Atrial Fibrillation and Heart Failure: Update 2015

Heart failure (HF) and atrial fibrillation (AF) commonly coexist, adversely affect mortality, and impose a significant burden on healthcare resources. The presence of AF and HF portends a poor prognosis as well as an increased thromboembolic risk. In patients whose AF is symptomatic, rhythm restoration with either antiarrhythmic drugs or procedural therapies (e.g., pulmonary vein isolation, either catheter-based or surgical) should be considered for symptom improvement, though a mortality benefit has yet to be demonstrated. Emerging evidence suggests that non-pharmacological treatment for AF (including catheter based ablation, hybrid surgical techniques, and atrioventricular node ablation with biventricular pacing) may be of value in improving HF patients’ quality of life

Lifestyle modification in the prevention and treatment of atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a significant impact on morbidity and mortality. Additionally, the incidence and prevalence of AF is expected to increase in the United States and worldwide over the next few decades. While the pathophysiology concerning the development of AF is not completely understood, multiple modifiable, as well as non-modifiable risk factors, for AF development have been discovered. The goal of this paper is to provide an overview of the modifiable risk factors that contribute to the development and recurrence of AF, in addition to discussing potential lifestyle changes that may aid in the prevention and treatment of AF

Cost-saving opportunities with appropriate utilization of cardiac telemetry

A third of healthcare spending in the United States is considered waste, and costs are growing at an unsustainable rate. Reducing unnecessary cardiac telemetry, a costly intervention with a high potential for overuse, may be an opportunity to reduce waste. We performed a review of 250 consecutive patients admitted to telemetry capable beds on the general medical-surgical, noncritical care units. Based on the American Heart Association Practice Standards for Electrocardiographic Monitoring in Hospital Settings, appropriateness of telemetric monitoring during each inpatient day was assessed, with identification of significant new arrhythmias, code calls, and clinical decisions resulting from telemetry. Cost of a telemetry day was calculated using a time-driven activity-based cost model. Patients (63 ± 19 years, 54% male) spent a total of 1,640 days hospitalized, 1,399 (85%) of which were on telemetry. Average length of stay was 6.6 days, and average telemetry time was 5.6 days. Only 334 (24%) telemetry days were deemed appropriate based on Practice Standards. During telemetric monitoring, 16 new significant arrhythmias were detected, 4 code calls were made, and 19 significant clinical decisions were prompted by telemetry. No cardiac code call occurred on a nontelemetry day. The cost of telemetry was calculated as $34.28 more per day than a nontelemetry hospital day. Elimination of inappropriate telemetry days would result in a minimum estimated savings of$37,007 in these 250 patients, and an annual savings of $528,241 overall. Telemetric monitoring is frequently overused. In conclusion, our findings propose that a reduction in inappropriate telemetry days in accordance with the American Heart Association Practice Standards could result in significant cost savings

Current evidence-based understanding of the epidemiology, prevention, and treatment of atrial fibrillation

Atrial fibrillation (AF) is the most common atrial arrhythmia in adults worldwide. As medical advancements continue to contribute to an ever-increasing aging population, the burden of atrial fibrillation on the modern health care system continues to increase. Therapies are also evolving, for treatment of the arrhythmia itself, and stroke risk mitigation. Internists and cardiologists alike are, in most instances, the frontline contact for AF patients, and would benefit from remaining facile in their understanding of care options. To continue to deliver high-quality care to this expanding patient group, an updated, concise review for the clinician is prudent. This article provides a comprehensive summary of the current epidemiology and pathophysiology of AF, as well as contemporary procedural therapeutic options

Searching for plasticity in dissociated cortical cultures on multi-electrode arrays

We attempted to induce functional plasticity in dense cultures of cortical cells using stimulation through extracellular electrodes embedded in the culture dish substrate (multi-electrode arrays, or MEAs). We looked for plasticity expressed in changes in spontaneous burst patterns, and in array-wide response patterns to electrical stimuli, following several induction protocols related to those used in the literature, as well as some novel ones. Experiments were performed with spontaneous culture-wide bursting suppressed by either distributed electrical stimulation or by elevated extracellular magnesium concentrations as well as with spontaneous bursting untreated. Changes concomitant with induction were no larger in magnitude than changes that occurred spontaneously, except in one novel protocol in which spontaneous bursts were quieted using distributed electrical stimulation

Forest dynamics following spruce budworm outbreaks in the northern and southern mixedwoods of central Quebec

The effects of 20th century spruce budworm (Choristoneura fumiferana (Clem.)) outbreaks on forest dynamics was examined in the southern and northern parts of the mixedwood forest zone in central Quebec, Canada. In each region, three study areas were placed in unmanaged stands that had not burned for more than 200 years. Disturbance impacts and forest succession were evaluated using aerial photographs and dendrochronology. Spruce budworm outbreaks occurred around 1910, 1950, and 1980 in both regions. The 1910 outbreak seemed to have limited impact in both regions, and the 1950 outbreak caused heavy mortality in conifer stands (mostly of balsam fir, Abies balsamea (L.) Mill.) in the southern region. The 1980 outbreak caused major mortality in the northern region, but had little impact in the southern region. Successive spruce budworm outbreaks led to a massive invasion by hardwood species in the last century in the southern region but not in the northern region. The reason for such contrasting dynamics between regions is unknown, but we hypothesize that differences in disturbance intensities, influenced by climate, played a major role. Results from this study emphasize that generalizations about the effect of spruce budworm outbreaks on forest dynamics cannot be derived from observations made during a single outbreak or at a single location

Two weeks of docosahexaenoic acid (DHA) supplementation increases synthesis-secretion kinetics of n-3 polyunsaturated fatty acids compared to 8 weeks of DHA supplementation

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.jnutbio.2018.07.002 © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Docosahexaenoic acid (DHA, 22:6n-3) must be consumed in the diet or synthesized from n-3 polyunsaturated fatty acid (PUFA) precursors. However, the effect of dietary DHA on the metabolic pathway is not fully understood. Presently, 21-day-old Long Evans rats were weaned onto one of four dietary protocols: 1) 8 weeks of 2% ALA (ALA), 2) 6 weeks ALA followed by 2 weeks of 2% ALA + 2% DHA (DHA), 3) 4 weeks ALA followed by 4 weeks DHA and 4) 8 weeks of DHA. After the feeding period, 2H5-ALA and 13C20-eicosapentaenoic acid (EPA, 20:5n-3) were co-infused and blood was collected over 3 h for determination of whole-body synthesis-secretion kinetics. The synthesis-secretion coefficient (ml/min, means ± SEM) for EPA (0.238±0.104 vs. 0.021±0.001) and DPAn-3 (0.194±0.060 vs. 0.020±0.008) synthesis from plasma unesterified ALA, and DPAn-3 from plasma unesterified EPA (2.04±0.89 vs. 0.163±0.025) were higher (P<.05) after 2 weeks compared to 8 weeks of DHA feeding. The daily synthesis-secretion rate (nmol/d) of DHA from EPA was highest after 4 weeks of DHA feeding (843±409) compared to no DHA (70±22). Liver gene expression of ELOVL2 and FADS2 were lower (P<.05) after 4 vs. 8 weeks of DHA. Higher synthesis-secretion kinetics after 2 and 4 weeks of DHA feeding suggests an increased throughput of the PUFA metabolic pathway. Furthermore, these findings may lead to novel dietary strategies to maximize DHA levels while minimizing dietary requirements.Natural Sciences and Engineering Research Council of Canada || 48259

Device-detected subclinical atrial tachyarrhythmias: Definition, implications and management - An European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulaci\uf3n Card\uedaca y Electrofisiolog\ueda (SOLEACE)

Among atrial tachyarrhythmias (AT), atrial fibrillation (AF) is the most common sustained arrhythmia. Many patients with AT have no symptoms during brief or even extended periods of the arrhythmia, making detection in patients at risk for stroke challenging. Subclinical atrial tachyarrhythmia and asymptomatic or silent atrial tachyarrhythmia often precede the development of clinical AF. Clinical AF and subclinical atrial fibrillation (SCAF) are associated with an increased risk of thromboembolism. Indeed, in many cases, SCAF is discovered only after complications such as ischaemic stroke or congestive heart failure have occurred