Mcdougallbarry2895

Multivariate logistic regression analysis demonstrated that EFT (

=.033, odds ratio [OR] 1.68, 95% confidence interval [CI] 1.6-2.7), higher troponin I level>0.04 (

=.034, OR 5.3, 95% CI 1.1-24.8), and lower age (

=.003, OR 0.8, 95% CI 0.8-0.9) were significantly associated with longer conversion time.

We determined that EFT and high troponin level affected the time to conversion to sinus rhythm in patients with new-onset AF.

We determined that EFT and high troponin level affected the time to conversion to sinus rhythm in patients with new-onset AF.

Global simultaneous recording of atrial activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for an individualized ablation strategy to treat persistent AF. The study aims to characterize left atrial endocardial activation patterns during AF using noncontact charge-density mapping.

Twenty-five patients with persistent AF were studied. Activation patterns were characterized into three subtypes (i) focal with centrifugal activation (FCA); (ii) localized rotational activation (LRA); and (iii) localized irregular activation (LIA). Continuous activation patterns were analyzed and distributed in 18 defined regions in the left atrium.

A total of 144 AF segments with 1068 activation patterns were analyzed. The most common pattern during AF was LIA (63%) which consists of four disparate features of activation slow conduction (45%), pivoting (30%), collision (16%), and acceleration (7%). LRA was the seco be determined.

Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol.

A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF. read more Left atrial (LA) CARTO voltage mapping was performed with the ablation catheter pre- and postablation to demonstrate entry block into the pulmonary veins, and pacing maneuvers were used to confirm exit block.

The CMC-free approach was successful in achieving PVI in 66 (98.5%) cases, with procedure time of 148±32minutes, ablation time of 27.5±5.7minutes, and fluoroscopy time of 7.8±1.0minutes. First-pass PVI was seen in 58(86.5%) patients, and pacing maneuvers successfully identified the residual gap in eight of the other nine cases. No complication was observed. At 12months follow-up, 60 (89.6%) patients remained free from AF. The CMC-free approach resulted in a cost saving of £47,190.

A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, and is associated with excellent clinical outcomes at 1year.

A CMC-free CLOSE-guided PVI approach is feasible, safe, and cost-saving, and is associated with excellent clinical outcomes at 1 year.

Venous bleeding complication is often observed after catheter ablation of atrial fibrillation (AF), but the risk factors remain unclear.

We retrospectively evaluated 570 consecutive patients who underwent catheter ablation of AF from April 2012 to March 2017. After the procedure, the sheaths were removed, and hemostasis was obtained by manual compression followed by application of rolled gauze with elastic bandage and continuous pressure to the puncture site. We evaluated the risk factors for venous bleeding complications defined as hemorrhage from the puncture site that needed recompression after removal of the elastic bandage and rolled gauze.

After excluding 11 patients because of missing data, 559 patients (395 [70.7%] men, mean age 65.6±8.7years) were included for analysis. Venous bleeding complication was observed in 213 patients (38.1%). In the multivariate logistic regression analysis, low body mass index (BMI; odds ratio [OR] 0.95, 95% CI 0.90-1.00,

=.04), short compression time (OR 0.77, 95% CI 0.68-0.88,

<.001), and antiplatelet therapy (OR 1.86, 95% CI 1.09-3.16,

=.02) were independent risk factors for venous bleeding complication.

Low BMI, short compression time, and antiplatelet therapy were independent risk factors for venous bleeding complication after catheter ablation of AF. Longer compression time may be needed for patients with low BMI and/or those receiving antiplatelet therapy.

Low BMI, short compression time, and antiplatelet therapy were independent risk factors for venous bleeding complication after catheter ablation of AF. Longer compression time may be needed for patients with low BMI and/or those receiving antiplatelet therapy.

The benefit of integrated care management was unknown in frail atrial fibrillation (AF) patients. This study evaluated whether compliance with the atrial fibrillation Better Care (ABC) pathway for integrated care management would improve clinical outcomes in frail AF patients.

From the Korea National Health Insurance Service database, 262,987 nonvalvular AF patients were enrolled between 1 January 2005 and 31 December 2015. For each patient, the Hospital Frailty Risk Score and category were calculated retrospectively using all available ICD-10 diagnostic codes. Patients were divided into three frailty-based risk categories low (<5 points, n=221,542), intermediate (5-15 points, n=37,341), and high risk (>15 points, n=4,104).

Over a mean follow-up of 5.9 (interquartile range 3.2, 9.4) years, in high frailty risk patients, the ABC group had lower rates of all-cause death (6.5 vs 17.5 per 100 person-years,

<.001; hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56-0.97) but was nonsignificant for the composite outcome (10.5 vs 26.0 per 100 person-years,

=.101; HR 0.79; 95% CI 0.59-1.05) compared with the Non-ABC group. When the three frailty categories were compared, the greatest benefit on mortality was seen in the high frailty group (p

<0.001), but for the composite outcome, there was no statistical interaction for the three frailty categories (p

=0.063).

Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with frail AF patients, integrated AF management should be implemented to improve outcomes in these patients.

Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with frail AF patients, integrated AF management should be implemented to improve outcomes in these patients.