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;

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 CORONARY ARTERY DISEASE IN PATIENTS WITH POLYCYTHEMIA VERA AND ESSENTIAL THROMBOCYTOSIS: RESULTS FROM THE NATIONAL INPATIENT SAMPLE 2009-10.

Background: Myelproliferative disorders (MPDs) including Polycythemia Vera (PCV) and Essential thrombocytosis (ET) are associated with increase in arterial and venous thromboembolic events. Chronic endothelial damage, hyperviscosity and platelet activation are possible mechanistic factors resulting in accelerated atherogenesis and coronary artery disease (CAD). However the differences in prevalence of CAD and traditional risk factors (TRFs) between PCV and ET are unknown. Hence, we aimed to determine the prevalence and predictors of CAD in PCV and ET patients using a national registry. Methods: All patients ≥18 years diagnosed with PCV and ET were identified in the Nationwide Inpatient Sample (NIS) 2009-2010 database using 9th revision of International Classification of Diseases (ICD) codes 238.4 and 238.71 respectively. Demographic factors namely age, gender, race and TRFs including diabetes, hypertension, hyperlipidemia and tobacco use were identified. Multivariate logistic regression was performed to evaluate the predictors of CAD. Results:Prevalence of PCV was 0.08% (n=38,393) and ET was 0.17% (n=77,109) of all discharges. Mean age of the population was 61.2±0.1 years and 54% were females. CAD was present in 22% of the total population with significant difference in PCV compared to ET (26% vs 19%; p Conclusions: CAD is present in 22% of patients with PCV and ET. PCV was associated with increase in TRFs, CAD and in hospital mortality rates compared to ET. In addition, ET predicted less CAD after adjusting for all confounding factors. These findings warrant increase awareness of CAD in patients with MPDs and aggressive management especially in PC

Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample.

INTRODUCTION: Primary hyperparathyroidism (pHPT), most commonly caused by solitary parathyroid adenomas, leads to mobilization of calcium and is known to result in nephrolithiasis and osteoporosis. To date, studies of pHPT and cardiovascular risk factors and events have produced discrepant findings, likely due to small sample sizes and enrolling populations with varying disease severity. HYPOTHESIS: We utilized a national registry, hypothesizing an association between pHPT and cardiovascular risk factors and events. METHODS: Patients \u3e18years with a diagnosis of pHPT were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Diseases code 252.01. Demographics, risk factors, and cardiovascular event rates were collected and compared to general population data. RESULTS: pHPT was present in 0.1% (n=37,922) of hospital admissions. There was a significant increase in the prevalence of most cardiac risk factors including hypertension (HTN), diabetes mellitus, hyperlipidemia, obesity, and chronic kidney disease. The rates of heart failure (HF) and coronary artery disease (CAD) were higher in the pHPT population. However, after performing multivariate regression for age and cardiac risk factors, pHPT did not independently predict HF or CAD. The risk of HTN, however, was independently predicted by pHPT (OR 1.3; p\u3c0.001). CONCLUSIONS: Primary hyperparathyroidism independently predicted the risk of hypertension in a patient population from a large national database. Despite significant differences in univariate analysis of cardiac risk factors and events, pHPT did not independently predict risk of HF or CAD after multivariate regression analysis. Future studies should explore potential mechanisms relating hypertension to pHPT

Gender and age differences in cardiovascular complications in anorexia nervosa patients.

BACKGROUND: Anorexia nervosa (AN) is characterized by severe malnutrition and electrolyte imbalances. Differences in cardiovascular complications between males and females with AN have not been studied. Additionally, coronary artery disease (CAD) prevalence and cardiovascular complications in patients with AN \u3e65years have not been reported. METHODS: AN patients\u3e18years were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Disease code 307.1. Demographics, risk factors, and cardiovascular event rates were compared to general population data. RESULTS: CAD incidence was lower in all AN patients compared to the general population (4.4% vs 18.4%, p65years old. When compared to the general population\u3e65years, older AN patients had lower rates of CAD (35% vs 16%; p CONCLUSIONS: Our data suggests that male AN patients experienced more cardiac arrests, arrhythmias, and heart failure than female AN patients. Additionally, older AN patients have a decreased incidence of CAD and heart failure compared to the general population\u3e65years old

Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients.

Apixaban (factor Xa inhibitor) is a novel anticoagulant and may be beneficial during atrial fibrillation (AF) ablation for prevention of thromboembolic events. However, the adverse effects of periprocedural apixaban therapy have not been thoroughly evaluated. A meta-analysis was performed to evaluate the safety of apixaban for anticoagulation in AF ablation. We searched the online databases till October 2015 for studies comparing Apixaban with Vitamin K antagonists in atrial fibrillation patients undergoing catheter ablation. Primary outcome of our study was composite of thromboembolic event and bleeding (includes major and minor bleeding). A total of 1,057 atrial fibrillation patients in 3 studies undergoing catheter ablation were included in this analysis. Zero thromboembolic events were reported in the apixaban group and 1 in the VKA group with no statistical difference (OR 0.75; 95% CI 0.03-18.49). No major differences were observed for the primary outcome (OR 0.92; 95% CI 0.54-1.55), risk of overall bleeding (OR 0.94, 95% CI 0.55- 1.58), major bleeding (OR1.37; 95% CI 0.33-5.67), minor bleeding (OR 0.89; 95% CI 0.50-1.55), pericardial effusion (OR 0.50; 95% CI 0.18-1.38) and groin hematoma (OR 1.36; 95% CI 0.70-2.65). Uninterrupted apixaban administration in patients undergoing AF catheter ablation was non-inferior to VKA without increasing the risk of major and minor bleeding

The Influence of Pregnancy in Patients with Congenital Long QT Syndrome.

Congenital long QT syndrome (LQTS) is a disorder of myocardial repolarization and is characterized by a prolonged QT interval on AN electrocardiogram. A prolonged QT predisposes patients to an increased risk of syncope and sudden cardiac death secondary to polymorphic ventricular tachycardia. Several mutations linked to the LQT syndrome have been identified, the most common of which have been found in the potassium channel KCNQ1 (LQT1) and hERG (LQT2) genes and in the sodium channel SCN5A (LQT3) gene. Female gender is an independent risk factor for the development of torsades de pointes (TdP) in LQTS. Furthermore, while pregnancy may be associated with protection against cardiac events in LQTS, the 9-month post-partum period represents a time of increased arrhythmogenicity. Interestingly, these cardiac events during the post-partum period are more common in patients with LQT2. The precise mechanisms that influence the cardiac repolarization during the post-partum period are unclear. Beta-blockers are considered reasonably safe during pregnancy and should be continued or initiated in patients with LQTS to reduce the risk of cardiac events. Implantable cardioverter defibrillators are safe in pregnancy, and there is no evidence that pregnant women with these devices are at any greater risk for adverse complications solely on the grounds of having the device