Impact of Suture Closure of Left Atrial Appendage to Thromboembolic Prevention in Atrial Fibrillation among Patients Undergoing Bio-Prosthetic Mitral Valve Replacement | Chapter 8 | Medical Science: Recent Advances and Applications Vol. 6

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia. The incidence of Left Atrial Thrombi (LAT) was significantly higher in patients with atrial fibrillation (14%) compared with patients in sinus rhythm (1%; P<0.001). Patients with AF have a fivefold higher risk of stroke. Cerebral thromboembolism is the number one cause of long-term disability and the third leading cause of death in patients with AF.

 

Objective: The aim of the study is to assess the effectiveness of intraoperative suture closure of the left atrial appendage in the prevention of thromboembolism.

 

Methods: In this study, 400 patients underwent bio-prosthetic mitral valve replacement between 2011 and 2017. Pre-operatively, they had rheumatic mitral valve disease and atrial fibrillation with controlled heart rate. The study group included 200 cases. Intra-operatively, each one had continuous suturing of margins of the mouth of the left appendage with 4/o polypropylene suture. Postoperatively, they received anticoagulants for 90 days. The control group, comprising another 200 patients, did not have such suturing of appendage. They received indefinite anticoagulants. Follow-up continued for 78 months and included clinical examination every 3 months and trans-esophageal echocardiography every year. Clinical profiles of the patients were compared using the Fisher exact test. All data were analysed using SPSS software version 11.0.

 

Results: Study group included 200 patients 109 (54%) females, mean age of 29 ± 2.1 years. Suturing of the margins of atrial appendage needed 4 ± 0.25 minutes to be conducted after incising the left atrium and examining the appendage. Atrial thrombi were removed from the appendage in 10 patients (5%). Postoperative thrombi or thrombo-emboli were not reported. Control group 200 patients, 101(51%) females, mean age 30 ± 1.02 years. Intra-operatively, thrombi in appendages were extracted in 8 patients (4%). Trans-esophageal echocardiography showed left appendage-thrombi in six patients (P-value 0.0001) and one case of thromboembolism was reported. Sinus rhythm was noticed for a mean period of 29 ± 3.5 hr postoperatively followed by Atrial Fibrillation among all patients.

 

Conclusion: Atrial Fibrillation, being a complex type of arrhythmia, is still not thoroughly understood in many patients. Intra-operative suture closure of left atrial appendage (LAA) kept patients, having atrial fibrillation, free of thromboembolic events in contradistinction to the control group. This technique is effective and reproducible. If complete LAA occlusion can safely take place in patients experiencing AF, it should be performed.

 

Author (s) Details

Elayouty HD
Department of Cardiothoracic Surgery, Suez Canal University, Egypt.

 

Hassan HS
Department of Cardiothoracic Surgery, Suez Canal University, Egypt.

 

Abdal Hafeez SAS
Department of Cardiothoracic Surgery, Suez Canal University, Egypt.

 

Faisal HS
Department of Cardiothoracic Surgery, Suez Canal University, Egypt.

 

Sami AT
Department of Cardiothoracic Surgery, Ain Shams University, Egypt.

 

Ahmed Hamdy D. Elayouty
Department of Cardiothoracic Surgery, Suez Canal University, Egypt.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v6/5229

Prophylactic and Curative Health Services for Stroke and Its Comorbidities | Chapter 4 | Disease and Health: Research Developments Vol. 2

Stroke, characterized by acute, focal neurological deficits, results from vascular injury leading to infarction or hemorrhage in the central nervous system. It is a major global health concern, ranking as the second most common cause of death in middle-to-high-income countries and the primary cause of acquired physical disability in adults worldwide. Incidence rates of ischemic and hemorrhagic stroke have risen, with low-income countries bearing a significant burden of stroke-related disability-adjusted life years and deaths. In India, the death rate has been noted around 44 per 1,00,000 in the year 1990 and has increased to 55 per 1,00,000 in the year 2021. The number of stroke attacks each year is around 1,85,000. Ischemic stroke is caused by arterial occlusion due to various etiologies, while hemorrhagic stroke involves blood vessel rupture. Diagnosis relies on imaging techniques and clinical assessments. Stroke risk factors are categorized into non-modifiable and modifiable factors, including hypertension, diabetes, and lifestyle habits. Nutritional factors and dietary patterns also influence stroke risk. Management strategies encompass acute interventions, rehabilitation, and preventive measures targeting risk factors. Multidisciplinary approaches involving healthcare professionals are essential for minimizing brain damage, optimizing recovery, and preventing recurrent strokes. Effective stroke management aims to improve patient outcomes and reduce the global burden of this debilitating condition. The scope of knowing prophylactic and curative health services for stroke and its comorbidities involves a multidisciplinary approach encompassing prevention, acute care, rehabilitation, and long-term management strategies. Effective management requires collaboration among healthcare professionals, patients, and caregivers to optimize outcomes and quality of life for individuals affected by stroke.

 

Author (s) Details

 

Karra Geetha
Department of Pharmaceutics, CMR College of Pharmacy, Hyderabad, India.

 

Kandi Sandhya Devi
Department of Pharm D, CMR College of Pharmacy, Hyderabad, India.

 

Madhavaneni Shishla
Department of Pharm D, CMR College of Pharmacy, Hyderabad, India.

 

Atchula SriPriya
Department of Pharm D, CMR College of Pharmacy, Hyderabad, India.

T. Rama Rao
Department of Chemistry, CMR College of Pharmacy, Hyderabad, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrd/v2/3331

Incidence and Outcome of Newly Diagnosed Atrial Fibrillation in Medical ICU Patients: An Observational Descriptive Study | Chapter 10 | Advancement and New Understanding in Medical Science Vol. 4

Introduction: Cardiac arrhythmias are a common occurrence among critically ill patients in the intensive care unit (ICU) and can have significant implications for their health outcomes. Among these arrhythmias, supraventricular cardiac arrhythmic tachycardia, particularly atrial fibrillation, is increasing in incidence and manifests across a range of medical and surgical settings [1]. In medical patients, the incidence ranges from 1% to 46%. In patients with sepsis, the incidence of acute AF varies with the severity of sepsis, with an incidence of 8% to 10% in sepsis, 6% to 22% in severe sepsis, and 23% to 44% in septic shock [2-6]. The development of cardiac arrhythmias in critically ill patients poses a substantial risk to both morbidity and mortality [3–6].

Aim: To study the incidence and outcome of new-onset atrial fibrillation in medical ICU patients.

Materials and Methods: New-onset atrial fibrillation was noted in patients who were admitted to the medical ICU with normal ECG and later on developed atrial fibrillation.

Results: A total of 420 patients were observed for 24 hours with continuous ECG monitoring. Among 420 patients, 68 developed new-onset arrhythmias. Out of 420 patients, 21 developed atrial fibrillation (5%). AF is more common in the population with pre-existing cardiac illness (76.1%). Among non-cardiac illnesses, pneumonia was the leading cause,12(57.1%) patients expired and 9 (42.8%) patients were discharged. Out of the discharged patients 5 patients still had persisting AF (45.4%).

Conclusion: It has been observed that there is an increased incidence of atrial fibrillation in critically ill patients. AF is associated with increased mortality and morbidity. Early detection and treatment can change disease outcomes. Hence, 24-hour ECG monitoring should be done in critically ill patients. The majority of individuals who survive acute illness and develop new-onset atrial fibrillation (AF) experience AF symptoms after being discharged from the hospital and may face higher long-term risks of heart failure, ischemic stroke, and mortality. There are no evidence-based guidelines or expert consensus documents on the management of NOAF. To address these uncertainties, well-designed multicentred, prospective randomized trials are necessary.

Author(s) Details:

Jyoti Prakash,
Department of General Medicine, AIIMS, Patna, India.

Please see the link here: https://stm.bookpi.org/ANUMS-V4/article/view/13180

Atrial Fibrillation and Diabetes: A Deadly Duo of Metabolic and Cardiac Disorders | Chapter 5 | Novel Research Aspects in Medicine and Medical Science Vol. 9

 Type 2 diabetes mellitus (T2DM) is a universal chronic metabolic affliction affecting millions general. Atrial fibrillation (AF) stands as the most coarse persistent irregular courage rhythm, boosting the likelihood of cardiac and cerebral problems. Recent studies have suggested that diabetes cases have a higher chance of expanding AF, but the exact link between these two conditions is fuzzy. This review aims to thoroughly resolve the intricate relationship betwixt type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF), prevalent incessant diseases significantly jolting public health. We delved into current evidence specifying how T2DM influences the energetic, structural, and functional facets of the atria, heightening susceptibleness and severity of AF.Additionally, we delved into the clinical suggestions of T2DM and AF coexistence, disclosing the elevated risks of stroke, heart failure, and cardiovascular demise. Moreover, we investigated handy treatment approaches for patients with two together conditions, including anti-diabetic and antiarrhythmic drugs alongside nonpharmacological interventions like cardioversion, catheter extraction, and direct current cardioversion. This review provides a inclusive insight of the pathophysiology, epidemiology, disease, prognosis, and administration of T2DM and AF. It enhances our understanding of the fundamental processes and possible treatment approaches for this complex position, providing an invaluable advantage for researchers engaged in this place domain. By combining current knowledge, we aspire to improve patient care effectiveness and stimulate future research in this domain.

Author(s) Details:

Roshni Ramachandran,
Vydehi Institute of Medical Science and Research Centre, India.

Elama Jami,
Herat University Faculty of Medicine, Afghanistan.

Mohammed Mahmood Mohiuddin,
Kamineni Academy of Medical Sciences and Research Centre, India.

Ritika Parekh,
KJ Somaiya Medical College and Research Centre, India.

Khadija Tul Kubra,
King Edward Medical University, Lahore, Pakistan.

Mankaranvir Singh,
Government Medical College, Patiala, India.

Shem O. Juma,
St. George’s University, Grenada.

Muhammad Subhan,
Allama Iqbal Medical College Lahore/Jinnah Hospital, Lahore, Pakistan.

Venkata Lohit Velivela,
Dr. P.S.I Medical College, Chinaoutpalli, India.

Fnu Danesh,
Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.

Doongro Mal,
Dow University of Health Sciences, Karachi, Pakistan.

Dileep Kumar URF Raj Kumar,
Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.

Ruqiya Bibi,
Allama Iqbal Medical College, (Lahore)/Jinnah Hospital, Lahore, Pakistan.

Effect of Mitochondrial Dysfunction for Atrial Fibrillation Associated with Aging | Chapter 9 | Current Progress in Medicine and Medical Research Vol. 8

The occurrence of atrial fibrillation (AF) increases with age, and telomere distance (TL) gradually diminishes with age. However, whether TL is had connection with AF is still inconclusive, and the exact means by which slumping causes the increased occurrence of AF is still unclear. We hypothesize that TL is compared with crumbling-related AF what mitochondrial dysfunction plays a role in this place. This research recruited 96 elderly male victims with AF the one were admitted to the Second Medical Center of Chinese PLA General Hospital from April to October 2018. After corresponding by age and gender, 96 non-AF aged male patients the one were admitted to the hospital for medical examination during the unchanging period were picked as the control group. Anthropometric, clinical, and lab analyses were performed on all cases. The mitochondrial membrane potential (MMP) of minor blood leukocytes was discovered as the indicator of mitochondrial function. Compared accompanying the control group, the leukocyte telomere time (LTL) was significantly shorter (P < 0.001), and the level of PGC-1α in antitoxin was significantly lower in AF victims. Additionally, in subjects outside any added diseases, the AF patients had lower MMP when distinguished with the control group. Multivariate logistic reversion confirmed that LTL (OR 0.365; 95% CI 0.235-0.568; P < 0.001) and antitoxin PGC-1α (OR 0.993; 95% CI 0.988-0.997; P = 0.002) were inversely guide the presence of AF. In addition, ROC analysis designated the potential diagnostic profit of LTL and serum PGC-1α accompanying AUC values of 0.734 and 0.633, individually. This research concludes that LTL and antitoxin PGC-1α are inversely correlated accompanying the occurrence of becoming older-related AF, at which point and that mitochondrial dysfunction plays a meaningful role in this.

Author(s) Details:

Chuanbin Liu,
Western Medical Branch of the Chinese PLA General Hospital, Beijing 100853, China.

Yating Chen,
Department of Cardiology, the Sixth Medical Centre of Chinese PLA General Hospital, Beijing 100048, China and Medical School of Chinese PLA, Beijing 100853, China.

Yang Li,
Department of Cardiology, the Sixth Medical Centre of Chinese PLA General Hospital, Beijing 100048, China.

Please see the link here: https://stm.bookpi.org/CPMMR-V8/article/view/11740

A Theoretical Assumption of Atrial Fibrillation | Chapter 19 | New Horizons in Medicine and Medical Research Vol. 9

 The most common cardiac arrhythmia in clinical practise is atrial fibrillation (AF). Many research have been conducted to determine what causes AF to develop, but the issue has yet to be resolved. Based on the cessation of atrial mechanical systole, atrial fibrillation has lately been hypothesised as a protective physiological mechanism. In pathological conditions, this lowers the pressure in the pulmonary veins and alveolar capillaries, lowering the risk of pulmonary congestion and edoema. This hypothesis explains the link between left ventricle (LV) dysfunction and atrial fibrillation (AF), aids in the development of algorithms for the relationship between AF and LV dysfunction, as well as other diseases and conditions, suggests a new approach to locating the source of AF, and demonstrates the atriums' protective role in AF. the progression of LV dysfunction The idea is well-supported by known facts and phenomena relevant to AF. The proposed idea may provide insight into the progression of AF. In the pulmonary veins, each person has a defensive physiological system that is most likely genetically designed.

In clinical practise, atrial fibrillation (AF) is the most common arrhythmia, and it is commonly associated to LV dysfunction and heart failure (HF). It's been termed "the pandemic of the century." AF is a form of arrhythmia that is more frequent in the elderly and is becoming more common as the population ages. Aside from age, AF has been linked to a variety of cardiac and medical conditions. Hypertension, coronary artery disease, heart failure, valvular heart disease, and hyperthyroidism are all conditions that can lead to death.

Author(S) Details

Vladimir Tilman
The Sheba Medical Center, Rehabilitation Hospital, Ramat Gan, Israel.

View Book:- https://stm.bookpi.org/NHMMR-V9/article/view/6915

Study on Left Ventricular Diastolic Dysfunction in Atrial Fibrillation Patients without Structural Cardiac Disease | Chapter 17 | New Frontiers in Medicine and Medical Research Vol. 15

Background: The most prominent contributions to left ventricular diastolic dysfunction (DD), left atrial remodelling, and atrial fibrillation are hypertension and left ventricular hypertrophy (LVH).

The major purpose of this study is to assess LA remodelling and left ventricular DD in individuals with and without paroxysmal atrial fibrillation (PAF) and essential hypertension (HTN).

Materials and Methods: A total of 128 patients with normal left ventricular systolic function participated in the study (LVEF50 percent ). They were split into two groups based on whether they had essential hypertension or not. The 65 normotensive people were divided into two groups: PAF (n=32) and no-PAF (n=33). PAF (n=32) and control no-PAF (n=31) hypertensive subjects were further divided into two groups.

In terms of gender, age, and weight, the patients in the control group were chosen to match the PAF groups. The patients were evaluated using a resting 12 lead ECG, 24 hour Holter ECG monitoring, 24 hour blood pressure monitoring, and 2D Doppler echocardiography. For three years, the follow-up was done every six months. The statistical analysis was performed using the MedCalc 12.3.0.0 statistics software for Windows.

The results were considered statistically significant when the p-value was less than 0.05.

PAF patients have bigger LA diameters as a result of their condition. Supplemental LA levels rise as a result of HTN. LA diameters are unaffected by the amount of PAF episodes. The gender of the patients has little impact on the statistical data, with PAF and HTN patients having bigger diameters.

Author (S) Details

Iosif Marincu
Department of Infectious Diseases, Pneumology and Parasitology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Methodological and Infectious Diseases Research Center, Romania.

Iulia Vidican
Department of Infectious Diseases, Pneumology and Parasitology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Methodological and Infectious Diseases Research Center, Romania.

Valentina Elena Avram
Department of Infectious Diseases, Pneumology and Parasitology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Methodological and Infectious Diseases Research Center, Romania.

Madalina Timircan
Department of Infectious Diseases, Pneumology and Parasitology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Methodological and Infectious Diseases Research Center, Romania.

Oana Suciu
Department of Infectious Diseases, Pneumology and Parasitology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Methodological and Infectious Diseases Research Center, Romania.

View Book :- https://stm.bookpi.org/NFMMR-V15/article/view/3877

A Critical Comparison between First- and Second-Generation Cryoballoon for Paroxysmal Atrial Fibrillation Ablation | Chapter 7 | Current Topics in Medicine and Medical Research Vol. 13

 The first paragraph is an introduction. For patients with paroxysmal atrial fibrillation, cryoballoon (CB) ablation has emerged as a promising treatment for pulmonary vein isolation (PVI) (PAF). The second-generation Arctic Front Advance (ADV) was redesigned with technological changes aimed at procedural and outcome improvements. Cryoballoon (CB) technology would potentially enable PVI with a single application. The aim of this study was to compare the effectiveness of the two different technologies over a long period of time.

A total of 120 patients with PAF were enrolled in the study. PVI was performed on 60 patients with the first-generation CB and 60 patients with the ADV catheter. Over the course of a two-year follow-up period, both patients were reviewed.

There were no substantial variations between the two groups of patients as a result of the study. The first-generation CB had a longer fluoroscopy time (36.3 16.8 versus 14.2 13.5 min, resp.; p = 0.00016), as well as a longer procedure time (153.1 32 versus 10224.8 min, resp.; p = 0.019). The overall long-term performance of the two groups differed substantially (68.3 versus 86.7 percent, respectively; p = 0.017). There were no gaps in the lesion areas of the left and right PV between the two groups (p = 0.61 and 0.57, respectively). In terms of procedural problems, there were no major variations.

Conclusion: As opposed to the first-generation balloon, the ADV catheter allows for a substantially higher success rate after a single PVI procedure over the long term. Using the ADV catheter, fluoroscopy and procedure times were greatly reduced. The lesion areas formed by the two CB were not statistically different, according to electroanatomical mapping.

Author (s) Details

Sergio Conti
Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy

Claudio Tondo
Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy

View Book :- https://stm.bookpi.org/CTMMR-V13/article/view/738