scholarly journals LO004: Short-term risk of arrhythmias among syncope patients presenting with atrial fibrillation/flutter to Canadian emergency departments

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S31-S31
Author(s):  
C. Toarta ◽  
K. Kwong ◽  
I.G. Stiell ◽  
M.A. Mukarram ◽  
M. Taljaard ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Baseline Risk ◽  
Future Research ◽  
Short Term ◽  
Secondary Outcomes ◽  
A Prospective Study

Introduction: Short-term risk of arrhythmia or death among emergency department (ED) syncope patients with atrial fibrillation/flutter (AFF) has not been reported in the literature. Our objectives were to assess the incidence and the independent risk of 30-day arrhythmia or death for syncope patients with AFF after ED disposition. Methods: We conducted a prospective study at 6 Canadian academic EDs to include adults with syncope. We collected demographic, clinical and ECG characteristics while our outcome assessments were completed by medical records review and by telephone follow-up of patients after 30 days. Primary outcome was arrhythmia or death within 30-days after ED disposition and secondary outcomes included non-arrhythmic cardiac and non-cardiac outcomes. We performed descriptive and logistic regression analyses. Results: We enrolled 4,266 patients: mean age 53.4 years, 55.4% females, and 8.5% with AFF. After excluding those with outcomes in the ED, lost to follow-up and those with other non-sinus rhythms, 3,417 patients in the sinus and 280 patients in the AFF groups were analyzed. The incidence of arrhythmia or death was significantly higher in the AFF group (Relative Risk 5.1; 95% CI 3.1-8.4; p<0.0001) but there were no significant differences in secondary outcomes between the groups. The unadjusted odds ratio for 30-days arrhythmia or deaths among ED syncope patients with AFF was 5.4 (95% CI 3.2- 9.2). After adjusting for important baseline risk factors by multivariable analysis, the odds ratio for arrhythmia or death in patients with AFF was 1.5 (95% CI 0.8-2.7). Conclusion: The risk of AFF for 30-day arrhythmia or death among syncope patients after ED disposition is higher but is attenuated when adjusted for important patient characteristics. Future research should assess long-term outcomes among syncope patients with AFF to guide follow-up after ED discharge.

scholarly journals Outcome Following Hemorrhage From Cranial Dural Arteriovenous Fistulae

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Matthew J. Koch ◽  
Christopher J. Stapleton ◽  
Ridhima Guniganti ◽  
Giuseppe Lanzino ◽  
Jason Sheehan ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Dural Arteriovenous Fistula ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Morbidity And Mortality ◽  
Cerebrovascular Lesions ◽  
Arteriovenous Fistulae ◽  
Poor Outcome

Background and Purpose: Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–related hemorrhage. Methods: A retrospective review of patients in CONDOR who presented with dural arteriovenous fistula–related hemorrhage was performed. Patient characteristics, clinical follow-up, and radiographic details were analyzed for associations with poor outcome (defined as modified Rankin Scale score ≥3). Results: The CONDOR dataset yielded 262 patients with incident hemorrhage, with median follow-up of 1.4 years. Poor outcome was observed in 17.0% (95% CI, 12.3%–21.7%) at follow-up, including a 3.6% (95% CI, 1.3%–6.0%) mortality. Age and anticoagulant use were associated with poor outcome on multivariable analysis (odds ratio, 1.04, odds ratio, 5.1 respectively). Subtype of hemorrhage and venous shunting pattern of the lesion did not affect outcome significantly. Conclusions: Within the CONDOR registry, dural arteriovenous fistula–related hemorrhage was associated with a relatively lower morbidity and mortality than published outcomes from other arterialized cerebrovascular lesions but still at clinically consequential rates.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range&lt;70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC&gt;80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p&lt;0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p&lt;0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

scholarly journals Radiofrequency versus Cryoballoon Ablation of Atrial Fibrillation: An Evaluation Using ECG, Holter Monitoring, and Implantable Loop Recorders to Monitor Absolute and Clinical Effectiveness

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Karapet Davtyan ◽  
Victoria Shatakhtsyan ◽  
Hermine Poghosyan ◽  
Alexandr Deev ◽  
Alexey Tarasov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Effectiveness ◽  
Holter Monitoring ◽  
Patient Characteristics ◽  
Cryoballoon Ablation ◽  
End Point ◽  
Radiofrequency Current ◽  
Implantable Loop Recorders

Introduction. While several studies have compared the radiofrequency current (RFC) and cryoablation for the treatment of patients with atrial fibrillation (AF), no study has monitored the long-term outcomes with the usage of implantable loop recorders (ILRs). Methods. We enrolled 89 consecutive patients with nonvalvular paroxysmal AF (N=44 for RFC and N=45 for cryoballoon). The primary efficacy end point was the assessment of effectiveness for each group (RFC versus cryoballoon) when examining freedom from arrhythmia by monitoring with ECG, Holter, and implantable loop recoder (ILR). The primary safety end point compared rates of adverse events between both groups. The secondary efficacy end point examined the duration of the postablation blanking period from ILR retrieved data. Results. The mean age of the study population was 56.6±10.2 years, and the follow-up duration was 12 months. There were no differences in baseline patient characteristics between groups. At 12 months, the absolute effectiveness (measured by ILR) was 65.9% in the RFC group and 51.1% in the cryoballoon group (OR = 1.85; 95% CI: 0.79–4.35; p=0.157), and the clinical effectiveness (measured by ECG and Holter) was 81.8% in the RFC group and 55.6% in the cryoballoon group (OR = 3.6; 95% CI: 1.37–9.46; p=0.008). There was no difference in safety between both groups. Asymptomatic episodes were significantly more present in the RFC group as measured by ILRs (p<0.010). In cryoballoon group, arrhythmia episodes were recorded equally irrespective of the follow-up method (i.e., ECG and Holter versus ILR (p>0.010)). The blanking period does not seem to be as important in cryoballoon as compared to RFC. Conclusion. RFC and cryoballoon ablation had similar absolute effectiveness at 12 months. ECG and Holter were effective when assessing the efficacy of the cryoballoon ablation; however, in the RFC group, ILR was necessary to accurately assess long-term efficacy.

Translational delivery of Cool Little Kids to prevent child internalising problems: Randomised controlled trial

2017 ◽  
Vol 52 (2) ◽  
pp. 181-191 ◽  
Author(s):  
Jordana K Bayer ◽  
Ruth Beatson ◽  
Lesley Bretherton ◽  
Harriet Hiscock ◽  
Melissa Wake ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Controlled Trial ◽  
Secondary Outcomes ◽  
Randomised Controlled ◽  
Internalising Problems

Objective: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. Methods: Design: a randomised controlled trial was used. Setting: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. Secondary outcomes: the secondary outcomes were parenting practices and parent mental health. Results: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal – 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms – mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = –0.47, 95% confidence interval = [–0.81, –0.13], p = 0.006). Parents’ participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. Conclusion: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood.

Abstract 16237: Zero Fluoroscopy Ablation of Atrial Fibrillation: A Safety and Feasibility Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Rodney Horton ◽  
Chintan Trivedi ◽  
Prasant Mohanty ◽  
Sanghamitra Mohanty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Radiation Risk ◽  
Control Group ◽  
Short Term ◽  
Af Ablation ◽  
And Control ◽  
Zero Fluoroscopy

Introduction: Radiofrequency catheter ablation of atrial fibrillation is performed under fluoroscopic guidance and therefore carries radiation risk exposure for the both the patient and the operator. Three-dimensional mapping systems and newer technologies to allow non-fluoroscopic catheter visualization together with intracardiac echo have reduced but not abolished the fluoroscopy exposure. We aim to demonstrate the feasibility, the safety and the efficacy of catheter ablation for atrial fibrillation without the use of fluoroscopy. Methods: A totally fluoro-less approach was developed for AF ablation at our Institution. 94 consecutive AF patients underwent zero fluoroscopy catheter ablation for atrial fibrillation. In the zero fluoroscopy cases, the fluoroscopy arm was kept far away from the patient table. Access including double trans-septal, mapping with the Carto 3 system and ablation were all performed without fluoroscopy with the use of ICE and the Carto 3 system. These 94 patients were compared with 94 control patients matched for age, sex and type of AF who underwent AF ablation by the same operator with the use of fluoroscopy. Results: Baseline characteristics were similar between fluoroless (N=94, Age=64.5 ± 10.1, 75.5% male, 48% paroxysmal) and control (N=94, Age=65.1 ± 9.9, 72.3% male, 50% paroxysmal) group. Non-PV triggers were detected and ablated in 51 (54.3%) and 56 (59.6%) patients in fluoroless and control group respectively (p=0.5). Average fluoro time in control group was 10.1 ± 4.7 minutes. Procedure duration was comparable (120.4 ± 25.8 vs. 122.2 ± 28.7, p =0.6). After the short term median follow-up of 4.5 (4 – 6.5) months, 10 (10.6 %) patients in flourless and 9 (9.6%) patients in control group experienced recurrences (p=0.8).One pericardial effusion requiring pericardiocenteis occurred in the fluoroless group. Conclusions: Our series show that zero fluoroscopy ablation of atrial fibrillation with the use of newer technologies is feasible, safe and efficacious at the short term follow up. Importantly in our series the double transeptal was performed without fluoroscopy and the ablation was not limited to the pulmonary veins only but included ablation of the posterior wall, the coronary sinus and the left atrial appendage.

scholarly journals A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

2016 ◽  
Vol 40 (6) ◽  
pp. E7 ◽  
Author(s):  
Syed F. Abbas ◽  
Morgan P. Spurgas ◽  
Benjamin S. Szewczyk ◽  
Benjamin Yim ◽  
Ashar Ata ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Neck Disability Index ◽  
Case Series ◽  
Patient Characteristics ◽  
Short Term ◽  
Instrumented Fusion ◽  
Minimally Invasive Surgical ◽  
Neck Disability

OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.

TREATMENT OF TRIGGER FINGERS BY INJECTION OF METHYLPREDNISOLONE ACETATE AND LIDOCAINE (DEPO-MEDROL®)

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 103-105
Author(s):  
J. Joris Hage ◽  
Jaap D.K. Munting
Keyword(s):  
Side Effects ◽  
Prospective Study ◽  
Success Rate ◽  
Adult Patients ◽  
Methylprednisolone Acetate ◽  
Short Term ◽  
Local Injections ◽  
One Year ◽  
A Prospective Study

Thirty-six adult patients with 44 trigger fingers of less than four months' duration entered a prospective study on the efficiency of treatment with local injections of a combination of corticosteroids and lidocaine. From this study it may be concluded that the short-term success rate (93%) of one to three injections of methylprednisolone and lidocaine 2% (Depo-Medrol®) is comparable to that achieved by surgical or percutaneous tenolysis. At one year of follow-up, this success rate still amounted to 86%. In our hands, this therapy is without complications or side effects.

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