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Background
Persistent iatrogenic atrial septal defect (iASD) is a common but poorly characterized complication after cryoballoon (CB) pulmonary vein isolation (PVI) procedures. We therefore investigate its prevalence, evolution, risk factors, and clinical outcomes in a prospective longitudinal study.Methods
A total of 108 patients (41 women, mean age 57 ± 11.3) underwent CB PVI for AF. Serial transesophageal echocardiography (TEE) was performed 9 months and then annually until 6 years after the procedure to study the characteristics of persistent iASD.Results
Persistent iASD occurred in 33 (30.6%) patients 9 months after CB PVI. Spontaneous closure of iASD was found in 6 (22.2%) and 3 (15.8%) patients 2 and 3 years after the procedures, respectively. No spontaneous closure was observed on 4, 5, and 6-year TEE follow-up. The projected long-term persistence rate of iASD after CB PVI was therefore 20% (30.6% × 0.778 × 0.842). Using multivariate logistic regression, a higher number of cryoapplications (≥ 2 minutes) was the only independent predictor of persistent iASD 9 months after CB PVI (odds ratio [OR] 1.207; 95% confidence interval [CI], 1.033-1.411, P = 0.018). Two (1.9%) patients with significantly larger iASD size than the others (long diameter 12.6 ± 0.8 vs 3.7 ± 1.5 mm, P < 0.001; short diameter 10.9 ± 0.2 vs 3 ± 1.1 mm, P < 0.001) required percutaneous closure because of exertional dyspnea and right ventricular enlargement. Over 129.7 patient-years follow-up, during which iASD persisted, there was no occurrence of neurologic events.Conclusions
Approximately one fifth of patients undergoing CB PVI will have permanently persistent iASD. Patients with defect sizes of greater than 10 mm may need percutaneous closure due to significant left-to-right shunting. 相似文献The present study investigates characteristics of treatment seeking problem gamblers with adult ADHD (n = 39) and those without ADHD (n = 87). Patients completed self-report questionnaires about gambling behaviors, impulsivity (UPPS-P), substance abuse (AUDIT/DAST), emotional dysregulation (PHQ-4), illegal activities, and gambling consequences. Each patient received a structured diagnostic interview (MINI) to assess for psychopathology, adult ADHD (ACDS), and gambling disorder (NODS). Results revealed that problem gamblers with adult ADHD encounter unique challenges above those common among problem gamblers including more problems with alcohol/drug abuse and higher levels of impulsivity. Earlier age for first gambling activities, onset of gambling problems, and higher severity of gambling problems was found among gamblers with ADHD. Gamblers with ADHD pawned more items to obtain money for gambling, were more likely to have debt, had significantly higher rates of bankruptcy and domestic violence arising from conflict with family members about their gambling. Interestingly, groups did not differ significantly on their time spent gambling prior to treatment, their win-to-loss ratio, and a number of other gambling-related consequences. These findings are discussed with their clinical ramifications for treatment.
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