Evaluating cardiac anatomy as a predictor for success after pulmonary vein isolation for the treatment of atrial fibrillation

Introduction: Atrial Fibrillation is a condition characterized by the production of ectopic beats by the heart. One common treatment for Atrial Fibrillation is catheter guided pulmonary vein isolation (PVI), however this treatment is only effective in around 60-70% of the population. Our research hopes to elucidate a link between cardiac anatomy and successful treatment of A-fib by pulmonary vein isolation. Methods: The medical records for 78 consecutive patients who underwent PVI for atrial fibrillation at Jefferson from July 2013 to March 2016 were gathered. Included in these charts were ECG-gated cardiac CT angiogram and two-year follow up history. Different variables from the imaging data such as left atrial volume, ejection fraction, and pulmonary vein area were analyzed and compared to likelihood of recurrence of A-Fib after PVI. A T-test was used to compare continuous variables in patients who had recurrence versus those that did not and a Chi-Squared Test was used to compare likelihood of recurrence in those with persistent versus paroxysmal A-Fib. Results: Recurrent atrial fibrillation was found in 32/72 (44%) of treated patients by 24 months. Univariate analysis demonstrated a higher incidence of recurrent atrial fibrillation among patients who remained on anti-arrhythmic medications 14/22 = as compared to those who did not 18/50, p = 0.03. There was a lower incidence of recurrent atrial fibrillation in males 20/52 (38%) as compared with females 12/19 (63%), though this difference was only marginally significant (p = 0.056). Multivariate analysis of additional variables with logistic regression demonstrated a marginally significant association of reduced ejection fraction with recurrent atrial fibrillation (p= 0.064). Logistic regression analysis demonstrated no significant differences in recurrence rate based upon age, paroxysmal/persistent fibrillation, left atrial volume, CHADS2 score, pulmonary vein area, and catheter type. Discussion: The only marginal predictors for recurrent atrial fibrillation after PVI were Gender and left ventricular ejection fraction. The other variables including anatomical features and the catheter type used for the procedure had no significant impact on long-term recurrence rates after PVAI. This was a surprising result given other data in the field, which seemed to indicate a link between cardiac anatomy and recurrence of A-Fib after PVI. More research should be conducted in this area, perhaps with a larger data set then was used in this study

High intensity interval training for people with Multiple Sclerosis: a systematic review

Background: Aerobic High Intensity Interval Training (HIIT) is safe in the general population and more efficient in improving fitness than continuous moderate intensity training. The body of literature examining HIIT in Multiple Sclerosis (MS) is expanding but to date a systematic review has not been conducted. The aim of this review was to investigate the efficacy and safety of HIIT in people with MS. Methods: A systematic search was carried out in September 2017 in EMBASE, MEDline, PEDro, CENTRAL and Web of Science Core collections using appropriate keywords and MeSH descriptors. Reference lists of relevant articles were also searched. Articles were eligible for inclusion if they were published in English, used HIIT, and included participants with MS. Quality was assessed using the PEDro scale. The following data were extracted using a standardised form: study design and characteristics, outcome measures, significant results, drop-outs, and adverse events. Results: Seven studies (described by 11 articles) were identified: four randomised controlled trials, one randomised cross-over trial and two cohort studies. PEDro scores ranged from 3-8. Included participants (n=249) were predominantly mildly disabled; one study included only people with progressive MS. Six studies used cycle ergometry and one used arm ergometry to deliver HIIT. One study reported six adverse events, four which could be attributed to the intervention. The other six reported that there were no adverse events. Six studies reported improvements in at least one outcome measure, however there were 60 different outcome measures in the seven studies. The most commonly measured domain was fitness, which improved in five of the six studies measuring aspects of fitness. The only trial not to report positive results included people with progressive and a more severe level of disability (Extended Disability Status Scale 6.0-8.0). Conclusion: HIIT appears to be safe and effective in increasing fitness in people with MS and low levels of disability. Further research is required to explore the effectiveness of HIIT in people with progressive MS and in those with higher levels of disability

Access, delivery and perceived efficacy of physiotherapy and use of complementary and alternative therapies by people with progressive multiple sclerosis in the United Kingdom: an online survey

Introduction: All people with progressive MS in the United Kingdom should have access to physiotherapy through the National Health Service (NHS). However levels of access and delivery are unknown. Furthermore there is no research on perceived efficacy of physiotherapy or the use of complementary and alternative medicine in people with progressive MS in the United Kingdom. Methods: An online survey was carried out via the UK MS Register. Inclusion criteria were diagnosis of progressive MS, a member of UK MS Register and 18 years or older. The survey asked participants regarding access and delivery of physiotherapy; perceived efficacy of physiotherapy and interventions received; barriers to accessing physiotherapy and use of complementary and alternative medicine. The following additional data were supplied from the UK MS Register: demographics, EQ5D, MSIS-29 physical and psychological sub-scales and geographical data. Results: Total number of respondents was 1,298 from an identified 2,538 potential registrants: 87% could access physiotherapy services, 77% received physiotherapy from the NHS and 32% were currently receiving physiotherapy. The most common interventions received were home exercise programme (86%), exercises with a physiotherapist (74%) and advice/education (67%). 40% had recently used complementary and alternative medicine. Perceived efficacy of physiotherapy was high with 70% reporting it to be either ‘beneficial’ or ‘very beneficial’. Main barriers to accessing physiotherapy were mobility, fatigue, continence, transport issues, requiring someone to go with them and pain. Discussion: Access to physiotherapy was high with most people reporting it as beneficial. However 13% reported not having access indicating a gap in accessibility. Considering some of the barriers reported may allow physiotherapy services to address this gap in accessibility