Long-Term Sinus Rhythm Stability after Intraoperative Ablation of Permanent Atrial Fibrillation

Introduction: Short‐ and medium‐term sinus rhythm (SR) rates after intraoperative radiofrequency ablation to treat permanent atrial fibrillation (AF) are well documented. Is rhythm success stable during a long‐term follow‐up? Methods and Results: A total of 130 patients who had undergone intraoperative radiofrequency cooled‐tip endocardial ablation (SICTRA) of permanent AF (mean AF duration 6±5 years) concomitant to open heart surgery more than 3 years ago were followed up using electrocardiogram (ECG), Holter‐ECG, and echocardiography and compared with 12‐month follow‐up data. In 55% of patients, only the left atrium and in 45%, both atria were treated using SICTRA. Mitral valve replacement was performed in 21, mitral valve reconstruction in 25, aortic valve replacement in 13, CABG procedures in 51 (including 11 patients with additional mitral valve surgery), and complex procedures in 20 patients. Sixty‐nine percent of patients (90/130) were in stable SR after a median period of 48 months, whereas 28% (36/130) were in AF and 3% (4/130) were in atrial flutter. In between the 12‐month follow‐up and the long‐term follow‐up, seven patients converted to AF after having documented SR, two patients converted to typical right atrial flutter after being in SR, and two patients from AF to left atrial macroreentry. After left and biatrial SICTRA, SR rates were comparable (73% vs 66%, P = 0.45). Echocardiography revealed 73% of patients in SR to have effective left atrial contraction. Conclusions: SICTRA restores long‐term stable SR in 69% of all patients. Nine percent of patients reconverted back to atrial arrhythmia after having documented SR at 12 months.     

Prospective cross-over comparisons of three low-density lipoprotein (LDL)-apheresis methods in patients with familial hypercholesterolaemia

We prospectively compared effectiveness, selectivity and biocompatibility of three LDL-apheresis methods, immunoadsorption (IMAL), dextran sulphate adsorption (DSAL) and heparin-induced extracorporeal LDL precipitation (HELP). Seven patients with familial hypercholesterolaemia were treated twice with each method in random sequence. Reduction in atherogenic lipoproteins was without significant difference: LDL −60% to −75%, VLDL −20% to −30%, triglycerides −20% to −42%. High-density lipoprotein (HDL)-cholesterol was reduced by IMAL only (−27%, P <0.05); DSAL and HELP did not decrease HDL. Total plasma protein reduction was 13–15% with each method, indicating unselectivity. Albumin was significantly decreased by IMAL (−15%, P <0.05) but not by the other methods. DSAL and HELP reduced fibrinogen (−40%, −58%, P <0.0001) and other clotting factors. IMAL had almost no effect on coagulation. The white blood cell count did not change. C3 and C4 complement were decreased (−20% to −46%) by all methods. C5a complement did not increase in systemic blood, but was increased in the extracorporeal circulation of IMAL (+200%) and HELP (+150%). Plasma PMN elastase rose in all methods (+200%) indicating neutrophile degranulation. In conclusion, in this short-term study of a small patient population, effectiveness of the three LDL-apheresis methods was similar, but selectivity and biocompatibility were different. The therapeutic relevance of these differences for long-term treatment remains to be elucidated.