Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease

Background: Amiodarone is often prescribed in the management of atrial fibrillation (AF) but is known to cause significant end-organ toxicities. In this study, we examined the impact of amiodarone on all-cause mortality in AF patients with structurally normal hearts. Methods: We performed a retrospective cohort analysis of all AF patients with structurally normal hearts who were prescribed antiarrhythmic drugs (AAD) for rhythm control of AF at our institution from 2006 to 2013 (n = 2,077). Baseline differences between the amiodarone (AMIO: n = 403) and other AADs (NON-AMIO: n = 1,674) groups were corrected for using propensity score matching. Results: Amiodarone use as first-line therapy decreased significantly with a higher degree of prescriber specialization in arrhythmia management (31%, 22%, and 9% for primary care physicians, general cardiologists and cardiac electrophysiologists, respectively, p < 0.001). After propensity score matching, baseline comorbidities were balanced between the AMIO and NON-AMIO groups. Over a median follow-up of 28.2 months (range 6.0–100.9 months), amiodarone was associated with increased all-cause (HR 2.41, p = 0.012) and non-cardiac (HR 3.55, p = 0.008) mortality, but not cardiac mortality. AF recurrence and cardiac hospi­talizations were similar between the two study groups. Conclusions: Amiodarone treatment of AF is associated with increased mortality in patients without structural heart disease and therefore should be avoided or only used as a second-line therapy, when other AF therapies fail. Adherence to guideline recommendations in the management of AF patients impacts clinical outcome

Survey of avifauna of the Gharana wetland reserve: implications for conservation in a semi-arid agricultural setting on the Indo-Pakistan border

Abstract Background The Gharana wetland conservation reserve (GWCR) is a semi-arid wetland adjacent to agricultural areas on the Indo-Pakistani border. Despite being declared an Important Bird Area (IBA) by Birdlife International, the occurrence and distribution of birds has not been well-documented in this area. Our aims were to systematically document the composition, relative abundance and feeding guilds of all avian fauna in order to form a baseline to monitor changes from—and to underwrite—future conservation actions. Results From 24 surveys over 1 year, we recorded 151 species from 45 families and 15 orders. 41% of species were listed as ‘rare’ and only 22% were ‘very common’. The largest number of families belonged to the order Passeriformes (40%), followed by Charadriiformes (14%) and Coraciiformes (11%). The most species (12%), were found in the family Anatidae (Anseriformes—widely recognized as bio-indicators), followed by Accipitridae (Falconiformes;12%) and Muscicapidae (Passeriformes; 6%). Carnivores and insectivores were the feeding guilds most frequently observed. Indeed, more than 50% of all species fed on the abundant fish, mollusks and insects and larvae. Bark-feeders and nectarivores were the least common. Conclusions Winter visitors were frequently found, while summer visitors were rare, reinforcing the importance of GWCR as a wintering site for high-altitude species. The conservation of this wetland is especially crucial for nine globally-threatened species. We have provided baseline documentation to help future monitoring efforts for this region, and a template to initiate the implementation of conservation plans for other remote IBAs

Survey of Avifauna of the Gharana Wetland Reserve

The Gharana wetland conservation reserve (GWCR) is a semi-arid wetland adjacent to agricultural areas on the Indo-Pakistani border. Despite being declared an Important Bird Area (IBA) by Birdlife International, the occurrence and distribution of birds has not been well-documented in this area. Our aims were to systematically document the composition, relative abundance and feeding guilds of all avian fauna in order to form a baseline to monitor changes from-and to underwrite-future conservation actions

Lead related complications in quadripolar versus bipolar left ventricular leads

AbstractBackgroundQuadripolar left ventricular (LV) leads are capable of pacing from four different electrodes which allows for easier and more stable intra-operative lead positioning with optimal pacing parameters. We therefore investigated the rate of combined intra-operative and post-operative LV lead related events in quadripolar vs. bipolar LV lead cardiac resynchronization therapy (CRT) recipients in the real world setting.MethodsWe retrospectively collected data for N = 1441 patients at our institution implanted with quadripolar (n = 292) or bipolar (n = 1149) LV leads from 2012 to 2014 and followed them to the primary end-point of composite lead outcome defined as intra-operative lead implant failure or post-operative lead dislodgement or deactivations.ResultsPatients implanted with a quadripolar lead were younger (70.6 ± 11.4 vs 72.5 ± 11.6, p = 0.014) and had higher incidence of diabetes (41.8% vs 32.8%, p = 0.004) compared to those with bipolar leads. All other baseline characteristics were comparable. Patients implanted with a quadripolar were significantly less likely to reach the primary endpoint in the first 12 months after LV lead implantation (Hazard Ratio 0.22, 95% Confidence Interval 0.08–0.60, p = 0.001). There were no differences between the two groups in rates of hospitalization for any cause or in mortality.ConclusionIn this real world study, quadripolar LV leads have significantly lower rates of implantation failure and post-operative lead dislodgement or deactivation. These results have important clinical implications to CRT recipients

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2