Introduction Anticoagulation has been shown to be highly effective in stroke prevention in patien... more Introduction Anticoagulation has been shown to be highly effective in stroke prevention in patients who have atrial fibrillation (AF). Many patients with AF do not have symptoms and may not seek medical attention. In this study we evaluated the clinical profiles of asymptomatic AF (AAF) patients and compared them to symptomatic ones to find what factors are associated with absence of symptoms. Methods We analyzed data of 2000 patients enrolled in the prospective multicenter Jordan AF study from May 2019 to October 2020. Symptoms included palpitations (43%), shortness of breath (34%), fatigue (21%), dizziness (11%), chest pain (2%) or syncope (2%) versus no symptoms (30%, n=591). Findings The average age of the whole group was 67.7±10.2 years and 47% were males. Clinical factors investigated in relation to absence of symptoms are presented in the attached table Conclusion AAF is associated with the following clinical features: male gender, age above 59 years, diabetes mellitus (DM), ...
pressure (RVSP), pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF), New ... more pressure (RVSP), pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and surgery as the most significant predictors of transient ischemic attack (TIA/stroke). MVA, PAP, LVEF, creatinine, hemoglobin (Hb), and diastolic blood pressure (DBP) were predictors for all-cause mortality. Conclusion The GBM model assimilates clinical data from all diagnostic modalities and significantly improves risk prediction performance and identification of key variables for the outcome of MS with AFL.
The purpose of this study was to determine the accuracy of percussion of the left cardiac border.... more The purpose of this study was to determine the accuracy of percussion of the left cardiac border. Sixty-six adult patients were studied. The left cardiac border as determined by percussion and marked with a calibrated lead marker was compared with that obtained by a chest X-ray. The error in locating the left cardiac border by percussion ranged from underestimating by 5.0 cm to overestimating by 5.5 cm. The mean absolute error was 1.6 cm (SD = 1.6 cm). In 74% (49/66) and 85% (56/66) of the patients the percussed border was within 1.0 and 2.0 cm, respectively, of that established by X-ray. In 24 of the 66 cases, a second examiner also independently percussed the left cardiac border. The differences between the location determined by the two observers ranged from 0 to 4 cm with a mean difference of 1.2 cm (SD = 1.0 cm). Conclusion: Percussion can accurately locate the left cardiac border in the adult patient and is a reproducible technique.
Journal of the American College of Cardiology, Feb 1, 1995
Forty-two patients, 23 had activated carbon tip (ACaTi) and 19 had steroid tip (ST) ventricular l... more Forty-two patients, 23 had activated carbon tip (ACaTi) and 19 had steroid tip (ST) ventricular leads. Bipolar (B) and Unipolar (U) voltage capture thresholds (VCT), energy CT (ECT), and impedance (imp) were followed for 6 months since implant. Results Lead Polarity Implant 2 Days 1 wk 1mo 2 mo 3mo 6mo ACaTi VCT B 0.92 1.17 2.09 2.33 2.17 2.01 1.80 U 0.78 1.03 1.71 1.98 1.85 1.78 1.57 ECT B 0.88 1.15 2.00 2.29 2.08 2.02 1.20 Imp B 715 623 593 681 645 645 661 ST VCT B 0.56 0.66 0.85 0.83 0.85 0.89 0.89 U 0.60 0.60 0.74 0.76 0.81 0.79 0.87 ECT B 0.24 0.22 0.55 0.57 0.65 0.69 0.65 imp B 584 538 520 530 523 551 515 ACaTi CT (VCT and ECT) increased peaking at 1 wk-l mo whereas ST CT had a slight increase by 1 wk then plateaued. The ST CT (U and B) were significantly lower than ACaTi CT (P l 0.001 at all times). There was no significant difference between U and B CT in each individual lead in both ST and ACaTi. Mean ECT and VCT were highly correlated Ir = 0.97 for both ACaTi and ST, P l 0.001 for both). Lead imp and ECT had weak negative correlation (r = -0.57). Conclusions 1) During lead evaluation VCT is an adequate descriptive value of ECT in spite of slight imp changes with time and slight imp difference among different leads. 2) ST CT is superior and not associated with substantial acute rise when compared to ACaTi lead CT (whether in U or B configuration).
Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, in... more Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, introduced to control otherwise malignant tachyarrhythmia. This article describes psychological aspects of its use in 18 patients. Despite pre-implant anxiety, most eventually adapted well and accepted the device, with the level of adaptation relating primarily to severity of illness and the ability to return to work. Common problems that decreased over time included emotional lability, depression, fear, and hyperarousal with night wakefulness. Helpful treatment interventions included education, individual and family counseling, and relaxation techniques.
Journal of the American College of Cardiology, Mar 1, 2018
Clinical decline leading to hospitalization is used as an endpoint in clinical trials for pulmona... more Clinical decline leading to hospitalization is used as an endpoint in clinical trials for pulmonary hypertension (PH). Burke et al. demonstrated in a study using the Optum Research Database that more than half (56.7%) of patients with WHO Group I pulmonary hypertension had more than two PH-related hospitalizations during a 35 month follow-up period. The cost of readmission exceeded that of the index hospitalization. We sought to identify predictors of 30-day readmission risk in order to target therapy, improve outcome, and reduce cost in patients with primary and secondary PH. METHODS: We analyzed patients with a diagnosis of PH from the 2013 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), which accounts for 14 million patients (49.1% of hospitalizations in the US). The International Classification of Disease, ninth revision (ICD9-CM) codes 416.0 and 416.8 were used to identify adult patients hospitalized with a diagnosis of primary (idiopathic) PH and secondary PH respectively. Patients with a diagnosis related to pregnancy were excluded. We compared patients with early readmissions (within 30 days) to those who did not require rehospitalization. We used multivariate logistic regression to identify risk factors for early readmission. RESULTS: In 2013 NRD database there were 4,846 admissions for primary and secondary PH, of which 1896 (39%) required rehospitalization that year, and 800 (17%) were readmitted within 30 days of discharge. When compared to patients who did not require rehospitalization, patients readmitted within 30 days were more likely to have other chronic comorbidities such as AIDS, renal failure, heart failure, valvular disease, lung disease, diabetes, electrolyte abnormalities, malignancy, and chronic liver disease. Patients who were readmitted within 30 days due to PH were more likely to have multiple readmissions that year (2.13 vs 1.05, p < 0.001), and have higher mortality (10.5% vs 0.3%, p < 0.001) as compared to those who had other causes of readmission. Using a multivariate logistic regression model we found that early readmission was associated with younger age (OR 0.86 for each decade, 95% CI 0.81-0.92), secondary PH (
Journal of the American College of Cardiology, 1998
perconi ol fhoS0 panen!s roporiod that symptoms 01 tnfccrion brartcd ~,lhtn ono week Pnor lo lho ... more perconi ol fhoS0 panen!s roporiod that symptoms 01 tnfccrion brartcd ~,lhtn ono week Pnor lo lho Ml onsot Using the c1so-crossavQr Analysis. iho odds rniro 01 MI for &xttone anu day pnor to Ml onsoi was 2 4 (95*, Cl i 7-3 4) comparad to Iho sovanlh day pnor to iho onsai Concluston Atlhough @xiornai Control data are not ava~lablo. tho ltndmg lhat 17% ol pallants In ihls large daiabaso reporl an IntQctrOn rn iha week pnor la MI or@81 IS compat~bls wIlh the poss~kl~iy thal mbxtten tnggere MI Thts findaq coo(nctd~s with recent Qiudles llnkmg inlhcllon and mltammatton lo nihorasciarosIs. supparls the need far coniroltod sludias 01 tntQciron as a lnffqar Cocaine Ulrc aa a Trlggat of Acute Myacardlal lnwctlon Although anecdotal reporis mdrcaie that cocaine use can trtggor acute my-ocard~al mniarc~~on (MI) onsol. them have peen no controlled studies 01 lho magmiude 01 lho rncreased risk. nor the uuraiton of Ine hazard penod WC iherotoro collected da!a In the Onsel Study lo ngorousty evaluate ihts asso ccalton.
via set questionnaire focusing on quality of care received by the patient.Results:Among the 30 pa... more via set questionnaire focusing on quality of care received by the patient.Results:Among the 30 patients who were included in our analysis, 7 were females and the average age in our cohort was found to be 72.8. In about 56% of the patients, there was no clear indication mentioned in the clinical notes regarding continuation/discontinuation of telemetry. Based on proposed indication, about 36.66% (11 patients out of which 2 were female) were identified to be at significant risk of an immediate life-threatening arrhythmia (Class I). Among this group, 2 patients were reported to have significant arrhythmia event necessitating treatment. Further analysis revealed that from our cohort, 46.66% (14 patients) had a Class II indication for their telemetry monitoring out of which only 2 patients had a significant event recorded. However, only 16.66% (5 patients) were found to meet the eligibility for Class III indications and none of them encountered a significant arrhythmia.From anonymously filled patient questionnaires, around two-third of the patients reported not being informed about the utility of telemetry and its predicted duration of stay. One-third of patients reported the device to be inconvenient, intrusive and heavy. Conclusions To accomplish a sustainable improvement, a patient-centred approach should be exercised to help identify the gaps in quality of care delivered. Our analysis showed that significant number of patients received telemetry when it was not clinically indicated. The proposed interventions include adopting formal request process for telemetry, predicting its duration, use of patient education tools and exploring compatibility of telemetry device used. Larger scale studies are required to gain more insight into the appropriateness and impact of telemetry in a hospital setting.
STUDY OBJECTIVE To assess survival after insertion of automatic implantable cardioverter defibril... more STUDY OBJECTIVE To assess survival after insertion of automatic implantable cardioverter defibrillators in high-risk patients who have malignant ventricular arrhythmias and left ventricular dysfunction. DESIGN Actual survival time compared with arrhythmia-free time in a single group of patients. SETTING Inpatient services of a tertiary referral center and outpatient follow-up. PATIENTS Seventy consecutive patients with clinical sustained ventricular tachycardia or fibrillation whose arrhythmia could not be controlled by medication as determined by programmed electrical stimulation, and who had an automatic cardioverter defibrillator implanted. INTERVENTION All patients received an implantable defibrillator. MEASUREMENTS AND MAIN RESULTS Two-year survival was 93.4% (95% CI, 87 to 99.8) and projected survival based on recurrence of malignant arrhythmias was 60.3% (CI, 47.3 to 73.3; P less than 0.001). In the 25 patients with left ventricular ejection fraction less than 30%, actual survival was 86.7% (CI, 72.3 to 91.1) and projected survival was 56.9% (CI, 35.9 to 77.9; P = 0.025). Projected survival percentages are similar to survival figures reported in the literature for such high-risk patients. There was only one sudden death; the remaining deaths were not arrhythmic in nature. Of the 65 patients who were alive at the end of follow-up, 13 were in New York Heart Association Class I; 44, Class II; 5, Class III; and 3, Class IV. CONCLUSIONS The automatic implantable cardioverter defibrillator is probably highly effective in preventing arrhythmic mortality even in high-risk patients. Such treatment does not appear to significantly impair a patient's functional status.
Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fi... more Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. Methods. The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. Results. Overall, 2020 patients were enrolled. The mean age was 67.9 + 13.0 years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score>3 in women, and>2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independen...
Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, in... more Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, introduced to control otherwise malignant tachyarrhythmia. This article describes psychological aspects of its use in 18 patients. Despite pre-implant anxiety, most eventually adapted well and accepted the device, with the level of adaptation relating primarily to severity of illness and the ability to return to work. Common problems that decreased over time included emotional lability, depression, fear, and hyperarousal with night wakefulness. Helpful treatment interventions included education, individual and family counseling, and relaxation techniques.
KADRI, N.N,, ET Al..: Efficacy and Safety of Clonazepam in Refractory Neurally-Mediated Syncope. ... more KADRI, N.N,, ET Al..: Efficacy and Safety of Clonazepam in Refractory Neurally-Mediated Syncope. /Neurallv mediated svncope is a complex svndronw that is often difficult to manage using currently available treatment strategies. The efficacy and safety of clonazepam was evaluated in 35 patients with refractory neurally mediated syncope. All patients had syncope (n=33) or disabling presyncope (n=2) and a positive head-up tilt table test (IIUTT) despite treatment with one or more of the following therapies: (3blocker, high-salt diet, fludrocortisone, elastic compression stockings, and disopyramide. Clonazepam was initiated at 0.5 mg/day and titrated in 0.25-0.5 mg/dav Increments for symptom control. Early (first 8 weeks) symptomatic response was achieved in 3'lof35 (89%) patients. Early HUTT reverted to negative in 29 of 35 (83%j patients. Two patients discontinued clonazepam during early follow-up due to side effects. Thirty-three patients received long-term clonazepam therapy. Twenty-five patients had late HUTT with 21 remaining negative. Of the eight patients who did not have late HUTT. one patient discontinued clonazepam prior to HUTT due to side effects. Seven patients refused late HUTT. Al! seven patients achieved symptomatic control on clonazepam with two requiring dose titration. Of the 21 patients with a negative late HUTT. 18 achieved symptomatic control with two of these patients requiring dose titration. Two patients who had only partial symptom control despite dose titration achieved total symptomatic control with the addition of disopvramide and fi-blockers. Two patients with a negative late HUTT discontinued clonazepam due to side effects. One patient had been symptomatically controlled while the other had recurrent symptoms with dose limiting side effects occurring after clonazepam dose titration. In the 4 patients with a positive late HUTT. 2 patients were symptomatically controlled. 1 patient required combination therapy with a ^-blocker to achieve symptomatic control, and 1 patient discontinued therapy due to side effects. Overall, 29 of 35 (83%) patients continue to receive clonazepam with symptom control. Based on intention-to-treat HUTT results. 21 of 35 (60%) patients were responders. Four patients required clonazepam dose titration and three required combination therapy with clonazepam plus disopyramide and/or a fi-blocker to achieve control. Clonazepam was discontinued in 6 patients. 5 for side effects and 1 following a transient ischemic attack. Clonazepam appears to be an effective therapeutic alternative in patients with refractory neurally mediated syncope. Based on our preliminary findings, a placebo controlled evaluation of clonazepam in neurallv mediated syncope is warranted.
The purpose of this study was to determine the accuracy of percussion of the left cardiac border.... more The purpose of this study was to determine the accuracy of percussion of the left cardiac border. Sixty-six adult patients were studied. The left cardiac border as determined by percussion and marked with a calibrated lead marker was compared with that obtained by a chest X-ray. The error in locating the left cardiac border by percussion ranged from underestimating by 5.0 cm to overestimating by 5.5 cm. The mean absolute error was 1.6 cm (SD = 1.6 cm). In 74% (49/66) and 85% (56/66) of the patients the percussed border was within 1.0 and 2.0 cm, respectively, of that established by X-ray. In 24 of the 66 cases, a second examiner also independently percussed the left cardiac border. The differences between the location determined by the two observers ranged from 0 to 4 cm with a mean difference of 1.2 cm (SD = 1.0 cm). Conclusion: Percussion can accurately locate the left cardiac border in the adult patient and is a reproducible technique.
Introduction Anticoagulation has been shown to be highly effective in stroke prevention in patien... more Introduction Anticoagulation has been shown to be highly effective in stroke prevention in patients who have atrial fibrillation (AF). Many patients with AF do not have symptoms and may not seek medical attention. In this study we evaluated the clinical profiles of asymptomatic AF (AAF) patients and compared them to symptomatic ones to find what factors are associated with absence of symptoms. Methods We analyzed data of 2000 patients enrolled in the prospective multicenter Jordan AF study from May 2019 to October 2020. Symptoms included palpitations (43%), shortness of breath (34%), fatigue (21%), dizziness (11%), chest pain (2%) or syncope (2%) versus no symptoms (30%, n=591). Findings The average age of the whole group was 67.7±10.2 years and 47% were males. Clinical factors investigated in relation to absence of symptoms are presented in the attached table Conclusion AAF is associated with the following clinical features: male gender, age above 59 years, diabetes mellitus (DM), ...
pressure (RVSP), pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF), New ... more pressure (RVSP), pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and surgery as the most significant predictors of transient ischemic attack (TIA/stroke). MVA, PAP, LVEF, creatinine, hemoglobin (Hb), and diastolic blood pressure (DBP) were predictors for all-cause mortality. Conclusion The GBM model assimilates clinical data from all diagnostic modalities and significantly improves risk prediction performance and identification of key variables for the outcome of MS with AFL.
The purpose of this study was to determine the accuracy of percussion of the left cardiac border.... more The purpose of this study was to determine the accuracy of percussion of the left cardiac border. Sixty-six adult patients were studied. The left cardiac border as determined by percussion and marked with a calibrated lead marker was compared with that obtained by a chest X-ray. The error in locating the left cardiac border by percussion ranged from underestimating by 5.0 cm to overestimating by 5.5 cm. The mean absolute error was 1.6 cm (SD = 1.6 cm). In 74% (49/66) and 85% (56/66) of the patients the percussed border was within 1.0 and 2.0 cm, respectively, of that established by X-ray. In 24 of the 66 cases, a second examiner also independently percussed the left cardiac border. The differences between the location determined by the two observers ranged from 0 to 4 cm with a mean difference of 1.2 cm (SD = 1.0 cm). Conclusion: Percussion can accurately locate the left cardiac border in the adult patient and is a reproducible technique.
Journal of the American College of Cardiology, Feb 1, 1995
Forty-two patients, 23 had activated carbon tip (ACaTi) and 19 had steroid tip (ST) ventricular l... more Forty-two patients, 23 had activated carbon tip (ACaTi) and 19 had steroid tip (ST) ventricular leads. Bipolar (B) and Unipolar (U) voltage capture thresholds (VCT), energy CT (ECT), and impedance (imp) were followed for 6 months since implant. Results Lead Polarity Implant 2 Days 1 wk 1mo 2 mo 3mo 6mo ACaTi VCT B 0.92 1.17 2.09 2.33 2.17 2.01 1.80 U 0.78 1.03 1.71 1.98 1.85 1.78 1.57 ECT B 0.88 1.15 2.00 2.29 2.08 2.02 1.20 Imp B 715 623 593 681 645 645 661 ST VCT B 0.56 0.66 0.85 0.83 0.85 0.89 0.89 U 0.60 0.60 0.74 0.76 0.81 0.79 0.87 ECT B 0.24 0.22 0.55 0.57 0.65 0.69 0.65 imp B 584 538 520 530 523 551 515 ACaTi CT (VCT and ECT) increased peaking at 1 wk-l mo whereas ST CT had a slight increase by 1 wk then plateaued. The ST CT (U and B) were significantly lower than ACaTi CT (P l 0.001 at all times). There was no significant difference between U and B CT in each individual lead in both ST and ACaTi. Mean ECT and VCT were highly correlated Ir = 0.97 for both ACaTi and ST, P l 0.001 for both). Lead imp and ECT had weak negative correlation (r = -0.57). Conclusions 1) During lead evaluation VCT is an adequate descriptive value of ECT in spite of slight imp changes with time and slight imp difference among different leads. 2) ST CT is superior and not associated with substantial acute rise when compared to ACaTi lead CT (whether in U or B configuration).
Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, in... more Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, introduced to control otherwise malignant tachyarrhythmia. This article describes psychological aspects of its use in 18 patients. Despite pre-implant anxiety, most eventually adapted well and accepted the device, with the level of adaptation relating primarily to severity of illness and the ability to return to work. Common problems that decreased over time included emotional lability, depression, fear, and hyperarousal with night wakefulness. Helpful treatment interventions included education, individual and family counseling, and relaxation techniques.
Journal of the American College of Cardiology, Mar 1, 2018
Clinical decline leading to hospitalization is used as an endpoint in clinical trials for pulmona... more Clinical decline leading to hospitalization is used as an endpoint in clinical trials for pulmonary hypertension (PH). Burke et al. demonstrated in a study using the Optum Research Database that more than half (56.7%) of patients with WHO Group I pulmonary hypertension had more than two PH-related hospitalizations during a 35 month follow-up period. The cost of readmission exceeded that of the index hospitalization. We sought to identify predictors of 30-day readmission risk in order to target therapy, improve outcome, and reduce cost in patients with primary and secondary PH. METHODS: We analyzed patients with a diagnosis of PH from the 2013 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), which accounts for 14 million patients (49.1% of hospitalizations in the US). The International Classification of Disease, ninth revision (ICD9-CM) codes 416.0 and 416.8 were used to identify adult patients hospitalized with a diagnosis of primary (idiopathic) PH and secondary PH respectively. Patients with a diagnosis related to pregnancy were excluded. We compared patients with early readmissions (within 30 days) to those who did not require rehospitalization. We used multivariate logistic regression to identify risk factors for early readmission. RESULTS: In 2013 NRD database there were 4,846 admissions for primary and secondary PH, of which 1896 (39%) required rehospitalization that year, and 800 (17%) were readmitted within 30 days of discharge. When compared to patients who did not require rehospitalization, patients readmitted within 30 days were more likely to have other chronic comorbidities such as AIDS, renal failure, heart failure, valvular disease, lung disease, diabetes, electrolyte abnormalities, malignancy, and chronic liver disease. Patients who were readmitted within 30 days due to PH were more likely to have multiple readmissions that year (2.13 vs 1.05, p < 0.001), and have higher mortality (10.5% vs 0.3%, p < 0.001) as compared to those who had other causes of readmission. Using a multivariate logistic regression model we found that early readmission was associated with younger age (OR 0.86 for each decade, 95% CI 0.81-0.92), secondary PH (
Journal of the American College of Cardiology, 1998
perconi ol fhoS0 panen!s roporiod that symptoms 01 tnfccrion brartcd ~,lhtn ono week Pnor lo lho ... more perconi ol fhoS0 panen!s roporiod that symptoms 01 tnfccrion brartcd ~,lhtn ono week Pnor lo lho Ml onsot Using the c1so-crossavQr Analysis. iho odds rniro 01 MI for &xttone anu day pnor to Ml onsoi was 2 4 (95*, Cl i 7-3 4) comparad to Iho sovanlh day pnor to iho onsai Concluston Atlhough @xiornai Control data are not ava~lablo. tho ltndmg lhat 17% ol pallants In ihls large daiabaso reporl an IntQctrOn rn iha week pnor la MI or@81 IS compat~bls wIlh the poss~kl~iy thal mbxtten tnggere MI Thts findaq coo(nctd~s with recent Qiudles llnkmg inlhcllon and mltammatton lo nihorasciarosIs. supparls the need far coniroltod sludias 01 tntQciron as a lnffqar Cocaine Ulrc aa a Trlggat of Acute Myacardlal lnwctlon Although anecdotal reporis mdrcaie that cocaine use can trtggor acute my-ocard~al mniarc~~on (MI) onsol. them have peen no controlled studies 01 lho magmiude 01 lho rncreased risk. nor the uuraiton of Ine hazard penod WC iherotoro collected da!a In the Onsel Study lo ngorousty evaluate ihts asso ccalton.
via set questionnaire focusing on quality of care received by the patient.Results:Among the 30 pa... more via set questionnaire focusing on quality of care received by the patient.Results:Among the 30 patients who were included in our analysis, 7 were females and the average age in our cohort was found to be 72.8. In about 56% of the patients, there was no clear indication mentioned in the clinical notes regarding continuation/discontinuation of telemetry. Based on proposed indication, about 36.66% (11 patients out of which 2 were female) were identified to be at significant risk of an immediate life-threatening arrhythmia (Class I). Among this group, 2 patients were reported to have significant arrhythmia event necessitating treatment. Further analysis revealed that from our cohort, 46.66% (14 patients) had a Class II indication for their telemetry monitoring out of which only 2 patients had a significant event recorded. However, only 16.66% (5 patients) were found to meet the eligibility for Class III indications and none of them encountered a significant arrhythmia.From anonymously filled patient questionnaires, around two-third of the patients reported not being informed about the utility of telemetry and its predicted duration of stay. One-third of patients reported the device to be inconvenient, intrusive and heavy. Conclusions To accomplish a sustainable improvement, a patient-centred approach should be exercised to help identify the gaps in quality of care delivered. Our analysis showed that significant number of patients received telemetry when it was not clinically indicated. The proposed interventions include adopting formal request process for telemetry, predicting its duration, use of patient education tools and exploring compatibility of telemetry device used. Larger scale studies are required to gain more insight into the appropriateness and impact of telemetry in a hospital setting.
STUDY OBJECTIVE To assess survival after insertion of automatic implantable cardioverter defibril... more STUDY OBJECTIVE To assess survival after insertion of automatic implantable cardioverter defibrillators in high-risk patients who have malignant ventricular arrhythmias and left ventricular dysfunction. DESIGN Actual survival time compared with arrhythmia-free time in a single group of patients. SETTING Inpatient services of a tertiary referral center and outpatient follow-up. PATIENTS Seventy consecutive patients with clinical sustained ventricular tachycardia or fibrillation whose arrhythmia could not be controlled by medication as determined by programmed electrical stimulation, and who had an automatic cardioverter defibrillator implanted. INTERVENTION All patients received an implantable defibrillator. MEASUREMENTS AND MAIN RESULTS Two-year survival was 93.4% (95% CI, 87 to 99.8) and projected survival based on recurrence of malignant arrhythmias was 60.3% (CI, 47.3 to 73.3; P less than 0.001). In the 25 patients with left ventricular ejection fraction less than 30%, actual survival was 86.7% (CI, 72.3 to 91.1) and projected survival was 56.9% (CI, 35.9 to 77.9; P = 0.025). Projected survival percentages are similar to survival figures reported in the literature for such high-risk patients. There was only one sudden death; the remaining deaths were not arrhythmic in nature. Of the 65 patients who were alive at the end of follow-up, 13 were in New York Heart Association Class I; 44, Class II; 5, Class III; and 3, Class IV. CONCLUSIONS The automatic implantable cardioverter defibrillator is probably highly effective in preventing arrhythmic mortality even in high-risk patients. Such treatment does not appear to significantly impair a patient's functional status.
Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fi... more Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. Methods. The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. Results. Overall, 2020 patients were enrolled. The mean age was 67.9 + 13.0 years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score>3 in women, and>2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independen...
Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, in... more Among recent technologic advances in cardiology is the implantable cardioverter-defibrillator, introduced to control otherwise malignant tachyarrhythmia. This article describes psychological aspects of its use in 18 patients. Despite pre-implant anxiety, most eventually adapted well and accepted the device, with the level of adaptation relating primarily to severity of illness and the ability to return to work. Common problems that decreased over time included emotional lability, depression, fear, and hyperarousal with night wakefulness. Helpful treatment interventions included education, individual and family counseling, and relaxation techniques.
KADRI, N.N,, ET Al..: Efficacy and Safety of Clonazepam in Refractory Neurally-Mediated Syncope. ... more KADRI, N.N,, ET Al..: Efficacy and Safety of Clonazepam in Refractory Neurally-Mediated Syncope. /Neurallv mediated svncope is a complex svndronw that is often difficult to manage using currently available treatment strategies. The efficacy and safety of clonazepam was evaluated in 35 patients with refractory neurally mediated syncope. All patients had syncope (n=33) or disabling presyncope (n=2) and a positive head-up tilt table test (IIUTT) despite treatment with one or more of the following therapies: (3blocker, high-salt diet, fludrocortisone, elastic compression stockings, and disopyramide. Clonazepam was initiated at 0.5 mg/day and titrated in 0.25-0.5 mg/dav Increments for symptom control. Early (first 8 weeks) symptomatic response was achieved in 3'lof35 (89%) patients. Early HUTT reverted to negative in 29 of 35 (83%j patients. Two patients discontinued clonazepam during early follow-up due to side effects. Thirty-three patients received long-term clonazepam therapy. Twenty-five patients had late HUTT with 21 remaining negative. Of the eight patients who did not have late HUTT. one patient discontinued clonazepam prior to HUTT due to side effects. Seven patients refused late HUTT. Al! seven patients achieved symptomatic control on clonazepam with two requiring dose titration. Of the 21 patients with a negative late HUTT. 18 achieved symptomatic control with two of these patients requiring dose titration. Two patients who had only partial symptom control despite dose titration achieved total symptomatic control with the addition of disopvramide and fi-blockers. Two patients with a negative late HUTT discontinued clonazepam due to side effects. One patient had been symptomatically controlled while the other had recurrent symptoms with dose limiting side effects occurring after clonazepam dose titration. In the 4 patients with a positive late HUTT. 2 patients were symptomatically controlled. 1 patient required combination therapy with a ^-blocker to achieve symptomatic control, and 1 patient discontinued therapy due to side effects. Overall, 29 of 35 (83%) patients continue to receive clonazepam with symptom control. Based on intention-to-treat HUTT results. 21 of 35 (60%) patients were responders. Four patients required clonazepam dose titration and three required combination therapy with clonazepam plus disopyramide and/or a fi-blocker to achieve control. Clonazepam was discontinued in 6 patients. 5 for side effects and 1 following a transient ischemic attack. Clonazepam appears to be an effective therapeutic alternative in patients with refractory neurally mediated syncope. Based on our preliminary findings, a placebo controlled evaluation of clonazepam in neurallv mediated syncope is warranted.
The purpose of this study was to determine the accuracy of percussion of the left cardiac border.... more The purpose of this study was to determine the accuracy of percussion of the left cardiac border. Sixty-six adult patients were studied. The left cardiac border as determined by percussion and marked with a calibrated lead marker was compared with that obtained by a chest X-ray. The error in locating the left cardiac border by percussion ranged from underestimating by 5.0 cm to overestimating by 5.5 cm. The mean absolute error was 1.6 cm (SD = 1.6 cm). In 74% (49/66) and 85% (56/66) of the patients the percussed border was within 1.0 and 2.0 cm, respectively, of that established by X-ray. In 24 of the 66 cases, a second examiner also independently percussed the left cardiac border. The differences between the location determined by the two observers ranged from 0 to 4 cm with a mean difference of 1.2 cm (SD = 1.0 cm). Conclusion: Percussion can accurately locate the left cardiac border in the adult patient and is a reproducible technique.
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