Impact of race and gender on clinical outcomes of catheter ablation in patients with atrial fibrillation

BACKGROUND

Radiofrequency catheter ablation (CA) is an effective treatment of drug-refractory atrial fibrillation (AF). However, the efficacy of CA by race and gender has not been well characterized. We sought to determine the impact of ethnicity and gender on clinical outcome following CA in patients with AF.

METHODS

Patients who underwent CA for AF from September 2013 to April 2016 were included in this study. Patients were identified retrospectively and followed prospectively.

RESULTS

A total of 118 patients (15.3% black and 78.8% white, 33% female) comprised the cohort, with mean age at ablation 63.4 ± 10.4 years. Black patients were older at time of the procedure (65.4 vs 63.4 years old) and had more prevalent comorbidities, including hypertension (77.8% vs 63.4%), diabetes (33.3% vs 15.0%), chronic kidney disease (22.2% vs 7.5%), and lower left ventricular ejection fraction (51.8% vs 56.2%). Blacks also had significantly larger left atrial size (P  =  0.03). Late recurrence of AF was similar between blacks and whites (33.3% vs 34.4%, P  =  1) as well as between women and men (28.2% vs 36.7%, P  =  0.41). Early recurrence was predictive of late recurrence in men (P < 0.001) but not in women (P  =  0.48). Enlarged left atrium and early recurrence of AF were significant predictors for late recurrence of AF in the cohort.

CONCLUSIONS

CA for AF is equally effective in black patients despite more prevalent comorbidity and increased left atrial size. Early recurrence of AF after CA was not predictive of late recurrence of AF in women but was in men.

Colchicine Toxicity: The Fatal Masquerader

Colchicine toxicity results in fatal multiorgan failure. We present a case of colchicine toxicity resulting in transient biventricular failure and cardiogenic shock that were successfully treated with packed red blood cell exchange. (Level of Difficulty: Beginner.)

Prevalence and predictors of atrial arrhythmias in patients with sinus node dysfunction and atrial pacing

PURPOSE

This study aimed to determine the incidence, prevalence, and predictors of atrial arrhythmias (AAs) in patients with symptomatic sinus node dysfunction (SND) who required permanent pacemaker implantation. Also, we evaluated the impact of atrial pacing (AP) on AAs.

METHODS

All consecutive patients who underwent pacemaker implantation from 2005 to 2011 were included. Atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), and AV nodal reentrant tachycardia (AVNRT) were detected via pacemaker interrogation and clinical documentation.

RESULTS

The study group included 322 patients (44% male) with mean age 68.8 ± 15 years and followed for an average of 5.6 ± 2.2 years (median 5.7 years). Overall, 61.8% were found to have any AA at follow-up. Individual prevalence of AAs was high as follows: AF 43.5%, AFL 6.5%, AT 25%, and AVNRT 6.8%. AF was documented in 23% of patients (n = 74) prior to pacemaker; among those, 15% (n = 11) had no recurrence of AF with average AP of 74%. The incidence of new-onset AF after pacemaker was 15.8%. In subgroup analysis, prevalence of AF was increased by 16% with high rate of AP (81-100%) and 17% with lower rate of AP (0-20%). Incidence of new-onset AF was not affected by AP. Diabetes, hypertension, and left atrial enlargement were predictors of AAs. White men and women had higher prevalence of AF.

CONCLUSIONS

AAs are highly prevalent in SND, particularly in white patients. Paroxysmal AF is suppressed with AP in minority, but there is no impact of AP on new-onset AF. Patients with diabetes, hypertension, and dilated atria must be monitored closely for early detection of AAs.

Impact of high-grade atrioventricular block and cumulative frequent pacing on atrial arrhythmias

BACKGROUND

The relationship between high-grade atrioventricular block (HGAVB) with cumulative frequent pacing and risk of atrial arrhythmias (AAs) has not been well characterized. We hypothesized HGAVB and pacing may have significant impact on incidence and prevalence of AAs by modulating atrial substrate.

OBJECTIVE

To determine impact of HGAVB and pacing on AAs including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT).

METHODS

All consecutive patients who underwent dual-chamber pacemaker implantation for HGAVB from 2005 to 2011 at the University of Chicago were included. AAs and percent of pacing were detected through device interrogation. Patients' data were collected from electronic medical records and clinic visits.

RESULTS

A total of 166 patients (mean age 71 ± 15 years; 54% female, 56% African American) were studied. AF was documented in 27% of patients before pacemaker implantation. During a mean 5.8 ± 2.2 years of follow-up, 47% had device-detected AF, 10% AFL, and 26% AT. New-onset AF was documented in 40 of the 122 patients without prior AF (33%). Continuous (≥ 99%) right ventricular pacing was associated with significantly decreased AF prevalence (34% vs 59%, P = 0.005), and correlated with lower incidence (26% vs 41%, P = 0.22). Pacing suppressed AF in 14% of patients with baseline AF; those patients had lower atrial pacing (3.2% vs 45%, P < 0.0001). Left atrial dilation was the only independent predictor of AF with frequent pacing (P = 0.009).

CONCLUSIONS

HGAVB is associated with high incidence and prevalence of AAs with and without pacing. Cumulative frequent (≥99%) ventricular pacing reduces risk of AF in patients with HGAVB.

Incentivizing physical activity through activity monitoring interventions in PAD - a pilot study

Background: There is ample evidence to show that supervised exercise is efficacious and cost effective for improving claudication symptoms in patients with peripheral artery disease (PAD). Home based exercise therapy can be an effective alternative to supervised exercise however, the results of this is variable depending on the level of motivation and engagement of the patient. Patients and methods: We performed a pilot study in 41 patients to determine whether a home based exercise program with the use of an activity tracking device with personalized feedback and financial incentives can increase daily activity, improve walking and sustain engagement in the exercise regimen in patients with PAD. In this randomized pilot study, the patients in the study group were fitted with an activity monitoring device and given behavioral monitoring, motivational updates and feedback regarding their exercise program. This study group was further divided in to two groups. One half of these patients in the study group were also given financial incentives if they reached their set targets. The control group wore the device with no feedback or ability to see their number of steps walked. Results: Results showed that at the end of the 12 week period, patients in the study groups walked more compared to the controls and the financial incentive structure resulted in an additional 38-63% increase in average daily steps. Conclusions: This pilot study revealed that a home-based exercise program with activity monitoring, feedback and financial incentives resulted increased daily steps, 6-minute walking distance and overall compliance with the program in PAD patients with claudication.