RESUMO
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Estenose de Veia Pulmonar , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Ablação por Cateter/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hemorragia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Estenose de Veia Pulmonar/etiologia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Metanálise como AssuntoRESUMO
Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed "disaster huddles") in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.