A decade of complex fractionated electrograms catheter-based ablation for atrial fibrillation: Literature analysis, meta-analysis and systematic review

AbstractBackgroundIt has been a decade since the complex fractionated atrial electrograms (CFAEs) were first established following the publication of Nademanee's standards. However, the status and focus of CFAE research are unclear, as is the efficacy of additional CFAE ablation in atrial fibrillation (AF). This literature review and meta-analysis were designed to determine the status of CFAE research and the efficacy and complications of CFAE ablation alone, pulmonary vein isolation (PVI) alone and PVI plus CFAE ablation in AF.MethodsWith the assistance from reference librarians and investigators trained in systematic review, we conducted a literature search of MEDLINE (via PubMed), Embase, the Cochrane Library, ScienceDirect, Wiley Blackwell and Web of Knowledge, using “complex fractionated atrial electrograms” for MeSH and keyword search.ResultsThe literature on CFAEs increased from 2007, mainly focusing on mapping studies, with mechanism studies increasing significantly from 2012. Fifteen trials with 1525 patients were qualified for our meta-analysis. Success rates were as follows. Overall (P < 0.001): CFAE ablation alone, 23.5–26.2%; PVI, 64.7%; PVI plus CFAE ablation, 67.0%. Single ablation: PVI, 60.4%; PVI plus CFAEs, 68.8% (OR 1.53, 95% CI 1.07–2.20, P = 0.02). Re-ablation: PVI, 69.0%; PVI plus CFAEs, 77.2% (OR 1.54, 95% CI 1.06–2.24, P = 0.02). Paroxysmal AF: PVI, 76.7%; PVI plus CFAEs, 79.1% (OR 1.20, 95% CI 0.79–1.81, P = 0.39). Persistent or permanent AF: PVI, 47.9%; PVI plus CFAEs, 58.7% (OR = 1.59, 95% CI 1.13–2.24, P = 0.008). Complication rates: PVI, 2.6%; PVI plus CFAEs, 3.4% (OR 1.22, 95% CI 0.58–2.57, P = 0.61).ConclusionsIn the literature, CFAE mapping studies preceded mechanism studies. CFAE ablation alone is insufficient for the treatment of AF. Additional CFAE ablation after adequate PVI or PVI plus linear ablation improves the outcome of single ablation and re-ablation without increasing complications, especially in persistent or permanent AF. There are insufficient data to support a similar improvement in paroxysmal AF or inducible AF after PVI for paroxysmal AF

Comparison of attitudes toward disability and people with disability among caregivers, the public, and people with disability: findings from a cross-sectional survey

Abstract Background A negative attitude toward disability is one of the potential barriers for people with disability (PWD) to achieve social equality. Although numerous studies have investigated attitudes toward disability, few have evaluated personal attitudes toward disability among PWD, and made comparisons with attitudes of healthy respondents. This study was to investigate and compare the attitudes of PWD, caregivers, and the public toward disability and PWD in China, to identify discrepancies in attitude among the three groupsand to examine potential influencing factors of attitude within each group. Methods A cross-sectional study was conducted among 2912 PWD, 507 caregivers, and 354 members of the public in Guangzhou, China. Data were collected on participants’ socio-demographic information and personal attitudes toward disability using the Attitude to Disability Scale (ADS). ANOVA and ANCOVA were applied to compare the level of attitude among the three groups. Simple and multiple linear regression analyses were used to investigate the relationship between each background factor and attitude within each group. Results Over 90 % of caregivers were PWD’s family members. After controlling the socio-demographic characteristics, caregivers had the lowest total scores of ADS (caregivers: 47.7; PWD: 52.3; the public: 50.5). Caregivers who had taken care of PWD for longer durations of time had a more negative attitude toward disability. In contrast, PWD who had been disabled for longer times had a more positive attitude toward disability. Conclusions The current national social security system of China does not adequately support PWD’s family-member caregivers who may need assistance coping with their life with PWDs. More research is needed, and the development of a new health-care model for PWD is warranted