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May 11th, 2015
Selections from Richard Lehman’s Literature Review: May 11th
CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.
NEJM 7 May 2015 Vol 372
Approaches to Catheter Ablation for Persistent Atrial Fibrillation (pg. 1812): Are the latest methods of pathway ablation for atrial fibrillation just fancy toys for boys? As a total ignoramus, I couldn’t possibly comment, but here is the conclusion of a trial comparing three techniques: “Among patients with persistent atrial fibrillation, we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation. (Funded by St. Jude Medical).”
JAMA Intern Med May 2015
Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device (OL): A major breakthrough in stroke prevention for patients with atrial fibrillation is closure of the left atrial appendage, the place where clot forms before it shoots into the brain. The Lariat device has received US Food and Drug Administration (FDA) 510(k) clearance for soft-tissue approximation and is being widely used off-label for left atrial appendage (LAA) exclusion. But a study based on published reports comes up with some worrying findings: “In the FDA MAUDE database, there were 35 unique reports of adverse events with use of the Lariat device. Among these, we identified 5 adverse event reports that noted pericardial effusion and death and an additional 23 reported urgent cardiac surgery without mention of death.”
Ann Intern Med 5 May 2015 Vol 162
Low-Molecular-Weight Heparin for Women With Unexplained Recurrent Pregnancy Loss (pg. 601): I don’t know if anyone in the UK uses low-molecular-weight heparin for women with unexplained recurrent pregnancy loss, but a new trial from Germany and Austria shows that it makes no difference to outcomes when given up to 24 weeks into gestation.
The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis (pg. 610): Just to remind you of the “obesity paradox” in type 2 diabetes, as observed in over 10,000 citizens of East Yorkshire with T2DM but no initial cardiovascular disease. Over 10 years, “overweight or obese patients (BMI >25 kg/m2) had a higher rate of cardiac events (such as the acute coronary syndrome and heart failure) than those of normal weight (BMI, 18.5 to 24.9 kg/m2). However, being overweight (BMI, 25 to 29.9 kg/m2) was associated with a lower mortality risk, whereas obese patients (BMI >30 kg/m2) had a mortality risk similar to that of normal-weight persons. Patients with low body weight had the worst prognosis.”