Procedure Note Template Cardioversion Is Procedure Note Template Cardioversion Still Relevant?

Patients with episodes of atrial fibrillation (AF) abiding beneath than 24 hours are decidedly added acceptable to be chargeless from alternate AF afterwards catheter ablation than patients with preablation AF that lasts longer, new assay suggests.



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“What we accept approved in our assay is that there is a bright beginning for ablation efficacy, whereby outcomes were bigger if the AF episodes were beneath than 24 hours compared to greater than 24 hours,” JasonG. Andrade, MD, University of British Columbia, Vancouver, Canada, told theheart.org | Medscape Cardiology.

The findings, forth with antecedent research, “suggest that there is article altered about AF patients with paroxysmal episodes abiding beneath than 24 hours, about to best durations,” said Andrade, who is advance columnist on the analysis, appear July 2 in JAMA Network Open.



The after-effects are additionally constant with the appearance that the accepted analogue of paroxysmal AF, “pragmatically but arbitrarily” said to be AF that lasts from 2 minutes to 7 days, the address notes, may not reflect the arrhythmia’s pathophysiologic underpinnings in the best clinically advantageous way.



Perhaps a afterlight to the analogue of paroxysmal AF is in order, the advisers propose.

The accepted abstraction “supports the abstraction that ablating beforehand in the advance of AF progression is associated with bigger outcomes. Best clinicians who accomplish these procedures accept continued empiric this in their own practices,” Peter Noseworthy, MD, told theheart.org | Medscape Cardiology.

“Although there accept been added studies that accept additionally approved this, it is acceptable to see added absolute affirmation appear in the literature,” added Noseworthy, from the Mayo Clinic, Rochester, Minnesota, who wasn’t complex in the study.

Andrade and colleagues adjourned the affiliation amid preablation continuance AF episodes and time to arrhythmia ceremony afterwards ablation in a prespecified accessory assay of the Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Continuance (CIRCA-DOSE) study.

The trial, conducted at eight centers in Canada, entered 346 patients (mean age, 59 years), two-thirds of whom were men, with appropriate AF adverse to medical assay who had been referred for a aboriginal catheter ablation procedure. All patients accustomed an implantable cardiac adviser at atomic 30 canicule above-mentioned to ablation and were stratified by continuance of their longest AF adventure during that month.

Overall, 263 patients (76.0%) accomplished preablation AF episodes abiding beneath than 24 hours, 25 (7.2%) had AF episodes abiding 24 to 48 hours, 40 (11.7%) had episodes abiding 2 to 7 days, and 18 (5.2%) had episodes abiding for added than 7 days.

Recurrence of any atrial tachyarrhythmia afterwards ablation was decidedly lower in patients with baseline AF episodes beneath than 24 connected hours than in those with best AF episodes.

Patients with preablation AF abiding beneath than 24 hours showed about a 60% to 75% abridgement in postablation accident for ceremony of any atrial tachyarrhythmia, in an unadjusted analysis, compared with patients with any of the three added AF-duration categories.

Such patients additionally had a decidedly lower average postablation AF accountability (0%) than those with AF preablation episodes abiding 2 to 7 canicule (0.1%; P = .003) and added than 7 canicule (1.0%; P = .008), the address notes.

There was no cogent aberration in arrhythmia ceremony amount or AF accountability amid the three groups with a preablation AF adventure continuance of best than 24 hours.

Left atrial amplification and baseline AF adventure continuance best than 24 hours were cogent predictors of postablation arrhythmia ceremony in multivariate analysis, with allowance ratios of 1.92 (95% CI, 1.11 – 3.34) and 3.36 (95% CI, 1.79 – 6.53), respectively, address Andrade and colleagues.

“Given the decidedly bigger post-ablation outcomes amid the subset of patients with AF episodes bound to beneath than 24 connected hours, application should be accustomed to 24 hours of connected AF as a beginning for defining AF persistence,” they write.

“The accepted definitions of AF — paroxysmal (less than 7 days), assiduous (greater than 7 days), and abiding assiduous (greater than 1 year) — accept been acclimated to characterize the severity of disease, ascertain accommodating populations in analytic trials, and anatomy the base of ameliorative recommendations apropos pharmacological and invasive arrhythmia management,” Andrade told theheart.org | Medscape Cardiology. “However, they are not based on clinically allusive events.”

But the accepted findings, he said, are “in acceding with antiarrhythmic biologic studies that appearance greater apology of atrium accent ability if cardioversion is performed for episodes of beneath than 24 hours, pacemaker studies that appearance greater achievement accident in patients with AF episodes abiding added than 24 hours, and cardioversion studies that authenticate that the periprocedural accident of achievement is added if cardioversion is performed for AF episodes added than 24 hours.”

The results, therefore, beggarly there may be a “pathophysiological rationale” to revisit the analogue of paroxysmal AF and accede abridgement the best continuance of its episodes from 7 canicule to 24 hours, Andrade proposed.

But Noseworthy said he’s “not abiding there is abundant in this abstraction to advance we should redefine the appellation ‘paroxysmal AF.’

Usually, “clinicians who booty affliction of patients with AF are best anxious with achievement prevention, not ablation outcomes. We apperceive that AF accountability is associated with achievement risk, but we do not absolutely apperceive the cut point at which the accident absolutely begins to increase,” Noseworthy said.

“I anticipate creating AF definitions about achievement accident would be best clinically useful, added so than framing atrial fibrillation definitions in agreement of ablation efficacy.”

The CIRCA-DOSE abstraction was partially adjourned by Medtronic and Bristol-Myers Squibb. Andrade letters accepting grants and claimed fees from Medtronic and claimed fees from Biosense Webster; disclosures for the added authors are in the report. Noseworthy had no accordant disclosures.

JAMA Netw Open. 2020;3:e208748. Full text

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