Outcomes of hybrid surgical ablation and concomitant left atrial appendage exclusion in long-standing persistent atrial fibrillation.

INTRODUCTION: Management of patients with long-standing persistent atrial fibrillation (LSPAF) presents a clinical challenge. Hybrid convergent ablation has been shown to have superior efficacy compared to endocardial-only ablation. However, data on concomitant left atrial appendage (LAA) management along with hybrid ablation is sparse. METHODS: We aimed to evaluate the effectiveness of concomitant hybrid convergent ablation and LAA clipping in patients with LSPAF. We conducted a retrospective analysis of all patients with LSPAF who underwent hybrid surgical ablation with LAA clipping at our institution. The primary endpoint was a recurrence of atrial arrhythmias at 12 months. Further, the durability of surgical left atrial posterior wall ablation was examined during the endocardial catheter ablation using standing electrophysiological criteria. RESULTS: A total of 79 patients were included. Mean age was 63.5 ± 9.6 years, and 71% were males. LAA clipping was performed in 99% of patients. The mean time between the surgical and endocardial stages of the procedure was 2.6 ± 1.7 months. Persistent posterior wall activity was observed in 34.2% (n = 27/79) patients during the endocardial phase of the procedure. Cardiac implantable electronic device was used in 74% of patients for monitoring of recurrence of atrial fibrillation (AF). The primary effectiveness of AF freedom at 12 months was 73.8% (45/61). Over a 12-month follow-up period, 11.4% (9/79) of patients required repeat catheter ablation, of which 88.9% (8/9) had evidence of persistent posterior wall activity. CONCLUSION: Concomitant hybrid convergent ablation and LAA exclusion with an atrial clip provides reasonable long-term AF-free survival in patients with LSPAF. Persistent posterior wall activity is seen commonly in patients presenting with recurrent AF following hybrid convergent AF ablation.

Basic Life Support Awareness and Knowledge in High School Students.

INTRODUCTION: Cardiovascular disease is the leading cause of death in the United States. When cardiovascular disease results in cardiac arrest, the ability to perform basic life support (BLS) can change the outcome from death to survival. There is no definitive statistical data on high schoolers' awareness of basic life support (BLS). METHODS: A survey-based research study was conducted to find high schoolers' awareness of BLS. A total of 105 students, primarily from Kansas City suburbs, took a survey with questions ranging from their views on whether BLS courses should be integrated into the high school curriculum to the steps they would take when a person collapses on the ground. Results were analyzed to determine the students' knowledge of different aspects of BLS and their interest in taking a BLS course in school. RESULTS: Over 70% of the students would take a BLS course should it be offered in a high school class. Most students answered questions regarding BLS steps correctly but lacked critical knowledge on an automated external defibrillator (AED). CONCLUSIONS: Although over 70% of the students were aware of the basics of BLS, most students lacked knowledge on the critical aspects of BLS, such as the use of an AED. Most students recognize the importance of BLS in the high school curriculum and would acquire the skills in a high school class. Introducing a BLS course in the high school curriculum would improve the students' knowledge and contribute to improved survival rates of victims of out-of-hospital cardiac arrest.