Open Access Original Research Article

Dronedarone after Catheter Ablation of Atrial Fibrillation: A New Option in Hybrid Therapy

Felix Gramley, Felix Vogt, Mohammed Natour, Eva Koellensperger, Klaus Kettering

Cardiology and Angiology: An International Journal, Page 1-10
DOI: 10.9734/CA/2017/32001

Background and Aim: Catheter ablation has become the therapy of choice in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, frequent AF recurrences often necessitate an adjunctive antiarrhythmic drug (AAD) therapy. Dronedarone is a new class III AAD with modest side effects. We compared a conventional AAD therapy (CAAT) with class I/III AADs to a novel therapy with dronedarone (NAAT)in regard to AF recurrences and improvement of symptoms.

Methodology: One hundred twenty five consecutive patients (84 men; mean age 62.1±12.4 years) with symptomatic paroxysmal (n=70) or persistent (n=55) drug refractory AF were enrolled in an open-label randomized study. Following successful pulmonary vein isolation (PVI) patients were randomized to receive CAAT (n=50), NAAT (n=50) or no AAD therapy (=control; n=25). Follow-up visits were scheduled at 3, 6, 9, and 12 months post ablation. Seven-day-Holter monitoring and patients’ histories served as indicators of treatment success. Bar signs of AF recurrence AADs were discontinued 6 months post ablation.

Results: The pre-ablation European Heart Rhythm Association (EHRA)-score decreased from 2.8±0.4 to 1.4±0.6 (NAAT) and 1.5±0.7 (CAAT) 6 months after PVI (1.7±0.7 in the control group). Fifty patients experienced an arrhythmia recurrence within 3 months. After 6 months, both hybrid therapy groups showed a significant advantage over the control group favoring sinus rhythm (SR).Whereas CAAT could retain its significant benefit at 9 months NAAT lost its relative advantages with only a positive trend remaining over the control group but a significant disadvantage compared to CAAT patients. At this point AF recurrences were found in 34% of NAAT patients, 26% of CAAT patients, and 40% of control patients. At 12 months, however, no group could preserve a significant lead over either of the others.

Conclusion: Dronedarone after PVI is safe and effective. Compared to a CAAT, NAAT reveals similar improvements of EHRA-scores and non-significantly different AF recurrence rates from 9 months on. Despite this, CAAT keeps significantly more patients in SR 9 months after PVI.


Open Access Original Research Article

Prevalence and Correlates of Pre-hypertension and Hypertension Results-II: A Screening Plan in a Selected Military Community in Central Saudi Arabia

Ashraf E. Saad, Ahmed AL Shehri, Raouf M. Afifi, Mohamed A. Tashkandi

Cardiology and Angiology: An International Journal, Page 1-21
DOI: 10.9734/CA/2017/32180

Background: Follow-up of patients destined to develop primary hypertension (HTN) demonstrates that blood pressure (BP) readings gradually increase over time.

Aim: Determine and analyze the prevalence and correlates of both pre-HTN and HTN among recruits serving in Wadi Al-Dawasir (WD) military district, central Saudi Arabia.

Methodology: Part of a “community diagnosis” plan led by the preventive medicine and family departments of the Armed Forces Hospital- WD (AFHWD), recruits were screened. A predesigned questionnaire and clinical interview were used to achieve study aim.

Results: The median age of participates was 34y (IQR 11.75); median systolic blood pressure (SBP) 120 mmHg (IQR 20), and diastolic BP (DBP) 80 mmHg (IQR 15). In screening, 531 recruits, all male, were surveyed. Forty-nine percent (253/516) were found with SBP 120-139 mmHg, compatible with “prehypertension;” 208/ (82.2%) of them were unaware they have prehypertension. Also, 12.2% (63/516) were found with SBP≥140 mmHg, meeting HTN diagnosis, 42 (66.7%) of whom were newly diagnosed. The participants’ body mass index (BMI) averaged 27.6±5.4 kg/m2, and 66.4% participants were overweight-obese. Abnormally high BMI levels were significant risk for high BP [Fisher’s exact 64.6, p<0.0001]. “Now-smokers accounted 17.0% (n= 81); smoking impacted their hypertension (42.9%) and pre-hypertensive (25.4%) states [χ2(df 2)=6.5, p=0.039]. Age significantly impacted BP level [χ2(df 2)=14.3 p=0.001]; same as education [Fisher’s exact 17.8, p=0.03]. Importantly, the recruits’ SBP level differed between random plasma glucose (RPG) groups [U=4745, p=0.002]. Among chronic-disease comorbidities, having diabetes mellitus (DM) was significantly associated with hypertension (OR 2.93, 95% CI 134.6-637.6). Dyslipidemia also impacted high BP reporting [Fisher’s exact =10.6, p=0.004]. The presence of family history of coronary heart disease (CHD) was significantly related to HTN among participants [χ2(df 2)= 14.9, p=0.001].

Conclusions: Prehypertension, virtually the undiagnosed, is alarmingly prevalent in this study’s population; hypertension, too, is less likely present. Most hypothesized risks were significant high BP correlates. With current insight, the main focus should be directed first to high BP and comorbid risks control; and continued screening to evaluate the effectiveness of intervention approaches on the recruits’ lifestyle modifications and the impact of treatment policy on minimizing the risk of subsequent cardiovascular, stroke, and other systemic complications.


Open Access Original Research Article

Effect of Short Systemic Intermittent Hypoxia on Systemic Hemodynamics Blunted in Cutaneous Microcirculation

Artūrs Paparde, Līga Plakane, Kristaps Circenis

Cardiology and Angiology: An International Journal, Page 1-11
DOI: 10.9734/CA/2017/33514

Background: Hypoxic stimulus induces a homeostatic disruption to enhance physiological adaptation. Blood flow in the microcirculation plays an important role in maintaining healthy tissues by delivering oxygen. The cutaneous microcirculations responses to short systemic hypoxia and especially its duration are poorly understood; however the mechanisms of this phenomenon are at the microcirculatory level. The aim of our study was to determine the short systemic intermittent hypoxia's influence on blood flow in skin, local regulatory mechanism fluctuations and changes of systemic hemodynamic parameters in humans.

Place and Duration of Study: Research was performed in University of Latvia, Institute of Cardiology and Regenerative Medicine, Ojāra Vacieša Street 4, Riga, Latvia, between May 2016 and December 2016.

Methodology: Twelve healthy subjects (n=12, 25.1±2.9 years old) participated in this study. After 20min of acclimatization 10 min of basal resting period in normoxia (FiO2=21%) was recorded. Intermittent hypoxic air breathing was made, corresponding 5 min of acute systemic hypoxic (FiO2=12%) period followed by 5 min of normoxic period, were repeated four times, after hypoxia, 10min of recovery period followed in normoxia. Heart rate variability and systemic hemodynamic parameters and regional blood flow were evaluated. To register skin blood flow laser-Doppler flowmetry was used and evaluation of local factor influences to cutaneous circulation was made by wavelet analysis; fluctuations in the frequency intervals of 0.0095–0.021, 0.021–0.052, and 0.052–0.145 Hz correspondingly represented endothelial, sympathetic, and myogenic activities.

Results: Intermittent acute hypoxia increased systemic hemodynamic parameters, but it didn't significantly change skin blood flow and local regulatory factor activities.

Conclusions: The main findings of study are that intermittent acute hypoxia increase systemic hemodynamic parameters, but didn't change skin blood flow and local endothelial, sympathetic, and myogenic activities.


Open Access Original Research Article

Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures

Klaus Kettering, Felix Gramley, Stephan von Bardeleben

Cardiology and Angiology: An International Journal, Page 1-18
DOI: 10.9734/CA/2017/34273

Background: Catheter of atrial fibrillation is still challenging because of the high degree of variability of the pulmonary vein anatomy. Therefore, 3D imaging systems are frequently used prior to an ablation procedure. Three-dimensional transesophageal echocardiography provides an excellent overview over the individual left atrial morphology without some of the limitations associated with other imaging techniques. 

Methods: In 50 patients, three-dimensional transesophageal echocardiography was performed immediately prior to an ablation procedure. The images were available throughout the ablation procedure. In most of the patients with paroxysmal atrial fibrillation, the cryoablation technique was used (Arctic Front Balloon, CryoCath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system (Biosense Webster; group A1 (paroxysmal atrial fibrillation), group B (persistent atrial fibrillation)).

Results: A three-dimensional transesophageal echocardiography could be performed successfully in all patients and all four pulmonary vein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely. The findings obtained by three-dimensional transesophageal echocardiography correlated well with the pulmonary vein angiographies performed during the ablation procedures. At 24-month follow-up, 76% of all patients were free from an arrhythmia recurrence (group A1: 81.8%, group A2: 78.9%, group B: 70.0%).  There were no major complications.  

Conclusions: AF ablation procedures can be performed safely and effectively based on prior 3D TEE imaging. 


Open Access Review Article

Use of Levosimendan in Patients With Low Left Ventricular Ejection Fraction in Ordu/Turkey: Report of Experience with Mini Review

Mihriban Yalcin, Eda Godekmerdan, Kaptanı Derya Tayfur, Serkan Yazman, Ahmet Ozyazicioglu

Cardiology and Angiology: An International Journal, Page 1-8
DOI: 10.9734/CA/2017/33415

Aims:To report the effect of prophylactic usage of levosimendan in patients with low left ventricular ejection fraction undergoing coronary artery bypass grafting (CABG).

Methods: We reported early results of 32 patients (26 male and 6 female; mean age 61.630 ± 9.653 years) who  received preoperative levosimendan who underwent CABG with left ventricular ejection fraction (LVEF) of 35% or less between March 2014 and August 2016.

Results: All patients achieved to wean from cardiopulmonary bypass. In only four patients there was a need for intraaortic baloon pump (12.5%). Mortality was in 4 patients (12.5%). And six months after the operation all patients (discharged from hospital) were alive.

Conclusion: Preoperatively administration of the long-acting inotrope levosimendan might be feasible and have a favourable safety profile in patients with severely reduced LVEF undergoing CABG. We suggest that levosimendan may be useful in high-risk CABG patients.