Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study)

Aims Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). This study evaluated the effectiveness of PVI performed with cryoballoon ablation (CBA) in comparison with radiofrequency ablation (RFA) in patients with persistent AF. Methods and results  A total of 101 patients with symptomatic persistent AF were enrolled and randomized (1:1) to CBA or RFA groups and followed up for 12 months. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s following a 3-month blanking period. Secondary endpoints were procedure-related complications, procedure and ablation duration, and fluoroscopy time. The ATA-free survival curves were estimated by Kaplan–Meier method and analysed by the log-rank test. According to intention-to-treat analysis, freedom from ATA was achieved in 36 out of 52 patients in the CBA group and 30 out of 49 patients in the RFA group (69.2% vs. 61.2%, P = 0.393). No difference in AF recurrence was found between the two groups (27.5% in CBA vs. 38.0% in RFA, P = 0.258), and less atrial flutter recurrence was documented in the CBA group compared with the RFA group (3.9% vs. 18.0%, P = 0.020). The procedure and ablation duration were significantly shorter in the CBA group (160 ± 31 vs. 197 ± 38 min, P  0.05). Conclusion  Compared with RFA, PVI performed by CBA led to shorter procedure and ablation duration, with less atrial flutter recurrence and similar freedom from ATA at 12-month follow-up.publishedVersio

PENERAPAN ALAT PERAGA MODEL SEL DALAM MENINGKATKAN HASIL BELAJAR SISWA PADA POKOK BAHASAN SEL DI SMAN 1 SURANENGGALA KABUPATEN CIREBON

DIAN MARYANI: Penerapan Alat Peraga Model Sel Dalam Meningkatkan Hasil Belajar Siswa Pada Pokok Bahasan Sel Kelas XI Di SMAN 1 Suranenggala Kab. Cirebon Penelitian ini dilatar belakangi oleh hasil belajar siswa yang belum tercapai, karena belum adanya sarana dan prasarana yang memadai sehingga pembelajaran masih menggunakan metode ceramah. Oleh karena itu perlu adanya kreativitas seorang guru untuk menciptakan dan membuat serta menerapkan suatu alat peraga dalam proses pembelajaran untuk meningkatkan daya ingat siswa sehingga hasil belajar siswa meningkat. Proses belajar mengajar merupakan proses komunikasi antar siswa dan guru. Untuk mempermudah suatu proses komunikasi dibutuhkan suatu media untuk menyampaikan konsep agar pembelajaran lebih mudah dipahami oleh siswa. Oleh karena itu dibutuhkan peran dan kreativitas guru dalam menyesuaikan media alat peraga dengan materi. Penggunaan media alat peraga membantu siswa untuk meningkatkan daya ingat karena dalam media alat peraga mampu merangsang panca indera yang meliputi indera pendengaran dan indera penglihatan yang mampu merangsang siswa dalam memahami dan mengingat materi pembelajaran sehingga mampu meningkatkan hasil belajar siswa. Tekhnik pengumpulan data dilakukan dengan menggunakan tes tertulis (pre tes dan post test) dan angket. Populasi dalam penelitian ini adalah seluruh siswa kelas XI SMAN 1 Suranenggala yang 234 siswa. Pengambilan sampel dalam penelitian ini dilakukan secara acak, sampel dalam penelitian ini diambil 1 kelas eksperimen yaitu kelas XI ipa 2 yang terdiri dari 40 siswa dan kelas kontrol pada kelas XI IPA 4 yang terdiri dari 40 siswa.data hasil penelitian kemudian dianalisis dengan menggunakan SPSS 16 for windows melalui uji normalitas, homogenitas, dan uji T. Berdasarkan hasil penelitian dapat disimpulkan bahwa: 1). penerapan alat peraga model sel pada pokok bahasan sel perlu dilaksanakan karena dapat meningkatkan daya ingat siswa sehingga mempengaruhi hasil belajar 2). adanya perbedaan peningkatan hasil belajar yang signifikan antara siswa yang menggunakan alat peraga dan yang tanpa alat peraga, Hal ini diketahui dari analisis data soal-soal pre test dan pos test yang diberikan kepada siswa kelas XI 2 (kelas eksperimen) di SMAN 1 Surannenggala, diperoleh data peningkatan rata-rata total skor pre test ke skor post test sebesar 39,78 atau lebih besar dari pada kelas kontrol yang mengalami kenaikan sebesar 3,75, Berdasarkan hasil uji mann whitney diperoleh nilai signifikan 0,000 dengan probabilitas < 0,05. Ho ditolak dan ha diterima. 3). Penerapan alat peraga model sel pada pembelajaran biologi sangat baik untuk diterapkan, hal ini bisa dilihat dari hasil respon siswa terhadap penggunaan media alat peraga ternyata hampir seluruh 77,5% siswa berpendapat bahwa pembelajaran dengan menggunakan alat peraga dapat meningkatkan hasil belajar siswa

Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study)

Aims Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). This study evaluated the effectiveness of PVI performed with cryoballoon ablation (CBA) in comparison with radiofrequency ablation (RFA) in patients with persistent AF. Methods and results  A total of 101 patients with symptomatic persistent AF were enrolled and randomized (1:1) to CBA or RFA groups and followed up for 12 months. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s following a 3-month blanking period. Secondary endpoints were procedure-related complications, procedure and ablation duration, and fluoroscopy time. The ATA-free survival curves were estimated by Kaplan–Meier method and analysed by the log-rank test. According to intention-to-treat analysis, freedom from ATA was achieved in 36 out of 52 patients in the CBA group and 30 out of 49 patients in the RFA group (69.2% vs. 61.2%, P = 0.393). No difference in AF recurrence was found between the two groups (27.5% in CBA vs. 38.0% in RFA, P = 0.258), and less atrial flutter recurrence was documented in the CBA group compared with the RFA group (3.9% vs. 18.0%, P = 0.020). The procedure and ablation duration were significantly shorter in the CBA group (160 ± 31 vs. 197 ± 38 min, P  0.05). Conclusion  Compared with RFA, PVI performed by CBA led to shorter procedure and ablation duration, with less atrial flutter recurrence and similar freedom from ATA at 12-month follow-up

Aerobic interval training reduces the burden of Atrial fibrillation in the short term: a randomized trial

Background Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities. However, a high level of endurance exercise is associated with an increased AF prevalence. We assessed the effects of aerobic interval training (AIT) on time in AF, AF symptoms, cardiovascular health, and quality of life in AF patients.Methods and Results Fifty-one patients with nonpermanent AF were randomized to AIT (n=26) consisting of four 4-minute intervals at 85% to 95% of peak heart rate 3 times a week for 12 weeks or to a control group (n=25) continuing their regular exercise habits. An implanted loop recorder measured time in AF continuously from 4 weeks before to 4 weeks after the intervention period. Cardiac function, peak oxygen uptake , lipid status, quality of life, and AF symptoms were evaluated before and after the 12-week intervention period. Mean time in AF increased from 10.4% to 14.6% in the control group and was reduced from 8.1% to 4.8% in the exercise group (P=0.001 between groups). AF symptom frequency (P=0.006) and AF symptom severity (P=0.009) were reduced after AIT. AIT improved , left atrial and ventricular ejection fraction, quality-of-life measures of general health and vitality, and lipid values compared with the control group. There was a trend toward fewer cardioversions and hospital admissions after AIT.Conclusions AIT for 12 weeks reduces the time in AF in patients with nonpermanent AF. This is followed by a significant improvement in AF symptoms, o(2)peak, left atrial and ventricular function, lipid levels, and QoL.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01325675

Oral anticoagulant therapy for stroke prevention in patients with atrial fibrillation undergoing ablation: results from the First European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA)

The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey of patients undergoing atrial fibrillation (AF) ablation, conducted to collect patient-based data on current clinical practices in AF ablation in context of the latest AF Guidelines and contemporary oral anticoagulant therapies. The EP Research Network Centres were asked to prospectively enrol consecutive patients during a 6-week period (September/October 2014). Data were collected via the web-based case report form. We present the results pertinent to the use of antithrombotic therapies. Thirteen countries prospectively enrolled 455 eligible consecutive patients [mean age 59 +/- 10.8 years, 131 (28.8%) females]. The mean CHA(2)DS(2)-VASc score was 1.12 +/- 1.06 [137 patients (30.1%) had a score of >= 2]. Before ablation, 443 patients (97.4%) were on anticoagulant therapy [143 (31.4%) on non-vitamin K antagonist oral anticoagulants (NOACs) and 264 (58.0%) on vitamin K antagonists (VKAs)]. Of the latter, 79.7% underwent ablation without VKA interruption, whilst a variety of strategies were used in patients taking NOAC. After ablation, most patients (89.3%) continued the same anticoagulant as before, and 2 (0.4%) were not prescribed any anticoagulation. At discharge, 280 patients (62.2%) were advised oral anticoagulation for a limited period of mean 3.8 +/- 2.2 months. On multivariate analysis, CHA(2)DS(2)-VASc, AF duration, prior VKA use, and estimated AF ablation success were significantly associated with the decision on short-term anticoagulation. Our results show the increasing use of NOAC in patients undergoing AF ablation and emphasize the need for more information to guide the periprocedural use of both NOACs and VKAs in real-world setting