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Biomedical subjects

Louise Harris

Publications and source records attributed to Louise Harris.

14 recordsLinked to original sources
PubMed2006

Psychological correlates of quality of life in atrial fibrillation.

OBJECTIVE: Atrial fibrillation (AF) is associated with significant health-related quality of life (QoL) impairments. Markers of heart disease severity have explained little variance in QoL and it is unclear what other factors will better account for the observed differences in adjustment. We examined whether specific personality traits and illness management styles would help explain the severity of QoL impairments reported in this population. METHODS: Patients with AF (N = 93) completed validated questionnaires measuring disease burden (dependent variables: physical and mental QoL, symptom severity, psychological distress), personality (independent variables: anxiety sensitivity, optimism), and illness management style (mediating variable: symptom preoccupation). Hypothesized relationships were evaluated using mediation models. RESULTS: Anxiety sensitivity was associated with poorer physical and mental QoL, greater symptom severity, and higher distress. Optimism was correlated with better mental QoL and lower distress, but unrelated to physical QoL and symptom severity. Symptom preoccupation significantly mediated the relationships between anxiety sensitivity and each of the QoL measures, as well as the relationships between optimism and mental well-being. CONCLUSIONS: Personality traits and illness management styles are important to consider when assessing the impact of AF on QoL. The data support a cognitive-behavioral model that explains the direct and indirect relationships between psychological predictors and multiple indices of QoL.

Aged↗
PubMed2006

Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes.

In women with heart disease, sustained arrhythmias can result in an increased risk to the mother and fetus. The purpose of this study was to determine the recurrence rates of arrhythmias during pregnancy in women with cardiac rhythm disorders and examine the impact on fetal and neonatal outcomes. Women with tachyarrhythmias before pregnancy who underwent obstetric care at the Toronto General and Mount Sinai Hospitals from 1990 to 2002 were included. The recurrence rates of arrhythmias were calculated. A multivariate logistic model was used to identify predictors of fetal complications. Seventy-three women had 87 pregnancies; 36 pregnancies were in women with a history of paroxysmal supraventricular tachycardia, 23 with paroxysmal atrial fibrillation or atrial flutter (AF/Afl), 6 with persistent AF/Afl, and 22 with ventricular tachycardia. In the women in sinus rhythm at baseline, 44% (36 of 81 pregnancies) developed recurrences of tachyarrhythmias during pregnancy or in the early postpartum period. The specific recurrence rates during pregnancy in women with a history of supraventricular tachycardia, paroxysmal AF/Afl, and ventricular tachycardia were 50%, 52%, and 27%, respectively. The 6 women in AF/Afl at baseline remained in this rhythm throughout their pregnancy. Adverse fetal events occurred in 17 of the 87 pregnancies (20%). Adverse fetal events occurred more commonly in women who developed antepartum arrhythmias (RR 3.4, 95% confidence interval 1.0 to 11.0, p = 0.045) compared with those who did not. In conclusion, in women with preexisting cardiac rhythm disorders, exacerbation of arrhythmia during pregnancy is common. Recurrence of arrhythmia during the antepartum period increases the risk of adverse fetal complications, independent of other maternal and fetal risk factors.

Adult↗
PubMed2006

Outcomes after late reoperation in patients with repaired tetralogy of Fallot: the impact of arrhythmia and arrhythmia surgery.

BACKGROUND: We evaluated outcomes in patients requiring late reoperation after tetralogy of Fallot (ToF) repair to identify risk factors for arrhythmia and determine whether arrhythmia surgery decreased the risk of subsequent death or recurrent arrhythmia. METHODS: Review was performed of all ToF patients from 1969 to 2005 undergoing reoperation late (> 1 year) after repair. Patients with associated lesions, except pulmonary atresia, were included. A total of 249 patients had 278 reoperations. Procedures at initial reoperation included pulmonary valve replacement (PVR) in 217, ablation in 63, and tricuspid valve repair/replacement in 46. Pre-reoperative arrhythmias were present in 75, including supraventricular tachycardia (SVT) in 31, ventricular tachycardia (VT) in 34, and SVT+VT in 10 patients. RESULTS: Median age at reoperation was 23 years (range, 1 to 63). Ten-year survival after reoperation was 93%, and was independent of arrhythmia status (p = 0.86). Arrhythmia patients were characterized by older age at initial repair and at late reoperation, tricuspid and pulmonary regurgitation, and longer QRS duration (p < 0.001 for all). Risk factors for post-reoperative recurrent arrhythmia were longer QRS duration and not having PVR. Longer QRS duration, with a cut-point of more than 160 msec, was associated with recurrent SVT (p = 0.004). Supraventricular tachycardia ablation improved arrhythmia-free survival (75% versus 33%, p < 0.001) but VT ablation did not (96% versus 95%, p = 0.50). However, recurrent VT occurred in only 3 patients (10%). CONCLUSIONS: Late mortality in patients undergoing reoperation after ToF repair is not impacted by pre-reoperative arrhythmia. Prolongation of QRS identifies patients at risk for recurrent VT and SVT, but recurrent VT is uncommon. Early PVR, and surgical ablation in patients with SVT, decreases arrhythmic risk.

Adolescent↗
PubMed2006

Gender differences and quality of life in atrial fibrillation: the mediating role of depression.

OBJECTIVE: This study investigated gender differences, depression, and health-related quality of life (QoL) in a cross-sectional sample of patients with atrial fibrillation (AF). METHODS: This cross-sectional study involved a convenience sample of AF patients from two tertiary-care clinics in Toronto, Canada. Ninety-three AF patients completed psychometrically validated measures of generic QoL and depression. Mediation analyses evaluated the relationship between gender and QoL using depression as mediating variable. RESULTS: Relative to male patients, female patients reported lower physical, but not mental, QoL. Gender was associated with both depression and physical QoL, while depression was correlated with poorer physical QoL. Path analyses demonstrated that depression significantly mediated the relationship between gender and physical QoL. CONCLUSION: Among AF patients, female patients report lower physical QoL relative to male patients, and this relationship may be mediated by self-reported symptoms of depression. Albeit correlational, the findings underscore the need to develop a better understanding of the role of depression in physical QoL, especially when considering the burden of AF in women.

Aged↗
PubMed2005

Cardiac resynchronization therapy: retiming the failing right ventricle.

Cardiac resynchronization therapy (CRT) improves symptoms, reduces hospitalization, and may decrease mortality in patients with moderate/severe heart failure and left bundle branch block. Whether CRT may have a role in the management of patients with adult congenital heart disease and a failing right (systemic) ventricle is unknown. We report the case of an adult patient with transposition of the great arteries and previous Mustard's repair, who successfully underwent CRT using a hybrid transvenous/epicardial approach. Exercise tolerance improved, right ventricular (systemic) ejection fraction improved, diuretic requirements reduced, and renal function improved. CRT may offer a new therapeutic option for this patient population.

Adult↗
PubMed2005

Atrial arrhythmias and special circumstances.

The present paper discusses the general principles of management of atrial fibrillation and atrial flutter under special circumstances. Management recommendations, which encompass initial assessment, initial arrhythmia management and chronic pharmacological therapy, are outlined for patients with hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome and congenital heart disease. Recommendations are also made for pregnant patients and pediatric patients without congenital heart disease. Discrepancies between the authors' recommendations and those from the American College of Cardiology/American Heart Association/European Society of Cardiology are discussed.

Atrial Fibrillation↗
PubMed2004

Long-term outcomes of cardiac pacing in adults with congenital heart disease.

OBJECTIVES: The purpose of this retrospective study was to define long-term outcomes after pacemaker therapy in adults with congenital heart disease (CHD). BACKGROUND: Adults with CHD represent a unique and expanding population. Many will require pacemaker or implantable defibrillator therapy, with a lifelong need for re-intervention and follow-up. They pose technical and management challenges not encountered in other groups receiving pacing, and the complication and re-intervention rates specific to this population are not well-defined. METHODS: We reviewed outcomes of 168 adults with CHD, 89 females, mean age 40 years, in whom a pacemaker or anti-tachycardia device was implanted. RESULTS: Mean age at implant was 28 years with mean pacing duration 11 years at follow-up (range, 0.5 to 38.0). Seventy-two (42%) received initial dual-chamber devices and remained in this mode, while 23 (14%) went from ventricular to dual-chamber pacing in follow-up. Initial mode of pacing did not have a significant effect on subsequent atrial arrhythmia. Patients receiving an initial epicardial system were younger than those paced endocardially (17 +/- 12 years vs. 35 +/- 16 years, p < 0.001) and more likely to undergo re-intervention (p = 0.019). Difficulty with vascular access was encountered in 25 patients (15%), while 45 (27%) experienced lead-related complications. No significant predictors of lead complications were identified. CONCLUSIONS: Lead complications were not significantly different for epicardial versus endocardial, nor physiologic versus ventricular pacing, but a trend toward improved lead survival in patients receiving endocardial leads at first implant was observed. Adults with CHD remain at risk for atrial arrhythmias regardless of pacing mode.

Adolescent↗
PubMed2004

Inappropriate therapy from a defibrillator complicating transcoronary ablation of septal hypertrophy in a patient with hypertrophic obstructive cardiomyopathy.

This case report describes a patient with obstructive hypertrophic cardiomyopathy who received therapy inappropriately from his implanted defibrillator, subsequent to transcoronary alcohol ablation for septal hypertrophy (TASH). Widening of the intracardiac electrogram postablation resulted in "double counting" of the intrinsic ventricular electrogram by the device and inappropriate tachycardia detection.

Atrial Fibrillation↗
PubMed2003

Electrophysiologic surgery in patients with congenital heart disease.

As patients with congenital heart disease increase in number and age, arrhythmia is becoming a more prevalent and important clinical problem. Although catheter-based therapy has revolutionized the management of arrhythmia, there remains an increasing patient population with congenital heart disease presenting for repair or reoperation with associated atrial or ventricular arrhythmias. Arrhythmia ablation may be safely and effectively included as an adjunct to repair of underlying structural cardiac lesions. Successful electrophysiologic surgery requires accurate preoperative characterization of the arrhythmia.

Arrhythmias, Cardiac↗
PubMed2002

Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot.

OBJECTIVES: The purpose of this study was to determine if left ventricular (LV) systolic dysfunction was also a predictor of sudden cardiac death (SCD) in adults late after repair of tetralogy of Fallot (TOF). BACKGROUND: Previous studies looking at risk factors for SCD in adults with repair of TOF have focused on the right ventricle (RV). METHODS: A retrospective chart review of patients assessed at the Toronto Congenital Cardiac Centre for Adults was performed. Twelve adult patients with repaired TOF and SCD were identified (SCD group). A total of 125 living adult patients with repaired TOF were randomly selected for comparison (control group). RESULTS: Patients with SCD were more likely to exhibit moderate or severe pulmonary regurgitation (92% vs. 51%, p = 0.02), have a history of sustained ventricular tachycardia (42% vs. 6%, p < 0.01), and have a QRS > or =180 ms (56% vs. 13%, p = 0.02). Moderate or severe LV systolic dysfunction was also significantly more common in patients with SCD than in the control group (42% vs. 9%, p < 0.01) with a positive predictive value of 29%. The combination of moderate or severe LV systolic dysfunction and QRS > or =180 ms had a positive and negative predictive value for SCD of 66% and 93%, respectively. CONCLUSIONS: Moderate or severe LV systolic dysfunction is significantly more common in adult patients with repaired TOF and SCD. The combination of QRS > or =180 ms and significant LV systolic dysfunction has high positive and negative predictive value for SCD. The implication of the role of prophylactic antiarrhythmic implantable cardiac defibrillator insertion in these patients needs further elucidating.

Adult↗
PubMed2002

Atrial arrhythmias in congenital heart disease.

Surgical scars, volume overload and pressure overload are the three main determinants of atrial arrhythmias in patients with prior congenital heart surgery. The workup should include a thorough hemodynamic assessment. Treatment modalities available include drugs, pacemakers, catheter ablation and surgery. Despite the above, arrhythmias have a significant negative impact on life expectancy and quality in these patients. Newer surgical strategies for repair of the heart defect may delay or prevent the development of arrhythmias and are being actively pursued.

Arrhythmias, Cardiac↗
PubMed2002

Split atrial electrograms recorded during dual chamber pacing.

Split atrial electrograms (AEGs), as a measure of intraatrial conduction delay, have been previously identified during electrophysiological studies and as such, may be related to the development of atrial tachyarrhythmias. This article reports the finding of split AEGs observed in two patients with implanted dual chamber pacemakers. The event marker and the surface electrogram identified these AEGs by using and interpreting the intracardiac AEG derived from the atrial pacing lead.

Aged↗