There is an experimental study that suggests deep needling with rotation produces higher acupuncture needling sensation than superficial needling with mock rotation. Also, there are opposing results about the relationship between acupuncture needling sensation and analgesic effect. In this study, we intend to investigate the relationship between acupuncture needling sensation and analgesic effect according to acupuncture stimulation.
Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Kyung Hee University Background A study to predict the risk of AF by analyzing the P-wave of the electrocardiogram in detail has been attempted for a long time, and P-wave signal-averaged ECG is also known to be helpful. Recently, the P-wave was analyzed by dividing it into two parts, and when the latter part is extended, it suggests left atrium dilatation or delayed conduction, and it is suggested that this may be a slightly more sensitive parameter. Objective The purpose of this study was to find the best predictor of atrial fibrillation by comparing the characteristics of the P-wave in the subjects with AF and healthy controls using 12-lead ECG and signal-averaged ECG (SAECG). Methods We recruited 58 paroxysmal atrial fibrillation patients in AF group and 57 people in the control group. All subjects underwent 12-lead ECG, P-wave signal-averaged ECG, and transthoracic echocardiography. The total P-wave duration (PWD), the second part of the P-wave were measured with an electronic caliper in lead II. Results The second part of the P-wave was higher in the AF group, which was statistically significant (70.8 ± 20.6 vs. 60.5 ± 12.3ms, respectively, p<0.01). Filtered PWD and the integral of the P-wave were significantly higher in the AF group. The second part of the P-wave, filtered PWD, and the integral of P-wave were univariate and multivariate predictors of AF. The second part of the P-wave showed ROC (Receiver operating characteristic curves) area of 0.635, and the cut-off value was 61.5ms with 59.6% sensitivity and 59.6% of specificity. Of the SAECG parameters, the longer filtered PWD predicted a history of AF with an AUC (Area under the ROC curve) of 0.669. Conclusions We confirmed that second part of the P-wave which reflects the electrophysiological status of the left atrium is a valuable marker for predicting AF. Also, Filtered PWD and the integral of the P-wave among the SAECG parameters were useful predictors of AF.
Background and purpose Although several studies reported that stroke risk in patients with paroxysmal atrial fibrillation (AF) is similar to those with persistent or permanent AF, there is still controversy on the relationship of AF type and stroke occurrence. We investigated the effect of AF type on AF burden and stroke risk in patients with non-valvular AF. Methods Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), we identified 8,883 patients ≥18 years of age with non-valvular AF and eligible follow-up visits. We compared AF burden and stroke risk among patients with 3 types of AF: paroxysmal (n=5,808) or persistent (n=2,806) or permanent (n=269). Results The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 36.0% were female. Patients with persistent and permanent AF were older and had higher CHA2DS2-VASc scores and anticoagulation rate than those with paroxysmal AF. Compared with permanent AF (5.2±16.4%), the arrhythmic burden of AF on 24hrs Holter monitoring was significantly lower in paroxysmal AF (2.1±7.2%, p<0.001) and persistent AF (2.0±7.5%, p<0.001). During median follow-up period of 1.38 years (interquartile range: 0.96–1.67), total 82 (0.92%) patients experienced ischemic stroke with incidence rates of 0.51, 1.04 and 1.69 events per 100 person-years for paroxysmal, persistent and permanent AF, respectively. Compared with paroxysmal AF, the risk of ischemic stroke was increased in persistent AF with clinical variable adjusted hazard ratio (aHR) of 1.94 (95% confidence intervals [CI], 1.23–3.07; P=0.005) and permanent AF with aHR of 2.64 (95% CI, 1.09–6.41; P=0.03). AF type and HR of stroke occurrence Paroxysmal (n=5,808) Persistent (n=2,806) Permanent (n=269) Stoke events 39 37 6 Person years (PYs) 7673 3544 356 /100 PYs 0.51 1.04 1.69 HR (95% CI), p-value HR (95% CI), p-value HR (95% CI), p-value Unadjusted HR 1 (Reference) 2.05 (1.27–3.31), 0.003 3.32 (1.15–7.90), 0.02 Clinical variables adjusted HR 1 (Reference) 1.94 (1.23–3.07), 0.005 2.64 (1.09–6.41), 0.03 PYs: Person years; HR: Hazard ratio. Conclusion Persistent and permanent AF was associated with the increased risk of stroke than paroxysmal AF, after adjustment of clinical variables including age, sex, comorbidities and anticoagulation rate. These results suggest that AF type and burden might be related with the risk of ischemic stroke and should be considered in the stroke prevention of AF.
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