Comparison of the Efficancy and Complication Rates of the Hybrid Maze, Complete Cox-Maze and Catheter Ablation in the Treatment of Atrial Fibrillation.

INTRODUCTION: Atrial fibrillation is the most common cardiac arrhythmia in the United States. It has been associated with a reduction in patient quality of life and more serious complications such as stroke and heart failure. The aim of this study was to compare the efficacy of commonly performed invasive procedures in keeping patients in normal sinus rhythm. METHODS AND RESULTS: A retrospective chart review was performed on all patients who underwent primary radiofrequency catheter ablation, the complete Cox-maze, or the hybrid maze at OSF Saint Anthony Medical Center between January 2010 and December 2013 (n=140). Immediately post-procedure, arrhythmia recurrence rates did not differ between the groups (p = 0.28). At all follow-up points thereafter, however, differences in procedural efficacy between surgical and catheter therapy remained highly significant (p < 0.001). At 2 years, 20.3% of the catheter ablation patients were in normal sinus rhythm, when compared to 57.9% of hybrid maze and 72.7% the complete Cox-maze groups. A difference in major complication rates was noted (p = 0.04), with the complete Cox-maze having a 17.4%, the hybrid having 22.7%, and the catheter ablation group having 5.6%. CONCLUSIONS: This study was unable to detect differences in the efficacy rates of the surgical procedures, however they were both superior to catheter ablation. Although the hybrid approach is considered minimally invasive, complication rates were similar to those of the complete Cox-maze. Catheter ablation was the safest procedure, and since evidence of reduced mortality after the use of aggressive rhythm therapy is currently lacking, the results suggest that hybrid surgery for atrial fibrillation should be used after the failure of more conservative measures.

Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues.

STUDY DESIGN: Narrative review. OBJECTIVE: Despite the numerous treatment options for vertebral compression fractures, a consensus opinion for the management of patients with these factures has not been established. This review is meant to provide an up-to-date overview of the most common treatment strategies for compression fractures and to suggest possible routes for the development of clearer treatment guidelines. METHODS: A comprehensive database search of PubMed was performed. All results from the past 30 years were obtained and evaluated based on title and abstract. The full length of relevant studies was analyzed for level of evidence, and the strongest studies were used in this review. RESULTS: The major treatment strategies for patients with compression fractures are conservative pain management and vertebral augmentation. Despite potential adverse effects, medical management, including nonsteroidal anti-inflammatory drugs, calcitonin, teriparatide, and bisphosphonates, remains the first-line therapy for patients. Evidence suggests that vertebral augmentation, especially some of the newer procedures, have the potential to dramatically reduce pain and improve quality of life. At this time, balloon-assisted kyphoplasty is the procedure with the most evidence of support. CONCLUSIONS: Based on current literature, it is evident that there is a lack of standard of care for patients with vertebral compression fractures, which is either due to lack of evidence that a procedure is successful or due to serious adverse effects encountered with prolonged treatment. For a consensus to be reached, prospective clinical trials need to be formulated with potential new biomarkers to assess efficacy of treatment strategies.