Patients with symptomatic, paroxysmal, untreated atrial fibrillation were randomly assigned to antiarrhythmic drug therapy or cryoablation. At 1 year, there was a significantly lower rate of ...recurrence of atrial fibrillation with cryoablation than with drug therapy.
This open-label, randomized trial assessed the safety of uninterrupted dabigatran versus warfarin in 635 patients undergoing ablation for atrial fibrillation. The incidence of major bleeding events ...was significantly lower with dabigatran than with warfarin (1.6% vs. 6.9%).
Catheter ablation of atrial fibrillation is a well-established treatment for symptomatic atrial fibrillation. Guidelines have incorporated catheter ablation of symptomatic atrial fibrillation as a class 1 or 2 indication, depending on previous antiarrhythmic treatment and type of atrial fibrillation.
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The most important complications associated with ablation of atrial fibrillation are periprocedural stroke or transient ischemic attack (TIA) and cardiac tamponade.
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Systemic anticoagulation before, during, and after ablation is important in reducing the risk of periprocedural cerebrovascular events.
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To minimize these risks, heparin should be administered during ablation to maintain an activated clotting time of more than 300 seconds. However, . . .
In patients with persistent atrial fibrillation, rates of recurrent atrial fibrillation at 18 months were not significantly different when linear ablation or ablation of complex fractionated ...electrograms was performed along with pulmonary-vein isolation.
Percutaneous catheter ablation is an effective treatment for paroxysmal atrial fibrillation,
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particularly in cases that are refractory to antiarrhythmic medications.
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Most triggers for paroxysmal atrial fibrillation come from the pulmonary veins, so ablation involves creating circumferential lesions around the veins to electrically isolate them from the rest of the left atrium.
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Catheter ablation for persistent atrial fibrillation is more challenging and is associated with less favorable outcomes.
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To improve outcomes, ablation targeting the substrate that maintains fibrillation (i.e., substrate modification) is often added to pulmonary-vein isolation.
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The two most common techniques for substrate modification are the . . .
Pulsed field ablation uses electrical pulses to cause nonthermal irreversible electroporation and induce cardiac cell death. Pulsed field ablation may have effectiveness comparable to traditional ...catheter ablation while preventing thermally mediated complications.
The PULSED AF pivotal study (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF) was a prospective, global, multicenter, nonrandomized, paired single-arm study in which patients with paroxysmal (n=150) or persistent (n=150) symptomatic atrial fibrillation (AF) refractory to class I or III antiarrhythmic drugs were treated with pulsed field ablation. All patients were monitored for 1 year using weekly and symptomatic transtelephonic monitoring; 3-, 6-, and 12-month ECGs; and 6- and 12-month 24-hour Holter monitoring. The primary effectiveness end point was freedom from a composite of acute procedural failure, arrhythmia recurrence, or antiarrhythmic escalation through 12 months, excluding a 3-month blanking period to allow recovery from the procedure. The primary safety end point was freedom from a composite of serious procedure- and device-related adverse events. Kaplan-Meier methods were used to evaluate the primary end points.
Pulsed field ablation was shown to be effective at 1 year in 66.2% (95% CI, 57.9 to 73.2) of patients with paroxysmal AF and 55.1% (95% CI, 46.7 to 62.7) of patients with persistent AF. The primary safety end point occurred in 1 patient (0.7%; 95% CI, 0.1 to 4.6) in both the paroxysmal and persistent AF cohorts.
PULSED AF demonstrated a low rate of primary safety adverse events (0.7%) and provided effectiveness consistent with established ablation technologies using a novel irreversible electroporation energy to treat patients with AF.
URL: https://www.
gov; Unique identifier: NCT04198701.
Secondary
infection is a significant cause of morbidity and mortality during influenza epidemics and pandemics. Multiple pathogenic mechanisms, such as lung epithelial damage and dysregulation of ...neutrophils and alveolar macrophages (AMs), have been suggested to contribute to the severity of disease. However, the fundamental reasons for influenza-induced susceptibility to secondary bacterial pneumonia remain unclear. In this study, we revisited these controversies over key pathogenic mechanisms in a lethal model of secondary bacterial pneumonia with an
strain that is innocuous to mice in the absence of influenza infection. Using a series of in vivo models, we demonstrate that rather than a systemic suppression of immune responses or neutrophil function, influenza infection activates IFN-γR signaling and abrogates AM-dependent bacteria clearance and thereby causes extreme susceptibility to pneumococcal infection. Importantly, using mice carrying conditional knockout of
gene in different myeloid cell subsets, we demonstrate that influenza-induced IFN-γR signaling in AMs impairs their antibacterial function, thereby enabling otherwise noninvasive
to cause deadly pneumonia.
In this trial, patients receiving oral anticoagulation therapy who required pacemaker or defibrillator surgery were assigned to heparin bridging or continuation of warfarin. Patients receiving ...warfarin had a markedly lower risk of clinically significant device-pocket hematoma.
Each year, an estimated 1.25 million pacemakers and 410,000 implantable cardioverter–defibrillators (ICDs) are implanted worldwide.
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Between 14 and 35% of patients receiving these devices require long-term oral anticoagulation therapy,
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and their periprocedural treatment presents a dilemma to physicians. This is particularly true for the subset of patients at moderate-to-high risk (≥5% per year) for thromboembolic events.
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Current guidelines recommend interruption of oral anticoagulation therapy and the use of bridging therapy with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin around the time of surgery.
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However, there are a number of potential drawbacks to bridging with heparin in the perioperative period. . . .
Abstract The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important ...advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Atrial fibrillation (AF) is an extremely common clinical problem with an important population morbidity and mortality burden. The management of AF is complex and fraught with many uncertain ...and contentious issues, which are being addressed by extensive ongoing basic and clinical research. The Canadian Cardiovascular Society AF Guidelines Committee produced an extensive set of evidence-based AF management guidelines in 2010 and updated them in the areas of anticoagulation and rate/rhythm control in 2012. In late 2013, the committee judged that sufficient new information regarding AF management had become available since 2012 to warrant an update to the Canadian Cardiovascular Society AF Guidelines. After extensive evaluation of the new evidence, the committee has updated the guidelines for: (1) stroke prevention principles; (2) anticoagulation of AF patients with chronic kidney disease; (3) detection of AF in patients with stroke; (4) investigation and management of subclinical AF; (5) left atrial appendage closure in stroke prevention; (6) emergency department management of AF; (7) periprocedural anticoagulation management; and (8) rate and rhythm control including catheter ablation. This report presents the details of the updated recommendations, along with their background and rationale. In addition, a complete set of presently applicable recommendations, those that have been updated and those that remain in force from previous guideline versions, is provided in the Supplementary Material.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract This article compares and contrasts the current recommendations, and highlights the important differences, in the American College of Cardiology (ACC)/American Heart Association (AHA)/Heart ...Rhythm Society (HRS), European Society of Cardiology (ESC), and Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: 1) the definition of non-valvular AF, which subsequently impacts anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants (NOACs); 2) the symptom-score used to guide management decisions and longitudinal patient profiling; 3) the stroke-risk stratification algorithm used to determine indications for OAC therapy; 4) the role of ASA in stroke prevention in AF; 5) the antithrombotic regimens employed in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; 6) the rate control target and medications recommended to achieve the target; and 7) the role of “first-line” catheter ablation, open surgical ablation, and left atrial appendage exclusion.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Ciprofloxacin (CIP) is a fluoroquinolone family antibiotic pollutant. CIP existence in water environment has been rising very fast in day-to-day life and subsequently, it gives enormous health issues ...for humans because of its potent biological activity. To encounter this, current researchers are focusing on the development of highly efficient visible light semiconductor nanocomposites with potential photocatalytic activity. In the present work, we have successfully synthesized highly efficient zinc-aluminum layered double hydroxides with graphitic carbon nitride (ZALDH/CN) composites via a simple microwave irradiation method first time for the degradation of CIP under visible light. The fabricated materials are subsequently characterized by various spectroscopic techniques. UV–Vis DRS, TRFL, XRD, FT-IR, BET, FE-SEM, TEM, and XPS for optical, crystal structure, morphological, and elemental analysis. The main reactive intermediates which are formed during the photocatalytic degradation process were analyzed by LC-MS analysis. It is worth to note that, the optimized ZALDH/CN-10 composite showed the highest photo-degradation rate constant of 1.22 × 10−2 min−1 with 84.10% degradation is higher than bare CN and ZALDH photocatalysts. Based on the electron-hole pair trapping experiment results, possible CIP photo-degradation mechanism was also explained in the present study. With all results, this work demonstrates the ZALDH/CN composite materials showed a high synergistic effect with more specific surface area. Highest specific surface area leads to enhanced visible light adsorption capacity. Subsequently improved number of catalytically active sites. Furthermore, as compared with pure materials, composites of ZALDH/CN are having low electron-hole pair recombination. Consequently, the composites ZALDH/CN showed superior photocatalytic activity for antibiotic pollutant CIP degradation under visible-light illumination.
Development of highly efficient ZnAl-LDH/g-C3N4 composite photocatalyst for Ciprofloxacin antibiotic degradation under visible light with the degradation rate is 1.22 × 10−2 min−1. Display omitted
•Development of efficient ZALDH/CN composites by microwave irradiation method.•ZALDH/CN composites shown good optical, structural, and morphological properties.•ZALDH/CN composites shows superior photocatalytic degradation of Ciprofloxacin.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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