhythmie-erhaltenden Flimmersubstrat mit der vorrangigen anatomisch-strukturellen Lokalisation beider Entitäten im Übergangsbereich der großen Pulmonalvenentrichter in den posterioren linken Vorhof wurden katheterinterventionelle Ablationskonzepte als potentiell kurative Therapien entwickelt. Limitationen der praktischen Umsetzung theoretischer Linienkonzepte ergeben sich aus komplexen anatomischen Gegebenheiten und instabilen Zugangsbedingungen infolge Atmung und kardialer Mobilität. Aufbauend auf non-fluoroskopischen Navigationssystemen wurden Verfahren für vollständig Modell-integrierte Ansätze der Ablationslinienplatzierung entwickelt, bei denen Planung, Durchführung und Validierung der Ablation an anatomisch korrekten dreidimensionalen CT-Modellen des linken Vorhofes erfolgen. Zur Verbesserung instabiler Zugangsbedingungen wurden Verfahren der Katheternavigation mittels steuerbaren Schleusensystemen eingeführt und in entsprechenden Studien mit klinischen Endpunkten validiert. Zu objektivierbaren Erfassung von Energietransfer und myokardialer Läsionsbildung während der Ablation wurden katheterinterventionelle Kontakttechnologien, die auf der Messung lokaler komplexer Impedanzen zwischen Katheter und Gewebe beruhen, in der ersten klinischen Anwendung erprobt und validiert. Mit diesen technologischen Entwicklungen gelangen eine zunehmend akkuratere klinische Umsetzung theoretischer Ablationskonzepte und damit eine Etablierung des Therapiekonzeptes als klinisches Standardverfahren. Eine zur Abschätzung des Nutzen/Risiko-Profils nötige detaillierte Komplikationsanalyse stellte die Ösophagusverletzung als schwerste Komplikation heraus, die mit 0,3% selten auftrat, aber für nahezu alle langfristigen Folgeschäden verantwortlich war. Entwicklungen zur periprozeduralen Visualisierung des Ösophagus mit paralleler intraösophagealer Temperaturmessung sind Ansätze zur Vermeidung dieser Komplikation in der Zukunft. Bedingt durch das Auftreten und die postinterventionelle Zunahme asymptomatischer Flimmerrezidive ist die Frage eines objektiven Vorhofflimmermonitorings von entscheidender Bedeutung für die Beurteilung der Effektivität der Ablation sowie weitergehende klinische und wissenschaftliche Fragestellungen; wie die Indikation zur Antikoagulation oder den Vergleich von Rhythmus- und Frequenzkontrolle. 7-Tage-LzEKGs und transtelephonische EKGs wurden als Standard zum Monitoring innerhalb klinischer Vorhofflimmerstudien etabliert. Entwicklungen im Bereich implantierbarer kontinuierlicher Rhythmusmonitore werden in Zukunft das Netz zur Erfassung asymptomatischen Vorhofflimmerns weiter verdichten.

Förmaksflimmer är den vanligast förekommande hjärtrytmsrubbningen och är associerat med en ökad risk för morbiditet och mortalitet, samt en negativ påverkan på livskvaliteten. Förmaksflimmer är en kronisk sjukdom och står för en stor del av sjukdomsbördan både för patienterna och för hälso- och sjukvården. Inom vården för patienter med förmaksflimmer fungerar verksamheter för omhändertagandet olika. För att hjälpa dessa patienter behövs specifik och avancerad patientutbildning och råd av multidisciplinära team med kunskap som är evidensbaserad. Där är sjuksköterskan en del av det multidisciplinära teamet. I riktlinjer från ESC (European Society of Cardiology) gällande förmaksflimmer, har patienten den centrala rollen och ska tillsammans med vårdpersonal ta beslut om sin vård. Ett personcentrerat förhållningssätt kan hjälpa till att stärka patientens tilltro till sin egna förmåga, förbättra livskvalitet och symtomlindring, samt leda till kortare vårdtider. Syftet var att belysa sjuksköterskeledda mottagningar och dess effekt för patienter med förmaksflimmer. Litteraturöversikt med strukturerad sökning användes som design. Detta självständiga arbete inkluderade 16 vetenskapliga artiklar från databaserna Pubmed och CINAHL Complete. De inkluderade artiklarna kvalitetsgranskades och analyserades med integrerad analys för att syntetisera resultaten i relation till varandra. Vid analysen framkom kategorier och underkategorier som beskrev artiklarnas resultat. Resultatet visade att sjuksköterskeledd mottagning hade ett antal olika effekter för patienter med förmaksflimmer. Effekterna för sjuksköterskeledd mottagning var likvärdig eller bättre för patienter med förmaksflimmer jämfört med sedvanlig vård. Resultatet visade att de positiva effekterna för patienter med förmaksflimmer som fick vård på sjuksköterskeledd mottagning resulterade i färre sjukhusinläggningar, lägre mortalitet, bättre behandling med antikoagulantia, bättre följsamhet till fler rekommendationer, reducerat antal symtom och ökad kunskap om förmaksflimmer hos patienter. Slutsatsen var att sjuksköterskeledd mottagning är likvärdig eller bättre för patienter med förmaksflimmer vid jämförelse med sedvanlig vård. personcentrerat förhållningssätt kan hjälpa till att stärka patientens tilltro till sin egna förmåga, förbättra livskvalitet och symtomlindring, samt leda till kortare vårdtider / Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of morbidity and mortality and negative impact on quality of life. Atrial fibrillation is a chronic disease and accounts for a large proportion of the disease burden both for patients and for health care. In the care of patients with atrial fibrillation, care activities work differently. To help these patients, specific and advanced patient education and advice from multidisciplinary teams with evidence-based knowledge is needed. There, the nurse is part of the multidisciplinary team. In guidelines from the ESC (European Society of Cardiology) regarding atrial fibrillation, the patient has the central role and must, together with care staff, make decisions about their care. A person-centered approach can help strengthen the patient's confidence in their own abilities, improve the quality of life and symptom relief, as well as shorten their care times. The aim was to illuminate nurse-led clinics and their effect for patients with atrial fibrillation. A literature review with structured search was used as a method. This master thesis included 16 scientific articles from the databases Pubmed and CINAHL Complete. The included result articles were quality reviewed and analyzed with integrated analysis to synthesize the results in relation to each other. The categories were then identified to describe the results of the articles. The results showed that nurse-led clinics had a number of different effects for patients with atrial fibrillation. The effects for nurse-led clinics were equivalent or slightly better for patients with atrial fibrillation compared with usual care. The results showed that the positive effects for patients with atrial fibrillation who received care at the nurse-led clinic to be: fewer hospital admissions, lower mortality, better treatment with anticoagulants, better adherence to more recommendations, reduced number of symptoms and increased knowledge of atrial fibrillation among patients. The conclusion is that nurse-led clinics are equivalent or better for patients with atrial fibrillation when compared with usual care.

Vid flertalet hjärtsjukdomar kan det förekomma störningar i den diastoliska funktionen, detta tillstånd benämns diastolisk dysfunktion. Detta innebär att fyllnadstrycken i vänsterkammare ökar på grund av nedsatt eftergivlighet i kammaren. Bedömning av diastolisk funktion, hos patienter som utvecklat förmaksflimmer, är en utmaning inom ekokardiografi. Detta beror på att förmaksflimmer innebär utebliven förmakskontraktion, oregelbunden längd av hjärtcykeln och förmaksdilatation, vilket försvårar bedömningen. Syftet med studien var att med ekokardiografi studera diastoliska parametrar hos patienter med förmaksflimmer för att studera om dessa kan användas vid bedömning av den diastoliska vänsterkammarfunktionen hos denna patientgrupp. I studien inkluderades 37 deltagare med förmaksflimmer som var remitterade för en ekokardiografisk undersökning med olika frågeställningar. Pulsad doppler teknik och vävnads doppler teknik användes för att registrera följande diastoliska parametrar: förmaksvolym, mitralisinflöde (E-vågshastigheten) och myokardiets diastoliska hastigheter (e´). Utöver dessa uppskattades även ejektionsfraktion, hjärtfrekvens, hypertrofi och trycket i lilla kretsloppet, som togs med vid bedömningen. Mann-Whitneys test visade att det förelåg ett starkt statistiskt samband mellan fyllnadstrycket (E/e´) och E-vågen, e ´samt förmaksvolym (p = <0,05). Signifikant resultat erhölls även för sambandet mellan PA-tryck och fyllnadstryck (p = 0,014) genom ett chitvå-test. Vidare gav multipel linjär regression utslag på E-vågen och e´. Analysen visade att det förelåg en hög förklaringsgrad för E-vågen (p = <0,001) och e´ (p = 0,008). Sammanfattningsvis visade resultaten att ekokardiografi kan användas för diagnostik av förmaksflimmerpatienter avseende fyllnadstryck där förmaksvolym, E-vågshastigheten och e´ anses vara bästa parametrarna. / In the majority of heart diseases disturbances in the diastolic function may occur, this condition is called diastolic dysfunction. This means that the left ventricular filling pressure increases due to reduced compliance in the chamber. The assessment of diastolic function in patients who have developed atrial fibrillation (AF), is a challenge in echocardiography. This is a result of AF which involves absence of atrial contraction, irregular length of the cardiac cycle and left atrium dilatation that complicates the assessment. The aim of this study was to observe the diastolic echocardiographic parameters in patients with AF to examine if these can be used in the assessment of diastolic left ventricular function in this population. The study included 37 participants with AF who were remitted for an echocardiographic examination due to various concerns. Pulsed Doppler technique and tissue Doppler technique was used to record the following diastolic parameters: atrial volume, mitral inflow velocity (E) and the myocardial diastolic velocity (e'). Ejection fraction, heart-rate, hypertrophy and pulmonary artery pressure were also estimated and included in the assessment. Mann-Whitneys test showed that there was a strong statistical correlation between the filling pressure (E/e') and E, e' and atrial volume (p = <0.05). Significant results were also obtained for the relation between pulmonary artery pressure and the filling pressure (p = 0.014) by a chi-square test. A multiple linear regression showed association between E and e'. The analysis showed that there was a significant value of coefficient of determination for E (p = <0.001) and e' (p = 0.008). In conclusion, the results showed that echocardiography can be used for diagnosis of AF patients regarding filling pressures, where atrial volume, E velocity and e' are considered to be the best parameters.