Thursday, August 29, 2013

Atrial Coronary Arteries: Anatomy And Atrial Perfusion Territories

Citation: V. Subbarao Boppana, Adam Castaño, Uma Mahesh R Avula, Masatoshi Yamazaki, Jérôme Kalifa

Metformin is an oral antidiabetic drug used for treatment of Type 2 diabetes mellitus (T2DM). It acts by decreasing gluconeogenesis in the liver and absorption of glucose from the gastrointestinal system, in addition to increasing the peripheral utilization of glucose. Metformin is excreted unchanged through the renal route. Severe side effects are noted in patients with renal and/or hepatic dysfunction. These may vary from severe lactic acidosis which can be life threatening, to cardiac arrhythmias.

Neuropsychological Decline After Catheter Ablation of Atrial Fibrillation

Citation: Schwarz, N., Schoenburg M., Gerriets, T

The article “Neuropsychological decline after cath- eter ablation of atrial fibrillation” by Schwarz et al. is the first publication that focused on cognitive side effects of elective circumferential pulmonary vein isolation (PVI). Adverse neuropsychological changes after left atrial catheter ablation, as report- ed in this paper, were found in verbal memory and the result, conjoined with ischemic brain lesions, might represent cerebral side-effects of the ablation procedure.

IntravenousCorticosteroid Use Is Associated With Reduced Early Recurrence of Atrial Fibrillation Immediately Following Radiofrequency Catheter Ablation

Citation: Nitesh A. Sood, Guru M. Krishnan, Craig. I. Coleman, PharmD; Jeffrey Kluger, Moise Anglade, Christopher A. Clyne

Background: Early recurrence of atrial fibrillation (ERAF) occurs in up to 40% of patients after radiofrequency catheter ablation for atrial fibrillation (RFCA), increasing hospital stay, need for anti-arrhythmic medications (AADs) and cardioversion, and, possibly, the risk of future AF. It has been postulated that inflammation plays a key role in developing ERAF. Short term postoperative use of corticosteroids to reduce ERAF post-RFCA has not been vigorously studied.
 
Methods: This was a case-control study of consecutive patients undergoing RFCA for the management of AF at a single-institution. RFCA was performed by a single operator from October 2005 through July 2009. Patients receiving intravenous corticosteroids immediately following the ablation and for 48 hours (6 doses) constituted the treatment group. Controls received no intravenous corticosteroids during their hospitalization. All other management strategies were similar between the 2 groups, including the administration of AADs post- operatively. All patients had continuous electrocardiographic monitoring throughout their hospitalization. Multivariable logistic regression analysis was used to determine the impact of intravenous corticosteroids on ERAF defined as any AF>10 minutes during hospitalization.
 
Results: A total of 68 patients undergoing RFCA for the management of AF were included in this analysis. The overall ERAF rate, irrespective of intravenous corticosteroid use, was 23.5%. The administration of intravenous corticosteroids (n=37; mean±SD dexamethasone mean dose 11.9±4.6 mg/day; range 4-16 mg/day) was associated with an 82% reduction in patients’ odds of ERAF (adjusted odds ratio; 0.18, 95% confidence interval [CI] 0.04 to 0.78) compared with those who did not receive corticosteroids (n=31). A dose-response effect was also observed, with a 17% reduction in ERAF odds for each dexamethasone mg-equivalent administered (adjusted odds ratio; 0.83, 95%CI 0.73 to 0.96).
 
Conclusions: The use of intravenous corticosteroids was associated with a dose-dependent reduction in the odds of developing ERAF after RFCA for the management of AF.

Atrial Fibrillation After Lung Transplantation: Incidence, Predictors and Long-Term Implications

Citation: Santiago Garcia, Mariana Canoniero, Srinivasan Sattiraju, Lin Y. Chen, Wayne Adkisson, Marshall Hertz, David G. Benditt

Background: Little is known about the frequency of, risk factors predisposing to, and long-term impact of post-operative atrial fibrillation (AF) after lung transplantation.

Methods: A prospectively collected registry of 167 consecutive patients who underwent single or bilateral lung transplantation at the University of Minnesota Medical Center from January 1st, 2004 to December 30th, 2008 was reviewed. Post-operative AF was confirmed by review of electrocardiograms by two cardiologists. Kaplan-Meier survival curves were constructed to determine the impact of new onset AF on long-term survival.

Results: The mean age (±SD) of the population was 55 ± 11 years and 52% were male. A total of 48 patients (28%) developed AF in the postoperative period. Predictors of postoperative AF in multivariate analysis included: age (per decade) Odds Ratio (OR): 1.61, 95% confidence interval (CI) 1.10-2.34, p=0.01, postoperative thromboembolic disease OR: 9.73 (95% CI: 2.16-43.81, p<0.01, and postoperative pericarditis OR: 3.57, (95% CI: 1.38-9.22, p < 0.01). Of the 48 patients who developed post-operative AF, 41 were discharged in sinus rhythm (SR). Survival among patients who were discharged in AF was significantly lower when compared to patients discharged in SR (HR: 0.08; 0.01-0.43, p<0.05).

Conclusions: Postoperative AF is common after lung transplant. Increased age, postoperative thromboembolic disease, and pericarditis are independent predictors of postoperative AF. Persistence of AF at the time of discharge is an identifier of decreased survival.

Metformin associated Atrial Fibrillation - A Case Report

Citation: Hemant Boolani, David Shanberg, Vineela Chikkam and Dhanunjaya Lakkireddy

Metformin is an oral antidiabetic drug used for treatment of Type 2 diabetes mellitus (T2DM). It acts by decreasing gluconeogenesis in the liver and absorption of glucose from the gastrointestinal system, in addition to increasing the peripheral utilization of glucose. Metformin is excreted unchanged through the renal route. Severe side effects are noted in patients with renal and/or hepatic dysfunction. These may vary from severe lactic acidosis which can be life threatening, to cardiac arrhythmias.

Wednesday, August 28, 2013

The Role of Atrial Fibrillation Catheter Ablation in Patients with Congestive Heart Failure: “Burning”for a Cure

Citation: Dimpi Patel, Mohammed Khan

Atrial Fibrillation (AF) and congestive heart failure (CHF) often co-exist. Catheter ablation is increasingly used to cure AF related to CHF.Clinical evidence supports the feasibil- ity of catheter ablation as a treatment option in drug refractory AF patients with CHF.Investiga- tors have reported an improvement in ejection fraction, quality of life, and functional capacity

Role of Echocardiography in Atrial Fibrillation Ablation

Citation: Andrew C. Y. To MBChB, Allan L. Klein

Radiofrequency catheter ablation is an increasingly adopted strategy for difficult-to-manage patients with atrial fibrillation. Echocardiography is the key imaging modality to assess left atrialstructure and function. In this review, the role of echocardiography in atrial fibrillation ablationbefore, during and after ablation is discussed. Currently established roles of echocardiography inpatient selection pre-ablation and peri-procedural guidance, as well as newer echocardiographic techniques including the assessment of atrial mechanics are reviewed in the context of atrial fibrillation ablation.