scholarly journals Anterior position of dispersive patch for esophageal protection during atrial fibrillation ablation. A pilot feasibility study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Futyma ◽  
N Burda ◽  
A Surowiec ◽  
A Kogut ◽  
M Iwanski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Thermal Injury ◽  
Significant Risk ◽  
Esophageal Injury ◽  
Esophageal Wall ◽  
Funding Sources ◽  
Significant Difference ◽  
Anterior Position ◽  
One Year ◽  
Dispersive Electrode

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ablation for atrial fibrillation (AF) carries a significant risk of esophageal injury. Current methods of esophageal protection are invasive, expensive and their cost-effectiveness can be questioned. Standard placement of dispersive patch (DP) at patient’s back exposes esophagus to radio-frequency (RF) current-mediated thermal injury and such complications as esophageal wall ulceration, peri-esophageal injury or life-threatening atrio-esophageal fistula. Redirecting RF current by DP repositioning to anterior chest can theoretically protect oesophagus from thermal injury, however, such an approach has not yet been investigated. Aim To determine feasibility of anterior DP position for treatment of AF using RF catheter ablation (RFCA)-based system. Methods We retrospectively analysed consecutive patients undergoing  RFCA-based pulmonary vein isolation (PVI) using multi-electrode PVAC catheter with DP located either in anterior or traditional-posterior position. Two additional patients underwent point-by-point RFCA and mapping of PV ostia with impedance measurements during RFCA performed using anterior and posterior DP positioning. Results 62 patients (25 females, age 60 ± 12 years) underwent PVI using PVAC: 40 patients in posterior and 22 in anterior DP group. There were no major complications during procedures. There was no significant difference in AF recurrence rate between anterior and posterior DP groups during one-year follow up (log rank p = 0.065). In two additional consecutive patients (1 female, age 74 ± 2 years) undergoing point-by-point RFCA a total number of 30 measurements around PV ostia were performed. There was a significant difference between impedance values in anterior vs posterior DP positions (134 ± 7 Ω vs 122 ± 8 Ω, p = 0.0004). Conclusions Anterior position of dispersive electrode for PV isolation using RFCA-based systems is safe, feasible, atraumatic and is not associated with any additional cost. Apart from redirecting RF current away from the esophagus, anterior dispersive patch placement is associated with higher impedance values which can act as an additional protection. Possible prevention of esophageal complications using anterior dispersive patch positioning needs to be determined in prospective studies. Abstract Figure. AF-free survival and impedance

scholarly journals Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Nishiwaki ◽  
S Watanabe ◽  
F Yoneda ◽  
M Tanaka ◽  
A Komasa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Main Role ◽  
Funding Sources ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
One Year ◽  
The Impact

Abstract Background Since atrial functional tricuspid regurgitation (AF-TR) is associated with increased heart failure and mortality, the management of AF-TR is clinically important. Atrial fibrillation (AF) plays the main role in AF-TR. However, the effectiveness of catheter ablation (CA) and mechanism of improvement of AF-TR haven't been fully evaluated. Purpose We sought to investigate the impact of CA for AF on AF-TR in patients with moderate or more TR. Methods We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Japan. The current study population consisted of 102 patients with moderate or greater TR who underwent CA for AF. The echocardiographic parameters were compared between pre-ablation and post-ablation transthoracic echocardiography (TTE), and the recurrence rate of AF/ atrial tachycardia (AT) was measured. Results The mean age was 73.2 years, 53% were women. TR severity and TR jet area significantly improved after CA for AF (TR jet area: 5.8 [3.9–7.6] cm2 to 2.0 [1.1–3.0] cm2, p<0.001). In addition, mitral regurgitation (MR) jet area, left atrial (LA) area, mitral valve diameter, right ventricular (RV) end-diastolic area, right atrial (RA) area, tricuspid valve (TV) diameter decreased after CA (p<0.001, <0.001, <0.001, = 0.02, <0.001, and <0.001, respectively). There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE (moderate 28.6%, moderate to severe 37.2%, and severe 31.6%, p=0.72). Conclusions TR severity and jet area improved after CA in patients with AF and moderate or more TR. RV size, RA size, TV diameter also decreased after CA, which may be associated with TR improvement. There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Awareness and Perception of Carbohydrate-Controlled Diets for Management of PCOS: A Benchmark Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 954-954
Author(s):  
Carolina Cartier ◽  
Cristen Harris ◽  
Alexandra Kazaks
Keyword(s):  
Nutrition Therapy ◽  
The United States ◽  
The Body ◽  
Carbohydrate Restriction ◽  
Funding Sources ◽  
Significant Difference ◽  
One Year ◽  
Definition Of ◽  
Registered Dietitian Nutritionists ◽  
Nutrition And Dietetics

Abstract Objectives Infertility affects 6.1 million women in the United States. There is currently no recognized Medical Nutrition Therapy to optimize fertility. Despite a lack of research evidence of safety and efficacy, carbohydrate restriction (CR) and carbohydrate-controlled diets (CCD) are utilized by individuals and practitioners as a treatment for subfertility. An aim of this study was to assess awareness and perception of CR as a treatment for subfertility by Registered Dietitian Nutritionists (RDN). In addition, a secondary aim was to compare similar questions gathered from individuals who followed a CCD for fertility enhancement. Methods This study was a combination of two surveys open for respondents July 2019 to January 2020 via REDCap. The survey for the first aim had a restricted population of RDNs consisting of 20 questions investigating perception of CR therapy and experience with patients with subfertility. The survey was emailed via listserv through the Academy of Nutrition and Dietetics. The second survey targeted individuals who implemented CR as a fertility therapy. It consisted of 45 questions and was distributed to CCD related social media groups. Results The first survey had 240 RDN respondents with an average of 12 years of experience. The second survey had 203 CCD respondents of which 49% had followed a CCD for less than one year. While the remaining 51% followed a CCD for an average of 3.6 years. There was a statistically significant difference between how the two groups defined carbohydrate restriction χ,2 (3, 410) = 265.4, P < 0.01. Among RDNs, 49.8% selected “Below 45% kcal from carbohydrate/day” and 32.2% selected “Below 100 g carbohydrate/day”. In contrast, 75.4% of followers of a CCD selected “Below 20 g carbohydrate/day”. A total of 41% of RDNs were familiar with research regarding the effect of carbohydrate reduction on female subfertility markers, such as PCOS and anovulation, of which 67% believe the body of evidence demonstrates “generally positive outcomes” on markers of fertility. Conclusions The results of this study highlight the lack of a consistent definition of CCD between providers and the public. There may be a need for educating providers that research regarding CCD and fertility exists, but effectiveness of CR as a treatment cannot be properly assessed without an agreed upon definition. Funding Sources N/A.

scholarly journals Quantitative Analysis of Ablation Technique Predicts Arrhythmia Recurrence Following Atrial Fibrillation Ablation

2019 ◽  
Author(s):  
Lior Jankelson ◽  
Matthew Dai ◽  
Scott Bernstein ◽  
David Park ◽  
Douglas Holmes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rf Ablation ◽  
Catheter Position ◽  
Factors Affecting ◽  
Ablation Technique ◽  
Modifiable Factors ◽  
Significant Difference ◽  
Position Data ◽  
One Year ◽  
Spatial Positioning

AbstractBackgroundOptimal ablation technique, including catheter-tissue contact during atrial fibrillation (AF) radiofrequency (RF) ablation is associated with improved procedural outcomes. We used a custom developed software to analyze high frequency catheter position data to study the interaction between catheter excursion during lesion placement, lesion-set sequentiality and arrhythmia recurrence.Methods100 consecutive patients undergoing first time RF ablation for paroxysmal AF were analyzed. Spatial positioning of the ablation catheter sampled at 60 Hz during RF application was extracted from the CARTO3 system (Biosense Webster Inc., USA) and analyzed using custom developed MATLAB software to determine precise catheter spatial 3D excursion during RF ablation. The primary end point was freedom from atrial arrhythmia lasting longer than 30 seconds after a single ablation procedure.ResultsAt one year, 86% of patients were free from recurrent arrhythmia. There was no significant difference in clinical, echocardiographic or ablation characteristics between patients with and without recurrent arrhythmia. Analyzing 15,356,998 position data-points revealed that lesion-set sequentiality and mean lesion catheter excursion were predictors of arrhythmia recurrence. Analyzing arrhythmia recurrence by mean single-lesion catheter excursion (excursion > 2.81mm) and by sequentiality (using 46% of lesions with inter-lesion distance >6mm as cutoff) revealed significantly increased arrhythmia recurrence in the higher excursion group (23% vs. 6%, p=0.03) and in the less sequential group (24% vs. 4%, p=0.02).ConclusionAblation lesion sequentiality measured by catheter inter-lesion distance and catheter stability measured by catheter excursion during lesion placement are potentially modifiable factors affecting arrhythmia recurrence after RF ablation for AF.

scholarly journals Comparing single approaches success in index atrial fibrillation ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
R Carvalho ◽  
A Ferreira ◽  
T Rodrigues ◽  
G Silva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
High Rate ◽  
Single Shot ◽  
Single Center ◽  
Event Free Survival ◽  
Free Survival ◽  
Af Ablation ◽  
Significant Difference ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) ablation can be performed by inducing pulmonary vein electrical isolation. There are two widely used approaches: point-by-point and single-shot.  Catheter AF ablation is effective in restoring and maintaining sinus rhythm. However, efficacy is limited by high rate of AF recurrence, after an initially successful procedure. Purpose To evaluate AF index ablation successfulness using single-shot techniques and compare them to conventional one (point-by-point using irrigated- tip ablation catheter). Methods We analyzed, from a single center, all patients submitted to an index AF ablation procedure and its successfulness. The last was defined as AF, atrial tachycardia or flutter recurrence (with a duration superior to 30seconds) event- free survival, determined by holter and/or event recorder. These exams were performed after 6 and 12months and then annually, until 5years post procedure were accomplished. Results From November 2004 to November 2020, 821patients were submitted to first AF ablation (male patients 67,2%(N = 552), mean age of 59 ± 12years old). Paroxysmal AF(PAF) was present in 62,9%(N = 516), with short-duration persistent AF in 21,8%(N = 179) and long-standing persistent in 15,3%(N = 126). Ablation techniques were irrigated tip catheter point-by-point (PbP)ablation in 266 patients (32,4%) and single-shot (SS)techniques on the remaining 555(67,6%), including PVAC in 294(35,8%),225(27,4%) submitted to cryoablation and 36(4,4%) to nMARQ. Globally, AF ablation had one-year success rate of 72,5%, and 56,2% at 3 years. A significant difference between AF duration type was found: Arrhythmic recurrence risk was 58% higher in persistent AF(PeAF) (HR 1.58;95%IC 1,22-2,04; p < 0.001). In patients presenting with PAF prior to the procedure, success was significantly higher in those submitted to SS technique(HR:0.69;95%CI 0,47-0,90;p = 0.046), while those with PeAF had similar results. Conclusion In this single center analysis almost three-quarters had achieved one-year event-free survival, and more than a half reached long-term freedom from atrial arrhythmia. Patients with paroxysmal atrial fibrillation submitted to single-shot procedure presented with a higher success-rate. Moreover, our study confirmed previous data on the importance of atrial fibrillation classification to postprocedural outcomes. Abstract Figure. Survival Curves

scholarly journals Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Je-Wook Park ◽  
Song-Yi Yang ◽  
Min Kim ◽  
Hee Tae Yu ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Complication Rate ◽  
Autonomic Function ◽  
Ablation Lesion ◽  
Efficacy And Safety ◽  
Procedure Time ◽  
Significant Difference ◽  
One Year

Introduction: Whereas, high-power short-duration (HPSD) radiofrequency (RF) ablation is generally used in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and influence on autonomic function have not been well established in a large population. This study compared HPSD-AFCA and conventional power (ConvP)-AFCA in propensity score matched-population.Methods: In 3,045 consecutive patients who underwent AFCA, this study included 1,260 patients (73.9% male, 59 ± 10 years old, 58.2% paroxysmal type) after propensity score matching: 315 in 50~60W HPSD group vs. 945 in the ConvP group. This study investigated the procedural factors, complication rate, rhythm status, and 3-month heart rate variability (HRV) between the two groups and subgroups.Results: Procedure time was considerably short in the HPSD group (135 min in HPSD vs. 181 min in ConvP, p < 0.001) compared to ConvP group, but there was no significant difference in the complication rate (2.9% in HPSD vs. 3.7% in ConvP, p = 0.477) and the 3-month HRV between the two groups. At the one-year follow-up, there was no significant difference in rhythm outcomes between the two groups (Overall, Log-rank p = 0.885; anti-arrhythmic drug free, Log-rank p = 0.673). These efficacy and safety outcomes were consistently similar irrespective of the AF type or ablation lesion set. The Cox regression analysis showed that the left atrium volume index estimated by computed tomography (HR 1.01 [1.00–1.02]), p = 0.003) and extra-pulmonary vein triggers (HR 1.59 [1.03–2.44], p = 0.036) were independently associated with one-year clinical recurrence, whereas the HPSD ablation was not (HR 1.03 [0.73–1.44], p = 0.887).Conclusion: HPSD-AFCA notably reduced the procedure time with similar rhythm outcomes, complication rate, and influence on autonomic function as ConvP-AFCA, irrespective of the AF type or ablation lesion set.

Abstract 16605: The Effectiveness and Safety of the Esophageal Temperature Monitoring During Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Miwa Ito ◽  
Hisanori Kanazawa ◽  
Tadashi Hoshiyama ◽  
Yusei Kawahara ◽  
Kenichi Tsujita
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Characteristic Curve ◽  
Predictive Marker ◽  
Patient Characteristics ◽  
Temperature Monitoring ◽  
Esophageal Injury ◽  
Radiofrequency Energy ◽  
Esophageal Temperature ◽  
Significant Difference

Introduction: Esophageal injury is known to be a serious complication occurs after catheter ablation (CA) of atrial fibrillation (AF). Hypothesis: We investigated the factors associated with the occurrence of EI after CA. Also esophageal temperature monitoring (ETM) can be useful, multiple factors such as patient characteristics and specific strategies for radiofrequency energy delivery also merit consideration. Methods: Among 508 patients who underwent CA of AF, endoscopy was performed the next day after CA to examine for EI. The incidence of EI was compared between 200 patients who done ETM (ETM group) and 308 patients who didn’t done ETM (Non-ETM group) during CA. The Shortest Distance between esophagus and posterior left atrium measured on contrast Computed Tomography (SD-CT) was also compared between both groups. Results: No differences were observed between both groups in total amount of radiofrequency energy applications. However, EI occurred more frequently in Non-ETM group (8/200 patients; 4.0 % vs 27/308 patients; 8.8 %, p=0.042). There was no significant difference in SD-CT between ETM and Non-ETM group. However, SD-CT in patients with EI was significantly shorter than SD-CT in patients without EI, both in ETM (2.4±0.7 vs 4.3±0.9 mm, p<0.001) and in Non-ETM group (2.5±0.2 vs 4.2±0.9 mm, p=0.017), respectively. Multiple regression analysis revealed that only SD-CT significantly correlated with EI. The area under a receiver operating characteristic curve using ST-CT as a predictive marker in EI patients was 0.968 (p<0.001). When the cut-off value of EI was set at 2.9mm, the sensitivity and specificity for EI diagnosis were 96.6% and 87.5%. Conclusions: The use of ETM is absolutely safe and necessary in order to prevent the occurrence of thermal EI.

Event Rate for Patients with Atrial Fibrillation with and without Low Molecular Weight Heparin Bridging.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 916-916
Author(s):  
Henny Heisler Billett ◽  
Eileen M. Madsen ◽  
Emily Giannattasio
Keyword(s):  
Atrial Fibrillation ◽  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Index Date ◽  
Event Rate ◽  
Statistical Significance ◽  
Low Molecular Weight ◽  
Significant Difference ◽  
Hemorrhagic Risk ◽  
One Year

Abstract The benefit of ’bridging’ atrial fibrillation patients with low molecular weight heparin until their INRs are at therapeutic levels with coumadin is unclear. Using a replicative hospital database available for IRB approved protocols and quality control analyses, we compared a cohort of patients over 65 years of age discharged with a diagnosis of atrial fibrillation (index date) who had been bridged (n=201) with a cohort of patients over 65 years of age who were not bridged on discharge but who achieved a therapeutic INR within 30 days of coumadin initiation (nonbridged and early INR, NB-E, n=1376). Log rank Mantel Haenszel two group comparisons were used to test for differences in time to event rate for admission for CVA, admission for hemorrhage, and number of laboratory INRs in therapeutic range (NLTR). The incidence of CVA admissions in the bridged group at 15, 30, 60, 90, 180 and 365 days was 0%, 0%, 0%, 0%, 0.5% and 1.2% whereas for the NB-E it was 0.1%, 0.3%, 0.8%, 1.3%, 1.8% and 2.8%. This difference did not reach statistical significance (p=0.19). No difference was noted in the time to admission for hemorrhage (3.5% at day 15, remaining unchanged at 30, 60 and 90 days for the bridged patients vs. 1.0%, 1.9%, 3.1% and 4.2% for NB-E patients, p=0.67). When NLTR were expressed as dichotomous variables (INR&lt;1.9=bad, 2–3.5=good, 3.6–20=bad) and assessed for one year from index date, there was no significant difference (good = 55.3% NLTR for bridged vs. 52.3% for NB-E). When either of these groups were compared to patients with AF who did not achieve therapeutic INRs until after 30 days (but less than one year, NB-L, n=2061), there was a difference in the incidence of admissions for CVA that was significant (0.2%, 0.7%, 1.1%, 1.2%, 2.5% and 4.8% at day 15, 30, 60, 90, 180, 365, p=0.025 vs. bridged, and p=0.048 vs. NB-E), NLTR (45.2%), but not in the incidence of admission for hemorrhage at 90 days (0.7%, 1.4%, 2.6% and 3.9% at 15, 30, 60 and 90 days). Because no risk factors prompting the decision to bridge patients were examined, the non-significant decreased incidence of CVA admissions in bridged patients may be important, since it may be that patients who were bridged were at higher risk for stroke than those who were not bridged (early or late). Future randomized trials with risk group stratification will be necessary to elucidate this but these data demonstrate there is no significant additional hemorrhagic risk for patients with atrial fibrillation who are bridged with low molecular weight heparin and suggest a potential benefit to early effective anticoagulation.

scholarly journals A Smoking Cessation Program in the Neonatal Intensive Care Unit

2008 ◽  
Vol 3 (2) ◽  
pp. 73-76 ◽  
Author(s):  
Stephen K. Ling ◽  
Susanne Wooderson ◽  
Karen Rees ◽  
Rose Neild ◽  
Ian M.R. Wright
Keyword(s):  
Smoking Cessation ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Perinatal Period ◽  
High Risk Population ◽  
Significant Difference ◽  
Predictor Of Success ◽  
One Year ◽  
Better Than

AbstractBackground: Parental smoking remains a significant risk to the preterm infant both pre and post delivery. Pharmacologically supported interventions have been previously contraindicated in this group during the perinatal period and during breastfeeding. We designed an evidence-based intervention for use in our high-risk population. This report assesses our outcomes after one year. Method: Questionnaire administered a median of 6 months after intervention. Results: There was no significant difference between those participants who returned the survey (n = 42) versus the group as a whole (n = 70). A total of 33% ceased smoking, p < .0001. If no nonresponders ceased smoking then this gives an overall success rate of 20%, p < .0001. Successful quitters had been smoking for a mean of 11 (SD = 7) years. Self-reported light smokers (< 10 cigarettes per day) were significantly more likely to quit (p < .01). Purchase of follow-on nicotine patches was a significant predictor of success in quitting (p = .02). If relapse occurred, it appeared to happen early and was mainly associated with current stressors. Conclusions: We have designed and applied a multidisciplinary intervention for parents and carers to be used in the perinatal period to decrease the postnatal risk for neonatal intensive care graduates. Our rates of successful smoking cessation are as good as, or better than, many published rates for opportunistic intervention. We suggest that randomised trials be focused on ways to further improve interventions at this time of opportunity for these infants and their families.

scholarly journals The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
P Purkayastha ◽  
A Ibrahim ◽  
D Haslen ◽  
R Gamma
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
Atrial Flutter ◽  
Dramatic Improvement ◽  
Success Rates ◽  
Funding Sources ◽  
Hospital Readmission Rate ◽  
Direct Current Cardioversion ◽  
Significant Difference ◽  
Chi Squared

Abstract Funding Acknowledgements Type of funding sources: None. Background & Purpose Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service.  Methods This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019.  Results Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure.  Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α&lt;0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α&lt;0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α&lt;0.05) or hypertension (χ2 = 2.075; p = 0.150; α&lt;0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α&lt;0.05) or LA size (χ2 = 1.310; p = 0.727; α&lt;0.05) upon cardioversion success rates.  We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α&lt;0.05).  Conclusion Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.

Abstract 3290: G674A Polymorphism of the Connexin 40.1 Gene and Atrial Fibrillation in Patients With Dilated Cardiomyopahty

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Akiyoshi Ogimoto ◽  
Hideki Okayama ◽  
Tomoaki Ohtsuka ◽  
Jun Suzuki ◽  
Akira Kurata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Atrial Myocytes ◽  
Odds Ratios ◽  
Junction Protein ◽  
Significant Difference ◽  
Gap Junction Protein ◽  
Connexin Genes ◽  
Allele Model

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and a leading cause of cardiovascular morbidity. The cardiac gap-junction protein connexin is expressed in atrial myocytes and mediates the coordinated electrical activation of the atria. Some polymorphisms in connexin genes were reported to be significantly associated with AF. We hypothesized that polymorphism (G674A) in the connexin 40.1 gene may be associated with AF in patients with dilated cardiomyopathy (DCM). Methods and Results: We genotyped this polymorphism (G674A, rs595652 ) in 83 patients with DCM by using the TaqMan chemical method. Patients were classified into AF group (n=21) if they had AF, and sinus rhythm (SR) group (n=62) if they had SR. Distribution of the connexin 40.1 genotypes (G/G, G/A, and A/A) among the total patients with DCM was 27.7%, 54.2%, and 18.1%, respectively. Allele frequency for the A allele was 0.52 in the AF group and 0.43 in the SR group. In a dominant G allele model (G/G and G/A genotypes vs A/A genotype), there was a significant difference in genotypes between the AF group and the SR group (p=0.035). This table shows odds ratios for atrial fibrillation in patients with DCM determined by logistic regression analysis. The odds of AF in DCM patients with the A/A genotype was 3.38-fold. In addition, age and left atrial dimension were also risk factors. Conclusion: The A/A genotype in the connexin 40.1 gene is a significant risk factor for AF in patients with DCM. Odds Ratios* for Atrial Fibrillation

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