Pulmonary function and exercise-associated changes with chronic low-level paraquat exposure

The present study was undertaken to test the hypothesis that chronic, low-level paraquat exposure causes restrictive lung function with gas transfer impairment. Three hundred thirty-eight Costa Rican farm workers from banana, coffee, and palm oil farms completed a questionnaire, spirometry, and a test of single-breath carbon monoxide diffusing capacity. Subjects 40 years of age or older, without other medical risk factors, completed maximal cardiopulmonary exercise tests. Most (66.6%) were paraquat handlers; 24.8% of handlers and 27.3% of nonhandlers reported current cigarette smoking. In linear regression models, cumulative paraquat exposure was not an independent predictor of VA, carbon monoxide diffusing capacity, peak oxygen uptake, FVC, or oxygen pulse peak. However, the ventilatory equivalent for CO(2), although within normal range, was significantly higher with increased cumulative paraquat exposure. Oxygen desaturation greater than 5% from rest to peak exercise had an odds ratio of 1.7 (95% confidence interval = 0.9-3.0) with the cumulative paraquat exposure index in models adjusted for age, weight, and smoking status. The association of paraquat exposure with ventilatory equivalent and oxygen desaturation suggests that paraquat may be associated with subclinical gas exchange abnormalities, but overall these findings are consistent with no clinically significant increases in interstitial thickening or restrictive lung disease among this population.     

Ablation of mitral annular flutter ablation utilizing a left atrial anterior line versus a lateral mitral isthmus line: a systematic review and meta-analysis

Journal of Interventional Cardiac Electrophysiology - Mitral annular flutter (MAF) is a common arrhythmia after atrial fibrillation ablation. We sought to compare the efficacy and safety of...     

Use of the Spanish Version of the Rapid Geriatric Assessment in Mexican Patients in Long-Term Care

We report our experience with the use of a Spanish version of the rapid geriatric assessment of 30 patients in 2 long-term care institutions in Mexico City by a group of healthcare students without prior experience in geriatric medicine. The Spanish version of the rapid geriatric assessment is a very easy tool to administer that can provide overall good results for identifying frailty, sarcopenia, anorexia, weight loss, and cognitive impairment.     

Efficacy and Safety Outcomes of Direct Oral Anticoagulants and Amiodarone in Patients with Atrial Fibrillation

Background

Direct oral anticoagulants (DOACs) and amiodarone are widely used in the treatment of nonvalvular atrial fibrillation. The DOACs are P-glycoprotein (P-gp) and cytochrome p-450 (CYP3A4) substrates. Direct oral anticoagulant levels may be increased by the concomitant use of potent dual P-gp/CYP3A4 inhibitors, such as amiodarone, which can potentially translate into adverse clinical outcomes. We aimed to assess the efficacy and safety of drug–drug interaction by the concomitant use of DOACs and amiodarone.

Catheter ablation versus conventional treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Purpose

We assessed conventional and reversed U curve methods for mapping and ablation of RVOT-type VAs.

Methods

Single-center data were reviewed from consecutive cases of symptomatic VAs of RVOT-type origin that were mapped and ablated successfully using conventional method in RVOT (pulmonary artery might be included) from January 2014 to December 2015 (cohort 1, n?=?75) or conventional method in RVOT and reversed U curve in PSC (for first ablation attempt) from January 2016 to March 2017 (cohort 2, n?=?60).

Results

At least 90% of RVOT-VAs could be eliminated using conventional method in RVOT or reversed U curve in PSC. For RVOT-VAs, if the earliest activation site was in midposterior free wall, midposterior septal side of RVOT, or anterior free wall/septal side of RVOT with conventional method, it was likely eliminated in right, left, and anterior PSC with reversed U curve method, respectively. Nearly the same earliest potential in almost the same region could be recorded by both methods. Compared with conventional method, the reversed U curve method showed better catheter stability and contact force during mapping and ablation, and showed distinctive features in presystolic potential recording, unipolar mapping, and ablation response.

Conclusions

Most of RVOT-VAs could be eliminated using conventional method in RVOT or reversed U curve in PSC. However, the reversed U curve method has superiority in catheter stability and contact force, especially for VAs form free wall of RVOT.

     

Is it safe to stop oral anticoagulation after catheter ablation for atrial fibrillation?

Introduction: Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine; however, their use after the blanking period of catheter ablation remains uncertain.

Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Major databases such as Pubmed or Embase were used. The most relevant articles published were used along with major recommendations of society guidelines. Authors will also discuss different proposed mechanisms of atrial fibrillation and more importantly future directions in this topic.

Expert commentary: The use of oral anticoagulants after catheter ablation for atrial fibrillation is debatable; however, based on current guidelines, we support the use of oral anticoagulants after the blanking period of catheter ablation. Noteworthy is that although the risk of bleeding can be fatal in some cases, it does not outweigh the risk of a disabling stroke.