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Hörnsten, Rolf
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Publications (10 of 27) Show all publications
Erelund, S., Karp, K., Wiklund, U., Hörnsten, R. & Arvidsson, S. (2021). Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?. Upsala Journal of Medical Sciences, 126(1), Article ID e6064.
Open this publication in new window or tab >>Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?
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2021 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 126, no 1, article id e6064Article in journal (Refereed) Published
Abstract [en]

Background: This research study aimed at assessing the electrocardiographic (ECG) changes caused by ageing in a cohort of healthy subjects with normal echocardiographic examinations.

Methods: A total of 219 healthy individuals (119 males and 100 females) were evaluated for possible arrhythmias with a standard 12-lead resting ECG and 24-h Holter ECG. As the recordings were performed between 1998 and 2000, a 20-year follow-up study was carried out by assessing the local medical records to investigate whether the subjects had experienced any cardiovascular health complications or disease since the baseline assessment.

Results: Eighty-three subjects (45 males and 38 females) presented with pathological ECG findings at baseline. The most common finding on analysis of Holter ECG recordings was premature atrial contractions, and the most severe pathological finding was episodes of ventricular tachycardia (eight subjects). Regarding the analysis of the standard 12-lead ECG, the most common finding was left ventricular hypertrophy, and the most severe pathological findings were ST-T changes and prolongation of the QT interval. Despite other cardiac examinations performed on these patients showing normal results, in combination with a strict inclusion criterion, this study showed that 28% of all subjects had pathological resting 12-lead ECGs at rest and 35% had pathological heart rhythms when assessed by 24-h Holter ECG. At follow-up, 21% of females and 43% of males had presented with ECG abnormalities, and 30% of females and 36% of males had cardiovascular disease. There was hypertension in 45% of females and in 58% of males. However, no association was found between the follow-up findings and ECG changes seen at baseline.

Conclusion: Although most ECG changes found at baseline could be considered as a normal variation, they may progress to more severe heart complications as the subject ages. The results of this study also validate ECG findings of previous studies and underline that diagnostic criteria should be based on gender and age.

Place, publisher, year, edition, pages
Upsala Medical Society, 2021
Keywords
Arrhythmia, Clinical physiology, Electrocardiogram, Heart function test, Normal values
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-186419 (URN)10.48101/ujms.v126.6064 (DOI)000683141300001 ()2-s2.0-85110436769 (Scopus ID)
Funder
Region Västerbotten
Available from: 2021-07-29 Created: 2021-07-29 Last updated: 2023-11-02Bibliographically approved
Hansson Mild, K., Bergling, R. & Hörnsten, R. (2021). Heart Rate Variability and Magnetic Field Exposure Among Train Engine Drivers: A Pilot Study [Letter to the editor]. Bioelectromagnetics, 43(3), 259-264
Open this publication in new window or tab >>Heart Rate Variability and Magnetic Field Exposure Among Train Engine Drivers: A Pilot Study
2021 (English)In: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 43, no 3, p. 259-264Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
autonomic nervous system, extremely low-frequency magnetic field, logger, occupational exposure
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-181535 (URN)10.1002/bem.22329 (DOI)000623233200001 ()33644873 (PubMedID)2-s2.0-85101828874 (Scopus ID)
Available from: 2021-04-01 Created: 2021-04-01 Last updated: 2021-07-02Bibliographically approved
Wiklund, U., Kadkhodaee, A., Andersson, K., Suhr, O. B. & Hörnsten, R. (2018). Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis. Amyloid: Journal of Protein Folding Disorders, 25(1), 54-61
Open this publication in new window or tab >>Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis
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2018 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 1, p. 54-61Article in journal (Refereed) Published
Abstract [en]

Background: The heart rate (HR) response to paced deep breathing (DB) is a common test of cardiac autonomic function, where high heart rate variability (HRV) is considered to reflect normal autonomic function. We evaluated the DB test in patients with hereditary transthyretin amyloid (ATTRm) amyloidosis, where autonomic dysregulation and atrial arrhythmias are common.Methods: Paced DB was performed during one minute (six breaths/min) in 165 recordings in adult ATTRm amyloidosis patients with the TTR Val30Met mutation, 42 hypertrophic cardiomyopathy (HCM) patients and 211 healthy subjects. HRV was scored by traditional DB indices and by a novel regularity index, estimating the fraction of the HRV that was coherent with the breathing pattern.Results: Twenty per cent of ATTRm amyloidosis patients presented with age-adjusted HRV scores within normal limits but poor regularity due to subtle atrial arrhythmias and cardiac conduction disturbances. Forty-seven per cent of ATTRm amyloidosis patients presented with HRV scores below normal limits, whereas HCM patients presented with higher HRV than ATTRm amyloidosis patients.Conclusions: Reduced HRV is common in ATTRm amyloidosis patients during DB, however, autonomic function cannot be evaluated in patients presenting with the combination of normal scores and low regularity, since their HR responses often reflects dysrhythmias.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
HRV, heart rate variability, amyloidosis hereditary, transthyretin, autonomic function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146594 (URN)10.1080/13506129.2018.1434140 (DOI)000428570300008 ()29394116 (PubMedID)2-s2.0-85041622820 (Scopus ID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2023-03-24Bibliographically approved
Henein, M. Y., Suhr, O. B., Arvidsson, S., Pilebro, B., Westermark, P., Hörnsten, R. & Lindqvist, P. (2018). Reduced left atrial myocardial deformation irrespective of cavity size: a potential cause for atrial arrhythmia in hereditary transthyretin amyloidosis. Amyloid: Journal of Protein Folding Disorders, 25(1), 46-53
Open this publication in new window or tab >>Reduced left atrial myocardial deformation irrespective of cavity size: a potential cause for atrial arrhythmia in hereditary transthyretin amyloidosis
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2018 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 1, p. 46-53Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac amyloidosis (CA) is a myocardial disease and commonly under-diagnosed condition. In CA patients, atrial fibrillation might occur in the absence of left atrial (LA) enlargement.

OBJECTIVES: The aim of this study is to assess LA size and function, and its relationship with atrial arrhythmia in patients with hereditary transthyretin amyloidosis (ATTR).

METHODS: Forty-six patients with confirmed ATTR amyloidosis on abdominal biopsy were studied. Assessment with 2D echocardiography and 2D strain showed 31 patients had increased LV wall thickness (LVWT) (septal thickness >12 mm), and 15 had normal LVWT. In addition to conventional measurements, LV and LA global longitudinal strain (GLS%) and strain rate (SR) were obtained. Western blot analysis was done to assess fibril type. ATTR patients with increased LVWT were compared with 23 patients with hypertrophic cardiomyopathy (HCM) and 31 healthy controls. ATTR amyloidosis patients also underwent 24 hour Holter monitoring to determine the presence of atrial arrhythmia.

RESULTS: Atrial deformation during atrial systole was reduced in ATTR amyloidosis patients with increased LVWT independent of LA size and in contrast to HCM. Twenty of the ATTR amyloidosis patients (54%) had ECG evidence of significant atrial arrhythmic events. LA strain rate, during atrial systole, was the only independent predictor of atrial arrhythmia (β = 3.28, p = .012).

CONCLUSION: In ATTR cardiomyopathy with increased LVWT, LA myocardial function is abnormal, irrespective of atrial cavity size. Reduced LA myocardial SR during atrial systole, irrespective of cavity volume, E/e' and LV deformation, is also a strong predictor for atrial arrhythmic events.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Arrhythmia, Holter ECG, deformation echocardiography, left atrial function
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-145431 (URN)10.1080/13506129.2018.1430027 (DOI)000428570300007 ()29369708 (PubMedID)2-s2.0-85040963408 (Scopus ID)
Available from: 2018-03-05 Created: 2018-03-05 Last updated: 2023-03-24Bibliographically approved
Hendrikx, T., Sundqvist, M., Sandström, H., Sahlin, C., Rohani, M., Al-Khalili, F., . . . Franklin, K. A. (2017). Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea. PLOS ONE, 12(2), Article ID e0171575.
Open this publication in new window or tab >>Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea
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2017 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 2, article id e0171575Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: Obstructive sleep apnea is common among patients with atrial fibrillation, but the prevalence and risk factors for atrial fibrillation among patients who are being investigated on suspicion of sleep apnea are not well known. The aim of the study was to estimate the prevalence of atrial fibrillation among patients investigated for suspected obstructive sleep apnea and to identify risk factors for atrial fibrillation among them.

METHODS: The prevalence of atrial fibrillation was investigated among 201 patients referred for suspected obstructive sleep apnea. Patients without known atrial fibrillation were investigated with a standard 12-lead ECG at hospital and short intermittent handheld ECG recordings at home, during 14 days.

RESULTS: Atrial fibrillation occurred in 13 of 201 subjects (6.5%), and in 12 of 61 men aged 60 years and older (20%). The prevalence of atrial fibrillation increased with sleep apnea severity (p = 0.038). All patients with atrial fibrillation were men and all had sleep apnea. Age 60 or older, the occurrence of central sleep apnea and diabetes mellitus were independent risk factors for atrial fibrillation after adjustments for body mass index, gender, sleep apnea and cardiovascular disease.

CONCLUSIONS: Atrial fibrillation is common among subjects referred for sleep apnea investigation and the prevalence of atrial fibrillation increases with sleep apnea severity. Independent risk factors for atrial fibrillation among patients investigated for suspected obstructive sleep apnea include the occurrence of coexisting central sleep apnea, age 60 years or older and diabetes mellitus.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-131353 (URN)10.1371/journal.pone.0171575 (DOI)000393712500051 ()28178304 (PubMedID)2-s2.0-85012113172 (Scopus ID)
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2023-05-09Bibliographically approved
Hendrikx, T., Rosenqvist, M., Sandström, H., Persson, M. & Hörnsten, R. (2015). Identifiering av paroxysmala, kortvariga arytmier: intermittent registrering mer effektiv än 24-timmars Holter-EKG: [Identification of paroxysmal, transient arrhythmias: intermittent registration more efficient than the 24-hour Holter monitoring]. Läkartidningen, 112(1-2), Article ID C6SE.
Open this publication in new window or tab >>Identifiering av paroxysmala, kortvariga arytmier: intermittent registrering mer effektiv än 24-timmars Holter-EKG: [Identification of paroxysmal, transient arrhythmias: intermittent registration more efficient than the 24-hour Holter monitoring]
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 1-2, article id C6SEArticle in journal (Refereed) Published
Abstract [en]

Many patients suffer from palpitations or dizziness/presyncope. These patients are often referred for Holter ECG (24 hour), although the sensitivity for detecting arrhythmias is low. A new method, short intermittent regular and symptomatic ECG registrations at home, might be a convenient and more sensitive alternative also suitable for primary health care. In this case report we present a patient who had contacted health care several times during a seven year period for paroxysmal palpitations. Routine examination with 24 hour Holter ECG and event recorder did not result in a diagnosis. Using intermittent handheld ECG registration at home, a paroxysmal supraventricular arrhythmia was diagnosed. Further investigation revealed that the patient had a concealed Wolff-Parkinson-White (WPW) syndrome.

Place, publisher, year, edition, pages
Stockholm: Sveriges läkarförbund, 2015
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-118044 (URN)25584602 (PubMedID)2-s2.0-84946854533 (Scopus ID)
Note

Publicerad på Lakartidningen.se 2015-01-07.

Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2023-07-24Bibliographically approved
Alenius Dahlqvist, J., Karlsson, M., Wiklund, U., Hörnsten, R. & Rydberg, A. (2014). Handheld ECG in analysis of arrhythmia and heart rate variability in children with Fontan circulation. Journal of Electrocardiology, 47(3), 374-382
Open this publication in new window or tab >>Handheld ECG in analysis of arrhythmia and heart rate variability in children with Fontan circulation
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2014 (English)In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 47, no 3, p. 374-382Article in journal (Refereed) Published
Abstract [en]

Background: Our aim was to evaluate the intermittent use of a handheld ECG system for detecting silent arrhythmias and cardiac autonomic dysfunction in children with univentricular hearts. Methods: Twenty-seven patients performed intermittent ECG recordings with handheld devices during a 14-day period. A manual arrhythmia analysis was performed. We analyzed heart rate variability (HRV) using scatter plots of all interbeat intervals (Poincare plots) from the total observation period. Reference values of HRV indices were determined from Holter-ECGs in 41 healthy children. Results: One asymptomatic patient had frequent ventricular extra systoles. Another patient had episodes with supraventricular tachycardia (with concomitant palpitations). Seven patients showed reduced HRV. Conclusions: Asymptomatic arrhythmia was detected in one patient. The proposed method for pooling of intermittent recordings from handheld or similar devices may be used for detection of arrhythmias as well as for cardiac autonomic dysfunction.

Keywords
Handheld ECG, Arrhythmia, Heart rate variability, Fontan circulation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-90080 (URN)10.1016/j.jelectrocard.2014.02.006 (DOI)000335712700018 ()2-s2.0-84899994917 (Scopus ID)
Available from: 2014-06-23 Created: 2014-06-17 Last updated: 2023-03-24Bibliographically approved
Hendrikx, T., Rosenqvist, M., Wester, P., Sandström, H. & Hörnsten, R. (2014). Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias. BMC Cardiovascular Disorders, 14, 41
Open this publication in new window or tab >>Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias
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2014 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 14, p. 41-Article in journal (Refereed) Published
Abstract [en]

Background: Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.

Methods:

Design: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope.

Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG ((R)) thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days.

Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT).

Results: 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.

Conclusions: Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Arrhythmias, Atrial fibrillation, Electrocardiography, Holter ECG, Intermittent ECG
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-88955 (URN)10.1186/1471-2261-14-41 (DOI)000334546200001 ()2-s2.0-84899699551 (Scopus ID)
Available from: 2014-05-23 Created: 2014-05-19 Last updated: 2023-03-24Bibliographically approved
Hendrikx, T., Hörnsten, R., Rosenqvist, M. & Sandström, H. (2013). Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population. BMC Cardiovascular Disorders, 13, 41, Article ID 41.
Open this publication in new window or tab >>Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population
2013 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, p. 41-, article id 41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke.

METHOD: Design: Cross-sectional study. Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden. Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). Interventions: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. Main outcome measures: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds.

RESULTS: 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7--5.2). These 35 patients had a mean age of 70.7 years (SD +/- 7.7; range 53--85) and a median CHADS2 of 2 (range 1--4).

CONCLUSIONS: Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.

Place, publisher, year, edition, pages
London: BioMed Central, 2013
Keywords
Arrhythmia, Atrial fibrillation, Handheld ECG, Stroke prevention, Screening
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-73635 (URN)10.1186/1471-2261-13-41 (DOI)000320401000001 ()2-s2.0-84878702323 (Scopus ID)
Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2023-03-23Bibliographically approved
Hörnsten, R., Suhr, O. B., Olofsson, B.-O. & Wiklund, U. (2012). Arrhythmia - a pitfall in tests of cardiac autonomic function after liver transplantation for familial amyloidotic polyneuropathy: a long-term follow-up of Swedish patients. Amyloid: Journal of Protein Folding Disorders, 19(2), 81-86
Open this publication in new window or tab >>Arrhythmia - a pitfall in tests of cardiac autonomic function after liver transplantation for familial amyloidotic polyneuropathy: a long-term follow-up of Swedish patients
2012 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 19, no 2, p. 81-86Article in journal (Refereed) Published
Abstract [en]

Liver transplantation (LT) is a potentially curative treatment for hereditary transthyretin amyloidosis, of which familial amyloid polyneuropathy (FAP) is the most common form in Sweden. This study investigated the long-term development in heart rate variability (HRV) after LT in Swedish FAP patients. HRV was analyzed before LT, and during a first (<40 months) and a second (>40 months) follow-up recording after transplantation, respectively. Power spectrum analysis was performed on 2-min sequences in the supine position and after passive tilt, after careful identification of patients with arrhythmia. Data were obtained from 33 patients, but 18 patients had developed cardiac arrhythmia or were pacemaker-treated (4 before LT and 14 after LT) and three patients had not performed the first follow-up recording. In the remaining 12 patients, HRV decreased between the pretransplant evaluation and the first follow-up, thereafter no significant changes were found. In conclusion, our study showed that the progressive development of cardiac arrhythmias after LT is a major pitfall when assessing cardiac autonomic function in FAP patients, especially in patients older than 40 years. In the minority of patients with sinus rhythm in all recordings, cardiac autonomic modulation remained stable after transplantation and no improvement was noted.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2012
Keywords
Amyloid, amyloidosis, FAP, heart rate variability, HRV, transthyretin
National Category
Cell and Molecular Biology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-56685 (URN)10.3109/13506129.2012.674073 (DOI)000304521800004 ()2-s2.0-84861601461 (Scopus ID)
Available from: 2012-06-26 Created: 2012-06-25 Last updated: 2023-03-23Bibliographically approved
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