Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry

Funding Information: Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011-21), Amgen Cardiovascular (2009-18), AstraZeneca (2014-21), Bayer AG (2009-18), Boehringer Ingelheim (2009-19), Boston Scientific (2009-12), The Bristol Myers Squibb and Pfizer Alliance (2011-19), Daiichi Sankyo Europe GmbH (2011-20), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014-17), Edwards (2016-19), Gedeon Richter Plc. (2014-16), Menarini Int. Op. (2009-12), MSD-Merck & Co. (2011-14), Novartis Pharma AG (2014-20), ResMed (2014-16), Sanofi (2009-11), Servier (2009-21), and Vifor (2019-22). Funding Information: Conflict of interest: T.B. has received grants from St. Jude Medical (Abbott), Biotronik, and Medtronic; speaker honoraria from Actavis-TEVA, Berlin-Chemie, Merck, Sanofi-Aventis, and Servier; and has served as a consultant for Boehringer Ingelheim. A.P.M. has no conflicts to disclose with respect to the present manuscript. Outside the present work, he received honoraria for participation in study committees sponsored by Bayer, Novartis, and Fresenius. J.K. has received speaker honoraria from Bayer, Boehringer Ingelheim, Biosense Webster, Biotronik, Boston Scientific, Medtronic, Merck Sharp & Dohme, Pfizer, and St. Jude Medical (Abbott); and has served as a consultant for Bayer, Boehringer Ingelheim, Biosense Webster, Boston Scientific, Etix, Medtronic, Merck Sharp & Dohme, Liva Nova (MicroPort), and St. Jude Medical (Abbott). L.T. is a trial committee member for Servier and CVIE Therapeutics and speakers bureau member for Servier. N.D. reports research grants from Abbott, Biotronik, Boston Scientific, and Medtronic to the institution without personal financial benefits. And all other authors have no conflict of interest to declare. Publisher Copyright: © 2019 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019.Aims: Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation. Methods and results: The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan-Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively. Conclusion: Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.Peer reviewe

Persistent phrenic nerve palsy after atrial fibrillation ablation: Follow-up data from The Netherlands Heart Registration

Background: Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. Methods: In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow-up data were collected for patients who developed persistent PNP. Results: Overall, the mean age was 62 ± 10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203 (113–351) and 184 (82–359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery. Conclusion: After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP

The VALUE national hysterectomy study: description of the patients and their surgery.

OBJECTIVES: To describe hysterectomies practised in 1994 and 1995: the patients, their surgery and short term outcomes. DESIGN: One of two large cohorts, with prospective follow up, recruited to compare the outcomes of endometrial destruction with those of hysterectomy. SETTING: England, Wales and Northern Ireland. POPULATION: All women who had hysterectomies for non-malignant indications carried out during a 12-month period. METHODS: Gynaecologists in NHS and independent hospitals were asked to report cases. Follow up data were obtained at outpatient follow up approximately six weeks post-surgery. MAIN OUTCOME MEASURES: Indication for surgery, method of hysterectomy, ovarian status post-surgery, surgical complications. RESULTS: 37,298 cases were reported which is estimated to reflect about 45% of hysterectomies performed during the period studied. The median age was 45 years, and the most common indication for surgery was dysfunctional uterine bleeding (46%). Most hysterectomies were carried out by consultants (55%). The proportions of women having abdominal, vaginal or laparoscopically-assisted hysterectomy were 67%, 30% and 3%, respectively. Forty-three percent of women had no ovaries conserved after surgery. The median length of stay was five days. The overall operative complication rate was 3.5%, and highest for the laparoscopic techniques. The overall post-operative complication rate was 9%. One percent of these was regarded as severe, with the highest rate for severe in the laparoscopic group (2%). There were no operative deaths; 14 deaths were reported within the six-week post-operative period: a crude mortality rate soon after surgery of 0.38 per thousand (95% CI 0.25-0.64). CONCLUSIONS: This large study describes women who undergo hysterectomy in the UK, and presents results on early complications associated with the surgery. Operative complications occurred in one in 30 women, and post-operative complications in at least one in 10. Laparoscopic techniques tend to be associated with higher complication rates than other methods

North American Workshop on Laser Ablation 2017: May 25-27, Austin

We are pleased to present the Abstract Book for the 2nd North American Workshop on Laser Ablation (NAWLA’17). NAWLA is a new biennial meeting with the mission to transfer laser ablation knowledge between specialists and promote a sense of community among laser ablation users. The inaugural 2015 workshop lasted two days and had 110 participants. NAWLA’17 now expands to 2.5 days and brings together 130 scientists and vendors from 12 countries. Once again, the Jackson School of Geosciences hosts NAWLA at the University of Texas at Austin. NAWLA’17 covers the latest progress in laser-based microanalytical instrumentation, methods and applications, and provides opportunities for informal interaction among attendees. We accepted 66 abstracts (34 oral, including 8 plenary talks, 32 poster presentations), contributing to eight thematic sessions – most concluding with a moderated Q&A period. Eminent guest speakers, Professors Sam Houk (USA) and Henry Longerich (Canada) initiate a theme session on the Foundations of LA-ICP-MS including a moderated discussion with all participants. NAWLA’17 introduces a laser ablation image competition, with a grand prize and people’s choice award.Geological Science

North American Laser Ablation Workshop 2015 : Program and Abstracts

Geological Science