Search

The role of early defibrillation has been well established as a pivotal ring of the chain of survival since the nineties. In the following years, the scientific evidences about the beneficial role of early defibrillation have grown, and most of all, it has been demonstrated that the main determinant of survival is the time of defibrillation more than the type of rescuer. Early lay defibrillation was shown to be more effective than delayed defibrillation by healthcare providers. Moreover, because of the ease of use of automated external defibrillators (AEDs), it has been shown that also untrained lay rescuers can safely use an AED leading the guidelines to encourage early defibrillation by untrained lay bystanders. Although strong evidence has demonstrated that an increase in AED use leads to an increase in out-of-hospital cardiac arrest (OHCA) survival, the rate of defibrillation by laypeople is quite variable worldwide and very low in some realities. Our review of the literature about lay defibrillation highlights that the AED is a life-saving device as simple and well tolerated as underused.

Seven editions of cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines have been published with many changes, in particular, about CPR.The aim of our study was to evaluate the temporal trend of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) as a possible effect of guidelines changes.We searched PubMed for observational studies on 'survival to hospital discharge after OHCA'. Survival to discharge was the primary outcome; prehospital return of spontaneous circulation and survival to hospital admission were our secondary endpoints. All data were analyzed according to the year of inclusion: group 1 before 2000; group 2 between 2000 and 2005; and group 3 after 2005. Mortality rates were compared between groups by means of a group frequency-weighted log-linear model.We considered 38 of 201 studies for a total of 156 301 patients. Survival to hospital discharge rate was 5.0% [95% confidence interval (CI) 4.9-5.2) in group 1; 6.1% (95% CI 5.9-6.4) in group 2; and 9.1% (95% CI 8.9-9.4) in group 3 (P0.001). A statistically significant decrease in risk of mortality in group 2 vs. group 1 (risk ratio 0.988, 95% CI 0. 985-0.0.992, P0.001) and in group 3 vs. group 2 (risk ratio 0.967, 95% CI 0.964-0.971, P0.001) was observed. Similar trends were observed for return of spontaneous circulation and survival to hospital admission.Survival to hospital discharge after OHCA has significantly improved. Many aspects may influence survival, but surely, the reduction of time and an early and good quality CPR have positively influenced the outcome.

Catheter ablation has been proven to be an effective treatment for patients with drug-resistant atrial fibrillation. Nevertheless its efficacy is limited to 60-80% of patients in different studies. Whether the use of pharmacological therapy after catheter ablation of atrial fibrillation might increase the procedural success rate is still a matter of debate. There is general agreement that antiarrhythmic drugs (AADs) are useful in the management of arrhythmias occurring in the very early period after catheter ablation (blanking period). On the contrary, limited data are available on the efficacy of AADs over a longer period. Some patients remain free of arrhythmia recurrences by the use of AADs that were ineffective before catheter ablation: whether this latter situation is to be considered a partial success of catheter ablation or a treatment failure, thus demanding a redo procedure, is still an open question. Some studies have also investigated the role of non-AADs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, statins and corticosteroids] in preventing atrial fibrillation recurrences after catheter ablation, reporting conflicting results. Whereas there is a general consensus on the use of anticoagulation therapy in the first phase after catheter ablation, no definite data are available on the proper long-term management of anticoagulation therapy after catheter ablation. This review focuses on the still open issue of what is the optimal pharmacological treatment of patients after catheter ablation of atrial fibrillation.