scholarly journals Staged surgical treatment of patients with combination of non-paroxysmal form of atrial fibrillation and isthmus-dependent atrial flutter

2020 ◽  
Vol 27 (1) ◽  
pp. 30-33
Author(s):  
S. A. Vachev ◽  
S. V. Koroljov ◽  
A. S. Zotov ◽  
R. I. Khabazov ◽  
R. I. Troitsky
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Heart Rhythm ◽  
Results Of Treatment ◽  
History Of ◽  
Supraventricular Tachyarrhythmias ◽  
Group 2 ◽  
Surgical Tactics ◽  
Group 1

Objective. To improve the results of treatment for the patients with non-paroxysmal atrial fibrillation (AF) in combination with isthmus-dependent (typical) atrial flutter (AFL) by determining the optimal surgical tactics.Material and methods. The research based on the study of treatment results for 37 patients who are consequentially underwent thoracoscopic radiofrequency fragmentation (TRF) of the left atrium (LA) in the period from April 2017 to December 2019. All of the patients suffered from a combination of 2 types of arrhythmias: non-paroxysmal AF and AFL. Depending on history of catheter ablation (CA) of cavotricuspid isthmus (CTI) before TRF, all patients divided into 2 groups: group 1 - there was anamnesis of CA of CTI before TRF (N = 16; 43%); group 2 - there was no CA of CTI before TRF of the LA (N = 21; 57%). In the postoperative period, all patients underwent examination and interviewed regarding cardiac arrhythmias. At the time of April 1, 2020, information about heart rhythm and its disorders during follow-up period was received from 100% of patients. The duration of the follow-up period after TRF was 17 (3; 35) months.Results. There was no supraventricular tachyarrhythmias (SVT) during all follow-up period after TRF among the patients of group 1. There was 8 patients (38%) of group 2 with AFL, which is developed in the period from 1 to 6 months after TRF. All these patients underwent a CA of CTI after the end of a “blanking” period. There was 2 of 8 patients with developing of SVT after CA of CTI. The source of new rhythm disorder was the ablation line formed during TRF on the roof of the LA.Conclusion. In order to achieve long-term freedom from SVT requiring surgical intervention in patients suffering from a non-paroxysmal AF in combination with a typical AFL it is reasonable to perform catheter radiofrequency ablation of CTI at the first stage before TFR of the LA.

Abstract 15328: Benefits of Prophylactic Pulmonary Vein Isolation in Reducing Future Risk of Atrial Fibrillation in Patients Undergoing Catheter Ablation for Typical Atrial Flutter: Results From a Randomized Trial (REDUCE AF)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
Prasant Mohanty ◽  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Randomized Study ◽  
Loop Recorder ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Group 2 ◽  
Group 1

Introduction: Catheter ablation of cavo-tricuspid isthmus (CTI) is considered to be the most effective therapy for eliminating target arrhythmia in lone atrial flutter (AFL). However, many patients subsequently develop AF after CTI ablation. Therefore, prophylactic pulmonary vein antrum isolation (PVAI) along with CTI ablation could be considered as an alternate option in these patients. We aimed to compare long-term incidence of post-ablation atrial fibrillation following CTI alone or CTI plus PVAI in patients presenting with isolated AFL and no history of atrial fibrillation. Methods: This multi-center prospective randomized study enrolled 216 patients undergoing catheter ablation for isolated typical atrial flutter. Patients were randomized to CTI alone (group 1, n=108, 61.2±9.7 year, 75% male, LVEF 59±10%) or combined ablation CTI+PVAI (group 2, n=108, 62.4±9.3 year, 73% male, LVEF 57±11%). Insertible Loop Recorder (ILR) was implanted in 21 and 19 patients from group 1 and 2 respectively, on the day of the ablation procedure. Remaining patients were monitored for recurrence with event recorders, ECG, 7-day Holter and cardiology evaluation. All patients were followed up for 18±6 months for recurrence. Results: Compared to group 1, group 2 had significantly longer average procedural duration (75.9±33 min vs. 161±48 min [p <0.001]) and fluoroscopy time (15.9±12.3 min vs 56.4+21 min [p<0.001]). At the end of 18±6 months follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank p=0.044). A subgroup analysis was performed with a 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI without undergoing the additional PVI (21 of 24 [83.3%] vs. 19 of 22 [86.4%] respectively, log-rank p=0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group compared to 58 of 86 (67.4%) with CTI+PVI (log-rank p= 0.029). Distribution of AF incidence was not different between patients with and without ILR. Conclusion: Prophylactic PVAI in lone atrial flutter caused marked reduction in new-onset AF in patients ≥ 55 years whereas younger patients (<55 years) did not incur any benefit from the additional procedure.

scholarly journals Risk factors and effective ablation strategy in patients presenting with left atrial flutter with no previous ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D.G Della Rocca ◽  
C Gianni ◽  
A Salwan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Success Rate ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Ectopic Beats ◽  
Group 2 ◽  
Reentrant Circuit ◽  
Group 1

Abstract Background A typical left atrial flutter (LAFL) may occur as a proarrhythmic complication of ablation for atrial fibrillation (AF). Objective We evaluated the risk factors and the best ablation strategy for LAFL in patients with no prior AF ablation. Methods Consecutive patients undergoing first catheter ablation for AFL with no prior procedure for AF were included in this prospective analysis. Based on the ablation strategy, patients were divided into, Group 1: PVI+ Flutter ablation (ablation of re-entry circuits) and Group 2: PVI+ Non-PV trigger ablation (targeting areas of focal activity as triggers). 3-D mapping of the LA was performed during tachycardia to identify the reentrant circuit. PV isolation was performed in all patients. In group 1, ablation line was chosen to transect the area critical for the circuit (roof and mitral line). In group 2, ectopic beats arising from extra-PV foci detected by isoproterenol challenge were ablated. Off-drug success rate was assessed in all. Results A total of 92 and 90 patients were included in group 1 and 2 respectively. Baseline characteristics are provided in table 1. Pre-existent LA scar was detected in 91.3% and 90% of patients in group 1 and 2 respectively. At 2 years of follow-up, 11/92 (12%) from group 1 and 60/90 (66.7%) from group 2 remained arrhythmia-free off-drugs (p&lt;0.001). In the multivariate analysis, PVI +flutter ablation was detected to be associated with significantly high risk of recurrence [HR: 3.92 (95% CI: 2.52–6.1, p&lt;0.001)] Conclusion In this series of patients presenting with LAFL with no earlier AF ablations, pre-existent left atrial scar was detected in majority of cases and PVI+ non-PV trigger ablation provided significantly better success rate than PVI+ flutter ablation. Funding Acknowledgement Type of funding source: None

Abstract 20107: Randomized Comparison of Personalized versus Standardized Substrate Modification During Catheter Ablation for Symptomatic Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Simon Kircher ◽  
Arash Arya ◽  
David Altmann ◽  
Sascha Rolf ◽  
Andreas Bollmann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Voltage ◽  
Randomized Study ◽  
Standard Group ◽  
Linear Lesions ◽  
Substrate Modification ◽  
Arrhythmogenic Substrate ◽  
Group 2 ◽  
Group 1

Introduction: Pulmonary vein (PV) isolation forms the cornerstone of any ablation procedure for atrial fibrillation (AF). There is, however, no uniform strategy how to detect and target left atrial (LA) arrhythmogenic substrate outside the PV antra. Fibrosis that corresponds well to LA low-voltage areas (LVAs) seems to play a key role in AF arrhythmogenesis and might therefore be a suitable target for additional substrate modification (SM). Objective: The purpose of this prospective randomized study was to compare a novel technique for SM based on ablation of potentially arrhythmogenic LA LVAs with a standard approach consisting of empiric LA linear ablation. Methods: Patients (pts) with symptomatic paroxysmal or persistent AF were randomized to standard (group 1) or personalized (group 2) SM. Circumferential PV isolation was the primary step in both groups. In group 1, pre-defined linear lesions were applied at the LA roof and bottom, respectively, and at the mitral isthmus only in pts with persistent AF. In group 2, targets for SM (i.e. LVAs) were identified by detailed bipolar voltage mapping (BVM) during sinus rhythm irrespective of AF type. Peak-to-peak electrogram amplitudes were defined as “normal” (> 0.5 mV), as “low voltages” (0.2 to 0.5 mV), or as “scar” (< 0.2 mV). LVAs were targeted by tissue homogenization and / or strategic linear lesions. The primary endpoint was freedom from any atrial arrhythmia (i.e. AF, atrial flutter, or atrial tachycardia) > 30 seconds off antiarrhythmic drugs on serial 7-d-Holter ECG recordings after a follow-up period of 12 months. Results: In total, 124 ablation-naïve pts (mean age 63 ± 9 years, 62 % male, 49 % with persistent AF) were enrolled in this study. LVAs were present in 18 % of pts with paroxysmal and in 41 % of pts with persistent AF (p<0.05). At the end of the follow-up period, 25 out of 59 pts (42 %) in the conventional group were free from arrhythmia recurrence as compared to 40 out of 59 pts (68 %) in the BVM-guided group (unadjusted log rank p = 0.003). Conclusion: Personalized SM guided by endocardial BVM is associated with a higher success rate compared to a conventional approach applying empirical SM based on AF phenotype.

P4766Edoxaban Treatment in routiNe clinical prActice for patients with atrial fibrillation (AF) in Europe (ETNA-AF-Europe): 1-year follow-up according to body mass index

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Weiss ◽  
R De Caterina ◽  
P Kelly ◽  
P Monteiro ◽  
J C Deharo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Weight ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Normal Weight ◽  
Routine Practice ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have substantially improved anticoagulation therapy for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF), and available routine care data have so far broadly confirmed the safety of different NOACs in routine practice. However, such data for edoxaban are scarce, especially in extremely low and high body weight (BW). These extreme BWs may affect the bioavailability, distribution, and half-life of NOACs and, consequently, outcomes of treatment. Methods We analysed outcomes in normal-weight (BMI 18.5–25) vs overweight (BMI 25–30) and obese (BMI >30) patients enrolled into the ETNA-AF-Europe observational study (NCT02944019) collecting information on patients treated with edoxaban in 825 sites in 10 European countries. This snapshot analysis set includes data of 7,672 patients (56.3% of all enrolled patients) which have completed their 1-year follow-up visit (mean follow-up: 343.5 days). Results Median patient age was 74 years for all patients, 76 years for patients with a BMI 18.5–25 (group 1), 75 years for patients with BMI 25–30 (group 2), and 72 for patients with a BMI >30 (group 3). CrCl was 64 mL/min for patients with a BMI 18.5–25, 68 mL/min for patients with BMI 25–30, and 72 mL/min for patients with a BMI >30. The CHA2DS2-VASc (mean 3.1±1.38) and HAS-BLED (mean 2.5±1.10) score did not differ significantly between groups. As expected, diabetes and hypertension were significantly less prevalent in leaner patients and - accordingly - inversely correlated to age. There was no correlation between body weight and life-threatening bleeding (group 1: 0.28%; group 2: 0.40%; group 3: 0.14%). Also, stroke rates (group 1: 0.74%; group 2: 0.81%; group 3: 0.76%) did not differ between groups. Conclusion BMI, within the range here assessed, does not affect 1-year outcomes in European AF patients treated with edoxaban. Acknowledgement/Funding Daiichi Sankyo Europe GmbH, Munich, Germany

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Results of treatment with bedaquiline containing regimens of MDR/XDR tuberculosis patients including those with concurrent HIV infection (the experience of Leningrad Region)

2020 ◽  
Vol 98 (9) ◽  
pp. 56-62
Author(s):  
T. I. Danilova ◽  
Yu. V. Korneev ◽  
D. A. Kudlay ◽  
N. Yu. Nikolenko
Keyword(s):  
Hiv Infection ◽  
Group Treatment ◽  
Heart Rhythm ◽  
Mycobacterial Infection ◽  
Leningrad Region ◽  
Results Of Treatment ◽  
Extensive Drug Resistance ◽  
Group 2 ◽  
Icd10 Code ◽  
Group 1

The effectiveness of tuberculosis control is associated with efficacy of treatment of TB patients and above all patients with multiple and extensive drug resistance (MDR/XDR MTB). Patients with TB/HIV co-infection providethe significant impact on the situation.The objective of the study is to assess outcomes of chemotherapy regimens containing bedaquiline in patients with MDR/XDR TB including those with concurrent HIV infection.Subjects and methods. The efficacy and safety of the regimes containing bedaquiline were assessed in the intensive phase of chemotherapy in 80 patients with MDR/XDR TB: Group1 consisted of 46 patients with negative HIV status (ICD10 code A15-A19); Group 2 – 34 HIV positive patients at the advanced stage with manifestations of a mycobacterial infection (ICD10 code B20.0).Results. Treatment outcomes in the groups were as follows: the effective treatment was statistically significantly more frequent in Group 1 versus Group 2 (80.4 and 52.9%, respectively, p = 0.0088). Treatment failure was registered in 3 patients from each group; treatment defaults were statistically significantly more frequent in Group 2 compared to Group 1: in 8/34 versus 2/46 (p = 0.011). 3 patients were transferred out in both Group 1 and Group 2 (3/46 and 3/34, p = 0.69). During treatment, only 1 patient from Group 2 developed an adverse event, most likely associated with the in-take of bedaquiline, a heart rhythm disorder (ventricular arrhythmia) and prolongation of QTcF > 450 ms. 

scholarly journals Glasgow Aneurysm Score: a predictor of long-term mortality following endovascular repair of abdominal aortic aneurysm?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anıl Özen ◽  
Metin Yılmaz ◽  
Görkem Yiğit ◽  
İsa Civelek ◽  
Mehmet Ali Türkçü ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Fold Increase ◽  
Abdominal Aortic ◽  
History Of ◽  
Group 2 ◽  
History Of Cancer ◽  
Long Term Mortality ◽  
Group 1

Abstract Background To evaluate the value of Glasgow Aneurysm Score (GAS) in predicting long-term mortality and survival in patients who have undergone endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Methods A retrospective single-center study of 257 patients with non-ruptured AAA undergoing EVAR between January 2013 and 2021. GAS scores were compared between the survivors (group 1) and the long-term mortality (group 2) groups. Cox regression analysis was used to determine independent predictors of late mortality. Receiver operating characteristic curve (ROC) analysis was used to determine the optimum cut-off values of GAS values to determine the effect on late-mortality. Survival analysis was conducted using Kaplan-Meier. Results The study included 257 patients with a mean age of 69.75 ± 7.75 (46–92), who underwent EVAR due to AAA. Average follow up period was 18.98 ± 22.84 months (0–88). Fourty-five (17.8%) mortalities occured during long-term follow-up. A past medical history of cancer resulted in a 2.5 fold increase in risk of long-term mortality (OR: 2.52, 95% CI 1.10–5.76; p = 0.029). GAS values were higher in group 2 compared to group 1 (81.02 ± 10.33 vs. 73.73 ± 10.46; p < 0.001). The area under the ROC curve for GAS was 0.682 and the GAS cut-off value was 77.5 (specificity 64%, p < 0.001). The mortality rates in patients with GAS < 77.5 and GAS > 77.5 were: 12.8% and 24.8% respectively (p = 0.014). Every 10 point increase in GAS resulted in approximately a 2 fold increase in risk of long-term mortality (OR: 1.8, 95% CI 1.3–2.5; p < 0.001). Five year survival rates in patients with GAS < 77.5 and > 77.5 were 75.7% and 61.7%, respectively (p = 0.013). Conclusions The findings of our study suggests that an increase in GAS score may predict long-term mortality. In addition, the mortality rates in patients above the GAS cut-off value almost doubled compared to those below. Furthermore, the presence of a past history of cancer resulted in a 2.5 fold increase in long-term mortality risk. Addition of cancer to the GAS scoring system may be considered in future studies. Further studies are necessary to consolidate these findings.

P426Routine use of transoesophageal echocardiography in patients with atrial fibrillation or atrial flutter undergoing cardioversion

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Etsadashvili ◽  
N Kuridze ◽  
T Kavtiashvili ◽  
T S Chaligava ◽  
V Chumburidze
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Anticoagulation Therapy ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Cardiac Thrombus ◽  
Group 2 ◽  
Anticoagulated Patients ◽  
Group 1

Abstract Background. According to the recent guidelines, effective anticoagulation is recommended for a minimum of 3 weeks before the cardioversion of Atrial Fibrillation/Atrial Flutter. Transoesophageal echocardiography (TOE) could be considered, but is not mandatory to exclude/confirm the cardiac thrombus before the cardioversion in adequately anticoagulated patients. Aim of the study was to reveal the incidence of thrombus or spontaneous echo contrasting (SEC) by TOE before cardioversion, despite effective anticoagulation. Material and methods. Patients, where TOE was performed to evaluate the evidence of thrombus/SEC before the cardioversion of AF/Atrial flutter at our clinic in period of 2016-2018, were studied. Incidence of intracardiac thrombus and its relation to patients’ gender, age, hypertension, diabetes, atrial diameter, LVEF, duration of Atrial Fibrillation/Atrial flutter, as well as to anticoagulation regimen were evaluated. Results. All patients received recommended anticoagulation therapy, DOACs or VKAs, for a minimum of 3 weeks before the TOE. Finally 180 patients were divided in two groups: group 1 (121 patients) without evidence of thrombus and group 2 (59 patients) where TOE revealed the thrombus. Thrombus was found in 37 (20.5%) patients, and SEC was found in 22 (12.2%) patients. There were no difference between the two groups with respect to: gender (85 male (70%) in group 1 vs. 38 male (64%) in group 2, p = NS), age (62.8 ± 8.73 vs. 63.0 ± 9.04, p = NS), hypertension (78 (64.4%) vs. 44 (74.6%), p = NS), diabetes (17 (14%) vs. 7 (12%), p = NS), CHAD2DS2-VASc score (2.2 ± 1.8 vs. 2.4 ± 4.0, p = NS), LVEF (48.1 ± 7.1% vs. 46.4 ± 7.3%, p = NS), duration of arrhythmia (7.7 ± 11.6 months vs. 9.7 ± 14.0 months, p = NS), type on anticoagulation (DOACs 59 (48.3%) vs. 30 (50.8%), p = NS, VKA (Warfarin) 54 (44.6%) vs. 29 (49.1%), p = NS)) respectively. Only difference in atrial diameter was found statistically significant between the two groups: left atrial diameter (42.6 ± 3.3mm vs. 45.3 ± 3.6mm, p &lt; 0.001) and right atrial diameter (39.4 ± 3.3mm vs. 40.8 ± 2.3mm, p = 0.001) respectively. Conclusion. Thrombus/SEC could persist despite the effective anticoagulation therapy for ≥3 weeks. Therefore all patients should perform TOE before the cardioversion to avoid the incidence of stroke.

Comparison of Rosuvastatin versus Atorvastatin for Preventing Postoperative Atrial Fibrillation

2013 ◽  
Vol 16 (3) ◽  
pp. 158 ◽  
Author(s):  
Okay Abaci ◽  
Cuneyt Kocas ◽  
Veysel Oktay ◽  
Cenk Eray Yildiz ◽  
Kadriye Orta Kilickesmez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular ◽  
Postoperative Atrial Fibrillation ◽  
Atorvastatin Treatment ◽  
Elective Cardiac Surgery ◽  
Increased Risk ◽  
History Of ◽  
Group 2 ◽  
Group 1

<p><b>Background:</b> Postoperative atrial fibrillation (AF) following cardiac surgery is associated with an increased risk of stroke, prolonged hospitalization, and increased costs. Statin therapy is associated with a lower incidence of postoperative AF. We aimed to compare the preventive effects of rosuvastatin and atorvastatin on postoperative AF.</p><p><b>Methods:</b> This study included 168 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups according to treatment of statin. Group 1 (n = 96) was patients receiving atorvastatin, and group 2 (n = 72) was patients receiving rosuvastatin. Postoperative electrocardiographs (ECGs) and telemetry strips were examined for AF within postoperative period during hospitalization.</p><p><b>Results:</b> The incidences of postoperative AF were 17.9% (n = 17) in group 1 and 22.2% (n = 16) in group 2 (<i>P</i> = .48). Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF) were not different between groups. Incidence of diabetes, hypertension, hyperlipidemia, smoking, myocardial infarction in past medical history, family history of atherosclerosis, male sex, drug use, and perioperative features were similar between groups.</p><p><b>Conclusions:</b> The present study revealed that preoperative rosuvastatin or atorvastatin treatment did not have a different effect in preventing postoperative AF.</p>

Preemptive Rituximab Infusions Efficiently Prevent Relapses In Acquired Thrombotic Thrombocytopenic Purpura. Experience Of The French Thrombotic Microangiopathies Reference Center

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 448-448
Author(s):  
Miguel HIE ◽  
Julie Gay ◽  
Lionel Galicier ◽  
Francois Provot ◽  
Sandrine Malot ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Median Number ◽  
Continuous Variables ◽  
Adamts13 Activity ◽  
Thrombocytopenic Purpura ◽  
History Of ◽  
Adamts13 Deficiency ◽  
Group 2 ◽  
Group 1

Context Acquired thrombotic thrombocytopenic purpura (TTP) results from a severe, antibody-mediated, deficiency in the von Willebrand factor-cleaving protease ADAMTS13. Rituximab is increasingly used in this indication in patients with a suboptimal response to plasma exchange. When severe acquired ADAMTS13 deficiency persists during remission, the estimated incidence rate is of 0.4/year. So far, it is still controversial whether preemptive rituximab efficiently prevents relapses in these patients. Patients and methods We defined two groups of patients with a history of acquired TTP who displayed a persistent severe ADAMTS13 deficiency during remission. Patients of group 1 were treated with preemptive infusions of rituximab. Patients of group 2 were managed in centers in which preemptive rituximab infusions were not the standard of care. The relapse incidence was evaluated and compared between both groups. Patients were treated according to National recommendations and enrolled from 12 French centers during a 12-year period. Patients were explored for ADAMTS13 activity and peripheral B-cell count every 3 months. Only patients with a > 12-month follow-up after rituximab administration are reported here. Median (25th - 75th percentile) was determined for all continuous variables. Wilcoxon’s test was used to compare continuous variables and the chi-square test or Fisher’s exact test to compare binary data. Relapse-free survival was compared between both groups using the Kaplan-Meier estimator with the corresponding 95% confidence interval. Results Forty-eight patients (20.6%) with a history of acquired TTP displayed a persistent severe ADAMTS13 deficiency on remission or experienced a subsequent severe ADAMTS13 deficiency (24 cases each) after a median follow-up of 17 months (12-29 months). Anti-ADAMTS13 antibodies concentration was 44 U/mL (24-59 U/mL). Thirty patients received preemptive infusions of rituximab (group 1), whereas 18 others had no therapeutical intervention (group 2). In group 1, 16 patients experienced a past history of TTP with a median number of 2 (1-3) episodes, corresponding to a relapse incidence of 0.22 (0-0.57)/year. Rituximab infusions were performed 14.5 months (6.5-27.4 months) after the last TTP episode. A median number of 4 (1-4) rituximab infusions were performed. The median follow-up between the first preemptive infusion of rituximab and the last ADAMTS13 evaluation is of 36 months (24-65 months). After preemptive rituximab administration, only 3 patients experienced a clinical relapse (0 [0] episode/year), corresponding to a significant reduction in the relapse incidence (P < .01). ADAMTS13 activity was 58.5% (30.5%-86.3%). Three months after the first rituximab infusion, ADAMTS13 activity was 46% (30-68); it further increased until the 12th month, and subsequently decreased. Accordingly, B-cell lymphocytes remained undetectable until the 6th month, and progressively increased at the 9th month to reach normal values at the 18th month. Nine patients (30%) required one (5 cases), two (2 cases), three (1 case) or ten (1 case) additional courses of rituximab for a further decrease or a persistent undetectable ADAMTS13 activity, which allowed to maintain a detectable ADAMTS13 activity in all but one patients. The time between two consecutive courses of rituximab was 26 months (5-59 months). At the end of follow-up, ADAMTS13 activity remained normal in 18 patients; 10 patients had a moderate ADAMTS13 deficiency, and 2 patients had a persistently undetectable ADAMTS13 activity. In four patients (13%), rituximab alone failed to increase durably ADAMTS13 activity, which required additional immunosuppressive drugs. In group 2, 14 patients relapsed after a 66-month follow-up (36-105 months), corresponding to a higher relapse incidence than in patients who received preemptive infusions of rituximab (0.23 [0.1-0.46] relapse/year, P<.01). Moreover, 2 patients died of TTP in group 2, whereas no fatal outcome was recorded in group 1. Relapse free survival over time was significantly longer in group 1 (Log-rank test: P = .049). Five patients experienced adverse effects including benign infections in 2 cases. Conclusion Rituximab efficiently prevents TTP relapses in most patients with a persistent acquired ADAMTS13 deficiency, with acceptable side effects. Disclosures: Off Label Use: Rituximab Rituximab may prevent relapses in acquired thrombotic thrombocytopenic purpura.

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