Figure-of-eight suture for venous hemostasis in fully anticoagulated patients after atrial fibrillation catheter ablation.

INTRODUCTION: Limited data exists for types of venous closure and its associated complications in patients after atrial fibrillation (AF) catheter ablation. We evaluated the subcutaneous figure-of-eight closure (FO8) for achieving venous hemostasis after AF catheter ablation compared to manual pressure. METHODS: 284 consecutive patients that underwent AF catheter ablation by two operators were included. All patients received continuous therapeutic warfarin or interrupted novel oral anticoagulants (NOAC) and heparin (ACT300-400 s) without reversal. Patients were divided into two groups: 1) sheaths were left in place and pulled once ACT < 180 s, with hemostasis being achieved with manual pressure (MP); and 2) a subcutaneous FO8 suture closed the venous access site immediately after the ablation on each groin site and sheaths were removed immediately after the ablation despite full anticoagulation with heparin and warfarin or interrupted NOAC. Sutures were removed after four hours, and the patients laid flat for an additional two hours. RESULTS: The MP group (n = 105) was similar to the FO8 group (n = 179). Time in bed was 573 ± 80 min for MP group vs. 373 ± 49 min for FO8 group (p < 0.0001). Eleven hematomas were seen in the MP group compared to seven in the FO8 group (P = 0.041). CONCLUSIONS: In fully anticoagulated patients undergoing AF catheter ablation, excellent hemostasis was achieved with figure-of-eight sutures, with no major vascular complications, a lower hematoma rate, and a significantly shorter flat-time-in-bed compared to manual pressure.

Utility of Brain Natriuretic Peptide in diagnosis of congestive heart failure and comparison with trans-thoracic echocardiography: a multicenter analysis in South Asian and Arabian population.

OBJECTIVE: To evaluate serum Brain Natriuretic Peptide levels (BNP) as a screening test in the diagnosis of congestive heart failure. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia between December 2010 to January 2012 and Nishtar Hospital, Multan, Pakistan, from February to August 2006. METHODOLOGY: A total of 80 patients with clinical diagnosis of Congestive Heart Failure (CHF) underwent measurement of serum BNP and had a trans-thoracic echocardiography to measure Ejection Fraction (EF). The normal limit for serum BNP levels, provided by the manufacturer of the kit was applied as a cut-off value for BNP. EF of > 45% was considered normal. RESULTS: Forty seven patients (94%) had an EF < 45%. BNP levels were elevated in 36 patients (72%). Sensitivity and specificity of BNP was found to be 80% and 66% respectively and accuracy was 80%. CONCLUSION: BNP measurements as a screening tool for CHF has good sensitivity and accuracy when compared to echocardiography.

A novel catheter in patients with peripheral chronic total occlusions: a single center experience.

OBJECTIVES AND BACKGROUND: Recanalization of a chronic total occlusion (CTO) is technically challenging with less than optimum results in arterial disease. Crosser® is a novel technology that utilizes high frequency (20 KHz) vibration energy to fragment occlusive fibrous atherosclerotic plaque and helps in traversing the occluded vessel. We report a single center experience with this catheter as the primary device in peripheral chronic total occlusions. METHODS: The catheter was used as the primary device in 25 consecutive patients with peripheral CTOs. The peripheral CTOs in this study are defined as 100% occluded vessels involving any segment of the iliac artery or below the inguinal ligament down to the trifurcation vessels which have been occluded for greater than 3 months judged by patient's history of longstanding symptoms with no worsening in the past 3 months. Procedural success was defined by the ability of the device to facilitate guide wire crossing of the occlusion. All angiograms were evaluated by two operators. Data on demographics, angiographic variables, and patient complications was collected. RESULTS: The device was used in 25 consecutive patients and 27 CTO lesions were treated. Critical limb ischemia and claudication were the indications in 32 and 68% of the patients, respectively. Average lesion length was 117 mm (range 10-300 mm). Superficial femoral artery was the most common lesion site (n = 20, 74%). Crosser-assisted guide wire recanalization was achieved in 11(41%) lesions while the final overall procedure success rate with any device was 63% (n = 17). Perforation occurred in five lesions with one directly attributable to this device. CONCLUSIONS: In this single center observational review, the Crosser device in peripheral CTO lesions had a procedural success of 41%. © 2010 Wiley-Liss, Inc.

Systematic review: comparing routine and selective invasive strategies for the acute coronary syndrome.

BACKGROUND: Patients with non-ST-segment elevation acute coronary syndrome (ACS) are managed with either a routine invasive strategy, in which all patients receive coronary angiography, or a selective invasive strategy, in which only patients with refractory or inducible ischemia receive coronary angiography. PURPOSE: To evaluate whether a routine invasive strategy improves cardiovascular outcomes more than a selective invasive strategy in patients with non-ST-segment elevation ACS. DATA SOURCES: English-language publications in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1966 to 18 September 2007. STUDY SELECTION: Two investigators independently reviewed searches and selected trials that compared death or myocardial infarction outcomes among adults with non-ST-segment elevation ACS by randomly assigning patients to either a routine invasive strategy or a selective invasive strategy. DATA EXTRACTION: Three investigators independently abstracted data from trial reports by using standardized forms. DATA SYNTHESIS: 10 trials with a total of 10,648 patients (mean age, 62 years; 71% male; median follow-up, 16.5 months) were found. Trial participants had typical symptoms of unstable angina and frequently had a positive electrocardiogram or marker evidence of myocardial ischemia. Of the 5330 participants assigned to the routine invasive strategy group, 847 had the composite outcome of death or nonfatal myocardial infarction, compared with 928 of 5318 participants assigned to the selective invasive strategy group (relative risk, 0.90 [95% CI, 0.74 to 1.08]). Four hundred thirty-eight patients in the routine invasive strategy group and 463 in the selective invasive strategy group died (relative risk, 0.95 [CI, 0.80 to 1.14]). Four hundred ninety and 569 nonfatal myocardial infarctions, respectively, occurred in the 2 groups (relative risk, 0.86 [CI, 0.68 to 1.08]). LIMITATIONS: Methodology, protocols, and outcome definitions differed substantially among the trials. The lower bound of the CI for the pooled results did not rule out the superiority of the routine invasive strategy. CONCLUSION: Available trial evidence is heterogeneous and insufficient for comparing routine and selective invasive strategies. Therefore, in patients with non-ST-segment elevation ACS a routine invasive strategy cannot be proven to reduce deaths or nonfatal myocardial infarction.