Atrial fibrillation in unexplained syncope: observations from the Reveal LINQ registry

Background

Implantable loop recorders (ILRs) have come to play an important role in the workup of patients with recurrent syncope of uncertain origin. In addition to detecting bradyarrhythmias related to syncope, which is the main diagnostic focus in these patients, ILRs are also capable of uncovering subclinical atrial fibrillation (AF).

Purpose

We sought to determine the percentage of patients monitored with an ILR for unexplained syncope who have AF detected and to describe clinical actions taken in these patients.

Methods

Patients enrolled in the Reveal LINQ Registry who received an ILR for unexplained syncope and had at least one follow-up form were included. The device automatically detects AF episodes lasting ≥2 minutes. Patients were considered to have AF based on an AF diagnosis made by the treating physician during follow-up or if device-detected AF was adjudicated as true AF by an external reviewer. AF detection rates were calculated using Kaplan-Meier methods.

Results

In total, 498 patients (aged 61.8±20.0 years, 49.6% female, CHA2DS2VASc score 2.2±1.7) were included and followed for 22±12 months. A history of AF was present in 97 (20%) patients, while 401 patients had no history. By 18 months, the incidence of AF was 70.9% (95% CI, 60.8%, 80.3%) in patients with a history of AF and 21.4% (95% CI, 17.4%, 26.1%) in patients without (Figure). AF detection in those with (30.4%) and without (30.1%) syncope during follow-up was similar. By the end of follow-up, and among patients with newly detected AF, 29/86 (33.7%) were on oral anticoagulation, 7 (8.1%) underwent AF ablation, 6 (7.0%) underwent other type of ablation, and 2 (2.3%) received cardioversion. Other actions among the whole cohort included implant of an IPG, ICD, or CRT in 98/498 (19.7%).

Conclusion

Among patients monitored with ILRs to determine the cause of recurrent syncope episodes, approximately 1 in 5 patients had new AF detected. In addition to improving the management of patients with syncope, ILR data served to support AF-related clinical decisions.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic Inc Incidence of AF according to baseline AF

Use of electrical stimulation and chilling to enhance meat tenderness of heavy lambs

Pouliot, E., Gariépy, C., Thériault, M. and Castonguay, F. W. 2014. Use of electrical stimulation and chilling to enhance meat tenderness of heavy lambs. Can. J. Anim. Sci. 94: 627–637. The aim of this study was to determine if electrical stimulation and chilling can modulate pre-rigor pH–temperature dynamics in order to enhance meat tenderness of heavy lambs produced in Quebec and determine if there is an optimum carcass temperature window to reach pH 6.0. A total of 128 heavy lambs (fasted body weight between 38 and 52 kg) were selected at the abattoir over 8 slaughter days (16 lambs d–1) and assigned to four processing treatments in a 2×2 factorial design: electrical stimulation (ES) or not (NES) and normal (NC) or slow (SC) chilling. Slow-chilled carcasses stayed warmer during the first 12 h postmortem (P<0.001), but reached the same temperature as NC ones thereafter. They also had a lower pH between 2 and 12 h (P<0.05). Stimulated carcasses had a lower pH than NES throughout the first 24 h postmortem (P<0.001), while ultimate pH was similar (P=0.738). Shear force values were improved (P<0.001) by both ES and aging as expected, although chilling had no effect (P=0.400). Stimulation×aging interactions for shear force values (P=0.019) and myofibrillar fragmentation index (P=0.097) indicate that aging began earlier following ES. Sarcomeres were longer for ES compared with NES carcasses (P<0.001) indicating that the latter were subject to cold shortening. Meat from NES carcasses was more prone to be tough, although an important part of NES carcasses provided tender meat. This illustrates the importance of individual variations on tenderness and the multiplicity of factors involved in its development. No optimal window was observed for temperature at pH 6.0.

Effects of low-voltage electrical stimulation and aging on lamb meat quality

Pouliot, E., Gariépy, C., Thériault, M., Avezard, C., Fortin, J., Simmons, N. J. and Castonguay, F. W. 2012. Effects of low-voltage electrical stimulation and aging on lamb meat quality. Can. J. Anim. Sci. 92: 59–66. The aim of this study was to evaluate the effect of electrical stimulation (ES) and aging time on meat quality of heavy lamb as produced in Quebec. Seventy-six Suffolk-sired crossbred male lambs were slaughtered at a target weight of 50±2 kg. Half of them were electrically stimulated (ES vs. control) at 5–10 min postmortem (21 V; 0.25 A; 60 s). Postmortem pH decline and temperature were monitored. After carcass cutting, longissimus dorsi sections were assigned to aging periods of 1, 3 or 8 d. Temperature decline was the same for both treatments (P=0.749). However, ES carcasses always had a lower pH value than controls during the first 24 h (P<0.001) while the ultimate pH was equivalent (P=0.803). Tenderness, as assessed by either Warner-Bratzler shear force (39 carcasses) or sensory evaluation (35 carcasses) was enhanced by both ES (P<0.001) and aging (P<0.001). At each aging time, tenderness was greater for ES meat. In addition, only 3 d of aging were necessary for ES meat to achieve the tenderness level attained by the controls after 8 d. Sarcomeres were longer (P<0.001) in ES meat than in controls while myofibrillar fragmentation index was not affected by ES treatment (P=0.743). Electrical stimulation also had small effects on color parameters (a*, b* and L*; P<0.01) and flavor (P=0.04). These results provide the first evidence that tenderness of the meat from heavy lambs produced and processed in Quebec could be enhanced by ES, mostly through cold shortening reduction.