Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial.

BACKGROUND: Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up. METHODS AND RESULTS: One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia >30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (P=0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (n=21 [34.4%] versus n=10 [15.9%]; P=0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage. CONCLUSION: In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00662701.

Entrapment of the circular mapping catheter in the mitral valve in two patients undergoing atrial fibrillation ablation.

The circular catheter is a useful tool to guide and test pulmonary vein (PV) isolation in atrial fibrillation ablation. However, its shape may facilitate entrapment in cardiac structures. We describe the entrapment of a circular mapping catheter within the mitral valve apparatus after transseptal catheterization and mapping of the left atrium and PVs in two of our patients.

Circumferential pulmonary vein ablation: does use of a circular mapping catheter improve results? A prospective randomized study.

BACKGROUND: The best method for performing atrial fibrillation (AF) ablation is still under debate. The importance of using a circular mapping (CM) catheter for assessing isolation of the pulmonary vein (PV) antrum on the outcome of the procedure has not been clearly established. OBJECTIVE: The purpose of this study was to evaluate whether use of a CM catheter improves the arrhythmia-free proportion after circumferential pulmonary vein ablation (CPVA). METHODS: A series of 146 consecutive patients (83% males, age 53 +/- 10 years, 53% paroxysmal AF) were randomized to two ablation strategies. In both groups, ipsilateral PV encirclement was performed until disappearance or dissociation of the local electrogram within the surrounded area. In the first group, only the radiofrequency catheter was used to both map and ablate (CPVA group, n = 73). In the other group, a CM catheter was added to assess the electrical activity of the PV antrum (CPVA-CM group, n = 73). An ablation line along the left atrial roof was also created in all patients. RESULTS: Procedural and fluoroscopic times were longer in the CPVA-CM group (P <.05). Severe procedure-related complications occurred in 1 (1.4%) patient in the CPVA group and in 3 (4.1%) patients in the CPVA-CM group (P = .317). After mean follow-up of 9 +/- 3 months, 31 (42.5%) patients in the CPVA group and 47 (64.4%) patients in the CPVA-CM group were arrhythmia-free without antiarrhythmic medication (P = .008). CONCLUSION: Use of a CM catheter to ensure isolation of the PV antrum improved the success of CPVA but increased some procedural requirements.

Late gadolinium-enhanced cardiovascular magnetic resonance identifies patients with standardized definition of ischemic cardiomyopathy: a single centre experience.

BACKGROUND: Definition of ischemic cardiomyopathy (IC) is not always obvious, which is why new criteria based on prognosis and the extent of the coronary artery disease (CAD) have been proposed. In the present study, we assess the capability of late gadolinium-enhanced cardiovascular magnetic resonance (CMR) for predicting IC as determined by standardized criteria previously reported. METHODS AND RESULTS: 123 patients with heart failure (HF) and left ventricular (LV) systolic dysfunction, underwent both late gadolinium-enhanced CMR and coronary angiography 37/123 (30%) of patients were assigned to the IC group and 86/123 (70%) to the non-IC group. Subendocardial late gadolinium enhancement (LGE) was found in 35/37 (94%) of patients in the IC group, whereas only 12/86 (14%) had this distribution in the non-IC group (p<0.001). There was a significant positive correlation between the extent of subendocardial LGE and that of the CAD as determined by the CAD Prognostic Index (r=0.78, p<0.01), the number of coronary stenoses > or = 50% (r=0.76, p<0.01) and the number of coronary stenoses of any percentage (r=0.70, p<0.01). CONCLUSION: In patients with HF and LV systolic dysfunction presence of subendocardial LGE makes an excellent indicator of underlying significant CAD, and the extent of the LGE correlates with the severity of the disease. It is therefore appealing as a method for diagnosing IC.

Diagnostico de VIH recomendaciones para el asesoramiento pre y post test / HIV diagnosis recommendations for pre and post test counseling

Es una publicación que pretender brindar herramientas conceptuales y practicas básicas sobre el proceso de asesoramientos a los equipos de salud del todo el país. Su objetivo es estimular la realización del diagnostico de VIH con asesoramiento sobre todo en el primer nivel de atención de la salud, teniendo en cuenta las particularidades locales y apelando a la creatividad de los equipos para su puesta en práctica. Es importante remarcar que si bien estas paginas refieren centralmente al diagnostico de VIH por involucrar algunos aspectos específicos y diferenciales respecto al resto de las infecciones de la transmisión sexual, se considera fundamental que el proceso de asesoramiento acompañe el diagnostico de todas las ITS. El documento está conformado por cinco capítulos. El primero presenta la importancia del asesoramiento en el contexto de los servicios de salud y la complementariedad con la estrategia de atención primaria de la salud. El capitulo dos enfatiza la relevancia y los beneficios del asesoramiento en el marco del proceso diagnostico del VIH. Los capítulos tres y cuatro desarrollan respectivamente los contenidos básicos del asesoramiento, objetivo principios contenidos y las etapas pre y post su realización. El ultimo capitulo recopila y sintetiza la información mínima sobre VIH y ETS necesaria para el desarrollo del asesoramiento

Directrices para el monitoreo de la estrategia de la eliminación de latransmisiónmaterno-infantil del VIH,sífilis, hepatitis B y chagascongénito / Guidelines for the Monitoring of the Strategy for the Elimination of Maternal and Child Transmission of HIV, Syphilis, Hepatitis B and Congenital Chagas

En el marco del plan estratégico nacional y el compromiso asumido en la estrategia de eliminación de la transmisión materno-infantil del VIH, sífilis, hepatitis B y chagas congenito, la Dirección de Sida, ETS, Hepatitis y TBC, la Dirección de Maternidad, Infancia y Adolescencia, la Dirección de Epidemiologia y el Programa Nacional de Chagas asumen la propuesta programática de incorporar a partir del año 2017 el documento ôDirectrices para el monitoreo de la estrategia de eliminación de la transmisión materno-infantil del VIH, sífilis, hepatitis B y chagas congénitoöbajo los lineamientos propuestos por la Organización Panamericana de la Salud (OPS) y la Organización Mundial de la Salud (OMS).Desde el año 2010, las direcciones y programas mencionados vienen trabajando en forma conjunta con OPS/OMS y UNICEF en la implementación de diversas estrategias para lograr las metas de eliminación a nivel nacional. En 2014, OPS/OMS publico los procedimientos y criterios mundiales y regionales de validación de la eliminación de la transmisión materno-infantil del VIH y la sífilis. Además de describir la repercusión y los indicadores del proceso de validación, la publicación destacaba la importancia de evaluar otros aspectos esenciales de este programa de eliminación, como son la calidad de los datos y la red de laboratorios. En este documento se describen la metodología de evaluación de los componentes programáticos, del sistema de vigilancia general, de la red de laboratorios y los servicios centrados en el VIH, sífilis, hepatitis B y chagas congénito de la estrategia de eliminación en Argentina.