Archive

Archive for March, 2015

Bench testing stent designs: insights into stent fracture

Stent fracture is an increasingly recognised entity and plays a role in late stent failure. This paper provides insights into the mechanical properties of some of the currently available drug eluting stent platforms.

Advertisements

Journal Club 11 March 2015

Paper

Effect ofperiproceduralamiodaroneonprocedureoutcome
in patientswithlongstandingpersistentatrial fibrillation
undergoing extendedpulmonaryveinantrumisolation:
Results fromarandomizedstudy(SPECULATE)

Presenter

PM

Summary

BACKGROUND

The impactofamiodaroneonablationoutcomeinlong-
standing persistentatrial fibrillation(LSPAF)patientsisnotknownyet.
OBJECTIVE The purposeofthisstudywastoassesstheeffectof
amiodarone onprocedural-outcomesinLSPAFpatientsundergoing
catheter ablation.

METHODS

We enrolled112LSPAFpatientsonamiodaroneand
scheduled toundergoatrial fibrillation (AF)ablation.Patientswere
randomized toamiodaronediscontinuation4monthsbeforeablation
(group1,n ¼ 56) andacontrolgroup(group2,n ¼ 56)inwhich
ablationwasperformedwithoutamiodaronediscontinuation.All
patientsunderwentpulmonaryvein(PV)antrumandposteriorwall
isolation, defragmentationandextraPVtriggersablation.Patientswere
followedupforrecurrencefor32 8 monthspost-ablation.Repeat
proceduresinallrecurrentpatientswereperformedoffamiodarone.

RESULTS

During ablation,AFterminationwasmorefrequentin
group 2comparedtogroup1[44(79%)vs32(57%), P ¼ .015].
After high-dosageisoproterenol,morenon-PVtriggersweredis-
closed ingroup1comparedtogroup2(42[75%]vs24[43%]
respectively, P o.001). Group2hadlowerprocedure,radiofre-
quency and fluoroscopy timescomparedtogroup1(2.7 1 vs
3.11 h,6913 minvs87 11 minand6414 minvs85 18
min respectively, p o .05). At32 8 monthfollow-up,onoroff
antiarrhythmic drugsuccessratewas37(66%)ingroup1and27
(48%) ingroup2(P ¼ .04). Duringredo,newnon-PVtriggersites
were identified ingroup2patients.

CONCLUSION

Periprocedural continuousamiodaronewasassoci-
ated withhigherorganizationrateandlowerradiofrequency
ablation rate.However,maskingnon-PVtriggersincreasedthelate
recurrence rate.

Journal Club 4 March 2015

Paper

Impact of Age on Access Site-related Outcomes in 469,983 Percutaneous Coronary Intervention Procedures: Insights From the British Cardiovascular
Intervention Society

Presenter

PS

Summary

Aim

To investigate adoption of the TRA in different age groups and study the relationship between age and access site related outcomes in a national cohort of patients undergoing PCI in the UK. Previous studies have reported conflicting data on radial access site adoption between different age groups, with age an independent predictor of failure of procedures undertaken through the radial approach.

Methods

Age and access site related outcomes (based on transradial (TRA) and transfemoral (TFA) access) were studied in 469,983 PCI procedures undertaken in the UK from 2006 to 2012 in the age groups; <60, 60–<70, 70–<80, and 80 in the British Cardiovascular Intervention Society database. Authors
studied access site practice in 469,983 patients who underwent PCI procedures in the United Kingdom.

Results

TRA utilization increased from 17.5% to 65.6% in the age group <60,
and 16.6% to 54.5% in the age group 80 between 2006 and 2012. TRA was independently associated with decreased 30-day mortality in all age groups (<60: OR 0.64; 95% CI 0.54–0.74, P< 0.0001; 60–<70: OR 0.65; 95% CI 0.57–75, P< 0.0001, 70–<80: OR 0.58 (0.52– 0.65, P< 0.0001 and 80: OR 0.65 (0.57–0.73, P< 0.0001).

Conclusions

Adoption of the TRA for PCI has occurred least in older patients in the UK despite similar associations between TRA use and decreased 30-day mortality observed in all age groups.