Long-term reverse remodeling and clinical improvement by MultiPoint Pacing in a randomized,international, Middle Eastern heart failure study

Journal of Interventional Cardiac Electrophysiology - Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint? Pacing, MPP) has been shown to improve...     

Cryoballoon vs radiofrequency ablation of atrial fibrillation: insights from the Veterans Healthcare System

Purpose

Catheter ablation is considered the mainstay treatment for drug-refractory atrial fibrillation (AF). The aims of our study were to compare the efficacy and safety of the most two currently approved approaches (point-by-point radiofrequency ablation (RFA), either with contact force (CF) or without contact force (nCF) catheters, and cryoballoon ablation (CBA)) in the Veterans Healthcare System.

Methods

We performed a retrospective study of patients who underwent ablation for treatment of AF at the veterans affairs healthcare system between 2013 and 2018. Only the first reported ablation procedure was included.

Results

We included 956 patients in the study (97.4% males, 91.5% Caucasians, 67% paroxysmal AF), with 682 patients in RFA-nCF, 139 in RFA-CF, and 135 in CBA. Thirty-day complication rates were comparable between the three groups with the exception of higher incidence of phrenic nerve injury in CBA group when compared to RFA-nCF (2.2% vs 0.0%, p < 0.01). Long-term recurrence rate of AF was significantly lower in the CBA group when compared to RFA-nCF (33.3% vs 47.7%, adjusted HR 0.60, 95% CI 0.44–0.83, p < 0.01). On the other hand, it was similar between RFA-CF and RFA-nCF groups (43.9% vs 47.7%, adjusted HR 1.01, 95% CI 0.76–1.33, p 0.97). After stratifying patients based on AF type, these findings were only present in patients with paroxysmal AF.

Conclusion

CBA for paroxysmal AF, in male dominant patients’ population, was associated with lower incidence of AF recurrence rate while having a comparable safety profile to RFA independent of the use of CF catheters.

     

Microencapsulation of eucalyptol in polyethylene glycol and polycaprolactone using particles from gas-saturated solutions

Eucalyptol is the natural cyclic ether which constitutes the bulk of terpenoids found in essential oils of Eucalyptus spp. and is used in aromatherapy for treatment of migraine, sinusitis, asthma and stress. It acts by inhibiting arachidonic acid metabolism and cytokine production. Chemical instability and volatility of eucalyptol restrict its therapeutic application and necessitate the need to develop an appropriate delivery system to achieve extended release and enhance its bioactivity. However, the synthesis method of the delivery system must be suitable to prevent loss or inactivation of the drug during processing. In this study, supercritical carbon dioxide (scCO₂) was explored as an alternative solvent for encapsulation and co-precipitation of eucalyptol with polyethylene glycol (PEG) and/or polycaprolactone (PCL) using the particles from gas-saturated solution (PGSS) process. Polymers and eucalyptol were pre-mixed and then processed in a PGSS autoclave at 45 °C and 80 bar for 1 h. The mixture in scCO₂ was micronized and characterized. The presence of eucalyptol in the precipitated particles was confirmed by infrared spectroscopy, gas chromatography and mass spectrometry. The weight ratios of PEG–PCL blends significantly influenced loading capacity and encapsulation efficiency with 77% of eucalyptol encapsulated in a 4 : 1 composite blend of PEG–PCL. The particle size distribution of the PGSS-micronized particles ranged from 30 to 260 μm. ScCO₂ assisted microencapsulation in PEG and PCL reduced loss of the volatile drug during a two-hour vaporization study and addition of PCL extended the mean release time in simulated physiological fluids. Free radical scavenging and lipoxygenase inhibitory activities of eucalyptol formulated in the PGSS-micronized particles was sustained. Findings from this study showed that the scCO₂-assisted micronization can be used for encapsulation of volatile drugs in polymeric microparticles without affecting bioactivity of the drug.

Application of supercritical carbon dioxide as an alternative solvent for microformulation of the volatile unstable drug, eucalyptol in polymeric composites.     

Predictive factors for extraction site hernia after laparoscopic right colectomy

Purpose

Incisional hernia at the extraction site (ESIH) is a common complication after laparoscopic colorectal resections. The aim of this study was to evaluate the prevalence and potential risk factors for ESIH in a large cohort study having standardized technique.

Methods

A cross-sectional study was performed including all patients who underwent elective laparoscopic right or extended right colectomy for cancer from November 2006 to October 2013 using a standard technique. All patients have been followed up for a minimum of 1 year with abdominal CT scan.

Results

A total of 292 patients were included with a median follow-up of 42 months. Twenty patients (6.8 %) developed ESIH. Obesity (odds ratio (OR) = 3.76, 95 % confidence interval (CI) 1.39–10.15; p = 0.009) and incision length (OR 2.86, 95 % CI 1.077–7.60; p = 0.035) significantly predisposed to the development of ESIH.

Conclusion

This study identified that the risk of ESIH is significant after colonic resections and there are several risk factors responsible for the development of ESIH.

     

Effects of Recombinant Human Bone Morphogenetic Protein‐2 on Vertical Bone Augmentation in a Canine Model

Background: Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)‐2, under space‐making titanium mesh in a canine model. Methods: Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP‐2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4‐month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro‐CT) assessment and histologic analysis. Results: Membrane exposure was found on five of 11 (45.5%) rhBMP‐2–treated sites, whereas it was found on nine of 11 (81.8%) non–rhBMP‐2–treated sites. Within 4 months of healing, rhBMP‐2–treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P <0.05) than controls. Experimental hemimandibles exhibited lower rates of membrane exposure and a noteworthy, ectopic bone formation above the mesh in 72% of sites. Results from micro‐CT also suggested a trend of less vertical bone gain and bone mineral density in controls (P >0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP‐2 sites. Conclusion: With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP‐2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non–rhBMP‐2 sites.     

Unusual Site of Left Ventricular Thrombus after Acute Myocardial Infarction

Left ventricular (LV) thrombus formation is a frequent complication in patients with acute anterior myocardial infarction (MI). Its incidence is lower with inferior wall MI. Risk factors for the development of LV thrombus are consistently irrespective of infarct treatment and include large infarct size, severe apical akinesia or dyskinesia LV aneurysm, and anterior MI.     

Safety and efficacy of transcatheter closure of atrial septal defect type II under transthoracic echocardiographic guidance: A case control study

Background

Transcatheter closure of secundum atrial septal defect is routinely performed under general anesthesia and transesophageal echocardiography guidance. If patients have good echo windows, the procedure could be performed under transthoracic echo guidance.