scholarly journals The 2021 Korean Heart Rhythm Society Guidelines for a New Approach and Integrated Management of Atrial Fibrillation

2021 ◽  
Vol 96 (5) ◽  
pp. 382-389
Author(s):  
Junbeom Park ◽  
Myung-Jin Cha ◽  
Yong Soo Baek ◽  
Min Soo Cho ◽  
Boyoung Joung
Keyword(s):  
Atrial Fibrillation ◽  
Integrated Management ◽  
Heart Rhythm ◽  
Integrated Approach ◽  
Current Approach ◽  
Diagnosis And Treatment ◽  
Team Members ◽  
Consistent Treatment ◽  
Treatment Policies ◽  
Improve Patient

The prevalence of atrial fibrillation (AF) is gradually increasing with the aging of the population, and there is also increasing interest in AF with the development of various single-lead electrocardiography measurement methods for diagnosis. Further, the current diagnosis and treatment policies for AF do not reflect its progression and complexity. In addition, the various factors related to AF diagnosis and treatment are not simple due to the diversification of tools, advances in treatment methods, and complex mechanism of AF. Therefore, there are many challenges to developing a simple AF classification system. To overcome these, there have been a number of attempts to systematically characterize AF according to treatment and prognosis rather than using a uniform classification. Further, as mentioned in the previous AF guidelines, further research is being conducted on an integrated patient–physician approach to AF. Such an approach would be the basis for consistent treatment based on the guidelines, and would help to improve patient outcomes. Further, for the integrated management of AF patients, some changes should be made to the current approach to develop a multidisciplinary approach, including changes to the behavior of team members, patients, their family members, and physicians. The Korean Heart Rhythm will introduce an integrated approach to the classification and structure of AF management, and provide guidelines for its application in clinical practice.

scholarly journals The 2018 Korean Heart Rhythm Society Guidelines for Integrated Management of Korean patients with Nonvalvular Atrial Fibrillation

2018 ◽  
Vol 93 (4) ◽  
pp. 336-343 ◽  
Author(s):  
Junbeom Park ◽  
Boyoung Joung ◽  
Jun Kim ◽  
Jin-Bae Kim ◽  
Hyung Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Integrated Management ◽  
Heart Rhythm ◽  
Nonvalvular Atrial Fibrillation ◽  
Korean Patients

Clinical and Morphological Features of Myocardial Damage and the Course of Fulminant Myocarditis on the Background of СOVID-19, Diagnosis and Treatment Tactics

2020 ◽  
Vol 75 (5S) ◽  
pp. 414-425
Author(s):  
Olga S. Oynotkinova ◽  
Evgenii L. Nikonov ◽  
Oleg V. Zayratyants ◽  
Elena V. Rzhevskaya ◽  
Evgenii V. Krukov ◽  
...  
Keyword(s):  
Myocardial Dysfunction ◽  
Myocardial Damage ◽  
Heart Rhythm ◽  
Microvascular Dysfunction ◽  
Symptomatic Treatment ◽  
Clinical Situation ◽  
Diagnosis And Treatment ◽  
Screening Tests ◽  
Fulminant Myocarditis ◽  
Heart Rhythm Disorders

In a review article based on my own clinical experience of managing patients with acute myocardial injury and fulminant myocarditis, taking into account expert recommendations on the clinical treatment of myocardial damage associated with novel coronavirus infection a National clinical geriatric medical research center, division of cardiovascular diseases, the Chinese geriatrics society, Department of cardiology, Beijing Medical Association and European clinics discusses the pathogenesis, diagnosis and treatment of myocardial damage and FM patients, infected with SARS-CoV-2 in the context of the COVID-19 pandemic. Clinical features and diagnostic criteria are presented, including screening tests of markers of myocardial damage in the form of a highly sensitive troponin test, a natriuretic peptide. The article discusses in detail the pathogenesis and mechanisms of myocardial damage, including immune mechanisms, cytokine storm, systemic inflammation with macro- and microvascular dysfunction and the development of myocardial dysfunction with acute heart failure, hypotension, cardiogenic shock and/or life-threatening heart rhythm disorders caused by hypoxia and metabolic disorders at the cellular level. Features of the clinical course of fulminant myocarditis in infected patients (SARS-CoV-2) in the conditions of the COVID-19 pandemic are presented. For the first time, a detailed histo-morphological analysis of pathological myocardial injuries and complications is presented on the basis of unique autopsy material on post-mortem diagnostics of various pathoanatomic autopsies of those who died from COVID-19 in Moscow. Based on the clinical, functional and morphological material, the Protocol of etiopathogenetic treatment is presented. The basis of standard therapy is considered antiviral drugs, immunoglobulin G, the use of monoclonal antibodies to interleukin-6, anticoagulants, glucocorticoids, depending on the clinical situation, cardioprotectors and symptomatic treatment are recommended to maintain the heart, which in combination can achieve a certain clinical effectiveness. As adjuvant cardioprotective targeted therapy, the sodium salt of phosphocreatine is considered in order to preserve the myocardium, maintain its contractility and vital activity.

A current approach to parathyroid cancer: etiology, pathogenesis, diagnosis and treatment

2019 ◽  
Vol 0 (1) ◽  
pp. 7-17
Author(s):  
V. O. Palamarchuk ◽  
O. A. Tovkai ◽  
V. V. Voitenko ◽  
O. V. Mazur ◽  
O. P. Nechay
Keyword(s):  
Current Approach ◽  
Diagnosis And Treatment ◽  
Parathyroid Cancer ◽  
Cancer Etiology ◽  
A Current

Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

2020 ◽  
Vol 13 (8) ◽  
pp. e234661
Author(s):  
Tahir Nazir ◽  
Mohiuddin Sharief ◽  
James Farthing ◽  
Irfan M Ahmed
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Options ◽  
Posterior Circulation ◽  
Diagnosis And Treatment ◽  
Neurological Deficits ◽  
Cerebellar Infarction ◽  
Af Ablation ◽  
Posterior Circulation Stroke ◽  
Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

scholarly journals Large extracellular vesicles in the left atrial appendage in patients with atrial fibrillation—the missing link?

2021 ◽  
Author(s):  
Andreas Zietzer ◽  
Baravan Al-Kassou ◽  
Paul Jamme ◽  
Verena Rolfes ◽  
Eva Steffen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Extracellular Vesicles ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Flow Cytometric Analysis ◽  
Heart Rhythm ◽  
Atrial Appendage ◽  
Peripheral Embolization

AbstractAtrial fibrillation (AF) is the most frequent arrhythmic disease in humans, which leads to thrombus formation in the left atrial appendage and stroke through peripheral embolization. Depending on their origin, large extracellular vesicles (lEVs) can exert pro-coagulant functions. In the present study, we investigated how different types of AF influence the levels of large EV subtypes in three distinct atrial localizations. Blood samples were collected from the right and left atrium and the left atrial appendage of 58 patients. 49% of the patients had permanent AF, 34% had non-permanent AF, and 17% had no history of AF. Flow cytometric analysis of the origin of the lEVs showed that the proportion of platelet-derived lEVs in the left atrial appendage was significantly higher in permanent AF patients compared to non-permanent AF. When we grouped patients according to their current heart rhythm, we also detected significantly higher levels of platelet-derived lEVs in the left atrial appendage (LAA) in patients with atrial fibrillation. In vitro studies revealed, that platelet activation with lipopolysaccharide (LPS) leads to higher levels of miR-222-3p and miR-223-3p in platelet-derived lEVs. Treatment with lEVs from LPS- or thrombin-activated platelets reduces the migration of endothelial cells in vitro. These results suggest that permanent atrial fibrillation is associated with increased levels of platelet-derived lEVs in the LAA, which are potentially involved in LAA thrombus formation.

scholarly journals Kardia Mobile and ISTEL HR applicability in clinical practice: A comparison of Kardia Mobile, ISTEL HR and standard 12-lead electrocardiogram records in 98 consecutive patients of a tertiary cardiovascular care centre

2021 ◽  
Author(s):  
Bartosz Krzowski ◽  
Kamila Skoczylas ◽  
Gabriela Osak ◽  
Natalia Żurawska ◽  
Michał Peller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Sinus Rhythm ◽  
Sensitivity And Specificity ◽  
Heart Rhythm ◽  
Everyday Practice ◽  
Portable Devices ◽  
Care Centre ◽  
Cardiovascular Care

Abstract Aims Mobile, portable ECG-recorders allow the assessment of heart rhythm in out-of-hospital conditions and may prove useful for monitoring patients with cardiovascular diseases. However, the effectiveness of these portable devices has not been tested in everyday practice. Methods and results A group of 98 consecutive cardiology patients (62 males [63%], mean age 69 ± 12.9 years) were included in an academic care centre. For each patient, a standard 12-lead electrocardiogram (SE), as well as a Kardia Mobile 6L (KM) and Istel (IS) HR-2000 ECG were performed. Two groups of experienced physycians analyzed obtained recordings. After analyzing ECG tracings from SE, KM, and IS, quality was marked as good in 82%, 80%, and 72% of patients, respectively (p < 0.001). There were no significant differences between devices in terms of detecting sinus rhythm (SE [60%, n = 59], KM [58%, n = 56], and IS [61%, n = 60]; SE vs KM p = 0.53; SE vs IS p = 0.76) and atrial fibrillation (SE [22%, n = 22], KM [22%, n = 21], and IS [18%, n = 18]; (SE vs KM p = 0.65; SE vs IS = 0.1). KM had a sensitivity of 88.1% and a specificity of 89.7% for diagnosing sinus rhythm. IS showed 91.5% and 84.6% sensitivity and specificity, respectively. The sensitivity of KM in detecting atrial fibrillation was higher than IS (86.4% vs. 77.3%), but their specificity was comparable (97.4% vs. 98.7%). Conclusion Novel, portable devices are useful in showing sinus rhythm and detecting atrial fibrillation in clinical practice. However, ECG measurements concerning conduction and repolarisation should be clarified with a standard 12-lead electrocardiogram.

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