Role Of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: A Meta-analysis of 23 Randomized Controlled Trials (Poster).

Background Several randomized clinical trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aim to determine the role of prophylactic Mg in 3 settings (intraoperative, postoperative, intraoperative + postoperative) in prevention of POAF. Methods A systemic literature search was performed (until October 20, 2015) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in the POAF. For each study, the incidence of atrial fibrillation in both the intervention and placebo groups was extracted to calculate odd ratio and 95% confidence intervals (CIs). Results We included a total of 2,973 participants (1,471 in the Mg group and 1,502 in the placebo group) enrolled in 23 randomized controlled trials. By using random-effects models, pooled analysis demonstrated no significant reduction in POAF (OR 0.81; 95% CI, 0.64-1.02; p = 0.08) in Mg group as compared to placebo. However, there was reduction in POAF in the group that received prophylactic Mg postoperatively (OR 0.66; 95% CI 0.44-0.99; p = 0.04) with no significant heterogeneity. Number needed to treat in our study = 13 (95% CI 7.04-81.34). Conclusions Prophylactic postoperative Mg supplementation resulted in a lower incidence of POAF in patients undergoing CABG

Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials.

Introduction: We aimed to study the procedural characteristics, efficacy and safety of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for catheter ablation of paroxysmal atrial fibrillation (AF). Methods: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to clinical trials comparing CBA and RFA for AF. Outcomes were evaluated for efficacy, procedure characteristics and safety. For each study, odd ratio (OR) and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We analyzed a total of 9,957 participants (3,369 in the CBA and 6,588 in RFA group) enrolled in 16 clinical trials. No significant difference was observed between CBA and RFA with regards to freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat catheter ablation. CBA group had a significantly higher transient phrenic nerve injury (OR 14.19, 95% CI: 6.92-29.10;

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials

Background Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I2=42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I2=17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I2=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I2=51.8%, respectively). Conclusions Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG

PCSK9 Inhibitors: A New Era of Lipid Lowering Therapy.

Hyperlipidemia is a well-established risk factor for developing cardiovascular disease (CVD). The recent American College of Cardiology and American Heart Association guidelines on lipid management emphasize treatment of individuals at increased risk for developing CVD events with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) at doses proven to reduce CVD events. However, there are limited options for patients who are either intolerant to statin therapy, develop CVD despite being on maximally tolerated statin therapy, or have severe hypercholesterolemia. Recently the Food and Drug Administration approved two novel medications for low-density lipoprotein (LDL)-cholesterol reduction: Evolocumab and Alirocumab. These agents target and inactivate proprotein convertase subtilsin-kexin type 9 (PCSK9), a hepatic protease that attaches and internalizes LDL receptors into lysosomes hence promoting their destruction. By preventing LDL receptor destruction, LDL-C levels can be lowered 50%-60% above that achieved by statin therapy alone. This review explores PCSK-9 biology and the mechanisms available to alter it; clinical trials targeting PCSK9 activity, and the current state of clinically available inhibitors of PCSK9

Role Of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: A Meta-analysis of 23 Randomized Controlled Trials

Background Several randomized clinical trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aim to determine the role of prophylactic Mg in 3 settings (intraoperative, postoperative, intraoperative + postoperative) in prevention of POAF. Methods A systemic literature search was performed (until October 20, 2015) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in the POAF. For each study, the incidence of atrial fibrillation in both the intervention and placebo groups was extracted to calculate odd ratio and 95% confidence intervals (CIs). Results We included a total of 2,973 participants (1,471 in the Mg group and 1,502 in the placebo group) enrolled in 23 randomized controlled trials. By using random-effects models, pooled analysis demonstrated no significant reduction in POAF (OR 0.81; 95% CI, 0.64-1.02; p = 0.08) in Mg group as compared to placebo. However, there was reduction in POAF in the group that received prophylactic Mg postoperatively (OR 0.66; 95% CI 0.44-0.99; p = 0.04) with no significant heterogeneity. Number needed to treat in our study = 13 (95% CI 7.04-81.34). Conclusions Prophylactic postoperative Mg supplementation resulted in a lower incidence of POAF in patients undergoing CABG

Predictors of 30-day readmissions after catheter ablation for atrial fibrillation in the USA.

BACKGROUND: Catheter ablation is considered as the mainstay treatment for patients with symptomatic atrial fibrillation (AF). We aimed to determine the predictors of 30-day readmission after catheter ablation for AF. METHODS: The study cohort consisted of patients who underwent AF catheter ablation (International Classification of Diseases, Ninth Revision 427.31 and procedure code 37.34) in 2014, identified from the National Readmission Database. RESULTS: Our final cohort consisted of 5322 unweighted cases, of which 4736 (89%) constituted the no-readmission group and 586 patients (11%) the readmission group. Female gender (OR 1.62, 95% CI 1.35-1.95), CAD (OR 1.36, 95% CI 1.08-1.71), peripheral vascular disease (OR 1.45, 95% CI 1.07-1.98), acute renal failure (OR 1.46, 95% CI 1.09-1.97), fluid and electrolyte disorders (OR 1.32, 95% CI 1.03-1.67), chronic pulmonary disease (OR 1.25, 95% CI 1.01-1.53), ablation on the day of admission (OR 0.74, 95% CI 0.61-0.91), and fourth quartile of hospital AF catheter ablation volume (OR 0.60, 95% CI 0.45-0.80) were independent predictors of 30-day readmission. Arrhythmias and heart failure were the most common cardiac etiologies for readmission. The most common ablation-related complications were hemorrhage (11%) and vascular (7%) complications. CONCLUSIONS: Several patient- and hospital-related factors were identified as predictors of 30-day readmission, the knowledge of which can potentially improve healthcare delivery

His Bundle Pacing: Hemodynamics and Clinical Outcomes.

From 1993 to 2009, nearly 2.9 million pacemakers were implanted in the United States; the majority of which were dual chamber pacemakers. One of the major physiologic advantages of dual chamber pacing over single chamber ventricular pacing is atrioventricular synchrony, which prevents the pacemaker syndrome. However, patients who are pacemaker dependent or use right ventricle (RV) apical pacing more than 40% of the time are at a risk of developing heart failure from electromechanical dyssynchrony. Studies have also shown that RV pacing results in non-physiological activation of the left ventricle, leading to adverse clinical outcomes. Hence, alternative pacing sites, including the RV outflow tract, the high-RV septal region, bi-ventricular pacing or His-Bundle pacing (HBP) have being explored for a better physiological electromechanical coupling of the ventricles. Although HBP has gained attention due to favorable data and clinical outcomes, it has not gained widespread acceptance into clinical practice. Hence, we aim to review the current experience with HBP and its clinical implications in this article