Šiame darbe apžvelgiama Vilniaus Universiteto Širdies ligų ir kraujagyslių klinikoje 1991−2008 metais sukaupta patirtis taikant nemedikamentinį gydymą pacientams su supraventrikulinėmis tachikardijomis ir skilveliniais ritmo sutrikimais. Apibendrinome nemedikamentinio gydymo rezultatus 1693 pacientams: 753 pacientams su atrioventrikulinio mazgo paroksizmine tachikardija, 657 pacientams su papildomais laidumo takais, 169 pacientams su skilvelinėmis tachikardijomis. Be to, apibendrinome kardioverterių defibriliatorių implantavimo rezultatus 118 pacientų. Nustatėme, kad atrioventrikulinio mazgo tachikardijos kateterinės abliacijos efektyvumas 99,2%, komplikacijų dažnis 0,53%. Įrodėme, kad saugu atlikti „lėtos“ zonos abliaciją pacientams su ilgu PQ intervalu. Papildomų laidumo takų kateterinė abliacija buvo efektyvi 98,1% atvejų, komplikacijų dažnis 1,7%. Papildomų laidumo takų grupėje sudėtingiausios lokalizacijos yra užpakalinė pertvarinė dalis ir vidurinė pertvarinė dalis (pastaroji – dėl rizikos sukelti III laipsnio AV blokadą). Skilvelinių tachikardijų kateterinės abliacijos rezultatas priklauso nuo etiologijos. „Idiopatinių“ skilvelinių tachikardijų atvejais kateterinės abliacijos efektyvumas viršija 90%. Koronarinės širdies ligos ir kardiomiopatijų atvejais kateterinė abliacija mažiau efektyvi (~60%). Kardioverterių defibriliatorių grupėje iki 11 m. stebint pacientus, defibriliatorius suveikė 68,6% atvejų. / This paper reviews the 1991−2008 experience with non-pharmacological treatment of supraventricular and ventricular tachycardias in the Clinic of Heart and vessel diseases of Vilnius University. We summarized the results of managing 1693 patients: 753 patients with atrioventricular nodal tachycardia, 657 patients with accessory pathways, 169 patients with ventricular tachycardias, and 118 patients with implanted cardioverter defibrillators. We have shown that the success rate of catheter ablation for atrioventricular nodal tachycardia is 99.2% with complication rate 0.53%. The safety of ablating the “slow” pathway in patients with prolonged PQ interval has been shown. The success rate of catheter ablation of accessory pathways is 98.1% with 1.7% complication rate. The most complex accessory pathway localization for ablation was posteroseptal area and midseptal area (the latter because of the risk to induce a complete atrioventricular block). The result of catheter ablation for ventricular tachycardia depends on etiology. For “idiopathic” ventricular tachycardias success rate exceeds 90%. In patients with coronary heart disease and cardiomyopathies, catheter ablation is less effective (60%). During the follow-up with duration up to 11 years, 68.6% of patients with implanted cardioverter defibrillators have experienced therapy delivered by the device.

Abstract Introduction: The perception of quality of life (QoL) in patients with implantable cardiac devices including implantable cardioverter-defibrillators (ICD), followed by telemonitoring care (Home Monitoring HM), has recently become an extremely hot topic due to constantly increasing number of patients wearing these devices. This increase has resulted in an increased demand for safe, prompt, and more effective out-patient care. Methods: Our research was carried out between December 2016 and March 2017. A cohort of 150 consecutive patients with ICD, followed using the Home Monitoring system (HM+), and 150 consecutive patients with ICD, followed using conventional in-office check-ups (HM-), was retrospectively drawn from the Ceske Budejovice Hospital Patient Information System. A questionnaire, which specifically addressed QoL (EQ5D), level of anxiety and depression (HADS), and a custom questionnaire examining the relationship between patients and the HM system and telecare workflow, was sent out to all patients. Results: For the final statistical analysis, 91 (60.7%) and 104 (69.3%) of the questionnaires were used from the HM+ and HM- groups, respectively. Our results showed that the method of ICD device follow-up did not directly influence QoL. Our statistical comparison of the data did not show any difference between HM+ and HM- patients. A non-significant trend towards better QoL in HM+ compared to HM- patients was noted based on total QoL scores from the EQ5D questionnaire (68.6 ? 19 vs. 64.6 ? 16.5, p = 0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM- patients. However, more than half of the patients in both groups were in the "normal" population range with respect to anxiety and depression. The most striking difference between HM+ and HM- patients was noted in the preference for the type of follow-up: while 54.9% of HM- patients expressed an interest in remote follow-up and 45.1% said they preferred in-office check-ups, only 6.7% (p < 0.0001) of HM+ patients expressed an interest in switching to in-office check-ups with personal contact instead of remote monitoring. Willingness to partially cover the financial costs of telecare was similar in both groups. HM+ patients were more inclined to use remote ICD monitoring (p = 0.007) and had a more positive attitude toward the telecare approach overall, compared to HM- patients (p = 0.034). Conclusion: The method of device follow-up does not significantly affect QoL in patients with ICD devices, nor does it affect levels of anxiety and depression. Generally, patients with ICDs followed using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring. Although, the willingness to, at least partially, cover the costs of the HM system was limited and comparable to that of patients receiving conventional follow-up.

Nursing care continuing the treatment of cardiac arrhythmias is an inseparable part of the patient?s care. As there are various types of arrhythmias and different types of treatment, similarly, the subsequent nursing care has its specifics as well. It relates not only to the post-treatment care but also to pre-surgery preparation and subsequent education. The theoretical part of the thesis contains the information on arrhythmias, their development and treatment. Organizations associating nurses working in arrhythmologic centres are mentioned as well. The practical part consists of the survey research. The quantitative enquiry is conducted in arrhythmologic centres by means of questionnaires addressing the nurses. The qualitative part contains interviews with patients who underwent some of the types of cardiac arrhythmia treatment. The objective of the thesis was to find out whether the nurses are aware of the specifics of the nursing care that follows the treatment of cardiac arrhythmia, in which stage the treatment is the most demanding for nurses and whether they can apply standardized nursing procedures in their work. Another objective is focused on mapping of the educative activity within the nursing care. Interviews with the patients are aimed at the areas of admission, prior to surgery, after surgery and during education. They should outline the view from ?the other side?. All the defined hypotheses were confirmed. The cardinal hypothesis of the thesis was the assumption that nurses, when providing nursing care to patients undergoing treatment of cardiac arrhythmias, do not work according to standardized nursing procedures. Subsequently, a draft of standardized nursing procedure focused on nursing care of patients undergoing implantation of a permanent cardiostimulator was prepared ? it could be applied in the University Hospital in Plzeň where most of the enquiry was conducted.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-07-14T11:34:00Z No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-07-14T11:45:20Z (GMT) No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-07-14T11:45:20Z (GMT). No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-12-12 / Background: Chagas’s heart disease remains a major public health problem in Brazil. Sudden death is the leading cause of decease, because of that, the implantable cardioverter defibrillator (ICD) has become an important therapeutic option in this disease. Objective: To define the prevalence and predictors of electrical storm (ES) in patients with Chronic Chagas Heart Disease (CCh) with an ICD. Methods: We retrospectively studied 81 consecutive patients with CCh in whom an ICD was implanted between January 2004 to December 2007, with a mean follow up of 45,9 ± 15 months. Patients were classified into two groups according to the presence of ES episodes. We compared baseline and funcional characteristics. p values less than 0,05 were considered statistically significant. Results: Thirty five patients (43,2%) developed TE during follow up. By univariate analysis, QRS width ≥ 150 ms (p=0,001), previous pacemaker (p=0,001), ventricular tachycardia (VT) for indication of ICD (p=0,001) and cumulative percent ventricular pacing (C%VP) > 40%/80%) were all predictors of TE. However, by multivariate analysis only the indication of ICD for VT (odds ratio (OR) = 9.16, 95% CI: 1.98 to 42.78, p = 0.005) and C%VP > 40%/80% (OR = 6.30, 95% CI: 1.56 to 25.49, p = 0.010) were independent predictors of TE. Conclusion: 1- ES is very frequent in subjects with CCh and ICD; 2- Indication of ICD for VT and C%VP > 40%/80% were independent predictors of TE. / Fundamento: A Cardiopatia Chagásica ainda é um importante problema de saúde pública no Brasil. A morte súbita é a principal causa de óbito, por isto, o cardioversor desfibrilador implantável (CDI) tornou-se importante opção terapêutica nesta doença. Objetivos: Avaliar a prevalência e fatores preditores da tempestade arritmogênica ou elétrica (TA ou TE) em pacientes chagásicos portadores de CDI. Metodologia: Estudo retrospectivo de uma coorte de 81 pacientes chagásicos submetidos a implante de CDI entre Janeiro de 2004 a Dezembro de 2007, com seguimento médio de 45,9 ± 15 meses.Os pacientes foram classificados em dois grupos de acordo com a presença ou não de TE. Comparou-se as características basais e funcionais da amostra utilizando-se testes estastísticos (t student, qui-quadrado e, quando necessário, Fisher). Resultados: A idade foi de 57,0 ± 9,5 anos, sexo masculino 60 (74,1%), a fração de ejeção (FE) média foi de 43,8 ± 7,6. Dos 81 casos da amostra, 35 (43,2%) apresentaram pelo menos um episódio de TE. Estes tiveram um total de 378 TE com média de 10,8 ± 11,6. Em análise univariada, identificou-se que a indicação do CDI por taquicardia ventricular sustentada espontanea (TVSE) (p=0,001), duração do QRS (dQRS) ≥ 150ms (p= 0,001), ser portador de marcapasso (MP) (p=0,001) , percentagem de estímulo de ventrículo direito (PEVD) > 40%/80% (p= 0,001) e classe funcional (CF) final III/IV (p= 0,015), foram fatores preditores de TE nesta coorte. Porém, a análise multivariada demonstrou que apenas a indicação de CDI por TVSE ( odds ratio (OR)= 9,16; IC 95%: 1,98- 42,78; p= 0,005) e PEVD > 40%/80% ( OR=6,30; IC 95%: 1,56-25,49; p=0,010 ) foram fatores preditores independentes para TE. Conclusão: Nos pacientes chagásicos portadores de CDI, houve elevada prevalência de TE (43,3%). Os fatores preditores independentes para TE foram: TVS (TVSE) prévia e PEVD > 40%/80%.

A estratificação de risco para morte súbita em pacientes com cardiomiopatia hipertrófica ainda é um desafio. Sua prevenção pelo cardiodesfibrilador automático é eficaz, porém, onerosa e não isenta de riscos. Pacientes com indicação de cardiodesfibrilador automático para prevenção primária, baseada em fatores de risco clínicos, apresentam baixa taxa de terapias apropriadas. Estudos que validem novos fatores de risco são necessários, visando identificar pacientes com maior probabilidade de morte súbita e, portanto, que se beneficiam do implante do dispositivo. Estudos que correlacionam a presença de realce tardio com arritmias ventriculares e morte súbita foram realizados, entretanto, sua aplicabilidade clinica ainda não é consenso. Objetivos: Avaliar, em portadores de cardiomiopatia hipertrófica, se a presença e a extensão de realce tardio, identificado pela tomografia computadorizada, correlaciona-se com a ocorrência de taquiarritmias ventriculares registradas no monitor de eventos do cardiodesfibrilador automático, durante um seguimento clínico ambulatorial. Métodos: Foram incluídos pacientes com cardiomiopatia hipertrófica dos ambulatórios de Eletrofisiologia e Miocardiopatias do Instituto Dante Pazzanese de Cardiologia. Os pacientes foram divididos em dois grupos: grupo I composto por aqueles que receberam terapia apropriada pelo cardiodesfibrilador automático ou tiveram apenas a documentação de taquicardia ventricular não sustentada pelo cardiodesfibrilador automático; grupo II, composto por pacientes sem documentação de arritmias ventriculares no monitor de eventos. As variáveis contínuas foram comparadas utilizando-se testes t de Student pareado ou Wilcoxon; para as categóricas o teste do x2. Para análise dos dados, utilizou-se o programa SPSS. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Sessenta e um pacientes (idade média 39±15 anos, 51% mulheres, com seguimento médio 5,13±3,0 anos) foram avaliados. Em 91,8%, a indicação do cardiodesfibrilador automático foi por prevenção primária. Durante o seguimento clínico, cinco pacientes (8,2%) apresentaram terapias apropriadas e 15 (24,6%) tiveram taquicardia ventricular não sustentada, mas sem terapia. A densidade de fibrose (incluindo massa de ventrículo esquerdo acometida e percentual de acometimento) não foi estatisticamente diferente entre os grupos I e II (4,3±4,8% vs 7,0±7,7% nos grupos I e II, respectivamente, p = 0,13). Entretanto, 85% dos pacientes com taquicardia ventricular apresentavam fibrose à tomografia computadorizada. Maiores densidades de fibrose se correlacionaram com idades mais jovens, com menores frações de ejeção e sexo masculino. Espessura septal >= 30mm se correlacionou à maior massa de fibrose. Houve correlação entre o surgimento de fibrilação atrial e maior porcentual de fibrose do ventrículo esquerdo. Dentre os fatores que se correlacionaram com maior densidade de fibrose, nenhum deles se correlacionou com eventos arrítmicos ventriculares. A associação dos fatores clínicos ou fatores clínicos isolados que motivaram a indicação do implante do cardiodesfibrilador automático não se correlacionou com eventos arrítmicos. Os pacientes do grupo I apresentaram maior diâmetro diastólico do ventrículo esquerdo e maior diâmetro do átrio esquerdo quando comparado com os pacientes do grupo II (47,7±4,7mm vs 43.1±5,4 mm, p = 0,002 e 47,8±8mm vs 41,5±7,1mm, p = 0,003, respectivamente). Conclusões: 1. A presença de fibrose detectada pela tomografia computadorizada apresenta razoável sensibilidade para identificação de pacientes com risco para taquicardia ventricular; 2. A densidade de fibrose foi similar nos pacientes dos grupos I e II; 3. Pacientes com fibrilação atrial apresentaram maior densidade de fibrose ventricular detectada pela tomografia computadorizada em comparação aos pacientes sem fibrilação atrial; 4. O diâmetro diastólico final de ventrículo esquerdo e o diâmetro atrial esquerdo associaram-se à maior risco de taquicardia ventricular; 5. Os fatores de risco convencionais, associados ou não à fibrose, não se correlacionaram com maior probabilidade de ocorrência de eventos arrítmicos ventriculares. / Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy patients is still challenging. Primary prevention of sudden death with implantable cardioverter-defibrillator is an effective, however, costly and not risk-free method. Patients with implantable cardioverter-defibrillator indicated for primary prevention based on clinical risk factors display low rates of appropriate therapies. Studies evaluating new risk factors are needed seeking to identify who would be mostly at risk of sudden cardiac death, and therefore benefit from cardioverter-defibrillator. Studies have been conducted to establish a correlation between late enhancement and ventricular arrhythmias and sudden cardiac death; however, its clinical applicability is still controversial. Objective: To evaluate if the presence and extension of late enhancement, identified by computed tomography, correlates with the occurrence of ventricular arrhythmias in hypertrophic cardiomyopathy patients. Methods: Patients with hypertrophic cardiomyopathy followed in Electrophysiology and Cardiomyopathies divisions at Dante Pazzanese Institute of Cardiology were included in the study. Patients were divided into two groups: group I composed by those with appropriate therapies (shock or overdrive) or non-sustained ventricular tachycardia; and group II, composed by patients without documented ventricular arrhythmias. Continuous variables were compared using paired t-student test or Wilcoxon test. Categorical variables were analyzed using chi-square test. For data analysis, the SPSS program was used. P values < 0.05 were considered statistically significant. Results: Sixty one patients (mean age 39 ± 15 years, 51% female, average follow up 5.13 ± 3 years) were evaluated. In 91.8%, cardioveter-defibrillator was indicated by primary prevention. During the follow up, five patients (8.2%) had appropriate therapies and 15 (24.6%) presented non-sustained ventricular tachycardia without therapies. Fibrosis density, (including left ventricular mass compromise and percentage) was not statistically different between the groups (4.3±4.8% for group I vs. 7.0±7.7% for group II, p =0.13). However, 85% of patients with ventricular tachycardia had fibrosis on cardiac computed tomography. Larger fibrosis density correlated with younger age, reduced ejection fraction and male gender. Septum >30 mm correlated with fibrosis mass. There was a correlation between atrial fibrillation and higher left ventricular fibrosis percentage. Among the factors that correlated with higher fibrosis density, none of them had correlation with ventricular arrhythmic events. The combination of clinical factors that motivated the implantation of cardioverter-defibrillator did not correlate with arrhythmic events. Patients at group I had larger left ventricular diastolic diameter (47.7±4.7 vs. 43.1±5.4mm, respectively, p= 0.002) and left atrium diameter (47.8±8.2 vs. 41.5±7.1 mm, respectively, p=0.003). Conclusions: 1. The presence of fibrosis detected by cardiac tomography had reasonable sensitivity to identify patients at risk of ventricular tachycardia; 2. Fibrosis density was similar between groups I and II; 3. Patients with atrial fibrillation had more fibrosis density detected by cardiac tomography compared to patients without atrial fibrillation; 4. Left ventricular end diastolic diameter and left atrial diameter correlated with increased risk of ventricular tachycardia; 5. Classical risk factors, associated or not with fibrosis, did not correlate with increased probability of ventricular arrhythmic events.

No description available.

This thesis deals with electromagnetic compatibility of implantable electro-medical devices using in cardiology. The main aim of this thesis is detection of the resistance of implantable pacemakers (PM) and implantable cardioverter defibrillators (ICD) to the electromagnetic interference. In the first part of this thesis, a function of the heart, which is necessary for understanding of PM and ICD operation, is described. The function and construction of PM and ICD is detailed in the theoretical part as well. The next part is focused on the electromagnetic compatibility. The next part is description of the measurement method and the experimental arrangement used for practical experiments with electromagnetic resistance of PM and ICD.

Pulmonary edema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. When the heart is not able to pump blood to the body efficiently, fluid can back up into the veins that take blood through the lungs to the left atrium. This then builds up the pressure in the blood vessels and fluid is pushed into the alveoli in the lungs. The fluid reduces normal oxygen movement through the lungs and can cause impaired gas exchange and respiratory failure. There are many causes of congestive heart failure that may lead to pulmonary edema such as heart attack, any diseases of the heart that weaken or stiffen the heart muscle, a leaking or narrowed heart valve, and sudden, severe high blood pressure. Pulmonary edema is a strong indicator of congestive heart failure in patients and therefore can be used as a gauge for congestive heart failure. One way to diagnose cardiogenic pulmonary edema constantly is through the continuous monitoring of the transthoracic impedance throughout the day. One method to achieve this constant monitoring is through the use of a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). Many patients who are at risk of heart failure have these medical devices implanted already. In these implantable cardiac devices, the connected cardiac leads can be utilized to continually screen several impedance vectors for decreases in impedance in the thoracic cavity. A pacemaker or ICD that implements Pulmonary Edema Monitoring is designed to continuously monitor these impedance vectors and alert the patient to seek medical attention. This thesis will discuss the implementation of Pulmonary Edema Monitoring via screening of multiple impedance vectors in a pacemaker or implantable cardioverter defibrillator and the effectiveness of this monitoring method. Furthermore, the design, implementation, and testing of this feature will be explored in greater detail.

Abstract Background: Implantable cardioverter-defibrillator (ICD) surgery in patients with implanted left ventricular assist devices (LVAD) is associated with an increased risk of bleeding complications because of the need to ensure that these patients are adequately anticoagulated. Our study aimed to evaluate the safety of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging during the surgical interval. Methods: Between January 2009 and January 2020, 116 patients with LVAD underwent ICD surgery. Since January 2015, 60 patients were operated under continued sufficient oral anticoagulation with a vitamin k antagonist (VKA group). Fifty-six patients underwent a heparin-bridging regimen (heparin group). Demographics, perioperative data, complications, and mortality were analyzed. Results: Bleeding complications attributable to the surgical intervention occurred more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory surgery (14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical significance. Moreover, the heparin group patients' postoperative total length of stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were no procedure-related deaths, no thromboembolic events, and no LVAD-related thrombosis. Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results in a reduction by more than half the number of days in hospital without an increase in adverse events.

Le taux de mortalité chez les patients à risque d’arythmies cardiaques menaçantes à la vie a été considérablement réduit grâce au défibrillateur cardiaque implantable (DCI). Toutefois, des préoccupations uniques face au DCI, y compris les chocs que l’appareil peut déclencher, sont susceptibles de provoquer des symptômes d'anxiété et une limitation perçue des activités chez les porteurs de DCI. Ces réactions émotives et modifications de comportement peuvent affecter l’acceptation du patient envers le DCI. Cette étude pilote randomisée avec groupe contrôle (n=15 /groupe) visait à examiner la faisabilité et l'acceptabilité d'une intervention infirmière individualisée de même que ses effets préliminaires sur l’anxiété, le fonctionnement dans les activités de la vie quotidienne et l’acceptation du DCI auprès de nouveaux porteurs de DCI. L'intervention infirmière, basée sur la théorie du Human Caring et teintée d’une approche cognitive comportementale, ciblait les préoccupations individuelles face au DCI. À partir des préoccupations identifiées, l’infirmière intervenait en mettant l'accent sur les croyances contraignantes du patient, qui pouvaient mener à de l’anxiété et des comportements d'évitement. Après randomisation, les patients du groupe intervention (GI) ont participé à un premier entretien en face-à-face avant le congé hospitalier. Subséquemment, deux entretiens se sont faits par téléphone, à environ 7 et 14 jours suite au congé hospitalier. Les résultats soutiennent la faisabilité et l’acceptabilité du devis de l’étude et de l’intervention évaluée. De plus, ils soulignent le potentiel de l’intervention à diminuer les sentiments anxieux chez les participants du GI. Les résultats de cette étude pilote offrent des pistes de recherches futures et permettront de guider la pratique clinique. / Patients with an implantable cardiac defibrillator (ICD) decrease their risk of mortality related to life threatening arrhythmias. However, multiple concerns about this device exist, including ICD shocks, which may result in increased anxiety and a perceived limitation in performing everyday activities. These emotional reactions and behavioral changes may have a negative impact on the acceptance of the device. The purpose of this randomized pilot study with a group control (n=15 / group), was to verify the feasibility and acceptability of an individualized nursing intervention aiming to decrease anxiety, improve performance in everyday activities and device acceptance in patients with newly implanted ICDs. Based on Human Caring theory and a cognitive behavioral approach, this intervention addressed each patient’s unique concerns. From the identified concerns, the nurse intervened focussing on the patient’s dysfunctional beliefs that can lead to anxiety and avoidance behavior. After randomization, the first encounter for the experimental group (EG) was face-to-face before hospital discharge. Subsequently, two encounters were made via telephone, 7 and 14 days after discharge. The results support the feasibility and acceptability of the study design and the intervention evaluated. In addition, they emphasize the potential of the intervention to reduce symptoms of anxiety among the participants of the EG. The results of this pilot study may provide directions for future research and help guide clinical practice.