Atrial electrophysiologic properties of patients with asymptomatic Wolff-Parkinson-White syndrome

To evaluate the existence of a peculiar atrial electrophysiologicsubstrate, we studied 18 patients with asymptomatic Wolff-Parkinson-White(WPW) syndrome. These patients were compared with 10 agematchednormal subjects (N). Effective and functional refractory periodswere determined at two right atrial sites (high and low in thelateral wall), during atrial pacing (100 min^–1) and attwice diastolic threshold. Disperson (D) of effective (ERP)and functional (FRP) refractoriness was evaluated as the differencebetween refractory periods at the two atrial sites. WPW patientsshowed significantly lower mean values of effective and functionalrefractoriness at both atrial sites and significantly highermean values of D-ERP and D-FRP. Moreover, in calculating thehighest normal values of D-ERP and D-FRP (as mean values ofN plus 2SD) it was observed that WPW with abnormal values ofD showed a statistically (x² test) higher incidence (100%) ofinduced atrial fibrillation (AF). These findings indicate theexistence of both an abnormal atrial electrophysiologic substrateand of a higher vulnerability in WPW. Finally, AF was inducedgenerally at the site with the lower refractoriness (i.e. lowlateral site). This should be taken into account when consideringhow atrial fibrillation can be induced more easily.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Assessing the accuracy of self‐reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation

Introduction and Aims. A significant level of misreport or error occurs during questionnaire‐based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participant's inclination to under‐report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self‐reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined. Design and Methods. Women attending two Aboriginal Medical services in Far North Queensland for antenatal care were invited to participate. Women completed an interviewer assisted questionnaire relating to their smoking status and a 24 h diary of their exposure to nicotine and consumption of alcohol. Urine samples were analysed for cotinine using an Enzyme Linked Immunosorbent Assay. Results. Cotinine analysis indicated that 17% of women who reported that they were non‐smokers were likely to have misreported this status, or be exposed to high levels of passive smoke. The only significant predictors of cotinine level were self‐reported nicotine exposure (including passive smoke) and number of cigarettes smoked in the previous 24 h. Other individual and environmental variables had no significant influence on cotinine level using this analysis technique. Discussion and Conclusions. The level of potential error in smoking assessment among this group was substantial. Exposure to environmental tobacco smoke might explain part of this error, but the reasons for misreport can only be speculated. This rate of misclassification should be taken into consideration in routine screening of antenatal women in primary health care.[Gilligan C, Sanson‐Fisher R, Eades S, Wenitong M, Panaretto K, D'Este C. Assessing the accuracy of self‐reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation. Drug Alcohol Rev 2009]     

Quality of life research: is there a difference in output between the major cancer types?

SANSON‐FISHER R., BAILEY L.J., ARANDA S., D'ESTE C., STOJANOVSKI E., SHARKEY K. & SCHOFIELD P. (2010) European Journal of Cancer Care 19 , 714–720
Quality of life research: is there a difference in output between the major cancer types? As a result of more people living with or surviving cancer, outputs for quality of life research may have increased over time to reflect the needs of the growing number of people affected by cancer. To determine if this is the case, the authors sought to examine the number and proportion of publications concerned with cancer patients' quality of life for four major cancer sites (breast, lung, prostate, colorectal) over five equal time periods (1985, 1990, 1995, 2000, 2005). A computer‐based literature search using Medline and PsycINFO databases was undertaken. A comparison search with cancer‐related biomedical terms was conducted. The results showed that the number of quality of life publications was substantially lower compared with biomedical publications over time, although the average annual relative increase in publications was greatest for quality of life. The total number of quality of life publications was greatest for breast cancer and lowest for colorectal cancer at all five time points. The relative increase over time of quality of life publications was greatest for prostate cancer and lowest for breast cancer. More research is needed regarding quality of life for cancer patients. Breast cancer has dominated quality of life research outputs despite a lower relative increase in publications over time compared with other cancer sites. There is need for debate among funding agencies and researchers to ensure research efforts are shared among cancer types.