Month: October 2012

How safe is catheter ablation of atrial fibrillation in patients 65 years or older?

This was a retrospective analysis of the US Centers for Medicare and Medicaid Services database, by Piccini et al (published in Circulation 2012; Sep 26).
All patients 65 years or older who underwent CA of AF in 2007-2009 were included. The sample size was 15,423 patients, with a mean age of 72 years. Outcomes were tracked for 1 year post-CA.

The mortality rate at 30 days was 0.8%. The 30-day rates of post procedure events were as follows: myocardial infarction (0.3%), pericardial effusion (1.7%), stroke (0.8%), and vascular complications requiring surgery (0.5%).
The mortality rate at 1 year was 3.8%. The 1-year rates of events were as follow: heart failure (2.5%), stroke (2.1%), hospitalization (43%), and repeat CA (11%).
Renal impairment, age >80 years, and heart failure were independent risk factors for death at 1 year.
The mortality rate was 5 times higher in patients older than 80 years than in patients 69 years or younger. Older age independently was predictive of all major complications.
Conclusions:
The overall risk of death and major complications after CA of AF is relatively low in Medicare beneficiaries, but the risk increases with advanced age. The redo CA rate of only 11% is considerably lower than the atrial fibrillation recurrence rate.

Source: Cardiosource.org

Beta-Blockers May Not Be Associated With Lower Event Rates in Patients With CAD

β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear.
S. Bangalore, et al, analysed data on 44,708 patients enrolled in the international REACH registry with a known prior MI (n=14,043), CAD without a history of MI (n=12,012) and patients with risk factors for CAD (n=18,653), to assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD.

The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure.
With a median follow-up of 44 months (range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively. In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]).
The study authors concluded that among patients enrolled in the international REACH registry, beta-blocker use was not associated with a lower event rate of cardiovascular events at 44-month follow-up, even among patients with prior history of MI. They suggest further research is warranted to identify subgroups that benefit from beta-blocker therapy and the optimal duration of beta-blocker therapy.

Source: JAMA. 2012;308(13):1340-1349.

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