Underuse of Catheter Ablation as First-Line Therapy for Supraventricular Tachycardia.

Background Catheter ablation (CA) is a safe, effective, cost-effective technique and may be considered a first-line strategy for the treatment of symptomatic supraventricular tachycardias (SVT). Despite the high prospect of cure and the recommendations of international guidelines in considering CA as a first-line treatment strategy, the average time between diagnosis and the procedure may be long. The present study aims to evaluate predictors related to non-referral for CA as first-line treatment in patients with SVT. Methods and Results The model was derived from a retrospective cohort of patients with SVT or ventricular pre-excitation referred for CA in a tertiary center. Clinical and demographical features were used as independent variables and non-referral for CA as first-line treatment the dependent variable in a stepwise logistic regression analysis. Among 20 clinical-demographic variables from 350 patients, 10 were included in initial logistic regression analysis: age, women, presence of pre-excitation on ECG, palpitation, dyspnea and chest discomfort, number of antiarrhythmic drugs before ablation, number of concomitant symptoms, symptoms' duration and evaluations in the emergency room due to SVT. After multivariable adjusted analysis, age (odds ratio [OR], 1.2; 95% CI 1.01-1.32; P=0.04), chest discomfort during supraventricular tachycardia (OR, 2.7; CI 1.6-4.7; P<0.001) and number of antiarrhythmic drugs before ablation (OR, 1.8; CI 1.4-2.3; P<0.001) showed a positive independent association for non-referral for CA as SVT first-line treatment. Conclusions The independent predictors of non-referral for CA as first-line treatment in our logistic regression analysis indicate the existence of biases in the decision-making process in the referral process of patients who would benefit the most from catheter ablation. They very likely suggest a skewed medical decision-making process leading to catheter ablation underuse.

Flowmetry of left internal thoracic artery graft to left anterior descending artery: comparison between on-pump and off-pump surgery.

BACKGROUND: Off-pump coronary bypass grafting (OPCAB) has become a widely used technique. Coronary flowmetry is the most common method employed to assess graft patency, nevertheless, few studies compare flow patterns between ONCAB and OPCAB surgery. The objective of this study was to compare flowmetry data in left internal mammary artery grafts bypasses to the left anterior descendent artery. METHODS: From March to September of 2010, thirtyfive consecutive, non-randomized patients underwent CABG and were retrospectively evaluated. Ten patients were located on group A (On Pump), and twenty-five on group B (Off Pump). The mean graft flow (MGF), pulsatile index (PI) and diastolic filling (DF) were obtained using Transit Time Flowmetry (TTFM). The Fisher exact test, and Mann Whitney test were used, and a P value of < 0.05 was considered to indicate statistical significance. RESULTS: There were no deaths, AMI, re-interventions or PTCA in a 30-day period. The number of bypasses performed per patient was 2.3 ± 0.8 in the OPCAB group, and 2.2 ± 0.6 in the ONCAB group, with no significant difference (P=0.10). The median of mean flow was 23 ml/min on group A, and 25 ml/min on group B (P=0.34). Diastolic filling percentage was 56% on group A, and 56.9% on group B (P=0.86). Pulsatile Index was 2.3 on group A, and 2.2 on group B (P=0.82). CONCLUSIONS: There was no difference between TTFM values (MF, PI and DF) in patients operated with or without cardiopulmonary bypass.

Fluxometria da artéria torácica interna esquerda na revascularização da artéria descendente anterior com e sem circulação extracorpórea / Flowmetry of left internal thoracic artery graft to left anterior descending artery: comparison between on-pump and off-pump surgery

INTRODUÇÃO: A cirurgia de revascularização do miocárdio (RM) sem circulação extracorpórea (CEC) é uma técnica amplamente utilizada. A fluxometria coronariana é a técnica mais usada para avaliação dos enxertos, porém, poucos estudos comparam os dados fluxométricos na RM com e sem CEC. O objetivo deste estudo foi comparar as variáveis fluxométricas dos enxertos de artéria torácica interna esquerda para a artéria descendente anterior em pacientes submetidos à RM com e sem CEC. MÉTODOS: Entre março e setembro de 2010, foram analisados retrospectivamente 35 pacientes consecutivos, não randomizados, submetidos à RM. Foram alocados 10 pacientes no grupo A (com CEC) e 25 no grupo B (sem CEC). O fluxo médio do enxerto (FME), o índice pulsátil (PI) e a porcentagem de enchimento diastólico (ED) foram obtidos por meio da fluxometria por tempo de trânsito. Foi utilizado o teste exato de Fisher e Mann-Whitney, sendo considerado estatisticamente significante P<0,05. RESULTADOS: Não houve óbito, infarto agudo do miocárdio ou necessidade de angioplastia em 30 dias de pós-operatório. O número médio de anastomoses distais foi 2,3 ± 0,8 por paciente no grupo sem CEC, e de 2,2 ± 0,6 no grupo com CEC (P=0,10). A mediana do fluxo médio do enxerto foi 23 ml/min, no grupo A, e 25 ml/min, no grupo B (P=0,34). A percentagem de enchimento diastólico foi 56%, no grupo A, e 59,5%, no grupo B (P=0,86). O índice pulsátil foi 2,3, no grupo A, e 2,2, no grupo B (P=0,82). CONCLUSÃO: Não houve diferença nos parâmetros fluxométricos (FME, ED e PI) encontrados nos pacientes submetidos à revascularização do miocárdio com e sem CEC.

BACKGROUND: Off-pump coronary bypass grafting (OPCAB) has become a widely used technique. Coronary flowmetry is the most common method employed to assess graft patency, nevertheless, few studies compare flow patterns between ONCAB and OPCAB surgery. The objective of this study was to compare flowmetry data in left internal mammary artery grafts bypasses to the left anterior descendent artery. METHODS: From March to September of 2010, thirtyfive consecutive, non-randomized patients underwent CABG and were retrospectively evaluated. Ten patients were located on group A (On Pump), and twenty-five on group B (Off Pump). The mean graft flow (MGF), pulsatile index (PI) and diastolic filling (DF) were obtained using Transit Time Flowmetry (TTFM). The Fisher exact test, and Mann Whitney test were used, and a P value of < 0.05 was considered to indicate statistical significance. RESULTS: There were no deaths, AMI, re-interventions or PTCA in a 30-day period. The number of bypasses performed per patient was 2.3 ± 0.8 in the OPCAB group, and 2.2 ± 0.6 in the ONCAB group, with no significant difference (P=0.10). The median of mean flow was 23 ml/min on group A, and 25 ml/min on group B (P=0.34). Diastolic filling percentage was 56% on group A, and 56.9% on group B (P=0.86). Pulsatile Index was 2.3 on group A, and 2.2 on group B (P=0.82). CONCLUSIONS: There was no difference between TTFM values (MF, PI and DF) in patients operated with or without cardiopulmonary bypass.