Long‐Term Results of Transcatheter Atrial Fibrillation Ablation in Patients with Impaired Left Ventricular Systolic Function

AF Ablation and Impaired Left Ventricular Function. Introduction: Long‐term outcome of AF ablation in patients with impaired LVEF is unknown. The aim of this study is to evaluate sinus rhythm (SR) maintenance, clinical status, and echocardiographic parameters over a long‐term period following atrial fibrillation (AF) transcatheter ablation in patients with left ventricular ejection fraction (LVEF) <50%. Methods and Results: A total of 196 patients (87.2% males, age 60.5 ± 10.2 years) with LVEF <50% underwent radiofrequency transcatheter ablation for paroxysmal (22.4%) or persistent (77.6%) AF. Patients were followed up for 46.2 (16.4–63.5) months regarding AF recurrences, functional class, and echocardiographic parameters. All patients underwent pulmonary vein isolation, while 167 (85.2%) required additional atrial lesions. Eleven (5.6%) patients suffered procedural complications. During follow‐up, 58 (29.6%) patients required repeated ablations. At the follow‐up end, 15 (7.7%) patients died, while 74 (37.8%) documented at least one episode of AF, atrial flutter, or atrial ectopic tachycardia. Eighty‐three (47.2%) patients maintained antiarrhythmic drugs. During follow‐up, NYHA class improved by at least one class more frequently among patients maintaining SR compared to those experiencing relapses (70.6% vs 47.9%, P = 0.003). LVEF showed a broader relative increase in patients maintaining SR (32.7% vs 21.4%; P = 0.047) and mitral regurgitation grading significantly decreased (P <0.001) only within these patients. At multivariable analysis SR maintenance emerged as an independent predictor (odds ratio 4.26, 95% CI 1.69–10.74, P = 0.002) of long‐term clinical improvement (reduction in NYHA class ≥1 and relative increase in LVEF ≥10%). Conclusions: Although not substantially worse than in patients with preserved LVEF, AF ablation in patients with impaired LVEF is affected by high long‐term recurrence rate. Among these patients SR maintenance is associated with greater clinical improvement. (J Cardiovasc Electrophysiol, Vol. 24, pp. 24‐32, January 2013)     

Influenza vaccination coverage in the geriatric population of the State of Geneva, Switzerland

Background: In Switzerland, every year the Federal Office ofPublic Health publishes recommendations for the use of influenzavaccine in people over 65 years, patients of all ages sufferingfrom chronic conditions or immunosuppression, families of thelatter and health professionals. However, prior to the presentstudy, there has been no evaluation of the degree to which theserecommendations are implemented. The purpose of the survey describedin this article was to evaluate flu vaccination coverage ofthe geriatric population living in the community, to obtainqualitative information on the motivation for receiving vaccinationand to understand the network of communication on flu prevention.Methods: The study was performed on a random sample of 1,200residents of the State of Geneva aged 65 years or older. Itinvolved a mail questionnaire and semi-structured telephoneinterviews on a subsample of respondents. Results: The estimatedvaccination coverage for 1994 was equal to 35.5% in persons65 years-old or older. Receiving information from a physicianwas the major determinant in the decision to be vaccinated.Misconceptions about flu were common. Conclusions: The resultsof this study indicate that national recommendations concerningvaccination of elderly people are insufficiently observed inthe State of Geneva. It is necessary to reinforce preventivemessages that explain why flu vaccination should be performed.These messages should aim at correcting and completing elementsof information already present in the at-risk population.     

Near‐infrared spectroscopy correlates with continuous superior vena cava oxygen saturation in pediatric cardiac surgery patients

Background: Cerebral regional oxygen saturation (rSO₂) measured with near‐infrared spectroscopy (NIRS) has a well‐proven clinical utility. A goal‐oriented treatment based on the rSO₂ resulted in a significant reduction in major morbidity and in a shortening of postoperative hospital stay in patients undergoing coronary revascularization. In this study, we have compared the values of superior vena cava saturation (ScvO₂) continuously measured with a Pediasat catheter and the corresponding NIRS rSO₂ values obtained during cardiac operations in pediatric patients. Methods: This was a prospective observational study enrolling fifteen pediatric patients (age: 6 days–7 years) undergoing cardiac operations. ScvO₂ data obtained with the Pediasat during the operation were compared with simultaneously recorded NIRS rSO₂ values. Results: One hundred and seventeen matched sets of data were obtained during the operation. ScvO₂ continuously measured with the Pediasat was significantly correlated with the corresponding NIRS rSO₂ values. However, there was a constant positive bias (ScvO₂ values were higher than NIRS rSO₂ values) of 5.6%, with a precision of 10.4%. Time‐related percentage changes of NIRS rSO₂ were significantly correlated with the corresponding ScvO₂ percentage changes. A decrease in ScvO₂ is predictive for a decrease in rSO₂ with a sensitivity of 73.7% and a specificity of 85.7%. Conclusions: The continuous measurement of ScvO₂ values obtained by the Pediasat may provide useful information about the metabolic conditions of the brain during cardiac operations in pediatric patients if considered as percentage changes. Absolute values of ScvO₂ tend to overestimate the correspondent rSO₂ values.     

Continuous quality improvement in primary health care: A five year project

Background: The aim of the study was to determine the feasibilityof a programme of continuous quality improvement (CQI) in threeprimary care teams (PCTs) and to test the effectiveness of correspondenceanalysis (CA) in identifying factors contributing to qualityperformance. Methods: A CQI task force was responsible for coordinatingall aspects of the programme. Six domains of performance weredefined, each having one or more indicators. The statisticalanalysis included comparison of proportions and, in addition,CA was used to further identify which factors were contributingto a performance below the standard. Results: In the domainof infant care, two of the three PCTs reached the 100% goalon immunisation coverage. The third PCT did not attain the standard(85%). However, through CA it was possible to identify the subpopulationat risk. The proportion of pregnant women accessing pre-natalcare during the first trimester increased from the initial 20to 66% (p<0.001). Physicians' compllance with pre-natal careprotocol increased from 70 to 93% (p<0.05). Performance relatedto recording of home health care visits in medical historiesdid not improve at all, nor did the providers reach the standardfor continuing education. The medical records Information improvedfor alcohol and tobacco consumption, allergies (p<0.05),and blood pressure (p<0.05). The patients' satisfaction wasgreater with doctors than nurses. Conclusions: This experienceindicates the feasibllity and benefits of a comprehensive CQIprogramme at the primary care level. CA is considered a usefulstatistical method for locating factors contributing to qualityperformance.     

Improvement of supportive nursing care in cancer patients autografted with bone marrow and mobilized peripheral blood haematopoietic progenitors

We report that in cancer patients a dramatic reduction in infection rate, days of isolation, oral mucositis and hospitalization due to high-dose chemotherapy is achievable by autografting with haematopoietic progenitor cells (CPCs) circulating in peripheral blood following cancer therapy with high-dose cyclophosphamide (HD-CTX) and administration of recombinant haematopoietic cytokines. Thirty patients (29 lymphomas, one breast cancer) were treated with total body irradiation and high-dose melphalan followed by either: (i) bone marrow transplant (Group A); (ii) bone marrow plus HD-CTX-mobilized CPC transplant (Group B); or (iii) bone marrow plus HD-CTX- and cytokine-mobilized CPC transplant (Group C). Nursing care load was remarkably higher in Group A patients compared to Group B and C patients, thus demonstrating clinical advantages of transplantation of HD-CTX- and cytokine-mobilized CPCs.