Hybrid ablation for atrial fibrillation: A systematic review and meta-analysis

Background: Both catheter and surgical ablation strategies offer effective treatments of atrial fibrillation (AF). The hybrid (joint surgical and catheter) ablation for AF is an emerging rhythm control strategy. We sought to determine the efficacy and safety of hybrid ablation of AF. Methods: Systematic review and meta-analysis interrogating PubMed, EMBASE, and Cochrane databases from January 1, 1991, to November 30, 2017, using the following search terms: “Cox-maze,” “mini-maze,” “ablation methods (including radiofrequency, cryoablation, cryomaze),” and “surgery.” Included studies required ablation procedures to be hybrid and report rhythm follow-up. Results: We included 925 patients with AF (38% persistent, 51% longstanding persistent) from 22 single-center studies (mean follow-up of 19 months). The surgical lesion set consisted of pulmonary vein isolation (n = 11) or box lesion (n = 11) with variable additional linear ablation. This was followed by sequential (n = 9), staged (n = 9), or combination (n = 4) catheter-based ablation to ensure isolation of pulmonary veins and to facilitate additional ablation or consolidation of surgically ablated lines. Overall, sinus rhythm maintenance was 79.4% (95% confidence interval [CI], 72.4-85.7] and 70.7% (95% CI, 62.2-78.7) with and without antiarrhythmic drugs, respectively at 19 ± 25 (range, 6-128) months. The use of the bipolar AtriCure Synergy system and left atrial appendage exclusion conferred superior rhythm outcome without antiarrhythmic drugs (P ≤ .01). The overall complication rate was 6.5% (95% CI, 3.4-10.2): mortality 0.2% (95% CI, 0-0.9); stroke 0.3% (95% CI, 0-1.1); reoperation for bleeding 1.6% (95% CI, 0.6-3.0); permanent pacing ~0% (95% CI, 0-0.5); conversion to sternotomy 0.3% (95% CI, 0-1.1); atrioesophageal fistula ~0% (95% CI, 0-0.5); and phrenic nerve injury 0.3% (95% CI, 0-1.1). Conclusions: Hybrid ablation therapy for AF demonstrates favorable rhythm outcome with acceptable complication rates.Jason A. Varzaly, Dennis H. Lau, Darius Chapman, James Edwards, Michael Worthington, and Prashanthan Sander

Predatory pricing: reforms foreshadowed

Predatory pricing under section 46 of the Trade Practices Act - competition policy law objectives - influence of leading Australian and US decisions on predatory pricing - differences between Australian and US approach to the concept of recoupment - proposed reforms under the Trade Practices Legislation Amendment Bill 2008 - argument that Australian law should move closer to the US approach.Varzaly, Jeniferhttp://search.informit.com.au/browsePublication;py=2008;vol=22;res=AGISPT;issn=0819-4262;iss=

Do directors’ duties in Australia provide adequate scope for risk-taking? An examination of the current law and defence reform proposals

© 2008 Monash Business ReviewDirectors must be able to make decisions which inevitably involve some degree of commercial risk if the economy is to be advantaged. Likewise, careless and dishonest director behaviour must be discouraged if shareholder interests are to be adequately protected. Australian corporate law has attempted to strike this balance through the enactment of provisions such as the business judgment rule contained in s180(2) of the federal Corporations Act 2001. This rule was introduced for the purpose of protecting and providing deference to directors in making management decisions. Yet, since its enactment, the rule has seldom been argued and has never been successfully applied in a major case. This article compares and contrasts the Australian business judgment rule with the more successfully argued US business judgment rule, and then examines current law reform proposals to extend the protection offered to directors in carrying out their duties. The article concludes that a general defence should be enacted to provide better protection for directors and prevent the undue restriction of their entrepreneurial activitiesJenifer Varzal

The Carbon Pollution Reduction Scheme

This article explores the potential tax issues that arise from the Carbon Pollution Reduction Scheme proposed by the Australian government.Sylvia Papadimitriou and Jenifer Varzalyhttp://www.ibfd.org/portal/mkt/preview/APTBPreview2009_06.htm