Tuija Vasankari

Arrhythmic complications after electrical cardioversion of acute atrial fibrillation: the FinCV study.

AIMS To determine the incidence and risk factors of arrhythmic complications after electrical cardioversion of acute atrial fibrillation (AF). METHODS AND RESULTS Our retrospective multicentre study collected data from 7660 cardioversions of acute (<48 h) AF in 3143 consecutive patients. Immediate arrhythmic complications were evaluated after 6906 (90.2%) electrical cardioversions performed in 2868 patients. We also assessed the predictors of arrhythmic complications and whether post-cardioversion bradycardia or asystole led to later a permanent pacemaker implantation. Altogether, 63 (0.9%) electrical cardioversions resulted in bradyarrhythmia in 54 patients. Asystole (>5 s) occurred immediately after 51 cardioversions leading to a short resuscitation in seven cases and two patients needed extrinsic pacing after the cardioversion. In nine cases, asystole was followed by bradycardia. Bradycardic ventricular rate (<40 b.p.m.) alone was seen after 12 procedures. No ventricular arrhythmias needing intervention were detected. Old age [odds ratio (OR) 1.1; 95% confidence interval (CI) 1.05-1.10, P < 0.0001], female sex (OR 2.5; 95% CI 1.4-4.8, P = 0.004), and unsuccessful cardioversion (OR 2.2; 95% CI 1.1-4.6, P = 0.03) were the independent predictors of bradycardic complications. Slow ventricular rate, use of digoxin, beta blocker, or antiarrhythmic medication did not increase the risk of bradycardic complications. Pacemaker was implanted in 24 (44.4%) patients after a median delay of 66 days. CONCLUSION Bradycardic complications are rare and usually benign after cardioversion of acute AF. They seem to reflect sinus node dysfunction and often result in later implantation of a permanent pacemaker.

Self-detection of atrial fibrillation in an aged population: the LietoAF Study

Background Early detection of atrial fibrillation (AF) in older people is important because AF is often asymptomatic and its first manifestation may be a disabling stroke. The objective of the LietoAF Study is to assess the motivation and capability of older people to learn pulse palpation and continue regular pulse measurements, and whether this self-assessment is helpful in the detection of new AF. Design and method The LietoAF Study is an intervention study. A total of 205 people aged ≥75 years were randomly selected to participate in the programme where a trained nurse gave individual education on pulse palpation. At 1 month, the eligible participants came to the first follow-up visit to assess the success of pulse self-monitoring. Results A total of 139 participants (68%) learned pulse palpation and performed regular measurements during the early follow-up period. The significant independent predictors for learning and motivation were high Mini-Mental State Examination score (>24) (OR 7.5, 95% CI 1.5–37.3, p = 0.014), computer use at home (OR 4.7, 95% CI 1.9–11.5, p = 0.001), independence at daily activities (OR 4.2, 95% CI 1.4–13.6, p = 0.013) and low heart rate (OR 1.04, 95% CI 1.0–1.08, p = 0.037). Education did not cause extra visits to local healthcare centres and did not affect quality of life. Four participants observed a new asymptomatic AF during the 1-month follow-up. Conclusion Active older people are motivated and seem to learn pulse palpation. Our early experience suggests that simple nurse-based education is effective and useful in the early detection of asymptomatic AF.

Gyrocardiography: A new non-invasive approach in the study of mechanical motions of the heart. Concept, method and initial observations

The pumping action of the heart is performed by contraction of the myocardium fibers. We present a non-invasive technique named gyrocardiography (GCG) that comprises a sensor of angular motion, gyroscope, configured to obtain three-dimensional angular velocity signals. A tri-axial micro electromechanical (MEMS) gyroscope sensor was attached to the surface of the chest to obtain gyrocardiogram. Color-coded Doppler tissue imaging (DTI) was recorded simultaneously and synchronized with the GCG in an off-line analysis. By placing a region of interest longitudinally around the myocardium in DTI allowed us to investigate whether GCG can provide information indicative of the tissue velocity and relative strain rate of the myocardium. Experimental observations by simultaneously recorded GCG and color DTI suggests that a gyroscope sensor attached to the chest is indeed capable to monitor the myocardial deformation during the cardiac cycle and therefore can provide a gateway to clinically relevant information.

Effect of spinal cord stimulation on myocardial perfusion reserve in patients with refractory angina pectoris

AIMS Epidural spinal cord stimulation (SCS) provides symptom relief in refractory angina pectoris, but its mechanism of action remains incompletely understood. We studied effects of short-term SCS therapy on myocardial ischaemia tolerance, myocardial perfusion reserve (MPR), and endothelium-mediated vasodilatation induced by cold pressor test (CPT) in patients with refractory angina pectoris. METHODS AND RESULTS We prospectively recruited 18 patients with refractory angina pectoris and studied them after implantation of SCS device at baseline before starting the therapy and after 3 weeks of continuous SCS therapy. Myocardial ischaemia was evaluated by dobutamine stress echocardiography. Global and regional myocardial blood flow (MBF) were measured using positron emission tomography and (15)O-water at rest, during adenosine stress, and in response to CPT. Systemic haemodynamics were comparable before and after 3 weeks of SCS at rest, during adenosine stress and during CPT. Appearance of angina pectoris induced by dobutamine stress was delayed after SCS therapy. Global MPR increased (P = 0.02) from 1.7 ± 0.6 at baseline to 2.0 ± 0.6 after 3-week SCS therapy. This was associated with a significant reduction in global MBF at rest and increase in MBF induced by adenosine in the ischaemic regions. Global MBF response to CPT was improved after SCS (0.27 ± 0.20 vs. 0.40 ± 0.15, P = 0.03). CONCLUSION Short-term SCS therapy improved myocardial ischaemia tolerance, absolute MPR, and endothelium-mediated vasomotor function in refractory angina pectoris, indicating that this therapy can alleviate myocardial perfusion abnormalities in advanced CAD.

Automatic detection of atrial fibrillation using MEMS accelerometer

The aim of the study was to assess the applicability of seismocardiogram (SCG) for the detection of atrial fibrillation (AF) in telemonitoring applications. SCG data used in this study consists of simultaneous SCG and ECG recordings of 12 patients during both AF and sinus rhythm (after cardioversion). An SCG-based AF-detection algorithm was developed and its performance tested with the acquired clinical data. The algorithm is able to distinguish AF positive samples from samples with sinus rhythm with high accuracy.

Predictors of pocket hematoma in patients on antithrombotic therapy undergoing cardiac rhythm device implantation: insights from the FinPAC trial

Abstract Background. The FinPAC trial showed that the strategy of uninterrupted oral anticoagulation (OAC) was non-inferior to interrupted OAC for the primary outcome of bleeding and thromboembolic complications in patients undergoing cardiac rhythm management device (CRMD) implantation. Methods. We conducted a post hoc analysis of the FinPAC data to explore the incidence and predictors of significant (> 100 cm2) pocket hematoma after CRMD implantation among the study population (n = 447). A total of 213 patients were on OAC, 128 were on aspirin, and 106 on no antithrombotic therapy. Results. The incidence of significant pocket hematoma during hospital stay was significantly higher among patients using OAC (5.6%) and aspirin (5.5%) than in those with no antithrombotic medications (0.9%), but only one patient (0.8%) in the aspirin group needed revision of hematoma. Two patients (0.9%) in the OAC group and one (0.8%) in the aspirin group needed blood products. In multivariable regression analysis, no pre- procedural features predicted the significant hematoma in any of the groups. Conclusions. Clinically significant pocket hematoma is a rare complication after CRMD implantation in patients with ongoing therapeutic OAC. The incidence of significant pocket hematoma formation is similar in patients using OAC and those using aspirin. Trial registration: ClinicalTrials.gov identifier: NCT00479362.

Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients undergoing elective cardioversion

Aims Non-vitamin K antagonist oral anticoagulants (NOAC) have been shown to be safe and effective alternatives to warfarin for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF). The aim of this study was to investigate the complications and the use of NOACs in AF patients undergoing elective cardioversion. Methods and results This nationwide multicentre study included consecutive elective cardioversions in AF patients treated with NOACs between October 2011 and May 2016. Data on patient characteristics, antithrombotic treatment and acute (<30 days) complications were collected. One thousand twenty-one patients (mean age 64 years, 70% men) underwent 1291 elective cardioversions, of which 680 (52.7%) cardioversions were performed in patients using dabigatran, 431 (33.4%) rivaroxaban, and 159 (12.3%) apixaban. Mean CHA2DS2-VASc score was 1.8 (±1.5). A total of 3 thromboembolic events occurred after the cardioversion (0.2%): 1 patient receiving dabigatran experienced an ischaemic stroke on Day 2 and 1 rivaroxaban treated patient on Day 4. One patient receiving dabigatran experienced a transient ischaemic attack on Day 11. All 3 patients had used recommended doses of the NOAC. A total of 6 (0.5%) clinically relevant, but not serious bleeding events occurred. Only short duration of AF was associated with lower rate of AF recurrence. Conclusion Thrombotic and bleeding complications related to NOACs were uncommon (<0.5%) in real life AF patients undergoing elective cardioversion.

A smartphone-only solution for detecting indications of acute myocardial infarction

In this paper we consider the detection of indications of acute myocardial infarction (AMI) through a smartphone only solution. AMI is a serious heart condition where a blood vessel of the heart is fully or partially blocked e.g. by a rupture of an atherosclerotic plaque, the arrival of oxygen to the heart muscle is disturbed, and part of the heart muscle tissue dies (irreversible injury) due to insufficient oxygen supply. When a person feels obscure acute chest pain (angina pectoris), it may be caused, for instance, by heartburn or it may be a symptom of AMI. The goal of this paper is to develop a solution, which could either be integrated into an emergency App for the use of telemedicine by trained medical personnel or as a standalone solution to smartphone users in order to help recognizing this life-threatening condition earlier. The developed solution extracts the heart signal of a patient who lies in supine position by utilizing the built-in accelerometer and gyroscope within a smart device (e.g. a smartphone), which is placed on the chest of the patient. The solution does not require any external sensors for the smartphone to operate, but in the future it could be supplemented with ECG, for instance, to improve its performance. We have collected data with smartphone running Google Android from 17 AMI patients before and after percutaneous coronary intervention (PCI), and in addition, control recordings were performed in 23 healthy individuals (CG) and in 12 patients with stable coronary artery disease (CAD) before elective PCI.

MANTA versus ProGlide vascular closure devices in transfemoral transcatheter aortic valve implantation

BACKGROUND The MANTA system is a novel vascular closure device (VCD) and its safety and efficacy were compared to the ProGlide VCD in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). METHODS This is a retrospective study including 222 patients who underwent transfemoral TAVI at three Finnish University Hospitals. The MANTA VCD was used in 107 patients and their outcome was compared with that of 115 patients in whom the arterial access was closed with the ProGlide VCD. RESULTS VARC-2 VCD failure occurred less frequently in the MANTA cohort (3.7% vs. 7.8%, p = 0.378), but the difference did not reach statistical significance. When adjusted for the introducer outer diameter, the MANTA cohort had similar rates of VARC-2 major vascular complications (9.3% vs. 12.2%, adjusted: p = 0.456), VARC-2 life-threatening/disabling bleeding (9.3% vs. 6.1%, adjusted: p = 0.296) and need of invasive treatment of bleeding (4.7% vs. 7.0%, adjusted: p = 0.416) compared to the ProGlide cohort. Additional VCDs were more frequently needed in the ProGlide cohort (58.3% vs. 1.9%, p < 0.0001). CONCLUSIONS In patients undergoing transfemoral TAVI, the MANTA VCD showed a similar risk of VARC-2 vascular and bleeding complications compared to the ProGlide VCD, but it reduced significantly the need of additional VCDs for completion of hemostasis.

Mobile Phone Detection of Atrial Fibrillation With Mechanocardiography: The MODE-AF Study (Mobile Phone Detection of Atrial Fibrillation)

Because of the frequent asymptomatic presentation of atrial fibrillation (AF), stroke is too often its first manifestation.1 For effective stroke prevention, timely diagnosis of AF is crucial. Mobile devices are becoming ubiquitous, providing significant possibilities for screening applications. In mechanocardiography, mechanical cardiac activity is recorded with accelerometers and gyroscopes, standard components of modern smartphones.2 In our previous proof-of-concept study, smartphone mechanocardiography demonstrated 94% sensitivity and 100% specificity for detecting AF among 39 subjects.2 Here, we validate smartphone mechanocardiography detection of AF against visual interpretation of telemetry electrocardiographic recordings in hospitalized patients.