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Sharma AN, Baranchuk A. Ambulatory External Electrocardiography Monitoring: Holter, Extended Holter, Mobile Cardiac Telemetry Monitoring. Card Electrophysiol Clin 2021; 13:427-438. [PMID: 34330370 DOI: 10.1016/j.ccep.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ambulatory external electrocardiography (AECG) monitoring is effective as an evidence-based diagnostic tool when suspicion for cardiac arrhythmia is high. Multiple modalities of AECG monitoring exist, with unique advantages and limitations that predict effectiveness in a variety of clinical settings. Knowledge of these characteristics allows appropriate use of AECG, maximizing patient adherence, diagnostic yield, and cost-effectiveness. In addition, new technology has allowed the development of a modern generation of devices that offer increased efficacy and functionality compared with Holter monitors.
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Affiliation(s)
- Arjun N Sharma
- Internal Medicine, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Adrian Baranchuk
- Department of Cardiac Electrophysiology and Pacing, Kingston General Hospital, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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Anselmino M, Frea S, Gili S, Rovera C, Morello M, Jorfida M, Teodori J, Perversi J, Salvetti I, Grosso Marra W, Faletti R, Righi D, Gaita F, DE Ferrari GM. Left atrial appendage morphology at transesophageal echocardiography: how to improve reproducibility? Minerva Cardiol Angiol 2020; 69:178-184. [PMID: 32657552 DOI: 10.23736/s2724-5683.20.05215-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) morphology, investigated by computed tomography and magnetic resonance imaging, has proved to relate to the risk of cerebrovascular events in patients with atrial fibrillation (AF). The aim of the present study was to assess reproducibility of transesophageal echocardiography (TEE) imaging in describing LAA morphology. METHODS Two-hundred consecutive patients referred for TEE were enrolled. In the first group of 47 (23.5%) patients LAA morphology was analyzed by conventional TEE and described as ChickenWing, Windsock, Cactus or Cauliflower. In the second group of 153 (76.5%) patients, instead, a 3D-Xplane diagnostic algorithm was performed to stratify LAA morphology as linear (ChickenWing) or complex (Windsock/Cactus and Cauliflower). Interobserver variability within three independent readers was assessed in both groups of patients and stratified by operator's experience and training. In a subgroup of 19 (12.4%) patients, the agreement of LAA morphology description by 3D-Xplane diagnostic algorithm was compared to cardiac magnetic resonance. RESULTS By conventional TEE the agreement among operators on LAA morphology classification was poor (ρ<0.13). The 3D-XPlane diagnostic algorithm, significantly increased interobserver agreement up to ρ=0.32 within all readers and up to ρ=0.82 among the experienced and specifically trained operators. LAA morphology description in this latter group provided strong agreement with cardiac magnetic resonance (up to ρ=0.77). CONCLUSIONS LAA morphology assessment is challenging by conventional TEE. To improve reproducibility, the use of the 3D-Xplane technique combined with a specific diagnostic algorithm and training of the operators is fundamental.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Interventional Cardiology Unit 3, IRCCS Monzino Cardiac Center, Milan, Italy
| | - Chiara Rovera
- Division of Cardiology, Hospital of Chivasso, Chivasso, Turin, Italy -
| | - Mara Morello
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marcella Jorfida
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Julien Teodori
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Perversi
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Ilaria Salvetti
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Riccardo Faletti
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Dorico Righi
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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Anselmino M, Ballatore A, Saglietto A, Stabile G, De Ponti R, Grimaldi M, Agricola PM, Della Bella P, Tritto M, Pappone C, Calò L, Bongiorni MG, Blomström-Lundqvist C, Gaita F, De Ferrari GM. Atrial fibrillation ablation long-term ESC-EHRA EORP AFA LT registry: in-hospital and 1-year follow-up findings in Italy. J Cardiovasc Med (Hagerstown) 2020; 21:740-748. [DOI: 10.2459/jcm.0000000000000999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications. MEDICINA-LITHUANIA 2019; 55:medicina55100709. [PMID: 31640260 PMCID: PMC6843475 DOI: 10.3390/medicina55100709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.
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