Search

Background: Transfusion of blood /component is an essential procedure in modern days of medical practice. As far as safe transfusion is concerned, it is a prime requirement i.e. handles TTIs infections including syphilis and other adverse events. Aims and Objectives: Focus of the present study is to assess seroprevalence and risk factors of Syphilis among blood donors in greater Gwalior Materials and Methods: The present retrospective descriptive study was conducted over a period of 8 years. All the samples of voluntary and relative blood donors, who came to donate blood, were tested for transfusion transmissible infections. Prevalence of TTIs and syphilis were analyzed in the view of different parameters of donors and along with its associated risk factors. Chi square (X2) test was applied to know the significant (p value) ratio of difference statistically as required. Results: In the present study prevalence of TTIs is 3.44% and for syphilis it is 0.268%, most common age group is 40-51years (41.18%); male to female ratio is insignificant statistically. Ratio of voluntary versus relative donors was 94.21% and 5.79 % and male to female was 91.27% and 8.473% were female respectively. Conclusion: An advance knowledge, attitude, and behavior of the volunteer blood donors’ population regarding risk factors will most probably improve public health and increase blood safety and quality.

In the present study, the antimicrobial, rheological, mechanical, barrier and optical properties of Carrageenan and Manihot esculenta (composite) starch biobased edible film incorporated with caraway (Carum carvi L.) essential oil (EO) were investigated. The Minimum Inhibitory Concentration (MIC) of caraway oil against B. cereus, E. coli, P. aeruginosa and S. aureus were found to be 0.6, 1.4, 1.4 and 0.8% respectively. The Gas Chromatography- Mass Spectroscopy (GC-MS) of caraway EO expressed a distinct chromatogram peak for phenolic compounds. Rheological results of Film-Forming Solution (FFS) revealed solid-like viscoelastic behavior. Incorporation of caraway EO in the film caused significant (P 0.05) changes in thickness, density, water activity, swelling, elongation at break, water vapor transmission rate, a and b value were observed with increasing caraway EO concentration. These results with some good rheological, physic-mechanical, antimicrobial and optical characteristics suggest the application of such active film into a variety of foods with improved food safety and quality.

Background: Among all blood group systems and antigens, ABO and D antigens of the Rh blood group system are of primary importance, hence included in routine blood grouping and transfusion. Other blood group systems and antigens that are important in multiparous women, multi-transfused patients and hemolytic disease of newborn are Kell, Rh, Duffy, and Kidd.Aims and Objectives:  To know the pattern of ABO, RhD and other clinically significant major antigens of Rh, Kell, Duffy and Kidd blood group systems as well as evaluation of phenotypes, genotypes and gene frequency of related antigens among blood donors in Gwalior region.Materials and methods: A prospective study was carried out at the Blood Bank from July 2017 to June 2019. During the study period 48500 blood donors were included for ABO and RhD grouping, Out of them 1000 randomly selected donor samples were processed for complete Rh, Kell, Duffy and Kidd blood grouping.Result:  ABO group pattern was; A - 22.56%, B -  36.52%, AB - 9.8% and O -31.12 %, while RhD status was RhD+ 90.99% and RhD- 9.01% . Prevalence of Rh phenotypes was DCCee 43%, DCcee 33%, DCcEe 10%, dccee 6.5%, DccEe 4.5%, Dccee 1%, DCCEe 0.3% and dccEe 0.2%. Kell phenotype was K-k+ 95.5%, K+k+ 4.5%, while K+ k- and K- k- phenotypes were not encountered in this study. Duffy phenotypes were Fya+ Fyb+ 47.5%, Fya+ Fyb- 35%, Fya- Fyb+17% and Fya- Fyb- 0.5%. Kidd phenotype was Jka+ Jkb- 44.5 %, Jka- Jkb- 26.5%, Jka+ Jkb+ 18% and Jka- Jkb+ 11%.Conclusion: Present study is helpful in the transfusion management of multiparous women and multi-transfused patients. Extended blood grouping is the need of future to ensure safe blood transfusion practices.

Objective: To evaluate serum Adenosine Deaminase (ADA) levels in obese and non obese Type II Diabetes Mellitus (T2DM) and compare it with healthy controls (obese and non obese). Materials and Methods: Total 100 subjects were included in the study. Fasting blood sugar (FBS) and ADA activity along with other routine biochemical parameters were determined in their serum. Based on their BMI and FBS level study subjects were divided into four groups: Control, Obese, Non obese T2DM and Obese T2DM. Results: ADA activity was significantly increased (P Conclusion: In this study we observed an increased ADA activity in obesity and T2DM. A close relation may be present between insulin resistance produced in obese subjects and diabetics. Therefore ADA could therefore be used in routine lab investigations, especially in obese patients as a predictive marker for assessing the development of insulin resistance and hence diabetes. Keywords: Diabesity, ADA, Obesity, Insulin resistance, Fasting blood sugar.

PRAETORIAN is the first randomized controlled trial that demonstrated the noninferiority of subcutaneous ICD (S-ICD) in comparison with transvenous ICD (TV-ICD). We retrospectively reviewed electronic records of patients with ICD implanted over the past 6 years, with the primary objective to compare our real-world single tertiary center experience with the randomized data from the PRAETORIAN study.Seventy S-ICD patients were compared with 197 TV-ICD patients, from July 2014 to June 2020 retrospectively, over a median period of 1304 days (296-2451 days). Primary composite endpoints included inappropriate shocks and device-related malfunctions.Patients with S-ICD implantation were younger than those who received TV-ICD (mean, 49.7 years vs 63.9 years,Although single-center experience with a small number of S-ICD patients, results of the PRAETORIAN study has been replicated in our real-world experience of S-ICD and TV-ICD implantations across diverse etiologies, indications, and age groups confirming the comparable performance of S-ICD and TV-ICD when implanted in selected patients.

Introduction Cardiac Resynchronisation Therapy (CRT) and implantable cardiac defibrillators (ICDs) are a well-established, scientifically proven and guideline recommended treatment for selected patients with left ventricular systolic dysfunction (LVSD), reducing mortality and/or hospitalisation, with the latter being the most expensive part of the treatment of such patients. Attempts have been made to maximise the yield of CRT/ICD devices by use of sensors which predict the onset of CHF well before the patient deteriorates, hence avoiding the need for hospitalisation and in the process conserving valuable financial resources. HeartLogic is one such new software incorporated into Boston Scientific (BSC) CRT/ICD devices which uses multiple sensors to track physiological trends, combining them into one composite index alerting healthcare professionals of potential worsening CHF. The MultiSense Study demonstrated a 70% sensitivity in detecting CHF events, a median of 34 days prior to clinical heart failure. Aims In this study we describe our experience of the use of HeartLogic in a tertiary care cardiology centre with a well-established complex devices and heart failure service. Methods Retrospective analysis of patients (n=49) with BSC devices and in whom HeartLogic was activated in March/April 2019. Patient records (electronic patient records, including Latitude downloads) were reviewed and the results of those having alert(s) of ≥16 were compared with those who did not during a follow-up period of 288 ± 6 days (median 288, range: 282-327). Results Whole cohort: mean age: 68±11 years (median 72, range 33-87), 37/49 (75.5%) males. 35/49 (71.4%) had LVSD due to ischaemic cardiomyopathy. Devices implanted were: Resonate X4 CRTD 28/49 (57.1%), Resonate EL ICD 13/49 (26.5%) and the remainder, Momentum CRT-D 8/49 (16.3%). During the monitoring period number of alerts were as follows: ≥ one alert: 22/49 (44.9%) patients, 2 alerts: 10/49 (20.4%), 3 alerts: 7/49 (14.3%); 4 alerts: 2/49 (4.1%) and 5 alerts: 1/49 (2%). For each patient who had an alert, the maximum alert value was considered for analysis. The maximum alert score was 26.6 ± 12.3 (median: 23, range: 16-67), and the duration of alert was 32.7 days (median: 29, range: 4-83). For each of the 5 physiological parameters, a change in the expected direction at the time of alert was evaluated. S3 was the most sensitive (increase 15/22, 68.2%), followed by thoracic impedance (decrease 14/22, 63.6%) and S1 (decrease 13/22, 59.1%). Respiratory rate and night heart rate were less sensitive parameters (increase 11/22, 50% and increase 9/22, 40.9% respectively). Though not part of HeartLogic, activity levels showed a decrease in 13/22 (59.1%) of patients who had an alert. Characteristics of those who did and did not have an alert were compared (Table 1). Heart Failure Nurse contact and change in medication over monitoring period were statistically significantly more common in the group with alerts. In our real world experience with HeartLogic, expected change in values of S3, thoracic impedance, S1 and activity levels were the most sensitive markers of CHF and so predictive of alerts, leading to early and increased frequency of Heart Failure Nurse contact and significant intervention, possibly helping in prevention of hospitalisation and in turn conservation of valuable financial resources. Conflict of Interest None

Now a day’s meat and meat products are not only generating convenience trends; they have been recognized as core of meat industry. Meat spread is a convenience cooked spreadable product prepared with meat and non-meat additives. Response surface methodology was used to investigate the effects of three different levels of honey (10, 15, 20 g), vinegar (2.0, 6.0, 10.0 ml) and tomato powder (0.5, 1.0, 1.5 g) on response variables viz. color/appearance, flavor, spreadability, texture, after taste, adhesiveability, overall acceptability, while standardizing the process of development of sweet and sour chicken meat spread box-behnken experimental design was used in which 17 different runs with 5 trials of three similar centre point. A second order polynomial was fitted to all the response variables and surface plots as well as equations were conducted. All the processing variables significantly affected the response variables either linearly or quadratically whereas the “Lack of Fit” was non-significant relative to the pure error. For optimization, target values were set in the form of ranges of all the processing and response variables. While applying multiple regression analysis, a total of 43 workable solutions was found, out of which the product with 14.28% honey, 5.38% vinegar and 1.39% tomato powder was selected. The responses for color/appearance, flavor, spreadability, texture, after taste, adhesiveability, overall acceptability, were predicted at 7.11, 6.72, 7.00, 6.99, 6.61, 6.94 and 6.79 respectively, with a desirability value of 1.

Aims An increase in the number of cardiac resynchronization therapy (CRT) device implantations worldwide has led to a consequent increase in the number of infections associated with the device, making extraction of the CRT device inevitable. Redo CRT implantation after treatment and recovery following device extraction is challenging. This study aimed to evaluate the success rate, complications, and long-term prognosis of redo CRT implantation, including the rates of subclavian, cava, and coronary sinus (CS) vein thrombosis as well as re-infection. Methods and results Between 2007 and 2014, 1712 lead extractions were performed in 537 patients with device-related infection at Heart Center Brandenburg. Of the 537 patients, 125 (23%) underwent CRT device and lead extraction, including extraction of the left ventricular lead from the coronary sinus. Of these 125, 62 (50%) patients underwent redo CRT implantation (mean age, 68 ± 10 years); 34 patients had coronary artery disease (CAD) while 28 had dilated cardiomyopathy (DCM). The mean left ventricular ejection fraction was 27% ± 7%. The mean QRS duration of the left bundle branch block was 158 (range, 147-162) ms, and 25 patients had atrial fibrillation (AF). All these patients were followed up for a median duration of 29.6 (range, 15-43) months. In 53 of the 62 patients (85%), the CRT system was successfully re-implanted; however, the original CS vein could be used again only in 28 (45%) patients. The all-cause mortality rate was 7.1% after 1 year, and it was significantly higher in patients whose N-terminal pro B-type natriuretic peptide level was ≥3,000 pg/mL (P

The present study was aimed to develop Manihot esculenta and Carrageenan bio-based composite active film functionalized with anise, caraway, and nutmeg essential oils (EOs) and to assess the shelf life of chicken nuggets wrapped with the developed film at refrigeration storage. Overall, the Minimum Inhibitory Concentration (MIC) values of the three EOs ranged from 0.4 to 0.8% v/v of which nutmeg EO was found most effective. Incorporation of EOs in the film resulted in significant (P ˂ 0.05) decrease in tensile strength and water activity while elongation at break was significantly (P ˂ 0.05) increased. No significant (P ˃ 0.05) changes in thickness and Water Vapor Transmission Rate (WVTR) were observed. Based on physicomechanical and sensory evaluation, films incorporated with 0.5, 1, and 1% concentration of anise, nutmeg, and caraway EO were selected. Chicken nuggets overwrapped with aforementioned films were stored aerobically at refrigeration temperature (4 ± 1 °C) to evaluate antimicrobial, antioxidant, and sensory characteristics. The result indicated that pH, peroxide, free fatty acid (FFA), and thiobarbituric acide (TBA) value of treatments were significantly (P ˂ 0.05) lower than controls however significantly (P < 0.05) higher DPPH activity was observed in all treatments. The total plate count, psychrophilic count and, yeast and mold count were also significantly (P ˂ 0.01) lower in treatment groups and were within the permissible limits. The treated samples were well acceptable during whole storage period of 15 days. The application of composite, active edible bio-based film was found proficient in confining product quality attributes throughout storage. PRACTICAL APPLICATION: The majority of films used for packaging of meat and meat products are derived from synthetic "plastic" materials. The demerits associated with plastics have eventually led to explore natural alternatives such as edible films. The composite-active bio-based films have a huge potential to be molded for specific film properties based on requirements of product-specific packaging conditions.

To describe the Greig Health Record for Young Adults (GHRYA), an evidence-based, peer-reviewed, endorsed guide that can assist providers with age-appropriate screening and counseling.A literature search was performed by the librarian from the Department of Family and Community Medicine at the University of Toronto in Ontario. PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, and Google Scholar were searched using the termsRecently, there has been a recognition of the unique health care needs of the 18- to 24-year-old age group. Emerging adults have higher risks of health issues including mental illness, substance use, sexually transmitted infections, and risk-taking behaviour. Providing preventive care requires an age-specific approach, especially as contact with health care providers is often infrequent and episodic. Primary care providers who are less familiar with the preventive care needs of young adults can use the GHRYA to guide their interactions with these patients. This new tool is an easy-to-access guide to evidence-based recommendations to be used when patients present to the office or an urgent-care setting and a ready-to-hand place to record prevention strategies when delivered. The tool includes a checklist and 4 pages of resources and recommendations.The GHRYA is a peer-reviewed, endorsed guide to the provision of prevention and screening for young adults, which provides an approach to patient care but also evidence-based resources.

OBJECTIF: Décrire Le guide de santé Greig pour jeunes adultes (guide Greig), un document révisé et entériné par des pairs qui se fonde sur des données probantes et qui peut aider les professionnels de la santé à offrir un dépistage et du counseling adaptés à ces âges. SOURCES DE L’INFORMATION: Une recherche documentaire a été effectuée par la bibliothécaire du Département de médecine familiale et communautaire de l’Université de Toronto (Ontario). La recension a été faite dans PubMed, MEDLINE, la base de données Cochrane des revues systématiques et Google Scholar, à l’aide des expressions young adults, emerging adults, preventive services, prevention, screening et health promotion. Des recherches supplémentaires ont été effectuées au moyen des expressions mental health, substance use, addictions, sexual health, bullying, abuse, nutrition, sleep, injury prevention et physical fitness. Parmi les 521 articles recensés, seuls les articles portant sur des études populationnelles, des lignes directrices et des revues systématiques pertinentes pour les jeunes adultes ont été retenus. MESSAGE PRINCIPAL: La particularité des besoins en matière de santé du groupe d’âge des 18 à 24 ans a récemment été reconnue. Les adultes émergents ont des risques plus élevés de problèmes de santé, notamment les maladies mentales, la toxicomanie, les infections transmises sexuellement et les comportements à risque. La prestation de soins préventifs exige une approche en fonction de l’âge, d’autant plus que leurs contacts avec des professionnels de la santé sont souvent rares et épisodiques. Les professionnels des soins primaires qui connaissent moins bien les besoins en soins préventifs des jeunes adultes peuvent se servir du guide Greig pour orienter leurs interactions avec ces patients. Ce nouvel outil est un guide facile d’accès menant à des recommandations fondées sur des données probantes, et il peut servir lorsque les patients se présentent à la clinique ou aux services d’urgence. Il peut aussi être utilisé pour consigner les stratégies de prévention lorsqu’elles sont effectuées. L’outil comporte une liste de vérification, de même que 4 pages de ressources et de recommandations. CONCLUSION: Le guide Greig est un outil révisé et entériné par des pairs pour la prestation de soins préventifs et les dépistages chez les jeunes adultes, qui propose non seulement une approche à l’endroit des soins à ces patients, mais aussi des ressources fondées sur des données probantes.

The Greig Health Record is an evidence-based health promotion guide for clinicians caring for children and adolescents 6 to 17 years of age. It provides a template for periodic health visits that is easy to use and adaptable for electronic medical records. On the record, the strength of recommendations is indicated in boldface for good, in italics for fair, and in regular typeface for recommendations based on consensus or inconclusive evidence. Checklist templates include sections for Weight, Height and BMI, Psychosocial history and Development, Nutrition, Education and Advice, Specific Concerns, Examination, Assessment, Immunization, and Medications. Included with the checklist tables are five pages of selected guidelines and resources. This update includes information from recent guidelines and research in preventive care for children and adolescents 6 to 17 years of age. Regular updates are planned. The complete Greig Health Record can be found online at the Canadian Paediatric Society's website: www.cps.ca.

Background Despite the increasing evidence on the efficacy of the second-generation cryoballoon (CB) ablation in patients with atrial fibrillation (AF), data on the utility of CB ablation as a day case procedure is missing. Same day discharge following AF ablation is at present time a guideline free zone. This study analyses the practice in view of safety and cost effectiveness of day case CB (DC-CB). Methods All consecutive patients between April 2013 to September 2017 undergoing CB ablation were included. Pulmonary vein angiograms were performed for anatomical delineation followed by PV freezing. Majority of patients received 6 hours post procedure recovery time which included a 4 hour femoral stop application as the standard practice of care. Results 161 procedures were performed over four and half years. Same day (Day Case, DC) CB discharges included 40 cases (age: 58.7±10.7, F/M: 11/29) whilst overnight stays (Non-Day Case, NDC) consisted of 121 cases (age: 62.5±10.1, F/M:54/67). Similar calculated CHA2DS2VASc (DC-CB:1.825±1.48 vs NDC-CB:1.69±1.41, P=0.7) and HASBLED scores (DC-CB: 1.05±0.81 vs NDC-CB: 0.86±0.82, P=0.2) were noted. Both groups had similar number of persistent and paroxysmal AF, 20% and 80% respectively. Mean fluoroscopy time was 36±12 mins with a corresponding DAP of 24.5±19.8 Gy/cm2. Mean procedure time was 181±47 mins in NDC_CB and 152±37 mins in DC_CB (P 0.001). Additional cavo-tricuspid isthmus dependent flutter ablation was performed in 21% NDC-CB and 15% DC-CB respectively. Over the five-year period, DC-CB ablation procedures increased rapidly whilst NDC-CB procedures reduced (figure 1). Procedure times in both groups improved with operator experience (table 1). A higher proportion of patients were on NOACS in the DC-CB group with an overall decline in warfarin use. Procedural complication rate was 1.8% [(n=3/161); phrenic nerve injury (n=2) and vascular injury requiring intervention (n=1)]. Readmission rates were none in DC-CB and 2 in NDC-CB (phrenic nerve injury n=2). The low composite complication rates suggest feasibility of the same day CB discharges. In this series, the overall 6 hour recovery period stipulated in the majority of cases (as part of the initial 2013/14 safety protocol) alongside procedures performed in the afternoon resulted in more overnight stays. Day case CB procedures facilitated an overall £12 000 savings over this analysis period (figure 2). Conclusion Cryo-balloon (CB) ablation performed as day case (DC) procedures are safe and cost saving. As operator experience increases, shorter procedure duration, catheter dwell time and recovery periods alongside the financial savings would see the trend in DC-CB procedures superseding NDC-CB procedures with the emergence of Cryo-lounges in the near future.

Long-term results after circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF) using a robotic navigation system (RNS) have not yet been reported.To evaluate long-term results of patients with PAF after CPVI using RNS.In this study, 200 patients (n = 151 (75.5%) male; median age 62.2 (54.7-67.7) years) with PAF were evaluated. In 100 patients, RNS (RN-group) was used for CPVI and compared to 100 manually ablated control patients (MN-group). Radiofrequency was used in conjunction with 3D electroanatomic mapping. Power was limited to 30 watts (W) at the posterior left atrial (LA) wall in the first 49 RNS patients (RN-group-a). After esophageal perforation occurred in one RN-group-a patient, maximum power was reduced to 20 W for the subsequent 51 patients (RN-group-b).After a median follow-up of 2 years, single (77/100 vs 77/100, p = 0.89) and multiple (90/100 vs 93/100, p = 0.29) procedure success rates were comparable between RN-group and MN-group. Single procedure success rate was significantly lower in RN-group-a as compared to RN-group-b (65.3 vs 88.2%, p = 0.047). In RN-group-a patients, procedural times [200 (170-230) vs 152 (132-200) minutes, p0.01] and fluoroscopy times [16.6 (12.9-21.6) minutes vs 13.7 (9.5-19) minutes, p = 0.043] were significantly longer compared to RN-group-b patients.Long-term success rate after CPVI using RNS was comparable to manual ablation. Despite a lower power limit of 20 W at the posterior LA wall, single procedure success rate was higher in RN-group-b as compared to RN-group-a. Procedure time and fluoroscopy time decreased, whilst success rate increased with increasing experience in the RN-group.

Background Severe mitral regurgitation (MR) ≥3+ and left ventricular dyssynchrony in heart failure patients are markers of CRT non response. The MitraClip (MC) implantation is a therapy for MR ≥3+ in patients with high surgical risk of mitral valve reconstruction. Methods and results We investigated 42 patients with CRT and MR ≥3+ who received an MC device at our center. One and two year mortality rates were compared with the predicted mortality by Seattle Heart Failure Model (SHFM) and meta-analysis global group in chronic heart failure (MAGGIC), using the baseline characteristics of patients at the time of MC implantation. The median time interval between CRT and MC implantation was 20.1 (4.5–43.3) months. In 19 patients we observed a functional regurgitation with normal leaflets and in 23 patients a degenerative mechanism for mitral regurgitation. There was no change in mean QRS duration by biventricular pacing or MC implantation. The use of MC led to significant reductions in: median N-terminal pro-brain natriuretic peptide (NT-proBNP) level (pg/ml) from 3923 to 2636 ( p =0.02), tricuspid regurgitation pressure gradient (TRPG) from 43 to 35mmHg ( p =0.019) and in left ventricular end-diastolic volume (LVEDV) by MC ( p =0.008). At the 2year follow-up interval the all-cause mortality was 25%. Conclusion MC implantation leads to an improvement of NT-proBNP level, TRPG and LVEDV in both functional and degenerative MR but does not influence QRS duration. Two year all-cause mortality was 25% and did not differ significantly from that predicted by SHFM and MAGGIC.

Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists. In this pilot study, CPVI combined with LAI-ablation were performed using a RNS and 3D-mapping system in 42 patients with persistent (n = 24, 57.1 %) or longstanding persistent AF. Ablation was performed using either a 3.5 mm irrigated tip catheter (ITC) with 6 (group-A, n = 16; max. 40 W, contact force 10–40 g) or (after a steam pop occurred in one patient) with a 4 mm ITC with 12 irrigation holes (group-B, n = 26; max. 30 W, contact force 10–30 g). Epicardial ablation was performed manually whenever bidirectional LAI-block could not be obtained with a maximum of 20 endocardial RF-applications. LAI-conduction block was achieved in all patients using RNS; in six patients (14.3 %), additional epicardial ablation was required to achieve LAI-block. A steam pop occurred during LAI-ablation resulting in cardiac tamponade in one patient in group-A. After a median follow-up period of 21 months, arrhythmia recurrence was seen in in 23/42 patients (18 patients with AF and 5 patients with atrial tachycardia) and repeat procedure was performed in 12 (28.6 %) patients; recovered LAI-conduction was found in 5/12 (41.7 %) patients. The RNS-group was compared to a historical group of 20 patients with manual LAI-ablation. Using RNS, LAI-block was more often achieved (42 (100 %) vs 16 (80 %), p

We are grateful for the letter from Briceno et al1 and their interest in our published data. We take this opportunity to clarify some of the issues raised in their response letter. First, our nonrandomized study presented findings that demonstrated the high incidence of left atrial appendage (LAA) thrombi after wide-area LAA isolation (LAAI). The mechanism of this high incidence of thrombus formation within the LAA remains unclear whether due purely to the isolation itself or to the combined effect of disease progression and the wide area of LAAI. This needs further investigation in subsequent studies. Because of the potentially significant clinical implications, we felt that these important findings must not be withheld from other electrophysiologists. Second, regarding the technique of LAAI in our study population,2 we fully agree with Briceno et al that a wide-area LAAI is different from the LAAI technique described by Di Biase …

Background— Electric left atrial appendage (LAA) isolation (LAAI) may occur during catheter ablation of atrial tachyarrhythmias. Data regarding the risk of thromboembolic events and stroke after LAAI are sparse. This study evaluated the incidence of LAA thrombus formation and thromboembolic events after LAAI. Methods and Results— Fifty patients had LAAI (age=71 years; female=56%; CHA 2 DS 2 -VASc score before ablation =3 [2;3]). LAAI patients were compared with matched patients with comparable baseline characteristics who underwent atrial fibrillation ablation without LAAI (n=50). Ablation strategies in the LAAI group included pulmonary vein isolation in 50 (100%), left atrial isthmus line in 47 (94%), anterior line in 45 (90%), complex atrial fractionated potentials in 24 (48%), and roofline in 14 (28%) patients. Transesophageal echocardiography was performed during follow-up in 47/50 (94%) patients in the LAAI group and in all patients of the control group. Oral anticoagulation (OAC) independent of CHA 2 DS 2 -VASc score was strongly recommended in all patients. During a median follow-up of 6.5 (4–12) months, stroke occurred in 2 patients on OAC and transient ischemic attack in one without OAC in the LAAI group. In the remaining 47 patients, LAA thrombus was identified on transesophageal echocardiography in 10 (21%) patients (OAC=9; no OAC=1). In the control group, no LAA thrombus was detected and no stroke occurred ( P Conclusions— After LAAI, an unexpectedly high incidence of LAA thrombus formation and stroke was observed despite OAC therapy.

Objectives This study describes the 5-year efficacy of catheter ablation for long-standing persistent atrial fibrillation (LS-AF). Background Long-term outcome data after catheter ablation for LS-AF are limited. Methods Long-term follow-up of 56 months (range 49 to 67 months) was performed in 202 patients (age 61 ± 9 years) who underwent the sequential ablation strategy for symptomatic LS-AF. Initial ablation strategy was circumferential pulmonary vein isolation (PVI). Additional ablation was performed only in acute PVI nonresponder, if direct current cardioversion failed after PVI. Results After the first ablation procedure, sinus rhythm was documented in 41 of 202 (20.3%) patients. After multiple procedures, sinus rhythm was maintained in 91 of 202 (45.0%) patients, including 24 patients receiving antiarrhythmic drugs. In 105 patients, PVI was the sole ablative therapy, 49 (46.7%) of those patients remained in sinus rhythm during follow-up. Patients with a total AF duration of 2 years (76.5% vs. 42.2%, respectively; p = 0.033). Persistent AF duration (hazard ratio: 1.09 [95% confidence interval: 1.04 to 1.13]; p Conclusions During 5-year follow-up, single- and multiple ablation procedure success was 20% and 45%, respectively, for patients with LS-AF. For patients with a total AF duration of

Background— The incidence of silent cerebral lesions (SCL) after atrial fibrillation (AF) ablation is highly variable, depending on the technology used. Recently, an increased risk for SCL has been described for a novel, nonirrigated ablation tool using multielectrode phased radiofrequency (PVAC). The aim of this prospective study was to evaluate the incidence and long-term follow-up of SCL in patients undergoing robotically assisted pulmonary vein isolation (RA-PVI) as compared with manual PVI. Methods and Results— Circumferential PVI using irrigated radiofrequency current was performed on 70 patients (41 patients with paroxysmal AF, 59%). Fifty patients underwent RA-PVI and 20 patients underwent a manual approach. Cerebral MRI was performed the day before and the day after the ablation procedure; follow-up MRI was performed on 9 of 12 (75%) patients after a follow-up period of 21 months. SCLs were found in 12 of 70 (17%) patients in this study; the incidence of SCLs was similar in patients undergoing RA-PVI as compared with manually ablated patients (n=9, 18% versus n=3, 15%; probability value=1.0). In 1 patient undergoing manual PVI (1%), an SCL with asymptomatic subarachnoid hemorrhage was detected; the bleeding completely resolved within 1 month. Transient ischemic attack occurred in 1 (1%) patient 2 days after manual PVI. After a median follow-up period of 21 months, no residual SCLs were detected. Conclusions— The incidence of SCL using the robotic navigation system was 18% in this study. Incidence and size of SCL appears to be similar after RA-PVI as compared with manual PVI. Repeat MRI showed no residual SCLs at long-term follow-up.

Summary Introduction: Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006. Methods: A total of 770 patients of mean age (SD) 70.1(10.1) underwent 1013 DCCVs (first n = 665, repeat n = 348) for atrial tachyarrhythmias from 1996 to 2006. Time to persistent arrhythmia recurrence was compared between first and multiple DCCV, and the effect of age, gender, presence of heart disease, left atrial size, fractional shortening, arrhythmia duration, anti-arrhythmic drug therapy (AAD) and other concomitant cardiac medication was evaluated using the Kaplan–Meier method and Cox’s Proportional-hazards model. Results: In all, 33% of first and 29% of repeat DCCVs were in sinus rhythm (SR) at 12 months (m). There was no difference in median time to arrhythmia recurrence (SE) between first and multiple procedures: 1.5 ± 0.1 m (1.3–1.7) and 1.5 ± 0.0 m (1.4–1.6) respectively, p = 0.45. AAD use was significantly higher, arrhythmia duration shorter and more diabetic patients underwent repeat procedures. Amiodarone, OR 0.56, p = 0.04, sotalol, OR 0.61, p = 0.02 and arrhythmia duration

The beneficial effects of atrial pacing on the incidence, duration and symptomatology of paroxysmal atrial fibrillation (PAF) may be negated by increased ventricular pacing. This prospective randomised study evaluates the effect of pacing algorithms that minimise ventricular pacing (MinVP) with and without anti-AF algorithms, on AF burden (AFB) in patients with symptomatic PAF. Patients implanted with pacemakers with MinVP capability with AFB 1–70% were enrolled. Three different DDDRP devices were assessed. Following a 1-month induction phase, patients were randomised to MinVP with and without preventive AF algorithms or dual chamber rate adaptive pacemaker (DDDR) (AV delay (AVD) 150 ms) for 2 months per study phase. The primary outcome measure was AFB. One hundred and ten patients were enrolled; of these, 66 (mean age 74.3 ± 7.9, 56% males) had an AFB of 1–70% during the induction phase and completed all study phases. There was no significant difference in AFB between the control phase DDDR, 13.8% (95% CI 8.7 to 18.8), and MinVP, 14.4% (95% CI 9.4 to 19.4), or MinVP with AF algorithms enabled, 14.7% (95% CI 9.7 to 19.7), (p = 0.65 and p = 0.49, respectively). Median ventricular pacing was significantly higher during the control phase, 86.0% (IQR 72.8, 97.3), than in MinVP 2.0% (IQR 0.0, 14.1) and MinVP + algorithms 3.0% (IQR 0.4, 15.6), p =

Aims Right ventricular pacing increases the risk of persistent atrial fibrillation (AF) in the long term. The effects of right ventricular pacing on paroxysmal AF (PAF) are unknown. The aim was to examine the effect of right ventricular pacing on AF burden (AFB) in patients with symptomatic drug-resistant PAF. Pooled analysis of pacemaker-derived counters and AF diagnostic data from the Atrial Fibrillation Therapy (AFT) and Pacemaker Atrial Fibrillation Suppression (PAFS) randomized anti-AF pacemaker algorithm trials were used. Methods and results Five hundred and fifty-four patients from the AFT ( n = 372) and PAFS ( n = 182) were studied. The individual percentages of pacing, Atrial Sense Ventricular Pace (ASVP), Atrial Pace Ventricular Pace (APVP), and Atrial Pace Ventricular Sense (APVS) as well as total ventricular pacing during synchronous rhythm (VPinSR, %) were examined for an effect on AFB. Three hundred and twenty-one (AFT, age 64 ± 11, 55% male) and 79 (PAFS, age 71 ± 8, 54% male) patients had complete data for analysis. Increased VPinSR was weakly associated with an increased AFB (effect size—10% VPinSR increased AFB by only 0.03%) in AFT ( P = 0.04) but not PAFS ( P = 0.98) or the pooled analysis ( P = 0.95). None of the synchronous paced modalities (ASVP, APVP, APVS) significantly increased AFB compared with sinus rhythm (Atrial Sense Ventricular Sense) ( P = ns). Conclusion No pacing modality, atrial or ventricular, had a significant effect on AFB. On the basis of these data, the detrimental effect of high-frequency right ventricular pacing on AFB in paced PAF patients, unlike with persistent AF, appears to be minimal in the short term.

Introduction Catheter ablation, in the immediate peri-and post procedural period is associated with a transiently increased thrombogenic state secondary to atrial inflammation arising as a result of endothelial damage caused by manipulation of ablation catheters and/or ablation lesions. For atrial fibrillation(AF) ablations, the 2016 European Society of cardiology Guidelines recommend uninterrupted warfarin therapy in the peri-procedural period. In observational cohorts and one randomised study (PIONEER-AF), uninterrupted NOAC therapy has also been found to be safe in patients undergoing AF ablations. EHRA states that simple ablation procedures have a low bleeding risk while complex ablation procedures have high bleeding risk. We describe our experience of a wide variety of catheter ablations performed on uninterrupted NOAC therapy and compare our results with similar procedures undertaken on uninterrupted warfarin therapy. Methods A retrospective analysis of the NICOR database for all ablations undertaken on uninterrupted anticoagulation at the New Cross Hospital, Wolverhampton, between April 2014 and August 2016 was undertaken. Data regarding the number and type of procedures, type of oral anticoagulation (warfarin versus NOACs), frequency of trans-septal punctures, DCCV during procedures and complications were analysed. Results Atrial of 648 ablations were performed in the study period of which328(50.7%) were undertaken on uninterrupted anticoagulants (uninterrupted warfarin group (uW Grp): 228 (35.1%) and uninterrupted NOAC group (UNOAC Grp): 101 (15.5%). Mean age was 59 in both groups with more male preponderance in the NOAC group. A range of simple and complex ablations were done including 131 (57.4%) AF in UW Grp compared to 26 (26.5%) in the uNOAC grp. Trans-septal punctures were more common in the UW Grp compared to the uNOAC Grp, however cardioversions (both external and internal) were used in similar fashion. Composite of bleeding and thrombo-embolic complications were relatively low in both the groups [n=5(2.1%) in the VKA group compared to n=1 (0.9%) in the UNOAC Grp with OR 2.21 (95% CI 0.25 to 19.2; p=0.47)]. Conclusions Our experience suggests that a wide range of simple and complex ablation procedures can be safely performed ion uninterrupted NOAC therapy. Complications in the uNOAC Grp were lower than the uW Grp, reflecting growing confidence among electrophysiologists to undertake such procedures even in the absence of antidote for majority of the NOACs.