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EP News: Clinical
EP News: Clinical N.A. Mark Estes III, MD, FHRS From the Tufts Medical Center, Boston, Massachusetts.
Effect of weight reduction on atrial fibrillation Abed and colleagues (JAMA. 2013 Nov 20; 310 (19):2050-60; PMID: 24240932) evaluated the effect of weight reduction on atrial fibrillation (AF) burden and cardiac structure in a randomized controlled trial. Obese patients with symptomatic AF (150) were randomized to weight management (intervention) or general lifestyle advice (control). The primary outcomes were AF Severity Scale scores, symptom burden, and symptom severity. Secondary outcomes were AF episodes and AF duration, left atrial area, and septal thickness. The intervention group showed a significantly greater reduction in weight (14.3 and 3.6 kg, respectively; P o .001) and in AF symptom burden scores (11.8 and 2.6 points, P o .001), symptom severity scores (8.4 and 1.7 points, P o .001), and cumulative AF duration (692-minute decline and 419-minute increase, P ¼ .002). There was a reduction in septal thickness in the intervention and control groups (1.1 and 0.6 mm, P ¼ .02) and left atrial area (3.5 and 1.9 cm2, P ¼ .02). The authors conclude weight reduction with intensive risk factor management reduces AF symptom burden and severity and in beneficial cardiac remodeling.
Initial human feasibility of infusion needle catheter ablation for refractory ventricular tachycardia Sapp and colleagues (Circulation. 2013 Nov 19; 128 (21):2289-95; PMID: 24036605) report the initial experience with a catheter with an extendable/retractable irrigated needle for intramyocardial mapping and ablation. Patients with recurrent VT underwent ablation with the use of this catheter. At target sites, the needle was advanced up to 9 mm into the myocardium, permitting pacing and recording. Temperature-controlled radiofrequency energy delivery through the needle was delivered in 8 patients with refractory VT. A mean of 22 (range, 3-48) needle ablation lesions were applied. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs. Two died of the progression of preexisting heart failure without recurrent VT. The authors conclude that intramyocardial infusion-needle catheter Address reprint requests and correspondence: Dr N.A. Mark Estes, Tufts Medical Center, 800 Washington St, Boston, MA 02111. E-mail address: [email protected].
1547-5271/$-see front matter
ablation is feasible and permits control of some VTs that have been refractory to medications and conventional catheter ablation therapy.
Edoxaban versus warfarin in patients with atrial fibrillation Giugliano and colleagues (N Engl J Med. 2013 Nov 19. Epub PMID: 24251359) conducted a randomized, doubleblind, trial comparing two once-daily regimens of edoxaban (E) with warfarin (W) in 21,105 patients with atrial fibrillation (AF). The primary efficacy end point was stroke or systemic embolism. The annualized rate of the primary end point during treatment was 1.50% with W as versus 1.18% with high-dose E (HR, 0.79; Po0.001) and 1.61% with lowdose E (HR, 1.07; P¼0.005). The annualized rate of major bleeding was 3.43% with W versus 2.75% with high-dose E (HR, 0.80; Po0.001) and 1.61% with low-dose E (HR, 0.47; Po0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (HR , 0.86; P¼0.01), and 2.71% (HR, 0.85; P¼0.008), and the corresponding rates of the secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (HR, 0.87; P¼0.005), and 4.23% (HR , P¼0.32). The authors conclude that both once-daily regimens of E were noninferior to W with stroke prevention or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes.
Targeted temperature management at 331C versus 361C after cardiac arrest Nielsen and colleagues (N Engl J Med. 2013 Nov 17 PMID: 24237006) compared two target temperatures for therapeutic hypothermia after cardiac arrest by randomizing 939 adults to 33 versus 361C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days. At the end of the trial, 50% of the patients in the 331C group (235/ 473) had died, as compared with 48% of the patients in the 361C group (225/466) (HR: 1.06; P¼0.51). At the 180-day follow-up, 54% of the patients in the 331C group had died or had poor neurologic function compared with 52% of patients in the 361C group (HR, 1.02; P¼0.78). The authors conclude that survivors of out-of-hospital cardiac arrest hypothermia at a targeted temperature of 331C did not confer a benefit as compared with a targeted temperature of 361C.
http://dx.doi.org/10.1016/j.hrthm.2013.12.012
Effect of weight reduction on atrial fibrillation Abed and colleagues (JAMA. 2013 Nov 20; 310 (19):2050-60; PMID: 24240932) evaluated the effect of weight reduction on atrial fibrillation (AF) burden and cardiac structure in a randomized controlled trial. Obese patients with symptomatic AF (150) were randomized to weight management (intervention) or general lifestyle advice (control). The primary outcomes were AF Severity Scale scores, symptom burden, and symptom severity. Secondary outcomes were AF episodes and AF duration, left atrial area, and septal thickness. The intervention group showed a significantly greater reduction in weight (14.3 and 3.6 kg, respectively; P o .001) and in AF symptom burden scores (11.8 and 2.6 points, P o .001), symptom severity scores (8.4 and 1.7 points, P o .001), and cumulative AF duration (692-minute decline and 419-minute increase, P ¼ .002). There was a reduction in septal thickness in the intervention and control groups (1.1 and 0.6 mm, P ¼ .02) and left atrial area (3.5 and 1.9 cm2, P ¼ .02). The authors conclude weight reduction with intensive risk factor management reduces AF symptom burden and severity and in beneficial cardiac remodeling.
Initial human feasibility of infusion needle catheter ablation for refractory ventricular tachycardia Sapp and colleagues (Circulation. 2013 Nov 19; 128 (21):2289-95; PMID: 24036605) report the initial experience with a catheter with an extendable/retractable irrigated needle for intramyocardial mapping and ablation. Patients with recurrent VT underwent ablation with the use of this catheter. At target sites, the needle was advanced up to 9 mm into the myocardium, permitting pacing and recording. Temperature-controlled radiofrequency energy delivery through the needle was delivered in 8 patients with refractory VT. A mean of 22 (range, 3-48) needle ablation lesions were applied. All patients had at least 1 VT terminated or rendered noninducible. During a median of 12 months follow-up, 4 patients were free of recurrent VT, and 3 patients were improved, but had new VTs. Two died of the progression of preexisting heart failure without recurrent VT. The authors conclude that intramyocardial infusion-needle catheter Address reprint requests and correspondence: Dr N.A. Mark Estes, Tufts Medical Center, 800 Washington St, Boston, MA 02111. E-mail address: [email protected].
1547-5271/$-see front matter
ablation is feasible and permits control of some VTs that have been refractory to medications and conventional catheter ablation therapy.
Edoxaban versus warfarin in patients with atrial fibrillation Giugliano and colleagues (N Engl J Med. 2013 Nov 19. Epub PMID: 24251359) conducted a randomized, doubleblind, trial comparing two once-daily regimens of edoxaban (E) with warfarin (W) in 21,105 patients with atrial fibrillation (AF). The primary efficacy end point was stroke or systemic embolism. The annualized rate of the primary end point during treatment was 1.50% with W as versus 1.18% with high-dose E (HR, 0.79; Po0.001) and 1.61% with lowdose E (HR, 1.07; P¼0.005). The annualized rate of major bleeding was 3.43% with W versus 2.75% with high-dose E (HR, 0.80; Po0.001) and 1.61% with low-dose E (HR, 0.47; Po0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (HR , 0.86; P¼0.01), and 2.71% (HR, 0.85; P¼0.008), and the corresponding rates of the secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (HR, 0.87; P¼0.005), and 4.23% (HR , P¼0.32). The authors conclude that both once-daily regimens of E were noninferior to W with stroke prevention or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes.
Targeted temperature management at 331C versus 361C after cardiac arrest Nielsen and colleagues (N Engl J Med. 2013 Nov 17 PMID: 24237006) compared two target temperatures for therapeutic hypothermia after cardiac arrest by randomizing 939 adults to 33 versus 361C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days. At the end of the trial, 50% of the patients in the 331C group (235/ 473) had died, as compared with 48% of the patients in the 361C group (225/466) (HR: 1.06; P¼0.51). At the 180-day follow-up, 54% of the patients in the 331C group had died or had poor neurologic function compared with 52% of patients in the 361C group (HR, 1.02; P¼0.78). The authors conclude that survivors of out-of-hospital cardiac arrest hypothermia at a targeted temperature of 331C did not confer a benefit as compared with a targeted temperature of 361C.
http://dx.doi.org/10.1016/j.hrthm.2013.12.012