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Zhang X, Xing Z, Fang C, Yang M, Luo J, Ning Z. Safety and Efficacy of Cryoballoon Pulmonary Vein Isolation and Left Atrial Appendage Closure Combined Procedure and Half-Dose Rivaroxaban After Operation in Elderly Patients with Atrial Fibrillation. J Multidiscip Healthc 2023; 16:2603-2611. [PMID: 37693855 PMCID: PMC10492544 DOI: 10.2147/jmdh.s424843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background To investigate the safety and effectiveness of cryo-balloon pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) combined procedure and half-dose rivaroxaban after operation in elderly patients with atrial fibrillation (AF). Patients and Methods A total of 203 AF patients presented for cryo-balloon PVI, and LAAC combined procedure was included from 2019 to 2021. Postoperative patients were anticoagulated with rivaroxaban with/without clopidogrel for 60 days, with oral rivaroxaban of 10 mg in the elderly group and 20 mg in the non-elderly group. Patients with AF ≥80 and <80 years were considered elderly and non-elderly groups, respectively. Scheduled follow-ups and transesophageal echocardiography were used to assess peri- and post-procedural safety and effectiveness. Results A total of 203 patients underwent the combined procedure, 83 in the elderly and 120 in the non-elderly groups. All patients successfully obtained PVI and satisfactory LAAC. During the perioperative period, one patient had puncture complications in the elderly group and one with thrombosis in the non-elderly group. Oral rivaroxaban was administered to 83.2% and 75% of patients in the elderly and non-elderly groups, respectively, and rivaroxaban was combined with clopidogrel anticoagulation in the remaining patients. The annual rates of composite clinical events were 8.4% and 9.2% in the elderly and non-elderly groups, respectively, with no statistically significant difference. Patients in both groups had complete sealing, and there was no displacement of devices, death and peripheral arterial thrombosis. Recurrence of AF occurred in 25 and 32 patients in the elderly and non-elderly groups, respectively, with no statistically significant difference. Besides, the two groups had no statistically significant difference in cerebral infarction/transient ischemic attack and device-related thrombosis (p > 0.05). Conclusion This study suggests that cryo-balloon PVI and LAAC combined procedure and half-dose rivaroxaban after the operation is safe and effective in treating elderly patients with AF.
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Affiliation(s)
- Xiaogang Zhang
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
| | - Zhongying Xing
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
| | - Chao Fang
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
| | - Meiling Yang
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
| | - Jun Luo
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
| | - Zhongping Ning
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, 201318, People’s Republic of China
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Cecchini F, Mugnai G, Kazawa S, Bolzan B, Iacopino S, Maj R, Placentino F, Ribichini F, Sieira J, Sofianos D, Sorgente A, Tomasi L, de Asmundis C, Chierchia GB. Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity score-based analysis with a younger cohort. J Cardiovasc Med (Hagerstown) 2023; 24:441-452. [PMID: 37285275 DOI: 10.2459/jcm.0000000000001486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In terms of safety and efficacy, cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation. However, CB-A data in octogenarians are still scarce and limited to single-centre experiences. The present multicentre study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years with a cohort of younger patients. METHODS AND RESULTS We retrospectively enrolled 97 consecutive patients aged ≥80 years who underwent PVI using the second-generation CB-A. This group was compared with a younger cohort of patients using a 1:1 propensity score matching. After the matching, 70 patients from the elderly group were analysed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow-up of 23 [18-32.5] months was 60.0% in the elderly group and 71.4% in the control group (P = 0.17). Phrenic nerve palsy was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients in the elderly group and in 5 patients (7.1%) in the younger group (P = 0.51). Only two (1.4%) major complications occurred: one (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage, and one (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period and the need for electrical cardioversion to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses. CONCLUSIONS The present study showed that CB-A PVI is as feasible, safe and effective among appropriately selected octogenarians as it is in younger patients.
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Affiliation(s)
- Federico Cecchini
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, RA, Italy
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Department of Medicine, Azienda Universitaria Ospedaliera Integrata Verona, Verona, Italy
| | - Shuichiro Kazawa
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Department of Medicine, Azienda Universitaria Ospedaliera Integrata Verona, Verona, Italy
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, RA, Italy
| | - Riccardo Maj
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | | | - Flavio Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Department of Medicine, Azienda Universitaria Ospedaliera Integrata Verona, Verona, Italy
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Department of Medicine, Azienda Universitaria Ospedaliera Integrata Verona, Verona, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Jette, Belgium
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Laércio de Araújo Sousa1,2 M, S Shimizu1,3a L, M Patino4 C, A. Torres-Duque5,6 C, Zabert7 I, E Zabert7 G, Perez-Padilla8 R, Varón-Vega5,9,10 F, Cohen11 M, C Ferreira1 J. COVID-19 knowledge, attitudes, and practices among health care workers in Latin America. J Bras Pneumol 2022; 48:e20220018. [DOI: 10.36416/1806-3756/e20220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/13/2022] [Indexed: 01/08/2023] Open
Abstract
Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.
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Affiliation(s)
- Mayson Laércio de Araújo Sousa1,2
- 1. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. 2. Interdepartmental Division of Critical Care Medicine, St. Michael’s Hospital, University of Toronto, Toronto (ON) Canada
| | - Lara S Shimizu1,3a
- 1. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. 3. Divisão de Fisioterapia, Faculdade de Ciências Médicas, Universidade Estadual do Piauí, Teresina (PI) Brasil
| | - Cecilia M Patino4
- 4. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (CA) USA
| | - Carlos A. Torres-Duque5,6
- 5. Fundación Neumológica Colombiana, Bogotá, Colombia. 6. Programa de Doctorado, Universidad de La Sabana, Bogotá, Colombia
| | - Ignacio Zabert7
- 7. Facultad de Ciencias Médicas, Universidad Nacional del Comahue, Cipolletti, Argentina
| | - Gustavo E Zabert7
- 7. Facultad de Ciencias Médicas, Universidad Nacional del Comahue, Cipolletti, Argentina
| | - Rogelio Perez-Padilla8
- 8. Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Fabio Varón-Vega5,9,10
- 5. Fundación Neumológica Colombiana, 9. LaCardio, Bogotá, Colombia.10. Universidad de Navarra, Neiva, Colombia
| | - Mark Cohen11
- 11. Hospital Centro Medico, Ciudad de Guatemala, Guatemala
| | - Juliana C Ferreira1
- 1. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Li F, Zhang L, Wu LD, Zhang ZY, Liu HH, Zhang ZY, Zhang J, Qian LL, Wang RX. Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies. J Clin Med 2022; 11:jcm11154468. [PMID: 35956085 PMCID: PMC9369410 DOI: 10.3390/jcm11154468] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Age is an independent risk factor of the progress and prognosis of atrial fibrillation (AF). However, ablation outcomes between elderly and younger patients with AF remain elusive. Methods: Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to 1 April 2022. Studies comparing AF ablation outcomes between elderly and younger patients and comprising outcomes of AF ablation for elderly patients were included. Trial sequential analysis (TSA) was performed to adjust for random error and lower statistical power in our meta-analysis. Subgroup analysis identified possible determinants of outcome impact for elderly patients after ablation. Moreover, linear and quadratic prediction fit plots with confidence intervals were performed, as appropriate. Results: A total of 27 studies with 113,106 AF patients were eligible. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (risk ratio [RR], 0.95; p = 0.008), as well as a higher incidence of safety outcomes (cerebrovascular events: RR, 1.64; p = 0.000; serious hemorrhage complications: RR, 1.50; p = 0.035; all-cause death: RR, 2.61; p = 0.003). Subgroup analysis and quadratic prediction fit analysis revealed the follow-up time was the potential determinant of freedom from AF for elderly patients after AF ablation. Conclusions: Our meta-analysis suggests that elderly patients may have inferior efficacy and safety outcomes to younger patients with AF ablation. Moreover, the follow-up time may be a potential determinant of outcome impact on freedom from AF for elderly patients after AF ablation.
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Cecchini F, Mugnai G, Iacopino S, Abugattas JP, Adriaenssens B, Al-Housari M, Almorad A, Bala G, Bisignani A, de Asmundis C, De Greef Y, Maj R, Osòrio TG, Pannone L, Schwagten B, Sieira J, Sorgente A, Stroker E, Wolf M, Chierchia GB. Safety and long-term efficacy of cryoballoon ablation for atrial fibrillation in octogenarians: a multicenter experience. J Interv Card Electrophysiol 2022; 65:559-571. [DOI: 10.1007/s10840-022-01313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
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Prasitlumkum N, Tokavanich N, Trongtorsak A, Cheungpasitporn W, Kewcharoen J, Chokesuwattanaskul R, Akoum N, Jared Bunch T, Navaravong L. Catheter Ablation for Atrial Fibrillation in the Elderly > 75 Years old: Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol 2022; 33:1435-1449. [PMID: 35589557 DOI: 10.1111/jce.15549] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is increasingly performed worldwide. As comfort with AF ablation increases, the procedure is increasingly used in patients that are older and in those with more comorbidities. However, it is not well established whether AF ablation in the elderly, especially those >75 years old, has comparable safety and efficacy to younger populations. OBJECTIVE To compare the efficacy and safety profiles in patients older than 75years undergoing AF ablation with younger patients. METHODS Databases from EMBASE, Medline, PubMed and Cochrane, were searched from inception through September 2021. Studies that compared the success rates in AF catheter ablation and all complications rates between patients who were older vs under 75 years were included. Effect estimates from the individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird. RESULTS Twenty-seven observational studies were included in the analysis consisting of 363,542 patients who underwent AF ablation. Comparing patients older than 75 years old to younger patients, there was no difference in the success of ablation rates between elderly and younger patients (pooled OR 0.85: 95% CI:0.69 - 1.05, p=0.131). On the other hand, AF ablation in the elderly was associated with higher complication rates (pooled OR 1.43: 95% CI:1.21 - 1.68, p<0.001) CONCLUSION: As AF ablation is expanded to elderly populations, our study found that AF ablation success rates were similar in both elderly and younger patients. However, older patients experience higher rates of complications that should be considered when offering the procedure and as a means to improve outcomes with future innovations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
| | - Nithi Tokavanich
- Department of Cardiovascular Medicine, Vajira Hospital, Bangkok, Thailand
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL, USA
| | | | - Jakrin Kewcharoen
- Department of Cardiovascular Medicine, Loma Linda University, Loma Linda, CA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nazem Akoum
- Department of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Abstract
This is the thirty-eighth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 28 March 2021. It includes data on COVID-19 cases diagnosed in Australia and the international situation.
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Affiliation(s)
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- Australian Government Department of Health
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