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102 Arrhythmia recurrence following durable pulmonary vein isolation and posterior wall isolation in persistent atrial fibrillation: a randomised study
IntroductionIn patients with advanced persistent atrial fibrillation the optimal ablation strategy during redo procedures is unknown. The utility of posterior wall isolation (PWI) in addition to pulmonary vein isolation (PVI) in these patients remains uncertain.Methods44 patients with PeAF or longstanding PeAF (mean age 63 ± 7.9 years, 77% male, median time since AF diagnosis 22.5 months, median indexed LA volume 36 ml/m2) were randomised to index radiofrequency PVI followed by protocol mandated redo at 2 months including PWI (PVI+PWI group) vs index cryoballoon PVI followed by protocol mandated redo without PWI (PVI-only group). Patients were followed-up with daily handheld ECG monitoring for 12 months, and quality of life (QOL) was assessed at baseline and 12 months using the EQ5D visual analogue scale (0 = worst, 100 = best).Results38 patients underwent both procedures (n=17 PVI-only, n=21 PVI+PWI). Over median 338 days of follow-up, there was no difference in arrhythmia recurrence between the groups (PVI+PWI 38.1% vs PVI-only 41.2%; HR 0.84 [95% CI 0.31–2.33]; p=0.743). QOL was similar at baseline (median 70 per group, p=0.383), improved to 83 with PVI-only (p=0.041 vs baseline) and 80 with PVI+PWI (p=0.046 vs baseline), and did not differ between arms (p=0.616). QOL improved significantly in those without arrhythmia recurrence (p=0.005), but not in those with recurrence (p=0.158).ConclusionPatients with advanced persistent atrial fibrillation have a high rate of arrhythmia recurrence following PVI, even with a repeat invasive procedure to ensure PVI durability. Addition of PWI does not appear to improve outcomes. QOL improvement may depend upon ablation success.Abstract 102 Figure 1Kaplan-Meier curves for PVI only vs PVI+PWIConflict of InterestNone
Journal Article
Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter
ObjectiveWe aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL).MethodsCryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy.ResultsTrial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61–71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000).ConclusionCryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF.Trial registration number NCT03401099.
Journal Article
Cryoballoon pulmonary vein isolation as first-line treatment of typical atrial flutter: long-term outcomes of the CRAFT trial
BackgroundCRAFT was an international, multicentre, randomised controlled trial across 11 sites in the United UK and Switzerland. Given the evidence that pulmonary vein triggers may be responsible for atrial flutter (AFL) as well as atrial fibrillation (AF), we hypothesised that cryoballoon pulmonary vein isolation (PVI) would provide greater symptomatic arrhythmia reduction than cavotricuspid isthmus (CTI) ablation, whilst also reducing the subsequent burden of AF. Twelve-month outcomes were previously reported. In this study, we report the extended outcomes of the CRAFT study to 36 months.MethodsPatients with typical AFL and no evidence of AF were randomised 1:1 to cryoballoon PVI or radiofrequency CTI. All patients received an implantable loop recorder (ILR) for continuous cardiac rhythm monitoring. The primary outcome was time-to-symptomatic arrhythmia recurrence > 30 s. Secondary outcomes included time-to-first-AF episode ≥ 2 min. The composite safety outcome included death, stroke and procedural complications.ResultsA total of 113 patients were randomised to cryoballoon PVI (n = 54) or radiofrequency CTI ablation (n = 59). Ninety-one patients reconsented for extended follow-up beyond 12 months. There was no difference in the primary outcome between arms, with the primary outcome occurring in 12 PVI vs 11 CTI patients (HR 0.97; 95% CI 0.43–2.20; p = 0.994). AF ≥ 2 min was significantly less frequent in the PVI arm, affecting 26 PVI vs 36 CTI patients (HR 0.48; 95% CI 0.29–0.79; p = 0.004). The composite safety outcome occurred in 5 PVI and 6 CTI patients (p = 0.755).ConclusionCryoballoon PVI shows similar efficacy to radiofrequency CTI ablation in reducing symptomatic arrhythmia recurrence in patients presenting with isolated typical AFL but significantly reduces the occurrence of subsequent AF.
Journal Article
Student nurses' perceptions of compassion
Compassion has been associated with the nursing profession since the days of Florence Nightingale. It is a general expectation that nurses should be compassionate when they are caring for people. In the United Kingdom (UK) concerns have been raised recently that nurses are failing to be compassionate as they carry out their nursing duties. There is little evidence within the literature of how student nurses perceive compassion as they engage in the pre-registration-nursing programme. In this study, I use narrative to produce case studies as a vehicle for the students to voice their perceptions of compassion. My ethnographic analysis of their stories is framed by my own experience as a professional registered nurse and nurse educator situated within their learning environment, and applies theories of compassion and learning. In my study, themes emerge that demonstrate commonalities, differences and tensions relating to the students’ individual beliefs and behaviours, and to the impact of their professional development as they transcend from university learning spaces into clinical practice.
Dissertation
The Effectiveness of Computer-Assisted Learning in the Teaching of Quantitative Volumetric Analysis Skills in a First-Year University Course
This paper presents findings from a project that commenced at The University of Melbourne in 1992 on the teaching of quantitative volumetric analysis skills to the first-year students. We discuss the extent to which the level of laboratory skills of a group of students, in this case with a weak chemistry background and poor experimental ability, can be changed by the introduction of the combination of a computer-assisted learning (CAL) tutorial and video before the first practical exercise. Analysis of feedback data from the tutorial and from video observation during the first laboratory session has shown that understanding and application of skills are improved to a level at least comparable to that of students who have a much better background and experimental ability.
Journal Article
At Last--The Maximum-Sex-Drive Diet
If you don't get carried away anymore, you could be eating yourself into a slump. Follow our food cues to feel fizzy again!
Magazine Article
Sisters of Providence: The Search for God in the Frontier South (1843-1858)
\"Sisters of Providence: The Search for God in the Frontier South (1843-1858)\" edited by Allen Paul Speer and Janet Barton Speer is reviewed.
Book Review