Patient Perspective :Left atrial image registration to guide catheter ablation of atrial fibrillation: In the eye of the technology

Citation : Osmar Antonio Centurion.Left atrial image registration to guide catheter ablation of atrial fibrillation: In the eye of the technology .JAFIB.2008 Sep;1(3): 190-193.

Your EP doctor uses state-of-the-art imaging techniques to evaluate and treat Atrial Fibrillation. The currently used imaging methods include Transthoracic echocardiography, Transesophageal echocardiography (or TEE), Intracardiac echocardiography (ICE), Magnetic resonance angiography, MRI and multidetector CT.

Using these techniques it would be feasible to identify any clots (thormbi) before any procedure. Before any ablation procedure it is important to understand the anatomy of the left atrium and pulmonary vein.

In this editorial comment Dr. Osmar Centurion from Division of Electrophysiology and Arrhythmia Cardiovascular Institute in Asuncion, Paraguay provides an overview of relevance of technology in use of imaging for Afib management.

Left atrial image registration to guide catheter ablation of atrial fibrillation: In the eye of the technology

Atrial fibrillation is a common arrhythmia, and its incidence rise sharply with age and with heart failure. Since the beginning of the new millennium, the debate on ectopic foci versus reentry as the mechanism underlying atrial fibrillation (AF) in humans has continuously evolved. The finding of ectopic beats proceeding from the pulmonary veins in the initiation of atrial fibrillation gave a different approach to the therapeutic management of this arrhythmia. Recently, the mechanism of AF is considered to be a spiral wave with a continuously changing pattern of the activation wavefront, that is, a random multiple reentry of independent wavelets wandering in the atria around arcs of refractory tissue or the accentuation of focal activity originating mainly from the pulmonary veins, the superior or inferior vena cava, the ligament of Marshall, or even the right atrium.

Patient Perspective : Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study

Suneet Mittal. Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study .JAFIB.2008 Sep;1(3): 185-186.

Dr. Mittal from The St. Luke's-Roosevelt Hospital Center,Columbia University College of Physicians & Surgeons,New York, NY reviews the recently published study showing the benefits of light to moderate exercise in significantly lowering AF incidence in older adults.

Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study

Retrospective case-control studies and case series of younger athletes and middle-aged adults have suggested an adverse association between physical activity and development of atrial fibrillation. However, these studies have evaluated subjects engaged in either vigorous exertion or endurance training. On the other hand, habitual physical activity might be expected through salutatory effects on blood pressure, vascular compliance, coronary disease, and heart failure to reduce the incidence of atrial fibrillation in the general population. The aim of this study was to assess the effect of habitual light to moderate physical activity on the incidence of atrial fibrillation among older adults.

Patient Perspective :Underutilization of Warfarin Therapy in Elderly Patients with Atrial Fibrillation – Fear or False Sense of Security!

Citation :Mazda Biria, Ahmad Batrash, James Vacek, Loren Berenbom, Dhanunjaya Lakkireddy.Underutilization of Warfarin Therapy in Elderly Patients with Atrial Fibrillation – Fear or False Sense of Security! .JAFIB.2008 Sep;1(3): 133-138.

Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant. It is named after the Wisconsin Alumni Research Foundation, which sponsored its development. Patients with Atrial Fibrillation (AF) have an increased risk of clots (or thrombi) due to irregular heart beat.

Dr. Batrash et al from Kansas City Veterans Affairs Medical Center, Kansas City report a retrospective study showing underutilization of warfarin in elderly patients with AF due to false sense of security about the paroxysmal nature of AF, lack of proper insight about stroke risk (CHADS (2)), and fear of bleeding.

Underutilization of Warfarin Therapy in Elderly Patients with Atrial Fibrillation – Fear or False Sense of Security!

Background: Under utilization of warfarin in elderly patients with atrial fibrillation (AF) has been recognized as a significant health care issue. This study examines the rate and reasons for warfarin underutilization in elderly patients with AF at the Kansas City Veterans Affairs Medical Center.

Methods: Retrospective study reviewing electronic medical records of all patients aged 65 and older with the diagnosis of atrial fibrillation. Patients on warfarin were excluded. Reasons for not using warfarin were extracted by reviewing the electronic medical record. Anticoagulation indications for these patients were determined based on the ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation.

Results:Warfarin was not used by 407 patients (25%) with known AF. Average age was 79+6.2 years. 60% of patients had persistent or permanent AF. Prevalence of risk factors for thromboembolism included hypertension (74%), heart failure or ejection fraction of <40%

Conclusions:Underutilization of warfarin in elderly patients with atrial fibrillation remains a common problem despite their high risk for thromboembolic events. A false sense of security about the paroxysmal nature of AF, lack of proper insight about stroke risk (CHADS (2)), and fear of bleeding are the most common reasons for non use of warfarin.

Patient Perspective :Echocardiographic Prediction of Symptomatic Atrial Fibrillation In Patients with Rheumatic Mitral Stenosis and Normal Sinus Rhyth

Citation : Fahriye Vatansever Agca, Ozan Kinay, Mustafa Karaca,Muge Ildizli Demirbas,Serdar Biceroglu,Baris Kilicarslan,Cem Nazli,A. Oktay Ergene.Echocardiographic Prediction of Symptomatic Atrial Fibrillation In Patients with Rheumatic Mitral Stenosis and Normal Sinus Rhythm. JAFIB .2008 Sep;1(3): 139-144.

Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.Rheumatic mitral stenosis (RMS) increases the risk of both atrial fibrillation (AF) and thromboembolism.

Dr. Karaca et al from Atakalp Heart Hospital Cardiology Department,Turkey report the benefit of echocardiography to predict symptomatic AF in a study on patients with mitral stenosis and normal sinus rhythm.