Optimal Timing of VT Ablation for Patients with ICD Therapies.
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ABSTRACT:
SUBMITTER: Radinovic A
PROVIDER: S-EPMC7344350 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
Optimal Timing of VT Ablation for Patients with ICD Therapies.
Radinovic Andrea A Baratto Francesca F Della Bella Paolo P
Current cardiology reports 20200709 9
<h4>Purpose of review</h4>Optimal timing for catheter ablation of ventricular tachycardia is an important yet unresolved subject. While it is clear that it is indicated with relatively advanced disease, it is still uncertain how early it should be recommended. In this review, we will focus on the status of timing of catheter ablation for VT in patients with ICD therapies.<h4>Recent findings</h4>The latest expert consensus statement added a new timing indication for catheter ablation after the fi ...[more]
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Project description:BackgroundElectrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown.HypothesisTiming of CV in AF is associated with risk of adverse events.MethodsWe analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up.ResultsStudy groups were stratified according to duration of index AF episode (<24 h, 24-48 h, 48 h-30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24-48 h), 11.1% (48 h-30d), and 13.9% (>30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24-48 h), 37.3% (48 h-30d), and 30.3% (>30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P < 0.01) in multivariate analysis.ConclusionsOptimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.
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Project description:ObjectiveAdministrative health data are frequently used for large population-based studies. However, the validity of these data for identifying neurologic conditions is uncertain.MethodsThis article systematically reviews the literature to assess the validity of administrative data for identifying patients with neurologic conditions. Two reviewers independently assessed for eligibility all abstracts and full-text articles identified through a systematic search of Medline and Embase. Study data were abstracted on a standardized abstraction form to identify ICD code-based case definitions and corresponding sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).ResultsThirty full-text articles met the eligibility criteria. These included 8 studies for Alzheimer disease/dementia (sensitivity: 8-86.5, specificity: 56.3-100, PPV: 60-97.9, NPV: 68.0-98.9), 2 for brain tumor (sensitivity: 54.0-100, specificity: 97.0-99.0, PPV: 91.0-98.0), 4 for epilepsy (sensitivity: 98.8, specificity: 69.6, PPV: 62.0-100, NPV: 89.5-99.1), 4 for motor neuron disease (sensitivity: 78.9-93.0, specificity: 99.0-99.9, PPV: 38.0-90.0, NPV: 99), 2 for multiple sclerosis (sensitivity: 85-92.4, specificity: 55.9-92.6, PPV: 74.5-92.7, NPV: 70.8-91.9), 4 for Parkinson disease/parkinsonism (sensitivity: 18.7-100, specificity: 0-99.9, PPV: 38.6-81.0, NPV: 46.0), 3 for spinal cord injury (sensitivity: 0.9-90.6, specificity: 31.9-100, PPV: 27.3-100), and 3 for traumatic brain injury (sensitivity: 45.9-78.0 specificity: 97.8, PPV: 23.7-98.0, NPV: 99.2). No studies met eligibility criteria for cerebral palsy, dystonia, Huntington disease, hydrocephalus, muscular dystrophy, spina bifida, or Tourette syndrome.ConclusionsTo ensure the accurate interpretation of population-based studies with use of administrative health data, the accuracy of case definitions for neurologic conditions needs to be taken into consideration.
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Project description:ObjectivesTo evaluate the optimal timing of tracheostomy for injured adolescents.DesignRetrospective cohort study.SettingTrauma facilities in the United States.PatientsAdolescents (age 12-17 yr) in the National Trauma Data Bank (2007-2016) who were ventilated for greater than 24 hours and survived to discharge.InterventionsNone.Measurements and main resultsAfter stratifying by traumatic brain injury diagnosis, we compared ICU and hospital length of stay, pneumonia, and discharge disposition of patients with tracheostomy prior to three cut points (3, 7, and 14 d after admission) to 1) patients intubated at least as long as each cut point and 2) patients with tracheostomy on or after each cut point. Of 11,045 patients, 1,391 (12.6%) underwent tracheostomy. Median time to tracheostomy was 9 days (interquartile range, 6-13 d) for traumatic brain injury and 7 days (interquartile range, 3-12 d) for nontraumatic brain injury patients. Nontraumatic brain injury patients with tracheostomy prior to 7 days had 5.6 fewer ICU days (-7.8 to -3.5 d) and 5.7 fewer hospital days (-8.8 to -2.7 d) than patients intubated greater than or equal to 7 days and had 14.8 fewer ICU days (-19.6 to -10.0 d) and 15.3 fewer hospital days (-21.7 to -8.9 d) than patients with tracheostomy greater than or equal to 7 days. Similar differences were observed at 14 days but not at 3 days for both traumatic brain injury and nontraumatic brain injury patients. At the 3- and 7-day cut points, both traumatic brain injury and nontraumatic brain injury patients with tracheostomy prior to the cut point had lower risk of pneumonia and risk of discharge to a facility than those with tracheostomy after the cut point.ConclusionsFor injured adolescents, tracheostomy less than 7 days after admission was associated with improved in-hospital outcomes compared with those who remained intubated greater than or equal to 7 days and with those with tracheostomy greater than or equal to 7 days. Tracheostomy between 3 and 7 days may be the optimal time point when prolonged need for mechanical ventilation is anticipated; however, unmeasured consequences of tracheostomy such as long-term complications and care needs must also be considered.
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