16-13: Comparision of Outcomes of Atrial Fibrillation Ablation Procedures between an Octagenerian cohort of patients and an Young-Old cohort of patients
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Background: Atrial Fibrillation (AF) ablations are performed in pts of all age groups. No data exists on the outcomes or Quality of Life (QOL) specific to the octogenarian population undergoing this procedure. We hypothesize the outcomes and risks would not be too dissimilar when compared to a younger cohort between 65-79 years. Methods: From a retrospective database we selected octogenarian pts compared to an age and sex matched control group, ages 65-79. Pre-ablation tests were performed as well as quality of life (QoL) and symptom inventories. Results of the ablation procedure, follow up QoL and symptom inventories, peri-procedure morbidity and freedom from AF or control of AF with anti-arrhythmic agents were compared between the 2 groups. Results: During follow-up (mean 2.3 ± 2.2 years), AF elimination (70% vs 81%, p 0.942) and AF control including those on antiarrhythmic agents (86% vs 86%, p 0.249) were compared. Conclusion: Outcomes of ablation in the octogenarians are highly favorable with no increase in procedural complications. Improvement in QOL scores is impressive in patients with advancing age. Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AF Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AFKeywords:
Refractory (planetary science)
Background Atrial fibrillation and delayed gastric emptying (DGE) are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7th postoperative day. Methods We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. Results Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005). Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03). 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007). This association held true when controlling for age. Conclusion Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.
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Stroke
Vitamin K antagonist
Anticoagulant Therapy
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Abstract Objectives To determine rates of stroke or transient ischaemic attack (TIA) and all cause mortality in patients with a diagnosis of “resolved” atrial fibrillation compared to patients with unresolved atrial fibrillation and without atrial fibrillation. Design Two retrospective cohort studies. Setting General practices contributing to The Health Improvement Network, 1 January 2000 to 15 May 2016. Participants Adults aged 18 years or more with no previous stroke or TIA: 11 159 with resolved atrial fibrillation, 15 059 controls with atrial fibrillation, and 22 266 controls without atrial fibrillation. Main outcome measures Primary outcome was incidence of stroke or TIA. Secondary outcome was all cause mortality. Results Adjusted incidence rate ratios for stroke or TIA in patients with resolved atrial fibrillation were 0.76 (95% confidence interval 0.67 to 0.85, P<0.001) versus controls with atrial fibrillation and 1.63 (1.46 to 1.83, P<0.001) versus controls without atrial fibrillation. Adjusted incidence rate ratios for mortality in patients with resolved atrial fibrillation were 0.60 (0.56 to 0.65, P<0.001) versus controls with atrial fibrillation and 1.13 (1.06 to 1.21, P<0.001) versus controls without atrial fibrillation. When patients with resolved atrial fibrillation and documented recurrent atrial fibrillation were excluded the adjusted incidence rate ratio for stroke or TIA was 1.45 (1.26 to 1.67, P<0.001) versus controls without atrial fibrillation. Conclusion Patients with resolved atrial fibrillation remain at higher risk of stroke or TIA than patients without atrial fibrillation. The risk is increased even in those in whom recurrent atrial fibrillation is not documented. Guidelines should be updated to advocate continued use of anticoagulants in patients with resolved atrial fibrillation.
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Objectives The aim of this study was to compare the differences between the ablation region and hyperechoic zones in microwave and radio frequency ablation of different tissues. Methods Microwave and radio frequency ablation were performed on fresh porcine muscle and liver with different power levels for 90 seconds. These 2 ablation methods were then performed on rabbit liver in vivo using 20 W for 60 seconds. The volumes of the ablation and hyperechoic zones were compared following different ablation methods. Results The ablation zones were significantly greater than the hyperechoic zones ( P < .05) with the same power and duration when using 2 ablation methods. The differences of the ablation and hyperechoic zones between muscle and liver tissues were significantly different ( P < .05). The difference values of the ablation and hyperechoic zones were also significantly different ( P < .05) using 2 ablation methods. Conclusions The hyperechoic zone may have underestimated the extent of ablation using a specified ablation time. In the same tissue, the hyperechoic zone could more accurately estimate the ablation zones using microwave ablation.
Microwave ablation
Ablation zone
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Objective:To evaluate junction rhythm and atria pacemaking to show pathway conduction block as successful ablation indicatives applied in AVNRT of slow pathway ablation and compare the difference of discharge time and ablation targets to ablation endpoint.Methods:153 patients with AVNRT were performed slow pathway radiofrequency ablation. According to characteristics of X-ray image and local electrograms the dischargeing power of ablation target was ascertained for 10～40W.Regarding to different successful ablation monitoring indicatives,patients were divided into ablation group in traditional method(GroupⅠ)and ablation group with atria pacemaking showing slow pathway conduction block as successful ablation indicative(GroupⅡ).86of GroupⅠ presented junction rhythm in dischargeing 15s or early pacemade then consecutively discharged 60～90 seconds;In GroupⅡ 67 patients after dischargeing 15s showed junction rhythm or after early pacemaking delayed dischargeing to 20s then stopped dischargeing.Before procedure AV1︰1 the shortest interval atrium stimulation(S1S1)showed slow pathway block and stopped pacemaking then continuously delivered up to 60s.If not deliver to ablation end-point,continuing to select sites ablating till delivered to ablation end-point.Results: All patients in two groups delivered to ablation end-point.Ablation end-points and end-points types between two groups were no difference.In 86 of groupⅠ 306 targets were successfully ablated,3.59±1.21 targets per were ablated and dischargeing time was 208.94±89.26s;In 67 of groupⅡ all successful ablation targets were 150,2.24±0.94 targets per patient were ablated and dischargeing time was 114.83±38.97s.All parameter including all items per patients in groupⅠ were higher than in groupⅡ.The comparison between two groups lied in significant difference(P0.05).Within 15s no effective ablation did not involve in targets.Conclusions: To show slow pathway conduction block as successful ablation indicative can monitor objectively the efficiency of discharged ablation and attenuate myocardial injury of ineffective ablation.
Junctional rhythm
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Background Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. Methods We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. Results A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. Conclusion We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.
Stroke
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Stroke
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Ablation zone
Lipiodol
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Background Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. Methods and Results Data from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N = 4869) and nonpermanent atrial fibrillation (N = 5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score ≥2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N = 2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke. Conclusion Permanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart failure, adequate rate control is an important target for improving the management of permanent atrial fibrillation patients.
Fibrillation
Stroke
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