Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry

Background

Catheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence; hence, there is scope to potentially improve outcomes through technical innovations such as ablation index (AI) guidance during AF ablation. We present real-world 5-year follow-up data of AI-guided pulmonary vein isolation.

Methods

We retrospectively followed 123 consecutive patients who underwent AI-guided CA shortly after its introduction to routine practice. Data were collected from the MPH AF Ablation Registry with the approval of the institutional research board.

Results

Our patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger left atrial sizes compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures is as follows: year 1: 0.95, year 2: 0.92, year 3: 0.85, year 4: 0.79, and year 5: 0.72. Age >75 years (p = 0.02, HR: 2.7, CI: 1.14-6.7), BMI >35 kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8-11.4), and left atrial width as measured on CT in the upper quartile (p = 0.04, HR: 2.5, CI: 1-5.7) were statistically significant independent predictors of recurrent AF.

Conclusion

AI-guided CA is an effective treatment for AF, with 95.8% of patients remaining free from atrial arrhythmia at 1 year and 72.3% at 5 years, allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age >75 years, BMI >35 kg/m2, and markedly enlarged atria were associated with higher recurrence rates.

Chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander peoples in Victoria, Australia: a population-based cohort study from 2015 to 2019

Background

This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain.

Methods

State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes.

Findings

From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre.

Interpretation

Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified.

Funding

National Health and Medical Research Council, National Heart Foundation.

Older Women's Experiences of a Community-Led Walking Programme Using Activity Trackers

Promoting physical activity amongst older adults represents a major public health goal and community-led exercise programmes present benefits in promoting active lifestyles. Commercial activity trackers potentially encourage positive behaviour change with respect to physical exercise. This qualitative study investigated the experiences and attitudes of older adults following a 6-week community-led walking programme utilising activity trackers. Eleven community-dwelling older women aged 60+ completed individual phone interviews following their involvement in the programme. The programme, codesigned with a group of senior citizens, equipped participants with wrist-worn activity trackers and included biweekly check-in sessions with a researcher to monitor progress and support motivation. Interviews explored participants’ experiences of the programme and of using activity trackers for the purpose of becoming more active. A thematic analysis produced three main themes: ‘programme as a source of motivation’, ‘user experiences with the technology’ and ‘views on social dimension of the programme’. Overall, participants highlighted the self-monitoring function of activity trackers as most beneficial for their exercise levels. This study provides insights into the personal and social factors perceived by older adults in relation to being part of a community-led programme using activity trackers. It highlights the role of the programme and trackers in maintaining motivation to stay active.

Reducing Inappropriate Overutilization of the Massive Transfusion Protocol

Introduction/Objective

Massive transfusion protocols (MTPs) make it possible to deliver blood products to exsanguinating patients in an efficient, sustained, and immediate manner. However, overutilization of MTPs continues to remain a significant problem for hospital blood banks. The study aims to address the characteristics of possibly inappropriate MTP activations during the first phase (cooler) at a level 1 trauma academic medical center.

Methods

This was a retrospective review of 328 phase 1 MTPs out of 696 total MTPs performed during a two-year period (Jan 1, 2017 and Dec 31, 2018) and divided into three categories: trauma, non-trauma surgery, and medicine services. We assumed that a possibly inappropriate MTP for trauma cases would show an Assessment of Blood Component (ABC) score of 1 or less and physicians used clinical discretion. For possibly inappropriate MTP non- trauma surgical and medicine cases, we devised a new system where we looked at only whether the blood pressure was equal to or less than 90 mm Hg and/or the pulse was greater than or equal to 120 beats per minute. If there was a score of 0 where there were neither vital sign criteria, then the MTP was considered possibly inappropriate.

Results

For trauma service, there were 43/168 (25.6%) cases that had an ABC score of 0, 49/168 (29.2%) cases that had an ABC score of 1, 53/168 (31.5%) cases that had an ABC score of 2, 21/168 (12.5%) cases that had an ABC score of 3, and only 2/168 (1.2%) case that had an ABC score of 4. Non-trauma surgery service had 31/51 (60.8%) cases with a new score of 0, 20/51 (39.2%) cases with a new score of 1, and 0/51 (0%) cases with a new score of 2. Medicine services had 57/109 (52.3%) patients with a new score of 0, 47/109 (43.1%) patients with a new score of 1, and 5/109 (4.6%) patients with a new score of 2. Non-trauma surgery service had the greatest possibly inappropriate MTP activations [31/51 cases (60.8%)], followed by trauma [92/168 (54.8%) cases] and medicine [57/109 (52.3%) cases].

Conclusion

Our study shows greater overutilization with MTPs using clinical judgment than with using the ABC criteria. Non-trauma surgery service had the greatest number of possibly inappropriate MTP activations at our hospital without having a significantly abnormal pulse or blood pressure. While ABC criteria is already liberal for activating an MTP, physician discretion appears to be more liberal in activating a possibly inappropriate MTP.

TECRA Listeria Visual Immunoassay (TLVIA) for Detection of Listeria in Foods: Collaborative Study

A collaborative study involving 26 laboratories and 5 food types was performed to compare the TECRA Listeria Visual Immunoassay (TLVIA) with standard culture methods. Three foods (lettuce, ice cream, and fish fillets), under the jurisdiction of the U.S. Food and Drug Administration, and 2 foods (cooked chicken and cooked ground turkey), under the jurisdiction of the U.S. Department of Agriculture, were used to determine the effectiveness of the TLVIA. Of the 900 samples tested, 300 were inoculated with low levels (1-5 cells/25 g) of Listeria spp. and 300 were inoculated with high levels of Listeria spp. (10-50 cells/25 g). Method agreement between the conventional culture methods and TLVIA (visual) was 94.7%. Method agreement between the conventional culture methods and TLVIA (reader) was 93.6%. The colorimetric polyclonal enzyme immunoassay (TLVIA) for detection of Listeria in foods has been adopted first action by AOAC INTERNATIONAL.

One bout of open skill exercise improves cross-modal perception and immediate memory in healthy older adults who habitually exercise

One single bout of exercise can be associated with positive effects on cognition, due to physiological changes associated with muscular activity, increased arousal, and training of cognitive skills during exercise. While the positive effects of life-long physical activity on cognitive ageing are well demonstrated, it is not well established whether one bout of exercise is sufficient to register such benefits in older adults. The aim of this study was to test the effect of one bout of exercise on two cognitive processes essential to daily life and known to decline with ageing: audio-visual perception and immediate memory. Fifty-eight older adults took part in a quasi-experimental design study and were divided into three groups based on their habitual activity (open skill exercise (mean age = 69.65, SD = 5.64), closed skill exercise, N = 18, 94% female; sedentary activity-control group, N = 21, 62% female). They were then tested before and after their activity (duration between 60 and 80 minutes). Results showed improvement in sensitivity in audio-visual perception in the open skill group and improvements in one of the measures of immediate memory in both exercise groups, after controlling for baseline differences including global cognition and health. These findings indicate that immediate benefits for cross-modal perception and memory can be obtained after open skill exercise. However, improvements after closed skill exercise may be limited to memory benefits. Perceptual benefits are likely to be associated with arousal, while memory benefits may be due to the training effects provided by task requirements during exercise. The respective role of qualitative and quantitative differences between these activities in terms of immediate cognitive benefits should be further investigated. Importantly, the present results present the first evidence for a modulation of cross-modal perception by exercise, providing a plausible avenue for rehabilitation of cross-modal perception deficits, which are emerging as a significant contributor to functional decline in ageing.

Treatment of type-two odontoid fractures in halothoracic vests

We treated 22 patients with type-two odontoid fractures in halothoracic vests for six to eight weeks followed by a Philadelphia collar for four weeks. Eighteen patients were reviewed by questionnaire and radiography at a mean of 40 months after injury. We assessed union, fracture position, the degree of permanent pain and stiffness, satisfaction with the treatment and the outcome.

The overall union rate was 82%. Posterior malunion with residual posterior displacement or angulation was associated with a higher incidence of persisting pain. The position at union did not correlate with the residual cervical stiffness. Fractures failed to unite in four patients (18%) none of whom had late neurological sequelae, although they had more late pain. There were associations between the development of nonunion and an extension-type injury, age over 65 years and delay in diagnosis.