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EP News: Clinical
EP News: Clinical N.A. Mark Estes III, MD From Tufts Medical Center, Boston, Massachusetts.
Efficacy and safety of prescription omega-3 fatty acids for prevention of recurrent symptomatic atrial fibrillation: a randomized controlled trial Kowey et al (JAMA 2010;[EPub ahead of print], PMID 21078810) evaluated omega-3 fatty acids for prevention of atrial fibrillation (AF) in a prospective, randomized, double-blind, placebo-controlled, parallel-group multicenter trial. A total of 663 outpatients with paroxysmal (n ⫽ 542) or persistent (n ⫽ 121) AF, with no structural heart disease, and in normal sinus rhythm at baseline were randomized to omega-3 (8 g/day) or placebo for the first 7 days, then omega-3 (4 g/day) or placebo thereafter through week 24. The primary endpoint was first symptomatic recurrence of AF. Secondary analyses included first recurrence in the persistent stratum and both strata combined. There was no difference between treatment groups for recurrence of symptomatic AF in the paroxysmal stratum (P ⫽ .26), in the persistent stratum (P ⫽ .09), and in both strata combined (P ⫽ .08). Other secondary endpoints were supportive of the primary result. A total of 5% of patients receiving placebo and 4% of those receiving prescription omega-3 discontinued due to adverse events. Eicosapentaenoic and docosahexaenoic acid blood levels were significantly higher in the prescription group than in the placebo group at weeks 4 and 24. The authors conclude that omega-3 compared with placebo did not reduce AF over 6 months.
Randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy Ellenbogen et al (Circulation 2010;[Epub ahead of print], PMID 21098426) prospectively randomized 980 patients receiving a cardiac resynchronization therapy defibrillator to a fixed empirical AV delay (120 ms), echo optimized AV delay, or AV delay optimized with SmartDelay, an electrogram-based algorithm in a 1:1:1 ratio. The primary endpoint was left ventricular end-systolic volume. Secondary endpoints included New York Heart Association functional class, quality-of-life score, 6-minute walk distance, left ventricular end-diastolic volume, and left ventricular ejection fraction. No difference in improvement in left ventricular end-systolic volume at 6 months was observed between the SmartDelay and echocardiography arms (P ⫽ .52) or the SmartDelay and fixed arms (P ⫽ .66). Secondary endpoints were not significantly different between arms. The authors conclude that neither SmartDelay nor echocardiography was superior to a fixed Address correspondence: Dr. N.A. Mark Estes III, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111. E-mail address: [email protected].
1547-5271/$ -see front matter
AV delay of 120 ms and that the routine use of AV optimization techniques is not warranted. However, these data do not exclude possible utility in selected patients who do not respond to cardiac resynchronization therapy.
Prevention of AF fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial Koyama et al (J Am Coll Cardiol 2010;56:1463–1472, PMID 20951321) randomized 125 patients undergoing radiofrequency ablation with paroxysmal AF to corticosteroids for 3 days or placebo. The prevalence of immediate AF recurrence (ⱕ3 days after pulmonary vein isolation [PVI]) was significantly lower in the corticosteroid group (7%) than in the placebo group (31%). Corticosteroid treatment did not decrease AF recurrences between 4 and 30 days after ablation. The AF-free rate at 14 months postablation was greater in the corticosteroid group (85%) than in the placebo group (71%, P ⫽ .032). The authors conclude that transient use of small amounts of corticosteroids shortly after AF ablation may be effective and safe for preventing not only immediate AF recurrences but also AF recurrences during the midterm follow-up period after PVI.
Radiofrequency catheter ablation of AF: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of AF Gaita et al (Circulation 2010;122:1662–1663, PMID 20937975) assessed the thromboembolic risk, either silent or clinically manifest, with preprocedural and postprocedural cerebral magnetic resonance imaging (MRI) in patients undergoing AF ablation. A total of 232 consecutive patients with paroxysmal or persistent AF underwent AF ablation. A periprocedural symptomatic cerebrovascular accident occurred in 1 patient (0.4). Postprocedural cerebral MRI was positive for new embolic lesions in 33 patients (14). No clinical parameters, such as age, hypertension, diabetes mellitus, previous history of stroke, type of AF, or preablation antithrombotic treatment, showed significant correlation with ischemic cerebral embolism. Procedural parameters such as activated clotting time value and cardioversion to sinus rhythm correlated with an increased incidence of cerebral embolism. Cardioversion was also associated with an increased risk of 2.75 (P ⫽ .009). The authors conclude that radiofrequency left atrial catheter ablation carries a low risk of symptomatic cerebral ischemia but a substantial risk of silent cerebral ischemia. Independent risk factors for cerebral thromboembolism are the level of activated clotting time and electrical or pharmacologic cardioversion to sinus rhythm during the procedure. doi:10.1016/j.hrthm.2010.12.005
Efficacy and safety of prescription omega-3 fatty acids for prevention of recurrent symptomatic atrial fibrillation: a randomized controlled trial Kowey et al (JAMA 2010;[EPub ahead of print], PMID 21078810) evaluated omega-3 fatty acids for prevention of atrial fibrillation (AF) in a prospective, randomized, double-blind, placebo-controlled, parallel-group multicenter trial. A total of 663 outpatients with paroxysmal (n ⫽ 542) or persistent (n ⫽ 121) AF, with no structural heart disease, and in normal sinus rhythm at baseline were randomized to omega-3 (8 g/day) or placebo for the first 7 days, then omega-3 (4 g/day) or placebo thereafter through week 24. The primary endpoint was first symptomatic recurrence of AF. Secondary analyses included first recurrence in the persistent stratum and both strata combined. There was no difference between treatment groups for recurrence of symptomatic AF in the paroxysmal stratum (P ⫽ .26), in the persistent stratum (P ⫽ .09), and in both strata combined (P ⫽ .08). Other secondary endpoints were supportive of the primary result. A total of 5% of patients receiving placebo and 4% of those receiving prescription omega-3 discontinued due to adverse events. Eicosapentaenoic and docosahexaenoic acid blood levels were significantly higher in the prescription group than in the placebo group at weeks 4 and 24. The authors conclude that omega-3 compared with placebo did not reduce AF over 6 months.
Randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy Ellenbogen et al (Circulation 2010;[Epub ahead of print], PMID 21098426) prospectively randomized 980 patients receiving a cardiac resynchronization therapy defibrillator to a fixed empirical AV delay (120 ms), echo optimized AV delay, or AV delay optimized with SmartDelay, an electrogram-based algorithm in a 1:1:1 ratio. The primary endpoint was left ventricular end-systolic volume. Secondary endpoints included New York Heart Association functional class, quality-of-life score, 6-minute walk distance, left ventricular end-diastolic volume, and left ventricular ejection fraction. No difference in improvement in left ventricular end-systolic volume at 6 months was observed between the SmartDelay and echocardiography arms (P ⫽ .52) or the SmartDelay and fixed arms (P ⫽ .66). Secondary endpoints were not significantly different between arms. The authors conclude that neither SmartDelay nor echocardiography was superior to a fixed Address correspondence: Dr. N.A. Mark Estes III, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111. E-mail address: [email protected].
1547-5271/$ -see front matter
AV delay of 120 ms and that the routine use of AV optimization techniques is not warranted. However, these data do not exclude possible utility in selected patients who do not respond to cardiac resynchronization therapy.
Prevention of AF fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial Koyama et al (J Am Coll Cardiol 2010;56:1463–1472, PMID 20951321) randomized 125 patients undergoing radiofrequency ablation with paroxysmal AF to corticosteroids for 3 days or placebo. The prevalence of immediate AF recurrence (ⱕ3 days after pulmonary vein isolation [PVI]) was significantly lower in the corticosteroid group (7%) than in the placebo group (31%). Corticosteroid treatment did not decrease AF recurrences between 4 and 30 days after ablation. The AF-free rate at 14 months postablation was greater in the corticosteroid group (85%) than in the placebo group (71%, P ⫽ .032). The authors conclude that transient use of small amounts of corticosteroids shortly after AF ablation may be effective and safe for preventing not only immediate AF recurrences but also AF recurrences during the midterm follow-up period after PVI.
Radiofrequency catheter ablation of AF: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of AF Gaita et al (Circulation 2010;122:1662–1663, PMID 20937975) assessed the thromboembolic risk, either silent or clinically manifest, with preprocedural and postprocedural cerebral magnetic resonance imaging (MRI) in patients undergoing AF ablation. A total of 232 consecutive patients with paroxysmal or persistent AF underwent AF ablation. A periprocedural symptomatic cerebrovascular accident occurred in 1 patient (0.4). Postprocedural cerebral MRI was positive for new embolic lesions in 33 patients (14). No clinical parameters, such as age, hypertension, diabetes mellitus, previous history of stroke, type of AF, or preablation antithrombotic treatment, showed significant correlation with ischemic cerebral embolism. Procedural parameters such as activated clotting time value and cardioversion to sinus rhythm correlated with an increased incidence of cerebral embolism. Cardioversion was also associated with an increased risk of 2.75 (P ⫽ .009). The authors conclude that radiofrequency left atrial catheter ablation carries a low risk of symptomatic cerebral ischemia but a substantial risk of silent cerebral ischemia. Independent risk factors for cerebral thromboembolism are the level of activated clotting time and electrical or pharmacologic cardioversion to sinus rhythm during the procedure. doi:10.1016/j.hrthm.2010.12.005