Abstract 16548: Low-dose Amiodarone for Control of Atrial Fibrillation (AF) Remains Effective in Patients With Ejection Fraction Less Than 50%

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Frank A McGrew ◽  
Sandy Charlton ◽  
Brian Dragutsky
Keyword(s):  
Atrial Fibrillation ◽  
Side Effects ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Low Dose ◽  
Amiodarone Therapy ◽  
Low Doses ◽  
Mortality And Morbidity ◽  
Titration Protocol ◽  
The Impact

Introduction: Our previous work has shown low-dose Amiodarone (often less than 600 mg per week) is effective for control of AF in a forced down-titration schema. Many studies have shown restoration of sinus rhythm in patients with CHF shows promise for reduced mortality and morbidity. This analysis compares results of this protocol in patients with ejection fraction above and below 50%. Methods: Consecutive patients with atrial fibrillation deemed suitable for Amiodarone therapy were prospectively followed with a forced down-titration protocol. Controlled atrial fibrillation was defined as an AF burden of less than 1% on device diagnostics (30% of patients) or no symptoms and sinus rhythm on clinical visit EKGs. Demographic and clinical data were analyzed for patients with ejection fraction above and below 50%. Results: Patients with EF less than 50% had greater success (35/38) or 92% than patients with ejection fraction greater than 50% (39/51) or 76%. However, patients with ejection fraction under 50% required larger doses. See graph for detailed doses. Overall success was good in both groups with no sustained side effects. Conclusions: Amiodarone in low doses is effective in control of atrial fibrillation in patients across the spectrum of ejection fractions. Lower ejection fractions may require a somewhat higher dose (less than 1000 mg per week) but at a higher success rate.Larger studies could potentially show the impact of this protocol on mortality.

Abstract 16468: Low Dose Amiodarone is Safe and Effective in Control of Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Frank A McGrew ◽  
Sandy Charlton ◽  
Brian Dragutsky
Keyword(s):  
Atrial Fibrillation ◽  
Side Effects ◽  
Low Dose ◽  
Systolic Heart Failure ◽  
Office Visit ◽  
Rhythm Control ◽  
Weekly Dose ◽  
Reduced Ejection Fraction ◽  
Term Administration ◽  
Titration Protocol

Introduction: Amiodarone is the most effective drug for the treatment of atrial fibrillation (AF), but long-term administration of standard doses can have prohibitive side effects. Little data is available for use of lower doses. We sought to determine the lowest effective dose for rhythm control in a single physician practice. Methods: Consecutive AF patients treated with Amiodarone using a down-titration schema were prospectively followed. The goal was the lowest dose providing effective rhythm control defined as less than 1% AF burden in patients with devices (42% of patients) or no symptoms or no AF on ECG at last office visit in non-device patients. Results: 170 patents (89M, 81F) were followed for a mean period of 63 months (range 12-177). 79 of 170 (46%) had devices (6 ILR, 29 PM, 27 ICD, 17 CRT). 5 patients had drug-related transient side effects, including 1 transient hyperthyroidism. No patient had pulmonary fibrosis or death. 130 of 170 patients (76%) had successful control of AF. Table 1 shows the number of patents effectively controlled at each weekly dose level. 51% had success at less than or equal to 400mg per week. Renal disease, systolic heart failure with reduced ejection fraction, and advanced age were common comorbidities. Conclusions: Low-dose Amiodarone is safe and effective for control of AF in most patients if carefully used in a down-titration protocol. Device diagnostics aid in patient management.

Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Chung ◽  
Gordon Ho ◽  
Andrew Schluchter ◽  
Francisco Contijoch ◽  
Jonathan C Hsu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Ct Scan ◽  
Blood Volume ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

Preservation of Cheese and Plain Yogurt by Low-dose Irradiation

1980 ◽  
Vol 43 (2) ◽  
pp. 114-118 ◽  
Author(s):  
S. YÜCEER ◽  
G. GÜNDÜZ
Keyword(s):  
Side Effects ◽  
Shelf Life ◽  
Total Dose ◽  
Room Temperature ◽  
Low Dose ◽  
Sorbic Acid ◽  
Low Doses ◽  
Dose Irradiation ◽  
Refrigerator Temperature ◽  
Number Of Bacteria

Irradiation preservation of Turkish kashar cheese and plain yogurt was studied using very low doses of Co-60 radiation. No side effects were observed below 0.15 Mrad. The number of bacteria killed was directly related to total dose up to 0.02 Mrad, then the effectiveness of the dose decreased. Coating cheese samples with a sorbic acid solution helped in reducing the number of bacteria by about 10–12% in irradiated samples. The shelf-life of irradiated samples stored at refrigerator temperature was almost the same as that of ones coated with sorbic acid but stored at room temperature. Mold formation in irradiated samples took three to four times longer than in nonirradiated ones. With plain yogurt the effect of total dose seemed to be the same as in cheese. Irradiation increased the shelf-life of yogurt three- to four-fold. Preservation by irradiation combined with refrigeration increased the shelf-life about five-fold.

Optimization of atrial fibrillation care: management strategies and quality measures

2020 ◽  
Author(s):  
Leona A Ritchie ◽  
Gregory Y H Lip ◽  
Deirdre A Lane
Keyword(s):  
Atrial Fibrillation ◽  
Management Strategies ◽  
Quality Measures ◽  
Standards Of Care ◽  
Management Approach ◽  
Mortality And Morbidity ◽  
Cardiovascular Comorbidities ◽  
Holistic Management ◽  
Health And Social Care ◽  
The Impact

Abstract Atrial fibrillation (AF) is the most common cardiac arrhythmia and a leading cause of mortality and morbidity. Optimal management of AF is paramount to improve quality of life and reduce the impact on health and social care services. Owing to its strong associations with other cardiovascular and non-cardiovascular comorbidities, a holistic management approach to AF care is advocated but this is yet to be clearly defined by international clinical guidelines. This ambiguity has prompted us to review the available clinical evidence on different management strategies to optimize AF care in the context of performance and quality measures, which can be used to objectively assess standards of care.

scholarly journals Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Mei-Yao Wu ◽  
Yen-Nien Lin ◽  
Hung-Pin Wu ◽  
Ying-Ying Huang ◽  
Jan-Yow Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Transesophageal Echocardiography ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Inverse Correlation ◽  
Atrial Appendage ◽  
Inclusion Criteria

AbstractImpaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

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