Evaluation Of Atrial Fibrillation Burden Before Catheter Ablation Predicts Outcome After Pulmonary Vein Isolation

Background: Paroxysmal atrial fibrillation (PAF) is defined as recurrent AF terminating spontaneously within 7 days. This definition allows the consideration of any AF occurrence lasting < 7 days as paroxysmal, irrespective of the frequency and duration of episodes. The aim of this study was to investigate symptomatic AF burden (AFB) defined as total duration of symptomatic AF episodes within 3 months prior to abalation, for prediction of outcome after pulmonary vein isolation (PVI).Methods: A total of 320 consecutive patients with symptomatic AF (PAF=244, men=214, age=58 y) were enrolled. AFB in patients with PAF was defined as time spent in AF within 3 months prior to PVI. After the AFB cut-off point was optimized at 500 h, patients with PAF were categorized into 2 groups: Group 1 - patients with AFB<500 h (n=192), Group 2 - patients with AFB≥500 h (n=52). Patients with persistent AF (PersAF, n = 76) comprised control group (Group 3). PVI was performed either with irrigated tip catheter (n=215) or using cryoballoon (n=105). The endpoint of study was first documented recurrence of AF >30 sec.Results: Symptomatic AFB was found to be appropriate for prediction of outcome after PVI. The freedom from AF within 2 years was observed in 69%, 31%, and 43% patients in Group 1, 2 and 3, respectively (Group 1 vs. Group 2, p <.001; Group 1 vs. Group 3, p< .001; Group 2 vs. Group 3, p = 0.46).Conclusions: Low AFB < 500 h /3 months was associated with better outcome after PVI. Patients with PAF and high AFB should be treated as patients with PersAF

Predictors of early and late left atrial tachycardia and left atrial flutter after catheter ablation of atrial fibrillation: Long-term follow-up

Background: The aim of the study was identification of the predictors of left atrial tachycardia and left atrial flutter (LATAFL) after radiofrequency catheter ablation of atrial fibrillation (CAAF). Methods: We followed 598 patients (71% male, 41% paroxysmal AF; median follow-up: 36 months) after a single step-wise CAAF procedure. The time to first documented LATAFL lasting longer than 30 s, documented in any kind of electrocardiography (ECG), was defined as an end-point. Results: A single CAAF procedure resulted in LATAF in 58 (10%) patients. Additional lesions were performed in 275 (46%) patients. Early LATAFL recurrence (£ 3 months since the index procedure) was observed in 11 (2%) patients. Late LATAFL (&gt; 3 months) was noted in 47 (8%) patients. The univariate predictors of LATAFL recurrence were: type of AF (p = 0.003), the size of LA (p = 0.002) and the type of procedure (p = 0.0001). The identified single independent predictors of LATAFL recurrence were enlarged LA (p = 0.001) and mul­tiple (≥ 2) additional lesions performed during the index procedure (p &lt; 0.0001). Conclusions: Higher rate of LATAFL recurrence was observed in patients with non-paroxysmal AF, enlarged LA and any additional lesions performed. Two independent predictors of LATAFL recurrence after CAAF were: the enlarged LA and multiple (≥ 2) additional lesions performed during the index procedure

Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?

Background: Relation between pre-procedural selection of patients and the success rate after a single cryoballoon ablation (CAB) procedure is unknown. Methods: CAB was performed in 378 (65% male, median age 58 years, 85% paroxysmal atrial fibrillation [AF]) consecutive patients with symptomatic and drug refractory AF. The combined ALARMEc (Atrial fibrillation type, Left Atrium size, Renal insufficiency, Metabolic syndrome, cardiomyopathy) risk score was calculated for each individual patient. The end-point of the study was the first AF, atrial flutter or atrial tachycardia recurrence after the 3-month blanking period in the 1-year follow-up since the index procedure, in the absence of anti-arrhythmic (class I and III) therapy. Results: Single and multi-catheter approach was used in 79% and 21% of patients, respec­tively. The acute success rate with single and multi-catheter approach was 79% and 99%, respectively. The overall 1-year success rate after a single CAB procedure was 70%. The 1-year outcome was: 83%, 70%, 60%, 40% and 29% in patients with ALARMEc risk score: 0, 1, 2, 3 and 5, respectively. Total rate of complications was 11%, including transient phrenic nerve palsy in 9.5% of cases. Conclusions: Multi-catheter approach was needed in 21% of patients to achieve acute pulmo­nary vein isolation. Patients with low (≤ 1) ALARMEc risk score, preferably young individuals with sole paroxysmal AF (ALARMEc = 0), are best candidates for CBA procedure. Performing CBA in patients with higher (&gt; 2) ALARMEc risk score should be avoided. Phrenic nerve palsy was a transient complication

Initial rhythm control with cryoballoon ablation vs drug therapy: Impact on quality of life and symptoms

Background Cryoballoon ablation (CBA) as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence; the impact of first-line CBA on quality of life (QoL) and symptoms has not been well characterized. Methods Patients aged 18 to 75 with symptomatic paroxysmal AF naïve to rhythm control therapy were randomized (1:1) to CBA (Arctic Front Advance, Medtronic) or AAD (Class I or III). Symptoms and QoL were assessed at baseline, 1, 3, 6, 9, and 12 months using the EHRA classification and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and SF-36v2 questionnaires. Symptomatic palpitations were evaluated via patient diary. Results Overall, 107 patients were randomized to CBA and 111 to AAD; crossovers occurred in 9%. Larger improvements in the AFEQT summary, subscale and treatment satisfaction scores were observed at 12 months with CBA vs AAD (all P <0.05). At 12 months, the mean adjusted difference in the AFEQT summary score was 9.9 points higher in the CBA group (95% CI: 5.5 –14.2, P <0.001). Clinically important improvements in the SF-36 physical and mental component scores were observed at 12 months in both groups, with no significant between group differences at this timepoint. In the CBA vs AAD group, larger improvements in EHRA class were observed at 6, 9 and 12 months (P <0.05) and the incidence rate of symptomatic palpitations was lower (4.6 vs 15.2 days/year post-blanking; IRR: 0.30, P <0.001). Conclusions In patients with symptomatic AF, first-line CBA was superior to AAD for improving AF-specific QoL and symptoms.publishedVersio

Which standard biomarkers are useful for the evaluation of myocardial injury after pulmonary vein isolation with cryoballoon?

Wstęp: W dotychczas opublikowanych badaniach dotyczących oceny uszkodzenia mięśnia sercowego po zabiegach ablacji oznaczano aktywność kinazy kreatynowej (CK), izoenzymu sercowego CK (CK-MB) i stężenie sercowych troponin I (cTnI) oraz T (cTnT). Dokonano pomiarów koncentracji kardio-specyficznych biomarkerów jako odpowiednika masy uszkodzonych komórek mięśnia sercowego. Cel: Celem pracy było wyjaśnienie, który ze standardowo dostępnych biomarkerów jest użyteczny w ocenie uszkodzenia komórek mięśnia sercowego po krio-balonowej izolacji żył płucnych (CBA). Metody: U 33 pacjentów z migotaniem przedsionków wykonano CBA. Próbki krwi pobrano przed CBA oraz w 1., 6. oraz 24. godzinie po CBA. Analizie poddano CK, CK-MB i cTnI. Wyniki: W próbkach pobranych po CBA zaobserwowano istotny wzrost koncentracji wszystkich badanych biomarkerów w stosunku do poziomu wyjściowego. Maksymalny wzrost zanotowano w 6. godzinie; CK, CK-MB i cTnI osiągnęły wartości patologiczne u, odpowiednio, 94%, 100% i 100% pacjentów. Maksymalne wartości CK i CK-MB korelowały (p < 0.05) z medianą temperatury osiągniętej w czasie CBA. Wnioski: Okazało się, że CK-MB jest najlepszym standardowym biomarkerem do oceny uszkodzenia mięśnia sercowego po CBA. Sercowa troponina I może być użyteczna jako dodatkowy parametr oceny uszkodzenia po CBA. Kardiol Pol 2011; 69, 11: 1151&#8211;1155Background: Many studies have used creatinine kinase (CK), myocardial bound for CK (CK-MB), and cardiac troponin I (cTnI) and T (cTnT) to evaluate myocardial cells injury after ablation. We applied measurements of the blood concentration of cardio-specific biomarkers as surrogates for the injured cell mass. Aim: To clarify which of the standard biomarkers are useful in the evaluation and quantification of lesions produced by cryoballoon ablation (CBA) during pulmonary vein isolation. Methods: The CBA was performed in 33 patients with atrial fibrillation. Blood samples were obtained before CBA and one, six, and 24 h after CBA. We analysed CK, CK-MB and cTnI. Results: A significant increase of all biomarkers was observed at each hour of collection as compared to the baseline measurement. Maximum median peak levels occurred at 6 h. Pathological values of CK, CK-MB and cTnI were observed in 94%, 100% and 100% of patients, respectively. Both maximum CK and CK-MB values correlated with median temperature (p < 0.05) reached during CBA. Additionally, CK-MB correlated with total cryo-time (p < 0.03). Conclusions: The CK-MB is the best biochemical marker for the evaluation of myocardial injury after CBA. The cTnI can be useful as an additional parameter of myocardial injury after CBA. Kardiol Pol 2011; 69, 11: 1151&#8211;115

Three essays in macroeconomics and finance

This thesis consists of three chapters on topics in macroeconomics and finance. In the first chapter, I use texts from corporate filings of US companies to investigate if liquidity shortages that occurred during the late-2000 financial crisis were different from cases that occur during more normal times. In the second chapter, I quantify narrative evidence from corporate filings to construct a novel dataset on the price-setting behavior of companies. I then use this dataset to investigate what factors cause firms to change the prices of their products or prevent them from doing so. In the third chapter, I use a number of high-frequency financial market estimates to identify the monetary policy shock in a non-recursive Factor Augmented Vector Autoregression of monthly frequency.Esta tesis consta de tres capítulos sobre temas de macroeconomía y finanzas. En el primer capítulo, utilizo textos de presentaciones corporativas estadounidenses para investigar si las faltas de liquidez que se produjeron durante la crisis financiera de finales del 2000 fueron diferentes de los casos que ocurren durante tiempos más normales. En el segundo capítulo, cuantifico evidencia narrativa de presentaciones corporativas para construir un nuevo conjunto de datos sobre el comportamiento de fijación de precios de las empresas. Luego utilizo este conjunto de datos para investigar qué factores hacen que las empresas cambien o dejen sin cambios los precios de sus productos. En el tercer capítulo, utilizo un número de estimaciones de datos financieros de alta frecuencia para identificar el shock de política monetaria en un modelo FAVAR de frecuencia mensual

How do firms set prices? : Narrative evidence from corporate filings

We quantify narrative evidence from archived corporate filings to construct a novel dataset on the price-setting behavior of public companies. Our approach is closely related to that of survey-based studies on price setting, but we collect data from twenty-five years instead of one specific point in time. This allows us to investigate variation over time and to establish that qualitative information provided directly by firms is informative about the aggregate variables macroeconomists are fundamentally interested in. Our findings suggest that (i) price setting is asymmetric and has a strong state-dependent component, (ii) real rigidities in the form of strategic pricing complementarities are very common, and (iii) an increase in the number of price changes does not necessarily reflect a decrease in price rigidity. We discuss to what extent our results can be explained by strategic reporting behavior and consider their implications in the context of widely-used price-setting models.

Three essays in macroeconomics and finance

This thesis consists of three chapters on topics in macroeconomics and finance. In the first chapter, I use texts from corporate filings of US companies to investigate if liquidity shortages that occurred during the late-2000 financial crisis were different from cases that occur during more normal times. In the second chapter, I quantify narrative evidence from corporate filings to construct a novel dataset on the price-setting behavior of companies. I then use this dataset to investigate what factors cause firms to change the prices of their products or prevent them from doing so. In the third chapter, I use a number of high-frequency financial market estimates to identify the monetary policy shock in a non-recursive Factor Augmented Vector Autoregression of monthly frequency.Esta tesis consta de tres capítulos sobre temas de macroeconomía y finanzas. En el primer capítulo, utilizo textos de presentaciones corporativas estadounidenses para investigar si las faltas de liquidez que se produjeron durante la crisis financiera de finales del 2000 fueron diferentes de los casos que ocurren durante tiempos más normales. En el segundo capítulo, cuantifico evidencia narrativa de presentaciones corporativas para construir un nuevo conjunto de datos sobre el comportamiento de fijación de precios de las empresas. Luego utilizo este conjunto de datos para investigar qué factores hacen que las empresas cambien o dejen sin cambios los precios de sus productos. En el tercer capítulo, utilizo un número de estimaciones de datos financieros de alta frecuencia para identificar el shock de política monetaria en un modelo FAVAR de frecuencia mensual

Der Mont-Blanc : Darstellung der Besteigung desselben am 31. Juli, 1. und 2. August 1859

ein Blick in die Eislandschaften der europäischen Hochalpen... / von W. PitschnerTextband: [6] Bl.,154 S., [1] Bl., 3 Taf.; Atlasmappe: 6 Taf

Der Mont-Blanc : Darstellung der Besteigung desselben am 31. Juli, 1. und 2. August 1859 : ein Blick in die Eislandschaften der europäischen Hochalpen...

von W. Pitschner"Textband" künstliche Bezeichnun