Cardioversion of Atrial Fibrillation: How Important is a Long Arrhythmia Duration?

1994 ◽  
Vol 39 (3) ◽  
pp. 78-79
Author(s):  
G.Y.H. Lip ◽  
K.J. Hogg
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Successful Outcome ◽  
Proper Selection ◽  
Long Duration ◽  
Selection Of Patients ◽  
Selection Of

A long duration of atrial fibrillation is usually considered as an adverse feature for successful cardioversion of atrial fibrillation and the maintenance of sinus rhythm. This often leads to the exclusion of such patients from being considered for this procedure. We report three patients in whom atrial fibrillation was present for a long duration (one for 2 years, two for 10 years), and successful cardioversion to sinus rhythm was achieved. Proper selection of patients with atrial fibrillation with an understanding of all features predicting a successful outcome will often allow a good result.

scholarly journals Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?

2015 ◽  
Vol 22 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Maciej Wójcik ◽  
Alexander Berkowitsch ◽  
Sergey Zaltsberg ◽  
Christian W. Hamm ◽  
Heinz F. Pitschner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Proper Selection ◽  
Selection Of Patients ◽  
Selection Of

Abstract 11814: Pulmonary Capillary Wedge Pressure as a Strong Predictor for Successful Outcome of Atrial Fibrillation Ablation: A Speckle Tracking Echocardiographic Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mayumi Kaneda ◽  
Masanori Kawasaki ◽  
Takeshi Hirose ◽  
Ryuhei Tanaka ◽  
Rieko Matsuoka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Capillary Wedge Pressure ◽  
Speckle Tracking ◽  
Filling Pressure ◽  
Successful Outcome ◽  
Af Ablation ◽  
Pulmonary Capillary ◽  
Wedge Pressure ◽  
Recurrence Group

Background: Atrial fibrillation (AF) is associated with left atrial (LA) remodeling caused by LA pressure or volume (LAV) overload represented by the elevated left ventricular filling pressure or LA enlargement. Pulmonary capillary wedge pressure (PCWP) as well as LAV may be useful predictor for successful outcome of AF ablation. The aim of the study was to elucidate the most useful predictor for successful outcome in AF ablation including PCWP measured by a speckle tracking echocardiography (STE). Methods: We measured LAV, LA emptying function (EF), strain and strain rate (SR) by the STE during sinus rhythm before ablation in 137 patients with paroxysmal AF (61±10 years, 80 men) who underwent pulmonary vein isolation. The parameters were compared between non-recurrence (successful) group (n=107, age 61±11, sinus rhythm was continued for more than 1 year) and recurrence group (n=30, age 60±10). The estimated PCWP (ePCWP) was determined as 10.7 - 12.4 x log (active LAEF / minimum LAV), as we previously reported. LA stiffness was calculated as ePCWP/LA strain. We also measured PCWP and LA pressure by cardiac catheterization just before AF ablation in 59 patients. Results: The ePCWP was correlated with PCWP measured by cardiac catheterization (r=0.71, p<0.01). The ePCWP and maximum LAV before ablation in recurrence group increased compared with non-recurrence group (15±3 vs. 11±4 mmHg, and 58±15 vs. 49±15 ml/m2, respectively). LA total and active EF decreased, and LA stiffness increased in recurrence group (39±10 vs. 44±11%, 20±7 vs. 25±10% and 0.83±0.59 vs. 0.47±0.33). In multivariate analysis, ePCWP was independently associated with successful ablation best among LAEF, active EF, maximum LAV and ePCWP. Using 13 mmHg of ePCWP as a cutoff, the sensitivity and specificity for successful ablation were 77 and 73% and the positive and negative predictive value were 44 and 92% (AUC= 0.81). Conclusion: Elevation of ePCWP before AF ablation was the best predictor of AF recurrence after AF ablation. This suggested a strong relation between LV filling pressure and the progression of LA remodeling responsible for AF. The ePCWP estimated by STE is useful to predict the successful outcome of AF ablation.

scholarly journals Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

2017 ◽  
Vol 3 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Ecaterina Scarlatescu ◽  
Dana Tomescu ◽  
Sorin Stefan Arama
Keyword(s):  
Anticoagulant Therapy ◽  
Coagulation Activation ◽  
Proper Selection ◽  
Beneficial Effects ◽  
Patient Heterogeneity ◽  
The Difference ◽  
The Right ◽  
Harmful Effects ◽  
Selection Of Patients ◽  
Selection Of

Abstract Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.

Predictors of Successful Outcome for Lumbar Chemonucleolysis: Analysis of 3000 Cases during the Past 14 Years

Neurosurgery ◽  
2002 ◽  
Vol 51 (suppl_2) ◽  
pp. S2-123-S2-128 ◽  
Author(s):  
Young-Soo Kim ◽  
Dong-Kyu Chin ◽  
Yong-Eun Cho ◽  
Byung-Ho Jin ◽  
Do-Heum Yoon
Keyword(s):  
Back Pain ◽  
Clinical Outcome ◽  
Patient Group ◽  
Chief Complaint ◽  
Leg Pain ◽  
Successful Outcome ◽  
Duration Of Symptoms ◽  
Straight Leg Raising ◽  
Selection Of Patients ◽  
Selection Of

Abstract OBJECTIVE Among numerous minimally invasive procedures for the treatment of herniated lumbar disc disease (HLD), chymopapain chemonucleolysis has the longest history of clinical usage. Long-term studies indicated good clinical results with a low risk for patients. However, much confusion still remains about the indications. This study was conducted to evaluate the predictors of successful outcome for chemonucleolysis and to firmly establish the proper indications for this procedure. METHODS Three thousand patients with HLD were treated with chemonucleolysis between 1984 and 1999. The clinical success rate in our series was 85%. The medical history and physical and radiological findings, including the type and direction of disc herniation, were analyzed retrospectively. RESULTS The patient group with the chief complaint of leg pain achieved a better clinical outcome than the patient group with low back pain (88% versus 59%, P &lt; 0.05). A positive straight-leg-raising test was strongly correlated with good clinical outcome (&lt; P &lt; 0.05). Patients manifesting a soft, protruded disc had a better outcome than those manifesting diffuse bulging disc (&lt; P &lt; 0.05). Other prognostic factors favoring a good outcome were as follows: young age, short duration of symptoms, and no bony spur or calcification on radiological study. CONCLUSION Chymopapain chemonucleolysis is a safe and effective procedure. Proper selection of patients is important for the success of treatment. We propose the following three clinical criteria (Kim's triad) for selection of patients: chief complaint of leg pain rather than back pain, positive straight-leg-raising test, and soft protruded disc.

scholarly journals Cardioembolic stroke: everything has changed

2018 ◽  
Vol 3 (2) ◽  
pp. 76-83 ◽  
Author(s):  
J David Spence
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Paradoxical Embolism ◽  
Percutaneous Closure ◽  
Cardioembolic Stroke ◽  
Severe Haemorrhage ◽  
Selection Of Patients ◽  
Selection Of ◽  
Metabolic Deficiency

Historically, because of the difficulty of using warfarin safely and effectively, many patients with cardioembolic stroke who should have been anticoagulated were instead given ineffective antiplatelet therapy (or no antithrombotic therapy). With the arrival of new oral anticoagulants that are not significantly more likely than aspirin to cause severe haemorrhage, everything has changed. Because antiplatelet agents are much less effective in preventing cardioembolic stroke, it is now more prudent to anticoagulate patients in whom cardioembolic stroke is strongly suspected. Recent advances include the recognition that intermittent atrial fibrillation is better detected with more prolonged monitoring of the cardiac rhythm, and that percutaneous closure of patent foramen ovale (PFO) may reduce the risk of stroke. However, because in most patients with stroke and PFO the PFO is incidental, this should be reserved for patients in whom paradoxical embolism is likely. A high shunt grade on transcranial Doppler saline studies, and clinical clues to paradoxical embolism, can help in appropriate selection of patients for percutaneous closure. For patients with atrial fibrillation who cannot be anticoagulated, ablation of the left atrial appendage is an emerging option. It is also increasingly recognised that high levels of homocysteine, often due to undiagnosed metabolic deficiency of vitamin B12, markedly increase the risk of stroke in atrial fibrillation, and that B vitamins (folic acid and B12) do prevent stroke by lowering homocysteine. However, with regard to B12, methylcobalamin should probably be used instead of cyanocobalamin. Many important considerations for judicious application of therapies to prevent cardioembolic stroke are discussed.

Cochlear Nerve Section for Intractable Tinnitus

1995 ◽  
Vol 74 (7) ◽  
pp. 468-476 ◽  
Author(s):  
Jack L. Pulec
Keyword(s):  
Spiral Ganglion ◽  
Accurate Diagnosis ◽  
Cochlear Nerve ◽  
Careful Examination ◽  
Complete Relief ◽  
Proper Selection ◽  
Nerve Section ◽  
Subjective Tinnitus ◽  
Selection Of Patients ◽  
Selection Of

Tinnitus is a common and often very disturbing symptom. The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery. Intractable subjective tinnitus originating within the cochlea or cochlear nerve can frequently be successfully treated by cochlear nerve section. The cochlear nerve must be severed medial to the spiral ganglion to obtain optimum results. One hundred fifty-one cases are reported. Complete relief of tinnitus was achieved in 101 patients, worthwhile improvement was obtained in 43 patients and 7 patients obtained no improvement. The indications for this surgery will be given. Careful examination, accurate diagnosis, and proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success.

scholarly journals Complications of Circumcision

2011 ◽  
Vol 11 ◽  
pp. 2458-2468 ◽  
Author(s):  
Aaron J. Krill ◽  
Lane S. Palmer ◽  
Jeffrey S. Palmer
Keyword(s):  
Health Care ◽  
Preoperative Evaluation ◽  
The United States ◽  
Safe Procedure ◽  
Significant Cost ◽  
Proper Selection ◽  
Significant Percentage ◽  
Bleeding History ◽  
Selection Of Patients ◽  
Selection Of

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

scholarly journals A STUDY OF PORT SITE INFECTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mahesh Joshi ◽  
Prama Dubey
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Quality Of Healthcare ◽  
Port Site ◽  
Site Infection ◽  
Proper Selection ◽  
Basic Principles ◽  
Elective Laparoscopic Cholecystectomy ◽  
Selection Of Patients ◽  
Selection Of

Background: Port site infections though rare, shall be evaluated and studied so as to improve the quality of healthcare. Materials and Methods: This prospective study was conducted on100 patients of all age group and both sexes with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were analysed for port site infection. Result:   Out of 100 patients studied only 3 patients presented with port site infection. Conclusion: It is concluded that port site infection are rare in elective laparoscopic cholecystectomy and can be further reduced by proper selection of patients, and strictly following basic principles of laparoscopic cholecystectomy Keywords: Port site infection, laparoscopic, Cholecystectomy

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