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  • Introduction Atrial fibrillation AF is

    2019-06-01

    Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it commonly occurs after cardiac surgery. AF is often associated with stroke, congestive heart failure, and myocardial infarction, all of which contribute to the increase in the length of hospital stay, higher medical costs, and increase in morbidity and mortality [1–6]. Approximately 20%–50% of patients experience post-operative atrial fibrillation (POAF) after cardiac surgery [1,6]. Based on the American and European task forces, AF prevention is one of the essential goals after any cardiac procedure [4,7,8]. POAF prevention has been a therapeutic challenge so far, and a number of medications have been studied, such as beta-blockers, amiodarone, colchicine, and calcium channel blockers [4,5,9,10]. Recent meta-analysis showed that beta-blockers reduces POAF incidence rate from 31% to CA-074 Me 16.3% compared with controls, whereas amiodarone decreased the incidence of POAF to 19.4% compared with a 33.3% incidence rate in the control group [5,6]. Ranolazine is a Food and Drug Administration-approved anti-anginal drug (AAD), which also blocks abnormal late sodium CA-074 Me and rapidly activates delayed rectifier potassium channels, which leads to attenuation of sodium–calcium currents and excessive electrical activity in atrial tissue. Thus, reduced after depolarization reserve suppresses AF [6,11,12]. Moreover, the mechanism of ranolazine to increase the refractory period after repolarization [5,13] could decrease AF after cardiac surgery. Ranolazine has been studied to prevent POAF; however, ranolazine is not required to prevent POAF, based on formal guidelines. Recent studies demonstrated promising results of ranolazine plus standard therapy compared to standard therapy in preventing POAF in patients undergoing cardiac surgery. Effectiveness of ranolazine in preventing POAF has been studied in a few randomized control trials, and the data suggests that ranolazine may have a role in preventing POAF without causing a significant increase in postoperative complications or mortality.
    Materials and methods
    Results
    Discussion
    Conclusions
    Conflict of interest
    Acknowledgements
    Introduction Percutaneous transcatheter radiofrequency ablation has shown superiority in rhythm control compared with antiarrhythmic drugs and has become an established standard of care for the invasive management of drug refractory atrial fibrillation [1–6]. The complexity of the procedure invariably results in long procedural time and significant fluoroscopic use [7]. Remote controlled magnetic navigation (RMN) theoretically lowers the risk of cardiac perforation compared with conventional catheters, thus, allowing reduction of fluoroscopy time during catheter maneuvering [8–14].
    Material and methods
    Results Baseline demographic and clinical characteristics are shown in Table 1. There were no significant differences in age and sex between the two groups. Both groups had a comparable proportion of initial procedures (RMN vs MAN: 82.7% vs 81.7%) and repeat procedures (17.3% vs 18.3%, respectively). The composition of paroxysmal and persistent atrial fibrillation in both groups was also similar (RMN: Paroxysmal 75.2%, Persistent 24.8% vs MAN: Paroxysmal 67.2%, Persistent 32.8%). There was a significantly greater proportion of atrial flutter ablations in the RMN group than the MAN group (50.5% vs 35.4%, respectively; p=0.001). The mean procedural and fluoroscopy times are shown in Table 2. These results excluded 2 patients (1 from each group) whose procedures were abandoned midway through, which would have resulted in shorter fluoroscopy and procedural times. Our results showed significantly lower fluoroscopy times in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6min; p<0.001). This was despite the higher proportion of atrial flutter ablations in the RMN cohort. Total procedure times were longer in the RMN cohort (276.9±75.0 vs 208.3±61.6min, p<0.001).